Yong “Tai” Wang, Ph.D.Professor of Physical Therapy

Gerontology InstituteGeorgia State University

USA

Gerontology

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I.IntroductioI.Introductionn

Gerontology and Health

Aging and Optimal Aging

Basic Definitions

GerontologyGerontologyGerontology – (from Greek:

geron, "old man" and -logy, "study of“) is the study of the social, psychological and biological aspects of aging.

Geriatrics – is the branch of medicine that studies the diseases of the elderly.

HealthHealthHealth – is the general condition of a

person in all aspects. It is also a level of functional and/or metabolic efficiency of an organism, often implicitly human.

Health – the state of being free from illness or injury.

Health – a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity (WHO).

Aging and Optimal AgingAging and Optimal AgingAging – is a natural process of growing

older, and is the accumulation of changes in an organism over time.

Aging - is an important part of all human societies reflecting the biological changes that occur, but also reflecting cultural and societal conventions. Age is usually measured in full years and maybe months for young children.

Aging and Optimal Aging Aging and Optimal Aging (cont.)(cont.)

Aging processes are plastic – to some extent, how we age and the rate at which we age are balanced between resources to which we have access and our exposure to various toxins.

The idea of plasticity – there are turning points through which people can change the trajectories of their life course.

Question: How can people change their life course?

Aging and Optimal Aging Aging and Optimal Aging (cont.)(cont.)Dividing lifespan

Juvenile [via infancy, childhood, preadolescence, adolescence (teenager)]: 0-19

Early adulthood: 20-39 Middle adulthood: 40-59 Late adulthood: 60+ Defining older adultsOlder adults - the young-old (65–79)Old-old (80-99)Oldest-old (100).

Aging and Optimal Aging Aging and Optimal Aging (cont.)(cont.)

Optimal aging – is a concept of aging process in a condition with high quality of life and longevity. It is a fairly new concept being discussed and finalized. We will address “Optimal aging’ later this semester.

http://highenergyforlife.com/event/improvebrainfunction/#

Basic DefinitionsBasic DefinitionsAge – the number of years of a person

has been alive. Cohort – a group of people who share

the same birth year or sometimes those who shared historical events, ex. baby boomers.

Period – the time at which the measurement or assessment occurred.

Age effect, cohort effect, and period effect.

Basic Definitions Basic Definitions (cont.)(cont.)

Life span – the absolute length of time a person may live.

Life expectancy – the length of time an average member of a particular cohort can live, or the age at which half of a particular cohort will have died.

Age-specific life expectancy – the average number of years that members of a given cohort who have reached a specific age can expect to live, examples at the end of page 6

Basic Definitions Basic Definitions (cont.)(cont.)

Mortality – death.Morbidity – illness. Acute disease – often self-limiting and/or

can be successfully treated with medicine.Chronic disease – often incurable, and

treatment focus is on the management and the delay of disability rather than cure.

Acute and chronic illnesses can intertwine to produce a cascade of health problem.

Basic Definitions Basic Definitions (cont.)(cont.)

Functional health (instrumental activities of daily living) – abilities to perform daily tasks such as shopping, paying bills, preparing meals, or getting around.

Activities of daily living (ADLs) – abilities to perform self-caring, such as bathing, dressing, and eating.

Do you agree with the above definitions?

Basic Definitions Basic Definitions (cont.)(cont.)

The free-radical theory of aging (FRTA) states that organisms age because cells accumulate free radical damage over time. A free radical is any atom or molecule that has a single unpaired electron in an outer shell. While a few free radicals such as melanin are not chemically reactive, most biologically-relevant free radicals are highly reactive. For most biological structures, free radical damage is closely associated with oxidative damage. Antioxidants are reducing agents, and limit oxidative damage to biological structures by passivating free radicals.

http://www.healthchecksystems.com/antioxid.htm

Basic Definitions Basic Definitions (cont.)(cont.)

Antioxidant therapy – the free radical theory of aging implies that antioxidants such as Vitamin A, vitamin C, vitamin E, and Superoxide dismutase will slow the process of aging by preventing free radicals from oxidizing sensitive biological molecules or reducing the formation of free radicals. The antioxidant chemicals found in many foods are frequently cited as the basis of claims for the benefits of a high intake of vegetables and fruits in the diet.

II. Demography of II. Demography of AgingAging

Aging in The WorldDemographic Factors and Rate

of Aging

Aging in The WorldAging in The WorldA dramatic change in population

demographics Population aging in the United States: In 1950, children and young people made up

the largest segment of the population (Fig. 2.2a)

In 1975, the largest cohort were the baby boomers aged 10 – 30 years old (Fig. 2.2b)

In 2010, the largest cohort in 1975 were the those between 45-69 (Fig. 2.2c).

By 2030, the project is 70 million people in the US will be 65 or older. The most growing the population in the US.

Figure 2.2a Population by Age and Sex: 1905

Figure 2.2d Projected Population by Age and Sex: 2030Figure 2.2c Population by Age and Sex: 2010

Figure 2.2b Population by Age and Sex: 1975

Aging in The World (cont.)Aging in The World (cont.)What we will face: There is concern about the economic

stress that growing numbers of older adults may place on the country. More than any other age group, those 85 and older have the greatest health and social needs, and an increase in their numbers may have a major impact on the resources of the nation.

