Kail 7e ch14
- 1. Chapter Fourteen The Personal Context of Later Life: Physical, Cognitive, and Mental Health Issues
- 2. 14.1 What Are Older Adults Like? Learning Objectives • What are the characteristics of older adults in the population? • How long will most people live? What factors influence this? • What is the distinction between the third and fourth age?
- 3. The Demographics of Aging • Demographers study population trends – Use population pyramids to illustrate these trends • The number of older adults in developed nations will increase even more by 2050 – The number of older Asian-, Native-, and especially Latino-Americans will continue to increase • The number of U.S. people over 85 will increase by 500% between 2000 and 2050
- 5. The Diversity of Older Adults • Older women in the U.S. outnumber older men – True of all ethnic groups • As of today, 50% of people over 65 have high school diplomas – 10% currently have college degrees – 75% will have college degrees by 2030 • Better educated people live longer due to higher incomes, giving them better healthcare access
- 6. Longevity • Number of years a person can expect to live – Maximum life expectancy: oldest age to which any person lives (circa 120 years) – Useful life expectancy: number of years a person is expected to live free from debilitating chronic disease – Average life expectancy: age at which half of the people born in a particular year will die in the U.S. • 80.4 years (women); 75.4 years (men)
- 7. Genetic and Environmental Factors in Life Expectancy • Heredity is a major factor in longevity – Particularly true for those over 100 • Environment plays a role through the effects of disease, toxins, and risky behaviors • Social class plays a role due to lack of access to health care • The U.S. healthcare system is broken, especially for older adults (cf. Healthy People 2020)
- 8. Ethnic and Gender Differences in Life Expectancy • Average life expectancy: Latin Americans > European Americans > African Americans • U.S. women live longer than men by 5 years at birth, but only 1 year by age 85 – Men are more susceptible to fatal infectious diseases – Complex interactions of lifestyle, genetics, and immune functioning differences • By age 90, however, men outperform women on cognitive tests
- 9. The Third-Fourth Age Distinction • Third age: ages of 60-80 (the young-old) – Knowledge and technological advances contribute to their better life quality • Fourth age: over 80 (the oldest-old) – Few interventions have been developed to reverse this group’s physiological, cognitive, and disease-related declines
- 10. The “Good News”: The Third Age (Young-Old) • Increased life expectancy • Improved physical and mental fitness • High emotional and personal well-being • Good strategies to master life’s losses or gains
- 11. The “Bad News”: The Fourth Age (Oldest-Old) • Sizeable losses in cognition and learning potential • Increases in chronic stress’s negative effects • High prevalence of: – Dementia (50% in those over 90) – Frailty and multiple chronic conditions
- 12. 14.2 Physical Changes and Health: Learning Objectives • What are the major biological theories of aging? • What physiological changes normally occur in later life? • What are the principal health issues for older adults?
- 13. Biological Theories of Aging • Rate-of-living theories – Relates a creature’s metabolism and age • Cellular theories – Aging chromosomes’ telomeres • Cross-linking – Muscles and arteries less flexible due to certain proteins • Programmed theories – Genetically programmed cell death
- 14. Physiological Changes • Neuronal changes are common in older age • Alzheimer’s and related diseases involve large changes in: – Declining neurotransmitters levels – Neuritic plaques: damaged or defective neurons form around a core of protein – Neurofibrillary tangles: spiral-shaped masses form in the axon’s fibers
- 15. Cardiovascular and Respiratory Systems • Normative age-related changes • 50% of adults over 65 have hypertension – Declining heart muscle tissue; fat deposits; artery stiffening due to calcification • Transient ischemic attacks (TIAs) • Cerebral vascular accidents • Vascular dementia • Chronic obstructive pulmonary disease (COPD)
- 16. Sensory Changes: Vision • Night vision problems • Decreased adaptation • Poorer green-blue-violent color discrimination • Difficulties focusing and adjusting • Loss of acuity between 20 to 60 years, especially with low light • Vision loss due to cataracts or glaucoma
- 17. Sensory Changes: Hearing • Presbycusis: losing the ability to hear low- pitched sounds – Neural: loss of auditory pathway neurons – Metabolic: diminished nutrient supply to receptor cells – Mechanical: atrophy and stiffening of the receptor area’s vibrating structures – Sensory: atrophy and degeneration of receptor cells
- 18. Sensory Changes: Other Senses • Taste, touch, temperature, and pain sensitivity are not significantly age-related • Detecting and distinguishing smells declines substantially in many after the age of 70 – Very true of Alzheimer’s disease – Very dangerous (e.g., gas leaks) • Older people fall more often due to changes in balance, eyesight, hearing, muscle tone, reflexes
- 19. Chronic Disease and Health Issues • Diabetes mellitus – Type 1 Diabetes – Type 2 Diabetes • Cancer • Health issues – Sleep • Circadian Rhythms • Nutrition
- 20. 14.3 Cognitive Processes: Learning Objectives • What changes occur in information processing as people age? How do these changes relate to everyday life? • What changes occur in memory with age? What can be done to remediate these changes? • What is creativity and wisdom, and how do they relate to age?
