Ismail Sadek

Longevity vs quality of life

The world population has never been as mature as now. Currently, the number of people aged 60 and over is more than 800 million.

Projections indicate that this figure will increase to over two billion in 2050. Soon the world will have a higher number of older adults than children.

Contrary to common sense perceptions, the majority of older people live in low- and middle-income countries, and some of the fastest rates of ageing are occurring in these areas

Low risk of disease and disease-related disability High mental and physical functioning Active engagement with life

The combination of these three factors constitute the essence of successful aging

Successful Aging

Common-sense practices Don't smoke Don't drink too much Eat a healthy dietGet at least 30 minutes of moderate physical activity each

day Get regular checkups and screeningsWear seat belts and take other safety precautions

A Long and Healthy Life

Attitudes and actions can transform our livesLifelong learningActive involvementA hopeful outlook

Other Factors for Successful Aging

Maintain a positive outlook on life

Take good care of your health Remain active

Stay in close contact with family and friends Eat right Remain mentally activeKnow what you believe

Caring for Yourself

Quality of life is the degree of need and satisfaction within the physical, psychological, social, activity, material and structural area.

Quality of life is a state of well-being which is a composite of two components: 1) the ability to perform everyday activities which reflects physical psychological, and social well-being and 2) patient satisfaction with levels of functioning and the control of disease and/or treatment related symptoms.

An individual’s perception of their position in life in the context of the culture and values systems in which they live and in relation to their goals, expectations, standards and concerns.

Definitions of Quality of Life

Many possible definitionsMulti-dimensionallySubjectiveRelated to society

No clear definition because:

old age and mental health

depression

movement

disorders

psychosis dementia

SYMPTOM OVERLAP:

depression

movement

disorders

psychosis dementia

Depression with dementia (“pseudodementia”)

Dementia with depression

PD with depression

PDD, LBD, AD with movement sx

PDD, LBD, AD, VaD with psychotic sx

Psychotic depression

Schizophrenia with depression

Schizophrenia with cognitive deficits

Schizophrenia with movement disorders

PDD, LBD, PD+ with cognitive deficits

med conditions & drugs

OVERVIEW: Consider main syndrome & comorbid conditions

Vascular depression with mild cognitive impairment

MCI with depression

Depression is the most frequent cause of emotional suffering in later life and frequently

diminishes quality of life.

A key feature of depression in later life is COMORBIDITY---

e.g., with physical illness such as stroke, myocardial infarcts, diabetes, and cognitive disorders (possibly bi-directional causality)

Depressive symptoms are less frequent or no more frequent than in middle life. However, may be due to under-reporting , survivor effect, and case finding. Clinically significant depression in community dwelling elderly: 8% to 16%, with major depression being about 2%. The 1-year incidence of clinically significant depression is highest in those age 85+--13% Depressive mood disorders decrease with age but depressive symptoms are more frequent among the old-old(age 75+) but may be due to factors associated with aging such as higher proportion of women, more physical disability, more cognitive impairment , and lower income. When these factors are controlled , there is no relationship with age.

Prevalence of depression among older persons in various settings:

Medically and surgically hospitalized persons—major depression 10-12% and an additional 23% experiencing significant depressive symptoms. Primary Care Physicians: 5-10% have major depression and another 15% have minor or subsyndromal depression.PCPs may not be aggressively identifying and treating depression  Long-Term Care Facilities: 12% major depression , another 15% have minor depression. Only half were recognized.

Approximately one-fourth of medically ill persons suffer from

clinical depression!

•Pseudodementia—“depression with reversible dementia” syndrome: dementia develops during depressive episode but subsides after remission of depression.

•Mild cognitive impairment in depression ranges from 25% to 50%, and cognitive impairment often persists 1 year after depression clears.

Cognitive risk

Cerebro-vascular lesions & risk factors

Apathy, motor retardation

Late-onset depression—look for this triad:

Bereavement(loss of a love one through death)

Grief (psychosocial reaction to any loss such as depression, anxiety, guilt, anger, etc)

•Approximately 800,000 older Americans are widowed each year.

