final Flashcards

1
Q

epigenetic principle

A

Each stage unfolds from the previous stage in a predestined order but  

People may experience a psychosocial issue at an age other that the one shown where it crosses the diagonal 

Dev doesn’t stop at 18, it continues throughout the life course

There is a certain order to things

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2
Q

erikson’s psychosocial theory stages

A

early infancy - basic trust vs mistrust
toddlerhood - autonomy vs shame
early childhood - initiative vs guilt
middle childhood - industry vs inferiority
adolescence - identity achievement vs identity diffusion
young adulthood - intimacy vs isolation
middle adulthood - generativity vs stagnation
later adulthood - ego integrity vs despair

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3
Q

Middle Adulthood: Generativity vs Stagnation

A

Focused on psychosocial issues of procreation, productivity + creativity 

  • Parenthood  
  • Can also be developed through teaching, mentoring, supervising  

Main feature (generativity) = feeling of concern over what happens to younger gen  

  • How do I contribute to the world
  • How do I give back?
  • Want to make world  a better place for them  
  • Donations, being more environmentally friendly  
  • ——->Creating legacy  

Once you finish generativity you move on to ego integrity  

Stagnation = concerns are focused on own age group 

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4
Q

Late Adulthood: Ego Integrity vs Despair

A

Did I lead a meaningful/fulfilling life?  

What are you most proud of?

What did you regret?

Relevant to wisdom assign

Am I happy with the life that I have lived?

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5
Q

critiques of epigenetic principle

A

Problem with this - in life we may experience psychosocial issue at younger age  

Step-wise fashion - critique

Ex: Breast Cancer at a younger age  

  • Could be facing ego-integrity vs despair  
  • Facing the end of life at an earlier age  
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6
Q

identity process theory

A

1) identity (favourable view of self)
2) -> threshold experience (normal changes, illness)

3)
- —>identity accomodation
- over the hill syndrome
- compulsive illness beh

  • —>identity balance
  • gradual integration
  • appropriate adaptation
  • —> identity assimilation
  • unhealthy denial
  • healthy denial
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7
Q

video - secret to longevity

A

Type of data we will be getting when we interview our wisdom person

Refusing to give up  
Engaged with life 
Embracing life   
Being active  
Try to be happy   
Eat healthy   
Be curious   
Find your passion   
Moderation - balance   
Love   
Friends and family  
Volunteering   
Don't give up   

How do these relate to stages in theory?  

  • Love, surround self with family - intimacy  
  • Giving back - generativity 
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8
Q

identity changes - identity process theory

A

Our identity will change as we get older  

Dynamic change  

Identity  
- Who am I?  

As we get older, theory states threshold experiences  

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9
Q

threshold experiences

A

Normal changes associated with aging  

Normal, social as well as illness  

Something has happened that will affect your identity  

Ex. Getting bifocal glasses

Ex. Having an age-related illness

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10
Q

3 ways to respond to threshold experiences

A

identity assimilation
identity accomodaation
balance

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11
Q

identity assimilation

A

Threshold experience interpreted in terms of existing identity  

Ex: being good student  

  • You see yourself as, others view you as 
  • Occasionally may do poorly 
  • Assimilation sees this as good student who ran through rough patch 
  • No change in identity, don’t let negative experiences shatter your view  
  • Exam was unfair; prof was..

Pro: feeling good regardless of having this bad experience  
Cons: distorted experiences/interpretations  
—-> Blaming other people, external factors  

Aging Example: Caring for mom who has dementia, come in one day, she yells, thinking you are intruder  

  • Can shape identity as good daughter  
  • Assimilation - good part  
  • ——>It’s the dementia, not me (not internalizing)  

NO CHANGE IN IDENTITY for assimilation
- Resist change in identity when criticized

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12
Q

identity accomodation

A

Changing your identity in response to an experience  

Parent with dementia - instead of seeing yourself as daughter, now caregiver  
- Role has shifted  

C - CHANGE IN IDENTITY for the accommodation

  • The best way to cope  
  • Feeling over-the-hill syndrome** check in textbook
  • —->Omg I’m old
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13
Q

