Exam 6 - later life Flashcards
What happens when birth rates decline
the median age of nation rises
People link old age with
physical and mental decline
Who is guilty of ageism
everyone young and old
Positive qualities of old age
- Seen as better handling conflict resolution
- seen as less powerful - but seen as more gifted storyteller’s and wise
Median age
The age at which 50 percent of a population is older and 50 percent is younger.
Ageism
Stereotypic, intensely negative ideas about old age.
Cognitive abilities that get better with age
- Expanding crystallized skills
- Wiser
Divided-attention tasks
A difficult memory challenge involves memorizing material while simultaneously monitoring something else.
Memory with age
declines
Worldview on older vs younger people memory
Young people: due to external forces
Old people: Mental decline or memory illness
Are older people’s memory abilities much worse than younger adults?
Yes
As memory tasks get more difficult
the performance gap between young and old expands
Remembering in old people gets worse when they need to remember
- Come up with word or name on their own
- Recall a face or name and link it to a specific context
Elderly do poorly on what memory challenge
divided-attention tasks
Memory demands + time pressures =
deficits in the late 20s
Gateway system that transforms information into permanent storage
working memory
What is working memory made of
Executive processor -
- controls our attention
- transforms contents of temporary storage
Working memory as we age
- Improves during childhood
- Declines after 21
Why does working memory decline?
- Loss of synaptic plasticity in the hippocampus
- Deficits with the executive processor
- Exceptional trouble mastering divided-attention tasks
- Deterioration in the frontal lobe
When older people memorize easy tasks
they have a broader pattern of frontal lobe activity
When older people memorize harder tasks
they have under activation in frontal lobe
Memory-system perspective
A framework that divides memory into three types:
- Procedural
- Semantic
- Episodic memory.
Procedural memory
In the memory-systems perspective, the most resilient (longest-lasting) type of memory;
refers to material, such as well-learned physical skills, that we automatically recall without conscious awareness.
Semantic memory
In the memory-systems perspective, a moderately resilient (long-lasting) type of memory; refers to our ability to recall basic facts.
Episodic memory
In the memory-systems perspective, the most fragile type of memory, involving the recall of the ongoing events of daily life.
Memory-system perspective’s 3 basic types of memory
- Procedural memory
- Semantic memory
- Episodic memory
Older people do just as well as young people with what type of memory
semantic
Why do people expect older people to outperform young people at crystallized verbal challenges
semantic memories stay intact until later life
Why is procedural memory is most resilient
different region of the brain from frontal lobe
Baltes three-step process of memory
- Selectively focus on what you want to remember
- Work hard to manipulate material in the system into permanent memory
- Use external memory aids
If people depend too heavily on extremal memory aids
memory gone when aid gone
People remember
emotional stimuli best
humans are biologically prime to be acutely sensitive to social cues
Mnemonic techniques
A strategy for aiding memory, often by using imagery or enhancing the emotional meaning of what needs to be learned.
Socioemotional selectivity theory
A theory of aging (and the lifespan) was put forth by Laura Carstensen, describing how the time we have left to live affects our priorities and social relationships. Specifically, in later life people focus on the present and prioritize being with their closest attachment figures.
The paradox of well-being
The fact that despite their physical and mental losses, the elderly report being just as happy and often happier than the young.
Positivity affect
The tendency for older people to focus on positive experiences and screen out negative events.
Why memory varies in puzzling ways
we learn emotionally important information without effort
When asked to recall self-defining events in personal autobiographies the elderly
performed better than the young
Labeling a test as measuring memory
impairs older person performance on any cognitive test
Carstensen view on the first half of adult life
our push is to look to the future
Carstensen view on the second half of adult life
Focus on making most of every moment
happiest life stage
Social priority shifts throughout life
- During childhood and adolescence and emerging adulthood = mission to leave attachment figures
- Once life goes achieved = less interested in developing new attachments
When we see our future is limited
- cut down on social contacts
- spend time with people we care about the most
Elderly perform better when asked to recall
happy versus sad images and faces
Young people recall more happy faces and images when
primed to expect a limited future
Boredom in old age
not common
older people motivated to engage in challenging flow
Why do older people live stress-free lives
- Fewer daily stress
- The outside world treats you with special care
- Focus on doing what makes them happy
Erosion of U.S retirement as life stage is destined to
impair emotional quality of old age
Happiness peaks in
late 60s
Integrity
Erik Erikson’s eighth psychosocial stage, in which elderly people decide that their life missions have been fulfilled and so accept impending death.
