Differences Between Communicating With Adults And Pupils

Wednesday, April 6, 2022 6:29:55 AM

Differences Between Communicating With Adults And Pupils



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M-10. Differences between adult and child learners

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Inspectors recognise that most schools will have been unable to implement the curriculum in the usual way during the COVID pandemic. Throughout the inspection, inspectors will seek to understand how the school adapted and prioritised the curriculum from September Where the school is directly deploying tutors to support education recovery from the pandemic, inspectors will consider how their deployment supports the aims of the school curriculum. Use of tutors will be integrated into the evaluation of quality of education and leadership and management and will not be inspected in its own right. Inspectors recognise that there may still be some limited circumstances in which a pupil may need to learn remotely.

Ofsted does not have a preferred model for remote education. Throughout the inspection, inspectors will discuss the decisions that school leaders have taken and how they have implemented them. Where remote education remains in place, inspectors may observe remote teaching and review materials. They may also review completed work and teaching materials. This will be the case regardless of whether remote education is in place at the time of inspection. Given the above, when we refer to the intent, implementation and impact of the curriculum in this handbook, this includes remote education, where it remains in place for some pupils.

Inspectors will consider available external data. However, they will be mindful of the age of this data, especially around statutory assessment and qualifications, when making judgements. Inspectors will not expect or accept internal data from schools either instead of or in addition to published data. Inspectors will seek to understand how school leaders have adapted their school development plans as a result of the COVID pandemic, including the rationale for any new or modified school improvement priorities. Inspectors will consider how school leaders adapted approaches to safeguarding during the pandemic to make sure that:.

Inspectors will discuss how safeguarding arrangements have changed over time due to the pandemic, and how school leaders have made sure that they remain effective. Inspectors will discuss attendance patterns with school leaders to understand how the pandemic specifically affected the individual school. They will want to understand how, in the circumstances, the school ensured the best possible attendance for those pupils eligible to attend in person. Attendance between March and March will not impact on our judgement of the school. Inspectors recognise that the context in which schools operate has changed as a result of the pandemic. Therefore, they will consider the specific context and the steps school leaders have taken to ensure the best possible rates of attendance since the school opened to all pupils in March When forming judgements about personal development, inspectors will seek to understand what took place before the pandemic, what the school has in place currently and what its future plans are.

Inspectors recognise that many elements of personal development that were in place before the pandemic may have been disrupted. Therefore, they will focus on understanding the steps that leaders have taken to offer a wide range of personal development opportunities since the school opened to all pupils in March Inspections will be carried out on site and face-to-face meeting will remain our usual method. This will be agreed with the headteacher at the start of the inspection. To support early years providers and schools during the COVID outbreak, in April the government temporarily disapplied and modified certain elements of the early years foundation stage EYFS statutory framework.

Disapplications end on 31 August We recognise that the disruption to learning caused by the pandemic may have impacted on what children have learned. This could result in some children having a wider than usual range of starting points and gaps in their knowledge. Inspectors will pay close attention to how schools identify and address any of these delays and gaps. When evaluating the quality of early years education, using the judgement criteria set out in paragraphs to , inspectors will consider the extent to which leaders have designed an ambitious and well-sequenced curriculum.

When considering the impact of the curriculum, inspectors will have due regard to any loss of learning the pandemic may have caused. However, inspectors will consider what the school is doing to address any disruption to learning to ensure that children are well prepared for their next stage of education. EYFS assessment arrangements may have been altered as a result of the pandemic. Inspectors will need to understand where providers may have previously relied on the modifications to some of the assessment requirements of the EYFS. They will also check how providers are supporting staff with any additional workload expectations as a result.

Inspectors will also consider how schools adapted approaches to safeguarding during the pandemic to make sure that:. Inspectors will discuss how safeguarding arrangements have changed over time due to the pandemic, and how schools have made sure that they remain effective. The EIF and this handbook set out the statutory basis for school inspections carried out under the Education Act The handbook applies to all schools in England that are to be inspected under section 5 of the Education Act In these cases, we will only inspect the boarding or residential provision.

All schools have a unique reference number URN. Any institution with its own URN that we inspect will receive an inspection report. Ofsted is required to inspect at prescribed intervals all schools to which section 5 applies. For the first routine inspection of schools after 4 May the interval will, instead, be 7 years. We use risk assessment to ensure that our approach to inspection is proportionate, so that we can focus our efforts on where we can have the greatest impact. Risk assessment combines an assessment of each school, with a more in-depth desk-based review of a wider range of available information. We use a broad range of indicators to select schools for inspection. The risk assessment process normally takes place in time for the start of the third school year after the most recent inspection.

We may also carry out unannounced inspections and monitoring visits under section 8 of the Education Act at any time. Between 15 May and 13 November , maintained primary and secondary schools and academies judged to be outstanding in their overall effectiveness at their most recent section 5 inspection were exempt from routine inspections. These schools are now once again subject to routine inspections under section 5. This also applies to academy converter schools that were formerly exempt because the overall effectiveness of their predecessor school was outstanding at its most recent section 5 inspection. All formerly exempt schools must receive an initial inspection under section 5 or section 8 before 1 August However, for that inspection they will not be subject to the risk assessment process set out in the next section.

