Chapter Fourteen

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?

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%. 29-29 yo will increase 50%.

Places a strain on pension and health care systems

Fastest growing age in the population Is over 85

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

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

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.

Average life expectancy has increased due to decreased infant and maternal mortality

Elimination of smallpox, polio Improvements in medical technology

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

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

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

Dramatic differences exist between longevity statistics among countries 38 in Sierra Leone 82 in Japan

Genetic, sociocultural, and healthcare factors contribute to the differences

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

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

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

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

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

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?

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

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

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

Metabolic Theories These theories examine the interaction

between caloric intake and stressProgrammed 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

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.

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

.

Structural – X-Rays, CT, MRIFunctional – shows brain activity,

single photon emission computerized tomography (SPECT), positron emission tomography (PET), magnoencephalography (fMRI), near infrared spectroscopic imaging (NIRSI)

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

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

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

TX-medications, levodopa, sinemet, staleva

Surgically implant a neurostimulator in the brain which acts like a brain pacemaker

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

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

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.

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

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

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

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

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?

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

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

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

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

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

Stereotypes about older people and memory loss impacts what elderly people believe about their own abilities, affecting strategies for remembering

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

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

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

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

General personal conditions, such as mental ability

Specific expertise conditions, such as practice or mentoring

Facilitative life contexts, such as education or leadership experiences

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?

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

Depression rates decline from early adulthood to old age. Average onset is early 30s

Latino and European rates are equalAfrica American and Asian rates are

lower for older adults Immigrant Latinos have higher ratesRates rise for those having home

health care

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

Depressed people tend to believe that-

They are personally responsible for the bad things that happen to them

Things are unlikely to get betterTheir whole life is in shambles

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

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.

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

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

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

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

The exact cause is not knownPossible 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

Familial,early Alzheimer’s before age 60 – certain genes indicate 100% chance of developing Alzheimer’s

Later onset may be linked to risk genes

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