psy 231 final

where one ends their life:

- 90% wish to die in their own home - 1/4-1/5 actually do - hospital - long term illnesses - nature of hospital, caretakers responsiveness, nature of illness - hospice: palliative care, comfort care - not promote life but ease transition to death - tremendous amount of support for those saying goodbye - the dash (2002 - 2052) the "inbetween" - right to die - controversial - if i am suffering, i should be able to seize my suffering - it's considered enduring to put down pets, relieving them from suffering - euthanasia: purposely ending a loved one's life (in animals, NOT in humans) - passive euthanasia: unplugging family member from life support/saying they don't want to be a vegetable (having a DNR: do not resuscitate) - voluntary active euthanasia: choose to go to the medical provider and choose to terminate one's life - legal in 10 states - medical support of a doctor to terminate self - must have a terminal illness, dying within months, must have been diagnosed for a long time, may meet with a therapist to see if that's what they really want - living will: you are able to express desires for medical care - can modify - otherwise, strangers will be making those for you - recommended for spouses/parents

watching their parents decline: "sandwhich gen"

- how often do they see each other? - what do they do when they see each other? - "sandwich gen" taking care of parents and kids at home - daughters and children who live close will fill those roles

time to work:

- increase in job satisfaction - increases for men are more prominent than in women and ethnic minorities - glass ceiling - career change: likely related to a desire for increased satisfaction - planning for retirement

influences on accepting death:

- appropriate death - 21y/o vs. 98y/o - hard loss, may be unfair (unique illnesses), children/babies vs. sick long term or very elderly - nature of disease - really sick vs. suicide - different if not related to illness - individual personality characteristics - problem focused coping: keeping busy - emotion focused coping: more emotional response - family member and health provider's b/h - communications in last moments - responses may make it harder for those saying goodbye - please don't go vs. it's okay, it's your time - blunt vs. empathic - spirituality, religion, culture - the more death is talked about, the less scary it may be - practicing religion/cultural values may differ in comfortability with death

4. Summarize typical grief reactions to the loss of loved ones and the influence of development on bereavement.

- bereavement: a state of loss, triggers - grief: which includes an array of emotions such as hurt, anger, guilt and confusion - mourning: refers to culturally patterned ritualistic ways of displaying and expressing bereavement, including special clothing, food, prayers, and gatherings - first step: organize a funeral or other ritual to make the occasion of loved one's death THE GRIEF PROCESS - people vary in the intensity of their reactions to loss and in the timing of their reactions - varying losses - intense but short lived grief - grief lingering for months - may seem to resolve only to resurface periodically - grief is experienced and expressed in many way,s in emotions, physical sensations and behaviors - physical responses such as tightness in the chest, feeling out of breath, stomach pains, and weakness are common manifestation of grief - a range of emotions, from anger, anxiety, loneliness, guilty, helplessness, and even relief occurs - behaviors such as looking for person in crowds and familiar places, absentmindedness, sleep problems, avoiding reminders of the deceased and loss of interest of common - grief: an active coping process in which the grieving person must confront the loss and come to terms with its effects on his or her physical world, interpersonal interactions, and sense of self - most importantly/difficulty: the grieving person must adjust to life without the deceased - must adapt by establishing new patterns of behavior and redefining relationships with family and friends in the light of the loss - the grieving person must construct a new sense of self that takes into account the loss of the deceased and how that loss has changed everyday life - attachment is illustrated in several behaviors common among the bereaved, such as feeling that the deceased is watching over them, keeping the deceased's possessions, adn talking about the deceased to keep their memory alive - successful adaptation entails moving toward abstract manifestations of attachment, such as thoughts and memories, and away from concrete manifestation, such as possessions - grieving appears to involve learning to live with loss, rather than getting over loss MODELS OF GRIEVING - people may traverse through several phases of mourning from shock, to intense grieving, to establishing a sense of balance, accommodating the loss into one's sense of being - the progression through grief is not linear; steps do not always occur in sequence, and there is no universal timeframe for processing grief - the bereaved person must accept the reality of the of the loss, experience the pain of grief, adjust to a life without the deceased, and develop a new life while maintaining an enduring connection to the decreased - fulfilling roles can help many bereaved adapt productively by developing new skills and growing - dual-process model of grief: bereavement accompanied by two types of stressors - the first loss is oriented and comprises the emotional aspects of grief that accompany the loss of an attachment figure, such as managing emotion sand breaking ties to the deceased - secondary losses are restoration-oriented stressors; life changes that accompany the death, such as moving to a different residence, social isolation, establishing new roles, and managing practical details, such as paperwork - at any time the freiving person may focus on the loss oriented stressors or the life changes that comprise the restoration-oriented stressors - healthy adjustment is promoted by alternating focus between the two types - when the person is able, he or she confronts the losses yet at other times the person may set the task aside to instead consider restoration - in this way, the person adaptively copes as he or she is able, gradually moving forward - some bereaved individuals experience overload: many losses, too many stimuli, too many stressors, and this can interfere with the grieving process CONTEXTUAL INFLUENCES ON THE GRIEF PROCESS - deaths are interpreted and grieved differently based on: age of the decreased, the nature of the death, and age of the bereaved - the death of a child or young adult is grieved more intensely and is viewed as more catastrophic than that of an older adult - the young are grieved more intensely as they are viewed as robbed of he change to experience life events such as falling in love, becoming a parent - not able to set and fulfill dreams - generally, off time deaths, especially those that occur much before expectations, are particularly difficult - sudden, unexpected deaths are particularly challenging - mourners are unprepared with no support group in place - often no chance to say goodbye or mend relationships - agner is common, especially if the descesaded contributed to their loss through poor decisions - traumatic deaths, such as from natural or manmade disasters, can leaves losses that are difficult to make sense of - feeling that death is traumatic is associated with increased grief, depression and loneliness - when the death is the result of a prolonged illness, it is no surprise yet it is still a source of grief - people grieve losses as they happen - knowing that death is to come permits the dying to make decisions , tie loose ends, and strengthen relationships - many people believe that having the time and opportunity to prepare for loss will be less distressing, although research finds this to be incorrect - all deaths are stressful, just in different ways ADJUSTING TO DEATH OF A LOVED ONE: losing a spouse: - widowhood: refers to the status of a person who has lost a spouse through death and has not remarried - women who have lost a spouse (widows) live longer than men (widowers) and are less likely to remarry - widows have lost the person closest to them, a source of companionship, support, status and income - widowhood poses a challenge of re-negotiating a sense of identity in the light of the loss of the role of spouse, often the most long lasting intimate role held in life - women who have a myriad of roles apart from spouse to tend fare better in adjusting to the death of a spouse than do women who have few roles, predominantly centered around their husbands - after becoming a widow, most older adults live alone, often in the same home - those who relocate often do so for financial reasons, and they tend to move closer to children and grandchildren - the greatest challenge widows and widowers face is loneliness - although widowhood marks the loss of a confidant, older adults often maintain and even increase their social participation following spousal loss - maintaining close relationships with family and friends give widows a sense of continuity, which aids adjusting to their loss - bereaved adults show increased levels of depression, anxiety, stress and more poor performance on cognitive tests measuring attention, processing speed, and memory - social interaction, and especially helping others, dies in reducing depressive symptoms - widows who help others by providing instrumental support show an associated decline in depressive symptoms for 6-18 months following a spousal loss, and men and women typically return to pre-widowed levels of depression within 24 months of being widowed - widowhood effect; the increased likelihood for a recently widowed person to die - has been found among men and women of all ages throughout the world - increases survivor's risk of dying from almost all causes but is especially linked with cardiovascular problems - the cause of spousal death matters, the mortality rate for widowed adults following spouse's death from Alzheimers and Parkinsons disease is lower, suggesting that anticipatory grief may provide a buffer from the widowhood effect - this suggests that it may be the the predictability of the death rather than the duration of the spouses terminal illness that shields the survivor from some fo the adverse consequences of bereavement - men tend to show more health problems, including an increased risk for dementia, and higher rates or mortality - men tend to sustain a high level of depression 6-10 years after losing a spouse - widowers of all ages are at higher risk risk suicide than their married counterparts - men often rely on their spouses for maintaining relationships with friends and family, managing household tasks, and assistance in coping with stress and managing emotions, and when the wife is no longer present to fulfill these roles, men tend to have difficulty asking for assistance - widowers are more likely to remarry than are widows, partly because there are for more single elderly women than men, but also because men have fewer social outlets and sources of support than women - the degree to which a spouse adapts to widowhood is influenced by - circumstances surrounding the spouse's death and their age - death of a spouse following a long illness such as cancer or Alzheimer's disease can evoke complex emotional response because such illnesses involve drastic physical and mental deterioration and intense demands for caregiving - in such cases, the spouse may feel relief from watching a partner slip away and from the pressures of caregiving - complex intermingling of sorrow and lreief may be confusing, and the widowed spouse may feel guilty - losing a spouse in young or middle adulthood consistents of unfulfilled roles, unfinished business, and an unlived life that can make adjusting to an early widowhood espeically difficult - younger widowed adults are likely to have been married fewer years than older widowed adults, and they probably have greater responsibilities for dependent children and jobs - these responsibilites can be stressful, but ont he positive side, children adn coworkers may provie comfort and emotional support to young widowed adults - resilience can vary in adults - those who are outgoing, have high self esteem, and have a high sense of perceived self efficacy in manging tasks of daily living tend to fare best - losing a spouse may pose lifelong challenges to physical and emotional health losing a child: - the most difficult of deaths to grieve is the loss of a child - it violates the prescribed order of natural life and comprises the continuity of the family life cycle - parenthood is a developmental achievement that provides a sense of purpose and engenders a sense of identity in people - for parents, the loss of a child entails the loss of self and loss of hopes and dreams for the child and the future - parents grieve what could have been and what did not occur, the life their child did not have. - in this way, they lack a sense of closure - age has little effect on severity of grief - parents, especially mothers, often experience severe grief after miscarriages, stillbirths or the loss of a young infant - parents of neonates and young infants grieve for the infant and the lost attachment but also the lack of memories and being robbed of the opportunity to become a parent - parents may question their adequacy in providing care - especially true is causes of death are not understood, like SIDS - lost of a child is associated with short term and long term problems in physical health, mental health, and even mortality - bereaved parents tend to experience grief over a longer period than other bereaved people, with grief symptoms often lasting throughout the remainder of the parent's life - parents often have difficulty finding meaning in their loss as the loss of child is often perceived as "senseless" - transforming their identity as parent represents a crisi as adults must reshape their sense of purpose, identity, and legacy - mourning a child appears to be a lifelong event for most parents - older adults who have lost a child many years ago report the loss as their most negative life experience losing a parent: - it is the loss of a lifelong relationship, attachment and shared experiences - adult children who acted as caregivers for their parents have devote much time and energy to care for their parent, often organize their lives to provide care - the loss of a parent may cause further household upheaval, and the adult child may be unprepared to redirect his or her attention, efforts and time - feelings of guilty and fear that has not provided adequate care may be combined and heightyend if the adult child felt overburdened by the level of care - adult children amy mourn lost opportunities to improve relationships and make amends for unfinished business - the loss of a parent influences adults' sense of self - often enhances adults' feelings of mortality as the loss of parents marks adult children as the oldest generation - the parents are no longer the buffer or generational protection against old age and death - the death of a parent often sparks a shift in development, causing adult children in development, causing adult children to alter their sense of selves and realize their responsibilities to others - can impact a sense of generativity to the next generation - some experience tension between grieving and parents death and facing their own death and their own grief over perceived lost opportunities - siblings must reevaluate the meaning of family and their roles without the grounding role of their parents - the pattern of sibling relationships over the lifespan tends to intensify, such that good relationships often get better and, without the parent, poor relationships may worsen or disrupt - a parent's death changes the fabric of family relations BEREAVEMENT IN CHILDHOOD AND ADOLESCENCE - cognitive and socioemotional development influence how children and adolescents understand, make sense of, and adjust to loss childhood: - children's grief is uniquely affected by their developmental level, including cognitive and socioemotional development, as well as their understanding of the nature of death - children's first experience with death is often a grandparent - how this affects the child depends on his or her proximity to and contact with the grandparent - children with close relationships to grandparents, who experience their grandparents as caregivers and sources of unconditional love, are more likely to find death traumatic than are children whose grandparents live far away and with whom they have less contact - many children find seeing parents and other adults upset distressing, perhaps increasing their sense of loss - many wonder if they caused the death to happen or if the loved one "went away" because of them - the degree to which children feel and express the fear that the death is somehow their fault varies with development - this is true in children who are least able to understand the nature of death - this is especially true in the case of sudden and accidental deaths - children also worry about who will take care of them - if they conceptualize death as magic, they have fear that they are in danger - in cases of natural disasters and terror attacks, children may feel worry about threats to themselves and family - the replay of such disasters on TV may intensify anxiety - bereaved children may experience grief for a longer period than do adults as they must grow up with the loss, their developmental milestones are affected, and the death robs them of emotional support from caregivers - many children strive to maintain a connection to the deceased parent by talking to him or her, feeling that the parent is watching them, dreaming of the parent, and holding on to symbolic objects- particular dolls, pictures or the parent's possessions - bereaved children need support, nurturance, and continuity in their lives - they need accurate information about the death and to have their fears addressed - children want to know that they will be cared for - adults should reassure children that they are not to blame, as well as provide support and listen - children, especially younger children, will often require help in understanding and managing their conflicting emotions - engaging in routine activities can help children gain a sense of normalcy despite all of the changes - adults should attempt to model healthy mourning by sharing their own grief and providing an example on of how to experience grief in constructive ways bereavement in adolescence: - adolescents' advancing cognitive abilities and their merging sense of self influence how they grieve - adolescents who lose a parent tend to feel intense loss, isolation, and the sense that the parent is irreplaceable and that loss cannot overcome - adolescents may be plagued by a strong sense that life is unfair - they are at risk to suffer social interpersonal difficulties in adjustment, including internalizing symptoms such as anxiety and depression, yet often show a strong desire of others to include them and take interests in them -their sense of grief is often influenced by their ability to understand and manage their emotions as well as their experience of egocentric thought - the existence of the personal fable may lead them to view their grief as unique and incomprehensible, that others could not understand and certainly do not feel the way they do - commonly display intense emotional outbursts that are brief but cyclical, punctuated by period during which they resume normal activity - alternatively, some may suppress their emotions altogether, out of fear of a loss of control - may retreat into themselves, reading and listening to music, or the may act out, engaging in risky behaviors - with each developmental shift, adolescents must reinterpret the death in the light of their new cognitive and emotional understanding - the task of grieving intertwine and potentially interfere with the normative developmental task of adolescence, such as developing a sense emotional autonomy as well as intimate relationship with friends - the grieving adolescent may find it challenging to develop a sense of autonomy while maintaining connection to the deceased parent, resulting in distress and often guilt - young adolescents who are concerned with pere acceptance may be reluctant to share their grief with friends, whereas middle and older adolescents who have form formed intimate relationships with peers may find that support from friends can help them work through their pain - if their friends do not understand their pain or are rejecting, the adolescent may be devastated and grieve not only the loss of the parent but of his or her friends too - bereaved adolescents need adults who are open to disccsing whatever they would to peplxore and who are careful listeners - grieving adolescents commonly worry that they will forget the person they have lost - adults can help them to find ways to remember the deceased and make meaningful connections that retain their attachment with the deceased loved one

psychological well being

- control vs. dependency - those who can maintain control: more positive outcomes - those who can't maintain control: can be a very challenging transition - lots of differences - those who choose to dependent will be an easier transition - health and its connection to psychology - declining result in depression - the elderly now may be dealing with psychological issues - recognizing mental health influences physical outcomes - positivity is associated w/ more positive outcomes - negative life changes: losing spouse or children - older adults deal w these easier - doesn't change amount, snowballing can occur - changes in social support structures - one spouse will die first - change is more pronounced for these individuals - friends, neighbor, etc

diabetes and mental disabilities:

- diabetes - troubles with diet and exercise, circulatory function - eating well and exercise can decrease risk - dementia - caused by Alzheimer's disease - complications among neurons, choking communication - can not be diagnosed without autopsy - 7-8 years - at beginning, maintain independence - at end, need round the clock care - early Alzheimer's: much worse, different diseases - tangles and plaques

(17) life expectancy:

- functional age - average life expectancy: decreased w/ COVID, although increasing - active lifespan- lower in US (can) - activities of daily living (ADLs) - let us know if older adults can live on their own, things young kids can do but takes them time to learn - instrumental activities of daily living (IADLs) - maintaining your own independence - going to the store, taking out trash, making dinner - teenagers can do these but young kids aren't expected - IADLs usually are the first to go - may not be prevalent to the person - women 80 years, men 75 years, overall 77 years

cardiovascular and immune system changes

- heart pumps with less force - blood flow throughout body slows down - resulting in feeling cold - maximum heart rate decreases - if succeed level of exercise, may have heart attack - autoimmune response - more immune disorders - body starts fighting itself: higher rates of illness - sleep quality problems - medical side effects, aging - hair follicles fall out - spines compress due to bone loss- resulting in being shorter - if active movement (weight bearing) is kept up with, this will be less

midlife relationships

- living w/ spouse, may/may not have kids - marriages that last - have better support and communication - healthy = better outcomes - support network in house - kids may leave home - have someone else to keep you in check - parents are passing - marriages that don't: divorce - 10% end past 20 years - waiting for kids - older adults are better able to handle divorce - women who initiate better outcomes than if man initiates - men who initiate a divorce often have another relationship waiting, remarry quickly - parent child relationships change - kids leave home - depends on proximity and how much that keep in touch - moms become "kin" keepers, organize family events

(16) Erikson's Psychosocial task of middle adulthood: generativity vs. stagnation: stage 7

- main task: reaching out to the next generation - sharing life stories - sharing meaning - taking care of grandkids - giving thanks: being generous - volunteers - having something to offer vs. not having something to offer - may feel stuck - poor health, relationships, outcomes

(18) Erikson's psychosocial task of late adulthood: integrity vs. despair: 8th (final) stage

- main tasks: coming to terms with one's life - happy with the life you've lived - integrity: life feels whole, complete - satisfaction - despair: feeling like made many wrong decisions integrity: - can commit, feel safe, ready for upcoming events, built relationships, proud, big piece despair: - had a hard time relating to others, wishing done/hadn't done more, not proud, transition to late life can be stressful

Levinson's Seasons of Life:

- midlife transition - modifying life structure - death is coming - making changes - new car/house/vacation home - ever see someone not dress their age? having issues with aging - acceptance of being older - positive view: better self esteem, face adulthood in a positive light

physical changes don't stop:

- nervous system - declines in brain mass - brain loss resulting in forgetfulness - frontal lobe declines - corpus callosum declines - occipital lobe doesn't experience change, although the eye does - myelination slows, slows connections, slows thinking - sensory system - cataracts: 1/4 70 year olds, 1/2 of 80 year olds - blurring of the lens - yellowing of the lens - macular degeneration: #1 leading cause of blindness - reduces blood flow to eye - prevented by eating green leafy vegetables - hearing: cell decline based on damage - reduced cell depth - taste and smell: experiences medication side effects, smoking, dentures - weight loss because people don't want to eat, high sodium levels resulting in heart problems - touch: fingertips become less sensitive - may lose ability to feel temp/read braille

