Chronic conditions with chronic conditions most common Chronic conditions 80 of older Americans have at least one 50 have at least 2 Heart disease cancer and stroke Dementia Alzheimer s Most common Dementia Deterioration in cognitive and behavioral functioning due to physiological causes Most irreversible 10 can be reversed Most caused by Alzheimer s disease Alzheimer s disease Progressive irreversible degenerative brain disorder characterized by cognitive deterioration and loss of control of bodily functions leading to death Degenerative brain disorder Gradually shrinks in capacity with age Also called working memory 3 categories episodic semantic procedural Episodic specific experiences or events linked to time and place o Most likely to deteriorate with age Semantic general factual knowledge social customs and language o Does not depend on where or when something was learned o Little decline with age Procedural motor skills habits and ways of doing things which can be recalled without conscious effort implicit memory o Unaffected by age culmination of a lifetime of personal growth and ego development exceptional breadth and depth of knowledge about the conditions of life and human affairs and reflective judgment about the application of this knowledge Studied by Baltes Achievement of late adulthood is a sense of ego integrity Ego integrity versus despair 8th and final stage of life span People in late adulthood either achieve a sense of integrity of the self by accepting the lives they have lived and thus accept death or yield to despair that their lives cannot be relived Some despair is inevitable Memory short and long term Reserve capacity Short term Long term Wisdom Chapter 18 Erickson Coping Ego integrity does not come from just reflecting on the past but also form continued stimulation and challenge Adaptive thinking or behavior aimed at reducing or relieving stress that arises from harmful threatening or challenging conditions Adaptive defenses Change people s perceptions of realities they are powerless to change May be unconscious or intuitive Humor altruism anticipation suppression etc Cognitive appraisal model Model of coping On the basis of continuous appraisal of their relationship with the environment people choose appropriate coping strategies to deal with situations that tax their normal resources Problem focused coping managing or improving a stressful situation Emotion focused coping emotional response to a stressful situation so as to lessen its physical or psychological impact directed toward managing the directed toward eliminating Pattern of retirement that revolves around family home and companions Conversation watching tv playing with cards etc Volunteer work Tied to well being during retirement Protects against identity loss and mental health decline Most older adults live with a spouse more women live alone with increasing age because of death of a spouse Aging in place Remaining in one s own home with or without assistance What most adults prefer Higher satisfaction Healthier Reduce anxiety and increase self esteem Widowhood Women more likely to be widowed Divorce and remarriage 11 divorce rate later in life Men more satisfied in late life marriages Less likely than unmarried couples to need support from the community More likely than divorced or widowed people to prefer single life and less likely to be lonely Least amount of social support Retirement family focused Volunteer work Family focused lifestyle Living arrangements what do people want Aging in place Marital relationships Long term marriage Nonmarital relationships Single life single strain practical and emotional stressors attributed to the lack of an intimate partner Cohabitation Very likely for older adults Disadvantage for women especially Gay and Lesbian relationships Strong supportive and diverse Friendship networks substitute for families No benefits such as partners social security Friendships Active circle of friends makes person happier and healthier Deal better with changes of aging Enjoy time with friends more than time with families Good relationships linked with less depression and loneliness Close mother daughter relationship Children provide a greater share of support siblings provide both companionship and emotional support rivalry decreases by old age sisters vital in maintaining family relationships and well being less involved than grandparents most find the role fulfilling and a mark of longevity source of wisdom links to the past Palliative care Personal patient and family centered care for a person with a terminal illness Focused of palliative care Care aimed at relieving pain and suffering and allowing the terminally ill to die in peace comfort and dignity Also called comfort care Leads to a higher quality of life better emotional statem and longer surivial time Nonmarital Kinship ties Relationships with adult children Relationships with siblings Great grandparents Chapter 19 Care of the dying Hospice Hospice palliative care Kubler Ross stages 5 stages in coming to terms with death 1 Denial 2 Anger 3 Bargaining 4 Depression 5 Acceptance Patterns of grieving Bereavement Classic grief work model Loss due to death of someone to whom one feels close and the process of adjustment to the loss 1 Shock and disbelief 2 Preoccupation with the memory of the dead person Suicide Euthanasia Advance directives End of life options 3 Resolution Rate in the US much lower than other countries native American men have highest rates for race white men over 75 have highest rates in general Passive euthanasia Active euthanasia Deliberate withholding or discontinuation of life prolonging treatment of a terminally ill person in order to end suffering or allow death in dignity Deliberate action taken to shorten the life of a terminally ill person in order to end suffering or to allow death with dignity Also called mercy killing living will document specifying the type of care wanted by the maker in the event of an incapacitating or terminal illness Different cultures see the path towards death in different ways need for better palliative care
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