This module is designed to look at the concepts of health and wellness as they relate to aging. Here are some questions this unit will attempt to answer: What is aging? Why do we age? How do we age? What is health for elders? What is the relationship between health, disease, and aging? How do we view health care for elders? Select from the following set of readings for this module.
SECTION 1: DEFINING HEALTH, WELLNESS, and AGE The term health in American culture is usually viewed from a perspective meaning absence of illness. This limited view paints people as a physical body with the primary focus on function. Any interruption in function due to illness or disease makes the person unhealthy. Since there are specific changes to the human body as it ages which affect function, this viewpoint of health would label all older persons unhealthy. Wellness is a concept used to broaden the scope of determining the health of people. It considers other factors that relate to how well a person adjusts to having an illness or disability, a the impact of an illness or disability on a person's quality of life. The changes related to aging can in general be looked at as a downhill course when related to speed, strength and endurance. Fortunately, humans can adapt to change. Wellness for elders can be viewed as a balance between one's environment and culture, and one's emotional, spiritual, social and physical processes (Ebersole & Hess, 1994). Each individual has the ability to attain an optimum level of wellness even in the face of chronic illness and dying. Productivity and usefulness are specific concerns that arise for elders when there is a loss of independence from illness. Everyone needs to feel a sense of self-worth and strives to find meaning in their life. An ethnographic research study was conducted looking at older adults perceptions of wellness. The results showed that elders view themselves as healthy only if they can perform activities they view as worthwhile and if they are free from pain (Campbell & Kreidler, 1994). This group of elders considered the physicians to be in control of their health evaluation and health care. Elders in this study would engage in health-promoting behaviors despite a negative perception of their health and feelings of powerlessness over their health situation. Elders can maintain a sense of being productive and useful. They can achieve wellness in the face of illness or disability when independence is maintained. Of course, each person's sense of independence is a subjective perception. Some people believe they have lost their independence by having to depend upon a wheelchair. Others welcome a wheelchair and perceive it as a vehicle to independence. This difference in perception demonstrates the intricate nature of health, wellness and aging. SECTION 2: NORMAL AGING vs. DISEASEKnowing the difference between normal aging processes and the effects of disease is complicated by a multitude of factors. It is known and accepted that age-related changes of the body are normal for all people, but take place at different rates and depend on genetic, lifestyle, and environmental circumstances that can alter the rate. It is also known that symptoms of disease closely resemble age changes. The only identifiable difference between the two is the cause. To make matters more complicated, certain symptoms can be caused by many different diseases. Researchers traditionally have studied age changes along with disease conditions. This has resulted in the misconception that normal physical changes related to age are attributable to disease and illness. Another reason for the promotion of this stereotypical idea is that most studies have compared different age groups rather than monitoring the same persons over time. Progress is being made with studies such as the Baltimore Longitudinal Study. It is designed to follow a group of men as they age to identify normal age changes not associated with disease. Another factor now being recognized is the previous practice of conducting research with men. One example of the lack of attention to women is in the area of heart disease. While heart disease is the number one cause of death in both older men and women, research studies addressing risk and treatment have focused on men. Symptoms of heart disease are usually identified earlier in men than in women, and more men undergo treatment procedures than women. Sometimes, symptoms of heart disease in women are attributed to anxiety. Obviously, gender differences with respect to aging and disease need to be more fully addressed. SECTION 3: DEMOGRAPHICS OF HEALTH ISSUESIn the United States the leading causes of death in the elder population are heart disease, cancer, and stroke (cerebrovascular disease). Accidents are the fourth leading cause of death and the outcome of falls alone account for over 6 billion health care dollars (see Table 6.1, p.126, in F & F text). Older people represent approximately 12% of the population, but are the largest users of health care services. They account for more than one third of all health care expenditures. Public health ordinances, health promotion activities and advance medical technology have raised the age at which an older adult can expect a life-threatening disease. Therefore, higher numbers of elders are living more years with chronic conditions. Approximately 80% of the elder population are living with at least one chronic illness, but only 25% are