Chapter 9 - Late Adulthood (1).pptx

Chapter 9: Late Adulthood Lifespan Development: A Psychological Perspective By Martha Lally and Suzanne Valentine-French In this chapter:  Late adulthood definition and demographics   Physical development   Theories of aging, physical and sensory changes, sleep, sexuality Cognitive deve...

Chapter 9: Late Adulthood Lifespan Development: A Psychological Perspective By Martha Lally and Suzanne Valentine-French In this chapter:  Late adulthood definition and demographics   Physical development   Theories of aging, physical and sensory changes, sleep, sexuality Cognitive development   Characteristics of the aging population, life span versus life expectancy Memory, intelligence, Alzheimer’s disease, compensation Psychosocial development  Stereotypes, integrity vs. despair, relationships, living arrangements Learning objectives: Late adulthood definition and demographics       Describe the increase in the number of individuals who are currently identified as late adults Describe the increase in late adulthood worldwide Explain gender and ethnic differences in the number of individuals identified as late adults Explain the different ways developmental psychologists describe aging Explain the difference between life span and life expectancy Define the three age categories for late adulthood The graying of America  Adults 65+ are fastest-growing segment of U.S. population    A current 65-year-old can expect to live 19 more years   Currently 1/7 population is 65+ By 2020, will be ¼ Increase of 5.5 years since 1950 Will affect work, health care, housing, Social Security, caregiving, and adaptive technologies Table 9.1 Percent of United States population 65 years and older Percent of United States Population 65 Years and Older 65-69 70-74 75-79 80-84 85 Years and Older 2012 2020 2030 13.7% 16.8% 20.3% 4.5% 3.2% 2.4% 1.8% 1.9% 5.4% 4.4% 3.0% 1.9% 2.0% 5.6% 5.2% 4.1% 2.9% 2.5% The graying of the world  524 million people 65+ worldwide (8% of global population)     Will increase to 16% of global population by 2050 Greatest increase (250%) in developing nations Caused by declines in fertility, increased longevity Logistical question: Who will provide care? Table 9.2 Percentage of citizens 65 years and older in six developed countries Percent of Population 65 and Older America Japan Germany Italy Canada 2012 2030 2050 13.7% 24% 20% 20% 16.5% 20.3% 32.2% 27.9% 25.5% 25% Russia 13% 20% 22% 40% 30% 31% 26.5 % 26% Life expectancy vs. lifespan  Life expectancy – Average number of years that members of a population (or species) live      2015 worldwide: 71.4 (females 73.8, males 69.1) 2012 U.S.: 79.7 (females 81.9, males 77.3) Affected by behavior, ethnicity, location Today’s children may live shorter lives than parents Lifespan – Greatest age reached by any member of a given population (or species  For humans, the lifespan is 120-125 Gender differences in life expectancy  Women have better genetic/developmental stability     Better immune functioning Lower rates of mental illness Estrogen has protective effect on circulatory system Better health behaviors Table 9.3 2012 U. S. life expectancy by sex, race, and ethnic origin in years Demographic Female All Groups 81.97 Non-Hispanic White and 81.7 Asian or Pacific Islander Male 77.32 77.1 Non-Hispanic Black and 78.0 American Indian or Alaskan Native 71.7 Hispanic 78.9 83.7 Age categories in late adulthood    Young–old (65-84) – Good health, social engagement, cognitive functioning Oldest-old (85- 99) – Increased health problems, care needs Centenarians (100+) – Often in good health until 90s, rapid terminal decline close to death Figure 9.6 Hospitalizations by age: United States 20002010 Learning objectives: Physical development in late adulthood  Describe different theories of aging  Describe the changes in physical appearance in late adulthood  Describe the sensory changes in late adulthood  Describe chronic health conditions during late adulthood  Describe the importance of nutrition and exercise in late adulthood  Describe the physical and functional changes in the brain during late adulthood  Explain what happens in Parkinson’s disease  Explain how sleep patterns change in late adulthood  Explain how sexuality changes in late adulthood Theories of aging: Programmed theories  Follow a biological timetable     Programmed longevity – Genes promote or decrease longevity Cellular clock theory – Cells lose ability to reproduce Declines in immune system functioning Hormonal stress theory – Hypothalamus doesn’t work as effectively, leading to metabolic problems A closer look: Cellular clock theory    Telomeres – Sequences of DNA at ends of chromosomes As cells reproduce, telomeres get shorter When telomeres get too short, the cell may:    Turn itself off (cellular senescence) Die (apoptosis) Continue to divide and become abnormal (like in cancer) A closer look: Immunological theory   Metabolic