Working with Seniors: Health, Financial, and Social Issues

Chapter 12: Cognitive Aging

One-hundred-and-two-year-old Russell Clark says, “Continuing to work keeps the mind sharp and the body healthy, which aids in maintaining a positive attitude.” Clark, of Orem, Utah, works every day as the manager of an industrial park and other real estate developments.

Experience Works, a national nonprofit that specializes in employment training and services for older workers, recognizes the contributions older employees make to workplaces around the country. In September 2003, the organization announced that Russell Clark was “America’s Oldest Worker” for that year.

At age 83, Clark retired from his day job as a physician and surgeon. His interest in real estate investment began while he was practicing medicine, and it led him to purchase a clinic and 47-bed hospital.

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Mrs. Blackwell had been living alone in a small community in the two months since her husband passed away suddenly. When her electricity was turned off unexpectedly, she called the electric company and was told that her bill had not been paid in the last two months. Mrs. Blackwell insisted that the bills had been paid and called her daughter to help her resolve the issue.

When Mrs. Blackwell's daughter went through the piles of paper on her mother’s desk, she discovered that many bills had not been paid since her father died, while others had been paid twice. She also found her mother’s brooch in the freezer and rotten food in the refrigerator, and realized her mother had not changed her dress since the two of them had gone out to lunch together a week before. Her daughter knew that Mrs. Blackwell had been having some problems with her memory for a couple of years and hadn’t been sleeping well, but didn’t think there was any other problem.

When questioned about the situation, Mrs. Blackwell became angry and defensive, stating that she just lost her husband and was grieving.

After calming her mother, Mrs. Blackwell's daughter was able to convince her to see the doctor. Several tests from her general practitioner and a psychiatrist (including assessment of her grief reaction) concluded that Mrs. Blackwell had likely been suffering from dementia for several years. Her husband had compensated for her deficits, a situation that became evident only after he died.

Introduction

While they might not reach the remarkable age that Russell Clark has, most seniors live full, productive lives until well into their seventh decade and beyond. Mrs. Blackwell's story is atypical. Normal aging through the later decades is accompanied by some minimal brain deterioration and slowing, but most mental functioning remains fully intact. Only a small percentage of younger seniors will become, like Mrs. Blackwell, victims of Alzheimer’s disease or a related dementia. However, by age 85 nearly half are affected (Alzheimer's Association, n.d.).

Alzheimer’s disease is a progressive, age-related, irreversible brain disorder that has become a topic of growing concern in both health care and social policy–circles. Not only is the nature of this illness frightening, it has a huge cost to individuals, families, the health care system, and society. The national annual financial cost of caring for people with dementia is $60–120 billion (Ernst & Hay, 1996). Added to that cost are the burden on caregivers and their families, lost family caregiver workdays, and strain on the overburdened health care system. This chapter will provide a foundation for understanding normal aging versus the disease process, and dementia as the syndrome caused by many underlying diseases, with focus on the most prevalent form of dementia, Alzheimer’s disease.