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UNIT 10 LATE ADULTHOOD 360 Unit 10 Late Adulthood Late Adulthood Late adulthood spans the time when we reach our until death . This is the longest developmental stage across the lifespan . In this chapter , we will consider the growth in numbers for those in late adulthood , how that number is expected to change in the future , and the consequences this will have for both the United States and the world . We will also examine several theories of human aging , the physical , cognitive , and changes that occur with this population , and the vast diversity among those in this developmental stage . Further , ageism and many of the myths associated with those in late adulthood will be explored . Late Adulthood in America Late adulthood , which includes those aged 65 years and above , is the fastest growing age division of the United States population ( 2016 ) Currently , one in seven Americans is 65 years of age or older . The of the baby boomers ( born from ) turned 65 in 2011 , and approximately baby boomers turn 65 every day . By the year 2050 , almost one in four Americans will be over 65 , and will be expected to live longer than previous generations . According to the Census Bureau ( a person who turned 65 in 2015 can expect to live another 19 years , which is years longer than someone who turned 65 in 1950 . This increasingly aged population has been referred to as the graying of America . This graying is already having effects on the nation in many areas , including work , health care , housing , social security , and adaptive technologies . Table shows the 2012 , 2020 , and 2030 projected percentages of the population ages 65 and older . Table Percent of United States Population 65 Years and Older Percent of United States Population 2012 2020 2030 65 Years and Older 85 Years and Older adapted from Lally ( 2019 ) and compiled from data from An Aging Nation The older population in the United States . United States Census Bureau . The Graying of the World Even though the United States is aging , it is still younger than most other developed countries ( Hogan , 2014 ) Germany , Italy , and Japan all had at least 20 of their population aged 65 and over in 2012 , and Japan had the highest percentage of elderly . Additionally , between 2012 and 2050 , the proportion aged 65 and over is projected to increase in all developed countries . Japan is projected to continue to have the oldest population in 2030 and 2050 . Table shows the percentages of citizens aged 65 and older in select developed countries in 2012 and projected for 2030 and 2050 . Late Adulthood 361
Table Percentage of Citizens 65 Years and Older in Six Developed Countries Percent of Population 65 and Older 2012 2030 2050 America 137 22 Japan 24 40 Germany 20 30 Italy 20 31 Canada 165 25 Russia 13 20 26 adapted from ( 2019 ) and compiled from data from An Aging Nation The older population in the United States . United States Census Bureau . According to the National Institute on Aging ( NIA , there are 524 million people over 65 worldwide . This number is expected to increase from to 16 of the global population by 2050 . Between 2010 and 2050 , the number of older people in less developed countries is projected to increase more than 250 , compared with only a 71 increase in developed Countries . Declines in fertility and improvements in longevity account for the percentage increase for those 65 years and older . In more developed countries , fertility fell below the replacement rate of two live births per woman by the , down from nearly three children per woman around 1950 . Fertility rates also fell in many less developed countries from an . average of six children in 1950 to an average of two or three 179 10 ide children in 2005 . In 2006 , fertility was at or below the replacement level in 44 less developed countries ( NIA , In total number , the United States is projected to have a larger older population than the other developed nations , but a smaller older population compared with China and India , the worlds two most populous nations ( et , 2014 ) By 2050 , China older population is projected to grow larger than the total population today . As the population ages , concerns grow about who will provide for those requiring care . In 2000 , there were about 10 people 85 and older for every 100 persons between ages 50 and 64 . These midlife adults are the most likely care providers for their aging parents . The number of old requiring support from their children is expected to more than double by the year 2040 ( He , 2005 ) These families will certainly need external physical , emotional , and support in meeting this challenge . Age Periods during Late Adulthood Late adulthood encompasses a long period , from age 60 potentially to age sixty years ! Researchers recognize that within that time period , from age 60 until death , there are multiple ages or , that can be distinguished based on differences in peoples typical physical health and mental functioning during those age periods . In this chapter , we will be dividing the stage into four age periods ( the ( and 362 Late Adulthood
( These categories are based on the conceptions of aging including , biological , psychological , social , and chronological differences . They also the increase in longevity of those living to this latter stage . Generally , this age span includes many positive aspects and is considered the golden years of adulthood . When compared to those who are older , the old experience relatively good health and social engagement ( Smith , 2000 ) knowledge and expertise ( Singer , 2003 ) and adaptive in daily living ( 2005 ) The also show strong performance in attention , memory , and crystallized intelligence . In fact , those as are more similar to those in midlife . This group is less likely to require care , to be dependent or poor , and more likely to be married , working for pleasure rather than income , and living independently . Overall , those in this age period feel a sense of happiness and emotional that is better than at any other period of adulthood ( Fung , Charles , 2003 George , 2009 Robins , 2005 ) It is also an ' unusual age in that people are considered both in old age and not in old age ( 2002 ) Adults in this age period are likely to be living independently , but often experience physical since chronic diseases increase after age 75 . For example , congestive heart failure is 10 times more common in people 75 and older , than in younger adults ( National Library of Medicine , 2019 ) In fact , half of all cases of heart failure occur in people after age 75 ( Strait , 2012 ) In addition , hypertension and cancer rates are also more common after 75 , but because they are linked to lifestyle choices , they typically can be can prevented , or managed ( Barnes , Among the older adult population . this age group often includes people who have more serious chronic ailments . In the US , the represented 14 of the older adult population in 2015 ( He , 2016 ) This age group is one of the fastest growing worldwide and is projected to increase more than 300 over its current levels ( NIA , It is projected that there will be nearly 18 million in age group by 2050 , or about of the population , compared with less than of the population today . Females comprise more than 60 of those 85 and older , but they also suffer from more chronic illnesses and disabilities than older males ( et , 2016 ) While this age group accounts for only of the population , it accounts for of all hospitalizations ( Levant , 2015 ) In a study of over patients age 65 and older who visited an emergency department , the admission rates increased with age . percent of admissions after an emergency room visit were the young old , almost 43 were the , and nearly half were the ( Lee , Oh , Park , Choi , Wee , 2018 ) The most common reasons for hospitalization for the were congestive heart failure , pneumonia , urinary tract infections , septicemia , stroke , and hip fractures . In recent years , hospitalizations for many of these medical problems have been reduced . However , hospitalization for urinary tract infections and septicemia has increased for those 85 and older Levant et , 2015 ) The mortality rate was also higher with age . Those 85 and older are more likely to require care and to be in nursing homes than the . Almost 50 of the require some assistance with daily living activities ( APA , 2016 ) However , most still live in the community rather than a nursing home ( The are less likely to be married and living with a spouse compared with the majority of the ( APA , 2016 , Gender is also an important factor in the likelihood of being married or living with one spouse . Late Adulthood 363
( A segment of the are , that is , 100 or older , and some are also referred to as , those 110 and older ( Wilcox , Wilcox , 2008 ) In 2015 there were nearly half a million worldwide , and it is estimated that this age group will grow to almost million by 2050 . The has the most , but Japan and Italy have the most per capita ( Most tended to be healthier than many of their peers as they were growing older , and often there was a delay in the onset of any serious disease or disability until their . Additionally , 25 reached 100 with no serious chronic illnesses , such as depression , osteoporosis , heart disease , respiratory illness , or dementia ( Ash et al . 2015 ) are more likely to experience a rapid terminal decline in later life , meaning that for most of their adulthood , and even older adult years , they are relatively healthy in comparison to many other older adults ( Ash et , 2015 Wilcox et , 2008 ) According to Guinness World Records ( 2016 ) Jeanne Louise has been documented to be the longest living person at 122 years and 164 days old ( See Figure ) Figure . Jeanne Louise from France Psychosocial Development during Late Adulthood Developmental Task of Late Adulthood Integrity . Despair framed the last part of the lifespan with the developmental task of Integrity versus Despair . In terms of psychosocial development , the tasks of adulthood were about becoming the self that you want to become ( Identity ) and creating the life you want to live , including establishing or maintaining the close interpersonal relationships that will be crucial to your physical and psychological health and well ( Intimacy ) The value of that life project is negotiated during middle adulthood in the search for meaning and a purpose larger than yourself that will contribute to your legacy ( So in old age , this task basically comes down to whether you have built a life and constructed a self that is to withstand the disintegration of your physical body , the death of many of those you love , and eventually and inevitably , strong enough to face your own impending death with dignity and grace . Like all psychosocial tasks , this one has two potential resolutions Integrity , or a sense of , contentment with life and imminent death versus Despair , or a lack of or peace and the inability to come to terms with life , aging , and approaching death . Development during elderhood , as during all developmental periods , is a social process that takes place in societal and historical . But this task , at the end of life , offers offers us the prospect of lifting off of those geographical , societal , and temporal limitations . We have the potential to transcend them , to establish a sense of wholeness and acceptance by getting in touch with our universal connection to humanity , past , present , and future . Like birth , death is a journey that every single one of us will take . Ninth Stage of Psychosocial Development collaborated with his wife , Joan , throughout much of his work on psychosocial development . In the older years , they the eight stages and generated additional ideas about how development evolves during a persons and . After Erik passed away in 1994 , Joan published a chapter on the ninth stage of development , in which she proposed ( from her own experiences and notes ) that older adults revisit the previous eight stages and deal with the previous in new ways , as they cope with the physical and social changes of growing old . In the eight stages , all of the are presented in a matter , meaning that the term 364 Late Adulthood
listed in the is the positive , achievement and the second term is the goal ( trust is more desirable than mistrust and integrity is more desirable than despair ) Perry et , 2015 ) During the ninth stage , the son argue that the , or less desirable outcome , come to take precedence again . For example , an older adult may become mistrustful ( trust mistrust ) feel more guilt about not having the abilities to do what they once did ( initiative guilt ) feel less competent compared with others ( industry inferiority ) lose a sense of identity as they become dependent on others ( identity role confusion ) become increasingly isolated ( intimacy isolation ) and feel that they have less to offer society ( stagnation ) 2012 ) The found that those who successfully come to terms with these changes and adjustments in later life make headway towards , a term coined by Lars to represent a greater awareness of ones own life and connection to the universe , increased ties to the past , and a positive , transcendent , perspective about life . Theories of Successful Aging Psychologists and sociologist have long wondered how people manage to age successfully , and many theories have been put developed that highlight the keys to successful aging . We examine ( Activity theory ( Continuity theory ( selectivity theory ( Selective optimization with compensation and ( Developmental theory . Developed by and in 1953 , activity theory addresses the issue of how persons can best adjust to the changing circumstances of old , retirement , illness , loss of friends and loved ones through death , and so on . In addressing this issue , they recommend that older adults involve themselves in voluntary and leisure organizations , child care and other forms of social interaction . Activity theory thus strongly supports the avoidance of a sedentary lifestyle and considers it essential to health and happiness that the older person remains active physically and socially . In other words , the more active older adults are the more stable and positive their will be , which will then lead to greater life satisfaction and higher morale ( 1953 ) Activity theory suggests that many people are barred from meaningful experiences as they age , but older adults who continue ways to remain active can work toward replacing lost opportunities with new ones ( et , 2015 ) Continuity theory suggests as people age , they continue to view the self in much the same way as they did when they were younger . An older persons approach to problems , goals , and situations is much the same as it was when they were younger . They are the same individuals , but simply in older bodies . Consequently , older adults continue to maintain their identity even as they give up previous roles . For example , a retired Coast Guard commander attends reunions with shipmates , stays interested in new technology for home use , is meticulous in the jobs he does for friends or at church , and displays mementos from his experiences on the ship . He is able to maintain a sense of self as a result . People do not give up who they are as they age . Hopefully , they are able to share these aspects of their identity with others throughout life . Focusing on what a person is still able to do and pursuing those interests and activities is one way to optimize and maintain . The Selectivity Theory focuses on changes in motivation for actively seeking social contact with others ( 1993 , Charles , 1999 ) This theory proposes that with increasing age , our motivational goals change based on how much time we have left to live . Rather than focusing on acquiring information from many diverse social relationships , as adolescents and young adults tend to do , older adults focus on the emotional aspects of relationships . To optimize the experience of positive affect , older adults actively restrict their social life to prioritize time spent with emotionally close others . In line with this theory , older marriages are found to be characterized by enhanced positive and reduced negative interactions and older Late Adulthood 365
partners show more affectionate behavior during discussions than do partners ( 1995 ) Research showing that older adults have smaller networks compared to young adults , and tend to avoid negative interactions , also supports this theory . Selective Optimization with Compensation is a strategy for improving health and well being in older adults and a model for successful aging . It is recommended that seniors select and optimize their best abilities and most intact functions while compensating for declines and losses . This means , for example , that a person who can no longer drive , is able to alternative transportation , or a person who is compensating for having less energy , learns how to reorganize the daily routine to avoid . Perhaps nurses and other allied health professionals working with this population will begin to focus more on helping patients remain independent by optimizing their best functions and abilities rather than simply treating illnesses . Promoting health and independence are essential for successful aging . Developmental Theory is a model that could have been based on Augustine serenity prayer . On the one hand , is primary control , or the strength and courage to take action to change the things that can be changed . This includes a sense of to take action needed to make lifestyle changes or undergo treatments that optimize functioning , such as a healthy diet , exercise , medical treatments ( like taking one insulin or cataract surgery ) or adopting outside aids like a cane or walker . The second process is called accommodation , and it involves the grace to accept the things that can not be changed . This attitude of willing acceptance includes understanding , gratitude for times past , and a focus on the positive things that still remain . Such accommodation can be contrasted with furious resentment or depressed resignation to the losses of aging . In fact , some researchers argue that depression in old age is often due , not to the losses of control aging inevitably entails , but from an inability to accommodate , that is , to relinquish activities and goals that are no longer feasible . in Late Adulthood People in late adulthood continue to be productive in many ways . These include work , education , volunteering , family life , and intimate relationships . Older adults also experience ( recall previous stage of stagnation ) through voting , forming and helping social institutions like community centers , churches and schools . Thinking of the issue of legacy , psychoanalyst Erik wrote I am what survives me ( 2015 ) Productivity in Work Figure . old body builder Shepard is Some older people continue to be productive in work . quoted with saying . You not getting old you re getting Mandatory retirement is now illegal in the United States . ready However , many do choose retirement by age 65 . Most people leave work by choice , and the primary factors that decisions about when to retire are health status , and satisfaction at work . Those who do leave by choice adjust to retirement more easily . Chances are , they have prepared for a smoother transition by gradually giving more attention to an avocation or interest as they approach retirement . And they are more likely to be ready to retire . Those who must leave abruptly for health reasons or because of layoffs or downsizing have a more time adjusting to their new circumstances . Men , especially , can unexpected retirement . Women may feel less of an identify loss after retirement because much of their identity may have come from family 366 Late Adulthood
