11 terms

Ch 14: The Personal Context of Later Life andCh 15: Social Aspects of Later Life and The Final Passage: Dying and Bereavement

Chapters 14,15,and 16.
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Sociocultural Definitions of Death
Cultures differ in how they view and deal with death
Criteria for a "good" vs. "bad" death
Funeral customs
Death icons
Mourning and bereavement rituals
The "afterlife"
Think about it: in which of the following ways do you view death? Are there other ways?
Ten Different Views of Death
Death as an image or object
Death as a statistic
Death as an event
Death as a boundary
Death as a state of being
Death as a thief of meaning
Death as an analogy
Death as fear and anxiety
Death as reward or punishment
Death as a mystery
Chapter Sixteen
The Final Passage: Dying and Bereavement
16.1 Definitions & Ethical Issues: Learning Objectives
How is death defined?
What legal and medical criteria are used to determine when death occurs?
What are the ethical dilemmas surrounding euthanasia?

Sociocultural Definitions of Death
Cultures differ in how they view and deal with death
Criteria for a "good" vs. "bad" death
Funeral customs
Death icons
Mourning and bereavement rituals
The "afterlife"
Think about it: in which of the following ways do you view death? Are there other ways?
Ten Different Views of Death
Death as an image or object
Death as a statistic
Death as an event
Death as a boundary
Death as a state of being
Death as a thief of meaning
Death as an analogy
Death as fear and anxiety
Death as reward or punishment
Death as a mystery
Legal and Medical Definitions
Clinical death: lack of heartbeat and respiration traditionally signified death
Today, whole brain death is required
No spontaneous movement to stimulation
No spontaneous respiration for 1 or more hours
Lack of response to even extreme pain
No eye movements, blinking, or pupil responses
No swallowing, yawning, or vocal or postural activity
No motor reflexes
A flat EEG for at least 10 minutes
No change in any of these after a 24-hour retest
Legal and Medical Definitions (cont'd)
All eight criteria must be met
Must rule out conditions mimicking death
In most hospitals, the lack of brain activity must extend to the brainstem (vegetative functions) and cortex (higher processes)
Persistent vegetative state: irreversible lack of cortical functioning, but continued brainstem activity
Cannot be ruled dead
Presents ethical dilemmas
Ethical Issues
Bioethics: study of interface between human values and technological advances in the health and life sciences
Grew out of respect for individual freedom and the difficulty of establishing what is moral through common sense or rational argument
Decisions must
honor the importance of individual choice
weigh a treatment's relative benefit vs. harm to a patient
Euthanasia
Euthanasia: merciful ending of life
Poses the moral dilemma of deciding under which circumstances to end a person's life
Must consider the morality of "killing" a person vs. "letting" the person die
Dilemma often arises when the person
is being kept alive by a machine
suffers from a terminal illness
Active and Passive Euthanasia
Active euthanasia: deliberately ending life (e.g., by a drug overdose)
Based on person's clear statement of this desire
Made by someone in legal authority
Passive euthanasia: allowing a person to die by not giving available treatment (e.g., withholding a cancer patient's chemotherapy)
Validity of this distinction is actively debated
Both raise moral and religious concerns and are highly "political"
Active and Passive Euthanasia (cont'd)
Most Americans favor certain forms of active and passive euthanasia for patients in a persistent vegetative state
Passive euthanasia cases often end up in court
U.S. Supreme Court ruled that nourishment can be stopped only through the patient's advanced directive (e.g., via a living will or durable health care power of attorney)
Physician-Assisted Suicide
Physician-assisted suicide: physicians providing fatal medication doses to patients
Oregon and Washington passed laws allowing physician-assisted suicide that
require physicians to inform people that they are terminally ill and to describe alternative options
give people the right to self-administer lethal medication doses obtained by prescription
require people to be mentally competent, to make two oral requests separated by 15 or more days, and to make a written request
Physician-Assisted Suicide (cont'd)
When the person is terminally ill, in great pain, and has no chance of recovery, do American adults support the
patient's right to choose to die?
17% disagreed
70% of all U.S. adults and 62% of those age 65 or older were in agreement
availability of physician-assisted suicide?
Physician-Assisted Suicide (cont'd)
Physician-assisted suicide is worldwide issue
Several countries tolerate this manner of suicide (e.g., Switzerland, Columbia, Belgium)
Holland's Supreme Court stipulated conditions under which physicians cannot be prosecuted for assisting
Making End-of-Life Intentions Known
Living will: stating one's wishes about life support and other treatments
Durable power of attorney for healthcare: person appoints someone to act as an agent for his/her healthcare decisions
Both serve to clarify one's wishes about
life-support interventions when the person is unconscious or otherwise incapable of expressing wishes
organ donation and other healthcare options
Making End-of-Life Intentions Known (cont'd)
Do not resuscitate (DNR): should the heart or breathing stop, there is to be no cardio or pulmonary resuscitation
Inform medical personnel that you have a DNR
Let your relatives know what your wishes are and where you keep all relevant documents

16.2 Personal Aspects of Thinking about Death: Learning Objectives
How do feelings about death change over adulthood?
What legal and medical criteria are used to determine when death occurs?
How do people deal with their own death?
What is death anxiety, and how do people show it?
How do people deal with end-of-life issues and create a final scenario?
What is hospice?
A Life-Course Approach to Dying
The shift from formal-operational to postformal thinking presumably helps young adults integrate feeling and emotions with their thoughts about death
May lessen feelings of immortality
Their parents' death helps middle-aged adults think about their own death
May lead to occupational changes or improving relationships
A Life-Course Approach to Dying (cont'd)
Older adults are generally less anxious about death and accept it more; partly due to
achieving ego integrity
less joy about living due to health declines
greater acceptance of their mortality
Young-old adults feel the most death anxiety because of the higher desired vs. expected discrepancy in number of years left to live
Attachment theory is the best framework for understanding how adults deal with death and how they grieve
Dealing with One's Own Death
Dying "trajectories" vary across diseases causing different reactions to impending death
Diseases such as cancer may have a terminal phase in which a patient may be able to predict and prepare for death
Some diseases that do not have a terminal phase may create a condition in which a person's death could occur at any time

Kübler-Ross's Theory
Elisabeth Kübler-Ross pioneered stages in the dying process beginning with her 1960s' interviews with terminally ill patients, who
were not always told they were dying, because death was not generally a topic of discussion
experienced five distinct emotional reactions
In fact, the five reactions can overlap, unfold in different sequences, plus there are individual differences in each stage's duration and each emotion's intensity
Kübler-Ross's Stages of Dying
Denial - shock, disbelief
Anger - hostility, resentment ("Why me?")
Bargaining - looking for a way out
Depression - no longer able to deny, patients experience sorrow, loss, guilt, and shame
Acceptance - acceptance of death's inevitability with peace and detachment
Discussion of death helps to move toward acceptance

A Contextual Theory of Dying
Stage theories do not state what moves a person through the stages
There is no single correct way to die
People vary in how they approach Corr's four "tasks" or issues for the dying
Bodily needs
Psychological security
Interpersonal attachments
Spiritual energy and hope
Death Anxiety
Death anxiety: diffuse anxiety about death
Terror management theory: our deeply rooted fear of mortality makes not dying the primary motive underlying all behaviors (e.g., taking care of ourselves, having & raising children properly)
Older adults represent existential threats to younger and middle-aged adults
Remind us of mortality, infallible bodies
Remind us that ways in which we secure self-esteem (and manage death anxiety) are transitory
Death Anxiety (cont'd)
Death anxiety consists of several components
Body malfunction, pain, being destroyed, nonbeing, interruption of goals, punishment, humiliation, rejection, and negative impact on survivors
Each is represented at public, private, and unconscious levels
Our public admission of death anxiety may differ greatly from our private or unconscious thoughts and feelings
Death Anxiety (cont'd)
Older adults may have less death anxiety because of their
greater ego integrity
tendencies to engage in life reviews
different time perspectives
higher religious motivation
Men have more death anxiety than women
Women are more fearful of the dying process

Learning to Deal with Death Anxiety
Enjoy what you do have without many regrets
Adolescent risk-taking is correlated with less death anxiety
Increasing one's death awareness (e.g., writing one's obituary, planning one's funeral)
Death education can significantly reduce fear
Presents factual information about death, dying, and advanced directives; increases sensitivity to others dealing with death
Creating a Final Scenario
End-of-life issues: discussing and formalizing management of life's final phases, after-death disposition of one's body, and lawful distribution of assets (e.g., through a will)
Baby-boomers are far more proactive and matter-of-fact about these issues
Final scenario: making one's choices known and providing information about how one wants his/her life to end, including the process of separating from family and friends
Healthcare workers help dying patients create a final scenario
The Hospice Option
Hospice: assisting dying people with pain management and a dignified death (as opposed to hospitals or nursing homes)
Hospices provide palliative care: focused on relief from pain or other disease symptoms
Hospices emphasize quality of life
Hospice's goal is to make the person comfortable and peaceful, but not to delay an inevitable death

