Learning pack 3 Flashcards
What is middle adulthood/mid-life?
- A developmental stage ‘halfway’ between the beginning and end of adulthood
- The sandwich generation:between parents/children/grandchildren
- 40 to 60 years of age
- May need revision if we keep living for longer
- it is a substantial time of transition
What are the mortality rates in mid-life?
Mok et al (2015)
- Longitudinal study of over 2 million
- Estimated that 1 in 50 males (2%) will die by age 40
- 1 in 120 females (0.8%) will die by age 40
Biological changes in mid-life
- Loss of physical youth
- Less than peak condition
- Andropause, Menopause and the biological clock
- Early indications of Alzheimer’s
Psychological changes in mid-life
- Slower cognitive processing
- Appraisal of circumstances –> mid-life crisis
- Depression vs. life satisfaction
Social changes in mid-life
- Concern for health/well-being of parents
- Children leaving home –> empty nest
- Liberated vs. isolated
Biological changes in mid-life: Hair and skin
- Effects of primary ageing become more obvious
- Grey, thinning hair/baldness
- Extra hair in unwanted places
- Photoageing: wrinkles, age spots, moles
- Sun exposure, smoking and alcohol consumption all contribute to accelerated ageing
Biological changes in mid-life Body composition
- Expanding waistline/redistribution of fat stores –> so called ‘middle-age spread’
- Slowing of basal metabolic rate –> loss of muscle and hormone production
- Low bone density which is also exacerbated by hormone loss –> osteoporosis
- 50+ years have higher risk of fractures due to brittle bones –> reduced mobility
Biological changes in mid-life: Vision
- Loss of visual acuity
- Thickening of the lens
- Reduced light at the retina - Poor focus/muscle contraction –> blurry vision
- Less able to adapt rapidly to changing light levels
- Also linked to cognition (Leon-Dominguez et al, 2016)
Biological changes in mid-life: Hearing
- Auditory nerves and inner ear structure degenerate
- Poor perception of very high and low frequencies
- Not usually problematic until age 50+, and major deficits stem from our own behaviour and occupational hazards
- Secondary ageing: Degree of hearing loss largely due to noise exposure over lifespan (Rabinowitz, 2000)
Biological changes in mid-life: Reproduction in women
- In women, menopause occurs around age 50 but begins 10-15 years prior, and results in a loss of ability to conceive
- Pre-menopausal: fluctuating hormone levels and irregular periods
- Peri-menopausal: more extreme variation in periods, hot flushes cause multiple issues (Bromberger et al, 2010)
- Post-menopausal: oestrogen and progesterone levels consistently low for a period of 1 year, such that menstruation ceases
Biological changes in mid-life: Reproduction in men
- In men, loss of reproductive capacity or andropause occurs later on
- Diminishing levels of testosterone: 1% per year from 40s
- Gradually reduced quantity of viable sperm
- Accompanied by loss in muscle tissue and strength
- Erectile dysfunction influences 31% by late 50s
- Can be improved with diet and exercise due to associations with the amount of body fat and individual has (Esposito et. al, 2004)
Biological changes in mid-life: Health
- Health is the biggest. factor affecting quality of life in middle-age
- Cancer: most likely cause of death in middle-aged women
- Cardiovascular disease: sudden heart attacks as the most likely cause of death in middle-aged men (particularly those with low socioeconomic status)
- The impact of lifestyle is cumulative
- Education is predictive of health behaviour (smoking, drinking, physical inactivity) in mid-life (Clouston et al, 2015)
- Cardiorespiratory fitness in mid-life (approx 49) is associated with lower healthcare costs in later life (65+)
Psychological changes in mid-life: Cognition
- In mid-life, our brains and cognitive processes become slower
- Cognitive skill is likely to decrease if you don’t stay mentally active (Salthouse, 2004)
- Linked to the function of the circulatory system (Raz and Rodrigue, 2006)
- Correlation between risk of heart disease/cancer and intellectual skills, mediated by physical activity
Psychological changes in mid-life: Memory
- The older we get the more forgetful we perceive ourselves to be
- Working memory: By age 55, we can no longer accommodate large, complex loads –> at least in vision
- Semantic memory as stable, episodic memory more prone to decline
- Themes are remembered better than specific details
Psychological changes in mid-life: Middle age and dementia
- One of the biggest financial burdens for society - £1.4 billion in Wales alone
- Cognitive impairment is often the most feared aspect of ageing
- Early-onset familial Alzheimer’s disease: by age 55, highly genetic, accounts for approx 5% of cases
- ‘Prodromal’ dementia in middle age –> Mild cognitive impairment (MCI)
- Associated with high glucose levels (Rosness et al 2016)
What are the related risk factors of dementia?
