death may occur. The emotional state of an older adult can either promote a healthy outcome or become detrimental to the recovery process.
Emotions
Emotions change with age; however, aging adults can improve in the area of emotional regulation (Kensinger, 2009). Healing emotions (serenity, gratitude, and reverence) bolster the immune system. They have been long understood in alternative medicine and are slowly coming to be accepted by the mainstream medical community as well. Since decreased immune function is common in later life, whatever can be done to strengthen it is good. Positive emotions boost two kinds of immune system cells: T cells and natural killer cells, large white blood cells that attack cancer cells and infected cells (Cohen, 1998). Immune function varies greatly, but people over 75 or 80 usually need longer to recover from a cold or from wounds, and their infections tend to be more serious than those of younger people.
Older adults can develop healing emotions. Practitioners can teach stress reduction techniques to encourage relaxation. They can also encourage older persons to develop a spiritual connection (if one does not already exist), and they can empower elders to be assertive and take control of their health. Practitioners can also encourage older adults to embrace the aging process, focus on their strengths and abilities, and give of themselves (talents, knowledge, experience) to others. A common way serenity is cultivated is gardening. Nurturing new growth is calming, and gardeners seem to thrive in old age. The ability to feel and express gratitude is an important part of healthy aging. In the lives of most people, there are at least a few things to be grateful for. Sometimes this is just a matter of mindfulness, for example, promoting thinking like “I’m grateful that it is a clear night and I can see the stars.” Gratitude does not depend on external circumstances, and it helps to counter the message from industrial societies that we need more of everything (Macy, 2007). Reverence is more abstract than gratitude or serenity. The hard breathing that accompanies strenuous exertion or exercise can induce feelings of reverence. This emotion acknowledges the life force greater than our individual spark. It may make us feel small or exalted. A group experience may evoke it, or it may be solitary. People who see the northern lights report feelings of reverence. This emotion may come from a flash of understanding that all things are interconnected. Looking over one’s life may inspire reverence for the sheer doggedness of humans who live to be old (Cruikshank, 2009).
Case Illustration 1.1 shows the natural physical changes that may accompany aging and the manner in which older persons can adapt to their environments with an adequate support system and stay actively engaged. The changes demonstrated include mobility issues, development of osteoporosis, decreased activities of daily living, loss of vision and hearing acuity, and digestive challenges.
Case Illustration 1.1
A 98-year-old elderly woman lives in her three-bedroom home with her adult daughter who is 75 years old. She drove until her early 80s, at which time she had an accident and was hospitalized. She ambulates with the assistance of a walker and an occasional arm to hold onto and is fearful of falling because of her recent diagnosis of osteoporosis. She attends church services regularly, watches television daily, and enjoys conversing with family and friends in her home and via telephone. Her daughter prepares her meals, washes her laundry, and manages her finances. She has one outside provider, a registered nurse, who comes to her home on a monthly basis and conducts a physical assessment. Overall, she is in good health and is thankful for every day she is alive. She doesn’t know if she will see age 99; however, she leaves it up to the “man upstairs.”
This individual is living in her home, has the assistance of a loving daughter, and is visited regularly by friends and neighbors. She is able to attend church (which is very important to her) and engage in a few activities that bring her joy. Despite her limited mobility and slowness in ambulating, she is overall very satisfied with life. She is able to live at home because she has an excellent support system. Though she has difficulty with her vision, she wears bifocal glasses to help her see; her hearing is impaired, but she wears a hearing aid, which enhances her ability to hear. Her biggest complaint is that of constipation, which is not uncommon due to the slowing of the digestive system and more sedentary lifestyle, along with decreased daily fluid intake.
Cognitive Changes That Accompany Aging
In general, cognitive changes are much more subtle than physical changes. Cognitive abilities peak in young adulthood (Ericsson, 2000). Losses in midlife occur primarily during peak performances; in other words, declines in developmental reserve capacity are apparent when performance is pushed to its limits (Lindenberger, Marsiske, & Baltes, 2000). Differences in cognitive developmental change can be seen when distinguishing between fluid and crystallized intelligence. Crystallized intelligence refers to general knowledge developed through a lifetime of experiences (accumulated knowledge) (Sternberg, Grigorenko, & Oh, 2001). In contrast, fluid intelligence refers to the “creative and flexible thinking” required to solve novel problems (e.g., anagrams, memory tests).
Generally, fluid intelligence declines with age, but crystallized intelligence remains stable or even increases (such as when one becomes specialized in a career, hobby, etc.) across the life span. It is important to distinguish between fluid intelligence pertaining to the solving of more practical problems versus more traditional (academic) problem-solving tasks. Performance on traditional problem-solving tasks peaks around the age of 20 and then declines, whereas performance on practical problem-solving tasks peaks in midlife, suggesting that it is at this time that individuals are best at practical problem solving (Sternberg et al., 2001).
Fluid cognition or fluid reasoning, the capacity to think logically and solve problems in novel situations, independent of acquired knowledge, has been shown to decline from midlife onward as a result of normal aging (Richards, Shipley, & Fuhrer, 2004; Singh-Manoux, Kivimaki, & Glymour, 2012), while cognitive decline of functional or clinical significances is generally not detected until much later in life, often as a result of significant neurologic morbidity such as cerebrovascular disease (Richards et al., 2004). Given that changes in cognitive and physical functioning probably result from interactions between aging and disease, their effects may not be fully distinguishable (Blumenthal, 2003). As people age, some individuals experience normal declines in physical and cognitive functioning that increase their risk of dependence on others and premature death (Cooper, Kuh, & Cooper, 2011; Cooper, Kuh, & Hardy, 2010; Dewey & Saz, 2001; Studenski, Perera, & Patel, 2011). There are, however, remarkable individual differences in rates of age-associated decline in the age at which these declines begin to accelerate.
In their related dual-processing model, Baltes and colleagues (1999) distinguish between the mechanics of intelligence that generally refer to processing abilities (information-processing strategies and problem-solving functions) independent of specific content and the pragmatics of intelligence that typically refer to knowledge about facts and procedures, including practical thinking, expertise, wisdom, and knowledge accumulated across the life span.
While the pragmatics of intelligence are expected to grow into adulthood and then remain stable into old age, there is abundant evidence of age-related decline in the mechanics of intelligence (Salthouse, 2003). This decline compromises individual capacities beginning in midlife only under conditions of multitasking and time pressure (Lindenberger et al., 2000). Thus, the implications of these declines for everyday functioning in midlife are constrained to time-sensitive multitasking in everyday behavior (e.g., talking on the phone while merging into freeway traffic) and select professions (e.g., air traffic controllers). Strategies that are part of the pragmatics of intelligence (e.g., sequence activities to avoid multitask overload) in midlife can compensate for the weaknesses in the mechanics of intelligence. Such strategies may become increasingly insufficient as cognitive decline progresses in advanced old age. Guided Practice Exercise 1.4 provides the opportunity to examine physiological changes and one’s personal adaptation to inevitable changes.
Guided
