Psychology 2314 Chapter 15 Late Adult Psychosocial Development

Psychology 2314 Chapter 15 Late Adult Psychosocial Development
Developmental theories The Frail elderly Positivity effect Activities in Late Adulthood Age in place Partnership in Late Adulthood Marital changes in Late Adulthood Friends and relatives in Late Adulthood

Theories of Late Adulthood
Development is more diverse in late adulthood than at any other age. Some elderly people run marathons and lead nations, while others are no longer able to move or think. Many social scientists have tried to understand these variations as well as the general course of old age.

Self Theories Theories of late adulthood that emphasize the core self, or the search to maintain one’s integrity and identity. Integrity versus despair The final stage of Erik Erikson’s developmental sequence, in which older adults seek to integrate their unique experiences with their vision of community.

Most older people consider their personalities and attitudes to have remained quite stable over their life span, even as they recognize the physical changes of their bodies. Objects and places become more precious in late adulthood than they were earlier, as a way to hold on to identity. The tendency to cling to familiar places and possessions may be problematic if it leads to compulsive hoarding.

Continuity theory The theory that each person experiences the changes of late adulthood and behaves toward others in a way that is consistent with his or her behavior in earlier periods of life. In this perspective, each innovation is a new expression of the old self. One source of continuity is temperament. The Big Five personality traits (see Chapter 13) are maintained throughout old age as in younger years.

Selective optimization with compensation is central to self theories. Positivity effect The tendency for elderly people to perceive, prefer, and remember positive images and experiences more than negative ones. Selective memory is a way to compensate for whatever troubles occur. Unpleasant experiences are reinterpreted as inconsequential.

Self-perception normally tilts toward integrity rather than despair. Research on what people hope for themselves (the ideal self ) and how they perceive themselves (the real self) finds that, with age, the two selves come closer together. As self theory contends, self-acceptance leads to happiness.

Stratification Theories Theories that emphasize that social forces, particularly those related to a person’s social stratum, or social category, limit individual choices and affect a person’s ability to function in late adulthood as past stratification continues to limit life in various ways.

STRATIFICATION BY AGE Industrialized nations segregate elderly people, gradually shunting them out of the mainstream of society as they grow older. Segregation by age harms everyone because it creates socialization deficits for members of all age groups.

disengagement theory The view that aging makes a person’s social sphere increasingly narrow, resulting in role relinquishment, withdrawal, and passivity. activity theory The view that elderly people want and need to remain active in a variety of social spheres—with relatives, friends, and community groups—and become withdrawn only unwillingly, as a result of ageism.

Activities in Late Adulthood
Work The activities of older people are intense and varied. The psychological benefits of work can be obtained through volunteer work. Work provides social support and status, boosting self-esteem. For many people, employment allows generativity.

Besides needing the money, some employees over age 65 stay on the job because they appreciate the social recognition and self-fulfillment that work brings. Many people once believed that older adults were healthier and happier when they were employed than when they were unemployed and that retirement led to illness and death. Only when retirement is precipitated by poor health or fading competence does it correlate with illness.

Home, Sweet Home One of the favorite activities of many retirees is caring for their own homes. In keeping up with household tasks and maintaining their property, many older people demonstrate that they prefer to age in place. They want to stay in the same dwelling where they lived as younger adults, adjusting but not leaving when health fades.

Naturally Occurring Retirement Community (NORC) A neighborhood or apartment complex whose population is mostly retired people who moved to the location as younger adults and never left. An important reason for both aging in place and NORCs is the social convoy, the result of years of close relationships.

Continuing Education About one out of five U.S. adults age 66 and older was enrolled in some kind of continuing education in 2005. Most elderly students are motivated primarily by a desire for personal or social improvement. In some ways, late adulthood is an ideal time for learning.

Religious Involvement Older adults are less likely to attend religious services than are the middle-aged. But, faith increases with age, as do praying and other religious practices. Religious institutions fulfill many needs, and a nearby house of worship is one reason American elders prefer to age in place.

Political Activism Fewer older people turn out for massive rallies and only about 2 percent volunteer in political campaigns. More older people write letters to their elected representatives, vote, and identify with a political party. Many government policies affect the elderly, especially those regarding housing, pensions, prescription drugs, and medical costs.

