chapter fourteen the personal context of later life

Chapter Fourteen

The Personal Context of Later

Life

Introduction

• What words can you think of that are associated with older adults?

• What are some health issues that older adults are faced with?

• What happens to cognition in older adulthood?

14.1 What Are Older Adults Like?

• Learning Objectives:– What are the characteristics of older adults in the

population?– How long will most people live?

• What factors influence this?

The Demographics of Aging

• Better health care and a lower childbirth mortality rate for women is responsible for a large population of older people in the U.S.

• Older population expected to increase– Puts a strain on the social services systems and

the health care system

• Population pyramid: used by demographers to illustrate population trends– See Figure 14.1

The Demographics of Aging (cont’d.)

Changing shapes of distributions in terms of the proportion of the population that is young versus old over time and as a function of whether countries are considered developed or developing.

Projected changes in the U.S. minority population of older adults. The number of older Latino Americans will increase the fastest.


• What will older adults look like in the coming decades?– Better educated; 75% will have a college degree

by 2030• Higher education leads to increased longevity by means

of healthier lifestyles and higher income to afford healthcare

– In Japan in 2025, adults over 65 will outnumber children 2:1


The proportion of older adults (65 years and older) is increasing in many countries and will continue to do so in the coming decades.


Longevity

• Longevity: the number of years a person can expect to live– Determined by genetic and environmental factors– Three types of longevity:

• Average life expectancy: age at which half of people born in a particular year will have died

• Useful life expectancy: number of years a person is free from debilitating chronic disease and impairment

• Maximum life expectancy: the oldest age to which any person lives

Longevity (cont’d.)

Life expectancy at birth and at 65 years of age in the United States, 1900–2007


• Heredity is a major determinant of longevity– Coming from a family of long-lived individuals

• Environmental factors also influence longevity– Diseases, lifestyles, toxins, social class, etc.– Overall, healthier lifestyles reduce disease

• Ethnic differences exist in life expectancy– Latino Americans have higher life expectancies

than European Americans at every age• As do African Americans once they hit age 85


• Women’s average longevity is about five years greater than men’s at birth– Narrows to one year by age 85– Mostly seen in developed countries

• Men have a greater risk of dying from the majority of the top causes of death at every age– More susceptible to infectious diseases


International data on average life expectancy at birth. Note the differences between developed and developing countries.

14.2 Physical Changes and Health

• Learning Objectives:– What are the major biological theories of aging?– What physiological changes normally occur in

later life?– What are the principal health issues for older

adults?

Biological Theories of Aging

• Two major types of theories explain why people grow old and die– Programmed theories: a biological clock in which

cells start to self-destruct– Damage or error theories:

• Wear-and-tear theory: suggests that the body (like a machine) gradually deteriorates and finally wears out

• Cellular theories: focuses on processes that occur within individual cells, which may lead to the buildup of harmful substances or the deterioration of cells over a lifetime

Biological Theories of Aging (cont’d.)

– Accumulation of free radicals over time:• Chemicals are produced randomly during normal cell

metabolism and bond easily to other substances within cells, resulting in aging

– Cross-linking: the random interaction of some proteins with certain body tissues

• Normally elastic tissue becomes stiffer

– Telomeres: tips of chromosomes that shorten and break with age

Physiological Changes

Basic structure of the neuron.

Physiological Changes (cont’d.)

• Changes impair the neurons’ ability to transmit information, leading to a decline in a person’s functioning– Neurofibrillary tangles: masses formed when fibers

in axons become twisted together• Large numbers associated with Alzheimer’s disease

– Some dendrites die and others grow– Neuritic plaques: changes produced when damaged

and dying neurons collect around a core of protein


• Levels of neurotransmitters decline with age– Believed to be responsible for changes in sleep

and memory in old age

• Neuroimaging is important for understanding normal/abnormal cognitive aging– Structural neuroimaging

• X-rays, CT scans, MRIs

– Functional neuroimaging• Indication of brain activity


• Cardiovascular and respiratory problems increase with age– Cardiovascular disease risk increases– Stroke or cerebral vascular accident (CVA): caused

by an interruption of blood flow in the brain due to blockage or hemorrhage in cerebral artery

– Transient ischemic attacks (TIAs): interruptions of blood flow to the brain

• Early warning sign of stroke


– Vascular dementia: a disease caused by numerous small CVAs

• Sudden onset and may progress slowly• Diagnosed by structural imaging

– Chronic obstructive pulmonary disease (COPD): most common form of incapacitating respiratory disease among older adults