2. Contrast children's, adolescents', and adults' understanding of death.

- noncorporeal continuation: the view that some form of life and personal continuity exists after the body has died - for ex: a spirit may endure, life may persist in heaven, or a soul may be reincarnated into another body - these beliefs are consistent with the doctrine of many religions and can coexist with mature understandings of death as the irreversible and inevitable ceasing of biological functioning - a person has a mature understanding of death when the following four components are understood 1. non functionality: the understanding that death entails the complete and final end of all life define abilities or functional capacities, internal and external, that are typically attributed to a living body 2. irreversibility: the understanding that the process involved in the transition from being alive to being dead and the resulting state of being dead cannot be undone. once a thing dies its physical body cannot be made alive again 3. inevitability: the understanding that death is universal, thal all living things will someday die 4. biological causality: the understanding that death is caused by events or conditions that trigger natural processes within the organism that it is not caused by bad behavior or wishes CHILDREN'S UNDERSTANDING OF DEATH: - infants can sense that something unusual is happening when the adults around them grieve - they notice changes in emotional tone of their families, changes in caregivers, and the degree to which their emotional needs are met or interrupted - young children perceive events around them before they have developed the ability to understand or explain them - children have more exposure to death and death themes than many adults realize - considering such exposure to the subject of death, it is not surprising that children's play is riddled with death related themes - death themes appear in children's rhymes, songs and fairytales - death themes in rhymes and play may help children work through fears related to loss in safe ways - ages 3-5 tend to view death as temporary and reversible - they believe dead things can become alive spontaneously and as the result of medical intervention, after eating or drinking and by magic, wishful thinking, or prayer - they may imagine that the person who has died is actually still living but under alternative circumstances - they may describe death as asleep with the ability to wake up, or a trip with the ability to return - they may personify death as a figure, a spirit that comes and "gets" you and may believe that only people who want to die or who are bad die - before understanding non functionality: children view dead things as possessing reduced or diminished capacities but retain some. functions such as the ability to feel hunger pangs, wishes, beliefs, and love - before understanding inevitability: children think that there are actions they could take to avoid death, such as being clever enough to outsmart it or being lucky - 5-7 years of age, the understability that death is final, irreversible and inevitable emerges, corresponding to the transition from preoperational reasoning to concrete operational reasoning in Piaget's theory - 6-7 years of age (or typically in late childhood), biological causality is the most complex element of the death concept and the final element to be acquired emerges - advances in executive function are closely related with the emergence of biological theory of death as these cognitive capacities permit the abstract thinking need for mature conceptions of death - around age 10, an understanding of biological nature of death is mastered - contextual differences in children's exposure to death that influence conceptions of death: - some children receive more exposure through media depictions of war, accidents, and devastating living conditions - others experience death firsthand - may be exposed directly to violence within their families and communities and may witness or be aware of traumatic events and deaths at home and in their neighborhoods - children who reside in war torn and poverty stricken nations soften experience multiple losses - children who have direct, personal experience of death tend to show a more advanced and realistic understanding of death than their peers - parents of children ages 3-6 tend to believe that their children hold misconceptions about death - they avoid talking about death, believing that children are not capable of grasping or coping with it - US parents often shield their young children from death - parents most likely to report having discussed death when the child has experienced a death of some kind, regardless of age; more conversations took place as the child's age increased - culture is a powerful influence on conceptions of death - European Americans tend to shield children from death - Mexican Americans are likely to believe that children should become familiar with death and are likely to include them as active participants in rituals related to death - celebrate the Day of the Dead where dead relatives are said to return to their homes to eat, drink, and visit with the living - children often develop spiritual or religious explanations in addition to biological explanations for death - children who grow up in cultures that endorse both religious and biological views of death may hold incompatible explanations about death, such as biological irreversibility and religious or spiritual continuity - it is not until adolescence that children gain the cognitive competence to integrate these ideas ADOLESCENTS' UNDERSTANDING OF DEATH - adolescents often describe death as an enduring abstract state of nothingness that accompanies the inevitable and irreversible end of biological processes - adolescents' understanding of death reflects the intersection of biological, cognitive, and socioemotional development - as adolescents progress through puberty, this may heighten their awareness of the inevitability of the biological changes of life - although adolescents are cognitively aware that death is universal and can happen to anyone at any time, this awareness is not reflected in their risk taking behavior - instead, they are prone to personal fable, viewing themselves a unique and invulnerable, including death - the risk taking behavior is a form of cheating death, an event is perceived as a distant, but unlikely possibility - adolescents' advances in abstract reasoning are reflected in their interest in considering the meaning of death, as well as whether some psychological functions, such as knowing and feeling, persist in a dying person after biological processes have ceased - adolescents and adults across cultures tend to share a belief in afterlife, whether religious or supernatural - this belief often arises in childhood, but it is in adolescence that we are first able to simultaneously hold a mature biological understanding of death as the end of all body functions alongside cultural and religious beliefs about an afterlife ADULTS' UNDERSTANDING OF DEATH - young adults begin to apply their mature understanding of death to themselves - the personal fable declines, as as they take on adult roles, young adults begin to acknowledge their vulnerability - risky activity declines and young adults' behavior begins to better align with their understanding of the inevitability of death - an awareness of death increases as individuals progress through middle adulthood, when they are likely to gain experience through the deaths of parents, friends, siblings, and colleagues - as midlife adults watch their children tak on adult roles as they become aware of their own aging bodies and minds, they develop a more personalized sense of their mortality and the inevitability of the life cycle - the awareness of death can cause midlife adults to reevaluate their priorities, often leading them to pursue a sense of generativity, the need to give back and leave a lasting legacy - midlife adults who look beyond their own losses to consider the profound meaning and of their absence to significant others, such as spouses and children, may be deeply saddened by the thought of their own death - with the deaths of many friends, and family members, older adults may become socialized to the nature and inevitability of death - they often talk about aging and death, perhaps helping them to prepare for the inevitability of their own death - also spend more time thinking about the processes and circumstances of dying than the state of death - death anxiety decreases over the lifespan - advances in psychosocial development, such an increasing ability to manage negative emotions, influence how older adults approach death, and may account for their reduced anxiety - religion specifically a religious sense of hope reduces death anxiety - the psychosocial task of older adulthood is to consider the meaning of life and death - engaging in life review and establishing a sense of ego integrity help older adults reduce regrets and construct a sense that they lives have been well lived

home is where the heart is:

- ordinary homes - may downsize - 1/4 of adults will remain independent in their own homes - should be able to take care of home/self - residential changes - not nursing homes - may have an age minimum - activities to engage in - shared space and independent living - those who choose this, positive experience - nursing homes - need for care - may have a medical condition - may be residential and nursing homes - inevitable - transition can be hard - illness and loss of someone being able to take care of them - elder abuse - lack of support and higher expenses - $6,000-$10,000 a month for in house care/nurse care - high rates of elder abuse: family members taking money, or someone outside of home caring for older adults is higher - granny dumping: women w dementia losing spouse & far away children and are getting dropped off at hospitals - hospital is forced to take care of them - may not have money to take care of patients - retirement: can be challenging - spend entire lives w career aspect of identity - those are forced to retire early: negative outcomes - those who retire early: positive outcomes - older adults who choose to work can be subjected to ageism/turned down from jobs

how understanding of death changes across lifespan:

- permanence - once someone is dead, there is no bringing them back - children often fail to understand this - inevitable - all living things die - can be confusing for kids, phones "die" - cessation - all systems must stop - can be confusing for spiritual kids - applicability - who is in mention, dog vs. computer vs. teddy bear - causation - when the body is no longer functioning, systems stop - preschool/age 3: when kids start to form an idea of death - will have different ideas of death based on experience, first hand vs. protected - usually lots of questions, big unknown - process of conceptualizing can be hard - individual/cultural variations - big differences in religiosity and culture - specifically religious teachings - may think they can still feel and think b/c of heaven - adolescents feel that death is really far away - puts at higher risk for energy - those who have experienced death have safer idea of death - romanticised death - romeo and juliet - gap between logic and reality - adulthood - not talked about as much in early adulthood - feels distant, highest death anxiety - "i don't have a lot of time left" and switching focusing in middle adulthood - welcomed in late adulthood - death anxiety is the least - more spirituality -> less anxiety, less -> more

(19) the process in which we die

- physical changes - agonal phase: gasps and muscle spams - body is slowing down - may be frequent or prolonged - clinical death: heart beat, circulation, breathing, brain function stops - resuscitation: depends on time frame and cause of death - mortality: permanent death - these stages can vary in term and time occurring, place - could be/couldn't be stressful - brain death: brain and brain stem are no longer active - persistent vegetative state (PVS): brain stem is active without sense of being alive/consciousness - "in a coma" only surviving on support (breathing, eating) - can be saddening/stressful for family and peers - recovery is rare

changes in personality development

- possible selves - vet vs. police vs. unrealistic dreams - self acceptance - richness beyond careers - autonomy - less concerned about others' expectations - environmental mastery - getting good at anticipating and resolving problems experience in environment - gender identity - solidification - relate sto raising children - parental imperative theory - dads acting like dads and moms acting like moms

adapting to these changes:

- primary aging: based on environment - biological aging - secondary aging: based on environment - exposure to toxins, pollution, psychological stress, hereditary, unique to individual - coping strategies help deal with changes - assistive technology: mitigates intensity of changes - scooters, auto-off things, hearing aids, canes, beeping for seatbelt/close fridge

evidence of midlife crisis:

- quitting a job - big purchases - cutting ties - new lifestyle choices - talking to children like adults

psychosocial dev't

- reminisce: recalling and sharing stories about life - younger generations/families/friends/neighborhoods - younger - has a lot of meaning - life review: contemplates the meaning of these recollections

changes in cognitive ability:

- selective optimization w/ compensation - getting to choose in order to focus on strengths - slowing song on piano to compensation for inability to play fast - writing things down - implicit memory "automatic memory": type of memory you're not really processing - what you ate for breakfast - little declines - remote memory: remembering things from far in past - prospective memory: remembering things needed to be done/future

stability and change:

- self concept changes in a positive direction - grow and expand - recognition of self becomes more detailed and refined - a lot of things has changed - spouses, parental roles - you are more than just your job - resilience: adaptability to change, optimism, agreeableness - acting positively towards change - being able to easily adapt, preserverace - deals with changes easier/better than those lacking resilience - spirituality: have rituals, symbols, beliefs that are valuable - may help adapt to these changes - ex: family traditions - sharing, having meaningful, continuing traditions

is there really a "midlife crisis"?

- self doubt and stress prompting restarting of the personality - may be exception rather than the rule - social clocks still present - few and far between

time to play:

- siblings and friends: time to have fun - provide support - children are grown, more time for friends

bereavement:

- state of losing someone you love - leads to grief - avoidance (hours-months) - nature of death allows this to vary - confrontation: highest level of pain, physically affected (loss of appetite/sleep), fixation, absentmindedness - restoration: loss of intensity of feelings, grief declines, can return to intense feelings (birthdays, etc.), women deal with death better than men due to leaning on bigger social networks - sudden vs. expected death - suicide vs. long lasting illnesses - sudden results in high grief - loss of parent (most profound loss) - depends on proximity and relationship - loss of child: greatest amount of grief - untimely/sudden/inappropriate - not everyone experiences (not having kids/outliving them) - loss of partner: only 50% will experience - not everyone experiences (not getting together/outliving) - most pronounced loss at time, more than parent because you expect parental death but less than child death

2. Identify risk and protective factors for health in late adulthood.

- young-old: ages 65-74, tend to be active, healthy, and financially and physically independent - old-old: ages 75-84, typically live independently but often experience some physical or mental impairment - oldest-old: ages 85+, at the highest risk for physical and mental health problems and often are unable to live independently, requiring physical and social support to carry out the tasks of daily life - successful aging vs. impaired aging - centenarians (individuals who life past 100) are becoming more common NUTRITION: - losses in muscle mass contribute to weight loss and a slowed metabolism - older adults require fewer calories than younger adults, and their diets must be ore nutrient dense to meet their nutritional needs with fewer calories - changing dietary needs mean that older adults are less likely to get all of their nutritional needs met through their diet and are therefore at risk for a nutritional deficiency - malnutrition is associated with illness, functional disability, and mortality - age related declines in taste and smell may influence older adults eating habits - older adults consume more sweet and salty foods - bereavement, social isolation, depression, and illnesses such as cancer are associated with malnutrition - medications can alter older adults' nutritional needs - a diet of nutritious foods, including fruits, whole grains, low fat dairy products, leafy green vegetables, and healthy sources of protein such as fish, nuts, beans, and chicken, can counter nutrition deficits - older adults may lack access to healthy foods, because of difficulty shopping, stores that lack healthy food options, or affordable food choices - vitamins and mineral supplements the provide levels of nutrients equivalent to that of a healthy diet can fill in gaps in older adults' diet - vitamin D and calcium can help reduce the risk of fractures - the effects of vitamin supplements on cardiovascular disease and cancer are less clear, with some studies suggesting a protective effect and others none - catechin: a polyphenol found in green tea, has an antioxidative effect and may protect against age related declines in cognitive function such as those associated with learning and memory as well as progressive neurodegenerative disorders such as Parkinson's and Alzheimer's - omega-3: an oil found in finish that is high in polyunsaturated fatty acids, promotes vascular health and is associated with reduced risk of cardiovascular disease - associated with reduced inflammation and degenerative diseases such as arthritis and potentially Alzheimer's - appears to have an epigenetic effect on longevity through its action on telomeres, the caps covering the tips of DNA - also associated with slowed and even reduced telomere shortening - improved nutrition holds the promise of protection against age related cognitive changes EXERCISE: - cardiovascular activity begun at 80 shows similar gains to those of much younger adults - weight bearing exercise begun as late as 90 can improve blood flow to the muscles and increase muscle size - the physical benefits of regular exercise influence increases in strength, balance, posture, and endurance and permit older adults to carry out everyday activities such as grocery shopping, lifting grandchildren, reaching for objects, and opening jars and bottles - moderate physical activity is associated with improved physiological function, a decreased incidence of disease, and reduced incidence of disability - exercise offers older adults stress relief, protects against depression and is associated with higher quality of life - increased blood flow to the brain that comes with exercise is protective - older adults who are physically active show less neural and glial cell losses throughout their cortex and less cognitive decline than do those who are sedentary - exercise in older adults is associated with increase hippocampal volume - adults who get regular cardiovascular exercise, such as brisk walks, show increased brain activity in areas that control attention and perform better on tasks measuring attention than do sedentary adults - also demonstrate improved performance on tasks examining executive function, processing speed, memory, and other cognitive processes - patients with dementia who engage in a program of physical exercise, specifically cardiovascular disease, show improvements in cognitive function, regardless of the intervention frequency or specific dementia diagnosis - National Guidelines: at least 150 minutes of moderate activity each week (or 75 minutes of vigorous activity), plus muscle strengthening exercises on at least 2 days each week - may be accumulated in 10 minutes increments throughout the day - if 150 minutes cannot be achieved: they should be as physically active as possible - older adults should do exercises that maintain or improve balance - lack of exercise may be contributed to fears of falling, neighborhood safety, bad weather, and chronic conditions, (such as arthritis: may believe that it is better to rest and that exercise will make symptoms worse) - exercise offers physical and mental benefits that slow the negative effects of aging - report feeling more energetic, experience greater life enhancement, and have a more positive psychological outlook as well as show greater levels of life satisfaction CHRONIC ILLNESS: - arthritis: a degenerative joint disease - the most common is osteoarthritis: affects joints that are injured by overuse, most commonly hips, knees, lower back and hands - those who suffer from osteoarthritis experience a loss of movement and a great deal of pain - often first appears in middle adulthood - nearly all older adults show at least some signs of osteoarthritis, but there are great individual differences - ex: people whose job or leisure activities rely on repetitive movements such as a workers who type everyday getting arthritis in hands or runners getting arthritis in knees - obesity also poses risk as it places abnormal pressure on joints - rheumatoid arthritis: an autoimmune illness in which the connective tissues, the membranes that line the joints, become inflamed and stiff - they thicken and release enzymes that digest bone and cartilage, often causing the affected joint to lose its shape and alignment - when inflammation flares, most rest is needed, as well as pain relief - however, instead of uninterrupted rest, it is best to deal with an arthritis flareup with some activities or exercises to help the muscles maintain flexibility, known as range of motion - joint replacement surgery has become increasingly common in recent decades - those with arthritis are at risk for depression - low SES is associated with a delay in seeking care, greater arthritis related symptoms, poorer well being, and greater use of maladaptive coping strategies OSTEOPOROSIS: - women undergo hormonal changes accompanying menopause - these changes are associated with bone loss, increasing women's risk for osteoporosis - osteoporosis: characterized by severe bone loss resulting in brittle and easily fractured bones - in the first ten years after menopause, women typically lose about 25% of their bone mass, largely due to menopausal declines in estrogen - this loss increases to 50% by late adulthood - men experience a more gradual and less extreme loss of bone, because age related decreases in testosterone, which their bodies convert to estrogen occurs gradually over the adult years - about 30% of women and 16% of men have osteoporosis - usually diagnosed after experiencing bone fractures - risk factors for men: - low body mass - sedentary lifestyle - advanced age - men often go undiagnosed and untreated - heredity and lifestyle contribute to the risk of osteoporosis - identical twins are more likely to share a diagnosis than fraternal twins - thin, small framed women ten d to attain a lower peak bone mass than do other women and are relatively higher risk of osteoporosis - other risk factors: sedentary lifestyle, calcium deficiency, cigarette smoking, and heavy alcohol consumption - risk can be reduced by: - encouraging individuals to maximize their peak bone density by consuming a diet rich in calcium and Vitamin D and engaging in regular exercise from childhood into emerging adulthood when bone reaches its peak density - consuming a diet rich in calcium and Vitamin D, avoiding smoking and heavy drinking, moderating alcohol consumption, and engaging in weight bearing exercise, can offset bone loss in postmenopausal women - medication can increase the absorption of calcium and slow the bone loss associated with osteoporosis INJURIES: - unintentional injuries account for 45.01 deaths per 100,000 in 65-69 year old adults and a striking 365.7 in adults age 85+ motor vehicle accidents: - driving a car represents autonomy - accidents involving older drivers, both nonfatal and fatal, have declined over the past two decades, but there remains predictable age related increases in accidents in older adulthood - per mile traveled, crash rates and fatal crash rates also start increasing when the driver reaches age 70 - senior drivers are more likely to be involved in collisions in intersections, when merging into traffic, and switching lanes - are also more likely to miss traffic signs, make inappropriate turns, fail to yield the right of way, and slower reaction time - declines in vision account fro much of the decline in older adult's driving - also likely to have difficulty with night vision and reading the dashboard - changes in working memory and attention also account for some of the problems in older adults' driving competence - many older adults appear to adapt to these changes, naturally reducing their driving as they notice that their vision and reaction time are less acute - they may, at least partially, compensate for their higher risk for motor vehicle accidents FALLS: - many aspects of aging increase the risk of falls, including changes in vision, hearing, motor skills, and neuromuscular control, and cognition - are less able to balance and regulate body sway, have reduced muscular density, and are less adept at navigating and avoiding obstacles - declines in cognition, particularly in executive functioning and processing speed, also increase the risk of falls - the natural loss of bone and high prevalence of osteoporosis increase the risk of bone fractures, especially a fractured hip - hip fractures are particularly dangerous as they immobilize an older adult, are painful, and take a great deal of time to heal - many elderly adults lose the capacity for independent living, and up to 25% die as a result of complications, such as infection within a year after the fall - after experiencing a fall, at least half of older adults report fear of falling - adults who fear falling tend to become more cautious, avoiding activities that pose a risk of falling but also limiting opportunities for physical activities that support physical health, retention of mobility, psychological well being, and social connections - exercise programs such as Tai Chi and strength and agility training can improve older adult's strength, balance, and confidence - environmental modifications such s addressing slippery floors, installing handrails on steps, and equipping shower/bath facilities with grip bars can also help prevent falls

4. Analyze changes in cognitive capacities during middle adulthood, including attention, memory, processing speed, and expertise.

