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FIRST INTERNATIONAL SOCIETY FOR GERONTECHNOLOGY MASTERCLASS IN GERONTECHNOLOGY

FIRST INTERNATIONAL SOCIETY FOR GERONTECHNOLOGY MASTERCLASS IN GERONTECHNOLOGY TUE, EINDHOVEN, NL MAY 22-23 2006 TECHNOLOGY FOR EXTENDED HEALTH. James L. Fozard, Ph.D. School of Aging Studies University of South Florida Tampa, FL 33260

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FIRST INTERNATIONAL SOCIETY FOR GERONTECHNOLOGY MASTERCLASS IN GERONTECHNOLOGY

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  1. FIRST INTERNATIONAL SOCIETY FOR GERONTECHNOLOGY MASTERCLASS IN GERONTECHNOLOGY TUE, EINDHOVEN, NL MAY 22-23 2006 TECHNOLOGY FOR EXTENDED HEALTH James L. Fozard, Ph.D. School of Aging Studies University of South Florida Tampa, FL 33260 For electronic copy of slides, send me an e-mail request at fozard@tampabay.rr.com

  2. Live long but don’t get old • “If I knew was going to live this long, I would have taken better care of myself” • One senior to another, “When does old age begin?” Answer: “Later!” • Young adult’s most serious life decision? “When to begin middle age.”

  3. Extended health?? • Health means more than the absence of disease • Physical, mental and social well being included in the WHO definition of health • Aging brings challenges and opportunities and technology addresses both

  4. Everyone knows about the challenges, but opportunities?? • Physical, Aging brings new opportunities for: • Adventurous and challenging activities • New social opportunities and friendships • Artistic expression • Learning • Work • Technology can help make up for lost time!

  5. Technology and New Opportunities?? • Aging brings new opportunities for: • Adventurous and challenging activities • Perhaps we, but surely our children and grandchildren enjoy video games • There is a great potential for adult adventure games; many current games simply require slower actions speeds

  6. Technology and New Opportunities ?? • Aging brings new opportunities for: • New social opportunities and friendships • Retirement, relocation, empty nest, widowhood—all create new opportunities • Communication technology—internet, e-mail, virtual neighborhoods—all are making a significant impact on aged as well as young persons.

  7. Technology and New Opportunities ?? • Aging brings new opportunities for: • Artistic expression • Group--Virtual jam sessions, group painting • Bouma and Harrington (2000) describe a virtual group painting activity in which all artists can see and share in the others’ painting. Possible with existing technology. • Bouma H, Harrington TL Information and communication. In TL Harrrington, MK Harrington Gerontechnology: Why and How Maastricht NL: Shaker Publishing 2000 pp.156-159

  8. Technology and New Opportunities ?? • Aging brings new opportunities for: • Artistic expression • Individual • Visual: making, copying and altering digital images; drawing, animation and cartoons etc. using existing software • Auditory: create, arrange, add music to visual scenes using contemporary software • Bouma H, Harrington TL Information and communication. In TL Harrrington, MK Harrington Gerontechnology: Why and How Maastricht NL: Shaker Publishing 2000 pp.156-159

  9. Technology and New Opportunities ?? • Aging brings new opportunities for: • Learning • Work • There are many existing examples of how technology makes it possible to learn “on line” and work at home or in a remote setting. Japanese program of “Kaizen” is recent example • www.seniornet.org;www.gerontechnology.org

  10. Gerontechnology Contributes in many Ways to aging and health • Education and training for aging • Prevention or delaying of age-associated losses in sensory-perceptual systems • Technology to lower impact of long-term exposure to environmental hazards and maintain cardiovascular health and strength • Compensation for age-associated losses • Enhancement of creativity and enjoyment of artistic activities

  11. Technology can help education and training activities related to aging • Three of life’s activities—education, work, leisure—should be distributed evenly across the lifespan • Simulations can help educate people for aging in various situations (BJ Fogg) • Cause and effect simulations (social skills) • Environmental simulations (treat phobias) • Object simulations (drunk driver)

