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Neuropsychologie voor de veroudering
HC 1 Neuropsychology of ageing
True/false?
1. Question: Old people are less happy and content than young people
False, in fact they tend to be happier and content than young people.
2. Question: Most older people will develop dementia
False, it is a minority - it is increasing.
3. Question: With ageing all cognitive functions will deteriorate
False, not all of them will deteriorate. (^ These are all prejudices).
Why ageing? Why relevant or important to study?
- Scientific reasons:
1. To present complete view of development because it has been neglected. -> We had
developmental psychology, where we focused on children/young adults and ignored
continuation development in adulthood.
• It’s not seen as very important, because there is an assumption up until a few years
ago in developmental psychology that there is nothing very interesting for
psychologists (once you reach age 23 it goes downhill) as there are gradual,
predictable decline in psychological functions with ageing - two-stage model.
Two stages of life model: physical and psychological functions develop (growth) up to a
point (maturity; early 20s usually) followed by a gradual and predictable decline (senescing),
therefore there wasn’t that much to study. We’ll see that:
o The biological functions model is mostly correct - with ageing you develop more
diseases and discomfort.
o But for psychological functions the model is outdated - it is not true that there is a
decline and we see that some functions become better and better with age.
2. Contrary to the two-stage theory there is a life span perspective: it doesn’t all stop at early
adulthood, it’s that the changes between birth and death are regarded as development.
Þ Changes in functional capacity are part of the life span
Þ Maturation doesn’t stop at age 23, it continues until death
Therefore psychological ageing changes are worth studying.
Þ Changes are also not predictable, there is not always necessarily deterioration of
functions
-> One e.g. of the few classic theories in developmental psychology that considers old age is
Erikson’s 8 stages (which is about psychological wellbeing over ages), but many of the
classic theories (e.g. Piaget) don’t mention adulthood, let alone ageing.
- Practical reasons
1. There is a strong increase in number of older people worldwide.
There always have been old people, Dante reached the age of 80 and even in the middle ages
and classic times people aged into their 80s but they were a small minority. But the number
of people that reach old age now is increasing.
• But the disadvantages of that is that there is an increase in diseases associated with
aging
• And also an increase of demands for treatment and care
• And therefore a call for prevention of age-related disorders
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2. Over 55s is the wealthiest age groups (peak 55-74 wealthiest age group). With wealth,
comes influence. So, apart from the fact that they are large they are also wealthy so more
reasons as to why they are important.
What age are we talking about?
o In most studies presented and here we talk about chronological age: the number of
years since birth. It is the most common measure in studies of ageing.
o That is not the only concept of age, there is also biological age: the age relative to
the years one expects to live or relative to physical appearance and bodily functions
(fitness of your body), e.g. blood pressure. E.g. one man looks way older and less fit
than the other man but they are the same chronological age (but not the same
biological age).
o There is also functional age: a person’s competence in carrying out specific tasks
relative to persons of the same chronological age. E.g. a French artist who performed
until he was 90 years old, and therefore functioned better than others of the same
chronological age.
o Psychological age: how well can a person adapt to changing conditions, how flexible
you are to change/adapt and attempt new activities. E.g. Fauja Singh took up
running at the age of 89 (better psychological age than others at the same
chronological age).
o Social age: the view held by most people in society about what a person of a
particular chronological age should do and behave (you are expected to do certain
things). E.g. a rockstar who became a father at the age of 70 (this is not the age you
expect someone to become a father).
Who is aging?
Older adulthood typically starts at 65 (retirement age was taken as cutoff for determining
older age). Further distinction:
- Young-old (65-74)
- Old-old (75-84)
- Oldest-old (>85)
These borders start to shift now, because of the increasing number of people living healthily
in old-age. The retirement age in many countries is shifting, so therefore the definition of
older adulthood will also shift eventually and may be changing perhaps to 70. But for the
moment 65 is the start of older adulthood.