roles as well . At the same time , however , women tend to have poorer retirement funds accumulated from work and if they take their retirement funds in a lump sum ( be that from their own or from a deceased husband funds ) are more at risk of outliving those funds . Because they will on average live longer , women need better planning in retirement . Sixteen percent of adults over 65 were in the labor force in 2008 ( Census Bureau 2011 ) Globally , are in the labor force and this number is expected to reach 101 million by 2016 . Many adults 65 and older continue to work either or either for income or pleasure or both . In 2003 , 39 of workers over 55 were women over the age of 70 53 were men over 70 . This increase in numbers of older adults is likely to mean that more will continue to part of the workforce in years to come ( He , et , 2005 ) Volunteering . and Virtually About 40 of older adults are involved in some type of structured , volunteer work . But many older adults , about 60 , engage in a sort of informal type of volunteerism , helping out neighbors or friends rather than working in an organization ( Berger , 2005 ) They may help a friend by taking them somewhere or shopping for them , etc . Some do participate in organized volunteer programs but interestingly enough , those who do tend to work as well . Those who retire and do not work are less likely to feel that they have a contribution to make . its as if when one gets used to staying at home , one to go out into the world diminishes . And those who have recently retired are more likely to volunteer than those over 75 years of age . New opportunities exist for older adults to serve as virtual volunteers by dialoguing online with others from around their world and sharing their support , interests , and expertise . According to an article from the American Association of Retired Persons ( virtual volunteerism has increased from participants in 1998 to over in 2005 . These volunteer opportunities range from helping teens with their writing to communicating with neighbors in villages in developing countries . Virtual volunteering is available to those who can not engage in interactions and opens up a new world of possibilities and ways to connect , maintain identity , and be productive ( 2006 ) Relationship with Adult Children Many older adults provide assistance housing to adult children . at this point in history , there is more support going from the older parent to the younger adult children than in the other direction ( 2011 ) In addition to providing for their own children , many elders are raising their grandchildren . Consistent with selectivity theory , older adults seek , and are helped by , their adult children providing emotional support ( Lang , 2002 ) Lang and , as part of the Berlin Aging Study ( BASE ) surveyed adult children ( mean age 54 ) and their aging parents ( mean age 84 ) They found that the adult children of older parents who provided emotional support , such as showing tenderness toward their parent , cheering the parent up when he or she was sad , tended to report greater life satisfaction . In contrast , older adults whose children provided informational support , such as providing advice to the parent , reported less life satisfaction . Lang and found that older adults wanted their relationship with their children to be more emotionally meaningful , but they did not want their children telling them what to do . Daughters and adult children who were younger , tended to provide such support more than sons and adult children who were older . Lang and also found that adult children who were more autonomous rather than emotionally dependent on their parents , had more emotionally meaningful relationships with their parents , from both the parents and adult children point of view . Friendships Friendships are not formed in order to enhance status or careers , and may be based purely on a sense of connection or the enjoyment of being together . Most elderly people have at least one close friend . These friends may provide emotional as well as physical support . Being able to talk with friends and rely on others is very important during this stage of life . Marshall , and Manning ( 2014 ) found that the availability of a friend played a role in protecting women health from the impact of widowhood . those who became widowed and had a friend as a , reported lower somatic depressive symptoms , better health , and fewer sick days in Late Adulthood 367
bed than those who reported not having a friend as a . In contrast , having a family member as a did not provide health protection for those recently widowed . Education Twenty percent of people over 65 have a bachelors or higher degree . And over million people over 65 take adult education courses ( Census Bureau , 2011 ) Enriching experiences of lifelong learning are offered through continuing education programs on college campuses or programs known as which allow older adults to travel abroad , live on campus , and study . Academic courses as well as practical skills such as computer classes , foreign languages , budgeting , and holistic medicines are among the courses offered . Older adults who have higher levels of education are more likely to take continuing education . But offering more educational experiences to a diverse group of older adults , including those who are institutionalized in nursing homes , can enhance elder students quality of life . Religious Activities People tend to become more involved in prayer and religious activities as they age . This provides a social network as well as a belief system which can combat the fear of death . Religious activities provide a focus for volunteerism and other activities as well . For example , one elderly woman prides herself on knitting prayer shawls that are given to those who are sick . Another serves on the alter guild and is responsible for keeping robes and linens clean and ready for communion . Political Activism The elderly are very politically active . They have high rates of voting and engage in letter writing to congress on issues that not only affect them , but on a wide range of domestic and foreign concerns . In the past three presidential elections , over 70 percent of people 65 and older showed up at the polls to vote ( Census Bureau , 2011 ) Loneliness or Solitude Loneliness is the discrepancy between the social contact a person has and the contacts a person wants ( Miller , Campbell , 2002 ) It can result from social or emotional isolation . Women tend to experience loneliness due to social isolation men from emotional isolation . Loneliness can be accompanied by a lack of , impatience , desperation , and depression . Being alone does not always result in loneliness . For some , being alone means solitude . Solitude involves gaining , taking care of the self , being comfortable alone , and pursuing one interests ( et , 2002 ) In contrast , loneliness is perceived social isolation . For those in late adulthood , loneliness can be especially detrimental . 2019 ) reviewed the research on loneliness and social isolation and found that loneliness was linked to a 40 increase in the risk for dementia and a 30 increase in the risk of stroke or coronary heart disease . This was hypothesized to be due to reasons that were both biological ( a rise in stress hormones ) psychological ( depression and anxiety ) as well as social ( eg , the individual lacks encouragement from others to engage in healthy behaviors ) In contrast , older adults who take part in social clubs and church groups have a lower risk of death . Opportunities to reside in mixed age housing and continuing to feel like a productive member of society have also been found to decrease feelings of social isolation , and thus loneliness . Late Adult Lifestyles Marriage . As can be seen in Figure , the most common living arrangement for older adults in 2017 was marriage 368 Late Adulthood
( 2017 ) This status was more common for older men than for older women , who based on differences in average life expectancy , typically outlive their husbands . 80 60 209 Married Widowed Divorced or Single ( never Spouse married ) Figure . Marital status Age in 2017 Divorce . As noted previously , older adults are divorcing at higher rates than in prior generations . However , adults age 65 and over are still less likely to divorce than and young adults ( Wu , 2007 ) Divorce poses a number of challenges for older adults , especially women , who are more likely to experience and are more likely to remain single than are older men ( Robb , 2004 ) However , in both America ( Lin , 2008 ) and England ( 2008 ) studies have found that the adult children of divorcing parents offer more support and care to their mothers than their fathers . While divorced , older men may be better off and are more likely to another partner , so they may receive less support from their adult children . Dating . Due to changing social norms and shifting cohort demographics , it has become more common for single older adults to be involved in dating and romantic relationships ( 2011 ) An analysis of widows and widowers ages 65 and older found that 18 months after the death of a spouse , 37 of men and 15 of women were interested in dating ( Carr , Unfortunately , opportunities to develop close relationships often diminish in later life as social networks decrease because of retirement , relocation , and the death of friends and loved ones ( de , 1996 ) Consequently , older adults , much like those younger , are increasing their social networks using technologies , including , chat rooms , and online dating sites ( Fox , 2004 Wright Query , 2004 , 2018 ) Interestingly , older men and women parallel online dating information as those younger . and ( 2011 ) analyzed 600 internet personal ads from different age groups , and across the life span , men sought physical attractiveness and offered information more than women . With advanced age , men desired women increasingly younger than themselves , whereas women desired older men until ages 75 and over , when they sought men younger than themselves . Research has previously shown that older women in romantic relationships are not interested in becoming a caregiver or becoming widowed for a second time ( Carr , Additionally , older men are more eager to than are older women ( 2001 , 2015 ) Concerns expressed by older women included not wanting to lose their autonomy , care for a potentially ill partner , or Late Adulthood 369
merge their with someone ( Watson , 2011 ) Older dating adults also need to know about threats to sexual health , including being at risk for sexually transmitted diseases , including chlamydia , genital herpes , and HIV . Nearly 25 of people living with in the United States are 50 or older ( on Women Health , and ( 2010 ) found that only 25 of adults 50 and over who were single or had a new sexual partner used a condom the last time they had sex . Robin ( 2010 ) stated that 40 of those 50 and over have never been tested for HIV . These results indicate that educating all individuals , not just adolescents , on healthy sexual behavior is important . Remarriage and Cohabitation . Older adults who remarry often that their are more stable than those of younger adults . Kemp and Kemp ( 2002 ) suggest that greater emotional maturity may lead to more realistic expectations regarding marital relationships , leading to greater stability in in later life . Older adults are also more likely to be seeking companionship in their romantic relationships . Carr ( found that older adults who have considerable emotional support from their friends were less likely to seek romantic relationships . In addition , older adults who have divorced often desire the companionship of intimate relationships without marriage . As a result , cohabitation is increasing among older adults , and like remarriage , cohabitation in later adulthood is often associated with more positive consequences than it is in younger age groups ( King Scott , 2005 ) No longer being interested in raising children , and perhaps wishing to protect family wealth , older adults may see cohabitation as a good alternative to marriage . In 2014 , of adults age 65 and up were cohabitating ( Living Apart Together . In addition to there has been an increase in living apart together ( LAT ) which is a monogamous intimate partnership between unmarried individuals who live in separate homes but identify themselves as a committed couple ( Benson Coleman , 2016 , 797 ) This trend has been found in several nations and is motivated by A strong desire to be independent in decisions Maintaining their own home Keeping boundaries around established relationships Maintaining stability Besides the desire to be autonomous , there is also a need for companionship , sexual intimacy , and emotional support . According to and Coleman , there are differences in LAT among older and younger adults . Those who are younger often enter into LAT out of circumstances , such as the job market , and they frequently view this arrangement as a transitional stage . In contrast , 80 of older adults reported that they did not wish to or marry . For some it was a conscious choice to live more independently . For instance , older women desired the LAT lifestyle as a way of avoiding the traditional gender roles that are often inherent in relationships where couples live together . However , some older adults become LATs because they fear social disapproval from others if they were to live together . Gay and Lesbian Elders Approximately million older adults in the United States identify as lesbian or gay ( Hillman , 2014 ) By 2025 that number is expected to rise to more than million ( National Gay and Lesbian Task Force , 2006 ) Despite the increase in numbers , older lesbian and gay adults are one of the least researched demographic groups , and the research there is portrays a population faced with discrimination . According to the Centers for Disease Control and Prevention ( 2011 ) compared to heterosexuals , lesbian and gay adults experience disparities in both physical and mental health . More than 40 of lesbian and gay adults ages 50 and over suffer from at least one chronic illness or disability and compared to heterosexuals they are more likely to smoke and binge drink ( Hillman , 2014 ) Additionally , gay older adults have an increased risk of prostate cancer ( Blank , 2005 ) and infection from HIV and other sexually transmitted illnesses ( Centers for Disease Control and Prevention , 2008 ) When compared to heterosexuals , lesbian and gay elders have less support from others as they are twice as likely to live alone and four times less likely to have adult children ( Hillman , 2014 ) 370 I Late Adulthood
Lesbian and gay older adults who belong to ethnic and cultural minorities , conservative religions , and rural communities may face additional stressors . Ageism , sexism , and racism can combine cumulatively and impact the older adult beyond the negative impact of each individual form of discrimination ( Hillman , 2014 ) David and Knight ( 2008 ) found that older gay black men reported higher rates of racism than younger gay black men and higher levels of perceived ageism than older gay white men . Elder Care . Approximately million people over age 50 will reside in the United States by 2030 , and million of them will need elder care . Decisions regarding elder care is often left for families , and because many people are estranged from their families and do not have children of their own , they are left in a vulnerable position when seeking living arrangements ( Bailey , 2019 ) A history of discriminatory policies , such as housing restricted to married individuals involving one man and one woman , and stigma associated with people make them especially vulnerable to negative housing experiences when looking for elder care . Although lesbian and gay older adults face many challenges , more than 80 indicate that they engage in some form of wellness or spiritual activity ( et , 2011 ) They also gather social support from friends and family members by choice rather than legal or biological relatives ( Hillman , 2014 ) This broader social network provides extra support to gay and lesbian elders . An important consideration when reviewing the development of gay and lesbian older adults is the cohort in which they grew up ( Hillman , 2014 ) The oldest lesbian and gay adults came of age in the 1950 when there were no laws to protect them from victimization . The baby boomers , who grew up in the and , began to see states repeal laws that criminalized homosexual behavior . Future lesbian and gay elders will have different experiences due to the legal right or marriage and greater societal acceptance . Consequently , just like all those in late adulthood , understanding that gay and lesbian elders are a heterogeneous population is important when understanding their overall development . Optional Reading Work Retirement and Leisure Physical Development Physical Changes of Aging The Baltimore Longitudinal Study on Aging ( NIA , began in 1958 and has traced the aging process in people from age 20 to 90 . Researchers from the have found that the aging process varies from individual to individual and from one organ system to another . However , some key generalization can be made including Heart muscles thicken with age Arteries become less Late Adulthood 371
