Psych Exam 4
Death in Different Cultures
In most societies, death is not viewed as the end of existence—although the biological body has died, the spirit is believed to live on (Hedayat, 2006). This religious perspective is favored by most Americans as well. Cultural variations in attitudes toward death include belief in reincarnation, which is an important aspect of the Hindu and Buddhist religions. In the Gond culture of India, death is believed to be caused by magic and demons. In many ways, we in the United States are death avoiders and death deniers (Norouzieh, 2005). This denial can take many forms: the tendency of the funeral industry to gloss over death and fashion lifelike qualities in the dead; the persistent search for a "fountain of youth"; the rejection and isolation of the aged, who may remind us of death; and the medical community's emphasis on prolonging biological life rather than on diminishing human suffering.
evolutionary theory of aging
natural selection has not eliminated many harmful conditions and nonadaptive characteristics in older adults - One criticism is that the "big picture" idea of natural selection leading to the development of human traits and behaviors is difficult to refute or test because evolution occurs on a time scale that does not lend itself to empirical study. Another criticism is the failure of evolutionary theory to account for cultural influences
Kübler-Ross' Stages of Dying
*Denial and isolation* is Kübler-Ross' first stage of dying, in which the person denies that death is really going to take place. The person may say, "No, it can't be me. It's not possible." This is a common reaction to terminal illness. However, denial is usually only a temporary defense. It is eventually replaced with increased awareness when the person is confronted with such matters as financial considerations, unfinished business, and worry about surviving family members. *Anger* is the second stage of dying, in which the dying person recognizes that denial can no longer be maintained. Denial often gives way to anger, resentment, rage, and envy. The dying person's question is "Why me?" At this point, the person becomes increasingly difficult to care for as anger may become displaced and projected onto physicians, Page 419nurses, family members, and even God. The realization of loss is great, and those who symbolize life, energy, and competent functioning are especially salient targets of the dying person's resentment and jealousy. *Bargaining* is the third stage of dying, in which the person develops the hope that death can somehow be postponed or delayed. Some persons enter into a bargaining or negotiation—often with God—as they try to delay their death. Psychologically, the person is saying, "Yes, me, but . . ." In exchange for a few more days, the person promises to lead a reformed life dedicated to God or to the service of others. *Depression* is the fourth stage of dying, in which the dying person comes to accept the certainty of death. A period of depression or preparatory grief may appear. The dying person may become silent, refuse visitors, and spend much of the time crying or grieving. This behavior is normal and is an effort to disconnect the self from love objects. Attempts to cheer up the dying person at this stage should be discouraged, says Kübler-Ross, because the dying person has a need to contemplate impending death. *Acceptance* is the fifth stage of dying, in which the person develops a sense of peace, an acceptance of his or her fate, and in many cases, a desire to be left alone. Feelings and physical pain may be virtually absent. Kübler-Ross describes this stage as the end of the dying struggle, the final resting stage before death. Figure 2 is a summary of Kübler-Ross' dying stages.
Technology
A 2013 national survey conducted by the Pew Research Center found that 59 percent of U.S. older adults reported that they use the Internet (in 2000, only 13 percent of older adults said they use the Internet) (Smith, 2014). Two distinct groups of older adult Internet users were identified: (1) those who are younger, more highly educated, and more affluent; and (2) those who are older, less affluent, and who have significant health or disability challenges. - once older adults begin using the Internet, it becomes an integral part of their daily lives. Among those 65 years and older who use the Internet, 71 percent report going online every day or almost every day (compared with 88 percent of 18- to 29-year-olds, 84 percent of 30- to 49-year-olds, and 79 percent of 50- to 64-year-olds). At approximately 75 years of age, Internet use drops off considerably.
Advance Care Planning
Advance care planning refers to the process of patients thinking about and communicating their preferences regarding end-of-life care (Anderson, 2015; Garmertsfelder & others, 2016; Koss & Baker, 2016). For many patients in a coma, it is not clear what their wishes regarding termination of treatment might be if they still were conscious. A recent study found that advance care planning decreased life-sustaining treatment, increased hospice use, and decreased hospital use (Brinkman-Stoppelenburg, Rietjens, & van der Heide, 2014). Recognizing that some terminally ill patients might prefer to die rather than linger in a painful or vegetative state, the organization "Choice in Dying" created the living will,Page 415 a legal document that reflects the patient's advance care planning. A recent study of older adults found that advance care planning was associated with improved quality of care at the end of life, including less in-hospital death and greater use of hospice care (Bischoff & others, 2013).
Health Care
An aging society also brings with it various problems involving health care (Gaugler, 2016; Moon, 2016), including escalating costs (Hudson, 2016). Approximately one-third of total health-care expenses in the United States involve the care of adults 65 and over, who comprise only 12 percent of the population. Medicare is the program that provides health-care insurance to adults over 65 under the Social Security system (Moon, 2016; Trivedi, 2016; Trivedi & others, 2016). Until the Affordable Care Act was enacted, the United States was the only developed country that did not have a national health care system.
