Chapter 17 Physical and Cognitive Development in Late Adulthood

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Chapter 17
Physical and Cognitive
Development in Late Adulthood
©2005 McGraw-Hill Ryerson Ltd.
Physical and Cognitive Development
in Late Adulthood
Longevity
The Course of Physical Development
in Late Adulthood
Physical and Mental Health
and Wellness
Cognitive Functioning in Older Adults
Religion and Spirituality in
Later Adulthood
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Longevity
Life Expectancy
and Life Span
The Young Old,
the Old Old,
and
the Oldest Old
The Robust
Oldest Old
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Biological
Theories of
Aging
Life Expectancy and Life Span
• Life span – the upper boundary of life; the
maximum number of years an individual can
live.
• The maximum life span of human beings is
approximately 120 years of age.
• Life expectancy – the number of years that will
probably be lived by the average individual born
in a particular year.
• The life expectancy of individuals born today in
the Canada is 79.9 years.
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Centenarians
• Today, there are 4,320 centenarians living in
Canada.
• It is projected that this number will increase to
45,000 by 2046.
• Research reveals that many centenarians are
quite healthy in their old age.
• Centenarians are a robust group, as many have
had difficult lives.
• Such rapid growth in the older population will
most likely lead to a variety of societal changes.
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Gender Differences in Longevity
• Today, life expectancy for females is 81.4, males
75.7.
• Beginning at age 45, females outnumber males,
and the gap continues to grow.
• By the time adults are 70–74 years of age, more
than 53.4% of the population is female.
• These differences are due to health attitudes,
habits, lifestyles, and occupation.
• Biological factors play a role, too, as females
outlive males in virtually all species.
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The Young Old, the Old Old, and
the Oldest Old
• Late adulthood has the longest span of any period of
human development—50–60 years.
• Developmentalists thus distinguish between subperiods
in this stage, although definite age boundaries are not
yet agreed upon.
• The young old are 65–74 years of age.
• The old old are 75 years and older.
• Some distinguish the oldest old as 85 years and older.
• Many experts prefer to make the distinction based on
functioning, rather than age.
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The Robust Oldest Old
• The oldest old are much more likely to be female.
• They have a much higher rate of morbidity and a greater
incidence of disability than the young old.
• They are much more likely to be living in institutions, less
likely to be married, and more likely to have low
educational attainment.
• A substantial portion function effectively, and the majority
continue to live in the community.
• Forty percent say they have no activity limitation.
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Biological Theories of Aging
• Cellular Clock
Theory
• Free-Radical
Theory
• Hormonal Stress
Theory
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Cellular Clock Theory
• Leonard Hayflick’s view that cells can divide a
maximum of about 75–80 times and that, as we
age, our cells become increasingly less capable of
dividing.
• Thus, Hayflick places the upper limit of the human
life span at about 120 years.
• Recent research has shown that telomeres are
DNA sequences that cap chromosomes, and that
each time a cell divides, telomeres become
shorter and shorter.
• Age-related telomere erosion has been found to
be linked with an impaired ability to recover from
stress and an increased rate of cancer formation.
©2005 McGraw-Hill Ryerson Ltd.
Free-Radical Theory
• States that people age because
inside their cells normal metabolism
produces unstable oxygen molecules
known as free radicals.
• These molecules ricochet around the
cells, damaging DNA and other
cellular structures.
• This damage can lead to a range of
disorders, including cancer and
arthritis.
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Hormonal Stress Theory
• Aging in the body’s hormonal system may lower
resilience to stress and increase likelihood of
disease.
• With age, hormones stimulated by stress that
flow through the hypothalamic-pituitary-adrenal
system remain elevated longer than when we
were younger.
• These prolonged, elevated levels of stressrelated hormones are associated with increased
risks for many diseases including heart disease
and cancer.
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The Course of Physical Development
in Late Adulthood
The Aging Brain
Physical Appearance
Sensory Development
The Circulatory System
The Respiratory System
Sexuality
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The Aging Brain
• Recent research has shown that adults continue
to grow new brain cells throughout their lives.
• Even in late adulthood, the brain has remarkable
repair capability.
• Growth of dendrites has been observed to
continue through the 70s.
• Brain activity of older and younger people were
compared; it was observed that older brains
literally rewired themselves to compensate for
losses.
