Physical and Cognitive Development in Late Adulthood Chapter 17: Physical and Cognitive Development in Late Adulthood

In This Chapter Variability in late adulthood Physical changes Mental health Cognitive changes

Variability in Late Adulthood Centenarians (100 years old or more) Fastest growing population segment Currently 60,000 centenarians in the U.S. Over 800,000 American centenarians by 2050 Fastest growing population segment of population in developed countries Currently 60,000 centenarians in the U.S. May be at least 800,000 American centenarians by 2050 General trend worldwide

Variability in Late Adulthood Characteristics of the Elderly Population Gerontology: Scientific study of aging Life expectancy Ethnic differences Subgroups Life expectancy: Males=75; females=80 If a man is 65, his life expectancy goes to 80, if 80 it goes to 90. 65 year old woman can live to 85. Increases as adults get older 65- to 74-year-old White Americans have longer life expectancies than African Americans of the same age By age 75, life expectancies of White- and African-Americans are the same Young old (60 – 75) Old old (75 – 85) Oldest old ( 85 and older) Fastest growing segment of population Suffer from more physical and mental impairments than other age groups

Figure 17.1 Percentage of people age 65 and over who reported having good to excellent health by age group and race and Hispanic origin, 2002-2004

Variability in Late Adulthood Self-Rated Health Overview of Results Most rate health as good Despite health challenges, elders remain emotionally resilient Adults with cardiovascular disease and Alzheimer’s Disease show earlier declines in mental abilities See Figure 17.1 on health. Most older adults rate their health as good Health the single largest factor affecting physical and mental states over time Despite any experiences with disease and disability, elders remain emotionally resilient Adults with cardiovascular disease show earlier declines in mental abilities as do those suffering from Alzheimer’s

Variability in Late Adulthood Racial and Ethnic Health Differences Among ethnic minorities: High level of variability Good to excellent health ratings Some difference: arthritis Health habits and health status correlated Disability – a limitation in an individual’s ability to perform certain roles and tasks. Particularly, problems with daily living chores and self-help lead to labels of disability. See Figure 17.3 to see the numbers of elderly who have problems. Disabilities rise with age. 1/2 of those over 75 have some disabilities with ADL Arthritis and hypertension most common Women considerably more likely than men to suffer from arthritis Percentage of sufferers with arthritis: 58% = white 50% = Hispanic Americans 67% = African Americans

Variability in Late Adulthood Limitations on Activities Disability: Limitations on someone’s ability to perform certain roles and tasks, especially self-help tasks Incidence by age and rate Common types Gender differences Categories of daily tasks Disability – a limitation in an individual’s ability to perform certain roles and tasks. Particularly, problems with daily living chores and self-help lead to labels of disability. See Figure 17.3 to see the numbers of elderly who have problems. Disabilities rise with age. 1/2 of those over 75 have some disabilities with ADL Arthritis and hypertension most common Women considerably more likely than men to suffer from arthritis Rates of disability among the old old and oldest old have declined in recent years Categories of daily tasks ADL – Activities of Daily Living Such as: bathing, dressing, using the toilet IADL – Instrumental Activities of Daily Living Such as: managing money

Variability in Late Adulthood Individual Heredity Twin studies Family history of longevity Long life and rates of chronic illnesses Identical twins more similar in length of life than fraternal twins Adults whose parents and grandparents were long-lived tend to live longer Long-lived individuals have lower rates of chronic illnesses such as diabetes

Variability in Late Adulthood Health Habits Does health matter? Health habits that predict longevity change very little with age Most crucial variable = physical exercise Eating patterns Smoking, low levels of physical activity, and being significantly underweight or overweight lead to increased risk of death. Exercise keeps people healthier. Most crucial variable = physical exercise Even over age 80, exercise leads to motor skill improvement and muscular strength Exercise can prevent height loss, too Eating patterns critical for health, especially calorie restriction Alternate day fasting Calorie restriction and alternate day fasting influence aging and longevity by reducing individual’s overall metabolic rate

