HDE 100c MIdterm 2

Mortality Rate

Rate of death in a given year- the probability of dying in one year

Morbidity Rate

The likelihood of getting sick

Acute Conditions

A temporary illness (flu)

Chronic Conditions

A lifelong illness (ALS, Crohns)

Disability Rates

Young Adults: two times as likely as those older than 65 to have acute conditions. \n Older Adults: 2-3x as likely to have a chronic disorder than those in their 30's

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Activity of Daily Living (ADL)

 

Basic self care activities (bathing, dressing, etc.)

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Instrumental Activities of Daily Living (IADL)

More complex everyday tasks (handling finances, taking medications, housework)

Nagi Abilities

Related to strength; the ability to stoop, bend, kneel, lift 10 pounds, lift arms above shoulders, walking 2/3 blocks.

Disability rates PT II

10% of 40 y/o or younger have at least 1 disability.

55% over 80 y/o have at least 1 disability.

Disability Prevalence in Older Adults in US

Substantial decline in last 20 years due to nutrition education, increases in skilled jobs, medical advancements. Changes attitude about health, better income-> better health, assistive tech, all age groups are healthier.

Self Ratings Vs Observations

Self report of IADLs may provide unrealistic (often unrealistically positive) description. \n -Observed tasks have objective measurements of problem solving skills

Leading Causes of Death

1900's: flu, pneumonia, tuberculosis, diarrhea/entoritis. \n 1990's: Heart disease, cancer, stroke \n -More acute/quick illness in 1900's more chronic illness in 1990's-> 2000's

Chronic Conditions

Illness, function limitation, cognitive impairment, more than a year, limits individual activities and requires ongoing care

Chronic Condition 65-69

74% with at least 1 chronic disability \n 14% have 5 or more chronic disabilities

Chronic Conditions 85+

85% with at least 1 chronic disability \n 28% with 5 or more chronic disabilities

Living Arrangements over 65

3%: nursing home/skilled care facilities \n 81% women, 90% men in community dwelling (home) \n Remaining % senior residences, assisted living facilitated or at home with families

Aging in Place

Aging at home, change home to fit needs of aging. Adding railing to stairs, taking out shower, capitol hill village in DC.

Cardiovascular System

Vascular System-arteries: heart-> outer, veins: used blood-> heart. Veins have no smooth muscle, negative effect, not pressured, leads to blood pooling in legs.

Arteriosclerosis

Hardening of the arteries, primary aging

Atherosclerosis

Specific arteriosclerosis, secondary, build up of plaque can burst causing a clot. Restricting blood flow. -lifestyle choices

Normal Cardiovascular Aging

\*Heart weakens-> larger, loss of myocytes, remaining ones get larger. Decrease volume chambers can hold, smaller area for blood to collect. \n \*Decreased heart rate- due to increased fat deposits, natural pacemaker loses some of its cells.

Impaired Cardiovascular Aging

Hypertension, Atherosclerosis, Myocardial Infarction (heart attack), Cerebrovascular Accident (stroke)

Cardiovascular Disease vs Cancer in Women

2x as many women die from cardiovascular disease each year than from all forms of cancer although they are initially protected from cardiovascular problems from estrogen

Hypertension Risk Factors

Age, Family history, Stress, Sedentary lifestyle, tobacco use, high salt/low potassium diet, alcohol, chronicc conditions- sleep apnea, diabetes, kidney disease.

Treatment

Decrease heart attack-27% \n Decrease stroke- 38% \n Decrease heart failure- 55%

Acute Myocardial Infarction

Over 1 million in US have a heart attack each year, half of them die within 1 hour of showing symptoms. \n #1 cause is atherosclerosis \n \*Risk factors: male over 45, women over 55

Skin Cancer

2 million diagnosed annually, 1 in 5 americans, 99% survival rate at first, penetrates skin- 15%. \n Melanoma: most common form in adults 25-29, asssymetric, uneven edges, border, 2 more more shades, 1/4 inch or more.

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Risk factors skin cancer

 

fair skin, sunny climate, high altitude, family history, exposure to poison, HPV, history of sunburns, excessive sun exposure, many abnormal moles, scars/burns, weakened immune system.

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Competence and Press Model

Gains and losses ideas, behavior and function depends on individual, demands of the environment, interaction/adaptation of person to the environment.

Competence and Press Model

Osteoarthritis competence low in locomotion, environmental press, weak not much pressure. Low +low= Adaptive level

Competence and Press Model

High environment pressure and low competence= negative affect of maladaptive behavior

Competence and Press Model

Tolerable affect, marginally adaptive behavior= competence high, environmental press weak. Competence high, environmental press middle/strong

Increasing Functional Independence

1\. Environmental supports in home \n 2. Usability of systems and products \n 3. Monitoring systems built into home

Psychological Disorders

\-46% of people in US experience in lifetime. \n -Onset- early adolescence, early adulthood. \n -US has highest % due to other developed countries. \n -Early onset death/premature death \n - 12 month prevalence. \n -60+ low due to coping

Most common psychological disorders?

