Psych 243 Final

Front 1

Life Expectancy and Life Span

Back 1

Life Span - the upper boundary of life, the maximum number of years an individual an live = 121 years

Life Expectancy - the average number of years lived by the average individual born in a particular year = 77 in the US, 81 in the highest country - sweden

Front 2

Gap in Life Expectancy

Back 2

Based on race and SES

Front 3

Centrnarians

Back 3

77,000 in 2000
834,000 in 2050
Research says most centenarians are pretty healthy... that's how they got there!

Front 4

Sex differences in longevity

Back 4

-Expectancy for males: 74
-Females: 80

By 75, more than 61% are female

Differences due to:
-health attitudes, habits, lifestyles, occupation
-women are more likely to seek help and comply with treatments
-also biological reasons - trend in most species

Front 5

The Young Old, the Old Old and the Oldest Old

Back 5

-Late adulthood has the longest span of any period of human development - 50-60 years

Subperiods:
-Young Old = 65-74 years old
-Old old = 75 years and older
-Oldest old - 85 years and older

Front 6

Biological Theories of Age

Back 6

A lot of scientists are looking at functional rather than biological
-Cellular clock theory
-Free-Radical Theory
-Hormonal Stress Theory
-Health Problems

Front 7

Activities of Daily living (ADLs)

Back 7

Ability to do the shit you need to do
-Large chunk of older adults say they have these - 40%-50%

Front 8

Cellular Clock Theory

Back 8

-View that, as we age, our cells become increasingly less capable/efficient of dividing
-recent research suggests telomeric loss (the tips of chromosomes) with each cell division throughout life span

Front 9

Free-Radical Theory

Back 9

-Cells normal metabolism produce unstable oxygen molecules known as free radicals
-these molecules damage DNA and other cellular structures
-This damage can lead to a range of disorders, including cancer and arthritis

Front 10

Hormonal Stress Theory

Back 10

-With age, hormones stimulated by stress that flow through the hypothalamic-pituitary-adrenal system (HPA) axis remain elevated longer than when we were younger

-ability to handle stress correlates directly to if we get sick

Front 11

Health Problems

Back 11

Lifestyle, social, and psychological factors are linked with health in older adults

Physical Activity
-Protective effect on health

Emotional Support
-social support
-linked with better functionality in individuals with cardiovascular disease
-Self-efficacy was protective factor for individuals with a history of cancer

Front 12

Health Problems - Loss of senses

Back 12

Decline of vision in early and mid life
-adapting to dark (night driving)

10-15% over 65 have loss of senses - legally dead

-ability to smell and taste highly correlated with quality of life
-eat more junk food when you can't taste

Front 13

Causes of Death in Older Adults

Back 13

1. Heart Disease
2. Cancer
3. Stroke
4. Pneumonia
5. Influenza
6. Diabetes

The top three account for 75% of death in older adults

If all cardiovascular and kidney disease went away, life expectancy would be 10 years longer

Smoking has been associated with 20% of all death

Front 14

Estimated contributions of different factors of health status

Back 14

30% - other factors
20% - genes
40% - behavior
10% - medical care

Front 15

Smoking

Back 15

Smoking has been associated with 20% of all deaths

Front 16

#7 cause of death in older adults

Back 16

Accidents:
-Fall at home
-Traffic accident
Each year, approximately 200.000 adults over the age of 65 fracture a hip in a fall
-1/2 die within a year and frequently from pneumonia

Front 17

The growing vitamin and aging controversy

Back 17

-antioxidants: vitamin C, vitamin E, betacarotene helps slow the aging process and improve the health of older adults by counteracting the cell damage caused by free radicals

Front 18

Psychoneuroimmunology

Back 18

-Effects of psychological and neurological (CNS)influences on the immune system
-Stress = suppression of the immune system
-Chronic stress an important contributor in range of immune - related conditions
-increase vulnerability to infectious disease

Front 19

Episodic Memory

Back 19

-The retention of information about the where and when of life's happenings
-Younger adults have better episodic memory than older adults
-the older the memory, the less accurate it is

Front 20

Semantic Memory

Back 20

-Doesn't decline much
-A person's knowledge about the world
-It includes a person's fields of expertise, general academic knowledge of the sort learned in school, and "everyday knowledge"

Front 21

Explicit Memory

Back 21

-declarative - like facts

Front 22

Implicit memory

Back 22

Procedural - w/out conscious recollection (like driving a car or bike)
-less likely to be affected by age

Front 23

Prospective Memory

Back 23

Involves remembering to do something in the future, such as remembering to take your medicine or remembering to do an errand

Front 24

The Terminal Drop Hypothesis

Back 24

States that death is proceded by a decrease in cognitive functioning over approximately a 5-year period prior to death
-Biological markers

Front 25

Dementia

Back 25

Neurological Deficit
-global term for any neurological disorder involving deterioration on mental functioning
-normative process
-increase risk with age
-Individuals with dimentia often lose ability to care for themselves and may lose the ability to recognize familiar surroundings and people
-progressive, gradual loss
-effect overall function
-6 different classifications of dementia in the DSM

Front 26

Alzheimer's disease

Back 26

#1 form of dementia
-approximately 4 million people in the US have Alzheimer's disease... 14 million by 2050
-10% of people over 65
-20% of people by age 85
-Progressive, irreversible disorder
-Characterized by gradual spread of plaques and tangles that disrupt the organization on nerve cells in the brain
-APP Gene on Chromosome 21
-Lead to deterioration of memory, reasoning, language, and eventually, physical functioning
-ideopathic

