SCIE 634
Health and Aging

Lisa Barry

Objectives of the Course

This course is designed as a multidisciplinary course that introduces students to the major concepts and principles of gerontology, particularly those applicable to health and older persons.  Students will learn requisite skills to identify emerging trends and issues in gerontology.  By the end of this course, students will be able to identify and discuss: 1) global aging trends; 2) biological and psychological aspects of adult development and aging; 3) aging stereotypes, myths, and taboos and their implications for health care of older persons; and 4) ethical dilemmas regarding older persons.  Furthermore, students will improve their knowledge of how to evaluate and utilize scientific publications.  Overall, the course is organized to examine people’s experiences with aging and health and the societal implications that aging has on healthcare. 

Course Requirements

The requirements for this course include participation (worth 15%), three response papers (worth 10% each), one in-depth interview of an older person regarding health and aging (worth 25%), and a semester research paper (worth 30%).

Participation

I hope that much of the class time will be devoted to class discussion.  You are encouraged to make comments, start ad hoc debates, ask questions to other students, bring news articles to the attention of the class, discuss the implications of the material, and, in effect, think critically.  I strongly believe that an exchange of information will maximize learning, for both the students and the instructor. 

Response Papers

The three response papers required in this course are opportunities to communicate your thoughts and ideas about two topics covered on the syllabus in which you have particular interest.  Response papers are due prior to class discussion of the particular topic.  Response papers should be approximately 1-2 double-spaced pages in length and may include thoughts as to why these articles/assigned readings were chosen, your reaction to the topic and material both before and after reading the articles/assigned readings, and any particular personal experience you have had that can help to explain your thoughts regarding the topic.  Understandably, your response to the topic may change after participating in the class discussion.  However, the purpose of these papers is to not be “right” or “wrong” about any certain issue, but rather to use critical thinking skills and personal interest and experience to help form opinions about the material so that class discussion can be enlivened by your responses. 

In-depth Interview

This exercise is an offshoot of a life history interview which has earned a place in the theory and practice of gerontology because it has cultural, therapeutic, and historical-political value.  The cultural value of life history interviews is the transmission of past values and lessons of the past to succeeding generations. The historical-political value is that the information gleaned both challenges many of the grand narratives embodied in the country’s conception of the past and adds the experiences of people whose voices were not heard in official versions of the past.  Tom Brokaw’s The Greatest Generation (1998) and Studs Turkel’s (1996) Coming of Age: The Story of Our Century by Those Who've Lived It are examples of New York Times best sellers, and each book is a composite of life history interviews.  The therapeutic value is the way reminiscence helps elder men and women actively create a sense of personal meaning.  A very good example of this can be found in the letters send to Tom Brokaw after his book; he compiled many of these letters in The Greatest Generation Speaks: Letters and Reflections (1999).

In this class, you are asked to conduct an interview regarding an older person’s health and how it has affected themselves and others in terms of quality of life, thoughts regarding aging, and thoughts regarding the healthcare system.  The objective is to personalize the issue of aging and health.  Through this interview you might want to also investigate the role of the family in determining well-being and the importance of the family in the delivery of primary health care.  Such added questioning & discussion is a common part of the "conversation" you are likely to have with the elder.

The person being interviewed does not necessarily have to have a medical illness (e.g., diabetes, Parkinson’s disease).  Interviews of individuals who do not have a specific medical condition are also important in terms of investigating how one ages without confronting common medical problems.  This interview provides an opportunity for you to learn from someone else more about a particular condition that may interest you, how older persons navigate the healthcare system, and/or what health means to an older person.

Although (hopefully) some individuals in this class may be over the age of 65, the age commonly considered as qualifying for the status of older adult, students cannot use an autobiographical interview for this exercise. 

Written responses to the interviews should be approximately 5-7 double-spaced pages.
Semester Research Paper

Both first-hand and library-grounded research make the process of studying health and older adults much more intriguing.  Characteristic of developing a semester paper, you come away from the experience with a deeper understanding of a topic and a certainty of having learned.  My expectation is for you to choose a research question pertaining to health and aging that you can delve into throughout the entirety of the semester.  (An example from my own research is “How does coronary artery bypass surgery impact the health-related quality of life of older persons?”)  To answer a research question, one sometimes may use library resources such as census data and published manuscripts and/or students may collect original data and analyze that data, such as the observational data you derive from being around elders or from elder interviews.  “Data” can be photographs, historical documents, interview materials, or observations. 

Again, this is an exercise designed to help you learn more about a topic in which you have particular interest.  It may be a topic that you want to learn more about because of a personal experience, it may be that you heard something about the topic on the news and it piqued your interest. 

Research papers are expected to be 10-12 double-spaced pages.  In class, we can discuss whether students would like to work on this assignment in small groups or individually.  In order to ensure that the topic is appropriate for meeting the course requirement, Ideas regarding potential research paper topics should be emailed to me (date to be determined).

