Growing Old: Psychological Aging

The physiological changes that are part of the aging process are often accompanied by behavioral and psychological changes. Most notably are declines in perception, memory, understanding, reasoning, and other cognitive abilities with old age. Because of the mental deterioration that occurs in some older adults, the erroneous conclusion can be reached that all older adults suffer from a reduction in cognitive abilities. However, although some memory may be lost, not all memory or even all types of memory are. In addition, research has shown that although the intelligence required for puzzle solving may decline in later years, other types of intelligence do not and older adults can continue to learn. Other problems associated with older adults include dementia, Alzheimer's disease, late life depression, and issues related to reconciling oneself with death and dying.

Keywords Ageism; Alzheimer's Disease; Cognitive Ability; Dementia; Marginalization; Neuron

Aging & Elderly Issues > Psychological Aging

Overview

In many ways, the physiological effects of the aging process are most noticeable as the hair thins and turns gray (or disappears completely), reaction times slow, and the senses dim. However, aging is not only a process of the body: it is also a process of the mind. In many ways, these changes can be even more disturbing if memories fade and depression sets in. Not all psychological symptoms associated with old age occur in every person, just as not all psychopathology occurs in every younger person. There are, however, a number of common emotional problems, psychiatric disorders, and decreases in cognitive abilities that are commonly associated with the aging process.

A Natural Slow Down

The physical changes that accompany the aging process can not only bring about changes in one's appearance and physical abilities, but behavioral and psychological changes as well. Although the brain ages long before obvious symptoms occur, there is little decline in cognitive abilities until late adulthood (i.e., over 65 years of age). Before that age, most older people think as quickly and are just as alert as younger people. Further, the young old may actually have improved cognitive abilities because in many situations they have a greater wealth of knowledge and experience to draw upon than do younger people (e.g., experienced teachers being better able to handle classroom disciplinary problems than novice teachers; experienced lawyers seeing the implications of a law or better understanding precedents than their less experienced colleagues). Eventually, however, there may be a decline in some mental abilities in some older people. These declines typically occur in cognitive abilities required for novel situations or that require rapid and flexible manipulation of ideas, symbols, and data as opposed to performing tasks that they have routinely performed for years. Physiologically, the aging process also brings about changes in the brain: neural processing is slowed and information needs longer times to be processed; resulting in longer reaction times and longer times needed to solve perceptual puzzles, perform complex tasks, or even to remember names.

Often, these changes do not cause severe problems or interfere with daily activities. Research has found, for example, that memory problems in older adults typically are episodic in nature (e.g., the inability to remember what they had for breakfast) rather than semantic (e.g., the inability to remember general information). In fact, for most people, competency in everyday tasks requiring verbal processes is unlikely to be affected until well into old age. Further, older people who are healthy and psychologically flexible; have a high level of education, income, and occupation; and live in a stimulating intellectual and social environment are less likely to experience cognitive decline than are those elders who do not. In addition, research has found that continuing to exercise one's cognitive abilities in old age (e.g., doing puzzles, painting, having stimulating conversations) can help older people retain their cognitive abilities.

Improving Conditions

Because of advances in medical science and healthcare and an increased emphasis on physical fitness even during one's later years, many older adults are experiencing better health and longer life. Researchers found that the same is true for the cognitive abilities of older persons. For example, declines in test scores of mental ability occur much less rapidly than they did before 1970. In another research study, it was found that less than half of the participants over the age of 81 had experienced declines in cognitive ability over the past seven years. It has been posited that such results are due to improved physical health in older adults today than in preceding generations, as well and as improved mental exercise (e.g., the trend for adults today to work longer in their careers or jobs than did the previous generation and participation in other mental activities). In 2012, Alan J. Gow, Erik L. Mortensen, and Kirsten Avlund published the results of their thirty-year longitudinal cohort study of 802 individuals from Glostrup, Denmark, who were all born in 1914. The study tested the participants’ cognitive abilities and collected information about their leisure and physical abilities to see if there was a correlation between physical activity level and cognitive ability over time. The researchers concluded that while greater activity was consistently associated with higher cognitive ability, they found that this association was largely due to preserved differentiation, although there was a small but significant correlation between higher levels of physical activity at age 60 and 70 and less cognitive decline.

