©2005 McGraw-Hill Ryerson Ltd. Chapter 17 Physical and Cognitive Development in Late Adulthood

©2005 McGraw-Hill Ryerson Ltd.

Chapter 17

Physical and Cognitive Development in Late Adulthood


Physical and Cognitive Development

in Late Adulthood

Longevity

The Course of Physical Development

in Late Adulthood

Physical and Mental Health

and Wellness

Religion and Spirituality in

Later Adulthood

Cognitive Functioning in Older Adults


Longevity

Life Expectancy

and Life Span

The Young Old,

the Old Old,

and

the Oldest Old

The Robust

Oldest Old

Biological

Theories of

Aging


Life Expectancy and Life Span

• Life span – the upper boundary of life; the maximum number of years an individual can live.

• The maximum life span of human beings is approximately 120 years of age.

• Life expectancy – the number of years that will probably be lived by the average individual born in a particular year.

• The life expectancy of individuals born today in the Canada is 79.9 years.


Centenarians

• Today, there are 4,320 centenarians living in Canada.

• It is projected that this number will increase to 45,000 by 2046.

• Research reveals that many centenarians are quite healthy in their old age.

• Centenarians are a robust group, as many have had difficult lives.

• Such rapid growth in the older population will most likely lead to a variety of societal changes.


Gender Differences in Longevity

• Today, life expectancy for females is 81.4, males 75.7.

• Beginning at age 45, females outnumber males, and the gap continues to grow.

• By the time adults are 70–74 years of age, more than 53.4% of the population is female.

• These differences are due to health attitudes, habits, lifestyles, and occupation.

• Biological factors play a role, too, as females outlive males in virtually all species.


The Young Old, the Old Old, and the Oldest Old

• Late adulthood has the longest span of any period of human development—50–60 years.

• Developmentalists thus distinguish between subperiods in this stage, although definite age boundaries are not yet agreed upon.

• The young old are 65–74 years of age.• The old old are 75 years and older.• Some distinguish the oldest old as 85 years and older.• Many experts prefer to make the distinction based on

functioning, rather than age.


The Robust Oldest Old

• The oldest old are much more likely to be female.• They have a much higher rate of morbidity and a greater

incidence of disability than the young old.• They are much more likely to be living in institutions, less

likely to be married, and more likely to have low educational attainment.

• A substantial portion function effectively, and the majority continue to live in the community.

• Forty percent say they have no activity limitation.


Biological Theories of Aging

• Cellular Clock Theory

• Free-Radical Theory

• Hormonal Stress Theory


Cellular Clock Theory

• Leonard Hayflick’s view that cells can divide a maximum of about 75–80 times and that, as we age, our cells become increasingly less capable of dividing.

• Thus, Hayflick places the upper limit of the human life span at about 120 years.

• Recent research has shown that telomeres are DNA sequences that cap chromosomes, and that each time a cell divides, telomeres become shorter and shorter.

• Age-related telomere erosion has been found to be linked with an impaired ability to recover from stress and an increased rate of cancer formation.


Free-Radical Theory

• States that people age because inside their cells normal metabolism produces unstable oxygen molecules known as free radicals.

• These molecules ricochet around the cells, damaging DNA and other cellular structures.

• This damage can lead to a range of disorders, including cancer and arthritis.


Hormonal Stress Theory

• Aging in the body’s hormonal system may lower resilience to stress and increase likelihood of disease.

• With age, hormones stimulated by stress that flow through the hypothalamic-pituitary-adrenal system remain elevated longer than when we were younger.

• These prolonged, elevated levels of stress-related hormones are associated with increased risks for many diseases including heart disease and cancer.


The Course of Physical Development

in Late Adulthood

The Aging Brain

Physical Appearance

Sensory Development

Sexuality

The Respiratory System

The Circulatory System


The Aging Brain

• Recent research has shown that adults continue to grow new brain cells throughout their lives.

• Even in late adulthood, the brain has remarkable repair capability.

• Growth of dendrites has been observed to continue through the 70s.

• Brain activity of older and younger people were compared; it was observed that older brains literally rewired themselves to compensate for losses.


General Slowdown in Central Nervous System Functioning

• A general slowing down of central nervous system functioning in middle adulthood increases in late adulthood.

• The slowdown affects physical coordination and intellectual performance.


Conclusions about Older Brains

• It appears that aging brains can shift responsibilities for a given task from one region to another.

• Neuroscientists believe the brain has a remarkable capacity to change and grow, even in old age.

• Stimulating the brain with mental exercises may cause neurons to increase their dendritic branching.

