Aging Psych Mids Notes PDF

Lec # 01 Introduction to Aging Psychology Introduction Progressive physiological changes that begins in early adulthood, or a decline of biological functions and of the organism’s ability to adapt to metabolic stress. Aging takes place in a cell, an organ, or the total organism w...

Lec # 01 Introduction to Aging Psychology Introduction Progressive physiological changes that begins in early adulthood, or a decline of biological functions and of the organism’s ability to adapt to metabolic stress. Aging takes place in a cell, an organ, or the total organism with the passage of time. It is a process that goes on over the entire adult life span of any living thing. Gerontology, the study of the aging process, is devoted to the understanding and control of all factors. Every species has a life history in which the individual life span has an appropriate relationship to the reproductive life span and to the mechanism of reproduction and the course of development. A life course is the period from birth to death, including a sequence of predictable life events such as physical maturation. Each phase comes with different responsibilities and expectations, which of course vary by individual and culture. Many adults look forward to old age as a wonderful time to enjoy life without as much pressure from work and family life. In old age, grandparenthood can provide many of the joys of parenthood without all the hard work that parenthood entails. And as work responsibilities abate, old age may be a time to explore hobbies and activities that there was no time for earlier in life. But for other people, old age is not a phase that they look forward to. Some people fear old age and do anything to “avoid” it by seeking medical and cosmetic fixes for the natural effects of age. These differing views on the life course are the result of the cultural values and norms into which people are socialized, but in most cultures, age is a master status influencing self-concept, as well as social roles and interactions. Major changes in Adulthood As Riley (1978) notes, aging is a lifelong process and entails maturation and change on. Biological Psychological or Social Aging & Sexuality Death & Dying Biological Changes Biological factors such as molecular and cellular changes are called primary aging, while aging that occurs due to controllable factors such as lack of physical exercise and poor diet is called secondary aging (Whitbourne and Whitbourne 2010). Most people begin to see signs of aging after fifty years old, when they notice the physical markers of age. Skin becomes thinner, drier, and less elastic Wrinkles form Hair begins to thin and gray  Men prone to balding start losing hair. The effects of aging can feel daunting, and sometimes the fear of physical changes (like declining energy, food sensitivity, and loss of hearing and vision) is more challenging to deal with than the changes themselves. The way people perceive physical aging is largely dependent on how they were socialized. If people can accept the changes in their bodies as a natural process of aging, the changes will not seem as frightening. Social & Psychological Changes Male or female, growing older means confronting the psychological issues that come with entering the last phase of life. What are the hallmarks of social and psychological change? Retirement—the withdrawal from paid work at a certain age—is a relatively recent idea. When people retire from familiar work routines, some easily seek new hobbies, interests, and forms of recreation. Many find new groups and explore new activities, but others may find it more difficult to adapt to new routines and loss of social roles, losing their sense of self-worth in the process. Each phase of life has challenges that come with the potential for fear. Erik H. Erikson (1902–1994), in his view of socialization, broke the typical life span into eight phases. Each phase presents a particular challenge that must be overcome. In the final stage, old age, the challenge is to embrace integrity over despair. Some people are unable to successfully overcome the challenge. They may have to confront regrets, such as being disappointed in their children’s lives or perhaps their own. They may have to accept that they will never reach certain career goals. Or they must come to terms with what their career success has cost them, such as time with their family or declining personal health. Others, however, are able to achieve a strong sense of integrity and are able to embrace the new phase in life. When that happens, there is tremendous potential for creativity. They can learn new skills, practice new activities, and peacefully prepare for the end of life. Aging & Sexuality It is no secret that people in Pakistan talking about sexuality is not acceptable. And when the subject is the sexuality of elderly people? No one wants to think about it or even talk about it. Although it is difficult to have an open, public national dialogue about aging and sexuality, the reality is that our sexual selves do not disappear after age sixty-five. People continue to enjoy sex well into their later years. Death & Dying For most of human history, the standard of living was significantly lower than it is now. Humans struggled to survive with few amenities and very limited medical technology. The risk of death due to disease or accident was high in any life stage, and life expectancy was low. As people began to live longer, death became associated with old age.  For many teenagers and young adults, losing a grandparent or another older relative can be the first loss of a loved one they experience. It may be their first encounter with grief, a psychological, emotional, and social response to the feelings of loss that accompanies death or a similar event. Aging in Society Gerontology & Social Gerontology Gerontology is a field of science that seeks to understand the process of aging and the challenges encountered as seniors grow older. Gerontologists investigate age, aging, and the aged. Gerontologists study what it is like to be an older adult in a society and the ways that aging affects members of a society. As a multidisciplinary field, gerontology includes the work of medical and biological scientists, social scientists, and even financial and economic scholars. Social gerontology refers to a specialized field of gerontology that examines the social (and sociological) aspects of aging. Researchers focus on developing a broad understanding of the experiences of people at specific ages, such as mental and physical wellbeing, plus age-specific concerns such as the process of dying. Social gerontologists work as social researchers, counselors, community organizers, and service providers for older adults. Because of their specialization, social gerontologists are in a strong position to advocate for older adults. Scholars in these disciplines have learned that “aging” reflects not only the physiological process of growing older but also our attitudes and beliefs about the aging process. Phases of Aging: The Young-Old, Middle-Old, and Old-Old All people over eighteen years old are considered adults, but there is a large difference between a person who is twenty-one years old and a person who is forty-five years old. More specific