PSYC 322 midterm 1

The current ageing pattern

Increasing population of those aged 65 and up

• The increase in 0-14 is pretty stable while 65+ has skyrocketed (14 is stagnant)

• Life expectancy is still increasing up to 85 or so 

• 2017 # of 65+ is more than the # of under 5(5 going down)

Aging questions

Why do humans age?

Is aging inevitable?

Is aging distinct from disease?

Is there a maximum lifespan for humans?

What gains may accompany aging?

Do attitudes and expectations influence the aging process?

Is it possible to age “optimally”?

How can psychology contribute to optimal aging, adding years to life and life to years?

What is older adulthood?

65+

young-old: 65-74 years

old-old: 75-84 years

oldest-old: 85+ years

centenarians: 100-109 years

supercentenarians: 110+ years

Designed to catch variability in old ppl 65+

young-old

65-74 years

old-old

 75-84 years

oldest-old

 85+ years

centenarians

100-109 years

supercentenarians

110+ years

Primary aging

Changes due to intrinsic, progressive, and universal alterations in bodily systems; normative and irreversible processes (e.g., skin wrinkling)

• Bio changes that are hard-wired

  • Ex. puberty, menopause

• Changes occurring across the world

• Time since birth

Secondary aging

Changes due to abnormalities and disease in bodily systems; preventable and/or reversible processes (e.g., skin cancer)

• These are abnormalities, and not everyone gets them

• Time to disability

Tertiary aging

Changes due to rapid losses across multiple bodily systems at the end of life; mortality-related processes (e.g., terminal drop)

• Occurs in the last 1-5 year of life

  • Decline in cognitive ability that do not generally decline in primary aging

    • Ex. Language, loss of vocabulary

  • Death is near

• Time to death

Factors contributing to heterogeneity(variability) in aging among older adults

Ferraro (2013): “Age is positively associated with heterogeneity in a population”; “standard deviations …were much greater for older adults than for younger ones

• The older ppl are, the more different they are

sex

marital status

ethnicity

Collectively, these factors: 

1.  interact to produce a unique developmental trajectory for a given person and

2. contribute to individual differences (i.e., heterogeneity) in aging among older adults

Research is needed to examine the impact of multiple jeopardy (i.e., disadvantage on multiple factors) on aging

• Multiple jeopardy may result in poorer outcomes among older adults through cumulative disadvantage

The concept of cumulative disadvantage helps one to see how trajectories [in older adulthood] arise from early inequalities”

heterogeneity - Sex

• Mortality rates are lower among females than males

• Morbidity (i.e., illness, disability) rates are higher among females than males

  • Mortality-Morbidity Paradox

• Men die, and women get sick

• Men are more likely to have the leading causes of death 

• Mediators:

  • physiological factors (e.g., hormones)

    • Estrogen seems to protect against leading causes of death

    • Having 2 X chromosomes can prevent recessive diseases

  • health-related habits (e.g., routine visits to a physician)

  • risk-taking behaviour (e.g., alcohol use)

  • occupation (e.g., construction work)

  • integration into social networks

  • socioeconomic status (e.g., feminization of poverty)

    • Accounts for the higher morbidity for women

    • Women are more likely to be poor than men

heterogeneity - ethnicity

• In contrast to sex and marital status, the association between ethnicity and mortality and morbidity rates is relatively complex and has changed over time

• Mediators:

  • migration history (e.g., Indigenous, refugee; healthy immigrant effect)

    • Live with trauma stress, live in bad regions, healthcare not made for them 

    • Ppl who choose to come here are happier cuz lots of them already have good health

  • health-related habits (e.g., use of traditional medicines)

  • language fluency

  • experiences of discrimination

  • socioeconomic status

heterogeneity - marital status

• Mortality and morbidity rates are lower among individuals who are married than individuals who are never married, divorced, or widowed

  • Younger widows experience worse effects 

    • widowhood effect where three is a increased probability of death within 6-12 months after death

      • Male or female?

    • Largely have to do with expectations

• Benefits are greater for married males than married females

• Mediators:

  • health-related habits (e.g., routine visits to a physician)

  • risk-taking behaviour (e.g., alcohol use)

  • integration into social networks

  • socioeconomic status

    • Dual income, so more money 

How do our biological systems change as we age?

The psychology of adulthood and aging begins at the biological level, as biological changes influence the psychological experience of aging

Cardiovascular

Thickening left ventricle wall resulting in larger, less efficient heart; reduced, irregular heartbeats; reduced elasticity of arteries

Digestive

• Weakened esophageal contractions, esophageal sphincter; reduced elasticity of stomach; increased vulnerability to lactose intolerance

Endocrine

• Reduced reproductive hormones; reduced thyroid hormone; insulin resistance

Immune

• Increased vulnerability to infection; increased autoimmune responses; reduced responsiveness to vaccinations

Integumentary

• Thinning of epidermis, dermis, subcutis; reduced elasticity of skin; reduced ability to filter UV radiation-less melanin 

Musculo-skeletal

• Reduced bone density (osteopenia), muscle mass; increased rigidity of ligaments, tendons; thinning of cartilage

Reproductive

• Menopause, andropause; changes in sexual functioning

Respiratory

• Reduced peak air flow; reduced gas exchange; increased breathlessness

Urinary

• Reduced kidney size; increased rigidity and decreased capacity of the bladder; bladder leakage

Nervous

• Reduced visual/auditory/tactile acuity; decreased olfactory and gustatory sensitivity; 

• structural and functional changes to the brain

  • Eyes yellowing, decreased transparency and less flexible

  • Receptors in inner ear degrade and auditory nerves degrade

Structural changes to the brain

• Decreases in volume of 0.2% per year after age 35 and 0.5% per year after age 60

• Shrinkage of gyri and widening of sulci

• Shrinkage of specific regions. Vulnerable regions: prefrontal cortex hippocampus, and cerebellum

  • Executive functions, attention, memory, balance, motor control

• Deterioration of grey matter: number of neurons, size and number of dendrites, synapses among neurons

• Deterioration of white matter (neuronal transmission) 

  • Happens mid-life

• Enlargement of cerebral ventricles (”cushion”)

• Changes in cerebral vasculature (blood flow)

• Loss of microglial cells (phagocytosis, inflammatory response)

  • Our ability to deal with infection in the brain decreases

what about healthy older adult brains?

