" Psychologycal AGING"

Definition :
The United States is on the brink of a longevity revolution. Americans are living longer than ever before. Life expectancies at both age 65 and age 85 have increased. By 2030, the number of people aged 65 and over is projected to be about 71.5 million, of which nearly 10 million will be 85 or older. Although people are living longer, recent research has shown that most older Americans report better health, greater wealth and higher levels of education than older people in the past. But the growing number and proportion of older adults places increasing demands on the public health system and on medical and social services.

Sound health, financial, and lifestyle choices can greatly enhance the quality of an individual's later years.

Because we are living longer we can expect to spend more time in retirement than previous generations did. Achieving a secure and comfortable retirement is easier if you are able to plan your retirement. Most financial planners recommend preparing for the future with a combination of social security, private pensions and personal savings. Experts estimate that retirees will need, on average, 70 percent of their pre-retirement income (90 percent or more for lower earners), to maintain their standard of living when they stop working. Social Security currently pays the average retiree about 40 percent of pre-retirement earnings if you retire at age 65.
Causes

Advances in medicine, science, and technology have enabled today's older Americans to live longer and healthier lives than any previous generation. Yet, many Americans fail to make the connection between undertaking healthy behaviors today and the impact of these choices later in life. Research has established that there are both physical and mental advantages to physical exercise. Individuals should design a program that is right for them. Moreover, screening programs can lead to preventive measures and early treatment, which can substantially reduce the impact of illnesses. A healthy diet is equally important. Nutrition influences the progression of many diseases, and studies have shown that good nutritional status can reduce the length of a hospital stay.

Many assessments of the quality of life of older Americans tend to focus primarily on financial and health aspects. However, second and third careers, lifelong learning, leisure pursuits, voluntary work, and care giving are also issues of importance that are sometimes neglected when planning for the future.
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Symptoms

Although the risk of disease and disability clearly increases with advancing age, poor health is not an inevitable consequence of aging. But there are a number of diseases and disorders more commonly encountered in old age. Chronic diseases such as heart disease, stroke, cancer, diabetes, and arthritis are the most common and costly health conditions. They exact a particularly heavy health and economic burden on older adults due to associated long-term illness, diminished quality of life, and greatly increased health care costs. Hearing and vision problems are also frequently encountered and are often thought of as natural signs of aging. However, early detection and treatment can often prevent, postpone, or lessen some of the debilitating physical, social, and emotional effects that these impairments can have on the lives of older people.

Mental disorders experienced by older adults may differ from those experienced by younger people, which can make accurate diagnosis and treatment difficult. For example, an older person who is depressed may be more likely to report physical symptoms such as insomnia or aches and pains rather than feelings of sadness or worthlessness. It is also important to note that many physicians and other health professionals may not provide effective mental health care because they receive inadequate training in the diagnosis and treatment of mental disorders in older adults.

Furthermore, mental disorders represent a grave threat to the health and well being of older adults. Older adults are disproportionately likely to die by suicide. Comprising only 13 percent of the U.S. population, individuals aged 65 and over accounted for 18 percent of all suicide deaths in 2000. White men age 85 and older are especially vulnerable, with a suicide rate five times greater than that of the general population. Mental disorders can also negatively affect the ability of older people to recover from other health problems. Research has shown that people with depression are at greater risk of developing heart disease. Furthermore, people with heart disease who are depressed have an increased risk of death after a heart attack compared with those who are not depressed.

The occurrence of Alzheimer's disease (AD) is not a normal development in the aging process. AD is characterized by a gradual loss of memory, decline in the ability to perform routine tasks, disorientation, difficulty in learning, loss of language skills, impaired judgment, an ability to plan, and personality changes. Over time, these changes become so severe that they interfere with an individual's daily functioning, resulting eventually in death. While the disease can last from 3 to 20 years after the onset of symptoms, the average duration is 8 years.

