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Late adulthood (old age) is generally considered to begin at about age 65. Erik Erikson suggests that at this time it is important to find meaning and satisfaction in life rather than to become bitter and disillusioned, that is, to resolve the conflict of integrity vs. despair. Despite the problems associated with longevity, studies of people in their 70s have shown that growing old is not necessarily synonymous with substantial mental or physical deterioration. Many older people are happy and engaged in a variety of activities. Gerontology, an interdisciplinary field that studies the process of aging and the aging population, involves psychology, biology, sociology, and other fields.

Theories of successful aging

Theories of successful aging include the following:

The disengagement theory states that as people age, their withdrawal from

society is normal and desirable as it relieves them of responsibilities and roles that have become difficult. This process also opens up opportunities for younger people; society benefits as more-energetic young people fill the vacated positions.

The activity theory contends that activity is necessary to maintain a life of

quality, that is, that one must use it or lose it no matter what one's age and that people who remain active in all respectsphysically, mentally, and sociallyadjust better to the aging process. Proponents of this theory believe that activities of earlier years should be maintained as long as possible.


Ageism may be defined as the prejudice or discrimination that occurs on the basis of age. Although it can be used against people of all ages, older people are most frequently its target and it may often result in forced retirement. Stereotyping of the elderly is also an aspect of ageism, as seen in such a statement as He drives like a little old lady.

Physical changes: People typically reach the peak of their physical strength and
endurance during their twenties and then gradually decline. In later adulthood, a variety of physiological changes may occur, including some degree of atrophy of the brain and a decrease in the rate of neural processes. The respiratory and circulatory systems are less efficient, and changes in the gastrointestinal tract may lead to increased constipation. Bone mass diminishes, especially among women, leading to bone density disorders such as osteoporosis. Muscles become weaker unless exercise programs are followed. The skin dries and becomes less flexible. Hair loss occurs in both sexes. There is also decreased sensitivity in all of the sensory modalities, including olfaction, taste, touch, hearing, and vision.

Cognitive changes: The

study of cognitive changes in the older population is

complex. Response speeds (neural and motor) have been reported to decline; some researchers believe that age-related decrease in working memory is the crucial factor underlying poorer performance by the elderly on cognitive tasks.

Intellectual changes: In

late adulthood do not always result in reduction of

ability. While fluid intelligence (the ability to see and to use patterns and relationships to solve problems) does decline in later years, crystallized intelligence (the ability to use accumulated information to solve problems and make decisions) has been shown to rise slightly over the entire life span. K. Warner Schaie and Sherry Willis reported that a decline in cognitive performance could be reversed in 40% to 60% of elderly people who were given remedial training.

Dementias are usually responsible for cognitive defects seen in older people. These disorders, however, occur only in about 15% of people over 65. The leading cause of dementia in the United States is Alzheimer's disease, a progressive, eventually fatal disease that begins with confusion and memory lapses and ends with the loss of ability to care for oneself.

Retirement at age 65 is the conventional choice for many people, although some work until much later. People have been found to be happier in retirement if they are not forced to retire before they are ready and if they have enough income to maintain an adequate living standard. Chronic health problems such as arthritis, rheumatism, and hypertension increasingly interfere with the quality of life of most individuals as they age.

Women tend to marry men older than they are and, on average, live 5 to 7 years longer than men. One study found ten times as many widows as widowers. Widowhood is particularly stressful if the death of the spouse occurs early in life; close support of friends, particularly other widows, can be very helpful.

Death and dying

Death and dying has been studied extensively by Elisabeth Kbler-Ross, who suggested that terminally ill patients display the following five basic reactions.

Denial, an attempt to deny the reality and to isolate oneself from the event, is

frequently the first reaction.

Anger frequently follows, as the person envies the living and asks, Why

should I be the one to die?

Bargaining may occur; the person pleads to God or others for more time. As the end nears, recognition that death is inevitable and that separation

from family will occur leads to feelings of exhaustion, futility, and deep depression.

Acceptance often follows if death is not sudden, and the person finds peace

with the inevitable. People who are dying are sometimes placed in a hospice, a hospital for the terminally ill that attempts to maintain a good quality of life for the patient and the family during the final days. In a predictable pattern after a loved one's death, initial shock is followed by grief, followed by apathy and depression.

