CHAPTER 15 Physical & Cognitive Development in Late Adulthood

How Long Will You Live? Longevity Number of years a person can expect to live Determined by genetic & environmental factors Average Life Expectancy Age at which half of the people born in a particular year will have died Useful Life Expectancy Number of years a person is free from debilitating chronic disease & impairment Maximum Life Expectancy The oldest age to which any person lives Maximum limit for humans is around 120 years

Longevity

Number of years a person can expect to live

Determined by genetic & environmental factors

Average Life Expectancy

Age at which half of the people born in a particular year will have died

Useful Life Expectancy

Number of years a person is free from debilitating chronic disease & impairment

Maximum Life Expectancy

The oldest age to which any person lives

Maximum limit for humans is around 120 years

How Long Will You Live? Genetic & Environmental Factors Good way to increase life expectancy is to come from a family of long-lived individuals Environmental factors affect life span Environment factors include Diseases, toxins & pollutants, life style, social class Most environmental factors are caused by people Ethnic & Gender Differences Women live longer than men in industrialized countries Men being more susceptible to infectious diseases may be cause of shorter life spans or may be due to genetics Women have 2 X chromosomes & have a higher metabolic rate, higher testosterone levels

Genetic & Environmental Factors

Good way to increase life expectancy is to come from a family of long-lived individuals

Environmental factors affect life span

Environment factors include

Diseases, toxins & pollutants, life style, social class

Most environmental factors are caused by people

Ethnic & Gender Differences

Women live longer than men in industrialized countries

Men being more susceptible to infectious diseases may be cause of shorter life spans or may be due to genetics

Women have 2 X chromosomes & have a higher metabolic rate, higher testosterone levels

The 3rd-4th Age Distinction 3rd Age (Young Old) “Good News” Increased life expectancy, with more older people living longer & aging successfully Substantial potential for physical & mental fitness, with improvement in each generation Evidence of cognitive & emotional reserves in the aging mind High levels of emotional & personal well-being Effective strategies to master the gains & losses of later life 4th Age (Oldest Old) “Bad News” Sizable losses in cognitive potential & ability to learn Increases in negative effects of chronic stress High prevalence of dementia (50% in people over 90), frailty, & multiple chronic conditions Problems with quality of life & dying with dignity

3rd Age (Young Old) “Good News”

Increased life expectancy, with more older people living longer & aging successfully

Substantial potential for physical & mental fitness, with improvement in each generation

Evidence of cognitive & emotional reserves in the aging mind

High levels of emotional & personal well-being

Effective strategies to master the gains & losses of later life

4th Age (Oldest Old) “Bad News”

Sizable losses in cognitive potential & ability to learn

Increases in negative effects of chronic stress

High prevalence of dementia (50% in people over 90), frailty, & multiple chronic conditions

Problems with quality of life & dying with dignity

Physical, Cognitive, & Mental Issues Demographics of Aging Many changes due to increased over 60 years Marketing will be targeted, have considerable political & economic power Pressure on pensions, health care, & other services Diversity of older adults Older women outnumber older men in all ethnic groups Older adults of the future will be better educated By 2030, 85% will have high school diploma & 75% will have college degree Better educated tend to live longer Due to higher incomes and better medical care

Demographics of Aging

Many changes due to increased over 60 years

Marketing will be targeted, have considerable political & economic power

Pressure on pensions, health care, & other services

Diversity of older adults

Older women outnumber older men in all ethnic groups

Older adults of the future will be better educated

By 2030, 85% will have high school diploma & 75% will have college degree

Better educated tend to live longer

Due to higher incomes and better medical care

Biological Theories of Aging Wear-&-tear Theory Body is like a machine that gradually deteriorates & finally wears out Explains some diseases (e.g. osteoarthritis)

Wear-&-tear Theory

Body is like a machine that gradually deteriorates & finally wears out

Explains some diseases (e.g. osteoarthritis)

