Module 3
Health, Prevention, and Cognitive Functioning in Aging
a. Diseases of the Cardiovascular System
We begin with cardiovascular diseases, a set of abnormal changes in the heart
and arteries that not only can cause chronic disability but are also the number one
cause of death. Because the distribution of blood throughout the body is essential for
the normal functioning of all other organ systems, diseases of the cardiovascular
system can have widespread effects on health and everyday life.
In the disease atherosclerosis (from the Greek words athero meaning paste and
sclerosis meaning hardness), these fatty deposits collect at an abnormally high rate, so
much so that they substantially reduce the width of the arteries and limit the
circulation of the blood. Arteriosclerosis is a general term for the thickening and
hardening of arteries, a condition that also occurs to some degree in normal aging.
Many people live with atherosclerosis and do not encounter significant health
problems. However, the progressive buildup of plaque that occurs with this disease
may eventually lead to partial or total blockage of the blood’s flow through an artery.
The organs or tissues that are fed by that artery will then suffer serious damage due to
the lack of blood supply. When this occurs in arteries leading to the heart muscle, the
outcome is called coronary heart disease.
The term myocardial infarction refers to the acute condition in which the
blood supply to part of the heart muscle (the myocardium) is severely reduced or
blocked. Systolic and diastolic refer to blood pressure at the stages of the heart during
contraction and at rest, respectively. Hypertension is the disease in which an
individual chronically suffers from blood pressure that is greater than or equal to 140
mm Hg systolic pressure and 90 mm Hg diastolic pressure. Changes in the arteries
associated with atherosclerosis are thought to be due to the damaging effects of
hypertension. If a person’s blood pressure is virtually always elevated, the blood is
constantly putting strain on the walls of the arteries. Eventually, the arterial walls
develop areas of weakness and inflammation, particularly in the large arteries where
the pressure is greatest. Damage to the walls of the arteries makes them vulnerable to
the accumulation of substances that form plaque, causing further thickening and
limitation of blood flow.
The increased resistance existing in the arteries also increases the workload on
the heart, which is forced to pump harder than it otherwise would have to do.
Consequently, people with hypertension are more likely to develop hypertrophy
(overgrowth) of the left ventricle of the heart, which limits its ability to do its job of
pumping the blood.
Congestive heart failure (or heart failure) is a condition in which the heart is
unable to pump enough blood to meet the needs of the body’s other organs. Blood
flows out of the heart at an increasingly slower rate, causing the blood returning to the
heart through the veins to back up. Eventually the tissues become congested with
fluid. This condition can result from a variety of diseases including coronary heart
disease, scar tissue from a past myocardial infarction, hypertension, disease of the
heart valves, disease of the heart muscle, infection of the heart, or heart defects
present at birth. People with congestive heart failure are unable to exert themselves
without becoming exhausted and short of breath. Edema, a condition in which fluid
builds up in their bodies, causes a swelling of the legs. They may also experience
fluid buildup in their lungs along with kidney problems.
The term ‘‘cerebrovascular disease’’ refers to disorders of circulation to the
brain. This condition may lead to the onset of a cerebrovascular accident, also known
as a ‘‘stroke’’ or ‘‘brain attack,’’ an acute condition in which an artery leading to the
brain bursts or is clogged by a blood clot or other particle. The larger the area of the
brain deprived of blood, the more severe the deterioration of the physical and mental
functions controlled by that area. Another condition caused by the development of
clots in the cerebral arteries is a transient ischemic attack (TIA), also called a
ministroke. The cause of a TIA is the same as that of a stroke, but in a TIA, the
blockage of the artery is temporary. The tissues that were deprived of blood soon
recover, but chances are that another TIA will follow. People who have had a TIA are
also at higher risk of subsequently suffering from a stroke.
Heart disease is the number one killer in the United States, resulting in 25% of
all deaths in the year 2007 (Xu et al., 2010). Together, heart and cerebrovascular
disease accounted for 35% of all deaths in the United States of people 65 and older
(Kung et al., 2008), a figure that is comparable to the rate observed in Canada (Tu et
al., 2009). However, given that deaths occur disproportionately in the population, with
over half of all deaths occurring in people 75 years and older, technically heart disease
is the number one killer among the oldest segment of the population. Worldwide,
coronary heart disease was the leading cause of death in 2002, amounting to 7.2
million deaths or nearly one third of all deaths around the globe. Another 5.5 million
people per year die from cerebrovascular disease. The countries with the highest death
rates as of 2009 were Russia, Bulgaria, Hungary, and Romania; the United States
ranked 13th and Canada ranked 26th in the world.
Understanding the contribution of lifestyle factors to heart disease is one of the
most heavily researched topics in the biomedical sciences. As a result of this research,
a great deal is being learned about the ways that even people who have a strong
genetic predisposition to cardiovascular disease can reduce their risks. These
behavioral risk factors fall into essentially four areas of lifestyle choices people can
make to reduce their risk of developing heart disease. A sedentary lifestyle is the first
major risk factor for heart disease. The relationship between leisure activity and heart
disease is well established (Yung et al., 2009), with estimates ranging from a 24%
reduction in the risk of myocardial infarction among non-strenuous exercisers to a
47% reduced risk among individuals engaging in a regular pattern of strenuous
exercise (Lovasi et al., 2007). As it happens, the majority of adults at highest risk for
heart disease (i.e., those 75 and older) are the least likely to exercise. Only about 36%
of people 65 to 74 and 16% of those 75 and older engage in vigorous leisure activity.
The second risk factor for heart disease is smoking. Although it is not known
exactly why smoking increases the risk of heart disease, most researchers believe that
smoking damages the arteries, making them more vulnerable to plaque formation and
ultimately leading to the deleterious changes we outlined earlier. Though having long-
lived parents is related to lower level of cardiovascular risk factors, among women
who smoke, the advantages of heredity benefits are offset (Jaunin et al., 2009).
Approximately one fifth of all adults in the United States are current smokers. The
rates of current smokers decrease across age groups of adults to 10% of those 65 and
older (National Health Interview Survey, 2009). It is very possible that the smoking
rates decrease not only because older adults are less likely to smoke but also because
the nonsmokers are more likely to survive.
