late adulthood

Polypharmacy

multiple medications and OTC drugs, can lead to adverse reactions. Notify doctor of all medications, herbals, and other OTC drugs. Keep a record of medications, dosage, and frequency. Limited alcohol use.

disengagment theory

mutual withdrawal between older adults and society takes place in anticipation of death. Older people decrease their activity levels and interact less frequently, becoming more preoccupied with their inner lives.

episodic memory

recall of everyday experiences, and difficulties with diverse aspects of remembering increase substantially in old age. Because older adults take in less about a stimulus and its meaning, their recall is reduced in relation to that of younger people.

average life expectancy

the number of years that an individual born in a particular year can expect to live.

residential communities

-Congregate housing. -Life-care communities.

memory

-Episodic Memory slower cognitive processing poor attention to context -Recall declines -Recognition easier than recall -Very long-term recall Autobiographical memory for both remote and recent events Reminiscence bump for events of adolescence, early adulthood -Prospective Memory Event based vs Time based. -People between ages 50 and 90 recall both remote and recent events more frequently than intermediate events. In memory tests of older adults, most of the remote events recalled happened between ages 10 and 30—a period of heightened autobiographical memory called the reminiscence bump. Adolescent and early adulthood experiences are retrieved more readily than those of middle adulthood for a variety of reasons. Adolescence and early adulthood are times of identity development, when many personally significant experiences occur. Youthful events occur during a period of rapid life change filled with novel experiences that stand out from the routine of daily life. The reminiscence bump describes emotionally positive, but not negative, memories.

despair

-Feel many decisions were wrong, yet time is now too short -Bitter, unaccepting of death -Expressed as anger, contempt for others

ego integrity

-Feel whole, complete, satisfied with achievements -View life in context of all humanity -Associated with more favorable psychological well-being

life review

-Form of reminiscence -Goal: greater self-understanding -Can lead to increased self-esteem, sense of purpose reduced depression

ordinary homes

-Living in own home: greatest personal control -Living with family members -Living alone: number increasing

aging and the nervous system

-Loss of brain weight accelerates in sixties. 5-10% by 80s. -Neurons lost, especially in prefrontal cortex (executive function) corpus callosum cerebellum (balance) Important as risk for falls glial cells -Autonomic nervous system less efficient: more sensitive to heat and cold -How the brain compensates: new fibers, neurons new connections use more parts of brain

widowhood

-Most stressful life event for many -One-third of older adults are widowed -Most live alone, cope with loneliness -Reorganizing life harder for men: -more physical, mental health problems -more likely than women to remarry. More than 40 percent of U.S. women age 65 and older are widowed, compared with just 13 percent of men. Most widows and widowers live alone rather than in extended families in order to retain control over their living space and to avoid disagreements with adult children. Aging adults have fewer lasting problems than younger individuals who are widowed, probably because death in later life is viewed as less unfair. Widowed seniors with outgoing personalities and high self-esteem are resilient in the face of loneliness and try to preserve social relationships. The stronger older adults' sense of self- worth in handling tasks of daily living, the more favorably they adjust. Widowed individuals must reorganize their lives, reconstructing an identity that is separate from the deceased spouse. Overall, men show more physical and mental health problems and greater risk of mortality after their wives die, partly because men rely on their wives for social connectedness and coping with stressors.

spirituality and religion

-Religion very important to majority of Americans age 65 and older -Late-life changes: +development of new faith capacities +openness to other religious perspectives +enlarged vision of common good -Religious involvement associated with +better physical, psychological well-being +closeness to family and friends +greater generativity. -over 70 percent of Americans age 65 and older say that religion is very important in their lives. U.S. seniors gradually become more religious or spiritual as they age, but the late-life increase in religiosity is modest, and it is far from universal. Involvement in both organized and informal religious activities is especially high among low-SES ethnic minority older people and among women. Both organized and informal religious participation is associated with longer survival and greater psychological well being. The benefits of religious involvement for quality of life are evident even in the final year of life.

reminiscence

-Telling stories about the past: +Self-focused: can deepen despair +Other-focused: solidifies relationships +Knowledge-based: effective problem-solving strategies. Reminiscence often occurs during times of life transition, such as retirement or widowhood, and helps older adults sustain a sense of personal continuity. Experts believe a new phase of late adulthood has evolved called the Third Age.

ego differentiation

-affirm self-worth through family, friendship, community life -alternative to work-role preoccupation -For those who invested heavily in their careers, finding other ways to affirm self-worth.