stress – Body’s life-sustaining activities Innate immune system - Skin, mucous membranes, cough reflex, stomach acid, and specialized cells that alert the body of an impending threat   With age these cells lose their ability to communicate Adaptive immune system – Tonsils, spleen, bone marrow, thymus, circulatory system and the lymphatic system that work to produce and transport T cells  With age we produce fewer T cells A closer look: Hormonal stress theory     Hypothalamus doesn’t regulate hormones as well Linked to excess of the stress hormone cortisol The more stress we experience, the more cortisol released Related to increased development of diabetes, thyroid problems, osteoporosis, and orthostatic hypotension Theories of aging: Damage/error theories   DNA damage due to increased age, exposure to harmful agents (UV radiation, hydrocarbons) Damage to mitochondria – Uses oxygen to produce energy from food  Generates less energy for cell, leading to cell death Theories of aging: Damage/error theories (continued)  Free radical theory  Free radicals – Oxygen molecules missing an electron Create instability in surrounding molecules by taking electrons from them  May cause damage in cells and tissue (cancer, cataracts)  Physical changes in late adulthood: Overview         Heart muscles thicken with age Arteries become less flexible Lung capacity diminishes Kidneys become less efficient in removing waste Bladder loses ability to store urine Neurons lose some functioning, but new ones produced Lots of variability Genetics, lifestyle, and disease all play a role Physical changes in late adulthood: Body shape and composition    After age 30, people tend to lose lean tissue Reduces the amount of water in your body Bones lose some minerals and become less dense   Early stages – Osteopenia, Later stages – Osteoporosis Body fat increases after age 30   Older individuals may have almost 30% more fat than when they were younger Fat tissue builds up toward the center of the body, including around the internal organs Physical changes in late adulthood: Skin and hair         Skin becomes thinner, less elastic, loses fat, and no longer looks plump and smooth Veins and bones seen more easily Scratches and cuts take longer to heal Bruise more easily Age spots, wrinkles, dryness, increased risk of skin cancer Skin aging heavily influenced by sun exposure Hair follicles stop producing new hairs Continued graying due to loss of pigment Physical changes in late adulthood: Muscles  Sarcopenia – Loss of muscle tissue as a natural part of aging   Physically active people will lose less Caused by: Reduction in nerve cells responsible for signaling muscles to move  Decreased ability to turn protein into energy  Inadequate calories/protein to sustain muscle mass    Leads to weakness and loss of stamina and mobility Increases frailty and likelihood of falls and fractures Physical changes in late adulthood: Height and weight  Height loss related to changes in bones, muscles, and joints      People typically lose almost ½ inch every 10 years after age 40 Generally lose 1-3 inches total Men often gain weight until about age 55 Women usually gain weight until age 65 Late life weight loss occurs because fat replaces lean muscle tissue Sensory changes in late adulthood: Vision   Cataracts – Clouding of the lens of the eye Macular degeneration – Center of retina deteriorates   Loss of central vision Glaucoma – Fluid buildup in eye damages optic nerve  Loss of peripheral vision Vision changes in aging Norma l vision Macular degenerat ion Catarac ts Glauco ma Sensory changes in late adulthood: Hearing  Almost 25% adults aged 65-74 have disabling hearing loss     50% adults aged 75 and older Presbycusis – Gradual loss of hearing in late adulthood Tinnitus – Ringing, hissing, or roaring sound in the ears Balance problems caused by decline in inner ear functioning Sensory changes in late adulthood: Taste and smell  Gradual loss of taste buds starting in 50s   Presbyosmia – Loss of smell due to aging     Usually not noticeable Produces most changes in sense of taste Decrease in olfactory receptor neurons Could indicate other neurological conditions Related to quality of diet Sensory changes in late adulthood: Touch   Reduced or changed sensations of vibration, temperature, and pressure Increased risk of injury Sensory changes in late adulthood: Pain   60%-75% of elders report some chronic pain But older adults generally less sensitive to pain   Can conceal conditions requiring medical attention Pain can produce cycle of disability   Pain → reduced activity → more pain with activity Also contributes to weight gain, sleep problems, depression Nutrition in later life  MyPlate for Older Adults guidelines:      50% of diet from fruits and vegetables 25% grains, many of which should be whole grains 25% protein-rich foods Nutrition affected by sensory and dental changes Older adults are likely to overuse