breakdowns, such as “young adult” and “middle-aged adult,” are helpful. In the same way, groupings are helpful in understanding the elderly. The elderly are often lumped together to include everyone over the age of sixty-five. But a sixty-five-year-old’s experience of life is much different from a ninety-year-old’s. Older adult population can be divided into three life-stage subgroups: ○ The young-old (approximately sixty-five to seventy-four years old) ○ The middle-old (ages seventy-five to eighty-four years old) ○ The old-old (over age eighty-five). Aging around the World From 1950 to approximately 2010, the global population of individuals age sixty-five and older increased by a range of 5–7 percent (Lee 2009). This percentage is expected to increase and will have a huge impact on the dependency ratio: the number of nonproductive citizens (young, disabled, or elderly) to productive working citizens (Bartram and Roe 2005). One country that will soon face a serious aging crisis is China, which is on the cusp of an “aging boom”— a period when its elderly population will dramatically increase.  The number of people above age sixty in China today is about 178 million, which amounts to 13.3 percent of its total population (Xuequan 2011). By 2050, nearly a third of the Chinese population will be age sixty or older, which will put a significant burden on the labor force and impacting China’s economic growth (Bannister, Bloom, and Rosenberg 2010) Worldwide, the expectation governing the amount and type of elder care varies from culture to culture. For example, in Asia the responsibility for elder care lies firmly on the family (Yap, Thang, and Traphagan 2005). This is different from the approach in most Western countries, where the elderly are considered independent and are expected to tend to their own care. Even then, caring for the elderly is considered voluntary. In the United States, decisions to care for an elderly relative are often conditionally based on the promise of future returns, such as inheritance or, in some cases, the amount of support the elderly provided to the caregiver in the past (Hashimoto 1996). These differences are based on cultural attitudes toward aging. Aging & the Elderly Supercentenarians are people living to 110 years or more. In August 2014, there were seventy-five verified supercentenarians worldwide—seventy-three women and two men. These are people whose age has been carefully documented, but there are almost certainly others who have not been identified. Centenarians are people living to be 100 years old, and they are approximately 1,000 times more common than supercentenarians. In 2010, there were about 80,000 centenarians in the United States alone. Lec # 02 Aging & Ageism Cultural Influences Introduction Cultural beliefs shapes social norms and values surrounding the aging process and the role of older people. These beliefs about aging are not static-they shift and change as society evolves. Ageism The term ageism was first defined in 1969 by psychiatrist Robert Butler. In later writings on the topic of ageism as experienced by older adults, he further defined it as “a process of systematic stereotyping of and discrimination against people because they are old” (Butler, 1975, p. 35). Thus, ageism is best described as a difference in one’s feelings, beliefs, or behaviors based on another person’s chronological age (Levy & Banaji, 2002). Types of Ageism Institutional ageism, which occurs when an institution perpetuates ageism through its actions and policies. Interpersonal ageism, which occurs in social interactions. Internalized ageism, which is when a person internalizes ageist beliefs and applies them to themselves. Examples of Ageism ➔ Ageism comes in many forms. Some examples of ageism in the workplace include: ➔ refusing to hire people over or under a certain age ➔ asking for someone’s age at a job interview when it is not relevant to the work ➔ enacting policies that unfairly privilege one age group over another ➔ viewing older people as out of touch, less productive, or stuck in their ways ➔ viewing younger people as unskilled, irresponsible, or untrustworthy ➔ bullying or harassment Some examples that appear in personal relationships include: ➔ treating family members as though they are invisible, unintelligent, or expendable based on their age ➔ making ageist jokes that imply someone is less valuable or less worthy of respect, based on their age ➔ making offensive generalizations about a specific generation, e.g., that millennials are entitled ➔ disregarding someone’s concerns or wishes due to their age ➔ taking advantage of someone’s age for personal gain, such as to make money ➔ using someone’s age as justification to undermine, deceive, or control them History of Ageism Attitudes toward older people have changed over time. In pre-modern times, the average life expectancy was significantly lower than it is now. Nonetheless, religion, culture, and ideology shaped social attitudes toward older adulthood (Johnson, 2005).  They are wise, hold a position of authority, and are treated with dignity and respect. Today, we see this reflected in the fact that those with money and power age better and later. In other words, when someone has the ability to access a multitude of resources, her/his living conditions, including housing, food, medical care, and leisure time, are far superior and will allow them to “age” more slowly than their counterparts in lower socioeconomic positions where life is much harder (Johnson, 2005). Culture of Ageism Today, ageism is likely the most socially accepted form of prejudice (Nelson, 2002). Many people are not even aware of their ageist thinking and probably do not intend to be hurtful in their ageist words or actions. As a result, many Western cultures, including the United States, can be readily described as “youth dominated.” Young people are seen as the embodiment of all that is valued—beauty, vitality, and longevity. Aging, on the other hand, is associated with disgust. This point of view on aging is culturally reinforced and supported, and negative characteristics are attributed to older people simply because they are “old” (e.g., Kite & Johnson, 1988) The combined cultural focus on youth and acceptance of stereotypes as truth leaves older people with significant status loss. In turn, this loss in status is used to justify the devaluation of older adults solely based on age. This cycle is self-perpetuating in that confirmation of a stereotype is used to justify differential treatment, which is then used to reinforce the stereotype. Being “old” and aging are undesirable, and birthdays represent death and decline. Older people are depicted as forgetful, frail, bad drivers, incontinent, sagging, wrinkly, and grumpy, among other things. Society is flooded with these messages, which supports the maintenance of an ageist culture. It is important to note that ageism and ableism often overlap but are distinct from one another. Ableism is defined as discrimination or prejudice against people with disabilities and favoritism to able-bodied people. Are Attitudes Toward Aging and Older Adults Better in the East? Positive & Negative Aging Myths Like other forms of prejudice, is based on both positive and negative stereotypes. Stereotypes create false