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Utvikling over livsløpet
Inger Hilde Nordhus
Livsløp og utvikling (1)
• Aldring er generelt beskrevet som en prosess
preget av svekkelse
• Psykologisk forskning støtter i stor grad dette:
• Arbeidsminne – (multiple oppgaver) og
informasjonsbearbeiding (hurtighet) svekkes
• Erfaringsbasert kunnskap viser ikke denne
tendensen men det gjør derimot prosessering
av ny kunnskap
• Etablert på tvers av kjønn, utdanning og
etnisk tilhørighet – normative endringer med
store individuelle forskjeller
National Research Council. 2000. The Aging Mind: Directions in Cognitive Aging Research . P.
Stern & L. L. Carstensen, Eds. National Academies of Sciences Press. Washington, DC.
Patologisk kognitiv utvikling demens
• Svært varierende prevalens av demens rundt om i verden
(3-30 % av eldre) 1-5
• Klassifikasjonssystemene påvirker diagnosen6
• I en canadisk kohort varierte prevalensen fra 3,1 % (ICD10) til 29,1 % (DSM-III)6
1.
2.
3.
4.
7.
8.
5.
9.
6.
70-74 år = 5 %
7-8 community in>Kerala,
S et al. An epidemiological
study of dementia
in a rural
India.
1996;168(6):745-9.
• Shaji
Prevalens
i vestlige
land:
75 år
= Br15J Psychiatry.
%
Wang W et al. Prevalence of Alzheimer's disease and other dementing disorders
in an
urban
community
of Beijing, China.
>
90
år
=
35
%
Neuroepidemiology. 2000 Jul-Aug;19(4):194-200.
Lobo A et al. Prevalence of dementia and major subtypes in Europe: A collaborative study of population-based cohorts.
9
Neurologic Diseases in the Elderly Research Group. Neurology. 2000;54:S4-9.
• Norske sykehjem:
70-80 %
Engedal K and Haugen PK. The prevalence of dementia in a sample of elderly Norwegians. International Journal of Geriatric
Engedal
K,1993;8:565-570
Haugen PK. The prevalence of dementia in a sample elderly Norwegians. Int J Geriatr Psychiatry 1993;8:565-570.
Psychiatry
Ott A et al. Prevalence of Alzheimer's disease and vascular dementia: association with education. The Rotterdam study. BMJ.
Skoog I etHTal.
population-based
study
of
dementiacriteria
in 85-year-olds.
N Engl Jof
Med.
1993;21:153-158.
Nygaard
etetA
al.
Mental
sviktofhos
sykehjemspasienter.
Tidsskr
Norprevalence
Lægeforen
2000;120:
3113-16.
1995;15:970-973.
Erkinjuntti
al.
The effect
different
diagnostic
on the
dementia.
N Engl J Med. 1997;4:1667-1674.
Livsløp og utvikling (2)
• Sosial og emosjonell fungering viser positiv utvikling
over livsløpet (med unntak av ved patologisk aldring)
• Subjektivt velvære (well-being) er ikke dårligere hos
eldre enn yngre voksne
• Negative emosjoner viser nedgang relativt til yngre
voksne; positive emosjoner rapporteres oftere hos
eldre enn yngre voksne
• Eldre rapporterer oftere større grad av tilfredshet mht
sosiale relasjoner, særlig nære (slekt og nære
venner)
• Sett opp mot kognisjon og biologiske prosesser:
paradox of aging ?
Löckenhoff, C. E. & L. L. Carstensen. 2002. Is the life-span theory of control a theory of
development or a theory of coping? I Personal Control in Social and Life Contexts. S. H.
Zarit, L. I. Pearlin & Schaie, Eds.: 233-262. Springer Publishing Company. New York.
Psykologiske mekanismer
• Senket forventning
• Endring av referansegruppe
• Benekting
Med andre ord:
……en grunnleggende oppfatning av:
at økt emosjonell trivsel og fokus på nære
bånd hos eldre er et utslag av mestring av
tap mer enn en positiv utvikling
Selektiv motivasjon – et
utviklingsperspektiv
• Mål rettet mot å utvide vår horisont/få mer
informasjon
• Mål rettet mot emosjonell bekreftelse
• Evne til å oppleve seg i tid gjør at en også kan
endre prioritet
Med andre ord:
……en alternativ oppfatning av:
at økt emosjonell trivsel og fokus på nære
bånd hos eldre er et utslag av relativ endring
i prioritering av mål
Selvregulering over livsløpet
• Selvregulering hos barn blir beskrevet i et
utviklingsperspektiv
• Selvregulering hos voksne og eldre tar lite
hensyn til ontogenetisk endring over livsløpet
• Fokus på voksne: individuelle forskjeller
• Fokus på eldre: Sviktende fysisk helse
forårsaker dysfunkjonell selvregulering
Oppsummerende
• I klinisk sammenheng vil vi selvsagt se store
individuelle endringer i evne til selvregulering
hos voksne og eldre pasienter
• Vi vil også bli konfrontert med klare
sammenhenger mellom fysisk helsesvikt og
psykisk helse
• De generelle funn om eldres selvregulering
peker imidlertid mer mot psykologisk gevinst enn
mot en normativ defensiv mestring av tap
Ageing – Health – Behaviour
• Optimize life expectancy or longevity
• Minimize physical, psychological and social
morbidity
• Increase of people surviving into advanced old
age leads to compression of morbidity (disease
closer to the time of death)
• Can we live free from disease?
Health and Disease
• Age is linked to many diseases (e.g., heart
disease, dementia)
• Diseases have a number of psychological
consequences
• The fact that people live longer also implies an
increase in both healthy as well as abnormal
ageing
• Health is also known to be the main determinant
of life satisfaction and quality of life in old age
Is Old Age Synonymous with
Disease?
