1. AGEISM, prejudice and discrimination against older people  Primary (genetic) VS secondary aging (environmental) Three definitions of aging, the greatest influence on these stages is caused by ENVIRONMENT: 1.Average life expectancy 2.Useful life expectancy 3.Maximum life expectancy  PRIMARY and/ or COMMON forms of illnesses that will effect these definitions: 1.COPD 2.CHF 3.cancer 4.***Vascular dementia - slow, physically caused, cognitive decline “organic” (CVA’s) a blood vessel bursts VS transient ischemic attacks (TIA’s) disorders 5.***Alzheimer's – has a genetic component of the 6.***Parkinson’s- a movement disorder due to deficiency of dopamine brain

2. OO ne of the most devastating diseases because it can/does strike in middle age and follows a progressive and LONG LASTING course for 3-20 YEARS TT here is no cure OO nly TRUE form of Diagnosis is AUTOPSY/ NN EUROFRIBRILLARY TANGLES AND PLAQUE TT here are SEVEN STAGES, these are used for frames of reference for making future plans: 1.No impairment 2.Very mild cognitive decline 3.Mild cognitive decline, (still classified as dementia, Alzheimer's can be diagnosed in some cases 4.Moderate cognitive decline, clear cut deficiencies in: a)Knowledge of recent or current events/ short term memory b)Decreased capacity to perform complex tasks c)Reduced memory of personal history/ loss of long term memory d)***APPEARANCE of WITHDRAWAL in social or mentally challenging situations

3. 5. Moderately severe cognitive decline (moderate or mid-stage Alzheimer’s disease a) unable to recall current address, date, day of the week, season **** (MENTAL STATUS EXAM)**** a)Know their name and family members b)**Still can perform daily living skills*** 6.Severe Cognitive Decline (mid-stage) a)Lose of most awareness of the “here and now” b)Can distinguish faces but not names c)***LOSE DAILY LIVING SKILLS*** d)Disturbance of normal sleep e)SIGNIFICANT PERSONALITY CHANGES f)***WANDERING**** 7. Very Severe cognitive decline (late stage) a)Lose organized speech b)Help with eating/toileting, ultimately may result with a feeding tube c)Inability to walk, sit, reflexes become abnormal and muscles are rigid

4. 1.Home care in the early stages by: a)Utilizing medications: cholinesterase inhibitors – improve memory TEMPORARILY b)OPTIMIZING ENVIRONMENTAL CONDITIONS-***LABEL/CUE/REMIND c)Utilizing supportive services - respite care/daycare 2. Nursing Home Care: a)In the sixth stage, ambulatory patients b)Special Alzheimer’s units to contend with wandering and aggressiveness 3. SKILLED nursing home care a)The seventh stage, difficulties with mobility b)Provide controlled environment to keep individual comfortable and assist with death process c)Fragility leads to compromised immune system with the occurrence of pneumonia, anorexia, and other medical complications

5.  LIFE REVIEW - process of reflection on events and experiences Acceptance of everything but dependency Study of aging is called- GERONTOLOGY SENESCENCE- declines in physical functioning associated with age  The largest growing population=Baby boomers/65 and older  90% depend on Social Security for income Coping mechanisms-Adaptive defenses  Cognitive –Appraisal model-consciously choose by analyzing a situation 1.Problem- focused coping (PROACTIVE) –solving problems 2.Emotion-focused coping- (PASSIVE) directed towards feeling better (acceptance of POWERLESSNESS) Helpful with AMBIGUOUS LOSS, things we can’t control  Disengagement VS activity Theory 1.Disengagement-moderately withdrawing 2.Activity-staying fully engaged, finding substitutes for lost roles, + successful  Continuity theory –staying connected to past and present  It is both internal and external structures

6. 1.FULL RETIREMENT – withdrawal from a full-time occupation Family focused lifestyle-doing what comes along, it is financially low cost Balanced investment-family/work/leisure Serious leisure-dominated by an activity that demands full focus 1.crisp- complete break from employment 2.blurred – repeatedly leaving and returning to work 3.bridge job – the job that is held between one’s exit from a career job and final retirement 4.Volunteerism Marital/ Remarriage Siblings Cohabitation Friendships Gay and lesbian children

