Ch 14: The Personal Context of Later Life andCh 15: Social Aspects of Later Life and The Final Passage: Dying and Bereavement

Chapter 14

Chapter 14

Chapter 15

Chapter 15

Chapter 16

Chapter 16

Sociocultural Definitions of Death

Cultures differ in how they view and deal with death Criteria for a "good" vs. "bad" death Funeral customs Death icons Mourning and bereavement rituals The "afterlife" Think about it: in which of the following ways do you view death? Are there other ways?

Ten Different Views of Death

Death as an image or object Death as a statistic Death as an event Death as a boundary Death as a state of being Death as a thief of meaning Death as an analogy Death as fear and anxiety Death as reward or punishment Death as a mystery

Ch 14: The Personal Context of Later Life Longevity- number of years a person can expect to live Maximum life expectancy: oldest age to which any person lives (circa 120 years) Useful life expectancy: number of years a person is expected to live free from debilitating chronic disease. Longevity differences: ethnic, gender, and international- Average life expectancy is Latin Americans > European Americans > African Americans Latin Americans live longer than European Americans at all ages European Americans live longer than African Americans especially before the age of 65 May reflect differential healthcare access However, African Americans live longer than European Americans after age 85 Ethnic and Gender Differences in Life Expectancy (cont'd) U.S. women live longer than men by 5 years at birth, but only 1 year by age 85 Why? Multiple explanations, such as men being more susceptible to fatal infectious diseases genetic differences between genders complex interactions of lifestyle, genetics, and immune functioning differences. By age 90, however, men outperform women on cognitive tests. International Differences in Longevity Longevity differs greatly across countries, e.g., 38 years in Sierra Leone, 82+ years in Japan Genetic, sociocultural, economic, healthcare factors, and disease contribute to these differences The Third-Fourth Age Distinction Third age: ages of 60-80 (aka the young-old) Knowledge and technological advances contribute to their better life quality Fourth age: over 80 (aka the oldest-old) Few interventions have been developed to reverse this group's physiological, cognitive, and disease-related declines The "Good News": The Third Age (Young-Old) Increased life expectancy Improved physical and mental fitness High emotional and personal well-being Good strategies to master life's losses or gains The "Bad News": The Fourth Age (Oldest-Old) Sizeable losses in cognition and learning potential Increases in chronic stress's negative effects High prevalence of dementia (50% in those over 90) frailty and multiple chronic conditions Biological Theories of Aging "Damage or error" and "programmed" theories are two types of biological explanations for aging Four "damage or error" theories Biological theories of aging: programmed, damage/error theories Wear and tear- suggests that the body much like any machine gradually deteriorates and finally wears out. Wear-and-tear theory: body simply wears out and deteriorates Fails to explain most aspects of aging (2) Free radicals: cellular damage is caused by chemicals bonding to cells' insides Antioxidants (e.g., vitamins A, C, & E) postpone only some aging effects, but do not increase longevity Biological Theories of Aging (cont'd) (3) Cellular theories: multiple processes include harmful substances build up cells cannot replicate because they can divide only so many times (Hay flick limit) chromosomes' telomeres become shorter and stress-prone aerobic exercise may maintain telomeres' length (4) Cross-linking: certain proteins make muscles and arteries less flexible Little support Biological Theories of Aging (cont'd) Programmed theories Genetically programmed cell death Clocklike changes in Hormones immune system decline innate tendency of cells to self-destruct dying cells triggering certain processes. Physiological Changes Neuronal changes are common in older age Alzheimer's and related diseases involve large changes in declining neurotransmitters levels neuritic plaques: damaged or defective neurons collect and form around a core of protein neurofibrillary tangles: spiral-shaped masses form in the axon's fibers interferes with signal transmission Free radicals- chemical produced randomly during normal cell metabolism and that bond easily to other substance inside cells, Cellular theories - explanation of aging that focused on processes that occur within individual cells that may lead to the buildup of harmful substance or the deterioration of cells over a lifetime. Hay flick limit, telomeres- (Hayflick limit) chromosomes' telomeres become shorter and stress-prone aerobic exercise may maintain telomeres' length (4) Cross-linking: certain proteins make muscles and arteries less flexible Little support Changes in neurons- Physiological Changes Neuronal changes are common in older age Alzheimer's and related diseases involve large changes in declining neurotransmitters levels neuritic plaques: damaged or defective neurons collect and form around a core of protein neurofibrillary tangles: spiral-shaped masses form in the axon's fibers interferes with signal transmission. Changes in cardiovascular and respiratory system- Cardiovascular and Respiratory Systems Normative age-related changes include declining heart muscle tissue; fat deposits in and around the heart and/or arteries the heart pumps 30% less blood by the late 70s-80s artery stiffening due to calcification increase in stroke risk 50% of adults over 65 have hypertension African Americans have higher death rate due to these problems because of poor healthcare access Cardiovascular and Respiratory Systems Sensory changes - Vision (cont'd) Poorer green-blue-violent color discrimination due to yellowing of the lens Difficulties focusing and adjusting because muscles around lens stiffen Loss of acuity between 20 to 60 years, especially with low light Takes more time to adjust to distance changes Higher risk for diabetes-related retinal changes and macular degeneration Vision loss due to cataracts (opaque spots in the lens of the eye) or glaucoma (increase in the eye's fluid pressure) Sensory Changes: Hearing Hearing loss is one of the most common normative changes in older adults (especially for high pitches) A person of any age can lose hearing after routine exposure to loud sounds Includes the sound levels that young people routinely hear while wearing earbuds or headphones Psychomotor slowing- the speed with which a person can make a specific response. Psychomotor speed: how quickly a person reacts to make a specific response Predicts performance on cognitive tasks requiring little effort Slows with age in all situations, but especially in ambiguous ones Occurs because older adults take longer to decide whether they need to respond May explain higher driving fatality rates in very old people Due to declines in the brain's white matter (mostly myelinated axons) that aid faster neural transmission Information Processing Changes in memory -dementia - family of diseases involving serious impairment of behavioral and cognitive functioning. Most people worry about memory loss and its possible implications for disease A serious problem may be suspected when memory failures interfere with everyday life Detecting whether memory problems are serious requires thorough testing through physical and neurological examinations batteries of neuropsychological tests Remediating Memory Problems E-I-E-I-O framework: combines explicit vs. implicit memory with external vs. internal memory aids to create four types of memory interventions Explicit-external aids: using environmental resources, such as pagers, calendars or notebooks; helps overcome limited or declining attention and storage space in working memory Explicit-internal aids: using mnemonic devices, such as visual imagery, rehearsal, or the method of loci Remediating Memory Problems (cont'd) E-I-E-I-O framework Implicit-external aids: using sensory images to help memory (e.g., pictographs to remind the person to take medication or to depict which items reside in a cupboard) Implicit-internal aids: using priming, retrieval training, or classical conditioning to help memory (e.g., teaching people to associate the color red with a heart medication) AD interventions - Mental Health & Intervention: What is Alzheimer's disease? One form of dementia, involving gradual declines in memory, learning, attention, and judgment confusion as to time and place difficulty communicating and finding the right words declines in personal hygiene and self-care personality changes and inappropriate social behaviors incontinence in later stages A disease marked by gradual declines in memory, attention and judgment confusion as time and place difficulties in communicating decline in self-care skills inappropriate behavior and personality change. Depression Depression rates are 9% in younger adults compared to 4.5% in older people living in the community 13% in older adults requiring home healthcare Depression rates in older adults are higher in immigrant Latinos than their native-born counterparts are higher in Latino- and European- than in African- or Asian-Americans Fewer than 40% of U.S. adults receive adequate treatment Diagnosing Depression in Older Adults Diagnosing depression: feeling and physical changes must be present for at least two weeks The feeling symptom cluster Dysphoria: feeling sad or down, which older people describe as "feeling helpless" or "feeling tired" Older people also often appear apathetic and expressionless, confine themselves to bed, neglect themselves, and make derogatory self-statements Depression in Older Adults (cont'd) The physical symptom cluster Physical changes: loss of appetite, insomnia, and trouble breathing; memory problems are common long-term facets of older adults' depression Must be carefully evaluated as symptoms of depression, since they may reflect normal age-related changes have other physical, neurological, metabolic, or substance abuse-related causes