• These findings offer new possibilities for preventing and treating brain diseases such as Alzheimer’s and stroke.


Physical Appearance

• The changes that take place in middle adulthood become more pronounced in late adulthood.

• The changes are most noticeable in the form of facial wrinkles and age spots.

• We get shorter when we get older.• Our weight usually drops after we are 60, most likely due

to muscle loss, which causes us to look “saggy.”• http://vad.mhhe.com/provided_module.cfm?ModuleID=2

28 (The Myths and Realities of Growing Old: “Have I Changed Since Age 20?”)

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http://vad.mhhe.com/provided_module.cfm?ModuleID=228


Sensory Development

• Vision

• Hearing

• Smell and Taste

• Touch

• Pain


Vision

• Any decline in vision that began in early or middle adulthood becomes more pronounced.

• Night driving is particularly difficult.• Dark adaptation is slower.• Visual field becomes smaller.• A recent study discovered that sensory acuity,

especially in vision, was related to whether and how well elderly adults bathed and groomed themselves, completed chores, engaged in intellectual activities and watched TV.


Other Vision Problems

• Cataracts – cloudy, opaque areas in the lens of the eye that prevent light from passing through, causing blurred vision.

• Glaucoma – a disease that involves a hardening of the eyeball because of fluid buildup in the eye.

• Macular Degeneration – a disease involving deterioration of the retina.


Hearing

• Hearing impairment may begin in middle age, but doesn’t become an impediment until late adulthood.

• Seventy-five percent of individuals aged 75–79 experience some type of hearing problem.

• Fifteen percent of those over 65 is legally deaf.• This hearing loss is usually due to the

degeneration of the cochlea, the primary neural receptor for hearing in the inner ear.


Smell and Taste

• Most older adults lose some of their sense of smell, taste, or both.

• Smell and taste losses often begin around 60 years of age.

• Many older adults often prefer highly seasoned foods to compensate for their diminished senses.

• This may lead to eating more non-nutritious, highly seasoned junk food.


Touch and Pain

• Studies have shown that with aging, individuals could detect touch less in the lower extremities than in the upper extremities.

• For most older adults, this decline is not a problem.• Older adults are less sensitive to pain and suffer from it

less than younger adults.• This can be harmful if it masks injury and illness that

need to be treated.


The Circulatory System

• When heart disease is absent, the amount of blood pumped through the heart is the same regardless of an adult’s age.

• Some experts argue that the healthy heart may even become stronger as we age through the adult years, with capacity increasing, not decreasing.

• Illness, obesity, anxiety, stiffening of blood vessels, or lack of exercise may cause blood pressure to rise with age.

• High blood pressure should be treated.


The Respiratory System

• Lung capacity drops 40% between the ages of 20 and 80, even without disease.

• Lungs lose elasticity, the chest shrinks, and the diaphragm weakens.

• Diaphragm-strengthening exercises can improve lung functioning.


Sexuality

• In a study of more than 1,200 elderly people, almost 30% had participated in sexual activity in the past month.

• In the absence of disease, sexuality can be lifelong, though aging does induce some changes.

• Orgasm becomes less frequent in males, and more direct stimulation is needed for erection.

• When intercourse is impaired by infirmity, closeness and sensuality needs persist.


Physical and Mental Health

and Wellness

Health Problems

Exercise, Nutrition, and Weight

Nature of Mental Health in Older Adults

Health Promotion

Dementia, Alzheimer’s Disease, and

Related Disorders

Depression


Health Problems

• Causes of Death in Older Adults

• Arthritis

• Osteoporosis

• Accidents



Causes of Death in Older Adults

• Heart Disease• Cancer• Stroke• Chronic Lung

Diseases• Pneumonia• Influenza• Diabetes


Arthritis

• Inflammation of the joints accompanied by pain, stiffness, and movement problems.

• Arthritis is especially common in older adults.• This disorder can affect hips, knees, ankles,

fingers, and vertebrae.• There is no known cure for arthritis, but

symptoms can be reduced by drugs, range-of-motion exercises, weight reduction, and joint replacement.


Osteoporosis

• An aging disorder involving extensive loss of bone tissue.

• The main reason many older adults walk with a marked stoop.

• Women are especially vulnerable to osteoporosis, the leading cause of broken bones in women.

• Afflicts two-thirds of women over age 60.• Related to deficiencies in calcium, vitamin D,

estrogen depletion, and lack of exercise.


Prevention and Treatment

• Eat foods rich in calcium, get more exercise, and avoid smoking.

• Estrogen replacement therapy may also be recommended for high-risk individuals, except those with a history of breast cancer.

