9.4.4^The Later Years of Life: Growing Old^372^377^,,^11188^11308%
The Later Years of Life: Growing Old

I've always enjoyed doing things in the mountains—hiking or, more recently, active cliff-climbing. The more difficult the climb, the more absorbing it is. The climbs I really remember are the ones I had to work on. Maybe a particular section where it took two or three tries before I found the right combination of moves that got me up easily—and, preferably, elegantly. It's a wonderful exhilaration to get to the top and sit down and perhaps have lunch and look out over the landscape and be so grateful that it's still possible for me to do that sort of thing. (Lyman Spitzer, age 74, quoted in Kotre & Hall, 1990, pp. 358-359)

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If you can't quite picture a 74-year-old man rock-climbing, some rethinking of your view of late adulthood may be in order. In spite of the societal stereotype of “old age” as a time of inactivity and physical and mental decline, gerontologists, specialists who study aging, are beginning to paint a very different portrait of late adulthood.

By focusing on the period of life that starts at around age 65, gerontologists are making important contributions to clarifying the capabilities of older adults. Their work is demonstrating that significant developmental processes continue even during old age. And as life expectancy increases, the number of people who reach older adulthood will continue to grow substantially. Consequently, developing an understanding of late adulthood has become a critical priority for psychologists (Birren, 1996; Moody, 2000, Schaie, 2005).

PHYSICAL CHANGES IN LATE ADULTHOOD: THE AGING BODY

Napping, eating, walking, conversing. It probably doesn't surprise you that these relatively nonstrenuous activities represent the typical pastimes of late adulthood. But it is striking that these activities are identical to the most common leisure activities reported in a survey of college students (Harper, 1978). Although the students cited more active pursuits—such as sailing and playing basketball—as their favorite activities, in actuality they engaged in such sports relatively infrequently, spending most of their free time napping, eating, walking, and conversing.

Although the leisure activities in which older adults engage may not differ all that much from the ones that younger people pursue, many physical changes are, of course, brought about by the aging process. The most obvious are those of appearance—hair thinning and turning gray, skin wrinkling and folding, and sometimes a slight loss of height as the thickness of the disks between vertebrae in the spine decreases—but subtler changes also occur in the body's biological functioning. For example, sensory capabilities decrease as a result of aging: Vision, hearing, smell, and taste become less sensitive. Reaction time slows, and physical stamina changes (Stenklev & Laukli, 2004; Schieber, 2006; Madden, 2007).

What are the reasons for these physical declines? Genetic preprogramming theories of aging suggest that human cells have a built-in time limit to their reproduction. These theories suggest that after a certain time cells stop dividing or become harmful to the body—as if a kind of automatic self-destruct button had been pushed. In contrast, wear-and-tear theories of aging suggest that the mechanical functions of the body simply work less efficiently as people age. Waste by-products of energy production eventually accumulate, and mistakes are made when cells divide. Eventually the body, in effect, wears out, just as an old automobile does (Ly et al., 2000; Miquel, 2006; Hayflick, 2007).

Evidence supports both the genetic preprogramming and the wear-and-tear views, and it may be that both processes contribute to natural aging. It is clear, however, that physical aging is not a disease, but a natural biological process. Many physical functions do not decline with age. For example, sex remains pleasurable well into old age (although the frequency of sexual activity decreases), and some people report that the pleasure they derive from sex increases during late adulthood (Gelfand, 2000; DeLamater & Sill, 2005).

Study ALERT

Two major theories of aging—the genetic preprogramming and the wear-and-tear views—explain some of the physical changes that take place in older adults.

COGNITIVE CHANGES: THINKING DURING LATE ADULTHOOD

At one time, many gerontologists would have agreed with the popular view that older adults are forgetful and confused. Today, however, most research indicates that this assessment is far from an accurate one of older people's capabilities.

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One reason for the change in view is that more sophisticated research techniques now exist for studying the cognitive changes that occur in late adulthood. For example, if we were to give a group of older adults an IQ test, we might find that the average score was lower than the score achieved by a group of younger people. We might conclude that this difference signifies a decline in intelligence. Yet if we looked a little more closely at the specific test, we might find that that conclusion was unwarranted. For instance, many IQ tests include portions based on physical performance (such as arranging a group of blocks) or on speed. In such cases, poorer performance on the IQ test may be due to gradual decreases in reaction time—a physical decline that accompanies late adulthood and has little or nothing to do with the intellectual capabilities of older adults.

Other difficulties hamper research into cognitive functioning during late adulthood. For example, older people are often less healthy than younger ones; when only healthy older adults are compared to healthy younger adults, intellectual differences are far less evident. Furthermore, the average number of years in school is often lower in older adults (for historical reasons) than in younger ones, and older adults may be less motivated to perform well on intelligence tests than younger people. Finally, traditional IQ tests may be inappropriate measures of intelligence in late adulthood. Older adults sometimes perform better on tests of practical intelligence than do younger individuals (Willis & Schaie, 1994; Dixon & Cohen, 2003).

