Implications of the Ageing
Process: Opportunities for
Prevention
Karen E. Peters, DrPH
University of Illinois at Chicago
School of Public Health
IL Prevention Research Center
March 6, 2007
Objectives
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To acquire insights into how and why aging
occurs
To understand the normal and abnormal
physical and mental health changes
associated with aging
The farmer community can acquire
knowledge about maintenance of workplace
safety, preservation of good health, and
prevention of chronic diseases that
compromise healthy aging
Old Age
Memory is short, and braine is dry.
My Almond-tree (gray haires) doth flourish now,
And back, once straight, begins apace to bow.
My grinders now are few, my sight doth faile
My skin is wrinkled, and my cheeks are pale.
No more rejoyce, at musickes pleasant noyse.
Anne Bradstreet (1612-1672)
The Aging World
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Increased longevity has resulted in an ‘Aging World’
Affluent nations/societies most affected by baby
boomers reaching > age 60
The older population (> 65 years) was 36.8 million in
2005 in USA
Represented 12.4% of U.S. population- about one in
every eight Americans
Expected to be 20% by year 2030- about 75 million
Will comprise 1 in 5 Americans by 2030
Definition of Ageing
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Can be defined as a progressive, generalized
impairment of function resulting in a loss of
adaptative response to a stress and in a
growing risk of age-associated disease
(Kirkwood, 1996).
21st Century Phenomenon of Global
Ageing
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20th century – saw a global phenomenon of longevity – a triumph
and a challenge
Average life expectancy at birth- increased by 20 years since
1950 to 66 years
Is expected to increase another 10 years by 2050
By 2050, the population of older people will exceed that of
children (0-14 yrs)
Is a social phenomenon without historical precedent
In 2002, number of persons > 60 years was 605 million; expected
By 2050, number is expected to reach almost 2 billion
Life Expectancy Rise
Population ageing
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Refers to a decline in the proportion of
children and young people and an increase in
the proportion of people age 60 and over.
As populations age, the triangular population
pyramid of 2002 will be replaced with a more
cylinder-like structure in 2025
Older Population in USA
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The older population (> 65 years) was 36.8 million in
2005 in USA
Represented 12.4% of U.S. population- about one in
every eight Americans
Expected to be 20% by year 2030- about 75 million
Will comprise 1 in 5 Americans by 2030
FASTEST GROWING GROUP OF OLDER
POPULATION IS OLDEST OLD I.E. > 80YRS
Impact on Society
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Affect family solidarity and relationships
within families
Equity across generations
Lifestyles
How Old is ‘Old’?
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We call ourselves 3 years ‘old’ or 80 years ‘old’
Some say ‘I am running in my 10th year’ or ‘I am
running in my 75th year’
So we can be old at 3 and running at 75!
Old is a relative term- I call friends my age ‘girls’,
while to ‘youngsters’ we are ‘older’ females or even
old!
However, Aging is a Reality- Prepare to Accept
Gracefully
Definitions
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Defined as latter part of animate life
Old, elderly, senior citizens- commonly used
Calendar age is not necessarily synonymous with
biological age
"Successful aging," "productive aging," and "vital
aging" commonly used now
UN – defines 60 +; developed nations 65+
Gerontology- The scientific study of the biological,
psychological, and sociological phenomena
associated with old age and aging.
Geriatrics- treats the clinical problems of later life
Senescence
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In biology, senescence is the process of ageing
Senescence is the steady deterioration of cell function following
the period of development in youth
Cellular senescence- cells lose the ability to divide in response to
DNA damage -cells either senesce, or self-destruct (apoptosis) if
the damage is irreparable
Organismal senescence is the aging of whole organisms. Aging
↔ Senescence
Species have different "rates of aging"- a mouse is elderly at 3
years; humans at 85 yrs
Apart from species specific genetics, chance events determine
the probability of death
Organismal ageing
Is characterized by:
 Declining ability to respond to stress
 Increasing homeostatic imbalance
 Increased risk of disease
 Death is ultimate consequence of ageing
Biological definition
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Pre-Conception - Ovum, Spermatozoon
Conception Fertilization
Pre-birth
Conception - 9 months
Infancy
Birth - 2 yrs
Childhood
3 – 12 yrs
Adolescence
13 - 19 yrs
Early Adulthood 20 - 39 yrs
Middle Adulthood 40 - 64 yrs
Late Adulthood 65+ yrs
Death – Cessation of vital body (somatic) functions
History
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Desire to live forever is ancient
Zeus(Greek God), granted Tithonus the gift of immortality, but not
of perpetual youth, when requested by his wife Eos.Tithonus
grew progressively ancient, and begged for death to overcome
him
‘Immortalized’ in Tennyson’s poem “Tithonus”:
“Man comes and tills the field and lies beneath,
And after many a summer dies the swan.
Me only cruel immortality
Consumes: I wither slowly in thine arms”
Living longer without youthful vitality is not pleasant
THEORIES OF AGING
How and Why we age are still not clear
WHY DO WE AGE?
 Many theories, none fully explain aging
 The rate of living theory of aging –rejected
 The oxidative-damage/free-radical hypothesis of
aging-topical area
 The evolutionary senescence theory of agingmost accepted
 The reliability theory of aging
 The neuron-endocrine hypothesis of aging
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The Rate Of Living Theory Of Aging- rejected by modern
scientists
 Ancient philosophers- Death occurs when a finite amount of “vital
substance” consumed
The Oxidative-Damage/Free-Radical Hypothesis of Aging
 Mitochondrial ability to repair DNA damage ↓ with age →
Decreased cell efficiency
 Too much mitochondrial damage → cell death
 Oxidative damage →free radicals → DNA damage, cross-linking
of proteins, formation of age pigments
 Injury caused by free radicals initiates a self-perpetuating cycle in
which oxidative damage impairs mitochondrial function, which
results in the generation of even greater amounts of oxygen-free
radicals.
