Module 7; Chapter 23-25
Module 7; Chapter 23-25 Nursing 200
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Late Adulthood Biosocial Development: Prejudice And Prediction: ● Ageism: ○ Prejudice in which people are categorized and judged solely on the basis of their chronological age. ○ Considers people as part of a category and not as individuals, can target people of any age. Believing The Stereotype: ● Institutionalization Of Ageism: ○ Ageism in U.S. culture and has become pervasive in the media, employment, and retirement communities. ○ Effects can erode feelings of competence. ○ Attitudes toward longevity vary by context and culture. ● The Elderly’s View of Ageism: ○ Ageism becomes a selffulfilling prophecy. ○ Stereotype threat can be as debilitating for the aged as for other groups. ● Sleep: ○ The daynight circadian rhythm diminishes with age. ○ Many older people wake before dawn and are sleepy during the day. ○ If allowed to select a personal sleep schedule, many elders feel less tired than young adults. ● Exercise ○ On average, only 35% of people over age 65 meet recommended guidelines for aerobic exercise; 16% for muscle strengthening. ● Elderspeak: ○ A condescending way of speaking to older adults that resembles baby talk, with short, simple sentences, exaggerated emphasis, repetition, and a slower rate and higher pitch than normal speech. ● Destructive Protection: ○ Elders are discouraged from leaving home by some younger adults and the media. ○ Street and violent crime rates are lower for those over age 65 than for younger adults. The Demographic Shift: ● World’s Aging Population: ○ A shift in the proportions of the population of various ages. ○ Once there were 20 times more children than older people. ○ Nearly 8% of the world’s population and 13% of the U.S. population are age 65 or older. ● Demographic pyramid is no longer accurate. ○ A graphic representation of population as a series of stacked bars in which each age cohort is represented by one car, with the youngest cohort at the bottom. ● Three reasons for traditional pyramidal shape: ○ 1. Far more children were born than the replacement rate. ○ 2. Before modern sanitation and nutrition, many children died before age 5. ○ 3. Middleaged people rarely survived adult diseases like cancer and heart attack. ● Dependency Ratio: ○ Involves estimating the proportion of the population that depends on care from others. ○ Is calculated by comparing the number of dependents to the number of people in the middle. ○ In most nations, including the U.S., the dependency ratio is about 1:2. ○ Assumes that older adults are dependent. Young, Older, And Oldest: ● YoungOld (70%): ○ Healthy, vigorous, financially secure older adults (those aged 60 to 75) who are well integrated into the lives of their families and communities. ● OldOld (20%): ○ Older adults (those aged 75 to 85) who suffer from physical, mental, or social deficits. ● OldestOld (10%): ○ Elderly adults (those over age 85) who are dependent on others for almost everything, requiring supportive services such as nursinghome care and hospital stays. Selective Optimization With Compensation: ● Every compensatory strategy involves personal choice, societal practices, and technological options. ● Three example include sexual intercourse, driving, and the senses. ● Personal Compensation Sex: ○ Most people remain sexually active throughout adulthood; intercourse generally becomes less frequent; and other behaviors become important. ○ Married couples adjust to whatever biological changes occur in their sexual arousal, but may also improve their relationship in the process ● Social Compensation Driving: ○ Older adults drive more slowly, may not drive at night or when there is bad weather and may give up driving altogether. ○ Societal compensations for agerelated driving deficits are generally not available. ○ Drive competency testing is not required in most states. Technological Compensation The Senses: ● Senescence is pervasive and inevitable. ○ Obvious in appearance (skin gets wrinkled, bodies change shape) and the senses. ○ Only 10% of people over age 65 see well without glasses. ○ Taste, smell, touch, and hearing are also impaired (by age 90, the average man is almost deaf, as are about half of the women). ● Technology can compensate for almost all sensory loss. ○ Visual Problems: ■ Brighter lights and bifocals or two pairs of glasses are needed. ■ Cataracts, glaucoma, and macular degeneration can be avoided or mitigated if diagnosed early. ■ Elaborate visual aids (canes that sense when an object is near, infrared lenses, service animals, computers