Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
233 Cards in this Set
- Front
- Back
|
Outer layer of eye
|
sclera and cornea
|
|
|
sclera
|
purpose is to let light through and protect eye. Dense, white, opaque outer layer that is continuous with the cornea (whites of the eye)
|
|
|
Cornea
|
transparent avascular (without blood vessels) surface of the eyeball through which light rays enter the eye.
Primary function is to refract light onto the focal point on the retina Acts as focuser most exposed part of eye, most vulnerable to damage |
|
|
Middle eye
|
uveal tract, lens, iris, vitreous humor
|
|
|
Uveal Tract
|
highly vascular middle layer of the eye that provides the blood supply and nutrition to the other 2 portions of the eye
|
|
|
Lens
|
the transparent, flexible, avascular crystalline lens helps to focus light rays so they converge, or come to a focal point, precisely on the part of the retinal surface producing the sharpest vision at different viewing distances.
Focuses light on the retina by relaxing and contracting muscles. Changes the shape of the lens, making it thickers or thinner (accommodation). continuously changing |
|
|
Iris
|
Thin, pigmented, circular, muscular sphincter suspended between the cornea and the lens. Opening at center, is the pupil.
Contrast sensitivity: ability to discriminate between object and its background. have to have intact and working well to tell different between subtle color changes and shading. as start to lose this contrast, you start bumping into things. seat of chair should be different color than carpet |
|
|
Vitreous Humor
|
clear, avascular gelatin making up 2/3 of the volume and weight of the eye.
keep shape of eye and help refract from front to back of eye. Median lets light shine through. |
|
|
Inner most layer of eye includes
|
retina, cones, rods, macula
|
|
|
Retina
|
photosensitive tissue at back of eye
has sensor cells Semitransparent-not going to impact how we're seeing at all. since sensor cells are attached to it, they have problem with desensed retinas. continous with optic nerve has blind spot where no sensor cells are where optic nerve comes in |
|
|
cones
|
color sensitive
visual acuity color vision in bright light(day and color vision) tell between light and dark colors important to tell where something begins and ends densely clustered at the back of the retina we have 6 million |
|
|
Rods
|
peripheral vision, esp. in dim room (night vision)
black and white vision located predominately along sides of retina 125 million |
|
|
Macula
|
Oval, yellowish spot to the side of the optic disc
carries most amt. of cones contains teh fovea largely compsed of cones the area of sharpest vision (most amt. of cones) |
|
|
Age related changes to lens
|
thickens and becomes less elastic, limiting ability to change shape
changes interfere with ability to shift focus from distant to near objects (cant focus/constrict, or doesn't do as quickly as when younger) presbyopia yellows and becomes opaque--cooler colors more hard to see pin-point opacities-floaters better to distinguish btwn bright colors |
|
|
presbyopia
|
age related changes to ability to focus on close things. Farsightedness increases with age and near vision becomes more difficult
|
|
|
Age related changes to Iris
|
eye color fades
looks milky |
|
|
Age related changes to Vitreous Humor
|
Becomes less transparent
Allows light to scatter instead of highly focused--absorb light or change path that it's going. instead of just being medium for light it starts affecting the light Floaters-cells from medium lining of eye, see these. can inhibit to focus clearly High Visual threshold |
|
|
Floaters
|
brief flashes of light and/or of opacities in eyes. loose cells and tissues casting shadows on retina
|
|
|
Higher Visual threshold
|
need higher/more color or light present to see. Highest amount of falls at night. Lot of blindness when light shining in their eyes, because it takes longer to adjust diamter to let light in.
|
|
|
Age related changes in pupil
|
pupil diameter decreases
direct pupil reaction to light tends to decrease resulting in much less light reaching the retina Slows down as get older bc rods and cones are not as many, or neurologic process just takes longer |
|
|
Sensitivity to Glare
|
Light scatters as a result of changes to the cornea, lens and vitreous humor
Loss of peripheral vision - difficulty seeing thigns coming rom the side. Start to lose peripheral vision every year that you age. Can also contribute to loss of musculature of eye. |
|
|
Cataracts
|
opacities on the lens as a result of protein build-up
Fair-skinned blue eyes, more likely Most common eye disorder related to aging! May see halos around objects, eperience blurred vision, decreased light and color perception Long term alcoholics have higher risk as well as high blood pressure, diabetes, excessive exposure to sunlight and family history have higher correlation with depression may be concerned about surgery with diabetes |
|
|
Glaucoma
|
Increased pressure in eye and leads to degeneration of the optic nerve and blindness if not treated. (intraocular fluid doesn't drain as quicly as more is formed)
Either eye is making too much vitreous humor. process making it is on all the time, filling faster than eye can absorb. Adding pressure onto the sensory cells because of that additional amt. of vitreous humor. older women more at risk can result in loss of peripheral vision occurs slowly over time open angle/closed angle |
|
|
Secondary Glaucoma
|
pathological process blocks the outflow channels through which aqueous humor drains from eye. Treatment is most likely want to remove obsturction or tumor
|
|
|
Primary Glaucoma: Angle closure
|
10% of cases. Rare, shallow anterior chamber of eye, lens grows and thickens with age. Reducing size of chamber and blocking out flow of fluid.