Alzheimer's disease affects as many as 4 million Americans. The disease usually begins after the age of 60, and risk increases with age. Most people diagnosed with AD are older than 65. However, it is possible for the disease to occur in people in their 40s and 50s. Research has shown links between some genes and AD, but in about 90 percent of cases, there is no clear genetic link. Early and careful evaluation is important, because many conditions, including some that are treatable or reversible, may cause dementia-like symptoms. Examples of such treatable medical conditions are depression, nutritional deficiencies, adverse drug interactions, and metabolic changes.

Being "down in the dumps" over a period of time is not a normal part of growing old. But it is a common problem, and medical help may be needed. For most people, depression can be treated successfully. "Talk" therapies, drugs, or other methods of treatment can ease the pain of depression.

There are many reasons why depression in older people is often missed or untreated. As a person ages, the signs of depression are much more likely to be dismissed as crankiness or grumpiness. Depression can also be tricky to recognize. Confusion or attention problems caused by depression can sometimes look like Alzheimer's disease or other brain disorders. Mood changes and signs of depression can be caused by medicines older people may take for high blood pressure or heart disease. Depression can happen at the same time as other chronic diseases. It can be hard for a doctor to diagnose depression, but the good news is that people who are depressed can get better with the right treatment.
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Aging is a natural process, but a healthy lifestyle can do much to slow the degeneration of body and mind. The treatment section below contains more specific information on preventive measures.
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Treatment

Many chronic conditions can be improved, if not cured, by treatment and, or, medication and so it is always worth seeking the advice of a doctor.

Many people mistakenly believe that mental disorders like depression or dementia are normal in older people and that no effective treatments are available. Another myth suggests that older people cannot change, experience psychological and spiritual growth, or contribute to society. Therefore, efforts to enhance their mental health might mistakenly be considered futile.

Some older people themselves believe that mental health disorders and treatment are shameful, represent a personal failure, or will lead to a loss of autonomy. They may thus deny having mental health problems or refuse treatment. If there is concern that an older adult is exhibiting symptoms of depression, the first step to getting help is to accept that help is needed. The subject of mental illness still makes some people uncomfortable. Some feel that getting help is a sign of weakness. Many older people, their relatives, or friends may believe, mistakenly, that a depressed person can quickly "snap out of it" or that some people are too old to be helped.

Once the decision is made to get medical advice, start with the family doctor. The doctor should check to see if there are medical or drug-related reasons for the depression. After a complete exam, the doctor may suggest talking to a mental health specialist. The special nature of depression in older people has led to a new medical specialty: geriatric psychiatry.

Be aware that some family doctors may not understand aging and depression. They may not be interested in these complaints. Or, they may not know what to do. If your doctor is unable or unwilling to take your concerns about depression seriously, you may want to consult another health care provider.

If a depressed older person won't go to a doctor for treatment, relatives or friends can help. They can explain how treatment may help the person feel better. In some cases, when an older person can't or won't go to the doctor, the doctor or mental health specialist can start by making a phone call. The telephone can't take the place of the personal contact needed for a complete medical checkup, but it can break the ice. Sometimes a home visit can be made.

Don't avoid getting help because you are afraid of how much treatment might cost. Short-term psychotherapy, with or without medication, will work in many cases. It is often covered by insurance. Also, community mental health centers offer treatment based on a person's ability to pay.

Currently, there is no known cure for Alzheimer's disease (AD). However, scientists have found some medications that may help control some of the symptoms. People with AD must work closely with their doctor to determine which drugs and activities are best for them because reaction to medications varies for each person. As researchers continue to learn more about the disease, new possibilities arise. Organizations such as the Alzheimer's Disease Education and Referral Center (ADEAR) and the Alzheimer's Association can provide up-to-date information, support and advice.

Preventive Measures

Research has shown that a healthy lifestyle is more influential than genetic factors in helping older people avoid the deterioration often associated with aging. People who are physically active, eat a healthy diet, do not use tobacco, and practice other healthy behaviors reduce their risk of suffering from chronic disease and have half the rate of disability compared with those who do not. Screening to detect chronic diseases (such as diabetes or cancers of the breast, cervix and colon) early in their course can save many lives.

Immunizations against influenza and pneumococcal disease will also reduce a person's risk for hospitalization and death from these diseases. Other preventative measures include removing tripping hazards in the home and installing grab bars which can greatly reduce the risk of falls and fractures..

