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SECTION 1: FOOD FOR THOUGHT IN THE STUDY OF ADULT DEVELOPMENT Gerontology refers to the study of aging from maturity through old age

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SECTION 1: FOOD FOR THOUGHT IN THE STUDY OF ADULT DEVELOPMENT Gerontology refers to the study of aging from maturity through old age. Who is old? • “Older adult” or “older person” is the preferred terminology for someone over the age of 65. • “Senior” and “elderly” are considered too limiting. • “Baby boomer” is also considered acceptable for a certain cohort of older adults (more on “boomers” later). • Older adulthood is usually defined as age 65+, but this is not a homogeneous group of individuals! Why would these groups differ significantly? OLDER ADULTHOOD – usually defined as 65+ based on Otto von Bismarck age of social insurance. We know a lot about the young-old, but much less about the other cohorts. Cohort Effects – These are referred to in the text as History and Context and refer to different historical and environmental factors, such as wars, access to education, immigration patterns, etc., can lead to significant differences. Cohort effects are important to consider in research on aging, because they suggest that we can’t easily generalize ideas about aging to all older adults based on one segment of the aging population. In fact, there is great variability in cognitive, emotional, and physical functioning amongst individuals who are 65 years and older. SECTION 2: THE DEVELOPMENTAL PERSPECTIVE OF AGING Aging Is a Lifelong Event “The journey of a thousand miles begins with a single step.” ~Lao-Tzu In reality, we are all aging from the moment of birth! Older adults form one age group on a trajectory of lifespan development from birth to death. Paul Baltes is credited with championing the study of development across the entire lifespan. Principles of Lifespan Development On an earlier slide we discussed how different age cohorts can look significantly different; these key principles mentioned above provide further context for studying older adults, and emphasize the diversity of this group across ages and stages. Developmental Influences: The Forces of Development There are four main forces, or strong factors, that influence how we develop and age as adults: 1. Biological forces, which refer to genetic and health-related factors 2. Psychological forces, which refer to perceptual, cognitive, emotional, and personality factors 3. Sociocultural forces, which refer to interpersonal, societal, cultural, and ethnic factors 4. Life-cycle forces, which refer to how the same event / combination of forces affect people at different times in life Controversies in Development There are four main controversies, or opposing explanations, for explaining the manner in which we develop and age as adults. They include the following: 1. Nature vs. Nurture Controversy – refers to the extent to which hereditary (nature) and environmental influence (nurture) determine who we are 2. Stability vs. Change Controversy – refers to the degree to which people stay the same over time or change over time 3. Continuity vs. Discontinuity Controversy – refers to whether specific developmental tasks are acquired through a smooth evolution over time (continuity) or through abrupt shifts (discontinuity) 4. Universal vs. Context-specific Controversy – refers to whether there is one pathway of development (universal) or multiple pathways (context-specific) Factors Influencing Lifespan Development • o Age-graded influences o History-graded influences o Normative influences o Non-normative influences SECTION 3: AGE: THERE IS MORE TO THE WORD THAN YOU MAY THINK Definitions of Age There are several ways of looking at the term AGE. Here are some ways of thinking about age and aging: 1. Primary aging, which refers to normal, diseasefree change over the life span 2. Secondary aging, which refers to developmental changes that are related to disease, lifestyle, and other environmentally induced changes that are not inevitable 3. Tertiary aging, which refers to rapid losses that occur shortly before death 4. Chronological age, which is an index variable that allows one to represent events in standard, calendar time 5. Other ways to define age include perceived, biological, psychological, or social age SECTION 4A: WORLDWIDE POPULATION AGING There have never been as many older adults in industrialized countries as there are now. Numbers increased dramatically during 20th century because of better health care and lowering of women’s mortality during childbirth. In 1976 there were many more young people than older adults. Older adults are the fastest growing section of the Canadian population, in particular those over 85. These trends are not unique to Canada. Number of older adults will increase dramatically in nearly all areas of the world over the next several decades. “Oldest” area of world will continue to be Europe. “Youngest” area will continue to be Africa. Also note that members of visible minorities in Canada are increasing. UN STUDY – Between 2015 and 2030, the number of people in the world aged 60 years and over is projected to grow by 56%, from 901 million to 1.4 billion. By 2050, the global population of older persons is projected to more than double in size reaching nearly 2.1 billion. Reasons for Worldwide Population Aging Better healthcare; greater access to healthcare; eradication of childhood diseases; and probably most important reason being the significant decline in global birth rate. FERTILITY REPLACEMENT LEVEL – This refers to the number of children born per woman necessary for the population to replace itself, taking into account childhood mortality and factoring out migration. Declines in fertility replacement level can explain some of why Canada’s population is aging so rapidly. The replacement level is around 2 for most countries. However, in Canada, since 1971, the total fertility rate has been below the replacement level, meaning that couples are no longer having enough children to replace themselves. Currently women have on average 1.61 children, compared to the turn of the century where women had five children, on average. Why do you think there was a fertility decline in the 1960s? Reasons include decreased influence on religion (which in turn influenced use of contraceptives), and more women in higher education and paid workforce. SECTION 4B: WORLDWIDE POPULATION AGING Changes in the Canadian Population The Canadian decline in fertility rate, as well as the larger “baby boom” generation living longer due to better health care, are radically changing the population composition. POPULATION PYRAMIDS – used to look like actual pyramids because of much greater younger people (at the base of the pyramid) than older people (at the apex) BABY BOOMERS – In 2015, for the first time in history, the Canadian population over 65 years exceeded the population under 14 years. Aside from declining fertility rates, this is also due to the baby boom cohort, which refers to the sudden rise in the number of births between 1946 and 1965, right after the end of World War II. Interestingly, although the baby boom was seen in the US, UK, and parts of Europe, it was most pronounced in Canada. Boomers are truly unique – not only in size, but also because of other factors. They are more highly educated, more likely to be in professional careers, more likely to work past retirement age, and were the first generation to challenge the underlying values and attitudes of the social order. They are more vocal self-advocates and more challenging of societal norms. SECTION 5: EAST VERSUS WEST: CHANGING VIEWS OF OLDER ADULTS? Cultural differences in views toward aging largely studied between Eastern and Western cultures. According to the 2006 Canadian Census, 30% (900 000) of older adults were immigrants, most of whom were established immigrants (i.e., been here for over 10 years). This is compared to 80 000 who were recent immigrants, most of which were family class immigrants, sponsored by their family to come to Canada. Many of the recent immigrants to Canada come from South and East Asian countries, as opposed to earlier decades when most immigrants came from the UK or Europe. As a result, it is interesting to consider differences between Eastern and Western cultural views on aging. Prompt for discussion – Solicit student responses for how their culture views aging. Do they view aging in the same way as their own culture, or has this changed for younger generations? Ask if they feel any obligations to care for older people in their family. Research on Culture and Aging • The research is mixed, at best, suggesting that we cannot rely on gross generalizations of cultures • Other factors affecting cross-cultural differences: o The influence of personal values, particularly communal values o Educational factors o Socio-economic factors • Some studies fail to find significant cultural differences, others show the assumed finding that Eastern cultures view older adults more sympathetically, while still other studies show the reverse pattern (that Western cultures view older adults more positively). • Zhang et al. (2016) – World Population Survey – Regardless of culture, attitudes toward older adults are more influenced by personal vs. cultural values, particularly communal values (i.e., friendliness, warmth, and love). • Nelson (2011); North & Fisk (2015) – Increasing literacy and education in younger generations undermines traditional elder roles as holders of wisdom, usually gained through life experience. • Luo et al. (2013) – Economic Factors – e.g., in China, one-child policy means extreme caregiver burden for younger people, plus a lack of government resources for caregiving • Educational and socio-economic factors could explain the studies that find that people in Eastern cultures actually have less positive views toward older adults than anticipated. SECTION 6: MYTHS AND STEREOTYPES OF AGING • • Think – When asked about older adults, what beliefs come to your mind? Think – Which of these beliefs constitutes a stereotype? Images provided represent some of the commonly held stereotypes or sources of prejudice toward older adults: Birthdays – Birthday cards often contain ageist messaging, emphasizing the belief that getting old (or “over the hill”) is a negative experience. Time running out – There is an assumption that because older adults have limited time left, their life is decreasing in quality and so they must be miserable all the time. As we will discuss in later lectures, research on emotion actually shows the contrary – that emotional experience tends to improve for many people as they age. Health – There is an assumption that getting older means poor health. While some conditions are more likely in the older adult population, many older adults can maintain good health into older adulthood. This includes cognitive health. This challenges the assumption that most older adults will develop dementia. SECTION 7A: INTERVENTIONS TO DECREASE AGEISM What Is Ageism? • First coined by Butler in 1969 • Manifestations of Ageism: o Being ignored or treated as invisible o Being treated as incompetent o Being assumed to be asexual o Being wise and benevolent o “Elderspeak” o Think – How do you interact with older adults? Ageism: The “systematic stereotyping of, and discrimination against, people because they are old, just as racism and sexism accomplish this with skin colour and gender” (Butler, 1969, p. 243). Why might ageism might be more tolerated than other –isms? • o Could be because of culture’s obsession with youth and beauty o Might this look different in other cultures? Revera Report on Ageism (2014) – 6 in 10 older adults aged 66 and older believe that they have been treated unfairly because of their age (examples provided in slide). Elderspeak is the practice of speaking to older adults in a similar manner to “baby talk” (e.g., speaking very loudly and slowly, using simplified language). People may use elderspeak if they are concerned that an older adult cannot hear them, or has cognitive issues. It can have good intentions, but may come across as patronizing or demeaning – so should be used with care. Sources of Ageism Why do ageism and stereotyping occur? What