activity 7

profileusername of me
COBH5_4607CH08.ppt
Home>English homework help>activity 7

Chapter 8
Cognitive and Psychological Changes Related to Aging

Objectives (1 of 3)

Describe the three basic factors that cause cognitive impairments in older adults.

Describe how general (fluid and crystallized intelligence) and specific aspects of cognition (attention, orientation, memory, executive functioning, and learning) may change with the aging process.

Describe compensatory measures that could be used for those with decreased or changed cognitive functioning.

Objectives (2 of 3)

List possible screens for use in detecting cognitive changes.

Compare and contrast signs of delirium, depression, and dementia.

Complete a screen for depression to make a referral for assistance.

List general guidelines for working with people to enhance performance of people with all cognitive levels

Objectives (3 of 3)

Understand conditions that may mimic dementia (but that are often reversible).

Differentiate aspects of personality that may tend to change over time from those that may not, based on current research.

Discuss aspects of behavioral change as these relate to older adults.

Describe factors believed to contribute to a positive quality of life in older people.

Typical Cognitive Changes of Aging (1 of 27)

  • Elders tend to become a more heterogeneous group over time
  • Some may be able to function as well as or better than when they were young
  • Others may succumb to disease or functional decline

Typical Cognitive Changes of Aging (2 of 27)

  • Typical cognition overview
  • Cognition or mental processing includes thinking, learning, and memory
  • Cognitive impairments in older adults are primarily caused by:
  • Disease
  • Disuse
  • Aging

Typical Cognitive Changes of Aging (3 of 27)

  • Crystallized and fluid intelligence
  • Crystallized intelligence
  • Include language comprehension, educational qualifications, and life and occupational skills
  • Tends to remain strong in older adults
  • Fluid intelligence
  • Speed and accuracy of information processing
  • Shows a significant decline in older adults

Typical Cognitive Changes of Aging (4 of 27)

  • Processing speed
  • Decreased processing speed may be linked to:
  • Higher level cognitive performance
  • Decreased physical motor speed
  • Impaired sensory functioning

Typical Cognitive Changes of Aging (5 of 27)

  • Learning among older adults
  • Ability to learn new information can change as people age
  • Research indicates older brain cells can regenerate
  • Older individuals may need:
  • More practice sessions to master a task
  • Instructions presented in a variety of ways, perhaps geared toward their sensory capacities

Typical Cognitive Changes of Aging (6 of 27)

  • Specific factors impacting cognition
  • Neuroplasticity
  • Older brains can adapt and engage in new learning
  • Motor skill training may enhance learning
  • Cognitive reserve
  • People with substantial reserves may be able to use readily available or alternative brain structures to maximize performance on cognitive tasks
  • Unknown whether people can build up their cognitive reserve

Typical Cognitive Changes of Aging (7 of 27)

  • Sensory issues
  • Sensory decline and deprivation
  • Decreases in hearing and vision can impact cognition indirectly
  • Not hearing or seeing properly can cause a person to demonstrate behaviors that outwardly look like they have decreased cognition
  • Someone who needs corrective lenses and/ or hearing aids should be encouraged to wear them

Typical Cognitive Changes of Aging (8 of 27)

  • Environmental factors
  • Can support or hinder learning for older adults
  • Includes:
  • Physical environment
  • Internal environment
  • Cultural aspects of the tasks to be completed
  • Social context
  • Learned helplessness is a complication related mostly to social context

Typical Cognitive Changes of Aging (9 of 27)

  • Stereotypes of aging
  • Most seem to be negative
  • Can become self-fulfilling prophecies
  • Positive messages could boost elders’ self-esteem and their ability to remain vital and productive
  • Many relate to dementia
  • Not part of the normal aging process
  • Dementiaphobia—many people find the prospect of cognitive decline more frightening than death

Typical Cognitive Changes of Aging (10 of 27)

  • Specific aspects of cognition
  • Orientation
  • People who are aging typically generally fully understand who they are, where they are, and the aspects of time and the situation they are in
  • Referred to as being A&O × 3
  • Flexible schedule of retirement may contribute to apparent disorientation to exact date or time of day
  • Psychiatric disturbance is indicated when a person is alert, but is not oriented

