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1 Physical and Cognitive Development in Late Adulthood Kuther, Lifespan Development. © 2017, SAGE Publications. 2 Dr. Kuther's Chalk Talks: Part VIII Kuther, Lifespan Development. © 2017, SAGE Publications. 3 Life Expectancy • In 2014, infants born in the United States can expect to live to age 80. • Some adults live well beyond the expected life span to a very old age. • The increase in life expectancy can be attributed to the influence of contextual factors. – Health care – Nutrition – Sanitation Kuther, Lifespan Development. © 2017, SAGE Publications. 4 Influences on Life Expectancy • Gender – Girls born in the U.S. today can expect to live about 5 years longer than boys. • Ethnicity – Mediated by socioeconomic status. • Nationality Kuther, Lifespan Development. © 2017, SAGE Publications. 5 Centenarians • Individuals who live past 100 years. • There were 37,000 centenarians recorded in the U.S. in 1990 and nearly 54,000 in 2010. • The longest recorded human life span is 122 years. Kuther, Lifespan Development. © 2017, SAGE Publications. 6 Changes in the Nervous System • Brain volume shrinks as dendrites contract and are lost, synapses decrease, and glial cells are lost. • Myelin losses contribute to cognitive declines with aging. • A program of aerobic exercise has been shown to restore brain volume, especially in the hippocampus (a brain region closely involved with memory). Kuther, Lifespan Development. © 2017, SAGE Publications. 7 Figure 17.1: Change in Hippocampal Volume With Aerobic Exercise Kuther, Lifespan Development. © 2017, SAGE Publications. 8 Compensation for Cognitive Declines • Older adults compensate for cognitive declines by showing more brain activity and using different brain areas in solving problems than do younger adults. • Older adults show brain activity that is spread out over a larger area, including both hemispheres, compensating for neural losses. • Cognitive reserve – The ability to make flexible and efficient use of available brain resources that permit cognitive, efficiency, flexibility, and adaptability. Kuther, Lifespan Development. © 2017, SAGE Publications. 9 Figure 17.2: Age Differences in Neural Activity During a Memory Task Kuther, Lifespan Development. © 2017, SAGE Publications. 10 Neurogenesis • The process by which new neurons are developed continues throughout life. • New neurons are created in the hippocampus and striatum (a subcortical part of the brain responsible for coordinating motivation with body movement). • It is estimated that about 2% of neurons are renewed each year. Kuther, Lifespan Development. © 2017, SAGE Publications. 11 Vision in Late Adulthood • Virtually all older adults have difficulty seeing objects up close. • Many adults develop cataracts, a clouding of the lens resulting in blurred, foggy vision that makes driving hazardous and can lead to blindness. – Cataracts result from hereditary and environmental factors. • Macular degeneration – A substantial loss of cells in the center area of the retina, the macula, causing blurring and eventual loss of central vision. Kuther, Lifespan Development. © 2017, SAGE Publications. 12 Figure 17.3: Age-Related Changes in the Eye Kuther, Lifespan Development. © 2017, SAGE Publications. 13 Hearing in Late Adulthood • Presbycusis – Age-related hearing loss. – Older adults experience difficulty distinguishing highfrequency sounds, soft sounds of all frequencies, and complex tone patterns. • Men tend to suffer hearing loss earlier and to a greater extent than do women. • About two thirds of older adults experience hearing loss, which can greatly diminish quality of life and poses health risks. Kuther, Lifespan Development. © 2017, SAGE Publications. 14 Compensation for Hearing Loss • Many older adults compensate for their hearing loss by reducing background noise and paying attention to nonverbal cues such as lip movements, facial expressions, and body language. • Use of hearing aids, although they are underused because: – Social attitudes that undervalue the importance of hearing. – Stigma associated with being seen wearing hearing aids. – Cost. Kuther, Lifespan Development. © 2017, SAGE Publications. 15 Cardiovascular Changes in Late Adulthood • With age, the heart experiences cell loss and becomes more rigid. Kuther, Lifespan Development. © 2017, SAGE Publications. 