Exam 4 Study Guide
Exam 4 Study Guide PSY 3620
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PSY 3620 Review Sheet for Final Chapter 12: Adulthood: Body & Mind 1) Define senescence, and describe signs it is occurring. Senescence: Gradual physical decline related to aging. Occurs in everyone and in every body part, but the rate changes between people differ. Ex: wrinkles, gray hair, body shape changes (gravity takes hold – weight around the middle and hips) Negative: in cultures that devalue aging. 2) How does age affect the sexualreproductive systems in both men and women? Sexual arousal occurs more slowly, orgasm takes longer. Counterbalance: reduced anxiety, longer lovemaking, better communication, partners become more familiar with bodies of selves and mates. Conception becomes difficult with each passing year of adulthood. Men: Prostate Gland needs to be checked at age 40. o Sperm count reduces. Men older than 45 take five times as many months to impregnate a woman as do men who are 25. Women: uterussmaller, ovulation and menstruation less regular (ceases soon), menopause. o Female fertility is affected by anything that impairs physical functioning: several diseases, smoking, extreme dieting, and obesity. o Pelvic Inflammatory Disease: PID. Scar tissue that prevents sperm from reaching an ovum. 3) Describe changes in the brain. Slows down with age. Multitasking becomes harder, processing takes longer, complex workingmemory tasks becomes almost impossible. Neurons fire more slowly. Reaction time lengthens. 4) Describe changes in the sense organs. Vision: Perception of some colors fade. Presbyopia: the decline in near vision = farsightedness. Due to lens of eye becomes less elastic and impedes ability to change from far to near. Causes people to buy readers. Hearing: Presbycusis: loss of auditory acuity for pure tones and highfrequency sounds. Happens in men two times as fast as women, may be due to occupation (increased exposure, listening to headphones). Women lose hearing at about 50. Taste, smell, and balance also change – not too noticeable, but testable in lab experiments. o Ex: This is when you can see older adults adding more salt on their foods. 5) Describe visible signs of senescence. First sign is in skin – dryer and rougher. Wrinkles appear next. Hair turns gray and thins. Waist widens, fat around the belly muscles weaken posture stoops height decreases (men 1 inch, women 2 inches). 6) Define menopause. Explain why it occurs, and when. Menopause: when ovulation and menstruation stop around age 50. Production of estrogen, progesterone, and testosterone drops. Usually happens one year after last menstrual period. Gradual period. Due to decline in estrogen production. o Shortterm effects: hot flashes, 8% increase of skin sweats (50% in US report having hot flashes, while in Japan 10% report – may be due to fish diet). o Longterm effects: tired, night sweats, fragile bones, increase risk of injuries, thin and dry vagina, pain during sex, dry skin, increase in heart disease. o Treatment: supplement estrogen. 7) What is Hormone Replacement Therapy? How effective is HRT for treating the "symptoms" of menopause? Know the results of the Women's Health Initiative study. Hormone Replacement Therapy: estrogen combined with progesterone. Used to alleviate menopause symptoms and prevent osteoporosis. First found heart disease, strokes, and dementia occurred less often. o Women’s Health Initiative: taking estrogen for 10 years or more increased the risk of heart disease, stroke, and breast and had no effect on most common types of dementia. o Premarin: artificial estrogen and progesterone drug menopausal women took Made from pregnant mares (horse) urine – obviously the wrong chemical composition! Horrible side effects: breast cancer, heart attack, etc. 8) Define andropause. Does it exist? Should HRT be used to treat low T? Andropause: (Male Menopause) A term coined to signify a drop in testosterone levels in older men, which normally results in reduced sexual desire, erections, and muscle mass. o A sudden drop in reproductive ability and hormones does not occur – men can produce viable sperm throughout their lives. Sexual inactivity and anxiety cause a reduction in testosterone. Taking HRT: to combat their decline in testosterone. Widespread use is not recommended – may be harmful. Overdose may lead to cardiac arrest. Low testosterone correlates with increased risk of heart disease. 9) What's the relationship between health habits and diseases (e.g., cancer) and chronic conditions? Cancer: rate of cancer increases with every year of life (lifestyle usually underlying cause). Specific lifestyle effects on susceptibility vary with each disease, even each type of cancer, and uncontrollable factors, usually genetic, play a major role in some diseases and a minor role in others. 10)Compare/contrast mortality and morbidity and disability and vitality. Mortality: means death Morbidity: means disease, the rates of which depend partly on diagnosis Disability: the usual result of morbidity, is the inability to do something that people usually can do. (Ex: vision loss – serious = only shapes or less serious = cannot read without glasses.) Vitality: also known as a life force, may be the most important, but most difficult to measure. Some people with morbid conditions that increase disability and the risk of mortality are nonetheless happy and active. 11)Effects of tobacco and alcohol (in moderation)? Tobacco: Cancer deaths reflect smoking patterns of years earlier. Longterm effects of smoking include reduced oxygen intake and lower vitality. Doserelated: each puff, each day, each secondhand smoke makes cancer, heart disease, stroke, and emphysema more likely. Alcohol: In moderation (no more than two drinks a day), live longer than abstainers. Alcohol reduces coronary heart disease and strokes. Increases HDL (the good form of cholesterol) and reduces LDL (bad cholesterol that causes clogged arteries and blood clots). Lowers blood pressure and glucose. 