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
The population of older adults in industrialized nations has been increasing rapidly in the 20th century
Demographers study population trends and use population pyramids to illustrate the changes
Their research predicts that in the year 2050 the number of people over 85 will increase500% yo will increase 50%.
Places a strain on pension and
health care systems
Fastest growing age in the population
Is over 85

4. Caption: Proportion of older adults aged 65 years and over by country.

5. Caption: Note the changing shapes of the distributions in terms of the proportion of the population that is young versus old over time and as a function of whether countries are considered developed or developing.

6. Caption: Projected changes in the U. S
Caption: Projected changes in the U.S. minority population of older adults. Note that the number of older Latinos will increase the fastest.

7. The Diversity of Older Adults
Older women outnumber older men in all ethnic groups in the U.S.
The number of older people in ethnic minority groups in the U.S. is increasing faster than European Americans
Currently, 50% of people over 65 have high school diplomas and 18% have college degrees. By 2030, 75% will have college degrees

8. Longevity Longevity is the number of years a person can expect to live
Determined by
genetic and
environmental
factors

9. Longevity Three types of longevity
Average life expectancy is the age at which half the people born in a particular year will have died. Average life span for women is80.4 and men is 75.4 years
Useful life expectancy is the number of years a person is free from debilitating chronic disease
Maximum life expectancy is the oldest age to which any person lives, currently 120 yrs.

10. Longevity
Average life expectancy has increased due to decreased infant and maternal mortality
Elimination of smallpox, polio
Improvements in medical technology

11. Genetic and Environmental Factors in Life Expectancy
Heredity is a major factor in longevity
Environment plays a role through the effects of disease, lifestyle, and toxins
Social class plays a role because certain conditions are related to lack of access to health care

12. Ethnic and Gender Differences in Life Expectancy
Life expectancy is complex and varies among ethnic groups
European American life expectancy is longer than that of African Americans’, but not as long as Hispanic Americans
Life expectancy varies at different ages

13. Ethnic and Gender Differences in Life Expectancy
Women live longer than men by about 5 years. For those who live to 85, the difference is only 1 year.
Men are more susceptible to infectious diseases and other conditions that are likely to be fatal
While many explanations have been offered, no consistent finding has been found that supports one theory

14. International Differences in Longevity
Dramatic differences exist between longevity statistics among countries
38 in Sierra Leone
82 in Japan
Genetic, sociocultural, and healthcare factors contribute to the differences

15. Caption: Increase in average longevity at birth in the U.S.

16. Longevity cont.
Human Genome Project has mapped the basic human genetic code
Some attempts have been made to place “corrected” genes in people in hopes of wiping out defective genes causing disease
Oldest-old show higher thresholds for disease and slower rates of disease progression

17. Longevity
Environmental factors contribute – toxins in fish ,lead poisoning from old lead pipes, air and water pollution
Social factors play a role, social class determines accessibility to healthy lifestyles and to health care

18. Ethnic and Gender Differences in Longevity
African Americans live 4-6 years less than European Americans until age 85. Then they live longer.
Latino Americans exceed European Americans despite less access to health care
Women live about 5 years longer then men until 85 when the difference narrows to 1 yr.
Women score higher on cognitive tests until age 90, when men score higher

19. The Third-Fourth Age Distinction
The Third age Young-old (60-80)
Increased life expectancy
Substantial potential for physical and mental fitness with improvements each generation
Evidence of cognitive and emotional reserves in the aging mind
High levels of personal and emotional well being
Effective strategies to master the gains and losses of later life

20. The Third-Fourth Age Distinction
Fourth generation (oldest old)
Sizable losses in cognitive potential and ability to learn
Increases in the negative effects of chronic stress
High prevalence of dementia (50% in people over 90), frailty, and multiple chronic conditions
Problems with quality of life and dying with dignity

21. 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?

