OT 251 Module 7

Define successful aging.

Gains are maximized and losses minimized, enabling realization of individual potential

How can music assist individuals who are dying?

Music thanatology, an emerging specialty in music therapy that focuses on providing palliative care to the dying through music Relaxation and psychological well-being and declined in emotional and physical symptoms, including anxiety, depression, insomnia, nausea, and shortness of breath Reduce pain

Describe the theory of selective optimization with compensation

Narrowing their goals, they select personally valued activities to optimize (or maximize) returns from their diminishing energy They also find new ways to compensate for losses

· What are common physical and mental disabilities in older age?

Physical disabilities Heart disease and cancer remain the leading causes of death, increasing dramatically from mid- to late life Higher for men than women Respiratory diseases, which rise sharply with age, are the third most common cause of death among older adults Emphysema, caused by extreme loss of elasticity in lung tissue, with most cases resulting from long-term cigarette smoking Stroke and Alzheimer's disease follow i. More prevalent among women, largely because women live longer ii. Stroke occurs when a blood clot blocks a blood vessel or a blood vessel hemorrhages in the brain, causing damage to brain tissue iii. Alzheimer's disease, the leading cause of dementia, also rises sharply with age Macular denegeration, which severely imapris vision and leads to blindness Osteoporosis Arthritis - bone disorder, adds to the physical limitations Type 2 diabetes and unintentional injuries These conditions are strongly related to age does not mean that they are entirely caused by aging Primary aging (another term for biological aging), or genetically influenced declines that affect all members of our species and take place even in the context of overall good health Secondary aging, declines due to hereditary defects and negative environmental influences, such as poor diet, lack of exercise, disease, substance abuse, environmental ollution, and psychological stress Frail older adults - people with extreme infirmity who display wasted muscle mass and strength, weight loss, severe mobility problems, and perhaps cognitive impairment i. Frailty involves weakened functioning of diversive organs and bod ysystems, which profoundly interferes with everyday competence and leaves older people highly vulnerablein the face of infection, extremely hot or cold weather, or injury ii. Although primary aging contributes to frailty, researchers agree that secondary aging plays a larger role, through genetic disorders, unhealthy lifestyle (including obesity and sedentary behavior), and chronic disease

What are common cognitive changes in older adulthood?

Problem solving Declines in late adulthood Older adults' memory limitations make it hard to keep all relevant facts in mind when dealing with a complex hypothetical problem Financial decision making - evaluating loan and investment options - tends to be less effective than it was in imdlfie Everyday problems older adults encounter differ from hypothetical problems devised by reesarchers - and also from everyday problems experienced at earlier ages After retirement, older adults do not have to deal with workplace problems Their children are typically grown and living on their own, and their marriages have endured long enough to have fewer difficulties Major concerns involve dealing with extended-family relationships (for example, expectations of adult children that they babysit grandchildren) and managing IADLs, such as preparing nutritious meals, paying bills, and attending to health concerns Older people are active and effective in solving problems of everyday life, as long as they perceive those problem as under their control and important They generate a smaller number of strategies compared to young and middle-aged adults, perhaps because they know which ones are most likely to be helpful due to their long life experience Older adults are particularly good at adapting strategies to fit problem conditions - home, relatives, and friends Because they are especially concerned with maintaining positive relationships, they usually do what they can to avoid interpersonal conflicts Older adults make faster decisions about whether they are ill, seek medical care sooner, and select treatments more quickly than young and middle-aged adults Interesting in view of their slower cognitive processing They have accumulated more health-related knowledge, which enables them to move ahead with greater certainty Older adults report that they often consult others - generally spouses and adult children, but also friends, neighbors, and members of their religious congregation - for advice about everyday problems Older couples more often collaborate in problem solving, and researchers judge their jointly generated strategies as highly effective - even on demanding tasks that require complex memory and reasoning Wisdom requires the pinnacle of insight into the human condition Cultures around the world assume that age and wisdom go together According to an evolutionary view, the genetic program of our species grants health, fitness, and strength to the young Culture tames this youthful advantage in physical power with the insights of the old, ensuring balance and interdependence between generations Results revealed that age is no guarantee of wisdom Type of life experience make a difference People in human-service careers who had extensive training and practice in grappling with human problems tend to attain high wisdom scores Other high-scorers held leadership positions When age and relevant life experiences were considered together, more older than younger people scored in the top 20 percent Haivng faced and overcome adversity appears to be an important contributor to late-life wisdom Low and moderate income older adults nominated by aging service providers as wise reported deriving valuable life lessons from coping with hardships, including patience, perseverance, forgiveness, and willingness to accept advice and support from others

What are common experiences of older adults?

Taste and smell Four basic tastes - sweet, salt, sour, and bitter Decline in number and distribution of taste buds on the tongue Older adults also have greater difficulty recognizing familiar foods by taste alone Cigarette smoking, dentures, medications, and environmental pollutants can affect taste perception When taste is harder to detect, food is less enjoyable, increasing the likelihood of dietary deficiencies Smell has a self-protective function An aging person who has difficulty detecting rancid food, gas fumes, or smoke may be in a life-threatening situation A decrease in the number of smell receptors, along with loss of neurons in brain regions involved in processing odors, contributes to declines in odor sensitivity Odor perception not only wanes but because distorted, a change that may promote complaints that food no longer smells and tastes right

What are common experiences of older adults?

Touch Touch discrimination is especially crucial for certain adults, such as the severely visually impaired reading Braille and people making fine judgments about texture Capacity to discriminate detailed surface properties and identify unfamiliar objects by touch declines Waning of touch perception on the hands, especially the fingertips - believed to be due to loss of touch receptors in certain regions of the skin and slowing of blood circulation to the extremities - contributes Responsiveness to the emotionally pleasant quality of soft, gentle stroking is an exception: Older adults rate it as more pleasurable than younger people

§ What is meant by ego transcendence?

· The individual is no longer so significant, but rather the total flow of life o Decreased self-centeredness · Individual is no longer obsessed by his/her body, but takes care of it nonetheless · Understanding of how different experiences throughout life have influenced and produced him/her as a person

· What are common physical and mental disabilities in older age?

