Chapter 17: Physical Development in Late Adulthood

1. Chapter 17:  Physical Development in Late Adulthood

2. Human life span has not changed throughout history Life expectancy (the number of years that will probably be lived by the average person born in a particular year) in the U.S. has increased 30 years since 1900 to an average of 77 years (80 for women, 74 for men) due to Medical advances Better nutrition More exercise Healthier lifestyles Life expectancy in the U.S. for African Americans is an average of 70 years Longevity Before the 20th century most individuals died before they reached 65. Although more people are living to an older age, the actual life span has remained unchanged since the beginning of recorded history. The life span is the upper boundary of life, or the maximum number of years an individual can live. The max life span for human beings is approximately 120 to 125 years.Before the 20th century most individuals died before they reached 65. Although more people are living to an older age, the actual life span has remained unchanged since the beginning of recorded history. The life span is the upper boundary of life, or the maximum number of years an individual can live. The max life span for human beings is approximately 120 to 125 years.

3. Cross-culturally Japan has highest life expectancy (81 years) Differences in life expectancy include health conditions and medical care across the life span Females� ability to outlive males widens, beginning in their mid-thirties By 75, 61% or the population is female, and by 85, 70% of the population is female. Men are more likely than women to die from Respiratory cancer and coronary heart disease Motor vehicle accidents Suicide Cirrhosis of the liver and emphysema Today, the average 65 year old woman can expect to live 20 more years, and the average 65 year old man can expect to live 16 more years.Today, the average 65 year old woman can expect to live 20 more years, and the average 65 year old man can expect to live 16 more years.

4. Sex differences in life expectancy May be narrowing as more women are exposed to workplace stress Is influenced by biological factors Centenarians in the U.S. numbered 77,000 in 2000 compared with 15,000 in 1980 Getting older may not mean getting sicker Many are women who never married and who had unique ways of coping with stress It is estimated that there will be 834,000 in the US in 2050. Many important factors are related to longevity including genes, family history, health (weight, diet, smoking, exercise), education, personality and lifestyle. If stress in the workplace accounted for the difference in life expectancy between men and women, we would�ve expected the gap to narrow as women entered the work place. However, the opposite has occurred and the gap is widening. In virtually all species, females outlive males. It seems that women have more resistance to degenerative diseases. Ex., estrogen helps protect women from arteriosclerosis and the additional X chromosome may be associated with the production of more antibodies to fight off disease. SEE PAGE 556 OF 10TH EDITION (590 in 11th) for Life Expectancy Self Test. In the New England Centenarian Study, a majority of the centenarians have had difficult lives, such as surviving the Holocaust and living in extreme poverty as immigrants to the US. If stress in the workplace accounted for the difference in life expectancy between men and women, we would�ve expected the gap to narrow as women entered the work place. However, the opposite has occurred and the gap is widening. In virtually all species, females outlive males. It seems that women have more resistance to degenerative diseases. Ex., estrogen helps protect women from arteriosclerosis and the additional X chromosome may be associated with the production of more antibodies to fight off disease. SEE PAGE 556 OF 10TH EDITION (590 in 11th) for Life Expectancy Self Test. In the New England Centenarian Study, a majority of the centenarians have had difficult lives, such as surviving the Holocaust and living in extreme poverty as immigrants to the US.

5. Individuals live longer on the Japanese island of Okinawa in the East China Sea than anywhere else in the world. In Okinawa, there are 34.7 centenarians for every 100,000 inhabitants, compared to 10 per 100K in the US. The life expectancy in Okinawa is also the highest in the world, with 86 for women and 78 form men. Factors that appear to contribute to this include a diet of healthy food (grains, fish, vegetables, less meat, eggs and dairy. When some Okinawans moved to Brazil and adopted local eating habits, their life expectancy was lowered by 17 years. Easy going lifestyle, caring community, activity and spirituality are also considered to be contributing factors.Individuals live longer on the Japanese island of Okinawa in the East China Sea than anywhere else in the world. In Okinawa, there are 34.7 centenarians for every 100,000 inhabitants, compared to 10 per 100K in the US. The life expectancy in Okinawa is also the highest in the world, with 86 for women and 78 form men. Factors that appear to contribute to this include a diet of healthy food (grains, fish, vegetables, less meat, eggs and dairy. When some Okinawans moved to Brazil and adopted local eating habits, their life expectancy was lowered by 17 years. Easy going lifestyle, caring community, activity and spirituality are also considered to be contributing factors.

