This document contains all the notes of the course Gerontology academic year 2021/2022.
It contains extensive explanations of the various diseases that are dealt with in the lectures.
The document is written in English.
Gerontology notes
Week 1: Normal Aging – Part I
Gerontology: the study of social, psychological and biological aspects of ageing. This course will be
about the last decades of life.
Course: neuropsychological perspective → interaction between brain and behaviour.
Learning objectives
After the course you know:
- Psychological, cognitive and biological changes that accompany normal ageing. Normal is
without e.g., having dementia.
- Biological and psychological theories of ageing.
- Sign and symptoms of the most common dementia syndromes.
- The daily life consequence of dementia syndromes for patients and their families.
Exam will be on location (so not online).
- 60 multiple choice questions.
- The exams will be based on the literature published on Nestor and on the lecture slides.
- In case of confliction information between lecture slides and literature, the information in the
lecture slides is valid.
First chance: 24-1-2022, 12.15-14.15 – Exam hall
Resit: 14-4-2022, 12.15-14.15 – Exam hall
Life course trajectories of body functions
A: normal development and decline.
B: exposure in early life may imprints on
structures of functions of body system.
May age quickly or do not reach the same
age.
C: exposure acting in mid or in later life
accelerating age-related decline (so,
mostly normal development up to a
certain age).
,Why do we talk about age so much?
1950 2014
Well, what do we see?
You see the baby boom generation. It’s coming in the 1950s in
the lower age range, and you see the baby boom generation
getting older in 2014.
You also see that the number of people who are 70 years and
older has increased. So there are more and more people who
reach a higher age.
And you see that the population pyramid is getting more
narrow at the bottom, so fewer children are born.
2060 This is what they think the population in 2060 will look like.
Still, fewer births, more narrow at the bottom. And there are
more and more people who reach a higher age.
So, more and more people having dementia. And more and
more people needing health care.
,But there are big differences
between countries in this ageing
progression.
You see that the graph for the less
developed countries looks a lot
like the graph of 1950.
This is what they think it will look
like in 2050. The less developed
countries are catching up.
Why is there such a high proportion of people 60 years and older?
The life expectancy is increases. When you are born now, the chance that you’ll turn 60 is much
higher, than when you were born fifty years ago.
But it also has to do with the number of children a woman has is decreasing. Less children are born.
This also has an impact on the proportion of people 60 years and older.
Definition of age
Chronological age: measured in units of time (months or years) that have elapsed since birth.
Biological age: basically ‘how old are you bodily functions. Where people stand relative to the
number of years they will live (in terms of body’s organ system and physical appearance).
- Speculative: because you don’t really know how long someone will live, it’s just a
speculation.
Functional age: person’s competence in carrying out specific tasks. Basically, about what you still can
do.
- In comparison with chronological age peers. E.g., someone of 80 years old who can still drive,
cook for him/herself, sports, works in the garden, compared to an 80 years old who is in a
nursing home and can’t take care of him/herself.
Psychological age: refers to how well a person adapts to changing conditions. How flexible are you?
People who are very flexible are often considered younger, than people who are not flexible.
Social age: views held by most members of society about what individuals in a particular
chronological age should do and how they should behave.
,What is old, actually?
Chronological age: the magic age of 65. Is rather arbitrary, why not 60 and why not 70?
- The Third Age (between retirement from work force and start of age-imposed limitations). A
period in time where you have freedom: you do not have to work, but you still have the
ability to do things.
- The Fourth Age (cognitive and physical impairments interfering with everyday functioning).
These two can overlap. E.g., some people already have limitations before they even retire.
It’s very hard to determine what is really old. You need an individual approach for this.
Perspectives on aging process
Normative aging: What is considered a usual, normal, or average outcome. E.g., something you
would expect for the age of 70 or 80. We expect a certain memory performance for someone who is
70 and we expect a different memory performance for someone who is 80. And this is also how we
determine when someone deviates from this.
Successful ageing: What is considered an ideal rather than average outcome.
Positive ageing: The ability to find happiness and well-being even in the face of physical and/or
psychological challenges. Having a good quality of life.
,Two theoretical models of ageing
The Selective Optimization with Compensation Model of Ageing (Baltes & Baltes, 1990)
The Ecological Model of Aging (Lawton & Nahemow, 1973)
The Selective Optimization with Compensation Model of Ageing
Individuals engage in adaptation throughout their lives. They are capable of learning and changing
and calling upon extra (reserve) capacity that they might not need to use under ordinary
circumstances. Throughout your life you constantly adapt, you’re able to learn and to change. And if
necessary to give the extra little bit, the reserve capacities. And this extra little bit is more than you
would need under normal circumstances.
It's very much about what is in the middle box, the selection, optimization, and compensation.
- Selection: is a strategy of concentrating efforts on domains in which effective functioning is
most likely to remain high. If you age you still have your strengths and your weaknesses. You
can focus more on your strengths than your weaknesses.
- Optimization: is a strategy of focusing on behaviours that maximize not only the quantity but
also quality of life. The most optimal approach. Learning to live with certain conditions.
- Compensation: refers to substituting new strategies when losses occur. If you have losses in
one domain, you can compensate that by functions in the other domain.
,The Ecological Model of Ageing
The interaction between a person competence and environment results in some level of adaptation.