perpetuates them? MAINSTREAM MEDIA in Western culture has a huge influence on our beliefs and opinions about being young and attractive as the most desirable. This occurs through the shows that are aired, as well as the marketing of products to make us look younger. This PERPETUATES CULTURAL IDEALS that to be beautiful is to be good. This is actually a specific type of stereotype identified by social psychologists Dion, Berscheid, & Walster (1972), the “beautiful-is-good” stereotype, where attractive people are associated with many positive attributes such as being intelligent, benevolent, successful, etc. Because of this cultural ideal, there is great pressure to appear youthful, as well as PSYCHOLOGICAL AND PHYSICAL DISTANCING from those who do not live up to this ideal. This is what is expressed in terror management theory (Martens, Goldenberg, & Greenberg, 2005) – because we are afraid of aging and death, older adults can inspire fear and threaten our self-concept. Engaging in negative stereotyping helps us keep older adults at a psychological distance. This can be accomplished through physical distancing as well. SECTION 7B: INTERVENTIONS TO DECREASE AGEISM Impact of Ageism and Stereotyping STEREOTYPE THREAT – There are pervasive negative stereotypes about older adults in our culture. Evidence that when older adults internalize those stereotypes, it negatively influences their performance on cognitive tasks, as well as their self-esteem and even physical health such as cardiovascular function. SELF-ESTEEM – Revera Report on Ageism in 2014 indicated that 52 percent of Canadians believe that ageism is the most tolerated form of social prejudice – why as a culture are we more tolerant of this type of –ism? Could be because of our culture’s obsession with youth and beauty. This puts tremendous pressure on people to look and act younger, which can negatively affect their self-esteem. As discussed in the text, large numbers of women in particular feel great pressure to use beauty work interventions to look younger. ECONOMIC DISCRIMINATION – As people are living longer, they are staying in the workforce longer. But many older adults find it hard to find new jobs later in life. This could be due to assumptions that they are not physically or cognitively competent to continue working, or depending on the field, may not be considered attractive enough. Decreasing Ageism Interventions to Decrease Ageism and Stereotyping CONTACT HYPOTHESIS – Sherif et al. (1961), social psychology researchers, found that having people work together on a common goal can reduce conflict and decrease stereotyping toward different groups. The idea is that spending time with individual people reduces the likelihood of making broad generalizations about them based on their group membership (supplemental point not in text). Because of this, people have designed programs meant to increase the amount of contact with younger and older people in order to break down stereotypes and build connections. These are known as intergenerational programs. INTERGENERATIONAL CONTACT – Some evidence that early education about aging can reduce stereotypes. Also research on different programs that bring undergraduate students into connection with older adults can help them learn about aging as well as decrease stereotypes. OKINAWA provides one example of intergenerational contact. This is a Japanese island that has the largest concentration of centenarians (100 years old and over) in the world. The island is featured in the documentary “Happy”, and the narrator tries to understand what makes the people of this island some of the happiest in the world. He discovers that these centenarians spend lots of time with children, even those with whom they have no relation. This is a great example of intergenerational contact that promotes happiness and well-being SECTION 1A: RESEARCH ON AGING AND THE AGING PROCESS Think – You have just been given a $500 000 grant to study how personality influences cognitive function as we age. • What are some of the most important things you will have to consider in designing your study? • What are some of the biggest challenges you will need to manage? Prompt for discussion – Get students brainstorming about important aspects of study design using this hypothetical example. Ideally, they will raise issues that you can connect back to the text in the remainder of the lecture. E.g., Who are your participants? What are your variables? How will you measure those variable? Over what time frame (i.e., design)? etc. Several issues are important to understand when measuring the adult development and aging process: reliability, validity, research designs, and ethical considerations. SECTION 1B: RESEARCH – RELIABILITY Reliability refers to extent to which a measure provides a consistent index of the behaviour or topic of interest. For example, a ruler is reliable if it produces about the same measure of your height when you measure your height with it more than once. Methods for Demonstrating Reliability Test-retest: This involves administering the test twice to the same group of people, with an interval of time between the two administrations. If the scores correlate highly, the test is considered reliable. Equivalent Forms: This involves developing two versions of the same assessment. The two versions are considered to measure the same thing reliably if they produce the same or highly similar results. Split Halves: This involves comparing the results of one half of a measure to the other half. The two halves are considered to measure the same thing reliably if they produce the same or highly similar results. Inter-rater: This involves having more than one rater on a given task. If the different raters produce very similar ratings, then they are considered to be producing reliable results. SECTION 1C: RESEARCH – VALIDITY Validity refers to the extent to which a measure measures what researchers think it should measure. A ruler is a valid measure of height or length. It is an invalid measure of weight. Values produces used a ruler to measure weight would be meaningless. Statistical Methods for Demonstrating Validity 1. Construct Validity: This method examines whether a hypothetical or theoretical concept is actually being measured, which affects the interpretation and meaning of test scores. 2. Known group’s validation is obtained when the measure can discriminate between groups who should differ in their scores on the measure. For example, my test should be performed well by my students but poorly by junior high students. If both groups perform well on my test, then the content does not discriminate well between those who should know something about personality theory and those who likely do not. 3. Convergent/concurrent validity is achieved when the test correlates significantly with at other tests that measure the same construct. For example, if I develop a leadership questionnaire that correlates strongly with other known measures of leadership, then my questionnaire is considered to have good construct validity. 4. Discriminant validity is achieved when the test correlates significantly poorly with tests that are not related. For example, if I develop a leadership questionnaire, it should not correlate well with a measure of interest in woodwork because they are very different concepts. If my measure does correlate highly with a measure of interest in woodwork, then I would not be very sure that my measure is a good measure of leadership. 5. Predictive Validity: This method examines how well a test score predicts other behavior. For example, we use high school scores to predict if you will do well in university. For high school scores to be valid predictors, they must correlate well with university grades. Non-statistical Methods for Demonstrating Validity 1. Content Validity: This method uses subject matter experts to examine the individual questions in a test. They assess whether or not each question in our test relates to the overall content of the test. 2. Face Validity: This method uses whether the test taker thinks the test seems valid. For example, for my test to seem valid, the questions need to assess the course material and not something else, such as how well you cook. SECTION 1D: RESEARCH – OTHER RESEARCH CONSIDERATIONS Other Research Considerations Systematic observations involve watching people and recording what they say or do. These can be naturalistic (observing how people behave spontaneously in real-life situations) or structured (done by creating a setting that is likely to elicit the behavior of interest). Sampling Behavior with Tasks refers to creating tasks when one can’t observe behavior directly. For example, leadership itself is not something we can see. It is defined by the tasks that characterize what we mean by leadership. Self-Reports refer to people’s answers to questions about a topic of interest. This information can be collected through surveys/questionnaires, interviews, or both. Representative Sampling refers to when a subset of a population represents the overall population of interest. For example, we may want to answer a question about SMU students (the defined population) but do not have the resources to ask every single student. Instead, we pick a subset of students (the sample) and ask them. Their answers are supposed to represent how SMU students feel overall. The sample is representative of all the students if they all had an equal chance of being selected to answer the questions. It is not representative if not everyone had an equal chance of being selected, such as only allowing biology students to answer the questions. SECTION 1E: RESEARCH METHODS – EXPERIMENTAL METHOD General Methods for Conducting Research There are three common types of research methods used to collect data: 1. Experimental Method 2. Correlational Method 3. Case Studies Experimental Method: The experimental method is the most scientifically rigorous research design. It allows researchers to control variables and situations, apply systematic techniques, duplicate a study (you may not get the same results, but you can follow the method), and allows you to make a cause and effect claim. The experimental method involves manipulating one or more independent variables to see if there is a change in one or more dependent variables while controlling for any known extraneous variables. This procedure allows us to precisely determine a behavior's causes. Independent variables are considered the cause and dependent variables are considered the effect. The independent variable is manipulated by the experimenter to see if different manipulations result in different changes to the dependent variable. For example, we want to see if treating colds reduces the number of days people are absent from work. Treatment of a cold is the independent variable and number of days absent from work is the dependent variable because it is expected that treating a cold causes changes in the number of days absent from work. To test whether treatment reduces absenteeism, half of our sample of people will receive a cold medicine (experimental group) and the other half will receive no medicine (control group). After everyone returns to work, we would compare the number of absences for each group to see if the experimental group has fewer absences than the control group. When setting up your independent variable in a clinically based research study, you will have an experimental group and a control group. The experimental group will be the one that is exposed to treatment and the control group will not receive any treatment. Let's say that I created a new drug called "Focus-In". I wonder what dosage will produce the desired "focus" effect on people. What I would do in my study is to manipulate how much of the drug is received. My experimental group participants get 20mg and the control group gets a sugar pill (placebo – no treatment). If there is a difference between the control and treatment (or experimental) group, then I can say that it is likely due to the effect of Focus-In. You can also have multiple treatment groups (e.g., I could have given one group 5mg, another 10mg, another 12mg, and so on). In this way I could not only see a difference between treatment and no treatment, but also see if different levels of