Front 27

Parkinson's Disease

Back 27

Is a chronic, progressive disease characterized by muscle tremors, slowing of movement, and partial facial paralysis
-It is triggered by degeneration of dopamine-producing neurons in the brain in the basal ganglia area

Front 28

Socioemotional Development in Late Adulthood
Erikson's Integrity Vs. Despair

Back 28

-Erikson's eighth and final stage of development
-reflect on the past and either piecing together a positive review or concluding that life has not been well-spent

Front 29

Robert Peck

Back 29

Reworked Eikson's final stage
-Older adults must redefine their worth in terms of something other than work roles

*Body Transcendence vs. Body Preoccupation
-Older adults must cope with declining physical well-being
-for those whose identity has revolved around their physical well-being, the decrease in health and deterioration of physical capabilities may present a severe threat to the identity feelings of life salvation
-decline is more times handled well

Ego Transcendence vs. Ego Preoccupation
-Older adults realize that while death is inevitable and probably not too far off, they feel at ease with themselves by realizing that they have contributed to the future through the competent rearing of their children or through their vocation and ideas

Front 30

Generational Inequity

Back 30

As pop grows, resources need to be allocated. Will baby boomers take away resources?

Front 31

Death and Grieving

Back 31

Stages of Dying
1)Denial and Isolation
2)Anger
3)Bargaining
4)Depression
5)Acceptance

Front 32

1)Denial and Isolation

Back 32

Individuals refuse to believe their condition is terminal
-inaccurate diagnosis
-disease will go away
-dying individuals seek isolation

Front 33

2)Anger

Back 33

Denial gives way to anger, resentment, rage and envy
-why me?
-dying person may become difficult to care for... displaced anger

Front 34

3)Bargaining

Back 34

Person develops hope that death can somehow by postponed or delayed
-some people enter bargaining or negotiation - often with god - as they try to delay death
-might sorta work

Front 35

4)Depression

Back 35

Dying person comes to accept the certainty of death
-at this point, period of depression or PREPARATORY GRIEF may appear
-the dying person may become silent, refuse visitors, and spend much time crying or grieving, and contemplating impending death

Front 36

5)Acceptance

Back 36

-Person develops a sense of peace; and acceptance of one's fate; and in many cases, a desire to be left alone
-In this stage, feelings and physical pain may be virtually absent

Front 37

Shifting Mortality curves to the right

Back 37

Contrary to what people say, there are many ways to do this.
-HYBRID VIGOR
-heterogeneity causes them to live longer

Front 38

Disclosure

Back 38

-Dying WITH a disease rather than dying OF a disease
-2050 projection 35.7% of population 65 years of age and older compared to 21.0% in 2005

Front 39

The Quality Crisis (Wennberg)

Back 39

-Systematic underuse of EFFECTIVE care (strong evidence of efficacy)
-Misuse of PREFERENCE-SENSITIVE care (treatment choices exists with differing risks and benefits)
-Overuse of SUPPLY-SENSITIVE care (services provided in the absence of evidence relative to frequency)

Front 40

Sources of Practice Variation

Back 40

Unwarranted (based on questionable forces)
-research gaps
-Inadequate knowledge transfer to practitioners
-practice not evidence-based
-institutional barriers
-inadequate patient education
-Inattention to preferences

Front 41

Warranted Variation

Back 41

Understandable and appropriate - acceptance of risks

-concern about time tradeoffs
-treatment preference
-outcome preferences
-comfort in decision making participation

Front 42

Remedy for Preference-Sensitive Care Variation

Back 42

Correct defects in quality of patient/physician decision-making process

Front 43

Shared Decision-Making

Back 43

Use decision support systems to provide patients with BALANCED INFORMATION about treatment options in a manner that allows them to arrive at INFORMED, PREFERENCE-BASED choices

Front 44

Measures of Decision Quality

Back 44

-Traditional measures focus on technical processes of care
-In preference-sensitive care, focus should be on the quality of patient decision-making
-Are patients fully informed about treatment options?
-Is there concordance between patient's values and chosen treatments?

Front 45

Decision Quality: Breast Cancer

Back 45

Long-term survival for early stage breast cancer is no different for women who have either mastectomy or lumpectomy with radiation

Mastectomy
-lose breast
-possible reconstruction

Lumpectomy
-keep breast
-radiation
-possible anxiety

Front 46

Decision Quality: Cardiac Care

Back 46

At least 70% of those who have bypass surgery get no better survival overall than management with medication alone
-30+% of those who get bypass surgery suffer significant cognitive effects after surgery

In a randomized trial, when patients were well informed before a decision, almost 25% fewer had the surgery, compared to those with "usual care"

Front 47

What we know about informed patients

Back 47

When patients are informed, they CONSISTENTLY choose less treatment and testing
-Bypass surgery
-Hormone replacement therapy
-PSA testing
-Breast cancer treatment
-Prostate surgery

Front 48

Reasons to require shared decision-making

Back 48

-getting the care that's right for you
-peace of mind
-empowerment in decision process
-unbiased perspective
-strengthens the MD/PT relationship

All perceived as extremely/very important