Chapter 8 Cognitive and Psychological Changes Related to Aging Objectives (1 of 3) Describe the three basic factors that cause cognitive impairments in older adults. Describe how general (fluid and crystallized intelligence) and specific aspects of cognition (attention, orientation, memory, executive functioning, and learning) may change with the aging process. Describe compensatory measures that could be used for those with decreased or changed cognitive functioning. Objectives (2 of 3) List possible screens for use in detecting cognitive changes. Compare and contrast signs of delirium, depression, and dementia. Complete a screen for depression to make a referral for assistance. List general guidelines for working with people to enhance performance of people with all cognitive levels Objectives (3 of 3) Understand conditions that may mimic dementia (but that are often reversible). Differentiate aspects of personality that may tend to change over time from those that may not, based on current research. Discuss aspects of behavioral change as these relate to older adults. Describe factors believed to contribute to a positive quality of life in older people. Typical Cognitive Changes of Aging (1 of 27)Elders tend to become a more heterogeneous group over timeSome may be able to function as well as or better than when they were youngOthers may succumb to disease or functional decline Typical Cognitive Changes of Aging (2 of 27)Typical cognition overviewCognition or mental processing includes thinking, learning, and memoryCognitive impairments in older adults are primarily caused by:DiseaseDisuseAging Typical Cognitive Changes of Aging (3 of 27)Crystallized and fluid intelligenceCrystallized intelligenceInclude language comprehension, educational qualifications, and life and occupational skillsTends to remain strong in older adultsFluid intelligenceSpeed and accuracy of information processingShows a significant decline in older adults Typical Cognitive Changes of Aging (4 of 27)Processing speedDecreased processing speed may be linked to:Higher level cognitive performanceDecreased physical motor speedImpaired sensory functioning Typical Cognitive Changes of Aging (5 of 27)Learning among older adultsAbility to learn new information can change as people ageResearch indicates older brain cells can regenerateOlder individuals may need:More practice sessions to master a taskInstructions presented in a variety of ways, perhaps geared toward their sensory capacities Typical Cognitive Changes of Aging (6 of 27)Specific factors impacting cognitionNeuroplasticityOlder brains can adapt and engage in new learningMotor skill training may enhance learningCognitive reservePeople with substantial reserves may be able to use readily available or alternative brain structures to maximize performance on cognitive tasksUnknown whether people can build up their cognitive reserve Typical Cognitive Changes of Aging (7 of 27)Sensory issues S.

1. Chapter 8
Cognitive and Psychological Changes Related to Aging
Objectives (1 of 3)
Describe the three basic factors that cause cognitive
impairments in older adults.
Describe how general (fluid and crystallized intelligence) and
specific aspects of cognition (attention, orientation, memory,
executive functioning, and learning) may change with the aging
process.
Describe compensatory measures that could be used for those
with decreased or changed cognitive functioning.
Objectives (2 of 3)
List possible screens for use in detecting cognitive changes.
Compare and contrast signs of delirium, depression, and
dementia.
Complete a screen for depression to make a referral for
assistance.
List general guidelines for working with people to enhance
performance of people with all cognitive levels
Objectives (3 of 3)

2. Understand conditions that may mimic dementia (but that are
often reversible).
Differentiate aspects of personality that may tend to change
over time from those that may not, based on current research.
Discuss aspects of behavioral change as these relate to older
adults.
Describe factors believed to contribute to a positive quality of
life in older people.
Typical Cognitive Changes of Aging (1 of 27)Elders tend to
become a more heterogeneous group over timeSome may be able
to function as well as or better than when they were
youngOthers may succumb to disease or functional decline
Typical Cognitive Changes of Aging (2 of 27)Typical cognition
overviewCognition or mental processing includes thinking,
learning, and memoryCognitive impairments in older adults are
primarily caused by:DiseaseDisuseAging
Typical Cognitive Changes of Aging (3 of 27)Crystallized and
fluid intelligenceCrystallized intelligenceInclude language
comprehension, educational qualifications, and life and
occupational skillsTends to remain strong in older adultsFluid
intelligenceSpeed and accuracy of information processingShows
a significant decline in older adults
Typical Cognitive Changes of Aging (4 of 27)Processing
speedDecreased processing speed may be linked to:Higher level