treatment have differing effects on people. Limitations of the experimental method: One limit is that ethical issues determine which variables can be manipulated. For example, we cannot expose people to harmful chemicals to see if it has an affect on them. A second limit is that being observed often changes behavior. The fact that you are in a study may artificially change your behavior. Therefore, changes to the dependent variable would be due to the artificial change in your behavior rather than the manipulation of the independent variable. SECTION 1F: RESEARCH METHODS – CORRELATIONAL METHOD Correlational Method: Sometimes we are not able to create an experiment to test our hypotheses. Let’s say that you suspect that children who are verbally abused on a daily basis will have lower self-esteems than children who are not verbally abused. Sometimes things occur in nature that we just cannot replicate in a lab, either for practical or ethical considerations. No research review board is going to let you assign a child to an experimental group where they will be abused, but in real life, unfortunately, abuse does occur and can be studied. The goal of the correlation design is to describe the strength of the relationship between two or more events or characteristics. No attempt is made to structure or manipulate the participant's environment. Instead, you take information as it is and try to determine whether variations in people's life experiences are associated with differences in their behaviors or patterns of development. You see if changes in one variable are accompanied with changes in another. The degree of relationship that exists between two variables (x and y) such as self-esteem and abuse can be measured statistically. To measure the relationship, a correlation coefficient, which ranges from -1.00 to +1.00, is calculated. A perfect positive correlation (+1.00) indicates that both variables (x and y) are changing in the same direction, and the magnitude of change is equal (as x decreases by 1 unit, y decreases by 1 unit). A perfect negative correlation (-1.00) indicates that the variables (x and y) are changing in opposite directions, and the magnitude of the change is equal (as x increases 1 unit, y decreases 1 unit). A coefficient equal to 0 means that no systematic pattern exists between the variables (as x increases or decreases, y may increase, decrease, or stay the same, depending on the case). Limitations of correlational methods: You cannot determine causation using a correlational method. This means you cannot establish cause and effect. For example, there is a greater incidence of child abuse in infants who cry more. However, we cannot say that crying causes child abuse. It could be that children who are abused and hurt cry more. Or there could be an altogether different factor operating, such as living in stressful conditions. SECTION 1G: RESEARCH METHODS – CASE STUDY METHOD Case Study Method: The case study method involves taking an in-depth look at an individual. This is used mainly by clinical psychologists when unique aspects of a person's life cannot be duplicated, either for practical or ethical reasons. When using this method, you prepare detailed descriptions of one or more individuals and attempt to draw conclusions by analyzing cases. The case study provides information about one's experiences, upbringing, family relationships, health, performance on psychological tests, or anything the psychologist can use to help understand that person's development. Limitations of case studies: It is difficult to generalize, can't apply conclusions to others. Data on different individuals may not be comparable, although it does provide very rich information about one person's life. Validity of conclusions depends on accuracy of observations/information received. For example, if recalling details about childhood, memories may be distorted (reasons are discussed in future chapters). SECTION 1H: RESEARCH – MEASUREMENT EFFECTS Measurement Effects Age effects – differences that occur as a result of getting older (Biological, psychological, sociocultural). For example, thinning/graying of hair, increased conscientiousness, changes in number of close relationships Cohort effects – differences that are unique to being born in a certain time period. These include same life experiences or circumstances unique to being born at that time. For example, baby boomers are a unique cohort due to the major cultural changes in the 1960s; the oldest-old having grown up through WWII and other major wars. Time of measurement effects – salient cultural, historical, or environmental effects at the time of data collection. For example, it is important in a longitudinal study where there may be unique findings at one certain data collection point due to salient events, e.g., 9/11 (the attack on the World Trade Center in New York); events such as this can impact people regardless of their age when they are tested. SECTION 1I: RESEARCH DESIGNS – EXAMPLE AND PROS/CONS General Designs for Conducting Research There are three common types of research designs used to collect data: 1. Cross-Sectional Designs 2. Longitudinal Designs 3. Sequential Designs Cross-Sectional Designs Data are gathered from multiple groups of people (e.g., 50 year olds, 60 year olds, 70 year olds) at one point of time, taking a cross-section of the population. Researchers control for as many variables as possible except for the key variables of interest (e.g., How do activity levels differ for adults in different age groups?). Longitudinal Designs Data are collected on the same group of people, on the same measurements, at multiple points in time (e.g., The Nun Study is one of the most well-known longitudinal aging studies). Nuns living in one particular convent in the US – idea was to track this group over time to understand cognitive decline and the natural progression of Alzheimer’s disease and other brain diseases A strength of this study is that this is a relatively homogeneous group of participants who live in a relatively controlled environment (e.g., good food, no tobacco or alcohol, very similar lifestyle), which naturally controls for many confounding variables that could influence the development of age-related cognitive decline. A limitation of the study is its generalizability. The study’s findings may not be completely generalizable to people in the general population, because most people don’t have the same lifestyle as nuns. SECTION 1J: RESEARCH DESIGNS – EXAMPLE AND PROS/CONS Sequential Designs Sequential designs are a combination of cross-sectional and longitudinal designs within the same study, meant to capitalize on the best of both. Cohort-sequential refers to at least two studies that are repeated later in time, but with new participants. This is simply repeating past studies and comparing then to now. An example would be past studies about smoking behavior are compared to current studies designed to measure the same questions as the past studies (e.g., teens then and now; pregnant moms then and now, etc.). These people can no longer be the same people many years later, because they would no longer be teens or pregnant, etc. Therefore, the research question is more about how groups of people (as a sign of the times) have changed (or not). It separates out age from cohort effects, but cannot control for time of measurement. Time-sequential is similar to above but using the same participants as those used in the past. The participants are tracked for later studies to compare then to now. An example would be comparing the smoking behavior or exercising behavior of the same people then and now. These people can be the same people many years later, because they could still be engaging in the behaviors in question. Therefore, the research question is more about how the same individuals have changed over time (or not). It separates out age from time-of-measurement effects. Cross-sequential uses two groups with two different start dates, such as ten years apart, and then tracks both groups over time. It is designed to answer questions asked in both of the above designs. Specifically, it answers whether times have changed (i.e., the groups are ten years apart, so e.g., did automobile use change for individuals who were 20 year olds in the 1970s compared to individuals who were 20 year olds in the 1980s?). It also answers whether people have changed (i.e., did those 20 year olds in the 70s change their auto use over their lifetime, up to today, compared to lifetime auto use for those who were 20 year olds in the 1980s?). Two different cohorts are recruited at age 65, but 10 years apart – then tracked over time. So there are in effect two longitudinal studies ongoing, but with different times of study entry and therefore the ability to separate out cohort effects but not time of measurement effects. SECTION 2A: ETHICAL ISSUES – EXAMPLE Ethics Example Maisie is a 75-year-old, widowed, Afro-Canadian woman. Her daughter is worried about Maisie’s memory loss, and wants to enroll her in a study looking at risk factors for Alzheimer’s disease. The study will involve answering questionnaires, drawing blood, and receiving a brain scan (i.e., PET scan) that includes a radioactive tracer. Maisie does not seem particularly enthusiastic about participating, but her daughter is worried she will not have access to care otherwise. What are some of the ethical issues that arise in this example? 1. Is Maisie cognitively impaired, and if so, can she give informed consent? 2. Is she being coerced by her daughter? 3. Do the benefits of the study outweigh the potential risk of harms (i.e., invasive assessment procedures)? 4. What role do cultural factors play (e.g., history of mistreatment of certain ethnic groups by medical researchers, such as Tuskegee in the US)? SECTION 2B: ETHICAL ISSUES – INFORMED CONSENT AND RIGHT TO WITHDRAW Informed Consent Consent must be free, informed, and ongoing. • Coercion can affect consent being freely given. • Informed means individuals must know everything that will occur within the study. • Ongoing means consent is not a one-time event, but a process. Think – What are some of the issues that could impact an older adult’s ability to give free, informed, and ongoing consent? FREE – e.g., If an older adult is in a vulnerable position (e.g., being cared for by a child) and there is a significant monetary incentive for the study, there could be a concern about coercion. Another example of coercion could be the provision of a treatment or diagnostic test that would otherwise be unavailable to that person (e.g., because it is too expensive). INFORMED – The consent has to be worded in plain language without jargon, that someone with a limited educational background could understand. This is particularly relevant for the oldest-old cohort, many of whom are less well-educated than the baby boomers. Some studies may be more invasive than others (e.g., medical testing), and participants should know exactly what is being asked of them before they sign on. In addition, many older adults retain much of their cognitive abilities as they age; however, some people with advanced age may start to show mild cognitive impairment and dementia, which would interfere with their ability to understand what is being asked of them by participating in a study. This is particularly a concern in longitudinal studies, where someone may be cognitively normal at study entry, but decline over time. Hence, the need for ongoing consent discussed below. Note that, according to TCPS guidelines, someone should not be excluded from research because of a lack of capacity or the cognitive ability to give informed consent. As long as they have an appropriate proxy who can give consent on their behalf, and the individual provides assent, then they should be permitted to enroll. ONGOING – Particularly in longitudinal studies, circumstances may change, including a person’s cognitive ability and ability to give consent. So consent has to be a process over time, particularly when any changes are made to a protocol. Right to Withdraw Consent is a process, not a single event, and so participants have a right to withdraw at any time without penalty. A distinction is made between right to withdraw oneself from further participation and