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Physical and Cognitive Development in Late Adulthood

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Life Expectancy

• In 2014, infants born in the United States can expect to live to age 80.

• Some adults live well beyond the expected life span to a very old age.

• The increase in life expectancy can be attributed to the influence of contextual factors.

– Health care

– Nutrition

– Sanitation

Influences on Life Expectancy

• Gender

– Girls born in the U.S. today can expect to live about 5 years longer than boys.

• Ethnicity

– Mediated by socioeconomic status.

• Nationality

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Centenarians

• Individuals who live past 100 years.

• There were 37,000 centenarians recorded in the U.S. in 1990 and nearly 54,000 in 2010.

• The longest recorded human life span is 122 years.

Changes in the Nervous System

• Brain volume shrinks as dendrites contract and are lost, synapses decrease, and glial cells are lost.

• Myelin losses contribute to cognitive declines with aging.

• A program of aerobic exercise has been shown to restore brain volume, especially in the hippocampus (a brain region closely involved with memory).

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Figure 17.1: Change in Hippocampal Volume With Aerobic Exercise

Compensation for Cognitive Declines

• Older adults compensate for cognitive declines by showing more brain activity and using different brain areas in solving problems than do younger adults.

• Older adults show brain activity that is spread out over a larger area, including both hemispheres, compensating for neural losses.

• Cognitive reserve

– The ability to make flexible and efficient use of available brain resources that permit cognitive, efficiency, flexibility, and adaptability.

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Figure 17.2: Age Differences in Neural Activity During a Memory Task

Neurogenesis

• The process by which new neurons are developed continues throughout life.

• New neurons are created in the hippocampus and striatum (a subcortical part of the brain responsible for coordinating motivation with body movement).

• It is estimated that about 2% of neurons are renewed each year.

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Vision in Late Adulthood

• Virtually all older adults have difficulty seeing objects up close.

• Many adults develop cataracts, a clouding of the lens resulting in blurred, foggy vision that makes driving hazardous and can lead to blindness. – Cataracts result from hereditary and environmental factors.

• Macular degeneration – A substantial loss of cells in the center area of the retina,

the macula, causing blurring and eventual loss of central vision.

Figure 17.3: Age-Related Changes in the Eye

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Hearing in Late Adulthood • Presbycusis

– Age-related hearing loss.

– Older adults experience difficulty distinguishing high- frequency sounds, soft sounds of all frequencies, and complex tone patterns.

• Men tend to suffer hearing loss earlier and to a greater extent than do women.

• About two thirds of older adults experience hearing loss, which can greatly diminish quality of life and poses health risks.

Compensation for Hearing Loss

• Many older adults compensate for their hearing loss by reducing background noise and paying attention to nonverbal cues such as lip movements, facial expressions, and body language.

• Use of hearing aids, although they are underused because: – Social attitudes that undervalue the importance of hearing.

– Stigma associated with being seen wearing hearing aids.

– Cost.

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Cardiovascular Changes in Late Adulthood • With age, the heart experiences cell loss and becomes more rigid.

Respiratory Changes in Late Adulthood

• The lungs gradually lose cells and elasticity over the adult years, substantially reducing the amount of oxygen that enters the system and is absorbed by the blood.

• Older adults have more trouble breathing, feel more out of breath during physical exertion, and have a harder time catching their breath than younger adults.

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Immune System Changes in Late Adulthood

• With age, the immune system becomes less efficient and adaptive.

• Declines in immune function place older adults at higher risk of diseases such as flu and pneumonia, cancers, and autoimmune diseases such as rheumatoid arthritis.

• Exposure to stress reduces immune function, and the effects increase with age.

Compression of Morbidity

• Over the past few decades, it has become increasingly common for older adults in industrialized nations to age well and delay disability and disease until the final months or years of life

• Advances in medicine, improvement in the standard of living, and increased recognition of the importance of lifestyle contribute to compression of morbidity

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Figure 17.5: Current Health Status Among

Adults Aged 18 and Over in the

U.S., 2012

Nutrition

• Losses in muscle mass contribute to weight loss and a slowed metabolism.

– Therefore, adults require fewer calories and their diets must be more nutrient dense to meet their nutritional needs with fewer calories.

– Older adults are less likely to get all of their nutritional needs met through their diet and are therefore at risk for a nutritional deficiency.

