Developmental Psychology: Chapter 14

Indeed “feeling youthful is more strongly predictive of health than any other factors including commonly noted ones like
chronological age, gender, marital status and socioeconomic status
Elders in all three groups (Chinese, deaf Americans, and hearing Americans) scored lower than their younger counterparts. This was expected; age differences are common in laboratory tests of memory.
The gap in scores between younger and older hearing North Americans (most exposed to ageism) was double that between younger and older deaf North Americans and five times wider than the age gap in the Chinese
When older people believe that they are independent and in control of their own life, despite the ageist assumptions of others, they are likely to be healthier
mentally, as well as physically—than other people their age.
For instance, at a restaurant, older people should feel no shame in asking a younger dinner companion to read the fine print of a menu, but that younger person should not spontaneously offer to cut the elder’s steak
elderly European American men have the highest suicide rate of any age, gender, or ethnic group
ealth professionals are less aggressive in treating disease in older patients, researchers testing new prescription drugs enroll few older adults (who are most likely to use those drugs), and caregivers diminish independence by helping the elderly too much
The day-night circadian rhythm diminishes with age:
Older adults spend more time in bed, take longer to fall asleep, wake frequently (about 10 times per night) (Ayalon & Ancoli-Israel, 2009). They also are more likely to nap.
: If they choose their own sleep schedules, elders are less likely to feel tired than are young adults.
In the United States, only 30 percent of those over age 64 meet recommended guidelines for exercise
(2½ hours a week of moderate activity),
, compared with 55 percent for adults aged 18 to 44 (CDC, 2011).
self-imposed ageism leads the elderly to exercise less
which increases stiffness and reduces range of motion while impairing circulation, digestion, and thinking
ageism is evident in many caregivers: Efforts to reduce that prejudice are not always successful, perhaps because they attempt to counteract a common stereotype
elderspeak
A condescending way of speaking to older adults that resembles baby talk, with simple and short sentences, exaggerated emphasis, repetition, and a slower rate and a higher pitch than used in normal speech.
The homicide rate
of those over age 65 is only one-tenth the rate for those aged 20 to 24.
15 percent of Europeans older than 75 ride their bicycles every day
demographic shift:
A shift in the proportions of the populations of various ages.
In an earlier era, there were 20 times more children than older people, and only 50 years ago,
the world had 7 times more people under age 15 than over age 64. No longer.
The United Nations estimates that nearly 8 percent of the world’s population in 2010 was 65 or older, compared with only 2 percent a century earlier.
This number is expected to double by the year 2050.
Already 13 percent in the United States are that old, as are 14 percent in Canada and Australia, 20 percent in Italy, and 23 percent in Japan
demographic pyramid- it was widest at the base, and each higher level was narrower than the one beneath it, for three reasons
More children were born than the replacement rate of one per adult, so each new generation had more people than the previous one.

Many babies died, which made the bottom bar much wider than later ones.

Serious illness was usually fatal, reducing the size of each older group.

Early death is uncommon; demographic stacks have become rectangles, not pyramids.
Worldwide, children outnumber elders more than 3 to 1, but not 20 to 1
United Nations predictions for 2015 are for 1,877,551,000 people younger than 15 and 602,332,000 older than 64. Not until 2065 is the ratio projected to be 1 to 1 (United Nations, 2012)
In 2010 in the United States, there were more than 4 times as many people 80 and older than there were 50 years earlier (11.8 million compared with 2.7 million
The percent of residents 80 and older has more than doubled, but not quadrupled (increasing between 1960 and 2010 from 1.6 percent to 3.8 percent).
What percent of the population 80 years and older are in nursing homes or hospitals?
only 10 percent of U.S. residents are in such facilities.
The average person 80 years or older spends two weeks per year in a hospital (CDC, 2011, 2009). These rates are actually lower than 20 years ago; now more people stay in their homes, with visiting nurses, home health aides, and so on, if needed.
dependency ratio
A calculation of the number of self-sufficient, productive adults compared with the number of dependents (children and the elderly) in a given population.
This ratio is calculated by dividing the number of dependents (defined as those under age 15 or over 64) by the number of people in the middle, aged 15 to 64
The highest dependency ratio is in Uganda, with more than one dependent per adult (1:1)
the lowest in Bahrain, with one dependent per three adults (1:3).
Most nations, including the United States, are about 1:2, that is, one child or elder for every two adults
Only 10 percent of those over age 64 are dependent on others for basic care, and those “others” are usually relatives, not taxpaying strangers.