IADLs (instrumental activities of daily living)

-conducting business of daily life -require some cognitive competence -shopping, food preparation, housekeeping, paying bills

body transcendence

-emphasize cognitive, emotional, social powers -alternative to body preoccupation -Overcoming physical limitations by emphasizing the compensating rewards of cognitive, emotional, and social powers

joan erikson

-eriksons widow -suggested that these attainments represent development beyond ego integrity to a psychosocial stage that she calls gerotranscendence

History of Family Violence

Adults who were abused as children are at increased risk of harming older adults.

alzheimers disease

-incidence: higher with age. 45% OVER 85 -Symptoms: Forgetting, disorientation, personality change, depression, motor problems, delusions, speech problems, infections -brain changes: Neurofibrillary tangles, amyloid plaques in cerebral cortex, synapse deterioration -risk factors:Genetic predisposition High-fat diet Lifestyle factors -protective factors: Education, active lifestyle Mediterranean diet Active social life -About 5 to 15 percent of all deaths among older adults involve Alzheimer's, making it a significant cause of late-life mortality. The earliest symptoms are often severe memory problems. At first, recent memory is most impaired, followed by loss of recall of distant events. Personality changes occur, including loss of spontaneity, anxiety, aggressive outbursts, and social withdrawal. As the disease progresses ability to manage ADLs is decreased greatly. The course of Alzheimer's varies greatly, from a year to as long as 20 years. There are major structural changes in the cerebral cortex including development of bundles of twisted tangles and dense deposits of a deteriorated protein, called amyloid develop. As synapses deteriorate, levels of neurotransmitters decline and neurons die, and brain volume shrinks. Alzheimer's disease comes in two types: familial, which runs in families, and sporadic, which has no obvious family history. I encourage you to view the video which I have placed in this weekly unit. It is a very moving and tragic story of a young woman who developed the disease at age 40.

macular degeneration

-light-sensitive cells in the macula, or central region of the retina, break down -the leading cause of blindness in older adults, in which central vision blurs and gradually is lost.

life changes and social support

-older people at high risk for negative life changes -multiple negative changes test coping skills -positive social support promotes physical health, -psychological well-being -important to take personal control of social support, -maintaining control of highly valued activities

Mental Disabilities in Late Adulthood

1. Dementia - thought and behavior impairments that disrupt everyday life 2. Parkinson's disease 3. Alzheimer's disease 4. Cerebrovascular dementia - strokes 5. Misdiagnosis, reversible dementia - depression - medication side effects

Erikson: Ego Integrity vs. Despair

50+ yrs. involves coming to terms with one's life. Adults who arrive at a sense of integrity feel whole and satisfied with their achievements; they have adapted to life's triumphs and disappointments. The capacity to view one's life in the larger context of all humanity contributes to the contentment that accompanies integrity. With the realization that the integrity of one's own life is part of an extended chain of human existence, older adults who report having attained personally gratifying life goals typically express acceptance of their own death, whereas those who emphasize attainment of extrinsic goals (such as money or prestige) more often fear life's end. Despair occurs when aging adults feel they have made many wrong decisions, yet time is too short to find an alternate route to integrity.

never married, childless

About 5% of older adults have remained unmarried and childless. Most have developed meaningful relationships, and women seem to have adapted more positively than men. Women have more close friendships with other women with whom they often travel and enjoy each other's families. Men on the other hand are more likely to feel lonely and depressed in their later years and this may lead to more unhealthy behaviors. Elder men have poorer physical and mental health then their counterpart, elderly married men.

relationship with adult children and siblings

About 80 percent of older adults in Western nations are parents of living children. In diverse ethnic groups and cultures, warm bonds with adult children reduce the negative impact of physical impairments and other losses on psychological well-being. Conflict or unhappiness with adult children contributes to poor physical and mental health. The level of assistance adult children provide aging parents is typically modest. Well into late adulthood, seniors in Western nations give more than they receive, in financial support as well as in practical assistance. Aid received from adult children in Western nations most often takes the form of emotional support rather than financial assistance. Most older adults have at least one sibling, who live within 100 miles and communicate regularly. Closer bonds seem to be with sisters. Widowed and never married siblings tend to have more contact with their siblings and often rely on each other for help when there is illness.

