Lecture notes, Health aging and the Life Cycle PDF

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Health, Aging and the Life Cycle HLTB01 HLTB01- LECTURE #1 JAN/10/13 Why Study Aging? -We live longer -Baby boomers (after world war 2) -More of us entering senior citizenship -Chronic degenerative diseases (Alzheimer’s) -Social support networks for people with such diseases -How well society can cope with this population -Strain on the care systems/support systems -Care for several generations (kids and grandparents) -Timely concern -“Of interest to human biologists is that senescence and aging are associated with greater biological, physiological, and sociocultural variation than observed during other periods of the human life span.” (Crews and Ice 2012: 638) Geriatrics: branch of medicine that deals with health problems and diseases of old age and aging individuals (medical aspect) Gerontology: field of study concerned with aging and problems of the aged (nonmedical aspect of aging, social aspect ex. Elder abuse) -Focus on baby boomers and how they form a large bulk of the demographic pyramid (2013; biggest it has been from ages 60-90) -Not people getting older, but fewer kids are being born -Less adults in the future because there are less kids being born -Pyramid becoming a rectangle -Need more resources and funding -Health care system needs to be reevaluated as more people have degenerative diseases -Reality… how seniors actually are compared to the stereotypes (hunch back, cane etc.) -What does being a senior really mean? -Elders are living longer because they know how to take care of themselves and are generally healthier -What does aging really mean? Need to reconceptualize this -Redefine what aging means… seniors are still working, going to school, starting a business, good to keep busy, find roles for them -Limits of human longevity; Jeanne Louise Calment lived 122 years! -Aging population is a trend not a global phenomenon -Crews and Ice 2012: Fig. 13.4a…. slight difference in life span between Canada and U.S. (hypothesis is health care)

Biocultural Perspective -Recognizes that culture shapes human biology (its capacities and limitations) -Human body is viewed as the embodiment/product of all environmental factors (social environment, living and non-living/ physical environment) -Environment, Biology, Culture -This is the most complete way we can look at the aging body -Machu Picchu 15th century, Peru (large society that could be examined by their skeletal structures as well as the social factors, the built environment that was created) -Ex. People that live in high altitude places have a certain lung capacity -A cultural environment and a physical environment affect each person -Ex. A person living in poverty would be at greater risk for malnourishment etc. -Social context is important ex. Elderly living in old age homes, how it affects them biologically -Not only living longer but living better?? Yes or no 2 1. What are the features of the ‘first demographic transition’? What is the resulting change in familial social relationships and interactions? -declining mortality, declining fertility -fewer deaths and fewer births result in intergenerational structures less pronounced at the bottom, but more pronounced at the top -horizontal ties (to siblings, cousins) are reduced in number -vertical ties are expanded in scope and complexity (grandparent to grandchild) -these developments have increased the availability of extended intergenerational kin, with grandparents, now more prominent within family relationships

2. Review the changes in national policies toward older adults (in Western societies) from the 1970s onward.

-notion of retirement as a major social institution, with entitlements to pensions (and social security) -grand parenting as an important role -intergenerational reciprocity; older people receiving care and support as part of the ‘moral economy’ underpinning an extended life course 3. What is ‘intergenerational reciprocity’? -a link between backwards and forwards migrations; Reflects great efforts of migrants to sustain connections across time and space…which challenges ability to maintain intergenerational reciprocity (and providing care across great distances) 4. How has the typical Western / North American family (or aspects of ‘demographic capital’) changed over the last 40 years? -Changes to family life in areas such as marriage and divorce, period of economic and social instability which development from the early to late 1970s/1980s, gathering intensity of globalization and its impact on social and family life 5. Describe aspects of the two important effects (re: economics and international migration) of globalization on intergenerational relations. -Intergenerational relationships: important issues generational equality, new forms of multi generational support, characteristics of intergenerational solidarity, changing roles and relationships within families challenges problem of families or societies ensuring continuity given changes in membership through birth, aging and generational succession, how to adapt to a changing social and environmental context, dealing with conflicts or tensions between generations Globalization and aging: now viewed as an influential force driving changes in later life, ex. International organization influencing social policy or through the impact of migration and urbanization on family life in old age 6. What is ‘transnationalism’ and what is the effect on families and social networks? -Transnationalism: the process by which immigrants build social fields that cross geographic, cultural and political borders to link their country of origin with their country of settlement -Transnational communities reflect both the growth of a global economy and the impact of this economy on the construction of family and community ties (‘global families’) -Globalization is producing a new kind of aging in which the dynamics of family and social life may be stretched across different contients and cross different types of societies 7. Review the varied cultural practices regarding elder care and intergenerational interactions in Indonesia. -Intergenerational relationships are most important for elder care -Two aspects of intergenerational relations: living arrangements of elderly and adult children; care arrangements for elderly people

