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Physical and Cognitive Development in Late Adulthood

By Leon Berry,2014-03-28 18:09
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Physical and Cognitive Development in Late Adulthood

    Physical and Cognitive Development in Late Adulthood

    Physical Development

    ; Functional age is the actual competence and performance a person displays,

    regardless of chronological age. People age biologically at different rates:

    o Young-old elderly appear physically young for their years.

    o Old-old elderly appear frail and show signs of decline.

    Life Expectancy

    ; Average life expectancy is the number of years that a person born in a particular

    year can expect to live. This has to do with nutrition, medical treatment available,

    safety. This has changed dramatically since 1900, when the average life

    expectancy was less than 50 years. Today, a person born in 2000 can expect to

    live 74 years (M) or 80 years (F). Certain death rates have declined greatly-

    especially heart disease- has dropped by 50% in the past 30 years due to declines

    in high blood pressure and smoking risks.

    ; Variations in life expectancy relate to gender (women can expect to live 4-7

    years longer than men due to the protective factor of the extra X chromosomes.)

    White people will generally outlive African-American people and Native-

    American people. This seems related to higher rates of infant mortality,

    unintentional injuries, life-threatening disease, poverty-linked stress, and higher

    levels of violent death in low-SES minority groups. Quality of life can be

    predicted by a country’s health care, housing and social services.

    o Active lifespan is the number of years of vigorous, healthy life a person thborn in a particular year can expect. Japan is first, and the US is 24.

    Japan has a low rate of heart disease due to the low-fat diet, along with

    good health care and positive policies that benefit the elderly. In

    developing nations the life expectancy is closer to 50 years, and active

    lifespan is shorter- 44 in Haiti, 38 in Afghanistan, 26 in Sierra Leone.

    ; Life expectancy in late adulthood- in the US, people age 65+ have grown in

    numbers- in North America, they have increased from 4% to 13%. The fastest

    growing group of elders is those 85+. The gender difference expands with age- at

    65 there are 111 women per 100 men. At 85+ there are 160 women for 100 men.

    o Life expectancy crossover surviving members of low-SES ethnic

    minority groups live longer than members of the white majority. Perhaps

    only the sturdiest males and females of low-SES groups survive into very

    old age, so they actually can outlive those in more favored groups. After

    people reach 75 years, heredity is not the same impact that environment is-

    now lifestyle makes the difference- diet, normal body weight, exercise,

    little substance use, optimistic outlook, low stress and social support.

    ; Maximum lifespan is the genetic limit to length of life free of external risk

    factors. 85 seems about average, but the oldest verified age is 122.

    Physical changes

    ; Centenarians’ secrets centenarians have increased 10 times in the past 40 years.

    Women outnumber men by 4/1. 60-70% have disabilities that prevent

    independent living, but many lead active lives. What do they do differently?

    o Health and longevity seems to run in families, so there is an inherited

    aspect to long lived survival. They also haven’t had many chronic illness.

    They have efficient immune systems and few brain abnormalities. Most

    never smoked and were physically active into their late years.

    o Personality is optimistic, not fear-driven. They score high in

    independence, hardiness, emotional security and openness to experience.

    They also cite close family bonds and a long and happy marriage.

    o Activities include community involvement, work, and leisure activities

    and continued learning.

    ; Nervous system impairments show up more after age 60, as the brain tissue declines due to loss of neurons and larger ventricles within the brain. As many as 50% of neurons may die in the visual, auditory, and motor areas of the brain. The cerebellum, which controls motor coordination, loses about 25% of neurons. Even so, aging neurons can establish new synapses in the wake of lost neurons. So parts of the brain compensate for lost ports. Temperature management is poorer as the autonomic nervous system is less efficient. So elderly are at greater risk during extreme weather.

    ; Sensory Systems there is reduced sensitivity with aging.

    o Vision is reduced in dim light, and in nearby focus, as well as color

    perception. The cornea becomes more translucent and scatters light which

    blurs images. The lens yellows which affects color discrimination.

    ; Cataracts are cloudy areas in the lens which blur vision and can

    cause blindness if there is no surgery. There is poorer dark

    adaptation when coming in from the light. Depth perception is also

    compromised since binocular vision declines, as well as visual

    acuity.