salt and sugar Health concerns in late adulthood: Chronic conditions  Ongoing, generally incurable illnesses   Prevalence increases with age   Affect daily life and require continuing medical attention Less than 50% of adults 50-64, but 90% aged 75+ More common in older women Table 9.6 Percentage of older adults with chronic conditions Percentage of Older Adults with Chronic Conditions High cholesterol 58.2 Hypertension 56.7 Arthritis 48.7 Cancer 23.1 Diabetes 20.5 Heart disease 17.9 Ulcers 11.3 Stroke 7.2 Asthma 6.9 Kidney disease 5.1 Chronic bronchitis 5.0 Emphysema 4.0 Health concerns in late adulthood: Cancer  Cancer risk increases with age    Age 65+: 60% of newly diagnosed cancer and 70% of all cancer deaths May be comorbid with other health problems Treatment may be difficult      Medication efficacy affected by decline in organ functioning Chemotherapy compromises cognitive functioning Treatment may be too hard on the body Increased prevalence and risk of malnutrition and environmental injury Depression associated with decreased survival rates). Health concerns in late adulthood: Heart disease  Age-related changes increase risk of heart disease     Stiffening blood vessels and valves may cause leaks or pumping problems Increased atherosclerosis and risk of heart attack or stroke Most cardiovascular problems caused by disease, not aging Heart-healthy lifestyle in earlier life important Health concerns in late adulthood: Osteoarthritis  Cartilage on/between bones wears way      Bone rubs against bone, causing pain, swelling, and stiffness May result in chronic pain and loss of joint functioning Almost half of adults with arthritis have mobility limitations Pain and limitations can cause depression and anxiety Risk factors: Genetics, obesity, age, previous injury Health concerns in late adulthood: Bones  Osteoporosis – Bones very fragile, break easily   Kyphosis – Hunched posture due to spinal weakness   Fractures can lead to permanent disability or death Can be hard to walk or sit Bone health helped by:    Healthy diet with enough calcium and vitamin D Regular exercise Limiting alcohol and not smoking Health concerns in late adulthood: Chronic obstructive pulmonary disease  Progressive lung disease in which the airways become damaged, making it difficult to breathe     Develops slowly, may be attributed to age or lack of exercise No cure; treatments aim at slowing further damage Exposure to tobacco smoke is most common cause Recessive genetic condition responsible for 1 in several thousand cases Figure 9.20 Chronic obstructive pulmonary disease Health conditions in late adulthood: Shingles    Caused by reactivation of chicken pox virus Risk increases with age due to immune system decline Pain, burning, rash, blisters   May leave scars or cause blindness if spreads to eye Post-herpetic neuralgia – Pain lasting after blisters clear up  Can interfere with daily activities Brain functioning in later life  Brain loses 5% to 10% of weight ages 20-90   Shrinkage of neurons, lower number of synapses, and shorter length of axons Other brain changes:     Reduced activity of genes involved in memory storage, synaptic pruning, plasticity, and glutamate and GABA (neurotransmitters) receptors Loss in white matter connections – neurons work less efficiently Loss of synapses in hippocampus and basal forebrain Larger regions of brain activated during complex tasks  Impaired executive functioning, working memory Brain functioning in later life (continued)  Scaffolding theory of aging and cognition     Brain adapts to neural atrophy by building alternative connections (scaffolding) Brain can compensate for age-related changes “Brain training” programs not effective Activity, social engagement, learning new skills better Parkinson’s disease  Caused by deterioration of substantia nigra    Decreased dopamine in brain Characterized by motor tremors, loss of balance, poor coordination, rigidity, and difficulty moving Combination of genetic and environmental factors (especially brain injury) Sleep in late life   Older adults need 7-9 hours of sleep per night Advanced sleep phase syndrome – Go to bed earlier and get up earlier    Caused by circadian rhythm changes Sleep important for mental and physical health, safety, cognitive functioning Health conditions can impair sleep Sleep problems in late life      Insomnia – Trouble falling asleep and staying asleep Sleep apnea – Repeated short pauses in breathing during sleep Restless legs syndrome – Tingling, crawling feeling in legs Periodic limb movement disorder – People to jerk and kick their legs every 20 to 40 seconds during sleep Rapid eye movement sleep behavior disorder – Muscles move during REM sleep, and sleep is disrupted Sexuality in late life  Many stereotypes about aging and sexuality     View of elders as genderless and asexual Sexual interest/activity viewed as creepy or gross Stereotypes may be internalized