Friends and Relatives Long-Term Partnerships Shared Laughter
Spouses buffer each other against the problems of old age, thus extending life. Married older adults are healthier, wealthier, and happier than unmarried people their age. Shared Laughter One characteristic of long-married couples is that they often mirror each other’s moods. Thanks to the positivity effect, the mood is often one of joy.

Friends and Relatives One of the amazing aspects of long-term relationships is how interdependent the partners become over time. Another aspect of long marriages also suggests mutual respect. Generally, older spouses accept each other’s frailties, assisting with the partner’s physical and psychological needs.

Friends and Relatives DEATH OF A SPOUSE
Another common event that long-married older adults must face is the death of their spouse. Adjustment to being widowed is especially difficult during the first two years after the death. Because women tend to marry older men, the average married woman experiences 4 to 10 years of widowhood and the average man, none.

Friends and Relatives Although elderly people’s relationships with members of younger generations are usually positive, they can also include tension and conflict. Few older adults stop parenting simply because their children are grown. Adult children also imagine parental disapproval, even if it is not outwardly expressed.

Friends and Relatives Filial responsibility
Feelings of familism prompt siblings, cousins, and even more distant relatives to seek out one another. Filial responsibility The obligation of adult children to care for their aging parents. A major goal among adults in the United States is to be self-sufficient. Adult children may be more willing to offer support than their parents are to receive it.

Friends and Relatives Extensive research has found that relationships between parents and adult children are affected by many factors: Assistance arises from need and from the ability to provide. Frequency of contact is related to geographical proximity, not affection. Love is influenced by the interaction remembered from childhood. Sons feel stronger obligation; daughters feel stronger affection.

Friends and Relatives In the United States, contemporary grandparents follow one of four approaches to dealing with their grandchildren: Remote grandparents (sometimes called distant grandparents) are emotionally distant from their grandchildren. Companionate grandparents (sometimes called “fun-loving” grandparents) entertain and “spoil” their grandchildren. Involved grandparents are active in the day-to-day lives of their grandchildren. Surrogate parents raise their grandchildren, usually because the parents are unable or unwilling to do so.

Friends and Relatives Friends
Many middle-aged adults, married and unmarried, have no children. Elderly people who have spent a lifetime without a spouse usually have friendships, activities, and social connections. All the research finds that older adults need at least one close companion.

The Frail Elderly Frail elderly
People over age 65, and often over age 85, who are physically infirm, very ill, or cognitively disabled. Most older adults become frail if they live long enough. Frailty is most common in the months preceding death.

The Frail Elderly Activities of Daily Life
Actions that are important to independent living, typically identified as five tasks of self-care: eating bathing, toileting dressing transferring from a bed to a chair Inability to perform any of these tasks is a sign of frailty.

The Frail Elderly Instrumental activities of daily life (IADLs)
Actions (for example, paying bills and driving a car) that are important to independent living and that require some intellectual competence and forethought. The ability to perform these tasks may be even more critical to self-sufficiency than ADL ability.

The Frail Elderly

The Frail Elderly Caring for the Frail Elderly
Family caregivers experience substantial stress. Their health may suffer, and their risk of depression increases, especially if the care receiver has dementia. In the United States, the spouse is the usual caregiver.

The Frail Elderly Even in ideal circumstances with community support, family caregiving can present problems: If one adult child is the primary caregiver, other siblings tend to feel relief or jealousy. Care receivers and caregivers often disagree about schedules, menus, doctor visits, and so on. Resentments on both sides disrupt mutual affection and appreciation. Public agencies rarely provide services unless an emergency arises.

The Frail Elderly When caregiving results in resentment and social isolation, the risk of depression, poor health, and abuse escalates. Abuse is likely when: the care receiver is a feeble person who suffers severe memory loss the caregiver is a drug-addicted relative care occurs in an isolated place visitors are few and far between

The Frail Elderly Most research finds that:
about 5 percent of elders say they are abused up to one-fourth of all elders are vulnerable but do not report abuse. Elders who are mistreated by family members are ashamed to admit it. Outright abuse is now rare in nursing homes. In the United States, the trend over the past 20 years has been toward fewer nursing-home residents (currently about 1.5 million people nationwide).