n/a

Ch 15: Social Aspects of Later Life Continuity theory - people use familiar remembered strategies to cope with daily life Too little continuity promotes a feeling that life is unpredictable Too much continuity promotes boredom, optimal continuity allows for challenges and interest without being overwhelming. Continuity Theory (cont'd) Memories of the past concern two types of continuity Internal: personal identity (e.g., skills experiences, emotions) Its continuity aids feelings of competence, mastery, ego integrity, and self-esteem External: physical and social environments, relationships, activities Familiar environments increase this continuity Competence-Environmental Press Model Competence: upper limit of physical health, ego strength; sensory-perceptual, motor, and cognitive skills. Environmental press: physical, interpersonal, or social demands of the environment Each person experiences different degrees or types of competence, environmental presses, and their combination. Adaptive behavior results when a person's competence fits environmental demands Competence-Environmental Press Model (cont'd) Adaptation level: point at which the press level is average for a particular level of competence. Zone of maximum performance potential: point at which slight increases in press level improve performance. Zone of maximum comfort: point at which slight decreases in press level maximize life quality, adaptive behavior, and positive affect. Competence-Environmental Press Model (cont'd) Changes in combinations of competence and environmental presses can lead to proactivity (choosing new behaviors to exert control over the changes) often results when people are high in competence docility (allowing the situation to dictate one's options when the changes occur) often results when people are low in competence. Integrity vs despair- according to Erikson the process in late life by which people try to make sense of their life. Reflecting on experiences and events of one's lifetime Can promote either integrity or despair (Erikson's 8th stage) Integrity: feeling good about one's past choices, coming to terms with one's death; judging one's life to have been meaningful and productive Self-acceptance and self-affirmation result from reaching integrity Despair: externalizing one's problems; feeling a sense of meaninglessness Well-Being and Social Cognition Subjective well-being: the positive feelings that can result from certain life evaluations Increases with age Varies with one's marital status, hardiness, social network quality, chronic illness, and stress Older women may experience less subjective well-being than men Why? Society less enables them to control these factors Recent societal changes have reduced this gender difference Well-Being and Social Cognition (cont'd) Why does subjective well-being increase with age? Amygdala activation and emotional arousal are lower in older adults Older adults' prefrontal cortex may help them better regulate negative emotions or reappraise them as less negative Declining cognitive ability (e.g., due to dementia) undermines this effect Religiosity & Spiritual Support- Religious faith and/or spirituality are important means by which older people cope with life. Stronger in some ethnic groups (e.g., African Americans) than others,Spiritual support: seeking pastoral care, faith in a God who cares for people; participation in organized or nonorganized religious activities Improves self-worth, coping; psychological and physical heath; reduces stress Religiosity & Spiritual Support (cont'd) Older adults describe turning problems over to God as a three-step process Separating what can vs. cannot be changed Focusing on problems that can be changed Disconnecting emotionally from unchangeable problems, but focusing on God providing the best outcome for those. Changes in brain activity occur during meditation, such as less activity in areas focusing on the self more organized attention. Spirituality -life review- the process by which people reflect on the events and experience of their lifetime. Subjective well being -meaning of retirement- an evaluation of one's life that is associated with positive feelings. "Crisp" and "blurred" retirement - What Does Being Retired Mean? 20%+ of people 65 or older are still in the workforce, which is more than ever People associate retiring with losing occupational identity, instead of what it may add to their lives Retirement is best viewed as a transition involving sudden ("Crisp") or gradual ("blurred") withdrawal from full-time employment Only ≤ 50% of men fit the crisp pattern and many hold bridge jobs (ones in between end of primary job and full retirement) Bridge jobs increase satisfaction both with retirement and one's overall life. Social convoy- a group of people that journey with us throughout our lives providing support in good times and bad. how a group of people journey with us through our lives, providing support in good and bad times Provides a protective, secure cushion so the person can explore and learn about the world; affirms who one is and means to others Sibling relationships -widowhood- keeping in touch with siblings long term friendships for many older adults. Sibling relationships are more important later in life Key predictors of sibling closeness are genetic relatedness health presence of other relationships proximity to each other Frail older adults -elder abuse and neglect- having physical disabilities, cognitive and/or psychological disorders; being very ill 40% of people over 65 have some kind of functional limitation Activities of daily living (ADLs): basic self-care tasks (e.g., eating, bathing, dressing, walking) Instrumental activities of daily living (IADLs): tasks requiring intellectual competence and planning These vary cross-culturally Prevalence of Frailty Frail older adults are prone to anxiety and depression disorders, especially if in a long-term care facility Need for assistance ... increases with age females > males in all ethnic groups rate in Americans is African > European > Latino > Asian rate is unknown for Native Americans. Independent Living Situations Sense of place: a person's cognitive and emotional attachments to his/her place of residence most older adults do not wish to move in with family or friends Most older adults do not prefer assisted living or nursing homes Home modifications — major or minor— can allow older adults to continue living in their home Assisted Living Assisted living facilities: for those with ADL or IADL limitations, but who do not need 24-hour care due to physical or cognitive impairments Do not provide 24 x 7 medical care 67% in these facilities are 65 or older and have one or more of these limitations 50% have a memory impairment ,Nursing Homes,Nursing homes provide 24 x 7 medical care house 5% of U.S. older adults,house 15% of those over 85 are evaluated carefully through the Nursing Home Quality Initiative The Eden Alternative, Green House Project, and Cohousing Initiatives The Eden Alternative seeks to eliminate loneliness, helplessness, and boredom The Greenhouse Project Housing options: aging in place, nursing homes, new approaches Housing Options: Living Arrangements Household: a person who lives alone, or a group of people living together 65 years+: 20% of households, 60 years+: 33% of households Functional health: ability to perform ADLs and IADLs determines which setting is optimal for the person Social policy issues: social security, Medicare Social Security and Medicare In the 1950s, roughly 35% of older adults fell below the federal poverty line In 2008, about 10% fell below these line yet older adults may need 200% of the current federal poverty limit to cover basic expenses and healthcare By 2039, Social Security and Medicare will consume 50% more of our GDP than in 2010 Social Security In 1935, Franklin D. Roosevelt created Social Security to supplement older people's savings and other types of support Today, after retirement, it is the primary source of financial support for retired people Yet government reforms may force people to rely on other means By the time baby-boomers retire, 2x more people will be collecting Social Security A diminishing working population soon will generate insufficient payroll taxes to fund it Social Security (cont'd) Reforming Social Security could involve privatization (e.g., retirement accounts) means-test benefits increasing years used to compute benefit increasing retirement age downwardly adjusting cost-of-living increases increasing payroll taxes increased earnings caps on SS payroll taxes across-the-board SS pension benefit decreases Medicare Medicaid is federally funded healthcare for the poor; supplemental or "medigap" insurance policies help with out-of-pocket expenses Medicare is federal medical insurance funded by payroll taxes To be eligible, a person must be over 65, be disabled, or have permanent kidney failure 40 million currently depend on it Faces many challenges and possible cuts due to increasing numbers of elderly Medicare (cont'd) Medicare coverage

