Dissertations / Theses on the topic 'Stress in old age'

The purpose of the study was to evaluate perceived stressors, coping strategies, and coping effectiveness in older adults. The theoretical framework was Lazarus and Folkman's (1984) theory of stress.Data was collected from 55 independent living adults. Findings showed that primary perceived stressors focused on health, family, and independence. The most frequently used and effective style of coping was optimistic. The least frequently used and least effective style was emotive. The most commonly used and most effective strategy was prayer. Few demographic differences in coping were noted.A major conclusion was that, while individual coping strategies were highly effective, overall older adults coped only somewhat effectively with stressors.The significance of the study was that effective coping strategies and styles as identified can guide nursing interventions for stress management among older adults. Replication of the study is needed with a large sample from a variety of populations.
School of Nursing

This study was undertaken to investigate the relationship between Sense of Coherence (SOC) and subjective report of health in elders. A systematic sample of 400 retirees from Ball State University faculty and staff was used in this study. The participants completed the information sheet and two questionnaires: Orientation to Life and Perceived Health. All data from the 198 responses were entered into the database for statistical analysis, although 169 (85%) had complete sets of data. Pearson r correlation coefficient was used to examine the relationship between SOC and subjective reports of health. The result revealed a statistically significant relationship between the two variables. Multivariate analysis of variance (MANOVA) and univariate analysis of variance were used to examine the relationship between SOC and subjective reports of health and other variables such as sex, education level, retirement status, and social support. Results indicate a significant relationship between sex, education level, SOC and subjective report of health. Retirement status and social support did not prove significant. A post hoc analysis of variance revealed a statistically significant relationship between SOC and education. This study has implications for worksite health promotion programs which address more than the physical dimension of wellness. Further march is recommended.
Institute for Wellness

Research into the health needs of Asian elders has been scarce, that which does exist has lacked a theoretical framework. A first attempt is made in the present research study to relate the literature on race and ethnicity to theory and practice in gerontology. A stress and coping model from the gerontological literature was adapted to account for outcomes of physical/psychological health and well-being amongst south Asian elders. In order to test the applicability of this model the first aim of the study was to gain an insight into the circumstances and situations of Asian elders on a range of demographic, support, health and well-being factors. And then-secondly, to see how these factors may interrelate according to the stress and coping model. A range of specific hypotheses were formulated on the basis of this model. Data were collected using semi-structured interviews conducted with a community sample of 70 South Asian elders who were 55 years and over. The interview schedule consisted of both standardised measures of health, stress and coping as well as structured questions on the use of formal/informal support, satisfaction with life and attitudes towards old age. Data were analysed in two phases. The results from the first phase which were largely descriptive, suggest that a significant number of Asian elders were living either alone or with their spouse. In general Asian elders were living in circumstances of material disadvantage, suffering from poor health and chronic illnesses, reporting high levels of psychological distress with little formal and informal support. Awareness and receipt of specialist support services for older adults was low. The results from the second phase involving analyses of correlations and regressions, indicate significant correlations between outcome measures of health/mental health and satisfaction with life with measures of coping, appraisals and to some extent resource variables. There were also significant correlations between positive/negative outcomes of health and well-being with positive/negative ways of coping, appraisal and some resource variables. The factor associated most strongly with outcome variables was social support (resource) rather than coping. Overall, the stress and coping model appears to account well for most of the research findings. The results were discussed in relation to previous research literature and implications for future research and clinical practice were discussed.

The purpose of this study was to build on previous descriptive research on grandparents' experiences of stress in raising their grandchildren. The research method used was a qualitative approach. The goal in utilizing a qualitative approach lay in a desire to understand the unique stress experience of grandfathers and grandmothers in raising their grandchildren, as they live it and feel it.

This research investigated the coping strategies that elderly caregivers use when caring for a spouse with brain impairment, categorizing their strategies into an external or internal locus of control.

Phenomenological inquiry was used to investigate stressors encountered by older adults during recovery from alcoholism. Thirteen men and thirteen women, ranging in age from 55 to 82 and in length of sobriety from 2 months to 41 years, generated 37 sources of stress which threatened stable recovery. Stressors were categorized as psychological, physiological, or environmental in origin.Results indicated that the number and multicomplexity of stressors intensified stress levels. Although some stressors were antecedent to sobriety, a significant proportion were unique in recovery and/or related to the maintenance of sobriety itself.Women's rates of response nearly doubled those of men. Women evidenced greater deficiencies in basic survival needs and family support for recovery, greater duration of stressors into the recovery period, and greater focalization on internal negative emotional states, particularly anxiety, guilt and anger. Males evidenced proportionally higher percentages of external sources of stress.Both genders showed higher percentages of environmental stressors than expected. Although the percentage of physiological stressors was lower than expected, there was notable incidence of iatrogenic cross-addiction to psychoactive medication during recovery.Treatment methods were an early sobrietal source of stress for both genders. Inpatient treatment experiences were negatively influenced by confrontive therapy approaches, mixed-age therapy groups, lack of assistance with problems other than alcoholism, and inattention to medical complications.This dissertation includes an extensive review of literature concerning alcoholism in older adults, and recommendations for research and practice.
Department of Educational Leadership

Utilizing a sample of community-residing older adults, this pretest-posttest design evaluated the short term (approximately 1 week) impact on everyday functioning of Stress Inoculation (SI) training, a cognitive-behavioral intervention that is essentially a coping skills enhancement program. The targets of training were anxiety and concern about being able to successfully perform everyday living tasks. The training program was contrasted with a no contact (waiting list) control. In an effort to maximize the practical aspects of this study, the assessment battery included the use of two ecologically valid measures of everyday problem solving skills (one self-rated and one interviewer-rated). Also included were a measure of everyday intelligence widely used in gerontological research, two measures of self-efficacy, a geriatric depression scale, a state-trait anxiety scale, and a self-report measure of failures in perception, memory, and motor function. The results suggest that Stress Inoculation training is an effective intervention for improving everyday competence but that personal perceptions of self-efficacy and the emotional states of anxiety and depression mediate treatment effects. In general, only persons with lower levels of self-efficacy and higher levels of anxiety and/or depression saw improvement in their cognitive performance following SI training.

Social support has been shown to lessen the negative effects of life stress on psychological and physical health. The stress buffering model and the main effects model of social support were compared using two samples of women over the age of 50 who were either married or recently widowed. These two groups represent low and high uncontrollable major life stress respectively. Other life stress events were also taken into account. Measures assessed current level of life stress, perceived social support, satisfaction with social support, and psychological symptomatology. Results using overall psychological health as the dependent variable support the main effects model.

