Utvikling over livsløpet

Inger Hilde Nordhus

Livsløp og utvikling (1)

• Aldring er generelt beskrevet som en prosess preget av svekkelse

• Psykologisk forskning støtter i stor grad dette: • Arbeidsminne – (multiple oppgaver) og

informasjonsbearbeiding (hurtighet) svekkes• Erfaringsbasert kunnskap viser ikke denne

tendensen men det gjør derimot prosessering av ny kunnskap

• Etablert på tvers av kjønn, utdanning og etnisk tilhørighet – normative endringer med store individuelle forskjeller

National Research Council. 2000. The Aging Mind: Directions in Cognitive Aging Research . P. Stern & L. L. Carstensen, Eds. National Academies of Sciences Press. Washington, DC.

Patologisk kognitiv utvikling - demens

• Svært varierende prevalens av demens rundt om i verden (3-30 % av eldre) 1-5

• Klassifikasjonssystemene påvirker diagnosen6

• I en canadisk kohort varierte prevalensen fra 3,1 % (ICD-10) til 29,1 % (DSM-III)6

• Prevalens i vestlige land:7-8

• Norske sykehjem:9

70-74 år = 5 %> 75 år = 15 %> 90 år = 35 %

70-80 %

1. Shaji S et al. An epidemiological study of dementia in a rural community in Kerala, India. Br J Psychiatry. 1996;168(6):745-9.

2. Wang W et al. Prevalence of Alzheimer's disease and other dementing disorders in an urban community of Beijing, China. Neuroepidemiology. 2000 Jul-Aug;19(4):194-200.

3. Lobo A et al. Prevalence of dementia and major subtypes in Europe: A collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology. 2000;54:S4-9.

4. Engedal K and Haugen PK. The prevalence of dementia in a sample of elderly Norwegians. International Journal of Geriatric Psychiatry 1993;8:565-570

5. Skoog I et al. A population-based study of dementia in 85-year-olds. N Engl J Med. 1993;21:153-158. 6. Erkinjuntti T et al. The effect of different diagnostic criteria on the prevalence of dementia. N Engl J Med. 1997;4:1667-1674.

7. Engedal K, Haugen PK. The prevalence of dementia in a sample elderly Norwegians. Int J Geriatr Psychiatry 1993;8:565-570.8. Ott A et al. Prevalence of Alzheimer's disease and vascular dementia: association with education. The Rotterdam study. BMJ.

1995;15:970-973. 9. Nygaard H et al. Mental svikt hos sykehjemspasienter. Tidsskr Nor Lægeforen 2000;120: 3113-16.

Livsløp og utvikling (2)

• Sosial og emosjonell fungering viser positiv utvikling over livsløpet (med unntak av ved patologisk aldring)

• Subjektivt velvære (well-being) er ikke dårligere hos eldre enn yngre voksne

• Negative emosjoner viser nedgang relativt til yngre voksne; positive emosjoner rapporteres oftere hos eldre enn yngre voksne

• Eldre rapporterer oftere større grad av tilfredshet mht sosiale relasjoner, særlig nære (slekt og nære venner)

• Sett opp mot kognisjon og biologiske prosesser: paradox of aging ?

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

Psykologiske mekanismer

Med andre ord:

……en grunnleggende oppfatning av:

at økt emosjonell trivsel og fokus på nære bånd hos eldre er et utslag av mestring av tap mer enn en positiv utvikling

• Senket forventning

• Endring av referansegruppe

• Benekting

Selektiv motivasjon – et utviklingsperspektiv

• Mål rettet mot å utvide vår horisont/få mer informasjon

• Mål rettet mot emosjonell bekreftelse• Evne til å oppleve seg i tid gjør at en også kan

endre prioritet

Med andre ord:

……en alternativ oppfatning av:

at økt emosjonell trivsel og fokus på nære bånd hos eldre er et utslag av relativ endring i prioritering av mål

Selvregulering over livsløpet

• Selvregulering hos barn blir beskrevet i et utviklingsperspektiv

• Selvregulering hos voksne og eldre tar lite hensyn til ontogenetisk endring over livsløpet

• Fokus på voksne: individuelle forskjeller• Fokus på eldre: Sviktende fysisk helse

forårsaker dysfunkjonell selvregulering

Oppsummerende

• I klinisk sammenheng vil vi selvsagt se store individuelle endringer i evne til selvregulering hos voksne og eldre pasienter

• Vi vil også bli konfrontert med klare sammenhenger mellom fysisk helsesvikt og psykisk helse

• De generelle funn om eldres selvregulering peker imidlertid mer mot psykologisk gevinst enn mot en normativ defensiv mestring av tap

Ageing – Health – Behaviour

• Optimize life expectancy or longevity• Minimize physical, psychological and social

morbidity• Increase of people surviving into advanced old

age leads to compression of morbidity (disease closer to the time of death)

• Can we live free from disease?

Health and Disease

• Age is linked to many diseases (e.g., heart disease, dementia)

• Diseases have a number of psychological consequences

• The fact that people live longer also implies an increase in both healthy as well as abnormal ageing

• Health is also known to be the main determinant of life satisfaction and quality of life in old age

Is Old Age Synonymous with Disease?

• How do we perceive ageing?

• What kind of images of old age do we have?

• What do we think of as normal ageing?

