Older Adulthood

Developmental Psychology

Developmental theorist Eric Erickson found that psychological growth and

development can occur throughout the life span. He identified eight life stages, each
with a specific psychosocial problem that, if successfully resolved, brings about
growth and the potential to master the next stage. The eighth and final life stage he
called maturity. At this juncture, a person comes to realize that his or her life cannot
be relived. Successful negotiation brings about ego integritya sense of peace with
life as it was lived. If integrity does not develop, the person experiences despair, and
regret about ones life dominates. There is fear that death will come before a
meaningful life can be experienced. Alternatively, a sense of integrity fosters wisdom.
Erickson viewed the wise elder as contributing to society and future generations
through interactions with younger people.
Compared to studies of intelligence, little research has been conducted on wisdom.
Difficulty in defining and measuring this construct is likely the reason. In many
situations, wisdom may be as valuable as intelligence, particularly in a rapidly
changing technological world that requires personal flexibility.
Knowledge is an aspect of wisdom and includes the ability to know the limits of ones
knowledge. Wisdom also involves knowing what problems need solving and what
problems can be let go. It includes the desire to evaluate things in depth. Those who
possess wisdom have a tolerance for ambiguity and for things that inevitably get in
the way. Further, those who are wise are motivated to understand and appreciate the
impact of the context that surrounds a situation.
Importance of relationships
Social contact is an essential human element that has direct effects on health and
emotional well-being. Relationships also act as potential buffers against stress.
Numerous studies have shown that stress negatively affects ones immune system.
This is of particular importance for the elderly because immune functioning tends to
diminish with age. New evidence is emerging that strong social relationships also
promote recovery from certain illnesses. A recent study of 180 elderly men showed
that those who experienced emotional support and companionship were at lower risk

for developing heart disease. Another investigation found subjects who had strong
relationships to be at lower risk of dying after a myocardial infarction than those who
lacked supportive relations. Death rates are higher among people who are socially
isolated. The sheer number of relationships is not the important factor, but the quality.
For example, the presence of a family member does not automatically imply a
meaningful relationship. Extensive research on gender differences suggests that the
nature of relationships differs for men and women. Women tend to have more intimate
connections. They benefit from having more positive feelings toward relationships.
However, women also tend to suffer more from relationships because investment in
others concerns can lead to increased conflict and stress. For this reason, relationships
for men sometimes can provide greater protection from stress.
Both fulfilling informal and formal human connections can be healthful. Formal
supports may include a member of the clergy, housekeeper, visiting nurse or
psychotherapist. Informal relations are family members and casual contacts, perhaps
the grocery store clerk. For some elderly, close neighbors are a crucial source of
informal support. Studies indicate that pets are a source of relational support. Elderly
pet owners have been shown to be less depressed, better able to tolerate social
isolation and be more active than those without pets.
Relationship loss is common in late adulthood. Parents are deceased, and siblings and
contemporaries begin to die. The opportunity for expression of sadness is critical for
emotional healing; however, depression is not a normal state for the elderly. Consider
Jane, who at 92 lives in a retirement home. She has no living siblings, has one
remaining son of three children and has outlived two husbands. Notwithstanding these
losses, she has a handful of meaningful friendships, is involved in her church and is
well-liked by the staff members.
Researchers who followed subjects from adolescence to old age in a large-scale
qualitative study of adult development discovered valuable information about
relationships and aging. Positive relationships at any age of the persons life were
found to correlate to satisfaction in old age. A satisfying marriage at age 50 predicted
positive aging at 80. Contentment in later life was the outcome for subjects who had
the ability to express gratitude and forgiveness in relationships. Overall, researchers
determined that loving relationships promote personal growth and emotional healing.
Successful aging also involves learning to play and be creative after retirement. This
ability to adapt to situational and physical changes helps explain why some people age
more successfully than others.
Cohort effects need to be taken into account in clinical situations as well as research
with the elderly. (Cohort refers to membership in a group as defined by a persons

