Module 10

Depression - prevalence and risk factors

- 13% of 65-to 69-year-olds have the diagnosis, compared to about 15% of those over 85 - inadequate social support, inadequate income, emotional loss (such as following the death of spouse, family, or friends), and nagging health problems - the more disabling conditions older adults have, the more depressive symptoms they have - elders living in poverty are at higher risk for depression - poorly educated older adults are more likely to have depression

Cataracts

- 17% of adults over the age of 40 - a condition in which the lens inside the eye becomes clouded or obscures vision - can be surgically corrected

Kliegl's Classic Study of Strategy Learning In Adulthood

- 18 college students and 19 older, but physically healthy, adults who ranged in age from 65 to 80, with an average age of 71.7 years - pictures of 30 familiar buildings in Berlin and asked to use the pictures to create associations that would help them remember a list of 30 words - older adults showed improvement after training, but their performance was poorer than that of younger adults

Growth in Population

- 1950 to 2010, the population of the US doubled, from about 150 million persons to just over 300 million - the over-65 population more than tripled, from 13 to 40 million - while the over-85 population increased nearly 12-fold, from one-half million to 6 million.

Asian and Hispanic Americans and Depression

- 37% among elderly Korean Americans - Chinese American and Mexican American elders may be near 20% - many older Asian Americans and Mexican Americans are recent immigrants to the United States, have poor English skills, and report feeling distressed and anxious about the differences between their home cultures and that of the United States - the longer older Asian American and Mexican American immigrants have been in the United States, and the better integrated they are into the society, the less likely they are to have depression.

African Americans and Depression

- African Americans were half as likely as Whites to be depressed - elderly African Americans were more likely than elderly White Americans to have schizophrenia - older African Americans who have depression, the tendency toward suicidal thoughts may be greater than it is among older White Americans with depression - African Americans are more likely to view feelings of sadness as a spiritual issue rather than a mental health problem - depression and religious beliefs and activities has shown that the tendency to turn to faith and the church for support in times of emotional difficulty is much more prevalent among African Americans than among White Americans

Death Rituals, Culture, and Social Roles

- Among Tibetan Buddhists, for instance, dead persons are believed to be unaware of their state for the first 4 days after their deaths. Mourners are expected to pray that they will realize that they are dead soon enough to avoid having to be reborn as another human or in another life form.

Task-Based Approach

- Charles Corr - coping with dying is like coping with any other problem or dilemma - four tasks for the dying person: 1. Satisfying bodily needs and minimizing physical stress 2. Maximizing psychological security, autonomy, and richness of life 3. Sustaining and enhancing significant interpersonal attachments 4. Identifying, developing, or reaffirming sources of spiritual energy, and thereby fostering hope - more for health professions who deal with dying individuals so more helpful to think in terms of the patient's tasks because the dying person may need help in performing some or all of them.

Changes in Eating Patterns

- ability of the brain to regulate appetite also changes with advancing age - satiety, the sense of being full - satiety part of the pattern seems to be impaired so older adults may feel hungry all the time and may overeat - rely more on habits such as taking their meals at certain times and eating the same foods every day

Changes in Sleeping Patterns

- adults older than 65 typically wake up more frequently in the night and show decreases in rapid eye movement (REM) sleep, the lighter sleep state in which dreaming occurs. - older adults are also more likely to wake early in the morning and go to bed early at night so "morning people" instead of "night people." - bc their night sleep is more often interrupted, older adults also nap more during the day to accumulate the needed amount of sleep

Attendance at Religious Services - healthy lifestyle choices

- adults who regularly attend such services are physically and emotionally healthier than their nonattending peers - African American elders with hypertension who attend church regularly are more likely than those who attend intermittently to comply with medical advice regarding blood pressure medication; also, the average blood pressure readings of the regular attendees are lower

The Effects of General Slowing

- affects complex motor activities such as driving - increase in reaction time affects elders' ability to switch attention from one thing to the next or to react quickly

Preliminary Explanations

- age-related memory decline is associated with changes in the ratio of grey to white matter in the brain - reduction in the volume of the hippocampus is associated with memory deficits among the elderly - older adults take longer to register some new piece of information, encode it, and retrieve it - timothy Salthouse tested both reaction speed and memory or other cognitive skills in adults of various ages, and found that a very large portion of the age decline in memory can be accounted for simply by slower reaction times in older adults.