12)What is the role of metabolism in increasing weight? Know the rates of obesity and morbid obesity in U.S., and describe some solutions to the obesity epidemic, especially gastric bypass surgery. Metabolism: decreases by onethird between ages 20 and 60 – need to eat less and move more. This doesn’t happen so obesity rises. Obesity: 35% obese Morbid Obese: 6% Solutions: diets, help from health practitioners, or quick fixes. Drugs and surgery both require a lifestyle change though. o Gastric Bypass Surgery: dramatic weight loss surgery, but in onefourth leads to additional surgery. Morbidly obese – have higher death rates from it. 13)What are effects of exercise? Protects against illness even if a person is overweight or a smoker. Lower blood pressure, stronger hearts and lungs, and reduced risk of almost every disease, including depression, diabetes, osteoporosis, heart disease, arthritis, and even cancer. Exercisefriendly communities: lower rates of obesity, hypertension, and depression. More than correlation, but also a cause! 14)Describe gender differences in the use of emotionfocused vs. problemfocused coping. Emotionfocused: people change their emotions to deal with stress rather than changing the stressor itself. o Women are more inclined to use this approach. “Tend and befriend” – seek reassurance of other people when they are under pressure. Their bodies produce oxytocin, a hormone that leads them to seek confidential and caring interactions. Problemfocused: people attack their problems or stressor directly o Men are more inclined to use this approach. Reacting to a “fightorflight” manner. Testosterone rises when they attack and decreases if they fail. This gender difference is why a woman might get mad if a man doesn’t want to talk or why a man gets mad when a woman just wants to talk instead of taking his advice on how to fix the problem. 15)How do money and education protect our health? After the age of 35, life span increases by 1.7 years for each year of education. SES: Rich nations have less disease, injury, and death. o Ex: a baby born in 2010 in Europe – lives to 79. Baby born in subSaharan Africa – lives to 55. 16)What does the term “g” refer to? General Intelligence (g): the idea of g assumes that intelligence is one basic trait, underlying all cognitive abilities. o Charles Spearman – proposed there is such thing as intelligence. Can’t be measured directly – inferred from abilities like vocabulary, memory, and reasoning. People have varying levels of this general intelligence 17)Describe the methodology and results from Schaie's Seattle Longitudinal study. Methodology: First he tested adults’ IQ based on five factors (vocab, spatial, inductive reasoning, number ability, and word fluency). Then he tested the same adults seven years later, as well as a new group of adults that were the same age that the first group was the first time they were tested. This would show a cohort effect as well as an aging on intelligence effect. Results: People improve in most mental abilities as they age, then eventually decline. Men are initially better with numbers and women with words, but that gap narrows with age. 18)How is fluid intelligence different from crystallized intelligence? How do each change during adulthood? Fluid intelligence: quick and flexible, very thorough, enabling people to learn anything (even unfamiliar and unconnected to things they already know). Decreases with age. o People high in fluidity: draw inferences, understand relations between concepts, quickly process new ideas and facts, abstract thought, and speed of thinking. Crystallized intelligence: Size of vocabulary and general information, increases with age. 19)What are Sternberg's three forms of intelligence? Which one seems most useful in adulthood? Why? Analytic intelligence: Fosters academic proficiency, involves such mental processes as abstract planning, strategy selection, focused attention, and information processing, as well as verbal and logical skills. Valuable for younger adults. Creative intelligence: involves the capacity to be intellectually flexible and innovative. Divergent rather than convergent. Value unexpected, imaginative, and unusual thoughts. Practical intelligence: (Tacit intelligence) intellectual skills used in everyday problem solving. Capacity to adapt to the demands of a given situation. Involves accurate grasp of expectation and needs of the people involved and an awareness of the particular skills that are called for, along with the ability to use these insights effectively. o Most useful and needed in adulthood – not obvious on tests, but in the real world. “Street smarts,” not “book smarts.” 20)Describe Baltes' selective optimization with compensation, along with changes in ability for multitasking. Selective optimization with compensation: people seek to optimize their development, looking for the best ways to compensate for losses and to become more proficient at activities they want to perform well. They look for a balance in their lives by compensating for physical and cognitive losses and to become proficient in activities they can already do well. Multitasking: becomes more difficult with each decade. Adults have learned to be selective, compensating for slower thinking by concentrating on one task at a time. Compensation allows optimal functioning. 21)Describe characteristics of experts. Expert: more accomplished, proficient, and knowledgeable in a particular skill, topic, or task than the average person. Every adult is an expert. Everyone can develop expertise, specializing in activities that are personally meaningful, although unfamiliar to someone else. When develop expertise in one area, pay less attention to others. Culture and context guide us to selecting areas of expertise. Chapter 13: Adulthood: Psychosocial Development 1) Compare/contrast Erikson and Maslow's theories of adult personality. Erikson: early stages tied to a particular chronological period. Adult was continuation of identity seeking through exploration of intimacy and generativity. Maslow: refused to link chronological age and adult development (like Erikson). 