Exam 4

How did participants discuss adaptation?

*All participants discussed how they adapt skills, routines, habits or environments for people at the end of life *AND how these adaptations can create a climate of trust, develop rapport, and establish well-being for people

What was the overall outcome for Pizzi's () study on promoting health and well-being at the end of life (hint: what was the take away message?

*Client-centered care facilitates, self-direction at the end of life, or, at the very least, provides clients with opportunities to say how they will live their lives until the end of that life. *Client centered care is important approach to end of life

Where do the amount of activity and cognitive demands placed on the individual fit within the competence-press model?

Competence

What framework did the authors work from? Why was this framework used?

Ecosystemic framework

What model that has been discussed frequently in lectures best represents the goals of the Balm of Gilead?

biopsychosocial model

The role of grandparenting to aging individuals is shown by researchers to:

contribute to their sense of identity

An advantage of the Green House model of institutional care for older adults is that it:

designed to feel like a home, medical equipment stored out of sight, rooms are bright, outdoors are easily accessible

The situation in families when parents and their adult children no longer want to be with each other and, in fact, no longer value the relationship is known as a(n):

developmental schism

The people who think life is ______ and ________ are 20% happier.

long and easy

The greatest degree of filial _____ is likely to be experienced by Asian American families.

obligation

What is palliative care?

"comfort care"-end of life care that focuses on patient comfort rather than recovery

A woman would like to have her mother cared for in one of the best nursing homes in her town, but is unable to afford the cost which, for a private pay facility would be about $____ thousand per year.

$74,800

What do DNR and AND stand for?

-Do Not Resuscitate -Allow Natural Death

According to the _____________, parents tend to give more support to their adult children who need the most help

contingency theory

The majority of nursing homes in the U.S. fall into which category of ownership?

for-profit

Health-related, but not intense nursing services are provided in a(n) __________ facility.

intermediate care

The balm of Gilead has recently received support from what type of facility for patient placement that will provide more 1-to-1 care?

skilled nursing homes

List and describe the levels of hospice care provided:

~Routine-doesn't need intensive care ~Respite-stay in hospice for 5 days to give caregiver a break at home ~General inpatient-living in hospice house with around the clock care ~Continuous-nurse stays in individual home until they can be moved to a hospice center

How did the participants discuss client goals?

*Ensuring to plan goals and meet people's needs that are important from the perspective of the client and family *Acknowledge the individuality of the patient, validating the client as a human with needs

How did the participants discuss choices?

*Giving clients a choice is a source of empowerment *Having choices is a free experience when the patient may feel their life is in turmoil or disarray

What are some of the strengths of older adults' social relationships (think about the size and ability to negotiate conflict)?

*Greater satisfaction than younger adults. *Social networks shrink in size across adulthood- remove casual acquaintances. *Interact with close social network members who allow emotionally meaningful interaction and sense of belonging. *Invest more time into maintaining relationships. *Fewer conflicts- greater use of problem-solving strategies than younger adults.

What are the components (i.e. individual, microsystem, etc.) of an ecosystemic framework? Briefly describe each.

*Individual- mental and physical health, knowledge -The experience of intimacy is a very individual experience that can be influenced by health status; hormonal changes, attitudes and mental health *Microsystem- peers, caregivers -Those with immediate contact to the elders may serve as educators, supporters, or influencers *Mesosystem- interactions between elements of microsystem -Ensure that communication is open and clear between all parts of the microsystem *Exosystem- mass media, laws and policies -The environment that may not have a direct connection with the individual (such as media or policies), but still impact intimate expression at the end of life *Macrosystem- attitudes, ideologies -The larger attitudes and ideologies that cultures/societies have of intimacy that shape opinions and thoughts of elders

Why focus on intimacy in late life?

*Intimate expression is valid at end of life stages *Research shows that older adults and those with terminal illnesses are still interested in intimacy *Practitioners still do not discuss intimacy

What was the overall purpose of this article? What were they trying to test? "Adaptive Midlife Defense Mechanisms and Late-Life Health" Malone Article

*Objective: examine the relationship between adaptive defense mechanisms in midlife and physical health in late life *Question: Does social support mediate the relationship between defense mechanisms and health?