Those schools that were last inspected under section 5 before September will receive an initial section 5 inspection. Those last inspected under section 5 after this date will receive an initial section 8 inspection. If an initial section 8 inspection indicates that outstanding performance may not have been maintained, we will normally carry out a section 5 inspection within the next academic year or as soon as possible thereafter and, in any event, before 1 August Beyond these initial inspections, future inspections for these schools will take place as set out in the next section.

Some good and outstanding schools will be subject to a full section 5 inspection instead of a section 8 inspection. This will happen, for example, if a school has undergone significant change, such as in its age range, or if there are indications that the quality of provision may have deteriorated significantly. We will select these schools through our risk assessment process except for previously exempt schools, which will be selected according to the process set out in the previous section.

The section 8 handbook explains how these inspections will be carried out. A section 8 inspection will not result in individual graded judgements. It cannot change the overall effectiveness grade of the school. If a section 8 inspection is deemed to be a section 5 inspection, then inspectors will make the full set of graded judgements, using the 4-point grading scale required under section 5. Usually, a section 8 inspection of a good or outstanding school will be followed by a further section 8 inspection after approximately a 4-year interval. However, if there is evidence that a good school has improved towards outstanding or may no longer be good, or that an outstanding school may no longer be outstanding, inspectors will specify that the next inspection is a section 5 inspection, with the full range of graded judgements available.

Our section 8 handbook sets out what is considered by inspectors on a section 8 inspection. For example, we may decide that we should inspect a school earlier than its next scheduled inspection if:. Maintained primary and secondary schools and academies that were judged good or outstanding at their previous section 5 inspection will normally receive an inspection under section 8 approximately every 4 years.

For the first inspection after the pandemic, this period will be extended by up to 6 terms. This is to confirm that the quality of education remains good or outstanding. If we carry one out, HMCI may charge the appropriate authority for its cost. We may use the evidence that inspectors gather during section 5 and section 8 inspections to inform other work, such as national reporting. The Secretary of State designates certain schools as having a religious character.

This is different in schools with a religious character. The first inspection will be within 8 years of the last, rather than the usual 3 to 5. The lead inspector on a section 5 inspection will check the section 48 arrangements. This includes when the next inspection is due and when the last inspection was. They will write about this in the inspection report. Inspectors will familiarise themselves with any issues raised in any section 48 inspection or equivalent held since the last Ofsted inspection. Inspectors will not, however, use that evidence in an Ofsted inspection.

They will do this in the inspection report. The new academy is legally a new school. Inspectors may look at the performance of any predecessor school as part of pre-inspection planning. However, inspectors must take care not to give undue weight to any progress or attainment compared with those of the predecessor. Inspectors will make clear to the new academy the extent to which they have taken account of the performance data from its predecessor school s.

Maintained schools that become academies are normally treated as new schools for inspection purposes and are subject to a section 5 inspection as their first inspection. This will normally take place within 3 years of the new school opening. New converter academies whose predecessor schools were most recently judged good or outstanding are eligible for an inspection under section 8 of the Education Act , as described in the section 8 handbook. Piccadilly Gate Academy converted to become an academy school on 1 September When its predecessor school, Piccadilly Gate Secondary School, was last inspected by Ofsted, it was judged to be good overall. Inspection can take place at any point from 5 school days after the first day pupils attend in the autumn term.

For example, if pupils return to school on a Wednesday, inspection can take place as early as the following Wednesday. The information below confirms our requirements. This is to dispel myths about inspection that can result in unnecessary workload in schools. It is intended to highlight specific practices that we do not require. Ofsted will normally contact the school by telephone to announce the inspection between If the headteacher is unavailable when the notification call is made, we will ask to speak to the most senior member of staff available. Once we have informed the school by telephone that the inspection will take place, we will send confirmation to the school by email.

During the initial notification phone call, the inspection support administrator will check the number of pupils on roll at the school, the governance arrangements for the school and whether the school has any SEND , nursery provision for 2- and 3-year-olds or additional resource provision. The inspection support administrator will then send the school a note setting out key information for leaders to be aware of before inspection. This will include:. The inspection support administrator will also send the school a note requesting that the following information is available to inspectors by 8am the next day, at the formal start of the inspection:.

Once we have informed the school of the inspection, the lead inspector will contact the school by telephone and ask to speak to the headteacher. It may be that both these elements are discussed in a single telephone conversation. Alternatively, they may be carried out as 2 separate conversations with a break in between, as agreed between the lead inspector and the headteacher. Inspectors will hold an introductory telephone conversation with school leaders on the day before the inspection begins.

Inspection experience shows that this helps both leaders and inspectors build stronger professional relationships. This conversation will normally last up to 90 minutes. It will help inspectors and school leaders to establish a rapport before inspection and give them a shared understanding of the starting point of the inspection. Our experience from implementing the new framework shows that this is the part of preparation that school leaders and inspectors often find to be the most helpful and constructive.

The lead inspector will also use the discussion to establish whether the school has any pupils who attend off-site alternative provision, either full time or part time, run either by the school or in partnership with other schools. If the school uses off-site alternative provision, the lead inspector will request further details about this. The lead inspector will also request that the school provides certain information as early as possible to aid preparation. It is important that inspectors speak to those responsible for leadership and governance during inspection.

