PowerPoint Presentation
LATE ADULTHOOD
The stage of life cycle that begins at 65
Divided into two groups by gerontologists (those who study the
aging process) :
YOUNG-OLD : ages 65 to 74
OLD-OLD : ages 75 and beyond
Some use oldest old to refer to those over 85
Older adults can also be described as :
WELL-OLD - persons who are healthy
SICK-OLD - persons who have an infirmity that interferes with
functioning and requires medical or psychiatric attention
DEVELOPMENTAL TASKS OF LATE ADULTHOOD
To maintain the body image and physical integrity
To conduct the life review
To maintain sexual interests and activities
To deal with the death of significant loved ones
To accept the implications of retirement
DEVELOPMENTAL TASKS OF LATE ADULTHOOD
To accept the genetically programmed failure of organ
systems
To divest oneself of the attachment to possessions
To accept changes in the relationship with grandchildren
Biology of Aging and Longevity
AGING PROCESS (OR SENESCENCE)
From Latin senescere, meaning to grow old
Generally means aging of cells
Characterized by gradual decline in functioning of all bodys
systems:
-cardiovascular, respiratory, genitourinary, endocrine, immune
etc.
Each cell has genetically determined life span
-it can replicate at a LIMITED number of times before it
dies
DNA/RNA structural changes, mutations, unrepaired damage
contribute to cellular aging.
In neurons, signs of degeneration are seen most commonly in
dementia of Alzheimers type
The belief that old age is associated with profound intellectual
and physical infirmity is a MYTH. Many older persons retain their
cognitive abilities and physical capacities to a remarkable
degree
NOT ALL organs deteriorate at the same rate, nor do they follow
similar pattern of decline for all persons. EACH PERSON IS
GENETICALLY endowed with vulnerable system
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During each cell division, telomeres shorten.
When the telomere reach a critical length, the cells stop
dividing and become senescence.
Telomerase-
expressed in germ cells
- responsible for restoring telomeres to the ends of
chromosome
ROLE OF TELOMERE AND TELOMERASE
ON CELL AGING
Aging biologists are investigating whether humans' telomere
length is associated with lifespan, health span, or both. In one
study of people age 85 years and older, researchers found telomere
length was not associated with longevity, at least not in the
oldest-old. In another study, researchers analyzing DNA samples
from centenarians found that telomeres of healthy centenarians were
significantly longer than those of unhealthy centenarians,
suggesting that telomere length may be associated with health
span.
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This telomere lengthening insures that cells can safely divide
and multiply.
Studies show that telomerase is activated in immortal cancer
cells.
It should also be noted, however, that the contribution of
telomere length to lifespan remains controversial.
Aging biologists are investigating whether humans' telomere
length is associated with lifespan, health span, or both. In one
study of people age 85 years and older, researchers found telomere
length was not associated with longevity, at least not in the
oldest-old. In another study, researchers analyzing DNA samples
from centenarians found that telomeres of healthy centenarians were
significantly longer than those of unhealthy centenarians,
suggesting that telomere length may be associated with health
span.
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LONGEVITY
Nevertheless, many conditions leading to shortened life can be
prevented or delayed with right intervention.
Family history of longevity is the best indicator of long
life
Heredity is one factor beyond a persons control
Family history of longevity is the best indicator of long life
(of persons who live past 80, half of their fathers also lived past
80)
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Predictors of longevity w/in persons control:
Regular medical checkups
Minimal or no caffeine or alcohol consumption
Work gratification
Perceived sense of the self
Healthy eating and adequate
exercise
Heart disease
Cancer
Stroke
Leading causes of death
Falls are most commonly the result of cardiac arrhythmias and
hypotensive episodes.
Falls
Pedestrian accidents
Burns
The leading causes of death among older persons are heart
disease, cancer, and stroke.
Accidents are among the leading causes of death of persons over
65. Most fatal accidents are caused by falls, pedestrian incidents,
and burns.
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AGING SYNDROME
Considered reason for death in very old persons (over 85) for
some gerontologists.