2) How can middleaged adults meet their needs for generativity? (also on p. 481) Generativity: caring for the next generation – having kids, mentoring, teaching, helping others. o When adults seek to be productive in a caring way, without it they feel a pervading sense of stagnation and personal impoverishment. (Erikson) o Art, caregiving, employment 3) Describe the midlife crisis. Explain how a “midlife crisis” might reflect cohort, rather than maturational, effects. Midlife Crisis: thought to be a time of anxiety and radical change as age 40 approaches. A time of self reexamination and sudden transformation that was once widely associated with middle age but that actually had more to do with developmental history than with chronological age. o Levinson (who coined the term) studied 40 men all from one cohort, then Seehy summarized his research. (Both not very scientifically sound.) Cohort: It depends on when the person grows up and what is going on in society at that time. 4) Name the “Big Five” personality traits, give characteristics of individuals who are high and low in each trait, along with how these traits affect career choices and social context, or ecological niche, and how they change over the lifespan. Is there stability or change in personality during middle adulthood? What accounts for this? Should "dependence on others" be added to the list? (p. 468) OCEAN O: Openness – imaginative, curious, artistic, creative, open to new experiences IQ: higher in people who are more open Verbal Fluency: higher Political Views: Conservatives are less open C: Conscientiousness – organized, deliberate, conforming, selfdisciplined Educatio : higher rates of college graduation Fertility: lower in recent cohorts for women E: Extroversion – outgoing, assertive, active Marriage: more likely to marry Verbal Fluency: higher A: Agreeableness – kind, helpful, easygoing, generous N: Neuroticism – anxious, moody, selfpunishing, critical Divorce: more often to divorce Ecological Niche: the particular lifestyle and social context that adults settle into because it is compatible with their individual personality needs and interests. Depends on the circumstance and what personality shows itself. Personality adapts to environment. Stability: Through adulthood, personality is mostly stable overall, but with minor ups and downs. – most people work in areas that meet their personality causing stability. “Dependence on others”: In Asian cultures they believe it should be added. Asian children are low on this trait and are encouraged to increase it, so cooperation is more common among Asian adults than among children. 5) What is a social convoy and why is it important? Social Convoy: a group of people who “provide a protective layer of social relations to guide, encourage, and socialize individuals as they go through life”. o Collectively the family members, friends, acquaintances, and even strangers who move through life with an individual. 6) Describe the changes in and benefits of friendships during adulthood. Friendships improve with age. Few are ambivalent and almost one are problematic. Friendships help with mental health: depression seems to decrease with age, friends are more supportive. Physical Health: encourage on another to eat better, quit smoking. But usually if one becomes overweight, the other friend does as well. 7) Describe how family closeness is cultural. It depends on the culture and how a family would interact with one another. In Denmark, a twin study was conducted: twins were less likely to need another close companion because they had one another, but when they did marry they were less likely to divorce because they were used to getting along with another person. Other nations found that physical separation did not weaken family ties: adult children bonds to parents are becoming stronger when they live apart from their parents. Sibling closeness: within many cultures, when siblings have children of their own this creates closer bonds between the siblings, aunts, uncles, parents, etc. It creates emotional and practical support. 8) What predicts partnership happiness? People who expect happiness to just happen once they are married become disappointed – they must work for the happiness of the marriage. People who live together out of convenience are less happy than those who cohabitate. When each year brings a new surprise, or a new step into the relationship, it creates a never ending flow of happiness. 9) What percentage of contemporary U.S. adults will never make a marriagelike commitment? 25% 10) How does having an “empty nest” usually affect marriages? Improves the marriage: a time when the couple can focus on them, without interruptions, and expenses become fewer. 11) What are factors that make divorce more likely? (Table 13.3) Before Marriage: Divorced parents, either partner under age 21, family opposed, cohabitation before marriage, previous divorce of either partner, large discrepancy in age/background/interests/values During Marriage: Divergent plans and practices regarding childbearing and child rearing, financial stress, unemployment, substance abuse, communication difficulties, lack of time together, emotional or physical abuse, unsupportive relatives In the Culture: High divorce rate in cohort, weak religious values, laws that make divorce easier, approval of remarriage, acceptance of single parenthood. 12) Define and describe kinkeepers. Kinkeepers: a caregiver who takes responsibility for maintaining communication among family members. o They gather everyone for holidays; spreads the word about anyone’s illness, relocation, or accomplishments; buys gifts for special occasions; and reminds family member of one another’s birthdays and anniversaries. 13) Define “sandwich generation” and describe the stresses and benefits of caring for an aging parent. Sandwich Generation: generation of middleaged people who are supposedly “squeezed” by the needs of the younger and older members of their families. o Reality: they feel the pressure from these obligations, but most are not burdened by them, either because they enjoy fulfilling them or because they choose to take on only some of them or none of them. o Benefits: Caregiving is beneficial because people feel useful when they help one another. Older adults are less likely to be depressed if they are supporting their adult children than when they are distant from them. Grown children get pleasure from helping their parents. 