3. cognitive performanceDecreased physical motor speedImpaired
sensory functioning
Typical Cognitive Changes of Aging (5 of 27)Learning among
older adultsAbility to learn new information can change as
people ageResearch indicates older brain cells can
regenerateOlder individuals may need:More practice sessions to
master a taskInstructions presented in a variety of ways,
perhaps geared toward their sensory capacities
Typical Cognitive Changes of Aging (6 of 27)Specific factors
impacting cognitionNeuroplasticityOlder brains can adapt and
engage in new learningMotor skill training may enhance
learningCognitive reservePeople with substantial reserves may
be able to use readily available or alternative brain structures to
maximize performance on cognitive tasksUnknown whether
people can build up their cognitive reserve
Typical Cognitive Changes of Aging (7 of 27)Sensory issues
Sensory decline and deprivationDecreases in hearing and
vision can impact cognition indirectlyNot hearing or seeing
properly can cause a person to demonstrate behaviors that
outwardly look like they have decreased cognitionSomeone who
needs corrective lenses and/ or hearing aids should be
encouraged to wear them
Typical Cognitive Changes of Aging (8 of 27)Environmental
factorsCan support or hinder learning for older

4. adultsIncludes:Physical environmentInternal
environmentCultural aspects of the tasks to be completedSocial
contextLearned helplessness is a complication related mostly to
social context
Typical Cognitive Changes of Aging (9 of 27)Stereotypes of
agingMost seem to be negativeCan become self-fulfilling
propheciesPositive messages could boost elders’ self-esteem
and their ability to remain vital and productiveMany relate to
dementiaNot part of the normal aging processDementiaphobia—
many people find the prospect of cognitive decline more
frightening than death
Typical Cognitive Changes of Aging (10 of 27)Specific aspects
of cognitionOrientationPeople who are aging typically generally
fully understand who they are, where they are, and the aspects
of time and the situation they are inReferred to as being A&O ×
3Flexible schedule of retirement may contribute to apparent
disorientation to exact date or time of dayPsychiatric
disturbance is indicated when a person is alert, but is not
oriented
Typical Cognitive Changes of Aging (11 of 27)AttentionAge
does not seem to affect ability to focusMay be more difficult for
older adults to divide their attention between two
activitiesOlder people have more difficulty with divided-
attention tasks, especially when the tasks are complex

5. Typical Cognitive Changes of Aging (12 of
27)MemoryMultifactorial and extremely complexRecall is more
affected by age than recognition isBasic memory tasks
preserved throughout the typical aging process include those
involving:Procedural memoryBasic cognitive
skillsRemembering well-learned facts
Typical Cognitive Changes of Aging (13 of 27)Types of
memory based on temporal aspects of remembering:Primary
memoryShort-term memoryWorking memoryProspective
memoryLong-term memory
Typical Cognitive Changes of Aging (14 of 27)Types of
memory based on the type of information to be
encoded:Episodic memorySemantic memoryProcedural memory
Typical Cognitive Changes of Aging (15 of 27)Not all types of
memory are affected equally by the typical aging processMore
severe decline for eventsVerbal memory tends to be better
preservedWorking memory tends to decline more sharply than
immediate or primary memoryOlder people seem to have more
difficulty with more complicated tasks and ignoring distractions
during working memory tasks

6. Typical Cognitive Changes of Aging (16 of 27)Compensating
for decreased memory performance seems to work bestTactics
may include:Make material to be learned interestingUse
multimodal sensory inputUse repetition, but not to the point of
boredomUse cuing, but only as neededHave clients engage with
the information if possibleHave clients paraphrase information
after a session
Typical Cognitive Changes of Aging (17 of 27)Tips to stimulate
remembering:Concentrate on paying attentionRepeat what you
want to remember by rehearsing aloudMake lists or use a date
bookEstablish habitsRelaxUse self and environmental care
Typical Cognitive Changes of Aging (18 of 27)Problems with
memory tasksMost commonly acknowledged types of age-
related cognitive declineDoes not mean the person has
dementiaMild forgetfulness, when it is an isolated cognitive
impairment, is not cause for alarmA red flag needs to be raised
when one forgets crucial, well-learned information
Typical Cognitive Changes of Aging (19 of 27)Executive
functioning (EF)Skills used by an executive on the job“Central
executives” are key to performance of EF skills in the realms
of:Working memoryMental flexibilitySelf-control
Typical Cognitive Changes of Aging (20 of 27)Older adults

