- How long will you live

- Longevity
- Influenced by genetic and environmental factors
- Average longevity - life expectancy, statistical measure referring to age at which
half of individuals born in given year will have died
- Lower for poorer countries
- Women have higher life expectancies than men
- Boys more susceptible to infectious disease
- Lower lifetime risk behaviours e.g. smoking, alcohol
- Lower rates of violence
- Biological advantages e.g. lower rates of cardiovascular disease, cancer
- Gap currently narrowing
- Increased smoking among women, falling rates of cardiovascular
disease among men in developed countries
- Gender based discrimination in some societies
- Aging baby boomers
- Increasing number of older adults - more than children
- More oldest olds than younger olds
- Centenarians in Canada and around the world
- Centenarians - 100 to 110 years
- >10000 in Canada, mostly women
- Highest rate in Japan
- Maximum longevity
- Oldest age one can live
- Supercentenarians - 110+
- Ethnic differences in longevity
- Healthy immigrant effect
- Foreign born individuals tend to live longer and be healthier in Canada
and US
- Three main reasons
- Healthy habits and behaviours prior to leaving home countries
- Immigrant self selection - healthiest and wealthiest migrate
- Strict health screening by authorities in host country
- Longer time spent in host country - more health resembles native born
residents
- Adopt behaviours and eating habits of host country
- Lack of information about Indigenous populations
- Younger and faster growing population
- Other factors affecting longevity
- Genetic factors account for 25-30% of individual differences in lifespan
- Environmental factors
- Lifestyle and socioeconomic factors
- Air and water pollution, carcinogens in food
- Smoking, drugs, alcohol
 - Lower socioeconomic status linked with shorter lifespan
- Illness and disability
- Health of older Canadians
- Definition of health
- Resource for everyday life, not objective of living
- Positive concept emphasising social and personal resources, physical
capabilities
- Health status of older Canadian adults
- Most older adults have at least one chronic disease
- Hypertension and periodontal disease most common
- Asthma and mood/anxiety disorders least prevalent
- Multimorbidity linked to increased risk of inappropriate drug use and adverse
drug effects
- Almost half of older adults report good or excellent health
- Most common risk factors are underconsumption of fruits and vegetables, low
levels of physical activity
- Factors affecting health
- Determinants of health - physical environment, social and economic
environments, individual characteristics and behaviours
- Genes affect likelihood of developing diseases
- Older adults provide support for peers
- More likely to be stressed by helping others
- Common illnesses and disease in older adulthood
- Acute illnesses
- Older adults most compliant with influenza vaccination
- Chronic diseases
- Seven of 10 leading causes of death
- Falls are leading cause of injury death in older adults
- May be due to increasing age, medication use, cognitive impairment,
chronic and acute health conditions, impaired balance, sensory factors,
inadequate nutrition, social isolation etc
- Disability
- Long term impairment which may hinder full and effective participation in
society on equal basis with others
- More common in older women
- Greater longevity, more chronic conditions, lower bone density, higher
rates of lifestyle factors e.g. sedentary behaviour, obesity
- Models of disability
- Medical model
- Disability caused by disease, injury, health condition
- Intervention needed to correct problem within individual
- Social model
- Disability is socially created problem not attribute of individual
- Something in political environments must change
 - Verbrugge and Jette model
- Includes sociocultural factors and personal ones
- Risk factors and intervention strategies
- Allows better understanding of individual in context of total
environment
- Tailor intervention to individual’s needs
- International classification of functioning, disability, and health
- Multidimensional classification system that provides framework
for health and disability
- Normalises experience of disability
- Frailty - age related syndrome of physiological decline, vulnerability to adverse
health outcome
- Functional health
- How well individual functions in daily life
- Most report good functional health but experience limitations due to long term
physical conditions caused by injury and disease
- Comorbidity and polypharmacy
- Co-occurrence of multiple chronic/acute medical conditions
- Polypharmacy - use of five or more medications daily
- Associated with adverse outcomes e.g. mortality, falls, adverse drug reaction,
increased hospital stay length, readmission to hospital soon after discharge
