Diseases through the decades – here’s what to look out for in your 40s, 60s, 80s and beyond

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You’re another year older but that doesn’t have to mean poorer health.
Lorene Farrugia

Stephanie Harrison, South Australian Health & Medical Research Institute; Azmeraw T. Amare, South Australian Health & Medical Research Institute; Jyoti Khadka, South Australian Health & Medical Research Institute; Maria Carolina Inacio, South Australian Health & Medical Research Institute; Sarah Bray, South Australian Health & Medical Research Institute, and Tiffany Gill, University of Adelaide

Many diseases develop and become more likely as we age. Here are some of the most common conditions, and how you can reduce your risk of getting them as you clock over into a new decade.

In your 40s

Maintaining a healthy weight can reduce the risk of developing arthritis, coronary heart disease, and other common and related conditions, including back pain, type 2 diabetes, stroke, and many cancers. But almost one-third of Australians in their 40s are obese and one in five already have arthritis.




Read more:
Arthritis isn’t just a condition affecting older people, it likely starts much earlier


From the age of 45 (or 35 for Aboriginal and Torres Strait Islanders), heart health checks are recommended to assess risk factors and initiate a plan to improve the health of your heart. This may include changing your diet, reducing your alcohol intake, increasing your physical activity, and improving your well-being.

Checks to identify your risk of type 2 diabetes are also recommended every three years from age 40 (or from age 18 for Aboriginal and Torres Strait Islanders).

If you don’t already have symptoms of arthritis or if they’re mild, this decade is your chance to reduce your risk of the disease progressing. Focus on the manageable factors, like shedding excess weight, but also on improving muscle strength. This may also help to prevent or delay sarcopenia, which is the decline of skeletal muscle tissue with ageing, and back pain.

Achieving and maintaining a healthy weight will set you up for decades of better health.
Sue Zeng

Most people will begin to experience age-related vision decline in their 40s, with difficulty seeing up close and trouble adjusting to lighting and glare. A baseline eye check is recommended at age 40.

In your 50s

In your 50s, major eye diseases become more common. Among Australians aged 55 and above, age-related macular degeneration, cataracts, diabetes-related eye diseases and glaucoma account for more than 80% of vision loss.

A series of health screenings are recommended when people turn 50. These preventive measures can help with the early detection of serious conditions and optimising your treatment choices and prognosis. Comprehensive eye assessments are recommended every one to two years to ensure warning signs are detected and vision can be saved.

National cancer screening programs for Australians aged 50 to 74, are available every two years for bowel and breast cancer.




Read more:
Women should be told about their breast density when they have a mammogram


To screen for bowel cancer, older Australians are sent a test in the post they can do at home. If the test is positive, the person is then usually sent for a colonoscopy, a procedure in which a camera and light look for abnormalities of the bowel.

In 2016, 8% of people screened had a positive test result. Of those who underwent a colonoscopy, 1 in 26 were diagnosed with confirmed or suspected bowel cancer and one in nine were diagnosed with adenomas. These are potential precursors to bowel cancer which can be removed to reduce your future risk.

To check for breast cancer, women are encouraged to participate in the national mammogram screening program. More than half (59%) of all breast cancers detected through the program are small (less than or equal to 15mm) and are easier to treat (and have better survival rates) than more advanced cancers.

In your 60s

Coronary heart disease, chronic obstructive pulmonary disease (a disease of the lungs that makes breathing difficult), and lung cancer carry the biggest disease burden for people in their 60s.

If you’re a smoker, quitting is the best way to improve both your lung and heart health. Using evidence-based methods to quit with advice from a health professional or support service will greatly improve your chances of success.

Quitting smoking is the best way to improve your health.
Ian Schneider

The build-up of plaques in artery walls by fats, cholesterol and other substances (atherosclerosis) can happen from a younger age. But the hardening of these plaques and narrowing of arteries, which greatly increases the risk of heart disease and stroke, is most likely to occur from age 65 and above.

