Chapter 14Chapter 14

Life’s Transitions: The Aging ProcessLife’s Transitions: The Aging Process

LIFE’S TRANSITIONS

Old People Are UselessUseless!

AGING: The process of growing old – IT WILL HAPPEN to

YOU !!!!• In 1975 In 1975 350 million 350 million

people over 60 yearspeople over 60 years

• In 2050 In 2050 1.1 billion 1.1 billion over 60 yearsover 60 years

PERCEPTION: PERCEPTION:

HOW YOU VIEWHOW YOU VIEW

PEOPLE OLDERPEOPLE OLDER

THAN YOUTHAN YOU

•

Studying AgingStudying Aging

Connotations:• A negative A negative

psychological shift. psychological shift. Western cultural Western cultural views are different views are different from othersfrom others

• GERONTOLOGY:

The study of aging.

• GERONTOLOGIST:

One who studies aging.

Old People Should RetireRetire So That YoungerYounger People Can

Work?

Why study the effects of aging? (5 reasons):

• biology of aging (genetic and environmental factors associated with aging)

• shift in survival and life expectancy has itself driven the inquiry about the social implications

• medical science documents the diseases of old age and attempts to moderate their effects

Aging

• health care costs of an older society

• psychologists attempting to understand the negative attitudes toward the elderly

Old People Are SlowSlow And Get In My Way!

Old People Aren’t BeautifulBeautiful!

The Changing Face of the Nation

• Baby Boomers approaching retirement.

• Elderly are living longer - combination of modern medicine and lifestyle related factors = age 115 years

Changing Face of the Nation

• higher quality of life - therefore older people are a major social, political and economic factor in society.

• Changing demographics also reflected in fact that not as many children are being born in first world countries.

I Will NeverNever Get That Old!

TYPES OF AGING:

BIOLOGICAL:BIOLOGICAL:

• physical changes with physical changes with timetime

• relative age – condition of relative age – condition of organs / body systems organs / body systems

• arthritis / osteoporosis / arthritis / osteoporosis / accelerate aging processaccelerate aging process

PSYCHOLOGICAL

adaptive capacity =adaptive capacity =• coping abilities coping abilities

intelligence intelligence

• individual capabilitiesindividual capabilities

• self-efficacy self-efficacy

• biological biological

• social changessocial changes

SOCIALSOCIAL

• habits and roles habits and roles relative to society’s relative to society’s expectationsexpectations

• people sharing people sharing common interests common interests

• changes in person's changes in person's familial, occupational familial, occupational and social roles and social roles (retirement, loss of (retirement, loss of income, etc.)income, etc.)

GETTING OLDERGETTING OLDER

Legal

chronological age chronological age

driving driving

drinking ( not together !) drinking ( not together !)

votingvoting

old age securityold age security

Canada Pension PlanCanada Pension Plan

Functional:

• how people compare how people compare at similar ages……..at similar ages……..

• health health

• capacitycapacity

• activity activity

• interestsinterests

• mobilitymobility

THE AGING PROCESS: a function of three factors:

True aging (also called primaryTrue aging (also called primary

aging):aging):

• unavoidable result of chronology that unavoidable result of chronology that affects all species sooner or lateraffects all species sooner or later

Disease processes (secondary aging)Disease processes (secondary aging)

• aging due to diseases, such as trauma, aging due to diseases, such as trauma, illness, stress, etc.; lifestyle can be illness, stress, etc.; lifestyle can be classified in this factor (smoking)classified in this factor (smoking)

THE AGING PROCESS: a function of three factors:

Disuse phenomena Disuse phenomena

((secondary aging)secondary aging)

• aging due to the lack aging due to the lack of activity (Sedentary of activity (Sedentary Lifestyle)Lifestyle)

THEORIES ON AGING

Biological:

• the wear and tear theory – “ It’s Not the Years.., – “ It’s Not the Years.., It’s the Mileage”It’s the Mileage”