    ; Macular degeneration occurs when light-sensitive cells in the

    macula, the central region of the retina break down, resulting in

    blurry central vision, and eventual blindness. A diet high in anti-

    oxidants can delay this condition. Driving may need to be curtailed

    at a certain point, as the older driver has a harder time

    discriminating the road distractions and signs. This is a hard thing

    to give up, since it signals physical dependence on others. Elders

    also are at higher risk of stumbling and serious falls at this point, as

    they don’t see changes in the floor and accommodate smoothly.

    o Hearing is impaired with reduced blood supply and death of the sense

    organs in the ear, the cilia, as well as the auditory cortex in the brain. The

    eardrum also stiffens, so not as much sensation gets to the inner ear. High

    frequencies are first to go. It is harder to distinguish speech in loud

    environments, especially after age 70. Hearing loss can affect safety,

    especially for pedestrians and drivers. Deafness is isolating, as people lose

    patience trying to communicate with deaf people. It also links to a certain

    paranoia, as deaf people fear others are talking about them. Many people

    learn to read lips as they experience hearing loss, so there are adaptations

    that can be made, if others will cooperate and help.

    o Taste and smell declines somewhat, and people may have difficulty

    recognizing familiar foods by taste alone. It may be due to dentures,

    smoking, medications or even strokes. If food tastes less, it is also less

    appealing, so diet may become poorer. Smell is also related to enjoying

    food, but also protects the person from bad food, gas fumes, or smoke.

    Smell receptors are lost after age 60, and odor perception often becomes

    distorted in late adulthood.

    o Touch perception declines after age 70. There is a loss of touch receptors

    as well as a slowing of blood circulation in the extremities.

    ; Cardiovascular and respiratory systems are affected by aging as the heart

    muscle becomes more rigid and some cells enlarge, thickening the left ventricle. Arteries stiffen and accumulate plaque. So the heart pumps with less force, and blood flow slows. So during activity, sufficient oxygen may not be delivered to critical tissues. Lung tissue also loses elasticity, & capacity is reduced by half. The blood absorbs less oxygen and expels less carbon dioxide. People feel more out of breath when exercising. This is more of a problem for people who have smoked, had a high-fat diet, or been exposed to pollutants. Exercise facilitates respiratory function.

    ; Immune system declines as T cells become less effective.

    o Auto-immune response is a problem when the immune system turns

    against normal body tissues. This puts elders at risk of infectious diseases,

    CVD, cancers, rheumatoid arthritis, or diabetes. The more impaired the

    immune system is, the more at risk the person is to a variety of agents.

    ; Sleep is essential for healthy functioning all one’s life, but as we age, sleep is harder to come by, as elders sleep less, more lightly, and have more trouble going to sleep. Men seem to have more sleep problems than women, due to the enlargement of the prostate gland and the need to urinate more often at night.

    o Sleep apnea is a condition where breathing ceases for 10 sec. or more,

    causing the person to awaken with a start to breathe again. This afflicts

    more men than women, but overweight people have problems with this

    condition, as more weight is pressing on the lungs, requiring more effort to

    keep breathing. Legs also move rapidly during the night- “restless legs”

    and this can disrupt sleep, too. Unfortunately poor sleep can afflict

    daytime energy, resulting in a cycle of downward energy, even depression.

    More prescriptions for sleep aids are given to older adults, but they can

    have rebound effects later with greater insomnia.

    ; Physical appearance and mobility involve changes in the skin, hair, facial

    structure, and body build. The face most often shows the ravages of aging skin. The only structures to continue to grow are the nose and ears, as cartilage continues to grow. Hair thins and loses pigment. Height declines as the spine collapses with bone loss. Mobility declines as muscle strength declines- 30 50%

    declines after ages 70. Stretching exercises can reduce this decline.

    ; Adapting to physical changes of late adulthood we can do much more to

    improve physical and cognitive skills than to delay wrinkling or external signs of aging, but many products are hawked because people are more willing to spend money on products than do the hard work of staying active.

    o Coping strategies include both problem-centered and emotion-centered

    coping. The more people take charge of their lives the greater control they

    feel about their fates. People can use compensating techniques to adapt to

    sensory losses, if they will make the effort. The more passive people are,

    the more they report negative adjustment to life.

    o Assistive technology is devices that permit people with disabilities to

    improve their functioning. They include computers, phones that can be

    dialed by voice command, or print out the speech of the caller allow blind

    or deaf elders to maintain independence. A computer chip can be placed

    on medicine bottles to remind elders to take meds on schedule. Smart

    homes promote safety and mobility.

    o Stereotypes of aging include the idea that “deterioration is inevitable” and

    result in younger people talking down to elders, or ignoring them entirely.

