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The Changing Residence With Aging Effects of Moving on Health

After moving to a nursing home, many people deteriorate mentally and physically. But some improve. People are likely to do well after entering a nursing home under two conditions: if the place they move to is a step up from their life outside, and if their personalities fit the requirements of nursing-home life.

If we are impoverished, in very bad health, and live an isolated life, going to a nursing home is likely to boost our health and well-being. Being there is an improvement from the terror of trying to cope outside.

Researchers find that people who are tough, assertive, and insensitive are also likely to do well in nursing homes because they have qualities that uniquely suit them for institutional living. Their talent for fighting gets them more of the limited resources available. Their harder-than-normal hearts help insulate them from the suffering around.

Luckily, the personality that equips us for success is very different in less harsh places. However, the criteria for judging whether we will do well are the same: Is the place you are going better or worse than the one you are coming from? Does your new home fit the kind of person you are?

For example, when gerontologist Frances Carp compared older people who had moved into a retirement residence – a high-rise building with a community center – with another group who had applied for the housing but stayed in their own homes, she discovered that, instead of being worse off, the people who moved were happier and healthier. Even though they were somewhat less involved with their families, they had more friends and were more active and involved in life than the non-movers.

One reason was that the retirement residence was indeed a better place than most of these low-income elderly were coming from. Not only was it physically more appealing, but it also offered a safer, socially richer life. But living in the residence was not good for everyone. Some people were unhappy after they moved. Introverts had particular trouble; they disliked the greater social pressure to get involved in their new home.

Their preferred style of living – to keep to themselves – did not fit the togetherness ethic at the residence, so they felt alienly uncomfortable, and unhappy after they moved. In other words, apart from whether it is better objectively, you must judge whether the place you are considering fits you emotionally.

In a 1985 follow-up to this study, Carp went back to the residence to find out what personality traits predict happiness in the housing of this type. She found that people who were congenial, extraverted, and well-adjusted were flourishing – content with themselves, popular with the staff and residents. So housing for older people is far from being all alike. The personal qualities that suit us for living in an unhappy place (a nursing home) and a happy one (this retirement residence) are totally opposite.

For the older people Carp studied, the move to the residence was a step up. Often there is no obvious difference in quality between retirement housing and what people can buy or rent outside. So, studies show that residents of retirement communities are on average as satisfied or happy as people who remain (or live) in traditional homes.

There also is no evidence that living in a retirement community decreases health problems or health complaints. But people who live in retirement housing, particularly places that have many programs, do tend to be more active socially. They are more involved in groups and leisure activities than the average person their age.

So the studies show that you will not die sooner (or live longer) by moving to a retirement community, and even though you may emerge a bit from your cocoon, neither will you shed a lifetime of shyness and become a social butterfly.

We take ourselves with us wherever we go. But since having the chance to live in this type of housing is such an interesting new opportunity that being older offers retirement communities deserve a closer look.


The Changing Residence Retirement Communities With Health

A retirement community is a self-contained complex for people over a certain age. However, this description says nothing about the variety that exists among the estimated 2,300 that have sprung up in every corner of America since the end of World War II. They are popular. About a million people are currently choosing the retirement community life.

A retirement community may be an entirely new town or subdivision. Or it can be a high-rise building. It may be in the middle of a forest or be a converted landmark in the center of town. It may range in size from a small mobile-home park to Sun City, Arizona, with its 45,000 residents.

A variety of housing designs and arrangements are available as well as a variety of agreements regarding financial and living commitments. Some communities offer a full range of recreational and educational activities – golf, tennis, indoor and outdoor pools, classes, a clubhouse.

Others provide varying levels of personal and medical care. Or a retirement community may be nothing more than a housing development restricted to people past a certain age. There are even retirement communities with no age restrictions at all.

For instance, the Greens at Leisure World, in Silver Spring, Maryland, is typical of a large recreation-oriented retirement complex. A variety of activities is available – a pool, tennis courts, golfing, exercise and card rooms, lectures, and classes and groups of different types. While the additional cost is very small, most of these amenities are not included in the monthly maintenance residents pay.

Homes here are relatively expensive, making the Greens primarily for upper-middle-class people (one spouse must be over fifty). Unlike its more isolated counterparts in Florida or Arizona, this retirement community is close to Washington, D.C. It has single-family homes, apartments, and semidetached units.

The Greens provides no paid-for medical care or meals (though there is a medical building near the grounds). Goodwin House, in Alexandria, Virginia, and Otterbein Home, in Lebanon, Ohio, typify housing for people who want to live in a place that includes more personal services and health care.

At Goodwin House (a single building) residents buy their apartments and then pay a substantial monthly fee. Their payment includes meals, personal and nursing care, and maid service, plus educational and recreational activities.

At Otterbein Home, the facilities are spread out more and differentiated by what are called levels of care. There are three types of independent housing – duplex apartments, cottages, and low-rise apartment buildings. In addition, there are three levels of health care – personal, intermediate, and skilled (the last two are classifications of nursing-home care).

Contracts involve an entrance fee and monthly payments, with a resident either paying for everything in a lump sum at the entrance and each month or paying extra when more medical or nursing care is needed. Goodwin House and Otterbein Home exemplify the most innovative type of retirement community – the continuing-care or life-care community.


The Two Aspects of Anxiety in Health Disease

The feeling of unease or dread which we experience as part of the anxiety alarm reaction is actually a feeling image of danger. The unconscious mind provides an image of what danger feels like. We are all more or less aware of how the unconscious mind operates in images because we experience some of the image logic of the unconscious mind in our dreams.

