Psychology of Aging Study Guide
Psychology of Aging Study Guide 22392
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This 7 page Study Guide was uploaded by Kenedy Ramos on Saturday April 16, 2016. The Study Guide belongs to 22392 at Gonzaga University taught by Dr. Wolfe in Spring 2016. Since its upload, it has received 54 views. For similar materials see Psychology of Aging in Psychlogy at Gonzaga University.
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Date Created: 04/16/16
Psychology of Aging Exam Study Guide Social Interaction in Older Adulthood Current cohorts of elderly have the opportunity to maintain marriage relationships for longer than any other generation. Due to increased life expectancy, there is the possibility of marriage for 50+ years. Societal changes in divorce rates and other types of relationship is impacting the elderly in ways not seen before. When children get divorced, grandparents may find themselves cut off from their grandchildren, and they can be a source of stability for those children. It is important for those grandparents to stay neutral about the split in order to not give off bias. Research has shown that having children generally decreases rates of marital happiness – the cause appears to be complex, but having children also decreases the rate of divorce in couples. Marital happiness has a “U-shaped” curve: marital satisfaction rates are high prior to having children, they tend to drop during the child rearing years, and then increase during the later years after the children has grown up Robert Sternberg’s Components of Love (Triangular Theory of Love): Passion – arousal, sexual desire, longing Intimacy – mutual understanding, concern for welfare, acceptance of person Decision/Commitment – deciding to commit to relationship as life choice Crush – passion without intimacy or commitment (infatuation) Empty Love (Marriages) – commitment without passion or intimacy Liking – intimacy without commitment or passion Companionate – Intimacy with commitment and no passion Romantic Love – passion and intimacy without commitment Fatuous Love – passion and commitment without intimacy Sternberg’s research suggests that after decades of marriage, most form into companionate (no passion), that increased intimacy can lead to “taking for granted” and passion decreases with familiarity Older adults have interest in sexual activity still (and still do it) In 1966, William Masters and Virginia Johnson published a study called the “Human Sexual Response” where they studied the sexual nature of adults. The concluded that there are four stages of sexual response cycles: excitement, plateau, orgasm, resolution. Men and women go through each stage but somewhat differently. Historically there has been little research on the age related changes with the sexual response cycle – although this is beginning to change. Men: Societal normal/expectation in conjunction with age related changes in function can increase anxiety about sexual functioning. Increased time to achieve an erection Increased time an erection can be maintained prior to ejaculation Less force of ejaculation Longer refractory period *testosterone production starts decreasing as well Women: Societal normal/expectation in conjunction with age related changes in function can increase anxiety about sexual functioning. Physiological changes ae associated with decreased circulating estrogen Decreases in size of the clitoral, vulvar, labial tissues, and decreases size of the cervix, uterus, and ovaries Thinning of the vaginal walls and decreased elasticity Decreased lubrication *estrogen production decreases, but quickly decreases to zero production after menopause DSM 5 Criteria for Dysfunction A. Must be persistent and recurrent B. Must cause distress and interpersonal problems C. Must considered problematic even when taking into account normal lifespan changes in sexual functioning and what is considered to be the individual’s own, regular level of sexual functioning These can be further classified by: A. Due to psychological factors B. Due to psychological factors combined with a general medical condition Disorders and the implications for older adults: Type of Disorder Men Women Desire Hypoactive Sexual Hypoactive Sexual Desire Disorder Desire Disorder (deficient/absent sexual (deficient/absent sexual fantasies and desire for fantasies and desire for sexual activity) sexual activity) Sexual Aversion Sexual Aversion Disorder (extreme Disorder (extreme aversion to/avoidance of aversion to/avoidance of all [or almost all] genitalall [or almost all] genital sexual contact with sexual contact with partner) partner) Arousal Male Erectile Disorder Female Sexual Arousal (inability to Disorder (inability to attain/maintain until attain/maintain until completion or sex completion or sex adequate erection in adequate lubrication in males) females) Orgasm Inhibited Male Orgasm Inhibited Female (delay or absence in Orgasm (delay or orgasm following normal absence in orgasm excitement phase that is following normal unusual for the person) excitement phase that is Premature Ejaculation unusual for the person) Pain Dyspareunia (genital Dyspareunia (genital pain with intercourse) pain with intercourse) Vaginismus (involuntary spasm of outer third of vagina that interferes with sex) *Reminder: In most cases in the elderly, sexual dysfunctions are more likely due to medical conditions, or a combination of medical conditions and psychological factors rather than psychological factors alone Employment, Retirement, and Living Arrangement Making Decisions in Advance Advance Directives: a legal mechanism to tell health care providers the types of health care you wish to receive in the event you wish to receive in the event you become unable to make decisions for yourself. Often addressed on admission to hospitals, often indicate types of care you don’t want, generally keyed to the seriousness or the illness Living Will: one type of advance directive, becomes in effect in the event someone is diagnosed with a terminal illness, allows you to select types of treatment you want in certain medical conditions, does not allow you to select substitute decision making Durable Power of Attorney (for health care): another type of advance directive, becomes active any time you are unconscious or are unable to make decisions for yourself, can be more useful than living will because allows for more flexibility, require the identification of a reliable and trustworthy person Do Not Resuscitate (DNR): legal document that gives EMS and hospitals permission to not perform CPR; must name the person be signed by the person and the person’s physician, generally signed during end stages of a terminal illness DNR orders were originally put in place because of the Nancy Cruzan case who was brain dead for seven years and doctors would not let the family members take her off the machine American Bar Association Tool: used for directive of the advance directives (test for the person who would be most reliable) Widowhood: A lot of emotions can be expressed during widowhood: shock, emotional