Disengagement Theory

- aging has three aspects 1. shrinkage of life space: as people age, they interact with fewer and fewer others and fill fewer and fewer roles. 2. increased individuality: in the roles and relationships that remain, the older individual is much less governed by strict rules or expectations. 3. acceptance of these changes: the healthy older adult actively disengages from roles and relationships, turning increasingly inward and away from interactions with others

Cohen's Stage Theory of Creativity

- apply to ordinary people who are more creative than others in their everyday lives as well as to "professional creators" such as composers and artists 1. Reevaluation Phase: - age 50ish - reflect on past accomplishments and formulate new goals - increasing sense of time limitations, leads to an intensification of the desire to create and produce 2. Liberation Phase - individuals in their 60s become freer to create because most have retired from everyday work - more tolerant of their own failures and thus are willing to take risks they would not have taken when younger 3. Summing-Up Phase - creative people in their 70s have a desire to knit their accomplishments together into a cohesive, meaningful story - begin to view their early accomplishments in terms of how they prefigured later achievements 4. Encore Phase - during the 80s and beyond, there is a desire to complete unfinished works or to fulfill desires that have been put aside in the past

Deciding on Nursing Home Care

- assisted-living facilities are not covered by government insurance programs such as Medicare and Medicaid - skilled nursing care is not covered by either government or private insurance unless it is medically necessary - cost is often a barrier that prevents an older adult from receiving the kind of care that best suits his or her needs - for this reason, a growing number of young and middle-age adults are opting to buy long-term care insurance (enables elders and their families to make decisions about their needs with less regard for cost)

Diagnosing and Treating Alzheimer's Disease

- at autopsy the brain contains extensive neurofibrillary tangles (are stringy masses of tissue that appear to "clog" connections btwn neurons & surrounded by deposits of proteins and other substances called plaques) 1. galantamine, drug increases the amounts of some neurotransmitters in the brain appear to slow down Alzheimer's disease & using strategies for everyday memory tasks

Philosophy and Types of Hospice Care

- by 1982, Congress added hospice care to the list of benefits in Medicare - 6,000 hospice cares in the US, serving two million ill patients and their families - 45% of individuals receive hospice care

Repair of Genetic Material and Cross Linking

- cell's ability to repair breaks in DNA - breaks in DNA are common events, resulting from unknown metabolic processes - unable to repair all the damage, the accumulation of unrepaired breaks results, over time, in loss of cellular function, and the organism ages - cross-linking occurs when undesirable bonds form between proteins or fats - ex. in skin, and in connective tissue, for example, two proteins called collagen and elastin form cross-linkages, either btwn molecules or within a given protein molecule & results cannot assume the correct shape for proper function, producing various effects, such as wrinkling of the skin and arterial rigidity.

Computers in Rehabilitation Programs

- computers are becoming increasingly important in the treatment of neurological disorders affecting the elderly - stroke victims have problems with comprehending speech and/or speaking themselves & computerized speech-rehabilitation programs are highly effective at improving the language skills of such people - virtual-reality programs help people recover motor functions after a stroke - remember routes from one place to another by guiding them through a virtual apartment

Causes of General Slowing

- decline in the speed of nerve impulses is responsible for age-related difficulties in translating thoughts into action - interferes with older adults' retrieval of the knowledge they need to accomplish the task and that they use behavioral feedback to compensate for mistakes.

With more elderly people, problems with social security

- decrease benefits to recipients or increase taxes on workers

Spouses as Caregivers in Late Adulthood

- deep bond that continues to exist in late-life marriages is the remarkable degree of care and assistance older spouses give each other when one or the other is disabled - many husbands and wives care for spouses who are ill or who have dementia for very long periods of time - even when both spouses have significant disabilities, they nonetheless continue to care for each other "until death do us part."

Delayed Retirement

- elders in challenging and interesting jobs or who are self-employed are likely to postpone retirement or reject entirely the idea of leaving paid work unless they are pushed into such a decision by ill health or attracted by some extra financial inducement - 40% of older adults with salaried jobs and 57% of those who are self-employed plan to continue working past the typical retirement age

Continuity Theory

- elders should adjust to aging by engaging in the same kinds of activities that interested and challenged them in their earlier years.

Aging in Place

- elders' preference for living in a private home environment has led to a pattern known as aging in place - making modifications to a private residence in response to the changing needs of older adults - hiring a home health aide to provide assistance with ADLs when necessary - for more than 70% of adults over the age of 65 in the United States, aging in place means living in their own homes either alone or with a spouse

Memory in Late Adulthood

- forgetfulness becomes more frequent with age - recognition is easier than recall, tasks that require speed are more difficult, and metamemory skills are important to memory function - moderate to severe memory problems are most prevalent among adults over the age of 75 - older adults achieve scores very similar to those of younger adults on tests of memory accuracy, although they typically take longer to complete memory tasks and make more errors - the length of the number increases to the 10 digits used for long-distance numbers, however, a decline with age becomes evident, beginning at about age 60

Free Radicals and Aging

- free radicals occur more frequently in older than in younger people's bodies bc of age-related deterioration of the mitochondria, the cell structures that convert food into energy - oxygen free radicals, enter into many potentially harmful chemical reactions, resulting in irreparable cellular damage that accumulates with age - ex. oxidation reactions caused by free radicals can damage cell membranes, thereby reducing the cell's protection against toxins and carcinogens.

