1. Adolescent/Adult Development Late Adulthood: Biosocial Development – Ch. 23
Apr 21-26, 2010
Class # 37-39

2. Ageism
Ageism—a term that refers to prejudice against older people because of their age
Why is ageism so strong?
cultural emphasis on growth, strength, and progress
veneration of youth
increasing age segregation

3. Gerontology Gerontology—study of old age
Geriatrics—The medical specialty devoted to old age
Two Different Perspectives
doctors in geriatrics view aging as an illness
gerontologists view aging as socially constructed problem

4. Demography Changing shape of demographic pyramid
the population stack has shifted from a pyramid to a square
reflects changes in recent decades—fewer births and increased survival
By 2030 the proportion of those over 65 is projected to double worldwide—to 15 percent

5. Reasons Not to Worry
Technology and science combining to allow more production with fewer workers
Inverse ratio between birth rates and longevity
Most people over 65 are not dependent
only 5 percent in nursing homes or hospitals
elderly married couples take care of each other
in other nations, elderly live with their children

6. Young, Old, and Oldest
Distinctions based on age, health, and social well-being
young-old—healthy and vigorous, financially secure, active in family and community life
old-old—have major physical, mental or social loses, but still have some strengths
oldest-old—dependent on others for almost everything

7. Young, Old, and Oldest
Some gerontologists like the following terms better
optimal aging
usual aging
impaired aging

8. Primary Aging in Late Adulthood
Primary aging—all irreversible and universal physical changes over time
Secondary aging—physical illnesses or changes common to aging but caused by individual’s health habits, genes, and other influences

9. Primary Aging in Late Adulthood
People vary in their selective optimization with compensation—the choosing of healthy activities that compensate for primary aging being experienced

10. Changes in Appearance Appearance changes as time passes
in ageist society, people who look old are treated as old
children quick to see the elderly as old-fashioned

11. The Skin and Hair Wrinkles, hair changes hair becomes grayer
hair all over body becomes thinner

12. Body Shape and Muscles
Alteration in overall body height, shape, and weight
With weight loss may come muscle loss
reduces flexibility
Self-perception can lead to a feeling of fragility and a fear of falling

13. Body Shape and Muscles Falls do occur
injuries may require medical treatment
exercise a very effective preventative
weightlifting should be part of the exercise routine
Flexibility is one of the best predictors of vitality

14. Dulling of the Senses Sense Organs
Until a century ago, sensory losses could be devastating
Today, they do not have to be debilitating

15. Vision Only about 10 percent of elderly see well
Cataracts—shrinking of lens, causing vision to be cloudy, opaque, and distorted
by 70, 30 percent have some visual loss due to cataracts

16. Vision Glaucoma—optic nerve damage, causing sudden and total blindness
1 percent of people in 70s; 10 percent in 90s
Senile macular degeneration—retinal deterioration
4 percent under 75; and 18 percent over 75

17. Hearing Presbycusis—age-related hearing loss
40 percent over 65 experience it
Tinnitis—buzzing or ringing
10 percent of elderly experience it

18. Elderspeak A way of speaking to elderly that resembles baby talk
simple, short sentences
exaggerated emphasis
slower rate, higher pitch, and repetition

19. Theories of Aging Many Theories of Aging we will look at two:
Wear and Tear
Genetic Aging Theory

20. Wear and Tear Theory Compares body to machine
Body wears down because of accumulated exposure to inadequate nutrition, disease, pollution, and other stresses
women who are never pregnant live longer
overweight people tend to sicken and die younger
today there are replacement “parts”
Wear out our bodies by living our lives

21. Genetic Aging Theory What makes entire body age?
focus on whole body rather than individual parts
Some theorists propose that aging is the normal, natural result of the genetic plan for the species

22. Life Expectancy
Genetic programming to reach biological maturation at fixed times and genetically programmed to die after a fixed number of years
maximum life span (humans 115)
average life expectancy
affected by culture, historical and socioeconomic factors

23. Selective Adaptation
Epigenetic theory provides some explanations for primary aging
Early adulthood: only nongenetic events are likely to cause death
Genetic diseases that affect older people may be passed on from generation to generation

24. Cellular Aging Cellular Accidents
accumulation of minor accidents that occur during cell reproduction cause aging
mutations occur in process of DNA repair
instructions for creating new cells become imperfect
cellular imperfections and declining ability to detect and correct them can lead to harmless changes, small functional loss, or fatal damage

