Chapter 18 LONGEVITY Life Expectancy and Life Span Although a greater percentage of persons live to an older age, the life span has remained virtually unchanged since the beginning of recorded history. Life span is 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. Improvements in medicine, nutrition, exercise, and lifestyle have increased our life expectancy an average of 30 additional years since 1900. Life expectancy is the number of years that will probably be lived by the average person born in a particular year. Life expectancy of individuals born today in the U.S. is 77 years (80 for women, 74 for men). Differences in life expectancies across countries are due to such factors as health conditions and medical care throughout the life span. Centenarians An increasing number of people are living to be 100 years or older. Many of these people are healthy for most of their older years and seem to cope with stress effectively. The most important factors in longevity are heredity, family history, health (weight, diet, smoking, and exercise), education, personality, and lifestyle. The rapid growth in the 85+ and 100+ age categories suggests that potential changes lie ahead. Retiring at age 65 may be too young. Increasing health and longer productivity of the elderly may offset some of the economic burden of the graying of America. A more positive view of individuals in late adulthood may need to be created. Sex Difference in Longevity Females live about 6 years longer on average than males do. Females outnumber males at the age of 25, and the gap widens from there. The sex difference is likely due to biological (infection resistance) and social (health attitudes, habits, lifestyles, and occupation) factors. Self-esteem and work satisfaction outweigh stress of work when the longevity of women is at issue. The Young Old, the Old Old, and the Oldest Old The young old are 65-74 years of age, the old old are 75 years and older, and the oldest old are 85years and older. Many experts on aging prefer to talk about the functioning of individuals in late adulthood, rather than age. Some 85-year-olds function far better than some 65-year-olds. The needs, capacities, and resources of the oldest old are often different than their younger counterparts. Today’s oldest old are much more likely to be living in institutions, less likely to be married, and more likely to have low educational attainment. Every period or subperiod of development is heterogeneous. Significant numbers of the oldest old function effectively and are in good health. Biological Theories of Aging Cellular Clock Theory The cellular clock theory is Hayflick’s view that cells can divide a maximum of about 75 to 80 times and that as we age, our cells become increasingly less capable of dividing. In the last decade, scientists have found that telomeres are involved in explaining why cells lose their dividing capabilities. Telomeres are DNA sequences that cap chromosomes. Free-Radical Theory The 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. As the free radicals bounce around inside the cells, their damage can lead to a range of disorders, including cancer and arthritis. Hormonal Stress Theory The hormonal stress theory states that aging in the body’s hormonal system may lower resilience to stress and increase the likelihood of disease. With aging, the hormones stimulated by stress remain elevated longer than when the individuals were young, which is associated with increased risk for many diseases. THE COURSE OF PHYSICAL DEVELOPMENT IN LATE ADULTHOOD Acknowledgement of variability in rates of decline in functioning has generated increased attention for factors involved in the maintenance of functional abilities with age. The Aging Brain General Slowdown in Central System Functioning A general slowdown of function characterizes the central nervous system. This slowdown can affect physical coordination and intellectual performance. Decreased Brain Lateralization Lateralization is the specialization of function in one hemisphere of the brain or the other. In one study, older adults who used both brain hemispheres were faster at completing a working memory task than their counterparts who primarily used only one hemisphere of their brain. Changes in Neurons Adults continue to grow new brain cells throughout their lives. Even in the late adulthood years, the brain has remarkable repair capability, losing only a portion of its ability to function. Stanley Rapaport concluded that as brains age, they can actually shift responsibilities for a given task from one region to another. The Mankato Nuns An intriguing ongoing investigation of the brain involves nearly 700 nuns in a convent in Mankato, Minnesota. Examination of the nun’s donated brains, as well as others, had led neuroscientists to believe that the brain has a remarkable capacity to change and grow, even in old age. Preventing and Treating Brain Diseases The capacity of the brain to change offers new possibilities for preventing and treating brain diseases: o The onset of Alzheimers disease symptoms might be delayed for years. The more educated people are, the less likely they are to develop Alzheimers. This probably occurs because intellectual activity develops surplus brain tissue that compensates for tissue damaged by disease. o Older individuals might recover better from strokes. Even when areas of the brain are permanently damaged by stroke, new message routes can be created to get around the blockage or to resume the function of that area. . Physical Appearance The most obvious signs of aging are wrinkled skin and age spots on the skin. Men lose