Because of the growing population of older adults in technologically advanced countries, researchers in a number of disciplines are becoming increasingly more interested in examining differences between older adults and very old adults as well as the transition to very late adulthood. Very old adults (also referred to as the oldest old) are typically defined in the literature as those adults who are 85 years old or older; however, some researchers set the criterion at 75 years old. In general, this population has a higher percentage of women compared with other age groups and is characterized by a high degree of comorbidity (i.e., multiple illnesses or conditions), a lower level of education in relation to other age groups, and high rates of institutionalization. The focus of this entry will be on the physical, psychological, emotional, and social characteristics of this group as well as changes that occur in these domains when older adults transition into being part of the oldest old population. It is important to note that this population is characterized by a high degree of heterogeneity, making generalizations very difficult.
As people age, the functioning of bodily systems tends to decline. In addition, the likelihood of adults older than 65 years having one chronic illness is extremely high (80%), with 50% having two or more conditions. These percentages are even higher in adults older than 85 years. The most prevalent of these diseases are cardiovascular disorders, arthritis, and diabetes, with many attributable to health risk behaviors (e.g., smoking, poor diet). In addition, the percentage of very old adults living with Alzheimer's disease increases from 3% in those who are 65 to 74 years old, to 18.7% of those 75 to 84 years old, to 47% of those living past 85 years old. Alzheimer's disease is also the most common reason for institutionalization. Another factor related to institutionalization is functional ability, or the ability to perform activities of daily living (ADLs). Functional ability is generally at a lower level in the oldest old compared with the young old. Research suggests that about one fifth of young-old adults require assistance with at least one ADL, whereas about one third of the very old require assistance with at least one ADL.
Sensory functioning also tends to be at a lower level in the oldest old compared with young-old adults. Longitudinal studies have also found that most (70%) older adults tested for visual and hearing acuity at age 70 had no visual or hearing impairment, and there was no coexistence of visual and hearing impairment. When tested again at age 81, about 10% demonstrated normal visual or hearing, and about 5% demonstrated a coexistence of hearing and visual impairment. At age 88, none of the men and fewer than 10% of the women had normal hearing and vision, and 8% to 13% demonstrated coexistence. In addition, mild impairment was evident in only 0.5% of the sample when tested at age 70, but increased to 23% and 9% for visual and hearing acuity, respectively, at age 88.
The psychological functioning of the oldest old has also received increased attention recently. The most commonly studied aspects of psychological functioning are cognitive abilities. Research suggests that cognitive decline in the oldest old differs from that in young-old adults in that it is more broad, more marked, less amenable to interventions, and more constrained by biological factors compared with cultural factors. For example, longitudinal research has found that the loss trajectory becomes markedly more negative after the age of 80 in terms of perceptual speed, memory, and fluency. Knowledge (e.g., vocabulary), on the other hand, tends to remain stable until about 90 years of age. Much of the variance in cognitive loss can be accounted for by sensory decline. This has been suggested by some researchers to represent an age-related slowing of the central nervous system (also referred to as the common cause hypothesis). Factors such as education, socioeconomic status, ethnicity, sex, and the presence of certain chronic conditions (e.g., diabetes, cardiovascular disease, Alzheimer's disease) also contribute to the heterogeneity of cognitive abilities in late adulthood. However, in general, old-old adults are more likely to be assessed as having lower psychological functioning than young-old adults.
Another research question is whether personality and self-identity remain stable into and throughout this stage. For example, it has been found that very old adults have a relatively stable sense of self, despite believing that some of their characteristics have changed. This suggests that there is a continuity of self into very late adulthood. Research has also found that self-esteem begins to decline in late adulthood. However, rather than being negative, this may represent an increased comfortableness and acceptance with one's self and personal faults. Finally, crosssectional research examining stability of personality traits as measured by the revised NEO Personality Index (NEO-PI-R), found that the oldest old scored lower on extraversion and on the facet traits of impulsiveness, warmth, and positive emotions in relation to the young-old group, but were similar in terms of neuroticism, openness to experience, conscientiousness, and agreeableness, thus suggesting an overall stability of personality.
It is widely recognized that as people enter later adulthood, their social networks tend to decrease in size. Activity theory suggests that this decrease is a result of factors such as decreased mobility, death of people in the social network, and other obstacles to social contact. In contrast, disengagement theory suggests that there is a mutual disengagement between society and old adults in preparation for impending death. However, recent research suggests that older adults are proactive in selecting their social partners in later life. Laura Carstensen's socioemotional selectivity theory posits that as people age, the importance of emotional support and regulation increases, while the salience of acquiring information decreases. Thus, older adults actively select relationships on which to focus their potentially decreasing resources in order to maximize the likelihood of positive experiences. Often this results in a decrease in the number of less close social contacts and stability in the relatively small, but very close and meaningful, social partners.
Another factor affecting social relationships in this age group is the high likelihood of being widowed. Because men have a shorter life expectancy, women are much more likely to be widowed and men are more likely to be married, thus providing men with a more salient source of social support.
Research has found conflicting results concerning changes in the experience and expression of emotion in very late adulthood. Some researchers suggest that because of increasing disability and role loss, the amount of negative affect experienced increases, whereas the amount of positive affect decreases. It has also been suggested that the experience of both negative and positive affect decreases because of less exposure to affect-inducing events or because of increased emotional regulation, and that positive affect increases and negative affect decreases as a result of older adults actively selecting situations that optimize the likelihood of experiencing positive affect. In a meta-analysis of the literature, it was found that negative affect does tend to increase and positive affect tends to decrease in the oldest old, and that the frequency and intensity of experiencing high-arousal emotions also decreases.
Research on depression in older adults generally suggests that age is not predictive of clinical depression, but depressive symptoms do tend to increase when transitioning into later life. Many researchers suggest that this increase is due to increased scores on negative symptoms and not decreased scores on items assessing well-being. Also of interest is that the relationship of functional ability, cognitive impairment, and depression is often mediated by psychological resources (e.g., mastery). This suggests that it may not merely be the presence of disabilities that lead to depression, but the ways in which they are interpreted.
Because the population of people older than 85 years is the fastest growing population in terms of age groups, research examining this age period is becoming more important. Although researchers have identified trends, the heterogeneity of this age group cannot be underemphasized, thus increasing the need for longitudinal studies examining intraindividual change. Caution should also be taken when interpreting the results from studies examining the oldest old because participants typically represent a very positive selection of the population and of their cohort. Finally, because of the relationships between the aspects of aging discussed (e.g., sensory ability and cognition, social relationships and emotion), there is a need for multidisciplinary research to further explicate when and how these interactions occur.
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