Importantly, studies (e.g., Burgmans et al., 2009) that have excluded participants with cardiovascular risk factors or “covert” brain diseases have failed to demonstrate some of these changes (e.g., deterioration of grey matter)

Functional changes to the brain

Changes in neurotransmitter systems

• Dopamine

  • Attention, memory, movement, reinforcement/reward

  • Produced in the substantia nigra and ventral tegmental area in the midbrain

    • Sn linked to movement

    • Vt linked to reinforcement and reward

  • Reduced dopamine functionality

  • Decreases across the dopamine system (i.e., synthesis, receptors, transporters) range from 3.7–14% per decade between young adulthood and older adulthood 

    • Decrease in synthesis (relatively small)

    • Loss in dope receptors we lose 14% of our D1 receptors (5 RECEPTORS

    • Transported on the presynaptic and facilitate reuptake

      • Decrease in transporter cuzes

      • Which limits the reuptake increases its bioavailability

      • This is compensating for the reduction in other dope funtions

• Serotonin

  • Mood, feeding, sleep, sexual functioning

  • Produced in the raphe nuclei of brainstem

  • Reduced serotonin functionality

  • Decreases across the serotonin system (i.e., synthesis, receptors, transporters) range from 1.5–7% per decade between young adulthood and older adulthood 

    • 14 receptors

    • Same thing as dopamine

Positive things happening

Despite these age-related structural and functional changes to the brain, research has demonstrated ongoing neuroplasticity (i.e., brain plasticity) in the aging brain

• Development of new neurons (e.g., in the hippocampus, olfactory bulb)

• Development of new synapses among neurons

  • Based on environmental challenges

Given ongoing neuroplasticity, research is underway to examine the effects of environmental interventions (e.g., diet, enriched environments, exercise, training programs) on the aging brain

• To enable ppl to have health brains 

• Vitamines 

How bio systems change do to age?

To date, more than 300 theories have been proposed to explain biological aging

At present, no single theory explains biological aging; a combination of theories may best account for age-related biological changes

Dominant theories:

1. Genetic theories of aging
2. Telomere theory of aging:

3. Free radical theory of aging

1. Genetic theories of aging

Biological aging is determined by genes that contribute to age-related diseases and influence life span

• Although some species do not show evidence of biological aging, age-related biological changes are observed in the majority of species

• Among species that do exhibit biological aging, differences in maximum life span vary considerably, suggesting that life span is genetically influenced:

  • The maximum life span for humans is 122 years, whereas the maximum life span for chimpanzees is 37 years

    • See s broad positive correlation btw size(BODY and MIND) and life

    • See negative correlation btw metabolic rate and life. Less neta rate = long

  • Given that the two species share 98% of their DNA, researchers have suggested that a relatively small number of genes influence life span

• Nature or nurture?

  • Heritability of life span: 25-30% of variability in span is genetic 

  • Heritable factors become more important determinants of life span with age 

    • Up until 60 is environmental, but 6,70,80 is more affected by genes

  • Examples of genes that influence life span:

    • Apolipoprotein E (APOE) gene: Located on chromosome 19; variant APOEe2 associated with longer life span

    • Forkhead Box O (FOXO) gene: Located on chromosome 6; variant FOXO3 associated with longer life span

  • Examples of genes that influence age-related disease

    • Kidney and Brain Expressed Protein (KIBRA) gene: Located on chromosome 5; variants associated with memory impairment and Alzheimer’s disease

    • Lipoprotein A (LPA) gene: Located on chromosome 6; variants associated with atherosclerosis, coronary artery disease, and stroke

    • SH2B adapter protein 3 (SH2B3) gene: Located on chromosome 12; variants associated with cancer, coronary artery disease, diabetes, and rheumatoid arthritis - lung cancer and prostate

• Given the role of genes in biological aging, researchers are investigating interventions to combat genes that reduce life span and contribute to age-related diseases

• Gene editing (e.g., knock out genes)

  • Injecting into cell RNA that guides enzyme to the gene, enzyme cuts out the gene, cell stitches itself back together 

• Viral vectors

  • Make a virus, take away it’s effects, attach gene of interest, inject into blood stream, virus migrate into nucleus, hijacking and integrating the genetic material into the DNA

2. Telomere theory of aging

Biological aging is determined by telomeres and their impact on cellular division

• Hayflick limit (Hayflick, 1996, 1998): Cells undergo a finite number of divisions; the number of possible divisions declines with age

  • Cells from human fetal lung tissue are capable of ~50 divisions; cells from human adult lung tissue are capable of ~20 divisions

  • Telomeres play a critical role in cellular division, determining the number of times that cells can divide

  • Telomeres are located at the ends of chromosomes; they protect the ends of chromosomes from DNA degradation and fusion with other chromosomal ends

  • With each cell division, telomeres shorten; when telomeres shorten to a “critical length,” cells can no longer divide

  • Cells that can no longer divide are in a state of “arrest” called cellular senescence and develop into senescence-associated secretory phenotypes (SASPs). this is the hayflex limit

    • Senescene- No longer capable of cell division 

  • SASPs are ”bad neighbours”: They secrete molecules that damage surrounding “healthy” cells and stimulate growth of malignant cells

  • SASPs accumulate with age

• Telomeres are repeat sequences of nucleic acids (TTAGGG) 

  • These aren’t replicated so you lose some all the time

• Given the role of telomeres in biological aging, researchers are investigating interventions to combat telomere shortening. Example:

• Telomerase gene transfer

  • Telomerase lengthen telomeres

  • Uncontrolled telomerase mean cancer due to uncontrolled division

  • They use viral vectors

3. Free radical theory of aging

Free radical theory of aging: Biological aging is determined by reactive oxygen species which cause cumulative damage to cells

• Reactive oxygen species (ROS) are chemically reactive oxygen-containing molecules (e.g., O2 -, H2O2)

  • 
    

• The majority of ROS are generated by the mitochondria (Harman, 1972, 2006), as byproducts of adenosine triphosphate (ATP) production; ATP is the main energy source of cells

• ROS attack and damage cellular macromolecules, including proteins (e.g., protein fragmentation), lipids (e.g., “leaky” cellular membranes), and DNA 

• Damaged cellular macromolecules accumulate with age

• Given the role of ROS in biological aging, researchers are investigating interventions to combat ROS (e.g., Ramis et al. 2015; Suja et al. 2016, Walsh et al., 2014). Examples:

• Antioxidants (e.g., vitamins C and E, superoxide dismutase)