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General Slowdown in Central
Nervous System Functioning
• A general slowing down of central nervous
system functioning in middle adulthood
increases in late adulthood.
• The slowdown affects physical
coordination and intellectual performance.
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Conclusions about Older Brains
• It appears that aging brains can shift responsibilities for a
given task from one region to another.
• Neuroscientists believe the brain has a remarkable
capacity to change and grow, even in old age.
• Stimulating the brain with mental exercises may cause
neurons to increase their dendritic branching.
• These findings offer new possibilities for preventing and
treating brain diseases such as Alzheimer’s and stroke.
©2005 McGraw-Hill Ryerson Ltd.
Physical Appearance
• The changes that take place in middle adulthood
become more pronounced in late adulthood.
• The changes are most noticeable in the form of facial
wrinkles and age spots.
• We get shorter when we get older.
• Our weight usually drops after we are 60, most likely due
to muscle loss, which causes us to look “saggy.”
• http://vad.mhhe.com/provided_module.cfm?ModuleID=2
28 (The Myths and Realities of Growing Old: “Have I
Changed Since Age 20?”)
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Sensory Development
•
•
•
•
•
Vision
Hearing
Smell and Taste
Touch
Pain
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Vision
• Any decline in vision that began in early or
middle adulthood becomes more pronounced.
• Night driving is particularly difficult.
• Dark adaptation is slower.
• Visual field becomes smaller.
• A recent study discovered that sensory acuity,
especially in vision, was related to whether and
how well elderly adults bathed and groomed
themselves, completed chores, engaged in
intellectual activities and watched TV.
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Other Vision Problems
• Cataracts – cloudy, opaque areas in the
lens of the eye that prevent light from
passing through, causing blurred vision.
• Glaucoma – a disease that involves a
hardening of the eyeball because of fluid
buildup in the eye.
• Macular Degeneration – a disease
involving deterioration of the retina.
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Hearing
• Hearing impairment may begin in middle age,
but doesn’t become an impediment until late
adulthood.
• Seventy-five percent of individuals aged 75–79
experience some type of hearing problem.
• Fifteen percent of those over 65 is legally deaf.
• This hearing loss is usually due to the
degeneration of the cochlea, the primary neural
receptor for hearing in the inner ear.
©2005 McGraw-Hill Ryerson Ltd.
Smell and Taste
• Most older adults lose some of their sense of
smell, taste, or both.
• Smell and taste losses often begin around 60
years of age.
• Many older adults often prefer highly seasoned
foods to compensate for their diminished
senses.
• This may lead to eating more non-nutritious,
highly seasoned junk food.
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Touch and Pain
• Studies have shown that with aging, individuals could
detect touch less in the lower extremities than in the
upper extremities.
• For most older adults, this decline is not a problem.
• Older adults are less sensitive to pain and suffer from it
less than younger adults.
• This can be harmful if it masks injury and illness that
need to be treated.
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The Circulatory System
• When heart disease is absent, the amount of blood
pumped through the heart is the same regardless of an
adult’s age.
• Some experts argue that the healthy heart may even
become stronger as we age through the adult years, with
capacity increasing, not decreasing.
• Illness, obesity, anxiety, stiffening of blood vessels, or
lack of exercise may cause blood pressure to rise with
age.
• High blood pressure should be treated.
©2005 McGraw-Hill Ryerson Ltd.
The Respiratory System
• Lung capacity drops 40% between
the ages of 20 and 80, even
without disease.
• Lungs lose elasticity, the chest
shrinks, and the diaphragm
weakens.
• Diaphragm-strengthening
exercises can improve lung
functioning.
©2005 McGraw-Hill Ryerson Ltd.
Sexuality
• In a study of more than 1,200 elderly people,
almost 30% had participated in sexual activity in
the past month.
• In the absence of disease, sexuality can be
lifelong, though aging does induce some
changes.
• Orgasm becomes less frequent in males, and
more direct stimulation is needed for erection.
• When intercourse is impaired by infirmity,
closeness and sensuality needs persist.
©2005 McGraw-Hill Ryerson Ltd.