Status of the Economy and Income
An important issue is whether our economy can bear the burden of so many older persons, who by reason of their age alone are usually consumers rather than producers. Especially troublesome is the low rate of savings among U.S. adults, which has contributed to the financial problems of older adults in the recent economic downturn
Divorced and Remarried Older Adults
An increasing number of older adults are divorced (Suitor, Gilligan, & Pillemer, 2016). In 2012, 14 percent of women and 12 percent of men 65 years and older in the United States were divorced or separated (U.S. Census Bureau, 2012). Many of these individuals were divorced or separated before they entered late adulthood. The majority of divorced older adults are women, due to their greater longevity, and men are more likely to remarry, thus removing themselves from the pool of divorced older adults (Peek, 2009). Divorce is far less common among older adults than younger adults, likely reflecting cohort effects rather than age effects since divorce was somewhat rare when current cohorts of older adults were young (Peek, 2009).
Cohabiting Older Adults
An increasing number of older adults cohabit (Wu, Schimmele, & Quellet, 2015). In 2010, 3 percent of older adults were cohabiting (U.S. Census Bureau, 2012), which is expected to increase as the large cohort of baby boomers become 65 years of age and older and bring their historically more nontraditional values about love, sex, and relationships to late adulthood. In many cases, the cohabiting is more for companionship than for love. In other cases, such as when one partner faces the potential need for expensive care, a couple may decide to maintain their assets separately and thus not marry. One study found that older adults who cohabited had a more positive, stable relationship than younger adults who cohabited, although cohabiting older adults were less likely to have plans to marry their partner than younger ones were (King & Scott, 2005). Other research also has revealed that middle-aged and older adult cohabiting men and women reported higher levels of depression than their married counterparts (Brown, Bulanda, & Lee, 2005). And one study indicated that cohabiting older adults were less likely to receive partner care than married older adults were (Noel-Miller, 2011).
Sleep
Approximately 50 percent of older adults complain of having difficulty sleeping (Farajinia & others, 2014). Researchers have found that older adults' sleep is lighter and more disruptive (takes longer to fall asleep and also involves more awakenings and greater difficulty in going back to sleep) (McRae & others, 2016). Poor sleep is a risk factor for falls, obesity, lower cognitive functioning, and earlier death and is linked to a lower level of cognitive functioning (Xiao & others, 2013). Many of the sleep problems of older adults are associated with health problems (Mantua, Baran, & Spencer, 2016; McRae & others, 2016). Recent research indicates that when older adults sleep less than seven hours and more than nine hours a night, their cognitive functioning is harmed (Devore, Grodstein, & Schemhammer, 2016; Lo & others, 2016). Another recent study revealed that engaging in regular aerobic exercise improved the sleep profiles of older men (Melancon, Lorrain, & Dionne, 2015). In addition, one study of older adults indicated that walking at or above the internationally recommended level of 150 minutes per week predicted a lower likelihood of problems with sleep onset or sleep maintenance four years later (Hartescu, Morgan, & Stevinson, 2015).
Older Adult Parents and Their Adult Children
Approximately 80 percent of older adults have living children, many of whom are middle-aged. About 10 percent of older adults have children who are 65 years or older. Adult children are an important part of the aging parent's social network. Older adults with children have more contacts with relatives than do those without children. Increasingly, diversity characterizes older adult parents and their adult children (Antonucci & others, 2016; Fingerman, Sechrist, & Birditt, 2013). Divorce, cohabitation, and nonmarital childbearing are more common in the history of older adults today than in the past. Gender plays an important role in relationships involving older adult parents and their children (Antonucci & others, 2016). Adult daughters are more likely than adult sons to be involved in the lives of aging parents. For example, adult daughters are three times more likely than adult sons to give parents assistance with daily living activities (Dwyer & Coward, 1991). Page 407A valuable task that adult children can perform is to coordinate and monitor services for an aging parent (or other relative) who becomes disabled (Jones & others, 2011). This might involve locating a nursing home and monitoring its quality, procuring medical services, arranging public service assistance, and handling finances. In some cases, adult children provide direct assistance with daily living, including such activities as eating, bathing, and dressing. Even less severely impaired older adults may need help with shopping, housework, transportation, home maintenance, and bill paying. Also, some researchers have found that relationships between aging parents and their children are usually characterized by ambivalence (Antonucci & others, 2016). And in another recent study of 40- to 60-year-old middle-aged adults, they reported that their relationships with their children were more important than those with their parents but that their relationships with their children were more negative than with their parents (Birditt & others, 2015).
