Chapter 15: Very Old Age (75 Until Death)

1. Chapter 15:Very Old Age(75 Until Death)

2. Very Old Age (75 Until Death) • Chapter Objectives • To identify very old age as a unique developmental period for those of unusual longevity; a stage with its own developmental tasks and psychosocial crisis • To describe some of the physical changes associated with aging, including changes in fitness, behavioral slowing, sensory changes, and vulnerability to illness, and the challenges these changes pose for continued psychosocial well‑being

3. Very Old Age (75 Until Death) • Chapter Objectives (cont.) • To develop the concept of an altered perspective on time and history that emerges among the long‑lived • To explore elements of the lifestyle structure for the very old, especially living arrangements and gender role behaviors

4. Very Old Age (75 Until Death) • Chapter Objectives (cont.) • To identify and describe the psychosocial crisis of immortality versus extinction, the central process of social support, the prime adaptive ego quality of confidence, and the core pathology of diffidence • To apply research and theory to concerns about meeting the needs of the frail elderly

5. Very Old Age (75 Until Death) • A New Psychosocial Stage: Very Old Age • Increasing numbers of people are living into old age • The 20th century was unique in history in that a large percentage of people lived well beyond their reproductive and childbearing years into later adulthood and very old age • The psychosocial stage of very old age occurs after one has exceeded the life expectancy for one’s birth cohort • Old-old – among the very old those who have suffered major physical or mental decrements

6. Very Old Age (75 Until Death) • A New Psychosocial Stage: Very Old Age (cont.) • Young-old – among the very old, those who remain healthy, vigorous and competent

7. Very Old Age (75 Until Death) • A New Psychosocial Stage: The Gender Gap Among the Very Old • Women outlive men in virtually all countries of the world, but the differences are accentuated in the developed countries • Because those currently at the stage of very old age are predominantly women, many of the social issues of aging – especially poverty, health care, the future of social security, and housing – are also viewed as “women’s issues”

8. Very Old Age (75 Until Death) • Coping with the Physical Changes of Aging: Fitness • The theme of physical changes of aging can be approached much like its counterpart in early adolescence • See a decline in fitness in late 20s and early 30s, but most people’s strength and capacity for moderate effort are about the same at age 70 as they were at age 40 • Older people are less resilient after a period of prolonged exertion

9. Very Old Age (75 Until Death) • Coping with the Physical Changes of Aging: Fitness (cont.) • Commitment to physical fitness is important for adults in order to face the later years in the best possible physical condition • In order to maintain optimal functioning and to retard the degenerative effects of aging, very old adults must continue to have frequent and regular opportunities for physical exercise

10. Very Old Age (75 Until Death) • Coping with the Physical Changes of Aging: Behavioral Slowing • One of the most commonly noted markers of aging is a gradual slowing in repose to stimuli – behavioral slowing • The speed of behavior is a composite outcome of the time it takes to perceive a stimulus, retrieve related information from memory, integrate it with other relevant stored information, reason as necessary about the required action, and then take action, whether that means simply pressing a button or performing a surgical procedure

11. Very Old Age (75 Until Death) • Coping with the Physical Changes of Aging: Behavioral Slowing (cont.) • Processing load – the more domains of information are called into play and the more work is necessary to select response categories • Biological, learned, and motivational factors have been identified to account for behavior l slowing • A common consequence of slowing is its impact on cognitive functioning

12. Very Old Age (75 Until Death) • Coping with the Physical Changes of Aging: Behavioral Slowing (cont.) • Since the slowing occurs gradually, most adults compensate for it by making their environments more convenient or by changing their lifestyles

13. Very Old Age (75 Until Death)

14. Very Old Age (75 Until Death) • Coping with the Physical Changes of Aging: Health, Illness, and Functional Independence • A mild but persistent decline in the immune system is observed as a correlate of aging. As a result, older adults are more susceptible to infections and take a longer time to heal • One of the most difficult health challenges of very old age is a group of disorders referred to as organic brain syndromes • In contrast to negative stereotypes about later life, the level of independent functioning among adults 80 years old and older is high

15. Very Old Age (75 Until Death) • Developing a Psychohistorical Perspective • Very old adults are more aware of alternatives; they can look deeply into both the past and the future and can recognize that opposing forces can exist side by side • Through a process of creative coping • Very old adults in each generation blend the salient events of their past histories with the demands on current reality – psychohistorical perspective

16. Very Old Age (75 Until Death) • Developing a Psychohistorical Perspective (cont.) • As society becomes more accustomed to having a significant group of very old adults functioning in the community, some scholars anticipate that a culture of aging will emerge in technological societies • A psychohistorical perspective contributes to the wisdom that the very old bring to their understanding of the meaning of life

17. Very Old Age (75 Until Death) • Traveling Uncharted Territory: Life Structures of the Very Old • Life begins in the 80s – one interpretation of this adage is that because there are so few norms for behavior and so few responsibilities when one reaches very old age, one can do whatever one wants • Changes in role relationships, especially role loss in later adulthood, present significant challenges to the preservation of a coherent self-concept

18. Very Old Age (75 Until Death) Figure 15.5 Living Arrangements for Older Adults by Age and Sex: 2003

19. Very Old Age (75 Until Death) • Traveling Uncharted Territory: Living Arrangements • Living Alone – increasing numbers of very old women are establishing a new single lifestyle in which they function as heads of households • In the United States, living arrangements for older women differ by race and ethnic group with Asian American women more likely to live with other family members than to live alone, in comparison to white women of similar economic and educational backgrounds