14) Compare/contrast values of familism and individualism regarding family caregiving. In North America, Western Europe, and Australia: older adults cherish their independence and feel like a burden on their kids. o Nations high in individualism: leads relatives to expect all adults to be selfsupporting and law abiding – will rat their family member out for anything and won’t help them when they are in a bind. Nations where dependence is a desirable personality trait: living with family is not a problem Latino families – high in familismo had little conflict between the husbands and wives, both very proud and nurturing of children. o Nations high in familism: lead relatives to help one another through anything life throws their way. 15) Answer the question, "Why do we work?" citing both extrinsic and intrinsic rewards of work. Extrinsic: tangible benefits – compensation (money, health insurance, pension) Instrinsic: intangible gratifications – come from oneself (job satisfaction, selfesteem, pride) 16) Describe differences between older and younger employees in terms of tardiness, commitment, and absenteeism. Older Employees: Strive to meet their generativity needs by being productive members of society, commitment is high, and absenteeism is low. Depends on how hectic their responsibilities are, but most couples and older employees have experience with time management and figuring out a schedule with their day to day lives. o Stresses become higher, skills are more difficult but aren’t being taught anymore, age discrimination is illegal but workers convinced that it is common after 50, relocation reduces both intimacy and generativity. Younger Employees: Grown up with people of more diversity, more flexible, can train easy. Chapter 14: Late Adulthood: Body and Mind 1) Define ageism. Why does it exist? Is it harmful? Ageism: the idea that age determines who someone is. A prejudice that categorizes and judges a person only on the age they appear to be. o Stereotyping makes ageism a social disease – like sexism or racism. This makes it debilitating for the aged as for other groups. They fear they are losing their mind – that fear itself becomes undermining. 2) Describe elderspeak. Elderspeak: a condescending way of speaking to older adults that resembles baby talk, with simple and short sentences, exaggerated emphasis, repetition, and a slower rate and a higher pitch than used in normal speech. o Patronizing, reduces communication, higher pitches harder for older adults to hear. 3) Describe the demographic shift of over 65. What percentage of the US population is over 65? Demographic Shift: the population of people over 65 moved from 2 percent to now 8 percent in the world. In the US, there are 13 percent that old, the number expected to double by 2050. 4) What percent of the US population (65 and older) lives in nursing homes or hospitals? Where do most elderly live? After 80, only 10% of US residents are in nursing homes or hospitals. The average person above 80 spends two weeks per year in a hospital. 5) Compare youngold, oldold, and oldestold. Youngold: 6075. largest group of older adults. Healthy, active, financially secure, independent. Oldold: 75 and older. suffer some losses in body, mind, social support. Proudly care for selves. Oldestold: 85 and older. dependent, most noticeable, frailty. 6) Why do we age? Explain it by three theories: wear and tear, genetic clock, and cellular aging. Define Hayflick limit. Wear and tear: Theory says body wears out part by part, after years of use. Organs are exhausted, stressed, and soon wear out. Does not explain aging overall. Genetic clock: a mechanism in the DNA of cells that regulates life, growth, and aging. When an injury occurs, aging genes spread the damage, so that an infection spreads rather than being halted and healed. Other genes show long and healthy life through certain alleles that other people don’t have. o They explain that we need aging because the young produce more for the population and the elders need to die to pass on their genes. Cellular aging: Focuses on molecules and cells that are affected by age. While cells are damaged and replaced, the immune system deteriorates over time and soon can no longer repair any longer. Hayflick limit: Healthy cells stop replicating at a certain point. The number of times a human cell is capable of dividing into two new cells. The limit for most human cells is approximately 50 divisions, an indication that the life span is limited by our genetic program. 7) Apply Baltes' notion of selective optimization with compensation to driving. Describe accident rates for older adults. With age, sign reading takes longer, head turning is reduced, reaction time slows, and night vision worsens. The elderly compensate: many drive slowly and avoid night driving. Accident rate goes down as age goes up. 8) Describe sexual activity during late adulthood. Many believe that sexual activity basically ceases, but late adulthood still very active sexually. Have more time to explore sexually with partner, more comfortable with partner. 9) Describe how the brain ages (e.g., production of neurotransmitters, size, processing speed). What factors correlate with less decline? What are ways to compensate? Less efficient as people become older. Senescence reduces production of neurotransmitters: these would allow impulse to jump quickly across the synaptic gap. Size: Some areas shrink more than other. Hippocampus (memory) and prefrontal cortex (planning, coordinating thoughts) shrink. Gray matter volume reduces (processes new experiences). 10)Why might older adults receive less input into their brains? Sensory threshold: divide between what is sensed and what is not, in order to be perceived. Sensory losses may not be recognized because the brain automatically fill sin missed sights and sounds. 11)Describe memory abilities of older adults, especially memory for names and vocabulary. What is source amnesia? Source amnesia: forgetting the origin of a fact, idea, or snippet of conversation. – elder may believe a rumor or political ad if they forget the source. o Memory for vocabulary stays strong through late adulthood. o Memory for names does drop into late adulthood though. 12)Describe changes in the five primary mental abilities as found in the Seattle Longitudinal Study. What may be underlying the decline after age 60? (processing speed) Verbal meaning spatial orientation inductive reasoning number ability word fluency. In all these areas it declined – especially spatial perception and processing speed. 