Adult Development and Aging Ch (1-8) Exam

New directions for Nursing Homes

(Eden Alternative, the Green House Concept, and the Pioneer Network have a commitment to viewing older adultsas worthwhile members of society regardless of their physical limitations) + The Eden Alternative - Caring for frail older adults starting from the premise that skilled care environments are habitats for people rather than facilities for the frail - Protecting the dignity of each person, with 10 principles 1) The 3 plagues of loneliness, helplessness and boredom account for the bulk of suffering among older adults 2) Creating a habitat where live revolves around close and continuing contact with plants, animals and children 3) Easy access to human and animal companionship, as antidote to loneliness 4) Eldred-centered community creates opportunity to five as well as receive care, as the antidote to helplessness 5) Daily life with variety and spontaneity by creating environments with unexpected and unpredictable interactions, as antidote to boredom 6) Meaningful activities for the human spirit 7) Medical treatment should be the servant of genuine human caring, never its master 8) Honors elders by de-emphasising top-down bureaucratic authority, seeking instead to place maximum possible decision making into hands of elders 9) Create elder centered community with human growth 10) Wise leadership - Help launched culture change to improve residents quality of life - Blends person-centered care with relational care (care that takes unintended actions into account) - Main outcomes are resident-directed care and staff empowerment + The Green House Project - Grounded in the Eden Alternative - Radical departure from the concept that skilled nursing care is best provided in large residential facilities - Provide older adults who need skilled care a small, homelike environment that shifts the focus from a large facility to a more homelike setting - 6-10 residents, in a dwelling that blends architectural with houses in the neighborhood + Emphasizes the importance of encouraging residents to participate in their care, by helping with daily tasks - Personal dignity is maintained and quality of life improved + The Pioneer Network - Focuses on changing the culture of aging in America regardless of where older adults live - Focuses on respecting older adults and providing maximally supportive environments - Know each person - Relationship is building block of a transformed culture - Respond to spirit as well as mind and body - Risk taking is a normal part of life - Put the person before the task - All elders are entitled to seld-determination wherever they live - Community is the antidote to institutionalization - Promote growth and development of all - Shape and use the potential of the environment in all aspects; physical, organizational, psychological, and spiritual - Practice self-examination, searching for new creativity and opportunities to do better - Recognize that culture change and transformation are not destinations but a journey, always a work in progress + All have in common a commitment to viewing older adults as worthwhile members of society regardless of their physical limitations

Cross Sectional Design

+ (Cross-sectional study) Developmental differences are identified by testing people of different ages at the same time + Examine age differences but not change + Weaknesses - Tests at one point in development, don't learn anything about continuity of development - Effected by cohort effects, differences in a group could be developmental or environmental - Age and Cohort effects are confounded in cross sectional research + But it dominated research + Strengths - Quick and inexpensive - Extreme age groups design

The Meaning of Age

+ Age is not a simple construct or a single process + It consists of at least 3 distinct processes: primary, secondary and tertiary aging + Primary Aging: - Normal, disease free development during adulthood - Changes in biological, psychological and life cycles process are inevitable part of developing + Secondary Aging - Developmental changes that are related to disease, lifestyle and other environmentally induced changes that are not inevitable - E.g. Alzheimer's + Tertiary Aging - The rapid losses that occur shortly before death - E.g. terminal drop: where intellectual abilities show a decline in the last few years + Everyone experience of growing old is somewhat different + Chronological age: a shorthand way to index time and organize events and data by using a commonly understood standard: the calendar time + Also use gender, ethnicity and SES + Age does not directly cause things to happen + Human behavior is affected by experiences that occur with the passage of time, not time itself + Perceived Age - the age you think yourself as ("you're only as old as you feel") + Biological Age - measuring the functioning of the various vital, or life limiting, organ systems + Psychological Age - functional level of psychological bailies people use to adapt to changing environmental demands (intelligence, feelings) + Sociocultural Age - specific set of roles individuals adopt in relations to other members of the society and culture to which they belong (behaviors, habits, dress) + Emerging Adulthood - An example of the complexities of age - Some developmentalists view the period from late teens to mid/late 20s, as emerging adulthood, a period when individuals are not adolescents but not fully adults

Common Theoretical Themes and Everyday Competence

+ All 3 theories focus on the interaction between person and environment, and no single environment meets everyone's needs + Everyday Competence: persons potential ability to perform a wide range of activities considered essential for independent living; it is not the persons actual ability to perform the tasks + An older persons competence in the psychological domain includes cognitive problem solving abilities, beliefs about personal control and self efficacy and styles of coping + Must identify cultural and contextual differences in everyday competence + Willis developed a model of everyday competence incorporating all key ideas discussed earlier + He distinguishes between antecedents, components, mechanisms and outcomes of everyday competence - Antecedents include both individual and sociocultural factors (e.g. health, cognition and stereotypes, social policy) - These influence the intraindividual and contextual components, the particular domains and context of competence - Which components are most important or exert the most influence depends on the overall conditions under which the person lives - These elements of the model reflect the basic ideas in both the competence and environmental press model and the person environment model - The mechanisms involve factors that moderate the way competence is expressed - The model proposes the primary outcomes of everyday competence are psychological and physiological well being + Understanding this is important for considering if people are capable of mankind decisions for themselves + Model also points out that health outcomes of one episode of everyday competence are the antecedents of the next - Means future competence is related to current competence + Older adults can age in place to the extent their everyday competence permits

What Age Related Changes Occur in Neurons

+ As we age, number of neurons decline, decrease in size and dendrites + Increases in the deposit of certain proteins + Number of potential connections declines, as measured by the number of synapses among neurons

Living In a Nursing Home

+ At any given time, only about 5% of older adults are in nursing homes. Such Facilities are excellent examples of the importance of person-environment fit + The percentage of older adults enrolled in Medicare who live in a long-term care facility at any given point in time increases from 2% in those aged 65-74 to abou 14% of adults over age 85 + over their lifetime, over 50% of older women and about 30% of older men will spend at least some time in a long-term care facility + the gender difference is because older women take care of their husbands at home, but in turn need to relocate to a long-term care facility for their own care because their husbands are, on average, deceased

Nutrition and Brain Aging

+ Two patterns associated with better cognitive functioning and greater brain volume: one higher in blood plasma levels of vitamins B, C, D, E and another high in blood plasma levels of omega 3 fatty acids + High trans fat associated with less favorable cognitive function and less total cerebral brain volume

Automatic and Effortful Processing

+ Automatic processing: places minimal demands on attentional capacity and gets information into the system largely without us being aware of it; occur without our conscious awareness (e.g. walking, typing notes [when your not thingking about what your typing]) o Some appear to be "prewired" in the sense they require no attentional capacity and do not benefit from practice + Effortful processing: (or controlled processes) requires all of the available attentional capacity (conscious attention [e.g. planning your semester] o We are typically aware of what we are doing o Age differences tend to emerge with effortful processing + Under conditions where the task requirement is to simply have a familiarity with the information, there are no age differences + When there is effort and deliberate processing involved to remember the information, age differences emerge

Exercise and Brain Aging

+ Brain plasticity is enhanced as a result of aerobic exercise + Counters the declines in the hippocampus associated with Alzheimer's + The sensory cortices, such as the visual cortex,show relatively little shrinkage

Interrelations among the Forces: Developmental Influences

+ Cohort: is a group of people born at the same point or specific time span in historical time + Baltes identifies 3 sets of influences that interact to produce developmental change over the life-span 1) Normative age graded influences 2) Normative history graded influences 3) Nonnormative influences + Normative Age Graded Influences - Are experiences caused by biological, psychological and sociocultural forces that occur - To most people of a particular age - Some of these events indicate a major change in a persons life (e.g. menopause) - Normative psychological events include focusing on certain concerns at different points - Sociocultural are things like getting married, retiring - They typically correspond to major time marked events, which are often ritualized + Normative History Graded Influences - Are events that most people in a specific culture experience at the same time? - Biological (epidemics), psychological (stereotypes), sociocultural (changing attitudes) - Often give a generation its unique identity, and can have profound effects across Generations + Nonnormative Influences - Are random or rate events that may be important for a specific individual but are not - Experienced by most people - Can be favorable or unfavorable - Their unpredictability is what makes them unique - Life-cycle forces are especially key in understanding the importance of non normative - Influences

The Stability vs. Change Issue

+ Concerns the degree to which people remain the same over time, as opposed to being different + Stability at some level is essential for us to recognize that one is the same individual as time goes on + But we like to believe that our characteristics can change + Controversy over if people change from 0-18, and also in adulthood

The Continuity vs. Discontinuity Issue

+ Concerns whether a particular developmental phenomenon represents a smooth progression over time (continuity) or a series of abrupt shifts (discontinuity) + Continuity approaches usually focus on the amount of a characteristic a person has + Discontinuity focus on the kinds of characteristics a person has + Plasticity: refers to the belief that capacity is not fixed but can be learned or improved with practice

