Sail On, Silver Girl Trivia Quiz

Answer: Yes, it is often the first sign that we are getting older

Grey hair is one of the universal signs of advanced age. More likely than not, your hair will start to go grey at some point in your life. Some individuals can maintain hair colour well into their older age, but most do not.

The main factors in determining what hair colour a person will have depend on the amount of melanin one has, and genetics. Two different types of melanin are present in hair follicles: If eumelanin is present, it results in black hair (increased amounts) and brown hair (moderate amounts). Very little eumelanin means blond hair. When eumelanin is hardly present, pheomelanin dominates, which produces red hair.

Eumelanin and pheomelanin are found in hair follicles in melanocytes, which produce melanin. As age increases, melanocytes decrease in number and also produce less melanin. Fewer melanocytes mean a lack of pigment in the hair, resulting in a silver/grey colour. After age 30, there is a 15 per cent decrease in the amount of melanin produced for each subsequent decade. By 50, half of men and women will have at least 50 per cent grey hair. Just because grey hair may be found in one's 20s does not mean a rapid decline due to aging. While grey hair is a sign of advancing age, it can appear up to three decades before other visible signs of aging.

Holding negative opinions about aging has been linked to an increased risk of diabetes, a lowered ability to rebound from disease, lower mortality rates, and a decreased ability to ward off cancer processes. However, going grey is inevitable - but the way one thinks about greying is within individual control.

Answer: Long lasting medical conditions with persistent effects

In the 21st century, there has been much (popular) press about how life expectancy (ie mortality) is increasing even in the poorest counties and this is seen as a marker of world health status. However, it does not measure the quality of life. Morbidity is the measure of sickness in any given community. As people get older they become more susceptible to chronic diseases. These are long-lasting conditions with no cure. Therefore people with chronic conditions will have ongoing symptoms that cannot be cured but they can be managed.

We probably reach our peak in optimal physiology in our 20s (arguably the age of many elite sporting figures and the age group most performance world records are set). After this age the body starts to lose functionality incrementally. This is unnoticeable at first, but it is noticeable in most people by the time they reach their mid-50s. Unfortunately, while we are now living longer than ever before, as we age more, we become susceptible to chronic diseases. As these have no cure, we need to manage them to minimise their symptoms and maximise our 'functional capacity' to keep doing the things we are used to doing.

Chronic diseases are essentially caused by environmental factors more than genetic factors (but good genes help!). It seems almost a cliché to say that we need to maintain (or obtain) a healthy lifestyle when we are younger to ward off, or at least postpone, the advent of chronic disease. However, many people do not recognise this, at the stage of life we need to, and a price is paid later in life.

Over 60% of people over 65 have at least one chronic disease and many have more than one. This has become one of the major (if not the major) health problems of the Western world.

Answer: Myocardial Infarction (Heart attack)

Blood is the medium that transports nutrients and oxygen to individual cells so tissue organs, and the whole person, can function effectively and efficiently. The arteries, veins and capillaries that act as pipes to deliver blood to the cells need clear pathways to deliver that blood. Atherosclerosis is the narrowing of blood vessels due to the build-up of plaque which occurs over a long period of time. Plaque is made up of cholesterol and fats and people with high levels of these constituents are particularly susceptible. Plaque build-up is accelerated by smoking and a fatty diet. Exercise acts to keep plaque levels down if exercise levels are consistent over the years. Healthy diets, filled with fruit, vegetables and fibre, also slow plaque build-up. Some people are genetically susceptible to high cholesterol levels, contributing to plaque. Plaque build-up cannot be reversed. If plaque build-up is severe it can either 1) occlude (totally block) the artery preventing any blood flow; 2) it can break off a larger vessel and travel through the ever smaller vessels until it becomes stuck and prevents blood flow, and 3) plaque can weaken artery walls and, if severe, the artery will burst causing a haemorrhage (aneurysm).

Plaque build-up is the basis of vascular disease. This is peripheral vascular disease when the build-up affects the limbs (mainly the legs). When the carotid arteries in the neck are affected, these are the main arteries that supply the brain so if these arteries, or the smaller connecting capillaries, become blocked, a stroke occurs. (Aneurysms are more likely to occur in the brain than anywhere else, except possibly the aorta).

