1
Q
What is Optimal Aging? Healtht aging…
A
Healthy aging can be defined as absence of disease &
good physical function, intact cognition, and an active engagement with life
2
Q
Optimal Aging- Losses are often balanced by gains
A
- Positive psychological characteristics include happiness
intellectual curiosity, gratitude, deep spirituality, & a strong sense of community - A certain level of detachment & wisdom may be necessary to learn to accept whatever level of illness & disability one has, thereby preserving mental health, & as much social functioning as possible within the confines of disability.
3
Q
Life Span
A
the maximum number of years an individual can live;
has remained between 120–125 years
4
Q
Life Expectancy
A
- the number of years that the average person born in a particular year will probably live
- Has increased an average of 30 years since 1900
- Average life expectancy today is 78.1 years
- -Overall female: 80.7
- -Overall male: 75.4
5
Q
Longer life span
A
– Decrease in infant mortality & infectious diseases
– Better health practices (sanitation, drinking water, nutrition & food safety, better heath behavior habits)
– Decline in heart disease & deaths due to cardiovascular
disease (such as stroke); though cancer deaths have
remained relatively stable
6
Q
Leading causes of death
A
– Smoking, poor diet & physical activity, & alcohol consumption—not pathogens
– Obesity is 4th leading cause
7
Q
Cellular Clock Theory
A
Cells can divide a max of 75-80 times; this places the max human life span at 120–125 years of age
-Telomeres become shorter each time a cell divides
8
Q
Free-Radical Theory
A
people age because when cells metabolize energy, the by-products include unstable oxygen molecules, or free radicals
-Free radicals damage DNA & other cellular structures
9
Q
Mitochondrial Theory
A
aging is due to the decay of mitochondria
-Mitochondria: tiny bodies within cells that supply essential energy for function, growth, and repair
10
Q
Hormonal Stress Theory
A
aging in the body’s hormonal system can lower resistance to stress and increase the likelihood of disease
-Prolonged, elevated levels of stress hormones are associated with increased risks for many diseases
11
Q
Vision
A
- Decline in vision becomes more pronounced
- Adaptation to dark and driving at night becomes especially difficult
- Decline may be the result of a reduction in the quality or intensity of light reaching the retina
- Color vision may decline as a result of the yellowing of the lens of the eye; affects green/blue/ violet spectrum
- Depth perception declines in late adulthood
- Decrease in contrast sensitivity
12
Q
Hearing
A
- Hearing impairments are typical in late adulthood
- 15% of the population over age 65 is legally deaf
- Usually due to degeneration of the cochlea
- Some (but not all) hearing problems can be corrected by hearing aids
13
Q
Smell and Taste
A
- Smell and taste losses typically begin about age 60
- Less decline in healthy older adults
- Often leads to a desire for more seasoned foods
14
Q
Touch and Pain
A
- Slight decline in touch sensitivity with age
2. Older adults are less sensitive to pain
15
Q
Research focus on motor control & aging has been captured in 3 distinct areas of study
A
- Physical fitness aspects such as strength, flexibility, & endurance
- The information processing activities that relate variables such as reaction time and movements time as factors that reduced motor performance with aging
- The neurophysiological control of posture, locomotion, & fine motor control
16
Q
Motor complex behavior
A
- A central hypothesis holds that as individuals age, they are less capable of producing complex behavior
– May be due to a reduction of individual structural components or a restriction of the coupling of these components - There is a strong relationship between the complexity of movement output & skill level of performance as a function of task
- Postural control is another element affecting complexity of movement & tends to decline with age
- Skill also influences output & complexity of movement & can serve as a buffer for motor decline
17
Q
Sexuality
A
- Orgasm becomes less frequent in males with age
- Many older adults are sexually active as long as they are healthy (Lindau & colleagues, 2007)
- Older adults who do not have a partner are far less likely to be sexually active than those who have a partner
- For women ages 70+, approx 70% do not have a partner compared to 35% of men - Various therapies have been effective for older adults who report sexual difficulties
- Sex education
18
Q
Substance Abuse
A
- Medications can increase the risks associated with consuming alcohol or other drugs
- Can lead to breathing impairment, excessive sedation, or fatal O/D
- Majority of U.S. adults 65 and older (58%) completely abstain from alcohol (Nat’l Center for Health Stats, 2006)
- Substance abuse among older adults may be an “invisible epidemic” (SAMHSA, 2002)
- Late-Onset Alcoholism: onset of alcoholism after the age of 65
- Often related to loneliness, loss of a spouse, or a disabling condition
- Moderate drinking of red wine is linked to better health and increased longevity (lowering stress & reducing coronary h.d.)
