Geropsych Quiz 2 PDF

Week 4 Outline - Symptoms - Development - Interventions Dementia: A Public Health Priority What are the symptoms? 1. Difficulties with everyday tasks 2. Confusion in familiar environments 3. Difficulty with words and numbers 4. Memory loss 5. C...

Week 4 Outline - Symptoms - Development - Interventions Dementia: A Public Health Priority What are the symptoms? 1. Difficulties with everyday tasks 2. Confusion in familiar environments 3. Difficulty with words and numbers 4. Memory loss 5. Changes in mood and behavior Symptoms Symptom Category Description Memory Loss Difficulty recalling recent events, forgetting names, faces, or appointments. Difficulty with Everyday Struggling to manage finances, prepare meals, or complete Tasks tasks that were once routine. Confusion in Familiar Getting lost in familiar places, not recognizing known people Environments or places. Difficulty with Words and Problems with communication, following conversations, and Numbers handling basic arithmetic or writing tasks.  Changes in Mood and Experiencing mood swings, increased anxiety, depression, or Behavior irritability, and changes in personality. Amyloid Hypothesis suggests that Alzheimer's disease is primarily caused by the accumulation of amyloid-beta (Aβ) plaques in the brain. These plaques are abnormal clumps of protein that build up between neurons. Over time, these plaques disrupt communication between brain cells, leading to cell death and the symptoms of Alzheimer's, such as memory loss and cognitive decline. Key points to know: Amyloid-beta proteins are produced naturally, but in Alzheimer's patients, they aren't cleared away properly and instead accumulate. The presence of these amyloid plaques is one of the main pathological features seen in the brains of people with Alzheimer's. Researchers believe that these plaques may trigger a cascade of other harmful processes in the brain, like the formation of tau tangles (another protein abnormality in Alzheimer's) and widespread brain cell death. While this hypothesis is central to understanding the disease, it's still being debated and researched as some treatments targeting amyloid-beta haven't been as effective as hoped. Stages on the Alzheimer’s Continuum: 1. Preclinical Stage: ○ At this stage, the person is not showing noticeable symptoms yet but might have early brain changes. This phase can last many years, and cognitive function remains relatively stable during this time. 2. Mild Cognitive Impairment (MCI): ○ In this stage, some cognitive decline starts becoming noticeable, such as mild memory problems. It’s not severe enough to interfere significantly with daily life, but it’s more than what’s seen with normal aging. 3. Dementia Stage: ○ This stage is where Alzheimer's symptoms become more pronounced and begin to interfere with daily life. The person experiences significant cognitive decline, leading to a steeper drop in cognitive function. Takeaway: The graph shows how Alzheimer's disease causes a much faster decline in cognitive function compared to normal aging.  People can be in the preclinical phase for a long time before symptoms become noticeable (MCI or dementia). Dementia is the most severe phase of Alzheimer's, where the impact on daily functioning is significant. Stage 1: Asymptomatic Amyloidosis What happens?: Amyloid-beta plaques begin to accumulate in the brain, but there are no noticeable cognitive symptoms yet. Key markers: ○ High PET amyloid tracer retention: This means that imaging scans show an increased amount of amyloid in the brain. ○ Low CSF Aβ1-42: Amyloid-beta levels in the cerebrospinal fluid (CSF) are reduced, indicating its buildup in the brain. Stage 2: Amyloidosis + Neurodegeneration  What happens?: In addition to amyloid buildup, neurons start to degenerate, but cognitive decline is still minimal or unnoticed. Key markers: ○ Neuronal dysfunction: Measured using FDG-PET (a type of brain scan) or fMRI, showing abnormal brain activity. ○ High CSF tau/p-tau: Tau proteins are another abnormality found in Alzheimer's, and their levels in the CSF are increased. ○ Cortical thinning/hippocampal atrophy on sMRI: Brain scans show shrinkage (atrophy), particularly in areas like the hippocampus, which is important for memory. Stage 3: Amyloidosis + Neurodegeneration + Subtle Cognitive Decline What happens?: Cognitive changes become noticeable but are not severe enough to meet the criteria for Mild Cognitive Impairment (MCI). This is still considered preclinical. Key markers: ○ Subtle cognitive decline: There is evidence of a decline in cognitive abilities, compared to a person's previous level. ○ Poor performance on challenging cognitive tests: Tests may detect difficulties in complex cognitive tasks. ○ Not yet MCI: The changes aren't enough to be classified as MCI yet. Transition to MCI and AD Dementia: After stage 3, the person may progress to Mild Cognitive Impairment (MCI) and then to Alzheimer’s Disease (AD) dementia as cognitive symptoms worsen and impact daily life. Amyloid Deposition and Neurodegeneration 1. Neuronal Dysfunction: ○ Functional Change: The brain begins to experience functional changes due to the accumulation of amyloid plaques. 2. Amyloid Deposition → Disrupted Network Circuitry: ○ Impaired Episodic Memory: As amyloid builds up in the brain, it disrupts the connections between neurons, leading to issues with episodic memory (your ability to remember specific events or experiences). 3. Overall Effect: ○ Lower Brain Activity: The brain’s overall activity decreases, meaning certain regions of the brain are not functioning as well as they used to.  ○ Poorer Connectivity Among Regions: The connections between different parts of the brain become less efficient, making communication between these areas slower and less effective. Amyloid Deposition and Neurodegeneration Neuronal loss (death) ○ Structural change ○ Measured by: Decreases in cortical thickness across brain regions Decline in hippocampal volume ○ Tau tangles: Kill neurons Amyloid induces the spread of tau through the neocortex Alzheimer's research: Alzheimer's drug trials have a 99.6% failure rate (source: Cumming et al., 2014). Vascular Hypothesis (Caused by strokes) Main Idea: Damage to the brain's blood vessels can reduce blood flow, depriving neurons of oxygen and nutrients. This can lead to brain cell damage and contribute to Alzheimer’s disease. Key Points: ○ Reduced blood flow: Poor circulation in the brain can lead to neuron damage, similar to what is seen in strokes, but on a smaller scale. ○ Blood-brain barrier breakdown: The barrier that protects the brain may weaken, allowing harmful substances to enter and damage neurons. ○ Link to amyloid: Vascular problems may also contribute to the buildup of amyloid plaques, which are linked to Alzheimer's. Interventions for Brain Health 1. Look After Your Heart: ○ Cardiovascular health is closely linked to brain health. Keeping your heart healthy through monitoring blood pressure, cholesterol, and avoiding smoking can help reduce the risk of dementia. 2. Be Physically Active: ○ Regular physical activity boosts blood flow to the brain and can help maintain cognitive function. It also reduces the risk of conditions like diabetes and hypertension, which are linked to cognitive decline. 3. Follow a Healthy Diet:  ○A balanced diet rich in fruits, vegetables, whole grains, and healthy fats (such as those found in the Mediterranean diet) supports overall brain health and reduces the risk of neurodegenerative diseases. 4. Challenge Your Brain: ○ Engaging in mentally stimulating activities (such as puzzles, learning new skills, or reading) helps keep the brain active and may reduce the risk of cognitive decline. 5. Enjoy Social Activity: ○ Maintaining social connections and interacting with others supports emotional well-being and reduces the risk of loneliness, which can contribute to cognitive decline. The Scaffolding Theory of Aging and Cognition (STAC) depicted in the diagram explains how the brain adapts to age-related structural and functional decline by creating "scaffolds" that help maintain cognitive abilities. Here’s a simplified breakdown: Key Concepts: 1. Biological Aging: ○ As we age, our brain undergoes structural changes that affect its function, such as neural depletion or loss of brain cells. 2. Life Course: ○ Experiences throughout life, including education, physical fitness, and other enriching activities, can help strengthen and enrich neural connections. 3. Neural Enrichment vs. Neural Depletion: ○ Neural enrichment occurs when positive life experiences (e.g., staying mentally and physically active) strengthen brain structure and function. ○ Neural depletion results from lack of stimulation or negative factors, which can worsen brain aging. 4. Compensatory Scaffolding: ○ As brain structure and function decline due to aging, the brain uses compensatory mechanisms (like recruiting different brain areas) to support cognitive function. This "scaffolding" helps maintain performance despite age-related changes. 