Aging and Study of Illness

Aging and Study of Illness

Paper details:

Write a 3 page paper in which you:

1. Describe one chronic disease that appears in older life and identify risk factors known to be involved in its development.

2. Estimate the likelihood that you could get this disease as you age based on your personal risk factors and the prevalence of the disease.

3. Describe prevention of this disease on primary, secondary, and tertiary levels.

4. Discuss the age at which primary prevention for this disease should begin.

As usual, please use the text listed below and additional professional journals.
Hooyman, N. R., & Kiyak A. H., (2011). Social Gerontology: A multidisciplinary perspective, (9th ed.). Boston: Allyn and Bacon. ISBN 0205763138 and 978-0205763139

Health and Illness in Aging
Common Health Problems: Causes, Prevention, and Treatment


In this lesson you will:

1. Estimate your chances of developing chronic diseases as you age.

2. Identify risk factors for one selected chronic disease and, using these, plan how you could implement a primary prevention strategy for that disease.

3. Apply national standards to describe secondary prevention efforts for a selected chronic disease.



You learned earlier in this course that nobody dies of old age. Unfortunately, everybody does die eventually, but from illness or injury. Although we cannot prevent death, we have learned more about how to modify the timing and cause of that human event.

Modifiable Factors that Influence Health Status

The first major modifiable factor that influences how long we live, and what we die from, is the power to control many hazards in ourenvironment. In the last hundred years or so, we have developed sanitation systems to dispose of human waste, and have found ways to provide cleaner water and air. We’ve improved housing, and expanded the availability of safe and healthy foods. Improvements in the quality of home, work-place, and community environments have also been achieved.

A second modifiable factor that improves health is changing lifestyles. During the past century, we have worked diligently to send out public messages aimed at motivating people to change their personal health behaviors. Unfortunately, we have been less than completely successful in finding ways to help people adopt those behaviors.

The third major factor in changing when and how we die is the growth of modern medicine. Medical research continues to reveal ways to prevent, diagnose, and cure or manage diseases that were fatal just a few years ago. This means, of course, that many people with chronic diseases live on (by definition, a chronic disease doesn’t go away), and require care to manage their disease.


Both environmental changes and medical developments have altered patterns of morbidity (illness), mortality (death), and quality of life for all age groups in America. The earliest environmental changes were most effective in saving the very youngest in our population. A child born in 1900 had a high chance of dying, before he was 5, of infectious diseases like small pox, diphtheria, scarlet fever, or infectious diarrhea. It is no surprise that life expectancy for his cohort was only 47 years. Advances in sanitation and immunization, and the development of antibiotics, have changed this picture dramatically.

A child born in 2005 can expect to live to an average age of 74 (men), and 81 (women) (U.S. Census Bureau, 2001). Notice the gender differences in life expectancy noted here; they have been evident for a long time, and are thought to be due, at least in part, to the protective effects of estrogen on women’s cardiovascular systems.

More recently, advances in medicine have extended the life of middle-aged and older adults, and have made the cohort of people aged 85 and above the fastest growing one today. Although this “old-old” group varies from totally incapacitated to healthy and competent, most are aging longer, and in much better health than their parents did


Further improvements in health care will probably be gained by focusing on the major causes of illness and death in our population. The diseases that cause death in older adults are mostly chronic rather than acute. As illustrated by the diagram below, acute diseases are those that can be treated and cured (if they don’t kill). Chronic diseases are never cured, but have consequences that may require rehabilitation and continuing efforts to “manage” them. This increase in numbers of people within our population who have one or more chronic diseases has resulted in the demand for very expensive health treatments, and has also influenced the quality of life for those affected.

The diagram below, suggested by classic public health theory (Leavell & Clark, 1965), illustrates that risk factors for chronic disease can be present long before diagnosis (think of smoking and lung cancer). Acute disease risk factors can be very short in duration, and are often followed immediately by symptoms (like influenza). In either case,primary prevention—stopping the disease from starting—requires removal of risk factors. This is tough to do, especially since chronic diseases often have a long “latency period” that slows onset of symptoms and makes diagnosis (secondary prevention), and timely treatment difficult.

Another characteristic that makes it hard to pin down exact causes for many chronic diseases is that most of them have more than one risk factor involved. For example, cardiovascular disease has genetic predispositions as well as a wide range of lifestyle factors as risks. The good news here is that modifying even one or a few risk factors for a disease may be enough to prevent its onset.