Social Security
The U.S. government’s national retirement support program.
Private Pensions
The major source of nongovernmental income support for U.S. retirees, in which the individual worker and employer put a portion of each paycheck into an account to help finance retirement.
Bridge jobs
When a retiree takes new work, often part-time, after retiring from a career job.
Well-being declines rapidly during
old-old years
Erickson’s psychosocial stage of late adulthood (late 60+)
Integrity vs. despair
5 things that operate as a self-fulfilling prophesy predicting longer life
- Feeling fulfilled in life
- Optimistic view of aging
- Live generative life
- Open to other people
- Remain lovingly attached
3 Places retirement no longer exists
- no government-financed programs that created retirement
- Bangladesh
- Jamaica
- Mexico
German retirement worry from
live in a rapidly aging nation where the government may cut back on funds
German retirees had more
spending power into old age
U.S age group to less likely to live under the poverty line
65+
- due to social security
The role of private pensions in financing retirement reflect
priority US places on individual initiative
Average retirement nest egg
$127,000
21st century age and work change
2 in 5 adults over 65 still working
More than 50% of retirees have
bridge jobs
- hard to live on meager allotment social security provides
Age discrimination
Illegally laying off workers or failing to hire or promote them on the basis of age.
Old-age dependency ratio
The fraction of people over age 60 compared to younger, working-age adults (ages 15 to 59). This ratio is expected to rise dramatically as the baby boomers retire.
Intergenerational equity
Balancing the needs of the young and old. Specifically, often referred to as the idea that U.S. government entitlements, such as Medicare and Social Security, “over-benefit” the elderly at the expense of other age groups.
Widowhood mortality effect
The elevated risk of death among surviving spouses after being widowed.
Age discrimination in the US
illegal but hard to prove
- encourage retirement via special buyout
Workers disengage emotionally from jobs when
- identify with negative stereotypes attached to “older workers”
- Feel discriminated against at work
Positive of wanting to work longer
- Love their jobs
- Feel good in careers
Retirement for educated workers
boost health
- if not forced out
What builds retirement happiness
- Be
- open to experience
- conscientious
- agreeable
- extraverted
- Don’t be neurotic
- Flow-inducing life plan
Social policy retirement issues
- Retirement is an at-risk life stage
- Older workers are (currently) an at-risk group
- Many older people are more at risk of being poor
- Intergenerational equity
Most tragic life change
death of spouse
The first month after a loved one dies
- people obsessed with events surrounding the final event
- Clear-cut attachment response reemerges
After widowhood well-being
rose
Why does well-being rise of widowhood
people notice they can cope on their own
- sense of self-efficacy
Widowed have higher
- depression rates
- poor quality of life
Most acute pain in humans
loneliness
What is the cure for loneliness
forcing yourself to establish regular routine
Loneliness ease in collectivist cultures
family support
or
moving in with children
Most important in deterring how people adjust
friends
Newly widowed people and support groups
should not be told to go unless having trouble dealing with it
Main widowed women concerns
financial
Widowed men concerns
loneliness
- higher chance of finding a new partner
Widowed people who are insecurely attached are primed to feel
unsupported by even most caring children and friends
Predicting spouse’s adjustment to widowhood
by looking at the deceased partner’s quality of life
- Upbeat, happy, highly satisfied with life = resilient after death
Living in an area with a high concentration of widowed people
= odds of dying reduced
3 tracing physical aging principles
Principle #1: Chronic Disease is Often Normal Aging “At The Extreme”
Principle #2: ADL Impairments are a Serious Risk During the old-old Years
Principle #3: The Human Lifespan Has a Defined Limit
Normal aging
The universal, often progressive signs, of physical deterioration intrinsic to the aging process.
Chronic disease
When normal aging changes happen at the extreme
ADL (Activities of daily living problems)
Difficulty in performing everyday tasks that are required for living independently. ADLs are classified as either
- basic
- instrumental.
Instrumental ADL problems
Difficulty in performing everyday household tasks, such as cooking and cleaning.
