week 5 mental health and aging

Health and Prevention “Do not try to live forever, you will not succeed.”

George Bernard Shaw 1856-1950

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1. Stay connected to friends and family. Loneliness can be harmful to your health. 2. Eat a healthy diet. High-fiber fruits, veggies, and whole grains help keep the digestive

system functioning. Avoid sugar, salt, prepackaged foods, butter, and fatty meats. 3. Watch your weight to avoid arthritis. Excess weight puts pressure on the weight-

bearing joints eventually leading to irreversible damage. 4. Stay physically active. Strength training and balance exercises can help reduce falls as

you age. 5. Practice sleep healthy habits. Turn off technology before bed and stick to a consistent

schedule. 6. Stop smoking or using any tobacco products. Now! 7. Take good care of your teeth. Brushing, flossing, and seeing the dentist can help

prevent later-life oral problems including gum recession, staining, decay, and tooth loss. 8. Learn to manage stress. Coping with stress can promote physical and mental health. 9. Stay on top of your health. Get regular check-ups and follow your medical

professional’s advice. 10.Take dance classes. You’ll get your exercise while benefiting from the mental

stimulation involved in learning new moves and remembering choreography.

KEY CONCEPTS IN HEALTH AND PREVENTION

Activities of daily living (ADL)

Eating Bathing Dressing

Transferring Toileting

Instrumental activities of daily living (IADL): • Use the telephone • Go shopping • Prepare meals • Complete housekeeping tasks • Do the laundry • Use private or public transportation • Take medications • Handle finances

Tobacco use

Alcohol use

Unhealthy diet

Sedentary lifestyle

Obesity

Cancer

Cardiovascular disease

Diabetes

Chronic lung disease

RI SK

F A

CT O

RS

CH RO

N IC D

ISEA SE

34.4

6 3.2

10.1

31.1

12.5

55.7

13.9

6.6

22.4

47.6

23

59.1

25.1

11.1

30.7

51.9

19.4

0

10

20

30

40

50

60

70

Hypertension Coronary Heart Disease Stroke Cancer, All Arthritis Diabetes

Percent within Age Groups 45 and Older with Chronic Conditions

45-64 65-74 75+

Non-Communicable Disease Burden

As of 2018, NCD’s accounted for deaths of

41 million people worldwide

Over 85% of those deaths occur in low and middle-income countries where they affect <70 yrs old

DISEASES OF THE CARDIOVASCULAR SYSTEM

Eastern Europe has the highest prevalence of deaths from heart disease (adjusted for age) followed by Central Asia and Central Europe. The lowest rates of heart disease are in Central Sub-Saharan Africa, with similarly low rates in southern Latin America and the high income countries in the Asia Pacific region

25% 27% 35%

50-64 65-74 75+

Rates of physical inactivity

14% inactivity in college- educated

Development of atherosclerosis

As plaque builds up in t he art e rie s of a pe rson wit h he art dise ase , t he inside of t he art e rie s be gins t o narrow, which le sse ns or blocks t he flow of blood.

A st roke happe ns w he n a blood clot blocks blood flow t o t he brain. This cause s brain t issue t o be come damage d or die .

HIGH BLOOD SUGAR

HIGH BLOOD PRESSURE

LOW HDL (“GOOD”) CHOLESTEROL

HIGH TRIGLYCERIDES

EXCESS FAT AROUND WAIST

METABOLIC SYNDROME

Metabolic syndrome is a term used to characterize people who show 3 of the 5 risk factors illustrated here.

Prevention of heart disease and stroke relies on 3 key factors

Cancer

Percent of new cancer cases by age, U.S.

Overweight and obesity present risk factors for cancer among women.

Worldwide cancer deaths in 2018

9.6 million deaths from cancer in 2018

70% were in low- and middle-income countries

One-third due to risk factors of :high BMI, low intake of fruits and vegetables, sedentary life style, and use of tobacco and alcohol.

The most common cancers are lung, breast, colorectal, prostate, skin, and stomach, with the most number of deaths due to lung cancer

Forms of cancer treatment

Radiation Surgery Chemotherapy Targeted drug therapies

Targeted therapy treats cancer by targeting the changes in cancer cells that help them grow, divide, and spread.