Risk Factors Diagnosis & Treatment Rehabilitation

Susceptibility Biologic Onset Clinical Onset Disability Chronicity


Primary Secondary Tertiary
Prevention Prevention Prevention

Let’s examine an example of how one chronic disease begins:

Mike Thornton, age 52, has been having chest pain on exertion lately, which he has ignored. He has a stressful job and a family situation with the usual financial issues to resolve. His favorite stress reliever is enjoying a good dinner with wine. In fact, he admits that he drinks a bit too much, and that he should stop smoking. Since his business life is so busy, he has not made time for exercise, or for regular medical check-ups (although he has been told that he has border-line hypertension and a high cholesterol level). One day– no surprise–Mike has a serious heart attack (a myocardial infarction).

By the time the diagnosis was made and treatment started (secondary prevention), irreversible damage to Mike’s heart muscle had been done, and the disease had become chronic. Mike will now have to modify the same risk factors that caused his initial attack through tertiary prevention efforts in order to prevent future attacks and recover from this one. Eliminating risk factors, even when they are as obvious as those described in this story, will involve changing many longstanding behaviors. This is a challenging, but not impossible feat, as we will discuss later.


Since risk factors for many diseases are unknown, or only partially known, primary prevention is not possible. In the case of myocardial infarction, we know some of the risk factors, and they can be controlled by lifestyle and medication. However, for Alzheimer’s Disease, one of the chronic problems most dreaded by aging adults, and the most common cause of dementia (loss of cognitive abilities), we only have a few clues to what risk factors might be. The older we are, the more apt we are to get this disease. But, although there is a lot of research going on to determine its risk factors, we still have not learned enough to prevent it.

Common Chronic Conditions, Risk Factors, and Prevention

More than 60% of mortality in people 65 and older is caused by heart disease, cancer, and strokes. The most frequently reported chronic conditions in older adults include, in order of their frequency, the following: Arthritis, hypertension, heart disease, diabetes, respiratory disease, stroke, and cancer (NCHS, 1999). Other health problems common in older adults include thinning of the bones (osteoporosis), urinary incontinence, sleep disorders, dementia, and depression.

We will review each of these conditions briefly below:

Heart Disease—Heart disease is the number one cause of death in the U.S. A number of diseases of the cardiovascular system become more common with age; among these is arteriosclerosis, in which fatty plaques form in the lining of blood vessels, blocking circulation, and the arteries become more rigid, as well. This condition can start so early in life that it has been found in autopsies of some children and teens. Reduced blood flow leads to poor circulation everywhere, and causes particular problems when it occurs in heart, the legs, and the brain. Symptoms of poor circulation in the heart include angina pectoris—pain in the chest, and/or arm, back, neck, or jaw, usually on exertion. If the circulation is blocked enough, a heart attack, or acute myocardial infarction, that may kill part of the heart muscle may result. In the same way, if enough blood does not get to the legs and feet, peripheral vascular disease occurs, creating pain when walking; if circulation gets bad enough, tissues die, and amputation may be required. Arteriosclerotic changes can also occur in blood vessels in the neck that supply circulation to the brain, and starve it for blood. Finally, the brain blood vessels themselves may be blocked by plaque that can encourage formation of clots that close off a blood vessel, or the vessel can burst because it has become weakened. In any of these cases, a “stroke” is said to have occurred. The outcome of the stroke will depend upon what part of the brain has been affected, and can include inability to speak or understand speech (aphasia), impairment of vision, and/or loss of the ability to move and/or sense stimuli in the side of the body that is supplied by the damaged part of the brain.

Risk factors for arteriosclerosis include genetic inheritance, a diet high in saturated fats, high blood pressure, lack of exercise, use of tobacco, and poorly managed stress. The lifestyle components listed here usually lead to a slow build up of plaque over time, as noted above. Some research suggests that plaque buildup may be linked to inflammation caused by chronic bacterial infections (Fong, 2000). These bacteria tend to be found in the mouth of people who have periodontitis (infection of the gums), and enter the blood-stream through breaks in swollen areas. We know that gum disease is the major reason for tooth loss in adults, so a high proportion of people may unknowingly be at risk for arteriosclerosis. Effective prevention of gum disease involves regular visits to the dentist, and regular brushing and flossing. People with established gum disease need specialist’s care from a periodontist. A recent survey revealed, however, that 57% of older adults had not seen a dentist in the previous year (U.S. Department of Health and Human Services, 2000).

