Chapter Twenty-Three Late Adulthood: Biosocial Development.
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Transcript of Chapter Twenty-Three Late Adulthood: Biosocial Development.
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Chapter Twenty-ThreeLate Adulthood: Biosocial Development
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Prejudices about late adulthood are held by people of all ages, including children and the very old
Prejudice and Predictions
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Ageism Ageism—a term that refers to prejudice
against older people because of their age
Why is ageism so strong? cultural emphasis on growth, strength, and
progress veneration of youth increasing age segregation
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Gerontology Gerontology—study of old age Geriatrics—The medical specialty
devoted to old age Two Different Perspectives
doctors in geriatrics view aging as an illness
gerontologists view aging as socially constructed problem
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Gerontology, cont.
Contrary to popular belief, many developmentalists now view aging, like all other periods, as marked by gains as well as losses
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Demography
A reason ageism is decreasing is that there are more aging individuals 7 percent of world’s population now
over 65 years 13 percent in developed nations such
as United States
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Demography, cont.
Changing shape of demographic pyramid the population stack has shifted from a
pyramid to a square reflects changes in recent decades—
fewer births and increased survival By 2030 the proportion of those over
65 is projected to double worldwide—to 15 percent
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Dependents and Independence
Dependency ratio—ratio of self-sufficient, productive adults (those between ages 15 and 65) to dependents—children and the elderly the greater the number of
dependents compared to workers, the higher the dependency ratio
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Dependents and Independence, cont.
What are some of the problems cultures may face as baby boomers age? crisis in geriatric medicine
Medicare, Social Security, and quality private health insurance in jeopardy?
entire tax and caregiving burden may fall on shrinking middle cohort
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Reasons Not to Worry Technology and science combining to allow
more production with fewer workers Inverse ratio between birth rates and
longevity Most people over 65 are not dependent
only 5 percent in nursing homes or hospitals elderly married couples take care of each other in other nations, elderly live with their children
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Distinctions based on age, health, and social well-being young-old—healthy and vigorous,
financially secure, active in family and community life
old-old—have major physical, mental or social loses, but still have some strengths
oldest-old—dependent on others for almost everything
Young, Old, and Oldest
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Young, Old, and Oldest, cont.
Some gerontologists like the following terms better optimal aging usual aging impaired aging
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Anti-Aging Measures Aging has many causes
wear and tear cellular accidents declining immune system programmed senescence
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Calorie Restriction Mammals can almost double their life
span if they eat half as much food throughout adulthood proven for mice and rats; probably true
for monkeys, chimps, and dogs true for humans—probably but must be
carefully done Pack more nutrients into fewer
calories
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Calorie Restriction, cont.
Older people take drugs that are considered harmless, but do affect nutritional requirements
Mammals with reduced calorie intake are stronger, more vital, and younger in their appearance as long as they consume adequate vitamins and minerals
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Prejudice and Delusion
Calorie restriction may arise from prejudice and delusion
An important question: what impact would calorie restriction have on the quality of life? would people be constantly hungry,
agitated, irritable?
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Primary Aging in Late Adulthood Primary aging—all irreversible and
universal physical changes over time Secondary aging—physical illnesses
or changes common to aging but caused by individual’s health habits, genes, and other influences
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Primary Aging in Late Adulthood, cont.
People vary in their selective optimization with compensation—the choosing of healthy activities that compensate for primary aging being experienced
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Changes in Appearance Appearance changes as time passes
in ageist society, people who look old are treated as old
children quick to see the elderly as old-fashioned
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Wrinkles, hair changes hair becomes grayer hair all over body becomes thinner
The Skin and Hair
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Alteration in overall body height, shape, and weight
With weight loss may come muscle loss reduces flexibility
Self-perception can lead to a feeling of fragility and a fear of falling
Body Shape and Muscles
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Body Shape and Muscles, cont.
Falls do occur injuries may require medical treatment exercise a very effective preventative
weightlifting should be part of the exercise routine
Flexibility is one of the best predictors of vitality
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Dulling of the Senses Sense Organs
Until a century ago, sensory losses could be devastating
Today, they do not have to be debilitating
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Vision Only about 10 percent of elderly see
well Cataracts—shrinking of lens, causing
vision to be cloudy, opaque, and distorted by 70, 30 percent have some visual loss
due to cataracts
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Vision, cont.
