CHAPTER 12CHAPTER 12LATE ADULTHOODLATE ADULTHOOD

Lori Rice, MALori Rice, MA

Developmental ThemesDevelopmental Themes Late Adulthood (65-death)Late Adulthood (65-death)

Erikson’s theory: Erikson’s theory: INTEGRITY versus DESPAIRINTEGRITY versus DESPAIR Integrity is defined as the ability to integrate or satisfactorily blend of Integrity is defined as the ability to integrate or satisfactorily blend of

evaluating & accepting one’s lifeevaluating & accepting one’s life

Continuity one’s history & experience with the task theory suggests Continuity one’s history & experience with the task theory suggests personality is fairly stable across adulthoodpersonality is fairly stable across adulthood

Socioeconomic selectivity is a newer theory addressing older adults’ Socioeconomic selectivity is a newer theory addressing older adults’ need for solitude, choice & meaningful relationshipsneed for solitude, choice & meaningful relationships

The oldest old & minority elders are the fastest growing agesThe oldest old & minority elders are the fastest growing ages

Leaving a legacy is an important goal for many in later lifLeaving a legacy is an important goal for many in later lifee

Developmental ThemesDevelopmental Themes

Young-old (65-74) - Young-old (65-74) - The young-old typically remain active in the The young-old typically remain active in the community & maintain strong ties with families & friends community & maintain strong ties with families & friends

Some may increase their recreation, adult education, & volunteer Some may increase their recreation, adult education, & volunteer activities activities

Many may still be employed full- or part-time because of financial Many may still be employed full- or part-time because of financial need or the personal desire to work; the phenomenon of women need or the personal desire to work; the phenomenon of women outliving their spouses emergeoutliving their spouses emerge

Retirement may bring new freedom, or it can bring losses (loss of Retirement may bring new freedom, or it can bring losses (loss of status & income, loss of being needed) status & income, loss of being needed)

Chronic illness may developChronic illness may develop

Source: Based on Hartford (1985).

Developmental ThemesDevelopmental Themes Middle-old (75-84) - Middle-old (75-84) - More in this age group experience chronic disease More in this age group experience chronic disease

(arthritis, cardiovascular, respiratory, circulatory) (arthritis, cardiovascular, respiratory, circulatory)

Added stresses through widowhood, deaths of friends, relatives & adult Added stresses through widowhood, deaths of friends, relatives & adult children. children.

Experience more physiological changes in terms of impairments in vision Experience more physiological changes in terms of impairments in vision or hearing, problems with balance that may lead to loss of mobility or hearing, problems with balance that may lead to loss of mobility (walking or driving) & slowing of response time & judgment of spatial (walking or driving) & slowing of response time & judgment of spatial relationshipsrelationships

Many people in this age cohort continue to manage well & contribute to Many people in this age cohort continue to manage well & contribute to their families & communitiestheir families & communities

Socially & physically active, in relative good health & able to function Socially & physically active, in relative good health & able to function independentlyindependently

The middle-old are more diverse than the young-old due to the noticeably The middle-old are more diverse than the young-old due to the noticeably different rates of change different rates of change of individuals in this age groupof individuals in this age group

Source: Based on Hartford (1985).

Developmental ThemesDevelopmental Themes

Source: Based on Hartford (1985).

Old-old (85+) - A predominant number of this group is dependent, frail & Old-old (85+) - A predominant number of this group is dependent, frail & experiencing more disabilities & chronic illnessesexperiencing more disabilities & chronic illnesses

Mobility is more likely to be limited, & very few are employed, though some Mobility is more likely to be limited, & very few are employed, though some work independently or use their creative capacities for fulfillmentwork independently or use their creative capacities for fulfillment

Social isolation tends to become greater for this cohort because they have Social isolation tends to become greater for this cohort because they have more physical decrements, many can no longer drive themselves & many more physical decrements, many can no longer drive themselves & many are widowedare widowed

The prevalence of dementia, such as Alzheimer’s disease, increases with The prevalence of dementia, such as Alzheimer’s disease, increases with age- up to 50% of the 85+ group show evidence of brain disorders or some age- up to 50% of the 85+ group show evidence of brain disorders or some form of dementiaform of dementia

Those elderly who have survived well continue to maintain daily routines & Those elderly who have survived well continue to maintain daily routines & live independently or with familieslive independently or with families

The ratio of women to men who have survived to this age is much greater: The ratio of women to men who have survived to this age is much greater: 265:100265:100

Theories of AgingTheories of Aging

Source: Based on Hartford (1985).

