Lecture 14:Ageing- Dr.Naif Al-Mutawa

AGEING

• Ageing is a popular, general term that describes advancing through the life cycle, beginning at birth and ending at death. Scientifically, however ageing is the process of gradual decline that occurs beginning in middle adulthood and continuing to death. As a result, many gerontologists prefer the more descriptive term senescence.

• Senescence has been defined as a decrease in viability and an increase in vulnerability. Senescence shows itself as a probability of death with increasing chronological age: the study of senescence is the study of the group of processes, different in different organisms, which lead to this increase in vulnerability.

• It is crucial to differentiate between chronological and biological age. Chronological age refers to a measurement, expressed in temporal terms such as months and years, of the time that has passed since the birth of the organism. Determination of accurate chronological age depends on accurate determination of the time of the individual’s birth, usually recorded on a birth certificate. It can be difficult to ascertain correct chronological age if an individual’s time of birth was not recorded. Determination of accurate chronological age in humans is therefore more difficult than for certain plants and animals that have markings or other signs of chronological age.

• Definitions of Ageing

• Most of us are used to defining age as simply the number of years, months, or days that an individual has lived. It is becoming increasingly clear, however, that we do not all age at the same rate, that definitions of ageing that focus exclusively on calendar time are incomplete, and that more complex definitions of both “age” and “ageing” are needed if we are to understand the intricacies associated with human ageing.

• Chronological Age• Chronological age refers to the length of time a person has lived. It is usually expressed by the number of years or months since birth, and its

measurement is independent of physiological, psychological, and socio cultural factors.• Many gerontologists believe that in order to increase our understanding of individual differences in the ageing process, it is necessary to

supplement chronological age with other measures of ageing that are designed to differentiate among persons of the same chronological age.

• Biological Age• Analysis, biological age focuses on senescent changes in biological or physiological processes. A wide variety of different approaches have been

adopted for the quantification of biological age.

• For example, an individual who is ageing successfully may have a biological age that is substantially younger than his or her chronological age, whereas a person who is suffering from multiple medical complications in old age may be found to have a biological age somewhat in excess of his or her chronological age.

• Psychological Age

• Psychological age refers to an individual’s capabilities along a number of dimensions of mental or cognitive functioning, including self-esteem and self-efficacy, as well as learning, memory, and perception.

• It is now recognized that it may be possible for persons of the same chronological ages to have different psychological ages.

• Social Age

• Social age refers to the notion that society often develops fairly rigid expectations with regard to what is considered to be appropriate behavior for a person of a particular age. As a result of these societal norms, we are sometimes uncomfortable when we encounter individuals who are behaving in a manner considered unorthodox or inappropriate for their chronological age. In these instances, we sometimes wish that they would “act their age”. Although socialization and the development of “age appropriate behavior” patterns is a complex topic, it is apparent that social roles and expectations can play an important role in the lifestyle choices of older persons.

• Individual Differences and Ageing

• Although structural decay and associated functional decline are an inevitable consequence of ageing, there are often considerable differences among individuals with respect to both the rate and extent of this decline. Numerous studies have shown that it is possible for individuals to deviate from expected patterns of ageing and, at least for some period of time, to postpone the consequences of ageing.

• Lifestyle Interventions and Ageing

• The extent to which intrinsic ageing processes may be subject to modification by lifestyle interventions. It has been known for centuries that hereditary factors play an important role in determining longevity. Gerontologists sometimes joke that the best thing to do to ensure longevity and successful ageing is to choose your parents wisely!

Define Fluid and Crystallized intelligence.

• In psychology, Fluid and Crystallized Intelligence (abbreviated gF and gC, respectively) are factors of general intelligence originally identified by Raymond Cattell.

• Fluid Intelligence is the ability to find meaning in confusion and solve new problems. It is the ability to draw inferences and

understand the relationships of various concepts, independent of acquired knowledge. Cattell defined fluid intelligence as "…the ability to perceive relationships independent of previous specific practice or instruction concerning those relationships." Examples of the use of fluid intelligence include solving puzzles and coming up with problem solving strategies. "Fluid intelligence is tied to biology. It is defined as our "on-the-spot reasoning ability, a skill not basically dependant on our experience.”

• Fluid Intelligence is: “a natural ability which is not dependant on acquired knowledge”

• Crystallized Intelligence Crystallized intelligence is the ability to use skills, knowledge, and experience. It should not be equated with memory or knowledge, but it does rely on accessing information from long-term memory. Situations that require crystallized intelligence include reading comprehension and vocabulary exams. This type of intelligence is based upon facts and rooted in experiences. This type of intelligence becomes stronger as we age and accumulate new knowledge and understanding.

• "Crystallized intelligence can be defined as "the extent to which a person has absorbed the content of culture.” It is the store of knowledge or information that a given society has accumulated over time.” or Crystallized Intelligence is: “ability dependent on acquired knowledge”

• Fluid and crystallized intelligence are correlated with each other, and most IQ tests attempt to measure both varieties. For example, the Wechsler Adult Intelligence Scale (WAIS) measures fluid intelligence on the performance scale and crystallized intelligence on the verbal scale. The overall IQ score is based on a combination of these two scales.

• Fluid intelligence includes such abilities as problem-solving, learning, and pattern recognition. As evidence for its continuity, Cattell suggests that gF abilities are rarely affected by brain injuries.