The heart itself also has its own blood supply. When one of these arteries becomes blocked, blood supply to the heart stops, causing intense pain from the death of blood-deprived cardiac muscle. This is called a heart attack but, medically, it is known as a myocardial infarction (literally cardiac muscle tissue death). This acute event needs urgent medical attention to reduce pain and to restart the heart if it has stopped.

Atherosclerosis cannot be reversed, but lifestyle changes such as a healthier diet, moderate exercise and cessation of smoking will slow any further development.

Answer: When the cancer can be controlled with treatment, becomes stable, or reaches remission

In the body, the maintenance of cells is carefully controlled. As aging cells die off they are replaced by new ones in a very regulated manner. When this replacement regulation fails, one type of cell will grow at a much faster rate than the same cells that die off. This upsets the balance (homeostasis) of the body and this uncontrolled growth needs to be stopped otherwise it can take over other parts of the body and death can occur quite quickly in some cases. Sometimes the uncontrolled growth can spread to adjacent tissues or organs or it can get into the bloodstream and be 'seeded' somewhere else in the body, known as metastasis.

Cancer is not a death sentence. Obviously, the earlier it is detected the better the chances that one can recover quickly. This is why there are so many screening programs for breast, colon and prostate cancer. However, treatment can be difficult - cells with cancer must be killed, and sometimes healthy cells are killed at the same time. Also, dead cells in large numbers circulating in the blood until they can be excreted is not healthy. The side effects from treatment, usually chemotherapy or radiotherapy, can be brutal and unpleasant at best.

When a diagnosis of cancer is made, there are a few possible outcomes:

If the cancer is aggressive or diagnosed late in the disease progression, death can occur sometimes quite suddenly.

If the treatment is 100% successful (e.g. total surgical removal), the cancer never returns.

Sometimes the person can be free of the cancer, which is called remission, but then it returns at a later date. This is because all of the cancer could not be removed during treatment. The remaining cancer is below detection thresholds and the little that remains grows until the patient becomes symptomatic again. In these cases, patients are subsequently screened frequently to determine if there is any cancer before symptoms appear.

Most professional cancer societies agree that cancer can be a chronic disease when cancer can be controlled with treatment and becomes stable (i.e. cell death = cell growth), or reaches remission. Sometimes, chronic cancer may move from remission to recurrence and progression and back to remission.

Cancer is such an emotive word because it is often diagnosed early in life long before chronic diseases associated with aging start being felt around the age of 55. Often the diagnosis is made with the person having no, few or mild symptoms. The main thing to remember is that it is nearly always treatable with early diagnosis.

While we cannot prevent cancer from happening, we can reduce the chances of it occurring. Good genes help, but healthy lifestyles can help as well. Healthy diet, moderate exercise, low alcohol consumption and not smoking. Stopping exposure to carcinogens, especially in the workplace, is also a big factor. Fortunately, we have been very good at identifying such dangers but 'new' carcinogens seem to appear on a fairly regular basis

Answer: Both can develop without symptoms

Type 2 diabetes is recognized as a serious public health concern with its rapid increase in incidence due to economic development and urbanisation of the world. Diabetes affects the functional capacity and quality of life of sufferers, which in turn, becomes significant morbidity and early mortality. In the 21st century more than one-third of diabetes-related deaths occur in people under the age of 60). This global burden is due mainly to increased consumption of unhealthy diets and sedentary lifestyles, resulting in increased Body Mass Index (BMI) and fasting serum glucose. The aging of the human population is another significant contributor, as diabetes tends to affect older people. Symptoms include excess urination, excessive thirst, tiredness, weight loss without reason, poor wound healing, poor eyesight and increased hunger. According to Diabetes UK, "6 out of 10 people have no symptoms when they're diagnosed with type 2 diabetes". Diabetes, if left undiagnosed or if poorly controlled, can cause blindness, kidney failure, heart attacks, stroke and amputation of the lower limbs. A simple plasma glucose level is a suitable screening test for diabetes when there are no symptoms.

Hypertension, or higher than normal, blood pressure, is a condition in which the blood vessels have persistently raised pressure making it harder for the heart to pump. Initially, it can be symptomless and be present for many years before it is diagnosed. Symptoms can include headaches, nosebleeds with no apparent reason, irregular heartbeat, changes to vision, and buzzing sounds in the ears.

