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Foundations of Health + Lifespan > Adult Development and Aging > Flashcards

Adult Development and Aging Flashcards

1
Q

Module’s learning activities

A
  • understand why our population is ageing
  • appreciate the diversity and potential of older adults
  • know ways we can ‘Age Well’
  • know about the common types of dementia and the importance of early detection
  • understand what it is like to live with dementia and know some strategies that may assist people living with dementia.
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2
Q

Lecture 1 structure: Development and ageing

A
  • psychological theory
  • researching ageing
  • ageing in Australia
  • the ageing population

Lecture 1 aims:
know: why ageing differs (between generations, countries, people), how we
study ageing, why we age, terms associated with ageing, statistics associated
with ageing, why our population is ageing

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3
Q

adult development

A

Youth = growth
Ageing = decline

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4
Q

Paul Baltes Lifespan Development Theory

A
  1. Development is a lifelong process
  2. Development varies between individuals and within individuals
  3. Plasticity & modifiability
  4. Historical embeddedness
  5. Joint occurrence of growth and decline
  6. Individuals are active participants
  7. Interaction of 3 major influences
    * Normative age-graded
    * Normative history graded
    * Non-normative
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5
Q

Normative age-graded

A
  • occur in similar way, for similar
    groups
  • closely related to chronological age
    e.g., puberty, menopause, starting
    school, retiring
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6
Q

Normative history-graded

A
  • common to people of a generation or cohort
    e.g., War, Great Depression, changing role of
    women
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7
Q

Non-normative

A
  • more unique to the individual rather
    than common to group
    e.g., lottery win, frequently moving
    schools
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8
Q

Ageing Research: Research methodologies

A
  • cross sectional studies
  • comparing different cohorts at the same point in time
  • generational influences
  • longitudinal studies
  • increases with age
  • difficult to measure
  • attrition
  • meta-analysis
  • study risk-of-bias and publication bias
  • biological and in vitro studies
  • ageing = ratio between damage accumulation and compensatory
    mechanisms
  • senescence
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9
Q

Terms

A

Chronological age
* time since birth
* does it explain much?
* risk of other processes (e.g., dementia)

Survivors age
* consideration of experiences

Old
* personal definition changes with age

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10
Q

Age categories

A
  • Childhood: <16 or <18?
  • Adulthood: 18 or 21?
  • young adults (18-39)
  • middle-aged people (40-61)
  • Old age: 40, 50? Studies use 60 or 65
  • older people (62+)\
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11
Q

morality and death define and stats

A
  • irreversible cessation of all vital functions
  • in Australia:
  • average age @ death 82 years, but 60 years for Aboriginals (2018)
  • males = 79 years 2020
  • females = 85 years 2020
  • 66% of deaths ≥75 years 2020
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12
Q

Leading cause of death in Australia

A

Men
1. Coronary Heart Disease
2. Dementia including Alzheimer’s disease
3. Lung Cancer
4. Cerebrovascular Disease
5. Prostate Cancer

Women
1. Dementia including Alzheimer’s disease
2. Coronary Heart Disease
3. Cerebrovascular Disease
4. Lung Cancer
5. Breast Cancer

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13
Q

Population Stats - In Australia older adults ≥ 65 years of age

A
  • 1 in 6
  • 16.2% of the population
  • expected to increase to 21-23% of the population by 2066
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14
Q

Now in 2024 there is a:

A

Longer life expectancy
Life expectancy is an average of 8 years less for Aboriginals born 2015-18

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15
Q

The ageing population

A
  • adults >90 years are the fastest growing demographic group
  • adults >65 years of age will double (almost triple) by 2060
  • upper limit on potential lifespan
  • age structure: pyramid to rectangle within 50 years
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16
Q

South Australia

A
  • highest proportion of older people (>50 years) on mainland Australia
  • 95% of people aged >65 years of age live at home
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17
Q

Centenarians & Supercentenarians

A

Centenarians
* number of centenarians has increased 185% compared to total
population growth of 31% over past 20 years

Supercentenarians
* 300-400 worldwide, most aged 110-113 yrs
* Ms van der Linden
* died 2024 aged 111 yrs

  • Lucile Randon
  • Died 2023 118 years old
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18
Q

Blue Zones = High rates of healthy centenarians

A
  • Sardinia (Italy)
  • Okinawa (Japan)
  • Nicoya peninsula (Costa Rica)
  • Ikaria (Greece)
  • Loma Linda (USA)
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19
Q

Blue zones – 9 traits

A
  1. physical activity in daily duties
    2.“ikiagai” reason for being - purpose
  2. stress reduction
  3. moderate calorie intake
  4. plant-based foods
  5. moderate alcohol consumption
  6. social groups that promote healthy habits
  7. engaging in religious communities and practices
  8. building and maintain family relationships
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20
Q

