Week 8 Incontinence and Intellectual Impairment
Incontinence the involuntary and inappropriate passage of urine and/or feces.
Normal bladder function:
o Normal average amount of urine secreted 100ml per hour.
o Sensations of bladder states:
Fullness 300ml 3 hours after fluid intake; easily suppressed.
Discomfort of full bladder 600ml 6 hours after fluid intake.
Desperation 750ml irresistible desire to urinate, leaking starts.
o Leakage of urine during exercise, laughing, coughing, sneezing or lifting.
o Inability to hold urine until you get to a toilet.
o Urine dribbles after urinating
o Smell of urine on clothes or in the house.
o Up to 25 million adult Americans
o 1 in 3 persons over the age of 60
o Twice as common in women than in men
o Frustrating, embarrassing debilitating condition.
o Only 25% seeks help usually after 4 6 years.
o 1 in 8 65 and over Canadian adults experience incontinence.
o 14% women, 9% men,
o Between 65 and 85 years, the percentages double.
o Pelvic flood muscles weaken due to changes resulting from pregnancy,
childbirth or menopause (women), enlarged or removed prostate (men).
o Stress: most common urine leaks during strenuous motions/activities.
Caused by overstretched pelvic muscles due to child bearing.
o Urge: Nerves controlling the bladder are overactive and involuntary action
of bladder muscle occurs. Happens in sleep, after drinking water, when
hearing running water.
o Overflow: Enlarged prostate constricts the urethra preventing complete
bladder emptying. Rare in women.
o Functional: Untimely urination due to other medical conditions that impair
thinking, moving, or communicating (I.e. Alzheimer’s or arthritis)
o Mixed: usually stress and urge incontinence together.
o Transient: temporary leakage occurs due to an acute infection or
o Electrical stimulation to pelvic muscles
o Biofeedback to track bladder and urethral muscle contractions
o Bladder timing training o Absorbent pads
o Nonsurgical devices pessaries
o Surgical treatments pulling dropped bladder up; catheterization
o Implants to close urethra.
Intellectual impairment brain failure, delirium, dementia.
Brain failure: brain malfunction in all or nearly all cortical structures due to
pathological change in the brain tissue or functional change in brain nutrition.
o Includes dementia and delirium; excludes hemorrhage, infarct, tumor or
Intrinsic develops slow and runs long (infarcts, Alzheimer, Parkinson’s,
Extrinsic develops rapidly and runs a short reversible course (toxic, metabolic,
Characteristics: wandering, confusion, disorientation, incontinence.
o Logical thought
o Stored memory
o Timespace coordinates.
Delirium: A state in which a person is out of touch with surroundings and is
spontaneously producing evidence of confusion and disorientation by muttering,
rambling, shouting, delusion hallucination.
o Disturbance of consciousness, reduced clarity of awareness of the
o Clinical syndrome not a disease.
o Managed by removing the underlying cause
o Associated with motor activity that leads to exhaustion
o 80% of ICU patients experience delirium
The Nun Study
longitudinal study (1991)
678 sisters (75107 years)
o Middlelife risk factors from convent archives
o Annual cognitive and physical function evaluations
o Postmortem neuropathogenic evaluations o Broad range of cognitive and physical functions and neuropathology
o Manifestation of dementia symptoms depended on:
Degree of pathology in the brain (location, type and amount)
Cognitive reserve capacity of the brain to resist the clinical
expression of present neuropathy.
• Passive: brain size, synapse count, nutrition, social support,
education, intellectual stimulation, maintenance throughout
middle age (environmental protection, appropriate medical
care good lifestyle diet, exercise, prevention of head
trauma, early treatment of diseases such as diabetes or
• Active: ability of the brain to adapt and compensate for the
presence of the pathology by activating regions and
networks that are not normally activated.
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Death rates from cardiovascular disease and cancer (top two killers) are higher for
men than for women.
Stroke is the third most common killer, more prevalent amongst women.
Primary aging: biological aging genetic influenced declines, taking place even in
the context of overall health.
Secondary aging: declines due to hereditary defects and negative environmental
Primary aging contributes to frailty, secondary aging however plays a larger role
(through genetic disorders, unhealthy lifestyle, and chronic disease)
Arthritis: condition of inflamed, painful, stiff, and sometimes swollen joints and
muscles. Disability caused by arthritis affects 45% of U.S. men over age 65 and
rises modestly with age. Among women, the incidence is higher and increases
sharply with age 50% of 65 to 84 year olds and 70% of those about 85 are
o Osteoarthritis most common, deteriorating cartilage at the ends of bones
of frequently used joints. There is a genetic influence to this disease, but
does not appear till forties or fifties. Obesity also contributes by placing
abnormal pressure on joints.