5. Cognitive Outcomes: ○ The final cognitive abilities depend on a combination of compensatory scaffolding, life course enrichment, and the rate of cognitive decline caused by aging. ○ Scaffolding helps slow the rate of cognitive change, ensuring that cognition remains relatively stable even as the brain ages. Modifiers Neural Depletion Factors:  Lifestyle: ○ Sedentary (less physical activity) ○ Lower cognitive engagement ○ Hypertension ○ Insomnia Possession of E4 allele of the APOE gene: ○ More rapid amyloid accumulation and deposition ○ Earlier onset of amyloid positivity Age: ○ Subpopulation at age 60 Modifiers Neural Enrichment Factors: Education: Higher levels of education are associated with a stronger cognitive reserve, which can help to protect against the onset of cognitive decline. People who have had more years of formal education often show later onset of Alzheimer's or dementia symptoms, as their brains may have developed more robust neural pathways. Cognitively challenging activities: Engaging in mentally stimulating tasks, such as puzzles, reading, learning new skills, or playing strategy-based games, promotes cognitive resilience. These activities help build cognitive reserve, which acts as a buffer against the effects of aging and neurodegeneration. ○ Cognitive Reserve: Refers to the brain's ability to compensate for damage by using alternate networks or strategies. Individuals with higher cognitive reserve tend to experience a delayed onset of Alzheimer's symptoms, as their brains are better able to cope with the early stages of neural depletion. Exercise (Single Domain) Whitty et al. (2020), by level of evidence: Grade A: Aerobic exercise programs for 16 weeks or more, at least twice a week (three times a week in lower ROB studies), with over 70% adherence to sessions, had a moderate-sized, positive effect on global cognition, relative to control interventions in people with and without MCI. Grade A: 1–3 weekly group interventions lasting six months or more, that combined cognitive and motor challenges (e.g., dance, dumbbell training, simulated task exercise), improved memory or global cognition by small to moderate effect sizes, in people with MCI. Multidomain Lifestyle Whitty et al. (2020), by level of evidence:  Grade B: A two-year, intensive intervention with dietary, exercise, cognitive training, and social components improved cognition with a small effect size, relative to treatment as usual, in people at risk of dementia. Grade B: Six weeks of home-based mental activities and clinician-delivered lifestyle advice were ineffective in improving cognition. Pharmacological Lecanemab ○ Slowed the progression of the disease by 27% over 18 months. ○ Small gains – it slows but does not even halve the progression of the disease. ○ Compare with potential risks, including death? ○ On 6 Jul 2023, U.S. Food and Drug Administration (FDA) fully approved lecanemab (brand name Leqembi) to treat very early Alzheimer's disease. ○ Not yet approved by Singapore’s Health Sciences Authority (HSA), but doctors may request to import the drug. Week 5 Outline 1. Introduction 2. Normal Late-life Sleep ○ Sleep Architecture Changes ○ Sleep Parameter Changes ○ Circadian Rhythm Changes 3. Epidemiology of Late-life Sleep Disorders ○ Diagnosis of Insomnia ○ Prevalence of Late-life Insomnia in 5 Countries ○ Prevalence of Sleep Disorders in Singapore True or false - The older you get the less sleep you need (FALSE) - Older adults need just as much sleep in their 70s as they did in their 40s - Older people take more daytime naps than younger people (TRUE) - Most people sleep between 7 and 9 hours each day. However, they may not get all their sleep at night. - Around 4 in 10 older people have at least one 30-minute nap every day. Most people over the age of 80 nap for more than one hour each day. - At night, some older people take more than half an hour to get to sleep. This is the case for about 1 in 3 women and 1 in 6 men. - The older you get, the easier to sleep through the night (FALSE) - Older people also tend to sleep lightly - They wake up more often and spend less time in deep, refreshing sleep  - Long sleep duration enhances cognitive performance of older adults (FALSE) - Long sleep duration (at least 10 hours per night) has been linked to poor cognitive performance in older adults, though poor cognition has also been correlated with other medical conditions and overall poor health (Grandner & Drummond, 2007). - The older you get, the more difficult to sleep well (TRUE) - Reported sleep complaints in community dwelling older adults - Difficulty falling asleep (19%) - Nocturnal awakenings (30%) - Waking too early (19%) - Napping during the day (25%), and - Unrefreshing sleep (13%) (Foley et al., 1995) - Older adults cannot generate the quality and quantity of sleep that they need Introduction Older adults with poor or inadequate sleep are at risk of: ○ Increased cognitive, mood, and functional impairments ○ Poorer self-rated health ○ Symptoms of depression ○ Greater number of physical disabilities ○ Respiratory symptoms ○ Increased use of prescription medications to induce sleep or reduce anxiety Chronic sleep complaints and excessive daytime sleepiness (EDS): Memory and attention difficulties Psychomotor retardation Mood disorders Dementia Negative impact of insomnia: Exacerbates other health conditions Increases risk of injury due to falls and unsafe driving Creates stress for family and caregivers Increases economic burden Reduces overall quality of life Age-related etiologies: Changes in sleep duration, continuity, and architecture. Non-age-related etiologies: Primary sleep disorders  Medical problems Medications Psychosocial factors Environmental factors Some of these are reversible factors that are treatable and/or preventable. Normal Late-Life Sleep Less deep sleep (stage N3) and more light sleep (stages N1, N2): ○ Affects men more than women. ○ Occurs before 60 years old, then plateaus. Longer time to fall asleep, increase in awakenings, difficulty resuming sleep: ○ Occurs until after 90 years old. Reasons unclear: ○ Perhaps biopsychosocial. ○ Perhaps age-related changes in neurobiologic substrates (e.g., growth hormones, serotonin, etc.). Sleep Architecture Changes Sleep architecture: the basic structural organization of normal sleep. Changes in sleep architecture occur throughout the life span. Infants exhibit a high percentage of REM sleep, which decreases dramatically throughout childhood, decreases somewhat during adulthood, and then remains stable after age 60. Sleep Architecture Changes: Slow Wave Activity Reduction  Ageing → Slow wave sleep (SWS) reduction: ○ In young adults, slow wave activity is highest in the first NREM cycle of the night, decreasing in quantity across successive sleep cycles. Ageing → Amplitude and density of slow waves are reduced, with maximal reduction over the frontal lobe (Carrier et al., 2011; Mander et al., 2017). Sleep Architecture Changes: Sleep Spindle Changes Sleep spindles: ○ Transient bursts of waxing and waning oscillations in the 11 to 16 Hz range, lasting 0.5 to 2 seconds. ○ A characteristic electroencephalogram (EEG) feature of NREM stage 2 sleep but are also seen in SWS. ○ Play a role in various learning paradigms, including consolidating memory of word-pair associations and procedural memory tasks (Ulrich, 2016). Sleep Architecture Changes: Sleep Spindle Changes Older adults: ○ Reductions in NREM stage 2 sleep spindles. ○ Density of sleep spindles declines significantly, with the greatest reductions occurring in frontal regions (Mander et al., 2017; Ulrich, 2016). ○ Duration and amplitude of sleep spindles decrease. ○ Impairments in hippocampal memory have been demonstrated in older adults with diminished sleep spindle activity (Mander et al., 2014; Ulrich, 2016; Westerberg et al., 2012). Sleep Parameter Changes Changes in sleep duration, timing, and sleep efficiency (defined as the percentage of time in bed spent asleep). Total sleep duration at night decreases: ○ From 10 to 14 hours in children, ○ To 6.5 to 8.5 hours in young adults aged 20 to 35 years, ○ To 5 to 7 hours in adults aged 35 to 60 years, and then ○ Plateaus after age 60 (Ohayon et al., 2004). Decreased time asleep at night is offset by increased daytime napping: 10% of adults aged 55 to 64, and 25% of adults aged 75 to 84 report daily napping (Foley et al., 2007). Daytime napping: 50% of naps are unplanned in older age groups. 25% experience daytime sleepiness that is severe enough to impair daytime activities on a regular basis (Foley et al., 2007). Circadian Rhythm Changes Earlier bedtimes and rising times. More vulnerable to the sleep-disturbing effects of factors that disrupt circadian timing: ○ Time zone changes ○ Reduction of daytime structure ○ Vision loss (Kim & Duffy, 2018; Monk, 2005). Name: Insomnia  Diagnostic criteria: ○ DSM-5: Dissatisfaction with sleep quantity or quality, with complaints of difficulty initiating and/or maintaining sleep, accompanied by clinically significant distress or impairment in social, occupational, or other important areas of functioning, which can occur independently or during the course of another mental disorder or medical condition. ○ ICSD-3: Persistent difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity and circumstances for sleep, and results in some form of daytime impairment. Subcategorized into chronic insomnia disorder, short-term insomnia disorder, other insomnia disorder, isolated symptoms and normal variants, excessive time in bed, and short sleeper. Considerations: ○ Pediatric insomnia: Reports from young people and parents or carers need to be taken into consideration when assessing for insomnia. Treatment: ○ Psychoeducation ○ Behavioral management ○ Pharmacotherapy First author / Country Sampl Age Method of sleep data Prevalence publication e size (years) collection estimate year Bonanni / Italy 1427 ≥65 Reported complaint of 44.2% 2010 insomnia symptoms Gureje / 2009 Nigeria 2152 ≥65 Reported complaint of 30.7% insomnia symptoms Leger / 2000 France 2456 ≥65 Reported complaint of 20.4% insomnia symptoms and related daytime impairment  Lichstein / United 772 ≥60 Reported complaint; sleep 60–69: M = 9%, 2004 States diaries with SOL or WASO W = 17% >31 min, ≥3 nights per week, ≥6 months' 70–79: M = 23%, duration; impaired daytime W = 26% functioning 80–89+: M = 23%, W = 41% Liu / 2005 China 1820 ≥65 Reported complaint of 32.9% insomnia insomnia symptoms and symptoms; related daytime impairment 8.9% insomnia symptoms with daytime consequences Key: M = Men, W = Women SOL = Sleep-onset latency WASO = Wake after sleep onset Prevalence of Late-Life Sleep Disorders in Singapore Sagayadevan et al. (2017): ○ 13.7% (n = 341) of older adults reported at least one sleep problem. ○ Of these: 69.4%: sleep interruption at night 48.9%: having difficulty falling asleep 22.3%: early morning awakening 11.4%: had all three problems Outline (Part 2) Interventions for Late-life Insomnia: ○ Pharmacological ○ Psychological ○ Hypnosis Development of Late-life Insomnia:  ○ Etiologies ○ Risk Factors ○ Theory Benefits and Challenges of Treating Sleep Problems in the Life Span Pharmacological Hypnotics (sleeping pills): ○ Benzodiazepine receptor agonists ○ Sedating antidepressants ○ Melatonin Side effects: ○ Impaired cognitive functioning ○ Daytime sleepiness ○ Increased risk of falls ○ Parasomnia-like symptoms: Sleepwalking For short-term use Psychological Multifaceted treatment approach Cognitive-behavioral therapy for insomnia (CBT-I) Older adults with insomnia have shown significant improvement in their insomnia symptoms (Edinger & Sampson, 2003; Pallesen et al., 2003) Firstline treatment for chronic insomnia above and beyond that of pharmacological interventions Multicomponent CBT-I SLEEP HYGIENE 1. Eliminate or reduce caffeine use after 12 pm. 2. Do not drink alcohol within 2h of bedtime. 