Chapter 29: Cognitive Development in Late Adulthood

Susan Tyler

Chapter 29: Cognitive Development in Late Adulthood

Chapter 29 Learning Objectives

Describe how memory changes for those in late adulthood
Describe the theories for why memory changes occur
Describe how cognitive losses in late adulthood are exaggerated
Explain the pragmatics and mechanics of intelligence
Define what is a neurocognitive disorder
Explain Alzheimer’s disease and other neurocognitive disorders
Describe work and retirement in late adulthood
Describe how those in late adulthood spend their leisure time

How Does Aging Affect Information Processing?

There are numerous stereotypes regarding older adults as being forgetful and confused, but what does the research on memory and cognition in late adulthood reveal? Memory comes in many types, such as working, episodic, semantic, implicit, and prospective. There are also many processes involved in memory, thus it should not be a surprise that there are declines in some types of memory and memory processes, while other areas of memory are maintained or even show some improvement with age. In this section, we will focus on changes in memory, attention, problem-solving, intelligence, and wisdom, including the exaggeration of losses stereotyped in the elderly.

Memory

Changes in Working Memory: As discussed in chapter 4, working memory is the more active, effortful part of our memory system. Working memory is composed of three major systems: The phonological loop that maintains information about auditory stimuli, the visuospatial sketchpad, that maintains information about visual stimuli, and the central executive, that oversees working memory, allocating resources where needed and monitoring whether cognitive strategies are being effective (Schwartz, 2011). Schwartz reports that it is the central executive that is most negatively impacted by age. In tasks that require allocation of attention between different stimuli, older adults fair worse than do younger adults. In a study by Göthe, Oberauer, and Kliegl (2007) older and younger adults were asked to learn two tasks simultaneously. Young adults eventually managed to learn and perform each task without any loss in speed and efficiency, although it did take considerable practice. None of the older adults were able to achieve this. Yet, older adults could perform at young adult levels if they had been asked to learn each task individually. Having older adults learn and perform both tasks together was too taxing for the central executive. In contrast, working memory tasks that do not require much input from the central executive, such as the digit span test, which uses predominantly the phonological loop, we find that older adults perform on par with young adults (Dixon & Cohen, 2003).

Changes in Long-term Memory: As you should recall, long-term memory is divided into semantic (knowledge of facts), episodic (events), and implicit (procedural skills, classical conditioning, and priming) memories. Semantic and episodic memory is part of the explicit memory system, which requires conscious effort to create and retrieve. Several studies consistently reveal that episodic memory shows greater age-related declines than semantic memory (Schwartz, 2011; Spaniol, Madden, & Voss, 2006). It has been suggested that episodic memories may be harder to encode and retrieve because they contain at least two different types of memory, the event and when and where the event took place. In contrast, semantic memories are not tied to any particular timeline. Thus, only the knowledge needs to be encoded or retrieved (Schwartz, 2011). Spaniol et al. (2006) found that retrieval of semantic information was considerably faster for both younger and older adults than the retrieval of episodic information, with there being little difference between the two age groups for semantic memory retrieval. They note that older adults’ poorer performance on episodic memory appeared to be related to slower processing of the information and the difficulty of the task. They found that as the task became increasingly difficult, the gap between each age groups’ performance increased for episodic memory more so than for semantic memory.

Studies that test general knowledge (semantic memory), such as politics and history (Dixon, Rust, Feltmate, & See, 2007), or vocabulary/lexical memory (Dahlgren, 1998) often find that older adults outperform younger adults. However, older adults do find that they experience more “blocks” at retrieving information that they know. In other words, they experience more tip-of-the-tongue (TOT) events than do younger adults (Schwartz, 2011).

Implicit memory requires little conscious effort and often involves skills or more habitual patterns of behavior. This type of memory shows few declines with age. Many studies assessing implicit memory measure the effects of priming. Priming refers to changes in behavior as a result of frequent or recent experiences. If you were shown pictures of food and asked to rate their appearance and then later were asked to complete words such as s_ _ p, you may be more likely to write soup than soap, or ship. The images of food “primed” your memory for words connected to food. Does this type of memory and learning change with age? The answer is typically “no” for most older adults (Schacter, Church, & Osowiecki, 1994).

