Lifespan Development: Ch 13, 14, 15

Later Life: Cognitive, and Socioemotional Development, Physical Challenges of Old Age, Death and Dying Chapter 13, 14, and 15

Facets Studied • • • • • • •

What is it?

Socioemotional Retirement Widowhood Successful Aging Health Caring for the Elderly • Death & Dying

Why is the population changing?

• Baby boomers entering later life • Longevity • Low fertility

Two Elderly Stages Help explain contradictory stereotypes about later life à the image of the vital sixty-something embarking on new experiences vs. the lonely, aged person languishing in a nursing home

Young-old (sixties and seventies) • Typically healthy, relatively wealthy

Old-old (80 and older) • More likely to be physically frail and poor

Socioemotional Selectivity Theory The time left to live affects priorities and social relationships Older adults realize the future is limited, thus refocus priorities ü Priorities shift from wanting to expand social horizons to being with closest attachment figures ü Focusing on making the most of every moment has the potential to be the happiest time of life

Priorities Shift According to socioemotional selectivity theory, we tend to reprioritize our lives as we get older Not wasting time on unpleasant people P Spending more time with those closest to us P Carefully choosing social obligations P

Old age as the best time of life Older people prioritize emotional states.

– Based on the positivity effect – focusing on positive experiences

Older people live less stressful lives.

– Report fewer stresses (e.g., raising children, work pressures) than young people

Old age as the worst time of life • Economic cutbacks will impair the quality of life • In old-old age, people can become isolated, disabled, and realize that death inevitable • This can lead to loss of purpose and meaning to life

Erikson’s Psychosocial Stage In Later Life Integrity vs. Despair – Reviewing one’s life and making peace with it – Having a sense of usefulness and meaning in present life – Having a sense of self-efficacy; feeling in control

Using emotion regulation is key – making the most of difficult situations such as chronic disease

Retirement • Most think of the U.S. retirement age as 65. Actually, the average age for collecting full Social Security benefits is now 66. It will be 67 for people born after 1970.

• True age of retirement is 60 rather than 65.

• Because, on average, we live another 20 years after retirement, it is now a full stage of life.

• Retirement depends on governments offering programs enabling their citizens to live without working.

• Therefore, in countries without government-sponsored programs (mainly in the developing world), people must stay on the job until they physically cannot work.

Social Security P Developed by FDR in the Great Depression P Operates as a safety net P Pay into it and get funds when at retirement P Designed to keep people from being destitute, not to fund a comfortable life P The only income source for most low-wage workers

Pension Plans Pensions: often employer-linked • • • • •

Workers put aside a portion of their paychecks Often matched by employer Funds placed in tax-free account Either gets regular pay-outs or one lump sum Often not available at low-wage jobs

During the Great Recession, pension plans were affected dramatically • Bankruptcies among middle-aged adults • Postpone retirement • By 2015, 1 out of every 2 people will work past age 65 à Typically due to necessity, insufficient retirement accounts, and/or helping cash-strapped children and grandchildren

Deciding To Retire Factors: – – – –

Enough money to live without working (top-ranking motivation) Physical ability to keep working (more apt to occur among low-income workers—especially those in physically demanding jobs) Age discrimination Job satisfaction

Age discrimination can affect retirement decisions: –

Defined as illegally laying off workers or failing to hire or promote them on the basis of age P

Is illegal in the United States

Life As A Retiree Are retirees depressed or pleased about retirement? “It depends.”

Positive – – – – – –

Physical and mental health Focus on “bucket list”; leisure activities Married Financial stability Consider retirement as a challenge; a new phase of life Volunteering

Negative

– Not leaving work by choice – forced retirement – Financial concerns – Health concerns

Summing Up Retirement Retirement is an at-risk stage of life – Declining pensions plans – Strain on Social Security

Older workers are an at-risk group of employees – Age discrimination

Older people may be more at risk of being poor

– High rates of poverty in the old-old (and among people who enter retirement relying just on Social Security)

Intergenerational equity – balancing the needs of the young and the old

– Abandoning the entitlement programs (i.e., Social Security) would hurt the young because they would be responsible for providing for the older family members.