25. Free Radicals
Some of body’s metabolic processes can cause electrons to separate from their atoms and can result in atoms with unpaired electron—oxygen free radicals
can produce errors in cell maintenance and repair, leading to cancer, diabetes, etc.
Antioxidants—compounds that nullify the effects of oxygen free radicals by forming a bond with their unattached oxygen electron
vitamins A, C, and E, mineral selenium

26. Errors in Duplication
Hormonal changes triggered in brain that switch off the genes promoting growth
The Hayflick Limit
genetic clock—according to one theory of aging, a regulatory mechanism in the DNA of cells that regulates the aging process
cells stop replicating at a certain point
Evidence for genetic regulation from diseases producing premature aging

27. The Immune System Diminished immune system is weakened
Two types of attack cells reduced in numbers
B cells in bone marrow, which create antibodies that attack invading bacteria and viruses
T cells, which produce substances that attack infection

28. Research on Immune Deficiency
Scientific support for the immune system theory comes from research on HIV/AIDS
HIV can be latent for many years, but eventually becomes AIDS
Individuals with weakened immune systems do not live as long as those with stronger immune systems; thus, immunity not simply result of aging

29. AIDS Acquired immune deficiency syndrome New and infectious
Worldwide, the majority of HIV+ are heterosexual non-drug users.
HIV – human immunodeficiency virus (attacks the immune system, notably the helper T cells and macrophages).
HIV+ can be asymptomatic for years.
In North America the highest rates are still amongst homosexuals and intravenous drug users.

30. First AIDS Patients
1980:
55 young men diagnosed with cluster of similar symptoms of unknown origin
Gaetan Dugas (“Patient Zero”)
Bragged about having sexual partners
250 per year

31. First AIDS Patients Symptoms looked like Kaposi’s sarcoma
Rare cancer found only among elderly
1984: New virus isolated
All white gay males
Shortly afterwards other ethnic groups
1991: 100,000th victim
1993: 200,000th victim
1994: 400,000th victim
Increased incidence of women and no effective drug treatments
2006: 25 million deaths (65 million infected)

32. AIDS Awareness: Magic Johnson

33. Demographics Center for Disease Control and Prevention (2004)
82% of those living with AIDS in US were males
73% between 25-44
Only 1% 14 or under
Misleading # because of incubation period

34. Ethnicity
78% of HIV/AIDS women are African-American and Hispanic despite accounting for less than 25% of all women in US
45% of AIDS cases of individuals who are African-American and Hispanic is caused by injection drug use
Only 17% of AIDS cases who are Caucasian fall into this category

35. AIDS – Route of Transmission
Three main routes for infection –
Sexual activity involving the exchange of body fluids
Sharing contaminated needles
Birth by infected mother
Highest rates among year olds
2-3 times higher in men

36. HIV Transmission HIV enters the bloodstream through: Open Cuts
Breaks in the skin
Mucous membranes
Direct injection

37. HIV Transmission Common fluids that are a means of transmission: Blood
Semen
Vaginal Secretions
Breast Milk

38. HIV in Body Fluids
Blood
18,000
Semen
11,000
Vaginal
Fluid
7,000
Amniotic
Fluid
4,000
Saliva 1
Average number of HIV particles in 1 ml of these body fluids

39. Routes of Transmission of HIV
Sexual Contact: Male-to-male
Male-to-female
Female-to-female
Blood Exposure: Injecting drug use/needle sharing
Occupational exposure
Transfusion of blood products
Perinatal: Transmission from mom to baby
Breastfeeding

40. Blood Supply The risk of getting HIV from a
blood transfusion in the U.S. is
extremely low
All blood donors are screened
for their risk of HIV
All donated blood is tested
All blood that tests positive for
signs of HIV is destroyed
Source: American Red Cross HIV/AIDS Program: HIV Education and Prevention
MDE HIV/AIDS PROGRAM

41. From HIV Infection to AIDS: Four Stages of Progression
Introduction of the retrovirus: HIV. Incorporated into the genetic material of a cell. Gradual decrease in T4 (CD4), helper t-cells over many years…
4 Stages:
Stage 1: Immune System destroys most HIV
Mild symptoms like those of other diseases (e.g., soar throat, fever, rash, headache). Lasts 1-8 weeks.
Stage 2: Latent period for as long as 10 years or more with no or few symptoms
T cell concentration falls dramatically during this time; HIV constantly replicated
Within five years, 30% will move on to Stage 3
AIDS related complex – other symptoms can include weight loss, rash, etc.
Other sites for opportunist infections include nervous system, liver, bones, and brain.

