Generations

Dementia is an all-- encompassing term that, when referring to individuals over age of 65, is used to indicate significant cognitive impairment. This impairment is usually defined by loss of the ability to care for one-- self and is often associated with problems in recognizing familiar surroundings and people (including family members). There are numerous diseases and factors that are known to contribute to dementia in the elderly, These can be categorized based on the roles of environmental, medical, and genetic influences. Indeed, all dementias are probably influenced if not caused by a combination of such factors. We will discuss the evidence for the genetic and environmental causes of some common dementias as well as the factors involved with the dementias that are associated with other medical conditions. The most common term associated with dementia in the elderly is Alzheimer's disease. More than 50 percent of cases of dementia in the elderly are classified as Alzheimer's disease based on pathological findings at autopsy (Katzman, 1976). The cause of Alzheimer's disease remains elusive despite an extensive amount of research. Dementia stemming from vascular disease is second only to Alzheimer's, causing 10-20 percent of cases of dementia in the elderly (Butler, 1993).The remaining 25 percent of dementias of the elderly not associated with Alzheimer's or cerebrovascular disease result from various conditions such as Pick's disease, Diffe Lewy Body disease, normal pressure hydrocephalus, Creutzfeldt-Jakob disease, brain tumors, and nutritional deficiencies. ALZHEIMER'S DISEASE Alzheimer's disease is the most frequent diagnosis of dementia in the elderly. In 1907, Alois Alzheimer examined the brain of a 51-year-old woman who had suffered from dementia before death and found the brain to contain numerous plaquelike structures in certain regions of the brain. He further noted that some of her neurons contained tangled filaments. These two microscopic findings, generally known as plaques and tangles, represent the main pathologic changes in Alzheimer's disease. Accordingly, a substantial amount of research has been devoted to the study of these lesions. Thus far, it has been established that plaques and to a lesser degree tangles accumulate with aging even in the individuals who are not demented (Schochet, 1998). In addition to the pathologic changes in the brain that help identify the postmortem Alzheimer's cases, advances in genetics and molecular biology have enabled the identification of several genes that may play a role in the disease. These genes were identified in families that appear to have a hereditary form of Alzheimer's disease that occurs at an early age, typically before the age Of 50. Finally, additional information has been gained regarding the effects of external factors such as head injury, education level, and certain toxins.' These and other recent advances will be discussed below. Plaques and amyloid. The most abundant constituent of a plaque is a protein called amyloid. This protein is considered by many to be toxic to neurons, and it is thought that Alzheimer's disease may result from the production or inappropriate cellular handling of this protein. The mechanism by which amyloid is toxic to neurons has not been identified, but a recent study suggests that amyloid reacts with iron, which is present in abnormally high levels in plaques, and generates toxic radical species of oxygen (see section on oxidative stress). There has been considerable research into amyloid beginning with the identification of families that have a mutation in the amyloid gene (APP gene). The association between a genetic defect in amyloid and Alzheimer's disease came from observations that those patients with Down's syndrome (also called trisomy 21, which refers to an extra twenty-first chromosome) also typically suffer from an early onset Alzheimer's-like dementia and have considerable plaque formation. …