The third risk factor for cardiovascular disease is alcohol intake. Moderate
alcohol consumption appears to have a protective effect on the risk of cardiovascular
disease as well as on functional health declines in general (Chen & Hardy, 2009), at
least for women (Djousse, Lee, Buring, & Gaziano, 2009). Moreover, there may be
gender differences in the relationship between alcohol intake and metabolic
syndrome, with men showing a stronger relationship than exists for women (Buja et
al., 2009). Beyond that point, heavy alcohol intake (more than 60 grams of alcohol—2
beers or 2 glasses of wine a day) may be associated with increased stroke risk
(Reynolds et al., 2003). Body weight is the fourth risk factor for cardiovascular
disease. An analysis of 57 longitudinal studies conducted in Western Europe and
North America showed a causal relationship between high BMI and mortality due to
vascular disease (Whitlock et al., 2009). According to the CDC, dramatic increases in
overweight and obesity have occurred among United States adults over the past 20
years. Currently, 30.3% of the United States population is considered obese by
government standards. According to the Organisations for Economic Co-operation
and Development (2007), this is the highest percent in the world. Intake of high-
cholesterol foods in particular is the component of obesity that places individuals at
greater risk for developing cardiovascular disease and stroke (Erqou et al., 2009).
Conversely, high levels of the ‘‘good’’ cholesterol (HDL) are related to lower risk of
cardiovascular disease.
Variations in stroke rates by race/ethnicity, social class, and poverty have
emerged as issues of national concern in the United States. The Southeast is
considered the ‘‘stroke belt’’ of the United States, with 8 to 12 states in this region
having substantially higher stroke mortality than the rest of the country. Three states
comprising the ‘‘stroke buckle’’ include North Carolina, South Carolina, and Georgia.
The high rates of stroke are attributed in part to diets in this region that are based on
high consumption of sodium, monounsaturated fatty acids, polyunsaturated fatty acids
and cholesterol, and the low consumption of dietary fiber.
Although stroke rates are in general elevated for the stroke belt, there are
racial differences in factors that contribute to stroke risk. In a study of more than
23,000 men and women 45 years and older, researchers found higher scores for
Blacks than Whites on measures related to stroke risk including hypertension, systolic
blood pressure, diabetes, smoking, and hypertrophy of the left ventricle of the heart.
Other factors contributing to the high stroke rates are lower levels of education
and access to health care in the states within this region of the United States.
Regardless of the cause for the elevated incidence of stroke, the data suggest that a
variety of interventions are urgently needed, particularly given the high costs incurred
by this at-risk population for health care. The concept of metabolic syndrome has
come into use within the past several years to draw attention to the cluster of
symptoms associated with cardiovascular disease. The symptoms include high levels
of abdominal obesity, abnormal levels of blood cholesterol (low ‘‘good’’ cholesterol
or HDL and high ‘‘bad’’ cholesterol or LDL), hypertension, insulin resistance, high
blood fats (known as triglycerides), high levels of C-reactive proteins in the blood (an
indication of inflammation), and the presence of coronary plaques. Even possessing
three of the risk factors involved in the metabolic syndrome increases a person’s risk
of mortality from cardiovascular disease.
Advances in the understanding of the causes of heart disease and stroke have
resulted in safer and more effective medical and dietary supplements that have
lowered cardiovascular death rates. The lowering of cholesterol through preventive
medications is becoming the primary mode of intervention. Chief among these
medications are statins, which work by lowering the levels of harmful cholesterol
(LDL) in the blood. However, in addition to or instead of medication, anyone can
benefit from the control of diet and participation in exercise as preventive strategies;
the earlier you begin to follow these strategies, the better.
Research has continued to advocate the benefits of the ‘‘Mediterranean diet,’’
or the consumption of meals that include minimally processed fruits, vegetables, nuts,
seeds, grains, olive oil, and low amounts of red meat and dairy foods (Rumawas,
Meigs, Dwyer, McKeown, & Jacques, 2009). Intake of the Mediterranean diet is also
associated with a diminished risk of metabolic syndrome (Perez-Lopez, Chedraui,
Haya, & Cuadros, 2009). Another essential ingredient of the Mediterranean diet is low
to moderate amounts of wine (SerraMajem, Roman, & Estruch, 2006). Finally,
exercise is a vital component of all preventive programs aimed at reducing the
prevalence of heart disease (Haskell et al., 2007). In addition to exercise, older adults
with hypertension can also benefit from relaxation training; even a 12-session audio
relaxation training program was shown in one study to have beneficial effects.
There are significant national differences in risk of heart disease, as well as
other major illness. Eastern European countries, such as Russia, Bulgaria, Romania,
and Poland, have the highest death rates from cardiovascular disease (Lloyd-Jones et
al., 2009). An analysis of the dietary habits and food intake of almost 27,000 people
living in the countries of Central and Eastern Europe suggested that poor dietary
habits contribute significantly to the high rates of morbidity and mortality in these
countries (Boylan et al., 2009). The United States has higher rates of the six major
chronic diseases associated with mortality (Banks, Marmot, Oldfield, & Smith, 2006).
It is important to remember in our discussion of available preventive treatments that
changing people’s lifestyle habits is difficult, particularly when these changes are
needed in adulthood. One failure can decrease a person’s self-efficacy and confidence
about the ability to enact these lifestyle changes. Therefore it is important to allow
people to feel that even small steps toward improved health habits represent progress.
b. Cancer
Cancer is a generic term for a group of more than 100 diseases. Each type of
cancer has its own symptoms, characteristics, treatment options, and overall effect on
a person’s life and health. In 2009, it was estimated that nearly 1.5 million Americans
received a diagnosis of cancer (not including skin cancer or noninvasive cancers) and
that about 10.5 million are living with the disease. The lifetime risk of developing
cancer is about 1 in 2 for men and 1 in 3 for women (American Cancer Society,
2009). Skin cancer is the most prevalent type of cancer in the United States, with an
estimated 1 million new cases occurring each year. Lung cancer accounts for 30% of
the deaths in men and 26% in women.
All cancer is genetically caused in the sense that it reflects damage to the
genes that control cell replication. Some damage is associated with genetic mutations
linked to an inherited tendency for developing cancer, most often involving breast and
colon cancer. About 5% of women with breast cancer have a hereditary form of this
disease. Similarly, close relatives of a person with colorectal cancer are themselves at
greater risk, particularly if it has affected many people within the extended family.
However, most cancer is not of the inherited variety. Instead, cancer develops when
random mutations occur that cause the body’s cells to malfunction. The mutations
develop either as a mistake in cell division or in response to injuries from
environmental agents such as radiation or chemicals. Most cancers become more
prevalent with increasing age in adulthood because age is associated with greater
cumulative exposure to harmful toxins (carcinogens) in the environment. Lifestyle
also plays a vital part. The three greatest lifestyle risk factors for the development of
cancer during adulthood are exposure to the sun, cigarette smoking, and lack of
control over diet.
