HDFS3710 TEST 4
When children reach the age at which they enter adulthood, they and their parents experience a phenomenon
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How was the building site for St. Mary's hospice center funded? How long did it take to complete the building process?
Donations ONLY; no funding from state-level
What is secondary trauma?
Indirect exposure to a traumatic event through a first hand account - often experiences by therapists
The least amount of nursing services is provided in what type of in-patient facility for older adults?
Intermediate care
What is an issue of the Balm of Gilead utilizing boarding homes for patient placement?
The idea that the ratio of caregiver to patient isn't one to one due to this they can experience burnout
List the top five deficiencies noted in the 1997 survey of U.S. nursing homes. Why do you think these problems exist?
These are infection control, accident environment, food sanitation, quality of care, and unnecessary drugs (over prescribing). For the exam you won't have to worry about the second half of the question.
The people who think life is ___ are 20% happier
long and easy
The role of grandparenting to aging individuals is shown by researchers to:
positively contribute to the grandparent's well-being
A woman would like to have her mother cared for in one of the best nursing homes in her town, but is unable to afford the cost which, for a private pay facility would be about $______________ per year.
$75 thousand
Summarize the five stages of dying in the theory of Kübler-Ross. Describe four criticisms of the theory.
-Denial -Anger -Bargaining -Depression -Acceptance -The critical point Kubler-Ross failed to make is that to reach acceptance of a fatal illness, the dying person must be allowed to talk openly about their illness
What are some of the vulnerabilities of older adults' social relationships (think about concerns such as unavoidable conflict)
-Early life experiences will influence ability to have close, positive network (For example, think attachment, coping skills, and social competency) -Some social network members cannot be avoided (May be a source of conflict) -Experience the loss of disruption of close relationships that are beyond one's control
What are some of the strengths of older adults' social relationships (think about the size and ability to negotiate conflict)?
-Social network ties tend to shrink with age= Emphasis placed on most rewarding contacts, Fewer but more emotionally close social relationships, Shift to emotional support relationships -Handle negativity more proficiently= Successfully manage conflict when it occurs, Leads to less negativity and more positivity in life - gaining and reaping health benefits
What is the difference between social network compensation and social network substitution?
-social network substitution: referring to the extent to which bereaved individuals derive support and companionship from alternative sources -social network compensation: referring to the extent to which these alternative sources of support and companionship boost emotional and physical health
What is the approximate percentage of grandparents raising grandchildren who are 60 years and older?
14%
.Pizzi discovered three sub-categories in the analysis of the interviews on the topic of promoting health and well-being at the end of life, what were these three categories?
Adaption, Client- goals, Choices
The majority of employees of nursing homes fall into which category?
Aides
What is the first priority of the Balm of Gilead palliative care services?
Alleviate physical pain and discomfort
What are the traits that are commonly associated with mature defense mechanisms (hint: see page 2 of the article)?
Allow for better modulation of distress while maintaining engagement with reality
Home health services typically include what types of support for older adults?
Assistance to older adults within their own private homes
In Ancient Egypt, the ____________________ was considered to be the guidebook to ensure that an individual would be guided through the underworld and into the afterlife.
Book of the Dead
Where do the amount of activity and cognitive demands placed on the individual fit within the competence-press model?
Both are considered aspects of competence
Discuss the implications of the competence-press model for the design of nursing home environments
Competence may be defined in terms of biological and psychological characteristics, such as mobility and cognitive resources. The social factors in this model are incorporated into the level of press in the environment, which include the expectations of staff and amount of stimulation provided by other residents.
Who fore fronted the hospice movement in US?
Coobler or (hoobler) Ross
What is one given reason for why age is relevant when considering the relationship between marital quality and health?
Cumulative marital strain has more apparent health consequences for older adults Older adults are more susceptible to chronic illnesses, marital strain may increase the vulnerability to these illnesses Marriages become more meaningful as we age
In the Blue Zones and Longevity video three countries were focused on, Denmark, Singapore, and Costa Rica. Describe what the people in each country do to contribute to their high longevity rates; what makes these people happy and health?
