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  • Normal aging Cognitive disorders associated with aging Aging and trauma
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  • Cognition & personality
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  • Productivity and decline: both characterize late life. Nearly half of older Americans consider themselves to be middle aged or young. 3 Only 15 percent of those 75 + consider themselves very old. 3 Migrant fruit worker from Arkansas, Berrien County, Michigan
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  • In aging, we experience increasing limits on intellectual and physical performance. However, changes may not interfere much with functioning in every day life activities. Age-related limitations become more apparent under stressful or demanding conditions Conversely limitations are less apparent when the environment is familiar and sufficient time is provided.
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  • Cross-sectional studies show peaks between 20-30 years old. 4 Longitudinal studies show increases into 30s to 40s, stability in mid 50s or 60s, and gradual decline thereafter. 5,6 Though many participants showed stable abilities in later life. Physical changes in the aging brain include loss of brain volume 7
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  • What doesnt change 5 Vocabulary the meanings of words and their pronunciation Fund of information facts we learn through education and experience. Implicit/incidental learning Ability to remember things that were heard or read but have not been told to memorize. Stable man at the Eastern States Fair, Springfield, Massachusetts
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  • What does change? 4,5 Speed of mental processing Abstraction ability using concepts to make and understand generalizations (e.g. shared properties or patterns). Mental flexibility tasks that require the individual to respond in novel ways; task-switching. Efficiency encoding new information in a way that it can be easily retrieved later on.
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  • Addressing changes Restoration Compensation Environmental supports Residents of St. Paul, Minnesota
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  • Compensation: Maintaining performance by drawing on other cognitive resources or abilities that are not affected by the aging process. 5 Example: Expert (older) typists were able to perform as rapidly and accurately as younger typists, despite experiencing slowing in reaction time. They compensated by anticipating upcoming words in the text better than less experienced typists. 8
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  • Environmental supports Recognition memory changes less than recall Assist the older person in organizing information to be learned Prevent distractions Provide more time for learning and recalling new material
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  • Basic personality traits remain relatively consistent throughout adult life. 5 Extroversion Openness to new experiences Anxious/depressed personality style "Fiddlin'" Bill Henseley. Asheville, North Carolina. Photographer: Ben Shahn
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  • Mr. and Mrs. Andrew Lyman. Windsor Locks, Connecticut. Photographer: Jack Delano Older people are more cautious When tested older individuals were less likely to guess than younger ones when uncertain about the correct answer. 9 Implication: May make more errors of omission. May be less willing to take risks, even if the probability of success is high. 10,11
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  • Common changes in personality May demonstrate less interest in the outside world. Both positive and negative feelings may be less intense 12 People perceive themselves as changing in meaningful ways, more self-confident, better adjusted, etc., even if tests cannot objectively confirm these changes. 5 Social and historical context (e.g. war, economic circumstances) shapes personality development. 5 Implication: We may attribute characteristics to aging when they are really more related to shared experiences.
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  • Review: Help each other to understand the material presented Discuss: How has the Genocide of 1994 affected the older people of Rwanda? Think: Think of older people you know personally or from your work, who have experienced changes in their thinking.
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  • Washstand in the dog run...Hale County, Alabama. 1935 or 1936. Photographer: Walker Evans
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  • Categories of cognitive impairment: Mild Cognitive Impairment Dementia of the Alzheimers Type (DAT) Stroke Traumatic Brain Injury (TBI) Depression Risk for certain conditions increases with age Risk for stroke more than doubles for each decade after 55 13 50% of adults over 85 years have DAT 14
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  • Impaired memory Affects new learning or recall of previously learned information One or more of the following: Aphasia disturbance of language Apraxia impaired ability to carry out motor activities despite intact motor function Agnosia failure to recognize or identify objects, despite intact sensory functioning Disturbance in executive functioning i.e. planning, organizing, sequencing, abstracting. Causes impaired social or occupational functioning and represents a decline from previous level of functioning
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  • Problems with thinking and memory that do not meet full criteria for dementia. May represent the onset of a progressive process. Imaging studies have shown that the brain may be able to recruit areas outside the usual structures that mediate memory, in order to maintain performance. 15
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  • Breathing disorders: (COPD, emphysema, sleep apnea) Chronic health conditions: (heart disease, diabetes, high blood cholesterol) Surgical procedures Smoking Heavy alcohol use
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  • Degenerative & terminal disease Slow, gradual onset (the long good-bye). Changes at the cellular level of the brain lead to changes in cognition, mood and behavior. No medical test available. Diagnosed by cognitive and behavior changes Medications are not very effective against the disease process.
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  • Memory impairment is the cardinal feature, Though, depression may be the first apparent symptom Later in the course decreased use of language, confusion, inability to recognize familiar things. In mid- to late stages, mood and personality can change and behavior can be disruptive Suspiciousness, delusions, repeated questions, combativeness, restlessness, utilization behavior Associated with high levels of caregiver stress
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  • Street scene, Washington, D.C.
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  • Ischemic or non-bleeding stroke (88%) Blockage or of blood vessels in the brain Prevents oxygen from reaching brain cells Hemorrhagic strokes (12%) Blood vessel in the brain burst Causes increase in pressure in skull Blood/oxygen is not transported to brain cells. Transient Ischemic Attacks (mini-strokes) Cannot be seen with imaging techniques Symptoms resolve
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  • LEFT BRAIN STROKES Right-sided paralysis Impaired vision on right Dysarthria speech Aphasia language Apraxia planned movement Slow / cautious behavior Impaired memory (verbal) RIGHT BRAIN STROKES Left-sided paralysis Left spatial neglect inattention Inability to recognize or appreciate body parts Visual-spatial skills Impaired vision on left Impulsive behavior Impaired awareness Impaired memory (activities)
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  • Adults 75+ years have highest rates of TBI related hospitalizations and deaths. 16 Some symptoms may be evident immediately, while others may not surface until several days or weeks.
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  • Impairments in: Memory Attention Visual-spatial skills Processing speed Expressive language Problem-solving Organization/planning Comprehension/receptive language Self-monitoring / personality change Outside water supply, Washington, D.C. Only source of water supply winter and summer for many houses in slum areas. In some places drainage is so poor that surplus water backs up in huge puddles
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  • ERRORS OF COMMISSION: Apathy Difficulty with initiation Risk for self-neglect Inability to mobilize if help is needed Risk for self-neglect ERRORS OF OMISSION: Disinhibition Impulsivity Confabulation Perseveration Intrusion errors Stimulus-boundedness Risk for falls, other injury, injury to others.
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  • In the U.S., falls are the leading cause of TBI (30%), followed by motor vehicle accidents (17%) 61% of TBI in persons 65+ years are due to falls 17 Elders may not report falls or injury: May feel fine even though they are behaving differently May attribute problems to an issue they are already aware of (e.g. nausea due to having a cold). Embarrassment Impaired memory/confusion
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  • Sleep changes/difficulty Diabetes Dehydration Decreased vision Vestibular/hearing changes Slowed reaction time Gait or balance problems Taking multiple medications Variable blood pressure (orthostatic hypotension) Cognitive impairments/confusion
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  • Hazards in the everyday environment: Poor lighting Clutter Uneven surfaces Small rugs Foot / shoe problems Marketplace in the French quarters of New Orleans, market for Resettlement Administration's rehabilitation clients
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  • Smooth out uneven surfaces Eliminate area rugs Maintain proper lighting Ke

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