Balance

A

Maintaining stable sense of who we are, our sense of self but also making the right changes along the way  

A combination of the two  

Equilibrium

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14
Q

affects of aging on identity

A

for some ppl, age-related changes in appearance serve to simulate changes in identity

Aging attitude

Simulation in class 

  • Mimicking normal/common age related problems  
  • Once people see changes  
  • Can really stimulate change in identity  

One way people age successfully is through self -efficacy  

  • Where identity is balanced well  
  • I’m in control, I feel confident
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15
Q

multiple threshold model

A

Individuals realize that they are getting older through a stepwise process as aging related changes occur; highlighting/indicators that you are getting old

Ex: being called Sir, Ma’am  

Not as young as you thought you were  
Not being able to keep up with younger people  

Realization that you aren’t as young as you thought you were 

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16
Q

selecive optimization w compensation model (SOC)

A

Paul Boulton

Applicable across the life course

1) Select - choose area of focus
2) Optimize - maximize performance in these areas
3) Compensate - make up for losses in one area w gains in another

Ex. When aerobic exercise becomes too strenuous, people might substitute it with gentle yoga

Ex. Piano player

  • Threshold experience: rigidity in hand
  • Figured he has difficulty playing fast songs
  • compensated for the loss of playing fast songs was to make the previous section slow so the change from slow to fast was evident
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17
Q

processing speed + attention

A

Rivals Khan theory

cognition - how our minds work  

  • Attention  
  • Memory  
  • Intelligence  
  • Problem solving  
  • Language use  

Processing Speed one of most widely studied measure of cognition  

  • Amount of time it takes to process information, and output info  
  • Most pop way its measured is by measuring how fast
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18
Q

simple reaction time

A

make response as soon as target appears

eg.push F button when you see red “n”

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19
Q

choice reaction task

A

make one response for one stimulus, and another for the other stimulus

e.g. push F button when you see red “n” and J button when you see green “n”

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20
Q

general slowing hypothesis

A

Proposes loss of speed in nervous system is main cause of poorer information processing

As task becomes more complicated, older adults take MUCH longer; rxn times much slower

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21
Q

brinley plot deviation

A

deviation of dots from diagonal line shows extent to which OAas disproportionately slower as task becomes more challenging for young adults

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22
Q

Attention as source of slowing of RXN time

A

Pyramid

  • Problem solving at top
  • Memory in middle
  • Attention at base

Wider at base: attention as foundation

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23
Q

types of attention

A

focused vs. divided

Focused - Concentrate on single source of input

Divided - concentrate on 2 or more sources of input

Divided req MORE effort

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24
Q

visual search tasks

A

require observer to locate specific target among set of distractors

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25
Q

simple visual search

A

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
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26
Q

conjunction visual search

A

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  
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27
Q

theories of attention + aging

A

attentional resources theory

inhibitory deficit hypothesis

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28
Q

stroop effect

A

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

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29
Q

attention resources theory

A

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

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30
Q

inhibitory deficit hypothesis

A

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

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31
Q

when doing research on older adults

A

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

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32
Q

studies on video games show……

A

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

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33
Q

driving and aging

A

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

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34
Q

younger vs older drivers

A

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
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35
Q

% of alc related deaths in canada 2010`

alc related car crashes

A
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 %

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36
Q

biopsychosocial view of driving + agign

A

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 
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37
Q

aging airline pilots might be safer

A

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

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38
Q

memory - diff types + how it works

A

How does memory work?  
- Starts with stimulus 

phonological loop
visuospatial scratch pad
episodic buffer
central executive

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39
Q

phonological loop

A

Auditory memory 

Can recourse information through repeating it over and over

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40
Q

visuospatial scratch pad

A

Visual memory 

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

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41
Q

episodic buffer

A

Retrieving information from long term memory 

Bring info temporarily into working memory  

Working memory keeps info temporarily + ready for use  

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42
Q

central executive

A

Allocated cognitive resources  

How to allocate  

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43
Q

processes of long term mem

A

encode -> store -> retrieve

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44
Q

aging + long term mem

abilities that decline

A

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  
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45
Q