The Hospice Option (cont'd)
St. Christopher's Hospice in England was founded by Dr. Cicely Saunders and is the model for modern hospices
When no treatment or cure is possible, hospice care is requested; the family and the patient are viewed as a unit.
May be inpatient or outpatient
An emphasis is placed on patient dignity
Hospice clients are more mobile, less anxious and depressed, visited often by families who take a greater part in the care
The Hospice Option (cont'd)
Questions to ask before opting for hospice care
Does the person know his/her condition's nature and prognosis?
What options are available to treat the person's current degree or type of disease?
What are the patient's expectations, fears, and hopes?
How well do the people in the person's social network communicate?
Are family members available to actively provide terminal care?
Is a high-quality hospice care program available?
16.3 The Grieving Process: Learning Objectives
How do people experience the grief process?
What feelings do grieving people have?
What is the difference between normal and complicated or prolonged grief disorder?
The Grieving Process
Bereavement: the state or condition caused by loss through death
Grief: the sorrow, hurt, anger, guilt, confusion, and other feelings that arise after suffering a loss (varies greatly)
Mourning: culturally approved ways in which grief is expressed (fairly standard within a culture)

The Grieving Process (cont'd)
Grief involves choices in how we cope and actively involves
acknowledging the loss's realty
working through the emotional turmoil
adjusting to an environment where the deceased is absent
loosening ties to the deceased
Grief is a process in which
no two people grieve alike
we must not underestimate how long people need to deal with various issues (at least 1 year is needed and 2 years are not uncommon)
we learn to live with the loss and move on, rather than "recovering" from it
Risk Factors in Grief
Purported risk factors are kinship relationship, social support, mode of death, age, personality, religiosity, and gender
Church attendance and spirituality may help coping
Older people suffer fewer health problems, but social support reduces this age effect
Anticipatory grief: going through a period of anticipating a loved one's death, which supposedly buffers its impact
Helps those who disengage from the dying person
Risk Factors in Grief (cont'd)
When the mode of death is sudden, a strong attachment increases grief, but lessens guilt because of fewer unresolved issues
Effects of kinship relationship?
Grief is greatest when children die, followed by spouses and a parent
Social support and mastery are more helpful for older than middle-aged adults
Normal Grief Reactions
Grief reactions vary in intensity, such as sadness-anger-hatred, confusion-helplessness-emptiness, loneliness-acceptance-relief
Most common are sadness, denial, anger, loneliness, and guilt
Grief work: psychological facets of coming to terms with bereavement
People need space and time, and others should give them these
Normal Grief Reactions (cont'd)
Five themes of grief
Coping: things people do to deal with grief
Affect: emotional reactions and triggers
Change: how life changes, including growth
Narrative: survivors' stories about deceased
Relationship: kind of person the deceased was and survivor's ties with him/her
Anniversary reaction: sadness-related behaviors seen on the anniversary of the death, including dates of natural disasters
Normal Grief Reactions (cont'd)
Physiological reactions to grief?
Widows: sleep, neurological, and circulatory problems
Illness, declining physical health and use of services
Severe depression in some cases, which SSRIs can help

Normal Grief Reactions (cont'd)
Expressions of grief differ with ethnicity and culture
Ex.: Latino- more than European-American men express grief behaviorally
Some cultures construct a "relationship" with the deceased (e.g., "ghosts," appearances in dreams)
Grief normally peaks 6 months after death, but can continue 5 and even 50 years later

Coping with Grief
Two integrative approaches to grieving
Four-component model
The context of the loss
The continuation of subjective meaning associated with loss
The changing representations of the lost relationship over time
The role of coping and emotion-regulation processes
Coping with Grief (cont'd)
Dual-process model (DPM)
Loss-oriented stressors - stressors related to the loss itself (e.g., grief work)
Restoration-oriented stressors - stressors present when adapting to the survivor's new life situation (e.g., finding new relationships and activities)
Dynamic process in which bereaved cycle back and forth between the two processes, ultimately balancing the two

Four-Component Model
Two implications of four-component model
Need to make meaning from the loss
Extensive grieving is helpful, whereas avoiding grieving is harmful
Grief work as rumination hypothesis: extensive rumination may actually increase distress
Rumination is a form of avoidance (person is not dealing with real feelings or moving on)
Chronically elevated depression is positively correlated with rumination 6 months post-loss
Resilient people use effective coping methods, such as automated processes (distraction, attending to positive emotions)
Complicated or Prolonged Grief Disorder
Two types of distress distinguish this disorder from normal grief and depression
Separation distress: isolation; preoccupation with, upsetting memories of, longing and searching for the deceased to the point of interfering with everyday functioning
Traumatic distress: disbelief and shock about the death, experiencing the deceased's presence; mistrust, anger, and detachment from others
Complicated or Prolonged Grief Disorder (cont'd)
Sufferers from complicated grief report symptoms distinct from those associated with depression or anxiety
Avoiding reminders of the deceased
Diminished sense of self
Difficulty accepting the loss
Feeling angry or bitter
Increased morbidity, smoking, and substance abuse
Difficulties in family or social relationships
16.4 Dying and Bereavement Experiences Across the Life-Span: Learning Objectives
What do children understand about death? How should adults help them deal with it?
How do adolescents deal with death?
How do adults deal with death? What are the special issues they face concerning the death of a child or parent?
How do older adults face the loss of a child, grandchild, or partner?
Childhood
Preschoolers: death is temporary and magical
5-7 years: death is permanent, it eventually happens to everyone, and is less scary; reflects the shift to concrete-operational thought
Typical reactions to death in childhood are regression, guilt for causing it, denial, displacement, repression, and wishful thinking about the deceased's return
Older children: problem-focused coping and a better sense of personal control appears
Children flip back and forth between grief and normal activity

Childhood (cont'd)
With adequate and loving care, support, and reassurance that it's ok to grieve, childhood bereavement usually has no long-lasting effects (e.g., depression)
Being open and honest reduces children's difficulty with the concept of death
The use of euphemisms such as "gone away" or "only sleeping" can confuse and cause literal interpretation
Researchers believe attending a funeral or having a private viewing aids recovery
Adolescence
40-70% experience the loss of a family member or friend during the college years
Their first experience of death is particularly difficult and its effects severe, especially if unexpected
Chronic illness, lingering guilt, low self-esteem, poorer school & job performance, substance abuse, relationship problems, and suicidal thinking
Adolescence (cont'd)
Adolescents try to find ways of keeping a dead sibling in their lives
They continue to miss and love them
Grief does not interfere with normative developmental processes
They experience continued personal growth similar to nonbereaved adolescents
Adulthood
Young adults may feel that those who die at this point are cheated out of their future
Also made difficult when peers ignore their grief, tell them that grieving is not good, or to get on with their lives
Loss of a partner in young adulthood is very difficult because the loss is so unexpected and grief can last for 5-10 years
Losing a spouse in middle adulthood results in challenging basic assumptions about self, relationships, and life options
Death of One's Child in Young and Middle Adulthood
Mourning is intense; some never reconcile the loss, and parents may divorce
Young parents who lose a child to SIDS report high anxiety, more negative view of the world, and guilt
Loss of a child during childbirth is traumatic due to strong attachment, even though society expects a quick recovery
Middle-aged parents' loss of a young adult child is equally devastating, causing anxiety, problems functioning, and difficulties in relationships with surviving siblings upwards of 13 years later
Death of One's Parent
When a parent dies, the loss hurts but also causes the loss of a buffer between ourselves and death; we may feel that we are now next in line.
Death of a parent may result in a loss of a source of guidance, support, and advice
The loss of a parent may result in complex emotions including relief, guilt, and a feeling of freedom
Important to express feelings for parents before they die
Losing a parent due to Alzheimer's disease may feel like a second death
Late Adulthood
Older adults are often less anxious about death and more accepting of it
Elders may feel that their most important life tasks have been completed
Older adults are more likely to have experienced loss before

Death of One's Child or Grandchild in Late Life
Older bereaved parents may feel guilty about how their pain about losing one child affected relationships with surviving children
Many grieving parents report that the relationship with the deceased child was the closest they ever had
Bereaved grandparents tend to hide their grief behavior in an attempt to shield the grieving parents from more pain
Death of One's Partner
U.S. society expects the surviving spouse to mourn briefly, but older bereaved spouses may grieve for 30+ months
A support system's helpfulness depends on
whether the bereaved wants contact
who is willing to provide support
whether the support is of high quality
Depressed survivors' memories of the relationship are positively biased, whereas those of the non-depressed are more negative (may reflect pre-death quality of the relationship)

Death of One's Partner (cont'd)
European-American wives who highly value this role "sanctify" their dead husbands
Helps the widow believe the marriage was strong and that she is a good & worthy person who can rebuild her life
Reduced hopelessness, intrusive thoughts, and obsessive-compulsive behavior occur when older bereaved spouses actually express their feelings
Cognitive-behavior therapy helps coping and making sense of the loss
Gays and lesbians experience grief plus negativity from the deceased's family members
n/a
Chapter Fifteen
Social Aspects of Later Life: Psychosocial, Retirement, Relationship, and Societal Issues
15.1 Theories of Psychosocial Aging: Learning Objectives
What is continuity theory?
What is the competence and environmental press model, and how do docility and proactivity relate to the model?