and affect enjoyment Reality: 72% of men and 45.5% of women aged 52 to 72 report being sexually active    Fewer distractions, including pregnancy worries More time and privacy Greater intimacy with a lifelong partner Sexual problems in late life  Health conditions can affect sexual functioning        Arthritis causes joint pain Diabetes causes erectile dysfunction Heart disease causes difficulty achieving orgasm Hormonal conditions may affect sexual response and enjoyment Feelings about sex may also affect performance Best way to experience a healthy sex life in later life is to keep sexually active at younger ages Lack of available partners can affect heterosexual women’s participation in sexual relationships Learning objectives: Cognitive development in late Adulthood        Describe how memory changes for those in late adulthood Describe the theories for why memory changes occur Describe how cognitive losses in late adulthood are exaggerated Explain the pragmatics and mechanics of intelligence Define what is a neurocognitive disorder Explain Alzheimer’s disease and other neurocognitive disorders Describe work and retirement in late adulthood Cognitive changes in late adulthood: Working memory  Central executive most negatively affected by age     Difficulty allocating cognitive resources Difficulty monitoring effectiveness of cognitive strategies Learning two new tasks simultaneously is difficult Other types of working memory tasks (e.g., digit span) aren’t as affected Cognitive changes in late adulthood: Longterm memory  Episodic memory shows greater age-related declines than semantic memory   Older adults often outperform younger adults on semantic tasks   Require recall of event and timeline But more tip-of-the-tongue events Implicit (procedural) memory shows few declines with age Cognitive changes in late adulthood: Prospective memory     Remembering things we need to do in the future Time-based – Remembering to do something at future time Event-based – Remember to do something when a certain event occurs More age-related declines for time-based prospective memories Other memory changes in late adulthood  Recall vs. recognition     Recognition tasks easier because they require less cognitive energy Older and younger adults perform similarly on recognition tasks Older adults do show declines in recall memory The “age advantage”    Older adults can use knowledge or experience to compensate Cognitive activity often more efficient Better decision making Cognitive changes in late adulthood: Attention    Affected by changes in sensory functioning and speed of information processing Older adults less able to selectively focus and ignore distractors Older adults have greater difficulty shifting attention Cognitive changes in late adulthood: Problem solving  Older adults use more effective strategies than younger adults to solve social and emotional problems    Use more efficient strategies and expertise to compensate for cognitive decline Performance on tasks that require processing non-meaningful information quickly decline with age May not translate into real-world problem solving Reasons for age-related cognitive differences  Processing speed theory – Slowing nervous system affects ability to process information   When speed is not a factor, few age-related differences Inhibition theory – Older adults have difficulty suppressing irrelevant information   Directed forgetting – Ask people to forget or ignore certain information Older adults do more poorly at directed forgetting tasks Reasons for age-related cognitive differences (continued)     Laboratory tasks tend to be meaningless Overreliance on cross-sectional research Lack of practice Sensory deficits Cognitive development in late adulthood: Intelligence and wisdom  Mechanics of intelligence – Basic information processing    Pragmatics of intelligence – Cultural exposure to facts and procedures    Dependent on brain functioning and decline with age Similar to fluid intelligence Maintained with age, may compensate for declines in other areas Similar to crystalized intelligence Wisdom – Ability to use the accumulated practical knowledge for good judgment and decision making  Dependent on experience and personality, not just age Neurocognitive disorders   Used to be called “dementia” Major Neurocognitive Disorder    Significant decline in one or more cognitive areas Interferes with independent functioning Minor Neurocognitive Disorder   Modest decline in one or more cognitive areas Does not interfere with independent functioning Types of neurocognitive disorders: Alzheimer’s disease  Most common type     2016: 5.4 million Americans diagnosed 5th leading cause of death age 65+ Memory decline extends to personality changes, behavior problems, loss of self-care skills Caused by genetic and environmental factors Figure 9.29 The timeline of Alzheimer’s disease Neurological causes of Alzheimer’s disease  