{"id":465957,"date":"2025-12-31T18:10:05","date_gmt":"2025-12-31T17:10:05","guid":{"rendered":"https:\/\/www.dynseo.com\/trisomy-and-aging-anticipating-cognitive-decline-and-senior-support\/"},"modified":"2026-01-05T22:39:43","modified_gmt":"2026-01-05T21:39:43","slug":"trisomy-and-aging-anticipating-cognitive-decline-and-senior-support","status":"publish","type":"post","link":"https:\/\/www.dynseo.com\/en\/trisomy-and-aging-anticipating-cognitive-decline-and-senior-support\/","title":{"rendered":"Trisomy and aging: anticipating cognitive decline and senior support"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; admin_label=&#8221;Article HTML&#8221; _builder_version=&#8221;4.16&#8243;][et_pb_row admin_label=&#8221;Contenu&#8221; _builder_version=&#8221;4.16&#8243;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243;][et_pb_code admin_label=&#8221;HTML import\u00e9&#8221; _builder_version=&#8221;4.16&#8243;]<link 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#ffeca7;border-radius:16px;padding:25px 30px;margin:30px 0;transition:all .3s ease}\n.dynseo-highlight-box:hover{transform:translateY(-3px);box-shadow:0 8px 30px rgba(255,236,167,0.4)}\n.dynseo-highlight-box h4{font-family:'Montserrat',sans-serif;color:#1a1a2e;margin:0 0 12px 0;font-size:1.1rem}\n.dynseo-highlight-box p{margin:0;color:#2c3e50}\n@media(max-width:768px){.dynseo-article h2{font-size:1.5rem}.dynseo-toc ol{grid-template-columns:1fr}.dynseo-feature-grid{grid-template-columns:1fr}}\n<\/style>\n<div class=\"dynseo-article\">\n<div class=\"dynseo-intro\"><pee>title: Down syndrome and aging: anticipating cognitive decline and senior support<\/pee>\n<pee>description: Comprehensive guide on the aging of people with Down syndrome: early aging, Alzheimer&#8217;s risk, cognitive decline, warning signs, prevention, adaptations, and care facilities for seniors with Down syndrome.<\/pee>\n<pee>keywords: aging Down syndrome, Alzheimer&#8217;s Down syndrome, cognitive decline Down syndrome, senior Down syndrome, early aging disability, prevention cognitive decline Down syndrome, senior support Down syndrome<\/pee>\n<pee>[\/META]<\/pee>\n<pee>Down syndrome, aging, Alzheimer&#8217;s, cognitive decline, senior, prevention, support, health<\/pee>\n<pee>[\/TAGS]<\/pee>\n<pee><em>Reading time: 21 minutes<\/em><\/pee>\n<\/a>\n<pee>&#8220;My son is 45 years old, I feel like he is regressing.&#8221; &#8220;She forgets things she used to know how to do.&#8221; &#8220;Is this decline normal?&#8221; &#8220;At what age will they age?&#8221; &#8220;How to prevent Alzheimer&#8217;s?&#8221; &#8220;What to do if there is significant decline?&#8221;<\/pee>\n<pee>The <strong>aging of people with Down syndrome<\/strong> is a complex reality: they age <strong>earlier<\/strong> than the general population (from 40-50 years old), with an <strong>increased risk of Alzheimer&#8217;s disease<\/strong> and cognitive decline. This reality worries families, but by knowing the signs, anticipating, and implementing prevention and support strategies, it is possible to preserve quality of life and autonomy for as long as possible.<\/pee>\n<pee>This guide explains aging in Down syndrome, warning signs, prevention methods, and support solutions for seniors with Down syndrome.