3. Do not use tobacco within 2h of bedtime. 4. Do not eat heavy meals within 2h of bedtime. 5. Do not exercise within 2h of bedtime (though routine exercise is encouraged). STIMULUS CONTROL 1. Lie down to go to sleep only when you are sleepy. 2. Do not use the bed for anything except sleep and sex. Do not eat, read, watch television, or worry in bed. 3. If you cannot fall asleep within 10 minutes, get up and go to another room. Only return to bed when you feel sleepy again.  4. If you return to bed and still cannot fall asleep, repeat Step 3. Do this as often as necessary throughout the night. 5. Set your alarm and get up at the same time every morning regardless of how much you slept during the night. This will help your body acquire a constant sleep rhythm. 6. Do not nap during the day. SLEEP RESTRICTION/SLEEP COMPRESSION Aims to match the patient’s time spent in bed to their actual time spent sleeping. Prescribe bed and wake times that more closely reflect time spent asleep. Sleep restriction abruptly tailors the time in bed to reflect sleep needs. Sleep compression gradually reduces time spent in bed to match sleep time. RELAXATION Diaphragmatic breathing, biofeedback, imagery, and meditation are all appropriate relaxation approaches for insomnia treatment. Progressive muscle relaxation (PMR) is an empirically supported treatment by the AASM. Leading patients through a deep breathing exercise, followed by alternatively tensing and relaxing muscle groups (e.g., arms, neck, back, legs) while attending to feelings of relaxation during and after the process. COGNITIVE THERAPY Identifying maladaptive beliefs about sleep and replacing them with more adaptive thoughts and attitudes. Integrates basic education about sleep; understanding normative sleep patterns and experiences can be helpful in addressing mistaken beliefs about sleep. Hypnosis Medical vs. psychological therapy Used by doctors, psychologists, and laymen Neurological vs. cognitive-behavioral Used for a variety of stress-related, behavioral, psychiatric, and chronic conditions From adjunctive to first-line treatment Mindfulness – Two Ingredients Mindfulness works by: ○ Single-minded focus ○ Distracted attitude (Source: Benson-Henry Mind-Body Institute) Be Present with Experience (Mindfulness Exercise) Activity: Balance on one leg. Focus on: ○ Expansion and contraction of leg muscles. ○ Contact of your feet or shoes with the ground. ○ The shift in body weight from one leg to another. ○ Your breathing. ○ Your thoughts and emotions. 3-Minute Body Scan Mindfulness Meditation Group Work: ○ Reader: Read the script slowly and in a regulated tone. ○ Observer: Monitor the process. ○ Meditators: Follow the verbal suggestions given by the reader during the meditation. Barriers (to Mindfulness or Meditation Practice): Boredom Anxiety Anger Doubt Depression Drowsiness Discomfort (Physical) Tips to reduce risk of falls: Make sure a light is within reach: It could be anything from a reading light to a small bedside lamp. Having a light source within reach makes switching on the light much easier and makes it less likely for us to stumble around in the dark when getting out of bed. It also makes accidents like stubbing your toes, falling, and tripping less likely. Reduce hazards in the bedroom: The things in our bedroom can become trip hazards if we aren’t careful. Be mindful of where things are placed, and if possible, remove them. Objects that are potential trip hazards can include things like rugs, cords, stools, or furniture, as we would not be able to see them when waking up in the middle of the  night. Having a phone with a list of important phone numbers within reach makes it easy to call for help from the bedroom if there is a need. Useful self-help tools Finding it hard to fall asleep? Try out these self-help tools that can help us relax and better ease into a good night’s sleep. 1. Guided imagery Try it now. 2. Progressive muscle relaxation Try it now. 3. Mindfulness Try it now. 4. Deep breathing Try it now. Etiologies of Poor Sleep in Older Adults Medications: ○ Antihistamines ○ Antineoplastic medications ○ Central nervous system stimulants ○ Beta-blockers ○ Bronchodilators ○ Calcium channel-blockers ○ Corticosteroids ○ Decongestants ○ Opiates ○ Stimulating antidepressants ○ Thyroid hormone Other substances: ○ Recreational drugs ○ Alcohol ○ Caffeine ○ Nicotine Psychosocial factors: ○ Bereavement ○ Lack of exercise ○ Partner sleeping habits ○ Retirement ○ Social isolation Poor sleep habits:  ○ Excessive time in bed ○ Heavy meals/fluids before bedtime ○ Nighttime light exposure Medical: ○ Angina pectoris ○ Arthritis ○ Autoimmune disorders ○ Congestive heart failure ○ Chronic obstructive pulmonary disease ○ Gastroesophageal reflux ○ Hyperthyroidism ○ Malignancy ○ Menopause ○ Musculoskeletal pain ○ Obstructive lung disorders (asthma, COPD) ○ Urinary disorders Neurologic: ○ Dementia ○ Movement disorders ○ Stroke Primary sleep disorders: ○ Circadian rhythm disorders ○ Periodic limb movements in sleep ○ Rapid eye movement behavior disorder ○ Restless legs syndrome ○ Sleep-related breathing disorders Psychiatric: ○ Anxiety ○ Depression Etiologies of Late-Life Insomnia Longitudinal studies: ○ Self-reported insomnia was associated with increased cognitive decline (Cricco, Simonsick, & Foley, 2001; Jelicic et al., 2002). Meta-analysis (n = 5 studies): ○ 1.5-fold risk of developing dementia in older adults with insomnia (Moraes De Almondes, Onica Vieira Costa, Fernandes Malloy-Diniz, & Satler Diniz, 2016). Nurses’ Health Study and Honolulu Aging Study:  Did not find any associations between insomnia and cognitive performance (Foley et al., 2001; Tworoger, Lee, Schernhammer, & Grodstein, 2006). Etiologies of Late-Life Insomnia Studies investigating the effects of extremes in sleep duration in adult populations have consistently demonstrated impairments in: ○ Executive function ○ Working memory ○ Attention ○ Episodic memory ○ Global cognition For both long and short sleep duration (Kronholm et al., 2009; Scullin & Bliwise, 2015; Sternberg et al., 2013; Wu, Sun, & Tan, 2018). Etiologies of Late-Life Insomnia Long sleep duration (at least 10 hours per night) has been linked to poor cognitive performance in older adults, though poor cognition has also been correlated with other medical conditions and overall poor health (Grandner & Drummond, 2007). Middle-aged adults who changed their sleep duration by at least 2 hours/day between middle age and old age demonstrated poorer performance on most cognitive measures (Devore et al., 2014) Increased wake time at night was associated with cognitive complaints after as few as 2 years and as many as 28 years later (Kulmala et al., 2013; Stenfors, Magnusson Hanson, Oxenstierna, Theorell, & Nilsson, 2013) Risk Factors Acute stressor: ○ Work deadlines ○ Traumatic life event Circadian rhythm issue: ○ Shift work ○ Circadian rhythm disorder Medical / neurologic condition:  ○ Medications ○ Substances: caffeine, alcohol, thyroid problem ○ Hypnotic-dependent insomnia Psychiatric disorder: ○ Mood disorder ○ Anxiety disorder SES (Socioeconomic status): ○ Low social support? ○ Unhealthy lifestyle? ○ Financial problems? Substances Many medications prescribed to elderly individuals have effects on sleep and wake. Medications are frequently prescribed to the elderly to help with sleep issues. Adults over 65 years have almost five times the odds ratio of being prescribed a medication for sleep relative to adults aged 18-35 years (Balkrishnan, Rasu, & Rajagopalan, 2005). Substances Antidepressants, anxiolytic medications, and sedative hypnotics comprised the most common potentially inappropriate medications in community-dwelling elderly patients (Mort & Aparasu, 2000). Risks of hypnotics in older adults include drug interactions, age-related changes in drug metabolism and clearance, risk of cognitive impairment, falls, and the development of tolerance. Older adults have nearly five times greater risk of unwanted cognitive and psychomotor \effects from the use of hypnotics relative to placebo (Glass, Lanctôt, Herrmann, Sproule, & Busto, 2005). Substances Concern has arisen regarding the use of hypnotics and the risk for dementia. The risk for dementia was higher among heavy past users as well as recent users, suggesting that the risk may persist despite discontinuation. In models of dementia pathogenesis linking poor sleep in middle adulthood with the development of dementia, the association between anticholinergic medications and dementia would thus be indirect. Neurocognitive Disorders Neurocognitive disorders include a wide array of progressive illnesses that include tauopathies such as Alzheimer's Disease (AD) and synucleinopathies such as Parkinson's Disease (PD). Earliest preclinical symptoms of dementia: ○ Sleep disturbances, including problems initiating and maintaining sleep  ○ Poor sleep quality ○ Excessive daytime sleepiness, which may begin decades prior to the onset of dementia itself. Neurocognitive Disorders The onset and progression of sleep problems may occur alongside preclinical histopathological development of the disorder prior to the onset of cognitive symptoms. Sleep problems may not only occur as a result of the neurocognitive disorder but may in fact contribute to its development. Findings suggest that for patients with dementia, poor sleep is associated with poorer cognitive function as well as behavioral and psychological symptoms, and treating sleep problems is associated with improvement in these daytime problems. Benefits of Treating Sleep Problems in Middle Adults Pathologic sleep changes in middle age may contribute to abnormal acceleration of cognitive decline (Scullin & Bliwise, 2015). This is most apparent in the concurrent development of sleep disturbances, cognitive changes, and histopathological changes occurring in individuals with dementia (Bhatt et al., 2005; Porter et al., 2015). Important to diagnose and treat sleep problems: ○ Particularly in the middle-aged population ○ May help slow or arrest pathologic changes in cognition occurring in later life. Challenges of Treating Sleep Problems in Older Adults For patients with dementia, poor sleep is associated with: ○ Poorer cognition ○ Psychological symptoms ○ Behavioral problems Recap Introduction Normal Late-life Sleep Epidemiology of Late-life Sleep Disorders Development of Late-life Insomnia Interventions for Late-life Insomnia Benefits and Challenges of Treating Sleep Problems in the Life Span Guest Speaker Notes State of Dementia in Singapore 1. Prevalence of Dementia: ○ Falls to 1 in 11 older adults in Singapore, according to an IMH study. ○ The reduction in dementia rates is partly attributed to increased employment, higher education, and lower stroke prevalence. 