Anxiety + Mood

Anxiety Disorder

Most common in US can be due to chemical imbalance, excessive/irrational dread of everyday situations. Begin during childhood. Treatment= meds or psychotherapy.

Generalized Anxiety Disorder

Happens across the board, normally not just 1 reason, anxiety in multiple situations.

Obsessive Compulsive Disorder (OCD)

Characterized by recurrent unwanted thoughts= obsession, or repetitive behaviors= compulsions. Can have 1 or the other or both. Think compulsion will make obsession go away.

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Post Traumatic Stress Disorder (PTSD)

Nightmares, flash backs, seeing face in crowd, dissociation, experience speaking of trauma like a grocery list even with PTSD bc mind can't cope.

Social Phobia/Social Anxiety Disorder

Concerned about what other people think of you to a whole new level, imaginary audience, concerned about what others say/do

Panic Disorder

Unexpected/repeated stress episodes. Anxious- heart pain, stomach ache, physical disorders due to anxiety.

Mood Disorders

One loses control of ones emotions which leads to distress. Big loss of control relative to normally functioning individuals.

Bipolar Disorder

Mood disorder; shifts in mood, energy, activity levels. Deep severe depression and mania, state of great energy/motivation/optimism. Brain disorder- chem imbalance. Leads to damaged relationships, poor work/school habits, can lead to suicide or psychotic symptoms. euthymia= normal, calm, depressed, manic.

Major Depression Disorder

Long term, pervasive sadness and hopelessness. More than 2 weeks, physiological symptoms. Onset most often around 30, most experience it by age 43. Lower rates among older adults vs young/middle aged adults.

Depressive Symptoms

Older adults experience these more than young/middle adults. Indicated to chronic health problems or bereavement

Suicide in Older Adults

12% of US pop is 65+ but 65+ commit 16% of suicides. Non hispanic white men 85+ most likely to die by suicide. (less likely to seek treatment, no support, coping with chronic illness, death of spouse)

Alcohol and Older Adults

Effect of alcohol increases with age, tolerance decreases. Medications may have side effects with alcohol. 65+ no more than 7 drinks a week or 3 a day.

When are mood disorders most prevalent within 12 months?

Middle Adulthood

Treatment Utilization Issues

only 40% of adults with mental disorders seek treatment. 1/3 of treated don't receive adequate treatment. 1/3 go to complementary/alt medicine. 70+ y/o tend to not get treatment at all.

Dementia

Umbrella term for a variety of conditions due to nerve cell death which leads to lower functioning which leads to worsened memory, behavior and ability to think clearly.

Dementia DSM IV Criteria

Must have 1/5 of these and memory must be affected. \n 1. Ability to generate speech/ understand written/spoken language. \n 2. recognize/identify objects. \n 3. Execute motor ability. \n 4. Think abstractly, make sound judgments, plan/carry out daily tasks. \n \*\*decline must be severe enough to interfere with daily life.

Dementia Causes

AD, small strokes, Parkinsons, multiple blows to head, single head trauma, certain tumors, advanced AIDS, depression, drug intoxication, hypothyroidism, vitamin b 12 deficiency

Alzheimers Disease and Depression

\-Loss of interest in once enjoyable activities \n -Social withdrawal \n -Memory Problems \n -Sleeping too much/too little \n -Impaired concentration \n -40% of people with AD have depression \n -Depression is a risk factor for later AD

Alzheimers Disease (AD)

Most common form of dementia, 50-70% of dementia cases. 5th leading cause of death for people 65+. 90% of all AD cases are 65+, 1 in 7 people 65+

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stress

Is a set of physical, cognitive, and emotional responses that humans display in reactions to demands from the environment.

Stressors

Environmental demands

General Adaptation Syndrome (GAS)- Selye

1\. Alarm Reaction= body quickly responds preparing for fight/flight \n 2. Resistance= body attempts to regain normal state \n 3. Exhaustions= alarm stage responses reappear, accompanied by physical illness or even death. \n -Selye first to suggest stress can cause physical effects. \n -Response oriented view

Response Oriented View

Focused on the physiological reactions within an individual resulting from exposure to stressors. Arousal and Performance

Life Change Event Scale

Rating scale made by Holmes and Rohe, consisted of 43 events assigned different points depending on how much stress it causes. \n -Stimulus Oriented View

Stimulus Oriented View

Focused on stressors themselves, the stressor/life events themselves. \n - More points in recent past, greater chance of illness in near future. Fairly accurate predictor of physical illness and psych symptoms.