problem solving

Aging brings both deterioration and adaptive changes in problem solving. The problematic situations that seniors encounter are often different from those experienced at earlier ages. For example, a major concern is managing ADLs, such as preparing nutritious meals and attending to health concerns. As long as they perceive problems as under their control and as important, older adults are active and effective in solving them. Older adults are particularly good at adapting strategies to fit problem conditions—as with home, relatives, friends, and finances. Older adults make faster decisions about whether they are ill, will seek medical care sooner than younger people, and select treatments more quickly. Compared with younger married couples, older married couples more often collaborate in problem solving, and their strategies are highly effective.

ego transcendence

As contemporaries die, facing the reality of death constructively through efforts to make life more secure, meaningful, and gratifying for younger generations. Research suggests that body transcendence and ego transcendence increase as seniors grow older.

friendships in late adulthood

As family responsibilities and vocational pressures lessen in late adulthood, friendships take on increasing importance. Intimacy and companionship are basic to meaningful late-life friendships. Late-life friends help shield each other from negative judgments stemming from stereotypes of aging. Friendships link aging adults to the larger community. Friendships help protect seniors from the psychological consequences of loss. Although older adults prefer familiar, established relationships over new ones, friendship formation continues throughout life. Women are more likely than men to have intimate friends.

accidents

At age 65 and older, the death rate from unintentional injuries is at an all-time high, largely due to motor vehicle collisions and falls. Older adults have higher rates of traffic violations, accidents, and fatalities per mile driven than any other age group, with the exception of drivers under age 25. Older adults also make up more than 30 percent of all U.S. pedestrian deaths. About 30 percent of adults over age 65 and 50 percent over age 80 have experienced a fall within the last year. Because of weakened bones and difficulty breaking a fall, about 10 percent of falls result in serious injury. Among the most common is hip fracture, which increases fifteenfold from age 65 to 85 and is associated with a 20 percent increase in mortality.

common health problems

CVD, stroke, respiratory problems especially if was a smoker, Mental acuity, fractures.

life expectancy

Chronological Age compared with Functional Ag. Average Life Expectancy: 78.5, 76 for men. 81 for women. Increasing in U.S. because of steady decline in infant mortality decrease in adult death rates Variations due to heredity, environment: gender SES ethnicity nationality

quality of life

Chronological age is also affected by one's quality of life. Elders who can continue to carry out the normal ADLs (activities of daily living) and maintain some degree of independence experience more satisfaction during the advanced years. Health care providers are frequently involved in assessing an elder's capability to carry out the normal activities. Adult children need to assess the parents' capability for such tasks as driving, managing financial affairs, maintaining a residence, meal preparation, and shopping.

physical appearance

Creasing and sagging of the skin extends into old age. Oil glands that lubricate the skin become less active, leading to dryness and roughness. "Age spots" increase. The face is especially likely to show these effects because it is frequently exposed to the sun, which accelerates aging. Facial wrinkling and age spots are also affected by long-term alcohol use, cigarette smoking, and psychological stress. Other facial changes occur. The nose and ears broaden. Hair on the head thins in both sexes. In men with hereditary pattern baldness, follicles produce fine, downy hair. Height continues to decline, especially in women, as loss of bone mineral content leads to further collapse of the spinal column. Muscle strength generally declines at a faster rate in late adulthood than in middle age. Bone strength deteriorates, as do strength and flexibility of the joints and the ligaments and tendons. A history of regular physical activity translates into greater mobility in late life.

health promotion and safety

Each year, more than 1.6 million older U.S. adults go to emergency departments for fall-related injuries. Among older adults, falls are the number one cause of fractures, hospital admissions for trauma, loss of independence, and injury deaths. Risk factors are muscle weakness, balance problems, vision and other sensory problems, postural hypotension when rising to standing position. And risk for fractures increases due to osteoporosis, hospitalization often results in the elderly developing pneumonia Measures to reduce falls and injury to older adults include: the Environment should be free of clutter, no rugs, adequate lighting, use of safety bars in showers and bathrooms. Proper use of assistive devices such as canes and walkers. Other safety measures include: Smoke alarms and carbon monoxide alarms and the use of emergency alert devices that can be worn.

