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80% own home. 75% single unit/detached. 45% live alone. 17% elderly householder had no ... One-Year Prevalence of Mental Disorders in Nursing Homes Estimates from ECA ...

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    Slide 1:Aging

    Or: how everything falls apart.

    Slide 2:References and Handouts

    http://www.brown.edu/Courses/BI_278/

    Slide 3:Everything Changes

    Psychological issues Socioeconomic Physical health Mental Health

    Slide 4:The stats on # elderly

    Increased 10-fold in last century Currently 35 million > 65 13% population By 2030 70 million 1/5 Americans > 65 1/11 > 85

    Slide 5:More stats

    Gender (percentage women) > 65 58% > 85 70% Ethnicity Will be more diverse Currently 85% white By 2050, 64%

    Slide 6:Everything Changes

    Psychological issues Socioeconomic Physical health Mental Health

    Slide 7:Psychological issues

    Aging has unique Challenges Life stresses

    Slide 8:Ex. Erickson

    Slide 9:Stage 8: Maturity

    Age: Late Adulthood -- 65 years to death Conflict: Integrity vs. Despair Important Event: Reflection on and acceptance of one's life

    Slide 10:Stage 8: Maturity

    Elements for a positive outcome: The adult feels a sense of fulfillment about life and accepts death as an unavoidable reality. Elements for a negative outcome: Individuals who are unable to obtain a feeling of fulfillment and completeness will despair and fear death.

    Slide 11:Other development approaches

    Psychodynamic Formation versus elaboration of psychic processes Levinson1 Structure building and changing Periods of transition 1 Levinson, D. (1986). A conception of adult development. American Psychologist, 41:3-13.

    Slide 12:Unique challenges of the elderly

    Losses Disablement Driving Health concerns

    Slide 13:What do the elderly worry about?

    National Council On Aging, 2000

    Slide 14:Everything Changes

    Psychological issues Socioeconomic Physical health Mental Health

    Slide 15:Socioeconomic changes

    Retirement Finances Social security Medicare Living situations

    Slide 16:Retirement

    Median age Men: 62.7 Women: 62.6

    Slide 18:Finances

    65+: net worth = $92,399 White = $181,000 African American = $13,000 annual household income = $22,812

    Slide 19:Percent Living in Poverty

    Elderly: 12.1% 3 points below general pop

    Slide 20:Living situations

    Among 65+ 80% own home 75% single unit/detached 45% live alone 17% elderly householder had no transportation

    Slide 21:Nursing Homes

    65+ 4% (1.46 million people) 85+ About 192 out of every 1,000

    Slide 22:Everything Changes

    Psychological issues Socioeconomic Physical health Mental Health

    Slide 23:Physical Health

    Self perception Survey of Americans age 65 (1996-96) vast majority considered themselves healthy. Whites: 74% AAs: 59.3 % Hispanics 64.9%

    Slide 24:The 3 big killers

    Heart disease Cancer Stroke Mortality rates Hrt Dx/Stroke: decr 1/3 since 1980 Cancer: up slightly

    Slide 25:Effects of Aging on the Body

    Bottom line Most of the news is bad. The question How much is inevitable?

    Slide 26:Examples of things we cant change

    Ocular accommodation Cardiac hypertrophy GI: malabsorption/intolerances Loss of immunity/allergies Loss of brain volume

    Slide 27:Examples of things we can change somewhat

    Loss of skin elasticity Auditory acuity Cardiac loss of elasticity

    Slide 28:Examples of things we can change a lot

    Muscle Mass, Muscle/Fat Ratio Osteoporosis Functional Cognition

    Slide 29:Everything Changes

    Psychological issues Socioeconomic Physical health Mental Health

    Slide 31:Why Rates in Elderly are Low?

    Greater difficulty remembering past symptoms Less psychologically oriented Greater mortality Cohort effect Sampling errors Instrument errors Diagnostic challenges

    Slide 32:Elderly Specific Criteria?

    Age 65+ Edmonton Canada Newman et al. Psychological Medicine 28; 1998

    Slide 35:Some specific diseases

    Slide 36:Psychotic Disorders

    Slide 37:Schizophrenia

    Slide 39:Psychosis in the Elderly

    Negative versus positive symptoms Look for alternative causes Esp. if NEW ONSET or no history Most common: MEDS ACUTE problems: infections, metabolic. Tumors, etc. less common

    Slide 40:Mood Disorders in the Elderly

    Slide 43:Depression in the Elderly

    Why so low? (see earlier) Forme Frustres Pseudodementia Diagnosing depression in complex cases How to approach

    Slide 44:Anxiety Disorder in the Elderly

    Slide 46:Anxiety Disorders

    Primary Versus Secondary Common Secondary Causes Drugs Medical Illness (cardiac, respiratory) Disorders that confuse (dementia, delirium)

    Slide 47:Substance Abuse in the Elderly

    Slide 49:Substance Abuse

    Gender differences and drug choice

    Slide 50:Dementia

    Slide 51:Problems in Dementia Prevalence Studies

    Size of sample Sample composition Age range Proportion of very old Education Method for case identification Content of Interview Supplementary diagnostic information Diagnostic criteria (NINCDS-ADRDA v DSM) Prevalence Estimate

    Slide 52:Age Specific Prevalence

    Jorms (1987)

    Slide 53:Stages of Dementia

    Depend on both Cognitive ability Testing Functional Ability Observe, ask.

    Slide 55:Special Settings

    Slide 56:One-Year Prevalence of Mental Disorders in Nursing Homes Estimates from ECA

    Slide 57:Differences in the Psych. Interview in the elderly

    Use of multiple sources Respect for confidentiality, but Relaxing of boundary issues Focus of interview Symptoms versus stories Explanations and honesty The power of genuine interest

    Slide 58:Epilogue: the question you are all asking

    How can I age well?

    Slide 59:To stay healthy

    Pick really healthy parents

    Slide 60:Other things you can do

    Dont smoke Low-fat, high-fiber diet Exercised vigorously for AT LEAST 30 min ALMOST EVERY day Maintained a healthy weight Consume a moderate amount of alcohol (about one drink per day). All 5 = 80% reduction in heart attack/stroke risk Which then also helps cognition Primary prevention of coronary heart disease in women through diet and lifestyle. M.Stampfer, et al., The New England Journal of Medicine, 2000, vol.343, pp.16--22

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