|
|
|
Primary Glaucoma: Open Angle
|
90% of cases. Out flow gradually becomes imparied as degenerative changes occur in eye. Not curable. controlled by topical and systematic meds. to increase outflow
|
|
|
approx how many americans have Glaucoma
|
3 million
|
|
|
how many of the Amercians that have Glaucoma or blind because of it
|
120,000
|
|
|
Causes of Glaucoma
|
Inflammation, Diabetes, Tumor
|
|
|
Treatment of Glaucoma
|
can often try to slow production of vitreous humor to slow progression or may either have surgery to remove tumor or figure out why it's producing too much.
|
|
|
Ocular Diseases include
|
Diabetic Retinopathy and Macular Degeneration
|
|
|
Diabetic Retinopaty
|
Decreased blood flow
Leading cause to adult blidness (associated with diabetes) Nearly every diabetic has some form of this after the 20 year mark of having Diabetes Small retinal blood vessels develop small aneurysms which cause hemorrhages (blood clots) - block light from reaching visual receptors or may damage receptors. Macula is usually affected first, then other structures |
|
|
Diabetic retinopathy symptoms
|
early symptoms: cloudy vision- causing damage to structural integrity of retina and seeing shower spots
|
|
|
Diabetic retionopathy treatment
|
laser photocoagulation- laser fixing of blood vessels regulary. may send home self screeners and if they are noticing a change thye must go in right away.
|
|
|
Macular Degeneration
|
Severe loss of central vision
Two types: Dry and Wet the need for increasingly bright light when reading or doing close work. Have probles with mobility at night.. risk for falling. put bright strip by stairs! printed words appear disorted/blurry. Straight lines will appear bent or curved, cannot be corrected with glasses. colors washed out and dull a gradual haziness of your overall vision- spread from inside to outside Difficulty seeing when moving from a bright room to a dimly lit room. (don't have as much sensitivity in macula) |
|
|
Macular Degeneration type 1
|
Dry= no bleeding. no treatment. Breakdown of macula, or loss of sensory cells in macula. the cones are dying for some reason. Slow progression. (90% of cases)
|
|
|
Macular Degeneration type 2
|
wet = bleeding. not only are cones damaged and dying, but there is bleeding attached. quicker progression when have bleeding present. when person's vision gets worse very quickly, go in and get blood clots removed! (10-15% of cases- severe)
|
|
|
Causes of Macular Degeneration
|
1. Genetics
2. smoking 3. cardiovascualar disease 4. long term sunlight exposure |
|
|
Signs Macular Degeneration is worsening
|
lack of sensory cells make it looks darker in the middle or waviness
|
|
|
previous diseases are the cause of ...
|
98% of vision loss in those over age 70
|
|
|
Low Vision
|
corrected visual acuity between 20/70 and 20/200. people that need big print, big glasses and hold close to face.
diagnosed by exclusion can be central (reduced visual acuity) or peripheral (reduced visual field) |
|
|
Peripheral vision loss may result in more difficulty with...
|
orientation and mobility (more insecure not knowing where going)
|
|
|
Emotional and social implications of vision loss
|
can't recognize your family well. better when you are one on one with a person than in a crowd. May be more anxious
|
|
|
Issues that affect a person's ability and style of learning
|
Learner's interest in learning
Readiness motivation self esteem attitudes culture presence of illness loss or grief the teacher's knowledge of special teaching techniques |
|
|
Intelligence
|
The person's ability to learn, reason and understand
|
|
|
Intelligence levels off around what age
|
50-60s
|
|
|
Intelligence decreases around what age?
|
70s & 80s
|
|
|
Compensation decrease of intelligence by
|
changing the pace of the teaching
using memory aids elaboration well planned approach |
|
|
Crystallized Intelligence
|
learning and acculturaiton required by individuals over a lifetime than formal and informal learning experiences
|
|
|
Fluid intelligence
|
reflects neurological and physiological functioning, not significantly affected by education or accultruation (info. processing, reasoning, abstraction)
|
|
|
Reaction Time
|
More time is required to take in and process information
Responding to multiple stimuli or demanding stimuli requires even more time If is difficult or complex it should be taught in steps Giving the person time to master each step before moving on |
|
|
Meaningfulness of the material
|
why is it meaningful? Why are you here? Deal with conversational manners, help use hearing aids. Let them know why they are there.
|
|
|
Speed it is presented at
|
slow it down, don't use high rate
|
|
|
Cautiousness of the learner
|
are they the reluctant learner? are they here cause they ahve to be? one foot in the room or mentally not in the room? So be a cheerleader for them :)
|
|
|
The learner's health status
|
is SLP session rafter after they ahve a blood transfusion or chemo? Either be aware of problems going on or make suggestions that they don't see them on that day and maybe another day.
|
|
|
Anxiety state of the individual
|
Not actually listening to what SLP has to say...very anxious. So worried they were never going to be able to use their hearing aids. May have to assure that everything is ok.
|
|
|
Sensory memory
|
however you're taking it in...with whatever senses?
An exact copy is retained for 1 to 2 seconds -- must start to actively work on it. Attention to information transfers it to short term memory- have to start doing rehearsal to get it from short to long term memory |
|
|
Short term memory/primary memory
|
shows older adults need more reheearsal to go from short to long term memory. Need active work.
Attention and retention of info is possible for 30sec-30min. If attended to or rehearsed to goes to long term memory Extra repetition, taking things home, bring up something mulitple times in a therapy session. Use multiple modalites to learn. |
|
|
Long term memory
|
where it's stored for the long haul. filing cabinets. as get older, more condenses and may be harder to find it.