Formation of beta-amyloid plaques    Block cell communication May trigger inflammatory response causing neuronal death Malfunctioning of tau protein   Forms twisted strands called tangles that disrupt neuronal transport system Nutrients and oxygen can’t get to neurons, and they die Figure 9.30 Plaques and tangles Types of neurocognitive disorders: Vascular neurocognitive disorder  Blockage of cerebral blood vessels     Generally affects one part of the brain, not all Personality not affected More abrupt onset, shorter course Risk factors: Smoking  Diabetes  Heart disease, hypertension, history of strokes  Types of neurocognitive disorders: Neurocognitive disorder with Lewy bodies  Lewy bodies – Microscopic protein deposits in neurons   Affect neurotransmitters (dopamine and serotonin) Impaired thinking, movement, behavior and mood Work in late adulthood  2015: 8.8 million adults 65+ employed or actively seeking employment    5.6% of the U.S. labor force Older workers have lower absenteeism, greater investment Better performance at jobs that require social skills, accumulated knowledge, and relevant experiences The transition to retirement  Average retirement age: 65    But 18.5% of adults over age 65 continue to work 60% of workers transition to bridge jobs (between a career and full retirement) About 15% of workers get another job after full retirement  Encore careers – Different field from the one in which they retired The timing of retirement  Certain benefits not available until age 65    ADEA eliminated mandatory retirement   Medicare Social Security (depending on birthdate) But not for all jobs Individual retirement decisions affected by:   Financial resources Psychological reasons Atchley’s retirement stages       Remote pre-retirement phase – Thinking about retirement Immediate pre-retirement phase – Making concrete plans Actual retirement Honeymoon phase – Participate in activities Disenchantment phase – Experience emotional letdown Reorientation phase – Adjust to retirement   Simplify plans Regular routine Post-retirement activities   Staying active and socially engaged is important Some retirees seek educational experiences    Additional training for encore career Personal fulfillment Educational travel programs Learning objectives: Psychosocial development in late adulthood            Explain the stereotypes of those in late adulthood and how it impacts their lives Summarize Erikson’s eighth psychosocial task of integrity vs despair Explain how self-concept and self-esteem affect those in late adulthood Identify sources of despair and regret Describe paths to integrity, including the activity, socioemotional selectivity, and convoy theories Describe the continuation of generativity in late adulthood Describe the relationships those in late adulthood have with their children and other family members Describe singlehood, marriage, widowhood, divorce, and remarriage in late adulthood Describe the different types of residential living in late adulthood Describe friendships in late life Explain concerns experienced by those in late adulthood, such as abuse and mental health issues Ageism   Prejudice based on age Belief in stereotypes can affect well-being     Self-fulfilling prophecy Stereotype threat May ignore health problems, not seek treatment Nonwhite elders may face both ageism and racism  Triple jeopardy – Ageism, racism, and sexism faced by nonwhite elderly women Older adults and poverty  Poverty rate differs by gender, marital status, race, and age  Women 65+ 70% more likely to be poor than men    Poverty rate for women increases with age Married couples less likely to be poor Poverty more prevalent among older racial minorities Living arrangements in late adulthood   72% of men, 46% of women 65+ live with spouse Number of elders living alone declined since 1990    Intergenerational households unlikely    Older women living with spouse or children Living alone associated with financial problems But depends on culture/ethnicity Most elders stay in place after retirement Only 3.2% of elders live in nursing homes  But this increases with age Figure 9.35 Elders living alone Erikson: Integrity vs. despair   Retrospective accounting of life Integrity:      Finding meaning in one’s life and accepting one’s accomplishments Acknowledging disappointments/failures Feeling contentment and accepting others’ deficiencies Erikson: Integrity = wisdom Despair can come from bitterness and resentment Activity theory  Staying active leads to greater life satisfaction     Better physical and mental health Sense of purpose and social connections True in general But goals must be realistic Generativity in late life  Volunteering   African American adults have highest volunteer rate Grandparents raising grandchildren  May be challenging Caused by traumatic events  Less energy and poorer health  Financial, education, and housing challenges  Social networks in late