2. Dementia Among Older Adults in Singapore: ○ The number of older adults with dementia has risen over the years, while the proportion with the condition has decreased. 3. Survey Comparisons (2013 vs. 2023): ○ Older adult population (aged 60 and above): 2013: 517,369 2023: 838,800 ○ Prevalence of dementia: 2013: 10% 2023: 8.8% ○ Prevalence by age group: 60-74 years: 2013: 3.4% (1 in 29) 2023: 3% (1 in 33) 75-84 years: 2013: 21.6% (1 in 5) 2023: 18.2% (1 in 5) 85 and above: 2013: 56.2% (1 in 2) 2023: 48.6% (1 in 2) ○ Number of older adults with dementia:  2013: 51,934 2023: 73,918 ○ Treatment gap: 2013: 70.6% 2023: 51.5% 4. Care Needs: ○ Needs care most of the time: 2013: 57.4% 2023: 62.3% ○ Needs care some of the time: 2013: 31.8% 2023: 25.6% Dementia Prevention, Intervention, and Care: 2020 Report of the Lancet Commission 1. Executive Summary: ○ The number of older adults, including those living with dementia, is increasing as mortality declines. However, age-specific dementia incidence is falling in many countries, likely due to improvements in education, nutrition, healthcare, and lifestyle changes. ○ Research increasingly supports the idea that dementia risks are potentially modifiable through interventions. These findings are modeled in the 2017 Lancet Commission report. ○ Prevention strategies target factors like education, hearing health, physical exercise, and depression. 2. Potentially Modifiable Risk Factors: ○ Early life: Less education contributes to 7% of dementia cases. ○ Midlife: Hearing loss: 8% Traumatic brain injury: 3% Hypertension: 2% Alcohol consumption (>21 units per week): 1% Obesity: 1% ○ Later life: Smoking: 5% Depression: 4% Social isolation: 4% Physical inactivity: 2% Air pollution: 2% Diabetes: 1% 3. Overall Modifiable Risks: ○ 40% of dementia cases could be prevented by addressing these modifiable risk factors. ○ 60% of dementia risks are unknown or not yet identified. Dementia Prevention, Intervention, and Care: 2024 Report of the Lancet Standing Commission 1. Summary: ○ The 2024 update provides new insights into dementia prevention, intervention, and care. ○ As life expectancy rises, more people live with dementia, but age-specific dementia rates are declining in high-income countries. ○ This update highlights the need for expanded prevention strategies, focusing on lifestyle and cognitive interventions, such as maintaining cognitive and physical reserve through activities and reducing known risk factors. 2. Research Findings: ○ New data since the 2020 report show how reducing smoking and managing high blood pressure have contributed to a lower dementia incidence. ○ Tackling other major risk factors (such as untreated vision loss, high LDL cholesterol, and hearing loss) is now seen as essential. ○ The importance of lifestyle interventions like hearing loss treatment, limiting alcohol, managing hypertension, and addressing obesity is emphasized. 3. New Additions for 2024: ○ Two additional risk factors: untreated vision loss and high LDL cholesterol. 4. Risk Factors for Dementia (2024 Update): ○ Early life: Less education (5%) ○ Midlife: Hearing loss (7%) High LDL cholesterol (7%) Depression (5%) Traumatic brain injury (3%) Physical inactivity (2%) Diabetes (2%) Smoking (2%) Hypertension (2%) Obesity (1%) Excessive alcohol (1%) ○ Late life: Social isolation (5%) Air pollution (3%) Untreated vision loss (3%) 5. Overall Modifiable Risk: ○ 45% of dementia cases could be prevented by addressing these modifiable factors. Window of Opportunity in Alzheimer's Disease Progression 1. Stages of Alzheimer's Disease (AD):  ○ Preclinical AD: No symptoms but evidence of AD pathology in the brain. No cognitive or functional decline. ○ MCI due to AD* (Mild Cognitive Impairment): Very mild symptoms that do not interfere with everyday activities. ○ Mild Stage: Symptoms interfere with some everyday activities. ○ Moderate Stage: Symptoms interfere with many everyday activities. ○ Severe Stage: Symptoms interfere with most everyday activities. 2. Diagnosis of Early Alzheimer’s Disease: ○ Preclinical AD is the earliest stage in the continuum of Alzheimer’s, characterized by a long asymptomatic phase. ○ Individuals have AD pathology in the brain without cognitive or functional symptoms, and their daily life remains unaffected. ○ The duration of preclinical AD can vary but typically lasts 6–10 years. ○ Progression: The risk of progression from preclinical AD to MCI due to AD is influenced by factors such as age, sex, and Apolipoprotein E (ApoE) status. Not all individuals with AD pathology will develop MCI or dementia. A study showed that 20% of individuals with preclinical AD progressed to MCI due to AD within 3.8 years. Another study found that 29.1% progressed from preclinical AD to MCI within an average follow-up period of 4 years. Duration of Preclinical, Prodromal, and Dementia Stages of Alzheimer's Disease in Relation to Age, Sex, and APOE Genotype 1. Study Overview: ○ This study examines the estimated duration spent in different Alzheimer's disease (AD) stages, including preclinical AD, prodromal AD, and dementia, based on age, sex, and APOE genotype. 2. Key Factors Affecting Disease Duration: ○ Age: Older individuals tend to spend less time in the preclinical and prodromal stages and progress to dementia faster. ○ APOE Genotype: Individuals with the APOE4 genotype, particularly those aged 65 and above, are at higher risk of faster progression through AD stages. ○ Sex: Females tend to spend more time in the preclinical and prodromal stages compared to males. 3. Data Breakdown: ○ Figure 2a: Duration per stage by age:  Individuals aged 75+ spend significantly less time in the preclinical AD stage compared to younger age groups. Those 65 and older without APOE4 generally have longer preclinical AD durations. ○ Figure 2b: Duration per stage by APOE genotype and setting: APOE4 carriers in clinical settings progress faster through the preclinical stage compared to non-carriers. Research settings show more variation, but APOE4 carriers still show faster progression. ○ Figure 2c: Duration per stage by sex and setting: Females tend to have longer preclinical AD stages compared to males, especially in research settings. 4. Interpretation: ○ This study emphasizes that factors like age, sex, and APOE genotype significantly influence the duration of different stages of Alzheimer's disease. Understanding these variables can help improve prediction models for disease progression and inform clinical interventions. Prevalence of Amyloid Plaques: Some scientists suggest that the prevalence of amyloid plaques may be just as high in individuals without Alzheimer’s disease as in those with the condition. Amyloid Plaque and Disease Severity: The amount of amyloid plaque does not strongly correlate with the severity of Alzheimer’s disease. Amyloid Plaques and Dementia: There are many individuals who have amyloid plaques but show no signs of dementia at all. Aducanumab for Alzheimer's Disease: The Amyloid Hypothesis Moves from Bench to Bedside 1. Role of Amyloid in Alzheimer’s Disease (AD): ○ Strong human genetic, biochemical, histological, and animal model evidence suggests that amyloid-beta (Aβ) is a key player in AD. ○ Brain amyloid can be detected at least 15 years before cognitive symptoms appear. ○ Amyloid buildup is associated with a significantly increased risk of developing Alzheimer’s dementia, which has led to the concept of a long preclinical or asymptomatic stage of the disease. 2. Challenges in Amyloid Pathology:  ○ The relationship between amyloid pathology, neurodegeneration, and dementia in AD is complex. ○ Clinico-pathological studies indicate that neither the regional distribution nor the total burden of amyloid plaques correlates well with the severity of cognitive deficits seen before death. ○ There is also no strong correlation between the amount of postmortem neuronal loss in AD and the burden of amyloid. 3. Amyloid Removal as a Treatment Strategy: ○ Removing amyloid is considered a promising approach for preventing both primary and secondary clinical disease. ○ Trials targeting the presymptomatic stages of AD are ongoing, focusing on amyloid removal as a preventative treatment. Understanding Alzheimer's Brains Without Symptoms 1. Challenge of Asymptomatic Alzheimer's: ○ Many individuals have brains that show Alzheimer’s disease pathology (plaques and tangles), but they do not exhibit any symptoms of the disease. ○ A new wave of drug developers is working to understand why these individuals remain symptom-free despite the presence of Alzheimer’s-related brain changes. 2. Quote from Neurologist Rudy Tanzi: ○ "You can have abundant plaques and tangles without having Alzheimer’s disease. The challenge is to figure out how." 3. Research on CD33 Gene: ○ Scientists, including Rudy Tanzi, have been investigating a gene variant called CD33. This gene typically helps microglia (immune cells in the brain) clear out amyloid and other debris. ○ In individuals with a specific variant of CD33, microglia lose their protective function, turning aggressive and leading to neuroinflammation. ○ This neuroinflammation is believed to kill more neurons than the plaques and tangles associated with Alzheimer's disease. ○ Brains can tolerate the buildup of amyloid plaques and tau tangles, but neuroinflammation is a key factor in cognitive decline. 