Denmark: mjost trust Singapore: order, racial equality, home ownership, benevolence; everyone owns their own home; fair wages Costa Rica: positive affect and attitude ** Living in environments that make the healthiest choice the easiest choice - walkable, fresh produce is easily accessible
The DSM-5 considers extreme grief past a 2-week period following the loss of a close relative or friend to fit the criteria for which disorder?
Depression
What do DNR and AND stand for?
Do not resuscitate; allow natural death
What are key points and concepts to the hospice philosophy?
Embraces a holistic approach that includes physical, emotional, and spiritual concerns
How did the participants discuss client goals?
Ensuring to plan goals and meet people's needs that are important from the perspective of the client and family. Acknowledge the individuality of the patient, validating the client as a human with needs
True or False: Hospice care requires that family be defined and limited to only immediate blood relatives?
False- whoever they define
The majority of nursing homes in the U.S. fall into which category of ownership?
For-profit facilities
What are the important personality traits or country beliefs in Denmark, Singapore, and Costa Rica? What 4 things do these countries have in common?
Generosity, tolerance, social, and trusting
What is a key common theme to the places that have the happiest and healthiest people?
Generosity, tolerance, trust and social **Four key ingredients to healthy diet: grains, greens, beans, nuts Can increase life 4-5 years
How did the participants discuss choices?
Giving clients a choice is a source of empowerment, Having choices is a freeing experience when the patient may feel that their life is in turmoil or disarray, Allows client to express themselves
The sibling relationship in later adulthood is unique because siblings typically:
Have known each other longer than anyone else in their lives
What type of care is provided in an intermediate care facility?
Health-related services for people who do not need hospitalization or skilled nursing care (PT for hip, knee surgery, etc.)
Which type of care for older adults provides such services as Meals on Wheels, friendly visiting, assistance with household tasks, and rehabilitation, outside of an institutional setting?
Home-health services
What are the components (i.e. individual, microsystem, etc.) of an ecosystemic framework? Briefly describe each.
In late life, and individual undergoes physical, psychological, and other aging-related health changes that affect their sexuality in this stage. For example, some undergo hormone changes that reduce the production of sex hormones, making sexual activity less appealing. This may also be the case for some other physical changes that make activity harder and more painful. The microsystem for an individual in later life includes family members and caregivers. They have earned this spot because they directly interact with the individual in their environment, which in this case would be their home or a health-care facility. Family members can include a partner as well. The Mesosystem in Bronfenbrenner's Ecological Systems Model includes connections between two or more microsystems. In later life, this would include interactions between family members and health-care practitioners. One suggestions the article gives is for health-care providers to use the PLISSIT model to make discussing sexuality easier and less tabooed. The PLISSIT Model includes offering permission, limited information, specific suggestions, or intensive therapy to patients, which supports communication about sexuality between partners and also caregivers. The Exosystem includes anything that indirectly affects the individual, but still has an impact. The example given in the article is the media, because it may affect the caregivers' perspectives on later-life sexuality and intimacy, which affects how the view their patients. An intervention mentioned for the exosystem is to write letters to the media about their depiction of later-life sexuality, as well as offering sex education courses for older adults. The macrosystem includes society's attitudes and ideologies that affect the individual, in this case one in the later stages of life. The article states how much of society believes that those in the later-life stage should not be engaging in intercourse, when that is not necessarily true. The limits older adult's "sexual freedom," which can hurt their intimacy and sexuality with their partner and can have other worsening psychological effects.
Were there any reported gender differences in the effects of marital quality on health
In the Umberson and colleagues (2006) study, "You make me sick", there were no reported gender differences. The authors hypothesized there would be, but results did not show any.
Discussed in the guest lecture was a key sign or trigger that is often associated with the beginning phases of the dying process - what was this sign/trigger?