Widowhood Death of a spouse à life’s most traumatic change Exploring mourning: – Obsession with the loved one and the events surrounding the death – Expect widowed people to “improve”

What helps widowed people cope?

–

–

–

–

Continuing bonds – feeling that the spouse is physically there helps people cope Working model – constructing an independent life as a phase of widowhood Religion – helps widowed people grieve by feeling spiritually connected to God Children and families – children make special effort to attend to grieving parent

Having Trouble Moving On Widowhood mortality effect à risk of death that occurs among surviving spouses – Men are more at risk, especially old-old men – Anyone with limited options for remaking a new life – People highly dependent on just a spouse – People in male-dominated cultures

Resiliency 1. Develop a network of attachments and fulfilling identities outside of your marriage before being widowed.

2. Draw on faith in a God. 3. Take comfort from children.

4. Graciously accept emotional support.

5. Try to see this tragedy as a challenge, an opportunity for understanding that you can function on your own.

Aging Successfully ü

ü ü ü ü

drawing on what gives one’s life meaning to live fully no matter how the body behaves having an internal sense of selfefficacy having support to function living with the potential for chronic disease that may come with old age combines nature (personal capabilities) and nurture (environmental fit)

Physical Aging Normal age changes à universal and progressive signs of physical deterioration that occur with age – Universal – Genetically programmed into our DNA – Can differ according to the time of onset

Three Basic Principles of Age-Related Disease 1. Chronic disease is often normal aging “at the extreme.”

– Moderate physical losses are normal; extreme changes are considered chronic.

– Bone density loss, when extreme, is called osteoporosis.

– Arthritis is the top-raking chronic illness in later life.

– Many age-related diseases are not fatal, but interfere with ADLs (activities of daily living).

2. ADL impairments – difficulty performing everyday tasks that are required for living independently – Become far more frequent among the old-old as the number of chronic diseases accumulates

3. Lifespan has a defined limit.

– Aging process has a fixed end.

– But, the 100-plus group is the fastest-growing age group of all!

Two Types of ADL Problems Instrumental ADLs P P

Difficulties performing everyday household tasks (cooking, cleaning) Common in advanced old age

Basic ADLs P

P P

Difficulties performing essential self-care activities (eating, getting to the toilet) Relatively rare until the old-old years Require full-time help or nursing home care

What affects the physical aging path? ü Socioeconomic status ü Ethnicity ü Gender ü Age

Socioeconomic Status • Socioeconomic/health gap − affluent people living longer and enjoying better health ü

This occurs universally

• The relationship between income and illness begins in middle age • However, accelerated aging process begins at the beginning of life ü ü

Low birth weight, which is often linked to social class, can cause obesity and poor health later in life Diet, illness, and life stresses can lead accelerated aging

• The poverty-illness relationship is bidirectional ü ü

Childhood illness can lead to poverty (missing school, less likely to attend college).

Poverty can lead to poor choices in later life (smoking, poor nutrition, less exercise, less access to good health care).

Ethnicity • Despite poverty, Hispanic Americans seem to fair better against physical aging than African-Americans • African Americans are more susceptible to illness and premature death than any other ethnic group • Be careful not to blame the person for the many forces that affect aging due to the “toxic” environment of being poor

Gender • Women survive longer due to less life stressors, support from family and friends, their second X chromosome. ü ü ü

Due to fewer heart attacks Presence of estrogen helps slow aging process May live longer but frail

• Men are twice as likely to die from a heart attack earlier in life (it’s biological).

• Women are more prone to illnesses that cause problems with ADLs but are not fatal.

• But women rank higher on sickness indicators, such as seeing a doctor throughout adult life.

• Both nature (biology) and nurture (accessing health care and awareness of health concerns) explain why women outlive men in every developed world nation by at least 4 years.

