final Flashcards

Question

simple visual search

Answer 1

Find the red  X   in group of all black Xs Just looking for the target  Will only differ by one variable (colour)   Uses parallel processing   - Scanning full array of stimuli at once  - Older and younger adults - no differences  - Easier than serial processing; less time

Answer 2

Looking for what is different   The one thing that is a little bit different from the rest   - find the red square in groups of red triangles + black squares   Target had more than one different feature   - Colour AND shape    Relies on serial processing   - Have to focus on colour AND shape  - Target differs from the stimuli by more than 2 features  Both younger and older adults find it harder than simple  - Both do worse   - If you put older adults in simulating environment   - Older adults are then comparable to younger adults  

Answer 3

attentional resources theory | inhibitory deficit hypothesis

Answer 4

Reading words in a box and colored to their respective name Then, reading words in a box which were not colored to their respective name Takes people a lil bit longer in the second condition

Answer 5

Aging reduces available cognitive resources  Older adults have less ability to think, process   Why they aren't so good at cognition related tasks   Very less empirical support/evidence

Answer 6

Aging reduces ability to tune out irrelevant information  Not that they don't have ability - just problem with tuning our irrelevant info   Ex: Gave older adults task - could be really stressed   - Unable to disregard the unimportant info   More evidence to it   Sometimes things get in the way with their ability to tune out the irrelevant info

Answer 7

One of removed the distractions; both adult and children do the same so remove any distraction when doing research on older adults

Answer 8

attentional advantages young adults: - improved functional capacity - faster reaction time - peripheral attention - ability to process rapidly changing stream of info - keeping track of multiple targets - improving useful field of view older adults - newer studies showing benefits as well

Answer 9

Lights present complex visual array - may create confusion for older adults   Merging or yielding to oncoming traffic Island in the road; confusing turns Left turns

Answer 10

Younger drivers - Have faster response times +ve - More like to drink and drive -ve - More likely drive while distracted -ve Older drivers +ve - more experience +ve - self regulate - Avoid driving during rush driver - Or night - Avoid talking on the phone while driving - More likely to leave bigger difference btwn cars - Have more experience, drive more cautiously - ve - difficulty with left turns - Problems/sensitivity with glare - Causes of accidents - ve - difficulty merging or yielding - Problems with field of view - Harder time responding to stimuli on periphery - ------->Ex. Pedestrian crossing