Glaucoma—optic nerve damage, causing sudden and total blindness 1 percent of people in 70s; 10 percent in
90s Senile macular degeneration—retinal
deterioration 4 percent under 75; and 18 percent over
75
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Hearing Presbycusis—age-related hearing
loss 40 percent over 65 experience it
Tinnitis—buzzing or ringing 10 percent of elderly experience it
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Compensation for Sensory Loss Compensation, not passive
acceptance, is crucial Adjustment means finding balance
between maintaining normal activities and modifying routines to fit diminished capacities new technology available specialists help connect techniques,
technology, and people personal determination helps
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Compensation for Sensory Loss, cont.
Critical factor is recognition of the problem and willingness to change
Attitudes make sensory impairments less isolating
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Compensation for Sensory Loss, cont.
Younger adults and social practices have not caught up medical insurance may not pay for
devices or counseling elderspeak—way of speaking to elderly
that resembles baby talk simple, short sentences exaggerated emphasis slower rate, higher pitch, and repetition
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Major Body Systems Primary and secondary aging combine to
make all major body systems slower and less efficient, eventually causing death
Exercise/physical activity is beneficial helps maintain strength of heart muscle and
lungs lack can lead to heart attack improves overall quality of life
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Compensation entails medical technology specialist advice personal determination cultural accommodation
Compensation for Aging Organs
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Compression of Morbidity Compression of morbidity—
increasing time for better quality of life without diseases or disability and once morbidity occurs, reducing amount of time remaining before death
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Compression of Morbidity, cont.
Healthier person likely to be intellectually alert socially active
Medical science has made compression of morbidity possible still, each individual must do his or her part
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Theories of Aging
Many Theories of Aging (300) we will look at two
Wear and Tear Genetic Aging Theory
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Wear and Tear Theory Compares body to machine Body wears down because of
accumulated exposure to inadequate nutrition, disease, pollution, and other stresses women who are never pregnant live longer overweight people tend to sicken and die
younger today there are replacement “parts”
Wear out our bodies by living our lives
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Genetic Aging What makes entire body age?
focus on whole body rather than individual parts Some theorists propose that aging is the
normal, natural result of the genetic plan for the species
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Genetic programming to reach biological maturation at fixed times and genetically programmed to die after a fixed number of years
Maximums and Averages maximum life span (humans 115) average life expectancy
affected by culture, historical and socioeconomic factors
Life Expectancy
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Epigenetic theory provides some explanations for primary aging
Early adulthood: only nongenetic events are likely to cause death
Genetic diseases that affect older people may be passed on from generation to generation
Selective Adaptation
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Cellular Aging
Cellular Accidents accumulation of minor accidents that occur
during cell reproduction cause aging mutations occur in process of DNA repair
instructions for creating new cells become imperfect
cellular imperfections and declining ability to detect and correct them can lead to harmless changes, small functional loss, or fatal damage
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Free Radicals Some of body’s metabolic processes can
cause electrons to separate from their atoms and can result in atoms with unpaired electron—oxygen free radicals can produce errors in cell maintenance and
repair, leading to cancer, diabetes, etc. Antioxidants—compounds that nullify the
effects of oxygen free radicals by forming a bond with their unattached oxygen electron vitamins A, C, and E, mineral selenium
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Errors in Duplication Hormonal changes triggered in brain
that switch off the genes promoting growth
The Hayflick Limit genetic clock—according to one theory of
aging, a regulatory mechanism in the DNA of cells that regulates the aging process
cells stop replicating at a certain point Evidence for genetic regulation from
diseases producing premature aging
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The Immune System Diminished immune system is
weakened Two types of attack cells reduced in
numbers B cells in bone marrow, which create
antibodies that attack invading bacteria and viruses
T cells, which produce substances that attack infection
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Scientific support for the immune system theory comes from research on HIV/AIDS HIV can be latent for many years, but
eventually becomes AIDS Individuals with weakened immune
systems do not live as long as those with stronger immune systems; thus, immunity not simply result of aging
Research on Immune Deficiency
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Who Cares About Living Longer?