- Harm due to drug-drug interactions and drug-disease interactions
- Affect pharmacokinetics (more susceptible to side effects) and
pharmacodynamics (slower absorption of drugs)
- Changes in cytochrome P450 system - altered metabolism of drugs, reduced
clearance from body
- Usually start with low dose, increase if needed
- Quality of life
- Individual’s perception of position in life in context of culture and value systems in which
they live, in relation to goals, expectations, standards and concerns
- Factors affecting quality of life
- King et al model
- Four broad categories of QOL
- Psychological
- Social
- Physical
- Spiritual
- Dignity and having sense of control in some aspect of daily life
- Maintaining current level of functioning
- Positive attitude and social relationships
- Acceptance of disability
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- Canada’s healthcare system
- Based on UPPAC principles
- Universality - all eligible residents entitled to public health insurance on uniform
terms and conditions
- Portability - coverage for insured services must be maintained when insured
person moves within or without country
- Public administration - must be administered on nonprofit basis by public
authority
- Accessibility - reasonable access to hospital and physician service
- Comprehensiveness - all medically necessary services provided by hospitals and
doctors must be insured
- Subsided by gov
- Healthcare providers predominantly private but receive public funding
- Hospitals largely private, nonprofit
- Successful aging
- Avoidance of disease and disability
- Maintenance of cognitive and physical function
- Engagement with life
- Model criticised for difficulty to maintain resources, few older adults meeting criteria,
neglects access to resources and cultural differences
- Social engagement in community most valued by older adults
- What is dementia
- Age associated memory impairment
- Could occur in 40-50 year olds
- Symptoms
- Memory loss
- Difficulty with thinking
 - Changes in mood or behaviour
- Usually progressive
- Types
- Alzheimer’s (most common)
- Creutzfeldt-Jakob
- Dementia with Lewy bodies
- Frontotemporal dementia
- Mixed dementia
- Vascular dementia
- Delirium
- Disturbance of consciousness, reduced ability to focus, sustain, shift attention
- Change in cognition i.e. memory deficit, disorientation, language disturbance
- Disturbance develops over short period
- Depression
- Higher rate in long term care and hospital settings
- Most common mental health problem

- Mental health and neurocognitive disorders

- Mental health
- Capacity to feel, think, act in ways that enhance ability to enjoy life, face
challenges
- Difficult to measure
- Criteria for psychological disorders (all three required)
- Range of behaviours and experiences that fall outside of social norms
- Different definitions of psychological disorders across time and
cultures with different social norms
- Create adaptational difficulty for individual on daily basis
- Risk of harm to individual or others
- Diagnostic and Statistical Manual (DSM-5) used in Canada and US to diagnose
psychological disorders
- Only for psychological disorders, specific
- Can only be used by clinical psychiatrist - less accessible
- ICD 10-11 used in rest of world
- For all diseases
- Can be used by any physician
- Psychological disorders decline with age with exception of dementia
- May be due to people with psychological disorders having shorter
lifespan
- Difficulties with diagnosis/misdiagnosis
- Develop better coping skills with age
- Older adults tend to have positivity bias
- Some symptoms characteristic of younger adults may not be observed in older
adults/may not be accurately characterised as abnormal
- Older adults most likely to seek care from family doctor
 - May not be well trained to diagnose mental disorders/examine older
adults
- Older adults unlikely to have private health care plans to cover mental health
treatment, long wait times for public mental health services
- Major depressive disorder
- Dysphoria most prominent feature
- Present most of time for at least 2 weeks, not characteristic of
usual mood
- Appetite and sleep disturbance, feelings of guilt, low self esteem and
difficulty concentrating
- Lifetime prevalence is about 17%, half as common for those above 60
- More common in young adult women than men, close to equal in old age
- Older adults tend not to report psychological symptoms, report physical
symptoms more often
- Cohort effect - negative attitudes about reporting mental health
- Early onset symptoms - think symptoms are normal
- Depression often misdiagnosed in older adults
- Comorbidity with other physical diseases
- Stereotypes - depression is natural course of aging/don’t want to
stigmatise older adults
- Suicide rates highest among older adults thoughout world
- Most depression benefits from intervention