Prospective memory refers to remembering things we need to do in the future, such as remembering a doctor’s appointment next week or to take medication before bedtime. It has been described as “the flip-side of episodic memory” (Schwartz, 2011, p. 119). Episodic memories are the recall of events in our past, while the focus of prospective memories is of events in our future. In general, humans are fairly good at prospective memory if they have little else to do in the meantime. However, when there are competing tasks that are also demanding our attention, this type of memory rapidly declines. The explanation given for this is that this form of memory draws on the central executive of working memory, and when this component of working memory is absorbed in other tasks, our ability to remember to do something else in the future is more likely to slip out of memory (Schwartz, 2011). However, prospective memories are often divided into time-based prospective memories, such as having to remember to do something at a future time, or event-based prospective memories, such as having to remember to do something when a certain event occurs. When age-related declines are found, they are more likely to be time-based, than event-based, and in laboratory settings rather than in the real-world, where older adults can show comparable or slightly better prospective memory performance (Henry, MacLeod, Phillips & Crawford, 2004; Luo & Craik, 2008). This should not be surprising given the tendency of older adults to be more selective in where they place their physical, mental, and social energy. Having to remember a doctor’s appointment is of greater concern than remembering to hit the space-bar on a computer every time the word “tiger” is displayed.

Recall versus Recognition: Memory performance often depends on whether older adults are asked to simply recognize previously learned material or recall material on their own. Generally, for all humans, recognition tasks are easier because they require less cognitive energy. Older adults show roughly equivalent memory to young adults when assessed with a recognition task (Rhodes, Castel, & Jacoby, 2008). With recall measures, older adults show memory deficits in comparison to younger adults. While the effect is initially not that large, starting at age 40 adults begin to show declines in recall memory compared to younger adults (Schwartz, 2011).

The Age Advantage: Fewer age differences are observed when memory cues are available, such as for recognition memory tasks, or when individuals can draw upon acquired knowledge or experience. For example, older adults often perform as well if not better than young adults on tests of word knowledge or vocabulary. With age often comes expertise, and research has pointed to areas where aging experts perform quite well. For example, older typists were found to compensate for age-related declines in speed by looking farther ahead at the printed text (Salthouse, 1984). Compared to younger players, older chess experts focus on a smaller set of possible moves, leading to greater cognitive efficiency (Charness, 1981). Accrued knowledge of everyday tasks, such as grocery prices, can help older adults to make better decisions than young adults (Tentori, Osheron, Hasher, & May 2001).

Attention and Problem Solving

Changes in Attention in Late Adulthood: Changes in sensory functioning and speed of processing information in late adulthood often translate into changes in attention (Jefferies et al., 2015). Research has shown that older adults are less able to selectively focus on information while ignoring distractors (Jefferies et al., 2015; Wascher, Schneider, Hoffman, Beste, & Sänger, 2012), although Jefferies and her colleagues found that when given double-time, older adults could perform at young adult levels. Other studies have also found that older adults have greater difficulty shifting their attention between objects or locations (Tales, Muir, Bayer, & Snowden, 2002). Consider the implication of these attentional changes for older adults.

How do changes or maintenance of cognitive ability affect older adults’ everyday lives? Researchers have studied cognition in the context of several different everyday activities. One example is driving. Although older adults often have more years of driving experience, cognitive declines related to reaction time or attentional processes may pose limitations under certain circumstances (Park & Gutchess, 2000). In contrast, research on interpersonal problem solving suggested that older adults use more effective strategies than younger adults to navigate through social and emotional problems (Blanchard-Fields, 2007). In the context of work, researchers rarely find that older individuals perform poorer on the job (Park & Gutchess, 2000). Similar to everyday problem solving, older workers may develop more efficient strategies and rely on expertise to compensate for cognitive decline.

Problem Solving: Problem-solving tasks that require processing non-meaningful information quickly (a kind of task that might be part of a laboratory experiment on mental processes) declines with age. However, many real-life challenges facing older adults do not rely on the speed of processing or making choices on one’s own. Older adults resolve everyday problems by relying on input from others, such as family and friends. They are also less likely than younger adults to delay making decisions on important matters, such as medical care (Strough, Hicks, Swenson, Cheng & Barnes, 2003; Meegan & Berg, 2002).