Biological Theories of Aging Cellular Theories Focuses on processes that occur within individual cells which may lead to a build up of harmful substances or the deterioration of cells over a lifetime Telomeres play a role Tips of the chromosomes Free Radicals Cause Cellular Damage that Impairs Functioning Chemicals produced randomly during normal cell metabolism, which bond easily to other substances inside cells Crosslinking Some proteins interact randomly with certain body tissues, such as muscles & arteries stiffening the tissue

Cellular Theories

Focuses on processes that occur within individual cells which may lead to a build up of harmful substances or the deterioration of cells over a lifetime

Telomeres play a role

Tips of the chromosomes

Free Radicals

Cause Cellular Damage that Impairs Functioning

Chemicals produced randomly during normal cell metabolism, which bond easily to other substances inside cells

Crosslinking

Some proteins interact randomly with certain body tissues, such as muscles & arteries stiffening the tissue

Biological Theories of Aging Metabolic Theories Higher caloric intake & stress lower life expectancy & disease susceptibility Programmed Cell Death Theories Aging is genetically programmed

Metabolic Theories

Higher caloric intake & stress lower life expectancy & disease susceptibility

Programmed Cell Death Theories

Aging is genetically programmed

Changes in the Neurons Neurofibrillary Tangles Fibers that compose the axon sometimes become twisted together forming a spiral-shaped mass Dendritic Changes Some shrivel up & die making communications difficult Others continue to grow Neuritic Plaques Damaged & dying neurons sometimes collect around a core of protein producing the plaques These plaques interfere with normal functioning of healthy cells

Neurofibrillary Tangles

Fibers that compose the axon sometimes become twisted together forming a spiral-shaped mass

Dendritic Changes

Some shrivel up & die making communications difficult

Others continue to grow

Neuritic Plaques

Damaged & dying neurons sometimes collect around a core of protein producing the plaques

These plaques interfere with normal functioning of healthy cells

The Aging Brain How the Brain Changes Shrink & Slowing Loses 5 to 10% of its weight between ages of 20 & 90 Dendritic losses & damage to myelin? Adapting to Losses Can repair itself Aerobic exercise can increase brain volume

How the Brain Changes

Shrink & Slowing

Loses 5 to 10% of its weight between ages of 20 & 90

Dendritic losses & damage to myelin?

Adapting to Losses

Can repair itself

Aerobic exercise can increase brain volume

Sensory Changes 2 Major Kinds of Age-related Structural Changes in the Eye Presbyopia Difficulty seeing close objects clearly, necessitating either longer arms or corrective lenses Other changes include cataracts Opaque spots on the lens that limit the amount of light transmitted Glaucoma Improper drainage of the fluid in the eye causing high pressure & loss of vision

2 Major Kinds of Age-related Structural Changes in the Eye

Presbyopia

Difficulty seeing close objects clearly, necessitating either longer arms or corrective lenses

Other changes include cataracts

Opaque spots on the lens that limit the amount of light transmitted

Glaucoma

Improper drainage of the fluid in the eye causing high pressure & loss of vision

Sensory Changes Changes in the Retina Macular degeneration: Progressive & irreversible destruction of receptors from different causes Diabetic retinopathy: Involves fluid retention in the macula, detachment of the retina, hemorrhage, & aneurisms

Changes in the Retina

Macular degeneration:

Progressive & irreversible destruction of receptors from different causes

Diabetic retinopathy:

Involves fluid retention in the macula, detachment of the retina, hemorrhage, & aneurisms

Sensory Changes Hearing Loss Presbycusis: Cumulative effects of noise & normative age-related hearing problem causing reduced sensitivity to high-pitched tones Hearing loss is gradual at first but accelerates during the 40s Results from 4 types of changes in the inner ear Sensory: consisting of atrophy & degeneration of receptor cells Neural: consisting of a loss of neurons in the auditory pathway to the brain Metabolic: consisting of a diminished supply of nutrients to the cells in the receptor area Mechanical: consisting of atrophy & stiffening of the vibrating structures in the receptor area

