Human Development III Flashcards
What are the common developmental experiences?
Marriage/partnership ― Parenthood ― Establishing career ― Vocational changes ― Divorce ― Empty nest (last child leaves house) ― Boomerang children (return of child to house) ― Dependency of elderly parents
― Retirement ▪ Phases: Honeymoon; Disenchantment; Reorientation & Stability ― Loss (deaths) ― Shrinking social network ― Loss of independence ― Chronic illness ― Facing end of life
Not all occur, and no set time for these experiences
• Developmental experiences can shape personality, even in adulthood (e.g.,
Erikson’s theory)
What are the stages of adult life?
Stages of Life (review DLA on Erikson’s Psychosocial Stages)
‒ Resolution of developmental conflicts from infancy
through adulthood predisposes specific traits
Developmental Phase* Early Adulthood (20s-40s) Middle Adulthood (40s-60s) Late Adulthood (65+)
Psychosocial Stage
Intimacy vs. Isolation
(gaining capacity for love)
Generativity vs. Stagnation
(feeling a sense of contribution)
Integrity vs. Despair
(reflecting on quality of life lived)
What are the issues 9f adult development?
• Many of the issues experienced during adult
development are stressors
• Stress increases risk of common chronic diseases such as cardiac disease, diabetes, and depression
What are the age related physical changes of adulthood?
Physical abilities peak in early adulthood, then decline: – Muscular strength – Cardiac output – Reaction time – Sensory acuity • Vision (presbyopia) • Audition • Olfaction
Sleep rhythms shift with age
– The need to sleep is moved earlier – “sleep phase advance”
Describe the gradual decline in sexual functioning
Gradual decline in sexual functioning
― Men: sperm count, testosterone level,
speed of erection, force of ejaculation, refractory period following ejaculation
― Women: hormone levels, longer to become sexually aroused, vaginal wall irritation due to decreased elasticity and lubrication, shorter and less intense orgasms
What are the features of increasing physical durability?
Increasing physical disability
―Diminished ability to recover after injury or
acute illness
―Onset of chronic illness
Summarize age related changes in brain structure
• White matter volume increases until ~40 years of age and
starts to slowly decline
• Gray matter volume shows a steady decline across the
adult life span
• Cerebrospinal fluid volume sharply increases ~60 years of age, corresponding with visible brain atrophy on MRI scans
What are the age related decline features of cognitive decline?
Crystallized intelligence
‒ Vocabulary, reading, facts
‒ Increases in early adulthood and generally plateaus throughout middle and late adulthood (i.e., there is less decline than with fluid intelligence)
Fluidintelligence
‒ Attention, memory, processing speed
‒ Increases in early adulthood and then declines throughout middle to late adulthood
What is a cognitive reserve?
Cognitive Reserve
‒ A person’s capacity to maintain normal cognitive function in the presence of brain degeneration (age-related or pathological)
▪ Increased education is associated with greater cognitive reserve
▪ Brain degeneration still occurs, but signs of cognitive dysfunction are delayed
What is life expectancy?
General increase over the past century ‒ US average in 2019= 78.8 yrs ‒ Average life expectancy decreased by 1.5 0 yrs in 2020 ‒ Women live longer than men by several years
What demographic often has chronic illnesses?
Chronic Illness (people ≥65) - Conditions lasting ≥1 year that require ongoing medical attention or limits activities
- Common examples − Heart disease − Cancer − Stroke - Respiratory - diabetes - Ahlzeimer’s dementia
Majority have ≥2 chronic conditions with associated complex treatment regimens
Growing proportion of elderly population (predicted to be almost 25% by 2060, up from 16%)
What are the leading causes of death?
Causes
‒ Top 5 causes of mortality vary by age
Trends ‒ Death by external causes in younger age groups • Unintentional injuries • Suicide* • Homicide
‒ Death by chronic disease in older age groups
• Heart disease
• Malignant neoplasms
• Respiratory disease
What are the major needs of dying persons and how are these needs met?
