1
Q
late adulthood
A
- Late adulthood is the fastest growing but least researched segment of the population
- More stereotypes about late adulthood than any other age group
- That old people offer nothing to society.
2
Q
myths about ageing
A
- Disabled and diseased.
Set in old ways, unable to change.
3
Q
young old
A
• ‘Young old’ (60 – 69 years) – as fit and forward-looking as 50-year-olds were some generations ago
4
Q
third age
A
• ‘Third age’ (70 – 79 years) – many of them function better physically and psychologically than their parents did at age of 55
5
Q
fourth age
A
• ‘Fourth age’ (80 years and over) – ‘old-old’ adults frail physical or mental health directly attributable to their advanced age
6
Q
physiological capacities of 75 yo compared to 30yo
A
- half the lung capacity
- third of the cardiac output
- kidney capacity half
- hand grip, body wright and matabolism decreased.
7
Q
cognitive ageing: Piaget
A
- Piaget: Formal operational thinking as the final stage of cognitive development
- Postformal thinking – lessened egocentrism of young adults and capacity to view world more relativistically
8
Q
seattle study
A
- Seattle Longitudinal Study (Schaie, 1994) – ‘cohort obsolescence’ needs to be considered when considering cross-sectional evidence about changes in cognitive abilities with age
- Fluid and crystallised intelligence
- Intelligence skills have a divergent pattern.
- Crystallised intelligence (verbal and inductive reasoning) increases.
- Fluid intelligence peaks in early adulthood or adolescence and decreases over time.
9
Q
cross-sectional studies
A
• Cross-sectional studies look at people at different ages at the same time. This study sees that generally capacities decrease with age, including perception and cognition.
10
Q
indictive reasoning
A
Inductive reasoning is used to solve problems with procedural memory (crosswords, soduku etc.). In old age, inductive reasoning increases due to increased practice and spare time.
11
Q
successful cognitive ageing
A
- Selective optimisation with compensation in order to balance gains and losses in cognitive functioning in old age (Baltes, 1987)
- When you start to realise you are getting older, to counteract these negative forces, we try to develop different strategies to cope.
12
Q
wisdom
A
• Wisdom as ‘expertise in the fundamental pragmatics of life’ (Baltes, 1993, p. 615)
• Linked with the last Erikson stage of integrity vs. despair.
• Wisdom entails:
• Rich factual knowledge with exceptional scope, depth and balance
• Rich procedural knowledge about how to behave and seek meaning in life
• Tolerance, respect for context and values
• Awareness and skilled coping with uncertainty and change
• Wise solutions containing all these elements generally rare, but more common in older than in younger adult
According to Erikson resolution of the developmental task of late adulthood (integrity vs despair) produces wisdom
13
Q
successful social ageing
A
Disengagement theory and activity theory take opposing perspectives on adapting to the loss of roles or activities that occurs in late adulthood
According to disengagement theory, the most success happens when the person disappears from society.
Activity theory says that optimal ageing occurs when the person stays active in society.
14
Q
socioemotional selectivity ageing
A
- Changes in social motives due to people becoming more aware of the limited amount of time they have left
- Reshaping of one’s life in late adulthood to concentrate on what one finds to be important and meaningful in the face of physical decline and possible cognitive impairment
- The process becomes more important than the outcome.
- How do others view us and how do we view ourselves in old age.
15
Q
defining death
A
- Death – the irreversible cessation of vital life functions.
- Dying – the end stage of life, in which bodily processes decline, leading to death.
- Previously absence of respiration and heartbeat
- Now criteria focus on brain death
- Definition critical for issues of organ transplant
16
Q
accepting death
A
- Death becomes more salient with age
- Young children see death as reversible or temporary and not necessarily inevitable
- Adolescents tend to deny their own mortality
- Young adults are often very angry when faced with their own death
- Middle-aged adults become more aware of their own mortality
- Late adulthood associated with increasing acceptance of death and increasing concern about the process of dying
17
Q
the dying process
A
- Kübler-Ross’s (1969) classic work on the stages of dying
- Stages are not necessarily progressive and are likely to overlap
- Since they are based on young and middle-aged adults dying of cancer, they do not represent the variability that exists in the course of dying
- Suggests that bereaved relatives go through the same stages, although not necessarily in synchrony with the dying person
18
Q
stages of dying
A
- Denial; not me
- Anger; why me?
- Bargaining; yes me, but …
- Depression; yes me (begins to mourn)
- Acceptance; my time is very close now, and its alright.
19
Q
bereavement
A
- Bereavement
- The experience of loss of a loved one through death
- Bereavement has two components:
- Grief – the emotional response to one’s loss (grief generally happens before mourning).
- Mourning – the social and cultural experience of grief
- Grief
- Loss of primary relationships
- Relationships of attachment
- Relationships of community
20
Q
stages of grief
A
- 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?