<\/pee><\/div>\n<nav class=\"dynseo-toc\">\n<div class=\"toc-title\">\ud83d\udccb Summary<\/div>\n<ol>\n<li style=\"border-left:4px solid #ffeca7\"><a href=\"#section-1\">Table of contents<\/a><\/li>\n<li style=\"border-left:4px solid #e73469\"><a href=\"#section-2\">Understanding aging in Down syndrome {#understanding}<\/a><\/li>\n<li style=\"border-left:4px solid #a9e2e4\"><a href=\"#section-3\">Signs of aging and cognitive decline {#signs}<\/a><\/li>\n<li style=\"border-left:4px solid #5e5ed7\"><a href=\"#section-4\">Prevention and slowing down decline {#prevention}<\/a><\/li>\n<li style=\"border-left:4px solid #5268c9\"><a href=\"#section-5\">Support and adaptations {#support}<\/a><\/li>\n<li style=\"border-left:4px solid #ffeca7\"><a href=\"#section-6\">Structures and solutions for seniors {#structures}<\/a><\/li>\n<li style=\"border-left:4px solid #e73469\"><a href=\"#section-7\">Testimonials<\/a><\/li>\n<li style=\"border-left:4px solid #a9e2e4\"><a href=\"#section-8\">Conclusion: Anticipating for better living<\/a><\/li>\n<\/ol>\n<\/nav>\n<section class=\"dynseo-section\">\n<h2 id=\"section-1\">Table of contents<\/h2>\n<pee>1. <a href=\"#comprendre\" target=\"_blank\">Understanding aging in Down syndrome<\/a><\/pee>\n<pee>2. <a href=\"#signes\" target=\"_blank\">Signs of aging and cognitive decline<\/a><\/pee>\n<pee>3. <a href=\"#prevention\" target=\"_blank\">Prevention and slowing down decline<\/a><\/pee>\n<pee>4. <a href=\"#accompagnement\" target=\"_blank\">Support and adaptations<\/a><\/pee>\n<pee>5. <a href=\"#structures\" target=\"_blank\">Structures and solutions for seniors<\/a><\/pee><\/section>\n<section class=\"dynseo-section\">\n<h2 id=\"section-2\">Understanding aging in Down syndrome {#understanding}<\/h2>\n<h3><strong>Early aging<\/strong><\/h3>\n<pee><strong>People with Down syndrome age faster<\/strong> than the general population.<\/pee>\n<pee><strong>Biological age \u2260 chronological age:<\/strong><\/pee>\n<ul class=\"styled-list\">\n<li>A 50-year-old person with Down syndrome has a <strong>biological age<\/strong> equivalent to 60-70 years.<\/li>\n<pee><strong>Onset of aging<\/strong>: From 40-50 years (vs 60-70 years in the general population).<\/pee>\n<h3><strong>Life expectancy<\/strong><\/h3>\n<pee><strong>Major progress<\/strong>: In the 1980s, life expectancy ~30 years. Today: <strong>60-65 years<\/strong> (or more with good care).<\/pee>\n<pee><strong>But<\/strong>: Still lower than the general population (average 80 years).<\/pee>\n<h3><strong>Causes of early aging<\/strong><\/h3>\n<pee><strong>1. Genetics<\/strong><\/pee>\n<pee><strong>Triple chromosome 21<\/strong>: Overproduction of certain proteins, accelerated oxidative stress, faster cellular aging.<\/pee>\n<pee><strong>2. Cardiovascular health<\/strong><\/pee>\n<pee><strong>Frequent heart problems<\/strong>: Heart fatigue, less effective circulation.<\/pee>\n<pee><strong>3. Weakened immune system<\/strong><\/pee>\n<pee><strong>More frequent infections<\/strong>: Wear and tear on the body.<\/pee>\n<pee><strong>4. Hypothyroidism<\/strong><\/pee>\n<pee><strong>Common in those with Down syndrome<\/strong>, slows metabolism, accelerates aging.<\/pee>\n<h3><strong>Increased risk of Alzheimer&#8217;s disease<\/strong><\/h3>\n<pee><strong>Major fact<\/strong>: People with Down syndrome have a <strong>very high risk<\/strong> of developing Alzheimer&#8217;s disease.<\/pee>\n<pee><strong>Alarming statistics:<\/strong><\/pee>\n<li><strong>50-70% of people with Down syndrome<\/strong> develop Alzheimer&#8217;s after 60 years<\/li>\n<li><strong>Earlier onset<\/strong>: from 40-50 years (vs 65+ in the general population)<\/li>\n<pee><strong>Why?<\/strong><\/pee>\n<pee><strong>Chromosome 21<\/strong> contains the APP gene (precursor of the amyloid protein).