Skin cancer, the most common form of cancer in adults, is directly linked to
exposure to ultraviolet (UV) radiation from the sun. In the United States, for example,
melanoma is more common in Texas than it is in Minnesota, given that the levels of
UV radiation from the sun are stronger in the South. Around the world, the highest
rates of skin cancer are found in South Africa and Australia, areas that receive
substantial amounts of UV radiation. Artificial sources of UV radiation, such as
sunlamps and tanning booths, can cause skin cancer despite the claims that the
manufacturers make about their safety. In fact, researchers have determined that
women in developed countries who use tanning beds before the age of 30 increase
their risk of developing skin cancer by 75%. Cancer of the eye is also more likely to
develop in people who use artificial tanning devices.
Cigarette smoking is the next greatest health risk, and is in many ways more
dangerous than UV exposure given that the forms of cancer related to cigarettes are
generally more lethal than skin cancer. Most lung cancer is caused by cigarette
smoking, and exposure to cigarette smoke is a risk factor for developing cancers of
the mouth, throat, esophagus, larynx, bladder, kidney, cervix, pancreas, and stomach.
The risk of lung cancer begins to diminish as soon as a person quits smoking. People
who have had lung cancer and stop smoking are less likely to get a second occurrence
of lung cancer than are people who continue to smoke. Exposure to cigarette smoke
(‘‘secondhand smoke’’) can be just as great a risk, if not greater, for lung cancer.
Though you are probably aware of the risks of cigarette smoke in developed countries
such as the United States, Canada, and Europe, you may not realize that carcinogens
are present in substances such as betel quid, which includes the toxic substance areca
nut. Approximately 600 million people in India and parts of Southeast Asia, or
perhaps as many as 80% of adults in parts of India, chew betel quid. Even if there is
no tobacco in the betel quid, this habit greatly increases the risk of liver and
esophageal cancer.
Diet is the third risk factor for cancer. A nationwide study of over 900,000
adults in the United States who were studied prospectively (before they had cancer)
from 1982 to 1998 played an important role in identifying the role of diet. During this
period of time, there were more than 57,000 deaths within the sample from cancer.
The people with the highest BMIs had death rates from cancer that were 52% higher
for men and 62% higher for women compared with men and women of normal BMI.
The types of cancer associated with higher BMIs included cancer of the esophagus,
colon and rectum, liver, gallbladder, pancreas, and kidney. Significant trends of
increasing risk with higher BMIs were observed for death from cancers of the
stomach and prostate in men and for death from cancers of the breast, uterus, cervix,
and ovary in women (Calle, Rodriguez, WalkerThurmond, & Thun, 2003). We can
conclude from this research that maintaining a low BMI is a critical preventive step in
lowering your risk of cancer.
In addition to BMI, eating specific foods seems to play a role in cancer
prevention. Stomach cancer is more common in parts of the world—such as Japan,
Korea, parts of Eastern Europe, and Latin America—in which people eat foods that
are preserved by drying, smoking, salting, or pickling. By contrast, fresh foods,
especially fresh fruits and vegetables, may help protect against stomach cancer.
Similarly, the risk of developing colon cancer is thought to be higher in people whose
diet is high in fat, low in fruits and vegetables, and low in highfiber foods such as
whole-grain breads and cereals. For instance, New Zealand and the United States have
the higher rates of colon cancer and also consume the largest amount of meat
(National Cancer Institute, 2010). There are several additional specific types of
experiences that seem to make certain people more vulnerable to cancer.
Environmental toxins include chemical compounds found in the air, food, and water.
Such compounds include asbestos, arsenic, beryllium, cadmium, chromium, and
nickel. Exposure to these compounds significantly increases the risk of cancer in
various sites in the respiratory system including the lung and nasal cavity. Increased
risk of bladder cancer is associated with exposure to arsenic, and ovarian cancer with
asbestos exposure. In addition, leather, silica, and wood dust increase the risk of
several forms of respiratory cancers (Straif et al., 2009). Certain occupations are more
at risk of exposure to these carcinogenic substances, including iron and steel
founding, manufacture of isopropyl alcohol, painting, and rubber manufacturing.
A host of other lifestyle habits and choices that people make can further
contribute to the risk of developing cancer. In the intensive efforts to find the causes
of breast cancer, a variety of lifestyle factors have been suggested, such as amount of
alcohol consumed and having an abortion or a miscarriage. The evidence is somewhat
stronger for the effect of personal history in the case of cervical cancer, which has a
higher risk among women who began having sexual intercourse before age 18 and/or
have had many sexual partners. For men, efforts are under way to determine whether
having had a vasectomy increases the risk of prostate cancer. In addition to a person’s
lifestyle and history of disease, variations due to race and ethnicity are observed
among certain types of cancers. Skin cancer is more likely to develop in people with
fair skin that freckles easily, while Black people are less likely to develop any form of
skin cancer. Other cancers varying according to race include uterine cancer (more
prevalent among Whites), and prostate cancer (more prevalent among Blacks).
Stomach cancer is twice as prevalent in men and is more common in Black people, as
is colon cancer. Rectal cancer is more prevalent among Whites.
Finally, hormonal factors are thought to play an important role in the risk of
certain forms of cancer. Although the cause of prostate cancer is not known, the
growth of cancer cells in the prostate, like that of normal cells, is stimulated by male
hormones, especially testosterone. Along similar lines, estrogen is thought to increase
the likelihood of a woman’s developing uterine cancer, though combined intake of
progesterone and estrogen may reduce the risk associated with its use (Grosse et al.,
2009). Therefore, the link found between higher weight and uterine cancer in women
may be due to increased production of estrogen among heavier women, so that the
estrogen rather than fat increases the risk of uterine cancer. Likewise, findings that
diabetes and high blood pressure increase the risk of uterine cancer may be related to
the fact that these conditions are more likely to occur in overweight women who have
higher levels of estrogen.
The best way to treat cancer is to prevent it. Cancer detection with frequent
screenings is the primary step in treatment. Public interest organizations such as the
American Cancer Society and the Canadian Cancer Society publicize the need for
tests such as breast selfexamination and mammograms for women, prostate
examinations for men, and colon cancer screenings for both men and women. There is
mixed evidence for the effectiveness of this publicity and within recent years,
considerable debate over the value of screenings. In November 2009, the U.S.
Preventive Services Task Force (USPSTF) released a controversial update to the 2002
recommendation statement for breast cancer screening. The 2002 recommendation
advocated breast mammography every 1–2 years for women over 40. The 2009
statement, citing insufficient evidence to assess the benefits and harms of screening,
recommends against routine mammography screening in women between the ages of
40 and 49. Biennial screening mammography is recommended for women between
the ages of 50 and 74. For women over the age of 75, the USPSTF determined
insufficient evidence to assess the additional benefits and harms of mammography.