n/a

Ch 16: The Final Passage: Death, Dying and Bereavement sociocultural definitions of death -legal and medical definitions of death Cultures differ in how they view and deal with death Criteria for a "good" vs. "bad" death Funeral custom Death icons Mourning and bereavement rituals The "afterlife". Euthanasia - the practice of ending life for reasons of mercy.and physician assisted suicide - process in which physicians provide dying patients with a fatal dose of medication that the patient self-administers. Hospice- an approach to assisting dying people emphasizes pain management or palliative care and death with dignity. -Living wills- a document in which a person states his or her wishes about life support and other treatment., durable power of attorney- for health care a document in which an individual appoints someone to act as his or her agent for health care decisions., DNR - do not resuscitate order-palliative care- care that is focused on providing relief from pain and other symptoms of disease at any point during the disease process. Kubler-Ross, death and dying - Kübler-Ross's Stages of Dying, Denial - shock, disbelief, Anger - hostility, resentment ("Why me?"), Bargaining - looking for a way out, Depression - no longer able to deny, patients experience sorrow, loss, guilt, and shame, Acceptance - acceptance of death's inevitability with peace and detachment Discussion of death helps to move toward acceptance. Death anxiety- Death Anxiety Death anxiety: diffuse anxiety about death Terror management theory: our deeply rooted fear of mortality makes not dying the primary motive underlying all behaviors (e.g., taking care of ourselves, having & raising children properly) Older adults represent existential threats to younger and middle-aged adults Remind us of mortality, infallible bodies Remind us that ways in which we secure self-esteem (and manage death anxiety) are transitory Death Anxiety (cont'd) Death anxiety consists of several components Body malfunction, pain, being destroyed, nonbeing, interruption of goals, punishment, humiliation, rejection, and negative impact on survivors Each is represented at public, private, and unconscious levels Our public admission of death anxiety may differ greatly from our private or unconscious thoughts and feelings Death Anxiety (cont'd) Older adults may have less death anxiety because of their greater ego integrity tendencies to engage in life reviews different time perspectives higher religious motivation Men have more death anxiety than women Women are more fearful of the dying process Learning to Deal with Death Anxiety Enjoy what you do have without many regrets Adolescent risk-taking is correlated with less death anxiety Increasing one's death awareness (e.g., writing one's obituary, planning one's funeral) Death education can significantly reduce fear Presents factual information about death, dying, and advanced directives; increases sensitivity to others dealing with death Creating a Final Scenario End-of-life issues: discussing and formalizing management of life's final phases, after-death disposition of one's body, and lawful distribution of assets (e.g., through a will) Baby-boomers are far more proactive and matter-of-fact about these issues Terror management theory grief process: four component model and dual process model- context of the loss referring to the risk factors such as weather the death was expected, continuation and subjective meaning associated with loss ranging from evaluation of everyday concerns to major questions about the meaning of life, changing representations of the lost relationship over time and the role of coping and emotion regulation processes that cover all coping strategies used to deal with grief (Bonanno and Kaltman). grief work as rumination hypothesis - an approach that not only rejects the neccesity of grief processing for recovery from loss but view extensive grief processing as a form of rumination that may actually increase distress. Risk factors in grief- the sorrow, hurt, anger, guilt, confusion and other feeling that arise after suffering a loss. Complicated or prolonged grief disorder- Expression of grief which is distin1uished from depression and form normal grief in terms of separation dis2ress and traumatic distress. Prolonged Grief Disorder Two types of distress distinguish this disorder from normal grief and depression. Separation distress: isolation; preoccupation with, upsetting memories of, longing and searching for the deceased to the point of interfering with everyday functioning Traumatic distress: disbelief and shock about the death, experiencing the deceased's presence; mistrust, anger, and detachment from others Complicated or Prolonged Grief Disorder (cont'd) Sufferers from complicated grief report symptoms distinct from those associated with depression or anxiety Avoiding reminders of the deceased Diminished sense of self, Difficulty accepting the loss Feeling angry or bitter, increased morbidity, smoking, and substance abuse Difficulties in family or social relationships. Meaning of death and grief expressions of grief in childhood- Preschoolers: death is temporary and magical 5-7 years: death is permanent, it eventually happens to everyone, and is less scary; reflects the shift to concrete-operational thought Typical reactions to death in childhood are regression, guilt for causing it, denial, displacement, repression, and wishful thinking about the deceased's return Older children: problem-focused coping and a better sense of personal control appears Children flip back and forth between grief and normal activity. Childhood (cont'd) with adequate and loving care, support, and reassurance that it's ok to grieve; childhood bereavement usually has no long-lasting effects (e.g., depression) Being open and honest reduces children's difficulty with the concept of death The use of euphemisms such as "gone away" or "only sleeping" can confuse and cause literal interpretation Researchers believe attending a funeral or having a private viewing aids recovery. Young, middle, and late adulthood less anxious and more accepting of it: death of a child, death of a parent, death of a partner- Adolescence 40-70% experiences the loss of a family member or friend during the college years Their first experience of death is particularly difficult and its effects severe, especially if unexpected. Chronic illness, lingering guilt, low self-esteem, poorer school & job performance, substance abuse, relationship problems, and suicidal thinking Adolescence (cont'd) Adolescents try to find ways of keeping a dead sibling in their lives They continue to miss and love them. Grief does not interfere with normative developmental processes They experience continued personal growth similar to nonbereaved adolescents Adulthood Young adults may feel that those who die at this point are cheated out of their future Also made difficult when peers ignore their grief, tell them that grieving is not good, or to get on with their lives. Loss of a partner in young adulthood is very difficult because the loss is so unexpected and grief can last for 5-10 years. Losing a spouse in middle adulthood - results in challenging basic assumptions about self, relationships, and life options. Death of One's Child in Young and Middle Adulthood Mourning is intense; some never reconcile the loss, and parents may divorce Young parents who lose a child to SIDS report high anxiety, more negative view of the world, and guilt. Loss of a child during childbirth is traumatic due to strong attachment, even though society expects a quick recovery. Middle-aged parents' loss of a young adult child is equally devastating, causing anxiety, problems functioning, and difficulties in relationships with surviving siblings upwards of 13 years later. Death of One's Parent When a parent dies, the loss hurts but also causes the loss of a buffer between ourselves and death; we may feel that we are now next in line. Death of a parent may result in a loss of a source of guidance, support, and advice The loss of a parent may result in complex emotions including relief, guilt, and a feeling of freedom. Important to express feelings for parents before they die Losing a parent due to Alzheimer's disease may feel like a second death Late Adulthood Older adults are often less anxious about death and more accepting of it Elders may feel that their most important life tasks have been completed Older adults are more likely to have experienced loss before Death of One's Child or Grandchild in Late Life Older bereaved parents may feel guilty about how their pain about losing one child affected relationships with surviving children. Many grieving parents report that the relationship with the deceased child was the closest they ever had. Bereaved grandparents tend to hide their grief behavior in an attempt to shield the grieving parents from more pain. Death of One's Partner U.S. society expects the surviving spouse to mourn briefly, but older bereaved spouses may grieve for 30+ months A support system's helpfulness depends on whether the bereaved wants contact who is willing to provide support whether the support is of high quality Depressed survivors' memories of the relationship are positively biased, whereas those of the non-depressed are more negative (may reflect pre-death quality of the relationship) Death of One's Partner (cont'd) European-American wives who highly value this role "sanctify" their dead husbands Helps the widow believe the marriage was strong and that she is a good & worthy person who can rebuild her life Reduced hopelessness, intrusive thoughts, and obsessive-compulsive behavior occur when older bereaved spouses actually express their feelings Cognitive-behavior therapy helps coping and making sense of the loss Gays and lesbians experience grief plus negativity from the deceased's family members one form of dementia, involving gradual declines in memory, learning, attention, and judgment confusion as to time and place difficulty communicating and finding the right words declines in personal hygiene and self-care personality changes and inappropriate social behaviors incontinence in later stages.