Mental disabilities 1. Dementia refers to a sert of disorders ocuring almost entirely in old age in which many aspects of thought and behavior are so impaired that everyday activities are disrupted 2. About a dozen tyeps of dementia have been identified a. Some are reversible with proper treatment, but most are irreversible and incurable b. Parkinson's disease involve deterioration in subcortical brain regions (primitive structures below the cortex) that often extends to the cerebral cortex and, in many instances, results in brain abnormalities resembling Alzheimer's disease c. But in the majority of dementia cases, subcortical brain regions are intact, and progressive damage occurs only to the cerebral cortex. d. Two most common forms of cortical dementia are Alzheimer's disease and vascular dementia 3. Alzheimer's disease a. The most common form of dementia, in which structural and chemical brain deterioration is associated with gradual loss of many aspects of thought and behavior b. Symptoms and course of the disease i. Progressively worsening memory problems - forgetting names, dates, appointments, familiar routes of travel, or the need to turn off the kitchen stove ii. At first, recent memory is most impaired iii. But as serious disorientation sets in, recall of distant events and such basic facts as time, date, and place evaporations iv. Faulty judgments put the person in danger v. Personality changes occur - loss of spontaneity and sparkle, anxiety in response to uncertainties created by mental problems, aggressive outbursts, reduced initiative, and social withdrawal vi. Depression appears in the early phse of Alzheimer's and other forms of dementia and seems to be part of the disease process vii. Skilled and purposeful movements disintegration c. Brain deterioration i. Diagnosis is made through exclusion, after ruling out other causes of dementia by a physical examination and psychological testing ii. Doctors inspect the brain after death for a set of abnormalities that eith cause or result from the disease iii. MRI and PET images of brain volume and acitviity predict whether individuals will receive an after-death confirmation of Alzheimer's iv. Assessments of the chemical makeup of the blood or cerebrospinal fluid are also strongly predictive v. Inside neurons, neurofibrillary tangles appear - bundles of twisted threads that are the product of collapsed neural structures and that contain abnormal forms of a protein called tau vi. Outside neurons, amyloid plaques, dense deposits of a deteriorated protein called amyloid, surrounded by clumps of dead neurons and glial cells, develop a. Risk factors i. Two types: 1. Familial, which runs in families a. Generally has an early onset and progresses more rapidly than the later-appearing sporadic type 2. Sporadic, which has no obvious family history b. Protective factors i. Among promising drug therapies are compounds that interfere with amyloid and tau breakdown and that suppress brain inflammation resulting from these toxi proteins, which worsen neuronal damage ii. Insulin therapy, delivered via a nasal spray to the brain, helps regulate neuronal use of glucose 1. It has memory benefits and slows cognitive decline among older adults with mild cognitive imapriment - diminished mental abilities that are noticeable to the affected person, that do not affect capacity to carry out everyday activities iii. Mediterranean diet emphasizing fish, unsaturated fat, vegetables, and moderate consumption of red wine to slower disease progression and also a reduction in vascular dementia 1. Contain antioxidants and other substances that help promote the health of the cardiovascular and central nervous systems iv. Education and an active lifestyle 1. Complex cognitive acitvies of better-educated people lead to reorganization of brain areas devoted to cognitive processes and to richer synaptic connections, which act as a cognitive reserve, giving the aging brain greater tolerance for injury before it crosses the threshold into mental disability v. Persistence, intensity, and variety of physical activities are associated with decreased risk of Alzheimer's and vascular dementia 2. Helping Alzheimer's victims and their caregivers a. Drugs that increase levels of the neurotransmitters acetylcholine and serotonin show promise in limiting challenging dementia symptoms - especially agitation nand disruptiveness, which are particularly stressful for caregivers b. Dementia caregivers devote substantially more time to caregiving and experience more stress than do people caring for older adults with physical disabilities c. They need assistance an encouragement from extended-family members, friends, and community agencies d. Avoiding dramatic changes in living conditions, such as moving to a new location, rearranging furniture, or modifying daily routiens, help people with Alzheimer's disease feel as secure as possible in a cognitive world that is disintegrationg Vascular dementia · A series of strokes leaves areas of dead brain cells, producing step-by-step degeneration of mental ability, with each step occurring abruptly after a stroke · Heredityar indirectly affects cerebrovascular dementia through high blood pressure, cardiovascular disease, and diabetes, each of which increases the risk of stroke · Environmental factors, cigarette smoking, heavy alcohol use, high salt intake, very low dietary protein, obesity, inactivity, and psychological stress - also heighten stroke risk · More men than women have vascular dementia · In most cases vascular dmenetia is caused by atherosclerosis

How can foster dignity in death?

We can provide the majority of dying people, who succumb gradually, with the utmost in humane and compassionate care Treating them with respect by taking interest in those aspects of their lives that they most value and by addressing their greatest concerns Candid about death's certainty Doctors and nurses can help dying people learn enough about their condition to make reasoned choices about whether to fight or on or say no to further treatment

o What does the theory of gerotranscendence posit?

§ Human development is a life long process that continues into old age and that, when optimized, ends in a new perspective. § The theory of geotranscendence focuses on two phenomena: the old person and the ageing process itself. § The theory describes both the experience of growing old and the characteristics of a normal and positive old age

· What are common physical and mental disabilities in older age?

A condition if inflamed, painful, stiff, and sometimes swollen joints and muscles Osteoarthritis, the most common type, which involves deteriorating cartilage on the end of bones of frequently used joints Wear and tear arthritis Degenerative joint disease Although a genetic proneness exists, the disease usually does not appear until the forties or fifties In frequently used joints, cartilage on the ends of the bones, which reduces friction during movement, gradually deteriorates. Or obesity place abnormal pressure on the joints an damages cartilage Osteoarthritis is the most common cause of surgical hip and knee replacements in older adults Rheumatoid arthritis Involves the whole body An autoimmune response leads to inflammation of connective tissue, particularly the membrances that line the joints, resulting in overall aching, inflammation, and stiffness Tissue in the cartilage tends to grow, damaging surrounding ligaments, muscles, and bones The result is deformed joints and often serious loss of mobility Sometimes other organs, such as the heart and lungs, are affected Support a strong hereditary contribution i. Presence of certain genes heightens disease risk, possibly by triggering a late-life defect in the immune system ii. Identical twins differ widely in disease severity, indicating that environment makes a difference iii. So far, cigarette smoking is the only confirmed lifestyle influence iv. Early treatment with powerful anti-inflammatory medication helps slow progression of rheumatoid arthritis Managing arthritis requires a balane of rest when the disease flares, pain relief, and physical activity Regular aerobic exercise and strength training lessen pain and improve physical functioning With proper analgesic medication, joint protection, lifestyle changes, and surgery to replace badly damaged hip or knee joints, many people with either form of the illness lead long, productive lives

What do these vignettes tell you about older adulthood?