42. From HIV Infection to AIDS: Four Stages of Progression
Stage 3: AIDS related complex
T cells further reduced
Immune function impaired
Opportunistic infections occur
Kaposi’s sarcoma
Cluster of symptoms
(e.g., swollen glands, loss of appetite, fever, fatigue, night sweats, persistent diarrhea)
Stage 4: Severe immune impairment
Almost all natural immunity is lost
T cell levels drop below 100 (1000 is considered healthy level)
Multiple opportunist infections (e.g., lungs, gastrointestinal tract)

43. AIDS Diagnosis “AIDS” diagnosis after development of:
Kaposi’s sarcoma, pneumocystis carinii pneumonia, or very low levels of CD4.
Viral load test: determines level of HIV in body.
Damage to part of the immune system that fights viral infections – existing antibodies usually still work
HIV attaches to CD4 and replicates itself, destroying the cells function

44. Prognosis
Unfortunately, HIV/AIDS diagnosis is still a “death sentence”
Not one well-documented case of infected person whose immune system has been completely cleared of the virus

45. Preventive Vaccine???
Biomedical researchers are looking for a vaccine to minimize and control the impact of HIV on the body
Major problems:
In an infected person, an estimated 10 billion new viruses are made every day
New strains are constantly appearing
Rapid speed that virus decreases T cells

46. But there is reason for hope…
Before 1995, there was really no treatment for AIDS patients
Today, an “AIDS cocktail” approach has increased hope that one day it will become a manageable chronic disease rather than a terminal disease

47. Treatment of AIDS/HIV Purpose Antiviral Therapy Halt viral replication
Prevent opportunistic infections
Treat infections as the occur
Maintain physical and mental well being
Antiviral Therapy
Maximize suppression of virus
Preserve immune function
Prolong efficacy, delay resistance
Patient compliance, tolerable regimens
Preserve future treatment options
Measuring success of treatment:
Decrease in clinical symptoms.
Decrease in opportunistic infections.
Viral load undetectable or at least one log decrease (i.e. From 100,00 copies of the virus to 1,000 copies of the virus).
Increase in CD4 count

48. HAART Regimen Today’s optimum treatment for HIV/AIDS victims
Involves multiple anti-HIV drugs that prevent the virus from replicating within host cells

49. HIV/AIDS: Pre-HAART era
Rapidly fatal course
Emphasis on treating opportunistic infections and on providing palliative care
Physicians and other care providers received specific training in palliative care
Slide Note
Prior to the advent of HAART, HIV/AIDS was seen as a death sentence. The usual prognosis was death at 2 years after HIV diagnosis; 6 months after AIDS diagnosis. The only treatments that providers had to offer were addressing symptoms such as fatigue, wasting or depression, treatment of opportunistic infections, and providing good end-of-life care. Clinicians used to experience multiple patient deaths per week or per month. Our definition of “success” with a patient was as much about helping a patient to have a good death as it was about providing as much quality of life as possible.

50. HIV/AIDS in the HAART era
Chronic, manageable disease for many
Unpredictable course with more prognostic uncertainty
Complex treatment regimen requiring specific expertise
Multiple symptoms with complex etiologies
Focus of care and training on HAART and not on palliative care
Slide Note
Since HARRT, there have been dramatic changes in the treatment and trajectory of HIV/AIDS. Deaths from AIDS are infrequent, and many HIV providers have not had much experience in the issues surrounding death and dying.
Although, it makes sense that we would want to focus on treatment now, when for so long we had so little hope to offer our patients, we still need to be able to offer good end-of-life care to the patients for whom HAART is not effective or who have co-infections or other fatal complications.

51. Importance of palliative care in HIV/AIDS
HIV/AIDS still a leading cause of death among Americans ages 15-44
Co-morbidities of Hep B & C and malignancies can be fatal
HAART is not a cure and has many side effects
Many symptoms throughout the disease impact quality of life
Complex psychosocial issues such as psychiatric illness and substance abuse
Slide Note
Why is palliative care important in HIV/AIDS care?
AIDS is still a significant cause of death in this country due to the limitations of HAART and because of significant co-morbidities. Also, HIV has an unpredictable and varying course. Palliative care may be needed at different points in the disease, as side effects of treatment and different symptoms arise. Palliative care also has much to offer in the psychosocial realm.