Attention: - each of these tasks becomes more difficult: - how much information a person ca attend to at once - the ability to divide attention and focus from one task to another in response to situational demands - the ability to selectively attend and ignore distracters and irrelevant stimuli - inhibiting irrelevant information - the ability to resist interference from irrelevant information (response inhibition) - people in occupations that require detecting critical stimuli and engaging in multiple complex tasks such as air traffic controllers, develop expertise in focusing and maintain attention and show smaller declines with age - practice also improves performance and reduces age related outcomes Memory: - the capacity of working memory declines gradually and steadily from the 20s through 80s, although change often is unnoticed until the 60s - changes in attention are related to memory decline - age differences in performance on working memory tasks can be partially explained by a decline in these of memory strategies, specifically organization and elaboration - from middle adulthood into old age, adults begin to have more difficulty retrieving information from long term memory, which makes them less likely to spontaneously use organizations and elaboration as memory strategies - as with attention, memory declines vary with the individual and task - most adults compensate for declines and show little to no differences in everyday settings, however, chronic stress and negative affect impair working memory - midlife adults who feel overwhelmed in daily life, such as those faced with many conflicting responsibilities and stressor that demand a great deal of multitasking, are more likely to rate their memory competence as poor Processing Speed: - the greatest change in information processing capacity with age is a reduction in the speed of processing - the more complex the task, the greater the age related decline in reaction time - age related declines are less in a vocal responses rather than motor responses - changes in brain underlie reductions in processing speed - the loss of white matter and myelinated connections reduces processing speed - the loss of neurons forces the remaining neurons to reorganize and form new, often less efficient, connections - changes in processing speed influence many of the cognitive declines associated with aging - declines in processing speed with age predict age related declines in memory, reasoning and problem solving tasks - the relationship between processing speed and performance on cognitive tasks becomes stronger withe age Expertise: - an elaborate and integrated knowledge base that underlies extraordinary proficiency in a given task - experts are not distinguished by extraordinary intellect but by an combination of inherent ability and extensive knowledge and experience - knowledge is transformative in that it permits an intuitive approach to approaching problems - process information more quickly and efficiently, and it makes complex tasks routine - have a broader range of strategies, have better strategies than novices, and can better apply them in response to unanticipated problems - expertise permits selective optimization with compensations, the ability to adapt to changes over time, optimize current functioning, and compensate for losses to preserve performance despite declines in fluid abilities

2. Discuss common health conditions and illnesses and the roles of stress and hardiness on health during middle adulthood.

cancer: - remains the leading cause of death in those ages 45-64 - 15% of adults will develop cancer between ages 50 and 69 - skin cancer is the most common form - women are most likely to be diagnosed with breast cancer and men with prostate cancer - men to be diagnosed at a higher rate than women - sex differences are influenced by: - genetics - contextual factors - workplace exposure to toxins - health related behaviors - smoking - making fewer visits to the doctor people who experience cancer at a higher rating than others: - low SES - inadequate access to medical care - poor diet - high levels of stress - occupations that may place them in contact with toxins - cancer occurs when the genetic program that controls cell growth is disrupted - when this happens, abnormal cells reproduce rapidly and spread to normal tissues and organs - cell mutations may cause cancer genes, known as oncogenes, to undergo abnormal cell division - other cell mutations may interfere with tumor suppressor genes that keep oncogenes from multiplying - finally, cell mutations may prevent cells from repairing the DNA errors that occur as a function of cell division, as well as those that occur from exposure to environmental toxins and free radicals - differences in medical detection practice and the prevalence of risk factors - smoking, obesity, and other health behaviors, as well as the national distribution of risk behaviors, as well as the national distribution of poverty and access to medical exposure - women can now be tested for mutations in the genes responsible for suppressing proliferation of breast cancer cells - only about 35% to 60% of women who test positive for genetic mutation actually develop breast cancer - influenced by environmental factors - heavy alcohol use - being overweight - the use of oral contraceptives - exposure to toxins - low SES cardiovascular disease: - cardiovascular disease (heart disease): responsible for over one quarter of all deaths of middle aged Americans each year - about 40% of men and women ages 40 to 59 have heart disease - markers include: - high blood pressure - high blood cholesterol - high plaque buildup in the arteries - irregular heartbeat - heart attack - can also cause a stroke - heart attack: blockage of blood flow to the heart caused by a blood clot occurring within a plaque-clogged coronary artery - stroke: a blood clot, often originating in the coronary arteries, travels to the brain or when the clot forms in the brain itself - more are more likely to be diagnosed with cardiovascular disease - symptoms include: - chest pain, unconformable pressure, squeezing, fullness, or pain in the chest that may come and go or last. discomfort or pain in other areas of the upper body, especially the left arm, but also the back, neck, jaw, or stomach. shortness of breath, nausea, or light headed can also occur - women are more likely than men to die of cardiovascular disease, especially heart attack - symptoms include: - less likely to report chest pain than men. more likely to describe it as pressure or tightness than pain. pain in the left shoulder or arm, pain between the shoulder blades, nausea, dizziness, and vomiting - risk factors: - heredity - age - diet heavy in saturated and trans fatty acids - smoking - hypertension - anxiety - psychological stress - poor diet diabetes: a disease marked by high levels of blood glucose - occurs when the body is unable to regulate the amount of glucose in the bloodstream because there either is not enough insulin produced (Type I) or the body shows insulin resistance and becomes less sensitive to it, failing to respond to it (Type II) - symptoms: - fatigue - great thirst - blurred vision - frequent infections - slow healing - hypoglycemia: when glucose levels become too low, producing symptoms of confusion, nervousness and fainting. - hyperglycemia: overly high glucose levels, also resulting in serious illness - 17% of adults ages 45-65 have diabetes, rises to over 1/4 - 25% of adults over age 65 - genetic component, but diet and exercise are important risk factors that interact with genetic propensities to influence diabetes risk - high level of glucose in the bloodstream raises the risk of heart attack, stroke, circulation problems in the legs, blindness and reduced kidney functions - women are as likely as men to be diagnosed, but women with diabetes experience a much higher risk for heart attack and stroke than men - declines in executive function, processing speed, memory, and motor function - associated with accelerated brain aging, including loses of gray matter, abnormalities in white matter and a heightened risk of dementia and Alzheimer's disease in older adults - depression is 2-3 times more likely in people in diabetes compared to peers - more likely to experience chronic depression with up to 80% of those treated for depression experiencing a relapse of depressive symptoms within a 5 year period - adults with depression are less likely to follow dietary restrictions, comply with medication, and monitor blood glucose stress: - sandwich generation: middle aged adults - stress is physiologically arousing - the fight or flight response can motive behavior, but if experienced daily in response to an excess of daily hassles, the cortisol response can impair health - cortisol is released and the body readies for action, raising blood pressure and heart rate - people who experience chronic stress, such as living in poverty, are morel likely not experience negative cardiovascular side effects of stress, such as hypertension (high blood pressure), high cholesterol, and arteriosclerosis (hardening of the arteries, which places more stress on the heart and increases the risk of heart attack and stroke - people of low SES - chronic stress is associated with acute illnesses, such as cold and flu, as well as chronic illness, such as disease, cancer and autoimmune diseases (lupus, Graves disease, chronic fatigue syndrome) - chronic stress is associated with higher rates of anxiety and depression and it can be a trigger for experiencing more serious mental illnesses that have a biological basis, such as bipolar disorder and schizophrenia - psychological stress is associated with lower cortisol levels, suggesting a reduced fight or flight response - daily stress tends to decline and feelings of well being increase in the second half of middle adulthood from age 50 and on hardiness and health: - optimism, conscientiousness, and positive emotions are associated with good health - people who score high on measures of hostility and anger, who tend to view others as having hostile intentions and are easily angered, are at risk for negative health outcomes, such as heart disease and atherosclerosis - hardiness: some adults are better able than others to adapt to the physical changes of midlife and the stress wrought by the changes in lifestyle that accompany midlife transitions, such as juggling career with caring for children and parent - tend to have a high sense of self efficacy, feeling a sense of control over their lives and experiences - view challenges as opportunities for personal growth and feel a sense of commitment to their life choices - view stressful situations more positively as manageable, approach problems with a problem focused coping style, and show fewer negative reactions to stressful situations - hardiness is associated with lower emotional reactivity, lower average blood pressure, slower progression of cardiovascular disease, and positive self ratings of physical and mental health - low in hardiness is associated with feeling less control, experience more negative reaction to stressful situations, and are more likely to use an emotion focused style of coping such as avoidance or denial which is maladaptive to health and functioning and is associated with higher stress in response to stimuli sexual activity: - highest among people in young adulthood, from their mid 20s-mid 30s, and declines gradually for people in their 40s and again in their 50s - major predictors of sexual activity: health and having a partner - by midlife, there are more women than men in the general population - physical changes and biological aging can influence sexual activity: - declining levels of estrogen slow sexual arousal and reduce vaginal lubrication, sometimes making intercourse uncomfortable or even painful - many women show no change in sexual interest after menopause, and some show an increased interest, others show a decline - with age, men are more likely to experience difficulties establishing or maintaining erections - the presence of erectile dysfunction ranges from 2% to 9% in men between ages 40 and 49 and rises to 20-50% in ages 60-69 - not inevitable, although it has a strong connection with health, with vascular disease as a cause in up to 80% of cases - ED is a strong predictor of future cardiovascular diagnoses - ED has also been associated with poor cognitive performance, particularly on attention-executive-psychomotor speed tasks

4. Discuss influences on job satisfaction and retirement planning during middle adulthood.

careers in middle adulthood: - throughout work, people have opportunities to interact with others; to display generativity by creating products, items, and ideas by advising and mentoring others; and to contribute to the support of their families and communities - young adults tend to gravitate toward jobs that emphasize extrinsic rewards such as high salaries and employee benefits, whereas middle-aged employees tend to place greater importance on the intrinsic rewards of work, such as friendships with coworkers, job satisfaction, self esteem, and feeling that one is making a difference - job satisfaction is more closely associated with the pleasures of surmounting challenges, engaging in creative pursuits, being productive, and other intrinsic rewards of work than with high pay and other extrinsic awards job satisfaction: - regardless of work experience, women tend to earn less than men - paradoxically, however, women tend to show higher job satisfaction than men, or in some cases, similar levels of satisfaction to men - gender differences lies in work orientations and preferences for extrinsic vs. intrinsic rewards - job satisfaction is more closely associated with intrinsic rewards - the pleasures of surmounting challenges - engaging in creative pursuits - being productive - than with extrinsic rewards - high salaries - benefits - for women, job satisfaction is positively linked to both extrinsic and intrinsic rewards, but for men, job satisfaction tends to be positively linked primarily to extrinsic rewards - age related increases in satisfaction are related to shifts in reward preferences - young adults tend to gravitate towards jobs that emphasize extrinsic rewards, whereas middle aged employees tend to place greater importance on intrinsic rewards of work, including friendships with coworkers, self esteem, and feeling that they are making a difference - age related increases in job satisfaction are greater for professional than blue collar workers - blue collar workers tend to have more highly structured jobs with fewer opportunities to control their activities than do white collar workers, which may contribute to their relatively lower level of job satisfaction - males in physically demanding occupations, such as laborers and construction workers, may find that the physical changes that occur over the course of middle adulthood make the males able to perform the tasks their jobs require - older workers face increased risk of experiencing age discrimination - some midlife adults experience job burnout, a sense of mental exhaustion that accompanies long term job stress, excessive workloads, and reduced feelings of control - relatively frequent in profession that are interpersonally demanding and whose demands may exceed workers' coping skills, such as in the helping professions of health care, human services, and teaching - burnout is linked to: - impairments in attention and concentration abilities - depression - illnesses - poor job performance - workplace injury - high levels of employee absenteeism - turnover - when workers receive social support, assistance in managing workloads and reducing stress, and opportunities to participate in creating an attractive workplace environment, they are less likely to experience job burnout planning for retirement: - important because retirement represents a major life transition, and adults who plan ahead for the financial and lifestyle changes that accompany retirement tend to show better adjustment and greater life satisfaction - In the US, most adults are not financially prepared for retirement - people with a college degree are more likely to have retirement savings (75%), than those with a high school degree (41%) or those with no degree (20%) - income disparities associated with low levels of education and ethnic minority status contribute to differences in retirement savings - retirement planning is also influenced by psychological factors - financial resources often are the determining factor with regard to whether and when an older adult retires - changing economics influence older adults' abilities to retire, as personal retirement investments such as IRAs and 401(k) plans may lose value unexpectedly - planning for retirement should also include recognition of impending life style changes and changes in the amount of free time available and how it will be used - retirement represents a major life transition , and adults who plan ahead for he financial and lifestyle changes that accompany retirement tend to show better adjustment and greater life satisfaction than those who do not plan

(17) 1. Discuss age-related changes in brain and body systems in late adulthood, and identify ways that older adults may compensate for changes.

APPEARANCE: - the skin loses collagen and elasticity throughout adulthood and becomes more dry as oil glands become less active - pigmented marks called age spots often appear on the hands and face - the skin also thins and loses the layer of fart underneath it, making blood vessels more visible, and older adults are more sensitive to cold - exposure to sunlight exacerbates these changes - the nose and ears grow larger and broader - hair whitens - both men and women experience hair loss a hair follicles die, while thin downy hair beings to grow from the scalp of men with heredity baldness - body shape changes as fat is redistributed and accumulates in the abdomen - sarcopenia: age related loss of muscle mass and strength - losses of 10-20% by 60-70 - losses of 30-50% by 70-80 - physically activity, especially resistance exercise, can strengthen muscles and offset losses into the 90s BRAIN AGING: - brain volume shrinks as dendrites contract and are lost, accompanied by a decrease in synapses and a loss of glial cells - many neural fibers lose their coating of myelin, and communication among neurons slows accordingly - declines are especially marked in the prefrontal cortex, responsible for executive function and judgement - reduction of brain volume is, on average, less than half of 1% each year - a program of aerobic exercise has been shown to restore brain volume, especially in the hippocampus, a brain region closely involved with memory, supporting the role individuals have in their own development - myelin losses contribute to cognitive declines with aging - the last areas of the brain to myelinate are also the first to show reductions in myelin, a pattern some experts call the "last-in first-out" hypothesis of brain aging - the sensory regions of the brain, including the areas responsible for vision and hearing, and the motor cortex are the first brain areas to myelinate in infancy; they are also the last areas to show loss with age - the brain retains plasticity and compensates for structural changes - older adults' brain compensate for cognitive declines by showing more brain activity and using different brain areas in solving problems than younger adults - older adults often show brain activity that is spread out over a larger area, including both hemispheres, compensating for neural losses - cognitive reserve: the ability to make flexible and efficient use of available brain resources that permits cognitive efficiency, flexibility, and adaptability - a type of plasticity cultivated throughout life from experience and environmental factors - educational and occupational attainment and engagement in leisure activity allow some adults to cope with age related changes better than others and show more successful aging - for example, being bilingual - neurogenesis: the creation fo new neurons - continues throughout life - new neurons are created in the hippocampus and striatum (a subcortical part of the brain responsible for coordinating motivation with body movement) and the olfactory bulb throughout life but at a much slower rate than prenatally - most of these neurons die off, but some survive, especially if exposed to experiences that require learning - surviving neurons migrate to parts of the brain where they will function and create synapses with other neurons, permitting lifelong plasticity - about 2% of neurons renew each year - synaptogenesis is associated with learning and plays a role in cognition and in stress and emotional responses, contributing abilities and advances in psychical maturing in the adult years THE SENSES: vision: - virtually all older adults have difficulty seeing objects up close - the lens yellows, the vitreous clouds, less light reaches the retina, and it becomes more difficult to see in dim light and to adapt to dramatic changes in light, such as those that accompany night driving - cataracts: a clouding of the lens resulting in blurred, foggy vision that makes driving hazardous and can lead to blindness - these are the result of a combination of hereditary and environmental factors associated with oxidative damage, including illnesses such as diabetes and behaviors such as smoking - other parts of the eye show structural changes - cells in the retina and optical nerve are lost with aging - macular degeneration - a substantial loss of cells in the center area of the retina, the macula, causing blurring and eventual loss of central vision - hereditary and environmental factors, such as smoking and atherosclerosis, influence the onset of macular degeneration - a healthy diet, including green leafy vegetables high in Vitamins A, C, and E, as well as vegetables rich in carotenoids, such as carrots, may protect the retina and offset damage caused by free radicals - laser surgery, medication, and corrective eye care can sometimes restore degeneration - macular degeneration in the leading cause of blindness - most changes in vision are so gradual that they may go unnoticed in people who do not visit an ophthalmologist regularly for eye examinations - older adults with vision loss participate less than their peers in recreational and sports activities and are more likely to be depressed, especially when vision loss interferes with their day-to-day functioning and independence hearing: - age related hearing loss typically beings in middle adulthood - it increase in older adulthood, with cell losses in the inner ear and cortex - older adults experience difficulty distinguishing high frequency sounds, soft sounds of all frequencies, and complex tone patterns and show less activation of the auditory cortex in response to speech as compared with younger adults - men tend to suffer hearing loss earlier and to a greater extent than do women - 2/3s of adults experience hearing loss which can greatly diminish quality of life and poses health risks - inability to hear car horns and other street sounds - hear the telephone or doorbell - difficulty hearing others' speech can socially isolate older adults, reducing their social network, increasing feelings of loneliness and depression, and reducing life satisfaction - quality of life for older adults can be improved with successful hearing loss management, which may include education about communication effectiveness, hearing aids, assistive listening devices, and cochlear implants for severe hearing loss smell and taste: - sensitivity to smell declines throughout adulthood beginning as early as the 20s but is usually not noticeable until late midlife - individuals vary - some may show marked declines and others more gradual change - the odor itself might matter in determining adults' performance on olfactory tasks - older adults are generally less sensitive to taste as compared with young and middle aged adults - they also produce less saliva with age, resulting in a dry mouth that interferes with taste - some individuals show marked declines while others retain ability - most older adults report that food seems more bland, and they tend to prefer more intense flavors, especially sweetness - they may lose interest in eating, or alternatively, may overuse salt and spicy seasonings with poor health consequences - a poor sense of taste can even be a health hazard by making it more difficult for an older adult to detect spoiled food - developmental changes in both smell and taste are influenced by many factors such as general health, chronic disease, medications, and smoking - most men show greater deficits than do women - different work environments - men are more likely to do work in factories and other environments that expose them to chemicals that can damage sensory abilities CARDIOVASCULAR, RESPIRATORY, IMMUNE SYSTEMS: - with age, the heart experiences cell loss and becomes more rigid - the heart contains pacemaker cells that signal when to initiate a contraction; over time, these cells diminish significantly, by nearly one half, and the heart becomes less responsive to their signals - the arteries stiffen, and the walls accumulate cholesterol and fat plaques, which reduce blood flow; this condition is known as atherosclerosis and is a cause of heart disease - cardiovascular disease may be manifested as heart valve problems, arrhythmia, heart attack, and stroke - heart disease becomes more common with age - the lungs gradually lose cells and elasticity over the adult years, substantially reducing the amount of oxygen that enters the system and is absorbed by the blood - older adults have more trouble breathing, feel more out of their breath during exertion and have a harder time catching their breath - experience and lifestyle influence cardiovascular and respiratory system changes - smoking and exposure to environmental toxins increases damage to the cardiovascular and respiratory systems - physical activity and good nutrition can compensate for decreases in cardiovascular and respiratory function - with age, the immune system becomes less efficient and adaptive - declines place older adults at higher risk for diseases such as the flu, pneumonia, cancers, and autoimmune diseases such as rheumatoid arthritis - exposure to stress reduces immune function, and the effects increase with age - older adults often show greater immune impairment in response to stress - the body's T cells become less effective at protecting the body by attacking foreign substances, and the immune system becomes more likely to malfunction and display an autoimmune response by turning against body tissues - there are large differences in immune functioning into older adulthood, but most experience at least some declines MOTOR AGING: - a lifetime of regular physical activity is associated with greater mobility in older adulthood - balance: the ability to control the body's position in space - involves integrating sensory information with awareness of the position of one's body in space in the surrounding environment - sensory abilities tend to decline in function, and these declines make balance more difficult to achieve and sustain - can be improved, interventions that encourage exercise and promote strength and balance, such as Tai Chi, can increase balance and strength and offset loss - with age, balance requires more attention and taps more cognitive resources - age related changes may be influenced by the ability to allocate attention and the neurological change plays a role in motor performance - gait: the speed at which people walk - declines with age, with declines in muscle strength, bone density and flexibility - many adults compensate for a slowed gait by taking longer steps - rapid or steep decline in gait may indicate overall physiological declines that predict mortality because motor function is a marker of overall health and is used in geriatric assessment in addition to measures of blood pressure, respiration, temperature and pulse