Hearing Loss

Presbycusis:

Cumulative effects of noise & normative age-related hearing problem causing reduced sensitivity to high-pitched tones

Hearing loss is gradual at first but accelerates during the 40s

Results from 4 types of changes in the inner ear

Sensory: consisting of atrophy & degeneration of receptor cells

Neural: consisting of a loss of neurons in the auditory pathway to the brain

Metabolic: consisting of a diminished supply of nutrients to the cells in the receptor area

Mechanical: consisting of atrophy & stiffening of the vibrating structures in the receptor area

Sensory Changes Taste, Smell, Touch, Temperature, Pain, & Balance Remain largely in tact Smell declines after 70 for most people Large declines are characteristic of Alzheimer’s Changes in balance make older people more likely to fall

Taste, Smell, Touch, Temperature, Pain, & Balance

Remain largely in tact

Smell declines after 70 for most people

Large declines are characteristic of Alzheimer’s

Changes in balance make older people more likely to fall

Cardiovascular Changes Heart Attack, Irregular Heartbeat, Stroke, Hypertension Increase with Age Overall death rated from these have been declining due to life style changes Changes that contribute to cardiovascular problems begin in young adulthood Fat deposits around the heart & in the arteries Amt. heart can pump per minute declines, muscle tissue in the heart declines due to replacement by connective tissue

Heart Attack, Irregular Heartbeat, Stroke, Hypertension Increase with Age

Overall death rated from these have been declining due to life style changes

Changes that contribute to cardiovascular problems begin in young adulthood

Fat deposits around the heart & in the arteries

Amt. heart can pump per minute declines, muscle tissue in the heart declines due to replacement by connective tissue

Cardiovascular Changes Strokes or Cerebral Vascular Accidents Interruptions in the blood flow to the brain due to blockage or hemorrhage in a cerebral artery Transient ischemic attacks are early warning signs of stroke An interruption in blood flow to the brain Vascular dementia Numerous small cerebral vascular accidents Can have a sudden onset & may or may not progress gradually with varying symptoms

Strokes or Cerebral Vascular Accidents

Interruptions in the blood flow to the brain due to blockage or hemorrhage in a cerebral artery

Transient ischemic attacks are early warning signs of stroke

An interruption in blood flow to the brain

Vascular dementia

Numerous small cerebral vascular accidents

Can have a sudden onset & may or may not progress gradually with varying symptoms

Cardiovascular Changes Chronic Obstructive Pulmonary Disease Most common form of incapacitating respiratory disease among older adults Can result in depression, anxiety, & need to be continually connected to oxygen Emphysema & asthma are most common forms

Chronic Obstructive Pulmonary Disease

Most common form of incapacitating respiratory disease among older adults

Can result in depression, anxiety, & need to be continually connected to oxygen

Emphysema & asthma are most common forms

Health Issues Sleep Older adults have more trouble sleeping Takes longer to fall asleep, get less sleep, feel more negative effects after little sleep Some problems can be due to physical disorders, side effects of medication, effects of caffeine, nicotine, & stress Sleep problems can disrupt circadian rhythm (sleep-wake cycle) Nutrition As long as eating a well-balanced meal, don’t need supplements Metabolism declines w/age causing body to not extract & use the nutrients the same way Cancer Unhealthy life-styles, genetics, & exposure to cancer-causing chemicals important

Sleep

Older adults have more trouble sleeping

Takes longer to fall asleep, get less sleep, feel more negative effects after little sleep

Some problems can be due to physical disorders, side effects of medication, effects of caffeine, nicotine, & stress

Sleep problems can disrupt circadian rhythm (sleep-wake cycle)

Nutrition

As long as eating a well-balanced meal, don’t need supplements

Metabolism declines w/age causing body to not extract & use the nutrients the same way

Cancer

Unhealthy life-styles, genetics, & exposure to cancer-causing chemicals important