adulthood  Convoy model of social relations – Social connections maintained by exchanges in social support    Close relationships (family, close friends) stable Peripheral relationships (coworkers, neighbors) less stable Socioemotional selectivity theory – Motivation for social contact changes with age    Optimizing positive affect rather than acquiring information Prioritize time spent with emotionally close significant others Smaller social networks Relationships with adult children  Elders support adult children more than vice versa     Financial assistance Housing Raising grandchildren Emotional support from adult children associated with better life satisfaction   No such relationship for informational support Consistent with socioemotional selectivity theory Friendships in late life   Provide emotional and physical support Associated with better health outcomes following widowhood  Not the case for having family members as confidantes Loneliness vs. solitude  Loneliness = Discrepancy between the social contact a person has and the contacts a person wants     For women, often caused by social isolation For men, often caused by emotional isolation Associated with lack of self-worth, impatience, desperation, and depression Solitude = Gaining self-awareness, taking care of the self, being comfortable alone, and pursuing one’s interests Figure 9.40 Marital status of adults 65 and older in 2015 Late adult lifestyles: Widowhood   Viewed as being significant life stressor Adjustment depends on:     Extraversion and self-efficacy Emotional support received from others Context of death (e.g., predictability) Widowhood mortality effect – Higher risk of death after the death of a spouse Late adult lifestyles: Divorce   Less common over age 65 than at other ages Divorced women more likely to:    Experience financial difficulties Remain single Get more support from adult children Late adult lifestyles: Dating    18 months after the death of a spouse, 37% of men and 15% of women were interested in dating Social networks decrease with age More reliance on internet technologies to meet people Online dating in late adulthood  Men seek physical attractiveness and offer status related information, want younger women   More interested in repartnering Women want older men until age 75   Older women don’t want to become caregivers or widowed again Also want to maintain personal and financial independence Sexual health in late adulthood  Age doesn’t eliminate risk of STDs     Nearly 25% of people living with HIV/AIDS in the United States are 50+ Only 25% of single/dating adults 50+ used a condom the last time they had sex 40% of adults 50+ have never been tested for HIV Need for education on health sexual behavior Late adult lifestyles: Remarriage and cohabitation  Late life remarriages often more stable than those of younger adults      Better emotional maturity More realistic expectations Emotional support from friends negatively correlated with seeking romantic relationships Many elders want companionship but not marriage Cohabitation increasing among older adults LGBT elders   About 3 million elder in the United States identify as lesbian or gay More likely to have:    Physical health problems Mental health and substance abuse problems Reduced social support from family     But broader social support from “chosen family” Experiences with discrimination Especially likely for rural and nonwhite elders May depend on cohort Elder abuse  At least 10% (4.3 million) elders abused each year     Ages 60-69 most susceptible Most likely abusers: Adult children and spouses Financial abuse costs elders $3 billion each year Common across racial/ethnic groups  But definitions of abuse may vary Elder abuse (continued)  Risk factors:      Cognitive impairment Decline in health that produces dependency on others Having a disability Being female Adult children depending on parents for financial/housing support Substance abuse in late life    2.5 million elders have substance abuse problem Risk factors: Social isolation, depression, pain Hard to diagnose     Often become dependent by accident May be confused with normal aging Stereotypes can contribute to underdiagnosis Less impairment in activities like work or school Substance abuse in late life (continued)  Most commonly used:    Alcohol Prescription opioids (painkillers) Benzodiazepines   May be overused instead of psychotherapy Marijuana  May increase as current Baby Boomers age Successful aging  Rowe and Kahn (1997):     Relative avoidance of disease, disability, and risk factors Maintenance of high physical and cognitive functioning Active engagement in social and productive activities Baltes: Selective optimization with compensation   Elder makes adjustments to continue living as independently and actively as possible Compensate by choosing other ways to achieve their goals  Example: drive Finding alternative transportation when can’t