Intro to Adult Lifespan Development 2024 PDF

The LIFEspan…in 90 seconds Introduction to Adult LifeSpan Development Lifespan Development  Adult Lifespan Young Adult (20-40) Middle Adult (40-65) Older Adult (65+)  Purpose of LifeSpan Course To know and understand the development of the “whole person” with...

The LIFEspan…in 90 seconds Introduction to Adult LifeSpan Development Lifespan Development  Adult Lifespan Young Adult (20-40) Middle Adult (40-65) Older Adult (65+)  Purpose of LifeSpan Course To know and understand the development of the “whole person” with reference to different age groups: Psychosocial Cognitive Physical Prepare to apply this knowledge and understanding in professional relationships, particularly as clinician and teacher, but also as colleague and supervisor  Purpose of LifeSpan Course Clinician and Teacher PTs take into consideration what experiences a patient may be having at home, school or at work: a Children who have injuries Children who have impairments that will be present for the entire span of their lives. Adults with various types of temporary impairments Adults who acquire permanent impairments or were born with them.  Purpose of LifeSpan Course Regardless of when a problem occurs in a stage of a patient’s life or the nature of an impairment experienced by a patient… the PT should be aware of not only normal physical development, but also the normal psychosocial and cognitive aspects of development that are likely to influence a patient’s participation in a physical therapy program of care…your Biopsychosocial Model…  Bio-Psycho-Social Model medicine.yale.edu  Purpose of LifeSpan Course PTs need to be aware of the experiences that people of various ages may be going through, particularly with regard to family responsibilities, or commitments to activities outside of work in their communities and how they can impact the care of these patients LifeSpan Course as a Framework Provides a framework for many courses in the DPT curriculum, particularly those courses within the major four systems of the body. Clinical Science Courses: CVP, MS, NM and “Other” systems PT Exam Courses include tests and measures relevant to different age groups. PT Interventions Courses include patient problems from different age groups  Adult Lifespan 3 aspects: Psychosocial Cognitive Physical  Psychosocial Personality and Social Development Personality: Stability and change in the characteristics that differentiate one person from another Social Development: The way in which an individual’s interactions and relationships with others grow, change and remain stable over the course of a lifetime  Cognitive Cognitive: How growth and change in intellectual capabilities influence a person’s behavior Problem Solving Memory Learning Intelligence  Physical Physical: Ways in which the body’s make up help determine behavior Brain Nervous System Muscles Senses Need for food, drink and sleep You’ve had an accident! (Oh no!) The car you were riding in was rear ended leaving you with a severe whiplash injury. You have severe pain and disability in the short term. The accident was not your fault and all other parties are fine. Your Car You You’ve had an accident! (Crisis) 13 year old you 18 year old you You Today Future You  13 year old you Cognitive Psychosocially Physically  18 year old you Cognitive Psychosocially Physically  You today Cognitive Psychosocially Physically  Future You Cognitive Psychosocially Physically How do we define Aging?  Aging How would you define it? When does it begin?  Aging A complex process that involves cells, tissues, organs and systems In general, it refers to changes that occur through the life-span Some changes that indicate aging, e.g., wrinkles and gray hair, are not harmful and are considered super cial. fi  Senescence vs Aging Harmless, superficial changes as we grow older that do not effect survival characteristics such as strength and mobility = Aging (Negligible Senescence) Changes that increase risk of disease, disability or death = Senescence Defined: The natural physical decline that affects survival characteristics brought about by increasing age the process of growing old, especially the conditions that result from the transitions and accumulations of the deleterious aging processes.  Senescence Poorly understood When does it begin? Birth? After peak reproductive years?  