8. From the Keasberry 2001 ethnography, which activities characterize IADLs vs. ADLs, and what were the findings of these measures in older Indonesian adults? -IADL (instrumental activities of daily life): shopping, cutting firewood, getting water, cooking, cleaning, etc. -Support for all IADLs mainly by female household members (e.g., daughter) -High IADL measures among those living alone -Many frail elderly maintain high IADL due to constant activity in old age -ADL (personal activities of daily life): washing oneself, using toilet, feeding oneself, dressing, etc. -Large majority: high ADL scores (if need help: from a co- residing daughter) -ADLs are usually last activities that others will take over (most don’t reach age at which they need help with ADL, or die relatively soon after they can’t perform them) -Research Findings: most elderly lived close to some of their children, most did not need help with instrumental and personal activities of daily life, slight preference to live with daughters, though older mothers preferred sons, poorer village: elderly lived more with a child (or with children often in same village) 9. Consider the following factors in the nature of intergenerational relationships in the Indonesian case study: living distance, out-migration, co-residence preference (of elders for particular children), and larger social processes of industrialization and urbanization. 10.From Lovell 2006, contrast the general negative vs. positive perspectives of aging and the elderly, including the factors behind such views. How do health care professionals’ attitudes of the elderly compare to the general public’s? -Many consider caring for the elderly as low status work and boring, frustrating, with unpleasant working environment, heavy, routine and more physically labor-intensive 11.What are some predictors of an individual’s attitude toward the elderly? Factors for negative views: childhood socialization, societal expectations, lack of exposure/interactions, images of youth and vitality promoted by media source- at same time as persistence of negative stereotypes in media 12.What could be implemented to improve the attitudes of health care workers, as well as the general public, toward the elderly? -Education of age related health changes, senior mentors and role models, positive attitudes of instructors toward the aged, increased exposure to seniors, research into healthy aging, acknowledgement of the fact that majority of elderly today are better educated and healthier, social programs and policies enabling the elderly to keep active and contribute to society 13. What is ‘ageism’? Which factors contribute to this attitude? Ageism: a negative bias or stereotype attitude toward aging and the aged (age-related discrimination) -4 factors: 1) fear of death, 2) societal emphasis on physical beauty of youth, 3)perceived lack of productivity of the elderly, 4) lack of research on well, healthy, elderly community-dwelling individuals (that is made widely known)

HLTB01- LEC 3 Jan, 2013 The Human Life Course and Aging Crewes 2003a (Reading): “humans are unique in that they possess an array of interrelated adaptations that improve their adaptability; these include bipedality, large brains, dependence on vision, verbal communication, culture, manual dexterity, altricial-dependent infants, and long lives.” -Altricial (helpless) Life history: refers to the changes through which an organism passes in its development from its primary stage of life to its natural death; in humans: fertilization, embryogenesis, fetal development, birth; infancy, juvenile, childhood, adolescence, reproductive adulthood, menopause, old age and senescence -the strategy an organism uses to allocate its energy toward growth, maintenance, reproduction, raising offspring to independence, and avoiding death Human Life History: Prenatal, Neonatal, Infancy, Childhood, Juvenile, Adolescence, Reproductive Adulthood, Old Age and Senescence Human vs. Other Primates • All primates have an infant stage, but in non-human primates, this tends to develop directly into juvenile pd. (of sexual maturation) • Human infancy = 0-3 yrs; childhood 3-7 yrs, juvenile = 7-10 (F) or 12 (M), adolescence = 10/12-18/20, reproductive adulthood = 18/20 until menopause for women and ~ 60 for most men -Developmental… refer to these ages not Crewes notes • After reproductive adulthood, other apes succumb to senescent and disease processes, while humans enjoy a period of late-life adult survival, followed by senescent degeneration • Childhood and adolescence are unique human life history stages NOTE: Crewes 2003a: human infancy = 0-1 year childhood = 1-4 yrs juvenile = 5-12 Evolution of Hominid Life History (Bar graph) -Overtime childhood phase grows, new phase of life called adolescence is created in the Erectus stage… -Changes happen because there are selective pressures that are advantageous -Lengthening of childhood has changed how people are socialized, longer life expectancy -New stages of learning, an extended period of time where we were once considered an adult we now have more time to grow (adolescence) Human Growth Pattern Graph -The growth rate decreases overtime during infancy compared to when babies are fetuses -Childhood allows an extensive period of growth Parental Growth and Development Cellular Growth:

