Exam 6 - later life Flashcards
1
Q
What happens when birth rates decline
A
the median age of nation rises
2
Q
People link old age with
A
physical and mental decline
3
Q
Who is guilty of ageism
A
everyone young and old
4
Q
Positive qualities of old age
A
- Seen as better handling conflict resolution
- seen as less powerful - but seen as more gifted storyteller’s and wise
5
Q
Median age
A
The age at which 50 percent of a population is older and 50 percent is younger.
6
Q
Ageism
A
Stereotypic, intensely negative ideas about old age.
7
Q
Cognitive abilities that get better with age
A
- Expanding crystallized skills
- Wiser
8
Q
Divided-attention tasks
A
A difficult memory challenge involves memorizing material while simultaneously monitoring something else.
9
Q
Memory with age
A
declines
10
Q
Worldview on older vs younger people memory
A
Young people: due to external forces
Old people: Mental decline or memory illness
11
Q
Are older people’s memory abilities much worse than younger adults?
A
Yes
12
Q
As memory tasks get more difficult
A
the performance gap between young and old expands
13
Q
Remembering in old people gets worse when they need to remember
A
- Come up with word or name on their own
- Recall a face or name and link it to a specific context
14
Q
Elderly do poorly on what memory challenge
A
divided-attention tasks
15
Q
Memory demands + time pressures =
A
deficits in the late 20s
16
Q
Gateway system that transforms information into permanent storage
A
working memory
17
Q
What is working memory made of
A
Executive processor -
- controls our attention
- transforms contents of temporary storage
18
Q
Working memory as we age
A
- Improves during childhood
- Declines after 21
19
Q
Why does working memory decline?
A
- Loss of synaptic plasticity in the hippocampus
- Deficits with the executive processor
- Exceptional trouble mastering divided-attention tasks
- Deterioration in the frontal lobe
20
Q
When older people memorize easy tasks
A
they have a broader pattern of frontal lobe activity
21
Q
When older people memorize harder tasks
A
they have under activation in frontal lobe
22
Q
Memory-system perspective
A
A framework that divides memory into three types:
- Procedural
- Semantic
- Episodic memory.
23
Q
Procedural memory
A
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.
24
Q
Semantic memory
A
In the memory-systems perspective, a moderately resilient (long-lasting) type of memory; refers to our ability to recall basic facts.
25
Episodic memory
In the memory-systems perspective, the **most fragile type** of memory, involving the **recall of the ongoing events of daily life.**
26
Memory-system perspective’s **3 basic types of memory**
1. **Procedural** memory
2. **Semantic** memory
3. **Episodic** memory
27
**Older people** do just as **well as young people** with **what type of memory**
semantic
28
**Why** do people **expect** **older people to outperform young people** at **crystallized verbal challenges**
**semantic** memories stay **intact until later life**
29
Why is **procedural memory is most resilient**
**different** region of the **brain from frontal lobe**
30
*Baltes* **three-step process of memory**
1. **Selectively focus** on what you want to remember
2. Work hard to **manipulate material in the system into permanent memory**
3. Use **external memory aids**
31
**If** people **depend** too heavily **on extremal memory aids**
**memory gone** when aid gone
32
People remember
**emotional stimuli best**
humans are biologically prime to be acutely sensitive to social cues
33
Mnemonic techniques
A strategy for **aiding memory**, often by using imagery or enhancing the **emotional meaning of what needs to be learned**.
34
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.
35
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**.
36
Positivity affect
The tendency for **older people to focus on positive experiences** and **screen out negative events**.
37
Why **memory varies in puzzling ways**
we **learn emotionally important information without effort**
38
When asked to **recall self-defining events in personal autobiographies the elderly**
performed better than the young
39
Labeling a **test as measuring memory**
**impairs older person performance** on any cognitive test
40
*Carstensen* view on the **first half of adult life**
our **push is to look to the future**
41
*Carstensen* view on the **second half of adult life**
**Focus on making most of every moment**
happiest life stage
42
**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**
43
When we **see our future is limited**
1. cut **down on social contacts**
2. **spend time with people** we care about the most
44
**Elderly perform** better when **asked to recall**
**happy versus sad images** and faces
45
**Young people recall more happy** faces and images **when**
primed to **expect a limited future**
46
**Boredom in old** age
**not common**
older people motivated to engage in challenging flow
47
**Why** do **older people live stress-free lives**
1. Fewer daily stress
2. The outside world treats you with special care
3. Focus on doing what makes them happy
48
**Erosion of U.S retirement as life stage** is destined to
impair **emotional quality of old age**
49
**Happiness peak**s in
late 60s
50
Integrity
Erik Erikson’s eighth psychosocial stage, in which elderly people decide that their **life missions have been fulfilled** and so accept impending death.