Answer 11

``` under 16 - 17% 16-19 - 47.2% 20-25 - 56.8% 26-35 - 55.3% 36-45 - 49.8% 46-55 - 38.6% over 55 - 16.5% ``` canada avg - 38.7% over 55 age group has lowest alc crash %

Answer 12

biological - changes in vision + reaction time psychology - internal distractions causing anxiety sociocultural - driving necessary to live independently - dependent on driving to b independent - When is it considered time to not be safe to drive anymore - a lot harder to get them to stop driving 

Answer 13

fewer accidents (fatal + non fatal) taking better advatange of training sessions more likely to identify complex situations -> air traffic controllers may also benefit from their greater experience May not be able to react to something as fast, but experience allows them to do their job successfully

Answer 14

How does memory work?   - Starts with stimulus  phonological loop visuospatial scratch pad episodic buffer central executive

Answer 15

Auditory memory  Can recourse information through repeating it over and over

Answer 16

Visual memory  How do I get to your house?   - Go through route in head  

Answer 17

Retrieving information from long term memory  Bring info temporarily into working memory   Working memory keeps info temporarily + ready for use  

Answer 18

Allocated cognitive resources   How to allocate  

Answer 19

encode -> store -> retrieve

Answer 20

Episodic memory   - What did you do last night  Source memory   - Who said what  False memory   - Something that happened but really didn't  Tip of the tongue (names)  - Harder time, recalling simple   Prospective memory   - Remembering to do something in the future   - Important as we age   - Taking medication  

Answer 21

Flashbulb memory  - Really important events ; may not be part of the personal life - Weddings, deaths   Semantic memory   - Words, facts   Procedural memory   - Remember how to do things   - Riding a bike  - Playing piano   - Cooking   Implicit memory   - Memory/info that we take on without actively trying Autobiographical memory    - Whatever is important to our own life  

Answer 22

Confidence that your memory is in good shape   If you have this confidence more likely to do well  

Answer 23

greater self-efficacy -> better memory performance

Answer 24

fear of being judged according to neg stereotype about a group of which you belong - reduces memory performace Ex: experiment when told which group they were competing with   - Stereotypical threat   - Affects performance   - If you threaten someone's memory - reduces negative performance  

Answer 25

identity + memory controllability - higher identity accomodation (e.g. over the hill) -> lower memory control beliefs higher memory control beliefs -> better use of strategies -> better memory performance

Answer 26

Cigarette smoking  - Poorer memory among smokers and former smokers  Exercise  - Positive benefits of aerobic exercise and strength training   Consumption of fish   - Lower rate of cognitive decline in fish eaters (Omega-3)  Metabolic factors  - Lower levels of IGF-1 associated with better memory  Dietary intake of:   - Vit B12, B6, folate (+)  - Homocytesine, or meat (neg)   - Flavonoids including chocolate (+)  Emotions   - Stress and depression can interfere with memory performance   Gingko boloba   - No benefits   Sleep   - Related to better memory, but only in young adults  

Answer 27

Strategy training   - Practice (esp in group setting)   - ----Better memory performance   - ----Better self efficacy   Support  during encoding / learning - Additional cues   - ----Ex: pair pictures and words  - Think about meaning of info  Training that taps into areas of expertise   - Ex: Older Adult who worked with numbers will do better with number related encoding strategy   - Fit training to their expertise

Answer 28

Virtual reality   Helped older adults by simulating walking through various destinations   - Playing soothing music   - Method of Loci - better performance  - Technique to remember things  Imagine where you're going - walking through a place that you know really well and associating one item with another thing  

Answer 29

Advanced Cognitive Training for Independent and Vital Elderly 2800 adults 65-94 2 yr period, 10 sessions, 1hr each, 5-6 weeks memory, reasoning, or speed of processing gains maintained for 2 yrs (and counting) Huge increase in reaction speed/speed of processing    - CAN learn and CAN be trained in older adulthood speed - 87% reasoning - 74% memory - 26%

Answer 30

Problem with "mechanism of intelligence" Focus on "pragmatic of intelligence"

Answer 31

First started with research on intelligence   Knowledge could be a criteria of wisdom   There are 2 components of intelligence   1) Mechanics - what we've talked about so far   - ---- Speed, working memory   - ----Doesn't capture wisdom   2) Focus on 'pragmatics of intelligence'  - --How to respond; addressing complicated issues - --Ability to apply your cognitive ability towards solving complicated life problems   

Answer 32

Life span contextualism   - Role of culture in shaping you, your life   - Being aware of this is an important part of being wise   Value relativism   - Wise people less likely to judge   - Greater appreciation for indiv differences   - ------>Values, experiences   - ------>Can accept and recognize multiple perspectives   Rich base of factual knowledge  - People who just know a lot of stuff   Extensive background  of procedural knowledge   - Know how things work   Can recognize and manage uncertainty  

Answer 33

development affected by processes at multiple levels indv -> microsystem -> mesosystem -> exosystem -> macrosystem Has implications on family members and who cares for us This looks at way we develop and the process that occurs in different levels  - Start at individual (physical and psychological aspects) - are very much within the person   This perspectives looks at the various influences that affect the individual   Microsystem: - Inner circle, high importance: Family, peers  - The type of people you hang out with will determine your health status   Also looks at other factors beyond immediate circle   - Role of school, HC agencies, media and larger systems   - Policy, political systems and culture   - ---->These are all systems that are important in our own development   Systems are also changing/maturing - Not static

Answer 34

change in systems over time

Answer 35

indv microsystem - daily life, daily impact - coworkers, peers, classroom, fam ``` mesosystem - 2+ systems interacting exosystem - not regular but impactful - community, health agencies, school, mass media ``` macrosystem - larger social system indirectly through exo - political systems, economics, society, nationality, culture

Answer 36

Something seen a lot in 4th year students by Sav   - Not sure what they want to do, stressed out   - Norms are - 'need to be applying to med school, PT'   Those who have a difficult time feel that their social clock is out of whack   - Not in sync with what they expect from their life  - Stress of not doing what everyone else is   norms, roles, attitudes about age help shape person's life Example in life course:   Everyone having a baby  

Answer 37

what happens over time (life events, life transitions) Key historical life events   - Ex: 9/11, WW2, Great Depression   - They help to influence how we think about the world   - Ex. 2009 financial crisis had a great impact on baby boomers Personal decisions   - Choices we make will have a huge impact on our life Individual opportunities   - Different sets of opportunities based on where we grew up   - ---> Low/high SES   - ---> More opportunities to go to school in stress free enviro  - ---> Good connections, easier to get a job (not what you know, WHO you know)  

Answer 38

emphasizes the way in which ppl's locations in the following shape their experience of old age: Social system - Especially in terms of SES  The historical period (in which they live)   - Ex: older adults lived through different periods in life   Their own personal biographies  

Answer 39

Changes in roles (e.g., student, employee, retiree, caregiver)   Age graded  - Expect "at a particular age" - But there are always exceptions to expectations Older adulthood: becoming more of an ambiguous transition  - Fewer rituals surrounding transitions in older adulthood   - Not really sure when being an "OA" starts   Why people get stressed in 4th year - go from being student to being in work force   - As well as retirement   - Taking on role of caregiving for older parent   - Transitions are usually age graded   - -----> Student, employee, retiree etc  

Answer 40

series of transitions   1) Ex: 2 Students in second year of high school  - One is successful   - Another becomes pregnant   - ----> The life course of this student will change   - ----> Teen to becoming a mother - ----> Kinds of opp will change - ----> They can still be successful- but the key point will set off different transitions They may not finish school at the same time, do they keep the baby? Timing - Say there is an expected death (person is 89, lived a good life) vs a sudden death 2) Getting in and out of the workforce - "Sandwich generation" - ----> Carrying on either end (kids and their own parents) - ----> Work and family trajectory - ----> Employment opp will change esp for money 3) Order of transitions are imp

Answer 41

1) sociodemographic factors - gender, ethnicity/ race, sexual orientation, socioeconomic status, educational attainment 2) opportunities later in life 3) disparities - health, economics, educational racism, sexism, homophobia Becomes chronic stress when microaggression and overt-aggression causes stress (referring to racism) African women made fried food when they got stressed because they want to feel good RIGHT AWAY. .

Answer 42

83 yo japanese, american born in seattle, living in vancouver - lives alone in vancouver, but has multiple med problems + mild dementia - her doctor recommends higher level of care HER LIFE COURSE - born in early 1920s - japanese - so personal + structural racism growing up -> housing + employment discrimination - sent to internment camp at 17, didnt finish highschool - lived through great depression in 1930s - widow at 75, no kids, moderate savings she experienced: - Disparities in health, economic and educational - Indiv opportunities low bc didn’t attend school - Historical event - Sociodemographic factors

Answer 43

Has to be based on life course perspective - take more into account that just her medical history   Whoever is in charge of care plan - good idea for similar cultural background   - May have mistrust after years of discrimination   Social isolation and loneliness - important to take this into account   - Especially susceptible - lost husband, no children   - Focus on social support to reduce risk of further health problems   Moderate life savings - try to keep at home as much as possible  - Comfort, familiarity   - To relocate into LTC home (especially ones that focus on certain treatments such as dementia)   Racism issue - integrating with her race of people - To feel comfort being around people who have experiences sim culture - Be sensitive to further marginalization by creating ghettos of older adults from same background   These are all important factors that will influence her care plan beyond multiple medical issues + dementia   A lot that can be done when taking into LC perspective  

Answer 44

Don't just look at her present problems alone, but look at the social determinants Consider Mrs. Tanaka's life course and transitions, not just the present context - Find culturally competent care setting - Familiar food, faces, customs, language - Honors/ accommodators Mrs. Taneka's life course in a community-based enviro - Look for community-based assisted lvig and skilled nursing with Asian ancestry clients

Answer 45

cohort effects - great depression, internment of japanese americans history - ww2, discrimination/ racism culture/ location - strong ties to japanese, american community in seattle gender - was wife + homemaker for most of life; held some low-paying jobs strengths - resilient, community-oriented

Answer 46

DISENGAGEMENT THEORY normal (+ desirable) course of life is for OA to loosen their social ties (e.g. retirement) - Highly criticized by gerontologists   - Has most criticism   - Says older adults just want to 'duck out of life'   - No one really buys into this theory   ACTIVITY THEORY OA better adjusted + more satisfied when remain involved in social roles - People want to keep maintaining their social roles   - Post retirement - if they played tennis, may still want to continue   - Remain INVOVLED   - Those are the people we end up being 'successful aging'   CONTINUITY THEORY The individual's personality determines whether activity or disengagement is optimal for the older adult   - Content loners - perfectly happy being alone   - Social butterfly   -----> They will continue to maintain their personality and it is an important factor as they age 

Answer 47

disengagement theory -> No activity theory -> yes continuity theory -> depends on person's personality

Answer 48

46.4% of Can adults 15+ were legally married in 2011 percent as decreased over the yrs mean age at first marriage in Can in 2008 was 31 for me, 29.6 for women % of people getting married decreasing and age at which people are marrying is increasing   Delaying the onset of first marriage

Answer 49

