Transcript Chapter 17 - FacultyWeb Support Center

CHAPTER 17
Late Adulthood: Physical and Cognitive
Development
Physical Development
Physical Development: Longevity and Life
Expectancy
• Life expectancy
– number of years a person in a given population can expect to
live
– has increased due to better medicines and vaccinations
– is different for members of different cultures
– Asian American women living in “America One” can expect to
live to be 80 years old, whereas African American men living in
“America Eight” may expect to live to be 60 years.
Gender Differences in Life Expectancy
• Longevity gap between men and women is narrowing
– Life expectancy among men trails that among women by about
5 years (76 years for men versus 81 years for women).
• Contributing factors to difference include
– heart disease occurring later in women due to drop off of
estrogen
– other diseases such as HIV/AIDS being more prevalent in men
– men avoiding medical attention until problems are exacerbated
Fig. 17-1, p. 351
Physical and Social Changes
• Ageism
– Prejudice against older people
• Chemical changes of aging can lead to vision disorders
such as cataracts and glaucoma.
• Cataracts cloud the lenses of the eyes, reducing vision
– Outpatient surgery for correcting cataracts is routine
• Glaucoma
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Buildup of fluid pressure inside the eyeball
Can lead to tunnel vision or blindness
Rarely occurs before age 40
Heritable
Affects about one in 250 people over the age of 40
Treated with medication or surgery
Physical Changes (cont’d)
• Presbycusis
– Age-related hearing loss that affects about one person in three
over the age of 65
– Hearing ability tends to decline more quickly in men than in
women
– Hearing aids magnify sound and can compensate for hearing
loss.
• Sense of smell decreases almost nine fold from youth to
advanced late adulthood
– Lose taste buds in the tongue with aging
– Foods must be more strongly spiced to yield the same flavor
Physical Changes (cont’d)
• Bones lose more density in late adulthood, becoming
more brittle and vulnerable to fracture.
– Bones in the spine, hip, thigh, and forearm lose the most density
as we age.
• Osteoporosis
– Disorder where bones lose so much calcium that they become
prone to breakage
– Estimated 10 million people in the United States over the age of
50 have osteoporosis of the hip (USDHHS, 2005)
– Osteoporosis results in more than 1 million bone fractures a
year in the U.S.
• Most serious are hip fractures
• Often result in hospitalization, loss of mobility, and in people in
advanced late adulthood, death from complications
Sleep
• Older people need about 7 hours of sleep per night.
– insomnia and sleep apnea more common in later adulthood
• Sleep apnea
– Person stops breathing repeatedly during the night, causing
awakenings
– Linked to increased risk of heart attacks and strokes
• Sleep problems may involve physical changes that bring
discomfort.
– May symptomize psychological disorders
– Other contributing factors may be men with enlarged prostate
glands needing to urinate during the night, causing awakening
and loneliness
Sleep
• Sleep medications most common treatment for insomnia
– Medicines can lead to dependence when used regularly, and to
“rebound insomnia” when discontinued
– Older people can benefit from developing healthier sleep habits,
such as limiting daytime napping and keeping a regular sleep
schedule, challenging exaggerated worries about the
consequences of remaining awake, and using relaxation
techniques.
• Sleep apnea may be treated with surgery to widen the
upper airways that block breathing or by the use of
devices such as a nose mask that maintains pressure to
keep airway passages open while sleeping.
Sexuality
• People do not lose their sexuality as they age.
• Sexual daydreaming, sex drive, and sexual activity all
tend to decline with age, but sexual satisfaction may
remain high.
• Older people with partners usually remain sexually
active.
• Most older people report they like sex; a majority state
orgasm is important to sexual fulfillment.
• Sexual activity is influenced by psychological well-being,
feelings of intimacy, and cultural expectations.
Changes in Women
• Changes in older women stem from a decline in
estrogen production.
