Santrock - Cognitive Development Late Adulthood

chapter 18
COGNITIVE DEVELOPMENT
IN LATE ADULTHOOD
chapter outline
1 Cognitive Functioning 3 Work and Retirement
in Older Adults Learning Goal 3 Discuss aging and adaptation
Learning Goal 1 Describe the cognitive to work and retirement
functioning of older adults Work
Multidimensionality and Multidirectionality Retirement in the United States and in Other
Countries
Education, Work, and Health
Adjustment to Retirement
Use It or Lose It
Training Cognitive Skills
Cognitive Neuroscience and Aging 4 Mental Health
Learning Goal 4 Describe mental health
2 Language Development problems in older adults
Depression
Learning Goal 2 Characterize changes in
language skills in older adults Dementia, Alzheimer Disease, and Other Afflictions
5 Religion and Spirituality

Learning Goal 5 Explain the role of religion
and spirituality in the lives of older adults
©Jonathan Kirn/The Image Bank/Getty Images

I n 2010, 90-year-old Helen Small com-
pleted her master’s degree at the Univer-
sity of Texas at Dallas (UT-Dallas). The topic of
her master’s degree research project was romantic relationships in
older adults. Helen said she had interviewed only one individual who
was older than she was at the time—a 92-year-old man.
I (your author, John Santrock) first met Helen when she took my
undergraduate course in life-span development in 2006. After the
first test, Helen stopped showing up and I wondered what had hap-
pened to her. It turns out that she had broken her shoulder when
she tripped over a curb while hurrying to class. The next semester,
she took my class again and did a great job in it, even though for
the first several months she had to take notes with her left hand
(she’s right-handed) because of her lingering shoulder problem.
Helen grew up during the Great Depression and first went to
college in 1938 at the University of Akron but attended for only
one year. She got married and her marriage lasted 62 years. After
her husband’s death, Helen went back to college in 2002, first at
Brookhaven Community College and then at UT-Dallas. When I
Helen Small with the author of your text, John Santrock, in his
undergraduate course on life-span development at the interviewed her recently, she told me that she had promised her
University of Texas at Dallas in spring 2012. Helen returns each mother that she would finish college. Her most important advice
semester to talk with students in the class about cognitive
aging. This past semester, I had to reschedule the date of the for college students is this: “Finish college and be persistent. When
topic because Helen had other work commitments the day it
you make a commitment, always see it through. Don’t quit. Go after
was originally scheduled.
Courtesy of John Santrock what you want in life.”
Helen not only has been a cognitively fit older adult, she also
has been physically fit. She regularly has worked out three times a week for about
an hour each time—aerobically on a treadmill for about 30 minutes and then on
six different weight machines.
What struck me most about Helen when she took my undergraduate course
in life-span development was how appreciative she was of the opportunity to
learn and how tenaciously she pursued studying and doing well in the course.
Helen was quite popular with the younger students and was a terrific role model
for them.
topical connections looking back

Most individuals reach the peak of their cognitive functioning in middle adulthood.
However, some cognitive processes increase while others decline in middle age. For
example, vocabulary peaks and speed of processing decreases in middle age. Expertise
also typically increases during this age period. For many people, midlife is a time when
individuals reflect and evaluate their current work and what they plan to do in the future.
Many middle-aged adults increasingly examine life’s meaning.
548 CHAPTER 18 Cognitive Development in Late Adulthood

After her graduation, I asked her what she planned to do during the next few
years and she responded, “I’ve got to figure out what I’m going to do with the
rest of my life.” Helen has come each semester to my course in life-span develop-
ment when we are discussing cognitive aging. She wows the class and has been
an inspiration to all who come in contact with her.
What has Helen done recently to stay cognitively fit? She has worked as a
public ambassador both for Dr. Denise Park’s Center for Vital Longevity at UT-
Dallas and the Perot Science Museum. And Helen has been active in delivering
meals through the Meals on Wheels organization that seeks to reduce hunger and
social isolation in older adults. She also wrote her first book: Why Not? My Seventy
Year Plan for a College Degree (Small, 2011). It’s a wonderful, motivating invitation
to live your life fully and reach your potential no matter what your age. Following
an amazing, fulfilling life, Helen Small passed away in 2017 at the age of 97.
preview
Helen Small has led a very active cognitive life as an older adult. Just how well older adults can
Helen Small published her first book, Why
and do function cognitively is an important question we will explore in this chapter. We also will Not? My Seventy Year Plan for a College
examine aspects of language development, work and retirement, mental health, and religion. Degree, in 2011 at the age of 91.
Courtesy of Helen Small
1 Cognitive Functioning in Older Adults LG1 Describe the cognitive functioning of older adults.
Multidimensionality Education, Work, Use It or Lose It Training Cognitive Cognitive Neuroscience

and Multidirectionality and Health Skills and Aging
At age 76, Anna Mary Robertson Moses, better known as Grandma Moses, took up painting
and became internationally famous, staging 15 one-woman shows throughout Europe. At age
89, Arthur Rubinstein gave one of his best performances at New York’s Carnegie Hall. When
Pablo Casals was 95, a reporter asked him, “Mr. Casals, you are the greatest cellist who ever
lived. Why do you still practice six hours a day?” Mr. Casals replied, “Because I feel like I am
making progress” (Canfield & Hansen, 1995).
developmental connection
MULTIDIMENSIONALITY AND MULTIDIRECTIONALITY Intelligence
In thinking about the nature of cognitive change in adulthood, it is important to keep in mind Fluid intelligence is the ability to rea-
that cognition is a multidimensional concept (Kinugawa, 2019; Silverman & Schmeidler, 2018; son abstractly; crystallized intelligence
Zammit & others, 2018). It is also important to realize that although some dimensions of is an individual’s accumulated infor-
cognition might decline as we age, others might remain stable or even improve. mation and verbal skills. Connect to
“Physical and Cognitive Development
Cognitive Mechanics and Cognitive Pragmatics Paul Baltes (2003; Baltes,
in Middle Adulthood.”
Lindenberger, & Staudinger, 2006) clarified the distinction between those aspects of the aging
mind that show decline and those that remain stable or even improve:
• Cognitive mechanics are the “hardware” of the mind and reflect the neurophysiological
architecture of the brain that was developed through evolution. Cognitive mechanics con- cognitive mechanics The “hardware” of
sist of these components: speed and accuracy of the processes involved in sensory input, the mind, reflecting the neurophysiological
architecture of the brain. Cognitive mechanics
attention, visual and motor memory, discrimination, comparison, and categorization. involve the speed and accuracy of the
Because of the strong influence of biology, heredity, and health on cognitive mechanics, processes involving sensory input, visual and
this aspect of thinking is likely to decline with age. Some researchers conclude that the motor memory, discrimination, comparison,
decline in cognitive mechanics may begin as soon as early midlife (Salthouse, 2013a, b). and categorization.
SECTION 9 Late Adulthood 549

• Cognitive pragmatics are the culture-based “software programs” of the mind. Cognitive
pragmatics include reading and writing skills, language comprehension, educational
qualifications, professional skills, and also the self-understanding and life skills that
help us to master or cope with challenges. Because of the strong influence of culture
on cognitive pragmatics, it is possible for them to continue improving into old age.
Performance level
Thus, although cognitive mechanics may decline in old age, cognitive pragmatics may
actually improve, at least until individuals become very old (see Figure 1).
The distinction between cognitive mechanics and cognitive pragmatics is similar to the
one between fluid (mechanics) and crystallized (pragmatics) intelligence. Indeed, the similarity
is so strong that some experts now describe cognitive aging patterns in terms of fluid mechanics
Cognitive pragmatics
and crystallized pragmatics (Lovden & Lindenberger, 2007).
Cognitive mechanics
What factors are most likely to contribute to the decline in fluid mechanics in late adult-
hood? Among the most likely candidates are declines in processing speed and working memory
0 25 50 75 100 capacity, and reduced effectiveness in suppressing irrelevant information (inhibition) (Lovden
Life course (years of age) & Lindenberger, 2007).
Now that we have examined the distinction between fluid mechanics and crystallized
FIGURE 1 pragmatics, let’s explore some of the more specific cognitive processes that reflect these two
THEORIZED AGE CHANGES IN general domains, beginning with speed of processing.
COGNITIVE MECHANICS AND
COGNITIVE PRAGMATICS. Baltes argues
that cognitive mechanics decline during Speed of Processing It is now well accepted that the speed of processing information
aging, whereas cognitive pragmatics do not declines in late adulthood (Anblagan & others, 2018; Baudouin, Isingrini, & Vanneste, 2018;
decline for many people until they become Gilsoul & others, 2018; McInerney & Suhr, 2016; Ross & others, 2016; Salthouse, 2012, 2017;
very old. Cognitive mechanics have a Sanders & others, 2017). Figure 2 illustrates this decline through the results of a study that
biological/genetic foundation; cognitive
measured reaction times in adults. A meta-analysis confirmed that processing speed increases
pragmatics have an experiential/cultural
foundation. The broken lines from 75 to
through the childhood and adolescent years, begins to decline at some point during the latter
100 years of age indicate possible individual part of early adulthood, and then continues to decline through the remainder of the adult years
variations in cognitive pragmatics. (Verhaeghen, 2013).
Although speed of processing information slows down in late adulthood, there is consider-
able individual variation in this ability. These variations in thinking speed appear to be cor-
2.0 related with physical aspects of aging. A recent study found that slow processing speed
Average reaction time (seconds)
predicted an increase in older adults’ falls one year later (Davis & others, 2017). Accumulated
knowledge may compensate to some degree for slower processing speed in older adults.
1.5
Researchers have found that a slowing of processing speed at baseline is linked to the
emergence of dementia over the next six years (Welmer & others, 2014). Further, a German
1.0 study of 50- to 90-year-olds found that those who were tested more recently had a faster pro-
cessing speed than their counterparts (at the same age) who were tested six years previously
(Steiber, 2015). And in a large-scale study of middle-aged and older adults, out of 65 mortality
0.5
risk factors, processing speed and health status were among the best predictors of living longer
(Aichele, Rabbitt, & Ghisletta, 2016).
0 The decline in processing speed in older adults is likely due to a decline in functioning
20 30 40 50 60 70 80 of the brain and central nervous system (Anblagan & others, 2018; Demnitz & others, 2017;
Age (years) Hedden & others, 2016). In a research meta-analysis, age-related losses in processing speed
were explained by a decline in neural connectivity or indirectly through changes in dopamine,
FIGURE 2 or both (Verhaeghen, 2013). Another study revealed that age-related slowing in processing
THE RELATION OF AGE TO REACTION speed was linked to a breakdown in myelin in the brain (Lu & others, 2013). Research suggests
TIME. In one study, the average reaction time that processing speed is an important indicator of the ability of older adults to continue to
began to slow in the forties, and this decline
safely drive a vehicle (Edwards & others, 2010; Ross & others, 2016). An analysis of driving
accelerated in the sixties and seventies
(Salthouse, 1994). The task used to assess accidents revealed that approximately 50 percent of accidents in people over 50 years of age
reaction time required individuals to match occur at intersections, compared with only about 23 percent for those under 50 years of age
numbers with symbols on a computer screen. (Michel, 2014). Intersections with yellow traffic lights posed difficulty for older adults, but
when given advance warning 1.5 seconds before the traffic light was about to change from
green to yellow, they were less likely to have an accident. A recent study indicated that impaired
cognitive pragmatics The culture-based visual processing speed predicted an increase in vehicle crashes in older adults (Huisingh &
“software programs” of the mind. Cognitive
others, 2017). And another recent study revealed that cognitive speed of processing training
pragmatics include reading and writing skills,
language comprehension, educational
was linked to driving frequency and prolonged driving across a five-year period in older adults
qualifications, professional skills, and also (Ross & others, 2016).
knowledge about the self and life skills that Recent research has included an effort to improve older adults’ processing speed through
help us to master or cope with life. exercise interventions. For example, a recent experimental study found that high-intensity