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Diet Suggestions for Older Adults

• Nutritious foods (fruits, whole grains, low-fat dairy products, leafy green vegetables, and healthy sources of protein).

• Supplements for vitamins A, B6, B12, C, and E.

• Antioxidants and omega-3.

– Important preventative effects for age-related declines in cognitive functions and neurodegenerative disorders.

Exercise • Exercise offers powerful health benefits to older adults.

– Individuals as old as 80 who begin a program of cardiovascular activity show gains similar to those of much younger adults.

– Weight-bearing exercise begun as late as 90 years of age can improve blood flow to the muscles and increase muscle size.

– It is never too late to start

• Throughout the adult years, moderate physical activity is associated with improved physiological function, a decreased incidence of disease, and reduced incidence of disease, and reduced incidence of disability.

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Psychological Benefits of Exercise

• Exercise offers older adults stress relief, protects against depression, and is associated with higher quality of life.

• Older adults who are physically active show less neural and glial cell losses throughout their cortex and less cognitive decline than do those who are sedentary.

• Exercise is associated with increased hippocampal volume. (better memory)

Chronic Illness: Arthritis

• A degenerative joint disease

• Osteoarthritis (most common) – Affects joints that are injured by overuse.

– Results in loss of movement and pain.

– Aging is the most prominent risk factor; it may first appear in middle adulthood but becomes more common and worsens in severity during older adulthood.

• Rheumatoid arthritis (not age- or use-related)

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Chronic Illness: Diabetes

• Diabetes is a disease marked by high levels of blood glucose.

• About one fourth of older adults over the age of 60 have diabetes.

• Diabetes is the leading cause of death among people age 65 and over.

• Diabetes is influenced by heredity and lifestyle factors.

– Ethnicity

Risks of Diabetes

• Increased risk of heart attack, stroke, circulation problems in the legs, blindness, and reduced kidney functions.

• Serious cognitive and neurological effects

– Brain aging, including declines in executive function, processing speed, memory, and motor function.

• Psychosocial functioning

– Depression

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Preventing Diabetes

• Maintaining a healthy weight through diet and exercise.

• Individuals can successfully manage the disease by adopting a diet that carefully controls the amount of sugar entering the bloodstream as well as engaging in regular exercise.

Injuries

• Deaths from unintentional injuries account for 61.5 deaths per 100,000 in 65-year-old adults, and a striking 361.9 in adults aged 85 and older.

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Injuries: Motor Vehicle Accidents

Injuries: Falls

• One out of three U.S. adults over the age of 65 and one half of those over the age of 80 fall each year.

• Factors associated with increased risk of falls among older adults:

– Changes in vision, hearing, motor skills, and cognition.

• Falls are a serious hazard for older adults because of the natural loss of bone and high prevalence of osteoporosis increase the risk of bone fractures.

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Dementia

• Dementia refers to a progressive deterioration in mental abilities due to changes in the brain that influence higher cortical functions such as thinking, memory, comprehension, and emotional control.

• Reflected in impaired thought and behavior

• Interferes with the older adult’s capacity to engage in every day activities.

Figure 17.9: Projected Growth in Dementia Prevalence: Low- Income vs. High-Income Countries, 2013–2050 (projected)

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Alzheimer’s Disease

• The most common cause of dementia.

• A progressive neurodegenerative disorder.

• It progresses from general cognitive decline, to include personality and behavior changes, motor complications, sever dementia, and death.

• The risk of Alzheimer’s disease grows exponentially with age, doubling approximately every five to six years in most Western countries.

Figure 17.10: Projected Prevalence of Alzheimer’s Disease in the U.S. Population, 2010-2015 (projected)

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Description of Alzheimer’s Disease

• Widespread brain deterioration and the presence of amyloid plaques and neurofibrillary tangles in the cerebral cortex.

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Diagnosis of Alzheimer’s Disease

• Alzheimer’s disease is diagnosed in living patients through exclusion: by ruling out all other causes of dementia.

– Brain imaging can help physicians rule out other, potentially treatable, causes of dementia, such as a tumor or stroke.

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Progression of Alzheimer’s Disease 1. Memory problems (episodic memory)

– May look like absentmindedness

2. Impairments in attentional control 3. Severe problems with concentration and short-term memory;

confusion 4. Vocabulary and speech impairments 5. Personality changes 6. Become unable to care for themselves 7. Inability to recognize objects and familiar people 8. Final stages – lose the ability to comprehend and produce

speech, to control bodily functions, and to respond to stimuli

Risk Factors for Alzheimer’s Disease

• Gender – Women are at greater risk than men.