n/a

Chapter Fifteen Social Aspects of Later Life: Psychosocial, Retirement, Relationship, and Societal Issues 15.1 Theories of Psychosocial Aging:Learning Objectives What is continuity theory? What is the competence and environmental press model, and how do docility and proactivity relate to the model? Continuity Theory Continuity theory: people use familiar remembered strategies to cope with daily life Too little continuity promotes a feeling that life is unpredictable Too much continuity promotes boredom Optimal continuity allows for challenges and interest without being overwhelming Continuity Theory (cont'd) Memories of the past concern two types of continuity Internal: personal identity (e.g., skills experiences, emotions) Its continuity aids feelings of competence, mastery, ego integrity, and self-esteem External: physical and social environments, relationships, activities Familiar environments increase this continuity Competence-Environmental Press Model Competence: upper limit of physical health, ego strength; sensory-perceptual, motor, and cognitive skills Environmental press: physical, interpersonal, or social demands of the environment Each person experiences different degrees or types of competence, environmental presses, and their combination Adaptive behavior results when a person's competence fits environmental demands Competence-Environmental Press Model (cont'd) Adaptation level: point at which the press level is average for a particular level of competence Zone of maximum performance potential: point at which slight increases in press level improve performance Zone of maximum comfort: point at which slight decreases in press level maximize life quality, adaptive behavior, and positive affect Competence-Environmental Press Model (cont'd) Changes in combinations of competence and environmental presses can lead to proactivity (choosing new behaviors to exert control over the changes) often results when people are high in competence docility (allowing the situation to dictate one's options when the changes occur) often results when people are low in competence 15.2 Personality, Social Cognition, & Spirituality: Learning Objectives What is integrity in late life? How do people achieve it? How is well-being defined in adulthood? How do people view themselves differently as they age? What role does spirituality play in late life? Integrity vs. Despair Life review: reflecting on experiences and events of one's lifetime Can promote either integrity or despair (Erikson's 8th stage) Integrity: feeling good about one's past choices, coming to terms with one's death; judging one's life to have been meaningful and productive Self-acceptance and self-affirmation result from reaching integrity Despair: externalizing one's problems; feeling a sense of meaninglessness Well-Being and Social Cognition Subjective well-being: the positive feelings that can result from certain life evaluations Increases with age Varies with one's marital status, hardiness, social network quality, chronic illness, and stress Older women may experience less subjective well-being than men Why? Society less enables them to control these factors Recent societal changes have reduced this gender difference Well-Being and Social Cognition (cont'd) Why does subjective well-being increase with age? Amygdala activation and emotional arousal are lower in older adults Older adults' prefrontal cortex may help them better regulate negative emotions or reappraise them as less negative Declining cognitive ability (e.g., due to dementia) undermines this effect Religiosity & Spiritual Support Religious faith and/or spirituality are important means by which older people cope with life Stronger in some ethnic groups (e.g., African Americans) than others Spiritual support: seeking pastoral care, faith in a God who cares for people; participation in organized or nonorganized religious activities Improves self-worth, coping; psychological and physical heath; reduces stress Religiosity & Spiritual Support (cont'd) Older adults describe turning problems over to God as a three-step process Separating what can vs. cannot be changed Focusing on problems that can be changed Disconnecting emotionally from unchangeable problems, but focusing on God providing the best outcome for those Changes in brain activity occur during meditation, such as less activity in areas focusing on the self more organized attention 15.3 Living in Retirement:Learning Objectives What does being retired mean? Why do people retire? How satisfied are retired people? How do retirees keep busy? What Does Being Retired Mean? 20%+ of people 65 or older are still in the workforce, which is more than ever People associate retiring with losing occupational identity, instead of what it may add to their lives Retirement is best viewed as a transition involving sudden ("crisp") or gradual ("blurred") withdrawal from full-time employment Only ≤ 50% of men fit the crisp pattern and many hold bridge jobs (ones in between end of primary job and full retirement) Bridge jobs increase satisfaction both with retirement and one's overall life Why Do People Retire? Today, more people retire by choice than for any other reason Most retire when they feel they are financially secure Some retire when physical health problems interfere with work Today's economic climate is forcing many to retire even though they may not wish to Gender Differences Compared to men, women enter the workforce later, have more interruptions in their work history, and generally have less retirement income due to lower wages rarely have their own sources of retirement income if they were never employed outside of the home spend less time planning for retirement are likelier to continue working part-time after retiring Ethnic Differences Little research has studied ethnic differences in the retirement process African Americans are likely to continue working beyond age 65 There are no gender differences in their health following retirement Adjustment to Retirement Adjustment to retirement improves when one has a high sense of personal control and internal motivation, plus good physical health, financial security, social support, and feelings about retiring men have positive resources in later life, despite having earlier disadvantages older men endorse nontraditional gender roles decisions to retire are voluntary neither partner influenced the retirement decision husbands did not influence their wives' decision Keeping Busy in Retirement National organizations advocate for retirees' interests and suggest many activities Ex.: American Association of Retired Persons (AARP) Retirees volunteer and find ways to provide service Volunteering will rise in the future due to older adults' increasingly higher education levels Volunteering benefits well-being by improving communities, maintaining social interactions, and staying active 15.4 Friends & Family in Late Life:Learning Objectives What role do friends and family play in late life? What are older adults' marriages and same-sex partnerships like? What is it like to provide basic care for one's partner? How do people cope with widowhood? How do men and women differ? What special issues are involved in being a great-grandparent? What Role Do Friends and Family Play in Late Life? Social convoy: how a group of people journey with us through our lives, providing support in good and bad times Provides a protective, secure cushion so the person can explore and learn about the world; affirms who one is and means to others Can increase mental health and well-being Its size and provision of support does not differ across generations Is especially important to African Americans and immigrants Friends and Siblings Later-life friendship patterns resemble those of young adulthood, including online friendships Older adults have fewer relationships and develop fewer new ones, but this is a decreasing trend in recent cohorts Socioemotional selectivity: friendships formed based on goals, such as information seeking, self-concept, and emotional regulation, with each goal resulting in different behaviors and of varying importance at different times Sibling Relationships Sibling relationships are more important later in life Key predictors of sibling closeness are genetic relatedness health presence of other relationships proximity to each other Marriage and Gay and Lesbian Partnerships Older couples report more positive behaviors in their spouses are less likely to to perceive events or partners negatively have reduced marital conflict have similar mental and physical health Satisfaction increases in older couples who had children, but decreases in those who did not Marriage and Gay and Lesbian Partnerships (cont'd) Older couples show fewer gender differences in sources of pleasure Household chores are divided more equally after husbands retire Marriage helps people cope better with chronic illness, functional problems, and disabilities Extant data shows no differences in relationship quality between heterosexual compared to gay or lesbian couples Caring for a Partner Caring for a chronically ill partner is more stressful and challenging than caring for a chronically ill parent Division of labor must be readjusted Marital satisfaction and depression decrease as a partner's symptoms and/or their severity increase (e.g., Alzheimer's) Caring for a Partner (cont'd) Higher prior marital satisfaction helps buffer caregivers from depression Caregivers' perceived competence promotes proactivity rather than docility After one month, caregivers remember only about 2/3 of major hassles Professionals' diagnostic judgments should not rely solely only on caregiver reports Widowhood A partner's death is one of the most traumatic experiences for a living partner whose own risk of dying lasts for 10 years whose death risk exists for European but not African Americans who experiences extreme loneliness and may lose friendships or family support When 65 or older, more than 50% of women, but 15% of men lose spouses or partners due to death Widowhood (cont'd) Widowers recover more slowly than widows, a difference that may partly be due to their typically older age especially without a strong support system because they are not used to doing household tasks Widowers, nonetheless, have greater opportunity than widows to form new heterosexual relationships Widowhood (cont'd) Widows suffer in other ways, such as being less financially secure due to benefits being only half of a husband's pension Widows are likelier to form close friendships than are widowers Some widowed people cohabit or remarry due to need for companionship and financial security but they do experience obstacles (e.g., family resistance, pressures to protect one's estate) Great-Grandparenthood More people today are becoming great-grandparents, especially women Three important aspects of great-grandparenthood are feeling a sense of personal and family renewal providing new diversions and a positive new role experiencing a major milestone of longevity, which is usually viewed positively 15.5 Social Issues & Aging:Learning Objectives Who are frail older adults? How common is frailty? What housing options are there for older adults? How do you know whether an older adult is abused or neglected? Which people are most likely to be abused and to be abusers? What are the key social policy issues affecting older adults? Frail Older Adults Frail older adults: having physical disabilities, cognitive and/or psychological disorders; being very ill 40% of people over 65 have some kind of functional limitation Activities of daily living (ADLs): basic self-care tasks (e.g., eating, bathing, dressing, walking) Instrumental activities of daily living (IADLs): tasks requiring intellectual competence and planning These vary cross-culturally Prevalence of Frailty Frail older adults are prone to anxiety and depression disorders, especially if in a long-term care facility Need for assistance ... increases with age females > males in all ethnic groups rate in Americans is African > European > Latino > Asian rate is unknown for Native Americans Housing Options: Living Arrangements Household: a person who lives alone, or a group of people living together 65 years+: 20% of households 60 years+: 33% of households Functional health: ability to perform ADLs and IADLs determines which setting is optimal for the person Independent Living Situations Sense of place: a person's cognitive and emotional attachments to his/her place of residence Most older adults do not wish to move in with family or friends Most older adults do not prefer assisted living or nursing homes Home modifications — major or minor— can allow older adults to continue living in their home Assisted Living Assisted living facilities: for those with ADL or IADL limitations, but who do not need 24-hour care due to physical or cognitive impairments Do not provide 24 x 7 medical care 67% in these facilities are 65 or older and have one or more of these limitations 50% have a memory impairment Nursing Homes Nursing homes provide 24 x 7 medical care house 5% of U.S. older adults house 15% of those over 85 are evaluated carefully through the Nursing Home Quality Initiative The Eden Alternative, Green House Project, and Cohousing Initiatives The Eden Alternative seeks to eliminate loneliness, helplessness, and boredom The Greenhouse Project seeks to create small homes for 6-10 residents; blend into neighborhood housing; and provide personal and professional care Cohousing is a planned community that values personal autonomy, fosters social interaction, and is modest in size; built around open, walkable space Elder Abuse and Neglect Seven different types of elder abuse Physical Sexual Emotional or psychological Financial or material exploitation Abandonment Neglect Self-neglect Determining whether and how much elder abuse occurs varies considerably with ethnicity-related cultural values Prevalence The most common types of abuse Neglect - 60% Physical abuse - 16% Financial or material exploitation - 12% 5 million people are victims of elder abuse Authorities learn about only 1 in 6 cases Risk Factors Results are conflicting, but some studies show abuse or neglect to be inflicted 2/3 of the time by family members at other times by care providers, trusted people (e.g., bankers, clergy), and telemarketers or investment schemes Causes of being victimized poverty, family problems, social isolation victimizer dependency on the victims (usually financial) or desire for financial gain victimizer retribution (for spousal abuse) victimizers gaining a sense of control or power Social Security and Medicare In the 1950s, roughly 35% of older adults fell below the federal poverty line In 2008, about 10% fell below this line Yet older adults may need 200% of the current federal poverty limit to cover basic expenses and healthcare By 2039, Social Security and Medicare will consume 50% more of our GDP than in 2010 Social Security In 1935, Franklin D. Roosevelt created Social Security to supplement older people's savings and other types of support Today, after retirement, it is the primary source of financial support for retired people Yet government reforms may force people to rely on other means By the time baby-boomers retire, 2x more people will be collecting Social Security A diminishing working population soon will generate insufficient payroll taxes to fund it Social Security (cont'd) Reforming Social Security could involve privatization (e.g., retirement accounts) means-test benefits increasing years used to compute benefit increasing retirement age downwardly adjusting cost-of-living increases increasing payroll taxes increased earnings caps on SS payroll taxes across-the-board SS pension benefit decreases Medicare Medicaid is federally funded healthcare for the poor; supplemental or "medigap" insurance policies help with out-of-pocket expenses Medicare is federal medical insurance funded by payroll taxes To be eligible, a person must be over 65, be disabled, or have permanent kidney failure 40 million currently depend on it Faces many challenges and possible cuts due to increasing numbers of elderly Medicare (cont'd) Medicare coverage exists in four parts Part A: inpatient hospital services, skilled nursing facilities, home health and hospice care Part B: cost of physicians, outpatient services, medical equipment, and other health supplies Part D: some prescription costs Part C: supplemental Medicare-approved coverage ("Medicare Advantage") adds coverage for Parts A, B, and usually Part D