7.  Loss of independence and or physical capacity 1.Frail older adults – physical disabilities, very ill, and have cognitive and or psychological disorders 2.Activities of daily living – basic self care activities 3. Instrumental activities of daily living – actions that require intellectual competence and planning  Changes or stability in relationships, marriage conflict or honeymoon stage Living arrangements: 1.Aging in place-remaining in your home 2.Living alone 3.Living with adult children 4.Living in institutions: assisted living facility – a facility which is housed on a “campus” with access to nursing staff and/or facilities Intermediate care – 24 hour care necessitating nursing SUPERVISION skilled nursing care – requires 24 hour nursing CARE

8.  bioethics – the study of human values (ethics) and technological advances in health sciences  euthanasia – the practice of ending life for reasons of mercy 1.active euthanasia – deliberate ending of a life which may be based on a clear statement of the person’s wishes (mercy killing or assisted suicide) 2.passive euthanasia – allowing someone to die by withholding available treatment clinical death – no heartbeat or respiration brain death – no identifiable signs of brain activity persistent vegetative state – cortical functioning ceases while brainstem activity continues  living will – a healthy or unhealthy person legally states their wishes about life support  Durable power of attorney – a legal document that gives a representative power over financial and medical decisions.  health care surrogate – identifies an individual to make medical decisions if you are incapacitated  Organ donation – harvesting organs as a result of brain death

9.  Kubler-Ross – identified stages of dying in terminally ill patients  Many people believe that these stages of grief are also experienced by others when they have lost a loved one, they reflect DISCONTINUITY  The process is easier? If the death was expected due to old age (less guilt)  The stages Kubler-Ross identified are: 1.Denial (this isn't happening to me!) 2.Anger (why is this happening to me?) 3.Bargaining (I promise I'll be a better person if...) 4.Depression (I don't care anymore) 5.Acceptance (I'm ready for whatever comes)  grieving for a loved one last seven years before the process can be completed, if at all.

10.   “caregiver syndrome”. During the illness/dying process which can go on for months or years the ill person has become a focus of the individual’s attention and consumed most if not all of their free time. The actual physical absence of having to care for the individual leaves the caregiver “empty” and every activity TRIGGERS the memory of the person. This is what type of conditioning?   In older individuals whose lose a spouse of 40 -50+ years it is not uncommon for them to die within the year following the death of the loved one.   “Complicated Bereavement”. Severe symptoms continue for up to year but eventually begin to diminish. If the individual remains in a severe state of incapacity they may be treated and eventually identified as:   Major Depressive Episode 1. 1.The “normal” symptoms of depressed mood, insomnia, anhedonia (loss of all pleasure), and lack of appetite will PERSIST beyond two months. 2. 2.The individual feels guilt about things OTHER than the actions taken or not taken by the survivor at the time of the death. 3. 3.Thoughts of death OTHER than the survivor feeling that he/she would be better off dead or should have died with the deceased person. 4. 4.morbid preoccupation with worthlessness 5. 5.marked psychomotor retardation (inability to get out of bed) 6. 6.prolonged and marked functional impairment (inability to work or do household chores)

11. “Each of us has the right to die pain-free and with dignity” The focus is on CARING not curing 1.PALLIATIVE CARE - to make comfortable by treating a person’s symptoms from an illness – no attempt to treat the illness 2.Most reimbursement sources require a prognosis of six months or less 3.They use a “TEAM APPROACH” 4.They treat on a multidimensional level: physical, psychological, and/ or spiritual. 5. The goal is to help keep the patient as pain-free as possible, it is NOT normal and can be observed even if it cannot be communicated 6.It is provided at “HOME”, the definition is multidimensional 7.Hospice does provide it’s own inpatient facility for those without support systems 8.Primary “caregiver” – anyone who is directly responsible for care in the home, usually a family member MMakes short-term inpatient care available when pain or symptoms become too difficult to manage at home, or the caregiver needs respite time BBest interest - a standard for making health care decisions based on what others believe to be "best" for a patient by weighing the benefit /risk ratio LLife-sustaining treatment - Treatments (medical procedures) that replace or support an essential bodily function, also referred to as:" extraordinary means”