Hypertension—This condition is a major risk factor for just about all cardiovascular problems, including myocardial infarction, stroke, and heart failure. It is also associated with certain types of kidney disease. Sadly, it has no obvious symptoms that would lead people to treatment. Risk factors include (you guessed it) heredity, obesity, lack of exercise, diet high in saturated fats and salt, cigarette smoking, and excessive alcohol intake. Research evidence that pointed out the importance of treating hypertension aggressively before it leads to further cardiovascular problems led, in the 1980’s, to a National Hypertension Prevention campaign. This campaign aims convincing the population that there is no such thing as a “little high blood pressure,” and educating providers in how to reduce hypertension. As a result, we have adopted new ways of dealing with this condition, including more frequent screening and drug treatments when lifestyle changes don’t lower blood pressure to an acceptable level. Interestingly, the level of what is considered “normal” blood pressure has been dropping constantly as we adjust old beliefs that elevations are normal with aging. This approach has made a huge impact in preventing and treating all cardiovascular diseases, and is one of the reasons for the continuing drop in cardiovascular deaths in the last couple of decades.

Heart Failure—Heart failure can occur for many reasons, including hypertension, myocardial infarction, and lung disease; heart failure often occurs as a “co-morbidity” (complication) of other diseases. A wide range of causes and types of failure occur, but in each one of them, blood fails to be pumped effectively out to the body, up to through the lungs to get fresh oxygen, and back to the heart to be re-circulated. Heart failure is usually treated by addressing related risk factors, and by the use of drugs that improve the heart’s pumping action.

Cancer—Cancer is not one disease. Advancing age is a risk factor for many cancers, including those of the stomach, pancreas, and lungs. Cancer of the bowel is the second leading cause of death in those who are 70 or older. Age is thought to be a risk factor because the immune system is less active in older adults, because they have had a lifetime of exposures to cancer-causing factors in the environment, and because many cancers are slow-growing and do not produce symptoms for a very long time.

Risk factors for cancer vary by the type of tumor, and we need to learn a lot more about most cancers before we can prescribe specific risk reduction behaviors for primary prevention of most types; a couple of major exceptions here are the well researched connections between smoking and lung cancer and between sun exposure and certain skin cancers.

It is important to note that treatment has advanced more rapidly than prevention, however, and many cancer survivors of every age (including many older adults) are experiencing their disease as a chronic one. Treatments such as radiation, chemotherapy, and surgery are amazingly effective, and put the disease into remission, sometimes permanently.

In order for secondary prevention to be effective, cancers must be found early. Many screening tests are used for this purpose. For example, the use of colonoscopy (visualizing the inside of the large bowel through a lighted instrument) finds many pre-cancerous and cancerous lesions and allows their removal without further surgery. This advance has led to the recommendation of colonoscopy for all people age 50 and above on a regular schedule, with annual checks to determine whether there is blood in the stool. Other secondary prevention methods, including those for cancers of the breast, prostate, cervix, head and neck, and skin involve screenings done on a regular schedule. Each type of screening uses methods and schedules recommended by expert groups, such as the U.S. Department of Public Health, and tend to change frequently as more becomes known about their effectiveness.

Diabetes—The number of people with Diabetes Mellitus has doubled during the past 25 years, with a large number of cases occurring in people ages 30-39, and the most dramatic increase occurring in African Americans and Latinos of that age (Mokdad et al, 2000). This dramatic increase has raised concerns that this cohort may develop significant health problems as they age, and predictions are that they may be the first generation ever to have a lower life expectancy than their parents.

Diabetes involves changes in insulin, a hormone made in the pancreas that helps our cells to use glucose for energy. There are two major types of diabetes, the first occurs because the pancreas stops making enough insulin; this influences the ability of cells to use glucose, a simple sugar that is created when we digest starchy foods. Treatment for this type of diabetes is diet and, often, injections of insulin—some people call this “Insulin-Dependent” or Type I Diabetes. Type II (or adult onset) diabetes occurs when enough insulin is made, but cannot be used by the cells to take up and use glucose. Type II diabetes usually starts between the ages of 40-50. Recent statistics indicate that Type II diabetes is occurring in younger people at a rapidly increasing rate; changes in diet and obesity seem to be implicated in this phenomenon. Treatment for Type II diabetes is primarily diet and weight loss, and medications that help glucose to move into the cells may be prescribed.

