Week 13 Slides Flashcards
Volunteering is associated with:
Increased longevity, better health and better cognitive functioning.
Physical and cognitive changes are responsible for:
Many of the inevitable role changes in old age, but some changes are the result of ageism
The loss of role definition can result in ___ but it can also result in a greater ___
isolation or alienation; “license for eccentricity”
African Americans and Latinos are overrepresented in:
Poverty statistics.
They are more likely to become ill, but less likely to receive treatment. Although their earnings contribute, many never reach the eligible age for Social Security and Medicare benefits.
Despite stress and discrimination, many ethnic minority individuals develop coping mechanisms for survival. These can include:
- Extended family networks.
* Churches.
Some developmentalists conclude that femininity ___ in women and masculinity ___ in
men when they reach late adulthood
decreases; decreases
- The evidence suggests older men may become more feminine (that is, nurturing or sensitive), but women do not necessarily become more masculine (that is, assertive or dominant).
- It is important to consider cohort effects
A possible double jeopardy is faced by many women:
The burden of both ageism and sexism.
What is “triple jeopardy?”
female ethnic minority older adults facing three levels of discrimination— ageism, sexism, and racism
In most cultures, three factors are important in living the “good life” as an older adult:
- Health
- Security
- Kinship/support
Older adults are more likely to be accorded a position of high status in a culture when:
Older persons have valuable knowledge, control key family/community resources, and are permitted to engage in useful/valued functions as long as possible.
What is successful aging?
individuals whose physical, cognitive, and socioemotional development is maintained longer and declines later
The idea of Successful aging includes three main components:
- Good physical health
- The retention of mental abilities
- A continuing engagement in social and productive activities
An additional aspect of successful aging is an individual’s subjective sense of life satisfaction.
The concept of successful aging is referred to as a:
paradigm because it presents patterns for examples of such aging
Many abilities can be maintained and/or improved in
older adults, especially when they have the following:
- Proper diet.
- Active lifestyle.
- Mental stimulation and flexibility.
- Positive coping skills.
- Good social relationships and support.
- Absence of disease.
In successful aging, ___ and ___ are especially important
being active and socially engaged
How are aging adults a growing resource to society?
Because they act as citizens who have deep expertise, emotional balance, and the motivation to make a difference.
The best educated show:
The least cognitive decline. Avoidance of learning may actually contribute to cognitive decline
The best educated show new learning helps to:
establish new connections between neurons, connections that may protect the aging brain against deterioration
The willingness to learn new things. Contributes to successful aging
Cognitive adventurousness
Higher life satisfaction is reported by those who:
have greater contact with family and friends
Social engagement contributes to successful aging because
it provides opportunities for older adults to give support as well as to receive it
Canadians aged 65 to 74 clocked the highest number of:
annual volunteer hours of any age group (234 hours), with those over 75 a close second (218 hours)
Other types of productivity (art and music lessons, academic classes, etc.):
- add purpose to life
- improve interaction with peers
- provide a sense of competence
—all of which helps elders stay healthy
A sense of personal well-being is an important component of successful aging.
Perceived adequacy of 2 things are critical (and perceived is a more important measure than objective measures):
- social support
2. income
______ may be the most significant predictors of life satisfaction and morale
Self-ratings of health.
Seeing others as worse off is an important self-protective psychological device.
Successful aging is related to three main factors:
selection, optimization, and compensation.
An aspect of SOC where older adults have reduced capacity and loss of functioning, requiring a reduction in performance in most of life domains.
Selection
An aspect of SOC that suggests that older adults can maintain performance in some areas through continued practice and use of new technologies.
Optimization
An aspect of SOC that becomes relevant when life tasks require a level of capacity beyond the current level of the older adult’s performance potential.
Compensation
Successful aging criticisms:
- It can give the erroneous impression that all the effects of aging are under one’s control
- An emphasis on successful aging may cause public and institutional support for disease related research to decline
- Critics concede its influence has been largely positive but suggest there is a need to balance the optimism of the successful aging paradigm against the realities of life in late adulthood
The components of successful aging:
- Health
- Mental activity
- Social engagement
- Productivity
- Life satisfaction
Robert Kastenbaum emphasizes that the death system in any culture comprises the following components:
- People.
- Places or contexts.
- Times.
- Objects.
- Symbols.
Two hundred years ago, almost one of every two children:
died before the age of 10, and one parent
died before children grew up
In the 1900s, most people died:
At home. They were cared for by family
Over 80% of deaths in the U.S. occur:
In Canada today, the majority of deaths (67%) occur:
in institutions or hospitals.
in hospitals. Individuals are cared for by
medical personnel
(The context in which people die)
Hospitals offer many important advantages, including:
- Professional staff members.
