leadership for a longevity population · by young people to honor the spirits of their ancestors....
TRANSCRIPT
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Leadership for a Longevity Population
Peter Martin [email protected]
Human Development and Family Studies Iowa State University
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Overview
• Introduction • Focus on the Longevity Population • Demographic Changes
• Longevity Hot Spots • Lessons Learned
• Health Behaviors and Longevity • Physical and Functional Health • Emotional Health • Cognitive Health • Environmental Support • Personality and Resilience
• Longevity Education and Prescription
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Defining the Longevity Population •Increased life expectancy (living longer) •Living longer + living well •Living longer without disability •Compression of morbidity
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The Longevity Dividend
•The economic and health benefits that would accrue to individuals and societies if we extend healthy life.
Jay Olshansky
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Demographic Changes and Longevity
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Demographic Changes
•Age group of the 90+ fastest growing segment of our population
He & Muenchrath (2011)
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Population Change, 90+ Population
There will be a rapid increase in the population that is 90 years and older. In 2050, we expect more
than 68 million people 90 years and older worldwide.
Source: United Nations – Profiles of Aging 2013
Chart1
198019801980
201320132013
203020302030
205020502050
100+
95-99
90-94
Year
World Population – 90 Years and Older, (in thousands)
53
475
1802
441
2889
13140
1241
6285
22289
3392
15513
49475
Sheet1
100+95-9990-94
1980534751,802
2013441288913,140
20301241628522289
205033921551349475
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Life Expectancy By Country Rank Country LE Men Rank Women Rank
1 Japan 84.6 82.0 1 87.3 2
2 Andorra 84.2 80.8 8 87.6 1
3 Singapore 84.0 82.0 2 85.6 5
4 Hong Kong 83.8 82.0 2 85.6 5
5 San Marino 83.5 82.0 2 85.0 11
6 Iceland 83.3 81.4 6 85.2 9
7 Italy 83.1 80.4 10 85.8 4
8 Sweden 83.0 81.4 6 84.6 13
9 Australia 83.0 80.5 9 85.5 6
10 Switzerland 82.8 80.4 10 85.4 7
…
42 U.S.A. 79.8 77.4 32 82.2 35
Source: World Health Organization
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Longevity Hotspots (“Blue Zones”)
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Longevity Hot Spots – “Longevity is a Way of Life”
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The Oldest Person Ever: 122 Years and 164 days (1875-1997)
Madame Calment claimed that an occasional glass of Port wine along with a diet rich in olive oil-- were the keys to her longevity.
Here are sample photos of the World's Oldest Documented Person, Madame Jeanne Calment of France, when she was 40 years old (in 1915) and then when she was 120 years old (in 1995).
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Currently Oldest Person
"I didn't want to be dominated by anyone.“ Emma Morano-Martinuzzi
Name Country Age Gender
1 Emma Morano-Martinuzzi
Italy 117 F
2 Violet Brown Jamaica 116 F
3
Nabi Tajima Japan 116 F
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Life Expectancy Differences
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Centenarians per 10,000 state population
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Centenarian Studies
Georgia Phase 1: 137 centenarians Phase 2: 55 centenarians Phase 3: 287 centenarians Iowa Rural Aging: 104 centenarians and nonagenarians Exceptional Longevity: 178 centenarians Heidelberg 91 centenarians Japan • 22 centenarians Total Number: 874 nonagenarians and centenarians
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The Secret of Longevity
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The “Fountain of Youth,” painted by Lucas Cranach the Elder in 1546, illustrates our long fascination with immortality.
The “Fountain of Youth” in Japan: Onsen
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Exceptional Longevity
Genetics and Family
Longevity
Personality
Environmental support
Physical and Mental Health
Health Behaviors
Activity
Core Dimensions of Exceptional Longevity
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Activity and Health Behaviors Lesson 1
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Poor Health Behaviors
Smoking, poor diet and physical inactivity were the causes of 35% of U.S. deaths in 2000.
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The Good News: Smoking Rates Have Declined
U.S.A.