Hyperplasia: new cell growth (division) by mitosis Hypertrophy: enlargement (growth) of already existing cells First Trimester: period of greatest cell production (multiplication of millions of cells and differentiation of cells into hundreds of different body parts) Second Trimester: completion of cell differentiation into tissues and organs; embryo now a fetus; see increase in rate of growth of length Third Trimester: growth rate in weight increases; see development and maturation of circulatory, respiratory, digestive systems Prenatal Life -maternal nutrition and lifestyle is very important Postnatal Life -very stressful, critical to the survivability of the child -low birth weight, brain size (50% adult size), SES factors- all important roles Infancy -birth to 3 years -human infants are reliable on breast milk for nutrition -brain growth Human Brain Growth and Function The Human Life Course and Aging 1. LifeHistory 2. StressandAdaptiveResponses 3. FetalProgramming 4. Menopause as a Biocultural Event Crewes 2003a “humans are unique in that they possess an array of interrelated adaptations that improve their adaptability; these include bipedality, large brains, dependence on vision, verbal communication, culture, manual dexterity, altricial-dependent infants, and long lives.” Life history: refers to the changes through which an organism passes in its development from its primary stage of life to its natural death; in humans: fertilization, embryogenesis, fetal development, birth; infancy, juvenile, childhood, adolescence, reproductive adulthood, menopause, old age and senescence the strategy an organism uses to allocate its energy toward growth, maintenance, reproduction, raising offspring to independence, and avoiding death (Stinson et al. 2012) HUMAN LIFE HISTORY Prenatal Neonatal Infancy Childhood Juvenile Adolescence Reproductive Adulthood Old Age and Senescence Humans vs. Other Primates

• All primates have an infant stage, but in non-human primates, this tends to develop directly into juvenile pd. (of sexual maturation) • Human infancy = 0-3 yrs; childhood 3-7 yrs, juvenile = 7-10 (F) or 12 (M), adolescence = 10/12-18/20, reproductive adulthood = 18/20 until menopause for women and ~ 60 for most men • After reproductive adulthood, other apes succumb to senescent and disease processes, while humans enjoy a period of late-life adult survival, followed by senescent degeneration • Childhood and adolescence are unique human life history stages NOTE: Crewes 2003a: human infancy = 0-1 year childhood = 1-4 yrs juvenile = 5-12 Evolution of Hominid Life History 3-4 2.3 mya mya 1 mya From Crewes 2003a Human growth pattern differs greatly from the general ape pattern of relatively constant growth from birth through to attainment of adult stature, as is observed for most mammals (see Bogin 1998a, 1999) (from Crewes 2003a) Crewes 2003a Prenatal Growth and Development Cellular Growth: Hyperplasia: new cell growth (division) by mitosis Hypertrophy: enlargement (growth) of already existing cells First Trimester: period of greatest cell production (multiplication of millions of cells and differentiation of cells into hundreds of different body parts) Second Trimester: completion of cell differentiation into tissues and organs; embryo now a fetus; see increase in rate of growth of length Third Trimester: growth rate in weight increases; see development and maturation of circulatory, respiratory, digestive systems Especially during first trimester (greatest metabolic activity / cell growth) - is a period of high susceptibility to growth pathology caused by either: a) inheritance of genetic mutations (congenital) b) exposure to harmful environmental agents that disrupt normal course of development Prenatal Life Importance of maternal nutrition and lifestyle Postnatal Life Stressful • fluid to gaseous environment, constant temp. to variable