Further details regarding each of the course assignments will be provided during class time.

Textbook

Gerontology: An Interdisciplinary Perspective; Eds. JC Cavanaugh, SK Whitbourne (1999).

Additional Books

Albom, M. Tuesdays with Morrie (1997) 

McGowin, D.  Living in the Labyrinth (1992). 

Selected articles (as outlined in the syllabus).

Course Schedule
September 12

Theories of Aging and Aging as a Demographic Phenomena

Our life span has increased 25 years in the past century.  What have people done with 25 added years?  How has society changed as a result of most people living beyond age 75?

Cavanaugh & Whitboune, Gerontology: Chapter 1 

Part of this class will be reserved for familiarizing students with terms (such as those found in the epidemiologic literature) that they are likely to encounter in some of the assigned readings.  Tips for navigating the readings also will be discussed.  In addition, the purpose of the Response Papers will be further explained and there will be brief discussion of the other class assignments (i.e., the elder interview and the semester research paper).  

September 19

Myths and Stereotypes

Are there myths and stereotypes regarding aging?  If so, can they be deconstructed?

Rodin J, Langer EJ.  Long-term effects of a control-relevant intervention with the institutionalized aged.  Journal of Personality and Social Psychology 33: 897-902, 1977.

Levy, B.R., Slade, M.D., Kunkel, S.R., and Kasl, S.V. Longevity Increased by Positive Self-Perceptions of Aging. Journal of Personality and Social Psychology 2002;83: 261-270.

Levy, B. Improving Memory in Old Age Through Implicit Self-Stereotyping. Journal of Personality and Social Psychology 1996;71:1092-1107.

Levy, B.R. and Schelsinger, M. When Self-Interest and Age Stereotypes Collide: Elders’ Preferring Reduced Funds for Programs Benefiting Themselves. Journal of Aging and Social Policy 2005;17: 25-39.

Miller DW. Leyell TS. Mazachek J. Stereotypes of the elderly in U.S. television commercials from the 1950s to the 1990s. International Journal of Aging & Human Development 2004; 58:315-40.

September 26

Physiological aging: Disability and Frailty

What is normal physical aging?  What is pathological aging?  Is disability an enduring condition?  What does it mean to be frail? 

Cavanaugh & Whitboune, Gerontology: Chapter 4

Verbrugge LM, Jette AM.  The disablement process.  Social Science and Medicine 1994;38:1-14.

Fried,LP; Ferrucci,L; Darer,J; Williamson,JD; Anderson,G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J. Gerontol. Med. Sci. 2004;59(3):255-263.

Hardy SE, Dubin JA, Holford TR, Gill TM.  Transitions between states of disability and independence among older persons.  Am J Epidemiol 2005;161:575-584.

Hardy SE, Gill TM.  Recovery from disability among community-dwelling older persons.  JAMA 2004;291:1596-1602.

October 3

Physiological Aging: Geriatric Syndromes & Self-Rated Health

What are geriatric syndromes and how do they affect how we treat illness in older persons and develop effective interventions to reduce disease burden?

Inouye SK. Schlesinger MJ. Lydon TJ. Delirium: a symptom of how hospital care is failing older persons and a window to improve quality of hospital care. American Journal of Medicine 1999;106:565-73.

Tinetti ME. Inouye SK. Gill TM. Doucette JT. Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes.  JAMA 1995; 273:1348-53.

Barry LC, Gill TM, Kerns RD, Reid MC.  Identification of pain-reduction strategies used by community-dwelling older persons.  Journals of Gerontology: Medical Sciences 2006; 60;1569-75.

Mossey JM. Shapiro E. Self-rated health: a predictor of mortality among the elderly. American Journal of Public Health 1982;72(8):800-8.

October 10

Psychological Aspects of Aging: Dementia

Is aging detrimental to mental health, and what is dementia v. Alzheimer's disease?

McGowan, D.  Living in the Labyrinth

Honig LS. Kukull W. Mayeux R. Atherosclerosis and AD: analysis of data from the US National Alzheimer's Coordinating Center. Neurology 2005. 64(3):494-500.

Tang MX, Stern Y, Marder K, et al.  The APOE-e4 allele and the risk of Alzheimer disease among African Americans, Whites, and Hispanics.  JAMA 1998;279:751-5. 

In class: View excerpts from documentary: “Almost Home”

October 17

Psychological Aspects of Aging: Mental Health

Is depression a necessary component of aging?  Can somatic symptoms be misinterpreted as depression?  Is depression a cause or a consequence of disability?

Cavanaugh & Whitboune, Gerontology: Chapter 11

Alexopoulos GS. Depression in the elderly. Lancet 2005;365(9475):1961-70.