The Universal vs. Context Specific Development Controversy

+ Concerns whether there is just one path of development or several + Some theorists argue that differences are more apparent than real and that development worldwide reflects one basic process for everyone + According to this view, differences in development are simply variations on a fundamental developmental process + The opposing view is that differences between people may not just be variations on a theme + They argue that adult development and aging are inextricably intertwined with the context in which the occur + The latter is what the text uses

The Nature vs. Nurture Issue

+ Debate over the influence of genetics and environment on development + The degree to which genetic or hereditary forces influences (nature) and experiential or environmental influences (nurture) determine the king of person you are + Virtually no features of life-span development are die exclusively to either heredity or environment + Instead development is shaped by both

Adult Day Care

+ Designed to provide support, companionship, and certain services during the day + Arises most often when the primary care giver is employed or has other obligations during the day + Primary goal is to delay placement into a more formal care setting + Provides alternative care that enhances self-esteem and encourages socialization + 3 general types available 1) Provides only social activities, meals and recreation, with minimal health services 2) Provides more intensive health and therapy intervention and social services for people with more serious medical problems or conditions 3) Provides specialized care to particular populations, like those with dementia or Alzheimer's + Can be independent or sponsored by a profit (22%) or non-profit (78%) organizations + May provide transportation to and from + Insurance may cover some expenses + about 35% of adult day care clients, live with an adult child and 20% with a spouse or partner + Average age of clients is over 70; about two-thirds (2/3) are women + For people with cognitive impairment, changes in routine can result in confusion or disruptive behavior, so it is important to inform them of the decision, and engage in trial runs + Compared with keeping relatives with cognitive impairments at home, the program can reduce problematic behaviors and lower the need for psychotropic medication in clients, and result in lower reports of care giving burden + Key factor in success is having appropriate programs in interventions

What factors did Langer identify as being detrimental to the well-being of nursing home residents?

+ Detrimental Factors: (1) Resident not included in decision making process. (2) Labels (e.g. "nursing home resident"; might mention priming age study here). (3) Reinforced dependence. (4) Physical qualities of Nursing Home. (5) Predictability of the environment (need to change the routine). + So, don't treat them like babies, it could kill them

Issues in Studying Adult Development and Aging

+ Developmentalists place special emphasis on 4 forces: - Biological, psychological, sociocultural, and life cycle + There are also controversies that underlie the study of human development: - Nature-nurture, change-stability, continuity-discontinuity, and universal vs. context- specific development

Implicit memory (Procedural)

Change in task performance that is attributable to having been exposed to information at an earlier time but does not involve active, explicit memory (non-conscious) Slight age differences favor younger adults Distinctions in perceptually (upper/lower) and conceptually (verb or noun) based tests

The Forces of Development

+ Developmentalists typically consider 4 interactive forces 1) Biological forces - Include all genetic and health related factors that affect development (e.g. menopause, facial wrinkling, 2) Psychological Forces - Include all internal perceptual, cognitive, emotional, and personality factors that affect development 3) Sociocultural Forces - Include interpersonal, societal, cultural and ethnic factors that affect development 4) Life-Cycle Forces - Reflect differences in how the same event or combination of biological, psychological and sociocultural factors affects people at different points in their lives + One useful way to organize the these forces on human development is with the biopsychosocial framework

The Life-Span Perspective

+ Divides human development into two phases: an early phase (childhood and adolescence), and a later phase (young adulthood, middle age, and old age) + The early phase is characterized by rapid age related increases in peoples size and abilities + During the later phase, changes in size are slow, but some abilities continue to develop as people continue adapting to the environment + View adult development and aging as complex phenomena that cannot be understood within the scope of a single disciplinary + Aging is a lifelong process meaning that human development never stops + One of the most important perspectives on life-span development is that of Paul Baltes, who identified 4 key features of the life-span perspective 1) Multidirectionality of Development involves both growth and decline; as people grow in one area, they may lose in another and at different rates. - Ex: Peoples vocabulary ability tents to increase throughout life but reaction time slows down 2) Plasticity - One's capacity is not predetermined or set in concrete. Many skills can be trained or improved with practice even late in life - There are limits to the degree of potential improvement 3) Historical Context - Each of us develops within a particular set of circumstances determined by the historical time in which we are born and the culture in which we grow up 4) Multiple Causation - How people develop results from a wide variety of forces, it is shaped by biological psychological, sociocultural and life-cycle forces + The life-span perspective emphasizes that human development takes a life time to complete + Balte et al. argued that life-span development consists of the dynamic interactions among growth, maintenance and loss regulation, with 4 critical factors 1) As people grow older, they show an age related reduction in the amount and quality of biologically based resources 2) There is an age related increase in the amount and quality of culture needed to generate continuously higher growth. Usually this results in a new slowing of growth as people age 3) People show an age related decline in the efficiency with which they use cultural resources 4) There is a lack of cultural "old age friendly" support structures + These factors create the need to shift more and more resources to maintain function and deal with biologically related losses as we grow old, leaving fewer resources to be devoted to continued growth

What Age Related Changes Occur in Neurotransmitters

+ Dopamine - A neurotransmitter associated with higher level cognitive functioning like inhibiting thoughts, attention, and planning, as well as emotion, movement, and pleasure and pain - Dopaminergic System: the neurons that use dopamine - High dopamine levels - linked to cognitive processing that is effortful and deliberate - Declines in dopaminergic system are related to declines in several different aspects of memory - such as episodic (short term) memory and working memory - the effective functioning of the dopaminergic system DECLINES in normal aging + Serotonin - Involves in several types of brain processes, including memory, mood, appetite and sleep - Abnormal processing of serotonin related to cognitive declines in normal again and Alzheimer's, as well as other disorders like schizophrenia + Acetylcholine - Has an important role in arousal, sensory perception, and sustaining attention - Damage to structures that use it is related to serious memory declines

The Ecology of Aging: Community Options

+ Ecology of Aging: field of environmental psychology, which seeks to understand the dynamic relations between older adults and the environments they inhabit + Small changes in environments can result in major changes in behavior

What is elderspeak? How should we communicate with older adults and nursing home residents?

+ Elderspeak is speaking to OA like they are babies. + Talk to them like they are adults...and don't yell. Basically, make them feel useful and competent, and minimize aspects of a conversation that emphasize one's limitations.

Memory Processes (memory processing) Three Steps

+ Encoding: is the process of getting information into the memory system + Storage: involves the manner in which information is represented and kept in memory (brain) + Retrieval: is getting information back our of memory (information that has been stored is accessed) + memory can fail at any of these stages

What do Structural Brain Changes mean

+ Executive functioning - Executive functioning failures in older adults can result in the erroneous selection of irrelevant information as relevant, the inability to divert attention away from irrelevant information to the task at hand, and inefficiency in switching tasks - well-practiced tasks vocabulary and wisdom can be preserved into old age - Linked to decreased volume of the prefrontal cortex - WHM in healthy older adults who show no signs of serious cognitive disease have been linked to lower cognitive test scores and decreased executive functioning - How one learns new skills has been linked to the volume of the prefrontal cortex and cerebellum + Memory - Reductions in volume of hippocampus related to memory decline - Atrophy (very severe shrinkage), abnormal neurons, losses of neurons are observed in temporal lobe in people with Alzheimer's - Similar correlations between temporal lobe atrophy and typical declines in memory performance seen late in life + Emotion (Structual Changes in Emotion) - Changes in prefrontal cortex and amygdala may lead to decrease in processing of negative emotional information, and increase in positive - Mostly see an increased emotional regulation with age - Kensinger proposed two distinct cognitive and neural processes that contribute to emotional processing and memory - Processing of negative high arousal information for memory is relatively automatic in nature and is linked to activation of amygdala as it interacts with hippocampus to support memory performance - amygdala: the region of the brain, located int the medial-temporal lobe, believed to play a key role in emotion - For memory processing of negative low arousal stimuli, more activation of the prefrontal cortexhippocampus network is necessary - Kensinger argues that whether emotional arousal enhances memory depends on the engagement in emption's specific processes that are linked to these distinct neural processes - Ex: f amygdala is damaged, you don't attend to arousing stimuli - Older adults show more brain activity between the prefrontal cortex and the medial temporal lobe than younger adults do, regardless of whether its positive or negative + Social-Emotional Cognition - Research has identified a social judgement process that involves a relatively automatic system in which people read cues un the environment quick and easy, and then make social judgements - Tendency to put people in pre-existing social categories - lateral temporal cortex, amygdala, and basal ganglia are associated with automatic social recognition - the neural basis of more reflective judgements appears to reside in the prefrontal cortex, the anterior cingulate cortex, and the hippocampus - structures involves in autonomic processing show less age related deterioration than the more reflective processing - processing speed declines rapidly as people age

Preventive and Corrective Proactivity (PCP) Model

+ Explains how life stressors and lack of good congruence in person environment interactions (component b), especially when the person has nothing to help protect against these things, results in poor life outcomes (component F) + The helpful buffers include external resources (component E), or internal resources or dispositions (component C), and specific proactive behaviors (component D) + The model proposes proactive adaptations and helpful external resources reduce the effect of life stressors on quality of live outcomes + Two types of proactive adaptations 1) Preventive Adaptations: actions that avoid stressors and increase or build social resources (ex: increasing social network by making friends) 2) Corrective Adaptations: actions taken in response to stressors and can be facilitated by internal and external resources (e.g. changing diet after heart attack) + Older adults tend to engage in more corrective adaptations than preventive + But many actions that start as corrective turn into preventive (Ex: exercise) + Proactive adaptations significantly reduce the negative impact of stressors

Deciding on the Best Option (how do people decide on the best option?)