Characterized by diminished elastic-mechanical properties of the
heart, arteries, lungs, and other organs.
On average, women live longer than men and are more likely than
men to live alone.
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FIFTH INDIVIDUATION
Primarily focused on the psychological effects of the
anticipation of personal death and the reaction to this idea.
Programmed failure of organ systems.
The 5th individuation in late adulthood is primarily focused on
the psychological effects of the anticipation of personal death and
the reaction to this idea.
Unique to the 5th individuation is the genetically programmed
failure of organ systems, which forces a separation from the sense
of possession of a fully competent, functioning body.
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EXERCISE, DIET, AND HEALTH
The aging body increasingly becomes a central concern
Diminution in function
Altered physical appearance
Increased incidence of physical illness
Replacing midlife preoccupations with
career and relationships
In late adulthood, the aging body increasingly becomes a central
concern, replacing midlife preoccupations with career and
relationships. This is so because of normal diminution in function,
altered physical appearance, and the increased incidence of
physical illness. Despite these occurrences, the body in late
adulthood can still be a source of considerable pleasure and can
convey a sense of competence, particularly if attention is paid to
regular exercise, healthy diet, adequate rest, and preventive
maintenance medical care.
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To Decrease the Chances of Developing Chronic Diseases
To control hyperlipidemia, reduce body weight, decrease intake
of saturated fat, limit intake of cholesterol.
Increasing the daily intake of dietary fiber can also help
decrease serum lipoprotein levels.
A daily intake of 1 ounce (about 30 mL) of alcohol has been
correlated with longevity and elevated high-density lipoproteins
(HDL). But we must also take note that the benefits of (for
example) 300 mL of wine is not equal to 300 mL of whisky.
Studies have also clearly demonstrated that statin drugs that
reduce cholesterol have a dramatic effect on reducing
cardiovascular disease in persons with diet- or exercise-resistant
hyperlipidemia.
Low salt intake (less than 3 g a day) is associated with a
lowered risk of hypertension.
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THIS SLIDE IS ABOUT DISSONANCE. Pag tumingin sila sa salamin,
ineexpect nila Makita ganiyan pero
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a discrepancy between the body image and the sentient self
ganito nakikita nila. It is an evidence of a discrepancy between
the body image and the sentient self, the latter being experienced
as younger and more vigorous, imprisoned, in a sense, in a shell of
a body that is no longer compatible with the mind or able to carry
out its commands.
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STAGE THEORIES OF PERSONALITY DEVELOPMENT
SIGMUND FREUD
Increasing control of the ego and ID with aging results in
increased autonomy
REGRESSION may permit primitive modes of functioning
disappear
ERIK ERIKSON
Central conflict: INTEGRITY VS. DESPAIR
- Integrity : the sense of satisfaction peoplefeel reflecting on
al life lived productively
- Despair :the sense that life has little purpose meaning.
GENERATIVITY VS. STAGNATION
Generativity: process by which persons guide the oncoming
generation or improve society
Stagnation: anathema, being within a cocoon of self-concern and
isolation
Integrity vs. Despair : Contentment comes only with getting
beyond
narcissism and into intimacy and generativity.
Generativity vs. Stagnation :This stage includes having and
raising children but a childless person can be generative by
helping others, being creative and contributing to society
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HEINZ KOHUT
MAINTENANCE OF SELF-ESTEEM is a major task of old age.
Old people must continually cope with narcissistic injury as
they attempt to adapt to the biological, psychological, and social
losses associated with the aging process.
BERNICE NEUGARTEN
The major conflict of old age relates to giving up the position
of authority and evaluating achievements and former competence.
It is a time of reconciliation with others and resolution of
grief over the death of others and the approaching death of
self.
DAVID LEVINSON
Ages 60 to 65 = late adult transition
People who are narcissistic and too heavily invested in body
appearance are liable to become preoccupied with death.
Creative mental activity is a normal and healthy substitute for
reduced physical activity.
