Late Adulthood

Question 1

What is an idea that needs to be challenged in adulthood and older age individuals?

Answer 1

That old people are frail, unproductive and unable to cope with the changing demands of modern society.

Question 2

How do the concepts of fluid and crystallised intelligence change in adulthood?

Answer 2

Fluid intelligence (biological facts and innate ability) decline with age in memory and speed of processing, however crystallised intelligence (resulting from education and culture) remain well into old age.

Question 3

What are the statistics on depression found in the Australian longitudinal study of ageing?

Answer 3

Two-thirds of participants in the ALSA reported no signs of depression with those who have higher were living in age-care facilities.

Question 4

What are the stats on the living arrangments of individuals in late adulthood?

Answer 4

Many people in their 80s and older live independently in their homes. Some remain in home or in their own country, family surrounds and support networks.

Question 5

Activity and disengagement theory of ageing take on different perspectives on adapting to the loss of roles or activities that occur in late adult hood, what is activity theory?

Answer 5

Older people have the same psychological needs middle-aged people do

Decreased social interaction in old age comes from withdrawal by society from the ageing person

Optimal ageing occurs when the person stays active

Substitute should be found for those that are lose (e.g. working at retirement)

Question 6

What is disengagement theory?

Answer 6

Older people have increased preoccupation with the self and decreased investment in society

Decreased social interaction in old age comes from mutual withdrawal of both the individual and society

Optimal ageing occurs when the ageing person establishes greater psychological distance from those around him or her

Decreased social interaction should be expected.

Question 7

What is socioemotional selectivity theory?

Answer 7

Changes in social motives due to people becoming more aware of the limited amount of time they have left.

Reshaping of one’s life in late adulthood to concentrate on what one finds to be important and meaningful in the face of physical and possible cognitive impairment.

Question 8

In socioemotional theory, what factors would contribute to how an individual would not reshape their life?

Answer 8

Reduced financial circumstances

Range of activity and interest levels

Social support

Question 9

What stereotypes about those in late adulthood would digress a practitioner from failing to diagnose and treat an individual?

Answer 9

Mental health problems are stigmatised

Mental health professionals may believe that elderly adults are less treatable than younger adults

Depression and anxiety may be seen as a normal part of getting older or becoming ill- may be mistaken for normal ageing.

Question 10

In terms of people having emotional reactions to events or situations, what stereotype do we overlay as the cause of these reactions?

Answer 10

As people in late adulthood are closer to death in their life, we perceive their emotional changes and reactions are a consequence of this awareness.

Question 11

What are the views of death across the lifespan?

Answer 11

Young children see death as reversible or temporary and not inevitable

Adolescents tend to deny their own mortality

Young adults are often very angry when faced with their own death

Middle-aged adults become more aware of their own morality

Late adulthood associated with increasing acceptance of death, generally less fearful than other age groups.

Question 12

What is dementia?

Answer 12

A term to describe the symptoms of any illness that causes a progressive decline in a person’s cognitive function.

Question 13

What are the most common causes of dementia and how do they generally differ from one another?

Answer 13

Most common Alzheimer’s disease, accounting for half of dementia cases

Vascular dementia, related to strokes

Other forms, frontotemporal dementia and dementia with lewy bodies

Each form has its own pattern of symptoms, and correct diagnosis is important as treatment and management may vary

Question 13

What are the most common causes of dementia and how do they generally differ from one another?

Answer 13

Most common Alzheimer’s disease, accounting for half of dementia cases

Vascular dementia, related to strokes

Other forms, frontotemporal dementia and dementia with lewy bodies

Each form has its own pattern of symptoms, and correct diagnosis is important as treatment and management may vary

Question 14

In the DSM V of major cognitive disorders, what is the most important category when assessing dementia what are they based on?

Answer 14

Evidence of significant cognitive decline from previous level of performance in one or more cognitive domains (complex attention, executive functioning, learning and memory, language, perceptual motor or social cognition):

1. concern for the individual, knowledgeable informant or the clinician has noticed this decline
2. A substantial impairment in cognitive performance, preferably documented by standardised neuropsychological testing, or in its absence, another quantified clinical assessment

Question 15

What is a key diagnostic feature of Alzheimer’s disease?

Answer 15

Memory impairment (inability to learn new info or recall previously known info)- this is not unitary, there is differential impairment of different memory, this is a cardinal feature of AD.

Question 16

What are some secondary features in isolation or combination outside of memory that is a diagnostic feature of AD?