In the United States, only 4 percent of people over 64 (less than one-half of 1 percent of the total population) are in nursing homes or hospitals.
Most are living completely independently, alone or with an aging spouse; only a minority are living with adult children.
The United States has a higher rate than most nations of people in hospitals and nursing homes, yet even after age 80, only 10 percent of U.S. residents are in such facilities.
Gerontologists distinguish among the young-old, the old-old, and the oldest-old.
young-old
are the largest group of older adults.
Healthy, vigorous, financially secure older adults (generally, those aged 60 to 75) who are well integrated into the lives of their families and communities.
old-old
suffer some losses in body, mind, or social support, but they proudly care for themselves.
Older adults (generally, those older than 75) who suffer from physical, mental, or social deficits.
oldest-old
are dependent, and they are the most noticeable.
Elderly adults (generally, those older than 85) who are dependent on others for almost everything, requiring supportive services such as nursing homes and hospital stays.
Many of the young-old are aged 65 to 75, old-old 75 to 85, and oldest-old over 85, but age itself does not indicate dependency.
For well-being and independence, attitude is more important than age
THEORIES OF AGING:three clusters.
: wear and tear, genetic adaptation, and cellular aging
The oldest, most general theory of aging is known as
wear and tear
wear and tear
A view of aging as a process by which the human body wears out because of the passage of time and exposure to environmental stressors.
Exercise improves heart and lung functioning; tai chi improves balance; weight training increases muscles; sexual activity stimulates the sexual-reproductive system; foods that require intestinal activity benefit the digestive system.
A second cluster of theories focuses on genes
genetic clock
genetic clock:
A purported mechanism in the DNA of cells that regulates the aging process by triggering hormonal changes and controlling cellular reproduction and repair.
Evidence for genetic aging comes from premature aging.
Hutchinson-Gilford syndrome (a genetic disease also called progeria)
stop growing at about age 5 and begin to look old, with wrinkled skin and balding heads. These children die in their teens of heart diseases typically found in people five times their age.
Certain alleles—SIR2, def-2, among them—directly accelerate aging and death
, allele 2 of ApoE is protective, aiding survival
Of men in their 70s, 12 percent have ApoE2, but of men older than 85, 17 percent have it.
Another common allele of the same gene, ApoE4, increases the risk of death by heart disease, stroke, dementia, and—if a person is HIV-positive—by AIDS
The third cluster of theories examines
cellular aging
cellular aging:
The ways in which molecules and cells are affected by age. Many theories aim to explain how and why aging causes cells to deteriorate.. Toxins damage cells over time, so minor errors in copying accumulate
This process is first apparent in the skin, an organ that replaces itself often. The skin becomes wrinkled and rough, eventually developing “age spots” as cell rejuvenation slows down.
ellular aging also occurs inside the body, notably in cancer, which involves duplication of rogue cells. Every type of cancer becomes more common with age because the body is increasingly less able to control the cells.
Hayflick limit:
The number of times a human cell is capable of dividing into two new cells. The limit for most human cells is approximately 50 divisions, an indication that the life span is limited by our genetic program.
the telomere is gone, duplication stops, and the creature dies
Hayflick himself believes that the Hayflick limit, and therefore aging, is caused by a natural loss of molecular fidelity—that is, by inevitable errors in transcription as each cell reproduces itself. He believes that aging is a natural process built into the very cells of our species, affected by stress, drugs, and so on (Hayflick, 2004).
by late adulthood, telomeres are longer in women than in men, and longer in European Americans than in African Americans (Aviv, 2011)
calorie restriction
The practice of limiting dietary energy intake (while consuming sufficient quantities of vitamins, minerals, and other important nutrients) for the purpose of improving health and slowing down the aging process.
Aging slows down in most living organisms with calorie restriction
However, specifics of diet and timing may be crucial. Some research on monkeys finds that calorie restriction extends life, but other studies do not (Mattison et al., 2012). Much remains to be understood; application to humans is controversial.
Less aging and longer life (sometimes twice as long), as well as stronger hearts, less disease, and better cognition, result from keeping nonhuman animals on a restricted diet
after puberty
Given all that, it would be difficult to recruit even a dozen people from the general population. However, in several places (e.g., Okinawa, Denmark, Norway), wartime brought severe calorie reduction plus healthy diets (mostly fresh vegetables) to entire populations. The result was a markedly lower death rate (Fontana et al., 2011).
Currently, more than 1,000 North Americans belong to the Calorie Restriction Society, voluntarily eating only 1,000 nutritious calories a day, none of them buttered or fried.