51
Social Security
The U.S. government’s **national retirement support program.**
52
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.
53
Bridge jobs
When a **retiree takes new work**, often part-time, **after retiring** from a career job.
54
**Well-being declines** rapidly during
**old-old** years
55
Erickson’s **psychosocial stage of late adulthood** (late 60+)
Integrity vs. despair
56
**5** things that operate as a **self-fulfilling prophesy predicting longer life**
1. Feeling **fulfilled in life**
2. **Optimistic** view of **aging**
3. Live **generative life**
4. **Open to other** people
5. Remain **lovingly attached**
57
**3 Places retirement no** longer **exists**
- **no government-financed programs** that created retirement
1. Bangladesh
2. Jamaica
3. Mexico
58
**German** **retirement** worry from
live in a **rapidly aging** nation where the **government may cut back on funds**
59
**German retirees** had **more**
**spending power** into **old** age
60
**U.S age** group to **less** likely **to live under** the **poverty line**
**65+**
- due to social security
61
The role of **private pensions in financing retirement reflect**
**priority US places** on individual initiative
62
Average **retirement nest egg**
$127,000
63
**21st** century **age and work change**
**2 in 5** adults **over 65** still **working**
64
More than **50% of retirees have**
**bridge jobs**
- hard to live on meager allotment social security provides
65
Age discrimination
**Illegally laying off workers** or failing to hire or promote them on the **basis of age.**
66
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.
67
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.
68
Widowhood mortality effect
The **elevated risk of death** **among surviving spouses** after being widowed.
69
**Age discrimination** in the **US**
**illegal but hard to prove**
- encourage retirement via special buyout
70
Workers **disengage emotionally from jobs when**
* **identify with negative stereotypes** attached to “older workers”
* **Feel discriminated against** at work
71
**Positive** of **wanting to work longer**
1. **Love** their **jobs**
2. **Feel good** in careers
72
**Retirement** **for** **educated** workers
**boost health**
- if not forced out
73
What **builds retirement happiness**
1. Be
1. **open to experience**
2. **conscientious**
3. **agreeable**
4. **extraverted**
2. **Don’t** be **neurotic**
3. **Flow-inducing** life plan
74
**Social policy retirement issues**
1. **Retirement** is an **at-risk life stage**
2. **Older workers** are (currently) an **at-risk group**
3. Many **older people** are **more at risk of being poor**
4. **Intergenerational equity**
75
Most **tragic life change**
**death of spouse**
76
The **first month after** a **loved one dies**
1. people **obsessed with events surrounding the final event**
2. **Clear-cut attachment** response **reemerges**
77
**After widowhood well-being**
rose
78
**Why** does **well-being rise of widowhood**
**people notice they can cope on their own**
- sense of self-efficacy
79
**Widowed** have **higher**
1. **depression** rates
2. poor **quality of life**
80
Most **acute pain in humans**
loneliness
81
What is the **cure for loneliness**
forcing yourself to **establish regular routine**
82
**Loneliness ease in collectivist** cultures
**family support**
or
**moving** in **with children**
83
Most **important in deterring how people adjust**
friends
84
Newly **widowed people** and **support groups**
should **not be told to go unless having trouble dealing with it**
85
**Main widowed women concerns**
financial
86
**Widowed men concerns**
**loneliness**
- higher chance of finding a new partner
87
**Widowed people** who are **insecurely attached are primed** **to feel**
**unsupported** by even most caring children and friends
88
**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**
89
**Living** in an area **with** a **high concentration of widowed people**
= odds of dying reduced
90
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**
91
Normal aging
The universal, often **progressive signs, of physical deterioration** intrinsic to the aging process.
92
Chronic disease
When **normal aging** changes **happen at the extreme**
93
ADL (Activities of daily living problems)
**Difficulty in performing everyday tasks** that are **required for living independently**. ADLs are classified as either
1. basic
2. instrumental.