The feeling of anxiety is like an image provided by the unconscious mind, of what being in danger would feel like if one were in danger. It is equivalent to the feeling of guilt as a feeling image of what punishment would feel like if the person were being condemned by others.

The physical symptoms of anxiety

As well as experiencing a feeling of dread in the alarm reaction known as anxiety, we experience as well, various body feelings due to the actions of adrenaline and noradrenaline, released by the sympathetic nervous system. These messenger substances prepare the body for possible physical action, in case there is a necessity to fight or run away.

Thus the design of the anxiety alarm system includes the double function of warning and preparing for the possibility of danger. The body’s systems are designed to regard the possible threat as a danger that one could run away from, or defend oneself physically, against.

However, preparation for physical activity may be quite inappropriate. It is a fact that most of the dangers we face in our lives now are not things we can physically sprint from, or punch our way out of.

Preparation for ‘fight or flight’ is of no practical use to us if the threats we face are things like the possibility of being sued, or being financially ruined by a stock market crash.

Preparation for fight or flight in those circumstances just makes us physically uncomfortable. On the other hand, the discovery that we are sharing a paddock with a savage bull would be a danger in which our preparation for rapid physical flight would be highly appropriate and useful.

As you might imagine, preparing the body for possible urgent physical activity involves a number of changes to the functional state of a number of different systems of the body. To remember what all these changes are and the symptoms we might expect from them, all we need to do is picture what changes in the body are required to prepare us to run away as fast as possible, or hold ourselves ready to fight, tense and vigilant.

• The state of tension of the muscle fibers increases, making them contract more efficiently and quickly.
• Blood supply is re-directed to decrease blood flow to the skin, internal digestive organs and kidneys, and increase blood flow to the brain, heart, and muscles.
• The pulse rate increases, pushing nutrients faster around the body, providing more oxygen, and carrying away more carbon dioxide. The rate of breathing increases.
• The nervous system’s automatic reflexes are sharpened; the person becomes vigilant and able to react faster to stimuli.
• Glycogen in the liver breaks down into glucose, increasing the available nutrient supply to the heart, brain, and muscle.

The symptoms of anxiety, therefore, include feelings of muscle tension and fatigue, particularly in the chest muscles, neck, and back. In order to fight one needs to stand stiffly up, bracing oneself for the attack.

Muscle stiffness as a result of being in a continual state of preparation can cause soreness, spasm, and pain in the back, neck, and chest muscles. Increased tension of agonist and antagonist muscle groups causes tremors, or shakes, seen most easily in the hands.

This tense state of muscular preparedness feels very uncomfortable unless the tension is put to some use. Physical exercise, by giving the prepared muscles some work to do, can alleviate some of the physical discomforts.

The sharpening of nervous system reflexes, with increased vigilance, tends to interfere with the person’s ability to sleep. Stimulation of the heart by the sympathetic nervous system may produce an awareness of rapid heart rate, flutters, and palpitations. The changes in blood supply and motility of the internal digestive organs can produce unpleasant feelings in the abdomen, and variable effects on bladder and bowel function.


The Primary Hiv Infection is Against for Your Health

Until now, the mainstay of HIV testing and surveillance efforts has been the testing of patients at increased risk for chronic HIV infection. However, an increasing focus of attention is the recognition and diagnosis of primary HIV infection.

Up to 90% of patients experience some symptoms at the time of initial infection with HIV, but the diagnosis is missed in the overwhelming majority of cases. This has important prognostic implications for the patient and the population as a whole, as a diagnosis of primary HIV infection could

• Prompt early antiretroviral treatment, which may
• Delay the onset of symptomatic acquired immune deficiency syndrome
• Decrease future viral load “set point,” or the maximum viral load that a patient may achieve off of antiretroviral therapy
• Preserve, to some extent, native immunity against HIV
• Identify HIV-infected patients up to 10 to 15 years before they would otherwise be diagnosed, which may
• Limit the epidemic spread of the virus
• Allow for retrospective identification of patients likely to have transmitted the infection

Furthermore, recent studies suggest that obtaining an HIV genotype in recently infected patients has a significant yield for the discovery of resistant viral populations, which could have an important impact on the choice of antiretroviral treatment regimen and the chance of success.

One of the major barriers to the diagnosis of primary HIV infection is the nonspecific nature of the clinical presentation: it can look like mononucleosis, influenza, or other nonspecific viral illnesses. In many cases, careful scrutiny will reveal symptoms not typical of these illnesses, but in most the provider must have a high index of suspicion in order to offer HIV testing.

The most common presenting symptoms of primary HIV infection are fever, macule popular rash, and pharyngitis, or oral ulcers. Fever is present in approximately 80% of primary HIV infection cases, and rash, or pharyngeal disease, myalgia’s or arthralgia’s, and fatigue are present in approximately 60% of cases.

These symptoms are common to a number of other illnesses, and providers should consider primary HIV infection in the differential diagnosis of syndromes such as infectious mononucleosis (particularly hater pile-negative) or streptococcal pharyngitis (particularly when rapid streptococcal testing or culture findings are negative).

In high-risk populations, some of the more common symptoms of primary HIV infection (e.g., fever, rash, malaise) have positive predictive values of 25% to 35%. Combining any two of these symptoms (e.g., fever and rash) increases the positive predictive value of the clinical syndrome to 50%.

However, these numbers should be applied with caution – they may be applicable in high-risk populations, but in wider use, the positive predictive value of any symptomatic diagnosis alone will fall dramatically as patients at lower risk are included.

Nevertheless, given the value of identification of primary HIV infection and the relative infrequency of false-positive HIV test results, providers should strongly consider testing for primary HIV infection when patients have analogous clinical syndromes with no known cause.