19
Q
Exercise
A
Active adults are healthier and happier: cardio & weights combined is best
20
Q
Benefits of Exercise
A
- Linked to increased longevity
- Related to prevention of common chronic diseases
- Associated with improvement in the treatment of many diseases
- Can optimize body composition and reduce the decline in motor skills as aging occurs
- Reduces the likelihood that older adults will develop mental health problems
- Linked to improved brain and cognitive functioning
21
Q
Nutrition & Weight
A
- Some older adults restrict their dietary intake in a way that may be harmful to their health
- Decreased snacking between meals may contribute to harmful weight loss
- Calorie restriction has been proven to extend the life span of certain animals, but it is not known if this works in humans
- Antioxidants (Vits. C, E, & beta-carotene) may help slow the aging process & possibly prevent some diseases
22
Q
Health Treatment
A
- Patient’s feelings of control & self-determination are
important for health & survival in nursing homes (Rodin & Langer, 1977)
-Coping skills may reduce stress-related hormones, improving overall health
-Assertiveness training and time-management skills
-Cortisol levels were lower for individuals who received assertiveness training
23
Q
Cognitive mechanics
A
- The “hardware” of the mind; components:
- Speed and accuracy of processes involved in sensory input, attention, visual and motor memory, discrimination, comparison, and categorization - Tends to decline with age
- Strongly influenced by biology and heredity
24
Q
Cognitive pragmatics
A
- culture-based “software” programs of the mind
- Reading, writing, and educational qualifications
- Professional skills and language comprehension
- Knowledge of self and life skills - May improve with age
- Strong cultural influences
25
Speed of Processing
1. Speed of processing information declines in late adulthood
- Considerable individual variation
- Accumulated knowledge may compensate to some degree
- Often due to a decline in brain and CNS functioning
2. Salthouse proposed that slowing of basic information processing might have insidious consequences for higher order cognition
26
Selective attention
1. Focusing on a specific aspect of experience that is relevant while ignoring others that are irrelevant
- Older adults are generally less adept at this
27
Divided attention
1. concentrating on more than one activity at the same time
- When tasks are easy, age differences are minimal
- The more difficult the tasks, the less effectively older adults divide attention
28
Sustained attention
1. Readiness to detect and respond to small changes occurring at random times in the environment
- Older adults perform just as well on simple tasks; but performance drops on complex tasks
29
Cognitive control: 3 types
1. Resistance to interference
－A breakdown of this function can lead to “mental clutter” in older adults’ working memory, thereby limiting its capacity & functioning
2. Coordination of distinct tasks
3. Task switching
4. Working memory “updating” has also been explored
30
Memory
Memory changes during aging, but not all memory
| changes in the same way (ex: Spanish language study)
31
Park & colleagues (2002) found about memory
– Episodic memory, speed of processing, short-term
memory, and working memory all decline
– Measures of verbal knowledge remain stable
– Familiarity as well as implicit memory showed
relatively little or no age-related decline
32
Explicit memory
memory of facts & experiences that individuals consciously know & can state
33
Implicit memory
memory without conscious recollection; skills and routines that are automatically performed (ex/ driving a car)
-Implicit memory shows less aging declines than explicit memory
34
Episodic memory
1. Problems with conscious or declarative retrieval of specific events located in time & place and/or retrieval of the context of experienced events
2. May reflect weakly formed associations at encoding, or the age-sensitive consequences of attentional demands at encoding or retrieval
35
Source memory
1. The ability to remember where one learned something