aerobic training was more effective than moderate-intensity aerobic training or resistance train-
ing in improving older adults’ processing speed (Coetsee & Terblanche, 2017). And in a recent
study of older adults, playing processing speed games for five sessions a week over four weeks
improved their processing speed (Nouchi & others, 2016).
Attention Changes in attention are important aspects of cognitive aging (Bechi Gabrielli
& others, 2018; Hoyer, 2015; Oren & others, 2018). In many contexts older adults may not be
able to focus on relevant information as effectively as younger adults can (Deroche & others,
2016; Fountain-Zaragoza & Prakash, 2017; Gilsoul & others, 2018; Williams & others, 2017).
Researchers have found that older adults are less able to ignore distracting information
than younger adults, and this distractibility becomes more pronounced as attentional demands
increase (Mund, Bell, & Buchner, 2010; Ziegler, Janowich, & Gazzaley, 2018). Research indi-
cates that the greater distractibility of older adults is associated with less effective functioning
in neural networks running through the frontal and parietal lobes of the brain, which are
involved in cognitive control (Campbell & others, 2012). Also, a research review concluded
that more active and physically fit older adults are better able to allocate attention when inter-
What are some developmental changes in
acting with the environment (Gomez-Pinilla & Hillman, 2013). Another study revealed that attention in late adulthood?
older adults who participated in 20 one-hour video game training sessions with a commercially ©Digital Vision/PunchStock
available program (Lumosity) showed a significant reduction in distraction and increased alert-
ness (Mayas & others, 2014). The Lumosity program sessions focus on problem solving, mental
calculation, working memory, and attention. And in a recent experimental study, yoga practice
that included postures, breathing, and meditation improved the attention and information developmental connection
processing of older adults (Gothe, Kramer, & McAuley, 2017). Also, another recent study
Attention
found that when older adults regularly engaged in mindfulness meditation their goal-directed
Young children make progress in
attention improved (Malinowski & others, 2017).
The chapter on “Physical and Cognitive Development in Early Childhood” described two many aspects of attention, including
types of attention—sustained and executive. Here we will discuss those two types of attention sustained attention and executive
in older adults as well as two other types of attention: selective and divided attention. attention. Connect to “Physical and
Cognitive Development in Early
• Selective attention involves focusing on a specific aspect of experience that is relevant
Childhood.”
while ignoring others that are irrelevant. An example of selective attention is the ability
to focus on one voice among many in a crowded room or a noisy restaurant. Another
is making a decision about which stimuli to attend to when making a left turn at an
intersection. Generally, older adults are less adept at selective attention than younger
adults are (Ben-David & others, 2014; Gilsoul & others, 2018; Zanto & Gazzaley, 2017).
Recent research indicates that older adults’ auditory selective attention with visual dis-
traction is especially impaired (Van Gerven & Guerreiro, 2016). Also, in one study,
10 weeks of training in speed of processing improved the selective attention of older
adults (O’Brien & others, 2013).
• Divided attention involves concentrating on more than one activity at the same time.
When the two competing tasks are reasonably easy, age differences among adults are
minimal or nonexistent. However, the more difficult the competing tasks are, the less
effectively older adults divide attention than younger adults (Bucur & Madden, 2007).
• Sustained attention is focused and extended engagement with an object, task, event, or
some other aspect of the environment. Sometimes sustained attention is referred to as
vigilance. On tests of simple vigilance and sustained attention, older adults usually per-
form as well as younger adults. However, on complex vigilance tasks, older adults’ per- selective attention Focusing on a specific
formance usually drops (Bucur & Madden, 2007). And a study of older adults found aspect of experience that is relevant while
that the greater the variability in their sustained attention (vigilance), the more likely ignoring others that are irrelevant.
they were to experience falls (O’Halloran & others, 2011).
divided attention Concentrating on more
It is possible, however, that older adults’ experience and wisdom might offset some of than one activity at the same time.
their declines in vigilance. For example, consider how frequently young people focus intently
sustained attention Focused and extended
on their smartphone rather than looking at traffic when crossing a dangerous intersection.
engagement with an object, task, event, or
• Executive attention involves planning actions, allocating attention to goals, detecting and other aspect of the environment.
compensating for errors, monitoring progress on tasks, and dealing with novel or diffi-
executive attention Aspects of thinking that
cult circumstances. One study found that older adults had deficiencies in executive include planning actions, allocating attention
attention (Mahoney & others, 2010). In this study, a lower level of executive attention to goals, detecting and compensating for
in older adults was linked to low blood pressure, which likely is related to reduced errors, monitoring progress on tasks, and
blood flow to the brain’s frontal lobes. dealing with novel or difficult circumstances.

Memory The main dimensions of memory and aging that have been studied include
explicit and implicit memory, episodic memory, semantic memory, cognitive resources (such
as working memory and perceptual speed), source memory, prospective memory, and noncog-
nitive influences such as health, education, and socioeconomic factors.
Explicit and Implicit Memory Researchers have found that aging is linked with a
decline in explicit memory (Lustig & Lin, 2016; Reuter-Lorenz & Lustig, 2017). Explicit memory
is memory of facts and experiences that individuals consciously know and can state. Explicit
memory also is sometimes called declarative memory. Examples of explicit memory include
being at a grocery store and remembering what you wanted to buy, being able to name the
capital of Illinois, or recounting the events in a movie you have seen. Implicit memory is
memory without conscious recollection; it involves skills and routine procedures that are per-
formed automatically. Examples of implicit memory include driving a car, swinging a golf club,
or typing on a computer keyboard without having to consciously think about how to perform
these tasks.
Implicit memory is less likely to be adversely affected by aging than explicit memory is
(Nyberg & others, 2012). Thus, older adults are more likely to forget what items they wanted
to buy at a grocery store (unless they write them down on a list and take it with them) than
they are to forget how to drive a car. Their perceptual speed might be slower in driving a car,
but they remember how to do it.
Episodic Memory and Semantic Memory Episodic and semantic memory are
viewed as forms of explicit memory. Episodic memory is the retention of information about
the details of life’s happenings. For example, what was the color of the walls in your bedroom
when you were a child, what was your first date like, what were you doing when you heard
that airplanes had struck the World Trade Center, and what did you eat for breakfast this
morning?
Younger adults have better episodic memory than older adults have, both for real and
imagined events (Allen & others, 2018; Despres & others, 2017; Siegel & Castel, 2018; Wang
& Cabeza, 2017). A study of 18- to 94-year-olds revealed that increased age was linked to
increased difficulty in retrieving episodic information, facts, and events (Siedlecki, 2007). Also,
older adults think that they can remember older events better than more recent events, typically
reporting that they can remember what happened to them years ago but can’t remember what
they did yesterday. However, researchers consistently have found that, contrary to such self-
reports, in older adults the older the memory, the less accurate it is. This has been documented
in studies of memory for high school classmates, foreign languages learned in school over the
life span, names of grade school teachers, and autobiographical facts kept in diaries (Smith,
1996). A recent study found that episodic memory performance predicted which individuals
would develop dementia 10 years prior to the clinical diagnosis of the disease (Boraxbekk &
others, 2015). In a recent study, a mindfulness training program was effective in improving
episodic memory recall in older adults (Banducci & others, 2017).
Semantic memory is a person’s knowledge about the world. It includes a person’s fields
of expertise, such as knowledge of chess for a skilled chess player; general academic knowledge
of the sort learned in school, such as knowledge of geometry; and “everyday knowledge” about
the meanings of words, the names of famous individuals, the significance of important places,
explicit memory Memory of facts and
and common things such as what day is Valentine’s Day. Semantic memory appears to be
experiences that individuals consciously
know and can state. independent of an individual’s personal identity with the past. For example, you can access a
fact—such as “Lima is the capital of Peru”—and not have the foggiest idea of when and where
implicit memory Memory without conscious you learned it.
recollection; involves skills and routine Does semantic memory decline with age? Among the tasks that researchers often use to
procedures that are automatically performed.
assess semantic memory are those involving vocabulary, general knowledge, and word identi-
episodic memory The retention of fication (Miotto & others, 2013). Older adults do often take longer to retrieve semantic infor-
information about the details of life’s mation, but usually they can ultimately retrieve it. However, the ability to retrieve very specific
happenings. information (such as names) usually declines in older adults (Hoffman & Morcom, 2018; Luo
& Craik, 2008). For the most part, episodic memory declines more than semantic memory in
semantic memory A person’s knowledge
about the world—including one’s fields of
older adults (Allen & others, 2018; Lustig & Lin, 2016; Reuter-Lorenz & Lustig, 2017; Siegel
expertise, general academic knowledge of & Castel, 2018).
the sort learned in school, and “everyday Although many aspects of semantic memory are reasonably well preserved in late adult-
knowledge.” hood, a common memory problem for older adults is the tip-of-the-tongue (TOT) phenomenon,

in which individuals can’t quite retrieve familiar information but have the feeling that they
should be able to retrieve it (Salthouse & Mandell, 2013). Researchers have found that older
adults are more likely to experience TOT states than younger adults are (Huijbers & others,
2017). A study of older adults found that the most commonly reported errors in memory over
the last 24 hours were those involving tip-of-the-tongue (Ossher, Flegal, & Lustig, 2013).
Cognitive Resources: Working Memory and Perceptual Speed One view of

memory suggests that a limited amount of cognitive resources can be devoted to any cognitive
task. Two important cognitive resource mechanisms are working memory and perceptual speed
(Baddeley, 2015, 2017, 2018a, b; McInerney & Suhr, 2016). Recall that working memory is
closely linked to short-term memory but places more emphasis on memory as a place for
mental work. Working memory is like a mental “workbench” that allows children and adults
to manipulate and assemble information when making decisions, solving problems, and com-
prehending written and spoken language (Baddeley, 2007, 2010, 2012, 2015, 2017, 2018a, b).
Researchers have found declines in working memory during late adulthood (Dai, Thomas, &
Taylor, 2018; Kilic, Sayali, & Oztekin, 2017; Nissim & others, 2017). One study revealed that
working memory continued to decline from 65 to 89 years of age (Elliott & others, 2011).
Explanations of the decline in working memory in older adults often focus on their less
efficient inhibition (preventing irrelevant information from entering working memory) and their
increased distractibility (Lopez-Higes & others, 2018; Lustig & Lin, 2016; Reuter-Lorenz &
Lustig, 2017). Is there plasticity in the working memory of older adults? Researchers have
found that older adults’ working memory can be improved through training (Cantarella &
others, 2017; Reuter-Lorenz & Lustig, 2017). And a research meta-analysis concluded that
training on working memory can improve fluid intelligence (Au & others, 2015). Also, an
experimental study revealed that moderate exercise resulted in faster reaction times on a work-
ing memory task in older adults (Hogan, Mata, & Carstensen, 2013). Further, in a recent study,
aerobic endurance was linked to better working memory in older adults (Zettel-Watson &
others, 2017). In addition, a recent study revealed that imagery strategy training improved the
working memory of older adults (Borella & others, 2017). Thus, there appears to be some
plasticity in the working memory of older adults (Oh & others, 2018). However, a recent study
of young, middle-aged, and older adults found that all age groups’ working memory improved
with working memory training, but the improvement was less in older adults than in young
adults (Rhodes & Katz, 2017).
Perceptual speed is a cognitive resource that involves the ability to perform simple per-
ceptual-motor tasks such as deciding whether pairs of two-digit or two-letter strings are the
same or different or determining the time required to step on the brakes when the car directly
ahead stops. Perceptual speed shows considerable decline in late adulthood and is strongly
linked to declines in working memory (Hoogendam & others, 2014; Salthouse, 2017; Wilson
& others, 2018). One study revealed that age-related slowing in processing speed was linked
to a breakdown in myelin in the brain (Lu & others, 2013). And in another study of older
adults, slower processing speed was associated with unsafe driving acts (Hotta & others, 2018).
However, another study found that 10 hours of training targeted toward enhancing visual speed
of processing was effective in improving older adults’ speed of processing, attention, and execu-
tive function (Wolinksy & others, 2013).
Source Memory Source memory is the ability to remember where one learned something
(Ward, 2018). Failures of source memory increase with age in the adult years and they can
create awkward situations, as when an older adult forgets who told a joke and retells it to the
source (El Haj, Fasotti, & Allain, 2015; Meusel & others, 2017). One study revealed that self- This older woman has forgotten where she
referenced encoding improved the source memory of older adults (Leshikar & Duarte, 2014). put the keys to her car. What type of memory
Lynn Hasher (2003, p. 1301) argues that age differences in performance are substantial is involved in this situation?
©Clarissa Leahy/The Image Bank/Getty Images
in many tests of memory, such as source memory, when individuals are asked “for a piece of
information that just doesn’t matter much. But if you ask for information that is important,
old people do every bit as well as young adults . . . young people have mental resources to
burn. As people get older, they get more selective in how they use their resources.”
Prospective Memory Prospective memory involves remembering to do something in the source memory The ability to remember
where one learned something.
future, such as remembering to take your medicine or remembering to do an errand (Ballhausen
& others, 2017; Ihle, Ghisletta, & Kliegel, 2017; Insel & others, 2016; Simard & others, 2018; prospective memory Remembering to do
Sullivan & others, 2018). Also, prospective memory has been referred to as remembering to something in the future.

remember (Kliegel & others, 2016). In one study, prospective memory played an important
role in older adults’ successful management of the medications they needed to take (Woods
& others, 2014). Some researchers have found a decline in prospective memory with age
(Kennedy & others, 2015; Smith & Hunt, 2014). However, a number of studies show that
whether there is a decline depends on factors such as the nature of the task, what is being
assessed, and the context of the assessment (Mullet & others, 2013; Scullin, Bugg, & McDaniel,
2012). For example, age-related deficits occur more often in prospective memory tasks that are
time-based (such as remembering to call someone next Friday) than in those that are event-
based (remembering to tell your friend to read a particular book the next time you see her).
Further, declines in prospective memory occur more often in laboratories than in real-life
settings (Bisiacchi, Tarantino, & Ciccola, 2008). Indeed, in some real-life settings, such as
keeping appointments, older adults’ prospective memory is better than younger adults’ (Luo
& Craik, 2008). And a recent study found that planning strategies were associated with older
Prospective memory involves remembering to
adults’ prospective memory (Wolff & others, 2016).
do something in the future. This woman is
keeping track of what she plans to buy when
she goes to a grocery store the next day. Conclusions About Memory and Aging Most, but not all, aspects of memory
©DAJ/Getty Images decline during late adulthood (Reuter-Lorenz & Lustig, 2017). The decline occurs primarily in
explicit, episodic, and working memory, not in semantic memory or implicit memory (Allen
& others, 2018; Lopez-Higes & others, 2018). A decline in perceptual speed is associated with
memory decline (Salthouse, 2017; Wilson & others, 2018). Successful aging does not mean elimi-
nating memory decline altogether, but it does mean reducing the decline and adapting to it.
Older adults can use certain strategies to reduce memory decline (Bottiroli & others, 2017;
Hinault, Lemaire, & Touron, 2017; Frankenmolen & others, 2018; Karthaus, Wascher, &
Getzmann, 2018; Kuhlmann & Touron, 2017). In recent research, strategies involving elabora-
tion and self-referential processing were effective in improving the memory of older adults,
actually helping older adults’ memory more than younger adults’ memory (Trelle, Henson, &
Simons, 2015). However, a recent analysis concluded that older adults are slower than younger
adults in shifting from an initial effortful strategy to using a faster and easier memory-based
strategy (Touron, 2015). In a recent study, using compensation strategies (for example, manag-
ing appointments by routinely writing them on a calendar) was associated with higher levels
of independence in everyday function in cognitively normal older adults and older adults with
mild cognitive impairment (Tomaszewski Farias & others, 2018).
Executive Function Recall that executive function is an umbrella-like concept that con-
developmental connection sists of a number of higher-level cognitive processes linked to the development of the brain’s
Cognitive Processes prefrontal cortex (Reuter-Lorenz, Festini, & Jantz, 2016). Executive function involves managing
Executive function is increasingly rec- one’s thoughts to engage in goal-directed behavior and to exercise self-control.
ognized as an important facet of cog- How does executive function change in late adulthood? The prefrontal cortex is one area
nitive development. Connect to of the brain that especially shrinks with aging, and recent research has linked this shrinkage
“Physical and Cognitive Development with a decrease in working memory and other cognitive activities in older adults (Reuter-Lorenz
in Early Childhood,” “Physical and & Lustig, 2017). One study found that dysregulation of signaling by the neurotransmitter GABA
Cognitive Development in Middle may play a role in impaired working memory in older adults (Banuelos & others, 2014).
and Late Adulthood,” and “Physical Executive function skills decline in older adults (Gaillardin & Baudry, 2018; Lin & others,
and Cognitive Development in 2017). Aspects of working memory that especially decline in older adults involve (1) updating
Adolescence.” memory representations that are relevant for the task at hand and (2) replacing old, no longer
relevant information (Friedman & others, 2008). Older adults also are less effective at engaging
in cognitive control than when they were younger (Lin & others, 2017; Zammit & others,
2018). For example, in terms of cognitive flexibility, older adults don’t perform as well as
younger adults at switching back and forth between tasks or mental sets (Chiu & others, 2018).
And in terms of cognitive inhibition, older adults are less effective than younger adults at
inhibiting dominant or automatic responses (Lopez-Higes & others, 2018; Reuter-Lorenz,
Festini, & Jantz, 2016).
Although aspects of executive function tend to decline in late adulthood, there is consider-
able variability in executive function among older adults. For example, some older adults have
a better working memory and are more cognitively flexible than other older adults (Kayama
& others, 2014). Further, there is increasing research evidence that aerobic exercise improves
executive function in older adults (Eggenberger & others, 2015). For example, a recent study
of older adults revealed that across a 10-year period physically active women experienced less
decline in executive function than sedentary women (Hamer, Muniz Terrera, & Demakakos,