6. Considering what is meant by �old� Young-old are aged 65 to 74 Old-old are aged 75 or more Oldest-old are aged 85 or more Most are female, living alone or institutionalized (25%). Most are hospitalized at some time in the last years of life, and the majority die alone or in an institution. The majority continue to live in the community and more than 1/3 over 80 rate their health as excellent or good, with only 40% claiming some activity limitation. Differences between levels of �old� Potential for physical and cognitive fitness Levels of emotional well-being Effective strategies for mastering gains and losses of old age Late adulthood is the longest span of any period of human development. Oldest Old might be better defined in terms of function rather than chronological age. The oldest old are a heterogeneous group. 8 weeks of leg strength training remarkably improved the walking ability of 90+ nursing home patients (Fiatarone and others, 1990).Late adulthood is the longest span of any period of human development. Oldest Old might be better defined in terms of function rather than chronological age. The oldest old are a heterogeneous group. 8 weeks of leg strength training remarkably improved the walking ability of 90+ nursing home patients (Fiatarone and others, 1990).

7. Cellular clock theory: cells replicate 75-80 times before dying � maximum life span is therefore 120�125 years. The telomere, DNA sequences that cap chromosomes, may limit the number of times a cell can divide. Free-radical theory: normal aging creates molecules that damage DNA and cells, leading to disorders and diseases � lifestyle can affect damage process Mitochondrial theory: decay of mitochondria in cells causes aging, creates continual loss of energy Hormonal stress theory: stress hormone levels stay higher for longer as one ages, diminishing immune system Cellular clock theory: Leonard Hayflick�s 1977 theory that our cells become less capable of dividing as we age. He found that cells extracted from adults in their fifties divided fewer than 75 to 80 times. Each time the cell divides, the telomere becomes shorter. Injecting telomerase (an enzyme) into human cells can substantially extend the life of the cells beyond the normal 70 to 80 cell divisions. Free-radical theory: people age because when cells metabolize energy, the byproducts include unstable oxygen molecules known as free radicals, that ricochet around the cells, damaging DNA and other cellular structures. Overeating is linked to an increase in free radicals, and calorie restriction seems to reduce the oxidative damage caused by them. Mitochondrial theory: free radicals are one by-product of energy production by mitochondria. Damage caused by free radicals leads to a cycle in which free radical damage impairs the function of mitochondria, which causes more free radical damage, until eventually, the mitochondria become too inefficient to meet cellular needs. Exercise seems to increase mitochondrial activity. Hard to know if this is cause or effect of aging. Hormonal stress theory: As we age, our bodies respond to stress with a more prolonged activation of the SNS, causing less effective functioning of the immune system. Recent research (2004 and 2006 � see 594 in 11th) � suggests that diminished restorative processes in older adults accelerate the effects of aging on immunity � the immune system function less well, leaving the body more open to infectious diseases, and less able to restore itself.Cellular clock theory: Leonard Hayflick�s 1977 theory that our cells become less capable of dividing as we age. He found that cells extracted from adults in their fifties divided fewer than 75 to 80 times. Each time the cell divides, the telomere becomes shorter. Injecting telomerase (an enzyme) into human cells can substantially extend the life of the cells beyond the normal 70 to 80 cell divisions. Free-radical theory: people age because when cells metabolize energy, the byproducts include unstable oxygen molecules known as free radicals, that ricochet around the cells, damaging DNA and other cellular structures. Overeating is linked to an increase in free radicals, and calorie restriction seems to reduce the oxidative damage caused by them. Mitochondrial theory: free radicals are one by-product of energy production by mitochondria. Damage caused by free radicals leads to a cycle in which free radical damage impairs the function of mitochondria, which causes more free radical damage, until eventually, the mitochondria become too inefficient to meet cellular needs. Exercise seems to increase mitochondrial activity. Hard to know if this is cause or effect of aging. Hormonal stress theory: As we age, our bodies respond to stress with a more prolonged activation of the SNS, causing less effective functioning of the immune system. Recent research (2004 and 2006 � see 594 in 11th) � suggests that diminished restorative processes in older adults accelerate the effects of aging on immunity � the immune system function less well, leaving the body more open to infectious diseases, and less able to restore itself.

