Advanced Adult Development

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timer Asked: Feb 4th, 2019

Question Description

Select a 3-4 of critical thinking questions from each chapter and answer them in written format, summarizing key ideas, evaluating information, and relating it to real life experiences.

Note: The critical thinking questions appear in blue in the margins of pages throughout each chapter, not at the end of chapters.

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*- \ Sloht Sionals -yH to Brain Figure Optic Nerve 2.3 C ross- section view of the human eye. G;tl;:::*:nffi :i'*5;,1,rf ,"1*:f ;l:#;:i:l"*il* j:ffi:.: Eilltfr iT*]'t'*,,"{t:,-#*':,'.*,#Hiifltu::'"::}*: G**#ru******,**m E more age-related conditions in the visual system may or may not be part Elif*i,*t*l+**=**r** J"a"rthood. ji.'ti'*}:}i*tri*#r,fi :# More than half of adults over B0 either have cataracts or have had G*'I Gffi* #i"xT'I"* il ff ff 11i:;1"i: lmf;,i: i,'lff #:; fi,r::*:f :'J3:J.Trffi ,[#'iT:i.:rr:t:;n1 GillH:ff Imr 1.5 million are done each year. Despite the ease and success of surgery, and B*',r:";'i:Jrr:.:'4s1ff.1:'rY"'*:::L::ffi ::::Til;;;i:iru: k-:1l*ffiHJ,:;::'td1Hitd,.tr,,Buike,&GIass,zoog),Riskfactors B*::,:T::':i"1::]i:'tr;:I,:;H:3,'l;TL:*:ur:;h:'i*x Efitr#iidtf*i-'fr*#*tr*fl i:,*':!ffi \ Chapter 2 T*his ;I.3 Risk Factors Ior Age-Related Visual Conditions Cataracts . lncreased Age-Belated Macular Degeneration Glaucoma age . lncreased . Family history . . Female gender . African or Mexican . Diabetes . lncreased age Family history ancestry age . Family history . European ancestry . Smoking* . Sunlight exposure* *Can be controlled or prevented. Source: National Eye lnstitute 12O12a,2012b\; Hildreth, Burke, & Glass (2009). It ./ I a a tL lL. is estimatedthat2 million people in the United States currentlyhave glaucoma, but only half are aware that they have it. Glaucoma can be detected as part of a routine eye examination, and it is recommended that people in high-risk groups be screened at age 40. Everyone should be screened at 60 (National Eye Institute, 2012b). Risk factors for glaucoma are also shown in Table 2.3. A chird common condition of the visual system is age-related macular degeneration, a disorder that affects the retina, causing central vision loss. The cause of this disorder is not clear, but the prevalence is; symptoms of macular degeneration appear in about l0o/o of people 66 to74 years of age and30o/o of people 75 to 85 years of age (Klein, Chou, Klein, et al., 201 1). Vitamin therapy and laser treatment have shown hopeful results for some types of this disorder, and rehabilitative interventions have helped people with low vision to firnction independendy and increase their qualiry of life (Gohdes, Baiamurugan, Larsen, et al., 2005). Risk factors for age-related macular degeneration are also included in Table 2.3. The overall result of declining visual abiliq, over middle and late adulthood can be Iimiting in many ways. Often older adults give up driving, which means they are no longer able to do their shopping and banking and no longer as able to visit friends, participate in leisure activities, attend religious services, or go to doctors' offices on their own. There is also a loss of status for some older adults when they must stop driving. Decreased vision is associated with many other problems in older adults, such as falls, hip fractures, family stress, and depression. The World Health Organization (2011) estimates that over 80o/o of visual impairments worldwide can be prevented or cured. Problems involve lack of information about diagnosis and treatment, such as the mistaken belief many adults have that the eye exam given to renew drivers' licenses will screen for these visual conditions. Another problem is that many people in the United States and around the world live in areas without access to eye-care specialists. And still another problem arises when older adults and their family members believe that failing eyesight is an unavoidable part of aging (Gohdes, Balamurugan, Larsen, et al., 2005). Hearing. Most adults begin to experience some hearing loss in their 30s, mainly of higher tones. There is also shortening of the loudness scale-that is, there is confusion between loud tones that are not being heard as well as before and softer tones that are still being heard accurately. \Tithout the loud-soft discrimihation, it is difficult to perceive which sounds are coming from nearby and which are from across a noisy roomwhich words are coming from your dinner partner and which from the server taking an Chapter 2 Iistening to music or listening to conversation. These devices ampli8/ and direct sound to better its chance of being picked up by the impaired hearing system. When sensorineural hearing loss is severe, doctors may recomm end cochlear implants, a surgicai procedure that allows sound waves to bypass the hair cells and go directly to the acoustic nerve. Taste and Smell. Taxe and smell depend on three mechanisms that interact to enable us to enjoy the food we eat and the fragrances in our environment. They also provide survival information that keeps us from eating food that is spoiled and warns us of dangerous substances such as smoke or gas leaks. These mechanisms consist of smell, taste, and common chemical sense. Smell takes place in the olfactory membrane, a specialized part of the nasal membrane. It consists of millions of receptors and thousands of difierent kinds of cells. This variery lets us experience subtle and complex flavors. In addition, we experience more basic flavors through the taste buds, which are receptor ceils found on the tongue, mouth, and throat. Saliva dissoives food, and the molecules that are released stimulate the receptors. Taste buds specialize; they respond to either sweet or salty tastes (at the front ofthe tongue), sour tastes (on the sides ofthe tongue), or bitter tastes (at the back ofthe tongue). Irritating properties offood and odors are sensed by receptors on the moist surfaces of the mouth, nose, throat, and eyes. These convey the spiciness of chili peppers and the coolness of mint. All three rypes of receptors take information to different parts of the brain, where the totai experience is integrated and translated into messages. such as knowing you are having a pleasurable dining experience or that the milk in your refrigerator has outlived its expiration date (Fukunaga, LJematsu, & Sugimoto, 2005). The abiliry to taste and smell declines over the adult years, beginning about 30 years of age and becoming more noticeable around 55 or70. Over 2 million people in the United States have disorders of taste or smell, and most of them are older adults. This happens for several reasons. First, Iess saliva is produced in older people, reducing the reiease of molecules in food to be sensed by the taste buds. Second, there are fewer taste buds-about half as many at 70 years of age as at 20; those that detect sweet and salry flavors decline more rapidly, making us salt our food and sweeten our coffee or tea to a greater extent than in earlier years. implications of older adults' decline in There is also a decrease in the number of odor receptors in the nose as we ability to detect tastes and smells? age (Rosenfeld, 2005). The risk factors for loss of taste and smell are older age, beionging ro the male gender, smoking, living in urban areas, and working in industries such as paper and chemical manufacturing. \X/hat are some of the health and safetl, l Bones and Muscles t t t The major change involved in primary aging of the bones is calcium loss, which causes bones to become less dense. Peak bone mass is reached around the age of 30, followed by a gradual