• Vaginal walls lose elasticity and grow paler and thinner;
sexual activity may become irritating; thinning of the
walls may place greater pressure against the bladder
and urethra during sex leading now and then to urinary
urgency and burning urination.
• Vaginal changes
– Labia majora lose much of their fatty deposits and become
thinner
– Vaginal opening constricts making penile entry difficult
– Following menopause, women produce less vaginal lubrication,
and lubrication may take minutes to appear; lack of adequate
lubrication is main reason for painful sex.
Changes in Women (cont’d)
• Changes may be slowed or reversed through estrogenreplacement therapy.
– Natural lubrication may be increased through more elaborate
foreplay.
– Artificial lubricants can ease problems.
– Older men will likely need more time to become aroused as well.
• Women’s nipples still become erect as they are sexually
aroused.
– Spasms of orgasm become less powerful, fewer in number;
orgasms may feel less intense, even though the experience of
orgasm may remain just as satisfying.
Changes in Men
• Age-related changes occur more gradually in men than
in women.
– Not clearly connected with any one biological event
• After about age 50, men take longer to achieve erection.
– Erections are less firm possibly due to lowered testosterone
levels
• Older men may require prolonged direct stimulation of
the penis to obtain an erection.
– Extending foreplay addresses this issue
• Most men capable of erection throughout their lives
– Erectile dysfunction not inevitable with aging
– Men generally require more time to reach orgasm as they age.
Changes in Men (cont’d)
• Testosterone production declines gradually from age 40
to age 60, then begins to level off.
– Decline not inevitable and may be related to the man’s general
health
– Sperm production tends to decline
– Viable sperm may be produced by men into their 70’s, 80’s and
90’s.
– Regaining erection takes longer
• Nocturnal erections diminish in intensity, duration, and
frequency.
– They do not normally disappear altogether
• Older men produce less ejaculate; contractions of
orgasm become weaker and fewer; may enjoy orgasm
as thoroughly as he did at a younger age; following
orgasm, erection subsides more rapidly
Patterns of Sexual Activity
• Older people can lead a fulfilling sex life; years of sexual
experience may compensate for any lessening of
physical response.
• Frequency of sexual activity tends to decline with age
because of hormonal changes, physical problems,
boredom, and cultural attitudes.
• Sexuality among older people is variable; some engage
in sexual activity as or more often as when younger;
some develop an aversion to sex; others lose interest.
Patterns of Sexual Activity (cont’d)
• Couples can adapt to the physical changes of aging by
broadening their sexual repertoire to include more
diverse forms of stimulation such as oral-genital
stimulation, pornography, anal stimulation, vibrators
• Sexual satisfaction may be derived from manual or oral
stimulation, cuddling, caressing, and tenderness, as well
as intercourse to orgasm.
• Availability of a sexually interested and supportive
partner may be the most important determinant of
continued sexual activity.
Theories of Aging
Theories of Aging
• Cellular clock theory
– Focuses on the built-in limits on cell division
– After dividing about 50 times, human cells cease dividing and
eventually die.
– Cells from longer-lived species divide more times before they
die than cells from shorter-lived species.
• Hormonal stress theory
– Focuses on the endocrine system
– Hormonal changes foster age-related changes such as puberty
and menopause.
– Stress hormones are left at elevated levels following illnesses,
making the body more vulnerable to chronic conditions such as
diabetes, osteoporosis, and heart disease.
Theories of Aging (cont’d)
• Immunological theory
– Holds that the immune system is preset to decline by an internal
biological clock
• Free-radical theory
– Attributes aging to damage caused by the accumulation of
unstable molecules called free radicals
– Free radicals are produced during metabolism by oxidation,
possibly damaging cell proteins, membranes, and DNA.
– Damage may cause us to age faster and become more
vulnerable to diseases associated with aging
Theories of Aging (cont’d)
• Cross-linking theory
– As we age, cell proteins bind to one another in a process called
cross-linking, thereby toughening tissues.