A mix of gains and losses characterizes these twilight years, extending the multi-directioality of development One one hand, old age is usually a time of pleasure and tranquility, when children are grown, life's work is nearly done, and responsibilities are lightened On the other hand, it brings concerns about declining physical functions, unwelcome loneliness, and the growing specter of imminent death

What is the meaning of the term, "functional age"?

Actual competence and performance People age biologically at different rates, making them look and feel younger or older than their agemates

What influences decisions to retire?

Affordability of retirement Many preretirees decide to let go of a steady work life n favor of alternative, personally meaningful work, leisure, or volunteer activities Bride employment seems to have a favorable impact on psychological well-being only when people engage in work related to their former career Personal and workplace factors in addition to income that influence the decision to retire People in good health, for whom vocational life is central to self-esteem, and whose work environments are pleasant and interesting are likely to keep on working What are common adjustment challenges to retirement? Workpalce factors - especially financial worries and having to give up one's job - predict stress following retirement Well-educated people with complex jobs usually adjust favorably Marital happiness fosters a favorable retirement transition

What impacts how we adapt to death?

Appropriate death is one that makes sense in terms of the individual's pattern of living and values and, at the same time, preserves or restores significant relaitonships and is as free of suffering as possible Maintaining a sense of identity, or inner continuity with one's past Clarifying the meaning of one's life and death Maintaining and enhancing close relationships Achieving a sense of control over the time that remains Confronting and preparing for death Nature of the disease Cancer patients show symptoms of severe depression Personality and coping style Dying as imprisonment Dying was a mandate to live ever more fully Dying as part of life's journey Dying as an experience to be transformed Family members' and health professionals' behavior Everyone close to and caring for the dying person acknowledges the terminal illness, is best. People who find it hard to engage in these tasks may pretend that the disease is not as bad as it is Withholding information is common in some cultures out of concern that telling might disrupt family relationships and harm patients' well-being Spirituality, religion, and culture Budhism emphasizes that all physical and mental states are transient, which fosters acceptance of death Native-American groups death is met with stoic self-control, an approach taught at an early age through stories that emphasize a circular, rather than linear, relationship between life and death and the importance of making way for others For African Americans, a dying loved one signals a criss that unites family members in caregiving. The terminally ill person remains an active and vital force within the family until they can no longer carry out this role - an attitude of respect that eases the dying process

· What are common and successful adaptations to aging?

Assistive technology Assistive technology, or array of devices that permit people with disabilities to improve their function, is available to help older people cope with physical declines Computers and smart devices Smartphones that respond to voice commands to make and answer calls help those with visual or motor difficulties For older people who take multiple medications, a tiny computer chip called a "smart cap" can be placed on medicine bottles that beeps periodically as a reminder to take the drug and tracks how many and at what time pills have been taken Smart watches and smart clothing can monitor diverse health indicators, improving prevention, early detection, and treatment These devices can also recognize emergency situations, including falls, and summon help automatically Robots are available that assist older adults with diverse tasks, such as retrieving objects, reading documents, and doing routine housework Architects have also designed homes that ca adapt to changing physical nees -equipping them with movable walls that expand and contract, plumbing that enables a full bathroom to be added on the main floor, and "smart-home" technologies that promote safety and mobility, such as sensors in floors that active room lights when an older persona gets up at night and alarm systems that detect falls

Define average life and healthy life expectancy. What is the difference between those terms?

Average life expectancy The number of years that an individual born in a particular year can expect to live, starting at any age Average healthy life expectancy The number of years a person born in a particular year can expect to live in full health, without disease or injury

· What is the relationship between health, fitness and disability?

Because older people compare themselves to same-age peers, the majority rate their health favorably. Aging adults' self-rated health does not decline as much as would be expected on the basis of objective health assessments Self-efficacy and optimism about one's health promote continued heatlh-enhancing behaviors SES continues to predict physical functioning African-American and Hispanic older people remain at greater risk for various health problems, including cardiovascular disease, diabetes, and certain cancers Native American aging adults are evne worse off Low-SES and ethnic minority older adults are more likely than their higher-SES and white counterparts to delay or forgo medical treatment i. One reason is cost ii. Another reason is perceived discriminatory treatment by health-care providers, which undermines ethnic minority patients' trust iii. Low-SES and minority older people often do not comply with doctors' directions because they feel les in control of their health and less optimistic that treatment will work

What are common experiences of older adults?

Cardiovascular and respiratory systems Heart becomes more rigid, and some of its cells die while others enlarge, leading the walls of the left ventricle (the largest heart chamber, from which blood is pumped to the body) to thicken Artery walls stiffen and accumulate some plaque (cholesterol and fats) due to normal aging (much more in those with atherosclerosis) Heart muscle becomes less responsive to signals from pace-maker cells within the heart, which initiate each contraction As a combined result of these changes the heart pumps with less force, maximum heart rate decreases, and blood flow throughout the circulatory system slows Sufficient oxygen may not be delivered to body tissues during high physical activity Because lung tissue gradually loses its elasticity, vital capacity (amount of air that can be forced in and out of the lungs) is reduced by half Lungs fill and empty less efficiently, causing the blood to absorb less oxygen and give off less carbon dioxide This explains why older people increase their breathing rate more and feel more out of breath while exercising - deficiencies that are more extreme in lifelong smokers and in people who are overweight or who have had many years of exposure to environmental pollutants

· What is the relationship between health, fitness and disability?

Compression of morbidity Ideally, as life expectancy extends, we want the average period of diminished vigor before death - especially, the number of months or years of ill-health and suffering - to decrease Impact of good health habits on postponement of disability is large i. In those who were low risk (no risk factors of smoking, obesity, or lack of exercise), disability was delayed by nearly 5 years compared with those who were moderate risk (had two or three risk factors), postponement of disability in the low-risk group exceeded 8 years

Stability and change in self-concept and personality

Continued stability of the "big five" personality traits from mid to late life Ingredients of ego integrity - wholeness, contentment, and image of the self as part of a larger world order - are reflected in several significant late-life changes in both self-concept and personality Secure and multifaceted self-concept Older adults have accumulated a lifetime of self-knowledge, leading to more secure, multifaceted conceptions of themselves than at earlier ages Positive, multifaceted self-definitions predicted psychological well-being As the future shortens, most older adults, into their eighties and nineties, continue to mention hoped-for selves in the areas of physical health, cognitive functioning, personal characteristics, relationships, social responsibility, and leisure Physical health is even more prominent than it was in midlife Possible selves reorganize well into old age Although future expectations become more modest and concrete with age, older adults usually take steps to attain their goals

changing social world p. 498-500 Define the following theories:

Continuity theory Most aging adults strive to maintain a personal system - an identity and a set of personality dispositions, interests, roles, and skills - that promote life satisfaction by ensuring consistency between their past and anticipated future Social emotional selectivity theory. Social interaction in alte life extends lifelong selection processes As people age, contacts with family and friends are sustained until the eighties, when they diminish gradually in favor of a few very close relationships In contrast, relationships with people to whom one feels less close decline steeply from middle through late adulthood For older adults, who have gathered a lifetime of information, the information-gathering function becomes less significant They realize it is risky to approach people they do not know for self-affirmation: Negative stereotypes of aging increase the odds of receiving a condescending, hostile, or indifferent response

What environmental and personal factors influence wellbeing in older age?