    The more negatively stereotyped elders are, the more negatively their

    response to stress, producing poorer handwriting, memory, and will to live.

    The more control seniors are allowed, the longer they live, and the better

    their quality of life is. The more positive a culture views its elders, the

    better quality of life those elders sustain.

    ; Cultural differences in aging in many varieties of culture, elders fare best

    when they retain social status and opportunities for community participation. The

    more they are excluded from social roles, aging reduces well-being. A tribe in

    Botswana treats aging as a marker of wisdom even making the eldest man and

    wife the village leaders. And as other elders become frail, children are sent to care

    for them, but it is considered a role of pride and prestige. In cultures where elders

    are segregated, they tend to dwell more on their disabilities and exclusion from

    younger, more powerful members of society. There develops a resentment

    between the generations, instead of an integration and enhancement of wisdom

    due to learning from the elders.

    Health, Fitness, and Disability- health is central to well-being in later life. Most elders do rate their health positively, & optimism is related to coping abilities in the area of health. There is possibility of overcoming a disability, especially if the elder has a desire to rehabilitate. African-American and Hispanic elderly are at greater risk for certain health problems, especially since they have more people living below the poverty line. Native-Americans are at even higher risk, health-wise, due to such high poverty rates- over 80%. By very old age, women are more impaired than men, since only the hardiest men have survived to this age.

    ; Compression of morbidity is the goal of reducing the period of disability in old

    age.

    ; Poverty rates and health problems of elderly ethnic minorities

    o African-American- 23% in poverty- risks of CVD, cancer, diabetes

    o Hispanic- 20% in poverty- risks of CVD, diabetes

    o Native-American- 80%+- diabetes, kidney disease, liver disease, TB,

    sensory impairments

    ; Nutrition and exercise Diet actually needs to be enriched with vitamins and

    minerals to protect elders’ immune system and bones. But many people have a

    poorer diet than in the past. Supplements can help, as well as weight-bearing exercise. Exercise also improves blood circulation to the brain, which enhances cognitive function and brain tissue. Exercise also contributes to higher sense of physical self-esteem. Unfortunately, those with chronic illnesses tend to think rest and sedentary life style if more healthful.

    ; Sexuality there is a decline in sexual desire and frequency of activity in older people, but desire is often still there. Good sex in the past predicts good sex in the future. Availability of a partner is still a powerful determiner of activity. Often when men have more trouble holding an erection they will refrain to act sexual, fearing embarrassment sexually. Certain illnesses and medications can impact blood flow to the penis- CVD, diabetes, meds for depression or high blood pressure. Unfortunately in our culture, sex among the elderly is viewed with disapproval.

    ; Physical disabilities do increase toward the end of the lifespan, especially illnesses such as CVD and cancer. Respiratory diseases also climb in late adulthood- emphysema is caused by loss of elasticity in lung tissue- most result from smoking. As the immune system declines, more people are at risk of thpneumonia, severe lung inflammation. Stroke is 4 most common killer in the

    elderly. There is a blockage of blood flow in the brain which leads to death of neural tissue and accompanying loss of function. Osteoporosis rises in late

    adulthood, as well as arthritis. Adult-onset diabetes and unintentional injuries

    also increase in late adulthood. These illnesses are not caused by aging, but are related to age- they occur more often in the aged.

    o Primary aging biological aging that occurs even in the context of good

    health.

    o Secondary aging is declines in function due to hereditary defects and

    negative environmental influences, poor diet, lack of exercise, disease,

    substance abuse, environmental pollution, and stress.

    ; Arthritis is a condition of inflamed, painful, stiff or swollen joints

    and muscles. There are 2 forms:

    ; Osteo-arthritis is the most common type- due to

    deteriorating cartilage on the ends of bones- “degenerative

    joint disease”. Cartilage that cushions the bones in joints

    deteriorates, so there is more discomfort with movement.

