Chapter #14: Late Adulthood -- Body and Mind

Changes in Life Expectancy**

Between 1950 and 2015 the average life expectancy in high income nations became 20 years longer from 60 to 80. In low income nations the average became 30 years longer, from 35 to 65 Most of these added averages resulted from fewer childhood deaths, thanks to clean water, immunization, nutrition, and newborn care. Obviously more advanced countries technologically had an advantage in these regards In these cultures, midlife deaths have decreased also because of life style changes (no smoking, more exercise) and medical advances in diagnosing and treating illnesses.

Things Slow Down With Age

- Deterioration of cognition correlates with slower movement and almost every kind of physical disability - Gait correlates strongly with many measures of intellect. If someone walks slowly, talks slowly, they probably think slowly

Urie Bronfenbrenner's Ecological Theory

- It is a continuous theory (not a stage theory) that focuses on the interaction of the individual throughout life with various levels of her/his environment - In old age, things change and certain compensations need to be made

Compensatory Actions in Old Age Macrosystem: Driving

- Macrosystem: The macrosystem setting looks at the relationship of an individual with his or her immediate circumstance or culture - A difficult and often controversial decision for older people is when it is the right time for them to stop driving in the interest of their safety and the safety of those around them - Queen Elizabeth, 91, has stopped driving on public roads

Abraham Maslow: Old Age & Wisdom

- Maslow maintained that older adults are more likely than younger people with his final stage of self actualization - His theory was not an age-based sequence of life, with only older people gaining self actualization - He did believe, however that life experience helps people move forward, so more of the older reach the final stage

Parkinson's Disease: Brain Changes

- Over time, neurons in the brain gradually break down or die. - Because of neuronal damage, dopamine, which is produced by neurons, decreases. - Dopamine plays a role in sending messages to the part of the brain that controls movement and coordination. - This leads to abnormal brain activity resulting in impaired movement and the other symptoms of Parkinson's Disease.

Effects of Sensory Changes on Cognition

- Small hearing losses may make a difference. It tends to decline with age and greater hearing loss correlates with greater cognitive decline. Many researchers feel that small input losses having a notable effect on output. - Research found that there was no loss in perception of emotion when the emotion was genuine and the participant could use three input sources (facial expressions, words, tone of voice)

Compensatory Actions in Old Age Chronosystem: The Brain**

- The chronosystem includes both historical time and time over the lifespan - The brain shrinks with age - and the hippocampus and the prefrontal cortex can be particularly problematic as they are needed for planning, inhibiting unwanted responses and coordinating thoughts - In a practical sense, many older people learn to use memory aids - the written reminder, the alarm clock, having a place for everything and everything in its place - With age, additional connections can form and new neurons may be born. When older people are presented with an intellectual task, they use more parts of their brain than younger people do including both hemispheres - The chronosystem also considers the sweep of history and it is possible that some intellectual capacities of the aged are superior to older people of the past; brains may have adapted to the social complexity of modern life. - Aging reduces the production of neurotransmitters, especially dopamine that allow a nerve impulse to jump quickly across the synaptic gap from one neuron to another - Neural fluid decreases, myelination thins, cerebral blood circulates more slowly - this becomes a general slowdown evident in reaction time, movement, speech and thought - Deterioration of cognition correlates with slower movement and almost every kind of physical disability.

Compensatory Actions in Old Age Microsystem: Sex

- The micro system's setting is the direct environment we have in our lives - Your family, friends, classmates, teachers, neighbors and other people who have a direct contact with you are included in your micro system - The micro system is the setting in which we have direct social interactions with these social agents - The rate of intercourse in a couple decreases in later life. The sex lives of most married people can be described as "selective optimization". Each older person decides how sexual to be - selecting, optimizing and compensating in their own way.