8. On average, the brain shrinks 5% to 10% between ages 20 and 90 � various theories try to explain it Some areas of the brain shrink more than others � shrinking of prefrontal cortex is linked to decrease in working memory in older adults A general slowing of function in the brain and spinal cord begins in middle adulthood � Affecting physical coordination and intellectual performance. The brain has remarkable repair capacity such that it retains most of its abilities in late adulthood The Course of Physical Development in Late Adulthood

9. Changes in neurotransmitter function and availability may explain some changes in the brain. A decline in neurons that produce Acetylcholine seems related to development of Alzheimer�s Disease. A decline in neurons that produce Dopmine seems related to development of Parkinson�s Disease A decline in neurons that produce GABA seems related to general changes in the functioning of the brain, such as controlling signals used for vision and muscular control. As the brain ages, it adapts in several ways: New brain cells are generated throughout life Dendrite growth increases from the 40s to 70s Older brains rewire to compensate for losses Myelination increases in the 40s and 50s Hemispheric lateralization can decrease Older brains rewire themselves to compensate for losses. Increased myelination occurs particularly in areas connecting the prefrontal cortex to the limbic system. When engaging in cognitive tasks, brain activity is less lateralized in the prefrontal cortex of older adults. May play a compensatory role � or may be a by-product of aging.Older brains rewire themselves to compensate for losses. Increased myelination occurs particularly in areas connecting the prefrontal cortex to the limbic system. When engaging in cognitive tasks, brain activity is less lateralized in the prefrontal cortex of older adults. May play a compensatory role � or may be a by-product of aging.

10. The immune system declines in functioning with aging, including a decrease in numbers of T cells Exercise improves the immune system, and influenza vaccination is very important for older adults People get shorter with aging due to bone loss Men losing about 1.25 inches from age 30 to 70 Women losing about 2 inches from age 25 to 75 Exercise and weight lifting help reduce muscle mass loss and changes in body appearance

12. Slower movement in older adults affects simple, everyday tasks like Reaching Grasping Walking Climbing Regular walking can slow onset of physical disability

13. Older adults take longer to move than younger adults, across a range of movement difficulty.Older adults take longer to move than younger adults, across a range of movement difficulty.