4. Analyze patterns of cognitive change in late adulthood.

ATTENTION - it becomes more difficult to divide attention, to engage in two complex tasks at once and focus on relevant information - age related declines are not uniform across adults, and these differences predict variations in cognitive performance - response inhibition becomes more challenging with age, and adults find it increasingly difficult to resist interference from irrelevant information to stay focused on the task at hand - make more errors of commission: suggesting that that are less able to inhibit responding extraneous noise - older adults also make more errors of omission - less likely to inhibit irrelevant items, are slower at inhibiting a response, and are more likely to retrieve irrelevant items, especially in tasks that are more complex and include the presence of distracters - appear more easily distracted, less able to attend and less able to take in information WORKING MEMORY: - age related declines influence a range of cognitive tasks, including problem solving, decision making, and learning - changes in attention influence declines in working memory - become more susceptible to distraction and are less likely to discard distracting information from working memory, which then leaves less space in working memory for completing a given task - once material is encoded in working memory, health adults of all ages retain the ability to exert control over working memory, that are able to orient their attention within working memory (and stay on task) - problems with working memory vary with the number of tasks and task demands, the greater the number of tasks and demands, the worse the performance - practice can reduce (but no eliminate) age related deficits in cognitive performance - age related decline is less apparent in cognitive tasks that are more passive and less attentionally demanding - when working memory maintenance systems are taxed, as in the case of interference, older adults perform more poorly - proactive interference: occurs when information that has previously been remembered interferes with memory for new information - more susceptible to to interference effects context, task demands, and memory performance - laboratory findings suggest that the ways in which we learn and remember change with age and experience - declines in memory evident in laboratory research are less apparent in everyday setting - knowledge of facts, procedures, and information related to one's vocation either remain the same or increase over the adult years, and adults' experience and knowledge of their cognitive system (metacognition) enable them to use their memory more effectively - using external supports and strategies to maximize their memory, such as by organizing their notes or placing their care keys in a designated spot where they can find them reliably - memory declines vary with individual and task - most adults compensate for declines and show little to no differences in everyday settings; however chronic stress impairs working memory - those who feel overwhelmed in daily life are more likely to rate their memory competence as poor - multitasking is difficult for all adults, but it becomes more challenging in older adulthood - managing and coordinating multiple tasks by switching attention among two sets of stimuli is associated with greater disruptions in working memory - if they have the opportunity to slow down to a pace with which they feel comfortable, they can show performance on working memory tasks similar to that of younger adults emotion and working memory: - findings: - positive mood enhances working memory capacity so that adults are better able to hold on to information while processing task irrelevant information when in a positive mood - however, a negative mood is not related to either an increase or decrease in working memory - older adults are naturally biased toward recalling positive over negative information - may be due to greater focus on managing their emotions - older adults may use cognitive control mechanisms that enhance positive and diminish negative information to feel good - emotion and cognition are intertwined - emotion characterizes most real life decisions, suggesting that older adults are likely able to focus their attention and cognitive capacities on the task at hand ,if it has real world emotional relevance, such as decisions about healthcare, financial, and living situations LONG-TERM MEMORY: - age related changes working memory also contribute to changes in long term memory - as cognitive processing slows, most adults show difficulties with recall - various types of long term emory show different patterns of change - semantic memory, memory for factual material shows little age related decline - episodic memory, memory for experiences, tends to deteriorate with age - autobiographical memory shows predictable patterns of deterioration - when asked to make a timeline of memorable events in their lives, older adults tend to remember events from adolescence through early adulthood; they also remember recent events better than midlife events - more likely to remember happy events that occurred between ages 10-30 than any other time of life - perhaps we process events differently during our adolescent and early adult years, a time when we are constructing our identities - perhaps we are less adept at recalling events from middle adulthood because of interference, as new memories interfere with our recall of older memories - similarities amongst events makes it difficult to distinguish them - throughout life, memory is malleable, and we often revise our memories in light of new experiences - older adults recall fewer details from recent events (within 5 years) and different types of details than do younger adults - this suggests that older and younger adults differ in what stimuli they attend to and select for processing - possible factors underlying cohort differences include secular trends in educational systems, disease prevalence, years of education and quality of education AGING AND LANGUAGE - language comprehension, the ability to understand spoken or written language and retrieve the meaning of words, shows little to no change with age - older adults maintain or improve their knowledge of words and word meanings, an example of the increases in crystallized intelligence that occur into older adulthood - changes in sensory and cognitive processing can affect language comprehension and production - hearing loss can make it more difficult to to hear all of the words spoken in a conversation, sot hat listeners must work hard to make sense fo what other people are saying, especially in the presence of background noise - older adults also have a rich backlog of experiences from which to draw when they listen, enabling them to compensate for impaired hearing - even if they are unable to hear each word, they are often able to derive the meaning of the collective words used in a straightforward conversation - most older adults experience some deficits in the accuracy and speed of word retrieval and naming - in conversations, older adults produce more ambiguous references and more filled pauses, or fillers and reformulate their words, suggesting that they have difficulty retrieving the appropriate words whens speaking - they use more unclear references and speak more slowly, taking time to retrieve words - most common deficits is difficulty recalling specific words while in conversation - more likely to use indefinite words, such as thing, in place of specific names - this is likely due to deficits in working memory and slower processing speed - difficulties in retrieving words and producing language may diminish older adults' success in communicating and weaken their and others' views of their own language competence - negative self appraisals promote withdrawal from social interaction - older adults often compensate for losses by taking more time speaking and simplify their sentences and grammar to devote their cognitive resources to retrieving words and producing speech that others can comprehend PROBLEM SOLVING AND WISDOM - cognitive changes in older adulthood are also reflected in problem solving skills - people remain efficient decision makers throughout adulthood - are better at making decisions about whether they require medical attention and seeking medical care - adults perform better on everyday problems that are relevant to the contexts they experience in their daily lives - older adults are more likely to act efficiently and decisively when solving problems they feel are under their control - older adults may be better at matching their strategies to their goals, perhaps because experience and crystallized knowledge provide an extensive base for making real life decisions and aligning goals with decisions - crystallized intelligence is a better predictor of performance on everyday problem solving tasks than fluid intelligence, suggesting importance of experience - older adults are more likely to report that they turn to spouses, friends and children for input when making decisions - wisdom: expertise in the conduct and meanings of life characterized by emotional maturity and the ability to show insight and apply it to problems - not "book smarts" but the ability to analyze real world dilemmas in which clean and neat abstractions often give way to messy, disorderly, conflicting concrete interests - wisdom requires metacognition, being aware of one's thought process, creativity, and insightfulness - wisdom may not necessarily come with age but rather with the opportunity and motivation to pursue its development - wisdom is especially likely to be shown when considering personal problems that are most relevant to individuals - we see age differences in wise reasoning about fundamental life issues depend on relevance of problems - life experience, particularly facing and managing adversity, contributes to the development of wisdom - experience, particularly expertise in solving the problems of everyday life, is associated with wisdom - those who are reflective attempt to find meaning in their experiences - they also have advanced cognition and emotional regulation skills, qualities that contribute to the development of wisdom but are also associated with better physical health, higher levels of education, openness to experience, positive social relationships, and overall psychological well being - perhaps wisdom is a rare quality, one that can be found at all ages but typically improves with age and is associated with well being - older adults are more likely to be among the very wise INFLUENCES ON COGNITIVE CHANGE IN ADULTHOOD - cognitive abilities tend to remain stable, relative to peers, over the lifespan - however, with advancing age comes greater diversity in cognitive ability - differences in experience and lifestyle can account for many differences in cognitive change over adulthood - cognitive engagement- through mentally stimulating career, educational and leisure activities predicts the maintenance of mental abilities - physical health is also a predictor - health conditions such as cardiovascular disease, osteoporosis, and arthritis are associated with cognitive declines - poor mental health, such as depression and anxiety, is associated with declines in processing speed, long term memory, and problem solving - interventions that train older adults and encourage them to use cognitive skills can preserve and even reverse some age related declines - generalization takes place in people of all ages who receive cognitive training - there is a great deal of variability in everyday functioning - it is possible to retain and improve cognitive skills in older adulthood - the challenge is to encourage older adults to seek experiences that will help them retain their mental abilities - older adults who maintain a high cognitive functioning tend to engage in selective optimization with compensation: they compensate for declines in cognitive reserve or energy by narrowing their goals and selecting activities that will permit them to maximize their strengths and existing capacities - healthy older adults retain the capacity to engage in efficient controlled processing of information

3. Summarize common dementias, including characteristics, risk and protective factors, and treatment.

DEMENTIA - dementia: refers to a progressive deterioration in mental abilities due to changes in the brain that influence higher cortical functions, such as thinking, memory, comprehension, and emotional control, are are reflected in impaired thought and behavior, interfering with the capacity to engage in everyday activities - DSM-5 has replaced dementia with neurocognitive disorder - poor access to education, health care, and nutrition contributes to geographic differences in dementia rates - the most common cause of dementia is Alzheimer's disease, followed by vascular dementia - dementia, even in its very early stages, is associated with higher rates of mortality - dementias can co-occur ALZHEIMER'S DISEASE - Alzheimer's disease: a neurodegenerative disorder that progress from general cognitive decline to include personality and behavior changes, motor complications, severe dementia, and death - the risk of Alzheimer's grows exponentially with age, doubling every 5-6 years - Alzheimer's is characterized by widespread brain deterioration associated with inflammation and accumulations of beta-amyloid, a protein present in the issue that surrounds neurons in the healthy brain - patients experience inflammation that cause the beta-amyloid to accumulate and join with clumps of dead neurons and glial cells, forming large masses called amyloid plaques - it is thought that amyloid plaques disrupt the structure and function of cell membranes and contribute to the formation of neurofibrillary tangles, twisted bundles and threads of a protein called tau that occur when neurons collapse - Alzheimer's is associated with altered neurogenesis and atrophy in the hippocampus, impairing the generation and development of new neurons diagnosis of Alzheimer's disease: - generally diagnosed in living patients through exclusion: by ruling out all other causes of dementia - symptoms, medical history, a comprehensive set of neurological and cognitive tests, and conversations with the adult and family members can provide useful information about a person's level of functioning - brain imaging ca help physicians rule out other, potentially treatable, causes of dementia, such as a tumor or stroke - MRI scans indicating larger spaces surrounding some of the blood vessels in the brain are associated with Alzheimer's disease - cerebrospinal fluid concentrations of beta-amyloid appear to serve as biomarkers progression of Alzheimer's disease: - the earliest symptoms are memory problems - likely because the neurological disruptions that comprise Alzheimer's disease usually being in the hippocampus, which is influential in memory - absentmindedness, the person may forget the names of new people, recent events, appointments, and tasks such as taking a tea kettle off the stove or turning off the iron - memory deficits are accompanied by impaired attentional control, which, to an outside observer, may appear as further absentmindedness and inattention, being "lost" in one's own world - vocabulary becomes more limited as they are likely to forget words - bilingual adults may shift from one language to another - speech becomes more long winded and tangential - communication skills deteriorate, and the person sometimes becomes unpredictably angry or paranoid - some adults may show unpredictable aggressive outbursts - others may become more withdrawn - personality changes may occur and are associated with CSF biomarkers - up to 50% of patients experience depression or depressive symptoms - depression can occur prior to and increase the risk for Alzheimer's disease, but the mechanism is not clear - depression can be harmful to Alzheimer's patients as greater cognitive and behavioral impairment, disability in activities of daily living, and a faster cognitive decline - a predictable routine with enjoyed activities may aid in this - patients will soon be unable to take care of themselves - they may forget how to eat, to dress themselves properly for the weather, or how to get back inside their home after they step outside - eventually, the brain will fail to process information and no longer recognize objects, faces, and familiar people - in the final stages, patients with Alzheimer's lose the ability to comprehend and produce speech, to control bodily functions, and to respond to stimuli - show heightened vulnerability to infections and illnesses that often lead to death - brain functions will eventually deteriorate to the point where organs fail and life cannot be sustained risk factors for Alzheimer's disease - risks for developing Alzheimer's varies with gender, age and ethnicity - women are at greater risk, perhaps because of their longer lifespans - in the US, African Americans and Hispanic older adults are disproportionately more likely to have Alzheimer's disease than European Americans - Alzheimer's often runs in families - several chromosomes are implicated, including the 21st - individuals with down syndrome are at high risk to develop Alzheimer's - high blood pressure and obesity heighten risk - hood nutrition mat serve as a protective role - education acts as an important protective factor against Alzheimer's disease - the process of learning that accompanies higher education and occupational complexity promotes neural activity and increases connections among neurons, thickening the cortex and boosting cognitive reserve - cognitive reserves can protect patients from the handicapping effects of brain atrophy and synaptic loss - low SES predicts mortality in adults diagnosed with dementia, likely throughout the limited access to health care and social resources that promote cognitive reserve - people who remain socially and physically active show lower risk of Alzheimer's disease as well because such activities stimulate and improve blood flow to the brain and increase synaptic connections - regular exercise may no only prevent but also reverse neural damage VASCULAR DEMENTIA - vascular dementia the second most common form off dementia and loss of mental ability in older adulthood worldwide - caused by strokes, or blockages of blood vessels in the brain - tend to show sudden, but often mild, losses with each stroke - as time passes, individuals tend to show improvement because the brain's plasticity leads other neurons to take on functions of those that were lost - additional strokes usually follow, however, and with each stroke, brain matter is lost and it becomes harder for the remaining neurons to compensate for losses - as vascular dementia worsens, the symptoms are similar to those of Alzheimer's disease - vascular dementia and Alzheimer's are neurologically different - damage caused by small strokes is visible on MRI scans and localized to specific areas of the brain - people with vascular dementia show substantial deterioration of areas of the brain and disruptions in white matter but not the widespread abundance of plaques and tangles that accompany Alzheimer's - is influenced by both genetic and environmental factors - cardiovascular disease significantly increases the risk of vascular dementia - genetics may influence obesity, diabetes and cardiovascular disease, which are linked to vascular dementia - men are more likely to suffer early dementia, in their 60s than women because of their heightened vulnerability to cardiovascular disease - behavioral influences on vascular dementia such as heavy alcohol use, smoking, inactivity, stress and poor diet are more prevalent in men - physical activity can prevent or slow the progression of vascular dementia - prevention and management of vascular risks may be the best weapon in a fight against age related cognitive decline - when symptoms of stroke arise, such as sudden vision loss, weakening or numbness in part of the body, or problems producing or understanding speech, anti clotting drugs can prevent the blood from clotting and forming additional strokes PARKINSON'S DISEASE: - some dementias first damange the subcortical parts of the brain, areas below the cortex - these dementias are characterized by a progressive loss of motor control - because the damage first occurs in the subcortical parts of the brain, mental abilities, which are controlled by the cortex, are not initially affected - as. the disease progresses and brain deterioration spreads to include the cortex, thought and memory deficits appear - the most common cause of subcortical dementia is Parkinson's disease - Parkinson's disease: a brain disorder that occurs when neurons in a part of the brain called the substantia nigra die or become impaired - neurons in this part of the brain produce the neurotransmitter dopamine, which enables coordinated function of the body's muscles and smooth movement - appears when at least 50% of the nerve cells are damaged - characterized by a specific progression of motor symptoms, including tremors, slowness of movement, difficulty initiating movement, rigidity, difficulty with balance, and shuffling walk - typically, these symptoms occur in one part of the body and slowly spread to the extremities on the same side of the body before appearing on the opposite side of the body - as neurons continue to degenerate, cognitive symptoms emerge - brain functioning declines and cognitive and speech abilities deteriorate - those with larger cognitive reserves and more synaptic connections among neurons have shown a slower progression of neurological changes before dementia appears - prevalence increases with age - people diagnosed with Parkinson's disease at advanced ages tend to develop dementia earlier into their disease than do younger people, likely because of age related differences in cognitive capacities and neural reserves - multiple studies support a genetic component, however there are few consistent findings regarding environmental and lifestyle influences - may be influenced by epigenetics - physical activity can act as protective factor, slowing its progression and improving motor control - diagnosing is difficult like Alzheimer's; no test confirms the presence of the disease - incorrect diagnoses are common - diagnosed by exclusion, through an examination to rule out other possible causes - researchers are searching for biomarkers - brain scans can detect changes in the substantia nigra associated with Parkinson's - these symptoms can be treated - some research has suggested that deep brain stimulation, stimulating specific parts of the brain with electricity, as well as resistance training, can improve some motor symptoms, such as poor gait and posture - most medications either mimic or replace dopamine, which temporarily improves the motor symptoms of the disease; anti-inflammatory medications may also help reduce neurodegeneration; and medication can help alleviate the symptoms of dementia - medication can temporarily reduce symptoms and perhaps slow its path, but it's not curable LEWY BODY DEMENTIA - Lewy Body Dementia is thought to be about as common as vascular dementia, vying for the second most common form of dementia - biggest challenging in diagnosis is differentiating with Alzheimer's - common features of both include progressive dementia that interferes with social or occupational dementia functions and deficits on cognitive tasks, such as attention, visuospatial ability, and executive function - can be distinguished from Alzheimer's by the presence of visual hallucinations, cognitive symptoms that fluctuate (improving and worsening), some Parkinson's-like motor symptoms, and, especially, sleep disorders in which individuals sleepwalk and act out their dreams - the hallmark of Lewy body dementia is the presence of Lewy bodies, spherical protein deposits, accompanied by neural loss - also common in Parkinson's - the genetics of Lewy body and Parkinson's overlap, suggesting they are linked - damage caused by Lewy bodies is usually not apparent on MRI scans until very late in the disease or after death - diagnosed by exclusion, ruling out other causes of dementia - the search is on for biomarkers - is managed, not cured - medication may treat symptoms, such as sleep problems, hallucinations, and cognitive problems, but Lewy body dementia is a progressive neurodegenerative disease that eventually ends in death DELIRIUM - some symptoms of dementia are sometimes caused by psychological and behavioral factors that can be reversed - delirium: dementia-like symptoms such as problems with attention and reasoning that develop quickly and are temporary - treatable, can be cured - may go unrecognized and untreated - common causes of delirium include poor nutrition and dehydration - older adults require fewer calories but nutritional demands remain or increase - may eat less do to loss of appetite that occurs with some medications, or depression - older adults are at risk for malnutrition and vitamin deficiencies, which are associated with declines in mental abilities and increases in psychological distress, including depression and anxiety - specifically, vitamin B12 deficiencies can mirror dementia symptoms, yet correcting this deficiency restores functioning - prescription and non prescription drugs and drug interactions can also contribute to symptoms of dementia - many medications impair nutrition buy reducing the body's ability to absorb vitamins - some painkillers, corticosteroid drugs, and other medications can cause confusion and erratic behavior similar to dementia - may be more overmedicated because of slower metabolism - physical illnesses themselves can sometimes cause dementia symptoms such as memory loss and agitation that go away as the illness is treated - symptoms of depression and anxiety in older adults, such as attention, forgetfulness, disorientation, and other cognitive difficulties, are often mistaken for dementia - if anxiety or depressive symptoms are misdiagnosed as dementia, prescribed medications that can increase dementia-like symptoms such as fatigue and slowed mental reactions to stimuli and events - treating anxiety and depression with combinations of anti anxiety and antidepressants as well as therapy reduces cognitive symptoms commonly mistaken for dementia