that “speak” written words) allow even the legally blind to the independent. ○ Auditory Problems: ■ Small and sensitive hearing aids are available but many people still hesitate to get aids. ■ Missing out on bits of conversation cuts down on communication and precipitates many other social losses. ■ Younger people tend to yell or use elderspeak, both of which are demeaning. ■ Elderly people are less vulnerable to stereotype threat if they have positive interactions with the younger generations. Society And Sensory Loss: ● A passive acceptance of sensory loss increases morbidity of all kinds. ○ Problems: ■ It is often difficult to individualize available technology. ■ Ageism is inherent in the design of everything from airplane seats to shoes. ■ Many disabilities would disappear if the environment were better designed. Compensation For The Brain: ● In every aspect of aging, it is the brain that selects, optimizes, and compensates. ○ The brain slows down, connections between parts are diminished, and volume decreases, especially in the neocortex and hippocampus. ○ New neurons form and cognitive reserves compensate, but do not completely mitigate brain senescence. ○ Exercise, nutrition and drug avoidanceand plasticityprotect the brain to some degree. Aging And Disease: ● Primary Aging: ○ The universal and irreversible physical changes that occur to all living creatures as they grow older. ● Secondary Aging: ○ The specific physical illnesses or conditions that become more common with aging but result from poor health habits, genetic vulnerability, and other influences that vary from person to person. High Blood Pressure And Cardiovascular Disease: ● Treatment of the elderly Flu: ○ Because of primary aging, medical intervention affects the old differently than the young. ○ Annual immunization is recommended for those over age 65, because their other infirmities make flu sometimes fatal. ○ 20122013 vaccine protected the elderly reasonably well against the B strains of flu but provided almost no protection against the A strain, even though it protected the young. Facts About CVD: ● CVD is considered secondary aging because not everyone develops it. ○ No single factor (including age, hypertension, inactivity, and smoking) makes CVD inevitable. ● The links among aging, risk, and CVD are undeniable. ○ A 90yearold is 1,000 times more likely to die of CVD than is a 30 yearold, even if both have identical genes, social contexts, and health habits. ○ Less than half those over age 65 have CVD, diabetes, or dementia but almost everyone has at least one of these three by age 90. ○ Risk factors and diseases of the aged are not distributed randomly: if a person has one risk factor, it is likely that he or she has several. Compression Of Morbidity: ● A shortening of the time a person spends ill or infirm before death; accomplished by postponing illness. ● Due to improvements in lifestyle, medicine, and technological aids. ● North Americans who live to be 95 are likely to be independent almost all of those years. The Effects Of Falling: ● With age, bones become more porous, losing calcium and strength. This can lead to osteoporosis where bones can be broken easily. ● Most common liability elders experience from falling is fear so they reduced their activity which caused them to become sicker. Theories Of Aging: ● Wear And Tear: ○ A process by which the human body wears out due to the passage of time and exposure to stressors. ● Genetic Clock: ○ A mechanism in the DNA of cells that regulates the aging process by triggering hormonal changes and controlling cellular reproduction and repair. Replication No More: ● Hayflick Limit: ○ The number of times a human cell is capable of dividing into two new cells. ● Telomeres: ○ The ends of chromosomes in the cells. ● Telomerase: ○ Enzymes that increases the length of telomeres. ● Calorie Restriction: ○ Slows down aging. The Immune System: ● B Cells: ○ Immune cells made in the bone marrow that create antibodies for isolating and destroying bacteria and viruses. ● T Cells: ○ Immune cells made in the thymus gland that produce substances that attack infected cells in the body. How Long Can Humans Live?: ● Maximums And Average: ○ Maximum Life Span: ■ The oldest possible age to which members of a species can live, under ideal circumstances. For humans, that age is approximately 122 years. ○ Average Life Expectancy: ■ The number of years that the average person in a particular population is likely to live. ■ In the U.S. today, average life expectancy at birth is about 75 years for men and 81 years for women. ■ Dramatic variations from nation