Contacts with Adult Children

- frequent contact - three-quarters of elders live within an hour's travel of at least one of their children

Heredity and Alzheimer's Disease

- gene on chromosome 19 (apoliprotein E or ApoE) that controls production of a protein that is linked to Alzheimer's disease & errors in the production of this protein occur, the dendrites and axons of neurons in the brain become tangled and, as a result, do not function as efficiently.

Chronic Health Conditions

- heart disease - hyper tension - stroke - asthma - chronic bronchitis or emphysema - cancer - diabetes - arthritis

Benefits of Partnership in Late Adulthood

- higher life satisfaction, better health, and lower rates of institutionalization - greater for married older men than for married older women

Filial Piety

- in Asian societies, allowing one's elders to live alone has traditionally been viewed as a violation of a set of cultural beliefs called filial piety

Trends in Life Expectancy

- increases in average life expectancy that have occurred over the past seven or eight decades result from improvements in nutrition, health care, and general living conditions for pregnant women, infants, and young children - the average 65-year-old man lives to about age 83, but once a man reaches 85, he is likely to live to be 91. - the average 65-year-old woman lives to the age of 86, and the average 85-year-old woman can expect to live to over 92.

Dual-Process Model - Margaret Stroebe and Henk Schut

- individuals alternate between an emotional state in which they confront their loss and actively grieve (confrontation) and another in which they focus on moving forward with their lives (restoration)

Grandchildren and Siblings

- interactions btwn grandchildren (when young) and middle-aged grandparents are beneficial -relationships with siblings is + in late adulthood - older siblings can provide a unique kind of emotional support for one another, based on shared reminiscences and companionship & "insurance policy," a source of support of last resort.

Fear of Death

- middle-age adults are most fearful of death

MCI and AACD

- mild cognitive impairment(MCI) & age-associated cognitive decline(AACD) - gradual decline in cognitive function along with low scores on standardized tests - AACD is the more common, afflicting just under one third of older adults - MCI is found in about 10% of elders in their 70s and 25% of those in their 80s. - MCI is believed to be a precursor to Alzheimer's disease, while AACD is not.

Everyday Memory

- on virtually all "everyday" tasks—such as remembering the main points of a story or a newspaper article; recalling movies, conversations, grocery lists, or recipes; recalling the information from a medicine label; remembering whether some action has been performed; remembering where something was heard (called source memory); or remembering to do something in the future—older adults recall less well than younger adults.

Elderly: physical activity and height

- participants who had exercised regularly lost significantly less height over a 30-year period than those who had not exercised - exercise after age 40 seemed to be especially important in preventing height loss.

Hearing Changes in Late Adulthood

- presbycusis 1. sex differences: more auditory problems in men than women, half of men over the age of 65 report hearing difficulties, compared to just under a third of older women, 8% of men and 4% of women over the age of 65 have a hearing disability 2. high frequency sounds: loss of ability to hear high-frequency sounds 3. speech perception: difficulties with speech perception, particularly with regard to word discrimination, when the sound is loud enough, older adults have more difficulty identifying individual words they have just heard, problems hearing under noisy conditions 4. tinnitus: a persistent ringing in the ears, 2 and 14% of adults over 65 5. the aging auditory system: older adults secrete more ear wax, which may block the ear canal; the bones of the middle ear become calcified and less elastic; the cochlear membranes of the inner ear become less flexible and less responsive; and the nerve pathways to the brain show some degeneration BUT there are hearing aids

Vision Changes in Late adulthood

- presbyopia: normal loss of visual acuity with aging, especially the ability to focus the eyes on near objects 1. reduced blood flow to the eye: results in an enlarged "blind spot" on the retina and thus a reduced field of vision 2. reduced pupillary response: pupil does not widen or narrow as much or as quickly as it did b4, so difficulty seeing at night and responding to rapid changes in brightness

Children's and Adolescents' Understanding of Death

- preschool age children = understand none of these aspects of death - children 6-7 understand death - adolescents' understand death way better than children - difference btwn suicidal adolescents' and suicidal adults' understanding of death

Therapy, Meds, and Prevention for Depression

- psychotherapy and medication 1. Therapy 2. Medication: antidepressants but increased incidence of falls among the elderly 3. Social Involvement: involvement with children & pet therapy or animal-assisted therapy 4. Religious Coping

Suicide in Late Adulthood

- rates rise among both White and Hispanic men - White men over the age of 75 are more likely to commit suicide than any other group.