• Emphysema is most common form; usually results from smoking but can be genetic


• Parkinson’s disease: a brain disease known for its characteristic motor symptoms– Very slow walking, difficulty getting in and out of

chairs, and slow hand tremor– Caused by a decrease of dopamine– Medication and surgery can cause a deterioration

of neurons that release dopamine


• Age-related structural changes occur in the eye– Decrease in amount of light that passes through

the eye– Ability to adjust to changes in illumination

decreases– Presbyopia: difficulty in seeing close objects

clearly • Caused by a yellowing of the lens and stiffening of

muscles around the lens


• Abnormal structural changes in the eye can cause diseases– Cataracts can develop on the lens– Pressure of fluid on the eye leads to glaucoma– Changes in the retina can also occur

• Macular degeneration results in loss of ability to see details

• Diabetic retinopathy can cause blindness; more common in those diagnosed with diabetes earlier in life


• People of all ages should avoid loud noises– Headphones at a high volume are a danger,

especially while exercising

• Presbycusis: reduced sensitivity to high-pitched tones– Happens in approx. half of adults by the late-70’s

• Hearing loss can cause emotional and interpersonal problems


Hearing loss occurs in all adults but is greatest for high-pitched tones and greater for men than for women. As a reference, the highest note on a piano is 4,186 Hz; normal human hearing ranges from 27 Hz to 20,000 Hz.


• Falls are increasingly likely in old age– Staying active and removing hazards can prevent

some falls

• Accidents around the home can occur as a result of sensory changes– Prevention and conditioning can help prevent

them, as well as environmental changes• Illuminating stairways, sturdy handrails, and nonskid

mats in bathtubs can help prevent falls

Health Issues

• Older adults report taking longer to fall asleep and feeling more negative after a night of inadequate sleep than younger adults

• Disruptions to the circadian rhythm can cause problems with attention and memory

• Older adults need a well-balanced diet– Usually can avoid taking vitamin and mineral

supplements– See Figure 14.8

Health Issues (cont’d.)

Dietary guidelines for older adults.


• Early detection of cancer is essential to surviving most forms

The risk of cancer increases greatly with age.


• Immigrants to the U.S. face many barriers in obtaining adequate healthcare– Language and cultural differences must be

considered– Immigrants show poorer health than U.S. born

people with the same ethnic background• Having an excellent relationship with their child can

mitigate this

14.3 Cognitive Processes

• Learning Objectives:– What changes occur in information processing as

people age? • How do these changes relate to everyday life?

– What changes occur in memory with age?• What can be done to remediate these changes

– What are creativity and wisdom?• How do they relate to age?

Information Processing

• Psychomotor speed or reaction time: the speed with which a person can make a specific response– People slow down as they get older

• Take longer to respond, especially when it involves ambiguous information

• Exercise can mediate effects of cognitive aging

• Do you think older adults should be allowed to have drivers’ licenses? – See Figure 14.10

Information Processing (cont’d.)

National fatal passenger vehicle driver crash involvements per 100,000 licensed drivers by driver age group, 1997–2008


• Decisions about at-risk drivers should be considered by more factors than age or medical diagnosis– Useful field of view (UFOV): can extract visual

information in a single glance without turning the head or moving the eyes

• Performance on UFOV predicts driving performance

– AAA Roadside Review assesses key functional areas• Effort to get states to have more uniform standards


How do our cognitive processes change with age? Earlier models suggest that as we age all of our cognitive processes slow down and that we should, as a result, expect reduced performance. But a newer model focuses not just on speed of performance, but on accuracy as well. Learn how for many cognitive processes, age alone, does not mean reduced performance.


• Working memory: the processes and structures involved in holding information and simultaneously using it for other functions– Generally declines with age– Older adults activate the prefrontal area

associated with working memory even on easy tasks

• Exhaust resources sooner than younger adults

Memory

• Study of memory focuses on two types– Explicit memory: deliberate and unconscious

remembering of information learned and remembered at a specific time

• Episodic memory: conscious recollection of information from a specific time or event

• Semantic memory: remembering meanings of words or concepts not tied to a specific time or event

– Implicit memory: the unconscious remembering of information learned at an earlier point in time

Memory (cont’d.)

• What types of memory changes in older adults?– Perform worse on tests of episodic memory– Age differences smaller, but still present on

recognition tests– Semantic memory difficulties usually only seen in

people with dementia

• Neuroscience research shows that structural changes in the brain underlie changes in memory

Memory (cont’d.)

• Is forgetfulness always indicative of something worse?– An array of tests are used to diagnose normal and

abnormal memory changes• Determine whether memory problems are interfering

with everyday functioning• A thorough examination is needed once a problem is

suspected

– Many memory diseases progress slowly

Memory (cont’d.)