Undue Ageism

Because of the mental deterioration that occurs in some older adults, the erroneous conclusion can be reached that all older adults suffer from a reduction in cognitive abilities. This can lead to prejudice and discrimination, ageism, and marginalization of older people. For example, employers may be concerned that older people have reduced memory and intellectual capacities and force them to retire at an arbitrary age even when they may still be able to continue to work at the same level at which they always have. Such attitudes have also prompted some families to place their elders in nursing homes based on the assumption that the elder will soon need help; even when the person is still capable of performing all the necessary activities of daily living for him- or herself.

Memory & Aging

One obvious cognitive change that occurs in many older adults is a loss of memory. However, not all memories or even all types of memory are typically lost. For example, although one might not remember what one had for breakfast that morning, that same person might easily recall events from their youth decades before. Research has found that part of the reason for this phenomenon is the relevance of the information to the person trying to remember it. For example, the ability to recall meaningless or unimportant information tends to decline with age. However, it has also been found that older people continue to remember information that is important to them. Although the ability of older people to learn and remember skills and information tends to decline, researchers have found that when this material is meaningful to the individual, there is less decline in retention. Prospective memory (i.e., the ability to remember to do something in the future such as pick up an item from the store or take one's medication) continues to be strong even in old age if something triggers the person's memory (e.g., driving by the store, seeing one's pill bottle on the kitchen table). The performance of routine or habitual tasks that do not have such memory triggers, on the other hand, can be more difficult for older people. However, in the end, it must be remembered that such memory declines are not universally observed across all older people. There is wide variation in the retention of cognitive abilities between older individuals. In fact, many older adults not only retain previously learned information but continue to grow and learn well into their later years. Researchers have found that most older students actually do better academically than the average 18-year-old. Although this finding more than likely has to do with the clear goals and focus of the older individuals, the fact remains that many people are still able to learn and acquire new knowledge and skills well into their later years.

Intelligence & Aging

One puzzle about the cognitive abilities of older people that has different answers across the years concerns the extent to which older individuals retain their intellectual capacities. In cross-sectional studies comparing the capabilities of individuals of different ages, research shows that representative samples of older people typically performed worse on standardized tests of intelligence than do younger people. Such research results lead to the conclusion that a decline in mental ability in later life is an unavoidable part of the aging process in general.

However, more recent research has investigated this phenomenon using longitudinal studies in which the scores of older people on intelligence tests were compared to the scores on the same test that they had received in their youth. Contrary to theories of inevitable decline based on cross-sectional studies, the longitudinal study results show that intelligence tended to remain stable until late in life and, on some tests, even increased. The reason for these differential findings most likely rests in the fact that comparing the intelligence of people in their seventies and people in their thirties involves not only individuals of different ages but also individuals from different eras. In general, older people tend to be less well educated than younger people today. More likely, it is this difference that has been caught in the cross-sectional research.

However, these later findings still have not put the controversy over the decline in intelligence to rest. Longitudinal studies are plagued by problems of their own, including the fact that research subjects will drop out of the sample for any number of reasons. In addition, many theorists believe that intelligence is not a unitary concept and, in fact, there is more than one type of intelligence. Studies have shown that one's ability to accumulate knowledge not only continues but increases up to old age. However, one's ability to be able to speedily and abstractly reason slowly decreases up to the age of approximately 75, and then begins to deteriorate more rapidly after that point. In research studies that have adjusted for differences in education, it has been found that verbal scores remained relatively steady between the ages of 20 and 74 whereas the ability to solve puzzles declined during the same time frame. In the end, therefore, whether or not intelligence declines during the older years depends on how intelligence is defined.