Regular exercise is a preventative measure that will enhance quality of life. Research has shown that even among frail and very old adults, mobility and functioning can be improved through physical activity. However, anyone at risk for any chronic diseases, such as heart disease or diabetes, or who smokes or is overweight, should first check with her doctor before becoming more physically active. Older adults also have special considerations:
Exercise can help older people feel better and enjoy life more, even those who think they're too old or too out of shape.
Most older adults don't get enough physical activity.
Regular exercise can improve some diseases and disabilities in older people who already have them. It can improve mood and relieve depression, too.
Staying physically active on a regular, permanent basis can help prevent or delay certain diseases (like some types of cancer, heart disease, or diabetes) and disabilities.

Plan on making physical activity a part of your everyday life. Do things you enjoy. Go for brisk walks. Ride a bike. Dance. And don't stop doing physical tasks around the house and in the yard. Trim your hedges without a power tool. Climb stairs. Rake leaves.

Safety Tips

Make sure you are exercising safely:
Start slowly. Build up your activities and your level of effort gradually. Doing too much, too soon, can hurt you, especially if you have been inactive.
Avoid holding your breath when exerting yourself. It may seem strange at first, but the rule is to exhale during muscle exertion; inhale during relaxation. For example, if you are lifting something breathe out on the lift; breathe in on the release. If you have high blood pressure, pay special attention to this tip.
If you are on medications or have any conditions that change your natural heart rate, don't use your pulse rate as a way of judging how hard you should exercise. "Beta blockers," a type of blood pressure drug, are an example of this kind of medicine.
Use safety equipment, such as helmets, knee and elbow pads, and eye protection.
Unless your doctor has asked you to limit fluids, be sure to drink plenty when you are doing endurance activities that make you sweat. Many older people do not drink enough fluids, even when not exercising.
When you bend forward, bend from the hips, not the waist. If you keep your back straight, you're probably bending correctly. If you let your back "hump," you're probably bending from the waist, which is wrong.
Make sure your muscles are warmed up before you stretch. For example, you can do a little easy biking, or walking, and light arm pumping first.

None of the exercises should hurt you or make you feel really tired. You might feel soreness, a slight discomfort, or a bit weary, but you should not feel pain. Physical activity and exercise will probably make you feel better.

Finally, exercising the mind is as important as keeping physically active. Recent research suggests that people who regularly engage in mentally stimulating activities such as reading, playing games or doing puzzles, listening to the radio and visiting museums, have a decreased risk of developing Alzheimer's disease. Thus the Japanese proverb "We begin aging when we stop learning" may well prove accurate.

Sources:
Federal Interagency Forum on Aging-Related Statistics
National Institute on Aging
National Center for Chronic Disease Prevention and Health Promotion

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"INSOMNIA"

Definition :

Insomnia is the feeling of inadequate or poor-quality sleep because of one or more of the following: trouble falling asleep (Initial Insomnia); trouble remaining asleep through the night (Middle Insomnia); waking up too early (Terminal Insomnia); or unrefreshing sleep. These can all lead to daytime drowsiness, poor concentration and the inability to feel refreshed and rested upon awakening.

href="http://perawat.blogspot.com/2006/12/7-tips-for-better-nights-sleep.html">Insomnia is not defined by the hours of sleep a person gets or how long it takes to fall asleep. Individuals vary normally in their need for, and their satisfaction with, sleep. Insomnia may cause problems during the day, such as tiredness, difficulty concentrating and irritability.

Insomnia can be classified as transient, intermittent and chronic. Insomnia lasting from a single night to a few weeks is referred to as transient. If episodes of transient insomnia occur from time to time, the insomnia is said to be intermittent. Insomnia (or Primary Insomnia) is considered to be chronic if it occurs on most nights and lasts a month or more.

Women, the elderly and individuals with a history of depression are more likely to experience insomnia. Factors such as stress, anxiety, a medical problem or the use of certain medications make the chance of insomnia more likely.
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Sign and Symptoms :



People will be unable to carry out their daily responsibilities either because they are too tired or because they have trouble concentrating due to lack of restful sleep.

