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Doctor at the Desk

Maintain Focus

Looking through the older lens
By: Marc Evans Abat, MD, FPCP, FPCGM article_19

My practice in geriatrics involves seeing senior citizens, 60 years old and up (or even slightly younger patients).  They come from various walks of life, and many have been involved in an assortment of vocational, academic and leisurely pursuits.  At some point, however, they would invariably consult due to the following concerns:

  • Difficulty remembering names (although they know these persons well)
  • Difficulty in multitasking
  • Forgetting appointments
  • Having a harder time following a group discussion
  • Feeling the need to be repetitive in order to assimilate information
  • And in general, having a hard time to focus

Their dominant concern is that they may be having dementia, which is the progressive deterioration of one’s cognitive abilities, leading to declines in behavior and overall functioning.  Dementia comes in several forms, the most common of which is Alzheimer’s disease.  In the United States alone, about 1 in 6 women and 1 in 11 men, of age 65 years and older, will develop Alzheimer’s disease, with the risk getting higher as one grows older.  People are now becoming more aware of dementia and its complications, hence the concern regarding any changes in one’s cognitive abilities.

However, it must be recognized that there are changes that happen as one age that may bring about many challenges regarding memory and other cognitive activities.  In fact, younger persons can also experience these previously mentioned concerns, especially in this hectic and digitally wired age.  These so-called “milestones” are not related to any gross loss in the ability to function or any behavioral disturbances.  It does necessitate some form of adaptation to sustain and improve functioning. 

Older patients appear to be slower in the ability to respond to particular stimulation while disregarding others that are not relevant to a given task (in other words, SELECTIVE attention), although not differently affected by distractions.  For example, older persons may be slower to identify the letter S within a grid containing many number 8s.

The ability to focus attention on 2 different sources and to switch from one source of stimulation to another generally declines in the older person.  Tasks that involve increasing difficulties, a change in skill sets, or need some level of prioritization, are also difficult to focus on.  This difficulty seems to arise from the general over-extension of declining processing resources of the brain that comes with aging.  For example, younger persons may easily read a book while listening to a radio and watching TV at the same time, while an older person can only do 1 or 2 of these.

For tasks needing SUSTAINED attention, older persons seem to have no significant difficulties (e.g. they are able to listen to a lecture and pick up particular points). Working memory is that “space” where information from different sources are actively manipulated, reorganized and integrated.  Tasks that may become more challenging include: 

  • Problem-solving,
  • decision-making and
  • planning of activities. 

The challenges with the working memories of older persons may arise from several changes, including those coming from:

  • attention,
  • information processing speed and
  • changes inhibitory controls over these activities. 

An example of the challenge in dealing with working memory would be when one tries to order several items from the overhead display menu of a fast food chain.

Episodic memory is that which was personally experienced at a particular place and time.  This seems to be the most affected by normal aging and brain damage.  Difficulties with episodic memory may arise from challenges in the initial encoding of the memory, to the consolidation of the memory, or from difficulties with retrieval. 

Procedural memory for highly skilled activities (e.g. riding a bicycle, typing or reading), is acquired through extensive practice.  Generally, older persons are able to acquire these skills and retain them across the life span, with minimal decline (except for the oldest of persons).

Prospective memory is involved for tasks that will be done in the future.  For those that are triggered by an environmental cue (e.g. remembering a doctor’s appointment), older persons seem to have very little difficulties remembering them. However, habitual tasks, like taking medications, there may be some challenges.

Perception difficulties (e.g. the ability to perceive the information) may account also for some of the difficulties with regard to information gathering and processing.  Hearing and visual loss has far-reaching implications on older people and most learn to develop compensatory mechanisms for these deficits.

Given these changes that happen in normal older adults, how can one improve focus?  Several strategies can be employed. 

  • It is important to first accept that as one age, these challenges will occur and there would be a need to adjust or compensate. 
  • Try to slow done and focus on doing your activities step by step, and taking notice of all the associated or concurring events. 
  • Use reminders or cues for an important task or event.
  • There are several groups promoting cognitive training for older adults with the benefit of improvements in reasoning and processing speed. 
  • Current technology, especially games, have been utilized also to improve cognition in the older person. 
  • Try to correct any existing problems with your vision and hearing; you would be surprised with the cognitive improvements gained by correcting these problems. 

Aging comes with many difficulties, especially with your concerns about your cognition.  However, there are also ways to overcome these challenges and there are appropriate ways for you to maintain focus.


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Keywords: age-related, memory decline, geriatrics, Perception difficulties, memory, aging, sustained attention, selective attention, distractions, Alzheimer, Dementia, senior citizens   
  
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