• Crystallized intelligence is possibly more amenable to change as it relies on specific, acquired knowledge. For example, a child who has just learned how to recite the member states of the GCC now owns a new piece of crystallized intelligence; but his or her general ability to learn and understand gF has not been altered.

• People with a high capacity of gF tend to acquire more gC knowledge and at faster rates. This is sometimes called investment. Researchers have found that criminals have disproportionately low levels of crystallized intelligence.

• Crystallized intelligence is measured by most of the verbal subtests of the Wechsler Adult Intelligence Scale (WAIS).

• Crystallized intelligence is important to psychologists as it relates to the study of aging. There is ongoing intense debate among psychologists as to whether or not intelligence declines with aging. Horn) hypothesized that because crystallized intelligence is based on learning and experience, it remains relatively stable over time. He claims it may even increase "as the rate at which we acquire or learn new information in the course of living balances out or exceeds the rate at which we forget.” On the other side of the debate, Belsky claims crystallized intelligence in fact declines with age. Why? Because, "at a certain time of life the cumulative effect of losses - of job, of health, of relationships - cause disengagement from the culture, and so forgetting finally exceeds the rate at which knowledge is acquired.”

• Fluid intelligence generally correlates with measures of abstract reasoning and puzzle solving. Crystallized

intelligence correlates with abilities that depend on knowledge and experience, such as vocabulary, general information, and analogies.

Development and Physiology

• Fluid intelligence, like reaction time, peaks in young adulthood and then steadily declines. This decline may be related to local atrophy of the brain in the right cerebellum. Other researchers have suggested that a lack of practice, along with age-related changes in the brain may contribute to the decline. Crystallized intelligence increases gradually, stays relatively stable across most of adulthood, and then begins to decline after age 65.

• While many people claim that their intelligence seems to decline as they age, research suggests that while fluid intelligence begins to decrease after adolescence, crystallized intelligence continues to increase throughout adulthood.

Understanding of age differences and age changes in intelligence including gender, cultural, and cohort-based findings.

• One of the earliest arguments concerning age changes in psychometric intelligence was that age changes in the speed of behavior limited intelligence test performance of older adults. According to this perspective, speed of processing acts as a confounded methodological factor that inflates estimated age differences in test performance. Essentially, this hypothesis states that speed relations to intellectual abilities are performance-specific rather than construct-relevant. That is, the relationship of processing speed to test performance produces systematic measurement errors that inflate age differences and reduce the construct validity of the test, perhaps differentially so for older adults. Hertzog (1989) found that the Primary Mental Abilities (PMA) Verbal Meaning test yielded larger age differences than other vocabulary tests and that these differences between tests were eliminated when partialling for processing speed (see also Salthouse, 1988). This pattern was interpreted as a performance-specific speed effect on the test that was independent of age differences in verbal ability, conceptualized as the amount of accessible knowledge about word meanings in the lexicon.

• Age Differences• Performance on a variety of tasks declines with age, especially after age 60 or so. The main point to make at this stage is

that scores on intelligence tests often decline with age, but the extent of decline depends on the nature of the test. The tests that show the strongest declines are those which tap the basic cognitive processes thought to contribute to intelligence, such as reasoning and working memory. Psychometric tests of this kind are sometimes referred to as fluid intelligence. Other tests are more dependent on learned intellectual skills (crystallized intelligence) such as mechanical knowledge, and having a good vocabulary and verbal comprehension abilities.

• Older adults frequently possess ample learned cognitive skills to compensate for any loss of fluid intelligence.• Depending on the task, there are genuine age difference in some aspects of intelligence test performance. How can these

be explained? Although older people may have some difficulties in handling laboratory environments, for example in dealing with time pressure, their fluid intelligence deficit is primarily one of competence in processing. Studies using information-processing tasks suggest that ageing is associated with loss of working memory, attentional impairment and slowing of elementary processing speed. Furthermore, loss of central nervous system efficiency undoubtedly explains these effects to a large extent.

• The relationship between loss of intelligence and degradation of processing functions remains somewhat unclear. Nettlebeck and Rabbitt showed that age differences in intelligence test performance were closely related to age differences in a measure of basic processing speed derived from simple tasks: controlling for “mental speed” eliminated the age difference on IQ measures, and some, but not all, cognitive tasks. They conclude that loss of fluid intelligence reflects loss of information-processing speed. Stankov offers a somewhat different perspective. As discussed, complex tasks are more age-sensitive than simple tasks, so it is possible that age difference in fluid intelligence are a consequence of the complexity of the tests.

• Biological factors implicated in sex differences include levels of sex hormones such as oestrogens and testosterone, which may influence both brain development in the foetus and adult brain function . Cerebral lateralization and other neuro-anatomical differences have also been identified), although there is currently no detailed account of how sex differences in neural functioning translate into sex differences in information processing. There is also increasing interest in evolutionary explanations for sex differences: male advantages may contribute to better hunting performance, whereas female advantages assist with foraging and social bonding .

