Life Span Midterm Exam Notes Study Guide PDF

Life Span Midterm Exam Notes Study Guide q q q q q q q q q q q q q q q q q q q q q q q q q q q q The Life-Span Perspective Characteristics of the Older Adult Population The Forces of Development Interrelations Among the Forces: Developmental Influences The Meaning of Age Measurement in Adult Development and Aging Research General Designs for Research Metabolic Theories Cellular Theories Genetic Programming Theories Implications of the Developmental Forces Changes in Skin, Hair, Voice, Body Build, Mobility Vision and Hearing Somatosensory System Taste and Smell Cardiovascular System Respiratory System Biological Female and Male Reproductive System Central Nervous System Autonomic Nervous System Genetic and Environmental Factors in Average Longevity Defining Health and Illness Chronic and Acute Diseases Common Chronic Conditions: Diabetes, Cancer, and Incontinence Patterns of Medication Use Developmental Changes in How Medications Work Medication Side Effects and Interactions Determining Functional Health Status q A Multidimensional Life-Span Approach to Psychopathology q Race, Ethnicity, Gender, Aging, and Mental Health q Areas of Multidimensional Assessment q Factors Influencing Assessment q Assessment Methods q Developmental Issues in Interventions q Depression Disorders q Anxiety Disorders q Delirium q Alzheimer’s Disease/Dementia q Describing Person-Environment Interactions q Competence and Environmental Press q The Congruence Model q Resilience and the Stress and Coping Framework q The Loss-Continuum Concept q Types of Long-Term Care Facilities q Characteristics of a Nursing Home q Can a Nursing Home be a Home q Communicating with Residents q Age-Related Changes in Neurons q Age-Related Changes in Neurotransmitters q Linking Structural Changes with Behavior q Theories and Models of Brain-Behavior Changes Across Adulthood q Information Processing Model q Attention: The Basics q Speed of Processing q Processing Resources q Automatic and Effortful Processing The Life Span Perspective This Photo by Unknown Author is licensed under CC BY-SA LSP helps place adult development and aging into the context of the WHOLE human experience ACROSS LIFE. v Development takes a lifetime to complete! It doesn’t stop! No one part of development is more or less important than others. LSP divides human development into two phases: 1. Early (childhood and adolescence) - rapid growth 2. Later (young adulthood, middle age, and old age) - longest phase - both growth and decline The Life Span Perspective (cont.) Paul Baltes (1987) identified FOUR key features of the LSP: 1. Multidirectionality 1. Multidirectionality 2. Multiple Causation Involves both GROWTH AND DECLINE 2. Multiple causation Development is a product of MULTIPLE CAUSES (biological, psychological, sociocultural, and lifecycle forces) 3. Plasticity CAPACITY TO IMPROVE, even in later life, to a certain degree 4. Historical context TIME AND PLACE we grew up in helps shape us 3. Plasticity 4. Historical Context Development: Age-related change in adaptive capacity Adaptive capacity: The ability of an individual to make positive change in response to adversity. Thus, individuals develop according to their capacity to adapt to adversity. With age, more “energy” is needed to maintain function and deal with age-related losses, leaving less “energy” for continued growth. Thus, according to Baltes, to adapt with age, one needs to selectively optimize and compensate: a) Select specific goals that are appropriate for the individual and situation b) Optimize available effective resources to meet goals c) Compensate in response to lost resources needed to meet goals Characteristics of older adult population Fastest Growing section of USA ****Challenges: health care (physical, mental, emotional), economic, social policy, occupational The number of older adults is increasing in all ethnic groups globally. Among older adults, ethnic groups in the United States are increasing faster than European Americans. vThere are more older women than older men in all ethnic groups in the United States and in many countries around the world. v The educational levels of older adults will continue to improve and allow them more opportunities. (1/3 at least bachelors degree) vWide age range (65-74/ 75-84 /and 85+) vWide range of Functioning and Ability The forces of Development Forces of development can help explain differences and similarities in individual development. These combined forces help shape and guide development. 1. Biological forces Genetic and health-related factors that affect the development 2. Psychological forces: Thoughts, feelings, perceptions, personality that affect development 3. Sociocultural forces: Interpersonal, societal, cultural, and ethnic factors that affect development 4. Life-cycle forces Differences in how forces affect people at different points in life Ex: widowed at 85 vs. 22 having first child at 52 vs. 22 Inter-relations among the forces: Development influences Based on interactions among these 4 forces, Baltes identified 3 influences that interact to produce developmental change over the lifespan. Developmental influences can describe how common or unique an experience is. 3 Developmental Influences: 1. Normative age-graded influences 2. Normative history-graded influences 3. Nonnormative influences 3 developmental influences interact to produce developmental change over the lifespan Normative age-graded influences – Occur as part of the aging process itself – Most people will experience these with age, no matter when they grew up – Commonly occurs to all who age – Examples: puberty, wrinkles, menopause, feeling “older” than younger individuals. Graduation from school, marriage, retirement, Normative history-graded influences – Events that most people in a specific culture experienced at a particular time because of when they grew up – Often give people and others in their generation an identity. – Common experiences that help shape most people in a culture at that time. – Examples: AIDS, polio, certain attitudes/stereotypes of a particular time: Great Depression, Vietnam War, 9/11, internet, Nonnormative influences – Rare or random events that may be important for that individual, but not experienced by most people at that age or in that generation – Unique events, not shared by most others their age or in their generation – Examples: Winning lottery, car accident, losing parents at age 18, death of a child, retirement at age 30 The meaning of age The Meaning of Age: Ageing is NOT a single process. 3 distinct aging processes: 1. Primary aging – Normal, disease-free development over life span – Inevitable part of development 2. Secondary aging – Changes related to disease, lifestyle, and other environmental agents – Not inevitable part of development 3. Tertiary aging – Rapid changes occurring shortly before death How old are you??? Many Definitions of Age: Chronological age – Index variable for how long we have lived Allows one to represent events in standard calendar time Perceived age – The age you think of yourself as Biological age – Where one is relative to the maximum number of years they could live – Simply put, changes in the body that commonly occur with age (cg. Beers, et al., 2004) Assessed by measuring the functioning of organ systems Psychological age – Functional level of psychological abilities used to adapt to changing environmental demands For example, memory, intelligence, and motivation Sociocultural age – The set of roles an individual adopts relative to other members of the society and culture to which they belong Based on customs, language, style of dress, etc. New Proposed Stages of Adulthood – Emerging Adulthood When individuals are not adolescents but not yet fully adults – Established adulthood The period between ages 30 and 45 when life is intense, demanding, and rewarding. A KEY ISSUE in adult development and aging: – HOW DO WE STUDY IT???? – It is essential to understand methods of research design in this area Many challenges Specific designs address specific questions Need to understand how conclusions are limited Controversies in Development Nature-Nurture – Genetic inheritance or environmental influences? Traditionally believed adult development and aging a function of nature, now believed to be due to both nature and nurture. Stability-Change – Do we change as adults over time or not? Depends on what you are measuring and how you are measuring it. Continuity-Discontinuity – If change occurs over adult development, is it a smooth evolution over time or abrupt shifts? Depends on characteristic Plasticity: capacity is not fixed but can be learned or improved with practice. Universal versus Context-Specific – Is there one pathway of development or several pathways? If one pathway, then one basic developmental process for everyone If context specific, development is a product of complex interactions with specific environmental influences. – Course will emphasize understanding context-specific influences on development, noting both similarities and differences among individuals. Measurement in Adult Development and aging research Types of data gathered: 1. Systematic observation (relatively rare in adult development research) – Naturalistic – Structured 2. Sampling behavior with tasks (e.g. give them a task and see how they perform) 3. Self-reports (most commonly used with adults) ********************************************************************** Representative sampling is important! – However, in aging research, many studies use Small samples Mostly White, well-educated, middle-class US adults, often men General Designs for Research 1. Experimental design – Try to determine cause and effect – Independent variables – Dependent variables 2. Correlational design: Much developmental research is correlational since some variables of interest (age) cannot be manipulated. – Look at the relationship between 2 variables – Pearson’s r = -1 to +1 – Cause and effect cannot be determined – Third variable effect – Thus, it may be used to describe a developmental phenomenon but may not be able to explain why it is happening. 