Since schools, and especially MATs , operate a wide variety of leadership and governance models, it is essential that inspectors establish who is responsible for leadership and governance. The lead inspector should be guided by the school here as to who they need to meet in the structure of a MAT. In addition to the information requested from the school, inspectors will review and consider:.

If the school has a SEND resource base delegated to it or the local authority maintains direct responsibility for the period when the pupils in the provision are in mainstream classes at the school being inspected, the resource base must be inspected. Inspectors must consider evidence about the resourced provision when making judgements about the school overall. If the specialist provision is for deaf pupils, it is important to establish, if British Sign Language is used, whether a British Sign Language interpreter will be provided by the school when inspectors are meeting with the pupils. The lead inspector will contact the inspection support administrator as soon as possible if this support is needed.

Details will be available in the team room. A school may request a deferral of its inspection. It may make a request to the inspection support administrator when it is notified of the inspection, or to the lead inspector on the day it is notified of the inspection. We will not normally consider deferrals if we receive them after 4. The inspection support administrator or lead inspector must immediately contact the regional duty desk. We will decide whether this should be granted in accordance with our deferral policy.

Normally, if the school is providing education to pupils, an inspection will go ahead. In exceptional circumstances, however, an inspection might be cancelled or deferred after the school has been notified, following a request made by the school. We will aim to let the school know whether a request is granted on the same day it is made, but in some cases particularly when the request for deferral comes later , this may happen by 8am the next morning. If a school is within 6 months of confirmed closure, [footnote 34] but the school does not request a cancellation when the inspector makes contact, the inspection support administrator will call the regional duty desk to highlight this and get advice about whether the inspection should still be carried out.

Decisions will be made case by case. We may carry out inspections without notice. In these cases, the inspector will make the initial call simply to inform the school that the inspection is about to begin and will leave all other arrangements until arriving at the school. When a school is notified of a section 5 inspection, it is required to take such steps as are reasonably practicable to notify all registered parents of registered pupils [footnote 36] at the school, including those who have been excluded, attend alternative provision or are away from school.

Schools are also required to notify relevant bodies, including providers of alternative provision. Inspectors have a statutory duty to have regard of the views of parents and other relevant persons at the point of a section 5 inspection. It also explains how to use Ofsted Parent View and how parents can contact inspectors. Schools will encourage parents to complete the Ofsted Parent View questionnaire by placing a link to it on their website. In addition, inspectors will encourage the school to notify parents using its own electronic systems such as text messages , if these are available.

Inspectors will review the evidence from Ofsted Parent View throughout the inspection to ensure that all online responses received during the inspection are taken into account. Inspectors will also take into account any other evidence from parents, including the results of any past surveys the school has carried out or commissioned. If individual parents raise serious issues, inspectors will follow these up with the school and record its response. The views of pupils and staff in schools are gathered through online questionnaires.

The inspection support administrator sends online links to the school with the formal notification of inspection. The school is asked to encourage staff and pupils to complete the online questionnaires, apart from those pupils in any boarding provision, whose views will have already been sought through the point-in-time survey. Pupils and staff should complete their questionnaires by 3pm on the first day of the inspection. As well as through online questionnaires, inspectors may gather evidence from parents or other stakeholders in person. These meetings must take place without the presence of the headteacher or senior staff. In drawing on evidence from these meetings, every attempt must be made to protect the identity of individuals.

There may be circumstances, however, in which it is not possible to guarantee the anonymity of the interviewee. Inspections do not normally last longer than 2 days. The size of the inspection team will vary according to the size and nature of the school. Inspectors will make sure that they communicate with each other before and during the inspections. They will also share evidence electronically. Inspectors will ensure that they give sufficient consideration to the emerging judgements of the linked provision.

The inspection of boarding or residential provision in a school is carried out by one or more social care regulatory inspectors. Contact between the education and social care regulatory inspectors will take place before the inspection. Guidance on pre-inspection activity for integrated inspections is set out in the social care common inspection framework SCCIF : boarding schools and residential special schools. Inspectors will evaluate evidence of the impact of the curriculum, including on the most disadvantaged pupils. This includes pupils with SEND. In addition, it includes children in need of help and protection, receiving statutory local authority support from a social worker.

Inspectors will give specific attention to the acquisition of knowledge and skills in lessons and on-site separate provision and evidence of learning in off-site alternative provision. Ofsted does not advocate that any particular approach should be used exclusively in teaching. Different approaches to teaching can be effective. What is appropriate will depend on the aims of a particular lesson or activity, and its place in the sequence of teaching a particular topic. Nevertheless, any approach used has features that must be present to ensure that it is delivered effectively. Our research commentary sets out our understanding of those factors.

When the lead inspector requests a copy of the current staff list, they must ask whether this includes:. In doing so, inspectors should take into account the fact that ECTs have less experience than other teachers, but must assess the effectiveness of the support and professional development put in place for ECTs , to ensure that ECTs have the knowledge and skills necessary to teach in their chosen subject or phase. This must include the quality of mentoring and what the school has done to support their development in areas for improvement identified by initial teacher training providers. Inspectors must meet with mentors and where possible, the induction tutor. Inspectors will meet any trainees employed by the school on the School Direct salaried route to assess their support, mentoring and induction.

