MODULE 8: Late Adulthood and End of Life

Do most older adults develop dementia? 

No. Some have memory lapses, which is normal. Dementia describes loss of cognitive abilities due to a physical reason such as Alzheimer's disease or stroke.

How common are neurocognitive disorders?

Rare before 60, but increases with age. About 50% of 85+ have a neurocognitive disorder.

Why do women typically outlive men?  

Partly genetics but mostly environmental. Men are more likely to engage in risky behaviors, abuse drugs and alcohol, and be less vigilant about their overall health.

Are memory problems inevitable as we get older?

Yes, one change is that elders have trouble remembering the precise source of information.

Do most older adults need to live in a nursing home?

No. Most elders are able to care for themselves and are able to carry on their normal activities, but some with more physical or cognitive problems will need nursing homes.

Primary Aging

Genetically influenced and thought to be unavoidable. What triggers this process, however, is up for debate.

Secondary Aging

Result of choices we make and environmental exposure.

Why is “wear and tear” inaccurate?

Focuses on secondary aging, doesn’t take into account that the body can repair itself, exercise is healthy, and does not explain the cause of the issue.

Cellular Theories of Aging

We age because our cells age. Includes Hayflick Limit and Free Radicals Theory

What is the Free Radical Theory

A person accumulates free radicals as they age and eventually the accumulations causes disease. Part of the cellular theories of aging.

Programmed Cell Death Theories

Cell apoptosis, may increase as aging occurs and possibly the cause of ALS, Alzheimer’s, etc.

Hayflick Limit

Cells have a limited number of times that they can divide before senescence. Part of the cellular theories of aging

List the subtypes of Neurocognitive Disorders (dementia)

Individuals can have mild or major versions of each subtype

• Parkinson’s disease

• Cognitive declines due to vascular disease

• A traumatic brain injury

• Substance/medication induced neurocognitive disorder

• A prion disease

• A number of individuals with an HIV infection

• Alzheimer’s disease

Describe Parkinson’s disease

may cause a neurocognitive disorder. Symptoms include anxiety, depression, hallucinations, and personality changes.

Describe Cognitive declines due to vascular disease

Cerebrovascular event such as a stroke. Risk factors include hypertension, smoking, obesity, and any factors that contribute to cerebrovascular disease.

Describe a Traumatic brain injury

result in cognitive impairment such as difficulty concentrating and slowed processing

Describe a Prion Disease

Example would be a form of Creutzfeldt-Jakob disease is known as "mad cow disease." While the precise process for developing a prion disease is not well understood, research indicates that transmission can occur by corneal transplantation, injection, and physical contact with contaminated matter.

Describe why a number of individuals with an HIV infection have a neurocognitive disorder

Approximately 25 percent of individuals with HIV have symptoms for at least a mild neurocognitive disorder. The module video discusses the percentage of individuals with AIDs who have neurocognitive disorders. Great gains have been made with treatment for HIV/AIDS. Individuals receiving HAART (highly active antiretroviral therapy), which suppresses HIV replication, often experience lower rates of neurocognitive issues.

Describe Alzheimer’s disease (AD)

Is the most common type of dementia (60 percent of cases). May not be just one disorder but multiple. It is progressive (few years-15 years) in nature and can be divided into 3 main stages. Women typically live longer with this disease, and it may be genetic

Describe the beginning stages of Alzheimer’s disease (AD)

Memory begins to decline. Deficits in declarative memory are most common, such as routinely forgetting basic words and substituting them with odd words (“I put on my cat”). Person is aware of decline, and may withdrawal to cope. Depression is common.

Describe the middle stages of Alzheimer’s disease (AD)

Problems with basic activities increase to the point of losing independence and should not cook or drive. Cognitive problems include forgetting to turn the stove off, forgetting names, unaware of current events, and personality changes. Physically, gait problems occur due to misinterpreting visual stimuli (clutter or chaotic patterns) and shuffling. Depressive symptoms may decrease because they are unaware.