What might explain these deficits as we age? The processing speed theory, proposed by Salthouse (1996, 2004), suggests that as the nervous system slows with advanced age our ability to process information declines. This slowing of processing speed may explain age differences in many different cognitive tasks. For instance, as we age, working memory becomes less efficient (Craik & Bialystok, 2006). Older adults also need a longer time to complete mental tasks or make decisions. Yet, when given sufficient time older adults perform as competently as do young adults (Salthouse, 1996). Thus, when speed is not imperative to the task healthy older adults do not show cognitive declines.

In contrast, inhibition theory argues that older adults have difficulty with inhibitory functioning, or the ability to focus on certain information while suppressing attention to less pertinent information tasks (Hasher & Zacks, 1988). Evidence comes from directed forgetting research. In directed forgetting people are asked to forget or ignore some information, but not other information. For example, you might be asked to memorize a list of words but are then told that the researcher made a mistake and gave you the wrong list and asks you to “forget” this list. You are then given a second list to memorize. While most people do well at forgetting the first list, older adults are more likely to recall more words from the “forget-to-recall” list than are younger adults (Andrés, Van der Linden, & Parmentier, 2004).

Cognitive losses exaggerated: While there are information processing losses in late adulthood, the overall loss has been exaggerated (Garrett, 2015). One explanation is that the type of tasks that people are tested on tend to be meaningless. For example, older individuals are not motivated to remember a random list of words in a study, but they are motivated for more meaningful material related to their life, and consequently perform better on those tests. Another reason is that the research is often cross-sectional. When age comparisons occur longitudinally, however, the amount of loss diminishes (Schaie, 1994). A third reason is that the loss may be due to a lack of opportunity in using various skills. When older adults practiced skills, they performed as well as they had previously. Although diminished performance speed is especially noteworthy in the elderly, Schaie (1994) found that statistically removing the effects of speed diminished the individual’s performance declines significantly. In fact, Salthouse and Babcock (1991) demonstrated that processing speed accounted for all but 1% of age-related differences in working memory when testing individuals from 18 to 82. Finally, it is well established that our hearing and vision decline as we age. Longitudinal research has proposed that deficits in sensory functioning explain age differences in a variety of cognitive abilities (Baltes & Lindenberger, 1997). Not surprisingly, more years of education, and subsequently higher income, are associated with the higher cognitive level and slower cognitive decline (Zahodne, Stern, & Manly, 2015).

Intelligence and Wisdom

When looking at scores on traditional intelligence tests, tasks measuring verbal skills show minimal or no age-related declines, while scores on performance tests, which measure solving problems quickly, decline with age (Botwinick, 1984). This profile mirrors crystallized and fluid intelligence. As you recall from the last chapter, crystallized intelligence encompasses abilities that draw upon experience and knowledge. Measures of crystallized intelligence include vocabulary tests, solving number problems, and understanding texts. Fluid intelligence refers to information processing abilities, such as logical reasoning, remembering lists, spatial ability, and reaction time. Baltes (1993) introduced two additional types of intelligence to reflect cognitive changes in aging. Pragmatics of intelligence are cultural exposure to facts and procedures that are maintained as one age and are similar to crystallized intelligence. Mechanics of intelligence are dependent on brain functioning and decline with age, similar to fluid intelligence. Baltes indicated that pragmatics of intelligence show a little decline and typically increase with age.

Additionally, the pragmatics of intelligence may compensate for the declines that occur with the mechanics of intelligence. In summary, global cognitive declines are not as typical as one age, and individuals compensate for some cognitive declines, especially processing speed.

Wisdom is the ability to use accumulated knowledge about practical matters that allow for sound judgment and decision making. A wise person is insightful and has knowledge that can be used to overcome obstacles in living. Does aging bring wisdom? While living longer brings experience, it does not always bring wisdom. Paul Baltes and his colleagues (Baltes & Kunzmann, 2004; Baltes & Staudinger, 2000) suggest that wisdom is rare. In addition, the emergence of wisdom can be seen in late adolescence and young adulthood, with there being few gains in wisdom over the course of adulthood (Staudinger & Gluck, 2011). This would suggest that factors other than age are stronger determinants of wisdom. Occupations and experiences that emphasize others rather than self, along with personality characteristics, such as openness to experience and generativity, are more likely to provide the building blocks of wisdom (Baltes & Kunzmann, 2004). Age combined with certain types of experience and/or personality brings wisdom.