2018). And in another study, more physically fit older adults had greater cognitive flexibility
than their less physically fit counterparts (Berryman & others, 2013). Also, in a research meta-
analysis, tai chi participation was associated with better executive function in older adults
(Wayne & others, 2014).
Executive function increasingly is thought to be involved not only in cognitive perfor-
mance but also in health, emotion regulation, adaptation to life’s challenges, motivation, and
social functioning (Forte & others, 2013). Research on these aspects of executive function has
only recently begun. In one study, deficits in executive function but not memory predicted a
higher risk of coronary heart disease and stroke three years later in older adults (Rostamian
& others, 2015).
Some critics argue that not much benefit is derived from placing various cognitive pro-
cesses under the broader concept of executive function. Although we have described a number
of components of executive function here—working memory, cognitive inhibition, cognitive
flexibility, and so on—a consensus has not been reached on what the components are, how
they are connected, and how they develop. That said, the concept of executive function is not
likely to go away any time soon, and further research, especially meta-analyses, should provide
a clearer picture of executive function and how it develops through the life span (Luszcz, 2011).
Decision Making Despite declines in many aspects of memory, such as working memory
and long-term memory, many older adults preserve decision-making skills reasonably well
(Healey & Hasher, 2009; You & others, 2018). However, some researchers have found negative
changes in decision making in older adults (Eppinger & others, 2013). One study revealed that
compared with younger adults, older adults were far more inconsistent in their choices (Tymula
& others, 2013). Also, in some cases, age-related decreases in memory will impair decision
making (Brand & Markowitsch, 2010). One study revealed that a reduction in effective decision
making in risky situations during late adulthood was linked to declines in memory and process-
ing speed (Henninger, Madden, & Huettel, 2010). Also, in a recent study, younger adults made
better decisions than older adults in unfamiliar domains, but not in familiar domains (Wayde,
Black, & Gilpin, 2017). Further, older adults often perform well when decision making is not
constrained by time pressures, when the decision is meaningful for them, and when the deci-
sions do not involve high risks (Boyle & others, 2012; Yoon, Cole, & Lee, 2009).
Metacognition By middle age, adults have accumulated a great deal of metacognitive

knowledge. They can draw on this metacognitive knowledge to help them combat a decline in
memory skills. For example, they are likely to understand that they need to have good orga-
nizational skills and reminders to help combat the decline in memory skills they face.
Older adults tend to overestimate the memory problems they experience on a daily basis.
They seem to be more aware of their memory failures than younger adults and become more
anxious about minor forgetfulness than younger adults do (Hoyer & Roodin, 2009). Researchers
have found that in general older adults are as accurate as younger adults in monitoring the
encoding and retrieval of information (McGillivray & Castel, 2017), as well as detecting errors
when asked to proofread passages and judging their own performance (Hargis & others, 2017).
However, some aspects of monitoring information, such as source memory (discussed earlier
in the chapter), decline in older adults (Souchay & others, 2007).
Mindfulness Recall that mindfulness involves being alert, mentally present, and cogni-
tively flexible while going through life’s everyday activities and tasks. Recently, there has been
growing interest in mindfulness training with older adults, which has mainly focused on medita-
tion (Fountain-Zaragoza & Prakash, 2017). Some, but not all, studies have shown that mindful-
ness training improves older adults’ cognitive functioning (Fountain-Zaragoza & Prakahs, 2017;
Kovach & others, 2018; Oken & others, 2018). In one study, a mindfulness-based stress reduc-
tion program involving meditation improved older adults’ memory and inhibitory control
(Lenze & others, 2014).
Wisdom Does wisdom, like good wine, improve with age? What is this thing we call “wis-
dom”? A research review found 24 definitions of wisdom, although there was significant overlap
in the definitions (Bangen, Meeks, & Jest, 2013). In this review, the following subcomponents
of wisdom were commonly cited: knowledge of life, prosocial values, self-understanding,
acknowledgment of uncertainty, emotional balance, tolerance, openness, spirituality, and sense
of humor.

Thus, while there is still some disagreement regarding how wisdom should be defined, the
following definition of wisdom has been used by leading expert Paul Baltes and his colleagues
(Baltes & Kunzmann, 2007; Baltes & Smith, 2008): Wisdom is expert knowledge about the
practical aspects of life that permits excellent judgment about important matters. This practical
knowledge involves exceptional insight into human development and life matters, good judg-
ment, and an understanding of how to cope with difficult life problems.
Thus, wisdom, more than standard conceptions of intelligence, focuses on life’s pragmatic
concerns and human conditions (Kuntzmann, 2019; Sternberg, 2018i; Sternberg & Glueck,
2018; Sternberg & Hagen, 2018). A recent study found that self-reflective exploratory process-
ing of difficult life experiences (meaning-making and personal growth) was linked to a higher
level of wisdom (Westrate & Gluck, 2017).
In regard to wisdom, research by Baltes and his colleagues (Baltes & Kunzmann, 2007;
Older adults might not be as quick with their Baltes & Smith, 2008) yielded the following findings:
thoughts or behavior as younger people, but
wisdom may be an entirely different matter. • High levels of wisdom are rare. Few people, including older adults, attain a high level
This older woman shares the wisdom of her of wisdom. That only a small percentage of adults show wisdom supports the conten-
experience with a classroom of children. tion that it requires experience, practice, or complex skills.
How is wisdom described by life-span • The time frame of late adolescence and early adulthood is the main age window for
developmentalists?
©Elizabeth Crews
wisdom to emerge (Staudinger & Dorner, 2007; Staudinger & Gluck, 2011). No further
advances in wisdom have been found for middle-aged and older adults beyond the level
they attained as young adults.
• Factors other than age are critical for wisdom to develop to a high level. For example,
certain life experiences, such as being trained and working in a field concerned with
difficult life problems and having wisdom-enhancing mentors, contribute to higher levels
of wisdom. Also, people higher in wisdom have values that are more likely to consider
the welfare of others than to focus solely on their own happiness.
• Personality-related factors, such as openness to experience, generativity, and creativity,
are better predictors of wisdom than cognitive factors such as intelligence.
EDUCATION, WORK, AND HEALTH

Education, work, and health are three important influences on the cognitive functioning of
older adults (Calero, 2019; Walker, 2019). They are also three of the most important factors
involved in understanding why cohort effects need to be taken into account in studying the
cognitive functioning of older adults. Indeed, cohort effects are very important considerations
in the study of cognitive aging (Schaie, 2013, 2016a). For example, a recent study found that
older adults assessed in 2013–2014 engaged in a higher level of abstract reasoning than their
counterparts who had been assessed two decades earlier (Gerstorf & others, 2015). And a recent
study of older adults in 10 European countries revealed improved memory between 2004 and
2013, with the changes more positive for older adults who had decreases in cardiovascular
disease and increases in exercise and educational achievement (Hessel & others, 2018).
Education Successive generations in America’s twentieth century were better educated,

and this trend continues in the twenty-first century (Schaie, 2013, 2016a). Not only were today’s
older adults more likely to go to college when they were young adults than were their parents
or grandparents, but more older adults are returning to college today to further their education
than in past generations. Educational experiences are positively correlated with scores on
intelligence tests and information-processing tasks, such as memory exercises (Steffener &
others, 2014). One study revealed that older adults with less education had lower cognitive
abilities than those with more education (Lachman & others, 2010). However, for older adults
with less education, frequently engaging in cognitive activities improved their episodic memory.
Another study found that older adults with a higher level of education had better cognitive
functioning (Rapp & others, 2013).
Work Successive generations have also had work experiences that included a stronger empha-
sis on cognitively oriented labor. Our great-grandfathers and grandfathers were more likely to
wisdom Expert knowledge about the practical be manual laborers than were our fathers, who are more likely to be involved in cognitively
aspects of life that permits excellent judgment oriented occupations. As the industrial society continues to be replaced by the information
about important matters. society, younger generations will have more experience in jobs that require considerable

cognitive investment. The increased emphasis on complex information processing in jobs likely
enhances an individual’s intellectual abilities (Lovden, Backman, & Lindenberger, 2017).
Researchers have found that when older adults engage in complex working tasks and
challenging daily work activities, their cognitive functioning shows less age-related decrease
(Fisher & others, 2017; Lovden, Backman, & Lindenberger, 2017). For example, in a recent
Australian study, older adults who had retired from occupations that involved higher complex-
ity maintained their cognitive advantage over their counterparts whose occupations had
involved lower complexity (Lane & others, 2017). Also, a study of middle-aged and older adults
found that employment gaps involving unemployment or sickness were associated with a higher
risk of cognitive impairment (Leist & others, 2013). Further, researchers have found that work-
ing in an occupation with a high level of mental demands is linked to higher levels of cognitive
functioning before retirement and a slower rate of cognitive decline after retirement (Fisher &
others, 2014). And in another recent study of older adults working in low-complexity jobs,
experiencing novelty in their work (assessed through recurrent work-task changes) was linked
with better processing speed and working memory (Oltmanns & others, 2017).
Health Successive generations have also been healthier in late adulthood as better treat-
ments for a variety of illnesses (such as hypertension) have been developed. Many of these
illnesses, such as stroke, heart disease, and diabetes have a negative impact on intellectual
performance (Li, Huang, & Gao, 2017; Loprinzi, Crush, & Joyner, 2017). Hypertension has
been linked to lower cognitive performance in a number of studies, not only in older adults
but also in young and middle-aged adults (Kherada, Heimowitz, & Rosendorff, 2015; van der
Flier & others, 2018). Also, researchers have found that cardiovascular disease is associated
with cognitive decline in older adults (Hagenaars & others, 2018; Hessel & others, 2018).
Further, in a recent review of older adults with type 2 diabetes, it was concluded that the
disease was linked with an increase in cognitive impairment (Riederer & others, 2017). In
addition, a recent study of the oldest-old Chinese revealed that early-stage chronic kidney
disease was associated with cognitive decline (Bai & others, 2017). And, as we will see later
in this chapter, Alzheimer disease has a devastating effect on older adults’ physical and cogni-
tive functioning (Park & Farrell, 2016). Researchers also have found age-related cognitive
decline in adults with mood disorders such as depression (Farioli-Vecchioli & others, 2018;
Bourassa & others, 2017). Thus, some of the decline in intellectual performance found in older
adults is likely due to health-related factors rather than to age per se (Drew & others, 2017;
Harrison & others, 2017; Koyanagi & others, 2018; Lin & others, 2017).
A number of research studies have found that exercise is linked to improved cognitive
functioning in older adults (Erickson & Liu-Ambrose, 2016; Gill & others, 2016; Kennedy &
others, 2017; Macpherson & others, 2017; Moreira & others, 2018; Strandberg, 2019; Walker,
2019). Walking or any other aerobic exercise appears to get blood and oxygen pumping to the
brain, which can help people think more clearly.
Dietary patterns also are linked to cognitive functioning in older adults (Perkisas &
Vandewoude, 2019). For example, a recent research review concluded that multinutrient
approaches using the Mediterranean diet are linked to a lower risk of cognitive impairment
(Abbatecola, Russo, & Barbieri, 2018).
A final aspect of health that is related to cognitive functioning in older adults is terminal
decline. This concept emphasizes that changes in cognitive functioning may be linked more to
distance from death or cognition-related pathology than to distance from birth (Bendayan &
others, 2017; Gerstorf & Ram, 2015; Wilson & others, 2018; Zaslavsky & others, 2015). In How are education, work, and health linked
one study, on average, a faster rate of cognitive decline occurred about 7.7 years prior to death to cognitive functioning in older adults?
(Top) ©Silverstock/Getty Images; (middle) ©Kurt Paulus/Getty
and varied across individuals (Muniz-Terrera & others, 2013). Also, in a recent Swedish study, Images; (bottom) ©Tom Grill/Corbis
time to death was a good predictor of cognitive decline over time (Bendayan & others, 2017).
USE IT OR LOSE IT developmental connection