Where info is stored for an extended or limited amt. of time. |
|
|
Most change occurs in the short term memory
|
Show lessened ability to move new info into long term memory
-must compensate for memory loss and inform them of memory loss. -Also have greater difficulty in ability to retrieve the info - filing cabinet becomes more disorganized. Getting it mixed with other info. |
|
|
Memory training programs
|
use imagery, cetegorization, analysis of written material and repetitive practice - use another modality. Time something else in. Categorization - talk about ways not going to choke today, or use their tongue or hear better, so that they are able to tore better in their filing cabinet.
|
|
|
Attention
|
Ability to concentrate despite distraction - ignore all other conversations going on around you.
|
|
|
Sustained attention
|
Being able to maintain mental alertness - maintain ability to focus
Remains intacts as long as you remove fatigue factors- if they fell asleep at 5 am for an 8 am appt, not going to do as well. |
|
|
Selective Attention
|
a person can selectively pick out one message from a mixture of messages occuring simultaneously
Declines with age |
|
|
Divided Attention
|
A state in which the focus of attention is spread across more than one object or event - attention focused over multiple thigns (lesson plan while riding a bike is more difficult
Declines with age |
|
|
More attention info
|
teaching sessions should be kept short
Presentations should consider one topic at a time and extraneous data removed - not topic jumping or trying to interweave a bunch of topics until maybe the end. Learners should be encouraged to use past experience to learn new things - past experiences can be used to tie something old together with something new. Make sure you ahve the learner's attention - if patient is not with you, you have to figure out why. Is the chair uncomfortable? |
|
|
Vision- ways to teach older adults with visual impairments
|
-Identify yourself to get their attention- reinforce who you are
-Racing the learners when speaking- good eye to eye contact reinforcer -Using non-verbal cues and aids along with verbal messages - don't want to rely on just their vision. -Make sure vision correction devices are cleaned and being used correctly - make sure they use their classes or magnifying glass if needed - Use large distinct print -present one concept at a time Do not stand in front of a mirror or windwo to avoid glare - Do not have learner face light source -Make sure the learner is sitting near the speaker/source -Use multiple sensory approaches when teaching...but do not over stimualte bc it may cause a decrease in the desired out come and stress on the behalf of the learner-not going to be able to use their vision well. |
|
|
Speech and Language
|
Use primary language of the learner (no medical jargon, or harder to make translations)
-Use the active voice, present tense and personal pronouns-want to relate it to hear and now -Avoid using words with 3 or more syllables and restricting sentences to 10 words or less depending on audience Encourage verbal responses to assess the learner's vocab and knowledge of the vocab Organize the content of your message and organize the info from sinmple to complex- not jumping thru the info. build off things. Frequently summarize what has been presented Provide opportunities for questions to be asked Pausing from time to time to allow the learners to focus and undersatnd info. Allowing the learners to set the pace of the learning session -Using well organized materials matching the reading level of the learners, including those with low literacy - eg. balance test: had to change techniques Use positive reinforcement and encouragement Reinforce spoken with written materials |
|
|
the learner may be feelings
|
Fear of failure
Catiousness Anxiety over class participation or test taking - may have fear of failure in front of grandchildren. let them know it's ok. |
|
|
make sure create not threatening environment by
|
avoid using tests
Reinforce and reassure generously (like topic sentence and body paragraph is reinforcing) To motivate the pt.the material needs to be meaningful and relevant |
|
|
Depression
|
slows thinking and concentration
Causing inattention and impaired learning ability When teaching it needs to be well designed and presented in a pleasant environment Remind them that they are learning the material to better their lives |
|
|
Learning Envrionment: one on one instruction
|
learner and instructor
maintain eye contact speak clearly show sincere personal interest positive attitude towards the learner should use written or recorded materail to supplement when possible. also encourage family members to participate - generalize so that the family members can help put hearing aid in for them for ex. |
|
|
Group instruction
|
highly supportive and secure setting - don't feel alon. but make sure that one is not taking up entire time.
Some may feel threatend if they do not want to share in public. |
|
|
Electronic learning
|
very helpful.
CDs, DVDs, computers allows learner to go at their own pace blended learning...eLearning and face to face instruction may be helpful for reaching those who cannon get to your clinic or return multiple times Comfortable, have attention, be appropriate for learning style, and be genuine and engage with person so that they will want to engage back with you. |
|
|
Limitations of Research
|
thereis no structure to give guidelines around the aspects of aging
American society feels that aging is a negative process studies do not accept that there can be positive changes and growth in aging studies do not take in considerations the culture changes. |
|
|
Zest
|
spirit, desired, engaging factor, active
|
|
|
Resolution and attitude
|
no matter how satisfying life is, things are goign to come up. Can you overcome it and deal with situation?
|
|
|
Congruence between desired and achieved goals
|
if you don't achieve goals you may not be happy with who you are
|
|
|
positive self-concept
|
seeing in positive light, being okay with who you are. Woulda, coulda, shoulda.
|
|
|
Mood Tone
|
positive vs. negative affects life satisfaction index
|
|
|
Successful Aging:
|
takes pleasure from the round of activities that constitutes their everyday lives - if you have the money to not go to work then don't!
