1. Gerontology Chapter 4

2. Our bodies are constantly changing and most of the time we don’t even notice unless these changes are a result of sudden or dramatic physical, psychological or cognitive events.

3. This chapter will focus on the psychological, behavioral and cognitive changes associated with aging.

4. Personality Each one of us is unique. Each of us have character traits, attitudes, habits, and emotional tendencies that distinguish us from the other. The question is : is there a significant personality change during old age?

5. Personality Theories Erickson : Integrity versus Despair McCrae and Costa : Trait Theory Bandura : Self-efficacy

6. Erik Erikson: –8 stages of psychological development –final era of life he calls integrity versus despair –elders either develop a sense of pride in their past accomplishments and present life, or experience a feeling of despair because they believe they do not have enough time left to improve their sense of life satisfaction

7. McCrae and Costa: –Trait Theory neuroticism extraversion openness to experience agreeableness conscientiousness –Studies on the elderly found strong stability of all five traits

8. Bandura: –Self-efficacy relates to the beliefs that each of us hold about the level of control we have over the future –Strength of one’s sense of self-efficacy may be variable across time –Studies have shown a decline in health is significantly correlated to decreased self- efficacy

9. There is significant correlation between a high level of self-perceived self-efficacy and positive health behaviors such as diet, exercise and non- smoking. Chronic illnesses can lower the level of perceived control, which in turn decreases one’s motivation to maintain a healthy lifestyle.

10. Other Research Mitchell and Helson found that people who are optimistic and managed their lives well at one stage of life, tended to feel more positive at other times as well. Another study by Erickson indicated that goals, values, coping styles, and control beliefs are likely to change over the course of time, peaking at middle age. Elders have been found to be more tolerant, patient, and open-minded.

11. Cognition Cognitive impairments in the elderly are primarily caused by disease, aging, and disuse Alzheimer’s disease if the most common cognitive disabling condition of aging

12. Attention –Attention: tuned in to the task which is being completed over a set period of time. Divided - paying attention to two or more tasks simultaneously Alternating - quickly alternating concentration between two or more tasks Selective - paying attention to relevant stimuli while filtering out the noise or unimportant data

13. Research: –divided attention skills decrease with age –alternating attention decreases with age –selective attention shows a decline with age Health care professionals must take this into account when working with the elderly –

14. Orientation Alert or Disorientated –Retirement –Medications Memory Types –Primary / Short term –Working –Secondary / Long term –Tertiary / Remote

15. Not all types of memory are affected equally by the normal aging process. Explicit memory tasks that require concentration and the motivation for new learning can be profoundly affected by age, where as subconscious memory tasks decreases only slightly with age.

16. Research: –Secondary memory seems to be affected by age more than primary. –Working memory declines more sharply with age than primary or secondary memory. –If memory skills start to diminish significantly, compensation and adaptive techniques may be necessary – what do I mean by that?

17. World Health Organization AACD - aging-associated cognitive decline –cognitive functioning below age and educational norms, but above what is expected for those with dementia AAMI - onset of age-associated memory impairment –although memory decline is evident, it often does not interfere with day-to-day functioning

18. Intelligence –IQ tests show younger people get higher scores than their older counterparts. Why so? –This is hard research to study unless over a course of people’s lifetimes

19. Learning - The ability to learn new information/skills Older individuals need more practice sessions repeated more often in order to master a task. Our brains need to be motivated to “remain open for business” use it or lose it, it’s never too late to learn

20. Perception: defined as the ability to meaningfully interpret sensory information –Sensation- visual skills, hearing, taste, smell visual skills decrease with age (ex’s) hearing tends to decline with age ability to detect smells and identifying differing odors decreases with age, which in turn decreases the desire for food thirst sensation declines with age

21. Praxis and Performance –Praxis: ability to carry out motor functions Dyspraxia refers to decreased ability to plan and execute purposeful movements Apraxia refers to the total inability to carry out these motor plans –Performance: balance, reaction time, strength

22. Reaction time declines with age along with “less accurate responses”. There is a decline in balance, coordination and strength with age, making falls more prevalent in the aging population. With a decrease in balance, coordination, and strength comes a decrease in praxis.

23. Quality of life Feeling of well being: –What does that mean? Is it affected by health status? The degree of health or illness has a significant impact on the level of quality of life –Researchers have concluded that health status was an excellent predictor of happiness

24. Depression –Screening criteria on page 132-133 in book –As many as 1 of 5 people older than age 65 show signs of clinical depression –Feeling down and depressed is NOT a natural consequence of the aging process Suicide –Depression can happen to anyone. –What would be some suicide signs?

25. Death and Bereavement –Living wills and advanced directives –When one lives through the death experiences more often, it doesn’t make bereavement any easier. –Kubler-Ross (5 stages of grief) –Isolation, feeling lost, and sadness, can persist for years - much longer than is socially acceptable.

26. Dementia Dementia encompasses multiple cognitive, psychological, and functional deficits, including memory impairment. –Definition: –Some signs: difficulties with understanding or communicating difficulty with problem solving behavioral disturbances impaired visual spatial skills

27. Alzheimer's’ Disease Affects over 4 million people in the United States (1998 stats) Physical symptoms are not common in the early stages of AD AD progresses through three stages: –mild, moderate, and severe –progression stages and symptoms on pg.139

28. Related disorders associated with depression and dementia: –malnutrition –stroke –hypothyroidism –failure to thrive –learned helplessness

29. Summary As people age they tend to: –move slower and prefer slower paced activities –take longer to learn new tasks –become more forgetful –lose sensory processing skills

30. Remember These changes are minimal and do not necessarily interfere with daily functioning It is important for individuals to remain active in order to age well As health care professionals we need to encourage activities and interactions with others and most importantly show caring, respect and empathy when caring for the elderly.