Control versus Dependency Dependency-support script Dependent behaviors are attended to immediately Reinforces dependent behavior at the expense of independent behavior, regardless of the older person's competencies Independence-ignore script Independent behaviors are mostly ignored Among older people who experience no difficulty with daily activities, opportunities to interact with others are related to high satisfaction with everyday life In Western societies, which highly value independence, many older adults fear relinquishing control and becoming dependent on others When family and caregiving environments support their efforts, most aging adults are resilient, sustaining a sense of optimism, self-efficacy, purpose, and investment in overcoming obstacles until very late in life Person-environment fit A good match between their abilities and the demands of their living environments, which promote adaptive behavior and psychological well-being

What is death education and how can it help students?

Death awareness movement that sparked increased sensitivity to the needs of dying patients has also led to the rise of college and university courses in death, dying, and bereavement Increase students' understanding of physical and psychological changes that accompany dying Enhancing students' awareness of options in end of life care, funeral services, and memorial rituals Promoting understanding of important social and ethical issues, including advance medical directives, medical aid-in-dying, euthanasia, and organ donation Improving students' ability to communicate effectively with others about death-related concerns Helping to prepare students for their professional roles in caring for the dying and supporting the bereaved Fostering studetns' appreciation of hwo lifespan development interacts with death, dying, and bereavement issues

What do these stories tell you about the author's perspective on death?

Death is essential for the survival of our species. We die so that our own children and the children of others may live.

· What are common physical and mental disabilities in older age?

Diabetes After a meal, the body breaks down the food, releasing glucose (the primary energy source for cell activity) into the bloodstream Insulin, produced by the pancreas, keeps the blood concentration of glucose within set limits by stimulating muscle and fat cells to absorb it When this balance system fails, either because not enough insulin is produced or because body cells become insensitive to it, type 2 diabetes (otherwise known as diabetes mellitus) results Over time, abnormally high blood glucose damages the blood vessels, increasing the risk of heart attack, stroke, circulatory problems in the legs (whcich impair balance and gait), and injury to the eys, kidneys, and nerves Impaired glucose tolerance also accelerates degeneration of neurons and synapses Diabetes was associated with more rapid cognitive decliens in older people and an elevatefd risk of dementia, especially Alzheimer's disease - an association we will soon revisit when we take up Alzheimer's Diabetes run in families, suggesting that heredity is involved But inactivity and abdominal fat deposits greatly increase the risk Higher rates of type 2 diabetes are found among African-American, Mexican-American, and Native-American gaining adults for both genetic and environmental reasons, including high-fat diets and obesity associated with poverty Treating type 2 diabetes requires a carefully controlled diet and regular exercise, which promote weight loss and glucose reabsorption

· What are common and successful adaptations to aging?

Effective coping strategies High sense of personal control usually deal with physical changes through problem-centered coping strategies i. Older adults who consider age-related declines inevitable and uncontrollable tend to be passive when faced with them, to report more physical and mental health difficulties, and to experience steeper later-life declines in health When physical disabilities become severe, sense of control has diminishing returns, no longer having as much impact on health status i. Aging adults with substantial physical impairments cope more effectively when they acknowledge reduced control and accept the need for caregiver or equipment assistance

How did Erikson describe this final conflict?

Ego integrity vs. despair Involves coming to terms with one's life Adults who arrive at a sense of integrity feel whole, complete, and satisfied with their achievements They have adapted to the inevitable mix of triumphs and disappointments and realize that the paths they followed, abandoned, and never selected were necessary for fashioning a meaningful life course The capacity to view one's life in the large context of all humanity - as the chance combination of one person and one segment in history - contributes to the serenity and contentment that accompany integrity Midlife generativity predicted ego integrity in late adulthood Ego integrity, in turn, was associated with greater self-acceptance, higher marital satisfaction, closer relationships with adult children, greater community involvement, and increased ease in accepting help from others when it is needed With the realization that the integrity of one's own life is part of an extended chain of human existence, Erikson suggested, death loses its sting Those who emphasize attainment of extrinsic goals (such as money or prestige) more often fear life's end Despair occurs when aging adults feel they have mae many wrong decisions, yet time is too short to find an alternate route to integrity These attitudes are often expressed as anger and contempt for others, which disguise contempt for oneself

What are common cognitive changes in older adulthood?

Episodic memory - retrieval of everyday experiences difficulty retrieving rise subdstantially Sementic memory - generally knowledge removed from the context in which it was first learned - is better preserved Explicit vvs. Explicit memory Slower cognitive processing meant that they retained fewer details Because their working memories could hold less at once, they attended poorly to context - where they saw themovie and who went with them Older people sometimes cannot distinguish an imagined event rom one they actually experienced Find it harder to recal l the source of information Temporal memory - recall of the order in which events occurred or how recently it happened suffers as well Recognition suffers less than recall in late adulthood because a multitude of environmental supports for remembering are present Age-related declines in meory are greatest on explicity memory tasks, which require controlled, strategic processing Implicit memory, or memory without conscious awareness Agfe differences in implicity memory are much smaller than in explicit memory Memory that depends on familiarity rather than on conscious use of strategies is better preserved in old age Sementic memory - recall of vocabulary and general information declines far less than recall of everyday experiences Associative memory Associative memory deficit, or difficulty creating and retrieving links between pieces of information Remote memory Very long-term episodic recall is clearer than their memory of recent events, research does not support this conclusion Autobiographical memory, or recall of personally meaningful events Older adults recall both remote and recent events more often than intermediate events Reminiscence bump A period of heightened autobiographical memory between ages 10 and 30 Prospective memory Remembering to engage in planned actions in the future Older adults do better on event-based than on time-bvased prospective memory tasks

· What are common physical and mental disabilities in older age?