Most people are not interested in living longer evidence for lack of interest found in daily
habits of many adults in research budgets, less money spent on
preventing aging than on treating diseases people would rather have better quality of
life than lengthen it
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The Centenarians People 100 years of age or older
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Other Places, Other Stories Remote regions where large numbers
of people have unusual longevity have been found in Georgia, Russia Pakistan Peru
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Other Places, Other Stories, cont.
Regions share 4 characteristics diet is moderate, mostly veggies and herbs work continues throughout life family and community are important exercise and relaxation part of daily life
But birth records of these regions not verifiable
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The Truth About Life After 100 Habits and culture allow for better
aging Increasing numbers are reaching
this age some in very good health centenarians have shorter period of
morbidity before death
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Chapter Twenty-Four
Late Adulthood:Cognitive Development
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Changes in Information Processing Schaie’s study found decline in all 5
primary mental abilities verbal meaning spatial orientation inductive reasoning number ability word fluency
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Input: Sensing and Perceiving With age it takes longer for information
to register in sensory register—holds incoming sensory information for a split second after it is received small reductions in sensitivity and power
sensory receptors (eyes, ears, etc.) now less acute
deficits can be compensated for if person is aware of reduction
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Input: Sensing and Perceiving, cont.
However, for information to reach perception, must cross sensory threshold senses must pick up relevant sensations this is where significant decline occurs
problem becomes serious because it is insidious person is unaware of things not seen or heard after time may miss substantial amount of information
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Working Memory Working, or Short-Term Memory
processing component through which current, conscious mental activity occurs
Two Interrelated Functions serves as temporary information storage processes information held in mind
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Working Memory, cont.
Older adults: smaller working memory capacity than younger adults multitasking especially difficult; focusing
helps to compensate Explanations for Decline
inability to screen out distractions and inhibit irrelevant thoughts
decline in total mental energy
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Long-Term Memory Knowledge Base
long-term storehouse of information and memories
evidence suggests memory for vocabulary remains unimpaired and can increase with age
areas of expertise relatively unimpaired Source amnesia—forgetting who or what
was source of fact, idea, or conversation increasingly common in late adulthood
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Control Processes Part of the information-processing system
that regulates analysis and flow of information e.g., selective attention, retrieval strategies,
storage mechanisms, logical analysis Older adults unable to gather and consider
all data relevant to logical analysis and decision making rather, they rely on prior knowledge, rule-of-
thumb, general principles
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Control Processes, cont.
Use of retrieval strategies also declines with age possible to learn better retrieval
strategies, but does not overcome age-related problems in memory and control
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Explicit and Implicit Memory Explicit memory—involves facts,
definitions, data, concepts, etc. learned consciously through deliberate
repetition and review because of rehearsal, usually easily retrieved
Implicit memory—information that is an unconscious or automatic memory such as habits, emotional responses, routines contents not deliberately memorized
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Resistance Rather than direct result of aging,
decline may be result of refusal to guess deliberate choice resistance to change reluctance to use memory aids
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Reasons for Age-Related Changes
Causes of declines in cognitive functioning primary aging secondary aging ageism
either reflected in self-perception or embedded in way scientists measure
cognition
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Primary Aging Brain Slowdown
reduced production of neurotransmitters that allow nerve impulses to jump across synapse from one neuron to another
decrease in total volume of neural fluid decrease in speed of cerebral blood flow slower pace of activation of various parts of cortex
Slowdown may affect learning new material, but the types of thinking not involving speed are less affected
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Compensation Strategies of Older Adults
employ memory tricks use written reminders allow for more time to solve problems repeat confusing instructions
Older adults slower but not less accurate than younger adults
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Terminal Decline Overall slowdown of cognitive abilities
in days or months before death marked loss of intellectual power results not from age—rather from being
close to death Change in cognitive ability and
increased depression often precede visible worsening of health
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Secondary Aging Several diseases impair cognition
among aging dementia, hypertension, diabetes,
arteriosclerosis, and diseases affecting lungs
Lifestyle habits contribute to these diseases poor eating, smoking, lack of exercise
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Secondary Aging, cont.