22. Biological Theories of Aging
Programmed Theories – functioning may be part of a master genetic program with a biological clock
Damage or error theories –
Wear-and-tear theory suggests that the body simply wears out
Free radicals cause cellular damage, aging is caused by this damage over the lifetime
Cross linking – some proteins interact randomly with certain body tissues and stiffen these tissues

23. Biological Theories of Aging
Cellular theories focus on the buildup of toxic cellular substances and subsequent deterioration
Some research indicates that cells have an absolute limit on the number of times they can divide
Telemeres on ends of chromosomes become shorter with each replication until they are too short and the chromosome becomes unstable and cannot replicate and they are susceptible to prolonged stress

25. Biological Theories of Aging (Cont)
Other Wear and Tear Approaches
Free radicals - chemicals produced by cell division that cause cell damage
Cross-linking is an explanation that suggests that certain proteins interact with body tissue, which results in stiffer tissues. Heart, muscle, and arteries can be affected

26. Biological Theories of Aging
Metabolic Theories
These theories examine the interaction between caloric intake and stress
Programmed Cell Death Theories
This approach points to evidence that aging is biologically or genetically programmed
Recent information about human genetics is contributing to these explanations

27. Physiological Changes
Changes in the Neurons
The fibers in the axon form spiral-shaped masses called neurofibrillary tangles, which interfere with transmission of signals increased in Alzheimer's Disease and forms of dementia
Damaged or defective neurons collect around a core of protein and form neuritic plaques, which interfere with other, healthy neurons. Large numbers cause dementia.

28. Physiological Changes
Changes in the Neurons cont.
Dendritic changes-some dendrites shrivel up and die, but some continue to grow in some areas of the brain
Structural and functional imaging show age-related changes in the brain associated with cognitive processes
Levels of neurotransmitters decrease causing behavioral changes, memory, sleep problems, and perhaps diseases such as Parkinson’s .

29. Neuroimaging Structural – X-Rays, CT, MRI
Functional – shows brain activity, single photon emission computerized tomography (SPECT), positron emission tomography (PET), magnoencephalography (fMRI), near infrared spectroscopic imaging (NIRSI)

30. Caption: Basic structure of the neuron.

31. Cardiovascular and Respiratory Systems
Cardiovascular diseases increase
dramatically with advancing age,
heart attack, HPT, irregular heartbeat
By young adulthood collection of fat in the arteries and in and around the heart decrease the efficiency of the circulatory system
These changes increase the chances of cerebral vascular accidents (CVAs) which are the leading cause of disability in the US, and heart attacks

32. Cardiovascular and Respiratory Systems
Older adults may experience transient ischemic attacks (TIAs), or interruptions of blood flow which can be warnings of stroke
Older adults may have many smaller CVAs, resulting in vascular dementia which may progress gradually, or quickly to death in 2-3 yrs
The most common respiratory disease in older adults is chronic obstructive pulmonary disease (COPD) such as emphysema mostly caused by smoking, asthma, and some genetic forms
Lung size does not change but the maximum amount of air breathed in one breath decreases by 40% by age 85

33. Parkinson’s Disease
Symptoms such as slow tremors in the hands and slow walking, difficulty getting in and out of chairs
Caused by deterioration of the neurons
in the midbrain that produce the neurotransmitter dopamine
Victims of Parkinson’s include Michael J. Fox, Muhammad Ali, Janet Reno, and Pope John Paul II
30-50% of people with Parkinson’s develop cognitive impairments similar to those of Alzheimer’s disease

34. Parkinson’s Disease cont.
TX-medications, levodopa, sinemet, staleva
Surgically implant a neurostimulator in the brain which acts like a brain pacemaker

35. Sensory Changes Eye and Vision Changes
A decrease in the amount of light admitted to the eye results in the need for increased light for reading
Decrease in adaptation to changes in illumination
Presbyopia is the age-related decline in the ability to see close objects clearly
Decrease in ability to change focus from near to far and far to near

36. Sensory Changes
Cataracts, or opaque spots in the lens of the eye, may develop. Also, glaucoma, or an increase in the pressure of the fluid in the eye, may cause loss of vision
Retinal changes such as those caused by diabetes and macular degeneration increase in older age

37. Sensory Changes
Structural changes in the eye may result in loss of visual acuity, or the ability to see detail, especially in low lighting
Diabetic retinopathy – fluid retention in the macula, detachment of the retina, hemorrhage, and aneurysms.