The Oxidative-Damage/Free-Radical Hypothesis
Of Aging
Self–perpetuating
Cycle of Impaired
Function
↓
Increased Oxygen free radicals
Oxidative cell
damage
↓
Mitochondrial
Damage
-DNA Damage
-Cross-linking
proteins
-Mitochondria
Damage
-Form age
pigments
Oxygen-free
radicals release
The Evolutionary Senescence
Theory of Aging
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Most widely accepted overall theory
Species prone to die to predation (e.g. Mice) invest more energy in
reproduction than in health maintenance
Humans, less prone, can allocate more resources to repairing
physical damage
Humans able to reproduce over a longer period of time
Thomas Kirkwood (1970’s)- disposable soma theory- organisms
have to balance the demands of maintaining their body, or soma,
cells and reproducing
States that humans have long life spans because we are much
better at repairing our bodies than short-lived animals
Steven Austad (early 1990s)-provided evidence that perilous
environments support early reproduction and short life spans,
whereas safer environments favor the opposite
Most agree that it is currently the best explanation for why we and
other organisms age
The Reliability Theory Of Aging
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Applies mathematical theories of reliability to predict
systems failure in machines
Natural selection programs animals to live long
enough to reproduce;
Takes variable lengths of time after reproductive
failure for animal’s subsystems to fail and make
animal vulnerable to death
This theory does not explain why certain species live
longer than others
Endorses numerous facets of evolutionary
senescence theory of aging
The Neuroendocrine Hypothesis Of
Aging
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The neuron-endocrine system –complex system
linking brain, nervous system and hormonal glands
Becomes less functional with age- can lead to HBP,
diabetes, and sleep abnormalities
Effects of hormones on different facets of aging
studied extensively
Some late-life functional changes linked to reduced
levels- e.g. menopause
However, recent evidence reveals the opposite:
reduction in some hormones can prolong life
Current Areas Of Research To
Decrease Aging
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Caloric Restriction
Altered dietary intake
Insulin-like growth factor (IGF)
Pharmaceuticals
Most target reactive oxygen species,
underscoring substantial role of oxidants in
the aging process
The Physiology of Aging
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Aging is both visible and invisible
Visible changes occur on surface of the body;
invisible affect internal organs to impair function
Affects all systems to varying extent; if vital functions
involved, cause death
Gerontologists - aging is the cumulative effect of
many lifelong influences
Influenced by heredity, environment, culture, diet,
exercise, past illnesses, etc
Genetic factors chiefly determine variations in
aging/lifespan- we exert no control
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However, we can control our
environmental/lifestyle insults to aging and
health
Normal aging in the absence of disease is
a remarkably benign process
Biologic and chronologic ages are not the
same
Most organs gradually lose some function;
noticeable only during exertion/stress
Slower reaction times are common
How are Adolescence and Senescence
Different?
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Changes of adolescence follows predictable norms can be graphed
Aging affects individuals uniquely; norms not
established
Some systems begin aging by age 30 (bones);
others much later (mental faculties)
Senescence should not be viewed as a “disease”
Cannot put a ‘Time Clock’ on aging
PHYSICAL IMPLICATIONS OF AGING
Skin:
 Exhibits most obvious sign of aging
 Loss of underlying connective tissue, fat and oil
glands → wrinkles, sagging skin
 Aging skin appears thinner, paler, and translucent
 Increased sensitivity to heat/cold, bruising, and
bedsores
 Develops "age spots" due to deposits of melanin
pigment
 Ability to perspire is decreased
 Contributing factors: nutrition; exposure to sun,
chemicals/toxins; hormones, and heredity
Hair:
 Shows obvious signs of aging
 Hair color is due to pigment ‘melanin’- gradually decreases after
age 30-40
 Loses pigmentation → turns hair gray/white
 Manifests earliest in scalp, followed by facial/body hair
 Occurs earlier in Caucasians compared to Asians
 Alopecia- baldness/ hair loss is the norm
 Coarsening of hair common
Nails:
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Become dull, brittle, ridged, thickened, grow slower
due to reduced blood flow to connective tissues
The Cardiovascular System
Overall reduction in blood flow occurs as we age
 Heart of a 20-year old can pump 10 times the
amount actually needed to preserve life
 After age 30, about 1% of reserve is lost/ year
Results in:
 Normal atrophy of the heart muscle
 Calcification of the heart valves
 Arteriosclerosis ("hardening of the arteries")
 Atherosclerosis (intra-artery deposits)
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Slower
Healing rate
Reduced
Brain, Liver
and Kidney
Function
Vulnerable to
Drug Toxicity
Poor Response
to Stress
CVD Changes
↓
Poorer Cell
Oxygen
↑ Risk of HBP,