No Brasil, a porcentagem de pessoas idosas e sua expectativa de vida aumentam gradualmente. O envelhecimento é considerado um fenômeno natural, social, cultural e econômico. Ademais, a redução da taxa de fecundidade, diminuição de integrantes das famílias, as mudanças nos padrões de nupcialidade e a crescente inserção da mulher no mercado de trabalho reduzem a disponibilidade de cuidadores familiares; tudo isso torna o idoso mais suscetível ao stress. Assim, pensar em questões referentes ao envelhecimento e ao dia a dia dos idosos passa a ser uma necessidade dentro da realidade brasileira. Entre os serviços especializados voltados para a população idosa em nosso país, estão as ILPIs (Instituição de Longa Permanência para Idosos), responsáveis por auxiliar os idosos em suas tarefas diárias e/ou dificuldades relacionadas ao envelhecimento físico, psicológico, cognitivo e social. O aumento paradoxal do nível de stress na vida cotidiana e da longevidade dos seres humanos convida a refletir sobre as estratégias desenvolvidas para minimizar o efeito deletério do agente stressor. Assim, este estudo pretende compreender e descrever o stress, a partir da perspectiva ainda pouco estudada, de idosos em situação de dependência física e/ou financeira, com autonomia cognitiva-funcional, residentes em ILPIs. Investigaremos a relação entre a história pessoal e o nível de stress nessa população, buscando compreender e descrever o impacto de eventos estressores em sua qualidade de vida. Foram entrevistados apenas idosos em condição de autonomia cognitivo-funcional, com idade igual ou superior a 70 anos, que residem em ILPI, na cidade de Santos SP. Para tanto, foram aplicados um Quesionário de Informações Gerais, O Mini Exame do Estado Mental, o Life Events Units (LEU/VAS) e algumas Questões Complementares. Entre os eventos de vida com nível de stress mais relevantes, estão Morte do Cônjuge, Acidente ou Doença, Casamentos, Aposentadoria, Gravidez, Nascimento de Crianças na Família, Morte de Alguém na Família, Mudança na Condição Financeira, Férias e Cirurgia. Foi possível observar que, os eventos citados atingiram nível de stress altíssimo no período em que foram vividos e nível alto ainda nos dias de hoje. Apesar dos altos níveis de stress encontrados, o grupo em que houve diminuição do nível de stress corresponde a 100% da amostra
The percentage of senior citizens and their life expectancy have been increasing gradually in Brazil. Aging is considered to be a natural, social, cultural and economic phenomenon. Therefore, questions concerning this phenomenon and the daily life of the elderly people have become a necessity in the Brazilian society. The ILPIs (long stay old age homes) are the institutions responsible for assisting the senior citizens in need of special care such as carrying out daily chores and/or difficulties related to physical, psychological, cognitive and social aging. Furthermore, factors like the decrease of the fertility rate, the decrease of members in families, changes in marriage patterns and the increase of the participation of women at the work market , have affected the availability of relatives to become care takers. Therefore, the elderly have become more susceptible to stress as before. The absurd rise of stress levels in our daily lives and the increase of our longevity, invite us to reflect upon the strategies which should be developed in order to minimize the harmful effect of the stress then.That being the case, this study intends to cast light on the comprehension and description of stress in the elderly people who find themselves in an economical and/or physical dependency but are still cognitively and functionally fit and living in the ILPIs, mentioned above. We will investigate the relationship between their life history and the stress level while living in the old age homes. Only cognitively and functionally fit elderly people have taken part in our research, at the age of 70 and older. The following tests and questionnaires have been applied: Firstly, a general questions questionnaire, then The mental health status examination, The Life Events Units(LEU/VAS) and other complementary questions. Relevant events which are linked to the rise of the stress levels are: the death of a spouse, accident or illness, marriage, retirement, pregnancy, the birth of children in the family, death in the family, financial difficulties, holidays, and surgery. It is important to mention that the stress levels have reached their highest during the occurrence of these life events mentioned before, and they still have an impact on the stress levels presently. Despite of the high levels of stress, we could observe that the people in the group which had a stress reduction corresponds to 100% of the samples taken

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
This dissertation aims to reflect on the relationship between "stress" and "care" in the Gerontology field. It brings to light, more specifically, a theoretical-methodological contrast of matters related to the effects of stress (both positive and negative) that the activity of taking care of an elderly person may promote over an elderly caretaker. The problems and solutions which arise when dealing with the multiple demands posed by such a relationship, as well as its advantages and disadvantages (from a biopsychosocial point of view), are discussed here using as reference the scientific literature in both the Gerontology and Psychology fields. That perspective has helped define the following specific goals: (1) to investigate if, and how, stress may be an intervenient factor in the caretaking relationship between two elderly people, and, consequently, what its biopsychosocial developments are; (2) to identify and analyze the main sources of stress in the caretaking relationship between two elderly people; (3) to investigate what the social support demands of such a caretaking relationship are; (4) to analyze the specificities of the support a therapist with a formation in Gerontology can offer to an elderly person who develops an array of stress symptoms while taking care of another elderly person. For that purpose, a field research involving 4 elderly subjects who care after 4 other elderly subjects was conducted. This case study was the chief methodological instrument used, along with a bibliographical review. It is important to note that "case" relates not only to a specific situation from which we can obtain certain universal principles of scientific grounds, but also to the unique situation of an individual. I, furthermore, clarify that key concepts established throughout the chapters have guided the analysis of the collected data, in which I seek to question the need for including pairs of opposites such as potency versus impotency; health versus disease; autonomy versus dependency; wellness versus illness when investigating the processes of aging and old age
O foco desta dissertação está voltado para uma reflexão que envolve a articulação entre estresse e cuidado no campo da Gerontologia. Mais especificamente, a investigação traz à cena o enfrentamento teórico-metodológico de questões relativas aos efeitos estressantes (positivos e negativos) que a atividade de cuidar de um idoso pode produzir sobre o (também idoso) cuidador. Os problemas e as soluções encontradas para lidar com as múltiplas demandas que tal relação comporta, bem como ganhos e perdas (do ponto de vista biopsicossocial) são discutidos tomando-se como referência a literatura pertinente ao tema, tanto no campo da Gerontologia, como no da Psicologia. Nessa perspectiva é que se configuraram seus objetivos específicos, quais sejam: (1) pesquisar se (e como) estresse pode se apresentar como fator interveniente no cuidado que um idoso dispensa a outro idoso e, consequentemente, quais são seus desdobramentos biopsicossociais; (2) identificar e analisar as principais fontes de estresse implicadas na relação de cuidado que envolve dois idosos: o cuidador e o ser cuidado; (3) investigar quais são as demandas de apoio social configuradas nesta relação de cuidado; (4) analisar a especificidade do apoio que um psicólogo com formação em Gerontologia Social pode oferecer para o idoso que, sob efeito das demandas de cuidado de outro idoso, desenvolve um quadro sintomático de estresse. Para tal, o trabalho conta com uma pesquisa de campo que envolve 04 sujeitos idosos cuidadores de outros 04 sujeitos idosos. O Estudo de Caso é, além da revisão bibliográfica, a ferramenta metodológica que fundamenta esta pesquisa. Procura-se levar em conta que caso é algo que diz respeito não apenas a uma situação particular na qual se pode recolher certo(s) universal(is) de origem científica, como também situação singular de um sujeito. Esclareço, ainda, que a interpretação dos dados coletados foi mobilizada pelos operadores de leitura construídos ao longo dos capítulos, em que se procura problematizar a necessidade de se incluir pares de opostos potência x impotência; saúde x doença, autonomia x dependência, bem x mal-estar, entre outros na investigação do processo de envelhecimento e da velhice

The occurrence of custodial grandparents is increasing greatly. These grandparents face added stress and many adversities that arise from caregiving. Findings of current research tends to be mixed on the effects of grandparents raising grandchildren experience. Much research concludes that grandparent caregivers experience negative declines in overall health and well-being, while other research points out that the caregiving role may actually be a positive experience for the grandparent. The current study hypothesizes that mixed research may be a result of varying levels of resilience in the custodial grandparent population. The model proposed in this study looks at resilience as a mediator between several variables that effect custodial grandparenting. The current sample consisted of 239 custodial grandparents. A regression/correlation analysis was conducted on the data, and it was found that resilience levels were significant in mediating the effects of grandparent caregiving.