aging + long term mem

abilities that do not decline

A

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  

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46
Q

self-efficacy

A

Confidence that your memory is in good shape  

If you have this confidence more likely to do well  

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47
Q

memory self-efficacy

A

greater self-efficacy -> better memory performance

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48
Q

stereotype threat

A

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  
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49
Q

memory controllability

A

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

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50
Q

memory also related to health-related beh in middle and later adulthood

A

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  

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51
Q

memory training studies show benefits for OA

A

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
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52
Q

future of helping ppl through gaming + VR

A

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  

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53
Q

ACTIVE study

A

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%

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54
Q

measuring wisdom

A

Problem with “mechanism of intelligence”

Focus on “pragmatic of intelligence”

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55
Q

problem w “mechanics of intelligence”

A

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   

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56
Q

berlin wisdom paradigm

A

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  

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57
Q

Brofbrenner’s ecological perspective

A

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

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58
Q

chronosystem

A

change in systems over time

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59
Q

brofbrenner’s ecological perspective - what each stage entails

A

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
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60
Q

social clock

A

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  

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61
Q

life course perspective - aging

A

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)  
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62
Q

what is life course perspective

A

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  

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63
Q

transitions - life course perspective

A

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  
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64
Q

trajectories - life course perspective

A

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

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65
Q

linking early life to later outcomes

A

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. .

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66
Q

mrs tanaka - background, life course,

A

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
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67
Q

mrs tanaka care plan

A

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  

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68
Q

cohort effects are limited by history

A

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
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69
Q

mrs tanaka - cohort, history, culture/location, gender, stregnnths

A

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

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70
Q

contrasting life course theories

A

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 

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71
Q

contrasting life theories - Q - shouldlife long runner continue running even tho he’s an OA?

A

disengagement theory -> No

activity theory -> yes

continuity theory -> depends on person’s personality

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72
Q

marriage - the facts

A

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

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73
Q

role of historical events and policies on marriages and divorces 

A

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  

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74
Q

same sex marriiages + mixed couples

A

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

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75
Q

marriage has advantages for both aprtners

A

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
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76
Q

men vs women - living alone

A

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?

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77
Q

cohabitation

A

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

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78
Q

cohabitation effect

A

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

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79
Q

intention of moving in w partner decreases w age

A

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  

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80
Q

same sex couples - stats

A

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

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81
Q

divorce + remarriage

A

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

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82
Q

divorce stats can be misleading

A

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

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83
Q

children in divorce

A

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

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84
Q

widowhood

A

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

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85
Q

widowhood effect, showing higher risk of mortality for widows than for married men and women

A

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)
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86
Q

mediators

A

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

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87
Q

ppl vary reactions to widowhood

A

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  

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88
Q

sexulaity remains improtant to OA

A

% 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.

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89
Q

pathways of longterm relationships (3)

A

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

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90
Q

perspectives on long term relationship

A

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

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91
Q

families

A

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
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92
Q

change in fam structure + functioning

A

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  
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93
Q

empty nest

A

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

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94
Q

concepts in parent-adult child relationships

A

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   
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95
Q

intergenerational solidarity model

A

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  

96
Q

siblings have unique bond

A

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  

97
Q

grandparents

A

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
98
Q

friendships in adulthood

A

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  

99
Q

OA labour force participation

A

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

100
Q

age discrimination in employment act

A

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  

101
Q

phases of retirement

A

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
102
Q

variations in retirement pattersn

A

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
103
Q

facts about retirement

A

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
104
Q

why retire?

A

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 
105
Q

retirement: a modern idea

A

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  
106
Q

retirement in 2011

A

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  
107
Q

who is eligible - OAS, CPP, QPP

A

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.)