13)What are “control processes,” what do they depend on, and what are signs that control processes are declining? Control processes: the various methods used to regulate the analysis and flow of information from all the parts of the brain. o Memory and retrieval strategies, selective attention, and riles or strategies for problem solving are all useful control processes. 14)How do primary and secondary aging differ? Primary aging: universal and irreversible physical changes that occur in all living creatures as they grow older. Secondary aging: specific physical illnesses or conditions that become more common with aging but are caused by health habits, genes, and other influences that vary from person to person. o Consequences of particular inherited weaknesses, chosen health habits, and environmental conditions. 15)Describe risk factors for osteoporosis. Osteoporosis: fragile bones that result from primary aging, which makes bones more porous, especially if a person is at genetic risk. o Risks: European women are more vulnerable, genetically, than women of other ethnic groups. A fall that would only bruise a young person could cause breaks in an elder. 16)Define dementia and describe its most common form (Alzheimer’s Disease). Describe brain changes and symptoms. Compare cognitive decline to those suffering from Vascular Dementia (Multiinfarct dementia). Know risk factors, and examples of disorders that mimic the symptoms of dementia (including polypharmacy). Dementia: irreversible loss of intellectual functioning caused by organic brain damage or disease. Becomes more common with age, but it is abnormal and pathological even in the very old. Can develop at 40 or 90 – symptoms the same at every age. o Polypharmacy: a situation in which elderly people are prescribed several medications. Side effects and interactions of those meds can result in dementia symptoms. o Delirium: refers to acute, severe memory loss and confusion that disappears in hours or days. Hallucinations, terror, and irrational behavior. Alzheimer’s Disease: most common cause of dementia. Gradual deterioration of memory and personality and marked by the formation of plaques of betaamyloid protein and tangles of tau in the brain. These destroy the ability of neurons to communicate with one another, eventually stopping brain function. Vascular Dementia (MultiInfarct Dementia): form of dementia characterized by sporadic, and progressive, loss of intellectual functioning caused by repeated infarcts (seizures), or temporary obstructions of blood vessels, which prevent sufficient blood from reaching the brain. Parkinson Disease: a chronic, progressive disease that is characterized by muscle tremor and rigidity and sometimes dementia; cause by reduced dopamine production in the brain. 3 percent of all dementia cases. Lewy body dementia: form of dementia characterized by an increase in Lewy body cells in the brain. Symptoms include visual hallucinations, momentary loss of attention, falling, and fainting. 17)What are recommendations to protect against dementia? Medications to prevent strokes, slowing down senescence, exercise, avoiding specific pathogens. 18)Define Butler's life review. Life Review: An examination of one’s own role in the history of human life, engaged in by many elderly people. o Elders provide an account of their personal journey by writing or telling their story. They want others to know their history, telling about them, their family, cohort, or ethnic group. 19)Define maximum lifespan, average life expectancy. Maximum lifespan: the oldest possible age that members of a species can live under ideal circumstances. Humans – 122 years. Average life expectancy: number of years the average newborn in a particular population group is likely to live. Humans – varies quite a bit, depending on historical, cultural, and socioeconomic factors as well as on genes. o Increases – due to reduction in deaths from adult diseases (heart attack, pneumonia, cancer, childbed fever) 20)What can we learn about aging from centenarians? Those who study centenarians have found many quite happy. Disease, disability, depression, and dementia may set in, but they find a higher rate of physical and mental health problems before age 100 than after. Centenarians were less likely to take antidepressants, but more likely to take pain medications. Many centenarians were energetic, alert, upbeat about life, and optimistic. – social relationships in particular correlate with robust mental health. Chapter 15: Psychosocial Development in Late Adulthood 1) Describe Erikson’s final stage. Integrity vs. Despair: older adults seek to integrate their unique experiences with their vision of community. Integrity – a feeling of being whole, not scattered, comfortable with oneself. They are proud of their past, even when it includes events that an outsider might not consider worthy of pride. 2) How do older people hold on to a sense of self? Very hard to hold on to a sense of self when everything around them seems to be changing. Hate to give up on driving a car, objects and places become more precious in late adulthood. Compulsive Hoarding: the urge to accumulate and hold on to familiar objects and possessions, sometimes to the point of their becoming health and/or safety hazards. This impulse tends to increase with age. o With time, problem gets worse. 3) What is the positivity effect? Positivity effect: tendency for elderly people to perceive, prefer, and remember positive images and experiences more than negative ones. Unpleasant experiences are reinterpreted as inconsequential. A form of selective optimization. 4) Compare/contrast disengagement and activity theories. Disengagement Theory: the view of aging makes a person’s social sphere increasingly narrow, resulting in role relinquishment, withdrawal, and passivity. Traditional roles become unavailable or unimportant. o Decrease socialization and activity to prepare for end of life. Activity Theory: the view that elderly people want and need to remain active in social spheres – with relatives, friends, and community groups – and become withdrawn only unwillingly, as a result of ageism. o Society does not have many activities for older adults to participate in. o Elders who are more active are also happier and intellectually more alert as well as less depressed. 