• Caloric restriction:

  • In diverse species (e.g., fish, rats, dogs), a 20-40% decrease in caloric intake extends life span by 20-50% and reduces the onset of age-related diseases

  • Caloric restriction slows metabolism and may, in turn, reduce ROS production

  • In humans, caloric restriction is controversial

stereotypes of older adults

Age stereotypes: Cognitive schemas or organized knowledge structures that reflect beliefs about the shared characteristics of individuals of distinct age groups

• Evolved so we can spend less cognitive effort when interacting with the world

• May be explicit or implicit

  • Conscious stereotypes and recognise these stereotypes

  • Implicit is automatic and unaware

  • We incorrectly assume our recognition of stereotypes

Multiple stereotype model

 Seven stereotype subtypes of older adults

• Reported by young, middle-aged, and older respondents

• Generate a list and sort into gourps

• Negative 

  • Severely impaired: slowthinking, incompetent, 

  • Despondent: sad hopeless

  • shrew/curmudgeon: complaining, ill-tempered

  • Recluse: quiet, timid, naive

• Positive

  • Golden ager: alert active, sociable, independent

  • Perfect grandparent: interesting, kind, loving, supporting

  • John Wayne Conservative: patriotic religious, determinded 

other findings of stereotypes in older adults

• Stereotypes of older adults include beliefs about physical characteristics, personality traits, behavioral tendencies, and social status

• Stereotypes of older adults are ambivalent (i.e., negative and positive)

• Number of stereotype subtypes among older respondents > number of stereotype subtypes among young and middle-aged respondents

  • Ingroup, outgroup, in is more different, out is more of the same

like the multiple stereotype model, the stereotype content model asserts that stereotypes of older adults are ambivalent

consequences of common stereotypes of older adults

Ageism: Negative attitudes toward older adults, old age, and the aging process; discriminatory behaviour against older adults; and institutional practices and policies that perpetuate stereotypes of older adults 

• Older adults are less likely to be screened in medic settings 

• Ageism reflects a deep seated uneasiness on the part of the young and middle-aged—a personal revulsion to and distaste for growing old, disease, disability; and fear of powerlessness, ‘uselessness,’ and death.

In Canada (International Federation on Ageing and Revera Inc., 2012, 2014; Qureshi et al., 2025):

• 51% of respondents believe that ageism is the most tolerated form of social bias

• 70% of older adults report experiences of “everyday ageism”

• 63% of older adults report unfair or differential treatment because of their age (e.g., “incompetent,” “invisible,” “nothing to contribute”; females > males)

Elder abuse: “A single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person” 

• Includes neglect and financial, physical, psychological, and sexual abuse

  • Not fulfilling duties, not providing food, clothing, medication

  • Stealing money, foreign signatures

• Associated with increased morbidity among victims: Anxiety, dementia, depression, posttraumatic stress disorder, somatic complaints (Dong et al., 2012)

• Associated with increased mortality among victims: Cardiovascular-related mortality, shorter telomere length

  • The chronic stress produces sustained low-grade inflammation, causing more cell division and turnover

  • Suppresses telomerase 

In Canada

• 10% of older adults report elder abuse in the previous year

• Underestimate? 1 in 24 cases is reported to authorities

  • May be dependant

  • Fear retaliation 

  • Feel stigmatized by police

  • The justice system can’t help

  • May not have the capacity to report it

The stereotype content model may be used to explain elder abuse

Stereotype Content Model

The development of age stereotypes begins early in life and is reinforced across the lifespan through representations of older adults in various forms of media

All stereotpyes vary on 2 dimensions

• Warmth ( not a source of competion or threat)

• Competence ( high social status)

Older adult are not a threat but low in social status 

• We see ambivious 

• When see group in pity + admiration, we offer help, support (facilitation)

• When see group in admiration + envy, unconscious low effort helping 

  • Offering a discount within a workplace, allowing for longer work period

• When see groups in pity + contempt, we unintentionally hurt (harm)

  • neglect

• When see contempt and envy, we active don’t like

Stereotype threat

Tendency for members of a stereotyped group to “underperform” following activation of a negative stereotype of their group

• Involves explicit stereotype activation

• Results from anxiety that they will confirm the negative stereotype; the anxiety hinders behaviour and, in turn, confirms the stereotype

• Adversely affects older adults across multiple domains (e.g., memory performance, self-reported health, self-reported loneliness, help-seeking behaviour

• Example: Hess et al., 2003 (also see Hess, 2006)

  • Participants: Younger adults (mean age=19 years) and older adults (mean age=71 years); randomly assigned to one of two conditions

  • Threat condition: Participants read a fictional research article that reported that older adults have poorer memory skills than younger adults

  • Non-threat condition: Participants were told that they would complete a series of tasks

  • Finding: Stereotype activation resulted in reduced performance on a memory recall test among older adults but not younger adults

•  … repeated exposure to stereotype threat can result in disengagement from domains that are perceived as threatening to one’s self-esteem, which in the longer term can lead to disidentification (i.e., avoiding any activities that may result in reaffirming negative stereotypes). … which can have a negative effect on their holistic health.

Self-stereotyping

Tendency for members of a stereotyped group to adopt and assimilate to the stereotype of their group

• Involves implicit stereotype activation

• Results from stereotype embodiment theory and its components

  • internalization, unconscious operation, salience from self-relevance, utilization)

• Adversely affects older adults across multiple domains (e.g., gait, health behaviours, memory performance, preference for end-of-life interventions, functional health, survival

• Example: Levy et al. (2002a, 2002b; Ohio Longitudinal Study of Aging and Retirement)

  • Participants: 50 years and over; recruited in 1975; followed for 20 years over multiple waves

  • Measures:

    • Self-perceptions of aging (e.g., “Things keep getting worse as I get older”)

    • Perceived control (e.g., “I can do just about anything that I set my mind to”)

    • Functional health (e.g., "Which of the following things are you physically able to do? Ordinary work around the house? Walk half-a-mile?)