Inspectors will not observe lessons given by trainees. This EIF seeks to put a single, joined-up educational conversation at the heart of inspection. Inspectors ask about what leaders intend pupils to learn. What are the end points they wish them to reach, what are the key concepts that they need to understand, and in what order will they learn them? Inspectors will then draw all this evidence together from different pupils, classes and year groups. The crucial element here is the connection between different pieces of evidence. Inspectors will not emphasise one specific type of evidence above all others. Instead, inspectors will focus on gathering evidence that is balanced and connected.

Our research on work scrutiny and lesson visits has shown that having a variety of types of connected evidence strengthens the conclusions that inspectors are able to reach. This evidence will always lead inspectors back to the overall quality of education on offer. The focus will not be on one particular lesson, book or pupil. Rather, the focus will be on the interconnection of all of these pieces of evidence and what they tell inspectors and leaders about whether pupils are learning the curriculum and making progress in the sense of knowing more, remembering more and being able to do more.

One element of the inspection will be visits to lessons. The lead inspector will invite the headteacher, curriculum leaders and other leaders to take part in joint visits to lessons. Inspectors will not take a random sample of lessons to visit. Instead, they will connect lesson visits to other evidence, such as discussions with curriculum leaders, teachers and pupils, and work scrutiny. Inspectors will visit several lessons in which the same subject is being taught, wherever possible, including lessons to different year groups. Lesson visits are not about evaluating individual teachers or their teaching; there will be no grading of the teaching observed by inspectors.

This will then provide part of the evidence for an overall view of quality of education or behaviour and attitudes. In summary, lesson visits are primarily useful for gathering evidence about how lessons contribute to the quality of education. Inspectors can use these visits to gather evidence about how well the curriculum is implemented. This evidence will complement the other evidence that inspectors gather about behaviour during inspection. Inspectors will not evaluate individual workbooks or teachers. Inspectors will connect work scrutiny to lesson visits and, where at all possible, conversations with pupils and staff. Inspectors can use work scrutiny to contribute to an evaluation of whether the work that pupils do over time reflects the intended curriculum.

Work scrutiny will help inspectors to form a view of whether pupils know more and can do more, and whether the knowledge and skills they have learned are well sequenced and have developed incrementally. Inspectors will synthesise what they find in order to contribute to their overall assessment of the quality of education across a faculty, department, subject, key stage or year group. Inspectors will ensure that they talk to and observe pupils in a range of situations outside normal lessons to evaluate other aspects of personal development, behaviour and attitudes, for example:.

Inspectors will take advantage of opportunities to gather evidence from a wide range of pupils, both formally and informally. Inspectors will ensure that all questions are appropriate. They would not expect any adult to be present. During the inspection, it is important that pupils are able to express their views freely to inspectors. Therefore, inspectors must have the opportunity to speak to pupils with no other adults present. This is particularly important when inspectors ask pupils questions around safeguarding. Inspectors will also try to ensure that they speak to at least some single-sex pupil groups to provide the opportunity for pupils to speak more freely about issues such as sexual harassment, online sexual abuse and sexual violence.

In a maintained school or standalone academy, this will usually include maintained school governors or academy trustees and sponsors including sponsor representatives, where they exist. In a school that is part of a MAT , the board of trustees is the governance body. Often, local governing bodies can appear responsible for governance, when in reality it is trustees who are accountable for the academy trust. Local governing bodies are committees to which trustees have often chosen to delegate some specific responsibilities, but in some cases they may act purely as advisory bodies and engage with the community. Inspectors will therefore need to be careful to establish who has overall responsibility for governance. Inspectors will also ensure that meetings are with those who are directly responsible for exercising governance of the school and for overseeing its performance.

As with the meetings between inspectors and pupils, parents and staff, meetings or telephone discussions with those responsible for governance should take place without the headteacher or other senior staff being present. The inspection team will meet at different points during the course of the inspection. In particular, the team should:. The lead inspector will invite the headteacher to the final team meeting at the end of day 2. It is important that the lead inspector makes it clear that observers who are invited to attend the final team meeting are there to listen to the scrutiny of evidence and agreed judgements made by the inspection team.

As appropriate, the lead inspector may request that observers clarify key points during the meeting. In a MAT , the headteacher or equivalent may report to a CEO or equivalent who is, in turn, accountable to the board of trustees. The CEO is part of the executive staff and may be a trustee. They should be invited to the final meeting or be allowed to send a delegate. If, by the end of day 1 or during day 2, there is evidence that the school might be judged as inadequate or requires improvement, the lead inspector will alert the headteacher to this possibility. The inspector must emphasise that they do not make final judgements until the final team meeting at the end of day 2.

Inspection activity, including lesson visits, will continue during day 2. The team will also ensure that time is set aside to prepare for the final team meeting and the final feedback. During the final team meeting, an evaluation card will be completed. The main points for feedback to the school will be recorded as the meeting progresses. The on-site inspection ends with a final feedback meeting with the school. Those connected with the school who may attend include:. Due to the diverse nature of school governance, in some schools a single individual may have more than one of the above roles.

During this meeting, the lead inspector will ensure that the headteacher, those responsible for governance and all attendees are clear:. The lead inspector must give sufficient detail to enable all attendees to understand how judgements have been reached and for those responsible for the governance of the school to play a part in beginning to plan how to tackle any areas for improvement. They may be shared with all those responsible for the governance of the school, irrespective of whether they attended the meeting, so long as they are clearly marked as provisional, confidential and subject to quality assurance.