+ Finding the optimal fit where individuals competence and the environmental press are in the nest balance + It must be determined whether the individual has significant cognitive or physical impairment requiring intervention or support + An assessment of the ability of family members to provide support of care + Then the next decision is whether there is an option for providing intervention in the current home situation or if other options are needed + The individual in question needs to be an intefral part of decision making

Designs for Studying Development

+ Gerontologists must also decide how to measure possible changes or age differences that emerge as people develop + Such designs are based on 3 key variables: Age, Cohort and Time of Measurement + Age Effects - Reflect differences caused by underlying processes, such as biological, psychological or sociocultural changes - Usually represented by chronological age - Also inherent changes within the person and are not caused by the passage of time + Cohort Effects - Differences caused by experiences and circumstances unique to the generation to which one belongs - Correspond to the normative history graded influences - Can be specific (born in year 1994) or general (baby boom) + Time of Measure Effects - Reflect differences stemming from sociocultural, environmental, historical or other events at the time the data are obtained from the participants - The point in time of doing research could lead to different conclusions + All 3 influences are interrelated + Confounding: in any situation which one cannot determine which of two or more effects is responsible for the behavior observed + Confounding of the 3 effects is a serious problem in adult development and aging research + What makes developmental researchers different that other areas, is the fundamental interest in understanding how people change + The most common ways to gather data about age differences and changes 1) Cross-Sectional 2) Longitudinal 3) Time lag 4) Sequential

Measurement in Adult Development and Aging Research

+ Gerontologists usually use one of three approaches: observing systematically, using tasks to sample behavior, and self reports + Reliability - The ability of a measure to produce the same value when used repeatedly to measure the identical phenomenon over time - The extent to which it provides a consistent index of the behavior or topic of interest - E.g. a measure of memory is reliable to the extent that it fives a consistent estimate of performance each time you administer it + Validity - The extent to which it measures what researchers think it measures - E.g. a measure of memory is valid only it if can be shown to actually measure memory - often established by showing that the measure in question is closely related to another measure known to be valid

Perspectives on Adult Development and Aging

+ Gerontology - the study of aging from maturity through old age + Ageism - a form of discrimination against older adults based on their age: assumption that chronological age is the main determinant of human characteristics and that on age is better than another + the baby-boom generation, consisting of people born between 1946 and 1964, are on average the healthiest and most active generation to begin reaching old age in history

Langer and Colleagues Studies: What do they say about the importance of congruence for older adults?

+ Group 1: Residents told staff were there to do everything the resident needed or wanted done. Group 2: Residents told staff were simply there to assist. - Group 2 residents showed greater well-being later, and even a lower mortality rate.

Competence and Environmental Press (C/EP)

+ How a theory incorporates elements of the biopsychosocial model into the person environment relation + Competence: the upper limit of a persons ability to function in five domains; the maximum capability a person has for functioning in the domains of physical health, sensory perceptual skills, motor skills, cognitive skills, and ego-strength (self-efficacy) + Environmental Press: the physical, interpersonal or social demands that environments put on people + Lawton and Nahemow's model establishes poiints of balance between the two, called adaptation levels. One implication of the model is the less competent a person is, the more impact the environment has + people can show proactivity (doing something to exert control over their lives) or docility (letting the situation determine their lives) + Both competence and environmental press change as peoples move through the life span + The demands put on you by the environment changes as you age, + The competence environmental press framework reflects the lifecycle factor as well + Adaptation Level: - The area where press level is average for a particular level of competence - This is where behaviour and affect are normal + Zone of Maximum Performance Potential - Slight INCREASES in press tend to improve performance + Zone of Maximum Comfort - Slight decreases in press in which people are able to live happily without worry about environmental demands **People with little competence can withstand less of a change in press than someone with more competence + Combinations of competence and environmental press that fall within either of these two zones result in adaptive behaviour and positive emotion that translate into high quality of life + As a person moves away from these areas, behavior becomes increasingly maladaptive - These can result from several different combinations and for different reasons - Ex: too many environmental demands on a person with low competence + Each person has potential of being happily adapted to some living situations, but not all + Whether people function well depends on if what they are able to do fits what the environment forces them to do + People respond with changes in their combinations of environmental press and competence is two basic ways 1) Proactivity: people choose new behaviors to meet new desires or needs and exert control over their lives (change behaviors) 2) Docility: when people allow the situation to dictate the options they have and have little control (fail to exert contol over life) + Proactivity is more likely in people with HIGH competence and docility in people with LOW (people with more competence are likely to be more proactive) ** E.g. Response to INCREASE Environmental Press, like loss of a spouse. Learn what the spouse had been doing, like cooking, laundry, cleaning, finances, etc. + The model accounts for why people choose the activities they do, how well people adhere to medication regiments, and how they adapt to changing housing needs over time + The Less competence a person is the greater the impact of environmental factors + To the extent people experience declines in health, they are less able to cope with environmental demands - Important because many older adults choose to live at home + Personal competence predicts how well older adults adapt after being discharged from a hospital or when provided with assistance technology + The model has been the basis for evaluating and optimizing living situations with people that have severe cognitive impairments - Must identify the right level of environmental support based on level of competence

Population Trends in the United States

+ In 2000 there were many more people between 30 and 40 than any other age group + Projections for 2025 show that this will change, as more people will live into their 80s, 90s, + by 2050, the shape of the distribution will be more like a beehive, as more people continue to live into their 80s, 90s, and 100s + The biggest change by 2100 will be the number of older men + The baby boomers will be an economic and political force + Support systems and medical care will become the largest expenditures in the federal and states budgets + the strain on health and social services will be exacerbate because the most rapidly growing segment of the U.S. population is over age 85.

How Should People Communicate with Nursing Home Residents?

+ Inappropriate speech to older adults is based on stereotypes of dependence and lack of abilities + patronizing and infantilizing speech are examples of demeaning speech, that are rated negatively by older adults + the communication enhancement model has been proposed as a framework for appropriate exchange + this model is based on a health promotion model that seeks opportunities for health care providers to optimize outcomes for older adults through more appropriate effective commmunication

Correlational Design

+ Investigators examine relations between variables as they exist naturally in the world + Usually measure two variables and see how they relate + Measured by competing a correlation coefficient, r, ranging from -1.00 to 1.00 - When r = 0, then they are unrelated - When r > 0, then they are positively related - When r < 0, the variables are inversely related + Correlation does not mean causation + But provides information about the strength of a relationship + do not give definitive information about cause-and-effect relations; for example, the correlation between study time and the number of groceries remembered does not mean that one variable caused the other

Experimental Design

+ Involves manipulating a key factor that the researcher believes is responsible for a particular behavior and randomly assigning participants to the experimental and control groups + Independent Variable - The key variable being manipulated + Dependent Variable - The behavior that is observed + Interested in identifying differences between groups of people + One group is the experimental group which receives the manipulation, and the other group is that control group which does not receive it + Researcher exerts control over all aspects of the study + Can infer cause and effect relations about the variable + Age cannot be an independent variable because we cannot manipulate it

Prospective Memory

+ Involves remembering to remember something in the future, such as an action or event - e.g., I have to remember to go to a meeting at 12:30 today. - An older adult may have to remember to take a pill at bedtime + The process starts with the intention to remember something in the future, and depends critically on monitoring bothevent and times cues + three types of task - In event-based tasks, an action is to be performed when a certain external event happens; "I have to remember to stop by the store to get milk when I drive home." - A time-based task involves performing an action after a fixed amount of time; "I have to remember to check the turkey in 10 minutes." ** Time-based tasks show more age differences as long as people used self-generated strategies to remember, as they tend to decline with age - Habitual: "I have to take my medicine in the morning, at dinner, and at bedtime." o The cues that typically accompany event-based tasks helped reduce or eliminate age differences Autobiographical memory: o Involves remembering information and events from our own life (e.g., I remember a cold windy day that I rode my horse named "Skinny Jimmy".) - More autobiographical memories are remembered for events in our 20's and 30's than other times of our lives - As we age, our autobiographical memories become less accurate, and tend to get blended together. - aoutobiographical meories increases fastest during young adulthood (ages 18-25) especially those involving social interaction - Even "flashbulb" memories are not as accurate as we may think o Primarily a form of episodic memory - can also involve semantic memory o The episodic component of this memory is the recollection of temporal and spatial events from one's past o The semantic component consists of knowledge and facts of one's past without having to remember exactly what or when things occurred o Flashbulb memories: memories for personally traumatic or unexpected events o For both younger and older adults, when asked to remember life events, vivid memories experienced earlier in life (between 10-30 years) are reported more often than those occurring during middle adulthood (between 30-50 years)

