What concept signifies the actual competence and performance of older adults?

Cognitive decline as part of mental ageing is typically assessed with standardized tests; below-average performance in such tests is used as an indicator for pathological cognitive aging. In addition, morphological and functional changes in the brain are used as parameters for age-related pathological decline in cognitive abilities. However, there is no simple link between the trajectories of changes in cognition and morphological or functional changes in the brain. Furthermore, below-average test performance does not necessarily mean a significant impairment in everyday activities. It therefore appears crucial to record individual everyday tasks and their cognitive (and other) requirements in functional terms. This would also allow reliable assessment of the ecological validity of existing and insufficient cognitive skills. Understanding and dealing with the phenomena and consequences of mental aging does of course not only depend on cognition. Motivation and emotions as well personal meaning of life and life satisfaction play an equally important role. This means, however, that cognition represents only one, albeit important, aspect of mental aging. Furthermore, creating and development of proper assessment tools for functional cognition is important. In this contribution we would like to discuss some aspects that we consider relevant for a holistic view of the aging mind and promote a strengthening of a multidisciplinary approach with close cooperation between all basic and applied sciences involved in aging research, a quick translation of the research results into practice, and a close cooperation between all disciplines and professions who advise and support older people.

chronological age is an imperfect indicator of "functional age": the actual competence and performance of the older adult

"average life expectancy" is the number of years a person born in a particular year can expect to live

in 2008 the average life expectancy in the U.S. reach 78.1

declines in infant death rates have historically been a major contributor to increases in average life expectancy

advances in medical care also boosted average life expectancy over the 20th century

women tend to live 4 to 7 years longer than men, although this difference is decreased in industrialized nations

life expectancy varies with SES, ethnicity, and nationality

"Average healthy life expectancy" refers to the number of years a person born in a particular year can expect to live in full health, without disease or injury

Japan currently ranks first in average healthy life expectancy, in part due to low rates of obesity and heart disease, and favorable health care policies

in developing nations with widespread poverty, disease, and armed conflict; average life expectancy is about 50 years

Life expectancy in late adulthood shows decreased differences between males and females, and among ethnic and SES groups; possibly reflecting attrition of less healthy individuals

Factors in a long life:

Heredity

Environment/Lifestyle

healthy diet, normal weight

exercise

low substance use

optimism

low stress

social support

community involvement

life long learning

Quality of life

"activities of daily living" (ADL's) refer to basic self-care tasks needed to live independently (bathing, dressing, managing medications, keeping appointments, transportation). Your textbook breaks ADL's into two groups: basic self-care and "instrumental activities of daily living" (paying bills); but many discussions tend to consider ADL's as a whole.

ADL's may be much more situational they we commonly realize

"Maximum lifespan": the genetic/biological limit to the life of a person (excluding external risk factors)

for most of us it appears to be between 70 and 110, with 85 being a commonly cited average

approximately 120 years of life appears to be the upper limit on human life span, although this continues to be a point of debate among scientists

II. Physical Changes

Nervous system

the aging of the central nervous system affects a wide range of complex activities in the older individual

brain weight declines throughout adulthood, but the loss becomes greater beginning in the 60's due to death of neurons and enlargement of ventricles within the brain

growth of neural fibers in healthy older adults occur at similar rates as in middle-aged adults

elders who do well on complex cognitive activities (memory, problem solving) tend to show more widely distributed neural activity across the cerebral cortex--this is usually interpreted as their compensating for neuron loss by recruiting additional brain areas to support cognition

the autonomic (peripheral) nervous system, involved in many life support functions, also performs less well with age--putting the elderly at risk during heat waves and cold spells

Sensory systems

Cardiovascular and respiratory systems

aging in the cardiovascular and respiratory systems tends not to be apparent until late adulthood

decreased blood flow limits the oxygen delivery to body tissues during high physical activity

Immune system

as the immune system ages, T cells, which attack antigens directly, become less effective

immune system malfunctions become more frequent, "autoimmune responses" or "autoimmune diseases" reflect the immune system attacking normal body tissue

decrease immune system efficiency increases the risk for a variety of diseases in the elderly

Sleep

older adults appear to require approximately the same amount of sleep as younger adults, around 7 hours a night

increased difficulty with falling asleep, staying asleep, and sleeping deeply is reported in the elderly and seen in sleep lab studies

these problems may reflect changes in the brain systems controlling sleep, and by higher levels of stress hormones in the bloodstream

restful sleep can be enhanced by "good sleep habits": consistent bedtime and waking time, using the bedroom only for sleep and sex, regular exercise

prescription sedatives (sleep medications) can help relieve temporary insomnia but long-term use is often problematic

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III Cognitive Development

Dementia: loss of cognitive abilities due to neurological dysfunction, disease, or damage

Dementia's can be classified in several ways:

severity: mild, moderate, severe

course: static/chronic, progressive, reversible, irreversible

cause (etiology): metabolic/infectious, toxic, injury (TBI), disease, anoxic,

neurological site: cortical, subcortical

Classification by cause if probably the most common, but is also fraught with difficulties

misdiagnosis is common, even in carefully evaluated cases

depression ("pseudodementia") and medication side effects are often confused with Dementia's

types of disease based Dementia's may be misdiagnosed

more than one etiological factor may be in play (Alzheimer's disease and CVA's)

Diagnosis is a process of excusion of other problems that could account for the mental difficulties and evaluation of cognitive functions

mental status examinations: brief screens of cognitive functioning

Mini-Mental State Examination (MMSE) is one of the most well known, formal, mental status assessment device.

