I will distribute outline from last class REMIND ME

					As requested, I will distribute information on your assigned reports REMIND ME

					Feedback

					Review from last class

					Do you consider yourself to be an “adult”?

					When will you be “old”?

					You are a member of a patient advocacy panel. An insurance agency will deny claims for hearing problems because it is a normal part of aging. How did the textbook distinguish aging from illness and how does increasing longevity complicate this distinction?

					You what to know if a particular therapy helps older adults. You run a quasi-experimental design in a nursing home. Some adults are in the treatment group and some are in the control group. What are two potential problems to this particular research design?

					You are evaluating research proposals to identify causes of divorce in late adulthood. Some proposed studies use longitudinal designs. Briefly discuss one advantage and 3 disadvantages of this design.

					A presidential candidate says the reason why Social Security will collapse is because life expectancy has increased. What exactly is life expectancy?

					Have you heard of the wonderful one-hoss shay, That was built in such a logical way It ran a hundred years to a day, ... She was a wonder, and nothing less! Colts grew horses, beards turned gray, Deacon and deaconess dropped away, Children and grandchildren -- where were they? But there stood the stout old one-hoss shay ... First of November,  ’Fifty-five! This morning the parson takes a drive. ......All at once the horse stood still, .....What do you think the parson found, When he got up and stared around? The poor old chaise in a heap or mound, As if it had been to the mill and ground! You see, of course, if you’re not a dunce, How it went to pieces all at once, -- All at once, and nothing first, -- Just as bubbles do when they burst. End of the wonderful one-hoss shay. Logic is logic. That’s all I say.

					External

					Brains

					Muscles and stamina

					Hormone Replacement Therapy

					Vision and Hearing

					There is a lot of anti-aging hype. 51 scientists issued a position paper in 2002: No marketed intervention has been proven to slow or reverse human aging. This is important for psychosocial therapists and clinicians. Are your clients doing themselves harm?

					Hot Areas of Research

					Lukewarm Areas of Research

					Cold areas: DHEA and GH

					Heart disease about 50% deaths in U.S.

					Cancer about 25%: curing cancer would only add several years to lifetimes

					Strokes

					Arthritis

					Hypertension

					General Question: How would these conditions influence the extended family?

					Purpose: Is this building “elderly-friendly”?

					Step 1: Divide class into two groups; The Vision-Hearing Team, the Movement Team.

					Step 2: Develop a 5 item checklist, perhaps on your index card: Items to check. Include your IDs.

					Step 3: Your tour: from parking lot to class, don’t forget faculty offices, computer classroom, cafeteria, restroom.

					Step 4: Report back

					LA: Elderly driver collides into crowd at Farmers Market injuring 50 and killing 10.

					Fort Wayne 87 women fatally hits a teen than leaves scene; probation for 6 months.

					LaCrosse: Doctor reluctantly acts to revoke license of 91 year old man. Man and wife loss independence and mobility.

					Note: accidents are many times higher in young adults than in older adults. Ca law requires in-person renewal over age 10 and periodic vision and hearing test.

					ACTIVITY

						DRIVING PERFORMANCE DECLINES WITH DEMENTIA AND AGE St. Louis, Oct. 3, 2003 -- In one of the first studies to track driving performance over time in older adults, researchers at Washington University in St. Louis found that driving abilities predictably worsen in individuals with early Alzheimer’s disease and, to a lesser extent, in older adults without dementia. The findings will appear in the October issue of the Journal of the American Geriatrics Society. “As we expected, people with dementia, generally in the mild stages, declined faster than the nondemented individuals,” says senior author Janet M. Duchek, Ph.D., associate professor of psychology and of occupational therapy. “But it is very interesting that there also was decline in some of our nondemented participants. This is a preliminary study, but it suggests that testing individuals with mild dementia every six months can be useful to identify those who become unsafe.” Alzheimer’s disease is the most common cause of dementia in older adults and affects about 4.5 million Americans. Affected individuals experience memory difficulties and problems with attention and eventually lose the ability to perform complicated tasks like driving. But according to co-author John C. Morris, M.D., principal investigator of the Alzheimer’s Disease Research Center and the Harvey A. and Dorismae Hacker Friedman Distinguished Professor of Neurology, it’s impossible to predict driving performance based solely on whether a person has been diagnosed with dementia. That’s why the research team, which also included Linda Hunt, Ph.D., formerly at the School of Medicine and now at Flathead Valley Community College in Mont., and David B. Carr, M.D., associate professor of medicine, developed an extensive, 45-minute, in-traffic driving test called the Washington University Road Test. “Appropriate testing is important,” Morris says. “For individuals who still drive safely, it can be reassuring and help them remain independent. It also can be used to follow individuals to detect the development of unsafe driving behaviors and intervene, hopefully before there is an actual crash or other problem.” In a study published by Hunt and the team in 1997, 41 percent of individuals with mild Alzheimer’s disease failed the driving test, compared with only 14 percent of those with very mild dementia and 3 percent of nondemented participants. The current study details longitudinal findings with the same group of participants. The team administered the road test every six months to the individuals who passed the test the first time and then compared the time it took each group to go from “pass” to “fail.” As expected, the mild Alzheimer’s group declined the fastest, followed by the very mild dementia group. Surprisingly, performance in the non-dementia group also declined over time, though at a slower rate than the other two groups. In addition, when data from all three groups was combined, increased age alone appeared to be a risk factor in driving performance. “While the majority of the nondemented people we tested remained very safe drivers, as we followed them, more and more became unsafe,” Morris says. “Age-related changes other than dementia likely contribute to driving performance and should be further investigated in larger groups of older adults.” Duchek and Morris emphasize the need to educate physicians and families about the importance of detecting changes that may impair an individual’s driving performance. Signs that should raise concern include an inability to maintain speed or to stay in one lane while driving, hesitating at turns or becoming lost, particularly in familiar areas. “One of the features of dementia is that individuals lose insight and may not recognize that they are becoming unsafe,” Morris explains. “We must increase public awareness about driving issues in demented persons and empower families and health care professionals to intervene before a tragedy occurs.” ### Duchek JM, Carr DB, Hunt L, Roe CM, Xiong C, Shah K, Morris JC. Longitudinal driving performance in early-stage dementia of the Alzheimer type. Journal of the American Geriatrics Society, vol 51, pp. 1342-1347, October 2003. Funding from the National Institute on Aging supported this research. The full-time and volunteer faculty of Washington University School of Medicine are the physicians and surgeons of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient-care institutions in the nation. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare. --------------------------------------------------------------------------