94
Instrumental ADL problems
**Difficulty in performing everyday household tasks**, such as cooking and cleaning.
95
Basic ADL limitation
**Difficulty in performing essential self-care activities**, such as rising from a chair, eating, and getting to the toilet.
96
**Top-ranking chronic illness** in **later life**
arthritis
97
**Chronic diseases interfer**e with
ADL
98
**ADL limitation** categories
1. **Instrumental** ADL problems
2. **Basic** ADL limitations
99
**ADL problems** strike **at age**
**old-old** years (90+ problems)
100
Most **humans live until**
100
101
“Super-centenarians”
people who **live passed 110 Y.O = 75 people**
102
**Rats** can **live longer if**
**given undernutrition without malnutrition**
- increase lifespan 60%
103
All-purpose **anti-ager**
**calorie restriction**
1. Glucose metabolism
2. Cardiac function
104
**Why** is **calorie restriction** an **anti-ager**
a side effect of diabetes causes **every organ to prematurely break down**
105
**Why can’t** we **live to 200**
1. There **isn’t** a single **magic-bullet intervention that stops aging**
2. Our **body’s evolutionary expiration date is naturally set** well below a century
106
**4 Cons** of **lifespan extension**
1. May **only** be **available for rich**
2. **Costs** too **much**
3. Makes **surfing less sweet**
4. **Live with ADL** impairments longer
107
Socioeconomic health gap
The worldwide **disparity between** the **health of the rich and poor.**
108
health span
The number of **years people can expect to live without ADL problems**.
109
Senescence
Overall **growth stops and aging beginnings**.
Sometime in the **early 20s**
110
What **predicts how long we live**
1. **socioeconomic** status
2. **gender**
3. Level of **education**
4. Nurturing **close relationships**
111
**Rich vs poor and life expectancy** the USA
* **Rich** = **rose by 3** years
* **Poor** = **barely** moved
112
**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
113
People **show clear differences in aging rates by**
late 30s
114
**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**
115
**Life-expectancy** at **poverty level differences**
**Live** in **higher average home values** = tend to **live longer**
116
Telomere shortening
overall **benchmark of body aging**
117
**High school** graduates vs **college students telomere**
**High school grads have shorter telomeres** than college students
- especially **black men**
118
**Why** do **women outlive men**
1. Wider web of **social connection**
2. **Extra X chromosome** makes women **physically hardier at every stage of life**
3. **Fewer** early **heart attacks**
119
**Women** worldwide **pattern of old age**
**surviving longer** but **being frailer**
120
**Women** have a **higher rate of**
1. Arthritis
2. Vision impairments
3. Obesity
121
list the **four abnormalities** that **occur in** an **Alzheimer’s patient’s brain.**
1. beta-amyloid protein plaques.
2. tangles of tau.
3. loss of connecting neurons among brain cells.
4. brain inflammation.
122
Presbyopia
is an age-related **midlife difficulty** **with near vision** caused **by the inability of the lens to bend.**
123
Lens
A **transparent, disk-shaped structure in the eye**, which bends to allow us to see close objects.
124
Cataract
**age-related lens clouding** becomes so pronounced that the person’s **vision is seriously impaired**
125
Macular degeneration
**deterioration of the receptors** promoting central vision
126
Glaucoma
a **buildup of pressure** that can **damage the visual receptors**
127
**Combating chronic disease**
1. Focus on **children**
2. Focus on **construction caring communities**
128
**Body shape changes** in **older** adults
may disturb but **not significantly impact the quality of life.**
129
**Aging affects** our **eyesight during**
middle life
130
**Age-related changes** in **vision**
1. Trouble seeing in **dim light**
2. Bothered by **glare**
3. Bothered by **direct beam if a light**
4. Can’t **distinguish** certain **colors**
131
**Presbyopia caused** by
lens **thinning and develops impurities** allowing it to no longer bend
132
**Old-age** **vision** **conditions**
* Curable
1. Cataracts
* Incurable
1. Macular degeneration
2. Glaucoma
3. Diabetic retinopathy
133
**Cons** of **losing sight**
1. Prime **cause of ALD impairments**
2. Risk **factor for falling**
3. **Not leaving home** because of fear
134
How to **help others with vision impairment**
1. Encouraged to **visit low vision center**
2. Offer **vision aids at a younger** age
135
Hearing loss predicts
later physical decline
136
Presbycusis
**Age-related difficulty in hearing**, particularly **high-pitched tones**, is caused **by the atrophy of the hearing receptors** located in the inner ear.
