Later Adulthood – PIES and Human Development

1. Later Adulthood – PIES and Human Development Lesson objective – to learn about the physical, intellectual, emotional and social factors and there effects on adults over the age of 65 years

2. Physical changes • Starter activity - List as many physical changes that you have observed in people over the age of 65 years • Information to help you on page 11 • Think about: • Colouring • Stance • Size • Skin tone • Posture • Health and well-being • How have their senses change? • Lesson objective – to learn about the physical, intellectual, emotional and social factors and there effects on adults over the age of 65 years

3. AfL • Common age-related physical changes include hearing impairment, weakening vision, and the increasing probability of arthritis, hypertension, heart disease, diabetes, and osteoporosis. The speed with which information is encoded, stored, and received may decrease as we age, and older Americans may experience memory loss. • Hearing impairment among older adults is often moderate or mild, yet it is widespread; 48 percent of men and 37 percent of women over age 75 experience hearing difficulties. • Visual changes among aging adults include problems with reading speed, seeing in dim light, reading small print, and locating objects. • The amount of time it takes to respond to features in the environment once they are detected is typically slower among older adults. • The proportion of older adults needing assistance with everyday activities increases with age. Nine percent of those between ages 65 and 69 need personal assistance, while up to 50 percent of older Americans over 85 need assistance with everyday activities. • The top five causes of death among older adults are heart disease, cancer, cerebrovascular disease (relating to the blood vessels that supply the brain), pneumonia and flu, and chronic obstructive pulmonary disease. In spite of a decline in physical health, two-thirds of older adults who are not living in institutions (such as nursing homes) report their health to be good, very good, or excellent compared with others their age. What's important to remember about people over age 65 is that while many begin to experience some physical limitations, they learn to live with them and lead happy and productive lives.

4. Later adulthood 65+ • In their sixties and early seventies, many adults lead varied and interesting lives. Lon-distance travel, often to see sibling and other relatives, and new leisure pursuits such as painting and writing are common. The opportunities for older people to meet new friends can be extensive when their health is good and they have sufficient money. There are, however, many older people who find it difficult to make ends meet and tend to withdraw from socialising, due to feelings of shame. In addition, there are those who suffer from ill-health and impairments, which result in their social isolation. A network of family and friends can provide vital and practical support, physically, socially and emotionally. Key concept in later adulthood – family is viewed as a social group made up of people connected to each other by blood or marriage. Families in Britain usually consist of adults acting as parents or guardians to children, grandparents are often an extension to this.

5. Emotional positives and negatives • Dementia, the irreversible deterioration of intellectual ability accompanied by emotional disturbance, afflicts between 5 and 7 percent of adults over age 65 and 30 percent of those over age 85. Unlike milder forms of mental decline with normal aging, dementia may lead to significant impairment in social functioning. People with dementia often suffer from depression, anxiety, and paranoia. • Six percent of older adults suffer from anxiety disorders, and the most common anxiety diagnosis is generalized anxiety disorder, in which a person experiences dread, apprehension, and tension for a period of at least 6 months. • The highest suicide rate of any age group is in older adults, primarily older Caucasian men who live alone. • The incidence of sexual dysfunction increases with age for both men and women. Sleep problems increase with age, and about one-half of those over age 80 complain of sleep difficulty. • Ten to 15 percent of older adults exhibit hypochondriasis, the persistent belief that one has a medical disorder despite the lack of medical findings. • Prevalence of alcohol abuse and substance dependence among those age 65 and over is 2 to 5 percent for men and 1 percent for women. • Drug abuse among older adults typically takes the form of prescription medication abuse, and older adults take 25 percent of the medication taken in the United States, which underscores that drug abuse among aging adults is often a result of having too many medications prescribed for them. • Depression is a negative emotion frequently characterized by sadness, feelings of helplessness, and a sense of loss. Those with depression are likely to have an abrupt onset of symptoms, a history of psychiatric problems, decreased motivation, and a tendency to complain about their memory problems. However, depression among noninstitutionalized older adults is less prevalent than depression in younger adults. • Behavior disorders in those over age 65 can take the form of physical aggression, motor overactivity (wandering), and disruptive verbal outbursts. Common causes of behavior disorders include delirium, depression, dementia, and psychosis. • Alzheimer's Disease is a progressive disease that leaves a victim unable to form new memories and is marked by the loss of other mental functions. One of the primary symptoms of Alzheimer's Disease is the inability to recall newly learned information, such as a change of address, and disorientation. The onset of Alzheimer's is often gradual, occurring over a period of 8 to 20 years. At first, victims suffer memory loss and often get lost--even in their own homes. Eventually, they may fail to recognize other people, including family; show childish emotions; and lose the ability to dress and clean themselves • Lesson objective – to learn about the physical, intellectual, emotional and social factors and there effects on adults over the age of 65 years