2. Older adults show deficits in remembering source information; partly due to association failures between targets
3. Makes older adults vulnerable to misleading info (especially when combined with poor working memory)
4. Older adults can remember info about a source when it is important to them
36
Semantic memory
1. does not decline as drastically as episodic memory
2. Relatively stable aspect of memory dependent on the intactness of distributed representations
3. Tip-of-the-tongue phenomenon
37
Working memory
1. Small age differences in the performance of short duration memory tasks that do not require much concurrent or controlled processing
2. Age-related deficits are larger for tasks such as reading span, listening span, or operation span
38
Prospective memory
1. Refers to a person’s intentions for actions to be carried out in the future
2. Less age sensitive than episodic memory—regardless of whether the task is time based or event based
3. Older adults may use compensatory strategies
39
Problem Solving
-Problem solving & decision making both refer to goal-
directed cognition, in which an individual constructs plans &/or formulates behavioral responses aimed at resolving a discrepancy between initial state and a desired end state
40
Problem Solving Research
1. The outcomes of problem solving & the effectiveness of solutions generated
2. How individuals appraise or represent problems & their problem solving skills
41
Four theoretical ideas have guided research on adult everyday problem solving
1. Contextualism
2. Experientialism
3. Componentialism
4. Postformalism
42
Problem Solving Strategies
1. On interpersonal & emotionally salient problems, older adults use both emotional coping strategies (e.g. managing their feelings) and problem-focused action (consistent with post-formal thinking)
2. Older adults also tend to use more passive-dependent & avoidant-
withdrawal solutions with interpersonal dilemmas
3. Individuals perform poorly on problem solving for which they had the lowest self-efficacy, and avoidant-denial solutions occurred more frequently for problems that individuals had the least confidence in their ability
4. Older adults are more passive in their coping (denial, suppressing emotion, accepting the situation)
43
Wisdom
1. expert knowledge about the practical aspects of life that permits excellent judgment about important matters
2. High levels of wisdom are rare
3. Late adolescence to early adulthood is the main age window for wisdom to emerge
4. Factors other than age are critical for wisdom to develop to a high level (e.g. some life experiences)
5. Personality-related factors are better predictors of wisdom than cognitive factors
44
Use it or lose it- cognitive activity
1. Changes in cognitive activity patterns can result in disuse and lead to atrophy of skills
2. Certain mental activities can benefit the maintenance of cognitive skills
- Reading books, doing crossword puzzles, going to lectures and concerts
4. Research suggests that mental exercise may reduce cognitive decline and lower the likelihood of developing Alzheimer disease
45
Training Cognitive Skills
1. Training can improve the cognitive skills of many older adults
2. There is some loss in plasticity in late adulthood, especially in the oldest-old
3. Improving the physical fitness of older adults can improve their cognitive functioning
- Improvements in planning, scheduling, working memory, resistance to distraction, and processing involving multiple tasks (Colcombe & Kramer, 2003)
46
Language Development
1. Some decrements in language may appear in late adulthood
- Tip-of-the-tongue phenomenon
- Difficulty understanding speech due to hearing problems
2. Speech of older adults is typically lower in volume, slower, less precisely articulated, and less fluent
3. Non-language factors may be responsible for some of the decline in language skills
- Slower information processing speed
- Decline in working memory
47
Dementia
any neurological disorder in which the primary symptoms involve a deterioration of mental functioning
-20% of individuals over the age of 80 have dementia
