Physical, Cognitive and Psychosocial Changes in Late Adulthood
Info: 2179 words (9 pages) Nursing Essay
Published: 2nd Jun 2020
Throughout our lives, we are constantly developing, and much research has been conducted to analyse patterns of behaviour and personality to determine which factors produce the best health outcomes and longevity (Santrock, 2019, pp. 518-519). With a focus on the late adulthood stage, this essay will describe physical, cognitive and psychosocial changes, the theories of attachment and lifespan development and their relevance to this age group, and finally discuss health behaviours exhibited by the adult over 65 years of age.
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As we age, our bodies continue to gradually change, and in late adulthood, many physical functions unavoidably decline; this is known as primary aging. The most obvious changes are those of physical appearance, with changes in skin pigmentation and wrinkles developing (Patton & Thibodeau, 2019, p. 1112), as well as a shortening of height due to a loss of bone density in the vertebral column (Patton & Thibodeau, 2019, p. 1111). Less apparent changes are declines in special senses: deteriorations in visual acuity, perception of colour and depth, and development of eye diseases all contribute to a decline in sight function (Santrock, 2019, pp. 530-531); functional declines in middle and inner ear structures contribute to a reduction in the frequencies able to be heard (Patton & Thibodeau, 2019, p. 1113;Santrock, 2019, pp. 531-532); senses of taste and smell also decline, with only 40% of the taste buds functioning at age 75 compared with those of a person at 35 years old. (Patton & Thibodeau, 2019, p. 1113). Fertility sharply decreases (Patton & Thibodeau, 2019, p. 1113), but older adults continue to remain sexually active for as long as their partner’s sexual performance and physical health enables (Santrock, 2019, pp. 533-534). The cognitive changes of late adulthood can be categorised into fluid mechanics and crystallised pragmatics (Santrock, 2019, pp. 549-550). Fluid mechanic abilities are strongly related to an individual’s physical health, and so declines in cognitive function are often seen in the older adult’s processing speed, attention, executive functioning, decision-making abilities, and episodic, source, prospective and working memory (Santrock, 2019, pp. 550-555; Whitman, 2011, p. 254) There is much variance in how much these skills deteriorate in the older adult population, with continued intellectual stimulation helping to slow decline in cognitive function (Santrock, 2019, pp. 554-560). Crystallised pragmatics are learned skills and knowledge including metacognition, mindfulness, wisdom, and semantic memory; these skills do not tend to decline and can even continue to improve right until extreme old age (Santrock, 2019, pp. 550-556). Incidences of dementia increase with age in late adulthood, and can cause a debilitating decline in all cognitive function (Santrock, 2019, pp. 568-569). Late adulthood also sees significant psychosocial change: their role within their family can change as they become grandparents and take on a carer role for grandchildren, or have to adapt to being cared for by their own children (Hunt, 2017, p. 405); their social circle becomes smaller, caused by a preference to maintain the more rewarding existing relationships and the death of peers and spouses (Santrock, 2019, p. 581). Retirement can be a positive or a negative change depending on individual circumstances and attitudes (Clendon & Munns, 2019, p. 214;Hunt, 2017, p. 394), and many older adults choose to spend their newly found free time volunteering (Santrock, 2019, p. 595).
Erik Erikson (1902-1994) theorised that our lives are divided into eight “psychosocial stages” (Santrock, 2019, p. 21) of development, with each stage consisting of a basic crisis likely to be encountered across the course of each stage of life, and can be resolved to result in either a positive or negative outcome. As a revision of Sigmund Freud’s (1856-1939) theory, Erikson’s theory of development differed from that of Freud by placing more emphasis on social interaction driving human behaviour than by our sexual desires. Erikson also differed from Freud by placing equal emphasis on all of an individual’s life experiences in shaping our behaviour and resulting personality, rather than solely our childhood experiences shaping the rest of our lives (Santrock, 2019, pp. 20-21). Erikson further felt that each conflict often took place consciously and because of societal structures, rather than in the unconscious mind and as a result of physical development (Funder, 2010, pp. 447-449). The final stage is characterised by the crisis of ‘integrity versus despair’, where in late adulthood an individual reflects on the experiences of their past and whether they had a fulfilling life or if they now have many regrets. If they feel they have had a good life or have gained wisdom from their mistakes, integrity is achieved; a negative perception of their life result could result in feelings of despair (Santrock, 2019, pp. 21-22, 579-580;Funder, 2010, p. 449).