Health
Changes in cognitive activity patterns might result in disuse and consequent atrophy of cogni-
Exercise is linked to increased longev-
tive skills (Calero, 2019; Fisher & others, 2017; Kinugawa, 2019; Kunzmann, 2019; Lovden,
ity and the prevention of common
Backman, & Lindenberger, 2017; Oltmanns & others, 2017; Park & Festini, 2018). This concept
chronic diseases. Connect to “Physical
is captured by the phrase “use it or lose it.” Mental activities that likely benefit the maintenance
Development in Late Adulthood.”
of cognitive skills in older adults include reading books, doing crossword puzzles, and going
to lectures and concerts. “Use it or lose it” also is a significant component of the engagement

model of cognitive optimization that emphasizes how intellectual and social engagement can
buffer age-related declines in intellectual development (Mistridis & others, 2017; Reuter-Lorenz
& Lustig, 2017). The following studies support the “use it or lose it” concept and the engage-
ment model of cognitive optimization:
• In the Victoria Longitudinal Study, participation in intellectually engaging activities
buffered middle-aged and older adults against cognitive decline (Hultsch & others,
1999). Further analyses of the participants in this study revealed that engagement in
cognitively complex activities was linked to faster and more consistent processing speed
(Bielak & others, 2007). And in the most recent analysis of these older adults over a
12-year period, those who reduced their cognitive lifestyle activities (such as using a
computer, playing bridge) subsequently showed decline in cognitive functioning in ver-
bal speed, episodic memory, and semantic memory (Small & others, 2012). The decline
in cognitive functioning was linked to subsequent lower engagement in social activities.
• In the Baltimore Experience Corps program, an activities engagement—health promo-
tion for older adults that involved their volunteerism in underserved urban elementary
schools—improved older adults’ cognitive and brain functioning (Carlson & others,
2015; Parisi & others, 2012, 2014, 2015).
• In a longitudinal study of 801 Catholic priests 65 years and older, those who regularly
read books, did crossword puzzles, or otherwise exercised their minds were 47 percent
less likely to develop Alzheimer disease than the priests who rarely engaged in these
An advertisement for a 2008 documentary
activities (Wilson & others, 2002).
about the Young@Heart chorus, whose • Reading daily was linked to increased longevity for men in their seventies (Jacobs &
average age is 80. The documentary displays others, 2008).
the singing talents, energy, and optimism of a • At the beginning of a longitudinal study, 75- to 85-year-olds indicated how often they
remarkable group of older adults, who clearly
are on the “use it” side of “use it or lose it.”
participated in six activities—reading, writing, doing crossword puzzles, playing card or
©Everett Collection, Inc./Alamy board games, having group discussions, and playing music—on a daily basis (Hall &
others, 2009). Across the five years of the study, the point at which memory loss accel-
erated was assessed and it was found that for each additional activity the older adult
engaged in, the onset of rapid memory loss was delayed by 0.18 years. For older adults
who participated in 11 activities per week compared with their counterparts who
It is always in season for the engaged in only 4 activities per week, the point at which accelerated memory decline
occurred was delayed by 1.29 years.
old to learn.
—Aeschylus
Greek Playwright, 5th Century b.c. TRAINING COGNITIVE SKILLS
If older adults are losing cognitive skills, can they be retrained? An increasing number of
research studies indicate that retraining is possible to some degree (Calero, 2019; Cantarella
& others, 2017; Gmiat & others, 2018; Kinugawa, 2019; Lopez-Higes & others, 2018; Reuter-
Lorenz & Lustig, 2017; Tommaso & others, 2018). Two key conclusions can be derived from
research in this area: (1) training can improve the cognitive skills of many older adults, but
(2) there is some loss in plasticity in late adulthood, especially in those who are 85 years and
older (Baltes, Lindenberger, & Staudinger, 2006). Let’s now examine the results of several
cognitive training studies involving older adults.
A study of 60- to 90-year-olds found that sustained engagement in cognitively demand-
ing, novel activities improved the older adults’ episodic memory (Park & others, 2014). To
produce this result, the older adults spent an average of 16.5 hours a week for three months
learning how to quilt or how to use digital photography. Consider also a recent study of 60-
to 90-year-olds in which iPad training 15 hours a week for 3 months improved their episodic
memory and processing speed relative to engaging in social or non-challenging activities
(Chan & others, 2016).
Researchers are also finding that improving the physical fitness of older adults can improve
their cognitive functioning (Coetsee & Terblanche, 2018; Erickson & Liu-Ambrose, 2016;
Gmiat & others, 2018; Erickson & Oberlin, 2017; Strandberg, 2019; Walker, 2019). A research
review revealed that aerobic fitness training in older adults improved their performance in the
areas of planning, scheduling, working memory, resistance to distraction, and handling multiple
To what extent can training improve cognitive
functioning of older adults? tasks (Colcombe & Kramer, 2003). In another research review, engaging in low or moderate
©Blend Images/Alamy exercise was linked to improved cognitive functioning in older adults with chronic diseases

(Cai & others, 2017). Also, in a recent study, engagement in physical activity in late adulthood
was linked to less cognitive decline (Gow, Pattie, & Deary, 2017).
Meta-examinations of four longitudinal observational studies (Long Beach Longitudinal
Study; Origins of Variance in the Oldest-old [Octo-Twin] Study in Sweden; Seattle Longitudinal
Study; and Victoria Longitudinal Study in Canada) of older adults’ naturalistic cognitive activi-
ties found that changes in cognitive activity predicted cognitive outcomes as long as two decades
later (Brown & others, 2012; Lindwall & others, 2012; Mitchell & others, 2012). However, the
studies provided no support for the concept that engaging in cognitive activity at an earlier
point in development improved older adults’ ability to later withstand cognitive decline. On a
positive note, when older adults continued to increase their engagement in cognitive and physi-
cal activities, they were better able to maintain their cognitive functioning in late adulthood.
The Stanford Center for Longevity (2011) and the Stanford Center for Longevity in part-
nership with the Max Planck Institute for Human Development (2014) reported information
based on the views of leading scientists in the field of aging. One of their concerns is the
misinformation given to the public touting products to improve the functioning of the mind
for which there is no scientific evidence. Nutritional supplements, brain games, and software
products have all been advertised as “magic bullets” to slow the decline of mental functioning
and improve the mental ability of older adults. Some of the claims are reasonable but not
scientifically tested, while others are unrealistic and implausible (Willis & Belleville, 2016). A
research review of dietary supplements and cognitive aging did indicate that ginkgo biloba was
linked with improvements in some aspects of attention in older adults and that consuming
omega-3 polyunsaturated fatty acids (fish oil) was related to reduced risk of age-related cogni-
tive decline (Gorby, Brownawell, & Falk, 2010). In this research review, there was no evidence
of cognitive improvements in aging adults who took supplements containing ginseng and glu-
cose. Also, an experimental study with 50- to 75-year-old females found that those who took
fish oil for 26 weeks had improved executive function and beneficial effects on a number of
areas of brain functioning compared with their female counterparts who took a placebo pill
(Witte & others, 2014). In another study, fish oil supplement use was linked to higher cognitive
scores and less atrophy in one or more brain regions (Daiello & others, 2015). And in a
recent study, fish oil supplementation improved the working memory of older adults (Boespflug
& others, 2016). Overall, though, most research has not provided consistent plausible evidence
that dietary supplements can accomplish major cognitive goals in aging adults over a number
of years.
However, some software-based cognitive training games have been found to improve older
adults’ cognitive functioning (Charness & Boot, 2016; Lampit & others, 2015; Nouchi & others,
2013; Ordonez & others, 2017; Szelag, 2018). For example, a study of 60- to 85-year-olds found
that a multitasking video game that simulates day-to-day driving experiences (NeuroRacer)
improved cognitive control skills, such as sustained attention and working memory, after train-
ing on the video game and six months later (Anguera & others, 2013). In another recent study,
computerized cognitive training slowed the decline in older adults’ overall memory perfor-
mance, an outcome that was linked to enhanced connectivity between the hippocampus and
prefrontal cortex (Suo & others, 2016). In a research meta-analysis, computerized cognitive
training resulted in modest improvement in some cognitive processes (nonverbal memory,
verbal memory, working memory, processing speed, and visuospatial skills) but did not improve
executive function and attention (Lampit, Hallock, & Valenzuela, 2014). And in another recent
study, cognitive training using virtual reality-based games with stroke patients improved their
attention and memory (Gamito & others, 2017). Nonetheless, it is possible that the training
games may improve cognitive skills in a laboratory setting but not generalize to gains in the
real world.
After examining research findings, Stanford Center for Longevity and the Max Planck
Institute for Human Development (2014) concluded that the effectiveness of brain games has
often been exaggerated and the research evidence for many success claims is often weak or
unfounded. They also concluded that there is little evidence that playing brain games in late
adulthood improves underlying broad cognitive abilities or that the games help older adults to
function more competently in everyday life.
In sum, some improvements in the cognitive vitality of older adults can be accomplished
through some types of cognitive, physical activity, and nutritional interventions (Bo & others,
2017; Erickson & Oberlin, 2017; Faroli-Vecchioli & others, 2018; Gillian & others, 2019;
Perkisas & Vandewoude, 2019; Reuter-Lorenz & Lustig, 2017; Strandberg, 2019). However,

benefits have not been observed in all studies (Salthouse, 2007, 2017). Further research is
needed to determine more precisely which cognitive improvements occur in older adults as a
result of training (Salthouse, 2017).
COGNITIVE NEUROSCIENCE AND AGING

developmental connection We have seen that certain regions of the brain are involved in links between aging and cognitive
functioning. In this section, we further explore the substantial increase in interest in the brain’s
Brain Development
role in aging and cognitive functioning. The field of cognitive neuroscience has emerged as the
The activities older adults engage in
major discipline that explores the links between brain activity and cognitive functioning (Ken-
can influence the brain’s development. nedy & others, 2017; Kinugawa, 2019; Nyberg, Pudas, & Lundquist, 2017; Park & Festini, 2018;
Connect to “Physical Development in Riekmann, Buckner, & Hedden, 2017). This field especially relies on brain-imaging techniques
Late Adulthood.” such as fMRI, PET, and DTI (diffusion tensor imaging) to reveal the areas of the brain that
are activated when individuals engage in certain cognitive activities (Madden & Parks, 2017;
Park & Festini, 2017, 2018). For example, as an older adult is asked to encode and then retrieve
verbal materials or images of scenes, the older adult’s brain activity will be monitored by an
fMRI brain scan.
Changes in the brain can influence cognitive functioning, and changes in cognitive
functioning can influence the brain (Kinugawa, 2019). For example, aging of the brain’s
prefrontal cortex may produce a decline in working memory (Reuter-Lorenz & Lustig,
2017). And when older adults do not regularly use their working memory (recall the section
on “Use It or Lose It”), neural connections in the prefrontal lobe may atrophy. Further,
cognitive interventions that activate older adults’ working memory may increase these neural
connections.
Despite being in its infancy as a field, the cognitive neuroscience of aging is beginning to
uncover some important links between aging, the brain, and cognitive functioning (Berron &
others, 2018; Bettio, Rajendran, & Gil-Mohapel, 2017; Cabeza, Nyberg, & Park, 2017; Ezaki &
others, 2018; Kinugawa, 2019; Park & Festini, 2018; Reuter-Lorenz & Lustig, 2017; Rugg, 2017).
These include the following:
• Neural circuits in specific regions of the brain’s prefrontal cortex
decline, and this decline is linked to poorer performance by older
adults on tasks involving complex reasoning, cognitive inhibition, work-
ing memory, and episodic memory (Grady & others, 2006; Reuter-
Lorenz & Lustig, 2017) (see Figure 3).
• Older adults are more likely than younger adults to use both hemi-
spheres of the brain to compensate for declines in attention, memory,
executive function, and language that occur with age (Davis & others,
2012; Dennis & Cabeza, 2008; Reuter-Lorenz, Festini, & Jantz, 2016).
For example, two neuroimaging studies found that older adults showed
better memory performance when both hemispheres of the brain were
active in processing information (Angel & others, 2011; Manenti,
Cotelli, & Miniussi, 2011).
• Functioning of the hippocampus declines to a lesser degree than the
functioning of the frontal lobes in older adults (Antonenko & Floel,
2014). In K. Warner Schaie’s (2013) research, individuals whose mem-
ory and executive function declined in middle age had more hippocam-
pal atrophy in late adulthood, but those whose memory and executive
function improved in middle age did not show a decline in hippocam-
pal functioning in late adulthood.
• Patterns of neural decline with aging are more dramatic for retrieval
FIGURE 3 than for encoding (Gutchess & others, 2005).
THE PREFRONTAL CORTEX. Advances in neuroimaging are • Compared with younger adults, older adults often show greater
allowing researchers to make significant progress in connecting activity in the frontal and parietal lobes of the brain on simple
changes in the brain with cognitive development. Shown here is tasks but as attentional demands increase, older adults display
an fMRI of the brain’s prefrontal cortex. What links have been
less effective functioning in areas of the frontal and parietal lobes
found between the prefrontal cortex, aging, and cognitive
development? of the brain that are involved in cognitive control (Campbell &
Courtesy of Dr. Sam Gilbert, Institute of Cognitive Neuroscience, UK others, 2012).