48
Alzheimer Disease
1. a common form of dementia that is characterized by a gradual deterioration of memory, reasoning, language, and eventually, physical function
- Rates could triple within the next 50 years as people live longer
- Divided into early-onset (younger than 65) or late-onset (later than 65)
2. Alzheimer involves a deficiency in the brain messenger chemical acetylcholine
3. Brain shrinks and deteriorates as memory ability decreases
- Formation of amyloid plaques and neurofibrillary tangles
4. Age is an important risk factor, and genes also play an important role
5. Healthy lifestyle factors may lower the risk
- higher risk associated for those with history of cardiovascular disease
49
Mild Cognitive Impairment
1. represents a transitional state between the cognitive changes of normal aging and very early Alzheimer disease and other dimentias
2. Deficits in episodic memory appear to be an especially important early indication of risk
50
Multi-Infarct Dementia
1. A sporadic and progressive loss of intellectual functioning caused by repeated temporary obstruction of blood flow in cerebral arteries—
2. Results in a series of mini strokes
3. More common among men with a history of high blood pressure
4. Recovery is possible
51
Parkinson Disease
1. A chronic, progressive disease characterized by muscle tremors, slowing of movement, and facial paralysis
2. Triggered by the degeneration of dopamine-producing neurons in the brain
3. Several treatments are available
52
Integrity vs. Despair
Involves reflecting on the past and either piecing together a positive review or concluding that one’s life has not been well spent
53
Life review
1. Looking back at one’s life experiences, evaluating them, and interpreting/reinterpreting them
2. Life review is set in motion by looking forward to death (Butler, 2007)
3. Can include sociocultural dimensions, interpersonal/ relationship dimensions, and personal dimensions
4. Each person’s life review is relatively unique
5. Revision & expanded understanding takes place
54
Regrets involve four major themes (Timmer et al., 2005)
1. Mistakes and bad decisions
2. Hard times
3. Social relationships
4. Missed educational opportunities
55
Reminiscence therapy
1. discussing past activities and experiences with another individual or group
2. Photographs, familiar items, video/audio recordings; can help to improve mood.
56
Activity Theory
1. The more active and involved older adults are, the more likely they are to be satisfied with their lives
2. Suggests that individuals will achieve greater life satisfaction if they continue their middle-adulthood roles into late adulthood
57
Socioemotional Selectivity Theory (Laura Carstensen, 1998, 2006, 2008)
Older adults become more selective about their social networks, spending more time with individuals with whom they have had rewarding relationships
58
Two important classes of goals in Socioemotional Selectivity Theory
1. Knowledge-related
2. Emotional; more positive emotional experience & more likely to remember positive events; less reactivity too
3. Depressive symptoms occur and mostly linked to declining health status
59
Trajectory for each type of goal is different
1. When time is perceived as open-ended, knowledge-related goals are pursued more often, even at the cost of emotional satisfaction
2. As older adults perceive that they have less time left, emotional goals become more important; more feel content especially when connected in positive ways to friends & family
60
Selective Optimization with Compensation Theory
Successful aging is linked with three main factors (Baltes)
- Selection
- Optimization
- Compensation
61
Selection
Older adults have a reduced capacity and loss of functioning, which require a reduction in performance in most life domains (narrowing goals)
62
Optimization
It is possible to maintain performance in some areas through continued practice and the use of new technologies (enhancing)
63
Compensation
Older adults need to compensate when life tasks require a higher level of capacity; esp. those with high mental or physical demands