n/a

Chapter Fourteen The Personal Context of Later Life: Physical, Cognitive,and Mental Health Issues 14.1 What Are Older Adults Like?Learning Objectives What are the characteristics of older adults in the population? How long will most people live? What factors influence this? What is the distinction between the third and fourth age? The Demographics of Aging Demographers study population trends Demographers use population pyramids to illustrate these trends The number of older adults in developed nations greatly increased in the 20th century and will increase even more by 2050 The number of older Asian-, Native-, and especially Latino-Americans is high now and will continue to increase The number of U.S. people over 85 will increase by 500% between 2000 and 2050 The Diversity of Older Adults U.S. older women outnumber older men True of all ethnic groups As of today, 50% of people over 65 have high school diplomas 10% currently have college degrees 75% will have college degrees by 2030 Better educated people live longer due to higher incomes, giving them better healthcare access Longevity Longevity: number of years a person can expect to live Maximum life expectancy: oldest age to which any person lives (circa 120 years) Useful life expectancy: number of years a person is expected to live free from debilitating chronic disease Average life expectancy: age at which half of the people born in a particular year will die In the U.S., it is 80.4 years for women 75.4 years for men Genetic and Environmental Factors in Life Expectancy Heredity is a major factor in longevity Particularly true for those over 100 Environment plays a role through the effects of disease, toxins, and risky behaviors Social class plays a role due to lack of access to health care The U.S. healthcare system is broken, especially for older adults (cf. Healthy People 2020) Ethnic and Gender Differences in Life Expectancy Average life expectancy is Latin Americans > European Americans > African Americans Latin Americans live longer than European Americans at all ages European Americans live longer than African Americans especially before the age of 65 May reflect differential healthcare access However, African Americans live longer than European Americans after age 85 Ethnic and Gender Differences in Life Expectancy (cont'd) U.S. women live longer than men by 5 years at birth, but only 1 year by age 85 Why? Multiple explanations, such as men being more susceptible to fatal infectious diseases genetic differences between genders complex interactions of lifestyle, genetics, and immune functioning differences By age 90, however, men outperform women on cognitive tests International Differences in Longevity Longevity differs greatly across countries, e.g., 38 years in Sierra Leone 82+ years in Japan Genetic, sociocultural, economic, healthcare factors, and disease contribute to these differences The Third-Fourth Age Distinction Third age: ages of 60-80 (aka the young-old) Knowledge and technological advances contribute to their better life quality Fourth age: over 80 (aka the oldest-old) Few interventions have been developed to reverse this group's physiological, cognitive, and disease-related declines The "Good News": The Third Age (Young-Old) Increased life expectancy Improved physical and mental fitness High emotional and personal well-being Good strategies to master life's losses or gains The "Bad News": The Fourth Age (Oldest-Old) Sizeable losses in cognition and learning potential Increases in chronic stress's negative effects High prevalence of dementia (50% in those over 90) frailty and multiple chronic conditions 14.2 Physical Changes and Health:Learning Objectives What are the major biological theories of aging? What physiological changes normally occur in later life? What are the principal health issues for older adults? Biological Theories of Aging "Damage or error" and "programmed" theories are two types of biological explanations for aging Four "damage or error" theories (1) Wear-and-tear theory: body simply wears out and deteriorates Fails to explain most aspects of aging (2) Free radicals: cellular damage is caused by chemicals bonding to cells' insides Antioxidants (e.g., vitamins A, C, & E) postpone only some aging effects, but do not increase longevity Biological Theories of Aging (cont'd) (3) Cellular theories: multiple processes include harmful substances build up cells cannot replicate because they can divide only so many times (Hayflick limit) chromosomes' telomeres become shorter and stress-prone aerobic exercise may maintain telomeres' length (4) Cross-linking: certain proteins make muscles and arteries less flexible Little support Biological Theories of Aging (cont'd) Programmed theories Genetically programmed cell death Clocklike changes in hormones immune system decline innate tendency of cells to self-destruct dying cells triggering certain processes Physiological Changes Neuronal changes are common in older age Alzheimer's and related diseases involve large changes in declining neurotransmitters levels neuritic plaques: damaged or defective neurons collect and form around a core of protein neurofibrillary tangles: spiral-shaped masses form in the axon's fibers interferes with signal transmission Physiological Changes (cont'd) Neuroimaging is used to assess abnormal and normal age-related declines in cognitive functioning Structural imaging: X-rays, CT scans, and MRIs are used to study brain anatomy Functional neuroimaging: SPECT, PET, fMRI, and MIRSI are used to measure brain activity Measuring neurotransmitter declines Cardiovascular and Respiratory Systems Normative age-related changes include declining heart muscle tissue; fat deposits in and around the heart and/or arteries the heart pumps 30% less blood by the late 70s-80s artery stiffening due to calcification increase in stroke risk 50% of adults over 65 have hypertension African Americans have higher death rate due to these problems because of poor healthcare access Cardiovascular and Respiratory Systems (cont'd) Transient ischemic attacks (TIAs): interruptions of blood flow to the brain that may forewarn a stroke Cerebral vascular accidents (CVAs): strokes reflecting reduced blood flow to the brain due to blockages or hemorrhages Vascular dementia: small cerebral vascular accidents causing dementia Progresses slowly, but can have sudden onset Symptoms are hypertension, MRI alterations, impaired neuropsychological test performance Cardiovascular and Respiratory Systems (cont'd) Air intake in one breath drops 40% between 25 to 85 years of age Chronic obstructive pulmonary disease (COPD): emphysema, asthma, and related breathing diseases the most common forms of respiratory disease may result in depression, anxiety, and the continual need for external sources of oxygen Parkinson's Disease Slow hand tremors, shaking, rigidity, walking problems; difficulties getting in and out of a chair Cause? Deteriorating dopamine production in the midbrain 30-50% of sufferers develop cognitive impairments and eventually dementia Symptoms are treated by drugs that raise dopamine or aid its delivery to the brain neurostimulators Sensory Changes Many accidents occur due to age-related sensory changes Sometimes preventable via environmental changes and exercise Vision Changes As we age, less light passes through the eye Results in night vision problems and the need for increased light for reading Decreased adaptation Difficulty adjusting to light-to-dark changes and vice versa Sensory Changes: Vision (cont'd) Poorer green-blue-violent color discrimination due to yellowing of the lens Difficulties focusing and adjusting because muscles around lens stiffen Loss of acuity between 20 to 60 years, especially with low light Takes more time to adjust to distance changes Higher risk for diabetes-related retinal changes and macular degeneration Vision loss due to cataracts (opaque spots in the lens of the eye) or glaucoma (increase in the eye's fluid pressure) Sensory Changes: Hearing Hearing loss is one of the most common normative changes in older adults (especially for high pitches) A person of any age can lose hearing after routine exposure to loud sounds Includes the sound levels that young people routinely hear while wearing earbuds or headphones Presbycusis: losing the ability to hear low-pitched sounds Caused by the cumulative effects of noise exposure and age-related changes Sensory Changes: Hearing (cont'd) Four changes in the ear cause this inability to hear low-pitched sounds (1) Neural: loss of auditory pathway neurons Also affects speech understanding (2) Metabolic: diminished nutrient supply to receptor cells Also lose sensitivity to all pitches (3) Mechanical: atrophy and stiffening of the receptor area's vibrating structures Loss of all pitches, but especially high ones (4) Sensory: atrophy and degeneration of receptor cells Few additional side effects Sensory Changes: Hearing (cont'd) Hearing loss does not cause social or emotional maladjustment, but it can elicit adverse emotional reactions (e.g., irritation, depression) can negatively affect how the person feels about interpersonal communication due to family's and relatives' impatience about needing to repeat themselves Hearing loss can be helped through amplification (e.g., analog or digital aids) cochlear implants that stimulate auditory nerve fibers Sensory Changes: Other Senses (cont'd) Taste, touch, temperature, and pain sensitivity are not significantly age-related Detecting and distinguishing smells declines substantially in many after the age of 70 Very true of Alzheimer's disease Very dangerous (e.g., gas leaks) Older people fall more often due to changes in balance, eyesight, hearing, muscle tone, reflexes Health Issues Older adults take 2x longer to fall asleep, sleep less, and have sleep-related problems, e.g., disrupted circadian rhythms (sleep-wake cycles), which timed exposure to bright light can help depression; sleep problems exacerbated by physical disease (e.g., heart or lung disease, diabetes, obesity) Older adults' nutritional deficits are due to poor care or the body less efficiently extracting nutrients Cancer increases with age; screening is imperative Unhealthy lifestyles do not fully explain age-related cancer increases Immigrant Status After SES is controlled, immigrants show poorer health than U.S.