• Cortical thickness in the frontoparietal network predicts executive function in older
adults (Schmidt & others, 2016).
• Younger adults have better connectivity between brain regions than older adults do
(Archer & others, 2016; Damoiseaux, 2017; Madden & Parks, 2017). For example, one
study revealed that younger adults had more connections between brain activations in
frontal, occipital, and hippocampal regions than older adults during a difficult encoding
task (Leshikar & others, 2010).
• An increasing number of cognitive and physical fitness training studies are using brain-
imaging techniques such as fMRI to assess the results of such training on brain func-
tion (Cooper, Moon, & van Praag, 2018; Erickson & Liu-Ambrose, 2016; Erickson &
Oberlin, 2017; Flodin & others, 2017; Kinugawa, 2019; Macpherson & others, 2017;
Walker, 2019). In one study, older adults who walked one hour a day three days a week
for six months showed increased volume in the frontal and temporal lobes of the brain
(Colcombe & others, 2006).
Denise Park and Patricia Reuter-Lorenz (2009) proposed a neurocognitive scaffolding
view of connections between the aging brain and cognition. In this view, increased activation
in the prefrontal cortex with aging reflects an adaptive brain that is compensating for declining
neural structures and function and declines in various aspects of cognition, including working
memory and long-term memory. Scaffolding involves the use of complementary neural circuits
to protect cognitive functioning in an aging brain. Among the factors that can strengthen brain
scaffolding are cognitive engagement and exercise.
Review Connect Reflect Review protect cognitive functioning in an aging

• How is cognition multidimensional brain. How has the term scaffolding
and multidirectional in older adults? been used elsewhere in the text?
LG1 Describe the cognitive
functioning of older What changes in cognitive processing
take place in aging adults?
Reflect Your Own Personal
adults. Journey of Life
• How do education, work, and health
• Can you think of older adults who
affect cognition in aging adults?
have made significant contributions in
• What is the concept of “use it or lose it”?
late adulthood, other than those we
• To what extent can older adults’
mentioned in the chapter? Spend some
cognitive skills be retrained?
time reading about these individuals
• What characterizes the cognitive
and evaluate how their intellectual
neuroscience of aging?
interests contributed to their life
Connect satisfaction as older adults. What did
• The term scaffolding was used in this you learn from their lives that might
section to describe the use of benefit your cognitive development
complementary neural circuits to and life satisfaction as an older adult?
2 Language Development LG2 Characterize changes in language skills in older adults.
Most research on language development has focused on infancy and childhood. It is generally
thought that for most of adulthood individuals maintain their language skills (Wingfield &
Lash, 2016). The vocabulary of individuals often continues to increase throughout most of
the adult years, at least until late adulthood (Schaie, 2013; Singh-Manoux & others, 2012).
Many older adults maintain or improve their word knowledge and word meaning (Burke &
Shafto, 2004).
In late adulthood, however, some decrements in language skills may appear (Antonenko
& others, 2013; Obler, 2009; Payne & Federmeier, 2018; Valech & others, 2018). Among
the most common language-related complaints reported by older adults are difficulty in

retrieving words to use in conversation and problems understanding spoken language in
certain contexts (Clark-Cotton & others, 2007). This often involves the tip-of-the-tongue
phenomenon mentioned earlier, in which individuals are confident that they know something
but can’t quite seem to retrieve it from memory (James & others, 2018). Older adults also
report that in less than ideal listening conditions they can have difficulty understanding
speech. This difficulty is most likely to occur when speech is rapid, competing stimuli are
present (a noisy room, for example), and when they can’t see their conversation partner
(in a telephone conversation, for example). The difficulty in understanding speech may be
due to hearing loss as well as cognitive impairment (Benichov & others, 2012). In general,
though, most language skills decline little among older adults if they are healthy (Wingfield
& Lash, 2016).
Some aspects of the phonological skills of older adults are different from those of younger
adults (Mattys & Scharenborg, 2014; Robert & Mathey, 2018). Older adults’ speech is typically
lower in volume, slower, less precisely articulated, and less fluent (more pauses, fillers, repeti-
tion, and corrections). Despite these age differences, most older adults’ speech skills are ade-
quate for everyday communication.
Researchers have found conflicting information about changes in discourse (extended
verbal expression in speech or writing) with aging. “Some (researchers) have reported
increased elaborateness, while others have reported less varied and less complex syntax”
(Obler, 2009, p. 459). One aspect of discourse where age differences have been found
involves retelling a story or giving instructions for completing a task. When engaging in this
type of discourse, older adults are more likely than younger adults to omit key elements,
creating discourse that is less fluent and more difficult to follow (Clark-Cotton & others,
2007). One study found that when retelling a story, older adults were more likely than
younger adults to compress discourse and less likely to improve the cohesiveness of their
narratives (Saling, Laroo, & Saling, 2012).
Nonlanguage factors may be responsible for some of the declines in language skills
that do occur in older adults (Obler, 2009). Slower information-processing speed and a
decline in working memory, especially in being able to keep information in mind while
processing, likely contribute to decreased language efficiency in older adults (Salthouse,
2017). For example, a recent study found that the lower working memory capacity of older
adults compared with younger adults impaired their comprehension of sentences (Sung &
others, 2017).
Language skills decline among individuals with Alzheimer disease, as we will discuss later
in the chapter (Valech & others, 2018). Word-finding/generating difficulties are one of the earli-
est symptoms of Alzheimer disease (Haugrud, Crossley, & Vrbancic, 2011). Individuals with
Alzheimer disease especially have difficulty on tests of semantic verbal fluency, in which they
have to say as many words as possible in a category (fruits or animals, for example) in a given
time, typically one minute (Pakhomov, Hemmy, & Lim, 2012; Weakley & Schmitter-Edgecombe,
2014). Most individuals with the disease do retain much of their ability to produce well-formed
sentences until the late stages of the disease. Nonetheless, they do make more grammatical
errors than older adults without the disease (Huang, Meyer, & Federmeier, 2012; Kail, Lemaire,
& Lecacheur, 2012). In a recent study, individuals with Alzheimer disease were less likely to
use syntactic components in their language than those who did not have Alzheimer disease
(Orimaye & others, 2017).
Recently, interest has been generated by the possibility that bilingualism may delay
the onset of Alzheimer disease (Antoniou & Wright, 2017; Bialystok, 2017; Bialystok &
others, 2016; Borsa & others, 2018). One study found that the onset of Alzheimer disease
occurred 4.5 years later in bilingual older adults than in their counterparts who were not
bilingual (Alladi & others, 2013). Another study revealed that the onset of symptoms and
first office visit for Alzheimer disease occurred several years later for bilingual than for
monolingual older adults (Bialystok & others, 2014). These results led Ellen Bialystok and
her colleagues (2016) to recently conclude that being bilingual may be one of the best
ways to delay the onset of Alzheimer disease by as much as four to five years. It is not
yet clear why the advantage occurs for bilingual older adults, but one explanation might
be better executive function (Gasquoine, 2016). For example, a recent study found that
bilingual Alzheimer patients had better neural network functioning, especially in the neural
network involving executive function, than did monolingual Alzheimer patients (Perani &
others, 2017).

Review Connect Reflect Review children typically capable of producing
• What are the main changes in all the vowel sounds and most of the
language skills in older adults? consonant sounds of their language?
LG2 Characterize changes in
language skills in older Connect Reflect Your Own Personal
adults. • In this section, we learned that some Journey of Life
aspects of the phonological skills of • What might you be able to do as an
older adults are different from those of older adult to preserve or even
younger adults. By what age are enhance your language skills?
3 Work and Retirement LG3 Discuss aging and adaptation to work and retirement.
Work Retirement in the United States and in Other Countries Adjustment to Retirement
What percentage of older adults continue to work? How productive are they? Who adjusts best
to retirement? What is the changing pattern of retirement in the United States and around the
world? Let’s look at the answers to these and other questions.
WORK
In 2000, 23 percent of U.S. 65- to 69-year-olds were in the workforce; in 2017, this percentage
had jumped to 32 percent (Mislinksi, 2018). Among 70- to 74-year-olds, 13 percent were in
the workforce in 2000, but this percentage had increased to 19 percent in 2015. The increased
percentage of older adults who continue to work has occurred more for women than men. For
example, the labor force participation for 75-and-over women has risen 87 percent since 2000, developmental connection
while participation in the work force for 75-and-over men has increased 45 percent (Mislinski, Work
2018). These increases likely are mainly driven by the need to have adequate money to meet In the United States, approximately
living expenses in old age (Cahill, Giandrea, & Quinn, 2016). The U.S. Labor Department 80 percent of individuals 40 to 59 years
projects that by 2020 35 percent of 65- to 74-year-old men and 28 percent of 65- to 74-year-old of age are employed. Connect to
women will be in the workforce (Hayutin, Beals, & Borges, 2013). A recent study found the “Physical and Cognitive Development
following were among the most important motives and preconditions older workers worked in Middle Adulthood.”
beyond retirement age: financial, health, knowledge, and purpose in life (Sewdas & others, 2017).
Research suggests that U.S. workers are reasonably satisfied with their jobs and that older
U.S. workers are the most satisfied of all age groups (AP-NORC Center for Public Affairs
Research, 2013). However, there are significant individual variations in worker satisfaction at
all adult ages (Antonucci & others, 2016).
Cognitive ability is one of the best predictors of job performance in older adults (Fisher
& others, 2017; Lovden, Backman, & Lindenberger, 2017). And older workers have lower rates
of absenteeism, fewer accidents, and higher job satisfaction than their younger counterparts
(Warr, 2004). Thus, the older worker can be of considerable value to a company, above and
beyond the older worker’s cognitive competence. Changes in federal law now allow individuals
over the age of 65 to continue working (Shore & Goldberg, 2005). Also, remember from our
discussion earlier in this chapter that substantively complex work is linked with a higher level
of intellectual functioning (Schooler, 2007; Wang & Shi, 2016). Further, researchers have found The night hath not yet come:
that working in an occupation with a high level of mental demands is linked to higher levels
We are not quite cut off from
of cognitive functioning before retirement and a slower rate of cognitive decline after retirement
(Fisher & others, 2014). In sum, a cognitively stimulating work context promotes successful labor by the failing of light;
aging (Fisher & others, 2017; Lovden, Backman, & Lindenberger, 2017). some work remains for us to
Several recent studies also have found that older adults who work have better physical do and dare.
and cognitive profiles that those who retire. For example, one study found that physical func-
tioning declined faster in retirement than in full-time work for individuals 65 years of age and —Henry Wadsworth Longfellow
older, with the difference not explained by absence of chronic diseases and lifestyle risks American Poet, 19th Century

(Stenholm & others, 2014). Another study revealed that retirement increased the risk of having
a heart attack in older adults (Olesen & others, 2014). Further, a recent study found that
individuals who retired for health reasons had lower verbal memory and verbal fluency than
their counterparts who retired voluntarily or for family reasons (Denier & others, 2017). And
in another recent study of older adults, those who continued to work in paid jobs had better
physical and cognitive functioning than retirees (Tan & others, 2017).
In sum, age affects many aspects of work (Cahill, Giandrea, & Quinn, 2016; Lovden,
Backman, & Lindenberger, 2017; Wang & Shi, 2016). Nonetheless, many studies of work and
aging—such as evaluation of hiring and performance—have yielded inconsistent results.
Important contextual factors—such as age composition of departments or applicant pools,
occupations, and jobs—all affect decisions about older workers. It also is important to recognize
that ageist stereotypes of workers and of tasks can limit older workers’ career opportunities
and can encourage early retirement or other forms of downsizing that adversely affect older
workers (Finkelstein & Farrell, 2007). A study of older workers found that accurately self-
evaluating one’s skills and values, being positive about change, and participating in a supportive
work environment were linked to adaptive competence on the job (Unson & Richardson, 2013).
Ninety-two-year-old Russell “Bob” Harrell
(right) puts in 12-hour days at Sieco Consulting
Engineers in Columbus, Indiana. A highway
RETIREMENT IN THE UNITED STATES
and bridge engineer, he designs and plans AND IN OTHER COUNTRIES
roads. James Rice (age 48), a vice president
of client services at Sieco, says that Bob At what age do most people retire in the United States? Do many people return to the work-
wants to learn something new every day and force at some point after they have retired? What is retirement like in other countries?
that he has learned many life lessons from
being around him. Harrell says he is not
Retirement in the United States The option to retire is a late-twentieth-century
planning to retire. What are some variations
in work and retirement in older adults?
phenomenon in the United States (Coe & others, 2012). It exists largely because of the 1935
©Greg Sailor implementation of the Social Security system, which gives benefits to older workers when they
retire. On average, today’s workers will spend 10 to 15 percent of their lives in retirement. A
survey revealed that as baby boomers move into their sixties, they expect to retire later than
their parents or their grandparents did (Frey, 2007). In 2017, in the United States, the average
age of retirement for men was 64 and for women 62 (Anspach, 2017). The labor force partici-
pation for women is now very close to that of men, especially among workers over 65 years
of age (Munnell, 2015). The average number of years spent in retirement by Americans is
18 years. A recent study found that baby boomers expect to work longer than their predeces-
sors in prior generations (Dong & others, 2017).
In the past, when most people reached an accepted retirement age, such as some point
in their sixties, retirement meant a one-way exit from full-time work to full-time leisure.
Increasingly, individuals are delaying retirement and moving into and out of work as the tra-
ditional lock-step process of full-time work to full-time retirement occurs less often (Cahill &
others, 2018; Kojola & Moen, 2016). Currently, there is no single dominant pattern of retire-
ment but rather a diverse mix of pathways involving occupational identities, finances, health,
and expectations and perceptions of retirement (Kojola & Moen, 2016). Leading expert Phyllis
Moen (2007) described how increasingly when people reach their sixties, the life path they
follow is less clear:
• Some individuals don’t retire, continuing in their career jobs.
• Some retire from their career work and then take up a new and different job.
• Some retire from career jobs but do volunteer work.
• Some retire from a post-retirement job and go on to yet another job.
• Some move in and out of the workforce, so they never really have a “career” job from
which they retire.
• Some individuals who are in poor health move to a disability status and eventually into
retirement.
• Some who are laid off define it as “retirement.”
Approximately 7 million retired Americans return to work after they have retired (Putnam
Investments, 2006). When retired adults return to the labor force, it occurs on average four
years after retirement (Hardy, 2006). In many instances, the jobs pay much less than their
pre-retirement jobs. In one study of older adults who returned to work, approximately