Exercise protects against atherosclerosis and research consistently shows any physical activity is better than nothing when it comes to heart health. If you’re not currently active, gradually build up to the recommended 30 minutes of moderate-intensity exercise on most, preferably all, days.




Read more:
Too much salt and sugar and not enough exercise – why Australians’ health is lagging


Other potentially modifiable risk factors for stroke include high blood pressure, a high-fat diet, alcohol consumption, and smoking.

Your 60s is also a common decade for surgeries, including joint replacements and cataract surgery. Joint replacements are typically very successful, but are not an appropriate solution for everyone and are not without risks. After a joint replacement, you’ll benefit from physiotherapy, exercise, and maintaining a healthy weight.

The treatment for cataracts is to surgically remove the cloudy lens. Cataract surgery is the most common elective surgery worldwide, with very low complication rates, and provides immediate restoration of lost vision.

In your 70s

Many of the conditions mentioned above are still common in this decade. It’s also a good time to consider your risk of falls. Four in ten people in their 70s will have a fall and it can lead to a cascade of fractures, hospitalisations, disability and injury.

Osteoporosis is one cause of falls. It occurs most commonly in post-menopausal women but almost one-quarter of people with osteoporosis are men. Osteoporosis is often known as a silent disease because there are usually no symptoms until a fracture occurs. Exercise and diet, including calcium and vitamin D, are important for bone health.

Exercise and diet can improve bone health.
Geneva, Switzerland

Older people are also vulnerable to mental health conditions because of a combination of reduced cognitive function, limitations in physical health, social isolation, loneliness, reduced independence, frailty, reduced mobility, disability, and living conditions.

In your 80s and beyond

Dementia is the second most common chronic condition for Australians in their 80s, after coronary heart disease – and it’s the most common for people aged 95 and above.

Many people think dementia is a normal part of the ageing process, but around one-third of cases of dementia could be prevented by reducing risk factors such as high blood pressure and obesity at mid-life.




Read more:
Why people with dementia don’t all behave the same


Early diagnosis is important to effectively plan and initiate appropriate treatment options which help people live well with dementia. But dementia remains underdiagnosed.

Around 70% of Australians aged 85 and above have five or more chronic diseases and take multiple medications to manage these conditions. Effective medication management is critical for people living with multiple conditions because medications for one condition may exacerbate the symptoms of a different coexisting condition.The Conversation

Stephanie Harrison, Research fellow, South Australian Health & Medical Research Institute; Azmeraw T. Amare, Postdoc researcher, South Australian Health & Medical Research Institute; Jyoti Khadka, Research Fellow, South Australian Health & Medical Research Institute; Maria Carolina Inacio, Director, Registry of Older South Australians, South Australian Health & Medical Research Institute; Sarah Bray, Registry of Older South Australians (ROSA) – Project Manager & Consumer Engagement Officer, South Australian Health & Medical Research Institute, and Tiffany Gill, Senior Research Fellow, University of Adelaide

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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How to reduce your risks of dementia

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If you engage in cognitively stimulating activities in midlife, such as reading and playing games, you can reduce dementia risk by about 26 per cent, according to research.
(Unsplash/Rawpixel), CC BY-SA

Nicole Anderson, University of Toronto

Many people do not want to think about dementia, especially if their lives have not yet been touched by it. But a total of 9.9 million people worldwide are diagnosed with dementia each year. That is one person every 3.2 seconds.

This number is growing: around 50 million people live with dementia today, and this number will rise to over 130 million worldwide by 2030.

You do not have to wait until you are 65 to take action. In the absence of treatment, we must think of ways to protect our brain health earlier. This month is Alzheimer’s Awareness month — what better time to learn how to reduce your risk of dementia, whatever your age?