Falls Declines in vision, hearing, mobility, muscle strength, and cognitive functioning; depressed mood; use of medications that affect mental processing; and development of certain chronic illnesses (such as arthritis) increase the risk of falling Most commonly hip fracture serious injury i. One in five older hip fracture patients dies within a year of the injury ii. Half enver regain the ability to walk without assistance iii. Falling can also impair health indirectly, by promoting fear of falling iv. A fall can limit mobility and social contact v. Although an active lifestyle may expose older people to more situations that can cause a fall, the health benefits of activity far outweigh the risk of serious injury due to falling

What are common experiences of older adults?

Hearing Reduced blood supply and natural cell death in the inner ear and auditory cortex, along with stiffening of membranes (such as the eardrum), cause hearing to decline in late adulthood Decrements are greatest at high frequencies, although detection of soft sounds diminishes throughout the frequency range Responsiveness to startling noises lessens, and discriminating complex tone patterns become harder As hearing declines, older people report lower self-efficacy, more loneliness and depressive symptoms, and a smaller social network than their normally hearing peers Of all hearing difficulties, the age-related decline in speech perception has the greatest impact on life satisfaction After age 70, ability to detect the content and emotionally expressive features of conversation declines, especially in noisy settings Because aging adults with hearing loss frequently misunderstand verbal communication others may conclude they are mentally impaired. Those with hearing loss, as well as those who are visually impaired, obtain lower scores on tests of executive function and memory The effort they must devote to perceiving information likely detracts from other cognitive processes needed to perform the tasks Assuming that older adults who hear or see poorly are mentally deficient is a mistaken, negative stereotype of aging Our perception is intermodal By attending to facial expression, gestures, and lip movements, older adults can use vision to help interpret the spoken word

What factors are related to cognitive change in late adulthood?

Heritability Modest genetic contribution to individual differences in cognitive change in late adulthood A mentally active life is vital for preserving cognitive resources Above-average education; frequent contact with family members and friends; stimulating work, leisure pursuits, and community participation; and a flexible personality predict higher mental test scores and reduced cognitive decline into advanced old age Health status powerfully predicts older adults' cognitive functioning Diverse chronic ocnditions, including cardiovascular disease, diabetes, osteoporosis, and arthritis, are strongly associated with cognitive declines As people grow older, their cognitive scores show larger fluctuations from one occasion to thenext Rising instability of performance - especially in speed of response - accelerates in the seventies and is associated with worsening cognitivion, along with neurobiological signs of shrinkage in the prefrontal cortex and deficient brain functioning It seems to signal end-of-life brain degeneration Terminal decline Acceleration in deterioration of cognitive functioning prior to death An accelerating falloff in cognitive performane or in emotional investment in life is a sign of loss of vitality and impending death

How are individuals impacted by the place where they die?

Home The home can offer an atmosphere of intimacy and loving care in which the terminally ill person is unlikely to feel abandoned or humiliated by physical decline Hospital Suddne deaths typically occur in emergency rooms Dying in intensive care is especially depersonalizing for patients linger between life and death while hooked to machines, sometimes for weeks or months Cancer patients typically die in general or specialized cancer-care hospital units Nursing home Care emphasizes rehabilitation rather than high-quality terminal care Hospice approach combined with nursing home care improves greatly in pain management, prevention of hospitalizations, emotional and spiritual support, and family satisfaction Hospice approach Not a place but a comprehensive program of support services for terminally ill people and their families It aims to provide a caring community sensitive to thedying person's needs so patients and family members can prepare for death in ways that are satisfying to them Palliative, or comfort, care that relieves pain and other symptoms (nausea, breathing difficulties, insomnia, and depression) rather than prolong life

What are common experiences of older adults?

Immune system As the immune system ages, T cells, which attack antigens (foreign substances) directly, become less numerous and effective The immune system is more likely to malfunction by turning against normal body tissues in an autoimmune response A less competent immune system reduces the effectiveness of available vaccines and increases the risk of a variety of illnesses - in addition to infectious diseases (such as the flu), cardiovascular disease, certain forms of cancer, and various autoimmune disorders, such as rheumatoid arthritis and diabetes The strength of the aging person's immune system seems to be a sign of overall physical vigor Certain immune indicators, such as high T cell activity, predict better physical functioning and survival over the next two years in very old people With age, the autonomic nervous system releases higher levels of stress hormones into the bloodstream As the immune responses decline with age, stress-induced susceptibility to infection rises dramatically A healthy diet and exercise help protect the immune response in old age, whereas obesity aggravates the age-related decline

How does engagement in leisure and volunteer activities impact quality of life in retirement?

Involvement in leisure activities and, especially, volunteer service is related to better physical and mental health and reduced mortality Time spent volunteering rose steadily over adulthood, not declining until the eighties Older adults report greater awareness of and interest in public affairs and typically vote at a higher rate than any other age group

What are common cognitive changes in older adulthood?

Language processing Language and memory skills are closely related Language comprehension - understanding the meaning of spoken or written prose We recollect what we have heard or read without conscious awareness Language comprehension changes little in late life, as long as conversational partners do not speak too quickly and older adults are given enough htime to process written text accurately Oler readers adjust to ensure comprehension, such as devoting more processing time to new concepts than younger readers do, pausing more often to integrate information, and making good use of story organization to help them recall both main ideas and details Those who invest more time in reading and other literacy activities over their lifetimes display faster and more accurate reading comprehension Two aspects of language production show age-related losses First is retrieving words from long-term memory Tip of the tongue state - certainty that they knew a word accompanied by an inability to produce it Planning what to say and how to say it in everyday conversation is harder Older adults develop compensatory techniques for their language production problems Speak more slowly so they can devote more effort to retrieving words and organizing their thoughts Sacrificing efficiency for greater clarity, they use more sentences, but shorter ones, to convey their message Most aspects of language production, including its content, grammatical correctness, and pragmatics (social appropriateness), are unaffected by aginging Aging adults are advantaged in narrative competence In telling a story, they draw on their extensivce life experience, constructing elaborate, hierarchically organized episodes with rich information about a main character's goals, actions, and motivations and with summarizing references to the story's contemporary significance As a result, listeners tend to prefer older adults' stories to those of young people

What do these vignettes tell you about physical and cognitive changes in late adulthood?

Late adulthood stretches from age 65 to the end of the lifespan Popular images fail to capture the quality of these final decades. Instead, many myths prevail - that older people have entered a period of deterioration and dependency and that they are no longer able to learn The typical 65-year-old can anticipate nearly two healthy, rewarding decades before this shift affects everyday life. Many find ways to surmount physical and cognitive challenges Late adulthood is best viewed as an extension of earlier periods, not a break of them As long as social and cultural contexts give older adults support, respect, and purpose in life, these years are a time of continued potential

· What are common and successful adaptations to aging?

