HGD Exam 5 Review PDF

HGD Exam #5 (Final) Review Chapter 15 Physical Changes (hearing, what causes changes in skin, muscle-fat makeup for men and women, skeleton: what causes spinal column to collapse, reproduction: what happens to estrogen levels and how this effects menstrual c...

HGD Exam #5 (Final) Review Chapter 15 Physical Changes (hearing, what causes changes in skin, muscle-fat makeup for men and women, skeleton: what causes spinal column to collapse, reproduction: what happens to estrogen levels and how this effects menstrual cycles) Vision Changes in Middle Adulthood Presbyopia: around age 60 o Inability to adjust focus to varying distances Pupil shrinks, lens yellows, vitreous and neural changes occur, blood supply decreases o Poor vision in dim light; increased sensitivity to glare o Decline in color discrimination o Retinal sensitivity decreases Glaucoma risk Hearing Changes in Middle Adulthood Presbycusis: between ages 45 and 64 o Initial decline in sensitivity to high frequencies; gradually extends to all frequencies o Speech more difficult to make out Men show earlier, more rapid decline Hearing aids, modifications to listening environment, communication can help Skin Changes in Middle Adulthood Wrinkles o Forehead: starting in thirties o Crow’s feet: forties Sagging in face, arms, legs Dryness Age spots after age 50 Blood vessels more visible Faster with sun exposure, and for women o The epidermis is less firmly attached to the dermis, less water content Muscle-Fat Makeup in Middle Adulthood Increase in body fat and loss of muscle and bone Middle-age spread common: fat gain in torso o Men: upper abdomen, back o Women: waist, upper arms  Muscle mass decline gradually Can be offset by exercise, especially resistance training Skeletal Changes in Middle Adulthood Bones broaden but become more porous o Loss in bone density o Women at greater risk o Decline in protective role of estrogen, testosterone Loss in bone strength o Disks collapse, height shrinks o Bones fracture more easily, heal more slowly Health lifestyle, exercise can slow bone loss Climacteric and Menopause Gradual end of fertility o 10-year climacteric ends with menopause o Ranges from late thirties to late fifties; on average, early fifties o Earlier in non-childbearing women, smokers Drop in estrogen: o Monthly cycles shorten, eventually stop o Increased complaints about sexual functioning o Decreased skin elasticity, loss of bone mass Menopausal Symptoms Hot flashes, night sweats Sexual difficulties Moodiness, irritability Reported sleep difficulties o Research does not link to menopause, through frequent hot flashes are linked to poor sleep Depression associated with climacteric, declines after menopause Asian women report fewer complaints Reactions to Menopause Individual difference in: o Importance of loss of childbearing capacity o Physical symptoms, or expectations of symptoms Many women find it little or no trouble Baby boomers seem more accepting Affected by cultural beliefs and practices  o E.g., African-American women hold favorable views Reproductive Changes in Men Decrease in: o Sperm volume, motility starting in twenties o Semen after age 40 Gradual decline in testosterone: o Sexual activity stimulates production Erection difficulties: o Frequent problems may be linked to anxiety, depression, physical disorders, injury, loss of sexual interest o Drugs that increase blood flow to penis offer temporary relief Benefits of hormone therapy: what do we know for certain that it can help Hormone therapy for Menopause Benefits: o Reduces hot flashes and vaginal dryness o Some protection against bone loss Risks: May increase risk for breast cancer (est & prog), blood clots (tablets only), or CV disease (over age 60) Unclear if there is any affect on demntia Hormone therapy options: o Estrogen or hormone replacement therapies (ERT, HRT) o Associated with many negative health consequences Alternatives: o New estrogen-based drugs with fewer side effects o Gabapentin nearly as effective Sexuality in middle adulthood- what is sexual frequency related to Slight drop in frequency among married couples: o Stability of sexual activity is typical o Best predictor is relationship satisfaction Intensity of response declines: o Slower arousal due to climacteric Sex still important, enjoyable to most Partner availability: fewer single men, more single women The best predictor of sexual frequency in midlife is relationship satisfaction Illness and disability (Leading causes of death, leading cancer incidence, breast cancer gene testing) Cancer and cardiovascular disease are leading causes of death in U.S. Falls resulting in bone fractures more than double Economic disadvantage strongly predicts poor health and premature death Close connection between psychological and physical well-being Cancer in Middle Adulthood One-third of U.S. midlife deaths: o More men than women o Higher in low SES, but varies by site Results from cell mutations: germline or somatic o Oncogenes o Tumor suppressor genes o Stability genes Often curable: 60% survive fiver years or more; survival brings emotional challenges Lung cancer causes more deaths than any other type of cancer Reducing Cancer Risks Know seven warning signs Get regular checkups and screenings Healthy diet Physical activity Avoid: o Tobacco o Excessive sun exposure o Unnecessary X-rays o Industrial chemicals, pollutants o Alcohol (limit) Weigh risks of hormone therapy Heart attack symptoms (men and women) – how might they differ Cardiovascular Disease Responsible for 25% of middle-aged deaths “Silent killers”: o High blood pressure, cholesterol o Atherosclerosis Symptoms: o Heart attack (blockage)  o Arrhythmia (irregular heartbeat) o Angina pectoris (chest pain) Heart Attack Signs in Men & Women Uncomfortable pressure, squeezing, fullness or pain in the center of your chest. It lasts more than a few minutes, or goes away and comes back Pain or discomfort in one or both arms, the back, neck, jaw, or stomach Shortness of breath with or without chest discomfort Other signs such as breaking out in a cold sweat, nausea, or lightheadedness As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, extreme fatigue, nausea/vomiting and back or jaw pain, and symptoms mistaken for a panic attack with upper back pain Reducing Heart Attack Risk Quit smoking Reduce cholesterol Treat high blood pressure Maintain ideal weight Exercise regularly Occasional wine or beer Take low-dose aspirin Reduce hostility and stress Hostility and Anger: Risks associated with high blood pressure and heart disease Hostility and Health Type a behavior pattern: o Competitive, impatient, angry, hostile o Associated with increased risk of heart disease Expressed hostility: o Angry outbursts, rudeness, criticism, contempt o Predicts heart disease and other health problems o Greater risk of high blood pressure, atherosclerosis, stroke Suppressed hostility and anger and ruminating are also linked to high blood pressure and heart