The terrorist attack of September 11th has been widely viewed as a traumatic event. Traumatic events have demonstrated psychological, emotional, behavioral, developmental and physiological detriment to individuals. Among older adults there may be compounding factors such as losses of function, resources, friends, family, and support.

Healthy aging influences peripheral and central levels of the neuromotor system. These age-related changes contribute to the decline in dexterous manual behavior. Difficulty in performing activities of daily living increases reliance on external assistance. Understanding specific mechanisms leading to the decline in fine manual performance is crucial for their rehabilitation. In this thesis, we have attempted to increase our awareness of the causes underlying manual disability in old age. The first study investigated how old adults apply forces and moments on a freely-movable object using a precision grip (thumb and index finger) during functionally-relevant tasks. During the grasp-lift task old adults misaligned their thumb and finger contacts and produced greater grip force, greater external moments on the object around its roll axis, and oriented force vectors differently compared with young adults. During a precision-orientation task of inserting a slot on the object over a bar (`key-slot' task), old adults were more variable in digit-tip force directions and performed the key-slot task more slowly. With practice old adults aligned their digits, reduced their grip force, and minimized external moments on the object. We conclude that with old age comes with a reduced ability to control the forces and moments applied to objects during precision grasp and manipulation. This may contribute to the ubiquitous slowing and deteriorating manual dexterity in healthy aging. Another study investigated the effects of transcranial direct current stimulation (tDCS) to the contralateral M1 combined with motor training (MP) on changes in the forces applied to the object during grasp and manipulation. We also measured performances on functional tasks in healthy elderly individuals. Our results indicate that anodal tDCS+MP facilitates retention of learning on a skillful manual task in healthy old adults. Furthermore, improved retention on the pegboard test was associated with reduced force variability on the key-slot task that demanded similar precise control over the forces applied to the object. These findings suggest that the improvement in force steadiness is one of the potential mechanisms through which short-term anodal tDCS during motor training improved performance on a functional task that outlasted the intervention period. Furthermore, anodal tDCS over M1 in combination with motor practice also influenced motor response to tasks that critically depend on sensory signals in healthy old adults. Finally, we found that, in healthy elderly individuals, the memory representations scaling the lift force for the grip and lift task generalized, while the training-based learning on the ballistic task showed an incomplete transfer to the contralateral hand. These differences may indicate task-dependent interhemispheric transfer of learning in old age. Collectively, the work presented in this thesis demonstrates that the performance on dexterous manual tasks in healthy old adults may depend on how they configure their grasp, and control their finger forces (both linear and rotational) applied to the grasped object, specifically how smooth is the applied force.

Past research suggests that age differences in measures of cognitive speed contribute to differences in intellectual functioning between young and old adults. To investigate whether speed also predicts age-related differences in intellectual performance beyond age 70 years, tests indicating 5 intellectual abilities—speed, reasoning, memory, knowledge, and fluency—were administered to a close-to-representative, age-stratified sample of old and very old adults. Age trends of all 5 abilities were well described by a negative linear function. The speed-mediated effect of age fully explained the relationship between age and both the common and the specific variance of the other 4 abilities. Results offer strong support for the speed hypothesis of old age cognitive decline but need to be qualified by further research on the reasons underlying age differences in measures of speed.

Through the theoretical lens of Foucault's archaeological method, this thesis undertakes a discourse analysis to examine how old age and ageing are strategically positioned as forms of governmentality in New Labour social care policy documents. It is argued that these discourses are not directed purely at the older generation, but at everyone, at all stages of life, encompassing all aspects of everyday living. Old age thus becomes a strategy of governing the population through individual everyday lives. This hints at the way ageing is prefigured, anticipated and lived in advance. An analytical method is developed by weaving together Foucault's notions of archaeology and governmentality; the latter is utilised both as an analytical perspective and to provide an understanding of how people primarily act and interact in contemporary Western societies. This analytical perspective is initially applied to an exploration of how the form and function of social policy enable ordinary practices of life to become targets of political government, making both possible and desirable the government of everyday living: governing how we ought to live in every aspect of life from work and finances to health, to personal relationships and leisure activities. The thesis progresses to explore this in more detail through a practical application of governmentality and focused discourse analysis of eight New Labour social care policy texts. The aim of the analysis is to explore what subjectivities and forms of life are possible within these discourses and therefore what these policies actually do, as distinguished from what they claim to be doing. It is argued that the discourses that emerge in these policies act to limit and subjectify, by attempting to contain and stabilise the multitude of possibilities for practices of living. By ostensibly aiming to create social inclusion the policies make possible vast areas of exclusion that become prime spaces of government. Thus many ways of living, ageing, and being old become untenable due to their inherent contradiction with the social values and rationalities upon which these discourses are based. Whilst governmentality analyses have been brought to many other policy areas, this thesis makes an original contribution by: developing a governmental analysis of social policy as a form of biopolitics; by applying this analysis to the social care field; and by using policy discourses of old age and ageing to draw out significant aspects of a governmental society. In particular it explores the dispersion of many traditional boundaries, leading to the rearrangement of relations, responsibilities and subjectivities.

Includes bibliographical references (leaves 71-74).
This study estimates the mortality of the South African oldest old age population (in five year age groups from age 75 up to the open age interval 100 and above) and in the process re-estimates the numbers of people in the population at these ages at the time of the 1996 and 2001 censuses, and the 2007 Community Survey. In countries where the data on the old age population have been verified, it has been observed that the data are marred by errors in the form of age exaggeration, age digit preference, relative under/over count of the population and under-registration of deaths. These errors have been observed to have the net effect of underestimating mortality of the oldest old age groups. The current research applies the method of extinct generations to estimate indirectly the population numbers at the oldest old age groups (75 up to 100 and above) using data on reported deaths alone. Age heaping and year of birth preference in the reported deaths are assessed using ratios of the probability of death estimated from the data. Age exaggeration in the data on reported deaths is assessed using ratios of deaths compared with same ratios from a standard population. Age heaping and year of birth preference in the census/survey population is assessed using the modified Whipple's Index of age accuracy. The Generalized Growth Balance (GGB) and Synthetic Extinct Generations (SEG+delta) methods are applied to adjust for under reporting of deaths and to assess patterns of age exaggeration in the census/survey population. The difference between the estimates of the completeness of reporting of deaths from the two methods is small (less than 1 per cent) and has been observed to have little impact on the mortality estimates. Final estimates of the completeness of reporting of deaths used are those derived using the SEG+delta method. After re-estimating the population numbers and adjusting for completeness of reporting of deaths, mortality rates were then estimated. Results obtained from the method of extinct generations suggest that there is no systematic difference between the census/ survey population and the population numbers estimated from deaths except at ages 95 and above. Measures of age accuracy show that there are patterns of preferring 1910, 1914, 1918, 1920 and 1930 as the years of birth in the census/survey population and these patterns are also found in the registered deaths. The impact of these errors was investigated and the results show that preference of certain years of birth cause fluctuations in the mortality rates. Patterns observed after applying the SEG+delta method suggest that the completeness of reporting of deaths falls with age at the advanced ages (from age 90 and above) and as a result, the estimated mortality rates above this age are lower than those estimated from the United Nations Population Division (UNPD) and US Census Bureau (USCB) population projections, and Dorrington, Moultrie and Timaeus (2004). Conclusions reached are that the mortality rates for the age groups 75 to 89 derived after re-estimating the population numbers and after allowing for the fall in the completeness of reporting of deaths are lower but not significantly different from those inferred from the UNPD and USCB population projections, and estimates derived by Dorrington, Moultrie and Timaeus (2004). The research recommends mortality estimates from the UNPD since they are the closest to the estimates derived using the published census population numbers for the whole period between the nights of 9-10 October 1996 and 9-10 October 2001. However, the research produced better estimates of the oldest old age population numbers relative to the census/survey numbers.