- Obesity
- Smoking
- Alcohol
- Depression
- Anxiety
What is the myelin model of neurodegeneration?
Bartzokis (2004)
Age-related breakdown in the protective membranes of neurons can increase the likelihood of developing AD
What is the interaction of genetics and lifestyle on Alzheimer’s
Rovio et al (2005)
- Leisure-time physical activity at least twice a week during mid-life is associated with a reduced risk of AD
- More pronounced among APOE e4 carriers
Psychological changes in mid-life: Personality
- Largely stable during adult life
- Openness, extraversion and neuroticism decline, potentially because there is less room for your own individual sense of self
- You often become less negative and impulsive in mid-life, as you take on more important responsibilities and roles
- Personality defines biological stress response –> lowest in those high in extraversion and conscientiousness
Psychological changes in mid-life: Depression in men
Hiyoshi et al (2015)
Those with high cognitive functioning in adolescence are less likely to be diagnosed with a mood disorder during middle age unless they also have low resistance to stress
Psychological changes in mid-life: Depression in women
Bromberger et al (2015)
The experience of mid-life in unlikely to trigger the onset of depression but changes due to menopause can lead to reoccurrence of depressive symptoms
What is a mid-life crisis
- Classified as a reaction to changes in life structure (Levinson et al, 1978)
- Erikson predicted ‘crisis’ at all life stages, not just mid-life
- Not as prevalent as you might expect
- May be more likely in your 60s (Wethington et al 2004)
- Often triggered by a specific occurrence: life event approach
What are the crises in mid-life?
- Not to be confused with mid-life crisis
- Erikson (1963): generativity vs. stagnation –> the need to care for the next generation
- Relationship to mental health: those with high generativity/life satisfaction are the least burdened by being a carer
- Vaillant (2002) work-based goals, ‘career consolidation’ and ‘keeper of the meaning’ stages
Social changes in mid-life: Career
- Peak work satisfaction despite lack of promotions
- Equally as good as younger employees at a large variety of roles, expect where speed is key
- Anxiety over having to acquire new skills
- Awareness is crucial –> knowing your weaknesses forces you to compensate for them to maintain performance
- Career change - voluntary vs involuntary
Social changes in mid-life: Role conflict
- As the ‘sandwich generation’, middle-aged adults take on the most number of roles
- Partner: Marital conflict declines, marital self-efficacy, control of the relationship, better strategies to cope with arguments
- Friend: more refined social network, genuine friends, less contact, family provides primary support
- Carer: 1/3 women in the UK are multi-generational care givers –> leads to you being the last person you think of
- Grandparent: A great source of satisfaction when the role is more remote
- Parent: pivotal role in young adulthood, less so in middle-age as children grow up and leave home
Social changes in mid-life: Multigenerational families
- Due to the dynamics and role changes in mid-life, it may not just be your children who live with you
- You may be responsible for looking after children’s children or caring for elderly parents and you may be helping financially (particularly stressful, and a source of conflict, for those of low socioeconomic status)
What is older adulthood?
- 60+
- Young old: 65-74
- Old old: 75-84
- Oldest old: 85+
- Diversity in later lifestyle –> lifestyle choices catch up with you
Biological changes in older adulthood
- More prevalent, deeper wrinkles
- Continued loss of elasticity
- By 75 most people have completely grey hair
- Thinning, pattern balding, hair loss (95% men, 20% women)
Biological changes in older adulthood: Teeth loss
- 26% of over 65’s
- Impact on facial structure
Biological changes in older adulthood: Weight/build
- 60+
- Loss of weight due to reduction in muscle mass
- Weight gain due to lower metabolism, but can be offset by exercise
- Advised to start strength/balance training before attempting aerobic activity
- Mental as well as physical benefits –> reduced ‘social physique anxiety’
Biological changes in older adulthood: Bones
- Loss of bone mineral content
- 50-60s
- Linked to loss of sex hormones –> worse in women
- Reduced risk with dietary protein, calcium, and vitamin D but 70% of bone loss is genetic
Biological changes in older adulthood: Mobility
- Loss of strength
- Stiff tendons
- Arthritis
- Joint inflammation
- Increased risk of falling
- Half of adults over 75 have difficulty with daily living
- Strength training is recommended, even in those 90+
Biological changes in older adulthood: Cardiovascular system
- Fats lining arteries, preventing blood flow –> often due to diet and high cholesterol levels
Risk of heart attack and stroke is more pronounced in:
- Males (due to lifestyle, lack of cardioprotective hormones, distribution of weight
- Smokers (carbon monoxide restricts oxygen)
- Someone 65+ has 40% less cardiovascular efficiency than a young adult
Biological changes in older adulthood: Immune system
