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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.

References

Maddox, G.L. (2001). The Encyclopedia of Aging (3rd ed.). New York: Springer Publishing Co.

Butler, R. & Lewis, M. (2002). The New Love and Sex After 60. New York: Ballantine Books.

Erickson, E.H. (1982). The Life Cycle Completed: A Review. New York: Norton.

Sternberg, R.J., & Lubatt, T.I. (2001). “Wisdom and creativity.” Birren J. & Schaie, W. (Eds.). Handbook of the Psychology of Aging (5th ed.). New York: Academic Press.

Raina, P., et al. (1999). “Influence of companion animals on the physical and psychological health of older people: an analysis of a one-year longitudinal study.” Journal of Geriatric Society, 47(3), 323-329.

Antonucci, T. (2001). “Social relations.” In Birren, J., & Schaie, W. (Eds.). Handbook of the Psychology of Aging (5th ed.). New York: Academic Press.

Sorkin, D., & Rook, K.S. (2002). “Loneliness, lack of emotional support, lack of companionship, and the likelihood of having a heart condition in an elderly sample.” Annals of Behavioral Medicine, 24(4)

Vaillant, G. (2002). Aging Well. New York: Little, Brown and Co.

Knight, B.G. (1996). Psychotherapy with Older Adults (2nd ed.). Thousand Oaks, Calif.: Sage Publications.

Calandra, J., & Peterson, R. (Sept. 24, 2001). “Midlife sexuality: Understanding the social, biological and emotional factors for women.” NurseWeek,

Rogers, W. A., & Fisk, A.D. (2001). “Understanding the role of attention in cognitive aging research.” In Birren, J., & Schaie W. (Eds.). Handbook of the Psychology of Aging (5th ed.) (pp. 267-277). New York: Academic Press.

Backman, L., Small, B.J., & Wahlin, A. (2001). “Aging and memory.” In Birren, J., & Schaie, W. (Eds.). Handbook of the Psychology of Aging (5th ed.) New York: Academic Press.

Ball, K., et al. (2002). “Effects of cognitive training interventions with older adults.” Journal of the American Medical Association.


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