David K. Epstein

James R. Connor

Dementia in the elderly: An overview

老年人痴呆症：概述

In a study conducted in Great Britain by Salkeld and colleagues (2000), 80 percent of older women report they would rather be dead than experience loss of independence as a consequence of a hip fracture and admission to a nursing home. Older adults' dread of hip fractures is understandable, since the personal and financial costs associated with hip fractures have been well documented. Additionally, according to the U.S. Department of Health and Human Services (2000), no progress has been made toward the Healthy People 2000 target of reducing the hospitalization rate for hip fractures. Consequently, that objective has been included in Healthy People 2010, which outlines major health priorities for the nation (U.S. Department of Health and Human Services, 2000). Finally, although more than twenty randomized trials of interventions to prevent falls have been conducted, conclusive practice directives for the prevention of fall-related injuries, especially among frail or hospitalized elderly, have not yet emerged. Compared to other evaluated strategies (e.g., exercise, multifactorial interventions), hip protectors are a novel approach to the prevention of fall-related hip fractures among older adults (Kannus and Khan, 2001). Increasing evidence of the effectiveness of certain types of hip protectors, combined with the increasing number of people at greatest risk for hip fracture, has focused attention on this secondary prevention strategy. HOW HIP PROTECTORS WORK Biomechanical studies have demonstrated that although bone strength and the force of the impact are important factors contributing to hip fracture, the point of impact must be on or near the hip for a fall to cause a hip fracture (Hayes et al., 1993). In most cases of hip fracture, the immediate cause of the fracture is a sideways fall with direct impact on the greater trochanter (a prominence at the top) of the proximal femur (Lauritzen, Peterson, and Lund, 1993). Hip protectors are anatomically designed to protect the hip bones during a fall by diminishing the force transferred to the proximal femur. The hip protector can both absorb some of the force of the fall and shunt the energy of the impact away from the greater trochanter of the femur to the surrounding soft tissues. DESIGN VARIATIONS About ten types of hip protectors are currently on the market. These products share the function of providing protection directly to the greater trochanter. However, the products vary dramatically in design and appearance. Most hip protectors on the market feature hard (padded) shields or soft pads sewn or inserted into a pair of underwear. In contrast, the HipGuard hip protector is held to the body by a belt worn around the hips. The shields used in hip protectors vary in thickness and construction. The HipSaver hip protector, which has been adopted by the National Health Service in the United Kingdom, uses foam (developed by NASA) in an airtight waterproof pouch that inflates in the event of a fall. The underwear used in hip protectors is typically stretchy, but at least one product uses loose, boxer-type shorts. All products are intended to be light-weight. While many of the shields used in hip protectors are oval or disc-shaped, the shape of hip protector shields may be changing. Funded by the National Institutes of Health and the Centers for Disease Control and Prevention, Toby Hayes and his colleagues at the Beth Israel Deaconess Medical Center have designed and tested a hip protector shaped like an inverted horseshoe. The pad is filled with cornstarch and water. Known as a dilatant fluid, the cornstarch-filled prototype changes from a soft medium to a solid form of protection during impact from a fall (Beth Israel Deaconess Medical Center, 1999). EFFICACY OF HIP PROTECTORS Hip protectors have been shown to prevent fractures among the frail elderly through individual randomized, controlled trials and through comprehensive analyses of well-designed studies as a whole. …

Elizabeth Walker Peterson

Jonathan Howland

Jes B. Lauritzen

Hip Protectors to Prevent Fall-Related Fractures

髋部保护器预防跌倒相关骨折

Narrative storytelling provides a structure for recounting the past as part of trying to understand the present, offering a way to make sense of what has happened. OCCUPATION AND STORY Stories concern both behavior and experience. They are about someone doing-or trying to do - something, about finding these attempts interrupted in the world, and about the resulting struggle to bring personal meaning, behavior, and opportunity into consonance (Mattingly, 1998). As older patients live with chronic diseases and deteriorations from which they cannot realistically expect to recover, treatment processes become a set of public behaviors and associated private feelings, meanings, judgments, and perceptions. That is, treatment of all sorts comes to rely on the telling and making of stories. As Matthews and colleagues describe (1994), the elder tells stories as a way of coming to terms with the many unfamiliarities of old age by situating them within models that arc culturally and personally acceptable. These stories may explicitly concern coping with disease and injury. They arc just as likely to concern broader themes of lifelong efficacy and powerlessness, of success and failure, of love and loss. Storytelling makes use of words as its primary medium of expression. But there is far more to storytelling than words. Occupation is a powerful means through which elders enact the stories of who they are. Using techniques of occupational storytelling (Clark et al., 1996), elders identify the constellation of existing personal occupations that comes to life as their story-each with its own internal consistency, tensions, and hints for resolution. Once told, the story reverberates. Teller and listener alike recognize themes of consonance. They also recognize dissonance between values held and actual behavior, between meaning held inside and activity demonstrated in the outside world (Hasselkus, 2002). And, through a complementary, creative process of occupational story making, elders learn to transform this story into one mat optimally suits their personal self in the current environment and life stage. That is, the person makes a new occupational story. Eloise's tale illustrates occupational storytelling and story making through a woman in her 90s who learned to cope with the ramifications of a devastating fall. VITAL INVOLVEMENT Erikson and colleagues (1986) clarified the principle that a person develops and exercises a unique identity through vital involvement with the environment. Vital involvement is defined as a person's meaningful engagement with the world outside the self (Kivnick, in press; Kivnick and Kavka, 1999). Vital involvement is purposeful activity-the circular mechanism through which individuals exercise capacities and make contributions of value to the world and to themselves, and through which they are influenced and changed by that world. Old age brings a number of constraints on opportunities for individual vital involvement. Maintaining psychosocial health through old age therefore requires the individual to take full advantage of existing opportunities for vital involvement. The construct of vital involvement may be understood as synthesizing fundamental principles from the disciplines of occupational science (Hocking, 2000; Clark et al., 1996; Jackson, 1996; Wilcock, 1993; Yerxa, 1993) and life-cycle, psychosocial development (Erikson, Erikson, and Kivnick, 1986; Erikson, 1980; 1950; Kivnick, 1991; Kivnick and Murray, 1997; Kivnick and Jernstedt, 1996) into an ongoing process that links person to community (See Figure 1). Occupational science rests on the notions (Yerxa, 1998) that occupation constitutes a personally meaningful chunk of activity, and, therefore, that a person's occupational performance may be understood as the person's expression of a unique self in a specific community environment. With every occupation, in every meaningful activity, the elder expresses who she or he is. …