Changes in Cognitive Output

- Younger people are faster thinkers, but there is knowledge that has accrued in older people's minds. - What should be assessed - pure abstract thinking or practical, contextual thought - depersonalized abilities or everyday actions? - Given that there are so many aspects of cognitive functioning, there might be abilities that older people maintain that are not measured by traditional cognitive tests. - With tests that are timed, younger people will outperform older people but is speed important? - Older people get along instead of using analysis and forethought, relying on prior knowledge, familiarity and rules of thumb - In daily life, output is usually verbal. If the timbre and speed of a person's speech sounds old, ageism might cause listeners to dismiss the content without realizing that the substance may be meaningful or even profound. - Often this is compounded by hearing loss. - If elders realize that what they say is ignored, they talk less, and output is diminished.

Lewy body Dementia

- a major neurocognitive disorder characterized by deposits of protein substances in the brain called Lewy Bodies. - Symptoms include visual hallucinations, momentary loss of attention, falling and fainting and a gradual but ultimately severe loss of thinking abilities that interfere with a person's capacity to perform daily activities. - The only way to accurately diagnose Lewy Body Disease is with an autopsy that can reveal the presence of Lewy Body deposits in the brain. - Robin Williams was diagnosed with Lewy Body Disease with an autopsy following his death (after a false diagnosis of Parkinson's.)

Erik Erikson: Old Age

- in old age many people gained interest in the arts, in children and in human experience as a whole - his last state integrity versus despair marks the time when life comes together in a "resynthesis of all the resilience and toughness of the basic strengths already developed".

Compensatory Actions in Old Age Exosystem: Senses***

- the exosystem relates to environments with which the person doesn't have an immediate person impact, but that do affect them - hearing and eyesight become less acute with age and universal design of things like road signs, writing on prescriptions etc. would help alleviate the difficulties of less acute senses - Exosystem Compensation - The senses - People's vision declines with age - changing the environment - brighter lights, halogen streetlights, newspapers with large and darker print can help - Hearing- Everyone loses some hearing with age. Of those over age 65 in the US, 39 percent acknowledge some trouble hearing and 8 percent say that they are virtually deaf. - Men are twice as likely to have problems than women. High frequencies, the voice of a small child - are lost more quickly than low frequencies - Loss of hearing is correlated with cognitive decline as the older person misses communication and becomes more isolated from the social scene

Parkinson's Disease: Causes & Treatment

-Age - commonly seen in older people -Heredity - slight increase in risk with relatives who have the disease -Sex - more common in men -Exposure to toxins- ongoing exposure to herbicides and pesticides can increase risk Treatment: - There is no cure. - Treatment involves drugs that increase the brain's production of dopamine

Other Problems of Old Age That are Reversable

1. Depression - The most common reversible condition that is mistake for a major NCD is depression. Normally older people are happy but untreated anxiety and depression when it happens increases the risk of major NCD. 2. Malnutrition and dehydration- are also common. Older people are often dehydrated and since homeostasis declines with age, older people are less likely to recognize and remedy their hunger and thirst which may inadvertently impair their cognition. 3. Polypharmacy - Older people often take numerous drugs. Many times there are interactions between the drugs that are not healthy and often the older person is confused about when to take the medication.

Long-Term Benefits of Joint Replacement Surgery

1. Everyday life is easier. - While the degree of improved movement varies from person to person, almost everyone who has a joint replaced experiences improved mobility. Pain is dramatically decreased 2. A person can be active again . - Reasonable recreational activities such as walking, swimming, golf, light hiking, biking, ballroom dancing, and other low-impact sports become achievable and enjoyable again. 3. A person might improve their overall health. - Osteoarthritis is the most common reason for joint replacement . Over time, osteoarthritis drastically limits a person's activity level. For these people, the impact in joint replacement surgery is very positive. - a 2013 study from the American Academy of Orthopedic Surgeons shows that people suffering from osteoarthritis who had a hip or knee replaced were 40% less likely to have a heart attack or stroke that those who didn't have surgery. - Joint replacement is correlated with a longer life span for older people

Challenges of Aging**

1. Sleep- interrupted at night, become day nappers, start to worry about changes being abnormal instead of developing new behavior parterns - physicians sometimes prescribe narcotics to aid sleep which can sometimes overwhelm on older body 2. Exercise- in the U.S. only 28% of those over the age of 75 and over meet the recommended guidelines for aerobic exercise - consistent and appropriate aerobic exercise is the number one correlate of cognitive health in old age - ageism is at play in a context in this country where most active, organized activities are based on the norms of the young 3. Talk and prejudice- it is important not to be patronizing to older people - calling an older person "honey" or "dear" and using a nickname rather than a surname ("Jimmy" rather than "Mr. White") can be demeaning - People often speak to older people with "Elderspeak- like baby talk uses simple and short sentences, slower talk, higher pitch, louder volume and frequent repetition. - Ironically, many aspects of elder-speak reduce communication. Higher frequencies are harder for the elderly to hear - shouting causes anxiety, simplified vocabulary reduces clarity.