– Cross-linking stiffens collagen.
– Collagen is the connective tissue supporting tendons, ligaments,
cartilage, and bone.
• Results in coarse, dry skin; believes the stiffening of body proteins
accelerates and eventually breaks down bodily processes, leading
to some of the effects of aging
– Immune system combats cross-linking, but becomes less able
to do so as we age
Health Concerns and Aging
Health Concerns and Aging
• Older people typically need more healthcare than
younger.
– They occupy 25% of the hospital beds
• Medicare
– Federally controlled health insurance program for older
Americans and the disabled, only partially subsidizes the health
care needs of these groups
• Medicaid
– Another federal program
– Covers a portion of the healthcare costs of people of all ages
who are otherwise unable to afford coverage
– Many older adults use both programs
Figure 17-2 p358
Health Concerns and Aging (cont’d)
• Most older adults don’t need institutional care.
– Two out of three older adults age 65 and older live in own
homes
– Less than 10% of older adults live in nursing homes or other
long-term care facilities
– Nursing homes are mostly made up of people age 80 and above
– If older adults live long enough, half will require some form of
nursing or home healthcare.
• Most older Americans spend later years in retirement
community
– Majority of older adults remain in their own communities after
retirement
• Americans aged 65 and above are less likely than
general population to live under the poverty level
Heart Disease, Cancer, and Stroke
• Three major causes of death of Americans age 65 and
over are heart disease, cancer, and stroke
• Heart disease
– Nation’s leading cause of death among both sexes beyond the
age of 80
• Cancer
– Leading cause of death of women age 40 to 79, and men age
60 to 79
– Risk of cancers rises as we age due to immune system
becoming less able to rid the body of precancerous and
cancerous cells
Heart Disease, Cancer, and Stroke (cont’d)
• Older people not adequately screened for cancer
– Physicians not as aggressive in treating them
– Same is true for heart disease and serious illnesses
– May be due to elder bias
• discrimination against the elderly on the part of some health
professionals.
• Dominant form of heart disease among those 65 and
older is coronary artery disease resulting from
atherosclerosis
• Other common cardiovascular disorders in older adults
– Hypertension, heart arrhythmias, and congestive heart failure
Heart Disease, Cancer, and Stroke (cont’d)
• Hypertension
– Affecting about 50% of Americans over the age of 65
– Major risk factor for heart attacks and strokes
– Diabetes is the fifth leading cause of death
– Other chronic conditions include
• cataracts, chronic sinusitis, visual impairment, and varicose veins
Arthritis
• Arthritis
– Joint inflammation that results from conditions affecting the
structures inside and surrounding the joints
– Symptoms progress from redness to heat, swelling, pain, and
loss of function
– More common with advancing age
– More common in women than men
– More common in African Americans than European Americans
Arthritis (cont’d)
• Osteoarthritis
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Painful, degenerative disease involving wear and tear on joints
By age 60, half of Americans show some signs of the disease
Among people over the age of 65, two of three have the disease
Joints most commonly affected are in the knees, hips, fingers,
neck, and lower back
More common among obese people because excess weight
adds to the load on the hip and knee joints
Health professionals use over-the-counter anti-inflammatory
drugs and prescription anti-inflammatory drugs to help relieve
pain and discomfort
In severe cases, joint replacement surgery may be needed
Specific exercises are prescribed
Arthritis (cont’d)
• Rheumatoid arthritis
– Characterized by chronic inflammation of the membranes that
line the joints because the body’s immune system attacks its
own tissues
– Affects the entire body
– Can produce unrelenting pain and eventually lead to severe
disability
– Bones and cartilage may be affected
– Disease begins between 40 and 60; anti-inflammatory drugs are
used to treat it
Substance Abuse
• 40% of all prescription drugs in the U.S. are taken by
people age 60 and above, more than half of them take
two to five medications daily.