Typical Cognitive Changes of Aging (11 of 27)

  • Attention
  • Age does not seem to affect ability to focus
  • May be more difficult for older adults to divide their attention between two activities
  • Older people have more difficulty with divided-attention tasks, especially when the tasks are complex

Typical Cognitive Changes of Aging (12 of 27)

  • Memory
  • Multifactorial and extremely complex
  • Recall is more affected by age than recognition is
  • Basic memory tasks preserved throughout the typical aging process include those involving:
  • Procedural memory
  • Basic cognitive skills
  • Remembering well-learned facts

Typical Cognitive Changes of Aging (13 of 27)

  • Types of memory based on temporal aspects of remembering:
  • Primary memory
  • Short-term memory
  • Working memory
  • Prospective memory
  • Long-term memory

Typical Cognitive Changes of Aging (14 of 27)

  • Types of memory based on the type of information to be encoded:
  • Episodic memory
  • Semantic memory
  • Procedural memory

Typical Cognitive Changes of Aging (15 of 27)

  • Not all types of memory are affected equally by the typical aging process
  • More severe decline for events
  • Verbal memory tends to be better preserved
  • Working memory tends to decline more sharply than immediate or primary memory
  • Older people seem to have more difficulty with more complicated tasks and ignoring distractions during working memory tasks

Typical Cognitive Changes of Aging (16 of 27)

  • Compensating for decreased memory performance seems to work best
  • Tactics may include:
  • Make material to be learned interesting
  • Use multimodal sensory input
  • Use repetition, but not to the point of boredom
  • Use cuing, but only as needed
  • Have clients engage with the information if possible
  • Have clients paraphrase information after a session

Typical Cognitive Changes of Aging (17 of 27)

  • Tips to stimulate remembering:
  • Concentrate on paying attention
  • Repeat what you want to remember by rehearsing aloud
  • Make lists or use a date book
  • Establish habits
  • Relax
  • Use self and environmental care

Typical Cognitive Changes of Aging (18 of 27)

  • Problems with memory tasks
  • Most commonly acknowledged types of age-related cognitive decline
  • Does not mean the person has dementia
  • Mild forgetfulness, when it is an isolated cognitive impairment, is not cause for alarm
  • A red flag needs to be raised when one forgets crucial, well-learned information

Typical Cognitive Changes of Aging (19 of 27)

  • Executive functioning (EF)
  • Skills used by an executive on the job
  • “Central executives” are key to performance of EF skills in the realms of:
  • Working memory
  • Mental flexibility
  • Self-control

Typical Cognitive Changes of Aging (20 of 27)

  • Older adults typically show declines in EF
  • Aspects that change with age include cognition-related biological markers such as:
  • Decreased brain mass
  • Less dense neuronal connections
  • High-level cognitive skills, such as EF, decrease

Typical Cognitive Changes of Aging (21 of 27)

  • Assessing cognition
  • Self-assessment
  • People, in general, do not have a good sense of how well they can remember
  • Those with other cognitive deficits likely have difficulty accurately judging their own cognitive performance
  • Observing functional memory performance
  • Healthcare practitioners use various screens to assess cognitive function

Typical Cognitive Changes of Aging (22 of 27)

Typical Cognitive Changes of Aging (23 of 27)

  • Interventions to maintain or enhance cognition in older adults
  • May never be too late for improvements
  • Prevention of significant decline may be easier to accomplish than returning to high performance levels once the roll downhill has begun

Typical Cognitive Changes of Aging (24 of 27)

  • The PACES program to promote brain health
  • Offers guidelines to promote positive outcomes in thinking, memory, and learning
  • PACES stands for:
  • Purpose
  • Activity
  • Cognitive (pursuits)
  • Emotional (health)
  • Socialization (and Sleep)

Typical Cognitive Changes of Aging (25 of 27)