institutional conditions

Elder maltreatment is more likely to occur in nursing homes that are rundown and overcrowded and that have minimal staff supervision and high staff turnover. Intervention involves immediate protection and provision of unmet needs for the older adult and of mental health services and social support for the spouse or caregiver.

exercise

Exercise continues to be a powerful health intervention. Brain scans show that physically fit older people experience less tissue loss in diverse areas of the cerebral cortex. It is never too late to benefit from good nutrition and physical exercise. Older people who come to value the intrinsic benefits of physical activity—feeling stronger, healthier, and more energetic—are more likely to engage in it, yet about 65 percent of U.S. 65- to 74-year-olds and 75 percent of those over age 75 do not exercise regularly. Managing arthritis requires a balance of rest when the disease flares, pain relief, and physical activity. Regular aerobic exercise and strength training lessen pain and improve functioning.

stereotyping of ages

In Western nations, where negative stereotypes of aging are widespread, older adults must overcome this pessimistic picture to adapt favorably to late-life physical changes. Research shows that as seniors encounter these negative messages, they experience stereotype threat, which results in diminished performance on tasks related to the stereotype. Positive stereotypes reduce stress and foster physical and mental competence. Products promoted in television ads geared toward seniors are mostly medications and medical services and "anti-aging" cosmetics and treatments.

adult onset diabetes

Insulin keeps the blood concentration of glucose within set limits by stimulating muscle and fat cells to absorb it. When this balance system fails, type 2 diabetes (diabetes mellitus) occurs. Over time, abnormally high blood glucose damages the blood vessels, increasing the risk of heart attack, stroke, circulatory problems in the legs, and injury to the eyes, kidneys, and nerves. Diabetes runs in families, suggesting that heredity is involved, and the risk is greatly increased by inactivity and abdominal fat deposits. Higher rates of type 2 diabetes are found among African-American, Mexican-American, and Native- American seniors for both genetic and environmental reasons. Treating type 2 diabetes requires lifestyle changes, including a carefully controlled diet, regular exercise, and weight loss.

language processing

Language comprehension changes little in late life. Two aspects of language production show age-related losses: retrieving words from long-term memory and planning what to say and how to say it. When providing care for the elderly it is important to speak more slowly and distinctly. Those who have had active reading during their lives display faster and more accurate comprehension. But they may take longer to retrieve words and organize their thoughts. The HCP who is patient and waits for answers to health questions is appreciated by elder clients.

factors contributing to long life

Life expectancy varies substantially with SES, ethnicity, and nationality. Genetic and environmental factors jointly affect aging. A family history of longevity along with proper diet, normal weight, exercise, no smoking and low alcohol use are contributing factors. The psychological and emotional makeup of the individual also contributes to longevity. Independent, optimistic elders who have a strong social and family support system and continue to stimulate their minds with ongoing learning have a better chance of living longer. The programmed effects of specific genes, as well as the random cellular events believed to underlie biological aging, make physical declines more apparent in late adulthood.

wisdom

Life experience also underlies wisdom, described as breadth and depth of practical knowledge, ability to reflect on and apply that knowledge in ways that make life more bearable and worthwhile. Emotional maturity, and the altruistic form of creativity that involves contributing to humanity and enriching others' lives characterize wisdom. Cultures around the world assume that age and wisdom go together. In addition to age and life experience, having faced and overcome adversity appears to be an important contributor to late-life wisdom. Compared to their agemates, older adults with the cognitive, reflective, and emotional qualities that make up wisdom are better educated and physically healthier, make more positive relations with others, and are more open to experience.

visual impairments

Lower visual acuity Poor dark adaptation, sensitivity to glare Decreased color, depth perception Cataracts Macular degeneration -Heredity increases risk, especially when combined with cigarette smoking or obesity. Protective factors include regular, brisk physical activity and a diet rich in green, leafy vegetables.

managing arthritis

Managing arthritis requires a balance of rest when the disease flares, pain relief, and physical activity. Regular aerobic exercise and strength training lessen pain and improve functioning.

dependency of the perpetrator

Many abusers are dependent, emotionally or financially, on their victims, but often the perpetrator-victim relationship is one of mutual dependency.