The presence of either type of diabetes is a risk factor for cardiovascular disease, including heart attack, stroke, kidney failure, and blindness. Risk factors for type II Diabetes include those familiar factors of obesity, improper diet, and lack of adequate exercise. In many cases of newly diagnosed Type II Diabetes, lifestyle changes can reverse risk factors and lead to the return of normal glucose use.

Respiratory Diseases—A number of diseases are categorized as “Chronic Obstructive Pulmonary Disease” (COPD). Risk factors include exposure to allergens and damaging fumes, dusts, or mists (including work-related exposures), and tobacco smoke (both primary and secondary exposure have been shown to be dangerous). In some cases, there may be genetic risk factors as well. These diseases are more common in men than women, probably because men who have the disease today were more likely to have smoked and/or worked in jobs with risky exposures than women from the same cohort.

COPD is a progressive, slowly developing disease that can start with chronic bronchitis and end with respiratory failure. The progression of this disease leads to extreme shortness of breath (in particular, difficulty in breathing out effectively), frequent lung infections, and episodes of heart failure. Treatment includes medications, oxygen, breathing exercises, and early treatment of infections.

Arthritis—Although not generally life-threatening, two major types of arthritis affect older adults. Both limit movement of the joints and cause pain that may be disabling. The first type of arthritis is osteoarthritis, a gradual wearing down of the joints that occurs in all of us to some degree, starting by the age of 40. The joints gradually deteriorate and this can cause a great deal of pain, especially when the person tries to get moving after rest. The joint deformity that accompanies this disease is most visible in the fingers. Risk factors that lead to severe osteoarthritis include heredity, obesity, and work stress. Modern treatment includes pain management, including use of medications, physical therapy, and the surgical replacement of badly damaged joints with artificial ones.

Rheumatoid arthritis is a chronic inflammation of the joints and surrounding tissues that leads to pain and degenerative changes that can be severe enough to prevent normal use of the joints. There are also associated systemic symptoms including weight loss, fatigue, and fever. Periods of acute inflammation tend to be followed by calm periods. Risk factors are not completely known, but we know that this is an autoimmune disease (one in which the immune system attacks tissues in the body). This type of arthritis often starts between the ages of 20 and 50. People who survive into their later years often have significant deformity and difficulty getting around. Treatment is similar to that for osteoarthritis, but also includes medications specific to reducing joint inflammation.

Osteoporosis—Normal aging involves loss of some bone mass (accumulated minerals that make bone hard) can start in the 30’s in both men and women. This loss accelerates, particularly in women at the time of menopause, and slows in the 70’s. While some bone mass loss is considered part of primary aging, progression to osteoporosis is considered secondary aging. Women are at particular risk to this disease, since they have less bone mass to start with, and lose more mass than men do in their 50’s when estrogen levels drop. The prevention of osteoporosis is extremely important because it is difficult to reverse once it develops, and because it is the leading cause of broken bones in older women (Ebersole et al., 2004).

Prevention involves reducing risk factors in earlier life, where diet is key. Calcium is taken into the body with food, especially dairy products and certain leafy greens and, as the food is digested, taken into the blood, and on to organs, including muscles (where it helps contraction) and bones. Calcium can also be taken as a supplement. Some calcium stays in circulating blood for other uses, but before senescence starts, the surplus is deposited, with the help of Vitamin D, into bone. This calcium moves back into the blood if needed in other organs. Think of bones as places where calcium can be “banked” for eventual withdrawal. Deposits are allowed from birth to around age 30, but then, withdrawals begin. If there have not been enough deposits in earlier life, withdrawals in middle and later life can deplete calcium deposits and leave bones spongy, brittle, and weak.

Bone density scans show that approximately 65% of women over 60 and almost all women over 90 have osteoporosis. Fair Caucasian and Asian women with small body-builds are the most vulnerable to this disease. Primary prevention consists of a diet high in calcium and Vitamin D early in life, and continuing weight-bearing exercise. Risk factors that should be controlled early in life are smoking and high intake of caffeine, protein and sodium. Frequent dieting for weight loss has been implicated as another risk factor. Use of steroid drugs to treat allergies or other diseases also puts people at higher risk for osteoporosis, and should be avoided whenever possible.