Lung capacity diminishes Kidneys become less in removing waste from the blood Bladder loses its ability to store urine Brain cells also lose some functioning , but new neurons can also be produced . Many of these changes are determined by genetics , lifestyle , and disease . Other changes in late adulthood include Body Changes . Everyone body shape changes naturally as they age . According to the National Library of Medicine ( 2014 ) after age 30 people tend to lose lean tissue , and some of the cells of the muscles , liver , kidney , and other organs are lost . Tissue loss reduces the amount of water in the body and bones may lose some of their minerals and become less dense ( a condition called in the early stages and osteoporosis in the later stages ) The amount of body fat goes up steadily after age 30 , and older individuals may have almost one third more fat compared to when they were younger . Fat tissue builds up toward the center of the body , including around the internal organs . Skin , Hair and Nails . With age skin loses fat , and becomes thinner , less elastic , and no longer looks plump and smooth . Veins and bones can be seen more easily , and scratches , cuts , and bumps can take longer to heal . Years of exposure to the sun may lead to wrinkles , dryness , and cancer . Older people may bruise more easily , and it can take longer for these bruises to heal . Some medicines or illnesses may also cause bruising . Gravity can cause skin to sag and wrinkle , and smoking can wrinkle skin as well . Also , seen in older adulthood are age spots , previously called liver spots . They look like flat , brown spots and are often caused by years in the sun . Skin tags are small , usually growths of skin that have a raised surface . They become common as people age , especially for women , but both age spots and skin tags are harmless ( NIA , Nearly everyone has hair loss as they age , and the rate of hair growth slows down as many hair follicles stop producing new hairs ( US . National Library of Medicine , 2019 ) The loss of pigment and subsequent graying begun in middle adulthood continues during late adulthood . The body and face also lose hair . Facial hair may grow coarser . For women this often occurs around the chin and above the upper lip . For men the hair of the eyebrows , ears , and nose may grow longer . Nails , particularly toenails , may become hard and thick . Lengthwise ridges may develop in the and toenails . However , pits , lines , changes in shape or color of should be checked by a healthcare provider as they can be related to nutritional or kidney disease ( US . National Library of Medicine ) Height and Weight . The tendency to become shorter as one ages occurs among all races and both sexes . Height loss is related to aging changes in the bones , muscles , and joints . A total of to inches in height is lost with aging . People typically lose almost inch every 10 years after age 40 , and height loss is even more rapid after age 70 . Changes in body weight vary for men and woman . Men often gain weight until about age 55 , and then begin to lose weight later in life , possibly related to a drop in the male sex hormone testosterone . Women usually gain weight until age 65 , and then begin to lose weight . Weight loss later in life occurs partly because fat replaces lean muscle tissue , and fat weighs less than muscle . Diet and exercise are important factors in weight changes in late adulthood ( National Library of Medicine , 2014 ) is the loss of muscle tissue as a natural part of aging . is most noticeable in men , and physically inactive people can lose as much as to of their muscle mass each decade after age 30 , but even people who are active still lose muscle ( 2016 ) Symptoms include a loss of stamina and weakness , which can decrease physical activity and subsequently shrink muscles further . typically increases around age 75 , but it may also speed up as early as 65 or as late as 80 . Factors involved in include a reduction in nerve cells responsible for sending signals to the muscles from the brain to begin moving , a decrease in the ability to turn protein into energy , and not receiving enough calories or protein to sustain adequate muscle mass . Any loss of muscle is important because it lessens strength and mobility , and is a factor in frailty and the likelihood of falls and fractures in older 372 ) Late Adulthood
adults . Maintaining strong leg and heart muscles are important for independence . walking , swimming , or engaging in other cardiovascular exercises can help strengthen muscles and prevent atrophy . Sensory Changes in Late Adulthood Vision . In late adulthood , all the senses show signs of decline , especially among the . In the last chapter , you read about the visual changes that were beginning in middle adulthood , such as presbyopia , dry eyes , and problems seeing in dimmer light . By later adulthood these changes are much more common . Three serious eyes diseases are also more common in older adults cataracts , macular degeneration , and glaucoma . Only the can be effectively cured in most people . Cataracts are a clouding of the lens of the eye . The lens of the eye is made up of mostly water and protein . The protein is precisely arranged to keep the lens clear , but with age some of the protein starts to clump . As more of the protein clumps together the clarity of the lens is reduced . While some adults in middle adulthood may show signs of cloudiness in the lens , the area affected is usually small enough not to interfere with vision . More people have problems with cataracts after age 60 ( and by age 75 , 70 of adults will have problems with cataracts ( Boyd , 2014 ) Cataracts also cause a discoloration of the lens , tinting it more yellow and then brown , which can interfere with the ability to distinguish colors such as black , brown , dark blue , or dark purple . Risk factors besides age include certain health problems such as diabetes , high blood pressure , and obesity , behavioral factors such as smoking , other environmental factors such as prolonged exposure to ultraviolet , sunlight , previous trauma to the eye , use of steroid medication , and a family history of cataracts ( NEI , Boyd , 2014 ) Cataracts are ' me years for , removing an rep acing ens eye wit a per 100000 inhabitants in lens . In developed countries , such as the United States , cataracts can be 2004 easily treated with surgery . no data El 540 630 However , in developing countries , access to such operations are limited , 90 I making cataracts the leading cause of blindness in late adulthood in the 30 I least developed countries ( 2004 ) El I As shown in Figure , in areas of the world with limited medical treatment for cataracts , people are living more years with a serious El ) I disability . For example , of those living in the darkest red color on the map , El 350 450 I 990 more than 990 out of people have a shortened lifespan due to the disability caused by cataracts . Older adults are also more likely to develop macular Figure degeneration , which is the loss of clarity in the center field of vision , due to the deterioration of the macula , the center of the retina . Macular degeneration does not usually cause total vision loss , but the loss of the central of vision can greatly impair day functioning . There are two types of macular degeneration dry and wet . The dry type is the most common form and occurs when tiny pieces of a fatty protein called form beneath the retina . Eventually the macular becomes thinner and stops working properly ( Boyd , 2016 ) About 10 of people with macular degeneration have the wet type , which causes more damage to their central of vision than the dry form . This form is caused by an abnormal development of blood vessels beneath the retina . These vessels may leak or blood causing more rapid loss of vision than the dry form . The risk factors for macular degeneration include smoking , which doubles your risk ( race , as it is more common among Caucasians than African Americans or high cholesterol and a family history of Late Adulthood I 373
macular degeneration ( Boyd , 2016 ) At least 20 different genes have been related to this eye disease , but there is no simple genetic test to determine your risk , despite claims by some genetic testing companies ( At present , there is no effective treatment for the dry type of macular degeneration . Some research suggests that some patients may from a cocktail of certain antioxidant vitamins and minerals , but results are mixed at best . They are not a cure for the disease nor will they restore the vision that has been lost . This cocktail can slow the progression of visual loss in some people ( Boyd , 2016 , For the wet type , medications that slow the growth of abnormal blood vessels and surgery , such as laser treatment to destroy the abnormal blood vessels , may be used . Unfortunately , only 25 of those with the wet version typically see improvement with these procedures ( Boyd , 2016 ) A third vision problem that increases with age is glaucoma , which is the loss of peripheral vision , frequently due to a buildup of in eye that damages the optic nerve . As we age the pressure in the eye may increase causing damage to the optic nerve . The exterior of the optic nerve receives input from retinal cells on the periphery , and as glaucoma progresses more and more of the peripheral visual deteriorates toward the central of vision . In the advanced stages of glaucoma , a person can lose their sight entirely . Fortunately , glaucoma tends to progresses slowly ( NEI , Figure . A normal range of Figure . View with macular Figure . View with glaucoma Figure 1010 . View with cataracts vision de , Glaucoma is the most common cause of blindness in the ( NEI , African Americans over age 40 , and everyone else over age 60 , have a higher risk for glaucoma . Those with diabetes , and with a family history of glaucoma also have a higher risk ( et , 2015 ) There is no cure for glaucoma , but its rate of progression can be slowed , especially with early diagnosis . Routine eye exams to measure eye pressure and examination of the optic nerve can detect both the risk and presence of glaucoma ( NEI , Those with elevated eye pressure are given medicated eye drops . Reducing eye pressure lowers the risk of developing glaucoma or slow its progression in those who already have it . Hearing . As you read previously , our hearing declines both in terms of the frequencies of sound we can detect , and the intensity of sound needed to hear as we age . These changes continue in late adulthood . Almost in adults aged 65 to 74 and in aged 75 and older have disabling hearing loss ( 2016 ) Table 103 lists some common signs of hearing loss . Table Common Signs Loss Have trouble hearing over the telephone Find it hard to follow conversations when two or more people are talking Often ask people to repeat what they are saying Need to turn up the volume so loud that others complain Have a problem hearing because of background noise Think that others seem to mumble Can not understand when women and children are speaking 374 Late Adulthood
adapted from NIA , Presbycusis is a common form of hearing loss in late adulthood that results in a gradual loss of hearing . It runs in families and affects hearing in both ears ( Older adults may also notice tinnitus , a ringing , hissing , or roaring sound in the ears . The exact cause of tinnitus is unknown , although it can be related to hypertension and allergies . It may come and go or persist and get worse over time ( The incidence of both presbycusis and tinnitus increase with age and males around the world have higher rates of both ( Somerset , Hall , 2016 ) Your auditory system has two jobs To help you to hear , and to help you maintain balance . Your balance is controlled when the brain receives information from the shifting of hair cells in the inner ear about the position and orientation of the body . With age , the functionality of the inner ear declines , which can lead to problems with balance when sitting , standing , or moving ( Martin , 2014 ) Taste and Smell . Our sense of taste and smell are part of our chemical sensing system . Our sense of taste , or gustation , appears to age well . Normal taste occurs when molecules that are released by chewing food stimulate taste buds along the tongue , the roof of the mouth , and in the lining of the throat . These cells send messages to the brain , where tastes are . After age 50 , we start to lose some of these sensory cells . Most people do not notice any changes in taste until their ( Senior Health , Given that the loss of taste buds is very gradual , even in late adulthood , many people are often surprised that their loss of taste is most likely the result of a loss of smell . Our sense of smell , or olfaction , decreases with age , and problems with the sense of smell are more common in men than in women . Almost in males in their have a disorder with the sense of smell , compared to in 10 women ( Senior Health , This loss of smell due to aging is called . Olfactory cells are located in a small area high in the nasal cavity . These cells are stimulated via two pathways when we inhale through the nose , or via the connection between the nose and the throat when we chew and digest food . It is a problem with this second pathway that explains why some foods such as chocolate or coffee seem tasteless when we have a head cold . There are several types of loss of smell . Total loss of smell , or anosmia , is extremely rare . Problems with our chemical senses can be linked to other serious medical conditions such as , or multiple sclerosis ( Senior Health , Any sudden changes in sensory sensitivity should be checked out . Loss of smell can change a person diet , with either a loss of enjoyment of food and eating too little for balanced nutrition , or adding sugar and salt to foods that are becoming to the palette . Table Types of Smell Disorders Smell loss due to aging Hyposmia Loss of only certain odors Anosmia Total loss of smell Change in the perception of odors . I Familiar odors are distorted Smell odors that are not present adapted from Senior Health Problems with Smell Touch . Research has found that with age , people may experience reduced or changed sensations of vibration , cold , heat , pressure , and pain ( Martin , 2014 ) Many of these changes are also consistent with a number of medical conditions that are more common among the elderly , such as diabetes . However , there are also changes in touch sensations among healthy older adults . The ability to detect changes in pressure have been shown to decline with age , with more Late Adulthood 375
pronounced losses during the decade and diminishing further with advanced age ( 2013 ) Yet , there is considerable variability , with almost 40 of the elderly showing sensitivity that is comparable to younger adults ( 1981 ) However , the ability to detect the smoothness or of an object shows no appreciable change with age ( McNulty , 2013 ) Those who show decreasing sensitivity to pressure , temperature , or pain are at risk for injury ( Martin , 2014 ) as they can injure themselves without detecting it . Pain . According to and ( 2014 ) approximately 60 of people over the age of 65 report at least some chronic pain , and this rate is even higher for those individuals living in nursing homes . Although the presence of pain increases with age , older adults are less sensitive to pain than younger adults ( Price , 1986 ) Farrell ( 2012 ) looked at research studies that included techniques involving older people who were healthy and those who experienced a painful disorder . Results indicated that there were decreases in brain volume in those structures involved in pain . Especially noteworthy were changes in the prefrontal cortex , brainstem , and hippocampus . Women are more likely to report feeling pain than men ( et , 2008 ) Women have fewer opioid receptors in the brain , and women also receive less relief from opiate drugs ( Garrett , 2015 ) Because pain serves an important indicator that there is something wrong , a decreased sensitivity to pain in older adults is a concern because it can conceal illnesses or injuries requiring medical attention . Chronic health problems , including arthritis , cancer , diabetes , joint pain , sciatica , and shingles are responsible for most of the pain felt by older adults ( 2014 ) Cancer is a special concern , especially breakthrough pain which is a severe pain that comes on quickly while a patient is already medicated with a painkiller . It can be very upsetting , and after one attack many people worry it will happen again . Some older individuals worry about developing an addiction to pain medication , but if medicine is taken exactly as prescribed , addiction should not be a concern ( Lastly , side effects from pain medicine , including constipation , dry mouth , and drowsiness , may occur that can adversely affect the elders life . Some older individuals put off going to the doctor because they think pain is just part of aging and nothing can help . Of course , this is not usually true . Managing pain is crucial to ensure feelings of for the older adult . When chronic pain is not managed , the individual tends to restrict their movements for fear of feeling pain or injuring themselves further . This lack of activity will result in more restriction , further decreased participation , and greater disability ( Jensen , Moore , 2011 ) A decline in physical activity because of pain is also associated with weight gain and obesity in adults ( Chapman , 2005 ) Additionally , sleep and mood disorders , such as depression , can occur ( 2014 ) Learning to cope effectively with pain is an important consideration in late adulthood and working with one primary physician or a pain specialist is recommended ( Of those 65 and older , 35 have a disability . Figure the percentage of those who have a disability based on the type . 376 Late Adulthood
Independent living difficulty Ambulatory Cognitive difficulty Vision Hearing difficulty Any disability 35 20 40 60 80 100 Figure Percentage of adults 65 and older with a disability in 2017 Brain Functioning Research has demonstrated that the brain loses to 10 of its weight between 20 and 90 years of age ( 2010 ) This decrease in brain volume appears to be due to the shrinkage of neurons , decreases in the number of synapses , and increasingly shorter axon lengths . According to Garrett ( 2015 ) normal declines in cognitive ability throughout the lifespan are associated with brain changes , including reduced activity of genes involved in memory storage , synaptic pruning , plasticity , and glutamate and ( neurotransmitters ) receptors . There is also a loss in white matter connections between brain areas . Without myelin , neurons demonstrate slower conduction and impede each other actions . A loss of synapses occurs in brain areas , including the hippocampus ( involved in memory ) and the basal forebrain region . Older individuals also activate larger regions of their attentional and executive networks , located in the parietal and prefrontal cortex , when they perform complex tasks . This increased activation coincides with reduced performance on both executive tasks and tests of working memory when compared to that of younger people ( 2011 ) Continued . Researchers at the University of Chicago found that new neurons continue to form into old age . et al . 2019 ) examined brain tissue of individuals between the ages of 79 and 99 ( average age ) and found evidence of neurogenesis in the hippocampus . Approximately 2000 neural progenitor cells and 150 , 000 developing neurons were found per brain , although the number of developing neurons was lower in people with cognitive or disease . et al . hypothesized that the lower levels of neurogenesis in the hippocampus were associated with symptoms of cognitive decline and reduced synaptic plasticity . The brain in late adulthood also exhibits considerable plasticity , and through practice and training , the brain can be to compensate for any changes ( 2015 ) Park and ( 2009 ) proposed the Scaffolding Theory of Aging and Cognition which states that the brain adapts to neural atrophy ( dying of brain cells ) by building alternative connections , referred to as scaffolding . This scaffolding allows older brains to retain high levels of performance . Brain compensation is especially noted in the additional neural effort demonstrated by those individuals who are aging well . For example , older adults who performed just as well as younger adults on a memory task Late Adulthood 377
used both prefrontal areas , while only the right prefrontal cortex was used in younger participants ( Cabeza , Anderson , 2002 ) Consequently , this decrease in brain lateralization appears to assist older adults with their cognitive skills . Healthy Brain Functioning . In longitudinal studies , Cheng ( 2016 ) found that both physical activity and stimulating cognitive activity resulted in reductions in the risk of disorders . Physical activity , especially aerobic exercise , is associated with less gray and white matter loss , as well and diminished neurotoxins in the bra Overall , physical activity preserves the integrity of neurons and brain volume . Cognitive training improves the of the prefrontal cortex and executive functions , such as working memory , and strengthens the plasticity of neural circuits . Both activities support cognitive reserve , or the structural and dynamic capacities of the brain that buffer against and lesions ( Cheng , 2016 , 85 ) Although it is optimal to begin physical and cognitive activities earlier in life , it is never too late to start these programs to improve one cognitive health , even in late adulthood Figure Exercise is important to brain functioning Can we improve brain functioning ?
