Adulthood: Biosocial Development - The Aging Process- Senescence Ψ Senescence: the organic process of growing & showing the effects of increasing age. Senescence happens to everyone in every body part but the rate of decline is highly variable. • Primary aging: The age related changes that inevitably take place in a person as time goes by. • Secondary aging: The age-related changes that take place as a consequence of a person's behavior or a society's failure to eliminate unhealthy conditions. Ψ Signs of Aging: Note: Outward signs of senescence are present long before old age arrives. • first visual in the skin • collagen – the connective tissue of the body, decreases by about 1% per year • hair turns gray & gets thinner • skin becomes drier • “middle-age spread” Excessive weight will impair health! • people get shorter • muscles weaken Ψ Each of the 5 senses becomes less acute. The 2 most obvious are: hearing (presbycusis - "aging hearing" Pure tones are lost 1st. Practical measure: Whisper test) & vision (losses in acuity & accommodation (presbyopia). Ψ The Aging Brain • The brain slows down with age. Reaction time is slower & complex memory tasks become impossible. • Neurons fire more slowly & messages sent from the axon of one neuron are not picked up as quickly by the dendrites of another neuron. • Multitasking becomes more difficult. The Sexual-Reproductive System Ψ Both males & females encounter analogous changes in their sexual reproductive systems. • Sexual responses gradually become slower with age & reproduction is less likely. • Attitude is more important than biology in evaluating the impact of these changes. • Women usually reach menopause between the ages of 42 & 58, average age is 51. At menopause, both ovulation & menstruation stop; several hormones, especially estrogen, progesterone, & testosterone are also reduced. • Menopause is dated one year after a woman’s last menstrual period.
Menopause a.k.a. the Climacteric Ψ The climacteric is a phase preceding actual menopause and lasting 6 years. Biological and psychological changes are associated with this period due to the lower levels of estrogen. Ψ The first symptom of the climacteric is usually shorter menstrual cycles. Ovulation here usually occurs early or late in the cycle rather than mid cycle as it did in earlier years. Ψ Mood fluctuations are common in this time. Ψ The most obvious symptoms of climacteric are hot flashes (feeling hot), hot flushes (suddenly looking hot), and cold sweats (feeling cold and clammy). These symptoms are all caused be vasomotor instability, a temporary disruption in the body’s homeostatic mechanism that constricts or dilates the blood vessels to maintain body temperature. Ψ Vasomotor instability varies in severity: Only 1 in 5 women (20%) find them bothersome while 3 in 5 women don’t even notice them. Ψ Other changes in a female’s body because of lower estrogen levels include: • Drier skin • Less vaginal lubrication • Loss of some breast tissue Ψ The two other changes caused by reduced estrogen levels that pose serious heath risks are: 1. Loss of bone calcium, which can lead to osteoporosis. This is more common in small framed women of European descent. 2. Increase of fat deposits in the arteries, which can lead to coronary heart disease. Ψ About 1 in 3 women in the U.S. have a hysterectomy (surgical removal of the uterus) at some point in their lives. The sudden onset of menopause caused by a hysterectomy is more likely to cause striking symptoms. Estrogen Replacement • 10% of all women going through natural menopause and 90% of all women going through surgically induced menopause receive estrogen replacement therapy. In most cases, the treatment is hormone replacement therapy (HRT). • Continued use of HRT can have health benefits, but may have some risks as well. • The benefits include a reduction in half the incidents of hip fractures as well as the reduced risk of Alzheimer’s disease when taken for more than 15 years. • HRT can increase the risk of some cancers especially breast cancer. HRT is no longer routinely prescribed for women who have reached menopause. Notes: The usual way to measure sexual activity is in frequency of intercourse and orgasm. Sexual expression gradually declines throughout adulthood. For men, sexual stimulation takes longer and needs to be more direct. Even so, most men are still satisfied with their sex lives. The woman’s capacity for orgasm is not impaired in any way by aging as long as there are no other health problems. Sex is usually the result of social interaction. Emotional problems, physical illness, and numerous medications can affect sexual performance. Sexual activity helps promote sexual interest and excitement. A satisfactory sex life is possible for most loving couples, at any age. Key Terms Menopause - The time in middle age, usually around age 50, when a woman’s menstrual periods cease completely and the production of estrogen drops considerably. Male Menopause (andropause) a term coined to signify a drop in testosterone levels in older men, which normally results in reduced sexual desire, erections, and muscle mass - Not biologically based? - Hormone (testosterone) level shifts are probably related to stress levels. Climacteric - Refers to the various biological and psychological changes that accompany menopause. Osteoporosis - A loss of calcium that makes bone more porous and fragile. It occurs somewhat in everyone with aging, but serious osteoporosis is more common in elderly