Delaying Senescence Life expectancy has improved with improvements in: Environmental Conditions (sanitation, etc.) Antibiotics Improved Medical Care Lifestyle Modifications Average Life Expectancy Average Life Expectancy Mortality Rates USA-Life Expectancy (based on Mortality Rates) CDC.gov  Quick quiz! List as many reasons as you can that may theoretically cause aging. For each one think of some ways that you as a physical therapist may be able to address this (directly or indirectly).  Theories of Aging/Senescence 2 Major Categories: Programmed Theories Aging is innate and programmed into our cells Error (Damage) Theories External forces gradually damage cells and organs Theories of Aging/Senescence  Programmed Theories Programmed Longevity Endocrine (Hormone) Theory Immunological Theory  Programmed Longevity Aging is caused by genes switching on/off over time Death is programmed in!  Programmed Longevity Evidence/Support: Some families live longer Different species have different lifespans eg dog 20 yrs, humans max out in 100’s Longevity genes isolated in fruit flies (Drosophila) and roundworms  Programmed Longevity Evidence/Support: When genes modified in yeast, mice, other organisms -- can almost double their lifespan! Researchers believe that genetics account for up to 35% of variation of aging among people Endocrine (hormone) theory Believes that aging is hormonally regulated Some believe there is an unknown hormone released that promotes the aging process  Endocrine (hormone) theory Evidence/Support: Not Much Understood that Hypothalamus degrades as we get older and HGH and other hormones decrease, Cortisol increases HGH replacement therapy thus far not shown to slow aging (only anectodal)  Immunological Theory The immune system is programmed to decline over time * Increased vulnerability to disease, infection, etc.  Immunological Theory Evidence/Support: Well documented that the immune system peaks at puberty and declines thereafter Dysregulated immune response linked to: Cardiovascular Disease, insulin resistance Alzheimers Disease Cancer Inflammation  Error (Damage) Theories Wear and Tear Theory Rate of Living Theory Cross-Linking Theory Free Radicals Theory Somatic DNA Damage Theory  Error (Damage) theories Wear and Tear Theory Cells and tissues have vital parts that wear out Rate of Living Theory The greater the rate of an organisms oxygen metabolism, the shorter it’s life span  Wear and Tear, Rate of Living Theories Evidence/Support: Wear and Tear We know caps of DNA lose the ability to divide over time - may be genetic vs wear/tear Rate of Living Animals with the most rapid oxygen metabolism tend to have the shortest lifespans No evidence in humans  Cross-linking Theory An accumulation of cross-linked proteins damages cells and tissues, slowing down body processes resulting in aging Evidence/Support: Studies have linked cross linked proteins to aging Cross-linked proteins slow cellular function Cross-linked Collagen fibers (most common protein in the body) affects lungs, arteries, tendons, fascia  Free Radicals theory Free Radicals: Atoms or molecules containing a net positive charge take electrons from neighboring molecules which may not be able to replace them. This theory says that free radicals created during cellular processes cause damage to macromolecular components, accumulating damage and causing cells & eventually organs to stop functioning Free Radical Damage  Free Radical Theory Evidence/Support: Rodent experiments found longer longevity with feeding of anti-oxidants Otherwise poor evidence in humans Somatic DNA Damage Theory DNA Damage occurs in cells of living organisms Most repaired, some accumulate Genetic mutations occur and accumulate with age Particularly relevant to mitochondrial DNA We also know DNA caps lose ability to divide over time SO Who’s Right? Theoretical Perspectives on Psychosocial Development  Psychodynamic Perspective Much of behavior is directed by inner forces, memories, and inner conflicts of which a person has little awareness or control Influences of childhood felt throughout life Freud, Erikson Psychodynamic Perspective Evidence/Support: Not backed by much research, but still used Biased towards men Erikson’s View that development continues throughout the lifespan is considered important and used Psychodynamic Perspective  Behavioral Perspective Keys to understanding development are observable behavior and outside stimuli in