- Measured in a person’s emotional well-being.
Competence: physical, sensory, cognitive and social abilities.
A person with high competence will adapt positively to a wider range of environmental press than a
person with low competence.
Ageing
Why does ageing occur?
What determines how long people live?
Biological changes: “Decremental physical changes (both structural and functional) that develop with
the passage of time and eventually end with death.”
Biology of ageing
- Gradual and cumulative: it’s something that happens over time. And it’s something that adds
up.
- Peak in early adulthood.
- Decline after early adulthood.
o Rate of decline differs strongly between individuals
Not the majority, but even so most older adults are neither helpless nor dependent.
,Are biological changes a consequence of the ageing process rather than a disease?
- Ageing in the absence of any disease is rare.
- The likelihood of many diseases increases with age.
Aging affects the consequences of disease then it occurs, i.e., ageing process and disease process
interact.
Morbidity: refers to illness and disease.
Mortality: refers to death.
Two terms are related:
- Illness and disease can result in death.
- Death is often preceded by illness and disease.
- Morbidity does not necessarily result in mortality.
Life span: how old can we get? What is the maximum age that we can reach? The maximum
longevity, or extreme upper limit of time, that members of a species can live (max is approximately
120 years).
This has stayed the same over time, so not life expectancy.
Life expectancy: the average number of years that individuals in a particular birth cohort can be
expected to live.
- Has increased over time.
- Affected by factors such as levels of nutrition, sanitary conditions, and medical care.
- More and more people will approach the maximum life span – compression of mortality.
Theories of biology of ageing
Some theories: biological ageing occurs withing the organism regardless of outside forces.
Other theories: biological aging is influenced by our environment and daily habits and the way we
cope with life’s challenges.
Primary ageing
- Unavoidable (inevitable) biological process that affects all members of a species (universal).
- Is set in motion early in life and progress gradually over time.
o Individual differences in progression rate.
- Is intrinsic: is determined by factors within the organism.
Secondary ageing:
- Experienced by most, but not necessarily all members of a species.
o Neither inevitable nor universal.
- Resulting from hostile environmental influences.
o Disease.
o Disuse (e.g., lack of exercise).
o Abuse (e.g., smoking).
,Programmed theories of ageing
Time clock theory
Finding:
- Cells from human infant doubles approximately 50 times, whereas cells from a mouse
(maximum life span 3 years) doubles 10-15 times. Aging has to do with the number of times
that your cells can double themselves.
- Life span is controlled by genetically
determined time clock at cellular level.
- Cells from infants and young children divide
more times than cells from older adults.
- Examples: down syndrome (life expectancy is
lower than people without DS) and progeria
(very rapid ageing). If you look at cell division of
people who have these conditions that’s all in
support of the time clock theory, which makes
it a very strong theory.
Recent studies: tolemeres → protective cap at tail ends
of chromosomes. It’s something that we loose with
age.
One of the most popular theories.
Immune theory
Immune system: defends body against invasion of foreign substances by producing antibodies.
Theory: immune system is programmed to maintain its efficiency for a certain amount of time, after
which it starts to decline.
- Insufficient antibodies.
- Inferior antibodies: mistakenly attack and destroy normal cells.
- Linked to cancer. Cancer is also more common when people get older, which makes it a
theory related to ageing.
,Evolutionary theory
Members of species are genetically programmed to bear and rear their young. Once they reproduce
and raise their offspring to independence, they have fulfilled their service in perpetuating the
species. This theory does not only apply to humans.
Depending on levels of energy organism coast along for a period of time.
Once excess of energy is used up, susceptibility to disease increases.
➔ Fruit flies forced to delay reproduction lived longer than fruit flies that reproduces early.
Time clock theory is the strongest theory in this context.
Stochastic theories of ageing
Focus on random damage to our vital systems that occurs with the process of ageing.
As damage accumulates, we cease to function efficiently and eventually life becomes impossible to
sustain.
Studies in twins: same genetic makeup, BUT different rates of ageing – they rarely live exactly the
same amount of time.
Error theory
Errors occur at cellular level resulting in the production of faulty molecules.
- Result from organism’s metabolic processes.
- Exposure to environmental factors (e.g., radiation).
Cells have a repair mechanism, but may not keep up with damage created by faulty molecules.
Over time: unrepaired damage builds up resulting into metabolic failure. The errors start to
accumulate.
Wear and tear theory
We begin life with a fixed amount of physiological energy. If we expend it quickly, ageing begins early
and proceeds rapidly. Can we retard ageing by conserving energy?
People wo work in physically strenuous jobs do NOT show signs of ageing any earlier than those who
work in less physically demanding jobs.
A theory that is around, but not very strongly supported.
, Stress theory
Two systems that are involved in a stress response.
Sympathetic system: stress response, e.g., your pupils dilate, your heartrate goes up. Flight and fight
response.
Stress triggers physiological activation that results in secretion of stress-related hormones
(glucocorticoids).
- Young organism: stress system quickly returns to normal levels.
- Old organism: stress system needs more time to return to normal levels.
• Prolonged exposure to glucocorticoids
o increased risk of high blood pressure
o increased risk of cardiovascular disease.
Stress-related damage to biological system can accelerate the aging process.
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