women than men. Hormone Replacement Therapy (HRT) - Treatment to compensate for hormone reduction at menopause or following surgical removal of the ovaries. - The Impact of Poor Health Habits - Tobacco & Alcohol Use Ψ Tobacco • In all its forms tobacco contains harmful drugs. • Nicotine is the most addictive of the drugs contained in tobacco. • Fewer people are starting to smoke. • Many people quit smoking by late adulthood. • Death from lung cancer is down by 20% from 1980 - 1995. Ψ Alcohol Ψ Adults who drink alcohol (wine, beer, spirits) in moderation live longer than those who never drink….reason? - Reduction in coronary heart disease. Alcohol increases "good cholesterol" (high-density lipoprotein) which in turn decreases "bad cholesterol" (low-density lipoprotein). Ψ Small amounts of alcohol may … • reduce tension. • aid digestion. Ψ Large amounts of alcohol may … • lead to alcohol abuse/dependence. • cause cirrhosis of the liver (kills 14,000 middle-aged adults in the US each year). • stress the heart & stomach & destroy brain cells. • decrease fertility & increase some forms of cancer (breast cancer). • cause Korsakoff's syndrome: An organic disorder in which the brain fails to cope with new information, though distant memory is preserved. It is usually due to chronic alcoholism. An ultimate & tragic consequence of years of alcoholic drinking, "wet brain" (Wernicke-Korsakoff syndrome) occurs from a thiamine deficiency due to malnutrition. In early stages, the syndrome can be partially reversed through treatment with large doses of thiamine; in late stage cases, there is no effective treatment. Ψ Deaths due to alcohol each year in the US - 108,000 Ψ Worldwide, alcohol is one of the leading causes of the Global Disease Burden - combines indicators of premature death with indicators of disability worldwide. Ψ IMPORTANT- just because moderate consumption of alcohol has health benefits…does not mean that it is not a major health risk. Lack of Exercise Ψ Adults exercise less as they age. Low exercise rates are blamed on • lack of commitment. • lack of support in the immediate social context. • community’s failure to provide appropriate facilities. Ψ Activity • burns calories. • decreases appetite. • increases metabolism. • reduces serious illness & death. Ψ Exercise not only improves an adult's physical state, it improves cognitive functioning because of improved blood circulation to the brain, this is thought to be the reason exercise decreases depression & hostility. Overeating Ψ Resistance to Good Nutrition
Ψ Resistance to Good Nutrition comes from • misinterpreting scientific research. • the existence of many high fat diet plans. • heavy drinking & smoking. Ψ Two proven conclusions from health studies: • Avoid too much fat • Get enough Fiber Ψ Adults should get less than 30% of their calories from fat. Ψ High fiber diets make some forms of cancer less likely (colon cancer) Ψ Adults should get more than 30 grams of fiber a day and have at least 5 servings of fruits and vegetables. Ψ Obesity Ψ Obesity is the leading cause of premature adult death. Ψ Obesity is a worldwide epidemic, & it will be followed by a worldwide epidemic of diabetes. Ψ The U.S. is the global leader in obesity & diabetes. Ψ Obesity is a BMI of 30 or more. Morbid obesity is a BMI of 40 or more. Ψ Obesity is a risk factor for: • heart disease • diabetes • stroke • arthritis Ψ Reasons for Obesity • genes - regulate hunger, metabolism, & fat accumulation out of step with modern civilization. • parental attitudes & practices - cause children to be taught to overeat. • environment - modern cultures encourage overeating. Preventive Medicine Ψ The damage & death caused by tobacco, alcohol, & obesity make it obvious that prevention is less risky than treatment. Ψ Much of prevention involves choices people make every day as to diet & exervise levels. Ψ Of course preventive screening & medical measures are helpful. Ψ Social measures that protect against harm & help those who suffer from trauma like requiring seatbelt use are obvious forms of prevention. - Measuring Health - Ψ Better health & mortality rates are characteristic of those who are relatively well-educated, financially secure & urban-dwelling. Four distinct measures of health: • Mortality: signifies death, as measured by the number of deaths each year per 1,000 individuals. • Morbidity: signifies disease, as measured by the rate of diseases of all kinds in a given population (acute- sudden/severe or chronic-extending long time). • Disability: signifies long-term difficulty in performing normal activities of daily life because of some physical, mental, or emotional condition. • Vitality: signifies a measure of health that refers to how healthy & energetic physically, intellectually, & socially an individual actually feels. Vitality is joie de vivre, the zest for life. Ψ Quality-Adjusted Life Years (QALYs): a way of comparing mere survival without vitality to survival with health; QALYs indicate how many years of full vitality are lost to a particular physical disease or disability; expressed in terms of life expectancy as adjusted for quality of life. A year of life adjusted for its quality or its value. A year in perfect health is considered equal to 1.0 QALY. The value of a year in ill health would be discounted. For example, a year bedridden might have a value equal to 0.5 QALY. For example if a person lives to be 70 in near perfect health, that is expressed as 70 QALYs. Ψ Disability-Adjusted Life Years (DALYs): are the reciprocal of Quality-Adjusted Life Years (QALYs). DALYs are a measure of the impact that disability has on the quality of life. A reduction in QALYs means an increase in DALYs. Ψ Global Burden of Disease: The total reduction in vitality that is caused by disease-induced disability. 