38. Sensory Changes
Hearing loss esp. high pitched sounds is one of the most common normative changes in older adults
The most common age-related hearing problem is presbycusis, which is caused by the cumulative effects of noise and age-related changes. This results in the loss of the ability to hear high-pitched sounds

39. Sensory Changes
Taste, touch, temperature, and pain sensitivity do not decline as significantly in older years
The ability to detect and distinguish smells declines after the age of 70 in many people
Older people fall more often due to changes in the sense of balance, eyesight, hearing, muscle tone, reflexes

40. Health Issues
Sleep is often problematic in older ages, disrupting the circadian rhythm, or sleep-wake cycle
Older adults may experience nutritional deficits because of declining health and eating patterns
The incidence of cancer increases with age and suggests the importance of screenings

41. Immigrant Status
Immigrants may have language barriers that interfere with obtaining health care, Immigrants show poorer health than US born people
Health examinations may be affected by communication problems
Higher rates of depression are noted among older immigrant Mexican Americans
Fewer chronic illnesses if have an
excellent relationship with child

42. 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?

43. Information Processing
Older adults do more poorly on selective attention tasks
Vigilance, or sustained attention, may decline with age, though studies are inconsistent
The ability to focus, switch, and divide attention is called attentional control and may show some decline in older age

44. Psychomotor Speed
The speed at which a person can make a specific motor response (psychomotor speed) may slow with advancing age
This finding may be due to taking longer to decide what response to make, especially when faced with an ambiguous situation
These changes make driving with advancing age a controversial issue

45. Working Memory
Working memory is the information that is being used at the moment, Involves the processes and structures involved in holding information in mind and simultaneously using it to solve a problem, make a decision, perform some function or learn new information.
Working memory typically declines with age
A combination of declining working memory and psychomotor speed may explain decline in cognitive performance in older adults

46. Memory
Explicit memory is the deliberate and conscious remembering of information
Episodic memory is memory of information from a specific time or event
Semantic memory is the remembering of the meaning of words or concepts unrelated to a specific time or event
Implicit memory is unconscious remembering of information learned at an earlier time

47. What Changes?
Episodic memory (conscious recollection of a specific event) is worse in older adults than younger adults
Older adults are not as good at spontaneously using memory strategies to improve recall
No age differences in implicit (unconscious remembering)and semantic memory( remembering words or concepts not tied to an event) have been found
For all groups, autobiographical memory is better for events that occur between ages of 10 and 30 years

48. The Impact of Beliefs About Memory Aging
Stereotypes about older people and memory loss impacts what elderly people believe about their own abilities, affecting strategies for remembering

49. When Is Memory Change Abnormal?
Most people worry about memory loss and its possible implications for disease
When memory problems seriously affect everyday life, a serious problem may be suspected
Diagnose with complete and through physical, neurological, neuropsychological, and neuroimaging,testing

50. Remediating Memory Problems
External aids are devices and materials that rely on environmental resources such as calendars and notebooks
Internal aids are methods that rely on mental processes such as imagery

51. Creativity and Wisdom
Creativity - the ability to produce work that is novel, in high demand, and task-appropriate
Creativity increases through the 30s, peaks I early 40s, and slowly declines thereafter
Different disciplines and arts have varying creativity peaks

52. Caption: The age it which individuals make their best contribution varies by field, but in no case does it occur in late life.

53. Creativity and Wisdom Wisdom (Baltes and Staudinger)
Wisdom deals with important matters
of life and the human experience
Wisdom is superior knowledge, judgment, and advice
Wisdom is related to crystallized knowledge, knowledge that builds over time and experience.
When used, wisdom is well-intended and combines mind and virtue
This research showed no association between wisdom and age

54. What Makes One Wise?
General personal conditions, such as mental ability
Specific expertise conditions, such as practice or mentoring
Facilitative life contexts, such as education or leadership experiences

55. 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?