affected by chronic illness to the point of needing some kind of assistance because of disability. The most common chronic illnesses are arthritis, high blood pressure, hearing disorders, heart disease, cataracts, chronic sinusitis, orthopedic conditions, diabetes, and visual impairments. CentenariansAbout 1 in 10,000 persons living in the United States lives to the age of 100. Many researchers are now looking at this group of centenarians to determine the factors that promote longevity. The Alameda Health Study examined behavioral, social, and demographic influences on disease and mortality over a seventeen year period among 7,000 residents in Alameda, California (Kaplan et al, 1987). Risk for death was decreased by four health-related factors: not smoking, regular physical activity, relative weight for height, eating breakfast regularly. The researchers also found that behavior in later life was related to health status, regardless of earlier behaviors or genetic behaviors. Another study evaluating autopsy records of a group of centenarians found that the leading causes of death were infection, followed by cancer and cardiovascular disease (Klatt & Meyer, 1987). Disorders such as diabetes, obesity, and hypertension were absent from the records. It is unknown whether this study looked into lifestyle and health-related behaviors of these centenarians. One question that could be addressed is if the lack of diabetes, obesity and hypertension was related to health behaviors found in other studies consistent with longevity. Among 30 Kentucky centenarians, over half had hypertension and one third were under treatment for some form of heart disease (Kinzel, Wekstein, & Kirkpatrick, 1986). However, more than half were moderately active and frequently left their homes. The two factors that stood out in this group were an absence of the use of tobacco and alcohol. The authors suggested that hypertension was consistent with longevity because of the absence of other risk factors. SECTION 4: BIOLOGIC THEORIES OF AGINGScientists continually pursue the piece of the puzzle that will provide a clear picture of the physical process of aging. To date many theories have been suggested; many overlap but none are able to outline the definitive answer to unlock the secrets of the aging process. The basic assumption of theories attempting to explain the phenomena of physical aging originates at the cellular level, specifically cell function and reproduction. Theories attempt to describe cell characteristics that result in mechanical failure, damage, depletion of reserves, changes in structure, and accumulation of metabolites. These results account for the changes that alter the human body in the way we view aging. Texts on aging provide many different formats for presenting biologic theories of aging; no two are exactly alike. The following is a summarization of the most popular theories proposed. They are presented in a format different from your textbooks. The theories are organized under three general headings: molecular, system and cellular. Remember that theories provide clues to aging, rather than absolutes written in stone. Knowledge of them can help you better understand the changes people experience as they age. These changes will be described in the next three units of this course. Molecular Theories of Aging This group of theories suggest that the process of aging is determined by genetic material, encoded to predetermine growth, development and decline. Gene Theory This theory suggests that one or more harmful genes become active later in life. This gene turns on the aging process and controls the life span of humans. Error Theory This theory purposes that cellular function becomes impaired due to errors in RNA protein synthesis (production). Over time defective cells are produced which interfere with biologic function. Somatic Mutation Theory Similar to error theory, this one suggests that errors are due to DNA exposure to radiation or chemicals resulting in chromosomal abnormalities. Damaged cells then replicate with the harmful effects of impaired function appearing in later life. Programmed Theory This theory, known also as the "biologic clock", originated from the premise that the aging process has specific built in features for development, maturation, and cessation of activity. This occurs due to a specified number of cell divisions during a human lifetime. The process that defines the actual number is yet unknown but suggested to be written in genetic material. Atrophy of the thymus, menopause, and greying of hair are some of the features considered to be a natural process of programmed aging. Run-Out-Of-Program Theory Similar to programmed theory, this one suggests that the human body is given a specific amount of genetic material. When the available material runs out, the process of aging occurs through cell, tissue and organ failure. System Level Theories of Aging These theories suggest a systemwide response to a genetic time clock controlling the length of a human lifespan. Neuroendocrine Control Theory Hormonal signals from the nervous system regulate communication between organs and tissues; these signals serve as a pacemaker to control the aging process and life span. Decreased activity and impaired function of various body systems are viewed as the manifestations of the aging process due to neurohormonal control. Immunologic Theory The immune system is designed to protect the body from