- Less able to respond to infection e.g. influenza
- People 65+ serious complications from flue e.g. bronchitis and pneumonia
- 90% of flu deaths occur in those aged 65+
- Vaccination is approx 88% effective in young adults but only 56% in older adults
- Efficiency of flu vaccination is increased by physical exercise (Kohut et al, 2004)
Biological changes in older adulthood: Digestive system
- Less motivation to eat aa healthy, varied diet
- ‘Anorexia of ageing” (Soenen and Chapman, 2013)
Biological changes in older adulthood: Urinary system
- Elasticity in bladder is reduced, particularly in smokers
- Frequent urge to urinate (30%, 65+)
- Incontinence and overactive bladder (25%, 65+)
Biological changes in older adulthood: Sleep
- Far more fragmented than in younger adults
- Frequent waking to go to the toilet and physical issues, such as arthritis and lung disease, influence sleep quality
- Decrease in stage 4 and REM (Kamel and Gammack, 2006)
- Sleep deprivation can lead to adverse effects in mental health and physical well-being
- Sleep disturbance in those over 60 promotes depression, risk of CVD and neurological dysfuntion (Gamaldo et al, 2016)
Biological changes in older adulthood: Smell/taste
- Half of 80 year olds have no sense of smell
- Relationship between poor cognition/inability to identify odours
Biological changes in older adulthood: Vision
- An 85 year old has 80% less visual acuity than a 40 year old
Biological changes in older adulthood: Balance
- Fear of falling leads to restricted movement, becoming less physically active leads to further loss of strength
Biological changes in older adulthood: Brain chanages
- Reduced weight
- Loss of grey matter
- Decline in dendrite density/number of connections
Biological changes in older adulthood: Genes
- Genes play a role in longevity
- Identical twins have more similar lifespans than non-identical twins
- They also have similar illness rates
- Centenarians run in the family (Murabito et al, 2012)
- Genes linked to common age-related diseases are depleted in those who age exceptionally (Fortney et al, 2015)
Behavioural effects of physical changes in old adulthood
- General slowing (Salthouse, 1996)
- Errors in retrieving knowledge/performing actions
- The use of behavioural feedback to compensate for mistakes e.g. when driving
- Learned skills remain butt are more difficult to perform
- It becomes harder to acquire new skills
Psychological changes in older adulthood: Memory
- At age 60, decline in remembering telephone numbers (West and Crook, 1990)
- Good general knowledge/recall, given contextual cues (Matzen and Benjamin, 2013)
- Need more time to learn things
- Given time, performance may be equivalent to younger adults
- Reduction in hippocampal volume may account for changes
- May also be due to changing processing strategies
What is Erikson’s ego integrity vs. despair
- Achieving the sense that you’ve lived a useful life or feeling hopelessness
- Part of ego integrity states that older adults value being able to pass on their experiences to younger generations
Psychological changes in older adulthood: Depression
- Poor social support
- Low income
- Experiencing loss
- Health problems
- Lower rates in males and African Americans
Psychological changes in older adulthood
- Cognitive decline –. due to avoiding challenging situations
- Remaining optimistic means quicker recovery when things go wrong e.g. post-stroke (Hillen et al, 2003)
Social changes in older adulthood: Retirement
- Not everyone 65= is retired
- Postponed due to interest/challenge or for financial reasons
- Poor health may lead to early retirement
- Often more of a transition/scaling back than a single stage
- Inequality in pay may means women work longer
- Health doesn’t change purely because of retirement –> linked to lifestyle factors
Social changes in older adulthood: social life
- steady decrease in social network across adulthood
- Loss of spouse decreased personal network (Wrzus et al, 2013)
- May experience stress over returning to active parent role
- Contact with friends/family –> better life satisfaction ratings than for contact with children
- Productivity/volunteering linked to successful ageing –> lower mortality and less hypertension
- New hobbies give life more structure and foster competence, social interaction and creativity –> offer a renewed sense of purpose
Social changes in older adulthood: Loss of partner
- When still together couples report higher satisfaction than in earlier married life
- Relationship based on campanionship
- Caring for each other if sick or disabled
- females expect to be without a spouse for many years as they tend to live for longer
- Men rely more on the social and emotional support of marriage
Social changes in older adulthood: Living arrangements
- Common to make changes to existing homes and/or hire someone to assist with daily activities
- Retain independence, physical and mental health
- Moving into the home of a relative e.g. adult children
What are social judgements?
- Believing others are worse off
- Acts as a self-protective mechanism
What are the crucial roles of diet, sleep and exercise in reducing depression?