Describe the final stages of Alzheimer’s disease (AD)

If the individual survives to this point, they have trouble remembering how to do things and impairment to limbs. They might not be able to speak, eat, walk, or use toilet

What are the 10 warning signs of Alzheimer’s disease

1. Memory loss that disrupts daily life

2. Challenges in planning or solving problems

3. Difficulty completing familiar tasks

4. Confusion with time or place

5. Trouble understanding visual images and spatial relationships

6. New problems with words in speaking or writing

7. Misplacing things and losing the ability to retrace steps

8. Decreased or poor judgment

9. Withdrawal from work or social activities

10. Changes in mood and personality

What are some common myths about Alzheimer’s disease

1. Memory loss is a natural part of aging (true)

2. Alzheimer’s and dementia are the same thing (false)

3. Alzheimer’s disease is not fatal (true, but most die of other complications first)

4. Only older people can get Alzheimer’s (false)

5. Certain meds can increase risk of Alzheimer’s (false)

6. It is not possible to diagnose AD until autopsy (for 100% accuracy: true, but other tests can confirm)

7. Flu shots and other vaccines increase risk (false)

8. Dementia can be prevented by specific food supplement (false)

9. Getting diagnosed isn’t important bc there are not treatments for Alzheimer’s (false, there are treatments/meds)

10. Alzheimer’s is a form of diabetes (false)

11. Memory signs are always a sign of dementia

What are some suspected causes of Alzheimer’s disease?

• Multiple genetic combinations (primarily APOEε4 allele, also APP, PSEN1, PSEN2)

• Vascular conditions (heart disease, stroke, hypertension)

• Associations with Alzheimer’s: hearing loss, depression, mild cognitive impairments, concussion

• Lifestyle (sedentary lifestyle, poor diet, alcohol abuse, smoking, chronic poor sleep, social isolation, lack of mental stimulation

What happens to the brain during Alzheimer’s disease?

Brain shrinks as disease kills brain cells. Specifically inhibited by Amyloid plaques and Neurofibrillary tangles, deficiency of acetylcholine

Amyloid plaques

disrupt normal communication between neurons. AD is thought to be at least partly attributed to problems processing beta-amyloid.

Neurofibrillary tangles

threads in the tau protein twist and tangle, which disrupts the brain’s ability to transport necessary nutrients throughout the brain.

What are some Socioemotional Development Theories of Aging?

Disengagement Theory, Activity Theory, Selective Optimization with Compensation Theory (SOC)

Describe Disengagement Theory

Older adults should withdraw from society in order to prepare for death. Cummings and Henry felt that older adults would be most satisfied in life if they didn’t overly concern themselves with society in their declining years. However, this has been debunked due to physical and cognitive decline.

Describe the Activity Theory

More active the older adult is, the more satisfied in life they will be.

Describe Selective Optimization with Compensation Theory

links successful aging with three things: selection, optimization, and compensation.

Describe Selection in regards to the Selective Optimization with Compensation Theory

What older adults choose to do. Should not completely disengage but may not be able to do the same activites.

Describe Optimization in regards to the Selective Optimization with Compensation Theory

Maintaining what an older adult can do through practice, even if there are declines in other areas

Describe Compensation in regards to the Selective Optimization with Compensation Theory

when an older adult simply cannot function as she used to and must learn to compensate accordingly (such as by resting after physical activity, driving more slowly, or watching peoples’ lips while they talk)

Describe Successful Aging

All three theories attempt to address this, with the addition of other qualities such as spirituality and humor, are currently considered to be excellent strategies

What were the definitions of death in the past?

• cessation of all bodily processes

• stopped heartbeat

• stopped breath

What is Brain Death

Complete cessation of all activity in the brain and brain stem. Controversial since some would say that this is all that is necessary to declare death.

What is the Elisabeth Kubler-Ross’s Theory

Kubler-Ross interviewed 200 terminally ill individuals to describe their responses to their approaching deaths.

1. Denial

2. Anger

3. Bargaining

4. Depression

5. Acceptance

What is misunderstood about Elisabeth Kubler-Ross’s Theory

The five stages are not “fixed”. They do not have to go in order or some can even be skipped.

Describe Euthanasia

painlessly killing or permitting the death of someone who is severely inquired or sick. Can be active or passive

Describe Hospice

Services for the terminally ill and their families. Include treating physical needs, such as nausea and pain, and addressing social and spiritual needs

Describe Palliative Care

Comfort care. Quality over quantity in regards to life. Can be for anyone with serious illness. Inpatient or outpatient or home

Describe Grief

The psychological reaction to a loss, internal. Include sadness, anxiety, anger, and even stigma and shame. No particular timetable to grief.

Describe Mourning

Behaviors undertaken while grieving, external. Strongly dictated by culture. Includes crying, spending time alone, spending time with close family, wearing black.

Greif and Mourning are largely influenced by

Culture. Various rituals may accompany end of life. Intensity and duration is also influenced by culture.

How do American and Canadian culture view grief?

Taboo, only a private family affair.

How is grief shown in other parts of the world

more open, even experienced communally.