MARRIAGES 1930s:   fewer marriages here then after   - Tough economic times   - High rates of unemployment (especially during the great depression)   - Marriage wasn't a priority   1939: spike in marriages  - WW2  - Some people married to avoid being enlisted in the military   - After WW2: steady increase   Peaks in 1972: PEAK: Baby boomer started to get married  - Been steady but kind of decline since high peak in 1972   DIVORCES 1968: Government  "No Fault Divorce"   - Nobody's fault - Separated for 3 years 1986: Amendment to the divorce act   - After Amendment = only separated for a year   - Spike in divorces     Appreciate power of historical events and policies on marriages and divorces   - is an example of Life course perspective in action  

Answer 50

Same sex marriages become legal in 2005   - They are aging - faced with a lot of discrimination when they have to move to a nursing home  - The people around them may not be accepting of same sex relationships  Mixed couples - marriage/ common-law btwn member of visible minority + someone who isnt & couples of 2 diff visible minorities - More mixed-couples; diverse set of relationships The structure of our relationships is changing

Answer 51

PRODUCTIVE EFFECTS OF MARRIAGE - 9-15% reduction in mortality among OA for married men and women - greater happiness + higher quality of life for both partners

Answer 52

There seems to be more women living alone (compared to men)  (decrease in living in a couple) More men are living in a couple situation  (increase in living in a couple) Part of the reason for this - women out live men   Think about planning for the future - there will be a lot of demand for women who are living alone   Having resources to connect to each other as well as catered to them and their needs   Co-housing?

Answer 53

steady increase in cohabitation in Canadians 1981 - first assessed in canada - 5.6% of all census families were common-law unions 2011 - 16.7% were common law unions - Nunavut - 32.7% - highest - Quebec - 31.5% - Ontario - 10.9% - lowest US - 50-60% all marriages preceded by cohabitation increases in cohabiting couples w children from 197000 in 1960 to 1.5 mil by 2011

Answer 54

higher divorce rates btwn couples who cohabitate before becoming engaged, esp "serial" cohabitors Living together before marriage works well if you're in a committed relationship and know the next step is marriage   - Especially good if not too long   People feel that they 'slide' into marriage   - People haven't thought it through   - Likelihood is that the couple wasn't well matched to begin with   - Just think it's the next thing they should do   Serial cohabitators - like to live with somebody and then break up   If live together before marriage; higher likehood for divorce - People who live together slide into marriage without much reflection

Answer 55

Turcotte, 2013 Living apart together (LAT) - couples in long-term committed relationships, but choose to have seperate residences - 1/ 13 Can are LAT couples - 1/3 in 20-24 - only 2% in 60+ Age was inversely related to the intention to move in together   - older age = less likely to want to move in We can see interesting age effect   - When younger - want to live with partner   - Couples who still want to be in a relationship but don't want to live together increase when older  - ---> These are likely widowed or divorced people   Lived on their own, like their situation but also like companionship   - They want to keep their living situation as is  

Answer 56

canada - legal in 2005 2011 - 64 575 same sex hosueholds - > increased 42.4% from 2006 - > ~ 21000 married, 43000 common-law Rltp dynamic sim to hetero But more likely to share household tasks q

Answer 57

Increase of 6.4% between 1981 to 2011 in divorce or separation in Canada (2011: 11.5%) Average marriage lasts 14 years (2008) Between 1981 and 2011 rates of divorce or separation increased from 4% to 12% Divorced have lower well-being, health, higher mortality, more mental health problems, less satisfying sex lives, and more negative life events. - > psychological aspects of divorce

Answer 58

50% rate not based on the same couples   - Not taking 5000 couples married in a certain year and following through   - It's not as simple as 1/2 marriages   The divorce prone increase the apparent odds   - Also includes those who divorce for 2nd or 3rd time   - they inflate overall stats divorce prone - addicted to divorcing

Answer 59

In 2011, approximately ¼ of the 5 million Canadians who had divorced or separated within the last 20 years had at least one child together, aged 18 years or younger. The majority of these children lived in the mother’s home (70%) 15% lived in the father’s home 9% lived at both residences What are some implications of this on aging?   - If one kid lives with the mom -they will be more drawn to taking care of the mom vs a dad   - Seen in hospital setting, OA comes into ER - who is there to care for them when they are released   - Long term care homes - people may not visit their parents due to events that happened earlier in life   Mediation – an alternative to dispute settlement (less adversarial) Neutral third party involvement - The living arrangement may be preferable for these children than living in a conflicted household  - Many complex situations arrive for all parties involved following a divorce or separation

Answer 60

Declined between 1971 and 2006 in Canada Average age of the widowed population: 75 years Men more prone to depression than women Anniversary reactions may continue for 35 years or longer female has a larger social network than males   - Women are the social department of the family  We have more single and divorced older adults less widowers because health care advancement

Answer 61

Time since death and all cause mortality   We see a gender effect   Males: more likely to die after losing spouse compared to females   There is a greater probability of death for widower/general males in general   Widows vs Married   - Widows have a higher mortality rate   - Especially in widower male vs female (men dying more likely than women)

Answer 62

Multiple mediators explaining why we see relationship between widowhood and death   May have depression   May be dealing with stress   - Associated with losing spouse   - Relocating   - How to do things alone? - taking on tasks of other partner   Financial hardship   Loss of social support   - Couples tend to be friends with other couples

Answer 63

Different reactions to widowhood   - Before and after loss   Higher scores mean that there is more depression   Most people will show what is seen at bottom   Resilient grief - 65+   - Common ones - Goes down - can happen with family caregivers  - Almost experience of relief   - ------> Free to do own thing   - ------> Feel that the person they were caring for is no longer suffering   Some people have chronic depression   - Depression will go up after loss  Most often we see common grief   - Low depression, increases after loss and then back to what it was before the loss   Widowhood is not a unitary process   - People will vary over time  

Answer 64

% of OA having sexual intercourse   There is a good % in just below older adults   Majority of people   Numbers drop a bit as get older   If you have access to a partner, more likelihood to engage in sexual activity Current cohort will be less likely to be grimes about sexuality bc they have gone through depression and availability of birth control pill aka baby boomers.

Answer 65

Enduring Dynamics  - A couples interactions early in relationship characterizes course of relationship over time   - Most research support   - ----> Marriages that end up in divorce prob had early problems Emergent Distress   - Relationship begins to develop problems over time, made worse by poor conflict resolution   - Instead of resolving conflict with open communication  Become defensive, withdrawn  - Trouble in the future - bc of conflict resolution   -----> Relationship will dissolve because of this   - Become increasingly unhappy over time   Disillusionment   - On a really HIGH then develop problems over time and get disappointed/disatisfcation - Couple starts out happy and in love and develop problems over time   - Ex: meet couple that everyone thinks is right for each other, 20 years go by, call it quits   - No one saw it coming   - Say they 'grew apart'   - Didn't work to maintain relationship enduring dynamics pathway has most empirical (research) support

Answer 66

socioemotional selectivity theory - ppl prefer long-term relationships to max positive effect social exchange theory - relationships evaluated according to costs + benefits equity theory - balance is sought btwn what each contributes to the relationship similarity - couples who are similar are happier need complementarity - couples who are diff are happier behavioural approach - behaviours couples engage in affect their relationship satisfaction

Answer 67

9.4 million Canadian families in 2011 In Canada the average family size was 2.9 in 2011 In Canada in 2011, there were 377,636 births (up slightly from 2010 but down from 2009). In 2011, the average age of first-time mothers was 28.5 years. Fertility rates in Canada were 1.61 children per woman in 2011, a figure that is significantly lower than the 2.1 children per woman that is required to replace the population in the absence of Migration. - fertility rates low rn - ppl having less kids Common low couples started emerging in 1980's - before 80s - lone parents & married parents - after 80s, lone + married + common law parents

Answer 68

Same-Sex Families   Fathers are taking on a greater role in raising children   - Changes relationships with others in social network   - How mothers perceive them can affect their involvement with children   - Single fathers seem to spend less time with children than mothers, but more than married fathers   Little is known about blended families   - Two divorcees getting together - Partners that have had children from previous relationships coming together   - People who don't have children coming together with those who do  

Answer 69

can be positive step for couple's relationship More leisure time together   Can also be stressful   - Children aren't there in the home - Peak time for divorces - ---->Maybe their relationship was focused on kids   - ----->Now they're on their own - also when there are increased separations   - -----> Must face each other without distraction of kids   Improved sexual relations     Some are at risk, however, of "empty nest syndrome"   - Feelings of grief and loneliness when kids leave   - Sim to retirement

Answer 70

INTERGENERATIONAL STAKE - older gen value relationship w adult children than children value relationship w their parents DEVELOPMENTAL SCHISM - gap btwn parents + kids in how much they value relationship + seek independence ROLE REVERSAL - discredited view that parents + kids switch roles - Seen a lot in dementia care giving   - Roles never truly reversed   - Take on more roles, but never fully reversed   FILIAL MATURITY - developmental changes in chidl FILIAL ANXIETY - worried about being forced to take on care of parents FILIAL OBLIGATION - Child should care for parent   - Feeling that you will never place parents in nursing home   - Feeling from parents that their children must take care of them   - Law in Singapore  - Can have complications if relationship is also complicated   

Answer 71

says families vary according to 6 dimensions characteristics that ensure family is close   Structural (availability)  - Are they available to you   Associational (frequency)   - Do you see them often?   - Only at Christmas?  Affectual (feelings)   - Feelings of closeness   Normative (obligation)   - Culture says you should check in on parents on the time, on kids all the time  Consensual (values, beliefs, lifestyles)   - Set of shared beliefs   - Blended family -  might affect level of closeness in blended family   Functional (help exchange)   - Helping parents out in one thing, they help you out in return  

Answer 72

May be longest of life In adulthood, they may support each other, especially if parents provided little support for them when young Parents might not always be with you When you become widowed, etc, implications in caregiving   Important relationships we nay forget about  

Answer 73

21.8 percent of adults aged 65 to 74 years and 8.9 percent of those over age 75 are involved in some form of caregiving. ``` In skip generation families, grandparents exclusively care for grandchildren First Nations - over-represented Care context Poverty Disability Multiple competing demands ``` grandparents vary to extent of which they are involved in lives of grandchildren - Types of grandparents vary from remote to involved - The role is more central for grandmothers - Those with good relationships to parents more likely to stay in contact

Answer 74

reciprocity - key dimension  Friendships are important across life dimension  People chose as friends people who are similar to them   - Many people remain close to their 'best friends'  When couple marries though, they may drop non-shared friends through dyadic withdrawal  Friendship can be affected by mobility    - Driving  - Using public transit   When someone has dementia - how do you deal with social relationships   People often don't want to identify themselves with people that make them feel older  

Answer 75

To what degree are the older people working Year 2000- Younger men (65 - 69) have highest labour force participation There is a rise in 65 - 69 age group participation in workforce - Almost tripling for women Why is there a rise? Changing nature of work: * Labour that we are performing is less physically intensive or demanding (development of technology) * Less labour intensive and more sedentary Increasing LE - don't feel 'old' when hitting retirement age - People living longer Pension coverage: - some jobs come with them, some don't - There is a decline or organizations offering pensions, individuals are left to save on their own - pension programs changing; employer may contribute less Slight rise in men/women 70+ May not have enough to retire