More than ever, scientists recommend exercise, a moderate diet, and staying away from harmful drugs (especially cigarettes). Many people seem unready to follow that advice.
selective optimization with compensation
The hope is that the elderly will compensate for any impairments of senescence and will excel (optimize) at whatever specific tasks they select.
INDIVIDUAL COMPENSATION: SEX
Desire correlates with sexual satisfaction and quality of life in late adulthood more than frequency of intercourse does
study found that kissing and hugging, not intercourse, predicted happiness in long-lasting romances
The research finds that older women, more often than older men, say they have no sexual desire
However, elders who feel sexual desire tend to be happier and healthier than those who do not
so the women with diminished sexual desire may be impaired by ageism and sexism.
There is no disagreement that women, on average, stop intercourse earlier than men, primarily because of partner availability, not biology.
With age, sign reading takes longer, head turning is reduced, reaction time slows, and night vision worsens. The elderly compensate
Many drive slowly and avoid night driving. As a result, elderly drivers have fewer accidents than do younger adults
. If an older adult causes a crash, age is blamed but not the family or the law (
Laws are often lax; many jurisdictions renew licenses without testing, even at age 80. If testing is required, it often focuses on knowing the rules of the road or being able to read with glasses, not on the characteristics that correlate with accidents.
TECHNOLOGICAL COMPENSATION: THE SENSES
Only 10 percent of people of either sex over age 65 see well without glasses
cataracts
As early as age 5o, about 10 percent of adults have cataracts
by age 70, 30 percent do
Glaucoma
About 1 percent of those in their 70s and 10 percent in their 90s have glaucoma
macular degeneration
About 4 percent of those in their 60s and about 12 percent over the age of 80 have deterioration of the retina.
Sensory loss need not lead to morbidity or senility, but without compensation, isolation and depression result in less movement and reduced intellectual stimulation.
Consequently, illness increases and cognition declines as the senses become less acute
New neurons form and dendrites grow in adulthood
growth is slow
Senescence reduces production of neurotransmitters
glutamate, acetylcholine, serotonin, and especially dopamine—that allow a nerve impulse to jump quickly across the synaptic gap from one neuron to another
Neural fluid decreases, myelination thins, cerebral blood circulates more slowly.
The result is an overall brain slowdown, evident in reaction time, moving, talking, and thinking.
Deterioration of cognition correlates with slower walking as well as with almost every kind of physical disability
Some areas shrink more than others, among them the
hippocampus (crucial for memory) and the prefrontal cortex (necessary for planning, inhibiting unwanted responses, and coordinating thoughts)
n every part of the brain, the volume of gray matter (crucial for processing new experiences) is reduced;
as a consequence, many people must use their cognitive reserve to understand events
White matter typically is reduced overall as well,
but white matter increases in an odd way: Bright white spots appear on MRIs after age 50 or so
Higher education and vocational challenge correlate with less decline, either because keeping the mind active is protective or because such people began late adulthood with more robust and flexible minds
Exercise, nutrition, and normal blood pressure are powerful influences on brain health, and all predict intelligence in old age.
In fact, some experts contend that with good health habits and favorable genes, no intellectual decrement will occur (Greenwood & Parasuraman, 2012).
A curious finding from PET and fMRI scans is that, compared with younger adults, older adults use more parts of their brains, including both hemispheres, to solve problems.
This may be selective compensation: Using only one brain region may be inadequate, so the older brain automatically activates more parts.
on many tasks, older adults are as intellectually sharp as they always were.
However, in performing difficult tasks that require younger adults to use all their cognitive resources, older adults are less proficient, perhaps because they already are using their brains to the max
Brain shrinkage interferes with multitasking.
young children and older adults are particularly affected when they are given several tasks at once
. Recognizing this, many elders are selective.
INPUT
sensations precede perception,
sensory threshold,
the divide between what is sensed and what is not, in order to be perceived.
People of all ages believe they look at the eyes of their conversation partner, yet a study that examined gaze following found that older adults were less adept at knowing where someone was looking
Another study found that already by age 50, adults were less adept at reading emotions by looking at the eyes
Older adults are less able to decipher the emotional content in speech, even when they hear the words correctly
Similarly, for older adults, understanding speech is impaired when vision is impaire
hus, small sensory losses—not noticed by the person or family but inevitable with age—impair cognition
MEMORY
The second step of information processing is memory.