Cognitive Processes Attention Selective attention: selection of relevant information & inhibition of irrelevant information Older adults tend to perform poorer on selective attention tasks With practice, differences minimized Vigilance: sustained attention, involving the maintenance of attention over time Uncertain if vigilance declines Attentional Control Ability to focus, switch, & divide attention With complex tasks, older perform poorer than youth Difference in attention depends on factors such as complexity, visual ability, & other cognitive factors

Attention

Selective attention: selection of relevant information & inhibition of irrelevant information

Older adults tend to perform poorer on selective attention tasks

With practice, differences minimized

Vigilance: sustained attention, involving the maintenance of attention over time

Uncertain if vigilance declines

Attentional Control

Ability to focus, switch, & divide attention

With complex tasks, older perform poorer than youth

Difference in attention depends on factors such as complexity, visual ability, & other cognitive factors

Cognitive Processes Psychomotor Speed The speed at which a person can make a specific response Rate at which cognitive processes slow varies greatly depending on the task Most important reason reaction time slows is that older adults take longer to decide the need to respond, especially for ambiguous information Older adults who are physically fit show less slowing

Psychomotor Speed

The speed at which a person can make a specific response

Rate at which cognitive processes slow varies greatly depending on the task

Most important reason reaction time slows is that older adults take longer to decide the need to respond, especially for ambiguous information

Older adults who are physically fit show less slowing

Memory Poor Memory often Viewed as Inevitable with Age Working Memory Generally declines with age May be reason for age-related differences on tasks of cognitive performance

Poor Memory often Viewed as Inevitable with Age

Working Memory

Generally declines with age

May be reason for age-related differences on tasks of cognitive performance

Memory Focus is Generally on 2 Types of Memory Changes Explicit Memory The deliberate & conscious remembering of information that is learned & remembered at a specific time Explicit is divided into Episodic memory : having to do with the conscious recollection of information from a specific time or event Semantic memory : concerning remembering meanings of words or concepts not tied to a specific time or event

Focus is Generally on 2 Types of Memory Changes

Explicit Memory

The deliberate & conscious remembering of information that is learned & remembered at a specific time

Explicit is divided into

Episodic memory : having to do with the conscious recollection of information from a specific time or event

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

Memory Implicit Memory The unconscious remembering of information learned at some earlier time Older adults tend to perform worse on tests of episodic memory Tend to be less efficient at spontaneously using memory strategies to help their memory Older adults have problems in finding words and having more tip-of-the-tongue experiences With autobiographical memory, memories experienced between 10 & 30 more often reported than after 30

Implicit Memory

The unconscious remembering of information learned at some earlier time

Older adults tend to perform worse on tests of episodic memory

Tend to be less efficient at spontaneously using memory strategies to help their memory

Older adults have problems in finding words and having more tip-of-the-tongue experiences

With autobiographical memory, memories experienced between 10 & 30 more often reported than after 30

Memory Widespread Belief that Memory Declines What adults believe about their memories affects how well they perform How much effort put into trying to remember, how well predict performance, strategies used to remember Beliefs Related to Assumptions About the Degree Memory is Supposed to Change People convince themselves the changes are worse than they are Beliefs influenced by changes in information processing (working memory)

Widespread Belief that Memory Declines

What adults believe about their memories affects how well they perform

How much effort put into trying to remember, how well predict performance, strategies used to remember

Beliefs Related to Assumptions About the Degree Memory is Supposed to Change

People convince themselves the changes are worse than they are

Beliefs influenced by changes in information processing (working memory)

Remediating Memory Problems Program for Memory Aids External Aids Memory aids that rely on environmental sources such as notebooks or calendars Internal Aids Memory aids that rely on mental processes such as imagery Explicit-internal Aids Rehearsal to remember a phone number Explicit-external Taking notes during a doctor’s visit Implicit-internal Associating the color of an indoor parking structure Implicit-external Visualizing images that represent time of day and number of pills to be taken

