CHAPTER 13-15

What helps widowed people to cope?

-Continuing bonds - feeling that the spouse is physically there helps people cope -Working model - constructing an independent life as a phase of widowhood -Religion - helps widowed people grieve by feeling spiritually connected to God -Children and families - children make special effort to attend to grieving parent

•Nursing homes or long-term care facilities

-Designed for people with basic ADL impairments -Provides 24-care intensive care -Serves mainly very old and female residents -Entry often occurs after trauma -People without families are most at risk of entry -Primarily funded through Medicaid in U.S.

Basic ADL's

-Difficulties performing essential self-care activities (eating, getting to the toilet) -Relatively rare until the old-old years -Require full-time help or nursing home care

Instrumental ADL's

-Difficulties performing everyday household tasks (cooking, cleaning) Common in advanced old age

•Traditional hearing aids that magnify all sounds

-May not help much and are difficult to manage

Reasons retirees may be pleased or displeased with retirement

-Positive •Physical and mental health •Focus on "bucket list"; leisure activities •Married •Financial stability •Consider retirement as a challenge; a new phase of life •Volunteering -Negative •Not leaving work by choice - forced retirement •Financial concerns •Health concerns

Some interventions to clarify Sight

-Use strong indirect lighting. •Avoid fluorescent lighting that produce glare, especially on bare floors. •Use adjustable lighting and larger numerals on appliances, and provide non-reflective surfaces. •Use low-vision aids such as magnifiers. •Investigate low-vision clinic for rehabilitation resources.

Why might the population median age be changing?

-baby boomers entering later life -longevity -declining fertility

How does time pressure affect memory in older adults?

...

Episodic Memory

1)Episodic - the ongoing events of daily life -Recalling isolated events (what you had for breakfast last Tuesday) Highly fragile in everyone Where real differences are seen between young and old

Procedural memory

1)Procedural - information remembered automatically -Physical skills or complex motor activity (e.g., riding a bicycle) Most resilient; last to go in patients with brain diseases Resides in a different (lower) area of the brain

Semantic Memory

1)Semantic - ability to recall facts and basic knowledge -George Washington as first president Elderly can perform as well on this type of memory as young Moderately resilient; long-lasting crystallized knowledge

•Use Selective Optimization with Compensation

1.Selectively focus on what you need to remember. 2.Optimize, or work hard to manipulate material in this system into permanent memory. 3.Use compensation, or external memory aids, when you do not feel confident about remembering information without help.

Three different pathways to death- what they care called, what they look like and what

1•Death occurs without any warning. •Accident •Sudden, fatal, age-related event (heart attack, stroke) 2•People decline steadily as they approach death. •A fatal disease, possibly in the advanced stages 3•People have an erratic course; fatal disease takes years or decades with ups and downs. •Most common dying pattern •Typically helped by medical technology

Kubler-Ross Emotional Stages of Death (Know all 5)

1•Denial •Person may believe the diagnosis was a mistake. •May try to get several "second opinions." 2•Anger •Person may lash out, maybe even at the doctor. 3•Bargaining •Person may plead for more time, often to God. •Makes promises to be "good" if death is delayed. 4•Depression •Person becomes distraught by the thought of his or her death. 5•Acceptance •Final stage where the person begins to accept his or her fate.

Advanced Directive

Advance directives are written document spelling out instructions with regard to life-prolonging treatment if the person becomes irretrievably ill and cannot communicate his or her wishes

What is ageism?

Attitudes and beliefs, feelings, and behavior toward people based on their age

What is age-based rationing of care?

Daniel Callahan, prominent biomedical ethicist, argues for age-based rationing of care -Defined as the idea that society should not use expensive life-sustaining technologies on people in their old-old years  Two arguments 1.After a person has lived out a natural lifespan, medical care should no longer be oriented to resisting death. 2.Existence of medical technologies capable of extending lives of elderly persons who have lived out a natural lifespan creates no presumption that the technologies must be used for that purpose.

•Selective problems

Hearing higher-pitched tones -Overpowering background noise

Ethical Problems associated with legalizing Euthanasia

Legalizing euthanasia may lead to: 1.Violating the religious injunction against suicide - belief that only God can give or take a life 2.Involuntary euthanasia - doctors terminating treatment for people who do not want to die 3.Person might be pressured into deciding to die by unscrupulous family members. 4.Person might be seriously depressed, and would not want to die if the depression were treated.

examples

Low birth weight, which is often linked to social class, can cause obesity and poor health later in life. Childhood illness can lead to poverty (missing school, less likely to attend college). Poverty can lead to poor choices in later life (smoking, poor nutrition, less exercise, less access to good health care).

Dementia (NCD

Major NCD commonly called dementia -Is general label for any illness that produces serious, progressive, usually irreversible cognitive decline -Chronic disease that involves total erosion of personhood -Typically, dementia is an illness in advanced old age, not young-old -Can be seen in younger adults who experience brain injury or illnesses such as AIDS

What is Presbyopia ?