-born people of the same ethnicity However, immigrants with excellent child relationships do have fewer chronic illnesses Language, cultural, misdiagnosis, and structural (e.g., health insurance) barriers interfere with them obtaining adequate healthcare These same barriers may explain higher rates of depression in older immigrant Mexican Americans These barriers do not exist for Canadian immigrants 14.3 Cognitive Processes:Learning Objectives What changes occur in information processing as people age? How do these changes relate to everyday life? What changes occur in memory with age? What can be done to remediate these changes? What is creativity and wisdom, and how do they relate to age? Information Processing Psychomotor speed: how quickly a person reacts to make a specific response Predicts performance on cognitive tasks requiring little effort Slows with age in all situations, but especially in ambiguous ones Occurs because older adults take longer to decide whether they need to respond May explain higher driving fatality rates in very old people Due to declines in the brain's white matter (mostly myelinated axons) that aid faster neural transmission Information Processing (cont'd) Various tests predict whether drivers should be allowed to continue to drive Useful field of view (UVOF): tests information-processing speed, simultaneous monitoring of central and peripheral stimuli; extraction of relevant information from irrelevant background information Clock drawing test: how well people reproduce various clock faces from memory AAA's "Roadwise Review": assesses eight functional areas, e.g., leg strength, head and neck flexibility, visual acuity, working memory Working Memory Working memory: processes and structures involved in holding information in mind and simultaneously using it in problem-solving, decision-making, and learning Small in capacity Without continued attention or rehearsal, the information is "lost" Declines with age Poorer working memory and psychomotor speed predict age-related declines in cognitive performance Memory Some psychologists distinguish explicit from implicit memory Different brain regions are involved in each Normal aging processes, brain trauma, and disease (e.g., Alzheimer's) affect each differently The basic distinction Explicit memory: conscious and deliberate memory for previously learned information Implicit memory: unconscious and automatic (non-deliberate) memory about previously learned information as seen through one's behavior or reactions Memory (cont'd) Explicit memory is also called "declarative" memory ("knowing that ...") We can "declare" these memories using language Ex.: recalling a song's lyrics or everything you read on the previous slide Two types of explicit memory (1) Semantic memory: remembering the meaning of words and concepts; recalling facts not tied to a specific event or time (e.g., facts about Osama Bin Laden; knowing what "adieu" means) Memory (cont'd) (2) Episodic memory: recalling information about the world tied to a specific time or event (e.g., what you can recall about 9-11) Autobiographical memory: one form of episodic memory for personal life events (e.g., your 5th birthday party) Implicit memory Sometimes called "nondeclarative" memory, because it's difficult to express in words Memory (cont'd) Implicit memory is seen in various ways Showing memory for "knowing how to do" reflexive, motor, or perceptual behaviors Successfully riding a bike demonstrates one's memory for its various components, even though these are difficult to put into words Showing memory for already learned classically conditioned responses, habits, or emotions Feeling nauseated upon seeing food (e.g., bologna) associated in memory with having had the flu Hearing that John is an engineer and thinking he must be smart ("engineer" primed your memory for this stereotype) What Changes? Evidence contradicts stereotypes about broad-based memory declines in older adults Brain areas involved in encoding (storing) new memories shrink with age (e.g., hippocampus and medial temporal lobe) Compared to younger adults, older adults generally have worse episodic explicit memory All age groups do best remembering autobiographical events and nonpersonal ones (e.g., news stories) that occurred between 10-30 years of age What Changes? (cont'd) Implicit memory is age-unrelated, as is semantic explicit memory, except difficulty finding the words increases in older adults and is related to decreased brain white matter (axonal projections) Older adults compensate for working memory problems by highly activating the prefrontal cortex, an ineffective strategy Older adults are not as good at spontaneously using memory strategies to improve recall When Is Memory Change Abnormal? Most people worry about memory loss and its possible implications for disease A serious problem may be suspected when memory failures interfere with everyday life Detecting whether memory problems are serious requires thorough testing through physical and neurological examinations batteries of neuropsychological tests Remediating Memory Problems E-I-E-I-O framework: combines explicit vs. implicit memory with external vs. internal memory aids to create four types of memory interventions Explicit-external aids: using environmental resources, such as pagers, calendars or notebooks; helps overcome limited or declining attention and storage space in working memory Explicit-internal aids: using mnemonic devices, such as visual imagery, rehearsal, or the method of loci Remediating Memory Problems (cont'd) E-I-E-I-O framework Implicit-external aids: using sensory images to help memory (e.g., pictographs to remind the person to take medication or to depict which items reside in a cupboard) Implicit-internal aids: using priming, retrieval training, or classical conditioning to help memory (e.g., teaching people to associate the color red with a heart medication) Creativity and Wisdom Creativity: ability to produce work that connects disparate ideas in novel ways and that is both task-appropriate and in high demand Predicted by how much white matter connects distant brain regions and cognitive control over these connections Generally increases through the 30s, peaking in the early 40s However, the age at which people make major creative contributions has increased during the 20th century Creativity and Wisdom (cont'd) Baltes and colleagues describe wisdom as dealing with important matters of life and the human experience superior knowledge, judgment, and advice knowledge with extraordinary scope, depth, and balance being used with good intentions, combining mind and virtue Wisdom is unrelated to age Creativity and Wisdom (cont'd) Baltes et al. identify three factors that facilitate wisdom General personal conditions, such as mental ability Specific expertise conditions, such as practice or mentoring Facilitative life contexts, such as education or leadership experiences Others suggest wisdom also may be facilitated by the integration of affect with cognition and having achieved generativity and integrity 14.4 Mental Health & Intervention:Learning Objectives How does depression in older adults differ from depression in younger adults? How is it diagnosed and treated? How are anxiety disorders treated in older adults? What is Alzheimer's disease? How is it diagnosed and managed? What causes it? Depression Depression rates are 9% in younger adults compared to 4.5% in older people living in the community 13% in older adults requiring home healthcare Depression rates in older adults are higher in immigrant Latinos than their native-born counterparts are higher in Latino- and European- than in African- or Asian-Americans Fewer than 40% of U.S. adults receive adequate treatment Diagnosing Depression in Older Adults Diagnosing depression: feeling and physical changes must be present for at least two weeks The feeling symptom cluster Dysphoria: feeling sad or down, which older people describe as "feeling helpless" or "feeling tired" Older people also often appear apathetic and expressionless, confine themselves to bed, neglect themselves, and make derogatory self-statements Depression in Older Adults (cont'd) The physical symptom cluster Physical changes: loss of appetite, insomnia, and trouble breathing; memory problems are common long-term facets of older adults' depression Must be carefully evaluated as symptoms of depression, since they may reflect normal age-related changes have other physical, neurological, metabolic, or substance abuse-related causes What Causes Depression? Biological explanations stress neurotransmitter imbalances Cannot be the sole explanation, because these imbalances increase with age, while depression declines with age Internal belief systems play a role, e.g., believing one is "bad" and personally responsible for bad events (e.g., a spouse's death) thinking things will not get better Less stress in older people and their experientially-based coping skills may account for age-related declines in depression rates Treating Depression in Older Adults Sometimes treated with medication to alter neurotransmitter levels Selective Serotonin Reuptake Inhibitors (SSRIs) are the most preferred Boost mood-regulating serotonin levels Zoloft has fewer adverse reactions Prozac is linked to high agitation levels Serzone can damage the liver Treating Depression in Older Adults (cont'd) Less preferred medications to alter neurotransmitter levels Heterocyclic antidepressants (HCAs) Cannot be used when hypertension or certain metabolic disorders also are present Monoamine oxidase inhibitors (MAOIs) Can interact fatally with foods containing dopamine or tyramine (e.g., cheddar cheese) Treating Depression in Older Adults (cont'd) Forms of psychotherapy Cognitive therapy: helps the person lessen maladaptive beliefs about the self and view the future more positively Behavior therapy: practice and homework assignments help the person experience more reinforcement and avoid negative events Anxiety Disorders Anxiety disorders: excessive, irrational dread about everyday situations, including irrational severe anxiety, phobias, obsessions and/or compulsions Common in older adults, partly due to loss of health, relocation of residence, isolation, loss of independence 17% of older men 21% of older women Anxiety disorders can often be successfully treated with relaxation therapy and medications (e.g., benzodiazepenes, SSRIs, beta-blockers, and buspirone) Dementia: Alzheimer's Disease Alzheimer's disease (AD): one form of dementia, involving gradual declines in memory, learning, attention, and judgment confusion as to time and place difficulty communicating and finding the right words declines in personal hygiene and self-care personality changes and inappropriate social behaviors incontinence in later stages Dementia: Alzh