Helen Q. Kivnick

Sharon Stoffel

Diane Hanlon

Eloise's Tale: Vital Involvement, Occupation, and Story

埃洛伊丝的故事：重要参与、职业与叙事

An important combination. Why consider lifelong learning as a potentially critical aspect of civic engagement for the population over the age of 50? As the concept of retirement is redefined and shaped by baby boomers' values and a changing economic oudook, a thorough and thoughtful examination of baby boomers' perspectives is essential if their civic engagement is to be initiated and sustained at levels necessary to respond to unmet needs in our communities. Current research on baby boomers' priorities and predictions concerning their future activities indicates that they have an interest in exploring new options, continuing lifelong learning and personal development, and being engaged in meaningful paid or unpaid work (Wilson and Simson, 2006). Winsten (2004) and the aarp survey (2004a) paint a specific picture of how the current 50-plus group of baby boomers perceives their time and activities in the future. Respondents to the aarp survey indicate that they expect to spend time in personal development, in full- or part-time paid work, in leisure activities, and in volunteer work. Another aarp survey (2004b) indicates that the shift toward expectations of continued work beyond retirement is increasingly strong, with findings indicating that 80 percent of baby boomers expect to continue working either full time or part time. The baby boomers' stated interest in continuing to learn and continuing to do meaningful paid and unpaid work evolves naturally out of changing demographics in an aging society, particularly related to education, with higher levels of education associated with higher levels of civic engagement. In 1995, only 14 percent of individuals between the ages of 65 and 74 were college graduates (Gwynn, 2000). By the year 2025, it is estimated that 33 percent of this age group will hold college degrees. Thirty-seven percent of baby boomers report that continuing their education is an important part of their retirement plan (Hart, 2002). Highly educated baby boomers are already filling the classrooms of colleges and universities seeking additional formal education toward alternative careers. In fact, a Merrill Lynch study (2005) indicates that 56 percent of baby boomers would like to change careers. These studies underscore the understanding that personal development and lifelong learning play a central role in future plans of the baby boomers. Boomers like to acquire new knowledge and skills, and they say they plan to continue to do so. This interest is driven both by personal preference and by the potential of making a career change into more meaningful and rewarding work. To do either requires seeking out and participating in avenues for lifelong learning. The concept of lifelong learning has itself been changing. Initially, lifelong learning was seen as an educational strategy targeted largely to adults ages 20-45 who required retraining or workforce entry credentials that had not been afforded them or in which they had not participated for other reasons as youth and young adults. As a policy strategy, lifelong learning has been seen as a way to optimize employment potential for adults and workers over the age of 40 (Dehmel, 2006). Globally, lifelong learning has been viewed as a way for governments to achieve their social objectives by improving the overall welfare and earning ability of constituents, thus reducing poverty and inequality (Kroukamp, 2004). Concurrently, the pace of technological change has made lifelong learning, whether formal or informal, critical for career progress. As a result of these views on the role of lifelong learning in strengthening society, lifelong learning has achieved increasing importance (Bork, 2001). The notion of lifelong learning as relevant and important to and for the 50-plus population is a more recent advance, which is supported by the literature that demonstrates the value of maintaining both cognitive capacity and social networking in aging populations. …