Heart Attack,
Stroke, Heart
Failure
The reduced blood flow results in less
strength due to:
 diminished oxygen exchange
 reduced kidney and liver function
 less cellular nourishment
Other problems:
 Intermittent pain in the legs with walking
 Varicose veins
 Prelediction for Blood clots
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Changes in Respiratory System
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Maximum lung function decreases with age
Diminished elasticity of airways and lung tissue
Reduced ciliary activity→ decreased oxygen uptake/exchange
Muscles of the rib cage atrophy, further reducing the ability to:
 breathe deeply
 cough
 expel carbon dioxide
Aggravating factors: Smoking, Pollution
Results in:
 Lower stamina for work; easily fatigued
 Shortness of breath
 Oxygen lack can increase anxiety
 Susceptibility to pneumonia increased
Skeletal System Changes
Manifest changes that affect QOL significantly
Osteoporosis is a common condition characterized by:
 progressive loss of bone density
 Increased vulnerability to fractures
 Thinning of vertebrae → loss of height; spontaneous fractures
 Reduction in height occurs by1 cm (0.4 inches) every 10 years
after age 40
 Height loss is even greater after 70 years
 The vertebrae calcify increasing rigidity, making bending difficult
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Joints
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Osteoarthritis- degenerative disease, most
common chronic condition in elderly
Rheumatoid arthritis- common connective
tissue disorder
Both impair mobility and the performance of
daily activities of living
Gastrointestinal System
A reduction in stomach hydrochloric acid,
digestive enzymes, saliva causes:
 Bloating and flatulence
 Impaired swallowing
 Reduced breakdown and absorption of foods
 Deficiencies in vitamin B, C, and K ;
malnutrition is a real possibility
Muscular System
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Progressive loss of muscle mass occurs as we age → change in
body shape
Accelerated after age 65- causes weight loss
Changes in body shape can affect balance, contributing to falls
Elderly individuals with weak muscles are at greater risk for
mortality than age-matched individuals
Increase in amount and rate of loss of muscle increases risk of
premature death
Physical inactivity is 3rd leading cause of death; plays role in
chronic illnesses of aging
Hormones
Sex Hormones
 Men may exhibit slightly decreased levels of testosterone
 Women have decreased levels of estrogens, progesterone and
prolactin after menopause
Insulin
 The normal fasting glucose level rises 6-14 mg/dL every 10 years
after age 50
 Probably due to loss in number of insulin receptor sites in cells
 Can lead to diabetes- annual testing recommended
Other Hormones
 Not significantly affected
Immune System
Overall effectiveness decreases, leading to:
 Increased infection risk
 Decreased ability to fight diseases
 Slowed wound healing
 Autoimmune disorders
 Cancers
Female Reproductive System
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Menopause is obvious milestone of aging (cessation
of periods > 1year)
Loss of Reproductive Capacity occurs
Normal around 50 years; occurs by age 40 in 8%
women
Secretion of estrogens, progesterone, and prolactin
hormones are reduced
Sex drive is not necessarily diminished
Aging does not impair a woman’s capacity to have
or enjoy sexual relationships
Physical manifestations
in Women
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Prolapse- descent of uterus may occur due to
lax tissues
Urinary stress incontinence common
Breasts lose tissue and subcutaneous fat→
flatten and sag
Breast cancer risk increases with age
The genital tissue atrophies; more prone to
infections
Male Reproductive System
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Men do not experience a sudden ‘andropause’
Age is not a good predictor of male fertility
Testosterone levels maintained/decrease slightly
Decreases in the sex drive (libido) may occur
Normal for erections to occur less frequently
Aging alone does not impair a man’s capacity to
enjoy sexual relationships
Physical Manifestations
in Men
Prostate grows in size- urinary problems
 Cancer of prostrate or bladder is commoner in older
men
Erectile dysfunction
 Erectile dysfunction may occur
 Is frequently related to diseases (diabetes) or
medicines
 90% of erectile dysfunction- has medical rather than
psychological origin
 May be amenable to treatment
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Changes in Kidneys
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Normally no change
Usually affected by diseases like high BP,
diabetes and cancer
Lead to increased risk for acute and chronic
kidney failure
Urinary tract infections are common
Teeth and Mouth
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Fall of teeth is an obvious sign of aging
All people eventually lose teeth- rate depends
on several factors
Proper hygiene can preserve teeth longer
Increased sensitivity to cold/heat common
with attrition
Loss can interfere with healthy eating habitsmalnutrition common
IMPLICATIONS OF AGING ON
MENTAL FACULTIES
The quality, not the longevity, of one's life is
what is important. — Martin Luther King Jr.