21
Q
helping yourself
A
- Try to defer major decisions for 6-12 months that cannot be reversed, e.g. disposing of belongings
- Keep a diary or journal
- Create a memorial - do or make something to honour your loved one
- Develop your own rituals - light a candle, listen to special music, make a special place to think
- Allowing yourself to express your thoughts and feelings privately can help. Write a letter or a poem, draw, collect photos, cry…
- Exercise - do something to use pent-up energy, walk, swim, garden, chop wood
- Draw on religious and spiritual beliefs if this is helpful
- Read about other people’s experience - find books and articles
- Do things that are relaxing and soothing
- Some holistic or self care ideas that may assist include meditation, distractions, relaxation, massage, aromatherapy and warmth
- To help with sleeplessness: exercise, limit alcohol, eat well before sleeping, and try to have a routine.
22
Q
helping other people
A
- Allow people to help you, don’t be embarrassed to accept their help. You will be able to help someone else at another time. It is your turn now.
- Talk to family and friends; sharing memories and stories, thoughts and feelings can be comforting and strengthen our connection with our loved one
- Consider joining a support group to share with others who have had similar experiences
- Take opportunities to join in public ceremonies where you can be private, yet part of a larger group
- Use rituals and customs that are meaningful to you
- Talk with a counsellor to focus on your unique situation, to find support and comfort, and to find other ways to manage, especially when either your life or your grief seems to be complicated and particularly difficult.
23
Q
ageing summary
A
- Ageing of the population has great social and economic implications.
- Late adulthood is a time of loss in efficiency of body systems, but also a time of compensation.
- Successful aging refers to the maintenance of psychological adjustment and wellbeing across the full lifespan. It requires psychological resilience in the face of age-related stress.
- Baltes suggests that selective optimisation with compensation is essential for balancing gains and losses in cognitive functioning in old age
- Disengagement and activity theory take opposing perspectives on how people adapt to the loss of roles and activities in old age. Socioemotional selectivity theory suggests that people’s social motives change as they become aware of the limited time they have left.
- Ageing associated with increased acceptance of death and a heightened concern about the process of dying. Work of Kübler-Ross influential in understanding reactions to dying.
- Grief a highly variable experience, and cultural differences in expressions.
24
Q
lack of understanding in dementia and AD
A
- No existing theoretical models either psychological, pathological or neural, sufficient enough to capture the essence of this catastrophic human condition
- No extant reliable preclinical diagnosis available
- No cure only palliative treatment
25
prevalence of Dementia
* Dementia is the term used to describe the symptoms of any illness that causes a progressive decline in a person’s cognitive function.
* Most people with dementia are over the age of 65 but only a small proportion of older people over 65 have dementia. However, the chance of developing dementia increases exponentially as we get even older (i.e., the oldest old)
26
dementia definition
* Old definition
* Symptom-based: Progressive decline in a person’s cognitive function
* Moving away from symptom-based diagnosis to brain-based diagnosis
27
causes of dementia
* The most common cause of dementia is Alzheimer’s disease (AD), and accounts for approximately half of all cases of dementia.
* Vascular dementia (VaD) related to strokes is the next most common cause.
* Other forms include Frontotemporal dementia, and Dementia with Lewy bodies.
* Each form of dementia has its own pattern of symptoms, and correct diagnosis is important as treatment and management vary.
28
key diagnostic features of AD
* 1- Memory Impairment (impaired ability to learn new info or recall previously known info)
* 2- One or more of the following:
* Aphasia
* Apraxia
* Agnosia
* Executive dysfuntion
29
neuropathology of AD
* Alzheimer’s disease has one important characteristic feature in the brain
* Neuritic plaques – masses of dying neural material with a toxic protein that damages neurons, beta-amyloid, at their core
30
memory and AD
• Memory
• Relatively spared STM and procedural memory (especially motor learning)
• Episodic and semantic memory deficits and impaired verbal and visual learning
○ Lots of repetition and intrusion errors on list learning
○ Not aided by cueing
• Loss of semantic network (no ‘semantic clustering’ during encoding)
31
language and AD
• Language
• Anomic aphasia (impaired confrontation naming)
General conversation skills relatively preserved until mid-late stages
32
visuospatial issues
* Visuospatial
* Range of visuospatial and spatial orientation deficits
* Clock drawing
33
executive functioning
* Executive Functioning
* Increased disorganisation
* Perseveration
* Impaired metacognitive awareness (poor self-monitoring)
* Impaired time estimation
34
sensory functioning
* Sensory Functioning
| * Preserved visual, auditory and tactile acuity
35
emotional functioning
```
• Depression highly comorbid
• Behavioural and psychiatric disturbance:
○ Insomnia
○ Persecutory ideation/delusion
○ Hallucinations
○ Apathy
○ Agitation
○ Irritability
```
36
deliruim
• Delirium is an acute confusional state or episode characterised by a sudden onset of impaired cognition.
• It is a serious medical problem that is often not recognised by health professionals.
• Approximately 10-15% of people admitted to hospital have delirium, and a further 5-40% are thought to develop delirium once in hospital.
• Delirium is different to dementia, although people with dementia are prone to episodes of delirium and both conditions may co-exist.
• Dementia is a progressive condition that has an onset of months to years. The symptom severity of a person with dementia does not appear to change throughout the day.
It is important for families and carers to note a sudden change in cognition and function as this may be due to delirium.
PYB203
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Decks in class (10)
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