decline for both men and women, but the overall effect of this bone loss is greater for women for several reasons. First, women's bones are smaller and contain Iess caicium-in other words, even if the decline is equal, women have started out at a disadvantage. Second, the decline is not equal; women's bone loss rate shows a marked acceleration between the ages of 50 and 65, whereas men's decline is more gradual. Severe loss of bone mass, or osteoporosis, makes the bones more likely ro break than those ofa younger person. There is controversy over whether osteoporosis is a disease or not because the process is not distinguishable from normal aging of th< bones, excepr in degree of severity. I have chosen to include it in this chapter, but it's a judgment call. Physical Changes l=l ! -'Jl il ll ffit ' 50-59 I 60-69 70-79 80 and Over Age Groups ; is based on a measure of bone mass density (BMD), which is easily ! a test calied a DXA scan (dual-energy X-ray absorptiometry scan) of ne. The results are compared to those of a young healthy person. BMD er hip or spine that are more than 2.5 standard deviations below normal sreoporosis. ; affects 16% of women and 4o/o of men over 50. Figure 2.4 shows the reoporosis for men and women in four different age groups. As you can more apt to develop osteoporosis and to develop it at an earlier age than orrud, Dawson-Hughes, et al., 2012). problem caused by osteoporosis is the increased risk ofinjury after a fall. ;ight and a decreased sense of balance result in a greater number of falls as hen brittle bones are entered into the equation, falls can result in serious -. loss of independent living, and even death. The typical sites of breaks and hip. ies to prevent osteoporosis focus on promoting bone health throughg rvith childhood, through proper diet containing required amounts vitamin D. Healthy bones also require a regimen of exercise of the muscles, including high-impact exercise such as running and jumping :bone mass density is becoming more and more a part of routine examina:ologists, internists, and family physicians. Treatment of bone loss consists esrrogen, and drugs that increase the effect ofestrogen and restore lost bone L as Fosomax (bisophosphonates). Recently more emphasis is being placed \eretzce to treatment for bone loss. Patients are being urged to refill their 5efore they run out of medication and to follow the instructions carefully rhe drug is being absorbed well into the system and to avoid unpleasant e\r medication-delivery systems are available that allow patients to take only rth or one IV treatment ayear. The major risk factors for osteoporosis are ,1i du-lt years, bones also change at the joints. Osteoarthritis is a condition rhat he soft cartilage that covers the ends of the bones wears away with use and rs the bones to rub together and causes pain, swelling, and loss of motion ccording to the CDC (2011a), over 27 million people in the United States Figure 2.4 Osteopo- rosis increases with age and is more prevalent for women than for men. Source: Looker, Borrud, Dawson-Hughes , et al. \2012) Chapter 2 Ts,bl* ?.5 Risk Factors for Osteoporosis and Osteoarthritis 0steoporosis 0steoarthritis . lncreased . lncreased age age . Family history . Female gender (after 50) . Female gender . Family history . European, Asian, or Latin ancestry o History of joint injury . History of earlier bone fracture o History of repeated . Sedentary lifestyle* . Overweight or obese BMI* j0int stress* . Smoking" . Excessive alcohol consumption* . Underweight BMl" * Can be controlled or prevented. Source:Adapted from National lnstitute on Aging (2013); CDC (2013). have osteoarthritis, most of them over the age of 65. In older aclults this condition is mor. prevalent in Iemales; irt 1'ounger adults it is more apr ro appcar in males and be the resp-. I a J a t L '! 7t d '-lfa olrwork and spolr, injuries. Researchers are investigating the long-term effects of middle-school and higl:school sports iniuries. For example, professor of orthopedic sulgery Klaus SiebenrIc.. and his colleagues (Srebenrock, Ferner, Noble, et al.,2011) examined young m.il. athletes who had plaved in an elite Swiss basketball club since the age of 8. Ther,"founthat these yollng men were 10 times more likely to have hip deformities that pur rhe:: at risk for osteo,rrthriris than a group of young men the same age who did not pl:. high-level sPorts. In addition, 19% of the arhletes reported at least one episode oih,: pain in the prer.ious 6 morrths, compared to 1.5% of a nonathl.,. g.o.rp. Other str.r;ies have shor,vn that adult athletes are significantlv more likely to ha,re o.teoarthri:., than nonathletes, ar.rc.l rhe prevalence depends on the sport. The most likely culpr-., are soccer, handball, basketbal], baseball, and track and field events that involve iu,-ning and jumping. \What can be done ? Coaches and sports therapists recommend that young athletes :rr: * their parents should be aware of the consequences of extreme trair"ring aiso take :. seriously, reporr rhem, allorv:rdequare healing time, and not "play"nJ through pain. lnjuries Hopefully there is a happv medium that can 1et young athletes.*..f their sporis ar.: "t still have many years of pain-free mobility ahead of them. osteoarthritis, no marrer the age or cause, can lead to depression, anxiety, feelinr of helplessness, lifesryle limitations, job limitations, and loss oL independence.'Hower-.-: most people with this condition find that the pain and stiffness of osteoarthritis car-r i. relieved r'vith anti-infl:rmmatory and pain-relief n-redication and also an appropriate b...ance of lest and exercise to preserve range of motion. \Meight,-,-,"rr,,.g.r-rr.rrris alo helpt-- lbr n.ranv. Some people r,vith osteoarthritis report that they have for-rnd help through alrern, tive and complementary medical treatment, such as acupuncture, -"rrrg. therapy, .-i:_mins, and nutritional supplements. Othcrs have injectio ns of hlah.trarric acid, ihich a natural component of cartilage and joint fluid. Studies are currenrty being done on .. Physical Changes lre For exa-mple, researchers recently conducted a meta-analysis of 29 randsid. of over 17,000 patients who either had needles inserted at traditional hl or at sham sites, chosen randomly. \7hen researchers asked patients }*s - - ::r-ss of the treatment in alleviating osteoarthritis pain, there was a -,,:r: difference in the rwo treatments, showing that the results patients .,i:rior-ral acupuncture sites is more than a placebo effict (Vickers, .: al..2012). - . ' : . .' :-r osteonrthritis cannot finc1 r'elief r,vith these treat[lents. thcrc is the .:r replacenrent. ]n recent vears, over 285,000 hip joints and over ..., have been replaced annualll, in the United States with high success - . ,,:in'of these surgeries are due to osteoarthritis (American Academr. - :-:seons,2011a;2011b). Risk factors for osteoarthritis are also shown r: experience a graclual clecrcase in muscle mass and strength. -:..: is rhat the number of muscle fibers decreases, probably as a result of t .:. '...'rh honnones and testosterone. Another normal, age-related change -.Jr-Llrs ndE doq'lv lose their ability to contract as quickly as they did at younger ages. E, aa- people do not regain muscle mass as quicldy as younger people after such, as when recovering from illness,or injury. All,this being said, frqin-, EItc have adequate muscle strength to attend to the tasks they need to do, as master athleres. However, even the best E_-j*j?jll$*:.tioning Eofexercise help rebuild muscle mass and strength: resistance training which muscles by lifting or pushing and holding the contraction for up - '.: 1 :-'etching, which lengthens muscles and increases flexibility. Stretches 6r j seconds when beginning, but up to 30 seconds with increased pracEl *.v to combine these two types of exercise is water aerobics, and I have ftrtof my exercise plan for many years. Stretching is much easier when the E!d"g much of your weight, and the water also provides more resistance exercises on land. I'm lucky enough to live in south Florida and can classes year-round. (But to be honest, they do heat the pool in the rry home when the air temperature is below 60.) Edry Effl Esnm. Jlrdm. Jf and Respiratory Systems lrmh, Eystem includes the heart and its blood vessels, and you may be glad r: ..:ri of an older person functions about as well as a younger person on a :,-- , :less rhere is some disease present. The difference arises when the car- ::.:: is challenged, as happens during healy exercise. Then the older heart is - - : -' ::re challenge and cannot increase its function as well as a younger heart. ,:.