o Rheumatoid arthritis involves whole body. An autoimmune response
leads to inflammation of connective tissue (membranes that line the
joints). Tissue in the cartilage tends to grow, damaging surrounding
ligaments, muscles and bones. The result is deformed joints, and a loss of
Diabetes mellitus: caused by the body’s inability to produce a sufficient amount of
insulin, OR by the body tissue to become insensitive to the levels of insulin in the
blood stream. o High blood glucose damages the blood vessels, increasing risk of stroke,
heart attack, and circulatory problems in the legs, injury to the eyes,
kidneys, and nerves. Also reduces blood flow to the hippocampus, causing
an elevated risk of Alzheimer’s disease.
o From middle to late adulthood, the incidence of type 2 diabetes doubles;
affecting 10% of the elderly in the U.S.
o Motor vehicle accidents
Higher rates of traffic violations, accidents, and fatalities per mile
than any other age group.
Elders are less likely to drive quickly and recklessly, but more
likely to fail to heed signs, yield the right of way, and turn
Giving up driving results in a loss of freedom, control over one’s
life, and selfesteem.
The elderly also take up more than 30% of all pedestrian deaths.
30% of adults over age 65 and 50% of over 80 have experienced a
fall within the last year.
Serious injury results about 10% of the time most common in hip
Dementia is a set of disorders occurring almost entirely in old age and in which
many aspects of thought and behaviour are so impaired that everyday activities are
disrupted. It strikes 13% of adults over 65, both sexes equally. 1% of people in
their 60s are affected, but the rate increases with age sharply after 80 years until
it reaches 50% after age 85.
Alzheimer’s disease: structural and chemical brain deterioration is associated with
gradual loss of many aspects of thought and behaviour.
o Accounts for 60% of all dementia cases.
o 8 10% of all people over 65 have the disorder. Those over 85, close to
45% are affected.
o Symptoms: earliest sign is sever memory problems. Initially, recent
memory is most impaired, and then recall of distant events and basic facts
disappear. Personality changes occur, depression is common, skilled and
purposeful movements disintegrate, and sleep is often disrupted. The
ability to comprehend and produce speech is lost. Patients become
vulnerable to infections.
o The average life expectancy for a 70 year old male 4 ½ years, for a
female 8 years.
o Brain deterioration: structural changes in the cerebral cortex inside the
neurons neurofibrillary tangles appear (contain abnormal forms of the
protein tau), and outside the neurons amyloid proteins (deteriorated
amyloid surrounded by dead nerve and glial cells) develop. Disruptions occur in a key neuronal structure responsible for
chopping up and disposing of abnormal proteins.
Amyloid causes synapses to malfunction also induces abnormal
electrical activity throughout brain, causing network
Risk factors: occurs in two ways familial or sporadic.
o Familial generally has an early onset, and progresses more rapidly than the
laterappearing sporadic type.
o Genes on chromosomes 1, 14, and 21 (involved in generation of amyloid)
are linked to familiar Alzheimer’s.
o Heredity plays a different role in sporadic Alzheimer’s somatic mutation.
Half of the people with this form of the disease have an abnormal gene on
chromosome 19 leading to excess levels of ApoE4.
ApoE4 blood protein that carries cholesterol throughout the body.
High concentrations of ApoE4 affects the expression of a gene
involved in regulating insulin.
o Elders with diabetes have a 65% increased risk of developing Alzheimer’s.
Protective factors: Mediterranean diet is linked to 13% reduced incidence of
Alzheimer’s, and also to a reduction in cerebrovascular dementia.
o Education and an active lifestyle are beneficial. Rate of Alzheimer’s is
reduced by more than half in elders with higher education. Education leads
to more synaptic connections (cognitive reserve).
o Latelife engagement in social and leisure activities also reduces the risk
of Alzheimer’s by stimulating synaptic growth.
Cerebrovascular Dementia: Series of strokes that leave areas of dead brain cells
causing degeneration of mental ability.
o About 20% of all cases of dementia in Western nations are cerebrovascular
10% are due to a combination of Alzheimer’s and repeated strokes.
o Because men are more susceptible to cardiovascular disease, more men
than women have cerebrovascular dementia by their late 60’s. Women are
not at great risk until after age 75.
o In most cases, the leading cause is atherosclerosis.
Misdiagnosed and Reversible Dementa:
o About 12% of people over age 65 are severely depressed, and another 2%
are moderately depressed.
o When we age we take drugs that may have side effects that resemble
Week 9 Aging Mind
Fluid and Crystallized Intelligence
o Depends on basic information processing skills:
Detecting relationships among stimuli Analytical speed
o Skills that depend on:
Mastery of social conventions
o Valued by person’s culture
Agerelated Slowing of Information Processing
Neural Network View:
o Neurons in brain die, breaking neural connections.
o Brain forms new connections.
o New connections are less efficient.
