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Chapter 17 - 19 : Late Adulthood

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William Cockrell

on 1 October 2018

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Transcript of Chapter 17 - 19 : Late Adulthood

Chapter 17 - 19 : Late Adulthood
Life Span and Life Expectancy
Life span :
the expected maximum amount of years an organism can reach. We do not know the exact number (highest accurate number is 122).
Life expectancy :
average amount of years, at birth, and individual can expect to live based on various factors
Life span has remained the same for thousands of years whereas life expectancy has changed over the years
In 500 B.C. Greece the life expectancy was 18 years. Near the start of the United States, in 1789, the life expectancy was 35 years. 1900 in America was 48, 2003 in America was 77.6 years
Typical Older Population
There is no typical older person
Older people, as a group, may have the largest amount of variability
Aging is a social construct
Different cultures determine being old by three different ways
Functional :
is the person able to continue their daily tasks?
Role based :
are people old when they become grandparents?
Chronological :
based on numerical number of years lived
So why is 65 considered the starting point?
Gerontological Terms of Aging
Young - Old :
65 - 75
Middle - Old :
75 - 84
Old - Old :
Centenarians :
people who have lived over one hundred years
A very healthy 80 year old could be mistaken for a "young - old" and a more frail 65 year old could be considered "old - old" (i.e., perceptions of health play a large factor in how old we are perceived)
The Older Population
The older generation is growing faster than any other group
In one hundred years we have gained 32 million people over the age of 65
The oldest-old (85+) are the fastest growing in the older population with 50,000 people over 100 in 2000
People continuing to live longer plays a large role in the increasing older population
The second reason is due to an increase in immigration of older people to America.
Life expectancy continued
Women have always had a longer life expectancy than men.
Men have more accidents, lower survival rates of disease, less social connections, and take more risks.
White people in America have the highest life expectancy
This may be due to racial privilege and better access to resources
Crossover phenomenon
Japan has the longest life expectancy at 81.9 years
What makes Japan so unique?
Gerontologist's gold mine
Oldest reported (and verified) Centenarian was Jeanne Calment at 122 in Southern France.
By 2050 it is projected that around 800,000 Americans will be over the age of one hundred.
Estimate your life expectancy!!
Neurological Changes in Aging
When we reach adulthood, our brains slowly start reducing in weight.
The frontal lobes, corpus callosum (the connection between the hemispheres), and the cerebellum all decrease in size after the age of 60.
After the age of 60, the brain also drastically reduces the amount of glial cells. What would the reduction of glial cells cause?
Brain plasticity does help a little for older adults. Different lobes of the brain will compensate the shrinking areas, but it is not as effective as it was during childhood.
As we age our body becomes more tolerant/less responsive to stress hormones. To compensate for this the brain starts releasing higher levels of stress hormones. This is one reason older people tend to report higher levels of anxiety.
The immune system also decreases, this is why the elderly and infants are the most important groups to receive flu shots.
Different neurotransmitters in the brain combined with the previously mentioned stress hormones cause elderly people to have higher levels of sleep disturbances.
Sensory Changes in Aging
As we age our lens slow changes from clear to a yellowish color. This causes older people to have greater problems distinguishing color.
Cataracts :
symptoms are cloudy/milky eyes that cause blurriness and eventual blindness. Used to be a debilitating health issue for older people, but now is a very easy surgical operation. 50% of people over the age of 80 experience cataracts.
Macular Degeneration :
the most extreme form of visual disorders. Symptoms include : problems adjusting to dark environments, reduced depth perception, a reduction in binocular vision, and problems seeing fine details.
Typically, it is harder for older adults to hear higher pitched sounds.
Reductions in hearing tend to produce higher levels of social anxiety than visual problems. Why does hearing loss cause social anxiety?
Intermodal processing :
combining multiple sensory sources to improve cognition. An example would be reading lips (visual) to help understand what a person is saying (audio). Older people increase intermodal processing to compensate for hearing loss.
A loss of blood circulation in the fingers causes older people to lose sensation in their fingertips. This causes the hands to be very hot or cold depending on temperature.
Changes in Sleep due to Aging
Older people typically spend less time asleep than their younger peers.