  12. Preventing or delaying age-related limitations in functioning • Technology can contribute to the monitoring of age-related changes in functioning • Technology can contribute to motivating people of any age adopt healthy life styles that prevent or delay limitations in functioning • Diet, weight control, exercise, substance abuse

  13. Hearing: Prevention 1 • Presbycusis:Age-related hearing loss. Recent research indicates that aging alone cannot explain hearing loss—etiology of presbycusis is more complex. • Together, hearing aid technology and longitudinal data on presbycusis provide new opportunity for research and intervention.

  14. Hearing: Prevention 2 • Presbycusis: Noise exposure is best known risk factor; but how much and how long exposure must be is still poorly understood • Existing data have two limitations: • noise exposure usually measured at source rather than at ear • Most data from occupational groups with various ages and varied histories of exposure

  15. Hearing: Prevention 3 • Presbycusis and noise exposure guidelines: • Starting with Corso (Arch Environ Health, 1963;6:350-3) age-specific HL data for screened listeners are subtracted from total HL loss to estimate HL attributable to noise exposure. • Corso’s age findings replicated and extended to longitudinal data by Brant and Fozard (J Acoust Soc Am 1990:88;813-820.

  16. Hearing: Prevention 4 • Presbycusis and noise: Longitudinal data from carefully screened men and women used to predict age related HL changes over 8-14 years in persons with different initial HL levels. Predictions available for cohorts with initial ages from 20s through 80s. • Morrell CH, Gordon-Salant S, Pearson JD, Brant LJ, Fozard JL Percentiles for cross-sectional and longitudinal changes in hearing level. J Acoust Soc Am 1996;100:1949-1967.

  17. HL Changes in 424 men with Initial Ages from 30s to 70s From Morrell, et al. J Acoust Soc Am 1996; 100;1959

  18. Hearing: Prevention 6 • Propose a clinical intervention trial that uses data from Morrell et al study to identify men and women at risk, and hearing aid technology to measure noise level at ear. • Need controlled clinical trial to determine if control of ‘usual’ noise over long period of time will delay or lessen risk of noise exposure. • The data from the Morrell et al study could be used to identify men and women at risk for hearing loss

  19. Hearing: Prevention 7 • Clinical trial in natural setting could use noise suppression feature of contemporary hearing aids to limit noise exposure and to monitor noise levels at ear. • In the intervention phase of the trial, the noise suppression feature would control the noise level in the intervention group

  20. Hearing: Prevention 8 • Presbycusis--tobacco and alcohol use • Positive relationship between tobacco use and hearing loss found in population study • Cruickshanks KJ, Wiley TL Tweed TS et al Prevalence of hearing loss in older adults in Bearver Dam WI Am J Epid 1998;148:879-886. • Less loss with moderate alcohol use • Popelka MM, Cruickshanks KJ Wiley TL et al Moderate alcohol consumption and hearing loss: A protective effect J Am Ger Soc 2000;48:1723-1278

  21. Hearing: Prevention 9 • Presbycusis--elevated blood pressure • Longitudinal data from men with initially normal hearing established relationship between hearing loss (>25db for .5,1,2,4 kHz) for three levels of systolic blood pressure (120, 140, 160 mmHg) • Brant, LF, Gordon-Salant S, Pearson JD, Klein LL, Morrell CH, Metter, EJ, Fozard JL. Risk factors related to age associated hearing loss in the speech frequencies. J Am Acad Audiol 1996;7;152-160.