* Technology that may prolong life.
a period during which vital signs are absent but resuscitation is still possible – Presumably, near death experiences occur in this state
Clinical death
the point at which family members and medical personnel treat the deceased person as a corpse
– Family and friends must begin to deal with the loss
Social death
irreversible absence of brain function: no electrical activity in the brain, no response to external stimuli, no reflexes. If brain stem is intact (but not cerebral cortex), the person may continue to live.
Brain death
Whole-Brain death is most widely accepted today. Includes eight specific criteria, all of which must be met, including:
- No spontaneous responses to any stimuli
- No spontaneous respiration for at least 1 hour
- Total lack of responsiveness to even the most painful stimuli
- No eye movements, blinking, or pupil responsiveness
- No postural activity, swallowing, yawning, or vocalizing
- No motor reflexes
- A flat EEG for at least 10 minutes
- No change in any of these when tested again 24 hours later.
Death can occur at any point in the human life span:
• Miscarriages and stillborn births.
• During the birth process or in the first few days
after birth.
• Sudden infant death syndrome (S I D S), the leading cause of infant death in the United States.
• In childhood, most commonly accidents or
illness.
• Most adolescent and young adult deaths result from suicide, homicide, or motor vehicle
accidents.
• Middle-age and older adult deaths usually
result from chronic diseases
the process of patients thinking about and communicating their preferences about end-of-life care.
Advanced care planning
a legal document that reflects the patient’s advance care planning.
Living will
a document such as a living will that indicates whether life-sustaining procedures should or should not be used to prolong an individual’s life when death is imminent.
Advance directive
a more specific document that translates treatment preferences into medical orders.
Physician Orders for Life-Sustaining Treatment (POLST)
A good death involves:
physical comfort, support from loved ones, acceptance, and appropriate medical care
the act of painlessly ending the lives of individuals suffering from incurable diseases or severe disabilities
euthanasia
___ euthanasia is when treatment is withheld and ___ euthanasia is when death is deliberately induced
passive; active
A process that requires the patient to self-administer lethal medication and determine when and where to do this. Legal in several countries and in an increasing number of U.S. states.
Assisted suicide.
An optional legally available in Canada to
provide patients who are experiencing intolerable suffering due to an irremediable medical condition with the assistance of a medical professional in ending their life
Medical Assistance in Dying (MAID)
June 17th, 2016 ___ was passed into law
MAID
What are some ongoing issues with MAID?
issues of autonomy and vulnerability, including who and when individuals can apply
In one 2019 study over 60% of participants reported ____ in their last year of life.
significant pain
Another study showed that 30% of terminally ill patients were depressed and confused
An alternative to traditional hospital-based care from the latin word pallium (improved). Emerged in England in the late 1960s and in Canada in the mid-1970s
hospice palliative care.
a holistic approach to care for the terminally ill that emphasizes individual and family control of the process of dying
hospice care
a form of care for the terminally ill that seeks to prevent, relief, or soothe the dying persons’ symptoms rather than cure their diseases or disorders
palliative care
Death with dignity is more likely if:
the dying person remains at home, or in a home-like setting in which contact with family and friends is part of the daily experience
End-of-Life Care: Hospice palliative care:
• Death should be viewed as normal
• The patient and family should be encouraged to prepare for the death
• The family should be involved in the patient’s care
• Control over the patient’s care should be in the hands of the patient and the family
• Care is aimed at satisfying the physical, emotional,
spiritual, and psychosocial needs of a person with a life-threatening or terminal condition and their family
• Medical care should be primarily palliative care rather
than curative. The emphasis is on controlling pain and
maximizing comfort, but not in invasive or life-prolonging measures
Hospice palliative care helps dying patients and their families to:
▪Address physical, psychological, social, spiritual, and
practical issues, as well as their associated expectations, needs, hopes, and fears
▪Prepare for and manage self-determined life closure
and the dying process
▪Cope with loss and grief during illness and bereavement
Dignity-based-care leads to:
– Heightened sense of dignity – Increased sense of purpose – Heightened sense of meaning – Better pain endurance – Increased will to live.
Caring for dying loved ones induces
A grief response. The grief response can lead to psychological disorders (depression, PTSD)
Many caregivers value their time caring for dying loved ones; apart from time spent together:
death encourages reflection on the meaning and purpose of life.
In regards to death, Preschool-age children do not understand that:
– death is irreversible
– it comes to everyone
– it means a cessation of all function
In regards to death, children:
Children as young as 4 to 5 years of age can understand the irreversibility of death and the cessation of functions.
