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1. Chapter Fourteen
The Personal Context of Later
Life: Physical, Cognitive, and
Mental Health Issues

2. 14.1 What Are Older Adults Like?
Learning Objectives
• What are the characteristics of older adults in
the population?
• How long will most people live? What factors
influence this?
• What is the distinction between the third and
fourth age?

3. The Demographics of Aging
• Demographers study population trends
– Use population pyramids to illustrate these
trends
• The number of older adults in developed
nations will increase even more by 2050
– The number of older Asian-, Native-, and
especially Latino-Americans will continue
to increase
• The number of U.S. people over 85 will
increase by 500% between 2000 and 2050

4. Older Adults Globally

5. The Diversity of Older Adults
• Older women in the U.S. outnumber older
men
– True of all ethnic groups
• As of today, 50% of people over 65 have high
school diplomas
– 10% currently have college degrees
– 75% will have college degrees by 2030
• Better educated people live longer due to
higher incomes, giving them better healthcare
access

6. Longevity
• Number of years a person can expect to live
– Maximum life expectancy: oldest age to
which any person lives (circa 120 years)
– Useful life expectancy: number of years a
person is expected to live free from
debilitating chronic disease
– Average life expectancy: age at which half
of the people born in a particular year will
die in the U.S.
• 80.4 years (women); 75.4 years (men)

7. Genetic and Environmental Factors
in Life Expectancy
• Heredity is a major factor in longevity
– Particularly true for those over 100
• Environment plays a role through the effects
of disease, toxins, and risky behaviors
• Social class plays a role due to lack of access
to health care
• The U.S. healthcare system is broken,
especially for older adults (cf. Healthy People
2020)

8. Ethnic and Gender Differences
in Life Expectancy
• Average life expectancy: Latin Americans >
European Americans > African Americans
• U.S. women live longer than men by 5 years
at birth, but only 1 year by age 85
– Men are more susceptible to fatal
infectious diseases
– Complex interactions of lifestyle, genetics,
and immune functioning differences
• By age 90, however, men outperform women
on cognitive tests

9. The Third-Fourth Age Distinction
• Third age: ages of 60-80 (the young-old)
– Knowledge and technological advances
contribute to their better life quality
• Fourth age: over 80 (the oldest-old)
– Few interventions have been developed to
reverse this group’s physiological,
cognitive, and disease-related declines

10. The “Good News”: The Third Age
(Young-Old)
• Increased life expectancy
• Improved physical and mental fitness
• High emotional and personal well-being
• Good strategies to master life’s losses or
gains

11. The “Bad News”: The Fourth Age
(Oldest-Old)
• Sizeable losses in cognition and learning
potential
• Increases in chronic stress’s negative effects
• High prevalence of:
– Dementia (50% in those over 90)
– Frailty and multiple chronic conditions

12. 14.2 Physical Changes and Health:
Learning Objectives
• What are the major biological theories of
aging?
• What physiological changes normally occur in
later life?
• What are the principal health issues for older
adults?

13. Biological Theories of Aging
• Rate-of-living theories
– Relates a creature’s metabolism and age
• Cellular theories
– Aging chromosomes’ telomeres
• Cross-linking
– Muscles and arteries less flexible due to
certain proteins
• Programmed theories
– Genetically programmed cell death

14. Physiological Changes
• Neuronal changes are common in older age
• Alzheimer’s and related diseases involve
large changes in:
– Declining neurotransmitters levels
– Neuritic plaques: damaged or defective
neurons form around a core of protein
– Neurofibrillary tangles: spiral-shaped
masses form in the axon’s fibers

15. Cardiovascular and Respiratory
Systems
• Normative age-related changes
• 50% of adults over 65 have hypertension
– Declining heart muscle tissue; fat deposits;
artery stiffening due to calcification
• Transient ischemic attacks (TIAs)
• Cerebral vascular accidents
• Vascular dementia
• Chronic obstructive pulmonary disease
(COPD)