Cohort • Are we seeing more age-related illness at younger ages? YES! • By early twenty-first century, odds of successfully aging physically has declined by 25 percent • Baby boomers are more disabled than previous cohorts • Obesity epidemic leads to diabetes and other laterlife conditions

Holistic Lifespan DiseasePrevention Approach • Focusing on total personal responsibility is unfair.

• The solution is to alter the health environment in the beginning by the following: 1. Focusing on children − preventing premature births, eliminating child poverty, improving education 2. Focus on communities – making it easier to exercise, promoting healthy nutrition

Health Sensory motor changes with age, which includes: Vision, Hearing, and Motor Abilities

Vision Changes: • Presbyopia: age-related difficulties with seeing close objects – universal change that happens in mid-life – often leads to the need to purchase reading glasses

• Poorer dark vision – cannot see as well in dimly lit places

• More troubles with glare – being blinded by bright light shining in the eye

Interventions: • Use strong indirect lighting.

• Avoid fluorescent lighting— especially on bare floors (produces glare).

• Use adjustable lighting and

larger numerals on appliances, and provide non-reflective surfaces.

• Look into low-vision aids such as magnifiers.

Hearing Changes:

Interventions:

• • • • • •

• Environments

Very common 1 in 3 Men > Women Environmental Cause Problems may increase!

Causing many barriers à limits the ability to connect with the human world through language

– Install carpeting in the house – Replace noisy appliances

• Reading lips • Avoid elderspeak – a mode of communication used with older adults who seem to be physically impaired.

– Involves speaking loudly and with slow, exaggerated pronunciation

• Prevention is key à AVOID EXCESSIVE NOISE!

Motor Abilities Changes: • Slowness – Loss in info processing speed – Primary reason for prejudices à people get annoyed by lack of their ability to keep up with the fast-paced, task-oriented society

• Reaction time – Cause issues with quick decision making

• Skeletal structures – – – –

Osteoarthritis: joints Osteoporosis: bones Women > Men Hip fractures

Interventions: • Exercise – Can help prevent falling

• Keep ADL problems from developing or getting worse – Aids help: scooters!

• Remodel house – Indirect lighting – Low-pile, wall-to-wall carpeting – Grab bars

• Careful in speed-oriented situations

Driving in Old Age Vision, hearing, and reaction-time problems converge to make driving more dangerous especially in the old-old years

Issues and Solutions The problem: Means loss of independence – – –

Driving is essential in a car-oriented society Prevents elderly person from getting to doctor or going to the store Can mean having to enter a nursing home

Potential solutions: – –

–

Some advocate for yearly license renewals along with vision tests Changing driving conditions P Larger signs, better lighting on exit ramps, etc.

P Extending yellow light signals P Roundabouts Construct less care-dependent communities P Build communities with stores within walking distance of homes

Caring for the Elderly • Institutionalization • Alternatives to Institutionalization: • Continuing-care retirement

ü Residential complex that provides different levels of services from

independent apartments to nursing home care, designed to provide personenvironment fit, allows person to not burden family

• Assisted-living facilities

ü For those experiencing ADL limitations but don’t need 24-hour care, less medicalized/more homey setting, private rooms and personal furniture

• Day-care programs

ü For elderly who live with family, place to go when caregivers are working, helps family continue to care without giving up other responsibilities

• Home health services

ü Paid care givers provide help with ADLs cooking, cleaning, bathing in home

Institutionalization Nursing homes or long-term care facilities – – – –

Designed for people with basic ADL impairments Provides 24-care intensive care Residents are mainly very old and female Entry often occurs after trauma: P such as breaking a hip P when the person has dementia – People without families (or the money for assisted-living facilities) are most at risk of entry

Evaluating Nursing Homes Nursing home system is often misunderstood and misrepresented • Myths include: – often viewed as “dumping ground” – abuse is widespread – residents are poorly care for until they die

• Movement to change nursing home culture – person-centered – attentive to resident’s individual years