Program for Memory Aids

External Aids

Memory aids that rely on environmental sources such as notebooks or calendars

Internal Aids

Memory aids that rely on mental processes such as imagery

Explicit-internal Aids

Rehearsal to remember a phone number

Explicit-external

Taking notes during a doctor’s visit

Implicit-internal

Associating the color of an indoor parking structure

Implicit-external

Visualizing images that represent time of day and number of pills to be taken

Abnormal Memory Change Does Memory Problem Interfere with Daily Life? Loss of memory of spouse’s name, etc., get an examination Complete physical & neurological with battery of psychological to identify the nature of the problem Take the necessary steps to alleviate the difficulties

Does Memory Problem Interfere with Daily Life?

Loss of memory of spouse’s name, etc., get an examination

Complete physical & neurological with battery of psychological to identify the nature of the problem

Take the necessary steps to alleviate the difficulties

Creativity & Wisdom Creativity The ability to produce work that is novel, high in demand, & task appropriate Highest creativity during 20s, plateaus in 30s, & declines after Creative people continue to produce creative ideas, but fewer after 30s Wisdom Seen from 3 main perspectives 1. The orchestration of mind & virtue, involving the ability to solve difficult real-world problems 2. Postformal thinking 3. Action-oriented knowledge acquired w/out direct help form others that enables people to achieve goals they value

Creativity

The ability to produce work that is novel, high in demand, & task appropriate

Highest creativity during 20s, plateaus in 30s, & declines after

Creative people continue to produce creative ideas, but fewer after 30s

Wisdom

Seen from 3 main perspectives

1. The orchestration of mind & virtue, involving the ability to solve difficult real-world problems

2. Postformal thinking

3. Action-oriented knowledge acquired w/out direct help form others that enables people to achieve goals they value

4 Characteristics of Wisdom Wisdom deals with important or difficult matters of life & the human condition Wisdom is superior knowledge, judgment, & advice Wisdom is knowledge with extraordinary scope, depth, & balance, applicable to specific situations Wisdom, when used, is well intended & combines mind & virtue

Wisdom deals with important or difficult matters of life & the human condition

Wisdom is superior knowledge, judgment, & advice

Wisdom is knowledge with extraordinary scope, depth, & balance, applicable to specific situations

Wisdom, when used, is well intended & combines mind & virtue

Wisdom A Wise Person: Is able to Integrate Thinking, Feeling, & Acting into a Coherent Approach to a Problem Empathy & compassion are important characteristics They are able to overcome automatic responses & see through situations getting to the heart of the matter than being caught in the details 3 Factors to Wisdom 1. General Personal Conditions Mental ability 2. Specific Expertise Conditions Mentoring or practice 3. Facilitative Life Contexts Education or leadership experience

A Wise Person:

Is able to Integrate Thinking, Feeling, & Acting into a Coherent Approach to a Problem

Empathy & compassion are important characteristics

They are able to overcome automatic responses & see through situations getting to the heart of the matter than being caught in the details

3 Factors to Wisdom

1. General Personal Conditions

Mental ability

2. Specific Expertise Conditions

Mentoring or practice

3. Facilitative Life Contexts

Education or leadership experience

Mental Health & Intervention Depression Diagnosing depression Most common symptom is feeling sad or down Dysphoria Older adults express this as “feeling helpless” or “feeling tired” Apathy & expressionless confining themselves to the bed, self neglect, & making derogatory statements re: self Loss of appetite, insomnia, & trouble breathing Causes Imbalances of specific neurotransmitters Psychosocial factors such as loss & internal beliefs systems Loss of a spouse, a job, good health, etc. Internal belief systems What one tells oneself about why certain things are happening Belief of being personally responsible for all the bad things that happen to them, things are not going to get any better, life is a mess

Depression

Diagnosing depression

Most common symptom is feeling sad or down

Dysphoria

Older adults express this as “feeling helpless” or “feeling tired”

Apathy & expressionless confining themselves to the bed, self neglect, & making derogatory statements re: self

Loss of appetite, insomnia, & trouble breathing

Causes

Imbalances of specific neurotransmitters

Psychosocial factors such as loss & internal beliefs systems

Loss of a spouse, a job, good health, etc.