Many training programs have been created to improve brain functioning . ACTIVE ( Advanced Cognitive Training for Independent and Vital Elderly ) a study conducted between 1999 and 2001 in which individuals age 65 to 94 , suggests that the answer is yes . These racially diverse participants received 10 group training sessions and follow up sessions to work on tasks of memory , reasoning , and speed of processing . These mental workouts improved cognitive functioning even years later . Many of the participants believed that this improvement could be seen in everyday tasks as well ( et , 2006 ) However , programs for the elderly on memory , reading , and processing speed training demonstrate that there is improvement on the tasks trained , but there is no generalization to other abilities ( 2015 ) Further , these programs have not been shown to delay or slow the progression of disease . Although these programs are not harmful , physical exercise , learning new skills , and socializing remain the most effective ways to train your brain ( 207 ) These activities appear to build a reserve to minimize the effects of primary aging of the brain . Women and Aging In Western society , aging for women is much more stressful than for men as society emphasizes youthful beauty and attractiveness ( 2010 ) The description that aging men are viewed as distinguished and aging women are viewed as old is referred to as the double standard of aging ( 2006 ) Since women have traditionally been valued for their reproductive capabilities , they may be considered old once they are . In contrast , men have traditionally been valued for their achievements , competence , and power , and therefore are not considered old until decades later when they are physically unable to work ( Carroll , 2016 ) Consequently , women experience more fear , anxiety , and concern about their identity as they age , and may feel pressure to prove themselves as productive and valuable members of society ( Chang , 2013 ) Attitudes about aging , however , do vary by race , culture , and sexual orientation . In some cultures , aging women gain greater social status . For example , as Asian women age they attain greater respect and have greater authority in the household ( Fung , 2013 ) Compared to white women , Black and Latina women possess fewer stereotypes about aging ( et , 2008 ) Lesbians are also more positive about aging and looking older than heterosexual women ( 378 Late Adulthood
2010 ) The impact of media certainly plays a role in how women View aging by selling products and supporting cosmetic surgeries to look younger ( 2000 ) Optional Reading Chronic Conditions Cognition , Wisdom , and Spirituality How Does Aging Affect Information Processing ?
There are many stereotypes regarding older as forgetful and confused , but what does the research on memory and cognition in late adulthood reveal ?
Memory comes in many types , such as working , episodic , semantic , implicit , and prospective . There are also many processes involved in memory . Thus it should not be a surprise that there are declines in some types of memory and memory processes , while other areas of memory are maintained or even show some improvement with age . In this section , we will focus on changes in memory , attention , problem solving , intelligence , cognition , and wisdom , including the effects of stereotypes that exaggerate these losses in the elderly . Memory Changes in Working Memory . Working memory is the more active , effortful part of our memory system . Working memory is composed of three major systems The phonological loop that maintains information about auditory stimuli , the , that maintains information about visual stimuli , and the central executive , that oversees working memory , allocating resources where needed and monitoring whether cognitive strategies are being effective ( Schwartz , 2011 ) Schwartz reports that it is the central executive that typically shows the most marked declines with age . In tasks that require allocation of attention between different stimuli , older adults fare worse than do younger adults . In a study by , and ( 2007 ) older and younger adults were asked to learn two tasks simultaneously . Young adults eventually managed to learn and perform both tasks without any loss in speed and , although it did take considerable practice . None of the older adults were able to accomplish this . Yet , when asked to learn each task individually , older adults could perform just as well as young adults . Having older adults learn and perform both tasks together was just too taxing for the central executive . In contrast , in working memory tasks that do not require much input from the central executive , such as the digit span test , which predominantly uses the phonological loop , older adults perform on par with young adults ( Dixon Cohen , 2003 ) Changes in Memory . memory is divided into semantic ( knowledge of facts ) episodic ( memories of specific events ) and implicit ( stored procedural skills , classical conditioning , and priming ) memory . Semantic and episodic memory are part of the explicit memory system , which requires conscious effort to create and retrieve . Several studies consistently reveal that episodic memory shows greater declines than semantic memory ( Schwartz , 2011 , Madden , Voss , 2006 ) It has been suggested that episodic memories may be harder to encode and retrieve because they contain at least two different types of memory ( the event and ( when and where the event took place . In contrast , semantic memories are not tied to any particular geography or time line . Thus , only the knowledge needs to be encoded or retrieved ( Schwartz , 2011 ) et al . 2006 ) found that retrieval of semantic information was considerably faster for both younger and Late Adulthood 379
older adults than the retrieval of episodic information , with there being little difference between the two age groups for retrieval of semantic memories . They note that older adults poorer performance on episodic memory appeared to be related to slower processing of the information and the of the task . They found that as tasks became more , the gap between the two age groups performance widened , but more so for tasks involving episodic than semantic memory tasks . Studies that examine general knowledge ( semantic memory ) of topics such as politics and history ( Dixon , Rust , See , 2007 ) or memory ( 1998 ) often that older adults outperform younger adults . However , older adults do that they experience more blocks at retrieving information that they know . In other words , they experience more ( TOT ) events than do younger adults ( Schwartz , 2011 ) memory blocks are especially common for the retrieval of nonsense words or concept labels . Unfortunately for older adults , nonsense words include the names of people , places , and things ( like movies , restaurants , or books ) which represent many common topics of conversation . Implicit memory requires little conscious effort and often involves skills or more habitual patterns of behavior . This type of memory shows few declines with age . Many studies assessing implicit memory measure the effects of priming . Priming refers to changes in behavior as a result of frequent or recent experiences . for example , if you were shown pictures of food and asked to rate their appearance and then later were asked to complete words such as , you may be more likely to write soup than soap or The images of food primed your memory for words connected to food . Does this type of memory and learning change with age ?
The answer is typically no for most older adults ( Church , 1994 ) Prospective memory refers to remembering things we need to do in the future , such as remembering a doctor appointment or to take medication before bedtime . It has been described as the of episodic memory ( Schwartz , 2011 , 119 ) Episodic memories are the recall of events in our past , while the focus of prospective memories is of events in our future . In general , humans are fairly good at prospective memory if they have little else to do in the meantime . However , when there are competing tasks that also demand our attention , this type of memory rapidly declines . One explanation given for this phenomenon is that this form of memory draws on the central executive of working memory , and when this component of working memory is absorbed in other tasks , our ability to remember to do something else in the future is more likely to slip out of Figure . Aids for prospective memory memory ( Schwartz , 2011 ) However , prospective memories are often divided into prospective memories , such as having to remember to do something at a future time , or prospective memories , such as having to remember to do something when a certain event occurs . When declines are found , they are more likely to be , rather than , and in laboratory settings rather than in the , where older adults can show comparable or slightly better prospective memory performance ( Henry , Phillips Crawford , 2004 Luo , 2008 ) This should not be surprising given the tendency of older adults to be more selective in where they place their physical , mental , and social energy . Having to remember a doctors appointment is of greater concern than remembering to hit the on a computer every time the word tiger is displayed , and outside the lab many more compensatory aids ( notes , calendars , phone alarms ) are readily available . Recall versus Recognition . Memory performance often depends on whether older adults are asked to simply recognize previously learned material or recall material on their own . Generally , for all humans , recognition tasks are easier 380 Late Adulthood
because they require less cognitive energy . Older adults show roughly equivalent memory to young adults when assessed with a recognition task ( Rhodes , Jacoby , 2008 ) However , in recall tasks , older adults show memory in comparison to younger adults . While the effect is initially not that large , starting at age 40 adults begin to show regular declines in recall memory compared to younger adults ( Schwartz , 2011 ) The Age Advantage . Fewer age differences are observed when memory cues are available , such as for recognition memory tasks , or when individuals can draw upon acquired knowledge or experience . For example , older adults often perform as well if not better than young adults on tests of word knowledge or vocabulary . Expertise often comes with age , and research has pointed to areas where aging experts perform quite well . For example , older typists were found to compensate for declines in speed by looking farther ahead at printed text ( Salthouse , 1984 ) Compared to younger players , older chess experts focus on a smaller set of possible moves , leading to greater cognitive ( 1981 ) Accrued knowledge of everyday tasks , such as grocery prices , can also help older adults make better decisions than young adults ( Hasher , May , 2001 ) Attention and Problem Solving Changes in Attention in Late Adulthood . Changes in sensory functioning and speed of processing information in late adulthood often translate into changes in attention ( Jefferies et , 2015 ) Research has shown that older adults are less able to selectively focus on information while ignoring ( Jefferies et , 2015 , Schneider , Hoffman , Sanger , 2012 ) although Jefferies her colleagues found that when given double time , older adults could perform at the same level as young adults . Other studies have also found that older adults have greater shifting their attention between objects or locations ( Tales , Muir , 2002 ) Consider the implication of these changes for older adults . How does maintenance or loss of cognitive ability affect older adults everyday lives ?
Researchers have studied cognition in the context of several different everyday activities . One example is driving . Although er adults often have more years of driving experience , cognitive declines related to reaction time or attentional processes may pose limitations under certain circumstances ( Park , 2000 ) In contrast , research on interpersonal solving suggests that older adults use more effective strategies than younger adults to navigate through social and emotional problems ( 2007 ) In the context of work , researchers rarely that older perform more poorly on the job ( Park , 2000 ) Similar to everyday problem solving , older workers may more strategies and rely on expertise to compensate for cognitive declines . Problem Solving . Declines with age are found on tasks that require processing information a kind of task that might part of a laboratory experiment on mental processes . However , many challenges facing older adults do not rely on speed of processing or making choices on one own . Older adults resolve everyday problems by relying on input from others , such as family and friends . They are also less likely than younger adults to delay making decisions on important matters , such as medical care ( Hicks , Cheng Barnes , 2003 Berg , 2002 ) What might explain these as we age ?
The processing speed theory , proposed by Salthouse ( 1996 , 2004 ) suggests that as the nervous system slows with advanced age our ability to process information declines . This slowing of processing speed may explain age differences on a variety of cognitive tasks . For instance , as we age , working memory becomes less ( 2006 ) Older adults also need longer time to complete mental tasks or make decisions . Yet , when given time ( to compensate for declines in speed ) older adults perform as competently as do young adults ( Salthouse , 1996 ) Thus , when speed is not imperative to the task , healthy older adults generally do not show cognitive declines . In contrast , inhibition theory argues that older adults have with tasks that require inhibitory functioning , or the ability to focus on certain information while suppressing attention to less pertinent information ( Hasher , Late Adulthood 381
1988 ) Evidence comes from directed forgetting research . In directed forgetting people are asked to forget or ignore some information , but not other information . For example , you might be asked to memorize a list of words but are then told that the researcher made a mistake and gave you the wrong list and asks you to forget this list . You are then given a second list to memorize . While most people do well at forgetting the list , older adults are more likely to recall more words from the list than are younger adults ( Andres , Van der Linden , 2004 ) Aging stereotypes exaggerate cognitive losses . While there are information processing losses in late adulthood , many argue that research exaggerates normative losses in cognitive functioning during old age ( Garrett , 2015 ) One explanation is that the type of tasks that people are tested on tend to be meaningless . For example , older individuals are not motivated to remember a random list of words in a study , but they are motivated for more meaningful material related to their life , and consequently perform better on those tests . Another reason is that researchers often estimate age declines from age differences found in studies . However , when Figure 1015 age comparisons are conducted longitudinally ( thus removing cohort differences from age comparisons ) the extent of loss is much smaller ( 1994 ) A third possibility is that losses may be due to the disuse of various skills . When older adults are given structured opportunities to practice skills , they perform as well as they had previously . Although diminished speed is especially noteworthy during late adulthood , 1994 ) found that when the effects of speed are statistically removed , fewer and smaller declines are found in other aspects of an individuals cognitive performance . In fact , Salthouse and ( 1991 ) demonstrated that processing speed accounted for all but of differences in working memory when testing individuals from ages 18 to 82 . Finally , it is well established that hearing and vision decline as we age . Longitudinal research has found that in sensory functioning explain age differences in a variety of cognitive abilities ( 1997 ) Not surprisingly , more years of education , higher income , and better health care ( which go together ) are associated with higher levels of cognitive performance and slower cognitive decline ( Stern , Manly , 2015 ) Beyond Formal Operational Thought Development ?
As mentioned previously , according to theory , formal operational thought emerges during adolescents . The hallmark of this type of thinking is the ability to think abstractly or to consider possibilities and ideas about circumstances not directly experienced . Thinking abstractly is only one characteristic of adult thought , however . If you compare a 15 with someone in their late , you would probably that the latter considers not only what is possible , but also what is likely . Why the change ?
The adult has gained experience and understands that possibilities do not always become realities . They learn to base decisions on what is realistic and practical , not idealistic , and can make adaptive choices . Adults are also not as by what others think . In addition to moving toward more practical considerations , thinking in adulthood may also become more relativistic , dialectical , and systemic . These advanced ways of thinking are referred to as Thought ( 1998 ) Relativistic thinking refers to the appreciation of multiple perspectives , and the understanding that knowledge depends on the perspective of the knower . In later life , adults are able to continue to entertain multiple perspectives simultaneously , and also at the same time , in the face of all those possibilities , to make a decision , commit to a course of action , and carry it out . This suggests that such thought goes beyond cognition to the integration of thought and action . Dialectical Thought . Abstract ideas that the adolescent believes in may become standards by which the adult 382 Late Adulthood
evaluates reality . Adolescents tend to think in ideas are true or false good or bad and there is no middle ground . However , with experience , the adult comes to recognize that there is some right and some wrong in each position , some good or some bad in a policy or approach , some truth and some falsity in a particular idea . This ability to appreciate essential paradox and to bring together salient aspects of two opposing viewpoints or positions is referred to as dialectical thought and is considered one of the most advanced aspects of thinking ( 1984 ) Such thinking is more realistic because very few positions , ideas , situations , or people are completely right or wrong . So , for example , parents who were considered angels or devils by their adolescent children , to adult children , eventually become just people with strengths and weaknesses , endearing qualities , and faults . Systemic thinking refers to the capacity to think about entire systems of knowledge or ideas . This way of thinking recognizes the complexity of the world around us , based on the of multiple subsystems at multiple levels . As you can imagine , such thinking is useful for tackling complex problems , and creating mental models that suggest entry points or levers for solving them . When combined with expertise and experience , these modes of thought can be very powerful . Two good examples of systemic thinking in this class are the notion of and the idea of of development . Both require thinking about complex like systems of theories and ecological perspectives . Does everyone reach or even formal operational thought ?
Formal operational thought involves being able to think abstractly however , this ability does not apply to all situations or all adults . Formal operational thought is by experience and education . Some adults lead lives in which they are not challenged to think abstractly about their world . Many adults do not receive any formal education and are not taught to think abstractly about situations they have never experienced . Further , many people are not exposed to conceptual tools used to formally analyze hypothetical situations . Those who do think abstractly may be able to do so more easily in some subjects than others . For example , psychology majors may be able to think abstractly about psychology but be unable to use abstract reasoning in physics or chemistry . Abstract reasoning in a particular requires a knowledge base that no one has in all areas . Consequently , our ability to think abstractly also depends on our experiences . Intelligence and Wisdom When looking at scores on traditional intelligence tests , tasks measuring verbal skills show minimal or no declines , while scores on performance tests , which measure solving problems quickly , decline with age ( 1984 ) This mirrors and intelligence . As you recall from last chapter , crystallized intelligence encompasses abilities that draw upon experience and knowledge . Measures of crystallized intelligence include vocabulary tests , solving number problems , and understanding texts . Fluid intelligence refers to information processing abilities , such as logical reasoning , remembering lists , spatial ability , and reaction time . 1993 ) introduced two additional types of intelligence to cognitive changes in aging . Pragmatics of intelligence are cultural exposure to facts and procedures that are maintained as one ages and are similar to intelligence . Mechanics of intelligence are dependent on brain functioning and decline with age , similar to intelligence . indicated that pragmatics of intelligence show little decline and typically increase with age whereas mechanics decline steadily , staring at a relatively young age . Additionally , pragmatics of intelligence may compensate for the declines that occur with mechanics of intelligence . In summary , global cognitive declines are not typical as one ages , and individuals typically compensate for some cognitive declines , especially processing speed . Wisdom has been as expert knowledge in the fundamental pragmatics of life that permits exceptional insight , judgment and advice about complex and uncertain matters ( Smith , 1990 ) A wise person is insightful and has knowledge that can be used to overcome obstacles in living . Does aging bring wisdom ?