Emotional and Social Development in Late Adulthood

Eriksons Theory: Ego Integrity vs. Despair is the final stage of life. This involves coming to terms with ones life. If there is a sense of integrity, people feel whole, complete, and satisfied with their life choices and achievements. They have accepted the setbacks and disappointments and celebrated the successes and found a way to meaning within all these life events. Everything gets put into a perspective which allows a certain contentment with life. Increased age is associated with greater maturity and well-being. There is even a peace about ones mortality, even as close to the end as these people are. Despair, on the other hand occurs when seniors feel they have made wrong decisions, but life is too short to remedy any life directions. They display bitterness, defeat and anxiety about death, a hopelessness. Their contempt for themselves is displayed as anger toward others. This further alienates them from the very relationships they need to put right in order to find peace. It is a sad cycle.

Other Theories of Psychosocial Development in Late Adulthood

Pecks Theory: three Tasks of Ego Integrity are involved in finding integrity. Ego differentiation vs. work-role preoccupation: This task comes out of retirement, as people who have been invested in careers find other ways to self-worth. They must find another role to invest in and find meaning. Body transcendence vs. body preoccupation. This task requires finding a way to transcend physical limitations, disabilities, loss of youth and beauty, to find value in cognitive, social strengths & relationships.

Ego transcendence vs. ego preoccupation. This task involves finding a constructive way of facing the reality of death. Elders must find a future beyond their own mortality, through giving back to a younger generation.

Stability and Change in Self-Concept and Personality

Secure and Multifaceted Self-Concept- after a lifetime of self-knowledge, people feel more secure about whom they are, and their self-concepts become more complex and multifaceted. With that complex knowledge, people can make compensations in areas of weakness, and they develop deeper self-acceptance. People define themselves more broadly, not just in terms of work. Healthy elders report areas they still hope for development, as if they are still a work in progress.

Agreeableness, Sociability, and Acceptance of Change- there are 3 shifts in personality at this point: a more flexible and optimist approach to life is present. Agreeableness generosity, acquiescence, and good-naturalness are higher for many people at this point. Sociability drops to some extent, as people become more selective about relationships and significant people die or move away. Acceptance of change seems to link to well-being. They develop a capacity to accept lifes vagaries, and they are resilient in the face of adversity. Spirituality and Religiosity- their sense of spirituality encompasses their lives more meaningfully. Often there develops a sense of truth and beauty in art, nature, and relationships. Religion gives people rituals that stabilize life and give meaning to the life struggle. 76% of Americans over 65 say religion is very important in their lives, and 16% say it is fairly important. They may not be as active in church because of physical limitations or transportation issues, but they say they would devote more time to it if they could. Spirituality advances to a higher level in late life- to a more reflective approach that is more at ease with the unknowable aspects of life. Factors related to Elder suicide- Two life events can prompt suicide: loss- of job, spouse may put people at sea trying to cope and adjust; and chronic or terminal illness that cause pain or diminish independent functioning. Men are so socialized to be active and independent, that if they lose that to an illness, they often cant find any compensating aspects of life. Prevention and treatment there are some warning signs- putting affairs in order, veiled statements about going away, dying, sleep or appetite changes. There are often self-destructive acts such as refusing to eat, or go to the doctor, or take meds. As many as 70% of suicide victims saw their doctor within a month of taking their lives, yet family nor doctor picked up on signals of despair. They need antidepressant meds, therapy, possibly hospitalization to deal with the immediate crisis. Its good if regular home visitors can be engaged, as well as day activities for the person to look forward to.

Health is a strong predictor of well-being in late adulthood. When people face illness or chronic disabilities, they feel a loss of personal control. Not only does helplessness increase, but social isolation increases, too. Then as mental health declines, it affects physical health, as people eat more poorly, get out less, distract themselves less from their ailments. If a senior must move to a nursing home, there is a redefinition of identity, as a person who can survive only in an institution. Many people get seriously depressed and deteriorate rapidly in a nursing home. Serious depression is associated with suicide. If they can retain any autonomy in an institution, it contributes to their successful survival. Negative Life Changes occur more often in late adulthood- loss of friends, spouses, poor health issues, financial strain & greater dependency. This issues hit women more often, but they still report that they have people who depend on them emotionally, so they retain some of their former identity, even though many relationships often feel strained, due to the womens lower ability to care for others. Social Support and Social Interaction social support reduces stress, so it promotes health & retain good mood and stay active and connected to others.