The most common sleeping problems are the inability to fall asleep, problems staying asleep, and problems with quality of sleep.
About half of all older people, especially above 80, experience problems with insomnia.
Older men tend to experience more sleep related problems than women due to an enlarged prostate. This creates pressure on the bladder which causes men to urinate multiple times during the night. Sleep Apnea is also more common for men than women.
Restless Legs :
not the same as Restless Leg Syndrome, but still painful for older adults. Typically caused by a deficiency in iron and potassium (common causes of muscular cramps).
Problems with quality of sleep typically deals with the inability to reach REM sleep. Lower quality sleep usually does not even reach NREM sleep.
Chemical dependent/drug-dependent insomnia :
insomnia created by dependency on sleeping aids.
People over the age of 65 are most likely to be prescribed sleeping medications (all of which are highly addictive and have strong withdrawal symptoms).
Alzheimer's Disease
Most common neurological disorder among elderly people.
Neuritic plaques :
nerve endings that have died and slow down mental processing
Neurofibrillary tangles :
brain, nerve fibers that become twisted and slow down mental processing.
Affects 10% over 65 and 50% over the age of 85. Around 4.5 million people have Alzheimer's in America (Alzheimer's Association, 2004).
Common symptoms are : deficit in recent memory, impairment of judgement, change in personality.
Alzheimer's Disease is often classified by a
Genes on chromosomes 1, 14, and 21 are all known to influence Alzheimer's. These genes are all dominant, meaning only one parent needs to have the abnormal genes.
People with Down Syndrome (remember it's caused by chromosome 21 defects) and diabetes are at a greater risk of Alzheimer's.
The ApoE4 gene is believed to be the strongest influence on if Alzheimer's occurs or not.
Long term care covers : assisted living facilities, home health care, and nursing homes.
More people do not live in long term care than people who do.
The majority of older people receive long term care from their friends and family.
Long term care :
Care over a long period of time for people that have chronic conditions and functional limitations.
As we have already learned, multiple characteristics (income, race, sex, class, etc) factor in the decision to receive long term care.
Long Term Care
Assisted Living
Assisted living facilities are the fastest growing long term care option in America.
Think of apartments where older people live who need minimal assistance.
Activities of Daily Living (ADL) :
examples are bathing, dressing yourself, transportation, etc. Assisted living facilities provide these services for the residents.
Average national cost = 24K annually, usually covered by private income (typically upper income residents?)
About 67% of assisted living residents are female (U.S. General Accountability Office, 1999).
Home Health Care
Least expensive
Spouse or adult daughter are usually the primary caregiver.
Whoever is closest (proximity) is also a large factor of who is the primary caregiver
Caregiver Burden
For terminally ill, hospice care is available
Social Security Act helped create Nursing Homes
In 1965, people were able to start using the newly created Medicare and Medicaid to help pay for nursing homes. This greatly increased the nursing home population.
Nursing Home :
A long term care facility that has at least three permanent beds. Must be licensed by the state.
An estimated 1.5 million residents are in nursing homes now. By 2050 it is expected that 6.6 million people will be in nursing homes.
Are considered
"total institutions"
Nursing Homes
Integrity Versus Despair
The last stage in Erikson's theory. Essentially, the process of this stage is the person deciding if they are happy with their life or dissatisfied.
Ego Integrity :
means that the person is satisfied with the outcome of their life. Maturity, wisdom, and a successful midlife are the strongest predictors of ego integrity.
Despair :
more common when people believe they had made a lot of mistakes in their life, unable to accept their personal mortality, blaming others for their life, and higher levels of hopelessness.
Ego Differentiation :
not placing all of your self-worth on your occupation. People who do this tend to experience higher rates of dissatisfaction when they retire. Ego differentiation means that you receive self-worth from activities, hobbies, friends, etc.
Body Transcendence :
not focusing on physical declines but instead acknowledging the increase in emotional developmental.
Ego Transcendence :
acceptance of death, but developing a focus on trying to improve life for future generations.
Affect Optimization :
the ability to focus on positive experiences and providing less attention to negative experiences.
Reminiscing :
the activity of older people reflecting on their life stories and sharing these experiences with people they love. While younger generations make fun of elderly people for this,
it is highly beneficial!!