Physical Changes Brain and Nervous System Four Main Changes Reduction of brain weight Loss or gray matter Decline in dendrite density Slower synaptic speed Between 60 and 90, adults with higher levels of education show significantly less atrophy of the cerebral cortex Reaction time increases for everyday tasks as synaptic speed slows Loss of neurons occurs but not as critical for cognitive functioning as once believed Plasticity decreases and reaction time increases

Physical Changes The Senses and Other Bodily Organs Vision Presbyopia (farsightedness) increases “Blind spot” and reduction of vision field Night vision Cataracts Glaucoma Macular degeneration Presbyopia (farsightedness) increases Blood flow to eyes decreases, enlarging the “blind spot” and reducing field of vision Vision loss has greater negative effect on elderly adult’s sense of well-being than for other ages More difficulty with night vision and responding to rapid changes in brightness Cataracts Lens inside the eye becomes clouded

Physical Changes The Senses and Other Bodily Organs Hearing Gradual hearing loss Sex differences Word discrimination decreases Tinnitus Men work in environments with higher noise levels. Auditory problems more often experienced by men Frequently, problems include less ability to hear high frequency sounds Older adults develop difficulties with word discrimination Noisy conditions hamper hearing in elderly Tinnitus, persistent ringing in the ears, increases with age Hearing aids improve many elders’ quality of life

Physical Changes The Senses and Other Bodily Organs Taste, Smell, and Touch Ability to taste four basic flavors does not seem to decline with age Sense of smell deteriorates with age Skin of elderly adults less responsive to heat and cold See Figure 17.5 for identifying smells data Ability to taste four basic flavors does not seem to decline with age BUT Less saliva secreted Elders report that flavors seem blander May be due to loss of sense of smell Sense of smell deteriorates with age Loss far greater among elderly men than women Skin of elderly adults less responsive to heat and cold

Figure 17.3 Age-related Declines in Sense of Smell Doty’s classic data show a very rapid drop in late adulthood in the ability to identify smells

? ? Questions To Ponder How long do you want to live? Will improvements in lifestyle and medicine improve the quality of your elder years so that they are enjoyable? Why or why not? Other than vision, which loss of senses would affect the quality of your life the most? Which could you tolerate the best if it were lost? Why?

Stop and Think If you were asked to give a presentation on the causes of physical aging, what would be your main points?

Theories of Biological Aging Longevity Maximum human lifespan is 110 – 120 years Hayflick limit Genetic Limits Argument Each chromosome in the human body has at its tip a string of repetitive DNA called a telomere. Maximum human lifespan 110 – 120 years Hayflick limit Each species subject to a time limit beyond which cells simply lose capacity to replicate themselves Genetic Limits Argument “Timekeeping mechanism” for the organism Number of telomeres reduces slightly each time a cell divides There may be crucial number of telomeres – if the number is too low, disease and death follow quickly Telomeres: Telomere is region of repetitive of DNA at the end of chromosome which protects the end of chromosome from deterioration.

Theories of Biological Aging More Theories to Consider Genetically programmed senescence Gradual deterioration of body systems with age Aging genes equipped with built-in clock preventing genes from having aging affect during reproductive years Genes switch on after reproductive peak passes Genetically programmed senescence Gradual deterioration of body systems with age Aging genes equipped with built-in clock preventing genes from having aging affect during reproductive years Genes switch on after reproductive peak passes

Theories of Biological Aging More Theories to Consider Repair of genetic material and cross-linking Accumulation of unrepaired breaks in DNA results in loss of cellular function over time Cross-linking occurs when undesirable chemical bonds form between proteins or fats Molecules fail to assume correct shape for proper functioning Cross-linking: Undesirable chemical bonds form between proteins or fats. Collagen and Elastin form cross-links; the resulting molecule cannot assume the correct shape for proper functions leading to effects such as wrinkling and arterial rigidity.