Age

• Immediate information about somebody we do not know

• Strong association with other variables

• Subjective marker (e.g., change)

• Social marker (e.g., being different from younger adults)

Age as a variable

• Age as a statistical concept

• Age as a process

• Age as a background variable

• Age as a predictor variable

What is Ageing?

• Biological perspective (cell loss, physiological changes)

• Developmental perspective (coping, adaptation)

• Cognitive perspective (memory, attention)

• Social perspective (status, resources)

Biological Age

• Observable physical changes

• Changes in the brain

• Increased vulnerability for developing

certain ailments and diseases

Sleep – an example

• Certain changes in the sleep architecture are defined as common and normal as we age

• Changes in sleep habits • Changes in activity level • Prevalence of sleep problems increases with

age, and about 50% of elderly subjects (60+) complain about sleep problems – Why?

Sleep in old age

Sleep changes naturally as we age

• Increased number of awakenings and arousals

• Less REM sleep

• Generally less deep sleep

• Moe sleep stage changes

• Less sleep cycles

• Reduced sleep efficacy

Sleep - Normal Changes in Sleep Architecture

Actigraphy

Polysomnography (1)PolysomnographyPolysomnography

Polysomnography (2)

Sleep DiaryUke: fra .......... til ........... År:...........

Eksempel Mandag Tirsdag Onsdag Torsdag Fredag Lørdag SøndagUtfyllingsdato (fylt ut om morgenen den) 27/2 28/2 1/3 2/3 3/3 4/3 5/3

1. Antall ganger jeg sov (duppet av) på dagtid (før natten) 22. Hvor lenge jeg sov (duppet av) på dagtid 403. Om kvelden la jeg meg i sengen kl 23104. Etter jeg la meg prøvde jeg å sove (slukket lysene) kl 24005. Etter å ha slukket lyset, sovnet jeg i løpet av… minutter 30 min6. Antall ganger jeg våknet i løpet av natten var 27. Hvor lenge jeg var våken til sammen om natten

(legg sammen for alle oppvåkninger) 208. Jeg våknet endelig kl (siste oppvåking om morgenen) 07009. Jeg stod endelig opp av sengen kl 074510. På dagtid i går følte jeg meg (1= svært søvnig,

2= noe søvnig, 3 = hverken søvnig eller opplagt, 4 = noe opplagt, 5= svært opplagt) 2

11. Da jeg stod opp i morges følte jeg meg (1= helt utslitt, 2= noe utslitt, 3= hverken utslitt eller uthvilt, 4= noe uthvilt, 5 = helt uthvilt) 2

12. Jeg inntok … enheter alkohol før jeg la meg (eks på enhet =én pils, et glass vin, én drink brennevin) 2

Ageing as a health related concept

• Pathological – normal- optimal

• Heterogeneity

• Risk

• Vulnerability

Psychological Age

• Changes in cognitive preparedness • Increased vulnerability in terms of critical

incidences • Increased vulnerability in terms of loss of

resources that in turn challenge coping and adaptation

What may challenge identity and coping in old age?

• Interpersonal loss

• Physical decline and loss and malfunction Increased dependency of care

• Fear of loosing autonomy and integrity

Affects basic human needs

Social Age

• Changes in roles and status

• Increased likelihood of being in a position of a recipient in many ways

• Exit from roles rather than entrance into roles as defined by

Age, Cognitive Functioning and Health

• The most feared diseases of old age are those that impair memory, thinking, problem-solving, perception and our personality

• It is a challenge to understand the borderlands between benign cognitive impairment and abnormal cognitive functioning (dementia )

A Healthy Old Age?• There is little evidence for marked

compression of morbidity• The absolute time spent with moderate

disability has increased• More people are able to perform activities of

daily living due to medical and technological improvement

• As for cognition, at least some decline is the norm, but there are great inter-individual variation

Age as a Mediator between Health and Behaviour

• It is well established that before old age, behaviour has both beneficial and negative effects on health

• Smoking, alcohol abuse, poor diet, obesity, lack of exercise, etc., reduce the likelihood of surviving into old age

• The debate in gerontology is whether risk factors associated with mortality and morbidity in middle age has as strong effect in old age

Two Conclusions:

• There is evidence that behaviour change in old age has a beneficial effect on health and psychological well-being

• It may also be the case that the same levels of behaviour in old age are more harmful than at younger ages

The Issue of Self-Efficacy

• There is a growing body of evidence demonstrating the role of age as a mediator between behaviour and health:

• One possible mechanism might be changes in perceived self-efficacy or control over health with age

• There is some evidence that here are decreases in perceived self-efficacy with age: Ageing or cohort?

”Elderly ”

• Persons 60+ (arbitrary limit)

• Chronological definition

• Social definition

• The experience of being old

Related to indentity

A correction

• The health status of those 60+ is better than ever

• Most elderly people can mange without any particular help

• Ageing is not identical with disease

• Aged people are not a homogenous group

Optimal ageing

• Optimal Ageing: ”The potential and preparedness for dealing with change” (Kilde: Baltes & Baltes, 1993).

• Discuss this statement

Ageing may imply

• Narrowing of choices as a consequence of loss

• Coping relates to use strategies that has proven to be effective earlier in life

• Coping may also mean to develop or reformulate old strategies to make them fit in a new context

Resources Stressors

SocialPsycologicalBiological

SocialPsycologicalBiological

Critical Life Events