Adult Development and Aging Conclusion

A
  • Adult development continues throughout the lifespan
  • there are normative (age and history –graded) and non-normative influences on development
  • There are many approaches to studying ageing, but all have limitations
  • “Old” is subjective
  • We are living longer
  • our population is ageing
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21
Q

Lecture 2 structure: normal and optimal ageing

A
  • who are our older adults?
  • heterogeneity in older adults
  • ageing stereotypes
  • ageism
  • elder abuse

Lecture 2 aims:
* understand: influences on our older adults, how older adults differ and
ways to optimise ageing
* detect: obstacles to healthy ageing and older adult stereotypes
* prevent: ageism and elder abuse

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22
Q

Normative age-graded influences

A
  • children that may have moved out or away
  • retirement
  • death of a loved one
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23
Q

Older Adults - Normative history-graded influences

A
  • Vietnam war
  • Ash Wednesday
  • recession
  • changing the role of women
  • AIDS
  • Stolen generation
  • massacres
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24
Q

Non-normative

A
  • unique to the individual rather than common to group
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25
Q

Older Adults - Cultural diversity

A
  • CALD
  • older Australians (≥65 years):
  • one third born overseas
  • 68% born in Europe
  • 1 in 5 can speak a language other than English
26
Q

Normal and optimal ageing - Other influences

A
  • medical & psychiatric history
  • educational and occupational history
  • social history
  • general functioning
27
Q

Older adults - diversity

A

heterogeneity = diversity
* heterogeneity increases with age (Ferrucci & Kuchel 2022)
* health heterogeneity increases with age (most domains) (Nguyen et al., 2021)
* highlights the importance of individualised / personalised care

28
Q

Older Adults Physical Functioning

A

Physical functioning
* frailty

  • decline in physical functioning

** risk factors include age, inactivity, poor diet

*Preventable

  • increasing with ageing population (O Hoogendijk et al., 2019)
  • 1 in 4 older adults (Veronese, et al., 2021)
  • females>males (O’Caoimh et al., 2021)

frailty onset or progression
- lifestyle factors
- biological factors
- clinical factors
- demographic and social factors

29
Q

physical achievements of older adults

A

F. Singh the worlds oldest Marathon runner @104 years.

R. Smith oldest woman to drive an F1 race car @80 years

M. Salto sailed solo non-stop around the world @ 77 years.

30
Q

Cognitive functioning

A
  • cognitive slowing
  • importance of age & education norms
  • Gf vs Gc
  • > Gc with age
  • accumulation of knowledge and experience
  • influence of individual differences (e.g., education, cognitive reserve, etc)
31
Q
  • cognitive achievements of older adults
A
  • David Unaipon
  • Judi Dench
  • Nelson Mandela
  • Colonel Sanders
  • J R R Tolkien
  • Peter Roget
32
Q

Older Adults Wisdom

A

Wisdom
* difficult to define
* expert judgement system in the fundamental
pragmatics of life (Max Planck Institute)
* increases with age?
* not purely accounted for by intelligence (Lindbergh, et al., 2021)

Elders
* recognised in their community as custodians of cultural
knowledge and law
* not defined by chronological age

33
Q

Contributions of older adults

A
  • volunteering & caring roles
  • adults >55 years contribute $74.5 billion in unpaid volunteering and caring roles
    each year
  • mentoring
34
Q

Ageism

A
  • stereotyping and/or discriminating against individuals or groups on the
    basis of their age
  • the Age Discrimination Act 2004 (ADA) prohibits discrimination in
    employment based on age
  • preventing ageism
35
Q

Elder abuse

A
  • elder abuse: an act or repeated acts that occur within a relationship of
    trust, which cause harm or distress to an older adult
  • elder abuse can take different forms
  • psychological abuse is the most common
  • 1 in 6 older adults affected (estimate. Yon et al., 2017)
  • > 140 million people affected

Reports are rising. Government must do more.

36
Q

South Australia’s Plan for Ageing Well

A

Strategic Priorities
- There is no place like home
- Meaningful connections
- Navigating Change

37
Q

South Australian Council Services

A
  • Social Activities
  • Community Transport
  • Stay Active
  • Social Activities
38
Q

Support with independent living

A
  • Many older adults want to age-in-place, rather than live in a residential care
    facility or nursing home
  • 24% increase in people receiving home care services
  • shortfall of aged-care workers
39
Q

United Nation’s Decade of Healthy Ageing

A

4 action areas:
1. age-friendly environments
2. combatting ageism
3. integrated care
4. long-term care

40
Q

How can we help older adults ‘Age Well’?