4. Importance of Targeting Neuroinflammation: ○ The focus is shifting towards targeting neuroinflammation as a critical element in preventing cognitive decline in Alzheimer’s patients, regardless of the presence of plaques and tangles. Big Question: What role do psychological factors play in the development of Alzheimer’s Disease (AD) and Dementia? The PROTECT Study:  The PROTECT Study is a major UK research initiative aimed at understanding the factors that influence cognitive aging. It seeks to provide opportunities for older adults to participate in research, with a focus on monitoring cognitive changes over time. Journal of Affective Disorders: Study on Affective Symptoms and Cognition: Title: "Are subtypes of affective symptoms differentially associated with change in cognition over time? A latent class analysis." Key Focus: ○ This study examines whether different subtypes of affective symptoms (such as depression, anxiety, and sleep issues) are associated with changes in cognition over time. ○ It uses a latent class analysis to identify different affective symptom profiles and how these profiles impact cognitive aging. Findings: ○ Certain affective symptoms, particularly those related to anxiety and worry, are linked to greater declines in cognitive function over time. ○ The study emphasizes the importance of understanding the specific types of affective symptoms that might predict cognitive decline. Study on Repetitive Negative Thinking (RNT) and Its Association with Amyloid, Tau, and Cognitive Decline: 1. Title: "Repetitive negative thinking is associated with amyloid, tau, and cognitive decline" ○ This study investigates the relationship between repetitive negative thinking (RNT) and Alzheimer’s disease biomarkers (amyloid and tau) and cognitive decline. 2. Key Concepts: ○ Repetitive Negative Thinking (RNT): This refers to a process of repetitive and often unproductive thoughts, including worry (future-oriented) and rumination (past-oriented). These thought patterns are stable but can be modified through interventions. 3. Research Objective: ○ The study seeks to determine if RNT is linked to higher levels of amyloid-beta (Aβ) and tau, which are key biomarkers associated with Alzheimer’s disease, and if it contributes to cognitive decline in affected individuals. 4. Methodology: ○ The study used PET scans to measure amyloid and tau in participants, with a focus on older adults at risk of Alzheimer's disease. Cognitive function was also assessed. 5. Results: ○ RNT was significantly associated with cognitive decline and higher amyloid-beta and tau deposition in the brain.  ○ These findings suggest that repetitive negative thinking may be a cognitive process that contributes to the pathological changes seen in Alzheimer’s disease. 6. Discussion: ○ The study supports the hypothesis that repetitive negative thinking could be a mechanism linking psychological stressors (such as depression and anxiety) to Alzheimer's disease. ○ Future research should explore the potential of targeting RNT through interventions to reduce Alzheimer’s disease risk. Study 1: Lifetime Affective Problems and Later-Life Cognitive State Title: "Lifetime affective problems and later-life cognitive state: Over 50 years of follow-up in a British birth cohort study" Key Findings: ○ Recurrent lifetime affective problems are predictive of diminished cognitive state in later life. ○ Individuals who experienced affective problems only once did not show a significant risk of lower cognitive state. ○ The recurrence and timing of affective problems are important in determining cognitive decline risk. ○ These associations remained significant even after controlling for early childhood cognition. ○ Cognitive decline risk can manifest as early as age 69. Study 2: Longitudinal Associations of Affective Symptoms with Mid-Life Cognitive Function Title: "Longitudinal associations of affective symptoms with mid-life cognitive function: evidence from a British birth cohort" Research Aim: ○ The study investigates the effects of affective symptoms (such as depression and anxiety) on mid-life cognitive function and whether these symptoms predict cognitive decline in midlife (age 50). Method: ○ Data was drawn from the National Child Development Study, assessing memory, verbal fluency, and information processing speed at ages 50, 43, 33, and 23. ○ The accumulation and persistence of affective symptoms were the key variables studied in relation to cognitive outcomes. Key Findings: ○ Accumulation of affective symptoms negatively impacted mid-life cognitive functions, particularly memory, verbal fluency, and information processing accuracy.  ○ The more persistent the affective symptoms, the greater the negative effect on cognitive health in midlife. Conclusion: ○ Persistent affective symptoms can affect cognitive performance in midlife, highlighting the importance of addressing these issues for better long-term cognitive outcomes. Study Title: "Inflammation mediates depression and generalized anxiety symptoms predicting executive function impairment after 18 years" 1. Objective: ○ The study examines whether increased major depressive disorder (MDD) and generalized anxiety disorder (GAD) severity predict executive function (EF) decline over an 18-year period and whether inflammation mediates this relationship. 2. Methodology: ○ The study involved community-dwelling adults, where assessments of T1 MDD, GAD severity, and T2 inflammation levels (measured through markers like Interleukin-6, C-reactive protein, and fibrinogen) were conducted. ○ Executive function (EF) was measured after 18 years using various cognitive tests. 3. Key Results: ○ Higher T1 MDD and GAD (but not panic disorder) predicted elevated T2 inflammation after 9 years. ○ Elevated T2 inflammation levels, in turn, predicted lower EF scores after 18 years. ○ Inflammation mediated the association between T1 MDD and GAD with lower EF scores, explaining 38% and 10% of the variance in EF decline, respectively. ○ Specific mediators, such as Interleukin-6, were significantly associated with cognitive decline. 4. Conclusions: ○ Inflammation likely plays a mediating role in the link between depression/anxiety symptoms and executive function decline over time. ○ Interventions targeting inflammation, worry, or depression may help prevent EF decline in individuals with MDD or GAD. Mixed Findings in Relation to Depression/Anxiety and Cognitive Decline: Various studies (e.g., Bunce et al., 2012; Neubauer et al., 2013; Brailean et al., 2017) have shown inconsistent results when examining the link between depression/anxiety and cognitive decline. Why?: Hypothesis: Heterogeneity of Affective Symptoms may explain these mixed findings. 1. Co-occurrence/Overlap Between Depression and Anxiety: ○ Some studies do not control for the presence of the other condition, leading to confounding results. ○ Some studies do control for both, but this could result in over-correction, masking true effects. 2. Somatic Symptoms: ○ Somatic symptoms (physical symptoms) are common in normal aging, which may complicate the differentiation between aging-related issues and affective disorders like depression or anxiety. Study Title: "Trait Mindfulness Is Associated with Less Amyloid, Tau, and Cognitive Decline in Individuals at Risk for Alzheimer’s Disease" 1. Background: ○ Mindfulness is defined as non-judgmental awareness of the present moment and has been linked to various mental and physical health benefits. ○ This study explores whether mindfulness may also reduce the risk of Alzheimer’s disease (AD) by affecting amyloid-beta (Aβ), tau deposition, and cognitive decline in individuals at risk. 2. Objective: ○ The study aimed to determine if trait mindfulness could influence the development of Alzheimer’s pathology and cognitive decline in adults with a family history of AD or other risk factors. 3. Methods: ○ The study involved 261 older adults who had a family history of AD. ○ Participants underwent neuroimaging (PET scans) to measure amyloid and tau levels in the brain. ○ Cognitive assessments and self-reported mindfulness measures were also collected. 4. Key Results: ○ Higher levels of trait mindfulness were associated with: Lower levels of amyloid-beta and tau in specific brain regions, including the bilateral medial and lateral temporal cortices. Less cognitive decline, particularly in episodic memory and attention/executive function. ○ Individuals with higher mindfulness traits showed better cognitive preservation compared to those with lower mindfulness scores. 5. Conclusion:  ○ The findings suggest that trait mindfulness may be protective against the deposition of amyloid and tau, as well as cognitive decline, in older adults at risk for Alzheimer’s disease. ○ This suggests that mindfulness interventions could be beneficial in Alzheimer’s prevention efforts. Week 6 Critical Gerontology Content - Introduction - Definition and evolution - Scopes - Popular Areas - Ageism - Future Directions Nocebo Effect: Definition: Negative preconceptions increase the number of adverse effects and symptoms experienced by humans. Key Components: 1. Previous experiences and views: ○ Past experiences can create negative expectations, even if they are partly unconscious. 2. Negative expectations: ○ These expectations affect how stimuli are processed, amplifying sensations and stress. 3. Stimulus: ○ External stimuli like medicine, sound, or smell can trigger adverse effects due to the nocebo effect. 4. Sensations and stress: ○ These factors contribute to the perception of adverse effects and symptoms. 