Neurocognitive Disorders

Historically, the term dementia was used to refer to an individual experiencing difficulties with memory, language, abstract thinking, reasoning, decision making, and problem-solving (Erber & Szuchman (2015). However, in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) (American Psychiatric Association, 2013) the term dementia has been replaced by the neurocognitive disorder. A major neurocognitive disorder is diagnosed as a significant cognitive decline from a previous level of performance in one or more cognitive domains and interferes with independent functioning, while a minor neurocognitive disorder is diagnosed as a modest cognitive decline from a previous level of performance in one or more cognitive domains and does not interfere with independent functioning. There are several different neurocognitive disorders that are typically demonstrated in late adulthood and determining the exact type can be difficult because the symptoms may overlap with each other. Diagnosis often includes a medical history, physical exam, laboratory tests, and changes noted in behavior. Alzheimer’s disease, vascular neurocognitive disorder and neurocognitive disorder with Lewy bodies will be discussed below.

Alzheimer’s Disease: Probably the most well-known and most common neurocognitive disorder for older individuals is Alzheimer’s disease. In 2016 an estimated 5.4 million Americans were diagnosed with Alzheimer’s disease (Alzheimer’s Association, 2016), which was approximately one in nine aged 65 and over. By 2050 the number of people age 65 and older with Alzheimer’s disease is projected to be 13.8 million if there are no medical breakthroughs to prevent or cure the disease. Alzheimer’s disease is the 6th leading cause of death in the United States, but the 5th leading cause for those 65 and older. Among the top 10 causes of death in America, Alzheimer’s disease is the only one that cannot be prevented, cured, or even slowed. Current estimates indicate that Alzheimer’s disease affects approximately 50% of those identified with a neurocognitive disorder (Cohen & Eisdorfer, 2011).

Alzheimer’s disease has a gradual onset with subtle personality changes and memory loss that differs from normal age-related memory problems occurring first. Confusion, difficulty with change, and deterioration in language, problem-solving skills, and personality become evident next. In the later stages, the individual loses physical coordination and is unable to complete everyday tasks, including self-care and personal hygiene (Erber & Szuchman, 2015). Lastly, individuals lose the ability to respond to their environment, to carry on a conversation, and eventually to control movement (Alzheimer’s Association, 2016). On average people with Alzheimer’s survive eight years, but some may live up to 20 years. The disease course often depends on the individual’s age and whether they have other health conditions.

The greatest risk factor for Alzheimer’s disease is age, but there are genetic and environmental factors that can also contribute. Some forms of Alzheimer’s are hereditary, and with the early onset type, several rare genes have been identified that directly cause Alzheimer’s. People who inherit these genes tend to develop symptoms in their 30s, 40s, and 50s. Five percent of those identified with Alzheimer’s disease are younger than age 65. When Alzheimer’s disease is caused by deterministic genes, it is called familial Alzheimer’s disease (Alzheimer’s Association, 2016). Traumatic brain injury is also a risk factor, as well as obesity, hypertension, high cholesterol, and diabetes (Carlson, 2011).

Βeta Amyloid and Tau: According to Erber and Szuchman (2015) the problems that occur with Alzheimer’s disease are due to the “death of neurons, the breakdown of connections between them, and the extensive formation of plaques and tau, which interfere with neuron functioning and neuron survival” (p. 50). Plaques are abnormal formations of protein pieces called beta-amyloid. Beta-amyloid comes from a larger protein found in the fatty membrane surrounding nerve cells. Because beta-amyloid is sticky, it builds up into plaques (Alzheimer’s Association, 2016). These plaques appear to block cell communication and may also trigger an inflammatory response in the immune system, which leads to further neuronal death.