Older people who reminisce positive life experiences typically are more accepting of death, report lower levels of depression, and higher levels of self-esteem.
Rumination :
focusing on negative experiences. This is not helpful to aging.
Suicide and the Elderly
All behaviors of deviance decrease with age, except committing suicide.
The elderly have relatively high rates of suicide compared to other age groups.
The elderly White male has the highest suicide rate of any group ; a White male over the age of 85 is 13 times more likely to commit suicide than an elderly White female.
When elderly White men become widowers they are at highest risk of suicide (think of previous aspects of elderly males we have talked about)
Classic research by Durkheim categorized suicide into four types : egoistic, altruistic, anomic, and fatalistic.
American Values Continued
"Enjoy the best years of your life before they are gone"
"You better work really hard before you are put out to pasture"
"People should stand on their own two feet"
"I don't want to be a burden"
"Don't be an old fool"
"Forget the past, look to the future"
Role Loss in Later Life
Each stage in life comes with newer roles to learn. The last stage in life is the opposite.
Examples of role loss include : widowhood, retirement, and going into a nursing home.
The additional drawback is that the loss of these roles includes a decrease in "social worth/value"
Role loss can lead to both physical and psychological stress
Three prominent theories related to aging are : Disengagement theory, Activity theory, and Continuity theory
Disengagement Theory
As already mentioned, when one gets older they often give up previously held roles
The relinquishment of roles leads the elderly people to "disengage" from society
The elderly disengage because they are preparing for death
Some argue disengagement always happens, others say it does not. What do you think? Does a person who works until death ever disengage?
When the elderly disengage, the younger generation is allowed to take their place.
Activity Theory
The elderly still lose the roles that they gained during adulthood.
Unlike the disengagement theory, the elderly people do not withdraw from society
Elderly people simply continue to participate in hobbies and activities that they have always enjoyed
From the activity theory perspective, society "withdraws" from the elderly instead of the other way around. Elderly people stay active to avoid being removed from society.
More supportive of American Values
Continuity Theory
Similar to Activity theory
Argues people do not drastically change (psychologically) as they age throughout life
We use adaptive resources that we have learned in life to further navigate our social world.
People do not have to be busy, busy, busy (gym, golf course, bingo every night) like how people often describe activity theory.
Focus is on having a balance of enjoying favorite activities while compensating for potential declining health
The elderly are the least likely to be victims of criminal activity
Elderly people are much less likely to be victims of violent crime when compared to younger people.
Even though elderly people are much less likely to be victims of crime,
"fear of crime"
is very high among elderly people.
Fear of crime can greatly influence the likelihood an elderly person will remain at home and not leave (remember, we've learned that social isolation is bad to health!)
The type of crime that should be a concern to elderly people is fraud. This is the most common type that elderly people experience.
Fear of Crime
More women will become widows after the age of 65 compared to men over the age of 65.
This is mainly due to women living longer than men.
78% of men over the age of 65 were married whereas only 56% of women over the age of 65 were married (U.S. Census Bureau, 2004).
Due to men dying earlier than women, this means that men still alive have a larger "selection" of women (i.e., skewed sex ratio).
Older men are 8 times more likely to remarry than women! They also are more likely to remarry younger women.
78% of women over 85 were widowed whereas only 35% of men over 85 were widowed. As you can see the gap increases as people age (Census, 2004).
Women report that they "prepare" for widowhood. Men....not so much.
Has always happened, but did not really start being publicly discussed until the 1970s. Often mentioned in a "comedic light"
Like all types of abuse, a large portion of the abuse will never be reported.
Common reasons that abuse is not reported : shame, guilt, embarrassment, fear, lack of authority, dependency on abuser.
The "typical" abused elderly person is a White, widowed, female over the age of 75 that is in poor physical health.
Elder abuse :
intentional acts or behavior that harms the person physically or psychologically.
Elder Neglect :
unintentional behaviors that harm an elderly person. Typically refers to malnourishment or forgetting to take care of the person.
The most common elder abuser is the spouse of the victim. This pattern of behavior may not be new (i.e., it could have been occurring their whole marriage).
Elder Abuse and Neglect
Suspected Reasons for Abuse
Environmental Factors :
outside variables that cause additional stress. Examples include finances, living conditions, relationship issues, drug use, taking care of both elderly parents and children.