Information about the inspection outcomes should be shared more widely only when the school receives a copy of the final inspection report. Regulations state that a maintained school that has been judged to require special measures may not appoint ECTs unless HMCI has given permission in writing. When the lead inspector has informed a maintained school that it may not appoint ECTs , the school must seek approval if it later wishes to appoint ECTs , by writing to the relevant Ofsted regional director, giving supporting reasons. The restriction on appointing ECTs does not extend to trainee teachers who joined employment-based training programmes at the school prior to the notice. A school that is judged as requires improvement overall effectiveness grade 3 is a school that is not good but overall provides an acceptable standard of education.

The judgement of requires improvement is not a formal category of concern, but the school may be subject to monitoring by Ofsted. This will not normally apply to a school that has been judged as requires improvement for the first time. We will inspect the school again under section 5, usually within 30 months of the publication of the previous section 5 report. If, at the next section 5 inspection, the school has not demonstrated that it has improved to good, the lead inspector will need to consider whether the school continues to require improvement or may be inadequate.

If the school has demonstrated improvement in some areas and there is a general upward trend, but key aspects of performance remain less than good, the school may be judged as requires improvement again. In that case, there will normally be monitoring before another section 5 inspection takes place within 30 months of the publication of the previous section 5 report for the first inspection after the pandemic, this period will be extended by up to 6 terms. These considerations will be made at each section 5 re-inspection of a school that was previously judged as requires improvement. Schools whose overall effectiveness is judged to be inadequate grade 4 will be deemed to be in a formal category of concern.

The lead inspector will be asked for their name and the name and URN of the school. In this call, the lead inspector must talk through the evidence used by inspector s in reaching an emerging provisional judgement of inadequate. The overall effectiveness judgement is not confirmed at this point. The lead inspector must record the main points of the conversation on an evidence form. During the second day of the inspection, the lead inspector may contact the regional duty desk again to discuss emerging findings. If the inspection team has made the provisional judgement that the school is inadequate and has serious weaknesses or requires special measures, the lead inspector must telephone the regional duty desk before the final oral feedback meeting with the school.

The lead inspector will be prepared to explain briefly the reasons and underpinning evidence for the inadequate judgement. If inspectors judge that the evidence shows that the overall effectiveness of the school is inadequate, they must consider whether the school is failing to give its pupils an acceptable standard of education. Inspectors must then consider whether leaders, managers and governors are demonstrating the capacity to improve the school. If inspectors find that the school is failing to give its pupils an acceptable standard of education and find that leaders, managers and governors are not demonstrating the capacity to improve the school, then they must find that school requires special measures.

In any case, where inspectors find that leaders, managers and governors are not demonstrating the capacity to improve the school, the leadership and management will be judged inadequate. If inspectors consider that the evidence shows that the overall effectiveness of the school is inadequate, but do not find that the school requires special measures in line with the above paragraph, they will instead judge the school to have serious weaknesses. If a school is provisionally judged to require special measures or to have serious weaknesses, inspectors must use the following words during the final feedback to the school, indicating that the overall effectiveness judgement is subject to moderation by HMIs and, in the case of special measures, agreement by HMCI.

If a school is judged to be causing concern, the timescale for publishing the report is extended so that the school can make comments on the inspection judgements. Rates are higher among women and blacks. Rates are highest for women over Coronary disease and stroke are higher among older men than women. The incidence of stroke is lower than that of coronary disease, but it is the No. While arthritis can affect children, it is predominantly a disease of the elderly. Arthritis is more common in women than men at all ages and affects all races, ethnic groups and cultures.

With an aging population, this number is expected to increase. Arthritis is a term often used to mean any disorder that affects joints. Symptoms generally include joint pain and stiffness. Other symptoms may include redness, warmth, swelling, and decreased range of motion of the affected joints. In some types of arthritis, other organs are also affected. Onset can be gradual or sudden. There are over types of arthritis. The most common forms are osteoarthritis degenerative joint disease and rheumatoid arthritis. Osteoarthritis usually increases in frequency with age and affects the fingers, knees, and hips. Rheumatoid arthritis is an autoimmune disorder that often affects the hands and feet.

Other types include gout, lupus, fibromyalgia, and septic arthritis. They are all types of rheumatic disease. Treatment may include resting the joint and alternating between applying ice and heat. Weight loss and exercise may also be useful. Pain medications such as ibuprofen and paracetamol acetaminophen may be used. In some a joint replacement may be useful. Type 2 diabetes T2D , formerly known as adult-onset diabetes, is a form of diabetes characterized by high blood sugar, insulin resistance, and a relative lack of insulin.

Common symptoms include increased thirst, frequent urination, and unexplained weight loss. Symptoms may also include increased hunger, feeling tired, and sores that do not heal. Often symptoms come on slowly. Long-term complications from high blood sugar include heart disease, strokes, diabetic retinopathy which can result in blindness, kidney failure, and poor blood flow in the limbs which may lead to amputations. Type 2 diabetes primarily occurs as a result of obesity and lack of exercise. Some people are more genetically at risk than others. In type 1 diabetes there is a lower total level of insulin to control blood glucose, due to an autoimmune induced loss of insulin-producing beta cells in the pancreas.