14. Sensory changes in late adulthood involve Vision and hearing Taste and smell Touch and pain Degenerative changes in the retina result in decreased light entering it, a process that begins before late adulthood Dark adaptation become slower, tolerance for glare decreases, and peripheral vision is decreased. Eye diseases of older adults include Cataracts: thickening of the lens of the eye that causes vision to become cloudy, opaque and distorted. Glaucoma: damage to the optic nerve because of pressure created by a buildup of fluid in the eye. Macular degeneration: involves deterioration of the macula of the eye, which corresponds to the focal center of the visual field. This is the leading cause of blindness in older adults. In one study, sensory functioning was linked with competence in everyday activities such as bathing and grooming themselves, completing household chores and engaging in intellectual activities. Greatest decline beyond 75 and especially beyond 85 involved being much less able to see clearly when glare was present. Color vision and depth perception may also decline to to yellowing of the lens of the eye and decrease in contrast sensitivity. Cataracts affect 30% of people by age 70. Glaucoma: affects 1% of people in their 70s and 10% in their nineties. Can be treated with eyedrops but will destroy vision is untreated. Macular degeneration: people with this might have good peripheral vision but not be able to see what is right in front of them. Affects 1 in 25 people ages 66 to 74 and 1 in 6 75+. Can be treated with laser surgery if detected early.In one study, sensory functioning was linked with competence in everyday activities such as bathing and grooming themselves, completing household chores and engaging in intellectual activities. Greatest decline beyond 75 and especially beyond 85 involved being much less able to see clearly when glare was present. Color vision and depth perception may also decline to to yellowing of the lens of the eye and decrease in contrast sensitivity. Cataracts affect 30% of people by age 70. Glaucoma: affects 1% of people in their 70s and 10% in their nineties. Can be treated with eyedrops but will destroy vision is untreated. Macular degeneration: people with this might have good peripheral vision but not be able to see what is right in front of them. Affects 1 in 25 people ages 66 to 74 and 1 in 6 75+. Can be treated with laser surgery if detected early.

16. Hearing impairments come in late adulthood but most can be corrected by hearing aids Smell and taste losses begin about age 60 Less loss in healthier older adults Creates a desire for highly seasoned foods Older adults are less sensitive to pain and suffer from it less than young adults When heart disease is absent, the amount of blood pumped by the heart is now known to remain the same regardless of age

17. Rising blood pressure with age can be linked to Illness Obesity Anxiety Stiffening of blood vessels Lack of exercise Lung capacity drops 40% between ages 20 and 80 even when disease-free Aging induces more changes in males than females but sexuality can be lifelong

18. Chronic diseases are rare in early adulthood but increase and become more common in late adulthood Arthritis is the most common Hypertension is the second most common Older women have a higher incidence of arthritis, hypertension, and visual problems than older men Older men are more likely than women to have hearing impairments Lifestyle and social and psychological factors are linked to health in older adults Health Chronic conditions associated with the greatest limitation on work are heart conditions (52%), diabetes (34%), asthma (27%) and arthritis (27%). The McArthur Studies of Successful Aging suggested that engaging in physical activity had a protective effect on health in virtually every age group of older adults (2002). In terms of social and psychological effects on health: Emotional support was linked with better functioning in people with cardiovascular disease. Self-efficacy was protective for people with a history of cancer Conflict in relationships was linked with greater decline for older adults with diabetes or hypertension. Low income is strongly related to health problems in older adulthood.Chronic conditions associated with the greatest limitation on work are heart conditions (52%), diabetes (34%), asthma (27%) and arthritis (27%). The McArthur Studies of Successful Aging suggested that engaging in physical activity had a protective effect on health in virtually every age group of older adults (2002). In terms of social and psychological effects on health: Emotional support was linked with better functioning in people with cardiovascular disease. Self-efficacy was protective for people with a history of cancer Conflict in relationships was linked with greater decline for older adults with diabetes or hypertension. Low income is strongly related to health problems in older adulthood.

20. The six leading causes of death in older adults are Heart disease Cancer Cerebrovascular disease (stroke) Chronic lung disease Pneumonia or influenza Diabetes Nearly 75% die from the first three of these causes Ethnicity is linked with death rates of older adults � overall rates of death from stroke, heart disease, lung cancer and female breast cancer are highest for African Americans and lowest for Asian Americans and Latinos. The number of strokes among older adults has declined in recent years, perhaps because of better treatment of high blood pressure, less smoking, better diet, and more exercise.The number of strokes among older adults has declined in recent years, perhaps because of better treatment of high blood pressure, less smoking, better diet, and more exercise.