While living longer brings experience , it does not always bring wisdom . Paul and his colleagues ( 2004 , 2000 ) suggest that wisdom is rare . In addition , the emergence of wisdom can be seen in late adolescence and young adulthood , with there being few gains in wisdom over the course of adulthood ( Gluck , 2011 ) This would suggest that factors other than age are stronger of wisdom . Occupations and experiences Late Adulthood 383
that emphasize others rather than self , along with personality characteristics , such as openness to experience and , are more likely to provide the building blocks of wisdom ( 2004 ) Age combined with a certain types of experience personality brings wisdom . Religion and Spirituality and ( 2004 ) found that in addition to personal health behaviors , such as regular exercise , healthy weight , and not smoking , social behaviors , including involvement in activities , have been shown to be positively related to optimal health . However , it is not only those who are involved in a religion that , but so too do those who themselves as being spiritual . According to , and Marks ( 2009 ) religiosity refers to engaging with a formal religious groups doctrines , values , traditions , and . In contrast , spirituality refers to an individual intrapsychic sense of connection with something transcendent ( that which exists apart from and not limited by the material universe ) and the subsequent feelings of awe , gratitude , compassion , and forgiveness . Research has demonstrated a strong relationship between spirituality and psychological , irrespective of an individual religious participation ( 2008 ) Additionally , Chiu ( 2005 ) found that spirituality was related to a higher quality of life for both individuals and societies . Based on reports from the 2005 National Survey of Midlife in the United States , et al . 2009 ) found that higher levels of spirituality were associated with lower levels of negative affect and higher levels of positive affect , personal growth , purpose in life , positive relationships with others , environmental mastery , and autonomy . In contrast , formal religious participation was associated with lower levels of autonomy but , among older adults , also with higher levels of purpose in life and personal growth . In summary , it appears that formal religious participation and spirituality relate differently to an individual overall psychological . Age . Older individuals identify as being more important in their lives than those younger ( Argyle , 1998 ) This age difference has been explained by several factors including the likelihood that religion and spirituality provide opportunities for socialization and social support in later life , and assist older individuals in coping with losses . These age differences may also cohort differences in that older individuals were typically socialized to be more religious and spiritual than those younger ( et , 2009 ) Gender . In the United States , women report identifying as being more religious and spiritual than men do ( de , 1987 ) According to the Pew Research Center ( 2016 ) women in the United States are more likely to say religion is very important in their lives than are men ( 60 47 ) American women are also more likely than American men to say they pray daily ( 64 47 ) and attend religious services at least once a week ( 40 32 ) Theories to explain these gender difference include the notion that women may more from the relational aspects of because social relationships more strongly influence women mental health . Additionally , compared to men , women have been socialized more to internalize the behaviors linked with religious values , such as cooperation and ( et , 2009 ) Worldwide . To measure the religious beliefs and practices of men and women around the world , the Pew Research Center ( 2016 ) conducted surveys of the general population in 84 countries between 2008 and 2015 . Overall , an estimated 83 of women worldwide with a religion compared with 80 of men . This equaled 97 million more women than men identifying with a religion . There were no countries in which men were more religious than women by percentage points or more . Among Christians , women reported higher rates of weekly church attendance and higher rates of daily prayer . In contrast , Muslim women and Muslim men showed similar levels of religiosity , except frequency of attendance at worship services . Because of religious norms , Muslim men worshiped at a mosque more often than Muslim women . Similarly , Jewish men attended synagogue more often than Jewish women . In Orthodox Judaism , communal worship services can not take place unless a minyan , or quorum of at least 10 Jewish men , is present , thus ensuring that men will have high rates of attendance . Only in Israel , where roughly 22 of all Jewish adults as Orthodox , did a higher percentage of men than women report engaging in daily prayer . 384 I Late Adulthood
Optional Reading Disorders Supplemental Materials This Ted Talk ageism and discusses the impacts of thinking and structures , as well as ways to disrupt ageism . One or more interactive elements has been excluded from this version of the text . You can view them online here ?
This short interview with David Williams discusses how racism shows up in the medical profession and the importance of it . One or more interactive elements has been excluded from this version of the text . You can view them online here ?
This TED Talk discusses the impact of menopause on brains . a One or more interactive elements has been excluded from this version of the text . You can view them online here ?
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Death , Dying , Bereavement The last phase of the lifespan includes death and dying . Most other developments across the rest of the lifespan represent sets of options , but this last step is not optional . It is where all our earthly journeys end . In this chapter , we explain differences in life expectancy and the factors that length of life , as well as theories of aging itself . We consider the end of life and how it is approached in different cultures . We examine the ways that conceptions of death differ and develop across childhood and adolescence , as well as processes of grief and bereavement and the factors that how they unfold and are resolved . Lifespan and Life Expectancy Healthy Aging Life Expectancy Lifespan Lifespan or maximum lifespan refer to the greatest age reached by any member of a given species ( or population ) For humans , the lifespan is currently between 120 and 125 . Life expectancy is as the average number of years that members of a species ( or population ) live . According to the World Health Organization ( WHO ) 2019 ) global life expectancy for those born in 2019 is years , with females reaching years and males reaching years . Women live longer than men around the world , and the gap between the sexes has remained the same since 1990 . Overall life expectancy ranges from years in the WHO African Region to years in the WHO European Region . Global life expectancy increased by years between 2000 and 2016 . Improvements in child survival and access to medication for the treatment of HIV are considered the main reasons for this increase . However , life expectancy in countries ( years ) is years lower than in countries ( years ) In countries , the majority of people who die are old , while in countries almost one in three deaths are in children under years of age . According to the Central Intelligence Agency ( 2019 ) the United States ranks in the world for life expectancy . World Healthy Life Expectancy . A better way to appreciate the diversity of people in late adulthood is to go beyond chronological age and examine how well the person is aging . Many in late adulthood enjoy better than average health and social and so are aging at an optimal level . In contrast , others experience poor health and dependence to a greater extent than would be considered typical . When looking at large populations , the WHO ( 2019 ) measures how many equivalent years of full health on average a newborn baby is expected to have . This age , called The Healthy Life Expectancy , takes into account current mortality , morbidity , and disability risks . In 2016 , the global Healthy Life Expectancy was years up from years in 2000 . The WHO African Region had the lowest Healthy Life Expectancy at years , while the WHO Western Region had the highest at years . Death , Dying , Bereavement 397
by aver ! me ( 2015 ) I I guns I 77540 I 75 us I us 22 675 I 62505 I 560 I 55 nu . Figure 1017 . Life around the world in 2015 Life Expectancy in America . The overall life expectancy for a baby born in 2017 in the United States is years , decreasing from years in 2016 and years in 2015 ( Arias Xu , 2019 ) The decrease from 2016 occurred for males , changing from years to years , while it did not change for females ( years ) Life expectancy at birth decreased by year for the white population ( to ) Life expectancy at birth did not change from 2016 for the black population ( and the Hispanic population ( Before this unprecedented decline , life expectancy had been increasing steadily for decades . Reasons given by the for this decrease in life expectancy include deaths from drug overdoses , an increase in liver disease , and a rise in suicide rates ( 2019 ) Figure 1018 shows the United States life expectancy from by ethnicity and sex . 398 Death , Dying , Bereavement
Figure 2017 Life Expectancy by Sex and Ethnicity female Mann am ! female ?
50 male 79 I I ' Inmate 75 MI I rate 76 I I I 45 black mate 70 69 65 2006 2007 2006 2009 2010 2011 2012 2013 2014 2015 2016 2017 . vu mourn Figure 1018 . US Life Expectancy by Sex and Ethnicity American Healthy Life Expectancy . To determine the current United States Healthy Life Expectancy ( factors were evaluated in to determine how long an individual currently at age 65 will continue to experience good health ( 2013 ) The highest Healthy Life Expectancy ( was observed in Hawaii with years of additional good health , and the lowest was in Mississippi with only years of additional good health . Overall , the lowest was among southern states . Females had a greater than males at age 65 years in every state and . was greater for whites than for blacks in and all states from which data were available , except in Nevada and New Mexico . BLUE ZONES Recent research on longevity reveals that people in some regions of the world live longer than people elsewhere . Efforts to study the common factors between these areas and the people who live there is known as blue zone research . Blue zones are regions of the world where Dan claims people live much longer than average . The term appeared in his November 2005 National Geographic magazine cover story , The Secrets of a Long Life . regions as Blue Zones ( Japan ) Italy ) Costa ) Greece ) and the in Loma Linda , Death , Dying , Bereavement 399
California . He offers an explanation , based on data and hand observations , for why these populations live healthier and longer lives than others . The people inhabiting blue zones share common lifestyle characteristics that contribute to their longevity . The diagram below ( Figure ) highlights the following six shared characteristics among the people of , and Loma Linda blue zones . Though not a lifestyle choice , they also live as isolated populations with a related gene pool . I Family put ahead of other concerns I Less smoking I the majority of food consumed is derived from plants I Legumes commonly consumed I Constant moderate physical activity an inseparable part of life I Social engagement people of all ages are socially active and integrated into their communities In his book , provides a list of nine lessons , covering the lifestyle of blue zones people I Moderate , regular physical activity . I Life purpose . I Stress reduction . I Moderate caloric intake . I diet . I Moderate alcohol intake , especially wine . I Engagement in spirituality or religion . I Engagement in family life . I Engagement in social life . 400 Death , Dying , Bereavement
Lorna Linda , United Slates IE ! VIII ! Japan Italy Figure 1019 . Blue zones share many common healthy habits contributing to longer . Although improvements have occurred in overall life expectancy , children born in America today may be the generation to have a shorter life span than their parents . Much of this decline has been attributed to the increase in sedentary lifestyle and obesity . Since 1980 , the obesity rate for children between the ages of and 19 has tripled , as of children were obese in 2014 compared with in 1980 ( American Medical Association , 2016 ) Obesity in children is associated with many health problems , including high blood pressure , type diabetes , elevated blood cholesterol levels , and psychological concerns including low , negative body image , and depression . Excess weight is associated with an earlier risk of diseases and death . In 2007 , former Surgeon General Richard stated , Because of the increasing rates of obesity , unhealthy eating habits and physical inactivity , we may see the generation that will be less healthy and have a shorter life expectancy than their parents ( Gender Differences in Life Expectancy Several explanations have been offered for the gender differences in average life expectancy that emerged in the late one focused on nature and the other on nurture . Biological Explanations . Biological differences in sex chromosomes and different pattern of gene expression are theorized as one reason why females live longer ( 2016 ) Males are heterogametic ( XY ) whereas females are homogametic ( with respect to sex chromosomes . Males can only express the chromosome genes that come from the mother , while females have the advantage of being able to select the better chromosome from their mother or father , while the worse chromosome . This process of selection for better genes is impossible in males and results in the greater genetic and developmental stability of females . In terms of developmental biology , women are the default sex , which means that the creation of a male individual requires a sequence of events at a molecular level . According to et al . 2016 ) these events are initiated by the activity of the gene located on the chromosome . This activity and change in the direction of development results in a greater number of disturbances and developmental disorders , because the normal course of development requires Death , Dying , Bereavement 401
many different factors and mechanisms , each of which must work properly and at a stage of the development ( Men are more likely to contract viral and bacterial infections , and their immunity at the cellular level decreases faster with age . Although women are slightly more prone to autoimmune and diseases , such as rheumatoid arthritis , the gradual deterioration of the immune system is slower in women ( 2013 et , 2013 ) Looking at the of hormones , estrogen levels in women appear to have a protective effect on their heart and circulatory systems ( 2005 ) also have antioxidant properties that protect against harmful effects of free radicals , which damage cell components , cause mutations , and are in part responsible for the aging process . Testosterone levels are higher in men than in women and are related to more frequent cardiovascular and immune disorders . The level of testosterone is also responsible , in part , for male behavioral patterns , including increased level of aggression and violence ( Martin , Poon , 2011 , 2012 ) Another factor responsible for risky behavior is the frontal lobe of the brain . The frontal lobe , which controls judgment and consideration of an action consequences , develops more slowly in boys and young men . This lack of judgment affects lifestyle choices , and consequently many more boys and men die by smoking , excessive drinking , accidents , drunk driving , and violence ( 2016 ) Lifestyle Factors . Certainly not all the reasons women live longer than men are biological . As previously mentioned , male behavioral patterns and lifestyle play a role in the shorter lifespans for males . One factor is that males work in more dangerous jobs , including police , and construction , and they are more exposed to violence . According to the Federal Bureau of Investigation ( 2014 ) there were homicides in the US . in 2014 ( last year for full data ) and of those 77 were males . Further , males serve in the military in much larger numbers than females . According to the Department of Defense ( 2015 ) in 2014 83 of all in the Services ( Navy , Army , Marine Corps and Air Force ) were male , while 85 of all enlisted service members were male . Males are also more than three times as likely to commit suicide ( Additionally , men are less likely than women to have health insurance , develop a regular relationship with a doctor , or seek treatment for a medical condition ( Scott , 2015 ) As mentioned in the middle adulthood chapter , women are more religious than men , which is associated with healthier behaviors ( Marks , 2009 ) Lastly , social contact is also important as loneliness is considered a health hazard . Nearly 20 of men over 50 have contact with their friends less than once a month , compared to only 12 of women who see friends that infrequently ( Scott , 2015 ) Hence , men lower life expectancy appears to be due to both biological and lifestyle factors . Theories of Aging Why do we age ?
There are many theories that attempt to explain how we age , but researchers still do not fully understand what factors contribute to the human lifespan ( Jin , 2010 ) Research on aging is constantly evolving and includes a variety of studies involving genetics , biochemistry , animal models , and human longitudinal studies ( NIA , According to Jin ( 2010 ) modern biological theories of human aging involve two categories . The is Programmed Theories that follow a biological timetable , possibly a continuation of childhood development . This timetable would depend on changes in gene expression that affect the systems responsible for maintenance , repair , and defense responses , 72 ) The second category includes Damage Theories which emphasize environmental factors that cause cumulative damage in organisms . Examples from each of these categories will be discussed . Primary Aging . Programmed Theories 402 Death , Dying , Bereavement
Genetics . Genetic certainly plays a role in longevity , but scientists are still attempting to identify which genes are responsible . Based on animal models , some genes promote longer life , while other genes limit longevity . longevity may be due to genes that better equip someone to survive a disease . For others , some genes may accelerate the rate of aging , while others slow that rate . To help determine which genes promote longevity and how they operate , researchers scan the entire genome and compare genetic variants in those who live longer with those who have an average or shorter lifespan . For example , a National Institutes of Health study genes possibly associated with blood fat levels and cholesterol , both risk factors for coronary disease and early death ( NIA , Researchers 1020 believe that it is most likely a combination of many genes that affect the rate of aging . Cellular Clock Theory . This theory suggests that biological aging is due to the fact that normal cells can not divide . This is known as the limit , and is ( evidenced in cells studied in test tubes , which divide about ' times before they stop ( 2014 ) But what is the I . mechanism behind this cellular senescence ?