Untreated hypertension can cause angina (chest pain), heart attacks, heart failure, and irregular heartbeat, all of which can cause sudden death. It can also cause strokes and kidney damage, leading to kidney failure. High blood pressure also damages the heart by hardening arteries and decreasing the amount of blood and oxygen that can be pumped by the heart. It can be diagnosed quickly by a blood pressure test in a doctor's surgery or at home with a suitable instrument. Treatment is simple once diagnosed. Lifestyle factors can be adjusted and simple medication taken to lower blood pressure levels.

Answer: No

Dementia is a general term for a decrease in mental ability which is defined as 'severe enough to interfere with daily life", according to the American Alzheimer's Association, while Alzheimer's is a specific disease. Alzheimer's is the most common cause of dementia. There are other causes including vascular dementia where a person experiences mini-strokes or TIAs (transient ischaemic attacks) which cause the part of the brain denied blood flow to die

The symptoms of dementia include loss of memory, language, problem-solving and other cognitive abilities. Dementia is often incorrectly called "senility" or "senile dementia," which is based on the incorrect (but widespread) belief that severe mental decline is considered a normal part of aging which it definitely is not. The largest risk factor is increasing age, and the majority of people with Alzheimer's are over 65. Alzheimer's worsens over time as it is a progressive disease, where dementia symptoms gradually deteriorate over the years. In early stages, memory loss is mild, but by the later stages of Alzheimer's, patients will have lost the ability to carry on a conversation and respond to their environment.

The two most common signs of Alzheimer's disease in the brain (usually found at autopsy) are beta-amyloid plaques and neurofibrillary tangles. It is unclear whether plaques and tangles in Alzheimer's disease cause the disease or are a by-product of the disease.

Alzheimer's has no cure, but two medications can remove the beta-amyloid, from the brain slowing cognitive and functional decline in people who are diagnosed early in the disease process. Other treatments are available to slow the progression of the disease.

Answer: No

Stress is necessary for life. In a very simplistic explanation, it was a survival mechanism necessary for the 'fight or flight' response needed to survive when life was more dangerous than it is today. There are different types of stress.

Good stress, or Eustress, occurs when stressors can be positive, exciting and even motivating. This type of stress helps in energy restoration but can also improve heart capability and increase our stamina and strength.

Distress is negative stress which has negative consequences on the body. It can cause displeasure and/or anxiety. Distress can have a negative impact on mental and physical problems.

Acute stress is short-term stress. It starts quickly and dissipates quickly. Acute stress is sometimes associated with symptoms such as anger, anxiety, irritability and short periods of depression.

When acute stress occurs too often it is called episodic stress. Episodic acute stress in some people occurs due to a series of successive stressful challenges occurring in their lives. When stress persists for longer periods it is called chronic stress.

Chronic stress is initiated by long-term exposure to stressors. Chronic stressors may not be as intense as acute stressors but they cause more harm. This is because the effect of chronic stress is the accumulated effects of stress for long periods. Chronic stress affects both physical health and mental health. The effects occur due to accumulated stress.

There are three stages in the stress response: 1. Alarm 2. Adaptation and 3. Exhaustion or Recovery. Alarm involves the 'fight-or-flight' response which enables us to deal with difficult or adverse. situations. At this time, the body is prepared either to face the threat or to run from it. Reactions in the body at this stage include the release of stress hormones: cortisol, noradrenaline and adrenaline from the adrenal glands, increased heart rate, rise in blood glucose levels, and an increase in blood pressure.

If the stress is not resolved, the body continues the ongoing secretion of stress hormones to provide energy for situation management to adapt to the stressful situation. This is the adaptation stage. Physical issues such as sleep problems, tiredness, muscular pains, indigestion, allergies, and susceptibility to minor infections all can be manifested. Mental problems such as concentration problems, impatience, bad temper problems and behavioural problems such as increasing/starting smoking and increasing the consumption of alcohol.

The recovery phase occurs when the body's compensatory processors have succeeded in overcoming the stressor's effect. However, if this can't be achieved, normal body function does not occur and exhaustion occurs. When exhaustion persists for long periods, a person is at risk for long-term health conditions such as hypertension and coronary artery disease, and chronic depression.

Long-term stress is an insidious issue. The pace of contemporaneous life means we are living with more stress than at any other time in history. Unless we take massive steps to lessen stress in our working lives we may pay the price in our later years.

Answer: Depression

Even in the 21st century, there is a stigma attached to mental illness. In the 1950s, medication allowed affected patients to escape from shut-away institutions and live productive lives in the community. Unfortunately, clinical depression is rising in incidence, particularly among those in their later years.