Still, some declines in intellectual functioning during late adulthood do occur, although the pattern of age differences is not uniform for different types of cognitive abilities (see Figure 1). In general, skills relating to fluid intelligence (which involves information-processing skills such as memory, calculations, and analogy solving) show declines in late adulthood. In contrast, skills relating to crystallized intelligence (intelligence based on the accumulation of information, skills, and strategies learned through experience) remain steady and in some cases actually improve (Stankov, 2003; Rozencwajg et al., 2005; van Hooren et al., 2007).

FIGURE 1
Age-related changes in intellectual skills vary according to the specific cognitive ability in question.
(Source: Schaie, K. W. (2005). Longitudinal studies. In Developmental influences on adult intelligence: The Seattle Longitudinal Study, Figure 5.7a (p. 127). Copyright © 2005 by Oxford University Press, Inc. By permission of Oxford University Press, Inc. www.oup.co.uk)

Even when changes in intellectual functioning occur during late adulthood, people often are able to compensate for any decline. They can still learn what they want to; it may just take more time. Furthermore, teaching older adults strategies for dealing with new problems can prevent declines in performance (Saczynski, Willis, & Schaie, 2002; Cavallini, Pagnin, & Vecchi, 2003; Peters et al., 2007).

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MEMORY CHANGES IN LATE ADULTHOOD: ARE OLDER ADULTS FORGETFUL?

One of the characteristics most frequently attributed to late adulthood is forgetfulness. How accurate is this assumption?

Alzheimer Disease

Most evidence suggests that memory change is not an inevitable part of the aging process. For instance, research shows that older people in cultures in which older adults are held in high esteem, such as mainland China, are less likely to show memory losses than are those living in cultures in which the expectation is that memory will decline. Similarly, when older people in Western societies are reminded of the advantages of age (for example, “age brings wisdom”), they tend to do better on tests of memory (Levy, 1996; Hess, Hinson, & Statham, 2004; Dixon et al., 2007).

Even when people show memory declines during late adulthood, their deficits are limited to certain types of memory. For instance, losses tend to be limited to episodic memories, which relate to specific experiences in people's lives. Other types of memories, such as semantic memories (which refer to general knowledge and facts) and implicit memories (memories of which we are not consciously aware), are largely unaffected by age (Fleischman et al., 2004; Mitchell & Schmitt, 2006; St. Jacques & Levine, 2007).

Declines in episodic memories can often be traced to changes in the lives of older adults. For instance, it is not surprising that a retired person, who may no longer face the same kind of consistent intellectual challenges encountered on the job, may have less practice in using memory or even be less motivated to remember things, leading to an apparent decline in memory. Even in cases in which long-term memory declines, older adults can profit from training that targets memory skills (Fritsch et al., 2007; West, Bagwell, & Dark-Freudeman, 2007).

In the past, older adults with severe cases of memory decline, accompanied by other cognitive difficulties, were said to suffer from senility. Senility is a broad, imprecise term typically applied to older adults who experience progressive deterioration of mental abilities, including memory loss, disorientation to time and place, and general confusion. Once thought to be an inevitable state that accompanies aging, senility is now viewed by most gerontologists as a label that has outlived its usefulness. Rather than senility's being the cause of certain symptoms, the symptoms are deemed to be caused by some other factor.

Some cases of memory loss, however, are produced by actual disease. For instance, Alzheimer's disease is a progressive brain disorder that leads to a gradual and irreversible decline in cognitive abilities. Nineteen percent of people age 75 to 84 have Alzheimer's, and almost 50 percent of people over age 85 are affected by the disease. Unless a cure is found, some 14 million people will experience Alzheimer's by 2050—more than three times the current number (Cowley, 2000b; Feinberg, 2002; Lovestone, 2005; Rogers, 2007).

Alzheimer's occurs when production of the beta amyloid precursor protein goes awry, producing large clumps of cells that trigger inflammation and deterioration of nerve cells. The brain shrinks, neurons die, and several areas of the hippocampus and frontal and temporal lobes deteriorate. So far, there is no effective treatment (Lanctot, Herrmann, & Mazzotta, 2001; Blennow & Vanmechelen, 2003; Wolfe, 2006; Medeiros et al., 2007).

In other cases, cognitive declines may be caused by temporary anxiety and depression, which can be treated successfully, or may even be due to overmedication. The danger is that people with such symptoms may receive no treatment, thereby continuing their decline (Selkoe, 1997; Sachs-Ericsson et al., 2005).

In sum, declines in cognitive functioning in late adulthood are, for the most part, not inevitable. The key to maintaining cognitive skills may lie in intellectual stimulation. Like the rest of us, older adults need a stimulating environment in order to hone and maintain their skills (Bosma et al., 2003; Glisky, 2007).

