Chapter Fourteen

The Personal Context of Later Life: Physical, Cognitive, and

Mental Health Issues

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?

The Demographics of Aging

• Demographers study population trends – Use population pyramids to illustrate these

trends• The number of older adults in developed

nations will increase even more by 2050– The number of older Asian-, Native-, and

especially Latino-Americans will continue to increase

• The number of U.S. people over 85 will increase by 500% between 2000 and 2050

Older Adults Globally

The Diversity of Older Adults

• Older women in the U.S. outnumber older men – True of all ethnic groups

• As of today, 50% of people over 65 have high school diplomas – 10% currently have college degrees– 75% will have college degrees by 2030

• Better educated people live longer due to higher incomes, giving them better healthcare access

Longevity

• Number of years a person can expect to live– Maximum life expectancy: oldest age to

which any person lives (circa 120 years)– Useful life expectancy: number of years a

person is expected to live free from debilitating chronic disease

– Average life expectancy: age at which half of the people born in a particular year will die in the U.S. • 80.4 years (women); 75.4 years (men)

Genetic and Environmental Factors in Life Expectancy

• Heredity is a major factor in longevity– Particularly true for those over 100

• Environment plays a role through the effects of disease, toxins, and risky behaviors

• Social class plays a role due to lack of access to health care

• The U.S. healthcare system is broken, especially for older adults (cf. Healthy People 2020)

Ethnic and Gender Differences in Life Expectancy

• Average life expectancy: Latin Americans > European Americans > African Americans

• U.S. women live longer than men by 5 years at birth, but only 1 year by age 85– Men are more susceptible to fatal

infectious diseases– Complex interactions of lifestyle, genetics,

and immune functioning differences • By age 90, however, men outperform women

on cognitive tests

The Third-Fourth Age Distinction

• Third age: ages of 60-80 (the young-old)– Knowledge and technological advances

contribute to their better life quality• Fourth age: over 80 (the oldest-old)

– Few interventions have been developed to reverse this group’s physiological, cognitive, and disease-related declines

The “Good News”: The Third Age (Young-Old)

• Increased life expectancy• Improved physical and mental fitness• High emotional and personal well-being• Good strategies to master life’s losses or

gains

The “Bad News”: The Fourth Age (Oldest-Old)

• Sizeable losses in cognition and learning potential

• Increases in chronic stress’s negative effects• High prevalence of:

– Dementia (50% in those over 90)– Frailty and multiple chronic conditions

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?

Biological Theories of Aging

• Rate-of-living theories– Relates a creature’s metabolism and age

• Cellular theories– Aging chromosomes’ telomeres

• Cross-linking– Muscles and arteries less flexible due to

certain proteins• Programmed theories

– Genetically programmed cell death

Physiological Changes

• Neuronal changes are common in older age• Alzheimer’s and related diseases involve

large changes in: – Declining neurotransmitters levels– Neuritic plaques: damaged or defective

neurons form around a core of protein– Neurofibrillary tangles: spiral-shaped

masses form in the axon’s fibers

Cardiovascular and Respiratory Systems

• Normative age-related changes • 50% of adults over 65 have hypertension

– Declining heart muscle tissue; fat deposits; artery stiffening due to calcification

• Transient ischemic attacks (TIAs) • Cerebral vascular accidents• Vascular dementia• Chronic obstructive pulmonary disease

(COPD)

Sensory Changes: Vision

• Night vision problems • Decreased adaptation • Poorer green-blue-violent color discrimination • Difficulties focusing and adjusting • Loss of acuity between 20 to 60 years,

especially with low light• Vision loss due to cataracts or glaucoma

Sensory Changes: Hearing

• Presbycusis: losing the ability to hear low-pitched sounds – Neural: loss of auditory pathway neurons– Metabolic: diminished nutrient supply to

receptor cells– Mechanical: atrophy and stiffening of the

receptor area’s vibrating structures– Sensory: atrophy and degeneration of

receptor cells

Sensory Changes: Other Senses

• Taste, touch, temperature, and pain sensitivity are not significantly age-related

• Detecting and distinguishing smells declines substantially in many after the age of 70– Very true of Alzheimer’s disease– Very dangerous (e.g., gas leaks)

• Older people fall more often due to changes in balance, eyesight, hearing, muscle tone, reflexes

Chronic Disease and Health Issues

• Diabetes mellitus– Type 1 Diabetes– Type 2 Diabetes

• Cancer• Health issues

– Sleep• Circadian Rhythms

• Nutrition

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?

Information Processing

• Psychomotor speed: how quickly a person reacts to make a specific response

• Slows with age in all situations, but especially in ambiguous ones– Occurs because older adults take longer to

decide whether they need to respond– May explain higher driving fatality rates in

very old people– Due to declines in the brain’s white matter

that aid faster neural transmission

Practical Aspects of Information Processing: Driving a Car

• Various tests predict whether drivers should be allowed to continue to drive– Useful field of view (UVOF): tests

information-processing speed; extraction of relevant information from irrelevant background information

– Clock drawing test– AAA’s “Roadwise Review”: assesses eight

functional areas

Working Memory

• Processes and structures involved in holding and using information in problem-solving, decision-making, and learning– Small in capacity– Without continued attention or rehearsal,

the information is “lost”• Declines with age• Poorer working memory and psychomotor

speed predict age-related declines in cognitive performance

Implicit and Explicit Memory

• Explicit memory: conscious and deliberate memory for previously learned information– Semantic memory: remembering the

meaning of words and concepts– Episodic memory: recalling information

about the world tied to a specific time or event (includes autobiographical memory)

• Implicit memory: unconscious and automatic memory about previously learned information as seen through one’s behavior or reactions

When Is Memory Change Abnormal?