5) Where do most people over 65 live in the U.S.? 65: Out of 100 – 86 will survive, 7 unable to do chores/take care of finances/go shopping, 6 have difficulty with at least one activity, 1 will live in a nursing home. Most live independently, caring for all their basic needs. 75: Out of 100 – 73 will survive, 7 unable to do chores/take care of finances/go shopping, 14 have difficulty with at least one activity of daily life, 4 will live in a nursing home. Most spend that decade caring for all their basic needs. 85: out of 100 – 68 will survive, 45 unable to do chores/care for finances/go shopping, 36 have difficulty with at least one activity, 13 will live in a nursing home. Most care for all their basic needs. 95: those who reach this age tend to be unusually healthy, living 4 years longer, on average. About half are still able to care for themselves. 15% of those 65 and older move in with an adult child or live in a nursing home 6) Describe the extent and benefits of employment and volunteering. What might explain why older people do not volunteer more often? Volunteering: offers some of the benefits of paid employment (generativity, social connections, less depression). Strong link between health and volunteering. o Retired, older people are less likely to volunteer than middleaged adults – ageism discourages them, institutions lack recruitment or training, older people may be afraid to leave their familiar patterns. 7) Where do older adults prefer to live? In their own homes. 8) What does "aging in place" mean? Aging in place: People aged 55 to 64 prefer to live in their homes when they retire. Living in the same home and community in later life, adjusting but not leaving when health fades. 9) Describe and explain marital satisfaction during late adulthood, including sexual intimacy. Married older adults: are healthier, wealthier, and happier than unmarried people their age. Throughout life, a spouse who is healthy and happy improves the other’s wellbeing. Divorced: lower in health and happiness than are those who are still married, although some argue that income and personality are the reasons, not marital status. 1 in 6 longterm marriages is not satisfying. Happiness increases with the length and quality of an intimate relationship. Conflicts: older adults figure out how to handle arguments and now call them discussions. Sexual Intimacy: sexual interactions remain important, differ than that of younger people though. Caressing, hugging, and sexual interaction very important. 10)Describe the role of familism in the relationships between older adults and their children. Relationships usually positive – include tension and conflict. Emotional support and help with managing life may be more critical and complex than financial assistance. A good relationship between grown children and older parent enhances a parent’s wellbeing. Filial Responsibility: the obligation for adult children to care for their aging parents. o Usually doesn’t work well for either generation, but valued in every culture – stronger in some than others. 11)How important are friendships? Older adults need at least one close companion. Intimate friend is spouse, relative, or unrelated convoy. Need for confidant is an important recognition for older adults who may not realize this necessity until a relationship is severed. Successful aging requires that people not be socially isolated. Quality, not quantity, of a friendship is crucial – especially among oldestold. 12)Describe frail elderly, and their ability to perform ADLs and IADLs. Frail elderly: people older than 65, usually older than 85, who are physically infirm, very ill, or cognitively disabled. o Not the majority, unlike societies belief. Onethird become frail a year before they die. ADL’s: eating, bathing, toileting, dressing, and moving from a bed to a chair – these 5 tasks are important to independent living. The inability to perform these are a sign of frailty. IADL’s: Requires intellectual competence and forethought – actions like budgeting, preparing food. These are important to independent living. The ability to perform these tasks may be even more critical to self sufficiency than ADL ability. o These tasks vary from culture to culture: Developed nations: include evaluating nutrition, preparing income tax forms, using modern appliances, and keeping appointments. Rural: feeding chickens, cultivating the garden, mending clothes, getting water from the well, or making dinner. 13)How do different countries care for frail elderly? NonWestern countries: strong cultural ideology that values filial responsibility. o India passed a law making it a crime to neglect one’s elderly parents. Developed nations: many middleaged adults would be caring for many elderly parents making it unfair to care for so many people – solution: government aid or prevent frailty. 14)Describe some burdens of caregiving, and list what support caregivers need. Family caregiving in US has many problems: o If one child primary caregiver, other siblings feel relief or jealousy. o Care receivers and caregivers disagree about schedules, menus, doctor visits, etc. Resentments on both sides disrupt mutual affection and appreciation. o Public agencies rarely provide services unless a crisis arises. Family caregivers experience substantial stress; experience less health and more depression. 15)Describe elder abuse. Abuse is likely if the caregiver suffers from emotional problems or substance abuse, if the care receiver is frail and demanding, and if care location is an isolated place where visitors are few and far between. Ironically, relatives are more likely to abuse elders: over medicating, locking doors, isolating, physical restraints, little outside help or supervision. Next step would be not feeding properly or rough treatment. Abuse begins gradually and continues for years without anyone realizing it. Outright abuse is now rare in nursing homes – government inspectors visit to stop “dreadful things from happening” 16)Who needs longterm care? What are characteristics of good care? Longterm care: Usually over 80 years old, frail and confused, with several medical problems. Good care: An institution with a high rate of staff turnover is to be avoided. Provisions for independence, individual choice, and privacy should be valued. Activities should not be demeaning (Bingo is now ageist). The training and workload of the staff are crucial. 