Background The prevalence and incidence of stroke are known to increase with age, which, combined with demographic change, means that very old patients with stroke are a growing patient group. Risk factors for incident stroke among very old people have not been widely investigated. The impact of depression on mortality in very old people who have had a stroke also remains unclear.  The aim of this thesis was to investigate the risk factors for incident stroke, the epidemiology of stroke and depression, and the consequences of having had a stroke regarding the risk of depression and mortality among very old people. Methods A randomly selected half of 85-, all 90-, and all ≥95-year-olds in certain municipalities in Västerbotten County, Sweden, and Pohjanmaa County, Finland were targeted in a population-based cohort study from 2000-2012. The 65-, 70-, 75-, and 80-year-olds in all the rural and random samples from the urban municipalities in the same counties were furthermore targeted in a survey in 2010. In the cohort study patients were assessed in their homes, by means of the 15-item Geriatric Depression Scale (GDS-15) and other assessment scales, as well as blood pressure measurements, several physical tests, and a review of medical diagnoses appearing in the medical charts. Incident stroke data were collected from medical charts guided by hospital registry records, cause of death records, and reassessments after 5 years. Depression was defined as a GDS-15 score ≥5. A clinical definition of all depressive disorders, based on assessment scale scores and review of medical charts was also used. A specialist in geriatric medicine evaluated the diagnoses. The survey included yes/no questions about stroke and depression status, and the 4-item Geriatric Depression Scale. Associations with mortality and incident stroke were tested using Cox proportional-hazard models.  Results In the ≥85-year-olds examined in 2005-2007 (n=601), the stroke prevalence was 21.5%, the prevalence of all depressive disorders was 37.8% and stroke was independently associated with depressive disorders (odds ratio 1.644, p=0.038). The prevalence of depression according to GDS-15 scores was 43.2% in people with stroke compared with 25.0% in people without stroke (p=0.001). However, in ≥85-year-olds examined in Sweden from 2000-2012 (n=955), from all past data collections in the study, depression was not independently associated with incident stroke.  In ≥65-year-olds who responded to a survey in 2010 (n=6098), the stroke prevalence rose with age from 4.7% among the 65- to 11.6% among the 80-year-olds (p<0.001). The prevalence of depression rose from 11.0% among the 65- to 18.1% among the 80-year-olds (p<0.001). In the group with stroke, depression was independently associated with dependence in personal activities of daily living and having a life crisis the preceding year, while in the non-stroke group, depression was independently associated with several additional demographic, social and health factors. In ≥85-year-olds examined in 2005-2007 with valid GDS-15 tests (n=452), having had a stroke was associated with increased 5-year mortality [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.15-2.03]. Having had a stroke and depression was associated with increased 5-year mortality compared with having only stroke (HR 1.90, 95% CI 1.15-3.13), having only depression (HR 1.59, 95% CI 1.03-2.45), and compared with having neither stroke nor depression (HR 2.50, 95% CI 1.69-3.69). Having only stroke without a depression did not increase mortality compared with having neither stroke nor depression. In ≥85-year-olds examined in Sweden from 2000-2012 (n=955), from all past data collections in the study, the stroke incidence was 33.8/1000 person-years during a mean follow-up period of about three years. In a comprehensive multivariate model, atrial fibrillation (HR 1.85, 95% CI 1.07–3.19) and higher systolic blood pressure (SBP; HR 1.19, 95% CI 1.08–1.30 per 10-mmHg increase) were associated with incident stroke overall. In additional multivariate models, diastolic blood pressure (DBP) ≥90 mmHg (HR 2.45, 95% CI 1.47–4.08) and SBP ≥160 mmHg (v. <140 mmHg; HR 2.80, 95% CI 1.53–5.14) were associated with incident stroke. Conclusion The prevalence of both stroke and depression increased with age, and rates were especially high among very old people. Having had a stroke was independently associated with a higher prevalence of depression among very old people, however, depression was not independently associated with a higher incidence of stroke. Having had a stroke was associated with increased all-cause mortality among very old people, but only among those who were also depressed. High SBP (≥160 mmHg), DBP (≥90 mmHg) and atrial fibrillation were the only consistent independent risk factors for incident stroke among very old people.
I västvärlden inklusive Sverige så ökar gruppen av människor som uppnår åldern 80 år eller äldre. Människorna som uppnår denna mycket höga ålder har en hög förekomst av kardiovaskulära riskfaktorer, har ofta flera samtidiga sjukdomar och ofta funktionsnedsättningar. Medicinska behandlingsåtgärder är ofta mindre effektiva och förknippade med biverkningar i åldersgruppen. Stroke är en sjukdom som beror på skada av hjärnvävnad till följd av minskad blodtillhörsel till delar av hjärnan. Det är känt att såväl förekomsten av och insjuknandet i stroke ökar med stigande ålder. Den som drabbas av stroke löper risk att få en bestående funktionsnedsättning och att dö i förtid. En vanlig komplikation efter att ha drabbats av stroke är nedstämdhet eller depression. Vetenskapliga studier om stroke har tidigare negligerat mycket gamla människor, vilket i takt med den pågående demografiska utvecklingen framstått som allt mer orimligt. Det är ej helt klarlagt vilka riskfaktorer som leder till att insjukna med stroke i mycket hög ålder. Överdödligheten förknippad med att drabbas av depression efter stroke är också oklar i åldersgruppen. Det är också oklart vad som skiljer depression efter stroke från depression bland den övriga befolkningen av åldrade människor. Den populations-baserade kohortstudien GErontologisk Regional DAtabas (GERDA) inleddes år 2000 för att kartlägga faktorer förknippade med gott åldrande bland mycket gamla människor. Hälften av 85-åringarna, alla 90-åringar och alla ≥95-åringar i utvalda kommuner i Västerbotten erbjöds att delta i studien. Därefter har återbesök hos tidigare deltagare i sina nya åldersgrupper och rekrytering av nya deltagare genomförts vart femte år. Studien utvidgades med utvalda kommuner i Österbotten, Finland vid den första femårsuppföljningen. Datainsamlingen i studien bestod av demografiska frågor, skattningsskalor, blodtrycksmätning och kognitiva test genomförda vid ett hembesök i deltagarens hem, samt genomgång av journalhandlingar. År 2010 skickades även en enkät ut till 65-, 70-, 75- och 80-åringar i alla kommuner i Västerbotten och Österbotten. Enkäten innehöll frågor om demografi, hälsa, sjukdomar och intressen. Bland deltagarna i kohortstudien bestämdes förekomsten av tidigare stroke baserat på genomgång av journaluppgifter och uppgifter från hembesöken. Förekomsten av depression bestämdes baserat på poängsättning från en validerad skattningsskala för depression, samt baserat på en sammanvägning av journaluppgifter och skattningsskalor. En specialist i geriatrik fattade det slutliga beslutet om diagnoser. Insjuknande i stroke bestämdes baserat på journalgenomgång av individer med stroke-relaterade diagnoskoder i sjukhusregistret, i dödsorsaksregistret eller uppgift om stroke vid femårsuppföljningen i studien. Bland deltagarna i enkätstudien bestämdes förekomsten av tidigare stroke baserat på självrapportering, och förekomsten av depression bestämdes baserat på en sammanvägning av självrapportering och en skattningsskala för depression.  Förekomsten av stroke i enkätstudien steg med ålder, från 4.7% bland 65-åringar till 11.6% bland 80-åringar. Förekomsten av stroke var omkring 20% bland ≥85-åringar, med minimal variation mellan 85-, 90- och ≥95-åringar. Förekomsten av depression var högre bland dem med stroke jämfört med de övriga deltagarna, både gällande den sammavägda diagnosen och baserat endast på poängsättning. Stroke och sömnproblem var oberoende associerade med depression. Bland ≥65-åringar i enkätstudien var funktionsnedsättning och genomgången livskris associerade med depression hos dem med en tidigare stroke. Bland deltagare utan stroke var ett antal ytterligare externa faktorer, inklusive subjektiv upplevelse av dålig ekonomi och att inte ha någon att anförtro sig till, associerade med depression. Både stroke och depression var associerade med ökad dödlighet bland ≥85-åringar. De med stroke utan depression hade en dödlighet i linje med normalbefolkningen utan stroke eller depression. Förekomsten av samtidig stroke och depression var associerad med högre dödlighet än normalbefolkningen, jämfört med dem med enbart stroke eller enbart depression. Högt systoliskt blodtryck (≥160 mmHg), högt diastoliskt blodtryck (≥90 mmHg) och förmaksflimmer var oberoende riskfaktorer för att insjukna i stroke bland ≥85-åringarna. Sambandet mellan blodtryck och strokerisk försvagades ej hos människor med kognitiv eller funktionell nedsättning. Tidigare stroke, hjärtsvikt, kognitiv nedsättning, näringsbrist, depressiva symtom och låg gånghastighet var också associerade med att insjukna i stroke, men ej oberoende av varandra. Sammanfattningsvis så stiger förekomsten av stroke med åldern och är särskilt hög bland mycket gamla människor. Depression är betydligt vanligare hos mycket gamla människor med stroke, även justerat för störningsfaktorer. Depression är främst associerat med funktions-nedsättning hos människor med stroke, men med ett större antal externa faktorer hos människor utan stroke. Mycket gamla människor med stroke har särskilt hög dödlighet om de samtidigt är deprimerade, men en dödlighet i linje med normalbefolkningen om de inte är deprimerade. Högt systoliskt och diastoliskt blodtryck samt förmaksflimmer är viktiga och behandlingsbara orsaker till att drabbas av stroke i mycket hög ålder.

