Mar 31 Flashcards
List that influence integrity and explain how each causes old to lose integrity
- Attractive, healthy body
- Respect and esteem from social network (old pushes to margins, lose people)
- Family (children move away, lose spouse)
- Power at work (can’t work anymore, retired, can’t achieve integrity and self esteem from occupation)
- Productivity and accomplishments (can look back and say you were able to produce and accomplish, but it’s all in the past now, much less to look forward to)
According to Erikson, what is a major task of old age
To enhance and maintain a sense of inner emotional integrity in the face of increasing external threat to health, financial status and support systems
How may one respond to these changes in integrity
Integrity can be expressed through creativity. Keeping self identity and value, keeping self worth, despite the decline.
Like a crumpled $20 bill, the value of the bill remains the same. The old person must understand that there is something beyond the factors that kept integrity before. Should be more abstract in his/her perception of the value of human beings
Despair
Anger, boredom, lack of meaning in life, resignation and depression, identity crisis in front of the mirror.
Looking back with dissatisfaction, feeling of missing something important, not accomplishing significant wishes. Many regrets.
Integrity
Looking back over one’a life, evaluating it, coming to terms with it. Sense of satisfaction and accomplishment. The fulfillment of possibilities that have come on the way in life. Regrets are few and less significant
Robert Peck’s 3 developmental tasks in late adulthood
- Redefinition of the self vs preoccupation with work role
- Body transcendence vs body preoccupation
- Ego transcendence vs ego preoccupation
Redefinition of the self vs preoccupation with work role
For young and middle aged, much of the definition of the self is connected with work.
Older person needs to find things to do that are not connected to work but connected to self esteem, such as volunteering, being involved in the community, having more responsible in the family, taking care of grand kids
Body transcendence vs body preoccupation
Transcending is going beyond body preoccupation. Know that you have problems in the body, don’t look so great, health isn’t as good, but you go beyond that
Ego transcendence vs ego preoccupation
How do you cake yourself vs other things. Young adults typical invested very much in their own selves - narcissistic aspect of perks other.
To go beyond ego, have to get rid of some of that, have to focus on something that is important that JA not you, such as your family’s the next generation, the fate of the nation, global warming, the community.
Preparing yourself for not being anymore. Invest not in yourself but in things that will remain after you.
Levinson’s approach
Old people come to know they are old bc of society. Society says you are old now. We learn to take the role of the d person. Think of stereotype threat. Society teaches you to regard yourself differently than before. Person who reaches each shave bad awareness that “I am over my highest point and have to live when it”.
Some are venerated elders. They are blessed with wisdom and are guides for the younger generation. Help young in terms of culture, norms, values, etc.
There is also a sense of freedom in old age. Free to pursue things that are pleasurable and enjoyable. Less obliged to do things just bc of conformity. Free to differentiate bw what is important and what are he shallow aspects of life. Care less about what others think. Not as dependent I social conventions
Nugarten’s approach
Talks about coping with aging. Identified 4 distinct groups of people - worst cases to better cases.
The 4 groups are disintegrated and disorganized, passive dependent, armour defended and integrated
Disintegrated and disorganized
Can’t accept aging. Little control over emotions poor cognitive capacities. Impaired psychological functioning. Tend to be hospitalized and can’t really enjoy old age at all
Passive dependent
Experience life as full of fear.
Fearful of the future, their own I abilities to cope.
Because of their fears, they tend to seek help even when it’s totally unnecessary
Armor-defended
Try to ward off the fact of aging. Attempt to act, behave, and look very young. Develop unrealistic expectations of themselves and others. Inevitably, this ends with great disappointment and despair
Integrated
Able to accept aging and the fact that they’ve reached the end of life. Cope comfortably with aging. Maintain a sense of dignity.
Most old people are in which of Nugarten’s groups?
Integrated
Examine life review and reminiscence
Triggered by prospects of one’s death. There is a will to reach a closure about life and leave a legacy to the younger generation. Leads to a better understanding, resolving of lingering problems, and greater serenity. When looking back, one is able to process some of the issues that were disturbing to them previously.
Life review and sharing
Older people like to tell their stories to younger people as part of social interaction
Cognitive benefits of life review and reminiscence
- Use of memory/organized thinking
- Usage of language in a correct manner
- To be able to articulate your ideas clearly
Life review and integration
When you tell a story about your past, you integrate your past into your present. In psychology, this is very important - to integrate who you are with who you were
How can life review be negative for some people
A minority of people feel in pain when talking about the past bc of despair - too many regrets. They find themselves obsessed over the things that troubled them, feeling guilty and depressed.