about 11/4 inches by the age of 70. Women lose about 2 inches by the age of 75. Weight often decreases after age 60 because of the loss of muscle. Exercise and appropriate weight lifting can help to reduce the decrease in muscle mass and improve the older person’s body appearance. Movement Older adults move slower than young adults. General slowing of movement in older adults had been found in everyday tasks such as reaching and grasping, moving from one place to another, and continuous movement. Sensory Development Vision The visual system declines but the vast majority of older adults can have their vision corrected so they can continue to work and function in the world. Some of the changes that occur include: Night vision decreases, dark adaptation is slower, cataracts (cloudy opaque areas in the lens that prevent light from passing through), glaucoma (disease involves hardening of the eyeball because of fluid buildup), and macular degeneration (disease involving deterioration of the retina). Hearing Hearing declines often begin in middle age but usually do not become much of an impediment until late adulthood. It is estimated that 15 percent of the population over age 65 is legally deaf, usually due to degeneration of the cochlea. Hearing aids can diminish hearing problems for many older adults. Smell and Taste Smell and taste losses often begin around 60 years of age. Smell and taste may decline although the decline is minimal in healthy older adults. Touch Changes in touch sensitivity are associated with aging although this does not present a problem for most older adults. Touch sensitivity decreases more in the lower extremities than in the upper extremities. Pain Older adults are less sensitive to pain and suffer from it less than younger adults. The Circulatory System When heart disease is absent, the amount of blood pumped is the same regardless of an adult’s age. High blood pressure is no longer just accepted but rather is treated with medication, exercise, and/or a healthy diet. Blood pressure may rise with age because of illness, obesity, anxiety, stiffening of blood vessels, or lack of exercise. The Respiratory System Lung capacity drops 40 percent between the ages of 20 and 80, even without disease. Older adults can improve lung functioning with diaphragm-strengthening exercises. Sexuality Aging in late adulthood does include some changes in sexual performance, more so for males than females (orgasm is less frequent for males, more direct stimulation is needed). There are no known age limits to sexual activity. HEALTH Health Problems As we age, the probability of disease or illness increases. Chronic disorders are rare in early adulthood, increase in middle adulthood, and become common in late adulthood. The most common chronic problems are arthritis and hypertension. Low income is strongly related to health problems in late adulthood. Three times as many poor as nonpoor older adults report that their activities are limited by chronic disorders. Causes of Death in Older Adults Nearly three-fourths of older adults die of heart disease, cancer, or cerebrovascular disease. If all cardiovascular and kidney diseases were eradicated, the average live expectancy would increase by approximately 10 years. Ethnicity is linked with the death rates of older adults. Arthritis Arthritis is an inflammation of the joints accompanied by pain, stiffness, and movement problems. Arthritis is especially common in older adults. There is no known cure for arthritis, though symptoms can be reduced with drugs, range- of-motion exercises, and weight reduction. Osteoporosis Osteoporosis is an aging disorder involving an extensive loss of bone tissue. Osteoporosis is 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. Almost two-thirds of all women over the age of 60 are affected by osteoporosis, especially White, thin, and small-framed women. This aging disorder is related to deficiencies in calcium, vitamin D, estrogen depletion, and lack of exercise. Prevention of osteoporosis is important in early and middle adulthood. Prevention focuses on calcium-rich foods, exercise, and avoiding smoking. Accidents Accidents are the seventh leading cause of death in late adulthood. Accidents are usually more debilitating to older adults than to younger adults. The Robust Oldest Old Early portrayals of the oldest old were too negative; there is cause for optimism in the development of new regimens and interventions. Health service researchers are discovering that a relatively large portion of people in old age are low-cost users of medical services. A sizable portion of individuals over age 80 are free of disability, able to cope with their disabilities free of assistance, or able to recover their functioning over time. Exercise, Nutrition, and Weight Exercise The physical benefits of exercise have been clearly demonstrated in older adults. In one study, sedentary participants were more than twice as likely to die during the 8- year time span than those who were moderately fit. Beginning moderately vigorous physical activity from the forties through the eighties was associated with a 23 percent lower risk of death, quitting smoking with a 41 percent lower death risk. Aerobic exercise and weight lifting are recommended if the adults are physically capable. Nutrition and Weight Scientists have accumulated considerable evidence that food restriction in laboratory animals can increase the animal’s life span. Experts recommend a well-balanced, low-fat diet that includes the nutritional factors needed to maintain good health. Leaner men do live longer, healthier lives. The Growing Vitamin