    • Will-to-live (e.g., “Check the … box that best describes what you think about your life in retirement: full, hopeful, worthy vs. empty, hopeless, worthless”)

    • Survival (via the National Death Index)

  • Findings:

    • Participants with more negative self-perceptions of aging at baseline had worse functional health over time than participants with more positive self-perceptions of aging

    • Perceived control (i.e., “the belief that one has a choice among responses that are differentially effective in achieving a desired outcome”) partially mediated the relationship between self-perceptions of aging and functional health over time

    • Median survival among participants with more negative self-perceptions of aging was 7.6 years shorter than median survival among participants with more positive self-perceptions of aging (15 years vs. 22.6 years past baseline)

    • Will-to-live (i.e., “the perceived benefits of one’s life outweigh the perceived hardships”) partially mediated the relationship between self-perceptions of aging and survival

Internalization of Stereotypes Across the Life Span

Children are exposed to age stereotypes from an early age.

Young adults may have an incentive to maintain negative stereotypes about older people because negative stereotypes can justify age discrimination.

• If older people are viewed as incompetent or less capable, society may prioritize younger people when distributing limited resources.

example:

• In a cohort of 440 participants, aged 18 to 49, those who held more negative age stereotypes at baseline were significantly more likely to experience a cardiovascular event over the next 38 years

• a younger subset of 229 individuals, aged 18 to 39 years, those with more negative age stereotypes at baseline were twice as likely to have a cardiovascular event after age 60

Unconscious Operation of Age Stereotypes

both positive and negative age stereotypes can be activated and influence functioning in the predicted direction on an unconscious level

• These effects resulted from flashing age-stereotype words, such as learned and confused, on a computer screen at subliminal speeds—fast enough to prevent conscious perception (i.e., 55 milliseconds for most people) but slow enough to allow encoding

• Individuals exposed to the negative-agestereotype primes produced handwriting that was rated older, compared to samples produced before exposure and those exposed to the positive-age-stereotypes primes had handwriting that was rated as younger

• Older participants were subliminally exposed to the primes and, after being presented with scenarios describing a potentially fatal illness, were asked if they would choose a lifeprolonging medical intervention, even when it resulted in two types of costs: losing their savings and extensive care by family members. Those in the positive-age-stereotype group tended to accept the life-prolonging intervention, while those in the negative-age-stereotype group tended to reject it

If older people aren't aware that stereotypes are influencing them, they may attribute their declining functioning to aging itself.

Salience Gain From Self-relevance

The process of age stereotypes becoming self-relevant for individuals is facilitated by their encounters with a plethora of societal cues, usually pejorative, that indicate they are old.

• unlike other forms of prejutice where you get from birth and learn to cope.

Utilization of Multiple Pathways

Age stereotypes appear to exert their influence along three tracks: psychological, behavioral, and physiological.

• Age stereotypes can create expectations about how someone should perform. These expectations can become self-fulfilling prophecies.

  • Stereotype-matching effect: The effect of the stereotype was strongest when the stereotype matched the task.

• Age stereotypes can influence health behaviours.

  • educe motivation to engage in healthy practices and self-efficacy

• The autonomic nervous system responds to environmental stress for ageism

  • exposed to stereotype, do task, levels of cardiovascular responce to stress

problem with Gerontology

• Gerontology currently lacks a single overarching paradigm (a fundamental image of its subject matter), a status common in social sciences but less typical in physical sciences.

• should we create a standardized curricula and professional certification or identitfy the paradigm first

Why do we need a paradigm

1. Defines which entities are (and are not) the concern of that scientific community.

2. Directs scientists where to look (and where not to look) to find entities of concern.

3. Predicts what scientists can expect to discover upon examining those entities.

Definition of the Gerontological Imagination

• the gerontological imagination is an awareness of the process of human aging that enables individuals to understand scientific contributions across disciplines and comprehend the complex links between biological, behavioral, and social structure factors that influence aging.

Seven Core Tenets of the Gerontological Imagination

1. Aging and causes

2. again as multifaceted change

3. genetic influences on aging

4. aging and heterogeneity

5. again and life course analysis

6. aging and cumulative disadvantage

7. aging and ageism

Tenet 1: Aging and Causality

Do not look at aging as the cause of all age-related phenomena(decline).

Time is separate and doesn’t cause anything

instead it is markers of time, the real causes being events, social context, life transitions, and resources. (underlying biological, neuropsychological, or social processes)

aging process is not a death process, and terminal drop is distance from death not years since birth

• Age effect: Changes that happen naturally as a person grows older (e.g., declining physical strength or shifting blood pressure).

• Period effect: Changes driven by a historical event or external condition happening right now, hitting everyone at once.

• Cohort effect: Shared experiences unique to a specific group born around the same time (e.g., growing up during the Great Depression or the digital revolution)

Tenet 2: Aging as Multifaceted Change

Aging involves biological, psychological, and social changes occurring interactively at varying, non-linear rates across individuals.

• Dynamic Equilibrium (Nathan Shock): Rates of aging differ across physiological systems within an organism, even as the whole organism ages and dies.

• Duration in State and Duration Dependence (Featherman & Petersen, 1986): Aging reflects the duration spent in specific life states. Recognizing duration dependence reveals the pace of individual aging across life spheres.

• Embedded Dynamisms: Changing biological organisms interact continuously with changing social and cultural contexts, meaning "there are many clocks that time us."

Tenet 3: Genetic Influences on Aging:

• Genetics accounts for approximately $25\%$ of the variance in human longevity

  • cellular maintenance and repair, metabolic modification, and resistance to oxidative stress, enabling organisms to avoid fatal chronic diseases

  • Antagonistic Pleiotropy

    • Genes good for early life survival or reproduction may be bad for later life

Tenet 4: Aging and Heterogeneity:

Older people are more diffferent than younger people

• cuz longer life, longer time to experience unique things

Modifiability of Aging

• Neuronal Plasticity: Aging does not universally shrink neurons; specific neuronal populations actually increase in size with age.

• Cognitive Pragmatics: Intellectual stability and positive cognitive growth occur in old age without specific brain pathology in favorable environments

Re-conceptualizing Normal Aging

• Pathological Aging: Age-related changes driven strictly by disease.

• Usual Aging: Non-pathological, typical age-linked functional losses.

• Successful Aging: Maintenance of high functional capability, disease avoidance, and social engagement without typical age-linked losses.

Tenet 5: Aging and Life Course Analysis

Aging is a lifelong process from birth to death

• Life transitions are non-linear and shaped by pivotal age markers ($16$, $21$, $50$, $65$, $100$) and biological milestones (puberty, fertility, menopause)

• Life Course Epidemiology: Early life events predict late-life health and functional trajectories.

Tenet 6: Aging and Cumulative Disadvantage:

Systemic early advantages or disadvantages compound over time, accentuating intra-cohort inequality (Cumulative Advantage/Disadvantage Theory).