As humans age, the brain undergoes many changes. This includes loss of the neurotransmitter dopamine, which forms a bridging link between age and the ensuing changes in cognition. However many questions about the precise nature of this relationship with regards to brain structure and function remain unanswered. These questions are important given our expanding aging population, and the answers may help the discovery of new therapeutic interventions for age-related impairments as well as identify mechanisms to promote successful aging. Old age also provides a model for understanding the role of dopamine in many fundamental human behaviours. The aim of my research was to use a multimodal approach to explore the contribution of dopamine to learning and memory in healthy older age. In this thesis I present four studies in which I used a combination of behavioural testing, pharmacological manipulation, structural and functional magnetic resonance imaging in older adults. I show that dopamine boosts delayed episodic memory in a non-linear dose-dependent manner. Using functional MRI, I show this effect is mediated through consolidation rather than encoding by the hippocampus. In two further imaging studies conducted to explore the role of dopamine in reward-based learning, I show that the flexibility of learning depends on the structural integrity of the substantia nigra/ventral tegmental area (the origin of dopamine projections) and that pharmacological enhancement of dopamine levels can remediate abnormal reward processing in the ventral striatum. Individual differences in neural activity associated with reward prediction also relate to anatomical nigro-striatal connectivity, identified using diffusion tensor imaging. Finally, I show that in old age, valence influences decision-making in relation to ones own beliefs about the future, mediated by volume of the anterior cingulate cortex. I conclude this thesis with a brief discussion of the implications of these findings, study limitations and potential future studies.

Why is independence a central theme for proponents of assisted living facilities? How do assisted living providers respond to this theme? These questions are pursued in an ethnographic study centered on Oregon's assisted living program. Assisted living facilities (ALF), defined and monitored by Oregon's Senior and Disabled Services Division (SDSD), are a type of housing for disabled, primarily elderly, persons. Oregon Administrative Rules (OAR-411-56) define independence, requiring ALF providers to support resident independence. Using social worlds theory as a sensitizing concept, assisted living is treated as a distinct social world. The activities of key groups, including SDSD staff, an ALF professional group, and assisted living managers, are described. These members commit to a “social model” approach to long-term care for which independence is the unifying construct. This approach offers a value-practice “package” that explains how to implement the value of independence (Fujimura, 1997). Three arenas where this package is apparent are described: marketing, manager training, and daily operations. Content analysis of marketing brochures from 63 assisted living facilities shows that independence is a dominant theme, promoted like any other product. These materials indicate that assisted living operators promote resident independence by providing a barrier-free environment, helping residents with daily tasks, and allowing residents control over their decisions. Manager training programs are another arena where the policy value of independence is evident. Here, new managers learn “who we are” and “what we do” in this social world. They learn a new vocabulary and are introduced to tools for daily practice. They learn the boundaries of this social world, and above all, how to behave differently from nursing facilities that they associate with the “medical model.” In daily practice, managers use institutional conventions, including the “negotiated service agreement” and "managed risk agreement." These tools are designed to respond to the tension between supporting independence and providing care to chronically ill, disabled individuals. Observations of marketing, management training, and resident assessments indicate that the social world of assisted living is in a formative stage, as members attempt to define and legitimate who they are and what they do.

The study of old age in the humanities has developed significantly in the last few decades, but there is still much scope for progress. This thesis, therefore, seeks to contribute to the growing academic discourse in this area by considering ageing as it is represented in ancient Greek theatre. At the same time, it seeks to take its place within Classical Studies by developing new readings of the plays. To develop a context for its analysis, this study begins with consideration of the contemporary demographics, social position, and stage portrayal of old age, and following this dedicates a chapter to each of the four surviving fifth century dramatists. In Aiskhylos’ Agamemnon, old age emerges as a crucial element in choral self-identity, and an important component of the authority that they display. Following this, the thesis considers the chorus of Euripides’ Herakles, in particular its use of metadramatic language, and the impact this has on plot-development and the representation of their age. The next chapter, on Oidipous Koloneus, shifts to consideration of the protagonist. The old age of Oidipous emerges as a powerful driver of his mental and spiritual power, and forms a striking background to the exploration of his character. The final chapter of the thesis examines how mechanisms of renewal that old men undergo in Aristophanes’ comedies (Knights, Akharnians, Peace, Wasps, Birds) differ across the dramas, and the impact this difference has on their interpretations. Such reassessments of ancient dramatic texts through the lens of old age can provide significant insight into the complexity of old men’s characterisations and of their involvement in the dramas. At the same time (from a gerontological perspective), this thesis’ analysis contributes to the developing discussion of the history of ageing, and highlights the differences between the ancient and modern worlds in this respect.