16 Respiratory Changes in Late Adulthood • The lungs gradually lose cells and elasticity over the adult years, substantially reducing the amount of oxygen that enters the system and is absorbed by the blood. • Older adults have more trouble breathing, feel more out of breath during physical exertion, and have a harder time catching their breath than younger adults. Kuther, Lifespan Development. © 2017, SAGE Publications. 17 Immune System Changes in Late Adulthood • With age, the immune system becomes less efficient and adaptive. • Declines in immune function place older adults at higher risk of diseases such as flu and pneumonia, cancers, and autoimmune diseases such as rheumatoid arthritis. • Exposure to stress reduces immune function, and the effects increase with age. Kuther, Lifespan Development. © 2017, SAGE Publications. 18 Compression of Morbidity • Over the past few decades, it has become increasingly common for older adults in industrialized nations to age well and delay disability and disease until the final months or years of life • Advances in medicine, improvement in the standard of living, and increased recognition of the importance of lifestyle contribute to compression of morbidity Kuther, Lifespan Development. © 2017, SAGE Publications. 19 Figure 17.5: Current Health Status Among Adults Aged 18 and Over in the U.S., 2012 Kuther, Lifespan Development. © 2017, SAGE Publications. 20 Nutrition • Losses in muscle mass contribute to weight loss and a slowed metabolism. – Therefore, adults require fewer calories and their diets must be more nutrient dense to meet their nutritional needs with fewer calories. – Older adults are less likely to get all of their nutritional needs met through their diet and are therefore at risk for a nutritional deficiency. Kuther, Lifespan Development. © 2017, SAGE Publications. 21 VIDEO CASE Aging and Physical Development Elsie and Margaret describe the physical changes that accompany aging and how they adapt to those changes. Note the variability in experiences. Kuther, Lifespan Development. © 2017, SAGE Publications. 22 Diet Suggestions for Older Adults • Nutritious foods (fruits, whole grains, low-fat dairy products, leafy green vegetables, and healthy sources of protein). • Supplements for vitamins A, B6, B12, C, and E. • Antioxidants and omega-3. – Important preventative effects for age-related declines in cognitive functions and neurodegenerative disorders. Kuther, Lifespan Development. © 2017, SAGE Publications. 23 Exercise • Exercise offers powerful health benefits to older adults. – Individuals as old as 80 who begin a program of cardiovascular activity show gains similar to those of much younger adults. – Weight-bearing exercise begun as late as 90 years of age can improve blood flow to the muscles and increase muscle size. • Throughout the adult years, moderate physical activity is associated with improved physiological function, a decreased incidence of disease, and reduced incidence of disease, and reduced incidence of disability. Kuther, Lifespan Development. © 2017, SAGE Publications. 24 Psychological Benefits of Exercise • Exercise offers older adults stress relief, protects against depression, and is associated with higher quality of life. • Older adults who are physically active show less neural and glial cell losses throughout their cortex and less cognitive decline than do those who are sedentary. • Exercise is associated with increased hippocampal volume. Kuther, Lifespan Development. © 2017, SAGE Publications. 25 Chronic Illness: Arthritis • A degenerative joint disease • Osteoarthritis (most common) – Affects joints that are injured by overuse. – Results in loss of movement and pain. – Aging is the most prominent risk factor; it may first appear in middle adulthood but becomes more common and worsens in severity during older adulthood. • Rheumatoid arthritis (not age- or use-related) Kuther, Lifespan Development. © 2017, SAGE Publications. 26 Chronic Illness: Diabetes • Diabetes is a disease marked by high levels of blood glucose. • About one fourth of older adults over the age of 60 have diabetes. • Diabetes is the leading cause of death among people age 65 and over. • Diabetes is influenced by heredity and lifestyle factors. – Ethnicity – Diet and exercise Kuther, Lifespan Development. © 2017, SAGE Publications. 27 Risks of Diabetes • Increased risk of heart attack, stroke, circulation problems in the legs, blindness, and reduced kidney functions. • Serious cognitive and neurological effects – Brain aging, including declines in executive function, processing speed, memory, and motor function. • Psychosocial functioning – Depression Kuther, Lifespan Development. © 2017, SAGE Publications. 