- 21. Information Processing • Psychomotor speed: how quickly a person reacts to make a specific response • Slows with age in all situations, but especially in ambiguous ones – Occurs because older adults take longer to decide whether they need to respond – May explain higher driving fatality rates in very old people – Due to declines in the brain’s white matter that aid faster neural transmission
- 22. Practical Aspects of Information Processing: Driving a Car • Various tests predict whether drivers should be allowed to continue to drive – Useful field of view (UVOF): tests information-processing speed; extraction of relevant information from irrelevant background information – Clock drawing test – AAA’s “Roadwise Review”: assesses eight functional areas
- 23. Working Memory • Processes and structures involved in holding and using information in problem-solving, decision-making, and learning – Small in capacity – Without continued attention or rehearsal, the information is “lost” • Declines with age • Poorer working memory and psychomotor speed predict age-related declines in cognitive performance
- 24. Implicit and Explicit Memory • Explicit memory: conscious and deliberate memory for previously learned information – Semantic memory: remembering the meaning of words and concepts – Episodic memory: recalling information about the world tied to a specific time or event (includes autobiographical memory) • Implicit memory: unconscious and automatic memory about previously learned information as seen through one’s behavior or reactions
- 25. When Is Memory Change Abnormal? • Most people worry about memory loss and its possible implications for disease • A serious problem may be suspected when memory failures interfere with everyday life • Detecting whether memory problems are serious requires thorough testing through: – Physical and neurological examinations – Batteries of neuropsychological tests
- 26. Remediating Memory Problems • E-I-E-I-O framework: combines explicit vs. implicit memory with external vs. internal memory aids to create four types of memory interventions – Explicit-external aids – Explicit-internal aids – Implicit-external aids – Implicit-internal aids
- 27. Creativity and Wisdom: Creativity • Creativity: ability to produce work that connects disparate ideas in novel ways – Predicted by how much white matter connects distant brain regions and cognitive control over these connections – Generally increases through the 30s, peaking in the early 40s – However, the age at which people make major creative contributions has increased during the 20th century
- 28. Creativity and Wisdom: Wisdom • Baltes and colleagues describe wisdom as: – Dealing with important matters of life and the human experience – Superior knowledge, judgment, and advice – Knowledge with extraordinary scope, depth, and balance – Being used with good intentions, combining mind and virtue • Wisdom is unrelated to age
- 29. 14.4 Mental Health & Intervention: Learning Objectives • How does depression in older adults differ from depression in younger adults? How is it diagnosed and treated? • How are anxiety disorders treated in older adults? • What is Alzheimer’s disease? How is it diagnosed and managed? What causes it?
- 30. Depression • Depression rates – 9% in younger adults compared to 4.5% in older people living in the community; 13% in older adults requiring home healthcare – Higher in older immigrant Latinos than native-born; and in older Latino- and European- than in African- or Asian- Americans • Fewer than 40% of U.S. adults receive adequate treatment
- 31. How is Depression Diagnosed in Older Adults • The feeling symptom cluster: dysphoria • The physical symptom cluster – Loss of appetite, insomnia, and trouble breathing – Must be carefully evaluated as symptoms of depression, because they may: • Reflect normal age-related changes • Have other physical, neurological, metabolic, or substance abuse-related causes
- 32. What Causes Depression? • Biological explanations stress neurotransmitter imbalances – Imbalances increase with age, while depression declines with age • Internal belief systems play a role, e.g., – Believing one is personally responsible for bad events, or thinking things will not get better • Older people have experientially-based coping skills to combat depression
- 33. How is Depression Treated in Older Adults • Selective Serotonin Reuptake Inhibitors (SSRIs) are the most preferred – Boost mood-regulating serotonin levels • Forms of psychotherapy – Cognitive therapy – Behavior therapy
- 34. Anxiety Disorders • Excessive, irrational dread about everyday situations, including irrational severe anxiety, phobias, obsessions and/or compulsions • Common in older adults, partly due to loss of health, relocation of residence, isolation, loss of independence • Anxiety disorders can often be successfully treated with relaxation therapy and medications (e.g., benzodiazepenes, SSRIs, beta-blockers, and buspirone)
- 35. Dementia: Alzheimer’s Disease • Alzheimer’s disease (AD): one form of dementia – Gradual declines in memory, learning, attention, and judgment – Confusion as to time and place – Difficulty communicating – Declines in personal hygiene and self-care – Personality changes/inappropriate social behaviors
- 36. How Is Alzheimer’s Disease Diagnosed? • Only autopsies provide a definitive diagnosis – Should reveal very large numbers of neurofibrillary tangles, structural neuronal changes, and amyloid plaques • Diagnosis of possible AD is based on extensive neurological, psychological, and medical testing to rule out other causes, and interviewing the family for their accurate reports of behavioral symptoms
- 37. What Causes Alzheimer’s Disease? • Cause(s) of AD are still being studied – Differ between its early vs. late onset (younger vs. older than 60) • Autosomal dominant inheritance: genes with 100% accuracy in predicting early onset AD • Risk genes: three genes are known thus far to increase the risk of later onset AD (e.g., APOE-e4 gene) – Increases risk even more if inherited from both parents
- 38. What Can Be Done for Victims of Alzheimer’s Disease? • AD cannot be treated or prevented • Drugs provide little long-term relief • Some symptoms can be alleviated • Spaced retrieval helps greatly – An implicit-internal E-I-E-I-O method – Teaches people to remember new information by gradually increasing the time interval between retrieval attempts • Montessori educational methods also help
- 39. Parkinson’s Disease • Slow hand tremors, shaking, rigidity, walking problems; difficulties getting in/out of a chair • Caused by deteriorating dopamine production in the midbrain • 30-50% of sufferers develop cognitive impairments and eventually dementia • Symptoms are treated by: – Drugs that raise dopamine or aid its delivery to the brain; neurostimulators
- 40. Chronic Traumatic Encephalopathy • A form of dementia caused by repeated head trauma such as concussions – CTE can occur as the result of repeated brain trauma not only in sports but also through other causes such as military combat – Emerging evidence shows that irrespective of the cause, there is structural damage to various parts of the brain that have to do with executive functions and memory
Editor's Notes
- #5: Figure 14.2. The proportion of older adults (aged 65 years and over) is increasing in many countries and will continue to do so in the coming decades.