56. Depression
Depression is diagnosed based on two changes: Feelings and physical changes present for 2 weeks
Feelings of sadness are called dysphoria
Physical changes include loss of appetite, insomnia, and trouble breathing,memory problems
Evaluation of older adults is difficult because some of these changes may be normal
Significant impairment of daily life
Other causes must be rules out

57. Depression
Depression rates decline from early adulthood to old age. Average onset is early 30s
Latino and European rates are equal
Africa American and Asian rates are lower for older adults
Immigrant Latinos have higher rates
Rates rise for those having home health care

58. What Causes Depression?
Biological and physical causes may include imbalances in neurotransmitters
Loss and internal belief systems may play a role in how people interpret things that happen to them

59. Depression Depressed people tend to believe that-
They are personally responsible for the bad things that happen to them
Things are unlikely to get better
Their whole life is in shambles

60. How Is Depression Treated in Older Adults?
Medicines that affect the levels of neurotransmitters, such as heterocyclic antidepressants (HCAs), monamine oxidase inhibiters (MAOIs), and selective seratonin reuptake inhibitors (SSRIs), may be used
SSRIs used first because fewer adverse effects, then HCAs and lastly MAOIs which have potentially fatal reactions with some foods – cheddar cheese, wine, chicken liver

61. How Is Depression Treated in Older Adults? Cont.
Psychotherapy in the forms of behavior (depressed people experience too few rewards or reinforcements from their environment) therapy or cognitive therapy (maladaptive beliefs about oneself are responsible for depression) may be used to learn new behaviors or examine the way patients think about their experiences. Cognitive therapy is the therapy of choice for older adults.

62. Anxiety Disorders
Anxiety disorders involve excessive dread in everyday situations, feelings of severe anxiety for no apparent reason, phobias and obsessive-compulsive thoughts or actions.
Anxiety disorders are more common in older adults, partly due to loss of health, relocation of residence, isolation, loss of independence, and other factors, more common in women.
Anxiety disorders can often be successfully treated with psychotherapy and medications
Psychotherapy is tx of choice for the aged

63. Dementia: Alzheimer’s Disease
Dementia is a family of diseases that results in serious behavioral and cognitive impairments. Alzheimer’s disease is one of the more common
Alzheimer’s disease may cause confusion, disability, and dependence
The incidence of Alzheimer’s disease increases with age, 50% for those 85 and older. Women are at greater risk

64. What Are the Symptoms of Alzheimer’s Disease?
Declines in memory, attention, and judgment
Confusion and difficulties in communication
Changes in personality, inappropriate social behavior, and decline in hygiene
Incontinence, or the loss of bladder or bowel control, loss of mobility,
Total loss of mobility
Life span typically averages 12 yrs

65. How Is Alzheimer’s Disease Diagnosed?
Diagnosis can only be confirmed by autopsy
Diagnosis is made by microscopic analysis of neurons in the brain
The diagnosis of possible Alzheimer’s disease is based on extensive psychoneurological testing and ruling out other causes for symptoms
Possibly abnormally high levels of the protein amyloid in the blood

66. What Causes Alzheimer’s Disease?
The exact cause is not known
Possible explanations have included a slow-acting virus and aluminum deposits in the brain. These have not be confirmed
Genetic research has shown promising results in identifying genetic markers related to specific genes

67. What Causes Alzheimer’s Disease?
Familial,early Alzheimer’s before age 60 – certain genes indicate 100% chance of developing Alzheimer’s
Later onset may be linked to risk genes

68. What Can Be Done for Victims of Alzheimer’s Disease?
Though symptoms can be successfully treated, no cure exists
Galantamine appears to help memory loss but does not reverse the deficits
Thioridazine and haloperidol are used to treat severe psychotic symptoms
Spaced retrieval – remembering new information and increasing the time between retrieval times
Antidepressants may be used to treat the depression that often goes along with the disease
Maintain dignity and optimizing level of functioning