A Changing Social World

Social Theories of Aging
Disengagement Theory - the idea that social interaction declines because of mutual withdrawal between elders and society in anticipation of death. But not everyone disengages. Activity theory is the theory that there are social barriers to engagement, not just the desires of elders to disengage. Offering older adults opportunities for social contact does not guarantee greater sociability. Socio-emotional Selectivity Theory states that social networks become more selective as we age. People limit their contacts to familiar partners with whom they have the most rewarding relationships.

Social Contexts: Communities, Neighborhoods, and Housing

Communities and Neighborhoods- elders living in the suburbs are better off in terms of income and health, but elders in inner cities have greater access to social services. Those in small towns have the least access. Elders in small communities report greater life satisfaction.

Aging, Time Perception, and Social Goals

Victimization and Fear of Crime those elders who live alone or in inner-city areas suffer with fears of criminal victimization. It restricts their activities and undermines morale. Housing arrangement

Ordinary Homes offer seniors the greatest personal control over their lives. When health and mobility problems appear, living alone presents safety issues, as well as financial difficulties. Residential communities are designed to offer elders as much safety and autonomy as is possible. These centers also offer recreational activities, transportation, & support services. Congregate housing offers common meals in a dining room, as well as transportation and activities. Life care communities offer a variety of care- from independent or congregate housing to full nursing care. When there is a sense of community, life satisfaction is higher. Nursing homes represent the greatest restriction of autonomy, but are necessary when family can no longer care for the physical/ nursing needs of a senior. Social interaction between residents is generally low, as language is often impaired, as well as cognitive function.

Relationships in Late Adulthood

Social convoy is a cluster of family members and friends who provide safety and support. Some bonds become closer with age, others more distant, a few are gained, and some drift away. Elders do try to maintain social networks of family and friends to preserve security and life continuity. Marriage marital satisfaction rises from middle to late adulthood if perceptions of fairness in the relationship increase. If couples engage in joint leisure activities and enjoy more positive communication, their relationships become more satisfying. Gay and Lesbian partnerships also report happy, highly fulfilling relationships in later life. Divorce and remarriage is more stressful for older than younger adults. Remarriage rates are low in late adulthood, but those who do remarry seem to create more stable relationships. Women suffer more financially in divorce late in life. There is much less chance of women remarrying at this point in life.

Widowhood Adaptation to Widowhood varies according to age, social support, and personality. Being widowed is somewhat easier later in life than earlier, since it is more natural at the later stage in life. Those widows who maintain social ties, have outgoing personalities, high self-esteem, and a sense of self-efficacy in dealing with their needs have more positive adjustments. Social report Senior centers Support groups Religious activities Volunteer activities

Never-Married, Childless Older Adults can develop alternative meaningful relationships. Siblings- Bonds with sisters are generally closer than those with brothers. Siblings enjoy reminiscing as they enter later adulthood. This allows them to feel a family continuity and harmony, as well as begin to put their lives into a perspective as they naturally do a life review. Friendships function to offer intimacy and companionship, acceptance, a link to the larger community, and protection from the toll of loss- physical and emotional. Women are more likely to have both intimate friends and secondary friends- people who are acquaintances they do some activities with occasionally. Relationships with Adult Children are important, as they exchange advice or wisdom, even offering some direct assistance. It is important if assistance is offered, though, that the elder maintain some means of reciprocation. Elders do not like to feel indebted to adult children, as they dont want to feel they cannot take care of themselves. Relationships with Adult Grandchildren and Great-Grandchildren offer elders a wider network of support. These are affectionate relationships, not so much aid or support. Affection may decline as the elder ages, but they feel great affection for adult grandchildren. Elder Maltreatment may occur at the hands of family members, caretakers, or friends. One of the most problematic situations is when there is a dependency between the elder and caregiver. Often the perpetrator is financially dependent on the elder and resents the person for that dependency. There are also problems in overcrowded institutions that are not sufficiently supervised.

Successful aging occurs when elders have developed many ways to minimize losses and maximize gains. Social contexts can foster successful aging. These are such things as wellfunded social security plans, good health care, safe housing that adjusts to changes in elders needs, social services, opportunities for lifelong learning. Better in-home help, adapted housing and sensitive nursing home care could make a difference in aging, too.

Physical and Cognitive Development in Late Adulthood

Physical Development
Functional age is the actual competence and performance a person displays, regardless of chronological age. People age biologically at different rates: 1) Young-old elderly appear physically young for their years. 2) Old-old elderly appear frail and show signs of decline.