Theories of Biological Aging More Theories to Consider Free radicals Molecules or atoms posses an unpaired electron that may cause irreparable cellular damage that accumulates with age Occurs more frequently in older adults because of age-related deterioration of mitochondria Antioxidants inhibit the formation of free radicals and promote chemical processes that help the body defend against them. Free radicals Molecules or atoms posses an unpaired electron Oxygen-free radicals Enter into many potentially harmful chemical reactions, cause irreparable cellular damage that accumulates with age Antioxidants inhibit formation of free radicals Foods high in vitamins C, E, and beta carotene typically high in antioxidants May lead to slightly longer life and lower rates of heart disease

Theories of Biological Aging More Theories to Consider Terminal drop hypothesis Significant declines occur within few years of death Lead to significant drops in functioning before death BUT only changes in cognitive functions support terminal drop hypothesis Longitudinal research supports a general loss of functioning that slowly occurs throughout older age Terminal Drop Hypothesis Significant declines part of dying process Occur within a few years of death Lead to significant drops in functioning before death BUT only changes in cognitive functions seem to support terminal drop hypothesis

Physical Changes Behavioral Effects of Physical Changes General slowing Dendrite loss Loss of muscle elasticity Decline in speed of nerve impulses Changes in temperature sensitivity Dendrite loss Loss of muscle elasticity Decline in speed of nerve impulses responsible for difficulties translating thoughts into actions Changes in temperature sensitivity

Physical Changes Sleeping and Eating Patterns Shifts in sleep patterns Wake more frequently at night Show decreases in REM sleep Eating Loss of feelings of satiety, thus overeat May become rigid in meal times and food selection to compensate Wake early in morning, go to bed early at night Ability to regulate appetite changes with age

Physical Changes Motor Functions Reduction in stamina, dexterity, and balance Loss of balance associated with higher risk of falling More problems with fine-motor control Reduction in stamina, dexterity, and balance Loss of balance associated with higher risk of falling Activities such as golf or Tai Chi may help with balance More problems with fine-motor control Impairs the rate at which older adults learn new skills, such as computer mouse activities

Stop and Think Do old people have sex?

Physical Changes Sexual Activity Decreases in sexual activity has many causes 70% of young old and about half of old old continue to have sexual activity Decline in testosterone Certain medications or physical pain Decreases in sexual activity has many causes Continued decline in testosterone Certain medications or physical pain may affect sexual activities Stereotypes that portray old age as asexual 70% of young old and about half of old old continue to have sexual activity Women may become more sexually adventurous

Mental Health Alzheimer’s Disease Alzheimer’s disease: Very severe form of dementia Early stages become evident very slowly As the disease progresses, more serious declines and changes appear Rate of decline related to age at onset Early stages become evident very slowly Subtle memory difficulties, repetitive conversation, disorientation in unfamiliar settings Memory for recent events begins to go Memories for long-ago events and well-rehearsed procedures are last to go Eventually may fail to recognize family members, forget names of common objects, forget how to do routine activities As the disease progresses more declines appear Declines in ability to communicate Inability to control eating habits Difficulty processing information about others’ emotions Displays of anger and inappropriate outbursts increase Depression increases

Mental Health Alzheimer’s Disease Diagnostic issues Diagnosis difficult because 80% of elderly complain of memory problems On autopsy, presence of neurofibrilar tangles and plaque deposits Mild cognitive impairment syndrome Mild cognitive impairment syndrome may offer a way to diagnose the disease

Mental Health Alzheimer’s Disease Treatment Galantamine Use of anti-inflammatory medication Training in memory strategies and tasks Galantamine Increases amounts of some neurotransmitters which can slow progress of the disease Use of anti-inflammatory medication, such as aspirin Training in use of specific everyday strategies and tasks that can improve memory

Mental Health Heredity and Alzheimer’s Disease Genetic factors appear in some but not all individuals; no gene acts alone Age of onset highly variable Wide variations in severity of behavioral effects of disease Genetic factors appear in some but not all individuals Chromosome 19 controls a particular protein Leads to dendrites and axons becoming tangled Age of onset highly variable 44 to 67 Wide variations in severity of behavioral effects of the disease

True or False? Dementia is a symptom, not a disease. It involves a different process than does Alzheimer’s Disease. True