At the end of each chromosomal strand is a sequence of DNA that does not code for ! any particular protein , but protects the rest of the chromosome , am which is called a . With each replication , the gets shorter . Once it becomes too short the cell does one of three things . It can stop replicating by turning itself off , called cellular senescence . It can stop replicating by dying , called . Or , as in the development of cancer , it can continue to divide and become and Hum senescence abnormal . Senescent cells can also create problems . While they may be turned off , they are not dead , thus they still interact with other cells in the body and can lead to an increase risk of disease . When we are young , senescent cells may reduce our risk of serious diseases such as cancer , but as we age they increase our risk of such problems ( NIA , The question of why cellular senescence changes from being to being detrimental is still under investigation . The answer may lead to some important clues about the aging process . DNA Damage . Over time DNA , which contains the genetic code for all organisms , accumulates damage . This is usually not a concern as our cells are capable of repairing damage throughout our life . Further , some damage is harmless . However , some damage can not be repaired and remains in our DNA . Scientists believe that this damage , and the inability to itself , is an important part of aging ( NIA , As DNA damage accumulates with increasing age , it can cause cells to deteriorate and malfunction ( Jin , 2010 ) Factors that can damage DNA include ultraviolet radiation , cigarette smoking , and exposure to hydrocarbons , such as auto exhaust and coal ( 2006 ) Mitochondrial Damage . Damage to mitochondrial DNA can lead to a decaying of the mitochondria , which is a cell organelle that uses oxygen to produce energy from food . The mitochondria convert oxygen to adenosine ( which provides the energy for the cell . When damaged , mitochondria become less and generate less energy for the cell and can lead to cellular death ( NIA , Death , Dying , Bereavement 403
Free Radicals . When the mitochondria use oxygen to produce energy , they also produce potentially harmful byproducts called oxygen free radicals ( NIA , The free radicals are missing an electron and create instability in surrounding molecules by taking electrons from them . There is a snowball effect ( A takes from and then takes from , etc . that creates more free radicals which disrupt the cell and causes it to behave abnormally ( See Figure 1022 ) Some free radicals are helpful as they can destroy bacteria and other harmful organisms , but for the most part they cause damage in our cells and tissue . Free radicals are with disorders seen in those of advanced age , including cancer , atherosclerosis , cataracts , and . Some research has suggested that adding antioxidants to our diets can help counter the effects of free radical damage because the antioxidants can donate an electron that can neutralize damaged molecules . However , the research on the effectiveness of antioxidants is not conclusive ( Harvard School of Public Health , 2016 ) Immune and Hormonal Stress Theories . Ever notice how quickly presidents seem to age ?
Before and after Ewe photos reveal how stress can play a role in the aging process . When study stress , they are not just considering major life events , such as unemployment , death of a loved one , or the birth of a child . They are also including metabolic stress , the life sustaining activities of the body , such as circulating the blood , eliminating 2008 2012 waste , controlling body temperature , and neuronal in the 1023 Fame President brain . In other words , all the activities that keep the body alive also create biological stress . To understand how this stress affects aging , researchers note that both problems with the innate and adaptive immune system play key roles . The innate immune system is made up of the skin , mucous membranes , cough , stomach acid , and specialized cells that alert the body of an impending threat . With age these cells lose their ability to communicate as effectively , making it harder for the body to mobilize its defenses . The adaptive immune system includes the tonsils , spleen , bone marrow , thymus , circulatory system and the lymphatic system that work to produce and transport cells . cells , or lymphocytes , bacteria , viruses , and other foreign threats to the body . are in a naive state before they are programmed to an invader and become memory cells . These cells now remember how to a certain infection should the body ever come across this invader again . Memory cells can remain in your body for many decades , which is why the measles vaccine you received as a child is still protecting you from this virus today . As older adults produce fewer new to be programmed , they are less able to off new threats and new vaccines work less effectively . The reason why the shingles vaccine works well with older adults is because they already have some existing memory cells against the varicella virus . The shingles vaccine is acting as a booster ( NIA , Hormonal Stress Theory , also known as Theory of Aging , suggests that as we age the ability of the hypothalamus to regulate hormones in the body begins to decline leading to metabolic problems ( American Federation of Aging Research ( AFAR ) 2011 ) This decline is linked to excessive levels of the stress hormone cortisol . While many of the body hormones decrease with age , cortisol does not ( The more stress we experience , the more cortisol we release , and the more hypothalamic damage that occurs . Changes in hormones have been linked to several metabolic and hormone related problems that increase with age , such as diabetes ( AFAR , 2011 ) thyroid problems ( 2013 ) osteoporosis , and orthostatic hypotension ( 404 Death , Dying , Bereavement
Secondary Aging Damage Theories A second set of theories focuses on aging as an outcome of the wear and tear our bodies receive as part of our daily lives . Damage theories examine the parts of aging and death that come from the outside . This perspective the nurture or environmental side of the equation , and holds that the body wears out through the cumulative effects of a host of life events and lifestyle factors , such as disease , disuse , abuse , stress , and environmental toxins . Evidence to support this position comes from three sources . Lifestyle Factors that Predict Aging and Death . The first body of research supporting the role of nurture in aging examines the effects of a variety of physical factors , such as poor diet , lack of exercise , and substance abuse , as well as psychological factors , such as stress , social inactivity , and pessimistic outlook . Studies show that these factors can predict both how healthy people will be and how long they will live . Such forces can cause biological damage , which is repaired more and more slowly as we age . From this perspective aging results from the accumulation of such damage . Exposure to Environmental Toxins . A second body of evidence shows that aging can be shaped by exposure to environmental pollution , as caused for example by pesticides , air pollutants , and radiation , or by harmful substances added to our food and water . When we metabolize these toxins , they do damage , not only to our bodies , but also to our our genetic DNA material at the cellular level . As our organ systems deteriorate and become more vulnerable , errors pile and our body ability to repair them slows down . Toxins can cause allergic reactions and diseases , as seen in the upswing in Type II diabetes and other chronic conditions . Effects of environmental toxins are also seen in processes involved in life threatening medical conditions , like cardiovascular disease , arthritis , and cancer . Historical Increases in Average Life Expectancy . A third source of evidence that aging can be speeded up or slowed down by external factors comes from documentation of steady historical increases in average life expectancy . These increases follow from changes in external factors , mostly related to public health . They include historical reductions in the number of people in extreme poverty as well as improvements in nutrition , quality and access to medical care , sanitation , child birth procedures , and the invention of antibiotics . These historical changes did not result in evolutionary changes in human biology . They produced recent changes in environmental factors that are shaping the rate of aging and the timing of death . In sum , as you can see that aging and death are processes that are multiply by biological , psychological , social , and contextual factors . Theories of primary aging are correct that we have the seeds of our aging programmed into our bodies . But theories of secondary aging are also the environment also and slows down our aging and dying via the damage it does to our increasingly vulnerable biology . And , of course , lifespan researchers would remind us that the active individual also plays a role through the decisions they make about behavioral risks , like smoking , drinking , and using or abusing substances , as well as via more positive routes , especially a healthy diet , exercise , and continued participation in positive social and cognitive activities . Dying and Grieving in Children and Adolescents Developmental Concepts of Death When we think of death and dying , we naturally focus on the elderly , and when we think of children in this process , we typically think of adult children , who often act as caregivers for their aging and dying parents . However , children and adolescents are also involved in both dying and bereavement . An understanding of grief reactions and conceptions of death are important when assessing a childs response to their own terminal illness and how they are dealing with the death of a loved one . This section reviews key developmental concepts and describes strategies for supporting children and adolescents who are grieving as well as those who are dying . Death , Dying , Bereavement 405
Children grieve differently than adults . They often grieve in spurts and can at new developmental stages as their understanding of death and perceptions of the world change . Childhood grief may be expressed as behavioral changes emotional expression . The two most important predictive factors of a child successful resolution after suffering a loss are the availability of one adult and the provision of a safe physical and emotional environment . Dying and Grieving during Infancy ( years ) Children at this age have no cognitive understanding of death . If they themselves are dying , they are not aware of this fact . Their reactions are based completely on local conditions , including their contact with caregivers and their own current levels of pain and suffering . Infants can be comforted by the presence of secure attachment and palliative care to reduce pain . The process of dying is much more psychologically painful for caregivers than for infants , but hospitals and hospice care know how important the active participation of a caring and responsive attachment can be , one who is making medical decisions based on the balance between the probability that a treatment will be effective ( prolong the dying process ) and the pain that treatments cause . In terms of infants reactions to the death of a loved one , even if infants are not cognitively aware of death , they are cognizant of separation and loss , and so separation anxiety and grief reactions are possible . Behavioral and developmental regression can occur as children have identifying and dealing with their loss they may react in concert with the distress experienced by their caregiver . There is a need to maintain routines and to avoid separation from others . If the death is the primary attachment , the presence of grief and the severity of the infant reaction will depend on their age and the quality of care they receive from their new primary caregiver . Before the age of months , the long term effects of maternal death depend almost entirely on whether a sensitive responsive substitute caregiver can be found who can take over immediately . For children older than months , who have formed a attachment to the primary caregiver , expressions of grief and loss are common , but the transition is easier if the new primary caregiver is someone who the infant or toddler knows and with whom they already have a trusting relationship ( father , aunt , grandmother ) As mentioned previously , children may repeatedly revisit and the loss of a primary caregiver at successive ages as they develop cognitive capacities that allow them to to on the loss in qualitatively different ways . Dying and Grieving during Early Childhood ( years ) Preschool age children see death as temporary and reversible . They interpret their world in a literal manner and may ask questions this perspective . When children themselves are facing death , they take their cues about what is happening almost entirely from their caregivers and the other people around them . They have typical graded concerns about attachment and abandonment , and have a hard time understanding why they have to accept painful treatments and why they ca just go home and get back to life as usual . They can have tantrums and regulating their emotions and behaviors , and it can be hard for parents to discipline or set limits with a terminally ill child . However , the same kinds of high quality parenting that are good for children in other circumstances , namely , love ( affection , caring , and concern ) combined with and reasonable limits , and autonomy support ( validation and opportunities for free expression of preferences and perspectives ) are helpful for young children in these situations . Young children should be protected from adult anguish , but they can sense when adults are upset . Small children from familiar routines , assurances that familiar adults are going to be with them the whole time , support for whatever emotions children are actually experiencing , and explanations and answers to young children questions . When preschool aged children are dealing with the death of a loved one , especially a central person in their lives , like a mother , father , or sibling , their conception of death makes the process of grieving more . They may believe 406 Death , Dying , Bereavement
that death can be caused by thoughts and provide magical explanations , often blaming themselves for the death . The conviction that death is reversible makes it for preschoolers to cognitively accept the death as . They sometimes beg parents to go get the dead person and bring them back home , and they can become frantic if they are told that the person has been buried . In the context of this conception of death , it is challenging to provide simple and straightforward explanations that emphasize that the child is not to blame , that the loved one can not return even though they did not want to go , and that the absent person still loves the child . Even when adults avoid euphemisms and try to correct , preschool children often regard death like a kidnapping ( with the dead person taken far away against their will ) until they reach the concrete operational stage of cognitive development , when they rework their understanding of the death . It is this combination of developmental when a young child has a attachment to a primary caregiver and a conception of death that makes it impossible to accept death as that puts children this age at particular risk for complicated grief and negative neurophysiological and psychological effects . As with infants , the greatest protection against developmental risk is provided by the immediate presence of a loving and stable attachment , preferably one to whom the young child is already securely attached . Dying and Grieving during the Stage of Concrete Operational Development Middle childhood ( years ) When children reach the concrete operational stage of cognitive development , they understand that death is and irreversible but do not believe that it is universal or could happen to them . Death is often personalized . Expressions of anger towards the deceased or towards those perceived to have been unable to save the deceased can occur . Anxiety , depressive symptoms , and somatic complaints may be present . The child often has fears about death and concerns about the safety of their other loved ones . In addition to giving clear , realistic information , offer to include the child in funeral ceremonies . Notifying the school will help teachers understand the child reaction and provide additional adult support . years ) Children at this age have an adult understanding of death that it is , irreversible , and universal . They are able to understand the biological aspects of death as well as relationships . They tend to intellectualize death as many have not yet learned to identify and deal with feelings . They may develop a morbid curiosity and are often interested in the physical details of the dying process as well as religious and cultural traditions surrounding death . The ability to identify causal relationships can lead to feelings of guilt such feelings should be explored and addressed . To facilitate with emotions , it may prove useful to talk about your own emotions surrounding death and to offer opportunities for the child to discuss death . The child should also be allowed to participate , as much as they feel comfortable , in seeing the dying patient and participating in activities surrounding the death . During middle childhood and , children have a concrete operational understanding of death . When children in this stage are themselves terminally ill and facing their own death , their concrete understanding of death can lead to a relatively acknowledgement of the actual situation . At this age , adults should still follow the child lead in terms of questions and explanations , and share their own grief and sadness only as appropriate . Children may show a wide variety of emotions , but they still have concerns focused , for example , on keeping up with their friends and their schoolwork . To the extent that the parents of a child friends are willing to let them keep the dying child company , the presence of friends can provide both distraction and comfort to the child . Connections with friends can also be maintained through letters , notes , phone conversations , and virtual meetings , where the friends can play games or work together on their homework . Dying and Grieving during Adolescence ( years ) Adolescents also have an adult understanding of death . At the same time , however , they are also developing the ability to think abstractly and are often curious of the existential implications of death . They often reject adult rituals and support Death , Dying , Bereavement 407