Different Groups of the "Old"

1. the young old: largest group; most are healthy, active financially secure and independent (65-75) 2. the old old: tend to be losses in body, mind, or social support but they can care for themselves (75-85) 3. the oldest old: often dependent, many times in nursing homes, the smallest group of the "olds" (85+)

Parkinson's Disease

A progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement. Symptoms: -Tremor -Slowed movement -Rigid muscles -Impaired posture and balance -Decreased ability to perform unconscious movements like blinking, smiling, swinging the arms while walking -Speech and writing changes

Alzheimer's Disease: Risk Factors

Age, family history, concussions or being knocked out Lack of stimulation may also be devastating for the brain, leaving it more vulnerable in later years. This may explain the finding that those who are poor as well as those with less education, lower measured intelligence early in life and less challenging occupational and leisure time activities in adulthood have a significantly higher risk of developing AD.

Alzheimer's Disease: Possible Causes

Causes are unknown and the extent of the impairment relates to the level of pathological changes taking place in the brain - Genetic Factors: roughly five percent of cases are early onset - before the age of 60 and there is a familial pattern of inheritance - Environmental Toxins: lead and mercury, pesticides, industrial chemicals and so on have been investigated as possible causes of AD. In sufficient quantity in a person's body, they can cause nerve cell death

Memory Changes

Memory- varies greatly among the older population - Stereotype threat and memory-older people get nervous taking memory tests - Explicit memory declines faster than implicit memory- learned facts forgotten more quickly than emotions and actions - Source amnesia- as time goes on sometimes hard to remember the source of a piece of information - Prospective memory- remembering to do a future task fades - Vocabulary - meaning of words is retained but retrieval of words can be difficult

Discovery of Alzheimer's Disease

Named after Dr. Alois Alzheimer who saw symptoms of the disease in an older patient in 1906 - after she died, did an autopsy and found abnormal clumps (now called amyloid plaques) and tangled bundles of fibers (now called neurofibrillary tangles) in her brain. These are the two main symptoms of the disease and the third is the loss of connections between neurons in the brain

Neurocognitive Disorders

Neurocognitive Disorders are any of a number of diseases that affect a person's ability to remember, analyze, plan or interact with other people The rate of neurocognitive disorders increases with every decade after age 60 Senile and dementia are not the best words to use for cognitive loss in older age- senile means "old"- not necessarily associated with dementia The DSM V now describes neurocognitive disorders as either major (previously called dementia) or mild (previously called mild cognitive impairment) Ageism would tend to have people believe that at least half of the older population suffers from NCD's but the rate is only about 8 percent of the aged population

Alzheimer's Disease

The progressive deterioration in intellectual functions such as thinking remembering and reasoning which is severe enough to interfere with the individual's ability to function in daily life Almost exclusively a problem of old age - it is a form of dementia and accounts for 60 to 90 percent of all cases and afflicts as many as 4.5 million Americans A progressive disease and as it progresses, individuals are robbed of their personalities, their ability to care for themselves and the capacity to relate to others AD results from the degeneration of neurons in the brain, particularly in the hippocampus and the frontal and temporal lobes of the cerebral cortex which are the areas of the brain involved in memory, language and higher order thought Motor and sensory areas are relatively unaffected Although it is a brain disorder, the primary symptoms are behavioral. Physical functioning may remain essentially normal throughout most of the course of the disease - but the changes in the brain strongly affect the way the individual feels, thinks and behaves Typically see the following: memory loss (first short term, then long term), confusion, impaired judgment , loss of language and communication skills, agitation, irritability and wandering There is a strong effect on the family - about 70% of the care given AD patients is from family, particularly females. Help is costly.