(1929-1968)
Nervous Tissue and Aging
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Aging has profound effects on mental faculties
Brain tissue is irreparable – changes are permanent
Speed of communication between nervous tissues is decreased
Transmission of messages within nerve cells becomes slower
The brain and spinal cord lose nerve cells and weight
Waste products collect in brain, causing plaques and tangles
Changes result in:
 Lost or reduced reflexes → problems with movement and safety
 Slight slowing of thought, memory, and thinking- a normal part of aging
 A change in thinking/memory/behavior are important indicators of
disease
 ALL ELDERLY PEOPLE DO NOT BECOME ‘SENILE’
Disease States
 Delirium, dementia, and severe memory loss are NOT normal
processes of aging
 Caused by degenerative brain disorders such as Alzheimer's disease
 Illnesses unrelated to brain can cause changes in thinking/ behavior
 Severe infections can lead to confused states
 Diabetes- fluctuations in glucose levels can cause thinking/behavioral
disorders
CHANGES IN SENSES
HEARING
30% people over
age 65 have
impairment
TOUCHGradual reduction
after 50- injuries,
hypothermia
SENSES
VISION
-Usually need
glasses by 55
-Only 15-20%
have ↓ driving
ability
Normal acuity
↓ with age
SMELLDecreases after
70 yrs- may affect
hygiene
TASTE- Minimal
changes
SENSES
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All senses are controlled totally by the brain
Aging increases minimum amount of stimulation
before a sensation is perceived
Any compromise in senses has tremendous impact
on lifestyle
Hearing and vision changes- dramatic effect on QOL
Many changes can be improved with glasses,
hearing aids, and lifestyle modifications
Communication problems common- lead to social
isolation and loneliness
HEARING
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Ears perform two functions – 1. Hearing 2. Maintaining body
balance (equilibrium)
Equilibrium (controlled by the inner ear)
Hearing is ruled by the outer ear– disorders respond better
Aging adversely affects both structures
Acuity of hearing declines slightly after age 50
30% people > 65 have significant hearing impairment
Impacted ear wax commoner with increasing age → deafness,
easy to treat
Persistent, abnormal ear noise (tinnitus) - common in older adults
VISION
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Visual acuity may gradually decline- not universal
After age 55, most people need glasses at least part
of the time
Driving ability is impaired in 15% to 20% due to bad
vision
5% become unable to read
Trouble adapting to darkness or bright light
Significant difficulty with night driving may be the
first sign of a cataract
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Color Perceptions Change
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As we age, it is harder to distinguish blues and greens
than reds and yellows
Elderly should use yellow, orange, and red contrasts at
home- improves ability to locate things
Using a red nightlight is better than a conventional bulb
"Floaters" in vision- harmless; sudden ↑ needs
consultation
Reduced peripheral vision occurs- cannot see
adjacent people- may cause offense to friends
Blindness- usually caused by diseases like
diabetes and high BP
Taste and Smell
 Taste does not seem to decrease until after age 60,
if at all
 Sense of smell may diminish, especially after age
70- leads to poor hygiene, and unawareness of gas
leaks etc
Touch, Vibration, And Pain
 Aging can reduce sensations of pain, vibration, cold,
heat, pressure, and touch
 Decreased temperature sensitivity increases the risk
of frostbite, hypothermia, and burns
 After age 50, many people have reduced sensitivity
to pain.
 Reduced feel of vibrations- loss of stability in motion
Social Behavior & Personality Changes
with Age
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Small changes normal - do not significantly change our sense of who the person
is
Personality and social interaction often change due to neurodegenerative
diseases
Drastic changes in personality reflect a disease process- difficult for caregivers
to cope with/accept
“Senility” or “senile” is an out-dated term- now replaced with “Dementia”
Senility or Dementia should NOT BE EQUATED TO AGING- DEMENTIA IS A
DISEASE STATE
Dementia – ‘condition where one has a progressive decline in memory and
other cognitive functions that results in a change in the ability to conduct one's
usual activities’
Dementia is characterized by multiple cognitive deficits with memory
impairments as an early symptom
Diagnosis of dementia- not given in absence of impairment in social
functioning/independent living
Psychological and Social Impact
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With a healthy lifestyle, few changes seen that are deleterious to QOL
In fact, some actions may grow more correct as we age (within limits)
Learning
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The ability to learn continues throughout life
Often require more time and effort to absorb new information
Need more effort to organize and understand new information
Tendency to avoid learning new things not perceived as beneficial
Reasons – unknown; may be partly attributed to decline in senses
as we age
Reaction time
 Information processed at a slower pace
 Reaction to stressful situations is delayed; uncertainty on how to
act may manifest
 A + for older people- tend to make fewer mistakes than younger
people in decisions taken
Intelligence
 Whether intelligence declines as we age is hotly debated- usually
maintained
 Older people perform lower on many standardized intelligence
tests
 In formal tests of performance, older people slow down, but
make fewer mistakes!
 However, most intelligence tests do not address situations in our
daily lives
 Value correctness as we age- answers are more accurate,
though response may be slower
 More cautious; less liable to make mistakes in judgment/ action
Life skills
 As we age, perform most life skills better with
experience
 As we age, majority are better at managing
daily affairs
 May fail only in times of stress or loss
 Reliable support network maintains QOL
longer
 Younger people can gain from experiences of
elders-meaningful exchanges can occur
Stresses
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Older adults must often deal with physical, medical
or social stressors
Stress can precipitate many diseases like diabetes,
high BP, anxiety attacks etc
Common stresses for older people are:
diseases or health conditions, possibly chronic (e.g.,
heart disease, arthritis, cancer)
perceived loss of social status after retirement
death of a spouse/child/sibling
Loss and grief
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Loss of a spouse is particularly stressful
In 2003, more than 1 million spouses (mostly women) were
widowed
This number is estimated to increase to 1.5 million every year by
2030
Loss of sight, hearing, and physical disabilities can induce
profound grief and loss
Retirement/job loss with loss of social status is a major cause
Most people grieve intensely for 6-12 months after a major losswithdraw from others
Takes about 1 year to accept the loss and start normal interaction
Substance abuse
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A growing problem among older adults, particularly
alcohol
Causes physical/mental health problems commonly,
especially older men
Exaggerated effects seen in older people
Has negative effects on self-esteem, coping skills,
and interpersonal relationships
Warning flags are less obvious in older adults e.g.