birth year.) Much of the difference between young and older groups is due to cohort
effects. Cohort groups are socialized into certain beliefs, attitudes and abilities based
on the time in history in which they live. These factors remain stable as the cohort
ages. Twenty years from now, a cohort of elderly Americans will look different than
the current group because of different historical experiences. For instance, older
people 20 years from now will have more formal education than todays cohort of
elderly. The way health care providers interact with and conduct patient teaching will
need to be modified for each new cohort.
Sexuality in later life
Elderly couples may have inaccurate assumptions about aging and sex. Health care
providers can sensitively present factual information to patients about the effects of
aging, illness and medications on sexual functioning.
The likelihood of sexual activity during later life is related to how sexually active a
person was during his or her younger years. Given an available partner, a person who
was sexually active in younger years is likely to remain active into late adulthood.
Men who have been sexually active generally can engage in some sort of sexual
activity well into their 70s or 80s. About 90 percent of erectile problems are physical
rather than psychological. To have an erection, the man must be in a responsive state
of mind and have normal hormone functioning, including adequate testosterone levels
and penile blood supply. Possible impediments include hypertension, elevated
cholesterol, diabetes, coronary artery disease, smoking, alcohol abuse and medications
(especially those used to treat hypertension and depression). Surgeries such as a
radical prostatectomy also may cause erectile problems. Aging itself is not to blame.
Reports indicate that about 52 percent of men aged 40 to 70 have some degree of
erectile dysfunction. About one out of four men aged 65 to 80 have serious problems
achieving and sustaining erections. In the group of men older than 80, one out of two
have substantial erectile problems. Sildenafil citrate (Viagra) works for more than half
of men who use it. Perhaps due to humiliation, shame or the belief that there is no
help, few men seek medical attention for sexual problems.
As a man enters late adulthood, it is normal for erections to occur less frequently.
More stimulation is needed for arousal. The ability to have repeated ejaculations is
lessened, but once achieved, an erection lasts longer. Ejaculation also can be delayed.
Volume of semen remains the same, but sperm counts are lowered. This information
will help the man and his partner understand normal changes.

Physiologically, women are able to be sexually active as long as they live. A woman
who enjoyed sex in younger years is likely to want to continue. The problem often,
however, is the lack of a partner. In 1998, 46 percent of women older than 65 were
widowed while only 15 percent of men were. Women who had orgasms in their
younger years will likely be able to do so well into their 80s or later. Sex, however,
will be different later in life than it was during earlier periods. Orgasms tend to be
shorter, and muscle contractions are fewer in number. With age, women may take
longer to become sexually aroused. Decreased ovarian estrogen production following
menopause is likely to create vaginal dryness, leading to painful intercourse. Older
women may need information about use of lubricants to ameliorate this problem.
Some aging women feel self-conscious about their appearance. As a woman ages,
weight gain is common, as are changes in body shape due to redistribution of adipose
tissue around the abdominal area. Counseling can provide an opportunity for
discussion about feelings related to normal body changes and help a woman feel more
comfortable with and knowledgeable about her physical self. Non-intercourse avenues
of sexual expression can be encouraged between elder adults.
Sexual functioning in both sexes is likely to be enhanced by physical fitness. Partners
who are in good physical condition are more likely to enjoy sex. They possess the
energy requirements for intercourse. Pain, from conditions such as arthritis or back
ailments, also can make sex less desirable.
Cognitive changes
Cognition refers to the mental process by which knowledge is acquired. It involves
perception, reasoning, attention, memory and language. With age, some cognitive
abilities remain intact or may even improve while others slowly decline. Overall,
changes occur in a slow and gradual trajectory. Information on cognitive changes
presented here is based on studies of averages from groups of elderly people. There is
much variability among older people with regard to the degree of decline and specific
area of functioning. A particular elderly person may function similarly to someone
decade's younger.
Cognitive decline is believed to be related to functional and structural changes in the
brain. As one ages, the brain shrinks (atrophy). The number of neurons and the
number of dendrites on each cell decreases. Cellular demyelination also occurs. These
changes slow message transmission between cells. Dead nerve cells collect in brain
tissue, causing plaques and tangles. Additionally, a fatty brown pigment called
lipofusin accumulates in brain tissue. Despite this picture of a seemingly deteriorating
brain, the majority of cognitive ability is retained as we age.