6. Ways of overcoming physical and emotional aggression – positive reinforcement and time-out • In a child's case - a lot of irritating behaviour – sibling rivalry and bickering, for example – is the manifestation of the lack of certain skills: the ability to share, postpone gratification, wait rather than interrupt. “If you work on teaching those skills, you don’t have to put as much emphasis on punishment,” Positive reinforcement is normally used by instructors who are teaching participants new skills. As the name implies, positive reinforcement is "good" and reinforces "good" (or positive) behaviour. Therapy and instruction in positive reinforcement will help older people if the instructions are continually reinforced and should be part of the teaching-learning process to ensure correct behaviour. Instructors need to use it on a frequent and regular basis early in the process to help the students/client retain what they have learned. Then, they should use reinforcement only to maintain consistent, positive behaviour. • Lesson objective – to learn about the physical, intellectual, emotional and social factors and there effects on adults over the age of 65 years

7. Lesson objective – to learn about the physical, intellectual, emotional and social factors and there effects on adults over the age of 65 years

8. Intellectual further development • Dementia, the irreversible deterioration of intellectual ability accompanied by emotional disturbance can affect some. • Given this, however, the human brain is able to continually adapt and rewire itself. Even in old age, it can grow new neurons. Severe mental decline is usually caused by disease, whereas most age-related losses in memory or motor skills simply result from inactivity and a lack of mental exercise and stimulation. In other words, use it or lose it. • In addition, it is a myth: “Many assume that memory abilities will decline in older adulthood to a degree that will significantly affect day-to-day functioning.” Rather, about 85% of adults age 65 and older do not show significant declines in memory ability and are able to live independently. • Lesson objective – to learn about the physical, intellectual, emotional and social factors and there effects on adults over the age of 65 years

9. AfL • The speed with which information is encoded, stored, and received may decrease as we age, and older people in the UK may experience memory loss. • Because it may take older adults more time to encode, store, and retrieve information, the rate at which new information is learned can be slower among aging adults, and older adults often have a greater need for repetition of new information. Although it may take older adults longer to input and retrieve new information, daily occupational and social functioning among those over age 65 is not impaired. • Long-term memory shows substantial changes with age, while short-term memory shows less age-related decline. • Most aspects of language ability remain strong, yet word-finding ability declines with age. Three-dimensional drawing similarly declines with age. • Wisdom and creativity often continue to the very end of life. • Overall prevalence of mental disorders in older adults is less than in any other age group, and general life satisfaction among older UK residence is as good as, if not better, than any other age group. • Lesson objective – to learn about the physical, intellectual, emotional and social factors and there effects on adults over the age of 65 years

10. Social positive and negative development • Lesson objective – to learn about the physical, intellectual, emotional and social factors and there effects on adults over the age of 65 years

11. In later life people may find that they mentally withdraw from cognitive activities and future develop0ment in this area. Therefore, it is important that treatment is given to older people to first, understand just how physically impaired they are, as often older people will feel that they are more physically incapable than is evident. Secondly, it is then the job of the occupational therapist to monitor the client’s interests and creatively put in place therapy and activities that will simulate and engage the client in a social and reconnecting way.

12. Apply some knowledge - Tasks • You are asked to read the case studies and plan out a range of activities that will reengage your client. • Eco-integrity • Social selectivity theory • Activity theory • Disengagement theory • Continuity theory • Secondly – you are asked to analyse how many of these theories and concepts you have used to help come up with an activity plan that results in a positive self-concept for your elderly client. • Lesson objective – to learn about the physical, intellectual, emotional and social factors and there effects on adults over the age of 65 years

13. Socio-emotionaltheory In later life people tend to maintain very close relationships with family and very close partners declines minimally • Lesson objective – to learn about the physical, intellectual, emotional and social factors and there effects on adults over the age of 65 years