• How do we perceive ageing?
• What kind of images of old age do we
have?
• What do we think of as normal ageing?
Age
• Immediate information about somebody
we do not know
• Strong association with other variables
• Subjective marker (e.g., change)
• Social marker (e.g., being different from
younger adults)
Age as a variable
•
•
•
•
Age as a statistical concept
Age as a process
Age as a background variable
Age as a predictor variable
What is Ageing?
• Biological perspective (cell loss,
physiological changes)
• Developmental perspective (coping,
adaptation)
• Cognitive perspective (memory, attention)
• Social perspective (status, resources)
Biological Age
• Observable physical changes
• Changes in the brain
• Increased vulnerability for developing
certain ailments and diseases
Sleep – an example
• Certain changes in the sleep architecture
are defined as common and normal as we
age
• Changes in sleep habits
• Changes in activity level
• Prevalence of sleep problems increases
with age, and about 50% of elderly
subjects (60+) complain about sleep
problems
– Why?
Sleep in old age
Sleep changes naturally as we age
• Increased number of awakenings and arousals
•
•
•
•
•
Less REM sleep
Generally less deep sleep
Moe sleep stage changes
Less sleep cycles
Reduced sleep efficacy
Sleep - Normal Changes in
Sleep Architecture
Actigraphy
Polysomnography (1)
Polysomnography
Polysomnography (2)
Sleep Diary
Uke: fra .......... til ........... År:...........
Eksempel Mandag Tirsdag Onsdag Torsdag Fredag Lørdag Søndag
27/2
28/2
1/3
2/3
3/3
4/3
5/3
Utfyllingsdato (fylt ut om morgenen den)
1.
Antall ganger jeg sov (duppet av) på dagtid (før natten)
2.
Hvor lenge jeg sov (duppet av) på dagtid
3.
Om kvelden la jeg meg i sengen kl
4.
Etter jeg la meg prøvde jeg å sove (slukket lysene) kl
5.
Etter å ha slukket lyset, sovnet jeg i løpet av… minutter
6.
Antall ganger jeg våknet i løpet av natten var
7.
Hvor lenge jeg var våken til sammen om natten
(legg sammen for alle oppvåkninger)
2
40
2310
2400
30 min
2
20
8.
Jeg våknet endelig kl (siste oppvåking om morgenen)
0700
9.
Jeg stod endelig opp av sengen kl
0745
10.
På dagtid i går følte jeg meg (1= svært søvnig,
2= noe søvnig, 3 = hverken søvnig eller opplagt,
4 = noe opplagt, 5= svært opplagt)
2
Da jeg stod opp i morges følte jeg meg (1= helt utslitt,
2= noe utslitt, 3= hverken utslitt eller uthvilt, 4= noe uthvilt,
5 = helt uthvilt)
2
Jeg inntok … enheter alkohol før jeg la meg (eks på enhet =
én pils, et glass vin, én drink brennevin)
2
11.
12.
Ageing as a health related concept
•
•
•
•
Pathological – normal- optimal
Heterogeneity
Risk
Vulnerability
Psychological Age
• Changes in cognitive preparedness
• Increased vulnerability in terms of critical
incidences
• Increased vulnerability in terms of loss of
resources that in turn challenge coping
and adaptation
What may challenge identity
and coping in old age?
• Interpersonal loss
• Physical decline and loss and malfunction
Increased dependency of care
• Fear of loosing autonomy and integrity
Affects basic human needs
Social Age
• Changes in roles and status
• Increased likelihood of being in a position
of a recipient in many ways
• Exit from roles rather than entrance into
roles as defined by
Age, Cognitive Functioning and
Health
• The most feared diseases of old age are
those that impair memory, thinking,
problem-solving, perception and our
personality
• It is a challenge to understand the
borderlands between benign cognitive
impairment and abnormal cognitive
functioning (dementia )
A Healthy Old Age?
• There is little evidence for marked
compression of morbidity
• The absolute time spent with moderate
disability has increased
• More people are able to perform activities
of daily living due to medical and
technological improvement
• As for cognition, at least some decline is
the norm, but there are great interindividual variation
Age as a Mediator between Health
and Behaviour
• It is well established that before old age,
behaviour has both beneficial and negative
effects on health
• Smoking, alcohol abuse, poor diet, obesity, lack
of exercise, etc., reduce the likelihood of
surviving into old age
• The debate in gerontology is whether risk factors
associated with mortality and morbidity in middle
age has as strong effect in old age
Two Conclusions:
• There is evidence that behaviour change
in old age has a beneficial effect on health
and psychological well-being
• It may also be the case that the same
levels of behaviour in old age are more
harmful than at younger ages
The Issue of Self-Efficacy
• There is a growing body of evidence
demonstrating the role of age as a mediator
between behaviour and health:
• One possible mechanism might be changes in
perceived self-efficacy or control over health with
age
• There is some evidence that here are decreases
in perceived self-efficacy with age: Ageing or
cohort?
”Elderly ”
•
•
•
•
Persons 60+ (arbitrary limit)
Chronological definition
Social definition
The experience of being old
Related to indentity
A correction
• The health status of those 60+ is better
than ever
• Most elderly people can mange without
any particular help
• Ageing is not identical with disease
• Aged people are not a homogenous group
Optimal ageing
• Optimal Ageing: ”The potential and
preparedness for dealing with
change” (Kilde: Baltes & Baltes,
1993).
• Discuss this statement
Ageing may imply
• Narrowing of choices as a consequence
of loss
• Coping relates to use strategies that
has proven to be effective earlier in life
• Coping may also mean to develop or
reformulate old strategies to make them
fit in a new context
Critical Life Events
Social
Psycological
Biological
Resources
Social
Psycological
Biological
Stressors