    Obesity can place abnormal pressure on joints and damages

    cartilage, too.

    ; Rheumatoid arthritis is an autoimmune disease that

    involves the whole body. There is inflammation of

    connective tissue, there is stiffness, inflammation, and

    aching. Deformed joints develop, reducing mobility.

    ; Disability due to arthritis affects 45% of American men

    over 65 & 52% of women. Water-based exercise can

    reduce pain and ensure mobility. Meds are prescribed for

    pain, but they can affect the stomach lining and cause

    ulcers, if the person is not careful.

    ; Adult-onset diabetes occurs when the insulin output of the

    pancreas can’t control blood sugar after a meal. High blood sugar

    damages the blood vessels, increases risk of stroke, heart attack,

    circulatory problems in the legs, and injury to the eyes, kidneys,

    and nerves. If there is severe loss of blood flow, it can result in

    amputations and blindness. It may require oral insulin or even

    shots to maintain blood sugar in the healthy range.

    ; Unintentional injuries- death rate from injuries increases after age

    65- mostly due to car collisions and falls.

    ; Motor vehicle accidents are responsible for ? of injury

    mortality later in life. But older adults have higher rates of

    traffic tickets, accidents, and fatalities per mile driven than

    any other age group, except for teens. Deaths due to injury

    are greater for men than women in late life. Driving is

    especially impaired as vision is impaired. They also have a

    slower reaction time, and don’t always read and interpret

    road signs effectively. They are also at risk on foot at

    intersections when they can’t determine when to walk.

    ; Falls 30% of those over 65, and 40% of those over 80

    have had a fall within the past year. Serious injury results

    about 10% of the time- most commonly a hip fracture.

    This type of break increases 20X from 65 to 85. It

    associates with a 12 20% increase in mortality. Half

    never regain the ability to walk without assistance again.

    Unfortunately, once someone falls, s/he will tend to avoid

    activities that may be associated with instability, so they

    restrict social contact and exercise.

    ; Prevention may entail corrective eyewear, improved safety in the

    home or car, and other family members taking on some of the

    responsibility for the elder’s transportation.

    ; Mental disabilities are really only shown when there is severe cell death and

    structural or chemical abnormalities in the brain.

    o Dementia is a set of disorders that occur mostly in old age in which many aspects of thought and behavior are so impaired that everyday activities are disrupted. Usually the person can no longer live alone. 1% of those 65 have dementia, but that rate increases with age- especially after age 75. It is 50% after 85 years old. There are a variety of causes of dementia, and some are reversible, such as medication interactions. Parkinson’s disease

    happens when neurons in the subcortical regions deteriorate, leaving symptoms of tremors, shuffling gait, loss of facial expression, rigidity of limbs, poor balance, stooped posture. It is very unusual to see it in a person the age of Michael J. Fox. There are cortical dementias- Alzheimer’s disease and cerebrovascular dementia:

    o Alzheimer’s Disease is the most common form of dementia, in which

    structural and chemical brain deterioration is associated with loss of

    thought, behavior, and personality. Alzheimer’s disease is responsible for

    60% of all dementias. 5% of deaths of the elderly involve Alzheimer’s.

    ; Symptoms and course of the disease include memory problems-

    even for repeated behaviors such as dressing, simple cooking, routes to common places. Short-term memory is first affected, but it gradually affects distant memory, and causes the person to be at risk if living alone. They have poor judgment in the beginning, allowing them to be taken advantage of by con men. As the personality is affected, there is a loss of affect, increased paranoia and fearfulness, aggressiveness, social withdrawal. Depression is also linked to the illness. Hygiene is unmanageable and the person needs help eating, bathing, dressing and even walking. There may be hallucinations which contribute to the fearfulness. Speech is lost, as well as comprehension of speech. The length of this deterioration can range from 1 year to 15. The average is 6-7 years. Diagnosis is made through excluding other possible causes of the cognitive deficits.