Depression can happen to anyone. People who have endured abuse, severe loss or other life-changing stressful events are more likely to suffer from depression. Women are more likely to have depression than men. Depression happens frequently in later life when people lose their sense of purpose in life from leaving work or their children have grown up and left home.

Effective treatments for depression are readily available but more than 75% of people with low- to middle incomes never receive treatment. Effective care prevention includes a lack of proportion in the health budget for mental health care, a lack of trained healthcare providers and the ever-present social stigma associated with mental disorders. Depression causes problems in all aspects of life, including home, work, school and community.

Depression is closely related to physical health. Many of the factors that influence depression, such as a sedentary lifestyle or excessive use of alcohol, are the same risk factors for chronic diseases including cardiovascular disease, cancer, and diabetes. Subsequently, people with these types of diseases may develop depression due to problems managing their physical well-being.

Self-care becomes important, particularly for those reluctant to seek professional intervention. These include small things that together can help people manage their depression: Doing enjoyable activities, regular exercise, even if that only means short walks, staying connected to friends and families and establishing regular eating and sleeping patterns can help. Avoiding illicit drugs and excessive alcohol and talking to people who you can trust all help. Perhaps the biggest item of self-care is the hardest - recognising that one needs medical help to help you get through this insidious illness.

Answer: Non-medical factors that influence health outcomes

Non-medical factors that influence health outcomes are called social determinants of health. These are the conditions under which people are born, grow, work, live, and grow older. They also include a broader range of systems within our society and include such far-reaching issues as social, economic and political systems and policies, social and societal norms and human development systems.

The World Health Organization has a list of the social determinants of health, which affect health equity in both positive and negative outcomes. They are:

- Income and social protection
- Education
- Unemployment and job insecurity
- Working life conditions
- Food insecurity
- Housing, basic amenities and the environment
- Early childhood development
- Social inclusion and non-discrimination
- Structural conflict
- Access to affordable health services of decent quality.

In much of the urbanised and industrialised countries, most of the items on the list are taken for granted but we must be made aware of social determinants of health, as globally massive inequality exists. No change will ever be effected unless there is a drive from the health-fortunate societies to address these inequities

Social determinants of health are very important in aspiring to health equity, a noble concept that we can only hope will be achieved one day. Health inequity is the unfair and preventable difference seen between countries and even within different groups within each country. A good example is the first peoples or indigenous people within an industrialised country. The sad, but indisputable, fact is that in any country, at all levels of income, health and illness, there is a 'social gradient'. Health follows a social gradient: the lower the socio-economic position of a group, the worse the overall health of that group. Also the older a group the greater the SDH.

There is conclusive evidence in the medical literature that social determinants are even more important than health care or lifestyle choices in influencing health outcomes. Studies have shown, as analysed by WHO, that the SDH accounts for 30-55% of health outcomes. Further, the contribution of sectors external to population health outcomes, the overall health of a population, externally exceeds the contribution from the health sector. In other words, action is required by all sectors of civil society to address SDH to fundamentally improve health and reduce inequities across the globe.

Answer: Prevention

In the twentieth century, with its massive increases in diagnostic medical technology plus the burden of people injured in two world wars, emphasis was on the treatment of patients, bigger and better-equipped hospitals successfully treated patients. Concurrently there has been a great deal invested in workplace safety and increased safety built into automobiles to reduce the death toll from road trauma and as a result, we saw increases in longevity in most industrialised nations.

However, an increase in the quantity of life does not mean an increase in the quality of life.

Indeed, an increase in chronic diseases is expected as people live longer. Some chronic diseases are absolutely debilitating and cause a poor quality of life. Chronic diseases as discussed are rarely cured but managed.

The best 'treatment' for chronic diseases is prevention. This needs to take place when we are much younger. All the issues that have been told to us many times: Healthy diet, healthy weight, sensible diet with plenty of fresh food, moderate exercise and alcohol consumption and avoidance of smoking. Add in public health measures such as optimal workplace safety, road safety as motorists and pedestrians, vaccination, regular medical checks with diagnostic blood testing monitoring and participating in screening programs for early disease detection are very helpful. If you are blessed with good genes and are fortunate enough to live in a country/society where all the social determinants of health are covered, you have done as much as you can for a healthier, longer life. We will never eliminate disease nor accidents and we will always have to live with premature death in some people but we can aspire to a healthier society overall.