Answer 16

Aphasia - language disturbances

Apraxia - The impaired ability to carry out motor abilities despite having full motor control

Agnosia - Difficulty recognising or identifying objects

Executive dysfunction - disturbances in ability to plan, organise, sequence a series of events or think abstractly.

Question 17

In the neuropathology of AD there are two characteristic features, what is neuritic plaques?

Answer 17

(waste product) masses of dying neural material with a toxic protein that damages neurons, beta-amyloid, at their core.

Question 18

In the neuropathology of AD there are two characteristic features in the brain, what is neurofibrillary tangles?

Answer 18

Twisted strands of neural fibres within the cell bodies of neurons.

Question 19

In the neuropsychological profile of AD, how is memory effected by the condition?

Answer 19

Relatively spared STM and procedural memory (especially motor learning)

Episodic and semantic memory deficits and impaired verbal and visual learning

Loss of semantic network (no ‘semantic clustering’ during encoding)

Question 20

In the neuropsychological profile of AD, how is language effected by the condition?

Answer 20

Anomic aphasia (impaired confronting naming, word finding)

General conversation skills relatively preserved until mid-late stages

Question 21

In the neuropsychological profile of AD, how is visuospatial orientation effected by the condition, how is this tested?

Answer 21

There is a range of deficits. Clock drawing, people have a sense of the numbers but due to poor planning of visuospatial difficulty may have poor placement of the numbers.

Perseveration, individuals believe they are writing the numbers on the clock-face but continue on in the sequence instead of stopping at 12.

Question 22

In the neuropsychological profile of AD, how is executive functioning effected by the condition?

Answer 22

Increased disorganisation

Perseveration

impaired metacognitive awareness (poor self-monitoring)

Impaired time estimation

Question 23

In the neuropsychological profile of AD, how is sensory functioning effected by the condition?

Answer 23

Preserved visual, auditory and tactile acuity until the very late stages of AD.

Question 24

In the neuropsychological profile of AD, how is emotional functioning affected by the condition?

Answer 24

Depression is highly comorbid.

Behavioural and psychiatric disturbances are the symptoms that families and individuals find the most difficult about the disease and often go untreated.

Question 25

What are the most common behavioural and psychiatric disturbances associated with dementia?

Answer 25

Insomnia
Persecutory ideation/delusion
Hallucinations
Apathy
Agitation
Irritability

Question 26

How is AD treated?

Answer 26

Medical management in the form of cholinesterase inhibitors. Galantamine and Rivastigmine may delay the rate of functional decline of Alzheimers disease and therefore help maintain activities of daily living.

Question 27

What are the cholinergic pathways in the brain response for and how do we increase their use in AD patients?

Answer 27

Pathways that are critical for cognition, attention and memory, we see these decreasing in their efficiency and efficacy in reducing cognitive impairment. (Affects hippocampus)

By making acetylcholine more available at the synapse the cholinergic pathways effectiveness is increased which helps arrest and stabilise AD.

Question 28

What is the normal transmission of acetylcholine?

Answer 28

ACh is released at the axon terminal
ACh crosses the synaptic cleft
ACh binds with a receptor on the post-synaptic membrane
ACh (E) (acetylcholine esterase) stops the action of ACh by breaking it down and removing it from the synapse.

By effectively blocking the esterase enzyme more ACh is able to flood the synapse.

Question 29

What is vascular dementia and how is it different from Alzheimers disease?

Answer 29

It has a more abrupt onset, compared to cognitive which is gradual

Step-wise deterioration
reflects changes in blood flow in the brain, a small bleed, we see these steps drop down

History of hypertension
When there are more people with heart disease we will see an increase in vascular dementia

Question 30

What is delirium characterised by?

Answer 30

An acute confusional state or episode characterised by a sudden onset of impaired cognition.

Question 31

What are the symptoms of delirium?

Answer 31

Decreased attention span, disorganised thoughts, rambling speech, and hallucinations and delusions. Fluctuating confusions throughout the day in response to disturbed sleep-wake cycles.

Question 32

What are some common causes of delirium?

Answer 32

Drug intoxication or withdrawal
Sudden onset of brain disease
Infections
Electrolyte imbalance
Anticholinergic drugs
Heart, kidney and liver failure

Question 33

How is delirium diagnosed differently to dementia?

Answer 33

Dementia is a progressive condition that has an onset of months to years. Symptom severity of a person with dementia does not appear to change throughout the day. It is important for families and carers to note a sudden change in cognition and function as this may be due to delirium.