52. Importance of palliative care in HIV/AIDS
HIV/AIDS disproportionately impacts minority and marginalized populations
These groups often enter care later in the disease progression
Some groups have less access to HAART
Some lack the support system to adhere to a complicated medication regimen
Slide Note
Groups that traditionally do not use health care or have less access to HIV care may have more need of palliative care. Patients who have not been receiving care but are diagnosed during a hospitalization when HIV is far advanced and less likely to respond to anti-retrovirals will also benefit from palliative care. Some of these marginalized groups lack a support system or have other pressing life issues such as poverty, substance abuse or depression that make it difficult to adhere and thus benefit from HAART.

53. Traditional view of Palliative Care
Therapies to modify disease (curative, restorative intent)
Hospice
Slide Note
In the past, we conceived of palliative care in this way. Palliative care was separate from curative care, and only happened after all treatment options had failed. Palliative care was synonymous with hospice care, and there was a standard Medicare hospice requirement that a patient had to have six or less months to live in order to qualify for this care.
Diagnosis
Death
Bereavement Care

54. AIDS (past): Trajectory of dying Steady decline
Health Status
Decline
Slide Note
That view assumed a trajectory of death that looks like this. The decline is steady and there is a predictable transition point or prognosis. Traditionally, treatment would stop and hospice services and palliative care would be offered at that point.
Death
Time
Institute of Medicine

55. AIDS (present): Trajectory of dying Periodic crises
Health Status
Decline
Crisis
Slide Note
This is how we perceive the trajectory of dying today, and this is a particularly appropriate model for the course of HIV/AIDS. People experience periodic crises alternating with periods where they return to close to baseline. A new model of palliative care is needed that takes into account the reality of this disease progression and a patient’s needs throughout the illness.
Time
Institute of Medicine

56. How do psychological factors predict the acquisition of HIV?
Unprotected sex
ARRM – Aids Risk Reduction Model (Catania et al., 1990) Understand the threat and recognize that ones behavior may put one at increased risk
Knowledge of risks does not always relate to preventive behaviors: College students and sex – because people are like you does not mean he/she might not be HIV positive
How much control does one have over another person’s previous sexual experience? The tendency to perceive a potential sex partner as safe

57. How do psychological factors predict the acquisition of HIV?
Positive attitudes towards condoms tends to increase their use
The influence of drugs and alcohol use on unprotected sex.

58. How do psychological factors predict the progression of HIV?
Stress – might increase the onset of AIDS due to compromised immune system functioning
The use of active-coping strategies slows the rate of progression of HIV. Some research suggest that avoidance coping for some HIV positive men, slowing the rate of decline of CD4 cells (Mulder et al., 1999).
Optimism is related to increase health behaviors, the sense of control is important.
Social support is important. Persons have reduced anxiety, depression, and slower rates of HIV progression.
Regular exercise can delay progression of HIV.

59. Psychosocial Barriers to AIDS Intervention
Condom Use
Over 80% of college students report having engaged in sexual relations yet only one-third use condoms
Often they report feeling awkward in asking partner about its use
Depth of Relationship
Whether the relationship is an established and committed relationship is related to high HIV risky behaviors (Sheeran et al., 1999)
Major drop-off of condom use as relationship advances
Recent Medical Advances
Less fear now
Recent developments of treatments might lead to increase risky behaviors (Vanable et al., 2000)

60. Psychosocial Barriers to AIDS Intervention
Psychological Factors
Optimistic Bias
Invincibility Fable
Personality Type
Sensation-seeking

61. Mass Screening
Most state and federal programs have primary prevention programs that include HIV screening and basic counseling
Health psychologists teach individuals to use self-control in sexual relationships
Imagery
Role-Playing

62. Promoting Disclosure
Often HIV-positive individuals do not disclose to their partners this information
Preventative counseling by health psychologists help increase the likelihood that they will

63. Complications
Family members and partners may have long-term negative effects even after patient has died
High burn-out among health-care providers and caregivers working with HIV/AIDS patients

64. Who Cares About Living Longer?
Most people are not interested in living longer
evidence for lack of interest found in daily habits of many adults
in research budgets, less money spent on preventing aging than on treating diseases
people would rather have better quality of life than lengthen it

65. The Centenarians
People 100 years of age or older

66. The Centenarians
Remote regions where large numbers of people have unusual longevity have been found in
Georgia, Russia
Pakistan
Peru

67. The Centenarians Regions share 4 characteristics
diet is moderate, mostly veggies and herbs
work continues throughout life
family and community are important
exercise and relaxation part of daily life
But birth records of these regions not verifiable

68. Credits http://www2.una.edu/psychology/health/ch10%20chronic3a.ppt12
of Transmission of HIV