CHAPTER 5

Health and Prevention

Lecture guidelines

As with the previous chapter, there is extensive biological material in this chapter. However, many of the topics lend themselves to discussions within the framework of the biopsychosocial perspective, as these diseases show significant sociocultural variations. It would be best, if time permits, to divide the material into two lectures, allowing an entire lecture for neurocognitive disorders, particularly Alzheimer’s disease, which is a major interest for most of the students in the course. It would be ideal to spend class time focused on healthy lifestyle habits. The PowerPoint slides contain ample data and illustrations, and can easily be updated from current CDC websites, which frequently update statistics and relevant infographics. Another useful source of information provides data on the global burden of cardiovascular disease, but could not be reproduced in the PowerPoint slides (https://www.sciencedirect.com/science/article/pii/S0735109717372443).

Videos and films

Given the explosion of interest in health in all areas of the media, it should be very easy for instructors to find videotape segments to illustrate lecture material. There is a helpful short video available on Alzheimer’s disease from the National Institute of Aging, https://www.nia.nih.gov/health/video-how-alzheimers-changes-brain. There is also a useful video on stroke on blausen.com: https://blausen.com/en/video/stroke/#. A National Geographic video describes cancer: https://video.nationalgeographic.com/video/science/101-videos/00000166-1ba9-d7e2-a966-9beb40320002. There are other cancer videos from the CDC. Discussing the problems of over-prescribing of medications, especially those with potential drug-drug interactions can be highlighted by showing a video of a commercial for a prescription drug along with its side effects.

Discussion questions

Key concepts in health and prevention

Why do variations exist by sex and race in chronic diseases?

What are the relative contributions of genetics and environmental factors in causing differential rates of diseases across age, sex, and racial subgroups of adults?

Can you define the major chronic diseases in your own words?

How do chronic diseases differ from changes associated with normal aging?

Diseases of the cardiovascular system

If you found out that you were at risk for heart disease based on your genetic predisposition, what steps would you take to lower chances of developing the disease?

Why do you think so many people in the U.S. fit the technical definition of "obese"?

Who is most likely to take advantage of preventive efforts to avoid heart disease?

How might public health efforts be better directed at reducing the risk for heart disease in this country?

Cancer

What are the most common forms of cancer?

Why do people ignore the evidence linking certain behavioral lifestyle choices to cancer risk?

How can prevention strategies be made more effective in helping adults to avoid the risks of cancer?

Do you know people with cancer? What has their treatment process been like?

Disorders of the musculoskeletal system

How does osteoarthritis differ from rheumatoid arthritis?

What measures can people take to prevent osteoarthritis?

How does the disease of osteoporosis differ from normal age-related changes in bone?

What do you think about the advisability of taking hormone replacement therapy to prevent osteoporosis compared to other preventive measures?

Diabetes

How does Type 1 diabetes differ from Type 2?

How can the spread of diabetes be slowed through education?

What measures can be taken to motivate people to comply with treatment of Type 2 diabetes?

Why might it be difficult to encourage people to watch their diet and exercise patterns as a way of controlling diabetes?

Respiratory diseases

Are anti-smoking advertisements successful in reducing the rate of cigarette smoking in the U.S. population? How could they be made more effective?

Neurocognitive disorders

What is the difference between dementia and Alzheimer's disease?

What are the political implications of the published prevalence rates of Alzheimer's disease?

What will be the implications of discovering the genetic causes of Alzheimer's disease?

If genetics are thought to be such a strong influence on Alzheimer's disease, how can we explain the findings from the studies showing environmental effects?

If a test is developed that can predict whether a person has a high chance of developing Alzheimer's disease, would you want to take that test and find out the results?

What would be the effects on society of discovering a medical cure for Alzheimer's disease?

Do you know anyone who is a caregiver for a person with Alzheimer's disease? What are the daily challenges this person faces?

Clarify that there are forms of dementia other than Alzheimer's disease and that some are reversible.

Why is it important to distinguish Alzheimer's disease from other forms of dementia?

Why might a depressed person appear to have Alzheimer's disease?

Why is it important to differentiate Alzheimer's disease from delirium?

Multiple choice questions

AgeFeed

Arthritis

As pointed out in the AgeFeed, a health problem that can exacerbate arthritis is:

1. exposure to the sun.
2. excess weight.
3. lack of sleep.
4. eating high fiber foods.

Dance lessons

AgeFeed points out that engaging in dance classes, for older adults, can have what effects?