<\/pee>\n<pee><strong>Triple dose of this gene<\/strong> \u2192 Accumulation of amyloid plaques in the brain \u2192 Alzheimer&#8217;s.<\/pee>\n<pee><strong>Consequence:<\/strong> Accelerated cognitive decline, loss of autonomy.<\/pee>\n<\/a><\/section>\n<div class=\"section-divider\">\u25c6 \u25c6 \u25c6<\/div>\n<section class=\"dynseo-section\">\n<h2 id=\"section-3\">Signs of aging and cognitive decline {#signs}<\/h2>\n<h3><strong>Physical signs of aging<\/strong><\/h3>\n<pee><strong>From 40-50 years:<\/strong><\/pee>\n<li><strong>White, gray hair<\/strong><\/li>\n<li><strong>More pronounced wrinkles<\/strong><\/li>\n<li><strong>Loss of skin elasticity<\/strong><\/li>\n<li><strong>Decreased vision, hearing<\/strong><\/li>\n<li><strong>Osteoarthritis, joint pain<\/strong><\/li>\n<li><strong>Increased fatigue<\/strong><\/li>\n<li><strong>Motor slowdown<\/strong><\/li>\n<pee><strong>Similar to the general population, but earlier.<\/strong><\/pee>\n<h3><strong>Signs of cognitive decline<\/strong><\/h3>\n<pee><strong>Warning: Do not confuse normal aging with Alzheimer&#8217;s.<\/strong><\/pee>\n<pee><strong>Mild cognitive decline (normal aging):<\/strong><\/pee>\n<li><strong>Occasional forgetfulness<\/strong> (names, dates)<\/li>\n<li><strong>Slower<\/strong> to learn new things<\/li>\n<li><strong>Need more time<\/strong> to complete tasks<\/li>\n<pee><strong>Severe cognitive decline (suspected Alzheimer&#8217;s):<\/strong><\/pee>\n<pee><strong>Memory:<\/strong><\/pee>\n<li><strong>Forget recent events<\/strong> (what he ate for lunch)<\/li>\n<li><strong>Repetitions<\/strong> (asks the same question 10 times)<\/li>\n<li><strong>Gets lost<\/strong> in familiar places<\/li>\n<li><strong>Forgets names<\/strong> of loved ones<\/li>\n<pee><strong>Language:<\/strong><\/pee>\n<li><strong>Difficulty finding words<\/strong> (increased)<\/li>\n<li><strong>Repetitions of phrases<\/strong><\/li>\n<li><strong>Decreased comprehension<\/strong><\/li>\n<pee><strong>Behavior:<\/strong><\/pee>\n<li><strong>Changes in mood<\/strong> (irritability, sadness, apathy)<\/li>\n<li><strong>Lack of interest<\/strong> in usual activities<\/li>\n<li><strong>Restlessness, wandering<\/strong><\/li>\n<li><strong>Sleep disturbances<\/strong><\/li>\n<pee><strong>Autonomy:<\/strong><\/pee>\n<li><strong>Loss of acquired skills<\/strong> (no longer knows how to dress, eat alone)<\/li>\n<li><strong>Incontinence<\/strong><\/li>\n<li><strong>Increased need for help<\/strong><\/li>\n<pee><strong>If multiple signs are present: Urgent medical consultation.<\/strong><\/pee>\n<h3><strong>Diagnosis of Alzheimer&#8217;s in those with Down syndrome<\/strong><\/h3>\n<pee><strong>More difficult<\/strong> to diagnose (baseline cognitive decline, communication difficulties).<\/pee>\n<pee><strong>Tools:<\/strong><\/pee>\n<li><strong>Adapted neuropsychological assessments<\/strong><\/li>\n<li><strong>Brain MRI<\/strong> (atrophy, plaques)<\/li>\n<li><strong>Functional assessment<\/strong> (autonomy)<\/li>\n<pee><strong>Regular follow-up recommended<\/strong> from age 40 (annual).<\/pee>\n<\/a><\/section>\n<section class=\"dynseo-section\">\n<h2 id=\"section-4\">Prevention and slowing down decline {#prevention}<\/h2>\n<h3><strong>1. Regular cognitive stimulation<\/strong><\/h3>\n<pee><strong>The brain = muscle<\/strong>: The more you use it, the less it declines.