• Some people need help remembering due to normal age-related memory changes

• Others need help because they are experiencing greater than normal memory changes

Memory (cont’d.)

The E-I-E-I-O model of memory helps categorize different types of memory and their aids.

Memory (cont’d.)

• Explicit-external interventions are used most frequently for normal aging memory problems– Can help older adults maintain their

independence

Creativity and Wisdom

• Do only young people display creativity?– Do only older people show wisdom?

• Creativity in adults is the ability to produce work that is novel, high in demand, and task-appropriate– Creative output peaks in the 40s and then declines – People do not stop being creative; they simply

produce fewer creative ideas than before– White matter in the brain is linked to creativity

Creativity and Wisdom (cont’d.)

• Four characteristics of wisdom:– Deals with important or difficult matters of life or

the human condition– Truly “superior” knowledge, judgment, or advice– Knowledge with extraordinary scope, depth, and

balance that is applied to specific situations– Well intended– Combines the mind and character


• Research suggests that there is no association between age and wisdom

• Whether a person is wise depends on whether or not she has extensive life experience with the problem and the prerequisite personality and cognitive abilities to deal with it

• Could be related to crystallized intelligence


• What helps a person become wise?– General personal attributes, such as mental ability– Specific expertise, such as mentoring– Facilitative life contexts, such as education or

leadership experience

14.4 Mental Health and Intervention

• Learning Objectives:– How does depression in older adults differ from

depression in younger adults?• How is it diagnosed and treated?

– What is Alzheimer’s disease?• How is it diagnosed and managed?• What causes it?

Mental Health and Intervention (cont’d.)

• True or false? Most older adults suffer from depression or dementia– Only a minority have mental problems

• Most can be treated with therapy

Depression

• Rate of severe depression actually decreases with age– Average age of onset is early 30s

• Depression in older people diagnosed by looking at feelings and physical changes– Must be present for at least two weeks

• Feeling of dysphoria is usually the most prominent symptom– “Feeling useless” or “feeling tired”

Depression (cont’d.)

• Physical changes include loss of appetite, insomnia, and trouble breathing– Must not be confused with normal age-related

physical changes– Must rule out other possible causes of symptoms

• What causes depression?– Biological and physiological processes, such as

nerotransmitter imbalance


– Psychosocial factors such as loss and internal belief systems

– Internal belief systems: what one tells oneself about why certain things are happening

• Example: depression may result is a person believes that his spouse died because he is a bad person

• Depressed people tend to believe that they are responsible for negative events that happen to them


• Medications can alter the balance of certain neurotransmitters– For severe depression, SSRIs, HCAs, and MAO

inhibitors are prescribed• Psychotherapy also used as an alternative or in

combination with medication– Behavior therapy: proposes depressed people

experience too few rewards from the environment– Cognitive therapy: proposes that maladaptive beliefs

about oneself cause depression

Dementia: Alzheimer’s Disease

• Dementia: a family of diseases involving serious impairment of behavioral and cognitive functioning– Alzheimer’s disease is most common

• Affects all socioeconomic, ethnic, and racial groups• Approx. half of all people 85 years of age and older

have Alzheimer’s

Dementia (cont’d.)

• What are the symptoms of Alzheimer’s?– Gradual declines in memory, attention, and judgment– Confusion as to time and place– Difficulties in communicating– Decline in self-care skills– Inappropriate behavior– Personality changes– Incontinence (loss of bladder control) in end stages


• Rate of deterioration varies from person to person, but usually is around 12 years from onset of symptoms

Listen to the story of a woman who struggled with her mother's Alzheimer's diagnosis.

Diagnosing Alzheimer’s disease requires a thorough process of ruling out other possibilities.



• What causes Alzheimer’s disease?– Early onset (before age 60)

• Tends to run in families• Autosomal dominant inheritance: the presence of

certain genes means that there is a 100% chance of the person eventually getting the disease

– Later onset (after age 60)• May be linked to genetic risks• Most commonly related to amyloid plaque formation

• Neuroimaging helps to identify changes


• Currently, there is no cure or preventative measures for Alzheimer’s

• Few medications show promising results• Behavioral and educational interventions

– Spaced retrieval: based on the E-I-E-I-O model that involves implicit memory and internal aids

• Alzheimer’s patients can learn names of new people

– Some programs bring older adults and preschoolers together to learn


Art reduces anxiety and evokes emotional memory in Alzheimer’s patients.

chapter fourteen the personal context of later life

Documents

older population

proportion of older

demographics of aging

older adulthood

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person liveslongevity

average life expectancy

number of years