• Cumulative Inequality Theory (Ferraro & Shippee, 2009): how social systems systematically generate and widen inequalities over a person's life course

• Tenet 7: Aging and Ageism:

• Modern societies exhibit prejudice and discrimination against older adults (ageism).

• Pat Moore's Participant Observation Study (Disguised, 1985): A 26-year-old designer spent 3 years disguised as an older woman across various social classes in the US and Canada. She experienced widespread condescension, patronizing behavior, neglect, and physical vulnerability—including at academic gerontology conferences.

• Clinical Ageism: Healthcare professionals working predominantly with impaired older adults risk developing a biased mindset that equates aging strictly with disease, disability, and death, ignoring "invisible elders" (vibrant, healthy older adults).

• Institutional and Internalized Ageism: Systemic structural constraints lead older adults to internalize negative stereotypes, manifesting as self-effacing behavior.

• Policy Ageism: Generational equity debates pitting children's needs against older adults' needs, and proposals to ration healthcare based on chronological age.

  • understand the gravity of neglecting children’s needs, but they also understand that one cannot dismiss an entire population group just because of age.

The PEACE Model

• In 2013, $14.1\%$ (1 in 7) of the US population was aged $65+$ ($44.7\text{ million}$, up from $35.9\text{ million}$ in 2003).

• The PEACE (Positive Education about Aging and Contact Experiences) Model proposes two primary, interconnected interventions to reduce negative ageism:

  1. Education about Aging: Providing accurate facts about aging and introducing positive older role models.

  2. Positive Contact Experiences: Fostering intergenerational contact structured under five optimal conditions.

Education About Aging

• Addressing Formal Educational Gaps:

  • Formal education regarding aging is absent or minimal in primary/secondary schools, higher education, and professional clinical programs.

  • K-12 teachers lack aging education training and frequently transmit negative portrayals.

  • High school and college students consistently demonstrate poor knowledge of aging processes.

  • Aging education in the home environment is virtually non-existent.

• Dispelling Media Myths and Misconceptions:

  • Mass media repeatedly portrays older adults as bored, cranky, forgetful, incompetent, lonely, and sickly.

  • Misconceptions include overestimating time spent sleeping/watching TV, underestimating time spent working/volunteering, and overestimating rates of memory loss, Alzheimer's disease, depression, and poverty.

• Evidence for Educational Interventions:

  • Gerontology electives and factual interventions in college courses significantly improve student attitudes toward older adults pre- to post-test.

  • Educational tools (e.g., the video "Myths and Realities of Aging") combining facts with positive older adult role models successfully refute negative stereotypes.

  • Role models (e.g., older marathon runners, working professionals) function effectively to dispel incompatibility myths, analogous to female role models reducing gender stereotypes in STEM fields.

Positive Contact Experiences

• Drawing from Intergroup Contact Theory (Allport, 1954; Pettigrew & Tropp, 2006) and Life-Review Theory (Butler, 1963), the PEACE model specifies five optimal contact conditions

1. Individualised / One-to-One Interactions.

2. Equal Status promoted or established within the interaction setting.

3. Cooperative Structure working toward shared goals (e.g., intergenerational service projects).

4. Sharing of Personal Information (autobiographical storytelling, life advice, self-disclosure).

5. Institutional Sanctioning by authority figures, educators, or setting structures

• Empirical Evidence across Interventions:

  • Higher self-reported quality of past contact directly correlates with reduced aging anxiety and more positive attitudes.

  • Intergenerational service-learning courses (e.g., undergraduate psychology students cooperating on community projects with older adults) lead to improved knowledge and positive attitude shifts compared to control groups.

  • Life-review/reminiscence interventions reduce depressive symptoms and enhance well-being in older adults while humanizing patients for healthcare providers and improving children's attitudes.

  • Grandparent-grandchild self-disclosure lowers both implicit and explicit age biases.

Interrelation Between Education and Contact

• Interconnectedness:

  • Education and contact naturally overlap (e.g., $19.7\%$ of K-12 teachers were aged $55+$ in 2011–2012, and many university professors teach past $65$, acting simultaneously as educators and active older role models).

  • Mentoring programs (e.g., Foster Grandparents) combine structured contact with active role-modeling.

  • Combined interventions (e.g., nursing bedside rounds with experienced practitioners; documentary viewing paired with panels of older professionals aged $70+$ ) yield powerful ageism reduction.

• Multi-Level Impacts:

  • Impact on Older Adults: Reminding older adults of ageist stereotypes induces stereotype threat, lowering cognitive test performance (comprehension, memory, recall). Positive intergenerational contact buffers against these negative cognitive effects. Reduces forced early retirement and health decline.

  • Impact on Children, Adolescents, and Adults: Shapes long-term health self-perceptions, lifespan planning, and career interest in geriatric specialties.

  • Impact on Society: Directly influences public support or opposition for societal policies, including funding for geriatric healthcare units and housing programs (e.g., tax support for multigenerational or age-segregated housing).

1.The majority of older people (i.e., over the age of 65) have Alzheimer's dementia

2. As people grow older, their intelligence declines significantly

3. It is very difficult for older adults to learn new things.

4. Memory loss is a normal part of aging.

5. As adults grow older, reaction time (i.e., the interval between the onset of a stimulus and the completion of a motor response, such as braking when a traffic light turns red) increases.

6. Depression occurs more frequently among older adults than youngerpeople.

10. Older adults have the highest suicide rate of any age group

23.Older adults are less anxious about death than younger and middle-aged adults.

37. People tend to become more spiritual as they age.

• 1. Alzheimer's Dementia Prevalence (False):

  • Only $11\%$ of adults aged $65+$ have Alzheimer's dementia (Alzheimer's Association 2023 Report).

  • Age breakdown: $5.0\%$ (ages 65–74), $13\%$ (ages 75–84), and $33\%$ (ages $85+$).

  • $73\%$ of all Alzheimer's dementia cases occur in individuals aged $75+$.

  • Younger-onset dementia (ages 30–64) affects approximately $110$ per $100,000$ people.

• 2. Intellectual Capacity in Aging (False):

  • Healthy adults maintain intellectual capacity well into older adulthood. Decline in the 6th and 7th decades is small and functionally minimal; larger average declines occur in the 8th decade with substantial individual variation.