two-thirds said they were happy they had done so, while about one-third indicated they were
forced to go back to work to meet financial needs (Putnam Investments, 2006).
Just as the life path after individuals reach retirement age may vary, so do their reasons
for working. For example, some older adults who reach retirement age work for financial rea-
sons, others to stay busy, and yet others to “give back” (Moen, 2007).
Work and Retirement in Other Countries What characterizes work and retire-
ment in other countries? One analysis concluded that France has the earliest average retirement
age of 60 for men and 61 for women (OECD, 2017). In this analysis, Korea had the oldest
average retirement age of 72 for men and 73 for women.
A large-scale study of 21,000 individuals aged 40 to 79 in 21 countries examined patterns In the study of work and retirement in
of work and retirement (HSBC Insurance, 2007). On average, 33 percent of individuals in 21 countries, what were some variations
their sixties and 11 percent in their seventies were still in some kind of paid employment. In across countries regarding the extent to
this study, 19 percent of those in their seventies in the United States were still working. A which retirees missed work and money?
©Ronnie Kaufman/Blend Images LLC
substantial percentage of individuals expect to continue working as long as possible before
retiring (HSBC Insurance, 2007).
In the study of work and retirement in 21 countries, Japanese retirees missed the work
slightly more than they expected and the money considerably less than they expected (HSBC
Insurance, 2007). U.S. retirees missed both the work and the money slightly less than they
expected. German retirees were the least likely to miss the work, Turkish and Chinese retirees
the most likely to miss it. Regarding money, Japanese and Chinese retirees were the least likely
to miss it, Turkish retirees the most likely to miss it.
Early retirement policies were introduced by many companies in the 1970s and 1980s
with the intention of making room for younger workers (Coe & others, 2012). A recent research
review found that workplace organizational pressures, financial security, and poor physical and
mental health were antecedents of early retirement (Topa, Depolo, & Alcover, 2018). However,
increasing number of adults are beginning to reject the early retirement option as they hear
about people who retired and then regretted it. In a 21-country study, on average only 12 percent
of individuals in their forties and fifties expected to take early retirement while 16 percent
in their sixties and seventies had taken early retirement (Coe & others, 2012). Only in
Germany, South Korea, and Hong Kong did a higher percentage of individuals expect to take
early retirement than in the past.
ADJUSTMENT TO RETIREMENT
Retirement is a process, not an event (Wang & Shi, 2016). Much of the research on retirement
has been cross-sectional rather than longitudinal and has focused on men rather than women.
One study found that men had higher morale when they had retired within the last two years
compared with men who had been retired for longer periods of time (Kim & Moen, 2002).
Another study revealed that retired married and remarried women reported being more satis-
fied with their lives and in better health than retired women who were widowed, separated,
divorced, or had never been married (Price & Joo, 2005). Yet another study indicated that
women spend less time planning for retirement than men do (Jacobs-Lawson, Hershey, &
Neukam, 2005). Another study revealed that higher levels of financial assets and job satisfac-
tion were more strongly linked to men’s higher psychological well-being in retirement, while
preretirement social contacts were more strongly related to women’s psychological well-being
in retirement (Kubicek & others, 2010).
Older adults who adjust best to retirement are healthy, have adequate income, are active, are
better educated, have an extended social network including both friends and family, and usually
were satisfied with their lives before they retired (Damman, Henkens, & Kalmijn, 2015; Ilmakunnas
& Ilmakunnas, 2018; Miller, 2018). Older adults with inadequate income and poor health, and
those who must adjust to other stress that occurs at the same time as retirement, such as the
death of a spouse, have the most difficult time adjusting to retirement (Reichstadt & others, 2007).
As mentioned earlier, the U.S. retirement system is in transition (Biro & Elek, 2018;
Mossburg, 2018). A 2017 survey indicated that only 18 percent of American workers feel very
confident that they will have enough money to have a comfortable retirement (Greenwald,
Copeland, & VanDerhei, 2017). However, 60 percent said they feel somewhat or very confident
What are some keys to adjusting effectively
they will have enough money to live comfortably in retirement. In this survey, 30 percent of in retirement?
American workers reported that preparing for retirement made them feel mentally or ©Bronwyn Kidd/Getty Images

emotionally distressed. In regard to retirement income, the two main worries of individuals as
they approach retirement are: (1) having to draw retirement income from savings, and (2)
paying for health-care expenses (Yakoboski, 2011).
Flexibility is also a key factor in whether individuals adjust well to retirement (Mossburg,
2018; Wang & Shi, 2016). When people retire, they no longer have the structured environment
they had when they were working, so they need to be flexible and discover and pursue their own
interests. Cultivating interests and friends unrelated to work improves adaptation to retirement.
Planning ahead and then successfully carrying out the plan are important aspects of
adjusting well in retirement (Topa, Lunceford, & Boyatzis, 2018; Treiger, 2016). A special
concern in retirement planning involves women, who are likely to live longer than men, more
likely to live alone, and tend to have lower retirement income (less likely to remarry and more
likely to be widowed) (Prickett & Angel, 2011).
It is important not only to plan financially for retirement but also to consider other aspects
of your life (Topa, Lunceford, & Boyatzis, 2018; Wang & Shi, 2016). In addition to financial
planning, individuals need to ask questions about retirement such as these: What am I going
to do with my leisure time? How am I going to stay physically fit? What am I going to do
socially? What am I going to do to keep my mind active?
Review Connect Reflect Review than East Asian adolescents do.

• What characterizes the work of older How might establishing challenging
adults? lifelong leisure activities as an
LG3 Discuss aging and
• Compare retirement in the United adolescent benefit an individual at
adaptation to work and
States with retirement in other retirement age?
retirement.
countries.
• How can individuals adjust effectively
to retirement?
Journey of Life
• At what age would you like to retire?
Connect Or would you prefer to continue
• U.S. adolescents spend much more working as an older adult as long as
time in unstructured leisure activities you are healthy?
4 Mental Health LG4 Describe mental health problems in older adults.
Depression Dementia, Alzheimer Disease,

and Other Afflictions
Although a substantial portion of the population can now look forward to a longer life, that
life may unfortunately be hampered by a mental disorder in old age (Brown & Wolf, 2017;
Bruce & Sirey, 2018; Guo & others, 2018; Szanto & others, 2018; van den Brink & others,
2018). This prospect is both troubling to the individual and costly to society. Mental disorders
make individuals increasingly dependent on the help and care of others. The cost of caring
for older adults with mental health disorders is estimated to be more than $40 billion per year
in the United States. More important than the loss in dollars, though, is the loss of human
potential and the suffering involved for individuals and their families (Frank & others, 2018;
Wolff & others, 2017). Although mental disorders in older adults are a major concern, it is
important to understand that older adults do not have a higher incidence of mental disorders
major depression A mood disorder in than younger adults do (Busse & Blazer, 1996).
which the individual is deeply unhappy,
demoralized, self-derogatory, and bored.
The person does not feel well, loses stamina DEPRESSION
easily, has poor appetite, and is listless and
unmotivated. Major depression is so Major depression is a mood disorder in which the individual is deeply unhappy, demoralized,
widespread that it has been called the self-derogatory, and bored. The person does not feel well, loses stamina easily, has a poor
“common cold” of mental disorders. appetite, and is listless and unmotivated. Major depression has been called the “common cold”

of mental disorders. A recent research review concluded that in the last two decades when
compared to younger adults, depression in older adults is not more common and is not more
often caused by psychological factors (Haigh & others, 2018). Also, it was found that compared
with middle-aged adults, depression in older adults is more likely to be chronic (that is, has a
higher rate of relapse), which is likely linked to higher rates of medical problems in older
adults (Haigh & others, 2018).
One study found that the lower frequency of depressive symptoms in older adults com-
pared with middle-aged adults was linked to fewer economic hardships, fewer negative social
interchanges, and increased religiosity (Schieman, van Gundy, & Taylor, 2004). Other research
indicates that older adults who engage in regular exercise, especially aerobic exercise, are less
likely to be depressed, whereas those who are in poor health and experiencing pain are more
likely to be depressed (Cimpean & Drake, 2011). Depressive symptoms increase among the
oldest-old (85 years and older), and this increase is associated with a higher percentage of
women in the group, more physical disability, greater cognitive impairment, and lower socio-
economic status (Hybels & Blazer, 2004).
In childhood, adolescence, and early adulthood, females have higher rates of depression
than males do (Nolen-Hoeksema, 2011). Does this gender difference hold for middle-aged and
older adults? For most of late adulthood, women are more likely to have a higher rate of
depression and have more severe depression than are males, with these differences narrowing
only among the oldest-old (Barry & Byers, 2016). These gender differences in depression
among older adults likely reflect factors such as women having lower incomes and having one
or more chronic illnesses. What characterizes depression in older adults?
Among the most common predictors of depression in older adults are earlier depressive ©Science Photo Library/Getty Images
symptoms, poor health, disability, losses such as the death of a spouse, low social support,
and social isolation (Park & others, 2018; Saint Onge, Krueger, & Rogers, 2014; Taylor &
others, 2018; Wermelinger Avila & others, 2018). In a recent study, suicidal ideation was
strongly associated with depression severity in older adults (Rossom & others, 2018). In this
study, older adults who had moderate to severe depression were 48 times more likely to engage
in suicidal ideation than their counterparts who had minimal to mild depressive symptoms.
Insomnia is often overlooked as a risk factor for depression in older adults (Fiske, Wetherell,
& Gatz, 2009). Curtailment of daily activities also is a common pathway to late-life depression
(Fiske, Wetherell, & Gatz, 2009). Often accompanying this curtailment of activity is an
increase in self-critical thinking that exacerbates depression. A meta-analysis found that the
following living arrangements were linked to increased risk for depression in older adults: living
alone, in a nursing home, or in an institutionalized setting (Xiu-Ying & others, 2012). Also, in
a recent study of community-dwelling older adults, engaging in light physical exercise, taking
lessons, using a computer, and participating in community events predicted a lower level of developmental connection
depressive symptoms (Uemura & others, 2018). Gender
Depression is a treatable condition, not only in young adults but in older adults as well One reason females have higher rates
(Bruce & Sirey, 2018; Casey, 2017; Frank & others, 2018; Raue & others, 2017). Unfortunately, of depression is that they ruminate
up to 80 percent of older adults with depressive symptoms receive no treatment at all. more in their depressed mood and
Combinations of medications and psychotherapy produce significant improvement in almost amplify it more than males do. Connect
four out of five older adults with depression (Koenig & Blazer, 1996). In a recent research to “Socioemotional Development in
review it was concluded that depressed older adults respond to psychological treatments as Adolescence.”
well as younger adults do (Haigh & others, 2017). However, this review found that antidepres-
sants are less effective with older adults than younger adults. Researchers have discovered that
electroconvulsive treatment (ECT) is more effective in treating older adults’ depression than
antidepressants (Dols & others, 2017; Rhebergen & others, 2015; Spaans & others, 2015).
Further, exercise can reduce depression in older adults (Chang & others, 2017, 2018; Holmquist
& others, 2017). For example, a study of older adults found that even light-intensity exercise
was linked to a lower level of depression (Loprinzi, 2013). Another recent study revealed that
older adults who had the highest levels of physical activity and who engaged in athletic activi-
ties were at a lower risk for depression (Joshi & others, 2016). And in a Taiwanese study,
consistent exercise of 15 minutes or more at a time of moderate intensity three times a week
was associated with a lower risk of developing depressive symptoms (Chang & others, 2017).
Also, engagement in valued activities and religious/spiritual involvement can reduce depressive
symptoms (Krause & Hayward, 2016). Life review/reminiscence therapy, which we will discuss
further in the chapter on “Socioemotional Development in Late Adulthood,” is linked to a
reduction in depressive symptoms and underutilized in the treatment of depression in older

adults (Rita Chang & Chien, 2018; Siverova & Buzgova, 2018; Wu & others, 2018; Yen & Lin,
2018). Further, researchers have found that depressed older adults are less likely to receive
treatment for their depression than younger adults are (Sanglier & others, 2015).
Major depression can result not only in sadness but also in suicidal tendencies (Barry
& Byers, 2016; Choi & others, 2017; Okolie & others, 2017; Park & others, 2018; Szanto &
others, 2018). Recent national statistics indicate that the highest suicide rate occurs for 45- to
64-year-olds (19.6 per 100,000 individuals), followed by individuals 85 years or older (19.4
per 100,000 individuals) (Centers for Disease Control and Prevention, 2015). For older adults
aged 65 to 84, the rate per 100,000 individuals was 16.1, similar to the rate for individuals
20 to 34 (15.5).
The older adult most likely to commit suicide is a male who lives alone, has lost his
spouse, and is experiencing failing health (Balasubramaniam, 2018; Ruckenhauser, Yazdani, &
Ravaglia, 2007). A recent study further explored the influencing and protective factors involv-
ing suicidal ideation in older adults (Huang & others, 2017). In this study, the triggers for
suicidal ideation included physical discomfort, loss of respect and/or support from family,
impulsive emotions due to conflicts with others, and painful memories. Psychological factors
contributing to suicidal ideation included feelings of loneliness, sense of helplessness, and low
self-worth. Protective factors that were linked to lower levels of suicidal ideation included sup-
port from family and friends, emotional control, a support network, and comfort from religion.
Further, a recent study found that declines in socioeconomic status were linked to increased
suicide attempts in older adults (Dombrovski & others, 2018).
DEMENTIA, ALZHEIMER DISEASE,