New drugs are available to help prevent continuing loss of minerals from bone, and can lead to addition of new bone mass for some. Secondary prevention includes measuring bone density as women approach menopause to determine risk status, and then treating with drugs and/or calcium and vitamin D supplements as needed. Tertiary prevention includes, in addition to the use of drug treatments, calcium and vitamin D supplements, and weight-bearing exercises, therapy to strengthen muscles, improve balance, and increase flexibility of the whole body in order to reduce the chance of falls. The environment of a person with osteoporosis should also be modified with fall prevention in mind.

Dementia—Dementia is a family of diseases marked by progressive and permanent loss of cognitive ability and behavioral changes. Causes of dementia include blood-vessel changes in the brain, Parkinson’s disease, Huntington’s Disease, Alcohol Dementia (Wernicke-Korsakoff syndrome), and AIDS Dementia Complex. The most common cause of dementia is Alzheimer’s disease. In this disease, microscopic changes in the brain lead to destruction of tissue. Rapid cell death occurs mostly in parts of the brain intimately connected with memory and higher-level cognitive activities. On autopsy, microscopic examination of the brain reveals a typical pattern of plaques on nerve cells in the brain that include beta-amyloid protein and neurofibrillary tangles. Interestingly, these changes are also found to a smaller degree in the brains of aging people who do not have the disease.

Many possible causes for this disease have been proposed including aluminum poisoning (now disproved). One of the more promising lines of research has been the search for markers on chromosomes that correlate to the disease. So far, some genetic links have been found for early-onset Alzheimer’s. These indicate that it could be transmitted from the genes of one parent (Gatz et al, 1997). Research on late onset Alzheimer’s, which represents the majority of cases, has been less definitive, but researchers have tentatively identified several areas on chromosomes that may be tied to this form of the disease (Raeburn, 1995). As research efforts continue, we can only hope that risk factors can be identified and potential treatments developed soon.

The symptoms of Alzheimer’s disease include gradual changes in cognitive functioning, memory loss beginning with recent memory and going on to remote memory, learning, attention, and judgment. Also, loss of spatial memory, difficulties finding words and communicating thoughts, poor personal hygiene, and inappropriate social behavior are seen. In time, personality changes occur and become more pronounced (Smyer & Qualls, 1999). Later, depression, agitation, and paranoia may be seen, and eventually simple self-care measures such as using the toilet, eating, and dressing become impossible. Not all people move through stages of the disease at the same pace, and some never move beyond earlier stages. A definite diagnosis is made only at autopsy, although clinical evaluation, with use of advanced scanning techniques, is becoming much more sophisticated.

Treatment of early stage Alzheimer’s may include the use of newly approved prescription drugs that slow progression. Care also includes behavioral and environmental interventions that promote a high level of safety for the patient while promoting maximal utilization of remaining abilities. Experiencing the changes this disease brings can be very difficult for both patient and family. Since many patients are cared for by families in their homes, family caregivers are at great risk for depression, and burnout is almost guaranteed due to this caregiver burden if they do not get adequate support and respite while doing this difficult work. Long term care settings specializing in the care of people with dementia can be found in most parts of the country, and many provide superior care for both patient and family.


Depression—Depression is the most common and treatable mental disorder found in adults. It affects biological, social, and psychological functioning. Clinical depression must be carefully distinguished from normal sadness that is associated with loss. This can be difficult because older adults suffer multiple losses, and because symptoms of clinical depression are often related to stereotypes of older people as slow, hopeless, withdrawn, and always complaining about multiple physical ills.

Cases of clinical depression are widely under-recognized in older people (Gatz, 2000). The highest incidence of depression in older adults is in men aged 75 and above, and it is also common in people who have other medical conditions like diabetes or heart disease. Clinical depression is accompanied by physical symptoms including insomnia, pain, shortness of breath, and fatigue; careful diagnosis to rule out other diseases that could cause these symptoms is important. The depressed older adult will tend to feel helpless, worthless, and withdraw from others rather than complain of a low mood. Presence of these symptoms for two weeks or more indicates that a thorough evaluation should be done and treatment started.