Laura B. Wilson

Karen Harlow-Rosentraub

Tracey Manning

Sharon Simson

Jack Steele

Civic engagement and lifelong learning

公民参与与终身学习

A natural intersection. Productive engagement among older adults has gained attention in recent years as a result of the growing size of the older population, the increased functional capacity in that population, and the needs of society. Today, most older adults can expect to live into their eighth decade, and they want more options to stay productively involved, not only to ensure income but to make contributions to family and community. Further, communities and civic society are likely to need the ongoing productive engagement of the older population (Morrow-Howell, Hinterlong, and Sherraden, 2001). This article examines the natural and compelling intersections between productive engagement and agingfriendly communities. We use the phrase productive engagement to include activities, whether paid or not, that produce goods and services. These activities include working in the labor force, volunteering for an organization, informal volunteering (mutual aid, helping friends and neighbors), and providing care to relatives or friends of any age (caregiving to dependent relatives, grandparenting). We view these activities as making economic and social contributions to other people and society. In this article, we consider aging-friendly communities as they relate to productive engagement among older adults. We use the definition of an offered by the World Health Organization (WHO) (2007) as a city that adapts its structures and services to be accessible to and inclusive of older people with varying needs and capacities. The WHO identified eight areas of a city that must demonstrate age-friendly characteristics: (1) outdoor spaces and buildings, (2) transportation, (3) housing, (4) social participation, (5) respect and social inclusion, (6) civic participation and employment, (7) communication and information, and (8) community support and health services. Similarly, Scharlach in this issue defines an aging-friendly community as having three primary characteristics: (1) age is not a significant barrier to the maintenance of lifelong interests and activities; (2) supports and accommodations exist to enable individuals with age-related disabilities to meet basic health and social needs; and (3) opportunities exist for older adults to develop new sources of fulfillment and engagement. The WHO definition contains direct statements about civic engagement and employment, and Scharlach clearly addresses work and volunteering in reference to maintenance of lifelong interests and opportunities to develop new sources of engagement. Many definitions of aging-friendly communities found in the literature have direct and indirect statements about participation or engagement, but fewer refer specifically to employment, volunteering, or civic engagement. However, almost universally, the definitions refer to infrastructures, attitudes, and facilitators that are necessary to ensure the participation of older adults in productive activities. Importance of Work and Volunteering Although informal volunteering and caregiving are extremely important productive activities, the focus of this article is on work and formal volunteering. Rising unemployment rates are creating great uncertainty about future labor-force needs, yet it is certain that older adults will need to work longer to meet their own financial requirements, especially given the decline in retirement savings and investments (Leland and Uchitelle, 2008). The nonprofit and government sectors will continue to need older adults as volunteers, as they are the backbone of civic activities in education, healthcare, nonprofits, and governmental agencies (Hager and Brudney, 2004). The current economic situation only fuels the need for a more involved citizenry to meet economic and social needs of communities. A growing body of research demonstrates that work and volunteering are beneficial for individuals, families, employers, and communities. …

Ernest Gonzales

Nancy Morrow-Howell

Productive Engagement in Aging-Friendly Communities

老龄化友好社区中的积极参与

Abstract In early modern England generation was often understood as a unit of historical chronology. This chapter examines the triangular relationship between religious controversies, the arts of history, and the sciences of time. It delineates the development of official and alternative narratives of the Reformation before considering when and why contemporaries came to think of this as a past event rather than an ongoing and unfinished process. Through an investigation of calendars, almanacs, and chronologies, it explores the naming and dating of the Reformation. It assesses how senses of religious rupture contributed to creating enduring models of periodization and engages with influential claims about the transformation of historiography and regimes of temporality in this era. A further theme is the intertwining of senses of historical and liturgical time with the rhythms of biological reproduction and the life cycle. The chapter traces the manner in which public memory of the English Reformations became entangled with family history and genealogy in printed and manuscript texts and material objects.