• However can vary dramatically in quality – Research shows 1 in 4 nursing homes provide substandard care

Nursing Home Providers Certified nurse assistant or aid – the front-line care provider in a nursing home, who helps elderly residents with basic ADL problems – Like child-care workers, these health-care providers have very low wages – Facilities are often understaffed – Care that these caregivers provide is tedious and time-consuming (feeding residents, assisting to the bathroom) – Research suggests that most get a true sense of satisfaction with their work

Death and Dying

Different Death Pathways Three Paths: Death without any warning ü ü

Accident Sudden, fatal, age-related event

Steady decline ü

Fatal disease

Erratic course ü ü ü

Fatal disease takes years with many ups and downs Most common dying pattern Typically helped by medical technology

Stages of Dying Kϋbler-Ross found: 1. Open communication is important 2. Dying people pass through five emotional stages • Denial – Person may believe the diagnosis was a mistake – May try to get several “second opinions”

• Anger – Person may lash out, maybe even at the doctor

• Bargaining – Person may plead for more time, often to God – Makes promises to be “good” if death is delayed

• Depression – Person becomes distraught by the thought of his or her death

• Acceptance – Final stage where the person begins to accept his or her fate

Issues with Stages of Death Theory It was seen as rigid and simplistic. Therefore, it may not be accurate for all people

Issues: – Not all terminally ill patients want to discuss their situation P Do not assume that every terminally ill patient will want to discuss his or her condition P Person may want to focus on quality of personal relationships as opposed to such a painful issue

– Not every culture feels it is appropriate to openly discuss death P Western culture says knowing is important, but the amount of information that is shared differs

– Not every person passes through distinctive stages adjusting to death P Feelings may be missed or minimized as “a phase”

The More Realistic View: Differing Emotions • Dying people experience many emotions (but not in predictable stages) • Some experience a state middle knowledge: terminally ill people know they are dying but can not fully grasp it emotionally • Hope is often the main emotion until the very end – This is contradictory to Kϋbler-Ross’s final stage of “acceptance” • Some are energized and feel more alive, often reevaluating life goals • The elderly typically report no fear of death, although they are afraid of the pain of dying

“Good” Death Markers: 1.

2.

3.

4.

Free of Debilitating Pain Feeling “In Control” Enhanced Relationships Spirituality, Integrity, and Purpose

Taking Control Of Death Two strategies for taking control of a person’s ability to achieve a “good death” – Advance Directives – Euthanasia

Advance Directives Written document spelling out instructions with regard to life-prolonging treatment if the person becomes irretrievably ill and cannot communicate his or her wishes Four types: 1. Living wills spells out a person’s wishes for life-sustaining treatment in case he or she becomes permanently incapacitated and unable to communicate

2. Durable power of attorney for health care person designates a specific surrogate to make health-care decisions if he or she becomes incapacitated and unable to make his or her wishes known

3. Do Not Resuscitate Orders (DNR) advanced directive completed by surrogates (typically doctors in consultation with the family) for an impaired person, specifying that no efforts will be made to revive him or her in case of cardiac arrest

4. Do Not Hospitalize Orders (DNH) advanced directive put into the charts of impaired nursing home residents, specifying that in a medical crisis they should not be transferred to a hospital for emergency care

Euthanasia Two Important Distinctions: – Passive euthanasia à withdrawing potentially lifesaving interventions (e.g., feeding tubes) – Active euthanasia à taking action to help the person die

Physician-assisted suicide: a type of active euthanasia in which a physician prescribes a lethal medication to a terminally ill person who wants to die

Issues with Active Euthanasia Surveys indicate support for “restricted” active euthanasia – If person is terminally ill and in pain – However, there is resistance to making it a legal practice Legalizing euthanasia may lead to: – Violating the religious injunction against suicide – belief that only God can give or take a life – Involuntary euthanasia – doctors terminating treatment for people who do not want to die – Person might be pressured into deciding to die by unscrupulous family members – Person might be seriously depressed, and would not want to die if the depression were treated