Continuity Theory
Continuity theory: people use familiar remembered strategies to cope with daily life
Too little continuity promotes a feeling that life is unpredictable
Too much continuity promotes boredom
Optimal continuity allows for challenges and interest without being overwhelming

Continuity Theory (cont'd)
Memories of the past concern two types of continuity
Internal: personal identity (e.g., skills experiences, emotions)
Its continuity aids feelings of competence, mastery, ego integrity, and self-esteem
External: physical and social environments, relationships, activities
Familiar environments increase this continuity
Competence-Environmental Press Model
Competence: upper limit of physical health, ego strength; sensory-perceptual, motor, and cognitive skills
Environmental press: physical, interpersonal, or social demands of the environment
Each person experiences different degrees or types of competence, environmental presses, and their combination
Adaptive behavior results when a person's competence fits environmental demands
Competence-Environmental Press Model (cont'd)
Adaptation level: point at which the press level is average for a particular level of competence
Zone of maximum performance potential: point at which slight increases in press level improve performance
Zone of maximum comfort: point at which slight decreases in press level maximize life quality, adaptive behavior, and positive affect

Competence-Environmental Press Model (cont'd)
Changes in combinations of competence and environmental presses can lead to
proactivity (choosing new behaviors to exert control over the changes)
often results when people are high in competence
docility (allowing the situation to dictate one's options when the changes occur)
often results when people are low in competence
15.2 Personality, Social Cognition, & Spirituality: Learning Objectives
What is integrity in late life? How do people achieve it?
How is well-being defined in adulthood? How do people view themselves differently as they age?
What role does spirituality play in late life?

Integrity vs. Despair
Life review: reflecting on experiences and events of one's lifetime
Can promote either integrity or despair (Erikson's 8th stage)
Integrity: feeling good about one's past choices, coming to terms with one's death; judging one's life to have been meaningful and productive
Self-acceptance and self-affirmation result from reaching integrity
Despair: externalizing one's problems; feeling a sense of meaninglessness
Well-Being and Social Cognition
Subjective well-being: the positive feelings that can result from certain life evaluations
Increases with age
Varies with one's marital status, hardiness, social network quality, chronic illness, and stress
Older women may experience less subjective well-being than men
Why? Society less enables them to control these factors
Recent societal changes have reduced this gender difference

Well-Being and Social Cognition (cont'd)
Why does subjective well-being increase with age?
Amygdala activation and emotional arousal are lower in older adults
Older adults' prefrontal cortex may help them better regulate negative emotions or reappraise them as less negative
Declining cognitive ability (e.g., due to dementia) undermines this effect

Religiosity & Spiritual Support
Religious faith and/or spirituality are important means by which older people cope with life
Stronger in some ethnic groups (e.g., African Americans) than others
Spiritual support: seeking pastoral care, faith in a God who cares for people; participation in organized or nonorganized religious activities
Improves self-worth, coping; psychological and physical heath; reduces stress
Religiosity & Spiritual Support (cont'd)
Older adults describe turning problems over to God as a three-step process
Separating what can vs. cannot be changed
Focusing on problems that can be changed
Disconnecting emotionally from unchangeable problems, but focusing on God providing the best outcome for those
Changes in brain activity occur during meditation, such as
less activity in areas focusing on the self
more organized attention
15.3 Living in Retirement: Learning Objectives
What does being retired mean?
Why do people retire?
How satisfied are retired people?
How do retirees keep busy?

What Does Being Retired Mean?
20%+ of people 65 or older are still in the workforce, which is more than ever
People associate retiring with losing occupational identity, instead of what it may add to their lives
Retirement is best viewed as a transition involving sudden ("crisp") or gradual ("blurred") withdrawal from full-time employment
Only ≤ 50% of men fit the crisp pattern and many hold bridge jobs (ones in between end of primary job and full retirement)
Bridge jobs increase satisfaction both with retirement and one's overall life
Why Do People Retire?
Today, more people retire by choice than for any other reason
Most retire when they feel they are financially secure
Some retire when physical health problems interfere with work
Today's economic climate is forcing many to retire even though they may not wish to

Gender Differences
Compared to men, women
enter the workforce later, have more interruptions in their work history, and generally have less retirement income due to lower wages
rarely have their own sources of retirement income if they were never employed outside of the home
spend less time planning for retirement
are likelier to continue working part-time after retiring
Ethnic Differences
Little research has studied ethnic differences in the retirement process
African Americans are likely to continue working beyond age 65
There are no gender differences in their health following retirement

Adjustment to Retirement
Adjustment to retirement improves when
one has a high sense of personal control and internal motivation, plus good physical health, financial security, social support, and feelings about retiring
men have positive resources in later life, despite having earlier disadvantages
older men endorse nontraditional gender roles
decisions to retire are voluntary
neither partner influenced the retirement decision
husbands did not influence their wives' decision
Keeping Busy in Retirement
National organizations advocate for retirees' interests and suggest many activities
Ex.: American Association of Retired Persons (AARP)
Retirees volunteer and find ways to provide service
Volunteering will rise in the future due to older adults' increasingly higher education levels
Volunteering benefits well-being by improving communities, maintaining social interactions, and staying active
15.4 Friends & Family in Late Life: Learning Objectives
What role do friends and family play in late life?
What are older adults' marriages and same-sex partnerships like?
What is it like to provide basic care for one's partner?
How do people cope with widowhood? How do men and women differ?
What special issues are involved in being a great-grandparent?
What Role Do Friends and Family Play in Late Life?
Social convoy: how a group of people journey with us through our lives, providing support in good and bad times
Provides a protective, secure cushion so the person can explore and learn about the world; affirms who one is and means to others
Can increase mental health and well-being
Its size and provision of support does not differ across generations
Is especially important to African Americans and immigrants
Friends and Siblings
Later-life friendship patterns resemble those of young adulthood, including online friendships
Older adults have fewer relationships and develop fewer new ones, but this is a decreasing trend in recent cohorts
Socioemotional selectivity: friendships formed based on goals, such as information seeking, self-concept, and emotional regulation, with each goal resulting in different behaviors and of varying importance at different times
Sibling Relationships
Sibling relationships are more important later in life
Key predictors of sibling closeness are
genetic relatedness
health
presence of other relationships
proximity to each other

Marriage and Gay and Lesbian Partnerships
Older couples
report more positive behaviors in their spouses
are less likely to to perceive events or partners negatively
have reduced marital conflict
have similar mental and physical health
Satisfaction increases in older couples who had children, but decreases in those who did not
Marriage and Gay and Lesbian Partnerships (cont'd)
Older couples show fewer gender differences in sources of pleasure
Household chores are divided more equally after husbands retire
Marriage helps people cope better with chronic illness, functional problems, and disabilities
Extant data shows no differences in relationship quality between heterosexual compared to gay or lesbian couples
Caring for a Partner
Caring for a chronically ill partner is more stressful and challenging than caring for a chronically ill parent
Division of labor must be readjusted
Marital satisfaction and depression decrease as a partner's symptoms and/or their severity increase (e.g., Alzheimer's)

Caring for a Partner (cont'd)
Higher prior marital satisfaction helps buffer caregivers from depression
Caregivers' perceived competence promotes proactivity rather than docility
After one month, caregivers remember only about 2/3 of major hassles
Professionals' diagnostic judgments should not rely solely only on caregiver reports
Widowhood
A partner's death is one of the most traumatic experiences for a living partner
whose own risk of dying lasts for 10 years
whose death risk exists for European but not African Americans
who experiences extreme loneliness and may lose friendships or family support
When 65 or older, more than 50% of women, but 15% of men lose spouses or partners due to death
Widowhood (cont'd)
Widowers recover more slowly than widows,
a difference that may partly be due to their typically older age
especially without a strong support system
because they are not used to doing household tasks
Widowers, nonetheless, have greater opportunity than widows to form new heterosexual relationships

Widowhood (cont'd)
Widows suffer in other ways, such as being less financially secure due to benefits being only half of a husband's pension
Widows are likelier to form close friendships than are widowers
Some widowed people cohabit or remarry
due to need for companionship and financial security
but they do experience obstacles (e.g., family resistance, pressures to protect one's estate)
Great-Grandparenthood
More people today are becoming great-grandparents, especially women
Three important aspects of great-grandparenthood are
feeling a sense of personal and family renewal
providing new diversions and a positive new role
experiencing a major milestone of longevity, which is usually viewed positively
15.5 Social Issues & Aging: Learning Objectives
Who are frail older adults? How common is frailty?
What housing options are there for older adults?
How do you know whether an older adult is abused or neglected? Which people are most likely to be abused and to be abusers?
What are the key social policy issues affecting older adults?
Frail Older Adults
Frail older adults: having physical disabilities, cognitive and/or psychological disorders; being very ill
40% of people over 65 have some kind of functional limitation
Activities of daily living (ADLs): basic self-care tasks (e.g., eating, bathing, dressing, walking)
Instrumental activities of daily living (IADLs): tasks requiring intellectual competence and planning
These vary cross-culturally