- Diets comprising of vegetables, fruit, meat, fish, and whole grains are associated with a 35% reduced risk of depression (Jacka et al, 2010)
- Non-depressed people with insomnia are predicted to have a two-fold increased risk of developing depression (Baglioni et al, 2011)
- In a longitudinal study of over 9,000 people, regular physical activity was associated with a reduced likelihood of depressive symptoms (Azevedo Da Silva et al, 2012)
Maintaining/restoring function in older adulthood: Physical exercise
- Physical activity can help cope with physical changes
- Enhanced mental health and even social interaction, low mobility impedes social engagement (Rosso et al, 2013)
- Frailty as a reason to prescribe exercise not a contraindication –> lower iincidence of cancer, cardiovascular disease, diabetes (Bherer. et. al, 2013)
Maintaining/restoring function in older adulthood: Memory
The Synapse Project (Park et al, 2014)
- 221 participants, 60-90 years
- Activities 15 hours a week for 3 months
- Older adults who were randomly assigned to learn digital photography, quilting or both showed enhanced episodic memory function at the end of the study and a year later
Maintaining/restoring function in older adulthood: Social factors predict memory decline
Ertel et al (2008)
- In immediate and delayed recall tasks, memory declined twice as fast in those with the least social integration
- This was particularly prominent in those with fewer years of education
- Social contact and education provide a buffer against severe decline
Classification of brain structures: Cortical
Superficial
Classification of brain structures: Subcortical
Deep
What are the lobes of the brain used for
- Primarily based on function
Frontal: Decisions
Temporal: Memory
Parietal: Attention
Occipital: Vision
Anatomical terms for the brain
- Anterior: In front
- Posterior: Behind
- Superior: Above
- Inferior: Below
- Dorsal: Above, anterior-posterior axis
- Ventral: Below, anterior-posterior axis
- Rostral: To the front, frontal cortex
- Caudal: To the back, occipital cortex or brain stem
What are the different types of methodologies for cognitive neuroscience?
- Position emission tomography (PET)
- Magnetic resonance imaging (MRI)
- Functional magnetic resonance imaging (fMRI)
- Diffusion weighted imaging (DWI)
How does the grey and white matter change affect older adults?
White matter: Decline in myelin sheath protecting axons declines with age. This leads to slower information processing
Grey matter: Loss of volume and scope for activation corresponds to a lack of available resources to perform cognitive functions
Reorganisation of brain activity
- Driven by decline of function
- Breakdown of functional specialisation: dedifferentiation
- Deficits in inter-hemispheric inhibition
- Reorganisation is designed to protect existing function
- More advantageous to work together when demand is high and resources are low
- Co-operation between regions: compensation
Current views on compensation?
Grady (2012)
- Defined by studies of individual differences
- Need to combine neuroimaging data with behavioural studies, so we can see what brain activity means in the context of cognitive capacity
- Dominant approach
What happens when compensatory mechanisms cannot maintain performance?
- Importance of early intervention
- Short-term behavioural training to alter processing strategies has worked well
What is tDCS?
- Transcranial direct current stimulation
What does tDCS do?
- Increase brain plasticity
- Maintain neural connections
- Trying to take the pressure off information processing and executive systems
Evidence for cognitive enhancement using tDCS
- Acquisition of a complex motor skill was enhanced 24 hours post-anodal tDCS (Zimermann et al, 2013)
- Improved object-location learning at a 1 week follow-up after temporoparietal tCDS (Floel et al, 2012)
Sustained benefits of tDCS
- Improved accuracy of verbal working memory at 4 week follow-up (Park et al, 2014)
- Enhanced verbal/visual working memory at a 1 month follow-up –> enhancement transferred to non-trained tasks (Jones et al, 2015)
- Sustained visual working memory improvement in mild-moderate Alzheimer’s disease (Boggio et al, 2012)
Neural enhancement due to tDCS
- Currently, few studies have combined behavioural and neuroimaging data
- Older adults experienced a word-generation deficit reversal with tDCS to inferior frontal gyrus
- fMRI activation more ‘youth-like’ (Meinzer et al, 2013)
- Anodal tDCS improved the semantic word retrieval of participants with Mild Cognitive Impairment (MCI) to the level of healthy controls but reduced over-activity in regions of frontal gyrus (Meinzer et al, 2014)
Methodological considerations with tDCS
- State-dependent effects: older adults may benefit more from stimulation during training (Fertonani et al, 2014)
- Timing of response: older adults exhibit a delayed response to tDCS (Fujiyama et al, 2014)
- Individual differences: education and/or baseline performance predict response to tDCS (Learmonth et al, 2015)
- Stimulation intensity/length: need for higher current levels and stronger durations e.g. 1.5mA for 20 mins (Laakso et al, 2015; Tatti et al, 2016)