Presbyopia •Includes age-related difficulties with seeing close objects •Is universal change that happens in mid-life •Often leads to need for reading glasses

reaction time

Problems with reaction time or decline in the ability to respond quickly to sensory input is the amount of time that elapses between the presentation of a sensory stimulus and a behavioral response. Or, in other words, how fast can a person execute a mental operation needed by the current task.

Factors that affect the age of death

Socioeconomic status Ethnicity Gender Age

What is Thanatology?

Thanatology (study of death and dying) classes became the rage on university. the scientific study of death and the practices associated with it, including the study of the needs of the terminally ill and their families

Living wills

a spells out persons wishes for life-sustaining treatment in case he or she becomes permanently incapacitated and unable to communicate

Physician assisted suicide

a type of active euthanasia in which a physician prescribes a lethal medication to a terminally ill person who wants to die

Do Not Hospitalize Order (DNH)

advanced diective put into the charts of impaired nursing home residents, specifying that in a medical crisis they should not be transferred to a hospital for emergency care.

Do Not Resuscitate Order (DNR)

advanced directive completed by surrogate (typically doctors in consultation with the family) for an impaired person, specifying that no efforts will be made to revive him or her in case of a cardiac arrest

What is prolonged grief )sometimes called complicated grief)

characterized by intense grief that lasts longer than would be expected according to social norms and the causes impairment in daily functioning.

What type of loss is the most devastating to an adult?

child

Divided Attention Tasks- what does this mean and why is it problematic?

divided-attention-task situation in which they need to memorize material or perform an activity while monitoring something else. -time pressure increase difficulties with memory -time pressure when learning something totally new (fluid task) is particularly problematic

What is a top ranking fear of older adults?

memory loss

Durable power of attorney for health care

person designates a specific surrogate to make healthcare decisions if he or she becomes incapacitated and unable to make his or her wishes known

Passive Euthanasia

taking action to help the person die - illegal everywhere but Belgium,netherland, and Luxembourg

Active Euthanasia

withdrawing paternally life-saving interventions (e.g feeding tube) -instruction typically designed in advance directive, therefore it is acceptable.

•Home health services

•"in place" care - provides care in home Paid caregivers provide help with ADLs - cooking, cleaning, bathing

Dementia Dimensions

•Chronic •Diagnosis to death approximately 4 to 10 years •Typically advanced old age •Progression Forget semantic information − recalling core facts about their lives (name, address, etc.) §Impairment in executive functions - the ability to inhibit one's actions §Thinking is affected - abstract thinking, decision making, impaired judgment §Language is compromised. §Later in life - loss of all functions such as ability to speak or move May become bedridden, unable to remember how to eat or swallow §May lead to infections or pneumonia, which can lead to death

•Continuing-care retirement

•Continuing-care retirement •Residential complex that provides different levels of services •Independent apartments to nursing home care •Designed to provide person−environment fit •Allows person to not burden family members

What is a dying trajectory?

•Dying trajectory refers to how hospital personnel make predictions and organize care about what pattern the person's dying likely to follow. -Expected swift death: Death is imminent with no chance of survival

•Day-care programs

•For elderly who live with families •Provides place for impaired elderly to go when caregivers are working •Helps family members continue to care for loved one in the home by providing support and help with care while not giving up other responsibilities

•Assisted-living facilities

•For those who are experiencing ADL limitations but do not need 24-hour care •Offers care in a less medicalized setting •More of a homey setting •Residents have private rooms and personal furniture.

Is hearing loss problematic? WHY?

•Hearing impairments may be more problematic than vision problems because they limit the ability to connect with the human world through language •Have an environmental cause − exposure to noise •Problems may increase in the iPod-oriented culture! -more likely in men

What is Presbycusis?

•Presbycusis is characteristic age-related, permanent hearing loss -Caused by atrophy of inner ear hearing receptors

Pros and cons to dying at home

•Pro •Avoid unwanted life-prolonging machines •Spending final days with people most cared about •Spending final days in most preferred physical setting •Con •No worries about pain control •No fear of burdening family •Privacy to express feelings •Avoiding embarrassment of depending on loved one for meeting intimate care needs

What is the problem with Kubler-Ross's theory?

•Problems with theory -Not all terminally ill patients want to discuss their situation -Not every culture feels it is appropriate to openly discuss death -Not every person passes through distinctive stages adjusting to death

Socioemotional Selectivity Theory

•Socioemotional selectivity theory suggests time left to live affects priorities and social relationships -Young people focus on the future -Older adults realize the future is limited, thus refocus priorities

Mnemonic Techniques

•Use Mnemonic Techniques − strategies to make things emotionally vivid -Basic principle: If it's vivid emotionally, we remember it (try to get a visual image).

Difference between Vascular Dementia and Alzheimer's disease

•Vascular neurocognitive disorder (Vascular dementia) •Caused by multiple small strokes •Involves impairments in the vascular system (blood flow in body) •Blood flow that feeds brain •Neurocognitive disorder due to Alzheimer's disease •Age-related dementia characterized by neural atrophy and abnormal by-products, such as senile plaques and neurofibrillary tangles. •Neurons decay and wither away. and are replaced by neurofibrillary tangles and senile plaques •Genetically linked (Genetic marker (APOE-4))