4. Physical Health and Aging

Maximum Life Span

The maximum number of years a member of a species can live

(110-125 years for humans; same for the past 100,000 years)

Life Expectancy

The number of years at birth an average member of a population can expect to live

(22 years in Ancient Rome to 75-80 years today)

How much longer do women live than men?

4 years longer

Study of Personal Health and Illness has 2 goals

What are they?

1) to understand changes in the body that come with age

2) to apply this knowledge to extend and improve human life

Canadian Community Health Survey (2013-14):

What % of Men aged 65+ in private household reported “good” - “excellent” health

About 78.6%

Education and Reports of Good Health (Turcott, 2011)

High education = high rate of good health

(in this study)

Turcott predicts a future increase in the proportion of senior women who will report very good/ excellent health.

Why?

As more women graduate from university

Patterns of Chronic Illness vs. Acute Illness in an Aging Society

Chronic Illness: rates increase (increased rate of noncommunicable diseases and chronic illnesses as people age)

Acute Illness: rates decrease (children surviving infancy, chance to grow into older age)

WHO (2018):

Chronic Diseases Represent ___ of all deaths worldwide

71% of all deaths worldwide

Deaths will increase as worldwide populations age

Epidemiological Transition

The transition a society makes when it moves from a high rate of acute illness (mostly in youth) to a high rate of chronic illnesses (most in older age)

Canada has made this transition

Chronic Illness

A condition that has lasted or is expected to last 6 months+ and has been diagnosed by a health professional

Reported Percentages of Senior Women and Men Who Have At Least One Chronic Health Problem

Women: 84.4%

Men: 82.2%

Specific Groups Report Higher Rates of Chronic Conditions…

What Groups?

• poorer people

• women have higher rates (arthritis and rheumatism in particular)

• women use more healthcare services

Health Deficit Accumulation

The accumulation of medical conditions, disabilities, and chronic diseases over time as a person ages

Zimmerman (2020):

3 Reasons for the Increased Death Rate Among Seniors

1) immune cells in the body decrease with age

2) chronic low-grade inflammation increased with age

3) some medications (including corticosteroids) may inhibit the immune system

What undermines immune function?

Lifestyle choices

(obesity, etc.)

Functional Disability

Limitation on a person’s ability to perform normal daily activities due to illness or injury

Chronic illness can lead to functional disability

Hughes and Colleagues (2018):

Activity Limitation due to Disability ____ with Each Older Age Group

Women vs. Men

Increases

Women have higher rates of disability than men

Biggest Health Issues in Seniors

• foot problems

• arthritis

• cognitive impairment

• heart problem

• vision

Construction worker injures a knee while on the job (pathology)

Impairment

Functional Limitation

Disability

I: injury may lead to arthritis and stiffness in the joint in later life

FL: difficulty walking or getting up from a chair

D: person may ultimately need to use a wheelchair

Does every medical condition follow a clear path from disease to disability?

NO

• disability can happen suddenly (i.e. car accident) rather than illness

• recovery from disability/ improvement of functional ability is possible (physio, etc.)

• influence of social conditions and personal factors

Do all chronic conditions turn into function disability?

NO

• more than ¾ of elderly people have at least 1 chronic condition

• less than ½ experience some functional disability

Sense Thresholds

“Points at which a person can begin to perceive a stimulus)

• begin to increase as early as age 30

• changes are noticed in the 60s

For aids to be useful, 3 things are necessary

1) people have to know about them

2) people have to understand their usefulness

3) products have to be affordable and accessible

Changes in Lifestyle:

Smoking

• one of the leading causes of serious disease and death in Canada

• immense economic burden on the healthcare system

• older people show lower rates of smoking

Sedentary Behaviour and Death

There is a relationship

BUT some sedentary behaviours are better suited than others

The Blue Zones: 9 Keys to a Long and Healthy Life:

Buettner (2010)

1) move

2) plan de vida (purpose in life)

3) down shift (work less, slow down, take vacation)

4) 80% rule (stop eating when you’re 80% full)

5) plant-power

6) red wine (consistency and moderation)

7) moderation (healthy social network)

8) beliefs (spiritual and religious)

9) your tribe (family as a priority)

Disability-Free Life Expectancy

Years of remaining life free of any disability

Dependence-Free Life Expectancy

Measures the number of years of remaining life a person will live in a state free of dependence on others for daily tasks

Health-Adjusted Life Expectancy (HALE)

Number of years a person can expect to live in good health

Biological Aging:

Intrinsic vs. Extrinsic

Intrinsic: normal wear and tear; variations in speed, but a universal occurance

Extrinsic: environment; depends on lifestyle and contextual factors

Mortality vs. Morbidity

Morality: number of deaths in a population during a given time

Morbidity: any depature from ‘health’

Life-Course Models:

Critical Period Model

• exposure during a specific period of life has lasting or lifelong effects

• vulnerable ages are fetal, adolescence, and early old age (65-75)

• the influence of socioeconomic status

• example: Dutch ‘Hunger Winter’

Life-Course Models:

Accumulation of Risk Models

• increase in number and/or duration of exposure, cumulative damages, higher risk for disease

• example: relationship between smoking and lung cancer (younger start to smoking = higher chance of developing lung cancer)

Life-Course Models:

Chain of Risk(s) Model

a by itself has no effect, only when it’s been mixed with b and c

Example of Chain Risk Model

• experiences of physical violence at any point of life were associated with mobility decline in old age

• possibly through physical activity and depression pathways

Gerontology

Systematic study of aging

(bio-psycho-socio-cultural aspects)

Why is disability an important issue in gerontology?

Disability causes dependency

A Standard Measure of Disability:

Activities of Daily Living (ADLs)

• eating

• bathing

• toileting

• getting dressed

• getting around inside

• getting out of bed

A Standard Measure of Disability:

Instrumental Activites of Daily Living (IADLs)

• grocery shopping

• money management

• medicine

• telephone use

• going places outside of walking distance

• preparing meals

• laundry

• housework

• getting around outside

A Standard Measure of Disability:

Short Performance Battery (SPPB)

Composite measure of balance + gait + speed + rise from a chair

A Standard Measure of Disability:

Nagi Scale

Self report of walking, lifting, and handling objects

A Standard Measure of Disability:

Late-Life Disability Instrument (LLDI)

Frequency of and limitations in performing mostly social activities

(family, travel, going out, etc.)

Compression of Morbidity

Same number of morbidity (on average), but compressed in a shorter time

Successful Aging

• does not mean not experiencing the natural process of aging

• lower chance of chronic conditions and disability (less, but not none)

• high mental, physical, and social functioning… think of WHO definition of health