Diagnosis of diabetes is by blood tests such as fasting plasma glucose, oral glucose tolerance test, or glycated hemoglobin A1C. Type 2 diabetes is partly preventable by staying a normal weight, exercising regularly, and eating properly. Treatment involves exercise and dietary changes. If blood sugar levels are not adequately lowered, the medication metformin is typically recommended. Many people may eventually also require insulin injections.

In those on insulin, routinely checking blood sugar levels is advised; however, this may not be needed in those taking pills. Bariatric surgery often improves diabetes in those who are obese. Rates of type 2 diabetes have increased markedly since in parallel with obesity. As of , there were approximately million people diagnosed with the disease compared to around 30 million in Typically it begins in middle or older age, although rates of type 2 diabetes are increasing in young people. Type 2 diabetes is associated with a ten-year-shorter life expectancy.

It is defined as having a bone density of 2. Osteoporosis increases with age as bones become brittle and lose minerals. It is the most common reason for a broken bone among the elderly. Osteoporosis becomes more common with age. In the United States in , about eight million women and one to two million men had osteoporosis. White and Asian people are at greater risk are more likely to have osteoporosis than non-Hispanic blacks. Early in the disease, the most obvious symptoms are shaking, rigidity, slowness of movement, and difficulty with walking, but thinking and behavioral problems may also occur. Dementia becomes common in the advanced stages of the disease, and depression and anxiety also occur in more than a third of people with PD. Those with a family member affected are more likely to get the disease themselves.

There is also an increased risk in people exposed to certain pesticides and among those who have had prior head injuries, while there is a reduced risk in tobacco smokers though smokers are at a substantially greater risk of stroke and those who drink coffee or tea. The motor symptoms of the disease result from the death of cells in the substantia nigra, a region of the midbrain, which results in not enough dopamine in these areas. The reason for this cell death is poorly understood but involves the build-up of proteins into Lewy bodies in the neurons. In , PD affected 6. Males are more often affected than females at a ratio of around The average life expectancy following diagnosis is between 7 and 14 years. There are a number of attempts to explain why we age and many factors that contribute to aging.

As well as controlling muscles and joints, the PNS sends all the information from the senses back to the brain. The generalized slowing hypothesis theory suggests that processing in all parts of the nervous system, including the brain, are less efficient with age. This may be why older people have more accidents. Genetics, diet, lifestyle, activity, and exposure to pollutants all play a role in the aging process. Cells divide a limited number of times and then stop. This phenomenon, known as the Hayflick limit , is evidenced in cells studied in test tubes which divide about 50 times before becoming senescent. In , Dr. According to telomere theory, telomeres have experimentally been shown to shorten with each successive cell division Jin, Senescent cells do not die.

They simply stop replicating. Senescent cells can help limit the growth of other cells which may reduce the risk of developing tumors when younger, but can alter genes later in life and result in promoting the growth of tumors as we age Dollemore, Limited cell growth is attributed to telomeres which are the tips of the protective coating around chromosomes. Each time cells replicate, the telomere is shortened. Eventually, loss of telomere length is thought to create damage to chromosomes and produce cell senescence.

The free radical theory of aging FRTA states that organisms age because cells accumulate free radical damage over time. A free radical is any atom or moleculewhich has a single unpaired electron in an outer shell. This means that as oxygen is metabolized, mitochondria in the cells convert the oxygen to adenosine triphosphate ATP which provides energy to the cell. Unpaired electrons are a byproduct of this process and these unstable electrons cause cellular damage as they find other electrons with which to bond. These free radicals have some benefits and are used by the immune system to destroy bacteria. However, cellular damage accumulates and eventually reduces the functioning of organs and systems. Many food products and vitamin supplements are promoted as age-reducing.

Antioxidant drugs have been shown to increase the longevity in nematodes small worms , but the ability to slow the aging process by introducing antioxidants in the diet is still controversial. This theory focuses on the role blood sugar, or glucose plays in the aging of cells. Glucose molecules attach themselves to proteins and form chains or crosslinks. These crosslinks reduce the flexibility of tissue and thus it becomes stiff and loses functioning. The circulatory system becomes less efficient as the tissue of the heart, arteries and lungs lose flexibility.

Joints grow stiff as glucose combines with collagen. Through the normal growth and aging process, DNA is damaged by environmental factors such as toxic agents, pollutants, and sun exposure Dollemore, This results in deletions of genetic material, and mutations in the DNA duplicated in new cells. The accumulation of these errors results in reduced functioning in cells and tissues. These theories promote the view that the cells of the body can only duplicate a certain number of times and that the genetic instructions for running the body can be read only a certain number of times before they become illegible.

As we age, B-lymphocytes and T-lymphocytes become less active. These cells are crucial to the immune system as they secrete antibodies and directly attack infected cells. The thymus, where T-cells are manufactured, shrinks as aging progresses. There are numerous stereotypes regarding older adults as being forgetful and confused, but what does the research on memory and cognition in late adulthood actually reveal?

Aging may create small decrements in the sensitivity of the senses. And, to the extent that a person has a more difficult time hearing or seeing, that information will not be stored in memory. This is an important point, because many older people assume that if they cannot remember something, it is because their memory is poor. In fact, it may be that the information was never seen or heard. Older people have more difficulty using memory strategies to recall details Berk, Working memory is a cognitive system with a limited capacity responsible for temporarily holding information available for processing.

