Lecture 11: physical and cognitive development in late adulthood Flashcards Preview

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Flashcards in Lecture 11: physical and cognitive development in late adulthood Deck (38):

Ageing and Ageism 

   • Treatment, stereotyping, discrimination because of someones age

• More stereotypes about old people than any other age group

• Older people also have ageist views
   • See themselves more positively than their peers

• May impact on treatment recommendations and expected outcomes 


Life Expectancy 

• Maximum lifespan is about 120 years
• Increased life expectancy means that more people are approaching that limit
• Centenarians = .02% of population

• Super centenarians

   • People 110 years+
• Average lifespan not expected to exceed 85

• Biological limitations 


Theories of Ageing 


Programming theories

Senescence (deterioration with age) explained by:

Cellular theories:

• Wear and tear

• Genetic errors

Programming theories:

Hayflick limit – 50 replications
• Death built-in
• Nothing can extend the lifespan 


Physical Functioning 

Primary ageing

Secondary ageing

Primary ageing – universal changes
Secondary ageing – effects of illness and disease
• Motor, sensory, intellectual slowing

     • Primary ageing of CNS and PNS

     • Can improve with training

• Skin, bone, and muscle changes

• Cardiovascular, respiratory and sensory systems change 


Sensory Change 

men lose their hearing more than women because they are exposed to more environmental hazards

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Improving Health Behaviours in Late Adulthood 

  • sleeping an average of 7-8 hours nightly
  • eating breakfast almost every day
  • seldom, if ever, eating snacks
  • controlling weight
  • exercising regularly
  • limiting alcohol consumption
  • being a nonsmoker for life



Current Research: Australian Longitudinal Study of Ageing  (ALSA)

• Australian Longitudinal Study of Ageing (Flinders University)

• Began 1992 with 2087 participants aged 70+ years in South Australia

• Aim: gain an understanding of how social, biomedical, and environmental factors are associated with age-related changes in health and wellbeing of elderly individuals



Chronic Illnesses: Cardiovascular Disease 

Risk factors

Coronary heart disease, heart failure, stroke and peripheral vascular disease

Risk factors:
• Family history
• Smoking, poor diet, lack of exercise

• Personality type
• Stress
• Gender 


Chronic Illnesses: Hypertension 

Risk factors

• High blood pressure

   • Systolic BP > 140
   • Diastolic BP > 90

• Deterioration of arterial walls (continued high blood pressure)

   • Arteriosclerosis

• Risks of heart attack, kidney damage, stroke

Risk factors

• Gender, genetics, obesity, poor diet, stress, personality characteristics 


Chronic Illnesses: Cancer 

Risk factors

• Uncontrolled cellular growth, dysfunction of DNA

• Malignant tumours
   • Spread through metastasis

Risk factors:

• SES, genetics, gender, lifestyle, diet

• Life events, negative affect, personality, social support, isolation, stress 


Chronic Illnesses: Arthritis 

• Inflammation of joints and connective tissue

   • Pain, stiffness, sometimes swelling

• Osteoarthritis
   • Degenerative joint disease

• Rheumatoid arthritis
   • Autoimmune reaction

   • Affects whole body

• Stress makes condition worse 


Mental Health Issues: Depression 

Associates of depression

• Mental disorders underestimated and undertreated in older adults

    • Stoicism limits reporting
• Most common disorder is depression

    • May be mistaken for normal ageing

    • Symptoms may mimic dementia

• Associates of depression

   • Chronic health issues, functional impairment, social deprivation, medication 


The Ageing Brain 


Acute and Chronic brain syndromes

  • Neuronal loss and growth
    • Axon sprouting, dendrite branching, synaptogenesis (growth)
    • neurofibrillary tangles, granulovacuolar degeneration (loss)
  • Pseudodementia: mimic symptoms of dementia (depression etc)
  • Brain syndromes:
    • Acute: caused by e.g., diabetes, liver failure
    • Chronic: e.g., multi-infarct dementia and Alzheimer’s disease 


Multi-infarct Dementia 

Caused by vascular disease

• Risk factors include hypertension, diabetes mellitus, advanced age, being male and smoking

• Blockage of oxygen to brain causes tiny strokes

• Sudden rather than gradual onset

• May have periods of lucidity 


Alzheimer’s Disease (AD) 

• 50-60% of organic brain syndrome patients over 65 have AD

• Degeneration of brain cells affecting memory, learning, and judgement

• Symptoms worsen with disease progression

• Care in controlled environment
• Causes and cures not understood 


Symptoms of Alzheimers Disease

• Memory impairment
• Deterioration of language
• Deficits in visual and spatial processing
• Repeating of questions
• Everyday tasks unfinished or forgotten
• Personality change (rigidity, egocentricity)

• Irritability or anxiety
• Lack of concentration 


Risk Factors for Alzheimers Disease 

• Chronological age
• Gender
• Vascular conditions
• Low education
• Head injury
• Biological susceptibility 