The Frail Elderly Assisted living
A living arrangement for elderly people that combines privacy and independence with medical supervision. Assisted-living facilities range from group homes for three or four elderly people to large apartment or townhouse developments for hundreds of residents.

Death often occurs in hospitals The main causes of death have changed
How Death and Dying has Changed in the Past Century How has death changed in the past century? Death occurs later Death often occurs in hospitals Dying takes longer The main causes of death have changed And after death… A century ago, the average life span worldwide was less than 40 years (47 in the rapidly industrializing United States). Half of the world’s babies died before age 5. Now newborns are expected to live to age 78; in many nations, elderly people age 85 and over are the fastest-growing age group. Death occurs later Instruction: Click to reveal additional information about “Death occurs later.” Click to reveal additional information about “Dying takes longer.” Click to reveal additional information about “Death often occurs in hospitals.” Click to reveal additional information about “The main causes of death have changed.” Click to reveal additional information about “And after death...” You may not realize that hope is the human response to death. Yet death is often considered a beginning, not an end; a community event, not a personal one; welcomed, not dreaded. A life-span perspective allows us to see that death is viewed by historical changes as well as by age, both of the person who dies and the one who mourns. Click to play an interview with an expert on the history of death over the past century. In this clip, you’ll hear from Barbara Coombs Lee, president of the Compassion in Dying Federation. What has changed over time, according to the video, is just death but more importantly the process, duration, and location of the dying process, partly because people are dying at an older age and of more chronic illnesses than they did 100 years ago. There also has developed a change in the medical profession of focusing too much on preventing death. thanatology: The study of death and dying, especially of the social and emotional aspects. 35 35 35 35 35

How Death and Dying has Changed in the Past Century How has death changed in the past century? Death occurs later Death often occurs in hospitals Dying takes longer The main causes of death have changed And after death… Dying takes longer In the early 1900s, death was usually fast and unstoppable; once the brain, the heart, or other vital organs failed, the rest of the body quickly followed. Now death can often be postponed through medical intervention: Hearts can beat for years after the brain stops functioning, respirators can replace lungs, and dialysis can do the work of failing kidneys. As a result, dying is often a lengthy process. Instruction: Click to reveal additional information about “Death occurs later.” Click to reveal additional information about “Dying takes longer.” Click to reveal additional information about “Death often occurs in hospitals.” Click to reveal additional information about “The main causes of death have changed.” Click to reveal additional information about “And after death...” You may not realize that hope is the human response to death. Yet death is often considered a beginning, not an end; a community event, not a personal one; welcomed, not dreaded. A life-span perspective allows us to see that death is viewed by historical changes as well as by age, both of the person who dies and the one who mourns. Click to play an interview with an expert on the history of death over the past century. In this clip, you’ll hear from Barbara Coombs Lee, president of the Compassion in Dying Federation. What has changed over time, according to the video, is just death but more importantly the process, duration, and location of the dying process, partly because people are dying at an older age and of more chronic illnesses than they did 100 years ago. There also has developed a change in the medical profession of focusing too much on preventing death. thanatology: The study of death and dying, especially of the social and emotional aspects. 36 36 36 36 36

How Death and Dying has Changed in the Past Century How has death changed in the past century? Death occurs later Death often occurs in hospitals Dying takes longer The main causes of death have changed And after death… Death often occurs in hospitals A hundred years ago, death almost always occurred at home, with the dying person surrounded by familiar faces. Now many deaths occur in hospitals, surrounded by medical personnel and technology. Instruction: Click to reveal additional information about “Death occurs later.” Click to reveal additional information about “Dying takes longer.” Click to reveal additional information about “Death often occurs in hospitals.” Click to reveal additional information about “The main causes of death have changed.” Click to reveal additional information about “And after death...” You may not realize that hope is the human response to death. Yet death is often considered a beginning, not an end; a community event, not a personal one; welcomed, not dreaded. A life-span perspective allows us to see that death is viewed by historical changes as well as by age, both of the person who dies and the one who mourns. Click to play an interview with an expert on the history of death over the past century. In this clip, you’ll hear from Barbara Coombs Lee, president of the Compassion in Dying Federation. What has changed over time, according to the video, is just death but more importantly the process, duration, and location of the dying process, partly because people are dying at an older age and of more chronic illnesses than they did 100 years ago. There also has developed a change in the medical profession of focusing too much on preventing death. thanatology: The study of death and dying, especially of the social and emotional aspects. 37 37 37 37 37