<\/pee>\n<pee><strong>Activities:<\/strong><\/pee>\n<li><strong>Memory games<\/strong> (Memory, card games)<\/li>\n<li><strong>Puzzles, fitting games<\/strong><\/li>\n<li><strong>Reading<\/strong> (adapted books, pictures)<\/li>\n<li><strong>Discussions, conversations<\/strong> (language stimulation)<\/li>\n<li><strong>Digital applications<\/strong>: JOE<\/li>\n<pee><strong>JOE: The ideal tool to prevent cognitive decline<\/strong><\/pee>\n<pee><strong>Application specially designed<\/strong> for adults (teens and seniors).<\/pee>\n<pee><strong>More than 30 games<\/strong> to stimulate:<\/pee>\n<li>Memory (visual, auditory, working)<\/li>\n<li>Attention, concentration<\/li>\n<li>Logic, reasoning<\/li>\n<li>Language<\/li>\n<li>Mental calculation<\/li>\n<pee><strong>Recommended use:<\/strong> 15-20 min\/day, every day.<\/pee>\n<pee><strong>Studies show<\/strong>: Regular cognitive stimulation = slowing down decline.<\/pee>\n<pee><strong>Discover JOE<\/strong><\/pee>\n<h3><strong>2. Regular physical activity<\/strong><\/h3>\n<pee><strong>Exercise = Alzheimer&#8217;s prevention<\/strong> (scientifically proven).<\/pee>\n<pee><strong>Recommendations:<\/strong><\/pee>\n<li><strong>30 min\/day<\/strong> of moderate activity (walking, swimming, cycling)<\/li>\n<li><strong>Strengthens cardiovascular health<\/strong> (better brain circulation)<\/li>\n<li><strong>Reduces inflammation<\/strong><\/li>\n<pee><strong>Adapt<\/strong> according to abilities (see dedicated article on adapted sports).<\/pee>\n<h3><strong>3. Balanced diet<\/strong><\/h3>\n<pee><strong>Mediterranean diet<\/strong> recommended:<\/pee>\n<li><strong>Fruits, vegetables<\/strong><\/li>\n<li><strong>Fatty fish<\/strong> (omega-3: salmon, sardines)<\/li>\n<li><strong>Olive oil<\/strong><\/li>\n<li><strong>Nuts, almonds<\/strong><\/li>\n<li><strong>Limit sugars, saturated fats<\/strong><\/li>\n<pee><strong>Hydration<\/strong>: Drink 1.5L water\/day.<\/pee>\n<h3><strong>4. Quality sleep<\/strong><\/h3>\n<pee><strong>Sleep = brain cleaning<\/strong> (elimination of waste, including amyloid protein).<\/pee>\n<pee><strong>Recommendations:<\/strong><\/pee>\n<li><strong>7-9h\/night<\/strong><\/li>\n<li><strong>Routine<\/strong> (regular hours)<\/li>\n<li><strong>Calm, dark environment<\/strong><\/li>\n<pee><strong>If sleep disturbances<\/strong>: Consult (sleep apnea frequent in those with Down syndrome).<\/pee>\n<h3><strong>5. Active social life<\/strong><\/h3>\n<pee><strong>Isolation = Alzheimer&#8217;s risk factor.<\/strong><\/pee>\n<pee><strong>Maintain social ties<\/strong>:<\/pee>\n<li>Club, community activities<\/li>\n<li>See family, friends<\/li>\n<li>Outings, leisure<\/li>\n<pee><strong>Social stimulation = cognitive stimulation.<\/strong><\/pee>\n<h3><strong>6. Regular medical follow-up<\/strong><\/h3>\n<pee><strong>Annual screening<\/strong>:<\/pee>\n<li>Cognitive assessment<\/li>\n<li>Thyroid check (frequent hypothyroidism, a factor in decline)<\/li>\n<li>Cardiovascular check<\/li>\n<li>Vision, hearing<\/li>\n<pee><strong>Quickly treat<\/strong> any pathology (infections, deficiencies).<\/pee><\/section>\n<div class=\"section-divider\">\u25c6 \u25c6 \u25c6<\/div>\n<section class=\"dynseo-section\">\n<h2 id=\"section-5\">Support and adaptations {#support}<\/h2>\n<h3><strong>If mild cognitive decline<\/strong><\/h3>\n<pee><strong>1. Maintain usual activities<\/strong><\/pee>\n<pee><strong>Do not overprotect<\/strong>: Let them do things alone (with discreet supervision).<\/pee>\n<pee><strong>Structured routine<\/strong>: Provides reassurance, compensates for forgetfulness.