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LATE ADULTHOOD

INTRODUCTION

— from approximately age 60 until death

— percentage increasing over time (highest in history)

1900: 6% population over 65 (US)

1990: 17%

2050: 25-30% (estimated)

— complex period

— still many changes occurring

— changes involve both development and decline

— great diversity among individuals

— some become less active/some become more

— some begin to withdraw/some become more interested in contributing

— in this stage development often occurs in reaction to aging

— it can occur to compensate for loss of abilities

— there is also the potential for conflict:

— most want their compensatory behaviours to not be an admission of helplessness

— elderly often fear loss of autonomy (incentive for many behaviours)

PHYSICAL DEVELOPMENT

1. External

— hair whitens, thins

— skin loses collagen, elasticity

— spinal cartilage thins, leading to a loss of height (loss of height also due to stooped posture)

2. Internal

i/

brain

— shrinks by at least a third

— some cell loss in the brain

— brain also undergoes decreased supply of blood, oxygen, glucose

ii/

motor function

— reaction time increases

— need more time for tasks (dressing, preparing meals, etc.)

— explained by two hypotheses:

1)

peripheral slowing hypothesis

— peripheral nervous system processing of info decreases in efficiency

— flow of information to brain becomes slower

— once the information arrives, the brain processing speed itself remains ok

— then, information from brain to periphery also becomes slower

2)

overall, increased reaction time generalized slowing hypothesis

— whole nervous system begins to function more slowely

— brain doesn’t processes information as well as before

iii/

sensory function

 

a) visual abilities decrease

decreased:

 

visual acuity light sensitivity ability to adjust for changes in light levels

 

b) hearing loss

— 30% experience some hearing loss by age 65

— 50% by age 75

— greater loss of high frequency sounds

 

difficulty hearing conversations when background noise high, etc.

 

c) taste and smell less sensitive

— decreased number of taste buds, smaller olfactory bulbs

— food now seems less palatable (requires more salt? risk for high blood pressure?)

iv/

other

— cardiac output decreases by 25% from peak

— decreased lung capacity and oxygen uptake by tissues

— decreased size and numbers of muscle fibers

— digestive system becomes less motile, less digestive enzyme activity

COGNITIVE DEVELOPMENT

Introduction

— Seattle Longitudinal Study: after 60, there is a decrease in most mental abilities

— especially processing speed, numeric ability

— 1999 study: a separate 4-year longitudianl study

— assessed 900 high-functioning adults over 70 (up to their 90’s)

— all subjects lead independent lives

— tested their cognitive abilities

— most abilities decreased (although the rates of decrease showed great variability)

— some improved in certain abilities

Effect of Sensory Deficits

— 1994 study:

— from 70-100 years, approximately half of the variance in cognitive scores was due to variance in visual or auditory abilities

— if there is less sensory ability, less information can reach the brain in time to be processed

— even in the brain, this could lead to slower processing, less ability to do tasks

Memory

1/

Working Memory

 
 

— holding, processing new information

— decrease in aging

 

— ability to remember lists reduced

especially when distracted

— ability to perform tasks while remembering lists also impaired

2/

Long-term Memory

 

— provides knowledge base

— “everything we know”

— decreases in aging

— but, not all memory equal

a) Explicit Memory

— facts: words, concepts, dates, places, events, etc.

— most people usually able to recall when required

— ability decreases in aging

b) Implicit Memory

— unconscious, automatic

— difficult to retrieve verbally

— recalled through:

— recognition

— performance

— less affected by aging

— 1992 study: learning serial patterns

— shown group of 4 boxes on screen

— when asterisk appears, must push button under box

— asterisk always appears in same serial pattern

— therefore once the pattern is identified, the subject can know which button to press next, even before the asterisk appears above it

— if young subjects are compared to old

— old make less rapid response

— but learn pattern just as quickly

— if asked to identify pattern, less able

— therefore, they learned implicitly

— causes of memory decline:

i/

self-fulfilling prophecy

— aging leads to awareness of memory deficits

— elderly often exaggerate previous abilities, thereby believing that their loss is relatively greater than it is

 

they then assume a great decline, becomes self-fulfilling prophecy, leads to further declines

ii/

culture

— respect for aging associated with abilities in aging

— in China, great respect for abilities of the elderly

 

memory loss in elderly reported to be 1/5 that of Americans

 

— for deaf Americans, less aware of attitudes towards aging

iii/

memory loss of deaf Americans 1/2 that of hearing Americans prescription drugs

— individuals over 65 y take 1/2 of all prescription drugs

— dosage usually determined in studies for 30 yr-olds

 

dosage may be too much for elderly

 

— may lead to memory loss in elderly

iv/

i.e., drugs for high blood pressure, Parkinson’s, pain brain cell loss

— found especially in hippocampus

— hippocampus found to have role in memory

— but not strong association

Compensation

— compensate for losses in abilities

— various forms:

i/

direct compensation

— use aids to improve abilities

— hearing aids, magnifying glasses, etc.

— pill dispensers

— sticks for turning off smoke detectors

ii/

selective optimization

— assess abilities and set appropriate goals

— choose small number of tasks

— maintain skill

— i.e., if play musical instrument

— choose particular pieces for ease of play

— then practice, practice, practice

iii/

anticipatory behaviours

— engage in behaviour to make upcoming task easier

— write notes to self to aid memory

— drive only in daylight due to deteriorating night vision

— drive route to avoid left-hand turns to avoid requirement for fast reaction speed

iv/

take buses at particular times or on particular routes so that seats not occupied, won’t have to stand cogiation

— withdraw from activities for short periods to reflect, consider options, etc.