• Age, Gender, and Education May Have Little Influence on Error Patterns in the Assessment of Set-shifting and Rule Induction Among Normal Elderly

• In addition to type of task, verbal or nonverbal, gender differences have been reported on cognitive measures (Kaufman; Kaufman; Kaufman and Reynolds). Research has consistently found that adult males outperform adult females on more global verbal and nonverbal cognitive measures, such as the WAIS-R Verbal and Performance IQ scales

• Gender differences have also been noted on numerous individual cognitive tasks, such as the Coding and Digit Symbol subtests of the Wechsler scales, where females have been reported to outperform males (Kaufman and Reynolds). These findings indicate relationships between age or gender and type of task, verbal or nonverbal, do exist and may have some bearing on the relationship between aging and error patterns on measures of set-shifting and rule induction.

• Another variable that may account for the differential outcomes in measures of set-shifting and rule induction among the elderly is education. In samples or subsamples composed of elderly individuals, older cohorts frequently have received less formal education than their younger cohorts. Thus, differences in education, age, or the relationship between education and age may account for differences in test score or error pattern performance. For example, education has been demonstrated to be associated with age on verbal cognitive measures, such as the WAIS-R Verbal IQ scale. It has been found when educational attainment levels were held constant (weighting for education) on the WAIS-R standardization sample of 1,480 adults, ranging in age from 20 to 74 years, the decline in Verbal IQ from age to age disappeared. However, declines across the 20- to 74-year range remained for the Performance IQ and Full Scale IQ, even after controlling for education, although these declines were not as substantial as they were before the education variable was held constant. According to Uchiyama et al. (1994), when groups evidence significant differences, the educational variable should be controlled. Few studies have examined the relationship between education and error pattern performance on measures of set-shifting and rule induction among the elderly, and even fewer studies have held the educational variable constant when groups evidence significant differences.

• Education, gender, and age have been shown to influence test performance by adults on verbal and nonverbal cognitive measures, such as the WAIS-R Verbal and Performance IQ scales.

Understand neurological changes that occur with ageing and consequences of such changes in the cognitive functions of the affected person

• Neurological Changes

• Many people believe that as individuals age, cognitive impairment is inevitable. While there are changes in the neurological system as people age, these changes do not result in cognitive impairment. Chronic cognitive impairment is a pathological change of aging resulting from dementia.

• Some of the normal changes of aging that occur include a reduction in total brain weight. There has been a documented shift in the proportion of gray matter to white matter, and there was a total loss of neurons and an increase in the number of senile plaques seen in the brain of older adults upon autopsy. Older adults also experience a decrease in blood flow to the cerebrum. The way these anatomical changes in the brain translate into human behavior has great variability. Some older adults are often thought of as “forgetful” and “slow”.

• The most appropriate interventions to prevent the effects of normal aging on cognitive functioning and reducing the risk for the development of dementia are to maintain an active mind and body. Older adults should be encouraged to participate in cognitive activities such as work, games or a course of study.

• It is estimated that up to one third of adults will experience a gradual decline in cognitive function known as mild cognitive impairment as they age. Less severe than dementia, mild cognitive impairment is defined as cognitive defects that do not interfere with daily living. It may include slower thinking, a reduced ability to learn, and impaired memory. While many conventional physicians view these defects as an inevitable consequence of aging, newer research has uncovered possible reasons for mild cognitive impairment and has also identified potential therapies that may enable people to battle age-related mental decline more effectively than ever before. Minimizing cognitive defects will become even more important as the average life span continues to lengthen and hundreds of thousands of people head into their 80s and 90s, when the risk for cognitive decline is greatest.

• Researchers have discovered multiple factors that influence our ability to think and remember as we age. These include well-known culprits such as alcohol abuse, and also newly discovered causes of mental decline, including chronic inflammation, vascular diseases, and even stress.

• Physical changes that occur in the aging brain are also implicated in mild cognitive impairment. For example, the number of nerve impulses and nerve cells decreases with age. Also, levels of neurotransmitters such as serotonin and acetylcholine, a primary transmitter for learning and memory, decrease. This loss of acetylcholine was noticed three decades ago, giving rise to a theory that coupled the loss of acetylcholine with cognitive decline. Once acetylcholine had been identified as a possible target for improving brain function, researchers began looking for ways to boost acetylcholine levels.

• Blood flow to the brain is also an important factor in brain health. Blood delivers the oxygen and nutrients necessary for normal functioning. Unfortunately, even during normal aging, blood flow to the brain may decrease by an average of 20 percent. The decreased blood flow that results from aging and associated diseases can cause nerve cells in the brain to be lost prematurely. This loss may contribute to the decline of cognitive function .

• Neurological changes result from both the aging process and common age-associated neurological disease.

• There are reports of deterioration in vision, hearing, taste, and smell.

• Vibratory sensation, proprioception, and touch have also been shown to decline. Muscle strength is said to decrease, especially in hand grip and leg extension . Tone increases in the lower extremities more often than in the upper extremities . There is a tendency toward unsteadiness of gait, with stooped posture, slowness of movement, decreased arm swing, and short step.

• Deep tendon reflexes decline, especially in the lower extremities

• Of the neurological changes described in apparently normal elderly, only a few seem to have a significant impact on function. Those changes that do affect function relate primarily to motor slowness, difficulty with cognitive complexity, and visual and auditory systems alterations. Driving at night becomes problematical because of poor night vision, dark adaptation, and difficulty with glare from oncoming head lights. Hearing loss is also independently associated with decreased mobility, although the reasons for this relation remain undetermined.