Answer 76

illegal to fire/ not employ ppl bc of age no protection for workers in which age affects performance (police, firefighters, pilots) ageism still exists & can create self-fulfilling prophecy supervisors can counter by self-efficacy of older workers Ex: You want to stay in workforce, just got let off your old job, looking for a new one  - illegal to fire/ employ based on age We used to have mandatory retirement, changed now  

Answer 77

anticipatory period -> decision to retire -> RETIREMENT -> immediate readjustment -> changes in activity pattern Anticipatory period  - Waiting and anticipating to retire   - Thinking about it   - Can go on for years, decades   - What would you like to do, when   Decision to retire   - Sometimes decision made for you RETIREMENT  Immediate adjustment   - Don't have to wake up early, go to work, make lunch  Changes in activity patterns   - Ease in to and adapt to retirement patterns Risk of death highest - BIRTH and RETIREMENT - If u don't plan retirement, ex. can go into depression

Answer 78

retirement thought of as process in which indv adapts overtime Crisp   - Leave labour force in single clear-cut exit   - Few workers showing this patter - Minority of workers  Blurred   - Exit and re-enter labour force several times - within same job  - Most common  Bridge   - Work in different occupation than during adult life   - Usually those who may have to go back into workforce for financial reason   - Maybe find something they enjoy more or is less taxing   - Related to money/ financial need

Answer 79

65-70 age group - Quarter of them still working - in 2011, 24% still working in CAn Among all 65+ who work, 42% are part-time parttime work - pay less - lower annual earnings

Answer 80

Some retire because they can afford to retire Social norm/pressure   - Life course perspective   May want to be more involved with grandchildren/family  - May take on childcare role for working parents   Health problems   Focus on doing the things you like, that you didn't have time to do   People will retire if they are financially capable to do so     $ possible   Fully retired   - Health disability   Retire - return to work pattern   - Like working/being active   - $   - Interesting work opportunity   - Lured back into work force   - Not liking being retired - Wanting a challenge 

Answer 81

Prior to 1900s: most worked into old age • Early 1900s  older workers redundant – Mechanization – Wars – Urbanization • Poverty among older adults lead to: – Old Age Pensions Act (1927) – Old Age Security Benefit – Old Age Security Act (1952) replaced 1927 Act – universal pension plan for older Canadians – 1966: Canada Pension Plan (employee + employer contributions) • Only for those who are in paid workforce – 1967: Guaranteed Income Supplement (for low income seniors) These created the idea of retirement   - Work is focused on the young, and those who can handle machinery   - When older adults could no longer work - segment of population became poor  - There are policies that are in place to prevent the elderly from reaching poverty  

Answer 82

In 2011 • 96.6% Canadians aged 65+: Old Age Security (OAS) benefits • 92.1% received Canada Pension Plan (CPP) or Quebec Pension Plan (QPP) benefits Other sources of income: • private investments (54.3%) • private pensions and Registered Retirement Savings Plans (RRSPs) (63.6%), • employment earnings (22.6 %) Median annual incomes in 2011 across all sources: - OAS/Guaranteed Income Supplement (GIS), $6,400; - CPP/QPP, $7,000; - private investments, $1,200; - private pensions and RRSPs, $11,800; - and employment earnings, $2,600 ADDED TOGETHER = ~$29,000/year   - Not really enough to live on   - Also not that bad if living with someone else, living in a city with lower cost of living   - Depends on (city, other people/multi-generational household?, health issues) - Already paid house off, living with other people   - Don't have to worry about expenses   - Depends on living situation and health   - Lot of out of pocket health costs  

Answer 83

OAS, Old Age Security Benefits:  all in CAN who meet the basic requirements   CPP and QPP  (quebec pension plan) - Only those in the paid workforce  *know these 2 points   - Disability benefits in the event of a severe and prolonged disability   - Amount of the pension depends on how much and how long the individual has contributed to CP Full-time homemakers are entitled to share their spouse’s benefits and may collect as much as 60 % in a survivor’s benefit once their spouse dies. (This also applies to common-law partners.)

Answer 84

One solution: raising the age of OAS eligibility   - Would negatively affect those who have health issues and are unable to work   - Also negatively affects  intensive labor jobs, more demanding   - Haver shorter LE, wont be benefiting from OAS for a long time Second solution: incentives to reduce early retirement   - Forces people to work longer and contributing to the tax system - Make it harder for people to retire early, keep them in workforce longer   - Disproportionately affects marginalized populations   - Normally we have incentives to encourage early retirement   - Ex: pay certain amount of money over next 3 years given that you retire early  

Answer 85

ROLE THEORY - job is source of fulfillment - loss of work is harmful  - Think about the role of the job   - What role does the job have, how does it affect their identity   (Ex: Professor)   Provides a lot fulfillment   Leaving that job - is like losing a part of their identity   Retirement can be problematic for people whose retirement is wrapped up in their workload   - VP who is now retired   Still has desire to help with project management   May take on volunteer roles   Helps them to maintain role without being completely lost   CONTINUITY THEORY - retains previous sense of identity - Retirement not necessarily seen as a crisis   - Work isn't necessarily shaped by identity   LIFE COURSE PERSPECTIVE - retirement is only stressful when unexpected   - Social clocks and normative/non normative events  - Age 65 - 'normal' to retire   - E: diagnoses , health problem - weren't ready   RESOURCE MODEL - Resource model alludes to having time, money and important resources to retire   - more resources = easier to adjust

Answer 86

biological - physical changes - health problems psychological - cognitive functioning - personality - expectations about retirement sociocultural - social class - income - opportunities for engagemen

Answer 87

Having leisure/relaxation can help deal with stressful things happening with you or around you   Fulfilling goals, can help find meaning in life   Contribute to sense of identity   Provide focus and meaning in life   Help maintain health and cognitive functioning   Social connections to others

Answer 88

Importance of fun in later adulthood  People low in physical activity are most likely to experience mortality / more likely to die

Answer 89

ikely watching TV, reading, shopping, dining out, walking   Moderately travelling, religious activities   When you look at leisure activities, think about how much engagement the person is having  Reading = exercising brain vs watching TV - might be less engaging (mentally and socially)   Structural lag reflection- do older people have what they want to spend their time doing

Answer 90

Older adults who become involved with new leisure activity can experience enhanced sense of meaning in life and feeling of self-reinvention “Innovators” seek personal growth and self-expression through travel

Answer 91

Family, friends, neighbours  Provide critical and often ongoing support:  personal, social, psychological and physical support, assistance and care  Without pay  “Care receiver” needs support due to  to frailty, illness, degenerative disease, physical/ cognitive/mental disability, or end of life circumstances

Answer 92

2012, 8 Million Canadians were family caregivers (Statistics Canada, 2013)  - Usually ends up being a female, generally a spouse (if alive) or daughter/daughter -inlaw   Who are the caregivers?  - 12% (666, 455) of older Canadians provided informal care to another older adult in 2012 (Statistics Canada, 2013)  - 54% female   - 39% adult-children  - 8% spouse/partner  Caregivers' ability to cope is linked with care receiver's survival and time until relocating to nursing home   - Related to how long the OA is able to live at home   Caregivers who are more strained → greater likelihood of mortality   - Stressed/strained caregivers have a greater likelihood of death  - Important to keep caregivers coping successfully  - -----> Most people want to live or die at home   - -----> Implications for family and population if kept in nursing home or hospital (cost, etc) 

Answer 93

Gender   - females  Generation   - Adult children   - --> Needs, responsibilities different from spouse   - --> May live apart from OA  - Spouse   - --> Often living with OA  Culture   - Collectivist cultures - 'take care of own'   - Taboo to move family member in nursing home   - Sense of independence   - Values of taking care of families vary between cultures   Caregiving context   1) Care receiver  - OA with the chronic conditions   - Taking care of OA with Alzheimer's different from person with cancer   - Alzheimer's - may have trouble communicating   2) Other family members  - Can be helpful   - Help with tasks, taking people to appointments   - Can also be a stressor   - Seen often with siblings   - Tensions - one 'primary caregiver sibling'   - Constantly complaining how other brothers don't contribute   - Family member who lives far away   - Doesn't see day to day experiences   - May be critical of caregiving   3) Support Services   - Home care   - Can be really stressful if person providing care isn't well trained  - Isn't acting in person-centred way   - Can lead to frustration  - Going to support groups   - Getting support from Alzheimer's society   - Can be + or - as well  

Answer 94

more females than males 30% live in the same household 50% live more than hour by car 20% live 1 hr or more by bar who provides care - most common to least - spouse, grown children, parent, other family, friend Adult children and spouses are the most imp type of care-givers we see

Answer 95

Peak:   - Middle agers - 45-64   - Providing the most care   - Sandwich generation   - People who are taking care of older adults as well as children   - Especially females   - Males are still often fairly involved in caregiving   65+   - Also still involved in care   - May have own health related issues   - Caring for spouse, other family member - OA taking care of OA - Not always only the receivers of care, also can be providers  OA also contribute to providing care   OA: when 75+   - Lot of care done by spouse or adult child  - Importance of friends, collogues or neighbours - As OA get older, mostly taken care by spouse and friends

Answer 96

spouse - ~58 hrs daughter - 30 son - 25 second caregiver - 12 Taking on tasks you may not have done before   - Paying bills   - Taking people to appointments   - Helping with household chores   - Personal care   - Mostly done by spouse, followed by children and secondary CG  Across the country - Rise in males taking on more care-giving responsibilities

Answer 97

Caregiving thought of as career/journey  People live with certain chronic illnesses for a longer period of time   Need different kinds of help as disease progresses 

Answer 98

Child: Starting to do more gradually   - Sometime might exit out faster bc might not be able to provide the care for a long time Spouse: Doing it sooner and with more intensity - Doing a lot more   - Helping them get through the night  - See difference between child and spousal caregiving

Answer 99

Instrumental Activities of Daily living   - Cooking, cleaning, household chores , grocering, driving to apt Activities of daily living   - Bathing, feeding, toileting, dressing   Vigilance   - Like you're always watching over person you are caring for   - ----> You are one alert - ----> Someone who might have dementia - Feel like you can't take a break   - Goes up as level of need for OA increases 

Answer 100

Stage 1   - Identify as 'caregiver'   Stage 2   - Begin Personal Care tasks  Feeding  Fall taking a bath   Dignity first   Roles start to change - will never necessarily reverse   Many 'check out' - from certain tasks (bc of continence- how do they help their OA with that)   Some may exit out of their role bc too much responsibility Relationship strains   Stage 3  First considerations of nursing home placement   Stage 4   Relocation to Nursing home placement   Development of care-giving role and dying of spousal role Some feel more of a caregiver than spouse  Adult children say it sooner that they are care-givers before spouses Depends on person and how they perceive the situation   There are challenges to spousal role and development of caregiving role throughout the stages 

Answer 101

1) Health Costs 2. Interference with other life activities 3. Relationship Costs

Answer 102

Physical costs of caring   - Caregiver's Health (neglect self-care)   - -- They may end up in the hospital, who will take care of the OA?  - Care recipient's Health   - --If the care giver isn't healthy, will impact care that receiver gets   Emotional Costs   - Anxiety   - Stress   - Depression  

Answer 103