Mental Disintegration

Although not every older adult suffers from a substantial loss of brain cells in their later years, some do. Between the ages of 60 and 95, the incidence of mental disintegration doubles approximately every five years. Such damage can occur from a series of small strokes, a brain tumor, or alcoholism. This gradual erosion of the brain can lead to dementia, a generalized, pervasive deterioration of a person's cognitive abilities (e.g., memory, language, executive function). Perhaps the greatest threat to the retention of cognitive abilities in one's later years today comes from Alzheimer's disease. This is a progressive and irreversible degeneration and death of neurons in the brain. Alzheimer's disease is characterized by dementia, a gradual deterioration of memory, reasoning, language, and physical functioning. Alzheimer's disease is not a normal part of aging and is not the same thing as the mild cognitive impairment that is experienced by some persons in their later years. (For example, forgetting where one left the car keys is probably not a cause for concern; forgetting where one lives, however, is, and may be a sign of Alzheimer's disease.) Although treatments are available to slow the progression of the disease and to manage the concomitant psychiatric symptoms, there are currently no known cures for Alzheimer's disease. Statistics show that approximately three percent of the world's population is affected by this disease by the age of 75. In 2013, Alzheimer’s Disease International reported that close to 36 million people worldwide had Alzheimer’s or a related dementia (Alzheimers.net, 2013); the Alzheimer’s Association reported that 5 million people age 65 and older were living with the disease in the United States, where it and was the sixth leading cause of death. The association expected that these numbers will increase by 2025 to 7.1 million. Alzheimer's disease can be devastating not only to the person with the disease, but also to the friends and relatives that continue to be involved in person's life. The progression of Alzheimer's disease starts with a decline in memory, followed by declines in reasoning and language abilities. Eventually, victims of Alzheimer's disease become emotionally flat, losing their ability to enjoy life or feel emotion. This stage is followed by a progression including disorientation, incontinence, and becoming mentally vacant. In the final stage of the disease, the person dies.

Applications

Confronting One's Mortality

Cognitive abilities are not the only psychological aspect of the aging process. Someone once remarked that "in life, no one gets out alive." For most people, part of the aging process is coming to terms with death and dying. When one is young and healthy, it is easy to postpone thinking about such concepts. However, in the years of later adulthood, this becomes more difficult as virtually everyone feels some symptoms of old age, including changes in appearance (e.g., thinning and graying hair, wrinkles and decreased elasticity in the skin), deteriorating health, waning strength and flexibility, and declining intellectual capability. Further, some people experience a sharp decline in mental functioning known as "terminal drop" a few years or months before their death. As one's peers die and a preponderance of evidence of impending death builds up in one's own body, one becomes increasingly aware of impending death.

According to some theorists, this brings about a final psychological crisis in which individuals evaluate their lives and accomplishments, judge whether or not these were meaningful, and put their lives into perspective. At this point in their lives, many people become increasingly reminiscent about their pasts and attempt to resolve any remaining conflict in their lives. They also may become increasingly reflective and philosophic. In addition, many people feel a new or renewed interest in spiritual and religious matters to help face questions of life, death, and the afterlife. For some people, this end-of-life reflection brings about depression and despair. However, this is not universally true, and many old people attempt to meet death on their own terms with dignity. If a person's reflections on past events in their lives are positive and issues resolved, s/he may be comforted by religious faith, past achievements, and the love of friends and family.