Adapting to Physical Changes Aging

Most older people sustain a favorable subjective age—say they feel younger than they look and than they actually are. A youthful self-evaluation is linked to satisfaction with growing older. Older people who report a high sense of personal control usually deal with physical changes through problem-centered coping strategies. Those who view age-related decline as inevitable and uncontrollable tend to report more physical and psychological adjustment difficulties. When physical disabilities become severe, sense of control has diminishing returns, no longer having as much impact on health status. Older adults with substantial physical impairments cope more effectively when they accept the need for caregiver or equipment assistance. A rapidly expanding assistive technology, or array of devices that permit people with disabilities to improve their functioning, is available to help older people cope with physical declines. Use of assistive devices slows physical declines and reduces the need for personal caregiving. Important that the assistive devices (canes, walkers, braces) are being used appropriately.

sleeping

Older adults require about the same total sleep as younger adults—around 7 hours per night. As people age, they have more difficulty falling asleep, staying asleep, and sleeping deeply. The time spent in stage 4, the deepest sleep period, and REM stage decreases. Restful sleep can be fostered by establishing a consistent bedtime and waking time, exercising regularly, and using the bedroom only for sleep. Enlargement of the prostate gland, which occurs in almost all aging men, leads to a need to urinate more often, including during the night. Men are also more prone to sleep apnea, a condition in which breathing ceases for 10 seconds or longer, resulting in many brief awakenings. Women also may have frequent trips to the bathroom during the night due to pelvic muscle weakening, especially after multiple births.

life long learning

Participation of older adults in continuing education has increased substantially over the past few decades. Road Scholar campus-based programs focus on innovative topics and experiences, and its travel programs are enriched by in-depth lectures and expert-led field trips. Similar educational programs have sprung up, including Osher Lifelong Learning Institutes, located on various college campuses in the United States. Community senior centers often provide inexpensive offerings related to everyday living, which attract more low- SES people than programs such as Road Scholar. Churches and synagogues often offer enrichment programs for the elderly. Older participants in continuing education say they understand new ideas in many disciplines, learn new life- enriching skills, make new friends, and develop a broader perspective on the world. Older adults' willingness to acquire new knowledge and skills is apparent in the recent, rapid rise in their use of computers and the Internet.

elderly maltreatment

Physical abuse Physical neglect:most Emotional abuse:most Sexual abuse Financial abuse:most Risk Factors Institutional Conditions

recognition

Recognition—a fairly automatic type of memory that demands little mental effort—suffers less than recall in late adulthood because a multitude of environmental supports for remembering are present. Memory that depends on familiarity rather than on conscious use of strategies is largely spared in old age.

taste and smell changes

Reduced sensitivity to the four basic tastes—sweet, salty, sour, and bitter—is evident in many adults after age 60; however, this change that may be due to factors other than aging, such as smoking and environmental pollutants. Besides enhancing food enjoyment, the sense of smell also has a self-protective function, such as helping to detect gas fumes. When taste is harder to detect, food is less enjoyable, increasing the likelihood of dietary deficiencies. The awareness of thirst also diminishes with age putting elders at risk for dehydration.

nursing homes

Restrict autonomy, social integration. No U.S. federal regulations govern assisted-living facilities. This is quite a difference from other industrialized nations. Low-income ethnic minority seniors are less likely to use assisted living, and those who do typically enter lower-quality settings. The 5 percent of Americans age 65 and older who live in nursing homes experience the most extreme restriction of autonomy and social integration

immune system aging

T cells, which attack antigens directly, become less affective. The immune system is more likely to malfunction by turning against normal body tissues in an autoimmune response. A less competent immune system can increase the risk of a variety of illnesses. A healthy diet and exercise help protect the immune response in old age, whereas obesity aggravates the decline.