Psychological Aspects of Aging
Image from:
https://winnieyong.files.wordpress.com/2010/01/oldman.jpg?w=547
SOCIAL ACTIVITY
May be precluded by physical illness or death of friends
Isolation may cause vulnerability to depression
Highlights importance of social activity for physical and
emotional well-being
Image taken from:
http://specialisthealthcentre.co.uk/wp-content/uploads/2014/12/Aging.jpg
Image from:
http://www.datingdementia.com/wp-content/uploads/2014/01/iStock_000011968698XSmall.jpg
Kaplan:
Healthy older persons usually maintain a level of social
activity that is only slightly changed from that of earlier years.
For many, old age is a period of continued intellectual, emotional,
and psychological growth. In some cases, however, physical illness
or the death of friends and relatives may preclude continued social
interaction. Moreover, as persons experience an increased sense of
isolation, they may become vulnerable to depression. Growing
evidence indicates that maintaining social activities is valuable
for physical and emotional well-being. (Sadock & Sadock,
2007)
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Contact with younger persons is important
Passage of cultural values
Provide care services
Maintains a sense of usefulness (better self-esteem)
Image from: http://www.todaysparent.com/
Image from: http://i.huffpost.com/
SOCIAL ACTIVITY
Contact with younger persons is also important. Old persons can
pass on cul- tural values and provide care services to the younger
generation and thereby maintain a sense of usefulness that
contributes to self-esteem. (Sadock & Sadock, 2007)
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Coined by Robert Butler
Discrimination or negative stereotyping of old age by younger
adults
Old age associated with:
Loneliness
Poor health
Senility
General weakness
Infirmity
Image from:
http://www.wherebuttheuk.com/uploads/8/0/1/6/8016027/410638.jpg?328
Image from:
https://refinedbyage.files.wordpress.com/2014/10/ageism-hurts.jpg
AEGISM
Ageism, a term coined by Robert Butler, refers to discrimination
toward old persons and to the negative stereotypes about old age
that are held by younger adults. Old persons may themselves re-
sent and fear other old persons and discriminate against them. In
Butlers scheme, persons often associate old age with loneliness,
poor health, senility, and general weakness or infirmity. (Sadock
& Sadock, 2007)
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Robust aging still found among oldest old!
Multidimensional factors affecting good (robust) aging:
Productive involvement
Affective status
Functional Status
Cognitive Status
Image from:
http://www.wallacerobinson.co.uk/images/ageism-age-is-just-a-number.jpg
Image from: http://www.oxfordmasteragingplan.ca/
AEGISM
The experience of older persons, however, does not consistently
support this attitude (Ageism).
Good health, however, is not the sole determinant of a good
quality of life in old age. Surveys of old persons show that social
contacts are at least as highly valued. In fact, the factors
affecting good aging appear to be multidimensional. Aging robustly
means considering aging in terms of productive involvement,
affective status, functional status, and cognitive status. These
four indicators are only minimally correlated. The most robustly
aging individuals report greater social contact, better health and
vision, and fewer significant life events in the past 3 years than
their less robustly aging counterparts. A linear, age-related de-
crease occurs in robustness, but it can still be found among the
oldest old.
(Sadock & Sadock, 2007)
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TRANSFERENCE AND COUNTERTRANSFERENCE
TRANSFERENCE
Development of a relationship with the therapist by the client
that is not based on the reality of the therapeutic relationship or
on the therapist's real characteristics as a human being
Parental Transference
Patient reacts to therapist like a child to a parent
Peer/Sibling Transference
Expressions of experiences from a variety of non-parental
relationships (siblings, spouse, friend)
Peer/sibling: patient looks to the therapist to share
experiences of an interpersonal nature involving other members of
the family. Therapist is transformed into a most trusted symbol of
the patients spouse, business associate, roommate
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Son/Daughter Transference
Extremely common in elderly patients
Therapist is cast in the role of the patients child, grandchild,
or son- or daughter-in-law
Sexual Transference
Frequent, intense
Therapist needs to accept them and manage his or her
countertransference responses
COUNTERTRANSFERENCE
Therapist's perception of a relationship with the client that is
not based on the reality of the relationship or the client's actual
characteristics
Therapeutic work with elderly confronts the therapist with
issues of aging, illness, loss of spouses and friends, and imminent
death
Therapists can be expected to react with: denial, avoidance of
difficult patients, fatigue of therapeutic burnout
Retirement
Could be a time of the pursuit of leisure and for freedom from
the responsibility of previous working commitments
It could also be a time of stress, especially when retirement
results in economic problems or loss of self-esteem.