Depression can be a fatal disease. Untreated, it can lead to suicide in people of any age, but the highest rates of suicide in older adults are found in older white males, with those aged 85 and over at highest risk (NCHS, 2000). Family members and health care providers must be vigilant in watching for subtle cues that may indicate potential suicide, as older people are less apt to make threats or announce their intentions than younger people are. Treatments for depression are just as effective for older adults as they are in younger people. The following risk factors are noted by Hooyman & Kiyak (2005):

• A serious physical illness or severe pain.

• The sudden death of a loved one.

• A major loss of independence or financial inadequacy.

• Statements that indicate frustration with life and a desire to end it.

• A sudden decision to give away precious possessions.

• A general loss of interest in social and physical environments.

Incontinence—Urinary incontinence is a problem faced by about 19% of men and 38% of women age 65 and over (Thom & Brown, 1998). Two major types of incontinence have been described: Urge (sudden need to empty the bladder) and stress (release of urine while straining, sneezing, etc.). A mixed type of incontinence can also occur. Although incontinence can occur due to more serious reasons, such as cancer of the bladder or neurological problems, in most cases, it is caused by a weakening of the muscles of the bladder and pelvis, damage to pelvic structures caused by childbirth in women, or enlargement of the prostate in men.

Ads in the public media for incontinence pads and adult diapers seem to infer that the condition is normal—it is not! Whatever the cause of incontinence, it can be treated. Of course it is embarrassing and damaging to the self-concept (not to mention unpleasantly smelly) to leak urine, and people often put off mentioning the problem to their doctors for that reason, and because they think that this is a normal age-related change. In fact, it is not normal, and treatments are widely available and quite effective. They include surgery to repair pelvic structures damaged in childbirth, bladder retraining (re-teaching the muscles used in urination how to perform normally, and stretching the bladder back to normal capacity), treatments to reduce prostate size, and exercises to strengthen the pelvic floor (Kegeles exercises). These should be the first line of treatment, as they frequently solve the problem if done properly. There are also prescription medications available for some types of incontinence that cannot be resolved using simpler methods.

Sleep Disturbances—How do you feel on a day when you have not slept well the night before?—Probably not very well. Not sleeping well is the most common complaint older adults have, and it can lead to moodiness, poor performance on tasks that require concentration, tiredness, and lack of motivation. Older adults report inability to fall asleep, awakening frequently, or staying awake for a long time, and easy awakening. Normal sleep/wake cycles (circadian rhythms) tend to become disrupted, particularly when people nap during the day to make up for lost sleep at night, and move from a two-phase cycle of sleep at night and awake during the day to a multi-phase cycle with multiple naps during the day, and little sleep at night.

Reasons for these changes are related to many factors including changes in the autonomic nervous system. Other reasons people can’t sleep well include sleep apnea, heartburn, restless leg syndrome, and a frequent need to urinate. Sleep apnea leads to the frequent stopping of breathing during sleep for 5-10 seconds at a time; when this happens, the person rouses and takes a breath. Too little deep sleep is obtained due to these frequent semi-awakenings. Heartburn is often due to esophageal reflux, a condition where acid from the stomach pushes up into the swallowing tube because the valve between those two structures is weakened. The acid causes irritation and leads to a burning feeling in the middle of the chest. Frequency of urination can occur due to the normal shrinking of bladder size, and for other reasons discussed above under the topic of incontinence. Restless leg syndrome involves involuntary movements of the legs and a need to move the legs to get comfortable. This tends to happen as the person tries to rest, or is asleep (Parker & Rye, 2002).

Appropriate treatment of each of these causes, and good sleep hygiene habits can make a huge difference in sleep for everybody. Sleep hygiene involves elimination of daytime naps, consistent times for going to bed and getting up, keeping a quiet and dark sleeping environment, avoiding caffeine or heavy foods late in the day, and getting regular aerobic exercise earlier in the day. The one treatment that should be avoided is use of sleeping pills which can, over the long haul, lead to increased problems.


The purposes of this lesson include not only raising your awareness of the causes of illness and death in older adults, but also pointing out the progress that has occurred in dealing with them. In reviewing the common illnesses of older adulthood, and their risk factors, we have set the stage for the next important, unit on health promotion. Health promotion isn’t about “them” (the old folks), but about each one of us, at any age, and what the quality of our lives can be. See you there!

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