Basic ADL limitation
Difficulty in performing essential self-care activities, such as rising from a chair, eating, and getting to the toilet.
Top-ranking chronic illness in later life
arthritis
Chronic diseases interfere with
ADL
ADL limitation categories
- Instrumental ADL problems
- Basic ADL limitations
ADL problems strike at age
old-old years (90+ problems)
Most humans live until
100
“Super-centenarians”
people who live passed 110 Y.O = 75 people
Rats can live longer if
given undernutrition without malnutrition
- increase lifespan 60%
All-purpose anti-ager
calorie restriction
- Glucose metabolism
- Cardiac function
Why is calorie restriction an anti-ager
a side effect of diabetes causes every organ to prematurely break down
Why can’t we live to 200
- There isn’t a single magic-bullet intervention that stops aging
- Our body’s evolutionary expiration date is naturally set well below a century
4 Cons of lifespan extension
- May only be available for rich
- Costs too much
- Makes surfing less sweet
- Live with ADL impairments longer
Socioeconomic health gap
The worldwide disparity between the health of the rich and poor.
health span
The number of years people can expect to live without ADL problems.
Senescence
Overall growth stops and aging beginnings.
Sometime in the early 20s
What predicts how long we live
- socioeconomic status
- gender
- Level of education
- Nurturing close relationships
Rich vs poor and life expectancy the USA
- Rich = rose by 3 years
- Poor = barely moved
Life expectancy at birth is defined as when and why
2015 mainly during middle age
- Women = easier death by classic age-related diseases
- Men = uptick in diseases by despair - poisonings, homicides, and accidents
People show clear differences in aging rates by
late 30s
Fetal programming hypothesis
The accelerated aging path emerges in the womb
- Low birth weight - linked to poverty = associated with premature heart disease and early death
Life-expectancy at poverty level differences
Live in higher average home values = tend to live longer
Telomere shortening
overall benchmark of body aging
High school graduates vs college students telomere
High school grads have shorter telomeres than college students
- especially black men
Why do women outlive men
- Wider web of social connection
- Extra X chromosome makes women physically hardier at every stage of life
- Fewer early heart attacks
Women worldwide pattern of old age
surviving longer but being frailer
Women have a higher rate of
- Arthritis
- Vision impairments
- Obesity
list the four abnormalities that occur in an Alzheimer’s patient’s brain.
- beta-amyloid protein plaques.
- tangles of tau.
- loss of connecting neurons among brain cells.
- brain inflammation.
Presbyopia
is an age-related midlife difficulty with near vision caused by the inability of the lens to bend.
Lens
A transparent, disk-shaped structure in the eye, which bends to allow us to see close objects.
Cataract
age-related lens clouding becomes so pronounced that the person’s vision is seriously impaired
Macular degeneration
deterioration of the receptors promoting central vision
Glaucoma
a buildup of pressure that can damage the visual receptors
Combating chronic disease
- Focus on children
- Focus on construction caring communities
Body shape changes in older adults
may disturb but not significantly impact the quality of life.
Aging affects our eyesight during
middle life
Age-related changes in vision
- Trouble seeing in dim light
- Bothered by glare
- Bothered by direct beam if a light
- Can’t distinguish certain colors
Presbyopia caused by
lens thinning and develops impurities allowing it to no longer bend
Old-age vision conditions
- Curable
- Cataracts
- Incurable
- Macular degeneration
- Glaucoma
- Diabetic retinopathy
Cons of losing sight
- Prime cause of ALD impairments
- Risk factor for falling
- Not leaving home because of fear
How to help others with vision impairment
- Encouraged to visit low vision center
- Offer vision aids at a younger age
Hearing loss predicts
later physical decline
Presbycusis
Age-related difficulty in hearing, particularly high-pitched tones, is caused by the atrophy of the hearing receptors located in the inner ear.
Diabetic retinopathy
leakage from the blood vessels of the retina into the body of the eye
Elderspeak
Communication style is used when an older person looks frail and impaired, involving talking loudly and slowly, as if with a baby.
Reaction time
The speed at which a person can respond to a stimulus.
Osteoporosis
An age-related chronic disease in which the bones become porous, fragile, and more likely to break. Osteoporosis is most common in thin women, and so most common in females of European and Asian descent.