disease Stress management: and relationship to illness Managing Stress  Reevaluate the situation Focus on events you can control View life as fluid Consider alternative Set reasonable goals Exercise regularly Use relaxation techniques Constructively reduce anger; e.g. assertive, not hostile, negotiate instead of exploding Seek social support Coping Styles Problem-centered coping o Identity and appraise situation as changeable o Choose and implement potential solutions Emotion-centered coping o Internal, private o Control distress when the situation can’t be changed o Ineffective when self-blaming, impulsive, escapist Flexibly moving between both styles reduce stress Stress Management in Midlife Improved ability compared with younger adults o Cope more effectively o More realistic about ability to change situation o More skilled at anticipating and managing stressful events Community social supports helpful, but less available more middle-aged than for younger and older adults Constructive approaches to anger reduction- regarding assertiveness and negotiation Constructively reduce anger; e.g. assertive, not hostile, negotiate instead of exploding Crystallized and Fluid Intelligence- definition of both Crystallized Intelligence (think formed and structured) Skills that depend on: o Accumulated knowledge o Experience o Good judgment o Mastery of social conventions Valued by person’s culture  E.g., vocabulary, verbal comprehension, general information, logical reasoning Peaks in midlife, declines in eighties Fluid Intelligence Depends on basic information-processing skills: o Detecting relationships among visual stimuli o Speed of analyzing information o Working memory Progressive falloff beginning in mid-twenties o E.g., spatial visualization, digit span, letter-number sequencing, symbol search Processing speed and executive function in Middle Adulthood how does slowing of processing speed affect executive function Explain Changes in Mental Abilities General slowing of central nervous system functioning Midlife declines in basic processing may not affect well-practiced performances until late adulthood Shift to activities that depend less on cognitive efficiency and more on accumulated knowledge As processing speed slows, executive function declines Age-Related Slowing of Information Processing Withering of myelin o Deteriorating neural connections Information loss as move through cognitive system o Whole system slows down to inspect, interpret information Other predictive factors: declines in vision, hearing, and executive function, especially working memory Executive Function in Middle Adulthood Decline in working memory o Spatial suffers more than verbal Reduced inhibition o Evident on continuous performance tasks o In everyday life, cause older adults to appear distractible Flexible shifting of attention more challenging o Sustaining two tasks simultaneously, switching between mental operations harder Adults can compensate through experience, training, practice Memory strategies (semantic memory, procedural memory, metacognitive knowledge) definition of each Memory Strategies in Middle Adulthood Ability to recall studied information declines o Reduced use of memory strategies o Harder to retrieve information from long-term memory o Difficulty keeping attention on relevant information Adults can compensate o Self-paced tasks o Training in strategies Few changes in semantic memory, procedural memory, occupational knowledge, or metacognitive knowledge o Semantic memory: the long-term storage of facts and is a form of declarative memory § Ex: memorizing birthdates of relative or memorizing names o Procedural memory: memory for how to do things. It is often juxtaposed to declarative memory which refers to memory of facts § Ex: how to ride a bike o Metacognitive knowledge: intentional thinking about how you think and learn; your thinking activities and processes Vocational Life and Cognitive Development Work environment is vital for learning and maintaining skills Complex work with challenging and new tasks: o Predicts cognitive flexibility o Reduces decline in fluid abilities o Sustains cognitive gains into retirement reasons for not completing degrees of returning students Becoming a Student in Midlife 40% of U.S. college students are over age 25; nearly 60% of them are women Reasons are diverse: o Job changes, seeking better income o Life transitions o Personal achievement, self-enrichment Concerns of adult learners: o Ability to handle academic work o Aging, gender, and ethnic stereotypes o Role overload Sources of Support (NEED SUPPORT) Partner and children Extended family Friends Educational institution Workplace Chapter 16 Erikson’s theory: what is generativity and stagnation? (Generativity vs Stagnation) Generativity : “a concern for establishing and guiding the next generation” Giving to and guiding younger generations Extending commitments beyond self and partner Integrating personal goals with larger social welfare May be realized through parenting, other family relationships, work, volunteering, mentoring, creativity, and productivity Optimistic “belief in the species” is a major motivator Stagnation Self-centered, self-indulgent, self-absorbed Lack of interest in young people Focus on what one can get from others, rather than what once can give Little interest in being productive at work, or developing talents Examples of stagnation include maintaining great distance from others and refusing to lend aid to neighbors. o Those who experience stagnation may feel a sense of emptiness, or lack of fulfillment in their lives Levinson- what does middle adulthood begin with? Levinson’s developmental tasks Levinson’s Four Tasks of Middle Adulthood Levinson believes middle adulthood begins with a transitional period in which they reevaluate goals and they must reconcile two opposing tendencies. Regrets and psychological well-being Is There a Midlife Crisis? Wide individual differences in response Life evaluation is common during middle age “Turning points” reported: most positive, leading to personal growth Interpretation of regrets greatly influences well-being o Serve a positive function when consider what went wrong and take possible corrective action Crisis and major restructuring are rare Those who experience regrets are very often associated with poor psychological well- being What Factors Promote Psychological Well-Being in Midlife? Good health and exercise Sense of control and personal life investment Positive social relationships Good marriage Mastery of multiple roles Possible selves-define and what can this accomplish?  