Continuity theory: emphasizes that people change less with aging than they Continuity theory: emphasizes that people change less with aging than they stay the same. Adaptation to changes that occur with age is done using stay the same. Adaptation to changes that occur with age is done using familiar strategies from the person’s past (based on longitudinal studies)familiar strategies from the person’s past (based on longitudinal studies)

Activity theory: applies social role theory to late life. Older people Activity theory: applies social role theory to late life. Older people experience greater subjective well-being when they continue to be active in experience greater subjective well-being when they continue to be active in many roles. many roles.

Disengagement theory: disengagement occurs in late adulthood through the Disengagement theory: disengagement occurs in late adulthood through the process of mutual withdrawal of the person and of society. Based on Jung process of mutual withdrawal of the person and of society. Based on Jung and Erikson’s notion that introspection seems to increase as we age and and Erikson’s notion that introspection seems to increase as we age and research that shows a decrease in social roles.research that shows a decrease in social roles.

Socioemotional selectivity: as people age familiar and reliable relationships Socioemotional selectivity: as people age familiar and reliable relationships become more important. People regulate emotions and conserve energy by become more important. People regulate emotions and conserve energy by selecting with whom to invest their emotional energies. selecting with whom to invest their emotional energies.

Biological DimensionBiological Dimension

Biophysical growth and developmentBiophysical growth and development Health care and medications Health care and medications Sexuality Sexuality Implications for practice: sexuality in late adulthoodImplications for practice: sexuality in late adulthood

Biophysical strengths and hazardsBiophysical strengths and hazards Chronic health problemsChronic health problems Death and dyingDeath and dying Advance directives for health careAdvance directives for health care Implications for practice: End-of-life careImplications for practice: End-of-life care

Cognitive Development & Cognitive Development & Information ProcessingInformation Processing

Fluid Intelligence-Abstract reasoning ability or Fluid Intelligence-Abstract reasoning ability or “native intelligence”“native intelligence”• Decreases with ageDecreases with age

Cystallized Intelligence- Accumulated information Cystallized Intelligence- Accumulated information & verbal skills& verbal skills• Remains stable or may even increase with ageRemains stable or may even increase with age

Common Myths Associated with Common Myths Associated with Mental ImpairmentMental Impairment

NORMALNORMAL Temporarily forgetting a Temporarily forgetting a

colleague’s namecolleague’s name

Having a word on the tip of the Having a word on the tip of the tonguetongue

Misplacing objects in moments of Misplacing objects in moments of distractiondistraction

Forgetting for a moment where Forgetting for a moment where you’re goingyou’re going

Having trouble balancing the Having trouble balancing the checkbook accuratelycheckbook accurately

Temporarily forgetting the day of Temporarily forgetting the day of the weekthe week

Possibly Alzheimer’s or DementiaPossibly Alzheimer’s or Dementia Not being able to recall the name laterNot being able to recall the name later

Substituting strange words for forgotten Substituting strange words for forgotten wordswords

Misplacing things in unusual places & Misplacing things in unusual places & having no memory of putting them therehaving no memory of putting them there

Getting lost on your own streetGetting lost on your own street

Forgetting how to add or subtract Forgetting how to add or subtract numbersnumbers

Not knowing what season or year it is, Not knowing what season or year it is, even after thinking about themeven after thinking about them

Attitudes & Emotions: Attitudes & Emotions: Loss, Grief & MourningLoss, Grief & Mourning

Factors that may affect experienceFactors that may affect experience

Personal losses or gain: marital partners; other loved & significant Personal losses or gain: marital partners; other loved & significant figures (friends, children)figures (friends, children)

Social forces (losses or gains): status changes, prestige changes: in Social forces (losses or gains): status changes, prestige changes: in social groups other than familysocial groups other than family