Osteoarthritis
the joint cartilage wears away
Why hearing loss predicts physical decline
makes hard for us to lovingly connect
More likely to develop hearing loss in midlife
men
Hearing problems over the years
- Reduced in recent years to government regulations in the work environment
- May rise in future due to modern technology
Affects people’s ability to quickly process speech =
presbycusis + neural declines
The best environment for a hearing-impaired person
- Avoid places with low ceilings or bare floors
- Install wall-to-wall carpeting
- Get rid of noisy appliances
How to speak to a hearing-impaired person
- Clearly and slowly
- Face person
- Use gestures
- Avoid elder-speak
Solutions for the hearing impaired
- Assistive devices available in public venues
- Hearing aid
Why no hearing aid
- Too lazy - hearing bad but not that bad
- Looking old
- Bothersome, expensive, and difficult to adjust
Why are old people slower
Lost in information processing speed
More susceptible to osteoporosis
women in old-old age group
The primary reason for needing to enter a nursing home
osteoporosis
Main risk factor for falling
frailty
- divided attention
Improve later life mobility
- Exercise
- Playing video games
Major neurocognitive disorder or Dementia
The general term for any illness involving serious, progressive cognitive decline that interferes with a person’s ability to live independently. (A minor neurocognitive disorder is a label for a less severe impairment in memory, reasoning, and thinking which does not compromise independent living.)
Vascular Neurocognitive disorder or vascular dementia
A type of age-related cognitive disorder caused by multiple small strokes.
Alzheimer’s disease
A type of age-related cognitive disorder characterized by neural atrophy and abnormal by-products of that atrophy, such as senile plaques and neurofibrillary tangles.
Senile plaques
Thick, bullet-like amyloid-laden structures that replace normal neurons and are characteristic of Alzheimer’s disease.
Amyloid
a fatty substance that is the basic constituent of the senile plaques
Tau-p
produced by a toxic form of amyloid, that internally sets off the tangles and neural decay
Home modifications for older people
- High-quality indirect lighting
- Wall to wall carpeting
- Grab bars in tubs
- A cabinet door that opens to touch
- Shelves within easy reach
The main barrier to living independently in later life
lower body impairments
Distinguish between minor and major NCD
minor form = thinking problem
- but don’t prevent indecent living
Cognitive decline in NCD
- forget basic semantic information
- impairments in executive functions
- Extravert withdraw from the world
- Conscientious people behave erratically
How long does decline by NCDs take
Time from diagnosis to death 4 - 10 years
Pros of NCDs
Mental impairments of advanced old age
- not whole life
What conditions produce NCDs
being diagnosed with
- Alzheimer’s disease
- vascular neurocognitive disorder
Promote neural loss
vascular problems
Chances of getting Alzheimer’s
- Old old years
- Two copies of APOE-4 Marker = symptoms at 68
- Adults with subjective cognitive decline and mild cognitive impairments
Pros and cons of being tested for Alzheimer’s gene
- Pros:
- knowing
- Cons:
- Insurances companies dropping you
- Doesn’t mean you will get it
Medicare
the U.S. health insurance system for the elderly pays only for services defined as cure-oriented
Alternatives to institutionalization
Services and settings are designed to keep older people who are experiencing age-related disabilities that don’t merit intense 24-hour care from having to enter nursing homes.
Continuing-care retirement community
Elderly housing options are characterized by different levels of care. People enter in relatively good health and then move to sections providing more intense help when they grow more disabled.
Assisted-living facility
Elderly housing option providing care for people with disabilities that, while significant, do not require a nursing home.
Day-care programs
Center offering activities and a safe place to go during the day for impaired older adults living with relatives.
Home health services
Nursing-oriented help is provided in the home of an impaired adult.
Nursing homes, or long-term-care facilities
A residential institution that provides shelter and intensive caregiving, primarily to older people who need help with basic ADLs.
Certified nurse assistant or aide
The main hands-on care provider in a nursing home who helps elderly residents with basic ADL problems.
