Two demographic trends will create the potential for significant worldwide change over the next few decades. First, increasing longevity in developed countries will result in more older adults. Second, the size of various generations will either exacerbate or lessen this problem. That is, the large baby-boom generation, combined with increased longevity, will make the issue of more older adults acute; the lower birth rate of the subsequent generation will lessen the pressures. Consequently, for the next few decades there will be increased emphasis on social policies that directly benefit older adults, and they are likely to demand such policies. While they have the numbers, and the concomitant political power, such policies are likely to be adopted, per­haps to the detriment of younger generations. The shift became apparent during the U. S. presidential election in 2000, in which issues pertaining directly to older adults, such as the Social Security program, were debated for the first time. Similar discussions occurred during the 2004 election.

However, as the baby boomers age and die, two things will occur. First, there will be a tremendous transfer of wealth to a smaller generation, with the likely outcome of concentrating the wealth in fewer hands. Second, policies generally favorable to older adults may get changed as the next large generation (the baby boomers’ grandchildren) enters middle age. These shifts in policy could have major implica­tions for everything from housing (e. g., more state and federal support for subsidized housing for older adults) to health care (e. g., substantially more expen­ditures for older adults’ health care). If the policies change to reflect the demographic needs of the day, then such policies could need to be undone in the future, which is often politically difficult to accom­plish. Close attention to all these issues is necessary for the best policies to be enacted.

Summary

4.1 How Long Will We Live?

What is the average and maximum longevity

for humans?

• Average longevity is the age at which half of the people born in a particular year will have died. Maximum longevity is the longest time a member of a species lives. Active longevity is the time during which people are independent. Dependent life expectancy is the time during which people rely on others for daily life tasks.

• Average longevity increased dramatically in the first half of the 20th century, but maximum longevity remains at about 120 years. This increase resulted mainly from the elimination of many diseases and a reduction in deaths during childbirth.

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What genetic and environmental factors influence longevity?

• Having long – or short-lived parents is a good predictor of your own longevity.

• Living in a polluted environment can dramatically shorten longevity; being in a committed relationship lengthens it. Environmental effects must be considered in combination.

What ethnic factors influence average longevity?

• Different ethnic groups in the United States have different average longevity. However, these differences result primarily from differences in nutrition, health care, stress, and financial status. In late life, people in some ethnic minority groups live longer than European Americans.

What factors create gender differences

in average longevity?

• Women tend to live longer than men, partly because men are more susceptible to disease and environmental influences. Numerous hypotheses have been offered for this difference, but none have been supported strongly.

4.2 Health and Illness

What are the key issues in defining health

and illness?

• Health is the absence of acute and chronic physical or mental disease and impairments. Illness is the presence of a physical or mental disease or impairment.

• Self-rated health is a good predictor of illness and mortality. However, gender and cultural differences have been found.

How is the quality of life assessed?

• Quality of life is a multidimensional concept encompassing biological, psychological, and sociocultural domains at any point in the life cycle.

• In the context of health, people’s valuation of life is a major factor in quality of life.

What normative age-related changes occur

in the immune system?

• The immune system is composed of three major types of cells that form a network of interacting parts: cell-mediated immunity (consisting of thymus-derived, or T-lymphocytes), humoral immunity (B-lymphocytes), and nonspecific immunity (monocytes and polymorphonuclear neutrophil leukocytes). Natural killer (NK) cells are also important components.

• The total number of lymphocytes and NK cells does not change with age, but how well they function does.

• The immune system can begin attacking itself, a condition called autoimmunity.

• Psychoneuroimmunology is the study of the relations between psychological, neurological, and immunological systems that raise or lower our susceptibility to and ability to recover from disease.

• HIV and AIDS are growing problems among older adults.

What are the developmental trends in chronic and acute diseases?

• Acute diseases are conditions that develop over a short period of time and cause a rapid change in health. Chronic diseases are conditions that last a longer period of time (at least 3 months) and may be accompanied by residual functional impairment that necessitates long-term management.

• The incidence of acute disease drops with age, but the effects of acute disease worsen. The incidence of chronic disease increases with age.

What are the key issues in stress across adulthood?

• The stress and coping paradigm views stress not as an environmental stimulus or as a response but as the interaction of a thinking person and an event.