AND OTHER AFFLICTIONS
Among the most debilitating of mental disorders in older adults are the dementias (Brown &
Wolf, 2018; Castro-Monteiro & others, 2016). In recent years, extensive attention has been
focused on the most common dementia, Alzheimer disease.
Dementia Dementia is a global term for any neurological disorder in which the primary
symptoms involve a deterioration of mental functioning. Individuals with dementia often lose
the ability to care for themselves and can become unable to recognize familiar surroundings
and people—including family members (Dooley, Bass, & McCabe, 2018; Morikawa & others,
2017). It is estimated that 23 percent of women and 17 percent of men 85 years and older are
at risk for developing dementia (Alzheimer’s Association, 2013). Dementia is a broad category,
and it is important that every effort is made to determine the specific cause of deteriorating
mental functioning (Hagenaars & others, 2017; Garcia Basalo & others, 2017;
MacNeil Vroomen & others, 2018; Mao & others, 2018). In one recent study, a
2-year multi-domain intervention of diet, exercise, cognitive training, and vascular
risk monitoring improved or maintained the cognitive functioning of 60- to 77-year-
olds at risk for developing dementia (Ngandu & others, 2015). And in another
recent study, a 12-week online program (consisting of modules on activity, goal-
monitoring, diet, social engagement, cognitive engagement, and management of
Former U.S. president Ronald Reagan was diagnosed with
Alzheimer disease at age 83. chronic conditions) reduced the dementia risks of middle-aged adults with multiple
©Bettmann/Getty Images risk factors (Anstey & others, 2015).
Alzheimer Disease One form of dementia is Alzheimer disease—a progressive, irrevers-

ible brain disorder that is characterized by a gradual deterioration of memory, reasoning,
language, and eventually, physical function. In 2017, an estimated 5.5 million adults in the
United States had Alzheimer disease, and it is projected that 10 million baby boomers will
develop Alzheimer disease in their lifetime (Alzheimer’s Association, 2017). Ten percent of
dementia A global term for any neurological individuals 65 and older have Alzheimer disease. The percentage of individuals with Alzheimer
disorder in which the primary symptoms disease increases dramatically with age: 3 percent aged 65 to 74, 17 percent aged 75 to 84,
involve a deterioration of mental functioning. and 32 percent aged 85 and older.
Alzheimer disease A progressive, irreversible
Women are more likely than men to develop Alzheimer disease because they live longer
brain disorder characterized by a gradual than men and their longer life expectancy increases the number of years during which they
deterioration of memory, reasoning, language, can develop it. It is estimated that Alzheimer disease triples the health-care costs of Americans
and eventually, physical function. 65 years of age and older (Alzheimer’s Association, 2017). Because of the increasing

prevalence of Alzheimer disease, researchers have stepped up their efforts to discover the
causes of the disease and to find more effective ways to treat it (Di Domenico & others, 2018;
Lin, Zheng, & Zhang, 2018; Perneczky, 2018; Wolters & Arfan Iframe, 2018).
Causes Alzheimer disease involves a deficiency in the brain messenger chemical called
acetylcholine, which plays an important role in memory (Kamal & others, 2017; Karthivashan
& others, 2018; Kumar & others, 2018; Lewis & others, 2017). Also, as Alzheimer disease
progresses, the brain shrinks and deteriorates (see Figure 4). This deterioration is characterized
by the formation of amyloid plaques (dense deposits of protein that accumulate in the blood
vessels) (Kocahan & Dogan, 2017; Morbelli & Baucknecht, 2018) and neurofibrillary tangles
(twisted fibers that build up in neurons) (Villemagne & others, 2018; Xiao & others, 2017).
Neurofibrillary tangles consist mainly of a protein called tau (Islam & others, 2017; Kuznetsov
& Kuznetsov, 2018). Currently, there is considerable research interest in the roles that amyloid
and tau play in Alzheimer disease (Michalicova & others, 2017; Park & Festini, 2018; Timmers
& others, 2018).
Until recently, neuroimaging of plaques and tangles had not been developed. However,
recently new neuroimaging techniques have been developed that can detect these key indicators
of Alzheimer disease in the brain (Park & Festini, 2018). This imaging breakthrough is provid-
ing scientists with an improved opportunity to identify the transition from healthy cognitive
functioning to the earliest indication of Alzheimer disease (Basselerie & others, 2017; Das &
others, 2018; Scarapicchia & others, 2018).
There also is increasing interest in the role that oxidative stress might play in Alzheimer
disease (Butterfield, 2018; D’Acunto & others, 2018; Mantzavinosa & others, 2017). Oxidative
stress occurs when the body’s antioxidant defenses don’t cope with free radical attacks and
oxidation in the body (Chhetri, King, & Gueven, 2018; Feitosa, 2018). Recall that free radical
theory is a major theory of aging.
Although scientists are not certain what causes Alzheimer disease, age is an important
risk factor and genes also are likely to play an important role (Del-Aguila & others, 2018;
Lane-Donovan & Herz, 2017). The percentage of individuals with Alzheimer disease doubles
every five years after the age of 65. A gene called apolipoprotein E (ApoE) is linked to increas-
ing presence of plaques and tangles in the brain. Special attention has focused on an allele
(an alternative form of a gene) labeled ApoE4, an allele that is a strong risk factor for Alzheimer
disease (Carmona, Hardy, & Guerreiro, 2018; Fladby & others, 2017). More than 60 percent
of individuals with Alzheimer disease have at least one ApoE4 allele, and females are more
likely than males to have this allele (Dubal & Rogine, 2017; Riedel, Thompson, & Brinton,
2016). Indeed, the ApoE4 gene is the strongest genetic predictor of late-onset (65 years and
older) Alzheimer disease (Carmona, Hardy, & Guerreiro, 2018; Dubal & Rogine, 2017). APP,
PSEN1, and PSEN2 gene mutations are linked to early-onset Alzheimer disease (Carmona,
Hardy, & Guerreiro, 2018).
Advances resulting from the Human Genome Project have recently resulted in identifica-
tion of other genes that are risk factors for Alzheimer disease (Carmona, Hardy, & Guerreiro,
2018; Kawalia & others, 2017; Kumar & Reddy, 2018; Nativio & others, 2018; Tang & others,
2018). However, they are not as strongly linked to the disease as the ApoE4 gene (Costa &
others, 2017; Gause & others, 2018; Shi & others, 2017).
Although individuals with a family history of Alzheimer disease are at greater risk, the
disease is complex and likely caused by a number of factors. Recently, researchers have shown
increasing interest in exploring how epigenetics may improve understanding of Alzheimer FIGURE 4
disease (Gangisetty, Cabrera, & Murugan, 2018; Sharma, Raghuraman, & Sajikumar, 2018). TWO BRAINS: NORMAL AGING AND
This interest especially has focused on DNA methylation, which we discussed in “Biological ALZHEIMER DISEASE. The photograph on
Beginnings.” Recall that DNA methylation involves tiny atoms attaching themselves to the the top shows a slice of a normal aging brain
outside of a gene, a process that is increased through exercise and healthy diet but reduced and the photograph on the bottom shows a
by tobacco use (Marioni & others, 2018; Zaghlool & others, 2018).Thus, lifestyles likely inter- slice of a brain ravaged by Alzheimer disease.
Notice the deterioration and shrinking in the
act with genes to influence Alzheimer disease (Kader, Ghai, & Mahraj, 2018; Shackleton,
Alzheimer disease brain.
Crawford, & Bachmeier, 2017). For example, older adults with Alzheimer disease are more ©Alfred Pasieka/Science Source
likely to have cardiovascular disease than are individuals who do not have Alzheimer disease
(Rodrique & Bishof, 2017; Theobald, 2017; Wolters & others, 2018). Recently, a number of
cardiac risk factors have been implicated in Alzheimer disease—obesity, smoking, atheroscle-
rosis, hypertension, high cholesterol, lipids, and permanent atrial fibrillation (Falsetti & others,
2018; Hersi & others, 2017; Ihara & Washida, 2018; Karlsson & others, 2017). One of the best

strategies for intervening in the lives of people who are at risk for Alzheimer disease is to
improve their cardiac functioning through diet, drugs, and exercise (Law & others, 2018;
McLimans & others, 2017). One study of older adults found that those who exercised three
or more times a week were less likely to develop Alzheimer disease over a six-year period than
those who exercised less (Larson & others, 2006).
A recent meta-analysis of modifiable risk factors in Alzheimer disease found that some
medical exposures (estrogen, statins, and nonsteroidal anti-inflammatory drugs) and some
dietary factors (folate, vitamin E/C, and coffee) were linked to a reduced incidence of Alzheimer
disease (Xu & others, 2015). Also in this meta-analysis, some preexisting diseases (atheroscle-
rosis and hypertension) as well as depression increased the risk of developing Alzheimer dis-
ease. Further, cognitive activity and low-to-moderate alcohol use decreased the risk of developing
Alzheimer disease.
Early Detection and Drug Treatment Mild cognitive impairment (MCI) represents a
potential transitional state between the cognitive changes of normal aging and very early stages
of Alzheimer disease and other dementias. MCI is increasingly recognized as a risk factor for
Alzheimer disease (Cespedes & others, 2017; Gasquoine, 2018). Estimates indicate that as
many as 10 to 20 percent of individuals 65 years of age and older have MCI (Alzheimer’s
Association, 2017). Many individuals with MCI do not go on to develop Alzheimer disease,
but MCI is a risk factor for Alzheimer disease. One study revealed that individuals with mild
cognitive impairment who developed Alzheimer disease had at least one copy of the ApoE4
gene (Alegret & others, 2014). In this study, the extent of memory impairment was the key
factor linked to the speed of decline from mild cognitive impairment to Alzheimer disease.
Distinguishing between individuals who merely have age-associated declines in memory and
those with MCI is difficult, as is predicting which individuals with MCI will subsequently
develop Alzheimer disease (Eliassen & others, 2017; Mendoza Laiz & others, 2018). A research
review concluded that fMRI measurement of neuron loss in the medial temporal lobe is a
predictor of memory loss and eventually dementia (Vellas & Aisen, 2010). Further, another
study revealed that amyloid beta—a protein fragment that forms plaques in the brain—was pres-
ent in the spinal fluid of approximately 75 percent of the individuals with mild cognitive impair-
ment (De Meyer & others, 2010). Every one of the older adults with mild cognitive impairment
who had the amyloid beta in their spinal fluid developed Alzheimer disease within five years.
Drug Treatment of Alzheimer Disease Five drugs have been approved by the U.S.
Food and Drug Administration (FDA) for the treatment of Alzheimer disease (Almeida, 2018).
Three of the medications, Aricept (donepezil), Razadyne (galantamine), and Exelon (rivastig-
mine), are cholinesterase inhibitors designed to improve memory and other cognitive functions
by increasing levels of acetylcholine in the brain (Gareri & others, 2017). A fourth drug,
Namenda (memantine), regulates the activity of glutamate, which is involved in processing
information. Namzatric, a combination of memantine and donepezil, is the fifth approved
medicine to treat Alzheimer disease; this medicine is designed to improve cognition and overall
mental ability (Almeida, 2018). A research review concluded that cholinesterase inhibitors do
not reduce progression to dementia from mild cognitive impairment (Masoodi, 2013). Also,
keep in mind that the current drugs used to treat Alzheimer disease only slow the downward
progression of the disease; they do not address its cause (Boccardi & others, 2017). Also, no
drugs have yet been approved by the Food and Drug Administration (FDA) for the treatment
of MCI (Alzheimer’s Association, 2017).
Caring for Individuals with Alzheimer Disease A special concern is caring for
Alzheimer patients (Callahan & others, 2017; Merlo & others, 2018; Wolff & others, 2018).
Health-care professionals emphasize that the family can be an important support system for
the Alzheimer patient, but this support can have costs for family members who become emo-
tionally and physically drained by the extensive care required by a person with Alzheimer
disease (Wawrziczny & others, 2017; White & others, 2018). A recent study confirmed that
family caregivers’ health-related quality of life in the first three years after they began caring
for a family member with Alzheimer disease deteriorated more than their same-age and same-
gender counterparts who were not caring for an Alzheimer patient (Valimaki & others, 2016).
Another study compared family members’ perception of caring for someone with Alzheimer
disease, cancer, or schizophrenia (Papastavrou & others, 2012). In this study, the highest
perceived burden was reported for Alzheimer disease.

connecting with careers
Jan Weaver, Director of the Alzheimer’s Association of Dallas
Dr. Weaver joined the Alzheimer’s Association, Greater Dallas Chapter,
as director of services and education in 1999. Prior to that time, she
served as associate director of education for the Texas Institute for
Research and Education on Aging and director of the National Academy
for Teaching and Learning About Aging at the University of North
Texas. As a gerontologist, Weaver plans and develops services and
educational programs that address patterns of human development
related to aging. Among the services that Weaver supervises at the
Alzheimer’s Association are a resource center and helpline, a family
assistance program, a care program, support groups, referrals and
information, educational conferences, and community seminars.
Weaver recognizes that people of all ages should have an
informed and balanced view of older adults that helps them perceive
aging as a process of growth and fulfillment rather than a process of
decline and dependency. Weaver earned her Ph.D. in sociology, with Jan Weaver gives a lecture on Alzheimer disease.
Courtesy of Jan DeCrescenzo
an emphasis in gerontology, from the University of Texas.
Respite care (services that provide temporary relief for those who are caring for individuals
with disabilities, individuals with illnesses, or the elderly) has been developed to help people
who have to meet the day-to-day needs of Alzheimer patients. This type of care provides an
important break from the burden of providing chronic care (Tretteteig, Vatne, & Rokstad, 2017;
Washington & Tachman, 2017; Wolff & others, 2018).
There are many career opportunities that involve working with individuals who have
Alzheimer disease. To read about the work of a director of an Alzheimer association, see
Connecting with Careers.
Parkinson Disease Another type of dementia is Parkinson disease, a chronic, progres-

sive disease characterized by muscle tremors, slowing of movement, and partial facial paralysis.
Parkinson disease is triggered by degeneration of dopamine-producing neurons in the brain
(Chung & others, 2018; Goldstein & others, 2018; Rastedt, Vaughan, & Foster, 2017). Dopamine
is a neurotransmitter that is necessary for normal brain functioning. Why these neurons degen-
erate is not known.
The main treatment for Parkinson disease involves administering drugs that enhance the
effect of dopamine (dopamine agonists) in the disease’s earlier stages and later administering
the drug L-dopa, which is converted by the brain into dopamine (Juhasz & others, 2017;
Muhammad Ali, considered one of the world’s
Radhakrishnan & Goyal, 2018). However, it is difficult to determine the correct level of dosage most influential sports figures, had Parkinson
of L-dopa, and the drug loses efficacy over time (Nomoto & others, 2009). disease.
Another treatment for advanced Parkinson disease is deep brain stimulation (DBS), which ©AP Images
involves implantation of electrodes within the brain (Singh & others, 2018; Stefani & others,
2017). The electrodes are then stimulated by a pacemaker-like device. Recent studies indicated
that deep brain stimulation may provide benefits for individuals with Parkinson disease
(Krishnan & others, 2018; Odekerken & others, 2016). Other recent studies indicate that
certain types of dance, such as the tango, may improve the movement skills of individuals with
Parkinson disease (Batson, Hugenschmidt, & Soriano, 2016). Stem cell transplantation and
gene therapy also offer hope for treating the disease (Choi & others, 2017; Parmar, 2018; Xu
& others, 2017). Parkinson disease A chronic, progressive
Older adults who are depressed, have a dementia, or have another mental disorder, may disease characterized by muscle tremors,
need mental health treatment (Haigh & others, 2017). To read about this topic, see Connecting slowing of movement, and partial facial
Development to Life. paralysis.