Life Expectancy
Average life expectancy is the number of years that a person born in a particular year can expect to live. This has to do with nutrition, medical treatment available, safety. This has changed dramatically since 1900, when the average life expectancy was less than 50 years. Today, a person born in 2000 can expect to live 74 years (M) or 80 years (F). Certain death rates have declined greatly- especially heart disease- has dropped by 50% in the past 30 years due to declines in high blood pressure and smoking risks. Variations in life expectancy relate to gender (women can expect to live 4-7 years longer than men due to the protective factor of the extra X chromosomes.) White people will generally outlive African-American people and Native-American people. This seems related to higher rates of infant mortality, unintentional injuries, life-threatening disease, poverty-linked stress, and higher levels of violent death in low-SES minority groups. Quality of life can be predicted by a countrys health care, housing and social services. Active lifespan is the number of years of vigorous, healthy life a person born in a particular year can expect. Japan is first, and the US is 24th. Japan has a low rate of heart disease due to the low-fat diet, along with good health care and positive policies that benefit the elderly. In developing nations the life expectancy is closer to 50 years, and active lifespan is shorter- 44 in Haiti, 38 in Afghanistan, 26 in Sierra Leone. Life expectancy in late adulthood- in the US, people age 65+ have grown in numbersin North America, they have increased from 4% to 13%. The fastest growing group of elders is those 85+. The gender difference expands with age- at 65 there are 111 women per 100 men. At 85+ there are 160 women for 100 men. Life expectancy crossover surviving members of low-SES ethnic minority groups live longer than members of the white majority. Perhaps only the sturdiest males and females of low-SES groups survive into very old age, so they actually can outlive those in more favored groups. After people reach 75 years, heredity is not the same impact that environment is- now lifestyle makes the difference- diet, normal body weight, exercise, little substance use, optimistic outlook, low stress and social support. Maximum lifespan is the genetic limit to length of life free of external risk factors. 85 seems about average, but the oldest verified age is 122.

Physical changes
Centenarians secrets centenarians have increased 10 times in the past 40 years. Women outnumber men by 4/1. 60-70% has disabilities that prevent independent living, but many lead active lives. What do they do differently? Health and longevity seems to run in families, so there is an inherited aspect to long lived survival. They also havent had many chronic illnesses. They have efficient immune systems and few brain abnormalities. Most never smoked and were physically active into their late years. Personality is optimistic, not fear-driven. They score high in independence, hardiness, emotional security and openness to experience. They also cite close family bonds and a long and happy marriage.

Activities include community involvement, work, and leisure activities and continued learning. Nervous system impairments show up more after age 60, as the brain tissue declines due to loss of neurons and larger ventricles within the brain. As many as 50% of neurons may die in the visual, auditory, and motor areas of the brain. The cerebellum, which controls motor coordination, loses about 25% of neurons. Even so, aging neurons can establish new synapses in the wake of lost neurons. So parts of the brain compensate for lost ports. Temperature management is poorer as the autonomic nervous system is less efficient. So elderly are at greater risk during extreme weather. Sensory Systems there is reduced sensitivity with aging. Vision is reduced in dim light, and in nearby focus, as well as color perception. The cornea becomes more translucent and scatters light which blurs images. The lens yellows which affects color discrimination. Cataracts are cloudy areas in the lens which blur vision and can cause blindness if there is no surgery. There is poorer dark adaptation when coming in from the light. Depth perception is also compromised since binocular vision declines, as well as visual acuity. Macular degeneration occurs when light-sensitive cells in the macula, the central region of the retina break down, resulting in blurry central vision, and eventual blindness. A diet high in anti-oxidants can delay this condition. Driving may need to be curtailed at a certain point, as the older driver has a harder time discriminating the road distractions and signs. This is a hard thing to give up, since it signals physical dependence on others. Elders also are at higher risk of stumbling and serious falls at this point, as they dont see changes in the floor and accommodate smoothly. Hearing is impaired with reduced blood supply and death of the sense organs in the ear, the cilia, as well as the auditory cortex in the brain. The eardrum also stiffens, so not as much sensation gets to the inner ear. High frequencies are first to go. It is harder to distinguish speech in loud environments, especially after age 70. Hearing loss can affect safety, especially for pedestrians and drivers. Deafness is isolating, as people lose patience trying to communicate with deaf people. It also links to a certain paranoia, as deaf people fear others are talking about them. Many people learn to read lips as they experience hearing loss, so there are adaptations that can be made, if others will cooperate and help. Taste and smell declines somewhat, and people may have difficulty recognizing familiar foods by taste alone. It may be due to dentures, smoking, medications or even strokes. If food tastes less, it is also less appealing, so diet may become poorer. Smell is also related to enjoying food, but also protects the person from bad food, gas fumes, or smoke. Smell receptors are lost after age 60, and odor perception often becomes distorted in late adulthood. Touch perception declines after age 70. There is a loss of touch receptors as well as a slowing of blood circulation in the extremities. Cardiovascular and respiratory systems are affected by aging as the heart muscle becomes more rigid and some cells enlarge, thickening the left ventricle. Arteries stiffen and accumulate plaque. So the heart pumps with less force, and blood flow slows. So