long term care

The cost of government-sponsored health insurance for older people, or Medicare, will nearly double by 2020 as more baby boomers enter late adulthood and average life expectancy extends further. Advancing age is strongly associated with use of long-term care services, especially nursing homes. Among disorders of aging, dementia—especially Alzheimer's disease—most often leads to nursing home placement, followed by arthritis, hip fracture, and stroke. Greater use of nursing homes is also prompted by loss of informal caregiving support through widowhood (which mostly affects women) and aging of adult children and other relatives. Overall, only 5 percent of Americans age 65 and older are institutionalized, about half the rate in other industrialized nations that provide more generous public financing of institutional care. Other alternatives include assisted living in retirement communities and having a home helper from the many home care agencies that have developed. But this is costly.

cardio/resp system: aging

The heart muscle becomes more rigid, leading the walls of the left ventricle to thicken. Artery walls stiffen and accumulate plaque. The heart muscle becomes less responsive to signals from pacemaker cells within the heart. As a result of these changes, the heart pumps with less force, maximum heart rate decreases, and blood flow throughout the circulatory system slows, which means that sufficient oxygen may not be delivered to body tissues during high physical activity. Cardiovascular and respiratory deficiencies are more extreme in lifelong smokers and in those who have failed to reduce dietary fat or have had many years of exposure to environmental pollutants. Exercise is a powerful means of slowing cardiovascular aging and facilitating respiratory functioning.

nutrition in late adulthood

The physical changes of late life lead to an increased need for certain nutrients, such as calcium, zinc, and vitamins A, B6, C, D, and E. Declines in physical activity, in the senses of taste and smell, and in ease of chewing can reduce the quantity and quality of food eaten. The aging digestive system also has greater difficulty absorbing certain nutrients, such as protein, calcium, and vitamin D. Older adults who live alone may have problems shopping or cooking and may feel less like eating by themselves. Except for calcium and vitamin D, a daily vitamin-mineral supplement is recommended only for older adults suffering from malnutrition. A diet high in nutrients is most effective in fostering physical and cognitive health in late adulthood.

cognitive changes

There is a modest genetic contribution to individual differences in cognitive change in late adulthood but a mentally active life is vital for preserving cognitive resources. In late adulthood, health status powerfully predicts older adults' cognitive functioning. But this relationship may be exaggerated by the fact that brighter adults are more likely to engage in health-protecting behaviors, which postpone the onset of serious disease. Retirement also affects cognitive change, both positively and negatively. When people leave routine jobs for stimulating leisure activities, outcomes are favorable. In contrast, retiring from a highly complex job without developing challenging substitutes accelerates intellectual declines. Terminal decline refers to acceleration in deterioration of cognitive functioning prior to death. Cognitive Interventions: Older adults who have a well preserved metacognition (awareness of thought) are mindful of memory declines and know they must take steps to ensure recall of important information. Two interventions/studies are The Adult Development and Enrichment Project (ADEPT), the most extensive cognitive intervention program conducted to date and ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly). Cognitive training was associated with reduced declines in general health problems and reduced difficulty in maintaining ADLs.

dependency of the victim

Very old, frail, and mentally and physically impaired older adults are more vulnerable to maltreatment. The worse the caregiver-recipient relationship, the greater the risk of elder abuse of all kinds.

failure to thrive

a complex group of symptoms that produce a gradual decline in physical and cognitive function that occurs without immediate explanation.. Symptoms of weight loss, disability, and social withdrawal may be caused by low income, hidden organic disease, polypharmacy, malnutrition, depression, inadequate support system. Need holistic focus that involves multidisciplinary team approach in caring for these people.

emotional abuse

abuse includes verbal assaults, humiliation and intimidation (like threatening to place in a nursing home.)

optimal aging

applies to people for whom gains are maximized and losses minimized. People age optimally when their growth, vitality, and striving limit and, at times, overcome physical, cognitive, and social declines. The research of George Vaillant, which followed adults over the lifespan, revealed that factors people could control to some degree (such as health habits, coping strategies, and marital stability) far outweighed uncontrollable factors (parental SES, family warmth in childhood, and longevity of family members) in predicting a happy, active old age. Optimal aging is facilitated by societal contexts that promote effective person-environment fit, such as well-funded social security plans, good health care, and safe housing.

rhematoid arthritis

arthritis involves the whole body. An autoimmune response leads to inflammation of connective tissue, particularly the membranes that line the joints. Disability due to arthritis affects 45 percent of U.S. men over age 65 and rises modestly with age. Among women, the incidence is 50 percent among 65- to 84-year-olds and 70 percent among those over age 85.

socioemotional selectivity theory

asserts that social interaction extends lifelong selection processes. Physical and psychological aspects of aging lead to changes in the functions of social interaction. When remaining time is limited, adults of all ages place more emphasis on the emotional quality of their social experiences. Similarly, seniors—aware that time is "running out"—turn to close friends and family members.