• the human body simply the human body simply wears outwears out

• some activities may some activities may predispose this condition predispose this condition (running)(running)

THEORIES ON AGING

• the cellular theory – limited number of cells / capacity to reproduce / once exhausted body begins to deteriorate / varies from individual to individual

• the autoimmune theory – declining immune system / loses control attacking body

THEORIES ON AGING

• the genetic mutation theory – the older you are the more mutant cells develop/ function differently than intended / dysfunction of body organs + systems

Physical Changes

The Skin:The Skin: • (30’s)thinner + loses elasticity

/(40’s) lines on the face /• (50’s) crow’s feet /(60’s) loses

colour + sags / (70’s) age spots etc.

Bones and Joints:• constantly changing constantly changing

accumulating and losing minerals accumulating and losing minerals (modeling)(modeling)

• 30’ and 40’s – net loss of minerals 30’ and 40’s – net loss of minerals – could lead to osteoporosis– could lead to osteoporosis

Physical Changes

OSTEOPOROSIS:• loss of bone material /

bone mass• post-menopausal women• fractures common• very debilitating• risk factors: calcium, lack

of exercise, lack of estrogen therapy post-menopause

Physical Changes

The Head:The Head: • features of the head

enlarge ( nose, ears, head - skull thickens)

Brain shrinksBrain shrinks

The Urinary Tract:The Urinary Tract:• urinary incontinence • individual • treatable - drug therapy

Physical Changes

Heart and Lungs:• Resting Heart Rate stays about

the same throughout life• stroke volume decreases • heart muscle deterioration• Vital Capacity decreases

(max. inhalation + exhalation)• exercise slows these changes

Eyesight:Eyesight:• 30 years of age – lens harden • 40 years of age – lens: yellow

and looses transparency• Cataracts – (clouding of the

lens) / focus on retina / blurred vision / blindness possible

• glaucoma – ( increased pressure within the eyeball)

• hardening of the eyeball , impaired vision, eventual blindness

Hearing and Taste

Hearing:Hearing: • range diminishes / normal and range diminishes / normal and

conversational retainedconversational retained

Taste:Taste:• age 30 – each papilla has 245 taste buds age 30 – each papilla has 245 taste buds

- # diminishes over time- # diminishes over time• age 70 – 88 remainingage 70 – 88 remaining• Smell and Touch:Smell and Touch:• pain and tactile sensors declinepain and tactile sensors decline• sense of smell also declines / may lead sense of smell also declines / may lead

to malnutrition ( food lacks appeal)to malnutrition ( food lacks appeal)

Getting Around and body Comfort

Mobility:Mobility:• 50% of older Canadians Report some

disability related to mobility or agility

Body Comfort:Body Comfort:• loss of body fat / thinning of epithelium /

diminished glandular function • body temperature• hypothermia / heat stroke / heat

exhaustion

Mental Changes:

Intelligence:Intelligence: • unchanged - except for

illness• continue to learn and

develop (time?)• compensate with practical

knowledge

Memory:Memory:• short-term can be memory

- affected • long-term unchanged

Coping with ChangeCoping with Change

Flexibility vs. Rigidity:Flexibility vs. Rigidity:• LIFE = diverse joys, sorrows, and

obstacles –developed coping methods

Depression:Depression: • most adults continue to lead

healthy, fulfilling lives• however, depression is the most

common

Confusion and Frustration

Senility:Senility:• over-generalizationover-generalization• misinterpreted as senility = misinterpreted as senility =

memory failure / judgment memory failure / judgment error / disorientation / error / disorientation / erratic behaviours…….. erratic behaviours…….. (any age!)(any age!)