Overcoming stereotypes of aging Many older adults report experiences of prejudice and discrimination i. Being ignored, talked down to, or assumed to be unable to hear or understand, and exposure to disparaging jokes about older people Aging stereotypes often operate automatically, without awareness i. People "see" older adults in stereotypical ways, even when they appear otherwise ii. Stereotype threat, which results in diminished performance on tasks related to the stereotype iii. Positive stereotypes, in contrast, reduce stress and foster physical and mental competence iv. Adults with less education are especially susceptible to the detrimental effects of aging stereotypes, perhaps because they tend to accept those messages uncritically

What are some helpful interventions for caregivers of elders with dementia

Long term health care · Advaning age is strongly associated with use of long-term heatlh-care servies, especially nursing homes · Dementia most often leads to nursing home placement; frailty is another strong predictor · Unless nursing home placement follows hospitalization for an acute illness, US Medicare does not cover it o Instead, oler adults must pay for it until their resources are exhausted. o At thata point, Medicaid (health insurance for the poor) takes over o Consequently, the largest users of nursing homes in the US are people with either very low or high incomes o Middle-incoem aging adults and their families are more likely to try to protect their savings from being drained by high nursing home costs · Varies across ethnic groups o European Americans arem ore likely to beinstitutionalized than African Americans and Hispanics and Asian and Native-American older adults · Experts advocate alternatives o Publicly fudned in-home help for family caregivers o Assisted living - homelike housing arrangements for older adults who require more help than can be provided at home but less than is usually provided in nursing homes § Cost-effective alternative to nursing homes that prevent unnecessary institutionalization § Enhance resident's autonomy, social life, community involvement, and life satisfaction

· What is the relationship between health, fitness and disability?

Men are more prone to fatal illnesses, women to non-loife-threatening disabling conditions By very old age, women are more impaired than men because only the sturdiest men have survived Older men are better able to remain independent and to engage in exercise, leisure, and volunteer pursuits, and social activities, all of which promote better health

What types of cognitive interventions for adults exist and how effective are they?

Metacognition Relatively well-preserved Most are aware of memory declines and know they must take extra steps to ensure recall of important information Adult Development and Enrichment Project (ADEPT) Intervention of training: gains for decliens were dramatic: 40% returned to the level at which they had been functioning 14 years earlier Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) Focus on one of three abilities - speed of processing, memory strategies, or reasoning or to a no-intervention control group Trained older adults howed an immediate advantage in the trained skill over controls Traiing was associated with reduced declines in ability to perform IADLs Speed gains also predicted other aspects of everyday functioning, including more favorable self-rated health, reduced depressive symptoms, fewer at-fault motor vehicle collisions, and longer time to giving up driving

· What are common physical and mental disabilities in older age?

Misdiagnosed and reversible dementia Depression is the disorder most often misdiagnosed as dementia Depression rises with age, is often related to physical illness and pain, and can lead ot cognitive deterioration The older we get, the more likely we are to be taking drugs that may have side effects resembling dementia Some disease can cause temporary memory loss and mental symptoms Environmental changes and social isolation can trigger mental declines When supportive ties are restored, cognitive functioning usually bounces back

· How does sexual activity change as individuals age?

Most married older adults reported continued, regular sexual enjoyment A new generation of older people, accustomed to viewing sexuality positively, will be more sexually active Good sex I nthe past predicts good sex in the future, and continued sexual activity is linked to relationship satisfaction Using intercourse as the only measure of sexual activity promotes a narrow view of pleasurable sex. Even at the most advanced ages, there is more to sexuality than the sex act itself -feeling sensual, enjoying close companionship, and bveing loved and wanted Both older men and older women report that the male partner is usually the one who ceases to interact sexually In cultures that emphasize an erection as necessary for being sexual, a man may withdraw from all erotic activity when he finds that erections are harder to achieve and more time must elapse between them Disabilities that disrupt blood flow to the penis - most often, disorders of the autonomic nervous system, cardiovascular disease, and diabetes - are largely responsible for dampening sexuality in older men Drug treatments can be helpful Cigarette smoking, excessive alcohol intake, mental health problems such as persistent anxiety an depression, and a variety of prescription medications also lead to diminished sexual performance

· What is the relationship between health, fitness and disability?

Nutrition and exercise Increased need for certain nutrients - calcium and vitamin D to protect the bovnes; zinc and vitamin B6, C, and E to protect the immune system; and vitamins A, C, and E to protect against excess free radicals Yet declines in physical activity, in the sense of taste and smell, and in ease of chewing (because of deteriorating teeth) can reduce the quantity and quality of food eaten The aging digestive system has greater difficulty absorbing certain nutrients, such as protein, calcium, and vitamin D Older adults who live alone may have problems shopping or cooking and my feel less like eating by themselves Together, these physical and environmental conditions increase the risk of dietary deficiencies Endurance training (walking, cycling, aerobic dance) shows gains in vital capacity that compare favorably with those of much younger individuals Weight-bearing exercise begun in late adulthood promotes muscle size and strength This translates into improved walking speed balance, posture, and ability to carry out everyday activities Exercise also increases blood circulation to the brain, which helps preserve brain structure and behavioral capacities Brain scans show that physically fit older people experience less tissue loss in the cerebral cortex Previous sedentary older adults who intiated a program of regular, moderate to vigorous exercise displayed gains in size of diverse cortical areas, including the prefrontal cortex and hippocampus, wih benefits for executive function and memory These findings offer clear biological evidence for the role of late-life physical activity in preserving central nervous system health

What are various living environments for older individuals and how do they each impact older adults' quality of life?