``` - Household tasks  Time with friends and family  Time for self  Work  Called “objective burden” in the literature ``` "objective burden" - No time for self, social, work because of caregiver role   Constantly caring   - OA may have outbursts  - As behavioural feature of dementia   - Don't want to leave them along, put them in social situations that may be awkward - resulting in social isolation  

Answer 104

Loss of quality   - Anger   - Fear   - Guilt   - Cultural   Loss of relationship   - 'he's not my husband anymore'   Loss of self   - Who am I anymore?     You want to have connection and reciprocity in a relationship   - Relationship changes with Alzheimer's disease   - Feel that they are losing this relationship  - Can see impact   In a relationship you want to confide in them, ask for advice   With dementia, they are unable to be that person for you   Tiring - not being able to have a conversation 

Answer 105

even tho they aren't dead it feels like they are

Answer 106

Brought joy and pain at the same time 1 - Greater appreciation for care receiver 2- Personal satisfaction  Sense of accomplishment  Self approval 3- Appreciation  Others  Care-recipient

Answer 107

Stress Burden  - Anxiety, emotional tension  Objective Burden   - I have no time for myself  Relationship Burden   - Relationship is changing, feel that you are losing original relationship that you had ; feeling of RESENTMENT

Answer 108

Expectations in the video of OA from the child 0, zero Children are taking care of their children less   Families are having children later in life   Families are having fewer children   Children are being located geographically further from their families   Time of care-giving has gone from months to decades Care provided by family v complex: learning how to care Also the emotional part, exp soothing the person Vigilance, constant one on one care Come at a cost Existing the workforce What if you don't have children?  

Answer 109

60% of those who live past 85 will live in nursing homes   - If they stay there for more than 6 months, they'll likely never leave   - "waiting rooms": waiting to die - Some are much better off in nursing home   Social interaction   - Not always a downturn for people   Giving up independence is the worst- worst fear Family is what is important to them after their career is gone - Relying on family to provide the care but sometimes it just isn't possible So another alternative is LTC - Cost of taking care of someone at home is very expensive   - People need complex care - why cost is expensive   - Compared to hospitals and nursing homes - home care is still the cheapest option 

Answer 110

Continuum of care  In-home care -> institutionalized care  Medical and non-medical support Institutional facility  a group residential setting that provides individuals with medical and/or psychiatric care Nursing homes (long-term care home)  Medical institutions that provide room, meals, skilled care, medical services, and protective supervision More women than men live in these special care facilities   Much higher for indiv over 85 

Answer 111

Facility-based long-term care is: • not covered by the Canada Health Act • not a fully insured health service in any province or territory Veterans or spouses of veterans have access to full LTC Each jurisdiction is responsible for providing long-term care • Variability across provinces in words used to describe levels of care • “long-term care” = “continuing care” in Alberta

Answer 112

public not-for-profit government ownership and/ or operation; private not-for-profit religious, ethnic, lay/charitable or organization ownership; private for profit ownership - Lower quality ratings, care more about the $$

Answer 113

E.g., facility charges, user fees, accommodation fees, copayments  Plus extra costs: drugs, special products (e.g., incontinence), private caregivers (e.g., PT, personal care)  Vary depending on location  Territories: $500 to $700 per month (with no cost in Nunavut)  Alberta: maximum fee is $1,335 per month  Atlantic provinces: maximum monthly costs of $2,000 - $3,000  Means-tested  % of after-tax income needed to pay for care among married older Canadians  Maritimes (88 - 95 %)  Quebec and Alberta: 45-50% • Saving for long-term care? • $7,500 per year over a 40-year period • total of $300,000 vary by location for costs

Answer 114

Means-tested Sliding scale for how much you pay based on your income for care you receive Usual for not for profit

Answer 115

Aging in place - older adults can remain in their own home, or at least in their own community and still have their needs met Home care and community-based services – • medley of medical and social services • provided by health care professionals, paid caregivers, and volunteers. Bringing professional care into home or day programs/Personal Support Worker come into home and help with activities of daily living and household chores  

Answer 116

 Canada Health Act – NOT insured  However, care at home is funded for  2 weeks after hospital discharge  2 weeks after mental heath care  End-of-life care  Variability across locations in funding and use of co-payments and user fees  In 2010, amount spent on home and community based services was between $8.9 billion - $10.5 billion (4.6 - 5.5% of total health care spending in Canada)

Answer 117

2012 - 54% of caregivers were female and 44% of caregivers were ages of 45 -64 Economic contribution of unpaid caregivers: $25-26 billion Ex: can't go to work because of taking parents to appointments, being actively involved in their caregiving through taking time off  

Answer 118

informal, formal, mixed

Answer 119

Adult day programs - older adults in need of assistance or supervision during the day receive a range of services in a nursing home, or some other facility such as a stand-alone agency. - Allow person with chronic illness to be actively engaged with life   - Art therapy, music therapy, gardening Respite care -Gives family caregivers a break while allowing older adult to receive needed services - someone elsse comes in and takes care of them; temporary + substitute living arrangements or special care

Answer 120

Government assisted housing - provided for individuals with low-moderate incomes who need affordable housing or rental assistance. Secondary suite - an accessory apartment, in-law suite, or granny flat, is a second living space in a family home that allows the older adult to have independent living quarters, cooking space, and a bathroom

Answer 121

Housing community with different levels of care   - Assisted living   - Come in as independent - there is a nurse on site that is there in case for everyone - Gradual movement into long term care home as age progresses   - Min amount of care Retirement communities before assisted living

Answer 122

Provides supportive care to older adults who do not require skilled nursing care.

Answer 123

Provides a room, meals, skilled nursing and rehabilitative care, medical services, and protective supervision. * In 2007, there were 2,577 facilities and 217,969 beds. * There is general recognition that there is a shortage of beds especially in First Nations communities. * Behavioural issues and mental health issues among the elders in care

Answer 124

Alternate level of care patients – hospitalized patients waiting to move to a long-term care facility Admission to long-term care in Canada is executed through a coordinated placement process, or single point of entry model (aka. screening, referring, and case-managing). • Access via ONE agency • This may limit choice of long-term care home.

Answer 125

Lack of meaningful activities so spend a lot of time doing nothing

Answer 126

Institutions must find ways to maximize individual’s independence while having to adjust to environment that fosters dependence • Psychological needs of the resident: the amount of control people feel they have over their environment – a challenge to meet. • Both physical and psychological qualities of the environment must be taken into account

Answer 127

positive effect + adaptive beh - max performance level + adaptiation level on edges - marginal outskrits - neg + maladaptive beh X axis - environmental press   - How difficult/challenging is the environment?   - Physical and Social   Y axis - competence   - Level of competence of OA   We want a nice balance where environment is demanding enough to match competence   - All the dark and light blue section Older man, smart , loves history, reading and current events that has moved into LTC   - All they do there is Bingo   - This is not a good fit for the OA   - It would be better for him to have a current events group, debate club that would match his competence   When demand is low, competence is high   - Will get agitated   - Negative affect and maladaptive behaviour   - Too much pressure isn't good as well   - We need a balance  

Answer 128

includes indices of physical, cognitive, and psychosocial health Who uses RAI? Yukon, British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Nova Scotia, and Newfoundland and Labrador. 2011-2012 data indicates: • 3 to 40% of residents had worsening symptoms of depression • 3 to 32% had worsening pain • residents who fell: 5 to 24% • residents taking antipsychotics w/ no related diagnosis: 18-50%

Answer 129

• 43% of front-line workers: were subjected to physical violence • 35.5% were criticized or told off by a resident or relative • 14.3% endured unwanted sexual attention, which often occurred when bathing a resident. More government funds are required to meet needs but also adequate staff training.