Socioeconomic adversities: income drop, inflationSocioeconomic adversities: income drop, inflation Unwanted retirement: arbitrary retirement policiesUnwanted retirement: arbitrary retirement policies Cultural devaluation of older persons: sense of uselessness, Cultural devaluation of older persons: sense of uselessness,

therapeutic pessimism, forced isolation, forced segregationtherapeutic pessimism, forced isolation, forced segregation

Social DimensionSocial Dimension Families & GroupsFamilies & Groups

Parent-Child RelationshipsParent-Child Relationships

Communities & Support SystemsCommunities & Support Systems The Continuum of CareThe Continuum of Care

Social Strengths & HazardsSocial Strengths & Hazards Elder Abuse & NeglectElder Abuse & Neglect

Parent-Child RelationshipsParent-Child Relationships

Increased health & longevity have complicated parent-child Increased health & longevity have complicated parent-child relationships, & there is considerable ambivalence about relationships, & there is considerable ambivalence about giving/receiving help & the changing roles giving/receiving help & the changing roles

Characterized by strong bonds & a sense of responsibilityCharacterized by strong bonds & a sense of responsibility

Caregiving is a broad term that may describe:Caregiving is a broad term that may describe:• Hands-on assistance with activities of daily livingHands-on assistance with activities of daily living• Helping to hire & manage professional caregiversHelping to hire & manage professional caregivers• Making decisions about care for a parent who needs help Making decisions about care for a parent who needs help • Overseeing the care a parent receives in a nursing homeOverseeing the care a parent receives in a nursing home

Contributors to Resilience in Contributors to Resilience in Family CaregiversFamily Caregivers

Distancing from the care situation, physically & Distancing from the care situation, physically & emotionallyemotionally

Regular physical exerciseRegular physical exercise Keeping up personal hobbiesKeeping up personal hobbies Having at least one close confidant for emotional Having at least one close confidant for emotional

supportsupport Personal religious beliefsPersonal religious beliefs A philosophy of duty toward the parentA philosophy of duty toward the parent Sense of humorSense of humorSource: Adapted from Ross, Holliman & Dixon (2003).Source: Adapted from Ross, Holliman & Dixon (2003).

Communities & Support Systems: Communities & Support Systems: The Continuum of CareThe Continuum of Care

Long-term care- Medical & social interventions for those who have Long-term care- Medical & social interventions for those who have chronic illnesses or impairments that are geared toward helping a chronic illnesses or impairments that are geared toward helping a patient live as satisfactorily as possible in an appropriate, least patient live as satisfactorily as possible in an appropriate, least restrictive settingrestrictive setting

Senior living options:Senior living options: Independent living senior apartmentsIndependent living senior apartments Low-income-housing tax credit propertiesLow-income-housing tax credit properties Board & care homes or adult foster homesBoard & care homes or adult foster homes Freestanding assisted-living facilitiesFreestanding assisted-living facilities Continuing care retirement communitiesContinuing care retirement communities Nursing homesNursing homes

Elder Abuse & NeglectElder Abuse & Neglect

Elder abuse includes any mistreatment of older adults, whether it is Elder abuse includes any mistreatment of older adults, whether it is abuse or neglect, intentional or unintentionalabuse or neglect, intentional or unintentional

Physical Abuse, including Sexual AbusePhysical Abuse, including Sexual Abuse Emotional AbuseEmotional Abuse Financial ExploitationFinancial Exploitation

Self-Neglect occurs when an independent older person is incapable of Self-Neglect occurs when an independent older person is incapable of necessary self-care resulting in being malnourished, dehydrated, dirty, ill necessary self-care resulting in being malnourished, dehydrated, dirty, ill or living in a cluttered, unsafe environmentor living in a cluttered, unsafe environment

Self-Neglect usually relates to dementia or psychiatric illness of an Self-Neglect usually relates to dementia or psychiatric illness of an elder who lacks involved family nearbyelder who lacks involved family nearby

Risk Factors & Signs of Risk Factors & Signs of Elder Abuse & NeglectElder Abuse & Neglect

Presence of family member’s mental illness, or Presence of family member’s mental illness, or drug or alcohol abusedrug or alcohol abuse

Stressful life events for the family, such as Stressful life events for the family, such as financial loss, death, divorcefinancial loss, death, divorce

Cognitive impairment of the older person (more Cognitive impairment of the older person (more likely to be neglected)likely to be neglected)

Physical impairment/dependence on others for Physical impairment/dependence on others for physical needs (more likely to be abusedphysical needs (more likely to be abused

Risk Factors & Signs of Risk Factors & Signs of Elder Abuse & Neglect Elder Abuse & Neglect (Cont.)(Cont.)