the environment. Classical/Operant Conditioning Social Cognitive Theory  Social Cognitive Theory Learning by observing the behavior of another person (a Model) Ex: PT School: you learn, some people model for you, you imitate and then you eventually make it your own Unlike classical/operant conditioning - States we don’t need to experience consequences, we can learn via observation  Social Cognitive Theory 4 Steps: 1. Person pays attention and perceives a model’s behavior 2. Observer must recall the behavior 3. Observer must reproduce the behavior accurately 4. Observer must be motivated to learn and carry out Lifespan trends Life Expectancy and Death Rates  Life expectancy at birth NOTE: Life expectancy data by Hispanic origin were available starting in 2006 and were corrected to address racial and ethnic misclassification. SOURCE: CDC/NCHS, Health, United States, 2015, Figure 18. Data from the National Vital Statistics System (NVSS).  Life expectancy at birth, by sex and race and Hispanic origin NOTES: Life expectancy data by Hispanic origin were available starting in 2006 and were corrected to address racial and ethnic misclassification. Life expectancy estimates for 2016 are based on preliminary Medicare data. SOURCE: CDC/NCHS, SOURCE: Health, NCHS, Health, United United States, States, 2017, 2012, Figure 1.Figure 1. Data Data from from the the National VitalNational Vital Statistics Statistics System (NVSS), System. Mortality. Age-adjusted death rates for selected causes of death, by sex NOTES: Stroke is cerebrovascular disease. CLRD is chronic lower respiratory diseases. SOURCE: NCHS, Health, United States, 2017, Figure 2. Data from the National Vital Statistics System (NVSS), Mortality. Activity Limitation and Disability  Top 10 Causes of Disability among US Adults of those reporting a disability Source: cdc.gov  Functional limitation NOTES: Functional limitation is defined by the reported level of difficulty in six domains of functioning: seeing (even if wearing glasses), hearing (even if wearing hearing aids), mobility (walking or climbing stairs), communication (understanding or being understood by others), cognition (remembering or concentrating), and self-care (such as washing all over or dressing). Estimates are age-adjusted. SOURCE: NCHS, Health, United States, 2017, Figure 11. Data from the National Health Interview Survey (NHIS). Non-Communicable Diseases (NCDs) A non-communicable disease (NCD) is a disease that is not transmissible directly from one person to another. Include: Parkinson's disease, autoimmune diseases, strokes, most heart diseases, most cancers, diabetes, chronic kidney disease, osteoarthritis, osteoporosis, Alzheimer's disease, cataracts, and others. Deaths worldwide from NCDs now exceed all communicable deaths combined and represent an emerging global health threat. Why It’s Important Today, over 75% of all deaths in low & middle-income countries are due to NCDs. Many of these diseases are preventable https://www.cdc.gov/globalhealth/healthprotection/ncd/about.html  Non-Communicable Diseases: NCDs https://www.ifpma.org/resource-centre/4-healthy-habits-mobilizing-volunteers-to-help-fight-noncommunicable-diseases/ Non-Communicable Diseases: NCDs http://www.jpma.or.jp/english/globalhealth/ncds/index.html  Current cigarette smoking SOURCE: CDC/NCHS, Health, United States, 2013, Figure 8. Data from the National Health Interview Survey and the National Institutes of Health/National Institute on Drug Abuse, Monitoring the Future Study. % Adults with COPD aged >18 with Activity Limitations CDC.gov https://www.youtube.com/watch?v=F0kCYP_iPtg  Uncontrolled high blood pressure for adults with hypertension NOTE: Uncontrolled high blood pressure is a measured systolic blood pressure of at least 140 mm Hg or a measured diastolic blood pressure of at least 90 mm Hg among those with measured high blood pressure or who reported taking antihypertensive medication. SOURCE: CDC/NCHS, Health, United States, 2012, Figure 9. Data from the National Health and Nutrition Examination Survey.  Hypertension and awareness of hypertension SOURCE: NCHS, Health, United States, 2017, Figure 10. Data from the National Health and Nutrition Examination Survey (NHANES).  Obesity among children and adolescents NOTE: Obesity is body mass index (BMI) at or above the sex- and age-specific 95th percentile BMI cutoff points from the 2000 CDC Growth Charts. SOURCE: CDC/NCHS, Health, United States, 2012, Figure 10. Data from the National Health and Nutrition Examination Survey.  