ADLs

basic self-care tasks bathing, dressing, eating

Cararacts

cataracts—cloudy areas in the lens, resulting in foggy vision and (without surgery) eventual blindness—increases tenfold from middle to late adulthood.

hearing changes

declines in late adulthood as a result of reduced blood supply and natural cell death in the inner ear and auditory cortex, along with stiffening of membranes (such as the eardrum). Decrements are greatest at high frequencies, but detection of soft sounds diminishes throughout the frequency range. Wax build up can also be a factor. Of all hearing difficulties, the age-related decline in speech perception has the greatest impact on life satisfaction.

Gerotranscendence

described this as a boundless perspective directed forward and outward, beyond the self. Joan Erikson speculated that success in attaining gerotranscendence is apparent in heightened inner calm and contentment and additional time spent in quiet reflection.

Peck: Tasks of Ego Integrity

ego differentiation, body transcendence, ego transcendence

touch changes

especially crucial for certain adults, including the severely visually impaired reading Braille and is probably related to loss of tactile receptors and decreased circulation. Diabetics with decreased circulation to the lower extremities are at risk for injury to feet and legs.

physical neglect

failure to provide caregiving resulting in lack of food, medication or health services, or in isolating the older person.

third age

his period—extending from ages 65 to 79—is a time of new goal setting and high life satisfaction.

financial abuse

illegal or improper exploitation of the aging person's property or financial resources through theft or use without consent by elder.

physical abuse

intentional infliction of pain, discomfort, injury through hitting, cutting, burning, physical force, restraint and sexual acts

osteoarthritis

involves deteriorating cartilage on the ends of bones of frequently used joints. The disease usually does not appear until the forties or fifties. It is the most common cause of mobility problems and of surgical hip and knee replacements in older adults

continuity theory

most aging adults strive to maintain an identity and a set of personality dispositions, skills, and roles that promotes life satisfaction and ensures consistency between their past and anticipated future. Participating in familiar activities with familiar people helps preserve physical and cognitive functioning, affirms identity, and helps ensure social support.

housing arrangements in late adulthood

ordinary homes, residential communities, nursing homes

prospective memory

refers to remembering to engage in planned actions in the future. The amount of mental effort required determines whether older adults have trouble with prospective memory. Event based activities are recalled more easily than time based events. Suggestions for remembering such as timers or alarms, use of post it notes and calendars can help the elder person respond to these activities.

activity theory

states that social barriers to engagement, not the desires of aging adults, cause declining rates of interaction. The life satisfaction of older people depends on conditions that permit them to remain engaged in roles and relationships, such as their health status. Activity theory fails to acknowledge any psychological change in old age. When health status is controlled, older people who have larger social networks and engage in more activities are not necessarily happier

fuctional age

the actual competence and performance of an older adult.

dementia

to a set of disorders occurring almost entirely in old age in which many aspects of thought and behavior are so impaired that everyday activities are disrupted. Dementia strikes 13 percent of adults over age 65; dementia rates rise dramatically with age, affecting about 22 percent among those 85 to 89 and over half after age 90. Beyond age 80, a larger proportion of women than men have dementia, perhaps reflecting the biological sturdiness of the oldest men. About a dozen types of dementia have been identified, most irreversible and incurable. . In most dementia cases, progressive brain damage occurs only to the cerebral cortex, as is seen in Alzheimer's disease and cerebrovascular dementia—the two most common forms of cortical dementia. Cerebrovascular dementia results from brain damage due to a stroke or bleeding into the brain tissue. Alzheimer's disease, the most common form of dementia, accounts for 60% of all cases of dementia.

sexual abuse

unwanted sexual contact of any kind.

aging in place

which is remaining in a familiar setting where they have control over their everyday life. For older adults who need more help with everyday tasks, assisted-living arrangements are available.