3. Case studies – Single individual – Good for new or rare areas, but limited generalizability Research Methods Studying Development : 3 “Building Block” Variables to Consider When Studying Development 1. Age effects – Reflect differences caused by age-related changes 2. Cohort effects: – Changes caused by different experiences and circumstances of a particular generation or group to which a person belongs. – For example, earlier cohorts (ie. older individuals) may have less education, less demanding curricula, less professional occupations, and more chronic health issues than those in later cohorts (ie. younger individuals) (Schaie, 2011) 3.Time of measurement effects – Differences due to sociocultural , environmental or historical events during the time when one is gathering data *****One of the challenges in studying adult development is identifying and separating these 3 effects – NOT EASY since age, cohort, and time of measurement are often confounded with one another General designs for research Study Designs Cross-sectional designs Longitudinal designs – One type is a microgenetic study Sequential designs Cross-Sectional Designs Compares various age groups at a single point in time Example: Compare 20 year olds, 30 year olds, 40 year olds, 50 year olds, on Digit Span scores Answers the question of if differences are present between age groups on the dependent measure – Easy and cheap to conduct, but….Some problems…. Doesn’t tell us about how changes over time, since data gathered at only one time point Confounds age and cohort effects – Are differences between age groups due to aging or cohort effects? – May lead us to believe there are greater differences between age groups than there really are. Longitudinal Designs Examines age changes in a single cohort of people over two or more times – The same people are tested repeatedly over time. Short-term longitudinal studies of development becoming more common, but only a few very long-term longitudinal studies. Can be expensive and labor intensive to conduct – Example: Compare ratings of feelings towards Vietnam war when individuals are age 40, then when they are age 50, when they are age 60, and again when they are age 70 Answers the question of if changes occur in individuals at different ages on a dependent measure (cf. Bee & Bjorklund, 2004) – Allows us to look at change in same individuals, since data gathered at multiple time points Can look at change in the group of individuals over time, in each individual (intra-individual) over time, and how different individuals differ from each other in change over time (see Ferrer & Ghisletta, 2011). – Cohort effect is no longer a confound, since follow same cohort over time Longitudinal Designs – Problems: Confounds age and time of measurement effects – Is change in individuals due to aging or to what was occurring at the time when measurement was conducted? Vulnerable to practice effects – Are changes over time simply to due same measures being completed repeatedly? Vulnerable to attrition (ie. subject drop-out over time) – If attrition is selective (i.e. not random), this can bias results (e.g. only healthiest stay in study over time) (see Ferrer & Ghisletta, 2011). – May lead us to believe there are less changes that occur with aging than there really are. Results may not generalize to other cohorts. Research Methods One type of longitudinal design is a Microgenetic study. – Involves taking many repeated measurements of the individual over a typically brief period of time (e.g., days or weeks), as they experience change in the domain of interest (cognitive, physical, etc.) – examines change as it occurs, thus attempting to identify and explain underlying mechanisms. – Three critical principlesof a Microgenetic study 1. Observations must span a known period of change (typically brief, such as days or weeks) 2.The density of observations must be high in comparison to change (e.g., many data points collected in short time). 3. Observations are analyzed intensively to establish the process that gave rise to them. Sequential Design Sequential designs provide the richest information about adult development and aging, – Disentangles age, cohort, and time-of-measurement effects – Not often done because of time and expense They combine elements of both cross-sectional and longitudinal designs Perform cross-sectional design, then do so again at a different time point Perform longitudinal design, then do so again with a different cohort Most complex: do a cross-sectional study, then follow these same people longitudinally over many years. Week 2 Metabolic Theories Rate-of-Living Theories – Assume that people are born with a limited amount of potential that can be expended at some rate One variation is that certain metabolic processes may be related to living longer Another variation that may partially impact aging is the body’s declining ability to adapt to stress Cellular Theories Cellular Theories – Hayflick limit Suggests that there might be limits on how often cells divide before dying Tips of chromosomes (telomeres) become shorter with each replication until can’t replicate anymore – Cross-linking Results from proteins interacting and randomly producing molecules that make the tissue more stiff – Free-radicals – Highly reactive chemicals produced randomly during normal cellular metabolism resulting in cellular damage – Formed when oxygen combines with other molecules Antioxidants (e.g. vitamin A, C, E, etc.) – Help prevent oxygen from combining with molecules to form free radicals – They have been shown to postpone the appearance of some age related disease (dz) (cancer and cardiovascular dz), but don’t increase life span Genetic Programming Theories Programmed Cell Death Theories Programmed Cell Death – The innate ability of cells to self-destruct, and the ability of dying cells to trigger processes in other cells Thought to be due to a genetic program that is triggered by physiological processes Need to further understand how this process works Implication of the Developmental Froces Implications of the Developmental Forces Need to understand how the biological, psychological, sociocultural, and lifecycle forces interact dynamically to explain individual differences in aging No single theory fully explains all the changes of aging. Unified theory not yet developed to explain all the changes that occur in aging and individual variability in aging New research is promising Changes in Skin, Hair, Voice, Body Build, Mobility Changes in Skin Wrinkles are the result of a four step process First, the outer layer of skin becomes thinner and more fragile Second, collagen fibers lose their flexibility making the skin less able to regain its shape after being stretched or pinched Third, elastin fibers lose their ability to keep the skin stretched out Fourth, the underlying layer of fat which makes the skin look smooth diminishes ***A major cause of wrinkles = sun exposure Skin overall becomes more susceptible to cuts, bruises, and blisters. Other skin changes Pigment-containing cells decrease, thus less protection against sun Age spots, moles Varicose veins Changes in Hair – Thinning and gray hair Hair loss is caused by the destruction of the germ centers that produce hair follicles Graying hair results from the cessation of pigmentation – Other hair changes Get increased hair growth other places—particularly in females Changes in the Voice – Older adults’ voices tend to be thinner and weaker including Slower Less precise pronunciation A decrease in volume An increase in breathlessness and trembling Unclear whether these are normative age-related changes or due to poor health. Changes in Body Build – Decreases in height Result from the compression of the spine, changes in the discs between vertebrae, and changes in the spine Between the mid-50s and mid-70s men lose about 1 inch and women about 2 inches – Weight= Increase then decrease Increase in weight in midlife (between 20s and mid-50s) Followed by weight loss in late life – Weight increases are due to a slowing of metabolism and reductions in levels of exercise – Weight loss is due to a reduction in muscle and bone, and some loss of fat Changes in Mobility Changes in Muscle – The amount of muscle decreases with age (begins in 30’s), but strength and endurance only change slightly until age 70 – Strength loss: by age 70, may have lost 20% of strength. By age 80, up to 40% of strength has been lost. Changes in Bone Mass Bone mass loss begins in the late 30s, with anacceleration in the 50s, and slows in 70’s – Bones become more hollow and porous Women lose bone mass twice as fast as men Increases the likelihood of clean fractures, which take longer to heal OSTEOPOROSIS is a bone degeneration disease in which bones become brittle and honeycombed – Most often found in fair-skinned, European-American women who are thin and small framed. Because women lose bone mass twice as fast as men, they have an increased risk for osteoporosis – 20 million women in the United States have osteoporosis, with most women over 65 affected (65%) ******It is the leading cause of broken bones in older women JOINTS – Beginning in the 20s, cartilage in joints show signs of deterioration which leads to aching joints Osteoarthritis results from degeneration of cartilage – It is marked by the gradual onset and progression of pain with minor signs of inflammation – This is a wear-and-tear disease with pain being worse when the joint is being used Hands, knees, hips, and spine are most affected – Treatment includes anti-inflammatory drugs, rest,range of motion exercises, diet, and a variety of homeopathic remedies Psychological Implications Because of societal stereotypes, many women and men use aids such as cosmetics, hair dye, and plastic surgery to compensate for appearance changes Further, many of the mobility changes make people feel as if they are not able to adapt and function in the environment – can be embarrassing or stressful – Especially arthritis which can limit movement, impair daily activities, and reduce independence These changes may cause older adults to withdraw from society and activities which would keep them healthier (i.e., exercise) Adaptive behaviors – Exercise and resistance training to improve muscle strength is useful up to age 90 – Some types of exercise program may help reduce some joint pain – Rehabilitation after hip fractures Vision and Hearing Vision Age-related changes in the structure of the eye (begin in 40’s) – Decrease in the amount of light that passes through the eye So increased illumination is often required – Increased susceptibility to glare Increasing illumination does not always work