Physical and Mental Health
and Wellness
Health Problems
Exercise, Nutrition, and Weight
Nature of Mental Health in Older Adults
Depression
Dementia, Alzheimer’s Disease, and
Related Disorders
Health Promotion
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Health Problems
• Causes of Death in
Older Adults
• Arthritis
• Osteoporosis
• Accidents
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Causes of Death in Older Adults
•
•
•
•
Heart Disease
Cancer
Stroke
Chronic Lung
Diseases
• Pneumonia
• Influenza
• Diabetes
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Arthritis
• Inflammation of the joints accompanied by pain,
stiffness, and movement problems.
• Arthritis is especially common in older adults.
• This disorder can affect hips, knees, ankles,
fingers, and vertebrae.
• There is no known cure for arthritis, but
symptoms can be reduced by drugs, range-ofmotion exercises, weight reduction, and joint
replacement.
©2005 McGraw-Hill Ryerson Ltd.
Osteoporosis
• An aging disorder involving extensive loss of
bone tissue.
• The main reason many older adults walk with a
marked stoop.
• Women are especially vulnerable to
osteoporosis, the leading cause of broken bones
in women.
• Afflicts two-thirds of women over age 60.
• Related to deficiencies in calcium, vitamin D,
estrogen depletion, and lack of exercise.
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Prevention and Treatment
• Eat foods rich in calcium, get more exercise, and
avoid smoking.
• Estrogen replacement therapy may also be
recommended for high-risk individuals, except
those with a history of breast cancer.
• Certain drugs can be used to reduce the risk.
• Older women should also get bone
density checks.
©2005 McGraw-Hill Ryerson Ltd.
Accidents
• Injuries resulting from a fall at home or during a
traffic accident are common.
• 618 of every 100,000 people over the age of 65
fractured a hip.
• Half of these adults die within 12 months,
frequently from pneumonia.
• One study showed an exercise program reduced
the risk of falls in elderly adults.
©2005 McGraw-Hill Ryerson Ltd.
Exercise, Nutrition, and Weight
• Exercise
• Nutrition and
Weight
• The Growing
Controversy over
Vitamins and Aging
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Exercise
• Older adults are healthier and happier the more active
they are.
• In a study of over 17,000 men and women, sedentary
participants were more than twice as likely to die during
the 8-year study as moderately fit participants.
• Another study showed that starting a moderately
vigorous sports activity from the 40s through the 80s was
associated with a 23% lower risk of death.
• Gerontologists recommend strength training too.
©2005 McGraw-Hill Ryerson Ltd.
Nutrition and Weight
• Evidence shows food restriction in lab animals
can increase life span.
• Animals fed restricted diets live as much as 40%
longer than animals given unlimited food access.
• Diet restrictions also delay biochemical
alterations that contribute to poorer health and
aging.
• Leaner men live longer, healthier lives.
• Current research is exploring the link between
body mass index and longevity in women.
©2005 McGraw-Hill Ryerson Ltd.
The Growing Controversy over
Vitamins and Aging
• Research shows antioxidants—vitamin C, vitamin E,
betacarotene—help slow the aging process and improve
the health of older adults.
• Antioxidants counteract the cell damage caused by free
radicals.
• No evidence shows antioxidants can increase the life
span, but some experts believe they can reduce one’s
risk of becoming frail and sick in later years.
• We still don’t know which vitamins should be given and
in what doses.
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The Nature of Mental Health in
Older Adults
• Mental disorders make individuals increasingly
dependent on the help and care of others.
• Although mental disorders in older adults are a
major concern, they do not have a higher
incidence of mental disorders than younger
adults.
• Mental disorders make individuals increasingly
more dependant on others.
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Depression
• Major depression is a mood disorder in which
the individual is deeply unhappy, demoralized,
self-derogatory, and bored.
• The individual with major depression does not
feel well, loses stamina easily, has a poor
appetite, and is listless and unmotivated.
• Depression is a treatable condition.
• Major depression can result in suicidal
tendencies.
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Dementia, Alzheimer’s Disease,
and Related Disorders
• Dementia
• Alzheimer’s
Disease
• Multi-infarct
Dementia
• Parkinson’s
Disease
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Dementia
• Dementia is a global term for any neurological
disorder in which the primary symptoms involve
a deterioration of mental functioning.
• Individuals with dementia often lose the ability to
care for themselves and may lose the ability to
recognize familiar surroundings and people.
• Over seventy types or causes of dementia have
been identified.
• It is estimated that 20% of individuals over the
age of 80 have dementia.