Answer 130

Innovations and new models of nursing home care to be developed with the goal of: • maximizing Person-Environment Fit • creating a feeling of a community or neighbourhood Staff training is critical • e.g., train personal support workers in person-centered approaches • Using team approaches

Answer 131

Individual homes within a small community of 6-10 residents and skilled nursing staff Designed to feel like a home Seems to result in improved adaptation in residents and their families

Answer 132

``` newfoundland - 0 ; 0 PEI - 0; 0 nova scotia - 11 ; 1.2 new brunswick - 7 ; 0.9 quebec - 65 ; 0.8 ontario - 110 ; 0.8 manitoba - 5 ; 0.4 saskatchewan - 1 ; 0.1 alberta - 16 ; 0.4 BC - 46 ; 1.0 territories - 0; 0 ``` Canada - 261 ; 0.7

Answer 133

Many older adults do not have psychological disorders  Contrary to what people may except   There are fewer rather than more OA with diagnosed mental conditions

Answer 134

is major psychiatric manual in US + canada - other countries use ICD (international classification of diseases) - Includes diagnostic criteria for major forms of psychological disorder • To meet criteria, client must have a fairly high degree of severity and symptoms must persist over period of time - Look at if there's been a change in baseline from previous time   - An increase in psychological symptoms   - Persistent symptoms 

Answer 135

Extremely sad mood lasting for most of time for 2 weeks • Appetite and sleep disturbances, feelings of guilt, difficulty concentrating and low sense of self-worth • 16.6% lifetime prevalence • Higher rates in 59 and younger; highest in 18-29 However, many older adults report depressive symptoms (30%)

Answer 136

Patterns that is quite overwhelming - 2 age groups  - 18-44   - 75+   - Consistently see 18-44 have greater lifetime prevalence of:  Anxiety, mood, substance use and 3+ disorders compared to 75 years+  This means that only approx 20-25% of OA who meet criteria for mental health disorder   - Dementia -seen more in OA compared to younger adults   The lifetime prevalence for DSM disorders decreases as we get older   Caution: Many older adults may underreport   - Statistics may not be representative  

Answer 137

OA with chronic illnesses have more anxiety or mood disorders   (third column)  There's an increased risk for anxiety or mood disorder when an OA has 3+ chronic illnesses   Takes into account comorbidity   As we get older, we don't just have ONE disease   If we have an anxiety or mood disorder, likely to have other chronic disorders  

Answer 138

EX: Depression:   Symptoms:   Fatigue   Sleep difficulty   Appetite changes   - Could all be related to other chronic illnesses   - Hard to disentangle physical health problems from mental health problems   - Interlinked   - There's a lot of variability among older adults who have mental health disorders   - Could have diagnosis in early life, first episode in late life or sometime in between   - Social context is important   - What is happening in their life?   EX: OA who loses interest in activities   - Her options may be limited   Due to living in nursing home  

Answer 139

Loss of social support from family and friends   Loss of income   Inability to keep working   Lifetime exposures to stigma   Connected with life course perspective   Early side effects of drug use   Specific to people diagnosed early in life living with mental health concerns from an early age   Institutionalization in large mental health hospitals  

Answer 140

Depressed mood, loss of interest/pleasure in daily activities   - For more than 2 weeks   - Have to experience symptoms almost daily or close to daily for over 2 weeks   - Mood has to represent change from person's baseline behaviour  - Experience should have impact on social, occupational or educational functioning   - Have to have at least 5 of these symptoms (almost daily) : Depressive mood, feeling irritable   - From yourself or others   Decreased interest/pleasure in daily activities   - Almost everyday   Change in sleep   - Can't sleep at all, want to sleep all the time   - Must be a change   Change in activity   - Fatigued, loss of energy   - Increased agitation   Guilt, feeling of worthlessness   - Has to be excessive   Lack of concentration and diminished ability to think   - Indecisive   Thoughts of death, suicide and having a plan for suicide 

Answer 141

Why might this be the case?   Health care professionals may not be trained in diagnosis of older adults   May have age stereotypes   OA may not accurately report symptoms   Physicians spent too little time with them   Reimbursement rates lower in psychological diagnosis than medical   Attitudes toward depression in older adults by professionals   May also be an issue preventing OA from talking about depressive symptoms   Medical and psychological symptoms may co-occur   Difficult to distinguish   Health care workers should look for possible contributing psychosocial factors   - Think holistically   - Issues that may contribute to people feeling sad or depressed  

Answer 142

Functional limitations   - Difficulty with mobility  Sensory impairments   - Vision, touch, hearing that may worsen the experience of depression   Problems with self care   - Not be able to take care of themselves   - Bathe, feed  - Can contribute to depression  Pain   - Physical   Institutional settings   - Limiting opportunities of social engagement   Changes in cognition and personality   - Cognitive issues such as dementia that may be masking on contributing to experiences of depression  Bereavement   - Grieving due to loss of family members   Loneliness   Stressful life events   - In recent past  - Contributing to depression  Avoidance as a coping strategy   Medical disorders  

Answer 143

* Arthritis * Hip fracture * Diabetes * Metabolic syndrome * Hypertension * Stroke * Tooth loss * Lack of vitamin D Depressive disorders may also cause further impairments in physical and cognitive functioning

Answer 144

Not a diagnosis in DSM-5   But related to psychological disorders such as depression   Mental health illness a risk factor in suicide   ``` Other risk factors:   Marital breakdown  Financial hardship   Deteriorating physical health   A major loss   Lack of social support   ``` All things that may increase risk of feelings or suicide itself  Many Risk Factors are psychosocial   Assessment MUST be multidimensional   Biological, psychological and social aspects that can increase risk of suicide in OA 

Answer 145

* 9th leading cause of death in Canada * Males are 3x more likely to commit suicide than women * Single or widowed people more likely to commit suicide than married counterparts * People aged 45-49 most likely to commit suicide * Suicide rates decrease between 65 to 69 then increase again * Older adults often have only mild to moderate symptoms of depression Highest rates among older, white men  

Answer 146

Rates much higher for men compared to women   Among 85+  especially

Answer 147

• One or more manic episodes (elated, grandiose, expansive, highly energetic) • May or may not have depressive episode • 3.9% lifetime prevalence • At least half begin before person reaches 25 years old • Less is known about bipolar disorder in later life than major depressive disorder • There may be neurological complications 60% of all people with bipolar disorder can life symptom-free with treatment

Answer 148

• Sense of dread about the future • Go to great lengths to avoid anxiety-provoking situations • Most highly prevalent of all psychological disorders except substance abuse • 28.8% lifetime prevalence • Prevalence rates are lower in people 60+ • Older women have higher rates than older men

Answer 149

Older adults may be more resilient   - They know how to cope with stressors   - By the time they reach older adulthood, developed strong coping strategies   Health Care Professionals may not recognize symptoms in older adults   - Underestimating   Medical symptoms coexist   - difficult to disentangle   Failing to diagnose anxiety disorders can be associated with increased mortality   - Issue of life and death   - Important to have ability to diagnose across life course  

Answer 150

 Generalized Anxiety Disorder — general fear or dread that impairs ability to function • Overall sense of uneasiness • Prone to worrying • Feelings of restlessness and tension • 5.7% lifetime prevalence • Among older adults: 6-month prevalence is 2% ```  Obsessive-compulsive disorder — focused on single act (e.g. hand washing) ```  Phobia — specific fears (e.g. fear of death)

Answer 151

• Symptoms include intrusion of distressing reminders, dissociative symptoms, avoidance of situations that remind one of the event, and hyperarousal • Acute stress disorder involves symptoms for up to 1 month • Post-traumatic stress disorder involves symptoms for >1 month • 6.8% lifetime prevalence;

Answer 152

experienced when older compared to PTSD (younger years that may continue into older adulthood) * observed in aging veterans who were exposed to stressful combat situations in young adulthood * Symptoms of LOSS are similar to those of PTSD, but the progression is distinct, as it develops later in life.

Answer 153

• Distorted perception of reality • Impairment in thinking, behavior, affect, motivation • Delusions, hallucinations, disorganized and incoherent speech, abnormal behavior, and “negative” symptoms • 1% lifetime prevalence • Other health and mental health problems may be associated with schizophrenia in older adults, though many show ability to cope w treatment, 40% can recover

Answer 154

In 2012, 4.4% of Canadians aged 15 and older met the criteria for a substance use disorder in the previous 12 months, most often alcohol abuse or dependence (3.2%). The lifetime prevalence rate for substance use disorders was 21.6% Older adults are at particular risk for abuse of prescription drugs

