Late Adulthood

1
Late Adulthood

• 65 and older
• Distinction between old,(65-85) and oldest old,
  those over 85.
• Formal label Gerontology

2
Demographics

• Fastest growing segment of the population
• Currently about18-20 of the population,
  predicted to be 25 by 2050
• Fastest growing part of the late adulthood
  population is the oldest old, those over 85.
• Trend is found world-wide, not just in developed
  countries

3
Ageism

• Defined prejudice and discrimination directed
  at older people
• Shows in negative attitudes toward older people
  and the aging process
• Emerges mostly on traits related to general
  competence and attractiveness

4
Overt Discrimination

• Employment
• Housing
• Legal status

5
More subtle discrimination

• Treatment baby talk in the nursing home
• Interpretation of behavior memory lapses
  mental disorder, vs. memory lapses temporary
  forgetfulness or distraction
• Overt reverence of youth and youthful appearance
  in media
• The only old people in TV ads are those being
  targeted

6
Physical Changes

• Outward Signs
• Grey or white hair
• Wrinkles (skin loses elasticity and collegen)
• Shrinking as much as 4 inches
• Partly due (especially in women) to osteoporosis,
  due to calcium loss
• Double standard in effect older women judged
  more harshly than older men

7
Physical Changes

• Internal Changes
• Brain becomes smaller and lighter
• Pulls away from skull, increasing effects of
  injury
• Decrease in number of neurons
• Reduction in blood flow
• Circulation decreases
• 25 less blood flow compared to age 20
• Caused by hardening and shrinking of blood vessels

8
Declining capacities (at 75, compared to 30)

• Brain weight 56
• Blood flow to brain 80
• Cardiac output 70
• O2 uptake 40
• Number of taste buds 36
• Nerve conduction velocity 90
• Hand grip 55
• Body weight (males) 88

9
Reaction Time

• Follows trend started in middle adulthood
• Explanations?
• Peripheral slowing hypothesis peripheral
  nervous system is less efficient
• Generalized slowing hypothesis all parts of the
  nervous system slow down
• Decreases ability to quickly process information
  and decreases ability to avoid danger

10
Vision

• Visual acuity decreases
• Need for brighter lighting, increase in night
  vision problems
• Slower transition from bright to dark or dark to
  bright
• Cataracts cloudy or opaque areas in the lens of
  the eye

11
Hearing

• 30 of adults between 65 and 75 have significant
  hearing loss
• 60 of adults over 75 have significant hearing
  loss
• Hearing aids would help about 75, but only about
  20 use them
• Most noticeable impact is on social relationships

12
Taste and Smell

• Decrease in sensitivity in both areas
• May trigger loss of appetite and even
  malnutrition
• Many compensate by increasing seasoning,
  especially salt, with related increase in
  hypertension and heart disease
• Cause by decrease in number of taste buds and
  shrinking of olfactory bulbs in brain

13
Health Issues in Old Age

• About 75 of older people self-report their
  health as good to excellent
• Physical problems related to age tend to be
  chronic and long term
• Arthritis
• hypertension

14
Psychological Problems in Old Age

• High levels of depression, related to cumulative
  loss, restricted sense of control and declining
  abilities
• Frequent psychological disorders related to
  non-psychiatric drugs and drug interactions
• Most common disorder Dementia, marked by memory
  loss, declines in other mental functions

15
Aging and Illness

• Health depends on the interaction of genetics and
  environment
• Environment includes access to medical care
• Psychological factors become more important
• Sense of control
• Remain active
• Optimism
• Exercise
• Diet

16
Sexuality in Old Age

• People remain sexually active into their 80s and
  90s
• Factors contributing to sexual activity
• use it or lose it
• Physical health
• Sex positive attitudes
• Availability of a partner and/or positive
  attitudes toward masturbation

17
Theories about Aging and Death

• Genetic preprogramming DNA contains a built-in
  lime limit
• Maximum genetic age somewhere near 120
• Associated with weight, diet, altitude, climate
• Wear and Tear The mechanical functions of the
  body simply wear out, just like cars and washing
  machines
• Includes lifelong build up of toxins and other
  external sources of damage

18
Life Expectancy

• Historically increasing 1776 35, 1900 47,
  1980 75, predicted to be 80 by 2050
• Best individual predictor is age of parents and
  grandparents, baring accidental or contagious
  disease deaths.