If older people suspect their memory is fading, anxiety itself impairs memory, a phenomenon more apparent among those with more education
Some aspects of memory remain strong throughout late adulthood, including vocabulary, while others do not, such as memory for names
forgetting the origin of a fact, idea, or snippet of conversation.
One memory deficit is source amnesia
Source amnesia is particularly problematic with the
information bombardment of television, radio, and print.
Working memory,
the memory of information held in the brain for a moment before processing. shrinks with age.
Older individuals take longer to perceive and process sensations, and this reduces working memory because some items fade before they can be evaluated.
Speed of processing would explain why memory for vocabulary (especially recognition memory, not recall) is often unaffected by age
Some research finds that when older people take their time and concentrate, their working memory may be as good as ever.
older people reread phrases more than younger people did, when allowed ample time the old and young were equally accurate in reading comprehension
For testing memory, not only time but also motivation and context are crucial
ecological validity
: The idea that cognition should be measured in settings that are as realistic as possible and that the abilities measured should be those needed in real life.
Ecological validity is particularly significant for the elderly, who are handicapped by traditional testing
older adults are at their best in the early morning, when adolescents are half asleep.
Traditional tests measure fluid cognitive abilities that are valued by the young, but the elderly are more adept at problem solving and emotional regulation
Those practical abilities may improve with age but are not traditionally measured.
there is no objective way to evaluate the degree of ecological validity…because ecological validity is a subjective concept”
The final ecological question is, “What is memory for?” Older adults usually think they remember well enough. Fear of memory loss is more typical at age 60 than at age 80
CONTROL PROCESSES
the elderly tend to rely on prior knowledge, general principles, familiarity, and rules of thumb in their decision making
They are less likely to use analytic reasoning and more likely to base conclusions on personal and emotional experience
analytical thinking is needed to control the impulses that arise from past experience.
the underlying impairment of cognition in late adulthood may be in
control processes,
control processes
The part of the information-processing system that regulates the analysis and flow of information. Memory and retrieval strategies, selective attention, and rules or strategies for problem solving are all useful control processes.
These include memory and retrieval strategies, selective attention, and rules or strategies for problem solving, all part of what is called
executive function
Control processes depend on the
prefrontal cortex, which shrinks with age.
One control process is retrieval.
Some developmentalists believe retrieval is crucial because elders may have many thoughts and memories that they cannot access.
Without retrieval of past instances, the benefits of past experiences fade.
Inadequate control processes may explain why many older adults have extensive vocabularies but limited fluency
why they are much better at recognition than recall, why tip-of-the-tongue forgetfulness is common, and why spelling is poorer than pronunciation.
Among the half who merely read the list, the younger adults assigned 78 percent of the items to the correct categories, whereas the older adults got only 52 percent correct. As for the half who were taught memory strategies, the younger adults still got 78 percent correct, but the older ones got 66 percent right (Thomas & Bulevich, 2006). Thus, guidance in retrieval strategies was more helpful to the old than to the young.
Many gerontologists think elders would benefit from using control strategies,
Unfortunately, even though “a high sense of control is associated with being happy, healthy, and wise,” many older adults resist suggested strategies because they believe that declines are “inevitable or irreversible” and that no strategy could help. Efforts to improve their use of control strategies are often discouraging
OUTPUT
he final step in information processing is output
In the Seattle Longitudinal Study
verbal meaning, spatial orientation, inductive reasoning, number ability, and word fluency—declined, beginning at about age 60.
Thus, the usual path of cognition in late adulthood is gradual decline, at least in output
Impairment in control processes—especially retrieval strategies—may underlie the cognitive deficits of old age.
primary aging:
The universal and irreversible physical changes that occur in all living creatures as they grow older.
secondary aging:
The specific physical illnesses or conditions that become more common with aging but are caused by health habits, genes, and other influences that vary from person to perso
Primary aging does not directly cause illness, but it makes almost every disease more likely.
For example, with age the heart pumps more slowly and the vascular network is less flexible, increasing the risk of stroke and heart attack.
The lungs take in and expel less air with each breath so that blood oxygen is reduced and chronic obstructive pulmonary disease is more common.
Digestion slows and the kidneys are less efficient, risking problems if people become dehydrated because they drink less to reduce incontinence, which itself is caused by an aging renal/urinary system
Indeed, pneumonia is a leading cause of death for the oldest-old.
Primary aging increases the impact of every secondary factor—cigarette smoking, viruses, obesity, stress.
anesthesia may damage an older person’s brain or may cause the heart to stop.
Temporary hallucinations and delirium after surgery are far more common for the old than for the young (Strauss, 2013).