28 Preventing Diabetes • Maintaining a healthy weight through diet and exercise. • Individuals can successfully manage the disease by adopting a diet that carefully controls the amount of sugar entering the bloodstream as well as engaging in regular exercise. Kuther, Lifespan Development. © 2017, SAGE Publications. 29 Injuries • Deaths from unintentional injuries account for 61.5 deaths per 100,000 in 65-year-old adults, and a striking 361.9 in adults aged 85 and older. Kuther, Lifespan Development. © 2017, SAGE Publications. 30 Injuries: Motor Vehicle Accidents Kuther, Lifespan Development. © 2017, SAGE Publications. 31 Injuries: Falls • One out of three U.S. adults over the age of 65 and one half of those over the age of 80 fall each year. • Factors associated with increased risk of falls among older adults: – Changes in vision, hearing, motor skills, and cognition. • Falls are a serious hazard for older adults because of the natural loss of bone and high prevalence of osteoporosis increase the risk of bone fractures. Kuther, Lifespan Development. © 2017, SAGE Publications. 32 Dementia • Dementia refers to a progressive deterioration in mental abilities due to changes in the brain that influence higher cortical functions such as thinking, memory, comprehension, and emotional control. • Reflected in impaired thought and behavior • Interferes with the older adult’s capacity to engage in every day activities. Kuther, Lifespan Development. © 2017, SAGE Publications. 33 Figure 17.9: Projected Growth in Dementia Prevalence: LowIncome vs. High-Income Countries, 2013–2050 (projected) Kuther, Lifespan Development. © 2017, SAGE Publications. 34 Alzheimer’s Disease • The most common cause of dementia. • A progressive neurodegenerative disorder. • It progresses from general cognitive decline, to include personality and behavior changes, motor complications, sever dementia, and death. • The risk of Alzheimer’s disease grows exponentially with age, doubling approximately every five to six years in most Western countries. Kuther, Lifespan Development. © 2017, SAGE Publications. 35 Figure 17.10: Projected Prevalence of Alzheimer’s Disease in the U.S. Population, 2010-2015 (projected) Kuther, Lifespan Development. © 2017, SAGE Publications. 36 Description of Alzheimer’s Disease • Widespread brain deterioration and the presence of amyloid plaques and neurofibrillary tangles in the cerebral cortex. Kuther, Lifespan Development. © 2017, SAGE Publications. 37 Diagnosis of Alzheimer’s Disease • Alzheimer’s disease is diagnosed in living patients through exclusion: by ruling out all other causes of dementia. – Brain imaging can help physicians rule out other, potentially treatable, causes of dementia, such as a tumor or stroke. Kuther, Lifespan Development. © 2017, SAGE Publications. 38 Progression of Alzheimer’s Disease 1. Memory problems (episodic memory) – May look like absentmindedness 2. Impairments in attentional control 3. Severe problems with concentration and short-term memory; confusion 4. Vocabulary and speech impairments 5. Personality changes 6. Become unable to care for themselves 7. Inability to recognize objects and familiar people 8. Final stages – lose the ability to comprehend and produce speech, to control bodily functions, and to respond to stimuli Kuther, Lifespan Development. © 2017, SAGE Publications. 39 Risk Factors for Alzheimer’s Disease • Gender – Women are at greater risk than men. • Age • Ethnicity – African Americans and Hispanic older adults are more likely to have Alzheimer’s disease and other dementias. • Genetics • Same factors that contribute to cardiovascular risk. Kuther, Lifespan Development. © 2017, SAGE Publications. 40 Protective Factors Against Alzheimer’s Disease • Education – The process of learning promotes neural activity and increases connections among neurons, thickening the cortex and boosting cognitive reserve. Kuther, Lifespan Development. © 2017, SAGE Publications. 41 Vascular Dementia • Also known as multi-infarct dementia. • The second most common form of dementia and loss of mental ability in older adulthood, worldwide. • Caused by strokes, or blockages of blood vessels in the brain. – With each small stroke, brain cells die, and an immediate loss of mental functioning occurs. – As time passes, individuals tend to show improvement because the brain’s plasticity leads other neurons to take on functions of those that were lost. Kuther, Lifespan Development. © 2017, SAGE Publications. 