In my work at Baycrest’s Rotman Research Institute, I address cognitive, health and lifestyle factors in aging. I investigate how we can maintain our brain health, while reducing the risk of dementia as we age. Currently, I’m recruiting for two clinical trials that explore the benefits of different types of cognitive training and lifestyle interventions to prevent dementia.

There are three dementia risk factors that you can’t do anything about: age, sex and genetics. But a growing body of evidence is discovering early-life, mid-life and late-life contributors to dementia risk that we can do something about — either for our own or our children’s future brain health.




Read more:
Is that ‘midlife crisis’ really Alzheimer’s disease?


Before going any further, let’s clear up some common confusion between Alzheimer’s disease and dementia. Dementia is a term to describe the declines in cognitive abilities like memory, attention, language and problem-solving that are severe enough to affect a person’s everyday functioning. Dementia can be caused by a large range of diseases, but the most common is Alzheimer’s.

Risk factors in early life

Children born at a low birth weight for their gestational age are roughly twice as likely to experience cognitive dysfunction in later life.

Many studies have also identified a link between childhood socioeconomic position or educational attainment and dementia risk. For example, low socioeconomic status in early childhood is related to late life memory decline, and one meta-analysis identified a seven per cent reduction in dementia risk for every additional year of education.

A diet high in unrefined grains, fruit, vegetables, legumes, olive oil and fish has been linked to lower dementia rates.
(Unsplash/Ja ma), CC BY

Poorer nutritional opportunities that often accompany low socioeconomic position can result in cardiovascular and metabolic conditions such as hypertension, high cholesterol and diabetes that are additional risk factors for dementia.

And low education reduces the opportunities to engage in a lifetime of intellectually stimulating occupations and leisure activities throughout life that build richer, more resilient neural networks.

Work and play hard in middle age

There is substantial evidence that people who engage in paid work that is more socially or cognitively complex have better cognitive functioning in late life and lower dementia risk. Likewise, engagement in cognitively stimulating activities in midlife, such as reading and playing games, can reduce dementia risk by about 26 per cent.

We all know that exercise is good for our physical health, and engaging in moderate to vigorous physical activity in midlife can also reduce dementia risk.

Aerobic activity not only helps us to maintain a healthy weight and keep our blood pressure down, it also promotes the growth of new neurons, particularly in the hippocampus, the area of the brain most responsible for forming new memories.

(Unsplash/Bruce Mars)

Stay social and eat well in later years

While the influences of socioeconomic position and engagement in cognitive and physical activity remain important dementia risk factors in late life, loneliness and a lack of social support emerge as late life dementia risk factors.

Seniors who are at genetic risk for developing Alzheimer’s disease are less likely to experience cognitive decline if they live with others, are less lonely and feel that they have social support.




Read more:
Will you be old and ‘unbefriended?’


You have heard that you are what you eat, right? It turns out that what we eat is important as a dementia risk factor too. Eating unrefined grains, fruit, vegetables, legumes, olive oil and fish, with low meat consumption — that is, a Mediterranean-style diet — has been linked to lower dementia rates.

Along with my Baycrest colleagues, we have put together a Brain Health Food Guide based on the available evidence.

What about Ronald Reagan?

Whenever I present this type of information, someone invariably says: “But my mother did all of these things and she still got dementia” or “What about Ronald Reagan?”

Playing games is proven to slow cognitive decline.
(Unsplash/Vlad Sargu), CC BY

My father earned a bachelor’s degree, was the global creative director of a major advertising firm, had a rich social network throughout adulthood and enjoyed 60 years of marriage. He passed away with Alzheimer’s disease. My experience with my dad further motivates my research.

Leading an engaged, healthy lifestyle is thought to increase “cognitive reserve” leading to greater brain resiliency such that people can maintain cognitive functioning in later life, despite the potential accumulation of Alzheimer’s pathology.

