PSYC 4072 Final Dr. Cherry

According to your book, successful cognitive aging can be defined as

"Cognitive performance that is above the average for an individual's age group as objectively measured"

The Medicaid Program - Title XIX of _____, a federal and state matching entitlement program that provides _____ assistance for individuals and families with ____ incomes. - It is essentially ____ assistance for the poor in need of medical and health related services. - Those covered by _____ who are ____ _____ may require Medicaid when their benefits have ____ ____ and they cannot afford to pay their _____ expenses.

- 1965 - medical - low - public - Medicare - not poor - run out - medical

Patient Self-Determination Act - Passed in _____ - Guarantees the right of all competent adults to have an ____ role in decisions about their ____ - ______ ______: a written statement of a person's wishes regarding medical treatment, often including a _____ _____ - _________________: is a type of written legal document called a _____ _____ _____. It allows another person to make _____ decisions on your behalf. This person is called a _____ _____. This person speaks for you if you are too _____ or _____ to make your wishes known.

- 1990 - active; care - Advance Directive; living will - Durable Power of Attorney for Healthcare - Medical Advance Directive - healthcare - healthcare agent - sick or injured

Hospice Concept of Care- The first well-known hospice was St. Christopher's in _______, which opened in ____. - The hospice movement spread to the United States in the _____. - In _____, hospice benefits were made available to persons on _______ who had a life expectancy of less than 6 months.

- London; 1967 - 1970s - 1982 - Medicare

Why is hospice care necessary when life expectancy is less than 6 months (physician ordered)? - ______ and ______ services - ______ care (ease pain and discomfort) - Meeting ______, ______, ______ needs

- Medical and Supportive services - Palliative care (ease pain and discomfort) - Meeting social, psychological, and spiritual needs

4 components of The Medicare Program - Medicare Part A: - Medicare Part B: - Medicare Part C: - Medicare Part D:

- Medicare Part A: Hospital insurance - Medicare Part B: Medical insurance (benefits for people age 65+ who pay a monthly premium based on income). - Medicare Part C: Medicare advantage plans (coverage through private health plans) - Medicare Part D: Prescription drug benefits

What is the age group that will experience the most death anxiety? why?

- Middle aged adults - Life-threatening health crises begin to emerge at this time. - Sparks in mid-life and then decreases with age.

According to your professor, why is the topic of institutionalization in later life and financing long-term care of older adults important to know about?

- Personal/family reasons (i.e., you may be facing these choices for a loved one someday) - Personal/professional reasons (i.e., you may be working in the nursing home industry) - Political/national reasons (i.e., taxes and revenue to cover the cost of long-term care) - International reasons (i.e., global aging is a reality) (all of the above)

Long-term Care Costs: Who Pays? 1. Families pay for long-term care costs: - ____ _____ - _____ _____ _____ insurance 2. Two Federal Government programs cover some long-term care costs: - _____ - _____

- Private pay - Long-term care insurance - Medicare - Medicaid

The Medicare Program - A federal funding agency, started as title XVIII of the U.S. _____ _____ Act passed and signed by President Lyndon B. Johnson in _____. - It was a ___ ___ ___ ___ system when it was passed. - Medicare's funding comes from _____ taxes, _____, general revenue from _____ taxes, and some payments from the _____. - ___ basic components.

- Social Security - 1965 - pay as you go - payroll - premiums - income - states - 4

Promoting successful aging requires consideration of psychological variables, including: - adaptation to ____ ____ ____ - ____attitude, optimism - social ____ and social ____

- age-related changes - positive - participation; support

Realities of nursing homes to consider: 1. Most nursing homes are a _____ with a _____ _____. 2. Nursing home residents have _____ needs. 3. Some nursing homes offer _____ placements (for _____). 4. _____ _____ _____ are monitored. 5. ______

- business - business model - medical - temporary - rehab - Standards of Care - Deficiencies

Realities of nursing homes to consider- Deficiencies: 1. Quality of ____. 2. Lack of ____ ____ (harm or immediate jeopardy to _____). 3. Continence (control over elimination of _____ and ____). 4. Quality of an _____ _____. 5. Quality of the _____ _____. 6. The use of _____ and _____ restraints.