64
Personality factors linked to Longevity
1. Conscientiousness predicts mortality risk from childhood through late adulthood
2. Low conscientiousness and high neuroticism predicts earlier death
3. Older adults characterized by negative affect do not live as long as those characterized by more positive affect
65
Self-Esteem
1. Tends to be higher for males than females; difference disappears in the 70s and 80s
2. Tends to decline significantly in the 70s and 80s; why?
- Deteriorating physical health
- Negative societal attitudes toward older adults
- Being widowed, institutionalized, physically impaired, having low religious commitment, & experiencing a decline in health
66
Possible Selves
what individuals might become, what they would like to become, and what they are afraid of becoming; hope related activities could have a positive effect on longevity
67
Self-Acceptance
depends on whether the individual is describing their past, present, future, or ideal selves
68
Self-Control
1. a majority of adults in their 60’s and 70’s
report being in control of their lives
2. Accommodating control strategies increase in importance,
and assimilative control strategies decrease in importance
69
Ageism
1. prejudice against others because of their age
2. Stereotypes against older adults are often negative
3. Most frequent form is disrespect, followed by assumptions about ailments or frailty caused by age
4. Can affect how adult perceives themselves; affecting well being & performance
5. Conversational style of older adults can also “cue” stereotypical thinking
- More prone to talking about ailments, loss & other personal problems
70
Problems involving health care
1. Increasing health care costs; despite Medicare support
2. Increasing # of older persons
3. Medical system is based on a “cure” rather than “care” model
- Trend toward home-based services, but more training needed
71
Income
1. 10%–12% of older people are living in poverty (since 1980s)
- Varies by gender and ethnicity
2. Average income for retired individuals is about half what they earned when they were fully employed
- Money spent on food, utilities, and health care
- Social security income comprises the largest source followed by assets, earnings, & pensions
72
Eldercare
physical and emotional caretaking of older members of the family
-Concern that the economy cannot bear the burden of so many older persons
73
Generational Inequity
1. the view that our aging society is being unfair to its younger members
2. Controversial issue that can produce intergenerational conflict & perpetuate ageism
74
Living Arrangements
1. 95% of older adults live in the community
2. Two-thirds live with family members, one-third alone
3. Half of older women 75 years and older live alone
75
Technology
1. Older adults are less likely to have a computer in their home and less likely to use the Internet
2. Older adults spend more time on the Internet, visit more Web sites, and spend more money on the Internet than young adults (Harris Interactive, 2003)
76
Married Older Adults
1. Marital satisfaction can be greater in older adults than middle-aged adults (Henry et al., 2007)
2. Retirement alters a couple’s lifestyle
-Greatest changes occur in the traditional family
-Conflicts include aging and illness; also more time together
3. Older adults who are married or partnered are usually
happier and live longer than those who are single
4. Marital satisfaction is often greater for women than men
77
Divorced and Separated Older Adults
1. Social, financial, and physical consequences of divorce
- Weakening of family ties
- Less financial resources
- Linked to more health problems
78
Remarriage
1. Remarriage is increasing due to rising divorce rates, increased longevity, and better health
2. Some older adults perceive negative social pressure about their decision to remarry
3. Majority of adult children support the decision of their older adult parents to remarry
79
Cohabiting Older Adults
1. Cohabiting is often more for companionship than for love
- Cohabiting older adults often have a more positive, stable relationship than cohabiting younger adults
2. Health of cohabiting couples does not differ from the health of married couples (Waite, 2005)
- Those who cohabit may be more depressed than their married counterparts (Brown et al., 2005)
80
Romance and Sex
1. Increased divorce rate and longer longevity has resulted in an increase in older adult dating
2. Healthy older adults may still engage in sexual activities though differently than younger adults
- Caressing & touching; intimacy
3. Companionship often becomes more important than sexual activity
81
Research on Friendship
1. Friendships have been found to be more important than some family relationships in predicting mental health (Fiori, Antonucci, & Cortina, 2006)
2. Individuals with close ties to friends were less likely to die across a 7-year period (Rasulo, et al., 2005)
3. Unmarried older adults with a strong network of friends fared better physically and psychologically than other unmarried older adults (Fiori et al., 2007)
82
Convoy Model of Social Relations
individuals go through life embedded in a personal network of individuals from whom they give and receive social support (Antonucci et al., 2007)
83
Social Support
1. Declines after retirement
| 2. May be constrained by health, finances, geography
84
Mary Pipher
Proposed that physical, cognitive, & social changes of late life segregate older people (e.g. living separately & in segregated areasè “islands of culture” that discourage intergenerational bonding
85
Social Integration
1. Greater interest in spending time with a small circle of friends and family (Carstensen, 2006, 2008)