and Aging Controversy The controversy focuses on whether vitamin supplements, especially the antioxidants vitamin C, vitamin E, and beta-carotene, can slow the aging process and improve older adults’ health. There is no evidence that antioxidants can increase the human life span, but some experts believe that they can reduce a person’s risk of becoming frail and sick in later adult years. Critics stress that the studies that have been conducted are correlational and not experimental. Health Treatment Care Options Although only 5 percent of adults over 65 reside in nursing homes, 23 percent of adults over age 85 do. The quality of nursing homes varies enormously. Alternatives to nursing homes include home health care, day-care centers, and preventive medicine clinics. Giving Options for Control and Teaching Coping Skills An important factor related to health, and even survival, in a nursing home is the patient’s feelings of control and self-determination. Simply giving nursing home residents options for control and teaching coping skills can change their behavior and improve their health. When older adults thought of themselves as younger, they had improved posture, gain a more positive outlook, better memory, and improved eyesight. Loss of control may even be worse than lack of control. The Older Adult and Health-Care Providers The attitudes of both the health-care provider and the older adult patient are important aspects of the older adult’s health care. Too often health-care personnel share society’s negative view of older adults. Health-care personnel tend to be less responsive to older patients. Older adults should be encouraged to take a more active role in their own health care. Chapter 19 COGNITIVE FUNCTIONING IN OLDER ADULTS Multidimensionality and Multidirectionality Cognition in adulthood is multidimensional. Cognitive change in adulthood is multidirectional. Cognitive Mechanics and Cognitive Pragmatics Baltes distinguishes between cognitive mechanics and cognitive pragmatics. Cognitive mechanics are the hardware of the mind and reflect the neurophysiology architecture of the brain developed through evolution. Cognitive mechanics involve the speed and accuracy of the processes involving sensory input, visual and motor memory, discrimination, comparison, and categorization. Cognitive pragmatics are the culture-based software programs of the mind. Cognitive pragmatics include reading and writing skills, language comprehension, educational qualifications, professional skills, and also the type of knowledge about the self and life skill that help us to master or cope with life. Cognitive mechanics are more likely to decline in older adults than are cognitive pragmatics. Sensory/Motor and Speed-of-Processing Dimensions Sensory functioning is a strong late-life predictor of individual differences in intelligence. Speed of processing information declines in late adulthood. There is individual variation in this decline. It is unclear how much this decline affects daily living. Attention Three aspects of attention have been investigated in older adults. Selective attention is focusing on a specific aspect of experience that is relevant while ignoring others that are irrelevant. Generally, older adults are less adept at selective attention than younger adults are. An example of selective attention is the ability to focus on one voice among many in a crowded room or noisy restaurant. Divided attention involves concentrating on more than one activity at the same time. When the two competing tasks are reasonably easy, age differences among adults are minimal or nonexistent. However, the more difficult the competing tasks are, older adults divide attention less effectively than younger adults. Sustained attention is the sate of readiness to detect and respond to small changes occurring at random times in the environment. Researchers have found that older adults perform as well as middle-aged and younger adults on measures of sustained attention. Memory Memory does change during aging, but not all memory changes with age in the same way. Episodic Memory Episodic memory is the retention of information about the where and when of life’s happenings. Younger adults have better episodic memory than older adults. Older adults think that they can remember older events better than more recent events, though research has not supported these claims. Semantic Memory Semantic memory is a person’s knowledge about the world. It includes a person’s fields of expertise (such as knowledge of chess, for a skilled chess player); general academic knowledge of the sort learned in school (such as knowledge of geometry), and “everyday knowledge” about meanings of words, famous individuals, important places, and common things (such as who Nelson Mandela and Mahatma Gandhi are). Semantic memory appears to be independent of an individual’s personal identity with the past. Cognitive Resources: Working Memory and Perceptual Speed One view of memory suggests that a limited number of cognitive resources can be devoted to any one cognitive task. Two important cognitive resource mechanisms are working memory and perceptual speed. Working memory is the concept currently used to describe short-term memory as a place for mental work. Working memory is like a mental “workbench” that allows individuals to manipulate and assemble information when making decisions, solving problems, and comprehending written and spoken language. 