pictures of older adults and keep our thinking narrow by limiting what we actually “see” when encountering an older person (Fiske & Taylor, 1991). Positive Aging Myth Positive stereotypes about older adults include these descriptors: wise, kind, dependable, and happy. Many people probably consider positive stereotypes a supportive stance, not an ageist one (Cherry & Palmore, 2008), and these attributes do appear to be pleasant representations of older adults. Greater sense of acceptance of self and of others; desire for connection and the means to create it; life experiences that help us make smart decisions; wisdom and empathy—all are available to us as we grow older. Negative Aging Myths Negative stereotypes include such beliefs that all older people are ill or have cognitive decline; live in long-term care facilities; are useless, isolated, and/or depressed; and are grumpy. Common conditions in older age include hearing loss, cataracts and refractive errors, back and neck pain and osteoarthritis, chronic obstructive pulmonary disease, diabetes, depression and dementia. Ageism: The Impact on Older Adults Ageism has many social as well as interpersonal implications for older adults, including employment, medical care, and issues of independence (Chonody & Teater, 2016a). Negative beliefs about aging can be both hurtful and harmful to older people. Negative self-perceptions of old age influence health by generating increased stress, which in turn weakens the immune system and increases the likelihood of illness (Staudinger, 2015). In longitudinal study of people age 50 and over, it was found that those who had a more optimistic perception of aging lived about 7.5 years longer than those who were pessimistic (Levy, Slade, Kunkel, & Kasl, 2002). Ageism can also be internalized by older adults and expressed through age passing— presenting yourself as younger than your true age—or through comments that suggest that the only thing that has changed over time is the body, which neglects the experiences and emotional changes that occur throughout a lifetime (Cruikshank, 2009). We are socialized into an ageist belief system, and cultural norms and values perpetuate this system. Ageism: How It Impacts Everyone Ageism keeps aging at a distance instead of it being thought of as part of our entire lifespan. This type of thinking creates a false barrier in the aging process (Butler, 1987; Calasanti, 2005). So when we think about ourselves as old, we think that it will never happen to us—this is only something that happens to other people (DeBeauvior, 1972). American culture reinforces these messages, suggesting that youth can be maintained through sheer will (e.g., diet, exercise, and antiaging products; Chonody & Wang, 2014b). Thus, we approach old age with a sense of ambivalence. Anxiety about aging creates a negative attitude toward the aging process, promoting the idea that this stage of the life course will be the worst phase and marked by loss. “The more a person is convinced that aging is an inevitable process of physical decline and loss of autonomy, the less this person will believe that she or he can exert influence on her or his aging process” (Staudinger, 2015, p. 200). When beliefs about aging are negative, attitudes toward older adults are also likely to be based on negative stereotyping (Braithwaite, 2002). And in turn, this ideology maintains aging anxiety and a negative perspective on older adulthood and contributes to fears about death. Theoretical Explanation for Ageism Unlike race and sex, age is something that is experienced by everyone. That is, “old age” is a category that we hope to join one day by virtue of continuing to live our lives. When one is in a position of privilege—that is young—it can be difficult to see the importance of age, even if one has experienced prejudice due to another social characteristic, such as gender (Calasanti, Slevin, & King, 2006). Nonetheless, young people may readily place older people in the category of an out-group member. But older adults were once young, too. “Thus, the relationship of the non-old to the old is unique” (Greenberg, Schimel, & Martens, 2002, p. 28). Intergroup Contact Theory Intergroup contact theory, developed by Gordon Allport in 1954, was originally used as a theoretical perspective to understand racial prejudice and as an approach to challenge stereotypes and negative attitudes that fuel prejudice from one group toward another. Allport (1954) hypothesized that mere contact between two different groups is not enough, but rather stereotypes and attitudes from one group toward another can only be changed when the contact between two different groups is structured along the following four conditions: 1. The two groups are of equal status. One group is not teaching or mentoring the other, but both groups are equally participating in the interaction, and both groups have a say in the direction of the contact. 2. The two groups are working toward a common goal. 3. There is cooperative interaction between the two groups where they are willing to interact and participate. 4. There is institutional support for the contact where any change as a result of the contact would be supported through social and cultural environments. Intergroup contact theory, oftentimes referred to as the “contact hypothesis,” is used to structure interactions between two different groups in order to challenge biases. For example, to challenge stereotypes and negative attitudes of young people toward older adults, with the aim of combating ageism, an intergenerational program involving creative activities was developed using the four conditions of the contact hypothesis. Social Identity Theory Social Identity Theory (SIT), developed by Tajfel and Turner (1979, 1986), explains the ways in which people attach themselves to or identify with a social group, and the ways in which people view themselves and others within their social group (in-group) compared to others who are not in their social group (out-group). People may self-identify with a particular social group or may be prescribed to the social group by the dominant culture. According to SIT (Tajfel & Turner, 1986), there are three stages to the identification and evaluation of the in-groups (“us”) and the out-groups (“them”).  First, social categorization occurs when we assign people to either the in-group or the out-group (e.g., females versus males; Republicans versus Democrats; young versus old), which provides us with information about that person, such as their characteristics, beliefs, traits, abilities, or disabilities. Second, social identification takes place when the individuals in the in-group subscribe to the “defined” characteristics, beliefs, traits, abilities, or disabilities. In this sense, individuals identify with their in-group and actively seek membership to the group, as it is their identity and source of self-worth. Finally, social comparison happens when individuals in the in-group compare their group membership to those in the out-group. Individuals’ identity and self-worth is defined by their membership to their in-group. SIT suggests that individuals moving from the young (in-group) into the old (out-group) can do so in one of three ways: 1. Social Mobility Individuals (literally or figuratively) attempt to remain a part of the young group (in-group) for as long as possible; thus, choosing not to identify with the less preferred out-group. For example, individuals may participate in recreational activities socially constructed as activities for younger individuals (e.g., playing football), or may use beauty treatments, or undergo plastic surgery. 