Tau is an important protein that helps maintain the brain’s transport system. When tau malfunctions, it changes into twisted strands called tangles that disrupt the transport system. Consequently, nutrients and other supplies cannot move through the cells and they eventually die. The death of neurons leads to the brain shrinking and affecting all aspects of brain functioning. For example, the hippocampus is involved in learning and memory, and the brain cells in this region are often the first to be damaged. This is why memory loss is often one of the earliest symptoms of Alzheimer’s disease. Figures 9.32 and 9.33 illustrate the difference between an Alzheimer’s brain and a healthy brain.

Washington University School of Medicine (2019) reported that researchers associated with the School of Medicine discovered that failing immune cells, known as microglia, appear to be the link between amyloid and tau, which are the two damaging proteins of Alzheimer’s disease. Amyloid plaques, which appear first, do not cause Alzheimer’s, but the presence of amyloid leads to the formation of tau tangles, which are responsible for the memory loss and cognitive deficits seen in those with Alzheimer’s disease. It appears that weakening microglia causes the amyloid plaques to injure nearby neurons, thus creating a toxic environment that increases the formation and spread of tau tangles. These findings could lead to a new approach for developing therapies for Alzheimer’s.

Sleep Deprivation and Alzheimer’s: Studies suggest that sleep plays a role in clearing both beta-amyloid and tau out of the brain. Shokri-Kojori et al. (2018) scanned participants’ brains after getting a full night’s rest and after 31 hours without sleep. Beta-amyloid increased by about 5% in the participants’ brains after losing a night of sleep. These changes occurred in brain regions that included the thalamus and hippocampus, which are associated with the early stages of Alzheimer’s disease. Shokri-Kojori et al. also found that participants with the largest increases in beta-amyloid reported the worst mood after sleep deprivation. These findings support other studies that have found that the hippocampus and thalamus are involved in mood disorders.

Additionally, Holth et al. (2019) found that healthy adults who remained awake all day and night had tau levels that were elevated by about 50 percent. Once tau begins to accumulate in brain tissue, the protein can spread from one brain area to the next along with neural connections. Holth et al. also found that older people who had more tau tangles in their brains by PET scanning had a less slow-wave, deep sleep. Holth et al. concluded that good sleep habits and/or treatments designed to encourage plenty of high-quality sleep might play an important role in slowing Alzheimer’s disease. In contrast, poor sleep might worsen the condition and serve as an early warning sign of Alzheimer’s disease.

Healthy Lifestyle Combats Alzheimer’s: Dhana and colleagues with the Rush University Medical Center in Chicago examined how healthy lifestyle mitigates the risk of Alzheimer’s disease (Natanson, 2019). The researchers followed a diverse group of 2765 participants for 9 years and focused on five low-risk lifestyle factors: healthy diet, at least 150 minutes/week of moderate to vigorous physical activity, not smoking, light to moderate alcohol intake, and engaging in cognitively stimulating activities.

Results indicated that those who adopted four or five low-risk lifestyle factors had a 60% lower risk of Alzheimer’s disease when compared with participants who did not follow any or only one of the low-risk factors. The authors concluded that incorporating these lifestyle changes can have a positive effect on one’s brain functioning and lower the risk for Alzheimer’s disease.

Vascular Neurocognitive Disorder is the second most common neurocognitive disorder affecting 0.2% in the 65-70 years age group and 16% of individuals 80 years and older (American Psychiatric Association, 2013). The vascular neurocognitive disorder is associated with a blockage of cerebral blood vessels that affects one part of the brain rather than a general loss of brain cells seen with Alzheimer’s disease. Personality is not as affected in vascular neurocognitive disorder, and more males are diagnosed than females (Erber and Szuchman, 2015). It also comes on more abruptly than Alzheimer’s disease and has a shorter course before death. Risk factors include smoking, diabetes, heart disease, hypertension, or a history of strokes.