17)Describe assisted living. Assisted living: a living arrangement for elderly people that combines privacy and independence with medical supervision. Provides a private room or apartment for each person, allowing pets and furnishings just as in a traditional home. Epilogue: Death and Dying 1) What is Thanatology? Thanatology: the study of death and dying, especially of the social and emotional aspects. 2) How has death changed in the past 100 years (Table EP.1)? Death occurs later: a century ago, the average life span worldwide was less than 40. Half of the world’s babies died before 5. o Now newborns are expected to live to age 79. In many nations, elderly people age 85 and over are the fastestgrowing age group. Dying takes longer: 1900s, death was usually fast and unstoppable; once the brain, the heart, or other vital organs failed, the rest of the body quickly followed. o Now death can often be postponed through medical intervention. Dying is a lengthy process now. Death often occurs in hospitals: a hundred years ago, death almost always happened at home being surrounded by familiar faces. o Now death occurs in hospitals surrounded by medical personnel and technology. The main causes of death have changed: People of all ages once died of infectious diseases and many women and infants died in childbirth. o Now disease deaths before age 50 are rare, and 99% of newborns and mothers live (unless infant is very frail or medical care). And after death: People once knew about the life after death. Heaven and hell, reincarnation, spirit world. Many prayers were repeated – behalf of the soul, deceased, for remembrance, to the dead, etc. Believers were certain their prayers were heard. o Now young adults are aware of cultural and religious diversity, which makes them question what earlier generations believed, raising doubts that never occurred to their ancestors. 3) Describe understanding of and attitudes about death across the lifespan, particularly fear (anxiety) about death. What do fatally ill children fear the most? Death in childhood: as young as 2 have some understanding of death, but perspective differs from older people. They find the idea that a person or animal cannot come back alive incomprehensible (won’t be sad initially). Each child affected by attitudes of other family members. Emotions are not that of an adult – they don’t have the vocabulary to express how they are feeling so they lash out in ways that they know. o Fatally ill children: fear that death means being abandoned by beloved and familiar people. Parents advised to stay with them day and night – reading, singing, holding, ensuring them that they aren’t going to leave them alone. Frequent and caring presence is more important than logic. Death in late adolescence and emerging adulthood: taking risks, valuing friends, expecting to die long before old age. o Terror management theory: the idea that people adopt cultural values and moral principles in order to cope with their fear of death. This system of beliefs protects individuals from anxiety about their mortality and bolsters their selfesteem, so they react harshly when other people go against any of the moral principles involved. o Fatally ill teens: first be saddened and shocked and then try to live life to the fullest, proving that death cannot conquer them. Death in adulthood: no longer romanticized, but avoided due to the responsibilities of life. Fear of death builds in early adulthood, reaching the peak in middle age. Start acting more precarious when they become parents. Reactions to news of other deaths are related to their age, they want details to see why their situation is different than the deceased. Death in late adulthood: anxiety decreases, hope rises. Preparation for death increases. Most try to maintain health and independence. Family becomes more important. 4) What do most people think is a "good" death? What are medical practices that make a good death more likely? The end of a long life, peaceful, quick, in familiar surroundings, with family and friends present, without pain/confusion/discomfort. Medical practices: modern medicine makes it more likely – when young people get sick surgery, drugs, radiation, and rehabilitation prolong life. Bad death: when cure is impossible, physical and emotional comfort may deteriorate, but they attempt to fight illness with drugs or surgery. This prolongs pain and confusion. Hospitals could exclude visitors at critical stage for patients – patient becomes delirious, unconscious, unable to die in peace. 5) Compare/contrast KublerRoss’s and Maslow’s 5 stages of dying. KublerRoss’s: 1. Denial “I am not really dying” 2. Anger “I blame my doctors, or my family, or God for my death” 3. Bargaining “I will be good from now on if I can live” 4. Depression “I don’t care about anything; nothing matters anymore” 5. Acceptance “I accept my death as part of life” o Denial, anger, and depression disappear and reappear. Bargaining brief stage. Acceptance may never occur. Maslow’s: 1. Physiological needs freedom from pain 2. Safety no abandonment 3. Love and acceptance from close family and friends 4. Respect from caregivers 5. Selfactualization appreciating one’s unique past and present 6. Later suggested – selftranscendence acceptance of death o All stages important throughout dying process, no set sequence though. Both lists remind caregivers that each dying person has emotions and needs that may be unlike those of another – might be different than what doctors, nurses, family, friends, or others would expect. 6) Define hospice, including principles of care. Hospice: an institution or program in which terminally ill patients receive palliative care to reduce suffering; family and friends of the dying are helped as well. Terminally ill could spend their last days in comfort here. Principles of care: o 1) Each patient’s autonomy and decisions are respected. Ex: pain meds are available, no strict schedule or minimal dosage. o 2) Family member and friends are counseled before the death, taught to provide care, and guided in mourning. Mourner’s needs, before and after death, are as important as the needs of the patient. 