Internal belief systems

What one tells oneself about why certain things are happening

Belief of being personally responsible for all the bad things that happen to them, things are not going to get any better, life is a mess

Mental Health & Intervention Treatment Severe cases medications for the balance of neurotransmitters Heterocyclic antidepressants, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors Behavior therapy Depressed people receive too few rewards from their environment Increase the good things that happen & minimize the negative Cognitive therapy Maladaptive beliefs or thoughts about oneself are responsible for the depression Depression is treatable

Treatment

Severe cases medications for the balance of neurotransmitters

Heterocyclic antidepressants, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors

Behavior therapy

Depressed people receive too few rewards from their environment

Increase the good things that happen & minimize the negative

Cognitive therapy

Maladaptive beliefs or thoughts about oneself are responsible for the depression

Depression is treatable

Anxiety Disorders Behavioral and Psychological Problems Feelings of severe nervousness for no apparent reason, phobias, obsessive-compulsive disorders, thoughts or actions that are repeatedly performed More common in older adults due to loss of health, relocation stress, isolation, fear of losing independence, etc. Can be treated with medication & psychotherapy Relaxation therapy is highly effective & easily learned

Behavioral and Psychological Problems

Feelings of severe nervousness for no apparent reason, phobias, obsessive-compulsive disorders, thoughts or actions that are repeatedly performed

More common in older adults due to loss of health, relocation stress, isolation, fear of losing independence, etc.

Can be treated with medication & psychotherapy

Relaxation therapy is highly effective & easily learned

Alzheimer’s Disease Involving Serious Impairment of Behavioral & Cognitive Functioning Symptoms: Gradual decline in memory, learning, attention, & judgment Confusion as to time & place Difficulties in communicating & finding the right words Decline in personal hygiene & self-care skills Inappropriate social behavior Personality changes In advanced stages, incontinence

Disease Involving Serious Impairment of Behavioral & Cognitive Functioning

Symptoms:

Gradual decline in memory, learning, attention, & judgment

Confusion as to time & place

Difficulties in communicating & finding the right words

Decline in personal hygiene & self-care skills

Inappropriate social behavior

Personality changes

In advanced stages, incontinence

Diagnosing Alzheimer’s Accuracy Depends on a thorough series of medical & psychological tests, including blood tests, metabolic & neurological tests, & neuropsychological tests Interview of family necessary Often inaccurate in assessment Much Attention Focused on Protein Beta- amyloid Protein that is produced in extremely high levels in Alzheimer’s possibly causing the plaques & tangles Causes Some forms are inherited Chromosomes 12, 14, 19, 21 Treatment: Symptoms can be alleviated with medication Acetylcholinestrase inhibitors

Accuracy

Depends on a thorough series of medical & psychological tests, including blood tests, metabolic & neurological tests, & neuropsychological tests

Interview of family necessary

Often inaccurate in assessment

Much Attention Focused on Protein Beta- amyloid

Protein that is produced in extremely high levels in Alzheimer’s possibly causing the plaques & tangles

Causes

Some forms are inherited

Chromosomes 12, 14, 19, 21

Treatment:

Symptoms can be alleviated with medication

Acetylcholinestrase inhibitors

Parkinson’s Disease Known for its Characteristic Motor Symptoms Very slow walking, difficulty getting into & out of chairs, & a slow hand tremor Effectively treated with L-dopa which raises the functional level of dopamine in the brain

Known for its Characteristic Motor Symptoms

Very slow walking, difficulty getting into & out of chairs, & a slow hand tremor

Effectively treated with L-dopa which raises the functional level of dopamine in the brain