Insomnia may cause a reduced energy level, irritability, disorientation, dark circles under the eyes, posture changes and fatigue.

Patients with insomnia are evaluated by a medical history and a sleep history. The sleep history may be obtained from a sleep diary filled out by the patient or by an interview with the patient's bed partner concerning the quantity and quality of the patient's sleep. Specialized sleep studies may be recommended, but only if there is suspicion that the patient may have a primary sleep disorder such as sleep apnea or narcolepsy.

Diagnostic criteria of primary insomnia:
The predominant complaint is difficulty falling or staying sleep, or nonrestorative sleep, for at least one month.
The sleep disturbance (or associated daytime fatigue) causes clinically significant distress or impairment in social, occupational or other important areas of functioning.
The sleep disturbance does not occur exclusively during the course of narcolepsy, breathing-related sleep disorder, circadian rhythm sleep disorder or a parasomnia.
The disturbance does not occur exclusively during the course of another mental disorder (such as major depressive disorder, generalized anxiety disorder, a delirium).
The disturbance is not due to the direct physiological effects of a substance (such as a drug abuse, a medication) or a medical condition.
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Causes

Certain conditions seem to make individuals more likely to experience insomnia. Examples of these conditions include:
Advanced age (insomnia occurs more frequently in those over age 60)
Female gender
A history of depression

There are a number of possible causes of insomnia:
Jet lag
Shift work
Wake-sleep pattern disturbances
Grief
Depression or major depression
Stress
Anxiety
Exhilaration or excitement
Bed or bedroom not conducive to sleep
Nicotine, alcohol, caffeine, food, or stimulants at bedtime
Aging
Excessive sleep during the day
Excessive physical or intellectual stimulation at bedtime
Overactive thyroid
Taking a new drug
Alcoholism
Inadequate bright-light exposure during waking hours
Abruptly stopping a medication
Medications or illicit drugs
Withdrawal of medications
Interference with sleep by various diseases
Restless leg syndrome
Transient and intermittent insomnia generally occur in people who are temporarily experiencing one or more of the following:
Stress
Environmental noise
Extreme temperatures
Change in the surrounding environment
Sleep/wake schedule problems such as those due to jet lag
Medication side effects

Chronic insomnia is more complex and often results from a combination of factors, including underlying physical or mental disorders. One of the most common causes of chronic insomnia is depression. Other underlying causes include arthritis, kidney disease, heart failure, asthma, sleep apnea, narcolepsy, restless legs syndrome, Parkinson's disease and hyperthyroidism. However, chronic insomnia may also be due to behavioral factors, including the misuse of caffeine, alcohol or other substances; disrupted sleep/wake cycles that may occur with shift work or other nighttime lifestyles; and chronic stress.

Some behaviors may prolong existing insomnia, and they can also be responsible for causing the sleeping problem in the first place:
Worrying about the upcoming difficulty sleeping
Ingesting excessive amounts of caffeine
Drinking alcohol before bedtime
Smoking cigarettes before bedtime
Excessive napping in the afternoon or evening
Irregular or continually disrupted sleep/wake schedules

Stopping these behaviors may eliminate the insomnia.
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Treatment :

Transient and intermittent insomnia may not require treatment since episodes last only a few days at a time. For example, if insomnia is due to a temporary change in schedule, as with jet lag, the person's biological clock will often get back to normal on its own. However, for some people who experience daytime sleepiness and impaired performance as a result of Transient Insomnia, the use of short-acting sleeping pills may improve sleep and next-day alertness. As with all drugs, there are potential side effects. The use of over-the-counter sleep medicines is not usually recommended for the treatment of insomnia.

Treatment for diagnosed chronic insomnia includes identifying and stopping (or reducing) behaviors that may worsen the condition, possibly using sleeping pills (although the long-term use of sleeping pills for chronic insomnia is controversial and should be a last resort), trying behavioral techniques to improve sleep, such as relaxation therapy, sleep restriction therapy, and reconditioning.

