Psychology of ageing

Question 1

People over 50 years of age are the fastest growing age group in the UK. By what year will nearly half of the UK population be over 50 years of age?

Answer 1

2031 - not far off

Question 2

Why is immigration good for health economics?

Answer 2

• Ageing population
• Immigrants immediately start working (pay for ageing pop)
• Immigrants can’t claim benefits (min 2 years)
• Also immigrants haven’t claimed education/health costs previously

Question 3

Briefly, what are the 3 main themes underlying psychology of ageing?

Answer 3

• Bio-psychology: focus = ageing of the CNS + associated decline of mental functions
• Bio-psycho-social approach: focus upon multiple sources of decline/vulnerability (physical health to social networks) + how individuals ‘adjust’
• Psychosocial approach: focus is upon ‘lifespan development’ and human character + personality across the whole lifespan

Question 4

What does the bio-psychological approach suggest?

Answer 4

• Suggests that the ageing brain is the principle determinant of psychological changes associated with age
• Cross sectional evidence of loss of brain weight/cell numbers indicate loss/deterioration of brain power - ie. decline in cognitive skill

Question 5

What part of the brain to do with memory and orientation is affected in ageing?

Answer 5

• Temporal lobe & hippocampus atrophy
• Important in orientation and place
• Suffer memory and orientation issues
• Doesn’t however interfere with ongoing functioning in normal ageing adult

Question 6

What does research on intellectual decline in later life suggest?

Answer 6

1. David Wechsler - scores on IQ tests were highest in early 20s + declined constantly afterwards
2. When first longitudinal studies followed up people’s performance on tests at various times after initial testing, results indicated less decline (Owens, Schaie)

Both above were lab studies, if you test elder adults in real world you find the same performance as younger adults as they make up for it by altering their behaviour to make up for ‘an atrophied brain’. So don’t clinically expect elderly patients to have worse IQ.

Question 7

What is the problem with the cross sectional approach?

Answer 7

• Flynn effect
• Cross section accentuates loss, due to cohort inequalities
• Eg. progressively more education received from 1890s to 1980s, so each cohort of 20 & 70 yr olds will be better educated than previous cohorts

Question 8

What is the problem with longitudinal data?

Answer 8

• Longitudinal data collection minimises the evidence of decline
• As those who are willing to be re-tested tend to be healthier, wealthier + wiser than those who ‘drop out or die’
• -> Sample loss

Question 9

Is intellectual decline normal?

Answer 9

Yes. There is evidence supported by both cross sectional + longitudinal studies of a drop in performance associated with greater age.

Question 10

What kind of tasks are affected by intellectual decline in the elderly?

Answer 10

This is more noticeable for tasks requiring speed of processing than for tasks dependent upon acquired knowledge + established problem solving strategies. BUT remember assessment issues.

Question 11

Does everybody follow the same path of intellectual decline?

Answer 11

• Not everyone follows such a path. Proportion of people exhibiting intellectual decline is small in a 50-60 y old population
• Becomes more common in ppl aged 80+, often referred to as the ‘old-old’
• Even then substantial numbers of 80+ people do not show evidence of intellectual decline

Question 12

When is intellectual decline to be considered abnormal?

Answer 12

• Statistically intellectual decline is more abnormal when it occurs earlier in old age
• Slight intellectual decline while normal, should not interfere with older adults ongoing life to any great degree - where it does, pathological processes should be investigated.
• Distinction between normal & abnormal is not fixed: however the transition from maintained functioning to decline is usually one way.

Question 13

What is meant by crystallised and fluid intelligence in terms of ageing and how they change?

Answer 13

• Wisdom = crystallised intelligence
• Wit = fluid intelligence
• Loss of wit is more common
• Lay perceptions suggest wisdom may even increase in older adults but research doesn’t support this

Question 14

Recovery from progressive (vs acute) mental decline remains an elusive goal + many prefer to bank on primary prevention. How can we primarily prevent intellectual loss/decline?

Answer 14

Important use of intellect + enriched environment across the lifespan appears protective. Provide offspring with advantageous environment between ages of 0-12.

Question 15

What is the main principle of Bernice Neugarten’s model?

Answer 15

Ageing is associated with physical, psychological and social loss, which require adjustment.

