Psychology of aging' Lecture 3: Physical and mental health'

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Psychology of aging.Lecture 3 Physical and
mental health.

• Prof Louise Phillips

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Lifespan v healthspan

• Lifespan substantially increased
• Attention now focussed on healthspan
• length of healthy life before disabling
  physical illness.
• Also - maximising quality of life
• functional limitations
• activities of daily living

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Most common chronic conditions in old age.

• Arthritis
• Osteoarthritis Stiff joints due to weakened
  cartilage
• Rheumatoid arthritis Immune system attacks
  joints so they become inflamed
• Diabetes
• Type I and Type II
• Cancer
• In men lung, prostrate, colon
• In women lung, breast, colon

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Vascular respiratory changes with age

• Cardiovascular changes
• Blood vessel walls thicken
• Circulation of blood impaired
• Myocardial infarctions
• Cerebrovascular accidents
• Poorer respiratory function with age
• Particularly in smokers
• Respiratory capacity decreases 40 from age 20 to
  age 85
• Restricts oxygen to the brain

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Health and cognition in old age

• Ferucci et al (1993)
• 385 77-78 year old adults in Florence
• Correlation between number of chronic conditions
  and intelligence test score -.58.

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Physical exercise

• Exercise improves
• Health and physical fitness
• Mood, sleep and susceptibility to stress
• Cognitive functions such as attention and memory
• Physical benefits as strong in those aged 80
• Colcombe Kramer (2003)
• Exercise improves cognitive function

Exercise now to cut dementia riskBBC News
website. 4/10/05
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Functional health

• Activities of daily living
• Disability
• Health behaviours

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Activities of daily living

• Increased focus on functional impairment
• Basic activities of daily living (ADLs)
• Essential to independent living
• e.g. get out of bed, bathe
• 15-20 of those aged 85 problems ADLs
• Instrumental activities of daily living (IADLs)
• e.g. washing clothes, shopping

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Disability in later life

• Pathology
• Medical conditions
• Impairments
• Structural dysfunctions
• Functional limitations
• Action restrictions
• Disability
• Problems in activities of daily life

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Seeking medical help

• Older people tend to be health optimists
• self-ratings of health good predictor of
  longevity.
• Those aged 75 visit doctor twice as often as
  those aged 45-64.
• Doctors spend less time with older patients.
• Managing disability, not treating disease
• Problems with ADLs common cause visits.

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Adult aging and mental health

• Depression and dementia

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Epidemiology of mental health problems

• People aged 18-24 twice rate of mental health
  problems of those aged 65.
• Community studies may underestimate prevalence in
  older adults.
• For older adults, specific diagnosis issues
• Potential confusion depression/dementia
• Changes in sleep and eating patterns
• Complex interaction with physical health

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UK hospital mental health admissions people
particular diagnoses
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Scottish figures on prevalence of depression.
NHS Scotland Improving Mental Health Services,
Feb 2005.
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Depression incidence in older adults

• Old lower levels depression than young?
• controversy about incidence
• underreported and underdiagnosed?
• Symptoms in old age cognitive/physical.
• Risk factors for depression in old age
• physical illness
• caregiver
• reduction in social contact

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Dementia

• Belsky the complete unravelling of the self
• severe and progressive cognitive decline
• Typical symptoms
• severe memory problems
• loss of language
• poor judgement
• inappropriate social behaviour
• disorientation

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Matthews et al. (2005). The Incidence of Dementia
in England and Wales
85 8
80-84 2
70-79 1
65-69 0.5
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Types of dementia

• Affects around 2-5 of those aged 65
• Vascular Dementia
• Blockage of brain blood vessels
• Repeated strokes
• Symptoms sudden
• Alzheimers Disease
• Neuritic plaques and tangles
• Gradual onset of cognitive problems
• No definite diagnosis till death

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Interventions

• Medication
• Aspirin and warfarin slow development of vascular
  dementia
• Cholinesterase inhibitors improve memory function
  in Alzheimers Disease.
• Environmental support
• e.g. simplify daily tasks, reminder notices
• May help memory problems in early stages
• Assistance for caregivers

Alzheimer's drugs appeal refusedBBC News
Website 11 October 2006
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Conclusions

• Arthritis, vascular and respiratory diseases
  common in old age.
• Can impact on cognitive function.
• Increased focus on functional limitations and
  managing disability.
• Physical exercise can improve health, mood and
  cognition.
• Mental health disorders in old age
• dementia and depression most common

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Questions to think about...

• Describe some of the most common health problems
  in old age.
• Outline some of the effects of physical exercise
  on older adults.
• What are activities of daily living?
• How does the incidence of mental health problems
  change with age?
• What are the main types of dementia and what
  interventions exist to treat them?