Effects of Reducing Free Radicals

- reducing free radicals can improve the condition of damaged brain and skin tissue - esearch on diet variations points to the possibility that some foods, especially those high in fat and/or food additives such as preservatives, promote the formation of oxygen free radicals, whereas others, referred to as antioxidants, inhibit the formation of these radicals or promote chemical processes that help the body defend against them - so vitamins C and E and beta carotene (vitamin A) - people who eat diets high in antioxidants or who take regular supplements of vitamin E or beta-carotene live somewhat longer and have lower rates of heart disease

4 Changes in the brain during the adult years

- reduction of brain weight - loss of gray matter - loss of density in the dendrites (decrease in useful dendritic connections & gradual slowing of synaptic speed so slowing of reaction time in everyday tasks) ! - slower synaptic speed - adults with higher levels of education show significantly less atrophy of the cerebral cortex t

Genetically Programmed Senescence - programmed senescence theory

- senescence is the gradual deterioration of body systems that happen as organisms age - age-related physical declines result from species-specific genes for aging - prevents older, presumably less fit, individuals from becoming parents at an age when they are unlikely to be able to raise offspring to maturity - aging genes are equipped with some kind of built-in clock that prevents the genes from having an effect when people are in their reproductive years, but switches them on once the reproductive peak has passed

Erikson's Stage of Ego Integrity Vs Despair

- sense that one has had lived a useful life - ego integrity, the feeling that one's life has been worthwhile - failure to achieve ego integrity in late adulthood would result in feelings of hopelessness and despair because there would be too little time to make changes before death 1. Older Adults Are More Reflective and Philosophical - those who use their growing capacity for philosophical reflection to achieve a degree of self-satisfaction are less fearful of death 2. Reminiscence - thinking about the past—is a necessary and healthy part of achieving ego integrity and thus an important aspect of old age and preparation for death - reduces elders' risk of depression and increases subjective quality-of-life ratings - may improve cognitive functioning in individuals with dementia - reminiscence interviews involving college students and older adults are beneficial to both students and elders bc students' stereotypes about the elderly are challenged, and elders appreciate having had an opportunity to pass on their experiences to a young adult 3. life review - process of life review, an evaluative process in which elders make judgments about their past behavior - results in both positive and negative emotional outcomes, and the overall balance of positive and negative emotions that results from the life review process is correlated with elders' mental health - but elders whose life reviews produce more regrets over past mistakes and missed opportunities than satisfaction with how they handled problems earlier in life are more prone to depression than those who have generally positive feelings about their lives.

Friendships in Late Adulthood

- significant impact on overall life satisfaction, on self-esteem, and on the amount of loneliness reported by older adults - can provide assistance with daily tasks, such as shopping or housework

Why Has Poverty Among Older Adults Declined?

- significant improvements in Social Security benefits in the US - in 1950, only 18% of adults over 65 were high school graduates, compared to 84% of the over-65 population in 2015 & five times as many elders today are college graduates than was the case as recently as 1965 when only 5% of elders had attended college MEANING - better jobs and earned a great deal more money before retirement than did members of previous cohorts so more savings and better retirement benefits - single older adults continue to be more poor than their married peers

Other Types of Dementia

- signs of dementia frequently appear after a person experiences multiple small strokes; in this case, the condition is called vascular dementia - dementia an be caused by depression, cardiovascular disease, metabolic disturbances, drug intoxication, Parkinson's disease, hypothyroidism, multiple blows to the head (frequent among boxers), a single head trauma, some kinds of tumors, vitamin B12deficiency, anemia, or alcohol abuse

Themes of Dying - Edwin Shneidman

- thanatology (the scientific study of death and dying) - people who are dying display a wide range of emotional responses and do not all have the same needs and the dying process has many "themes"

Activity Theory

- the psychologically and physically healthiest response to old age is to maintain the greatest possible level of activity and involvement in the greatest possible number of roles - most active older adults report slightly greater satisfaction with themselves or their lives, are healthiest, and have the highest morale.

A Study of Psychological Changes at the End of Life

- those nearer death not only showed terminal decline on tests of memory and learning but also became less emotional, introspective, and aggressive or assertive and more conventional, docile, dependent, and warm

Group Differences in the Rates of Dementia

- two and eight percent of all adults over age 65 show significant symptoms of dementia, and that two to five percent have Alzheimer's disease - rate of dementia rises rapidly among people in their 70s and 80s - in the US, 19% of 75-to 84-year-olds have Alzheimer's disease, while 42% of adults over the age of 85 have it

Gender Differences in Retirement

- women retire at about the same age as men do, on average, but retirement benefits, health, or job characteristics do not predict just when they will retire - women encounter the best opportunities for advanced and leadership roles that they have ever experienced at just about the time they reach traditional retirement age - others keep working to maintain sufficient earnings to augment future Social Security benefits—a factor that may be especially important for women who took several years off from full-time work to raise children

Types of Moves Made By Older Adults - Charles Longino

1. Amenity Move: - in a direction away from the older person's children, frequently to a warmer climate where living costs are lower - still married and relatively healthy and to have adequate or good retirement income - move seasonally rather than make a permanent move to a new location 2. Compensatory (Kinship) Migration - occurs when the older adult—most often a widow living alone—develops such a level of chronic disability that she has serious difficulty managing an independent household - a shift to be closer to a daughter, son, or some other relative who can provide regular assistance 3. Institutional Migration - nursing home care

Criteria for evaluating a long-term care facility

1. Be certain that the facility has the staff and equipment required to meet your elder's physical needs. 2. Check with authorities to see whether any complaints have been filed and how they were resolved; avoid facilities with many outstanding complaints. 3. Research the results of state and local inspections and the extent to which any deficiencies were corrected; do not admit your elder to a facility that has any current deficiencies. 4. Visit at different times such as during meals, recreation periods, early morning, late evening, and so on to note how residents are cared for in different situations. 5. Talk to family members of other residents if possible. 6. Ask about the facility's policies regarding medical emergencies.