Alzheimer’s Disease and other Dementias

Dementias – progressiveDementias – progressive

brain impairments thatbrain impairments that

interfere with memoryinterfere with memory

and intellectualand intellectual

functioningfunctioning

ALZHEIMER'S DISEASE

The disease most dreaded by the elderly isThe disease most dreaded by the elderly is

dementia; loss of mental functions in an alertdementia; loss of mental functions in an alert

individual, characterized by group of symptoms :individual, characterized by group of symptoms :

• memory loss

• loss of language functions

• inability to think abstractly

• inability to care for oneself

• personality change

• emotional instability

• loss of sense of time

ALZHEIMER'S DISEASE

• three quarters (75%) dementia’s caused by Alzheimer's disease - chronic, degenerative dementing illness / cause unknown

• no known cure to stop the progression

• 6% of people over 65 years have Alzheimer's disease

• Alzheimer's disease 4th leading cause of death - older adults

• < seventy conditions can cause dementia

Types of Dementia:

• Degenerative = Alzheimer's, Parkinson's, Huntington's.

• Vascular dementia: cerebral embolisms, blood clots, and infarctions.

• Traumatic dementia: head injuries.

• Lesions: tumors, hematomas, and cancers.

• Toxic dementia: alcohol, poisons.

• Others: epilepsy, post-traumatic stress disorders, and heat stroke.

THEORIES OF AGING:

• Brain size & longevity

• Biological clock determines how long we live.

• Disposable soma: Allocation of resources - optimal is as little as possible to body repair, and more to other functions.

• Wear and tear: Accumulated damage leads to breakdown - like a machine!

Genes and AgingGenes and Aging

• Genetic theories: Loss of genetic info. over time = loss of protein to rebuild.

• Immunological: Breakdown of immune system.

• Others: Error accumulation, cell loss, nutritive, environment, and brain chemistry.

AGEISM• discriminationdiscrimination• stereotyping - generalization of stereotyping - generalization of

characteristics - characteristics - + / -+ / - without without knowing the individualknowing the individual

• concept of young or oldconcept of young or old• healthy or unhealthyhealthy or unhealthy• value youth, devalue old age value youth, devalue old age • western culture vs. other western culture vs. other

cultures respectcultures respect wisdom of wisdom of elderlyelderly

DEATH AND DYING

• THANATOLOGY: the study of death and dying.

• PSYCHOLOGY: fascination yet denial in western society.

• people not prepared!

• DEATH - a process, not a point in time

KUBLER ROSS: STAGES OF DYING (5):

• Dying person may experience several intense emotions.

DENIAL:DENIAL:

• "No, not me!"• patient rejects the news• initial positive defense

mechanism but can become a problem if reinforced by family and friends, leading to poor coping.

ANGERANGER

ANGER:ANGER:

• "Why me?"• resentment and rage

over impending death;• may be directed

outwards at loved ones.

BARGAINING

acknowledgement acknowledgement but……...but……...

try to bargain withtry to bargain with

GODGOD

in this stage e.gin this stage e.g

Exchange recoveryExchange recovery

promise to be a betterpromise to be a better

personperson

DEPRESSION:

• gradual realization ofgradual realization of

consequencesconsequences• difficult time - persons needs difficult time - persons needs

to be watched and supportedto be watched and supported• a period of grievinga period of grieving

must be allowed to work must be allowed to work through this stagethrough this stage

• trying to cheer up isn’t an trying to cheer up isn’t an asset now!asset now!

ACCEPTANCE

• ““I’m scared but, I’m scared but, I'm ready."I'm ready."

• These stages may These stages may overlap and overlap and repeat.repeat.

DEFINITION OF DEATH:Spiritual death:Spiritual death:• death of meaningful lifedeath of meaningful life

• including responsiveness to others, with activity of the brain including responsiveness to others, with activity of the brain and consciousness and consciousness

ALSO: Unreceptive and unresponsive to ALSO: Unreceptive and unresponsive to painful stimuli - CPR painful stimuli - CPR

• No movement for an hourNo movement for an hour

• No breathing for 3 minutesNo breathing for 3 minutes

• No reflexesNo reflexes

• Pupils fixed and dilated - flat EEGPupils fixed and dilated - flat EEG

• LIFE SIGNS………………..LIFE SIGNS………………..

