Lecture 11: physical and cognitive development in late adulthood Flashcards
Ageing and Ageism
Ageism
• Treatment, stereotyping, discrimination because of someones age
• More stereotypes about old people than any other age group
- Older people also have ageist views
- See themselves more positively than their peers
• May impact on treatment recommendations and expected outcomes
Life Expectancy
- Maximum lifespan is about 120 years
- Increased life expectancy means that more people are approaching that limit
- Centenarians = .02% of population
• Super centenarians
- People 110 years+
- Average lifespan not expected to exceed 85
• Biological limitations
Theories of Ageing
Senescence
Programming theories
Senescence (deterioration with age) explained by:
Cellular theories:
- Wear and tear
- Genetic errors
Programming theories:
- Hayflick limit – 50 replications
- Death built-in
- Nothing can extend the lifespan
Physical Functioning
Primary ageing
Secondary ageing
Primary ageing – universal changes
Secondary ageing – effects of illness and disease
• Motor, sensory, intellectual slowing
- Primary ageing of CNS and PNS
- Can improve with training
- Skin, bone, and muscle changes
- Cardiovascular, respiratory and sensory systems change
Sensory Change
men lose their hearing more than women because they are exposed to more environmental hazards
Improving Health Behaviours in Late Adulthood
- sleeping an average of 7-8 hours nightly
- eating breakfast almost every day
- seldom, if ever, eating snacks
- controlling weight
- exercising regularly
- limiting alcohol consumption
- being a nonsmoker for life
Current Research: Australian Longitudinal Study of Ageing (ALSA)
- Australian Longitudinal Study of Ageing (Flinders University)
- Began 1992 with 2087 participants aged 70+ years in South Australia
- Aim: gain an understanding of how social, biomedical, and environmental factors are associated with age-related changes in health and wellbeing of elderly individuals
Chronic Illnesses: Cardiovascular Disease
Risk factors
Coronary heart disease, heart failure, stroke and peripheral vascular disease
Risk factors:
• Family history
• Smoking, poor diet, lack of exercise
- Personality type
- Stress
- Gender
Chronic Illnesses: Hypertension
Risk factors
• High blood pressure
- Systolic BP > 140
- Diastolic BP > 90
- Deterioration of arterial walls (continued high blood pressure)
- Arteriosclerosis
- Risks of heart attack, kidney damage, stroke
Risk factors
• Gender, genetics, obesity, poor diet, stress, personality characteristics
Chronic Illnesses: Cancer
Risk factors
• Uncontrolled cellular growth, dysfunction of DNA
- Malignant tumours
- Spread through metastasis
Risk factors:
- SES, genetics, gender, lifestyle, diet
- Life events, negative affect, personality, social support, isolation, stress
Chronic Illnesses: Arthritis
- Inflammation of joints and connective tissue
- Pain, stiffness, sometimes swelling
- Osteoarthritis
- Degenerative joint disease
- Rheumatoid arthritis
- Autoimmune reaction
- Affects whole body
- Stress makes condition worse
Mental Health Issues: Depression
Associates of depression
• Mental disorders underestimated and undertreated in older adults
- Stoicism limits reporting
- Most common disorder is depression
- May be mistaken for normal ageing
- Symptoms may mimic dementia
- Associates of depression
- Chronic health issues, functional impairment, social deprivation, medication
The Ageing Brain
Pseudodementia
Acute and Chronic brain syndromes
- Neuronal loss and growth
- Axon sprouting, dendrite branching, synaptogenesis (growth)
- neurofibrillary tangles, granulovacuolar degeneration (loss)
- Pseudodementia: mimic symptoms of dementia (depression etc)
- Brain syndromes:
- Acute: caused by e.g., diabetes, liver failure
- Chronic: e.g., multi-infarct dementia and Alzheimer’s disease
Multi-infarct Dementia
- Caused by vascular disease
- Risk factors include hypertension, diabetes mellitus, advanced age, being male and smoking
- Blockage of oxygen to brain causes tiny strokes
- Sudden rather than gradual onset
• May have periods of lucidity
Alzheimer’s Disease (AD)
- 50-60% of organic brain syndrome patients over 65 have AD
- Degeneration of brain cells affecting memory, learning, and judgement
- Symptoms worsen with disease progression
- Care in controlled environment
- Causes and cures not understood
Symptoms of Alzheimers Disease
- Memory impairment
- Deterioration of language
- Deficits in visual and spatial processing
- Repeating of questions
- Everyday tasks unfinished or forgotten
- Personality change (rigidity, egocentricity)
- Irritability or anxiety
- Lack of concentration
Risk Factors for Alzheimers Disease
- Chronological age
- Gender
- Vascular conditions
- Low education
- Head injury
- Biological susceptibility
Memory Changes
- Anticipatory dementia
- Gradient of vulnerability
• Some memory processes change more than others
Memory changes:
- Working memory – age deficits
- Episodic memory – steady decline
- Semantic memory – largely intact
- Procedural memory – least change
Erikson: Ego-integrity vs. Despair
