Psychology of Aging/Successful Aging 2024 PDF

Psychology of Aging/Successful Aging JULIA VAN LIEW, PH.D. DEPARTMENT OF BEHAVIORAL MEDICINE, MEDICAL HUMANITIES, & BIOETHICS DES MOINES UNIVERSITY Select slides originally developed by: Jeritt Tucker, Ph.D. Objectives 2 u Recognize how patient and provider attitudes about aging, including ageism, c...

Psychology of Aging/Successful Aging JULIA VAN LIEW, PH.D. DEPARTMENT OF BEHAVIORAL MEDICINE, MEDICAL HUMANITIES, & BIOETHICS DES MOINES UNIVERSITY Select slides originally developed by: Jeritt Tucker, Ph.D. Objectives 2 u Recognize how patient and provider attitudes about aging, including ageism, can influence patient outcomes. u Describe elements of successful aging and goal selection, optimization, and compensation. u Identify common psychosocial experiences in older adulthood. u Evaluate the role of older adult values in medical decisionmaking. 3 Attitudes about Aging 4 Ageism u 5 Stereotypes, prejudice, or discrimination towards others or oneself based on age u How we think, feel, and act based on age u The most socially “normalized” of any prejudice; just as prevalent and impactful (WHO) u May be conscious or unconscious u u u Young-Old Implicit Association Test May be individual or structural u E.g., employment policies against older persons u 3 in 5 older workers have seen or experienced age discrimination Associated with poorer physical and mental health Ageism u Positive stereotypes: sweet, cute, gentle, grandparent-like u Negative stereotypes: weak, slow, needing assistance, asexual u Range of settings: health care, marketing, media images u Images: frailty or “super seniors;” alone; limited mobility u Microaggressions 6 “I want people to define me by who I am, not how old I am. It’s not about aging, it’s about living. People want to be selfsufficient, stay active, build intimacy, but they are being held back because of the dominant cultural view of aging as a process of deterioration, dependency, reduced potential, family dispersal, and digital incompetence.” Disrupt Aging by Jo Ann Jenkins, CEO of AARP 7 “It is true that aging does eventually involve some degree of loss — in the form of challenges that are real and should not be disregarded. As Mitchell poignantly sings, ‘Something’s lost, but something’s gained.’ Aging can also bring increased wisdom, deepened perspectives, greater resilience and often more time to contribute to families, friends and communities.” Mary O’Donnell Op Ed for The Chicago Tribune 8 National Poll on Health Aging, University of Michigan, July 2020 9 World Health Organization Reframing Aging u 10 Use terms like: older adults, older persons, older people u Instead of: seniors, the elderly, the aged, seniors u Provide age-range qualifiers: older adults ages 75-84 years u Person-first language that does not depict a struggle or battle with illness u Suffers from dementia à Lives with dementia Gerontological Society of America Common myths u Dementia is an inevitable part of aging. u u Most older adults have good functional health. A small proportion are caredependent Older adults have no interest in sex or intimacy. u u The aging population is becoming more and more heterogeneous. Diversity is not random. Most older adults are frail and ill. u u Older adults tend to have lower rates of depression. Older adults are a homogeneous group. u u Most older adults are cognitively intact Older adults have higher rates of mental illness than younger adults. u u 11 Most older adults have meaningful interpersonal and sexual relationships. Older adults are inflexible and stubborn. u Most older adults have the same personality traits as at younger age. World Health Organization;APA, 2014 12 National Poll on Health Aging, University of Michigan, July 2020 Positive Changes with Aging u u u 13 Older adults tend to focus more on the positive and have fewer regrets Older adults tend to have lower stress reactivity and better emotion regulation Positive changes can come with age and experience: u Wisdom u Experience of handling past problems u Knowledge of personal strengths u Better emotion regulation u Focus on present moment experiences, “big picture” values World Health Organization; Levy et al., 2002 14 Chen et al. (2022) Older Adult Health Care Interactions-Provider Attitudes 15 u Myths and attitudes about aging can be a self-fulfilling prophecy for patients and providers u Providers: u Assessment and diagnosis u Premature closure of diagnostic exploration u Implicit sense of futility impacts treatment selection, expectations for improvement: undertreat, overtreat u E.g., health behavior change seen as futile u Hesitancy asking about potentially sensitive topics u Communication: directed at family vs. patient, infantilizing, “elderspeak” Cassel & Fulmer (2022) Older Adult Health Care Interactions-Patient Attitudes u 16 Older adults may be more hesitant to talk with you about sensitive subjects u Incontinence u Sexuality u Mental health symptoms, suicidal ideation u Substance use u Death, suffering u Older adults may have internalized some societal messages and stereotypes about their abilities u May see younger providers as unable to understand their experiences Older Adult Health Care Interactions Recommendations for providers: u Consider how your own attitudes and life experiences may influence working with older adults u u u E.g., discomfort with aging and death Normalize to increase patient disclosure, comfort u Many people your age experience … u Some people taking this medication have trouble with … u I am going to ask you a lot of questions some that might seem odd, please don’t be offended if I make you uncomfortable … Attend to the language you use about older adults 17 Discussion u 1) What examples of ageism have you seen in popular culture, or in health care interactions? u 2) If you have met older adults who seem to be aging well, what were they like? When you consider “successful aging,” what characteristics come to mind? u 3) How would you imagine your goals and priorities will be different in 50 years compared to today? 