Individuals in hospice care lose appetite
What perspective or theory did Umberson and colleagues work from in their study on the effects of marital quality and health over a lifetime?
Life course perspective
What are some of the eligibility requirements for entering hospice?
Life-limiting illness with a prognosis of 6 months or less; Care by a GA licensed MD or out Medical Director will assume care of patient; Resides in the service area; Primary caregiver or alternative home arrangements; Provides medical treatment of distressing symptoms but does not provide interventions to cure disease or prolong
Who covers costs associated with hospice?
Medicare/medicaid
Which psychological disorders are most prevalent among residents of nursing homes?
Mood and Anxiety
Describe in detail the 9 traits (i.e. what are key components of the common theme, diet? Or what are the elements of the common theme of socialization?)
Move naturally (exercise), Know your purpose, Downshift, 80% rule (80% of diet is grains, greens, nuts, and beans), Plant Slant, Wine @5, Family first, Belongingness (3 people to have meaningful conversations with), Right Tribe (who you select as friends determines who you are as a person)
What are the 9 common traits of locations with the happiest and healthiest people?
Move naturally (exercise), Know your purpose, Downshift, 80% rule (80% of diet is grains, greens, nuts, and beans), Plant Slant, Wine @5, Family first, Belongingness (3 people to have meaningful conversations with), Right Tribe (who you select as friends determines who you are as a person)
What were some of the acceptable places of residence for receiving hospice care? What was mentioned as an unacceptable place of residence (i.e. they were ineligible to receive hospice care)?
Personal home, assisted living facility **homelessness is not an acceptable form
What was the overall purpose of this article? What were they trying to test?
Personality characteristics relate to physical health. Wanted to examine the relationship between the adaptive defense mechanisms in midlife and objectively assessed physical health in late life
Couples in long-term relationships characterized by emergent distress show which pattern of conflict over time?
Poor communication patterns (defensiveness, withdrawing, stonewalling, and viciousness)
Older adults in the Living Apart Together relationship status do so primarily because of which consideration?
Preference to stay in separate households, concerns about finances and caregiving
Within the competence-press model of adaptation to the institutional environment, which dimension captures the extent to which the environment places demands on the individual resident?
Press
List and describe the levels of hospice care provided:
Routine- someone who can live at home respice- to give caregiver a break General inpatient - someone who is living in a hospice house and needs around the clock care Continuous-around the clock care in home during a crisis.
A hospital social worker decides that one of her patients, an 82-year-old man who is recovering from a stroke, needs to be in a facility that provides him with rehab, round-the-clock nursing care, and help with planning his return to his own home. These kind of services are likely to be found in which type of long-term care facility?
Skilled nursing facility
What variable did the authors think would mediate the relationship between adaptive defense mechanisms and late life health?
Social Support
How do older adults navigate the loss of a close social tie (think about substitution and compensation as well as actively seeking new contacts or not)?
Social network substitution and compensation
Based on socioemotional selectivity theory, members of a couple in a long-term relationship should show which pattern of social interaction in relation to their friends and social network?
Spend more time with their partner than investing in new relationships
What are mature defense mechanisms considered to be according to this article?
Sublimation, suppression, anticipation, altruism, humor
According to the perspective known as _______________________________, activating a person's thoughts about death may trigger a set of positive changes, including closer relationships, greater creativity, and more connection to others.
Terror Management Theory
What model that has been discussed frequently in lectures best represents the goals of the Balm of Gilead?
The Biopsychosocial Model
Why focus on intimacy in late life?
The article states that intimacy was chosen as a focus because it is a very important part of life for every age, but it becomes even more important towards the end of our lives, because our time left with those close to us is limited.
What best represents the definition of caregiver burnout?
The state of physical, emotional, and mental exhaustion - may be accompanied with a change of attitude
What are the four major categories of community-based services and facilities?
These include home health services (i.e. meals on wheels, support visitors), Geriatric partial hospital, adult day care, and community housing alternatives (i.e. government assisted housing, continuing care retirement community). For chapter 12 I would recommend focusing on knowing the differences between the varying types of nursing homes, understanding the competence press model, and what home health services include.
