1. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Paramedic Care: Principles & Practice Volume 1 Introduction to Advanced Prehospital Care

2. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 12 Life-Span Development

3. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Topics Infancy (Birth to 12 Months) Toddler (12 to 36 Months) and Preschool Age (3 to 5 Years) School Age (6 to 12 Years) Adolescence (13 to 18 Years) Early Adulthood (19 to 40 Years) Middle Adulthood (41 to 60 Years) Late Adulthood (61 Years and Older)

4. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Life Span Click here to view a video on life span.here

5. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Infancy (Birth to 12 Months)

6. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Infancy Physiological development –Vital signs, weight, cardiovascular system, pulmonary, renal system

7. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Normal Vital Signs

8. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Physiological Development The younger the child, the more rapid the pulse and respirations. Blood pressure is related to age and weight. –Average systolic blood pressure increases from a range of 60 to 90 at birth to a range of 87 to 105 at 12 months.

9. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Weight Normal birth weight is 3.0–3.5 kg. Weight drops within first week due to excretion of extracellular fluid. In the first month, infants grow approximately 30 grams per day. The infant’s head is equal to 25% of the total body weight.

10. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Weight Infants double their weight by 4 to 6 months old and triple it by 9 to 12 months.

11. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Cardiovascular System Several changes occur to transition the infant from fetal to pulmonary circulation: – The ductus venosus constricts. – The foramen ovale closes. – The ductus arteriosus constricts. These changes lead to an immediate increase in systemic vascular resistance and a decrease in pulmonary vascular resistance.

12. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pulmonary System Infant’s airway is shorter, narrower, less stable, and more easily obstructed than at any other time. Infants are obligate nose breathers. Lung tissue is fragile. Accessory muscles are immature. Chest wall is less rigid: –Ribs are horizontal, causing diaphragmatic breathing

13. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Renal System An infant’s kidneys are unable to produce concentrated urine. The infant excretes a relatively dilute fluid. –Infants are much more easily dehydrated.

14. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Immune System The fetus acquires some of the mother’s immunity which may remain active for six months to a year after birth. Naturally acquired passive immunities.

15. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Nervous System Infants lack ability to localize pain. Infants have several reflexes that disappear over time: – Moro reflex (startle) – Palmar grasp – Rooting reflex – Sucking reflex

16. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Nervous System Fontanelles allow for compression of the head during childbirth and allow for rapid growth of the brain. Newborns sleep 16–18 hours daily, evenly distributed over a 24-hour period. Sleep decreases to 14–16 hours, with a 9– 10 hour period at night for infants.

17. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Musculoskeletal System Extremities grow from growth plates. Epiphyseal plates are secondary growth centers. Factors affecting bone development and growth include: –Nutrition –Exposure to sunlight –Growth hormone –Thyroid hormone –Genetic factors –General health

18. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Other Characteristics Two Months Recognizes familiar faces and objects Three Months Moves objects to mouth, displays primary emotion Four MonthsReaches out to people Five Months Sleeps through the night, differentiates between family and strangers

19. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Other Characteristics Six Months Sits upright, makes single syllable sounds Seven MonthsExhibits fear of strangers Eight Months Responds to the word “no,” sits alone, plays “peek-a-boo” Nine Months Pulls up to standing position, explores objects by mouthing, sucking, chewing, and biting them

20. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Other Characteristics Ten Months Pays attention to name, crawls well Eleven Months Attempts to walk without assistance, shows frustration about restrictions Twelve Months Can walk without help, knows name

21. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Psychosocial Development Family Processes and Reciprocal Socialization –Crying –Attachment –Trust vs. mistrust

22. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Crying Crying is an infant’s only means of communication. Mothers quickly learn to distinguish the differences between cries.

23. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Attachment Infants have their own unique timetables and paths to becoming attached to their parents. –Secure attachment Bonding –Anxious resistant attachment Leads to a child who is always prone to separation anxiety –Anxious avoidant attachment Infants have no confidence that they will be responded to helpfully when they seek care.

24. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Trust vs. Mistrust The infant wants the world to be an orderly place where causes and effects can be anticipated. The infant develops trust when he or she can count on consistent parental care. –Mistrust develops if he or she cannot count on parental care. May in turn develop into antisocial or even criminal behavior

25. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Scaffolding Scaffolding is a teaching/learning method whereby the infant builds on what he or she already knows. Dialogue is maintained just above the level where the child can perform activities independently.

26. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Temperament Easy child: –Regular body functions, low or moderate intensity of reactions, accepts new situations Difficult child: –Irregular body functions, intense reactions, withdrawal from new situations Slow-to-warm-up child: –Low intensity of reactions and somewhat negative mood

27. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Parental Separation Stages Infants usually follow a predictable sequence of behaviors when they experience a situational crisis : –Protest –Despair –Detachment or withdrawal

28. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Toddler (12 to 36 Months) and Preschool Age (3 to 5 Years)

29. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Toddler A toddler begins to stand and walk on his own. © Michal Heron

30. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Body System Changes Cardiovascular: – Capillary beds better developed and assist in thermoregulation – Hemoglobin levels approach normal adult levels Pulmonary: – Alveoli increase in number – Chest muscles still immature

31. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Body System Changes Renal: – Kidneys well developed – Urine characteristics similar to adult Immune: –Passive immunity is lost and child is susceptible to minor respiratory and GI infections Nervous: – Brain at 90% of adult weight – Myelination has increased – Fine motor skills developing

32. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Body System Changes Musculoskeletal: –Muscle mass and bone density increase Dental: –All primary teeth have erupted by the age of 36 months Senses: –Visual acuity is 20/30 during toddler years –Hearing reaches maturity at 3 to 4 years old

33. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Psychosocial Development Cognition: –Starts to grasp meaning of words at 1 year –By 3 or 4, has mastered basics of language –Between 18 and 24 months, begins to understand cause and effect –By 24 to 36 months, develops magical thinking and engages in play-acting Play: –Able to play simple games and follow basic rules

34. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Psychosocial Development Sibling relationships: –Sibling rivalry may occur Peer group functions: –Provides source of information about other families and the outside world

35. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Parenting Styles and Their Effects Authoritarian parents are demanding and desire instant obedience. Authoritative parents believe both they and the children have rights and try to maintain a balance. Permissive parents take a tolerant, accepting view of a child’s behavior.

36. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Divorce and Child Development Children express feelings of shock, depression, and fear that their parents no longer love them May feel abandoned Cannot see the divorce from the parent’s perspective

37. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Television and Modeling Television: –TV violence increases aggression –Increases passive acceptance of use of aggression by others Modeling: –Begin to recognize sexual differences and begin to incorporate gender-specific behaviors of parents, siblings, and peers

38. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ School Age (6 to 12 Years)

39. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ School-Age Children School-age children are allowed more self-regulation and independence as they grow older. © Michal Heron

40. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Physiological Development Average child gains 3 kg per year Vital signs reach adult levels Lymph tissues are proportionately larger than those of an adult Brain function increases in both hemispheres Primary teeth are being replaced by permanent ones

41. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Psychosocial Development Development of self-concept Begin to develop self-esteem Moral development begins: – Pre-conventional reasoning – Conventional reasoning – Post-conventional reasoning

42. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Adolescence (13 to 18 Years)

43. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Adolescence Children reach reproductive maturity during adolescence © Index Stock

44. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Physiological Development Usually experience a rapid two- to three- year growth spurt Both males and females reach reproductive maturity Muscle mass and bone growth are complete

45. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Psychosocial Development Family conflict may occur. –Adolescent strives for autonomy Privacy and modesty become important. There is a need to be treated as an adult. There is increased idealism, which leads to disappointment. Depression and suicide are more common at this age than any other.

46. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Ethical Development Development of logical, analytical, and abstract thinking occurs. A personal code of ethics develops. –They tend to get disappointed in anyone who does not meet their personal code of ethics.

47. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Early Adulthood (19 to 40 Years)

48. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Early Adulthood Peak physical conditions occur in early adulthood.

49. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Physiological Development Muscle strength decreases. Accidents are the leading cause of death. The highest levels of job stress occur. Love develops.

50. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Physiological Development The body begins its slowing process. Spinal discs settle, leading to decreased height. Fatty tissue increases, leading to weight gain. Childbirth is common in this stage.

51. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Middle Adulthood (41 to 60 Years)

52. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Middle Adulthood People in middle adulthood still function at a high level.

53. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Physiological Development Hearing and visual changes occur. Cardiac output decreases and cholesterol levels increase. Cancer often strikes this age group. Weight control is more difficult.

54. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Physiological Development For women in their late 40s and early 50s, menopause commences. Offspring have left home, and “empty-nest syndrome” may occur. Often there are financial commitments to elderly parents and young adult children.

55. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Late Adulthood (61 Years and Older)

56. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Late Adulthood Maximum life span is the theoretical, species-specific, longest duration of life. Life expectancy is the average number of additional years of life expected for a member of a population.

57. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Cardiovascular System Vessel walls thicken Increased peripheral vascular resistance, and reduced blood flow to organs Decreased baroreceptor sensitivity Decreased vessel elasticity Heart starts showing disease Functional blood volume decreases, as well as red blood cells

58. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Respiratory System Trachea and large airways increase in diameter. Decreased surface area of lungs as well as decreased elasticity in the lungs. Coughing is less effective due to weakened chest wall and bone structures.

59. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Endocrine System Glucose metabolism and insulin production decrease. The thyroid shows diminished triiodothyronine production. Cortisol is diminished by 25%. The pituitary is 20% less effective. The reproductive organs atrophy in women.

60. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Gastrointestinal System Tooth loss can lead to dietary changes, increased chance of malnutrition, vitamin and mineral deficiency. The swallowing mechanism changes. Peristalsis is decreased; the gastric sphincter is less effective.

61. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Gastrointestinal System Stomach secretions decrease. Intestines atrophy. Metabolism and absorption change.

62. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Renal System Reduced kidney function leads to decreased clearance of some drugs and decreased elimination. The kidneys’ hormonal response to dehydration is reduced. The kidneys are less able to modify vitamin D to a more active form.

63. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ The Senses Taste buds diminish. Smell declines, and parts of the brain involved in smell degenerate. Response to pain is diminished. Ability to sense movement diminishes. Visual acuity decreases, and reaction times increase. Hearing decreases.

64. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ The Nervous System Neurotransmitters are decreased. Loss of coordination and memory. Sleep problems may occur.

65. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Psychosocial Development The terminal drop hypothesis states that death is preceded by a five-year period of decreasing cognitive function. Individual may or may not be aware of diffuse changes in mood, mental functioning, or the way his body responds.

66. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Challenges Housing becomes a challenge. Maintaining a sense of self-worth becomes a problem as it is harder to care for themselves. Finances become stressful with retirement and the decreased ability to work.

67. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Dying Companions or Death Because of the death or impending death of companions, fear and grief are present. People must go through the stages of the grieving process.

68. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Summary Infancy (Birth to 12 Months) Toddler (12 to 36 Months) and Preschool Age (3 to 5 Years) School Age (6 to 12 Years) Adolescence (13 to 18 Years) Early Adulthood (19 to 40 Years) Middle Adulthood (41 to 60 Years) Late Adulthood (61 Years and Older)