137
Diabetic retinopathy
**leakage** from the **blood vessels of the retina** into the body of the eye
138
Elderspeak
**Communication style** is used when an **older person looks frail and impaired**, involving **talking loudly and slowly**, as if with a baby.
139
Reaction time
The **speed** at which a **person** can **respond to a stimulus.**
140
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**.
141
Osteoarthritis
the **joint cartilage wears away**
142
**Why** **hearing loss predicts physical decline**
makes **hard for us to lovingly connect**
143
**More likely** to **develop hearing loss** in midlife
men
144
**Hearing problems over** the **years**
1. **Reduced** in recent years **to government regulations in the work environment**
2. May **rise in future due to** modern **technology**
145
**Affects people's ability to** quickly **process speech** =
presbycusis + neural declines
146
The **best environment for a hearing-impaired** person
1. **Avoid** places with **low ceilings or bare floors**
2. Install **wall-to-wall carpeting**
3. Get **rid of noisy appliances**
147
**How** to **speak** **to** a **hearing-impaired person**
1. Clearly and slowly
2. Face person
3. Use gestures
4. Avoid elder-speak
148
**Solutions** for the **hearing impaired**
1. **Assistive devices** available in public venues
2. **Hearing aid**
149
**Why no hearing aid**
1. **Too lazy** - hearing bad but not that bad
2. Looking **old**
3. Bothersome, expensive, and difficult to adjust
150
**Why** are **old people slower**
**Lost** in **information processing speed**
151
More **susceptible to osteoporosis**
**women** in **old-old** age group
152
The primary **reason for** needing to **enter a nursing home**
osteoporosis
153
Main **risk factor for falling**
**frailty**
- divided attention
154
Improve later life mobility
1. Exercise
2. Playing video games
155
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.)
156
Vascular Neurocognitive disorder or vascular dementia
A type of **age-related cognitive disorder** caused **by multiple small strokes.**
157
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.
158
Senile plaques
Thick, bullet-like **amyloid-laden structures that replace normal neurons** and are **characteristic of Alzheimer’s disease**.
159
Amyloid
a **fatty substance** that is the **basic constituent of the senile plaques**
160
Tau-p
produced by a **toxic form of amyloid**, that internally **sets off the tangles and neural decay**
161
**Home mod**ifications for **older people**
1. High-quality **indirect lighting**
2. **Wall to wall** **carpeting**
3. **Grab bars** in tubs
4. A cabinet door that **opens to touch**
5. Shelves within **easy reach**
162
The main **barrier to living independently in later life**
**lower body impairments**
163
Distinguish **between minor and major NCD**
**minor form = thinking problem**
- but don’t prevent indecent living
164
**Cognitive decline in NCD**
1. **forget basic semantic** information
2. **impairments** in **executive functions**
3. Extravert **withdraw from the world**
4. **Conscientious people** behave erratically
165
**How** long does **decline by NCDs take**
Time from **diagnosis to death 4 - 10 years**
166
**Pros** of **NCDs**
**Mental impairments of advanced old age**
- not whole life
167
What **conditions produce NCDs**
being **diagnosed with**
1. **Alzheimer’s disease**
2. **vascular neurocognitive disorder**
168
**Promote neural loss**
vascular problems
169
**Chances** of getting **Alzheimer’s**
1. **Old old** years
2. **Two copies of APOE-4 Marker** = symptoms at 68
3. Adults with **subjective cognitive decline and mild cognitive impairments**
170
**Pros and cons** of being **tested for Alzheimer's gene**
* Pros:
1. knowing
* Cons:
1. Insurances companies dropping you
2. Doesn’t mean you will get it
171
Medicare
the **U.S. health insurance system for the elderly** pays only for services defined as cure-oriented
172
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.**
173
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.
174
Assisted-living facility
**Elderly housing option** providing care for people with **disabilities that,** while significant**, do not require a nursing home**.
175
Day-care programs
Center offering activities and a **safe place to go during the day for impaired older adults** living with relatives.