2. Social Creativity Individuals embrace their move from one group into another, focus on the more positive aspects of the new group, and creatively establish this as their identity. For example, older adults who participate in a weekly singing group refer to themselves as “Goldies.” 3. Social Competition Individuals acknowledge their move from the in-group to the out-group and aim to tackle the stereotypes and negative attitudes associated with their new group in order to create a more positive image for their new group. For example, participating in the work of the AARP, Inc. (Kite & Wagner, 2002). Terror Management Theory Terror management theory (TMT) is based on the writings of Ernest Becker (1962, 1973, 1975) who wrote about humans’ unique self-awareness regarding their own mortality. Becker proposed that this knowledge terrifies us. But, we cannot escape it even though we will do what we can to actively avoid thinking about it. Therefore, ageism acts as a protective mechanism against death anxiety associated with the knowledge of our own mortality by creating a barrier against reminders that we are going to die (Martens, Goldenberg, & Greenberg, 2005; Martens, Greenberg, Schimel, & Landau, 2004). Physical signs of aging are indicators of decline (Greenberg et al., 2002). Much like intergroup contact theory and SIT, TMT also includes the idea of “us” versus “them” or in-groups and out-groups (Greenberg et al., 2002). The old are a threat to the fate of younger people—fading beauty and health and finally, death (Greenberg et al., 2002). The older person reminds us that life is finite.  But in this process they are further fueling their terror of growing old because that means moving into the out-group of older adults, which is equated with their negative beliefs and eventually death. Lec # 03 Biopsychosocial Model in Aging Psychology Introduction The Biopsychosocial model was first conceptualized by George Engel in 1977, suggesting that to understand a person's medical condition it is not simply the biological factors to consider, but also the psychological and social factors. ○ Bio (physiological pathology) ○ Psycho (thoughts emotions and behaviors such as psychological distress, fear/avoidance beliefs, current coping methods and attribution) ○ Social (socio-economical, socio-environmental, and cultural factors such as work issues, family circumstances and benefits/economics) This model is commonly used in chronic pain, with the view that the pain is a psychophysiological behavior pattern that cannot be categorized into biological, psychological, or social factors alone. There are suggestions that physiotherapy should integrate psychological treatment to address all components comprising the experience of chronic pain. Somatic and medical factors (S-Factors) For physical therapist the physical examination is a very important part of his intervention - essential to: Be aware that some findings of clinical examinations such as mobility, strength, neurodynamic, coordination, etc. could be altered because there is greater sensitivity to mechanical stimulation and modified movement patterns in patients with non-neuropathic pain of central sensitization. Main goal in this stage is to evaluate the quality of movement, if the pattern of movement causes the pain to persist and if there is Kinesiophobia. Ask about current or previous health conditions, the disuse of body parts, changes in movement patterns, exercise capacity, strength and muscle tone during movement, the action of the drug in the CNS It is useful for data collection Biological factors Biological Factors: (physiological pathology):Some biological and genetic factors affect specific populations more than others. Examples of biological and genetic determinants of health include age, sex, inherited conditions and genetic make-up. Cognition / Perceptions (C-factors) Both influence biologically on hypersensitivity in the brain by activating neuromatrix pain and also influence the emotional and behavioral factors: 1. Ask about perceptions: expectations of the intervention, expectations of the prognosis of their pain, understanding of their situation and the strategies they have available to face their situation, what the pain represents emotionally 2. Brief Illness Perception Questionnaire (Brief IPQ) 3. Pain Catastrophizing Scale (PCS) Psychological factors Psychological factors Thoughts Emotions and Behaviors such as psychological distress, fear/avoidance beliefs, current coping methods and attribution) Emotional factors (E- factors) Ask if there is fear of specific movements, avoidance behaviors, psychological traumatic appearance of pain, psychological problems at work, family, finances, society, etc. It is also suggested to use the following scales: 1. State-Trait Anxiety Inventory (STAI) 2. Tampa-Scale of Kinesiophobia (TSK) and Fear Avoidence Belief Questionare 3. Injustice Experience Questionnaire (IEQ) 4. Patient Health Questionnaire-2 (PHQ-2), or Patient Health Questionnaire-9 (PHQ-9), or Center of Epidemiologic Studies Depression Scale (CES-D) Behavioral factors (B- factors) Can lead to avoid activity or movement due to fear, which in turn is presented as physical inactivity or disuse and, finally, disability. Therefore it is important to evaluate the behavior and adaptations that the patient has made due to the pain. Social factors (S- factors) It refers to the social and environmental factors in which the patient develops, which could be useful and supportive or harmful and stressful for the improvement of the patient's health condition. The data collection can be divided as follows: 1. Housing or living situation 2. Social environment 3. Work 4. Relationship with the partner 5. Previous interventions Social factors Socio-economical Socio- environmental Cultural factors such as work issues, family circumstances and benefits/economics) Motivation (M- factors) Evaluating the motivation in the patient and his willingness to change is useful to modify his thoughts regarding the relationship between pain-kinesiophobia, pain-disability, and acceptance-catastrophism. For this purpose, the following scale can be used: 1. Psychology Inflexibility in Pain Scale (PIPS) ○ PIPS "evaluates components of psychological inflexibility (avoidance and fusion)” Assumptions of Biopsychosocial model: 1. Individual should be held responsible for his/her health. 2. The whole person should be treated e.g., behavior change, change in belief, and coping strategies and compliances with medical recommendations. 3. The focus is the whole person treated not just their physical illness, the person is therefore responsible for their treatment (e.g., Taking the medicine or changing their behavior). 4. Health and Illness exist on a continuum. Individual progress along this continuum from health to illness and back again. 