during activity, sufficient oxygen may not be delivered to critical tissues. Lung tissue also loses elasticity, & capacity is reduced by half. The blood absorbs less oxygen and expels less carbon dioxide. People feel more out of breath when exercising. This is more of a problem for people who have smoked, had a high-fat diet, or been exposed to pollutants. Exercise facilitates respiratory function. Immune system declines as T cells become less effective. Auto-immune response is a problem when the immune system turns against normal body tissues. This puts elders at risk of infectious diseases, CVD, cancers, rheumatoid arthritis, or diabetes. The more impaired the immune system is, the more at risk the person is to a variety of agents. Sleep is essential for healthy functioning all ones life, but as we age, sleep is harder to come by, as elders sleep less, more lightly, and have more trouble going to sleep. Men seem to have more sleep problems than women, due to the enlargement of the prostate gland and the need to urinate more often at night. Sleep apnea is a condition where breathing ceases for 10 sec. or more, causing the person to awaken with a start to breathe again. This afflicts more men than women, but overweight people have problems with this condition, as more weight is pressing on the lungs, requiring more effort to keep breathing. Legs also move rapidly during the nightrestless legs and this can disrupt sleep, too. Unfortunately poor sleep can afflict daytime energy, resulting in a cycle of downward energy, even depression. More prescriptions for sleep aids are given to older adults, but they can have rebound effects later with greater insomnia. Physical appearance and mobility involve changes in the skin, hair, facial structure, and body build. The face most often shows the ravages of aging skin. The only structures to continue to grow are the nose and ears, as cartilage continues to grow. Hair thins and loses pigment. Height declines as the spine collapses with bone loss. Mobility declines as muscle strength declines- 30 50% declines after ages 70. Stretching exercises can reduce this decline. Adapting to physical changes of late adulthood we can do much more to improve physical and cognitive skills than to delay wrinkling or external signs of aging, but many products are hawked because people are more willing to spend money on products than do the hard work of staying active. o Coping strategies include both problem-centered and emotion-centered coping. The more people take charge of their lives the greater control they feel about their fates. People can use compensating techniques to adapt to sensory losses, if they will make the effort. The more passive people are, the more they report negative adjustment to life. o Assistive technology is devices that permit people with disabilities to improve their functioning. They include computers, phones that can be dialed by voice command, or print out the speech of the caller allow blind or deaf elders to maintain independence. A computer chip can be placed on medicine bottles to remind elders to take meds on schedule. Smart homes promote safety and mobility. o Stereotypes of aging include the idea that deterioration is inevitable and result in younger people talking down to elders, or ignoring them entirely. The more negatively stereotyped elders are, the more negatively their response to stress, producing poorer handwriting, memory, and will to live. The more control seniors are allowed, the longer they live, and the better their quality of life is. The more positive a culture views its elders, the better quality of life those elders sustain.