7. typically show declines in EFAspects that change with age
include cognition-related biological markers such as:Decreased
brain massLess dense neuronal connectionsHigh-level cognitive
skills, such as EF, decrease
Typical Cognitive Changes of Aging (21 of 27)Assessing
cognitionSelf-assessmentPeople, in general, do not have a good
sense of how well they can rememberThose with other cognitive
deficits likely have difficulty accurately judging their own
cognitive performanceObserving functional memory
performanceHealthcare practitioners use various screens to
assess cognitive function
Typical Cognitive Changes of Aging (22 of 27)
Typical Cognitive Changes of Aging (23 of 27)Interventions to
maintain or enhance cognition in older adultsMay never be too
late for improvementsPrevention of significant decline may be
easier to accomplish than returning to high performance levels
once the roll downhill has begun
Typical Cognitive Changes of Aging (24 of 27)The PACES
program to promote brain healthOffers guidelines to promote
positive outcomes in thinking, memory, and learningPACES
stands for:PurposeActivityCognitive (pursuits)Emotional
(health)Socialization (and Sleep)

8. Typical Cognitive Changes of Aging (25 of 27)PurposeFinding
meaning in lifeActive/ActivityRemaining active and engaged in
lifeCognitive pursuitsCognitive stimulation is as important as
physical stimulationEngage in lifelong learning
Typical Cognitive Changes of Aging (26 of 27)Emotional
healthMaintaining control over our attitude or how we respond
to traumatic events in our livesTypically aging elders tend to
focus on the positiveCan make them overly trustingDepression
can have a negative impact on health and cognitionCan be
treated
Typical Cognitive Changes of Aging (27 of 27)Socialization and
sleepHumans are social beingsFace-to-face social interactions
are preferred over online communication and
relationshipsIsolation is associated with loneliness, depression,
poor health behaviors, and worse healthAdequate sleep is
essential for optimal cognitive functioningPromotes brain
plasticity
Atypical Changes of Cognitive Aging (1 of 27)Changes in
cognitive performance exist on a continuumStart with mild
changesEnd, for some, with major debilitating cognitive
changesDementia and major neurocognitive disorders are not a
normal part of aging

9. Atypical Changes of Cognitive Aging (2 of 27)Risk factors for
cognitive declineDiabetesSmokingHypertensionSedentary
lifestyleNot engaging in cognitively challenging tasksHigh
cholesterol levelsDepression
Atypical Changes of Cognitive Aging (3 of 27)Minor
neurocognitive disorders Mild cognitive impairment
(MCI)Diagnosis of mild neurocognitive disorder (NCD)Affected
individuals can complete ADLs, but might experience decreases
in memory or performance of complex tasks such as IADLsRisk
of MCI increases with ageThose with MCI are more likely to
develop dementia
Atypical Changes of Cognitive Aging (4 of 27)Four questions
predictive of amnestic MCI:Does the person have trouble
remembering the date, year, and time? (most predictive)Does
the person repeat questions/statements in the same day?Does the
person have difficulty managing finances?Does the person have
a decreased sense of direction?
Atypical Changes of Cognitive Aging (5 of 27)Overview of
DSM-V major neurocognitive disorders (major NCD)Cognitive
deficits can be described on a continuum from mild to late stage
dementiaThe major NCDs affect life relatively more than the
mild disordersThe major disorders are often commonly referred
to as dementia
Atypical Changes of Cognitive Aging (6 of 27)Alzheimer’s