Answer 155

Opposite of things such as hallucinations - not feeling anything, not wanting to engage  Delusions are positive symptoms/active symptoms, very prevalent 

Answer 156

• As many as 14% who receive medical attention in hospitals and ERs • Prevalent in nursing homes and retirement communities • Risks include cirrhosis to increased risk of injury as well as diabetes, high blood pressure, congestive heart failure, osteoporosis and mood disorders • Alcohol also interacts poorly with common meds • Chronic alcohol use can also lead to changes in kidneys and brain

Answer 157

atttiudes - be aware of attitudes/ beliefs about aging general knowledge - learn more about aging clinical issues - understand psychopathy in OA assessment - learn to use + interpret appropriate tools service provision - know about efficacy of interventions education - learn about geropsychology Guidelines focus a lot on attitudes and knowledge about aging   Why we focus in our class on normal aging and stereotypes is because it is important to do a self-assessment and identify attitudes on aging   See ways in which treatment of OA is affected 

Answer 158

• Should be tailored to older adults, including practical considerations • Need to account for sensory, motor, and cognitive limitations Take into account hearing problems and normal aspects of aging (not necessarily hearing things bc of psychological)  - May not be a psychological problem   Changes in sensation and perception   Any problems with mobility and movement   - Can affect experience of mental health concerns   Cognitive assessments   - Problems in thinking or affect (feeling)  

Answer 159

Depression is not a part of the normal aging process. Health professionals must advocate for treatment of depression in older adults  health care professionals and family members often view depression as an unavoidable condition because of elders’ multiple losses and debilitating physical conditions.

Answer 160

Assessment must be multidimensional ``` PSYCHOLOGICAL FACTORS   Such as life stress  Bereavement   Past history of depression   Trauma   Any stresses in the person's life   ``` ``` SOCIAL FACTORS Minority status  Gender  Education   Poverty  Marital status   Social isolation   Experiencing stigma and discrimination across the life course possibly contributing towards experiences in depression in later life   ``` BIOLOGICAL FACTORS Physical illness and disabilities   View the clients + ask them to the meanings they attribute to the symptoms, accept their treatment preferences   - Conduct a thorough suicide assessment when working with older adults who feel depressed   - Rule out medical conditions and medications - Be educated in way that different cultures talk about/address depression

Answer 161

Assessment has to be not only multidimensional but also different types of measurements   Clinical interview   - Face to face   Mental Status  examination - Cognition   - Get a sense of if there is a cognitive issue   Specific Symptom Measures  - Geriatric depression scale   - What are the symptoms of depression that the OA may be experiencing  - 20 item questionnaire  - Screens for depressive symptoms   Functional Abilities - Activities of daily living   (ADL) - ----Bathing   - ------Feeding   - -----Toileting   - Instrumental activities of daily living  (IADL) - -----Get around house   - -----Cook for themselves   - -----Get to appointments   Full comprehensive assessment to find out what is going on in their life that may pose as risk factors for depression  

Answer 162

Antidepressants, antianxiety medications, neuroleptics - Take precautions against drug interactions - May have serious side effects including addiction Neuroleptics: Typically given to people with schizophrenia  Side Effects: tardive dyskinesia -involuntary repetitive movements are a consequence resulting in rigid mobility  - OA more likely to feel effects   - Neuroleptics - alter dopamine acitivity, effective in reducing delusions  ``` Electroconvulsant therapy (ECT) - May cause short-term memory loss ```

Answer 163

integration - combo of approaches Psychotherapy - Another important aspect to consider, not just medication - Can be varied   Psychodynamic  - Can be things such as looking at life review and understanding early life experiences and how they contribute to experiences of depression in later life   Behavioural   - Increasing amt of pleasant activities   - Social engagement   Cognitive  - How to manage dysfunctional thoughts   Combination - Cognitive-Behavioural  - Changing thoughts and behaviours   Interpersonal Skills   - Developing social skills to increase social engagement  

Answer 164

 New diagnostic criteria and guidelines (since 1984)  Diagnosed when there are cognitive or behavioral (neuropsychiatric) symptoms that: 1 Interfere with ability to function at work or at usual activities; and 2 Represent decline from previous levels of functioning; and 3 Are not explained by delirium or major psychiatric disorder; 4 Cognitive impairment is detected and diagnosed through a combination of  history-taking from patient and knowledgeable informant and  objective cognitive assessment (mental status examination or neuropsychological testing). Neuropsychological testing should be performed when the routine history and mental status examination cannot provide a confident diagnosis.

Answer 165

a. Impaired ability to acquire and remember new information; e.g. repetitive questions or conversations, misplacing belongings. b. Impaired reasoning and handling of complex tasks, poor judgment; e. g., poor understanding of safety risks, poor decision-making ability, inability to plan complex or sequential activities. c. Impaired visuospatial abilities; e.g., inability to recognize faces despite good acuity d. Impaired language functions (speaking, reading, writing)––difficulty thinking of common words while speaking, hesitations; speech, spelling, and writing errors. e. Changes in personality, behavior, or comportment; e.g., agitation, loss of empathy, compulsive or obsessive behaviors

Answer 166

Primary dementias  Due to pathological conditions in brain  E.g., Alzheimer’s disease, frontotemporal dementias Secondary dementias  Associated with other conditions (e.g., depression, tumors, AIDS, etc.)

Answer 167

60% to 80% of all cases of dementia A. Insidious onset. Symptoms: gradual onset over months to years, not sudden over hours or days; B. History of worsening of cognition by report or observing  Results in the death of nerve cells  Memory failure  Personality changes  Increasing inability to manage activities of daily living ``` Diagnosis  History  Physical examination  Neuropsychological testing  Definitive diagnosis: autopsy after death ```

Answer 168

MILD - memory, personality, spatial, disorientation MODERATE - aphasia, apraxia, confusion, agitation, insomnia SEVERE - resistiveness, incontinence, eating difficulties, motor impairment TERMINAL - bedfast, mute, dysphasia, incurrent infections early stages   -> Memory problems, spatial disorientation   - Over time, more physical symptoms  

Answer 169

Memory problems:   Depression: rapid onset,    - Can be treated more readily - Poor memory for recent and past events   - Distressed over memory problems   - Provide details about memory problems   - May show wide variations in performance from one test to another  Dementia: gradual   - Typically things that are not reversible - Retain memory for past events   - Long term memory   - Poor memory for recent events   - Not aware of memory problems   - May hide details about memory problems   - Progressive loss of cognitive abilities 

Answer 170

• In the early 1900s, most individuals died at home • Dying has become more institutionalized • Society struggles with the roles that government and regulatory bodies play in providing care at life's end • Dying has become more medicalized

Answer 171

The dying trajectory describes variations in the dying process that vary by duration and shape: 1) Sudden death   - One dying trajectory  - Life-course perspective: trajectory (series of events)  2) Progressive disease in terminal phase   - Progressive and Slow - Gradual decline (never going back up)   - Start off healthy (same as sudden death)   - Starting at a higher health status - Ex. Cancer or some terminal illness, Palliative 3) advanced illness w slow decline, periodic crisis, sudden death - Start off lower compared to A and B   - Already compromised - Maybe a part of normal aging - Co-morbidity - Never get back to same starting level as before   - Until death   - Ex. Going into a hospital and coming out not as before

Answer 172

(number death during specified period/ number of ppl multiplied by period of observation ) X 10n

Answer 173

Crude death rate for a specific age group

Answer 174

Statistic that combines all age-specific death rates within groups of the population Accounts for the reality that more deaths occur in older age groups measures for population health

Answer 175

In 2011 - 242,074 deaths in Canada, and an age-standardized mortality rate of 4.9 per 100,000 population Most useful is the age standardized in terms of pop perspective - Measure of population health   - How healthy a country is, province   - Looks at age specific death rates   Indicates likelihood that people are dying within and among their own age group   Takes into account the fact that OA are more likely to die

Answer 176

Mortality rates have declined  - Especially for top 3 causes   Cancer, heart disease and stroke Good for Canada's population health   Shows that we are getting healthie

Answer 177