- care - accident prevention - residents - urine and feces - individual's life - staff's life - physical; chemical

Dorothy Custer at age 100 on Jay Leno show - She's a quintessential role model for: o humor (as a ____ ____) o importance of attitude (____ is everything) o ____ relations (successful 60+ year relationship) o retention of musical ability (intact ____ ____)

- coping strategy - outlook - social - procedural memory

Cortical death - The absence of higher order ____ activity but ____ _____ activity persists - With cortical death, the person might be considered a "_____" - Cortical death is not used as a ____ ____ anywhere in the US at this time

- cortical; lower brainstem - vegetable - legal definition

Rowe and Kahn Model of Successful Aging SUCCESSFUL AGING: - Absence of ____ or____ - High ____ and ____ capacity - Active engagement with ____

- disease or disability - physical and cognitive - life

Why do elderly long-term care issues matter: 1. Personal / Family: - Part of your _____. - _____ is a key issue within gerontology (study of old people). - You may work in the ____ ____ industry. - You may have to place a _____ _____ in a nursing home. - You may be facing a _____ _____ _____ yourself. 2. Political / National: - "We owe them the right of _____ in ____ as well as in _____." - John F. Kennedy 3. Global / International: - _____ _____ is a _____ issue facing the world.

- education - Institutionalization - senior housing - loved one - nursing home placement - dignity; sickness; health. - Population aging - global

4 main types of Residential Care Facilities: 1. Board and care homes - _____ living arrangements for older adults that ____ live on their own and need some ____ services. 2. Group homes - provide _____, _____ living in a house _____ by several older adults. 3. Assisted living facilities - _____ and _____ managed housing complexes with _____ living older adults in their own ____, some have ____ services available on ____. 4. Adult foster care - when a ____ provides care in their ____ to an older adult.

- group - cannot - nursing - independent - private - shared - licensed - professionally - independently - apartments - health - site - family - home

Financing Long-Term Care: The Realities - The need for long-term care for seniors is _____. - The cost of this care is increasing _____ at an alarming rate.

- increasing - nationally

Two types of nursing homes: 1. Skilled nursing facilities: Provide _____ nursing care. 2. Intermediate care facilities: Provide _____ _____ services for older adults who do not require ______ or _____ _____ facility care.

- intensive - health related - hospital - skilled nursing

Social and psychic death - Occurs when people are _____ or ____ by others, being ____ or written off by family / friends - People with _____ illnesses are often treated this way - Role of the hospice movement: _____ _____ _____

- isolated or abandoned - shunned - terminal - Death with Dignity

Which of the following factors contributes to subjective well-being?

- personality - adaptation - achievement of goals - social comparison (all of the above)

Promoting Successful Aging - Recognize domains of normal age-related declines: - ____ function - ____ function Recognize that successful aging is not the ____ ____ ____, but ____ adaptation to change

- physical - psychological - absence of change; positive

Successful aging has also been defined in terms of: - ____ - ____ reminiscence - high quality of ____ - personal ____ - life ____ and an ____ outlook

- spirituality - adaptive reminiscence - high quality of life - personal growth - life satisfaction and an optimistic outlook

Stages of Dying (Kubler-Ross): The process considered to occur universally among _____ _____ patients including: (5)

- terminally ill 1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance

What are the dysfunctional methods of coping? (3)

1. Avoidance: "keeping busy" strategy; many think this is therapeutic and function. 2. Obliteration: trying to erase the former existence of the deceased. 3. Idolization: opposite of obliteration; making the deceased greater in death than he or she was in life

What we know about grief and the grieving process: 1. Grieving is a very real _____ _____ 2. Grieving is ______ 3. Grieving takes a _____ _____

1. Grieving is a very real psychological phenomenon (can be the most severe psychological trauma a person can experience) 2. Grieving is obligatory (mandatory) 3. Grieving takes a long time