1. Lower respiratory tract infections 2. HIV/AIDS 3. Birth complications & defects 4. Diarrhea 5. Unipolar (major) depression 6. Heart disease (1st in U.S.) 7. Vaccine-preventable diseases 8. Stroke 9. Malaria 10. Malnutrition Ψ The top four health problems are treatable by modern medicine (treatment lags in 3rd world countries). Note: cancer which is 2nd in America, does not even appear on the worldwide top 10 chart. CAUSES OF DEATH, USA, 2002 FORMAL NAME - INFORMAL NAME - % ALL DEATHS (1) Diseases of the heart - heart attack (mainly) - 28.5% (2) Malignant neoplasms - cancer - 22.8% (3) Cerebrovascular disease - stroke - 6.7% (4) Chronic lower respiratory disease - emphysema, chronic bronchitis - 5.1% (5) Unintentional injuries - accidents - 4.4% (6) Diabetes mellitus - diabetes - 3.0% (7) Influenza and pneumonia - flu & pneumonia - 2.7% (8) Alzheimer's Disease - Alzheimer's senility - 2.4% (9) Nephritis and Nephrosis - kidney disease - 1.7% (10) Septicemia - systemic infection - 1.4% (11) Intentional self-harm - suicide - 1.3% (12) Chronic Liver/Cirrhosis - liver disease - 1.1% (13) Essential Hypertension - high blood pressure - 0.8% (14) Assault - homicide - 0.7% (15) All other causes - other - 17.4% [Source: National Vital Statistics Report, Volume 53, Number 5 (October 2004)] Ψ Compared to middle-aged women, men are twice as likely to die of heart disease. Contributing to the gender difference in mortality is the fact that men are more likely to smoke, drink, be overweight, repress emotions & ignore their medical symptoms. Beginning in middle age, however, women have higher morbidity & disability rates than men. Ψ This gender difference in morbidity is exacerbated by the focus of medical research on acute illnesses rather than chronic conditions. - Variations in Health - Gender Differences Ψ There are genetic difference in genetic risks for certain illnesses. Ψ Senescence affects women more than men because small, superficial signs of aging, changes in skin, hair, weight, are of more concern (to both sexes) but especially to women. In reality women age slowly & females live longer worldwide. Twice as many women in the U.S.are alive as men by age 85. Socioeconomic Status Ψ People who are relatively well educated, financially secure, & living in or near cities tend to live longer lives & have fewer chronic illnesses or disabilities. They feel healthier than the average person of their age, sex & ethnicity. Ψ Compared to people in rich nations, those in poor nations experience higher rates of disease, injury, & death. Ψ Conditions such as lung & breast cancer, which were once more common among the rich than the poor, have been called diseases of affluence. Ψ SES may help to explain why the health of immigrants is generally better than that of the native born members of their ethnic group. Immigrants usually have been raised in families with relatively high SESs. Ψ Among the health hazards that accompany the context of poverty is more pollution, more crowding, & more health hazards of every kind. Ethnic Differences Ψ Both genetic & cultural factors affect the overall health of various ethnic groups, but social & psychological factors are even more influential. Ψ The reason for regional difference in the heath of Americans include variations in the quality of the environment & health care, as well as genetic, dietary, socioeconomic, religious, cultural, & medical patterns. Ψ Between 45 & 54, the chance of dying is twice as high for African Americans, & only half as high for Asian Americans, as it is for European Americans. In between are the mortality rates for Native Americans & Hispanic Americans. Self reported health status, disability, & morbidity follow the same ethnic patterns as mortality. Ψ In all minority groups, the illness & death rates among recent immigrants are lower than among long time U.S. residents. Why? They are hardier, have better health habits, are more optimistic, & have better family communication / support. Ψ There are genetic difference in genetic risks for certain illnesses.Ψ Our health care system works less well for people who are ethnic minorities, & the poor. Members of these groups are less likely to have insurance or to seek medical care.Ψ Medical personnel, like all people are subject to bias, which influences treatment. Key Questions 1. What age-related changes in appearance typically occur during adulthood? 2. How do vision & hearing change during adulthood? 3. As a person ages, how is the brain affected? 4. How do age & other factors affect a typical couple’s sex life? 5. What are some of the factors that diminish fertility? 6. Why might a woman welcome menopause? 7. What changes in rates of tobacco use have occurred over the past few decades, & what are the consequences of those changes? 8. What is the effect of alcohol on a person’s risk of mortality? 9. How does obesity affect physical and psychological health? 10. In what way(s) can preventive medicine have a positive effect on health? 11. What are the four measures of health, & what does each signify? 12. Why does health vary between & within ethnic groups? ------------------------------------------------------- Robert C. Gates