(16) 1. Summarize the theories and research on psychosocial development during middle adulthood.

Erikson's: generativity vs. stagnation generativity: - a sense of responsibility for the future generations and society as a whole - often expressed through childrearing - over the years, begins to expand to include a concern and commitment to the social world beyond oneself and one's immediate family to future generations and even the species itself - fulfills adults needs to feel needed and to make contributions that will last beyond their lifetimes, achieving a sense of immortality - serves a societal need for adults to guide the next generation, sharing their wisdom with youth through their roles as parents, teachers, and mentors. - can be fulfilled through teaching and mentoring others in the workplace and community, volunteering, and engaging in creative work- increases from the 30s through 60s in adults of all ethnicities and socioeconomic backgrounds others experience disappointment, as follows: - after not achieving career and family goals or finding them dissatisfying, some middle aged adults remain self absorbed - they focus on their own comfort and security rather than seeking challenges, being productive, and making contributions to help others and make the world a better place - adults who fail to develop a sense of generativity experience stagnation, self absorption that interferes with personal growth and prevents them from contributing to the welfare of others generativity is associated with: - life satisfaction - self acceptance - low rates of anxiety and depression - cognitive function - overall well being - creativity gender differences: - men who have children tend to score higher in measures of generativity - having children is not related to generativity in women - having attention may draw men's attention to the need to care for the next generation while women may already be socialized to nurture young - men and women who are involuntarily childless may experiences difficulty developing a sense of generativity - in women and men, influenced by psychological issues addressed earlier in life and reflects a timeline of psychosocial development, including the ability to trust others and oneself, understand one's self, and sustain meaningful relationships Levinson's: - seasons of life: adults progress through a common set of phases - life structure: the overall organization of a person's life: relationships with significant others as well as institutions such as marriage, family and vocation - individuals progress through several season over the lifespan in which their life structures are constructed then tested and modified in response to intrapersonal and social demands - early adulthood: we construct our life structure by creating a dream, an image of what we are to be in the adult world, which then guides our life choices - men tend to emphasize occupational role and construct images of themselves as independent and successful in career settings - women tend to create dual images that emphasize both marriage and career - age 30 transition: entails a reconsideration of the life structure in which adults may shift priorities from career to family or vice versa - adults who do not have satisfying experiences at home or work may struggle to revise their life structure and may experience the age 30 transition as a crisis - men tend to experience the mid to late 30s as a period of settling down, focusing on some goals and relationships and giving up others based on their overall values - women tend to remain unsettled through middle adult because they generally take on new career or family commitments and balance multiple roles and aspirations - 40-45: become aware of the passage of time, that galf of life is spent - reexamine their dream established in early adulthood and evaluate their progress, coming to terms with the fact that they will not realize many of them - in areas where they have achieved hoped-for success, they must reconcile reality with their dream and perhaps wonder if the experience was "worth it" or whether they are missing out on some other aspects of life - some adults make substantial changes to their life structure by changing careers, divorcing, or beginning a new project such as writing a book midlife crisis: - proposed as a stressful time in the early to middle 40s when adults are thought to evaluate their lives - only 10-20% of adults over 40 - has significant individual difference and occurs at various periods of life - those who, believe they have experienced upheavals - personal characteristics may determine this - men who scored higher on measures of psychological problems earlier in adulthood were more likely to report experiencing a midlife crisis 10 years later than did men who scored lower on psychological problems - outside events that can occur at any time in adulthood, such as job loss, financial problems, or illness, may trigger responses that adults and their families may interpret as midlife crises - middle adulthood is unquestionably a transition and is perhaps the most stressful time in life, given changes in adult's bodies, families, careers, and contexts - midlife represents a transition similar to adulthood, it entails creating, clarifying, and evaluating values, goals, and priorities - insights about oneself, revisions in identity, and decisions to revise plans - most respond by making minor adjustments, creating turning points in their lives rather than dramatic changes - if they cannot revise their life paths, they try to develop a positive outlook - goals are not set in stone - adults asses and adjust goals throughout life, often without awareness - most adults tend to view middle adulthood as a positive time in life - a time for increasing life satisfaction, self esteem, well being - personality remains stable from young adulthood through middle adulthood to older adulthood

3. Summarize features of older adults' relationships with friends, spouses, children, and grandchildren, and identify how these relationships affect older adults' functioning.

FRIENDSHIPS - friendships become more important and more fulfilling, partly due to the declines in family and work responsibilities - with more time to devote to leisure activites, friendships become more centered on activites, such as playing gold or card games, and older adults report having more fun with their friends than younger adults - although friends become fewer in number, older adults form new friendships throughout their lives and tend to report more meaningful relationships - older adults describe close friendships as entailing mutual interests, a sense of belonging, and opportunities to share feelings - older adults tend to choose friends who share similarities in age, race, ethnicity, and values - with increasing age and death of friends, more likely to report having friends in different generations - giving and receiving support from friends is an important influence on older adults well being and is protective against depression - lack of social contact and friendship is adversely related to physical health - friendships help adults manage age related losses in health, are associated with improved well being and happiness and can help older adults cope with major life events such as bereavement at the death of a loved one SIBLING RELATIONSHIPS - the history of personal and family experiences that adult siblings share contributes to a powerful bond - most older adults feel close to their siblings and consider them to be close friends, even if they do not live near each other and do not visit regularly - siblings grow closer with the experience of family events, hardships, and age related issues - the closeness that siblings share includes sharing experiences, trust, concern for the other, and enjoyment of the sibling relationship - siblings provide tangible support and are considered important sources of help in times of crisis - those who were never married or have no children rely more on siblings for support - widowed adults show increased reliance on siblings - close relationships with siblings influence well being through pleasurable and self affirming activities such as reminiscing about shared experiences MARRIAGE - marital satisfaction tends to increase from iddle adulthood through late adulthood - marriages in older adulthood are characterized by greater satisfaction, less negativity, and more positive interactions - older adults describe their relationships as having less conflict and higher levels of pleasure and report greater positive affect in marital interaction - show fewer disagreements and tend to discuss disagreements with more respect and humor and resolve arguments more quickly and constructively with less resulting anger and resentment than younger couples do - older adults perceive more positive characteristics in their partners - show greater positive sentiment override - they praise their spouse's behavior as more positive - tend to view their spouses through rose colored glasses, which predicts marital satisfaction - a variety of factors contribute to marital satisfaction - in young adulthood, personal growth is a primary concern - in middle adulthood, instrumental goals such as raising children - in late adulthood, companionship goals - many women receive greater fairness in their relationships and greater equity of household tasks, as retired men often take on a greater role in completing household tasks - retirement provides the opportunity for couples to spend more time together - a lifetime of shared experiences brings couples closer DIVORCE AND REMARRIAGE - couples over the age of 65 are less likely to divorce - older couples report divorcing because of poor communication, emotional detachment, and few shared interests - adults in long term marriages may find it more difficult to adjust to divorce than do younger adults - feel a sense of failure after spending their lives in a relationship - divorce poses financial challenges for couples because accumulated assets must be divided and financial security in retirement is at risk - women face greater financial and emotional difficulties than men as they are more likely to remain single throughout the remainder of their lives - rates of remarriage decline in older adulthood - particularly older men remarry after divorce - single women, whether by divorce or widowhood, are less likely to marry than men - when elders remarry, their unions tend to be more stable those those of younger people - gains in maturity and perspective may contribute to a more realistic concept of marriage and support the longevity of late life marriages - many older adults choose cohabitation over remarriage COHABITATION - increasingly common among all adults - more consistently associated with positive outcomes in older adulthood as compared with younger adulthood - tend to report higher quality relationships, perceiving more fairness, more time spent alone with their partner, fewer disagreements , and a lower likelihood of heated arguments - those who cohabitate tend to be in relationships of longer duration, are more likely to have experienced the dissolution of a marriage, and tend to report fewer marriage plans, viewing the relationship as an alternative to marriage - may be less interested in marriage because they are past the age of childbearing - may also be more interested in protecting the wealth they have accrued over their lifetime than they are in pooling economic resources - cohabiting unions are similar to marriage in terms of adults' reports of emotional satisfaction, pleasure, openness, time spent together perceived criticism, and demands and overall well being - shows similar health benefits to marriage, and this finding holds true in a variety of cultures SEXUALITY IN LATE ADULTHOOD - many assume that sexuality is irrelevant to older people, reflecting the stereotype that fing is a feared negative event marked by rapid physical and cognitive decline - as the population of older adults increases and healthy aging becomes more common, widespread advertising of medications for sexual performance may shift assumptions toward the view that older adults desire but are physically unable to have sex - in fact, adults remain interested and capable of sexual activity well into older adulthood - good sex in the past predicts good sex in the future - reasons for lack of sexual activity include physical problems, lack of interest, partners lack of interest, partner's physical problems and the loss of a partner - the nature of sexual expression shifts with age, encompassing an array of behaviors, as well as sexual activity in both long term and new relationships - because of the hormonal changes that accompany menopause, women may experience a lack of vaginal lubrication and therefore find intercourse uncomfortable - with increasing age, males' erections tend to take longer to achieve, are less frequent, and are more difficult to sustain than was they cause when they were younger, however, these normative changes should not be mistaken for erectile dysfunction - many factors diminish sexual response and satisfaction: cigarette smoking, heavy drinking, obesity, poor health, and attitudes toward sexuality and aging - many illnesses (such as arthritis, heart disease, diabetes, Parkinson's disease, stroke, cancer and depression) can have a negative impact on an individual's interest or participation in sexual activity - over the counter meds, herbal supplements may have side effects that can alter or impair sexual function - sexual activity is a correlate of health, as those who report good health are more likely to be sexually active - there is a bidirectional relationship: sexual activity is likely to enhance health by reducing stress and improving positive affect and well being RELATIONSHIPS WITH ADULT CHILDREN AND GRANDCHILDREN - the nature of the relationship and exchange of help changes over time, from predominantly parent-to-child assistance in childhood through earl ydulkthpood to increasing assitance provided y adult children to elderly parents - adult child-to-parent assistance most often takes the form of emotional support and companionship, which helps elders cope with and compensate for losses such as disabilities and widowhood - adult daughters tend to be closer and more involved with parents than sons, speaking with and visiting more often than sons - fewer older adults receive instrumental assistance from adult children - many older adults, especially those of high SES continue to assist their adult children, primarily with financial assistance - family relations make take many forms - support is provided either primarily from parent to adult child or adult to parent - other families provide support at a distance where they do not live nearby, engage in frequent contact, endorse fewer family obligation norms, provide mainly financial support: often from parents to children - other family relationships are autonomous, not living nearby, engaging in little contact, little endorsement of family obligation norms and few support exchanges - grandchildren and great grandchildren increase older adults' opportunities for emotional support - quality of the relationship is influenced by the degree of involvement in the grandchild's life - a history of close and frequent contact, positive experiences, and affectionate ties predicts good adult child-grandparent relationships - contact with grandchildren tends to decline as young and middle aged grandchildren take on time consuming family and work roles, bubt affection between grandchildren and grandparents tends to remain strong ELDER MALTREATMENT - about 1 in 10 adults experience elder maltreatment - elder maltreatment: acts or omissions of care that cause harm to the older person and occur within the context of a trusting relationship - physical abuse: intentionally inflicting physical harm or discomfort through cutting, burning or other acts of physical force - sexual abuse: inflicting unwanted sexual contact - psychological abuse intentionally inflicting emotional harm through verbal assaults, humiliation, intimidation, or withdrawal of affection - financial abuse: exploiting the elder's financial resources by theft or unauthorized use (eg withdrawing funds from savings, selling an elder's jewelry or other possessions, charging purchases to the elder's - physical neglect: providing inadequate care and failing to meet an elder's basic needs for food, medication, physical comfort, and health care; leaving an elder with special needs unattended - victims of maltreatment are more likely to be advanced in age and suffer and physical and mental illness, frailty, and impairment with activities of daily living - women and adults of color are more likely to be victimized, as are those who experience a lack of social support or social isolation - most cases are perpetrated by caregivers, most often spouses or children, who lack social support, experience psychological problems, and feel overwhelmed with the task of caregiving - within nursing homes, institutional factors such as overcrowding and understaffing contribute to caregiver stresses and can increase the likelihood of elder maltreatment - reducing the stressful working conditions such as, increasing oversight, aiding caregivers, social workers and family counselors, can aid caregivers in learning how to cope with anger and manage strong emotions, respite service such as in home assistance, education