Reasonable alternatives to nursing home or residential care placement include Community-Based Services, such as: 1. _____ _____ services 2. ______ _____ _____ facilities 3. _____ ______ ______ (aka "mother-in-law" apartments) 4. ______ housing (e.g., Bishop Ott) 5. ______ _______ _____ _____

1. Home health services 2. Geriatric Partial Hospital facilities 3. Accessory dwelling units (aka "mother-in-law" apartments) 4. Subsidized housing (e.g., Bishop Ott) 5. Continuing Care Retirement Communities (CCRCs)

Death anxiety in older adults: - Not really anxious, but how do they see it? (3)

1. Less emphasis on life: doesn't mean they're depressed, but by the time they're 70ish they feel contentment with life 2. Death isn't unfair: not a thief, does not take something from you 3. Anticipatory rehearsal: - exciting upcoming event that you think about. - older people do this about funerals (think how they want the funeral to happen)

Why do elderly long-term care issues matter: (3)

1. Personal / Family 2. Political / National 3. Global / International

What are the different expressions of grief? 1. _____ expressions of grief: 2. _____ expressions of grief: 3. _____ expressions of grief: 4. _____ expressions of grief:

1. Physical expressions of grief: (loss of appetite, trouble sleeping, weak, drained of energy) 2. Cognitive expressions of grief: (depersonalization, numbness, nothing feels real, hypersensitivity or oversensitivity to noise, confusion, disbelief, preoccupation with the dead person, attempting to make sense of the event) 3. Affective expressions of grief: (sadness, sorrow, crying, squeezing back tears, raw emotion, anger) 4. Behavioral expressions of grief: (person may become slow, 35 year old acting like 80 year old, whatever your bad habit is tends to increase in frequency, will be bad but usually gets back over time)

Two types of nursing homes: 1. _________________: Provide intensive nursing care. 2. ________________: Provide health related services for older adults who do not require hospital or skilled nursing facility care.

1. Skilled nursing facilities 2. Intermediate care facilities

the widowhood effect may be due to: 1. ______ 2. _____ stress 3. _____ hardship 4. loss of _____ _____/_____

1. depression 2. psychosocial stress 3. economic hardship 4. loss of social support/resources

Academic Approaches to Successful Aging- McArthur Study of Successful Aging: Rowe and Kahn (1997) describe three components of successful aging: 1. the absence of ____ and ____ and the lack of ____ ____ predisposing one toward these 2. the maintenance of ____ and ____ function that promotes ____ ____ 3. ____ with other people and involvement in ____ ____

1. disability and disease; risk factors 2. physical and cognitive; well-being 3. connection; productive activities.

Factors contributing to well-being (MIDUS study): 1. Personality: Extraversion was related to well-being, especially for ____. 2. Adaptation: A psychological mechanism that allows people to reach higher levels of well-being than their ____ would predict. 3. Achievement of personal goals: The extent to which our experiences are consistent with ____ 4. Social comparison: Look at other people's circumstances and realize they are ____ off than you 5. Regulation of affect: Allows us to change the focus of our ____ investments, have a different ____ on situations. 6. Positive relationships with others: Fosters ____ support and the feeling of being ____

1. men 2. circumstances 3. goals 4. worse 5. emotional; perspective 6. social; valued

Criteria for clinical death: 1. No spontaneous _____ in response to ____ 2. No spontaneous ______ for at least _____ 3. Total ____ of responsiveness to even the most ____ stimuli 4. No ____ movements, blinking, or pupil responses 5. No _____ activity, yawning, swallowing, or vocalizing 6. No ____ reflexes 7. A flat ____ for at least ___ ____ 8. No change in any of these criteria when they are tested again ___ ____ later

1. movement; stimuli 2. respirations (breathing); 1 hour 3. lack; painful 4. eye 5. postural 6. motor 7. EEG (brain activity); 10 minutes 8. 24 hours

5 functions of the funeral: 1. It helps _____ 2. It strengthens _____ _____ 3. It gives the survivors an opportunity to say... 4. It forces the realization that a loved one... (____ casket encouraged) 5. It helps put the death within a ______ context (e.g., church)

1. survivors 2. social cohesion 3. their feelings about the dead 4. is dead; open 5. meaningful

There are at least ____ million widows in U.S. At least ___ million are men At least ___ million are women

14 3 11

Külber-Ross' book (written in ____), called "______________", describes...