Preventing Alzheimer’s
limit buildup of amyloid plaque while healthy
Excellent predictor of Alzheimer’s
- measuring amyloid and tau-p levels in cerebrospinal fluid
- MRIs assessing brain gray matter and volume
- Blood tests to measure protein
What helps slow Alzheimers
being well educated but decline faster once get the disease
External aids for those with Alzheimer’s
- Note cards
- Shoes right next to socks
- double lock or put buzzers on doors
- deactivate dangerous appliances
- Put toxic substances out of reach
2 Caregiver goals for those with Alzheimer’s
- Protect people and keep them functioning as well as possible for as long as possible
- Be caring and offer a loving support
Caregiving in the past
the oldest generation would live with the younger generation
Collectivist cultures turning to which model for elderly care
the western model of nursing homes
Scandinavian countries elder care
government funding home health services
Choices of older people in the USA instead of nursing home
- Continuing-care retirement community
- Assisted-living facility
- Day-care programs
- Home health services
Why people don’t want assisted-living and continuing-care facilities
- Feeling too old
- Maybe poisonous group status hierarchies
- People only have the option of selecting continuing care if they are deathly
Type of people entering nursing homes mostly
being very old and women
What causes people to enter nursing homes
- incapacitating event
- dementing disease
- If a network of attachment figures is available for care
Who is paying mostly for nursing homes
medicaid
Cons of living in a nursing home
- Medicare requires two to a room
- Have no control over day-to-day
- Can get mistreated or abused
Cons of working in a nursing home
- Hazardous to caregivers
- Poverty-level wages
- Understaffed
Pros of working in nursing homes
- Enormous gratification
- Chance to make a difference
- Pride in stamina and skill
- Feeling close to people
- Generative job
What basic human drive is important at old-old age
autonomy
Stage theory of dying
The landmark theory, developed by psychiatrist Elisabeth Kübler-Ross, that person who is terminally ill progress through five stages in confronting death:
- denial
- anger
- bargaining
- depression
- acceptance.
The 3 pathways to death
- Death occurs suddenly
- Death occurs after a steady decline
- Dying is a long and erratic process
Most common pathway to death
long and erratic process
19th-century death pattern
- quickly
- Everyday norm
What changed the pattern of death in the 19th century
modern medical science
20th-century death pattern
- In hospitals and nursing homes
- Disconnected from life
- Never discussed
Hmong culture on when one dies
- Never talks about dying
- Four-day funeral solely to care for and prepare the body
Kübler-Ross stages theory of dying stages
- Anger
- Denial
- Acceptance
- Depression
- Bargaining
Kübler-Ross stages of dying criticisms
- Terminally ill patients often don’t want to fully discuss their situation
- Truth better but don’t cause pain
- Terminally ill patients often don’t want to fully discuss dying to protect attachment relationships
Why was Kübler-Ross wrong
people don’t pass through getting over death in a stage-to-stage way
Middle Knowledge
The idea is that terminally ill people can know that they are dying yet at the same time not completely grasp or come to terms emotionally with that fact.
Persistent complex bereavement-related disorder
Controversial new diagnosis, appearing in the most recent versions of the American Psychiatric Association’s Diagnostic and Statistical Manual, in which the bereaved person still shows intense symptoms of mourning or an increase in symptoms six months to a year after a loved one’s death.
More realistic view on facing the death of a loved one
complicated clustering of intellectual and affective states
- some fleeting
When people are close to death what emotion is most strong
hope
Older people view on death
because approbate at their age
- don’t show avoidance to death-related words
What do most religions have in common in terms of death
- death should be celebrated after a long life
- Death should be peaceful
- Death should happen in the homeland
Guidelines to a good death in 21st century
- Minimize physical distress
- Maximize psychological security - feel in control of how we die
- Enhance our relationships and be emotionally close to people we care about
- Foster our spirituality and believe there was integrity and purpose to our loves
Main dimension related to feeling comfortable about dying
sense of purpose in life
The first stage of grieving - first few months
absorbed in mourning
The second stage of grieving - after 6 months
recover in sense of reconnecting to the world
Grief patterns are shaped by
each culture’s unique norms
Emotions of a child’s death
- survivor guilt
- Disbelief
- Failure
Parents of child death apt to get partial closure if
- discuss what is happening with a child during the final weeks
- Finding new meaning in one’s disrupted life story
- Finding “social support”
How to keep the marriage alive after the death of a child
- Keep a connection to loved ones strong
- Don’t force conversation
- Draw on your memories
Dying trajectory
The fact that hospital personnel makes projections about the particular pathway to death that a seriously ill patient will take and organize their care according to that assumption.