5. Social Influence: ○ Experiences, views, and knowledge from others can reinforce the nocebo effect, further increasing the likelihood of negative outcomes. Case Report: Nocebo Effects with Antidepressant Clinical Drug Trial Placebos Study Description:  ○ A 26-year-old male took 29 inert placebo capsules, believing he was overdosing on an antidepressant during a clinical drug trial. ○ He experienced significant negative effects, including hypotension (low blood pressure), which required intravenous fluids to stabilize. Outcome: ○ The adverse symptoms abated once the true nature of the placebo (inert capsules) was revealed. Key Insight: ○ The nocebo effect refers to undesirable symptoms following the administration of an inert substance that the patient believes to be active. ○ This effect may have significant negative impacts on certain patients. Conclusion: ○ Further research is necessary to better understand the nocebo effect and its influence in clinical settings. Typing "Old" in MS Office Thesaurus: Ancient: ○ Hoary (over-used, stale). ○ Timeworn. Previous: ○ Outmoded. Old-fashioned: ○ Outdated. ○ Archaic. ○ Out-of-date. Elderly: Happiness Curve (The U-bend): The graph depicts self-reported well-being (on a scale of 1-10) across different age groups, illustrating the U-bend in psychological well-being. Well-being starts relatively high in early adulthood (18-21), declines through the middle ages (40s-50s), and then starts rising again in later years (60s-70s), peaking in older age (70+). The source of the data is from a PNAS paper titled "A snapshot of the age distribution of psychological well-being in the United States" by Arthur Stone. Immunity Curve: The graph shows the immune response in terms of serum antibody titer over time, measured in weeks. Antigen A is introduced at week 0, triggering a primary anti-A response. ○ This initial response rises and then falls after a few weeks. At week 6, Antigen A is introduced again, along with Antigen B. ○ This results in a secondary anti-A response, which is stronger and faster than the primary response. ○ A primary anti-B response also occurs, but it is slower and smaller, similar to the first response to Antigen A. The secondary immune response is stronger and more efficient due to immune system memory. Counterclockwise Study (Ellen J. Langer): Study Overview: ○ The Counterclockwise Study conducted by Ellen J. Langer explored the impact of changing one's environment to reflect a younger time in life and how it could potentially reverse aspects of aging. Key Concept: ○ The idea behind the study is that mindfulness and the power of possibility can lead to improved health outcomes, both mentally and physically. Experiment Setup: ○ Older men were placed in a retreat designed to look and feel like an earlier decade. ○ Participants were asked to live as if they were younger, resulting in measurable improvements in physical and cognitive functions. Main Takeaway: ○ The mind-body connection and environment play a significant role in aging, suggesting that a change in mindset and surroundings can improve well-being. A New Paradigm: The image conveys the message that age is just a number and encourages a mindset shift. "You're not 60, you're twenty-one with 39 years of experience" emphasizes a more positive, youthful outlook on aging, focusing on experience and vitality rather than the number of years lived. Definition: The application of critical theories or thinking into gerontology (study of aging) as per Lynott and Lynott (2002). Definitions: Critical theories are used to describe a variety of theoretical perspectives that counter the conventional construction of old age, aging, and related policies. These theories highlight how conventional views on aging often overlook social, economic, political, and environmental factors (Estes and Grossman 2007; Katz 2019; Lynott and Lynott 2002; Moody 2008; Phillipson 2003). Definitions: Critical theories in gerontology represent a combinative way of questioning and criticizing the assumptions and theories of mainstream or conventional gerontology. It is defined as a "collection of questions, problems, and analyses that have been excluded by the established mainstream" (Baars 1991, p. 220). 3 Core Elements of Critical Gerontology: 1. Recognizes the ideological and socially constructive conceptualization of aging at societal, community, and individual levels. 2. Understands aging as a dynamic process, rather than a static condition. 3. Rejects aging as a purely biomedical construct, emphasizing the broader social and ideological dimensions. 1. Critical Theory Critical theory is a broad approach that critiques and challenges traditional societal norms, structures, and power dynamics. It looks beyond the surface of issues to examine underlying societal, political, and cultural influences. 2. Critical Psychology This branch of psychology challenges mainstream psychological practices and concepts, particularly focusing on how societal structures influence individual mental health. It looks at issues like power, inequality, and marginalization, questioning traditional practices that often focus only on the individual without considering social factors. 3. Critical Sociology Critical sociology critiques traditional sociological theories that often overlook the impacts of social inequality, power imbalances, and structural issues on society. It examines how  society is structured in ways that benefit certain groups over others, emphasizing the need for societal change to address these inequities. 4. Critical Gerontology (Late 1970s) Critical gerontology emerged in the late 1970s as a response to traditional gerontology. It challenges conventional views of aging, focusing on the social, political, and ideological forces that shape the experiences of older adults. It argues that aging is not just a biological process but also influenced by broader social structures like economic policies, healthcare systems, and societal attitudes toward the elderly. Late 20th Century Theories: 1. Life Course Theory: ○ Focuses on how life events and social roles impact individuals throughout their lives, considering the timing and order of these events. 2. Age Stratification: ○ Society is organized by age groups, and different generations experience unique social roles, privileges, and challenges. 3. Lifespan Development: ○ Examines how people grow and change physically, cognitively, and socially throughout their entire lifespan, from birth to old age. 21st Century Approaches: 1. Interdisciplinary: ○ Combines knowledge and methods from different disciplines to study aging from various perspectives. 2. Transdisciplinary: ○ Integrates ideas from multiple disciplines to create new theories or methods that go beyond traditional boundaries. 3. Multidisciplinary: ○ Uses insights from several disciplines, keeping their approaches distinct but contributing to a broader understanding of aging. Scopes: Conventional Gerontology vs. Critical Gerontology 1. Mainstream vs Non-Mainstream: ○ Conventional gerontology follows mainstream ideas and methods, while critical gerontology challenges these norms, offering alternative perspectives. 2. Objective Knowledge vs Subjective Reality: ○ Conventional gerontology tends to rely on objective data, while critical gerontology focuses on understanding the subjective experiences of aging. 3. Data and Methodological Approach:  ○ Conventional gerontology keeps data and methods separate, while critical gerontology views them as intertwined, emphasizing how social context influences data. Guest lecture (Geropsychological issues) Key Message: We are living longer in a rapidly changing environment. Psychological health in seniors is just as important as physical health. Importance of Geropsychology: Geropsychology focuses on studying human aging in adulthood. It aims to understand mental health issues in older adults. Statistics on Singapore’s Aging Population by 2030: 1 in 4 Singapore citizens will be aged 65 and above. There will be 2.7 working adults for every senior over 65 years old. An estimated 83,000 seniors will live alone. About 100,000 seniors will have at least mild disability, requiring assistance with activities of daily living. Ageing: Individuals age in various ways: biologically, sociologically, psychologically, spiritually, and chronologically. Gerontology is the study of this aging process. Reflections on Ageing: Aging is a normal process with complex issues. It is the last stage of biological life, characterized by physical deterioration, ultimately ending with death. It also represents the last stage of social life, reflecting the culmination of an individual’s personal and collective social experiences. Question: What is Active Ageing? Bleak Look at Singapore’s Ageing Population: Common issues among seniors include:  ○ Depression ○ Anxiety ○ Stress ○ Cognitive impairments ○ Loneliness ○ Social isolation Statistics: 1 in 7 seniors aged 60+ face depressive symptoms (IMH, 2021): ○ Causes include health deterioration, loss of independence, grief, and bereavement. 1 in 10 seniors aged 60+ has dementia (MOH, 2020): ○ Symptoms include memory loss, disorientation, and mood changes. 34% of seniors reported feeling lonely (NUS, 2020): ○ Contributing factors include loss of spouse, shrinking social circle (loss of peers), and smaller family sizes. Factors Affecting Geropsychological Well-being: Physical Health and Mental Well-being: ○ Seniors with chronic illnesses are more prone to depression (SLAS, 2019). ○ Physical decline often leads to feelings of helplessness. Factors Affecting Geropsychological Well-being: Social Support: ○ Strong family bonds reduce the risk of depression (SUSS, 2022). ○ Social networks help combat isolation and loneliness. ○ Supportive programs such as the Silver Generation Office (SGO) provide additional assistance. Factors Affecting Geropsychological Well-being: Financial Stress: ○ 15% of seniors reported financial insecurity (CPF, 2019). ○ Financial concerns contribute to stress, feelings of worthlessness, and depression. Factors Affecting Geropsychological Well-being: Technology and Digital Literacy: ○ 58% of seniors are confident using digital tools (IMDA, 2020). ○ Digital literacy helps in maintaining social connections and accessing essential services. Case Study 1: Struggles with Dementia Mr. T (75) experienced cognitive decline. This led to frustration, depression, and mood swings. His wife, who was the primary caregiver, faced burnout. Intervention: Dementia care facility for professional support. Counselling: ○ Helped to improve family communications. Case Study 2: Social Isolation Mdm L (75) felt isolated after losing her husband. She refused to join community activities and felt out of place. Intervention: Silver Generation Office (SGO) connected her with a senior support group. Active Ageing Centre (AAC) sent befrienders to provide companionship and support. Case Study 3: Anxiety Mr K (70) became dependent due to arthritis. He developed anxiety, feeling like he was a burden. Intervention: A daycare center provided therapy and physiotherapy. His social circle expanded, helping him feel more supported. Current Support Services Existing Support Systems: ○ Government programs: Action Plan for Successful Ageing. ○ Community services: Community Networks for Seniors (CNS) Active Ageing Centres (AAC) Silver Generation Office (SGO) These services provide both medical and psychological support to seniors. HOPE worldwide (Singapore) Founded in 1998. Part of the HOPE worldwide network of charities in over 60 countries.  