Thus, although all of these factors may not stop Alzheimer’s disease, they can allow people to live longer in good cognitive health. In my mind, that alone is worth a resolution to lead a healthier, more engaged lifestyle.The Conversation

Nicole Anderson, Associate Professor of Geriatric Psychiatry, University of Toronto

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Study shows dementia care program delays nursing home admissions, cuts Medicare costs

Woman in nursing home

Sima Dimitric/Flickr

 

News Release
December 2018 | UCLA – Study shows dementia care program delays nursing home admissions, cuts Medicare costs

 

New research shows that a comprehensive, coordinated care program for people with dementia and their caregivers significantly decreased the likelihood that the individuals would enter a nursing home. The study also shows that the program saved Medicare money and was cost-neutral after accounting for program costs.

The research, conducted at the UCLA Alzheimer’s and Dementia Care Program, was designed to evaluate the costs of administering the program, as well as the health care services used by program participants, including hospitalizations, emergency room visits, hospital readmissions and long-term nursing home placement.

“The findings of this study show that a health care system-based comprehensive dementia care program can keep persons with dementia in their homes and in the community without any additional cost to Medicare,” said the study’s senior author, Dr. David Reuben, Archstone Professor of Medicine and chief of the UCLA Division of Geriatrics at the David Geffen School of Medicine at UCLA.

The study was published Dec. 21 in JAMA Internal Medicine.

The research focused on the UCLA Alzheimer’s and Dementia Care Program. In the program, people with dementia and their caregivers meet with a nurse practitioner specializing in dementia care for a 90-minute in-person assessment and then receive a personalized dementia care plan that addresses the medical, mental health and social needs of both people. The nurse practitioners work collaboratively with the patient’s primary care provider and specialist physicians to implement the care plan, including adjustments as needs change over time. A total of 1,083 Medicare beneficiaries with dementia were enrolled in the program and were followed for three years. The study compared them to a similar group of patients living in the same ZIP codes who did not participate in the program.

“The most striking finding was that patients enrolled in the program reduced their risk of entering a nursing home by about 40 percent,” said lead author Dr. Lee Jennings, assistant professor at the University of Oklahoma College of Medicine. Jennings began the project while on faculty at the Geffen School and finished it after arriving at Oklahoma.

There were no differences between the two study groups in hospitalizations, emergency room visits or hospital readmissions. However, cost was another important element of the study. Participants in the program saved Medicare $601 per patient, per quarter, for a total of $2,404 a year. However, after program costs were factored in, the program was cost-neutral and might result in savings in other settings, such as at other health care systems. That was good news to the study’s authors.

“We found the study to be very exciting,” Jennings said, “because it showed that an intensive intervention can delay nursing home entry without adding costs. The intervention isn’t going to reverse dementia, but it allows us to provide high-quality care to help patients cope with the progression of this disease and stay in their homes for longer.”

Jennings added that individuals with dementia typically have not received good-quality care. “Part of the reason,” she said, “is that the care takes a significant amount of time, which primary care physicians don’t have in abundance. In addition, pharmacologic treatments for dementia are limited, which makes community resources all the more important for both patients and caregivers. However, community programs tend to be underutilized.”

The intervention featured in the study addresses those issues directly. The assessment looks not only at what the patient and caregiver need, but also at their strengths, such as financial security, family assistance and proximity to community resources. It is designed to be interdisciplinary and to address the needs of both patients and caregivers.

“This study aligns with similar studies of collaborative care models for other chronic diseases, such as heart failure,” Jennings said. “It underscores that we need to be thinking differently about how we provide care to persons with chronic illnesses, like dementia. This study shows the benefit of a collaborative care model, where nurse practitioners and physicians work together to provide comprehensive dementia care.”