because of this – Adaptation to change in illumination takes longer This leads to slower light and dark adaptation More time needed to adjust to light and dark changes – Yellowing of the lens Causing poorer color discrimination – Presbyopia: difficulty seeing nearby objects Due to stiffening of the lens which makes it harder to adjust and focus Glasses often needed to read – More time is needed to adjust our focus from near to far objects and vice Versa – Decreased contrast sensitivity Vision Disease can cause abnormal structural changes in the eye – Cataracts Opaque spots on the lens limit amount of light transmitted Treated by removing cataracts – Glaucoma Build up of pressure on the eye due to fluid not draining correctly which can lead to internal damage and to vision loss Treated with eye drops Vision Changes in the retina of the eye, which holds specialized receptor cells in vision (rods and cones), begin in 50’s Some retinal diseases – Macular degeneration Involves the progressive and irreversible destruction of receptors in the macula, a region of the retina which contains dense amounts of rods and cones – Results in the inability to see details Roughly 1 in 5 people over 75 have macular degeneration, making it the leading cause of functional blindness in older adults Especially at risk are smokers and European American women – Diabetic retinopathy A by-product of diabetes that can involve fluid retention in the macula, detachment of the retina, hemorrhage, and aneurysms Most common among people who have had diabetes since they were younger Vision As a result of the changes in the eye there is a decrease in acuity, or the ability to see detail and discriminate different visual patterns – There is a steady decline in acuity between the ages of 20 and 60 – Corrective environmental changes Brighter lights Larger type Psychological Effects of Visual Changes Decrease glare Reading Allow longer times for adjusting to changes in TV watching Grocery labels-cooking instructions Driving a car Walking without falling illumination Allow longer times for focusing when looking at near vs. far and vice versa Corrective actions High contrast in color between target of interest and – Glasses (Presbyopia) background – Surgery (cataracts) Hearing Presbycusis – Normative declines in the ability to hear high-pitched tones are universal – Cumulative effects of noise are an important cause of high- pitched hearing loss across the lifespan Hearing loss begins to accelerate during the 40s and by the late 70s about 50% of people suffer from presbycusis – More men than women suffer from presbycusis Social adjustment to hearing loss – Loss of independence, social isolation – May be seen as having more cognitive problems – Irritation, paranoia, depression Corrective action Somatosensory Sytem Somesthesia Loss of Touch on certain parts – With age it takes more pressure to feel touch on smooth,nonhairy skin, such as the fingertips Temperature – Older adults report having more trouble regulating body temperature to comfortable levels Pain sensitivity – Older adults report more pain, however it is unclear if they experience more pain sensitivity Balance The vestibular system is responsible for maintaining our balance and initiating movements Dizziness and vertigo are common in older adults and increases with age, as do falls Dizziness is the feeling of being unsteady, floating, and lightheaded Vertigo is the feeling that one or one’s surroundings are spinning 1/3rd of adults over 65 fall Environmental hazards – Loose rugs – Slippery floors – Others Adaptive means – Learn to attend to position of lower body limbs and adjust posture during dizziness/vertigo – Tai Chi to improve balance – Wii Fit virtual reality simulations Taste and Smell Taste and Smell Taste – Age-related changes in taste are minimal – Greater loss in sour and bitter tasks – However, many older adults complain of bland food , likely due to changes in smell – Risk of malnutrition Smell – The ability to detect odors begins to decline after the age 60 in most people – These changes may reduce the pleasure derived from food and lower the quality of the diet – Loss of smell may also have life-threatening consequences, such as the inability to smell gas leaks Cardiovascular System Cardiovascular System Age-related changes in heart – fat accumulates in and around the heart as well as inside the arteries – the heart muscle is gradually replaced with stiffer connective tissue As a result the amount of blood pumped declines Stiffening of arterial walls – The most important change in the circulatory system due to calcification of arterial walls and less elastic fibers *****Can lead to a decline in coping with physical exertion – Older adults more at risk for heart attacks doing moderately exerting tasks – If attempt to stay in good shape throughout adulthood, you will have less decline in ability to cope with physical exertion Cardiovascular Disease – Cardiovascular disease is the ***leading cause of death in all ethnic groups in the US***** Prevalence increases with age – Types of Cardiovascular dz Congestive heart failure Angina pectoris Myocardial infarctions or heart attacks Atherosclerosis Hypertension Congestive heart failure – Occurs when the ability of the heart to contract severely declines along with cardiac output – This causes the heart to enlarge, pressure in the veins to increase, and the body to swell – The most common cause of hospitalization for people over the age of 65 Angina pectoris – Chest pain which occurs when the supply of oxygen to the heart becomes insufficient – In most cases chest pain is brought on by physical exertion and can be relieved by rest and/or nitroglycerine Myocardial infarctions or heart attacks – Are caused when blood supply to the heart is severely reduced or cut off – The initial symptoms are the same as angina but are more severe and prolonged – Silent heart attacks, those without chest pain, occur in as many as 25% of adults and are more frequent in older adults Atherosclerosis – A disease caused by the buildup of fat deposits on and the calcification of arterial walls – Fat deposit in the arteries interfere with blood flow Some build up is normal and develops through out the life span Poor nutrition and smoking can lead to excessive deposits Severe atherosclerosis can lead to oxygen to brain being cut off (cerebrovascular accidents (CVA’s) ) CVA’s – Increases with age – Risk factors: male, Afr. Am, HTN, Heart disease, or Diabetes – Tx: within 3 hours give tissue plasminogen activator (TPA) to dissolve clot Hypertension (HTN) – Severe increases in blood pressure – Increased risk of death and cognitive problems – Aggravated by stress and high salt diet Respiratory System Respiratory System With increasing age – The rib cage and air passageways become stiffer and make it harder to breath – There is a decrease in the maximum amount of air we can breathe into the lungs This decline begins in the 20s and by age 85 has decreased 40% – There is a lowered ability to exchange oxygen and carbon dioxide Results from the destruction of membranes of the air sacs in the lungs ***Changes in the respiratory system include shortness of breath -which may result in a reduction of activity in older adults Respiratory System Diseases Chronic obstructive pulmonary disease (COPD) – A family of diseases which includes emphysema and chronic bronchitis – Emphysema The most common age-related form of COPD Results from the destruction of membranes around the air sacs in the lungs which creates holes in the lung – Reducing the ability to exchange oxygen and carbon dioxide Further, bronchial tubes collapse preventing the lungs from emptying completely which leaves the blood poorly oxygenated Person struggles for air even with little exertion Most cases result from smoking (82%), but some cases are caused by genetics – Chronic bronchitis More prevalent in people over the age of 45, especially those exposed to high levels of dust and pollution Chronic bronchitis and asthma are increasing in prevalence Biological Female and Male Reproductive system Female Reproductive System Menopause and Climacteric – The transition from being able to have children to the cessation of ovulation (usually begins in 40’s and complete by mid-50’s) – This is accompanied by the end of menstruation and a reduction in estrogen and progesterone – A variety of physical and psychological symptoms occur These most frequently include hot flashes, night sweats, headaches, and mood changes Symptom expression can vary culturally Male Reproductive System Sperm production – Declines gradually with age – even at the age of 80 men are still half as fertile as they were at 25 Testosterone levels – Men also show a gradual decline in testosterone levels beginning the mid 20s Prostate gland – With increasing age the prostate gland enlarges, becomes stiffer, and may interfere with urination – Annual screenings are important for men over 50 years of age to prevent prostate CA Female Reproductive System Women’s genital organs change after menopause – Vaginal walls shrink – Vaginal size decreases – Vaginal lubrication is reduced and delayed – Shrinkage of external genitalia No physiological reason why most women cannot continue sexual activity into old age Male Reproductive System Physiological changes in men’s sexual performance include – A longer time and the need of more stimulation to achieve an erection and orgasm – A longer resolution time – The loss of erection during intercourse Impotence can be tx with drugs For healthy men and women, sexual activity is a lifelong option Stereotyping has important consequences Central Nervous System Central Nervous System Neurons – Individual brain cells Most changes in the brain occur at the level of individual brain cell – We are born with about 1 trillion neurons Dendrites – Where neurons receive chemical information from other neurons Cell body – The chemical signal is brought into the cell body and converted into an electrochemical Signal Axon – This electrochemical signal is sent down the axon Terminal buttons and neurotransmitters – At the terminal buttons, the signal is converted to chemicals called neurotransmitters Synapses – Chemicals are sent out into the gap between neurons to be picked up by a neighboring neuron’s dendrites Structural Changes in Neurons There are aspects of growth and loss of dendrites during the life span – As