What framework did the authors work from? Why was this framework used?
This study used an ecosystem framework so that they are able to provide suggestions for fostering intimacy throughout all levels of Bronfenbrenner's Ecological Systems Model. This is important because most interventions of this type only focus on the smaller levels of the model.
What was the overall goal of this article? "Intimacy at the End of Life" Morissey-Stahl Article
To provide and discuss the importance of caregivers to foster intimacy in the later life of their patients, and to make it less "taboo"
Soon after becoming widows, research shows that women exhibit which of the following behaviors that relate to their health?
Worse diet, less exercise, increased drinking and smoking
The relatives in a young woman's family see each other only for major holidays and family events on average about two or three times a year, even though they live within 30 minutes from each other. Based on this information, you would rate this family as on the negative end of which dimension of the Intergenerational Solidarity Model?
associational
According to the ______________ view of bereavement, the bereaved can continue to benefit from maintaining emotional bonds to the deceased individual.
attachment
The phenomenon in families known as "doing gender" describes what happens when parents:
behave in stereotypically gendered ways
The "anniversary reaction," as applied to widowhood, refers to the:
bereaved experience of a renewal of their feelings at or around the time of the spouse's death
Mental health workers who serve the older adult population are concerned about the skip generation family because they believe it has the potential to:
cause stress and strain to the grandparent
What was the overarching theme that emerged from the qualitative data on the study of promoting health and well-being at the end of life?
client-centered care is important approach to end-of-life
What was the overall outcome for Pizzi's () study on promoting health and well-being at the end of life (hint: what was the takeaway message?
client-centered care is important approach to end-of-life; provides clients with opportunities to say how they will live their lives until the end of that life
According to the __________ parents tend to give more support to their adult children who need the most help.
contingency theory
The idea that Western culture is unwilling to accept the reality of mortality led Ernest Becker to write the critique of this attitude, called:
death with dignity
The situation in families when parents and their adult children no longer want to be with each other and, in fact, no longer value the relationship is known as a(n):
developmental schism
In a test of the intergenerational solidarity model, researchers found that siblings were likely to exchange more help with each other when their parents:
did not provide enough support for their children
Siblings in later life who exchange more help, according to research on a Netherlands sample, are likely to have had parents who:
did not provide enough support to their children
A couple who had initially seemed destined to remain together for years, if not decades, surprised their families when they announced their impending divorce. Neither of them could cite a particular problem; it's just they felt they grew apart. This pattern of long-term relationship is known as:
disillusionment
Because many adults enter into remarriages more likely to leave because they are open to the relationship's ending, they are said to be high on the factor known as:
divorce proneness
A meta-analysis of studies on satisfaction among couples before and after birth of the first child showed that, compared to non-parents, the parents:
experienced a slight decline in marital satisfaction
Research on satisfaction in close, long-term relationships shows that the couples who are most likely to get along well in their later years were those who:
expressed their love through affectionate behaviors, enjoyed being together, and made sure that they spent time together
A young woman feels that her parents treated her too much like an adult when she was growing up, giving her more responsibility than even she felt she could handle. This situation reflects a relationship characterized by:
filial maturity
The greatest degree of _________ is likely to be experienced by Asian American families.
filial obligation
The phenomenon known as doing ____ occurs after the transition to parenthood, when men and women adopt more stereotyped roles in the household.
gender roles
In equity theory, partners are seen as having the highest marital satisfaction if they:
get out of the relationship what they are putting into the relationship
Being able to die in a way that protects the individual's sense of autonomy and control over end-of-life decisions is consistent with the idea of:
good death
How did participants discuss adaptation?
how they adapt skills, routines, habits, or environments for people at the end of life AND how these adaptations can create a climate of trust, develop rapport, and establish well-being for people
The number one deficiency in U.S. nursing homes in 2014, involving 43% of all institutions, was:
infection control
How does Socioemotional Selectivity Fit into the study of older adults' social networks?