Systematic Observation

+ Involves watching people and carefully recording what they say or do + Two forms + In naturalistic observation, people are observed as they behave spontaneously in some real life situation + Structured observations, differ in that the researcher rates a setting that is particularly likely to elicit the behavior of interest, usually for behaviors that are hard to study in the natural environment

Working Memory

+ Is the active processes and structures involved in holding information in mind and simultaneously using that information, sometimes in conjunction with incoming information, to solve a problem, male a decision, or learn new information + It plays an active, critical, and central role in encoding, storage, and retrieval + Working memory has a relatively small capacity + Rehearsal: is the process that information is held in working memory, either by repeating items over and over or by making meaningful connections between the information in working memory and information already known + There is a significant age related decline in working memory + Age-related decline in spatial working memory tends to be greater than that in verbal working memory - there is decline in both though + Working memory ability declines with age because alertness at different times of the day, order of the task, and task interference as well as the idea that older adults have more trouble juggling all of the element once they are accessed

Who is Likely to Live in Nursing Homes?

+ Latineo American and Asian residents increased roughly 55% each between 1999 and 2008, and African American residents increased nearly 11% percent, meanwhile; European American residents declined to 10% + Average resident has significant mental and physical problems + Main reason for placing almost 80% of residents is significant health problems + 80% have mobility problems, and more than 1/3 have mobility, eating and incontinence issues + between 30 and 50% show signs of clinical depression + Often do not see it as an option until all other avenues have been explored, which may be why there is such high numbers of truly impaired people + Placement decisions are often made quickly in reaction to a crisis + Older White women over the Age of 75 + People with cognitive impairment, problems with mobility, and/or incontinence + no spouse, children, or siblings nearby + recently discharged from a hospital

Stress and Coping Framework

+ Lazarus and Folkmans cognitive theory of stress in coping (chapter 4) to understand older persons interaction with environment + People evaluate situations to assess their potential threat value, and establish a range of coping responses they have at their disposal for avoiding harmful situations + Outcomes of coping are positive or negative depending on many contextual factors + Schooled showed the presence of social support systems affect the likelihood that situations would be defined as threatening - Applied to certified nurse aides (CNA)

Integrating Findings from Different Studies

+ Meta-Analysis - Allows researchers to synthesize the results of many studies to estimate relations Between variables - Find all studies published on a topic over a substantial period of time

Conducting Research Ethically

+ Minimize risks to research participants + Describe the research to potential participants so they can determine whether they wish to participate + Avoid deception; if the participants must be deceived, provide a thorough explanation of the true nature of the experiment as soon as possible + Results should be anonymous or confidential

Special Care Units

+ Most residents have cognitive impairment, with the majority having dementia + Providing a supportive environment for people with moderate to severe dementia requires certain specialized design and intervention features - This need has resulted in development of special care units in many nursing homes + Provide a supportive and therapeutic set of programs that help the person function at the highest level possible + Staff receive specific training to work with persons with dementia + Best units have physical designed elements that take functional limitations into account + Most residents with cognitive impairments wear wrist or ankle bands that trigger alarms if they wander beyond a certain point + Also provide private dining area to minimize possible negative interactions between residents with dementia and those without + Must have the right level of environmental support at the time of placement, as well as the availability of additional levels of support when the persons competence declines + Memory aids should be built into the unit + Staff training includes aspects such as - Appropriate and effective communication techniques - Behavioural management techniques to address aggressive/aggregated behaviour - Appropriate techniques for assisting with personal health and hygiene that protect residents dignity - Methods for dealing with incontinence - Techniques for handling sexuality in persons with dementia - Controlling wandering - Supervising and assisting with eating - Interventions to address memory failure and disorientation - Assisting with mobility + Residents of special care units are younger, more behaviorally impaired, and less likely to be minority than general nursing home residents when both exist in the same facility + Residents tend to have lower hospitalization rates, were less likely to have serious other health issues, and family members who were satisfied with quality of care, compared to residence of non-special care units - The increased quality of care is more the result of a difference in philosophy of care

General Designs for Research

+ Must embed their measure in a research design that yields useful, relevant results + Gerontologists rely on primary designs in planning their work: 1) Experimental Studies 2) Correlational Studies 3) Case Studies

Neuroimaging Techniques

+ Neuroimaging: a set of techniques in which pictures of the brain are taken in various ways to provide understanding of both normal and abnormal cognitive aging + Allows us to see inside the brain to examine the various structures + Help figure out which changes are normative and which ones are not + We need to know what a healthy brain looks like in different points in the human life span + Structural Neuroimaging - Provides highly detailed images of anatomical features in the brain - Includes X-rays, computerized tomography scans (CTs), and magnetic resonance imaging (MRI) - What a specific brain structure looks like at a specific point in time - Effective at identifying such things as bone fractures, tumors + Functional Neuroimaging - Provides an indication of brain activity but not high anatomical detail - Includes single photon emissions computerized tomography (SPECT), positron emissions tomography (PET), functional magnetic resonance imaging (fMRI), magnetoencephalography, and near infrared spectroscopic imaging (NIRSI) - fMRI is the most commonly used technique in cognitive neuroscience researc, it focuses on the blood oxydation and flow of that occur in response to neural activity (imaging normal brain function) - Provides information about what parts of the brain are active when people are doing a specific task + Shown that age related brain changes are responsible for age related changes in performance

Characteristics of Nursing Homes

+ One way of evaluating them is applying the competence-environmental press model + The goal is to find the optimal level of environmental support for people who have relatively low levels of competence + Most important things to consider when selection are: - Quality of life for residents (e.g. well groomed, food is tasty, rooms are comfortable) - Quality of care (e.g. if staff respond quickly, if family is involved in decisions) - Safety (e.g. enough staff, hallways are open) + Skilled nursing care is usually available only for short time following hospitalization, whereas custodial care may be an option for a much longer period + Nursing homes that only take Medicaid residents may offer longer term but less intensive care levels + Nursing homes without Medicaid might force residents out when funds run out + Ensure the facility and administrator are fully licensed, and a full array of staff training on topics like neglect, how to deal with difficult residents, and how to report complaints + Ensure the residents care plan is put together by a team of professionals, and residents have choices and can exert some control over routines and care + The best nursing homes use "person-centered care" approach to policies, especially when working with people with cognitive impairments - Based on promoting residents well being though increasing their perceived level of personal control and treating them with respect - Focus on on the individual, and does not use one size fits all approach - Involves a team who knows and cares about the individual - Method has shown major decreases in the need for certain medications, soft restraints, and number of residents who are incontinent + Residents who have higher perceived personal control show significant improvement in well being and activity level, and actually live longer + Feelings of self-efficacy are crucial to doing well and adjusting to life in a long-term care facility + Many nursing homes still use the traditional approach of rules, routines, and requirements person-centered care is considered a best practice in nursing homes

Decision-Making Capacity and Individual Choices

+ Patient Self Determination Act (PSDA): a law that mandates that all facilities receiving Medicare and Medicaid funds comply with 5 requirements regarding advance care kenning, referred to as advance directives 1) Provide written information to people at time of admission about their right to make medical treatment decisions and to formulate advance directives (i.e. decisions about life-sustaining treatments and who makes decisions if they are incapacitated) 2) Maintain written policies and procures regarding advanced directives 3) Documenting the completion of them in persons medical chart 4) Complying with state law regarding the implementation of advance directives 5) Providing staff and community education about advanced directives + Assessing a persons capacity to make medical decisions is a challenge for medical ethics - Many studies show the theory does not hold up well in practice - Most people see such planning as a family process - They engage in informal advance care planning, preferring to allow family members to make decisions for them when the need arises and to give them leeway in interpreting advance directives even when they exist - Thus it is unlikely a person being admitted will have a complete formal advance directive + New resident is unlikely to understand the information presented as mandated by the PSDA + If they are cognitively impaired, they may be thought to be unable to act on their own behalf in communication treatment preferences and end of life wished + No uniform approach to determining residents cognitive competence exists + Lack of agreement between residents and families also caries with ethnicity + Resolving the problem involves using the various approaches considered for determining person-environment interactions, combined with clinical assessment

Congruence Model

+ People look for environments that fit their abilities and needs: The better the congruence, the better the well-being. - e.g. An OA might move into an assisted living facility after the loss of a spouse, or illness.