20. Very Old Age (75 Until Death) • Traveling Uncharted Territory: Living Arrangements (cont.) • The majority of very old men, about 70%, are married and live with their spouses

21. Very Old Age (75 Until Death) • Traveling Uncharted Territory: Interstate Migration and Housing Options • Although most older adults remain in their home communities, the trend toward interstate migration has increased since the mid-1960s • Differences in lifestyle, health, interest, ability to perform daily activities, marital status, and income enter into the very old person’s preference for housing arrangements

22. Very Old Age (75 Until Death) • Traveling Uncharted Territory: Interstate Migration and Housing Options (cont.) • The majority of older adults live in urban areas, and 31% of them live in inner-city neighborhoods

23. Very Old Age (75 Until Death) • Traveling Uncharted Territory: Institutional Care & Assisted Living • About 1.6 million adults over age 65 live in nursing homes • The likelihood of a person living in a nursing home increases when there is no family member who can help manage his or her daily living needs

24. Very Old Age (75 Until Death) • Traveling Uncharted Territory: Institutional Care & Assisted Living (cont.) • The fastest growing component of the Medicare program is community-based long health care which provides medical and social services to those who are chronically ill and are eligible for institutionalization but who nevertheless, live in the community

25. Very Old Age (75 Until Death) • Case Study: Mr. Z • Thought Questions • Imagine that you were having lunch with Mr. Z. What questions would you want to ask him? • What are the physical challenges of aging with which Mr. Z must cope? • Why might Mr. Z be living in a nursing home? • How could you describe Mr. Z’s psychohistorical perspective? • What are the unique, creative adaptations that characterize Mr. Z’s story? • In what sense is the nursing home optimizing Mr. Z.’s functioning?

26. Very Old Age (75 Until Death) • Traveling Uncharted Territory: Gender‑Role Definitions, Evaluating the Concept of Sex-Role Convergence • Sex-role Convergence – a transformation of sex-role orientation in which men and women become more androgynous and more similar in gender orientation during later life • Affliliative Values – the values placed on helping or pleasing others, reflected in the amount of time spent and the degree of satisfaction achieved in such actions

27. Very Old Age (75 Until Death) • Traveling Uncharted Territory: Gender‑Role Definitions, Evaluating the Concept of Sex-Role Convergence (cont.) • Instrumental Values – the values place on doing things that are challenging, reflected in the amount of time spent and the degree of satisfaction achieved in such actions

28. Very Old Age (75 Until Death) • Traveling Uncharted Territory: Gender‑Role Definitions, Romance & Sexuality and Ageism & Sexuality • Older men and women tend to be tied to many of the sex-role standards of their historical cohort • Today’s very old adults are also likely to be uncomfortable about sexuality and dating • Sexuality, intimacy, and romance remain important among older married couples • Older adults continue to have negative ageist social attitudes about sexual activity that may inhibit their sexual behavior

29. Very Old Age (75 Until Death) • The Psychosocial Crisis: Immortality Versus Extinction • Immortality is when a person transcends death through a sense of symbolic continuity • One may live on through one’s children, sensing a connection and attachment to the future through one’s life and the lives of one’s offspring • One may believe in an afterlife or in a spiritual plane of existence that extends beyond one’s biological life • One may achieve a sense of immortality through creative achievements and their impact on others

30. Very Old Age (75 Until Death) • The Psychosocial Crisis: Immortality Versus Extinction (cont.) • Immortality is when a person transcends death through a sense of symbolic continuity (cont.) • One may develop the notion of participation in the chain of nature • One may achieve a sense of immortality through experiential transcendence

31. Very Old Age (75 Until Death) • The Psychosocial Crisis: Immortality Versus Extinction (cont.) • Extinction - feared that the end of life is the end of all continuity • The possibility of ending one’s life with a sense of extinction is reflected in the public health concern about suicide among the elderly

32. Very Old Age (75 Until Death) • The Central Process: Social Support • The Benefits of Social Support – socioemotional support and instrumental support contribute to maintaining well-being and fostering the possibility of transcending the physical limitations that accompany aging • The Dynamics of Social Support – most older adults continue to see themselves as involved in a reciprocal, supportive relationship with their friends • The Social Support Network – is usually family members in later life

33. Very Old Age (75 Until Death) • The Prime Adaptive Ego Quality and the Core Pathology • Confidence – a conscious trust in oneself and in the meaningfulness of life • Diffidence – the inability to act, due to overwhelming self-doubt

34. Very Old Age (75 Until Death) Figure 15.6 Levels of Dependency and Types of Care

35. Very Old Age (75 Until Death) • Applied Topic: Meeting the Needs of the Frail Elderly • Defining Frailty • Difficulties in the activities of daily living (ADLs) or difficulties in managing instrumental activities of daily living (IADLs) • Supporting Optimal Functioning • Is what a person is capable of doing when he or she is motivated and well prepared

36. Very Old Age (75 Until Death) • Applied Topic: Meeting the Needs of the Frail Elderly (cont.) • The Role of the Community • Interventions at the community level may be necessary to meet the safety, health, and social needs of some older adults who want to remain in the community • The Role of Creative Action • Older adults can alter the structure of their environment to enhance their sense of well-being