Prevalence of Frailty
Frail older adults are prone to anxiety and depression disorders, especially if in a long-term care facility
Need for assistance ...
increases with age
females > males in all ethnic groups
rate in Americans is African > European > Latino > Asian
rate is unknown for Native Americans


Housing Options: Living Arrangements
Household: a person who lives alone, or a group of people living together
65 years+: 20% of households
60 years+: 33% of households
Functional health: ability to perform ADLs and IADLs
determines which setting is optimal for the person

Independent Living Situations
Sense of place: a person's cognitive and emotional attachments to his/her place of residence
Most older adults do not wish to move in with family or friends
Most older adults do not prefer assisted living or nursing homes
Home modifications — major or minor— can allow older adults to continue living in their home
Assisted Living
Assisted living facilities: for those with ADL or IADL limitations, but who do not need 24-hour care due to physical or cognitive impairments
Do not provide 24 x 7 medical care
67% in these facilities are 65 or older and have one or more of these limitations
50% have a memory impairment
Nursing Homes
Nursing homes
provide 24 x 7 medical care
house 5% of U.S. older adults
house 15% of those over 85
are evaluated carefully through the Nursing Home Quality Initiative
The Eden Alternative, Green House Project, and Cohousing Initiatives
The Eden Alternative seeks to eliminate loneliness, helplessness, and boredom
The Greenhouse Project seeks to create small homes for 6-10 residents; blend into neighborhood housing; and provide personal and professional care
Cohousing is a planned community that values personal autonomy, fosters social interaction, and is modest in size; built around open, walkable space

Elder Abuse and Neglect
Seven different types of elder abuse
Physical
Sexual
Emotional or psychological
Financial or material exploitation
Abandonment
Neglect
Self-neglect
Determining whether and how much elder abuse occurs varies considerably with ethnicity-related cultural values
Prevalence
The most common types of abuse
Neglect - 60%
Physical abuse - 16%
Financial or material exploitation - 12%
5 million people are victims of elder abuse
Authorities learn about only 1 in 6 cases

Risk Factors
Results are conflicting, but some studies show abuse or neglect to be inflicted
2/3 of the time by family members
at other times by care providers, trusted people (e.g., bankers, clergy), and telemarketers or investment schemes
Causes of being victimized
poverty, family problems, social isolation
victimizer dependency on the victims (usually financial) or desire for financial gain
victimizer retribution (for spousal abuse)
victimizers gaining a sense of control or power
Social Security and Medicare
In the 1950s, roughly 35% of older adults fell below the federal poverty line
In 2008, about 10% fell below this line
Yet older adults may need 200% of the current federal poverty limit to cover basic expenses and healthcare
By 2039, Social Security and Medicare will consume 50% more of our GDP than in 2010
Social Security
In 1935, Franklin D. Roosevelt created Social Security to supplement older people's savings and other types of support
Today, after retirement, it is the primary source of financial support for retired people
Yet government reforms may force people to rely on other means
By the time baby-boomers retire, 2x more people will be collecting Social Security
A diminishing working population soon will generate insufficient payroll taxes to fund it

Social Security (cont'd)
Reforming Social Security could involve
privatization (e.g., retirement accounts)
means-test benefits
increasing years used to compute benefit
increasing retirement age
downwardly adjusting cost-of-living increases
increasing payroll taxes
increased earnings caps on SS payroll taxes
across-the-board SS pension benefit decreases
Medicare
Medicaid is federally funded healthcare for the poor; supplemental or "medigap" insurance policies help with out-of-pocket expenses
Medicare is federal medical insurance funded by payroll taxes
To be eligible, a person must be over 65, be disabled, or have permanent kidney failure
40 million currently depend on it
Faces many challenges and possible cuts due to increasing numbers of elderly
Medicare (cont'd)
Medicare coverage exists in four parts
Part A: inpatient hospital services, skilled nursing facilities, home health and hospice care
Part B: cost of physicians, outpatient services, medical equipment, and other health supplies
Part D: some prescription costs
Part C: supplemental Medicare-approved coverage ("Medicare Advantage")
adds coverage for Parts A, B, and usually Part D
n/a
Chapter Fourteen
The Personal Context of Later Life: Physical, Cognitive,and Mental Health Issues
14.1 What Are Older Adults Like? Learning Objectives
What are the characteristics of older adults in the population?
How long will most people live? What factors influence this?
What is the distinction between the third and fourth age?
The Demographics of Aging
Demographers study population trends
Demographers use population pyramids to illustrate these trends
The number of older adults in developed nations greatly increased in the 20th century and will increase even more by 2050
The number of older Asian-, Native-, and especially Latino-Americans is high now and will continue to increase
The number of U.S. people over 85 will increase by 500% between 2000 and 2050


The Diversity of Older Adults
U.S. older women outnumber older men
True of all ethnic groups
As of today, 50% of people over 65 have high school diplomas
10% currently have college degrees
75% will have college degrees by 2030
Better educated people live longer due to higher incomes, giving them better healthcare access

Longevity
Longevity: number of years a person can expect to live
Maximum life expectancy: oldest age to which any person lives (circa 120 years)
Useful life expectancy: number of years a person is expected to live free from debilitating chronic disease
Average life expectancy: age at which half of the people born in a particular year will die
In the U.S., it is
80.4 years for women
75.4 years for men
Genetic and Environmental Factors in Life Expectancy
Heredity is a major factor in longevity
Particularly true for those over 100
Environment plays a role through the effects of disease, toxins, and risky behaviors
Social class plays a role due to lack of access to health care
The U.S. healthcare system is broken, especially for older adults (cf. Healthy People 2020)
Ethnic and Gender Differences in Life Expectancy
Average life expectancy is Latin Americans > European Americans > African Americans
Latin Americans live longer than European Americans at all ages
European Americans live longer than African Americans especially before the age of 65
May reflect differential healthcare access
However, African Americans live longer than European Americans after age 85

Ethnic and Gender Differences in Life Expectancy (cont'd)
U.S. women live longer than men by 5 years at birth, but only 1 year by age 85
Why? Multiple explanations, such as
men being more susceptible to fatal infectious diseases
genetic differences between genders
complex interactions of lifestyle, genetics, and immune functioning differences
By age 90, however, men outperform women on cognitive tests
International Differences in Longevity
Longevity differs greatly across countries, e.g.,
38 years in Sierra Leone
82+ years in Japan
Genetic, sociocultural, economic, healthcare factors, and disease contribute to these differences


The Third-Fourth Age Distinction
Third age: ages of 60-80 (aka the young-old)
Knowledge and technological advances contribute to their better life quality
Fourth age: over 80 (aka the oldest-old)
Few interventions have been developed to reverse this group's physiological, cognitive, and disease-related declines

The "Good News": The Third Age (Young-Old)
Increased life expectancy
Improved physical and mental fitness
High emotional and personal well-being
Good strategies to master life's losses or gains


The "Bad News": The Fourth Age (Oldest-Old)
Sizeable losses in cognition and learning potential
Increases in chronic stress's negative effects
High prevalence of
dementia (50% in those over 90)
frailty and multiple chronic conditions
14.2 Physical Changes and Health: Learning Objectives
What are the major biological theories of aging?
What physiological changes normally occur in later life?
What are the principal health issues for older adults?

Biological Theories of Aging
"Damage or error" and "programmed" theories are two types of biological explanations for aging
Four "damage or error" theories
(1) Wear-and-tear theory: body simply wears out and deteriorates
Fails to explain most aspects of aging
(2) Free radicals: cellular damage is caused by chemicals bonding to cells' insides
Antioxidants (e.g., vitamins A, C, & E) postpone only some aging effects, but do not increase longevity
Biological Theories of Aging (cont'd)
(3) Cellular theories: multiple processes include
harmful substances build up
cells cannot replicate because
they can divide only so many times (Hayflick limit)
chromosomes' telomeres become shorter and stress-prone
aerobic exercise may maintain telomeres' length
(4) Cross-linking: certain proteins make muscles and arteries less flexible
Little support
Biological Theories of Aging (cont'd)
Programmed theories
Genetically programmed cell death
Clocklike changes in
hormones
immune system decline
innate tendency of cells to self-destruct
dying cells triggering certain processes
Physiological Changes
Neuronal changes are common in older age
Alzheimer's and related diseases involve large changes in
declining neurotransmitters levels
neuritic plaques: damaged or defective neurons collect and form around a core of protein
neurofibrillary tangles: spiral-shaped masses form in the axon's fibers
interferes with signal transmission