some neurons die others increase their number of dendrites Neurofibrillary tangles – When fibers of the axon become twisted to form spiral filaments Neuritic plaques – Occurs when dying neurons collect around a core of protein *****The above changes are normal, but in high numbers are associated with Alzheimer's disease Changes in Neurotransmitters Acetylcholine – As people age, acetylcholine levels decrease – Research has speculated that abnormally low levels of acetylcholine are related to Alzheimer’s disease Dopamine – As people age, dopamine levels decrease An extreme decline in the dopamine system, which controls motor movement, is related to Parkinson’s disease – Parkinson’s disease is characterized by tremors of the hands, arms, and legs Autonomic Nervous System Autonomic Nervous System Regulating body temperature – Older adults: Have decreased ability to tell that body temperature is low Have slower vasoconstrictor response to raise body temperature Do not sweat as much and Are less likely to drink water to cool themselves THUS older adults to have a harder time dealing with heat and cold which puts them at risk for: – Hypothermia – Hyperthermia Autonomic Nervous System Sleep and aging – It is more difficult to fall asleep and stay asleep for older adults It takes older adults longer to fall asleep They are awake more at night They are more easily awakened – They experience major shifts in their circadian rhythms Shift from a two-phase rhythm to a multiphase rhythm – Two-phase rhythm: awake during the day and asleep during the night – Multiphase rhythm: more like infants with daytime napping and shorter sleep cycles at night Autonomic Nervous System Other majors causes of sleep disturbances include – Sleep apnea Stopping breathing for 5 to 10 seconds – Leg jerks – Heartburn – Frequent need to urinate – Poor physical health – Depression To compensate for sleep disturbance older adults often – take daytime naps or – take sleep meds, which actually results in more disturbances Adaptive strategies: – Increase physical exercise – Reduce caffeine intake – Avoid day naps – Environment that promotes sleep Genetic and Environmental Factors in average longevity Interacting Genetic and Environmental Factors in Average Longevity Genetic Factors: – Being born into families who have lived long – A very strong predictor of your longevity Genes associated with blood fat levels, inflammation, and the cardiovascular and immune systems (USDHHS, NIH, 2020) can reduce health risks related to disease Environmental Factors: – Disease – Toxins (e.g., pollution) – Health behaviors/lifestyle (e.g., tobacco use, diet, exercise) – Socioeconomic status (e.g., poverty, access to care) Most environmental factors are the result of human activity and needlessly shorten lives Ethnic and Gender Differences Ethnic: – Members of different ethnic groups may face different environmental variables, leading to lower average longevity at birth than European-Americans Gender: – Women have nearly a 5-year edge over men Men are more vulnerable to disease than women. Men are risk-takers. Men smoke and use alcohol more than women. Men allow stress to enter their lives more than women. Anything else? Defining Health and Illness Defining Health and Illness – Health – A state of complete physical, mental, and social well-being, and not just the absence of disease or impairment. – Illness – Presence of a physical or mental disease or impairment. – Self-ratings of health are typically very predictive of future health outcomes Quality of Life – Relating to specific diseases or conditions To what extent does distress from illness or side effects associated with treatment reduce the person’s will to live? – Two domains: health-related and non-health-related. Valuation of life – degree to which one is attached to the present life. Qualitative. – Relating to end-of-life issues Functioning and well-being Alzheimer's (and related dementia) Chronic and Acute Stress Age-related stress: – Individuals across the lifespan have different sources of stress Older age groups: chronic illness, disability, loss Younger age groups: marriage/divorce, conceiving children, job stress Age-related coping: – Older adults typically: Attempt to avoid getting into stressful situations and reporting less stress in response to stressors Use prior experiences as a guide to cope Tend to use coping strategies that help them feel in control Use more emotion-focused coping Effects of Stress on Health – Short-term stress vs. long-term stress – Chronic Stress Immune system suppression Increases risk of atherosclerosis and hypertension Increases the level of LDL cholesterol Common Chronic Conditions: Diabetes, Cancer, and incontinence Chronic Conditions: – Conditions that develop slowly and worsen over an extended period of time (minimum of 3 months) – May be accompanied by residual functional impairment that necessitates long-term Management Acute Conditions: – Conditions that develop suddenly and last a short period of time (few days or weeks) – May cause rapid changes in health – Of note, older adults’ immune systems may not work as well: tend to be less able to combat new strains of bacteria and viruses so may be more prone to new infections, and take them longer to fight off dz, so illness can last longer and be more severe General Issues in Chronic Conditions Common Chronic Conditions: Arthritis Cardiovascular (heart) and cerebrovascular (stroke) disease Diabetes Mellitus Cancer – Risk increases with age – Males are at greater risk compared to females Incontinence: – Lack of voluntary control over urination – More embarrassing than dangerous – Four major reasons: stress, urge, overflow, and functional. Chronic Conditions and Their Management Managing Pain – Pharmacological Non-narcotic and narcotic medications – Non-pharmacological Therapeutic touch, massage, vibration, heat, cold Electrical stimulation to spine or pain site Acupuncture and acupressure Biofeedback Distraction techniques Relaxation, meditation, and imagery Hypnosis, self-induced or by another person Physical therapy Patterns of Medication Use Developmental changes in how medications work Medication Side Effects and interactions Polypharmacy: – The use of multiple medications by the same person On average, older adults take 6-7 medications per day Be aware of drug interactions and side effects Many different prescribers and complexity of drug regimen can make adherence difficult Drugs metabolized slower Drugs excreted slower – Older adults often need lower doses of drugs to obtain desired effects – When prescribing, physicians “start low and go slow” Determining Functional Health Status Determining Functional Health Status – Activities of daily living (ADL) = basic self-care activities Eating/drinking Walking Transfer from chair/bed Toileting Bathing Getting dressed – Instrumental activities of daily living (IADL) = daily activities that require more cognitive effort Telephone use Taking medications Managing finances Meal prep Shopping Housework Week 3 A Multidimensional Life-Span Approach to Psychopathology Each of the developmental forces needs to be taken into account when assessing mental health – Biological forces Health problems increase with age. – Some psychological problems can be occurring against the “backdrop” of physical health problems Physical problems may present as psychological, and vice versa – thyroid problem can lead to depressive symptoms – Vitamin deficiencies can lead to memory problems – Medications may lead to reduced appetite – Respiratory conditions can make one feel short of breath – Depression can reduce appetite – Anxiety can make one feel “short of breath” or “jumpy Psychological Forces Normative age changes can mimic certain mental disorders Normative changes can mask true psychopathology Sociocultural Forces and Life-Cycle Factors Social norms and cultural factors play a role in helping to define psychopathology We must ask if the behaviors we see are appropriate for a particular person or culture – Paranoia or healthy suspicion? – Look at cultural differences Life-Cycle factors – Examine behavior in “point-of-life” context – How a person behaves is influenced by one’s past experiences Race, Ethnicity, Gender, Aging, and Mental Health Ethnicity, Aging, and Mental Health There is very little research on ethnic differences in the definition of mental health and mental health problems in older adults Ethnic differences must be considered when assessing and treating older adults, particularly willingness to speak about self with clinicians. Complex picture in later life regarding ethnicity and mental health: AA older adults have lower rates of depression than other ethnic groups, though Latino older adults have higher rates Ageism – Defined by the APA as “prejudice toward, stereotyping of, and/or discrimination against any person or persons directly and solely as a function of their having attained a chronological age which the social group defines as old” – An endemic problem among older adults – Disproportionately affects older adults of color – Remains prominent among professionals – Affects older adults physically and psychologically Gordon Allport’s Social Categorization Theory – Older adults are regarded as the “out-group” – Older adults are often viewed as: a) all alike b) alone and lonely, c) sick, frail and dependent, d) depressed, e) rigid and f) unable to cope Areas of Multidimensional Assessment Areas of Multidimensional Assessment Assessment – The formal process of measuring, understanding, and predicting behavior – Accurate assessment depends on measuring functioning across a spectrum of areas Multidimensional assessments assess: – physical health, – cognitive functioning, – psychological functioning, – daily living, and – social factors How? – Interviews with patient and informants, observation, tests, and clinical examinations, info from past records Factors Influencing Assessment Negative and positive biases can influence accuracy of assessment – Ageism among care providers can lead to false stereotypes. E.g. – Most older adults suffer from dementia: FALSE – Older adults can not change so they are not good candidates for psychotherapy: FALSE – Depression is part of normal aging so shouldn’t be treated: FALSE – Older adults don’t have problems with ETOH: FALSE Environmental conditions may also influence the accuracy of an assessment Must consider how