  • Plasticity is preserved. Maintenance of intelligence is linked to absence of cardiovascular disease, preserved perceptual speed, average or above SES, engaged/stimulating lifestyle, and flexible mid-life attitudes.

• 3. Learning Ability Across the Lifespan (False):

  • All age groups retain the capacity to learn. Learning performance improves with instruction, practice, extra time, and tasks matching personal experience/interests.

• 4. Memory Loss in Normal Aging (True):

  • Modest short-term memory loss (recent events) is a normal part of aging; past information, general knowledge, and life-event memory are well retained.

  • Retrieval speed slows. Recall is facilitated by association, environmental cueing, spatial connection, categorization, physical activity, and visualization.

• 5. Reaction Time Changes (True):

  • Reaction time (interval between stimulus onset and motor response completion) increases significantly with age when processing ordinary stimuli.

• 6. Depression Rates (False):

  • Major depressive disorder symptoms decline with age. Situational depression (from illness, isolation, medication effects, role loss) occurs but is often underdiagnosed.

• 10. Suicide Statistics in Canada (False):

  • Highest suicide rate in Canada (2020) occurred in adults aged 50–64 ($29$ per $100,000$), followed by ages 35–49 ($28.1$), ages 20–34 ($26.6$), ages $80+$ ($24.7$), and ages 65–79 ($20.9$).

  • Males account for the majority of suicides across all age groups. For ages $80+$, male suicide rate is $21.7$ per $100,000$ vs. $4.0$ for females.

• 23. Death Anxiety Patterns (True):

  • Death anxiety decreases with age due to goal fulfillment, exposure to peer/family deaths, acceptance of finitude, and surviving past expected lifespans. The process of dying is feared more than death itself.

• 37. Spirituality in Later Life (True):

  • Spirituality ("inner, subjective region of life revolving around individual experiences of being, transcending the personal self, and connecting with the sacred", Atchley, 2008) increases in mid and later life.

  • Gerotranscendence Theory (Tornstam, 2005): Aging involves a shift from a materialistic and role-oriented mindset to a spiritual and transcendent perspective.

• 8. Alcoholism and alcohol abuse are significantly greater problems among adults over age 65 than under age 65.

• 9. Older adults have more trouble sleeping than younger adults.

• 11. Blood pressure increases with age.

• 12. Older people perspire less, resulting in increased susceptibility to hyperthermia (i.e., “overheating”).

• 13. All women develop osteoporosis (i.e., a bone disease associated with decreased bone mineral density and bone mass; “porous bones”) as they age.

• 14. Height tends to decline in older adulthood.

• 15. Physical strength tends to decline in older adulthood.

• 16. Most older adults lose interest in and capacity for sexualrelations.

• 17. Bladder capacity decreases with age, leading to frequent urination.

• 18. Kidney function is not affected by age

• 19. Increased constipation is a normal change associated with aging.

• 21. As people live longer, they face fewer acute (i.e., less than three months) health conditions and more chronic health conditions.

• 45. Older adults take longer to recover from stress than younger people.

• 46. Most older adults consider their health to be good or excellent.

• 47. Older women exhibit better health care practices than older men.

• 8. Alcohol Metabolism and Abuse (False):

  • Heavy drinking is highest among young adults aged 18–34 ($26.9\%$) vs. older adults ($7.6\%$).

  • Slower metabolism and lower total body water volume in older adults lead to higher blood-alcohol concentration (BAC) and acute impairment for identical alcohol amounts, increasing medication reaction risks.

• 9. Sleep Disturbance Patterns (True):

  • Older adults take longer to fall asleep, wake more frequently, nap more, experience circadian shifts, and spend less time in deep/REM sleep.

  • Driven by comorbidities, CNS/GI/urinary disorders, polypharmacy, chronic pain, noise, and poor sleep hygiene.

• 11. Blood Pressure Guidelines (True and False):

  • Blood pressure tends to rise with age, but the Eighth Report of the Joint National Commission (JNC 8) relaxed drug treatment thresholds for adults $60+$ to $\ge 150/90\,\text{mmHg}$ to prevent overtreatment, hypotension, and fall risks.

• 12. Thermoregulation and Hyperthermia (True):

  • Older adults perspire less, have reduced skin receptor sensitivity, decreased subcutaneous fat insulation, diminished thirst perception, and less efficient hypothalamic regulation.

  • Core body temperature recovery following extreme heat or cold exposure is significantly prolonged at age $70+$.

• 13. Osteoporosis Prevalence and Prevention (False):

  • Osteoporosis is not universal in older women. Bone mineral density deficiency affects $50\%$ of women over 50, $57\%$ over 70, and $45\%$ over 80 (rare before age 70).

  • Prevention: Lifetime calcium intake, Vitamin D, weight-bearing exercise, reduced alcohol/salt/caffeine, smoking cessation, and HRT.

• 14. Height Loss Dynamics (True):

  • People lose approximately $0.4\,\text{inches}$ ($1\,\text{cm}$) per decade starting around age 40, accelerating after age 70 due to disc space compression, muscle atrophy, and vertebral weakening.

• 15. Sarcopenia and Strength Loss (True):

  • Sarcopenia (age-related loss of muscle mass, strength, and function) begins around age 45 at a rate of $\sim 1\%$ loss per year. Resistance exercise and aerobic training restore muscle function and balance.

• 16. Sexuality and Intimacy in Later Life (False):

  • Defined by Waite et al. (2009); healthy older adults maintain sexual interest and activity.

  • Decline in sexual activity is largely due to partner loss; among coupled adults, activity remains consistent through age 74 with modest drops thereafter. Physical changes (vaginal dryness, ED) are treatable with clinical counseling and medical intervention.

• 17. Bladder and Renal System Changes (True):

  • Decreased bladder capacity and elasticity; elevated risk of urinary retention, incontinence, prolapse in women, enlarged prostate in men, and UTIs.

• 18. Kidney Function Metrics (False - Affected):

  • Kidney function significantly declines: Glomerular Filtration Rate (GFR) is maintained at $\sim 140\,\text{ml/min}/1.73\,\text{m}^2$ through age 40, then drops by $\sim 8\,\text{ml/min}/1.73\,\text{m}^2$ per decade.

  • Renal Blood Flow (RBF) is maintained at $\sim 600\,\text{ml/min}$ through age 40, then drops by $\sim 10\%$ per decade due to nephron loss, glomerular sclerosis, and cortical thinning.