2. Low level of social integration is linked with coronary heart disease
3. Being a part of a social network is linked with longevity, especially for men
4. In Zunzunegui et al.’s (2003) longitudinal study, poor social connections, infrequent participation in social activities, and social disengagement predicted cognitive decline in older
adults
86
Altruism and Volunteerism
1. Older adults benefit from altruism and engaging in volunteer activities
2. Helping others may reduce stress hormones, which improves cardiovascular health and strengthens the immune system (Brown et al., 2003)
3. Volunteering is associated with a number of positive outcomes
- More satisfaction with life
- Less depression and anxiety
- Better physical health
- More positive affect
87
Ethnicity
African Americans and 1.Latinos are overrepresented in poverty statistics
2. Elderly ethnic minority individuals face both ageism
and racism: double jeopardy
-More likely to become ill but less likely to receive treatment
-Many never reach the age of eligibility for Social Security benefits
3. Many ethnic minority individuals have developed coping mechanisms that allow them to survive
-Extended family networks
-Churches
-Residential concentrations of ethnic minority groups
88
Gender
1. Some developmentalists believe that there is decreasing femininity in women and decreasing masculinity in men during late adulthood
- Older men often become more feminine, but women do not necessarily become more masculine
2. Keep in mind cohort effects re: gender roles
3. Older adult females face ageism and sexism
- Poverty rate for older adult females is almost double that of older adult males
89
Seven factors are likely to predict high status for older adults in a culture
1. Have valuable knowledge
2. Control key family/community resources
3. Are allowed to engage in useful/valued functions as long as possible
4. Have role continuity throughout their life span
5. Make age-related role changes that give greater responsibility, authority, and advisory capacity
6. Extended family is common, and older person is integrated into extended family
7. Respect for older adults is greater in collectivistic cultures
90
Atchley’s (1976) phases of retirement
```
Stage 1- honeymoon
Stage 2- disenchantment
Stage 3- reorientation
Stage 4- stability
Stage 5- termination
```
91
Life paths for individuals in their 60’s (Phyllis Moen,
| 2007)
1. l Some continue work
2. Some retire from their career work & start a new & different job
3. Some retire from career jobs but do volunteer work
4. Some move in and out of the work force
5. Some individuals move to a disability status and eventually into retirement
6. Some who are laid off define it as “retirement”
92
Older adults who adjust best to retirement
1. Have an adequate income
2. Are better educated
3. Are healthy and active
4. Have extended social networks and family
5. Were satisfied with their lives before retiring
93
The Role of Wisdom in Aging Well
1. Many problems adults face do not have one right answer-they are ill-defined or ill-structured
2. Wisdom involves solving problems using a more relativist perspective and recognizing that problems are complex with contextually embedded truth systems
3. Involve “post-formal” thought (advanced logical thinking)
4. Involves creativity and intelligence (Sternberg, 2001)
5. In leadership roles- wise people are able to balance the need for change with the need for stability
6. Wisdom is related to age and training and experience in one’s occupation
94
Religion
1. More significant in older adults’ lives
2. Related to a sense of meaning in life
3. Related to higher levels of life satisfaction, optimism, and self-esteem
4. Associated with better health
5. Perhaps associated with living longer
6. Can provide social opportunities
95
The view of death
1. In most societies, death is not viewed as the end of existence because the spiritual body is believed to live on
2. People in the U.S. tend to be death avoiders and death deniers
96
Changing Historical Circumstances in death system
1. The age group in which death most often strikes
2. Life expectancy has increased
3. Location of death
97
Living Will
is designed to be filled in while the individual can still think clearly
98
People engaged in end-of-life planning are more likely to
1. Have been hospitalized in the year prior
2. Believe that patients rather than physicians should make health-care decisions
3. Have less death anxiety
4. Have survived the painful death of a loved one
99
Euthanasia
the act of painlessly ending the lives of individuals who are suffering from an incurable disease or severe disability
100
Passive euthanasia
treatment is withheld
| -Trend is toward acceptance of passive euthanasia in the case of terminally ill patients
101
Active euthanasia
death deliberately induced
- was made famous by Dr. Jack Kevorkian in the U.S. as “assisted suicide”
- is a crime in most countries and in the U.S. (except Oregon, Washington, & Montana)
102
Patients who have a desire for euthanasia are often (Canadian study—Wilson et al., 2007)
1. Less religious
2. Have been diagnosed with depression
3. Have a lower functional living status
103
End of life care
Should include respect for the goals, preferences, and choices of the patient and his or her family
104
Good death
involves physical comfort, support from loved ones, acceptance, and appropriate medical care
105
Hospice
a program committed to making the end of life as free from pain, anxiety, and depression as possible
- Focus on...Palliative care
- Makes every effort to include the dying patient’s family members
- Includes home-based programs today, supplemented with care for medical needs and staff