Study ALERT

It's important to be able to describe the nature of intellectual changes during late adulthood.

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THE SOCIAL WORLD OF LATE ADULTHOOD: OLD BUT NOT ALONE

Just as the view that old age predictably means mental decline has proved to be wrong, so has the view that late adulthood inevitably brings loneliness. People in late adulthood most often see themselves as functioning members of society, with only a small number of them reporting that loneliness is a serious problem (Binstock & George, 1996; Jylha, 2004).

Certainly, late adulthood brings significant challenges. People who have spent their adult lives working enter retirement, bringing about a major shift in the role they play. Moreover, many people must face the death of their spouse. Especially if the marriage has been a long and good one, the death of a partner means the loss of a companion, confidante, and lover. It can also bring about changes in economic well-being.

Widows Enjoy Life

There is no single way to age successfully. According to the disengagement theory of aging, aging produces a gradual withdrawal from the world on physical, psychological, and social levels. However, such disengagement serves an important purpose, providing an opportunity for increased reflectiveness and decreased emotional investment in others at a time of life when social relationships will inevitably be ended by death (Adams, 2004; Wrosch, Bauer, & Scheier, 2005).

Although there are declines in fluid intelligence in late adulthood, skills relating to crystallized intelligence remain steady and may actually improve.

The activity theory of aging presents an alternative view of aging, holding that the people who age most successfully are those who maintain the interests, activities, and level of social interaction they experienced during middle adulthood. According to activity theory, late adulthood should reflect a continuation, as much as possible, of the activities in which people participated during the earlier part of their lives (Crosnoe & Elder, 2002; Nimrod & Kleiber, 2007).

Both disengagement and activity can lead to successful aging. Not all people in late adulthood need a life filled with activities and social interaction to be happy; as in every stage of life, some older adults are just as satisfied leading a relatively inactive, solitary existence. What may be more important is how people view the aging process: Evidence shows that positive self-perceptions of aging are associated with increased longevity (Levy et al., 2002; Levy & Myers, 2004).

People in late adulthood usually see themselves as functioning, well-integrated members of society, and many maintain activities in which they participated earlier in life.
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Regardless of whether people become disengaged or maintain their activities from earlier stages of life, most engage in a process of life review, in which they examine and evaluate their lives. Remembering and reconsidering what has occurred in the past, people in late adulthood often come to a better understanding of themselves, sometimes resolving lingering problems and conflicts, and facing their lives with greater wisdom and serenity.

Clearly, people in late adulthood are not just marking time until death. Rather, old age is a time of continued growth and development, as important as any other period of life.

© The New Yorker Collection 1993 Roz Chast from cartoonbank.com. All Rights Reserved.
BECOMING AN INFORMED CONSUMER of psychology
Adjusting to Death

At some time in our lives, we all face death—certainly our own, as well as the deaths of friends, loved ones, and even strangers. Although there is nothing more inevitable in life, death remains a frightening, emotion-laden topic. Certainly, little is more stressful than the death of a loved one or the contemplation of our own imminent death, and preparing for death is one of our most crucial developmental tasks (Aiken, 2000).

A generation ago, talk of death was taboo. The topic was never mentioned to dying people, and gerontologists had little to say about it. That changed, however, with the pioneering work of Elisabeth Kübler-Ross (1969), who brought the subject of death into the open with her observation that those facing impending death tend to move through five broad stages:

  • Denial. In this stage, people resist the idea that they are dying. Even if told that their chances for survival are small, they refuse to admit that they are facing death.

  • Anger. After moving beyond the denial stage, dying people become angry—angry at people around them who are in good health, angry at medical professionals for being ineffective, angry at God.

  • Bargaining. Anger leads to bargaining, in which the dying try to think of ways to postpone death. They may decide to dedicate their lives to religion if God saves them; they may say, “If only I can live to see my son married, I will accept death then.”

  • Depression. When dying people come to feel that bargaining is of no use, they move to the next stage: depression. They realize that their lives really are coming to an end, leading to what Kübler-Ross calls “preparatory grief” for their own deaths.

  • Acceptance. In this stage, people accept impending death. Usually they are unemotional and uncommunicative; it is as if they have made peace with themselves and are expecting death with no bitterness.

It is important to keep in mind that not everyone experiences each of these stages in the same way. In fact, Kübler-Ross's stages pertain only to people who are fully aware that they are dying and have the time to evaluate their impending death. Furthermore, vast differences occur in the way individuals react to impending death. The specific cause and duration of dying, as well as the person's sex, age, and personality and the type of support received from family and friends, all have an impact on how people respond to death (Carver & Scheier, 2002; Coyle, 2006).

Few of us enjoy the contemplation of death. Yet awareness of its psychological aspects and consequences can make its inevitable arrival less anxiety-producing and perhaps more understandable.