infection by monitoring for foreign substances and mounting an attack to destroy and remove them from the body. This theory suggests that with aging comes autoaggression, a progressive impairment of surveillance ability.With impairment, there are increased problems with misidentification of and attack upon normal cells of the body. Whether the cause is error or programmed is not known. Research suggests that impaired immune efficiency may be related to diseases such as cancer and arthritis. Cellular Theories of Aging These theories suggest that the aging process is a result of damage that occurs to cells, thus altering or destroying proper function. Free Radical Theory Free radicals are molecules derived from external and internal environmental sources. External sources include smog and petrol products. Internal sources are certain chemical reactions within the body related to oxidation. Accumulation of the resulting electrically charged molecules causes an irreversible reaction that damages or alters the structure and function of the cell membranes of protein, enzymes and DNA. Current research has linked Vitamins A, C, and E, and the mineral Selenium to the reduction of free radical activity (antioxidants). Cross-Link or Connective Tissue Theory As the body ages, cell molecules from DNA and connective tissue react with free radicals causing bonds (cross-linking) to form between the cells. The reaction of cross-linked cells is the loss of the ability to replicate itself for repair and decreased elasticity. One of the best examples is skin; once smooth and silky, the aging skin becomes dry, saggy, and less elastic. Clinker Theory This theory represents a combination of the somatic, cross-link, and free radical theories. Chemical by-products of metabolism deleterious to cells accumulate and interfere with normal cell function by displacement. Specific cells effected include the heart, skeletal muscle, brain, and nervous tissue. Wear-and-Tear Theory This theory incorporates the damage from internal and external stressors. It suggests that repeated injury or overuse produce mechanical and chemical injury thus wearing out cells. SECTION 5: HEALTH ATTITUDES & VALUES/RURAL & URBANApproximately one-fourth of the older adult population resides in rural areas of the United States. During the 1980's there was a reversal in the trend of moving from rural to urban areas. This trend increased the number of elders living in rural areas. Attributed to rural elders are attitudes of independence and self-reliance. These attitudes when added to the increased distance rural elders have to travel for health care may be the reason for increased incidence of chronic illness and disability over those elders residing in urban areas (Lee, 1993). Thorson and Powell (1992) suggest that these attitudes keep rural elders from seeking health care until it is needed. Controversy exists regarding the health perceptions and health care practices of rural elderly. While health maintenance and health promotion strategies may help improve the health status of rural elders, they need to be designed and implemented with the above attitudes in mind to insure successful outcome. SECTION 6: AGEISM IN HEALTH CAREAgeism accompanies old age in various situations because of the misperceptions of incapable and nonproductive frailty. Health care providers possessing these misperceptions allow them to guide their practice. A study of ageism in health care conducted by the National Institute on Aging (USDHHS, 1990) had these findings:
A now famous joke depicts George at 102 years of age visiting his physician with complaints of right leg pain. The doctor told George "What do you expect at your age?" George replied "Yeah Doc, but how come there is no pain in my left leg?" Unfortunately, older adults are a product of their environment. They were once part of the process of building and perpetuating the myths that has led to old age discrimination in all areas of life as well as health care. As a true picture of old age becomes apparent through more research findings, there will be a need for people of all ages to be educated in order to break age old stereotypes. Downs, H. Must We Age?; Parade Magazine August21, 1994 pg 4, 5. Hotz, R.L. Races blur in biology; Missoulian Feb. 20, 1995; pg A-10 Campbell, J. & Kreidler, M. (1994). Older Adults' Perceptions About Wellness. Journal of Holistic Nursing, 12(4), 437-447. Coward, R.: Aging in the Rural United States. From: Rathbone- McCuan, E. & Havens, B. (Eds.), North American Elders: United States and Canadian Perspectives. Westport, Ct: Greenwood Press, 1988. Kaplan, G.A. et al. (1987). Mortality Among the Elderly in the Alameda County Study: Behavioral and Demographic Risk Factors. Am J Public Health, 77:307. Kinzel, T., Wekstein, D., Kirkpatrick, C. (1986). A Social and Clinical Evaluation of Centenarians. Exp Aging Res, 12:173. Klatt, E. & Meyer, P. (1987). Geriatric Autopsy Pathology in Centenarians. Arch Pathol Lab Med, 111:367. Lee, H. (1993). Rural Elderly Individuals: Strategies for Delivery of Nursing Care. Nursing Clinics of North America, 28(1), 219-230. Thorson, J. & Powell, F. (1991). Rural and Urban Elderly Construe Health Differently. The Journal of Psychology, 126(3), 251- 260. U.S. Department of Health and Human Services: National Institute on Aging: Special Report on Aging 1990, National Institutes of Health, Public Health Service, Bethesda, 1990, Government Printing Office. |