less likely to be caught on the job, in public
Memory Decline in Normal Aging
Definition: Memory refers to the storage,
retention and recall of information including
past experiences, knowledge and thoughts
 Only some types of memory loss are
associated with normal aging
 Other types are typical of disease states
Types of Memory and Loss
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Working (intermediate term) – loss occurs with normal aging
Episodic- especially impaired in normal aging e.g. ability to
process recent information
Semantic (e.g. vocabulary) – Improves with age; lost in
dementias
Procedural (long-term memory of skills) - shows No Decline with
age; affected by diseases
Very long-term memory (months to years)- increases upto age
50; maintained until well after 70
Short-term memory- shows little decline; loss associated with
diseases
Older adults tend to be worse at remembering the source of their
information
Abnormal Memory Loss in Aging
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Forgetting things much more often than you used to
Forgetting how to do things you've done many times
before
Trouble learning new things
Repeating phrases or stories in the same
conversation
Trouble making choices or handling money
Not being able to keep track of what happens each
day
Risk Factors for Cognitive Decline
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High blood pressure, diabetes, poor nutrition,
and social isolation
Heart disease
Family history of dementia
Psychological factors like stress and
depression
Normal Cognition
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Executive Functioning include:
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Organization: attention, decision-making,
planning, sequencing, problem solving
Regulation: initiation of action, self-control, selfregulation
Language- coherent, sensible
Working (immediate) Memory
Spatial Memory
Verbal Memory
Dementia
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The word dementia is used to describe the condition where one
has a progressive decline in memory and other cognitive
functions that results in a change in the ability to conduct one's
usual activities
Dementias are neurodegenerative diseases which cannot be
cured
Each type characterized by specific effects on cognitive and
motor function
Diagnosis of dementia is not generally given in absence of
impairment in social functioning and independent living.
Dementia seriously affects a person’s ability to carry out daily
activities
People with dementia lose their abilities at different rates
Eventually, patients may need total care
Symptoms of Dementia
Dementia symptoms may include:
 asking the same questions repeatedly,
 becoming lost in familiar places,
 being unable to follow directions,
 getting disoriented about time, people, and
places, and
 neglect of personal safety, hygiene, and
nutrition.
Alzheimer's Disease (AD)
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Definition: Is a progressive, neurodegenerative disease characterized in
the brain by abnormal clumps (amyloid plaques) and tangled bundles of
fibers (neurofibrillary tangles) composed of misplaced proteins
AD is the most common dementia in older adults
Incidence expected to more than double by 2050- from 377,000 in 1995
to 959,000
The proportion of new cases >85 will increase from 40% in 1995 to 62%
in 2050
The annual incidence expected to shoot up by 2030 (baby boomers
[persons born between 1946 and 1964] will be over age 65)
Most of the increase will occur among people age 85 or older
Early symptoms of AD, which include forgetfulness and loss of
concentration, are often missed because they resemble natural signs of
aging
Multi-infarct dementia
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Caused by a series of strokes in the brain
Infarcts result in irreversible death of brain tissue
Location/severity of compromised area governs
severity of symptoms/loss of function
Symptoms – abrupt onset; progress step-wise as
strokes recur
Treatment to prevent further strokes is very
important
Other Mental Conditions
Anxiety
 Anxiety disorders- commoner as we get older as medical,
psychological, and social problems build up
 One in five older adults suffers anxiety symptoms severe enough to
necessitate treatment
 Persistent or extreme anxiety can seriously decrease QOL
 Can be a sign of other problems like depression, dementia, physical
illness
 Anxiety is often associated with over-arousal
 Specific anxiety disorders include the following:
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General Anxiety Disorder –Most Common
Panic Attacks –Previous History Present
Phobias- E.G. Unable To Urinate In Public Bathrooms; Inability To Eat In
Public
Obsessive Compulsive Disorder –Usually Present At Younger Age
Post-Traumatic Stress Disorder
Delirium
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Delirium, or acute confusion, is a sudden change in mental
function
Delirium is usually a short-term, temporary problem
May persist for weeks to months in a substantial number of
people
Is a common complication of medical illness in elderly
One-third of older adults arrive at hospital emergency
departments in delirious state
Is strongly associated with poor outcomes among hospitalized
patients
Can be mistaken for dementia or schizophrenia
Delirium common in people with dementia
Parkinson's Disease
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Parkinson's disease is a slowly progressive degenerative disease of the
nervous system
About 50,000 Americans are diagnosed with PD each year
Many more undiagnosed as attribute symptoms to old age
Average age of onset is 60; commoner as we grow older
Caused by loss of nerve cells in brain that produce dopamine
Usually familial
Exposure to high levels of manganese, carbon disulfide or certain
pesticides increases risk
An increased risk in people who live in rural areas in advanced
countries (unproved)
Depression

Depression is a serious medical illness characterized by:
 Persistent sad, anxious, or "empty" mood
 Feelings of hopelessness, pessimism
 Feelings of guilt, worthlessness, helplessness
 Loss of interest or pleasure in hobbies and activities that were
once enjoyed
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1%—2% of older women, and < 1% of older men have major
depression
Is a continuation of problem from earlier life in 30%—50% of cases
Major depression may accompany disorders that result in dementia
Many older adults face cancer or grief that promote depression
There is a strong link between major depression and increased risk
of dying from heart disease.