My Brain Robbie campaign aims to help your kids keep their brains healthy

News Release
January 2019 | Global Brain Health Institute – My Brain Robbie animation campaign aims to help keep little brains healthy

My Brain Robbie animation campaign aims to help keep little brains healthy

My Brain Robbie, a fantastic new initiative to promote brain health among school going children, has been launched through the Pilot Awards for Global Brain Health Leaders, an initiative of the Global Brain Health Institute (GBHI), Alzheimer’s Association and Alzheimer’s Society UK. The project includes an animated video of a little brain which helps children learn about the eight steps to keeping our brains healthy, along with free educational resources for parents and teachers.

The My Brain Robbie campaign aims to fill an educational gap in the field of dementia prevention by generating a public health educational initiative for children aged 6 to 12 years. It also aims to increase global public awareness of the importance of brain health across the lifespan, rather than it being considered that brain protection strategies are an issue only for the elderly.

The video and materials bring together the latest scientific research in neurology and epidemiology which encourage early prevention and lifelong healthy lifestyles to mitigate the risk of developing chronic brain diseases including Alzheimer’s disease. Recent studies project that up to 30% of dementia may be preventable by targeting modifiable risk factors. The initiative was developed by researcher, doctor/physician and Atlantic Fellow for Equity in Brain Health at GBHI, Dr. Eleonore Bayen.

My Brain Robbie explains in child friendly language, the simple ways to keep our brain healthy using eight neuroprotective habits which connect with known modifiable risk factors for cognitive decline:

  1. ‘Learn’ touches on the role of education, cognitive stimulation and learning new things, in building cognitive reserve.
  2. ‘Be active’ describes the importance of physical activity and preventing sedentary lifestyles. Bad habits can develop as a result of spending too much time in front of electronic screens, a key issue for children, not to mention adults too!
  3. ‘Avoid head injuries’ looks at the prevention of traumatic brain injury.
  4. ‘Have a healthy diet’ refers to the “Mediterranean diet”. Another Atlantic Fellow, Claire McEvoy, among others has demonstrated the benefits of the ‘Mediterranean diet’ for brain health.
  5. ‘Avoid dangerous substances’ educates children in age-appropriate language about the dangers of tobacco and drug intake as well as excessive alcohol use.
  6. ‘Sleep well’ explains the importance of healthy sleep.
  7. ‘Take good care of your health’ looks at the importance of following medical care instructions for chronic diseases that can impact brain health, for example, hypertension.
  8. ‘Spend time with family and friends’ highlights the importance of social interaction for keeping our brains healthy.
robbie and suitcase 2.png

My Brain Robbie, which was funded by GBHI and the Alzheimer’s Association, empowers children to maintain a healthy brain throughout their lives by providing them with simple public health messages. Dr Bayen hopes that, by providing information about brain health as part of early life education, this will create a shift in perceptions, beliefs, attitudes and stigma towards diseases of the brain, particularly dementia, in this generation and beyond.

Dr Bayen said: “This pilot arrives at a perfect time in history when the fight against dementia in high, low and middle income countries has become a top priority with an urgent need for innovative actions and “out of the box” thinking in prevention and care. While education at school offers us an amazing opportunity to fight stigma as well as social and health inequities, it appears that ‘dementia prevention and brain health at school’ is currently not being addressed and this would surely improve public awareness worldwide.”

She continued: “We hope that by teaching these important healthy brain habits to a younger generation that this may, in turn, educate upwards through the generations by motivating their parents and grandparents to learn more about the subject of brain health and dementia prevention. It may also, in turn, help to create a more supportive and inclusive living environment for people with neurocognitive disability and to create a feeling of optimism in a field of neurology where there have been limited therapeutic successes. Children are often wonderful teachers for their peers, parents, grandparents, and society at large.”

Dr Bayen worked in collaboration with a wide variety of experts such as neuroscientists, medical and health professionals, education specialists, teachers, parents, communication and design experts, as well as other Atlantic Fellows and faculty from GBHI.

The videos are currently available in English and French with plans to translate these into many more languages. My Brain Robbie welcomes interest from educators, health groups, parenting communities and others in sharing this initiative with as many children as possible.