• Most people worry about memory loss and its possible implications for disease

• A serious problem may be suspected when memory failures interfere with everyday life

• Detecting whether memory problems are serious requires thorough testing through: – Physical and neurological examinations– Batteries of neuropsychological tests

Remediating Memory Problems

• E-I-E-I-O framework: combines explicit vs. implicit memory with external vs. internal memory aids to create four types of memory interventions – Explicit-external aids– Explicit-internal aids– Implicit-external aids– Implicit-internal aids

Creativity and Wisdom: Creativity

• Creativity: ability to produce work that connects disparate ideas in novel ways– Predicted by how much white matter

connects distant brain regions and cognitive control over these connections

– Generally increases through the 30s, peaking in the early 40s

– However, the age at which people make major creative contributions has increased during the 20th century

Creativity and Wisdom: Wisdom

• Baltes and colleagues describe wisdom as: – Dealing with important matters of life and

the human experience– Superior knowledge, judgment, and advice– Knowledge with extraordinary scope,

depth, and balance– Being used with good intentions,

combining mind and virtue

• Wisdom is unrelated to age

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?

Depression

• Depression rates– 9% in younger adults compared to 4.5% in

older people living in the community; 13% in older adults requiring home healthcare

– Higher in older immigrant Latinos than native-born; and in older Latino- and European- than in African- or Asian-Americans

• Fewer than 40% of U.S. adults receive adequate treatment

How is Depression Diagnosed in Older Adults

• The feeling symptom cluster: dysphoria• The physical symptom cluster

– Loss of appetite, insomnia, and trouble breathing

– Must be carefully evaluated as symptoms of depression, because they may:• Reflect normal age-related changes • Have other physical, neurological,

metabolic, or substance abuse-related causes

What Causes Depression?

• Biological explanations stress neurotransmitter imbalances– Imbalances increase with age, while

depression declines with age• Internal belief systems play a role, e.g.,

– Believing one is personally responsible for bad events, or thinking things will not get better

• Older people have experientially-based coping skills to combat depression

How is Depression Treated in Older Adults

• Selective Serotonin Reuptake Inhibitors (SSRIs) are the most preferred– Boost mood-regulating serotonin levels

• Forms of psychotherapy– Cognitive therapy– Behavior therapy

Anxiety Disorders

• Excessive, irrational dread about everyday situations, including irrational severe anxiety, phobias, obsessions and/or compulsions

• Common in older adults, partly due to loss of health, relocation of residence, isolation, loss of independence

• Anxiety disorders can often be successfully treated with relaxation therapy and medications (e.g., benzodiazepenes, SSRIs, beta-blockers, and buspirone)

Dementia: Alzheimer’s Disease

• Alzheimer’s disease (AD): one form of dementia – Gradual declines in memory, learning,

attention, and judgment– Confusion as to time and place– Difficulty communicating– Declines in personal hygiene and self-care– Personality changes/inappropriate social

behaviors

How Is Alzheimer’s Disease Diagnosed?

• Only autopsies provide a definitive diagnosis– Should reveal very large numbers of

neurofibrillary tangles, structural neuronal changes, and amyloid plaques

• Diagnosis of possible AD is based on extensive neurological, psychological, and medical testing to rule out other causes, and interviewing the family for their accurate reports of behavioral symptoms

What Causes Alzheimer’s Disease?

• Cause(s) of AD are still being studied– Differ between its early vs. late onset

(younger vs. older than 60)• Autosomal dominant inheritance: genes with

100% accuracy in predicting early onset AD• Risk genes: three genes are known thus far

to increase the risk of later onset AD (e.g., APOE-e4 gene) – Increases risk even more if inherited from

both parents

What Can Be Done for Victims of Alzheimer’s Disease?

• AD cannot be treated or prevented• Drugs provide little long-term relief• Some symptoms can be alleviated• Spaced retrieval helps greatly

– An implicit-internal E-I-E-I-O method– Teaches people to remember new

information by gradually increasing the time interval between retrieval attempts

• Montessori educational methods also help

Parkinson’s Disease

• Slow hand tremors, shaking, rigidity, walking problems; difficulties getting in/out of a chair

• Caused by deteriorating dopamine production in the midbrain

• 30-50% of sufferers develop cognitive impairments and eventually dementia

• Symptoms are treated by: – Drugs that raise dopamine or aid its

delivery to the brain; neurostimulators

Chronic Traumatic Encephalopathy

• A form of dementia caused by repeated head trauma such as concussions– CTE can occur as the result of repeated

brain trauma not only in sports but also through other causes such as military combat

– Emerging evidence shows that irrespective of the cause, there is structural damage to various parts of the brain that have to do with executive functions and memory