What one hopes to become (strives for) or fears becoming (tries to avoid) Rely more on temporal than on social comparisons Fewer in number, more modest and concrete with age Can be redefined by the individual, permitting affirmation of the self Strong motivator of action in midlife Play protective role in self-esteem Individual differences in personality traits (Big five) 2 questions The “Big Five” Personality Traits model to comprehend the relationship between personality and academic behavior Individual differences that are highly stable: o Neuroticism : high on worrying, low on calm o Extroversion: high in affection, low in reserved o Openness to experience: high in imagination, low in conservative o Agreeableness: high in generous, low in stingy o Conscientiousness: high in hard-working, low in negligent Enduring foundation, yet responsive to the pressures of life experiences Marriage and Divorce (2 questions) what is life satisfaction associated with? What group is associated with poverty? Marriage in Middle Adulthood Middle-aged households typically well-off compared with other age groups Contemporary view of midlife marriage: expansion, new horizons Need for review and adjustment of marital relationship Marital satisfaction predicts psychological well-being Psychological intimacy strengthened by physical affection, low conflict, and sense of fairness Divorce in Midlife Rate doubled over past 20 years for U.S. ages 50+ o Longer life expectancy, greater social acceptance, and greater financial security contribute More likely among those highly educated or remarried Midlifers adjust more easily than young adults: o Practical problem solving o Effective coping strategies o Can being relief when marriage highly distressed Contributes to feminization of poverty: women who support themselves or their families have become the majority of the adult population living in poverty Changing parent-child relationships (kinkeeper) Launching: culmination of “letting go” process: o Decline in parental authority o Continued contact, affection, support to children o Adjusting to in-laws o Kinkeeper role, especially for mothers Affected by: o Investment in nonparental relationships and roles, especially work o Children’s characteristics: “off-time” children stress parents o Cultural variations in social clock for children’s departure Grandparent-grandchild relationships (grandparents who step in as primary caregivers) Grandparenthood On average, begins in early fifties; can spend one-third of life as a grandparent Significant milestone for most Valued means of fulfilling personal and societal needs Grandparent-grandchild relationships: o Influenced by age, sex, proximity, SES, ethnicity, culture, relations with daughter- or son-in-law o Vital context for sharing between generations Meanings of Grandparenthood Valued older adult Immortality through descendants Reinvolvement with personal past Opportunity for indulgence Grandparents Rearing Grandchildren: The Skipped-Generation Family Grandparents as primary caregiver have increased Many assume role under very stressful circumstances o Children with learning, emotional, behavioral problems o Parent interference o Financial hardship o Worries about child if own health fails Need social and financial support, service for troubled children Highly fulfilling; some view it as a “second chance” Caring for aging parents (women who reduce employment or leaving work) “Sandwich generation,” expected to increase  o Middle-aged adults aged 40-60 years old, who are caring for both their growing children and aging parents at the same time/ Factors include finances, location, gender, culture With age, sex difference in caregiving declines Highly stressful: o Time devoted to care is great, more for women o Challenges magnified for working women o Over time, parents’ condition declines, tasks escalate o Greatest stress for those sharing a household Most help willingly and benefit personally Consequences of Caring for Aging Parents Emotional, physical, and financial Risks include role overload, job absenteeism, exhaustion, inability to concreate, depressing, anxiety about aging; women more profoundly affected Supportive measures: o Positive experiences at work o Social support, team effort among family o Government-sponsored home helper systems (U.S. is lacking) Women who leave their job to care for parents feel isolated and have financial strain Relieving Caregiving Stress Use effective coping strategies Seek social support Use community resources get workplace help Press for helpful workplace and public policies Job satisfaction (burnout occurs in which professions more often?) – Caring professions ex: Healthcare (nurses, doctors) Job Satisfaction in Midlife Increased satisfaction with work itself Improved capacity to manage difficult situations Determining factors o Involvement in decision making o Reasonable workloads o Good physical working conditions Causes of Burnout  Long-term job stress Work with high emotional demands Unsupportive work environment Excessive work assignments for available time Lack of encouragement from supervisors Consequences of Burnout Impaired attention and memory Severe depression On-the-job injuries Physical illness Poor job performance Absenteeism and turnover Unemployment: losing a job in midlife Midlife Unemployment Disrupts generativity and life appraisal Decline in physical and mental health Remain jobless longer Seldom attain former status or pay Goal of counseling: problem-centered coping categories Planning for retirement and how income often changes after retirement Ingredients for Effective Retirement Planning Finances Fitness Role adjustment Where to live Leisure and volunteer activities Health insurance Legal affairs Annual income often drops by about 50 percent upon retirement and those who strongly identified with their career have a harder adjustment. Chapter 17 Physical development: functional age vs chronological age (define both) Functional Age  Actual competence and performance may not match chronological age Variation exists between and within individuals No single biological measure can predict rate of aging Combination of physiological, psychological, and social age Chronological age Based on when you were born o Ex: 60 years old, born in 2005 = 19 years old Maximum Lifespan: what are the gains in average life expectancy largely the result of? Life Expectancy in Late Adulthood Older adults now represent 15% of U.S. population, compared with 4% in the early 1900s Life expectancy increasing in U.S. o Steady decline in infant mortality o Decrease in adult death rates: improved nutrition, medical treatment, sanitation, and safety Due to aging baby boomers, population of older adults will rise significantly in coming years Factors Influencing Life Expectancy Variations due to heredity and environment: Gender: women outlive men SES: increases with education and income Lifestyle factors: behaviors, job, social supports Governing policies and programs: health care, housing, social services Variations in Healthy Life Expectancy Healthy life expectancy: years living with full health, without disease or injury Japan ranks first: o Low rates of obesity and heart disease, low-fat diet o Favorable health-care policies U.S. lags behind overwhelming majority of industrialized nations In developing nations, greatly