• Primary appraisal categorizes events into three groups based on the significance they have for our well-being: irrelevant, benign or positive, and stressful. Secondary appraisal assesses our ability to cope with harm, threat, or challenge. Reappraisal involves making a new primary or secondary appraisal resulting from changes in the situation.

• Attempts to deal with stressful events are called coping. Problem-focused coping and emotion – focused coping are two major categories. People also use religion as a source of coping.

• There are developmental declines in the number of stressors and in the kinds of coping strategies people use.

• Stress has several negative consequences for health.

4.3 Common Chronic Conditions and Their Management

What are the most important issues in chronic disease?

• Chronic conditions are the interaction of biological, psychological, sociocultural, and life-cycle forces.

What are some common chronic conditions across adulthood?

• Arthritis is the most common chronic condition. Arthritis and osteoporosis can cause mild to severe impairment.

• Cardiovascular and cerebrovascular diseases can create chronic conditions after stroke.

• Diabetes mellitus occurs when the pancreas produces insufficient insulin. Although it cannot be cured, it can be managed effectively. However, some serious problems, such as diabetic retinopathy, can result.

• Many forms of cancer are caused by lifestyle choices, but genetics also plays an important role. The risk of getting cancer increases markedly with age. Prostate and breast cancer involve difficult treatment choices.

• For many people, the inability to control the elimination of urine and feces on an occasional or consistent basis, called incontinence, is a source of great concern and embarrassment. Effective treatments are available.

How can people manage chronic conditions?

• Effective pain management occurs through pharmacological and nonpharmacological approaches. Pain is not a normal outcome of aging and is not to be dismissed.

4.4 Pharmacology and Medication Adherence

What are the developmental trends in using medication?

• Older adults use nearly half of all prescription and over-the-counter drugs. The average older adult takes six or seven medications per day.

How does aging affect the way that medications work?

• The speed with which medications move from the stomach to the small intestine may slow with age. However, once drugs are in the small intestine, absorption rates are the same across adulthood.

• The distribution of medications in the bloodstream changes with age.

• The speed of drug metabolism in the liver slows with age.

• The rate at which drugs are excreted from the body slows with age.

What are the consequences of medication interactions?

• Older adults are more prone to harmful medication side effects.

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• Polypharmacy is a serious problem in older adults and may result in serious drug interactions.

What are the important medication adherence

issues?

• Polypharmacy leads to lower rates of correct adherence to medication regimens.

4.5 Functional Health and Disability

What factors are important to include in a

model of disability in late life?

• Disability is the effects of chronic conditions on people’s ability to engage in activities in daily life.

• A model of disability includes pathology, impairments, functional limitations, risk factors, extraindividual factors, and intraindividual factors. This model includes all four main developmental forces.

What is functional health?

• Frail older adults are those who have physical disabilities, are very ill, and may have cognitive or psychological disorders and who need assistance with everyday tasks.

• Activities of daily living (ADLs) include basic self-care tasks such as eating, bathing, toileting, walking, and dressing.

• Instrumental activities of daily living (IADLs) are actions that entail some intellectual competence and planning.

• Rates of problems with ADLs and IADLs increase dramatically with age.

What causes functional limitations and

disability in older adults?

• The chronic conditions that best predict future disability are arthritis and cerebrovascular disease. Other predictors include smoking, heavy drinking, physical inactivity, depression, social isolation, and fair or poor perceived health.

• Being wealthy helps increase average longevity but does not protect one from developing chronic conditions, meaning that such people may experience longer periods of disability late in life.

• Women’s health generally is poorer across cultures, especially in developing countries.

• Ethnic group differences are also important. The validity of measures of functioning sometimes differs across ethnicity and gender.

Review Questions

4.1 How Long Will We Live?

• What is the difference between average longevity and maximum longevity?

• What genetic and environmental factors influence average longevity?

• What ethnic and gender differences have been found?

4.2 Health and Illness

• How are the definitions of health and illness linked?

• How is the quality of life defined generally and in relation to health?

• What are the major age-related changes in the immune system? How do they affect health and illness?

• What is the difference between acute and chronic diseases? How do the rates of each change with age?

• How does the stress and coping paradigm explain the experience of stress? What age-related changes occur in the process?

4.3 Common Chronic Conditions and Their Management

• What are the general issues to consider in managing chronic disease?

• What are some common chronic diseases experienced by older adults?

• How is pain managed?

4.4 Pharmacology and Medication Adherence

• What is the typical pattern of medication use in older adults?

• What changes occur with age that influence how well medications work?