In regards to death, adolescents:
Adolescents develop more abstract conceptions about death than children do, and they may develop religious and philosophical views. Deaths of friends, siblings, parents, or grandparents bring death to the forefront of adolescents’ lives.
Unrealistic beliefs about personal death appear to contribute to:
adolescent suicide (e.g. death is a pleasurable experience)
Like those of children, adolescents’ ideas about death are affected by their personal experiences
The sudden loss of a loved one appears to shake the belief in their unique invulnerability and, as a result, is often more traumatic for ___, compared to ___
young adults compared to older adults.
The Meaning of Death for Adults: (Early adulthood)
The deaths of relatively young public figures also challenge young people’s beliefs in unique invulnerability
Young adults look for reasons that death came early to these people, but won’t affect themselves
___ adults fear death more than ___ adults do
middle-aged; young
In middle age, many individuals switch the way they think about time from:
“time since birth” to “time until death”
– Those middle-aged and older adults who
continue to be preoccupied with the past are more likely to be fearful and anxious about death
____ adults are most fearful of death
Middle-aged.
In middle-age, a belief in one’s own immortality begins to break down, resulting in increasing anxiety about the end of life
By late life, the inevitability of death has:
been accepted, and anxieties are focused on how death will actually come about.
Older adults are more likely to fear the period of uncertainty before death than they are to fear death itself
Both those who are deeply religious and those who are totally irreligious report:
less fear of death
Religious beliefs may moderate fears of death
▪Death is seen as a transition from one form of life to another
▪The belief that God exists increases with age
Adults who have accomplished goals or believe they have become the person they set out to be:
Have less fear of death
– Belief that life has purpose or meaning reduces the fear of death
– Fear of death may be an aspect of the despair described in Erickson’s theory of ego integrity versus despair
Most psychologists argue it is best for dying individuals to:
Know that they are dying
- Dying individuals can close their lives in accord with their own ideas about proper dying.
- They may be able to complete plans and projects, make arrangements for survivors, and participate in decisions about a funeral and burial.
- They have the opportunity to reminisce and converse with others.
- They will have a better understanding of what is happening to them and what medical staff are doing.
Knowledge of death’s inevitability permits us to:
Establish priorities and structure our time
- Most dying individuals want an opportunity to make some decisions regarding their own life and death.
- Some want time to resolve problems and conflicts and to put their affairs in order.
Practical preparations for death include:
- obtaining life insurance
- making a will
- end of life expectations
- agreeing to be an organ donor
Those nearer to death became increasingly more:
- conventional
- docile
- dependent
- non-introspective
** This pattern did not occur among those of the same age who were further from death
Sharp declines in __ _____, commencing in
the four years prior to death.
life satisfaction
A sudden, steep drop in _______ seems to signal that death is imminent
crystallized intellectual ability
an individual’s decline in mental functioning accelerates a few years immediately preceding death
terminal decline
In the 1960s, ______ formulated a model
that asserted that those who are dying go
through a series of psychological stages
Kübler-Ross
According to Elisabeth Kübler-Ross, we go through five stages of dying:
- Denial and isolation
- Anger
- Bargaining
- Depression
- Acceptance
Elisabeth Kübler-Ross’ first stage of dying, in
which a dying person denies she or he is really going to die. Many people confronted with a terminal diagnosis react with some form of denial, a psychological defence that may be useful in the early hours and days after such a diagnosis
Denial
Kübler-Ross’ second stage of dying. A dying person’s denial gives way to anger, resentment, rage, envy. Anger often expresses itself in thoughts that life is not fair, but may also be expressed toward God, or toward doctors, nurses, or family members
Anger
Kübler-Ross’ third stage of dying. A dying person develops hope that death can be postponed. The patient in stage 3 tries to make “deals” with doctors, nurses, family, or God
Bargaining
Kübler-Ross’ fourth stage of dying. When bargaining fails as a result of declining physical status, the patient sinks into depression; when the dying person comes to accept the certainty of her or his death, a period of depression or preparatory grief may appear
Depression
Kübler-Ross’ fifth and final stage of dying. Kübler-Ross views this depression as a necessary preparation for the final step of acceptance, since a person must grieve for all that will be lost with death. When such grieving is finally done, the individual is ready to die. The dying person develops a sense of peace, an acceptance of his or her fate, and in many cases, a desire to be left alone.
Acceptance
Kübler-Ross’s observations might be correct only for a small subset of dying individuals, i.e.:
200 individuals who were mostly adult cancer patients with Westernized, individualistic cultural values, because her hypothesis was only based on this sample.
The five-stage interpretation fails to consider variations in patients’ situations.