n/a

Chapter Sixteen The Final Passage: Dying and Bereavement 16.1 Definitions & Ethical Issues:Learning Objectives How is death defined? What legal and medical criteria are used to determine when death occurs? What are the ethical dilemmas surrounding euthanasia? Sociocultural Definitions of Death Cultures differ in how they view and deal with death Criteria for a "good" vs. "bad" death Funeral customs Death icons Mourning and bereavement rituals The "afterlife" Think about it: in which of the following ways do you view death? Are there other ways? Ten Different Views of Death Death as an image or object Death as a statistic Death as an event Death as a boundary Death as a state of being Death as a thief of meaning Death as an analogy Death as fear and anxiety Death as reward or punishment Death as a mystery Legal and Medical Definitions Clinical death: lack of heartbeat and respiration traditionally signified death Today, whole brain death is required No spontaneous movement to stimulation No spontaneous respiration for 1 or more hours Lack of response to even extreme pain No eye movements, blinking, or pupil responses No swallowing, yawning, or vocal or postural activity No motor reflexes A flat EEG for at least 10 minutes No change in any of these after a 24-hour retest Legal and Medical Definitions (cont'd) All eight criteria must be met Must rule out conditions mimicking death In most hospitals, the lack of brain activity must extend to the brainstem (vegetative functions) and cortex (higher processes) Persistent vegetative state: irreversible lack of cortical functioning, but continued brainstem activity Cannot be ruled dead Presents ethical dilemmas Ethical Issues Bioethics: study of interface between human values and technological advances in the health and life sciences Grew out of respect for individual freedom and the difficulty of establishing what is moral through common sense or rational argument Decisions must honor the importance of individual choice weigh a treatment's relative benefit vs. harm to a patient Euthanasia Euthanasia: merciful ending of life Poses the moral dilemma of deciding under which circumstances to end a person's life Must consider the morality of "killing" a person vs. "letting" the person die Dilemma often arises when the person is being kept alive by a machine suffers from a terminal illness Active and Passive Euthanasia Active euthanasia: deliberately ending life (e.g., by a drug overdose) Based on person's clear statement of this desire Made by someone in legal authority Passive euthanasia: allowing a person to die by not giving available treatment (e.g., withholding a cancer patient's chemotherapy) Validity of this distinction is actively debated Both raise moral and religious concerns and are highly "political" Active and Passive Euthanasia (cont'd) Most Americans favor certain forms of active and passive euthanasia for patients in a persistent vegetative state Passive euthanasia cases often end up in court U.S. Supreme Court ruled that nourishment can be stopped only through the patient's advanced directive (e.g., via a living will or durable health care power of attorney) Physician-Assisted Suicide Physician-assisted suicide: physicians providing fatal medication doses to patients Oregon and Washington passed laws allowing physician-assisted suicide that require physicians to inform people that they are terminally ill and to describe alternative options give people the right to self-administer lethal medication doses obtained by prescription require people to be mentally competent, to make two oral requests separated by 15 or more days, and to make a written request Physician-Assisted Suicide (cont'd) When the person is terminally ill, in great pain, and has no chance of recovery, do American adults support the patient's right to choose to die? 17% disagreed 70% of all U.S. adults and 62% of those age 65 or older were in agreement availability of physician-assisted suicide? Physician-Assisted Suicide (cont'd) Physician-assisted suicide is worldwide issue Several countries tolerate this manner of suicide (e.g., Switzerland, Columbia, Belgium) Holland's Supreme Court stipulated conditions under which physicians cannot be prosecuted for assisting Making End-of-Life Intentions Known Living will: stating one's wishes about life support and other treatments Durable power of attorney for healthcare: person appoints someone to act as an agent for his/her healthcare decisions Both serve to clarify one's wishes about life-support interventions when the person is unconscious or otherwise incapable of expressing wishes organ donation and other healthcare options Making End-of-Life Intentions Known (cont'd) Do not resuscitate (DNR): should the heart or breathing stop, there is to be no cardio or pulmonary resuscitation Inform medical personnel that you have a DNR Let your relatives know what your wishes are and where you keep all relevant documents 16.2 Personal Aspects of Thinking about Death: Learning Objectives How do feelings about death change over adulthood? What legal and medical criteria are used to determine when death occurs? How do people deal with their own death? What is death anxiety, and how do people show it? How do people deal with end-of-life issues and create a final scenario? What is hospice? A Life-Course Approach to Dying The shift from formal-operational to postformal thinking presumably helps young adults integrate feeling and emotions with their thoughts about death May lessen feelings of immortality Their parents' death helps middle-aged adults think about their own death May lead to occupational changes or improving relationships A Life-Course Approach to Dying (cont'd) Older adults are generally less anxious about death and accept it more; partly due to achieving ego integrity less joy about living due to health declines greater acceptance of their mortality Young-old adults feel the most death anxiety because of the higher desired vs. expected discrepancy in number of years left to live Attachment theory is the best framework for understanding how adults deal with death and how they grieve Dealing with One's Own Death Dying "trajectories" vary across diseases causing different reactions to impending death Diseases such as cancer may have a terminal phase in which a patient may be able to predict and prepare for death Some diseases that do not have a terminal phase may create a condition in which a person's death could occur at any time Kübler-Ross's Theory Elisabeth Kübler-Ross pioneered stages in the dying process beginning with her 1960s' interviews with terminally ill patients, who were not always told they were dying, because death was not generally a topic of discussion experienced five distinct emotional reactions In fact, the five reactions can overlap, unfold in different sequences, plus there are individual differences in each stage's duration and each emotion's intensity Kübler-Ross's Stages of Dying Denial - shock, disbelief Anger - hostility, resentment ("Why me?") Bargaining - looking for a way out Depression - no longer able to deny, patients experience sorrow, loss, guilt, and shame Acceptance - acceptance of death's inevitability with peace and detachment Discussion of death helps to move toward acceptance A Contextual Theory of Dying Stage theories do not state what moves a person through the stages There is no single correct way to die People vary in how they approach Corr's four "tasks" or issues for the dying Bodily needs Psychological security Interpersonal attachments Spiritual energy and hope Death Anxiety Death anxiety: diffuse anxiety about death Terror management theory: our deeply rooted fear of mortality makes not dying the primary motive underlying all behaviors (e.g., taking care of ourselves, having & raising children properly) Older adults represent existential threats to younger and middle-aged adults Remind us of mortality, infallible bodies Remind us that ways in which we secure self-esteem (and manage death anxiety) are transitory Death Anxiety (cont'd) Death anxiety consists of several components Body malfunction, pain, being destroyed, nonbeing, interruption of goals, punishment, humiliation, rejection, and negative impact on survivors Each is represented at public, private, and unconscious levels Our public admission of death anxiety may differ greatly from our private or unconscious thoughts and feelings Death Anxiety (cont'd) Older adults may have less death anxiety because of their greater ego integrity tendencies to engage in life reviews different time perspectives higher religious motivation Men have more death anxiety than women Women are more fearful of the dying process Learning to Deal with Death Anxiety Enjoy what you do have without many regrets Adolescent risk-taking is correlated with less death anxiety Increasing one's death awareness (e.g., writing one's obituary, planning one's funeral) Death education can significantly reduce fear Presents factual information about death, dying, and advanced directives; increases sensitivity to others dealing with death Creating a Final Scenario End-of-life issues: discussing and formalizing management of life's final phases, after-death disposition of one's body, and lawful distribution of assets (e.g., through a will) Baby-boomers are far more proactive and matter-of-fact about these issues Final scenario: making one's choices known and providing information about how one wants his/her life to end, including the process of separating from family and friends Healthcare workers help dying patients create a final scenario The Hospice Option Hospice: assisting dying people with pain management and a dignified death (as opposed to hospitals or nursing homes) Hospices provide palliative care: focused on relief from pain or other disease symptoms Hospices emphasize quality of life Hospice's goal is to make the person comfortable and peaceful, but not to delay an inevitable death The Hospice Option (cont'd) St. Christopher's Hospice in England was founded by Dr. Cicely Saunders and is the model for modern hospices When no treatment or cure is possible, hospice care is requested; the family and the patient are viewed as a unit. May be inpatient or outpatient An emphasis is placed on patient dignity Hospice clients are more mobile, less anxious and depressed, visited often by families who take a greater part in the care The Hospice Option (cont'd) Questions to ask before opting for hospice care Does the person know his/her condition's nature and prognosis? What options are available to treat the person's current degree or type of disease? What are the patient's expectations, fears, and hopes? How well do the people in the person's social network communicate? Are family members available to actively provide terminal care? Is a high-quality hospice care program available? 