A full member of NCSS (National Council of Social Service) and IPC (Institution of a Public Character). Dedicated to serving the community through impactful and sustainable programs. Aims to inspire greater hope and transform lives. 3 Pillars of HOPE worldwide (Singapore) 1. Learning Buddies: ○ Focus: Holistic learning for youths, with outreach to youths in need. ○ Programs include: Structured academic support. Learning journeys. Enrichment programs. 2. Silvers: ○ Focus: Dignified aging for seniors, with outreach to seniors in the community and nursing homes. ○ Programs include: Falls Prevention Program. Joyful Journeys (social interactions, outings). Befriending. 3. Samaritans: ○ Focus: Inclusion for economically disadvantaged individuals. ○ Programs include: Essential aid (care packages, financial aid). Home Refresh (cleaning and decluttering). Community projects. Challenges in Elder Care: Challenges in addressing mental health among seniors: ○ Shortage of mental health professionals trained in geriatric care. ○ Caregiver burnout is under-addressed. Geropsychological Interventions: Future Directions in Geropsychology: 1. Community-based mental health interventions: ○ Training healthcare professionals in geriatric mental health. 2. Using technology to bridge gaps in care: ○ Remote support and counseling: Telemedicine. Mental health apps. ○ Smart Homes: Improve safety.  Reduce anxiety. Reframing ageing, or maybe even laugh at it Week 7 (Discrimination and retirement of Older workers) True or False 1. On average, older workers are less productive than their younger counterparts (FALSE) Lower Performance: Stereotype vs. Fact Stereotype: ○ Motivation: Older workers are seen as less dedicated, more absent, and more focused on personal life. ○ Competence: Viewed as slower, less intelligent, and having outdated skills. ○ Productivity: Assumed to be less productive, with poor performance attributed to internal factors like age. Fact: ○ No relation between age and job performance, as supported by research (Ferris & King, 1992; McEvoy & Cascio, 1989). ○ Older workers often perform better by contributing beyond core work tasks (Ng & Feldman, 2008). 2. Older workers are generally less interested in career development and training than their younger counterparts (TRUE) Lack of Adaptability: Stereotype vs. Fact Stereotype: ○ Personality: Older workers are perceived as more rigid and dogmatic. ○ Capability: Seen as having outdated skills, and less willing or able to update them. Fact: ○ There is a positive relationship between age and change-oriented behaviors. ○ There is no significant relation with attitudes toward organizational changes, risk-taking, creative self-efficacy, and innovative behaviors (Ng & Feldman, 2012). Older workers may be generally less interested in career development and training activities than their younger counterparts (Greller, 2006; Ng & Feldman, 2012). ○ Consistent with developmental research pointing out that young adults tend to be oriented toward growth, while older adults put more emphasis on preventing losses (Freund, 2006; Heckhausen, Wrosch, & Schulz, 2010). Age differences may also be due to the nature (e.g., topics, goals) and format of the training currently offered in organizations.  ○ Choices of training and delivery method may be important (Beier & Ackerman, 2005; Callahan, Kiker, & Cross, 2003; Posthuma, & Campion, 2009; Warr, 1993). 3. In general, older office workers are paid more, but work less hours than their younger counterparts (FALSE) Higher Costs: Stereotype vs. Fact Stereotype: ○ Explicit: Higher salaries due to age. Higher healthcare usage. Fact: ○ Paid more due to valued experience, not age. ○ Less likely to have dependents (i.e., young children) whose medical costs are often high and covered by employers too (Cappelli & Novelli, 2010). 4. It is financially more costly to employ older workers than their younger counterparts (FALSE) Higher Costs: Stereotype vs. Fact Stereotype: ○ Implicit: Absenteeism → paid more but work less. Shorter tenure → low return-on-investment (ROI). Fact: ○ Lower level of nonmedical-related absenteeism than other workers (Ng & Feldman, 2008). ○ Data typically not collected to assess training ROI. ○ Skills life span is short. ○ Voluntary turnover of older workers is low. Content Discrimination ○ What stereotypes do older workers face? ○ What are the consequences of stereotyping older workers? ○ What are the implications of age norms? Retirement ○ Why study retirement? ○ What is retirement? What are the Consequences of Stereotyping Older Workers?  Professionals' attitudes towards older workers Stereotypes lead professionals to develop preconceived notions about the productivity, adaptability, and competence of older workers. This can create bias in hiring, promotions, and workplace interactions. Evidence for behavioural intentions not actual workplace behaviours Research shows that these stereotypes often reflect professionals’ intentions or assumptions rather than real differences in workplace performance. Essentially, older workers may be judged based on stereotypes, but this doesn’t necessarily translate into differences in how they actually perform. **Older workers’ own beliefs and behaviours** Stereotype threat: Older workers may change their behavior out of fear of confirming stereotypes others hold about their age group. Stereotype embodiment: Older workers may internalize these stereotypes, leading to behaviors that fulfill those expectations, creating a self-fulfilling prophecy. What are the Implications of Age Norms? Age norms: ○ Formulated as prescriptions or proscriptions (what people should or shouldn't do at certain ages). ○ Define the social clock, which refers to the cultural expectations of when certain life events should occur (e.g., marriage, career milestones). Implications of Age Norms Behind schedule → Poor performance rating. Social norms about retirement age → Coercive push-factor. Experience requirements → Over-qualification. Social hierarchy of age → Dysfunctional interpersonal dynamics at work. Why Study Retirement? Retirement can be either: ○ A remarkable reserve to society (e.g., caregiving, volunteer work, labor force reserve). ○ A burden (e.g., poor psychological or physical health, reliance on pensions) (McKelvey 2009). Factors that lead to retirees being self-sufficient and well-adjusted:  ○ Help society realize the benefits and manage potential risks associated with an aging population. What is Retirement? Conceptualization Corresponding Theories Research Examples Retirement as decision Rational choice theory, Image Hatcher (2003), Feldman making theory, Role theory, Theory of (1994), Talaga and Beehr planned behavior, Expectancy (1995), Cron, Jackofsky, and theory Slocum (1993), Kim (2003) Retirement as an Life course perspective, Wang (2007), Kim and adjustment process Continuity theory, Role theory Feldman (2000), Adams, Prescher, Beehr, & Lepisto (2002) Retirement as a career Protean career model, Retiree Freund and Baltes (1998), development stage career development model Shultz and Wang (2008) Retirement as part of General system theory, Social Birati and Tziner (1995), human resource context theory Greller and Stroh (2003) management Role Theory Retirement constitutes a role transition: ○ The individual may exit their role as a worker, organizational member, or career role, and reinvest time and energy into family and community roles. Adjustment may result from three dimensions: ○ Clarity of role identity: How clear an individual’s role is after retirement. ○ Role investment: The degree to which a person invests in their new roles. ○ Role demands: The expectations and responsibilities of these new roles. Role Theory and Active Aging Services  Value: Social values are based on role cognition—how individuals perceive their roles in society. Behavior: Social actions are influenced by role expectations—what society expects from individuals in specific roles. Environment: The social environment is aimed at fulfilling roles—supporting individuals in achieving their roles. Active Aging Services: These services integrate values, behaviors, and the environment to support role fulfillment in older adults. Life Course Perspective Focus: Examines the past, present, and interlinked contexts that influence an individual's retirement. 1. Society/country: The larger societal and national policies that affect aging and retirement. 2. Community/organization: The role of the community and organizations in shaping experiences of aging. 3. Family: Family dynamics and support systems that contribute to aging and retirement experiences. 4. The individual: Personal choices and circumstances that affect the course of one's life into retirement. Continuity Theory Core Idea: The theory suggests that older adults adapt by replicating preferences, relationships, and behaviors from their earlier life stages into post-retirement. Transition Ease: A smooth transition into retirement can be achieved if individuals are able to maintain their pre-retirement preferences, social relationships, and lifestyle patterns. Explanation: Older adults engage in activities and maintain relationships similar to those they had earlier in life to provide continuity in their behavior and lifestyle. Examples: A person with anger issues may continue to have similar reactions as they age, possibly exacerbated by life events like loss. A man who enjoyed reading throughout his life will likely continue this hobby as he grows older. Resource Perspective  Core Idea: Resources represent an individual’s capacity to meet their essential needs, such as physical, cognitive, motivational, financial, social, and emotional (Wang and Shi, 2014). Well-being: Changes in resources after retirement can predict well-being. An individual’s well-being will depend on whether their resources are improving, depleting, or remaining stable during retirement (Wang and Shi, 2014). Retirement Outcomes: This perspective is helpful in explaining multiple patterns of well-being changes after retirement. It can offer a broader explanation compared to life course, continuity, or role theories, which each account for only specific outcomes (Wang and Shi, 2014). Guest lecture (Paradigm shift on older workers and the role of Centre