DISEASES OF THE MUSCULOSKELETAL SYSTEM

A jo in t w it h s e ve r e o s t e o a r t h r it is

Risk factors and treatment for osteoarthritis

Risk Factors • Impact and

repeated use of joints

• Overweight and obese, especially affects lower joints

Treatment • Over-the-counter

pain medications • Exercise, geared to

individual’s ability • Injection into joints

affects • Replacement of joint

Percentage of adults with arthritis by obesity, diabetes, and heart disease status, U.S. 2013-2015 (age- adjusted)

Osteoporosis

Risk factors and treatments for osteoporosis

Risk factors • Postmenopausal status • White female • Excessive alcohol use • Cigarette smoking • Diets low in calcium,

protein, minerals, vitamins

• Sedentary lifestyle

Treatment • Medications (have

risks) • Not calcitonin • Dietary silicon • Prevention through

weight-bearing exercise

Prevalence of osteoporosis or low bone mass at the femur neck among adults aged 50 and older having elevated 10-yr probability of hip or major osteoporotic fracture

Diabetes

Pancreas

Insulin

Insulin moves glucose into cell where it’s converted to glycogen

Healthy

Type 2

Cells fail to respond to insulin properly; glucose accumulates outside cell

Treatment involves insulin, dietary changes, exercise, and avoidance of interactions with over-the-counter medications

Estimated age-adjusted prevalence of diagnosed diabetes by race/ethnicity and sex among adults 18 years of age and older, U.S. 2013-2015.

RESPIRATORY DISEASES

Neurocognitive disorders

Diagnostic criteria for neurocognitive disorders

Memory loss

Aphasia

Apraxia

Agnosia

Social cognition

Disturbances in executive functioning

Diagnostic criteria for

neurocognitive disorders

• Memory loss • Aphasia • Apraxia • Agnosia • Social cognitive disturbances • Disturbance in executive

functioning

Prevalence Estimates of Neurocognitive Disorders, U.S. vs. World

10% 5-8%

World Health Organization includes all forms of neurocognitive disorders and uses different modeling approach

Alzheimer’s Association places estimate at 5.8 million (includes all forms of neurocognitive disorders); using the WHO modeling approach yields 3.25 million and rule out the 25% who do not have Alzheimer’s Disease.

Other factors affecting prevalence estimates

HIGHER RATES IN LOW- TO MIDDLE-INCOME

COUNTRIES

ACCURACY OF DIAGNOSTIC METHODS

AVAILABILITY OF AUTOPSY RECORDS

Progression of changes that can lead to Alzheimer’s disease

Differences between normal aging and Alzheimer’s disease

Normal aging • Making a bad decision once

in a while • Missing a monthly payment • Forgetting which day it is and

remembering it later • Sometimes forgetting which

word to use • Losing things from time to

time

Alzheimer’s disease • Making poor judgments

and decisions a lot of the time

• Problems taking care of monthly bills

• Losing track of the date or time of year

• Trouble having a conversation

• Misplacing things often and being unable to find them

APP APP

Normal APP Cleavage Formation of β-amyloid plaque

plaque

How Alzheimer's changes the brain

Normal cleavage of APP occurs when it is snipped by α-secretase, releasing a neuroprotective fragment along with the snipped APP. In the formation of a plaque, the snipping by β-secretase and ϒ-secretase results in abnormal cleavage and the production of plaques.

secretase

secretase

secretase

Tau disintegration

Microtubule

Neurofibrillary tangles are formed when tau disintegrates leading microtubules to become twisted and tangled.

Genetic theories of Alzheimer’s disease

Early onset cases led to discovery of potential genetic

causes

The ApoE gene now thought to be involved in

plaques

Social support Mental activity

Physical exercise

Limited alcohol

Mediterranean diet

May reduce Alzheimer’s risk

Protective factors against Alzheimer’s disease

Medical treatments for Alzheimer’s disease

• Anticholinesterase • THA (tacrine) • Donepezil hydrochloride (Aricept) • Galantamine (Razadyne) • Rivastigmine (Exelon)

• Glutamate • Memantine (Namenda)

• Anti beta-amyloid oligomers • Aducanumab

Psychosocial treatments

Teach behavioral methods

01 Adhere to schedule

02 Target problematic behaviors

03 Identify when patient becomes disruptive

04

Other forms of neurocognitive

disorder

• Vascular neurocognitive disorder (multi-infarct dementia)

• Frontotemporal neurocognitive disorder

• Parkinson’s disease • Neurocognitive disorder with

Lewy bodies • Pick’s disease

Reversible neurocognitive disorders

Normal pressure hydrocephalus

Subdural hematoma Delirium

Polypharmacy

Wernicke’s disease (can progress to

Korsakoff syndrome)

Pseudodementia