• Age • Ethnicity

– African Americans and Hispanic older adults are more likely to have Alzheimer’s disease and other dementias.

• Genetics • Same factors that contribute to cardiovascular

risk.

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Protective Factors Against Alzheimer’s Disease

• Education

– The process of learning promotes neural activity and increases connections among neurons, thickening the cortex and boosting cognitive reserve.

Vascular Dementia

• Also known as multi-infarct dementia.

• The second most common form of dementia and loss of mental ability in older adulthood, worldwide.

• Caused by strokes, or blockages of blood vessels in the brain. – With each small stroke, brain cells die, and an immediate

loss of mental functioning occurs.

– As time passes, individuals tend to show improvement because the brain’s plasticity leads other neurons to take on functions of those that were lost.

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Risk Factors for Vascular Dementia

• Genetic and environmental factors

– Obesity and overweight in middle-age adults.

– People who are at risk for cardiovascular disease.

– Gender – men are more likely to suffer early vascular dementia.

– Heavy alcohol use, smiling, inactivity, stress, and poor diet (all more prevalent in men).

– Cross-cultural differences.

Preventing Vascular Dementia

• Factors that prevent cardiovascular disease, such as physical activity, also prevent and slow the progression of vascular dementia.

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Parkinson’s Disease

• The most common cause of subcortical dementia.

• A brain disorder that occurs when neurons in a part of the brain called the substantia nigra die or become impaired.

– Neurons in this part of the brain produce the neurotransmitter dopamine, which enables coordinated function of the body’s muscles and smooth movement.

– Symptoms appear when at least 50% of the nerve cells in the substantia nigra are damaged.

Symptoms of Parkinson’s Disease

• Motor symptoms – Tremors

– Slowness of movement

– Difficulty initiating movement

– Difficulty with balance

– Shuffling walk

• Cognitive symptoms – Those with larger cognitive reserves and more synaptic

connections among neurons show a slower progression of neurological changes before dementia appears.

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Risk Factors for Parkinson’s Disease

• Genetic, environmental, and lifestyle influences:

– Epigenetics.

• the study of changes in organisms caused by modification of gene expression rather than alteration of the genetic code itself.

– No gender, ethnic, social, economic, or geographical boundaries.

Reversible Dementia

• Dementia caused by psychological and behavioral factors that can be reversed.

• Common causes:

– Poor nutrition and dehydration.

– Prescription and nonprescription drugs and drug interactions.

– Symptoms of depression and anxiety in older adults.

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Working Memory

• Age-related declines in working memory span from young through older adulthood.

• The greater the number of tasks and demands, the worse the performance.

• Reduced sensory capacity contributes to older adults’ difficulty with working memory.

• Multitasking is challenging in older adulthood.

• Older adults show a significant information processing bias toward positive versus negative information.

Long-Term Memory

• Age-related changes in working memory contribute to changes in long-term memory.

• Semantic memory (memory for factual material) shows little age-related decline.

• Episodic memory (autobiographical memory) and memory for experiences tends to deteriorate with age.

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Figure 17.11: Age and Cohort

Differences in Cognitive Aging

Age-Related Changes in Language

• Sensory and cognitive changes influence older adults’ capacities for language.

– Age-related hearing loss and reductions in attention and processing speed mean that following rapid speech and understanding speech when there is background noise require more effort with age.

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Problem Solving

• Problem-solving skills in everyday settings show that people remain efficient decision makers throughout adulthood.

• Older adults are better at matching their strategies to their goals than are young adults.

Wisdom

• Expertise in the conduct and meanings of life.

• Characterized by emotional maturity and the ability to show insight and apply it to problems.

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Cognitive Changes

• Fluid intelligence declines in older adulthood.

• Crystallized intelligence remains the same or improves.

• Cognitive abilities tend to remain stable, relative to peers, over the life span.

• Differences in experience and lifestyle can account for many differences in cognitive change over adulthood.

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Socioemotional Development in Late Adulthood and the End of Life

Figure 18.1: Challenges of Aging as Expected and Experienced by Older Adults

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The Sense of Self

• A more multifaceted and comprehensive sense of self enables older adults to accept their weaknesses and compensate by focusing on their strengths.