• Sleep patterns change in the elderly, although the functional implications are unclear. Autonomic function is altered, perhaps contributing to the increasing incidence of orthostatic hypotension. The subtle bowel and bladder changes that occur in normal individuals do not lead to functional decline.

• Neurological disorders appear to account for most disabilities in the elderly. Increases in the occurrence of medical disorders, use of medications, and the consequent complications contribute to further functional decline. Many age-associated neurological conditions can dramatically impair function, including Alzheimer’s disease, Parkinson’s disease, and stroke.

• As our brains age, we're less likely to think as quickly as we used to or remember things as well. But the knowledge we gain from life experience can sometimes compensate for other changes in our brains as we age. Older professionals, for example, are often better at their jobs than younger ones. Research is now revealing how the brain changes and adapts as we age. These insights are shedding light on real-life challenges, like how to remember things and how to avoid scams. Dr. Denise C. Park, director of the Royal Center for Healthy Minds at the University of Illinois, explains that knowledge and experience are protected as you age. "When you're performing a complex task," she says, "your memory may be less efficient, but your knowledge about how to do it may be better." In most real-world experiences, older people already have previous knowledge that they can use to interpret new situations and decide how to respond.

It's a fact of life that age slows mental processing as well as working memory, the everyday recall we take for granted when we make coffee, set down our keys, or go shopping. Often aggravated by impaired sight and hearing, elders respond more slowly to an external stimulus, be it a question, a loud noise, or a funny joke. Older brains take longer to learn new things as well. And recent studies show that for the same task, thinking pathways differ. Functional MRI and other brain imaging, which can map activity during problem solving, indicate that elders use more and often different regions of their brain, giving credence to a common parental lament—the young just think differently.

• Know also that there's more to the ageing mind than its decline. Some cognitive functions—like vocabulary and arithmetic abilities—tend to hold steady. So does well-practiced expertise like playing chess or the piano. In two areas, elders are distinctly better than younger people. With age, temperament mellows and emotions even out. Older folk generally pay more attention to their own and others' emotional well-being. Perhaps that's because wisdom grows with age and experience. Yes. When it comes to wisdom, seniors excel, consistently scoring higher than younger adults on tests of life choices, handling conflict and ambiguity, and setting priorities.

• The gradual and extended loss of one’s mental powers brings different dilemmas, frustrations, and miseries, both for the suffering person and for his or her caregivers. With a disease like Alzheimer’s, some people suffer at first by knowing what is coming—by seeing one’s mental powers decline, one’s memory erode, one’s grasp of one’s surroundings becoming hazy. Eventually, this self-awareness of decline fades into the loss of self-awareness entirely—including the inability to understand how to behave appropriately, the incapacity to recognize loved ones, and the confusion that comes with not remembering life from one minute to the next or the paranoia that comes from not understanding what others are doing and why. Eventually, with Alzheimer’s and other senile dementias, this cognitive disability becomes so severe that it leads to physical disability—the inability to speak, to control one’s bowels, to eat and drink. Eventually, as the mind shuts down completely, so too does the body.

• The combination of physical debility and cognitive health can bring a host of personal frustrations: the powerful desire to do something for oneself or another, even the simplest thing, but not being able to do it; the inability to control one’s bowels, with enough awareness to be embarrassed by it; the heartache of watching loved ones sacrifice so much on one’s behalf, when all one wants is for them to flourish themselves. Yet the gift of self-awareness until the end is also great. The ageing individual with a healthy mind and sick body can still savor some of life’s greatest joys—experiential, interpersonal, and intellectual. He might still be able to read his favorite books, listen to his favorite music, see a grandchild off to the prom, and thank a devoted family caregiver. But the grave imbalance of physical and mental powers also often brings its own special misery—including the feeling of being trapped inside a body that does not respond to one’s desires, needs, and efforts at control.

• Disorders of gait increase the risk of falls, hip fractures, and death. The usual culprits are drugs and musculoskeletal, visual, and neurological disorders.

• Dizziness is a common complaint that is often associated with sensory dysfunction, depression, and cardiovascular diseases, which are commonly associated with institutionalization and death.

• Urinary incontinence can be caused by local factors (e.g., urinary tract infections, urethral incompetence, or fecal impaction), systemic influences (e.g., diabetes or medications), and restricted access to bathroom facilities (e.g., due to ambulation difficulties or physical restraints).

• Delirium is associated with high morbidity and mortality and often presents major management challenges.

• http://www.ted.com/talks/lang/en/gregory_petsko_on_the_coming_neurological_epidemic.html

WomenWomen are normally in the majority in later life. Since in most cultures women marry men older than themselves and men die earlier, a rise in older women means an increase in the number of widows. Numbers can be very high, for example in India 70 per cent of women over 65 were widows in 1980. High rates of widowhood in countries where the status of women is slow, represent high levels of poverty and disadvantage. As birth-rates fall, the number of older women without children is also set to increase and the number of older men with no children, or who have lost contact with their children, seems likely to rise even faster as a consequence of divorce

Life Expectancy• It is sometimes thought that when life expectancy at birth was low, there were no old people. For example, if life

expectancy was 40, it might erroneously be assumed that nearly everyone would be dead by 40, grandparenthood would be a short-term activity and the problems and contributions of the old would be minimal. However, life expectancy is heavily influenced by infant mortality.