- Family members report better psychological adjustment to the death of a loved one when hospice care is used
106
Focus on...Palliative care
Reducing pain and suffering, helping individuals die with dignity
107
Causes of death vary across the life span
1. Prenatal death through miscarriage
2. Death during birth or shortly afterwards (e.g., SIDS)
3. Accidents or illness cause most childhood deaths
4. Most adolescent and young adult deaths result from suicide, homicide, or motor vehicle accidents
5. Middle-age and older adult deaths usually result from chronic diseases
108
Attitudes toward death vary at different points in the life span
1. Separation anxiety in infants may be an indicator of a child’s awareness of separation and loss
2. Young children use illogical reasoning to explain death, believing magic or treatment can return life
3. Those in middle and late childhood have more realistic perceptions of death
- Occurs at about age 9
109
Death of a parent
1. Is especially difficult for children
2. Most psychologists believe that honesty is the best strategy in discussing death with children
- Depends on the child’s maturity level
3. Terminally ill children may distance themselves from their parents as death approaches (depression, protection)
110
Most adolescents Toward Death
1. Avoid the subject of death until a loved one or close friend dies
2. Describe death in abstract terms (dark, light, transition, or nothingness) & have religious or philosophical views about it
3. Often think that they are somehow immune to death
111
Concerns about death increase as one ages
1. Awareness usually intensifies in middle age
- Middle-aged adults often fear death more than young adults or older adults
2. Older adults are more often preoccupied by it and want to talk about it more & have more direct experience
3. One’s own death usually seems more appropriate in old age, possibly a welcomed event, and there is an increased sense of urgency to attend to unfinished business
112
Facing Own Death
1. Knowledge of death’s approach permits us to establish priorities and structure our time
2. Most dying individuals want an opportunity to make some decisions regarding their own life & death
113
Three areas of concern (Terry et al., 2006) in Facing Own Death
1. Privacy and autonomy in regard to their families
2. Inadequate information about physical changes and medication as death approached
3. Motivation to shorten their life
114
Kubler-Ross's Stages of Dying
1. Denial and Isolation: “It can’t be!”
2. Anger: “Why me?”
3. Bargaining: “Just let me do this first!”
4. Depression: withdrawal, crying, and grieving
5. Acceptance: a sense of peace comes
115
Kastenbaum suggested some problems about Kubler-Ross's Stages of Dying
1. Existence of 5-stage sequence has not been demonstrated
| 2. Stage interpretation neglects patients’ unique situations
116
Other Problems of Kubler-Ross's Stages of Dying
1. Some psychologists prefer to describe them not as stages but as potential reactions to dying
2. Some individuals never reach acceptance and struggle until the end; desperately hanging on to their lives
117
Perceived Control and Denial
1. Perceived control may be an adaptive strategy for remaining alert and cheerful
2. Denial insulates and allows one to avoid coping with intense feelings of anger and hurt
- Can be maladaptive depending on extent
118
Contexts in Which People Die
1. More than 50% of Americans die in hospitals
2. Nearly 20% die in nursing homes
3. Hospitals offer many important advantages:
- Professional staff members
- Technology may prolong life
4. Most individuals say they would rather die at home
119
Open communication with a dying person is very important because
1. They can close their lives in accord with their own ideas about proper dying
2. They may be able to complete plans and projects, and make arrangements and decisions
3. They have the opportunity to reminisce and converse with others
4. They have more understanding of what is happening to them
120
Grief
1. Emotional numbness, disbelief, separation anxiety, despair, sadness, and loneliness that accompany the loss of someone we love
- Grief is a complex, evolving process with multiple dimensions
- More like a roller-coaster ride than an orderly progression of stages
2. Cognitive factors are involved in the severity of grief
3. Good family communications and grief counselors can help grievers cope with feelings of separation and loss
121
Prolonged Grief
approximately 10%–20% of survivors have difficulty moving on with their life after 6 months have passed
122
Disenfranchised Grief
An individual’s grief involving a deceased person that is a socially ambiguous loss that can’t be openly mourned or supported
-Examples: ex-spouse, abortion, stigmatized death (such as AIDS)
123
Loss-oriented stressors
1. focus on the deceased individual
| - Can include grief work and both positive and negative reappraisal of the loss
124
Restoration-oriented stressors
1. secondary stressors that emerge as indirect outcomes of bereavement
- Changing identity and mastering new skills
125
Dual-Process Model
1. Loss-oriented stressors
2. Restoration-oriented stressors
3. Effective coping involves cycling between coping with loss and coping with restoration
126
Impact of death on surviving individuals is strongly influenced by the circumstances under which the death occurs
1. Traumatic, violent, or sudden deaths are likely to have more intense and prolonged effects
- Can be accompanied by PTSD-like symptoms
127
Cultural Diversity
1. Some cultures emphasize the importance of breaking bonds with the deceased and returning quickly to autonomous lifestyles