Arthritis
Arthritis is an inflammation of the joints accompanied by pain, stiffness, and movement problems. This incurable disorder can affect hips, knees, ankles, fingers, and vertebrae. Individuals with arthritis often experience difficulty moving about and performing routine daily activities. Arthritis is especially prevalent in older adults (Chalan & others, 2015). Recent research documents the benefits of exercise in older adults with arthritis Page 381 (White & others, 2015; Wood & others, 2016). A recent study of women found that leisure-time physical inactivity was found to be a risk factor for subsequent development of arthritis (Di Giuseppe & others, 2016). In this study, women engaging in the most vigorous category of leisure-time activities were the least likely to develop arthritis.
successful aging
As we have discussed aging, it should be apparent that there are large individual differences in the patterns of change for older adults. The most common pattern is *normal aging*, which characterizes most individuals (Schaie, 2016). Their psychological functioning often peaks in early midlife, plateaus until the late fifties to early sixties, then modestly declines through the early eighties, although marked decline often occurs prior to death. Another pattern involves *pathological aging*, which characterizes individuals who in late adulthood show greater than average decline. These individuals may have mild cognitive impairment in early old age, develop Alzheimer disease later, or have chronic disease that impairs their daily functioning. A third pattern of change in old age is *successful aging*, which characterizes individuals whose physical, cognitive, and socioemotional development is maintained longer than for most individuals and declines later than for most people. Successful aging also involves perceived control over the environment (Lachman, Agrigoroaei, & Hahn, 2016). In the chapter on physical and cognitive development in late adulthood, we described how perceived control over the environment had a positive effect on nursing home residents' health and longevity. In recent years, the term *self-efficacy* has often been used to describe perceived control over the environment and the ability to produce positive outcomes (Bandura, 2010, 2012, 2015). Researchers have found that many older adults are quite effective in maintaining a sense of control and have a positive view of themselves (Park, Elavsky, & Koo, 2014). For example, a study of centenarians found that many were very happy and that self-efficacy and an optimistic attitude were linked to their happiness (Jopp & Rott, 2006). And one study revealed that maximizing psychological resources (self-efficacy and optimism) was linked to a higher quality of life for older adults (Bowling & Lliffe, 2011). Examining the positive aspects of aging is an important trend in life-span development that is likely to benefit future generations of older adults (Reed & Carstensen, 2015, 2016). And a very important agenda is to continue to improve our understanding of how people can live longer, healthier, more productive and satisfying lives
Determining Death
Brain death is a neurological definition of death which states that a person is brain dead when all electrical activity of the brain has ceased for a specified period of time. A flat EEG (electroencephalogram) recording for a specified period of time is one criterion of brain death. The higher portions of the brain often die sooner than the lower portions. Because the brain's lower portions monitor heartbeat and respiration, individuals whose higher brain areas have died may continue to breathe and have a heartbeat (MacDougall & others, 2014). The definition of brain death currently followed by most physicians includes the death of both the higher cortical functions and the lower brain stem functions (Sung & Greer, 2011). - Some medical experts argue that the criteria for death should include only higher cortical functioning. If the cortical death definition were adopted, then physicians could claim a person is dead who has no cortical functioning, even if the lower brain stem is functioning. Supporters of the cortical death policy argue that the functions we associate with being human, such as intelligence and personality, are located in the higher cortical part of the brain. They believe that when these functions are lost, the "human being" is no longer alive.
The Circulatory System and Lungs
Cardiovascular disorders increase in late adulthood (Jansen & others, 2015; Wang, Monticone, & Lakatta, 2016). Consistent blood pressures above 120/80 should be treated to reduce the risk of heart attack, stroke, or kidney disease. Various drugs, a healthy diet, and exercise can reduce the risk of cardiovascular disease in older adults (Endes & others, 2016; Kramer, 2015; Wang, Monticone, & Lakatta, 2016). In a recent study of older adults, a faster exercise walking pace, not smoking, modest alcohol intake, and avoiding obesity were associated with a lower risk of heart failure (Del Gobbo & others, 2015). Lung capacity drops 40 percent between the ages of 20 and 80, even without disease (Fozard, 1992). Lungs lose elasticity, the chest shrinks, and the diaphragm weakens (Lalley, 2013). The good news, though, is that older adults can improve lung functioning with diaphragm-strengthening exercises.
Three diseases that can impair the vision of older adults
Cataracts involve a thickening of the lens of the eye that causes vision to become cloudy and distorted (Marra & others, 2016). By age 70, approximately 30 percent of individuals experience a partial loss of vision due to cataracts. Initially, cataracts can be treated by glasses; if they worsen, a simple surgical procedure can replace the natural lenses with artificial ones (Grewal & others, 2016). Glaucoma involves damage to the optic nerve because of the pressure created by a buildup of fluid in the eye (Kostanyan & others, 2016). Approximately 1 percent of individuals in their seventies and 10 percent of those in their nineties have glaucoma, which can be treated with eye drops. If left untreated, glaucoma can ultimately destroy a person's vision. Macular degeneration is a disease that involves deterioration of the macula of the retina, which corresponds to the focal center of the visual field. Individuals with macular degeneration may have relatively normal peripheral vision but be unable to see clearly what is right in front of them
Hormonal Stress Theory
Cellular clock and free radical theories attempt to explain aging at the cellular level. In contrast, hormonal stress theory argues that aging in the body's hormonal system can lower resistance to stress and increase the likelihood of disease. Normally, when people experience stressors, the body responds by releasing certain hormones. As people age, the hormones stimulated by stress remain at elevated levels longer than when people were younger (Simm & others, 2008). These prolonged, elevated levels of stress-related hormones are associated with increased risks for many diseases, including cardiovascular disease, cancer, diabetes, and hypertension (Steptoe & Kivimaki, 2012).