42 Risk Factors for Vascular Dementia • Genetic and environmental factors – Obesity and overweight in middle-age adults. – People who are at risk for cardiovascular disease. – Gender – men are more likely to suffer early vascular dementia. – Heavy alcohol use, smiling, inactivity, stress, and poor diet (all more prevalent in men). – Cross-cultural differences. Kuther, Lifespan Development. © 2017, SAGE Publications. 43 Preventing Vascular Dementia • Factors that prevent cardiovascular disease, such as physical activity, also prevent and slow the progression of vascular dementia. Kuther, Lifespan Development. © 2017, SAGE Publications. 44 Parkinson’s Disease • The most common cause of subcortical dementia. • A brain disorder that occurs when neurons in a part of the brain called the substantia nigra die or become impaired. – Neurons in this part of the brain produce the neurotransmitter dopamine, which enables coordinated function of the body’s muscles and smooth movement. – Symptoms appear when at least 50% of the nerve cells in the substantia nigra are damaged. Kuther, Lifespan Development. © 2017, SAGE Publications. 45 Symptoms of Parkinson’s Disease • Motor symptoms – – – – – Tremors Slowness of movement Difficulty initiating movement Difficulty with balance Shuffling walk • Cognitive symptoms – Those with larger cognitive reserves and more synaptic connections among neurons show a slower progression of neurological changes before dementia appears. Kuther, Lifespan Development. © 2017, SAGE Publications. 46 Risk Factors for Parkinson’s Disease • Genetic, environmental, and lifestyle influences: – Epigenetics. – No gender, ethnic, social, economic, or geographical boundaries. Kuther, Lifespan Development. © 2017, SAGE Publications. 47 Reversible Dementia • Dementia caused by psychological and behavioral factors that can be reversed. • Common causes: – Poor nutrition and dehydration. – Prescription and nonprescription drugs and drug interactions. – Symptoms of depression and anxiety in older adults. Kuther, Lifespan Development. © 2017, SAGE Publications. 48 VIDEO CASE Caring for Ill Older Adults Elsie, a certified nurse’s assistant, discusses her experiences working with older adults. Kuther, Lifespan Development. © 2017, SAGE Publications. 49 Working Memory • Age-related declines in working memory span from young through older adulthood. • The greater the number of tasks and demands, the worse the performance. • Reduced sensory capacity contributes to older adults’ difficulty with working memory. • Multitasking is challenging in older adulthood. • Older adults show a significant information processing bias toward positive versus negative information. Kuther, Lifespan Development. © 2017, SAGE Publications. 50 Long-Term Memory • Age-related changes in working memory contribute to changes in long-term memory. • Semantic memory (memory for factual material) shows little age-related decline. • Episodic memory (autobiographical memory) and memory for experiences tends to deteriorate with age. Kuther, Lifespan Development. © 2017, SAGE Publications. 51 Figure 17.11: Age and Cohort Differences in Cognitive Aging Kuther, Lifespan Development. © 2017, SAGE Publications. 52 Age-Related Changes in Language • Sensory and cognitive changes influence older adults’ capacities for language. – Age-related hearing loss and reductions in attention and processing speed mean that following rapid speech and understanding speech when there is background noise require more effort with age. Kuther, Lifespan Development. © 2017, SAGE Publications. 53 Problem Solving • Problem-solving skills in everyday settings show that people remain efficient decision makers throughout adulthood. • Older adults are better at matching their strategies to their goals than are young adults. Kuther, Lifespan Development. © 2017, SAGE Publications. 54 Wisdom • Expertise in the conduct and meanings of life. • Characterized by emotional maturity and the ability to show insight and apply it to problems. Kuther, Lifespan Development. © 2017, SAGE Publications. 55 Cognitive Changes • Fluid intelligence declines in older adulthood. • Crystallized intelligence remains the same or improves. • Cognitive abilities tend to remain stable, relative to peers, over the life span. • Differences in experience and lifestyle can account for many differences in cognitive change over adulthood. Kuther, Lifespan Development. © 2017, SAGE Publications. 56