    ; Brain deterioration- Under imaging techniques, the brains of

    Alzheimer’s victims show shrinking of tissue, due to massive degeneration and death of neurons. Blood flow and activity in the brain are reduced. There are also chemical changes- lowered levels of neurotransmitters necessary for communication between neurons. Acetylcholine is especially lost. It is necessary to

    developing new learning. Serotonin is also lost, and it regulates

    arousal and mood, relating to sleep disturbances, aggression, impulsivity and depression. Autopsies show 2 major structural changes in the cortex of Alzheimer’s victims: neurofibrillary tangles and amyloid plaques.

    ; Neurofibrillary tangles are bundles of twisted threads that

    occur as neural structures collapse.

    ; Amyloid plaques are deposits of a deteriorated protein

    called amyloid, surrounded by clumps of dead nerve cells.

    ; Risk factors Alzheimer’s occurs in 2 types- familial and

    sporadic, which has no heredity history. Sporadic form occurs later in life and progresses faster. There are genes on certain chromosomes that link to familial Alzheimer’s. Another chromosomal abnormality has to do with excess levels of ApoE4, and is linked to amyloid plaque formation. Head injuries are linked to later development of Alzheimer’s. It also seems to attach once

    there has been stroke damage in the brain. High-fat diets also seem to relate, since Africans have lower incidence of Alzheimer’s than African-Americans with their high-fat diet.

    ; Protective factors include Vitamin C and E supplements, as well

    as anti-inflammatory drugs like aspirin. Education and an active lifestyle seem to be protective, as they increase synaptic

    connections and allow the brain to compensate for losses more

    effectively.

    ; Helping Alzheimer’s Victims and Caregivers there are some

    new drugs to increase the levels of acetylcholine and reduce the

    symptoms of Alzheimer’s disease. Spouses and family are heavily

    burdened with caregiving for these sufferers. It is a tragic disease

    to watch and stress on caregivers is enormous. There are some

    community aids- health care workers who come to the house, as

    well as day care for seniors. The more the environment can be kept

    the same, the better the person can manage.

    o Cerebrovascular Dementia is a series of strokes that leave the brain dead in different areas, producing degeneration of mental ability in a step-wise format. Heredity influences susceptibility to high blood pressure, CVD, and diabetes, but many environmental influences such as smoking, alcoholism, high salt intake, low protein, obesity, inactivity and stress also heighten stroke risk. More men have cerebrovascular dementia by their late 60s than women. Women are at higher risk after 75. Symptoms of stroke are weakness, tingling, numbness in an arm, leg or the face, sudden vision loss or blurring, speech problems, dizziness. Once there has been a stroke, there may be paralysis, loss of speech, vision, coordination, memory, and other mental abilities.

    o Misdiagnosed and reversible dementia depression can be missed as a

    cause of dementia. 3% of those over 65 are moderately or severely depressed. Medication and exercise can overcome the cognitive deficits associated with depression. There are also drugs that can mimic signs of dementia. Infections can also contribute to dementia. Severe alcoholism will produce dementia which may not remit if drinking stops.

    o Interventions for Caregivers of Elders with Dementia (The 36-hour Day) Caregiving for those with Alzheimer’s is so demanding, that it cuts short the lives of elders who care for spouses, which includes 15 25% of

    the elderly.

    ; Knowledge helps in finding assistance, and in knowing the natural

    progression of the disease.

    ; Coping strategies include strategies for managing the ill person’s

    behavior, techniques for dealing with resentment, support groups,

    therapy, and educational groups.

    ; Caregiving skills have to do with handling everyday tasks, and

    managing the person’s needs when they can no longer help the

    caregiver. This includes communication skills, distraction,

    empathy development and expression of honest feelings.

    ; Respite can help the caregiver survive- just a short break during

    the week or a few days at a time, while the ill person is in a care

    facility. Eventually other family members may insist that the

    Alzheimer’s patient be put in a nursing home, because the

    caregiver’s quality of life may be impaired if they do this too long.

    ; Health care is becoming a large issue politically as seniors are becoming so

    impoverished as they try to pay for their meds and still live independently that the

    government is being pressured to do something to help.

    o Cost of health care for the elderly is increasing, as more people are

    living longer and needing medical care. Medical costs rise with age, as 75

    year olds receive 70% more benefits from Medicare than younger seniors.