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Age and Stress

 

Stress decline with age, most stressed is young adults, but declines more into adulthood

Discrimination and Stress

Black Americans have higher incidence of high blood pressure + stroke not due to genetic predisposition, but the stress of discrimination. 2-6 times more likely to develop cardiovascular disease amongst foreign/religions/races.

Human Social Genomics

The study of changes in gene expression due to subjective perceptions of the social environmen

Stress-Related Growth

The positive changes that follow the experience of stressful life events.

Buffering Effect

Social support doesn't decrease stressors, but it will provide protection against the harms of stressors.

Psychometrics

The field of psych that studies the measurement of human abilities such as intelligence to understand psychological phenomena.

Crystallized Intelligence

Dependent on education and experience knowledge as we gain from growing up in a certain culture, reason about real life problems, counting change, etc.

Fluid Intelligence

More under biological processes- ordering patterns correctly, reproducing designs.

Intelligence Type Analogies

Crystallized intelligence= software on computer like dictionary. \n Fluid Intelligence= hardware of computer, memory, info processing capacity, etc.

Intelligence

Predicts longevity and health

Declarative memory (explicit)

Knowledge available to conscious awareness and can be directly assessed by tests of recall or recognition memory. (Long term store)

Semantic Memory

Our knowledge of language, rules and concepts.

Episodic Memory

The ability to recall events, usually when people lose memory its in this area.

Info Processing Perspective

Distinction between 3 memory stores- sensory, short term, long term.

Sensory Store

Information picked up by senses, processed briefly by perceptual system. Held in memory for a few seconds less than short term. Death star is outside of Young hall

Short Term Store

Longer than sensory store. 10-30 seconds, discard or encode for long term. Use working memory, rehearsal, etc.

Long Term Store

Info retained for years, includes declarative and non declarative memory.

Non declarative Memory Example

Getting bitten by a dog when you are 2 years old, but having no memory of it. Suddenly you see a dog and tense up as an adult.

Word Finding Failure

Tip of the tongue theory, one loss of memory for older folks who can't find the word they want to use, effects SEMANTIC memory

Prospective Memory

Remembering to do something later or in the future.

Socioemotional Selectivity Theory (Carstensen)

Young people focus on the future and broadening horizons while older people view time as limited. Therefore older people emphasize positive aspects of experiences and devote more cognitive effort to them.

Acute Stress Response

Fight or flight, stops digestion, stops ovulation, feel arms/legs tingle and fill with energy, breathing and heart rate increase

Types of Stress

Short term: beginning and end \n Chronic: continuous, effects social relationships \n Major life events: death, divorce. \n Daily stressors: getting to class on time.

Top sources of stress for 25-74 y/o

1\. Interpersonal Relations \n 2. Network (aunt sick) \n 3. Work or School \n 4. Home \n 5. Health Care

Stress in Young (25-39) and Middle Adults (40-59)

Higher frequencies of stressors, felt stresses were more severe, more likely to affect how others would feel about them, overloads and demands greatest source of daily stressors.

Stress in Older Adults (60-74)

Greater proportion of network stressors and spouse related stressors. Mostly focused on relationships.

Stress Related to

Hypertension, atherosclerosis, immune function, cancer, hippocampus neuronal loss, telomere shortening

Lazarus and Folkman Factors of Stress

Situation + personal factors--> Appraisal of Stress--> coping--> outcome

Primary Appraisal

Am I threatened? How?

Secondary Appraisal

What can I do about it?

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Problem Focused Coping

 

Directly addresses the problem causing stress. \n Example: ask if can re-apply for graduate school mid-year. \n \n -If used when you have no control, can lead to maddening and no improvement.

Emotion-Focused Coping

Ways that people try to improve negative emotions associated with a stressful situation. \n Example: going out for a run or drinking a lot of alcohol \n \n -Best for chronic illness

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Meaning-Focused Coping

 

Ways that people use to manage the meaning of a stressful situation. \n Example: thinking another graduate school would be a better fit

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Social Coping

Involves seeking instrumental and emotional support from others. \n Example: calling best friend to talk about grad school rejection and receiving kind words of support

Effectiveness of Coping

Different coping mechanisms are most useful for different situations. \n \n Different types of coping may be more/less appropriate depending on whether or not person has control over situation. \n \n -coping flexibility, goodness of fit

Types of Coping Behavior (Brief COPE inventory)

\-Self-distraction •Active coping •Denial \n •Substance use \n •Use of emotional support •Use of instrumental support \n •Behavioral disengagemen

Coping Behaviors

Thoughts, feelings, and actions that reduce the effects of stressful events

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Social Support

 

Affect, affirmation, and aid from others. \n Emotional: Supporter of family going to hospital, telling parent they are good parents. \n Instrumental: Giving a resource- drive to hospital, cook food for family.

Measuring Social Support

Objective vs. subjective measures \n -subjective: more useful \n -perception of social support most strongly related to health

Measuring Social Support (sexes)

Women: Giving \n Men: Receiving