16.3 The Grieving Process:Learning Objectives How do people experience the grief process? What feelings do grieving people have? What is the difference between normal and complicated or prolonged grief disorder? The Grieving Process Bereavement: the state or condition caused by loss through death Grief: the sorrow, hurt, anger, guilt, confusion, and other feelings that arise after suffering a loss (varies greatly) Mourning: culturally approved ways in which grief is expressed (fairly standard within a culture) The Grieving Process (cont'd) Grief involves choices in how we cope and actively involves acknowledging the loss's realty working through the emotional turmoil adjusting to an environment where the deceased is absent loosening ties to the deceased Grief is a process in which no two people grieve alike we must not underestimate how long people need to deal with various issues (at least 1 year is needed and 2 years are not uncommon) we learn to live with the loss and move on, rather than "recovering" from it Risk Factors in Grief Purported risk factors are kinship relationship, social support, mode of death, age, personality, religiosity, and gender Church attendance and spirituality may help coping Older people suffer fewer health problems, but social support reduces this age effect Anticipatory grief: going through a period of anticipating a loved one's death, which supposedly buffers its impact Helps those who disengage from the dying person Risk Factors in Grief (cont'd) When the mode of death is sudden, a strong attachment increases grief, but lessens guilt because of fewer unresolved issues Effects of kinship relationship? Grief is greatest when children die, followed by spouses and a parent Social support and mastery are more helpful for older than middle-aged adults Normal Grief Reactions Grief reactions vary in intensity, such as sadness-anger-hatred, confusion-helplessness-emptiness, loneliness-acceptance-relief Most common are sadness, denial, anger, loneliness, and guilt Grief work: psychological facets of coming to terms with bereavement People need space and time, and others should give them these Normal Grief Reactions (cont'd) Five themes of grief Coping: things people do to deal with grief Affect: emotional reactions and triggers Change: how life changes, including growth Narrative: survivors' stories about deceased Relationship: kind of person the deceased was and survivor's ties with him/her Anniversary reaction: sadness-related behaviors seen on the anniversary of the death, including dates of natural disasters Normal Grief Reactions (cont'd) Physiological reactions to grief? Widows: sleep, neurological, and circulatory problems Illness, declining physical health and use of services Severe depression in some cases, which SSRIs can help Normal Grief Reactions (cont'd) Expressions of grief differ with ethnicity and culture Ex.: Latino- more than European-American men express grief behaviorally Some cultures construct a "relationship" with the deceased (e.g., "ghosts," appearances in dreams) Grief normally peaks 6 months after death, but can continue 5 and even 50 years later Coping with Grief Two integrative approaches to grieving Four-component model The context of the loss The continuation of subjective meaning associated with loss The changing representations of the lost relationship over time The role of coping and emotion-regulation processes Coping with Grief (cont'd) Dual-process model (DPM) Loss-oriented stressors - stressors related to the loss itself (e.g., grief work) Restoration-oriented stressors - stressors present when adapting to the survivor's new life situation (e.g., finding new relationships and activities) Dynamic process in which bereaved cycle back and forth between the two processes, ultimately balancing the two Four-Component Model Two implications of four-component model Need to make meaning from the loss Extensive grieving is helpful, whereas avoiding grieving is harmful Grief work as rumination hypothesis: extensive rumination may actually increase distress Rumination is a form of avoidance (person is not dealing with real feelings or moving on) Chronically elevated depression is positively correlated with rumination 6 months post-loss Resilient people use effective coping methods, such as automated processes (distraction, attending to positive emotions) Complicated or Prolonged Grief Disorder Two types of distress distinguish this disorder from normal grief and depression Separation distress: isolation; preoccupation with, upsetting memories of, longing and searching for the deceased to the point of interfering with everyday functioning Traumatic distress: disbelief and shock about the death, experiencing the deceased's presence; mistrust, anger, and detachment from others Complicated or Prolonged Grief Disorder (cont'd) Sufferers from complicated grief report symptoms distinct from those associated with depression or anxiety Avoiding reminders of the deceased Diminished sense of self Difficulty accepting the loss Feeling angry or bitter Increased morbidity, smoking, and substance abuse Difficulties in family or social relationships 16.4 Dying and Bereavement Experiences Across the Life-Span:Learning Objectives What do children understand about death? How should adults help them deal with it? How do adolescents deal with death? How do adults deal with death? What are the special issues they face concerning the death of a child or parent? How do older adults face the loss of a child, grandchild, or partner? Childhood Preschoolers: death is temporary and magical 5-7 years: death is permanent, it eventually happens to everyone, and is less scary; reflects the shift to concrete-operational thought Typical reactions to death in childhood are regression, guilt for causing it, denial, displacement, repression, and wishful thinking about the deceased's return Older children: problem-focused coping and a better sense of personal control appears Children flip back and forth between grief and normal activity Childhood (cont'd) With adequate and loving care, support, and reassurance that it's ok to grieve, childhood bereavement usually has no long-lasting effects (e.g., depression) Being open and honest reduces children's difficulty with the concept of death The use of euphemisms such as "gone away" or "only sleeping" can confuse and cause literal interpretation Researchers believe attending a funeral or having a private viewing aids recovery Adolescence 40-70% experience the loss of a family member or friend during the college years Their first experience of death is particularly difficult and its effects severe, especially if unexpected Chronic illness, lingering guilt, low self-esteem, poorer school & job performance, substance abuse, relationship problems, and suicidal thinking Adolescence (cont'd) Adolescents try to find ways of keeping a dead sibling in their lives They continue to miss and love them Grief does not interfere with normative developmental processes They experience continued personal growth similar to nonbereaved adolescents Adulthood Young adults may feel that those who die at this point are cheated out of their future Also made difficult when peers ignore their grief, tell them that grieving is not good, or to get on with their lives Loss of a partner in young adulthood is very difficult because the loss is so unexpected and grief can last for 5-10 years Losing a spouse in middle adulthood results in challenging basic assumptions about self, relationships, and life options Death of One's Child in Young and Middle Adulthood Mourning is intense; some never reconcile the loss, and parents may divorce Young parents who lose a child to SIDS report high anxiety, more negative view of the world, and guilt Loss of a child during childbirth is traumatic due to strong attachment, even though society expects a quick recovery Middle-aged parents' loss of a young adult child is equally devastating, causing anxiety, problems functioning, and difficulties in relationships with surviving siblings upwards of 13 years later Death of One's Parent When a parent dies, the loss hurts but also causes the loss of a buffer between ourselves and death; we may feel that we are now next in line. Death of a parent may result in a loss of a source of guidance, support, and advice The loss of a parent may result in complex emotions including relief, guilt, and a feeling of freedom Important to express feelings for parents before they die Losing a parent due to Alzheimer's disease may feel like a second death Late Adulthood Older adults are often less anxious about death and more accepting of it Elders may feel that their most important life tasks have been completed Older adults are more likely to have experienced loss before Death of One's Child or Grandchild in Late Life Older bereaved parents may feel guilty about how their pain about losing one child affected relationships with surviving children Many grieving parents report that the relationship with the deceased child was the closest they ever had Bereaved grandparents tend to hide their grief behavior in an attempt to shield the grieving parents from more pain Death of One's Partner U.S. society expects the surviving spouse to mourn briefly, but older bereaved spouses may grieve for 30+ months A support system's helpfulness depends on whether the bereaved wants contact who is willing to provide support whether the support is of high quality Depressed survivors' memories of the relationship are positively biased, whereas those of the non-depressed are more negative (may reflect pre-death quality of the relationship) Death of One's Partner (cont'd) European-American wives who highly value this role "sanctify" their dead husbands Helps the widow believe the marriage was strong and that she is a good & worthy person who can rebuild her life Reduced hopelessness, intrusive thoughts, and obsessive-compulsive behavior occur when older bereaved spouses actually express their feelings Cognitive-behavior therapy helps coping and making sense of the loss Gays and lesbians experience grief plus negativity from the deceased's family members

n/a