and feel that no one understands them . They may engage in activities in order to more fully challenge their own mortality . They often have strong emotional reactions and may have identifying and expressing feelings . It is important that adults support independence and access to peers , but also provide emotional support when needed . When adolescents face their own deaths , they also have full blown emotional and psychological reactions . Like adults , they can grieve the lives and possibilities that are lost with death at a young age . Parents and peers can help them create legacy projects , like blogs , videos , music , or books , that can enable adolescents to feel that they have accomplished at least some parts of their life purposes . However , they remain adolescents , with concerns and problems . For example , the emotional instability and need for autonomy that is characteristic of adolescence can sometimes make it for parents to provide helpful support under such circumstances . Adolescents can get into arguments with parents about whether or not they will accept certain medical treatments , especially if the treatments affect their physical appearance . Adolescents , especially young adolescents , can diseases embarrassing , because it makes them different from their peers during a time when they are concerned with peer conformity . However , adults can rest assured that even if they do not always acknowledge it , adolescents count on the presence , wisdom , and support of their parents . In sum , the generalizations and strategies provided here only serve as a framework when helping a child come to terms with their own death or that of a loved one . The overarching message is that children and adolescents have conceptions of death , and concerns and challenges in dealing with grieving and dying . They also need individually and developmentally attuned supports during these processes , which can be demanding for their adults . When in doubt , seek help from pediatricians , specialists , mental health professionals , and others specializing in bereavement . Loss during Childhood Loss of a family member . For a child , the death of a parent , without support to manage the effects of the grief , may result in psychological harm . This is more likely if adult caregivers are struggling with their own grief and are psychologically unavailable to the child . The surviving parent or caregiver plays a crucial role in helping the child adapt to a parent death . Studies have shown that losing a parent at a young age does not just lead to negative outcomes there are also some potentially positive effects . Some children showed increased maturity , better coping , and improved communications skills . Adolescents who have lost a parent value other people more than those who have not experienced such a close loss ( Ellis , 2008 ) The loss of a parent , grandparent , or sibling can be very troubling in childhood , but even in childhood there are age differences in relation to the loss . A very young child , under six months of age , may have no reaction if a caregiver dies , but older children are typically affected by the loss . This is especially true if the loss occurs during the time when trust and dependency are formed . During critical periods such as months , when attachment and separation anxiety are at their height , even a brief separation from a parent or other person who cares for the child can cause distress . Even as a child grows older , death is still to fathom and this affects how a child responds . For example , younger children see death more as a separation , and may believe death is curable or temporary . Reactions can manifest themselves in acting out behaviors a return to earlier behaviors such as sucking thumbs , clinging to a toy or angry behavior though they do not have the maturity to mourn as an adult , they feel the same intensity . As children enter and teen years , there is a more mature understanding , but strong emotional reactions are still normal . Loss of a friend or classmate . Children may experience the death of a friend or a classmate through illness , accidents , suicide , or violence . Loss from sudden violence , like drive by or school shootings , are particularly traumatic . Initial support involves reassuring children that they are safe , that their emotional and physical feelings are normal , and that support is available . Schools are advised to plan for these possibilities in advance . Planning and participating in rituals 408 Death , Dying , Bereavement
and memorials may be helpful , but will also challenging . Some children choose to continue visiting with the parents or family of their dead friend or classmate , to keep the connection , share the loss , and comfort the family . Other forms of loss . Children can experience grief as a result of losses due to causes other than death . For example , children may grieve losses connected with divorce and pine for the original family that has been forever lost . As with other losses , they may this transition as they get older and have more sophisticated cognitive capacities to reflect on and rework the meaning of the divorce . can also cause children grief particularly if they are combined with other circumstances such as neglectful or abusive parental behaviors , other losses , etc . It is also possible for children who have been physically , psychologically , or sexually abused to grieve over the damage to or the loss of their ability to trust . Since such children usually have no support or acknowledgement from any source outside the family unit , this is likely to be experienced as disenfranchised grief . Stages of Loss Based on her work and interviews with terminally ill patients , 1975 ) described stages of loss experienced by someone who faces the news of their impending untimely death . These stages are not really stages that a person goes through in order or only once nor are they stages that occur with the same intensity . Indeed , the process of death is by a person life experiences , the timing of their death in relation to life events , the predictability of their death based on health or illness , their belief system , and their assessment of the quality of their own life . Nevertheless , these stages provide a framework to help us to understand and recognize some of what a dying person experiences psychologically . And by understanding , we are more equipped to support that person as they die and to face death ourselves when our time comes ( 1975 ) Denial is often the reaction to overwhelming , unimaginable news . Denial , or disbelief or shock , protects us by allowing such news to enter slowly and to give us time to come to grips with what is taking place . The person who receives positive test results for a condition may question the diagnosis , seek second opinions , or may simply feel a sense of psychological disbelief even though they know that the results are true . Anger also provides us with protection in that being angry energizes us to against something and gives structure to a situation that may be thrusting us into the unknown . It is much easier to be angry than to be sad or in pain or depressed . It helps us to temporarily believe that we have a sense of control over our future and to feel that we have at least expressed our rage about how unfair life can be . Anger can be focused on a person , a health care provider , at God , or at the world in general . And it can be expressed over issues that have nothing to do with our death consequently , being in this stage of loss is not always obvious . Bargaining involves trying to think of what could be done to turn the situation around . Living better , devoting oneself to a cause , being a better friend , parent , or spouse , are all agreements one might willingly commit to if doing so would lengthen life . Asking to just live long enough to witness a family event or a task are examples of bargaining . Depression is sadness and sadness is appropriate for such an event . Feeling the full weight of loss , crying , and losing interest in the outside world is an important part of the process of dying . This depression makes others feel very uncomfortable and family members may try to console their loved one . Sometimes hospice care may include the use of antidepressants to reduce depression during this stage . Acceptance involves learning how to carry on and to incorporate this aspect of the life span into daily existence . Reaching acceptance does not in any way imply that people who are dying are happy about it or content with it . It means Death , Dying , Bereavement 409
that they are facing it and continuing to make arrangements and to say what they wish to say to others . Some terminally ill people that they live life more fully than ever before after they come to this stage . In some ways , these stages serve as coping mechanisms , allowing the individual to make sense of the situation while coming to terms with what is happening . They are , in other words , the mind way of gradually recognizing the implications of ones impending death and giving him or her the chance to process it . These stages provide a type of framework in which dying is experienced , although it is not exactly the same for every individual in every case . when death is on time and comes at the an advanced age , people have had more opportunity to come to grips with impending death and so may show only acceptance . In fact , research shows that as people age , they become less and less afraid of death , so that for many who are ( years ) death seems like a natural next step . Since presented these stages of loss , several other models have been developed . These subsequent models , in many ways , build on that of , offering expanded views of how individuals process loss and grief . While model was restricted to dying individuals , subsequent theories tended to focus on loss as a more general construct . This ultimately suggests that facing one own death is just one example of the grief and loss that human beings can experience , and that other loss or situations tend to be processed in a similar way . Cultural Differences in Decisions Cultural factors strongly how doctors , other health care providers , and family members communicate bad news to patients , the expectations regarding who makes the health care decisions , and attitudes about care ( Ganz , 2019 , In Western medicine , doctors take the approach that patients should be told the truth about their health . Blank ( 2011 ) reports that 75 of the worlds population do not conduct medicine by the same standards . Thus , outside Western nations , and even among certain racial and ethnic groups within the those nations , doctors and family members may conceal the full nature of a terminal illness , as revealing such information is viewed as potentially harmful to the patient , or at the very least is seen as disrespectful and impolite . and Simon ( 2008 ) reported that in India doctors routinely abide by the family wishes and withhold information from the patient , while in Germany doctors are legally required to inform the patient . In addition , many doctors in Japan and in numerous African nations used terms such as mass , growth , and unclean tissue rather than referring to cancer when discussing the illness to patients and their families ( Holland , 1987 ) Family members also actively protect terminally ill patients from knowing about their illness in many Hispanic , Chinese , and Pakistani cultures ( Putsch , 1997 Joyce , 2004 ) In western medicine , we view the patient as autonomous in health care decisions ( Simon , 2008 , However , in other nations the family or community plays the main role , or decisions are made primarily by medical professionals , or the doctors in concert with the family make the decisions for the patient . For instance , in comparison to European Americans and African Americans , Koreans and are more likely to view family members as the decision makers rather than just the patient ( Berger , 1998 , In many Asian 1024 cultures , illness is viewed as a family event , not just something that impacts the individual patient ( Blank , 2011 , 2002 Simon , 2008 ) Thus , there is an expectation that the family has a say in the health care decisions . As many cultures attribute high regard and respect for doctors , patients and families may defer some of the decision making to the medical professionals ( The notion of advanced directives , which spell out a patients wishes for , hold little or no relevance 410 I Death , Dying , Bereavement
in many cultures outside of western society ( Blank , 2011 ) For instance , in India advanced directives are virtually existent , while in Germany they are regarded as a major part of health care ( Simon , 2008 ) Moreover , decisions involve how much medical aid should be used . In the United States , Canada , and most European countries feeding is more commonly used once a patient has stopped eating , while in many other nations lack of eating is seen as a sign , rather than a cause , of dying and do not consider using a feeding tube ( Blank , 2011 ) According to a Pew Research Center Survey ( 2014 ) while death may not be a comfortable topic to ponder , 37 of their survey respondents had given a great deal of thought about their wishes , with 35 having put these in . writing . Yet , over 25 had given no thought to this issue . 2014 ) also found . A . that there were clear racial and ethnic differences in wishes ( see , i ' Figure ) Whites are more likely than Blacks and Hispanics to prefer to have mix . treatment stopped if they have a terminal illness . In contrast , the majority of Blacks ( 61 ) and Hispanics ( 55 ) prefer that everything be done to keep them alive . and ( suggest that the low rate of completion of advanced directives among may a distrust of the health care system as a result of the health care disparities have experienced . Among Hispanics , patients may also be reluctant to select a single family member to be responsible for decisions out of a concern of isolating the person named and of offending other family members , as this is commonly seen as a family responsibility ( Morrison , Meier , 1998 ) Figure 1025 Religious Practices after Death Funeral rites are expressions of loss that personal and cultural beliefs about the meaning of death and the afterlife . Ceremonies provide survivors a sense of closure after a loss . These rites and ceremonies send the message that the death is real and allow friends and loved ones to express their love and respect for those who die . Under circumstances in which a person has been lost and presumed dead or when family members were unable to attend a funeral , there can continue to be a lack of closure that makes it to grieve and to learn to live with loss . Although many people are still in shock when they attend funerals , the ceremony still provides a marker of the beginning of a new period of ones life as a survivor . The following are some of the religious practices regarding death , however , individual religious interpretations and practices may occur ( Dresser , 2010 , 2009 ) The Hindu belief in reincarnation accelerates the funeral ritual , and deceased Hindus are cremated as soon as possible . After being washed , the body is anointed , dressed , and then placed on a stand decorated with ready for cremation . Once the body has been cremated , the ashes are collected and , if possible , dispersed in one of India holy rivers . Judaism . Among the Orthodox , the deceased is washed and then wrapped in a simple white shroud . Males are also wrapped in their prayer shawls . Once shrouded the body is placed into a plain wooden . The burial must occur as soon as possible after death , and a simple service consisting of prayers and a eulogy is given . After burial the family members typically gather in one home , often that of the deceased , and receive visitors . This is referred to as sitting shiva . Muslim . In Islam the deceased are buried as soon as possible , and it is a requirement that the community be involved in the ritual . The individual is washed and then wrapped in a plain white shroud called a . Next , funeral prayers are said followed by the burial . The shrouded dead are placed directly in the earth without a casket and deep enough not to be disturbed . They are also positioned in the earth , on their right side , facing Mecca , Saudi Arabia . Death , Dying , Bereavement 411
Roman Catholic . Before death an ill Catholic individual is anointed by a priest , commonly referred to as the Anointing of the Sick . The priest recites a prayer and applies consecrated oil to the forehead and hands of the ill person . The individual also takes a communion consisting of consecrated bread and wine . The funeral rites consist of three parts . First is the wake that usually occurs in a funeral parlor . The body is present , and prayers and eulogies are offered by family and friends . The funeral mass is next which includes an opening prayer , bible readings , liturgy , communion , and a concluding rite . The funeral then moves to the cemetery where a blessing of the grave , scripture reading , and prayers conclude the funeral ritual . Green Burial In 2017 , the median cost of an adult funeral with viewing and burial was . The median cost for viewing and cremation was ( National Funeral Directors Association ( 2019 ) The same survey found that nearly half of all respondents had attended a funeral in a setting , such as an outdoor setting that was meaningful to the deceased , and over half of the respondents said they would be interested in exploring green funeral options ( 2017 ) According to the Green Burial Council ( 2019 ) Americans bury over 64 thousand tons of steel , 17 thousand tons of copper and bronze , million tons of concrete , 20 million feet of wood , and over million gallons of embalming every year . As a Figure 1025 Green burial Site in the UK result , there has been a growing interest in green or natural burials . Green burials attempt to reduce the impact on the environment at every stage of the funeral . This can include using recycled paper , biodegradable caskets , cotton shroud in the place of any casket , formaldehyde free , or no embalming , and trying to maintain the natural environment around the burial site ( 2019 ) According to the ( 2017 ) many cemeteries have reported that consumers are requesting green burial options , and since many of the ons of a traditional burial , such as a concrete vault , embalming , and casket are not required , the cost can be substantially less . Optional Reading Curative , Palliative , and Hospice Care When individuals become ill , they need to make choices about the treatment they wish to receive One age , type of illness , and personal beliefs about dying affect the type of treatment chosen ( Bell , 2010 ) Curative care is designed to overcome and cure disease and illness ( Fox , 1997 ) Its aim is to promote complete recovery , not just to reduce symptoms or pain . An example of curative care would be chemotherapy . While curing illness and disease is an important goal of medicine , it is not its only goal . As a result , some have criticized the curative model as ignoring the other goals of medicine , including preventing illness , restoring functional capacity , relieving suffering , and caring for those who can not be cured . Palliative care focuses on providing comfort and relief from physical and emotional pain to patients throughout their illness , even while being treated ( 2007 ) In the past , palliative care was to offering comfort for the dying . Now it is offered whenever patients suffer from chronic illnesses , such as cancer or heart disease ( 2015 ) Palliative care is also part of hospice programs . 412 Death , Dying , Bereavement
Hospice emerged in the United Kingdom in the century as a result of the work of Cicely Saunders . This approach became popularized in the by the work of Elizabeth ( 2015 ) and by 2012 there were hospice programs in the ( National Hospice and Palliative Care Organization ( 2013 ) Hospice care whether at home , in a hospital , I nursing home , or hospice facility involves a team of professionals and volunteers who provide terminally ill patients with medical , psychological , and spiritual support , along with support for their families ( Shannon , 2006 ) The aim of hospice is to help the dying be as free from pain as possible , and to comfort both the patients and their families during a time . In order to enter hospice , a patient must be at diagnosed as terminally ill with an anticipated death Figure 1028 within months ( 2015 ) The patient is allowed to go through the dying process without invasive treatments . Hospice workers try to inform the family of what to expect and reassure them that much of what they see is a normal part of the dying process . According to the National Hospice and Palliative Care Organization ( 2019 ) there are four types of hospice care in America Routine hospice care , where the patient has chosen to receive hospice care at home , is the most common form of hospice . Continuous home care is predominantly nursing care , with caregiver and hospice aides supplementing this care , to manage pain and acute symptom crises for to 24 hours in the home . Inpatient respite care is provided by a hospital , hospice , or care facility to provide temporary relief for family caregivers . General inpatient care is provided by a hospital , hospice , or care facility when pain and acute symptom management can on be handled in other settings . In 2017 , an estimated million people residing in America received hospice care ( 2019 ) The majority of patients on hospice were patients suffering from dementia , heart disease , or cancer , and typically did not enter hospice until the last few weeks prior to death . Almost one out of three patients were on hospice for less than a week . According to Shannon ( 2006 ) the basic elements of hospice include Care of the patient and family as a single unit Pain and symptom management for the patient Having access to day and night care Coordination of all medical services Death , Dying , Bereavement I 413