Brain deterioration due to poor lifestyle habits can be halted by improved nutrition and exercise various drugs, e.g., long-term use of anti-
inflammatory steroids aspirin and ibuprofen
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Attitudes of the Elderly Influence of Expectations and
Stereotyping people aged 50–70 overestimate their
early adulthood memory skills, which can lead to loss of confidence that impairs present memory
confidence in memory skills also eroded when others interpret hesitancy as sign of impaired memory
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Ageism in Research Laboratory research may favor younger
adults, rather than older because older adults at intellectual best early in day at
home Experiments on memory biased toward
people used to being tested in school setting, young adults regularly memorize
information not immediately relevant to daily life older adults unpracticed at, and may be
suspicious of, exams
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Beyond Ageism Laboratory research on memory
uniformly reports some memory loss in late adulthood
but few older adults consider memory loss significant handicap Compensate by using reminders the more realistic the circumstances, the
better older people remember supportive environments aid memory
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Dementia Dementia—irreversible loss of intellectual
functioning caused by organic brain disease
Symptoms confusion and forgetfulness
More common with age More than 70 diseases can cause
dementia Difficult to diagnose
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Alzheimer’s Disease Disorder characterized by
proliferation of plaques and tangles abnormalities in cerebral cortex that
destroy brain functioning Plagues formed from protein called B-amyloid Tangles are twisted mass of protein threads
within cells
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Risk Factors for Alzheimer’s Gender, ethnicity, and especially age
affect odds of developing it women at greater risk than men more common in North America and
Europe than in Japan and China less common among Asian Americans
than European Americans
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Risk Factors for Alzheimer’s, cont.
Age is chief risk factor incidence rises from about 1 in 100 at age
65 to 1 in 5 over age 85 Alzheimer’s is partly genetic
ALZHS—variant of the ApoE gene (allele 4)—increases risk in United States, 20 percent inherit ApoE4
from one parent; thus, have a 50/50 chance of developing disease by age 80
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Risk Factors for Alzheimer’s, cont.
Factors decreasing risk allele ApoE2 dissipates protein that
causes plaques lifestyle habits (e.g. physical exercise
and mental activity) said to be protective
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Stages: From Confusion to Death
Stage 1 general forgetfulness
Stage 2 more general confusion noticeable differences in concentration
and short-term memory speech can be aimless or repetitive
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Stages: From Confusion to Death, cont.
Stage 3 memory loss becomes truly dangerous no longer able to take care of own basic
needs Stage 4
need for full-time care as cannot care for self or respond normally
occasionally irrationally angry or paranoid
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Stages: From Confusion to Death, cont.
Stage 5 completely mute unable to respond with any action or
emotion death usually occurs 10 to 15 years
after onset
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Many Strokes Vascular Dementia or Multi-Infarct
Dementia characterized by sporadic, progressive, loss
of intellectual functioning temporary obstruction of blood vessels
prevent sufficient supply of blood to brain; commonly called a stroke, or ministroke
common cause is arteriosclerosis different progression than that of
Alzheimer’s
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Subcortical Dementias Begin with motor ability impairments
and later produce cognitive impairment
Parkinson’s disease most common degeneration of neurons in area of brain
that produces dopamine, neurotransmitter essential to normal brain functioning majority of newly diagnosed over 60
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Subcortical Dementias, cont.
Other Dementias Huntington’s disease multiple schlerosis
Toxins and infectious agents can cause dementia syphilis AIDS psychoactive drugs
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Reversible Dementia From Overmedication
drug management difficult for older adults living at home who typically consume 5 or more different drugs a day
From Undernourishment can cause vitamin deficiencies which lead
to depression confusion cognitive decline
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Psychological Illness Anxiety, antisocial personality and bipolar
disorders, schizophrenia, depression less common among the elderly
higher mortality rates for people with those illnesses illnesses themselves become less severe in later life
Mental illness can produce what seems like dementia but is not e.g., depression, anxiety careful diagnosis can differentiate
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New Cognitive Development in Later Life Theorists believe older adults can develop
new interests patterns of thought deeper wisdom
Aesthetic Sense and Creativity many older people gain appreciation of nature
and of aesthetic experience as for people already creative, they generally
continue to be productive; often experiencing renewed inspiration
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The Life Review Many older people do a life review—the
examination of one’s own past life helps older people connect their own lives
with the future as they tell their stories to younger generations
renews links with past generations, as older people remember ancestors
process is more social than solitary crucial to self-worth that others recognize its
significance
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Wisdom Are older people typically wiser? But first, what is wisdom?
