1. Chapter 20 Elizabeth Lytle, MPH, BSN, RN Los Altos School District A Lifetime of Health

2. Topics of Focus For This Chapter Gender Longevity gender gap Midlife Hormone changes Aging Challenges Physical Activity Benefits Death Advance directives Stages and emotions

3. 75.7 years 80.6 years The Difference In Life Expectancy Men Women 4.9 years

4. Why Do Women Live Longer Than Men? Estrogen Protects heart, brain, bone and blood vessels Boosts immune function May protect against metastases X Chromosome Extra dose of immune genetics Testosterone Depresses immune function Increases risk of heart disease and stroke Injury Men die more frequently of injury

5. Life Years Lost Due To Lifestyle Habits Health Hazard Years Lost (man) Years Lost (woman) Smoking 2.5 1.8 High Blood Pressure 1.5 1.6 High Blood Sugar 0.5 0.3 Obesity 1.3

6. Changes At Midlife For Women Perimenopause Begins 4 to10 years before last period Hormone shifts begin causing night sweats and hot flashes  FSH and LH increase; estrogen decreases Menopause Complete cessation of menstrual periods for 12 consecutive months Average age for menopause is 51.5

7. Menopause Has Some Health Effects Decreased estrogen causes: Dryness of skin and mouth Increased effect of androgens Increased risk of Urinary Tract Infections Increased risk of other health conditions Obesity Metabolic syndrome Heart disease Stroke Breast cancer

8. Hormone Therapy During Menopause Recommended for short-term symptom relief Estrogen Only Minimize hot flashes and night sweats Protect from heart disease and osteoporosis Combination Therapy Increases breast cancer, heart disease, breast cancer and stroke

9. Men Experience Changes At Midlife Too Decreased Testosterone By 30-40% between ages 48-70 Effects:  Decreased muscle  Increased fat  Loss of bone density  Lowered fertility and virility  Low energy Prostate Change Benign Prostatic Hypertrophy  May affect urine flow

10. Sexuality and Aging Better health translates into better sex life Men Sexually active men live longer Need more time for erection or orgasm Women Those who enjoyed sexual activity lived longer Produce less vaginal lubricant

11. Summary of Effects Of Aging On The Body  Brain shrinks  Senses fade  Immune system weakens  Osteoporosis and arthritis  Tissue degeneration  Digestion slows  Heart grows less efficient

12. Alzheimer’s Disease Is a Form of Dementia DementiaLoss of previous mental capability Alzheimer’s Disease Progressive deterioration of brain cells and mental capacity Early Signs  Insomnia  Irritability  Increased sensitivity to alcohol  Decreased energy  Decreased frustration tolerance

13. Alzheimer’s Disease Is a Form of Dementia Still not sufficient evidence to prove that any preventative strategy can prevent Alzheimer’s May Lower Risk Regular exercise Have a purpose in life Weight management Healthful diet Cholesterol-lowering drugs TreatmentNo known treatment

14. Osteoporosis Is a Chronic Disease Defined Losses in bone density become so severe that a bone will break with slight trauma or injury Prevention  Eat enough calcium or take a supplement  Drink alcohol moderately  Don’t smoke  Let the sunshine in  Exercise regularly

15. The Aging Pill: Physical Activity Older people receive additional benefits from exercise  Greater ability to live independently  Reduced risk of falling and bone fractures  Lower risk of dying from heart disease  Lower risk of developing high blood pressure, colon cancer and diabetes  Fewer symptoms of anxiety and depression  Improvements in mood and well-being

16. Mental Ability Does Not Decrease With Age Older adults are wiser: See multiple points of view Search for compromise Solve social conflicts These skills remain about the same: Understanding Vocabulary Ability to remember key information Verbal Intelligence

17. Two Common Types of Advance Directives Health- Care Proxy Gives someone else power to make decisions on your behalf Living Will Indicate whether you want or don’t want all medical treatment and technology used to prolong life Additional Options Do-Not-Resuscitate: Advance directive component that specifies you do not want to be resuscitated if heart stops Five Wishes Holographic Will

18. Stages Of Death DeathMoment heart stops Functional Death End of all vital functions Cellular Death Gradual death of body cells after heart stops Brain Death Absence of electrical activity on EEG and lack of reflexes Spiritual Death Moment when soul leaves body

19. Kubler-Ross’ Emotional Response To Dying

20. Five Emotions Faced While Dying 1Denial 2Anger 3Bargaining 4Depression 5Acceptance

21. Other Death Topics Care-giving Typically daughter, wife or sister may experience anxiety and depression HospiceHome-health program helps dying Near-Death Experience Autoscopy—watching from above as resuscitated Transcendence—passing into foreign region or dimension

22. Suicide Is Most Common In Those Above 65 ‘Rational’ Suicide? Person suffering without future positive outcome ends their life Perhaps as a result of undiagnosed depression Physician-Assisted Suicide Authorized in Oregon and Netherlands Debate about physician’s responsibility

23. Autopsies Examine Body After Death Medicolegal Cause of death Gather information for evidence Medical/ Educational Increase knowledge Determine more exact cause of death

24. Grief’s Effects On Health Are Numerous  Changes in respiratory, hormonal and central nervous system  Mood swings  Lose appetite, feel physically sick  Sleep poorly  Increased rates of depression, suicide, serious mental illness and premature death