  • Purpose
  • Finding meaning in life
  • Active/Activity
  • Remaining active and engaged in life
  • Cognitive pursuits
  • Cognitive stimulation is as important as physical stimulation
  • Engage in lifelong learning

Typical Cognitive Changes of Aging (26 of 27)

  • Emotional health
  • Maintaining control over our attitude or how we respond to traumatic events in our lives
  • Typically aging elders tend to focus on the positive
  • Can make them overly trusting
  • Depression can have a negative impact on health and cognition
  • Can be treated

Typical Cognitive Changes of Aging (27 of 27)

  • Socialization and sleep
  • Humans are social beings
  • Face-to-face social interactions are preferred over online communication and relationships
  • Isolation is associated with loneliness, depression, poor health behaviors, and worse health
  • Adequate sleep is essential for optimal cognitive functioning
  • Promotes brain plasticity

Atypical Changes of Cognitive Aging (1 of 27)

  • Changes in cognitive performance exist on a continuum
  • Start with mild changes
  • End, for some, with major debilitating cognitive changes
  • Dementia and major neurocognitive disorders are not a normal part of aging

Atypical Changes of Cognitive Aging (2 of 27)

  • Risk factors for cognitive decline
  • Diabetes
  • Smoking
  • Hypertension
  • Sedentary lifestyle
  • Not engaging in cognitively challenging tasks
  • High cholesterol levels
  • Depression

Atypical Changes of Cognitive Aging (3 of 27)

  • Minor neurocognitive disorders
  • Mild cognitive impairment (MCI)
  • Diagnosis of mild neurocognitive disorder (NCD)
  • Affected individuals can complete ADLs, but might experience decreases in memory or performance of complex tasks such as IADLs
  • Risk of MCI increases with age
  • Those with MCI are more likely to develop dementia

Atypical Changes of Cognitive Aging (4 of 27)

  • Four questions predictive of amnestic MCI:
  • Does the person have trouble remembering the date, year, and time? (most predictive)
  • Does the person repeat questions/statements in the same day?
  • Does the person have difficulty managing finances?
  • Does the person have a decreased sense of direction?

Atypical Changes of Cognitive Aging (5 of 27)

  • Overview of DSM-V major neurocognitive disorders (major NCD)
  • Cognitive deficits can be described on a continuum from mild to late stage dementia
  • The major NCDs affect life relatively more than the mild disorders
  • The major disorders are often commonly referred to as dementia

Atypical Changes of Cognitive Aging (6 of 27)

  • Alzheimer’s disease (AD)
  • Most frequent diagnosis under the umbrella of major NCDs
  • Involves:
  • Significant decline in learning and memory
  • Continuing decline in cognition
  • Behavioral and psychological changes
  • Prevalence increases with age, but it is never an inevitable diagnosis for most older adults

Atypical Changes of Cognitive Aging (7 of 27)

Atypical Changes of Cognitive Aging (8 of 27)

  • AD progresses through three stages:
  • Mild
  • Moderate
  • Severe
  • Current emphasis is to prolong the first two stages

Atypical Changes of Cognitive Aging (9 of 27)

Atypical Changes of Cognitive Aging (10 of 27)

  • Frontotemporal NCD
  • Insidious in its onset and has behavioral or language variants
  • More frequently found among those younger than 65
  • Behaviors:
  • Disinhibition
  • Apathy
  • Loss of social skills
  • Preservative behaviors
  • Hyperorality

Atypical Changes of Cognitive Aging (11 of 27)

  • Dementia with Lewy Bodies
  • Now named Neurocognitive Disorder with Lewy Bodies (NCDLB)
  • Cognitive performance may fluctuate
  • Perceptual disturbances are more common
  • May account for up to 30% of all dementias
  • Person may display times of confusion or delirium prior to diagnosis

Atypical Changes of Cognitive Aging (12 of 27)

  • Parkinson’s disease (PD) with dementia
  • Can be minor (mild) or major (serious)
  • Tends to have an insidious onset
  • Cognitive impairments take place after physical symptoms of PD are well established
  • More common in men
  • Hallucinations are common, but have less impact on quality of life than those with schizophrenia