In the Blue Zones and Longevity video three countries were focused on, Denmark, Singapore, and Costa Rica. Describe what the people in each country do to contribute to their high longevity rates; what makes these people happy and health?

*Singapore- Everyone owns their own home. Everyone is paid a fair quality *Denmark- Most trust *Costa Rica- Highest rating of positive affect

What is the difference between social network compensation and social network substitution?

*Social Network Compensation- extent to which alternative sources boost emotional and physical well-being. *Social Network Substitution- attain social support from others; extent to which bereaved individuals derive support and companionship from alternative sources.

What are the 9 common traits of locations with the happiest and healthiest people?

-Move Naturally -Right Outlook *Downshift *Know Your Purpose -Eat Wisely *Grains, Greens, Nuts and Beans *Wine @ 5 *80% -Connect *Loved Ones First *Belong *Right Tribe

How was the building site for St. Mary's hospice center funded? How long did it take to complete the building process?

-community donations -took over 10 years to raise money

Summarize the five stages of dying in the theory of Kübler-Ross. Describe four criticisms of the theory.

-denial -anger -bargaining -depression -acceptance

What are key points and concepts to the hospice philosophy?

-embraces a holistic approach that includes physical, emotional and spiritual concerns -hospice: means to be both host and guest; implying a mutual care giving between patient, family and hospice staff -key concepts: dignity, quality of life, family as defined by the patient, comfort, honor of traditions

What is secondary trauma?

-indirect exposure to a traumatic event -stress resulting from helping or wanting to help traumatized or suffering person

What is one given reason for why age is relevant when considering the relationship between marital quality and health?

-marriages may become more noticeable in later life -stress takes a heavier toll as they age** -chronic stress creates biological vulnerability to illness

Based on socioemotional selectivity theory, members of a couple in a long-term relationship should show which pattern of social interaction in relation to their friends and social network?

-not as interested in meeting new people -interact with long-term friends and family-only those who are able to serve emotional functions as a result of shared experiences

What are some of the vulnerabilities of older adults' social relationships (think about concerns such as unavoidable conflict)

-some close relationships are indecisive -other close relationships may be disrupted -persistent conflict: source of chronic stress

In a test of the intergenerational solidarity model, researchers found that siblings were likely to exchange more help with each other when their parents:

-were not here for them -had a poor relationship with them

What is the approximate percentage of grandparents raising grandchildren who are 60 years and older?

14%

The relatives in a young woman's family see each other only for major holidays and family events on average about two or three times a year, even though they live within 30 minutes from each other. Based on this information, you would rate this family as on the negative end of which dimension of the Intergenerational Solidarity Model?

Associational

In Ancient Egypt, the ______________ was considered to be the guidebook to ensure that an individual would be guided through the underworld and into the afterlife.

Book of the Dead

Mental health workers who serve the older adult population are concerned about the skip generation family because they believe it has the potential to:

Create undue caregiving burdens in grandparents

The Theoretical Model of Strength and Vulnerability Integration is focused on what?

Distressing situations that cause changes in an aging body; health consequences of inability to reduce situations in older adults

Because many adults enter into remarriages are more likely to leave because they are open to the relationship's ending, they are said to be high on the factor known as:

Divorce Proneness

What were some of the acceptable places of residence for receiving hospice care? What was mentioned as an unacceptable place of residence (i.e. they were ineligible to receive hospice care)?

Eligible-home, hospital, long term care facility Ineligible-homeless

True or False: Hospice care requires that family be defined and limited to only immediate blood relatives?

False

A study of Canadian parents showed that the greatest difficulty in adapting to the empty nest was experienced by parents who:

Indo/East Indian ethnicity- culture emphasizes continuing bonds between parents and adult children. Also parents who lack support network, worried about child's safety, have few children, felt that identity was primarily their parenting role, or felt they were losing control over child's lives.

Who fore fronted the hospice movement in US?

Kubler-Ross

The DSM-5 considers extreme grief past a 2-week period following the loss of a close relative or friend to fit the criteria for which disorder?