Psychological Stages of Death Acknowledgment

Although from the perspective of someone not facing imminent death it might be tempting to assume that older people fear death, researchers have found that this is generally not true. In fact, older people are found to have fewer fears in general than younger people. However, although most older people may not fear death, they do tend to fear the circumstances of dying (e.g., pain, helplessness). Research based on interviews with the terminally ill revealed a general pattern of five reactions to impending death. Many people first go through a stage of denial and isolation in which they first question their prognosis and then attempt to avoid reminders of the situation. Many people also become angry and rail against their fate and even direct their rage toward the living. Another common reaction is bargaining with God through prayer or with fate by promising to mend their ways in exchange for a few more years. People may also become depressed, particularly as they realize that death is, indeed, inevitable and that their time has come. However, many people also are able to come to terms with their mortality and imminent death, and accept it with peace and dignity. Although these are commonly observed reactions to death and dying, it is important to note that not every terminally ill person exhibits all these reactions nor do those who do necessarily go through them in this order.

Elderly Depression

As mentioned above, one of the commonly observed reactions of people facing death is depression. In some older adults, depression may be observed even earlier than the terminal stage of an illness, however. Perhaps in conjunction with the process of facing one's mortality, as one's physical and mental capabilities begin to decline, a syndrome of late life depression has been observed in some older adults. Late life depression is depression that occurs in older individuals and is often associated with the stress and physical problems that are attendant with advancing age. In addition, a number of medications routinely taken by older adults may also have the side effect of depression.

Like depression in younger individuals, late life depression is a treatable disorder, not a normal part of the aging process. Elders at greatest risk for depression include others who have a history of depression, have a chronic physical illness, brain disease, or alcohol abuse, or who have experienced stressful events in their lives. Unfortunately, because of concurrent medical conditions and lowered expectations for functionality both on the part of the elder and the physician, depression in older adults often goes undiagnosed and untreated. Further complicating the situation is the fact that depression in older adults often presents differently than in younger ones, with insomnia, anorexia, and fatigue often being the major symptoms. In addition, many older people are reluctant to be forthcoming about depressive symptoms. Treatment for depression in older patients can be done with medication or psychotherapy, with a combination of both treatment modalities often the most effective.

Conclusion

Just as there is a deterioration of other bodily systems with advancing age, there is also typically deterioration within the brain which evidences itself in psychological changes. In some (but not all) cases, this may lead to obvious psychological symptoms including a decline in cognitive abilities, dementia, or depression. In addition, other psychological disorders may be exhibited by older individuals. In some situations (such as in the case of Alzheimer's disease), the outward psychological and behavioral symptoms are an expression of an underlying and irreversible condition. However, regarding general mental declines in old age, researchers are increasingly finding that continuing to remain active and stimulate one's mind well into older age can help older adults remain alert and mentally active.

Terms & Concepts

Ageism: Discrimination based on age or discrimination against the elderly.

Alzheimer's Disease: A progressive and irreversible disease caused by the degeneration and death of neurons in the brain. Alzheimer's disease is characterized by dementia—a gradual deterioration of memory, reasoning, language, and physical functioning. Although treatments are available to slow the progression of the disease and to manage the concomitant psychiatric symptoms, there are currently no known cures.

Cognitive Ability: A skill or aptitude related to perception, learning, memory, understanding, awareness, reasoning, judgment, intuition, or language. Cognitive abilities include all forms of knowing (e.g., perceiving, conceiving, remembering, reasoning, judging, imagining, and problem solving) and thinking.

Dementia: In the generic sense of the term, dementia is a generalized, pervasive deterioration of a person's cognitive abilities (e.g., memory, language, executive function). The deterioration caused by dementia can be very severe, and can significantly impact the ability of the individual to perform on the job, function well within society, or even accomplish the daily activities of living. Dementia is a group of symptoms rather than a specific disease. It can be caused by different diseases, including Alzheimer's disease, stroke, Pick's disease, Parkinson's disease, Huntington's disease, and AIDS dementia complex. Brain tumors and other treatable conditions may also cause dementia. Although the onset of dementia may vary, in most cases it occurs later in life, typically after 65 years of age.

Marginalization: To relegate a person or subgroup to the outer edge of the group (i.e., margin) by demonstrating through word or action that the person or subgroup is less important and less powerful than the rest of the group.