• Older adults tend to express more positive than negative self-evaluations well into old age.

Subjective Age

• Adults older than 25 tend to have younger subjective ages, and the discrepancy between subjective and chronological age increases over the adult years.

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Figure 18.3: When Does Old Age Begin?

Reminiscence and Life Review

• Reminiscence – The vocal or silent recall of events in a person’s life.

• Recalling past experience and acquired knowledge and sharing it with young people is rewarding, life enriching, and positively associated with well-being.

• Life review – Reflecting on past experiences and contemplating

the meaning of those experiences and their role in shaping one’s life.

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Ego Integrity Versus Despair

• The last stage in Erikson’s psychosocial theory.

• Older adults who are successful in establishing a sense of ego integrity are able to find a sense of coherence in life experiences and ultimately conclude that their lives are meaningful and valuable.

• Despair is the tragedy experiences if the retrospective look at one’s life is evaluated as meaningless and disappointing, emphasizing faults, mistakes, and what could have been.

The Attainment of Ego Integrity

• Relies on cognitive development

– Complexity and maturity in moral judgment and thinking style

– Tolerance for ambiguity

– Dialectical reasoning

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Personality

• The Big 5 personality traits largely remain stable into late adulthood.

• Personality traits shift subtly over the life course: – Agreeableness tends to increase with age.

– Extroversion and openness to experience decline with age (most pronounced drops after the mid-50’s).

– Conscientiousness increases from emerging to mid- adulthood, peaks between 50 and 70 and then declines.

Religiosity

• Nearly 75% of U.S. adults report being “absolutely certain” of the existence of God or a similar spiritual entity.

• Over 90% report that they believe in a God or a similar spiritual entity.

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Religiosity

(and it only gets more

important as you get older)

Factors Associated With Religiosity

• Religiosity can take the form of behaviors (attendance at religious services) or attitudes and orientation (prayer).

• In North America, low SES ethnic minority groups show the highest rates of religious participation.

• Religiosity is associated with positive socioemotional functioning.

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Social Support

• Older adults’ physical and psychological health can benefit from social interaction and a sense of support from significant others.

• Spouses and children are primary sources of support.

• Assistance and support send the message that older adults are valued and helps them to feel a sense of belonging and see their place in the wider social order.

Perceived Support

• Low levels of perceived social support are associated with higher rates of cardiovascular disease, cancer, infectious diseases, and mortality.

• People who perceive social support are more likely to engage in health maintenance behaviors such as exercising, eating right, and not smoking.

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Disengagement Theory (reciprocity)

• Older adults disengage from society as they anticipate death; at the same time society disengages from them.

• Elders’ withdrawal and society’s simultaneous disengagement serve to allow older adults to advance into very old age and minimize the disruptive nature of their deaths to society.

Activity Theory

• Declines in social interaction are not a result of elders’ desires but are instead a function of social barriers to engagement.

• Adults attempt to remain active despite losses

• When adults lose roles due to retirement or disability, they attempt to replace the lost roles in an effort to stay active and busy.

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Continuity Theory

• Successful aging entails not simply remaining active but maintaining a sense of consistency in self across their past into the future.

• Successful elders retain a sense that they are the same person they have always been despite physical, cognitive, emotional, and social changes.

Socioemotional Selectivity Theory

• Older adults become increasingly motivated to derive emotional meaning from life and thereby cultivate emotionally close relationships and disengage from more peripheral social ties.

• Older adults place more emphasis on the emotional quality of their social relationships and interactions.

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Neighborhoods

• Most older adults live in suburban communities.

– Older adults who live in the suburbs tend to be healthier and wealthier and show higher rates of life satisfaction than those who live in cities.

– After retirement, they remain in the homes they have lived in for decades.

• One fourth of U.S. and one third of Canadian older adults live in rural areas where they tend to be more disadvantaged in terms of health, wealth, and availability of services; they are less likely to live near their children.

Residing at Home

• Most older adults live in or near the home they have lived in most of their lives.

• Living in their own home permits them the greatest degree of control over their lives.

• Because of divorce, widowing, or never marrying, about 1/3 of North American older adults live alone; nearly 50% of women over the age of 75 live alone.

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Figure 18.6: Older Adults Residing in Multigenerational Households

Residential Communities

• Residential communities include:

– Single houses

– Condominiums

– Large apartment complexes

• Designed to meet older adults’ physical and social needs.