Social work , counseling , and pastoral services ' Bereavement counseling for the family up to one year after the patient death Although hospice care has become more widespread , these new programs are subject to more rigorous insurance guidelines that dictate the types and amounts of medications used , length of stay , and types of patients who are eligible to receive hospice care ( 2007 ) Thus , more patients are being served , but providers have less control over the services they provide , and lengths of stay are more limited . In addition , a recent report by the of the Inspector General at US . Department of Health and Human Services ( 2018 ) highlighted some of the vulnerabilities of the hospice system in the . Among the concerns raised were that did not always provide the care that was needed and sometimes the quality of that care was poor , even at Medicare facilities . Not all racial and ethnic groups feel the same way about hospice care . families may believe that medical treatment should be pursued on behalf of an ill relative as long as possible and that only God can decide when a person dies . families may feel very uncomfortable discussing issues of death or being near the deceased family member body . The view that hospice care should always be used is not held by everyone , and health care providers need to be sensitive to the wishes and beliefs of those they serve ( Coolen , 2012 ) Family Caregivers According to the Institute of Medicine ( 2015 ) it is estimated that 66 million Americans , or 29 of the adult population , are caregivers for someone who is dying or chronically of these caregivers are women . This care takes its toll physically , emotionally , and . Family caregivers may face the physical challenges of lifting , dressing , feeding , bathing , and transporting a dying or ill family member . They may worry about whether they are performing all tasks safely and properly , as they receive little training or guidance . Such tasks may also interfere with their ability to take care of themselves and meet other family and workplace obligations . Financially , families may face high out of pocket expenses ( 2015 ) As can be seen in Table , most family caregivers are providing care by themselves with little professional intervention , are employed , and have provided care for more than years . The annual loss of productivity in the US . was 25 billion in 2013 as a result of work absenteeism due to providing this care . As the prevalence of chronic disease rises , the need for family caregivers is growing . Unfortunately , the number of potential family caregivers is declining as the large baby boomer generation enters into late adulthood ( Redfoot , Houser , 2013 ) 414 Death , Dying , Bereavement
Table Characteristics of Family Caregivers in the United States Characteristic Percentages No home visits by health care professionals 69 Caregivers are also employed 72 Duration of employed workers who have been for years 55 Caregivers for the elderly 67 adapted from Lally ( 2019 ) and ( 2015 ) Advanced Directives Advanced care planning refers to all documents that pertain to care . These include advance directives and medical orders . Advance directives include documents that mention a health care agent and lining wills . These are initiated by the patient . Living wills are written or video statements that outline the health care initiates the person wishes under certain circumstances . Durable power of attorney for health care names the person who should make health care decisions in the event that the patient is incapacitated . In contrast , medical orders are crafted by a medical professional on behalf of a seriously ill patient . Unlike advanced directives , as these are doctor orders , they must be followed by other medical personnel . Medical orders include Physician Orders for Treatment ( or . In some instances , medical orders may be limited to the facility in which they were written . Several states have endorsed so that they are applicable across heath care settings ( 2015 ) Despite the fact that many Americans worry about the burden of care , more than quarter of all adults , including those aged 75 and older , have given little or no thought to their wishes , and even fewer have captured those wishes in writing or through conversation ( 2015 , 18 ) Grief , Bereavement , and Mourning The terms grief , bereavement , and mourning are often used interchangeably , however , they have different meanings . Grief is the normal process of reacting to a loss . Grief can be in response to a physical loss , such as a death , or a social loss including a relationship or job . Bereavement is the period after a loss during which grief and mourning occurs . The time spent in bereavement for the loss of a loved one depends on the circumstances of the loss and the level of attachment to the person who died . Mourning is the process by which people adapt to a loss . Mourning is greatly by cultural beliefs , practices , and rituals ( The Process of Grieving Typical grief reactions involve emotional , mental , physical , and social responses . These reactions can include feelings of numbness , anger , guilt , anxiety , sadness , and despair . The individual can experience concentrating , sleep Death , Dying , Bereavement 415
and eating problems , loss of interest in formerly pleasurable activities , physical problems , and even illness . Research has demonstrated that the immune systems of individuals grieving is suppressed and their healthy cells behave more sluggishly , resulting in greater susceptibility to illnesses ( 2010 ) However , the intensity and duration of typical grief symptoms do not match those seen in severe grief reactions , and symptoms typically diminish within weeks ( 2016 ) Prolonged and Complicated Grief . After the loss of a loved one , however , some individuals experience complicated grief , which includes atypical grief reactions ( 2011 ) Symptoms of complicated grief include Feelings of disbelief , a preoccupation with the dead loved one , distressful memories , feeling unable to move on with one life , and a yearning for the deceased . Additionally , these symptoms ( complicated grief requires clinical judgment . The psychologist needs to evaluate the clients individual history and may last six months or longer and mirror those seen in major depressive disorder ( 2016 ) 10 27 According to the Diagnostic and Statistical Manual of Mental 19 Disorders ( ed . American Psychiatric Association , 2013 ) distinguishing between major depressive disorder and determine whether the symptoms are focused entirely on the loss of the loved one and represent the individuals cultural norms for grieving , which would be appropriate . Those who seek assistance for complicated grief usually have experienced traumatic forms of bereavement , such as unexpected , multiple and violent deaths , or those due to murders or suicides ( 2010 ) Anticipatory Grief . Grief that occurs when a death is expected , and survivors have time to prepare to some extent before the loss is referred to as anticipatory grief . Such anticipation can make adjustment after a loss somewhat easier ( Ross Kessler , 2005 ) Anticipatory grief can include the same denial , anger , bargaining , depression , and acceptance experienced in loss one might experience after a death this can make adjustment after a loss somewhat easier , although a person may then go through the stages of loss again after the death . A death after a , painful illness may bring family members a sense of relief that the suffering is over or the exhausting process of caring for someone who is ill is over . At the same time , when a person has organized all their waking hours around the care of a dying loved one , upon their death the caregiver may experience feelings of emptiness and disorientation in addition to relief . Survivor guilt ( also called survivor syndrome ) is a mental condition that occurs when a person blames themselves for surviving a traumatic event when others did not . It may be found among survivors of combat , natural disasters , epidemics , among the friends and family of those who have died by suicide , and in situations such as among those whose colleagues are laid off . Disenfranchised Grief . Social support from others plays an important role in processes of grieving . However , grief that is not socially recognized is referred to as disenfranchised grief ( 1989 ) Examples of disenfranchised grief include death due to AIDS , the suicide of a loved one , deaths , abortions , the death of a pet , lover , or , and psychological losses , such as divorce or a partner developing disease . Due to the type of loss , there is no formal mourning practices or recognition by others that would comfort the grieving individual . Consequently , individuals experiencing disenfranchised grief may suffer symptoms due to the lack of social support ( 2010 ) Patterns of grief . It has been said that intense grief lasts about two years or less , but grief is felt throughout life . One loss triggers the feelings that surround another . People grieve with varied intensity throughout the remainder of their lives . It does not end . But it eventually becomes something that a person has learned to live with . As long as we experience 416 Death , Dying , Bereavement
loss , we experience grief . Over time , grief becomes interlaced with gratitude for the presence of the loved one in our lives and the cherished memories that remain . There are layers of grief . Initial denial , marked by shock and disbelief in the weeks following a loss may become an expectation that the loved one will walk in the door . And anger directed toward those who could not save our loved one life , may become resentment and bitterness that life did not turn out as we expected . There is no right way to grieve . A bereavement counselor expressed it well by saying that grief touches all of us on the shoulder from time to time throughout life . Grief and mixed emotions go hand in hand . A sense of relief is accompanied by regrets , and periods of reminiscing about our loved ones are interspersed with feeling haunted by them in death . Our outward expressions of loss are also sometimes contradictory . We want to move on but at the same time are saddened by going through a loved ones possessions and giving them away . We may no longer feel sexual arousal or we may want sex to feel connected and alive . We need others to befriend us but may get angry at their attempts to console us . These contradictions are normal and we need to allow ourselves and others to grieve in their own time and in their own ways . The , world is often the approach to grief in our modern society . We are asked to grieve privately , quickly , and to medicate our suffering . Employers grant us to days for bereavement , if our loss is that of an immediate family member . And such leaves are sometimes limited to no more than one per year . Yet grief takes much longer and the bereaved are seldom ready to perform well on the job . It becomes a clash between life having to continue , and the individual being unready for it to do so . One coping mechanism that can help smooth out this is called the fading affect bias . Based on a collection of similar , the fading affect bias suggests that negative events , such as the death of a loved one , tend to lose their emotional intensity at a faster rate than pleasant events ( Walker et , 2003 ) This is believed to help enhance pleasant experiences and avoid the negative emotions associated with unpleasant ones , thus helping the individual return to his or her normal daily routines following a loss . Factors that Affect Grief and Bereavement Grief reactions vary depending on whether a loss was anticipated or unexpected ( parents do not expect to lose their children ) and whether or not it occurred suddenly or after a long illness , and whether or not the survivor feels responsible for the death . Struggling with the question of responsibility is particularly felt by those who lose a loved one to suicide or overdose ( Gibbons et , 2018 ) These survivors may torment themselves with endless what ifs , even if they know cognitively that there was nothing more that could have been done . And family members may also hold one another responsible for Figure 1029 . Bereavement is the term to describe those who the The Same may be true for any Sudden or have lost a loved deals with this is unexpected death , making an added complication to Ways . Me Some threads Shared by many who experience this loss . the grieving process . Much of this laying of blame is an effort to think that we have some control over these losses the assumption being that if we do not repeat the same mistakes , we can control what happens in our life and prevent such losses in the future . While grief describes the response to loss , bereavement describes the state of being following the death of someone . Death , Dying , Bereavement 417
As we ve already learned in terms of attitudes toward death , individuals own lifespan developmental stage and cognitive level can their emotional and behavioral reactions to the death of someone they know . But what about the impact of the type of death or age of the deceased or relationship to the deceased upon bereavement ?
Death of a Child Death of a child can take the form of a loss in infancy such as miscarriage or stillbirth or neonatal death , Alternatively , death can take an older child , adolescent , or adult child . In most cases , parents the grief almost unbearably devastating , and the death of a child tends to hold greater risk for negative psychical and psychological outcomes than any other loss . This loss also begins a lifelong process One does not get over the death but instead must bear , assimilate , and live with it . Intervention and comforting support can make a big difference to the survival of a parent in this type of grief but , the risk for negative outcomes is great and may include family breakup , depression , or suicide . Feelings of guilt , whether legitimate or not , are pervasive , and the dependent nature of the relationship predisposes parents to feelings of responsibility , and hence to a variety of problems as they seek to cope with this great loss . Parents who suffer miscarriage or a regretful or coerced abortion may experience resentment towards others who experience successful pregnancies . And seeing other children who are the age that the child would have been had they lived can be painful and triggering . Suicide and Drug Overdoses Suicide rates are growing worldwide and over the last thirty years there has been international research to gather knowledge about who is and to out how to successfully intervene to curb this phenomenon . When a parent loses their child through suicide ( and suicide is the second leading cause of death during adolescence ) it is traumatic , sudden , and impacts all those who loved this child . Suicide leaves many unanswered questions and leaves most parents feeling hurt , angry , and deeply saddened by such a loss . Parents may feel they ca openly discuss their grief and feel their emotions because of how their child died and how the people around them may perceive the situation . Parents , family members and service providers have all the unique nature of bereavement following the loss of a child . They report that a wall of silence goes up around them that shapes how people interact with them . One of the best ways to grieve and move on from this type of loss is to a support group of other parents who have suffered a similar loss , and to ways to keep that child as an active part of their lives . It might be privately at but as parents move away from the silence they can move into a more proactive healing time . When adolescents or other family members die from a drug overdose , the grieving process can also be prolonged and complicated , with patterns similar to grieving someone who committed suicide . Survivors may experience feelings of guilt , anger , resentment , and helplessness and may not receive the sympathy and social support from others that they otherwise would . Survivors may worry about the persons reputation and the value placed on them by society because they committed suicide or died from an accidental overdose , and so may feel defensive , inhibited , or worried about sharing their experience of loss . Death of a Spouse The death of a spouse is usually a particularly powerful loss . A spouse often becomes part of the other in unique ways . Many widows and widowers describe losing half of themselves and losing their past selves as well . The days , months , and years after the loss of a spouse can echo with emptiness , and learning to live without them may be harder than the survivor expects . The grief experience is unique to each person . Sharing and building a life with another human being , then learning to live alone , can be an adjustment that is more complex than those providing support may realize . Depression and loneliness are very common . Feeling bitter and resentful are also normal feelings for the spouse who is left behind . Oftentimes , the may feel it necessary to seek professional help in dealing with their new life . After a long marriage , at older ages , the elderly may it a very transition to begin anew but at younger ages 418 Death , Dying , Bereavement
as well , the death of a spouse is unexpected and . A marriage relationship is often a profound anchor around which one life is organized , and the loss can completely disrupt the life of the survivor . Furthermore , most couples have a division of tasks or labor , the husband mows the yard , the wife pays the bills , etc . which , in addition to dealing with great grief and life changes , means added responsibilities for the bereaved . Immediately after the death of a spouse , there are tasks that must be completed . Planning and a funeral can be very if was not completed . Changes in insurance , bank accounts , claiming of life insurance , securing childcare are just some of the issues that can be intimidating to someone who is grieving . If there are children still at home , the survivor must take care of them , support them in their grieving processes , and still time to take care of themselves as well . Social isolation may also become an issue , as many groups composed of couples it to adjust to the new identity of the bereaved , and the bereaved themselves have great challenges in reconnecting with others . In fact , seeing other couples still together may be intensely painful . Widows in many cultures , for instance , wear black for the rest of their lives to signify the loss of their spouse and their ongoing grief . Only in more recent decades has this tradition been reduced to shorter periods of time . Death of a Parent When an adult child loses a parent in later adulthood , it is considered to be timely and so a normative life course event . This allows the adult children to feel a permitted level of grief . However , research shows that the death of a parent in an adult midlife is not experienced as a simple normative life event by any measure , but instead represents a major life transition that can trigger an evaluation of ones own life or mortality . Others may shut out friends and family in processing the loss of someone with whom they have had the longest relationship ( Marshall , 2004 ) And the grieving process can be especially challenging if the relationship was contentious or , and many issues were unresolved . Death of a Sibling The loss of a sibling can be a devastating life event . Despite this , sibling grief is often the most disenfranchised or overlooked of the four main forms of grief , especially with regard to adult siblings . Grieving siblings are often referred to as the forgotten mourners who are made to feel as if their grief is not as severe as their parents grief . However , the sibling relationship tends to be the longest relationship since it can last for the lifespan , and siblings who have been part of each others lives since birth , such as twins , help form and sustain each others identities . With the death of one sibling comes the loss of that part of the survivors identity because your identity is based on having them there . The sibling relationship is a unique one , as they share a special bond and a common history from birth , have a certain role and place in the family , often complement each other , and share genetic traits . Siblings who enjoy relationship participate in each others daily lives and special events , in each other , share joys , spend leisure time together ( whether they are children or adults ) and have a relationship that not only exists in the present but often looks toward a future together ( even into retirement ) Surviving siblings lose this companionship and a future with their deceased siblings ( White , 2006 ) Conclusion Death and dying , like every other developmental task across the lifespan , are biological , psychological , and social processes . All lifespan perspectives begin at conception and end at death , so textbooks cover from the cradle to the grave , or from sperm to worm or from womb to Many philosophers and spiritual guides suggest that you should Let death be your This phase has many meanings , but as Carlos explains , Death is the only wise advisor that we have . Whenever you feel , as you always do , that everything is going wrong and about to be annihilated , turn to your death and ask if that is so . Your death will tell you that you wrong that nothing really matters outside its touch . Your death will tell you , I have touched you Death helps us keep life in perspective , reminds us Death , Dying , Bereavement 419
what is really important , encourages us to treasure and make good use of the time we have remaining , and ties us to all of living things , past , present , and future . Supplemental Materials In this Ted Talk , David Williams explains the health outcomes of chronically experiencing racism . a One or more interactive elements has been excluded from this version of the text . You can view them online here ?
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