Since the late 1980s, representations of Japanese national identity and Japanese old age have been deconstructed. Images of the resilience of traditional cultural and social institutions are shown to have over-emphasized social and cultural homogeneity, elided social differentiation and inequality and minimized the significance of historical transformation. Key institutions of the postwar modernization project, including the patriarchal seniority system and household structure, are being transformed through globalization and feminization. This thesis focuses on the problem of representing individual and collective ageing in Japan in the context of modernization. Research is focussed on the contradictions, within essentialist representations of Japanese collective and individual identity, between socially constructed policy forms of old age and collective identities. Contemporary trends towards individualization and diversification of identities, and discourses on the ageing/information society, indicate cultural distance between an instrumentally rational administration and the life world of old people. Research explores the concept of embodiment through its significance in debates on postmodernization of the lifecourse in accordance with the structural shifts towards a postindustrial structure. This study examines representations of old age in broader social and cultural processes. Images of the social and cultural trajectory of the lifecourse draw attention to the embodiment of individual identities and ultimately generational cultures in contemporary social and cultural spaces. This research is the result of analyses of old age, which have been informed by postmodern theory. It in turn informs sociological theorizations of cultural representations of old age in contemporary societies.

While population ageing is attracting ever more attention of international scientific community and social policy, its cultural and communicative aspects remain underinvestigated. The goal of the dissertation is to investigate the old age (ageing) identity in Lithuania, applying the sociological concept of stigma. In the pursuit of this goal, the research areas of stigma and ageism are connected, highlighting their common denominator - discrimination. The following questions are raised: whether/to what extent old age is stigma in contemporary Lithuania? When and why old age did become stigma? What are manifestations of the old age stigma? How is it reproduced? Searching for answers the historical changes of attitudes towards ageing are reviewed, dominant theories of ageing identity are examined and the concepts of A.Gidden‘s reflexive self and E.Goffman‘s stigma are applied. Scientifically new theses presented for defense are grounded in the findings of three empirical investigations: media texts analysis, interviews with older people and data analysis of the European Social Survey Round 4. The results lead to conclusion that old age in Lithuania is an „open secret" type stigma: verbally favourable view of older people conceals discrimination. The constructed and internalized stigma is detected both in media and in everyday interactions. The level of discrimination experienced by Lithuanian population over 60 is close to other post-communist and Mediterranean countries.
Tarptautinei mokslo bendruomenei bei socialinei politikai vis daugiau dėmesio skiriant gyventojų senėjimui, kultūriniai ir komunikaciniai jo aspektai lieka mažai tyrinėti. Šios disertacijos tikslas yra ištirti senatvės (senėjimo) tapatumą Lietuvoje, remiantis sociologine stigmos koncepcija. Šio tikslo siekiama, sujungiant priešiškumo vyresniam amžiui (ageism) ir stigmos tyrinėjimų sritis bei išryškinant jų bendrą vardiklį – diskriminaciją. Joje keliami klausimai: ar/kokiu mastu senatvė šiuolaikinėje Lietuvoje yra stigma? Kada ir kaip ja tapo? Kuo pasireiškia? Kaip senatvės stigma palaikoma? Atsakymų ieškoma, apžvelgiant istorinę nuostatų į senėjimą kaitą, tikrinant vyraujančias senėjimo tapatumo teorijas ir taikant Anthony Giddenso reflektyvaus Aš bei Ervingo Goffmano stigmos koncepcijas. Gynybai teikiami moksliškai nauji disertacijos teiginiai yra pagrįsti trijų empirinių tyrimų rezultatais: medijų tekstų analize, interviu su vyresnio amžiaus žmonėmis ir Europos socialinio tyrimo 4 bangos duomenų analize. Rezultatai leidžia daryti išvadą, kad senatvė Lietuvoje yra stigma: už verbaliai deklaruojamo palankaus požiūrio į senus žmones slypi priešiškumas. Masinėse medijose ir kasdienėse sąveikose aptinkama konstruojama ir internalizuota senatvės stigma. 60 m. ir vyresni Lietuvos gyventojai dažniau nei pažengusių Vakarų šalių vyresnio amžiaus žmonės patiria diskriminavimą - Lietuvos rezultatai panašūs į kitų pokomunistinių ir Viduržemio jūros šalių rezultatus.

Objectives: The context of the increase in life expectancy and the demographic shift towards a more elderly population in the UK presents a number of challenges to society‟s perception of old age and to the likelihood of increasing demands upon health professionals and psychologists who work with the elderly. Existing studies have focused on the effectiveness of therapeutic endeavours with older people, yet have failed to discretely examine the constructs of old age among psychologists who work in the field. Given the prominence of the ageing population and the likelihood of an increase in demands for therapeutic interventions, the aim of the present study was to explore how psychologists discussed and constructed old age within the context of their therapeutic work with older people. The research questions focused on the way in which psychologist who have experienced working with older people talk about old age, the way they construct ideas of therapy with old people and how those constructs of age relate to wider cultural and social constructs of old age. Method: Individual in-depth interviews were conducted with eight psychologists, who were aged between mid thirties to late fifties, all of whom had a minimum of two years experience working therapeutically with older people. The interview transcripts were analysed using the discursive analysis methods of Discursive Psychology and Foucauldian Discourse Analysis. The analysis focused on the way the psychologists used discursive resources when discussing old age and the implications of their subject positions in their therapeutic work with older people. Results: The results identified a number of discourses of old age; old age as heterogeneous, old age as dichotomous, that the therapeutic intervention with older people can be seen as complex and challenging as well as a rewarding pursuit for the therapist, that the choice of the therapeutic model has implications itself and that old age can be seen as an internal attribute. Discussion: The study demonstrated how constructions of old age influenced psychologists in terms of their expectations, their therapeutic delivery, their willingness to integrate a number of therapeutic models, and in their ability to set goals with their elderly clients. The clinical implications of the present study are discussed and the study concludes with recommendations suggesting additional training aiming at furthering psychological knowledge of old age and current theories of ageing.

This study describes the situation for community living older people, 65 years of age and older in Iceland, analyzing their needs for care and services and how these needs are met. The study analyzes the relationship between the main providers of help and care, the formal caregivers and the informal carers. The study further depicts what kinds of care and support older informal caregivers provide and receive themselves and analyze what factors are related to providing care alone or in combination with other caregivers, informal and formal. The study also analyzes the relationship and mutual support between grandparents and grandchildren and whether there are gender differences in intergenerational relations and support. As little research has been conducted on informal care in Iceland, it is important to show the importance of the informal carers in the care paradigm. Two Icelandic studies were used for the descriptions and analysis. The main data source is the ICEOLD survey (Icelandic older people), based on a random representative national sample of 700 non-institutionalized persons in ages 65 – 79 years and 700 persons aged 80+. The final sample consists of 1,189 older persons to which an introduction letter was sent. They were contacted by phone a few days later and 782 persons, 341 men and 441 women, agreed to participate, giving a response rate of 66%. A study carried out among college students in Iceland, The Grammar School study, was also used to retrieve information on intergenerational relations between grandparents and grandchildren. The study indicates that older people in Iceland are receiving help and care from both informal and formal carers but informal help provided by family members seems to play a major role in supporting older people in their home. The great majority of the respondents with Instrumental Activities of Daily Living (IADL) limitations and Personal Activities of Daily Living (PADL) limitations received either informal or formal help but not both. The care and help provided is more often help with domestic tasks than with personal care. However, when the need increases the formal system steps in. It is not clear whether the informal care is a substitute for the formal one. As the formal help provided is rather sparse, it is suggested that when the need for personal care increases, the older person moves into a nursing home instead of increasing the formal care in the home. Women more often than men are the sole carers, and daughters are more important carers for older people than sons are. Older informal caregivers were alone in their caregiving in almost half of the cases and women more often than men. One third provided help with several tasks, such as help with errands and surveillance or keeping company in addition to ADL help. Older caregivers provide care even when they need help themselves. The results indicate that grandparents and grandchildren exchange more emotional than practical support. The emotional support provided and received by the generations is of great value. Gender influences the contact frequency between the generations, as women more often cultivate ties between grandparents and grandchildren.