2. Beliefs about continuing bonds with the deceased vary extensively
3. There is no one right, ideal way to grieve
128
Grieving often stimulates individuals to try to make sense of their world
1. A reliving of the events leading to the death is common
2. Each person involved may offer their own piece of the puzzle
3. When a death is caused by an accident or a disaster, the effort to make sense of it is often pursued more vigorously
129
Telomeres
1. Protective ends of chromosomes that are shortened by phsiological stress as well as age.
130
Representations
1. The kinds of schemas or systems of schemas one develops over time to interact with the world.
2. The foundation of crystallized intelligence.
131
Control
Involves the ways one works with knowledge and includes attention, learning efficiency, flexibility of working memory, inhibitory control and processing speed.
132
Plaques
Clumps of insoluble protein that are damaging to neurons
133
Tangles
twisted filaments of another protein, which may interfere with communication between neurons and even cause cell death.
134
Amyloid precursor protein (APP)
Operate on it appear to play an initial role in development of plaque formation
135
Cerebrovascular accidents/strokes
1. Limit the oxygen supply to the brain for some period of time
2. An artery serving the brain is either clogged or bursts
3. A single stroke can lead to acute onset of dementia.
136
Multi-infarct dementia
1. Many minor strokes can gradually do sufficient damage to cause dementia.
137
Terminal drop and terminal decline
Describe the phenomena of deteriorating cognitive ability as adults approach the end of their lives.
138
Autobiographical memory
1. The remembered self, "representations of who we have been at various points in the past"
2. draws from several long-term memory systems
139
Recency
1. One of two very salient characteristics of self-memories for adults of all ages
2. The strength of a memory declines the more time has passed since the memory was formed.
3. We are more likely to remember something that has happened to us recently than something that happened in the more distant past.
140
"The bump"
A second salient feature of self-memories is a phenomenon that is ignominiously called "the bump" or the "reminiscence bump"
141
Flashbulb memories
Recollections that are especially vivid and personally relevant.
142
Primary control
When our control efforts are attempts to affect the immediate environment beyond ourselves
143
Secondary control
Our attempts to modify our expectations in the face of things we can't change.
-Using secondary control strategies when, we change our aspirations and goals because we cannot do everything we used to do or when we minimize the importance of specific needs after failing to achieve some end.
144
Decathecting
Detaching emotionally, from the former relationship and reinvesting psychic energy into the formation of new attachments
145
Shock
Bowlby's grieving process first phase
- the loss is met by disbelief
- Experience numbness or feelings of unreality
146
Protest
Second phase of Bowlby's grieving process
-Bereaved individuals may experience periods of obsessive yearning or searching for the lost loved one as well as bouts of restlessness or irritability
147
Despair
Bowlby's third phase in Bowlby's grieving process
-May be characterized by great sadness; social withdrawal; sleeping, eating, or somatic disturbances; and other symptoms of depression or emotional upset.
148
Reorganization
Bowlby used the term reorganization to describe the last phase of grieving a permanent separation.
-Taking a position in opposition to Freud's, Bowlby believed that bereaved individuals do not decathect, or detach, from their lost loved ones.
149
Complicated or abnormal grief
1. Several studies report gradual declines in depressive symptoms within the first 2 years after loss, but depression may persist even longer, particularly if the circumstances surrounding the death have been especially traumatic.
- Allow for longer periods of normal grieving
150
Loss focused
Lead to rumination or excessive preoccupation and, often, great distress.
151
Restoration focused
1. Balance loss focused work
| 2. Is directed toward handling the practical tasks that need to be done to carry on with daily life.
Lifespan
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