-:=.:red change is that the walls of the arteries become thicker and less fudo oot adjust to changes in blood flow as well as younger arteries. This loss -=-r -=ise hvpertension, or high blood pressure, which is more prevalent in ---,--. lr \"ounger ones. Figure 2.5 shows the proportion of men and women i::: -: rhe United States who have been diagnosed with high blood presD"- see, r}re proportion increases with age for both men and women, with : i- , . r','omen being lower than men untii the 45 to 64 group, then similar J!*.75+ grotp, when it exceeds the proportion for men (American Heart Chapter 2 i r,.rrr:,,: .,:.,:, The pfO- portion of men women who and have been diagnosed with high blood pressure increases with age. Men are more likely to have this condition in earlier adulthood; women in later adu lthood. Source'An.]er can Heart Asso c at on i201 2) c- o E^^ (Ebu =o 950 E+o c 3so o L20 10 llll.l.., 20-34 35-44 45-54 55-64 65-74 75+ Age The lespiratorv s\-srerl is made up of the lungs and the mr-rscles involved in bre.'.. ing. This system s.eakens slightly rvith age, but in healthy people who don't smoke. :.' respirtltoryr functior.r is good enough to srlpport dail,v activities. As with the carcliov:rscr.. . sysrem, the c'liffilence is noticed when the system is chailenged, as it is r'vith vigorc exercise or at higl-r altitudes (Beers, 2004). One good piece of nervs is that regular exercise can reduce some of these effects aging. Exelcise can make the he:rrt stronger and lower: blood pressLtre; lvell-toned m.. ' cles can aid in circulation and breathing. Aerobic exercise, which includes brisk walkirrunning, :rnd bio,cling, is recornmended for the cardiovascular and respiratory svst(n" Brain and Nervous System il ) J t I 1 rI +- Manv people believe that aging means deterioration of the brain, and research in the p.-.,' seemed to supporr this, but recent studies using new technology have shown that loss ilrl-i,1r+r:i5; or brain cells, in prirnary aging is much less severe than once thought. Eviden:. now s|ows that the nervolls system is characterized by lifelong pi.:r;l-lt.i.i:.' meaning th' -neurons are capable ol making changes with age' For example' neurons fbrm nerv ctt nections rvith other neurons, change thresholds and response rates, and take oVer t:-.: functions of nearby neurons that have been damaged (Beers, 2004). Another exarnple of plasticiry in the brain is i:.,r'r.ii-..ttg, the abiliry to shut down ne'..rons that are not needed in order to "fine-tune" the s1'stem and improve functionir-rq rhe remaining neurons. Mosr pruning takes place in early infancv, but there is also e', dence that some neuron loss in old:lge ma)/ reflect this process (Woodruff-Pak, 1997). S althoLrgh rhere is a loss in the total number of neurons rvith age, r-rot all the loss translar., into Ftrnctionrl declin.. Along r,virh neuronal loss and plasticity, the role of ';,:l.r;:,;;genesis, or growth of ne'.' neurons, has been investigated in adult blains. Contrary to long-heid beliefs that tnatui. neurons do not divide and replicate, researchers have found that r.reurogenesis takes p1a;. throughout the adult years, primarily in the dentate gyrus, a small area of the hippocan:pus, rvhich is crucial fbr forming memories (Eriksson, Perftlieva, Bjork-Eriksson, et irr, 1998). The process involves the production ofsr-e*: ;e.iis" immature undifferentiated cei-, that can mr-r1tip1v easily and matlrre into rnany different kinds of cells. Although nellrf genesis conrinues well ii'rto older adulthood, the rate at which neurons are produced slo.',' dou,,n as \e.e age, presumably leading to age-related cognitive loss. Researchers are trying t, fir-rd rvays to boost the rate olt neurogenesis in the later years either by ircre,rsing ste n1 rL. Physical Changes - :: bv identifi,ing factors that lead to the slowdown and finding ways to reduce that a combination of physicai exercise and cognitive have shown -:, Studies -. rromotes neurogenesis in aging animals (Klempin & Kempermann,2007). . :odies comprise the gray mlttter of the brain; myelin, which is a fatry sub-.: -isulates and protects the neuronal axons, is a major component of the wbite i ::: brain. It was once thought that white matter was simply insulation, but -:::lrchers have found that the white matter of the brain may be as important to FEnr as the gray matter. Myelin aids in the processing speed of information along . and its formation begins shortly before birth (Sherin & Bartzokis, 2011). The ra1 timing of white matter more closely fits the changes we experience in our :, : r-havioral, and emotional abilities over the life span than the developmental j . i:lr- matter. Furthermore, it is white matter that makes the major difference - -:'rAn brains and those of other primates (Schoenemann, Sheehan, & Glotzer, :.:.:rg scientists to suggest that myelin underlies our human thinking Processes, : -. ,:-iousness, language, Irlemor/, and inhibitory control (Saithouse, 2000). -a :teging techniques, researchers have demonstrated rhat myelin increases with .,.hildhood and early adulthood, peaks in middle age, and then rapidly decreases " ';th.r, compared to reaction time measures such as finger tapping, both follow ;: r:: .atirr€d U pattern, leading to the speculation that the slowdown of cognitive ; ,- : in old age may be caused more by the breakdown of myelin-the white matter :-, :.. rhan the loss of neurons-the gray matter (Sherin & Bartzokis, 2011)' The r :::-kdown of myelin seems to be a part of primary aging, but it can also be exac' :. :rain trauma, hypertension, diabetes, high cholesterol, and substance abuse. i--,:1f,n., the aging process is not as destructive to the brain and nelwous system :--. rhought. There is gain in many areas throughout adulthood, and not ail the l. related to decline. Researchers are investigating ways to increase neurogenesis : orv down its decline. They are also working on ways to boost the myelin pro-, .i repair processes in older adulthood. However, the overall result of primary lrh". tfri Urai" and nervous system may function less well with age. Older people har longer to react to stimuli than younger people and may show a reduction As - - ::re nral abilities, such as short-term memory and the ability to recali words. Iearn in Chapter 4, many of these changes of primary aging are apparent only n- tests and may not be noticeable to healthy people in their day-to-day lives. , S\-stem system protects the body in rwo ways: The B cells, produced in the bone make proteins called antibodies, which react to foreign organisms (such as -:.i other infectious agents), and the T cells' produced in the thymus gland, -r-: --onsume harmful or foreign ceils, such as bacteria and transplanted organs. with age, and these have been implicated in the increase of in older adults. 