PHYSICAL AND COGNITIVE DEVELOPMENT IN LATE ADULTHOOD

CHAPTER 17

PHYSCIAL DEVELOPMENT IN LATE ADULTHOOD

What is old age?

GERONTOLOGISTS

Specialists who study aging•Late adulthood as a period of considerable diversity in which people change

•Growth in some areas, decline in others•Geriatrics: Is associated with the medical care of older people.

Aging: Myth and Reality

Late adulthood holds a unique distinction among the periods of human life: It is actually increasing in length•Greater proportion of people living in late adulthood

•Elderly population now divided by functional aging– Young old (65 to 74 years)– Old old (75 to 84 years)– Oldest old (85 years and older)

How is old age divided?

Some researchers divide aging people into three groups:•Young old are healthy and active

•Old old have some health problems and difficulties

•Oldest old are frail and need care

Who are the oldest old?

Oldest old•Fastest growing segment of the population

•People who are 85 or older

•Group's size has nearly doubled in the last 20 years

•Trend is occurring in every developed country in the world

Ageism

Prejudice and discrimination directed at older people is manifested in several ways

Discrimination based on age.•Negative attitudes about older people, especially about competence and attractiveness

•Job discrimination•Nurses need to reflect on personal beliefs and values toward older adults

Discrimination

Identical behavior by an older person and a younger person is interpreted differently

•People talk baby talk to persons in nursing homes

•Most negative views are based on misinformation

Myths of Aging

Myths and Realities of Aging

You know you are aging when…

• Grey and white hair; thinner

• Wrinkles

• Diminishing height

Osteoporosis

Bones become brittle, fragile, and thin, often brought about by a lack of calcium in the diet•25 percent of women over 60 have osteoporosis

•Largely preventable with sufficient calcium and exercise

Double Standard

Women, especially in Western cultures, suffer from the double standard for appearance•Women who show signs of aging are judged more harshly than are men

•Women are more likely to dye their hair

•Women are more likely to have plastic surgery

Changes in Internal Function

• Brain becomes smaller and lighter with age– Reduction of blood

flow to the brain

– Space between the skull and the brain doubles from age 20 to 70

– Number of neurons, or brain cells, declines

All Systems Go…or Gone?

• 75-year-old's heart pumps less than three-quarters of the blood it pumped during early adulthood

• Efficiency of the respiratory system declines with age

• Digestive system produces less digestive juice and is less efficient in pushing food through the system

Peripheral Slowing Hypothesis

Older adults’ reaction time slows significantly •Suggests that overall processing speed declines in peripheral nervous system (spinal cord and brain)

Generalized Slowing Hypothesis

Processing in all parts of the nervous system, including the brain, is less efficient•Older people have more accidents

•Decision process is slowed down

Senses

Old age brings a distinct declining in the sense organs of the body

•Vision– Lens becomes less transparent and the pupils shrink– Optic nerve becomes less efficient– Distant objects become less acute

The Eyes Have It!

Cataracts•Cloudy or opaque areas of the lens of eye that interfere with passing light, frequently develop

•Cataracts can be surgically removedIntraocular lens implants

Glaucoma

• Pressure in the fluid of the eye Glaucoma can be corrected with drugs or surgery

• Age-related macular degeneration (AMD)– Affects the macula

Hearing

• 30 percent of adults between 65 and 74 have some hearing loss

• 50 percent of adults over 75 have hearing loss

• High frequencies are the hardest to hear

• Overall, more than 10 million elderly people in the United States have hearing impairments of one kind or another

Hearing Aids

Hearing aids would be helpful 75 percent of the time•Only 20 percent of people wear them•Are imperfect and amplify all sounds so it is difficult to discern conversations

•There is a stigma attached to wearing a hearing aid

•Because they cannot hear, some people withdraw from society because they feel left out and lonely

Taste and Smell

Both senses become less discriminating in old age•Due to decline in taste buds on tongue•Olfactory bulbs in the brain shrink and reduce the ability to smell

– People eat less and get poor nutrition– Older people may over-salt their food and develop

hypertension, or high blood pressure

HEALTH AND WELLNESS IN LATE ADULTHOOD

Health Problems in Older People

• People of all ages suffer from cancer, heart disease, and other diseases and illnesses

• Incidence of these diseases increase with age

• Rebound is often slower

Physical Disorders

Psychological and Mental Disorders

Alzheimer's Disease

• Progressive brain disorder

• Produces loss of memory and confusion

• Incidence and projection

Symptoms of Alzheimer's Disease

Symptoms•Develop gradually

•Start with forgetfulness

•Affect recent memories first and then older memories fade •Causes total confusion, inability to speak intelligibly or recognize closest family members

•Loss of voluntary control of muscles occurs

What about a genetic link?