broad, practical, comprehensive approach to life’s problems, reflecting timeless truths
expertise in life fundamentals, permitting exceptional insight and judgment in complex and uncertain matters
Research found little correlation between wisdom and age, although attributes like humor, perspective, altruism may increase
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Chapter Twenty-Five
Late Adulthood: Psychosocial Development
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Theories of Late Adulthood• Three Types of Theories
– self theories– stratification theories– dynamic theories
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Based on premise that adults make choices, confront problems, and interpret reality to be themselves as fully as possible people begin to self-actualize, as Maslow
described it each person ultimately depends on
himself or herself
Self Theories
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Integrity Versus Despair Erikson’s eighth and final stage—
Integrity vs. Despair older adults seek to integrate their unique
experience with their vision of community Ideally, reality of death brings “life-
affirming involvement” in present The more positively a person feels
about him- or herself, the less depression or despair is felt
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Identity Theory Identity Challenged in Late Adulthood
as health, appearance, employment, crumble Two Extremes of Coping
identity assimilation—new experiences incorporated into stable sense of identity distortion of reality and denial anything major
changed identity accommodation—altering self-
concept to adapt to new experiences viewed as an over-adjustment
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Selective Optimization Older person chooses to cope with
physical and cognitive losses Older person makes selective
changes to cope with losses This readiness to make changes is a
measure of strength of the self
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Support From Behavioral Genetics Behavioral genetics support self
theories twin studies: some inherited traits more
apparent in later adulthood Power of genetics extends beyond the
environments we seek even self-concept, including assessment
of abilities, partly genetic but environment always plays major role
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Stratification Theories Social forces limit individual
choice and direct life at every stage, especially late adulthood
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Stratification By Age Disengagement Theory vs. Activity Theory Disengagement theory—aging increasingly
narrows one’s social sphere, resulting in role relinquishment, withdrawal, passivity
Activity theory—elderly people need to remain active in a variety of social spheres—with relatives, friends, and community groups. If elderly withdraw, they do so unwillingly due to ageism dominant view now supports activity theory
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Stratification by Gender and Ethnicity Sexual Discrimination Feminist theory draws attention to
gender divisions demographics make aging women’s issue because most social structures and
economic policies have been established by men, women’s perspectives and needs not always given a high priority, or even recognized
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Stratification By Gender and Ethnicity, cont. Many older women impoverished because of
male-centered economic policies pension plans based on continuous employment;
more unlikely to be situation for women with children
medical insurance pays more for acute illness (more common in men) and less for chronic disease (more common in women)
women more likely to be caregivers for frail relatives, often sacrificing their independence and well-being
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Stratification By Gender and Ethnicity, cont. Critical race theory views ethnicity and race
as social constructs whose usefulness is determined by one’s society or social system
Ethnic discrimination and racism cause stratification, shaping experiences of both minorities and majorities minority elderly more likely to be poor
and frail less access to senior-citizen centers,
clinics, etc.
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Better Female, Non-European, and Old? Positive Effects of Non-European
American’s Strong Familism: fewer elderly in nursing homes elderly feel more respected elderly feel more appreciated by families in one study, minority women outlived
majority women who were economically better off but had less family support
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Better Female, Non-European, and Old?, cont.