Uncertainties pertaining to the harm of screening (including misdiagnosis) were cited
as a basis for the recommendations. When the report was made public, countless
groups and organizations were quick to criticize harshly the recommendations,
sparking debate in the medical field and media outlets.
c. Disorders of the Musculoskeletal System
Although not generally fatal, musculoskeletal diseases can be crippling and
may even lead to injury or bodily damage that can eventually end the afflicted
individual’s life. Two primary disorders of the musculoskeletal system affecting
middle-aged and older adults are arthritis and osteoporosis. These relatively common
disorders range in their effects on the individual, and can be classified from minor to
severe.
Arthritis is a general term for conditions that affect the joints and surrounding
tissues. It refers to any one of several diseases that can cause pain, stiffness, and
swelling in joints and other connective tissues. The most common form of arthritis is
known as osteoarthritis, a painful, degenerative joint disease that often involves the
hips, knees, neck, lower back, or the small joints of the hands. Osteoarthritis typically
develops in joints injured by repeated overuse in the performance of a particular job
or a favorite sport. Obesity, associated with the carrying of excess body weight, is
another risk factor. There may also be causes common to both obesity and
osteoarthritis that further increase the risk for osteoarthritis (Gabay, Hall, Berenbaum,
Henrotin, & Sanchez, 2008). Eventually, injury or repeated impact thins or wears
away the cartilage that cushions the ends of the bones in the joint so that the bones rub
together. The articular cartilage that protects the surfaces of the bones where they
intersect at the joints wears down, and the synovial fluid that fills the joint loses its
shockabsorbing properties. Joint flexibility is reduced, bony spurs develop, and the
joint swells. These changes in the joint structures and tissues cause the individual to
experience pain and loss of movement.
Pain management is an important feature of the treatment for osteoarthritis and
typically involves medication such as aspirin, acetaminophen, ibuprofen, and
nonsteroidal anti-inflammatory drugs (NSAIDs). Unfortunately, the use of NSAIDs
can lead to the development of gastrointestinal problems, including ulcers.
Corticosteroids can also be injected directly into joints to reduce swelling and
inflammation. These drugs are used sparingly, however, because chronic use can have
destructive effects on bones and cartilage. Pain medications only alleviate symptoms;
they do not provide a cure for the disease. More active forms of treatment are
becoming available to people who have osteoarthritis, including injection of a
synthetic material into an arthritic joint to replace the loss of synovial fluid. A second
option is injection of sodium hyaluronate into the joint, an injectable version of a
chemical normally present in high amounts in joints and fluids. Increasingly common
is the total replacement of an affected joint, such as a hip or a knee. While
replacement surgery may seem like a drastic measure, it is one that typically proves
highly satisfactory.
Short of control through medication or surgery, exercise can have beneficial
effects on reducing the pain of arthritis (Kujala, 2009). Clearly the type of exercise
must be carefully monitored as is true for normal age-related changes in the joints.
Exercise can also be beneficial in weight reduction, further improving the arthritic
patient’s prognosis. Finally, although mechanical strain increases the risk of
osteoarthritis, maintaining high muscle strength may compensate for the strain placed
on the joints.
The technical term for the loss of bone mineral content is osteoporosis
(literally, ‘‘porous bone’’), and occurs when the bone mineral density is more than 2.5
standard deviations below the mean of young, White, non-Hispanic women. It is
estimated that 8 million women and 2 million men in the United States suffer from
osteoporosis (Sweet, Sweet, Jeremiah, & Galazka, 2009). Women are at higher risk
than men because they have lower bone mass in general but nevertheless,
osteoporosis is a significant health problem in men. Rates of osteoporosis-related
bone fracture are equivalent to the rates of myocardial infarction (Binkley, 2009).
Women vary by race and ethnicity in their risk of developing osteoporosis; White and
Asian women have the highest risk, whereas Blacks and Hispanics the lowest. In
addition, women who have small bone structures and are underweight have a higher
risk for osteoporosis than heavier women.
Alcohol and cigarette smoking increase the risk of developing osteoporosis.
Conversely, risk is reduced by an adequate intake of calcium through dairy products,
dark green leafy vegetables, tofu, salmon, and foods fortified with calcium such as
orange juice, bread, and cereal (a regimen similar to that recommended to prevent
heart disease). A diet high in protein and a variety of other nutrients such as
magnesium, potassium, vitamin K, several B vitamins, and carotenoids can also be of
value in preventing osteoporosis (Tucker, 2009). Vitamin D, obtained through
exposure to sunlight (while wearing sunblock of course!), or as a dietary supplement,
is another important preventative agent (Bischoff-Ferrari et al., 2009). Exercise and
physical activity are also significant factors in reducing the risk of osteoporosis.
Prevention and treatment of osteoporosis involve an attempt to restore bone
strength through nutritional supplements and a regular program of weightbearing
exercise (Guadalupe-Grau, Fuentes, Guerra, & Calbet, 2009). Medication may also be
prescribed to slow or stop bone loss, increase bone density, and reduce fracture risk.
Alendronate is a bisphosphonate used to increase bone density, and calcitonin is a
naturally occurring hormone involved in the regulation of calcium and bone
metabolism. Each of these has advantages but also can have serious side effects that
make them more or less useful for particular individuals. For example, they may
increase bone loss in the jaw among patients with dental problems.
For both men and women, a deficiency of sex hormones may play a causative
role in osteoporosis; as discussed above, the risks of hormone replacement therapy
need to be weighed against the gains in preserving bone health (Pietschmann, Rauner,
Sipos, & Kerschan-Schindl, 2009). Calcitrol, though linked to risks involving buildup
of calcium byproducts in the body, may also prove to be effective when combined
with other treatments (Peppone et al., 2009). Interestingly, certain types of alcohol
may be preventive for women. In a study of beer drinkers compared to women who
drank no alcohol or other forms of alcohol, it was the women who consumed beer
who had the lowest rates of osteoporosis, perhaps due to the fact that beer contains a
form of estrogen.
d. Diabetes
A large fraction of the over-65 population suffers from Type 2 diabetes, a
disease that begins in adulthood. This form of diabetes is associated with long-term
complications that affect almost every organ system, contributing to blindness, heart
disease, strokes, kidney failure, the necessity for limb amputations, and damage to the
nervous system.