    Much of this cost is nursing care and hospital care, as seniors have

    progressively more chronic ailments. Even so, Medicare doesn’t cover all

    medical costs for the elderly- it only covers about half of their costs. So

    more elders are sinking into poverty as they try to manage their health.

    o Long-term care is more common the older the person becomes. Only

    4.5% of Americans over 65 will be institutionalized, but the costs of

    nursing care will bankrupt most seniors. And Medicaid requires that the

    senior use his/her own funds for nursing care until he gets down to $2000

    in assets before Medicaid will pay for nursing home costs. White

    Americans are more likely to use nursing homes than African-Americans.

    African-Americans are more likely to be cared for in extended families.

    More people are using assisted living, which is a homelike setting with

    some help for seniors, but not extreme nursing care. This can allow

    functional seniors to maintain their independence longer. Some of these

    places are in conjunction with day cares, allowing seniors to rock babies

    and play with toddlers during the day. This allows both generations access

    to the benefits of one another’s life stage.

    Cognitive development- there is a general loss cognitively as people move closer to the

    end of life. But there are still techniques of compensation available. ; Selective optimization with compensation is one means of making best use of

    their cognitive skills. They narrow their goals, select personally valued activities

    so as to optimize or maximize returns from their energy. They find means to

    compensate for losses.

    Memory- older adults are taking in information more slowly, and they use strategies less,

    can’t inhibit irrelevant information and retrieve important information from long-term

    memory. So memory failure increases. Slower processing speed means there will be less

    retained from current activities. They also forget context, which helps us recall

    information. Recognition memory does not decline as much as free recall. ; Deliberate vs. automatic memory

    o Implicit memory is memory without conscious awareness. This memory

    is more intact than deliberate memory, trying to recall information.

    ; Associative memory

    o Associative memory deficit is a problem creating and retrieving links

    between pieces of information. This is more common for elders.

    ; Remote memory is very long-term recall. It is not any clearer than recent recall

    for seniors, even though the myth is that seniors remember the past better than

    recent events.

    ; Autobiographical memory is memory for your own personally experienced

    events. Seniors best recall their adolescent and early adulthood experiences better

    than later life experiences. There was a lot of novelty in those times, as well as

    life choices being made- spouses, jobs, educational choices. These experiences

    were more emotionally charged, so they are remembered better. They become

    part of a person’s life story, and are remembered often.

    ; Prospective memory is remembering to do planned activities in the future. There

    is more forgetfulness and absentmindedness as people age. They tend to do better

    on event-based memory tasks than time-based tasks.

    Language processing- two aspects of language processing diminish in older age: finding the right words and planning what to say and how to say it. Their speech will have more pronouns, unclear references, they will speak more slowly, pause more often, have trouble finding the right words. There will be more hesitations, false starts, sentence fragments, word repetitions as they age. They tend to simplify their grammatical structures, so they can better retrieve the words they want.

    Problem solving- problem solving declines in late adulthood so married people tend to collaborate more in problem-solving. They will be better at solving problems they think are under their control. They will make more rapid decisions in areas of health, as that is an area they feel they have learned a lot about.

    Wisdom includes practical knowledge, ability to reflect on and apply that knowledge, emotional maturity, listening skills, and creativity in a way that helps others. This does increase with age. It occurs as people deal with more difficulties in life and find various means to adapt to change. Those with wisdom tend to have better education and are physically healthier. It requires insight into the human condition and often follows that people with this ability are found in high positions in business and politics and religion.

    ; Knowledge about fundamental concerns of life: human nature, social

    relationships, emotions

    ; Effective strategies for applying that knowledge to making life decisions,

    handling conflict, giving advice

    ; A view of people that considers multiple demands of their life contexts

     Concern with ultimate human values, the common good, respect for ;

    individual differences in values

    ; Awareness and management of the uncertainties of life- many problems have

    no perfect solution

Factors related to Cognitive change- mentally active people are likely to maintain their

    cognitive abilities into advanced old age. Retirement can bring about changes in cognitive abilities depending on how those years are used.

    ; Terminal decline is a steady, marked decrease in cognitive functioning prior to

    death.

Cognitive interventions

    Lifelong learning

    ; Types of programs include Elderhostel, which encourages older adults to live on

    college campuses and take courses from experts, as well as travel the world.

    Many universities offer classes at low or no cost for seniors.

    ; Benefits of continuing education include learning new information,

    understanding new ideas, making new friends, and developing a broader

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