reduced by: o Poverty, malnutrition, disease o Armed conflict Life Expectancy in Late Adulthood Women’s advantages shrinks with age  Ethnicity life expectancy crossover after age 80 Fastest-growing segment is 85-and-older group Heredity: longevity runs in families Environmental factors: more influential with age What Can We Learn About Aging from Centenarians? Biological, psychological, social influences combine Factors contributing to long life: o Genetics: efficient immune system, few brain abnormalities o Health: diet, low substance use, exercise o Personality: optimism, independence, emotional security o Social support: close family bonds, happy marriage o Activities: Community involvement, stimulating work, learning Maximum Lifespan Species-specific biological limit o Little increase in life expectancy for those 65 and older o Centenarians still rare Some scientists believe upper limit not yet reached o Should maximum lifespan be increased? o Goal should be quality, not quantity, focusing on extending healthy life expectancy ADLs vs IADLs (define) Quality of Life Activities of Daily Living (ADLs) o Basic self-care tasks o Bathing, dressing, eating Instrumental Activities of Daily Living (IADLs) o Conducting business of daily life o Require some cognitive competence o Shopping, food preparation, housekeeping, paying bills Aging and the Nervous System Neuron loss, especially in: o Prefrontal cortex (executive function) o Corpus callosum (links cortical hemispheres) o Cerebellum (balance) o Hippocampus (memory and spatial awareness) Central nervous system and autonomic nervous system less efficient  How the brain compensates: o Generates neural fibers and, to limited degree, new neurons o Calls on other brain regions to support cognitive processing Sensory systems (vision and hearing) differences in loss in women and men Visual Impairments and Aging Increased sensitivity to glare Impaired color discrimination Poor dark adaptation Decreased depth perception Lower visual acuity Cataracts o Progressive cloudy looking lens that blocks light; makes vision fuzzy Macular degeneration o A dark spot in the middle of their vision Hearing Impairments and Aging Declines in detecting sounds o High frequencies most affected o Soft sounds throughout frequency range o Speech perception: greatly affects life satisfaction Do not predict cognitive declines, when other factors linked to cognitive functioning controlled For most, not disruptive to daily life until age 85+ Compensation relies on intermodal perception, quiet environments, hearing aids and devices Taste and Smell in Late Life Declines in taste buds on tongue Greater difficulty recognizing familiar foods Declines in odor sensitivity o Decrease in smell receptors o Loss of neurons in brain regions that process odors o Perception distorted: “food no longer smells and tastes right” Smell’s self-protective function diminishes Effects of Sensory Changes Cardiovascular and respiratory systems (heart) what changes in the heart as the years pass? Aging Body Systems – Cerebral Vascular Accident (mentioned in class) (blockage and rupture) Cardiovascular/respiratory systems: o Heartbeat less forceful; reduced maximum heart rate, blood flow o Less oxygen delivered to tissues during exertion o Vital lung capacity reduced by half Immune system: o Effectiveness declines o More infectious, autoimmune diseases o Stress-related susceptibility Healthy diet, exercise help protect immune response, cardiovascular and respiratory functioning Sleep and Aging Total sleep needs remain constant Sleep timing changes: earlier bedtime and wakening Sleep difficulties: o Insomnia o Nighttime waking o Sleep apnea Fostering restful sleep: o Consistent bedtime, waking time o Regular exercise  o Using bedroom only for sleep Health, fitness and disability (low SES)- why are low SES adults less likely to seek medical care? Factors Influencing Health in Older Adults Self-efficacy Optimism SES Ethnicity Health-care costs Gender Nutrition Exercise Nutrition and Exercise – 2 questions (what offers some protection against mental disabilities and what gains are possible for older adults who begin endurance training?) Nutrition in Late Adulthood Need extra nutrients to: o Protect bones, immune system o Protect against excess free radicals Diet high in nutrients fosters physical, cognitive health Eating fish high in omega-3 fatty acids offer some protection against mental disabilities in late adulthood Exercise in Late Adulthood Benefits: o Physical: stronger, more energetic o Cognitive: memory, executive function Preserves brain and central nervous system (less tissue lose in cerebral cortex) Even sedentary healthy older adults show gains o Endurance training increases vital capacity o Weight-bearing exercise improves walking, balance, posture o Regular, moderate to vigorous exercise improves cognition Importance of instilling sense of control Signs of a Stroke BE FAST o balance, eyes, face, arms, speech, time Arthritis Type 2 Diabetes Primary and secondary aging- examples of each Primary (Biological) o Genetically influenced declines o Affects all members of species o Occurs even when health is good Secondary o Declines due to hereditary defects and negative environmental influences, e.g., diet, pollution o Effects individualized: major contributor to frailty Mental Disabilities: normal age-related cell death and ability to perform everyday activities? Mental Disabilities in Late Adulthood Dementia involves impairments to thought and behavior that disrupt daily life; two most common: o Alzheimer’s disease: 70% of all dementia cases o Vascular dementia: 15% of all dementia cases Misdiagnosed or reversible dementia: o Depression  o Medication side effects o Diseases involving temporary mental symptoms o Environmental changes and social isolation o Adequate mental health services, doctor referrals needed Alzheimer’s: symptoms and course of the disease, (first symptoms) brain deterioration (what physically happens to the brain?), risk factors (what diseases are associated with), protective factors Alzheimer’s Disease Alzheimer’s Disease: Risk and Protective Factors Mediterranean diet: vegetables, healthy fats (olive oil), fish, grains, and nuts, some chicken and dairy Social Issues: Health (Interventions for caregivers of older adults with dementia)- what do caregivers desire the most? Interventions for Caregivers of Older Adults with Dementia  Effective interventions address multiple needs: o Knowledge about disease, available resources o Coping strategies o Caregiving skills o Respite o Social support o Family intervention programs Memory: associative, remote, prospective- define each Associative Memory Deficit in Late Life Difficulty creating and retrieving links between pieces of information o Associations between unrelated items o Sensory declines subtract from working memory Deficits greatly affected by lack of strategy use Helpful strategies: o Provide memory cues o Encourage used of memory