Integrity versus despair
Erikson's eighth and final stage of development, which individuals experience during late adulthood. This stage involves reflecting on the past and either piecing together a positive review or concluding that one's life has not been well spent. Life review is prominent in this final stage. It involves looking back at one's life experiences and evaluating, interpreting, and often reinterpreting them
Ethnicity
Ethnic minority older adults, especially African Americans and Latinos, are overrepresented in poverty statistics (Antonucci & others, 2016; Jackson, Govia, & Sellers, 2011). Comparative information about African Americans, Latinos, and non-Latino Whites indicates a possible double jeopardy for elderly ethnic minority individuals, facing problems related to both ageism and racism (Allen, 2016; Nadimpalli & others, 2015). They also are more likely to have a history of less education, longer periods of unemployment, worse housing conditions, and shorter life expectancies (Treas & Gubernskaya, 2016). In recent analyses, non-Latino White men and women with 16 years or more of schooling had a life expectancy that was 14 years higher than that of African Americans with fewer than 12 years of education
Euthanasia
Euthanasia ("easy death") is the act of painlessly ending the lives of individuals who are suffering from an incurable disease or severe disability (Macleod, 2015; Pope & Okinski, 2016; Radbruch & others, 2016). Sometimes euthanasia is called "mercy killing." Distinctions are made between two types of euthanasia: passive and active. *Passive euthanasia* occurs when a person is allowed to die by withholding available treatment, such as withdrawing a life-sustaining device. For example, this might involve turning off a respirator or a heart-lung machine. *Active euthanasia* occurs when death is deliberately induced, as when a lethal dose of a drug is injected. Technological advances in life-support devices raise the issue of quality of life (Bloodworth, Bloodworth, & Ely, 2015). Nowhere was this more apparent than in the highly publicized case of Terri Schiavo, who suffered severe brain damage related to cardiac arrest and a lack of oxygen to the brain. She went into a coma and spent 15 years in a vegetative state. Across the 15 years, the question of whether passive euthanasia should be implemented, or whether she should be kept in the vegetative state with the hope that her condition might change for the better, was debated between family members and eventually at a number of levels in the judicial system. At one point toward the end of her life, a judge ordered that her feeding tube be removed. However, subsequent appeals led to its reinsertion twice. The feeding tube was removed a third and final time on March 18, 2005, and she died 13 days later from passive euthanasia.
Biological Theories of Aging
Even if we stay remarkably healthy, we begin to age at some point. Four biological theories provide intriguing explanations of why we age: evolutionary, cellular clock, free-radical, and hormonal stress.
exercise
Exercise is an excellent way to maintain physical and mental health (Erickson & Liu-Ambrose, 2016; Gill & others, 2016; Raji & others, 2016; Rhyner & Watts, 2016). The current recommendations for older Page 382 adults' physical activity are 2 hours and 30 minutes of moderate-intensity aerobic activity (brisk walking, for example) per week and muscle strengthening activities on 2 or more days a week (Centers fxor Disease Control and Prevention, 2016). In the recent recommendations, even greater benefits can be attained with 5 hours of moderate-intensity aerobic activity per week. Exercise helps people to live independent lives with dignity in late adulthood (Ballesteros & others, 2015; Nagamatsu & others, 2016). At age 80, 90, and even 100, exercise can help prevent older adults from falling down or even being institutionalized (Lupsa & Insogna, 2015; Witard & others, 2016). A recent study found that an exercise program reduced the number of falls in older adults with dementia (Burton & others, 2015). And a recent study of sarcopenic older adults found that those who were physically active had a 25 percent higher probability of greater longevity than their sedentary counterparts (Brown, Harhay, & Harhay, 2016). Exercise also is linked to the prevention or delayed onset of chronic diseases, such as cardiovascular disease, type 2 diabetes, and obesity, as well as improvement in the treatment of these diseases (Endes & others, 2016; Grace & others, 2016; Roh & others, 2016). Researchers also increasingly are finding that exercise improves cellular functioning in older adults (Broskey & others, 2016). For example, researchers recently have discovered that aerobic exercise is linked to greater telomere length in older adults (Denham, O'Brien, & Charchar, 2016; Loprinzi & Loenneke, 2016).