• Certain drugs can be used to reduce the risk.• Older women should also get bone

density checks.


Accidents

• Injuries resulting from a fall at home or during a traffic accident are common.

• 618 of every 100,000 people over the age of 65 fractured a hip.

• Half of these adults die within 12 months, frequently from pneumonia.

• One study showed an exercise program reduced the risk of falls in elderly adults.


Exercise, Nutrition, and Weight

• Exercise

• Nutrition and Weight

• The Growing Controversy over Vitamins and Aging


Exercise

• Older adults are healthier and happier the more active they are.

• In a study of over 17,000 men and women, sedentary participants were more than twice as likely to die during the 8-year study as moderately fit participants.

• Another study showed that starting a moderately vigorous sports activity from the 40s through the 80s was associated with a 23% lower risk of death.

• Gerontologists recommend strength training too.


Nutrition and Weight

• Evidence shows food restriction in lab animals can increase life span.

• Animals fed restricted diets live as much as 40% longer than animals given unlimited food access.

• Diet restrictions also delay biochemical alterations that contribute to poorer health and aging.

• Leaner men live longer, healthier lives.• Current research is exploring the link between

body mass index and longevity in women.


The Growing Controversy over Vitamins and Aging

• Research shows antioxidants—vitamin C, vitamin E, betacarotene—help slow the aging process and improve the health of older adults.

• Antioxidants counteract the cell damage caused by free radicals.

• No evidence shows antioxidants can increase the life span, but some experts believe they can reduce one’s risk of becoming frail and sick in later years.

• We still don’t know which vitamins should be given and in what doses.


The Nature of Mental Health in Older Adults

• Mental disorders make individuals increasingly dependent on the help and care of others.

• Although mental disorders in older adults are a major concern, they do not have a higher incidence of mental disorders than younger adults.

• Mental disorders make individuals increasingly more dependant on others.


Depression

• Major depression is a mood disorder in which the individual is deeply unhappy, demoralized, self-derogatory, and bored.

• The individual with major depression does not feel well, loses stamina easily, has a poor appetite, and is listless and unmotivated.

• Depression is a treatable condition.• Major depression can result in suicidal

tendencies.


Dementia, Alzheimer’s Disease, and Related Disorders

• Dementia

• Alzheimer’s Disease

• Multi-infarct Dementia

• Parkinson’s Disease


Dementia

• Dementia is a global term for any neurological disorder in which the primary symptoms involve a deterioration of mental functioning.

• Individuals with dementia often lose the ability to care for themselves and may lose the ability to recognize familiar surroundings and people.

• Over seventy types or causes of dementia have been identified.

• It is estimated that 20% of individuals over the age of 80 have dementia.


Alzheimer’s Disease

• Causes and Treatments

• Early Detection of Alzheimer’s Disease

• Progressive Decline • Caring for Individuals with

Alzheimer’s Disease


About Alzheimer’s Disease

• The most common form of dementia.• It is a progressive, irreversible disorder that is

characterized by gradual deterioration of memory, reasoning, language, and eventually physical functioning.

• As Alzheimer’s disease progresses, deterioration and shrinking of the brain occurs.

• Approximately 240,000 people over the age of 65 in the Canada have Alzheimer’s disease.


Causes and Treatment

• Efforts to identify the cause of Alzheimer’s have not yet been successful.

• What scientists now believe is that Alzheimer’s disease is a complex unraveling of neural structure and function that likely involves many different molecular and cellular dimensions.

• The disease involves a deficiency in acetylcholine, which plays an important role in memory.

• The main drug used to treat Alzheimer’s disease works by blocking chemicals that ordinarily cut acetylcholine apart.


Early Detection of Alzheimer’s Disease

• Brain scans such as an MRI (magnetic resonance imaging) can detect changes in the brain that are fairly typical of early Alzheimer’s disease even before symptoms develop.

• Certain spinal fluids give reasonably good clues of early signals of Alzheimer’s disease.

• Recently a sophisticated urine test called the neural thread protein has predicted the occurrence of Alzheimer’s in some individuals two years before the symptoms appear.


Progressive Decline

• There is a predictable, progressive decline in physical, cognitive, and social functioning when individuals have Alzheimer’s disease.

• Once diagnosed, most patients live approximately 8 years.

• They progress from early problems of memory loss and declining intellectual function to later stages in which hospitalization in a near vegetative state ensues.


Caring for Individuals with Alzheimer’s Disease

• There is a predictable, progressive decline in physical, cognitive, and social functioning when individuals have Alzheimer’s disease.