Self-Reports

+ People's answer to questions about the topic of interest + Written report is a questionnaire, verbal report is an interview + Sometimes may not be good measures of peoples behavior

Neural Plasticity and the Aging Brain

+ Plasticity: involves the changes in the structure and function of the brain as the result of interaction between the brain and the environment + Plasticity provides a way to understand compensatory changes in both the more observable behavior and less observable reorganization of neural circuitry in the brain + Older adults are able to improve cognitive ability in memory tasks through tailored strategy training beyond the level of untrained younger adults, this is highly task specific, and the ability level gains are very narrow in focus + Basic cognitive processes affected by aging can indeed be improved through training + Neural Stem Cells: are cells that persist in the adult brain and can generate new neurons throughout the life span

The Parieto-Frontal Integration Theory (P-FIT)

+ Proposes that intelligence comes from a distributed and integrated network of neurons in the parietal and frontal areas of the brain + In general, P-FIT accounts for individual differences in intelligence as having their origins in individual differences in brain structure and function + research now shows that the prefrontal cortex, along with the parietal lobe (an area of the brain at the top of the head), plays an important role in general intellectual abilities +the limbic system and amygdala, influence how we process emotional content

Aspects of Memory Self-Evaluations

Metamemory: involves knowledge about how memory works and what we believe to be true about it - There don't seem to be large age differences, except that OAs believe it declines more than YAs. + RELATED: Self-efficacy: "My memory is really good, especially compared to Martha's." - OAs report that their memory is worse now than when they were young. o We many know recall is typically harder than recognition memory strategies are often helpful, and working memory is not limitless o Most often assessed with questionnaires asking about these various facts and beliefs + Memory monitoring: refers to the awareness of what we are doing with out memory right now o At times we know how we study, search for some particular fact, or keep tract of time for an appointment

Assisted Living

+ Provides assistance with some ADL's and IADL's but person is still fairly independent + Are housing options for older adults that provide a supportive living arrangement for people needing assistance with personal care (such as bathing or raking medications) but who are not so impaired physically or cognitively that they need 24 hour care + Ideal assisted living situation has 3 essential attributes 1) The physical environment where a person lives is designed to be as much like a single family house as possible - That way, the setting has a residential appearance, a small scale, and personal privacy that includes at a minimum a private room and a full bath that is not shared with other residents - Indoor and outdoor access 2) The philosophy of care at an ideal assisted living facility emphasises personal control, choice, dignity and autonomy, and promotes a preferred lifestyle residents and their families consider to be abnormal quality of life - Residents exert control over lives, schedules, and dwellings 3) Should meet residents routine services and special needs - Levels of support are not meant to deal with high level, intensive nursing or other complex needs - Transportation, socialization, and daily checks + There are serious gaps in service and regulation among assisted living facilities + A more cost effective approach than long term care facilities for those older adults who cannot live independently + Residents are independent apartments or similar units + Usually include monitoring and management of health care, assistance with activities of daily living, housekeeping, reminders for medication, recreation and entertainment, transportation and security + Ranges between $25000-50000 + Medicare does not pay for either living costs or any of the services provided, but sometimes they may pay for services under certain circumstances + Residents well being is related to whether the decision to live there was under their control and to the quality of relationships formed with co-residence + One of the main future challenges will be the blurring of congregate (independent) living, assisted living, and long term care facilities into hybrids of these + The cost of assisted living, is another challenge, that is already out of reach for many +Different Housing Options that exist for older adults who experience change in competence: - Modify the home (e.g. build a ramp.) - Adult Day Care: 1. Social activities, meals, recreation 2. Health care and Therapy 3. Special Care (Dementia). Most are non-profit

Processing Resources

+ Refers to the amount of attention one has to apply to a particular situation + Many theorists and researchers believe with increasing age comes a decline in the amount of cognitive "energy" one deploys on a task + The idea is that there is only so much of this processing resource to go around, and older adults have less of it than younger adults. + Problem with theory is that the "processing resource" is poorly defined and some forms suffer from circular logic. + Circularity of logic: We say that there are limited resources because we can't do two things at once very well. But, we say that the fact that we can't do two things at once very well is evidence that we have limited resources. + Inhibitory Loss: o One hypothesis is older adults have reduced processing resources because they have difficulty inhibiting the processing of irrelevant information - Evidence: When asked to divide attention between irrelevant information and relevant information, young adults can focus on the relevant information better than older adults. o The oldest-old have more task-irrelevant thoughts during processing and have trouble keeping them out of their mind o Kimbler and colleagues showed emotionally supportive messages reduce distracting thoughts and improve performance on everyday tasks for middle-aged and older adults o When information that was initially distracting but later becomes relevant, older adults performed better than younger adults o Under certain conditions inhibitory loss can be a hindrance, and in others it can be helpful Attentional Resources: - Views attention as a resource, and supposedly older adults have less of it than young adults. - Evidence: Older adults do more poorly on some tasks that require them to divide attention. o Divided attention: concerns how well people perform multiple tasks simultaneously; doing two or more things at a time - older adults are slower to switch between tasks o Age differences observed are due to older adults' difficulties with the individual tasks and not to spreading their attention across them per se o Older adults are able to multitask but perform each task more slowly than younger adults o Older adults encounter difficulties dividing their attention when a task becomes more complex o Age differences can be minimized if older adults are given training o Older adults focus on the task most important to them; but they are slower to focus on something (selective attention) o Younger adults optimized their memory performance - Older adults have more difficulty on vigilance tasks (or sustained attention).

Sequential Designs

+ Represent different combinations of cross-sectional or longitudinal studies + Cross - sequential design consists of two or more cross sectional studies conducted at two or more times of measurement + Longitudinal sequential design consists of two or more longitudinal designs that represent two or more cohorts + Are more powerful and provide the richest source of information + Not used often because they are costly

Case Studies

+ Researchers study a single individual in great detail + Useful when wanting to investigate a rare phenomenon + Primary limitation is figuring out if the information from one person can be generalized to others

Representative Sampling

+ Researchers usually interested in broad groups of people called populations + Most only include a subset of the population - a sample + Researchers must be careful to ensure that their sample is truly representative of a population of interest + Must be careful not to assume that findings from one group apply to another

How is Decision making Capacity Assesed?

+ The Patient Self-Determination Act (PSDA) requires people to complete advance directives when admitted to a health care facility + A major ethical issue concerns how to communicate this information to people with cognitive impairment in nursing homes

How is the Brain Organized?

+ The brain is made up of cells called neurons + Dendrites: the key structural features of the neuron, which act like antennas to receive signals from other nearby neurons, the axon + The axon which is part of the neuron containing the neuronfibers, which are the structures that carry information inside the neuron from the dendrites to the terminal branches, which are the end points of the neuron + In order for information to be passed from on neuron to another, the terminal branches release chemicals called neurotransmitters, that travel across the space between neurons, called the synapse, where they are received by the dendrites of the next neuron + Neuroanatomy is the study of the structure of the brain + Cerebral Cortex - The outermost part of the brain - Consists of two hemispheres (left and right) that are connected by a thick bundle of neurons called the corpus collosum + Prefrontal and Frontal Cortex - Intimately involves in higher order executive functions - Includes; ability to make and carry out plans, switch between tasks, maintain attention and focus, and connects with other key brain structures that are involves with emotions + Cerebellum - At the back of the brain - Controls equilibrium and the coordination of fine motor movements, and may be involves in some cognitive functions + Hippocampus - Located in the middle of the brain - Key structure associated with memory + Limbic System - A set of brain structures involved with emotion, motivation, and long term memory - Most important components include the amygdala and hippocampus

Longitudinal Designs

+(Longitudinal Study) The same individuals are observed or tested repeatedly at different points in their lives + Involves a lengthwise account of development and is the most direct way to watch growth occur + Microgenetic study - A special type of longitudinal design, participants are tested repeatedly over a span of days or weeks, typically with the aim of observing change directly as it occurs - Useful when investigators have hypotheses bout a specific period when developmental change should occur, or in order to intensively document a behavior over time - Useful in tracking changes as a result of intervention + Three Problems - Practice effects - performance may improve over time because people are tested over and over again with the same measures - Participant drop out - because it is difficult to keep a group of research participants intact over the course of a longitudinal study - Generalization is limited

Home Modification

+ The competence environmental press model provides two options for people who experience difficulties dealing with everyday tasks - People can increase their competency and develop better or new skills - People can lower the environmental press by modifying the environment to make the task easier + The most frequent solution involves modifying ones home (i.e. changing the environment) in order to create a new optimal balance or better fit between competence and environmental press + Many strategies, from minor structural changes like assistive devices, to more extensive modifications like making home fully accessible by wheelchair + Some options may be unaffordable + Home modifications done to address difficulties with accomplishing ADLs typically reduce disability related outcomes + Auxiliary dwelling unit ( ADU ) is a portable hospital room that is a separate dwelling place next to a family's main dwelling to give an older relative privacy and proximity to family - Colloquially known as granny pods, the dwelling contains a number of devices; can have a number of "smart" devices that do everything from serving as a virtual companion - They can be as temporary or permanent as needed - Provide independence and support for aging in place

