Utvikling over livslpet

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Utvikling over livsløpet

• Inger Hilde Nordhus

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Livsløp og utvikling (1)

• Aldring er generelt beskrevet som en prosess
  preget av svekkelse
• Psykologisk forskning støtter i stor grad dette
• Arbeidsminne (multiple oppgaver) og
  informasjonsbearbeiding (hurtighet) svekkes
• Erfaringsbasert kunnskap viser ikke denne
  tendensen men det gjør derimot prosessering av ny
  kunnskap
• Etablert på tvers av kjønn, utdanning og etnisk
  tilhørighet normative endringer med store
  individuelle forskjeller

National Research Council. 2000. The Aging Mind
Directions in Cognitive Aging Research . P. Stern
L. L. Carstensen, Eds. National Academies of
Sciences Press. Washington, DC.
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Patologisk kognitiv utvikling - demens

• Svært varierende prevalens av demens rundt om i
  verden (3-30 av eldre) 1-5
• Klassifikasjonssystemene påvirker diagnosen6
• I en canadisk kohort varierte prevalensen fra 3,1
  (ICD-10) til 29,1 (DSM-III)6
• Prevalens i vestlige land7-8
• Norske sykehjem9

70-74 år 5 gt 75 år 15 gt 90 år 35

• Shaji S et al. An epidemiological study of
  dementia in a rural community in Kerala, India.
  Br J Psychiatry. 1996168(6)745-9.
• Wang W et al. Prevalence of Alzheimer's disease
  and other dementing disorders in an urban
  community of Beijing, China. Neuroepidemiology.
  2000 Jul-Aug19(4)194-200.
• Lobo A et al. Prevalence of dementia and major
  subtypes in Europe A collaborative study of
  population-based cohorts. Neurologic Diseases in
  the Elderly Research Group. Neurology.
  200054S4-9.
• Engedal K and Haugen PK. The prevalence of
  dementia in a sample of elderly Norwegians.
  International Journal of Geriatric Psychiatry
  19938565-570
• Skoog I et al. A population-based study of
  dementia in 85-year-olds. N Engl J Med.
  199321153-158.

70-80

• Engedal K, Haugen PK. The prevalence of dementia
  in a sample elderly Norwegians. Int J Geriatr
  Psychiatry 19938565-570.
• Ott A et al. Prevalence of Alzheimer's disease
  and vascular dementia association with
  education. The Rotterdam study. BMJ.
  199515970-973.

6. Erkinjuntti T et al. The effect of
different diagnostic criteria on the prevalence
of dementia. N Engl J Med. 199741667-1674.
9. Nygaard H et al. Mental svikt hos
sykehjemspasienter. Tidsskr Nor Lægeforen
2000120 3113-16.
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Livsløp og utvikling (2)

• Sosial og emosjonell fungering viser positiv
  utvikling over livsløpet (med unntak av ved
  patologisk aldring)
• Subjektivt velvære (well-being) er ikke dårligere
  hos eldre enn yngre voksne
• Negative emosjoner viser nedgang relativt til
  yngre voksne positive emosjoner rapporteres
  oftere hos eldre enn yngre voksne
• Eldre rapporterer oftere større grad av
  tilfredshet mht sosiale relasjoner, særlig nære
  (slekt og nære venner)
• Sett opp mot kognisjon og biologiske prosesser
  paradox of aging ?

Löckenhoff, C. E. L. L. Carstensen. 2002. Is
the life-span theory of control a theory of
development or a theory of coping? I Personal
Control in Social and Life Contexts. S. H. Zarit,
L. I. Pearlin Schaie, Eds. 233-262. Springer
Publishing Company. New York.
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Psykologiske mekanismer

• Senket forventning
• Endring av referansegruppe
• Benekting

Med andre ord en grunnleggende oppfatning
av at økt emosjonell trivsel og fokus på nære
bånd hos eldre er et utslag av mestring av tap
mer enn en positiv utvikling
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Selektiv motivasjon et utviklingsperspektiv

• Mål rettet mot å utvide vår horisont/få mer
  informasjon
• Mål rettet mot emosjonell bekreftelse
• Evne til å oppleve seg i tid gjør at en også kan
  endre prioritet

Med andre ord en alternativ oppfatning av at
økt emosjonell trivsel og fokus på nære bånd hos
eldre er et utslag av relativ endring i
prioritering av mål
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Selvregulering over livsløpet

• Selvregulering hos barn blir beskrevet i et
  utviklingsperspektiv
• Selvregulering hos voksne og eldre tar lite
  hensyn til ontogenetisk endring over livsløpet
• Fokus på voksne individuelle forskjeller
• Fokus på eldre Sviktende fysisk helse forårsaker
  dysfunkjonell selvregulering

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Oppsummerende

• I klinisk sammenheng vil vi selvsagt se store
  individuelle endringer i evne til selvregulering
  hos voksne og eldre pasienter
• Vi vil også bli konfrontert med klare
  sammenhenger mellom fysisk helsesvikt og psykisk
  helse
• De generelle funn om eldres selvregulering peker
  imidlertid mer mot psykologisk gevinst enn mot en
  normativ defensiv mestring av tap

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Ageing Health Behaviour

• Optimize life expectancy or longevity
• Minimize physical, psychological and social
  morbidity
• Increase of people surviving into advanced old
  age leads to compression of morbidity (disease
  closer to the time of death)
• Can we live free from disease?

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Health and Disease

• Age is linked to many diseases (e.g., heart
  disease, dementia)
• Diseases have a number of psychological
  consequences
• The fact that people live longer also implies an
  increase in both healthy as well as abnormal
  ageing
• Health is also known to be the main determinant
  of life satisfaction and quality of life in old
  age

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Is Old Age Synonymous with Disease?