• Once diagnosed, most patients live approximately 8 years.

• They progress from early problems of memory loss and declining intellectual function to later stages in which hospitalization in a near vegetative state ensues.


Multi-infarct Dementia

• Involves a sporadic and progressive loss of intellectual functioning caused by repeated temporary obstruction of blood flow in cerebral arteries.

• The result is a series of mini-strokes which the individual usually recovers from quickly.

• Symptoms include confusion, slurring of speech, writing impairment, and numbness on one side of the face, arm, or leg.

• Approximately 35–50% of people who have these attacks will have a major stroke within 5 years unless the underlying problems are treated.


Parkinson’s Disease

• Parkinson’s disease is a chronic, progressive disease characterized by muscle tremors, slowing of movement, and partial facial paralysis.

• It is triggered by degeneration of dopamine-producing neurons in the brain.

• Dopamine is a neurotransmitter that is necessary for normal brain functioning.

• Why the degeneration of the production of dopamine occurs is not known.

• A drug called L-dopa is the main treatment of Parkinson’s disease.


Health Promotion

• Care Options• Prescription Drug Use• Giving Options for Control and

Teaching Coping Skills • Meeting the Mental Health Needs of

Older Adults• Health Care Provision, the Older

Adult, and Health Care Providers


Care Options

• Only about 7.3% of adults age 65 and over reside in a nursing home at any point in time.

• Due to nursing home care costs , gerontologists believe alternatives need to be considered.

• Alternatives include home health care, day-care centres, and preventive medicine clinics.

• They are cheaper and less likely to engender feelings of depersonalization and dependency.


Prescription Drug Use

• Seniors use more prescription drugs in Canada than any other single age group.

• Inappropriate use of prescription drugs result in 30% of hospitalizations of people over 65 years.

• 50% of seniors do not take their medications as prescribed.

• It is critical that care providers manage their medications.


Giving Options for Control

• Having a sense of personal control is found to be important both physically and psychologically.

• Ellen Langer argues that it is extremely important for aging individuals to understand that they can choose the way they think.

• She has shown one reason people act old is that they base their actions on mental images of stereotypic old people.

• When people were induced to think of themselves as younger, they showed many outward changes and had a more positive outlook on life.


Teaching Coping Skills

• Being in control reduces stress and stress-related hormones.

• Nursing home residents were given assertiveness training and learned time management skills.

• Their subsequent levels of cortisol were greatly reduced and remained lower 18 months after training.

• The residents were also healthier and had reduced need for medication compared with residents without training.

• Training changed their behaviour and improved health.


Meeting the Mental Health Needs of Older Adults

• Some common mechanisms of change that improve the mental health of older adults are:– fostering a sense of control, self-efficacy, and hope– establishing a relationship with a helper– providing or elucidating a sense of meaning– promoting educative activities and development of

skills• Psychologists must be encouraged to include more older

adults in their client lists.• The elderly must be convinced that they can benefit from

therapy.• Mental health care must be made affordable.


Health Care Provision, the Older Adult, and Health Care Providers

• People over 65 use physicians more than any other group, have more hospital admissions, and have generally longer stays.

• Approximately 12% of people over the age of 65 receive Home Care.

• Too often, health-care providers share society’s stereotypes and negative attitudes toward the elderly.

• Older patients tend to take a less active role in medical encounters with health-care providers.


Cognitive Functioning

in Older Adults

The

Multi-dimensional,

Multi-directional

Nature of Cognition

Education, Work,

and Health: Links

to Cognitive

Functioning

Promoting

Cognitive Skills

in Later Life


The Multi-dimensional, Multi-directional Nature of Cognition

• Cognitive Mechanics and Cognitive Pragmatics

• Sensory/Motor and Speed-of-Processing Dimensions

• Memory

• Wisdom


Cognitive Mechanics

• The hardware of the mind; reflect the neurophysiological architecture of the brain developed through evolution.

• Involve the speed and accuracy of the processes involving sensory input, visual and motor memory, discrimination, comparison, and categorization.

• Due to the strong influence of biology, heredity, and health on cognitive mechanics, their decline with age is likely.


Cognitive Pragmatics

• The culture-based software programs of the mind.

• Include reading and writing skills, language comprehension, educational qualifications, professional skills, and also the type of knowledge about the self and life skills that help us to master or cope with life.

• Because of the strong influence of culture on cognitive pragmatics, their improvement into old age is possible.


Sensory/Motor and Speed-of-Processing Dimensions

• The speed of processing information declines in late adulthood.

• There is, however, considerable individual variation in this ability.