• Most commonly used drugs are
– blood pressure medications, tranquilizers, sleeping pills, and
antidepressants
• Millions of older adults run the risk of becoming addicted
to prescription drugs, especially tranquilizers.
– A quarter of a million older adults are hospitalized each year
because of adverse drug reactions.
Substance Abuse (cont’d)
• Reasons for addiction or adverse reactions include
– doctors prescribing an incorrect dosage
– some people misunderstanding directions or being unable to
keep track of their usage
– many older people having more than one doctor, so treatment
plans not being coordinated
• Many older adults suffer from long-term alcoholism.
– Health risks of alcohol abuse increase with age
– Slowdown in the metabolic rate reduces the body’s ability to
metabolize alcohol, increasing the likelihood of intoxication
– Combination of alcohol and other drugs, even prescription
drugs, can be dangerous, even lethal
Accidents
• Older people face greater risks of unintentional injuries.
• Accidents
– Ninth leading cause of death among older Americans
– Falls especially dangerous for older adults with osteoporosis
• Accidents could be prevented by equipping the home
with safety features such as railings and nonskid floors.
– Wearing proper glasses and using hearing aids can reduce risk
of accidents resulting from vision or hearing problems, including
many motor vehicle accidents
– Adherence to safe driving speeds is important because older
adults have slower reaction times
Dementia and Alzheimer’s Disease
• Dementia
– Condition characterized by dramatic deterioration of mental
abilities involving thinking, memory, judgment, and reasoning
• Dementia is not a consequence of normal aging
– Involves a disease process that damages brain tissue
– Some causes of dementia include brain infections such as
meningitis, HIV infection, and encephalitis
– Chronic alcoholism, infections, strokes, and tumors
– Most common cause is Alzheimer’s disease (AD)
• Progressive brain disease affecting 4-5 million Americans
Dementia and Alzheimer’s Disease (cont’d)
• Alzheimer’s disease
– About one in 10 Americans over the age of 65 has
AD, jumping to more than one in two among those in
the 75 to 84 year age range; AD is rare in people
under the age of 65.
– Some dementias may be reversible, such as those
caused by tumors and treatable infections, or those
that result from depression or substance abuse, but
the dementia resulting from AD is progressive and
irreversible.
Fig. 17-3, p. 361
Figure 17-4 p361
Dementia and Alzheimer’s Disease (cont’d)
• AD is the fifth leading killer of older Americans.
• AD begins with subtle cognitive and personality changes
where people with AD have trouble managing finances
and recalling recent events.
– Continues with people with AD finding it harder to manage daily
tasks, select clothes, recall names and addresses, and drive
– Progresses to having trouble using the bathroom and
maintaining hygiene
– People with AD no longer recognize family and friends or speak
in full sentences.
– They may become restless, agitated, confused, and aggressive
Dementia and Alzheimer’s Disease (cont’d)
• People with AD may get lost in stores, parking lots, even
in their own homes.
– May experience hallucinations or paranoid delusions, believing
that others are attempting to harm them
– People with AD may eventually become unable to walk or
communicate and become completely dependent on others.
• Scientists believe that both environmental and genetic
factors are involved.
• Medicines can help improve memory functioning of
people with AD, but effects are modest.
Cognitive Development
Memory: Remembrance of Things Past and
Future
• Retrospective and prospective memories
– Memories of the past (“retro”) and memories of the things we
plan to do in the future
– Can be divided into explicit and implicit memories
• Explicit memories
– Specific information
• Things we did or things that happened to us
• General knowledge, such as the author of Hamlet
• Implicit memories
– More automatic
– About performance of tasks
• Reciting the alphabet or multiplication tables, riding a bicycle
Explicit versus Implicit Memories
• Working memories of older adults hold less information
simultaneously than the working memories of young
adults.
• Temporal memory of older adults
– Recall of the order in which events have occurred may become
confused
• Do not fare as well as younger adults in tasks that
measure explicit memory, but tend to do nearly as well
in tasks that assess implicit memory
Associative Memory
• Older adults have greater difficulty discriminating
between new and already experienced combinations of
items on an associative recognition task.