Ordinary homes Staying in their own homes not physically impaired, affords the greatest possible personal control When health and mobility problems appear, independent living poses risks to an effective person-environment fit - most homes are not modified to suit the physical capacities of their older residents Increasing numbers of ethnic minority older people want to live on their own, although poverty often prevents them from doing so As the site of memorable life events, the home strengthens continuity with the past, preserving a sense of identity in the face of physical declines and social losses Permits older adults toa dap to their surroundings in familiar, comfortable ways Older people also value their independence, privacy, and network of nearby friends and neighbors Residential communities Differ only from ordinary homes in that they have been modified to suit older adults' capacities Independent living communities - an increasingly popular option - provide a variety of hotel-like support services, including meals in a common dinning room, housekeeping, laundry services, transportation assistance, and recreational activities Life-care communities - independent living, residents providing personal and health-related services to accommodate older adults with physical and menatal disabilities, and full nursing home care. For a large intial payment and additional monthly fees, life care guarantees that individuals' changing needs will be met within the same facility as they age Nursing homes Most extreme restriction of autonomy and social integration Although potential companions are abundant, interaction is low Nursing home residents have little opportunity to choose their social partners, and timing of contact is generally determined by staff Social withdrawal is an adaptive respone to these often over-croweded, hospital-like settings, which typically provide few ways for residents to use their comeptencies Green House US nursing home concept Large, outdated nursing home in Mississippi was replaced by 10 small, self-contained houses Stable staff of nursing assistants fosters agingin adults' control and independence Residents determine their own daily schedules and are invitef to join inboth recreational and household activities A professional support team visits regularly to serve residents' health needs Reported substantially better quality of life, and they also showed less decline over itme in ability to carry out activities of daily living

How have other theorists extended his ideas of this period?

Peck's tasks of ego integrity Ego integrity involves three distinct tasks Ego differentiation: For those who invested heavily in their careers, finding other ways to affirm self-worth - through family, friendship, and community life Body transcendence: Surmounting physical limitations by emphasizing the compensating rewards of cognitive, emotional, and social powers Ego transcendence: As contemporaries die, facing the reality of death constructively through efforts to make life more secure, meaningful, and gratifying for younger generations Ego integrity requires older adults to move beyond their life's work, their bodies, and their separate identities As people grow older, both body transcendence (focusing on psychological strengths) and ego transcendence (orienting otward a better life for those who will follow) increase Geotranscendence - a cosmic and transcendent perspective directed beyond the self to affinity with past and future generations and oneness with the universe Heightened inner calm and contentment and additional time spent in quiet reflection Beyond getting older, major negative life events, such as declines in health or financial difficulties, are associated with reports of cosmic, geotranscendent reflections. Inner contemplation is one means older adults use to adapt to stressful, unchangeable circumstances Many of the very old ocntinue to be invested in the real world - strengthening bonds with intimate partners and friends, keeping up with current events, and engaging in career, leisure, and volunteer pursuits

How can we support successful aging?

People age well when their growth, vitality, and strivings limit and, at times, overcome physical, cognitive, and social declines Perspectives on successful aging have turned away from specific achievements toward processes people use to reach personally valued goals Optimal aging rather than successful aging Aging well involves not only achievement of desirable outcomes but also effective coping with life's challenges and losses Factors that people can control to some degree (such as health habits, coping strategies, marital stability, and years of education) far outweighed uncontrollable factors (parental SES, family warmth in childhood, early physical health, and longevity of family members) in predicting a satisfying, active old age

What are common experiences of older adults?

Physical Appearance and mobility Creasing and sagging of the skin Oil glands that lubricate the skin become less active, leading to dryness and roughness Age spots increase The arms, backs of the hands, and face may be dotted with these pigmented marks Blood vessels can be seen beneath the more transparent skin, which has largely lost its layer of fatty support Further limits ability to adapt to hot and cold temperatures Face is especially likely to show these effects, as it is frequently exposed to the sun, which accelerates aging Other factors to face wrinkling and age spots Long term alcohol use Cigarette smoking Psychological stress Additional facial changes The nose and ears broaden as new cells are deposited on the outer layer of the skeleton Especially in older adults with a history of poor dental care, teeth may be yellowed, cracked, and chipped, and gums may have receded As hair follicles under the skin's surface die, hair on the head thins in both sexes, and the scalp may be visible Body build changes as well Height continues to decline, especially in women, as loss of bone mineral content leads to further collapse of the spinal column Weight generally drops after age 60 because of additional loss of lean body mass (bone density and muscle), which is heavier than the fat deposits accumulating on the torso Mobility factors Muscle strength, which generally declines at a faster rate in late adulthood than in middle age Bone strength deteriorates because of reduced bone mass Strength and flexibility of the joints and the ligaments and tendons (which connect muscle to bone) diminish Endurance athletes who continue training retain their uscular physiques and much of threir strength into their sixties and seventies Among non-athletes as well, a history of regular leisure time physical activity translates into greater mobility in later life At the same time, a carefully planned exercise program for older adults can enhance joint flexibility and range of movement

What are common experiences of older adults?

Physical changes Nervous system Loss becomes greater starting in the fifties and amounts to as much as 5 to 10 percent by age 80, due to withering of the myelin coating on neural fibers, loss of synaptic connections, death of neurons, and enlargement of ventricles (spaces) within the brain Neuron loss occurs throughout the cerebral cortex but at different rates among different regions. The frontal lobes, especially the prefrontal cotex( responsible for executive function and strategic thinking), and the corpus callosum (which connects the two cortical hemispheres), tended to show the greatest shrinkage The cerebellum (which controls balance and coordination and supports cognitive processes) and the hippocampus (involved in memory and spatial understanding) also lose neurons EEG measures reveal gradual slowing and reduced intensity of brain waves - signs of diminished efficiency of the central nervous system Brain imaging research reveals wide individual differences in the extent of these losses, which are moderately associated with declines in cognitive functioning. And the brain can overcome some decline. Aging neurons established new synapses after other neurons had degenerated The aging cerebral cortex can, to a limited degree, generate new neurons Older people who do well on memory and other cognitive tasks show more widely distributed activity across areas of the cerebral cortex This suggests that one-way older adults compensate for neuron loss is to call on additional brain areas to support cognitive processing The autonomic nervous system, involved in many life-support functions, also performed less well. Placing older adults at risk during heat waves and cold spells. Because of decreased sweating, tolerance for hot weather declines. During cold exposure, body core temperature rises less readily The autonomic nervous system also releases higher levels of stress hormones into the blood stream than it did earlier, perhaps to arouse body tissues that have become less responsive to these hormones

How have other theorists extended his ideas of this period?

Reminiscence Telling stories about people and events from their past and reporting associated thoughts and feelings Life review - calling up past experiences with the goal of achieving greater self-understanding Most older adults engage in life review as part of attaining ego integrity Contemporary older people in industrialized nations are largely present and future-oriented: They seek avenues for personal growth and fulfillment Reminiscence that is self-focused, engaged in to reduce boredom and revive bitter events, is linked to adjustment problems Older adults less often engage in this ruminative form of reminiscence Extroverted people favor other-focused reminiscence directed at social goals, such as solidifying family and friendship ties and reliving relationships with lsot loved ones Older adults - especially those who score high in openness to experience - engage in knowledge-based reminiscence, drawing on their past for effective problem-solving strategies and for teaching younger people Reminiscence often occurs during tiems of life transition

What are common experiences of older adults?