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Nutrition: Typical Meals in Three Countries
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Nutrition: Typical Meals in Three Countries American Meal
Japanese Meal
German Meal
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Community Connectedness in Japan
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Community Connectedness in Sardinia
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The Okinawa and Mediterranean Diet
• Eating a plant-based diet (green and yellow vegetables)
• Limiting sugar and grains • Eating more soy and other legumes • Using herbs and spices instead of salt to flavor
foods • Enjoying meals with family and friends. • Caloric restriction: Only eat until you are 80% full:
“Hara hachi bume.”
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Inactivity
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Activity - Exercise
Stairs
Bicycles
Gardening
More Stairs
More Stairs
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Activity – Arts and Crafts
Centenarian playing the sanshin
Eisā – originally performed by young people to honor the spirits of their ancestors.
Centenarian poetry book
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Benefits of Physical Activity
• Physical health benefits • Increases “good” cholesterol • Prevents diabetes, high blood pressure, and colon cancer, maintains
healthy bones and muscles, joint mobility
• Mental health benefits • Reduce distress, anxiety and depression, increases social support,
cognitive functioning
• Financial benefits • In the United States, increasing physical activity could reduce direct
medical costs by $77 billion annually. • In the United States, inactive women 45 years and older had at least
double the health care costs of their active counterparts
31
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Lesson for Leaders
• Healthy living needs to be encouraged • Individual responsibility
• Communities need to support healthy living • Healthy communities, age friendly communities, bike-friendly
communities
• Focus on three primary health behaviors • Smoking • Eating • Exercise
• Educational programs should focus on life-span behaviors • Teach early, teach late…
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Physical and Functional Health Lesson 2
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Physical Health “Healthy centenarians do not exist…”
(Andersen-Ranberg et al.,2001) Most common causes of death: Cardiovascular disease Cancer Breast cancer (10.8% GCS – 3.0% TCS) Lung cancer(1.2% GCS – 0.0% TCS) Respiratory diseases (3.3 GCS – 7.7 TCS) Diabetes (8.6% GCS – 4.3% TCS)
The prevalence of major diseases (except for cardio-vascular disease) among centenarians is very low.
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Subjective Health Questions
How would you rate your overall health at the present time? ◦ 21% Excellent ◦ 49% Good ◦ 21% Fair ◦ 9% Poor
Chart1
Excellent
Good
Fair
Poor
Rating of Overall Health
21
49
21
9
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Rating of Overall Health
Excellent21
Good49
Fair21
Poor9
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Activity and Functional Capacity
Martin, P., Poon, L. W., Kim, E., & Johnson, M. A. (1996). Social and psychological resources of the oldest old. Experimental Aging Research, 22, 121-139.
Chart1
PhonePhonePhone
WalkWalkWalk
ShopShopShop
CookCookCook
HouseworkHouseworkHousework
MoneyMoneyMoney
60-69
80-89
100+
Percent
98.9
96.8
74.4
94.5
83.9
11.5
95.6
88.2
20.8
100
91.4
41.3
94.5
81.7
24
97.8
90.3
42.3
Sheet1
PhoneWalkShopCookHouseworkMoney
60-6998.994.595.610094.597.8
80-8996.883.988.291.481.790.3
100+74.411.520.841.32442.3
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Changes in Activities of Daily Living
Randall, K., Martin, P., Bishop, A., Poon, L. W., & Johnson, M. A. (2011). Age differences and changes in resources essential to aging well: A comparison of sexagenarians, octogenarians, and centenarians. Current Gerontology and Geriatrics Research, 2011, 1-12. doi: 10.1155/2011/357896
Chart1
BaselineBaselineBaseline
20 months20 months20 months
40 months40 months40 months
60 months60 months60 months
60s
80s
100+
Follow-Up Testing
ADL
12.88
12.38
7.73
12.77
12.02
5.87
12.66
11.66
12.54
11.3
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60s80s100+
Baseline12.8812.387.73
20 months12.7712.025.87
40 months12.6611.66
60 months12.5411.3
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Care and Health Behaviors
Skin Protection on a Sunny Day
Universal Health Care
Mouth Protection
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Lessons for Leaders
• Maintain Physical and Functional Health (cardiovascular disease, cancer, diabetes, ADL)
• Individual responsibility • Communities need to support physical and functional health
• Healthy communities, age friendly communities, bike-friendly communities, health care
• Focus on three primary areas • Activities of daily living • Maximize health insurance coverage • Maintain high strength levels
• Educational programs should focus on life-span behaviors
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Emotional Health Lesson 3
