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48 Cards in this Set
- Front
- Back
Life Expectancy and Life Span
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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 |
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Gap in Life Expectancy
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Based on race and SES
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Centrnarians
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77,000 in 2000
834,000 in 2050 Research says most centenarians are pretty healthy... that's how they got there! |
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Sex differences in longevity
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-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 |
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The Young Old, the Old Old and the Oldest Old
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-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 |
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Biological Theories of Age
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A lot of scientists are looking at functional rather than biological
-Cellular clock theory -Free-Radical Theory -Hormonal Stress Theory -Health Problems |
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Activities of Daily living (ADLs)
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Ability to do the shit you need to do
-Large chunk of older adults say they have these - 40%-50% |
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Cellular Clock Theory
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-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 |
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Free-Radical Theory
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-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 |
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Hormonal Stress Theory
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-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 |
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Health Problems
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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 |
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Health Problems - Loss of senses
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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 |
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Causes of Death in Older Adults
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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 |
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Estimated contributions of different factors of health status
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30% - other factors
20% - genes 40% - behavior 10% - medical care |
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Smoking
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Smoking has been associated with 20% of all deaths
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#7 cause of death in older adults
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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 |
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The growing vitamin and aging controversy
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-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
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Psychoneuroimmunology
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-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 |
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Episodic Memory
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-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 |
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Semantic Memory
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-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" |
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Explicit Memory
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-declarative - like facts
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Implicit memory
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Procedural - w/out conscious recollection (like driving a car or bike)
-less likely to be affected by age |
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Prospective Memory
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Involves remembering to do something in the future, such as remembering to take your medicine or remembering to do an errand
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The Terminal Drop Hypothesis
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States that death is proceded by a decrease in cognitive functioning over approximately a 5-year period prior to death
-Biological markers |
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Dementia
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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 |
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Alzheimer's disease
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#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 |
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Parkinson's Disease
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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 |
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Socioemotional Development in Late Adulthood
Erikson's Integrity Vs. Despair |
-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 |
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Robert Peck
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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 |
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Generational Inequity
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As pop grows, resources need to be allocated. Will baby boomers take away resources?
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Death and Grieving
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Stages of Dying
1)Denial and Isolation 2)Anger 3)Bargaining 4)Depression 5)Acceptance |
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1)Denial and Isolation
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Individuals refuse to believe their condition is terminal
-inaccurate diagnosis -disease will go away -dying individuals seek isolation |
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2)Anger
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Denial gives way to anger, resentment, rage and envy
-why me? -dying person may become difficult to care for... displaced anger |
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3)Bargaining
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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 |
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4)Depression
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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 |
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5)Acceptance
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-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 |
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Shifting Mortality curves to the right
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Contrary to what people say, there are many ways to do this.
-HYBRID VIGOR -heterogeneity causes them to live longer |
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Disclosure
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-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 |
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The Quality Crisis (Wennberg)
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-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) |
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Sources of Practice Variation
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Unwarranted (based on questionable forces)
-research gaps -Inadequate knowledge transfer to practitioners -practice not evidence-based -institutional barriers -inadequate patient education -Inattention to preferences |
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Warranted Variation
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Understandable and appropriate - acceptance of risks
-concern about time tradeoffs -treatment preference -outcome preferences -comfort in decision making participation |
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Remedy for Preference-Sensitive Care Variation
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Correct defects in quality of patient/physician decision-making process
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Shared Decision-Making
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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
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Measures of Decision Quality
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-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? |
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Decision Quality: Breast Cancer
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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 |
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Decision Quality: Cardiac Care
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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" |
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What we know about informed patients
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When patients are informed, they CONSISTENTLY choose less treatment and testing
-Bypass surgery -Hormone replacement therapy -PSA testing -Breast cancer treatment -Prostate surgery |
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Reasons to require shared decision-making
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-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 |