Cognitive ability is commonly divided into two general areas, verbal and
performance. Performance skills involve manipulation of objects. They tend to decline
at a more rapid rate than verbal skills. Verbal abilities deal with language and remain
relatively intact with age.
The speed at which a person processes information gradually slows over the life span.
Comprehension and production of speech becomes slightly slower over time. In some
cases, diminished visual acuity and decreased auditory sensitivity may account for
slowed processing.
On tests that require complex functions, the elderly do not do as well as younger
people. The elderly perform better when they are dealing with familiar tasks as
compared to new ones. When their ability is measured in everyday tasks, the elderly
do better than in the laboratory. In some cases, older adults outperform younger adults
when assessed in terms of everyday, real-world functioning.
Generally, attentional abilities decline with advancing age. Attention involves the
complex mental processes of focusing, selecting, dividing, sustaining and inhibiting.
Driving a motor vehicle is a task requiring complex attention. Divided attention is
required to drive the vehicle, monitor the dashboard, look at the road and road signs
and be aware of changes in engine sounds. Intersections can be particularly taxing on
attentional abilities. Older adults show decreased ability when attentional tasks are
complex, in other words, when attention is required to more than one source of
information (e.g., driving). However, they continue to do well on simple tasks
requiring attention.
Memory types
Memory is the ability to register, retain and recall a wide range of information such as
thoughts, sensations, experiences and knowledge. Some aspects of memory remain
relatively intact with age while others decline.
Short-term memory consists of two components called primary and working memory.
Primary memory involves holding small amounts of information for a short amount of
time, such as remembering a new phone number long enough to write it down.
Primary memory remains relatively intact with age. By contrast, working memory,
which requires briefly holding and manipulating information, declines. For instance,
this ability is required to repeat digits in reverse (e.g., 4, 9, 7 backwards is 7, 9, 4).
Semantic memory is knowledge of facts and meanings of words. This type of memory
does not require a reference to time. Generally, decline in semantic memory is
negligible.

The type of memory that deals with remembering how to perform a motor skill such
as riding a bicycle is called procedural memory. Overall, decline in this area is
minimal.
Long-term, or episodic, memory is a unique form of recall because it deals with
acquiring and retrieving information from a particular place at a certain time.
Remembering what you had for breakfast today or what you did on your 21st birthday
are examples of episodic memory. Episodic memory peaks in young adulthood, so it
is not uncommon for the elderly to remember information from that period of their
lives. Long-term memory declines slowly over time.
Memory problems associated with aging are likely due to difficulty with both
encoding (registering the message into memory) and retrieval. Older adults are
generally less precise in encoding new information, and retrieval is slowed. Overall,
cognitive decline in the elderly is subtle and more evident in laboratory tests, in which
the limits are tested beyond what is typically required for everyday functioning.
Humans are remarkable in their ability to adapt and compensate for deficits. Further,
evidence shows that cognitive training can conserve and improve memory,
concentration and problem solving. In the largest study of its kind, independent adults
aged 65 to 94 who had no cognitive problems received training for two hours a week
for five weeks on tasks related to everyday living. The intervention resulted in
improvement in memory, concentration and problem-solving skills. These findings
hold the promise that training applied to specific tasks such as using medication and
managing finances may benefit older adults.
Gradual physical and cognitive decline is inevitable with age. The health care
provider must keep this in mind in order to accurately assess and identify problems in
each individual. Likewise, each elderly patient also must be assessed for strengths
that, when tapped, can promote health, satisfaction and happiness in later years.

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