Chapter Fourteen. What are the characteristics of older adults in the population? How long will...
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Transcript of Chapter Fourteen. What are the characteristics of older adults in the population? How long will...
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