DEFINITION OF DEATH:

Traditional legal definition:

• failure of heart and lungs = functional death.

Modern medicine:

• brain death = absence of electrical impulse activity in the brain (EEG).

Cellular death:

• Cells die- e.g., heart, brain, muscle

CIRCUMSTANCES OF DEATH

• Death at/or before 50 years of age Death at/or before 50 years of age or younger emotional trauma – or younger emotional trauma – unexpectedunexpected

• Religious belief = less fearReligious belief = less fear

• Pain and physical distress.Pain and physical distress.

• Immediately prior to death there Immediately prior to death there is often an increased in vitalityis often an increased in vitality

• People often "hold on" for a People often "hold on" for a specific life event or personspecific life event or person

EUTHANASIA: Mercy killing.

INDIRECT INVOLUNTARYINDIRECT INVOLUNTARY

(PASSIVE) -(PASSIVE) -

remove life supportremove life support

DIRECT VOLUNTARYDIRECT VOLUNTARY

administer fatal drug as conditionadminister fatal drug as condition

worsens worsens

DIRECT INVOLUNTARY-DIRECT INVOLUNTARY-

drug once a patient is in a coma.drug once a patient is in a coma.

ILLEGAL / ETHICAL ISSUESILLEGAL / ETHICAL ISSUES

LIVING WILL

• A statement requesting A statement requesting removal from life support removal from life support systems……. if the chance systems……. if the chance for survival is limited….for survival is limited….

• Not accepted in all Not accepted in all provinces, e.g. provinces, e.g. SaskatchewanSaskatchewan

DEATH OF A LOVED ONE:

STAGES OF GRIEF:STAGES OF GRIEF:

• Bereavement: the experience of Bereavement: the experience of lossloss

• Grief: intense emotional Grief: intense emotional sufferingsuffering

• Mourning: social response e.g.Mourning: social response e.g.

wearing black, funerals, etcwearing black, funerals, etc.

Stages and ExperiencesStages and Experiences when coping with loss….when coping with loss….

• Physical: Exhaustion, feeling weighed down Physical: Exhaustion, feeling weighed down - stress. - nutrition, rest, exercise crying - stress. - nutrition, rest, exercise crying very importantvery important

• Emotional: ask or accept helpEmotional: ask or accept help

• Ask for what you need! Being alone or with Ask for what you need! Being alone or with friends and familyfriends and family

• Talk to others with similar experiences - Talk to others with similar experiences - take the time take the time

• Sadness and crying natural - share feelings. Sadness and crying natural - share feelings.

Stages and ExperiencesStages and Experiences when coping with loss….when coping with loss….

• Intellectual: Avoid making major life decisions at this time.

• Process includes anger, resentment, and negative emotions.

• Work through the feelings - don't avoid or deny them

• Spiritual: surviving loss and finding meaning to continue, look inside yourself, your faith, and your life!

FUNERALS:FUNERALS:

• A number of A number of considerations: cost, considerations: cost, embalming, burial, and embalming, burial, and cremation.cremation.

• Rites of passage - A Rites of passage - A process - saying process - saying goodbye very important goodbye very important for closure - found in for closure - found in most culturesmost cultures

SOME IMPORTANT TERMSSOME IMPORTANT TERMS

• 1.1. SIDS: Sudden infant SIDS: Sudden infant death syndrome - babies 1 to 3 death syndrome - babies 1 to 3 months.months.

2.2. STILLBIRTH: Infant is born STILLBIRTH: Infant is born dead.dead.

3.3. PERINATAL DEATH: Death PERINATAL DEATH: Death occurs within hours or days of occurs within hours or days of birth.birth.

HELPING SOMEONE FACE HELPING SOMEONE FACE DEATHDEATH:

Hospices:Hospices:

• concept rather than concept rather than a placea place

• provides health careprovides health care

• supportsupport

• free of painfree of pain

• death with dignitydeath with dignity