comorbid physical conditions and medications can affect assessment Must be sensitive to patient’s feelings about mental health, especially among older adults. – Mental health stigma – Not as likely to contact a mental health care provider on own – May feel mental health problems are a “normal” part of aging Specialized training in mental health issues among older adults important among professionals. ALL THESE FACTORS CAN LEAD TO UNDERRECOGNITION AND TREATMENT OF MENTAL HEALTH PROBLEMS IN OLDER ADULTS Assessment Methods Assessment Methods Cognitive, psychological, and social assessment: – Self-report – Report by others (e.g., family members) – Psychophysiological assessment (e.g., electroencephalogram) – Direct observation – Performance-based assessment (e.g., mental status exam) Developmental Issues in Interventions Developmental issues in Therapy – Need to consider how physical health conditions (and their medical treatments) could be related to presenting problem – When treating mental health with medication, consider… Consider that ways medication works at different ages How over-the-counter medications can interfere with prescription medications – When engaging in psychotherapy- adapt appropriately Be sensitive to developmental context (bio, psych, social/cohort and life cycle considerations), : – Hearing? medical conditions?, more directive/write down key points – Greater emotional access, better coping, transference/countertransference – longer time to establish rapport/orient to therapy/combat stigma Look at effectiveness for age-related needs Take a positive approach focused on recovery/promotion of successful aging/resilience Depression Disorders Depression – A very common and treatable mental disorder in adults, in general Affecting about 2 to 5% of the population DEPRESSION AND AGE: The SYMPTOMS of depression may be more prevalent in older adults….. ….. but the DIAGNOSIS of depression seems to be less prevalent in older adults (about 1% in community samples). Though this may be influenced by cohort effects Depression is under diagnosed and under treated in older adults! – Risk factors for depression in older adults: female, being widowed/unmarried, lacking social support, having a chronic illness, living in a nursing home, and being a caretaker for another SAD MOOD OR LOSS PLEASURE/INTEREST Lasts most of the day, nearly every day for at least 2 weeks: Plus, at least some additional sx: appetite or weight change sleep change psychomotor retardation or agitation loss of energy worthlessness or excessive guilt problems with concentration/indecisiveness recurrent thoughts of death or suicide Causes the person distress or impairment in functioning in some way. Age Differences in Clinical Presentation of Depression Older vs. Younger Adults Older adults LESS likely to report: – sad mood/”depression” – suicidal ideation Older adults MORE likely to: – Acknowledge somatic symptoms – Acknowledge lack of pleasure/interest – Withdraw socially – Engage in less self care Other things to keep in mind when assessing depression symptoms in older adults…. Somatic sx : disturbance in sleep, appetite, and energy level need to be evaluated particularly carefully in older adults. – Are these symptoms really caused by depression? – Are these symptoms caused by comorbid medical problems or medications/substances? – Are these symptoms due to normative age-related changes? Older adults less likely to express suicidal ideation Older adults more likely to use lethal methods, – especially guns Older adults make less attempts before succeeding Suicide and Age Older adults are the most likely age group to die from suicide. Older adult males have the highest suicide death rate, Suicide among older adults is a “critical public health concern” (Cui & Fike, 2020, p. 2) Assessment Scales Depression is diagnosed with the aid of assessment scales, interviews, and rating scales – Many assessment scales do not consider age differences in symptoms For example, Beck Depression Inventory (BDI) includes physical sx, along with others – Geriatric Depression Scale (GDS) A newer scale for depression that was designed for use with older populations The physical symptoms have been removed format is easier for older adults Exercise to compare 2 scales Potential Causes of Depression in Older Adults – Biological factors Genetics, changes in the brain, neurotransmitters – Psychosocial theories Psychological effects of loss are the most common basis for depression – Cognitive-Behavioral Theories Internal belief systems are affected by experiencing uncomfortable and uncontrollable events Treatment of Depression Effective Treatment Options: – Psychological Therapy: Work with mental health professional to understand and change patterns that contribute to depression. A major theme with aging patients is helping theme to cope with LOSS. Behavioral therapy and cognitive therapy often used – Drug Therapy Work to help increase the amount of certain chemicals in the brain. Selective serotonin reuptake inhibitors (SSRI’s), or other antidepressants are typically used – Electroconvulsive Therapy (ECT) Involves inducing a seizure that is believed to bring about same changes as antidepressants. For very severe or treatment refractory cases Anxiety Disorders Other Disorders Anxiety disorders involve excessive worry or intense fear that interferes with daily life. – Generalized Anxiety D/O – Panic Disorders – Phobias Some data indicate that anxiety disorders are one of the most frequent mental health concerns within older adults, – though it has traditionally not received as much attention as depression (Bee & Bjorklund, 2003). Other Disorders Anxiety Disorders – Anxiety can be difficult to dx in older adults Need to know: – medical background, – Meds (BOTH OTC AND PRESCRIBED) – Other substances//ETOH Context in which anxiety sx are occurring: – Are sx appropriate for circumstances? Anxiety Disorders – Drug Therapy SSRI’s (eg. sertraline)/ SNRI’s (eg. venlafaxine) drugs of choice in long-term. Fast-acting benzodiazepines should be used carefully with older adults (e.g. diazepam, lorazepam) – Psychological Therapy Cognitive Behavioral Therapy (CBT) : Learn skills to manage anxiety – Gradual exposure to situations that evoke anxiety until situation loses its effect – Identify, challenge, and replace dysfunctional catastrophic thoughts – Relaxation Training: Deep breathing and progressive muscle relaxation Delerium Delirium – Characterized by rapid onset of disturbances of consciousness and changes in cognition that fluctuates throughout the day – There are difficulties with attention PLUS a problem in either: – Memory (especially for recent events) – Orientation (time, place, person), – Perception (illusions, hallucinations, or delusions) – or language (e.g. incoherent or rambling speech) – These patients often also have: Disturbed sleep-wake cycle Can be combative Psychomotor disturbance DELIRIUM IS OFTEN MISSED CLINICALLY Delirium Can be caused by many things: – Medical conditions (e.g. pneumonia, UTI, infection, fever, heart attack, dehydration, HI, electrolyte imbalance) – Medication side effects – Substance intoxication or withdrawal (e.g. ETOH) – Stressful situations (post-op, ICU) – Sleep deprivation – Combination of above or others Usually due to a general medical condition in the body. – Even “minor” medical conditions can bring on delirium in older adults. Because older adults take more medications, they are more susceptible to delirium Delirium Important to accurately diagnose Involve Medical Personnel Immediately – It is essential to determine what might be causing the delirium and tx it. – Following prompt tx of underlying condition, sx should eventually resolve. – Elderly and those with preexisting dementia may be less likely to recover completely. Delirium: Management of Symptoms Provide support and information to family Simple, firm communication Clear verbal and physical reminders to orient patient Day, time, location Who the person talking is Clock, calendar, daily schedule on wall Familiar objects from patient’s home placed in room Open shades in room during daytime, close them at night If possible, allow family member/staff to stay with them Avoid extremes in environment for patient Minimize sensory problems for patient If needed, small doses of antipsychotics or benzodiazepines may be effective to manage sx while underlying cause being treated. Once sx are stable, – Schedule appointments so that patient can get maximal uninterrupted sleep – Maintain activity level during the day (e.g., walk 3 x a day) Alzheimer's Disease/Dementia Dementia Dementia is not a single disease; it is simply a term that describes a cluster of cognitive sx. Dementia involves a decline in memory and other mental functions leading to impairment in daily life. – Problems with mood, behavior, and/or psychosis may also accompany different types of dementia. Affects over 48 million people globally Dementia Good medical, neurological, neuropsychological, and psychological work-up ASAP is essential to determine cause of symptoms. – Many conditions can cause dementia symptoms, some which may be reversible – E.g. Severe depression can masquerade as dementia (pseudodementia) Medication side effects Thyroid or vitamin deficiency Dementia can be caused by a number of different things: – Examples: » Alzheimer’s disease (AD) » Stroke (CVA) » Head Injury » Thyroid Problems » Vitamin deficiency » Substances » Diseases » HIV » Vascular health issues » Huntington’s Disease » Lewy Body » Parkinson’s It can be either reversible or irreversible, depending on the cause. Dementia can occur at any age but increases in prevalence with age. – However, most older adults do NOT have dementia, but the incidence rates increase with age Because more people are living to older age, the number of individuals with dementia is also increasing Dementia of Alzheimer’s type (Alzheimer’s disease, AD) Most common cause of dementia – In 2023, affects 6.7 million individuals in US – Accounts for about 60-80% of all dementias, Of note, many may have changes due to other types of dementias in addition to AD (“mixed dementia”) Many other disorders, cognitive or mental, can present as AD. – AD is a dx of exclusion. You need to R/O all other possible etiologies first. – True definitive confirmation of dx possible only through examination of brain at autopsy. – Clinicians can currently dx AD with 