21. Arthritis is common in older adults, affecting joints and vertebrae, but symptoms can be reduced by Use of some drugs like aspirin Range-of-motion exercises Weight reduction Joint replacement in extreme cases Osteoporosis affects many more women than men and can be prevented by Eating calcium-rich foods and vegetables Having a regular exercise program Medication Accidents are the 7th leading cause of death for older adults. Healing and recuperation take longer in an older adult, increasing vulnerability to diseases like pneumonia. There is no known cure for arthritis. Osteoporosis involves an extensive loss of bone tissue and is the leading cause of broken bones in women. 80% of US cases occur in females and is related to deficiencies in calcium, vitamin D, estrogen, and lack of exercise.There is no known cure for arthritis. Osteoporosis involves an extensive loss of bone tissue and is the leading cause of broken bones in women. 80% of US cases occur in females and is related to deficiencies in calcium, vitamin D, estrogen, and lack of exercise.

22. The common image of the oldest-old is one of frailty and disability � those aging successfully are unnoticed Less than 50% of US 85 to 89 year olds have a disability. Regular exercise in late adulthood leads to a healthier, happier, and longer life The average adult�s lean body mass declines with age � about 6.6 pounds every 10 years Exercise helps adults live independent lives with dignity in late adulthood

23. Sedentary participants were more than twice as likely to die during this eight year study than those who were highly fit.Sedentary participants were more than twice as likely to die during this eight year study than those who were highly fit.

24. Some older adults restrict their dietary intake in a way that may be harmful to their health Loss of taste and smell sensitivity contributes to a decline in interest in food. Decreasing snacks between meals contributes to harmful weight loss � especially in women Is is not known if low-calorie diets can extend human life, but low-calorie diets are not recommended for older adults Animals fed diets restricted in calories, although adequate in protein, vitamins, and minerals, live as much as 40% longer than animals given unlimited access to food. New research shows antioxidants may help slow the aging process � and possibly prevent some diseases The Calorie Restriction diet (CR) was related to a delay in problems like kidney disease and the age-related rise in cholesterol for both humans and animals. The animals in these studies had a 30% restriction in calories, which would relate to 1120 calories a day for women and 1540 for men. This CR diet may trigger �survival mode,� which may cause the body to eliminate all unnecessary functions and focus on staying alive. Leaner men do live longer, and as body mass increases, so does risk of death.The Calorie Restriction diet (CR) was related to a delay in problems like kidney disease and the age-related rise in cholesterol for both humans and animals. The animals in these studies had a 30% restriction in calories, which would relate to 1120 calories a day for women and 1540 for men. This CR diet may trigger �survival mode,� which may cause the body to eliminate all unnecessary functions and focus on staying alive. Leaner men do live longer, and as body mass increases, so does risk of death.

25. The Growing Controversy Over Vitamins and Aging: Other factors such as exercise, better health practices, and good nutritional habits may be actual cause of positive correlation between vitamin intake and slower aging, but more research needs to be done There is now more interest in possible links between vitamins and cognitive performance in older adults A majority of U.S. adults over age 65 abstain from alcohol mostly because of illness or disease Substance abuse in older adults may go undetected because its consequences get diagnosed independently Late-onset alcoholism: alcoholism beginning after age 65. Some research does suggest that antioxidants like Vit C, E and beta-carotene may help slow the aging process and help improve the health of older adults, primarily by neutralizing free radical activity. However, there is no evidence that such supplements can increase life span, but some evidence suggest they can reduce chances of becoming frail and sick in later years. Studies are preliminary are primarily correlational. Some research does suggest that antioxidants like Vit C, E and beta-carotene may help slow the aging process and help improve the health of older adults, primarily by neutralizing free radical activity. However, there is no evidence that such supplements can increase life span, but some evidence suggest they can reduce chances of becoming frail and sick in later years. Studies are preliminary are primarily correlational.

27. Some studies show older adults in the U.S. get less than half of the recommended health care that they need About 3% of adults over age 65, and 23% of adults over age 85, will reside in nursing homes at some time in their lives The quality of nursing homes and extended-care facilities varies and is a source of concern � over 33% fail to meet minimum federal standards Attitudes of both health-care provider and older adult are important in older-adult health care