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LATE ADULTHOOD
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
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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
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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
LIFE EXPECTANCY
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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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DISSONANCE
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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AEGISM
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
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
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