'il/ith age, T cells show reduced abiliry to fight -ion. It is difficult to establish that the aging body's decreasing ability to defend ..-.--..'abnormalities disorders :-- disease is a process of primary aging. It is possible, instead, that the immune :".:L)mes weakened in older adulthood as chronic diseases become more prevalent .s- ,rnd nutrition decline r.r nutritional supplements to boost immune function is a topic of controversy. : je are warnings from the U.S. Food and Drug Administration that supplements .:,:ended to treat, prevent, or cure disease. On the other side are research findvarious antioxidant supplements (vitamins C, E, and others) increase immune ;, I Chapter 2 function in lab animals (Catoni, Peters, & Schaefer, 2008) and the nutritional su:, piement manufacturers, who claim that their products will prevent (and reverse) mai.'. asPects of primary aging. My personal conclusion is that that unless your physician re--: you otherwise, middle-aged adults (and younger) with relatively healthy diets and lir.styles don't need to take vitamin supplements. For older adults, especiaily those n'i:-appetite loss or who don't get ourdoors much, a daily multiple vitamin may help ar:; 6xn'1 hupl-excepr for rhe cosr (Porrer, 2009). Hormonal System Both men and women experience changes in their hormonal systems over the course c: adult life, beginning about age 30. Growth hormone decreases with age, reducing musc-. mass, as discussed earlier in this chapter. Aldosterone production decreases, leaving son:. older adults prone to dehydration and heatstroke when sllmmer temperarures ,o".. Ho..' ever, as with many other aspects of primary aging, most of these changes are not noticeabr; until late adulthood (Halter, 2011). One change in the neuroendocrine sysrem that is mor. obvious is the reduction of hormones that results in loss of reproductive ability, a time c: life known as the climacteric. The climacteric takes place gradually for men over midd,. and late adulthood and more abruptly for women around the late 40s and early 50s. The Climacteric in Men. Research on healthy adults suggesrs rhar the quantiry of viabi. sperm produced begins to decline in a man's 40s, but tlie-decline is noirapid, and there are documented cases of men in their 80s fathering children. The testes shrink gradua1ly, and after about age 60, the volume of seminal fluid begins to decline. These changes are associated in part with testicular failure and the resulting gradual decline in testosterone, the major male hormone, beginnins Belore you read on, rvhat have you in early adulthood and extending into old age (Rhoden & Morgentaler. heard about menopause? Do you rhink 2004). Declining hormone levels in men are also associared with decreases men undergo a similar period of change in muscle mass, bone density. sexual desire, and cognitive functions ani in midlife? What picture do the media rvith increases in body fat and depressive symproms (Almeida, \Taterreus. give us ofthis part ofadulthood? Spry, et a1.,2004). 1 2 The Climacteric in Women. During middle adulthood, women's menstrual periods become irregular, then further apart, and then stop altogether. Menopause is defined a-. occurring 12 months after a woman's final menstrual period. Premenopaus,g is the time when a woman is having regular periods, but hormone levels have begun to change. Perimenopause is the time a woman begins having irregular periods but has had a period in the last 12 months. Postmenopause is the time after a woman has not had a period for 72 months, and it extends until the end of her life (Bromberger, Schott, Kravitz. et al., 2010). The main cause of menopause is ovarian failure, leading to a drop in estrogen and complex changes in progesterone, both important hormones in women's reproductive health. \(/omen's health in general, and menopause specifically, have nor been topics of vasr research untii the last few decades (Oertelt-Prigione, Paroi, Krohn, et al., 2010). Common knowledge came from old wives' tales or advice passed down from morher to daughter. Fortunately, several large-scale longitudinal studies have contributed accurate, scientificbased information on the timing of menopause and the changes rhar mosr women experience during this process. One of the best-known and largest of these studies is the \7omen's Health Study (.$ZHS), which has gathered data from almost 40,000 women health professionals over the age of 45. Although the initial study lasted only 10 years. L Physical Changes ::: -onrinue to gather data annually from the participants, and this has been :-:.'aluable findings aboutwomen's health from middle age to the end of life :i ee. 2013). From studies such as this, we know that the average age of meno:'.,.-r:nen in the United States is 51.3 years, ranging from 47 rc 55 years of age. : ,: rhat women today can expect to live well into their 70s, most will spend ': ::::rd of their lives in the postmenopause years. --:. :r.n, this series of hormone changes is accompanied by changes in more than -,. , . abriliry. There is some ioss of tissu.e in the genitals and the breasts, and breast - ::;s less dense and firm. The ovaries and uterus become smaller, the vagina ,.1-1:rer and smaller in diameter with thinner and less elastic walls, and there is -.:-Lrn produced in response to sexual stimulation. . .: tiequently reported and most distressing physical symptom that comes with ..-.isal transition is the hotflash, a sudden sensation of heat spreading over the ::::.:,ih the chest, face, and head. It is usually accompanied by flushing, sweat-::J ofren palpitations and anxiety. The duration of a hot flash averages about : --rout a third ofwomen in the \flomen's Health Study reported that they had nd &eir doctors for treatment because the hot flashes were frequent and severe. r about women's psychological functioning around the time of menopause? It gbeen believed by some that menopause can bring irrational behavior and volatile tenges. However, recent studies that divided women into pre-, peri-, and postrcl satus have shown that women in the perimenopausal and postmenopausal :nx)re apt to have depressive symptoms, especially those women who also report ;gEft events, lack of social support, Iower education, and hot flashes (Bromberger, ,Krerita er al. 2010). trer, I must remind you thar even though these studies show that depressive rs are more likely to occur in women who are perimenopausal and postmenopauJrolute number of women who experience them is very small, and unlike major Lr. depressive symptoms are not severe and often do not last for long. (This will rrod in more detail in Chapter 3.) If primary aging is due to a decline in bormone production in men '.." ;. nlt re?l/lce the lost hormones and reuerse the process? This is not a new - .: has been the impetus behind many failed "fountain-of-youth" therapies - .-..srorv, including the injection of pulverized sheep and guinea pig testicles c ?oolacemenh t):.1' F :-.: -a rhe 1890s and chimpanzee testicle and ovary implants into elderly men rhe 1920s (Epelbaum,2008). Needless to say, none of these measures -:-.. but more recent attempts to replace diminished hormone supplies in -- r: rlle met with some success. Although none reverse the aging process, they r : --,'*'n somewhat. - . ,:- 'sed hormone replacement regimen is a combination of estrogen and pro: ::::--:ibed for women at menopause. This hormone replacement therapy pro-.