As we age, the working memory loses some of its capacity. This makes it more difficult to concentrate on more than one thing at a time or to remember details of an event. However, people often compensate for this by writing down information and avoiding situations where there is too much going on at once to focus on a particular cognitive task. When an elderly person demonstrates difficulty with multi-step verbal information presented quickly, the person is exhibiting problems with working memory.

Working memory is among the cognitive functions most sensitive to decline in old age. Several explanations have been offered for this decline in memory functioning; one is the processing speed theory of cognitive aging by Tim Salthouse. Drawing on the findings of the general slowing of cognitive processes as people grow older, Salthouse argues that slower processing causes working-memory contents to decay, thus reducing effective capacity.

For example, if an elderly person is watching a complicated action movie, they may not process the events quickly enough before the scene changes, or they may processing the events of the second scene, which causes them to forget the first scene. The decline of working-memory capacity cannot be entirely attributed to cognitive slowing, however, because capacity declines more in old age than speed. Another proposal is the inhibition hypothesis advanced by Lynn Hasher and Rose Zacks. This theory assumes a general deficit in old age in the ability to inhibit irrelevant information.

Therefore, working memory tends to be cluttered with irrelevant content which reduces the effective capacity for relevant content. The assumption of an inhibition deficit in old age has received much empirical support but, so far, it is not clear whether the decline in inhibitory ability fully explains the decline of working-memory capacity. An explanation on the neural level of the decline of working memory and other cognitive functions in old age was been proposed by Robert West Age-related decline in working memory can be briefly reversed using low intensity transcranial stimulation, synchronizing rhythms in bilateral frontal, and left temporal lobe areas.

Long-term memory involves the storage of information for long periods of time. Retrieving such information depends on how well it was learned in the first place rather than how long it has been stored. If information is stored effectively, an older person may remember facts, events, names and other types of information stored in long-term memory throughout life. The memory of adults of all ages seems to be similar when they are asked to recall names of teachers or classmates. And older adults remember more about their early adulthood and adolescence than about middle adulthood Berk, Older adults retain semantic memory or the ability to remember vocabulary.

Younger adults rely more on mental rehearsal strategies to store and retrieve information. Older adults focus rely more on external cues such as familiarity and context to recall information Berk, A positive attitude about being able to learn and remember plays an important role in memory. When people are under stress perhaps feeling stressed about memory loss , they have a more difficult time taking in information because they are preoccupied with anxieties. Many of the laboratory memory tests require comparing the performance of older and younger adults on timed memory tests in which older adults do not perform as well. However, few real-life situations require speedy responses to memory tasks. Older adults rely on more meaningful cues to remember facts and events without any impairment to everyday living.

Can the brain be trained in order to build a cognitive reserve to reduce the effects of normal aging? These mental workouts improved cognitive functioning even 5 years later. Many of the participants believed that this improvement could be seen in everyday tasks as well Tennstedt et al. Learning new things, engaging in activities that are considered challenging, and being physically active at any age may build a reserve to minimize the effects of primary aging of the brain. Wisdom is the ability to use common sense and good judgment in making decisions.

A wise person is insightful and has knowledge that can be used to overcome the obstacles they encounter in their daily lives. Does aging bring wisdom? While living longer brings experience, it does not always bring wisdom. Those who have had experience helping others resolve problems in living and those who have served in leadership positions seem to have more wisdom. So it is age combined with a certain type of experience that brings wisdom.

However, older adults generally have greater emotional wisdom or the ability to empathize with and understand others. Divided attention has usually been associated with significant age-related declines in performing complex tasks. For example, older adults show significant impairments on attentional tasks such as looking at a visual cue at the same time as listening to an auditory cue because it requires dividing or switching of attention among multiple inputs. Deficits found in many tasks, such as the Stroop task which measures selective attention, can be largely attributed to a general slowing of information processing in older adults rather than to selective attention deficits per se.

They also are able to maintain concentration for an extended period of time. In general, older adults are not impaired on tasks that test sustained attention, such as watching a screen for an infrequent beep or symbol. The tasks on which older adults show impairments tend to be those that require flexible control of attention, a cognitive function associated with the frontal lobes. Importantly, these types of tasks appear to improve with training and can be strengthened. One important aspect of daily functioning impacted by attentional problems is driving. This is an activity that, for many older people, is essential to independence.

Driving requires a constant switching of attention in response to environmental contingencies. Attention must be divided between driving, monitoring the environment, and sorting out relevant from irrelevant stimuli in a cluttered visual array. Research has shown that divided attention impairments are significantly associated with increased automobile accidents in older adults. Therefore, practice and extended training on driving simulators under divided attention conditions may be an important remedial activity for older people. Problem-solving tasks that require processing non-meaningful information quickly a kind of task which might be part of a laboratory experiment on mental processes declines with age.

Older adults are able to resolve everyday problems by relying on input from others such as family and friends. They are also less likely than younger adults to delay making decisions on important matters such as medical care Strough et al. It is further specified as a mild or major neurocognitive disorder. Even though this change was made in , the term dementia is still often used by laypersons. Common symptoms of neurocognitive disorders include emotional problems, difficulties with language, and a decrease in motivation. Globally, neurocognitive disorders affected about 46 million people in In , dementia resulted in about 1.