3. Analyze relationships in middle adulthood, including friend, spousal, parent-child, and grandparent relationships.

Friendships: - middle aged adults tend to share demographic similarities with their friends - women's friendships continue to be more intimate , and they report having more close friends and experience more pleasure and satisfaction in their friendships than do men, whose friendships tend to center on activities - work and family demands tend to reduce available time and resources adults have for friends, leading adults to prune their social networks - the amount of friends and the contact with them tend to decrease - report having fewer friends and spending less time with friends than young adults, but the friendships that have endured tend to be described as close and a few to none are ambivalent or troubled - friendships offer powerful protection against stress for both men and women - adults turn to close friends for support with daily hassles as well as major stressors - increasingly, friends offer companionship and support from afar marriage: - over 80% of adults marry by age 45, 90% by age 60, and over 95% by age 80 - marriage is positively associated with physical and mental health for both opposite-sex and same-sex partners - men generally report being happier with their marriages than women, although the difference is small - for opposite and sam sex marriages, satisfaction tends to be highest in the egalitarian relationships in which home and family duties are shared and couples view themselves as equal contributors - the most satisfying marriages reflect congruence in which partners have enough shared interests, goals, and interaction styles to get along but also some differences that generate and sustain interest in one another - marriage satisfaction tends to wax and wane - in middle adulthood, satisfaction tends to increase as childrearing tasks and stress decline, family incomes rise, and spouses get better at understanding each other and have more time to spend together - the advances in emotion regulation that typically come with age may also improve the quality of marital interactions and predict satisfaction divorce: - divorces most often occur within the first 10 years of marriage, but about 10% of marriages break up after 20 years or longer - overall, middle aged adults list similar reasons for divorce as do young adults: communication problems, relationship inequality, adultery, physical and verbal abuse, and desires for autonomy - women are more likely than men to initiate divorce, and women who are the initiators tend to fare better than those who do not initiate the divorce - divorce is associated with decrease life satisfaction, heightened risk for as range of illnesses, and even 20-30% increase in early mortality - divorce is thought to be more harmful to women's health than to that of men, because it tends to represent a greater economic loss for women, often including a loss of health insurance - research suggests that, in women, illness often precedes divorce or perhaps a contributor rather than outcome of divorce - women tend to report ruminating about arguments, having more detailed memories of conflicts, and feeling more depressed after arguments than men, all of which predict poor health outcomes - although some adults show poor health outcomes of divorce, most people are resilient and fare well after divorce, especially after the initial adjustment - women who successfully make the transition through a divorce tend to show positive long term outcomes - they tend to become more tolerant, self reliant, and nonconforming- all characteristics that are associated with the increased autonomy and self reliance demands that come with divorce - divorce is challenging, but middle aged persons generally show less of a decline in psychological well being and show overall better adaptation than do young adults - it may be that increases in experience, flexibility, and problem solving and coping skills in middle adulthood aid adaptation - divorce represents an opportunity for growth and development and adaptive outcomes following divorce appear to be the norm, not the exception parents to adult children: - mothers report the move as more stressful than fathers, but most parents adjust well to their children's transition to independent living and the resulting empty nest - however, the extended transition to adulthood common today means that middle aged adults have more contact with their emerging adult children for a longer period of time and often provide more emotional and financial support than parents of prior generations - most parents report having positive interactions with their grown children on a regular basis - negative interactions with adult children, however, are consistently associated with parent reports of negative affect and predict daily patterns of the stress hormone cortisol - over 1/3 of U.S. young adults ages 18 to 31 live with their parents - norms for parental involvement with grown children and the economic context may shape the implications of the involvement for parents' marital ties and well being - parents are harmed when they believe their grown children should be more autonomous - children's success in life infleucnes their midlife parents' sense of well being - both mothers and fathers show negative emotional responses to their adult children's problems unmet career and relationship goals - adult children's problems are associated with low parental well being, including more negative than positive affect, low levels of self esteem, marital quality, and poor parent-child relationships - parents who perceive their grown children as needing too much support report lower life satisfaction - families who live apart continue to provide various forms of emotional and physical support to one another, including advice, babysitting, loans, car repair, and more - how much support family members provide each other depends on many factors, such as attachment, relationship quality, cultural norms, and resources - familism is a value that mandates the family comes before all else and that family members have a duty to care for one another, regardless of the problem or situation, whether personal, financial, or legal - poverty often leads family members to provide financial and physical assistance to each other, including living together - early midlife parents continue to give children more assistance than that receive, especially when children are unmarried or facing challenging life transitions such as unemployment and career change or divorce - most parents are happy in their roles, but their satisfaction varies with parental age, health, ethnic background, parent-child relationship quality, and perception of how their children "turn out" which influence their subjective levels of happiness parents to infants and young children - middle aged parents may find the social side of their new role challenging as their daily experiences may not match those of their peers - a new mother may find that her social clock is discordant with her same age peers who may be sending their children to college or planning for weddings and grandchildren - a middle aged mother may find herself much older than many of the other parents of infants she meets at child care, play groups, and parks - benefits: - many midlife adults have established careers with financial security, enabling flexibility in how they spend their time - feel better prepared for parenthood than they would have been at a younger age - feel mature, competent and generative, and they tend to be less stressed - greater increases in life satisfaction and are less prone to depressive symptoms - tend to have a younger perspective - complaints: - having less energy for parenting and feeling stigmatized as older parents - the cognitive and emotional changes that take place from early to middle adulthood contribute to midlife adults' readiness to be a parent - child benefits: - tend to receive more positive parenting behaviors and less negative ones - tend to be healthier, have fewer visits to the hospital, a greater likelihood of receiving all of their immunizations by 9 months of age, and higher scores on measures of cognitive, language, and social development through age 5 grandparenthood: - the role of grandparent is an important one for adults because, with increasing lifespans, many will spend one third of their lives as grandparents - adults who become grandparents early or late relative to their peers may experience amore challenging transition - the grandparent role is rewarding, and time caring for a new grandchild is associated with positive mental health - it can be accompanied by role strain as they may juggle expectations of employers, spouses, children, adult children, and grandchildren - grandparent involvement is associated with child well being and adolescent adjustment - in low income, families, grandparents often take on important financial and caregiving roles - grandparent involvement is predicted by regular contact, close relationships with grandchildren, and parental encouragement to visit with grandchildren - grandparents who are engaged and spend time with their grandchildren tend to report high levels of life satisfaction - relationships between grandparents and grandchildren are influenced by: - grandparent and grandchild gender - geographic proximity - SES - culture - in most cultures, grandparents and grandchildren of the same sex tend to be closer than those of the opposite sex, especially grandmothers and daughters - grandmothers tend to have more contact with their grandchildren than do grandfathers, and they tend to report higher satisfaction with the grandparent role - grandparents who live closer to their children tend to have closer relationships with their grandchildren than do those who have contact only on special occasions - because parents tend to regulate grandparent-grandchildren contact, grandparents' relationships with their own children influence their contact and relationships with grandchildren - grandparent role provides adults opportunities to satisfy generative needs by nurturing a new generation, enjoying spending time and playing with children without the responsibility of parenthood, and gain a sense of immortality by passing along family and personal history as well as a second generation progeny - some theorist suggest this has an evolutionary aspect such as the correlation between the presence of the maternal grandmother and child survival - close grandparent-grandchild relationships predict close relations in adulthood - grandparents and adult grandchildren tend to agree that their relationships are close and enduring - grandparents offer an important source of emotional support for their grandchildren - contact with grandchildren tends to decline as young and middle aged grandchildren take on time-consuming family and work roles, but affection between grandchildren and grandparents remains strong caring for aging parents: - "sandwich generation" middle aged adults scrambling to meet the needs of both dependent children and frail elderly parents and thus sandwiched between the two - although the popular "sandwich" metaphor may exaggerate the number of middle aged adults who financially support two generations, most adults do provide emotional support and assistance to multiple generations - motivations for providing emotional and financial care for aging parents: - obligation - reciprocity - the quality of the relationship - young adults ten dot adopt an idealistic perspective, perceiving strong obligations and ability to care for their parents, regardless of the level of care needed - middle adults tend to adopt a more realistic perspective as they anticipate the need to provide care and appreciate the responsibilities and sacrifices given the specific level and nature of care needed by a parent - the care that adult children provide aging parents is influenced by the parent child relationship as well as family circumstances and ethnicity - cultural differences of caring for older generations: pg 493 - parents and adult children who have a lifetime of close and positive relations tend to remain close, with adult children providing more assistance than do those who family relations are less positive - in middle age, many people looked back and gain more appreciation for their parents' assistance and sacrifices over the years - relationships between mothers and daughters (usually the closest) tend to become more intimate and complex as daughters enter middle age - adults with weak parent-child relationships often provide care to parents out of a sense of duty - daughters, especially those who live in close proximity, are most likely to be parental caregivers - as adults' caregiving responsibilities increase, they are more likely to experience conflicts among their many roles - caregivers can feel overwhelmed by their obligations to parents, children, spouses, employers, and friends, and this role overload is associated with anxiety, exhaustion, and depression - as women are more likely to provide care, caregiving can interfere with women's employment, causing losses in hours and earnings - may lose $300,000 on average - caregiving responsibility for parents may place female caregivers at risk of living in poverty and requiring public assistance later in life - caregivers who face multiple career and childrearing demands are at risk for role strain, depressive symptoms, and a reduced sense of personal mastery, self-efficacy, and they engage in fewer outside activities

1. Identify ways in which death has been defined and end-of-life issues that may arise.

MORTALITY: - declined 60% between 1935 and 2010, and 2% in 2014 - women are less likely to die in childbirth, infants are more likely to survive their first year, children and adolescents are more likely to grow to adulthood, adults are more likely to overcome conditions that were once fatal - infants under a year are more likely to die from genetic, prenatal, and birth complications, with SIDS third most common cause of death - childhood deaths are most often due to accidents, illness, and alarmingly, homicide - adolescents and adults through age 44 are more likely to die from unintentional injuries, such as falls and traffic accidents but most often drug overdose - suicide is the second leading cause of death in adolescents - illnesses are the leading source of mortality throughout life, but homicide is a more common source of injury death from ages 15-34 - over middle adulthood, cancer, heart disease, and injury become top three causes - suicide, the number four cause of death ages 45 to 54, becomes less common in middle adulthood, dropping to 8th - chronic illnesses such as diabetes and disease of the liver and respiratory system emerge as sources of mortality in midlife and late midlife - older adults over the age of 65 are most likely to die of chronic illnesses, with heart disease as the number one killer, followed by cancer - Alzheimer's is the 5th most common cause of death in adults 65+ - although unintentional injuries are the leading causes of death through age 44, the most common source of injuries vary with age - the opioid crisis is responsible for most overdose deaths DEFINING DEATH: - in prior centuries, death was defined as the cessation of cardiopulmonary function - clinical death: a person is dead once the heart stops beating - when the heart stops beating, blood, and thereby oxygen, no longer circulates throughout the body and permanent brain damage can occur after 3 minutes of oxygen deprivation - today's medical practices, including CPR, have permitted many people to regain a heartbeat and be "revived" from clinical death - a heartbeat is no longer a clear marker of life or, in its absence, death - with the production of mechanical ventilators, it is possible for the heart to continue to beat even though the person cannot eat, think or breathe on his or her own - therefore, a more precise definitions of death are necessary: - A 1968 physician led committee at Harvard Medical School concluded that patients who meet criteria for specific severe neurological injuries may be pronounced dead before cardiopulmonary cessation occurs - whole brain death: refers to the irreversible loss of functioning in the entire brain, including the higher and lower brain brain regions, the cortex and brainstem, without the possibility of resuscitation - may occur prior to clinical death - death is declared if all criteria are met and other conditions that may mimic death, such as overdose or deep coma, are ruled out - The President's commission for Ethical Study of Problems in Medicine, Biomedical, and Behavioral Research established the criteria used to diagnose whole brain death 1. no spontaneous movement in response to stimuli 2. no spontaneous respiration for at least 1 hour 3. total lack of responsiveness to even the most painful stimuli 4. no eye movements, blinking or pupil responses 5. no motor reflexes 7. a flat electroencephalogram (EEG) for at least 10 minutes 8. no change in any of these criteria when they are tested again 24 hours later - reaffirmed the whole brain definition - All 50 US states and DC apply the whole brain standard in defining death, thereby permitting a person to be declared legally dead and removed from life support - the most controversial definition of death: in the late 19th century, several researchers and physicians noted instances in which brain damage caused a cease in cortical functioning while the heart continued to beat - inadequate blood supply to the brain after heart attack, stroke or drowning, traumatic brain injury can irreparably damage the cortex while leaving the brainstem intact and functional - neurons of the brainstem often survive stressors that kill cortex neurons, resulting in cortical death or a - persistent vegetative state (PVS): the person appears awake but is not aware, due to the permanent loss of all activity in the cortex - PVS patients retain an intact brainstem, which permits heart rate, respiration and gastrointestinal activity to continue - PVS patients are neither clinically dead nor meets the criteria for whole brain death - remains biologically alive - may open his or her eyelids and show sleep wake cycles but does not show cognitive function, as indicated by measures of brain activity, such as MRI, EEG, and positron emission tomography scans - at first appearance, vegetative state, then after 4 weeks the patient is diagnosed with PVS - courts require authoritative medical opinion that recovery is not possible before terminating life-prolonging activities END OF LIFE ISSUES: - dying with dignity: refers to ending life in a way that is true to one's preferences, controlling one's end of life care advancing directives: - the individual's wishes must be known ahead of time - these decisions will likely be made by spouses, children, family, friends or health care workers - the Patient Self Determination Act of 1990 guaranteed the right of all competent adults to have a say in decision about their health care by putting their wishes regarding end of life and life sustaining treatment in writing - living will: a legal document that permits people to make known their wishes regarding medical care if they are incapacitated by an illness or accident and are unable to speak for themselves - can identify what, if any, medical intervention should be used to prolong their lives if they are unable to express a preference, can also designate the medical treatment they do not want - durable power of attorney: for health care is a document in which individuals legally authorize a trusted relative or friend (called a health care proxy) to make health care decisions on their behalf if they are unable to do so - it is important to have both a living will and a durable power of attorney, as they each fulfill different functions - advance directives: permit patients to take control over their health care, their deaths, and what happens to their bodies and possessions after death - facilitate communication about health care needs and preferences and can reduce anxiety on the part of patients - helps foster autonomy and retain a sense of dignity - caregivers benefit because an understanding of the patient's wishes can help in decision making and in reducing stress, emotional strain, and potentially guilt - can spare spouses and families the anguish, guilty, and potential conflict among family members of making decisions for a loved one without knowing his or her wishes euthanasia: - euthanasia: ("easy death") refers to the practice of assisting terminally ill people in dying more quickly - passive euthanasia: occurs when life sustaining treatment, such as ventilator is withheld or withdrawn, allowing a person to die naturally - active euthanasia: death is deliberately induced, such as administering a fatal dose of pain medication physician-assisted suicide: - physician-assisted suicide: a type of voluntary active euthanasia in which terminally ill patients make the conscious decision that they want their life to end before dying becomes a protracted process - patients receive from physicians the medical tool needed to end their lives, the patient self administer the medication hospice: - a desire to die with dignity, minimal pain, and on one's terms has advanced the hospice - hospice: an approach to end-of-life care the emphasize dying patient's needs for pain management; psychological, spiritual, and social support, and death with dignity - does not emphasize prolonging life but prolonging quality of life - dying persons have needs that set them apart from other hospital patients, and hospital settings are often not equipped to meet these needs - palliative care, focusing on controlling pain and related symptoms - hospice services are enlisted after the physician and patient believe the illness is terminal, and no treatment or cure is possible - may be provided on an inpatient basis, at a formal hospice site that provides all care to patients, but they are frequently provided on an outpatient basis in a patient's home - outpatient service is becoming more common because it is cost effective and enables the patient to remain in familiar surroundings of his or her home - home hospice care is associated with increased satisfaction by patients and families - the team typically physicians, nurse, social workers, and counselors who act as spiritual and bereavement counselors who support the patient in facing his or her impending death and help the patient's loved ones cope with the loss

2. Identify social contexts in which older adults live and their influence on development.

SOCIAL SUPPORT IN OLDER ADULTHOOD: - spouses and children are primary sources of support, as are siblings and other relatives - assistance and support send the message that older adults are valued and help them to feel a sense of belonging and see their place in the wider social order - social support from family and friends is associated with life satisfaction and protects elders from negative effects of stress, promotes longevity, and enhances well being - low levels of perceived support are associated with higher rates of cardiovascular disease, cancer, infectious diseases, and mortality - people who perceive social support are more likely to engage in health maintenance behaviors such as exercising, eating right, and not smoking, and that are more likely to adhere to medical regimens - social support is thought to influence health and longevity by enhancing positive feelings and a sense of control as well as buffering the negative effects of stress - an older adult might choose to focus attention and effort on writing a novel or volunteering at a local child care center, asserting control over and optimizing an activity that interest her and is within her scope of capabilities, while accepting assistance in day to day activities that she finds difficult, such as maintaining a tidy house and yard - frequently, psychological outcomes and well being are influenced by the perception of having others to turn to rather than the actual amount of help provided AGING AND THE SOCIAL WORLD: disengagement, activity, and continuity theories: - disengagement theory: older adults disengage from from society as they anticipate death - older adults with draw and relinquish valued social roles, reduce their social interaction, and turn inward, spending more time thinking and reflecting - society pulls away, reducing employment obligations and social responsibilities as they are transferred to younger people - elder's withdrawal and society's simultaneous disengagement serve to allow older adults to advance into very old age and minimize the disruptive nature of their deaths to society - in years, the disengagement theory as become apparent that its central tenet is not true - rather than disengage, most older adults prefer to remain active and engaged with others, and they benefit from social engagement - any amount of social activity is more beneficial than lack of involvement - many people continue rewarding aspects of their work after retirement or adopt new roles in their communities - most retain the same leisure activities from work to retiree, and many develop new hobbies - activity theory: declines in social interaction are not a result of elders' desires but are instead of function of social barriers to engagement - when they lose roles due to retirement or disability, they attempt to replace lost roles in an effort to to stay active and busy - volunteer work, for ex - it is not simply the quantity of activity and social relationships that influences well being and health but the quality, and individuals differ in their needs and desires - the more active they are, the more likely they are to report high levels of well being and life satisfaction and live longer, healthier lives - continuity theory: successful aging entails not simply remaining active but maintaining a sense of consistency in self across their past into the future - despite changing roles, people are motivated to maintain their habits, personalities, and lifestyles, adapting as needed to maintain a sense of continuity, that they are the same person hey have always been - this entails acknowledging and minimizing losses, integrating them with their sense of self, and optimizing their strengths to construct a life path that maintains their sense of remaining the same person over time despite physical, cognitive, emotional, and social changes - older adults tend to seek routine, familiar people, familiar activities, familiar settings - engaging in familiar activities, and familiar people preserves a sense of self and offers comfort, social support, self esteem, mastery and identity socioemotional selectivity theory: - older adult's narrowing social circles may rest on the uniquely human ability to monitor time - people become increasingly aware that they have little time left to live - this causes them to shift their goals and priorities and accounts for continuity and change in social relationships - socioemotional selectivity theory: older adults become increasingly motivated to derive emotionally close relationships and disengage from more peripheral social ties - as perceived time left diminishes, people tend to discard peripheral relationships and focus on important ones, such as those with close family members and friends - aging is related to steep declines in social relationships - but their relationships are particularly close, supportive and reciprocal - older adults place more emphasis on the emotional quality of their social relationships and interactions - older adults ten dot perceive their social network as eliciting less negative emotion and more positive emotion - this process of strengthening and pruning relationships is associated with positive well being; it allows older adults to focus their limited time and energy on relationships that are most beneficial while avoiding those that are inconsequential or detrimental, thereby maximizing their emotional well being - in this sense, social selectivity is an emotional regulation strategy - the functions of social interactions change with age and psychological and cognitive development - information sharing function of friendship becomes less salient - it is the emotion-regulating function of social relationships that becomes more important - the emotional correlates of friendship, feeling good and avoiding feeling bad, become more important over the lifespan - as physical frailty and psychological changes pose more challenges for adaption, older adults tend to place emphasis on having positive interactions with others, reducing negative interactions, and avoiding stress - smaller social networks are associated with greater life satisfaction in older adults due to the chances that older adults will have positive interactions with chosen relatives and close friends - social contexts are important influences on development, such as changes in physical, cognitive and social functioning, as well as adaptive functioning - the immediate contexts that influence older adults are neighborhoods and the elder's living environment NEIGHBORHOODS: - older adults who live in the suburbs tend to be healthier and wealthier and show higher rates of life satisfaction than those who live in cities - as their neighborhoods are less compact, suburban older adults tend to walk less and show greater declines in walking with age, both influence health and ability to live independently - urban elders have better access to transportation and health and social services than do suburban and rural elders, enhancing their opportunities for social participation - older adults in more accessible and safe neighborhood contexts, including walking friendly sidewalks and the availability of public transportation, are more likely to retain a higher degree of mobility and social activity than those in less accessible contexts - older adult's access to resources is influenced by neighborhood factors - older adults who live in poor neighborhoods experience more physical and mental health problems - the degree to which older adults walk in their communities may depend on their perceptions of safety - the effects of neighborhood poverty and disadvantage accumulate over a lifetime, with significant implications for functional decline and mortality - older adults who live in rural areas tend to interact with their neighbors more than their urban and suburban counterparts - close relationships with friends and neighbors, composed of frequent interaction and high levels of social support, are important emotional and material resources for older adults - life satisfaction in all older adults is associated with living in neighborhoods with many seniors who interact with each other - the family is no longer the sole source of support when older adults have close relationships with friends who can aid their adjustment over older adulthood AGING IN PLACE: - when elders are healthy and not physically impaired, living in their own home permits them the greatest degree of control over their lives, such as choosing what and when to eat - older adults who live alone are more likely to worry about finances and to live in poverty - elderly women are about 50% more likely to be poor than elderly men, risk of poverty increases with age - as health declines, living alone poses physical and psychological risks, including social isolation and loneliness - despite the challenges, remaining in a lifelong home strengthens elder's feelings of continuity with the past, aids their sense of identity, and maintains connections with the community, an important source of support - when adults choose to move to new communities, it is often to be closer to children or to relocate to a warmer environment - African American older adults are especially likely to remain in their lifelong neighborhoods and to live in poverty, but they also tend to rely on informal support systems for care, a helper network that includes spouses, children, siblings, friends, neighbors, and church members - this helper network is the basis for informal caregiving for those older persons who find themselves unable to maintain complete self care due to illness or physical infirmities - provides adults with instrumental assistance, such as help in grocery shopping, transportation, and meal preparation, and expressive assistance, such as help in grocery shopping, transportation, and meal preparation, and expressive assistance including emotional support, giving advice, encouragement, companionship and prayer - frequently, health care and transportation services are provided informally by friends and relatives to allow the older individual to live out his or her life within the context of home and community - many older adults live with kin, in intergenerational families - older adults often provide child care and share housing and financial assistance with younger family members, adult children and grandchildren - when it comes to beginning a coresidence (an older family member giving up his or her own home moving in with younger family members), an adjustment in attitude is often at issue - the older person may have concerns about not wanting to be a burden, losing autonomy, or losing privacy; younger family members may have similar concerns about an older family member disrupting the household - the new extended family consisting of grandparents, parents and grandchildren must find a new balance - attitudes about coresidence are based on family obligation norms, beliefs about repaying older adults for past help, perceived relationship quality, other demands on the younger adult's resources, the older person's resources, and family members' sense of moral responsibilities to assist RESIDENTIAL COMMUNITIES: - environments that met elder's changing physical abilities can help offset declines in mobility and aid in elder's attempts to remain active - living in a community of older adults supports social activities, the formation of friendships, and provision of assistance to others, which increase a sense of competence and leadership - older adults how better adaptation to living in residential communities when they share similar backgrounds and values, have frequent contact and communication with like minded elders, and feel socially integrated into the community - those who perceive a lack of social support and feel disconnected from the community are at risk for depression - overall, those who reside in residential communities tend to show higher levels of perceived autonomy, sense of security, an NURSING HOMES: - a nursing home is a facility that provides care to older adults who require assistance with daily care and health issues - offers the greatest amount of caer - constraints on autonomy can lead to loneliness, feelings of helplessness, and depression - older adults who are not mentally impaired in nursing homes tend to show higher rates of depression and anxiety than their peers in the community - factors that determine the quality of life of older adults: - freedom of choice and involvement in decision making - recognition of individuality - right to privacy - continuation of normal social roles - a stimulating environment with age appropriate opportunities and activities, a sense of connectedness between home, neighborhood, and community - well being is enhanced in nursing homes that are designed to foster a sense of control over day to day experiences and social life - encouraging social interaction in communal spaces, allowing residents to furnish and deinstitutionalize their environments to meet their changing needs while retaining as much autonomy as possible can help residents adapt to nursing home living