Falls and gait impairment in older populations present a major challenge to healthcare systems and reduce quality of later life. There is evidence that cognitive decline contributes to falls and gait impairment in older adults and may, therefore, serve as a marker for persons at risk. Intraindividual variability (IIV; trial-to-trial fluctuations in response time across a neurocognitive task) may have screening potential in this respect as this measure is thought to capture unique information about cognitive function not captured by other neuropsychological metrics. The present research, therefore, examined relationships between IIV, gait and falls in cognitively intact older adults. The extent to which relationships varied according to age and the demands placed on the individual when assessing IIV and gait, was also investigated. Finally, a mediational approach identified potential mechanisms underpinning these relationships. Systematic reviews of published research were followed by cross-sectional experimental studies and a longitudinal investigation. The findings provided mixed evidence of a link between IIV and falls. There was strong cross-sectional evidence that greater IIV was associated with poorer gait performance, and that this relationship strengthened with increasing age. Variability better predicted gait outcomes when gait was assessed under more demanding dual-task conditions, and when IIV measures were derived from tasks with higher executive demands. Tests of mediation suggested that processing speed underpinned relationships between IIV and less demanding single-task gait, whereas executive function played a greater role in more demanding gait conditions. Together, the outcomes suggest that IIV measures have potential as an early screening tool for gait impairment, and also falls. Importantly, general slowing accounts of cognitive ageing explained findings when IIV and gait were assessed under lower demand conditions, whereas frontal lobe/executive control perspectives provided a better account when demands were greater.

We use 32 age measurements of passively evolving galaxies as a function of redshift to test and compare the standard model ($\Lambda$CDM) with the $R_{\rm h}=ct$ Universe. We show that the latter fits the data with a reduced $\chi^2_{\rm dof}=0.435$ for a Hubble constant $H_{0}= 67.2_{-4.0}^{+4.5}$ km $\rm s^{-1}$ $\rm Mpc^{-1}$. By comparison, the optimal flat $\Lambda$CDM model, with two free parameters (including $\Omega_{\rm m}=0.12_{-0.11}^{+0.54}$ and $H_{0}=94.3_{-35.8}^{+32.7}$ km $\rm s^{-1}$ $\rm Mpc^{-1}$), fits the age-\emph{z} data with a reduced $\chi^2_{\rm dof}=0.428$. Based solely on their $\chi^2_{\rm dof}$ values, both models appear to account for the data very well, though the optimized $\Lambda$CDM parameters are only marginally consistent with those of the concordance model ($\Omega_{\rm m}=0.27$ and $H_{0}= 70$ km $\rm s^{-1}$ $\rm Mpc^{-1}$). Fitting the age-$z$ data with the latter results in a reduced $\chi^2_{\rm dof}=0.523$. However, because of the different number of free parameters in these models, selection tools, such as the Akaike, Kullback and Bayes Information Criteria, favour $R_{\rm h}=ct$ over $\Lambda$CDM with a likelihood of $\sim 66.5\%-80.5\%$ versus $\sim 19.5\%-33.5\%$. These results are suggestive, though not yet compelling, given the current limited galaxy age-$z$ sample. We carry out Monte Carlo simulations based on these current age measurements to estimate how large the sample would have to be in order to rule out either model at a $\sim 99.7\%$ confidence level. We find that if the real cosmology is $\Lambda$CDM, a sample of $\sim 45$ galaxy ages would be sufficient to rule out $R_{\rm h}=ct$ at this level of accuracy, while $\sim 350$ galaxy ages would be required to rule out $\Lambda$CDM if the real Universe were instead $R_{\rm h}=ct$. This difference in required sample size reflects the greater number of free parameters available to fit the data with $\Lambda$CDM.

Spatial navigation is essential for everyday function. It is successfully achieved by combining internally generated information – such vestibular and self-motion cues (known as path integration) – with external sources of information such as visual landmarks. These multiple sources and sensory domains are often associated with uncertainty and can provide conflicting information. The key to successful navigation is therefore how to integrate information from these internal and external sources in the best way. Healthy younger adults do this in a statistically optimal fashion by considering the perceived reliability of a cue during integration, consistent with the rules of Bayesian integration. However, the precise impact of ageing on the component senses of path integration and integration of such self-motion with external information is currently unclear. Given that impaired spatial ability is a common problem associated with ageing and is often a primary indicator of Alzheimer’s disease, this thesis asks whether age-related navigational impairments are related to fundamental deficits in the components of path integration and/or inadequate integration of spatial cues. Part 1 focussed on how ageing impacts the vestibular, kinaesthetic and visual components of path integration during linear navigation in the real world. Using path reproduction, distance estimation and depth perception tasks, I found that older adults showed no performance deficits in conditions that replicated those of everyday walking when visual and self-motion cues were present. However, they were impaired when relying on vestibular information alone. My results suggest that older adults are especially vulnerable to sensory deprivation but that weaker sensory domains can be compensated for by other sensory information, potentially by integrating different spatial cues in a Bayesian fashion: where the impact of unreliable/diminished senses can be minimised. Part 2 developed the conclusions of Part 1 by testing younger and older adults’ integration of visual landmarks and self-motion information during a simple homing task. I investigated the hypothesis that the integration of spatial information from multiple sensory domains is driven by Bayesian principles and that old age may affect the efficiency and elasticity of reliability-driven integration. Younger and older participants navigated to a previously visited location using self-motion and/or visual information. In some trials there was a conflict of information, which revealed the relative influence of self-motion and visual landmarks on behaviour. Findings revealed that both younger and older adults integrated visual and self-motion information to improve accuracy and precision, but older adults did not place as much influence on visual information as would have been optimal. This may have been the result of increased noise in the underlying spatial representations of older adults. Furthermore, older adults did not effectively re-weight visual and self-motion cues in line with the changing reliability of visual information, suggesting diminished plasticity in the underlying spatial representations. However, further development of the testing paradigm would strengthen support for these findings. Together, the findings of Part 2 suggest that increased neural noise and the suboptimal weighting of spatial cues might contribute to the common problems with navigation experienced by many older adults. This thesis provides original evidence for age-related changes to multisensory integration of spatial cues. Path integration abilities are relatively preserved when older adults navigate linear paths in the real world, despite loss of vestibular function. However, navigation is affected by old age when the task becomes more complex. Multisensory integration of spatial cues is partially preserved but it is not fully efficient. I offer evidence that the navigational impairments common to old age are related to fundamental deficits in the components of path integration, task complexity, and suboptimal integration of spatial cues. Crucially however, path integration is preserved sufficiently in older adults that they are able to navigate in small scale with relative success.