connecting development to life
Meeting the Mental Health Needs of Older Adults
Older adults receive disproportionately fewer mental health services than
young or middle-aged adults (Sanglier & others, 2015). One estimate is that
only 2.7 percent of all clinical services provided by psychologists go to older
adults, although individuals aged 65 and over make up more than 11 percent
of the population. Psychotherapy can be expensive. Although reduced fees and
sometimes no fee can be arranged in public hospitals for older adults from
low-income backgrounds, many older adults who need psychotherapy do not
get it (Brown & Menec, 2018; Kietzman & others, 2018; Haigh & others, 2017).
It has been said that psychotherapists like to work with young, attractive, ver-
bal, intelligent, and successful clients (called YAVISes) rather than those who
are quiet, ugly, old, institutionalized, and different (called QUOIDs).
Psychotherapists have been accused of failing to see older adults because they
perceive that older adults have a poor prognosis for therapy success; they do
not feel they have adequate training to treat older adults, who may have spe-
cial problems requiring special treatment; and they may have stereotypes that
label older adults as low-status and unworthy recipients of treatment (Virnig &
others, 2004). Also, many older adults do not seek mental health treatment
because of a fear that they will be stigmatized or because of a lack of under- Margaret Gatz (right) has been a crusader for better
mental health treatment of older adults. She believes
standing about the nature of mental health treatment and care.
that mental health professionals need to be encouraged
How can we better meet the mental health needs of older adults? First, to include greater numbers of older adults in their
mental health professionals must be encouraged to include greater numbers of client lists and that we need to better educate the
older adults in their client lists, and older adults must be convinced that they can elderly about how they can benefit from therapy.
benefit from therapy (Knight & Kellough, 2013; Nelson & Purtle, 2018; Olfson & What are some common mechanisms of change
that can be used to improve the mental health of
others, 2018). Second, we must make mental health care affordable. For exam-
older adults?
ple, Medicare continues to fall short of providing many mental health services for Courtesy of Dr. Margaret Gatz
older adults, especially for those in need of long-term care (Knight & Lee, 2007).
Earlier in this chapter, we discussed stereotypes and ageism with regard to older adults in the workforce. How are those concepts related to
what you just read in this interlude?
Review Connect Reflect Review Reflect Your Own Personal

• What is the nature of depression in Journey of Life
older adults? • Have any of your relatives
LG4 Describe mental health
• What are dementia, Alzheimer experienced mental health problems
problems in older adults.
disease, and Parkinson disease like in as older adults? If so, what were these
older adults? mental health problems? If they have
experienced mental health problems,
Connect what were the likely causes of the
• What are some differences in how problems?
depression is characterized in
adolescence as opposed to late
adulthood?

5 Religion and Spirituality LG5 Explain the role of religion and spirituality in the lives of older adults.
Earlier we discussed religion, spirituality, and meaning in life with a special

focus on middle age, including links between religion/spirituality and health.
Here we will continue our exploration of religion and spirituality by consider-
ing their importance in the lives of many older adults.
In many societies around the world, older adults are the spiritual leaders
in their churches and communities. For example, in the Catholic Church
more popes have been elected in their eighties than in any other 10-year
period of the human life span.
The religious patterns of older adults have increasingly been studied (Krause
& Hayward, 2016). A longitudinal study found that religious service attendance
was stable in middle adulthood, increased in late adulthood, then declined later
in the older adult years (Hayward & Krause, 2013b). A research review con-
cluded that individuals with a stronger spiritual/religious orientation were more
likely to live longer (Lucchetti, Lucchetti, & Koenig, 2011). Also, in a recent
study of older adults, those who regularly attended religious services lived longer During late adulthood, many individuals increasingly engage in
than their counterparts who did not attend these services (Idler & others, 2017). prayer. How might this be linked with longevity?
©ozgurdonmaz/Getty Images
Individuals over 65 years of age are more likely than younger people to
say that religious faith is the most significant influence in their lives, that they try to put reli-
gious faith into practice, and that they attend religious services (Gallup & Bezilla, 1992). A
study of more than 500 African Americans 55 to 105 years of age revealed that they had a
strong identification with religious institutions and high levels of attendance and participation
in religious activities (Williams, Keigher, & Williams, 2012). And a Pew poll found that belief
in God was higher in older adulthood than in any other age period (Pew Forum on Religion
and Public Life, 2008). Further, a recent study revealed that older women had higher levels
of spirituality than did older men (Bailly & others, 2018).
Is religion related to a sense of well-being and life satisfaction in old age? In a recent study of
older adults, secure attachment to God was linked to an increase in optimism and self-esteem in
the future (Kent, Bradshaw, & Uecker, 2018). In another study, older adults who derived a sense
of meaning in life from religion had higher levels of life satisfaction, self-esteem, and optimism
(Krause, 2003). Further, a recent study of older adults revealed that religious service attendance
was associated with a higher level of resilience in life and lower levels of depression (Manning &
Miles, 2018). And in a recent study of Korean older adults, higher levels of religious/spiritual coping
were linked to lower levels of depressive symptoms (Lee & others, 2017). Further, a recent study developmental connection
of Latinos found that lack of religiosity was associated with elevated anxiety and depressive symp- Religion and Spirituality
toms in older adults but not in young and middle-aged adults (Leman & others, 2018). Meaning-making coping involves
Religion and spirituality can meet some important psychological needs in older adults, drawing on beliefs, values, and goals
helping them to face impending death, to find and maintain a sense of meaning in life, and to change the meaning of a stressful
to accept the inevitable losses of old age (Krause & Hayward, 2016; Park & others, 2016, 2017). situation, especially in times of chronic
Socially, the religious community can serve many functions for older adults, such as social
stress such as when a loved one dies.
activities, social support, and the opportunity to assume teaching and leadership roles (Krause,
Connect to “Physical and Cognitive
2012). One study revealed that over a period of seven years, older adults who attended church
Development in Middle Adulthood.”
regularly increased the amount of emotional support they gave and received but decreased the
amount of tangible support they gave and received (Hayward & Krause, 2013a).
Review Connect Reflect Review Why is this especially important in the

• What are some characteristics aging process?
Explain the role of religion of religion and spirituality in older

LG5
adults?
and spirituality in the lives Journey of Life
of older adults. Connect • Do you think you will become more
• Prayer and meditation may reduce or less religious as an older adult than
stress and dampen the body’s you are now? Explain.
production of stress hormones.

topical connections looking forward
In the next chapter, you will read about a number of theories that seek to explain older
adults’ socioemotional development, including Erikson’s final stage (integrity versus
despair). Older adults become more selective than middle-aged adults about the people
they want to spend time with. There is considerable diversity in older adults’ lifestyles,
and an increasing number of older adults cohabit. Social support is especially important
in older adults’ lives and is linked to their physical and mental health. An important
aspect of late adulthood is not dwelling too extensively on the negative aspects of aging
but rather pursuing the key dimensions of successful aging.
reach your learning goals
Cognitive Development in Late Adulthood

1 Cognitive Functioning in LG1 Describe the cognitive functioning of older adults.
Older Adults
Multidimensionality and
• Cognitive mechanics (the neurophysiological architecture, including the brain) are more likely
Multidirectionality to decline in older adults than are cognitive pragmatics (the culture-based software of the
mind). Speed of processing declines in older adults. Older adults’ attention declines more on
complex than simple tasks. Regarding memory, in late adulthood explicit memory declines
more than implicit memory; episodic memory declines more than semantic memory; working
memory also declines. Components of executive function—such as cognitive control and work-
ing memory—decline in late adulthood. Decision making is reasonably well preserved in older
adults. Recently, there has been increased interest in the role of metacognition and mindfulness
in improving older adults’ cognitive functioning.
• Wisdom is expert knowledge about the practical aspects of life that permits excellent
judgment about important matters. Baltes and his colleagues have found that high levels
of wisdom are rare, the time frame of late adolescence and early adulthood is the main
window for wisdom to emerge, factors other than age are critical for wisdom to develop,
and personality-related factors are better predictors of wisdom than cognitive factors such
as intelligence.
• Successive generations of Americans have been better educated. Education is positively
Education, Work,
and Health correlated with scores on intelligence tests. Older adults may return to college for a number
of reasons. Recent generations have had work experiences that include a stronger emphasis
on cognitively oriented labor. The increased emphasis on information processing in jobs likely
enhances an individual’s intellectual abilities. Poor health is related to decreased performance
on intelligence tests by older adults. Exercise is linked to higher cognitive functioning in
older adults.
• Researchers are finding that older adults who engage in cognitive activities, especially
Use It or Lose It
challenging ones, have higher cognitive functioning than those who don’t use their
cognitive skills.
Training Cognitive Skills

• Two main conclusions can be derived from research on training cognitive skills in older
adults: (1) training can improve the cognitive skills of many older adults, and (2) there is
some loss in plasticity in late adulthood.

Cognitive Neuroscience
• There has been considerable recent interest in the cognitive neuroscience of aging that focuses
and Aging on links among aging, the brain, and cognitive functioning. This field especially relies on fMRI
and PET scans to assess brain functioning while individuals are engaging in cognitive tasks.
One of the most consistent findings in this field is a decline in the functioning of specific
regions in the prefrontal cortex in older adults and links between this decline and poorer
performance on tasks involving complex reasoning, working memory, and episodic memory.
2 Language Development LG2 Characterize changes in language skills in older adults.
• For many individuals, knowledge of words and word meanings continues unchanged or may even
improve in late adulthood. However, some decline in language skills may occur in retrieval of
words for use in conversation, comprehension of speech, phonological skills, and some aspects
of discourse. These changes in language skills in older adults likely occur as a consequence of
declines in hearing or memory, a reduced speed of processing information, or disease.
3 Work and Retirement LG3 Discuss aging and adaptation to work and retirement.
Work • An increasing number of older adults are continuing to work past 65 years of age, compared
with their counterparts in past decades. An important change in older adults’ work patterns
is the increase in part-time work. Some individuals continue a life of strong work productivity
throughout late adulthood.
• A retirement option for older workers is a late-twentieth-century phenomenon in the United
Retirement in the
United States and in States. Americans are more likely to continue working in their seventies than are workers in
Other Countries other countries.
• The pathways individuals follow when they reach retirement age today are less clear than in
Adjustment to Retirement the past. Those who adjust best to retirement are individuals who are healthy, have adequate
income, are active, are better educated, have an extended social network of friends and family,
and are satisfied with their lives before they retire.
4 Mental Health LG4 Describe mental health problems in older adults.
Depression • Depression has been called the “common cold” of mental disorders. However, a majority of
older adults with depressive symptoms never receive mental health treatment.
• Dementia is a global term for any neurological disorder in which the primary symptoms
Dementia, Alzheimer
Disease, and Other involve a deterioration of mental functioning. Alzheimer disease is by far the most common
Afflictions dementia. This progressive, irreversible disorder is characterized by gradual deterioration of
memory, reasoning, language, and eventually physical functioning. Special efforts are being
made to discover the causes of Alzheimer disease and effective treatments for it. The increase
in amyloid plaques and neurofibrillary tangles in Alzheimer patients may hold important keys
to improving our understanding of the disease. Alzheimer disease is characterized by a defi-
ciency in acetylcholine, a brain chemical that affects memory. Also, in Alzheimer disease the
brain shrinks and deteriorates as plaques and tangles form. Important concerns are the
financial implications of caring for Alzheimer patients and the burdens placed on caregivers.
In addition to Alzheimer disease, another type of dementia is Parkinson disease.
5 Religion and Spirituality LG5 Explain the role of religion and spirituality in the lives of
older adults.
• Many older adults are spiritual leaders in their church and community. Religious interest
increases in old age and is related to a sense of well-being in the elderly.

key terms
Alzheimer disease episodic memory Parkinson disease sustained attention
cognitive mechanics executive attention prospective memory wisdom
cognitive pragmatics explicit memory selective attention
dementia implicit memory semantic memory
divided attention major depression source memory
key people
Paul Baltes K. Warner Schaie Patricia Retuer-Lorenz
Phyllis Moen Denise Park

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chapter 18

5 Religion and Spirituality

©Jonathan Kirn/The Image Bank/Getty Images

topical connections looking back

548 CHAPTER 18 Cognitive Development in Late Adulthood

Multidimensionality Education, Work, Use It or Lose It Training Cognitive Cognitive Neuroscience

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Cognitive Resources: Working Memory and Perceptual Speed One view of

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Metacognition By middle age, adults have accumulated a great deal of metacognitive

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EDUCATION, WORK, AND HEALTH

Education Successive generations in America’s twentieth century were better educated,

556 CHAPTER 18 Cognitive Development in Late Adulthood

USE IT OR LOSE IT developmental connection

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COGNITIVE NEUROSCIENCE AND AGING

560 CHAPTER 18 Cognitive Development in Late Adulthood

Review Connect Reflect Review protect cognitive functioning in an aging

2 Language Development LG2 Characterize changes in language skills in older adults.

SECTION 9 Late Adulthood 561

562 CHAPTER 18 Cognitive Development in Late Adulthood

SECTION 9 Late Adulthood 563

564 CHAPTER 18 Cognitive Development in Late Adulthood

SECTION 9 Late Adulthood 565

Review Connect Reflect Review than East Asian adolescents do.

4 Mental Health LG4 Describe mental health problems in older adults.

Depression Dementia, Alzheimer Disease,

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DEMENTIA, ALZHEIMER DISEASE,

Alzheimer Disease One form of dementia is Alzheimer disease—a progressive, irrevers-

568 CHAPTER 18 Cognitive Development in Late Adulthood

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570 CHAPTER 18 Cognitive Development in Late Adulthood

Parkinson Disease Another type of dementia is Parkinson disease, a chronic, progres-

SECTION 9 Late Adulthood 571

Review Connect Reflect Review Reflect Your Own Personal

572 CHAPTER 18 Cognitive Development in Late Adulthood

Earlier we discussed religion, spirituality, and meaning in life with a special

Review Connect Reflect Review Why is this especially important in the

Explain the role of religion of religion and spirituality in older

SECTION 9 Late Adulthood 573

reach your learning goals

Cognitive Development in Late Adulthood

Training Cognitive Skills

574 CHAPTER 18 Cognitive Development in Late Adulthood

2 Language Development LG2 Characterize changes in language skills in older adults.

4 Mental Health LG4 Describe mental health problems in older adults.

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576 CHAPTER 18 Cognitive Development in Late Adulthood

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