Mental Health Other Types of Dementia Dementia can have many causes Multi-infarct dementia may appear after multiple small strokes Many forms involve irreparable brain damage Different forms of therapy may improve functioning May appear after multiple small strokes – multi-infarct dementia Dementia has various causes Many forms involve irreparable brain damage Careful physical examination is needed

Mental Health Depression Prevalence and demographics Older adults at greater risk 14% of 65-69 year olds and 19% of 85+ year olds suffer from depression More common among less-educated adults regardless of other factors, such as ethnicity Full story on late adulthood depression is complex

Mental Health Depression Risk Factors Inade-quate social support Poverty Gender Education (indepen-dently related) Emotional loss or absence of significant others Persistent health concerns Therapy and medications are the same for older adults. They may benefit from psychotherapy that stresses optimism as a coping strategy Risk Factors Inadequate social support and income Depressed women outnumber men 2 to 1 Women respond to accumulation of everyday stressors Men respond to traumatic events Poverty puts elderly at high risk Emotional loss or absence of significant others Persistent health concerns Strongest risk factor The more disabling the conditions, the more depressive symptoms older adults display

Mental Health Depression Ethnic and Cultural Differences Poverty and education accounts for some ethnic differences in older adult depression Health status linked to depression In general, minorities have less education, greater poverty, worse health Mexican and Chinese American immigrants suffer from poor English skills, which is correlated with depression African Americans may have lower rates of clinical depression May be underdiagnosed May reflect beliefs that depression is a spiritual problem not a mental state

Mental Health Suicide Risks Gender differences Incidence increase and age Death of spouse Poor health Older white men have highest suicide risk Suicide rates increase in older men with age but remain stable in women Older men have several risk factors that may lead them to commit suicide Loss of economic status may trouble men more Death of a spouse plays a role for men Idea that one is a burden to others, especially if health is poor

Figure 17.4 Gender and Elder Suicide Rates The data on which the figure is based indicate that suicide rates increase substantially in old age among men but remain fairly stable among women

Cognitive Changes Memory Memory and Aging Forgetfulness Short term memory capacity Cognitive speed Strategy learning effects See Figure 17.8 for memory learning. Forgetfulness increases as we age Short term memory capacity begins to be a problem, especially handling multiple tasks Responses that require cognitive speed show greater decline Strategy learning helps older adults improve memory functions. Suggests that learning process takes longer

Figure 17.5 Percentage of Older Adults with Moderate to Severe Memory Impairment UPDATE The percentage of memory problems as older adults age

Cognitive Changes Everyday Memory So WHERE are those car keys? Everyday memory tasks decline among older adults compared to younger adults Prior knowledge critical factor in memory functioning Loss of speed is key aspect of the process of memory decline Remembering points of a newspaper article, recalling movies, conversations, grocery lists, whether they did something, medicines – all examples f everyday memory tasks that show decline with age Virtually all everyday memory tasks decline among older adults compared to younger adults Demonstrated in longitudinal and cross-sectional research, especially over age 70 Prior knowledge a critical factor in memory functioning Loss of speed is key aspect of the process of memory decline

Figure 17.7 Strategic Learning in Later Adulthood These results from Kieg’s classic study show that older adults can learn complex information processing skills and improve their performance after training, but they don’t gain as much as young adults do This study also suggest that given enough time older adults can learn new strategies What does this tell us about older adult strategic learning?

Wisdom and Creativity Factual knowledge only ONE part of wisdom Baltes measured wisdom using major life decision stories Wisdom central to solving practical life problems Complex answers rated as being higher in wisdom Wisdom central to solving practical life problems Complex answers rated as being higher in wisdom Younger adults perform as well as older adults on fictional tasks Wisdom may not be a defining characteristic of the elderly

Cognitive Changes Wisdom and Creativity Gene Cohen stage theory of mid- to late-life creativity Reevaluation phase Liberation Summing-up Encore phase Reevaluation phase – 50’s; reflect on past accomplishments and formulate new goals Liberation – 60’s; freer to create, more tolerant of failures, willing to take more risks Summing-up – 70’s; desire to knit accomplishments together into a cohesive story Encore phase – 80’s; desire to complete unfinished work or fulfill desires