Physiological Changes (cont'd)
Neuroimaging is used to assess abnormal and normal age-related declines in cognitive functioning
Structural imaging: X-rays, CT scans, and MRIs are used to study brain anatomy
Functional neuroimaging: SPECT, PET, fMRI, and MIRSI are used to measure brain activity
Measuring neurotransmitter declines
Cardiovascular and Respiratory Systems
Normative age-related changes include
declining heart muscle tissue; fat deposits in and around the heart and/or arteries
the heart pumps 30% less blood by the late 70s-80s
artery stiffening due to calcification
increase in stroke risk
50% of adults over 65 have hypertension
African Americans have higher death rate due to these problems
because of poor healthcare access
Cardiovascular and Respiratory Systems (cont'd)
Transient ischemic attacks (TIAs): interruptions of blood flow to the brain that may forewarn a stroke
Cerebral vascular accidents (CVAs): strokes reflecting reduced blood flow to the brain due to blockages or hemorrhages
Vascular dementia: small cerebral vascular accidents causing dementia
Progresses slowly, but can have sudden onset
Symptoms are hypertension, MRI alterations, impaired neuropsychological test performance
Cardiovascular and Respiratory Systems (cont'd)
Air intake in one breath drops 40% between 25 to 85 years of age
Chronic obstructive pulmonary disease (COPD): emphysema, asthma, and related breathing diseases
the most common forms of respiratory disease
may result in depression, anxiety, and the continual need for external sources of oxygen
Parkinson's Disease
Slow hand tremors, shaking, rigidity, walking problems; difficulties getting in and out of a chair
Cause? Deteriorating dopamine production in the midbrain
30-50% of sufferers develop cognitive impairments and eventually dementia
Symptoms are treated by
drugs that raise dopamine or aid its delivery to the brain
neurostimulators
Sensory Changes
Many accidents occur due to age-related sensory changes
Sometimes preventable via environmental changes and exercise
Vision Changes
As we age, less light passes through the eye
Results in night vision problems and the need for increased light for reading
Decreased adaptation
Difficulty adjusting to light-to-dark changes and vice versa
Sensory Changes: Vision (cont'd)
Poorer green-blue-violent color discrimination due to yellowing of the lens
Difficulties focusing and adjusting because muscles around lens stiffen
Loss of acuity between 20 to 60 years, especially with low light
Takes more time to adjust to distance changes
Higher risk for diabetes-related retinal changes and macular degeneration
Vision loss due to cataracts (opaque spots in the lens of the eye) or glaucoma (increase in the eye's fluid pressure)
Sensory Changes: Hearing
Hearing loss is one of the most common normative changes in older adults (especially for high pitches)
A person of any age can lose hearing after routine exposure to loud sounds
Includes the sound levels that young people routinely hear while wearing earbuds or headphones
Presbycusis: losing the ability to hear low-pitched sounds
Caused by the cumulative effects of noise exposure and age-related changes
Sensory Changes: Hearing (cont'd)
Four changes in the ear cause this inability to hear low-pitched sounds
(1) Neural: loss of auditory pathway neurons
Also affects speech understanding
(2) Metabolic: diminished nutrient supply to receptor cells
Also lose sensitivity to all pitches
(3) Mechanical: atrophy and stiffening of the receptor area's vibrating structures
Loss of all pitches, but especially high ones
(4) Sensory: atrophy and degeneration of receptor cells
Few additional side effects

Sensory Changes: Hearing (cont'd)
Hearing loss does not cause social or emotional maladjustment, but it
can elicit adverse emotional reactions (e.g., irritation, depression)
can negatively affect how the person feels about interpersonal communication due to family's and relatives' impatience about needing to repeat themselves
Hearing loss can be helped through
amplification (e.g., analog or digital aids)
cochlear implants that stimulate auditory nerve fibers
Sensory Changes: Other Senses (cont'd)
Taste, touch, temperature, and pain sensitivity are not significantly age-related
Detecting and distinguishing smells declines substantially in many after the age of 70
Very true of Alzheimer's disease
Very dangerous (e.g., gas leaks)
Older people fall more often due to changes in balance, eyesight, hearing, muscle tone, reflexes
Health Issues
Older adults take 2x longer to fall asleep, sleep less, and have sleep-related problems, e.g.,
disrupted circadian rhythms (sleep-wake cycles), which timed exposure to bright light can help
depression; sleep problems exacerbated by physical disease (e.g., heart or lung disease, diabetes, obesity)
Older adults' nutritional deficits are due to poor care or the body less efficiently extracting nutrients
Cancer increases with age; screening is imperative
Unhealthy lifestyles do not fully explain age-related cancer increases

Immigrant Status
After SES is controlled, immigrants show poorer health than U.S.-born people of the same ethnicity
However, immigrants with excellent child relationships do have fewer chronic illnesses
Language, cultural, misdiagnosis, and structural (e.g., health insurance) barriers interfere with them obtaining adequate healthcare
These same barriers may explain higher rates of depression in older immigrant Mexican Americans
These barriers do not exist for Canadian immigrants
14.3 Cognitive Processes: Learning Objectives
What changes occur in information processing as people age? How do these changes relate to everyday life?
What changes occur in memory with age? What can be done to remediate these changes?
What is creativity and wisdom, and how do they relate to age?
Information Processing
Psychomotor speed: how quickly a person reacts to make a specific response
Predicts performance on cognitive tasks requiring little effort
Slows with age in all situations, but especially in ambiguous ones
Occurs because older adults take longer to decide whether they need to respond
May explain higher driving fatality rates in very old people
Due to declines in the brain's white matter (mostly myelinated axons) that aid faster neural transmission
Information Processing (cont'd)
Various tests predict whether drivers should be allowed to continue to drive
Useful field of view (UVOF): tests information-processing speed, simultaneous monitoring of central and peripheral stimuli; extraction of relevant information from irrelevant background information
Clock drawing test: how well people reproduce various clock faces from memory
AAA's "Roadwise Review": assesses eight functional areas, e.g., leg strength, head and neck flexibility, visual acuity, working memory
Working Memory
Working memory: processes and structures involved in holding information in mind and simultaneously using it in problem-solving, decision-making, and learning
Small in capacity
Without continued attention or rehearsal, the information is "lost"
Declines with age
Poorer working memory and psychomotor speed predict age-related declines in cognitive performance
Memory
Some psychologists distinguish explicit from implicit memory
Different brain regions are involved in each
Normal aging processes, brain trauma, and disease (e.g., Alzheimer's) affect each differently
The basic distinction
Explicit memory: conscious and deliberate memory for previously learned information
Implicit memory: unconscious and automatic (non-deliberate) memory about previously learned information as seen through one's behavior or reactions
Memory (cont'd)
Explicit memory is also called "declarative" memory ("knowing that ...")
We can "declare" these memories using language
Ex.: recalling a song's lyrics or everything you read on the previous slide
Two types of explicit memory
(1) Semantic memory: remembering the meaning of words and concepts; recalling facts not tied to a specific event or time (e.g., facts about Osama Bin Laden; knowing what "adieu" means)
Memory (cont'd)
(2) Episodic memory: recalling information about the world tied to a specific time or event (e.g., what you can recall about 9-11)
Autobiographical memory: one form of episodic memory for personal life events (e.g., your 5th birthday party)
Implicit memory
Sometimes called "nondeclarative" memory, because it's difficult to express in words
Memory (cont'd)
Implicit memory is seen in various ways
Showing memory for "knowing how to do" reflexive, motor, or perceptual behaviors
Successfully riding a bike demonstrates one's memory for its various components, even though these are difficult to put into words
Showing memory for already learned classically conditioned responses, habits, or emotions
Feeling nauseated upon seeing food (e.g., bologna) associated in memory with having had the flu
Hearing that John is an engineer and thinking he must be smart ("engineer" primed your memory for this stereotype)
What Changes?
Evidence contradicts stereotypes about broad-based memory declines in older adults
Brain areas involved in encoding (storing) new memories shrink with age (e.g., hippocampus and medial temporal lobe)
Compared to younger adults, older adults generally have worse episodic explicit memory
All age groups do best remembering autobiographical events and nonpersonal ones (e.g., news stories) that occurred between 10-30 years of age
What Changes? (cont'd)
Implicit memory is age-unrelated, as is semantic explicit memory, except
difficulty finding the words increases in older adults and is related to decreased brain white matter (axonal projections)
Older adults compensate for working memory problems by highly activating the prefrontal cortex, an ineffective strategy
Older adults are not as good at spontaneously using memory strategies to improve recall
When Is Memory Change Abnormal?
Most people worry about memory loss and its possible implications for disease
A serious problem may be suspected when memory failures interfere with everyday life
Detecting whether memory problems are serious requires thorough testing through
physical and neurological examinations
batteries of neuropsychological tests
Remediating Memory Problems
E-I-E-I-O framework: combines explicit vs. implicit memory with external vs. internal memory aids to create four types of memory interventions
Explicit-external aids: using environmental resources, such as pagers, calendars or notebooks; helps overcome limited or declining attention and storage space in working memory
Explicit-internal aids: using mnemonic devices, such as visual imagery, rehearsal, or the method of loci
Remediating Memory Problems (cont'd)
E-I-E-I-O framework
Implicit-external aids: using sensory images to help memory (e.g., pictographs to remind the person to take medication or to depict which items reside in a cupboard)
Implicit-internal aids: using priming, retrieval training, or classical conditioning to help memory (e.g., teaching people to associate the color red with a heart medication)