Alcohol abuse causes depressed mood
Dizziness
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Dizziness is lightheadedness, feeling like you might faint, being
unsteady, loss of balance, or vertigo (a feeling that you or the room is
spinning or moving)
Most causes of dizziness are not serious; quickly resolve on their own
or are easily treated
Common complaint of people over age 65, affecting 13%—38% of older
Americans
Dizziness increases the risk of falling and decrease QOL
Lightheadedness happens when there is insufficient blood supply to the
brain- often seen on sudden change in position
Near-fainting/fainting not uncommon in elderly while straining at stools
or coughing
Vertigo is dizziness accompanied by a sensation of spinning – due to
ear problems/infections
Benign positional vertigo is commonest; happens on sudden change in
position of head
Disturbances in heart rhythm
Dizziness due to drugs not uncommon in elderly
Active Ageing (WHO)
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Active ageing is the process of optimizing opportunities for
health, participation and security in order to enhance quality of
life as people age
Ageing is a social phenomenon – involves friends, work
associates, neighbors, family
Interdependence and intergenerational solidarity are important
tenets of active ageing
“Yesterday’s child is today’s adult and tomorrow’s grandmother or
grandfather”
Healthy life expectancy is also a synonym for “disability-free life
expectancy”
“Disability-free life expectancy” is important to an ageing
population
Measures of Independent Living
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Autonomy is the perceived ability to control, cope with and make
personal decisions about how one lives on a day-to-day basis,
according to one’s own rules and preferences – difficult to
quantify
Independence is commonly understood as the ability to perform
functions related to daily living – i.e. the capacity of living
independently in the community with no and/or little help from
others
ADL’s (Activities related to daily living) - can be measured; e.g.
bathing, eating, using the toilet and walking
IADL (Instrumental activities of daily living); measurable; e.g.
shopping, housework, making meals
Quality of life (QOL)
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QOL is “an individual’s perception of his or her position in life in
the context of the culture and value system where they live, and
in relation to their goals, expectations, standards and concerns
Incorporates a person’s “physical health, psychological state,
level of independence, social relationships, personal beliefs and
relationship to salient features in the environment.” (WHO, 1994)
As people age, their QOL is determined by their ability to
maintain autonomy and independence
ADL and IADL are important measures of QOL
Religion, Spirituality and Aging
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In USA, > 90% of elderly persons consider themselves religious and spiritual
5% consider themselves spiritual but not religious
Religion is associated with better mental health and a greater ability to cope with
stress, illness and disability
Provides relief/support to elderly and their caregivers
Active involvement in a religious community helps to maintain physical
functioning/health
Elderly who attend services more likely to stop smoking, exercise more, increase
social contacts, stay married, and live longer
Religious activities foster development of community and broad social support
networks
Increased networking ↑ likelihood of awareness, early detection of diseases, seeking
treatment and adherence
Elderly often have distinct spiritual needs that overlap but are not the same as
psychologic needs
Many elderly persons prefer counseling from a clergy member rather than from a
mental health care practitioner, as it avoids stigma
Farming – an Aging and Hazardous
Occupation
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Agriculture ranks among the most hazardous industries
More than 3.1 million workers were employed in the agriculture,
forestry, and fishing industry in 2001
In USA the average age of civilian laborers was 38, compared to
57 in farmers
Agriculture employs proportionately more workers aged 55 and
older (22.9% versus 13.6% for all industries)
Agricultural workers are predominately male (72.4%)
Fatal occupational injury rates in the agricultural sector > 4 times
that for private sector (1992–2002)
Were disproportionately high for older workers
Work-related injuries increase as farmers move into their 60’s
Facts on Older Farmers
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According to the 1997 Agricultural Census, of estimated 500,000 farm
workers, 25% farm operators are 65 years or older
The only age category showing a substantial increase in 1992 included
farmers age 70 or older
Proportion of farmers age > 55 has risen from 37% in 1954 to 61% in
1997
Share of farmers < 35 years declined from 15 percent in 1954 to 8
percent in 1997
No mandatory retirement age exists for older farmers → continue to
perform beyond their safety limits
Full retirement is seldom a choice- farmers live in proximity to
workplace/ family enterprises
The average age of farmers within the United States is 54.3 years
Older farmers unwilling to recognize or accept their physical limitations
Older farmers underrepresented in research efforts related to farm
health and safety
Farmers Are At High Risk
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Fatal and nonfatal injuries
Work-related lung diseases
Noise-induced hearing loss
Skin diseases
Certain cancers associated with chemical use
Prolonged sun exposure → skin cancer
Entire families, including children, at similar risk as
often share work
Fatal Occupational Injury Rates
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Rates higher in agriculture, forestry, and
fishing in every age group than in the private
sector
Rates ranged from 13.7/100,000 for workers
aged 16–24 to 62.0 for workers older than 64
These differences increase with age
The greatest differences noted for workers
aged 55 or older
Adverse Health Effects in Farmers
Are due to:
 Chronic as well as acute exposures
 Delayed as well as immediate effects
 Cumulative and multiple exposures
Common Adverse Health Effects
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Neurological damage – due to pesticides (organophosphates,
OP)
The weight of current evidence suggests that chronic, low-level
exposure to OP produces neurotoxicity
Cancers – due to pesticides and sun exposure
Birth Defects – due to pesticides
Respiratory – due to allergens or gases
Developmental, reproductive – mostly due to pesticides
Immune suppression
Eye damage- macular degeneration with fungicide use
Nausea, convulsions, other acute effects due to pesticides
Age-Related Changes as Risk Factors
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Age-related sensory and physical impairments occur among senior farm
operators at various rates
Vision
 To see objects as clearly as at age 20, many 45-year-olds need four times as
much light
 By age 60, the amount of light required is double that needed by 45-year-olds
 Decline in visual acuity o detect normal environmental stimuli → impaired
reactions
 Older farmers routinely work in situations with inadequate lighting → more prone
to injury
Hearing
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Farm workers of all ages have higher levels of noise-induced hearing loss than
the general population
Senior farmers who have difficulty hearing words or sounds may not be able to
detect warning signals
Sense of Balance
 Loss of balance and a feeling of dizziness increase the risk of injury for
senior farmers :
 May lead to loss of concentration while driving/ performing tasks
 Walking across an uneven surface such as hay, or moving in a small
fishing boat
 Falls around tractors and farm machinery poses a particularly serious
safety risk
Muscular capability impairment
 Farmers need strength and flexibility in all limbs and joints to work
safely
 Aging eventually reduces agility and strength - regulate/ delegate heavy
work
 Compensate by providing invaluable practical experience to younger
workers
Safety for Senior Farmers
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ACCEPTANCE OF IMPAIRMENT IMPORTANT – It is not a sign of weaknessRedesign work schedule
Increase lighting levels in barns and other buildings
Ensure that all steps, stairs, and handrails are of excellent quality and well
lighted with switches at both ends of stairs and by all entrances
Put non-slip surfaces on walkways and steps where possible.
