Late Adulthood

Leonard Cohen on Aging
- Age 82; shares a positive perspective on aging despite challenges.
- Importance of personal resources: family support, friends, and mental wellness.
- Emphasizes the comfort of "putting one's house in order".

Focus on how different systems (microsystem, mesosystem, macrosystem) affect the individual, and the impact of chronological and age-graded events (chronosystem).
Importance of social security systems (Social Security, Medicare, Medicaid) for financial stability.

Biological factors significantly influence social and psychological domains.
Elements affecting late adulthood:
- Good cardiovascular health, brain reserves, health behaviors, social support, and fiscal planning are critical.

Young-Old: Age 65-80
Oldest-Old: Age 80+
Functional age is significant; some age 65 may be infirm, while others at 85 may be independent.

Historical Data:
- 1900: average life expectancy was 47 years.
- 2000: increased to 78.74 years.
- Current: approximately 76 years, with recent declines due to deaths of despair and COVID-19.
Population pyramid changing to a rectangular shape due to decreased infant mortality and older adults living longer.

Inevitable, irreversible changes in structural and functional ability post-reproductive maturity.

Age-related declines from external factors (pathological changes, health behaviors, disease).
senescence - cellular aging that affects the body's ability to repair and regenerate tissues, leading to a gradual decline in physical and cognitive functions.

Sensorimotor Decline:
- Cerebellum and substantia nigra thinning lead to reduced motor control and balance issues.
  - cerebellum loses 3% per decade
  - sensory system - 2.5% loss per decade
  - falls are the main cause of accidental deaths for ages 65+
- Reaction time is 50% slower in late adulthood
Frailty:
- Defined as slowing, decreased muscle mass (1% per year post-50), and risk of osteoporosis.
  - sarcopenia - loss of muscle mass that occurs as result from old age (1% per year when 50)
  - osteoporosis - disease of bone, and BMD is reduced

Changes primarily in dendritic development rather than loss of neurons.
Aging leads to reduced cognitive mechanics (processing speed) and changes in cognitive pragmatics (cultural knowledge).
- wisdom can emerge and is formed during adolescence and early adulthood
- increased attention to positive info compared to negative
- increase in positive face ratings
brain changes result in behavioral changes
- reduced amygdala/insula activity and alarm feedback
- poor recognition of negative emotional expressions

Explicit memory (conscious recall of facts) declines; implicit memory remains robust.
Recognition abilities stay relatively stable, but free recall is poorer in older adults.
cognitive mechanics - “hardware” of the mind that involves speed and accuracy of the process
cognitive pragmatics - “software” of the mind that involves language comprehension, reading/writing skills, etc.

Loneliness significantly increases mortality risk.
Risk factors: being unmarried, low physical health, low socioeconomic status, and living in nursing homes.

Successful aging involves reflecting and assessing life achievements positively; engaging in life review promotes integrity.

Delirium: Acute, fluctuating disturbance in attention and cognition; resolves with treatment of underlying issues.
Dementia: Progressively chronic and irreversible cognitive decline; includes Alzheimer's disease as the most common form.

Importance of living wills and health care surrogates to direct end-of-life care.
- Preparation: legal wills, guardianships, and end-of-life directives.
Self efficacy is important

Elder care costs are rising; typical nursing home costs are between $40,000-$100,000/year.
Social Security provides financial support, but average benefits are below living expenses.

"Use it or lose it" mentality for cognitive skills; mental activities can reduce decline risks.
Establish support systems for emotional and physical assistance underline adaptive aging.