The Personal Context of Later Life:

Physical, Cognitive, and Mental

Health Issues
 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?
 Older Adults Globally

The proportion of older adults (aged 65 years and over) is increasing in many countries and
will continue to do so in the coming decades.
 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
• Population estimates produced by Statistics South Africa (Stats SA) in
2017 show that South Africa’s population is estimated at 56,5 million
people. The estimates indicate that the proportion of elderly (60 years
and older) in South Africa is growing, reaching 8,1 % in 2017. According
to the estimates, there are 4,6 million people in South Africa over the
age of 60.
• Between 2002 and 2017, the proportion of elderly among black
Africans increased by 0,5%, among coloureds by 2,7%; among
Indians/Asians by 4,2% and among whites by 7,3%. Disparities in
ageing by province and population group have a historical context that
can be traced to fertility, mortality and migration streams over time.
 StatsSA mid 2017
Average life expectancy in South Africa
• In 2017, life expectancy at birth was estimated at 61,2
years for males and 66,7 years for females.– a staggering
increase of 8.5 years since the low in 2005.
• By 2025, the total population over 60 is projected to be
over 10.5% and by 2050, 14.2% (6.4 million)
• The expansion of health programmes related to HIV has
contributed to a decline in deaths due to communicable
diseases such as HIV and TB.
• Focus now lies on programmes to combat the increase in
deaths due to non-communicable diseases such as heart
disease, diabetes, etc., particularly among those aged 65
and older.
 The Diversity of Older Adults
• In the US, 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
• In South Africa racial differences show that
elderly whites and Indians/Asians occupied a
higher socio-economic status than black Africans
and Coloureds.
• The proportions of rich white elderly
persons were far higher than that of black African
elderly persons
 South African Issues
• The highest impact of ageing is in populations where
social and economic hardships are greatest, and where
poverty and HIV/AIDS have the greatest impact.
• Currently, black South Africans (male and female) have
been dying at a younger age than any other group.
• Rural provinces, where access to healthcare and
services for the elderly may be minimal, have higher
proportions of poor elderly persons than urban areas.
• At the same time, we are seeing an alarming increase
in the incidence of diabetes, heart disease and stroke,
which are effectively lifestyle diseases. This is
particularly prevalent among affluent sectors of the
population
 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)
– 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
• Think about it…. Why is this?
 Genetic and Environmental Factors in Life
Expectancy
• Heredity is a factor in longevity
– Particularly true for those over 100
• Environment plays a role through the effects of disease, toxins, and
risky behaviours
• Social class plays a role due to
lack of access to health care
• One might suspect this is so in South Africa
but even in the U.S. healthcare system is
described as broken, especially for older
adults
How do you believe that the South African
services cater for our elderly?
 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
 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
 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
 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?
 Biological Theories of Aging
• Rate-of-living theories
– Relates a creature’s metabolism and age
• Cellular theories
– Aging chromosomes’ telomeres
• Cross-linking
– Random protein interaction causes muscles and arteries
less flexible
• Free-radicals
– Highly reactive unstable molecules alter cellular oxygen
levels
• Programmed theories
– Genetically programmed cell death
•Chromosome ends called telomeres prompt the aging process in cells.
•Nobel Laureate Elizabeth Blackburn says we have more control over our telomeres than we think.
 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
 Cardiac, Vascular 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)
 Sensory Changes: Vision
• Night vision problems
• Decreased adaptation
• Poorer green-blue-violent colour discrimination
• Difficulties focusing and adjusting
• Loss of acuity between 20 to 60 years,
especially with low light
• Vision loss due to cataracts or glaucoma
 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
 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
 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?
 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
 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
 Older Persons Act (Act 13 of 2006)
The Older Persons Act aims to
maintain and protect the status,
wellbeing, safety and rights of older
persons. It also aims to promote their
integration in the community by
creating an enabling environment and
promoting participation in activities
with people of other ages and
cultures.
 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
 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 behaviour or reactions
 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
 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
 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
 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
 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?
 Depression
• Depression is a common condition among the elderly, occurring either in
isolation or in association with other diseases. The elderly are particularly at
risk for developing depressive illness as they are more likely than younger
individuals to suffer from impaired health. Depressive illness has a
substantial negative impact on the quality of life of patients and their
relatives. In addition, a strong link between depression and suicide has been
demonstrated.
• Depression is a widespread illness with an overall prevalence of 5 – 8%
throughout the world. The cumulative incidence of depression in people
aged up to 70 years is 26.9% for men and 45.2% for women. Clinical
depression is a whole body disorder, affecting the way you think and feel,
both physically and emotionally.
• 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
 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
 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
 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
– Behaviour therapy
 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)
 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
behaviours
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 behavioural symptoms
 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
 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
 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
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
 The Neuroscience Approach
• Learning Objectives
– What brain imaging techniques are used in
neuroscience research?
– What are the main research methods used and
issues studied in neuroscience research in adult
development and aging?
 The Neuroscience Approach
• Neuroimaging Techniques
– Two techniques are used most often:
• Structural neuroimaging: provides highly detailed
images of anatomical features of the brain
– Includes X-rays, CT and MRI
• Functional neuroimaging: provides an indication of
brain activity
– Includes SPECT, PET, fMRI and NIRSI
 The Neuroscience Approach
• Neuroscience Perspectives
– Neuropsychological Approach
• Compares healthy older adults with those with
pathological disorders of the brain
– Neurocorrelational Approach
• Links measures of cognitive performance to measures
of brain structure or functioning
– Activation Imaging Approach
• Links functional brain activity with cognitive behaviour
data
 Neuroscience, Adult Development
& Aging
• Learning Objectives
– How is the brain organized structurally?
– What are the basic changes in neurons as we age?
– What changes occur in neurotransmitters with
age?
– What changes occur in brain structures with age?
– What do age-related structural brain changes
mean for behaviour?
 Neuroscience and Adult Development &
Aging
• How is the Brain Organized?
– Brain is made up of neurons
• Neurons consist of dendrites, axon, neurofibers,
terminal branches.
• Neurotransmitters travel across the synapse.
 Neuroscience and
Adult Development & Aging
• How is the Brain Organized?
– Neuroanatomy: The study of the structure of the
brain, including the:
• Cerebral cortex
• Corpus callosum
• Prefrontal and frontal cortex
– Important for executive functions
• Cerebellum
• Hippocampus
• Limbic system
• Amygdala
 Neuroscience and
Adult Development & Aging
• Age-Related Changes in Neurons
– Number of neurons declines
– Number and size of dendrites decreases
– Tangles develop in axon fibers
– Increases in deposits of proteins
– Number of synapses decreases
 Neuroscience and
Adult Development & Aging
• Age-Related Changes in Neurotransmitters
– Dopamine is associated with higher–level cognitive
functioning, so declines are related to poorer:
• Episodic memory
• Tasks that require fast processing
– Serotonin and acetylcholine also
decline with age.
 Neuroscience and
Adult Development & Aging
• Age-Related Changes in Brain Structures
– White matter hyperintensities (WMH)
• Indicates myelin loss or neural atrophy
– Considerable shrinkage occurs in the brain
• Especially in prefrontal cortex, hippocampus and cerebellum
– Diffusion tensor imaging (DTI)
• Provides index of density or structural health of the white
matter
 Neuroscience and
Adult Development & Aging