Have easily operated or maneuvered fence gates, building doors, and animal
handling devices.
Use properly fitted and easily accessible personal protection devices/clothes
Pay special attention to their ability to operate a tractor safely ( for self and
others)
Get adequate rest, breaks and eat nutritiously
Know the symptoms of heart attack and stroke
Undergo regular medical check-ups annually for vision, hearing, balance, and
muscular range and mobility.
Consult a family physician about physical limitations and work limits.
Health Protection Strategies
Hand Protection
 Necessary to prevent injuries and exposure to chemicals
 Wear rubber or leather gloves, as needed
Hearing Protection
 To protect from deafness caused by loud noises (e.g. threshers)
 Can use ear inserts/muffs
Respiratory Protection
 Helps avoid exposure to allergens and toxic gases
 Two types- air supplying and air purifying respirators
 Air supplying respirators- use in manure pits, silos, where toxic gases
released
 Air purifying respirators-commonly used to remove air contaminants
'Prescription for Prevention’

Hippocrates, the Father of Medicine, said
nearly 2,400 years ago,"If we could give
every individual the right amount of
nourishment and exercise, not too little and
not too much, we would have found the
safest way to health."
Healthy Eating
Tips for Older Adults
Recommended daily calorie consumption for people over age 50
are:
For women:
 1600 calories, if physical activity is low level
 1800 calories, for moderate levels of activity
 2000 calories, for an active lifestyle
For men:
 2000 calories, if physical activity is low level
 2200-2400 calories, for moderate levels of activity
 2400-2800 calories, for an active lifestyle
Daily Dietary Guidelines
US Dietary Guidelines suggest a daily mixture of five food sources for good health:
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Grains—5-10 ounces
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Choose whole grain breads/pasta
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Eat high fiber foods like beans, peas, soya products etc- helps avoid
constipation, diverticulosis, and diverticulitis
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Vegetables—2 to 31/2 cups with a variety of colors and types of vegetables
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Fruits—11/2 to 21/2 cups
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Milk, yogurt, and cheese—3 sevings:
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1 cup of yogurt equals one cup of milk,
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11/2 to 2 ounces of cheese equals one cup of milk,
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1 cup of cottage cheese equals 1/2 cup of milk.
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Meat, poultry, fish, dry beans, eggs, and nuts—5 to 7 ounces
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Choose lean meat, poultry, or fish (without skin)
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Fats- limit to 2 teaspoon; use unsaturated vegetable fats
Tips for Healthy Eating
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Do not skip meals
Use low-fat dairy products and salad dressings
About 2/3 of a teaspoon of table salt
Drink plenty of liquids like water, juice, milk, and soup
Date leftover food, as maybe unable to smell spoilt food
Choose foods fortified with vitamin B12-adults over 50 have
difficulty absorbing adequate amounts of this vitamin
Limit high-fat and high-sugar snacks
Use unsaturated vegetable oils like canola, corn, or olive
Many medications may alter the taste of food
Learn to read food package labels-The first one listed is present in the
food in the largest amount.
Healthy Weight
Healthy BMI is between 20-25(Wt. in lbs/height in
feet)
 Maintain a healthy weight -reduce risk of many
chronic diseases
Health Risks of Being Underweight
 Poor Memory
 Decreased Immunity
 Osteoporosis (Bone Loss) – prone to fractures
 Decreased Muscle Strength
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Health Risks of Overweight
Overweight predisposes to development of:
 Type 2 Diabetes
 High Blood Pressure/Cholesterol
 Coronary Heart Disease/Stroke
 Some Types Of Cancer
 Osteoarthritis
 Gallstones
 Slow reaction times and avoidance of activity
 May reduce life span
Advantages of Physical Activity
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The more physically active you are, the less likely to gain weight
Improves your strength, endurance, and flexibility
Regular physical activity helps avoid obesity, diabetes, heart
disease/stroke, arthritis, high BP, and mental disorders
Reduces functional declines associated with aging
Lowers stress and boosts your mood and energy
Meet new friends by joining a class or walking group
Reduces risk of bone fractures/other injuries
Improves immunity; recovery from illness is faster
Enhances QOL- keeps one mentally alert and physically
independent
How Much Physical Activity?