Diversity of Older Adults in the United States

+ The number of older adults among ethnic minority groups is increasing faster than among European Americans + Future adults will be more educated than the past, and they tend to live longer + As the number of ethnic minority older adults increases, an important emerging issue will be the differences between individualism and collectivism + Individualism is much more focused on the person, while collectivism includes the broader family or network of friends + in 2010, a little more than half of the people over 65 have only a high school diploma or some college, and about 25% have a bachelor's degree or higher + by 2030 it is estimated that 85% will have a high school diploma and 75% will have a college degree

Population Trends Around the World

+ The number of older adults is increasing dramatically in nearly all areas of the world + The oldest area of the world is Europe, and the youngest is Africa + Economically powerful countries around the world (like China), are trying to cope with increased numbers of older adults that strain the country's resources + Because of Chinas 1 child policy there will be way more older adults than those under 15 + The economic impact will be significant for China + In general the aging of the worlds workforce and population in general will have significant effects on the world economy + Also explosive increase of older adults in developing countries + Economic conditions in different countries have a powerful effect on aging + Poverty is related to the odds of living a long life, less likely to live long - On reason some countries are aging is because of a significantly lower birth rate - Creates of problem of how their economies will handle a shrinking supply of workers + In contrast, increase in older adults of the rest of the world presents problems of financing and health care

Theories of Brain-Behaviour Changes Across Adulthood

+ The underlying brain changes are not overly specific to a narrow set of circumstances + Additional age related neural activation may be functional and adaptive for optimal performance as people grow older + A number of models have been used to explain these findings: the HAROLD, the CRUNCH, and STAC model + The HAROLD model - Hemispheric Asymmetry Reduction in Older adults Explains the empirical findings of reduces lateralization in prefrontal lobe activity in older adults (that is, the reduced ability of older adults to separate cognitive processing in different parts of the prefrontal cortex) - Suggests that the function of the reduced lateralization is compensatory in nature, that is, additional neural units are being recruited and used to increase attentional resources, processing speed, or inhibitory control + The CRUNCH model - Compensation-Related Utilization of Neural Circuits Hypothesis - Describes how the aging brain adapts to neurological decline by recruiting additional neural circuits (in comparison to younger adults) to perform tasks adequately - Incorporates bilaterality of activation, but suggests this is not the only form of compensation - Two main mechanisms are suggested that the older brain uses to perform tasks: more of the same and supplementary processes - More of the same means that when task demands are increased more activation can be found in the same brain region that is activated for processing easier tasks - in older adults additional neuronal circuits are recruited earlier - Supplementary processes take place when different brain regions are activated to compensate for lacking or insufficient processing resources + The STAC model - Scaffolding Theory of Cognitive Aging - Based on the idea that age related changes in ones ability to function reflect a life long process of compensating for cognitive decline by recruiting additional brain areas - The increase in frontal activity may be a response to decreased efficiency of neural processing in the perceptual areas of the brain - Older adults have trouble suppressing the default network of the brain, resulting in poorer performance on cognitive tasks - Default network of the brain - refers to regions of the brain that are most active when one is at rest - Older adults may fail to shift from a resting state to a more active state - Model suggests that older adults continue to perform at high levels because they rely on a back up neural path way - Older adults performance can be understood in terms of factors that impact decline and those that impact compensation - Without scaffolding, performance would have been worse because older adults would have to rely on the more focal areas

The Demographics of Aging

+ There have never been as many older adults as there is now + Health care improved, and baby boomers began reaching 65

Culture and Ethnicity

+ They jointly provide status, social settings, living conditions and personal experiences for people of all ages, and they influence and are influenced by biological, psychological and life cycle developmental forces + Culture: - Shared basic value orientations, norms, beliefs, and customary habits and ways of - Living - Culture provides the basic worldview of a society in that it gives the basic - Explanations about the meanings and goals of everyday life - Important in gerontology because how people define person, age and life courses varies - Across cultures + Ethnicity - An individual and collective sense of identity based on historical and cultural group membership and related behaviors and beliefs - Have both solid and fluid properties, reflecting the fact that there are both unchanging and situation specific aspects to ethnic identity • Both culture and ethnicity are key dimensions along which adults vary • But we know little about how if effects how people experience old age

What Age Related Changes Occur in Brain Structures

+ Thinning and shrinkage in volume and density, and declining health of white matter or WMH + White Matter: neurons that are covered by myelin that serve to transmit information from one part of the cerebral cortex to another or from the cerebral cortex to other parts of the brain + White Matter Hyperintensities (WMH): are determined by the observation of high signal intensity or a bright spotty appearance on images, which indicate brain pathologies such as neural atrophy + One important change is that considerable shrinkage occurs in the brain by late life - Prefrontal cortex, hippocampus and cerebellum show profound shrinkage - Areas related to sensory functions, show little + Diffusion Tenso Imaging (DTI): neuroimaging method that assesses the rate and direction that water diffuses through white matter + DTI examining WHM have demonstrated that deterioration of white matter may represent a cause of increased prefrontal dysfunction in older adults + WHM are linked to cerebrovascular disease

Consider the implications of cognitive impairment with respect to involving older adults in decisions about the care they receive.

+ Those with cognitive impairment will likely have difficulty making decisions about their care. ** It can be difficult to tell when they become incapable of making informed decisions.

Communicating with Residents

+ Uneasiness of communication often results in people relying on stereotypes of older adults, and results in inappropriate communication styles + Patronizing Speech: inappropriate speech to older adults that is based on stereotyped of incompetence and dependence - Described as a general 'communication predicament' of older adults - Conveys a sense of declining abilities, loss of control and self esteem, and withdrawal - Increased volume, higher pitch, repetitions, simple words + Infantilization/ elderspeak: secondary baby talk, also involves the unwarranted use of a persons first name, terms of endearment, simplified expressions, short imperatives, and assumption that the recipient has no memory, and cajoling as a way to demand compliance - Community dwelling older adults Viewed extremely negatively by some older adults and were resentful of its intonation aspects as indicative of lack of respect - Nursing home residents were less harsh, giving support to the idea that being exposed to it lowers ones awareness of its demeaning qualities + Residents with dementia tend to be more resistive to care when they are targets of elderspeak + More experience in interacting with older adults is related to lower use of patronizing speech + There may be different types of elderspeak with different effects on the targets of the communications - Two types: right and wrong - Used towards women most often + Ryan et al. proposed the communication enhancement model as a framework for appropriate exchange - Based on a health promotion model that seeks opportunities for health care providers to optimize outcomes for older adults through more appropriate forms of communication - Communication must be based on recognizing individualized cues - Modifying communication to fit individual needs and situations - Appropriately assessing health and social problems + Combining communication enhancing model with person-centered care model provides we way for paraprofessional staff in facilities to communicate more effectively + Less positive perceptions of conversations in some casesin Korea, Japan, China, Philippians, than in some Western countries + Few suggestions for visiting with older adults (page 150)

Who pays for nursing home care?

+ We do. + $80, 000 per year and rising beyond inflation rate. + Medicare only pays for a few months. - 100 days (20 fully covered; 80 - copay $152/day). - Clock resets after 60 days of non-use. + Insurance doesn't pay much, and is prohibitively expensive anyway. + People must "spend down" until they are poor, so that Medicaid will pay. + Is this fair or moral?

Sampling Behavior with Tasks

+ When investigators can observe a behavior directly, another alternative is to create tasks that are thought to sample the behavior of interest + Convenient + Main question with this approach is validity: does the task provide a realistic sample of the behavior of interest

Can a Nursing Home be a Home?