Losing a Life Partner
How surviving spouses cope varies considerably (Caserta & others, 2014; Hasmanova Marhankova, 2016). Becoming widowed is likely to be especially difficult when individuals have been happily married for a number of decades. In such circumstances, losing your spouse, who may also be your best friend and with whom you have lived a deeply connected life, can be extremely emotional and difficult to cope with. A six-year longitudinal study of individuals aged 80 and older found that the loss of a spouse, especially in men, was related to a lower level of life satisfaction over time (Berg & others, 2009). Another study revealed that widowed persons who did not expect to be reunited with their loved ones in the afterlife reported more depression, anger, and intrusive thoughts at 6 and 18 months after their loss (Carr & Sharp, 2014).
Married Older Adults
In 2014, 58.6 percent of U.S. adults over 65 years of age were married (U.S. Census Bureau, 2015). Older men were far more likely to be married than older women. In 2014, 24.7 percent of U.S. adults over 65 years of age were widowed (U.S. Census Bureau, 2015). There were more than four times as many widows as widowers. Page 405 Individuals who are in a marriage or a partnership in late adulthood are usually happier, feel less distressed, and live longer than those who are single (Piazza & Charles, 2012). The following studies support the view that positive marital relationships are linked to a number of positive outcomes for older adults: - Marital satisfaction helped to insulate older adults' happiness from the effects of daily fluctuations in perceived health (Waldinger & Schulz, 2010). - More frequent negative (but not positive) marital experiences were linked to a slower decline in older adults' cognitive abilities over time (Xu, Thomas, & Umberson, 2016). - Compared with other sources of social support, spousal support was more strongly linked to an important biomarker of cellular aging, telomere length (Barger & Cribbet, 2016). - A longitudinal study of adults 75 years of age and older revealed that individuals who were married were less likely to die during a seven-year time span (Rasulo, Christensen, & Tomassini, 2005). - Marital satisfaction in older adults was linked to whether an individual was depressed or not (Walker & others, 2013). - For both married and cohabiting couples, negative relationship quality predicted a higher level of blood pressure when both members of the couple reported having negative relationship quality (Birditt & others, 2016).
Friendship
In early adulthood, friendship networks expand as new social connections are made away from home. In late adulthood, new friendships are less likely to be forged, although some adults do seek out new friendships, especially following the death of a spouse (Zettel-Watson & Rook, 2009). Aging expert Laura Carstensen (2006) concluded that people choose close friends over new friends as they grow older. And as long as they have several close people in their network, they seem content, says Carstensen. A recent study found that activities with friends increased positive affect and life satisfaction in older adults (Huxhold, Miche, & Schuz, 2014). In another study of married older adults, women were more depressed than men if they did not have a best friend, and women who did have a friend reported lower levels of depression (Antonucci, Lansford, & Akiyama, 2001). Similarly, women who did not have a best friend were less satisfied with life than women who did have a best friend. And a longitudinal study of adults 75 years of age and older revealed that individuals who maintained close ties with friends were less likely to die across a seven-year age span (Rasulo, Christensen, & Tomassini, 2005). These findings were stronger for women than men.
Physical Appearance and Movement
In late adulthood, the changes in physical appearance that began occurring during middle age become more pronounced. Wrinkles and age spots are the most noticeable changes. We also get shorter as we get older. Both men and women become shorter in late adulthood because of bone loss in their vertebrae
Vision
In late adulthood, the decline in vision that began for most adults in early or middle adulthood becomes more pronounced (Polat & others, 2012). The eye does not adapt as quickly when moving from a well-lighted place to one of semidarkness. The tolerance for glare also diminishes. The area of the visual field becomes smaller, and events that occur away from the center of the visual Page 378 field sometimes are not detected (Scialfa & Kline, 2007). All of these changes can make night driving especially difficult (West & others, 2010). Depth perception typically declines in late adulthood, which can make it difficult for older adults to determine how close or far away or how high or low something is (Bian & Anderson, 2008). A decline in depth perception can make steps or street curbs difficult to navigate.
Centenarians
In the United States, there were only 15,000 centenarians in 1980, but that number rose to 50,000 in 2000 and to 72,000 in 2014 (Xu, 2016). The number of U.S. centenarians is projected to reach 600,000 by 2050 (U.S. Census Bureau, 2011). Among the factors in the NECS that are associated with living to be 100 are longevity genes and the ability to cope effectively with stress. The researchers also have discovered a strong genetic component to living to be 100 that consists of many genetic links, each with modest effects but collectively having a strong influence (Sebastiani & others, 2013). Other characteristics of centenarians in the NECS study include the following: few of the centenarians are obese, habitual smoking is rare, and only a small percentage (less than 15 percent) have had significant changes in their thinking skills (disproving the belief that most centenarians likely would develop Alzheimer disease).