How Death and Dying has Changed in the Past Century How has death changed in the past century? Death occurs later Death often occurs in hospitals Dying takes longer The main causes of death have changed And after death… People of all ages once died of infectious diseases (tuberculosis, typhoid, smallpox), and many women and infants died in childbirth. Now disease deaths before age 50 are rare, and almost all newborns (99 percent) and their mothers (99.99 percent), live unless the infant is very frail or medical care of the mother is grossly inadequate. The main causes of death have changed Instruction: Click to reveal additional information about “Death occurs later.” Click to reveal additional information about “Dying takes longer.” Click to reveal additional information about “Death often occurs in hospitals.” Click to reveal additional information about “The main causes of death have changed.” Click to reveal additional information about “And after death...” You may not realize that hope is the human response to death. Yet death is often considered a beginning, not an end; a community event, not a personal one; welcomed, not dreaded. A life-span perspective allows us to see that death is viewed by historical changes as well as by age, both of the person who dies and the one who mourns. Click to play an interview with an expert on the history of death over the past century. In this clip, you’ll hear from Barbara Coombs Lee, president of the Compassion in Dying Federation. What has changed over time, according to the video, is just death but more importantly the process, duration, and location of the dying process, partly because people are dying at an older age and of more chronic illnesses than they did 100 years ago. There also has developed a change in the medical profession of focusing too much on preventing death. thanatology: The study of death and dying, especially of the social and emotional aspects. 38 38 38 38 38

Understanding Death through the Life Span
What do children understand about death? Three- to 12-year-olds in a U.S. study saw a puppet skit and were asked about a sick mouse that was eaten by an alligator. Results based on the children’s responses to these questions appear in this graph. Now That the Mouse is Dead... Will he ever be alive again? Is he still thirsty? Does he still feel sick? Does he still want to go home? Instruction: Click to reveal the study findings for each age group Even the youngest children knew that the mouse was dead, but most of them believed that it still had feelings, needs, and wishes. For children, death does not stop life. These researchers also surveyed 20 college students, 13 of whom (65 percent) thought that love for one’s mother continues after one’s death. (In this series of studies, not every age group was asked every question, which explains why only two sets of responses are shown for two of the questions.) In another study of 4- to 8-year-olds, those who knew more about the specifics of a loved one’s death were less anxious about death and dying (Slaughter & Griffiths, 2007). Click to see an interview with Laura Rothenberg, a young woman with cystic fibrosis. A year after this interview was filmed and her diary, “My So Called Lungs,” was broadcast nationally, Laura Rothenberg died. Click to see an interview with two terminally ill women. This video clip contains an interview with Lucky, a young woman, and an older woman, Dorothy. Does he still love his mother? 10 20 30 40 50 60 70 80 90 100 Percent answering yes Groups of participants (average age) Youngest (5) Middle (7) Oldest (10) Source: Bering & Bjorklund, 2004. 39 39 39 39 39

Choices and Controversies
living will: A document that indicates what medical intervention an individual prefers if he or she is not conscious to express a decision. health care proxy: A person chosen by another person to make medical decisions if the second person becomes unable to do so. What are some differences in end-of-life attitudes between those who administer hospital care for the dying and those who receive it? Attitudes Toward End-of-Life Decisions Regard quality of life as more important than length of life Physicians Instruction: Click each colored square for subject groups to reveal the study findings. As an example of what a living will can do, some people use a living will to let it be known that they do not want mechanical breathing. Responding to a survey taken in six European nations’ intensive-care units (ICUs), higher percentages of ICU doctors and nurses than of ICU patients and their families said they considered quality of life more important than a long life. Designated health care proxies often find it difficult to choose death over even the slimmest chance of recovery for a loved one, nor do they know what the person would want in every instance, nor do doctors want to say that there is no hope. The risks, benefits, and alternatives to every medical procedure have rarely been contemplated in advance by anyone. Nurses Family members Would prefer not to be in a hospital if they were terminally ill Patients in intensive care 10 20 30 40 50 60 70 80 90 100 Percent Source: Sprung et al., 2007. Source: Sprung et al., 2007. 40