Factors That Contribute to Delayed Retirement

1. Bridge Jobs - allows elders to transition from full-time work to full-time retirement, and they can do so for many years before withdrawing entirely from the workforce - older adults' income derived from employment was only 10% in 1967; today it is about 24% - 40% of the income of the top 20% of earners over the age of 65 comes from work 2. Family Composition - elders who are still supporting minor or college-age children retire later than their peers whose children are economically independent - elders in their 60s have living parents in their 80s or 90s & many require financial assistance

Philosophy of Hospice Care

1. Death should be viewed as normal, not to be avoided but to be faced and accepted 2. The patient and family should be encouraged to prepare for the death by examining their feeling, planning for after the death, and talking openly about death. 3. The family should be involved in the patient's care as much as is physically possible, not only because this gives the patient the emotional support of loved ones but also because it allows each family member to come to some resolution of her or his relationship with the dying person. 4. Control over the patient's care should be in the hands of the patient and the family. They decide what types of medical treatment they will ask for or accept; they decide whether the patient will remain at home or be hospitalized. 5. Medical care should be primarily palliative care rather than curative treatment. The emphasis is on controlling pain and maximizing comfort, but not in invasive or life-prolonging measures.

Greer's Studies of Responses to Impending Death

1. Denial (Positive Avoidance) - person rejects evidence about diagnosis; insists that surgery was just precautionary 2. Fighting Spirit - maintains an optimistic attitude and searches for more information about the disease & see their disease as a challenge and plan to fight it with every method available 3. Stoic Acceptance (Fatalism) - acknowledges the diagnosis but makes no effort to seek any further information, or person ignores the diagnosis and carries on normal life as much as possible 4. Helplessness/Hopelessness - overwhelmed by diagnosis; sees herself as dying or gravely ill and as devoid of hope 5. Anxious Preoccupation - originally been included in the helplessness group, but they were separated out later - includes those whose response to the diagnosis is strong and persistent anxiety - they seek information, they interpret it pessimistically; they monitor their body sensations carefully, interpreting each ache or pain as a possible recurrence

Stages of Dying (Kübler-Ross)

1. Denial: a psychological defense 2. Anger: extreme forms of denial would fade within a few days, to be replaced by anger, response to sense of loss of control and helplessness 3. Bargaining: patient tries to make "deals" with doctors, nurses, family, or God 4. Depression 5. Acceptance

Effects of Relationships with Adult Children

1. Elders' Sense of Well-Being: when relationships between elders and adult children are warm and close, they are more important to elders' sense of well-being 2. Beneficial but Unnecessary: childless elders are just as happy and well adjusted as those who have children - good relationships and regular contact with adult children can add to an elderly adult's quality of life 3. Role Prescriptions: elders and their adult children feel that they need to live up to their demands and expectations

Batle's Techniques for Measuring Wisdom

1. Factual knowledge 2. Procedural knowledge 3. Understanding of the relevance of context 4. Understanding of the relevance of values 5. Recognition that it is impossible to know in advance how any decision will ultimately affect one's life

Living with Relatives - four factors influence an older adult's decision to live with an adult child:

1. Health: elders who need help with ADLs are more likely to live in the homes of family members than those who can manage the physical demands of living independently 2. Income: those with lower incomes are more likely to live with family members 3. Adult children's characteristics: elders with more daughters are more likely to live with grown children than are those with those with few daughters. married adults are more likely to take in their aging parents than those who are single. 4. Ethnicity: Hispanic American, African American, and Asian American elders are more likely to live with relatives than those in other groups.