Creativity and Wisdom
Creativity: ability to produce work that connects disparate ideas in novel ways and that is both task-appropriate and in high demand
Predicted by how much white matter connects distant brain regions and cognitive control over these connections
Generally increases through the 30s, peaking in the early 40s
However, the age at which people make major creative contributions has increased during the 20th century

Creativity and Wisdom (cont'd)
Baltes and colleagues describe wisdom as
dealing with important matters of life and the human experience
superior knowledge, judgment, and advice
knowledge with extraordinary scope, depth, and balance
being used with good intentions, combining mind and virtue
Wisdom is unrelated to age

Creativity and Wisdom (cont'd)
Baltes et al. identify three factors that facilitate wisdom
General personal conditions, such as mental ability
Specific expertise conditions, such as practice or mentoring
Facilitative life contexts, such as education or leadership experiences
Others suggest wisdom also may be facilitated by the integration of affect with cognition and having achieved generativity and integrity
14.4 Mental Health & Intervention: Learning Objectives
How does depression in older adults differ from depression in younger adults? How is it diagnosed and treated?
How are anxiety disorders treated in older adults?
What is Alzheimer's disease? How is it diagnosed and managed? What causes it?
Depression
Depression rates are
9% in younger adults compared to 4.5% in older people living in the community
13% in older adults requiring home healthcare
Depression rates in older adults
are higher in immigrant Latinos than their native-born counterparts
are higher in Latino- and European- than in African- or Asian-Americans
Fewer than 40% of U.S. adults receive adequate treatment
Diagnosing Depression in Older Adults
Diagnosing depression: feeling and physical changes must be present for at least two weeks
The feeling symptom cluster
Dysphoria: feeling sad or down, which older people describe as "feeling helpless" or "feeling tired"
Older people also often appear apathetic and expressionless, confine themselves to bed, neglect themselves, and make derogatory self-statements
Depression in Older Adults (cont'd)
The physical symptom cluster
Physical changes: loss of appetite, insomnia, and trouble breathing; memory problems are common long-term facets of older adults' depression
Must be carefully evaluated as symptoms of depression, since they may
reflect normal age-related changes
have other physical, neurological, metabolic, or substance abuse-related causes
What Causes Depression?
Biological explanations stress neurotransmitter imbalances
Cannot be the sole explanation, because these imbalances increase with age, while depression declines with age
Internal belief systems play a role, e.g.,
believing one is "bad" and personally responsible for bad events (e.g., a spouse's death)
thinking things will not get better
Less stress in older people and their experientially-based coping skills may account for age-related declines in depression rates
Treating Depression in Older Adults
Sometimes treated with medication to alter neurotransmitter levels
Selective Serotonin Reuptake Inhibitors (SSRIs) are the most preferred
Boost mood-regulating serotonin levels
Zoloft has fewer adverse reactions
Prozac is linked to high agitation levels
Serzone can damage the liver
Treating Depression in Older Adults (cont'd)
Less preferred medications to alter neurotransmitter levels
Heterocyclic antidepressants (HCAs)
Cannot be used when hypertension or certain metabolic disorders also are present
Monoamine oxidase inhibitors (MAOIs)
Can interact fatally with foods containing dopamine or tyramine (e.g., cheddar cheese)


Treating Depression in Older Adults (cont'd)
Forms of psychotherapy
Cognitive therapy: helps the person lessen maladaptive beliefs about the self and view the future more positively
Behavior therapy: practice and homework assignments help the person experience more reinforcement and avoid negative events
Anxiety Disorders
Anxiety disorders: excessive, irrational dread about everyday situations, including irrational severe anxiety, phobias, obsessions and/or compulsions
Common in older adults, partly due to loss of health, relocation of residence, isolation, loss of independence
17% of older men
21% of older women
Anxiety disorders can often be successfully treated with relaxation therapy and medications (e.g., benzodiazepenes, SSRIs, beta-blockers, and buspirone)
Dementia: Alzheimer's Disease
Alzheimer's disease (AD): one form of dementia, involving
gradual declines in memory, learning, attention, and judgment
confusion as to time and place
difficulty communicating and finding the right words
declines in personal hygiene and self-care
personality changes and inappropriate social behaviors
incontinence in later stages

Dementia: Alzh
n/a
Chapter 14
Chapter 14
Ch 14: The Personal Context of Later Life

Longevity- number of years a person can expect to live Maximum life expectancy: oldest age to which any person lives (circa 120 years) Useful life expectancy: number of years a person is expected to live free from debilitating chronic disease.


Longevity differences: ethnic, gender, and international- Average life expectancy is Latin Americans > European Americans > African Americans
Latin Americans live longer than European Americans at all ages
European Americans live longer than African Americans especially before the age of 65
May reflect differential healthcare access
However, African Americans live longer than European Americans after age 85

Ethnic and Gender Differences in Life Expectancy (cont'd) U.S. women live longer than men by 5 years at birth, but only 1 year by age 85
Why? Multiple explanations, such as men being more susceptible to fatal infectious diseases genetic differences between genders complex interactions of lifestyle, genetics, and immune functioning differences. By age 90, however, men outperform women on cognitive tests.

International Differences in Longevity

Longevity differs greatly across countries, e.g.,
38 years in Sierra Leone, 82+ years in Japan Genetic, sociocultural, economic, healthcare factors, and disease contribute to these differences


The Third-Fourth Age Distinction
Third age: ages of 60-80 (aka the young-old)
Knowledge and technological advances contribute to their better life quality
Fourth age: over 80 (aka the oldest-old)
Few interventions have been developed to reverse this group's physiological, cognitive, and disease-related declines

The "Good News": The Third Age (Young-Old)
Increased life expectancy
Improved physical and mental fitness
High emotional and personal well-being
Good strategies to master life's losses or gains


The "Bad News": The Fourth Age (Oldest-Old)
Sizeable losses in cognition and learning potential
Increases in chronic stress's negative effects
High prevalence of dementia (50% in those over 90) frailty and multiple chronic conditions

Biological Theories of Aging
"Damage or error" and "programmed" theories are two types of biological explanations for aging
Four "damage or error" theories

Biological theories of aging: programmed, damage/error theories


Wear and tear- suggests that the body much like any machine gradually deteriorates and finally wears out. Wear-and-tear theory: body simply wears out and deteriorates
Fails to explain most aspects of aging

(2) Free radicals: cellular damage is caused by chemicals bonding to cells' insides
Antioxidants (e.g., vitamins A, C, & E) postpone only some aging effects, but do not increase longevity

Biological Theories of Aging (cont'd)
(3) Cellular theories: multiple processes include
harmful substances build up cells cannot replicate because they can divide only so many times (Hay flick limit) chromosomes' telomeres become shorter and stress-prone
aerobic exercise may maintain telomeres' length

(4) Cross-linking: certain proteins make muscles and arteries less flexible

Little support
Biological Theories of Aging (cont'd)
Programmed theories Genetically programmed cell death
Clocklike changes in Hormones immune system decline innate tendency of cells to self-destruct dying cells triggering certain processes.

Physiological Changes Neuronal changes are common in older age Alzheimer's and related diseases involve large changes in
declining neurotransmitters levels neuritic plaques: damaged or defective neurons collect and form around a core of protein neurofibrillary tangles: spiral-shaped masses form in the axon's fibers interferes with signal transmission


Free radicals- chemical produced randomly during normal cell metabolism and that bond easily to other substance inside cells,

Cellular theories - explanation of aging that focused on processes that occur within individual cells that may lead to the buildup of harmful substance or the deterioration of cells over a lifetime.

Hay flick limit, telomeres- (Hayflick limit) chromosomes' telomeres become shorter and stress-prone aerobic exercise may maintain telomeres' length
(4) Cross-linking: certain proteins make muscles and arteries less flexible
Little support

Changes in neurons- Physiological Changes
Neuronal changes are common in older age Alzheimer's and related diseases involve large changes in declining neurotransmitters levels neuritic plaques: damaged or defective neurons collect and form around a core of protein neurofibrillary tangles: spiral-shaped masses form in the axon's fibers interferes with signal transmission.