She was inspired to develop the initiative during her Atlantic Fellowship with GBHI based at the University of California, San Francisco and Trinity College Dublin. GBHI focuses on protecting the world’s aging populations from threats to brain health. Collectively with partners, GBHI aims to reduce the scale and impact of dementia. The Pilot Awards for Global Brain Health Leaders is an initiative launched by GBHI and partners, the Alzheimer’s Association and the Alzheimer’s Society UK. The awards aim to support emerging leaders in brain health protection by funding small-scale innovative activities to delay, prevent, or mitigate the impact of dementia.

“Dr Bayen’s work is a wonderful example of GBHI’s approach to attaining a global impact on dementia prevention. It engages inter-professional contributions to development on a global scale. It also recognizes that brain protection is a life-long dialogue. Her innovative strategy of teaching children who will then engage in dialogue within households to ‘educate-up’ to parents and grandparents while reducing the stigma of dementia is timely.” said Victor Valcour, Executive Director of GBHI and the Atlantic Fellows for Equity in Brain Health program.

Dr Bayen said: “As a researcher and also a physician, I feel that my duty is not only to advance pure science but also to communicate it with others in creative ways. I hope that the My Brain Robbie campaign inspires children to feel responsible for their own brain health and to become aware of others’ brain health too.”

To watch and download the videos and materials please visit www.mybrainrobbie.org

 

Further Information

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Dr Eleonore Bayen holds a Medical Degree with specialty training in Neurology and a PhD in Health Economics. She specializes in traumatic brain injury (TBI). She has advanced experience in architecting educational intervention programs about brain and disability for patients, family caregivers, and non-medical populations. Dr. Bayen was supported in her Atlantic Fellowship as a Fulbright grantee to the United States and was trained at the University of California, San Francisco site of GBHI in 2016. In this capacity, she was selected to be part of the first international class of the Atlantic Fellows who graduated from the Global Brain Health Institute in 2017. Bayen is currently an assistant professor in neuro-rehabilitation in Paris at Sorbonne University – La Pitié-Salpêtrière hospital.

Top 10 secrets about stress and health

The strain of life — from everyday conflicts to major losses — can stretch our well-being to the breaking point. Here’s what scientists know, and still don’t know, about the stress-illness connection.

08.30.2018

It’s no secret that stress is bad for your health.

Everybody knows that “life stress events” — things like loss of a job, death of a loved one and getting divorced (or married) raise the risk of getting sick.

All sorts of other life events also generate stress, with possible negative health effects ranging from catching a cold to major depression to a fatal heart attack.

Of course, knowing about the link between stress and sickness just gives you something else to worry about, adding even more stress. If you value your health, perhaps you should stop reading now.

On second thought, don’t. Much of the lore about stressful events impairing health is certainly true, but some research is reassuring. There are some secrets about the stress-disease connection that aren’t all bad.

If you’ve read the psychological, psychiatric and medical scientific literature over the last several decades, you might already be aware of these “secrets.” If not, they’ve been nicely summarized in a paper to appear in the next issue of Annual Review of Psychology, in which Sheldon Cohen, Michael L.M. Murphy and Aric A. Prather analyze (in no particular order) what they call the “Ten surprising facts about stressful life events and disease risk.”

10. Experts disagree about what counts as stressful.

Nobody disputes that certain events inflict severe psychological (and physiological) stress. Death of a spouse, getting diagnosed with a terminal illness and (ahem) separation of children from parents are indisputably “major stressful life events.” But no clear rules have been established to define what features place an event in that category (which makes stress research complicated, with often ambiguous results).

Some researchers hold that stress magnitude hinges on how much “adaptation” is required to cope with it (which is why marriage can be considered especially stressful). A second theory gauges stressfulness as the amount of threat or harm an event poses. Some experts view stress as a mismatch between demands and resources. (If you have the resources — say, money — to address and control a demanding situation, it’s less stressful; if your boss expects you to complete a three-person project all by yourself under an impossible deadline, you’re stressed.) A fourth view regards “interruption of goals” as the prime feature of a life stress event; diabolically, one of the goals most commonly interrupted is the goal to be psychologically well.