Types of Residential Choices Available to Older Adults

1. Independent Living Community: is an apartment complex or housing development in which all the residents are over a certain age, typically 55 or 60 - residents join together for a variety of social activities and outings - offer older adults the opportunity to remain socially active without having to travel far from home 2. Assisted-Living Facility: - 3% of older adults - average age of assisted-living residents is 80, and most require help with one or two activities of daily living (toileting, bathing, and so on) - residents live in small apartments and get help with housework and meal preparation along with ADL assistance - nurses are on site around the clock and can be called on in emergencies, but residents are generally responsible for routine health care such as taking medications - knowing that help is close by if they need it, elders who move from their own homes to an assisted-living facility have less stress and an enhanced sense of well-being - provide senior citizens with organized social activities 3. Skilled Nursing Facility (Nursing Homes): when older adults need more help with ADLs than is available in an assisted-living facility - 4% of the elderly adults - 15% of those over the age of 85 - most residents are females in her late 70s or early 80s - most require help with three to four ADLs - about half of nursing home residents have dementia - older adults who require 24-hour supervision, however, particularly those with dementia, nursing homes often represent the best residential option. 4. Continuing Care Community - continuing-care retirement communities (CCRCs) - offer a continuum of care ranging from independent living to skilled nursing care - residents can move from one level of care to another on an as-needed basis while remaining within the same community - ex. an elder who lives in the independent living part of the facility can temporarily move to the skilled nursing sector for a few days or weeks while she recovers from surgery or an accident

Four Patterns of Grieving - Wortman and Silver

1. Normal: person feels great distress immediately following the loss, with relatively rapid recovery 2. Chronic: person's distress continues at a high level over several years 3. Delayed: grieving person feels little distress in the first few months but high levels of distress some months or years later 4. Absent: person feels no notable level of distress either immediately or at any later time

Stages of Grief (Bowlby)

1. Numbness 2. Yearning 3. Disorganization and Despair 4. Reorganization

The Effect of Widowhood on Health

1. Physical Health - immune system 2. Mental Health - depression 3. Complicated Grief - depressionlike symptoms following the death of a loved one - individuals who continue to experience grief symptoms, such as loss of appetite, more than 2 months following loss of a loved one may be developing complicated grief - grief symptoms continue for 6 months or longer are more likely to suffer long-term depression, as well as physical ailments such as cancer and heart disease Prohibiting Long-Term Problems: - talk it out

Types of Hospice Care

1. Residence Based - one family caregiver provides constant care for the dying person, with the support and assistance of specially trained nurses or other staff who visit regularly, provide meds, and help the family deal psychologically with the impending death - private home, but nursing homes as well. - two thirds of hospice patients receive residence-based services. 2. Hospice Facility - special hospice center, where about one quarter of patients in the last stages of a terminal disease are cared for in a homelike setting. 3. Hospital Based - 7% of terminally ill patients - palliative care with daily involvement of family members and hospital staff in the patient's care.

Stages of Grief (Sander)

1. Shock 2. Awareness 3. Conservation/Withdrawal 4. Healing and Renewal

Bowlby's Attachment Theory - Bowlby's and Sanders's Stages of Grief

1. Shock or Numbness - mourner experiences disbelief, confusion, restlessness, feelings of unreality, a sense of helplessness 2. Yearning or Awareness of Loss - anger is a common ingredient - bereaved person tries to recover the lost person; may actively search or wander as if searching; may report that he sees the dead person; mourner feels full of anger, anxiety, guilt, fear, frustration; may sleep poorly and weep often 3. Disorganization and Despair or Conservation and Withdrawal - great lethargy - searching ceases, and the loss is accepted, but acceptance of loss brings depression and despair or a sense of helplessness; this stage is often accompanied by great fatigue and a desire to sleep all the time. 4. Reorganization - resolution of the grieving process in Bowlby's 4. Healing and Renewal - Sanders views this as two periods, Bowlby as only one. Both see this as the period when the individual takes control again. Some forgetting occurs, and some sense of hope emerges, along with increased energy, better health, better sleep patterns, and reduced depression. - grieving person begins to be able to maintain control.

Freud's Psychoanalytic Theory and Grief

1. Working Through Grief - necessity of "working through" grief to avoid its long-term negative effects - need to talk openly about their loss & encourage the person to cry or express grief in other ways 2. Defense Mechanisms - encourage children to express their feelings through art (sublimation, will lead to better health outcomes) & identification, to manage their grief so child watches popular films depicting children's grief

Age-Related Disease of the Eye

1. age-related macular degeneration (AMD), a disease of the retina that diminished vision for fine details (lose central vision and ability to read and engage in other activities that require discrimination of fine details)

Types of Death

1. clinical death: - refers to the few minutes after the heart has stopped pumping, when breathing has stopped, and there is no evident brain function, but resuscitation is still possible. 2. brain death - a state in which the person no longer has reflexes or any response to vigorous external stimuli and no electrical activity in the brain - when the cortex, but not the brain stem, is affected, the person may still be able to breathe without assistance and may survive for long periods in a vegetative state or on life-support systems. - when the brain stem is also dead, no body functioning can occur independently, and the individual is said to be legally dead - brain death most often occurs after a period of 8-10 minutes of clinical death - body organs, such as the heart and kidneys, can be used for organ donation, as long as they are removed without delay 3. social death - occurs at the point when other people treat the deceased person like a corpse