Barry LC, Allore HG, Guo Z, Bruce Ml, Gill TM. Higher burden of depression among older women: The effect of onset, persistence, and mortality over time.  Archives of General Psychiatry (in press). 

(Additional readings to be assigned)

October 24

Caregiving and Family Relations

The family life cycle involves greater "verticalization", a term that refers to the links between preceding and subsequent generations.  Care by friends and family members has long been a cultural norm imposed by family values, public opinion, & laws requiring families to provide care.

Cavanaugh & Whitboune, Gerontology: Chapter 12

Hayslip B Jr. Kaminski PL. Grandparents raising their grandchildren: a review of the literature and suggestions for practice. Gerontologist 2005;45:262-9.

Amirkhanyan AA. Wolf DA. Caregiver stress and noncaregiver stress: exploring the pathways of psychiatric morbidity. Gerontologist 2003;43:817-27.

Kolomer SR, McCallion P.  Depression and caregiver mastery in grandfathers caring for their grandchildren.  International Journal of Aging and Human Development 2005;60:283-294.

October 31 NO CLASS - MAKE UP TBD

Death, Dying, Bereavement and Widowhood

Cavanaugh & Whitboune, Gerontology: Chapter 6

Albom, M.  Tuesdays with Morrie       

Prigerson HG. Shear MK. Frank E. Beery LC. Silberman R. Prigerson J. Reynolds CF 3rd. Traumatic grief: a case of loss-induced trauma. American Journal of Psychiatry 1997;154:1003-9.

Barry LC, Prigerson HG.  Perspectives on preparedness for the death among bereaved persons.  Connecticut Medicine 2002; 66(11):691-697.

Cherlin E. Schulman-Green D. McCorkle R. Johnson-Hurzeler R. Bradley E.  Family perceptions of clinicians' outstanding practices in end-of-life care.  Journal of Palliative Care 2004;20(2):113-6.

November 7

IN-DEPTH INTERVIEW DUE 

Health Care and Long-Term Care

Most older adults do not suffer from serious health problems or from disabilities that result in a need for personal care.  But with aging, an increasing proportion experiences multiple chronic conditions.  Older people are likely to find that the kind of care they need is unavailable, and the kind of care they find may be inappropriate.  Why is desirable long-term care rare?

Cavanaugh & Whitboune, Gerontology: Chapter 15

Tornatore JB. Grant LA. Family caregiver satisfaction with the nursing home after placement of a relative with dementia. Journals of Gerontology Series B-Psychological Sciences & Social Sciences 2004;59:S80-8.

Frankel S, Ebrahim S, Smith GD.  The limits to demand for health care.  British Medical Journal 2000;321:40-5. 

Guest lecturer to discuss recent CT legislation regarding health care options and long-term care for older adults.

November 14

No class on November 14 – Instructor at Gerontological Society of America conference

November 21

No class on November 21 – Thanksgiving Break

November 28

Ethical Issues and Aging

Cavanaugh & Whitboune, Gerontology: Chapter 14

Quinn K. Zielke H. Elder abuse, neglect, and exploitation: policy issues. Clinics in Geriatric Medicine 2005;21:449-57.

Gordon M. Ethical challenges in end-of-life therapies in the elderly. Drugs & Aging 2002;19(5):321-9. 

(Additional readings to be assigned)

December 5

Hot Topics in Aging: Driving; Sexuality and Aging

When are you too old to drive?  What are the effects of aging on sexuality and intimacy?

Marottoli RA. de Leon CFM. Glass TA. Williams CS. Cooney LM Jr. Berkman LF. Consequences of driving cessation: decreased out-of-home activity levels. Journals of Gerontology Series B-Psychological Sciences & Social Sciences 2000;55(6):S334-40.

Marottoli RA. Riding off into the sunset: Implications of an aging motorcyclist population. Annals of Emergency Medicine 2002;39:196-7.

Trobe JD. Waller PF. Cook-Flannagan CA. Teshima SM. Bieliauskas LA. Crashes and violations among drivers with Alzheimer disease. Archives of Neurology. 53(5):411-6.

Butler RN.  The Viagra Revolution.  Geriatrics 1998;53:8-9.

Jacoby, "Great sex: What's age got to do with it?" AARP Magazine

Bakos, "From lib to libido: How women are reinventing sex for grown-ups."  AARP Magazine

Brotman S, Ryan B, Cormier R.  The health and social service needs of gay and lesbian elders and their families in Canada.  Gerontologist 2003;43:192-202.

December 12 RESEARCH PAPERS DUE
The Future

Many ideas about physiological aging are tied to the concept of the life span – the maximum length of life that is biologically possible. 

Olshansky SJ, Carnes BA, Cassel C.  In search of Methuselah: estimating the upper limits to human longevity.  Science 1990;250:634-40.

Vladeck BC. Economic and policy implications of improving longevity. Journal of the American Geriatrics Society 2005;53(9 Suppl):S304-7.

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