Diabetes is caused by a defect in the process of metabolizing glucose, a simple
sugar that is a major source of energy for the body’s cells. Normally, the digestive
process breaks food down into components that can be transported through the blood
to the cells of the body. The presence of glucose in the blood stimulates the beta cells
of the pancreas to release insulin, a hormone that acts as a key at the cell receptors
within the body to ‘‘open the cell doors’’ to let in the glucose. Excess glucose is stored
in the liver or throughout the body in muscle and fat. After it is disposed of, its level
in the blood returns to normal. In Type 2 diabetes, the pancreas produces some
insulin, but the body’s tissues fail to respond to the insulin signal, a condition known
as insulin resistance. Because the insulin cannot bind to the cell’s insulin receptor,
glucose cannot be transported into the body’s cells to be used. Eventually the excess
glucose overflows into the urine and is excreted. The body therefore loses a main
source of energy, although large amounts of glucose are potentially available in the
blood.
The symptoms of diabetes include fatigue, frequent urination (especially at
night), unusual thirst, weight loss, blurred vision, frequent infections, and slow
healing of sores. These symptoms develop more gradually and are less noticeable in
Type 2, compared with Type 1 (child-onset), diabetes. If blood sugar levels become
too low (hypoglycemia), the individual can become nervous, jittery, faint, and
confused. When hypoglycemia develops, the individual must eat or drink a sugary
substance as quickly as possible. Alternatively, the person can also become seriously
ill if blood sugar levels rise too high (hyperglycemia). Women who develop diabetes
while pregnant (a condition known as gestational diabetes) are more likely to
experience complications, and their infants are more likely to develop birth defects.
It is estimated that 10 million Americans have been diagnosed with diabetes,
and there may be as many as 5 million people who have the disease but have not
received a diagnosis. Diabetes is estimated to afflict 10.3 million people 60 years of
age and older: approximately 21% of adults in this age category. The CDC estimates
that having diabetes doubles the risk of death compared with other people in one’s
own age group (Centers for Disease Control and Prevention, 2010d). Though Type 1
diabetes was once considered a children’s disease, higher rates of Type 2 diabetes in
children have increased at an alarming rate. Such findings will have important health
implications for future generations of older adults. According to the World Health
Organization, the number of people suffering from diabetes worldwide is
approximately 171 million in 2010, a number that will double by 2030.
Approximately 3.2 million deaths per year are due to complications of diabetes. The
United States is third following India and China in the number of people who suffer
from diabetes, but the rise in cases is greater in the developing countries.
Diabetes can be understood in terms of the biopsychosocial perspective in that
it involves physical, behavioral, and sociocultural risk factors. The main risk factors
for diabetes are obesity and a sedentary lifestyle. Epidemiologists attribute the rise in
diabetes to the increase in BMI, noted as a risk factor for heart disease. Researchers in
this area warn that older adults are becoming increasingly likely to experience
metabolic syndrome, insulin resistance, high lipid levels, and hypertension, leading to
greater risk of cardiovascular and kidney disease (Bechtold, Palmer, Valtos, Iasiello,
& Sowers, 2006). Echoing the findings of other research on the benefits of moderate
consumption of alcohol, research on diabetes risk also indicates a protective effect of
between 20 and 50–60 grams of alcohol per day or between 1 and 2 ounces.
Other risk factors contributing to diabetes risk are race and ethnicity. The
incidence of diabetes is about 60% higher in African Americans and 110 to 120%
higher in Mexican Americans and Puerto Ricans compared with Whites. The highest
rates of diabetes in the world are found among Native Americans. Half of all Pima
Indians living in the United States, for example, have adult-onset diabetes.
Given the clear relationship between obesity and diabetes, the most important
means of preventing Type 2 diabetes are control of glucose intake, control of blood
pressure, and control of blood lipids. Moderate alcohol consumption also seems to
offer a protective effect (Paulson, Hong, Holcomb, & Nunez, 2010). Once an
individual has Type 2 diabetes, diet and exercise continue to be important. Frequent
blood testing is also necessary to monitor glucose levels, although saliva testing
advancements are under way. Much of this treatment involves trying to keep blood
sugar at acceptable levels. Many individuals with Type 2 diabetes must take oral
drugs or insulin to lower their blood glucose levels. In addition to medication and
monitoring of diet, people with diabetes are advised to develop an exercise plan to
manage their weight and to lower blood pressure and blood fats, important steps that
can lead to reductions in blood sugar levels.
The main form of respiratory disease affecting adults in middle and late life is
chronic obstructive pulmonary disease (COPD), a group of diseases that involve
obstruction of the airflow into the respiratory system. Two related diseases—chronic
bronchitis and chronic emphysema—often occur together in this disease (see Figure
5.4). People with COPD experience coughing, excess sputum, and difficulty breathing
even when performing relatively easy tasks, such as putting on their clothes or
walking on level ground. According to the internationally-based Global Initiative for
COPD (2009), the disease is the fourth leading cause of chronic illness and death and
the fifth in the world in terms of the burden of disease. COPD’s prevalence increases
with age, such that the disease is estimated to affect about 25% of those 75 and older.
Chronic bronchitis is a long-standing inflammation of the bronchi, the airways
that lead into the lungs. The inflammation of the bronchi leads to increased production
of mucus and other changes, which in turn leads to coughing and expectoration of
sputum. People with this disorder are more likely to develop frequent and severe
respiratory infections, narrowing and plugging of the bronchi, difficulty breathing,
and disability. Chronic emphysema is a lung disease that causes permanent
destruction of the alveoli. Elastin within the terminal bronchioles is destroyed, leading
to collapse of the airway walls and an inability to exhale. The airways lose their
ability to become enlarged during inspiration and to empty completely during
expiration, leading to a lowering of the quality of gas exchange. For people with
COPD, the symptom they are most aware of is shortness of breath. They also suffer
from restrictions in their ability to enjoy daily life, including limitations in mobility.