Regards his life as meaningful and accepts resolutely that which life has been- put past in past Feels he has succeeded in achieving his major goals Holds a positive self image of himself Maintains a happy and optimistic attitudes and mood |
|
|
6 criterion for successful aging
|
acceptance
positive relations with others autonomy environmental mastery purpose of life personal growth |
|
|
acceptance
|
feel good about themselves
|
|
|
positive relations with others
|
disclude people who have negative effects on you
|
|
|
autonomy
|
independent, able to function on own.
more autonomous you are, the better you feel about yourself encourage them to do the things they can do as much as they can |
|
|
environmental mastery
|
manipulate your environment to fit your needs
getting around your house, neighborhood, being able to get out of bed, toilet, have purpose |
|
|
purpose in lfie
|
goals, intentions, sense of direction, why get up? get a pet!
|
|
|
personal growth
|
continues to expand their personal herizons - gardening, social group
|
|
|
3 components of successful aging
|
avoiding disease
maintaining high cognitive and physical function engagement in life |
|
|
Recommended for successful aging:
|
preventative health regiment to reduce effects of secondary aging
doing puzzles, playing cards and talking to others remaining physically active - moving around and doing things (mall walking) continuing with behavior that is productive and maintains relationships- continue with who've you been |
|
|
predictors of successful aging
|
healtheir the better (if you're in denial you won't get better)
Socioeconomic Status (more money the better, should feel secure and stress impacts well being, you also need to feel you are more well off than those around you) Age (advancing age not as significant as other factors) Work, Retirement and Leisure (Continued employment is good only if person enoys job, more you do the happier, and leisure is good if shared with others) Marital Status (married individuals seems to have larger social networks-married to groups of friends, has to be good marriage! increase happiness in early years of marriage leads to longer term happiness) Living Situation (Very important, only factor more important is health! those living at home are happier, want to be happy where living and comfy) |
|
|
Social Interactions
|
Tend to have more conversations on world and community events (outwardly active in convos)
May only need to have one stable relationship) Interactions with friends are more important (peers know what going through) Having family involved may make a person feel less independent-associated with guilt. |
|
|
Relational Considerations
|
must be able to balance relationships throughout life (dont want friend to just call for ride)
does not matter if they are new or from childhood as long as you feel comfortable |
|
|
Function of communication: youth
|
up to mid 20s... shared experience, learning and having fun together. Mating, feeling you'r enot alone and learning from other people's experiences. Education- learning new terms and concepts and everything is new. Learning how to be in work environment and function in society. lots of leeway
|
|
|
Function of Communication: Middle Age
|
25-65...more leeway about building concepts you know.Ideals may change. Vocation and family, communicationg with spouse, children, those close to you, learning how to do your work, work rold. Family-learning new things
|
|
|
Function of Communication: 65+
|
small social network. Vocational aspect decreases, don't talk to as many people. not uncommon to focus on self and how feeling than focusing on child or someone else. not a lot of learning going on, but a lot of maintaining
|
|
|
Importance of communication: youth
|
need to know how to communicate, to learn too.
|
|
|
importance of communication: middle age
|
will have troubles keeping jobs and maintaining relationships if can't communicate
|
|
|
Importance of communication: 65+
|
if can't communicate, can't have successful aging. you must communicate and be a part of something
|
|
|
barrier: distance
|
lives far away, dno't have friends at work to regularly communicate with. has to do with ability to be mobile too.
|
|
|
barrier: sensory
|
hering, vision. hard to havce conversation if can't hear or communicate non-verbal cues if can't see
|
|
|
barrier: cognition
|
hard to have convo when people don't know waht you're talking abotu. can't build off conversations. being able to understand basic conversation and lingo is important. when picking conversational partner you want to pick someone with same conversational level.
|
|
|
Barrier: emotional
|
if depressed, it's hard to communicate with people. a lot of times, focused on self. have emotional response every time someone says something, hard to have communication. bipolar disorder, psychological functions play into emotional aspect to communcation
|
|
|
barrier: agism
|
baby talk, oversimplification of things
|
|
|
barrier: touch
|
no one toucehs each other! older people need to be touched too, engage each other
|
|
|
What can we do to encourage communication?
|
do things that are close and that they enjoy
address hearing and vision issues and wearing aides and glasses, being aware of problems in that area joing organizationwhere you might have common interests as get older (bingo, red hat ladies, silver sneakers, encoruage technology) |
|
|
Social Support
|
people who do not have strong, reliable social support tend to suffer negative consequences.
Good psychological and physical health Enhanced immunce function Protecting Against the Effects of Negative Mood Encouraging Health Related Behaviors Encouraging Sense of Self-Efficacy-don't say"oh you're old let me do that" encourage them to do something. |
|
|
What you disclose to someone is based on
|
how comforable you are with them. (freinds vs family)
|
|
|
Spouse
|
most person you want social support with
|
|
|
family
|
second people you want social support with
|
|
|
Friends
|
3rd person you want social support with
|
|
|
Reminiscence
|
Recalling events that happened long ago --> when they got thier first job, went to college, let me show I have things in common with you and build relatinoships. But if it turns into off topic verbosity and talking for an hour about something that doesn't have anything to do with you it will turn off target listener.