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Alzheimer’s Disease
• Causes and Treatments
• Early Detection of Alzheimer’s
Disease
• Progressive Decline
• Caring for Individuals with
Alzheimer’s Disease
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About Alzheimer’s Disease
• The most common form of dementia.
• It is a progressive, irreversible disorder that is
characterized by gradual deterioration of
memory, reasoning, language, and eventually
physical functioning.
• As Alzheimer’s disease progresses,
deterioration and shrinking of the brain occurs.
• Approximately 240,000 people over the age of
65 in the Canada have Alzheimer’s disease.
©2005 McGraw-Hill Ryerson Ltd.
Causes and Treatment
• Efforts to identify the cause of Alzheimer’s have not yet
been successful.
• What scientists now believe is that Alzheimer’s disease
is a complex unraveling of neural structure and function
that likely involves many different molecular and cellular
dimensions.
• The disease involves a deficiency in acetylcholine, which
plays an important role in memory.
• The main drug used to treat Alzheimer’s disease works
by blocking chemicals that ordinarily cut acetylcholine
apart.
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Early Detection of Alzheimer’s
Disease
• Brain scans such as an MRI (magnetic
resonance imaging) can detect changes in the
brain that are fairly typical of early Alzheimer’s
disease even before symptoms develop.
• Certain spinal fluids give reasonably good clues
of early signals of Alzheimer’s disease.
• Recently a sophisticated urine test called the
neural thread protein has predicted the
occurrence of Alzheimer’s in some individuals
two years before the symptoms appear.
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Progressive Decline
• There is a predictable, progressive decline in
physical, cognitive, and social functioning when
individuals have Alzheimer’s disease.
• Once diagnosed, most patients live
approximately 8 years.
• They progress from early problems of memory
loss and declining intellectual function to later
stages in which hospitalization in a near
vegetative state ensues.
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Caring for Individuals with
Alzheimer’s Disease
• There is a predictable, progressive decline in
physical, cognitive, and social functioning when
individuals have Alzheimer’s disease.
• Once diagnosed, most patients live
approximately 8 years.
• They progress from early problems of memory
loss and declining intellectual function to later
stages in which hospitalization in a near
vegetative state ensues.
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Multi-infarct Dementia
• Involves a sporadic and progressive loss of intellectual
functioning caused by repeated temporary obstruction of
blood flow in cerebral arteries.
• The result is a series of mini-strokes which the individual
usually recovers from quickly.
• Symptoms include confusion, slurring of speech, writing
impairment, and numbness on one side of the face, arm,
or leg.
• Approximately 35–50% of people who have these
attacks will have a major stroke within 5 years unless the
underlying problems are treated.
©2005 McGraw-Hill Ryerson Ltd.
Parkinson’s Disease
• Parkinson’s disease is a chronic, progressive disease
characterized by muscle tremors, slowing of movement,
and partial facial paralysis.
• It is triggered by degeneration of dopamine-producing
neurons in the brain.
• Dopamine is a neurotransmitter that is necessary for
normal brain functioning.
• Why the degeneration of the production of dopamine
occurs is not known.
• A drug called L-dopa is the main treatment of
Parkinson’s disease.
©2005 McGraw-Hill Ryerson Ltd.
Health Promotion
• Care Options
• Prescription Drug Use
• Giving Options for Control and
Teaching Coping Skills
• Meeting the Mental Health Needs of
Older Adults
• Health Care Provision, the Older
Adult, and Health Care Providers
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Care Options
• Only about 7.3% of adults age 65 and over
reside in a nursing home at any point in time.
• Due to nursing home care costs , gerontologists
believe alternatives need to be considered.
• Alternatives include home health care, day-care
centres, and preventive medicine clinics.
• They are cheaper and less likely to engender
feelings of depersonalization and dependency.
©2005 McGraw-Hill Ryerson Ltd.
Prescription Drug Use
• Seniors use more prescription drugs in
Canada than any other single age
group.
• Inappropriate use of prescription drugs
result in 30% of hospitalizations of
people over 65 years.
• 50% of seniors do not take their
medications as prescribed.
• It is critical that care providers manage
their medications.
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Giving Options for Control
• Having a sense of personal control is found to be
important both physically and psychologically.