• How do we perceive ageing?
• What kind of images of old age do we have?
• What do we think of as normal ageing?

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Age

• Immediate information about somebody we do not
  know
• Strong association with other variables
• Subjective marker (e.g., change)
• Social marker (e.g., being different from younger
  adults)

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Age as a variable

• Age as a statistical concept
• Age as a process
• Age as a background variable
• Age as a predictor variable

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What is Ageing?

• Biological perspective (cell loss, physiological
  changes)
• Developmental perspective (coping, adaptation)
• Cognitive perspective (memory, attention)
• Social perspective (status, resources)

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Biological Age

• Observable physical changes
• Changes in the brain
• Increased vulnerability for developing
• certain ailments and diseases

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Sleep an example

• Certain changes in the sleep architecture are
  defined as common and normal as we age
• Changes in sleep habits
• Changes in activity level
• Prevalence of sleep problems increases with age,
  and about 50 of elderly subjects (60) complain
  about sleep problems
• Why?

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Sleep in old age

• Sleep changes naturally as we age
• Increased number of awakenings and arousals
• Less REM sleep
• Generally less deep sleep
• Moe sleep stage changes
• Less sleep cycles
• Reduced sleep efficacy

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Sleep - Normal Changes in Sleep Architecture
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Actigraphy
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Polysomnography (1)
Polysomnography
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Polysomnography (2)
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(No Transcript)
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Sleep Diary

• Uke fra .......... til ...........
  År...........
• Eksempel Mandag Tirsdag Onsdag
  Torsdag Fredag Lørdag Søndag
• Utfyllingsdato (fylt ut om morgenen den)
  27/2 28/2 1/3 2/3
  3/3 4/3 5/3
• 1. Antall ganger jeg sov (duppet av) på dagtid
  (før natten) 2
• 2. Hvor lenge jeg sov (duppet av) på dagtid
  40
• 3. Om kvelden la jeg meg i sengen kl
  2310
• 4. Etter jeg la meg prøvde jeg å sove (slukket
  lysene) kl 2400
• 5. Etter å ha slukket lyset, sovnet jeg i løpet
  av minutter 30 min
• 6. Antall ganger jeg våknet i løpet av natten
  var 2
• 7. Hvor lenge jeg var våken til sammen om natten
• (legg sammen for alle oppvåkninger)
  20
• 8. Jeg våknet endelig kl (siste oppvåking om
  morgenen) 0700
• 9. Jeg stod endelig opp av sengen kl
  0745
• 10. På dagtid i går følte jeg meg (1 svært
  søvnig,
• 2 noe søvnig, 3 hverken søvnig eller opplagt,
  
• 4 noe opplagt, 5 svært opplagt)
  2
• 11. Da jeg stod opp i morges følte jeg meg (1
  helt utslitt,
• 2 noe utslitt, 3 hverken utslitt eller
  uthvilt, 4 noe uthvilt,
• 5 helt uthvilt) 2

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Ageing as a health related concept

• Pathological normal- optimal
• Heterogeneity
• Risk
• Vulnerability

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Psychological Age

• Changes in cognitive preparedness
• Increased vulnerability in terms of critical
  incidences
• Increased vulnerability in terms of loss of
  resources that in turn challenge coping and
  adaptation

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What may challenge identity and coping in old
age?

• Interpersonal loss
• Physical decline and loss and malfunction
  Increased dependency of care
• Fear of loosing autonomy and integrity

Affects basic human needs
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Social Age

• Changes in roles and status
• Increased likelihood of being in a position of a
  recipient in many ways
• Exit from roles rather than entrance into roles
  as defined by

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Age, Cognitive Functioning and Health

• The most feared diseases of old age are those
  that impair memory, thinking, problem-solving,
  perception and our personality
• It is a challenge to understand the borderlands
  between benign cognitive impairment and abnormal
  cognitive functioning (dementia )

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A Healthy Old Age?

• There is little evidence for marked compression
  of morbidity
• The absolute time spent with moderate disability
  has increased
• More people are able to perform activities of
  daily living due to medical and technological
  improvement
• As for cognition, at least some decline is the
  norm, but there are great inter-individual
  variation

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Age as a Mediator between Health and Behaviour

• It is well established that before old age,
  behaviour has both beneficial and negative
  effects on health
• Smoking, alcohol abuse, poor diet, obesity, lack
  of exercise, etc., reduce the likelihood of
  surviving into old age
• The debate in gerontology is whether risk factors
  associated with mortality and morbidity in middle
  age has as strong effect in old age

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Two Conclusions

• There is evidence that behaviour change in old
  age has a beneficial effect on health and
  psychological well-being
• It may also be the case that the same levels of
  behaviour in old age are more harmful than at
  younger ages

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The Issue of Self-Efficacy

• There is a growing body of evidence demonstrating
  the role of age as a mediator between behaviour
  and health
• One possible mechanism might be changes in
  perceived self-efficacy or control over health
  with age
• There is some evidence that here are decreases in
  perceived self-efficacy with age Ageing or
  cohort?

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Elderly

• Persons 60 (arbitrary limit)
• Chronological definition
• Social definition
• The experience of being old

Related to indentity
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A correction

• The health status of those 60 is better than
  ever
• Most elderly people can mange without any
  particular help
• Ageing is not identical with disease
• Aged people are not a homogenous group

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Optimal ageing

• Optimal Ageing The potential and preparedness
  for dealing with change (Kilde Baltes Baltes,
  1993).
• Discuss this statement

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Ageing may imply

• Narrowing of choices as a consequence of loss
• Coping relates to use strategies that has proven
  to be effective earlier in life
• Coping may also mean to develop or reformulate
  old strategies to make them fit in a new context

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Critical Life Events
Social Psycological Biological
Social Psycological Biological
Resources
Stressors