Life-Span Development in Late Late AdulthoodLife-Span Development in Late Late Adulthooddealing with end of life

developmental tasks and issues

dealing with end of life

developmental tasks and issues

Caitlyn AndrewsVanessa Barriga Anna Clark Jennifer Jaber Beth Lee Alisa Meyer

Agenda• Relationships

Vanessa Barriga

• Physical Health Caitlyn Andrews

• Brain Changes Anna Clark

• Mental Health / Behavioral Health Alisa Meyer

• Death and End of Life Preparation Beth Lee

• The Best Parts of Being at Late Late Age Jennifer Jaber

RELATIONSHIPS: SOCIAL & COMMUNITY

• Age Groups Level two

• Life Expectancy Level two

• Stereotypes Level two

• Work and Retirement Level two

• Theories Level two

• Religion Level two

• Political Issues Level two

• Social Support and Integration Level two

• Friendship Level twoVanessa Barriga

RELATIONSHIPS:SEXUALITY & PARTNERS

• StatisticsLevel two

• Level 3

• Romance and SexLevel two

• Level 3

Vanessa Barriga

RELATIONSHIPS:SEXUALITY & PARTNERS

Vanessa Barriga

http://www.youtube.com/watch?v=fT4KovVUc78

RELATIONSHIPS:FAMILY SYSTEM & LIVING ARRANGEMENTS

• Marriage StatisticsLevel two

• Level 3

• Divorce and RemarriageLevel two

• Level 3

• CohabitationLevel two

• Level 3

• Grandparents, ParentsLevel two

Vanessa Barriga

PHYSICAL HEALTH

At my age, happy hour is nap time.

Caitlyn Andrews

PHYSICAL APPEARANCE & MOVEMENT

• Shorter in height drop in weight lose muscle move more slowly

• Vision/visual acuity color vision and depth of perception decline

• Hearing: Can be significant loses in high and middle frequencies

• Smell and taste Decreases in sense of taste and smell

• Touch and pain Declines in sensitivity

• Changes in Sexuality Sexuality can be life long! Men have more trouble with sexual performance at this

age; orgasms become less frequent.Caitlyn Andrews

PHYSICAL HEALTH: DISEASES (HEALTH PROBELMS)

• Arthritis: An inflammation of the joints accompanied by pain, stiffness, and movement problems

• Osteoporosis: Extensive loss of bone tissue 80% of people affected are women. Prevention: Diet, Bone density checks, and EXERCISE

• Danger of Accidents: 7th leading cause of death for older adults. Fall at home, Traffic accident, Slower recuperation time

• Substance Abuse: Danger when taking multiple medications “Invisible epidemic”

• Nursing Homes 23% of adults over 85 live in nursing homes or

extended-care facilities Concerns for privacy, medical information, safety and

lifestyle freedom, expensive, qualityCaitlyn Andrews

PHYSICAL HEALTH

My forgetter's getting betterBut my rememberer is brokeTo you that may seem funnyBut, to me, that is no joke.

At times I put something awayWhere it is safe, but, Gee!The person it is safest from

Is, generally, me!

When shopping I may see someone,Say "Hi" and have a chat,

Then, when the person walks awayI ask myself, "who was that?"

Yes, my forgetter's getting betterWhile my rememberer is broke,And it's driving me plumb crazy

And that isn't any joke.

Caitlyn Andrews

• Progressive, irreversible brain disorder that is characterized by a gradual deterioration of memory, reasoning,

language and physical function. • 25 million people world wide • Deficiency in chemical acetylcholine • Genes play an important role

• Prevention Diet: Vitamin D3, antioxidants found in green tea, naturally occurring

compound found in extra-virgin olive oil. EXERCISE Complex thinking and socialization: “exercising the brain”