If systolic blood pressure is above 140, and diet and exercise do not lower it, drugs not only reduce it but also make strokes and heart attacks less likely for middle-aged adults.
the same drugs for the same blood pressure are counterproductive for the oldest-old. For them, mild hypertension (140-160) may be protective because their slower homeostasis does not quickly respond to a sudden dip in blood pressure. That can be fatal
Allostatic load
is measured by 10, or even 16, biomarkers—including cortisol, C-reactive protein, systolic and diastolic blood pressure, waste-hip ratio, and insulin resistance
Thus, measurement of allostatic load assesses the combined, long-term effect of many indicators, none necessarily dangerous alone.
If many of these biomarkers are outside the normal range, people become sick and die, especially when aging already has reduced organ reserve
Thus, lifelong responses to stress create a biological burden, a load that becomes lethal.
Cerebrovascular disease ( stroke)
20 times more likely in adults over 65
Illness can be delayed, and its severity can be limited by having established good childhood habits
compression of morbidity:
A shortening of the time a person spends ill or infirm, accomplished by postponing illness.
For instance, unlike 30 years ago, most people diagnosed with cancer, diabetes, or a heart condition continue to be independent for decades
the percentage of U.S. residents over age 65 with a limitation in activity—something that interferes with self-care, work, or socialization—decreased from 35 percent to 31 percent between 1997 and 2009 (
The importance of compression of morbidity is apparent with
osteoporosis
osteoporosis
(fragile bones), which occurs because primary aging makes bones more porous, especially if a person is at genetic risk (
(European American women are more vulnerable, genetically, than women of other ethnic groups).
How can morbidity from osteoporosis be compressed?
Tobacco and alcohol weaken bones, as does low calcium and insufficient weight-bearing exercise.
By old age, the most common liability from a fall is fear.
Second, through faster recuperation if a fracture occurs
one-third of those who fell became overcautious, reducing their activity.
Ironically, only 6 percent of the falls for these elders resulted in serious injury, but the 94 percent with less serious injuries often moved less.
Cognitive impairment increases falling more than physical weakness
This provides a clue for compression of morbidity. If falling can be reduced with special equipment, such as shoes, canes, and so on—and if the elderly and their caregivers become less fearful and fatalistic—then morbidity will decrease. Ideally, elders strengthen their muscles and improve their balance, so morbidity does not even begin.
If the elderly selectively remedy whatever challenges their primary aging presents,
morbidity will be compressed.
senile
simply means “old,” but senility is used to mean severe mental impairment, implying that old age brings intellectual failure
dementia:
Irreversible loss of intellectual functioning caused by organic brain damage or disease. Dementia becomes more common with age, but it is abnormal and pathological even in the very old.
when dementia occurred before age 60, it was called
presenile dementia
when it occurred after age 60, it was called
senile dementia or senile psychosis
A person may develop dementia at age 40 or age 90; the symptoms are the same at every age.
More than 70 diseases can cause dementia, each different in sequence, severity, and particulars, although all are characterized by mental confusion and forgetfulness.
delirium:
A temporary loss of memory, often accompanied by hallucinations, terror, grandiosity, and irrational behavior.
Older adults who cannot remember names or places as well as they did might have
mild cognitive impairment
About half of them will be mildly impaired for decades or will regain cognitive abilities
researchers selected a representative sample of people 70 years and older from every part of the United States,
14 percent had some form of dementia
indicates that probably about 4 million U.S
only about 1 percent of people in their 60s have dementia, as do even fewer people younger than 60.
2 to 25 percent, with an estimated 35 million people affected worldwide
Developing nations have lower rates, but that may be because millions of people in the early stages are not counted or because health care overall is poor.
Diabetes, for example, increases the rate of dementia, but in some nations most people with diabetes die in middle age.
If good health habits reduce the underlying factors that increase dementia, then rates will fall
if exercise increased and obesity decreased overall, then dementia would be less common as well. That is the public health goal: less illness, less dementia, as well as longer lives.
Genetics and social context always affect rates, but it is not known by how much
more women than men have dementia, which may be genetic, educational, or stress-related.
However, it may be simply that women live longer than men
Plaques are clumps of a protein called
beta-amyloid
found in tissues surrounding the neurons;
tangles are twisted masses of threads made of a protein called
tau
Alzheimer disease these plaques and tangles proliferate, especially in the hippocampus
Forgetfulness is the dominant symptom; working memory disappears first.
between 20 and 30 percent of cognitively normal elders have, at autopsy, the same level of plaques in their brains as people who had been diagnosed with probable AD
possibly plaques are a symptom, not a cause.