• What Structural Brain Changes Mean

– Executive Functioning
• Difficulty focusing solely on relevant information
• Due to WMH and reduced volume of prefrontal cortex
– Memory
• Specific structural changes (e.g., the hippocampus) result in
memory decline
– Emotion
• Increased processing of positive emotional information
with age
 Neuroscience and
Adult Development & Aging
• What Structural Brain Changes Mean
– Social-Emotional Cognition
• Older adults may rely more on automatic judgment
processes than reflective processing
– Prefrontal Cortex
• The Positivity Effect: Older adults are more motivated
to derive emotional meaning from life and to maintain
positive feelings than younger adults
 Making Sense of Neuroscience Research

• Learning Objectives
– What is the Parieto-Frontal Integration Theory,
and what does it explain?
– How do older adults attempt to compensate for
age-related changes in the brain?
– What are the major differences among the
HAROLD, CRUNCH, and STAC models of brain
activation and aging?
 Neuroscience and
Adult Development & Aging
• The Parieto-Frontal Integration Theory
– Also known as P-FIT
– Proposes that intelligence comes from a distributed
and integrated network of neurons in the parietal
and frontal areas of the brain
The P-FIT Model
 Neuroscience and
Adult Development & Aging
• Can Older Adults Compensate for Brain Changes?
– Studies show that, when presented with similar tasks,
younger adults exhibit focal, unilateral activity in left
prefrontal region and older adults exhibit bilateral
activity (both left and right prefrontal areas).
• Older adults are compensating.
• Bilateral activation in older adults plays a supportive role in
older adults’ cognitive function.
Prefrontal Bilateral Activation
 Neuroscience and
Adult Development & Aging
• Theories of Brain-Behavior Changes
– HAROLD (hemispheric asymmetry reduction in older adults.
• Suggests bilaterality is compensatory in older adults with reduced
cognitive ability
– CRUNCH (compensation-related utilization of neural circuits
hypothesis)
• Similar to HAROLD but suggests additional mechanisms at work of
aging brains over-utilizing other regions in the left hemisphere on
demanding tasks before going to the right hemisphere.
– STAC (scaffolding theory of cognitive age)
• Default network theory holds that when the cognitive demands are
made on the brain the default network is suppressed.
 Neural Plasticity and the Aging Brain
• Learning Objectives
– What evidence is there for neural plasticity?
– How does aerobic exercise influence brain
changes and cognitive aging?
– How does nutrition influence brain changes and
cognitive activity?
 Neural Plasticity and the Aging Brain
• Plasticity: involves the interaction between
the brain and the environment and is mostly
used to describe the effects of experience on
the structures and function of the neural
system.
• Neural stem cells: give rise to new neurons;
persist in adult brains and can generate new
cells throughout adulthood.
 Neural Plasticity and the Aging Brain
• Role of Exercise
– Brain plasticity is enhanced by aerobic exercise.
• Role of Nutrition
– Researchers are beginning to understand the
relations between categories of nutrients and
brain structures.
Chronic Disease and Health Issues
• Diabetes mellitus
– Type 1 Diabetes
– Type 2 Diabetes
• Cancer
• Health issues
– Sleep
• Circadian Rhythms
• Nutrition
The End