14. Lesson objective – to learn about the physical, intellectual, emotional and social factors and there effects on adults over the age of 65 years AfL

15. Key words and literacy - Ego-integrity - Self-concept Independence – Dementia – Sedentary - Acceptance Resilience - Reminiscence Multifaceted Despair Stability – Psychological - Disengagement - activity theory - • Lesson objective – to learn about the physical, intellectual, emotional and social factors and there effects on adults over the age of 65 years

17. Lesson objective – to learn about the physical, intellectual, emotional and social factors and there effects on adults over the age of 65 years

18. Deciding to retire and the reasons why you want to retire • Lesson objective – to learn about the physical, intellectual, emotional and social factors and there effects on adults over the age of 65 years

19. We all know that people age at different rates, according to their genes, their health or their environment; but many people in their 60s and 70s are no more vulnerable than the rest of the population, all of whom, after all, are pretty vulnerable: they may be robbed, mugged, run over by a bus, choked by the field of rape the local farmer has sown next to their house, fall victim to swine flu, whatever their age. In fact, the very concept of vulnerability is suspect, if applied to the old as a class defined solely by date of birth. It should be reserved for those who are manifestly at risk, those whose bones, or grasp of reality, have become fragile, or who have become blind, or unable to walk. These people are vulnerable in the sense that, like children, they need to be protected from accidents, and they can no longer live alone. These and these alone should count as old; and so when to deem yourself old at last must be a personal decision (though I admit that many people fight so hard against making this decision that they have already become a source of anxiety to their children or neighbours, who may therefore seek to take the decision vicariously). In any case, before the decision has been taken, to assume that we all need special protection is an insult. I believe that I am as capable as any other householder of detecting a bogus offer from a cowboy builder, or a fraudulent telephone call offering me the chance to win millions of pounds. That is a matter of education and common sense, not of age. Nor does the fact of living alone itself render me vulnerable, as people often suppose. It's often inconvenient, if I can't open a packaged-up toothbrush, or hang a picture without destroying the whole wall. But I have never been able to do these things, it's only that I once had someone to do them for me, like doing the income tax returns. I'm certain that I'm not the only old person who does not want to be pitied or patronised, but left to get on with life on my own, until that becomes impossible. Then I'll be ready to join the ranks of the looked-after, and treated like a child. It will be the worst thing in the world. So what does this dread of succumbing to the designation "vulnerable" tell me about personal identity? Am I the same as I always was? If I am honest the depressing answer is probably: "Yes, only worse." I have always been happy by myself, and now, with increasing deafness, I am more so. I have always been bad at putting up with items of popular culture like easy-listening music, convenience food, television or radio comedy (except Yes, Minister) and what the BBC calls "a light-hearted look" at this or that. Now I can bear them even less. It is the thought that one day I may have to live in a world where there is nothing but these items that appals me, as much as the physical decrepitude I shall by then be suffering. Looking after the old ought essentially to be a matter of trying to understand what they like and hate, what they have always liked and hated, and of trying to protect them, not against their own supposed mental frailty and dependence, but against a life bereft of any of the pleasures they value. Our present record falls short of this by many miles.