<\/pee>\n<pee><strong>2. Memory aids<\/strong><\/pee>\n<pee><strong>Visual calendar<\/strong>, to-do list, reminders (phone, alarms).<\/pee>\n<pee><strong>3. Simplification<\/strong><\/pee>\n<pee><strong>Tasks in simple steps<\/strong>, short instructions.<\/pee>\n<pee><strong>4. Patience<\/strong><\/pee>\n<pee><strong>More time<\/strong> to complete tasks.<\/pee>\n<pee><strong>No pressure.<\/strong><\/pee>\n<h3><strong>If severe cognitive decline (Alzheimer&#8217;s)<\/strong><\/h3>\n<pee><strong>1. Medical treatment<\/strong><\/pee>\n<pee><strong>Medications<\/strong> (acetylcholinesterase inhibitors) can slow progression (neurologist consultation).<\/pee>\n<pee><strong>2. Increased supervision<\/strong><\/pee>\n<pee><strong>Risk of wandering<\/strong>, falls, accidents.<\/pee>\n<pee><strong>Secure home environment<\/strong> (locks, alarms).<\/pee>\n<pee><strong>3. Enhanced human support<\/strong><\/pee>\n<pee><strong>Home aide<\/strong>, day care.<\/pee>\n<pee><strong>If significant loss of autonomy<\/strong>: Consider adapted accommodation (nursing home, specialized facility).<\/pee>\n<pee><strong>4. Adapted communication<\/strong><\/pee>\n<pee><strong>Short, simple sentences<\/strong>, repeat if necessary.<\/pee>\n<pee><strong>Eye contact<\/strong>, gestures.<\/pee>\n<pee><strong>Encourage<\/strong>, reassure.<\/pee>\n<pee><strong>5. Maintain stimulation (adapted)<\/strong><\/pee>\n<pee><strong>Even with Alzheimer&#8217;s<\/strong>: Continue gentle stimulation (music, photos, caresses, walks).<\/pee>\n<pee><strong>JOE at an adapted level<\/strong> (simpler games).<\/pee><\/section>\n<section class=\"dynseo-section\">\n<h2 id=\"section-6\">Structures and solutions for seniors {#structures}<\/h2>\n<h3><strong>Home care<\/strong><\/h3>\n<pee><strong>If sufficient autonomy, prefer home<\/strong> (familiarity, comfort).<\/pee>\n<pee><strong>Supports:<\/strong><\/pee>\n<li><strong>SSIAD<\/strong> (Home Nursing Service)<\/li>\n<li><strong>Home aide<\/strong> (PCH, APA)<\/li>\n<li><strong>Meal delivery<\/strong><\/li>\n<li><strong>Teleassistance<\/strong><\/li>\n<h3><strong>Day care<\/strong><\/h3>\n<pee><strong>During the day<\/strong> in a facility (activities, meals, care), <strong>return home in the evening<\/strong>.<\/pee>\n<pee><strong>Benefits:<\/strong><\/pee>\n<li>Socialization<\/li>\n<li>Stimulation<\/li>\n<li>Respite for caregivers<\/li>\n<pee><strong>Structures:<\/strong><\/pee>\n<li>Day care for disabilities<\/li>\n<li>Day care for Alzheimer&#8217;s (some accept those with Down syndrome)<\/li>\n<h3><strong>Adapted accommodation<\/strong><\/h3>\n<pee><strong>If significant loss of autonomy, need for constant care:<\/strong><\/pee>\n<pee><strong>1. FAM (Medicalized Reception Center)<\/strong><\/pee>\n<pee>For aging disabled individuals, needing care.<\/pee>\n<pee><strong>2. MAS (Specialized Reception House)<\/strong><\/pee>\n<pee>For severe disabilities.<\/pee>\n<pee><strong>3. EHPAD (Accommodation Establishment for Dependent Elderly Persons)<\/strong><\/pee>\n<pee><strong>Rare<\/strong> are the EHPADs accepting individuals with Down syndrome (often too young, specific needs).<\/pee>\n<pee><strong>But<\/strong>: Some EHPADs are developing specialized units for mental disabilities.<\/pee>\n<pee><strong>Inquire<\/strong> with MDPH, associations.