release, depression, loneliness and a sense of isolation, physical symptoms of distress, feelings of panic, a sense of guilt, anger or rage, inability to return to usual activities, the gradual regaining of hope, acceptance as we adjust our lives to reality DSM 5 Diagnosis of Bereavement (V62.82) Presentation may include symptoms characteristic of a major depression such as sadness, insomnia, poor appetite and weight loss – person does not view them as abnormal Duration of symptoms can vary from culture to culture and person to person MDD generally not diagnosed before 2 months after the loss MDD more likely if thoughts of death beyond feeling should have died with deceased person, excessive sense of worthlessness, marked psychomotor retardation, prolonged and marked functional impairment, hallucinations other than or hearing or seeing the decreased person, excessive guilt beyond actions or not taken at time of deceased death Studies have been done by interviewing people who lost a loved one to see what the process of normal mourning was and found guilt, blaming themselves, anger at other people, preoccupation with the image of the loved one Duke University did a study that found that widowers died at a higher rate in the first 6 months while widows did not Women “guard” men’s health Men have fewer relational attachments Higher numbers of elderly women and widows may help support each other However grief and mourning seems to be about equal although different for men and women Mental Health Services Prevalence of Depression: 25% of elderly have symptoms of depression but don’t meet the full criteria (some of the symptoms are because of physiological changes rather than pure depression) In 2000, persons over 65 made up 13% of the population and yet accounted for 17% of completed suicides Suicidality is very high in elderly white males, medical problem, substance abuse and lack off social support Men are also more likely to use lethal methods such as guns, hanging, and carbon monoxide poisoning Diagnosing Depression in the Elderly A. 5 or more symptoms for 2 weeks with at least one symptom (sxs) is either depressed mood or loss of interest or pleasure a. Depressed mood most of the day nearly every day, markedly diminished interest or pleasure in all or almost all activities, significant weight loss when not dieting or weight gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, diminished ability to think or concentrate or indecisiveness, recurrent thoughts of death or suicide B. Sxs do not constitute a mixed episode C. Clinically significant distress or impairment in social, occupational, or other important areas of functioning D. Sxs are not due to direct physiological effects of a substance or a general medical condition E. Sxs are not better accounted for by bereavement Confounding Factors in Diagnosis Medical A first in lifetime episode of depression in late life may signal an underlying or comorbid medical illness Depression may precede such conditions are Alzheimer’s or Parkinson’s, may occur during recovery from medical illnesses such as heart attack or stroke, is frequently associated with cancer with 80% of all cancers occurring in persons over 60 Depression Inventories Beck: 21 sxs grouped together, sometimes over or under diagnosed disorders Whooley: asks two questions; have you been bothered by feeling sad, depressed or hopeless and have you been bothered by little interest or pleasure in doing things, very accurate but it did over diagnose slightly Geriatric Depression Scale: short form, 15 questions answered either yes or no, scores greater than 5 suggest depression and scores greater than 10 suggest highly indicative of depression Biology of Depression Stress causes the hypothalamus to release CRH (corticotrophin-releasing hormone). CRH acts on the anterior pituitary to cause release of ACTH (adrenocorticotrophic hormone). ACTH acts on the adrenal gland to release cortisol. Cortisol associated with structural changes to the hippocampus including cell loss. Cortisol appears to cause neuronal cell loss in the hippocampus. Hippocampus is an area of the brain known to be capable of neurogenesis throughout life. Treatment with antidepressants causes increased cell production in the hippocampus. Brain derived neurotrophic factor (BDNF) is known to be upregulated with use of antidepressants. Three major neurotransmitters implicated in depression are dopamine, norepinephrine, and serotonin. Tricyclics are dangerous for the elderly with depression – they have too many side effects that could endanger their health. SSRI’s are therefore used more often than any other type of medication. Psychology of Depression Martin Seligman created the learned helplessness theory by studying dogs who were repeatedly shocked versus dogs who were not shocked. He found that those who were shocked and let free did not move, while those who were not shocked quickly escaped when set free. Seligman applied this theory to humans as a potential explanation for depression, but he also found that there were some people who despite many bad experiences were not depressed and that depressed people thought differently bout bad events. Three Events: Personalization – internal vs. external Pervasiveness – specific vs. universal Permanence – temporary vs. permanent Ex/ Failing a psychology test I’m stupid vs. that test was rigged I’m not good in psychology vs. that was a crappy score I’m never going to graduate vs. it was a one-time thing, not big deal Alcohol Abuse in the Elderly Approximately 50% of persons 65+ use alcohol at least occasionally. People older than 75 are less likely to use alcohol than younger people. Culture/Environmental factors are also at play. Diagnosing Alcohol Abuse A. Maladaptive pattern of use leading to clinically significant impairment or distress with one of the following sxs in the past 12 months: a. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school or home, recurrent use in situations in which it is physically hazardous, recurrent legal problems related to substance use, continued use despite persistent or recurrent social or interpersonal problems caused or exacerbated by effects of using the substance B. Doesn’t meet criteria for alcohol dependence Diagnosing Alcohol Dependence A. Maladaptive pattern of use leading to clinically significant impairment or distress as manifested by 3 or more of the following sxs in the past 12 months a. Tolerance; increased amounts to achieve effects or, diminished effect with use or same amount, Withdrawal; withdrawal sxs if use is stopped or, use of substance to avoid withdrawal effects use of larger amounts over longer time periods than intended, unsuccessful attempts or desire to cut down or control use, a great deal or time spent obtaining, using, or recovering from use, important social, occupational, or recreational activities are giving up or reduced because of the substance abuse, continued use despite knowledge or a persistent or recurrent physical or psychologic problem either caused or exacerbated by substance use
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