Major Depressive Disorder

Within the competence-press model of adaptation to the institutional environment, which dimension captures the extent to which the environment places demands on the individual resident?

Press

According to the perspective known as ________________ Theory, activating a person's thoughts about death may trigger a set of positive changes, including closer relationships, greater creativity, and more connection to others.

Terror Management

The idea that Western culture is unwilling to accept the reality of mortality led Ernest Becker to write the critique of this attitude, called:

The Denial of Death

Couples who cohabitate before getting engaged will have a higher divorce rate should they marry. The most likely contributing factor is that:

They "slide" into marriage because they are living together

The ________ effect refers to the fact that widows are more likely to die after losing their spouse.

Widowhood

Pizzi discovered three sub-categories in the analysis of the interviews on the topic of promoting health and well-being at the end of life, what were these three categories?

adaption, client goals, choices

The majority of employees of nursing homes fall into which category?

aides

What is the first priority of the Balm of Gilead palliative care services?

alleviating patient's pain and distress

According to the ________________ view of bereavement the bereaved can continue to benefit from maintaining emotional bonds to the deceased individual.

attachment

The _______ approach to marital satisfaction predicts greater happiness when couples engage in positive behaviors such as expressing affection.

behavioral

Those who study death and dying believe that the main outcome of the work of Kübler-Ross was her emphasis on:

being able to openly talk about their illness

Discussed in the guest lecture was a key sign or trigger that is often associated with the beginning phases of the dying process - what was this sign/trigger?

decreased appetite

A middle-aged man was disappointed that his family reunion was spoiled when the older relatives clashed with the younger relatives about the most recent presidential election. No matter what he did, it was impossible for him to get each side to see the other's point. According to the Intergenerational Solidarity Model, the generations were separated by:

disagreement and values

A couple who had initially seemed destined to remain together for years, if not decades, surprised their families when they announced their impending divorce. Neither of them could cite a particular problem; it's just they felt they grew apart. This pattern of long-term relationship is known as:

disillusionment pathway

Siblings in later life who exchange more help, according to research on a Netherlands sample, are likely to have had parents who:

do not support them

Soon after becoming widows, research shows that women exhibit which of the following behaviors that relate to their health?

engage in less physical activity

Women who adapt more favorably to widowhood tend to be those women who:

experienced extensive caregiver burden at the end of their spouses life

When children reach the age at which they enter adulthood, they and their parents experience a phenomenon

filial maturity

Older adults in the Living Apart Together relationship status do so primarily because of which consideration?

financial concerns

The phenomenon known as doing _____ occurs after the transition to parenthood, when men and women adopt more stereotyped roles in the household.

gender

What are the important personality traits or country beliefs in Denmark, Singapore, and Costa Rica? What 4 things do these countries have in common?

generosity, tolerance, social, trusting

What is a key common theme to the places that have the happiest and healthiest people?

generosity, tolerance, social, trusting

Being able to die in a way that protects the individual's sense of autonomy and control over end-of-life decisions is consistent with the idea of:

good death

In equity theory, partners are seen as having the highest marital satisfaction if they

have balance in the relationship

The sibling relationship in later adulthood is unique because siblings typically:

have known each other longer than anyone else they have known their entire lives

What type of care is provided in an intermediate care facility?

health and rehabilitation services as well as food

Which type of care for older adults provides such services as Meals on Wheels, friendly visiting, assistance with household tasks, and rehabilitation, outside of an institutional setting?

home health services

Since 1970, of the following, there has been the greatest decrease in U.S. households that fall into the category of:

hyphenated last name

Couples who divorce seem to adapt best if, in the process, they protect each other's sense of identity, in what's referred to as:

identity assimilation

The number one deficiency in U.S. nursing homes in 2014, involving 43% of all institutions, was:

infection control

List the top five deficiencies noted in the 1997 survey of U.S. nursing homes. Why do you think these problems exist?

infection control, accidents, food sanitation, quality of care, and unnecessary drugs

Research on satisfaction in close, long-term relationships shows that the couples who are most likely to get along well in their later years were those who:

interacted well early in the relationship

The least amount of nursing services is provided in what type of in-patient facility for older adults?