Most cases of AD begin much later, at age 75 or so
Then many genes have some impact, including SORL1 and ApoE4 (i.e., allele 4 of the ApoE gene).
. People who inherit one copy of ApoE4 (as about one-fifth of all U.S. residents do) have about a
50/50 chance of developing AD.
Those who inherit two copies almost always develop the disease if they live long enough,
although many die before diagnosis because ApoE4 increases the risk of many other serious ailments
The second most common cause of dementia is a stroke
or a series of strokes, called transient ischemic attacks
vascular dementia (VaD) also called multi-infarct dementia.
A form of dementia characterized by sporadic, and progressive, loss of intellectual functioning caused by repeated infarcts, or temporary obstructions of blood vessels, which prevent sufficient blood from reaching the brain. (Also called multi-infarct dementia.)
The progression of VaD is different from the progression of Alzheimer disease, but the result is similar (
In North America and Europe, VaD is not the primary diagnosis for most people with dementia,
but in Japan and China, as well as in the oldest-old everywhere, VaD is more common than Alzheimer disease.It correlates with stroke risk, stroke recovery, and with the ApoE4 allele
Vascular dementia is also a risk if an older person undergoes surgery that requires general anesthesia,
probably because it can cause a ministroke, which, added to reduced cognitive reserve, damages the brain
frontal lobe dementia:or frontotemporal lobar degeneration
Deterioration of the amygdala and frontal lobes that may be the cause of 15 percent of all dementias. (Also called frontotemporal lobar degeneration.)
frontal lobe dementias,
which causes perhaps 15 percent of all cases of dementia in the United States.
Parts of the brain that regulate emotions and social behavior (the amygdala and the frontal lobes) deteriorate, with emotional and personality changes being the main symptoms
Frontal lobe dementia may be worse than Alzheimer disease or vascular dementia
in that compassion, self-awareness, and judgment fade in a person who otherwise seems normal.
usually begins before age 70 and progresses rapidly, leading to death in about five years.
Many other dementias begin with impaired motor control (shaking when picking up a coffee cup, falling when trying to walk), not with impaired thinking.
The most common of these is Parkinson disease,
Parkinson disease:
A chronic, progressive disease that is characterized by muscle tremor and rigidity and sometimes dementia; caused by reduced dopamine production in the brain.
Parkinson disease
he cause of about 3 percent of all cases of dementia
Parkinson disease starts with rigidity or tremor of the muscles as dopamine-producing neurons degenerate,
affecting movement long before cognition.
older people with Parkinson disease develop dementia sooner
Another 3 percent of all dementias in the United States are
Lewy body dementia,
Lewy body dementia:
A form of dementia characterized by an increase in Lewy body cells in the brain. Symptoms include visual hallucinations, momentary loss of attention, falling, and fainting.
Lewy bodies are also present in Parkinson disease,
but in Lewy body dementia they are more numerous and dispersed throughout the brain
Motor movements and cognition are both impacted, although the motor effects are less severe than in Parkinson disease and the memory loss is not as dramatic as it is in Alzheimer disease
The main symptom is loss of inhibition: A person might gamble, or become hypersexual.
Comorbidity is common with dementia.
For instance, most people with Alzheimer disease also show signs of multi-infarct dementia
. Parkinson, Alzheimer, and Lewy body dementias can occur together
People who have all three experience more rapid and severe cognitive loss
Huntington disease, multiple sclerosis, a severe head injury, repeated concussions as experienced by athletes or soldiers, or the last stages of syphilis, AIDS, or bovine spongiform encephalitis
Some other types of dementia begin in middle age or even earlier
Although the rate of systemic brain disease increases dramatically with every decade after age 60, Boogaard and many dead professional boxers and football stars reveal that brain disease can occur at any age
Obviously, senility and senescence are not synonyms for dementia.
PREVENTING IMPAIRMENT
exercise that improves blood circulation also may build brain capacity and repair damage, not merely prevent loss
Medication to prevent stroke also protects against dementia
half of a large group of older Finns were given drugs to reduce lipids (primarily cholesterol)
Years later, fewer of them had developed dementia than did a comparable group who were not given the drug (Solomon et al., 2010).
Avoiding toxins (lead, aluminum, copper, and pesticides) or adding supplements (hormones, aspirin, coffee, insulin, antioxidants, red wine, blueberries, and statins)
have been tried but not proven effective in controlled, scientific research.