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 in older adults. Explicit and Implicit Memory Explicit memory (declarative memory) refers to memory of facts and experiences that individuals consciously know and can state. Implicit memory (procedural memory) refers to 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. Prospective Memory Prospective memory involves remembering to do something in the future, such as remembering to take your medicine or remembering to an errand. Some researchers have found a decline in prospective memory with age, a number of studies show that whether there is a decline is complex and depends on such factors as the nature of the task and what is being assessed. Memory Beliefs An increasing number of studies are finding that people’s beliefs about memory play an important role in their memory performance. Noncognitive Factors Noncognitive factors (health, education, and SES) are linked to memory in older adults. Good health does not eliminate memory decline. Critics claim that most memory research occurs in laboratories and lacks external validity. Conclusions about Memory and Aging Some aspects of memory decline in older adults. Decline occurs in episodic and working memory, but not in semantic memory. Decline in perceptual speed is associated with memory decline. Successful aging does not eliminate memory decline, but reduces it and facilitates adaptation to the decline. Wisdom Wisdom is expert knowledge about the practical aspect of life that permits excellent judgement about important matters. Although theorists propose that older adults have wisdom, researchers usually find that younger adults show as much wisdom as older adults. Wisdom involves solving practical problems. Education, Work, and Health: Links to Cognitive Functioning Education, work, and health are three important influences on the cognitive functioning of older adults. It is also important to examine cohort effects when studying cognitive functioning in older adults. Education Successive generations of Americans have been better educated. Education is positively correlated with scores on intelligence tests. Older adults may return to education for a number of reasons (to understand their own aging, to learn about societal and technological changes, to remain competitive in the workforce, to enhance their self-discovery and leisure activities, may facilitate the transition to retirement). Work Successive generations have had work experiences that include a stronger emphasis on cognitively oriented labor. The increased emphasis on information processing in jobs likely enhances an individual’s intellectual abilities. Health Successive generations have been healthier in late adulthood due to medical advances. Poor health is related to decreased performance on intelligence tests in older adults. Exercise is linked to higher cognitive functioning in older adults. The terminal drop hypothesis states that death is preceded by a decrease in cognitive functioning over approximately a 5-year period prior to death. The chronic diseases that older adults are more likely to have may decrease their motivation, alertness, and energy to perform competently on tests. The terminal drop hypothesis was supported for tests of vocabulary, not for numerical facility and perceptual speed. Use It or Lose It Researchers are finding that older adults, who engage in cognitive activities, especially challenging ones, have higher cognitive functioning than those who don’t use their cognitive skills. Training Cognitive Skills Two main conclusions can be derived from research on training cognitive skills in older adults. There is plasticity, and training can improve the cognitive skills of many older adults. There is some loss in plasticity in late adulthood. Using individualized training, researchers improved the spatial orientation and reasoning skills of two-thirds of the adults. Mnemonics are techniques designed to make memory more efficient and can be used to improve older adults’ cognitive skills. Greater time spent in communication and leisure activities is linked with positive training effects. WORK AND RETIREMENT Work Today, the percentage of men over 65 who continue to work full-time is less than at the beginning of the twentieth century. An important change involved in adults’ work patterns is the increase in part-time work. Some individuals continue a life of strong work productivity throughout late adulthood. Good health, a strong psychological commitment to work, and distaste for retirement are the most important characteristics related to continued employment into old age. Cognitive ability is one of the best predictors of job performance in the elderly. Older workers have lower rates of absenteeism, fewer accidents, and increased job satisfaction compared to younger workers. An increasing number of middle-aged and older adults are embarking on a second or third career. An increasingly number of retirees only partially retire, moving to a part-time employment by either reducing the number of hours they work on their career jobs or by taking on new (and frequently lower-paying) jobs. Retirement in the United States and Other Countries Retirement is a late twentieth century phenomenon in the United States. On average, today’s workers will spend 10-15 percent of their lives in retirement. Eighty percent of baby boomers expect to work during retirement for a variety of reasons (enjoyment, income, new career interest). The U.S. has extended the mandatory retirement age upward to 70 years old. Congress voted to ban mandatory retirement for all but a few occupations (police officers, fire fighters, and pilots) where safety is an issue. Efforts have been made to reduce age discrimination in work-related circumstances. Many European countries have lowered the age for mandatory retirement. Adjustment to Retirement Individuals who are healthy, have adequate income, are active, are better educated, have an extended social network of friends and family, and are satisfied with their lives before they retire adjust better to retirement. Flexibility is also a key factor to retirement adjustment. It is important to plan psychologically as well as financially for retirement. Individuals who retire involuntarily are more unhealthy, depressed, and poorly adjusted than those who retire voluntarily. MENTAL HEALTH The cost of mental health disorders in older adults is estimated at more than $40 billion per year in the U.S. More important is the loss of human potential and the suffering. There is not a higher incidence of mental disorders in older adults than in younger adults. 