1. risk of injury
2. mental stimulation
3. higher stress levels
4. interference with sleep

Key concepts in health and prevention

Behavioral risk factors

The behavioral risk factors for chronic diseases in later adulthood include tobacco smoking, unhealthy diet, harmful use of alcohol, and:

1. lack of close relationships.
2. low income and education.
3. physical inactivity.
4. living in rural areas.

ADL

Which of the following is assessed in the Activities of Daily Living measure?

1. ability to use computers
2. number of close friends
3. ability to dress oneself
4. knowledge of one’s finances

IADL

The handling of an individual’s personal finances is an ability included in which measure?

1. Daily Functioning Score
2. Health Prevention Rating
3. Subjective Fitness Assessment
4. Instrumental Activities of Daily Living

Physical inactivity

The rates of physical inactivity for individuals 75 and older are estimated to be:

1. 35%
2. 60%
3. 25%
4. 14%

Diseases of the cardiovascular system

Atherosclerosis

The main feature of atherosclerosis is what physiological change?

1. enlargement of the heart
2. expansion of the arteries
3. overproduction of red blood cells
4. accumulation of plaque in the arteries

Congestive heart failure

What is the term for the cardiovascular disease in which the heart does not pump enough blood to meet the needs of the body’s organs, causing buildup of fluid in the tissues?

1. transient ischemic attack
2. cerebrovascular accident
3. congestive heart failure
4. ischemic heart disease

Atherosclerosis prevention

The combination of eating foods that are low in cholesterol, engaging in aerobic exercise, and avoiding cigarette smoking are important preventive steps for which disease in particular?

1. Atherosclerosis
2. Rheumatoid arthritis
3. Type 1 diabetes
4. Chronic emphysema

WHO non-communicable diseases

According to the World Health Organization, non-communicable diseases (NCD’s) accounted for what percent of deaths worldwide?

1. 41
2. 12
3. 53
4. 85

Death rates global

The highest prevalence of deaths from heart disease occur in which region of the world?

1. Africa
2. Latin America
3. Eastern Europe
4. North America

Stroke belt

Epidemiologists believe that which factor plays an important role in creating risk within the “stroke belt” in the southeastern U.S.?

1. Unhealthy diets
2. Strong UV rays
3. Use of swimming pools
4. Lack of strong family ties

Mediterranean diet

People on the Mediterranean diet use which cooking product in preparing their meals?

1. red meat
2. dairy products
3. olive oil
4. processed grains

Disorders of the musculoskeletal system

Osteoarthritis

The disease in which individuals experience thinning or wearing away of the cartilage at the end of the bones is known as:

1. metabolic syndrome
2. osteoarthritis
3. atherosclerosis
4. osteoporosis

Osteoarthritis risk

Which of the following behaviors is known to be a risk factor for osteoarthritis?

1. cigarette smoking
2. overweight
3. sun exposure
4. low-heeled shoes

Osteoporosis treatment

Research is calling into question the benefits of treating osteoporosis with _____________, a naturally occurring hormone once thought to regulate calcium and bone metabolism.

1. melatonin
2. betacarotene
3. calcitonin
4. vitamin D

Cancer

Ethnic variations

Which sex and racial/ethnicity group has the highest rates of new cancer cases and deaths per year?

1. Hispanic females
2. Asian/Pacific Islander males
3. White females
4. Black males

Cancer prevalence world

The most common form of cancer around the world is cancer of the:

1. lung
2. prostate
3. breast
4. pancreas

Diabetes

American Indian/Native American

Approximately ____% pf American Indian/Native American women ages 18 years and older have an estimated prevalence of diagnosed diabetes.

1. 26
2. 15
3. 7
4. 10

Type 2 cause

Type 2 diabetes involves failure of the body’s tissues to respond to signals of which hormone?

1. glycogen
2. calcitonin
3. insulin
4. melatonin

Diabetes global

Countries in which region of the world showed the greatest increase in diabetes between 1980 and 2014?

1. Eastern Europe
2. Central America
3. Northern Europe
4. Southeast Asia

Metabolic syndrome

A 58-year-old man with a waist size of 41 inches is concerned because he’s just seen an online news story about metabolic syndrome, a condition he fears he has because it’s defined as including:

1. a large waist circumference.
2. high levels of HDL cholesterol.
3. low fasting glucose levels.
4. unusually low blood pressure.

Metabolic syndrome

Increases in which condition among older adults are thought to be related to greater prevalence of diabetes?