Palliative care
Any intervention is designed not to cure illness but to promote dignified dying.
How did hospital staff treat patients based on dying trajectory
Would set you a prediction on what pattern that individual was dying and used that to govern how to act
The problem of using dying trajectory
death is unpredictable so trajectory is inaccurate and makes death harder
Accuracy of healthcare workers predicting death
50-50
5 things family members and patients want in hospitals
- want caring & respectful nurses
- Respected as a dignified human being
- Response quickly
- To be greeted
- Give families times when the doctors are available
Physicians goal in hospital
to cure living patients not care for families
Palliative care includes
- Educating healthcare personnel about dealing with patients
- Modifying hospital structure
End-of-life care instruction
Courses in medical and nursing schools are devoted to teaching healthcare workers how to provide the best palliative care to the dying.
Palliative-care service
A service or unit in a hospital that is devoted to end-of-life care.
Hospice movement
A movement, which became widespread in recent decades, focused on providing palliative care to dying patients outside of hospitals and especially on giving families the support they need to care for the terminally ill at home.
End-of-life care instructions include
- Best drugs to ease pain without “knocking patient out”
- Ethics of withdrawing treatment
Most healthcare professionals want training in
how to deal with dying patients
Pros of palliative-care services
- Doctors feel the job is calling
- A better way to control one’s pain
Hospice workers job description
- Minimize patient’s physical discomfort
- Provide a humanistic supportive psychological environment
- Providing counseling after death to loved ones
Hospice caregiver’s primary concerns
- Getting loved ones addicted
- Finial powerful opioid will kill loved one
Cons of hospice
- Facing a terminal disease
- African Americans may fear hospice will quicken death
- Want to spend dying hours with people who share the same religion
- No privacy
Pros of hospice
- Can still receive curable care
- If not by loved ones - free from guilt
- Privacy to vent feeling
- Avoid the embarrassment of depending on loved ones
What 2 strategies do people use to promote “good death”
- People should make their dishes know - will
- People should be allowed to get help if they want to end their lives
Advance directive
Any written document spelling out instructions with regard to life-prolonging treatment if individuals become irretrievably ill and cannot communicate their wishes.
Passive euthanasia
Withholding potentially life-saving interventions that might keep a terminally ill or permanently comatose patient alive.
A durable power of attorney for health care
A type of advance directive in which people designate a specific surrogate to make health-care decisions if they become incapacitated and are unable to make their wishes known.
Active euthanasia
A deliberate health-care intervention that helps a patient die.
Living will
A type of advance directive in which people spell out their wishes for life-sustaining treatment in case they become permanently incapacitated and unable to communicate.
Physician-assisted suicide
A type of active euthanasia in which a physician prescribes a lethal medication to a terminally ill person who wants to die.
Do Not Hospitalize (DNH) order
A type of advance directive inserted in the charts of impaired nursing home residents, specifying that in a medical crisis patients should not be transferred to a hospital for emergency care.
Do Not Resuscitate (DNR) order
A type of advance directive filled out by surrogates (usually a doctor in consultation with family members) for impaired individuals, specifying that if they go into cardiac arrest efforts should not be made to revive them.
Age-based rationing of care
The controversial idea is that society should not use expensive life-sustaining technologies on people in their old-old years.
4 types of advance directives
- Individual drafted
- Living will
- Durable power of attorney for health care
- Surrogate - filled out by others when a person is seriously mentally impaired
- Do Not Resuscitate (DNR) order
- Do Not Hospitalize (DNH) order
Problems of advance directives
- Not common - people don’t want to talk about death
- Living wills are often too vague
The best advance directive is
durable power of attorney for health care
Where is active euthanasia legal
- Belgium
- Luxembourg
- Netherlands
8 places where is physician-assisted suicide legal
- Switzerland
- Germany
- Canada
- Oregon
- Montana
- Vermont
- California
- Washington
Why the death on euthanasia
- Killing violates the religious dictum that only God can give and take life
- Fear that legalizing euthanasia will allow families to “pull the plug” on elderly impaired people
- Can spare the expense of treating seriously disabled citizens
- Not knowing where to draw the line
Arguments in favor of age-based rationing of care
- After a person has lived out a natural lifespan medical care should no longer be oriented to restricting death
- We should not blindly be using each intervention on every person, no matter what that individual’s age.