Question 16

Describe Bernice Neugarten’s model

Answer 16

• Life is bio-socially structured through events such as birth, education, work, marriage, childbirth, retirement etc.
• The more predictable the event ie. the more socially expected it is, the less likely it is to demand individual adjustment (eg. widowhood for women over 60)
• The less predictable the event (eg. death of a child) the more effortful the adjustment and greater risk of being destabilised is.

Question 17

What is meant by positive illusions work (taylor & brown) and how is this clinically relevant?

Answer 17

• Positive illusions (T & B) – got nonmedical background people, ask them how likely are you to get cancer in your lifetime (actual: 50%). 1 in 10,000 was the average estimate.
• Humans consistently underestimate likelihood of anything bad happening to them, average person thinks they are more attractive and intelligent than average which is statistically impossible. Set mechanism of human thinking -> this is bad for health as people won’t do self-exams, not quit smoking, not look after themselves better. In terms of ageing, if you live long enough bad things will happen so require more adjustment.

Question 18

How do life course experiences impact on later adjustment?

Answer 18

• Experiences earlier in life may confer unique strengths or vulnerabilities, making adjustmeant easier or harder
• Experience of the Depression in early adult life helped older people cope with reduced income better than those not affected
• Dutch elders who had been exposed to traumas of war in chldhood were more likely to suffer from anxity disorders in later life than those who did not have such experiences

Question 19

The experience of permanent physical impairment is a stressor for many people. What does research suggest about how individuals who express a sense of personal responsibility over such events adjust later on?

Answer 19

Those expressing personal responsibility over the event are more likely to adjust to such trauma than those who see such events as their bad luck.

Question 20

What does the work of Jung suggest, in terms of lifespan developmental psychology?

Answer 20

• Introduced idea that continuing psychosocial development is normal during adult life. Thus, development continues across lifespan.
• For Jung, he argued there needed to be a shift in character + temperament from early-late adulthood.
• One central feature was expression of aspects of one’s character in later life that had been suppressed in early adulthood (eg. exhibiting one’s fem/masculine side)

Question 21

What does the Socioemotional Selectivity Theory (Carstensen) suggest?

Answer 21

• Perception of time remaining in life prompts shift in motivation away from gaining knowledge towards emotional satisfaction.
• E.g. in the young, more focus on education + partnerships to improve future, which is seen less in the elderly.
• This may confer defensive advantages in later life, by positivity effects and therefore is seen by the decreases in prevalence of mental health problems in old age, so older adults consistently happier than younger ones.

Question 22

Describe the Theory of the Third Age (Laslett)

Answer 22

• Looks at late life as period of self-fulfilment when individuals can follow their own projects + plan their lives
• BUT criticised as only possible if physical + material well being in access.
• Responsible for growing emphasis on older adults taking an active role in their care + treatment.

Question 23

Erikson’s model is probably the best known though least well researched example of lifespan development. What did Erikson argue?

Answer 23

He argued that at each stage of life we face a particular type of psychosocial crisis, whose resolution helps establish an emergent trait or ‘virtue’ that then serves us well in addressing challenges in later life

Question 24

What are the Eriksonian stages of psychosocial development?

Answer 24

1. Infancy: basic trust vs mistrust
2. Early childhood: autonomy vs doubt
3. Play age: initiative vs guilt
4. School age: industry vs inferiority
5. Adolescence: identity vs role diffusion
6. Young adulthood: intimacy vs isolation
7. Middle adulthood: generativity vs stagnation
8. Late adulthood: integrity vs despair

Question 25

What are key adult ‘qualities’ and what questions can you ask yourself as a doctor to help with these qualities?

Answer 25

• Key adult qualities are:
• > sense of identity (being a somebody)
• > capacity for intimacy (having a somebody)
• > exp of generativity (helping a somebody)
• > acquisition of integrity (taking responsbilitiy)
• How can I maximise chances that these qualities continue to be expressed?
• How can I support these qualities to develop?
• How can I protect those with limited or no exp of developing or exercising these qualities?

Question 26

Older adult assessment is difficult in view of their tendency to underreport psychological complaints. What can this lead to?

Answer 26

• “Masked depression”
• Older adults at high risk for suicide - esp older adult males (85+)
• Difficult to detect as older adults tend to minimise psychological symptoms + great overlap between physical symptoms + psychological