Sexuality
In the absence of two circumstances—disease and the belief that old people are or should be asexual—sexuality can be lifelong (Corona & others, 2013). Aging, however, does induce some changes in human sexual performance, more so in the male than in the female (Gray & Garcia, 2012). Orgasm becomes less frequent in males with age, occurring in every second to third attempt rather than every time. More direct stimulation usually is needed to produce an erection.Page 380 Many older adults are sexually active as long as they are healthy (Thomas, Hess, & Thurston, 2015). However, in one study, sexual activity did decline through the later years of life: 73 percent of 57- to 64-year-olds, 53 percent of 65- to 74-year-olds, and 26 percent of 75- to 85-year-olds reported that they were sexually active (Lindau & others, 2007). Nonetheless, with recent advances in erectile dysfunction medications, such as Viagra, an increasing number of older men, especially the young-old, are able to have an erection (Hosny, El-Say, & Ahmed, 2016; Sheu & others, 2016). Also, recent research suggests that declining levels of serum testosterone, which is linked to erectile dysfunction, can be treated with testosterone replacement therapy to improve sexual functioning in males (Almehmadi & others, 2016; Hassan & Barkin, 2016; Mayo Clinic, 2016). However, the benefit-risk ratio of testosterone replacement therapy is uncertain for older males (Isidori & others, 2014).
Cellular clock theory
Leonard Hayflick's (1977) theory that cells can divide a maximum of about 75 to 80 times and that as we age our cells become less capable of dividing. Hayflick found that cells extracted from adults in their fifties to seventies divided fewer than 75 to 80 times. Based on the ways cells divide, Hayflick places the upper limit of human life-span potential at about 120 to 125 years of age.
Gender
Many older women face the burden of both ageism and sexism (Angel, Mudrazija, & Benson, 2016) and also racism for female ethnic minorities (Hinze, Lin, & Andersson, 2012). The poverty rate for older adult females is almost double that of older adult males.
Smell and Taste
Most older adults lose some of their sense of smell or taste, or both (Correia & others, 2016). A recent national study of community-dwelling older adults revealed that 74 percent had impaired taste and 22 percent had impaired smell (Correia & others, 2016). These losses often begin around 60 years of age (Hawkes, 2006). A majority of individuals 80 years of age and older experience a significant reduction in smell (Lafreniere & Mann, 2009). Researchers have found that older adults show a greater decline in their sense of smell than in their taste (Schiffman, 2007). Smell and taste decline less in healthy older adults than in their less healthy counterparts.
Osteoporosis
Normal aging brings some loss of bone tissue, but for some individuals loss of bone tissue becomes severe. Osteoporosis involves an extensive loss of bone tissue and is the main reason many older adults walk with a marked stoop (Black & Rosen, 2016; Rothman & others, 2014).
The Shrinking, Slowing Brain
On average, the brain loses 5 to 10 percent of its weight between the ages of 20 and 90. Brain volume also decreases (Liu & others, 2016; Peng & others, 2016). A recent study found a decrease in total brain volume and volume in key brain structures such as the frontal lobes and hippocampus from 22 to 88 years of age (Sherwood & others, 2011). Also, recent analyses concluded that in healthy aging the decrease in brain volume is due mainly to shrinkage of neurons, lower numbers of synapses, reduced length and complexity of axons, and reduced tree-like branching in dendrites, but only to a minor extent attributable to neuron loss (Fjell & Walhovd, 2010; Penazzi, Bakota, & Brandt, 2016). Of course, for individuals with disorders such as Alzheimer disease, neuron loss occurs
Perceived Control and Denial
Perceived control may work as an adaptive strategy for some older adults who face death. When individuals are led to believe they can influence and control events—such as prolonging their lives—they may become more alert and cheerful. Giving nursing home residents options for control improved their attitudes and increased their longevity (Rodin & Langer, 1977).
Life Span and Life Expectancy
Since the beginning of recorded history, life span, the maximum number of years an individual can live, has remained steady at approximately 120 to 125 years of age. But since 1900 improvements in medicine, nutrition, exercise, and lifestyle have increased our life expectancy by an average of 31 years. Recall that life expectancy is the number of years that the average person born in a particular year will probably live. The average life expectancy of individuals born in 2013 in the United States was 78.8 years (Xu, 2016). Sixty-five-year-olds in the United States today can expect to live an average of 19.3 more years (20.5 for females, 17.9 for males) (Xu, 2016). People who are 100 years of age can only expect to live an average of 2.3 years longer (U.S. Census Bureau, 2011).
Culture
Six factors are most likely to predict high status for older adults in a culture (Sangree, 1989): 1. Older persons have valuable knowledge. 2. Older persons control key family/community resources. 3. Older persons are permitted to engage in useful and valued functions as long as possible. 4. Age-related role changes involve greater responsibility, authority, and advisory capacity. 5. The extended family is a common family arrangement in the culture, and the older person is integrated into the extended family. 6. In general, respect for older adults is greater in collectivistic cultures (such as China and Japan) than in individualistic cultures (such as the United States). However, some researchers are finding that this collectivistic/individualistic difference in respect for older adults is not as strong as it used to be and that, in some cases, older adults in individualistic cultures receive considerable respect (Antonucci, Vandewater, & Lansford, 2000).