1969; "On Death and Dying", 5 stages of dying

Nursing Home Reform Act (NHRA): Passed in _____. Requires specific services: - Must be ____ in accordance with ____ and ____ laws. - Must have a ____ body legally responsible for _____ and the appointment of a qualified _____. - Must have 1 or more _____ on call at all times, and there must be ____ ____ ____ ____ services. - The facility must admit ____ patients without ____.

1987 - licensed; - state; local - governing - policies; administrator - physicians - 24-hour nursing care - eligible - discrimination

Hospice Care is necessary when life expectancy is less than ____ _____ (Physician ordered)

6 months

76% of widows are old people _____ years of age

65+

in the 85+ years of age __________ of women are widows and _________ of men are widows

73%; 36%

how many of the criteria for death have to be met for someone to be considered clinically dead?

8

Colette Maze of Paris, France

A classical pianist at 103 years of age; she's been playing piano for more than a century!

4 main types of Residential Care Facilities: ____________ - when a family provides care in their home to an older adult.

Adult foster care

sadness, sorrow, crying, squeezing back tears, raw emotion, anger Is what type of expression of grief?

Affective expressions of grief

refers to the principle that with appropriate services, older adults can remain in their own homes, or at least in their own communities

Aging in place

4 main types of Residential Care Facilities: ___________ - licensed and professionally managed housing complexes with independently living older adults in their own apartments, some have health services available on site.

Assisted living facilities

the view that the bereaved can continue to benefit from maintaining emotional bonds to the deceased.

Attachment view of bereavement

The ___ things to say to someone in grief: - I am so sorry for your loss. - I wish I had the right words; just know I care. - I don't know how you feel, but I am here to help in any way I can. - You and your loved one will be in my thoughts and prayers. - My favorite memory of your loved one is... - I am always just a phone call away. - Give a hug instead of saying something. - We all need help at times like this, I am here for you. - I am usually up early or late, call if you need anything. - Saying nothing, just be with the person

BEST

Person may become slow, 35 year old acting like 80 year old, whatever your bad habit is tends to increase in frequency, will be bad but usually gets back over time Is what type of expression of grief?

Behavioral expressions of grief

the process during which people cope with the death of another person.

Bereavement

Professionals whose practice and focuses on bereavement care and services to hospice and palliative care patients and families

Bereavement professionals

4 main types of Residential Care Facilities: ___________ - group living arrangements for older adults that cannot live on their own and need some nursing services.

Board and care homes

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

Olga Kotelko

Canadian Track Star

depersonalization, numbness, nothing feels real, hypersensitivity or oversensitivity to noise, confusion, disbelief, preoccupation with the dead person, attempting to make sense of the event Is what type of expression of grief?

Cognitive expressions of grief

a housing community that provides different levels of care based on the needs of the residents.

Continuing Care Retirement Communities (CCRC's, like St. James Place)

Challenges to Successful Aging 2. ____. Helps us counter ____ in our lives: - Some coping strategies are healthy, leading to ____ outcomes and ____ _____ (e.g., social support seeking; acceptance, seeing silver linings, humor). - Some coping strategies are not healthy, leading to ____ outcomes and ____ ____ (e.g., substance abuse, denial, wishful thinking, blaming others).

Coping! stress -positive; personal growth - negative; poor adjustment

__________: The absence of higher order cortical activity but lower brainstem activity persists. with this, the person might be considered a "vegetable". is not used as a legal definition anywhere in US at this time

Cortical death

_____________: The idea that death should NOT involve extreme physical dependency or the loss of control of bodily functions - Death that is allowed to occur in accordance with the wishes of a patient

Death with Dignity

Promoting successful aging requires consideration of physical variables, including: (3)

Exercise Diet Lifestyle

4 main types of Residential Care Facilities: ___________ - provide independent, private living in a house shared by several older adults.