• from reliance on mom’s oxygen and nutrients to self-reliance for digestion, respiration and waste elimination • Nearly 1⁄2 of all neonatal deaths occur during first 24 hrs • Most neonatal mortality due to LOW BIRTH WEIGHT resulting from growth retardation during fetal life (prematurity, congenital defects, maternal nutrition/lifestyle) • At birth: brain approx. 50% adult size (chimps: 75%), though body much smaller proportionally: 20-25% adult height and 1-5% adult weight Importance of Socioeconomic Status (SES) Ultimately Infancy • Period (up to age 3) of most rapid postnatal growth (though decelerated compared to prenatal pd.) • Principle reliance on mother’s breast milk • Deciduous dental eruption • Rapid development of motor and cognitive skills (skeletal/muscular/nervous systems) • Importantly: BRAIN GROWTH (brain grows more rapidly in infancy than almost any other tissue/organ): by age 2: brain reaches ~ 80% adult size Human Brain Growth and Function • Newborn uses 87% of its resting metabolic rate (RMR) (body energy expenditure during rest) for brain growth and function (under 5yrs: 44-85% RMR) • By 5 years: 44% of RMR for brain growth/function • Adult human: 16-25% of RMR for brain function • Transition to solid food that marks end of infancy, usually 24-36 mths in preindustrialized societies Weaning • Notably early compared to other mammals - generally when 3.2-4.9 times birth wt; humans before 3x birth wt. • Coincides with emergence of last primary tooth (usually m2); thus have all primary teeth to process solid foods • Period of notable morbidity & mortality (to age 5) • Synergy of malnutrition-infection Childhood The period following infancy, when the youngster is weaned from nursing but still depends on older people for feeding and protection (Bogin 1997) Childhood

• 3-7 years; defined by its own pattern of growth, feeding behaviour, motor development (incl. adult walking gait by 7) and cognitive maturation • Growth rate now levels off at ~5cm per year (unusual for mammals, who experience continued deceleration in growth velocity after infancy) • Kids weaned but still reliant on adults/older kids for food and protection • IMPORTANTLY: 1) Replacement of primary teeth with permanent dentition (M1=56yrs) and 2) Completion of brain growth (in weight) (see correlation of M1 eruption with brain growth completion ~ 6-7 yrs) Childhood Dependence on others due to: 1) Need for diet dense in energy, lipids and protein to support brain growth 2) Having immature primary dentition, w/thin enamel and shallow roots, which cannot process adult-type diet 3) Relatively small body size – and thus small digestive system, which limits total food intake, furthering requirements for (low volume) nutrient-dense foods Combined with: motor and cognitive immaturity, social inexperience and vulnerability to disease and accidents requiring protection Developmental “Milestones” 1) Social and emotional development 2) Language and communication 3) Cognitive (learning, thinking, problem-solving) 4) Physical development and movement (motor skills) Mid-Growth Spurt • Unique to humans • Small increase in growth velocity at end of childhood • Not observed in all kids (more often in boys than girls) Juvenile Stage • Prepubertal individuals who are no longer dependent on adults/older siblings for survival (have physical and cognitive abilities to survive independently) • 7-10 in girls; 7-12 in boys (later onset of adolescence) • Period of slowest rate of growth since birth; is also predictable and stable (thus, with SES difference, ht/wt values may be reduced, but rate of growth is similar) Juvenile Stage • Period of social learning and in industrialized nations, coincides with start of formal schooling • Point of greatest decrease (dip) in rate of growth signals end of juvenile stage Adolescence

• Start of increased growth rate after juvenile decrease (from deceleration to acceleration now); begins with puberty or gonadarche: reinitiation of activity of hypothalamic-pituitary- gonadal system of hormone production • Period of social and sexual maturation (sex organs, menarche) • Sexual dimorphism in body size and composition (muscle mass) 1. Compared to non-human primates, humans have a prolonged adolescence (pd. between puberty and age of full reproductive maturity...on average 5-8 yrs, compared to 3 yrs for apes) 2. Human boys and girls experience rapid acceleration in growth velocity of almost all skeletal tissue (adolescent growth spurt), unlike other primates (either no acceleration or very small increase) • Little difference in average stature between boys and girls until adolescence • Girls usually begin adolescent growth spurt about 2 years earlier; thus on average, girls taller than similarly aged boys for ...