Changes in cardiovascular and respiratory system- Cardiovascular and Respiratory Systems Normative age-related changes include declining heart muscle tissue; fat deposits in and around the heart and/or arteries the heart pumps 30% less blood by the late 70s-80s artery stiffening due to calcification increase in stroke risk
50% of adults over 65 have hypertension African Americans have higher death rate due to these problems because of poor healthcare access Cardiovascular and Respiratory Systems

Sensory changes - Vision (cont'd)

Poorer green-blue-violent color discrimination due to yellowing of the lens
Difficulties focusing and adjusting because muscles around lens stiffen
Loss of acuity between 20 to 60 years, especially with low light
Takes more time to adjust to distance changes Higher risk for diabetes-related retinal changes and macular degeneration Vision loss due to cataracts (opaque spots in the lens of the eye) or glaucoma (increase in the eye's fluid pressure)

Sensory Changes: Hearing

Hearing loss is one of the most common normative changes in older adults (especially for high pitches) A person of any age can lose hearing after routine exposure to loud sounds Includes the sound levels that young people routinely hear while wearing earbuds or headphones


Psychomotor slowing- the speed with which a person can make a specific response. Psychomotor speed: how quickly a person reacts to make a specific response
Predicts performance on cognitive tasks requiring little effort Slows with age in all situations, but especially in ambiguous ones Occurs because older adults take longer to decide whether they need to respond May explain higher driving fatality rates in very old people Due to declines in the brain's white matter (mostly myelinated axons) that aid faster neural transmission Information Processing

Changes in memory -dementia - family of diseases involving serious impairment of behavioral and cognitive functioning. Most people worry about memory loss and its possible implications for disease A serious problem may be suspected when memory failures interfere with everyday life Detecting whether memory problems are serious requires thorough testing through physical and neurological examinations batteries of neuropsychological tests

Remediating Memory Problems
E-I-E-I-O framework: combines explicit vs. implicit memory with external vs. internal memory aids to create four types of memory interventions
Explicit-external aids: using environmental resources, such as pagers, calendars or notebooks; helps overcome limited or declining attention and storage space in working memory

Explicit-internal aids: using mnemonic devices, such as visual imagery, rehearsal, or the method of loci

Remediating Memory Problems (cont'd)
E-I-E-I-O framework
Implicit-external aids: using sensory images to help memory (e.g., pictographs to remind the person to take medication or to depict which items reside in a cupboard)
Implicit-internal aids: using priming, retrieval training, or classical conditioning to help memory (e.g., teaching people to associate the color red with a heart medication)


AD interventions - Mental Health & Intervention:

What is Alzheimer's disease? One form of dementia, involving gradual declines in memory, learning, attention, and judgment confusion as to time and place difficulty communicating and finding the right words declines in personal hygiene and self-care personality changes and inappropriate social behaviors incontinence in later stages
A disease marked by gradual declines in memory, attention and judgment confusion as time and place difficulties in communicating decline in self-care skills inappropriate behavior and personality change.

Depression

Depression rates are 9% in younger adults compared to 4.5% in older people living in the community 13% in older adults requiring home healthcare
Depression rates in older adults are higher in immigrant Latinos than their native-born counterparts are higher in Latino- and European- than in African- or Asian-Americans
Fewer than 40% of U.S. adults receive adequate treatment
Diagnosing Depression in Older Adults
Diagnosing depression: feeling and physical changes must be present for at least two weeks

The feeling symptom cluster

Dysphoria: feeling sad or down, which older people describe as "feeling helpless" or "feeling tired" Older people also often appear apathetic and expressionless, confine themselves to bed, neglect themselves, and make derogatory self-statements

Depression in Older Adults (cont'd)

The physical symptom cluster

Physical changes: loss of appetite, insomnia, and trouble breathing; memory problems are common long-term facets of older adults' depression
Must be carefully evaluated as symptoms of depression, since they may reflect normal age-related changes have other physical, neurological, metabolic, or substance abuse-related causes
n/a
Chapter 15
Chapter 15
Ch 15: Social Aspects of Later Life


Continuity theory - people use familiar remembered strategies to cope with daily life
Too little continuity promotes a feeling that life is unpredictable

Too much continuity promotes boredom, optimal continuity allows for challenges and interest without being overwhelming.
Continuity Theory (cont'd)

Memories of the past concern two types of continuity
Internal: personal identity (e.g., skills experiences, emotions)
Its continuity aids feelings of competence, mastery, ego integrity, and self-esteem

External: physical and social environments, relationships, activities
Familiar environments increase this continuity
Competence-Environmental Press Model

Competence: upper limit of physical health, ego strength; sensory-perceptual, motor, and cognitive skills.

Environmental press: physical, interpersonal, or social demands of the environment
Each person experiences different degrees or types of competence, environmental presses, and their combination.

Adaptive behavior results when a person's competence fits environmental demands
Competence-Environmental
Press Model (cont'd)

Adaptation level: point at which the press level is average for a particular level of competence.

Zone of maximum performance potential: point at which slight increases in press level improve performance.

Zone of maximum comfort: point at which slight decreases in press level maximize life quality, adaptive behavior, and positive affect.

Competence-Environmental

Press Model (cont'd)
Changes in combinations of competence and environmental presses can lead to
proactivity (choosing new behaviors to exert control over the changes) often results when people are high in competence docility (allowing the situation to dictate one's options when the changes occur) often results when people are low in competence.


Integrity vs despair- according to Erikson the process in late life by which people try to make sense of their life. Reflecting on experiences and events of one's lifetime
Can promote either integrity or despair (Erikson's 8th stage)

Integrity: feeling good about one's past choices, coming to terms with one's death; judging one's life to have been meaningful and productive

Self-acceptance and self-affirmation result from reaching integrity
Despair: externalizing one's problems; feeling a sense of meaninglessness

Well-Being and Social Cognition

Subjective well-being: the positive feelings that can result from certain life evaluations
Increases with age

Varies with one's marital status, hardiness, social network quality, chronic illness, and stress

Older women may experience less subjective well-being than men
Why? Society less enables them to control these factors
Recent societal changes have reduced this gender difference

Well-Being and Social Cognition (cont'd)

Why does subjective well-being increase with age?
Amygdala activation and emotional arousal are lower in older adults
Older adults' prefrontal cortex may help them better regulate negative emotions or reappraise them as less negative
Declining cognitive ability (e.g., due to dementia) undermines this effect

Religiosity & Spiritual Support- Religious faith and/or spirituality are important means by which older people cope with life. Stronger in some ethnic groups (e.g., African Americans) than others,Spiritual support: seeking pastoral care, faith in a God who cares for people; participation in organized or nonorganized religious activities
Improves self-worth, coping; psychological and physical heath; reduces stress

Religiosity & Spiritual Support (cont'd)

Older adults describe turning problems over to God as a three-step process
Separating what can vs. cannot be changed

Focusing on problems that can be changed

Disconnecting emotionally from unchangeable problems, but focusing on God providing the best outcome for those.

Changes in brain activity occur during meditation, such as
less activity in areas focusing on the self more organized attention.

Spirituality -life review- the process by which people reflect on the events and experience of their lifetime.

Subjective well being -meaning of retirement- an evaluation of one's life that is associated with positive feelings.

"Crisp" and "blurred" retirement - What Does Being Retired Mean?
20%+ of people 65 or older are still in the workforce, which is more than ever
People associate retiring with losing occupational identity, instead of what it may add to
their lives Retirement is best viewed as a transition involving sudden

("Crisp") or gradual ("blurred") withdrawal from full-time employment

Only ≤ 50% of men fit the crisp pattern and many hold bridge jobs (ones in between end of primary job and full retirement) Bridge jobs increase satisfaction both with retirement and one's overall life.


Social convoy- a group of people that journey with us throughout our lives providing support in good times and bad. how a group of people journey with us through our lives, providing support in good and bad times Provides a protective, secure cushion so the person can explore and learn about the world; affirms who one is and means to others

Sibling relationships -widowhood- keeping in touch with siblings long term friendships for many older adults. Sibling relationships are more important later in life
Key predictors of sibling closeness are genetic relatedness health presence of other relationships proximity to each other


Frail older adults -elder abuse and neglect- having physical disabilities, cognitive and/or psychological disorders; being very ill 40% of people over 65 have some kind of functional limitation Activities of daily living (ADLs): basic self-care tasks (e.g., eating, bathing, dressing, walking) Instrumental activities of daily living (IADLs): tasks requiring intellectual competence and planning These vary cross-culturally

Prevalence of Frailty

Frail older adults are prone to anxiety and depression disorders, especially if in a long-term care facility Need for assistance ... increases with age females > males in all ethnic groups rate in Americans is African > European > Latino > Asian rate is unknown for Native Americans.

Independent Living Situations

Sense of place: a person's cognitive and emotional attachments to his/her place of residence most older adults do not wish to move in with family or friends Most older adults do not prefer assisted living or nursing homes Home modifications — major or minor— can allow older adults to continue living in their home Assisted Living

Assisted living facilities: for those with ADL or IADL limitations, but who do not need 24-hour care due to physical or cognitive impairments
Do not provide 24 x 7 medical care 67% in these facilities are 65 or older and have one or more of these limitations 50% have a memory impairment ,Nursing Homes,Nursing homes provide 24 x 7 medical care house 5% of U.S. older adults,house 15% of those over 85 are evaluated carefully through the Nursing Home Quality Initiative
The Eden Alternative, Green House Project, and Cohousing Initiatives
The Eden Alternative seeks to eliminate loneliness, helplessness, and boredom
The Greenhouse Project



Housing options: aging in place, nursing homes, new approaches
Housing Options: Living Arrangements
Household: a person who lives alone, or a group of people living together
65 years+: 20% of households, 60 years+: 33% of households
Functional health: ability to perform ADLs and IADLs determines which setting is optimal for the person



Social policy issues: social security, Medicare Social Security and Medicare
In the 1950s, roughly 35% of older adults fell below the federal poverty line
In 2008, about 10% fell below these line yet older adults may need 200% of the current federal poverty limit to cover basic expenses and healthcare By 2039, Social Security and Medicare will consume 50% more of our GDP than in 2010 Social Security
In 1935, Franklin D. Roosevelt created Social Security to supplement older people's savings and other types of support Today, after retirement, it is the primary source of financial support for retired people Yet government reforms may force people to rely on other means By the time baby-boomers retire, 2x more people will be collecting Social Security A diminishing working population soon will generate insufficient payroll taxes to fund it

Social Security (cont'd)

Reforming Social Security could involve privatization (e.g., retirement accounts) means-test benefits increasing years used to compute benefit increasing retirement age downwardly adjusting cost-of-living increases increasing payroll taxes increased earnings caps on SS payroll taxes across-the-board SS pension benefit decreases Medicare Medicaid is federally funded healthcare for the poor; supplemental or "medigap" insurance policies help with out-of-pocket expenses Medicare is federal medical insurance funded by payroll taxes To be eligible, a person must be over 65, be disabled, or have permanent kidney failure 40 million currently depend on it Faces many challenges and possible cuts due to increasing numbers of elderly

Medicare (cont'd)

Medicare coverage
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Chapter 16
Chapter 16
Ch 16: The Final Passage: Death, Dying and Bereavement

sociocultural definitions of death -legal and medical definitions of death Cultures differ in how they view and deal with death Criteria for a "good" vs. "bad" death
Funeral custom Death icons Mourning and bereavement rituals
The "afterlife".