Current stratification effects may not apply to cohort shift happening now more women are working younger African-Americans less strongly
tied to church and family and have fewer children
To better understand stratification theory, we need to take a multicultural perspective
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Dynamic Theories Dynamic theories—emphasize change
and readjustment rather than either the ongoing self or legacy of stratification
Continuity theory—each person experiences changes of late adulthood and behaves towards others in much the same way as he or she did earlier in life adaptive change dynamic response
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Keeping Active Reality of older people’s lives does
not correspond exactly with either disengagement or activity theories
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Chosen Activities Employment has many advantages,
but it is not typically something person has a choice about doing
One positive aspect of retirement: allows freedom to be one’s own person—to choose one’s main activities e.g., in areas of education, helping
others, religion, politics
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Continuing Education Elderhostel—program in which people aged
55 and older live on college campuses and take special classes usually during college vacation periods
Around the world, thousands of learning programs filled with retirees
Many elderly hesitate to take classes with mostly younger students if they overcome this fear, typically find they
earn excellent grades
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Volunteer Work Higher percent of elderly adults have strong
commitment to their community and believe they should be of service older adults especially likely to volunteer to
assist the young, very old, or sick 40 percent of the elderly are involved in
structured volunteering many of the other 60 percent volunteer
informally elderly benefit, but not if forced to volunteer
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Religious faith increases with age increase in prayer and religious practice
Research shows religious institutions are particularly important to older Americans who may feel alienated from overall society
Religious Involvement
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Political Activism Elderly more so than any other age group Know more about national and local issues Political participation translates into power
ARRP—major organization representing elderly, is largest U.S. special interest group
Most elderly are interested in wider social concerns—e.g., war, peace, the environment
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Home, Sweet Home Many busy maintaining home and yard Some move, but most want to age in
place, even if adult children have moved far away naturally occurring retirement community
(NORC) created when they stay in neighborhood they moved into with young children
One result of aging in place is that many elderly live alone
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The Social Convoy Social Convoy—collectively, the family
members, friends, acquaintances, and even strangers who move through life with an individual We travel our life in the company of others Special bonds formed over lifetime help in
good times and bad People who were part of a person’s past
help him or her to maintain sense of identity
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Long-Term Marriages
Spouse buffers many problems of old age
Married elders generally are healthier wealthier happier
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Long-Term Marriages, cont.
Nature of long-lasting relationships tends to get better over time sharing of accumulated experiences affectionate acceptance of each other’s
frailties with feelings of affection passionate love still exists
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Divorce is rare in late adulthood Widowhood is common Death of a spouse eventually occurs
for half of all older married people Adjustment to loss varies depending
on sex of surviving partner Many older widows come to enjoy
their independence
Losing a Spouse
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4 x as many widows as widowers Because women take better care of
their health, they live longer than men Husband’s death is never easy Death can mean loss of close friend,
social circle, income, and status Widows do not usually seek another
husband
Widows
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Living without a spouse is more difficult for men
Widowers often lack social support Historical gender differences make
adjustment more difficult have restrictive notions of masculine
behavior
Widowers
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Widowers, cont.
Over course of marriage, tend to become increasingly dependent on wives for social support of all kinds
After death of spouse, more likely to be physically ill than widows or married people of their age
Many widowers prefer not to remarry, but with favorable gender ratio and loneliness, often find themselves more likely to remarry than widows
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Men are lonelier than women Those without partners are lonelier
than those with partners Divorced or widowed are lonelier Recent losses heighten loneliness The more partners lost, the lonelier
one is
Differences in Loneliness
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Friendship 4 percent of people over 65 have never
married most married cohort in U.S. history
Never marrieds quite content contentment is linked more to friends than family
Older women do more befriending Even oldest adjust to changes in social
convoy Many elderly keep themselves from being
socially isolated
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Younger Generations Typical older adult has many family
members of many ages As more families have only one child,
that child grows up with no aunts, uncles, siblings, etc. relationship across generations may
become more important
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Younger Generations, cont. Relationships with younger generations
generally positive, but can include tension or conflict Few older adults stop “parenting” Mother-daughter relationship is close but also
vulnerable Assistance arises from both need and
ability to provide it Personal contact depends mostly on
geographic proximity
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Younger Generations, cont.
Affection is influenced by a family’s past history of mutual love and respect
Sons feel strong obligation, while daughters feel stronger affection
Cultures and families vary markedly—there is no right way for generations to interact
Assistance typically flows from older generation to their children
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The Frail Elderly Defined as—over 65, physically
infirm, very ill, or cognitively impaired
Activities of daily life (ADLs) bathing, walking, toileting, dressing,
and eating inability to perform these tasks sign of
frailty
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The Frail Elderly, cont.
Instrumental activities of daily life (IADLs) vary from culture to culture require some intellectual competence in developed countries: phone calls,
paying bills, taking medication, shopping for groceries
in rural areas of other nations: feeding chickens, cultivating the garden, getting water from the well
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Increasing Prevalence of Frail Elderly At any moment, no more than 2 percent of
world population are frail elders Increasing number for 4 reasons
more people reach old age medical establishment geared toward death
prevention rather than life enhancement medical care now prolongs life measures that could prevent or reduce
impairment often unavailable to people with low incomes
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Age and Self-Efficacy Active drive for autonomy, control, and
independence best defense against becoming dependent
Loss of control invites further weakness Both one’s attitudes and social
structures influence outcomes Cultural forces become more important Protective buffers help
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Caring for the Frail Elderly Most are cared for by relatives
In North America, 60 percent, by family and friends
Other 40 percent, combination of family, friends, and professional care
Current U.S. trend: husbands and wives care for each other until this becomes impossible
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The Demands of Family Care Toll of home caregiving is heavy
caregiver’s physical health suffers and depression increases
caregiver often has to give up other activities
when caregiver is appreciated by others for efforts, he or she may feel fulfilled by the experience
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Demands of Family Care, cont.