Group homes

Promoting Successful Aging: - ____ ____: Start now! - diet - exercise - healthy lifestyle - social engagement - seek an environment that promotes healthy aging

Health promotion

medical professional who cares for a patient's spiritual needs throughout the end-of-life process

Hospice chaplains

____ + ____ + ____ + ____ = Whole Health

Me + Self-care + Professional care + Community = Whole Health

a U.S. federal law that mandated that facilities must meet physical standards, provide adequate professional staffing and services, and maintain policies governing their administrative and medical procedures:

Nursing Home Reform Act (NHRA)

______ is a medical institution that provides care in a single setting for people who need daily care and support services.

Nursing Homes

Elderly long-term care issues include: 1. _____ _____ _____ and _____ 2. The financing of ____ ____ and ____ ____ for seniors

Nursing home placements and Institutionalization mental health and medical services

Type of Care: Average Cost in Baton Rouge, LA _______________: annual rate around $66,600 ______________: monthly rate around $3,500 ____________ and ___________: per visit rate around $125 _______________: hourly rate around $20

Nursing homes: annual rate around $66,600 Assisted Living Facilities: monthly rate around $3,500 Registered Nurses and LPCs (Licensed Practical Nurse): per visit rate around $125 Home health worker: hourly rate around $20

Passed in 1990, guarantees the right of all competent adults to have an active role in decisions about their care:

Patient Self-Determination Act (1990)

Loss of appetite, trouble sleeping, weak, drained of energy Is what type of expression of grief?

Physical expressions of grief

successful aging Positive health behaviors: (5) Psychological aspects: (4)

Positive health behaviors: physical activity, exercise, diet, moderation (alcohol) and abstinence (smoking) Psychological aspects: independence, mastery/growth, positive adaptation, social interconnectedness

Challenges to Successful Aging 3. ____ - Defined as the ability to bounce back from adversity - Successful aging is about ____ and ____ ____ ____

Resilience! - resilience and adaptation to change

Academic Approaches to Successful Aging- McArthur Study of Successful Aging: ____ ____ (1997) describe three components of successful aging

Rowe and Kahn

- The world's oldest competing athlete says: "As long as I don't fail, I am a winner" - age 100

Ruth Frith of Australia

Traits you should ____ when helping someone grieve: - Supportive, but not trying to fix it. - They are about feelings. - Non-active, not telling anyone what to do. - Admitting we can't make it better. - Not asking for something or someone to change feelings. - Recognize the loss. - Not time limited.

SHOULD HAVE

the view that people's personalities influence their level of well-being throughout life.

Set point perspective

Let's look at the stress / coping dynamic more closely... ____ --> ____ --> ____

Stress --> Coping --> Resilience

Challenges to Successful Aging 1. ____ Sources of Stress in Our Lives:

Stress! - negative life events - interpersonal relationships (family, friends) - environment (job stress, co-workers)

Proposed a series of steps used to improve enforcement of nursing home quality including altering the timing of nursing home inspections to include both weekends and evenings as well as weekdays, providing more frequent inspections of previous violators, and imposing immediate ban on nursing homes found guilty of a second offense:

The 1998 Nursing Home Initiative (NHI)

Title XIX of the Social Security Act of 1965, known as ______, is a federal and state matching entitlement program that provides medical assistance for certain individuals and families with low incomes and resources.

The Medicaid Program

_______: A federal funding agency, started as title XVIII of the U.S. Social Security Act passed and signed by President Lyndon B. Johnson in 1965. Designated as ''Health Insurance for the Aged and Disabled.'' 4 basic components.