• Even though life expectancies have increased and infant mortality has fallen, it is worth nothing, in the midst of doom and gloom about population ageing, that the total world population remains young. For example, if current predictions are right, by 2025 the numbers of people over 60 are expected to amount to 14 per cent of the total world population. This projection depends on a falling birth-rate. Birth rates have fallen consistently as women became more educated and prosperity increased. The median age (the age at which half the world’s population are older and half younger) will move from 23.4 in 1950 to 31.1 in 2025 (United Nations, 1991:11)

• Some signs of ageing are obvious. As a rule we tend not to look favorably on the gray hair, the wrinkles, and the other changes that tell us we are growing older.

How long will we live?• How long we live depends on both intrinsic and extrinsic factors. Intrinsic factors are genetically programmed

processes that are responsible for determining the maximum possible life span. Extrinsic, or environmental, factors encompass forces such as diseases or toxic chemicals that modify the intrinsic factors and shorten one’s longevity, sometimes drastically. To understand intrinsic and extrinsic factors, though, we need to define longevity.

• Longevity refers to the duration of an individual’s life. It is expressed by two different concepts, average longevity and maximum longevity. Average longevity is commonly called “average life expectancy”. It refers to the age at which half of the individuals who are born in a particular year will have died.

• These increases in average longevity are due mostly to declines in infant mortality rates through the elimination of diseases such as smallpox and polio and through better long-term health care.

• Attempts have been made to predict the maximum longevity of different species, including humans, by considering important biological functions such as metabolic rate or relative brain size.

• Evidence from research on twins also points towards the importance of genetics in determining longevity. Kallmann (1957) showed that even when identical twins lived in different environment, they died, on average, within about 3 years of each other, whereas fraternal twins died on the average of about 6 years apart. Radical differences in longevity have also been noted. These differences are related mainly to socioeconomic factors-principally, lower access to quality health care-and not to genetic factors.

Extrinsic Factors in Longevity• These include diseases, smoking, exercise and nutrition, as well as social class. The impacts of the first four factors

are fairly well known. The impact of social class is reflected by the reduced access to goods and services especially medical care that characterizes most minority groups, the poor, and many of the elderly.

Socioeconomic status and ageing

•It is well known that poverty is a major determinant of disability and mortality in older persons. Socioeconomic status of older persons is positively associated with favorable health outcomes as found in a survey. The relatively more affluent persons among the elderly enjoy a much superior quality of life than the relatively poor in Kerala, India. In Taiwan, higher educational attainment level was associated with a decreased incidence of functional limitation and played a substantial role in primary prevention of morbidity. Several studies have reported that people with higher education enjoy better health and longer life. Although it is well known that most risk factors are more common among individuals with a lower level of education, the underlying mechanism is not fully understood.

•Older persons residing in lower social class families in an area of Egypt received a lower degree of regular physician visits, foot care, and had poorer personal hygiene.

Gender and ageing

•By 1995-2000 the female advantage in life expectancy at birth had grown to almost eight years in more developed regions and three years in less developed regions. At older ages women are less likely to be married and more likely to be widowed. On a global basis, 79% of older men are married compared with only 43% of older women.

Psychosocial health, Disability and ageing

•Ageing of the world population is expected to bring about a dramatic change in disease patterns. There will be increasing rates of cancer, liver cirrhosis, kidney failure, osteoarthritis, mental illness and chronic degenerative illness. The number of people with diabetes in developing countries is projected to almost triple by the year 2025.

Ageing in Kuwait•Kuwait has one of the lowest crude death rates (2.8/1000) in the world while life expectancy for females and males is 77 years and 75 years, respectively. As the population ages and larger numbers survive for a longer duration, it is important to ensure that the physical and psychological health of the ageing population remains reasonably good. That is, the goal of health care providers and planners should be to minimize avoidable morbidity to the extent possible and ensure that the burden of disease and ill health among the older population is managed efficiently.

•The results below are from a project designed to assess the psychosocial health, physical health, and disability among Kuwaitis aged 50 years or older and relate these to the degree of social support available to them.

Results

•Among all respondents, only about 3% said they consider their memory to be excellent while 13% consider it to be very good. Almost two-thirds of the respondents said that they had poor appetite or restless sleep, and half said that they felt unhappy at least some time during the previous 7 days. However, a linear positive gradient by age was still present, and the difference was particularly large between those aged less than 70 and the ones aged 70 or more. About 22% said they did not enjoy doing anything during the last 7 days.

•At each age, women had a higher mean level of depressive symptoms than men. Bedouins reported a higher mean score than non-Bedouin. A marked inverse association between mean depressive symptom score and educational level was present. Also, the mean score was particularly high among those with multiple chronic illnesses (13.3) and ones who considered their health to be poor (13.8). Finally, those who did not have any children living with them had a markedly higher mean score than those who had several children living with them.

•When asked about their level of health at the time of survey, only 2.2% said that it was excellent and another 10.3% said that it was very good. The majority (44.3%) said that it was good. A linear, positive gradient by age was observed for joint pain as well as back pain. Prevalence of chest pain was reported by about 41% and diarrhea by about 36% respondents.