Caregivers may feel resentful if only one person is giving care while
others do little or nothing when caregiver and receiver often
disagree if dealing with public agencies, which
rarely provide services until the need is so great that it may be too late
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When caregiver has feelings of resentment and social isolation, he or she typically experiences stress, depression,
and poor health may be more likely to be abusive if he or
she suffers from emotional problems or substance abuse that predate the caregiving
other risk factors: victim’s social isolation, household members’ lack of education and/or poverty
Elder Abuse
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Elder Abuse, cont.
Maltreatment usually begins benignly but can range from direct physical attack to ongoing emotional neglect
Frail elderly particularly vulnerable to abuse Most abuse is perpetrated by family
member(s) Simplest form is financial—a relative or
stranger gets elderly to sign over life savings, deed to house, or other assets
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Nursing Homes Most elderly want to avoid them at all costs
believe they are horrible places In U.S., the worst tend to be those run for-
profit, where patients are mostly on Medicare and Medicaid But, overall, abuse has been reduced
In the United States and Europe, good nursing-home care available for those who can afford it
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Epilogue
Death and Dying
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Deciding How to Die Practices and rituals relating to dying,
death, and bereavement are universal, but there are variations
Rituals may be changing with globalization
One of first steps in understanding death is to accept it for most of human history, death accepted
as unanticipated, unavoidable, and quick today, because of medical miracles, death
less of everyday event
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Medical Professionals As illness came to be perceived as a
domain of medicine rather than of religion, we began to believe physicians could work medical miracles
Elizabeth Kübler-Ross brought solid research and compassionate attention to the psychological needs of the dying
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Medical Professionals, cont.
In the early 21st century, only 1/2 of medical books discuss care of dying
In recent years, more physicians are more accepting of death
3 innovations are helping to help the dying achieve a “good death” hospice care palliative care end-of-life decision making
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Hospice Care Hospice—institution where terminally
ill patients receive palliative care provides skilled medical treatment, but
avoids death-defying interventions human dignity respected
Dying person and the family are considered to be the “unit of care” sometimes then the home is where care
given
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Hospice Care, cont.
Hospices try to help as many people as possible, but do not reach everyone patients must be diagnosed as terminally ill patients and caregivers must accept diagnosis
of terminal illness hospices were typically designed for adults
with terminal cancer, not older adults with severe illnesses
hospice care is expensive availability depends mainly on location
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Palliative Care Designed mainly to relieve pain and
suffering of patient and family Double effect—primarily relieves
pain, but could also hasten death Psychological symptoms of patients
and their families more difficult to treat depression, anxiety
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Legal Preparations Explicit guidelines for a person’s
preferences for end-of-life care are needed because he or she often becomes incapable of making or expressing decisions about medical care
Passive euthanasia—situation in which a seriously ill person is allowed to die naturally via cessation of medical interventions
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Legal Preparations, cont.
Active euthanasia—a situation where someone takes action to bring about another’s death, with the intention of ending that person’s suffering
Living will—document that indicates what medical intervention should occur
Health care proxy—the person chosen to make medical decisions if the person who chose becomes unable to make his/her own decisions
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Living wills are only a start Hospitals today ask about living wills
and advance directives upon admission some people resist signing them
End-of-life care involves probabilities, not certainties, until the very last moment
What quality of life is acceptable?
Disagreements About End-of-Life Care
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Disagreements About End-of-Life Care, cont.
Problems with Designated Proxy many proxies choose measures neither
they nor the dying person want may involve clashing cultural values
family members may disagree bitterly about how much suffering is acceptable
even if patient has signed living will and specified proxy, hospital staff may ignore them
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Euthanasia Legally, decisions made in living wills
and by health care proxies are to be honored
Active euthanasia is fiercely controversial, even if the dying person requests it is illegal in almost every part of the world
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Euthanasia, cont.