Cultural differences in aging in many varieties of culture, elders fare best when they retain social status and opportunities for community participation. The more they are excluded from social roles, aging reduces well-being. A tribe in Botswana treats aging as a marker of wisdom even making the eldest man and wife the village leaders. And as other elders become frail, children are sent to care for them, but it is considered a role of pride and prestige. In cultures where elders are segregated, they tend to dwell more on their disabilities and exclusion from younger, more powerful members of society. There develops a resentment between the generations, instead of an integration and enhancement of wisdom due to learning from the elders. Health, Fitness, and Disability- health is central to well-being in later life. Most elders do rate their health positively, & optimism is related to coping abilities in the area of health. There is possibility of overcoming a disability, especially if the elder has a desire to rehabilitate. African-American and Hispanic elderly are at greater risk for certain health problems, especially since they have more people living below the poverty line. Native-Americans are at even higher risk, health-wise, due to such high poverty ratesover 80%. By very old age, women are more impaired than men, since only the hardiest men have survived to this age. Compression of morbidity is the goal of reducing the period of disability in old age. Poverty rates and health problems of elderly ethnic minorities o African-American- 23% in poverty- risks of CVD, cancer, diabetes o Hispanic- 20% in poverty- risks of CVD, diabetes o Native-American- 80%+- diabetes, kidney disease, liver disease, TB, sensory impairments Nutrition and exercise Diet actually needs to be enriched with vitamins and minerals to protect elders immune system and bones. But many people have a poorer diet than in the past. Supplements can help, as well as weight-bearing exercise. Exercise also improves blood circulation to the brain, which enhances cognitive function and brain tissue. Exercise also contributes to higher sense of physical self-esteem. Unfortunately, those with chronic illnesses tend to think rest and sedentary life style if more healthful. Sexuality there is a decline in sexual desire and frequency of activity in older people, but desire is often still there. Good sex in the past predicts good sex in the future. Availability of a partner is still a powerful determiner of activity. Often when men have more trouble holding an erection they will refrain to act sexual, fearing embarrassment sexually. Certain illnesses and medications can impact blood flow to the penis- CVD, diabetes, meds for depression or high blood pressure. Unfortunately in our culture, sex among the elderly is viewed with disapproval. Physical disabilities do increase toward the end of the lifespan, especially illnesses such as CVD and cancer. Respiratory diseases also climb in late adulthoodemphysema is caused by loss of elasticity in lung tissue- most result from smoking. As the immune system declines, more people are at risk of pneumonia, severe lung inflammation. Stroke is 4th most common killer in the elderly. There is a blockage of blood flow in the brain which leads to death of neural tissue and accompanying loss of function. Osteoporosis rises in late adulthood, as well as arthritis. Adult-onset diabetes and unintentional injuries also increase in late adulthood. These illnesses are not caused by aging, but are related to age- they occur more often in the aged. o Primary aging biological aging that occurs even in the context of good health.

Secondary aging is declines in function due to hereditary defects and negative environmental influences, poor diet, lack of exercise, disease, substance abuse, environmental pollution, and stress. Mental disabilities are really only shown when there is severe cell death and structural or chemical abnormalities in the brain. Brain deterioration- Under imaging techniques, the brains of Alzheimers victims show shrinking of tissue, due to massive degeneration and death of neurons. Blood flow and activity in the brain are reduced. There are also chemical changes- lowered levels of neurotransmitters necessary for communication between neurons. Acetylcholine is especially lost. It is necessary to developing new learning. Serotonin is also lost, and it regulates arousal and mood, relating to sleep disturbances, aggression, impulsivity and depression. Autopsies show 2 major structural changes in the cortex of Alzheimers victims: neurofibrillary tangles and amyloid plaques. Neurofibrillary tangles are bundles of twisted threads that occur as neural structures collapse. Amyloid plaques are deposits of a deteriorated protein called amyloid, surrounded by clumps of dead nerve cells. Risk factors Alzheimers occurs in 2 types- familial and sporadic, which has no heredity history. Sporadic form occurs later in life and progresses faster. There are genes on certain chromosomes that link to familial Alzheimers. Another chromosomal abnormality has to do with excess levels of ApoE4, and is linked to amyloid plaque formation. Head injuries are linked to later development of Alzheimers. It also seems to attach once there has been stroke damage in the brain. High-fat diets also seem to relate, since Africans have lower incidence of Alzheimers than African-Americans with their high-fat diet. Protective factors include Vitamin C and E supplements, as well as anti-inflammatory drugs like aspirin. Education and an active lifestyle seem to be protective, as they increase synaptic connections and allow the brain to compensate for losses more effectively. Helping Alzheimers Victims and Caregivers there are some new drugs to increase the levels of acetylcholine and reduce the symptoms of Alzheimers disease. Spouses and family are heavily burdened with caregiving for these sufferers. It is a tragic disease to watch and stress on caregivers is enormous. There are some community aids- health care workers who come to the house, as well as day care for seniors. The more the environment can be kept the same, the better the person can manage. o Health care is becoming a large issue politically as seniors are becoming so impoverished as they try to pay for their meds and still live independently that the government is being pressured to do something to help. o Cost of health care for the elderly is increasing, as more people are living longer and needing medical care. Medical costs rise with age, as 75 year olds receive 70% more benefits from Medicare than younger seniors. Much of this cost is nursing care and hospital care, as seniors have progressively more chronic ailments. Even so, Medicare doesnt cover all medical costs for the elderly- it only covers about half of their costs. So more elders are sinking into poverty as they try to manage their health. o Long-term care is more common the older the person becomes. Only 4.5% of Americans over 65 will be institutionalized, but the costs of nursing care will bankrupt most seniors. And Medicaid requires that the senior use his/her own