176
Home health services
**Nursing-oriented help** is provided **in the home of an impaired adult.**
177
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**.
178
Certified nurse assistant or aide
The **main hands-on care provider** in a nursing home who helps **elderly residents with basic ADL problems.**
179
Preventing Alzheimer’s
**limit buildup of amyloid plaque** while healthy
180
Excellent **predictor of Alzheimer's**
1. measuring **amyloid and tau-p levels in cerebrospinal fluid**
2. MRIs assessing **brain gray matter and volume**
3. Blood tests to **measure protein**
181
What helps **slow Alzheimers**
being **well educated but decline faster** once get the disease
182
External **aids** **for** those with **Alzheimer's**
1. Note cards
2. Shoes right next to socks
3. double lock or put buzzers on doors
4. deactivate dangerous appliances
5. Put toxic substances out of reach
183
**2 Caregiver goals** for those with **Alzheimer’s**
1. Protect people and keep them **functioning as well as possible for as long as possible**
2. Be **caring** and offer a **loving support**
184
**Caregiving** in the **past**
the **oldest generation** would **live with** the **younger generation**
185
**Collectivist cultures** turning to which **model for elderly care**
the western model of **nursing homes**
186
**Scandinavian** countries **elder care**
**gov**ernment funding **home health services**
187
Choices of older people in the **USA instead of nursing home**
1. **Continuing-care retirement** community
2. **Assisted-living** facility
3. **Day-care** programs
4. **Home health** services
188
**Why** people **don’t want assisted-living and continuing-care facilities**
1. Feeling **too old**
2. Maybe **poisonous group status hierarchies**
3. People only have the **option of selecting continuing care if they are deathly**
189
Type of people **entering nursing homes mostly**
being **very old and women**
190
What **causes people to enter nursing homes**
1. **incapacitating event**
2. **dementing disease**
3. If a **network of attachment figures is available for care**
191
Who is **paying mostly for nursing homes**
medicaid
192
**Cons** of **living in a nursing home**
1. Medicare **requires two to a room**
2. Have **no control over day-to-day**
3. Can get **mistreated or abused**
193
**Cons** of **working in a nursing home**
1. **Hazardous** to caregivers
2. **Poverty-level** wages
3. **Understaffed**
194
**Pros** of **working in nursing homes**
1. Enormous **gratification**
2. Chance to **make a difference**
3. Pride in **stamina and skill**
4. Feeling **close to people**
5. **Generative** job
195
What **basic human drive** is **important at old-old age**
autonomy
196
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**:
1. denial
2. anger
3. bargaining
4. depression
5. acceptance.
197
The **3 pathways to death**
1. Death occurs **suddenly**
2. Death occurs after **a steady decline**
3. Dying is a **long and erratic process**
198
Most **common pathway to death**
long and erratic process
199
**19th**-century **death pattern**
* quickly
* Everyday norm
200
What **changed** the **pattern of death in** the **19th century**
modern **medical science**
201
**20th**-century **death pattern**
1. In **hospitals and nursing homes**
2. **Disconnected from life**
3. **Never discussed**
202
**Hmong** culture on **when one dies**
* **Never** **talks** about **dying**
* **Four-day funeral** solely to care for and prepare the body
203
*Kübler-Ross* stages **theory of dying stages**
1. **A**nger
2. **D**enial
3. **A**cceptance
4. **D**epression
5. **B**argaining
204
*Kübler-Ros*s **stages of dying criticisms**
1. Terminally ill patients often **don’t want to fully discuss their situation**
2. **Truth better** but **don’t cause pain**
3. Terminally ill patients often **don’t want to fully discuss dying to protect attachment relationships**
205
**Why** was *Kübler-Ross* **wrong**
people **don’t pass** through getting **over death in a stage-to-stage way**
206
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.**
207
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.**
208
More **realistic view on facing the death of a loved one**
**complicated clustering of intellectual and affective states**
- some fleeting
209
When people are **close to death** what **emotion is most strong**
hope
210
**Older** people **view on death**
because approbate at their age
## Footnote
**- don’t show avoidance to death-related words**
211
What do most **religions** have in **common in terms of death**
1. death should be **celebrated after a long life**
2. Death should be **peaceful**
3. Death should **happen in the homeland**
212
**Guidelines** to a **good death in 21st** century
1. **Minimize physical distress**
2. **Maximize psychological security** - feel in control of how we die
3. **Enhance** our **relationships and be emotionally close to people** we care about
4. **Foster our spirituality** and believe there was integrity and purpose to our loves
213
Main **dimension** related to **feeling comfortable about dying**
sense of **purpose in life**
214
The **first stage of grieving** - first few months
absorbed in **mourning**
215
The **second stage of grieving** - after 6 months
recover in **sense of reconnecting to the world**
216
**Grief patterns** are **shaped by**
each **culture’s unique norms**
217
**Emotions** of a **child’s death**
1. survivor guilt
2. Disbelief
3. Failure
218
**Parents of child death** apt to get **partial closure if**
1. **discuss** what is **happening with a child during the final weeks**
2. Finding **new meaning in one’s disrupted life story**
3. Finding **“social support”**
219
**How** to keep the **marriage alive after the death of a child**
1. Keep a **connection to loved ones strong**
2. **Don’t force conversation**
3. **Draw on** your **memories**
220
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.