Neurocognitive Disorder with Lewy bodies: According to the National Institute on Aging (2015a), Lewy bodies are microscopic protein deposits found in neurons seen postmortem. They affect chemicals in the brain that can lead to difficulties in thinking, movement, behavior, and mood. Neurocognitive Disorder with Lewy bodies is the third most common form and affects more than 1 million Americans. It typically begins at age 50 or older and appears to affect slightly more men than women. The disease lasts approximately 5 to 7 years from the time of diagnosis to death but can range from 2 to 20 years depending on the individual’s age, health, and severity of symptoms. Lewy bodies can occur in both the cortex and brain stem which results in cognitive as well as motor symptoms (Erber & Szuchman, 2015). The movement symptoms are similar to those with Parkinson’s disease and include tremors and muscle rigidity. However, the motor disturbances occur at the same time as the cognitive symptoms, unlike Parkinson’s disease when the cognitive symptoms occur well after the motor symptoms.

Individuals diagnosed with Neurocognitive Disorder with Lewy bodies also experience sleep disturbances, recurrent visual hallucinations, and are at risk for falling.

Work, Retirement, and Leisure

Work: According to the United States Census Bureau, in 1994, approximately 12% of those employed were 65 and over, and by 2016, the percentage had increased to 18% of those employed (McEntarfer, 2019). Looking more closely at the age ranges, more than 40% of Americans in their 60s are still working, while 14% of people in their 70s and just 4% of those 80 and older are currently employed (Livingston, 2019). Even though they make up a smaller number of workers overall, those 65- to 74-year-old and 75-and- older age groups are projected to have the fastest rates of growth in the next decade. See Figure 9.35 for the projected annual growth rate in the labor force by age in percentages, 2014-2024.

Livingston (2019) reported that similar to other age groups, those with higher levels of education are more likely to be employed. Approximately 37% of adults who are 60 and older and have a bachelor’s degree or more are working. In contrast, 31% with some college experience and 21% of those with a high school diploma or less are still working at age 60 and beyond. Additionally, men 60 and older are more likely to be working than women (33% vs. 24%). Not only are older persons working more, but they are also earning more than previously, and their growth in earnings is greater compared to workers of other ages (McEntarfer, 2019).

Older adults are proving just as capable as younger adults at the workplace. In fact, jobs that require social skills, accumulated knowledge, and relevant experiences favor older adults (Erber & Szuchman, 2015). Older adults also demonstrate lower rates of absenteeism and greater investment in their work.

Transitioning into Retirement: For most Americans, retirement is a process and not a one-time event (Quinn & Cahill, 2016). Sixty percent of workers transition straight to bridge jobs, which are often part-time and occur between a career and full retirement. About 15% of workers get another job after being fully retired. This may be due to not having adequate finances after retirement or not enjoying their retirement. Some of these jobs may be in encore careers or work in a different field from the one in which they retired. Approximately 10% of workers begin phasing into retirement by reducing their hours. However, not all employers will allow this due to pension regulations.

Retirement age changes: Looking at retirement data, the average age of retirement declined from more than 70 in 1910 to age 63 in the early 1980s. However, this trend has reversed and the current average age is now 65. Additionally, 18.5% of those over the age of 65 continue to work (US Department of Health and Human Services, 2012) compared with only 12% in 1990 (U. S. Government Accountability Office, 2011). With individuals living longer, once retired the average amount of time a retired worker collects social security is approximately 17-18 years (James, Matz-Costa, & Smyer, 2016).

When to retire: Laws often influence when someone decides to retire. In 1986 the Age Discrimination in Employment Act (ADEA) was amended, and mandatory retirement was eliminated for most workers (Erber & Szuchman, 2015). Pilots, air traffic controllers, federal law enforcement, national park rangers, and firefighters continue to have enforced retirement ages. Consequently, for most workers, they can continue to work if they choose and are able. Social security benefits also play a role. For those born before 1938, they can receive full social security benefits at age 65. For those born between 1943 and 1954, they must wait until age 66 for full benefits, and for those born after 1959, they must wait until age 67 (Social Security Administration, 2016). Extra months are added to those born in years between. For example, if born in 1957, the person must wait until 66 years and 6 months. The longer one waits to receive social security, the more money will be paid out. Those retiring at age 62, will only receive 75% of their monthly benefits. Medicare health insurance is another entitlement that is not available until one is aged 65.