5. The focus is on interaction between the mind and the body. 6. Psychological factors are not only consequents but they are contributory factors to all stages along the continuum from health to illness. Evaluation of bio-psychosocial model Strengths: 1. Improve patient satisfaction a. Better adherence to prescriptions, b. More maintained behavior change, better physical and psychological health. 2. Development and application of techniques to reduce health risk behavior. 3. Reduce multiple visits and admission into hospitals. 4. Individuals with health challenges are acknowledged to be active participants in the recovery process and good health, rather than mere passive victims. 5. Bio-psychosocial model can be used as a predictor of pain and other psychosocial problems resulting into development appropriate prevention and intervention strategies. 6. Development and introduction of programs of life quality improvement for chronic patients, physically disabled individuals and the elderly patients. 7. Development and application of psychosocial support for the terminally ill patients and their families. 8. The use of the biopsychosocial model as a clinical practice guide in physiotherapy allows the physiotherapist to be aware of all the factors that influence the patient's state of health. In addition, it allows laying the foundations of pain neuroscience education. Limitations of bio-psychosocial model: Time-consuming and expensive. It requires more information be gathered during the assessment about an individual’s socioeconomic status, culture, religion, as well as psychological factors that might affect the individual’s condition. There is a lack of theoretical basis of bio- psychosocial model and scientific evidence to support the model. The complex relations between causes and effects of biological, psychological and social factors to influence the state of health and or occurrence of diseases. Biopsychosocial Model in Aging Psychology Aging is a process that is universal to the human experience. Due to the inevitability of old age, fully understanding the aging process is of great importance. Using a biopsychosocial approach, the factors leading to successful aging will be examined. The influence of diet and exercise will be analyzed to understand its effects on physical and mental health. Psychological influences, including depression, mindset, self esteem, and mental stimulation will be evaluated into their respective roles in the aging process. In addition, the presence of cultural beliefs and social engagements will be considered as stimulants for emotional wellbeing. Due to the great intricacies of aging, it is imperative that the physical, psychological and social influences be taken into consideration as catalysts for healthy aging. Biological changes in Aging The first indication of aging is often physical. A grey hair, a wrinkle on the face - these characteristics have become typical features of increasing age. Physical degradation plays a large role in the aging process. The body deteriorates slowly, which causes bones to weaken, neurons to become inert, and cells to die from the natural process of apoptosis. Biopsychosocial Model for Biological changes However, despite the seemingly uncontrollable physical deterioration over time, certain factors can aid in prolonging health. The first, and arguably most important, is regular exercise. Not only does exercise boost energy and improve mood, but it also increases levels of high-density lipoprotein and decreases unhealthy triglycerides (Mayo Clinic, 2016). Another factor that has the ability to extend life is diet. Through the consumption of foods, the body receives the nutrients and minerals it needs to survive. Certainly, the purer the diet, the healthier the organism. In particular, calorie restriction has been of great interest in recent years. Psychological Changes in Aging Psychology Throughout the aging process, great psychological changes can occur. For example, while crystallized intelligence, or accumulated knowledge, stays constant throughout adulthood, fluid intelligence, or the ability to reason speedily and abstractly, decreases up until the age of 75 (Myers, 2011, 464 One Korean study shows that depression is most often associated with the elderly. This is possibly due to the fact that in the late adulthood stage, most close relationships decrease in number (KyungHun, YunJung, JaSung, Hee, JongHee, and KwuyBun, 2015). This most often causes loneliness, which is a stimulant for depression. Furthermore, there is an increased risk of death for people with low self rated health rather than low objective health.  In other words, people who thought they were ill had a statistically higher risk of death than people who were actually suffering from a physical illness (Mossey, Shapiro, 1982). Biopsychosocial Model for Psychological changes High self esteem points to better psychological health through age. Mental stimulation, especially before the aging process truly begins, has been proven to improve psychological development. Social Changes in Aging Psychology In old age, social support is one of the greatest influences. With retirement comes decreasing social connections, and thus can lead to feelings of loneliness, despair and lack of intimacy. Additionally, chronic and disabling illnesses and stressful events such as the loss of a spouse can contribute to depressive episodes (NAMI, 2009). However, studies have shown that retirement can have many benefits to the elderly. Retirement effectively reduces daily stress, and therefore improves mental health and decreases negative thinking (Coursolle, 2010). Biopsychosocial Model for Social changes The presence of social support resources have a great impact on emotional health for people of old age. Support centers that focus on geropsychology help older people to overcome problems in family life and acclimate to major changes in later years (APA, 2005). However, there is a great shortage in qualified geropsychologists, especially with increasing rates of elderly people (IOM, 2012; SAMHSA, 2007). In fact, fewer social support resources are associated with higher levels of depression in the elderly (Vanderhorst & Mclaren, 2005). In addition, a lack of social support can also lead to greater risk of suicidal ideation (Vanderhorst & Mclaren, 2005). Lec # 04 Primary and Secondary Changes in Aging Psychology What is Primary Aging? According to scientists, the primary aging definition describes the biological factors that are largely beyond our control. It’s basically the notion that, like it or not, getting older is part of the natural life cycle—even the most fit among us can’t possibly live forever. Scientists associate age-related changes like vision, graying hair, and wrinkles as key examples of primary aging. 