The Medicare Program

_____________: defined active aging as the process of optimizing opportunities for health, participation, and security in order to enhance quality of life as people age

The World Health Organization (WHO)

Jeanne Louise Calment

The World's Oldest Person (age 122 years, 164 days)

proposes that both practical (restorative) and emotional (loss) dimensions describe the period of adaptation to the loss of a loved one

The dual-process model of bereavement

The ___ things to say to someone in grief: - At least she lived a long life, many people die young. - He is in a better place. - She brought this on herself. - There is a reason for everything. - Aren't you over him yet, he has been dead for a while now. - You can have another child still. - She was such a good person God wanted her to be with him. - I know how you feel. - She did what she came here to do, and it was her time to go. -Be strong.

WORST

What are funerals good for?

When a person dies, a family must reorganize itself since many of the relationships were disrupted by the death. Funerals (or some sort of ritual to celebrate the life of the deceased) is a way to get life back on track for those still living

______: an approach to health care that empowers and enables YOU to take charge of your health and well-being and live your life to the fullest. From the U.S. Department of Veterans Affairs (Doka & Tucci)

Whole Health

The WHO model of active aging proposes a wide range of influences that contribute to ____ or ____ ____

active, or successful, aging.

Remember that effective stress management is all about striking a ____ in different ____ of our lives (e.g., work, home, family....)

balance; domains

What makes the dysfunctional methods of coping dysfunctional? - You're avoiding processing _____ of any sort. - When you push back these emotions, you don't allow yourself to _____. - You're delaying the ______ of grief

emotions grieve resolution

Fossil record from 70,000 years ago at the Neanderthal Burial Site in Regourdon, France shows evidence of _____

funerals

For elderly adults, death isn't a _____ _____ that doctors can fix. Instead, _____ _____ is called for, in response to age-related frailty.

medical challenge community support

Widowhood- Men _____ prone to depression than women Anniversary reactions may continue for _______ or longer

more 35 years

The maintenance of self-image despite physical limitations is called the - Older adults often maintain a positive sense of well-being despite age-related declines in health status

paradox of well-being.

An Israeli study on an older sample of adults between 75 and 94 years of age showed the effects of ____ ____ can continue for as long as ____ years, even after controlling for ____, ____, ____, and ____ status. The effect was more pronounced for ____ than ____

parental bereavement 20 age, gender, education, and widowhood mothers than fathers

Recommendations for coping with the loss: 1. Be ____ with yourself. 2. Do not be afraid or ashamed to _____ _____ _____. 3. Realize that emotional reactions to loss ____. 4. Seek to emphasize the _____ _____ you have of the deceased. 5. Share your _____ with others. 6. Take steps to maintain _____ and _____ well-being.

patient express your emotions. vary positive memories feelings physical and psychological

The 1998 Nursing Home Initiative (NHI): Proposed a series of steps used to improve enforcement of nursing home ____ including: - Altering the timing of nursing home ____ to include both _____, _____, and _____ - Providing ____ frequent inspections of previous _____ - Imposing immediate ____ on nursing homes found guilty of a ____ offense

quality - inspections - weekdays, weekends and evenings. - more - violators - ban - second

Building ____: What are the core factors? - laughter, happiness, being socially connected. - other personal and social characteristics (e.g., humor and spirituality)

resilience

The dual-process model of bereavement proposes that both practical (_______) and emotional (______) dimensions describe the period of _______ to the loss of a loved one

restorative; loss; adaptation

Traits you should ____ when helping someone grieve: - They want to fix the loss. - They are uncomfortable with our pain/discomfort. - They are directive in nature. - They rationalize or try to explain loss. - They may be judgmental. - Not about the griever. - They may minimize the loss. - Put a timeline on loss.

should NOT have

The paradox of well-being defined as: "The presence of ____ ____ ____ in the face of objective difficulties or other sociodemographic or contextual risk factors that intuitively should predict unhappiness" (Mroczek & Kolarz, 1998)

subjective well-being

A general concept related to an individual's overall sense of happiness - conceptualized into three components:

subjective well-being - Positive affect - Negative affect - Life satisfaction

________: defined as the loss of a spouse. very stressful and is the end of a relationship. happens to people of all ages, but most are _______ and ______ adults

widowhood female; older

a greater probability of death for widows than non-widowed people who are married

widowhood effect