A
  • Treat every older adult as an individual
  • appreciate their:
  • diversity (influences on their development, cultural and other factors)
  • achievements
  • contributions
  • Encourage their participation in activities
  • physical
  • cognitive
  • social
  • Detect negative stereotypes of older adults
  • Stop ageism and elder abuse
  • Provide individualised supports when needed
41
Q

Older Adults - conclusion

A

Every older adult is different
* Ageing stereotypes, ageism, and elder abuse STOPS with US!
* SA’s Office for Ageing Well
* Get involved….

42
Q

AGEING & THE OLDER ADULT- Lecture 3 structure: dementia

A

dementia
* neurodegenerative disorders and dementia
* increase in dementia cases
* common types of dementia

detecting dementia
* mild cognitive impairment
* obstacles to detecting dementia

  • benefits of early detection
    1. prolonging life with dementia
    2. maintaining independence through accessing support
    3. planning for the future
    4. improving mental health and wellbeing

Lecture 3 aims:
* understand:
* how dementia presents
* the importance of early diagnosis
* treatments/interventions that can prolong and improve life with dementia

43
Q

Ageing and neurodegenerative disorders

A

People are living longer
* Adults >65 years of age will double (almost triple) in the United States (US)
and Australia (AU) by 2060 (Mather et al., 2015; Australian Institute of Health and Welfare 2018; WHO, 2022)
* Neurodegenerative disorders are increasing (Hou, et., 2019)

44
Q

Ageing and neurodegenerative disorders

A

Neurodegenerative disorders
* range of different diseases that progressively damage the brain and/or spinal cord
(Sierra, 2020)
* over 60 million older adults live with a neurodegenerative disorder (Parkinson’s Foundation, 2021;
World Health Organisation, 2020)
* many more family, friends, and carers are affected (Perneczky, 2019)
* annual healthcare expenditure
* >$1,000,000,000,000 in US
* >$10,000,000,000 in AU
* no cures
* treatments and interventions can slow disease progression and improve life
* efficacy reliant on early detection (von Armin et al., 2019)

45
Q

Most prevalent neurodegenerative disorders in >65 year olds

A

dementia of the Alzheimer’s type
* Parkinson’s disease
* other types of dementia
* motor neuron disease (Lang et al., 2017; Liang et al., 2021)

dementia = most prevalent
neurodegenerative disorder

46
Q

Range of neurodegenerative disorders characterised by progressive and
irreversible cognitive decline (Lisko et al., 2021)

A
  • Cognitive decline:
  • memory
  • higher-level ‘executive’ functioning
  • speed of processing
  • attention
  • perception
  • language (Harrington et al., 2021)
  • Can be associated with behavioural disturbance (DSM-5)
47
Q

Prevalence of dementia

A
  • 50,000,000 people are living with dementia
  • 470,000 Australians with dementia
  • > 65 years of age 1/10 with dementia
  • > 85 years of age 3/10 with dementia (WHO, 2021)
  • dementia is the leading cause of disability and mortality in older adults (Connor, 2021)
  • 150,000,000 by 2050 (Rocca, 2018; World Health Organisation, 2021).
48
Q

Dementia

A

Not detected
* 60% (est) of affected adults in the community (Amjad et al., 2018; Lang et al., 2017; Walker et al., 2017)

Diagnostic delays
* Initial onset of symptoms (average age 68 yrs)
* Diagnosis delayed by 5 years (average age 73 yrs)
* Death at an average age of 78 years (Beam et al., 2018; Liang et al., 2021)
* Dementia detection = public health priority (WHO; 2020)

49
Q

Dementia

A

Specific dementia types
* 4 most common dementia types
1. dementia of the Alzheimer’s type
2. vascular dementia
3. lewy body dementia
4. frontotemporal dementia
Dementia co-occurs with other neurodegenerative diseases (e.g.,
Parkinson’s and Motor Neuron Disease)

50
Q

Alzheimer’s disease

A
  • the most common dementia type
  • 80% of all cases of dementia
  • cause:
  • abnormal brain changes
  • amyloid plaques
  • tau tangles
  • atrophy
  • damage to the hippocampus
  • symptoms:
  • amnestic-type: decline in memory
  • non-amnestic-type: decline in executive, visuospatial and/or language (McKhann et al., 2011)
51
Q

Vascular dementia

A
  • second most prevalent type of dementia
  • pathology:
  • conditions that damage the flow of blood and oxygen
    to the brain
  • symptoms:
  • stepwise decline in cognition and functioning
  • declines in information processing, memory, and
    executive functioning, etc
  • can appear similar to Alzheimer’s disease
  • mixed dementia (vascular and Alzheimer’s disease)
    (Bir et al., 2021; Goodman et al., 2017; Livingston et al., 2020)
52
Q

