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Cognition in Later Life Requires Your Full Attention (Please laugh at my jokes!) Now let’s get serious. Could one of ...

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Cognition in Later Life

Requires Your Full Attention (Please laugh at my jokes!)

Now let’s get serious. Could one of these people sitting on a park bench be you in 30 (or 40 or 50) year’s time?

The answer is that you will not be like any of them. Even when you are their age, you still belong to a cohort that evolved during a different historical period. Cohort and historical effects shape the course of aging within and across cultures. A common mistake is to group people as similar based on age alone. As age increases, so does diversity. We are products of our genes, age, cohort, and history. Differences between the young and old have more to do with cohort and history than with age.

Our culture stereotypes and devalues both older people and youth.

We confuse old age with disability, and mistake disability for a lack of competence.

For example, how many seniors are free from disorders that affect the brain? What proportion has impaired cognition? Probably fewer than you think.

Does normal aging bring about a loss of cognition? 1. Learning and memory Research beginning in the 1880s showed that reaction time is slower in the aged. Generations of gerontologists interpreted such findings as evidence that the speed with which the brain processes new information declines with normal aging. Findings consistent with this hypothesis include evidence that old people are particularly disadvantaged in learning new information that is • Presented at a fast rate; • Poorly organized; • Unfamiliar (e.g., filled with jargon). Consequently, helpful hints to lawyers include the use of slow paced, wellorganized, jargon free communication. However, be aware that low recall does not necessarily imply failure to acquire information. Older people often show similar recognition levels as younger people, even if recall is lower. So use recognition to verify acquisition rather than rely solely on recall.

Does normal aging bring about a loss of cognition? 2. Intelligence

Intelligence consists of two main components: • Basic problem solving skills; • Practical problem solving. The basic skills are those measured by intelligence tests. For most of the last century, psychologists thought that lower scores on intelligence tests by successive cohorts meant that basic intelligence declined after age 25 years. Studies that measured the same people at different ages, showed this interpretation to be false. Findings from longitudinal studies show that major declines in intelligence occur after people are in their eighties. Practical problem solving remains intact with practice of those skills.

Does normal aging bring about a loss of cognition? 3. Cognitive expertise

Chess experts retain high proficiency throughout life. The same applies to games like bridge and scrabble. However, older cognitive experts solve problems differently from younger experts. Older experts rely more on knowledge, whereas younger experts solve problems by using basic skills. The important principle from this research is that problem solving in older people is knowledge based. Consequently, an effective way to impart information is to tap into their existing knowledge structures. An older person is more likely to acquire new information quickly if presented in a way that relates to that person’s existing knowledge base.

Conditions that Diminish Competence Conditions that diminish competence include anxiety, delirium, dementia, and depression. Anxiety: State anxiety is a transient condition associated with a stressful situation. Signs of anxiety include muscular tension, rigid posture, nervous demeanour, and verbal expression of fear or worry. Older people may experience anxiety in a lawyer’s office because of preconceptions and unfamiliarity. Try to relax the person by being relaxed, unhurried, and friendly. Delirium: Delirium is a transient state of cognitive impairment often associated with illness, changed or withdrawn medication, trauma, bereavement, or relocation. The symptoms include confusion and clouded consciousness. If you or a family member detects signs of recent confusion, reschedule the appointment to a later date.

Conditions that Diminish Competence Dementia: The symptoms of dementia include a progressive loss of cognitive competence. Early signs include a loss of short-term memory, poor everyday problem solving, poor orientation for place and time. The person may be unsure about (1) the current setting, (2) the month or year, and (3) current events (e.g., who the Prime Minister is). You can insert questions about such matters into ongoing discourse to test for cognitive loss. Because of the progressive nature of dementia, resumption of full cognitive competence is unlikely. However, gains may occur through improved situation or the treatment of comorbid conditions. Communication with a demented person should proceed very slowly, include repetition and good organization, avoid jargon, and tap into retained knowledge structures. A demented person is typically frightened and frustrated, but remains a human being having purposes in life that require dignity and our respect.

Conditions that Diminish Competence Depression: The symptoms include low positive affect, high negative affect, or both. Depression promotes cognitive loss in the aged and may accompany early dementia. It is often undetected in the elderly, but does respond to treatment. Many older people show depression by low positive affect – ‘depression without sadness’. Low positive affect includes • Loss of pleasure; • Withdrawal from former activities; • Withdrawal from social interaction. High negative affect includes: • Frequent negative statements; • Anger and hostility; • Unrealistic fears; • Frequent complains about health or other matters; • Sad facial expression; • Tearfulness or crying. If several symptoms are present much of the time several days a week, the person may be clinically depressed.

Conclusions Older people belong to a different cohort than the lawyers who serve them. In the absence of disease that affects cognition, they are intelligent and able to acquire information. Communication should be slow paced, well-organized, jargon free, and consistent with knowledge structures. Older people may be intimidated in a lawyer’s office or try to disguise those feelings by bombast. The lawyer should allay anxieties and thereby enable more effective communication and information exchange. Of the conditions that impair cognitive competence, dementia is progressive. Delirium and depression have symptoms sometimes mistaken for dementia, but are transient or treatable conditions. People with dementia are frightened, frustrated, and often depressed in the early stages. Adjust your communication accordingly, and be sure to treat them with honour and respect.