1. Late Adulthood Death & Dying Chapter 13 & 14 Life Span

2. Old age > 65 3 periods – Young old 65 – 74 – Old 75 – 90 – Very old 90 +

3. Life Span Maximum number a years a species is capable of surviving – 120

4. When does the aging process begin? A.Conception B.Retirement C.Onset of illness D.When you get that first gray hair E.When your oldest child turns 13

5. Aging Normal Senescence – Symptoms of normal aging Gerontology – Study of aging

6. Theories of aging Biological Theories Clockwork theory Free-radical theory Wear & Tear theory Immune system failure theory Autoimmune theory Psychosocial theories Disengagement theory Activity theory Continuity development theory

7. Clockwork theory Connective tissue has an internal clock Stop reproducing after “so many” times

8. Free-radical theory Metabolism  free radicals  Bind with proteins etc.  Mutations  Aging

9. Anti-oxidants prevent formation of free radicals

10. Wear & Tear theory Repeat injury

11. Immune-System Failure theory Decrease in immune function  slow response to invaders  susceptibility to infection

12. Autoimmune theory Weakened immune system  Failure to recognize its own system  Destroys self

13. Disengagement theory Gradually withdraw

14. Activity theory Satisfaction come by social activity and involvement Replace activities  activites – No purpose

15. Continuity-development theory Unique personality

16. Physical Characteristics Quality of life – Age? – independence

17. Height & Weight  – 1 cm /decade p\ 30 – Spinal column nose & ears lengthen

18. Musculoskeletal system Osteoporosis Kyphosis – Breathing – Balance Flexibility – 

19. Cardiovascular system Heart valves – Thick and ridged Lumen – Narrows

20. Respiratory system Vital capacity –  Residual volume – 

21. GI system Dysphagia – Difficulty swallowing Peristalsis – 

22. Dentition Gums recede Enamel wears away

23. Integumentary system Wrinkles Subcutaneous fat –  Sweat glands –  – Sweat less – Chill Pruritis Thin Less elastic

24. Nervous system neurons

25. Sensory system Presbyopia Opacity Lactrimal ducts Cerumen Tinnitus Taste buds

26. GU system Atrophy GFR – 

27. Endocrine system Diabetes mellitus Thyroid dysfunction

28. Homeostasis Ideal temp 75 o F

29. Vital signs

30. Motor development

31. Sexual development

32. Psychosocial development Ego Integrity vs despair Reminiscences Agism – Prejudice against old people

33. Change in body image Depressed?????

34. Changes in family roles Husband retires  Yikes!

35. Changes in work and leisure #1 variable – Health

36. 7 phases of retirement 1.Remote phase 2.Near phase 3.Honeymoon period 4.Disenchantment 5.Reorientation phase 6.Stability phase 7.Terminates

37. Changes in sexuality Privacy Non-judgmental Grooming

39. The inevitability of Death He said: "I was in my early forties, With a lot of life before me, An' a moment came that stopped me on a dime. I spent most of the next days, Looking at the x-rays, An' talking 'bout the options an' talkin’ ‘bout sweet time. I asked him when it sank in, That this might really be the real end? How’s it hit you when you get that kind of news? Man whatcha do? An' he said: I went sky diving, I went rocky mountain climbing, I went two point seven seconds on a bull named Fu Man Chu. And I loved deeper and I spoke sweeter, And I gave forgiveness I'd been denying. An' he said: Some day, I hope you get the chance, To live like you were dyin'."

40. Cognitive development Sensory lose Reaction time slow Memory

41. Moral development wisdom

42. Nutrition Preparation Alone  –  appetite Guidelines –  salt –  Fluids – Soft/moist foods – Fiber – 6 small meals – Vitamin C

43. Caloric intake Women (51 – 75) – 1,300 – 1,800 / day > 75 – 1,550 – 1,700 Men (51 – 75) – 2,000 – 2,300 / day >75 – 1,650 -2,000 / day

44. Protein 12 – 13%

45. Weight loss Malnutrition – Hospitalization – Nursing homes

46. Sleep and rest  sleep needs  sleeping troubles

47. Exercise & leisure

48. Safety Vision/hearing Falls Abuse

49. Health promotion LTC

50. Delirium Acute response – Cognition – Attention S&S develop over hours or days

51. Dementia Not inevitable “Loss of cognitive ability”

52. Dementia Gradual onset Chronic Irreversible Disorientation (late) Day/night reversal Psychomotor changes (late) Delirium Abrupt onset Follows an Acute illness Reversible Disorientation (early) Disturbed sleep Psychomotor changes***

53. Depression & Suicide Losses Disease medications

54. Social Security 1935 New Deal Supplement retirement

55. Medicare & Medicaid

56. Rights of the Elderly

57. DEATH & DYING Chapter 14

58. Death as part of life Inevitable

59. Death as part of life Loss – Something removed

60. Death as part of life Coping – process

61. Death as part of life Grief – Expression of loss Anticipatory grief – Expected loss Maladaptive grief – Exaggerated – Unresolved conflicts

62. Death as part of life Mourning – Process following loss

63. Death as part of life Bereavement – State of loss

64. Elisabeth Kubler-Ross’s stages 1.Denial 2.Anger 3.Bargaining 4.Depression 5.Acceptance

65. John Bowlby’s stages of separation 1.Protest 2.Despair 3.Detachment

66. Bowlby’s Phases of Mourning 1.Numbing stage 2.Painful stage 3.Disorganized & despair 4.Reorganization stage

67. Types of lose Physical – Death of spouse – Death of parent – Death of child – Death of friend Symbolic losses – Loss of work – Loss of status – Loss of mobility – Loss of independence

68. Loss of a Spouse Great magnitude Risk of death – >2yrs Men – Feel alone Women – Feel abandoned Widows younger than widowers

69. Loss of a parent Age?

70. Loss of a child One of most difficult Blame

71. Loss of unborn child Hold child

72. Loss of sibling Blame self

73. Facing one’s own death Terminal illness

74. Signs of approaching death Withdraw  senses Cheyne-Stokes Respirations BP –  Pulse –  Temp – 

75. End of life issues

76. Advanced directive Legal document Wishes for medical treatment is they cant make these decisions

77. Living Will Form of advanced directive States wishes regarding life-sustaining treatment

78. Durable power of attorney for health care Appoint someone to make their wished known in the event they can’t any longer

79. Do not Resuscitate (DNR)

80. Euthanasia Assisted suicide “Mercy killing” Oregon

81. Right to die Can refuse medical treatment

82. Palliative care Relieve suffering

83. Hospice Care Part of Medicare/medicaid – Care for terminally ill – < 6 months to live