- Selective serotonin reuptake inhibitors (SSRIs) are most common first
line treatment of depression with few side effects
- Tricyclic antidepressants effective but have side effects, can’t be
combined with blood pressure medications
- Start low and go slow approach
- Cognitive behaviour therapy particularly effective for older adults
- Increases behaviours that lead to positive outcomes, ignore
negative thoughts
- Recognise automatic negative thoughts and reattribute cause of
events
- Slower, takes more trials to learn due to changes in memory
- Neurocognitive disorder (used to be dementia)
- Dementia requires memory loss, imply older adults
- Neurocognitive disorders can occur at any age
- Group of disorders characterised by cognitive and behaviour decline involving brain
damage
- Minor or major
- Progressive (e.g. Alzheimer’s) or non-progressive
- Primary (main diagnosis) or secondary (e.g. Huntington, primary symptoms not
neurocognitive)
- May or may not involve memory impairment
- Not inevitable part of aging
 - 7% among Canadian seniors (25% among 85+ population)
- Majority in low or middle income countries
- Delirium
- Acute cognitive disorder characterised by confusion with sudden onset
- Many potential causes usually serious physical problem
- Dehydration
- Head injury
- Medication interactions/overdose
- Vitamin deficiency
- Should be treated quickly to prevent long term damage (permanent cell death)
- Often misdiagnosed as dementia
- Alzheimer’s disease
- Most common cause of dementia, likelihood increases with age
- Most of cost and care taken informally by friends and family
- Diagnosed through process of exclusion
- Requirements
- Memory impairment
- At least 2 other cognitive symptoms in language, perception, executive
function/action control
- Revised to include biomarkers (changes in brain with no symptoms,
pre-clinical) and mild cognitive impairment (pre-dementia)
- Not yet adopted
- Biomarkers e.g. plaques and tangles not definite signs of
dementia
- 3 broad stages
- Early
- Difficult to diagnose - more severe versions of normal aging
changes
- Mild anterograde amnesia (inability to form new memories)
- May not be noticeable unless actively trying to learn new
things
- Lexical retrieval difficulties
- Intermediate
- Severe anterograde amnesia
- Retrograde episodic and semantic amnesia
- Language difficulties
- Impaired problem solving
- Difficulties with complex motor patterns
- Late
- Severe retrograde amnesia
- Basic motor control can be difficult
- Language may be lost
- Is only diagnosed by presence of beta-amyloid plaques (abnormal protein
deposits body cannot dispose of, can lead to cell death) and neurofibrillary
 tangles (malformed tau proteins - tangled microtubules in axon, loss of function,
potentially cell death)
- Correlated with but may not cause disease
- Presence does not guarantee individual will develop dementia
- Genetic component
- Early onset familial AD
- Onset between 30-60 year olds
- Entirely genetic - linked to single presenilin gene mutation
- 5% of AD cases
- Late onset not linked to any particular gene
- APOE-4 is genetic risk factor, associated with 25% of AD cases
- APOE-2 may be protective factor
- Most people have APOE-3 - not risk factor or protective
- Likely due to combination of genes, environment, lifestyle factors
- 50% chance that both monozygotic twins will develop AD
- High blood glucose levels linked with increased risk of AD
- 45-90% correlation between type II diabetes and AD
- Hyperglycemia increases amyloid plaque development
- Amyloid plaques increase insulin resistance
- Decreased glycolysis and increased brain glucose correlated with
increased plaques, tangles, AD symptoms
- Currently not sufficient evidence to support link between AD and aluminium
- Overexposure e.g. from working in aluminium factories increases chance
of Alzheimer’s
- Nun study
- Writing complexity in youth negatively correlated with risk of
developing AD
- Vascular theory
- AD results from continuous reduced blood flow to brain
- Improving cardiovascular health = reducing risk of AD
- Reducing chronic stress
- Hippocampus responsible for turning off stress response, stress
leads to degeneration of hippocampus - cycle
- Chronic stress - losing sense of control
- Stressors (environmental demands) -> appraisal of
demands and adaptive capacities -> secondary appraisal
if negative -> chronic stress if can’t change situation
- Can be alleviated by positive appraisal
- Treatment
- No cure
- Medication can slow progression and development of symptoms
- May be placebo
- Only effective for certain number of years
- Early diagnosis important
- Behavioural therapies, external aids, training
- Errorless learning and spaced learning
- Repetition, many cues and constant immediate feedback
- Reminiscence therapy
- Help patients maintain sense of personal identity
- Recall events/people/emotions with photo cues