Atypical Changes of Cognitive Aging (13 of 27)

  • Working with those who have major NCD
  • Caring and respect are essential
  • Never speak about persons with dementia in front of them, ignoring them as if they were not there
  • Controlling your emotions is crucial
  • Soothing music may defuse the intensity of an uncomfortable situation
  • A sense of humor can be extremely helpful

Atypical Changes of Cognitive Aging (14 of 27)

  • Methods of diversion:
  • Involvement in simple activities
  • Playing games or enjoying music
  • Drawing, writing, or painting
  • Looking through old photograph albums
  • Reminiscing
  • Involving them in tasks or parts of tasks they enjoy

Atypical Changes of Cognitive Aging (15 of 27)

  • Comparing dementia with depression and delirium
  • Depression
  • Most prevalent in:
  • Women
  • Minority groups
  • Persons with less than a high school education
  • Those previously married
  • Individuals unable to work or who are unemployed
  • Persons without health insurance

Atypical Changes of Cognitive Aging (16 of 27)

  • Clinical depression
  • Common comorbid condition in those diagnosed with dementia
  • Can potentially be viewed as a consequence of having, as well as a risk factor for getting, dementia
  • Often goes unnoticed and undiagnosed

Atypical Changes of Cognitive Aging (17 of 27)

  • Common signs of clinical depression:
  • Subjective report of a “depressed mood” “most of the day, nearly every day”
  • Sleep disturbances
  • Disinterest in formerly valued activities
  • Agitation, listlessness, loss of energy
  • Feelings of worthlessness or guilt
  • Thoughts of death or suicidal ideation
  • Decreased cognition, such as indecisiveness

Atypical Changes of Cognitive Aging (18 of 27)

  • Suicide in older adults
  • Fixed risk factors in the United States:
  • Being male, single, and older
  • Having a family history of suicide
  • Major depressive disorders
  • Psychiatric illness
  • Chronic physical illness and pain
  • Decreased functional capacity
  • Social disconnectedness

Atypical Changes of Cognitive Aging (19 of 27)

  • Indicators of potential suicide:
  • Past history of attempts
  • Threats of suicide
  • Substance misuse
  • Sudden feelings of euphoria
  • Giving away possessions
  • Bodily complaints
  • Persistent bereavement

Atypical Changes of Cognitive Aging (20 of 27)

  • Delirium
  • Not commonplace in a healthy aging population
  • Generally a transient state of fluctuating cognitive abilities characterized by:
  • Hallucinations
  • Decreased ability to focus
  • Increased confusion
  • Poor memory performance
  • Can be mistaken for dementia or depression

Atypical Changes of Cognitive Aging (21 of 27)

  • Development of delirium is associated with:
  • Increased mortality
  • Increased length of stay in hospital
  • Increased rate of discharge to long-term care facilities
  • Increased medical complications

Atypical Changes of Cognitive Aging (22 of 27)

  • Risk factors for delirium:
  • Age older than 70 years
  • Self-reported alcohol abuse
  • Poor cognitive status
  • Visual impairment
  • Depression
  • Poor functional status
  • Malnutrition

Atypical Changes of Cognitive Aging (23 of 27)

  • Risk factors for delirium (continued):
  • Metabolic abnormalities
  • Infections
  • Non-cardiac thoracic surgery
  • Abdominal aneurysm surgery
  • Changes in mental status should be reported to and addressed by the healthcare team
  • Family collaboration is crucial

Atypical Changes of Cognitive Aging (24 of 27)

  • Related potentially reversible disorders
  • Malnutrition
  • Can cause behavioral disturbances
  • Vitamin B12 deficiency can cause dementia symptoms
  • Cerebrovascular accident (CVA) or stroke
  • May cause behaviors similar to depression or AD
  • Multi-infarct dementia is caused by a series of strokes
  • Hypothyroidism
  • Slows metabolic processes, which causes slow responses and lethargy

Atypical Changes of Cognitive Aging (25 of 27)

