Gerontology October 15 2012 Preventing Chronic Disease Living with Chronic Conditions How do we define health Good health State of complete physical mental social well being Health status Presence absence of disease Degree of disability Disability Impairment in the ability to complete multiple daily tasks need for assistance with ADLs Lifestyle factors exercise smoking Disability ADL Limitations Disability related to Older age oldest old Gender More likely for women Race ethnicity More common for African Americans SES More common for lower SES Good news Disability rates have declined managing chronic health conditions Chronic Health Conditions More than 80 of those 70 over have at least 1 chronic condition What are chronic health conditions Often permanent may requite long term management or case vs cure Long term more than 3 months Chronic Conditions Development course Rare in early adulthood more likely in midlife and most common in later life Co morbidity Co existence of 2 or more chronic or psychiatric conditions Quality of Life Combination of functional health feeling of competence autonomy in performing ADLs and satisfaction with one s social circumstances Majority of older adults rate their health as good to excellent What characteristics might contribute to a lower quality of life Cardiovascular Disease Leading cause of death over age 65 Atherosclerosis Coronary artery disease Myocardial infarction Heart Attack Symptoms differ for older adults Generalized sense of weakness Dizziness Confusion Shortness of Breath Hypertension High blood pressure Higher among African Americans Increases risk of stroke coronary heart disease Hypotension Low blood pressure Stroke Portion of brain denied blood Highest risk for African Americans men before 75 Higher risk for women after age 75 Measures to Reduce Cardiovascular Disease Risk Control weight Engage in daily physical activity Manage diabetes Reduce intake of salt saturated fat processed carbohydrates Increase intake of fruits rich in potassium bananas and oranges and vegetables rich in magnesium Increase intake of foods high in calcium Replace animal fat with olive oil Avoid partially hydrogenated oils Prevent cigarette smoking Avoid excessive alcohol intake Cancer 60 of new cancers 70 of cancer related deaths occur in people 65 Older women Breast cancer Older men Prostate cancer For survivors cancer can be chronic vs life threatening in some cases Greater risk with age more difficult to diagnose in later life Arthritis Second more common chronic disease Rheumatoid arthritis Inflammation of joints tendons Symptoms Pain swelling bone dislocation limited range of motion Treatment Medications exercise physical therapy surgery Osteoarthritis Gradual degeneration of the joints of the hands knees hips shoulders Most prevalent for women 85 Related to heredity lifestyle factors Obesity Occupational stresses Wear and tear on the joints Therapies anti inflammatory drugs exercise heat cold surgery Osteoporosis Extreme form of bone loss More common for women small stature low body weight Greatest bone loss during after menopause Related to Deficiencies in calcium Vitamin D Estrogen Depletion Lack of exercise Symptoms Health Issues Back pain bent spine increased risk of fractues Treatment Medications exercise sometimes HRT increased risk of breast cancer heart disease stroke Preventing Osteoporosis Bone density scan Increased intake of calcium daily Increased intake of Vitamin D Weight bearing exercise walking Possibly medications No smoking Diabetes Above normal glucose sugar in blood urine Inability to create or effectively use insulin Type I diabetes Type II diabetes most common form Treatment Medications diet and exercise Pre diabetes blood glucose is higher than normal but lower than the diabetes range Smoking poor diet lack of physical activity and alcohol consumption Serious complications Stroke blindness kidney disease loss of limbs Symptoms may not be present in older adults Increased thirst hunger Fatigue Increased urination especially at night Symptoms include Weight loss Blurred vision Sores that do not heal Preventing Diabetes Exercise regularly Reduce fat and calorie intake Lose a little weight Lower blood pressure and cholesterol Role of Health Behaviors Leading cause of death Smoking Decreases with age Benefits to smoking cessation Healthy Diet Under and overweight have highest mortality rates Obesity Increased risk of chronic disease Exercise can slow rate of aging Improve immune functioning Decreases rate of falls maintain functional capacity Implications for Older Drivers Driving important for maintaining independence Still at increased risk for car accidents Changes in eye hand coordination Hearing impairments Declining attention divided attention Declines in physical strength More vulnerable to injury death Slower reaction time Impaired vision especially at night Could we make design changes to help older drivers Wider rearview mirrors Pedal extensions Electronic detectors in front back of car that signal when too close to other Less complicated legible instrument panels cars Better protection on doors Booster cushions for shorter stature drivers Aura of Survivorship Older adults who enter late life still in relatively good health the robust older old Low cost users of medical services Who are the robust oldest old Physically robust Remain active Volunteer Free of disability or able to recover The Road to Good Health Do not smoke Eat healthy Get regular check ups Exercise body mind Know your family health history Get early and quality treatment Summary Thoughts Some physical changes are inevitable with age although rate of decline varies Aging is not a disease Some older adults at higher risk for disease than others Importance of prevention lifestyle choices diet exercise