to nation. And So…: ● All the theories of aging, and all the research on genes, cells, calorie restriction, sirtuins, antioxidants, and so on, have not yet led to any straightforward way to stop senescence. Late Adulthood Cognitive Development: The Aging Brain: ● New Brain Cells: ○ Neurons form and dendrites grow in adulthood, particularly in the olfactory region and the hippocampus. ○ New neurons provide cognitive adaptability to success in context of challenging and changing environments. ○ Growth of brain is slow, limited, and not sufficient to restore itself to its younger state. Senescence And The Brain: ● Senescence reduces production of neurotransmitters that allow a nerve impulse to jump quickly. ○ Results in a brain slowdown, seen in reaction time, talking, and thinking. ● Brain slowdown correlates with slower walking and most other physical disabilities. ○ Although transmission of impulses from the brain are disrupted with age, specifics correlate more with cognitive ability. Brain Slowdown: ● Brain senescence varies markedly from individual to individual. ○ Suggested reasons include gender, education, experiences, and elders’ assessment of whether their everyday activities are restricted by their health. Evidence From Neuroscience: ● The hypothalamus (memory) and the prefrontal cortex (planning, inhibiting unwanted responses, and coordinating thoughts) shrink faster than other areas. ● Complicated relationship among past education, current mental exercise, and intellectual functioning in late adulthood. ○ Schooling may slow the rate of brain shrinkage. ○ Good health may protect the brain more than education. ○ Education strengthens inhibition, the ability to say no or keep quiet. ■ This masks impairment when the prefrontal cortex shrinks. Why does higher education and vocational status correlate with less cognitive decline? ● Three Hypotheses: ○ HighSES people began late adulthood with more robust and flexible minds, so their losses are not as noticeable. ○ Keeping the mind active is protective. ○ HighSES people generally avoid pollution and drugs, and have better medical cre than lowSES people. Using More (Or Less) Of The Brain: ● Multitasking: ○ Older adults who were better at working memory and multitasking used their prefrontal cortex; those who were worse did not. ○ Brain shrinkage interferes with multitasking more than with other cognitive challenges. ○ Multitasking slows down people of every age, but older adults more so. ○ Older adults usually need to concentrate on one task at a time. Information Processing After Age 65: ● Input: ○ Some information never reaches sensory memory in older people because the senses never detect the stimuli. ○ The brain automatically fills in missed sights and sounds. ○ Most older people believe they see and hear whatever is important but vital information may be distorted or lost without the person realizing it. ● Memory: ○ Stereotype threat impedes memorial processes; suspecting memory loss can impact memory. ○ Memory loss can be normal and pathological, but generally explicit memory loss is greater than implicit memory loss. ○ Source amnesia may contribute to less analysis of information when elders cannot remember origin of a fact. ● Prospective Memory: ○ Involves remembering to perform a future task. ○ Fades notably with age. ○ Includes the ability to quickly shift mentally among tasks. ● Working Memory: ○ Brain slowdown reduces working memory. ■ Older individuals take longer to perceive and process sensations. ○ Reduced working memory inhibits multitasking. ■ When older people can take their time and concentrate, their working memory seems as good as ever. ■ Concentration may crowd out other mental tasks that a younger person could do simultaneously. ● LongTerm Memory: ○ It is difficult to get an accurate assessment of longterm memory. ■ Emotional memories encoded at one point in life tend to endure, without much loss of distortion. ● Recognition: ○ At every age, recognition memory is better than recall. ● Control Processes: ○ Are the underlying impairment of cognition in late adulthood, especially impaired retrieval. ○ Included executive function of the brain: selective attention, strategic judgement, and then appropriate action. ○ Shift as analysis and forethought give way to reliance on prior knowledge, general principles, and rules of thumb. Reminding People Of What They Know: ● Priming: ○ A control strategy where words or ideas are presenting in order to make it easier to remember something. ○ With proper control processes, cognition in late adulthood can be good. ○ Stereotype threat can trigger