Dementia's of the Alzheimer's Type (DAT): progressive and irreversible declines in higher mental functions

Memory problems are usually the first observed symptom of DAT's

DAT's are usually defined as a generalized loss of mental ability (i.e., involving more than one cognitive capacity); this is usually operationalized as problems in Memory and one other broad category of mental functioning (Language, Praxis functions, Executive functions, Recognition of objects)

Alzheimer's Disease is a specific neuropathology that can only be conclusively diagnosed with biopsy (or autopsy) of brain tissue

inside neurons, neurofibrillary tangles appear: bundles of twisted threads that are the product of collapsed neuro structures and contain abnormal forms of the protein tau

outside neurons, amyloid plaques develop: dense deposits of a deteriorated protein called amyloid, surrounded by clumps of dead nerve and glial cells

synapses malfunction within the brain, possibly due to increased levels of amyloid

as synapses deteriorate, levels of neurotransmitters decline, neurons die, and brain volume shrinks

early onset of Alzheimer's disease (before 65) is associated with a family history of dementia (familial) and tends to progress more rapidly than late onset (after 65)

an abnormal gene on chromosome 19 which causes excessive production of ApoE4, a blood protein, is the strongest know association with nonfamilial (sporadic) Alzheimer's disease

genes on chromosomes 1, 14, and 21 are associated with familial Alzheimer's disease

individuals with Trisomy 21 (Down's syndrome) develop Alzheimer's disease in their late 30's

Alzheimer's Disease is the most common cause of dementia in the elderly

current treatments are symptomatic: slow progression of mental loss with halting the underlying pathology

cholinesterase inhibitors (donepezil/Aricept, galantamine/Reminyl, rivastigmine/Exelon) work by increasing the availability of a neurotransmitter called acetylcholine, which tends to be depleted in the brains of individuals with Alzheimer's disease; these medications are most effective early in the course of the disease

medications that affect another neurotransmitter, glutamate (memantine/Namenda), may augment the benefits of cholinesterase inhibitors and may be effective latter in the disease course

Cerebrovascular Dementia's: mental declines associated with circulatory system problems within the CNS (strokes, TIA's)

dementia associated with CVA's can be halted (not reversed) and stabilized if the underlying medical problems are dealt with

losses tend to be acute (discrete and abrupt), rather than the progressive (slow, gradual) pattern seen in DAT

Parkinson Dementia: a subcortical dementia associated with Parkinson's disease

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Aging and Normal Cognitive Functioning

Many types of remembering

"deliberate memory": intentional recall (What was the name of that actor, song, your Mother's neighbor, etc.)

recall ("associative memory") more difficult than recognition memory (in part due to environmental support)

context helps retrieval, but slower processing and smaller working memory means that context is less efficiently encoded

"automatic memory"

implicit memory (unconscious) better than deliberate memory

occurs without conscious awareness

depends on familiarity rather than on conscious use of recall stratgies

"remote memory"

very long-term recall

autobiographical memory

"prospective memory"

remembering to do something

event-based easier than time-based

reminders and repetition help

important in "adaptive behaviors of daily living"

Why Dr. Perry Spencer, the inventor of microwave oven, should have gotten a Nobel prize in Medicine

Language processing

comprehension changes very little

word retrieval may be more of a problem

"tip of the tongue" state

increased use of pronouns and pauses in speech

organization of speech

hesitations, false starts, repetition, and sentence fragments increase

problems planning what to say may show up in less organized statements

Executive functioning in late adulthood

are typically intact (unless dementia is occurring)

abstract/hypothetical reason tends to decline; in contras--applied, practical reasoning and problem solving is often very well retained

motivation matters: older adults do better with problems they perceive as important and situations they perceive themselves as having some control in

decision making may be rapid (this may reflect experience) but the elderly are also likely to consult trusted others

experience/wisdom tends to compensate for decreased fluid intelligence/working memory

but not everyone has found that the old are in fact more wise: Paul Baltes used fictional dilemma tasks to evaluate wisdom and younger adults did as well on his tasks.

the question becomes: What do we measure wisdom?

what contributes to wisdom?

life experience (not simply age)

overcoming adversity, solving problems, leadership experiences

emotional maturity/stability

human service, practice, mental activity (reflecting on your life, continued learning)

Terminal decline: increased speed and severity of mental deterioration often seen prior to death

is probably a real phenomenon but difficulties in definition make clear conclusions difficult

may not be (probably isn't) a unitary phenomenon

chicken and egg question: Does the cognitive change lead to the decreased emotional investment in life or does decreased emotional investment in life lead to the cognitive changes? (or do both the phenotypic [observed] changes reflect the effect of some more basic process?)

What did Baltes define as expertise in the conduct and meaning of life?

Baltes and colleagues define wisdom as expertise in the conduct and meaning of life. According to their theory, a wise person is someone who knows what is most important in life and how to get it.

Which of the following psychological constructs refers to the belief that one's performance in a situation depends on something that one personally does?

Which of the following psychological constructs refers to the belief that one's performance in a situation depends on something that one personally does? Personal Control.

Which of the following is an example of when an individual must perform divided attention?

Divided attention is the ability to pay attention to two tasks at once such as cooking a meal while talking to a friend or driving a car and talking to a passenger at the same time – neither activity is stopped in order to carry out the other activity.

Which of the following factors accounts for why adults in late adulthood may have gray hair?

Hair color change. Hair color is due to a pigment called melanin, which hair follicles produce. Hair follicles are structures in the skin that make and grow hair. With aging, the follicles make less melanin, and this causes gray hair. Graying often begins in the 30s.