Attachment theory also began with influence from Freud, with the concept that we continue learned patterns of behaviour and emotion into new relationships (Funder, 2010, pp. 458-459). John Bowlby (1907-1990) further developed this theory with an ethological perspective, broadening it to analyse infants’ early emotional attachment to their caregivers (Santrock, 2019, pp. 27, 180-181), based on the idea that these early patterns of attachment taught feelings of self-worth and the degree to which the person could rely on others in relationships with others in the future (Funder, 2010, pp. 459-460). Mary Ainsworth (1913-1999) developed the strange situation test to measure infants’ attachment reactions in a more concrete and measurable way, and categorised these reactions into secure, avoidant and anxious attachment styles (Grey & Bjorklund, 2014, p. 464). The implications of attachment styles in older adulthood are much less researched than those of early life stages (Santrock, 2019, p. 593), but some have found that secure attachment styles cause better overall quality of life, and resilience to loss of physical and cognitive health and loss of social support (Bodner & Cohen-Fridel, 2010, p. 1354). Others have found that characteristic habits of our attachment styles appear in moments of stress, and as seen in elderly patients with dementia who can become extremely distressed when experiencing new places and meeting new people without another familiar person present (de Vries & McChrystal, 2010, p. 291), with implications for how well carers are able to provide quality care to their residents (de Vries & McChrystal, 2010, pp. 298-299).
Secondary aging is the result of behaviours and habits which affect our health (Doyle, 2017), which in turn should be seen in the context of determinants of health: the individual’s social, economic and environmental conditions which are almost always outside of their control (World Health Organisation, 2019). An example of a health behaviour is tobacco use. The most recent New Zealand Health Survey (Ministry of Health (a), 2019) recorded that an estimated 39000 people over the age of 65 currently smoke at least once a month. Social pressures are often the reason for starting, and for the current older adult population, societal factors would have helped to maintain this behaviour: most smoking habits are already established by young adulthood, a stage at which the youngest of this population would already have been approaching by the time the harmful effects of tobacco use were publicised in the mid-1960s (Brannon, Feist, & Updegraff, 2014, pp. 288-292). Smoking rates also increase as socioeconomic status, income and education levels decrease, with those from the most deprived areas being three times as likely to smoke as those from the least deprived areas in New Zealand (Ministry of Health (a), 2019). Smoking is a significant contributor to poor health outcomes, with approximately half who engage in this behaviour eventually dying of a disease related disease (Ministry of Health (b), 2019). Smoking causes increased risks of cancer, cardiovascular disease, chronic lower respiratory issues and disease, as well as dental and upper respiratory issues (Brannon, Feist, & Updegraff, 2014, pp. 296-297). Engaging in exercise is another health behaviour which older adults may engage in. Physical activity is linked to many health benefits, but without environmental support from the local community, older people who do not have access to transport or the income to attend gyms or reach equipment are less likely to keep up with recommended levels of activity (Clendon & Munns, 2019, pp. 210-212). Older adults also require good health literacy to understand the benefits of exercise and that a previously sedentary lifestyle can still benefit their health (Santrock, 2019, p. 539). Benefits include improved mobility, reduced falls risks, reduced blood pressure and cholesterol, prevention of chronic diseases, improvement in mood, and improved cognitive function (Hunt, 2017, p. 407; Santrock, 2019, pp. 537-539). The amount of reported physical activity drops considerably between the 65-74 and 75+ age groups from 52.7% to 37% of the New Zealand population (Ministry of Health (a), 2019), with the older group more likely to lead an increasingly sedentary lifestyle than their younger counterparts. However, as this age group represents the widest range of years, this most likely represents the decline in function as his group approaches the end of their life, as it also has a reasonably even spread of reported levels of activity between high, moderate and little physical activity (Ministry of Health (a), 2019).
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Older adulthood should not be viewed simply as a life stage for declines in biological function, but rather a culmination of life experiences. Attachment styles and our progression through Erikson’s crises of life stages can affect our psychosocial stability. And while social, economic and environmental factors may be significant outside influencers of health, health behaviours of smoking and physical activity patterns can affect the degree to which our physical and cognitive abilities decline or are maintained.
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