Overweight and obesity among adults NOTES: Estimates are age-adjusted. BMI is body mass index. Overweight but not obese is defined as a BMI at or above 25.0 to 29.9. Grade 1 obesity is a BMI at or above 30.0 to 34.9, Grade 2 obesity is a BMI from 35.0 to 39.9, and Grade 3 obesity is a BMI greater than or equal to 40.0. SOURCE: NCHS, Health, United States, 2017, Figure 6. Data from the National Health and Nutrition Examination Survey (NHANES).  Insurance, Health Expenditures and Prescription Drug Usage Health insurance coverage among adults aged 18–64 NOTE: The Medicaid category includes the Children’s Health Insurance Program (CHIP). SOURCE: CDC/NCHS, Health, United States, 2012, Figure 14. Data from the National Health Interview Survey.  Health insurance coverage among adults aged 19–25 NOTE: The Medicaid category includes the Children’s Health Insurance Program (CHIP). Persons with Medicaid or private coverage may have additional types of coverage. SOURCE: CDC/NCHS, Health, United States, 2013, Figure 15. Data from the National Health Interview Survey.  Health insurance coverage among adults aged 19–25 Young adults highest rate of uninsured of any age group About 30% of young adults are uninsured higher than any other age group, three times higher than the uninsured rate among children. Source: CMS.gov: The Center for Consumer Information & Insurance Oversight: “Young Adults and the Affordable Care Act: Protecting Young Adults and Eliminating Burdens on Families and Businesses”: 10/2015  Health insurance coverage among adults aged 19–25 Young adults lowest rate of access to employer-based insurance. As young adults transition into the job market, they often have entry-level jobs, part-time jobs, or jobs in small businesses, and other employment that typically comes without employer-sponsored health insurance. Source: CMS.gov: The Center for Consumer Information & Insurance Oversight: “Young Adults and the Affordable Care Act: Protecting Young Adults and Eliminating Burdens on Families and Businesses”: 10/2015  Health insurance coverage among adults aged 19–25 Young adults Health and finances are at risk. Contrary to the myth that young people don’t need health insurance, one in six young adults has a chronic illness like cancer, diabetes or asthma. Nearly half of uninsured young adults report problems paying medical bills. Source: CMS.gov: The Center for Consumer Information & Insurance Oversight: “Young Adults and the Affordable Care Act: Protecting Young Adults and Eliminating Burdens on Families and Businesses”: 10/2015 88 89 Use of three or more prescription drugs in the past 30 days SOURCE: CDC/NCHS, Health, United States, 2012, Figure 16. Data from the National Health and Nutrition Examination Survey.  Drug poisoning deaths involving opioid analgesics NOTES: Rates are age-adjusted, except for age group data. Drug poisoning deaths with the drug type unspecified (up to 25% of total drug poisoning deaths) are not included. SOURCE: CDC/NCHS, Health, United States, 2013, Figure 28. Data from the National Vital Statistics System. Drug overdose deaths Annual Deaths: NSAIDs  Summary Life Expectancy: Getting longer; longer for females than males White living longer than Black Hispanic living longer than White; Hispanic Females, the longest More than 50% of mortality is from chronic conditions Many NCDs are preventable and PTs have a role in this. Disability: Trends staying fairly constant; with some changes Arthritis/Musculoskeletal huge cause of activity limitation  Summary Health Risk Factors: Cigarette Smoking and Uncontrolled HTN Declining; COPD still around Heart Disease & Cancer still prevalent, but increase is flattening a bit. OBESITY & Diabetes RISING! Alzheimer’s is Rising  Summary Other: COPD is still a big contributing factor to Activity Limitations and Participation Restrictions: including mobility reduction and ability to work Prescription drug use and related deaths are Rising Opioids and NSAIDs: related use deaths are increasing. Insurance - Trends are changing…more people are covered since the ACA. Expansion of Medicaid has helped bridge the gap of the uninsured Boom in overall health spending  Questions: Who will be our biggest customers? What role will PTs play in helping reverse some of the negative trends?