108
Q

CAnada, US, EU - struggling w aging pop that will have to be supported by smaller workforce

  • some solutions?
    /
A

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  
109
Q

theories of retirement + the ind

A

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
110
Q

biopsychosocial model of retirement

A

biological

  • physical changes
  • health problems

psychological

  • cognitive functioning
  • personality
  • expectations about retirement

sociocultural

  • social class
  • income
  • opportunities for engagemen
111
Q

leisure pursuits in later adulthood

A

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

112
Q

predicting mortality based on physcial activity in leisure activitieis

A

Importance of fun in later adulthood 

People low in physical activity are most likely to experience mortality / more likely to die

113
Q

what are the leisure activities? what are they doing to have fun?

A

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

114
Q

innovation theory + leisure

A

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

115
Q

family caregivers

A

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

116
Q

caregiving: public health issue

A

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) 
117
Q

diversity among caregivers

A

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  

118
Q

ontario’s family caregivers

A

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

119
Q

ppl who provided help or care

A

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
120
Q

hours of care

A

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

121
Q

caregiving as a career

A

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 

122
Q

child vs spouse - caergiving career

A

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
123
Q

care needs over time

A

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 
124
Q

stages of perfomring caregiver tasks

A

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 

125
Q

multidimensional aspects of caregiver burden

A

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

126
Q

caregiver - health costs

A

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  
127
Q

caregiver - life interefernce

A
- 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  
128
Q

caregiver - relationship costs

A

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 

129
Q

anticipatory mourning

A

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

130
Q

joys of caaregiving

A

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

131
Q

multidimensional aspects of caregiver burden

montgomerry, borgotta

A

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

132
Q

from movie - home care

A

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?  

133
Q

from movie - nursing home

A

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 
134
Q

long-term care (LTC)

A

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 

135
Q

overview of LTC in canada

A

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

136
Q

3 types of ownership of nursing homes

A

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 $$

137
Q

out of pocket costs in LTC

A

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

138
Q

LTC - means tested?

A

Means-tested

Sliding scale for how much you pay based on your income for care you receive

Usual for not for profit

139
Q

home care + community-based services

A

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  

140
Q

home care

A

 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)

141
Q

economic contributions of caregivers

A

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  

142
Q

source of care from most common to least

A

informal, formal, mixed

143
Q

adult day programs + respite care

A

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

144
Q

community housing alternatives

A

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

145
Q

Continuing care retirement community (CCRC) -

A

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

146
Q

supportive or assisted living

A

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

147
Q

nursing homes

A

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
148
Q

relocating to LTC

A

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.

149
Q

psychological issues in LTC

A

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

150
Q

models of adaptation

A

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

151
Q

environmental press vs competence graph

A

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  
152
Q

resident assessment instrument

A

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%

153
Q

Surveyed published in 2012 of 948 staff in Canadian longterm care facilities found:

A

• 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.

154
Q

improving long term care

A

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

155
Q

greenhouse model

A

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

156
Q

number of dcotors & doctors/ 100 000 in geriatric med , 2015

A
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

157
Q

psychopathology in OA

A

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

158
Q

DSM 5

A

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 
159
Q

major depressive disorder

A

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%)

160
Q

dsm 5 - patterns

A

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  

161
Q

OA w chronic illnesses

A

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  

162
Q

OA - mental health dsm 5 examples - depression + lsoing interest in activities

A

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  

163
Q

Think about unique challenges OA face + coping with mental health problems in late life

A

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  

164
Q

Symptomology and impacts that distinguish this disorder from another  

  • How long symptomology is lasting
A

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 

165
Q

OA might not be correctly diagnosed for major depressive disorder - why?

A

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  
166
Q

risk factors for depression

A

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  

167
Q

Medical conditions can present

significant risk factors, including:

A
  • 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

168
Q

suicide

A

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 

169
Q

facts about suicide

A
  • 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  

170
Q

Mortality rates due to suicide  

A

Rates much higher for men compared to women  

Among 85+  especially

171
Q

bipolar disorderr

A

• 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

172
Q

anxiety disorders

A

• 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

173
Q

why are prevalence rates lower among OA?