• It is not clear that this slowdown affects our lives in substantial ways.

• Studies indicate we may engage in compensatory behaviours, so as to not be hindered by the slowdown.


Memory

• Episodic Memory• Semantic Memory• Cognitive Resources: Working Memory

and Perceptual Speed• Explicit and Implicit Memory• Memory Beliefs• Noncognitive Factors• Conclusions about Memory and Aging


Episodic Memory

• The retention of information about the where and when of life’s happenings.

• Younger adults have better episodic memory than older adults, even though older adults think that they can remember older events better than more recent events.

• Researchers have consistently found that in older adults the older the memory, the less accurate it is.


Semantic Memory

• A person’s knowledge about the world. • It includes a person’s fields of expertise, general

academic knowledge of the sort learned in school, and “everyday knowledge.”

• Semantic memory appears to be independent of an individual’s personal identity with the past.

• For the most part, episodic memory declines more in older adults than semantic memory.


Cognitive Resources: Working Memory and Perceptual Speed

• Working memory is the concept currently used to describe short-term memory as a place for mental work.

• Perceptual speed is the ability to perform simple perceptual-motor tasks such as deciding whether pairs of two-digit or two-letter strings are the same or different.

• Researchers have found declines in working memory and perceptual speed during the late adulthood years.


Explicit and Implicit Memory

• Explicit or declarative memory – memory of facts and experiences that individuals consciously know and can state.

• Implicit memory – memory without conscious recollection; it involves skills and routine procedures that are automatically performed.

• Implicit memory is less likely to be adversely affected by aging than explicit memory.


Memory Beliefs

• Research shows that people’s beliefs about memory play an important role in their actual memory.

• What people tell themselves about their ability to remember matters.

• Findings have shown a relationship between positive and negative beliefs about one’s memory and actual memory performance.


Noncognitive Factors

• Positive aspects of these noncognitive factors are associated less with memory decline; they do not eliminate it.

• Researchers have found that using more everyday life memory tasks in their studies reduces age decrements in memory but does not eliminate them.


Conclusions about Memory and Aging

• Some, but not all, aspects of memory decline in older adults.

• The decline occurs primarily in episodic and working memory, not in semantic memory.

• A decline in perceptual speed is associated with memory decline.

• Successful aging does not mean eliminating memory decline, but reducing it and adapting to it.


Wisdom

• Expert knowledge about the practical aspects of life that permits excellent judgment about important matters.

• Focuses on life’s pragmatic concerns and human conditions.

• Research shows no age differences in wisdom.• Wisdom involves solving practical problems.• Research indicates that older adults are quite

competent in problem solving with regard to everyday types of situations.


Education, Work, and Health: Links to Cognitive Functioning

• Education

• Work

• Health


Education

• More older adults are returning to college today to further their education.

• Educational experiences are positively correlated with scores on intelligence tests and information processing tasks, such as memory.

• Older adults seek more education to: – remain competitive in the workforce – learn about societal and technological changes – enhance their self-discovery


Work

• Successive generations have had work experiences that include a stronger emphasis on cognitive-oriented labour.

• The increased emphasis on information processing jobs likely enhances an individual’s intellectual abilities.

• One recent study linked substantive complex work with higher intellectual functioning in older adults.

• Exposure to complex environments increases intellectual functioning throughout the life course.


Health

• In a recent study, physical health and physical activity were positively related to cognitive performance in older adults.

• K. Warner Schaie concluded that some diseases are linked to cognitive dropoffs, most likely due to the lifestyles of the individuals with diseases.

• Overeating, inactivity, and stress are related to both physical and mental decay.

• Walking or any other aerobic exercise appears to get blood and oxygen pumping to the brain, which may help people think more clearly.


Promoting Cognitive Skills in Late Life

• Possibly changes in cognitive activity patterns result in disuse and consequent atrophy of cognitive skills.

• In the Victoria Longitudinal Study, when middle-aged and older adults participated in intellectually engaging activities it served to buffer them against cognitive decline.

• The mental activities that likely benefit the maintenance of cognitive skills in older adults are reading books, doing crossword puzzles, and going to lectures and concerts.


Religion and Spirituality in Later Adulthood

• A recent study showed that individuals who said they rarely or never prayed had about a 50% greater risk of dying during the 6-year study compared with their counterparts who prayed or meditated at least once a month.

• Possibly the lower incidence of death in these individuals occurred because prayer and meditation reduce stress and dampen the body’s production of stress hormones.

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©2005 McGraw-Hill Ryerson Ltd. Chapter 17 Physical and Cognitive Development in Late Adulthood