- 8th and final critical stage of psychosocial development
- People in late adulthood either achieve a sense of integrity of the self by accepting the life they have lived, and thus accept death, or yield to despair that their life cannot be re- lived
Erikson: Ego-integrity vs. Despair
Life Review
Life Review: Reminiscence about one’s life in order to see its significance
- Writing or taping autobiography
- Constructing a family tree
- Looking over scrapbooks and old letters
- Trips to childhood locations
- Reunions with friends and family
Attitudes Towards Death
Death awareness movement
- Death most likely to be in institutions
- Often removed from everyday life
- The dying may experience social death
• Language about death often full of euphemisms
Death awareness movement (70s)
- New meanings for death and dying
- Cultural analysis of attitudes
- Promoted the notion of the good death
Defining Death
- Previously absence of respiration and heartbeat
- Now criteria focus on brain death
- Irreversible coma
- Definition critical for issues of organ transplant
- Conflicting views in Japan and North America
- Reflection of cultural views on death
Accepting One’s Own Death
• Death becomes more salient with age
Earlier death experiences
- Death of sibling in childhood
- Death of friends or peers in adolescence
• Death of cultural icons
Death acceptance (Wong, Reker, & Gresser, 1994):
- Neutral acceptance
- Approach-avoidance acceptance
• Escape-avoidance acceptance
Death Anxiety
Terror Management Theory
Terror Management Theory
• Defensive reactions are a key human motive
• Adherence to own cultural worldview increases as death becomes more salient
Differences in Death Anxiety
Age
Gender
Religiosity
Age differences
• Some evidence of decline with age
Gender differences
• Conflicting results
Religiosity differences
• Strong and low religiosity relates to lower anxiety than medium religiosity
• Specific religious beliefs about death important
Kübler-Ross’ Five Stages in Coping with Death
Quality of Death
Seven domains of experience of death (Hales, Zimmerman, & Rodin, 2008)
Seven domains of experience of death (Hales, Zimmerman, & Rodin, 2008):
- Physical
- Psychological
- Social
- Spiritual or existential
- Nature of health care
- Life closure and death preparation
• Circumstances of death
Experience of Death
western good death
- Western attributes of a good death
- Control, comfort, closure, values and beliefs honoured, trusting in care providers, recognising impending death, minimising burden, and optimising relationships
- Death awareness movement
- Open rather than closed awareness
- “Respecting Choices”
- Advanced care planning
Caring for the Dying
• Importance of the hospice movement
Difficulties with home death:
- Intensive care needs of dying person
- Hard to arrange round the clock care
- Family conflict, unresolved anger
- Cognitive impairment
Home care appropriate when person:
- Is alert
- Can benefit from familiar surroundings
Hastening Death
Euthenasia, Passive and Active
Euthanasia: intentional ending of life
- Unendurable, crippling, final, terminal
- Voluntary or involuntary
Passive or active:
• Passive: withholding or discontinuing treatment to end suffering or allow death with dignity
• Active: deliberate action taken directly to shorten life of terminally ill person to allow death with dignity (mercy killing)
Concerns about slippery slope
Advantages and Disadvantages of Legalising Euthanasia
Advantages and Disadvantages of Legalising Euthanasia 2
more negatives than positives
Bereavement and Grief
Bereavement
• The process of adjusting to the loss of someone close
• Change in status, role, and social and economic circumstances
Grief
• Emotional response experienced in early phase of bereavement
- Loss of primary relationships
- Relationships of attachment
- Relationships of community
Losses are not equivalent
• Girls impacted more by death of siblings
• Boys impacted more by death of parents
Stages of Grief
Stages of grief:
• Shock, disbelief, denial
- Intense mourning
- Period of restitution
Kübler-Ross’s five stages of coping with death also suggested to apply to grieving
• However, not a predictable, linear process Grief is culture-bound
Individual or collective experience?
Anticipatory Grief
• Death process can be prolonged and debilitating
- Many experience intense sadness and grief during caregiving period
- Anticipatory grief more likely when
- Illness is over a long period
- Dying person not cognitively intact
• Resilience associated with pre-loss death acceptance
Mourning
- Mourning the social experience of grief
- Series of restricted behaviours and obligations
- Few prescriptions as to how to interact with someone who is mourning
- Different expectations for expressions of grief depending on whether it is an on- or off-time loss
- Cultural differences
Recovery
Is recovery the appropriate term?
• Maybe resilience, adaptation, reintegration, resolution
Arguments against the term:
- Does not allow for transformative outcomes
- Leads to the view of bereavement as a disorganised state
- Outcome depends on meaning of the loss and survivor’s coping resources