anxiety, fear, and depression hurting cognition and learning potential. Output: ● Gradual decline in output of primary mental abilities (verbal meaning, spatial orientation, inductive reasoning, numeric ability, word fluency) is normal. ● In daily life, output is usually verbal. ● Two important modifiers are health and training. ● Cognitive Tests: ○ Usual path of cognition in late adulthood as measured by psychological tests is gradual decline, at least in output. ○ Such tests are normed and validated via the output of younger adults; abstract, and timed. ● Ecological Validity: ○ The idea that cognition should be measured in settings that are realistic and that the abilities measured should be those needed in real life. ○ May be key to accurately measuring cognition in the elderly. ● Fundamental Ecological Issue: ○ Address the question: what should be assessedpure, abstract thinking or practical, contextual thought, depersonalized abilities, or everyday actions? Neurocognitive Disorders: ● Ageism Of Words: ○ Lines between normalage related problems, mild disorder, and major disorder are not clearly defined, and the symptoms vary depending on the specifics of brain loss and context. ○ Caution is advised in the use of words used to describe cognitive decline in the elderly. ■ Older terms: senile, dementia. ■ DSM5: neurocognitive disorders (NCDs) either major neurocognitive disorder or mild neurocognitive disorder, depending upon the severity of symptoms. Mild And Major Impairment: ● Mild NCD, formerly called mild cognitive impairment (MCI). ○ Older adults who have significant problems with memory, but who still function well at work and home. ○ Forgetfulness and loss of verbal fluency that often comes before the first stage of AD. ○ About half will become demented, but some stabilize with mild impairment and others regain their cognitive abilities. ● Measuring Mild Loss: ○ Qmci; biological indicators (biomarkers); clinical judgement of professionals. Prevalence of NCD: ● Most elderly people never experience a neurocognitive disorder. ● Among people in their 70s, only 1% in 20 does, and even by age 90 or 100, most people still think well enough. ● Presented another way, the prevalent data sound more dire: almost 4 million people in the United States have a major neurocognitive disorder. Major And Minor Impairment: ● Alzheimer Disease (AD): ○ Most common cause of NCD, characterized by gradual deterioration of memory and personality and marked by the formation of plaques of betaamyloid protein and tangles of tau protein in the brain. ● Genes And Alzheimer Disease: ○ AD in middle age is rare, usually caused by genes (down syndrome), and progresses quickly. ○ Most cases begin much later and many genes have some impact. ○ Genetic tests for AD in late adulthood are rarely used before symptoms appear because they might evoke false fear or deceptive reassurance. ● Hopeful Brains: ○ Even the brain without symptoms might eventually develop Alzheimer's disease, but people with a certain dominant gene definitely will. Prevalence Of NCD: ● Vascular Dementia (VaD): ○ A form of dementia characterized by sporadic and progressive loss of intellectual functioning caused by repeated infarcts, or temporary obstructions of blood vessels, which prevent sufficient blood from reaching the brain; also called multiinfarct dementia. ○ VaD is more common than Alzheimer's disease for those over age 90 but not for the youngold. ○ Vascular disorders correlate with the ApoE4 allele and, for some of the elderly, are caused by surgery that requires general anesthesia. ○ This may cause a mini stroke, which added to reduced cognitive reserve, damages the brain. The Progression Of Two NCDs: Alzheimer’s Disease And Vascular Dementia: ● Cognitive decline is apparent in both Alzheimer’s disease (AD) and vascular dementia (VaD). ● However, the pattern of decline for each disease is different. ● Victims of AD show steady, gradual decline, while those who suffer from VaD get suddenly worse, improve somewhat, and then experience another serious loss. Prevalence Of NCD Other Dementia: ● Frontal lobe disorders (frontotemporal lobar degeneration). ○ Characterized by personality changes. ○ Caused by deterioration of the frontal lobes and the amygdala. ○ Emotional and personality changes are the main symptoms. ○ Usually begins later. Prevention And Treatment: ● Since aging increases the rate of cognitive impairment, slowing down senescence may postpone major NCD, and ameliorating mild losses may prevent worse ones. ○ Improving overall health is the first step in prevention and treatment. ○ Engaging in