-:'--rrausal and postmenopausal women with the hormones once produced by ,- :: .:J cirn reduce some of the adverse symptoms of the climacteric. Hormone :,:-: --jr-r.1p\/ can alleviate hot flashes, vaginal dryness, and bone fractures; however, . ',.:: related to an increased risk for breast cancer, heart attacks, stroke, and - - '.,. omen in certain high-risk groups. \7omen are advised to talk to their phy:. -: :,::ir menopausal symptoms to decide on the best course of action for them. ,-i-. - -,:rrroversial, testosterone replacement therapy is popular arnong middle-aged :'1 ---. :r the form of injections, skin patches, and gels applied to the underarms. : -..,--:.trout 20olo of men over 60 have lower-than-norma,l testosterone levels, -:- -: Chapter 2 prescriptions for testosterone replacement in the United States increased from 692,000 in 2000 to 2,660,000 in 2008. Despite this increase in use, the benefits and risks of long-term testosterone replacement therapy (over 3 years) is unknown at this time. For the 20o/o of men who have lower-than-normal testosterone levels, 3 years of treatment has brought increased bone mineral densiry and improved sexual function without adverse effects (Gruntmanis, 2012). Age-related declines in both sexes have been documented for two other hormones, DHEA (dehydroepiandrosterone) and GH (growth hormone). Not only do these hormones decline naturally with age, but animal studies suggest that replacing these hormones reverses aging and provides protection against disease. lVhat about humans? Results have been mixed. Arl early study using DHEA with a small group of older men and women showed promise, but large clinical trials using placebo controls have failed to demonstrate that it has any effect on body composition, physical performance, or qualiry of life (Nair, Rizza, O'Brien, et al., 2006). A meta-analysis of 31 randomized, controlled studies of GH's effects on healthy adults over 50 showed that there were small decreases in body fat and small increases in lean body mass, but increased rates of adverse effects (Liu, Bravata, Olkin, er a1.,2007). A similar study showed that GH has little effect on athletic performance in young, active adults (Liu, Bravata, Okin, et al., 2008). All that being said, DHEA is widely used by adults of all ages in the United States, where it is considered a nutritional supplement and sold in health food stores and over the Internet. GH is also widely available in the United States, despite the fact that it must be prescribed by a doctor If the GH replacement sold on rhe and the FDA has not approved it as an antiaging drug. Products claimInternet is worthless, why are there so many websites selling repeat customers? it and so mau' ing to contain GH account for millions of dollars of Inrernet sales each year (Perls, Reisman, & Olshansky,2005).Clearly, the age-old quest for restored youth continues. Changes in Physical Behavior l The changes in various body systems discussed so far form the foundation for age-related changes in more complex behaviors and day-to-day activities. These changes include a gradual slowing of peak athletic performance; the decline of stamina, dexterity, and balance; changes in sleep habits; and the changes that occur in sexual firnctioning for both men and women. Athletic Abilities T In any sport, the top performers are in their teens or 20s, especially any sport involving in their teens, short-distance runners in their early 20s, and baseball players at about 27. As endurance becomes more involved in performance, such as for longer-distance running, the peak performance age rises, but the top performers are still in their 20s. Few of us have reached the heights of athletic superstars, but most of us notice some downturn in athletic ability shortly after the high school years. Cross-sectional comparisons of athletes of different ages show this dramatically. Figure 2.6 shows the oxygen uptake for three groups of men ranging in age from 20 to 90 years of age (Kusy, Kr6l-Zielinska, Dormaszewska, et aL., 2012). The group represented by the set of bars on the left are professional athletes and masters athletes in Poland who trained for endurance sports (cyclists, triathletes, and longBascd on what you have learned so far, distance runners). The group represented by the bars in the center is their what rvould you guess the peak ages countrymen who have trained for speed-power sports (sprinters, jumpers, would be fbr soccer players, golfers, and and throwers). The set of bars on the right are for untrained men, defined discus throwers? as those who do not have more than 150 minlrtes of vigorous activiry per speed. Gymnasts peak a a a L I Physical Changes Figure 2.6 Athletes who train in endurance sports have greater oxygen uptake at all ages than those who train in speed-power sports. Both groups of athletes have greater oxygen uptake across the adult years than nonathletes, Source: Kusy, K16l-Zieliska, Domaszewska, et al. \2012) Endurance Trained Speed-Power Trained Non-Athletes Type of Training -.-ou can see, the athletes trained for endurance sports have significantly higher -:,-,'qen uptake than those trained for speed-power sports. And both rypes of ath. significantly higher oxygen uptake leveis than the nonathletes at all age levels. -.-':e. although all the men decline with age in oxygen uptake, the differences in : i:oups continue, with some trained athletes in their late BOs still testing higher -=i aonarhletes in their 20s The lesson is clear; we slow down as we get older, but : i:.irr out in better shape and keep exercising, we are still ahead of those who -- :-=d at all. -i : ffiitil*#,'H:l#r:I.'iiln:Ti:ii:t"T::k?ff nrf m: Imil.'rffi ,'J,I'.':"1:ii"i::'Ji}trii:,ffi'.'"|',i:'.H:,'Ilh";n:: A slowdown in athletic ability begins in the 20s, although it is only noticeable for those who are top performers. Chapter 2 changes in muscles. Dexterity, the ability to use rhe hands or body way, result of arthritic changes in the joints. Another significant change, one with clear practical ramifications, is a gradual I< of balance, the ability to adapt body position to change. Older adults are likely to ha greater difficulry handling uneven sidewalks or sno\4y streets or adapting rhe body tc swaying bus. AII these situations require flexibiliry and muscle strengrh, both of whi, decline in old age. One result of less steady balance is a greater incidence of falls amor the elderly. As mentioned before, declining eyesight and brittle bones combine with tl decline in balance to produce a hazardous situation for older adults. The seriousness of this problem and the increasing number of older adults h led ro exercise programs being instituted around the world, in community cenrer vereran's halls, and private homes, offering srrengrh and flexibility training, aerob endurance training, and other activities, such as Tai Chi, a gende form of martial ar that emphasizes fluid movements and balance. These programs also include visits fror social u.orkers to give advice on "fall-proofing" the home (for example, have well-l stairs and no throw rugs, avoid loose-fitting shoes, and mark the edges of steps). Th resulrs have been very positive, and the CDC has endorsed a number of communir programs (Stevens, 2010). lost primarily as a Sleep l\'lost of us think of sleep as simply the absence of conscious thought and purposefu actir-in', and this is true to some extent. It is a period of time set aside for cellular resrora rion. energl' conservation, and consolidation of newly formed memories and learning But sleep also has an active component. There are important processes going on while u,, sleep. \\'e find new answers to problems we have mulled over during the day, our creari\' in'is fired up after a good night's sleep, and mental roadbocks have been circumvenre< during the night ranging from how to end the opera we are writing to how to solve , familv relationship problem that seemed hopeless the night before (Lockley & Foster 20i2). So it stands to reason that it is important for us to get a healthy dose of sleep or I I a regular basis. Younger aduits typically need 8.5 hours of sleep each night, and older adults neec 7.5 hours. Yet the average adult gets only 7 hours of sleep each night. Almost half o al1 adults reporr having sleep problems every night, and 70o/o of emerging adults repor not getring the recommended amount of sleep on school nights (National Institute, of Healrh, 2011). This chronic sleep deprivation can lead to increases in accidents heart disease, obesity, diabetes, cancer, and mental disorders and a decrease in immun, function. Sleep probiems differ by age in adulthood. Emerging adults have sleep/wake cycle, thar are about 2 or 3 hours behind that of other adults, making them "night owls' who don't get sleepy until late at night and then don't feel wakeful until midmorn ing. This has been interpreted by generations of parents as laziness, lack of discipline and general belligerence, but recently sleep researchers have come down on the sidt of the younger generation, stating that this is a normal developmental phenomenor and that parents (and educators) should be more understanding and let them sleep ir (Carskadon, 2009). Several states have acted on these findings and delayed rhe star: of high school classes, with a subsequent reduction of absences, tardiness, behavior problems, breakfast-skipping, and auto accidents invoiving teenage drivers (Nationa Sleep Foundation, 2011). Not all school districts have done this, including mine. As am writing this, my l4-year-old grandson, Brendan, is starting his second week of higl a a a t I . e i ' ,_1 ro - -Physical Changes :--:S tuom a middle-school start time of 9:20 in the morning school -- *a high ---O^^'--^.--^ ^--D to frne oi7:30. His bus picks him up four blocks from his house at 6:30. His laments :l me of how unfair adolescence can seem when both biology and bureaucracy . . :l:t l-OUl hg adults continue to have sleepiwake cycles that are slightfy behind their older prerrs, but most of their sleep problems are related to work schedules, family obli.:.r srress. In middle age, lack of sleep due to health problems becomes a factor, .:..'eight has increased and activiq, level has decreased. Stress also contributes to lnblems at this age, when children are entering adulthood and careers are demand-,.--:rrain). Menopause affects sieep with hot flashes and also an increase in sleep rhich is a pause in breathing during sleep due to a constriction of the airway :'- l'oster, 2012). f:r adults sleep about an hour less at night than younger adults, waking about an r:-- ... on average, but also being more apt to take naps during the day. Sleep prob.::: adults can be the effect of physical and mental disorders and also medication. -:'-.:.:;hers believe that although sleep patterns change in old age, it does not mean bmrti" is part of aging-it's just that health problems and medication increase Lockley & Foster, 2072) and time spent exercising decreases (Buman, Hekler, . .. 201 1). ia-the inabiliry to sleep-increases with age and affects women more than .-..:e are three major causes. First, some people seem to be inherently predisposed ra. Second are outside factors such as disease, medication, depression and anxi,::ess. Third are iifestyle factors such as alcohol use, overuse ofcaffeine, Iack of *. :-:.ih-napping, and the use of blue-screen electronic devices before bedtime (and ---,. night). Besides not allowing us to clear our minds and relax, the light from .' .:. phones mimics daylight and confuses the circadian rhythms much like jet lag :" :-: people, especially adolescents and emerging adults, are extremely sensitive to :: results in insomnia. hi Remedies for insomnia include increased physical exercise and time spent outdoors, Chapter 2 As yos can see, some of these firctors can be changed easil,v and others not at all. It i. relatively eas), ro monitor caffeine intake irnd get regular exercise, but dealing rvith heirltl: problegrs anrl r.neclication requires rvorkirrg i,vith yor-rr physician (Punnoose, 20 1 2). Hou ever, this is the best place to starr belt)re moving on to medication, tvhich has not Proveito be as safe and eflective as it rvould seem on TV commercials. Sexual Activiry As a result of normal changes in various systems of the body, sexual behaviol shows tht effects of primary aging. Tlre key indicator usecl in research is the average nu.mber of tin'rt. p.. -orr,h people of diff...rrt ages have intetcourse. A number of early studies sholr'e.l in their 20s rvirh reqular partners, the numbet is high-as much a, .h", "-or"rgp.opl. 10 times oi irror. per month, dropping to about 3 tirnes per moflth fur people in thei: 60s and 70s, and this is found ir-r both cross-sectional and longitudinal studies. Horvever', or-re problem rvith this rcsearch qliestion is that it reduces a vert' comple:' human interacrion into a simple fieqr-renc,v coLlnt. F'erv studies rell us about the qualiry o the sexual relations people have ar different ages oI abour tvpes ofsexual cxpression tha: dont involve intercourse . An exception was a studrr by social psr.chologists John Delamat..: ar1d Sara Moorman (2007) using data collected by the,{ARP in their Modern Maturit= Hot, r'vould you desigtt ,r studr'' ro determine rvhether the drop in seru:rl activity rvith age is a tunction of age or of length of partnership? I 2 Sexualiry Surverr In this survey, over 1,300 men and\\ronten fi'or-n the age ' of 45 to 94 r.vere asked about sexual activities si-rch as kissing and huggirrs sexual touching, oral sex, and m:rstulbatiot-r, as u,ell as sexual intelcourse. Althoueh participation in all these sexual activities rvas related to age, oth': factors rvere importanr, roo, such as pli,vsical :rbilit,v, sexual desire, soci,t. surroundings, and envirottmental aspects ollife at different points in adr-rlrhood. Let's look at sclme of tb.ese factors il.r more detail. PhysicalAbility. Srudies of the ph,vsiological componenrs of the sextral responses.ofyounqc: ,rr.r-r ,.rrd *.o,',-,.r-r (aged 20 to 40) compared to oldel rnen and r'vomen (aged 50 to 7S shou,that there are.1iff.r.,.,.., in all fbur stages of sexual r-espolise (Medina, 1996; Shif-re r: & Ha1flins, 2010). These changes, i,vhich are clescribed in Table 2.6, show that sexu:rresponses of,r,oung., men andwomen are a little fastel ar-rd a little more intense than tl'r. oli., grotrp. Although many changes may result in less sexual activitv with age, some car: hrrr. tL. opposite reiult, sucl'r as lack olconcerns about pregnancy, more privacy in th. home, g..r,.t experience, fer,ver inhibitions, and a deeper understandjng of one's pcrson,',1..d, i,rd those of one's partner (Fraser', Maticka-T1'nda1e, & Srny1ie,2004; Shifren N Hanfling, 2010). On. of the most comrrron sexual problems is -.'..' .'.', 1,,,,'1,1, , :.: '; which i, c1efi1ed as the inability for a man to har.e an ercction adequate fbr satisfactory sexlt,t performance. This problem occurs in an estimated 30 million men in the Urlited State. Lalf of them over 65. Thr,rs, erectile dyslunction is associatecl rvith age, occurritrg in 5t' of men benvecn 40 and 65, ancl in25oh of men over 65 (Schover, Fouladi, Varneke' e ' I I t al., 2004). Alrhough erecrile d,vsfunction occurs for many teasons (heart disease, diabeter excessive alcohol consumprion, medication, smoking), the underlving mechanism seen.i. ,' to be similar in most cases-a shortage ol..'