— avoid distractions, etc.

PSYCHOSOCIAL DEVELOPMENT

1.

Self-Evaluation

according to Erikson, late middle adulthood is period of crisis of integrity vs. despair

— attempt to unify personal history and experience with experience of larger community

— attempt to maintain continuity through offspring, etc.

— either experience satisfaction/contentment or despair/sense of wasted opportunities

2.

Ageism

 

tendency to stereotype people of advanced chronological age

two forms:

 

i/

attitudes

 

— expectancies that person will show signs of dementia, helplessness,

 

etc.

 

— emphasize lapse of memory in the elderly, reduced ability to react in timely fashion, etc.

— denigrate attempts to compensate for age as further proof of increasing vulnerability

— problems:

 
 

such behaviour leads to a greater risk of decrease in communication

 

— elderly may become afraid to admit to vulnerabilities

— could refuse to admit to health, financial problems

 

ii/

behaviour

 

— by speaking to elderly using “baby talk”

 

loud, simple sentences

 

— could discriminate against elderly directly ( when they apply for

 

jobs, volunteer positions, etc.)

 

— by ignoring need for privacy, need for autonomy, etc.

3.

Challenges to Identity

 

foundations of identity throughout most of life:

i/

physical appearance physical health employment/responsibilities autonomy/agency

ii/

iii/

iv/

no longer tenable in late life

lead to loss of identity?

coping strategies developed

i/

identity assimilation

— no change in identity

— new experiences assimilated into previous identity

— denial of change

— can be adaptable, but lead to problems if extreme:

— increased hostility to others

(due to maintenance of false reality)

ii/

— risk to health

— ignore own limitations

identity accomodation

— adapt to new reality by changing self-concept

— again, can be adaptable but could lead to problems if extreme:

— can lead to sense of loss (of self)

— increased self-doubt

— sense that previous values, beliefs, selves unimportant, wrong

require balance of each

 

4.

Gender Differences

difference in lifespan (women live longer)

difference increases over time

women comprise 2/3 of the population over 65 (North America)

— but comprise 3/4 of elderly poor

— if over 64, 4X as many widows as widowers

policies favour men?

 

— pension plans often based upon full-time employment

— women most likely caregivers through life

 

— now responsible for ailing husbands

— negative effect on health

i/

effect of death of spouse

 

— for women:

 

2 yrs after death of spouse, more likely to be happier than unhappy

 

— for men:

 
 

— more likely to be unhappy

— more likely to remarry (more chances)

 

— women more likely to prepare for death of spouse

 

more likely to be caregiver during spouses last months

ii/

effects of divorce

 

— women:

— do well in late adulthood

— if reared children as single parent, then greater satisfaction

— closer to children

— independent (employed)

— increasing number of widows means that they now enjoy being part of a larger social group

— men:

— do less well

— less contact with children

— less contact with old friends (wives usually social co-ordinator)

— diverced elderly men report increased physical and psychological. problems (compared to non-divorced men)

5.

Sex

sexual activity continues in 90’s

after 70 y:

 

— 2/3 men and women still have sex with spouse

 

if have sex, once/week (average)

 

— 43% men and 33% women masturbate

 

once/week

complications:

— males: erections more difficult

 

refractory period longer

 

— females: less lubrication of vagina

if individual was sexually active throughout life, they are more likely to remain so in late adulthood

— if elderly stop having sex for several months, they become less likely to restart

HEALTH IN LATE ADULTHOOD

Introduction

— study of health in the elderly very complex due to

i/

death and/or illness inevitable (not true for any other age group)

process

ii/

because many of the changes associated with aging are natural, it’s

iii/

difficult to assess whether some changes are natural or part of a disease

institutionalization of many elderly creats certain health problems, affects

iv/

certain treatment decisions, etc. elderly have less autonomy, agency

— less of these is associated with poorer health

Loss Of Intellectual Function

— some loss normal

— often due to disease

— generally classified as category of dementia

— includes more than 70 diseases

— chronic, degenerative (most)

— if temporary, called delirium

1.

Alzheimer’s

 

most common (comprises 50% dementia cases in world)

leads to abnormalities in cerebral cortex

— involves protein called beta-amyloid

— can form plaques outside brain cells

— can form tangles inside brain cells

— usually begin in hippocampus (site of memory)

incidence:

 

— by 65, 1/100

 
 

rate approximately doubles every 5 yrs.

 

— if over 80, 1/5

 

stages:

 

i/

noticeable forgetfulness

 

self-aware

 

sometimes, no advance (for more than 10 y) generalized confusion

— unaware of problems

 

ii/

 

— may have mood changes

 

emphasis of prior moods

 

iii/

debilitating memory loss

 

— less able to recognize people, places

— dangerous, risk of accidents

— under home care if possible

 

iv/

full-time care

 
 

no recognition/normal response

 

v/

no response/emotion/communication

 

eventually, death

2.

Multi-infarct Dementia

 

2nd leading cause of dementia

series of strokes

 

— blockages of cerebral blood vessels

— lack of oxygen to tissue leads to tissue damage

— restricted to immediate area

symptoms varied (type and severity)

— often:

— blurred vision

— slurred speech

— localized paralysis

— confusion (can be specific)

— usually, some recovery over time (neural compensation)

— as number of infarcts increases, more severe symptoms occur until

dementia results

associated with lifestyle, nutrition, smoking, etc.

3.

Subcortical Dementias

 

damage in subcortical regions

intellectual function not impaired Parkinson’s disease

i/

damage to neurons producing dopamine

ii/

loss of motor control Multiple sclerosis

— loss of myelin in brain