16. Sensory Changes: Vision
• Night vision problems
• Decreased adaptation
• Poorer green-blue-violent color discrimination
• Difficulties focusing and adjusting
• Loss of acuity between 20 to 60 years,
especially with low light
• Vision loss due to cataracts or glaucoma

17. Sensory Changes: Hearing
• Presbycusis: losing the ability to hear low-
pitched sounds
– Neural: loss of auditory pathway neurons
– Metabolic: diminished nutrient supply to
receptor cells
– Mechanical: atrophy and stiffening of the
receptor area’s vibrating structures
– Sensory: atrophy and degeneration of
receptor cells

18. Sensory Changes: Other Senses
• Taste, touch, temperature, and pain
sensitivity are not significantly age-related
• Detecting and distinguishing smells declines
substantially in many after the age of 70
– Very true of Alzheimer’s disease
– Very dangerous (e.g., gas leaks)
• Older people fall more often due to changes
in balance, eyesight, hearing, muscle tone,
reflexes

19. Chronic Disease and Health Issues
• Diabetes mellitus
– Type 1 Diabetes
– Type 2 Diabetes
• Cancer
• Health issues
– Sleep
• Circadian Rhythms
• Nutrition

20. 14.3 Cognitive Processes:
Learning Objectives
• What changes occur in information
processing as people age? How do these
changes relate to everyday life?
• What changes occur in memory with age?
What can be done to remediate these
changes?
• What is creativity and wisdom, and how do
they relate to age?

21. Information Processing
• Psychomotor speed: how quickly a person
reacts to make a specific response
• Slows with age in all situations, but especially
in ambiguous ones
– Occurs because older adults take longer to
decide whether they need to respond
– May explain higher driving fatality rates in
very old people
– Due to declines in the brain’s white matter
that aid faster neural transmission

22. Practical Aspects of Information
Processing: Driving a Car
• Various tests predict whether drivers should
be allowed to continue to drive
– Useful field of view (UVOF): tests
information-processing speed; extraction of
relevant information from irrelevant
background information
– Clock drawing test
– AAA’s “Roadwise Review”: assesses eight
functional areas

23. Working Memory
• Processes and structures involved in holding
and using information in problem-solving,
decision-making, and learning
– Small in capacity
– Without continued attention or rehearsal,
the information is “lost”
• Declines with age
• Poorer working memory and psychomotor
speed predict age-related declines in
cognitive performance

24. Implicit and Explicit Memory
• Explicit memory: conscious and deliberate
memory for previously learned information
– Semantic memory: remembering the
meaning of words and concepts
– Episodic memory: recalling information
about the world tied to a specific time or
event (includes autobiographical memory)
• Implicit memory: unconscious and automatic
memory about previously learned information
as seen through one’s behavior or reactions

25. When Is Memory Change Abnormal?
• Most people worry about memory loss and its
possible implications for disease
• A serious problem may be suspected when
memory failures interfere with everyday life
• Detecting whether memory problems are
serious requires thorough testing through:
– Physical and neurological examinations
– Batteries of neuropsychological tests

26. Remediating Memory Problems
• E-I-E-I-O framework: combines explicit vs.
implicit memory with external vs. internal
memory aids to create four types of memory
interventions
– Explicit-external aids
– Explicit-internal aids
– Implicit-external aids
– Implicit-internal aids

27. Creativity and Wisdom: Creativity
• Creativity: ability to produce work that
connects disparate ideas in novel ways
– Predicted by how much white matter
connects distant brain regions and
cognitive control over these connections
– Generally increases through the 30s,
peaking in the early 40s
– However, the age at which people make
major creative contributions has increased
during the 20th century

28. Creativity and Wisdom: Wisdom
• Baltes and colleagues describe wisdom as:
– Dealing with important matters of life and
the human experience
– Superior knowledge, judgment, and advice
– Knowledge with extraordinary scope,
depth, and balance
– Being used with good intentions,
combining mind and virtue
• Wisdom is unrelated to age

29. 14.4 Mental Health & Intervention:
Learning Objectives
• How does depression in older adults differ
from depression in younger adults? How is it
diagnosed and treated?
• How are anxiety disorders treated in older
adults?
• What is Alzheimer’s disease? How is it
diagnosed and managed? What causes it?

