Gerontopsychology: Ageing is All in Your Head - Martin, Theill, & Schumacher - 2013 - Article

Gerontopsychologists look at the effects of ageing on the brain and the personality. They also look at how cognitive functions change when people age and how individuals can cope with the changes to maintain a high quality of life. One of the most important age-related cognitive changes is dementia. That is a disease that causes memory loss and capability loss. Gerontopsychology looks at the stability and changes of behaviour and experience of people in their later life. Gerontopsychology thinks that processes of development and change when one ages is not a unidirectional decline process, but a process that can be stable or multidirectional. Gerontopsychology looks at the developmental potentials of older people and at their environmental and personal resources. The research has shifted from pathological to healthy ageing.

Theories and concepts

In this section, the basic concepts of Gerontopsychology shall be discussed. The emphasis of this will be primarily on cognitive ageing. Important concepts in this are the concepts of quality of life and cognitive health. The terms look at functional concepts of competence. Cognitive health is not just the absence of disease, but also the preservation of a multidimensional cognitive structure. This structure allows older people to maintain a sense of purpose, the abilities to function independently, social connectedness and to cope with illnesses and functional deficits. Quality of life looks at a person’s resources. Somebody who thinks that his/her resources are functional to perform activities that serve goals, will have a higher quality of life. So both concepts look at the environmental and individual contexts and they also imply that characteristics of a person’s resources are not the only thing important when measuring performance, but that one also needs to look at the integration into social structures and the adaptation to different situations.

Cognition consists of multiple abilities and these abilities have different developmental courses. The level of most cognitive abilities declines differentially across adulthood. Usually, cognitive abilities are categorized into two types of intelligence. These types are fluid intelligence and crystallized intelligence. Fluid intelligence is the process speed, working memory, recall, verbal fluency and reasoning. Research has shown that there is a decline in measures of fluid intelligence when someone ages. Crystallized intelligence is the experiences and culture-dependent performances that somebody learns. In general, cognitive abilities decrease with increasing age, but some people maintain their cognitive abilities in old age and some even increase the cognitive abilities. There are individual differences in cognitive ageing and there are also differences between generations.

There are four main theories which researchers use to explain the differential age-related changes in crystallized and fluid intelligence. Salthouse’s processing speed theory suggests that age-related difference in performance are due to a general decrease in speed of performing mental operations. According to the theory, a slower processing speed is related to all aspects of cognition, even if they don’t have a speed component. Craik and Byrd argue that the age-related decline in cognitive functioning is due to reduced processing resources. Processing resources are abilities to manipulate and process information (measured by working memory tasks). Other researchers see the decline in inhibitory control as the cause for cognitive deficits. Inhibitory control is the ability to suppress currently irrelevant information or behaviour. This theory suggests that older people have more problems to inhibit prior information from working memory and that because of this, the work space for new material is reduced. Yet other researchers relate sensory functions (visual and auditory) to age-associated changes in cognitive function. Some researchers have found that auditory and visual functions together can account for a large amount of the variation in intellectual functioning. This is also called a common cause hypothesis and it states that declining sensory function will have a negative effect on all cognitive abilities. All these theories can account for age differences in cognitive abilities. All the theories just mentioned differ in the focus on basic mechanisms. Schaie thinks that most of the age differences in cognitive abilities tests result from cohort differences rather than age differences. This means that factors other than age and practice in specific skills should be used to look at the development of cognitive abilities. Some of these factors are generational differences in schooling and the use of technology.

Cognitive health and quality of life

The concept ‘cognitive health’ is getting more and more popular among scholars. As mentioned shortly in a previous section, cognitive health refers to a person’s ability to adapt their cognitive performance to changes in the environment and the ability to make the cognitive functioning stable. Most research on cognitive ageing focuses on interventions to improve impaired cognitive functioning or on the prediction of cognitive decline, but cognitive health research looks at which factors may support stable levels of cognitive functioning. Often, cognitive health goes together with the term ‘plasticity.’ When someone adapts successfully to the environment, we speak of health cognitive development. Successful adaptation of a person also leads to neuronal and behavioural plasticity. Cognitive plasticity is often defined as a person’s cognitive capacity under certain specific conditions. Cognitive plasticity is seen in neuronal and behavioural data, because there is a relationship between cognition for certain cognitive abilities and neuronal activation. However, researchers still don’t know the exact relationship between these two. There are researchers who have found that there are small or negative effects in older people between the reduction in cortical volume and cognitive performance. According to some, cognitive plasticity can exist even if the neuronal plasticity has been compromised, this is called cognitive reserve. Passive cognitive reserve sees reserve as the result of brain size and synapses and the active cognitive reserve theory argues that the brain actively copes with pathology. This means that the brain is able to use brain networks more efficiently or to acquire new brain networks. This has been seen in human beings with higher levels of intelligence and who had more education and a high level of occupation. Research has shown that people with lower intelligence show functional deficits after brain damage and people with high intelligence in the same situation maintain their performance level. Being active during the youth can build up cognitive reserve and this will result in long-term plasticity in old age.