right to withdraw one’s data. WITHDRAW ONESELF – People can leave at any time without penalty. This might happen spontaneously, or at a point where continued consent is solicited and then declined. WITHDRAW ONE’S DATA – Often researchers will make a statement in a consent form about what will happen to a participant’s data if they leave the study (e.g., it will be analyzed with everyone else’s data). SECTION 2C: ETHICAL ISSUES – CONFIDENTIALITY OF DATA Confidentiality of Data This refers to how information is handled (e.g., who has access, where is the info stored, for how long, how will it be used). Anonymity vs. Confidentiality • Confidentiality likely more common than anonymity • Conditions under which confidentiality may need to be broken (e.g., clinical psychologists) • Risks/benefits of data disclosure ANONYMITY – Participants give no identifying info and cannot ever be identified (probably less common, except in reporting of results, e.g., in journal articles). CONFIDENTIALITY – Participants can be identified, but would only be identified under certain circumstances – e.g., clinical psychologists have a duty to break confidentiality if they believe someone may be at harm to themselves or other. Examples of conditions to break confidentiality: 1. Study on cognitive abilities, and one participant is severely impaired that raises a question about driving safety 2. An “incidental finding” is found on an MRI scan suggesting a participant has a brain tumor 3. A participant is suicidal or homicidal ADDITIONAL NOTES: Note that researchers should also make clear the conditions around accessing one’s personal data. In a health context, individuals have a right to access their own personal health information (PHI). However, when health information is collected in a research context, such rights may not apply. It is common in research studies for participants to not have access to their individual data, as they are not meaningfully interpretable at the individual level. Analyses are meant at the group level only. Some participants may withdraw and request to take their own personal data (e.g., an MRI brain scan), but this could give rise to ethical issues where data are misinterpreted by individual participants. In this instance, if a participant does not wish for their data to be retained in a study after they leave, the researcher may opt to destroy the data altogether. SECTION 2D: ETHICAL ISSUES – THE ROLE OF RESEARCH ETHICS BOARDS The Role of Research Ethics Boards Research Ethics Boards (REBs) monitor applications for the factors discussed, i.e., consent, anonymity versus confidentiality, coercion/vulnerability, etc. Data above are from a study done by Pachana et al. (2015) on researchers in Australia and the US, asking about their experiences of working with REBs when submitting applications for research studies on aging. Stereotyping in an Ethical Context Pachana et al. (2015) Study Researchers trying to conduct studies on older adults with and without dementia often found ethics boards to be overly restrictive and narrow in who they deemed eligible for participation. Such restrictions seem to be related at least in part to stereotypes and biases about older adults – e.g., they are too sick, cognitively impaired, or vulnerable to safely participate TCPS Guidelines TCPS guidelines are used by REBs to determine whether a study is ethical or not. May help to mitigate some of the stereotypes and biases – e.g., Chronological age is not the main issue in determining consent, but rather, capacity is. Tri-Council is Canada’s primary federal funding agencies of NSERC, CIHR, and SSHRC. Tri-Council Policy Statement (TCPS) provides guidelines for ethical conduct of research involving humans in regard to respect for persons, concern for welfare, and justice. SECTION 1: PHYSICAL CHANGES WITH AGING: OLD AND NEW CONCEPTS Rate-of-living Theories (e.g., caloric restriction) These theories of aging assume that people are born with a limited amount of energy to be expended in a lifetime, which is why we age. This is demonstrated by the following facts: slower metabolic rates in animals are correlated with longer life spans; decreased caloric intake is associated with lower risk of premature death, slower normative age-related changes, and longer life spans; and the body's ability to deal with stress decreases with age. Cellular Theories These theories point to causes of aging at the cellular level. The Hayflick limit suggests that there might be limits on how often cells divide before dying. Tips of chromosomes become shorter with each replication and eventually become unable to replicate. Cross-linking results from proteins interacting and randomly producing molecules that make the body more stiff. Free-radicals are highly reactive chemicals produced randomly during normal cellular metabolism resulting in cellular damage. All of these are result in aging. Programmed Theories and Error Theories According to these theories, the innate ability of cells to self-destruct, and the ability of dying cells to trigger processes in other cells, is due to a genetic program that is triggered by physiological processes. Error theories assume that an external environmental factor inflicts damage to living organisms. These include wear and tear theory and free radical theory. Implications of the Developmental Forces Biological theories provide ways to describe biological forces. We cannot truly understand health and aging without considering the other developmental forces (psychological, sociocultural, and life-cycle). Section 2: CHANGES IN Appearance Intrinsic aging is the gradual irreversible changes in structure and function of an organism that occur due to the passage of time, while extrinsic aging is due to external factors such as exercise, diet, exposure to sunlight, and smoking. External aging is associated with actinic keratosis, as well as skin cancers such as melanoma and basal cell and squamous cell carcinoma. Changes in the Skin Wrinkles are the result of a complex, four step process. First, the outer layer of skin becomes thinner and more fragile. Second, collagen fibers lose their flexibility, making the skin less able to regain its shape after being stretched or pinched. Third, elastin fibers lose their ability to keep the skin stretched out. Fourth, the underlying layer of fat which makes the skin look smooth diminishes. How quickly your face ages is largely in your control. The majority of the changes to the skin with age are preventable (e.g., due to extrinsic factors). One of the best ways to minimize wrinkles and reduce the other changes to your skin described above is to protect your skin against both UVA and UVB rays. Protection against UVA and UVB rays also helps to minimize the risk of skin cancer. Skin cancer is currently the most common type of cancer—it is also one of the most preventable types of cancer. Recommendations for protection against skin cancer include the use of a broad-spectrum sunscreen that has a sun protection factor (SPF) of 15 or higher. Limiting exposure to UV radiation, whether it is from the sun or from artificial sources such as sunlamps and tanning beds, can reduce the risk of developing skin cancer. Results from a recent review of 19 studies over a 25-year span on indoor tanning equipment revealed that there is an association between indoor tanning and two types of skin cancer: squamous cell carcinoma and melanoma. Results also indicated that risk of melanoma, one of the deadliest skin cancers, increases by 75 percent when tanning-bed use starts before age 35. Finally, the results from this same report also found that there is an association between UV-emitting tanning devices and cancer of the eye (ocular melanoma). Changes in the Hair Thinning and greying hair results from the cessation of pigmentation. Hair loss is caused by the destruction of the germ centers that produce hair follicles. Age-related changes in hair include: • Androgenetic alopecia (male-pattern baldness) – affects 80% of Caucasian men and 42% of Caucasian women • Greying of the hair due to reduced melanin/melanocytes, which occurs earlier in Caucasians than those of African and Asian descent Changes in the Voice Our voices tend to be thinner and weaker when we get older. Presbyphonia refers to age-related voice changes including: • Higher pitch in men • Lower pitch in women, reduction in volume and projection, tremor/shakiness in the voice, and reduced vocal endurance Changes in Body Build Decreases in height result from the compression of the spine, changes in the discs between vertebrae, and changes in the spine. The animation to the right demonstrates these changes. Weight gain is an additional change in body build in midlife (between 20s and mid-50s) followed by weight loss in late life.which would keep them healthier (e.g., exercise). Section 3A: CHANGES IN THE Sensory SYSTEMS – Vision Changes in Vision Structural changes in the eye during aging include a decrease in the amount of light that passes through the eye, so increased illumination is often required. Ability to adjust to changes in illumination takes longer and leads to slower light and dark adaptation. The lens of the eye becomes more yellow with age causing poorer color discrimination in the green-blue-violet spectrum. Because of stiffening, the lens has a harder time adjusting and focusing, making it difficult to see nearby objects. Disease such as cataracts and glaucoma can cause abnormal structural changes in the eye. In terms of retinal changes during aging, the retina lines the inner two thirds of the eye with specialized receptor cells known as rods and cones. The most densely packed area of rods and cones in the retina are at the focal point region known as the macula. With increasing age, the likelihood of macular degeneration increases and results in the inability to see details. Diabetic retinopathy is a by-product of diabetes, which can lead to blindness. This involves fluid retention in the macula, detachment of the retina, hemorrhage, and aneurysms. As a result, there is a decrease in acuity, or the ability to see detail and discriminate different visual patterns. Age-related macular degeneration is a leading cause of vision loss among persons 50 years and older and is the leading cause of vision loss in Canada. Other types of age-related vision disturbance include cataracts (an opacification of the lens), glaucoma (characterized by increased intraocular pressure), dark adaptation, and presbyopia (a loss of accommodation due to lost elasticity in the lens). Psychological effects of vision loss during aging can be seen in many areas that most young people take for granted such as reading, watching TV, and driving. These changes may cause older adults to withdraw from society and activities which they previously enjoyed. Section 3B: CHANGES IN THE Sensory SYSTEMS – HEARING Changes in Hearing Hearing loss is one of the most well-known normative changes with age. There is a reduced ability to hear high-pitched tones due to four types of changes in the inner ear: sensory changes due to atrophy and degeneration of receptor cells, neural changes due to loss of neurons in the auditory pathways in the brain, metabolic changes due to diminished supply of nutrient to the receptor area, and mechanical changes due to atrophy and stiffening of the vibrating structure in the receptor area. Age-related hearing loss (ARHL) includes: • Conductive hearing loss – damage to the middle ear • Sensorineural hearing loss – permanent damage to the inner ear (i.e., cochlea), a form of which is presbycusis • One of the main risk factors for ARHL is long-term repeated exposure to noise resulting in gradual, irreversible damage to the sensory cells and other structures, leading to permanent hearing loss Think – What do you imagine would be the psychological impact of age-related hearing loss, or loss of any of the senses (e.g., vision, taste, touch)? Contemplate how loss of hearing, vision, etc. could impact older adults psychologically, e.g., difficulty to converse and socialize, decreased independence, being mistaken for being cognitively impaired, etc. Section 3C: CHANGES IN THE Sensory SYSTEMS – TASTE, SMELL, AND TOUCH Changes in Taste, Smell, and Touch The ability to taste declines gradually and varies greatly taste to taste