1. But while wrinkles, for example, are an inevitability for most of us, our lifestyle choices (sun exposure) can also have an impact on how and when they appear. And that’s where secondary aging comes in. What is Secondary Aging? If primary aging is purely biological (intrinsic), secondary aging describes the environmental aspect of aging (extrinsic)—the idea that our lifestyle choices can certainly have an impact on our long-term wellbeing and even the aesthetic effects of aging. This can range from our diet and physical activity to stress and even factors like where we choose to live. In other words, good habits can add up over time—for younger and older adults alike. The Link Between Senescence, Primary Aging, and Secondary Aging To understand the differences between primary aging and secondary aging, we first need to look at a process called senescence. What Is Senescence? Senescence literally means "the process of growing old." It's defined as the period of gradual decline that follows the development phase in an organism's life. So senescence in humans would start sometime in your 20s, at the peak of your physical strength, and continue for the rest of your life. Once that limit is reached, the cell becomes senescent and remains metabolically active. But what happens to it? When cells lose the ability to divide because of DNA damage or a shortening of telomeres, (Chromosomes are thread-like structures located inside the nucleus of a cell. Each chromosome is made of protein and a single molecule of DNA. At each end of a chromosome is a telomere which people will often compare to the plastic tips at the ends of a shoelace. Telomeres are important because they prevent chromosomes from unraveling, sticking to each other, or fusing into a ring.) They go through a transformation that results in decline or destruction. The cells either self-destruct (called apoptosis) or go into a period of decline (called senescence). The ultimate end result is cell death, which is a normal part of a biological functioning and occurs regularly in your body. A 2016 study published in the Journal of Nature Medicine details the three ways in which senescence can take place: ❖ Senescence due to normal aging ❖ Senescence due to diseases ❖ Senescence due to medical treatments This shows that both primary aging and secondary aging are associated with senescence. Longevity, Healthy Aging, and Senescence Science has not yet found a way to interrupt the process of senescence as it relates to humans, and some researchers (although not all by any means) argue that we will never be able to stop it. But we can slow it down. Your goal, then, is to slow the process of senescence as much as possible. You can do this by: ○ Eating a Healthy Diet: This provides your body with the nutrients it needs to repair damage and fight off future damage. ○ Reducing Stress: This prevents long-term damage from over-exposure to the stress hormones and the physiological state they create. ○ Avoiding Exposure to Damaging Substances: This helps limit the amount of damage to your body’s tissues. Avoid over-exposure to UV lights, pollution, and toxins. ○ Exercising more: This helps your body to build strong tissues that resist damage. ○ Preventing Disease: See your healthcare provider for routine checkups and keep your blood pressure, weight and other risk factors under control. Primary Aging and Senescence The main cause of primary aging is accumulated "wear-and-tear" at the cellular level. This damage is triggered by cellular stressors like free radicals, telomere shortening, and DNA damage. As such, your cells and tissues degenerate over time, leading to slower physical movements and brain activity. Telomere Shortening: A telomere is a region of repetitive DNA sequences at the end of a chromosome. Telomeres protect the ends of chromosomes from becoming frayed or tangled. Each time a cell divides, the telomeres become slightly shorter. Eventually, they become so short that the cell can no longer divide successfully, and the cell dies. Free radicals: A type of unstable molecule that is made during normal cell metabolism (chemical changes that take place in a cell). Free radicals can build up in cells and cause damage to other molecules, such as DNA, lipids, and proteins. This damage may increase the risk of cancer and other diseases. Secondary Aging and Senescence On the other hand, senescence in secondary aging is caused by diseases and medical treatments. Disease-related senescence is triggered by chronic diseases that take place as a result of environmental factors and unhealthy habits. For instance, smoking leads to long-term oxidative stress that increases cellular damage in the lungs. In response, there is now a greater number of senescent cells. This then results in lung disease. Therapy-induced senescence is normally experienced during medical treatments like chemotherapy. Such treatments further intensify cellular damage beyond the normal levels experienced in primary aging. This subsequently leads to high levels of senescent cells that speed up aging. What Does Aging Do to You? After learning about the differences between both aging processes, let's take a look at their effects on the physiological level. Effects of Primary Aging Since primary aging is linked to a buildup of cellular damage over time, it leads to: A weakened immune system Loss in skin elasticity and firmness Increased fine lines and wrinkles Hair loss and graying hair A decline in cognitive functions Impaired hearing and vision Reduced ability to cope with stress Loss in muscle mass and bone density Slower heart rate Effects of Secondary Aging On the contrary, secondary aging processes are often related to illnesses and disabilities like: Alzheimer’s disease Arthritis Cancer Cardiovascular diseases Diabetes Forms of self-harm Kidney disease Lung diseases Strokes Can Aging Be Prevented or Reversed? Since primary aging is brought about by the slow deterioration of cellular structure and function, it cannot be prevented or reversed. However, the impacts of some age-related changes caused by primary aging can be lessened by adopting healthy practices. For instance, the gradual loss in bone density can be managed through physical activity. Conversely, the secondary aging process is mostly due to a mix of environmental factors and lifestyle choices. By becoming healthier and more active, most chronic diseases like heart diseases and high blood pressure can be prevented. Certain health conditions like obesity and hair loss can even be reversed with dietary changes and treatments. Ways to Promote Healthy Aging Caloric Restriction: There is a scientifically proven method to slow it down — caloric restriction. While a healthy and well-balanced diet is key to healthy aging, caloric restriction goes one step further to slow down the aging process. Sun Protection Sun damage results in wrinkles, sun spots, and drier skin. Too much sun damage can also result in premature skin aging and increase your risk of skin cancer. Avoid Unhealthy Habits Common vices like smoking and alcohol consumption are part of secondary aging. These habits increase cellular damage and accelerate aging. The bottom line here is that lifestyle choices play a major role in speeding up secondary aging. Physical Activity Instead of indulging in vices like smoking and alcohol, get your heart rate pumping. Physical inactivity is a risk factor for chronic diseases and reduced life expectancy. Exercise can be used to counteract some effects of primary aging such as reduced bone density and muscle mass. To counter these age-related changes, exercise by walking, swimming, or cycling. These low-impact physical activities do not need much time, cost, or effort but still provide immense health benefits. Health Checkups While most age-related changes associated with primary aging cannot be stopped, it's possible to pick up early