+ Yes + The circumstances fostering this feeling include - Having time to thing about and participate in the placement decision - Having prior knowledge and positive experience with a specific facility - Defining home in terms of family and social relationships rather than in terms of place, objects or total autonomy - Being able to establish a kind of continuity between home and nursing home through activities or similarities in living arrangements + Residents pull from their repertoire of coping stratifies to help them come to terms + Getting residents to reminisce about home actually facilitates adjustment + Residents satisfaction related to; facility, staff, residential factors (figure 5.5) - Staff satisfaction plays a crucial role

Aging in Place

+ You grow old and die where you have lived most of your life + As the environment in which one lives becomes more restrictive, many older adults engage in selection and compensation to cope + May select a different place to live or adapt behavior in order to compensate for their limitations + The idea of aging in place reflects a balance of environmental press and competence through selection and compensation + Being able to remain independent in community is important for people, especially in terms of their self esteem + Older adults who age in place form strong emotional and cognitive bonds with their residences that help transform a house into a home - Having a home provides a strong source of self identity + Making a change in where people live, and having to psychologically disconnect with a place where they may have lived for many decades, can be difficult and traumatic + Feeling one is at home is a major aspect of aging in place + Providing older adults a place to call their own that supports the development of the psychological attachments necessary to convert a place to a home is key for successful aging in place + Cluster housing is an alternative that combines the aging in place philosophy with supportive services - Key feature is that services are provided to the residents by staff hired by the owner or provider under contract - Emphasizes individual choice on the part of the residents in terms of what services to use - Low cost alternative to nursing home, but not covered by insurance

Information-Processing Model

+ assumes that the brain-mind relationship is analogous to a computer and its software + Uses a computer metaphor to explain how people process stimuli + Information enters the system and is transformed, coded, and stored in various ways + Based on three long-held assumptions: 1. People are active participants in the process 2. Both quantitative (how much information is remembered) and qualitative (what kinds of information are remembered) aspects of performance can be examined 3. Information is processed through a series of processes First, incoming information is transformed based on what a person already knows about it Second, researchers look for age differences in both how much information is processed and what types of information are remembered best under various conditions + Third, researchers in adult development and aging focus on several aspects of information processing + Using this model poses three fundamental questions for adult development and aging: 1. What areas of information processing show evidence of age differences? 2. How can we explain variability when we find age differences in information processing? 3. What are the practical implications of age related changes in information processing? Sensory Memory: o Is a brief and almost identical representation of the stimuli that exists in the observable environment o Takes in a large amounts of information rapidly o This type of memory is as if the representation exists in your mind in the absence of the stimuli itself o Unless we pay attention to sensory information the representation will be lost quickly o Age differences are not typically found in sensory memory (age differences in sensory memory) *** sensory memory is the storage system that retains very large amounts of information, in close to the original form, for very brief periods of time *** this information is lost if it is not given some attention and rehearsed *** sensor memory seems to remain fairly intact with age

Complex Development in the Prefrontal Cortex

+ involved in the most important part aspects of thinking and reasoning, including executive functioning, memory and emotion + Positive Effect: the fact that older adults are more motivated to derive emotional meaning from life and to maintain positive feelings + Positive and negative processing occurs in different brain regions + When older adults process information that is emotionally positive, they also show increased activity in the middle portion of the prefrontal cortex, the amygdala and the cingulate cortex

Types of Nursing Homes

+ little to no independence, high degree of medical care required + House the largest number of older residents of long-term care facilities + They are governed by the state and federal regulations that establish a minimum standards of care + Two levels of care are defined - Skilled nursing homes: consist of 24 hour care; covered by Medicare Part A (Inpatient Care) for 100 days; Patients need continous care - Intermediate care is also 24 hour, but at a less intense level; covered by Medicare Part B (Outpatient Care) - The difference is the type and numbers of health care workers on the staff + The cost is high + Will be an increasingly important political issue in coming decades because of baby boomers

Congregate Housing

+Kind of like living in campus dorm; cafeteria, some health services, but not extensisve + Includes a range of living options from those providing only housing to those providing some level of medical services + Most common form is an apartment complex of older faults that provides a level of support such as shared meals + Often the least expensive form of supported living for older adults, because the cost is typically subsidized by various government agencies and non-profit organizations + Especially important option for low income, who need support to remains out of a nursing home + There is a shortage of them though + Level of medical assistance is lower than in assisted living + Do not provide 24 hour medical services on site + Service coordination accomplished several things: interface with housing officials, individual service plans for residents, coordination of shared activities and mediation of resident conflicts + Most require residents to be capable of independent living and not require continual medical care, be medically stable, know where they are and oriented in time, show no evidence of disrupted behaviour, and be about to follow any specific service plan developed for them + Typically move in, in response to a significant decline in functioning or health related problem + Good for those seeking specific types of social engagement

Can Older Adults Compensate for Changes in the Brain

+studies focusing on verbal working memory and long-term memory and long-term memory show focal, unilateral activity in the left prefrontal region in younger adults but bilateral activation (i.e. in both the left and right prefrontal areas) in older adults when performing the same task + Older adults do compensate + Bilateral activation in older adults may serve a functional and supportive role in their cognitive functioning + There is greater prefrontal bilateral activity in older adults during working memory tasks than in younger adults - There is left lateralized prefrontal engagement in younger adults, where older adults also engage the right prefrontal areas - May be that older adults are more adept at compensating for normative deterioration in the brain by utilizing other areas

Person-Environment Interaction

- means behavior (B) is a function of both the person (P) and the environment (E) + Most models emphasize the importance of peoples perceptions of their environments + Kurt Lewin's Equation: - B=F(P,E): Behavior is a function of both the person and the environment; so is well being and health

Neuroscience Perspectives

1) Neuropsychological Approach - Compares brain functioning of healthy older adults with adults displaying various pathological disorders in the brain - Interested in whether patients of any age with damage in specific regions of the brain show similar cognitive deficits to those shown by healthy older adults - If this is the case, researchers can conclude that decline in cognitive functioning as we grow older may be related to unfavourable changes in the same specific regions of the brain observed in the brain damaged patients - Also want to isolate the neural or brain mechanisms that are associated with both normal and pathological decline in cognitive functions - These findings stimulate developmental theories 2) Neurocorrelational Approach - Attempts to relate measures of cognitive performance to measures of brain structure or functioning - Instead of direct measures, some may investigate the correlation between behavioural tests that are associated with the function of specific brain regions 3) Activation Imaging Approach - Attempts to directly link functional brain activity with cognitive behavioural data - Allows real time investigation of changes in brain functioning as they affect cognitive performance in older adults - Relies on fMRI - Compensatory Changes: changes that allow older adults to adapt to the inevitable behavioural decline resulting from changes in specific areas of the brain

The Betual Project on Memory, Health, and Aging

>4000 Ss, aged 35-80, tested at three-year intervals (15 year data available) Primary objectives: o Examine the development of health and memory in adulthood and old age o Determine early preclinical signs of dementia o Determine risk factors for dementia o Assess pre-morbid memory in subjects in accidents or who acquire diseases during the course of the study

Factors that Preserve Memory

Cognitive reserve: there may be specific factors that help preserve memory performance Exercise: o Physical fitness training improves cognitive performance in older adults regardless of the training method of the older adults personal characteristics o Regular exercise increases neural plasticity and can be viewed as an intervention alternative for diseases such as Parkinson's, Alzheimer's, and stroke, and may prevent some of the normative decline typically associated with aging Multilingualism and Cognitive Functioning: o Older adults from 75 to 95 years of age who spoke four languages or more showed the best cognitive state o Bilingualism plays a large role in protecting older adults from cognitive decline Semantic memory in service of episodic memory: o Older adults perform better when they can use previously learned semantic information to support episodic knowledge o The more associations are made, the stronger the effect and the more performance is improved Negative stereotypes and memory performance: o Negative or threatening stereotypes suppress older adults controlled or conscious use of memory while increasing the likelihood they will use automatic responses instead

Declarative memory

Declarative = one type of explicit memory, may be subdivided into two subsystems: o Episodic memory: conscious recalling of information form a specific event or time o Recall remembering without hints vs. Recognition choosing from items Ex: learning for this course, memorizing information o Semantic memory: learning and remembering the meaning of words and concepts not tied to specific occurrences of events in time Ex. Recalling word definitions for a puzzle, translating languages Example: o Sample: 1796 community dwelling adults (1005 women, 791 men); age groups (35-50 yrs, n=671; 55-65 yrs, n=569; 70-85 yrs, n=556) o Measures: 12 episodic memory tests; 5 semantic memory tests o Covariate: co-varied years of education for all analyses, MMSE <24 removed from study

Age Differences in Encoding Vs. Retrieval

Encoding: o A strategy is anything people do to make the task easier and increase the efficiency of encoding and retrieval o Older adults tend not to behave as strategically when studying information to be remembered o Age changes observed reflect more a decrease in the degree the strategies are used spontaneously, rather than a decrease in the ability to use strategies Retrieval: o Older adults tend to spontaneously use fewer retrieval strategies o Even when encoding strategies are provided, and the opportunity to apply them during recall is allowed, older adults still do worse Neuroscience Evidence: o Neuroimaging studies indicate during encoding, older adults prefrontal cortex shows over-activity, indicating the usual pattern of compensatory processes with age o Neuroimaging studies show age-related differences in how the prefrontal cortex and hippocampus work together In younger adults, activity in these areas depends on the extent the retrieval task requires relations to be made between the information being remembered In older adults, activity in these areas stayed equivalent irrespective of relational processing o Younger adults have extensive neural network connections in the parietal and frontal regions involved in retrieval than older adults o Older adults show higher levels of brain activity in these regions, indicating a likely compensatory strategy for less extensive networks Research in encoding and retrieval processes is important for 2 key reasons: 1. It emphasizes age-related decrements in memory are complex; they are not due to changes in a single process 2. Memory intervention or training programs must consider both encoding and retrieval

