Late Life Development

Diagnosis and treatment of emotional and cognitive disorders of late life require first an understanding of normal aging. The epigenetic framework of Erik Erikson has stood the test of time as a useful framework for outlining the normal process from childhood to old age. As people advance through the experiences of life, they adopt modalities of coping and adaptation appropriate to their stages of maturation. In maturity, defense mechanisms such as altruism, sublimation, and humor replace immature ones such as denial and acting out. Reminiscence serves many sustaining functions. Structurally, gray matter begins to decrease first in the prefrontal cortex, and only later in posterior domains. Plasticity in the brain also declines, lessening the ability to adapt structurally to cognitive challenges. Processing speed decreases with age and distractibility increases. Working memory is adversely affected by these changes. Older adults are less likely to use mnemonic devices than younger cohorts. Verbal memory is more vulnerable than visuospatial memory. Over adulthood, crystallized intelligence (one’s accumulated body of knowledge) continues to increase, while fluid intelligence (processing and reasoning) diminishes from early adulthood on. Most sensory systems decline in acuity and range, with multiple functional consequences. Sexual function decreases in both sexes, but desire appears more resilient. Diet and lifestyle can ameliorate some of the detrimental physical effects of aging in brain and body.