• 19. Gastrointestinal Function and Constipation (False):

  • Healthy older adults exhibit normal colon motility; constipation is caused by secondary factors (inadequate fluid/fiber intake, lack of exercise, medications, hypothyroidism, Parkinson's disease).

• 20. Sensory Decline Across the Senses (True):

  • All 5 senses decline on average: Hearing loss starts at age 20 (loss of high frequencies); taste sensitivity decreases; over $75\%$ of adults aged $80+$ have impaired smell; vision suffers from reduced lens elasticity and pupil narrowing.

• 21. Acute vs. Chronic Disease Shift (True):

  • Acute illness incidence decreases, but chronic condition prevalence rises: $73\%$ of older Canadians (2020) have at least 1 of the top 10 chronic conditions (top 5: hypertension, periodontal disease, osteoarthritis, ischemic heart disease, diabetes).

• 45. Stress Recovery Duration (True):

  • Recovery from physical/psychological stress takes longer in older adults due to age-related reductions in peak heart rate, cardiac output recovery, and immune response resilience.

• 46. Self-Rated Health Paradox (True):

  • A majority of older adults rate their health as "good," "very good," or "excellent" by shifting comparative reference points to age peers and adapting effectively to chronic conditions.

• 47. Gender Differences in Health Practices (True):

  • Women practice superior preventative health care (checkups, vitamins, compliance) across life; "women get sicker, but men die quicker" reflects later medical engagement by men resulting in higher hospitalization severity

• 7. Older adults are at risk for HIV/AIDS

• 22. Retirement is often detrimental to health (i.e., people frequently become ill or die soon after retirement)

• 24. Currently, people 65 years of age and older make up about 10% of the population.

• 25. Most older adults live in nursing homes (i.e., long-term care facilities).

• 26. The modern family no longer takes care of its “elderly.”

• 27. In Canada, the life expectancy of males is about the same as that of females.

• 28. In Canada, the life expectancy of Indigenous peoples is about the same as that of non-Indigenous peoples

• 29. Canada Pension Plan benefits automatically increase with inflation

• 30. The poverty rate among older adults in Canada is higher than all other age groups.

• 31. Most older drivers are capable of safely operating a motor vehicle.

• 32. Older workers are less effective than younger workers.

• 33. Most older adults are set in their ways and unable to change

• 34. The majority of older people are bored

• 35. In general, most older people are pretty much alike.

• 36. Older adults have higher rates of criminal victimization (e.g., assault, theft, vandalism) than adults under age 65

• 38. Older adults are more fearful of crime than younger people.

• 39. Following relocation to a new environment, older people do not adapt as well as younger people.

• 40. Volunteer participation in organizations (e.g., community organizations, religious organizations) tends to decline in older adulthood.

• 41. Older people are happier when they disengage from society

• 42. All medical schools require students to take courses in geriatrics (i.e., the medical care of older adults).

• 43. Elder abuse is not a significant problem in Canada.

• 44. Grandparents today take less responsibility for rearing grandchildren than in the past.

• 48. Research shows that “old age” begins at 65 years

• 7. HIV/AIDS Demographics in Canada (True):

  • Adults aged $50+$ represent $>50\%$ of Canadians living with HIV and accounted for $22.8\%$ of new diagnoses in 2017 (up from $15.1\%$ in 2008), with high growth among older women.

• 22. Retirement and Health Causality (False):

  • Retirement does not cause health decline or mortality; health changes are driven by aging and pre-existing health conditions (Health and Retirement Study).

• 24. Demographic Proportion of Older Adults (False):

  • In 2022, adults aged $65+$ represented $19.0\%$ of the Canadian population (up from $14.1\%$ in 2010); projected to reach $22.5\%$ by 2030 and stabilize at $\sim 25\%$ by mid-century.

• 25. Institutionalization and Nursing Home Rates (False):

  • Only $1.2\%$ of older Canadians lived in nursing homes/seniors' residences overall in 2017. Rates rise sharply at extreme ages: $35.3\%$ of adults aged 85–89 and $52.8\%$ of centenarians lived in long-term care in 2021.

• 26. Family Caregiving Contributions (False):

  • Family caregivers provide up to $80\%$ of all care for community-dwelling older adults prior to long-term care placement.

• 27. Sex Differences in Life Expectancy (False):

  • Females outlive males globally; Canadian life expectancy at birth (2023) was $84.1\,\text{years}$ for females vs. $79.6\,\text{years}$ for males (a $4.5\text{-year}$ gap).

• 28. Indigenous Life Expectancy Disparities (False):

  • Life expectancy is significantly lower for Indigenous peoples due to colonial disruption (residential schools, Sixties Scoop), systemic health inequities, and lack of culturally safe care (NWAC, 2024).

  • At age 1, Inuit males have an $11.4\text{-year}$ lower life expectancy than non-Indigenous males.

  • Probability of reaching age 75: Inuit (Males $51\%$; Females $63\%$), First Nations (Males $53\%$; Females $66\%$), Métis (Males $64\%$; Females $74\%$) vs. non-Indigenous population.

• 29. Canada Pension Plan Inflation Indexing (True):

  • CPP benefits are legislated under the Canada Pension Plan Act to increase annually every January based on the Consumer Price Index (CPI) ($4.4\%$ increase in 2024).

• 30. Poverty Rates Across Age Groups (False):

  • Older adults ($65+$) have the lowest poverty rate in Canada at $4.7\%$ (2021 Census), compared to young adults aged 18–24 ($14.0\%$), ages 55–64 ($9.0\%$), and core working ages 25–54 ($7.9\%$), due to CPP and Guaranteed Income Supplement (GIS) protection.

• 31. Driving Safety Metrics (True):

  • Older drivers ($54+$) drive $3\times$ more kilometers than young drivers ($<25$), yet younger drivers have $50\%$ more collisions. Older driver collisions are tied to right-of-way judgment, not speed or alcohol.

• 32. Older Worker Productivity (False):

  • Older workers show lower turnover, lower absenteeism, and fewer workplace injuries; employers rate them higher on dependability, accuracy, loyalty, and emotional stability.

• 33. Adaptability and Attitude Shifts (False):

  • Older adults remain flexible and adapt to major life transitions (empty nest, retirement, widowhood, relocation, illness); political/social attitudes shift along with broader societal trends.

• 34. Activity Levels and Engagement (False):

  • Most older adults describe themselves as "very busy," maintaining active participation in volunteering, hobbies, and leisure.

