1. Middle and Old Age

2. Maximum Recorded Life Spans Human Indian Elephant Gorilla Common Toad Domestic Cat Domestic Dog Vampire Bat House Mouse 120 70 39 36 27 20 13 3

3. Top 10 Causes of Death: 65 and Older 1.Heart Disease 2.Cancer 3.Cerebrovascular Disease 4.Chronic Obstructive Pulmonary Disease 5.Pneumonia/Influenza 6.Diabetes 7.Accidents 8.Alzheimer’s Disease 9.Kidney Disease 10.Septicemia

4. Predictors of Longevity Health (overall best predictor) Nonsmoking status Intelligence Education Work satisfaction Usefulness Happiness For men – good financial stead For women – high/moderate activity level

5. Physical Changes in Middle Age Eyesight declines Hearing declines Spine compresses Cardiovascular disease and cancer Sexuality changes –Menopause –Erectile difficulties

6. Dementia The development of multiple cognitive deficits manifested by both:  memory impairment  one or more of the following:  aphasia (language disturbance  apraxia (impaired ability to carry out motor activities despite intact motor function)  agnosia (failure to recognize or identify objects despite intact sensory function)  disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting)

7. Alzheimer’s Disease Brain tissue irreversibly deteriorates, and death usually occurs 10-12 yrs after onset Accounts for 50% of dementia in elderly. Diagnosis made by exclusion which alive. Physiological effect - atrophy of cerebral cortex, hippocampus, and other brain areas Plaques - small, round areas comprising the remnants of lost neurons and  -amyloid, a waxy protein deposit - scattered throughout the cortex Neurofibrillary tangles - abnormal protein filaments which accumulate within the cell bodies of the neurons

8. Normal MRI

9. MRI of an Alzheimer’s Patient

10. Delirium Disturbance of consciousness with reduced ability to focus, sustain, or shift attention A change in cognition (such as memory deficit) or the development of a perceptual disturbance that is not better accounted for by a preexisting, established, or evolving dementia The disturbance develops over a short period of time (usually hours or days) and tends to fluctuate during the course of the day.

11. Dementia versus Delirium The clinical “feel” of talking with a person with delirium is rather like talking to someone who is acutely intoxicated or in an acute psychotic episode. Whereas the demented patient may not remember the name of the place where she or he is, the delirious patient may believe it is a different sort of place altogether, perhaps mistaking a psychiatric ward for a used car lot…Hallucinations, especially visual hallucinations, are common in delirium, but are rarely seen in demented patients until the very late stages of the disease. Knight (1996)

12. Nursing Homes The decision to institutionalize comes as a last choice For a large number of families, moving the parent to a nursing home lead to improved family ties and closeness Langer and Rodin - nursing home research which indicates that conscious thinking as well as perceived control are essential in maintaining emotional and physical well-being in nursing homes