funds for nursing care until he gets down to $2000 in assets before Medicaid will pay for nursing home costs. White Americans are more likely to use nursing homes than African-Americans. African-Americans are more likely to be cared for in extended families. More people are using assisted living, which is a homelike setting with some help for seniors, but not extreme nursing care. This can allow functional seniors to maintain their independence longer. Some of these places are in conjunction with day cares, allowing seniors to rock babies and play with toddlers during the day. This allows both generations access to the benefits of one anothers life stage.

Cognitive development
There is a general loss cognitively as people move closer to the end of life. But there are still techniques of compensation available. Selective optimization with compensation is one means of making best use of their cognitive skills. They narrow their goals, select personally valued activities so as to optimize or maximize returns from their energy. They find means to compensate for losses.

Older adults are taking in information more slowly, and they use strategies less, cant inhibit irrelevant information and retrieve important information from long-term memory. So memory failure increases. Slower processing speed means there will be less retained from current activities. They also forget context, which helps us recall information. Recognition memory does not decline as much as free recall. Deliberate vs. automatic memory o Implicit memory is memory without conscious awareness. This memory is more intact than deliberate memory, trying to recall information. Associative memory o Associative memory deficit is a problem creating and retrieving links between pieces of information. This is more common for elders. Remote memory is very long-term recall. It is not any clearer than recent recall for seniors, even though the myth is that seniors remember the past better than recent events. Autobiographical memory is memory for your own personally experienced events. Seniors best recall their adolescent and early adulthood experiences better than later life experiences. There was a lot of novelty in those times, as well as life choices being made- spouses, jobs, educational choices. These experiences were more emotionally charged, so they are remembered better. They become part of a persons life story, and are remembered often.

Prospective memory is remembering to do planned activities in the future. There is more forgetfulness and absentmindedness as people age. They tend to do better on event-based memory tasks than time-based tasks. Language processing- two aspects of language processing diminish in older age: finding the right words and planning what to say and how to say it. Their speech will have more pronouns, unclear references, they will speak more slowly, pause more often, have trouble finding the right words. There will be more hesitations, false starts, sentence fragments, word repetitions as they age. They tend to simplify their grammatical structures, so they can better retrieve the words they want. Problem solving- problem solving declines in late adulthood so married people tend to collaborate more in problem-solving. They will be better at solving problems they think are under their control. They will make more rapid decisions in areas of health, as that is an area they feel they have learned a lot about. Wisdom includes practical knowledge, ability to reflect on and apply that knowledge, emotional maturity, listening skills, and creativity in a way that helps others. This does increase with age. It occurs as people deal with more difficulties in life and find various means to adapt to change. Those with wisdom tend to have better education and are physically healthier. It requires insight into the human condition and often follows that people with this ability are found in high positions in business and politics and religion. Knowledge about fundamental concerns of life: human nature, social relationships, emotions Effective strategies for applying that knowledge to making life decisions, handling conflict, giving advice A view of people that considers multiple demands of their life contexts Concern with ultimate human values, the common good, respect for individual differences in values Awareness and management of the uncertainties of life- many problems have no perfect solution

Factors related to Cognitive change

Mentally active people are likely to maintain their cognitive abilities into advanced old age. Retirement can bring about changes in cognitive abilities depending on how those years are used. Terminal decline is a steady, marked decrease in cognitive functioning prior to death.

Cognitive interventions
Lifelong learning

Types of programs include Elderhostel, which encourages older adults to live on college campuses and take courses from experts, as well as travel the world. Many universities offer classes at low or no cost for seniors. Benefits of continuing education include learning new information, understanding new ideas, making new friends, and developing a broader perspective on the world. This may serve to shake up their stereotypes and value diversity in a new way.