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Age Group Sexagenarians Octogenarians Centenarians
Variable n M (SD) n M (SD) n M (SD) F
Dysphoria 88 0.85 (1.64) 86 0.73 (1.43) 131 0.98 (1.37) 0.78
Fatigue (WAV) 84 1.57a (1.70) 84 2.30b (1.17) 128 3.34c (1.47) 32.21***
Anxiety 88 0.49 (0.86) 90 0.52 (1.00) 134 0.51 (0.92) 0.03
Mental Impairment
87 1.00a (1.10) 89 1.46b (1.23) 128 1.34a,b (1.15) 3.81*
Hopelessness 87 0.39a (0.87) 88 0.55a (0.90) 139 1.04b (1.14) 12.58***
Summary Score
80 11.10a (2.91) 79 11.52a (2.59) 117 13.40b (3.58)
15.43***
Note. WAV – Withdrawal-Apathy-Vigor. Means with different superscripts are significantly different from each other. *p < .05. **p < .01. ***p < .001. Temple-Scheetz, L., Martin, P., & Poon, L. W. (2012). Do centenarians show higher levels of depression? Findings from the Georgia Centenarian Study. Journal of the American Geriatric Society.
Depression or Fatigue?
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Emotional Health
Poon, L. W., Martin, P., & Margrett, J. (2010). Cognition and emotion in centenarians. In C. A. Depp, & D. V. Jeste (Eds.) Successful Cognitive and Emotional Aging (pp. 115-133). Arlington, VA: American Psychiatric Publishing, Inc.
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Emotional Health
Poon, L. W., Martin, P., & Margrett, J. (2010). Cognition and emotion in centenarians. In C. A. Depp, & D. V. Jeste (Eds.) Successful Cognitive and Emotional Aging (pp. 115-133). Arlington, VA: American Psychiatric Publishing, Inc.
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Lessons for Leaders
• Seek positive experiences • Individual responsibility
• Communities need to support emotional health • Provide meaningful activities for older adults, oldest-old
• Focus on three primary areas • Fatigue • Positive experiences • Usefulness
• Educational programs should focus on oldest-old
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Cognitive Health Lesson 4
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Cognitive Health, Iowa Centenarian Study
0
5
10
15
20
0 1 2 3 4 5 6 7 8 9 10
Perc
ent
SPMSQ Scores
Frequencies of SPMSQ scores at baseline (N = 152)
Margrett, J. A., Hsieh, W-H., Heinz, M., & Martin, P. (2012). Cognitive status and change among Iowa Centenarians. International Journal of Aging and Human Development, 75, 317 - 335. doi: 10.2190/AG.75.4.b
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Cognitive Health, Iowa Centenarian Study
0
1
2
3
4
5
6
7
8
9
10
Baseline Time 1 Time 2 Time 3 Time 4
SPM
SQ Sc
ore
Occasion
Individual change in SPMSQ scores across baseline and 4 follow-up assessments occurring during an 8-month period (n = 28)
Margrett, J. A., Hsieh, W-H., Heinz, M., & Martin, P. (2012). Cognitive status and change among Iowa Centenarians. International Journal of Aging and Human Development, 75, 317 - 335. doi: 10.2190/AG.75.4.b
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Lessons for Leaders
• Maintain cognitive health (challenging activities) • Individual responsibility
• Communities need to support cognitive health • Involve oldest old adults in community activities
• Focus on three primary areas • Activity • Memory training • Challenges
• Educational programs should focus cognitive training
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Environmental Support Question 5
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Social Support: “There are people I can depend on to help me, if I really need it”
Chart1
Strongly Disagree
Disagree
Agree
Strongly Agree
Series 1
0
5.3
25.4
69.3
Sheet1
Series 1
Strongly Disagree0
Disagree5.3
Agree25.4
Strongly Agree69.3
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Community Connectedness
Family support is important – More social support is related to better health, memory functioning, and longer life
Spending Time Together
Helping Each Other
Sharing Emotions and Feelings
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Town Square Festivals
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Social Support
Picnic during cherry-blossom season
Meeting at the Market
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Lessons for Leaders
• Maintain social engagement • Individual responsibility
• Communities need to provide social engagement opportunities for old and very old adults
• Focus on three primary areas • Association (time spent) • Affect (quality time) • Assistance (help)
• Educational programs should be social engagement opportunities
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Personality and Resilience Question 6
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Robust, Resilient Personality
Adapted centenarians are • not likely to worry • extraverted • open to new experiences • quite agreeable • conscientious individuals
Big-5
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Personality
-8
-6
-4
-2
0
2
4
6
8
Raw
Sco
re
Neur
otic
ism
Extra
vers
ion
Ope
nnes
s
Agre
eabl
enes
s
Cons
cien
tious
ness
Self ReportsProxy Reports
Martin, P., da Rosa, G., Siegler, I., Davey, A., MacDonald, M., Poon, L. W., et al. (2006). Personality and longevity: Findings from the Georgia Centenarian Study. Age, 28, 343-352.