. ,. .,.. a sr-rbstance that is released by th: brain durinq sexual arousal. Part of tl-re job of c,vclic GMP is to close down the veins olth. penis that ,-,orn',allv drain away blood so that the blood sr-rpply increases and the tissuc, t..o-. engorged ancl erect. \flhen cyclic GMP is in short suppl,v, regardless of the rer son, rhe ..r.r1,1 erecrile clysfunction. In the last decade, drugs have been developed th,'magnifi. the effects olcl,clic GMP, making erections possible if even a small amoLlnt L' h L ..'..'..........'......- Physical Changes Sexual Besponse in Older Adults (50-78 Years of Age) Compared to Younger Adults (2040 Years of Age) Men Women Decreased blood flow to genitals. Lower levels cf estrogen and testosterone. Thinning of ,.'aginal lining. Loss of vaginal elasticity and nuscle tone. Decreased blood flow to the genitals. Lower levels of testosterone. Less sensitivity in the penis. Decreased libido. Fewer sexual thoughts and Decreased libido. Fewer sexual thoughts and lantasies. fa S oi,ver arousal. Vaginal lubrication takes 1-5 Greater difficulty achieving an erection. Erection after stimulation takes 10 seconds to several minutes (compared to 3-5 seconds in younger men). Erections not as rigid. -rnutes (compared to 15-30 seconds in younger .'.0men), . agina does not expand as much. Less blood ::ngesti0n in the clitoris and lower vagina. I r-ninished clitoral sensitivity (compared ntasies. Pressure for ejaculation is not felt as quickly (compared to younger men). t0 the -:sponse of younger women). -:ss intense orgasms. Vagina contracts and =':ands in 4to 5 smooth, rhythmic waves :::rrring at 0.8-second intervals (compared to waves occurring at 0.8-second intervals - , iunger women). Uterus contracts and is s:-etimes more painful (compared to younger i :: 10 Less intense orgasms. Urethra contracts in 1 to waves at 0.8-second intervals (compared to 3 to 4 waves at o.8-second intervals for younger men), and the semen can travel 3 to 5 inches after expulsion (compared to 12 to 24 inches in 2 younger men). Smaller volume of semen. ,.,:-gn), :::-rn to prearousal stage is more rapid ::-rpared to younger women). Return to prearousal stages takes only a few seconds (compared to return in younger men, which take f rom minutes to hours). More time between erections. hifren & Hanfling (2010). nr The first of these drugs, Viagra (sildenafil citrate), was approved bw,vears, new drugs have become available for ED, such as Levitra is (radalafil) that are time released to give men a wider window of ming of their sexual activity (Shifren & Hanfling, 2010). In 2010, on ED medication, and another $100 million was spent by drug them (Cohen, 2012). bre, one of the effbcts of menopause for some women is vaginal drytabiliry to lubricate when sexually aroused. This is often alleviated q either pills, patches, or creams, or the use of an artificial lubricant. dirussed later in this section, sexual behavior involves more than rod vaginal lubrication; there is also general health and well-being, onducive surroundings, and the perception of oneself as a sexual ge- So far there is no "little blue pill" that will correct problems in se ilcsire to participate in sexual acdvity waxes and wanes throughout ple, voung adults report loss of desire when career Pressures and is are at a peak. Middle-aged adults report increased sexual desire ncryonsibilities of parenthood end. Older adults report loss of desire Chapter 2 because they believe that sex is only for the young or those with youthfrrl hodii:s. Brrt all in all, the desire to har.e sex is highest in emerging adr-rlthood and declines wirh age as parr of primarr. aging. Although lack of phvsical abilitu- is the major sex-related complaint ot men, clinicians reporr that lack of clesire is by far the most common complaint of women (Tomic, Gallicchio, \71.riteman, et al., 2006). Sexual desire is driven by testosterone in r'vomen as w'e1l as in mct-t. Bv menopause. women have about half of rhe amotrnt of testosterone as the)' clid in their 20s, and that deciine can contribure ro reduced desile for sex anc{ bliefcr, less pleasur:rble orgasms for some women. Tesrosterone replacement theraptr fbr u.omen is fairil, recent and controversial. Several stuciies have shor.r,r-r that clai[v testosterone, delir.ered via a skin patch. can boost sexual desire and incre;rse orgasnrs fol postmenopausal women, but questions remain about the side elfects, s'hich c;rn inciude excess hair growth, acne, liver problems, and lowcr ler.els of HDL (the "soori" cholesreroi). The FDArvill not give approval fbr the use of testosrerone lepl:rcement fbr rvomen u,ith lou, sexual desire until further longterm studies are cornpleted (Shifren & Hanfling, 2010), thoush it is widely prescribecl "ofT 1abel." It should be notecl that tl'rere are safe and proven remedies fol female sexual dysfunction that har.e been helpful to many couples, such as reducing alcohoi coltsumption and stress, increasing exelcise and qualitv time together as a collple, and consulting a professional sex I J tl're rapist. Sexttal Pttrtner. Regardless of age, the main reason most people do not have sexual relarions is thar they don't have a partner. Emerging adults may be ner'v to the d:rting scene or busr. rvirh studies, nor ro mention living in their parents' homes. Young adtilts may be benveen parrners or recovering from a bad breakup and just r-rot readl'to pllt themselves "out there" again. Middie-aged adults cor,rld be divorced after a lor.rg-term marriage and uncornfortable with the changes in the dating culture (and changes in themselves) since they were last single. And oldel adults, divorced or widou'ed, may have problems finding suitable sexual partnels, especiallv wornen, rvho are rnore plentiftrl than mell rtt this age. Some feel conrellt to be alone, feeling that r.ro one can live r-rp to their forrner spolrses. Still others face cliticism from their adr-Llt children, u,ho see Mom or Dad's sexuality as a threat to the memory of their deceasecl parents (or a thlerrt to theil inheritances). Regardless of the Leason, being without a suitable partner is a bigser factor in people's sex lives than their lack of phl,sical abilities and clesirc. Age-related c{ifferences exisr in the nature of the relationship one has rvith his or'her sexual partners, too. Emerging adults'sexual encounters increasingly take the form of t:1;1-1.;,,11,r. or casual sexwithout commitment (Galcia, Reiber, I\4asse1., et al.,2012). We don't know if tl-ris is age-specific or if it u,ili continue for this cohort through their adult r.ears. Micldle-aged and older adr-rlrs todat want more cotnmitment r'vith their sex and, furthermore, wanr a warm and loving relationship. In a study of 60- to 9O-year-old couples ir-r Greece, researchers found that those rvho married out of love, as opposed to being in arranged marriages, reportecl stronger sexual dcsire for: each other ancl rnore fi'equent sexual relarions. The sanle was true of those r,vho reportecl that ther,'r'vere "sdll in love with each other" (Papaharitou, Nakopoulou, Kirana, et al., 2008). Other studies have shown thar fbr adtLlts of al1 ages, having a happier marriage is relatecl to more freqttent sexual intercourse (Del-amater, 201 2). Priuacy. For the 5% of oldel adults who are in nursing hon.res and for those u.ho live with their aclult children, prir'trc' is ;i rnajor' :tLLmbling block to sextlal relarions, e\ren if they have the desire, the :rbility. and a willing partner. Nursing homes and other: residential Physical Changes .: .an be problematic for sexually active residents, married or single. home directors and staff often include information on .-. :nd how to structure the environment to be conducive to their ,-,-,-srnrans, 2012). Homophobic attitudes make it very difficult for .: -iirs to establish or maintain relationships in nursing homes or the .-.