1. metabolic syndrome
2. liver disease
3. respiratory illness
4. insulin absorption

Respiratory diseases

COPD

Chronic Obstructive Pulmonary Disease (COPD) includes chronic bronchitis plus which other respiratory disease?

1. lung cancer
2. asthma
3. emphysema
4. cystic fibrosis

Emphysema

Which component of Chronic Obstructive Pulmonary Disease (COPD) involves damage to the alveoli, or air sacs?

1. emphysema
2. sinusitis
3. bronchitis
4. pneumonia

Elastase

Which is the enzyme which serves to destroy lung tissue in emphysema?

1. insulin
2. protease
3. mucosin
4. elastase

Spirotiger

A device known as a(n) ____________ appears to hold promise in strengthening the respiratory muscles of people with Chronic Obstructive Pulmonary Disease (COPD).

1. ElastoProbe
2. SpiroTiger
3. PneumoTube
4. BronchiAssist

Neurocognitive disorders

Aphasia

The symptom of aphasia seen in neurocognitive disorders such as Alzheimer’s disease involves which loss of function?

1. movement
2. language
3. planning
4. object recognition

Memory decline

Although they each have differing exact patterns of symptoms, all forms of neurocognitive disorder have as a defining feature which type of change?

1. Declines in memory
2. Lowered emotional inhibition
3. Unsteady gait and tremors
4. Loss of consciousness

Normal aging vs. Alzheimer’s disease

Which of the following symptoms is more likely to characterize Alzheimer’s disease than normal aging?

1. Losing things from time to time
2. Occasionally forgetting a word
3. Problems taking care of monthly bills
4. Making a bad decision once in a while

Normal aging vs. Alzheimer’s disease

Which of the following symptoms is more likely to characterize normal aging rather than Alzheimer’s disease?

1. Losing track of the date or time of year
2. Trouble having a conversation
3. Missing a bill payment.
4. Misplacing things and not finding them

WHO Alzheimer’s prevalence

The World Health Organization’s estimate of the prevalence among older adults of all forms of neurocognitive disorder, including Alzheimer’s disease, is _____%:

1. 60-70
2. 5-8
3. 1-2
4. 10-14

WHO countries with neurocognitive disorder

The World Health Organization reports that, around the world, the majority of individuals with neurocognitive disorder are found in countries that are:

1. south of the Equator
2. low to middle income
3. English speaking
4. primarily urban

Biological changes in Alzheimer’s disease

Amyloid plaques and neurofibrillary tangles are biological changes in the brain associated with which specific disease?

1. Normal pressure hydrocephalus
2. Frontotemporal dementia
3. Pick’s disease
4. Alzheimer’s disease

Amyloid plaques

The plaques that develop in Alzheimer’s disease are made up of which substance?

1. substance T
2. amyloid
3. neurofibers
4. cholinesterase

Alpha secretase

In normal brains, amyloid precursor protein is snipped by which enzyme?

1. beta secretase
2. elastase
3. alpha secretase
4. tau polymerase

Beta secretase

Difficulty:

In the development of amyloid plaques, amyloid precursor protein is snipped by which enzyme?

1. beta secretase
2. elastase
3. alpha secretase
4. tau polymerase

Tau protein

Which protein within the neuron disintegrates in the formation of a neurofibrillary tangle?

1. senilin
2. alpha
3. collagen
4. tau

Neurofibrillary tangles

In Alzheimer’s disease, the twisting of microtubules in the neurons causes:

1. neurofibrillary tangles.
2. gamma secretases.
3. senilin bundles.
4. amyloid plaques.

Time to death Alzheimer’s disease

The average time from diagnosis to death of individuals with Alzheimer’s disease is approximately (for men and women combined):

1. 5 years
2. 2 months
3. 10 years
4. 1 year

ApoE gene

The ApoE gene, involved in cholesterol transport throughout the body, is thought to play a role in the formation of which substance in the brains of people with Alzheimer’s disease?

1. amyloid plaques
2. Pick bodies
3. extracellular tau
4. neurofibrillary tangles

Nun study

Longitudinal research following the Sisters of Notre Dame provided support for which potential protective factor in Alzheimer’s disease?

1. alcohol intake
2. physical exercise
3. mental activity
4. social support

Medical research problems

The primary reason that researchers currently are unable to establish the efficacy of medications to treat Alzheimer’s disease is that:

1. patients are unwilling to undergo experimental treatment.
2. physicians regard the medications as too expensive.
3. there is lack of evidence for a single disease mechanism.
4. the government has put a halt to further research.