20. The nation needs to invest much more in the ability of older people to make best use of their brains, according to anew report from a government think-tank. Foresight, the government unit charged with thinking strategically for the future, said it was vital to exploit the "mental capital" of mature adults. However, little money has gone into anything other than leisure classes, with scant evidence of how useful they are. Addressing dementia should be a priority for government, declares Foresight's latest report, distilled from more than 100 expert submissions. "Treating dementia costs the UK £17bn a year – this is set to rise to £50 billion a year within 30 years," it says. By 2071 the numbers of people aged over 80 are expected to more than treble to 9.5 million, while there could be twice as many over 65s (21 million) as now. Action is needed now to protect their prosperity and physical and psychological health, according to the report. An appetite for lifelong learning needs to be developed among the very young. Foresight, which is part of the government office for science, does not make government policy but aims to inform it. John Denham, secretary of state for innovation, universities and skills, who is the report's ministerial sponsor, launched a consultation into informal adult learning in January and will in due course publish a policy document. Foresight's report coins the phrase 'mental capital', which refers to person's cognitive and emotional resources, how flexible and efficient they are at learning, and their social skills and resilience in the face of stress. The thinktank says: "In a society where the mental capital of older people is seriously undervalued, it is unsurprising that there has been little investment to date in providing other than recreational classes for older students." "The mental capital of older people is a massive and under-utilised resource. Unlocking this could benefit the wellbeing and prosperity of older people and society as a whole." Continuing education is increasingly important, Foresight says. For one thing, work is changing rapidly. People will need to be more flexible and prepared to re-train. "The 'use it or lose it' principle in which an individual's mental capital is nurtured in order to protect against cognitive decline will also be important," the thinktank notes. But at present, despite increasing interest in the principle of lifelong learning the great majority of people entering older age will have had little education since school many decades earlier. Training in information technology could be one highly effective means of promoting self-education among older adults as well as bringing them new opportunities for business or voluntary work. The links between education and training and economic reward are clear though complex, comments the report, which draws on an extensive two-year study involving more than 400 international experts in subjects ranging from neuroscience to economics. Other wider benefits are not so easily measured but are nonetheless of important social value. Many of these are about preventing such negative outcomes as social exclusion, community breakdown and mental health problems. Evidence from a number of countries shows that education is strongly linked to people's health and their behaviour to safeguard their health. It can cause more people to take preventative care, which increases health care costs in the short term but may lead to long-run saving. Education appears to protect against depression. Young men and women with at least one O-level were reckoned to reduce their risk of adult depression by 6 percentage points. But its impact on general happiness or wellbeing has been less well substantiated. Welcoming the report, Denham said: "Future prosperity and social justice in the UK will be strengthened by drawing on the mental capital and talents of its citizens and I am pleased this report recognises that the government is already on the right track in many areas. "A range of departments and organisations across government and more widely are committed to taking forward the project's findings and I look forward to overseeing the progress of that over the coming year."

21. Conclusion to PIES • Armed with the facts about the myths and realities surrounding aging, society can better prepare itself to assist its older population, as can individual families. Regular mood and memory checkups should be encouraged for all older adults, just as we now encourage regular physicals. What's important to remember is that depression and social isolation are not normal for older UK residence -living happily and productively is the norm for today's older adults. Continuity theory, continued engagement and activity theory all help us understand more the value and important role that the over 65’s play in our society. • Lesson objective – to learn about the physical, intellectual, emotional and social factors and there effects on adults over the age of 65 years

22. A truly enduring love: Britain's longest-married couple (77 years) tell their enchanting story with photos from their album • Last week it was revealed that Ralph and Phyllis Tarrant are the longest-married couple in Britain. In an age where few marriages endure, their 77 years together are inspiring. • So what 's their secret for a long-lasting union? Here, LAURA TOPHAM tells the story of Ralph, 107, and Phyllis,101,through their own enchanting words and pictures. • 1925 WE'RE JUST GOOD FRIENDS • Phyllis was 16 when she met Ralph, a 22-year-old steelworker. For years they were simply friends in a group of youngsters who congregated on a Sheffield street corner each evening to go walking or cycling. • 'There was no thought of sex in those days,' says Ralph. • Romance developed when they bumped into one another alone one evening. Ralph says: 'We started talking, then realised we'd been walking for hours  -Phyllis had to fly to get home by 10pm.'  • Says Dorie: 'Folk don't put up with things these days. The least little problem and they're up and off, aren't they'? • 2010 STILL SO DEVOTED • So, 85 years after the couple met, what is their secret to such a long and happy marriage? 'I always enjoy myself as much as I can,' says Ralph, 'Whatever the object or opposition. I like life and I've always looked after myself.'  • Phyllis is less sure: 'I have no idea,' she says, 'but it's certainly a great achievement.' Ralph credits their longevity to being healthy and active and having lots of cheese and onion sandwiches. • Their 74-year-old son, also called Frank, said the main secret of his parents' wedded bliss was simply being happy with each other. • "They've enjoyed themselves, enjoyed their lives very much but they've been always very content with their lot," he said. http://www.dailymail.co.uk/femail/article-1297273/A-truly-enduring-love-Britains-longest-married-couple-77-years-tell-enchanting-story-photos-album.html http://www.focusonthefamily.com/

23. Secure your knowledge - Examination style questions – please answer in full • Lesson objective – to learn about the physical, intellectual, emotional and social factors and there effects on adults over the age of 65 years

24. Examination style questions – please answer in full

25. Examination style questions – please answer in full