Physician-assisted suicide—form of active euthanasia in which a doctor provides the means for someone to end his or her life
Voluntary euthanasia—form of active euthanasia in which, at patient’s request, someone else ends his or her life
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Euthanasia, cont.
Several places have legalized physician-assisted suicide the Netherlands Switzerland Belgium Oregon
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Euthanasia, cont.
In Oregon, the following conditions must exist person must be terminally ill—less than 6 months
to live 2 doctors must confirm diagnosis of terminal illness both doctors must certify patient’s judgment
unimpaired person must ask for lethal drugs at least 2x orally
and 1 time in writing 15 days must elapse between first request and
written prescription
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Preparing for Death
Responses to death vary greatly It has been denied, sought, feared,
fought, avoided, and welcomed by all involved
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Avoiding Despair
Kübler-Ross helped us to understand death
Acceptance of death was elusive before Kübler-Ross’s 5 Stages
denial anger bargaining depression acceptance
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Avoiding Despair. cont.
Others that study death (thanatology) have disagreed about the stages
5 stages appear and reappear throughout process
Research has clarified some patterns older people more likely to plan for death concern is more likely to be for a “good
death”—swift, painless, dignified, and occurring at home
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Cultural Variations Hope takes the form of the desire
that death be held at pay can also be expressed as a belief in an
afterlife or the significance of person’s life in context of family and community
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In many traditional African religions, adults gain new status through death and the joining of ancestors
For Muslims, death affirms religious faith life is transitory, so people should be
ready for death at any time
Death in Religions of Africa and Asia
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Death in Religions of Africa and Asia, cont.
For Buddhists, death and disease are among life’s inevitable sufferings may bring spiritual enlightenment
For Hindus, helping the dying to surrender their ties to the world and prepare for the next is a particularly important obligation for the family a holy death is welcomed by dying person eases person into the next life
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Indigenous tribes (over 400) all consider death an affirmation of nature and community values
Jews hope for life to be sustained; thus, death is not emphasized and the dying person is not left alone
Many Christians believe that death is not an end, but rather the beginning of eternity in heaven or heal; so death may either be welcomed or feared
Death in North America
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Religious and spiritual concerns often reemerge at death
It is common for dying people to return to their roots
For many, spiritual beliefs and a connection to community offer hope at time of dying
Spiritual and Cultural Affirmation
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The considerable variations in practices that follow death are due to religion and culture
Bereavement—sense of loss following a death
Coping with Bereavement
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Forms of Sorrow Grief—individual’s emotional response to
bereavement private
Mourning—culturally prescribed ceremonies and behaviors for expressing grief at the death of a loved one public
The two are connected mourning is designed by religions and cultures grief, though personal and private, follows
social rules
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Forms of Sorrow, cont.
Mourning customs are designed by various cultures and religions to channel grief into reaffirmation
Crucial to reaffirmation is people’s search for the meaning in death
Unexpected or violent deaths are particularly likely to shock and to precipitate a search for meaning September 11, 2001
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Mourning has become more private, less emotional, and less religious funeral trends
cremation vs. burial
As mourning diminishes, grief becomes less welcome; people are less likely to be given time to grieve
Contemporary Challenges
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Contemporary Challenges, cont.
“Disenfranchised grief” is the practice of excluding certain people from mourning the unmarried partner the young child the ex-spouse the friend from work
Any kind of prohibition, restriction, or exclusion can make healing, hope, and affirmation more difficult for bereaved of all ages
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Contemporary Challenges, cont.
Murders and suicides often trigger police investigations, etc., that interfere with the grief process
Inadequate grief is thought to harm the larger community as well
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What Friends Can Do to Help the Bereaved Person first, be aware that powerful,
complicated, and unexpected emotions are likely
do not judge another person’s sorrow understand that culture and cohort play
a role in the different responses to death
Responses to Bereavement
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Responses to Bereavement, cont.
Bereavement is an ongoing, often lengthy process; sympathy, honesty, and social support may be needed for months or even years especially true for families
Recovery begins with acceptance of grief and may lead to reaffirmation of life
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Working through the emotions can help the person have a deeper appreciation of him/herself and life, including human relationships
Conclusion