Older person’s social isolationOlder person’s social isolation

Poor hygiene & nutritional status; obvious lack Poor hygiene & nutritional status; obvious lack of careof care

The older person appears hypervigilant or The older person appears hypervigilant or nervousnervous

The caregiver displays hostility & impatience The caregiver displays hostility & impatience toward the eldertoward the elder

Causes of Elder Abuse & NeglectCauses of Elder Abuse & Neglect Caregiver StressCaregiver Stress- Refers to situations in which the caregiver becomes - Refers to situations in which the caregiver becomes

overwhelmed by the demands of the dependent elderoverwhelmed by the demands of the dependent elder Caregiver may perpetrate abuse in a moment of anger/stress or may Caregiver may perpetrate abuse in a moment of anger/stress or may

neglect the person’s needsneglect the person’s needs Caregiver stress only accounts for a very small amount of abuse casesCaregiver stress only accounts for a very small amount of abuse cases Wolf (2000) cites multiple risk factors that cause elder abuse, including Wolf (2000) cites multiple risk factors that cause elder abuse, including

the earlier relationship of the victim & abuser, the abuser’s mental state the earlier relationship of the victim & abuser, the abuser’s mental state & the lack of appropriate alternative services or caregivers& the lack of appropriate alternative services or caregivers

Caregiver ImpairmentCaregiver Impairment- Refers to a caregiver’s mental illness, personality - Refers to a caregiver’s mental illness, personality disorder, or substance abuse & may involve more serious acts that are disorder, or substance abuse & may involve more serious acts that are perpetrated repeatedlyperpetrated repeatedly

Developmental Considerations for Developmental Considerations for Assessment in Late AdulthoodAssessment in Late Adulthood

Chronic health conditionsChronic health conditions Availability of appropriate health careAvailability of appropriate health care Functioning in activities of daily livingFunctioning in activities of daily living Medications used & their side effectsMedications used & their side effects Ability to obtain nutritious mealsAbility to obtain nutritious meals Opportunities to exerciseOpportunities to exercise Alcohol & other drug useAlcohol & other drug use Mental status: Memory, judgment Mental status: Memory, judgment Emotional expressionEmotional expression

Developmental Considerations for Developmental Considerations for Assessment in Late AdulthoodAssessment in Late Adulthood

Availability of companionship friendshipAvailability of companionship friendship Family support or family conflictsFamily support or family conflicts Caring for others: spouse, family & Caring for others: spouse, family &

grandchildrengrandchildren Neighborhood safetyNeighborhood safety Transportation issuesTransportation issues Home safety & appropriatenessHome safety & appropriateness Employment or volunteer opportunitiesEmployment or volunteer opportunities Social & community opportunitiesSocial & community opportunities

Developmental Considerations for Developmental Considerations for Assessment in Late AdulthoodAssessment in Late Adulthood

STRENGTHS & LANDMARKS OF DEVELOPMENTSTRENGTHS & LANDMARKS OF DEVELOPMENT

Maintaining interests & activities to capabilityMaintaining interests & activities to capability Interest in remaining as independent as possibleInterest in remaining as independent as possible Interest in sexual expression & companionshipInterest in sexual expression & companionship Desire to leave a legacy- e.g., creative work, possessions, Desire to leave a legacy- e.g., creative work, possessions,

or familyor family Desire to maintain family & friendship connectionsDesire to maintain family & friendship connections Adapting to new rolesAdapting to new roles May be more reflective or introvertedMay be more reflective or introverted May take comfort in religious beliefs or spirituality May take comfort in religious beliefs or spirituality