  22. % with normal hearing: a:SBP 120 b:SBP 140 c:SBP 160 From Brant,et al 1996

  23. Hearing: Prevention 10 • Brant et al findings come from observational study, need clinical trial • Other measures of circulation would probably be better for study, e.g., computed tomography imaging of arteries to detect coronary calcification, doppler techniques for assessing loss of flexibility of the arteries or possible imaging of cerebral or aural blood flow. • Clay RA Research to the heart of the matter Monitor on Psychol 2001;32:42 • Grady CL, et al Age-related changes in cortical blood flow activation during visual processing of faces and location J Neurosci 1994;14:1450-1462

  24. Vision: Prevention • Conclusions: inconclusive data • Best evidence is that control of elevated blood pressure will reduce visual problems that are secondary to diseases for which high blood pressure is a primary risk factor

  25. Proprioception, Balance and Movement: Prevention 1 • Strength training and physical activity improve muscle mass, control of movement, and balance • Ivey FM, Tracy BL, Lemmer JT, NessAiver M, SM, Metter EJ, Fozard JL, Hurley BH. The effects of strength training and detraining on muscle quality : Age and gender comparisons J Gerontol:Biol Sci 2000;55A:B152-B157. • Miller ME, Rejeski WJ, Reboussin BA, Ten Have TR, Ettinger WH Physical activity, funcional limitations and disability in older adults J Am Ger Soc 2000;48:1264-1272.

  26. Young Men Young Women Older Men OlderWomen Muscle Quality(MQ) is strength/volume. Strength training of right leg occurred over 9 months; detraining over 31 weeks. From Ivey et al 2000

  27. Proprioception, Balance and Movement: Prevention 2 • Midlife strength predicts functioning 25 years later • Grip strength measured at age 45 to 68 in Japanese-American men. 25 years later speed of walking, ability to stand up from chair, and self-reports of difficulty lifting 10 lbs, doing housework, etc were measured. • Rantanen T, Guralnik JM, Masaki K et al Midlife hand grip strength as a predictor of old age disability JAMA 1999;281:558-560

  28. Proprioception, Balance and Movement: Prevention 3 • Grip strength divided into thirds: <37, 37-42, >42kg; outcome measures included • Walking speed<0.4m/s (6.2%) • Chair rise without using arms (2.2%) • Difficulty doing housework (18.2%) • Difficulty walking up 10 steps (14.1%) • Rantanen T, Guralnik JM, Masaki K et al Midlife hand grip strength as a predictor of old age disability JAMA 1999;281:558-560

  29. % with Limitations in Strength Groups Measured 25 Yrs Ago Data from Rantanen et al, JAMA 1999;281:559

  30. Strength and Gait Speed 2 • Leg exension strength and leg power correlate with gait speed. The distributions of leg power associated with different speeds may provide the basis for setting goals for strength needed for walking. • Rantanen T, Avela J Leg extension power and walking speed in very old people living independently. J Gerontol Med Sci 1997;52A:M225-M331. • Correlations between power and speed ranged from .4 to.7 in old people

  31. Cumulative distributions of leg power for 5 groups of walking speed from <1m/s to>2m/s Data from Rantanen andAvela 1997 Cum %

  32. Prevention:Strength and Gait • There is considerable work relating contemporary strength to gait speed and balance, e.g., Rantanen and Avela • Prevention requires that we set standards for reserve strength needed for adequate functioning at a later age • Rough estimates are that we need 40% of our strength at age 25 to function well at age70

  33. Old Adults perform ADLs closer to max than young adults Hortobagyi T, Mizelle C, Beam S, DaVita P. J. Gerontology:Medical Sciences, 2003, 58A,453-460.

  34. Walking, going up and down stairs and rising from chair requires relatively higher percentage of maximum reserve capacity in older than younger adults--True for cardiovascular and muscle function Study measured relative effort to perform these tasks by assessing maximal leg strength on a machine and by the force used when going up or down stairs or standing up from a chair. Force was measured by special recording plate embedded in the floor or steps Participants were healthy women in two age groups mean ages 22 and 74 years. Purpose/Methods

  35. Relative effort (%) of maximum strength required to perform ADLs

  36. Conclusions • Prevention possibilities discussed include • Hearing • Gait, balance • Simulations for anticipating age changes in function

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