7) What are reasons why many dying people delay or do not begin hospice care? Predictions on anticipated death are hard to make – need to have diagnosis of 6 months to live. Hard to accept the death for patients and caregivers – curative treatments can still occur, but if they get too much better they are discharged. Too expensive for some – many hands on treatment from many different people gets pricy. It depends on where a person lives and if it is available for them in that location 8) Define palliative care. Palliative care: care designed not to treat an illness, but to provide physical and emotional comfort to the patient and support and guidance to his or her family. 9) When is a person dead? (Table EP.3) Brain death: when all brain activity has stopped for a prolonged period of time with complete absence of voluntary movements; no spontaneous breathing; no response to pain, noise, and other stimuli. Brain waves have ceased; the ECT is flat; the person is dead. Lockedin Syndrome: Person can’t move, except for the eyes, but normal brain waves are still apparent; the person is not dead. Coma: State of deep unconsciousness where the person can’t be aroused. Some people wake up all of a sudden; others enter a vegetative state; the person is not yet dead. Vegetative State: State of deep unconsciousness where all cognitive functions are absent, but eyes may open, sounds can be made, and breathing continues; the person is not yet dead. o Person can be transient, persistent, or permanent. No one recorded to recover after 2 years. 15% recover after 3 weeks. After sufficient amount of time, person may, effectively, be dead (number of days has not been determined). 10)Distinguish between the various forms of euthanasia and physicianassisted suicide. Where are they legal? Why do Oregon residents request physician assistance in dying? (Tale EP.4) Passive Euthanasia: A situation where a seriously ill person’s medical intervention is stopped and they are allowed a natural death. Legal everywhere. DNR (Do Not Resuscitate): a written order from a physician, by a patient’s advance directive, or by a health care proxy’s request that no attempt should be made to revive a patient if he or she suffers cardiac or respiratory arrest. Legal everywhere. Active Euthanasia: deliberately doing something to cause someone’s death, such as turning off a respirator before a person has been declared brain dead. Some perform active euthanasia when 1) Suffering they cannot relieve 2) illness they cannot cure 3) a patient who wants to die. PhysicianAssisted Suicide: doctor provides lethal medication that a patient can then swallow in order to die. o Oregon residents: “Death with dignity” was the proposed name. Reasons: 91% loss of autonomy, 88% less able to enjoy life, 83% loss of dignity, 54% loss of control over body, 36% burden on others, 23% pain. Where it is legal: Oregon, Washington, Montana, Vermont, and California is in the process. Netherlands since 1980, Belgium, Luxembourg, Switzerland. 11)Explain why legalizing euthanasia is so controversial, including the “slippery slope” in your arguments. People fear that euthanasia will lead to a slippery slope of hastening death for people that are not ready to die – disabled, the old, the minorities, and the poor. People see this as a scare tactic to prevent euthanasia. In Oregon, people who used fatal prescriptions were well educated, lived a long life (but not too long to be a burden on society), and died a peaceful death with family at home. o These people were used to refute the slippery slope argument. Most states do not legalize euthanasia, but they do not persecute doctors that follow out euthanasia privately and quietly. 12)What's the purpose of advance medical directives? Describe forms of advance directives. Discuss the relevance of Terri Schiavo's case to having an advance directive. Advance Medical Directives: increase personal choice about death. o Living will: indicates what kind of medical intervention an individual prefers if he or she is not conscious when a decision has to be made. (Like mechanical breathing) o Health care proxy: a person chosen by another person to make medical decisions if the second person becomes unable to do so. Theresa (Terri) Schiavo: at 26 years old, her heart suddenly stopped. When her heart was restarted, she fell into a coma. o With no advance directives, her husband was put as her health care proxy. o After 11 years in a vegetative state, her husband petitioned to have her feeding tube removed. o Her parents then appealed the decision and lost so they pleaded to the public. The case went all the way to the Florida legislature where they made the feeding tube be reinserted. o 3 years later, Congress said legislature was correct in leaving the feeding tube in and passed a law requiring that artificial feeding be continued. o That law was overturned as unconstitutional and the feeding tube was finally removed. o Terri was declared dead March 31, 2005 (although some would say she died 15 years earlier). 13)Distinguish between grief and mourning. Describe different types of grief. What are ways to help someone who is grieving? Grief: the deep sorrow that people feel at the death of another. Grief is personal and unpredictable. Highly personal emotion, an anguish that overtakes daily life. o Complicated Grief: impedes a person’s future life, usually because the person clings to sorrow or is buffered by contradictory emotions. o Absent Grief: situation where mourners do not grieve, either because other people do not allow grief to be expressed or because the mourners do not allow themselves to feel sadness. o Disenfranchised Grief: situation where certain people, although they are bereaved, are prevented from mourning publicly by cultural customs or social restrictions. o Incomplete Grief: situation where circumstances, such as a police investigation or an autopsy, interfere with the process of grieving. Mourning: The ceremonies and behaviors that a religion or culture prescribes for people to employ in expressing their bereavement after a death. To help a griever, a friend should listen and sympathize, never implying that the person is too grief stricken enough.
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