Genetics•Inherited disorder

•Nongenetic factors such as high blood pressure or diet may increase susceptibility

•Cross-cultural influences

Treatment and Cure

Treatment and cure•No cure

•Treatment deals only with the symptoms

•Drugs effective in only half of Alzheimer's patients •Many end in nursing homes

Caring for People with Alzheimer's Disease

• Make patients feel secure• Provide labels for everyday objects• Keep clothing simple• Put bathing on a schedule• Prevent people with the disease from driving• Monitor the use of the telephone• Provide opportunities for exercise• Take care of caregiver!

Relationship Between Aging and Illness

• Certain diseases, such as cancer and heart disease, have clear genetic component

• Economic well-being also plays role

• Psychological factors play important role in determining people's susceptibility to illness—and ultimately likelihood of death

Chronic Illness

Most older people have at least one chronic, long-term condition•Arthritis

– Inflammation of one or more joints, is common, striking around half of older people

•Hypertension– High blood pressure, striking about one-third of older

people

Psychological Illness

15 to 25 percent of those over age 65 show some symptoms of psychological malady•Depression

•Dementia

Can well-being improve?

People can do specific things to enhance their physical and psychological well-being and their longevity – their active life spans -- during old age•Eat a proper diet

•Exercise

•Avoid threats to health, such as smoking

Malnutrition and Hunger

Sometimes older people experience difficulties that prevent them from following even these simple guidelines.

•Varying estimates suggest that between 15 and 50 percent of elderly people do not have adequate nutrition, and several million experience hunger every day

– Poverty– Physical inability to shop or cook– Lack of motivation to eat properly– Decline in taste and smell sensitivity

Sex in Old Age: Use It or Lose It

• Related to physical and mental health and previous sexual activity

• Evidence suggests that people are sexually active well into their 80s and 90s

• Previous sexual activity increases the desire for sex

• Having sex regularly is associated with lower risk of death

Animal Life Spans

Maximum recorded life spans for animals found in the wild.(Source: Based on Kirkwood, 2010).

Environmental Factors

• Certain environmental and cultural factors are related to greater or lesser degrees of intellectual decline

• Lesser declines are associated with many factors

1, 2, 3…Think!

Exercising the aging brain•Continued cognitive stimulation keeps cognitive abilities sharp

•Training showed long-term effects

•Engaging in some form of mental workout- consistently and continually increasing the level of difficulty-is key to success

• Physiological Aging:– Lean body mass is reduced, fat tissue increases, and

bone mass decreases.– Decreased total body fluids

Integument

• Dry skin, less elastic• Hair loses color• Thick toenails• Increased facial hair• Loss of elastic fiber, resulting in double chin, sagginf

eyelids and earlobes and wrinkles of skin

Neuromuscular

• Reduction in speed and power of skeletal or voluntary muscle contractions

• Diminished physical activity• Kyphosis (humpback of the upper spine• Osteoporosis: decrease in bone density

Sensory/Perceptual

• Changes in vision, changes around the eye, shrunken appearance of the eyes, decreased visual acuity

• Atrophy of the lacrimal glands – eye dryness• By 80 all older adults have some lens opacity, cataract• Loss of hearing – presbycusis.• Poorer sense of taste and smell• Loss of skin receptors loss of sensations of pain, touch

and temperature

Pulmonary

• Decreased respiratory efficiency• Dyspnea• Mucous secretions collection in respiratory tree -

infections

Cardiovascular

• Reduced working capacity of the heart• Reduced arterial elasticity• Orthostatic hypotension

Gastrointestinal

• Periodontal disease – loss of teeth• Reduced saliva production• Decreased esophageal motility – lead to slow emptying

process• Decreased stomach motility- increased incidence of

gastric irritation• Decreased intrinsic factor – pernicious anemia• Decreased intestinal absorption

urinary

• Decreased secretory function• Urinary urgency and frequency• Nocturia• Urinary incontinence

Genitals

• Degenerative changes in the gonads• Breast tissue atrophy

Psychosocial aging

• Erikson: Integrity versus despair – sense of wholeness and satisfaction from past accomplishments. Death is an acceptable completion of life. By contrast with people who believe that they made poor life choices and wish they could live life over

Cognitive abilities

• Perception– Brain loses mass – Reduced blood flow to brain

Moral reasoning

• Older adult at the preconventional level obeys rules to avoid pain and the displeasure of others

• Older adults at conventional level follow society’s rules of conduct in response to the expectations of others

Health problems

• Injuries: car accidents, fire hazards, hypothermia– Alzheimer people suffer safety problems

• Chronic disabling illness: arthritis, osteoporosis heart disease, stroke, obstructive lung disease, hearing and visual alterations, cognitive dysfunctions, fractures, pneumonia, trauma from falls, motor vehicle crashes

• Drug misuse• Alcoholism• Dementia• Mistreatment of older adults