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Late Adulthood: Physical and Cognitive
Development
Chapter 17
Sex Differences in Life Expectancy
• Longevity gap between men and women is
narrowing, life expectancy among men trails that
among women by about 5 years (75.2 years for
men versus 80.4 years for women)
• Contributing factors to difference may be heart
disease occurring later in women due to drop off
of estrogen, other diseases such as HIV/AIDS
being more prevalent in men, and men avoiding
medical attention until problems are exacerbated
Physical Development: Longevity and Life
Expectancy
• Life expectancy — number of years a person in
a given population can expect to live
• Life expectancy has increased due to better
medicines and vaccinations
• Life expectancy 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
Physical 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 — 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 Continued
• 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 Continued
• 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
Physical Changes Continued
• 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
Physical Changes Continued
• 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
while sleeping
Fig. 17-2, p. 318
Table 17-2, p. 318
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.
• The vagina shrinks; labia majora lose much of
their fatty deposits and become thinner; vaginal
opening constricts; penile entry may become
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 Continued
• Changes may be slowed or reversed through
estrogen-replacement 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 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 Continued
• 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 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; it may seep
out rather than shoot out; 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 Continued
• 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
• 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 Continued
• 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 Continued
• Cross-linking theory — as we age, cell
proteins bind to one another in a process called
cross-linking, thereby toughening tissues; crosslinking stiffens collagen — 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
• Older persons typically need more health care
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 health care costs of people of all
ages who are otherwise unable to afford
coverage. Many older adults use both programs.
Health Concerns and Aging Continued
• Most older adults don’t need institutional care;
two 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 health care.
• 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
• Cancer is the leading cause of death of women
age 40 to 79, and men age 60 to 79; heart
disease is the nation’s leading cause of death
among both sexes beyond the age of 80
• 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 Continued
• 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 are:
hypertension, heart arrhythmias, and congestive
heart failure
Heart Disease, Cancer, and Stroke Continued
• Hypertension, affecting about 40% of
Americans over the age of 65, is major risk
factor for heart attacks and strokes; diabetes is
the sixth 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 and in
African Americans than European America
Arthritis Continued
• Osteoarthritis — 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 Continued
• 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
• Forty percent 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 medication, 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 Continued
• Reasons for addiction or adverse reactions
include the following: 1) doctors may prescribe
an incorrect dosage; 2) some people may
misunderstand directions or be unable to keep
track of their usage; and 3) many older persons
have more than one doctor, treatment plans may
not be 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 they 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,
but of disease processes that damage brain
tissue; some causes of dementia include brain
infections such as meningitis, HIV infection, and
encephalitis; and 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 Continued
• 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, the dementia resulting from
AD is progressive and irreversible
Dementia and Alzheimer’s Disease Continued
• 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 Continued
• 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
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, such
as things we did or things that happened to us
and general knowledge, such as the author of
Hamlet
• Implicit memories are more automatic, of the
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 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 which may reflect poor binding
during encoding, poor use of strategic processes
during retrieval, or both
Associative Memory Continued
• 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, logically impairing 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
Long-Term Memory Continued
• 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 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 Continued
• Age-related decline in prospective memory is
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 tend to disappear; 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 more likely to experience
“tip-of-the-tongue” phenomenon
Problem Solving
• Experiments show older adults use fewer
strategies and display slower processing speed
in solving complex math problems than younger
• Abstract problem-solving ability, as in complex
math problems, is not related to older adults’
quality of life; “real-world” or everyday problemsolving skills are; crystallized experience with
people play a helpful role.
• Younger groups more likely to express feelings
of anger or frustration, to seek support from
other people, or 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) note that 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