Of the 5, ____ seems to be most common (at least among Western patients).
depression
Schneiderman suggests themes to the dying process, rather than stages:
- terror
- pervasive uncertainty
- fantasies of being rescued
- incredulity
- feelings of unfairness
- a concern with reputation after death
- fear of pain
– These stages may appear, disappear, and reappear
The scientific study of death and dying
thanatology
Charles Corr offers a task-based approach to death.
He suggests 4 tasks for the dying person:
- satisfy bodily needs and minimize physical stress
- maximize psychological security, autonomy, and richness of life
- sustain and enhance significant interpersonal attachments
- Identify, develop, or reaffirm sources of spiritual energy, thereby fostering hope
▪Corr believes that health professionals may be able to help the dying person achieve these tasks
What is most important to remember is that there is _______ in approaches to impending death
no typical or common pattern
Does a fighting spirit prolong life?
Probably not.
But pessimism and hopelessness may reduce life.
The extent to which people have found meaning and purpose in their lives is linked with how they approach death.
The state or condition caused by loss through death
Bereavement
The sorrow, hurt, anger, guilt, confusion, or other feelings that arise after a loss
Grief
The way we express our grief, heavily influenced by cultural norms.
Mourning
Funerals, wakes, and other death rituals provide several psychological functions:
- They help family members manage their grief by giving them a specific set of roles to play
- providing shape to the first hours and days
They bring family members together;
– strengthen family ties
– clarify the new lines of influence or authority
within a family
– pass on the flame in some way to the next
generation
the emotional numbness, disbelief,
separation anxiety, despair, sadness, and
loneliness accompanying the loss of someone loved.
Grief
a model of coping with bereavement that emphasizes oscillation between two main dimensions.
• Loss-oriented stressors: the loss itself
• Restoration-oriented stressors: adapting
to the new life situation
Dual-process model of coping with bereavement
Approximately three times as many women as men are widowed.
Those left behind after the death of an intimate
partner often:
- Suffer profound grief.
- Die earlier than expected.
- Endure financial loss, loneliness, increased physical illness, and psychological disorders.
Widows may be more likely to:
- use positive reframing, active distraction, help seeking, and turning to God for strength.
- use avoidant strategies and seek connection with their late spouse.
Finding meaning in the death of a spouse is linked to a lower level of anger in bereavement
Death of a spouse is more negative for ___ than for ___
men; women
substantial rise in mortality for both men and women following the death of their spouse
The Widowhood Effect
_____ are suppressed somewhat immediately after the death of a spouse. Most return to normal by a year after the death
Immune system functions
Grief symptoms for more than two months following the loss of a loved one may indicate:
pathological grief
Persistent symptoms of depression brought on by the death of a loved one.
Pathological grief
Grief lasting longer than 6 months can lead to long-term depression and physical ailments such as:
cancer and heart disease
grief that involves enduring despair and remains unresolved over an extended period of time. Individuals who lose someone on whom they were emotionally dependent are often at greatest risk.
Prolonged grief disorder
The “talk-it-out” approach to managing grief can be helpful in:
preventing grief-related depression
– Participating in support groups helps
– Developing a coherent personal narrative of the events surrounding the spouse’s death helps manage grief
Appropriate amount of time off from work to grieve is important. Returning to work too soon can contribute to:
illness and depression
Widow-to-Widow programs provide support for
newly widowed women
an individual’s grief involving a deceased person that is a socially ambiguous loss and cannot be openly mourned or supported.
• For example, death of an ex-spouse.
Disenfranchised grief
Children express feeling of grief very much the way teens and adults do:
through sad facial expressions, crying, loss of appetite, and age-appropriate displays of anger
Knowing that a loved one is ill and in danger helps:
children cope with the loss in advance, just as it does for those who are older
Teens may be more likely to experience _____ than children or adults
prolonged grief
Adolescents are more likely to grieve for a sibling ____ than children or adults
longer
Adolescent ___ whose ___ have died are at high-risk of grief-related problems
girls; mothers
Death’s impact on survivors is strongly influenced by the death’s circumstances. Sudden deaths are likely to have:
more intense and prolonged effects on survivors
Widows who have cared for spouses during a period of illness prior to death are ____ to
become depressed after the death
less likely
A death that has ____ provides the
bereaved with a sense that the death has not been without purpose
intrinsic meaning
Suicide produces unique responses among survivors:
▪They experience feelings of rejection and anger
▪They may feel that they could have done something to prevent the suicide
▪They are less likely to discuss the loss
▪Suicide survivors may be more likely to experience long-term negative effects
Verbal intelligence and education are related to:
physical health and social engagement