Memory and Nutrition

Flavonoids, found in green tea and blueberries, among other foods, may reverse age-related deficits in spatial memory Dietary iron intake in midlife has also been associated with better verbal memory Several vitamins, especially B vitamins 6,9 (folic acid) and 12 have been associated with memory and other cognitive functions

Normal Vs. Abnormal Memory Aging

From a functional perspective, one way to distinguish normal and abnormal changes is to ask whether the changes disrupt a person's ability to perform daily living tasks Along with the prefrontal cortex, parietal region, and hippocampus that are involved with memory, there are also structural changes in the white and grey matter o Local atrophy in these structures has been shown to be related to memory decrements in older adults Memory and Physical and Mental health: o Damage to the brain resulting from physical or mental health disorders can result in profound decrements in different types of memory o Sever seizures in epilepsy can result in damage to the hippocampus and is heavily involved in creating associations between incoming information and information already in memory o Temporary global amnesia (TGA): a condition were people temporarily experience a complete loss of memory and are disoriented in time o TGA has been associated with malfunctions of the valve in the jugular vein allowing blood to flow in the wrong direction

Attention - The Basics

From the functional perspective, attention is composed of separate dimensions serving different functions o The complex tasks we engage in when processing information usually require more than one attentional functions Attentional processes are influenced by the capacity to sustain attention, as well as the speed that information is processed Attentional control is linked to the processes in the parieto-frontal lobe - the parieto-frontal integration processes undergo significant change with age

Implicit Vs. Explicit Memory

Implicit Memory: (procedural memory) involves retrieval of information without conscious or intentional recollection o We do things from memory but we do not have to think about them o Learning sequences tend to show age differences, whereas learning spatial context does not Explicit Memory: (declarative memory) is intentional and conscious remembering of information learned and remembered at a specific point in time o Performance on explicit memory tasks decline with age

Speed of Processing

Is how quickly and efficiently the early steps in information processing is completed Research shows whether or not you observe slowing depends on what the task is because all components of mental processing do not slow equivalently The amount of beta-amyloid protein found in the central nervous system, a biomarker linked with the possible subsequent development of dementia, has been shown to be related to the degree processing speed slows

Memory and Aging: Working memory:

Limited capacity - about seven chunks Plays an active, critical, and central role in encoding (Y), storage (N), and retrieval (Y) Older adults, presented with multiple tasks, do poorly compared to younger Evidence of age-related decline in working memory not entirely clear, but there is evidence these differences relate to performance on more complex cognitive tasks Older adults may be able to access info but then have trouble "juggling" or making sense of it

Age Differences in Metamemory and Memory Monitoring

Older adults seem to know less than younger adults about the internal workings of memory and its capacity, view memory as less stable, expect memory will deteriorate with age, and perceive they have less direct control over memory The Role of Memory Self-Efficacy: o Belief in oneself is referred to as memory self-efficacy; it is the belief one will be able to perform a specific task o One may know a great deal about how memory works but still believes one's ability to perform in a specific situation is poor o Emerged as one of the key aspects of metamemory because of its importance in accounting for performance in several different types of situations o Also helps to explain how people make performance predictions in the absence of direct experience with tasks o Studies show older adults with lower memory self-efficacy perform worse on memory tasks o Yet older adults with low memory self-efficacy compensate for poor memory performance by using people for assistance and compensatory strategies to aid in their memory performance Age Differences in Memory Monitoring: o The ability to monitor one's memory does not appear to decline with age o Older adults who are better at monitoring are more likely to use effective strategies and apply strategies learned in training to other, appropriate situations

Long-Term Memory

Refers to the ability to remember rather extensive amounts of information from a few seconds to a few hours to decades Long-term memory represents a relatively large-capacity store where information can be kept for long periods Semantic memory: o Concerns learning and remembering the meaning of words and concepts not tied to specific occurrences of events in time Ex. Knowing the definition of words to complete cross-word puzzles o Increases from 35-55 years of age and then levels off - starts to decline at age 65 but it is less substantial than for episodic o There are no deficits is processes such as language comprehension, the structure of knowledge, and the activation of general knowledge o Retrieval typically does not tax working memory - older adults can draw upon experience in word and/or general world knowledge o Changes can happen if it becomes hard to access and retrieve If the knowledge is not used on a regular basis Momentary retrieval failure for information that is otherwise accessible o Tip-of-the-tongue (TOT): is when you try to retrieve a name or word you are certain you know, but it is not quite accessible at the moment o Older adults not only experience more TOT's, but also report less partial information about the target - suggest retrieval difficulty Episodic memory: o Is the general class of memory having to do with the conscious recollection of information from a specific event or point in time Ex. Learning the material in this course so you will be able to reproduce it on an exam o Remains fairly stable until around 55-60 years of age and then shows a precipitous decline beginning around age 65 o Recall test: people are asked to remember information without hints or cues o Recognition: involves selecting previously learned information from among several items o Older adults perform worse than younger adults on recall tests of episodic memory because they omit more information, include more intrusions, and repeat more previously recalled items o Older adults are more likely to say they recognize items that were never-presented, especially if they share a conceptual meaning or perceptual resemblance to the items actually presented o Age differences can be reduced (but not eliminated) in several ways: Allowing older adults to practice or perform a similar task before learning a new list Using material more familiar to older adults Using compensatory strategies to help themselves remember

Training Memory Skills

Some of the best memory strategies share several things in common 1. They require paying attention to the incoming information 2. They rely on already-stored information to facilitate making new connections with the new material in semantic memory 3. In the process of encoding, strategies provide the basis for future retrieval cues E-I-E-I-O framework combines two types of memory, explicit and implicit memory, with two types of memory aids, external and internal aids External memory aids: o Are memory aids that rely on environmental resources, such as notebooks or calendars o Research indicates for external cues to be most effective, they should 1. Be given close to the time action is required 2. Be active rather than passive 3. Be specific to the particular action 4. Be portable 5. Fit a wide range of situations 6. Store many cues for long periods 7. Be easy to use 8. Not require a pen or pencil Internal memory aids: are memory aids that rely on mental processes such as imagery o Healthy older adults are less willing to use effortful internal strategies o Older adults with dementia are unlikely to benefit from these types of strategies o Spaced retrieval is one implicit-internal memory aid that involves teaching persons with dementia or other serious cognitive impairments to remember new information by gradually increasing the time between retrieval attempts Memory Drugs: o Two groups of medication receiving most of the attention are cholinesterase inhibitors o A second group of medications are memantine, target glutamate, another neurotransmitter

Source Memory and Processing of Misinformation

Source memory: o Refers to the ability to remember the source of a familiar event as well as the ability to determine if an event was imagined or actually experienced (where information originated from [e.g. self, other]) o Older adults are less accurate at a number of source-memory tasks o Younger adults are better than older at connecting the item to be remembered with the context in which it is learned o The decrements in performance happen gradually across the adult life span o If information is emotional, both younger and older adults show identical patterns of performance o DRYAD model proposes older adults are presumed to have less valid representations of events and objects than are younger adults o Neuroimaging research indicates older adults show over-activation of areas in the prefrontal cortex - a pattern reflecting compensatory behavior False memory: o Is when one remembers items or events that did not occur o Older adults tend to be more susceptible to these issues than younger adults o Older adults have more difficulty in correctly identifying information as false because they have trouble linking content information to its context o Older adults have more difficulty separating misleading context from relevant context - a large cross-sectional study of source memory with adults between 21 and 80 years revealed a linear decrease in performance, implying the decrements in performance happen gradually across the adult life span

STAC

Summary: - Based on idea that the age related changes in ones ability to function reflect a life long process of compensation for cognitive decline by recruiting additional brain areas - Explains how older adults build and rely on back up neural pathways

CRUNCH

Summary: - Describes how the aging brain adapts to neurological decline by recruiting additional neural circuits to perform tasks adequately - Explains how older adults show over activation of certain brain regions

HAROLD

Summary: - Explains the finding of the reduces ability f older adults in separating cognitive processing in different parts of the prefrontal cortex

Long-term memory

The ability to remember extensive amounts of information from a few seconds to a few hours to decades Two types of systems: o Explicit or Declarative memory: deliberate conscious remembering o Implicit or Procedural memory: change in performance by exposure to information at some earlier time but not deliberately trying to remember...non-conscious memory Age differences in episodic memory: o Recall - remembering information without hints or clues (taking an essay exam or describing a movie you saw) o Recognition - choosing from among several items (multiple choice exams or choosing from a list) + Older adults perform worse that younger on tests of episodic memory recall + Differences are smaller on recognition tests + Age differences in semantic memory o No deficits related to age in processes such as language comprehension, knowledge structure, and general knowledge activation o There is age-related decline in accessibility and speed of retrieval o Tip of the Tongue (TOT) experiences

Core Issues in Development

• 4 main issues occupy most of the discussion 1) Nature vs. Nurture 2) Stability vs. Change 3) Continuity vs. Discontinuity 4) Universal vs. Context-Specific