• Some homes are designed for low-income elderly and are subsidized by the government; most are private.

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Benefits of Residential Communities

• Help offset declines in mobility and aid elders’ attempts to remain active.

• Supports social activities, the formation of friendships, and provision of assistance to others (all increase a sense a competence and leadership).

Nursing Homes • Only a small number of older adults reside in nursing

homes.

• Nursing homes offer the greatest amount of care, 24 hours a day and seven days a week.

• The most restrictive of elders’ autonomy.

– Leads to loneliness, feelings of helplessness, and depression.

• Family members often experience guilt and anguish when they see no other choice but nursing home placement.

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Friendships in Older Adulthood

• Friendships become more important and more fulfilling.

• Friendships become more centered on activities.

• Older adults report having more fun with their friends than do younger adults.

• Older adult friends tend to provide more emotional support than instrumental support.

Sibling Relationships in Older Adulthood

• The majority of older adults have a sibling, most live within 100 miles of each other, and most communicate regularly.

• Most older adults feel close to their siblings and consider them to be close friends.

• Sisters tend to be closest, followed by cross- sex siblings.

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Marital Satisfaction in Late Adulthood

• Marital satisfaction peaks in late adulthood.

• Older adult marriages are characterized by greater satisfaction, less negativity, and a higher frequency of positive marital interactions than in other developmental periods.

Cohabitation

• Cohabitation is increasingly common among older adults.

– Cohabitation among adults over age 50 more than doubled from 1.2 million in 2000 to 2.75 million adults in 2012 (8% of persons over age 50).

• Cohabitation is associated with more positive outcomes in older adulthood as compared with younger adulthood.

– Relationships tend to be of a longer duration; are more likely to have experienced a dissolution of a marriage; tend to report fewer marriage plans.

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Divorce and Remarriage

• Couples over the age of 65 are less likely to divorce than are younger couples (less than 1% of all divorces comprise elders).

• Similar to younger people, older adults report divorcing because of poor communication, emotional detachment, and few shared interests.

• Rates of remarriage decline in older adulthood.

– Older men are more likely to remarry after divorce.

Relationships With Adult Children

• Adult child-to-parent assistance most often takes the form of emotional support and companionship.

• Most older adults and their adult children keep in touch even when they are separated by great distance.

• Older adult daughters tend to be closer and more involved with parents than sons.

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Relationships With Grandchildren

• About one half of older adults in Western nations have an adult grandchild.

• Grandchildren and great-grandchildren increase elders’ opportunities for emotional support.

• A history of close and frequent contact, positive experiences, and affectionate ties predicts good adult child-grandparent relationships.

Elder Maltreatment

• Acts or omissions that cause harm to the older person and occur within the context of a trusting relationship.

• Overall about 6% to 10% of elders in industrialized countries report experiencing abuse within the last month.

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Types of Elder Maltreatment

• Physical abuse (Intentionally inflicting physical harm or discomfort through cutting, burning, and other acts of physical force.

• Sexual abuse (Inflicting unwanted sexual contact). • Psychological abuse (Intentionally inflicting emotional harm

through verbal assaults, humiliation, intimidation, or withdrawal of affection).

• Financial abuse (Exploiting the elder’s financial resources by theft or unauthorized use).

• Physical neglect (Providing inadequate care and failing to meet an elder’s basic needs for food, medication, physical comfort, and health care).

Victims of Elder Maltreatment

• Victims of maltreatment are more likely to be:

– Advanced in age.

– Suffer from physical and mental illness, frailty, and impairments with activities of daily living.

– Women and minorities.

– Those who experience a lack of social support of social isolation.

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Perpetrators of Elder Maltreatment

• Caregivers, most often spouses or children, who lack social support, experience psychological problems, and feel overwhelmed with the task of care giving.

• Within nursing homes, institutional factors such as overcrowding and understaffing contribute to caregiver stress and can increase the likelihood of elder maltreatment.

Figure 18.7: Labor Force Participation Rates in 1992, 2002, 2012, and Projected 2022, by Age

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Deciding to Retire

• Retirement is a process that begins long before the last day of employment.

– Begins with imagining the possibility of retirement, what it might be like.

– Adults assess their abilities and their resources.

– Determine when is the best time to let go of the work role.

– Put plans into action.

• Influenced by job conditions, health, finances, and personal preferences.

