Directions:

Initial Post:

Based on what you have encountered in this module, answer both of the following questions:

1. Which disparities earlier in life impact older adult wellness the most?
2. Which disparities occur in older adulthood that impact quality of life?

Response Post:

In your reply post to another peer, answer all of the following questions:

1. Which disparity creates the greatest quality of life disparities for older adults in your community?
2. What observations lead you to select this as the greatest community challenge?
3. Are there any community initiatives aimed to help decrease this disparity? If so, share what they are. If not, suggest what might help reduce the disparity to improve older adults quality of life feasibly in your community.
5. Reference informationChildhood Health Impact on Aging
   

   Childhood Health Impact on Aging

   • As we enter into adulthood, we may question whether past experiences still hold true, particularly if they create barriers to activities we might want to participate in. As youth transition to their more independent young adult lives, they often challenge and perhaps even neglect childhood health conditions. With increasing age, it is not uncommon to question whether childhood health and environment have a lasting impact or whether we can change lifestyle enough to overcome any early-life diagnoses, environmental exposures, socioeconomic health inequities, or genetic predispositions. While many adults will explore and challenge what could become self-limiting beliefs, they also develop fear and encounter ambiguous information and experiences; when this fear and ambiguity compounds with additional age-related physiological changes, injuries, illnesses, and social input, people often begin self-limiting activities with each decade of older adulthood. Research demonstrates that early pediatric health conditions predict physical health problems, health related-stress, and depressive symptoms that persist into adulthood (Dalton, 2016). Four major categories of childhood health carry forward to impact adult health: childhood environmental exposures, health-related behaviors, risk states, and diagnosed disorders (Forrest, 2004). Each category can have health subtracting or health additive components. For example, a child who has inadequate nutrition options may have a predisposition to illnesses and learning difficulties. Conversely, a child who engages with well-balanced, age-appropriate nutrition may have lower incidences of illness and be more actively engaged in learning opportunities. Both of these situations can impact health and socioeconomics later in life. Common childhood exposures that impact health later into adult life include (Forrest, 2004):
     • Poor air quality contributing to potentially higher cardiovascular and respiratory illness incidence
     • Maternal factors that may lead to low birth weight, which correlate with higher risks of cardiovascular disease later in life
     • Abuse, which alters the brain’s function and lifelong stress response
     • Household social dysfunctions that elevate mental disorder and depression risks
     • Parent rejection or neglect that alters the child’s interaction with the environment, which in turn limits health behaviors

     Common health-related behaviors that often persist through the lifespan include (Forrest, 2004):

     • Smoking
     • Poor dietary habits
     • Sedentary activity
     • High-risk sexual activities
     • Substance abuse

     These high-risk behaviors become risk factors for a broad range of chronic conditions ranging from cardiorespiratory disease to obesity to sexually transmitted diseases, such as HIV.Risk states elevate further development of cardiovascular or metabolic disease (Forrest, 2004):

     • Glucose intolerance
     • Hypertension (HTN)
     • High cholesterol
     • Early atherosclerosis

     Fully developed disorders include (Forrest, 2004):

     • Type I diabetes (DM I)
     • Inflammatory bowel disease (Bowel Dz)
     • Rheumatoid arthritis (RA)
     • Epilepsy
     • Celiac
     • Behavioral, emotional, and mental disorders

     
     Fig 1. Health risk categories impacting lifespan health. (Content based on Forrest, 2004; graphic created by SME).Mental conditions are much more likely to significantly impact the entire lifespan, while most other chronic disease states (like type I diabetes, rheumatoid arthritis, and epilepsy) only impact 5% of the population (Forrest, 2004). Other childhood conditions do not persist into older adult life, as lifespans are limited in the presence of conditions like muscular dystrophy, sickle cell anemia, many childhood cancers, or cystic fibrosis. Other conditions, like asthma, obesity, or allergies, may exist in childhood but have variable expressions in adult life (Dalton, 2016). Summary: In summary, we have examined types of childhood conditions that typically persist into impacting quality of life throughout the life span.

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     Case Study

     Ronnie is a 60 year old female seeking a total knee replacement for her knee arthritis. Because of her advanced arthritis, she is having trouble walking. The knee replacement would likely help improve her mobility and function, contributing to her overall quality of life. She is not a candidate at this time, as her BMI is 40. She has been referred to a nutrition coach with a goal to decrease her BMI to 35 so she can have the surgery. The nutrition coach understands the importance of a holistic view of lifestyle preferences, habits, and history. History includes being raised in a single-parent home, where her main childhood activity was watching TV or helping clean the house. She was inactive other than this and did not participate in extra-curricular activities. She found it difficult to make friends and notes this is even difficult in adulthood. She did have physical education class but did not enjoy it and did the minimum to get by. She recalls several incidents where she did not have access to food other than the school lunch. Her favorite was pizza and fries, which were offered most days of the week. As a teenager, she had a job at a local fast-food franchise. At this point, she often relied on school lunch and a free shift meal, which was usually a burger, fries, milkshake, and soda. She recalls being “one of the bigger kids.” With limited resources, she did not have a primary care doctor and rarely saw the doctor. When she was sick, she had to just “tough it out.” On adult medical screening, she has had increasing body weight every year but is otherwise considered healthy. She does not smoke or consume alcohol, and her current hobbies are puzzles and reading. She works a sedentary job at a call center. She notes they always have donuts, pizza, and chips. When she feels stressed, she goes to the break room and gives herself an extra treat to give her the energy to get back to work. As you consider this case and the multi-factorial contributors to obesity, which childhood factors may have contributed to the current elevated body mass index? Take a moment to list each factor you can identify, as well as a potential current strategy to help address each factor. After outlining your answers, examine the sample answer below. Ronnie’s early life challenges in childhood and health-behavior development likely became the key behaviors that carried through the lifespan to this point. The primary childhood exposure likely contributing to continued deficits in health-related behaviors elevating BMI is parental neglect. Ronnie did not have a strong parent figure to help encourage healthy behaviors like activity and seeking access to nutrient-rich foods like fruits and vegetables. She also did not experience much social interaction, and social isolation may contribute to poor stress management and food-related coping behaviors. Based on this factor, Ronnie would benefit from education on health-related behaviors and collaboration on which health-related behaviors she would be willing to try. Specific examples include:

     1. Sharing a list of appropriate activities in the context of the previous dislike of exercise and current knee pain, then asking Ronnie to pick three, she agrees to try.
     2. Helping Ronnie come up with alternative strategies to re-focus her work when she recognizes stress.
     3. Educating Ronnie on how increasing her diversity of food choices will help with her goal.
     4. Sharing recipes that include a more balanced approach to include vegetables and fruits.
     5. Establishing plans for accountability and revision of movement and nutrition plans on a regular basis.
     6. EngagingRonnie in a group of people with similar goals and starting points can help offer social support.

     The key elements of this case study can be carried over to other adult health behaviors and goals as well; before offering older adults solutions, including an understanding of their holistic background from childhood can help identify key areas for collaboration to succeed with health later in life.

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     References

     Forrest C, Riley A. (2004). Childhood origins of adult health: a basis for life-course health policy. Health Affairs. 23(5): E. D., Hammen, C. L., Brennan, P. A., & Najman, J. M. (2016). Pathways maintaining physical health problems from childhood to young adulthood: The role of stress and mood. Psychology & health, 31(11), 1255–1271.