Euthanasia - the practice of ending life for reasons of mercy.and physician assisted suicide - process in which physicians provide dying patients with a fatal dose of medication that the patient self-administers.

Hospice- an approach to assisting dying people emphasizes pain management or palliative care and death with dignity.

-Living wills- a document in which a person states his or her wishes about life support and other treatment., durable power of attorney- for health care a document in which an individual appoints someone to act as his or her agent for health care decisions., DNR - do not resuscitate order-palliative care- care that is focused on providing relief from pain and other symptoms of disease at any point during the disease process.

Kubler-Ross, death and dying - Kübler-Ross's Stages of Dying, Denial - shock, disbelief, Anger - hostility, resentment ("Why me?"), Bargaining - looking for a way out, Depression - no longer able to deny, patients experience sorrow, loss, guilt, and shame, Acceptance - acceptance of death's inevitability with peace and detachment
Discussion of death helps to move toward acceptance.
Death anxiety- Death Anxiety Death anxiety: diffuse anxiety about death
Terror management theory: our deeply rooted fear of mortality makes not dying the primary motive underlying all behaviors (e.g., taking care of ourselves, having & raising children properly) Older adults represent existential threats to younger and middle-aged adults Remind us of mortality, infallible bodies Remind us that ways in which we secure self-esteem (and manage death anxiety) are transitory Death Anxiety (cont'd) Death anxiety consists of several components Body malfunction, pain, being destroyed, nonbeing, interruption of goals, punishment, humiliation, rejection, and negative impact on survivors Each is represented at public, private, and unconscious levels
Our public admission of death anxiety may differ greatly from our private or unconscious thoughts and feelings Death Anxiety (cont'd) Older adults may have less death anxiety because of their greater ego integrity tendencies to engage in life reviews different time perspectives higher religious motivation Men have more death anxiety than women
Women are more fearful of the dying process Learning to Deal with Death Anxiety
Enjoy what you do have without many regrets Adolescent risk-taking is correlated with less death anxiety Increasing one's death awareness (e.g., writing one's obituary, planning one's funeral) Death education can significantly reduce fear
Presents factual information about death, dying, and advanced directives; increases sensitivity to others dealing with death Creating a Final Scenario
End-of-life issues: discussing and formalizing management of life's final phases, after-death disposition of one's body, and lawful distribution of assets (e.g., through a will)
Baby-boomers are far more proactive and matter-of-fact about these issues

Terror management theory

grief process: four component model and dual process model- context of the loss referring to the risk factors such as weather the death was expected, continuation and subjective meaning associated with loss ranging from evaluation of everyday concerns to major questions about the meaning of life, changing representations of the lost relationship over time and the role of coping and emotion regulation processes that cover all coping strategies used to deal with grief (Bonanno and Kaltman).

grief work as rumination hypothesis - an approach that not only rejects the neccesity of grief processing for recovery from loss but view extensive grief processing as a form of rumination that may actually increase distress.
Risk factors in grief- the sorrow, hurt, anger, guilt, confusion and other feeling that arise after suffering a loss.

Complicated or prolonged grief disorder- Expression of grief which is distin1uished from depression and form normal grief in terms of separation dis2ress and traumatic distress. Prolonged Grief Disorder Two types of distress distinguish this disorder from normal grief and depression. Separation distress: isolation; preoccupation with, upsetting memories of, longing and searching for the deceased to the point of interfering with everyday functioning Traumatic distress: disbelief and shock about the death, experiencing the deceased's presence; mistrust, anger, and detachment from others
Complicated or Prolonged Grief Disorder (cont'd) Sufferers from complicated grief report symptoms distinct from those associated with depression or anxiety Avoiding reminders of the deceased Diminished sense of self, Difficulty accepting the loss Feeling angry or bitter, increased morbidity, smoking, and substance abuse Difficulties in family or social relationships.


Meaning of death and grief expressions of grief in childhood- Preschoolers: death is temporary and magical 5-7 years: death is permanent, it eventually happens to everyone, and is less scary; reflects the shift to concrete-operational thought
Typical reactions to death in childhood are regression, guilt for causing it, denial, displacement, repression, and wishful thinking about the deceased's return
Older children: problem-focused coping and a better sense of personal control appears
Children flip back and forth between grief and normal activity.
Childhood (cont'd) with adequate and loving care, support, and reassurance that it's ok to grieve; childhood bereavement usually has no long-lasting effects (e.g., depression)
Being open and honest reduces children's difficulty with the concept of death
The use of euphemisms such as "gone away" or "only sleeping" can confuse and cause literal interpretation Researchers believe attending a funeral or having a private viewing aids recovery.

Young, middle, and late adulthood less anxious and more accepting of it: death of a child, death of a parent, death of a partner- Adolescence
40-70% experiences the loss of a family member or friend during the college years
Their first experience of death is particularly difficult and its effects severe, especially if unexpected.
Chronic illness, lingering guilt, low self-esteem, poorer school & job performance, substance abuse, relationship problems, and suicidal thinking
Adolescence (cont'd)
Adolescents try to find ways of keeping a dead sibling in their lives
They continue to miss and love them.
Grief does not interfere with normative developmental processes
They experience continued personal growth similar to nonbereaved adolescents
Adulthood
Young adults may feel that those who die at this point are cheated out of their future
Also made difficult when peers ignore their grief, tell them that grieving is not good, or to get on with their lives.
Loss of a partner in young adulthood is very difficult because the loss is so unexpected and grief can last for 5-10 years.
Losing a spouse in middle adulthood - results in challenging basic assumptions about self, relationships, and life options.
Death of One's Child in Young and Middle Adulthood
Mourning is intense; some never reconcile the loss, and parents may divorce
Young parents who lose a child to SIDS report high anxiety, more negative view of the world, and guilt.
Loss of a child during childbirth is traumatic due to strong attachment, even though society expects a quick recovery.
Middle-aged parents' loss of a young adult child is equally devastating, causing anxiety, problems functioning, and difficulties in relationships with surviving siblings upwards of 13 years later.
Death of One's Parent
When a parent dies, the loss hurts but also causes the loss of a buffer between ourselves and death; we may feel that we are now next in line.
Death of a parent may result in a loss of a source of guidance, support, and advice
The loss of a parent may result in complex emotions including relief, guilt, and a feeling of freedom.
Important to express feelings for parents before they die
Losing a parent due to Alzheimer's disease may feel like a second death
Late Adulthood
Older adults are often less anxious about death and more accepting of it
Elders may feel that their most important life tasks have been completed
Older adults are more likely to have experienced loss before
Death of One's Child or Grandchild in Late Life
Older bereaved parents may feel guilty about how their pain about losing one child affected relationships with surviving children.
Many grieving parents report that the relationship with the deceased child was the closest they ever had.
Bereaved grandparents tend to hide their grief behavior in an attempt to shield the grieving parents from more pain.
Death of One's Partner U.S. society expects the surviving spouse to mourn briefly, but older bereaved spouses may grieve for 30+ months A support system's helpfulness depends on whether the bereaved wants contact who is willing to provide support whether the support is of high quality
Depressed survivors' memories of the relationship are positively biased, whereas those of the non-depressed are more negative (may reflect pre-death quality of the relationship)
Death of One's Partner (cont'd)
European-American wives who highly value this role "sanctify" their dead husbands
Helps the widow believe the marriage was strong and that she is a good & worthy person who can rebuild her life
Reduced hopelessness, intrusive thoughts, and obsessive-compulsive behavior occur when older bereaved spouses actually express their feelings
Cognitive-behavior therapy helps coping and making sense of the loss
Gays and lesbians experience grief plus negativity from the deceased's family members one form of dementia, involving gradual declines in memory, learning, attention, and judgment confusion as to time and place difficulty communicating and finding the right words declines in personal hygiene and self-care personality changes and inappropriate social behaviors incontinence in later stages.
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