and from individual to individual. The ability to smell odors begins to decline after the age 60 in most people, but there are wide variations. Interestingly, there are abnormal changes in Alzheimer's patients' smell ability. The psychological impact of changes in taste and smell are easy to see. With reduced pleasure in eating due to these changes, diets suffer. Also, decreases in the ability to smell can lead to dangerous situations, such as not detecting the smell of smoke during a fire or not being able to detect that food has gone bad. Changes in Taste • The research on changes in taste perception with age is contradictory; some studies indicate no decline, and other studies indicate declines but not for all types of taste Changes in Smell • Anosmia has been described as the “canary in the coalmine” with regards to overall physiological declines and death Changes in Touch • Research that has been done indicates that tactile thresholds increase significantly with age, as do thresholds for pain and temperature. These changes have important implications for everyday living. Prompt for discussion – Why would changes in taste, smell, and touch be potentially dangerous for older adults? • E.g., can’t smell or taste food that is off – could get sick • E.g., can’t smell gas or burning – could be accident in home • E.g., decreased touch means possibly higher risk of burns, not feeling serious bruises after falls, etc. SECTION 3D: CHANGES IN THE SENSORY SYSTEMS – SOMESTHESIA AND BALANCE CHANGES IN SOMETHESIA AND BALANCE Somesthesia refers to systems that convey information about touch, pressure, temperature, pain, movement, and body position. With age, it takes more pressure to feel touch on smooth, non-hairy skin such as the fingertips. Older adults report having more trouble regulating body temperature to comfortable levels, but the cause of this is unclear. Some degree of age-related change in pain sensitivity has been identified, with older adults reporting more, but research is inconclusive about the causes. Kinesthesis, or your sense of body position, involves sensory feedback from passive and active movements. Differences have been found for passive movements, or those initiated by something or someone else, but not for active or voluntary movements. The vestibular system is responsible for maintaining our balance and initiating movements. Dizziness and vertigo are common in older adults and increase with age. Dizziness is the feeling of being unsteady, floating, and lightheaded. Vertigo is the feeling that one or one's surroundings are spinning. Because of these changes, falls become more likely and life-threatening with increasing age. One way to improve balance is through Tai Chi training, which increases body position awareness. Section 4: CHANGES IN THE Cardiovascular System As part of aging, some fat accumulates in and around the heart as well as the stiffening of the heart muscle. As a result, the amount of blood pumped declines from 5 liters per a minute at 20 years of age to 3.5 liters at 70 years of age. The stiffening of arterial walls is caused by calcification of the arterial walls and less elastic fibers. By the age of 65 most adults experience a 60 to 70% decline in aerobic capacity. 80% of Canadians have at least one risk factor for cardiovascular disease. Deaths from cardiovascular disease have been declining, especially among men. Types of cardiovascular disease include congestive heart failure, angina pectoris, myocardial infarctions, atherosclerosis, cerebrovascular accident (CVA), hypertension, and hypotension. Sections 5 and 6: CHANGES IN THE Digestive AND Immune Systems Digestive System On page 67-68 of your textbook, review the various changes to the digestive system as we age, along with how to manage, reduce, and prevent various ailments associated with digestive changes. Immune System The primary function of the immune system is to fend off invading organisms. Several immune system cells create a network of interacting parts that defend against malignant or cancerous cells, viral and fungal infections, and some bacteria. Older adults’ immune systems take longer to build up defenses against specific diseases. As a result, they are more prone to serious consequences from illnesses. Components of the Immune System: Innate immune system – present at birth, white blood cells activate in response to infectious and noninfectious agents Adaptive immune system – develops over time through exposure to certain pathogens. B or T cells that are activated create immunological memory, building up resistance to attack over time – this is the basis for vaccination. Immune System Changes with Age Both innate and adaptive immune systems decline with age. Infectious diseases account for roughly 1/3 of all deaths in persons 65 years and older. Hospital/long-term care stays can increase the risk for exposure to infections. Autoimmunity is when the immune system begins attacking the body itself. Psychoneuroimmunology refers to the study of the relations between psychological, neurological, and immunological systems that raise or lower our susceptibility to disease and ability to recover from disease. AIDS is increasingly more prevalent among older adults. In 2004, there were 177 new cases of HIV identified among adults over the age of 50. Older adults may be more likely to contract HIV due to immune system changes, but also due to physiological changes (e.g., thinning of the vaginal wall). This may be further complicated by lower condom use. Section 7: CHANGES IN THE Metabolic System Metabolic System The metabolic system includes the pancreas, liver, thyroid, and hypothalamus. Diabetes, particularly Type II diabetes, becomes increasingly prevalent in later life. Insulin, used to manage diabetes, was discovered in 1921 by Frederick Banting and Charles Best, a Canadian surgeon and medical student, respectively. Type 1 diabetes (juvenile diabetes) is usually more severe and is characterized by the body’s impaired ability to produce insulin. Daily insulin injections are required to manage Type 1 diabetes. Type 2 diabetes (adult onset diabetes), on the other hand, is typically less severe and is marked by the body’s impaired ability to recognize and utilize insulin. Type 2 diabetes can be managed by diet alone or in combination with oral hypoglycemic agents. Some individuals with Type 2 diabetes, are, however, treated with insulin. Due to population growth, the aging of the population, increasing rates of obesity, and an increase in a sedentary lifestyle, the number of people with diabetes is rapidly increasing in many jurisdictions worldwide. In 2008/2009, nearly 2.4 million Canadians (6.8 percent) were living with diagnosed diabetes. Long-term complications include increased risk of cardiovascular disease, kidney disease, retinopathy and other eye disorders such as glaucoma, and nerve damage (neuropathy). Section 8: Changes in the Musculoskeletal System Changes in the Musculoskeletal System Muscles: Muscle mass decreases with age, but strength and endurance only change slightly. Bones: Loss of some bone mass is normative. It begins in late 30s and accelerates in the 50s. Women lose bone mass twice as fast as men, putting them at an increased risk for osteoporosis, a bone degeneration disease in which bones become brittle and honeycombed. Joints: Beginning in the 20s, cartilage in joints shows signs of deterioration which leads to aching joints. Osteoarthritis is a wear-and-tear disease that results from degeneration of cartilage. It is marked by the gradual onset and progression of pain with only minor signs of inflammation. Rheumatoid arthritis is a more destructive disease of the joints. It affects different joints and includes aching along with swollen joints. Section 9: CHANGES IN THE Central and Autonomic Nervous SystemS Central Nervous System Neurons are individual brain cells. Dendrites are where neurons receive chemical information from other neurons. The cell body is where the signal is brought in and converted into an electrochemical signal. The axon is the tail of the neuron where the now electrochemical signal is sent. Terminal branches are where the signal is converted back into a chemical message to be transmitted to other neurons. We are born with about 1 trillion neurons; all the neurons we will ever have. Neurotransmitters are chemicals that carry the information signal to the next neuron. The synapse is the gap between neurons where chemicals are sent out to be picked up by a neighboring neuron's dendrites. Structural changes in neurons in most cases are normal, but in high numbers are associated with Alzheimer's disease. Neurofibrillary tangles occur when fibers in the axon become twisted to form spiral filaments. Although there are losses there are also gains in dendrites. Plasticity refers to the capability of the brain to adapt and change its functional and structural organization. Neuritic plaques occur when dying neurons collect around a core of protein. Changes in communication between neurons can be due to changes in the amount of neurotransmitters created. Dopamine controls motor movement. Its levels decrease with age. Parkinson's disease is characterized by tremors of the hands, arms, and legs due to extreme declines in dopamine. Treatments include L-dopa, which can be converted to dopamine, and COMT which block the breakdown of L-dopa before reaching the brain. Surgical treatments are available and embryonic stem cells hold promise. Acetylcholine declines are linked with memory problems in old age. Research has speculated that abnormally low levels of acetylcholine are related to Alzheimer's disease and Huntington's disease. Three types of brain imaging techniques are frequently used: computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET). Autonomic Nervous System With regard to regulating body temperature, older adults have a decreased ability to tell that their core body temperature is low resulting in them being less able to tell that they are cold. They have a vasoconstrictor response, the ability to raise one's core body temperature, when the body's peripheral temperature drops. They do not sweat as much and are less likely to drink water to cool themselves. All of this puts older adults at increased risk for hypothermia (body temperature below 95 degrees) and hyperthermia (body temperature above 98.6 degrees). With regard to sleep, older adults take longer to fall asleep, are awake more at night, are more easily awakened, and experience major shifts in their circadian rhythms. There is a move from a two-phase rhythm (awake during the day and asleep during the night) to a multiphase rhythm (daytime napping and shorter sleep cycles at night). Other major causes of sleep disturbances include sleep apnea, leg jerks, heartburn, frequent need to urinate, poor physical health, or depression. PSYCHOLOGICAL IMPLICATIONS Fear revolves around potential dementia or the loss of memory, emotional response, and bodily functions (described in detail in Chapter 4). This is further perpetuated by the use of the term senile, which no longer has any medical or psychological meaning. Section 10: CHANGES IN THE Reproductive System FEMALE REPRODUCTIVE SYSTEM Perimenopause is a time of transition that usually begins in the 40s, as menstrual cycles become irregular, and is complete by the mid 50s. This is accompanied by the end of menstruation, a reduction in estrogen and progesterone, changes in reproductive organs, and changes in sexual functioning. Menopause refers to the point at which ovaries stop releasing eggs. A variety of physical and psychological symptoms may occur during perimenopause and menopause. These most frequently include hot flashes, night sweats, headaches, and mood changes. There are ethnic and cultural differences in number and type of reported symptoms. Hormone replacement therapy has resulted in much contradictory data. Physiological changes in women's sexual performance include increased possibility of painful intercourse due to smaller and thinner vaginal walls, smaller vagina, and reduced and delayed vaginal lubrication. MALE REPRODUCTIVE SYSTEM With increasing age men show a gradual decline in testosterone levels beginning the mid 20s. Sperm production declines gradually with age for men. However even at the age of 80 men are still half as fertile as they were at 25. With age, the prostate gland enlarges, becomes stiffer, and may interfere with urination. Annual screenings are important for men over 50 years of age. Physiological changes in men's sexual performance result in a longer time and more stimulation needed to achieve an erection and orgasm. Problems with sexual function over time include a failure to achieve an orgasm, a much longer resolution time, and the loss of erection during intercourse. PSYCHOLOGICAL IMPLICATIONS The social constraints placed on older adults reduce the opportunity to engage in sexual relationships. Section 11: Changes in the Urinary System URINARY SYSTEM The urinary system consists of the kidneys, ureters, bladder, and urethra. With increasing age: 1. Kidneys get smaller and blood flow to the kidneys decreases 2. Kidneys lose the ability to balance the amount of salt and acid in the body 3. Bladder tissue declines in capacity to hold urine 4. Urinary frequency/urgency increases Specific health problems can include: 1. Urinary incontinence is a highly prevalent condition in older adults, more so in women. Incontinence is the loss of control over the elimination of urine and feces on an occasional or consistent basis. Urinary incontinence, the most common form, increases with age. There are five reasons for urinary incontinence, most of which can be alleviated with interventions: stress incontinence (due to pressure in the abdomen), urge incontinence (caused by damage to the CNS), overflow incontinence (result of improper contraction of the kidneys), functional incontinence (results because of lack of awareness of the need to urinate), and iatrogenic incontinence (caused by medication side effects). 