• Two theories why there is a deficit in associative
memory
– Binding hypothesis
• Older adults are impaired primarily at associating items with one
another, but not at remembering individual items
– Impairment in recollection theory
• When the individual attempts to retrieve the information that may
reflect poor binding during encoding, poor use of strategic
processes during retrieval, or both
Associative Memory (cont’d)
• Cohn et al. (2008) believe the frontal regions—executive
center of the brain—are involved in directing one’s
attention and organizing information and strategic
processes.
– Medial temporal lobe binds elements to form memory traces,
recovers information in response to use of proper memory cues,
and is a key to recollection
– Neurological research indicates deterioration evident in aging in
the frontal lobes and to a lesser degree in the medial temporal
lobe, which impairs binding, recollection, and the use of
effective strategies for the retrieval of information
Long-Term Memory
• Bahrick and colleagues (2008) conducted research on
recollection of grades on college graduates from early
adulthood through late adulthood.
– Number of correct recollections fell off with the age of the
respondent, due, generally, to errors of omission
• Leaving items blank rather than entering the wrong grade
– Graduates who were out of school more than 40 years entered
no more wrong grades, on average, than those who were out of
school 8 years or so.
Fig. 17-5, p. 324
Long-Term Memory (cont’d)
• People seem to recall events from the second and third
decades of life in greatest detail and with the most
emotional intensity.
– May be due to hormones
Prospective Memory
• Prospective memory
– The attempt to remember things we have planned to do in the
future
• despite the passage of time
• despite the occurrence of interfering events
– For prospective memory to succeed, we need to have foolproof
strategies, such as alarms going on or off on our cell phones, or
we need to focus our attention and keep it focused.
– Distractibility will prevent us from reaching the goal.
– Even if fluid intelligence remained intact, prospective memory
might decline.
Prospective Memory (cont’d)
• Age-related decline in prospective memory
– Greatest when the task to be completed is not all that crucial
and the cues used to jog the memory are not very prominent
– When the task is important and older adults use conspicuous
cues to remind them, age-related declines in prospective
memory are reduced
– The adults have to be cognitively intact enough to plan the
strategy
Language Development
• Knowledge of the meaning of words can improve into
late adulthood.
• Due to decline in working memory and also due to
impairments in hearing, many older adults find it more
difficult to understand the spoken language.
– Speakers need to slow down and articulate more clearly so
older people’s comprehension will increase.
• Older adults may show deficiencies in language
production.
– Declines in associative and working memory decrease the
likelihood that words will “be there” when older people try to
summon up ideas.
– Older people are more likely to experience “tip-of-the-tongue”
phenomenon.
Problem Solving
• Experiments show older adults use
– fewer strategies
– display slower processing speed in solving complex math
problems than younger adults
• Abstract problem-solving ability
– As in complex math problems, is not related to older adults’
quality of life
– “Real-world” or everyday problem-solving skills are crystallized;
experiences with people play a helpful role
• Younger versus older
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More likely to express feelings of anger or frustration
Seek support from other people to solve interpersonal problems
Older adults focus on remaining calm and unperturbed
Difference due to older adults’ decreased tendency to express
anger and increased priority on regulating emotion
Wisdom
• Distractibility may contribute to wisdom
– Hasher (2008) suggests distractibility can enable older adults
to take a broader view of situations.
• Kunzmann and Baltes (2005)
– People with wisdom approach life’s problems by addressing
the meaning of life by including the past, present, and future,
and the contexts in which the problems arise.
– People with wisdom tend to be tolerant of other people’s value
systems.
– Acknowledge that there are uncertainties in life and that one
can only attempt to find workable solutions in an imperfect
world
– Ardelt (2008a, 2008b) suggests that wise people tend to
possess an unselfish love for others and also to be less afraid
of death.