221
Palliative care
Any **intervention** is **designed not to cure illness** but to **promote dignified dying.**
222
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**
223
The **problem** of **using dying trajectory**
**death is unpredictable** so trajectory is inaccurate and makes death harder
224
**Accuracy** of healthcare workers **predicting death**
50-50
225
**5** things **family** members **and patients want in hospitals**
1. want **caring & respectful nurses**
2. **Respected** as a dignified human being
3. **Response quick**ly
4. To be **greeted**
5. **Give families times** when the doctors are available
226
**Physicians goal** in hospital
to **cure living patients not care for families**
227
**Palliative care includes**
* **Educating** healthcare personnel about **dealing with patients**
* **Modifying hospital structure**
228
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**.
229
Palliative-care service
A service or **unit in a hospital** that is **devoted to end-of-life care.**
230
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.
231
**End-of-life care** **instructions** include
* Best drugs to **ease pain without “knocking patient out”**
* **Ethics** **of withdrawing** treatment
232
Most **healthcare professionals want training in**
how to **deal with dying patients**
233
**Pros** of **palliative-care services**
1. Doctors feel the **job is calling**
2. A better way to **control one's pain**
234
**Hospice** workers **job description**
1. **Minimize** patient's **physical discomfort**
2. Provide a **humanistic supportive psychological environment**
3. Providing **counseling after death to loved ones**
235
**Hospice caregiver’s primary** concerns
1. **Getting** loved **ones addicted**
2. Finial **powerful opioid will kill loved one**
236
**Cons** of **hospice**
1. Facing a **terminal disease**
2. African Americans may **fear hospice will quicken death**
3. Want to **spend dying hours with people who share the same religion**
4. **No privacy**
237
**Pros** of **hospice**
1. Can still **receive curable care**
2. If not by loved ones - **free from guilt**
3. Privacy to **vent feeling**
4. **Avoid the embarrassment** of depending on loved ones
238
What **2** strategies do **people use to promote “good death”**
1. People should **make their dishes know - will**
2. People should **be allowed to get help if they want to end their lives**
239
Advance directive
Any **written document spelling out instructions with regard to life-prolonging treatment** if individuals become irretrievably ill and cannot communicate their wishes.
240
Passive euthanasia
**Withholding potentially life-saving interventions** that might keep a terminally ill or permanently comatose patient alive.
241
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.
242
Active euthanasia
A **deliberate health-care intervention** that **helps a patient die.**
243
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.
244
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.
245
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.**
246
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.**
247
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.**
248
4 **types** of **advance directives**
* Individual drafted
1. **Living will**
2. Durable **power of attorney** for health care
* Surrogate - filled out by others when a person is seriously mentally impaired
1. Do Not **Resuscitate** (DNR) order
2. Do Not **Hospitalize** (DNH) order
249
**Problems** of **advance directives**
* Not common - people **don’t want to talk about death**
* Living wills are **often too vague**
250
The **best advance directive** is
durable **power of attorney** for health care
251
**Where** is **active euthanasia legal**
1. Belgium
2. Luxembourg
3. Netherlands
252
**8** places **where** is **physician-assisted suicide legal**
1. Switzerland
2. Germany
3. Canada
4. Oregon
5. Montana
6. Vermont
7. California
8. Washington
253
**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**
254
**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.