2. Urinary tract infections are the most common bacterial infections, which can cause not only physical but also cognitive symptoms, including delirium. Section 12: Changes in Sleep SLEEP With regard to sleep, older adults take longer to fall asleep, are awake more at night, are more easily awakened, and experience major shifts in their circadian rhythms. There is a move from a two-phase rhythm (awake during the day and asleep during the night) to a multiphase rhythm (daytime napping and shorter sleep cycles at night). Other major causes of sleep disturbances include sleep apnea, leg jerks, heartburn, frequent need to urinate, poor physical health, or depression. Section 13: IMPACT OF CHANGES IN APPEARANCE AND STEREOTYPES It is hoped that studying this material will bring to light greater awareness of the ways our bodies change as we age, as well as highlighting the stereotypes we might have about older adults going through those changes. What have you learned in this chapter that confirms or disconfirms your stereotypes about the meaning and impact of physical changes with aging? Factors Affecting Health Our current health is determined by many factors: INDIVIDUAL CHARACTERISTICS – older age means greater likelihood of disease; the patterns of disease differ for men and women SOCIAL AND ECONOMIC ENVIRONMENT – lower education and income are associated with lower health status across all age groups INDIVIDUAL BEHAVIORS – e.g., eating habits, level of physical activity, smoking and drinking habits, and ways of coping with stress • Like many younger Canadians, many older Canadians fail to eat a balanced diet, and malnutrition is a significant health risk for older adults • The majority of older adults are sedentary and activity levels decrease with advanced age • Smoking and drinking are less common in older versus younger adults • Stress and mental health are big contributors in late life, and those older adults caregiving for other older adults likely have greater levels of stress and mental health adversity Social support and social engagement are also major determinants of health status, with loneliness being a risk factor for poor health outcomes and mortality. SECTION 1: NEUROIMAGING TECHNIQUES In the past 20 years, neuroimaging has revolutionized the study of cognition and aging. Neuroimaging refers to a variety of techniques for investigating the brain in both humans and animals, including: Structural methods, such as computed tomography (CT) and magnetic resonance imaging (MRI). These show a snapshot of the structure of the brain in time, and can demonstrate changes with age such as atrophy. They can also show certain types of pathology, such as white matter disease. Functional methods, such as functional MRI (fMRI), positron emission tomography (PET), single-photon emission computerized tomography (SPECT), near-infrared spectroscopic imaging (NIRSI), and diffusion tensor imaging (DTI). These show the functioning of the brain in real time, either at rest or in response to a task. However, “real time” is relative, because the signals of these various methods are not necessarily instantaneous, but may be showing activity from a few seconds prior. Of the functional methods, fMRI is the most widely used and researched. Neuroimaging studies have led to the development of certain cognitive models, such as: HAROLD (hemispheric asymmetry reduction in older adults) – the level of bilateral activations in the prefrontal cortex of aging brains demonstrates compensatory processes for numerous cognitive tasks. CRUNCH (compensation-related utilization of neural circuit hypothesis) – more activation is seen on easy tasks, while equal or less activation is seen on difficult tasks. STAC (scaffolding theory of cognitive aging) – compensatory scaffolding (i.e., recruitment of additional brain circuitry) allows for the maintenance of performance on various tasks of cognition. Section 2: Normal Age-related Changes to the Brain The frontal lobes, hippocampus (in the temporal lobe), and parietal lobes are particularly vulnerable to age-related decline, affecting cognitive abilities such as executive functions and episodic memory. Research is unclear as to why the brain changes and shrinks with age. It is not simply due to neuronal loss, but also includes loss of glial cells, reduced myelination, and a decrease in white matter volume. Changes in neurotransmitters, most notably dopamine, serotonin, and acetylcholine also occur with age. Cognitive reserve (CR) was a concept that developed after numerous studies showed that there is not always a perfect correlation between brain damage and cognitive/functional abilities. - Two people with similar levels of brain pathology can show significantly different levels of function - Factors affecting CR are thought to include education, complex work experiences, and an active lifestyle, although education is often the most common proxy measure - One can contribute to CR throughout life - CR is believed to be one factor that can act as a buffer against cognitive decline - Bilingualism can contribute to CR, and is associated with better executive functions and decreased risk of Alzheimer’s Section 3A: Changes in Memory and Attention There are many different types of memory: Sensory memory – lasts only for a few seconds Short-term/working memory – lasts for up to 20 seconds, involves mental manipulation of information, as well as consolidation/transfer of information to long-term memory Long-term memory – can be classified as episodic (i.e., new learning for events) vs. semantic (i.e., knowledge of facts and information) Research suggests that sensory memory is not strongly affected by age, whereas short-term/working memory is (largely through the central executive). Episodic memory declines, while semantic memory ability does not decline per se but can be difficult to retrieve. Information is passed from our sensory memory to our short-term memory through the process of attention. Importantly, sensory memory often is confused with short-term memory but there is a significant difference between the two. Sensory memory, which cannot be controlled, lasts only a few seconds at most, whereas information in short-term memory can last for approximately 20 seconds. Working memory has been heavily researched over the years, and one of the most influential models of working memory is Baddeley’s model of working memory. The phonological loop and visuospatial sketchpad are modality-specific “slave systems”. The episodic buffer holds information from these systems, as well as from long-term memory. The central executive controls and coordinates the other three components of working memory. Research suggests that the central executive is the aspect of working memory most vulnerable to age-related declines. In general, there are few, if any, changes in the phonological loop, the visuospatial sketchpad, and the episodic buffer with age. However, changes in central executive function with age have been identified as a key contributor to age-related declines across a range of cognitive tasks. Declines in working memory have implications for everyday function. Many complex cognitive tasks depend on the central executive for managing and coordinating the different components of the task. For example, working memory is needed for everyday abilities such as managing finances, shopping, and cooking, as well as for everyday activities such as following spoken directions, actively participating in group discussion, and organizing materials and activities. Not all forms of attention are affected similarly by age. For example, some research suggests that declines in selective attention are due to general slowing of processing speed. Older adults have greater difficulty with divided attention (i.e., doing more than one thing at once). On simple sustained attention tasks, older adults perform normally, but on more complex sustained attention tasks, they make more omission and commission errors relative to younger adults. Section 3B: Organizing Memory Beyond sensory memory and attention, how is information kept in mind for processing? Working memory refers to the active processes and structures that hold information in mind and use it, sometimes in conjunction with incoming information, to solve a problem, make a decision, or learn new information. It has a limited-span capacity where only a few items can be processed at once. Working memory capacity declines with age due to reductions in storage capacity, ability to allocate capacity to more than one task, and information processing speed. Age-related declines vary depending on information provided, task type and complexity, gender, and life experience. Long-term memory refers to multiple brain systems that work together to allow us to remember extensive amounts of information over a few seconds to a few hours to decades. Implicit memory refers to a change in task performance that is due to exposure to information at some earlier point in time, but does not involve active explicit memory. For example, you may know words in another language because of exposure to them on television even though you may never have explicitly tried to learn those words. Results from studies are mixed and this type of memory is generally spared from age-related declines. Explicit memory is described as deliberate and conscious remembering of information learned and remembered at a specific time. It can be divided into the following subsets: 1. Declarative memory, or memory for facts and events, which further breaks down into the following: a. Episodic memory, which is memory of information from a specific event or time (e.g., what you did on spring break). b. Semantic memory, which concerns learning and remembering the meaning of words and concepts that are not tied to any specific occurrences of events in time (e.g., knowing definitions of words). 