Estimating the level and trend in population mortality rates at advanced ages in South Africa is complicated by problems with both the population and death data. Population and death data, particularly in developing countries, often suffer from age misreporting - age exaggeration and digit preference. Also, censuses may under- or overestimate the population and registration of deaths is usually incomplete in developing countries (Dorrington, Moultrie and Timæus 2004). To avoid these problems, the research in this dissertation relies on the method of extinct generations and its extensions (Thatcher, Kannisto and Andreev 2002) to re-estimate the population using only the death data, which is often recorded more accurately than the population data. Since deaths are not reported completely in South Africa, the death data must be corrected before use. Death Distribution Methods (Moultrie, Dorrington, Hill et al. 2013) are used to correct the death data for incomplete registration of deaths. After correction, Near Extinct Generation methods (NEG) are used to re-estimate the population by projecting future deaths of nearly extinct cohorts. After showing that mortality rates produced using the original NEG methods are biased because of age and year of birth heaping present in the South African death data, the NEG methods are adapted to the South African context. The adapted NEG model smooths the age and year of birth heaping in the death data and produces mortality rates that are less biased than the original NEG methods. This model - referred to as the NEG-GAM model in this research - is used to re-estimate the population at each age from 70 and above and to calculate mortality rates since 1985. The population estimates aged 70+ produced using the NEG-GAM model match those from the 2011 census well. It is found that both the population and death data suffer from the same pattern of heaping, that the population and death data are affected by age exaggeration and that the death data are less affected by age exaggeration than the population data. The level and trend in mortality rates calculated using the NEG-GAM model are discussed and compared to the mortality rates in the Human Mortality Database and other studies of South African mortality. The mortality rates produced for the African and Coloured population groups appear too low at the older ages due to age exaggeration in the death data, while those for the Indian and White population groups appear to be reasonable over the entire age range. Mortality appears to be improving in the age range 70-79 for the Coloured, Indian and White population groups and deteriorating slowly for the African population group.

Old-age hippocampal sclerosis (HS), characterised by severe neuron loss in hippocampal CA1, is a poorly understood cause of dementia. At present no objective pathological HS criteria exist. In life HS is commonly diagnosed as Alzheimer's disease. HS aetiology is unclear, although it has been associated with both ischaemia and TAR-DNA-binding protein-43 (TDP-43)-related neurodegeneration. Variations in genes GRN, TMEM106B and ABCC9 are proposed as HS risk factors. The aim of this thesis was to investigate epidemiological, clinical, pathological and genetic characteristics of HS in older European populations. 976 brains donated for the Cambridge City over-75s Cohort, the Cognitive Function and Ageing Study and the Finnish Vantaa 85+ study were available for evaluation -including bilateral hippocampi from 302 individuals. A protocol capturing the extent and severity of hippocampal neuron loss was developed, establishing objective HS diagnosis criteria and allowing observation of distinct neuron loss patterns associated with ischaemia and neurodegeneration. 71 HS cases (overall prevalence: 7.3%) were identified. HS was significantly associated with an advanced age at death as well as dementia at the end of life. Neuropsychological and cardiovascular characteristics were similar between HS and AD, except for a longer duration of dementia and more disability in HS. HS was not associated with neurofibrillary tangles, amyloid plaques, or vascular pathologies, but all HS cases evaluated for TDP-43 showed neuronal inclusions in the hippocampal dentate and a high frequency of other glial, neuronal and neurite TDP-43 pathologies. GRN and TMEM106B but not ABCC9 variations were linked to HS. A moderating effect of TDP-43 on this association was detected. HS presented pathologically similarly to frontotemporal dementia cases with TDP-43 (FTLD-TDP) caused by mutations in GRN, but differed from other FTLD-TDP subtypes. Results of this thesis reveal the importance of HS in the oldest old in the population, the key role of TDP-43, as well as providing robust methods to capture HS characteristics for an area that has been under-researched but is clearly vital to understanding dementia in the oldest old.

Background: Old-old age (80+ years) is associated with substantial cognitive decline. In this population, training-induced cognitive plasticity has rarely been studied. While earlier findings on strategy trainings suggested reduced training gains in old-old age, recent results of an extensive process-based working memory (WM) training have been more positive. Objective: Following up on previous research, the present study aimed at examining the effects of a short WM training in old-old adults and the influence of baseline WM capacity on training gains. Methods: A training group (mean age: 86.8 years) and a matched control group (mean age: 87.1 years) participated in the study. The WM training consisted of five tasks that were trained in each of 10 sessions. To evaluate possible transfer effects, executive functions were assessed with two tests before and after training. The training group was divided via median split in high- and low-capacity individuals to determine the influence of baseline WM capacity on training gains. Results: The training group improved in four of the trained tasks (medium-to-large effects). Training gains were significantly larger in the training group than in the control group in only two of those tasks. The training effects were mainly driven by the low-capacity individuals who improved in all trained tasks. No transfer effects were observed. Conclusions: These positive effects of a short WM training, particularly for low-capacity individuals, emphasize the potential for cognitive plasticity in old-old age. The absence of transfer effects may also point to its limits
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich

Background: Old-old age (80+ years) is associated with substantial cognitive decline. In this population, training-induced cognitive plasticity has rarely been studied. While earlier findings on strategy trainings suggested reduced training gains in old-old age, recent results of an extensive process-based working memory (WM) training have been more positive. Objective: Following up on previous research, the present study aimed at examining the effects of a short WM training in old-old adults and the influence of baseline WM capacity on training gains. Methods: A training group (mean age: 86.8 years) and a matched control group (mean age: 87.1 years) participated in the study. The WM training consisted of five tasks that were trained in each of 10 sessions. To evaluate possible transfer effects, executive functions were assessed with two tests before and after training. The training group was divided via median split in high- and low-capacity individuals to determine the influence of baseline WM capacity on training gains. Results: The training group improved in four of the trained tasks (medium-to-large effects). Training gains were significantly larger in the training group than in the control group in only two of those tasks. The training effects were mainly driven by the low-capacity individuals who improved in all trained tasks. No transfer effects were observed. Conclusions: These positive effects of a short WM training, particularly for low-capacity individuals, emphasize the potential for cognitive plasticity in old-old age. The absence of transfer effects may also point to its limits.
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

This thesis heeds W. Andrew Achenbaum’s call for historians of ageing to analyse the inner lives of their subjects. Building on and problematizing existing studies of health and welfare policies for the old, it explores the ways that mid-century public and private life shaped how individuals felt about old age. Both public discussions and private narratives of ageing are used to consider how older people understood and expressed their emotional experiences during a challenging period of the life cycle. I argue that old age in general, and its emotional dimensions in particular, are missing from British historiography. Yet both were vital to social life in the mid-century, when the ageing population was an important political issue and a large number of experts hoped to manage the emotional and psychological aspects of this ‘problem’. This thesis begins by setting out this national context for old age, showing that heightened interest in ageing and emotion were significant influences over the expansion of the welfare state. However, contrary to the expectations of mid-century researchers and policy-makers, my subsequent chapters show that older people frequently maintained their social roles and relationships through informal means. This thesis explores how ageing men and women engaged with work, retirement, ill health, marriage, bereavement, fashion, beauty culture, and autobiography as opportunities to find meaning in late life. Together, these varied perspectives on old age make a series of interventions in its history. I argue that historians could do much more to detail the significance of the life cycle for their subjects, whether they write political, social, or cultural history. As this thesis shows, such studies should approach ageing as a lifelong and personal process, which has been shaped by reminiscence and story-telling. I suggest that historians of emotion are best-equipped to write scholarship that is sensitive to the passing of time and personal biography in this way.