Neuron: A cell in the nervous system (i.e., the brain, spinal column, and nerves) that conducts impulses. Neurons are the basic cellular unit of the nervous system and comprise a nucleated cell body with one or more dendrites (the part of the cell that conducts impulses from adjacent cells toward the cell body) and a single axon (the nerve fiber that conducts impulses away from the body of the nerve cell). A neuron is also called a "nerve cell."

Sample: A subset of a population. A random sample is a sample that is chosen at random from the larger population with the assumption that such samples tend to reflect the characteristics of the larger population.

Bibliography

Alzheimers.net (2013). Alzheimer’s statistics 2013. Retrieved November 14, 2013 from http://www.alzheimers.net/resources/alzheimers-statistics-2013/

Alzheimer’s Association (2013). Alzheimer’s facts and figures. Retrieved November 14, 2013 from http://www.alz.org/alzheimers%5Fdisease%5Ffacts%5Fand%5Ffigures.asp

American Psychological Association (2006). CHAPTER 2: Theories of aging. Gerontological Practice for the Twenty-First Century (pp. 22-47). Columbia University Press. Retrieved November 14, 2013 from EBSCO Online Database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=31551281

Barrett, A., Redmond, R., & Rohr, C. (2012). Avoiding aging? Social psychology's treatment of age. American Sociologist, 43, 328-347. Retrieved November 14, 2013 from EBSCO Online Database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=78643835

Bernstein, D. A. & Nash, P. W. (2002). Essentials of psychology (2nd ed.). Boston: Houghton Mifflin Company.

Coon, D. ((2001). Introduction to psychology: Gateways to mind and behavior (9th ed.). Belmont, CA: Wadsworth/Thomson Learning.

Gow, A. J., Mortensen, E. L., & Avlund, K. (2012). Activity participation and cognitive aging from age 50 to 80 in the Glostrup 1914 cohort. Journal of the American Geriatrics Society, 60, 1831-1838. Retrieved November 14, 2013 from EBSCO Online Database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=82370166

Myers, D. G. (2001). Psychology (6th ed.). New York: Worth Publishers.

Wienclaw, R. A. (2007). Late life depression. In The Gale encyclopedia of mental health (2nd ed.). Detroit: Thomson/Gale.

Suggested Reading

Butler, R. N, Lewis, M. I., & Sunderland, T. (1998). Aging and mental health: Positive psychosocial and biomedical approaches (5th ed.). Boston: Allyn and Bacon.

Hokenstad, M., & Restorick Roberts, A. (2013). The United Nations Plans for a future free of ageism and elder invisibility. Generations, 37, 76-79. Retrieved November 14, 2013 from EBSCO Online Database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=86024540

Jeon, H., Dunkle, R., & Roberts, B. L. (2006). Worries of the oldest-old. Health and Social Work, 31, 256-265. Retrieved July 10, 2008, from EBSCO Online Database Academic Search Premier. http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=24090647&site=ehost-live

Uhlenberg, P. (2013). Demography is not destiny: The challenges and opportunities of global population aging. Generations, 37, 12-18. Retrieved November 14, 2013 from EBSCO Online Database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=86024530

van Hooren, S. A. H., Valentijn, A. M., Bosma, H., Ponds, R. W. H. M., van Boxtel, M. P. J., & Jolles, J. (2007). Cognitive functioning in healthy older adults aged 64-81: A cohort study into the effects of age, sex, and education. Aging, Neuropsychology and Cognition, 14, 40-54. Retrieved July 10, 2008, from EBSCO Online Database Academic Search Premier. http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=23409222&site=ehost-live

Winder, L., Parker, B., & Schneider, M. (2007). Imagining the alternatives to life prolonging treatments: Elders' beliefs about the dying experience. Death Studies, 31, 619-631. Retrieved July10, 2008, from EBSCO Online Database Academic Search Premier. http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=25347302&site=ehost-live