2. Procedural memory, or conscious memory for procedures such as how to ride a bike or do laundry (i.e., skills). Section 3C: Source of Age Differences in Memory Age Differences in Episodic Memory Many day-to-day activities we perform fall into episodic memory; as a result, this is the most researched area of memory. Research often involves learning information and then recalling or recognizing information at a later point. Recall involves remembering information without hints or cues (i.e., an essay exam). Older adults perform worse. These differences are large, with 80% of adults in their 20s outperforming adults in their 70s. Recognition involves selecting previously learned information from among several items (i.e., a multiple-choice exam). The differences between younger and older adults are greatly reduced on recognition tests. However, older adults are more likely to accept never presented items, especially if they are conceptually or perceptually similar. Older adults also are less spontaneous in their memory strategy use, but when told to use one, can do so effectively. Age differences can be reduced by slowing the presentation pace, providing time to practice, and using familiar stimuli. Age Differences in Semantic Memory There appears to be very small changes in semantic memory with increased age. There are no differences in language comprehension, structures of knowledge, and activation of general knowledge, partly due to the ability to draw on prior experience, which taxes working memory less. The major agerelated decline is in accessibility, such as difficulty finding words. Remote/Autobiographical Memory Remote memory refers to information that is kept for a very long time, such things as facts learned early, meanings of words, and past experiences. Two types of remote memory include memories of general events, such as public events (see flashbulb memories below), and memories specifically about one's own life, such as graduation day (see autobiographical memories below). 1. Flashbulb memories are remembered well because they are historical events that have considerable personal relevance, are very unusual or novel events, or are events that are highly emotional (i.e., September 11th). 2. Autobiographical memories involve aspects of remote memory having to do with remembering information and events from one's own life. a. Episodic autobiographical memory is conscious recollection of temporal and spatial events from one's past b. Semantic autobiographical memory consists of knowledge and facts of one's past without having to remember exactly when it occurred and in what order. For older adults, episodic details are more difficult to remember than semantic details. Older adults have less vivid recollections of their past, but general memory of real-life events contain more personal thoughts and feelings and are rated as more interesting. Age Differences in Encoding and Retrieval Research suggests age-related decrements in encoding, not in storage. Elaborative rehearsal involves making connections between incoming information and information already known. Age-related losses may be due to difficulty making connections with incoming information. However, once connections are made, they are maintained at the same rate as younger adults. Section 3D: Strategies, Retrieval, and MISINFORMATION Use of Strategies When confronted with large amounts of information that we need to remember, we tend to use strategies that make the task easier and increase the efficiency of storage. Two effective strategies for learning new information involve organizing it and establishing links to help you remember the information. Older adults do not spontaneously do either as well as younger adults. Age differences are greater for tip-of-the-tongue states and feeling-of-knowing (feeling you know something yet not sure what) after failure to retrieve information. Based on research evidence, age-related differences occur at both encoding and retrieval, with encoding problems being especially important. The Emerging Role of Automatic Retrieval False fame effect refers to when a previously observed nonfamous name (on an original list) is mistakenly identified as a famous name at testing. Older adults show larger false fame effects. Misinformation and Memory Source information refers to the ability to remember the source of a familiar event and whether the event was imagined or actually experienced declines with age. False memory involves remembering items or events that do not occur. Older adults are more susceptible to false memories. Section 3E: Memory of Discourse Discourse Discourse collectively includes reading books, magazine, newspapers, and pamphlets and watching television and movies. It is investigated at two levels of linguistic structure of the text: The basic level involves specific propositions (each of the basic ideas represented in the text), some of which may be central to the story and others that are less important; the situation model level is a higher level of processing where people use their world knowledge to construct a more global understanding of the text. Text-based Levels Older adults recall similar levels of main ideas as young adults when the text is clearly organized and when the structure and the main ideas are clearly emphasized. However, there are observed deficits under specific conditions: higher presentation speeds, highly unpredictable or unorganized material, and highly dense in propositions. Age-related slowing in cognitive processing explains much of these differences. Prior beliefs about material may also make it more difficult to learn and remember elements of text. Situation Models These include features besides text-based information, such as emotional information, goals, and personality characteristics of main characters as well as spatial relationships among the people, objects, and events described. A reader’s characteristics, such as biases, the social context in which one is recalling a text, and personal motivations for remembering or forgetting certain pieces of information also influence the model. Older and younger adults construct and update situation models similarly. Text Memory and Episodic Memory Text memory is another way to examine episodic memory. Both are influenced by pacing, prior knowledge or familiarity, and organization of materials. Section 3F: Memory in Everyday Life Spatial Memory Unless the location is familiar or cues are given, older adults have poorer memory for location than younger adults. Unless the environment is familiar, older adults are poorer at learning routes than younger adults. In familiar environments, older and younger adults are equally able to learn a route, but gender and age differences appear when people use maps. Older men do more poorly when provided no aids, but with a map they are no different from younger men. Older women do more poorly when they used a map, but there were no differences between younger and older women when the map was labeled a diagram. Prospective Memory This form of memory involves remembering to perform a planned action in the future, such as taking medication. Event-based prospective memory is an action is performed when a certain external event happens, such as clapping at the end of a speech. Time-based prospective memory involves performing an action after a fixed amount of time or a fixed point in time, such as going for monthly blood work. Age differences are less likely on event-based prospective memory because there are more contextual cues than on time-based prospective memory tasks. Memory of Pictures Older adults are worse at remembering some types of pictures including faces and objects placed in a colored three-dimensional array or on a distinctive map. To compensate, older adults are more likely to rely on schemas to help them remember scenes, especially disorganized scenes. Section 3G: Self-evaluations of Memory Abilities Aspects of Memory Self-evaluations Metamemory refers to what one knows about how memory works and believes to be true about it. Memory monitoring is awareness of our current memory activity. Age Differences in Metamemory Questionnaires are often used to assess age differences in memory. Older adults know less about memory and its capacity, view it as less stable, expect decline with age, and perceive they have little control over it. Belief in inevitable decline is very strong among older adults, but does not apply equally to all areas of memory. For example, remembering names declines more quickly than remembering events that happened long ago. The Role of Memory Self-efficacy Memory self-efficacy refers to the belief that one will be able to perform a specific task. Older adults with lower memory self-efficacy have poorer memory performance. However, these same older adults are more likely to rely on someone else or use strategies to help themselves remember. Age Differences in Memory Monitoring Predictions without experience refer to estimating your performance without having a chance to see if what we are up against is hard (e.g., estimating your performance on the first exam in this class). Older adults with low levels of recall overestimate performance. Predictions with experience refer to when you have a chance to see the task before making a performance prediction. Age differences usually are absent for both recognition and recall. However, adults of all ages overestimate performance on recall tasks and underestimate on recognition tasks. When given multiple practice trials, adults of all ages adjust their predictions across trials. Section 3H: Clinical Issues and Memory Testing Normal and Abnormal Memory Aging One way to separate normal from abnormal aging is to determine whether memory changes are affecting daily functioning because some diseases are marked by severe memory impairments. Memory and Mental Health Several mental health problems are related to or can cause memory problems, including dementia and depression. With Alzheimer’s disease, severe and pervasive memory impairment is progressive and irreversible. Those with depression have difficulty recalling new material, remembering important information, organizing information, and implementing strategies. They have increased sensitivity to sad memories and decreased psychomotor speed. Clinical Memory Tests Neuropsychological tests assess brain-behavior relations of broad aspects of cognitive functioning, including memory, attention, and problem solving. Behavioral assessments involve having people perform everyday memory tasks. These assessments measure global decline, not declines that occur in specific domains of functioning. Self-report scales assess various memory situations and correlate moderately with performance. Rating scales are designed to assess memory from the viewpoint of an observer, usually a mental health professional (e.g., structured interviews and checklists). Memory, Nutrition, and Drugs Poor nutrition and many types of drugs also can cause memory problems. In particular, alcohol, caffeine, and some prescriptions and over-the-counter can have major effects on memory. Section 3I: Remediating Memory Problems Training Memory Skills The E-I-E-I-O framework refers to explicit-implicit aspects of memory and external-internal memory aids. Explicit memory involves conscious and intentional recollection of information. Implicit memory involves effortless and unconscious recollection of information. External aids rely on environmental resources (i.e., taking notes, making lists, and using calendars). They are common, widely available, and have been shown to be effective. Internal aids rely on mental processes such as rehearsal (repeating tobe-remembered information), mental imagery (making a picture in your head), method of loci (remembering items by mentally placing them in locations in a familiar environment), mental retracing (thinking about all the places you have been to help remember a location), and acronyms (taking the initial letter of words to create a word, such as CPA for Canadian Psychological Association). Training and monitoring learning performance improves memory in older adults. Memory should be exercised like any muscle, and practice improves memory. Both physical and mental activity can protect against memory decline. Memory drugs usually affect acetylcholine and generally have modest, short-term effects. The situation determines the best strategy to use. For optimal improvement, the best approach is to tailor specific strategies to specific situations and to use multiple techniques. Individual Difference Variables in Memory Training Adults are a heterogeneous group when it comes to memory performance. Memory training may be more effective when individual difference factors (i.e., emotional issues and self-efficacy) are considered and when specific needs are addressed. However, older adults tend not to generalize the strategies across a range of different tasks. Section 4: Language Changes with Age Vocabulary tends to