Grief How might people feel and act when a loved one dies?
bereavement: The complicated and multifaceted reactions to the feelings of loss following a death. grief: The deep sorrow that people feel at the death of another. Grief is personal and unpredictable. mourning: The ceremonies and behaviors that a religion or culture prescribes for people to employ in expressing their bereavement after a death. How might people feel and act when a loved one dies? Instruction: Mourning customs are designed to move grief from loss toward affirmation (Harlow, 2005). For this reason, eulogies emphasize the dead person’s good qualities; people who did not personally know the deceased person attend wakes, funerals, or memorial services to help comfort the survivors. Sometimes “meaning becomes grounded in action” to honor the dead (Armour 2003, p. 538). Organizations devoted to causes such as fighting cancer and banning handguns find their most dedicated supporters among people who have lost a loved one to that particular circumstance. Normal grief reaction is intense and irrational at first but gradually eases, as time, social support, and traditions help first with the initial outpouring of emotion and then with the search for meaning and reaffirmation. 41

Complicated Grief Complicated grief
What are some of the ways that grief can cause long-lasting problems in functioning? Absent grief Disenfranchised grief A situation in which mourners do not grieve, either because other people do not allow grief to be expressed or because the mourners do not allow themselves to feel sad. A situation in which certain people, although they are bereaved, are prevented from mourning publicly by cultural customs or social restrictions. Complicated grief Incomplete grief Instruction: Click to reveal more about this type of grief. The appearance of not mourning might be a bereaved person’s first reaction of not being able to face the reality of death. Over time, physical and psychological symptoms—from trouble breathing or walking to sudden panic attacks or depression—may appear, as if for no reason. These might occur over a death that was never mourned. Modern life increases the incidence of disenfranchised grief by unmarried lovers (of the same or other sex), divorced spouses, young children, or close friends at work that may be excluded from the mourning arrangements through benign neglect or on purpose. The inability to recover the body, as happens for soldiers who are missing in action or some victims of a major flood or fire, impedes mourning and hence halts a bereaved person’s progress toward reaffirmation. A situation in which circumstances, such as a police investigation or an autopsy, interfere with the process of grieving. complicated grief: A type of grief that impedes a person’s future life, usually because the person clings to sorrow or is buffeted by contradictory emotions. 42 42 42 42 42

Diversity of Reactions
What kinds of reactions do people have to the death of a spouse? Reactions to Spouse’s Death Uncomplicated grief 11% Less depressed 18% Resilient 50% Instruction: Click each section of this graph to reveal the data it represents. As you can see in this graph, grief varies, in duration and depth. A few mourners may never recover, but that is a small minority. In this study, 18 months after such a death, one in nine survivors was still grieving. Most widows (68 percent) and widowers were no longer depressed after 6 months; indeed, some (18 percent) were happier after the death than before. Another group (10 percent) were chronically depressed, even before the death, and some (11 percent) took 18 months to regain their equilibrium. Specifics from other studies vary, but all the research finds that time heals most sadness; grief that lasts more than a year is unusual. If someone you know is grieving, the first step is simply to be aware that powerful, complicated, and unexpected emotions are likely. A friend should listen and sympathize, never implying that the person is too grief-stricken or not grief-stricken enough. Click to see a video with experts discussing bereavement and grief. This video clips includes an interview with Dr. George Bonanno of Columbia University, and journalist Carol Abaya. Click to see a video about bereavement and grief in children. This video clip includes an interview with a boy who has lost a family member. Click to see a video about bereavement and grief in early and middle adulthood. This video clip shows an interview with a young adult daughter and middle-aged mother on the death of the mother’s brother, to whom both were close. Click to see a video about bereavement and grief in late adulthood. This video clip includes interviews with older adults who have lost loved ones, plus Anna Zimmer of Brookdale Center on Aging at Hunter College. Slow to recover 11% Depressed 10% Source: Boerner et al., 2005. 43 43 43 43 43

Psychology 2314 Chapter 15 Late Adult Psychosocial Development

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