Progression of Alzheimer's Disease

1. early stages - very slowly, beginning with subtle memory difficulties, repetitive conversation, and disorientation in unfamiliar settings - memory for recent events begins to go & memory for long-ago events or for well-rehearsed cognitive procedures, such as simple calculations, is often retained until late in the illness 2. Significant Memory Losses and Functional Declines - may fail to recognize family members and may be unable to remember the names of common objects or how to perform such routine activities as brushing her teeth or dressing - may consume as many as three or four complete meals at one sitting without realizing how much they have eaten 3. Declines in Emotional Information Processing - difficulty processing information about others' emotions, such as facial expression - problems controlling their own emotions and display sudden bursts of anger or even rage - others with increased level of dependency and clinginess toward family members or friends - 40% are depressed

Successful aging - John Rowe and Robert Kahn

1. good physical health 2. retention of mental abilities 3. continuing engagement in social and productive activities - the term gerontologists use to describe maintaining one's physical health, mental abilities, social competence, and overall satisfaction with one's life as one ages - referred to as a paradigm

Income in Late Adulthood - five potential sources of income

1. government pensions, such as Social Security 2. other pensions, such as those offered through an employer or military pensions 3. earnings from continued work 4. income from saving or other assets 5. or those living below the poverty line, public assistance, such as food stamps and Supplementary Security Income

Where Death Occurs in the US

1. hospital: 37% 2. decedent's home: 30% 3. hospice facility: 8% 4. nursing home/long-term care: 19% 5. other: 6%

Changes in Motor Functions in Late Adulthood

1. loss of stamina - from changes in the cardiovascular system + changes in muscles. - dexterity is lost primarily as a result of arthritic changes in the joints. 2. diminished sense of balance - effects of aging on white matter in the parts of the brain that control balance and motor functions so older adults fall more often - older adults who practice Tai Chi or play golf regularly are better able to maintain their balance t 3. declining fine motor skills

Factors Contributing to Fear of Death Among Adults

1. religious beliefs: - adults who are religious are less afraid of death than are those who describe themselves as less religious - those who are deeply religious and those who are totally irreligious report less fear of death - 72% of the population believes in some kind of life after death. 2. personal worth: - adults who feel that they have achieved the goals they set out to achieve or who believe that they have become the person they wanted to be are less anxious about death than are those who are disappointed in themselves.

Components of Successful Aging

1. staying healthy and able 2. retaining cognitive abilities: those who are the best educated show the least cognitive decline & avoidance of learning may actually contribute to cognitive decline - cognitive adventurousness, a willingness to learn new things, appears to be a key component of successful aging bc new learning helps to establish new connections between neurons, connections that may protect the aging brain against deterioration. 3. social engagement: - nursing home residents report greater satisfaction with their lives when they have frequent contact with family and friends - elders with disabilities, frequency of contact with family and friends is associated with reduced feelings of loneliness 4. productivity - volunteerism, or performing unpaid work for altruistic reasons, has been linked to successful aging - mortality rates were 60% lower among volunteers than among nonvolunteers - elders who volunteered 200 hours or more per year were less likely to develop hypertension than nonvolunteers - older adults remain productive by venturing into new pursuits, such as taking music lessons, attending college classes, or learning to paint or sculpt (producing art gave them a purpose in life, opportunities to interact with like-minded peers, and a sense of competence. & creating art helped them stay healthy) - creative productivity may help older adults maintain an optimistic outlook that contributes to physical and mental health 5. life satisfaction - a sense of personal well-being - perceived adequacy of social support and perceived adequacy of income are critical - self-ratings of health may be the most significant predictors of life satisfaction and morale - social comparisons—how well an older adult thinks he is doing compared to others his age—are just as important to these perceptions as the older adult's awareness of the changes he has undergone since his younger years - self-protective psychological device

Changes in Taste, Smell, and Touch in Late Adulthood

1. taste: basic flavors does not seem to decline over the years of adulthood & less saliva, producing a "woolly mouth" 2. smell: sense of smell clearly deteriorates in old age, loss of sensitivity to odors is far greater among elderly men than women, & both men and women who worked in factories (where, presumably, they were exposed to more pollutants) show much greater losses of smell in old 3. touch: skin of elderly adults is also less responsive to cold and heat, loss of sensitivity occurs in a pattern that is a reversal of the proximodistal principle of growth, so to be able to feel a warm bath, the water temperature may have to be so high that it will burn the skin.

Chapter 17

Physical and Cognitive Development in Late Adulthood

Chapter 18

Social and Personality Development in Late Adulthood

The Hayflick Limit

The number of times a human cell is capable of dividing into two new cells. The limit for most human cells is approximately 50 divisions, an indication that the life span is limited by our genetic program - each chromosome in the human body has, at its tip, a string of repetitive DNA called telomeres & serve as a kind of time-keeping mechanism for the organism, raising the possibility that there may be a crucial minimum number of telomeres and when the total falls below that number, then disease or death comes fairly quickly.

Jeanne Calmet

a French woman who lived to be 122 years old

Wisdom

a cognitive characteristic that includes accumulated knowledge and the ability to apply knowledge to practical problems of living, popularly thought to be more commonly found in older adults - Wisdom does not appear to be a characteristic of the elderly that distinguishes them from other subgroups of adults.