With the growing numbers of older population, we are facing more challenges as well as opportunities.

Aging in The World (cont.)Aging in The World (cont.)Total dependency ratio (TDR) is a rough

estimation of the number of people who need to be supported by workers:

TDR = (a + c)/bwhere a = children < 18, b = adults 18

– 65, and c = adults 65 and older.

Application of this equation?

Aging in The World (cont.)Aging in The World (cont.)Life expectancy – the average number of

years a person in a particular cohort can expect to live.

A child born today can expect to live at least 30 years longer than one born a century.

Life expectancy in 1900 was about 47 years.Life expectancy in 1999 for a female is 79

years and for male is 74 years.Oldest people: Jeanne Calment of France

(1875–1997), who died at age 122 years, 164 days; the oldest documented living person is 114-year-old Eunice Sanborn of Texas, United States, who was born on 20 July 1896.

Aging in The World (cont.)Aging in The World (cont.)Projection of population over 65+ years

old in the US:State Projections of Population Aged 65 and over: July 1, 2005 to 2030Number of Persons 65 and over

StateCensus

2000Projection

2005Projection

2010Projection

2015Projection

2020Projection

2025Projection

2030

US 34,991,753 36,695,904 40,243,713 46,790,727 54,631,891 63,523,732 71,453,471

http://www.aoa.gov/aoaroot/aging_statistics/future_growth/future_growth.aspx#gender

Aging in The World (cont.)Aging in The World (cont.)International Aging:In 2000, there were about 420 million

older population 65+ years older in the world.

The average annual rate of population increase from 1950 to 2000 and projected it to 2030 in Figure 2.2 (next slide)

The changed populations and older populations in other countries (more slides)

Figure 2.2 Average Annual Percent Growth of Older Population in Developed and Developing Countries

http://www.stat.go.jp/english/data/handbook/c02cont.htm

Figure 2.x. Changes in the population pyramid in Japan.

http://www.stat.go.jp/english/data/handbook/c02cont.htm

Figure 2.x Proportion of elderly population by country (aged 65 years and over).

Aging in The World (cont.)Aging in The World (cont.)Two major controversies about the

increase in life expectancy:1.Older people would remain healthy

longer, until a few months before their maximum life span (85 years old), and would then die after a relatively short period of disability; other argued that the late life translates into an extension of morbidity; still other may maintain the period of active life expectancy exceed disability.

2. There is a maximum life span in human. Is this life span age 85 or 100 years old?

Demographic FactorsDemographic FactorsDemographic factors play a major role

as accelerators or decelerators of aging or rate of aging. Demographic predictors of longevity are:

GenderMarital statusEthnicitySocioeconomic status

Demographic Factors (cont.)Demographic Factors (cont.)Gender: Females live longer than males due to a number of

biological, behavior, and environmental factors in life span. Reduced pregnancy and childbirth mortality.As infants, males may have more prenatal and neonatal

problems and are more susceptible to infections and cardiovascular problems

In Childhood, accidents cause more deaths among males than females.

In adulthood, males develop heart disease earlier that females.

In the late life, females have a higher incidence of nonfatal but disabling conditions, and males have more fatal illnesses.

Demographic Factors (cont.)Demographic Factors (cont.)Marital status:Marriage appears to have a protective

effect on health; married people live longer than the never-married, widowed, or divorced, although men may benefit form marriage more than women.

Why married people are healthier and live longer?

1.Better health behavior habits (less smoking, alcohol and drug, better diet and exercise)

2.Higher incomes and socioeconomic status3.Social activities and companionship.

Demographic Factors (cont.)Demographic Factors (cont.)Ethnicity:The US is undergoing a rapid

transformation in not only the size but the composition of its older population. (Figure 2.4)

Mortality rates and life expectancy vary by ethnicity for a variety of reasons that are as yet poorly understood. Death rates from all causes for person 65 and over per 100, 000 population from 1995 to 1997 are presented in Figures 2.5. & 2.6.

Figure 2.4 Ethnicity of older adults in 2000 and 2050 (United States).

Figure 2.5 Figure 2.6 Death rates from all causes for person aged 65 and over per 100,000 population: Females (Figure 2.5) and Males (Figure 2.6).

Demographic Factors (cont.)Demographic Factors (cont.)Socioeconomic status (SES):SES has highly significant effects on

morbidity and mortality among older population and the costs of health care, housing, and transportation are often greater in later life.

Poverty rates for older people have been decreased since 1959. Poverty rates by age are presented in Figure 2.7.

Demographic Factors (cont.)Demographic Factors (cont.)Socioeconomic status (SES):The US Census declared that in 2008

13.2% of the general population lived in poverty:[28]

o 8.6% of all non-Hispanic Whiteo 11.8% of all Asian-Americano 23.2% of all Hispanic (of any nationality)o 24.2% of all American Indian and Alaska

Nativeo 24.7% of all African-American.

Figure 2.7 Poverty rates by age: 1959 to 2008.

Reference book websites:Reference book websites:

http://books.google.com/books?hl=en&lr=&id=-GXBsmzyAyoC&oi=fnd&pg=PR15&dq=health,+illness+and+optimal+aging&ots=9KiSXAYN5c&sig=xGXP2TSogyVrwOLvhTyEXSuT528#v=onepage&q&f=false

http://www.uk.sagepub.com/books/Book11478#tabview=google