Although the cause of COPD is not known, it is generally agreed that cigarette
smoking is a prime suspect. Exposure to environmental toxins such as air pollution
and harmful substances in the occupational setting also may play a role, particularly
for people who smoke. The specific mechanism involved in the link between smoking
and emphysema is thought to involve the release of an enzyme known as elastase,
which breaks down the elastin found in lung tissue. Cigarette smoke stimulates the
release of this enzyme and results in other changes that make the cells of the lung less
resistant to elastase. Normally there is an inhibitant of elastase found in the lung,
known as alpha-1 antitrypsin (AAT). However, cigarette smoke inactivates AAT and
allows the elastase to destroy more lung tissue. Of course, not all smokers develop
COPD, and not all people with COPD are or have been smokers. Heredity may also
play a role. There is a rare genetic defect in the production of AAT in about 2 to 3% of
the population that is responsible for about 5% of all cases of COPD. Apart from
quitting smoking, a necessary first step in prevention and treatment, individuals with
COPD can benefit from medications and treatments. These include inhalers that open
the airways to bring more oxygen into the lungs or reduce inflammation, machines
that provide oxygen, or, in extreme cases, lung surgery to remove damaged tissue.
e. Dementia and Related Neurological Disorders
Dementia is a clinical condition in which the individual experiences a loss of
cognitive function severe enough to interfere with normal daily activities and social
relationships. Dementia can be caused by a number of diseases that affect the nervous
system, including cardiovascular disorders, a variety of neurologically based
disorders, and abnormalities in other bodily systems. Alzheimer’s disease receives the
most attention, most likely since it is the most common cause of dementia.
The disorder now known as Alzheimer’s disease has been given many names
over the years, including senile dementia, presenile dementia, senile dementia of the
Alzheimer’s type, and organic brain disorder. The current terminology reflects the
identification of the condition as a disease by Alois Alzheimer (1864–1915), a
German neurologist who was the first to link changes in brain tissue with observable
symptoms. Alzheimer treated Auguste D., a woman in her 50s who suffered from
progressive mental deterioration marked by increasing confusion and memory loss.
Taking advantage of what was then a new staining technique, he noticed an odd
disorganization of the nerve cells in her cerebral cortex. In a medical journal article
published in 1907, Alzheimer speculated that these microscopic changes were
responsible for Auguste D.’s dementia. The discovery of brain slides from this patient
confirmed that these changes were similar to those seen in the disease (Enserink,
1998). In 1910, as a resulting number of autopsies from severely demented
individuals showed the same abnormalities, a foremost psychiatrist of the era, Emil
Kraepelin (1856–1926), gave the name described by his friend Alzheimer to the
disease.
The World Health Organization estimates the prevalence of Alzheimer’s
disease worldwide of people over 60 as 5% of men and 6% of women (World Health
Organization, 2001). The incidence rates of new cases is less than 1% a year for those
aged 60 to 65 or possibly as high as 6.5% in those 85 and older (Kawas, Gray,
Brookmeyer, Fozard, & Zonderman, 2000). A commonly quoted figure regarding the
number of people in the United States with Alzheimer’s disease is 5–5.5 million
people, representing a rate of over 12% of the over-65 age groups and 50% or higher
of those over 85 years of age. The media and other sources have projected this
number to soar into the mid-21st century, reaching a staggering 14 million individuals
who will suffer from the disease by 2050 unless a cure is found.
However, it is necessary to look more carefully at these statistics, which,
according to other estimates, are overly high. In the first place, the estimates originate
from a non-peer-reviewed publication of the privately funded Alzheimer’s
Association. The number they project in this report is based on a study of 856 U.S.
residents living in 42 states ranging in age from 71 and older. U.S. prevalence
statistics were extrapolated from the figures in this sample (Plassman et al., 2007).
This approach of generalizing from a relatively small sample has characterized much
of the Alzheimer’s prevalence research and thus has led to disputes among researchers
about the validity of this estimate. Others have arrived at an estimated prevalence of
about half the media number at 2.3 million (Brookmeyer, Corrada, Curriero, &
Kawas, 2002; Hy & Keller, 2000). Furthermore, norms for diagnostic tests for the
disorder vary by education and age, so estimates of its prevalence in the oldest-old
and the less well educated might result in inflated figures (Beeri et al., 2006).
Although the numbers presented by the media draw attention to an important
problem, they can also reinforce the notion that ‘‘senility’’ is an inevitable feature of
aging.
Particularly important when evaluating statistics on the prevalence of
Alzheimer’s disease is whether the data refer specifically to dementia due to
Alzheimer’s disease only or whether they include vascular dementia. Approximately
20% of cases of dementia are due to cerebrovascular disease (Knopman, 2007). This
is an important distinction because, as you will learn later, other forms of dementia
are different in their cause, prognosis, and treatment.
The psychological symptoms of Alzheimer’s disease evolve gradually over
time. The earliest signs are occasional loss of memory for recent events or familiar
tasks. Although changes in cognitive functioning are at the core of this disease’s
symptoms, changes in personality and behavior eventually become evident as well.
By the time the disease has entered the final stage, the individual has lost the ability to
perform even the simplest and most basic of everyday functions. The rate of
progression in Alzheimer’s disease varies from person to person, but there is a fairly
regular pattern of loss over the stages of the disease. The survival time following the
diagnosis is 7 to 10 years for people diagnosed in their 60s and 70s, and drops to 3
years for people diagnosed in their 90s.
One set of changes that Alzheimer discovered in the brain of Auguste D.
consisted of what looked like the accumulated waste products of collections of dead
neurons. Now known as amyloid plaques, they can develop 10 to 20 years before
behavioral symptoms become noticeable and are thought to be one of the first events
in the pathology of the disease. Amyloid is a generic name for protein fragments that
collect together in a specific way to form insoluble deposits (meaning that they do not
dissolve). The form of amyloid most closely linked with Alzheimer’s disease consists
of a string of 42 amino acids and is therefore referred to as beta-amyloid 42.
Beta-amyloid is formed from a larger protein found in the normal brain,
referred to as amyloid precursor protein (APP). As APP is manufactured, it embeds
itself in the neuron’s membrane. A small piece of APP is lodged inside the neuron and
a larger part of it remains outside. In healthy aging, the part of APP remaining outside
the neuron is trimmed by enzymes called secretases so that it is flushed with the
neuron’s outer membrane. In Alzheimer’s disease, something goes wrong with this
process so that the APP is snipped at the wrong place, causing beta-amyloid 42 to
form. The cutoff fragments eventually clump together into beta-amyloid plaques, the
abnormal deposits that the body cannot dispose of or recycle.
Apart from its tendency to form insoluble plaques, beta-amyloid seems to have
the potential to kill neurons. Caspase theory proposes that beta-amyloid stimulates the
production of substances called caspases, enzymes that are lethal to neurons. This
destruction of neurons, referred to as apoptosis, ultimately leads to the loss of
cognitive functioning that occurs in Alzheimer’s disease (Galvan et al., 2006). The
second mysterious change observed in Auguste D.’s brain was a profusion of
abnormally twisted fibers within the neurons themselves, known as neurofibrillary
tangles (literally, tangled nerve fibers). It is now known that the neurofibrillary tangles
are made up of a protein called tau, which seems to play a role in maintaining the
stability of the microtubules that form the internal support structure of the axons. The
microtubules are like train tracks that guide nutrients from the cell body down to the
ends of the axon. The tau proteins are like the railroad ties or crosspieces of the
microtubule train tracks. In Alzheimer’s disease, the tau is changed chemically and
loses its ability to separate and support the microtubules. With their support gone, the
tubules begin to wind around each other and they can no longer perform their
function. This collapse of the transport system within the neuron may first result in
malfunctions in communication between neurons and may eventually lead to the
death of the neuron.