These theories about stress-event criteria aren’t mutually exclusive, of course. “There is obvious overlap among these approaches,” Cohen and colleagues write. On the whole, though, they suggest the “threat or harm” perspective is the most commonly accepted.

Examples of recent stressful life events (major and minor) psychologists may ask about to gauge a person’s stress level. These include everything from the death of a spouse to taking on a mortgage to getting a speeding ticket.

9. Stress can affect a long list of diseases.

Depression and heart disease are commonly associated with stressful events, but stress’s influence extends to other health problems as well. Many, perhaps even most, diseases can be linked to life stress in some way. Stress can boost anxiety, mess with your hormones and discourage healthy practices such as exercising and eating well. At the same time stress can instigate bad behaviors such as smoking and drinking. All these responses can have negative impacts on important organs (brain, heart, liver), possibly resulting in multiple health problems either by triggering the onset or accelerating the progression of a disease. Stress events can reduce resistance to infections, and even cancer may be linked to stress. But the evidence on cancer is less clear. Stress might influence the development of cancer, but the strongest research shows that a more likely effect of stress is reducing cancer survival rates rather than initiating cancer onset.

8. Just being stressed doesn’t mean you’ll get sick.

There’s no doubt that trauma and stressful events can harm your health. But not always. “On the whole,” Cohen and colleagues write, “most people who experience stressful events do not get sick.” Experiments exposing stressed and nonstressed people to a common cold virus found that more of the stressed people caught the cold than those in the nonstressed group, but nevertheless half the members of the stressed group remained healthy. Even depression is not an inevitable effect of major life stress; some people are more resilient than others. Positive self-image and sense of control are signs of resilience; negative attitude and excessive rumination tip the scales toward depression.

7. Stressful events do not strike at random.

Apart from the relatively rare natural disasters, fatal accidents and a few other nasty exceptions, stressful events are not equal-opportunity assailants. Your personal traits and situation and the circumstances in which you live make you more or less at risk for life stress. Neighborhoods with low socioeconomic status are sites of higher-than-average levels of stressful events, and people with low personal socioeconomic status have more risk of encountering violence, death of a child and divorce. Even personality can boost your stress risk (neurotic, unconscientious and disagreeable people are more likely to get divorced, for some reason). One study found that “individuals characterized by negative attributional style” (i.e., jerks) encounter more “interpersonal conflicts,” raising the risk of stressful events. Furthermore, one stressful event — such as loss of a job — can lead to others (such as loss of income, moving or divorce).

Evidence is strong that stressful events make a disease you already have worse.

6. Disease might come before the stress.

While some evidence supports the notion that stress can initiate various diseases, this may not be the case in truly healthy people. “Rather, events may influence risk for disease by either suppressing the body’s ability to fight invading pathogens or exacerbating the progression of ongoing premorbid processes,” Cohen and colleagues write. What looks like a disease triggered by stress “may actually be stressor-triggered progression of previously unidentified disease.” So in some cases stress might not be responsible for the disease itself, just for making a previously unnoticed disease worse.

5. Some stressful events are more powerful than others.

The magnitude of a stressful event’s impact depends a lot on the nature of the stress. Most damaging, research indicates, are “experiences that threaten an individual’s sense of competence or status,” striking at a person’s “core identity.” Loss of status, losing a job and interpersonal conflict with spouses or close friends can all exacerbate health problems, from raising the risk of depression to worsening high blood pressure and reducing resistance to respiratory infection.