85-90% accuracy Dementia of Alzheimer’s type (Alzheimer’s disease, AD) AD has a vague, gradual onset AD course a slow, gradually progressive decline Sx progress from mild to severe. Dementia of Alzheimer’s type (Alzheimer’s disease, AD) Symptom presentation and rate of decline varies greatly between individuals – Mild Stage: Short-term memory loss Misplacing things Difficulty remembering acquaintances. Word finding problems, Difficulties with complex tasks or in unfamiliar environments. Personality change or depression/anxiety – At disease progresses… Continued short-term memory loss, with eventual long-term memory loss too Difficulties recalling long term personal history Difficulty remembering familiar individuals More loss of language, More problems with complex tasks, need some assistance with activities of daily living Insight and judgment become markedly impaired May withdraw more Disruptive behaviors and psychotic sx MAY emerge – Very Severe Stage: Eventually Mute Can’t recognize self Bedridden Complete loss of self-care Incontinent Dementia of Alzheimer’s type Exact cause unknown – Likely combination of genetic and environmental factors Brain tissue degenerates in hippocampus and other parts of the brain. – Neuron loss – Increased rates of neurofibrillary tangles and amyloid plaques – Decreases in neurochemicals involved in memory, such as acetylcholine. Dementia of Alzheimer’s type Drug Interventions: – To slow down disease progression Cholinesterase inhibitors to prevent break down of acetylcholine in mild to moderate cases: – donepezil (Aricept) – rivastigmine (Exelon) – galantamine (Reminyl) Regulates glutamate to prevent cell death in moderate/severe cases – memantine (Namenda) used for moderate to severe More recently: immunotherapy to reduce amyloid plaques in mild cases – Lecanemab – To manage behavioral sx (agitation, disruptive behaviors, depression, psychosis), if needed Antipsychotics Antidepressants Sedatives Anxiolytics The Family of Dementias (cont.) Intervention strategies Caring for patients with dementia at home – Caregivers have significant problems, extremely stressful – “caregiving career” Psychosocial support for patient and family: – Individual and Family therapy – Caregiver support groups – Plan for future: driving, power of attorney, needs for future care/services, end of life issues, etc. Providing a supportive care environment and improving quality of life: – Keep environment safe, structured, and as familiar as possible – Safety proof house – Adequate lighting and visibility – Labels/cues/timers to remind – Daily routine that is predictable and not rushed – Stress-free, pleasurable activities that don’t frustrate person – Physical exercise during day can reduce agitation Effective behavioral strategies for AD – Arguing with patient is counterproductive – Orient patient when you will be assisting them Calmly approach from front, simply tell patient what you will do – Simplify complex tasks that may frustrate patient – Try to identify cause of problem behavior and remove it E.g. overstimulation – If problematic behavior occurs, distract and redirect – Successful techniques for addressing cognitive and behavioral problems include: Differential reinforcement of incompatible behavior (DRI): – Reward behavior that are appropriate and can not be done at the same time as problem behaviors. Spaced retrieval: – Practice learning and recalling information over progressively longer time intervals. Montessori methods: complete Montessori-based activities in an intergenerational format Respite care and adult daycare Week 4 Describing personEnvironment Interactions Describing Person-Environment Interactions Person-environment interaction Refers to the fact that behavior is a function of both the person and the environment (Lewin, 1936). B = f(P,E) B = Behavior P = Environment E = Person Describing Person-Environment Interactions Person-environment interaction More recent theorists have attempted to build upon Lewin’s original assertion in their models. ▪ ▪ ▪ ▪ ▪ Lawton & Nahemow (1973): Competence and Environmental Press Model Kahana (1982): Congruence Model Schooler (1982): Stress and Coping Theory Pastalan (1982): The Loss-Continuum Concept Many of these theorists also tend to emphasize the importance of the person's perception of the environment Personal choice Willis Model of Person-Environment Interactions Developed to incorporate all the key ideas from previous theories Four primary parts ▪ Antecedents Involves individual and sociocultural factors ▪ Components Involve intraindividual and contextual factors ▪ Mechanisms Factors that moderate the way in which competence is expressed ▪ Outcomes of everyday competence: Psychological and physical well-being Common Theoretical Themes All theories discussed agree that: the focus must be on interactions between the person and the environment ▪ No single environment will meet everyone’s needs!!! Ecology of Aging (environmental psychology) ▪ A field of study that seeks to understand the dynamic relations between older adults and the environments they inhabit ▪ Focuses on examining age-friendly communities Age-friendly Communities ▪ A community that encourages “active aging,” through optimizing opportunities for health, participation, and security. This allows enhanced quality of life as people age by adapting structures and services to be accessible to and inclusive of older people with varying needs and abilities. Competence and Environmental Press Competence and Environmental Press: Lawton & Nahemow Simply put.. ▪How well an individual functions is based on the fit between their competence and the environmental press. ▪ Competence is the upper limit on the capacity to function Involves five domains ▪ Biological health ▪ Sensory-perceptual functioning ▪ Motor skills ▪ Cognitive skills ▪ Ego strength (feel effectively cope with and tolerate challenges?) ▪ Environmental press reflects the demands the environment places on people This can be physical, interpersonal, or social This can be physical, interpersonal, or social In this model the level of adaptive functioning in an environment depends on: ▪ An individual’s particular level of competence at a particular level of environmental press ▪ Ideally, a person will have adaptive functioning if their level of individual competency fits with the demands of the environment. Many different combinations of competence and environmental press can lead to positive affect and adaptive behavior functioning. ▪ Maximum performance potential Leads to positive affect and adaptive behavior Aware of positive affect and adaptive behavior ▪ Adaptation levels Are points of balance between environmental press and level of competence. Leads to positive affect and adaptive behavior Less aware of positive affect and adaptive behavior. As stated previously, the level of adaptive functioning in an environment depends on the individual’s particular level of competence at a particular level of environmental press ▪ However, a person will have maladaptive functioning if their level of individual competency does not fit with the demands of the environment. Many different combinations of competence and environmental press can also lead to negative affect and maladaptive behavior functioning. ▪ ▪ For example, if environmental press is too great for individual’s competency For example, if individual competency is too great for environmental press. ▪ One implication of this model is that the less competent a person is, the more impact the environment has. Why? The less competent individual can only adaptively function in a small range of environments. Thus, if one’s competency declines, they may be less able to show adaptive functioning to environment. Decrease in environmental press (or increase in competency, if possible) will be needed for adaptive functioning to occur. Implications for aging and age-related diseases ▪ Examples The Congruence Model The Congruence Model: Kahana In the congruence model, people search for environments that best meet their needs ▪ Environments vary in terms of their ability to meet different people's needs ▪ Congruence between the person and the environment is especially important when either individual or environmental options are limited If the two match, then people feel content and satisfied If the two do not match, problems result. ▪ If in a restricted environment, person may feel that their needs aren’t met and continue to want to search for other environments. The congruence model helps focus on individual differences and on understanding adaptation in nursing homes and other long-term care facilities The Congruence Model: Kahana Some more examples: A person without personal transportation seeks a house near a bus route. A handicapped person seeks out a home adapted to a wheelchair (no steps). An elderly person who needs more assistance may chooses to relocate to an assisted-living facility. Resilience and the Stress and Coping Framework Stress and Coping Theory: Schooler This model suggests that older adults’ adaptation depends on their perception of environmental stress and their attempts to cope ▪This model is an adaptation of Lazarus and Folkman’s model of stress, but is applied to older adults interactions with environment. Stressors (environmental demands) are evaluated as harmful, beneficial, or irrelevant. If stressor is perceived as harmful/threatening, a negative emotional response happens. -However, if person feels they are able to cope appropriately with stressor, they will have a more positive emotional response. -If the person feels they are not able to cope appropriately with the stressor they will have additional negative emotional response. ▪ SCHOOLER: Social systems and institutions may buffer the effects of everyday stress in older adults. Example: In older adults, living alone may be viewed as stressful if one haslittle social support. Older adults with social support perceived such situations as less stressful. The Loss-Continuum Concept The Loss-Continuum Concept The loss-continuum concept views aging as a progressive series of losses that reduces one’s social participation in community. This includes: Children leaving home Loss of social roles Loss of income Loss of friends Loss of spouse Loss of mobility Loss of sensory acuity ▪ Thus, older adult’s still existing environments (home, familiar neighborhood, especially within 1 block radius in urban