3 trajectories of dying
- Sudden death from unexpected cause
- Steady decline from progressive disease with a terminal phase
- Advanced illness marked by a slow decline with period of crisis and sudden death
Sudden death from unexpected cause
No preparation. Seemingly normal life and then death occurs. Person hasn’t experienced much of the process of dying, but people who care for the person need time to adjust to something totally unexpected
Steady decline from a progressive disease with a terminal phase
Clear decline from health to death
Advanced illness marked by slow decline with a period of crisis and sudden death
Can see slow decline with occasional crisis until one of them leads to death. We can see this a lot in cancer patients that go through different treatments that help and bring them from one crisis to slow decline and then another crisis, etc.
Thanatology
The study of death
What was unique about Elizabeth Kubler-Ross
Before her, people in psych were not talking about death - it was considered taboo. She was able to talk about death with dying people. Before her, medical professionals tended to protect the dying person and didn’t allow any discussion about death with them. She changed this. She developed a theoretical model regarding facing death. In her later years, she became less concerned with a specific point of view and related to spiritual aspects if death. She interviewed people who were dying and people who cared for them
Elizabeth Kubler-Ross’ 5 stages model
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
Denial
First stage in Kubler Ross model. Denies their disease/problem. Believes the diagnosis is a mistake. Defense mechanism that aims at protecting us and gives us the opportunity to grasp the info at our own pace. Sometimes, this can become problematic, such as when surgery is needed quickly and the person denies the problem
Anger
Second stage in Kubler Ross model. Patient angry/irritable that he or she is sick. Asks the question “why me”. Angry at everyone, particularly angry at anyone who is healthy. Why do bad things happen to good people? Sometimes cease to believe in god if they were believers before, bc of the anger (spiritual crisis). When dealing with an angry person, need to contain the anger and not reject the person
Bargaining
Third stage of Kubler Ross model. Very characteristic of people who believe in god. Try to bargain with god in a very infantile manner. If I behave very well, it will give me more time. I will try to behave in a certain way just to stay live until something happens. If I pray every days can I have another christmas? Interesting research finding of mortality decreasing before major holidays and after major holidays
Depression
4th stage of Kubler Ross theory. Major depressive episodes. Sleep disturbance. Dysphoria. Appetite disturbance. Low energy. Worst of all, hopelessness. Profound sadness as one understands that one’s life is going to end. Deep sense of loss - loss of functioning at home and work, loss of dignity when can’t go to the washroom. Most important is the loss of hope - you know you are going to die.
Acceptance
5th stage in Kubler Ross theory. Person realizes that death is inevitable and accepts that fate. Characterized by lack of emotions, neither positive not negative. No concern about present or future. Kubler Ross suggested that they’re in a spiritual realm, as if death doesn’t carry any sting anymore. Often prefer to be alone
Evaluation of Kubler Ross work
Good
Unique contribution
Bad
Relevant only for people who are aware if immanent death.
Stages too orderly (docs could push ppl to go through stages and that’s bad)
Ignores crucial factors like age, gender, cultural background, personality factors, and social support the dying person has
11 Tips on how to relate to a dying person
- Respect your own emotional limits
- Try to contain anger and depression from dying psn without rejecting them
- Don’t intellectualize
- Don’t patronize
- Be tactful and honest - ask what they want to talk about
- Don’t force unasked difficult issues
- Don’t preclude hope
- Give support
- Be sensitive to other family members and support them
- Encourage life review
- Assertively ask medical agents for effective pain management
Of all the tips about relating to a dying person, which is the most important
Assertively ask medical agents for affective pain management
Advance directives (AD)
A living will that should relate to the following:
Life sustaining measures
Resuscitation
Who should act on one’a behalf (“proxy”) for medical issues and financial issues
Should be known by relatives so they could inform the medical staff and keep this knowledge as a guideline for medical interventions
Life sustaining treatment
Sometimes aggressive
Intrusive
Can be totally unnecessary
Includes over-treatment and resuscitation
More common in hospitals (med staff trained to postpone death bc hard to accept person’s helplessness about death, leading to actions of control)
Palliative care
Promoting comfort of life rather than death itself
More pain control
No resuscitation
Common in hospices and at home
Accepting the loss of power at the end of life
Understanding that person would die pretty soon and offering the person a smooth transition
