Late Adulthood Death & Dying Chapter 13 & 14 Life Span

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

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

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

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

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

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

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

Anti-oxidants prevent formation of free radicals

Wear & Tear theory Repeat injury

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

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

Disengagement theory Gradually withdraw

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

Continuity-development theory Unique personality

Physical Characteristics Quality of life – Age? – independence

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

Musculoskeletal system Osteoporosis Kyphosis – Breathing – Balance Flexibility – 

Cardiovascular system Heart valves – Thick and ridged Lumen – Narrows

Respiratory system Vital capacity –  Residual volume – 

GI system Dysphagia – Difficulty swallowing Peristalsis – 

Dentition Gums recede Enamel wears away

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

Nervous system neurons

Sensory system Presbyopia Opacity Lactrimal ducts Cerumen Tinnitus Taste buds

GU system Atrophy GFR – 

Endocrine system Diabetes mellitus Thyroid dysfunction

Homeostasis Ideal temp 75 o F

Vital signs

Motor development

Sexual development

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

Change in body image Depressed?????

Changes in family roles Husband retires  Yikes!

Changes in work and leisure #1 variable – Health

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

Changes in sexuality Privacy Non-judgmental Grooming

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'."

Cognitive development Sensory lose Reaction time slow Memory

Moral development wisdom

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

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

Protein 12 – 13%

Weight loss Malnutrition – Hospitalization – Nursing homes

Sleep and rest  sleep needs  sleeping troubles

Exercise & leisure

Safety Vision/hearing Falls Abuse

Health promotion LTC

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

Dementia Not inevitable “Loss of cognitive ability”

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***

Depression & Suicide Losses Disease medications

Social Security 1935 New Deal Supplement retirement

Medicare & Medicaid

Rights of the Elderly

DEATH & DYING Chapter 14

Death as part of life Inevitable

Death as part of life Loss – Something removed

Death as part of life Coping – process

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

Death as part of life Mourning – Process following loss

Death as part of life Bereavement – State of loss

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

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

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

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

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

Loss of a parent Age?

Loss of a child One of most difficult Blame

Loss of unborn child Hold child

Loss of sibling Blame self

Facing one’s own death Terminal illness

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

End of life issues

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

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

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

Do not Resuscitate (DNR)

Euthanasia Assisted suicide “Mercy killing” Oregon

Right to die Can refuse medical treatment

Palliative care Relieve suffering

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