Thousands of scientists seek to halt the production of beta-amyloid, with some success in mice but not yet in humans.
One goal is to diagnose Alzheimer disease 10 or 15 years before the first outward signs, to prevent brain damage
the first step in treating dementia is to improve overall health
High blood pressure, diabetes, arteriosclerosis, and emphysema all impair cognition.
TREATMENT OF DEMENTIA
Early, accurate diagnosis, years before obvious symptoms appear, leads to more effective treatment
Drugs do not cure dementia, but many slow the progression
The U.S. Pentagon estimates that more than 200,000 U.S. soldiers who were in Iraq or Afghanistan suffered traumatic brain injury,
which predisposes them to early-onset dementia (Miller, 2012).
Measures to remedy their brain damage may, ironically, help the aged as well.
Two decades ago, many people thought senility, dementia, and Alzheimer disease were synonyms.
Yet even today, diagnosis is often missed or delayed (Bradford et al., 2009), partly because symptoms are ignored or accepted as mere aging.
Tests of behavior, cognition, blood, spinal fluid, and brain can help in specific diagnosis, but they also are expensive, time-consuming, and stressful.
the major types of dementia, including Alzheimer disease, have several distinct subtypes
ach may have particular symptoms, and varied drug responses, so treatment must be tailored to each person.
Few physicians are trained care providers for people with dementia; many avoid telling caregivers when dementia seems likely. That hesitancy is understandable, but wrong in two ways: (
(1) early treatment might slow the progression, and (2) caregivers are often relieved to know why someone they love is confused, distant, and forgetful (
REVERSIBLE DEMENTIA?
care improves when everyone knows that dementia is occurring and what form it’s taking.
Accurate diagnosis is even more crucial when memory problems are not dementia.
Mini-Mental State Examination (MMSE):
A test that is used to measure cognitive ability, especially in late adulthood.
which reveals whether a person’s cognition is worsening because of dementia or whether some nondementia problem is the likely cause.
The most common reversible condition that is mistaken for dementia is
depression.
Normally, older people tend to be quite happy; frequent sadness or anxiety is not normal
Ongoing depression, untreated, increases the risk of dementia
people with untreated anxiety or depression may exaggerate minor memory losses or refuse to talk
Quite the opposite reaction occurs with early Alzheimer disease, when victims are often surprised when they cannot answer questions, or with Lewy body or frontal lobe dementia, when people talk without thinking.
Specifics provide other clues. People with dementia might forget what they just said, heard, or did because current brain activity is impaired, but they might repeatedly describe details of something that happened long ago.
The opposite may be true for emotional disorders, when memory of the past is impaired but short-term memory is not.
Five other conditions—malnutrition, dehydration, brain tumors, physical illness, and overmedication—
can also cause symptoms that can mimic dementia
The aging digestive system needs better nutrition but fewer calories. That requires new habits, less fast food, and more money (which many do not have).
Since homeostasis slows with age, malnutrition and dehydration are harder to recognize and remedy (e.g., thirst signals from body to brain are reduced)
Symptoms of brain tumors (headaches, blurred vision) or other serious diseases may not get medical attention if getting to a physician requires considerable effort.
In this regard, living alone is a liability: Partners make each other go to the doctor.
The fifth item listed above, overmedication, is a risk for almost every older person and is least likely to be recognized by
a partner, friend, or caregiver.
polypharmacy
Refers to a situation in which elderly people are prescribed several medications. The various side effects and interactions of those medications can result in dementia symptoms
In addition, anesthesia often triggers hallucinations, and pain medication can produce delirium.
Risks of polypharmacy increase with transitions: When someone is transferred from a hospital to a nursing home, overmedication and confusion are common
The average elderly person in the United States sees a doctor
eight times a year
A “prescribing cascade”
when a drug is prescribed to treat an adverse effect of another drug)
Both Erik Erikson and Abraham Maslow were particularly interested in the elderly,
Erikson found that many older people gained interest in the arts, in children, and in human experience as a whole.
His eighth stage, integrity versus despair,
is the time when life comes together in a “re-synthesis of all the resilience and strengths already developed” (
Maslow maintained that older adults are more likely than younger people to reach the highest stage of development
self-actualization.
Maslow rejected an age-based sequence of life
efusing to confine self-actualization to the old.
self-actualization
The stage of self-actualization is characterized by aesthetic, creative, philosophical, and spiritual understanding
Studies of centenarians find that they often have a deep spiritual grounding and a surprising sense of humor—surprising, that is, if one assumes that people with limited sight, poor hearing, and frequent pain have nothing to laugh about.