areas) take on far greater importance. Older adults can be sensitive to even small environmental changes. This approach is a guide to helping older adults maintain competence and independence. Types of Longterm Care Facilities Types of Age-Friendly Communities Home Modification ▪ Helping people deal with the tasks of daily living by modifying the environment Examples: handrails in the bathroom, lowered countertops, wheelchair ramps Adult Day Care ▪ Designed to provide support, companionship, and services throughout day Goal is to delay placement in a more formal care setting Congregate Housing ▪ Apartment complex for older adults Residents must be capable of independent living Deciding on the Best Age-Friendly Community Answer these questions: ▪ ▪ ▪ ▪ Does an individual have a significant cognitive or physical impairment that requires intervention? If so, what is the severity? Is the individual capable of being part of the decision- making process? The individual should always be involved, as much as possible What is the ability of the individual’s support system to provide care? What does the individual’s physician recommend? Physician’s diagnostic evaluations are often required. Long-Term Care Facilities At any given point in time, only about 4.5% of older adults are in long-term care facilities. ▪ Most older adults do not end up living in long-term care facilities, though about ½ of women and 1/3 of men will spend time in one. Types of long-term care facilities ▪ Nursing homes house the largest number of older adults in long-term care and provide 24-hour care The most important distinction in nursing homes is between intermediate care and skilled care facilities ▪ Both are strictly regulated by states ▪ Other types include skilled nursing facilities and special care facilities. Long-Term Care Facilities (cont.) Assisted living facilities ▪ Provide supportive living arrangement for people who need assistance with personal care, but do not need 24-hour care ▪ These facilities are generally smaller and cost less than nursing homes Adult foster care or adult family homes ▪ Are usually very small (5 or 6 people) and house people who need assistance with daily activities due to disabilities or chronic disorders, but are generally in good health ▪ Quality of care can vary widely in these facilities, no federally guidelines. Long-Term Care Facilities (cont.) Because nursing homes are such a controlled environment, most of the research on person-environment interactions is conducted here. ▪ ▪ Nursing homes can vary greatly amongst each other. We need more research on effects of living in other settings. Who is likely to live in a Long-Term Care Facility? Characteristics ▪ ”Very Old” (typically over the age of 85) ▪ European American female Though there are increasing numbers of older adults of color living in nursing homes ▪ Financially disadvantaged ▪ Widowed or Divorced ▪ Has lived in a nursing home for more than a year ▪ Has no children or siblings nearby ▪ Health issues and functional impairment Average resident has significant mental and physical problems (Main reason for placement—up to 80% of the population) Characteristics of a Nursing Home Who is Likely to Live in Nursing Homes? (Continued) Who is Likely to Live in Nursing Homes? Median Cost of a Nursing Home in the U.S. Nursing Home Costs in 2024 by State and Type of Care (seniorliving.org) Last resort for most people 25% of placements follow the death of primary caregiver Decision to enter NH often made quickly in reaction to a crisis Selection of Nursing Home Family and friends of the individual should consider… ▪ Level of skilled nursing care ▪ Whether the facility is primarily Medicare or Medicaid ▪ Whether the director of the facility and it’s upper staff are fully licensed ▪ Whether there is a care plan put in place by the professionals. Most importantly: ▪ Ask questions about the educational levels and staff turnover. How Do Characteristics of Nursing Homes Effect Psychological Well-Being? Three approaches have been used to address psychological well-being in nursing homes: ▪ Kahana's Congruence Model ▪ Moos’s Multiphasic Environmental Assessment Procedure (MEAP) ▪ Langer: Social Psychological Perspectives Kahana's Congruence Model: Psychological Well-Being In Nursing Homes Kahana's congruence model emphasizes the importance of fit between the person’s needs and the nursing home If the person’s needs are congruent with the nursing home’s ability to meet these needs, person should have well-being. ▪ In her research, she attempts to describe different dimensions of nursing home to meet needs of individual. ▪ E.g. If person’s need for independence is not congruent with the level of control exerted upon individual by nursing home facility, person will not experience psychological well-being. ▪ Thus, personal well-being depends not just on facilities, but on congruence of person’s needs and the ability of the facility to meet those needs ▪ Unfortunately, many nursing homes based on traditional medical model where residents are viewed as “sick patients” who are helpless. 80% of nursing home residents perform below their personal ability because of the lowered expectations of the staff Moos’ Multiphasic Environmental Assessment Procedure (MEAP): Psychological Well-Being In Nursing Homes Moos and colleagues use the Multiphasic Environmental Assessment Procedure (MEAP) to assess psychological well-being in nursing homes ▪ This scale assesses four aspects of the facility Physical and architectural features Administrative and staff policies and programs Resident and staff characteristics Social climate This approach allows one to establish areas of strength and weakness in nursing home ▪ ▪ Can be used to make judgments about how well facility might meet needs of residents Can be especially useful in choosing a nursing home Langer’s Social Psychological Work: Psychological Well- Being In Nursing Homes Langer (1985) has emphasized the importance of maintaining a sense of personal control in maintaining well-being and even staying alive. ▪ In short, residents’ perceptions that they are in control of their lives and competent is key for psychological well-being. Many aspects of nursing homes fail in this regard ▪ ▪ ▪ ▪ ▪ First, the decision to place a person in a nursing home is often made by other people. Second, the label “nursing home resident” may have strong negative connotations Third, what the staff may consider tender loving care may reinforce the belief in one’s incompetence Fourth, the physical aspects of the environment may reinforce the belief of no control Five, if the environment is too predictable there is little for people to think about Can a Nursing Home be a Home? Can a Nursing Home be a Home? It is possible……. Coming to the feeling that one is at home is facilitated by ▪ Having time to think about and participate in the placement decision ▪ Having prior knowledge of, and positive experience with, a specific facility ▪ Defining home predominantly in terms of family and social relationships ▪ Being able to establish some kind of continuity between home and nursing home Communicating with Residents Communicating with Residents Inappropriate speech to older adults is based on stereotypes of dependence and lack of abilities. It can lead to older adults feeling lower self-esteem and social withdrawal. It may eventually foster dependency over time if older adults conform to these stereotypes (social facilitation of the non-use of competence). Patronizing speech Is inappropriate speech based on stereotypes of incompetence and dependence ▪ E.g. Talking overly loud, overly slow, exaggerated intonation ▪ Infantilizing speech (or secondary baby talk) Involves unwarranted use of a person’s first name, simplified expression, short imperatives, an assumption the recipient has no memory, terms of endearment and cajoling as a way to demand compliance OLDER ADULTS PERCEIVE INAPPROPRIATE SPEECH AND CARE STAFF WHO CONTINUE TO USE IT AS NEGATIVE This is especially true for community-dwelling older adults Communicating with Residents (cont.) The communication enhancement model (Ryan et al., 1995) has been proposed as a framework for appropriate exchange ▪ This model is based on a health promotion model that seeks opportunities for health care providers to optimize outcomes for older adults through more appropriate and effective communication Intergenerational Communication (Giles & Gaiorek, 2011) Note that while younger adults tend to “overaccommodate” to older adults leading to communication problems and older adults feel patronized…… Younger adults may also “under accommodate” (e.g. ignore difficulties, dismiss legitimate concerns, etc.) Intergenerational Communication (Giles & Gaiorek, 2011) Older adults also may also contribute to problematic communication with younger adults by: Overaccommodating them leading to younger adults feel patronized…. ▪ Disapproving/disrespecting youth ▪ Overprotective/parental Underaccommodating them leading to younger adults to feeling uncertain of how to respond/unable to engage in communication ▪ ▪ Painful self-disclosure Off-target conversation Intergenerational Communication (Giles & Gaiorek, 2011) In short, both generations tend to “missing each other communicatively. The right amount of accommodation (not over, not under) is necessary to facilitate good intergenerational communication Also need to be aware of ageist stereotypes that can fuel mutual negative inferences of regarding other generation’s motives… ▪ ▪ ▪ Older adults may be misperceived as overcontrolling and declining/incompetent Younger adults may be misperceived as overcontrolling and disrespectful Thus, become aware of ageist stereotypes and combat them. Decision-Making Capacity and Individual Choices The Patient Self-Determination Act (PSDA) ▪ Requires people to be informed about advance directives when admitted to a health care facility that receives Medicare and Medicaid funds. ▪ Advance directives= decisions about life sustaining treatments and who the individual would like to make these decisions for them if they become incapacitated The Patient Self-Determination Act (PSDA) also requires facilities to maintain ▪ Written policies and procedures regarding advance directives ▪ Documenting the completion of advance directives in the person’s medical chart ▪ Complying with state law regarding the implementation of advance directives ▪ Providing