Historically associated with old age Has roots in oral history before printed word Now seen as a self indulgence instead of people sharing beneficial lessons Focus seems to change with situation Used as coping mechanism |
|
|
Reminiscence helps deal with
|
Unresolved conflict- understand why things happen now, eg. Why won't get into the car
Fear of death - fear no one will remember us, no legacy Grief, Depression Loss of self- identity or self esteem -> help to build yourself back up; "that's wonderful or that must have been difficult to deal with" Share with others- may see more psoitives with other and helpl you out. |
|
|
older people reminisce about what
|
reminiscence more about distant past than younger people, who focos on more recent past. in 80's talk about when they were young and in 20s and it you're 20 you talk about what happened last week
May be searching for a time in which they were last valued --> they felt best about themselves in 20s. They remember times when they were best selves. Can lead to a group cohesiveness, intimacy, feeling of self-worth, and life satisfaction-- share commonalities. -- helps hand down culture and provide historical contribution |
|
|
Negative Consequences of Reminiscence
|
Dwell on things that you can't change. If you dwell on things you're not happy about: you may have depression, guilt, inner panic -> afraid things aren't going to be able to be fixed, and make same mistakes over and over again. These sually occur when done alone! May need to seek counseling if it persists -> wonderful things. Appropriate for older people too esp. if experiencing acute problems like grief, loss of spouse, moving.
|
|
|
Imtimacy
|
Involves: mutual trust, support, understanding, sharing confidence.
Studies have shown it is essential to self-esteem and emotional well-being. Reminiscing can facilitate |
|
|
Sexuality involves
|
holding hands, supporting each other, sex happens frequently through 70s or 80s and medical problems usually stop it.
|
|
|
Sexuality Aspects include
|
Intimacy
Identity Reproduction Sexualization Dailey emphasized that ppl need to have fantasy, memories of sex and desire for physical contact Should not feel embarrassed or bad about having these feelings This lead to further depression and loneliness if not fulfilled? Society has made elder sexuality a joke Sexual interest overall declines with age however those who were very interested when younger are more likely to continue to be interested as they age for longer -> decreases as you get older usually due to hormones. Point where sex drives go away is different. Supplements can increase interest. Women lose interest first sexual activity frequently occurs well into their 70s |
|
|
Menopause
|
may effect hormones
some women also feel sex is not enjoyable or important if they can't become pregnant other feel a sense of relieve and show more interest |
|
|
sexuality and health
|
men also fear heart attacks
some studies have shown that good health is reflective of a good sexual relationship |
|
|
sexuality and privacy
|
we lose it as we age
|
|
|
Consequence of Sexual Activity
|
Higher life satisfaction
severity of sexual problems correlates with severity of marital problems- no sexual activity between couple, usually more marital problems. Feel good each other by having sex. Even just putting arm around should may be intimate, doesn't have to be act. Lower rate of depression should not place too much emphasis on it- if it doesn't happen, don't worry can try again another time. (may need to be more lighthearted view) |
|
|
Homosexuality
|
Traditionalists have been less open about it, does not mean it occurs less often --> may have lived together for cost, but doesn't really mean that.
Many have been in heterosexual relationships until they have fulfilled societies expectations of them Report same levels of satisfaction in relationships Struggle with issues of societal acceptance and legal issues of inheritance |
|
|
Communicative Competence
|
how well can you have a conversation, how competent you are at communication. As you lose support or have small group to communicate with then their competence decreases
|
|
|
communicative competence factors
|
take longer to react in conversation..longer to process info.
Sentence comprehensions ability decreases- tendency not to do turn taking aspect of communication; have longer delay in responding to initiation in convo and changing of topics (5 sec. delay) Make more mistakes Mistakes ore more serious Skills may atrophy b/c they are less likely to engage in social activites |
|
|
Enviornmental limitations require elders to wait for otehr to engage them in social activities
|
Waiting for someone to come talk to them. if family is scattered, the opportunity for communication partner decreases
Problematic bc people find elders to be unattractive communication partners- if i go see her she's just going to say the same story again, or seh doesn't know what it's like to be in college. Expectations of elder's communication ability may be lower. |
|
|
There is hope tho! for communcation competence
|
Training studies have been positive
We can teach them to interact more Appropriately, with more sympathy Volunteer or doing different thigns to set up interaction so they can communicate effectively. Staged communication therapy and have partner Studies have also shown that people who discuss info. that is not self centered reported more happiness. |
|
|
Confirming
|
Statements that validate and acknowledge the other person and their experience of reality
|
|
|
Disconfimation
|
Do not provide this and may completely ignore statement
|
|
|
Imperviousness
|
When someone says they know what you are feeling more than you do
"I'm having problems with X" "Oh yeah I'm having problems with X, everyone does" or maybe ask why...? |
|
|
Disqualification
|
Give a tangential comment in response
"I am worried about my health". "I am in the best shape of my life!" "I'm not worried about it, life goes on" Not very helpful. Not registering what you're saying is actually happening. You're teaching them not to talk to you. They won't open up to you again. |
|
|
Helping and Loneliness
|
Social support is key to life satisfaction -> someone to even come over and check on them.
Elderly people receive most of their help from family living near by -> mostly seek help from family People in their neighborhood help often -> if family doesn't live close by Decreased loneliness with increased involvement in causes, activites Social isolation from friends impacts loneliness more than family -> technology has helped significantly: skype, e-mail, texting, helps close gap. |
|
|
Marriage and Quality of Life
|
Primary predictor of global well-being and satisfaction with life.
Men are more satisfied than women in marriages: women have to take care of men, so men are more satisfied. Women are more affected by the quality of their marraige |
|
|
later years of marriage
|
more complaints and less idealization of partner.