10. disease (AD)Most frequent diagnosis under the umbrella of
major NCDsInvolves:Significant decline in learning and
memoryContinuing decline in cognitionBehavioral and
psychological changesPrevalence increases with age, but it is
never an inevitable diagnosis for most older adults
Atypical Changes of Cognitive Aging (7 of 27)
Atypical Changes of Cognitive Aging (8 of 27)AD progresses
through three stages:MildModerateSevereCurrent emphasis is to
prolong the first two stages
Atypical Changes of Cognitive Aging (9 of 27)
Atypical Changes of Cognitive Aging (10 of 27)Frontotemporal
NCDInsidious in its onset and has behavioral or language
variantsMore frequently found among those younger than
65Behaviors:DisinhibitionApathyLoss of social
skillsPreservative behaviorsHyperorality
Atypical Changes of Cognitive Aging (11 of 27)Dementia with
Lewy BodiesNow named Neurocognitive Disorder with Lewy
Bodies (NCDLB)Cognitive performance may
fluctuatePerceptual disturbances are more commonMay account
for up to 30% of all dementiasPerson may display times of
confusion or delirium prior to diagnosis

11. Atypical Changes of Cognitive Aging (12 of 27)Parkinson’s
disease (PD) with dementiaCan be minor (mild) or major
(serious)Tends to have an insidious onsetCognitive impairments
take place after physical symptoms of PD are well
establishedMore common in menHallucinations are common,
but have less impact on quality of life than those with
schizophrenia
Atypical Changes of Cognitive Aging (13 of 27)Working with
those who have major NCDCaring and respect are
essentialNever speak about persons with dementia in front of
them, ignoring them as if they were not thereControlling your
emotions is crucialSoothing music may defuse the intensity of
an uncomfortable situationA sense of humor can be extremely
helpful
Atypical Changes of Cognitive Aging (14 of 27)Methods of
diversion:Involvement in simple activitiesPlaying games or
enjoying musicDrawing, writing, or paintingLooking through
old photograph albumsReminiscingInvolving them in tasks or
parts of tasks they enjoy
Atypical Changes of Cognitive Aging (15 of 27)Comparing
dementia with depression and deliriumDepressionMost
prevalent in:WomenMinority groupsPersons with less than a
high school educationThose previously marriedIndividuals

12. unable to work or who are unemployedPersons without health
insurance
Atypical Changes of Cognitive Aging (16 of 27)Clinical
depressionCommon comorbid condition in those diagnosed with
dementiaCan potentially be viewed as a consequence of having,
as well as a risk factor for getting, dementiaOften goes
unnoticed and undiagnosed
Atypical Changes of Cognitive Aging (17 of 27)Common signs
of clinical depression:Subjective report of a “depressed mood”
“most of the day, nearly every day”Sleep
disturbancesDisinterest in formerly valued activitiesAgitation,
listlessness, loss of energyFeelings of worthlessness or
guiltThoughts of death or suicidal ideationDecreased cognition,
such as indecisiveness
Atypical Changes of Cognitive Aging (18 of 27)Suicide in older
adultsFixed risk factors in the United States:Being male, single,
and olderHaving a family history of suicideMajor depressive
disordersPsychiatric illnessChronic physical illness and
painDecreased functional capacitySocial disconnectedness
Atypical Changes of Cognitive Aging (19 of 27)Indicators of
potential suicide:Past history of attemptsThreats of
suicideSubstance misuseSudden feelings of euphoriaGiving

13. away possessionsBodily complaintsPersistent bereavement
Atypical Changes of Cognitive Aging (20 of 27)DeliriumNot
commonplace in a healthy aging populationGenerally a transient
state of fluctuating cognitive abilities characterized
by:HallucinationsDecreased ability to focusIncreased
confusionPoor memory performanceCan be mistaken for
dementia or depression
Atypical Changes of Cognitive Aging (21 of 27)Development of
delirium is associated with:Increased mortalityIncreased length
of stay in hospitalIncreased rate of discharge to long-term care
facilitiesIncreased medical complications
Atypical Changes of Cognitive Aging (22 of 27)Risk factors for
delirium:Age older than 70 yearsSelf-reported alcohol
abusePoor cognitive statusVisual impairmentDepressionPoor
functional statusMalnutrition
Atypical Changes of Cognitive Aging (23 of 27)Risk factors for
delirium (continued):Metabolic abnormalitiesInfectionsNon-
cardiac thoracic surgeryAbdominal aneurysm surgeryChanges in
mental status should be reported to and addressed by the