• Ellen Langer argues that it is extremely important for
aging individuals to understand that they can choose the
way they think.
• She has shown one reason people act old is that they
base their actions on mental images of stereotypic old
people.
• When people were induced to think of themselves as
younger, they showed many outward changes and had a
more positive outlook on life.
©2005 McGraw-Hill Ryerson Ltd.
Teaching Coping Skills
• Being in control reduces stress and stress-related
hormones.
• Nursing home residents were given assertiveness
training and learned time management skills.
• Their subsequent levels of cortisol were greatly reduced
and remained lower 18 months after training.
• The residents were also healthier and had reduced need
for medication compared with residents without training.
• Training changed their behaviour and improved health.
©2005 McGraw-Hill Ryerson Ltd.
Meeting the Mental Health Needs
of Older Adults
• Some common mechanisms of change that improve the
mental health of older adults are:
– fostering a sense of control, self-efficacy, and hope
– establishing a relationship with a helper
– providing or elucidating a sense of meaning
– promoting educative activities and development of
skills
• Psychologists must be encouraged to include more older
adults in their client lists.
• The elderly must be convinced that they can benefit from
therapy.
• Mental health care must be made affordable.
©2005 McGraw-Hill Ryerson Ltd.
Health Care Provision, the Older
Adult, and Health Care Providers
• People over 65 use physicians more than any
other group, have more hospital admissions,
and have generally longer stays.
• Approximately 12% of people over the age of 65
receive Home Care.
• Too often, health-care providers share society’s
stereotypes and negative attitudes toward the
elderly.
• Older patients tend to take a less active role in
medical encounters with health-care providers.
©2005 McGraw-Hill Ryerson Ltd.
Cognitive Functioning
in Older Adults
The
Multi-dimensional,
Multi-directional
Nature of Cognition
Education, Work,
and Health: Links
to Cognitive
Functioning
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Promoting
Cognitive Skills
in Later Life
The Multi-dimensional, Multidirectional Nature of Cognition
• Cognitive Mechanics and
Cognitive Pragmatics
• Sensory/Motor and Speedof-Processing Dimensions
• Memory
• Wisdom
©2005 McGraw-Hill Ryerson Ltd.
Cognitive Mechanics
• The hardware of the mind; reflect the
neurophysiological architecture of the brain
developed through evolution.
• Involve the speed and accuracy of the
processes involving sensory input, visual and
motor memory, discrimination, comparison, and
categorization.
• Due to the strong influence of biology, heredity,
and health on cognitive mechanics, their decline
with age is likely.
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Cognitive Pragmatics
• The culture-based software programs of the
mind.
• Include reading and writing skills, language
comprehension, educational qualifications,
professional skills, and also the type of
knowledge about the self and life skills that help
us to master or cope with life.
• Because of the strong influence of culture on
cognitive pragmatics, their improvement into old
age is possible.
©2005 McGraw-Hill Ryerson Ltd.
Sensory/Motor and Speed-ofProcessing Dimensions
• The speed of processing information declines in
late adulthood.
• There is, however, considerable individual
variation in this ability.
• It is not clear that this slowdown affects our lives
in substantial ways.
• Studies indicate we may engage in
compensatory behaviours, so as to not be
hindered by the slowdown.
©2005 McGraw-Hill Ryerson Ltd.
Memory
• Episodic Memory
• Semantic Memory
• Cognitive Resources: Working Memory
and Perceptual Speed
• Explicit and Implicit Memory
• Memory Beliefs
• Noncognitive Factors
• Conclusions about Memory and Aging
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Episodic Memory
• The retention of information about the where
and when of life’s happenings.
• Younger adults have better episodic memory
than older adults, even though older adults think
that they can remember older events better than
more recent events.
• Researchers have consistently found that in
older adults the older the memory, the less
accurate it is.
©2005 McGraw-Hill Ryerson Ltd.
Semantic Memory
• A person’s knowledge about the world.
• It includes a person’s fields of expertise, general
academic knowledge of the sort learned in
school, and “everyday knowledge.”
• Semantic memory appears to be independent of
an individual’s personal identity with the past.
• For the most part, episodic memory declines
more in older adults than semantic memory.
©2005 McGraw-Hill Ryerson Ltd.
Cognitive Resources: Working
Memory and Perceptual Speed
• Working memory is the concept currently used
to describe short-term memory as a place for
mental work.