Social Support and Social Integration
Social support and social integration play important roles in the physical and mental health of older adults (Antonucci & others, 2016; Jeon & Lubben, 2016; Lee, Kahana, & Kahana, 2016; Windsor & others, 2016). In the *social convoy* model of social relations, individuals go through life embedded in a personal network of individuals to whom they give, and from whom they receive, social support (Antonucci & others, 2016). Social support can help individuals of all ages cope more effectively with life's challenges. For older adults, social support is related to their physical health, mental health, and life satisfaction (Lee, Kahana, & Kahana, 2016). For example, a recent study found that a higher level of social support was associated with older adults' increased life satisfaction (Dumitrache, Rubio, & Rubio-Herrera, 2016). Social support also decreases the probability that an older adult will be institutionalized and is associated with a lower incidence of depression (Heard & others, 2011). Further, one study revealed that older adults who experienced a higher level of social support showed later cognitive decline than their counterparts with a lower level of social support (Dickinson & others, 2011). In a recent analysis, it was concluded that 80 percent of the supportive care for older adults with some form of limitation was provided by family members or other informal caregivers, which places an enormous burden on the caregiver
Forms of Mourning
The funeral industry has been a target of controversy in recent years. Funeral directors and their supporters argue that the funeral provides a form of closure to the relationship with the deceased, especially when there is an open casket. Their critics claim that funeral directors are just trying to make money and that embalming is grotesque. One way to avoid being exploited during bereavement is to purchase funeral arrangements in advance.
The Adaptive Brain
The human brain has remarkable repair capability (Cai & others, 2014; Garcia-Mesa & others, 2016). Even in late adulthood, the brain loses only a portion of its ability to function, and the activities older adults engage in can still influence the brain's development (Espeland & others, 2016; Jackson & others, 2016; Moore & Murphy, 2016). For example, in an fMRI study, higher levels of aerobic fitness were linked with greater volume in the hippocampus, which translates into better memory (Erickson & others, 2011). Can adults, even aging adults, generate new neurons? Researchers have found that *neurogenesis*, the generation of new neurons, does occur in lower mammalian species, such as mice (Kask & others, 2015). Also, research indicates that exercise and an Page 376 enriched, complex environment can generate new brain cells in rats and mice, and that stress reduces their survival rate (Garthe, Roeder, & Kempermann, 2016; Lucassen & others, 2015). For example, in a recent study, mice in an enriched environment learned more flexibly because of adult hippocampal neurogenesis (Garthe, Roeder, & Kempermann, 2016). One study revealed that coping with stress stimulated hippocampal neurogenesis in adult monkeys (Lyons & others, 2010). And researchers have discovered that if rats are cognitively challenged to learn something, new brain cells survive longer
Needed: Better Care for Dying Individuals
Too often, death in America is lonely, prolonged, and painful. Scientific advances sometimes have made dying harder by delaying the inevitable. Also, even though painkillers are available, too many people experience severe pain during their last days and months of life (Meng & others, 2013). A recent study found that 61 percent of dying patients were in pain in the last year of life and that nearly one-third had symptoms of depression and confusion prior to death (Singer & others, 2015). Care providers are increasingly interested in helping individuals experience a "good death" (Bauchner & Fontanarosa, 2016; Carr & Luth, 2016; Meffert & others, 2015) that involves physical comfort, support from loved ones, acceptance, and appropriate medical care. For some individuals, a good death involves accepting one's impending death and not feeling like a burden to others. Three frequent themes identified in articles on a good death involve (1) preference for dying process (94 percent of reports), (2) pain-free status (81 percent), and (3) emotional well-being (64 percent) (Meier & others, 2016). *Hospice* is a program committed to making the end of life as free from pain, anxiety, and depression as possible (Balk, 2016; Odejide, 2016; Ong & others, 2016). Traditionally, a hospital's goals has been to cure illness and prolong life; in contrast, hospice care emphasizes *palliative care*, which involves reducing pain and suffering and helping individuals die with dignity (Cox & Curtis, 2016; Hudson & others, 2016; Moore, 2015). However, U.S. hospitals recently have rapidly expanded their provision of palliative care. More than 85 percent of mid- to large-size U.S. hospitals have a palliative care team (Morrison, 2013). Hospice-care professionals work together to treat the dying person's symptoms, make the individual as comfortable as possible, show interest in the person and the person's family, and help everyone involved cope with death (Levy & others, 2016; West & others, 2016). Page 417Today more hospice programs are home-based, a blend of institutional and home care designed to humanize the end-of-life experience for the dying person.