signs of it. This is where health examinations are useful. A comprehensive health checkup can detect risk factors for diseases that may be due to primary aging and secondary aging. Early diagnosis and the right treatment plan can help manage symptoms of chronic illnesses to promote a better quality of life in old age. If you're below 40 years old, it's recommended to get a medical checkup every five years. For older adults above 40 years old, a health assessment should be done every one to three years. Mindfulness Meditation As you age, you may find it more difficult to fall asleep or stay asleep throughout the night. This is a natural part of the primary aging process. The Sleep Foundation explains that “older people spend more time in the lighter stages of sleep than in deep sleep”. This age-related change may also account for the higher rate of sleep disorders, like insomnia, among the aged. To help you sleep better at night, give mindfulness meditation a try. Mindfulness refers to being fully present — paying attention to where you are and what you’re doing. You can practice being mindful through meditation, which is how the term “mindfulness meditation” is conceived. And that’s not all, mindfulness meditation has also been proven to slow down the deterioration of an aging brain. A 2015 study in the Journal of Frontiers in Psychology highlighted “less age-related gray matter decline” in participants who meditated compared to those that didn't. Another 2011 study in the Journal of Psychiatry Research found that eight weeks of mindfulness meditation enhanced cortical  thickness in the hippocampus — the brain structure that controls learning, memory, and emotional control. This suggests that meditation not only slows down age-related cognitive decline but may also improve brain plasticity over time. Demography of Aging People worldwide are living longer. Today most people can expect to live into their sixties and beyond. Every country in the world is experiencing growth in both the size and the proportion of older persons in the population. By 2030, 1 in 6 people in the world will be aged 60 years or over. At this time the share of the population aged 60 years and over will increase from 1 billion in 2020 to 1.4 billion. By 2050, the world’s population of people aged 60 years and older will double (2.1 billion). The number of persons aged 80 years or older is expected to triple between 2020 and 2050 to reach 426 million. Lec # 05 Cognitive Development & Aging Life Expectancy Increased population life expectancy Increase in disease prevalence Increase in care consumption Loss of independence and quality-of-life Cognition Cognition is the set of all mental abilities and processes related to knowledge: Attention, Memory and working memory, Judgment and evaluation, Reasoning, Problem solving, Decision making, Comprehension and production of language. These processes are not independent of one another – E.g. attention may be part of perception; language may be part of memory and decision-making, etc. Neurocognitive Domains The DSM-5 defines six key domains of cognitive function, and each of these has subdomains. Brain Development Timeline of major events in brain development. Brain development can be divided into three processes: Proliferation: (rapid growth of brain matter and the formation of new connections within the brain). Pruning: (cutting away of unused or unimportant connections). Myelination: (insulating of brain pathways to make them faster and more stable) ) (Sowell et al., 1999; Sowell et al., 2001) Proliferation (rapid increase in the number or amount of something.) TOTAL BRAIN VOLUME By age 6, the brain is about 95% of its maximum size. It reaches its maximum size at 11.5 years in girls, and at 14.5 years in boys. (Giedd et al., 1999) Boys brains are larger (on average) than girls brains Maximum brain size does not mean maximum brain maturity! The brain continues to mature for at least another 10 years. And although boys brains are anatomically bigger than girls brains, size is not directly related to intelligence. Grey matter is where all the thinking happens. This is your brain’s processing center. White matter, containing those long axons, are like a super highway. They transport information to different parts of your brain. Pruning/ Grey Matter Maturation The brain matures in a back-to-front pattern. The frontal & temporal lobes are the last to mature. Remember: the frontal lobe is the home of planning, organization, judgement, impulse control and reasoning. The developmental trajectory of cortical gray matter followed a regionally specific pattern with areas subserving primary functions, such as motor and sensory systems, maturing earliest and higher order association areas, which integrate those primary functions, maturing later. For example, in the temporal lobes the latest part to reach adult levels is the superior temporal gyrus/sulcus which integrates memory, audio-visual input, and object recognition functions Proliferation And Myelination: WHITE MATTER. Age-related Volumetric Changes of Prefrontal Gray and White Matter from Healthy Infancy to Adulthood. White matter makes up myelin, which insulates axons and speeds up the communication between neurons. It develops continuously from birth onwards, with a slight increase during puberty. The increase occurs just after the peak in grey matter volume (around age 11 in girls* and around age 13 in boys). Cognitive Functions And Aging Cross-sectional aging data adapted from Park et al. (2002) showing behavioral performance on measures of speed of processing, working memory, long-term memory, and world knowledge. Almost all measures of cognitive function show decline with age, except world knowledge, which may even show some improvement. On an average aging is accompanied by decline in three fundamental cognitive- processing resources: 1. Processing Speed: reduced speed of information processing and response- most predictable 2. Working Memory: refers to short-term retention and manipulation of information held in conscious memory, a type of “online” cognitive processing. Examples include consciously recalling a telephone number long enough to write it down 3. Sensory and Perceptual changes: decrements in visual and auditory acuity and other perceptual changes. Neuroplasticity (You Can’t Teach An Old Dog A New Trick) Neuroplasticity: The brain's ability to reorganize itself by forming new neural connections throughout life. Neuroplasticity allows the neurons (nerve cells) in the brain to compensate for injury and disease and to adjust their activities in response to new situations or to changes in their environment. Exists at all levels of the brain (in cells, genes, behavior) Neuroplasticity occurs through three main mechanisms – myelination, synaptic connection and neurogenesis.  Every time we change our habits, learn something new, change our mind about how we think of the world, stop an addiction, and so on, we have literally dismantled an old neural network, and created a new one that has a new way of thinking wired into it, one that rewards us in a healthier way. Learning new skills – such as a new language, or a physical skill like riding a bicycle, playing music and such, creates new brain wiring as well. Theories Of Aging 1- The Programmed Theory : Has three sub-categories: 1. Programmed Longevity. Aging is the result of a sequential switching on and off of certain genes, with senescence being defined as the time when age-associated deficits are manifested. 