• Treatment Cholinerase inhibitors (Drugs) NMDA drugs Marijuana

Caitlyn Andrews

PHYSICAL HEALTH:ALZHEIMER’S

PHYSICAL HEALTH:EXERCISE & NUTRITION

• Body mass declines with age 6.6 pounds of lean muscle each decade

during the adult years

• 60 years +30 minutes of moderately intense activity

(brisk walk) five or more days a week

• Strength training two or more days a week

Caitlyn Andrews

PHYSICAL HEALTH:IMPORTANT OF DIET &RISK OF

MALNUTRITION

• Dietary restrictions• Risk of malnutrition • Antioxidants •

Caitlyn Andrews

PHYSICAL HEALTH:7 WAYS EXERCISE CAN IMPROVE QUALITY OF

LIFE

Increased longevity

Prevention of diseases

Improvement of treatment of many diseases

Improves cellular functioning

Optimize body composition and reduce decline in motor skills

Reduces likelihood of developing metal health problems

Improve brain and cognitive functioning Caitlyn Andrews

BRAIN CHANGES:THEORIES OF AGING

• Cellular Clock Theory cells can divide a maximum of 75 to 80 times

• Free Radical Theory free radicals damage DNA and other cellular

structures causing the aging of the body

• Mitochondrial Theory aging is due to the decay of mitochondria which

supplies the cell with essential energy for function, growth and repair

• Hormonal Stress Theory aging in the body’s hormonal system can lower

resistance to stress and increase the likelihood of disease

Anna Clark

BRAIN CHANGES: PHYSICAL & COGNITIVE CHANGES

• Cognitive Mechanicsthe “hardware” of the mind speed and accuracy of processesdeclines as one ages

• Cognitive Pragmaticsthe “software” of the mind learned skills and knowledgedoes not necessarily decline

Anna Clark

BRAIN CHANGES: PHYSICAL & COGNITIVE CHANGES

Cognitive changes in older adults:

• Decreased speed of processing

• Decline in ability to control attention selective attention-being able to focus on relevant stimuli

and ignoring irrelevant stimuli divided attention-concentrating on more than one activity

at the same time sustained attention-vigilance

• Memory decline in episodic, working, perceptual speed, explicit,

source, and perspective very little decline in semantic and implicit those with positive beliefs about their memory remember

more

• Correlated to higher cognitive ability:

Education level Cognitively complex work Health (lifestyle and exercise)

Anna Clark

BRAIN CHANGES: PHYSICAL & COGNITIVE CHANGES

• Physical changes in older adults:Brain Shrinkage

Brain Slowing

Lack of Dendritic Growth

Reduction in Neurotransmitter ProductionAnna Clark

BRAIN CHANGES: ADAPTATIONS OF THE BRAIN

• Neurogenesisthe generation of new neurons

• Rewiringolder brains rewire themselves to

compensate for losses

• Decrease in lateralizationolder adults are more likely to use both

hemispheres in carrying out tasks

Anna Clark

BRAIN CHANGES

Ways to Counteract Brain Decline :

Cognitively complex activities

Physical exercise

Diet

Minimize stress

Anna Clark

MENTAL /BEHAVIORAL HEALTH:DEPRESSION

“A lot of what passes for depression these days is nothing more than a body saying that it needs work.” –Geoffrey Norman

• What is Depression? According to Santrock, depression is a mood disorder in which

the individual feels deeply unhappy, de-moralized, self-derogatory, and bored.

• Research Studies Researchers found that depressive symptoms vary from less

frequent to no more frequent in late adulthood than middle adulthood.

 What do these studies show? Lower freq of depressive symptoms in older adults compared to

middle aged was linked with fewer economic hardships, fewer negative social interchanges and increased religiosity.

• Who is affected? More common in males than females.

• Predictors Poor health, disability, loss, low social support.

• Treatment Depression IS treatable.Alisa Meyer

MENTAL /BEHAVIORAL HEALTH:VICTIMIZATION, CRIME, & MALTREATMENT

• FearThe decline and limitations in late

adulthood contribute to sense of vulnerability and fear.

• CrimeOlder adults less likely than younger

adults to be victim of crime

• How often does it occur?Found 6 percent experienced abuse in the

past month.