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 has been called the “common cold” of mental disorders. The most common predictors of depression in older adults are earlier depressive symptoms, poor health, loss events such as death of a spouse, and low social support. As many as 80 percent of older adults with depressive symptoms receive no treatment at all. Combinations of medications and psychotherapy produce significant improvements in almost 4 out of 5 elderly adults with depression. Nearly 25 percent of individuals who commit suicide in the U.S. are 65 years of age or older. Dementia, Alzheimer’s Disease, and Other Afflictions Dementia Dementia is a global term for any neurological disorder in which the primary symptoms involve a deterioration of mental functioning. It is estimated that 20 percent of individuals over the age of 80 have dementia. The most common form of dementia is Alzheimer’s disease, a progressive, irreversible disorder that is characterized by gradual deterioration of memory, reasoning, language, and eventually physical functioning. Alzheimer’s Disease Approximately 4 million adults in the U.S. have Alzheimer’s disease. It is predicted to triple in the next 50 years, as increasing numbers of people live to old age. Alzheimer’s disease can be either early-onset (initially occurring in individuals younger than 65 years) or late-onset (initial onset after 65 years of age). Early onset is rare (about 10 percent of all cases). Causes and Treatments Special efforts are being made to discover the causes of Alzheimer’s disease and effective treatments of it. Alzheimer’s disease involves a deficiency in the important brain messenger chemical acetylcholine, which plays an important role in memory. Efforts to identify the cause of Alzheimer’s have not been successful. Among the main characteristics of Alzheimer’s disease are the increasing number of tangles (tied bundles of protein that impact the functioning of the neurons) and plaques (deposits that accumulate in the brain’s blood vessels). An abnormal gene may be responsible for as many as one-third of all cases of Alzheimer’s disease. Early Detection of Alzheimer’s Disease Special brain scans, analysis of spinal fluids, and a sophisticated urine test are being used to detect Alzheimer’s disease before its symptoms appear. Progressive Decline Alzheimer’s disease involves a predictable, progressive decline in physical, cognitive, and social functioning. Most individuals with Alzheimer’s disease live 8 years after symptoms first appear. Caring for Individuals with Alzheimer’s Disease A special concern is the care of Alzheimer’s patients and the burden it places on caregivers. Depression has been reported in 50 percent of family caregivers. Respite care can periodically relieve the caregiver from the burden of chronic caregiving. Multi-Infarct Dementia Multi-infarct dementia involves a sporadic and progressive loss of intellectual functioning caused by repeated temporary obstruction of blood flow in cerebral arteries. It is estimated that 15-25 percent of dementia involves multi-infarct dementia. Multi-infarct dementia is more common among men with high blood pressure. Individuals can recover from multi-infarct dementia. Symptoms include confusion, slurring of speech, writing impairment, and numbness on the side of the face, arm, or leg. Parkinson’s Disease Another dementia is Parkinson’s disease, 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. Fear of Victimization, Crime, and Elder Maltreatment Some of the physical decline and limitations that characterize development in late adulthood contribute to a sense of vulnerability and fear among older adults. Elder maltreatment is primarily carried out by family members. Almost one-fourth of older adults say they have a basic fear of being the victim of a crime. Older women are more likely to be victimized or abused than older men. Meeting the Mental Health Needs of Older Adults Older adults receive disproportionately fewer mental health services. A number of barriers to mental health treatment in older adults exist (expense, biases of health-care providers, failed diagnoses). There are many different types of mental health treatment available. Some mechanisms of change that improve 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 education activities and the development of skills. RELIGION Many elderly are spiritual leaders in their church and community. Religious interest increases in old age (put faith into practice, and attend services). For some, religious practice is associated with sense of well-being. Religion and religious organizations can meet important psychological needs in older adults, offering social support and an opportunity to assume leadership roles.
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