• 35. Heterogeneity vs. Monolithic Aging (False):

  • Older adults are the most diverse age demographic due to cumulative life course trajectories; terms like "the elderly" are inaccurate and reductive.

• 36. Criminal Victimization Rates (False):

  • Adults aged $65+$ have the lowest rates of violent crime victimization of any age group (e.g., ages 20–24 face $6\times$ higher violent victimization risk than $65+$).

• 38. Fear of Crime Trends (False):

  • Older Canadians report higher satisfaction with personal safety ($82\%$ vs. $77\%$) and higher police confidence ($50\%$ vs. $39\%$) than younger Canadians.

• 39. Relocation and Environment Adjustment (False):

  • Relocation adaptation follows a normal distribution; success depends on environmental predictability, controllability, and similarity to previous housing.

• 40. Volunteer Contributions (False):

  • While younger adults have higher raw participation rates, older adults contribute far more total hours: Baby Boomers contribute nearly $1,000,000$ full-time job equivalents ($31\%$ top volunteers) vs. iGen ($214,000$ job equivalents; $18\%$ top volunteers).

• 41. Disengagement Theory Refutation (False):

  • Disengagement Theory (Cumming & Henry) is disproven; maintaining active social roles directly correlates with higher subjective well-being and life satisfaction.

• 42. Geriatric Medical Training Deficits (False):

  • Medical schools do not universally require geriatric rotations (unlike mandatory pediatrics). Canada has only $\sim 300$ practicing geriatricians, despite older adults accounting for $33\%$ of physician services and $46\%$ of healthcare expenditures (projected to exceed $70\%$ by 2040).

• 43. Elder Abuse Realities (False):

  • Elder abuse is widespread and underreported; $25\%$ of violent victimization of older adults is committed by non-spousal family members (vs. $15\%$ for under-65). Older women report higher rates of non-spousal family violence ($30\%$) and intimate partner violence ($16\%$) than older men ($22\%$ and $7\%$ respectively).

• 44. Grandparenting and Multigenerational Households (False):

  • In 2021, $9\%$ of Canadian children lived with a grandparent ($93\%$ in multigenerational homes). $93\%$ of grandparent caregivers aged $65+$ provide unpaid care for grandchildren, averaging $15\,\text{hours}$ per week.

• 48. Social Construction of "Old Age" (False):

  • Age 65 is an arbitrary administrative boundary created for social policy/pension eligibility (CPP); functional age, health, and social engagement dictate actual individual aging.

Ageism is a complex social issue

What does it mean that an issue is "complex"?

→ Consists of many interacting parts with relationships that shift over time.

→ Change cannot be fully predicted.

→ The whole system cannot be fully understood by breaking it down into parts.

E.g., A city is complex. Even if you understand individual residents, businesses, and institutions, you cannot easily predict traffic patterns, housing prices, cultural trends, or political movements because these emerge from many different interactions and relationships.

This is why social change is so difficult! Changes or “fixes” can have unpredictable consequences.

Ex. A mechanical watch

• Many parts, but their relationships are fixed and fully knowable.

•  Take it apart and put it back together; it still works the same way.

•  Same input, same output every time.

•  A skilled expert can master the whole thing and fix failures.

Human systems are not like watches!

Understanding the issue: Root Cause Analysis

Define the issue -> gather data -> identify causal factors -> identify the root causes -> create and implement solutions -> evaluate impact of changes

Whole process of understanding the issue

The Inequalitree

🍃 LEAVES WHAT

What is happening?
→ The visible problem/impact.

🌳 TRUNK HOW

What system or structure is creating the problem?
→ Policies, services, practices, access, institutions.

🌱 ROOTS WHY

What belief or assumption created that system?
→ Mental models, beliefs, assumptions.

Example:

Leaf:
Older adults aren't using an online service.

↓

Trunk:
The service requires digital access and assumes users can navigate it independently.

↓

Root:
The designers assumed that everyone can easily use digital technology.

HelpAge Canada

Improving the lives of older adults and strengthening the organizations that support them.

Main goal

• age with dignity

• Have a sense of purpose

• Have a sense of belonging

HelpAge Canada helps local organizations by providing:

• Funding

• Resources

• Training

• Opportunities to collaborate

• Opportunities to share knowledge

Age Better is:

• A national granting program

• Funds community-led projects

• Focused on older adults

CanBelong focuses specifically on:

• Loneliness

• Social isolation among older adults

It partners with local organizations to support older adults affected by:

• Poverty

• Displacement

• Conflict

• Humanitarian crises

emphasises that older adults should be involved in shaping the programs, services, and decisions that affect them.

411 Seniors Centre Society

A major part of 411 Seniors' work is helping older adults:

• Avoid social isolation

• Navigate everyday challenges

• Find information

• Access appropriate services

411 Seniors helps older adults find information and support related to:

• Housing

• Finances

• Government benefits

• Health services

• Transportation

It also functions as a community hub.

"By seniors, for seniors"

• Independence

• Meaningful participation

• Older adult leadership

South Vancouver Neighbourhood House

It serves people across the lifespan

• Cultural backgrounds

• Economic backgrounds

• Religious backgrounds

• Social background

South Vancouver Seniors Hub

• Brings together seniors

• Community agencies

• Other organizations

Better at Home

• Transportation

• Light housekeeping

• Home maintenance

• Grocery support

• Friendly visiting

Adult Day Programs

• Physical challenges

• Cognitive challenges

CARES Program — MOSAIC

• Learn about the person's needs

• Understand their goals

• Identify appropriate supports

• Connect them to community resources

The program is individualized.

North Shore Community Resources

Seniors One Stop (SOS)

• It acts as a first point of contact for older adults and families who aren't sure where to begin when looking for help.

• Information, referrals, navigation, form help.

SOCIAL PRESCRIBING

• Community Connectors provided tailored, ongoing and collaborative support to navigate complex systems and access community supports.
  
  

  • Over 80% of health comes from social aspects 

BETTER AT HOME

• Transportation, light housekeeping, minor repairs, groceries and friendly visiting.

CAREGIVER SUPPORT

• Individual support, groups, information and resources for family and friend caregivers.

why services are ageist

A service can appear neutral while assuming everyone can:

• GO DIGITAL

• SPEAK ENGLISH

• TRAVEL EASILY

• ADVOCATE PERSISTENTLY

• We systems assume everyone faces these things the same way; older adults are excluded

  • Do we allow people to access things they need