Alexandra Walsham

History and Time

历史与时间

Abstract This chapter argues that consciousness of being part of a historical or chosen generation was one of the by-products of the English Reformations. It examines the implications of the biblical language of generations and seed in early modern thinking and investigates what this reveals about senses of group identity derived from a shared location in time. It explores the various ways in which religious change engendered senses of belonging to a particular cohort bound by common experiences and transformed how people understood their relationships with their ancestors and descendants. It demonstrates that generational awareness was a mode of subjectivity intimately connected with the workings of memory, but that it also gave expression to collective hopes and dreams about the future, especially in the mid-seventeenth century, when the concept of ‘generation work’ became prominent in contemporary discourse. The chapter also examines the pressing questions that devout people from all denominations faced about the spiritual fate of their dead relatives and about how to ensure the salvation of their children and heirs. It traces these dilemmas and debates across the Atlantic to New England, where the appealing notion that election was in some sense a birthright found expression in the Half-Way Covenant.

Generations and Seed

世代与种子

Abstract This chapter focuses on ancestry and genealogy. It explores the neglected connections between contemporary fascination with questions of lineage, blood, birth, and descent, as manifested in the production of pedigrees, and the religious impulses and upheavals of the era. It argues that the biological and spiritual, dynastic and confessional dimensions of the genealogical craze must be assessed in conjunction with each other. The chapter investigates the interweaving of biblical, secular, and polemical genealogy and demonstrates that genealogical thinking stretched further downwards into English society than has previously been recognized. Attentive to the pervasive influence of theology and Scripture in this society and culture, it also sheds fresh light on contemporary assumptions about sex and original sin; pregnancy, fertility, and childbirth; and race and heredity.

Blood and Trees

血液与树木

Abstract This chapter examines memory and its transmutations over the course of the several generations that experienced England’s plural and contested Reformations. It investigates shifting commemorative practices, including the creation of memorials and monuments to past generations and the spiritual legacies that the dying left to the living. It examines the impulses that led men and women to record the dramatic religious changes they had witnessed and in which they had participated, and the textual and material forms in which they transmitted these recollections to posterity as heirlooms. It explores what people strategically forgot as well as what they selectively remembered; how they retrospectively edited their own life stories as their religious and cultural preoccupations changed over time; and the manner in which events passed out of living memory and entered into the realm of inherited legend. The chapter also evaluates the role of generational transmission in creating the very archives, libraries, and museums through which our own knowledge of the Reformation past is filtered, and the interpretative paradigms that shape how we analyse this period.

Memory and Archive

记忆与档案

Extract It feels as if this book has been a generation in the making. In the period since its first inception, I have accumulated many debts and I am glad to have the opportunity to acknowledge them here. I begin by warmly thanking the electors to the Ford Lectureship in British History at the University of Oxford, who invited me to deliver the lectures in the Hilary Term 2018. The honour of being selected to carry on this distinguished tradition is accompanied by a particularly daunting sense of responsibility. I was filled with trepidation as I mounted the marble steps to the cavernous South Schools each Friday afternoon, but I found a warm, loyal, and receptive audience. I am grateful to Steve Gunn for being such a gracious host, and to all those who kept coming and saved me from the embarrassment of being moved to a smaller room. Among them were Susan Brigden, Susan Doran, the late John Elliot, Felicity Heal, Clive Holmes, Paulina Kewes, Lyndal Roper, Steve Smith, Andrew Spicer, and Keith Thomas. The members of Oxford’s early modern British history seminar made the lectures the subject of a thought-provoking discussion, from which they have benefited in the process of the revisions that have expanded them into this book. I also thank the Warden and Fellows of All Souls College who welcomed me into their midst during that time as a Visiting Fellow and provided a quiet and leafy retreat in Iffley.

Abbreviation
Journal Impact	0.20
Quartiles(Global)	GERONTOLOGY(Q4)

ISSN	0738-7806, 2694-5126
h-index	40

Publication Information	Publisher: American Society on Aging，Publishing cycle: ，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 1996，Proportion of original research papers: 100.00%，Self Citation Rate:0.00%， Gold OA Rate: 0.00%

Generations

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