Researchers look much at the quality of life when they study the outcomes of health-improving interventions in old age. There are many instruments that measure quality of life, but there is still no firm consensus on what quality of life exactly is. The World Health Organization sees quality of life as a meta-disciplinary construct which involves psychological, medical and sociological aspects, but that broad definition doesn’t clearly separate quality of life from similar constructs, like life satisfaction. There are two main approaches to determine quality of life in old age. The first one is the so-called sQOL which measures the subjective evaluation of a person’s life situation and quality of life and the second one is the oQOL, which looks at the quality of life of a person from the outside, like measuring health impairments. The first approach thinks that quality of life is a subjective state and that is must be measured through subjective statements. The subjective quality of life looks at the discrepancy between a person’s current life situation and his/her ideal life situation.

There are different instruments that measure sQOL and the particular instrument determines which type of quality of life (social relationships, physical health, environment) is studied. It is therefore difficult to make direct comparisons between different instruments. The second approach looks at objective measures of quality of life and sees quality of life as better the higher the given resources of an individual are. The oQOL can be determined more reliably, without a person’s report bias and without a statement from the person whose oQOL is being measured. This is a positive think, because people with dementia might not make a reliable statement. But, this approach doesn’t take into account inter-individual differences in the availability of resources to achieve goals. There is also a new model, called the fQOL model, which defines quality of life as an integration of multiple subjective representations of the functionality of a person’s resources. This model assumes that quality of life is higher, the more strongly a person represents his/her resources as being functional to perform complex activities that serve central goals. This model is different than the other two. It does use subjective assessments, but these are not satisfaction judgments, but functionality judgments.

Coping strategies

The resources of a person and the person’s ability to adopt to different situations and environments has an impact on cognitive health and the quality of life. There is a mechanism to achieve a successful and healthy personal development and also a healthy adaptation and that is the selective optimization with compensation (SOC) strategy. Choosing tasks that are of high individual importance and that match a person’s abilities is the selection part of the strategy. This selection is divided into elective selection (ES) and loss-based selection (LS). Elective selection is guided by social norms or preferences and loss-based selection is a shift in personal goals due to a loss of external or internal resources. Selection thus leads to a smaller number of alternative options and the persons can concentrate on a reduced range of achievable goals. Old people usually lose resources and their number of achievable goals will also decrease. In order to achieve a selected goal, a person has to optimize his/her strategy by refining and deploying resources (that is the O in SOC). Training, a good motivation and learning new skills can help with optimization. Compensation refers to acquisition and utilization of alternative means to reach certain goals and keeping performances at a desired level, despite the actual or anticipated decreases in resources.

A concept that looks a bit like the SOC is the concept of resource orchestration. This concept assumes that performance in complex cognitive tasks requires using multiple cognitive abilities in different degrees during the performance of the task. This means that multiple skills have to be timed and orchestrated. This means that an improvement in elementary abilities will probably not lead to large improvements in the complex behaviour. interventions of this approach look at individually meaningful goals and they focus on the orchestration process itself. This means that they help to identify the goals, the relevant abilities and to optimize decisions when to use certain strategies.