• Perceptual speed is the ability to perform simple
perceptual-motor tasks such as deciding
whether pairs of two-digit or two-letter strings are
the same or different.
• Researchers have found declines in working
memory and perceptual speed during the late
adulthood years.
©2005 McGraw-Hill Ryerson Ltd.
Explicit and Implicit Memory
• Explicit or declarative memory – memory of facts
and experiences that individuals consciously
know and can state.
• Implicit memory – memory without conscious
recollection; it involves skills and routine
procedures that are automatically performed.
• Implicit memory is less likely to be adversely
affected by aging than explicit memory.
©2005 McGraw-Hill Ryerson Ltd.
Memory Beliefs
• Research shows that people’s beliefs about
memory play an important role in their actual
memory.
• What people tell themselves about their ability to
remember matters.
• Findings have shown a relationship between
positive and negative beliefs about one’s
memory and actual memory performance.
©2005 McGraw-Hill Ryerson Ltd.
Noncognitive Factors
• Positive aspects of these noncognitive factors
are associated less with memory decline; they
do not eliminate it.
• Researchers have found that using more
everyday life memory tasks in their studies
reduces age decrements in memory but does
not eliminate them.
©2005 McGraw-Hill Ryerson Ltd.
Conclusions about Memory and
Aging
• Some, but not all, aspects of memory decline in
older adults.
• The decline occurs primarily in episodic and
working memory, not in semantic memory.
• A decline in perceptual speed is associated with
memory decline.
• Successful aging does not mean eliminating
memory decline, but reducing it and adapting to
it.
©2005 McGraw-Hill Ryerson Ltd.
Wisdom
• Expert knowledge about the practical aspects of
life that permits excellent judgment about
important matters.
• Focuses on life’s pragmatic concerns and
human conditions.
• Research shows no age differences in wisdom.
• Wisdom involves solving practical problems.
• Research indicates that older adults are quite
competent in problem solving with regard to
everyday types of situations.
©2005 McGraw-Hill Ryerson Ltd.
Education, Work, and Health: Links
to Cognitive Functioning
• Education
• Work
• Health
©2005 McGraw-Hill Ryerson Ltd.
Education
• More older adults are returning to college today to
further their education.
• Educational experiences are positively correlated
with scores on intelligence tests and information
processing tasks, such as memory.
• Older adults seek more education to:
– remain competitive in the workforce
– learn about societal and technological changes
– enhance their self-discovery
©2005 McGraw-Hill Ryerson Ltd.
Work
• Successive generations have had work experiences that
include a stronger emphasis on cognitive-oriented
labour.
• The increased emphasis on information processing jobs
likely enhances an individual’s intellectual abilities.
• One recent study linked substantive complex work with
higher intellectual functioning in older adults.
• Exposure to complex environments increases intellectual
functioning throughout the life course.
©2005 McGraw-Hill Ryerson Ltd.
Health
• In a recent study, physical health and physical
activity were positively related to cognitive
performance in older adults.
• K. Warner Schaie concluded that some diseases
are linked to cognitive dropoffs, most likely due to
the lifestyles of the individuals with diseases.
• Overeating, inactivity, and stress are related to both
physical and mental decay.
• Walking or any other aerobic exercise appears to
get blood and oxygen pumping to the brain, which
may help people think more clearly.
©2005 McGraw-Hill Ryerson Ltd.
Promoting Cognitive Skills in Late
Life
• Possibly changes in cognitive activity patterns
result in disuse and consequent atrophy of
cognitive skills.
• In the Victoria Longitudinal Study, when middleaged and older adults participated in
intellectually engaging activities it served to
buffer them against cognitive decline.
• The mental activities that likely benefit the
maintenance of cognitive skills in older adults
are reading books, doing crossword puzzles,
and going to lectures and concerts.
©2005 McGraw-Hill Ryerson Ltd.
Religion and Spirituality in Later
Adulthood
• A recent study showed that individuals who
said they rarely or never prayed had about a
50% greater risk of dying during the 6-year
study compared with their counterparts who
prayed or meditated at least once a month.
• Possibly the lower incidence of death in
these individuals occurred because prayer
and meditation reduce stress and dampen
the body’s production of stress hormones.
©2005 McGraw-Hill Ryerson Ltd.
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