19
Cognitive Development

• Generally lower IQ scores as people age but
• Shaie (1994), using cross-sequential methods
  found
• No uniform pattern in age related change in IQ
• Some declines in everyone by age 67, but not
  significant until the 80s
• Individual differences greater than group
  differences

20
IQ, Environment and Culture

• Higher SES less loss
• Higher stimulation less loss
• Honor for the aged less loss

21
Memory

• Least noted in cultures with high respect for the
  aged
• Tend to show up more in episodic memory than in
  semantic or implicit memory
• Short-term memory effected more than long-term
  memory, especially if material is presented
  quickly and verbally

22
Autobiographical Memory

• Follows the Pollyanna Principle , the tendency to
  recall pleasant memories more then unpleasant
  memories
• Memory also tracks current self-image
• Memory best for early adulthood experiences

23
Factors in Late Adult Memory

• Environment Rx drugs are single worst enemy,
  followed by lack of stimulation
• Information-processing problems general loss of
  efficiency in processing speed and inability to
  inhibit irrelevant thoughts
• Biological deterioration in the frontal lobes

24
Late Life Learning

• Mostly influenced by the use-it-or-lose it rule
• Tend to do better than average work when enrolled
  in formal educational processes
• Late life learning limited mostly by opportunity

25
Personality Development

• Personality tends to be stable on most traits
• Agreeableness
• Satisfaction
• Intellect
• Extroversion
• Energy
• Even-temperedness
• Self-concept

26
Eriksons Final Stage

• Ego Integrity A sense of satisfaction and
  accomplishment, with a sense of realized
  potential, and few regrets
• Despair A sense of dissatisfaction, with focus
  on missed opportunities and lack of
  accomplishment, with associated gloom and sadness

27
Pecks Developmental Tasks in Late Adulthood

• Redefinition of self vs. preoccupation with work
• Body transcendence vs. body preoccupation
• Ego transcendence vs. ego preoccupation

28
Levinsons Final Season

• A transition process at 60-65 where people come
  to view themselves as being old
• Includes integration of societies negative
  stereotypes of old age
• Also involves dealing with physical changes
• Involves willingness to give up center stage

29
Life Review

• Common across all developmental theories of late
  adulthood
• Triggered by increasing awareness of ones own
  death
• Involves a better understanding of ones personal
  history
• Usually leads to greater sense of
  interconnectedness with others
• Can be negative, with obsessive thoughts on old
  insults, mistakes and guilt

30
Theories of Successful Aging

• Disengagement theory a gradual withdrawal from
  the world on physical, social and psychological
  levels
• Withdrawal is a gradual, mutual process
• Seen as largely positive in that it allows for
  more reflection and less constraint by social
  roles
• Also helps others use less emotional energy
  during serious illness and death

31
Theories of Successful Aging

• Activity theory people maintain interests,
  activities and social interactions at about the
  same level as in middle adulthood
• Later life should reflect a continuation of
  activities pursued earlier in life.
• An lost activity (such as work at retirement age)
  should be replaced by something else
• Critics say that not all activities are created
  equal and it unrealistic to expect people to hang
  on to all of them and that the ability to
  eliminate some activities is a benefit of old age

32
Theories of Successful Aging

• Selective Optimization concentrating on
  particular skills or activities to compensate for
  losses in other areas.
• More like Activity theory, but more realistically
  addresses loss of function
• Stresses that older adults should do this as a
  conscious, self-aware process.