-iren. For many the answer has been gay and iesbian retirement ,:S: centers (Clunis, Fredriksen-Goldsen, Freeman, et al., 2005). " :or nursing .i,'-lctittit)/. Not all rypes of sensual pleasure entail all these require- .::i serual fantasies can be sources ofarousal and pleasure for older -.-:s or the physical capability to have intercourse. The National -.. :nd Behavior found that almost half of men and almost a third =:. rrf age reported engaging in masturbation in the past year (LauI -r0S). A substantial number of men and women over 50 report ::-ir \-ear) including about25o/o of men andSo/o of women over70 .,.: don't know if this was in place of vaginal intercourse or along ',.. :nd rve dont know the statistics for same-sex couples. However, -, :rrerest and activiry remain a significant part of life and relation,: lr vears. nl hobbms. \7e previously discussed several treatments for sexual oedication for erectile dysfunction and various hormone replacement rer-e shown that somewhere between l0o/o and 40o/o of middle-aged rc sought treatment from a professional for a problem related to sexual rgh rhat is a pretty wide range, one thing is common among all the of &ose who sought help did so from their primary care physician. :need for these medical personnel (family practice physicians, nursepossess an understanding of the treatment of 'rorienrs of all ages. They also need to feel comfortable discussing the ir oldesr patients. Interestingly, the participants in this study who did uual problems reported no increased frequency of intercourse after 6e majoriry of them did experience an increase in sexual satisfaction ftssician assistants) to :-: l. rliii ri .ill ll rhere is often a big difference between group means and :s in research findings. The accounts of primary aging in this .t'ed the practice, for example, of reporting the auerage scores for ',.:'.r1 scores for 75-year-old wornen. But we can look around us : of diversity among people of the same ages. In fact, the older --:-s there are between us and our own agemates. If you have had : a hieh school reunion, you will know what I mean. Seniors in :-.lr. and they look and behave in much the same manner, but at the age of 28 or so-differences are already apparent. Some -ar ch from their 18-year-old appearances, but others have begun to shape and thinning of hair. By the time you reach your 3}-year ':48 or rrersiry? -- f^- will be even more dramatic. -What factors And, more specifically, you may ask, "\[hat factors might so-the --2t, differences Chapter 2 Genetics Twin studies and other family studies show that the number of years a person li moderately heritable (McClearn, Vogler, & Hofer, 2001), but this may be due to the absence of genetic predispositions for certain diseases, as you will see in th< chapter. Still, living a long life doesn't tell us much about the rate of primary aginl genes influence the rate at which we age? \Would a pair of identical twins start shc wrinkles at the same age and have their hair start turning gray rogether? In one s researchers gathered data about the aging of skin at the Annual Twins Festival in Twinsburg, Ohio, and compared identical twins' faces and those of fraternal t For 130 pairs of twins ranging upto77 years of age, theyfound that the identical I a It t $ t rj L pairs were more alike in their facial skin aging patterns than the fraternal twin and that the genetic contribution to facial skin aging is about 60%. This means 40o/o of our facial skin aging is due to other causes, such as smoking and UV r tion exposure from the sun (Marrires, Fu, Polster, et al., 2009), as well as rhe u tanning beds (Robinson & Bigby,2011). In addition, about 60% of the variatir total body weight is influenced by genetics, as well as the parrern of age-related w change (Ortega-Alonso, Sipild, Kujala, et al., 2009), though physical exercise can r iS, the genetic influence of both total body weight and waist circumference (Mus Silventoinen, Pietihinen, et al., 2009). In a study of overali perception of aging, epidemiologist Kaare Christensen anr colleagues (Christensen, Iachina, Rexbye, er al., 2004) took head-shot photos of same-sex rwin pairs who were at leasr 70 years of age. About half the pairs were id cal rwins and half were fraternal twins, and the pairs were about evenly split ben males and females. Twenry female nurses viewed the photos and estimated the ar each person pictured. On one day, they were questioned about one rwin of each on another day they were questioned about the other twin. The perceived ages o identical nvins were significantly more alike than the perceived ages of the fraternal r Results shorved thar 600/o of perceived age is genetic and 40o/o is due to other fac Furthermore, the judgments turned out to be more than perceptions of age when, years later, researchers found that rwins who were judged as looking older than twin siblings were more apt to have died during that period. "Looking old" and "loo young" are traits that run in families, and these traits are more rhan appearancesare reiated to mortaliry. 4ttutyle Another broad category of factors that affect the rate of primary aging involves the lif< choices we make. This involves exercise, diet, and use of alcohol, tobacco products, other substances. AII through this chapter we have seen risk factors for various age-re conditions, and one of the most frequently mentioned risk factors is sedentary lifes AJI experts on healthy aging emphasize the importance of an active lifestyle. I try to fc my own advice and get a balance of aerobic exercise, strength and flexibility training, yoga.I attend early morning classes almost every weekday before sertling down at my to write. It does wonders for my back and gives me an energy boost. The social asl of visiting with others in my classes are importanr ro my mood, too. Although I have never been a comperitive athlete, I do take inspiration from the ter athletes discussed previously in this chapter. These people 35 to 90 years of age older) who train for athletic events have betier aerobic fitness, higher lerrjs of "gooJ" lesterol, fewer risk factors for diabetes, and better bone densiqy than their peers wh, Physical Changes Etr arhletes. They also are able to consume more calories while weighing less than who have more sedentary lifestyles (Rosenbloom & Bahns, fhis doesn't make them immune from primary aging, but their appearances and :bilities are much "younger" than their chronological agemares. r;omparable ages 6ose rvho dread the idea of starting an exercise program, there is some encourags. Researchers have found that people rypically think negatively about starting a , rorkout regimen, but feel more positive about it once they get srarred. In other reu if it seems difficult and unpleasant ahead of time, just do ir. You will be hapr rou get involved in it (Ruby, Dunn, Perrino, et al., 201 1). 6er important factor in primary aging is diet. I recently bit the bullet (and a kr sticks) and lost 20 pounds that had crept up on me slowly over rhe last few cing that 20 pounds increased my energy level and made me a litde happier mcising. I noticed when traveling that my knees didn't hurt after a long day reing, and I was not out of breath when I climbed srairs or hills (both a rarity r Florida). Better yet, it lowered my cholesterol level and blood pressure so I no *e medication for them. .:.: a healrhy diet has multilevel benefits. There is the weight and appearance : ,,-lso the health benefit. tWhen we eat heaithy food, there is no need to spend :. jesrionable nutrirional supplements and ar-rtiaging potiolrs. Recently research:::J a hidden problem with dependence on nutritional supplements by demoneir "ironic effects." Puzzled by the increase in nutritional supplemenrs on rhe :.
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