30. Depression
• Depression rates
– 9% in younger adults compared to 4.5% in
older people living in the community; 13%
in older adults requiring home healthcare
– Higher in older immigrant Latinos than
native-born; and in older Latino- and
European- than in African- or Asian-
Americans
• Fewer than 40% of U.S. adults receive
adequate treatment

31. How is Depression Diagnosed in
Older Adults
• The feeling symptom cluster: dysphoria
• The physical symptom cluster
– Loss of appetite, insomnia, and trouble
breathing
– Must be carefully evaluated as symptoms
of depression, because they may:
• Reflect normal age-related changes
• Have other physical, neurological,
metabolic, or substance abuse-related
causes

32. What Causes Depression?
• Biological explanations stress
neurotransmitter imbalances
– Imbalances increase with age, while
depression declines with age
• Internal belief systems play a role, e.g.,
– Believing one is personally responsible for
bad events, or thinking things will not get
better
• Older people have experientially-based
coping skills to combat depression

33. How is Depression Treated in Older
Adults
• Selective Serotonin Reuptake Inhibitors
(SSRIs) are the most preferred
– Boost mood-regulating serotonin levels
• Forms of psychotherapy
– Cognitive therapy
– Behavior therapy

34. Anxiety Disorders
• Excessive, irrational dread about everyday
situations, including irrational severe anxiety,
phobias, obsessions and/or compulsions
• Common in older adults, partly due to loss of
health, relocation of residence, isolation, loss
of independence
• Anxiety disorders can often be successfully
treated with relaxation therapy and
medications (e.g., benzodiazepenes, SSRIs,
beta-blockers, and buspirone)

35. Dementia: Alzheimer’s Disease
• Alzheimer’s disease (AD): one form of
dementia
– Gradual declines in memory, learning,
attention, and judgment
– Confusion as to time and place
– Difficulty communicating
– Declines in personal hygiene and self-care
– Personality changes/inappropriate social
behaviors

36. How Is Alzheimer’s Disease
Diagnosed?
• Only autopsies provide a definitive diagnosis
– Should reveal very large numbers of
neurofibrillary tangles, structural neuronal
changes, and amyloid plaques
• Diagnosis of possible AD is based on
extensive neurological, psychological, and
medical testing to rule out other causes, and
interviewing the family for their accurate
reports of behavioral symptoms

37. What Causes Alzheimer’s Disease?
• Cause(s) of AD are still being studied
– Differ between its early vs. late onset
(younger vs. older than 60)
• Autosomal dominant inheritance: genes with
100% accuracy in predicting early onset AD
• Risk genes: three genes are known thus far
to increase the risk of later onset AD (e.g.,
APOE-e4 gene)
– Increases risk even more if inherited from
both parents

38. What Can Be Done for Victims of
Alzheimer’s Disease?
• AD cannot be treated or prevented
• Drugs provide little long-term relief
• Some symptoms can be alleviated
• Spaced retrieval helps greatly
– An implicit-internal E-I-E-I-O method
– Teaches people to remember new
information by gradually increasing the
time interval between retrieval attempts
• Montessori educational methods also help

39. Parkinson’s Disease
• Slow hand tremors, shaking, rigidity, walking
problems; difficulties getting in/out of a chair
• Caused by deteriorating dopamine production
in the midbrain
• 30-50% of sufferers develop cognitive
impairments and eventually dementia
• Symptoms are treated by:
– Drugs that raise dopamine or aid its
delivery to the brain; neurostimulators

40. Chronic Traumatic Encephalopathy
• A form of dementia caused by repeated head
trauma such as concussions
– CTE can occur as the result of repeated
brain trauma not only in sports but also
through other causes such as military
combat
– Emerging evidence shows that irrespective
of the cause, there is structural damage to
various parts of the brain that have to do
with executive functions and memory