Dependency :
the most abused elderly people are typically in the worst health and highly depend on their caregivers. This higher level of care often causes the caregiver to become angry or resentful which influences abusive behavior.
Past relationships :
Elderly parents who abused their children often experience "karma" when the abused children become the caregivers.
Caregiver deficiencies :
caregivers that have psychotic tendencies, extreme antisocial disorders, substance abuse problems, or who are ill themselves often make abusive caregivers (intentional or not)
Chance of being reported/arrested
Death and Dying
Death is commonly viewed as a taboo subject.
Since so many people avoid talking about the taboo subject, little people are equipped to cope with death.
Research shows that middle - aged people are most afraid of death whereas people aged 65 - 74 were the least afraid of dying (Kastenbaum, 1992).
Elderly people come to terms with death by talking and thinking about it often.
The most religious and irreligious are the least likely to fear death (Kalish, 1985).
Stages of Death
Trajectory of Dying :
the death process measured by duration and shape.
relates to time whereas
refers to the "status". The duration of death could be fast or slow whereas the shape references patterns of recovery or decline.
Familiar Lingering pattern :
dies slower than expected
Short - reprieve pattern :
patient remains "stable" longer than expected.
Abrupt - surprise trajectory :
the patient is expected to improve but suddenly dies.
Suspended Sentence :
when the patient is sent home and lives for years in long term care.
Entry - reentry :
continually going between home and hospital.
Terminal Decline
Terminal Decline :
medical term describing that they patient's has started shutting down. There is no chance of recovery once this starts.
Ways to identify terminal decline :
reduction in movement, communication, interest in eating or drinking, body temperature, blood pressure, and circulation. The patient eventually becomes paler as the circulation decreases.
Agonal Phase :
the most common symptoms are hitched breathing and muscular spasms. These typically give the appearance that the patient is seizing.
Clinical Death :
The brain, heart, circulation, and breathing have all stopped. This is prior to "time of death" where the person could potentially be resuscitated. This is a very small time frame (minutes at most).
Mortality :
Time of Death has been announced and there is no chance of resuscitation.
As technology has improved, we have become better at restoring vital signs for people that experience clinical death. Unfortunately, most of the time this causes additional stress on the loved ones. Why is this?
Brain Death :
newer term to better establish death and when medical intervention should cease. The key measurement is "irreversible cessation in the brain and the brain stem".
Persistent Vegetative State :
the cerebral cortex (brain) is no longer producing EEG waves, but the brain stem (spinal cord) is still active. Is this similar to reflex responses after death or is the person truly still alive?
It is very important to maintain realistic, scientific perspectives when it comes to patients experiencing brain death. The chances of full resuscitation is slim to none and almost every case involves the person requiring artificial respiration the rest of their life.
Stage Theory of Dying
Stage theory of dying :
theory that argues people come to terms with death in multiple stages.
What about people that die suddenly? What about people who enter a coma before dying?
Little research support
Viewed as too broad
Rights of People Dying
Should patients not be told if they are dying?
Is this an issue with people under 65 who are dying?
Responses to being told (or not) depends on how the person views death.
The general trend is for there to be complete transparency between doctor and patient.
Passive Euthanasia :
allowing the person to die naturally
Assisted Suicide / Active Euthanasia :
when a medical professional terminates life intentionally
The public is becoming more accepting of euthanasia
Coping with death
Society is less shocked when an older person dies (Harris, 2007)
Older people "prepare" for the death of their friends and family. They even prepare for their own death.
Bereavement overload :
occurs when older people experience multiple people dying in a short time together.
It is even argued that older people may never finish grieving death when all of their social network starts slowly passing away
Funerals are symbolic and functional aspects of society that help people cope with death.
Stereotypes of the elderly
Ageism =
termed by Robert Butler. Similar to racism and sexism, but focused on age. Ageism occurs when people have strong, negative reactions towards the elderly.
In one media sample, the elderly were only represented 8% of the time (Hajjar, 1997).
What do they advertise? Medicine, insurance, Life-Alert, Adjustable Mortgage Loans
Ageist beliefs are so strong that the elderly often support and believe the negative beliefs.
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