As more people are living longer, dementia is becoming more common in the population as a whole. Dementia generally refers to severely impaired judgment, memory, or problem-solving ability. It can occur before old age and is not an inevitable development even among the very old. Dementia can be caused by numerous diseases and circumstances, all of which result in similar general symptoms of impaired judgment, etc. Malnutrition, alcoholism, depression, and mixing medications can also result in symptoms of dementia.

If these causes are properly identified, they can be treated. Cerebral vascular disease can also reduce cognitive functioning. Delirium , also known as acute confusional state, is an organically caused decline from a previous baseline level of mental function that develops over a short period of time, typically hours to days. It is more common in older adults, but can easily be confused with a number of psychiatric disorders or chronic organic brain syndromes because of many overlapping signs and symptoms in common with dementia, depression, psychosis, etc. Delirium may manifest from a baseline of existing mental illness, baseline intellectual disability, or dementia, without being due to any of these problems.

Delirium is a syndrome encompassing disturbances in attention, consciousness, and cognition. It may also involve other neurological deficits, such as psychomotor disturbances e. Among those requiring critical care, delirium is a risk for death within the next year. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks.

The most common early symptom is difficulty in remembering recent events. As the disease advances, symptoms can include problems w ith language, disorientation including easily getting lost , mood swings, loss of motivation, not managing self-care, and behavioral issues. Other risk factors include a history of head injuries, depression, and hypertension. The disease process is associated with plaques and neurofibrillary tangles in the brain. A probable diagnosis is based on the history of the illness and cognitive testing with medical imaging and blood tests to rule out other possible causes.

Initial symptoms are often mistaken for normal aging, but an examination of brain tissue, specifically of structures called plaques and tangles, is needed for a definite diagnosis. In , there were approximately In developed countries, AD is one of the most financially costly diseases. Our ideas about aging, and what it means to be over 50, over 60, or even over 90, seem to be stuck somewhere back in the middle of the 20th century. We still consider 65 as the standard retirement age, and we expect everyone to start slowing down and moving aside for the next generation as their age passes the half-century mark.

Erikson: Integrity vs. Despair Wisdom. From the mids to the end of life, we are in the period of development known as late adulthood. He said that people in late adulthood reflect on their lives and feel either a sense of satisfaction or a sense of failure. People who feel proud of their accomplishments feel a sense of integrity, and they can look back on their lives with few regrets. However, people who are not successful at this stage may feel as if their life has been wasted. They may face the end of their lives with feelings of bitterness, depression, and despair.

As a person grows older and enters into the retirement years, the pace of life and productivity tend to slow down, granting a person time for reflection upon their life. For he knows that an individual life is the accidental coincidence of but one life cycle within but one segment of history; and that for him all human integrity stands and falls with the one style of integrity of which he partakes. Thus, persons derive a sense of meaning i. Ideally, however, integrity does not stop here but rather continues to evolve into the virtue of wisdom. According to Erikson, this is the goal during this stage of life.

If a person sees their life as unproductive, or feel that they did not accomplish their life goals, they may become dissatisfied with life and develop what Erikson calls despair, often leading to depression and hopelessness. This stage can occur out of the sequence when an individual feels they are near the end of their life such as when receiving a terminal disease diagnosis. Erikson collaborated with his wife, Joan, through much of his work on psychosocial development. In the first eight stages, all of the conflicts are presented in a syntonic-dystonic matter, meaning that the first term listed in the conflict is the positive, sought-after achievement and the second term is the less-desirable goal ie.

During the ninth stage, Erikson argues that the dystonic, or less desirable outcome, comes to take precedence again. For example, an older adult may become mistrustful trust vs. Developed by Havighurst and Albrecht in , activity theory addresses the issue of how persons can best adjust to the changing circumstances of old age—e. In addressing this issue they recommend that older adults involve themselves in voluntary and leisure organizations, child care, and other forms of social interaction. Activity theory thus strongly supports the avoidance of a sedentary lifestyle and considers it essential to health and happiness that the older person remains active physically and socially. Activity theory suggests that many people are barred from meaningful experiences as they age, but older adults who continue to want to remain active can work toward replacing opportunities lost with new ones.

Disengagement theory , developed by Cumming and Henry in the s, in contrast to activity theory, emphasizes that older adults should not be discouraged from following their inclination towards solitude and greater inactivity. In other words, disengagement theory posits that older adults in all societies undergo a process of adjustment which involves leaving their former public and professional roles and narrowing their social horizon to the smaller circle of family and friends. This process enables the older person to die more peacefully, without the stress and distractions that come with a more socially involved life.

The theory suggests that during late adulthood, the individual and society mutually withdraw. Older people become more isolated from others and less concerned or involved with life in general. This once-popular theory is now criticized as being ageist and used in order to justify treating older adults as second class citizens. Continuity theory suggests as people age, they continue to view the self in much the same way as they did when they were younger.

They are the same individuals, but simply in older bodies. Consequently, older adults continue to maintain their identity even as they give up previous roles. For example, a retired Coast Guard commander attends reunions with shipmates, stays interested in new technology for home use, is meticulous in the jobs he does for friends or at church, and displays mementos from his experiences on the ship. He is able to maintain a sense of self as a result. People do not give up who they are as they age. Hopefully, they are able to share these aspects of their identity with others throughout life. Skills developed. Progression of skills.

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