The current state in Europe

Europe has the highest median age of the population in the world. This brings a couple of challenges to societies. One of these challenges is the increase of the prevalence of dementia. Dementia causes a person to lose his/her cognitive abilities faster than they would lose it during the normal ageing process. This will result in memory loss and even the loss of physical functioning. Older people suffer more from dementia than younger people (5.9% to 9.4% of people aged 65 and up in Europe and 0.1% of younger people). 6.2% of people aged 60 and over in Europe suffer from dementia and 60-70% from these people have Alzheimer’s disease. This rate is almost the same as the rate in other developed regions, like Australia and North America, but it is higher than those of other regions, like Africa and Asia. This is actually not so strange, because the more developed regions have longer life expectancies. The number one risk factor of dementia is old age. In Europe, more people life up to an old age and there will therefore also be more people (proportionally) with dementia than in Africa and Asia. Researchers estimate that in the year 2050 the number of dementia diseases in Europe is going to double and that the number in less developed regions is going to more than triple. This is because the population of the less developed regions is going to increase in the next 40 years. In Europe only the part of the population aged 60 years and older is going to increase and other parts of the population are expected to decrease. Dementia costs Europe a lot of money and it is important to determine the factors that can help a successful cognitive ageing process and that stop the development of dementia. It is also important to arrange good care for people who already suffer from dementia. It is therefore important to look at the individual and environmental resources that can contribute to maintaining the functional level and the ability to adapt to the environment.

Stopping dementia

Not everybody will lose his or her cognitive abilities or develop dementia. Most of old people are able to maintain their functional level to a very old age. To figure out why some people suffer from dementia and others do not, one first needs to know which environmental and individual resources may support successful cognitive ageing without developing dementia. Although people have a decline in cognitive and physical resources, certain resources (knowledge and strategic skills) may increase with age. Most resources can be improved through training interventions. Researchers therefore should identify these resources and look at how they interact and look at the factors that may influence them.

Research has shown that cognitive and intellectual stimulation contributes to a cognitive healthy ageing process and that it seems to prevent dementia. It has also been shown that education has a protective effect on dementia. However, what’s not clear is if education is able to prevent dementia or if educated people are just diagnosed at a later date because their capabilities compensate for the losses for some time. There are also physical conditions that have a protective effect on dementia. For example, the absence of diabetes has been reported to have a protective effect on dementia. However, many reported effects are based on retrospective data and causal effects actually require intervention studies. A couple of studies have looked at the effects of cognitive training and they have found positive effects for cognitive health in older adults and also in people who are in risk groups (people with mild cognitive impairment) or who are already suffering from dementia. Other studies have shown positive effects of physical training interventions on cognitive abilities. The studies have also shown that physical training improves cognitive function. Physical training may thus protect against cognitive decline and dementia. Global cognitive stimulation is more effective than concentrating on a specific functioning. It is therefore better to have an enriched environment that allows a person to engage in activities that stimulate physical, cognitive and social skills than just concentrating on one of these things. Sadly, there are only a few studies that have looked at the effect of combining physical and cognitive trainings. More research has to be done on this subject. The research should look at stimulating these things simultaneously, because in daily life, different motor and cognitive resources engage together.

Strengthening the resources is not the only thing that should be done to help older people with cognitive impairments. People with dementia also have specific care needs and require specific housing because of their disease. The environment should be adapted so that there is an optimal person-environment fit that can provide adequate care and that allows a person to life an independent life for as long as possible. However, one needs to consider the individual resources and goals of the person in order for an optimal person-environment fit. On must look at the social context situation of a person, at the general mobility and at the presence of other mental and physical diseases. The different countries in Europe have different care provisions. In certain countries, especially in Southern Europe (Italy, Spain), the family predominantly provides care. The family takes care of the relative who suffers from dementia and patients in those countries are thus less frequently institutionalized. However, this also means that these patients are not able to benefit from professional care and the family can also be burdened with the patient. This may also be a burden for the patient. In Western Europe, many people with dementia are institutionalised, but the majority of patients with dementia are cared for at home. Many countries there provide help at home or make an institution as home-like as possible. One example of this is a small-scale living or group living arrangement, which can be found in the Netherlands, Germany and the United Kingdom. These arrangements have six to eight people living in a place which has a 24/7 care and surveillance by a couple of staff members. Certain rooms are shared, like the living room and kitchen, but some rooms are private areas that have the private stuff of the patient. These arrangements provide intensive professional care and a homelike living situation. The care and treatment can be adapted to the individual needs of the patients. Care providers should provide the adaptation of the environment to the available resources of the patients and the individual needs of the person. This will result in different forms of care. Providers also need to support independence and they should let the patient feel as much in control as possible.