• Type of abuseInstitutional abuse

• What can we do?Alisa Meyer

• Affect and OutlookPositive and Negative outlook

• Self EsteemLow self-esteem in the elderly population

MENTAL /BEHAVIORAL HEALTH:LIFE SATISFACTION

Alisa Meyer

MENTAL /BEHAVIORAL HEALTH:SOCIOEMOTIONAL DEVELOPMENT IN LATE ADULTHOOD

“…There are chapters for pain, anger, guilt, and grief, but there are also opportunities for resolution and celebration, for affirmation and hope, for reconciliation and personal growth.” – Robert Butler

• Erickson’s Theory Integrity vs. Despair (8th and final stage of development) Life review (Robert Butler)

use of Reminiscence Therapy

• Activity Theory Increased happiness with increased activity

• Socioemotional Selectivity Theory Theory that older adults become more selective about their

social networks

• Selective Optimization with Compensation Theory Composed of selection, optimization, compensation (SOC) Proposed by Paul Bates, based on Rubenstein who was

interviewed at 80 years old about what factors were responsible for his ability to maintain his status as an admired pianist

Alisa Meyer

DEATH & END OF LIFE PREPARATION

ATTITUDES AT LATE LATE AGE• Know the psycho-social aspects of Death

among the elderlyElder death touches everyone at some timeCounselors often serve as

• Containers of difficult or awkward feelings• The neutral party who can raise important topics

• Theorists and researchers considerAwareness (insight)Increasing certainty in a culture that denies itTemporal nearness (salience)Qualitative nature of preparedness

(developmental tasks)• Cultural definitions of a “good death”

Beth Lee

DEATH & END OF LIFE PREPARATION

TALKING ABOUT DEATH Elderly people think and talk readily about death

• Non-institutionalized more frequently• Institutionalized, less opportunity

– “the belief that discussing death creates a negative mental framework and self-image that may interfere with the best possible client care” (Leif, 1982)

More thinking and talking than preparedness• 74% have a will, but only 53% & 65% spoke to family &

friends about end of life wishes

Beth Lee Schrader, Nelson, & Eidsness (2009)

DEATH & END OF LIFE PREPARATION

DEATH ANXIETY• Existential Definition

Although the physicality of death destroys us, it is the idea of death that saves us (Yalom, 1980)

Death is the condition that makes it possible for us to live in an authentic fashion (Heidegger, 1926)

• By allowing us to embrace our possibilities and limits

• Boundary pressure drives choices towards authenticity

• This is the death driven developmental task of late late age

Beth Lee

 It's not that I'm afraid to

die, I just don't want to be there when

it happens. Woody Allen

DEATH & END OF LIFE PREPARATION

DEATH ANXIETY• Geriatric care providers (medical, behavioral,

pragmatic) encounter DA daily in clients and their familiesMay impair the ability to make unbiased decisionsMay prevent the flow of information, sometimes against

the law (Sinoff, et al, 2008)

DA on the part of care givers may obstruct an elderly person’s right to die naturally• 4 out of 5 people would prefer to die at home (Hine, 1979)

• DA is functionally two constructs:Fear of deathFear of the dying process

• DA as a function of age Peaks in middle- ageAll but disappears in elderly (Twelker, 2006)

Beth Lee

Death Anxiety as a Function of Age

Sinoff, Iosipovici, Almog, & Barnett-Greens (2008)

DEATH & END OF LIFE PREPARATION

CULTURAL ISSUES OF PREPARING

• Cultural Sensitivity about Death rituals requires investigation In the US, preparedness for death has a legal and

psycho-social component Excellent resource on emerging ritual:

http://www.dailyundertaker.com

Beth Lee

DEATH & END OF LIFE PREPARATION

CULTURAL ISSUES OF PREPARING• Emerging EOL Traditions

There’s an app for that….• Kaddish, the Jewish Mourner's prayer, is recited publicly every day for

11 months after a parent's death as a reaffirmation of faith. This requirement can be difficult for many to fulfill properly though, as the prayer is in Aramaic. Now there is help in the form of an iPhone app to tutor mourners in the pronunciation of this important prayer.