•Acute grief: traumatic distress, separation distress, guilt/remorse, social withdrawal, preoccupation with images of dead person---approximately 6 months---leads to Integrated Grief as a background state (reestablish interests, accessibility of memories of deceased but not preoccupied,more positive emotions)

•Prolonged (also termed “complicated,” “traumatic”) grief: instead of transition form acute to integrated grief person fails to accept the death, guilt persists, overlap with major depression and/or PTSD

•Very highs levels of symptoms after 1 month—about two-fifths meet criteria for major depression; in one study, at one year, 16% met criteria for major depression. Thus, roughly between 10-20% of widows develop clinically significantly depression in the first year of bereavement . •The presence of any substantial symptoms of depression at 2 months after a loss was associated with a significant increased risk of continued problems with depressive spectrum disorders. Other risk factors include personal/family hx of depression, depression at time of loved one’s death,poor medical health, younger age of survivor

Quality of life of older people

The quality of life of older people is a complex and multidimensional issue. There is no single definition of quality of life for older people, so we aim to break down quality of life of older people into the domains that are most important to them

the main domains are reported as follows: health; psychological well-being; social relationships; activities; home and neighbourhood; financial circumstances; and spirituality and religion.

quality of life of older people

Bowling (2005) emphasizes that theories on ageing have moved away from the traditional negative models to more positive ones.

Health status is treated by gerontologists and other academics as an important influence on quality of life. As ill-health may result in physical and/or psychological dependency, older people frequently nominate health as an important element of quality of life.

Health

Indeed, Bowling et al. concluded that ill-health is the most negative influence on quality of life;

There was no difference in the weights assigned to health by the older and younger age groups interviewed. This implies that the domain of health is important at all ages.

Being healthy allows respondents to participate in activities, thus contributing to feelings of enjoyment and having a role in life.

Health

Psychological well-being is important for quality of life. Indeed, psychological well-being and quality of life are sometimes interpreted as meaning the same thing.

A positive outlook on life was believed to contribute to quality of life. It is referred to being optimistic, satisfied, believing that one had a role in life and also having happy memories of the past.

Those who spoke of the negative effect of a poor psychological outlook were more likely to be suffering from anxiety or depression (or other psychiatric morbidities).

Psychological Well-Being

There is conflicting evidence from the literature in relation to disability and self-esteem. On the one hand the literature indicates that self-esteem is negatively associated with the severity of disability and disease progression.

Alternatively it is suggested that satisfactory psychological adjustment is possible despite the extent of disability or seriousness of disease progression.

With regard to the older person and self-esteem, the literature is also ambiguous, with some research indicating that self-esteem reduces in old age and others indicating an increase or no change.

Self-concept is related to self-esteem in that ‘people who have good self-esteem have a clearly differentiated self-concept’.

In relation to intellectual disabilities the literature indicates that this group are more at risk for low self-concept and, hence, low self-esteem.

Social interaction with people, including connectedness to family and friends, is usually beneficial and a positive influence on quality of life.

People who are not connected to others often experience loneliness, which detracts from quality of life.

That said, loneliness is not always mentioned by respondents in response to quality of life surveys, but this may be due to the stigma attached to being lonely.

However, older people sometimes mention being afraid of feeling lonely as a result of a decline in social networks due to illness and death among friends.

Social Relationships

Good social relationships were critical to quality to life. Individuals emphasized the emotional and practical support provided by children and grandchildren. This support was often through face-to-face contact or by telephone. They felt they were able to play a reciprocal role by taking care of and helping their grandchildren.

Aspects of social relationships that detracted from quality of life included

1. difficulties maintaining contact, 2. family disputes or 3. family members not having enough time to visit. The importance of family and social relationships is also

highlighted in other studies. and found that those with the highest self-rated quality of life had ‘excellent’ or ‘good’ social support.

The environmental approach to quality of life posits the theory that an individual’s physical and social environments affect quality of life.

Furthermore, quality of life is dependent on how an individual relates to, and perhaps adapts to, environments that are not ideal.

If the structures that help people relate to their neighborhoods aren’t in place, then this may affect quality of life. For example, a lack of transport facilities may prevent an older person from leaving their home, thus substantially reducing their ability to interact with the local and regional environment.

Home and Neighbourhood

The main factors in the category of home and neighbourhood were: 1. living in a safe, 2. secure, friendly area; 3. having friendly, helpful neighbours; and 4. the availability of good local facilities. 5. The availability of Council services, including refuse collections

and 6. having pleasant landscapes and surroundings. Independence was also mentioned in relation to the availability of

reliable and frequent transport services. The individuals with the highest quality of life also had the highest

satisfaction with their residential environment.

