insel10ebrup ppt ch14

© 2008 McGraw-Hill Higher Education. All rights reserved.

The Challenge of Aging

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Life is Like a River

• “The flow is continuous, and you never step in the same place twice.”

• There is no precise age when a person becomes “old.”

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Generating Vitality As You Age

• What happens As You Age?– Characteristics associated with aging are not due to aging but to

abuse and neglect.• Life-Enhancing Measures: Age-Proofing

– Challenge Your Mind.• Stay mentally active

– Develop Physical Fitness.– Eat Wisely.– Maintain a Healthy weight.– Control Drinking and Overdependence on Medications.– Don’t Smoke.– Schedule Physical Examinations to Detect Treatable Disease.– Recognize and Reduce Stress.

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Confronting the Changes Of Aging

• Planning for Social Changes.– Changing Roles and Relationships.– Increased Leisure Time.– The Economics of Retirement.

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Adapting to Physical Changes

• Some physical changes are inevitable• Hearing Loss• Vision Changes

– Age-related macular degeneration (AMD)– Presbyopia– Cataracts

• Arthritis– Osteoarthritis (OA)– Rheumatoid arthritis– Lupus

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Adapting to Physical Changes

• Menopause

• Osteoporosis– Build bone throughout your life– Diet and exercise– Avoid tobacco– Manage depression and stress

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Handling Psychological and mental Changes

• Dementia– Severe and significant brain deterioration– Two most common forms

• Alzheimer’s disease• Multi-infarct dementia

• Grief• Depression

– Unresolved grief can lead to depression– Suicide

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Life In An Aging America

• America’s Aging Minority– 65 or Older.

• 35 million people, about 13% of the total American population in 2000.

• Affecting the stereotypes.• Political attention to the growing population.• The Aging population is increasing

proportionately.

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Family and Community Resources for Older Adults

• Family Involvement in care giving.• Other Living and Care Options.• Community Resources.

– Senior citizens’ centers– Homemaker services– Visiting nurses– Household services– Friendly visitor– Home food delivery– Adult day hospital care– Low-cost legal aid– Transportation.

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Government Aid and Policies

• Food stamps

• Housing subsidies

• Social Security

• Medicare and Medicaid

• Life insurance and old-age pension plan

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What is Death?

• Defining death.– Defined as cessation of the flow of bodily fluids.– Life-support systems.– 1968 Harvard Medical School Committee, Brain death involves:

1. Lack of receptivity and response to external stimuli.2. Absence of spontaneous muscular movement and breathing.3. Absence of observable reflexes.4. Absence of brain activity.

1. Electroencephalogram (EEG).

5. Second set of tests after 24 hours1. Hypothermia (Below 90 degrees F)2. Central nervous system depressants

Clinical death Cellular death

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Dying Versus Welcoming Death

• Anxiety associated with death.

• Many seek to avoid any thought or mention of death.– “Out of sight, out or mind”

• United states attitude is to “death denying”.

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Planning for Death

• Making a will.– Legal instrument expressing a person’s intentions

and wishes for the disposition of his or her property after death.

– Estate.• Money, property, and other possessions

– Testator.• The person making the will

– Interstate.• Without having left a valid will

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Considering Options for End-of Life Care

• Spending your last days at home, cared for by relatives and friends?

-OR-• Access to the sophisticated medical

technologies in the hospitals.• Home care.• Hospital-based palliative care.• Hospice programs.

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Deciding to Prolong Life or Hasten Death

• Would you want aggressive treatment to keep you alive, even if it meant that your were put on life-support?

• Modern medicine.– Persistent vegetative state.– Ethical questions about the “right to die”.

• U.S. Supreme Court – 1990. Cruzan case– 2003. Schiavo case– The right to refuse life sustaining treatment is constitutionally

protected.– The importance of expressing one’s wishes about life-

sustaining treatment

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Deciding to Prolong Life or Hasten Death

• Withholding or Withdrawing Treatment.– The right of a competent patient to refuse unwanted

treatment.– Passive euthanasia.

• Assisted Suicide and Active Euthanasia.– Physician-assisted suicide (PAS).

• 1997. Supreme Court cases– Washington v. Glucksberg– Vacco v. Quill

• Oregon is the only state permitting PAS– The Death with Dignity Act (1994)

– Active euthanasia.

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Completing an Advance Directive

1. Living will.• Enables individuals to provide instructions

about the kind of medical care they wish to receive.

2. Health care proxy.• Durable power of attorney for health care• Appoint another person to make decisions

about medical treatment• Surrogate.

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Becoming an Organ Donor

• Human body is a valuable resource.

• Each day 60 people receive an organ transplant.

• Each day 18 people on the waiting list die because not enough organs to assist.

• Uniform Donor Card.

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Planning a Funeral or Memorial Service

• Disposition of the body.– Considerations:

• Social• Cultural• Religious • Psychological • Interpersonal

• Arranging a Service.– Choice of last rites

• Traditional funeral ceremony• Simple memorial service• Costs between $5,000-$7,000

– Non-profit memorial society.

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Coping With Dying

• No one right way to live or die of a life-threatening illness.– Doctors treat diseases; people suffer from

illness.– Concerns with:

• Costly medical care.• Loss of income.• Repeated and lengthy hospitalization.• Physical pain.

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The Tasks of Coping

• On Death and Dying (Elisabeth Kubler-Ross).– 5 Psychological stages:

1. Denial.2. Anger.3. Bargaining.4. Depression.5. Acceptance.

• Charles Corr’s primary dimensions in coping with dying.– Four primary dimensions in coping with dying

1. Physical.2. Psychological.3. Social.4. Spiritual.

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Coping With Loss

• Experiencing Grief.– Reaction to loss

• Thoughts, feelings, physical and mental responses.

– Bereavement.

– Mourning.

• Tasks of Mourning.1.Accepting the reality of the loss.

2.Working through the pain and grief.

3.Adjusting to a changed environment.

4.Emotionally relocating the deceased and moving on.

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Coping With Loss

• The Course of Grief.– Early phase

– Middle phase

– Last phase

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Supporting a Grieving Person

• Give kind and loving support.

• Be a good listener.

• Refrain from making judgments about the survivor’s feelings are “good” or “bad”.

• Social support is critical.

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Coming To Terms With Death

• Confronted with emotions and thoughts that relate to the immediate loss but also to our own mortality.

• Teaches us that relationships are more important than things

• Allow ourselves to make room for death• Denying death, it turns out, results in

denying life.


Aging: A Vital Process

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