Aricept

The trade name of which medication intended to treat some of the symptoms of Alzheimer’s disease has, as its active ingredient, an anticholinesterase?

1. Aricept
2. Namenda
3. Memantine
4. Melatonin

Behavioral treatments

Which of the following is a recommended type of behavioral method that caregivers can use to their patient with Alzheimer’s disease function more effectively?

1. negative reinforcement
2. punishment
3. modeling
4. time-out

MCI

The diagnosis known as Mild Cognitive Impairment (MCI) is used in cases involving:

1. memory loss that may progress to Alzheimer’s disease.
2. pronounced loss of memory, language, and judgment.
3. loss of blood supply to the subcortical brain regions.
4. poor judgment due to acute alcohol intoxication.

Delirium

Which form of neurocognitive disorder is considered reversible in that, with timely intervention, can be successfully treated?

1. Pick’s disease
2. fronterotemporal
3. delirium
4. Parkinson’s disease

Multi-infarct

Multi-infarct neurocognitive disorder is the result of which set of pathological changes in the brain?

1. abnormal cell bodies
2. minor strokes
3. abnormal protein deposits
4. cancerous growths

Pseudodementia

In the disorder known as pseudodementia, an individual’s cognitive changes may be the result of:

1. depression
2. intoxication
3. poisoning
4. small strokes

Anterograde amnesia

The form of amnesia in which people are unable to learn anything new is known as:

1. retrograde
2. depressive
3. traumatic
4. anterograde

Short answer questions

Diseases of the cardiovascular system

1. Describe five diseases of the cardiovascular system along with their causes.
2. What are two forms of cerebrovascular disease?
3. How do incidence rates of cardiovascular and cerebrovascular disease vary by sex and race in adulthood?
4. What are the four major risk factors for diseases of the cardiovascular system?
5. What three measures can people take to lower their risk of cardiovascular disease?

Cancer

1. Describe five major forms of cancer according to their site in the body and the nature of the specific form of cancer.
2. What are the three greatest risk factors for the development of cancer?
3. What four forms of treatment are available for cancer? What are their side effects?

Disorders of the musculoskeletal system

1. List four forms of treatment for osteoarthritis.
2. What are five risk factors for the development of osteoporosis?
3. List five forms of treatment and prevention of osteoporosis.

Diabetes

1. Describe the disease process in Type 2 diabetes.
2. What are four interventions that can be implemented for people with Type 2 diabetes?

Chronic respiratory disease

1. List the two forms of respiratory disease that make up COPD.
2. What two forms of treatment are available for people with COPD?

Neurocognitive disorders

1. Describe the issues involved in determining the prevalence of Alzheimer's disease.
2. What are three major psychological symptoms of Alzheimer's disease?
3. What are the two major microscopic changes in the brain associated with Alzheimer's disease? What processes are thought to be responsible for the development of these changes?
4. What are the three genes thought to be the major causes of Alzheimer's disease?
5. Describe three lifestyle or environmental factors thought to be causes of or contributors to Alzheimer's disease.
6. List the five diagnostic criteria of the American Psychiatric Association for the diagnosis of neurocognitive disorder.
7. What types of medical treatment are currently being tested for people with Alzheimer's disease?
8. Psychosocial treatments for Alzheimer's disease attempt to change which two major categories of problems dealt with by caregivers?
9. List and describe six forms of dementia that may appear to be Alzheimer's disease. Indicate how each form of dementia is different from Alzheimer's disease.
10. What are six forms of reversible dementia that may be confused with Alzheimer's disease? Why is it important to identify these forms of dementia?

Essay questions

1. Take the role of a public health expert working on behalf of the American Heart Association. Design a media campaign that would help lower the risk for cardiovascular and cerebrovascular disease among the groups with the highest rates of these diseases. Justify the steps you would take and the information you would provide.
2. Diseases of later life are becoming increasingly important for physicians to understand, diagnose, and treat. What would you regard as the main lessons that physicians should learn about these diseases? How can efforts to educate physicians about gerontology and geriatrics be improved?
3. Some scientists who conduct research on Alzheimer's disease believe that the U.S. statistics overestimate its prevalence. What is the basis for this argument? How do epidemiological studies of Alzheimer's disease fit into the political scene in terms of the funding of research and long-term care?
4. If you were designing a program to help family caregivers of people with Alzheimer's disease, what types of features would you emphasize to make your program as effective as possible? Why would you include those features?
5. What are the unhealthy practices followed by your own peers? List the five you believe to be most prevalent and summarize ways in which you would combat those unhealthy habits.