Needs
‒ To control pain
‒ To maintain dignity
‒ To receive love and affection
Meeting these needs
1. ‒ Active pain management
control ▪ Requires patient to actively participate in
pain-managing activity (e.g., yoga, exercise)
- Maintain Dignity
‒ Patient participation in treatment decisions
‒ Use of Advance Directives (as per the Patient Self-Determination Act) - Love & affection ‒ Holding, touching, listening, and supporting
as appropriate
‒ Facilitating continuous family involvement
What do we do when dealing with dying patients?
• Patients (and families) may experience preparatory (anticipatory) grief
― Normal mourning that occurs before death, in reaction to forthcoming losses
― Explore such feelings with patients to help avoid depression/isolation often seen in terminal illness
• Distinguish normal grief from depression
― Due to symptom similarity with grieving,
depression may be overlooked
▪ Even when grieving, person can still have joy
▪ Feeling joyless and worthless are more
evident in depression
Summarize the dying process: Kübler Ross
Based on clinical experiences with dying patients • Five stages of dying (grief) – Denial – Anger – Bargaining – Depression – Acceptance
- Stages are not invariable or universal
- May apply to loss in genera
Describe denial phase
Resistance to reality of impending death
– May search for other diagnoses or miracle cures
– May withdraw from physician’s care
– Physician should:
• Facilitate further evaluation
• “Leave the door open” for patient return
Describe the anger phase
ANGER
– Why me?
– Hostility, resentment, envy
– Anyone can be the recipient of the patient’s anger
– Anger at physician could lead to threats of lawsuit
Describe the bargaining phase
BARGAINING
– Making a deal with a deity
– Plea to extend life in exchange for a change in behavior
• If I can live until…then I won’t/will…
Describe the depression phase
DEPRESSION
– Occurs when manifestations of the illness become too serious to deny
– Realization of unavoidable death
– Immense sadness and sense of great loss
Describe the acceptance phase
ACCEPTANCE – Resolute about impending death – End of struggle – Sincere preparations can begin • Put affairs in order • Say goodbye – Able to comfort others
What is palliative care?
Specialized medical care for people with serious illness to improve quality of life for patient and family
• PC Team
‒ Multi-disciplinary, specially-trained team of doctors, nurses, and specialists who work with a patient’s other doctors
‒ Provides an extra layer of support
PC Care
‒ Appropriateatanystagein
a serious illness
‒ Can be provided along with curative treatment
What is palliative care provided by?
• Support provided by PC: – Providing relief from the symptoms and stress of a serious illness ▪ Symptom management (pain, nausea) ▪Psychological, sociocultural, spiritual support
– Advanced communication
▪ Enhance understanding of disease
▪ Clarify treatment goals and options
▪ Emphasis on informed, shared decision making
What is hospice care?
A specific type of palliative care for people with ≤6 months to live and are no longer seeking disease treatment
• Primary goal
‒ To help people at end of life to die with
minimal discomfort and maximal serenity
• Multi-disciplinary care to: ‒ Manage pain and other symptoms ‒ Support emotional, psychosocial, and spiritual aspects of dying ‒ Provide bereavement care and counseling
• Settings
‒ Home with support ‒ Specialized center
Contrast hospice and palliative care?
Palliative Care (PC)
• Offeredatanytimeduring disease course, regardless of prognosis
• Patients still have access to all treatments (e.g., chemotherapy)
Hospice Care
• A type of PC offered to patients with expected prognosis ≤6 months
• Requirescessationofalldisease- directed therapy
What is the statement of respect?
Different cultures have different practices around death
– Understanding the patient’s cultural practices assists the physician in helping the patient die with dignity
Statement of Respect
“I know very little about how your culture deals with things at such a time. I understand and respect the fact that different people handle things in different ways. I would very much appreciate it if you would teach me what I need to know to be of help.”