Similar to taking photocopies, quality goes down with use/time.
Brain forms new connections, but the newer connections aren’t as
efficient as the ones that once existed.
o Information lost as it moves through cognitive system
o Whole system slows down to inspect and interpret information.
Whole system slows down to try to determine information that is
passing through – that means information gets lost/ doesn’t get
Individual and Group Factors in High Intelligence Scores
o High education
o Complex job or leisure
o Lasting marriage
o High Social economic status.
o Flexible personality
o Perceptual speed
Attention in Middle Adulthood
o More difficulties in:
Focusing on relevant information
Connecting visual information
o Could be linked to slower processing
o Experience, practice, and training help older adults compensate. Having a flash light and pointing light at anything. Wherever light
goes, that is where your attention goes. As you get older, the
movement of the light/paying attention slows down. Speed of
processing. Cognitive inhibition – truncate –registering
information, but pushing it aside because it’s not relevant. Why do
we have lower ability to process multiple things? Processing speed.
Memory in Middle Adulthood
o Working memory decreases from 20s to 60s.
Ineffective memory strategies (organization, elaboration and
linking) due to slower processing, attention problems.
o Adults can compensate by:
o Few changes in:
Factual knowledge: dates, time.
Procedural knowledge: driving the car, etc.
Metacognitive knowledge: ‘knowing what you know’; forgetting
where you park your car compensate by always parking the same
Problem Solving and Expertise
o Practical Problem Solving
Evaluate realworld situations
Achieve goals that have high uncertainty
Helped by expertise.
Extensive, highly organized and integrated knowledge base.
Provides efficient, effective approaches to solving problems.
Organized around abstract principles
Result of years of experience.
o Peaks in late 30s, early 40s.
o Changes with age:
From spontaneous and intensely emotional to deliberate and
From unusual products to integration of ideas.
From egocentric to more altruistic (humane, philanthropic) goals.
• We peak in our ability to contribute to the world. Around
age 45 there is something called the shift – up to age 45
you are building yourself, who you are, what you are.
Working on establishing yourself. At age 45 you can say
that you’re finally there – and you say how can I give back
and contribute to the greater good of others?
Selective Optimization with Compensation: o Select choose personally valued activities, avoid others.
o Optimize devote diminishing resources to valued activities.
o Compensate find creative ways to overcome limitations.
o Deliberate (calling names): Recall more difficult
Context helps retrieval, but slower processing, smaller working
memory makes context harder to encode.
With age you have a smaller working memory, making context
harder to encode.
o Automatic: Recognition is easier than recall.
More environmental support.
Implicit memory better than deliberate.
• Without conscious awareness & depends on family.
o Associative Memory Deficit
Difficulty in creating or retrieving links between pieces of
Using memory cues, enhancing meaningfulness of information
Very longterm recall.
Remembering to engage in planned actions
Eventbased easier than timebased
Use reminders, repetition to help.
Aging and Autobiographical Memories
o Constant evolution finishing school, getting married, having kids.
Periods of being busy, then downtime.
o Real problems include family relations, IADLs
o Extend strategies from middle adulthood
–Avoid uncontrollable problems
–Use experience to decide quickly
– Consult others
o Depth and breadth of practical knowledge
o Reflect on knowledge
o Apply knowledge to improve life
o Listening and evaluating
o Altruistic creativity
Factors Related to Cognitive Change:
o Mentally active life: Education, stimulating leisure, social participation, flexibility.
o Distance to death
o Cognitive interventions
Mental Disabilities in Late Life
o Dementia thought and behaviour impairments that disrupt everyday life.
Aging and the Nervous System
o Loss of brain weight accelerates after 60
o Neurons lost in frontal lobes, corpus callosum, cerebellum (balance), glial
o Autonomic nervous system less efficient
o Brain can compensate
Use more parts of brain
o Ischemic Stroke clots in arteries of the brain
Embolic blood clot from elsewhere in the body that travels to
Thrombotic clot that forms locally in brain.
o Hemorrhagic blood vessel ruptures and bleeds into brain.
Subarachnoid blood spills into the spinal fluid
Caregivers of Elders with Dementia
About the disease
About available resources
o Coping strategies
o Caregiving skills
At least twice a week
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Changes in Mental Abilities The cohort effect findings on five mental abilities showed the typical cross
sectional drop after the midthirties. But longitudinal trends for those abilities
revealed modest gains in midlife, sustained into the fifties and the early sixties.
Each new generation experienced better health and education than the one before
Crystallized intelligence skills that depend on accumulated knowledge and
experience, good judgment, and mastery of social conventions all valued by the
Fluid intelligence basic informationprocessing skills ability to detect
relationships among visual stimuli, speed of analyzing information, and capacity
of working memory.