Relaxation Therapy

There are specific and effective techniques that can reduce or eliminate anxiety and body tension. As a result, the person's mind is able to stop racing, the muscles can relax and restful sleep can occur. It usually takes much practice to learn these techniques and to achieve effective relaxation.

Sleep Restriction

Some people suffering from insomnia spend too much time in bed unsuccessfully trying to sleep. They may benefit from a sleep restriction program that at first allows only a few hours of sleep during the night and gradually increases the time until the person achieves a normal night's sleep.

Reconditioning

Another treatment that may help some people with insomnia is to recondition them to associate the bed and bedtime with sleep. For most people, this means not using their beds for any activities other than sleep and sex. As part of the reconditioning process, the person is usually advised to go to bed only when sleepy. If unable to fall asleep, the person is told to get up, stay up until sleepy and then return to bed. Throughout this process, the person should avoid naps and wake up and go to bed at the same time each day. Eventually the person's body will be conditioned to associate the bed and bedtime with sleep.

Practice good sleep hygiene: Avoid using alcohol in the evening. Avoid caffeine for at least eight hours before bedtime. Quit smoking. Establish a regular bedtime, but don't go to bed if you feel wide-awake. Avoid staying in bed for long periods of time while awake, or going to bed because of boredom. Exercise regularly, but not in the last two hours before going to bed. Sex can be a natural sleep inducer and helps some people. If these fail, you may want to ask you health care provider to recommend other options.

Tips for a Good Night's Sleep:

Set a schedule:

Go to bed at a set time each night and get up at the same time each morning. Disrupting this schedule may lead to insomnia. Sleeping in on weekends also makes it harder to wake up early on Monday morning because it resets your sleep cycles for a later awakening.

Exercise:

Try to exercise 20 to 30 minutes a day. Daily exercise often helps people sleep, although a workout soon before bedtime may interfere with sleep. For maximum benefit, try to get your exercise about five to six hours before going to bed.

Avoid caffeine, nicotine, and alcohol:

Avoid drinks that contain caffeine, which acts as a stimulant and keeps people awake. Sources of caffeine include coffee, chocolate, soft drinks, non-herbal teas, diet drugs and some pain relievers. Smokers tend to sleep very lightly and often wake up in the early morning due to nicotine withdrawal. Alcohol robs people of deep sleep and REM sleep and keeps them in the lighter stages of sleep.

Relax before bed:

A warm bath, reading or another relaxing routine can make it easier to fall sleep. You can train yourself to associate certain restful activities with sleep and make them part of your bedtime ritual.

Sleep until sunlight:

If possible, wake up with the sun, or use very bright lights in the morning. Sunlight helps the body's internal biological clock reset itself each day. Sleep experts recommend exposure to an hour of morning sunlight for people having problems falling asleep.

Don't lie in bed awake:

If you can't get to sleep, don't just lie in bed. Do something else, like reading, watching television or listening to music, until you feel tired. The anxiety of being unable to fall asleep can actually contribute to insomnia.

Control your room temperature:

Maintain a comfortable temperature in the bedroom. Extreme temperatures may disrupt sleep or prevent you from falling asleep.

See a doctor if your sleeping problem continues:

If you have trouble falling asleep night after night, or if you always feel tired the next day, then you may have a sleep disorder and should see a physician. Your primary care physician may be able to help you; if not, you can probably find a sleep specialist at a major hospital near you. Most sleep disorders can be treated effectively.

Sleep research is expanding and attracting more and more attention. Researchers now know that sleep is an active and dynamic state that greatly influences our waking hours, and they realize that we must understand sleep to fully understand the brain. Innovative techniques, such as brain imaging, can now help researchers understand how different brain regions function during sleep and how different activities and disorders affect sleep. Understanding the factors that affect sleep in health and disease also may lead to revolutionary new therapies for sleep disorders and to ways of overcoming jet lag and the problems associated with shift work. We can expect these and many other benefits from research that will allow us to truly understand sleep's impact on our lives.

Sources:
Diagnostic and Statistical Manual of Mental Disorders
National Heart, Lung, and Blood Institute Information Center
National Institute of Neurological Disorders and Stroke
National Institutes of Health - National Library of Medicine

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