2. Endocrine Theory. Biological clocks act through hormones to control the pace of aging. 3. Immunological Theory. The immune system is programmed to decline over time, which leads to an increased vulnerability to infectious disease and thus aging and death. The Damage Or Error Theory include: 1. Wear and tear theory: Cells and tissues have vital parts that wear out resulting in aging. Like components of an aging car, parts of the body eventually wear out from repeated use, killing them and then the body. 2. Rate of living theory: The greater an organism’s rate of oxygen basal metabolism, the shorter its life span. 3. Cross-linking theory: The cross-linking theory of aging was proposed by Johan Bjorksten in 1942. According to this theory, an accumulation of cross-linked proteins damages cells and tissues, slowing down bodily processes resulting in aging. 4. Free radicals theory: proposes that superoxide and other free radicals cause damage to the macromolecular components of the cell, giving rise to accumulated damage causing cells, and eventually organs, to stop functioning. 5. Somatic DNA damage theory: DNA damages occur continuously in cells of living organisms. While most of these damages are repaired, some accumulate, as the DNA Polymerases and other repair mechanisms cannot correct defects as fast as they are apparently produced. Cognitive Reserve The term cognitive reserve describes the mind's resistance to damage of the brain. Various studies have shown that there is major variation in the clinical manifestations and severity of cognitive aging as a result of neurodegenerative changes that are similar in nature and extent. These mismatches led to the emergence of the concept of cognitive reserve (CR), which focuses on the adaptability and the flexible strategies of the brain that allow some people to cope better than others in the circumstance of age-related or Alzheimer's disease (AD)-related pathology. It is believed that CR is mainly influenced by an individual's education, intellect, mental stimulation, participation in leisure activities, dietary preferences, and social stimulation.  These determinants of CR help in slowing the rate of memory decline in the normal aging process and also reduce the risk of developing AD. Brain Reserve "THE HARDWARE“ THE QUANTITATIVE MODEL Brain reserve (BR) is an element of the "threshold model" or the passive model. According to this model, there is a fixed threshold value at which functional impairment manifests for everyone. The brain's size, the neuronal count, and the synaptic density form the basis of BR. Larger brains, due to sufficient neural substrate, are able to sustain more insult till symptoms emerge. A brain insult of a particular size might cause a clinical deficit in an individual with less BRC, whereas it may not cause any deficit in individuals with greater BRC. Cognitive Reserve - "The Software“ The Qualitative Model Cognitive reserve (CR), on the other hand, constitutes the active model According to this model the brain copes with damage by using either pre-existing cognitive processes to increase the efficiency and capacity of existing neural pathways or by using compensatory processes to recruit new pathways that are usually not used while accomplishing a task. Thus, a person with a greater CR may be able to sustain a larger lesion than a person with lesser CR before clinical symptoms start appearing, even though both may have the same BRC. Illustration of the association between the emergence of dementia-associated neuropathology, its clinical expression and cognitive reserve. Educational attainment and occupational challenges can usually no longer be changed in individuals aged 50 years and older. However, cognitive leisure activities may increase their cognitive reserve and thus lead to a delay in the emergence of cognitive decline. Cognitive activity, education and socioeconomic status as preventive factors for mild cognitive impairment and Alzheimer’s disease. When ad pathology is mild, individuals with lower levels of reserve might already appear to be clinically demented, while those with higher reserve might appear clinically normal. At higher levels of pathology, both groups might appear to be clinically demented. Determinants Of Cognitive Reserve Cognitive engagement and stimulating activities In a study of 65 healthy older individuals, it was found that individuals with greater early and middle life cognitive activity (reading, writing, playing games, physical exercise) had lower Pittsburgh Compound B (PiB) on positron emission tomography (PET) scan studies. The study found that lifestyle factors found in individuals with high cognitive engagement may prevent or slow the deposition of β-amyloid, resulting in slower progress to AD. Another measuring factor of cognitive engagement could be bilingualism. Bilinguals required greater amounts of neuropathology before the disease manifested.  Social isolation as a risk for cognitive decline. The risk of AD was found to be more than double in lonely persons as compared with those who were not. Cognitive Remediation Cognitive remediation. It is a behavioral treatment that aims to enhance the compensatory and adaptive strategies to facilitate improvement in specific brain areas such as attention, memory, judgement, speed of information processing, and problem solving. The training activities consist of computerized exercises and real-time strategy-based video gaming. This treatment is reported to enhance executive functioning in the elderly. Education may indirectly help in increasing the CR by reducing the impact of neuropathological lesions during aging. Even a few years of formal education is associated with decreased impairment in cognitive functioning as compared to no formal education at all, irrespective of the socioeconomic and demographic characteristics of a population Role of leisure activities Various epidemiological studies have demonstrated that late-life mental stimulation activities are reported to aid in better cognitive functioning. Social network and stimulation Social support and networking provide psychological and material resources that are usually intended to benefit an individual's ability to cope with stress. A number of social parameters such as marital status, number of children, frequency of meeting family members and relatives, living arrangements, satisfaction with life have been studied. Other variables such as attending social functions, participating in religious activities, and having a part-time or full-time job are equally important. Successful Cognitive Aging Definition: ‘‘Not just the absence of cognitive impairment, but the development and preservation of the multi- dimensional cognitive structure that allows the older adult to maintain social connectedness, and ongoing sense of purpose, and the abilities to function independently, to permit functional recovery from illness and injury, and to cope with residual cognitive deficits.’’ 2006 National Institutes of Health’s Cognitive and Emotional Health Project (Hendrie et al. 2006).