Retirement
The frequency of orgasm, from coitus and masturbation, decreases
with age in men and women.
SEXUAL ACTIVITY
Important factors:
Health and survival of spouse
Own health
Level of past sexual activity
SEXUAL ACTIVITY
LONG TERM CARE
About 35 % of older persons require care in a long-term facility
at some time during their lives.
Many older persons who are infirm require institutional
care.
Although only 5 percent are institutionalized in nursing
homes
at any one time, about 35 percent of older persons require care
in
a long-term facility at some time during their lives (Fig.
2.54).
Older nursing home residents are mainly widowed women, and
about 50 percent are over age 85.
Nursing home care costs are not covered by Medicare; they
range from $20,000 to $50,000 a year. About 20,000 long-term
nursing care institutions are available in the United
Statesnot
enough tomeet the need. Those older personswho do not
require
skilled nursing care can be managed in other types of
healthrelated
facilities, such as centers they attend during the daytime
hours, but the need for care far exceeds the availability of
such
centers.
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Outside institutions, care for older persons is provided by
their children (primarily their daughters and daughters-in-law),
their wives, and other women.
In general, women end up as caregivers more often than men
because of cultural and societal expectations.
Outside institutions, care for older persons is provided by
their children (primarily their daughters and
daughters-in-law),
their wives, and other women (Fig. 2.55).More than 50
percent
of these women caregivers also work in jobs outside the
home,
and about 40 percent also care for their own children. In
general,
women end up as caregivers more often than men because of
cultural and societal expectations. According to the
American
Association of Retired Persons, daughters with jobs spend an
average of 12 hours a week providing care and currently
spend
about $150 amonth for travel, telephone calls, special foods,
and
medication for older persons.
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PSYCHIATRIC PROBLEMS OF OLDER PERSONS
Despite the ubiquity of loss in old age, the prevalence of major
depressive disorder and dysthymia is actually less than in younger
age groups.
Proposed explanations: rarity of late-onset depression, higher
mortality among persons with depression, and a general decrease in
disorders caused by emotional upheavals or substance abuse in older
persons.
Depression in old persons is often accompanied by physical
symptoms or cognitive changes that may mimic dementia.
The incidence of suicide among older persons is high (40 per
100,000 population) and is highest for older white men. The
suicide of older persons is perceived differently by
surviving
friends and family members on the basis of gender: Men are
thought to have been physically ill, and women are thought
to
have been mentally ill.
The relation between good mental and good physical health
is clear in older persons.Adverse effects on the course of
chronic
medical illness are correlated with emotional problems.
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REFERENCES
Sadock, B. J. and Sadock, V. A. (2007). Kaplan & Sadock's
Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry,
10th Edition. New York : Lippincott Williams & Wilkins
http://whattoknowaboutstagesoflife.weebly.com/late-adulthood.html
https://sharepractice.com/featured-dx-hyperlipidemia/
http://dietaryfiberguide.com/
http://www.docsopinion.com/2014/11/02/alcohol-and-heart-disease/
http://www.drjohnlapuma.com/vitamins-and-supplements/do-statins-raise-diabetes-risk/
https://www.studyblue.com/notes/note/n/psych-240/deck/4901547
http://ellenmorcomb.global2.vic.edu.au/2013/10/30/late-adulthood-social-development/
http://www.huffingtonpost.com/2013/03/27/tom-hussey-mirror-series-shows-elderly-people-looking-at-younger-selves_n_2958505.html