Changing Historical Circumstances
We have already described one of the historical changes involving death—the increasing complexity of determining when someone is truly dead. Another involves the age group in which death most often strikes. Two hundred years ago, almost one of every two children died before the age of 10, and one parent died before children grew up. Today, death occurs most often among older adults. In the United States, life expectancy has increased from 47 years for a person born in 1900 to 79 years for someone born today (U.S. Census Bureau, 2015). In 1900, most people died at home, cared for by their family. As our population has aged and become more mobile, growing numbers of older adults die apart from their families. More than 80 percent of all U.S. deaths occur in institutions or hospitals. The care of a dying older person has shifted away from the family and minimized our exposure to death and its painful surroundings.
mTOR pathway
a cellular pathway that involves the regulation of growth and metabolism. TOR stands for "target of rapamycin," and in mammals it is called mTOR - Rapamycin is a naturally derived antibiotic and immune system suppressant/modulator, first discovered in the 1960s on Easter Island. It has been commonly used and is FDA approved for preventing organ rejection and in bone-marrow transplants.
Sirtuins
a family of proteins that have been linked to longevity, regulation of mitochondria functioning in energy, possible benefits of calorie restriction, stress resistance, and a lower incidence of cardiovascular disease
Mitochondrial theory
a theory of aging that emphasizes the decay of mitochondria—tiny bodies within cells that supply essential energy for function, growth, and repair—that is primarily due to oxidative damage and loss of critical micronutrients supplied by the cell
reminiscence therapy
discussing past activities and experiences with another individual or group
grief
emotional numbness, disbelief, separation anxiety, despair, sadness, and loneliness that accompany the loss of someone we love. However, even six months after their loss, some individuals have difficulty moving on with their life. They feel numb or detached, believe their life is empty without the deceased, and feel that the future has no meaning. This type of grief reaction has been referred to as prolonged or complicated grief (Glickman, Shear, & Wall, 2016; Holland & others, 2016; Prigerson & Maciejewski, 2014). Approximately 7 to 10 percent of bereaved individuals have this prolonged or complicated grief (Maccalum & Bryant, 2013). This prolonged grief has been labeled *complicated grief or prolonged grief disorder*. Complicated grief usually has negative consequences for physical and mental health (Li & Prigerson, 2016; Shear, 2015; Tay & others, 2016). In a recent study of individuals diagnosed with complicated grief, 40 percent reported at least one full or limited-symptom grief-related panic attack in the past week (Bui & others, 2015). A person who loses someone on whom he or she was emotionally dependent is often at greatest risk for developing prolonged grief. Another type of grief is *disenfranchised grief*, which describes an individual's grief over a deceased person that is a socially ambiguous loss that can't be openly mourned or supported (Cavuoti, 2015; Yu & others, 2016). Examples of disenfranchised grief include a relationship that isn't socially recognized such as an ex-spouse, a hidden loss such as an abortion, and circumstances of the death that are stigmatized such as death because of AIDS. Disenfranchised grief may intensify an individual's grief because it cannot be publicly acknowledged. This type of grief may be hidden or repressed for many years, only to be reawakened by later deaths.
volunteering
increase longevity
Socioemotional selectivity theory
older adults become more selective about their social networks. Because they place a high value on emotional satisfaction, older adults spend more time with familiar individuals with whom they have had rewarding relationships. - Developed by Laura Carstensen - this theory argues that older adults deliberately withdraw from social contact with individuals peripheral to their lives while they maintain or increase contact with close friends and family members with whom they have had enjoyable relationships. - This selective narrowing of social interaction maximizes positive emotional experiences and minimizes emotional risks as individuals become older Socioemotional selectivity theory also focuses on the types of goals that individuals are motivated to achieve (Sims, Hogan, & Carstensen, 2015). Two important classes of goals are (1) knowledge-related and (2) emotion-related. The trajectory of motivation for knowledge-related goals starts relatively high in the early years of life, peaks in adolescence and early adulthood, and then declines in middle and late adulthood. The emotion-related trajectory is high during infancy and early childhood, declines from middle childhood through early adulthood, and increases in middle and late adulthood.
ageism
prejudice against others because of their age, especially prejudice against older adults - They are often perceived as incapable of thinking clearly, learning new things, enjoying sex, contributing to the community, or holding responsible jobs.
Selective optimization with compensation theory
successful aging is linked with three main factors: selection, optimization, and compensation (SOC). The theory describes how people can produce new resources and allocate them effectively to the tasks they want to master - *Selection* is based on the concept that older adults have a reduced capacity and loss of functioning, which require a reduction in performance in most life domains. - *Optimization* suggests that it is possible to maintain performance in some areas through continued practice and the use of new technologies. - *Compensation* becomes relevant when life tasks require a level of capacity beyond the current level of the older adult's performance potential.
Activity Theory
the more active and involved older adults are, the more likely they are to be satisfied with their lives - when older adults are active, energetic, and productive, they age more successfully and are happier than they are if they disengage from society - three times more likely to have a slower progression to having a functional disability
free-radical theory
which states that people age because when cells metabolize energy, the by-products include unstable oxygen molecules known as free radicals. The free radicals ricochet around the cells, damaging DNA and other cellular structures