•Chronic illnesses (diabetes, hypertension and heart disease) among men as well as women were found to be highly prevalent and increased with age. 50.6% reported that they had been diagnosed as diabetic, 53.4% as hypertensive and 17.5% to have heart disease. Among those aged 50-59, about 18% suffered from at least two chronic illnesses compared with 35% among those aged 60-69 and 42% among those aged 70+. The percentage suffering from all three diseases increased from about 4% among those aged 50-59 to 9% among those aged 60-69 and 21% among those aged 70+.

•Regarding functional ability, about one-third of those aged 70+ reported that they had a lot of difficulty in squatting, walking, climbing stairs, or lifting heavy items. 

Explain the extent to which age related change in cognitive performance may be improved by education and training during middle and later years

• News reports• May 2008• Active social life may delay memory loss among older adults• Data gathered from 1998 to 2004 from the very large U.S. Health and Retirement Study has supported previous research suggesting that social activity is associated with slower

cognitive decline. Indeed, memory decline among those with the highest social integration was less than half the rate among the least integrated. Social integration was assessed by marital status, volunteer activity, and frequency of contact with children, parents, and neighbors. The findings were independent of sociodemographic factors (such as age, gender, and race) and health status in 1998. The researchers found that the protective effect of social integration was largest among individuals with fewer than 12 years of education. There was no evidence that a poor or declining memory caused social withdrawal.

• The study appeared online May 29 ahead of the July issue of the American Journal of Public Health. Full reference• http://www.eurekalert.org/pub_releases/2008-05/hsop-asl052708.php• Incidentally, another study that appeared in the same issue found that larger social networks were associated with a lower risk of dementia in women aged 78 and older. The study

examined 2249 members of a health maintenance organization who were free of dementia at the start of the study. 268 (12%) of these were identified as having dementia four years later. Full reference

• Older adults with more schooling spend fewer years with cognitive loss• A seven-year study involving over 7,000 people 70 years and older has found that a 70-year old person with at least 12 years of education can expect to live 14.1 more years without

cognitive impairment, which is two-and-a-half years more than 70-year olds with fewer than 12 years of education. They can then expect to spend 1 year with impairment, which is about 7 months less than a person with fewer years of education. The impairment is also likely to be more severe for the more educated, and associated with worse health. This is consistent with the idea of cognitive reserve — that education provides a “buffer” that enables people to continue functioning well despite physical damage in the brain. However, when the damage finally can no longer be compensated for, the effects will be greater. But it shouldn’t be assumed that it is all downhill from there — even the severely impaired may recover, depending on the cause. Overall, about 11% of the mentally impaired recover, presumably because the decline is caused by a treatable condition.

• The study appeared in the June issue of the Journal of Aging and Health. Full reference• http://www.eurekalert.org/pub_releases/2008-05/uosc-mlo051208.php• • October 2007• 10 minutes of talking has a mental payoff• A study of 3,610 people aged 24—96 examined mental functioning and social interaction, and found that, across all ages, cognitive functioning was better the higher the level of

participants' social interaction. Participants' level of social interactions was assessed by asking how often each week they talked on the phone with friends, neighbors and relatives, and how often they got together. Researchers controlled for age, education, race/ethnicity, gender, marital status and income, physical health and depression. In a second experiment involving college students, short-term social interaction lasting for just 10 minutes boosted participants' intellectual performance as much as engaging in so-called 'intellectual' activities for the same amount of time.

• The study will be published in the February 2008 issue of the Personality and Social Psychology Bulletin.• http://www.eurekalert.org/pub_releases/2007-10/uom-tmo102907.php• •

• August 2007• Age differences in cognitive benefits of exercise and mental stimulation• A mouse study has found that while physical exercise (a running wheel) and mental stimulation (toys), singly and together, improved memory in old mice, exercise alone or exercise and

stimulation improved memory in middle-aged mice but not stimulation alone, and only exercise alone benefited young mice. The results suggest that as we get old and maybe less able to exercise, cognitive stimulation can help to compensate, but exercise is central to memory reinforcement at all ages.

• The report appeared in the August issue of Behavioral Neuroscience. • Full text available at http://www.apa.org/journals/releases/bne1214679.pdf• http://www.eurekalert.org/pub_releases/2007-08/apa-eam080107.php• • June 2006• Alzheimer's pathology related to episodic memory loss in those without dementia• A study of 134 participants from the Religious Orders Study or the Memory and Aging Project has found that, although they didn't have cognitive impairment at the time of their death, more than

a third of the participants (50) met criteria for a pathologic diagnosis of Alzheimer's disease. This group also scored significantly lower on tests for episodic memory, such as recalling stories and word lists. The results provide further support for the idea that a ‘cognitive reserve’ can allow people to tolerate a significant amount of Alzheimer's pathology without manifesting obvious dementia. It also raises the question whether we should accept any minor episodic memory loss in older adults as 'normal'.

• The study was published in the June 27 issue of Neurology. • http://www.eurekalert.org/pub_releases/2006-06/aaon-apr062006.htm• • May 2006• Simple Lifestyle Changes May Improve Cognitive Function• A study involving 17 people (35–69 years) with mild self-reported memory complaints but normal baseline memory performance scores, has found that 2 weeks on a program combining a brain

healthy diet plan (5 small meals a day; diet rich in omega-3 fats, antioxidants and low-glycemic carbohydrates like whole grains), relaxation exercises, cardiovascular conditioning (daily walks), and mental exercise (such as crosswords and brain teasers) resulted in participants' brain metabolism decreasing 5% in working memory regions (left dorsolateral prefrontal cortex), suggesting an increased efficiency. Compared to the control group, participants also performed better in verbal fluency.