Delayed Retirement: Older adults primarily choose to delay retirement due to economic reasons (Erber & Szchman, 2015). Financially, continuing to work provides not only added income but also does not dip into retirement savings which may not be sufficient. Historically, there have been three parts to retirement income; that is, social security, a pension plan, and individual savings (Quinn & Cahill, 2016). With the 2008 recession, pension plans lost value for most workers. Consequently, many older workers have had to work later in life to compensate for absent or minimal pension plans and personal savings. Social security was never intended to replace full income, and the benefits provided may not cover all the expenses, so elders continue to work. Unfortunately, many older individuals are unable to secure later employment, and those especially vulnerable include persons with disabilities, single women, the oldest- old, and individuals with intermittent work histories.

Some older adults delay retirement for psychological reasons, such as health benefits and social contacts. Recent research indicates that delaying retirement has been associated with helping one live longer. When looking at both healthy and unhealthy retirees, a one-year delay in retiring was associated with a decreased risk of death from all causes (Wu, Odden, Fisher, & Stawski, 2016). When individuals are forced to retire due to health concerns or downsizing, they are more likely to have negative physical and psychological consequences (Erber & Szuchman, 2015).

Retirement Stages: Atchley (1994) identified several phases that individuals go through when they retire:

Remote pre-retirement phase includes fantasizing about what one wants to do in retirement
Immediate pre-retirement phase when concrete plans are established
Actual retirement
Honeymoon phase when retirees travel and participate in activities they could not do while working
Disenchantment phase when retirees experience an emotional let-down
Reorientation phase when the retirees attempt to adjust to retirement by making less hectic plans and getting into a regular routine

Not everyone goes through every stage, but this model demonstrates that retirement is a process.

Post-retirement: Those who look most forward to retirement and have plans are those who anticipate adequate income (Erber & Szuchman, 2015). This is especially true for males who have worked consistently and have a pension and/or adequate savings. Once retired, staying active and socially engaged is important. Volunteering, caregiving, and informal helping can keep seniors engaged. Kaskie, Imhof, Cavanaugh, and Culp (2008) found that 70% of retirees who are not involved in productive activities spent most of their time watching TV, which is correlated with negative affect. In contrast, being productive improves well-being.

Elder Education: Attending college is not just for the young as discussed in the previous chapter. There are many reasons why someone in late adulthood chooses to attend college.

PNC Financial Services surveyed retirees aged 70 and over and found that 58% indicated that they had retired before they had planned (Holland, 2014). Many of these individuals chose to pursue additional training to improve skills to return to work in a second career. Others may be looking to take their career in a new direction. For some older students who no longer are focus on financial reasons, returning to school is intended to enable them to pursue work that is personally fulfilling. Attending college in late adulthood is also a great way for seniors to stay young and keep their minds sharp. Even if an elder chooses not to attend college for a degree, there are many continuing education programs on topics of interest available. In 1975, a nonprofit educational travel organization called Elderhostel began in New Hampshire with five programs for several hundred retired participants (DiGiacomo, 2015). This program combined college classroom time with travel tours and experiential learning experiences. In 2010 the organization changed its name to Road Scholar, and it now serves 100,000 people per year in the U.S. and in 150 countries. Academic courses, as well as practical skills such as computer classes, foreign languages, budgeting, and holistic medicines, are among the courses offered. Older adults who have higher levels of education are more likely to take continuing education. However, offering more educational experiences to a diverse group of older adults, including those who are institutionalized in nursing homes, can bring enhance the quality of life.

Leisure: During the past 10 years, leisure time for Americans 60 and older has remained at about 7 hours a day. However, the amount of time spent on TVs, computers, tablets or other electronic devices has risen almost 30 minutes per day over the past decade (Livingston, 2019). Those 60 and older now spend more than half of their daily leisure time (4 hours and 16 minutes) in front of screens. Screen time has increased for those in their 60s, 70s, 80s and beyond, and across genders and education levels. This rise in screen time coincides with significant growth in the use of digital technology by older Americans. In 2000, 14% of those aged 65 and older used the Internet, and now 73% are users and 53% own smartphones. Alternatively, the time spent on other recreational activities, such as reading or socializing, has gone down slightly. People with less education spend more of their leisure time on screens and less time reading compared with those with more education. Less-educated adults also spend less time exercising: 12 minutes a day for those with a high school diploma or less, compared with 26 minutes for college graduates.

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