human aging final review

Policy Perspective

- advanced age and chronic diseases
- at increased of infections
- increased health costs
- importance of interventions to increase healthy years
- immune interventions may have multiple beneficial effects

Edward Jenner (1796)

created the first vaccine

physical barriers (skin) and the immune system

how do we deal with pathogens?

integumentary system

skin; protects against temperture

epidermis

-contains keratinocytes, melanocytes, Langerhans cells, and mast cells
-replenishes itself bu shedding dead cells and replacing them
- when aging, process of cell replacement is slowed up to 50% between 30 and 70

dermis

contains collagen, elastin, blood vessels, lymphatics, sweat glands, hair follicles, and mast cells
- becomes less elastic with age, wound healing slows

subcutaneous fat

tends to lose fat and water
- higher risk of getting hypothermia and hyperthermia when getting older

pathogens

things that are bad for us

melanocytes

give skin color

keratinocytes

helps with the absorption of vitamin d

normal aging of skin

wrinkles, keratinocytes decrease in number and slow in their ability to divide, can't absorb vitamin d

disease in skin

skin cancer (melanoma)

NK, Mac, and DC

main types of cells in the innate immune system

innate immune system

- primitive part of the immune system (swelling)
- really fast
-non-specific - no memory of what it saw before
- sometimes sufficient

macrophages (Mac)

"big eaters"; engulf things

Natural killer cells (NK)

as they age, their function declines and inflammatory cytokines increase

Dendritic Cells (DC)

when aged there is a decrease migration to infection sites, capturing antigen

adaptive immune system

- part of immune system that has specificity
- takes longer to respond
- can develop memory
- contains B and T cells

B cells

- recognizes the virus and turns out large amounts of antibodies
- can recognize "free" antigen
- when aging, auto antibodies increases and quality of regular antibodies decrease
- antibody response to vaccines decreases

T cells

recognizes virus in infected cells and will kill the infected cell
- develops in the thymus

senescent T cells

- will lose CD28 so they cannot identify infected cells correctly
- short telomerase
- unable to divide
increased inflammatory state and cytokines (bone loss) associated with osteoporotic fractures

HIV

causes premature aging of the immune system and increased proportions of senescent T cells

flow cytometry

allows us to identify specific cells

Chronic Psychological Stress

associated with shortened telomeres
experiments include: mothers of chronically ill children, Alzheimer caregivers

flu

36,000 people die from this each year and there are over 400,000 hospitalizations
- young people respond to vaccinations better than old people

malaria

no vaccine for this

therapeutic vaccines

- do not prevent infection
- reduce disease severity

immune cells

can turn on telomerase transiently during an immune response and undergo extensive cell division

thymus

"educates" T cells

thymic involution

the shrinking of the thymus that starts in childhood

osteoclasts

resorb old bone

osteoblasts

create new bone

osteoporosis

a dramatic loss in calcium and bone mass due to a greater rate of bone resorption than bone formation that results in diminished height, slumped posture, increased brittleness of the bones and increased risk of fracture

osteopenia

reduced bone density (not a disease)

osteoarthritis

wear and tear-induced joint degeneration

rheumatoid arthritis

autoimmune disease; joint inflammation due to T cell reactivity to collagen

sarcopenia

decline in muscle mass

Social Security Act

aimed to establish a system of income maintenance for older persons to protect against financial disaster

4 trust funds of social security

Old-Age and Survivors Insurance (OASI), Disability Insurance (DI), Hospital Insurance (HI), and revenues for the supplemental insurance portion of Medicare

Social adequacy

refers to a shared societal responsibility and mutual obligation to provide protection and a basic standard of living for all potential beneficiaries, or a "safety net", regardless of the size of their economic contributions

individual equity

refers to an individual's benefits that reflect that person's actual monetary contributions proportionate to what they have paid into the system

Older Americans Act (OOA)

federal legislation for a network of social services specifically for older people

eligibility criteria

factors that determines whether people can receive benefits from specific programs

Age-based entitlement

programs that all adults are automatically entitled to receive benefits based on their age, not on their financial or health needs (social security and medicare)

Needs-based programs

based on financial need

Selective benefits

determined on a case-by-case basis

contributory plans

Older adults are entitled to these benefits based on their mandatory contributions into the system as a paid worker throughout their lives (social security and medicare)

discretionary funding

congress has to approve its funding annually and the amount varies from year to year

privitization

changes in social security that would divert payroll taxes to private investment accounts

Supplemental Security income (SSI) program

a safety net programs that provides monthly cash benefits to people who are older, with visual impairments or living with disabilities and who have very low incomes and resources (funded by federal general revenues)

Supplemental Nutrition assistance Program (SNAP)

federal food assistance program for low-income individuals

defined benefit

a pension plan where employers promise employees a guaranteed benefit upon retirement based on a benefit formula that takes account of length of service and earnings as stated in the plan

defined contribution

a pension plant that is dependent on how much the employer and employee contribute and therefore unpredictable