Reasons they decided to marry have deteriorated: based on how happy u were when u first started dating? |
|
|
empty nest syndrome
|
all kids have moved out and it's just the couple again in a relationship
Post-parental life described as freedom better relationship with spouse can be described as the "second honeymoon" |
|
|
Retirement
|
stressful for both parties in a couple
Unstable marriages feel more strain "Good" marriages continue to improve Redefining themselves, a stressful time Depression can be associated with retirement if you don't find other ways to define yourselves by Can go to happiness or sadness depending on how you handle it and you have an active choice of where it's going to go |
|
|
Mutal Satisfaction
|
Both are not always happy in the relationship or the same aspects of the relationship
Base on if we feel our needs are being met Women tend to feel they do not get enough communication and men tend to feel they don't get enough respect |
|
|
Convergence
|
Initially people have "wife" tasks and "husband" tasks
As we age these are more likely to become mutual tasks or become assigned based on familiarity with task Lower class couple showed less convergence than mid to upper class-- may not have flexibility in time to sit not and negotiate The more rigid the role definition the more difficult it is to adjust to retirement |
|
|
Congruence
|
Increases over time
In happy marriages people seem to become more similar over time-- start to act and think alike |
|
|
Instrumentality
|
communicating for a purpose (men)
|
|
|
Expressiveness
|
refers to communicating because you want to talk but listener does not need to ehar the info (women)
|
|
|
over time with instrumentality and expressiveness...
|
couple seem to come more to the middle, usually more towards expressiveness
|
|
|
Conflict resolution:
younger couples |
highly engaged: openly and directly deal with issues
|
|
|
Conflict Resolution:
Middle Aged couples |
Analytical: problem solving, solution oreinted comments
|
|
|
Conflict Resolution:
older couples |
avoidance strategies
Changing Topics, making abstract remarks Change in strategies may be a result of decreased importance placed on conflict/problems |
|
|
Characteristics of a successful marriage
|
High marital adjustment associated with even sharing of power- so each personm feels equal no dominant or submissive person
More interdependence and equality Less traditional division of labor More support on both sides Women younger than man |
|
|
Characteristics of an unsuccessful marriage
|
less equality
Similar ages Wife has higher IQ than husband Less frequent sex Decline in joint activities Fewer expression of love/commitment Frequent disagreements Don't act like you like the person, don't hug, kiss,squabble. |
|
|
Why do couples say help?
|
They liked each other
Strong sense of commitment to the relationship Looked for humor in situations- don't pick on each other, do in fun way High level of agreement on important matters- same view on politics, financial, children |
|
|
Adult Children and Parents
|
Continuity (close to family, stay close; quick to run out, stay out...how parents view you -> view as individual have healthier relationship)
Studies have shown it's not stereotypical: kids are afraid that parents will be a burden, but it's shown that it's not alwasy the case, a lot of parents are independent. |
|
|
Sibling relationships
|
Older adults, relationship is even more importnant for unmarried or widowed women- becomes more important as get older.
|
|
|
change in image of Grandparent
|
Previously: older person in rocking chair, pleasure without responsibility. Hang with grandparents
Currently: Active, vital older adults Changing role of older women: More likely to maintain active lifestyle and friendships following death of spouse |
|
|
Grandparent/grandchild relationship
|
Previously GPs take a more active role, espeically when divorce, surrogate child care, and lower socioeconomic status
GPs sometimes seen as Role models/mentors |
|
|
Older vs. Younger GP styles
|
Younger GPs tend to take more active rold (child care disciple, advice) May have had children late
|
|
|
Degree of closenss to Grand child
|
Gma's report closer relationships than Gpas
|
|
|
stats: how many children under 18 live in grandparent-headed households
|
4.9 million children (7%)
|
|
|
how many of children living in grandparent headed households have neither parent present and the grandparents are responsible for their basic needs
|
20% of the 4.9 million children (964,579)
|
|
|
Fundamental concern
|
physical: GPs are run down, and systems don't run as they are supposed to
Finances: supposed to be saving and expenses are less than saving, or living off savings. Now putting most expensive responsibilites on their shoulders. Emotional Stress: GPs social group doesn't have children usuall -> social isolation. Guilt: Cant help but to have a little resentment bc you want that life that your friends have. |
|
|
Challenge for GPs assuming surrogate parent role
|
Stress-related illness
social isolation Financial difficulties (financial strain, stress on community relationships) GMas likely to diminish their own health problems due to fear of GC placed in foster care- don't want to seek help and diagnose problem, bc then they feel they will take kids away Many working full or part time and need to obtain child care May also be caring for other family or community members |
|
|
Factors contributing to GP caregiving
|
Alchohol and drug abuse
neglect, abuse, and abandonment Death of parent HIV/AIDS divorce unemployment/poverty-want to keep stability parental incarceration Teen pregnancy Welfare Reform- harder to get welfare, more difficult to quality for welfare, losing benefits. |
|
|
Types of support: Emotional
|
finding yourself more isolated, less support
Family members social groups |
|
|
Types of Support: Financial
|
have some type of equity in house (401k) but what happens when child leaves what do you have?
Difficult to obtain |
|
|
GPs reported high levels of
|
anxiety
depression stress frequent illness They still were wiling to sacrifice their own needs to meet GCs needs |
|
|
Family vs. Friend #1
|
Friendship is a personal relationship that is seen as involving individuals as individuals not as members of a group or collective (person A meets B and want to get to know each other and has friendship bases on them being themselves)
Lacks formality: allow people to be relaxed and be themselves. Being accept for who you are and let your guard down. Allows person to be relaxed and themselves |
|
|
way to distinugish frienship #2
|
voluntary nature of relationship
Free choice Selection of individuals Joy is derived from friendship itself not just an activity done with the person. |
|
|
way to distinguish friendship #3
|
Non-exploitive nature of the relationship - not only calls you when they have a problem and needs you.