Alzheimer's Disease: Treatment

There are various treatments but some of the drugs have serious side effects. Physical activity, social involvement, good nutrition and health care, and a calm and well structured environment may be helpful in managing the disease. Caregivers need to support procedures that aid memory.

Changes in Health Facts in the U.S.**

Things that were once true and are not any longer: - more babies were born than the replacement rate of one per adult, so each new generation had more children than the previous one (now false) - many young children died which made the bottom bar much wider than upper ones (now false) - serious illness was almost always fatal reducing the size of each adult group. (now false)

Points From Clay DeStefano Talk About Positive Aging and Life Expectancy Statistics

Ways in which to live longer, to a "healthy 100" from Clay DeStefano: -He said, "Genetics Loads the Gun, Lifestyle Pulls the Trigger" -Need to have a positive attitude - be a half full glass of water -Be in green spaces to relax and appreciate nature -Get enough sleep - optimally in a cool, dark, quiet environment -Have friends and pick up interesting hobbies -Eat good food and exercise even if you don't feel like it -He said, "It's all about the choices you make, let's choose to be better" Is it possible some people don't have the chance to make those good choices? Life expectancy in America; Asian Americans - 86.3 years White Americans - 78.6 (77 for men, 81 for women) African Americans - 75 (69 for men, 76 for women)

Problems with Ageism

ageism is the idea that age determines whom a person is and therefore that people should "act their age" it leads to stereotypes and restrictions

Demographic Shift

demography is the science that describes populations 200 years ago there were 20x more children under 15 than people over 64; now there are only 3x as many 8% of the world's current population is over 65 -- in the U.S. 15% of the population is over 65

Genetics: Theory #2**

every specifies has a maximum life span defined as the oldest possible age that remembers of that species can attain - genes affect the entire agin process and many of the inherited characteristics that a person has - there is a complex relationships between aging, genes, and environment that tend to occur together to increase the risk of age related diabetes, heart disease and cancer. Every aspect of metabolic syndrome is affected by genesbut the total cluster is powerfully influenced by diet, exercise, and stress.

Selective Optimization with Compensation

in getting older people can compensate for changes that are limiting and optimizes other areas of continued strength

Metabolic Syndrome**

includes a cluster of conditions that increase the risk of heart disease, stroke and diabetes characterized by high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels which increase a person's risk for heart attack and stroke underlying causes of metabolic syndrome include overweight and obesity, insulin resistance, physical inactivity, genetic factors and increasing age weight loss, exercise, a healthy diet, and smoking cessation can help. Medications may also be prescribed

Infant Mortality Changes in the U.S.

infant mortality dropped from approximately 100 deaths per 1,000 live birth in 1915 to 29.2 deaths per 1,000 births in 1950 and 7.1 per 1,000 in 1999

Ageist Language is Common**

many words and phrases in standard vocabulary are ageist some terms begin with "old" (maid, fart, coot, geezer, battle ax, blue hair) many phrases demean the elderly: (dirty old man, over the hill, one foot in the grave, senior moment)

Theories of Aging**

the biological consequences of age are sometimes divided into primary (the direct result of time) and secondary aging (the accumulated consequences of what people and societies do) there are more available actions people can take to reduce secondary aging there is increasing research on primary aging: 3 theories

The Wear and Tear Theory: Theory #1

the idea that the body wears out after years of use organ reserve and repair processes are exhausted as the decades pass i.e. exposure to toxics, stress, smoke damage to lungs, blows to the head

Aging Cells: Theory #3**

the third cluster of theories examines cellular aging, focusing on molecules and cells. Cells duplicate many times over the life span. Minor errors, repetitions and deletions of base pairs, in copying accumulate. - early in life the immune system repairs such errors but later in life the immune system becomes less adept. - cells eventually lose the ability to replicate themselves. One particular cell change that has been studied in connection with aging is the telomere, which is material at the end of each chromosome that becomes short over time. - telomeres are longer in children and shorter in old adults. Eventually the telomere is gone, duplication stops, and the creature dies.