Human Growth and Development Chapters 2326: Late Adulthood and Death and Dying

1
Human Growth and DevelopmentChapters 23-26Late
Adulthood and Death and Dying
2

• Ageisma term that refers to prejudice against
  older people because of their age
• 7 percent of worlds population now over 65 years
• 13 percent in developed nations such as United
  States
• By 2030 the proportion of those over 65 is
  projected to double worldwideto 15 percent
• while the lowest rates of MVAs are in those
  55-64, the rate does increase slightly for those
  over 65though still lower that any group between
  15 and 54!

3
Health

• Falls do occur
• injuries may require medical treatment
• exercise a very effective preventative
• weightlifting should be part of the exercise
  routine
• Flexibility is one of the best predictors of
  vitality

4
Compensation for Sensory Loss

• Compensation for loss of vision and hearing, not
  passive acceptance, is crucial
• Adjustment means finding balance between
  maintaining normal activities and modifying
  routines to fit diminished capacities
• Critical factor is recognition of the problem and
  willingness to change
• Others often respond with Elder Speaklike baby
  talk, it is short, exaggerated, slower, higher
  pitched, and repetitious only repetition is
  helpful

5
Sleep

• Sleep disorders are common in elderly
• spend more time in bed, but take longer to fall
  asleep, spend less time in deep sleep, wake up
  more often (10X/night), take more naps, and feel
  more drowsy in the daytime

6
Health and the Immune System

• The diminished immune system is why cancer is
  more common and why the flu can be fatal

7
Free Radicals

• Oxygen free radicalscan cause cellular problems
  that lead to diseases such as cancer and diabetes
• come from infections and inflammation of the
  intestinal tract and as a result of ultraviolet
  radiation (especially UV-B) as well as being
  normally produced by our bodies
• Antioxidantscompounds that nullify the effects
  of oxygen free radicals
• vitamins A, C, and E, mineral selenium

8
Life Expectancy

• Maximums and Averages
• maximum life span (humans 115)
• average life expectancy
• affected by culture, historical and socioeconomic
  factors

9
The Centenarians

• People 100 years of age or older
• Expected to be over 1,000,000 people over 100 by
  2050

10
Cognitive Abilities

• Schaies study found decline in all 5 primary
  mental abilities by age 60
• verbal meaning
• spatial orientation
• inductive reasoning
• number ability
• word fluency
• Decline is worst in those with processing speed
  and spatial perception

11

• Working memory shows the most decline in old age
• Long term memory
• evidence suggests memory for vocabulary remains
  unimpaired and can increase with age
• areas of expertise relatively unimpaired

12

• We see less actual memory loss but impaired
  control processes (memory and retrieval
  strategies like selective attention, problem
  solving, storage of memories, logic, retrieving
  memories)
• This leads to a harder time with explicit memory
  (pulling up facts on demand) than with implicit
  memory (habits, routines)

13
Dementia

• Dementiairreversible loss of intellectual
  functioning caused by organic brain disease
• Symptoms
• confusion and forgetfulness
• More common with age
• More than 70 diseases can cause dementia
• Difficult to diagnose

14

• Alzheimers Disease is the most common cause of
  dementia
• Other causes include strokes, Parkinsons
  disease, Huntingtons disease, Multiple
  Sclerosis, overmedication, undernourishment

15
Alzheimers Disease

• Age is chief risk factor
• incidence rises from about 1 in 100 at age 65 to
  1 in 5 over age 85
• Alzheimers is partly genetic
• in United States, 20 percent inherit ApoE4 from
  one parent thus, have a 50/50 chance of
  developing disease by age 80
• Factors decreasing risk
• lifestyle habits (e.g. physical exercise and
  mental activity) said to be protective

16
Stages From Confusion to Death

• Stage 1
• general forgetfulness
• Stage 2
• more general confusion
• noticeable differences in concentration and
  short-term memory
• speech can be aimless or repetitive

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• Stage 3
• memory loss becomes truly dangerous
• no longer able to take care of own basic needs
• Stage 4
• need for full-time care as cannot care for self
  or respond normally
• occasionally irrationally angry or paranoid

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• Stage 5
• completely mute
• unable to respond with any action or emotion
• death usually occurs 10 to 15 years after onset

19
Psychological Illness

• Anxiety, antisocial personality and bipolar
  disorders, schizophrenia, depression
• less common among the elderly
• higher mortality rates for people with those
  illnesses
• illnesses themselves become less severe in later
  life
• Mental illness can produce what seems like
  dementia but is not
• e.g., depression, anxiety
• careful diagnosis can differentiate