• The study was published in the June issue of the American Journal of Geriatric Psychiatry. Full reference• http://www.newsroom.ucla.edu/page.asp?RelNum=7062• • April 2006• Risk of mild cognitive impairment increases with less education• A study of 3,957 people from the general population of Olmsted County, Minnesota is currently in train to find how many of those who did not have dementia might have mild cognitive

impairment. A report on the findings so far suggests 9% of those aged 70 to 79 and nearly 18% of those 80 to 89 have MCI. Prevalence varied not only with age but also years of education: 25% in those with up to eight years of education, 14% in those with nine to 12 years, 9% in those with 13 to 16 years, and 8.5% in those with greater than 16 years.

• Findings from this study were presented April 4 at the American Academy of Neurology meeting in San Diego.• http://www.eurekalert.org/pub_releases/2006-04/mc-mci033006.htm•

• December 2005• Lifestyle changes improve seniors’ memory surprisingly quickly• A small 14-day study found that those following a memory improvement plan that included memory training, a healthy diet, physical exercise, and stress reduction, showed a 5% decrease in brain metabolism in the dorsal

lateral prefrontal region of the brain (involved in working memory) suggesting they were using their brain more efficiently. This change in activity was reflected in better performance on a cognitive measure controlled by this brain region, and participants reported that they felt their memory had improved. The memory training involved doing brainteasers, crossword puzzles and memory exercises. Diet involved eating 5 small meals daily (to prevent fluctuations in blood glucose levels) that were rich in omega-3 fats, low-glycemic index carbohydrates (e.g., whole grains) and antioxidants. Physical exercise involved brisk walking and stretching, and stress reduction involved stretching and relaxation exercises.

• The study was presented at the American College of Neuropsychopharmacology's Annual Meeting on December 11-15, in Hawaii.• http://www.eurekalert.org/pub_releases/2005-12/g-nsf121205.htm• • March 2005• How higher education protects older adults from cognitive decline• Research has indicated that higher education helps protect older adults from cognitive decline. Now an imaging study helps us understand how. The study compared adults from two age groups: 18-30, and over 65. Years

of education ranged from 11 to 20 years for the younger group, and 8 to 21 for the older. Participants carried out several memory tasks while their brain was scanned. In young adults performing the memory tasks, more education was associated with less use of the frontal lobes and more use of the temporal lobes. For the older adults doing the same tasks, more education was associated with less use of the temporal lobes and more use of the frontal lobes. Previous research has indicated frontal activity is greater in old adults, compared to young; the new study suggests that this effect is related to the educational level in the older participants. The higher the education, the more likely the older adult is to recruit frontal regions, resulting in a better memory performance.

• The report appeared in the March issue of Neuropsychology. Full reference• Full text of the article is available at http://www.apa.org/journals/releases/neu192181.pdf• http://www.eurekalert.org/pub_releases/2005-03/apa-bi030705.htm• • January 2005• Diet, exercise, stimulating environment helps old dogs learn• A new study of beagles provides more evidence that diet and mental stimulation are important in reducing or preventing age-related cognitive decline. The study, involving 48 older beagles (aged 7 to 11), compared four

combinations of behavioral enrichment (regular exercise and lots of mental stimulation) and supplementation of diet with antioxidants had on a beagle's ability to learn: regular diet and regular experience; regular diet and enriched experience; regular experience and an enriched diet; and enriched diet and an enriched experience. The study followed the beagles over two years. Those in the groups with either an enriched diet or enriched environment did better than those without either, but those who had both the enriched diet and an enriched environment did noticeably better than all the rest.

• The study was published in the January 2005 issue of Neurobiology of Aging. Full reference• http://www.eurekalert.org/pub_releases/2005-01/uot-mtc011705.htm• http://www.eurekalert.org/pub_releases/2005-01/nioa-des011805.htm• • June 2004• Being fluent in two languages may help keep the brain sharper for longer• A study of 104 people aged between 30 and 88 has found that those who were fluent in two languages rather than just one were sharper mentally. Those fluent in two languages responded faster on tasks assumed to

place demands on working memory, compared to those who were fluent in just English, at all age groups. This is consistent with the theory that constant management of 2 competing languages enhances executive functions. Bilingual volunteers were also much less likely to suffer from the mental decline associated with old age. The finding is consistent with other research suggesting that mental activity helps in protecting older adults from mental decline. The participants were all middle class, and educated to degree level. Half of the volunteers came from Canada and spoke only English. The other half came from India and were fluent in both English and Tamil.

• The report appeared in the June issue of Psychology and Aging. • Full reference: http://news.bbc.co.uk/2/hi/health/3794479.stm

• November 2003• A British study questioned some 5,350 civil servants aged between 35 and 55 about their participation in 13 leisure activities, ranging from DIY

and housework to cultural visits and evening classes. They were then given tests in verbal memory, mathematical reasoning, vocabulary and verbal fluency. Independent of socio-economic position, the highest level of cognitive ability was associated with regular cultural visits to theatres, art galleries and stately homes. This was closely followed by reading and listening to music, then by involvement in clubs and voluntary organizations, and participation in courses and evening classes. The association was stronger among men. While the researchers suggested that seeking mental stimulation may have a beneficial effect on cognition in middle age, and the research was popularly reported as indicating that “going to the pub is good for the brain” (going to the pub was indeed associated with a slightly higher cognitive ability, but less so that the afore-mentioned), it must be remembered that correlation does not imply causation.