For many, “old age can be a time of emotional sensory awareness and enjoyment”
For that reason, some of the elderly take up gardening, bird watching, sculpting, painting, or making music, even if they have never done so before.
In a study of extraordinarily creative people, almost none felt that their ability, their goals, or the quality of their work had been much impaired by age.
In their seventies, eighties, and nineties, they may lack the fiery ambition of earlier years, but they are just as focused, efficient, and committed as before
Expressing one’s creativity and aesthetic sense is said to aid in social skills, resilience, and even brain health
life review:
An examination of one’s own role in the history of human life, engaged in by many elderly people.
A massive international survey of 26 nations, at least one on each inhabited continent,
found that most people everywhere agree that wisdom is a characteristic of the elderly
most objective research finds that wisdom does not necessarily increase with age.
An underlying research quandary is that a universal definition of wisdom is elusive:
One summary describes wisdom as an “
expert knowledge system dealing with the conduct and understanding of life”
Several factors just mentioned,
ncluding the ability to put aside one’s personal needs (as in self-actualization), self-reflective honesty (as in integrity), and perspective on past living (the life review), are considered part of wisdom.
These researchers posed life dilemmas to adults of various ages and asked others (who had no clue as to how old the participants were) to judge whether the responses were wise
They found that wisdom is rare at any age, but, unlike physical strength and cognitive quickness, wisdom does not fade with maturity. Thus, some people of every age were judged as wise.
longitudinal study of 814 people concludes that wisdom is not reserved for the old,
perspective, and altruism increase over the decades, gradually making people wiser. He then wrote:
A more comprehensive study (Pitskhelauri, 1982) found that the lifestyles in all three of these regions were similar in four ways:
Diet. People ate mostly fresh vegetables and herbs, with little meat or fat. They thought it better to be a little bit hungry than too full.

Work. Even the very old did farm work, household tasks, and childcare.

Family and community. The elderly were well integrated into families of several generations and interacted frequently with friends and neighbors.

Exercise and relaxation. Most took a walk every morning and evening (often up and down mountains), napped midday, and socialized in the evening.

THE TRUTH ABOUT LIFE AFTER 100
Everyone who claimed to be a centenarian was probably exaggerating, and every researcher who believed them was too eager to accept the idea that life would be long and wonderful if only the ills of modern civilization could be avoided
It is important to distinguish the average life span from the maximum.
maximum life span:
The oldest possible age that members of a species can live under ideal circumstances. For humans, that age is approximately 122 years
humans, 122
Maximum life
average life expectancy:
The number of years the average newborn in a particular population group is likely to live.
average life expectancy
In human groups, average life expectancy varies a great deal, depending on historical, cultural, and socioeconomic factors as well as on genes
Recent increases in life expectancy are attributed to the reduction in deaths from adult diseases
In the United States in 2012, average life expectancy at birth was about 76 years for men and 81 years for women.
That is four years longer than it was 30 years ago, and it is projected to be another five years longer in 2050
hose who study centenarians find many quite happy (
Some studies find a higher rate of physical and mental health problems before age 100 than after
For example, in Sweden, where medical care is free, researchers found that centenarians were less likely to take antidepressants, but more likely to use pain medication, than those who were aged 80 or so
Social relationships in particular correlate with robust mental health
Centenarians tend to be upbeat about life.
The presence of _______ increases the risk of Alzheimer disease.
ApoE4
The fact that older adults have difficulty gathering and considering all relevant information with which to make a decision can be explained by:
a shrinking prefrontal cortex.
Most late adults who maintain sufficient intellectual powers:
gain a greater appreciation of aesthetics and become creative.
Researchers need to consider _________ when measuring memory.
ecological validity
Which of the following comments about the life review is false?
Nostalgia represents a preoccupation with self that is meaningless.
ageism:
A prejudice whereby people are categorized and judged solely on the basis of their chronological age.
This author believes a major problem is that ageism is institutionalized in our culture, evident in television, employment, and retirement communities
The resulting self-doubt fosters anxiety, morbidity, and even mortality.
ageist idea
“extremely resistant to change,” undercutting their own health and intellect
Those who were most ageist initially were twice as likely to have serious heart disease 30 years later, compared with those who were least ageist
. Most people older than 70 think they are doing better than other people their age—who, they believe, have worse problems and are too self-absorbed
Asked how old they feel, typical 80-year-olds lop a decade or more off their age
This is illogical, but in an ageist culture, thinking you feel younger than your chronological age is self-protective.

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