• Bosan, which in Japanese means grave honoring, is a newly

released iPhone app from KnowledgEx which allows you to register information about and carry photos of a loved one’s grave, as well as photos of the deceased. Whenever you want and where ever you are in your busy schedule, you can virtually honor the grave of your loved one with a prayer, along with offerings of incense, flowers, food and water.

Beth Lee

THE BEST PART OF LATE LATE AGE!

Jennifer Jaber

THE BEST PART OF LATE LATE AGE!

Benefits of Late Late Adulthood

Jennifer Jaber

THE BEST PART OF LATE LATE AGE: SUCCESSFUL AGING

• Positive Aspects being studied Growing subject in psychology

• Factors linked with Successful Aging Active lifestyle Positive coping skills Good social relationships Support Absence of disease

• Being Active is especially important to successful aging Mental and Physical exercise Generativity

• Self -efficacy Control over the environment

Keeping a positive attitude Result: higher levels of happinessJennifer Jaber

THE BEST PART OF LATE LATE AGE!

• Felice NewsNot- for- profit based in Toronto that tells only

good news• http://www.felicenews.com/the-five-best-things-about-getting-older.html

Late Age gives you ready made excuses!• Failing memory (even if your hearing is fine!)• Hearing “loss” (selective hearing)• Other people get to take care of you• Freedom to do what you want•

Jennifer Jaber

THE BEST PART OF LATE LATE AGE!

Secrets of the Centenarians (NYTimes.com)

Jennifer Jaber

http://www.nytimes.com/interactive/2010/10/19/health/20101018-centenarians-voices-photos.html

THE BEST PART OF LATE LATE AGE!

Age is an issue of mind over matter.

If you don't mind, it doesn't matter. Mark Twain

Jennifer Jaber

1855, aprox 20 yrs old

Much older: Be good, and you will be lonesome.

referencesAlzheimer’s Disease Research. August 8. 2010. American Health Assistance Foundation. Ahaf.org. http://www.ahaf.org/alzheimers/about/risk/?gclid=CJuA-ZWF8aQCFQIGbAodeFsV1w

Denny’s Poems and Quotes. http://www.dennydavis.net/poemfiles/aging2b.htm

Knoth, R., Singec, I., Ditter, M., Pantazis, G., Capetian, P., et al. (2010). Murine features of neurogenesis in the human hippocampus across the lifespan from 0 to 100 years. PLoS ONE 5(1). doi:10.1371/0008809

Kennard, Christine. Marijuana May Prevent Alzheimer’s Disease. About.com. October 6.2006. http://alzheimers.about.com/od/research/a/marijuana_alz.htm

Kramer, A.F., Fabiani, M., & Colcombe, S.J. (2006). Contributions of cognitive neuroscience to the understanding of behavior and aging. In handbook of the psychology of aging (4). doi: 10.1016/B978012101264-9/50007-0

Lieff, Jonathan D. (1982). "Eight reasons why doctors fear the elderly, chronic illness, and death." Journal of Transpersonal Psychology 14, no. 1: 47-60.

May, R., & Yalom, I. (1989). Existential psychotherapy. Current psychotherapies (4th ed.) (pp. 363-402). Itasca, IL US: F E Peacock Publishers.

Schrader, S., Nelson, M., & Eidsness, L. (2009). 'South Dakota’s dying to know': A statewide survey about end of life. Journal of Palliative Medicine, 12(8), 695-705.

Sinoff, G., Iosipovici, A., Almog, R., & Barnett-Greens, O. (2008). Children of the elderly are inapt in assessing death anxiety in their own parents. International Journal of Geriatric Psychiatry, 23(11)

Twelker PA. 2006. The relationship between death anxiety, sex, and age. Internet resource available at URL: http://www.tiu.edu/psychology/deathanxiety.htm

Weed, W.S. (n.d.). 7 anti-aging tips to keep your brain young. Retrieved from http://www.rd.com/living-healthy/7-anti-aging-tips-to-keep-your-brain-young/article28203.html

Yalom, I. (2008). Staring at the sun: Overcoming the terror of death. The Humanistic Psychologist, 36(3-4), 283-297.