4. Chronic stress is worse than acute stress, usually.

It’s not necessarily obvious that chronic, long-lasting or recurrent stress is worse than one-shot stress events. It may be possible to adapt to ongoing stress — once you’re used to it, maybe it won’t bother you so much (or harm your health). On the other hand, ongoing stress may be worse for health because it’s always there, ready to attack whenever your body is vulnerable for some other reason. Overall, chronic stress is probably worse, as it may have a persistent detrimental effect on the body’s disease-fighting immune system. Acute stress, like single traumatic events, may trigger a dramatic worsening of an existing condition, such as heart disease. In that case, a sufficiently powerful stress event can induce a fatal heart attack.

3. Many stress events are worse than fewer, maybe.

Effects from stressful events may add up over time; simple checklists of how many stressful events a person has experienced over the past year show that experiencing more events predicts worse health. But it’s too complicated to say exactly why that is, or even if it is really generally true. (The checklist method of gathering data might be faulty.) In fact, if a single event is strong enough to increase health risk substantially, additional events don’t necessarily increase that risk further. For that matter, it isn’t clear how events should be counted; a divorce followed by changing residences and reduced income might count as one event or three, Cohen and colleagues point out. And it may not be the number of events but rather the number of “life domains” in which you’re experiencing stress that’s more important. (Job, home life, medical issues and financial issues all represent different domains in which stress may occur.)

Data from a 1998 study shows that among people reporting an enduring stressful life event of one month or more (total: 75), 49.3% (37 people) came down with a cold after exposure to a rhinovirus, while 50.7% (38 people) remained healthy. In those who reported no stressful life events (total: 201), 35.8% (72 people) developed a cold, while 64.2% (129 people) did not.

2. The effect of stress events depends on where you are in life.

Just as some events are stressful, so are some nonevents — things that don’t happen when they’re supposed to in a typical course of life. People generally expect to graduate from school (high school or maybe college), get a job, get married, have kids and then retire. Failure to graduate, inability to get a job or rejection of marriage proposals can all be very stressful during the time of life when success at those things is expected. It may also be that different times of life are more susceptible than others to the ill effects of stress. Trauma in childhood, for instance, has been linked to higher risk of chronic diseases much later in life. Such trauma may induce long-lasting biological changes that contribute to disease in later years. In addition, “adversity during childhood may set an individual on a trajectory to being exposed to more stressors over the life course,” Cohen and coauthors write.

1. Stress doesn’t affect men and women equally.

Men and women respond differently to stress, both in their behavior and their physiological response. And women are apparently exposed more frequently to stressful experiences than men are. Partly that may be because “men tend to only report stressful events that occur directly to them” while women consider themselves stressed also when the actual event happens to someone close to them. Men and women may also differ in their vulnerability to stress-induced illness. Women seem more prone to stress-related depression, for instance.

Toll of stress on disease

All these “secrets” sketch a still incomplete picture of the stress-illness connection. Some things are clear: Evidence is strong that stressful events make a disease you already have worse, but the research is iffy about whether stress can make you sick to begin with. There are clues about how stressful events exacerbate disease — by altering your biology, your mood and your behavior. Chronic, ongoing stress (like working for a psychopath boss) generates a more general susceptibility to the kinds of physiological and emotional changes that promote disease, while acute immediate stressful events can be effective triggers for turning underlying conditions like cardiovascular disease into heart attacks.

Still many questions about the stress-disease relationship remain unanswered. Experts don’t even know exactly why stressful events are stressful. And evidence is meager on whether particular types of stress are especially likely to promote specific diseases. Much remains to be learned about how a stress event’s effects vary with your stage in life.

Nailing down those details remains a major research challenge. It’s not easy for researchers to answer all these questions, because the obvious experiments would be somewhat unethical. You’d have to give one big group of people a bad job with a bad boss and then make sure bad things happened to them all the time, while rigging conditions for another group to enjoy stress-free luxury. It would be kind of like The Truman Show, only with manipulating enough characters to get statistical significance.

This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews. Sign up for the newsletter.

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