• What are the major risks for side effects and drug interactions?

• How can adherence to medication regimens be improved?

4.5 Functional Health and Disability

• What are the key components in a model of disability in older adults?

• What are ADLs and IADLs? How does the number of people needing assistance change with age?

• What conditions result in disability most often?

• How do socioeconomic status, ethnicity, and gender affect health and disability?

Integrating Concepts in Development

• What physiological changes described in Chapter 2 are important in understanding health?

• Based on information in Chapters 2 and 3, how might a primary prevention program be designed to prevent cardiovascular disease? (Compare your answer with the intervention types described in Chapter 5.)

• How do the ethnic differences in average longevity and in health relate to the diversity issues we examined in Chapter 1?

Key Terms

active life expectancy The age to which one can expect to live independently.

activities of daily living (ADLs) Basic self-care tasks such as eating, bathing, toileting, walking, and dressing.

acute diseases Conditions that develop over a short period of time and cause a rapid change in health. autoimmunity The process by which the immune system begins attacking the body. average longevity The length of time it takes for half of all people born in a certain year to die. chronic diseases Conditions that last a longer period of time (at least 3 months) and may be accompanied by residual functional impairment that necessitates long-term management.

compression of morbidity The situation in which the average age when one becomes disabled for the first time is postponed, causing the time between the

onset of disability and death to be compressed into a shorter period of time.

coping In the stress and coping paradigm, any attempt to deal with stress.

dependent life expectancy The age to which one can expect to live with assistance. diabetes mellitus A disease that occurs when the pancreas produces insufficient insulin.

disability The effects of chronic conditions on people’s ability to engage in activities that are necessary, expected, and personally desired in their society.

frail older adults Older adults who have physical disabilities, are very ill, and may have cognitive or psychological disorders and need assistance with everyday tasks.

health The absence of acute and chronic physical or mental disease and impairments.

illness The presence of a physical or mental disease or impairment.

incontinence The loss of the ability to control the elimination of urine and feces on an occasional or consistent basis.

instrumental activities of daily living (lADLs) Actions that entail some intellectual competence and planning.

maximum longevity The maximum length of time an organism can live, roughly 120 years for humans.

polypharmacy The use of multiple medications. primary appraisal First step in the stress and coping paradigm in which events are categorized into three groups based on the significance they have for our well-being: irrelevant, benign or positive, and stressful.

psychoneuroimmunology The study of the relations between psychological, neurological, and immunological systems that raise or lower our susceptibility to and ability to recover from disease. reappraisal In the stress and coping paradigm, this step involves making a new primary or secondary appraisal resulting from changes in the situation. secondary appraisal In the stress and coping paradigm, an assessment of our perceived ability to cope with harm, threat, or challenge. stress and coping paradigm A model that views stress not as an environmental stimulus or as a response but as the interaction of a thinking person and an event.

Resources

www. cengage. com/psychology/cavanaugh

Visit the companion website, where you will find tutorial quizzes, glossary, flashcards, and more. You can also access the following websites from the companion website.

The American Cancer Society maintains an excellent site that has a range of information for laypeople and professionals. Especially useful are their reports and treatment and prevention guidelines.

The National Center for Chronic Disease Prevention and Health Promotion has a very informative website concerning all aspects of chronic disease. This center is part of the Centers for Disease Control and Prevention. RxList provides an online index to medications that includes information about how the drugs are used, usual dosage, side effects, and other useful data. Also included in the website is a discussion list for commonly prescribed medications. Although this site is not a replacement for physicians or pharmacists, it can be used to gather information about medications.

Readings

Numerous well-written pamphlets on topics related to cancer prevention, assessment, and treatment can be obtained from your local chapter of the American Cancer Society. These pamphlets are easy to read yet provide up-to-date information on technical topics. Hazzard, W. R., Ouslander, J. G., & Halter, J. B. (2009). Hazzards geriatric medicine and gerontology. New York: McGraw-Hill. Moderately difficult overview of geriatric medicine.

Institute of Medicine. (2008). Retooling for an aging America: Building the health care workforce. Washington, D. C.: National Academies Press. Easy to moderately difficult overview of the career opportunities and need to respond to an aging population.

Levine, R. (2008). Aging with attitude: Growing older with dignity and vitality. Westport, CT: Greenwood Publishing Group. Easy-to-read summary of research on aging and the steps you can take to stay healthy.

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