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Lessons for Leaders
• Maintain resilience • Individual responsibility
• Communities need to support resilience • Focus on three primary areas
• Relax • Be conscientious • Accept
• Educational programs can teach resilience
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Implications for
Gerontology Education
•Degree Programs at Iowa State University • Undergraduate Minor • Graduate Minor • Gerontology Certificate Program (online) • Master’s Degree in Gerontology (online) • Master’s Degree in Gerontology (on campus) • Doctoral Degree in Gerontology (on campus)
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Curriculum
Core Courses
•Geron 530: Perspectives in Gerontology •Geron 534: Adult Development •Geron 540: Nutrition and Physical Activity in Aging •Geron 545: Economics, Public Policy and Aging •Geron 563: Environments and Aging •Geron 577: Aging in the Family •Geron 584: Program Evaluation and Research Methods •Geron 594: Professional Seminar in Gerontology
•12 credits of electives: Elective courses are offered in areas such as biological aspects of aging, gender and aging, spirituality, creativity, cognitive aging, sexuality, mental health and aging, long-term care, gerontechnology, and contemporary concepts in design.
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Summary
• Longevity is the Social Revolution of the 21st Century • Core Dimensions of Healthy Longevity
• Health behaviors • Physical and functional health • Mental health and emotions • Cognitive health • Social engagement • Resilience
• Individual Responsibility • Community Responsibility • Educational Responsibility
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Age (Cecilia Payne Grove at 100)
Age is a quality of mind If you have left your dreams behind, If hope is lost If you no longer look ahead If ambitions fires are dead – Then you are old
���Leadership for a �Longevity Population�OverviewDefining the Longevity PopulationThe Longevity DividendDemographic Changes �and LongevityDemographic ChangesPopulation Change, 90+ PopulationLife Expectancy By CountryLongevity Hotspots �(“Blue Zones”)Longevity Hot Spots – �“Longevity is a Way of Life”The Oldest Person Ever: �122 Years and 164 days (1875-1997)Slide Number 12Life Expectancy DifferencesCentenarians per 10,000 state populationSlide Number 15The Secret of LongevitySlide Number 17Core Dimensions of Exceptional LongevityActivity and Health Behaviors�Poor Health BehaviorsThe Good News: Smoking Rates Have DeclinedSlide Number 22Nutrition: Typical Meals in Three CountriesNutrition: Typical Meals in Three CountriesSlide Number 25Community Connectedness in SardiniaThe Okinawa and Mediterranean DietInactivityActivity - ExerciseActivity – Arts and CraftsBenefits of Physical ActivityLesson for LeadersPhysical and Functional HealthPhysical HealthSlide Number 35Slide Number 36Changes in Activities of Daily LivingCare and Health BehaviorsLessons for LeadersEmotional Health�Depression or Fatigue?Slide Number 42Slide Number 43Lessons for LeadersCognitive Health�Cognitive Health, �Iowa Centenarian StudyCognitive Health, �Iowa Centenarian StudyLessons for LeadersEnvironmental SupportSlide Number 50Community ConnectednessTown Square FestivalsSocial SupportLessons for LeadersPersonality and ResilienceRobust, Resilient PersonalitySlide Number 57Lessons for Leaders�Implications for �Gerontology EducationCurriculumSummaryAge (Cecilia Payne Grove at 100)