Home and Neighbourhood

Various studies have found a positive correlation between engagement in meaningful activities and quality of life.

What tends to be missing is elaboration on how the process of engagement influences quality of life.

Nevertheless, almost two thirds of respondents in Bowling et al.’s study (2003) indicated that involvement in social activities, and local community and voluntary organizations contributed to a good quality of life.

Activities

The importance of ‘having things to do and taking part in life was discussed by all respondents in the Grewal et al. study (2006). Activities identified included

1. travel, 2. bridge, 3. politics, 4. continuing to work and 5. helping other people. 6. Activities were also associated with feelings of self-worth

and having a role in life.

Activities

Bond and Corner (2004) referred to the changes in financial circumstances which have taken place over the last century.

They pointed out that the number of people in absolute poverty has declined dramatically. Absolute poverty occurs when individuals cannot afford the basic necessities in life.

However, relative poverty for older people has increased in many countries. Relative poverty occurs when one is financially worse off than others, but has sufficient money to live on.

As individuals are inclined to compare themselves to others, being relatively poor may detract from an individual’s quality of life.

Financial Circumstances

There is difference between religion and spirituality. The former is associated with powerful religious organizations, whilst the latter is a private, subjective experience.

Even if church attendances have fallen, this does not mean that spirituality will have little influence on quality of life of future generations of older people.

Spirituality and Religion

However, attending a place of worship was mentioned by respondents and was recorded by the authors under the domain of activities. Spirituality was also mentioned by respondents but it was recorded in the psychological well-being domain.

A study which assessed the influence of spirituality, religion and personal beliefs (SRPB), using the WHO Quality of Life measure, found that SRPB was an influence on quality of life, but was not as important an influence as environmental, psychological or social domains (WHOQOL, 2005).

However, SRPB plays a part in an individual’s ability to cope with illness and stress, and maintain well-being.

Spirituality and Religion

Maintaining Emotional Health

Mental Health and quality of life Issues in Later Life

1. A measure of personal life satisfaction and quality of life that affects the older individual and the community

(www.asaging.org)2. “Striking a balance in all aspects of your life

– social, physical, spiritual, economic, mental”

(www.stjosham.on.ca/mentalhealth/about.htm)

Definitions of Mental Wellness

3. Successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity… mental health is the springboard of thinking and communication skills, learning, emotional growth, resilience, and self esteem

(www.surgeongeneral.gov)

Definitions of Mental Wellness (continued)

Good mental health can help youEnjoy life moreHandle difficult situationsStay better connected to your loved onesKeep your body strongSave money on healthcare expensesLive longer

(DHHS publication No. [SMA] 02-3618, 2001)

A Healthy Mind is Important

Most older adults enjoy good mental healthEmotional, mental, and physical health are all connectedA healthy mind is as important as a healthy body, and should

be given the same attention!

Maintaining Emotional Health

Sleep is an important part of our ability to rememberNeuronal connections may be

remodeled during sleepSome memory tasks appear to be more

vulnerable to sleep deprivation than others

Sleep deprivation may produce effects in the brain that resemble those associated with aging   

Evidence that sleep plays an important role in memory consolidation

(http://www.memory-key.com/NatureofMemory/sleep.htm)

Sleep

Managing stress can affect one’s outlook on life Not all stress is negative Chronic stress takes a toll on the brain

In older persons, stress is thought to play a bigger role in triggering depression than in other groups

Stress

Managing StressEat regular healthy

mealsAvoid caffeineGet enough sleep Engage in some kind

of regular physical activity

Recognize that there are some things you cannot control and focus your attention on the things that you can

Develop a sense of humor; put some fun back into your life by doing something you really enjoy every day

Staying Connected

Mental Health Issues in Later Life

Maintaining social connections is important to wellness in later life

Social relationships serve as a key source of informal support

Loneliness is a problem for many older adults

Social Connection

1. Take a slow exit2. Try a new job on a part-time basis3. Share your job 4. Take a break 5. Volunteer

Retirement

Dealing with Grief

Mental Health Issues in Later Life

Denial Anger

Reactive Depression

Guilt

Acceptance

Stages of Grief

Take care of body

Take care of mind

Take care of spirit

Coping with Grief

Thanks