18 19 Successful Aging MODELS AND THEORIES Successful Aging 20 Biopsychosocial model, with geriatrics emphasis on: Biological -functional outcomes -quality of life Psychological Social Successful Aging 21 Maintaining cognitive and physical function Reducing disease and disability Engagement with life Successful Aging Successful Aging 22 “The process of developing and maintaining the functional ability that enables wellbeing in older age.” -World Health Organization Intrinsic Capacity mental, physical Environment physical, social Functional Ability ability to live out values Successful Aging: Selection, Optimization, & Compensation Model Selection Age-related loss leads to restriction of one’s life to fewer domains of functioning Optimization Engage in behaviors that enrich/augment general reserves and maximize chosen life-course 23 Baltes, 1987, 1990; Baltes & Baltes, 1990 Compensation is needed when behavioral capacities reduced below standard required for adequate functioning Successful Aging: Selection, Optimization, & Compensation Model 24 u Focuses on the processes individuals engage in to maximize gains and minimize losses in response to everyday demands and functional decline in later life u Success is not outcome-dependent—tied to doing the best you can with what you have u May entail making adaptations (compensations) through help from others, assistive devices, activity pacing u You can encourage this! Goal Changes in Selection, Optimization, and Compensation Model u Goal Restriction u u u narrowing in number of goals Goal Focusing u Pursuing goals more alike in content, or relevant to similar life domains u Less diverse goals Goal Motivation u Search for new goals increasingly oriented toward maintenance and loss-prevention, and less oriented toward gains 25 26 Psychosocial Experiences of Older Adulthood Retirement is now 20% of life 27 Today 17 yrs retirement on avg Early 20th century 3 yrs of retirement on avg (life expectancy = 47 yrs) https://waitbutwhy.com/2014/05/life-weeks.html Major Late-Life Events 28 Context Psych Social Environment Bio Family Guilt re: loss Aging parents Change in family living Serious illness Love Death of spouse Divorce/ remarriage Changing homes Sexual declines Parenting Grown children Grandparent Move in w/ children Child’s illness Health Decline in activity level Physical dependence Living conditions Injury/ disability Social age-appropriate Community friendships engagement Forced relocation Loss of close friends Finance Changing SES Financial loss Inheritance & mgmt. Health care costs Work Unemployment, retirement Leaving labor force Redesign of workplace Work disability Common Late-Life Stressors u Death of spouse, friends, family u Fixed income u Multiple medical conditions, pain u Functional limitations u Increased dependency on others; “burden” u Cognitive changes u Changing roles: spouse à caregiver, parent-child relationships 29 Common Themes u Accommodating to physical, social, and functional changes u Coping with loss, transitions u Retrospective life review u Wisdom, finding meaning in past experiences 30 31 Values and Clinical DecisionMaking WHAT MATTERS MOST Values: What Matters Most Values vs. Goals u Values: important life directions, areas, or ongoing qualities of action; stable u Goals: specific desired outcomes; SMART; flexible Being an active grandparent Babysitting my grandchildren every Saturday morning Older Adult Values in Medical Decision-Making Self-Sufficiency Life Enjoyment Taking care of oneself Not depending on others Functioning in daily life Meaningful physical and emotional health Activities associated with enjoyment of life Naik et al. (2016) 34 Connectedness and Legacy Balancing quality and length of life Engagement in Care Social and spiritual relationships Conveying how one wants to be understood or remembered by important people in one’s life Weighing desire for quality of life with prolonging life when evaluating treatment preferences and goals Extent of personal and/or family participation in medical and end-of-life decisions Values: What Matters Most Paradigm shift: Understanding patient values and aligning care to support preferences u Instead of starting with symptoms and diseases, starting with what a patient cares about most with their life and health u Shift from focusing on prolonging life medically to helping ensure that a prolonged life is worth living u Contextualizes health care in what matters most to patients u Informs treatment preferences u Improves patient motivation and adherence What is the matter? à What matters most? Bayliss et al., 2014; Boyd et al., 2019; Naik et al., 2016; Tinetti et al., 2016 Example of Clinical Decision Making for Older Adults with Multiple Chronic Conditions u https://youtu.be/BwbEwtcn6Og 36 Take Homes u Individual and structural ageism continues to limit older adults, inside and outside of health care settings. u Your own, and your patients’, attitudes about aging influence health care interactions and outcomes. u Older adulthood is a time of cumulative changes. The most successful patients focus on adaptation, such as outlined in the selection, optimization, and compensation model. u Asking about older adults’ values and goals and incorporating them in medical treatment planning supports your patients’ successful aging. When possible, design a treatment plan that optimizes functioning in valued domains. 37 Select References 38 u American Psychological Association (2014). Guidelines for Psychological Practice with Older Adults. American Psychologist, 69(1), 34-65. u Levy BR et al. (2002). Longevity increased by positive self-perceptions of aging. Journal of Personality and Social Psychology, 83(2):261-270. u Naik, AD et al. (2016). Health values and treatment goals of older, multimorbid adults facing life-threatening illness. J Am Geriatr Soc, 64: 625-631. u World Health Organization Ageing: https://www.who.int/ageing/ageism/en/