Title XX or Social Service Block Grants

funding for social services (e.g., homemaking chores, adult day care) based on need, not age

aging network

the system of social services for older adults funded by the OOA

administration for community living (ACL)

created in 2012, includes the Administration on Aging, the Administration on Intellectual and Developmental Disabilities, and the Center for Disability and Aging Policy in a single agency with the goal of increasing community supports and full participation for both older Americans and people of all ages with disabilities

aging disability network

the system of services that, as of 2012, served both older adults and persons with disabilities of all ages

aging and disability resource centers (ADRCs)

aim to integrate long-term service and supports for both older adults and adults with disabilities into a single coordinated system with one entry point or "no wrong door"

policies of entitlement

political preferences for the allocation of resources based on the view of older persons as needy, worthy, and deserving of public support

politics of productivity

political preferences for the allocation of resources based on capacity of continued productivity and contributions of older adults

intergenerational inequity framework

the view that one generation or age group receives benefits that are disproportional to those received by another, or are at the expense of other generations

interdependence of generations framework

recognition of intergenerational transfers that occur across the life course

generational investment

investments made by one generation for the benefit of another, such as the payment of Social Security taxes by the working population for the benefit of retirees, the services provided by older persons for child care, and the payment of property taxes to benefit schoolchildren

generational justice

older adults receiving benefits based on age is morally justifiable because all adults can eventually benefit from age-based programs

Long-Term Services and Supports (LTSS)

range of paid and unpaid, social and personal care assistance, including home and community-based services, that people may need on an ongoing basis as a result of chronic illness or disability; typically include assistance with ALDs and IADLs

determinants of health

environmental or structural factors that influence health and opportunities for active aging, such as education, employment, and income

medicare

a social insurance program, part of the social security act of 1965, intended to provide financial protection against the cost of hospital and physician care (acute care) for people ages 65 and over

hospital insurance (part a), supplemental medical insurance (part b), medicare advantage (part c), prescription drugs (part d)

4 parts of medicare

Medicare Advantage Plans (MAP)

not paid for under traditional medicare a and b; have more generous benefits than traditional medicare, and must be coordinated and approved by a primary doctor

home health care

a variety of nursing, rehabilitation, and other therapy services for people who are homebound; if funded by medicare, older adult must meet strict medical criteria for eligibility; also be available for private pay

home care

personal assistance with activities of daily living for adults with disability and functional limitations; not covered by medicare

prospective payment system

shift from a fee-for-service to a flat rate based on classification of a patient's medical condition and associated needs

capitated payments

payments for services based on a predetermined amount per person per day rather than fees for service; system includes incentives for agencies to be more efficient, manage resources more carefully, and restore their focus on short-term, post-acute medical care such as nursing and other therapies in order to be profitable

medicare modernization act (medicare part d)

prescription drug reform legislation; older adults pay for a private insurance plan to cover medications

doughnut hole

prescription costs that a medicare enrollee must pay 100% out of pocket each year between $2,400 and $5,452. Amounts below and above this gap are covered partially by medicare part d

parity

mental health services covered by medicare at the same rate (20%) as health care services for physical disorders

medicaid

federal and state means-tested program on medical assistance for those who meet income criteria, regardless of age

spenddown

to use up assets for personal needs, especially health care, in order to become qualified for medicaid

dual eligibles

qualify for both medicaid and medicare. Medicaid makes medicare affordable for the duals by covering medicare's premiums, co-payments, and deductibles for physician and outpatient coverage

centers for medicare and medicaid services (CMS)

the federal agency that administers the medicare and medicaid programs; prior to 2001, known as the health care financing administration

consumer directed care

under the medicaid waiver system, older adults can hire personal care attendants including family members (except for spouses)

aging and disability resource centers

aim to integrate long-term services and supports for both older adults and adults with disabilities into a single coordinated system with one entry point or "no wrong door"

long-term care insurance (LTCI)

private insurance designed to partially cover the costs of institutional and sometimes home-based services for people with chronic illnesses and disabilities

traditional care

care during the interval between preparing a patient to leave one setting and receiving the patient in the next setting

triple aim

the ACA's three-part goal of improved access to care, enhanced quality of care, and reduced cost of care

center for medicare and medicaid innovation (CMMi)

tests new ways to improve quality and reduce costs and, over time, to transform health care financing and delivery

accountable care organization (aco)

composed of health care providers who share both accountability for the quality of overall care of medicare beneficiaries and the risk for the cost of care

money follows the person (MFP)

expanded under the ACA to provide individuals with LTSS that enable them to move out fo institutions and into their own homes or other community-based settings

managed care

a health plan in which medicare beneficiaries recieve care from a network of providers, and all services are coordinated in order to maximize benefits and reduce cost

affordable care act

expanded coverage by putting stipulations on states

assisted living facilities (ALFs)

a housing model aimed at elders who need assistance with personal care but who are not so physically or cognitively impaired as to need 24-hour attention

adult family home (afh)

a private home facility, licensed by the state, in which the owner of the home provides housekeeping, personal care, and come delegated nursing functions for the residents

long-term services and supports

a broad range of services, including home and community-based services, geared to healing frail older adults be autonomous as long as possible in their setting of choice

skilled nursing facilities

staffed 24 hours per day by health professionals who provide skilled nursing care, subacute care, or intensive post-hospital rehabilitation and personal or long-term care

memory care units

offer care at a higher level for persons with dementia who are likely to have disruptive behavioral problems such as wandering. Often part of a CCRC or a skilled nursing facility

long-term care ombudsman

works on behalf of residents of long-term care facilities by resolving resident complaints, monitoring state oversight agencies, and reviewing and commenting on proposed state laws and regulations

culture change

new models of nursing homes care that attempt to humanize these facilities and make them more home-like and less institutional

eden alternative

a paradigm for nursing home care that encourages active participation by residents and greater staff decision making

green house model

an expansion of the eden alternative that focused on smaller groups of residents served by a core group of workers who perform multiple tasks

home and community-based services

a general label for residential and community-based long-term care options other than nursing homes