Mild Cognitive Impairment

a cognitive disorder that includes a gradual decline in cognitive function along with low scores on standardized tests

Western Culture and Death

a dying person should have the right to take his or her own life is more widely accepted in individualistic than in collectivist cultures

Palliative Care

a form of care for terminally ill people that focuses on relieving patients' pain rather than curing their diseases

multi-infarct dementia

a form of dementia caused by one or more strokes - brain damage caused by such strokes is irreversible

Disability

a limitation in an individual's ability to perform certain roles and tasks

Dementias

a neurological disorder involving problems with memory and thinking that affect an individual's emotional, social, and physical functioning

Octogenarian

a person in his or her 80s

Centenarian

a person over 100 years of age

Widowhood Effect

a phenomenon in which the death of one spouse is soon followed by the other - thought to result from the immune system's response to emotional trauma

Alzheimer's disease (neurocognitive disorder)

a very severe form of dementia, the cause of which is unknown

Hospice care

an approach to care for the terminally ill that emphasizes individual and family control of the process of dying - emerged in England in late 1960s and early 1970s in the US

Mexican Culture and Death

death is seen as a mirror of the person's life - your way of dying tells much about what kind of person you have been - death is discussed frequently, even celebrated in a national feast day, the Day of the Dead, when the lives of the dead are remembered and honored

Native American Culture and Death

death is to be faced and accepted with composure - part of nature's cycle, it is not to be feared or fought

Fictive kin

in African American groups, friends who acquire that status of a close sibling, aunt, uncle, or grandparent

Martial Satisfaction in Late Adulthood

marital satisfaction is higher in the late adult years than when children are still at home - marriages tend to be based less on passion and mutual disclosure and more on loyalty, familiarity, mutual investment in the relationship, and companionship - late adult marriages are more likely to reflect companionate love than romantic or even consummate love.

Source Memory

memory on everyday tasks

Free Radicals

molecules or atoms that possess an unpaired electron - normal by-product of body metabolism and also arise as a result of exposure to certain substances in foods, sunlight, x-rays, or air pollution

Instrumental activities of daily living (IADLs)

more intellectually demanding daily living tasks such as doing housework, cooking, and managing money

Oldest old

older adults ages 85 and over

Young old

older adults from ages 60 to 75

Old old

older adults from ages 75 to 85

Frail elderly

older adults whose physical and/or mental impairments are so extensive that they cannot care for themselves

Passion in Late Adulthood

older couples spend more time with each other than with other family members or friends, and although much of this time is spent in passive or basic maintenance activities—watching TV, doing housework, running errands—it is also true that those married elders who spend more time with their spouses report high levels of happiness - elders in satisfying, long-term relationships are more satisfied with life and generally healthier

Diagnostic Procedures of MCI AND AACD

procedures involved in determining which diagnosis is appropriate can take several weeks to complete and must usually be repeated a few months later - progression to dementia in patients with MCI can be slowed or even prevented through the use of drugs that have been shown to be effective against fully developed Alzheimer's - BUT MCI does not always lead to Alzheimer's Disease

Retrospective memory

recalling something in the past - older adults perform more poorly than younger adults

Prospective memory tasks

require individuals to remember to do something in the future

Activities of daily living (ADLs)

self-help tasks such as bathing, dressing, and using the toilet

Paradigm

something that presents a pattern or example

Health Care Power of Attorney (HCPA)

specifies who can make decisions for an individual in the event that he or she becomes unable to do so

unique invulnerability

the belief that bad things, including death, happen only to others - young adults

Grieving

the emotional response to a death or other type of loss

Hayflick limit

the genetically programmed time limit to which each species is theoretically proposed to be subject, after which cells no longer have any capacity to replicate themselves accurately

Terminal Decline Hypothesis

the hypothesis that mental and physical functioning decline drastically only in the few years immediately preceding death

Acceptance

the last stage in Kübler-Ross's stages of dying

Synaptic plasticity

the redundancy in the nervous system that ensures that it is nearly always possible for a nerve impulse to move from one neuron to another or from a neuron to another type of cell - but with age, the increasing loss of dendrites, the shortest route may be lost, so plasticity decreases and reaction time increases.

Gerontology

the scientific study of aging

Religious coping

the tendency to turn to religious beliefs and institutions for support in times of difficulty - the tendency to turn to religion for comfort is stronger among African Americans - women make more use of religious coping than men do - elders who place a great deal of emphasis on religious faith worry much less than those who do not - positive effects of religious faith may have more to do with a general attitude of spirituality, a tendency to focus on the aspects of life that transcend one's physical existence, than on any particular set of doctrines or teachings

Advance directive

written instructions regarding end-of-life care - ex. either do or do not wish to have their lives prolonged with feeding tubes and other device