regular physical exercise prevents, postpones, and slows cognitive loss of all kinds. ○ Avoiding the pathogens is critical. Reversible Impairment: ● Accurate diagnosis is crucial when a person is wrongly thought to have NCD. ● The most common reversible cause of NCD symptoms is depression. ● Malnutrition, dehydration, brain tumors, physical illness and over medication can cause NCDlike symptoms. ● With age, bodies become less efficient at digesting food and using its nutrients. ● Polypharmacy : ○ When the elderly are prescribed several drugs and the side effects can cause NCD symptoms. ○ Some drug combinations can produce confusion and psychotic behavior. New Cognitive Development: ● Erikson And Maslow: ○ Integrity Versus Despair: ■ The final stage in Erikson’s model in which older people gain interest in the arts, in children, and in human experience as a whole. ○ SelfActualization: ■ The final stage in Maslow’s hierarchy of needs, characterized by aesthetic, creative, philosophical, and spiritual understanding. ● Learning Late In Life: ○ A variety of teaching or training tasks to improve the intellectual abilities of older adults have been investigated. ○ Schaie's: Seattle Longitudinal Studyimprovement of spatial understanding. ○ Basak and colleagues Video game protocol and improvement in skills related to specific executive functions. ○ Vranica and colleagues: memory strategies instruction and improvement in memory functions. Aesthetic Sense And Creativity: ● Elderly artists with extraordinary talents did not feel their ability had been ageimpaired. ○ Grandma Moses and paintings/age 80. ○ Michelangelo and Sistine Chapel/age 75. ○ Verdi and Falstaff/age 80. ○ Frank Lloyd Wright and Guggenheim design/age 91. ● Life Review: ○ An examination of one’s own part in life, which often takes form of stories written or spoken by elderly people who want to share them with younger ones. ○ Results are almost always positive. ● Wisdom : ○ Expert knowledge system dealing with the conduct and understanding of life. ○ Life review, selfactualization, and integrity are considered parts of wisdom. ○ Some elderly people are unusually wise. Late Adulthood Psychosocial Development: Theories Of Late Adulthood: ● Development is more diverse in late adulthood than at any other stage. ● Some elderly people run marathons and lead nations, while others can no longer walk or talk. ● Many social scientists have tried to understand these variations as well as the general course of old age. ● Self Theories: ○ Theories of late adulthood that emphasize the core self, or the search to maintain one’s integrity and identity. ● Integrity Versus Despair: ○ The final stage of Erik Erikson’s developmental sequence, in which older adults seek to integrate their unique experiences with their vision of community. ● Compulsive Hoarding: ○ The tendency to cling to familiar places and possessions, sometimes to the point of becoming a health or safety hazard. ● Holding On To The Self: ○ Most older people feel their personalities and attitudes have remained stable over their lifespan, even as they recognize the physical changes of their bodies. ○ Objects and places become more precious, as a way to hold on to identity. ● Socioemotional Selectivity Theory: ○ Older people prioritize their emotional regulation, seeking familiar social contacts who reinforce their generativity, pride, and joy. ● Selective Optimization With Compensation: ○ Slightly different version of above. ○ With changes in external appearance, key aspects of self are selected and optimized. ● Positivity Effect: ○ Outgrowth of socioemotional activity and selective optimization. ○ Tendency for elderly people to perceive, prefer, and remember positive images and experiences more than negative ones. ○ Research on what people hope for themselves (the ideal self) and how they perceive themselves (the real self) finds that, with age, the two selves come closer together. ○ As self theory contends, selfacceptance leads to happiness. ● Stratification Theories: ○ Theories that emphasize that social forces, particularly those related to a person’s social stratum, or social category, limit individual choices and affect a person’s ability to function in late adulthood as past stratification continues to limit life in various ways. ● Stratification By Gender: ○ Feminist theory draws attention to society’s guides and pressures to put males and females on different paths. ○ Irrational, genderbased fear may limit women’s independence (older women persuaded not to live alone more than older men). ○ Men seek medical help less than women. ● Stratification