strategy of eleaboration Remote Memory Autobiographical memory stronger for both remote and recent events than for immediate events Reminiscence bump for events of adolescence, early adulthood o Evident across cultures o Novel experiences stand out o Culturally shared, important life events o Strengthened through lifetime of recalling, retelling Prospective Memory Remembering to engage in planned actions in the future Event-based easier than time-based Older adults often generate external memory aid to compensate With completed tasks, harder to deactivate invention; risk of repeating Benefit from system of reminders that regularly scheduled taks completed Wisdom- define – what is wisdom? Universal, cross-cultural association with age Five ingredients: o Knowledge about life’s fundamental concerns o Effective strategies for applying that knowledge  o View of people considers multiple demands of their lives o A concern with ultimate human values o Awareness and management of life’s uncertainties Wisdom requires: broad practical knowledge, emotional maturity, and the ability to apply knowledge to make life more worthwhile What Contributes to Wisdom? Age no guarantee of wisdom Type of life experience: o Human-service training and practice o Leadership positions o History of overcoming adversity Personal motivations: o Continued desire for personal growth o Sense of autonomy and purpose o Generativity Factors related to cognitive maintenance and change (terminal decline)- what are signs of terminal decline? Factors Related to Cognitive Change Modest genetic contribution Mentally active life: education, stimulating leisure, community participation, flexibility Health status Rising instability of performance that increases in the seventies Terminal decline: accelerated deterioration of functioning prior to death Cognitive Interventions Training in strategies to reverse age-related declines o ADEPT, ACTIVE o Metacognition a powerful asset o In ACTIVE, speed-of-processing training showed broadest benefits for IADLs and other aspects of everyday functioning Community programs in the participatory arts Targeting self-efficacy Working in groups The Art of Acting Enhances Cognitive Functioning in Older Adults Verbatim recall without rote memorization: o Analyze script for small, goal-directed dialogue chunks  o Deep elaborative processing of dialogue chunks Results in greater gains on tests of: o Working memory o Word and prose recall o Verbal fluency o Problem solving o IADLs Chapter 18 Erikson’s Theory (final psychological conflict) Ego Integrity vs. Despair Ego integrity o Feel whole, complete, satisfied with achievements o View life in context of humanity o Associated with favorable psychological well-being Despair o Feel many decisions were wrong, yet time is now too short o Bitter, unaccepting of death o Expressed as anger, contempt for others Gerotranscendence- what occurs according to Joan Erikson Beyond ego integrity Cosmic, transcendent perspective Directed forward and outward, beyond self Heightened inner calm, contentment Quiet reflection The Positivity Effect Attend to and better recall emotionally positive over negative information o Contributes to resilience o Constructive strategies to avoid interpersonal conflict o Greater competence at emotional self-regulation o Shortened time perspective induces focus on meaningful experiences o High levels of emotional stability are the norm Reminiscence (self-focused, knowledge-based other focused) - know the definition of all 3 Reminiscence and Life Review Reminiscence: telling stories about the past o Self-focused: linked to adjustment problems  o Other-focused: solidifies relationships o Knowledge-based: effective problem-solving strategies, teaching younger people Life review: form of reminiscence o Goal: greater self-understanding o Counselor-led life review interventions can lead to: § Increased self-esteem, sense of purpose § Reduced depression The New Old Age Third Age: o Ages 65 to 79 and sometimes beyond o Personal fulfillment, self realization, high life satisfaction Today’s Third agers: o Contribute billions in volunteer work o Many continue to participate in the work force o Give generously their families o More volunteer and services opportunities needed How do adults who are high in Neuroticism cope with stress? Self-Concept and Personality in Late Adulthood Secure, multifaceted self-concept: o Supported by a lifetime of self-knowledge o Autobiographical selves emphasize coherence, consistency o Allows for self-acceptance o Continued pursuit of possible selves Shifts in some personality characteristics o Gain in agreeableness, but being high in neuroticism causes risk for health problems o Decline in extroversion and openness to experience o Greater acceptance of change Resilience promotes adaptive functioning Dependency -support vs independence-ignore – define both Control vs. Dependency in Late Adulthood Reinforcing dependent behavior at expense of independent behavior o Dependency-support script: attend immediately to dependent behaviors (reduces autonomy) o Independence-ignore script: ignore independent behaviors  Person-environment fit: match between person’s abilities and demands of living environments o Sustains optimism, self-efficacy o Promotes adaptive behavior, psychological well-being Risk factors for late life depression – what is the strongest risk factor? Physical Health Powerful predictor of psychological well-being o Physical impairment-depression relationships Mental health interferes more than physical disabilities with activities of daily living Optimism, self-efficacy, effective coping, caregiver-supported autonomy are vital Need for greater mental health service for older adults and regular interventions in nursing home Depression Risk Factors Physical declines, chronic disease Perceived negative health Move to nursing home Social isolation, lack of personal control Women of advanced age unable to care for others “Giving up”: triggers rapid decline Elder Suicide Increased risk in older adults, especially white men Indirect self-destructive acts: a form of suicide Prompted by loss or chronic, terminal illness o Leads to hopelessness, cognitive declines, social isolation Prevention and effective treatment: o Spot signs: despondency, indirect self-destructive acts o Antidepressant medication plus therapy o Help in coping with life transitions o Screenings, hotlines, home visitors, “buddy system” Social support in late adulthood is associated with what? As in middle age, continues to reduce stress, promote health and well-being Older adults desire to reciprocate o Assistance they cannot return reduces self-efficacy amplifies stress Formal support relieves caregiving burden and aging adults’ feelings of dependency o Exception: ethnic minority older adults  Social support increases the odds of living longer and good quality relationships help with psychological well-being Social Theories of Aging (DO NOT need to know top two: Disengagement and Activity theory) Continuity theory of aging – define and recognize an example Continuity Theory Effort to maintain consistency between past and anticipated future o Finding a way to continue; ex: volunteering or rather than playing piano professionally, teaching piano occasionally from home Life satisfaction for nursing home residents – what predicts satisfaction? Housing Arrangements in Late Adulthood Ordinary homes: o Living in own home: greatest personal control o Living with family members o Living alone: number increasing Residential communities: o Private dwellings suited to older adults’ capacities o Independent living and life-care communities Nursing homes o Greatly restricts autonomy, social integration- need outside interaction for life satisfaction o Green House model: effective person-environment fit Cohabitation- are they as satisfied as those who are married? Elder maltreatment – most frequently reported type? Forms of abuse o Physical abuse o Physical neglect o Emotional abuse o Sexual abuse o Financial abuse Usually a trusted family member or caregiver Nursing homes a major concern Red Flags Signs and symptoms of elder abuse can include: Injuries such as bruises, cuts, or broken bones Malnourishment or weight loss Poor hygiene Symptoms of anxiety, depression, or confusion Unexplained transactions or loss of money Withdrawal from family members or friends Experience corps outcomes – what do fMRIs show? Experience Corps: Promoting Retired Adults’ Physical and Mental Health and Children’s Academic Success “High-dose” volunteering: retired adults tutor and mentor young schoolchildren 15+ hours per week  Outcomes: o Gains in physical activity and strength o Fewer physical limitations and depressive symptoms o Enhanced social support o Gains in executive function o Gains in size of cerebral cortex and hippocampus (memory) o Increased brain plasticity of regions supporting cognitive skills Chapter 19 Three phases of death – what happens during the clinical phase of death? Phases When Death is Imminent Agonal phase o Rattled breathing sound, gasps and muscle spasms during first moments in which regular heartbeat disintegrates § One of the breathing rhythm changes is called Cheyne-Stokes breathing; a cycle anywhere from 30 seconds to two minutes where the dying person’s breathing deepens and speeds up, then gets shallower and shallower until it stops § Then there is a pause, which can sometimes stretch on so long that you think the person has stopped breathing altogether before the cycle resumes § Another is the awfully-named ‘death rattle’, caused by a build-up of saliva or secretions at the back of the throat Clinical death o Interval in which heartbeat, circulation, breathing, brain functioning stop, but resuscitation still possible (4-6 min) Mortality (Biological death) o Permanent death Defining Death Brain death o Irreversible cessation of all activity in brain and brain stem o Standard for death in most industrialized nations Persistent vegetative state o Cerebral cortex no longer registers electrical activity o Brain stem remains active Cultural variations, spiritual beliefs may influence o China and Japan: absence of heartbeat and respiration Death with dignity – importance of educating patients so that they can make choices. Dignity fostered through communication with and care for dying person: o Assurance of support o Compassionate care o Esteem and respect, addressing greatest concerns o Candidness about death’s certainty o Information to make reasoned end-of-life choices o Maximum personal control over final phase of life Enhancing understanding of death for children and adolescents – does discussing death cause them anxiety? How to help teens build a bridge between death as a logical concept. Discussing death with children and adolescents reduces their anxiety about death o Rather than not having any answers Concepts of Death Nonfunctionality Finality Universality Applicability Causation Children’s Understanding of Death Depends on basic notions of biology o Linked to reduced anxiety about death Most attain adultlike understanding by age 6 Americans’ death-avoidant culture impedes accurate knowledge Factors that affect understanding: o Experience with death o Cultural practices and religious teachings o Candid, sensitive discussions with adults Adolescents’ Understanding of Death Full understanding of death subconcepts of nonfunctionality and finality, but attracted to alternatives Difficulty integrating logic with reality o Illusion of control over reality, death-defying acts Conversations with parents promote understanding Adulthood and Understanding of Death Discussing Death with Children and Adolescents Take the lead Listen perceptively Acknowledge feelings Provide facts candidly, with cultural sensitivity Engage in joint problem solving Death Anxiety Cultural variations: religious, spiritual beliefs Individual variations: o Gender: women more anxious o Age: mostly adolescents, adults; declines in late adulthood o Children: terminal illness, war and high-crime exposure Factors that reduce fear: o Firmness, consistency of religious beliefs and practices o Positive view: participatory vs. overcoming perspective o Effective emotion regulation o Symbolic immortality: can be a motivator Kubler-Ross’s Theory - what did she believe these reactions should be viewed as? Five coping strategies: o Denial o Anger o Bargaining o Depression o Acceptance Not a fixed sequence, rather coping strategies o They don’t have to reach acceptance etc. Dying people respond in many additional ways The Dying have “unfinished needs” A place to die (home) – where do most say they hope to die? Traditional Places of Death Home o Most preferred option: intimacy, loving care o Only about one-fourth of Americans die at home o Need for adequate caregiver support Hospital o Often depersonalizing, painful, without wishes being met o Comprehensive treatment programs, trained staff optimal Nursing home o Focus usually not on terminal care o Improves greatly when combines with hospice care Appropriate Death Suits the individual’s pattern of living, values Preserves or restores significant relationships As free of suffering as possible “Good death” includes: o Achieving a sense of control o Confronting and preparing for death The hospice approach and palliative care – definition of both Hospice Approach Comprehensive program of support for terminally ill and their families that focuses on quality of life: o Patient and family as unit of care o Meeting physical, emotional, social, spiritual needs o Interdisciplinary team o Home or homelike setting o Palliative (comfort) care § Pain and symptom management; trying to keep the patient as comfortable as comfortable ex: pain medicine, anxiety medicine o Regular visits and 24/7 on-call services o Bereavement services o Care provided by a team including: a doctor, a nurse or home health aide, a chaplain, a counselor or social worker, and a trained volunteer