3. Discuss the physical and emotional process of dying as it is experienced over the lifespan.

THE DYING PROCESS - dying trajectory: the rate of decline that people show prior to death - great variability - in duration and descent and can be categorized into four patterns - abrupt-surprise death: the sudden, unexpected, instantaneous, such as an accident, a shooting or a heart attack or SIDS in infants - normal functioning until a steep, catastrophic decline occurs, bringing a sudden death without warning - short term expected death: a steady predictable decline due to a terminal illness such as cancer - expected lingering death: anticipated but prolonged, such as in the case of frailty and old age - entry-re entry deaths: slow declines are punctuated by a series of crises and partial recoveries; the dying person may have repeated hospital stays, returning home between stays - influences adaption on the part of the dying person and their family - short term expected death is most predictable and most likely to be experienced in hospice care as the lifespan is clearly identified as limited - lingering and entry-re entry deaths are prolonged - can tax caregiver's coping skills - toward the end of life, many people lose their appetite, which is often distressing to family as the patient may show dramatic weight loss - those suffering lengthy illnesses often show extreme weight loss and the loss of muscle mass, known as cachexia - the person will sleep most of the time, may be disoriented and less able to see, and may experience visual and auditory hallucinations - many terminally ill patients experience declines in cognitive function in the weeks prior to death - the dying person may experience: - pain, shortness of breath, irregular breathing, nausea, disrupted bladder and bowel function, and lethargy - will lose interest in the ability to eat, drink and talk as well as show reduced mobility and drowsiness - breathing may be difficult and the person may experience dry mouth and difficulty swallowing - breathing becomes noisy, a gurgling or crackling sound with each breath, referred to as the death rattle - the average time from the onset of the death rattle to death is about 16 hours - fluids may accumulate in the abdomen and extremities, leading to bloating - psychological symptoms such as anxiety, depression, confusion, the inability to recognize family members, and delirium are common EMOTIONAL REACTIONS TO DYING - denial, anger, bargaining, depression, acceptance - Ross described these reactions as a series of stages that not everyone experiences all of them or proceeds through them at the same pace/order - upon learning that one has terminal illness - denial is usually the first stage of processing, reflecting the initial reaction to the news - the person may not believe the diagnosis, deny that it is true, or seek a second or third option - once the realization sets in, so may anger - "why me?" - may feel cheated and robbed out of life, the person may harbor resentment and envy toward family and friends, and caregivers, as it may seem unfair that others live while they must die - the bargaining stage is common but not universal - the dying person bargains to find a way out - a deal may be struck with God or fate - might promise to be a better person and help others if only he or she can survive - "just let me live to see my daughter give birth" - eventually when they realize death is inevitable, depression is common, especially as the illness becomes more evident because of pain, surgery, or a loss of functioning - knowing it is the end brings profound sadness - the dying person feels great loss and sorrow - the person may feel guilt for the illness and its consequences for loved ones - may withdraw from emotional attachments to all but the few people whom they have the most meaningful relationships -sharing their feelings with others can help dying people come to an acceptance of death, the final stage - dying people no longer fight death - they accept that death is inevitable, seem at peace, and begin to detach themselves from the world - a stage view of death ignores the relevance of the context: including relationships, illness, family, and situation - the dying person has a myriad of emotions and must be allowed to experience and express them to come to terms with their grief, complete unfinished business with loved ones and ultimately accept death - it is difficult to predict the psychological state and needs of a dying person as they vary greatly according to factors like age, experience, and the situation - many dying people experience a sense of calm toward the end, releasing denial, anger, and a fear to die in peace EXPERIENCE OF ONE'S DEATH: the dying child: - physicians/parents find it difficult to talk to children about prognosis and death so children are less likely to develop a clear understanding of their condition and imminent death - dying children who have been ill for along time have been observed to show a maturity beyond their years - in a hospital setting, it is natural for children to acquire info about their disease during the progression of the illness - children's experiences are an important determinant of how they view the concepts of sickness, more so than age or intellectual ability - 3-4 year olds who are dying may understand more about impending death than well children - it is experience with the disease and its treatment that advances children's awareness of dying - children with life threatening diseases tend to show a greater awareness of death than their healthy or chronically ill peers - just as parents try to protect children, children may keep their knowledge that they are dying from their parents, perhaps in an attempt to protect them from distress - because dying children tend to want to know about their illness and treatment, experts advice that discussion about death should use concrete terms - open ended questions can gauge children's knowledge, and children's questions should be answered honestly and directly in lauge suited to the child's developmental level - children who are dying tend to express sadness and fears of loneliness, separation and abandonment - parents are advised to stay with a dying child, reading, singing, holding, and and sleeping with him or her THE DYING ADOLESCENT - adolescents' abilities for abstract reasoning translate in to more mature conceptions of death, its finality and permanent - adolescents' responses to a terminal illness influence and are influenced by the normative developmental tasks they face - tend to feel they have a right to know about their illness and prognosis, consistent with emerging sense of autonomy - the sense of invulnerability that is typical of adolescents can lead some to deny their illness or need for treatment - side effects of treatment such as hair loss, weight loss/gain can have devastating consequences for body image, often causing much distress or leading them to shun treatment - lengthy absence from home and the normal social milieu can distance adolescents from their friends and make them feel increasingly different from their parents - adolescents tend to focus on the social implications of their illness, such as their ability to attract a boy/girlfriend, be rejected by peers, or lack of independence from peers - they may have fewer opportunities to exercise autonomy or experience independence, leading them to feel anger over what they are missing and their need to be dependent on parents or doctors - dying adolescents may mourn the loss of the future - may feel angry and cheated, that life is unjust - given adolescents drive for autonomy, it is important they are informed and involved in planning treatment and decision making - dying adolescents especially need to live in the present, have the freedom to try out different ways of coping with the illness-related challenges, and find meaning and purpose in both their lives and deaths THE DYING ADULT - dying adults often feel angry and that the world is unfair, they have many developmental tasks that will be unfilled - the primary psychosocial task of young adulthood consists of developing relationships, specifically a sense of intimacy - a terminal illness can pose challenges to satisfying intimacy needs as it is difficult to form close and secure relationships when one is ill and has limited time left to live - isolation and abandonment are often principle fears of young adults who are dying - also lose the sense of an unlimited future - goals, plans, and aspirations are threatened - midlife adults mourn losing the present - worry about abandoning family and not having completed their journey - the normative process of taking stock in midlife transition from planning for the future to putting affairs in order - have a need to find ways to continue to meet their responsibilities to others, ushc as children, after they die - their developmental task is to come to a sense of integrity after a successful life review - terminal illness may pseed, thep process, adding stress, so that the elder may find it difficult to do the work involved in life review - more likely to accept death, feel that it is appropriate, and be free of any sense of unfinished business - have a desire to close tires, to make peace with family, and to engage in legacy working, leaving something behind

3. Contrast the findings of cross-sectional and longitudinal studies of crystallized and fluid intelligence over adulthood.

crystallized intelligence: - broad knowledge base acquired through experience and education - memory of spelling - vocabulary - formulas - dates in history - people who score high of measures of crystallized intelligence not only know more but also learn more easily and remember more information than do people with lower levels of crystallized intelligence fluid intelligence: - refers to a person's underlying capacity to make connections among ideas and draw inferences - flexible, creative and quick thought, which enables people to solve problems quickly and adapt to complex and rapidly changing situations - information processing abilities such as the capacity of working information, influence fluid intelligence - fluid and crystallized intelligence, but they interact in the sen that the basic information processing capacities that embody fluid intelligence make it easier for a person to acquire knowledge and developed crystallized intelligence - the relationship is not causal - gains in crystallized intelligence help adults compensate and permit adaptive function despite fluid losses intelligence over the years: - 461 - components of crystallized intelligence, such as verbal ability and inductive reasoning, remain stable and even increase into middle adulthood, suggesting that individuals expand and retain their wealth of knowledge over their lifetimes - fluid intelligence, such as perceptual speed and spatial orientation, decreases beginning in the 20s, suggesting that cognitive processing slows, somewhat, with age - may be due to the biological slowing of the central nervous system, as evident in declines in processing speed - other research points to declines in frontal lobe functioning and reduction in neural interconnectivity in explaining declines in fluid intelligence - intellectual ability is largely maintained over the adult years - crystallized intelligence doesn't see declines, sticks around - puzzles can help

4. Discuss influences on the timing of retirement and adaptation to retirement

deciding to retire: - it begins with imagining the possibility of retirement and what it might be like - adults then assess their abilities and their resources, determine when is the best time to let go of the work role, and put plans into action - the decision of when to retire is typically influenced by job conditions, health, fiances, and personal preferences - adults with poor health and visual and hearing impairments tend to retire earlier - workers tend to retire early from jobs that are stressful or hazardous and tend to delay retirement from jobs that are highly stimulating, take place in pleasant environments, and are a source of identity and self esteem - workers in professional occupations and those who are self employed tend to stay in their jobs longer - a sense of control and perceived working conditions, such as feeling respected by coworkers and leaders, is associated with delaying retirement in German and Finnish older adults - women often retire earlier than men, often to care for aging relative or spouse - women in poverty, however, especially African American women, ten dto work well into old age because they often lack the financial resources to make retirement possible - financial resources are often the determining factor - changing economics influence older adult's abilities to retire, as personal retirement investments such as IRAs and 401k plans may lose value unexpectedly - the creation of Social Security was designed to aid elders in affording retirement transition to retirement an adjustment: - beings years before leaving the workforce and continues well into retirement - adults generally seek to preserve continuity in their sense of self, and this tendency influences their transition to retirement - adults who are more satisfied a t work amy see work as central to their sense of self, may experience retirement as a disruption to their sense of self, and may thereby delay retirement - as workers approach retirement, they may adjust their attitudes toward work, revising their views on its importance - gains in one domain, such as increased family time, might compensate for losses in another, job related status - attitudes toward retirement may be based on their evaluation of the expected balance between the gain and losses associated with leaving working and being retired, and that is shaped in part by the expected disruption to their lifestyle - the net balance of perceived gains and losses will vary between individuals, with some older adults expecting greater gains or losses than others - attitude is likely to be characterized by attitudinal ambivalence in which individuals will hold both favorable and unfavorable attitudes toward the subject of retirement - feelings of well being and life satisfaction may decline as people worry an danciticpate the loss of the work role - after retirement, retires may experience a short honeymoon phase marked by vacations and new interests or a rest and relaxation phase of brief respite from the obligations of work - as they adjust, these positive feelings may change to disenchantment - over time, the adult develops. realistic view of the social and economic opportunities and constraints of retirement, and a period of reorientation occurs in which the person attempts to replace the lost work role with new activities or becomes stressed if he or she cannot - stability occurs once the retirees accommodate and adjust to retirement - research shows majority of adults show an increase in life satisfaction and adjust well to their postretirement life, but some show poor adjustment - retirees who experienced significant declines in life satisfaction tended to have worse health and lower access to a range of social and economic resources prior to retirement, suggesting that pre-retirement experiences influence adjustment - declines in well being and life satisfaction may occur when the retirement transition causes an important role loss of worker that must be replaced in other social roles over time - the loss of a role central to an adults identity may be especially stressful, contributing to increases in anxiety and depression, and poor well being - retirees with other role involvements, or those retiring from an unpleasant job, may be less troubled by, and even pleased with, the loss of those work roles - for those who find their job stressful or burdensome, retiring could be a very positive experience, a relief from ongoing strains and conflicts, energizing and fulfilling - for individuals who would like to participate more heavily in the roles of family member and community member, retirement is an opportunity for them to enjoy the rewards and responsibilities tied to those roles - continuity in other social roles and the ability to adapt to role changes lead to few change sin life satisfaction after retirement - retirement satisfaction tends to increase for most older adults over the first half dozen years of retirement influences on retirement adjustment: - characteristics of the individual, his or her social relationships, and the job - positive predictors of successful adjustment: - physical health, finances, leisure, voluntary retirement, social integration, psychological health, and personality related attributes - engagement in satisfying relationships and leisure activities - planning ahead for the financial and social changes that come with retirement - workers in high stress, demanding jobs, those that provide little satisfaction tend to show positive adaptation to retirement - retirement often comes as a relief - works in highly satisfy, low stress, pleasant jobs tend to experience more challenges in adaptation - the greater the intrinsic value of older workers job, the lower levels of retirement satisfaction - the length of the transition, whether abrupt or gradual matterseless in determining happiness after retirement than the worker's sense of control over the transition, whether it is chosen or forced - having a sense of control over the decision to retire, as well as the timing and manner of leaving work, has an important positive impact on psychological and social well being that lasts throughout the retirement transition - social support also influences adjustment - relationship satisfaction as well - increased time together can serve to enhance marital satisfaction - adults who are lonely or recently divorced are more likely to experience difficulty - maintaining multiple roles after retirement promotes well being - ex: volunteer work

grandparenthood

meanings: - valued elder - immortality through descendants passing down names - reinvolvement with personal past, recalling stories in response to relevant stores - indulgence (spoiling), trips, food, financial support, support can be over the top because now you have time and resources - role is positively viewed - proximity and time spent plays a big role

(15) 1. Summarize age-related physical changes during middle adulthood.