Memory Changes 

• Anticipatory dementia
• Gradient of vulnerability

   • Some memory processes change more than others

Memory changes:

• Working memory – age deficits
• Episodic memory – steady decline

• Semantic memory – largely intact
• Procedural memory – least change 


Erikson: Ego-integrity vs. Despair 

• 8th and final critical stage of psychosocial development

• People in late adulthood either achieve a sense of integrity of the self by accepting the life they have lived, and thus accept death, or yield to despair that their life cannot be re- lived 


Erikson: Ego-integrity vs. Despair 

Life Review

Life Review: Reminiscence about one’s life in order to see its significance

• Writing or taping autobiography
• Constructing a family tree
• Looking over scrapbooks and old letters

• Trips to childhood locations
• Reunions with friends and family 


Attitudes Towards Death 

Death awareness movement

• Death most likely to be in institutions
   • Often removed from everyday life
   • The dying may experience social death

• Language about death often full of euphemisms

Death awareness movement (70s)

• New meanings for death and dying
• Cultural analysis of attitudes
• Promoted the notion of the good death 


Defining Death 

• Previously absence of respiration and heartbeat

• Now criteria focus on brain death

   • Irreversible coma

• Definition critical for issues of organ transplant

• Conflicting views in Japan and North America

   • Reflection of cultural views on death 


Accepting One’s Own Death 

• Death becomes more salient with age

Earlier death experiences

• Death of sibling in childhood
• Death of friends or peers in adolescence

• Death of cultural icons

Death acceptance (Wong, Reker, & Gresser, 1994):

• Neutral acceptance
• Approach-avoidance acceptance

• Escape-avoidance acceptance 


Death Anxiety 

Terror Management Theory

Terror Management Theory
• Defensive reactions are a key human motive

• Adherence to own cultural worldview increases as death becomes more salient 


Differences in Death Anxiety 




Age differences
• Some evidence of decline with age

Gender differences

• Conflicting results

Religiosity differences
• Strong and low religiosity relates to lower anxiety than medium religiosity
• Specific religious beliefs about death important 


Kübler-Ross’ Five Stages in Coping with Death 

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Quality of Death 

Seven domains of experience of death (Hales, Zimmerman, & Rodin, 2008)

Seven domains of experience of death (Hales, Zimmerman, & Rodin, 2008):

• Physical
• Psychological
• Social
• Spiritual or existential
• Nature of health care
• Life closure and death preparation

• Circumstances of death 


Experience of Death 

western good death

  • Western attributes of a good death
    • Control, comfort, closure, values and beliefs honoured, trusting in care providers, recognising impending death, minimising burden, and optimising relationships
  • Death awareness movement
    • Open rather than closed awareness
  • “Respecting Choices”
    • Advanced care planning 


Caring for the Dying 

• Importance of the hospice movement

Difficulties with home death:

• Intensive care needs of dying person

• Hard to arrange round the clock care

• Family conflict, unresolved anger
• Cognitive impairment

Home care appropriate when person:

• Is alert
• Can benefit from familiar surroundings 


Hastening Death 

Euthenasia, Passive and Active

Euthanasia: intentional ending of life

   • Unendurable, crippling, final, terminal

• Voluntary or involuntary

Passive or active:

• Passive: withholding or discontinuing treatment to end suffering or allow death with dignity

• Active: deliberate action taken directly to shorten life of terminally ill person to allow death with dignity (mercy killing)

Concerns about slippery slope 


Advantages and Disadvantages of Legalising Euthanasia 

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Advantages and Disadvantages of Legalising Euthanasia 2

more negatives than positives

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Bereavement and Grief 

• The process of adjusting to the loss of someone close
• Change in status, role, and social and economic circumstances

• Emotional response experienced in early phase of bereavement

• Loss of primary relationships
• Relationships of attachment
• Relationships of community

Losses are not equivalent
• Girls impacted more by death of siblings

• Boys impacted more by death of parents 


Stages of Grief 

Stages of grief:
• Shock, disbelief, denial

• Intense mourning
• Period of restitution

Kübler-Ross’s five stages of coping with death also suggested to apply to grieving

• However, not a predictable, linear process Grief is culture-bound

Individual or collective experience? 


Anticipatory Grief 

• Death process can be prolonged and debilitating

• Many experience intense sadness and grief during caregiving period
• Anticipatory grief more likely when

   • Illness is over a long period

   • Dying person not cognitively intact

• Resilience associated with pre-loss death acceptance 



• Mourning the social experience of grief

• Series of restricted behaviours and obligations

• Few prescriptions as to how to interact with someone who is mourning

• Different expectations for expressions of grief depending on whether it is an on- or off-time loss

• Cultural differences 



Is recovery the appropriate term?
• Maybe resilience, adaptation, reintegration, resolution

Arguments against the term:

   • Does not allow for transformative outcomes

   • Leads to the view of bereavement as a disorganised state

• Outcome depends on meaning of the loss and survivor’s coping resources