Like the formation of plaques, the development of neurofibrillary tangles
appears to occur early in the disease process and may progress quite substantially
before the individual shows any behavioral symptoms. The earliest changes in the
disease appear to occur in the hippocampus and the entorhinal region of the cortex,
the area near the hippocampus, and are critical in memory and retention of learned
information.
f. Information Processing
Researchers working within the information processing perspective regard the
cognitive functioning of humans as comparable to the functioning of a computer. The
‘‘data’’ from experiences enter into the brain through various sensory routes, where
they progress through a series of stages of analysis. Like a computer, the brain can
discard the information, store it for future purposes, or use it instantly. Studies of
information processing in adulthood focus on whether and how the aging process
alters the efficiency and effectiveness of these analytical phases. Findings from
laboratory studies on information processing can have significant importance to daily
life.
Theories about changes in the overall quality of information processing in
adulthood are based on studies of psychomotor speed, the amount of time it takes to
process a signal, prepare a response, and then execute that response. Researchers
believe that psychomotor speed reflects the integrity of the central nervous system
(Madden, 2001). The basic framework of a study on psychomotor speed is fairly
straightforward. You enter a laboratory equipped with a computer set up to record
your responses. The screen flashes a stimulus array (or a number of items organized in
a specific way) that you are asked to examine. Your instructions typically tell you how
to respond when a particular stimulus, known as a target, appears in that array. The
time taken to respond (called reaction time) is recorded. Building on this basic
procedure, experimenters then manipulate conditions to determine what factors
influence the speed of performance. Simple reaction time involves viewing one
stimulus at a time; in choice reaction time tasks, respondents must select from an
array. Some procedures use cuing, in which participants are given a prompt to direct
their attention to a particular region of the screen. In some studies, misleading or
irrelevant cues are presented to determine whether older adults are more distracted by
such information. The measurement of the effects of these manipulations (compared
to simple or cued reaction time) forms the basis for research on age differences in
psychomotor speed.
Researchers know with certainty that your reaction time as a young adult will
be lower (i.e., you will be quicker) than it will be as you get older. The question is,
how much lower and under what circumstances will it increase as you get older? The
documented increases in reaction time with age in adulthood are typically a matter of
several hundreds of milliseconds, not enough to be particularly noticeable in everyday
life, but enough to be significant under the scrutiny of the laboratory researcher. The
rate at which reaction time changes occur may vary considerably from person to
person. Despite this increasing variability in reaction times with age, overall, the net
effect of the changes are negative across adulthood, particularly for choice reaction
time tasks.
Why do reaction times slow as people age? According to the general slowing
hypothesis (Salthouse, 1996), the increase in reaction time reflects a general decline
of information processing speed within the nervous system of the aging individual.
Related to this idea is the age-complexity hypothesis, which proposes that through
slowing of central processes in the nervous system, age differences increase as tasks
become more complex and processing resources are stretched more and more to their
limit. The general slowing hypothesis was derived through examinations of cross-
sectional studies on reaction times. The reaction times of older groups of adults were
plotted against the times of younger adults on a graph called a Brinley plot, older
adults perform at similar speeds on tasks completed relatively quickly by a young
adult (500 ms). On tasks that take longer for young adults (1,000 ms), older adults
take proportionately longer (1,500–2,000 ms) than they do on the 500 ms tasks.
The general slowing hypothesis is consistent with a large body of data on
reaction time performance in adulthood. This hypothesis does not identify any
particular stage or component of information processing as the culprit causing age
differences in reaction time, though there is the assumption that slowing reflects lack
of efficiency in the nervous system. As we will see later, the general slowing
hypothesis is also used to explain age differences in memory. Loss of speed leads to
memory impairments, as a backlog develops in cognitive processes when multiple
operations must be completed simultaneously or within a limited time.
The slowing of reaction time with age may be attributed to many factors. One
that has intrigued researchers is the hypothesis that older adults are particularly
disadvantaged in the attentional stage of information processing.Attention involves
the ability to focus or concentrate on a portion of experience while ignoring other
features of that experience, to be able to shift that focus as demanded by the situation,
and to be able to coordinate information from multiple sources. Once your attention is
focused on a piece of information, you are then able to perform further cognitive
operations, such as those involving memory or problem solving. If you are someone
who has difficulty concentrating or focusing your attention for long periods of time,
you are certainly aware of how frustrating it can be to miss important information or
details. Persistent and serious attentional problems characterize people with attention
deficit disorder who, as a result, may have difficulty learning new information or
performing more than one task at a time. The attentional deficits associated with the
normal aging process can involve deficits of a similar nature, particularly when
complex decisions must be made quickly.
Studies of attention are important for understanding the cognitive functions of
adults of varying ages and their abilities to function in various real-life situations in
which cognitive resources must be focused on some target or goal. Researchers
approach these issues by breaking down the attentional tasks involved in everyday life
into components to examine in the laboratory. For the most part, these studies suggest
that people become less efficient in the use of attentional processes as they get older.
One particularly important area of attentional performance involves dividing the focus
of attention between multiple inputs. Commonly known as ‘‘multitasking,’’ you most
likely engage in dividing your attention on a regular basis throughout your day. You
may be reading this book while listening to your iPod, watching television, or
intermittently updating your Facebook status. Experiments that attempt to replicate
this real-life situation use a dual task paradigm (also called a divided attention task),
in which the individual is given information from two input sources and must attend
to both sources at once to identify a target.
Most people are disadvantaged when it comes to multitasking. Accident data
showing the risks of texting or talking on a cell phone while driving are now on the
books in several U.S. states and are being proposed in others. Disadvantages of
multitasking increase progressively with age (Kramer & Madden, 2008). To a certain
extent, older adults appear to compensate for attentional deficits under multitasking
conditions by shifting activation of regions of the brain involved in attentional
processing. For example, it appears that they reduce the activity of frontal regions of
their brains (responsible for planning) while increasing activity in brain regions
involved in the storage of visual and spatial information (Fernandes, Pacurar,
Moscovitch, & Grady, 2006). The ability of older adults to compensate for attentional
losses in later life by shifting brain activation is a phenomenon observed over a
number of other areas of performance.