Friendship formed fo itself not for ulterior motives Reciprocity: needs to both call whenever you want them for emotional support and problem.s both does give and take Symmetry- if feel on side it's not going to be a good friendship that works out well |
|
|
Later in friendship: lifelong friendship
|
cloeset confidants
Understand each other well History that helps support each other (can tell a bunch of details and both laugh hysterically bc of history) |
|
|
Qualities of later in life friendship
|
report more closeness than younger friendships
Do not have to have constant/frequent contact to remain friends |
|
|
Factors in later in life friendship
|
1) the physical reality of illness and death
2) the long shared histories of individuals 3) the importance of haivng friends one's own age |
|
|
Friendship Styles
|
Different types dependent on the purpose of the friendship and personality of the person(s) inolved in the friendship- may be quiet and reserved about who they pick as friends. Want to make sure that peole you're in friendships with ahve same views as you. (only want a couple friends vs. people who want a whole group of friends- still need reciprocality)
|
|
|
Functions of Friendship: Psychosocial wellbeing
|
The strongest predictor of positive physchosocial wellbeing in older people is having at least one confidant.
Someone who cares about you Has a high level of inolvement-level is very superficial as you get older. Group meetings- no communication about person. So need person who cares about you and can open up to and feel like youre cared about. |
|
|
Functions of Friendships
|
Homophily
Voluntary nature of relationsihp Relationships involve more people from their community than familiy relationships Self Disclosure Informal social support (support without guilt or obligation, consideration of inconvenience being experienced by friend/caregiver) |
|
|
Gender Differences in Friendships
|
Women tend to be better off in friendship later in life
Men report fewer intimate frienships that are less supportive in nature (may be related to societal expectations) |
|
|
Barriers to older male friendships
|
(Society doesn't really teach guys how to be friends)
Men are socialized to be competitive Lack skills to maintain intimate friendships Men don't show affections easily Men have a need to be in control of a relationship Don't teach sharing As a result, most male friendships are word/role/activity related |
|
|
Friendships in nursing homes
|
Physical and mental barriers exist: don't always pair people with their mental ability
Environmental barriers Can be rich with communicative interactions Determines friendship: lucidity, ability to speak (can't communicated it's going to be hard), ability to see (differentiate people, nonverbal expressions) |
|
|
New concept of Retirement
|
Usually only in well developed countries
Must have enough workers to support the needs of the country-enough workers that allow people to leave their job and people to fulfill their roles Must have enough money to set aside to pay for them not working Must have a positive attitude towards older people not working-they earned that right instead of they're lazy |
|
|
Patterns of Retirement
|
Partial retirement
Bridge Jobs Unretirement |
|
|
Partial Retirement
|
start stepping down and working part time or working in a lesser job within the company
|
|
|
Bridge Jobs
|
"You've gotta go". There's no other position within the company and then you have to go find a job somewhere else. Go somewhere else to keep yourself afloat because you can't really afford to keep yourself reitred. Learning new skill set-- similar but not usually realetd to what it used to be
|
|
|
"Unretirement"
|
don't have enough money in bank you realize and try to get back position, or people are bored. so after summer, i'm bored! i'm sick of my husband! i wanna go back to work...
|
|
|
Economic status of aged adults
|
Substantially lower cash incomes
7.9% live below poverty level % may be significantly higher with recent economic changes and new definitions of poverty More women than men (guys have more chance of getting job by even just walking in) 85+ population: 16% mean and 23% women Percentage in poverty varies by ethnic group: caucasion: 10% Hispanic: 23% Black: 34% |
|
|
absolute povery line
|
if you are below this amount of money you are in poverty
The threshold below which families or individuals are considered to be lacking the resources to meet the basic needs for healthy living; having insufficient income to provie the food, shelter and clothing needed to preserve health. |
|
|
"Orshansky Povery Thresholds"
|
A little bit of leeway
Gave a range of income cutoffs, or thresholds, adjusted for factors such as family size, sex of the family head, number of children under 18 years old, and farm or non-farm residence |
|
|
Supplemental Poverty Formula
|
Takes into consideration:
child care, housing, medical treatment, utilities Will increase the number of people over the age of 65 under the poverty line from 9.7% to 18.7% |
|
|
Economic Status of Aged Adults
|
Financial problems may result in emotional problems
|
|
|
Retirement Income, Tripod structure
|
Social Security (has become larger source of elder income than employment program income)
Private pensions (moderate increase) Individual savings or other assests (income from assests has dramatically increased) Traditionally more dependent on social security and private pension, and now having to go towards our own way of finding retirement. Change way we think |
|
|
Effect of Social Security
|
Has helped institutionalize and promote retirement
Makes retirement a social legitimate transition and life cycle Has provided a reliable source on income of older Americans- up until maybe last 15-20 years. Created financial disincentives to continued employment, earnings test. When we get to a certain age we qualify automatically for this. |
|
|
Retirement Income
|
overall, retirement income has significantly increased; however the elderly have not shared equally in the increase.