Sensory systems Vision Cornea (clear covering of the eye) becomes more translucent and scatters light, which blurs images and increases sensitivity to glare The lens continues to yellow, leading to further impairment in color discrimination Cataracts Cloudy areas in the lens, resulting in foggy vision and (without surgery) eventual blindness - increases tenfold from middle to late adulthood Heredity, sun exposure, cigarette smoking, alcohol consumption and certain diseases (such as hypertension and diabetes) increase the risk of cataracts Removal of the lens and replacement with an artificial lens implant is highly successful in restoring vision Impaired eyesight in alte adulthood largely results from a reduction in light reaching the retina and from ell loss in the retina nad optic nerve Dark adaptation - moving from a brightly lit to a dim environemtn, such as a movie theatre - becomes harder A decline in binocular vision (the brain's ability to combine images received from both eyes) makes depth perception less relianbe Visual acuity (fineness of discrimination) worsens Macular degeneration When light-sensitive cells in the macula, or central region of the retina, breaks down, in which central vision blurs and gradually is lost Macular degeneration is the leading cause of blindness among older adults If diagnosed early, macular degeneration can sometimes be treated with laser therapy. Heredity increases risk, especially when combined with cigarette smoking or obesity Atherosclerosis also contributes by constricting blood flow to the retina Protective factors include regular, brisk physical activity and a diet emphasizing fish high in omega-3 fatty acids, which promote cardiovascular health, and fruits and vegetables high in vitamins A,C, E, and carotenoids (yellow and red plant pigments), which help shield cells in the macular from toxic levels of free radicals

What are common experiences of older adults?

Sleep Older adults require about as much total sleep as younger adults: around seven hours per night Yet as people age, they have more difficulty falling asleep, staying asleep, and sleeping deeply The timing of sleep tends to change as well, toward earlier bedtime and earlier morning wakening Changes in brain structures controlling sleep and higher levels of stress hormones in the bloodstream, which have an alerting effect on the central nervous system, are believed to be responsible Ways to foster restful sleep Establishing a consistent bedtime and waking time Exercising regularly Using the bedroom only for sleep (not for eating, reading, or watching TV) Older adults receive more prescription sedatives for sleep complaints than do people under age 60 Used briefly, these drugs can help relieve temporary insomnia But long-term medication can make matters worse by inducing rebound insomnia after the drug is discontinued

How have other theorists extended his ideas of this period?

The positivity effect Cognitive-affective complexity (awareness and coordination of positive and negative feelings into an organized self-description) increases from adolescence through middle adulthood and then decliens as basic information-processing skills diminish in alte adulthood Positivity effect: Compared with younger people, they selectively attend to and better recall emotionally positive over negative information Aging adults' wealth of life experiences has enabled them to become expert in emotional self-regulation Awareness of less time left to live also motivates older adults to accentuate positive affect - focus on gratifying, meaningful experiences I nthe present Cognitive declines or chronic stressors can overwhelm their capcacity to manage negative experiences When intense, persistent stress arises, it is more taxing for older adults: Age-related changes in cardiovascular and endocrine system functioning lead blood pressure and cortisol levels to remain elevated for longer periods, with negative consequences for both physical and mental health that heighten stress further

What are common attitudes towards death and how do they often change as we age?

Today more young people reach adulthood without having experienced the death of someone they know well Death anxiety - fear and apprehension of death - is widespread People with a well-developed, positive personal philosophy of death are also less fearful Participatory perspective, in which death and dying are viewed as natural and life-promoting, as fulfillment of life goals, and as a time to share one's experience with others Overcoming perspective, in which death is seen as imposed on people, as defeat or failure, and as robbing them of opportunities to achieve their goals As long as it is not overly intense, death anxiety can motivate people to strive to live up to internalized cultural values

· What are common physical and mental disabilities in older age?

Unintentional injuries Motor bvehicle accidents Older adults have higher rates of traffic violations, accidents, and fatalities per mile drive nthan any other age group, with theexception of drivers under age 25 The greater older adults 'isual processing difficulties, the higher their rate of moving violatiosn and crashes Older people are less likely to drive quickly and recklessly but more likely to fail to heed signs, yield the right of way, and turn appropriately They often try to compensate for their difficulties by being more cautious Slowed reaction time and indecisiveness pose hazards, too Tasks requiring spatial working memory, inhibition of irrelevant information and impulses, and flexible shifting of attention between activities become increasingly challenging Older people usually tyr to dirve as long as possible i. Giving up driving results in loss of personal control over daily life and decline in productive roles, suchas paid work and volunteering

What sorts of individuals tend to be high in "death anxiety"?

Women appear more anxious about death than men do People who are depressed or generally anxious tend to have more severe death concerns Largely limited to adolescence and adulthood. Children rarely display it unless they live in high-crime neighborhoods or war-torn areas where they are in constant danger

o How is it different from other theories of aging like activity and disengagement theory?

§ It defines a reality somewhat different from the middle-age reality and lifestyle. Other theories of ageing are often based on the assumption that 'successful ageing' implies retaining the activities and ideals of middle age § The activity theory claims that an older person should continue a middle-aged lifestyle, denying the existence of old age as long as possible. § Disengagement implies only a turning in ward. Geotranscendence implies a development which includes a new definition of reality. Disengagement connects with social withdrawa; geotranscendence correlates positively with social activity, but also a greater need for 'philosophizing' is experienced.

§ What is meant by the cosmic dimension?

· A vision in which the individual no longer considers him/herself particularly significant, but has a gorwing feeling of being part of a larger context, part of 'the universe'. · The fear of death is lessened, while there is an increasing feeling of affinity with former, present and coming generations · Time is no longer as important as it once was - past, present, and future are erased, causing then and now to flow together · The mystery dimensions in life are accepted, and there is no longer a need ot explain and understand everything. Even the sources of enjoyment in life change, to such an extent that ordinary everyday events become more important than grand ones

§ What is meant by the dimension of social and personal relationships?

· Individual becomes less self-occupied and at the same time more selective in his/her choice of social and other activities

o What could be some practical signs that an individual is gerotranscendent?

· Superficial contacts lose their importance and deep and close relations become more important instead · Prefers to spend more time on reflection and meditation and less on material things and superficial social relations. The spiritual world becomes more important than the material world. They have a greater need for reflection. · Social rules and norms are no longer so important and in which older people allow themselves to be foolish and playful, which may result in a sense of freedom and chances to grow