• The research was published in the Journal of Epidemiology and Community Health. Full reference• http://news.bbc.co.uk/1/hi/health/3239641.stm• http://www.smh.com.au/articles/ 2003/11/06/1068013332038.html• A 15-year study of 92 seniors found that those with a low sense of self worth were more likely to suffer from memory loss as they got older.

Moreover, the brains of those with low self-worth were up to a fifth smaller than those who felt good about themselves. It is speculated that those who are anxious and think negatively may set themselves up for memory loss by not bothering to engage themselves in activities that would stimulate and enrich their brains.

• The study was presented at a conference at the Royal Society in London.• http://news.bbc.co.uk/2/hi/health/3224674.stm• • December 2002• 6,158 persons aged 65 years and older from a biracial community in Chicago self-rated current frequency of participation in seven cognitive

activities (e.g., reading a newspaper) and nine physical activities (e.g., walking for exercise). Four years later, 842 of those judged dementia-free were given a detailed clinical evaluation. 139 of these met criteria for Alzheimer's on clinical evaluation. When adjusted for age, education, sex, race, and possession of the gene allele associated with Alzheimer's, a one-point increase in cognitive activity score was associated with a 64% reduction in risk of Alzheimer's. Weekly hours of physical activity had no effect. Education and occupation were both associated with Alzheimer's risk, but these effects were substantially reduced when cognitive activity was taken into account.

• The report was published in the December 24 issue of Neurology.

• November 2002• PET scans of the prefrontal cortex reveal that older adults who perform better on a simple memory task display more activity on both sides of

the brain, compared to both older adults who do less well, and younger adults. Although this seems counter-intuitive – the older adults who perform less well show activity patterns more similar to that of younger adults, this supports recent theory that the brain may change tactics as it ages, and that older people whose brain is more flexible can compensate for some aspects of memory decline. Whether this flexibility is neurological, or something that can be taught, is still unknown.

• The study appeared in NeuroImage. • http://www.nytimes.com/2002/11/19/health/aging/19AGIN.html?8vd

• October 2002• Earlier research has indicated cognitively stimulating activities (such as doing crosswords, playing scrabble, bridge, etc.) may help protect

against cognitive decline (and perhaps even Alzheimers). Now a new report (not yet published) from the Institute for Social Research at the University of Michigan supports and extends this research by suggesting that simply talking helps keep your mind sharp at all ages. The lead researcher also speculates that, by encouraging children to develop their social skills, parents and teachers could also be helping them to improve their intellectual skills. And in the workplace, instead of encouraging employees to keep their noses to computer monitors and complete their tasks, effective supervisors might encourage them to take plenty of time out to socialize.

• http://www.eurekalert.org/pub_releases/2002-10/uom-sig102202.htm• February 2002• A study of 700 seniors over several years found that more frequent participation in cognitively stimulating activities, such as reading books,

newspapers or magazines, engaging in crosswords or card games, was significantly associated with a reduced risk of Alzheimer’s disease (AD). General cognitive decline was also less among people who did more cognitively stimulating activities, in particular, in working memory, perceptual speed, and episodic memory. It is not yet known whether engaging in such activities helps prevent cognitive decline, or whether those who develop cognitive impairment are less likely to engage in cognitively stimulating activities.

• The study appeared in the February 13 issue of the Journal of the American Medical Association.• http://www.eurekalert.org/pub_releases/2002-02/nioa-io020802.htm•

• December 2001• 1,772 people age 65 or older participated in a 7-year study that investigated the effect of leisure activities on risk of dementia.

It was found that, even when controlling for factors like ethnic group, education and occupation, those with high leisure activity had 38% less risk of developing dementia. There also appeared to be a cumulative effect, with an additional 8% risk reduction associated with each leisure activity engaged. Activities of all kinds were shown to be beneficial, but intellectual activities were associated with the highest risk reduction. The report was published in the December 26 issue of Neurology. Full reference

• http://www.eurekalert.org/pub_releases/2001-12/aaon-lad121401.htm• March 2001• Memory failures in which you feel the information you want is "on the tip of my tongue" appear to occur because the memory

trails to those items have become faint, either because the items haven't been used regularly or because of age. Similar sounding items can help recall. To keep your memory trails strong, you need to use them - by reading, doing crosswords, anything that uses language and keeps you meeting new words.

• The study appeared in the November issue of the Journal of Experimental Psychology: Learning, Memory and Cognition.• http://unisci.com/stories/20004/1113005.htm• Related article: Tip-of-the-tongue experiences• The Seattle Longitudinal Studies of adult intelligence suggested that the observed decline in many community-dwelling older

people is probably a function of disuse and is often reversible. It was found that some 2/3 of participants in a cognitive training program showed significant improvement, and 40% of those who had declined significantly were indeed returned to their earlier (pre-decline) level of cognitive functioning. These training gains were retained over seven years.

• Related article: Memory Training

• http://www.youtube.com/watch?v=aBvDScfCCMQ