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Levels vary from person to person
Consult your healthcare provider for safe limits
A gym is not at all necessary
Most people require 30 minutes of moderate
physical activity daily
Exercise intensity is less important than total amount
spent exercising
Intermittent exercise is as effective as continuous
activity
Spurts of three 10 minute walks are effective
Tips for Safe Physical Activity
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Take time to warm up, cool down, and stretch.
Start slowly and build up to more intense activity.
Stop the activity if you experience pain, dizziness, or shortness of
breath.
Drink plenty of water.
When you are active outdoors, wear lightweight clothes in the
summer and layers of clothing in the winter.
Wear sunscreen, sunglasses, and a hat for sun protection.
Wear shoes that fit well and are right for your activity.
Can I Take Alcohol Safely?
Yes,
 Drinking a small amount (1-2 units per day) protects
against heart disease and stroke
Recommended Weekly Limits
 Men: maximum 21 units of alcohol per week
 Not more than four units in any one day
 Women:14 units of alcohol per week
 Not > three units in any one day).

How Much is One Unit of Alcohol?
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One unit of alcohol is 10 ml by volume, or 8 g by weight, of pure alcohol
(100%)
One unit of alcohol is about equal to:
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There are one and a half units of alcohol in:
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Half a pint of ordinary strength beer, lager, or cider (3–4% alcohol by
volume), or
A small pub measure (25 ml) of spirits (40% alcohol by volume), or
A standard pub measure (50 ml) of fortified wine such as sherry or port (20%
alcohol by volume).
A small glass (125 ml) of ordinary strength wine (12% alcohol by volume), or
A standard pub measure (35 ml) of spirits (40% alcohol by volume).
Strong beer at 6% has six units/liter. If you drink half a liter or just under
a pint - then you have had three units.
Wine at 12% has12 units/liter. If you drink a quarter of a liter (250 ml) or
two small glasses, then you have had three units.
Smoking is a No!No!
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Smoking is the leading preventable cause of death in the United States
Causes about one in five deaths annually
An estimated 38,000 of 438,000 deaths are due to secondhand smoke
exposure
On average, smokers die 13 to 14 years earlier than nonsmokers
Among adult smokers, 70% report that they want to quit completely, and
more than 40% try to quit each year
The risk of dying from lung cancer is 22 times higher in men and 12
times in women who smoke cigarettes, compared with never smokers
Increases the risk for many cancers, including cancers of the lip, oral
cavity, pharynx, esophagus, pancreas, larynx (voice box), lung, uterine
cervix, urinary bladder, and kidney
Adverse Systemic Effects of Smoking
Heart Disease and Stroke
 Smokers 2–4 times more likely to develop
coronary heart disease than nonsmokers
 Doubles a person’s risk for stroke.
 Smokers 10 times likely to develop
peripheral vascular disease – limb
amputations
Respiratory Health
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Smoking- tenfold increased risk of dying from chronic obstructive
lung diseases like emphysema, bronchitis
About 90% of all deaths from chronic obstructive lung diseases
are attributable to cigarette smoking
Cigarette smoking has many adverse reproductive and early
childhood effects, including an increased risk for infertility,
preterm delivery, stillbirth, low birth weight, and sudden infant
death syndrome (SIDS)
Postmenopausal women who smoke have lower bone density
than women who never smoked
Women who smoke have an increased risk for hip fracture than
never smokers
Quit Smoking is Possible
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Needs determination and self control
Use free Quitline sources for help
Nicotine replacement drugs are available to
make withdrawal easier and feasible
Benefits of quitting far outweigh the expense
and agonies of quitting
Why Quit Smoking?
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Within 20 minutes of quitting: blood pressure and pulse rate drop to normal
Within 24 hours of quitting: risk of sudden heart attack decreases
Within 2 weeks - 9 Months:
Walking is easier, lung function increases 30%
Symptoms like coughing, nasal congestion, fatigue, and shortness of breath
decrease
Within 1 year of quitting: excess risk of coronary heart disease is half that of a
tobacco user
Within 5 years of quitting:
lung cancer death rate decreases by nearly 50%( for 1 pack smoker)
Risk Of Cancer Of The Mouth Is Half That Of A Tobacco User
Within 10 years of quitting: lung cancer death rate declines to that of a non
tobacco user
Risk of stroke is lowered, possibly to that of a non-tobacco user
Within 15 years of quitting: risk of coronary heart disease is same as nonsmokers
Steps to Healthy Aging
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MONITORING YOUR OWN HEALTH IS A GOOD ADAGE
Chronic diseases like diabetes, high BP, obesity, etc cause most problems in old
age
Most chronic diseases can be delayed or severity reduced
Adopt healthy lifestyle behaviors from childhood
Keep weight at BMI < 26
Be physically active within limitations
Eat nutritious foods
Eat sparingly
Avoid misuse of alcohol/drugs; abstinence best
Avoid smoking
Make a social network
Save for care in old age
Regular screening for cancer/diabetes, high BP etc
Regular medical examinations/dental checks
Prevent Chronic Diseases
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Practicing a healthy lifestyle
Avoid tobacco use
Use screening for:
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Breast, cervical, prostate and colorectal cancers
Diabetes
High Blood Pressure
Cholesterol
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Regular physician visits
Adherence to treatment
Be Good To Yourself
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Get adequate sleep
Maintain contacts with family and friends
Join a social group
Surround yourself with people whose company you enjoy
Volunteer or get active with groups in your community.
Try a part-time job at a place you would enjoy working for a few hours a
week
Indulge in activities you always yearned to do, but never had the time
for when younger!
"The secret of life is enjoying the passage of time.“ James Taylor