interactions with close ties provides emotional and health related benefits, evoking more positive and less negative emotions
Health-related, but not intense nursing services are provided in a(n) ______________ facility.
intermediate care
Moving dying patients from the home to hospitals in mid-20th Century Western culture has led to the ethos of the _____________ death.
invisible
A woman grieving after the sudden and unexpected death of her husband is engaged in the "restoration" function of bereavement. This means that she
is adapting to the practical changes in her living situation, including taking on new tasks or functions
An advantage of the Green House model of institutional care for older adults is that it:
is designed to feel like a home
The healthy lifespan refers to the length of time that an individual can:
live without significant disease and disability
According to Umberson et al (2006)______ accelerated typical decline in self-rated health that occurs over time.
marital strain
Since 1970, of the following, there has been the greatest decrease in U.S. households that fall into the category of:
married couples with children
The ______________________ is the length of time an individual can live without significant disease and disability.
maximum health expectancy/healthy lifespan
A couple in their 30s is thinking of getting married. One partner is very outgoing and sociable, and the other is introverted and shy. According to the____________________ hypothesis on long-term relationships, they should be very happy together.
need complementarity
Couples who divorce seem to adapt best if, in the process, they protect each other's sense of identity, in what's referred to as:
not losing their "face"
What age group were the effects of marital quality most pervasive for individual health (i.e. when poor marital quality was reported what age group had the worst health effects?)
oldest populations
A study in the Netherlands of parents and adult children testing the Intergenerational Solidarity Model showed that when parents had poor relationships with their children, the siblings:
provided more support for one another
The concept of defenses originated from __________ tradition
psychoanalytical tradition (remember Freud and Valiant)
Women who adapt more favorably to widowhood tend to be those women who:
show resilient grief
The balm of Gilead has recently received support from what type of facility for patient placement that will provide more 1-to-1 care?
skilled-nursing homes
A new administrator in a nursing home in a large city is concerned because the staff are not providing what she feels is adequate training in bladder continence. She feels this should be a priority because she knows that incontinence is associated with which problem in nursing home residents?
social disengagement
The _______ approach to marital satisfaction predicts greater happiness when couples engage in positive behaviors such as expressing affection.
socioemotional selectivity
What is palliative care?
specialized medical care for people with serious illness
The intergenerational stake hypothesis about families with adult children proposes that:
that parents are higher in affectual solidarity toward their children than children are toward their parents; parents more likely to try to resolve parent-child conflicts
A middle-aged man was disappointed that his family reunion was spoiled when the older relatives clashed with the younger relatives about the most recent presidential election. No matter what he did, it was impossible for him to get each side to see the other's point. According to the Intergenerational Solidarity Model, the generations were separated by:
the consensual dimension
A marriage therapist working from the social exchange theory of interpersonal relationships would attempt to assess whether the partners in a distressed couple feel that:
the rewards of the relationship outweigh the costs
Couples who cohabitate before getting engaged will have a higher divorce rate should they marry. The most likely contributing factor is that:
they "slide" into marriage instead of deciding to marry
What is an ambivalent social relationship?
those characterized by both positive and negative patterns of interaction
Those who study death and dying believe that the main outcome of the work of Kübler-Ross was her emphasis on
to reach acceptance of a fatal illness, the dying person must be allowed to talk openly with family members and health care workers.
A study of Canadian parents showed that the greatest difficulty in adapting to the empty nest was experienced by parents who:
were wrapped up in their parent identity, feeling as if they were losing control over children, had a small number of children, lacked a support network, and worried about their children
The Theoretical Model of Strength and Vulnerability Integration is focused on what?
when older adults are unable to avoid or mitigate situations that kindle high and sustained levels of distress, they are likely to experience arousal that will challenge their aging systems and compromise their physical and emotional health; body can't handle stress anymore
The _______ effect refers to the fact that widows are more likely to die after losing their spouse.
widowhood