maintain or accumulate over the lifespan, due to increased semantic knowledge. However, there are some age-related declines in language ability: WORD-FINDING – Word-finding difficulty, also known as “tip-of-the-tongue”, is one of the most common age-related changes. Older adults report about twice as many word-finding difficulties as younger adults, and they tend to use circumlocutions (i.e., talking around a topic) to compensate for not being able to come up with the right word. SENTENCE COMPLEXITY – Complexity of sentences also seems to decline, which is believed to be related to a decline in working memory. Having lots of clauses in a sentence can be mentally taxing, requiring the listener (or speaker) to keep multiple pieces of information in mind while the sentence is produced. ELDERSPEAK – Elderspeak is a stereotyped way of speaking to older adults, akin to “baby talk”, which involves slow speaking, exaggerated intonation, simplified vocabulary and grammar, and a higher pitch. Although people adopting this way of speaking may be well-meaning, research suggests that older adults find this to be patronizing, degrading, demeaning, and disrespectful. It assumes or implies cognitive impairment or significant communication problems. Section 5: Can training modify changes? Two main types of training programs are cognitive training programs and cognitive stimulation programs. The pattern of evidence for these programs is inconsistent, with some concern that claims of effectiveness are exaggerated. • Findings are mixed in part because the methods, duration, and dose of these interventions vary so dramatically across studies, making general conclusions difficult to reach. • The ACTIVE study is one of the most well-known cognitive training programs, conducted in the US. • “Transfer of training” is a perennial issue. COGNITIVE TRAINING – directed practice of specific cognitive tasks as a method to improve or prevent age-related cognitive decline in older adults COGNITIVE STIMULATION – designed to increase general cognitive functioning Training is often used in healthy older adults, while stimulation is often used in individuals with more significant cognitive impairment, such as dementia. ACTIVE Study (Advanced Cognitive Training for Independent and Vital Elderly) – Focused on domains of memory, processing speed, and reasoning in community-dwelling older adults. The findings showed that this training improved cognitive skills in these targeted domains but this training did not transfer to other cognitive domains. Nonetheless, these improvements could still be observed up to five years later in many of the participants. Transfer of training: Of the cognitive training studies that show an intervention effect, this is often limited to very similar tasks as those on which the person was trained (i.e., near transfer). But there is usually limited evidence of transfer to daily functioning (i.e., far transfer), which raises questions about the utility of these training programs to enhance older adults’ daily functions, functions that would presumably be contingent on the cognitive processes being trained (e.g., working memory needed for mental arithmetic at the grocery store). Section 6A: Overview of Intelligence There are many different theories of intelligence: Psychometric approach – assumes that intelligence is something that can be measured in greater or lesser amounts (e.g., Spearman’s G, the WAIS-IV) Primary mental abilities – Thurstone argued that G was a statistical artifact, and that intelligence consisted of 7 primary abilities, organized into clusters of secondary mental abilities. Fluid and crystallized intelligence are two such secondary mental abilities that have been widely studied. Fluid refers to abilities needed for problem-solving in novel situations, and crystallized refers to accumulated skills, knowledge, and life experience, influenced by culture. Raymond Cattell and John Horn argued that G should be divided into fluid and crystallized intelligence: Multiple intelligences – Gardner outlined 8 types of intelligence that are not all focused on “book smarts”, but include interpersonal intelligence, musical intelligence, and kinesthetic intelligence. David Wechsler (1939) defined intelligence as “the aggregate or global capacity of the individual to act purposefully, think rationally, and to deal effectively with the environment”. PSYCHOMETRIC – Spearman’s G – all mental tests measure a global element of intellectual ability (“general G”) in addition to specific cognitive skills. The Wechsler Adult Intelligence Scale, the “WAIS”, is one of the most widely used measures of intelligence used by neuropsychologists and other clinical psychologists who conduct assessment. It is an example of the psychometric approach to intelligence. The “classic aging pattern” is an age-related decline in fluid abilities, with relative stability or even increase in crystallized abilities and only modest declines after age 70. The general consensus among researchers is that fluid intelligence is influenced by biology and therefore subject to early decline, whereas crystallized abilities are acquired through experience, learning, and culture, and are thought to grow and develop with age. The CHC model of intelligence has had tremendous influence over the study of intelligence. Many psychologists today believe that the CHC model of intelligence is the most comprehensive and empirically supported psychometric theory of the structure of cognitive abilities to date. Section 6B: Overview of Intelligence The landmark research study investigating changes in performance on intelligence tests associated with age is the Seattle Longitudinal Study (SLS), which was first initiated in 1956 by K. Warner Schaie. Data collection is ongoing and occurs every seven years. To date, over 6000 adults from 22 to over 100 years of age have participated in the study. Schaie uses the Thurstone Primary Mental Abilities Test to measure intellectual change. Study results over the years have consistently shown that there is no uniform pattern of age-related decline in intellectual abilities. While the findings did lend support to the Classic Aging Pattern, the rate of decline in fluid intelligence was much slower than originally thought. Moreover, there were significant individual differences in performance across measures of both fluid and crystallized intelligence. Thought question – What might account for these cohort differences? Examples could be economic factors, geographic displacement interrupting school (e.g., due to wars), gender disparities (e.g., women being allowed into higher education), etc. Section 6C: Overview of Intelligence Health in late life can impact intelligence. Terminal drop refers to a rapid decline in cognitive function immediately prior to death. Regardless of age, lower IQ scores are associated with cardiovascular disease, obesity, and stroke. Beyond health, other factors related to the maintenance of intelligence in late life include: • High socioeconomic status, engagement in stimulating environments, high intellectual status of spouse, strong social connections, and high levels of processing speed • Positive beliefs, a flexible attitude, and high openness to experience have all been associated with intelligence Thought question: Why would intelligence influence mortality? It could be the case that higher intelligence reduces mortality in that individuals with higher intelligence engage in more healthful behaviors. Conversely, those individuals with lower IQ test scores likely experience numerous disadvantages all through their lives that contribute to an increased rate of mortality. Interestingly, the effects of social class, income, and the role of education, when adjusted statistically, have been shown to reduce (but not eliminate) the effect of intelligence on mortality. However, this finding is being debated by other researchers. The upshot is, we still don’t understand the relationship of intelligence and mortality, nor do we fully understand the direction of causality. Section 7: Post-formal Thought Although Piaget’s stages have been highly influential, recently researchers have proposed the idea of post-formal thought as an entirely different adult stage of cognitive development. This stage involves greater tolerance for ambiguity and incorporation of emotion into thinking. There have been limited studies investigating post-formal thinking abilities, and there is some controversy regarding the theoretical definition of concepts. King & colleagues have identified a systematic progression of reflective judgment that begins in young adulthood. This is a stage model in which there are seven distinct but developmentally related sets of assumptions about the process of knowing and how knowing is acquired. As an individual moves throughout each stage, knowledge of what is true becomes less certain. The seven stages are summarized into three distinct levels of thinking: pre-reflective (Stages 1–3), quasi-reflective (Stages 4 and 5), and reflective (Stages 6 and 7). Pre-reflective thinkers tend to be blackand-white. Quasi-reflective thinkers understand knowledge can be subjective, and judgments are highly personal. Reflective thinkers recognize that knowledge claims can’t be made with certainty. Beliefs are fluid and receptive to revision based on further accumulation of knowledge and experience. Section 8: Wisdom What does wisdom mean to you? What are the characteristics of “wise” people that you know? There is no single consensus definition of wisdom. In turn, this makes measuring it equally challenging. Personal wisdom has cognitive, reflective, and affective components (Ardelt, 2015). General wisdom refers to wisdom concerning life in general. Although there is a stereotype that wisdom increases with age, the research doesn’t necessarily support this. COGNITIVE DIMENSION – A need for a deep and thorough understanding of both interpersonal and intrapersonal aspects of life, with a recognition that knowledge has its limits. An individual is very much aware of, and accepts, both the positive and negative aspects of human nature. REFLECTIVE DIMENSION – Enables profound insight as well as an ability to self-reflect or perceive events from multiple viewpoints. Individuals learn to control their feelings through the practice of selfexamination and self-awareness and, little by little, rise above their subjectivity and the tendency to blame external factors for one’s shortcomings. This does not mean that wise individuals hold back or deny negative emotions; rather, they are able to acknowledge, regulate, and eventually dissolve negative emotions. AFFECTIVE DIMENSION – Includes empathy, social connectedness, and generativity It is unclear whether it is the reflective, affective, or cognitive dimension of wisdom that is the most important. The level of importance may differ depending on the culture or context. These researchers also point out that behavior or action should be a critical part of wisdom. Jeste and Oswald (2014) argue that a wise individual not only “thinks wisely, but also acts wisely.” Section 1A: How long will you live? Longevity is influenced by both genetic and environmental factors. • Average longevity (life expectancy) refers to the age at which half of the individuals born in a given year will have died. Between 1921 and 2011, the gain in overall life expectancy for Canadians was nearly 25 years, largely due to reductions in infant mortality. • In 2011, the average Canadian life expectancy at birth was estimated to be 81.76 years of age. In 2015, the oldest living Canadian was Orma Slack, who lived to almost 115 years. • Life expectancy varies significantly from province to province. Consider why longevity matters. For example, consider lifestyle choices, health and service program provision, budgeting for retirement, age-appropriate housing, etc. The Prairies have much younger populations as compared to all other provinces. This is thought to be due in part to higher fertility rates, international immigration, and interprovincial migration. According to the WHO (2014), women in all countries outlive men. In 2012, global life expectancy at birth was 72.7 years for women and 68.1 years for men, although as you can see from the table above, these numbers vary sign...