``` marital status race/ ethinicity sex involvement in organized religion level and pattern of jobs (stress) ```

Answer 178

Can tell a lot about a culture's perspective of death based on funeral rituals etc   In some cultures not seen as end but transition Death have become invisible in western world

Answer 179

the characteristic spirit of a culture, era, or community as manifested in its beliefs and aspirations.

Answer 180

Funeral rituals   Treatment of dying   Belief in presence of ghosts   Belief in afterlife   Treating death topics as taboo   Representation of death in the arts

Answer 181

``` Facing fears about dying   Having choices about dying   Making amends   Controlling pain/symptoms   Having wishes respected   Honouring spiritual and non-spiritual preferences  Preserving autonomy and control  Avoiding prolonged suffering  Minimizing stress for loved ones  Preserving dignity  Maintaining hope   Accepting help  Remaining in the moment  Obtaining closure  Putting legal affairs in order   Living fully until death   Dying with tranquility   Continuing support of health care team   ```

Answer 182

Ancient Egypt   - Belief in eternal life   Middle Ages   - Tamed death  - Death was viewed as familiar + simple   - Transition to eternal life   - Supported by prayers that 'tamed' the unknown   - Death and dying involved entire community   Late 1800's   - Beautiful death   - Death was glorified   - Was considered noble to die for a cause   Current Views   - Invisible death   - We don't really want to see/address death  - Keep death confined to hospitals   - Social death   - Process where dying are treated as non-persons by family or HCW 

Answer 183

Although stages aren’t supported by research, they set the stage for better treatment of the dying: death with dignity and the “good death” Denial -> anger -> bargaining -> depression -> acceptance Biggest critique: these stages aren't supposed to go in an order - Many of these can happen simultaneously - Ex of bargaining: please let this patient live for a little longer

Answer 184

Poorly coordinated care across health care and home settings Lack of advance planning around end of life care decisions Complicated or prolonged medical technology Have health care proxies

Answer 185

• Life’s ending may alter individual’s identity and view of life • Through legitimization of biography, people give meaning to their life stories • Recognition of mortality occurs when people reach awareness of finitude • Issues of ego integrity become activated toward end of life • Terror management theory proposes that people may change their health behaviors when thoughts of death are activated

Answer 186

• Two types 1. Instructional directive (aka Living Will) – Do not resuscitate order directs health care workers not to use resuscitation – Request for palliative care: provides relief from symptoms (e.g. pain) and some services but does not hasten or postpone end of life 2. Proxy directive – Durable power of attorney for health care appoints a health care proxy

Answer 187

Death with dignity, generally speaking, can mean various things: • knowing that one is dying and what to expect • retaining control over what happens • receiving treatment for pain and other symptoms • choosing the place one would like to die • receiving spiritual and emotional support, as desired • having access to hospice/palliative care • having a chance to say goodbye to family, friends

Answer 188

• Legal since 2016 in Canada (Bill C-14) • (a) the administering by a medical practitioner or nurse practitioner of a substance to a person, at their request, that causes their death; or • (b) the prescribing or providing by a medical practitioner or nurse practitioner of a substance to a person, at their request, so that they may self-administer the substance and in doing so cause their own death Eligibility Criteria: – Eligible for health services in Canada – At least 18 years and mentally competent – Grievous and irremediable medical condition – Make voluntary request – Give informed consent

Answer 189

Physician Assisted Suicide   - Terminally ill patients make conscious decision to end their lives and receive tools from physicians to do this   - Self-administer Euthanasia   - Physician takes actions causing patient to die   - Injection by doc Opponents cite   - "do no harm" ethical code   - Suicidal dying patients can be treated  

Answer 190

When deemed palliative:   Aromatherapy   - Provide scents for relaxation   Music   Providing family with food and beverages to make sure that they feel welcomed   Provide them with space both with and away from resident   Families want to know that their loved one is being cared for, not in pain   People come by to visit once they see the butterfly on the door   People share their memories of the resident that passed away to the family   Make them feel like family   Personal involvement  Example of palliative care in high quality caliber   Focusing on Relationship-centered care

Answer 191

Palliative: (of a medicine or medical care) relieving pain without dealing with the cause of the condition Palliative care starts when you are diagnosed with the illness Longer period of time End of life: the last 6 months of life

Answer 192

A site or program that provides medical and supportive services for dying patients • May take place in the home • Allows patient to have pain control and symptom management, avoid extended period of dying, achieve sense of personal control, reduce burden on others, and strengthen ties with those close to them

Answer 193

Controlled trial to improve care of seriously ill hospitalized patients Multicenter study 9000 patients with life threatening illness ◼ 1st phase- How people die in hospitals ◼ 2nd phase- RCT of nurse based intervention, 2500 subjects in each group

Answer 194

53% - Physician did not understand that a patient wanted to avoid CPR 38% - Prolonged Suffering: 10/More Days in ICU, in Coma, or on Ventilator 50%- Experienced Moderate or Severe Pain at Least Half of the Time Within Their Last Few Days

Answer 195

``` Needed large amount of family caregiving 34% Lost most family savings 31% Lost major source of income 29% Major life change for family member 20% Other family illness from stress 12% At least one of the above 55% ```

Answer 196

``` • Site of death predicted by (instead of patient preferences : –number of hospital beds –hospice spending –% patients in nursing home –expenditures on long term care –diagnostic category ``` • Patient preferences irrelevant

Answer 197

RAPID DECLINE OVER FEW WEEKS OR MONTHS BEFORE DEATH Integration w hospice or palliative care - maximize continutity - plan for rapid decline, changing needs + death - manage pateint's symptoms at home - provide support for caregiver CHRONIC ILLNESS W INTERMITTENT EXACERBATIONS Disease management w education + rapid intervention - provide education on self-care - attempt to avoid hospitalization when possibke - assist in decision making on interventions that might not work - plan for potential of sudden death VERY PPOR FUNCTIONING, W LONG SLOW DECLINE long-term supportive care - plan for long-term care and future problems - avoid non-beneficial and harmful interventions - provide support + assistance for long-term caregvers - provide reliable institutiona care when necessary

Answer 198

Bereavement is best understood from a BIOPSYCHOSOCIAL perspective Biological - Stress on body Psychological • Range of negative emotions • Impaired attention and memory Sociocultural • Altered position in family and community • Financial burden • Change in support network Loss of child is most stressful of all forms of bereavement

Answer 199

traditional: grieving for more than a year is abnormal   Newer: attachment view   Always going to be grieving   Each person's grief trajectory may be different   - Adjusting to emotional loss  

Answer 200

Traditional view - death should b worked through - grief that goes on for 1+ yr is abnormal Attachment view - maintain continuing bond w deceased - keeping possessions is not abnormal Dual-process model proposes that practical adaptations to loss (“restorative”) are as important to adjustment as the emotional (“loss”).

Answer 201

(Ole Kassow) Cycling without age

Answer 202

Freedom is the most common word that pops up when they do the bike assimilation - Bike is equal to freedom With magic super hero glasses, you notice little things that you wouldn’t notice before - In 2012, he noticed an older adult who loved the outdoor - Immobility causes - Social isolation and poor mental health - Senses were stimulated when they were on the bike

Answer 203

Togetherness and sharing stories An individual that the speaker knew who passed away around 101 years There was a lot of wisdom hidden within him “Pyt” – it means never mind (is what the individual used to use) Secret of happiness is let things go We all have the power to get that wisdom to share with our generation Great sense of relief is when older adults can pass something on to the next generation and they know that their experiences and stores are not dying For the first year there was only about 30 people cycling with them (that is where he started the concept of helping each other, doing experiments, etc.)

Answer 204

If we were to rank the 10 factors to contribute to a long healthy life, where does not smoking rank? (The list was published by a psychologist living in Montreal) ``` Number 3 is not smoking Exercise is number 7 Being lean vs. overweight number 8 Number 1 is social integration Number 2 is close relationships ```

Answer 205

If you want to live a long life, you have to be able to go out and make new friends and be recognized in your local community The psychologists research she finds that a strong and large social network is effective for how old we get and how happy we are Inge Paris – 97 woman always wanted to stop by the bakery when they would go out cycling and she would always stop and talk to people and that was her way to stay connected outside the nursing home When you’re in a nursing home, the number of new people you meet is fairly low (no where near sufficient social integration that gives you a long and happy life)

Answer 206

Second on that list The grey escape – documentary

Answer 207

40 countries, 1,500 chapters, 15,000 cycle pilots now In Canada we have around 50 chapters and the US is 150 chapters These bikes are freedom technologies that allow you to live longer and happier We often try to solve things with complex solutions but this bike idea is such a simple solution and everyone can do it 90-95% of our time is spent indoor Comfort and convenience rules us now but we are made to be out in nature

Answer 208

Liz and Paula (who turned 100 this September) If you have untreated hearing loss there is an increase risk of developing dementia because parts of the brain won’t get stimulated if you don’t treat hearing loss It goes for other senses as well like sight, smell, touch If we don’t treat the senses than our health will suffer The speaker believes we should get out of our comfort zone and that we should be using or senses (like hearing the snow under the tires while driving, sitting under the shade on a hot summer day that you cant do if you stay indoors)

Answer 209

RSGW r - relationships s - slowness g - generosity w - without age

Answer 210

“Tour de Oresund” – you can cycle around it and it’s a 3 day ride 150 kilometers They take their time (slowness is one of their guidelines)

Answer 211

Volunteers One group are seniors helping other seniors - John – Santa Barbara, CA – he wants to help other people - Everyone you meet knows something you don’t - Arne – 62 and his purpose gives him something to get up to in the morning (and he feels so bored after he retired) - Not only about physical health but the right to enjoy life - Suzie – dignity (wanted to learn so she can take out her mother) – not about fear of an accident but being put in a compartment like the cycle, it looks like a wheelchair and you’re really under pressure and you feel like you lose your dignity when you use it - But with the cycle, they always address the passenger first and it gives them back their dignity Another type of volunteer is – Oshkosh Police department - They also work with corporate volunteers (sales force) - Developing program where the outcomes include - Being curios What do you do when you don’t know what to say How to make stronger connections in a short period of time How to be good social networkers

Answer 212

Consider them as virtues rather than negative terms It is irresponsible not to take risks because it leads to amazing experiences Take out elders when staff and nursing staff say that it cant be done Example this women who has dementia (but they found that this woman became very happy person who slept throughout the night – broke the isolation, they overcame her aggression, it changed her sleep and eating patterns and it all came from this bike experience)

Answer 213

(guiding principle where they accept that age does not matter) Group of volunteers and passengers called the runaways Age ranges from 43, 86, 31, 100, 76 etc. Why not? Just because you’re in a nursing home doesn’t mean you cant go out and do things There was a jam in the cycle and Knud 84 (a passenger) got out and fixed the problem when no one else could He talked about how it feels good that he can still make a difference And that “he is being counted now” – he was a retired maintained guy And then he asked to be a volunteer and now he is the person who fixes the cycles and maintains them The right to be mischievous – the story where one of the older ladies kept taking the apples from the tree and her friend kept saying “stop stealing the apples” but the other lady was laughing as she was doing it