By Ethnicity: ○ Stratification theory says that factors such as education, health, employment, and place of residence create large discrepancies in income by old age. ○ Immigrant elders often face multiple challenges related to cultural differences in care by children, housing, and stereotypes. ○ Weathering (past stresses and medical disabilities) creates a high allostatic load which is an accumulation of problems that make a person vulnerable to serious disease. ● Financial Effects Of Stratification: ○ Direct effects of poverty are magnified by gender, ethnicity, and age. ○ Employment is directly and indirectly related to income in late adulthood (social security benefits). ○ Stress and accumulating disadvantages are increasingly limited as age advances. ● Stratification By Age: ○ Industrialized nations segregate elderly people, gradually shunting them out of the mainstream of society as they grow older. ○ Segregation by age harms everyone because it creates socialization deficits for members of all age groups. ● Critique Of Stratification Theories: ○ Developed habits may protect people from the worst stratification effects. ○ Some theories may arise from cultural stereotypes. ○ Selective survival may help to explain race crossover. Ethnic inequality may diminish because very old age is a powerful “leveler,” overwhelming ethnic and SES stratification. Activities Of Late Adulthood: ● Working: ○ The activities of older people are intense and varied. ○ The psychological benefits of work can be obtained through volunteer work. ○ Work provides social support and status, boosting selfesteem. ○ For many people, employment allows generativity. ● Retirement ○ Besides needing the money, some employees over age 65 stay on the job because they appreciate the social recognition and selffulfillment of work. ○ It was once believed that older adults were healthier and happier when they were employed than when they were unemployed and that retirement led to illness and death. ○ Only when retirement is precipitated by poor health or fading competence does it correlate with illness. ● Volunteer Work: ○ Volunteering is linked to generativity, social connections, less depression, and health. ○ Culture or national policy and the microsystem affect volunteering. ● Concerns: ○ Older retirees may be less likely to volunteer than middleaged employed people. ○ Less than onethird of adults of any age volunteer. ● Home Sweet Home: ○ One of the favorite activities of many retirees is caring for their own homes. ● Aging In Place: ○ Involves remaining in the same home and community in later life, adjusting but not leaving when health fades. ● Naturally Occurring Retirement Community (NORC): ○ A neighborhood or apartment complex whose population is mostly retired people who moved in the location as younger adults and never left. ○ An important reason for both aging in place and NORCs is the social convoy, the result of years of close relationships. ● Religious Involvement: ○ Older adults are less likely to attend religious services than are the middleaged. ○ Yet, faith increases with age, as do praying and other religious practices. ○ Religious institutions fulfill many needs, and a nearby house of worship is one reason American elders prefer to age in place. ● Political Activism: ○ Fewer turn out for massive rallies and only about 2% volunteer in political campaigns. More letter writing to elected representatives, voting, and identifying with a political party. ○ Many government policies affect the elderly, especially those regarding housing, pensions, prescription drugs, and medical costs. ○ AARP : ■ A U.S. group of people aged 50 and older that advocates for the elderly. Friends And Relatives: ● Companions are particularly important in old age. ● As socioemotional theory predicts, the size of the social circle may shrink with age, but close relationships become more crucial. ● One amazing aspect of longterm relationships is how interdependent the partners become over time. ● Generally, older spouses accept each other’s frailties, assisting with the partner’s physical and psychological needs. ● LongTerm Partnerships: ○ Spouses buffer each other against the problems of old age, thus extending life. ○ Married older adults are healthier, wealthier, and happier than unmarried people their age. ● Shared Laughter: ○ One characteristic of longmarried couples is that they often mirror each other’s moods. ○ Thanks to the positivity effect, the mood is often one of joy. ● Relationships With Younger Generations: ○ In past centuries, most adults died before their grandchildren were born. ○ Today, some families span five generations. ● Beanpole Family: ○ Multiple generations but only a few members in each one. ● Feelings of familism prompt siblings, cousins, and even more distant relatives to seek out one another. ○ Filial Responsibility: ■ The obligation of adult children to care for their aging parents. ■ A major goal among adults in the U.S. is to be selfsufficient. ■ Adult children may be more willing to offer support than their parents are to receive it. ● Tensions between older and younger adults. ○ Although elderly people’s relationships with members of younger generations are usually positive, they can also include tension and conflict. ○ Few older adults stop parenting simply because their children are grown. ○ Adult children also imagine parental disapproval, even if it is not outwardly expressed. ● Extensive research has found that relationships between parents and adult children are affected by many factors: ○ Assistance arises from need and from the ability to provide. ○ Frequency of contact is related to geographical proximity, not affection. ○ Love is influenced by the interaction remembered from childhood. ○ Sons feel stronger obligations; daughters feel stronger affection. ● Grandchildren: ○ Most (85%) elders over age 65 are grandparents. ○ Factors influencing the nature of the grandparentgrandchild relationships: ■ Personality. ■ Ethnicity. ■ National background. ■ Past family interactions. ■ Age and the personality of the child. ● In the U.S., contemporary grandparents follow one of four approaches to dealing with their grandchildren. ○ Remote grandparents (sometimes called distant grandparents) are emotionally distant. ○ Companionate grandparents (sometimes called “funloving” grandparents) entertain and “spoil” their grandchildren. ○ Involved grandparents are active in the daytoday lives of their grandchildren. ○ Surrogate parents raise their grandchildren, usually because the parents are unable or unwilling to do so. ● Friendship ○ Many middleaged adults, married and unmarried, have no children. ○ Elderly people who have spent a lifetime without a spouse usually have friendships, activities, and social connections. ○ All the research finds that older adults need at least one close companion. The Frail Elderly: ● Frail Elderly: ○ People over age 65, and often over age 85, who are physically infirm, very ill, or cognitively disabled. ○ Most older adults become frail if they live long enough. ○ Frailty is most common in the months preceding death. ● Caring For The Frail Elderly: ○ Family caregivers experience substantial stress. ○ Their health may suffer, and their risk of depression increases, especially if the care receiver has dementia. ○ In the U.S., the spouse is the usual caregiver. ● Even in ideal circumstances with community support, family caregiving can present problems. ○ If one adult child is the primary caregiver, other siblings tend to feel relief or jealousy. ○ Care receivers and caregivers often disagree about schedules, menus, doctor visits, and so on. ○ Resentments on both sides disrupt mutual affection and appreciation. ○ Public agencies rarely provide services unless an emergency arises. ● When caregiving results in resentment and social isolation, the risk of depression, poor health, and abuse escalates. ○ Elder Abuse: ■ More Likely To Occur When: ● The care receiver is a feeble person who suffers severe memory loss. ● The caregiver is a drugaddicted relative. ● Care occurs in an isolated place. ● Visitors are few and far between. ● Most Research Finds That: ○ About 5% of elders say they are abused; up to onefourth of all elders are vulnerable but do not report abuse. ○ Elders who are mistreated by family members are ashamed to admit it. ○ Outright abuse is now rare in nursing homes. ○ In the U.S., the trend over the past 20 years has been toward fewer nursinghome residents (currently about 1.5 million people nationwide). LongTerm Care: ● Good nursing care is available for those who can afford it and know what to look for. ○ Although 90% of elders are independent, half of them will need nursinghome care at some point as they recuperate from hospitalization. Alternative Care: ● Assisted Living: ○ A living arrangement for elderly people that combines privacy and independence with medical supervision. ○ Assistedliving facilities range from group homes for three or four elderly people to large apartment or townhouse developments for hundreds of residents. ● Village Care: ○ Elderly people who live near each other pool their resources, staying in their homes but also getting special assistance when they need it.