A number of investigations of attention and aging use an inhibitory task in
which the individual must deliberately suppress one response in order to perform
another. The purpose of this type of task is to determine whether older adults are able
to ignore aspects of a stimulus that are irrelevant. One of the best known inhibitory
attention tasks is the Stroop test, in which you are told to name the color of ink in
which a word is printed. Critical trials on the Stroop test involve comparing your
performance when the color and the word match (e.g., the word ‘‘red’’ printed in red)
with your performance when the color and the word do not match (‘‘red’’ is printed in
green). The inhibitory part of this test is surprisingly difficult because you have to
dissociate your reading of the word from your naming of the color.
The third type of attentional task involves the ability known as sustained
attention. This type of task requires the participant to be on guard for a change in a
stimulus array; many video games require a similar process of monitoring the screen
for moving objects that demand a response of some sort. Laboratory tasks of sustained
attention are similar in principle though not as elaborate. For example, a typical
experiment requires participants to watch a computer screen as a series of stimuli are
presented and told to respond only when the target stimulus appears (such as the letter
‘‘X’’ moving onto a screen containing all ‘‘Y’’s). The experimenter manipulates the
cuing conditions that determine how long it will take you to detect the target. Older
adults typically have more difficulty on sustained attention tasks than do younger
adults.
g. Driving and Aging
As we mentioned earlier, age-related changes in information processing have
effects on many aspects of daily life. The ability to drive is probably one of the most
important. This is a particularly sensitive topic for older adults and it is a topic that
continues to receive attention in the media. Questions about whether older adults have
lost the cognitive abilities to drive are often raised in the aftermath of an accident
involving an older driver if there has been loss of life or significant property damage.
As we examine the actual data on driving and aging, however, we will show that some
of these media reports are exaggerated and that older drivers, though experiencing
attentional deficits, have other abilities and resources that they use to compensate for
these deficits. Given that reaction time is greater for older adults, they may be
particularly disadvantaged when they need to evaluate a complex situation in which
they have to make a quick decision.
Yet the effects of age on vision and cognition do not necessarily translate into
higher accident rates of older drivers compared to some of their younger counterparts.
According to the National Highway Traffic Safety Administration, in the United
States, the highest fatality rates (27 per 100,000) are for 16- to 25-year-olds; people
65 and older have a much lower fatality rate (18 per 100,000 population).
Younger people are also involved in many more crashes than older drivers per
mile driven; the rates of motor vehicle accidents among teen drivers 16 to 19 years
old are four times the rates of accidents for drivers 65 and older. Some of the factors
involved in the higher accident rates of younger drivers include driving at higher
speeds, failing to wear seat belts, following too closely behind the vehicle in front of
them, and tending to underestimate or not sufficiently recognizing hazardous
situations. Distractions incurred while driving (such as text messaging, eating, or
searching for a dropped cell phone) also constitute a major concern for younger
drivers, prompting a summit by the U.S. Department of Transportation in 2009 on the
dangers of distracted driving. Research suggests that even hands-free devices (such as
the use of a Bluetooth earpiece) do not improve driving performance (Ishigami &
Klein, 2009). In other words, any type of talking on the phone while driving is unsafe.
By contrast, older adults are more likely to be involved in a crash at an
intersection when making a left-hand turn, at least in the United States. The opposite
is true in Australia, where people drive on the left, making a right-hand turn more
complex and dangerous there (Braitman, Kirley, Chaudhary, & Ferguson, 2006).
Tasks requiring a high demand of visual attention while driving (such as merging or
yielding to oncoming traffic) are associated with greater problems navigating the
environment.
Therefore, we can conclude that older drivers have certain difficulties but do
not pose the fatal threat that many in the media associate with this age group,
particularly compared to teens who drive under the influence of substances. Yet, as we
have discussed earlier, fear of loss of abilities can become a self-fulfilling prophecy,
particularly for older adults who interpret their driving-related experiences through
identity accommodation. Older adults who doubt themselves more frequently will
hesitate before making a response due to worries about their abilities, or may suffer
internal distractions because they are so preoccupied with their own concerns.
Prejudice against them by younger people can exacerbate whatever fears and concerns
older drivers already have about their changing abilities. They may hear derogatory
phrases such as ‘‘driving while old’’ or ‘‘gray head’’ and become even more
concerned and hence distracted.
Driving provides a perfect example of the importance of adopting a
biopsychosocial perspective to understand the aging process. Biology (changes in
vision and reaction time) and psychology (internal distractions causing anxiety) each
play important roles. The sociocultural component of the equation provides further
insight into this comprehensive model. Driving is virtually a requirement of the ability
to live independently in many regions of the United States and other countries that
lack comprehensive public transportation but require automobiles to get from place to
place. Older adults who live in suburban or rural areas with limited or no public
transportation lose an important connection to the outside world, and risk becoming
housebound and socially isolated.
Yet, it is also important to recognize that many older drivers are able to self-
regulate their behaviors to compensate for changes in cognitive and perceptual
abilities. They avoid driving at night, on interstate highways, or situations in which
they must make risky left-hand turns. Although younger people complain about the
slower habits of older drivers, data show that older people have fewer accidents per
person. Interestingly, the data on aging and driving correspond closely to research
about aging and crash prevalence among older airline pilots, who have fewer fatal and
nonfatal accidents than younger pilots. Pilots who are older and more experienced
also take better advantage of training sessions to improve their performance in flight
simulators, tasks where decision time and judgment both play an important role.
Older, experienced pilots are also more likely to identify and elaborate problems
encountered in complex flight situations compared with younger, less experienced
pilots.
Chesley Sullenberger was 57 years old when in 2009, he avoided loss of life
by landing U.S. Airways flight 1549, which lost its engines, in the Hudson River. His
performance in this life and death situation is a testimony to the positive role that
years of experience can play in compensating for attentional deficits. Up until 2007,
when the federal government raised the mandatory retirement age for commercial
airline pilots from 60 to 65, Sullenberger would have been forced to retire just 3 years
later (though he did retire in 2010). Consider Sullenberger’s performance compared to
the pilots of the ill-fated Colgan Air Flight 3497 that crashed just a few weeks later
outside of Buffalo, New York; the cause was determined to be pilot error. Neither the
pilot (age 47) nor the co-pilot (age 24) had sufficient hours in the cockpit to enable
them to overcome the relatively minor problems of icing that brought down the plane,
resulting in the deaths of 50 people. There are likely countless other less well-
publicized examples in the area of driving performance that attest to the value of
greater experience as a factor that prevents accidents involving older adults.