20
Psychosocial Development

• Eriksons eighth and final stage Integrity vs.
  Despair
• older adults seek to integrate their unique
  experience with their vision of community
• Ideally, reality of death brings life-affirming
  involvement in present
• The more positively a person feels about him- or
  herself, the less depression or despair is felt

21
Volunteer Work

• Higher percent of elderly adults have strong
  commitment to their community and believe they
  should be of service
• older adults especially likely to volunteer to
  assist the young, very old, or sick

22
Long-Term Marriages

• Spouse buffers many problems of old age
• Married elders generally are
• healthier
• wealthier
• happier
• Those who never married are happier than those
  who experienced death of a spouse or divorce

23
Widows

• 4 x as many widows as widowers
• Because women take better care of their health,
  they live longer than men
• Husbands death is never easy
• Death can mean loss of close friend, social
  circle, income, and status
• Widows do not usually seek another husband

24
Widowers

• Living without a spouse is more difficult for men
• Widowers often lack social support
• Historical gender differences make adjustment
  more difficult
• have restrictive notions of masculine behavior

25

• After death of spouse, widowers more likely to be
  physically ill than widows or married people of
  their age
• Many widowers prefer not to remarry, but with
  favorable gender ratio and loneliness, often find
  themselves more likely to remarry than widows

26
Younger Generations

• Relationships with younger generations generally
  positive, but can include tension or conflict
• Few older adults stop parenting
• Mother-daughter relationship is close but also
  vulnerable
• Assistance arises from both need and ability to
  provide it
• Personal contact depends mostly on geographic
  proximity

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• Affection is influenced by a familys past
  history of mutual love and respect
• Sons feel strong obligation, while daughters feel
  stronger affection
• Cultures and families vary markedlythere is no
  right way for generations to interact
• Assistance typically flows from older generation
  to their children

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Frailty

• Active drive for autonomy, control, and
  independence best defense against becoming
  dependent and frail
• Loss of control invites further weakness
• Both ones attitudes and social structures
  influence outcomes
• Most frail are cared for by relatives

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The Demands of Family Care

• Toll of home caregiving is heavy
• caregivers physical health suffers and
  depression increases
• caregiver often has to give up other activities
• when caregiver is appreciated by others for
  efforts, he or she may feel fulfilled by the
  experience

30
Elder Abuse

• When caregiver has feelings of resentment and
  social isolation, he or she
• typically experiences stress, depression, and
  poor health
• may be more likely to be abusive if he or she
  suffers from emotional problems or substance
  abuse that predate the caregiving

31

• Most abuse is perpetrated by family member(s)
• Simplest form is financiala relative or stranger
  gets elderly to sign over life savings, deed to
  house, or other assets

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Epilogue Death and Dying

• Hospiceinstitution where terminally ill patients
  receive palliative care
• provides skilled medical treatment, but avoids
  death-defying interventions
• human dignity respected
• Palliative care Designed mainly to relieve pain
  and suffering of patient and family

33
Euthanasia

• Legally, decisions made in living wills and by
  health care proxies are to be honored
• Passive euthanasiasituation in which a seriously
  ill person is allowed to die naturally via
  cessation of medical interventions often only
  done when patient has a DNR order
• Active euthanasia is fiercely controversial, even
  if the dying person requests it
• is illegal in almost every part of the world

34

• Several places have legalized physician-assisted
  suicide
• the Netherlands
• Switzerland
• Belgium
• Oregon

35

• Kübler-Ross helped us to understand death
• Acceptance of death was elusive before
• Kübler-Rosss 5 Stages
• denial
• anger
• bargaining
• depression
• acceptance

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Forms of Sorrow

• Griefindividuals emotional response to
  bereavement
• private
• Mourningculturally prescribed ceremonies and
  behaviors for expressing grief at the death of a
  loved one
• public

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Responses to Bereavement

• What Friends Can Do to Help the Bereaved Person
• first, be aware that powerful, complicated, and
  unexpected emotions are likely
• do not judge another persons sorrow
• understand that culture and cohort play a role in
  the different responses to death

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• Bereavement is an ongoing, often lengthy process
  sympathy, honesty, and social support may be
  needed for months or even years
• especially true for families
• Recovery begins with acceptance of grief and may
  lead to reaffirmation of life