Lewy body dementia

A
  • third most prevalent type of dementia
  • 5% of dementia cases
  • pathology:
  • build-up of protein in the brain called Lewy bodies
  • symptoms:
  • physical: rigidity, tremor, reduced mobility
  • cognitive: confusion, reduced alertness, forgetfulness, executive difficulties, hallucinations
    (Jellinger, 2018; McKeith et al., 1996; Taylor et al., 2020;)
53
Q

Frontotemporal dementia

A
  • 1% of dementia cases
  • younger onset
  • earlier death
  • pathology:
  • build-up of proteins in the brain such as Tau
  • symptoms:
  • behavioural: changes in social behaviour, personality, empathy, and insight
  • language: problems understanding language and speech and communicating verbally
    (Li et al., 2020; Roca et al., 2013; Hogan et al., 2016)
54
Q

Diagnosing dementia

A
  • qualified healthcare professionals
  • multiple investigations
  • diagnosis of exclusion
55
Q

Dementia Diversity

A
  • symptomology
  • severity
  • diversity in older adults pre-dementia
56
Q

Detecting dementia

A

Mild cognitive impairment
* precursor/prodrome to dementia (Baiano et al., 2020)
* cognitive impairment but not severe enough to be classified as dementia (Petersen et al., 2001)
* not everyone will progress to dementia
* 9.6% convert to dementia annually (Mitchell & Shiri-Feshki, 2009)
* start interventions to prevent or delay dementia onset (Han et al., 2019)

57
Q

Detecting dementia

A
  • often person or significant other notices thinking difficulties (Ismail et al et al., 2020, also see NIH website)
  • it’s important to discuss these difficulties with a clinician/Dr/GP
  • why?
  • to detect treatable causes
  • to monitor decline (see NIH website)
  • benefits of early detection (upcoming slides)
  • there are often long delays between the onset of thinking difficulties and problems being discussed with
    a healthcare professional (Zhang et al., 2021)
  • why?
  • changes are attributed to normal aging (Galvin, 2018)
  • misconception that dementia is a normal part of ageing (Cations et al., 2018)
  • fear of dementia (see https://www.youtube.com/watch?v=VzlcBAlQ5ps)
58
Q

Benefits of early detection

A
  1. Access interventions that may prevent or prolonging life with dementia
    * Lancet commissioned review identified the following potentially modifiable
    risk factors for dementia (2020):
  2. hypertension
  3. diabetes mellitus
  4. hearing loss
  5. obesity
  6. depression
  7. smoking
  8. lower educational achievement
  9. physical inactivity
  10. social isolation
    10.excessive alcohol consumption
    11.head injury
    12.air pollution (Livingston et al., 2020)
59
Q

A brief summary of the WHO guidelines on risk reduction for cognitive decline and
dementia (released 2019)

A

Low physical
activity
Interventions to increase exercise engagement and activity

Smoking
Interventions to assist people to quit smoking

Poor diet
Recommend a Mediterranean-like diet, but no support for
Vitamins B and E, polyunsaturated fatty acids and multi-complex
supplementation

Alcohol misuse
Interventions to reduce or cease harmful drinking practices

Unhealthy weight gain
Interventions to reduce midlife overweight/obesity levels

Hypertension
Management as per WHO guidelines though evidence for specific dementia outcomes is low

Diabetes
Management and lifestyle interventions

Unhealthy cholesterol levels
Management at midlife to reduce risk

Low cognitive reserve
Cognitive training interventions supported

Lack of social engagement
Social participation should be encouraged/no specific
intervention proposed

Depression
Management according to WHO guidelines/no specific
intervention proposed

Hearing loss
Timely identification and management/no specific intervention
proposed

60
Q

Benefits of early detection

A
  1. Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and
    Disability

International network of multidomain trials is being conducted to determine
the most effective interventions for reducing the risk of dementia

  1. Address the impact of cognitive decline on everyday activities (Laske et al., 2015; Milne, 2010;
    Sanford, 2017)
    * supports are available
  2. Identify those at risk of mental health issues
    * depression and anxiety are common in people with dementia (Kuring et al., 2018; 2020)
    * psychological intervention can help (Livingston et al., 2020)
  3. Plan for the future
    * plan future healthcare
    * document their likes, dislikes, and preferences
    * less distressing for loved ones
    * Advanced Care Planning
61
Q

Dementia Conclusion

A
  • Neurodegenerative disorders are increasing due to the aging population and of these
    dementia by far is the most prevalent.
  • There are specific types of dementia that have different symptoms.
  • Understanding the diversity of older adults and the symptoms of dementia can help us
    provide individualised care.

Foundations of Health + Lifespan (5 decks)

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