Another misconception is that older people are all the same (e.g. they all have grey hair,
particular hair reduce) People over 65 are not a homogeneous group, there is individual
variability.
- Inter-individual differences (between)
- Intra-individual differences (within)
In fact, individual differences between and within individuals usually become even bigger
than in younger age groups, this makes sense because with ageing some age very healthy and
very well and have very few diseases and impairments whereas others have many
impairments and diseases. So, the differences between people at those older ages become
higher with some being very healthy and others very disabled.
At the moment: Increase in the number of older persons (the idea: emergent baby
booming health care crisis - the people born in the first 20 years after WOII who are now
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reaching retirement age). “At the root of the process of population ageing is the exceptionally
rapid increase in the number of older persons, a consequence of the high birth rates of the
early and middle portions of the 20th century and the increasing proportions of people
reaching old age” (World population ageing 2013).
Why are there so many people growing older? Partly because:
- Medical care is better
- Levels of hygiene is better
People that used to die at age early 60s now easily reach 80. But increasing life expectancy is
not just a phenomenon in the west, in different parts of the world (the most and the least
developing countries) the trend is the same, in all countries people tend to live longer. At
the same time, less and less children are born so the fertility rates also go down.
Population pyramids: percentage of the population per 5-year age category.
These pyramids as a consequence of this hardly look like pyramids anymore, you see in 1970
it looks like a pyramid (the older the less people, the younger the more people aka more
children born).
But what is happening now, in 1970 the baby boomers were young adults or children. Now
the baby boomers in 2013 are middle aged, in 2050 they have reached old adulthood, so the
shape has changed and there is no longer a pyramid it is now a pillar. There is an increasing
number of older people relative to younger people, to children.
Over 60s will become the largest age group.
o 2013: population over 60 outnumbered population aged 0 to 19 years (the group
children).
o 2024: population over 60 expected to outnumber all other age groups in more
developed regions (so it will be the largest age group, and the less developed
countries are also picking up).
Consequences of population ageing:
1. Demographic changes
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o Dependency ratio: ratio of how many people in the working age there are to
care for the more vulnerable (so the number under 15 + persons aged 65 years
and over) / number of persons 15 until 64 years). So ratio population in most
dependent ages and population in main working ages.
If you have higher dependency rate, you have:
- More “dependents” (either very old or very young persons) relative to the group in
the productive ages
- More economic pressure on the productive group
- The ratio is expected to change, so dependency rate in more developed countries
will rise (mainly due to increase number of older people) so there will be more
dependent relative to the group of economic active age groups
o Old age support ratio: Ratio of how many people are available in the main
working ages to support each older person: number of persons aged 15 until 64 /
number of persons aged 65 or over.
In 2013, there were just 4 persons of working age for each older person (over 65 years) in
more developed regions. This ratio is expected to decline further; so fewer people
working/to care and create economic activity that is required to support the older
groups who are no longer working. This is where the shift of retirement age comes from to
expand the group that is economically active.
2. Health and health care costs changes
Even though we’re healthier with aging than 200 years ago,
• Health expenditures (uitgaves) grow rapidly due to ageing.
There are more diseases, older people require more health care in general and more
specialized services for more complex pathologies.
• Major cause of disability and health problems in older age are non-communicable
diseases, including: heart disease, cancer, diabetes, “the four giants of geriatrics”
(immobility, instability, incontincence (overactieve blaas), intellectual impairment
(interesting for neuropsychologists). Last year was an exception because of corona
being an infectious disease, but the typical diseases are the ones stated above.
Intellectual impairment or dementia (if severe enough). Projection from 2010 to the next 40
years, in all countries (high income and middle/low income countries) the expectant
prevalence of number of people with dementia is expected to rise to 65.7 million in 2030 and
115.4 million in 2050 (WHO dementia). The sharpest increase is in the lower- and middle-
income countries.
Number of people expected to develop cognitive impairments or dementia is large. Mainly
due to the fact that there are more older people, with age being the largest risk factor.