middle adulthood: 40-65 - gradual changes - many middle aged adults tend to think of their lives in terms of years left of life rather than years lived wear and tear theory: viewed the body as wearing out from use on the contrary: "use it or lose it" - regular exercise is associated with longevity in all people regardless of ethnicity or SES aging is influenced by: - genetics - interaction of epigenetic factors, the dynamic interplay between heredity and environment - contextual factors - availability of healthcare - lifestyle factors - health related behaviors - diet and exercise - alcohol use or smoking - exposure to environmental toxins research as to what contributes to longevity: - caloric restriction in animals - immune system - cellular mutation - some mutations may be due to free radicals: highly reactive and corrosive molecules that form when oxygen corrodes cells and trip off an election - destroy cellular materials in an attempt to replace the missing electrons - may increase likelihood of many age related diseases such as cancer, cardiovascular disorders, and arthritis - reductions in the capacity for cell division, specifically the limited capacity for human cells vision: - the cornea flattens, the lens loses flexibility, and the muscle that permits the lens to change shape, or accommodate, weakens - presbyopia: (developed in adults in their 40s) farsightedness, the inability to focus the lens on close objects, such as in reading small print - by age 50: virtually all adults are presbyopic and require reading glasses or other corrective options - most require corrective lenses for distance - the ability to see in dim light declines with age because the lens yellows, the size of the of the pupil shrinks, and over middle age, most adults have lost about one of half of the rods in the retina, which reduces the ability to see in dim light and makes adults' night vision decline twice as fast as their day vision - as rods are lost, so too are cones, color-receptive cells) because rods secrete substances that permit cones to survive - color discrimination, becomes limited with gradual declines beginning in the 30s - night vision is further reduced because the vitreous (transparent gel that fills the eyeball) becomes more opaque with age, scattering light that enters the eye (creating glare) and permitting less light to reach the retina. - in middle adulthood, about one third more light is needed to compensate for theses changes - muscles weaken, harder for adjustment to happen - light changes, etc. - goo in eye becomes cloudier/vision blurs (ventricles humors), lens yellowing - hard to distinguish amongst colors, older adults: dark colors - cataracts become common - replace lens - due to sun damage/UV vays - loss of rods and cons - presbyopia: weakening of lens, harder time seeing small print - harder time adjusting - same thing with heart muscles- expanding vs. adjusting - helps nearsighted people's vision improve - glaucoma: fluid is not draining, overload of fluid can lead to blindness - severe case: may not know, cause damage to optic nerve - treated, not curable - leading cause of blindness in middle adulthood hearing: - presbycusis: becomes apparent in the 50s, and is caused by natural cell death that results in the deterioration of the ear structures that convert sound into neural impulses - first limited to high pitched sounds, which enables us to distinguish between consonants such as f vs. s and p vs. t, as a result, the person often can hear most of a message but may misinterpret parts of it, such as names - middle-aged adults tend to experience more difficulty hearing under conditions of background noise and perform more poorly under that condition than do young adults - presbycusis hearing deficits tend to be more apparent in setting with background noise, such as a dinner party - presbycusis: - age related - genetics - contextual factors - men's hearing declines more rapidly than women's, perhaps up to twice as quickly - may work louder jobs, headphones/concerts, illnesses (cerebrovascular disease) - 45-64, 15% of individuals are having problems with hearing - change in ear- environmentally dependent - damage to ears: caused by earphones/concerts - presbycusis: effects high frequencies first skin: - 30s: developing lines on forehead - 40s: lines are accompanied by crows feet around the eyes and smile lines, markers of four decades of smiles, frowns, laughter and other emotions - skin becomes less taut as the epidermis: the outer protective layer of the skin that produces new skin cells, loosens its attachment to the thinning dermis: the middle layer of skin consisting of connective tissue that gives skin its flexibility. - the resulting loss in elasticity is accompanied by the loss of fat in the hypodermis: the innermost layer of skin composed of fat, which leads to wrinkling and loosening of the skin - women tend to experience age related changes sooner and more quickly than do men - their dermis is thinner, and as they age, they experience hormonal changes that exacerbate aging, particularly a reduction in the female hormone estrogen - influenced by: - sun - heat - cold - pollution - smoking - exposure to the sun's rays - most people reach peak muscle strength during their 20s, followed by a small gradual decline through the 30s, changes usually go unnoticed until the mid-to-late 40s - the rate of decline in muscle mass and strength tends to accelerate in the 40s - by age 60, about 10% to 15% of muscle mass and strength are lost - not all parts of the body age at same rate - isometric strength: the subtle contractions used to hold a hand grip, push off against a wall, stretch, or practice yoga - loss of endurance tends to occur after age 40, but the decline - both men and women tend to experience weight gain in middle adulthood, with an increase in body fat and loss of muscle and bone - muscle mass tends to be replaced by fat, however good nutrition and an active lifestyle can reduce losses and even increase muscular density - when adults gradually reduce their caloric intake to match their reduced need for calories, age related weight gain is minimized - normal aging brings some loss of bone tissue that begins around age 40 - bone loss increases in the 50s, especially in women, whose bones have less calcium to begin with and who lose the protective influence of estrogen on bones after menopause - increases risk of - osteoporosis: a disorder entailing severe bone loss that leads to brittle and easily fractured bones - bones become thinner, more porous and more brittle as calcium is absorbed - as the bones that make up the vertebrae in the spinal column become thin and more brittle, the disks collapse and adults lose height, about an inch or more by age 60 and more thereafter - loss of bone density causes bones to break more easily and heal more slowly, making a broken bone more serious as we age - losses in bone density can be slowed by behavior, such as avoiding - smoking - excess drinking - engaging in weight bearing exercise - osteocopinia: earliest level of osteoporosis - more prominent in women, less screened in men - epidermis becomes less firmly attached to dermis - dermis thins - dermis when young: thick/fat - fat in hypodermis decreases as skin becomes less taut, it fills in pockets where fat use to be - prevents: eating well, using sunblock - diet and exercise can't do much - different complexions: impact amount of damage changes in our bodies: - fat increases, muscle decreases - exercise can help pause reproductive abilities: - level os sex hormones in the body declines in both men and women - women experience the end of fertility - men retain their reproductive capacity but at a diminished level women: - at about 51 years of age on average, but starting as early as 42 and as late as 58, women experience - menopause: the cessation of ovulation and menstruation - influenced by: - heredity - lifestyle choices - contextual influences - exposure to pollution - occurs earlier in women who: - smoke - are malnourished - have not given birth - of lower SES - said to have reached menopause 1 year after her last menstrual period - perimenopause: refers to the transition to menopause, extending to approximately 3 years before and after m menopause - production of reproductive hormones declines and symptoms associated with menopause first appear - first indicator: shorter menstrual cycle, followed by erratic periods - ovulation becomes less predictable, occurring earlier or later in the cycle, sometimes several ova are released and sometimes none - hot flashes: the expansion and contraction of blood vessels cause sudden sensations of heat throughout the body accompanied by sweating - hormone replacement therapy: designed to address perimenopause symptoms - whether they report severe mood changes and irritability or few psychological or physical consequences, varies with their attitudes and expectations for menopause, which are influenced by: - personal characteristics - circumstances - societal views about women and aging - high levels of education and high SES are both associated with more positive views of menopause and fewer reports of menopausal symptoms - African American and Mexican American women tend to hold more favorable views toward menopause than White non-Hispanic American women, often describing it as a normal part of life, one that many women look forward to - in the us, post menopausal women tend to view menopause more positively than do younger women, tend to report menopause causing few difficulties and instead view it as a beginning men: - reproductive ability declines gradually and steadily over the adult years, with declines in testosterone beginning as early as age 30 in some men and continuing at a pace of about a 1% decrease a year to a total decline in testosterone of about 30% by age 70 - produce less testosterone and they become less fertile, bit about 75% of men retain testosterone levels in the normal range, with most adult males continuing to produce sperm throughout adulthood, many are able to father children into their 80s and beyond - the number and quality of sperm produced decline in middle adulthood, beginning at about age 40 and offspring of older men may be at greater risk of congenital abnormalities - levels can shift dramatically in response to stress and illness creating the appearance of "male menopause" - stress from problems can cause reductions in testosterone, which decrease sexual desire and responses - low levels of testosterone may interfere with a man's ability to achieve or maintain erection, which can influence anxiety about his sexual capacity, which can lead to further declines in testosterone - climacteric: describing menopause (go through climacteric -> ending in menopause) - earlier for those who smoked/have children - less estrogen, decreases in sexual arousal, reproductive organs shrinks - testosterone levels slightly drop - things may take a little longer

nontraditional students: 40-65

nontraditional students: - school in middle adulthood - returning to college - divorce -> need to be financially independent - opportunities at work - career changes - boredom - what's it like for an older adult in a young adult dominated environment? - may have kids, other jobs, etc. to take care of

2. Describe the changes that occur in self-concept, identity, and personality during middle adulthood

self concept: - describing themselves in more complex ways, adults are increasingly likely to integrate autobiographical information and experiences into their self descriptions as they grow older - emerging adults tend to perceive themselves as older, but adults older than 30 tend to have younger subjective ages - adults tend to consistently identify with their younger selves, perhaps as compensatory strategy to counteract the negative cultural messages associated with aging and to maximize their happiness - subjective age is multidimensional, and people are more likely to feel younger in areas that tend to be associated with negative age related stereotypes, such as cognitive aging and health gender differences: - women tend to hold more youthful self concepts because western cultures tend to define aging as a more negative experience for women than men - tend to be more optimistic than men about their cognitive competencies, their ability to maintain memory, and other aspects of cognitive abilities regardless of their actual age, although this effect is also seen in men to some degree - tend to score higher on measures of well being, mental health, and life satisfaction - tend to show better performance and slower declines in episodic memory, executive function, and health - adults who perceive themselves as older might be more likely to seek to alter their appearance - predicts poor life satisfaction only when adults have negative attitudes about aging but not when aging attitudes are more favorable - the adults with the greatest well begin are those who recognize their age but remain active, engage in preventive health habits, and do not become distressed by age related physical changes possible selves - individuals' conceptions of who they might become in the future, are self orientations that guide and motivate choices and future-oriented behaviors - motivator of behavior from early-older adulthood - people are motivated to try to become the hoped-for ideal self and avoid becoming the feared self, the self that they hope never to become - failure to achieve the hoped-for self, or failure to avoid the feared self, results in negative self evaluations and affect - people often protect themselves from failure by revising their possible selves to be more consistent with their actual experience, thereby avoiding disappointment and frustration - by middle adulthood, most people realize that their time and life opportunities are limited, and they become motivated to balance images of their possible selves with their experiences to find meaning and happiness in their lives - middle adulthood is an important time of self growth - over their lifetimes, adults revise their possible selves to be more practical and realistic, typically aspiring to competently perform the roles of worker, spouse, and parent and to be wealthy enough to live comfortably and meet the needs of children and aging parents gender identity: - some theorists argue that adult gender roles are shaped by the parental imperative, the need for mothers and fathers to adopt different roles to successfully raise children - in many cultures, young and middle aged men emphasize their ability to feed and protect families, characteristics that rely on traditional masculine traits (often referred to as traditionally masculine traits (often referred to as instrumental traits because they are associated with acting on the world - young and middle aged women emphasize their potential to nurture the young and care for families, traditional female traits (expressive traits that are associated with maintaining relationships) - although today most men and women in developed nations express more flexible views of gender than traditional roles dictate, parenthood often signals a shift in couples behavior and division of labor - most couples adopt traditional rules after the birth of a child - women showed greater changes in gender role attitudes and behavior than did men, and first time parents changed more than than experienced parents - although women still spend about twice as much time on housework and childcare as men while men spend more time working outside the home, since 1965 the average hours of housework per week for men rose from 4 to 10 - over the middle adult years, individuals' identification with he masculine or feminine gender role tends to become more fluid and integrated - begin to integrate instrumental and expressive aspect of themselves, becoming more androgynous - men begin to adopt more traditionally expressive characteristics, such as being sensitive, considerate, and dependent, and women adopt more traditionally instrumental characteristics, such as confidence, self-reliance, and assertiveness - although there are individual differences, the aver age man, initially low in expressive traits, becomes more expressive across the lifespan; the average woman, initially high in expressive traits, becomes less expressive across the lifespan androgyny: - integrating instrumental and expressive characteristics, provide adults with greater repertoire of skills for meeting the demands of middle and late adulthood - predicts positive adjustment and is associated with high self esteem, advanced moral reasoning, psychosocial maturity, and life satisfaction in later years - men and women with androgynous gender roles have a greater repertoire of skills, both instrumental and expressive, which permits them to adapt to a variety of situations with greater ease than do those who adopt either a masculine or feminine gender role self and well being in middle adulthood - middle aged adults are more likely than young adults to acknowledge and accept both their good and bad qualities and feel positively about themselves - revised, more modest, possible selves influence adults' sense of self esteem and well being - self esteem increases throughout middle adulthood - self esteem associated with positive emotional, social, and career outcomes throughout life, from adolescence through older adulthood - although self esteem increases in middle adulthood, paradoxically, well being shows a U shaped curve, with its lowest point in early middle age, typically in the early 40s - perhaps the overall decline in well being in middle adulthood is related to the great many roles most middle aged adults occupy - when accompanied by a sense of control, multiple role involvement predicts positive well being, more sense of life purpose, and greater overall well being - perceived control is associated with life satisfaction, and multiple demands that middle aged adults face often test their sense of control - positive processing, a tendency to interpret events in a favorable light, is associated with high levels of well being in middle adulthood - multiple roles must be accompanied by a sense of control or mastery in that area to influence well being - although most people experience midlife shifts in well being, they typically rate their subjective life satisfaction in the moderate to high range personality: - Big Five Personality Traits: thought to reflect inherited predispositions that persist throughout life, and a growing body of evidence supports their genetic basis - predict career, family, and personal choices in adulthood - - openness: the degrees to which one is open to experience, ranging from curious, explorative, and creative to disinterested, uncreative, and not open to new experiences - conscientiousness: the tendency to be responsible, disciplined , task oriented, and planful. this trait relates to effortful self-regulation. individuals low in this trait tend to be irresponsible, impulsive, inattentive - people high in this are more likely to complete college, those high in extroversion are more likely to marry - extroversion: includes social outgoingness, high activity, and enthusiastic interest, and assertive tendencies, this trait is related to positive emotionality. one the opposite pole, descriptors include social withdrawal and constrictedness - people who in this are more likely to divorce - agreeableness: this trait includes descriptors such as trusting, cooperative, helpful, caring behaviors and attitudes toward others. individuals low in agreeableness are seen as difficult, unhelpful, oppositional, and stingy - neuroticism: this trait relates to negative emotionality. descriptors include moodiness, fear, worry, insecurity, and irritability, the opposite pole includes traits such as self confidence - people high in extroversion, agreeableness, and conscientiousness and low in neuroticism report higher levels of well being - high scores of conscientiousness predict better performance on cognitive tasks and slower rates of cognitive decline - low conscientiousness predicts low morality - conscientiousness is especially close association with health as it influences the behaviors persons engage in- exercise, eating habits, and risky behaviors such as smoking- and these behaviors affect the likelihood of good or poor health outcomes - conscientiousness measured in childhood predicts health in middle adulthood - someone who is highly extroverted in young adulthood, perhaps with a very active social life, will also be highly extroverted in middle adulthood, perhaps manifested as being active in a parent teacher organization, leading a scout group, or participating in a book group. - research suggests adults mellow out with age - conscientiousness increases from emerging adulthood to mid adulthood, peaks between 50-70 and then declines, agreeableness tends to increase with age - people choose behaviors, lifestyles, mates, and contexts based on their personalities, and then the outcomes of these choices and life experiences may strengthen and stabilize personality traits - contextual factors: - social, living, and working contexts - social roles, such as spouse or parent - become established and, for most people, are largely stable over adulthood contributing to continuity in personality and individual differences in personality - personality traits can be expressed in many ways, depending on the situation and on the individual's personality makeup - most people are motivated to maintain a stable sense of personality as part of developing and maintaining a consistent sense of self

1. Examine the contributions of self-concept, personality, and religiosity to older adults' well-being.

the self in late adulthood: - global self esteem tends to decline in late life, most adults maintain a positive view of themselves, expressing more positive than negative self evaluations into old age - both 70-84 and 85-103 adults rate themselves more positively than negatively with regard to a variety of domains, including hobbies, interests, family, health, and personality, and there positive self evaluations predicted psychological well being - older adults tend to compartmentalize their self concept more so than younger and middle aged adults by categorizing the positive and negative aspects of self as separate roles, whereas younger and middle aged adults tend to integrate them into one - life experience and advances in cognitive affective complexity underlie older adult's multifaceted self conceptions and evaluations - the developmental task for adults is to accept their weaknesses and compensate by focusing on their strengths - adults reframe their sense of self by revising their possible selves in light of experience and emphasizing goals related to the sense of self, relationships, and health - adults reports of life satisfaction and well being typically increase into old age, along with corresponding decreases in negative affect SUBJECTIVE AGE: - older adults tend to feel that they are younger than their years, and this tendency increase with age - avoiding the self categorization of being old - categorizing oneself as a member of one's age group influences how individuals think about themselves, their competencies, and their future - adults may employ strategies to void the negative consequences of identification with their age group such as denying or hiding their age by excluding themselves from the "old age" category - adults with more negative self views are more likely to feel older than their years over time - individuals experiencing challenge contexts and situations, such as those experiencing financial distress, tend to report older subjective ages - subjective age is associated health and well being, including the risk for cardiovascular disease, engagement in health behaviors, life satisfaction, and longevity - those who feel younger than their years are less likely to internalize negative stereotypes about aging and they remain active, which promotes good health - younger subjective ages are associated with physical functioning, such as grip strength, as well as cognitive performance - subjective age is malleable in response to contextual conditions - age related declines are seen in tasks tapping fluid intelligence, such as working memory, but not tasks tapping crystallized intelligence, such as vocabulary REMINISCENCE AND LIFE REVIEW: - self concept remain stable over the lifespan - adults who have lived a relatively long life tend to reminisce and review their past experiences and achievements, reaffirming their sense of self - often tell stores and discuss their thoughts about people and events they have experienced - reminiscence: the vocal or silent recall of events in a person's life, happens naturally in everyday conversations and serves a variety of functions - older adults who engage in knowledge based reminiscence recall problems that they have encountered and problem solving strategies they have used - recalling past experience and acquired knowledge and sharing it with young people is rewarding, life enriching, and positively associated with well being - reminiscence can also help adults in managing life transitions, such as retirement or widowhood, and provide a sense of personal community, preserving a sense of self despite these changes - reminiscence remains stable, positively and negatively - when adults focus and ruminate bitterly over difficult events, they sustain and even increase negative emotions, as well as show poor adjustment - life review: reflecting on past experiences and contemplating the meaning of those experiences and their role in shaping one's life - life review permits self understanding and helps older adults assign meaning to their lives - can help elders adapt to and accept the triumphs and disappointments of their lives, become more tolerant and accepting of others, become free of the feeling that time is running out, and enhance emotional integration, life satisfaction, and well being - individual and group interventions can encourage and aid older adults in reminiscence and life review - reminiscence is fostered by encouraging autographical storytelling to teach others, remember positive events, and enhance positive feelings - life review interventions tend to focus on helping older adults evaluate and integrate positive and negative life events into a coherent life story - social support may facilitate the life review process in elders, a interaction with others can help to point out blind spots and self serving biases that rise in the process of autobiographical reconstruction - close family members and friends can provide feedback and guidance that enhance the life review process - encouraging adults to engage in reminiscence and life review is associated with increases in. a sense of mastery, well being, purpose in life, positive mental health, and social integration EGO INTEGRITY: - ego integrity vs. despair: last stage in Erikson's psychosocial theory, in which older adults find a sense of coherence in life experiences and ultimately conclude that their lives are meaningful and valuable - adults who achieve ego integrity can see their lives within a larger global and historical context and recognize that their own experiences, while important, are only a very small part of the big picture - viewing one's life within he context of humanity can make death less fearsome, more a part of life, and simply the next step in one's path - the alternative, to developing a sense of integrity is despair, the tragedy experienced if the retrospective looks at one's life are evaluated as meaningless and disappointing, emphasizing faults, mistakes, and what could have been - may ruminate over lost chances and feel overwhelmed with bitterness and defeat, becoming contemptuous toward others in order to mask self contempt - more likely to experience a poor sense of well being and depression - a sense of integrity relies cognitive development, such as complexity and maturity in moral judgement and thinking style, tolerance for ambiguity, and dialectical reasoning - the ability to realize that there are multiple solutions to problems and recognize that one's life path may have taken many different courses is integral to developing a sense of ego identity - ego integrity is also predicted by social factors, including social support, generatively, and good family relationships - interactions with others PERSONALITY: - personality traits remain stable such that scores relative to peers remain stable over their lifetimes - personality traits shift subtly over life course in patterns suggesting that most people experience a mellowing of personality characteristics with age - individual's patterns of Big 5 personality traits predict physical and cognitive functioning - conscientiousness is associated with health and longevity, as well as better performance on cognitive tasks - neuroticism is associated with worse average cognitive functioning and steeper rate fo decline - Big 5 personality traits show complex associations with well being correlates with higher levels of extroversion, agreeableness, and conscientiousness and with lower levels of neuroticism - this relationship may be bidirectional - individuals whoa re initially extroverted, agreeable, conscientious, and emotionally stable subsequently increased in well being and in turn became even more agreeable, conscientious, emotionally stable, and extroverted - the mellowing of personality aids older adults in adjusting to change, contributing to well being RELIGIOSITY IN LATE ADULTHOOD - religiosity can take the form of behaviors (attendance at religious services) or attitudes and orientation, such as religious affiliation and private religious practices (such as prayer) - people tend to consider participation in personal religious activity such as prayer more important as they age - adults are more likely to attend religious services with age, from middle adulthood into late adulthood - although religious attendance declines in late adulthood, this is likely due to changes in health, mobility, and transportation - low SES ethnic minority groups show the highest rates of religious participation - for many older adults, the church is a place of worship that enables them to find meaning in their lives - women show higher rates of religiosity and religious participation - this may be because women find religion helpful in buffering the stresses that accompany juggling multiple roles such as parent, employee, and caregiver - although adults generally show increases in religiosity with age, women tend to show greater increases than men - religiosity is positively associated with physically health, including more time exercising, reductions in hypertension, and increased longevity - religiosity and spirituality is also associated with well being - a strong sense of religiosity can buffer stress in the face of disadvantages and stressful life events and help older adults to find meaning in life - also associated with optimism, a sense of self worth, life satisfaction, low rates of depression - religious attendance may facilitate mental health through social means by increasing an older adult's connections with older people in the community, both in giving and receiving support - church attendance is positively associated with social network size, frequency of social contact, and perceived support - social engagement and feeling part of a community are important benefits of religious service attendance