intermediate care

Moving dying patients from the home to hospitals in mid-20th Century Western culture has led to the ethos of the _________ death.

invisible

What perspective or theory did Umberson and colleagues work from in their study on the effects of marital quality and health over a lifetime?

life course perspective

What are some of the eligibility requirements for entering hospice?

life limiting illness of 6 months or less, resides in service area, provide care to all ages

Home health services typically include what types of support for older adults?

light housekeeping, PT, OT , speech therapy, rehabilitation

The healthy lifespan refers to the length of time that an individual can:

live in optimal health

According to Umberson et al (2006) ______ accelerated typical decline in self-rated health that occurs over time?

marital strain

Discuss the implications of the competence-press model for the design of nursing home environments.

maximizing fit between the person and the environment

The __________________ is the length of time an individual can live without significant disease and disability.

maximum health expectancy

Who covers costs associated with hospice?

medicare, medicaid, private insurance, private pay

Which psychological disorders are most prevalent among residents of nursing homes?

mood and anxiety disorders

A couple in their 30s is thinking of getting married. One partner is very outgoing and sociable, and the other is introverted and shy. According to the _______ hypothesis on long-term relationships, they should be very happy together.

need complimentary

What age group were the effects of marital quality most pervasive for individual health (i.e. when poor marital quality was reported what age group had the worst health effects?)

older populations

The intergenerational stake hypothesis about families with adult children proposes that:

parents are higher in affectual solidarity toward children than children are towards parents

The phenomenon in families known as "doing gender" describes what happens when parents:

parents take on more traditional roles around the house

What are mature defense mechanisms considered to be according to this article?

prominent in individuals with greater levels of success in work and relationships, lower levels of psychopathology

What was the overarching theme that emerged from the qualitative data on the study of promoting health and well-being at the end of life?

promoting a good death

The concept of defenses originated from ____________ tradition?

psychoanalytic

What is an issue of the Balm of Gilead utilizing boarding homes for patient placement?

ratio of caregiver to patient is not 1:1. caregiver has to provide care to more than 1 patient at a time

What is an ambivalent social relationship?

relationship that has both positive and negative characterisitcs

The "anniversary reaction," as applied to widowhood, refers to the:

renewal of their feelings at/around the time of partner's death

A marriage therapist working from the social exchange theory of interpersonal relationships would attempt to assess whether the partners in a distressed couple feel that:

rewards out weight the costs

A meta-analysis of studies on satisfaction among couples before and after birth of the first child showed that, compared to non-parents, the parents:

showed a slight decline in relationship satisfaction

A hospital social worker decides that one of her patients, an 82-year-old man who is recovering from a stroke, needs to be in a facility that provides him with rehab, round-the-clock nursing care, and help with planning his return to his own home. These kind of services are likely to be found in which type of long-term care facility?

skilled nursing facility

A new administrator in a nursing home in a large city is concerned because the staff are not providing what she feels is adequate training in bladder continence. She feels this should be a priority because she knows that incontinence is associated with which problem in nursing home residents?

social disengagement

What variable did the authors think would mediate the relationship between adaptive defense mechanisms and late life health?

social support

What best represents the definition of caregiver burnout?

state of physical, emotional, and mental exhaustion that may be accompanied by a change in attitude--from positive and caring to negative and unconcerned

A young woman feels that her parents treated her too much like an adult when she was growing up, giving her more responsibility than even she felt she could handle. This situation reflects a relationship characterized by:

structural ambivalence

What are the traits that are commonly associated with mature defense mechanisms (hint: see page 2 of the article)?

sublimation, suppression, anticipation, altruism, and humor

A study in the Netherlands of parents and adult children testing the Intergenerational Solidarity Model showed that when parents had poor relationships with their children, the siblings:

support each other more

A woman grieving after the sudden and unexpected death of her husband is engaged in the "restoration" function of bereavement. This means that she:

taking on new tasks or functions

What was the overall goal of this article? "Intimacy at the End of Life" Morissey-Stahl Article

to determine how end of life intimacy can be supported by practitioners

Couples in long-term relationships characterized by emergent distress show which pattern of conflict over time?

unable to cope, become defensive, withdraw, stonewall