A

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  
174
Q

diff types of anxiety disorders

A

 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)

175
Q

trauma + stress related disorders

A

• 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;

176
Q

Late-onset stress symptomatology (LOSS)

A

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.
177
Q

schizophrenia + other psychotic disorders

A

• 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

178
Q

substance related disorders

A

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

179
Q

schizophrenia negative vs postiive symptoms

A

Opposite of things such as hallucinations - not feeling anything, not wanting to engage 

Delusions are positive symptoms/active symptoms, very prevalent 

180
Q

alc dependence in OA

A

• 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

181
Q

treatment issues in mental health care

A

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 

182
Q

asssessment - mental health aging

A

• 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)  

183
Q

assessmen - deprssion as an ex

A

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.

184
Q

Must assess depression from a bio-psycho-social

perspective, and consider:

A

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
185
Q

assessment measures

A

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  

186
Q

treatment - medical interventions

A

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
187
Q

models of psychotherapy w OA

A

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  

188
Q

NINCDS-ADRDA criteria for dementia (2011)

A

 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.

189
Q

NINCDS-ADRDA criteria for dementia (2011)

Cognitive or behavioral impairment involves a minimum of two of the following domains:

A

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

190
Q

primary vs secondary dementai

A

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.)

191
Q

alzheimers disease

A

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
192
Q

progressive decline in AD

volicier, brandice, hurley

A

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  

193
Q

dementia vs depression

A

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 
194
Q

dying + death in north america

A

• 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

195
Q

medical aspects of death

A

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

196
Q

crude mortality rate

A

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

197
Q

age specific mortality rate

A

Crude death rate for a specific age group

198
Q

age-standardized mortality rate

A

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

199
Q

death by the numbers

A

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

200
Q

top 3 causes of death

A

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

201
Q

many demographic factors predict mortality rates

A
marital status
race/ ethinicity
sex 
involvement in organized religion
level and pattern of jobs (stress)
202
Q

cultural perspectives on dying

A

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

203
Q

ethos

A

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

204
Q

Culture’s prevailing philosophy of death can be inferred by:  

A

Funeral rituals  

Treatment of dying  

Belief in presence of ghosts  

Belief in afterlife  

Treating death topics as taboo  

Representation of death in the arts

205
Q

components of positive dying experience

A
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  
206
Q

shifts in western attitudes towards death

A

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 
207
Q

stages of dying on Kubler-ross on death + dying

A

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
208
Q

barriers to a better death experience

A

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

209
Q

psychological changes associated w dying process

A

• 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

210
Q

advanced directives

A

• 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
211
Q

what is death w dignity

A

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

212
Q

medical assistance in dying (MAID)

A

• 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

213
Q

physician assisted suicde vs euthanasia

A

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  
214
Q

Video: showing proper palliative care in a long-term home - McCormick Home 

A

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

215
Q

palliative care

A

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

216
Q

hospice care

A

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

217
Q

the study to understand prognoses and prefernces for outcomes + risks of treatement (SUPPORT)

A

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

218
Q

stats of not knowng pateints’s wishes

A

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

219
Q

impact of srs illness of pateint family

A
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%
220
Q

SUPPORT - Site of death

A
• 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

221
Q

getting services for dying “right”

  • trajectory, model of care, specific care needs
A

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

222
Q

Bereavement is best understood from a

______________ perspective

A

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

223
Q

grief

A

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  

224
Q

theories of bereavement

A

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”).

225
Q

guest speaker

A

(Ole Kassow)

Cycling without age

226
Q

bike + freedom

A

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
227
Q

relationships - ole kassow

A

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.)

228
Q

how do u live a long and healthy life? - ole krassow

A

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
229
Q

Social integration (number 1 on the list) - ole krassow

A

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)

230
Q

Close relationships (2nd on the list) - ole krassow

A

Second on that list

The grey escape – documentary

231
Q

other things speaker was talking about

A

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

232
Q

risk of not using our sense - ole krassow

A

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)

233
Q

ole krassow - what was he spelling out

A

RSGW

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

234
Q

slowness - ole

A

“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)

235
Q

generorsity

A

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

236
Q

risk + inconvenient as virtues

A

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)

237
Q

without age - ole

A

(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