staff and community education about advance directives Week 5 Age-related Changes in Neurons Neuroscience and Adult Development & Aging Age-Related Changes in Neurons ▪ ▪ ▪ ▪ ▪ ▪ ▪ Number of neurons declines Number and size of dendrites decreases Tangles develop in axon fibers Increases in deposits of proteins Number of synapses decreases These above changes occur in greater numbers in diseases such as Alzheimer’s disease White matter hyperintensities (WMH) Indicates myelin loss or neural atrophy Diffusion tensor imaging (DTI) ▪ Provides index of density or structural health of the white matter Age-related Changes in NeuroTransmitters Age-Related Changes in Neurotransmitters ▪ Dopamine is associated with higher-level cognitive functioning, so declines are related to poorer: episodic memory Effortful tasks that require higher-level cognitive functioning like inhibiting thoughts, attention, and planning. ▪ changes in dopamine levels may play a major role in cognitive aging and may explain why effortful and not automatic processes show more age-related change. ▪ Other neurotransmitters Abnormal processing of serotonin has been shown to be related to cognitive decline. Damage to structures that use acetylcholine is associated with memory declines Linking Structural Changes with behavior Linking Structural Changes with Behavior ▪ Considerable shrinkage occurs in the brain ******Especially in prefrontal cortex, hippocampus, and cerebellum The Positivity Effect: Older adults are more motivated to derive emotional meaning from life and to maintain positive feelings than younger adults. Theory of Mind (ToM): The ability to understand that others have beliefs, desires, and viewpoints different from our own ▪ Research shows age-related decline in ToM (over 75) Linking Structural Changes with Behavior Executive Functioning ▪ ▪ ▪ ▪ Difficulty focusing solely on relevant information Due to WMH and reduced volume of prefrontal cortex – Memory Specific structural changes (e.g., the hippocampus) result in memory decline Better emotional regulation with age Linking Structural Changes with Behavior ▪ Emotion Increased processing of positive emotional information with age Better emotion regulation with age Increased processing of positive emotional information Age-related increase in connections ▪ Social-Emotional Cognition Older adults may rely more on automatic judgment processes than reflective processing Theories and Models of Brain Behavior Changes Across Adulthood Theories and Models of Brain–Behavior Changes Across Adulthood ▪ The Parieto-Frontal Integration Theory (P-FIT) Proposes that intelligence comes from a distributed and integrated network of neurons in the parietal and frontal areas of the brain Theories and Models of Brain–Behavior Changes Across Adulthood ▪ CRUNCH (compensation-related utilization of neural circuits hypothesis) Additional mechanisms at work of aging brains overutilizing other regions in the left hemisphere on demanding tasks Theories and Models of Brain–Behavior Changes Across Adulthood ▪ STAC-r (scaffolding theory of cognitive age—revised) Default network theory holds that when cognitive demands are made on the brain the default network is suppressed. ▪ Default network: regions of the brain that are most active when one is at rest. Neural resource enrichment and depletion interact with neural plasticity to account for age-related changes in cognitive functioning. Information Processing Model The Information-Processing Model One of the most popular models of cognition. It is based on a computer metaphor. The information-processing model is based on three assumptions (Neisser, 1976) ▪ #1 Active processing The individual actively involved in transforming incoming information ▪ #2 Both quantitative and qualitative aspects of performance can be examined. How much is remembered and what kinds of information are remembered ▪ #3 Information processed through a stage-like series of “stores” The Information-Processing Model (cont.) Three fundamental questions for adult development and aging ▪ Is there evidence of age differences in how we store information at different stages (e.g. memory)? ▪ Is there evidence for age differences in how we process information (e.g. attend)? ▪ Can the age differences in the storage aspects be explained through differences in processing? Sensory memory ▪ It is the first level of processing incoming information from the environment This is where new incoming information is first registered. ▪ Information is represented similarly to how it was originally sensed in environment ▪ Is a large capacity but very short-lived store ▪ Only if we pay attention will the representation will be kept ▪ Bottom line: Age differences in sensory memory are not common. Attention: The Basics Which information is processed beyond sensory memory is determined by attention. Attentional control is linked to the parieto-frontal lobes. Attention consists of 3 interdependent aspects: ▪ Selective attention ▪ Divided attention ▪ Sustained attention Attention: Selective, Divided, and Sustained ▪ Selective attention (selectivity) Describes how we choose which information will be processed further ▪ For example, how information gets passed from sensory memory to working memory ▪ Information is “selected” to be attended to or not Helps us to focus on relevant information and ignore irrelevant information Novel information is more likely to be selectively attended to ****The small amount of information that is selectively attended to gets passed along to next stage for further processing. Attention: Selective, Divided, and Sustained (cont.) Divided attention ▪ The degree to which information competes for our attention at any given time. Examples Vigilance or sustained attention ▪ How we maintain our attention while performing a task over a period of time Examples Speed of Processing Speed of Processing A major explanation of age-related decline in cognitive performance speed is decreased speed of processing. Speed of processing is how quickly and efficiently the early steps of in information processing are completed. ▪ As we age, we become slower at processing information. *****This is one of the most robust findings in the gero literature.****** ▪ Though this seems to be process specific (varying across tasks), rather than global (across all tasks) However, debate continues as evidence indicates that age-related slowing depends on what adults are being asked to do and how hard task is All components of processing do not slow at same rate, and some don’t slow at all. ▪ The amount of beta-amyloid protein in the central nervous system is related to the degree processing speed slows. ▪ Reaction time is an index of speed Speed of Processing ▪ Speed of processing is measured using reaction time tasks: 1) simple reaction time tasks 2) choice reaction time tasks 3) complex reaction time tasks Reaction Time Tasks Simple reaction time tasks involves responding as quickly as possible to a stimulus ▪ In general, most age differences on this task are due to older adults taking longer to decide to make a response Choice reaction time tasks involves making separate responses to separate stimuli as quickly as possible ▪ Older adults do not prepare as well as younger adults to make a response, Complex reaction time tasks involves making complicated decisions about how to respond based on the stimulus observed ▪ Driving is a task that involves complex reactions ▪ Consistent results: When required to make complex responses, older adults are at an increased disadvantage Bottom line: there is much robust evidence of slower processing speed with age (though it is not found across alt tasks). This can affect one’s ability to attend to and select relevant information as one ages. Processing Resources What might there be changes in attention for older adults? Decline in Specific Types of Processing Resources with Age Inhibitory loss: ▪ Older adults may have difficulty inhibiting the processing of irrelevant information (mind wanders, hard to focus) What helps? ▪ Emotionally supportive messages reduce distracting thoughts and improve performance on everyday tasks ▪ Look away from the distractor ▪ Practice Of note, inhibitory loss may be helpful if previously irrelevant information becomes relevant Changes in Attentional Capacity…but older adults are not worse at dividing attention than younger adults, in general. Older adults are just as able to multitask but perform each task a bit more slowly. What Causes Age-Related Slowing? Many believe that physiological changes in neurons of brain cause age-related slowing There are two theories of the causes of slowing from this perspective: ▪ ▪ 1. Neural Networks and 2. Information Loss What Causes Age-Related Slowing? ▪ Neural Networks This approach argues that with age-related neuronal loss it takes more neurons to make decisions, thereby slowing down the decision process. ▪ In other words, you need more neurons to get the job done with age. ▪ Cerella (1990): Slower processing in older adults is due to them having to use more neural links to “bypass” damaged neural links. What Causes Age-Related Slowing? (cont.) Information Loss (Myerson et al., 1990) ▪ This model suggests that more information is lost at each step in processing for older adults than younger adults ▪ Basic assumptions of this model Information processing occurs in discrete steps, and overall processing speed is the total of how long it takes to accomplish each steps How long each step takes depends on how much information is available at the beginning of the step. The less information available, the longer processing will take Information is lost during processing There are age-related increases in the rate at which information is lost. Thus, this model suggests that as we age, we lose information at a faster rate Automatic and Effortful Processing What might there be changes in attention for older adults? Automatic and Effortful Processing Automatic Processing ▪ Places minimal demands on attentional capacity ▪ Gets information into system, largely without us being aware of it ▪ Performance on tasks that demand automatic processes do not typically demonstrate significant age differences Effortful Processing: ▪ Requires all of the available attentional capacity ▪ When there is effort and deliberate processing involved to age differences emerge.

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