Transition to Retirement and Adjustment

• Retirement is commonly thought of as a stressful experience.

• The transition to retirement is a process: 1. Feelings of well-being and life satisfaction may decline as

people worry and anticipate the loss of the work role.

2. After retirement, retirees may experience a short honeymoon phase marked by vacations and new interests.

3. Positive feelings may change to disenchantment.

4. Period of reorientation involving new activities.

5. Stability occurs once the retirees accommodate and adjust.

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Influences on Retirement Adjustment

– Characteristics of the individual

– The individual’s social relationships

– The job

• Workers in high stress, demanding jobs, or those that provide little satisfaction tend to show positive adaptation to retirement.

• Positive adjustment to retirement is associated with engagement in satisfying relationships and leisure activities.

The Dying Process

• There are predictable changes that occur in the dying person hours and days before death. – The person sleeps most of the time, may be disoriented

and less able to see, and may experience visual and auditory hallucinations.

– The dying person shows irregular breathing, produces less urine, and may have cool hands and an overly warm trunk.

– Closer to death, the person will lose interest and the ability to eat, drink, and talk; breathing will be difficult; bloating may occur; and psychological symptoms are common.

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Dying Trajectories

• First trajectory:

– Some people show normal functioning and a steep decline representing a sudden death without warning or knowledge of illness.

• Second trajectory:

– The person who typically has advance warning of a terminal illness and experiences steady losses of function.

• Third trajectory:

– Marked by steady declines broken by sharp drops in functioning, the final leading to a loss of life functions and death.

Table 18.1: Stages of Death

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Views of Death

• Today, death is removed from everyday life.

– Most deaths occur in hospital and nursing homes; only about one in five older adults dies at home.

– People no longer have contact with death in everyday settings which makes death more mysterious and feared.

• Death anxiety

– Fear and discomfort that centers around death and the process of dying.

– Older adults experience lower levels of death anxiety.

Dying With Dignity

• Ending life in a way that is true to one’s preferences, controlling one’s end-of-life care.

• Requires planning so that the individual’s wishes are known ahead of time.

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Table 18.2: Advanced Directives

Figure 18.8: Percentage of Adults Who Have Written Down Their Wishes for End-of-Life

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Figure 18.9: Communications About End-of-Life Issues

Hospice

• An approach to end-of-life care that emphasizes dying patients’ needs for pain management, psychological, spiritual, and social support as well as death with dignity.

• Hospice services are enlisted after the physician and patient believe that the illness is terminal and that no treatment or cure is possible.

• The philosophy of the hospice approach emphasizes prolonging quality of life.

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Bereavement

• The process of coping with the sense of loss that follows death.

• Mourning and grief are aspects of bereavement.

– Mourning refers to culturally patterned ritualistic ways of displaying and expressing bereavement (i.e., special clothing, food, prayers, and gatherings).

– Grief refers to the affective response to bereavement and includes an array of emotions such as hurt, anger, guilt, confusion, and other feelings.

Grief Process

• Grief is an active coping process in which the grieving person must confront the loss and come to terms with its effects on the physical world, interpersonal interactions, and his or her sense of self.

• Grieving is an individual experience. – The person in grief must acknowledge his or her emotions, make

sense of them, and learn to manage them.

• Grieving is influences by the relationship between the person and the deceased.

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Dual-Process Model of Stress and Coping

• Emphasizes two sets of losses that occur with bereavement.

1. The first is emotional and concerns the grief that comes with losing an attachment figure.

2. The second set of losses are the life changes that accompany the death, such as moving homes, experiencing social isolation, and reframing one’s identity.

Widowhood

• About 1/3 of U.S. older adults are widows, having lost their spouse.

• Women live longer than men and are less likely to remarry.

• Losing a spouse begins one of the most stressful transitions in life. – Necessitates the renegotiation of a sense of identity

– Loneliness

• Compared to widowers, widows are more dependent on their children for financial and/or legal advice yet provide more emotional and instrumental support to their children.

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Risks of Widowhood

• Anxiety and depression (especially in the first year after the loss of a spouse).

• Physical health – The “widowhood effect” – the increased likelihood for a

recently widowed person to die.

– Men tend to show more health problems and higher rates of mortality.

• Higher risk of suicide.

• Widowers tend to show less social engagement.

• Widowers are more likely to remarry than are widows.

• And Sex. . .