Offers choices to ensure an appropriate death Cost-effective alternative to life-saving treatments; covered by U.S. health care  Contributes to improved family functioning Culturally sensitive approaches needed to reach ethnic minorities Greater access needed for patients in developing nations Advance medical directives – what are they? Written statement of desired medical treatment in case of incurable illness o Advance directives are legal documents that allow you to convey your decisions about end-of-life care ahead of time. They provide a way for you to communicate your wishes to family, friends, and health care professionals, and to avoid confusion later on. Living will: specifies desired treatments Durable power of attorney for health care: o Authorizes another person to make health-care decisions on one’s behalf o More flexible than living will handle unexpected situations o For couples, not legally married, can ensure partner’s role in decision making End of Life Medical Practices Reasons for given by Oregon patients requesting medical aid in dying Losing autonomy Less able to engage in enjoyable activities Loss of dignity Losing control of bodily functions Burden on family, friends/caregivers Inadequate pain control or concern about it Financial implications of treatment Medical Aid-in-Dying (assisted suicide) At incurably ill patient’s request, doctor provides lethal does of drugs for patient to use to end life Legal in five U.S. states, six nations; criteria differ: o Most U.S. states require six months or less to live o In other countries, need not be terminally ill, but requires “unbearable” suffering Majority: cancer patients, age 65+, enrolled in hospice or died at home Aid-in-Dying Controversy Proponents argue terminally ill patient not suicidal Opponents argue chance for misuse amidst high family-caregiving burdens and health- care costs American Academy of Hospice and Palliative Medicine: Urges doctors to ensure conditions met: o Patient has access to optimal palliative care o Patient has full decision-making capacity o All reasonable alternative have been considered o Practice aligns with doctor’s values Prolonged dying – what can this cause for survivors? Grieving Sudden or Prolonged Death Sudden, unanticipated o Avoidance pronounced, confrontation highly traumatic from shock and disbelief o Adjustment easier when understand reasons o Suicide especially hard to bear Prolonged, expected o Anticipatory grieving: allows emotional preparation Parents grieving the loss of a child – what are the risks for them? Grief Process Avoidance o “emotional anesthesia,” short-lived Confrontation o Most intense pain of grief; depression common Restoration o Dual-process model of coping with loss: Alternating between dealing with loss and attending to life changes offers relief and distraction from grieving Difficult Grief Situations Parents losing a child: high risk of marital break-up Children or adolescents losing a parent or sibling Adults losing an intimate partner o Disenfranchised grief presents unique challenges Bereavement overload o Multiple losses o Public tragedies Kahoot Questions ch15,16,17 Women’s hearing declines earlier and more rapidly than men’s (T/F) o FALSE Expressed hostility with frequent angry outbursts predicts cardiovascular risks (T/F) o TRUE Skin changes as we age include… o Decline in water content and cells § Epidermis is LESS attached to the dermis  § Fat in face and neck DECREASES § IS vulnerable to sun damage Heart attack symptoms in women often resemble panic (T/F) o TRUE Levinson describes middle adulthood starting with… o A transitional period If I’m even tempered an unemotional, I am low in… o Neuroticism Life satisfaction is most associated with happiness in marriage (T/F) o TRUE Income typically drops by 70% with retirement in the U.S. (T/F) o FALSE § Correct answer: 50% As we age, the heart muscle becomes more rigid (T/F) o TRUE A diet that includes omega-3 fatty acids can protect some mental capacity (T/F) o TRUE § Lowers risk for dementia ch18,19 For the parents who are grieving the loss of a child o Risk of marital breakup tends to increase over time T/F : Most Oregon’s aid in dying patients stated “loss of autonomy” as reason for considering (could be test question) o TRUE T/F : Talking to children about death will only cause anxiety o FALSE Music-Thanatology is live music that o Unites music & medicine in end of life care, is performed by a certified musician, can help ease pain and restlessness T/F : Palliative care and hospice care are the same o FALSE This predicts nursing home resident’s life satisfaction o Interaction with people outside of the nursing home T/F : Physical abuse and sexual abuse are the most frequently reported types of elder abuse (the least reported) o FALSE § Financial and emotional The Strongest risk factor for late-life depression is o Chronic disease  At age 88, Bill spends time in quiet reflection and exhibits inner cal. According to Joan Erikson, Bill has reached o Geotransedence T/F : During the clinical death phase, resuscitation is no longer possible o False Exam 5 Review Chapter 15-19 (4 questions will have questions and with “this is the correct answer” -> CHOOSE that one; it’s a form of extra credit) Middle Adulthood: Physical Changes Age related hearing loss and changes in vision o What are they called? § Presbyopia: Inability to adjust focus to varying distances § Presbycusis: Initial decline in sensitivity to high frequencies What causes changes in skin as we age o The epidermis is less firmly attached to the dermis, less water content Body fat accumulation for men and women o Men: upper abdomen, back o Women: waist, upper arms What loss of bone strength can cause o Disks collapse, height shrinks o Bones fracture more easily, heal more slowly What causes peri-menopause o Decrease in estrogen (ovaries aren’t functioning as well thus less estrogen) What can hormone replacement therapy help with o Help with symptoms, protect against bone loss, protect against colon cancer, generally mixed messages Health Risks: Middle Adulthood Leading causes of death in middle adulthood o cardiovascular disease and cancer are leading causes of death in U.S. Leading causes of cancer deaths o #1 killer is lung cancer BRCA I and BRCA II mutations o Breast cancer (early onset), ovarian cancer  What negative outlook and expression of anger and hostility on a regular basis can be risk for o Cardiovascular disease and heart attack Middle Adulthood Cognitive changes Crystalized and fluid intelligence o Crystallized Intelligence (think formed and structured); § Accumulated knowledge § Experience o Fluid Intelligence: Depends on basic information-processing skills: § Detecting relationships among visual stimuli § Speed of analyzing information § Working memory What declines as processing speed slows o Executive function also begins to slow Metacognitive knowledge vs. Procedural knowledge o Metacognitive: what you know about yourself o Procedural: the steps that I learned to do something in Middle Adulthood: Social and Emotional Examples of generativity o “a concern for establishing and guiding the next generation” Erikson’s stage in Middle Adulthood o Generativity vs Stagnation Levinson’s developmental tasks: young-old, destruction-creation, masculine-feminine, engagement-separateness o  o Levinson believes middle adulthood begins with a transitional period in which they reevaluate goals and they must reconcile two opposing tendencies. Possible selves o What one hopes to become (strives for) or fears becoming (tries to avoid) o Strong motivator of action in midlife Big 5 personality traits o Openness, Contentiousness, Extraversion, Agreeableness, Neuroticism Feminization of Poverty o Women who support themselves or their families have become the majority of the adult population living in poverty Kinkeeper o Kinkeeper role, especially for mothers Ruminating on regrets is associated with o Being unhappy o Also linked to high blood pressure and heart disease Grandparents taking on responsibility of grandchildren can cause o Many assume role under very stressful circumstances § Children with learning, emotional, behavioral problems § Parent interference § Financial hardship § Worries about child if own health fails o Need social and financial support, service for troubled children o Highly fulfilling; some view it as a “second chance” Women who leave their job to care for aging parents o Women who leave their job to care for parents feel isolated and have financial strain § Giving up and maybe feeling isolated (in the house all day) Which professions are more likely to have burn out o Caring professions (those who care for others) What is most difficult for midlife workers who are laid off from their long-time jobs o Finding another job where they make about the same amount of money Late Adulthood Physical & Cognitive What to include in diet for health benefits o Omega 3 fatty acids (brain function, reduce risk for dementia), calcium, vitamin D § Eating fish high in omega-3 fatty acids offer some protection against mental disabilities in late adulthood What can an exercise program achieve in Late Adulthood o Endurance training increases vital capacity  o Weight-bearing exercise improves walking, balance, posture o Regular, moderate to vigorous exercise improves cognition § LUNG FUNCTION (vital capacity), help sleep easier, relieve feelings of depression, increase immune system Functional age o Combination of physiological, psychological, and social age o How they are able to function in their life ADL vs IADL o Activities of Daily Living (ADLs) § Basic self-care tasks § Bathing, dressing, eating o Instrumental Activities of Daily Living (IADLs) § Conducting business of daily life § Require some cognitive competence § Shopping, food preparation, housekeeping, paying bills What happens to the heart muscle in late adulthood o Heartbeat less forceful; reduced maximum heart rate, blood flow o Thickens, doesn’t beat as effectively Low SES individuals and their belief that medical treatment will work o May not take their medicine, do not have faith that it will work because the medical system has failed them for most of their life What can help decrease brain tissue loss in late adulthood o Exercise, using brain, learning new things, challenging brain, volunteering Primary vs Secondary aging o Primary (Biological) § Genetically influenced declines § Affects all members of species § Occurs even when health is good Ex: menopause, skin, etc o Secondary § Declines due to hereditary defects and negative environmental influences, e.g., diet, pollution § Effects individualized: major contributor to frailty ex: follows chronic disease Normal age-related cell death is associated with o Slowing of memory Early signs of Alzheimer’s o Loss of short-term memory § Ex : can’t remember what had for breakfast but can remember the names of all children Late Adulthood Social & Emotional Associative memory deficit o Difficulty creating and retrieving links between pieces of information o Ex: remember face but cannot remember how you’re related to me Wisdom o Wisdom requires: broad practical knowledge, emotional maturity, and the ability to apply knowledge to make life more worthwhile Erikson’s Stage of Late Adulthood o Integrity vs Despair Gerotranscendence o Heightened inner calm, contentment o Quiet reflection § The inner calm and quiet reflection Independence- ignore vs. dependency – support o Dependency-support script: attend immediately to dependent behaviors (reduces autonomy) o Independence-ignore script: ignore independent behaviors What is biggest risk factor for depression in late adulthood o Chronic illness that is keeping them from doing what they want to do Biggest factor contributing to living longer o Social support increases the odds of living longer and good quality relationships help with psychological well-being § Having a happy relationship § + Diet and exercise Continuity theory of aging o Effort to maintain consistency between past and anticipated future § Finding a way to continue; ex: volunteering or rather than playing piano professionally, teaching piano occasionally from home What predicts Nursing home resident’s satisfaction o Outside interaction: having some contact with the outside world Most frequent types of elder abuse o Financial, neglect, and emotional abuse Experience Corps o Gains in executive function o Gains in size of cerebral cortex and hippocampus (memory) o Increased brain plasticity of regions supporting cognitive skills Death, Dying, and Bereavement Clinical phase of death  o Interval in which heartbeat, circulation, breathing, brain functioning stop, but resuscitation still possible (4-6 min) § No heartbeat, breathing, etc How to reduce anxiety about death in children o Answer their simple questions about death to reduce anxiety Symbolic immortality o How you live on: legacy, memories, children left behind 5 coping strategies o Five coping strategies: § Denial § Anger § Bargaining § Depression § Acceptance o Not a fixed sequence, rather coping strategies (don’t have to go through all of them) Palliative care vs hospice care o Palliative (comfort) care § Pain and symptom management; trying to keep the patient as comfortable as comfortable ex: pain medicine, anxiety medicine o Hospice care § Comprehensive program of support for terminally ill and their families that focuses on quality of life § Care provided by a team including: a doctor, a nurse or home health aide, a chaplain, a counselor or social worker, and a trained volunteer (can include palliative care) Medical directives o Written statement of desired medical treatment in case of incurable illness § Give someone authority to make legal decisions o Living will: specifies desired treatments o Durable power of attorney for health care: § Authorizes another person to make health-care decisions on one’s behalf Parents grieving loss of a child as risk for o Divorce/breakup