Crystallized intelligence increases steadily through middle adulthood, whereas
fluid intelligence begins to decline in the twenties.
Midlife rise in crystallized abilities makes sense because adults are constantly
adding to their knowledge and skills at work, at home, and in leisure activities.
Five factors that gained in early and middle adulthood verbal ability, inductive
reasoning, verbal memory, spatial orientation, and numeric ability.
A sixth skill perceptual speed. Decreases from the twenties to the late eighties,
indicating cognitive processing slows.
Some believe that general slowing of central nervous system functioning underlies
nearly all agerelated declines in cognition.
Decrease in basic processing may not be great enough to affect many well
practiced performances until late in life.
Adults can often compensate for cognitive limitations.
Response time increases steadily from the early twenties to the nineties.
Neural network view: neurons in the brain die causing breaks in the neural
networks. Brain adapts by forming bypasses, but these connections aren’t as
efficient as the ones that died.
Informationloss view: older adults experience greater loss of information as it
moves through the cognitive system the whole system must slow down to inspect
and interpret the information.
As adults get older, correlations between processing speed and other cognitive
performances strengthen processing speed contributes broadly to declines in
Knowledge and experience can also compensate for impairments in processing
Sustaining two complex tasks at once becomes more challenging with age.
Inhibition resistance to interference from irrelevant information becomes harder.
Older adults can focus on relevant information and handle two tasks proficiently
when they have extensively practiced those activities over their lifetime.
Find it hard to retrieve information from longterm memory that would help them
As irrelevant stimuli take up space in working memory, less is available for the
memory task at hand.
Middleaged people who have trouble recalling something often draw on decades
of accumulated metacognitive knowledge about how to maximize performance. o Aging has little impact on metacognition
Practical problem solving sizing up realworld situations and analyzing how best
to achieve goals that have a high degree of uncertainty.
Gains in expertise help us understand why practical problem solving takes this
This development of expertise is under way in early adulthood and reaches its
height in midlife results of years learning, experience, and effortful practice.
Although physical strength and dexterity declined with age, job knowledge and
organizational and social skills increased.
o Middleaged employees performed more competently.
From middle age on, adults place greater emphasis on thinking through a practical
problem trying to understand it better, interpreting it from different perspectives,
and solving through logical analysis.
Youthful creativity in literature and the arts is often spontaneous and intensely
emotional, while creative works produced after age 40 often appear more
Many creators shift from generating unusual products to combining extensive
knowledge and experience into unique ways of thinking.
Creativity in middle adulthood frequently reflects a transition from a largely
egocentric concern with selfexpression to more altruistic goals.
Having a stimulating, nonroutine job helped explain the relationship between SES
and flexible, abstract thinking. People who do intellectually demanding work seek
out stimulating leisure pursuits, which also foster cognitive flexibility.
60% of adult learners are women.
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The more a mental ability depends on fluid intelligence, the earlier it starts to
Mental abilities that rely on crystallized intelligence are sustained longer.
Loss outweighs improvements and maintenance as people approach the end of life,
but plasticity is still possible.
Elders who sustain high levels of functioning engage in selective optimization with
compensation: narrowing goals, select personally valued activities to optimize
returns from their diminishing energy. Find new ways to compensate for losses.
Older adults accentuated maintenance and loss prevention.
o The highenergy demands of growth goals induced this shift towards
Implicit memory memory without conscious awareness.
Age differences in implicit memory are much smaller than in explicit, or
o Memory that depends on familiarity rather than on conscious use of
strategies is largely spared in old age.
Memory deficits are part of a general, agerelated decline in binding information
into complex memories. o Associative memory deficit difficulty creating and retrieving links
between pieces of information.
Remote memory long term recall.
People between ages 50 and 90 recall both remote and recent events more
frequently than intermediate events.
Among remote events recalled using either wordcute or timeline procedures,
most happened between ages 10 and 30.
Why are youthful events most recalled? Adolescence and early adulthood are times
of rapid life changes and identity development personally significant experiences
Older adults recall recent personal experiences more readily than remote ones
due to interference produced by years of additional experience.
Prospective memory refers to remembering to engage in planned actions in the
Older adults do better on eventbased than on timebased prospective memory
Timebased prospective memory requires considerable initiative to keep the
planned action in mind, and declines in late adulthood are large.
Language comprehension recollect what we have heard or read without
conscious awareness. Like implicit memory, language comprehension changes
very little in late life.
Two aspects of language production do show agerelated losses. The first is
retrieving words from longterm memory
o Speaking more slowly and pausing more often needing more time to
search memories for certain words.
The second is planning what to say and how to say it
o More hesitations, false starts, word repetitions sentences are less well
Older adults develop compensatory techniques for language production problems.
As long as they perceive