33
Living Arrangements in Late Adulthood

• Most continue to live in there own homes
• One of the decisions is about relocating on
  retirement
• Pro different climate, new activities, closer
  (farther?) from children
• Con lost of social connections, expense,
  age-ghettos
• Ethnic variations in living with other family
  members
• More common in minority groups than whites

34
Other living options

• Life-care communities offers an environment
  where everyone is retirement age or older,
  needing various levels of care
• Adult day-care care is provided only during the
  day, nights and weekends at home
• Skilled-nursing facilities full-time nursing
  care for those with chronic illness or recovering
  from a severe but temporary medical condition
• Satisfaction based largely on degree of control
  and number of choices maintained by the
  individual

35
Retirement

• Multiple Motives
• Burnout
• Exhaustion
• Health
• Employee incentives
• Normative

36
Stages of Retirement

• Honeymoon variety of activities previously
  restricted by jobs
• Disenchantment missing the stimulation of a job
  and other people
• Reorientation review of options and
  identification of fulfilling activities
• Retirement Routine settling into a comfortable
  day-to-day pattern (not reached by all)
• Termination major physical deterioration and
  loss of independent functioning

37
Relationships in Late Adulthood

• Marriage 75 of men and 40 of men are married
  in late adulthood
• Remarriage easier for men the marital gradient
  still applies
• Divorce rate drops, holding at about 2 for those
  over 60

38
Issues in marriage

• Too much togetherness?
• Reshaping relationship with more time together
• Reversal of gender roles
• Men become more affiliative and less competitive
• Women become more assertive and autonomous

39
The death of a spouse

• Surviving spouse assumes new and difficult role
• Loss of companionship
• Assumption of new roles
• Loss of social connectedness
• Economic issues

40
Stages of adjusting to Widowhood

• Preparation
• Grief and mourning
• Adaptation
• May not apply to everyone

41
Social Networks in Late Adulthood

• Social networks involve choice (unlike family)
• Social networks have greater flexibility than
  family
• Offer potential substitutes for loss of spouse
• Source of additional loss as friends die

42
Social Support

• The assistance and comfort supplied by another
  person or a network of caring, interested people
• High value placed on reciprocity , the
  expectation that if someone provides something
  positive, there is the ability to provide a
  return benefit

43
Relationships with Family

• Sibling become increasingly important
• Children as source of support become more
  important with parents having a larger
  developmental stake than children
• Grand-parenting roles follow what was established
  in middle adulthood

44
Death and Dying

• Functional death absence of heartbeat and
  respiration
• Brain death loss of all brain activity
• Qualitative death lack of the qualities that
  make us human
• Thinking
• Reasoning
• Feeling
• Experiencing

45
Kubler-Ross Stages

• Health
• Dx of terminal illness
• Denial and shock
• Anger
• Bargaining
• Depression
• Acceptance

46
Evaluation of Kubler-Ross

• Enormous impact
• Applies only to those aware of pending death
• Not very useful in cases with ambiguous prognosis
• May be too restrictive
• Role of anxiety
• Role of chronic severe pain

47
Choices about the manner of Death

• DNR do not resuscitate?
• Living Wills?
• Assisted Suicide?
• Euthanasia?

48
Bereavement and Grief

• Bereavement Acknowledgment of the objective
  fact that one has experienced a death
• Grief The emotional response to ones loss

49
Phases of Bereavement and Grief

• Phase one shock, numbness disbelief, denial
• Tend to have important functions numbness can
  get you through the funeral arrangements, etc
• Usually self-limiting
• Phase two confronting the death and facing the
  issues involved
• Marked by depression, yearning for the lost one,
  impatience, sadness

50
Phases (continued)

• Phase three accommodation to the loss
• Construction of new identities
• Increase in self-reliance
• Marked individual differences in how phases are
  experienced and managed
• Healthy vs. Unhealthy Grief
• Common idea in both laypeople and experts, but
  serious lack of evidence
• Generally accepted timeline of about one year

51
Rites and Funerals

• Important way to formally acknowledge death
• May provide closure
• Short-term intensification of grief may have
  cathartic effects
• Triggers needed increase in social support

52
Test

• Official Schedule Friday, May 17, 2002, 800 am
  
• Alternatives
• Tuesday, 5/14/01, 1000, room 209
• Tuesday, 5/14/02, 100, room 209
• If none of these work, come see me.
• Chapters 9-19.Middle Childhood through Death
  and Dying