14. healthcare teamFamily collaboration is crucial
Atypical Changes of Cognitive Aging (24 of 27)Related
potentially reversible disordersMalnutritionCan cause
behavioral disturbancesVitamin B12 deficiency can cause
dementia symptomsCerebrovascular accident (CVA) or
strokeMay cause behaviors similar to depression or ADMulti-
infarct dementia is caused by a series of
strokesHypothyroidismSlows metabolic processes, which causes
slow responses and lethargy
Atypical Changes of Cognitive Aging (25 of 27)Failure to thrive
(FTT)Insidious deterioration in functioningNot related to a
specific diseaseCan be caused by depression, dementia, chronic
conditions, or medication/drug reactionsCommon features
include weight loss from loss of appetite, impaired ambulation,
and incontinencePerson seems to be giving up on lifeReferral to
a geriatrician is usually appropriate
Atypical Changes of Cognitive Aging (26 of 27)Urinary tract
infection (UTI)Most common infection in long-term care
settingSymptoms include frequent, often painful voiding;
potential back pain; and malaiseLack of oxygen
(hypoxemia)Can lead to tissue damage and mental
confusionAdministering oxygen may improve mental status
quickly

15. Atypical Changes of Cognitive Aging (27 of 27)Substance
misuse and abuseGrowing issue among older adultsCan cause
cognitive problems such as slurred speech, drowsiness, and
confusionCan exacerbate the effects of current cognitive
impairments or impairments in hearing and visionBrief
substance use/misuse screening is recommended for everyone
Personality Development (1 of 11)PersonalitySet of character
traits, attitudes, habits, and emotional tendencies that make a
person uniqueCan predict life events to a degreeErik Erikson
stages of psychosocial developmentNew ninth stage is
gerotranscendence, which is associated with wisdom and
moving away from early and midlife materialismMove toward
selflessness, compassion, and reflection
Personality Development (2 of 11)Five-factor model of
personalityNeuroticismExtraversionOpenness to
experienceAgreeablenessConscientiousness
Personality Development (3 of 11)Personality stabilityStrong in
older peoplePersonality traits are relatively permanent in aging
older adultsPacing healthcare intervention for the convenience
of older clients, rather than the provider, is essential for good
care
Personality Development (4 of 11)Personality differences by

16. cohortOlder participants show a higher level of
agreeablenessMen may become more nurturing and open about
their feelings as they get olderWomen may become more
assertive, confident, and comfortable with themselvesAs people
age, they can gain a new understanding and tolerance of others’
behavioral styles
Personality Development (5 of 11)Malleability of personality
traitsPersonality changes can and do occurRepresentations of
the self are likely to change over the course of one’s
lifetimeSome older adults’ personalities change due to disease
processesDon’t blame the person, blame the diseaseCompassion
is the path of least resistance and most fulfillment
Personality Development (6 of 11)Personality summaryThere
are many types of personalities, and they are not all compatible
with one anotherHealthcare professionals need to make a
concerted effort to provide excellent service to all clients,
regardless of age and personality styleOld age does not equate
with any specific personality traits
Personality Development (7 of 11)Behavior changeWhen people
age well, they become more aware of the positive changes they
encounterWell elders also take actions to counteract negative
changes associated with agingOne is never “too old” to make a
positive change in behavior

17. Personality Development (8 of 11)Behavior change
theoriesTranstheoretical Model (TTM)Divides behavior change
into several steps from precontemplation to terminationHealth
Belief ModelSets out to predict health behaviors by assessing
the person’s self-perceived views on the severity, susceptibility,
benefits, and barriers to change
Personality Development (9 of 11)“Art of Happiness”
programGroup sessions on humor, mindfulness, positive
relationships, happiness, and stress managementOutcomes
included decreased tension, increased happiness, and stress
management“Lighten up!”Group of elders worked on changing
perspectivesLearned to recognize emotions and savor positive
experiences
Personality Development (10 of 11)Motivational interviewing
(MI)Key concepts:Collaboration and compassionUse of open-
ended questions, affirmations, reflections, and summary
statementsPromotes conversations about ambiguityMay involve
clients of any age setting goals and making self-motivated
changesPractitioners guide and follow
Personality Development (11 of 11)Motivational interviewing
(continued)Healthcare professionals can:Help clients set and
fulfill behavior change goalsEngage older adults in programs
intended to improve well-beingHealthcare professionals’
contributions may be minimal or may be invaluable and much
appreciated