<\/pee><\/section>\n<div class=\"section-divider\">\u25c6 \u25c6 \u25c6<\/div>\n<section class=\"dynseo-section\">\n<h2 id=\"section-7\">Testimonials<\/h2>\n<h3><strong>Isabelle, sister of Maxime, 55 years old<\/strong><\/h3>\n<pee><em>&#8220;Maxime is 55 years old. For the past 2-3 years, we have seen a decline. He forgets things, he is slower. We consulted: early Alzheimer&#8217;s. It&#8217;s hard. But we have put many things in place: he does JOE every day (it helps him stay cognitively active), we have a home aide for 3 hours a day, and we maintain his routine. He still lives at home, with our support. We take it one day at a time.&#8221;<\/em><\/pee>\n<h3><strong>Sophie, mother of Nathan, 48 years old<\/strong><\/h3>\n<pee><em>&#8220;Nathan is 48 years old. I am aging too (72 years). I worry about the future. We anticipated: he has been in FAM for 2 years. At first, I was sad. But ultimately, it is good for him: he has friends, activities, trained staff. I see him every weekend. And I know he will be well taken care of when I am no longer there.&#8221;<\/em><\/pee><\/section>\n<section class=\"dynseo-section\">\n<h2 id=\"section-8\">Conclusion: Anticipating for better living<\/h2>\n<pee>The aging of people with Down syndrome is a reality, with its challenges: early aging, high Alzheimer&#8217;s risk, cognitive decline. But by knowing the signs, implementing prevention strategies (cognitive stimulation with JOE, exercise, diet, social life), and anticipating support solutions, it is possible to preserve quality of life, autonomy, and dignity for as long as possible.<\/pee>\n<pee><strong>The keys to successfully supporting aging:<\/strong><\/pee>\n<pee>1. <strong>Monitoring<\/strong> from age 40 (annual assessments)<\/pee>\n<pee>2. <strong>Active prevention<\/strong>: Cognitive stimulation (JOE), exercise, diet<\/pee>\n<pee>3. <strong>Early detection<\/strong> of decline signs<\/pee>\n<pee>4. <strong>Adaptation<\/strong> of support (aids, simplification)<\/pee>\n<pee>5. <strong>Anticipation<\/strong> of accommodation solutions<\/pee>\n<pee>6. <strong>Maintain social ties<\/strong>, reassuring routine<\/pee>\n<pee><strong>Aging with Down syndrome is possible. Aging well requires anticipation, love, and support. Accompany your loved one with gentleness, patience, and the right tools. Every day gained in quality of life is a victory.<\/strong><\/pee>\n<pee><strong>DYNSEO resources to prevent cognitive decline:<\/strong><\/pee>\n<li>JOE: Brain coach for adults and seniors: Daily cognitive stimulation, Alzheimer&#8217;s prevention<\/li>\n<li>COCO THINKS and COCO MOVES: For young adults (up to 40 years)<\/li>\n<li>Training &#8220;Supporting a child with Down syndrome&#8221;<\/li>\n<pee><strong>Medical resources:<\/strong><\/pee>\n<li><strong>Neurologist specialized<\/strong> in disability\/Alzheimer&#8217;s<\/li>\n<li><strong>MDPH<\/strong>: Aids, accommodation<\/li>\n<li><strong>Associations<\/strong>: Down syndrome France, Unapei, France Alzheimer<\/li>\n<\/ul>\n<pee><em>Aging is moving forward. With your support, your loved one with Down syndrome will age gently, safely, surrounded by love. It is the greatest gift.<\/em><\/pee><\/section>\n<\/div>\n<p>[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n<p>[et_pb_code]<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"FAQPage\",\"mainEntity\":[{\"@type\":\"Question\",\"name\":\"At what age do people with Down syndrome typically start showing signs of aging?\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"People with Down syndrome typically begin showing signs of aging earlier than the general population, usually starting around 40-50 years old. 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