  • Failure to thrive (FTT)
  • Insidious deterioration in functioning
  • Not related to a specific disease
  • Can be caused by depression, dementia, chronic conditions, or medication/drug reactions
  • Common features include weight loss from loss of appetite, impaired ambulation, and incontinence
  • Person seems to be giving up on life
  • Referral to a geriatrician is usually appropriate

Atypical Changes of Cognitive Aging (26 of 27)

  • Urinary tract infection (UTI)
  • Most common infection in long-term care setting
  • Symptoms include frequent, often painful voiding; potential back pain; and malaise
  • Lack of oxygen (hypoxemia)
  • Can lead to tissue damage and mental confusion
  • Administering oxygen may improve mental status quickly

Atypical Changes of Cognitive Aging (27 of 27)

  • Substance misuse and abuse
  • Growing issue among older adults
  • Can cause cognitive problems such as slurred speech, drowsiness, and confusion
  • Can exacerbate the effects of current cognitive impairments or impairments in hearing and vision
  • Brief substance use/misuse screening is recommended for everyone

Personality Development (1 of 11)

  • Personality
  • Set of character traits, attitudes, habits, and emotional tendencies that make a person unique
  • Can predict life events to a degree
  • Erik Erikson stages of psychosocial development
  • New ninth stage is gerotranscendence, which is associated with wisdom and moving away from early and midlife materialism
  • Move toward selflessness, compassion, and reflection

Personality Development (2 of 11)

  • Five-factor model of personality
  • Neuroticism
  • Extraversion
  • Openness to experience
  • Agreeableness
  • Conscientiousness

Personality Development (3 of 11)

  • Personality stability
  • Strong in older people
  • Personality traits are relatively permanent in aging older adults
  • Pacing healthcare intervention for the convenience of older clients, rather than the provider, is essential for good care

Personality Development (4 of 11)

  • Personality differences by cohort
  • Older participants show a higher level of agreeableness
  • Men may become more nurturing and open about their feelings as they get older
  • Women may become more assertive, confident, and comfortable with themselves
  • As people age, they can gain a new understanding and tolerance of others’ behavioral styles

Personality Development (5 of 11)

  • Malleability of personality traits
  • Personality changes can and do occur
  • Representations of the self are likely to change over the course of one’s lifetime
  • Some older adults’ personalities change due to disease processes
  • Don’t blame the person, blame the disease
  • Compassion is the path of least resistance and most fulfillment

Personality Development (6 of 11)

  • Personality summary
  • There are many types of personalities, and they are not all compatible with one another
  • Healthcare professionals need to make a concerted effort to provide excellent service to all clients, regardless of age and personality style
  • Old age does not equate with any specific personality traits

Personality Development (7 of 11)

  • Behavior change
  • When people age well, they become more aware of the positive changes they encounter
  • Well elders also take actions to counteract negative changes associated with aging
  • One is never “too old” to make a positive change in behavior

Personality Development (8 of 11)

  • Behavior change theories
  • Transtheoretical Model (TTM)
  • Divides behavior change into several steps from precontemplation to termination
  • Health Belief Model
  • Sets out to predict health behaviors by assessing the person’s self-perceived views on the severity, susceptibility, benefits, and barriers to change

Personality Development (9 of 11)

  • “Art of Happiness” program
  • Group sessions on humor, mindfulness, positive relationships, happiness, and stress management
  • Outcomes included decreased tension, increased happiness, and stress management
  • “Lighten up!”
  • Group of elders worked on changing perspectives
  • Learned to recognize emotions and savor positive experiences

Personality Development (10 of 11)

  • Motivational interviewing (MI)
  • Key concepts:
  • Collaboration and compassion
  • Use of open-ended questions, affirmations, reflections, and summary statements
  • Promotes conversations about ambiguity
  • May involve clients of any age setting goals and making self-motivated changes
  • Practitioners guide and follow

Personality Development (11 of 11)

  • Motivational interviewing (continued)
  • Healthcare professionals can:
  • Help clients set and fulfill behavior change goals
  • Engage older adults in programs intended to improve well-being
  • Healthcare professionals’ contributions may be minimal or may be invaluable and much appreciated