for Seniors) Lifespan Increase (1965–2024) Life expectancy has increased by 17 years, from 65 to over 82 years. This prompts important questions: ○ How do we resource and manage the extended lifespan? ○ What are the societal, workplace, and personal implications? These areas need to adapt to the demands of a population living longer. The focus may include financial sustainability, health care, work adjustments, and lifestyle changes. Demographic Overview Of Singapore 45 years+ population: 1.8 million, accounting for more than 50% of the population. Education: Higher educational attainment for men than women. PMEs (Professionals, Managers, Executives): ○ 17% male, 13% female (over 500,000 individuals). Non-PMEs: ○ Over 1.2 million: 39% female, 31% male. ○ A significant portion of individuals over 55 years: 45% female, 36% male. Demographic Overview: 2030 Prediction for PMEs vs Non-PMEs Age groups and distribution: ○ 35 years and above: 61% PMEs, 38% Non-PMEs. ○ 40 years and above: 58% PMEs, 42% Non-PMEs. ○ 45 years and above: 53% PMEs, 47% Non-PMEs. ○ 50 years and above: 47% PMEs, 53% Non-PMEs. ○ 55 years and above: 40% PMEs, 60% Non-PMEs. ○ 60 years and above: 33% PMEs, 66% Non-PMEs. ○ 65 years and above: 27% PMEs, 72% Non-PMEs. The data suggests that as the population ages, there will be a larger percentage of non-PMEs (especially those aged 50 years and above) compared to PMEs, particularly by 2030. This trend may have implications for workforce planning and policies. Reasons to Preserve Employability Society: Minimize socioeconomic repercussions and conserve resources. Employer: Mitigate the effects of declining new workforce entrants by leveraging the experience and expertise of older workers. Individual: Maintain social connectivity, cognitive preservation, eudaimonic wellness (a sense of purpose and well-being), and ensure financial security. Challenge What is Ageism? Bias: Prejudices and preconceptions based on age. Discrimination: Unfair treatment of individuals due to their age. Stereotype: Oversimplified and generalized beliefs about older adults. Impact on How We Treat Others: Cognitive: How we think about others. Feel: Our emotional responses towards others based on their age. Behave: How we act or treat people based on their age. Impact on How We Treat Ourselves: Ageism can also affect self-perception and self-treatment, contributing to negative feelings about one's own aging process. Ageism affects both how we perceive and interact with others and ourselves, leading to societal and internalized negative outcomes. Antecedents for Successfully Aging at Work Self Perception of Aging: Influenced by: ○ Personal Antecedents: Age identity, health status, mastery, optimism, self-efficacy, work meaning, and stereotypes. ○ Contextual Antecedents: Daily stressors, job demands, priority conflicts, and age discrimination. Core Self-evaluations: Includes self-esteem, emotional stability, and generalized self-efficacy. Occupational Future Time Perspective (FTP): Shaped by:  ○ Personal Antecedents: Career goals, learning orientation, learning experiences, work centrality, and self-efficacy. ○ Contextual Antecedents: Job control, job complexities, organizational support for aging. Workplace Learning: Supported by organizational structures, learning goals, psychological capital, and self-efficacy. Job Crafting: Involves adjusting job autonomy, job challenge, work significance, workload, and supervisor relationship. Successful Aging at Work: Achieved through: ○ Psychological capital ○ Self-efficacy ○ Positive personality traits ○ Supportive leadership and work environment. Key Outcomes: Competency diversity, job satisfaction, work engagement, problem-solving resilience, task performance, occupational self-efficacy, health, and perception of age discrimination. Mindset on Hiring Likelihood of hiring mature workers: ○ 73% say "Yes." Likelihood of hiring older workers: ○ 52% say "Yes." Breakdown by Management Level: ○ C-Suite: 58% ○ Hiring Manager: 51% ○ HR Manager: 48% (Source: Nielsen study commissioned by Tsao Foundation, July-Aug 2023) 1. Mature Worker: This generally refers to workers who have been in the workforce for a significant amount of time and are experienced, regardless of age. It emphasizes experience, reliability, and professionalism rather than age alone. The focus is more on their level of expertise and maturity in handling work responsibilities, decision-making, and interpersonal relationships. 2. Older Worker: This term specifically refers to employees who are of an older age, typically 50 years and above, as defined in many employment contexts. The focus here is on age rather than experience, though older workers may also be mature workers. The term can carry connotations related to the aging process, such as concerns about retirement, health issues, or adaptability to new technologies. In summary, mature worker highlights experience and professional maturity, while older worker is more about age and may include societal or organizational concerns related to aging in the workforce. The likelihood of hiring from the slide highlights how having older or mature workers already in the team or organization increases the likelihood of hiring more older or mature workers. 65% likelihood of hiring older workers in organizations that already have older workers in their team. 53% likelihood of hiring mature workers (aged 45-54) when such workers are already part of the team. 22% likelihood of hiring older workers in teams or organizations where there are currently no older workers. Overall likelihood of hiring across all respondents is 52%. This data suggests that the presence of older or mature workers in a team positively influences employers' openness to hiring more workers in those age groups, possibly due to increased familiarity with their work ethic, reliability, and experience. Conversely, organizations without older workers are less inclined to hire them. Mindset Change Active life increase from 35 to 50 years Till 1997: Life was divided into three distinct phases: 1. Education (Birth – 24 years) 2. Career (25 – 59 years) 3. Retirement (60 – 77 years) From 1998 onwards: Active life phases extended and became more segmented: 1. Education (Birth – 24 years) 2. 1st Career (25 – 62 years) - Prime work years 3. 2nd Career (63 – 67 years) - Re-employment or step-down from full-time positions 4. 3rd Career (68 – 74 years) - Flexi or voluntary work engagements 5. Retirement (75 – 85 years) This shift reflects an increase in active life from 35 years to around 50 years, emphasizing prolonged careers and the possibility of multiple career phases, along with more flexible or voluntary work in later years before retirement. Three stages of career Birth – 24 years (Education): ○ Concerns: Study, good job, relationships. ○ Options: Focus on education. 25 – 55 years (Prime):  ○ Concerns: Coping with changes, balancing family and work, ensuring financial security. ○ Options: Job role changes, department shifts, mid-career switches, and employer changes. 56 – 62 years (Re-employment or Step-down): ○ Concerns: Exploring work options, retirement planning. ○ Options: Mid-career switches, stepping down in job responsibility, self-employment. 68 – 74 years (Flexi or Voluntary): ○ Concerns: Health and financial security. ○ Options: Contract work, part-time roles, gig economy, and volunteering. 75 – 85 years (Retirement): ○ Concerns: Ageing with confidence. ○ Options: Retirement phase, transitioning fully out of the workforce. This framework highlights the evolving career phases and concerns that individuals face as they age, along with the flexible career options available during each stage. Mindshift change at work 1. Work Longer: With increasing life expectancy and changes in retirement age, people are expected to stay in the workforce longer. 2. Multi-generational Organisation: Workplaces now consist of multiple generations, which can bring a range of experiences, perspectives, and expectations. 3. Supervisors and Managers Younger Than Us: As older employees continue working, it’s possible that they will be managed by younger supervisors, which may require adaptation in expectations and working relationships. 4. Team with Diverse Cultures and Beliefs: Globalisation and multicultural teams have become more common, requiring flexibility and open-mindedness when working with individuals from diverse backgrounds and belief systems. Skills demand for the future Thinking Critically: Creative Thinking: Generating innovative ideas. Decision Making: Making sound judgments and decisions. Sense Making: Understanding complex information to create meaning. Transdisciplinary Thinking: Integrating knowledge from different disciplines. Problem Solving: Addressing complex issues efficiently. Interacting with Others: Collaboration: Working effectively with others. Communication: Clearly conveying information. Customer Orientation: Focusing on customer satisfaction.  Developing People: Supporting others' growth and development. Building Inclusivity: Encouraging diverse perspectives and participation. Influence: Persuading and motivating others. Staying Relevant: Adaptability: Adjusting to new conditions and challenges. Digital Fluency: Navigating digital tools and platforms with ease. Learning Agility: Quickly learning new skills and knowledge. Self Management: Managing one's own work and time effectively. Global Perspective: Understanding global trends and perspectives. The Centre for Seniors (CFS) was founded in July 2006 as a non-profit, social service agency with charitable status. Its mission is to help seniors remain meaningfully engaged in both work and life, providing support for purposeful living as they age. The Vision of the Centre for Seniors (CFS) is to promote the well-being of older persons in Singapore, focusing on their vocational, financial, and psycho-social health. Their Mission is to encourage seniors to stay gainfully employed for as long as possible and to remain actively engaged in the community, fostering an active ageing mindset. Their Focus includes: 1. Employment Facilitation – Partnering with employers to place seniors in meaningful jobs. 2. Training – Equipping seniors with job-relevant skills to support active ageing. 3. Empowering mature workers by ensuring fair pay. 4. Enabling organizations by building a pool of skilled