Poor getting more poor, richer getting richer. Disadvantged: jobs don't allow them to collect maximum money benefits, pension, or to accumulate wealth. Low wages with negligible fringe benefits Poor job security Race and gender issues: compounds over the years Elderly women Pensions go away (vulnerable financial status. May change dramatically when husbands die. Widows can collect SSI at age 60. Spousal benefits from private pensions are generally less generous) 2/3 older widows live in poverty Elderly divorced women: no-fault divorce results in little or no compensation in the form of alimony. Typically receive nothing from ex-husband's pension) |
|
|
Tripod: SSI
|
Biggest source of income for those over 65
16% of US population of retired elderly, disable, and family dependent receive SS payments Current eligibility requirement: 65 years old (if born before 1937; 67 yo: 1960 or later) start adding month increments after that. 62 for partial benefits (reduced by 20-30%) -- lose 20-30% Wage earning history in a job covered by social security (even flipping burgers at McDonalds will get you social security. Be married to a spouse with that history |
|
|
Tripod: Pensions
|
Contractual plan by employer to provide regular income payments to employees after they have left employment (typically retirement)
Become widespread after WWII Not univeresal for elderly 45% of households over 65 have prive pension plans Proportion is declining |
|
|
Defined Benefit pension plan
|
specific or defined amt. of pension. Promises a specific or defined amt. of pension for the remainder of life. Co. has to set aside funds to cover this. (get % of amt. of top earning years. doesn't matter how much you make, you get % of amt.)
|
|
|
Defined Contribution
|
employers, employees, or both contribute money
amt. of pension is dependent upon how much is contributed over the years and how successfully it is invested Current trend that means future retirees could face less economic security than those currently retired If you do more of this, you're going to be a lot more safe. If you leave the system...it won't matter how long you worked there for teach. For hospitals it rolls over... |
|
|
Cash balance plan
|
every month you put in money and whatever you put in, that's what you're going to walk away with
|
|
|
More on pensions
|
US employers are not required to provide pensions
|
|
|
Employment Retirement Income Security Act
|
if co. goes out of business, we have to be able to continue to give you money. Can't be denied benefits even if they close down. If promised $1100 a month for the rest of your life, cant be denied
Protection for workers and retirees Regulates private pension plans and provides protection against loss of benefits to reitred workers Protection is not absolution. Pension can be terminated if co. goes out of busniness or merges with another co. Employers are not required to include those that work <20 hrs./wk. Problem for recent tremendous growth of part-time employment- dont' have to pay into this if you have part time workers. |
|
|
Medicare Part A
|
hospital insurance that helps cover inpateint care in hospitals, skilled nursing facility, hospice, and home health care.
|
|
|
Medicare Part B
|
something that you can purcahse as a supplemental insurance to part A. Monhtly fee you may have to pay, as high as $150 depending on which medicare part b you purchase. Cancer will be covered under this medicare. Hearing aids, glasses, dental work, not covered by this. minimal preventive care covered under part B. In order for someone to be seen they ahve to have a problem. Some type of diagnosis.
Part B is paid for by the monthly premiums of poeple enrolled and by general funds from the U.S. Treasury. It helps pay for doctors' fees, outpatient hospital visits, and other medical services and supplies that are not covered by Part A Has a deductible Related services when a prescribed or referred by a physician Premium has increased to $115.40 per months in 2011 for the lowest income levels. |
|
|
Medicare Part C
|
Supplemental insurance that helps pay for the % not paid for in Part B
Additional monthly premium required Buy additional insurance that doesn't go along with Part B Medicare Advantage plans allow you to choose to receive all of your health care services through a provider organization. These plans may help lower your costs of receiving medical services, or you may get extra benefits for an additional montly fee. You must have both Parts A and B to enroll in Part C. |
|
|
Medicare Part D
|
Prescription
Additional premium required Last 10 years it came out voluntary allow prescription coverage |
|
|
Medicare vs Medicaid
|
Medicare is primary and Medicaid is secondary insurance ( will pick up what medicare doesn't pay). Medicare doesn't pay for nursing homes. Need rehab after surgery, medicare will pay for that. but if need to be there longer than you need to be, then it has to be out of pocket.
|
|
|
Getting qualified for Medicaid
|
have no assets, sell house and everything until you qualify for medicaid
|
|
|
Living Options
|
Home, Relatives, Retirement Complex/community (55 and older homes. Usually single level homes. Have social center, planned group trips, drive golf carts around. Little expensive to live there), assisted living (as person ages, don't need as much change. keeps people independent fo a longer period of time. expensive. medicaid/medicare doesn't pay for assisted living), nursing home
|
|
|
Caregiving
|
More than 65 million pepole in the US is currently an informal caregivier to another adult
On average spend more than 20 hrs a week, non-paid, little recognition, 375 billion annually if paid. 78% of all long term care is provided by caregivers 14% is a combination of caregiver and pd formal caregivier only 8% receiving care are getting it just from formal care providers |
|
|
typical caregiver:
|
49 year old woman caring for her widowed 69 year old mother who does not live with her
|
|
|
Caregiving Stats
|
~ 66% of family caregivers are women. More than 37% have children or grandchildren uner 18 years old living with them.
|
|
|
Caregiver attitudes
|
Very reluctant. We can help educate them why they're doing what they're doing and providing skills for them
Make sure telling them thank you and doing a wonderful thing-- encouraging them to continue what they're doing and give them recognition. Contintue to use service available for people. (adult day care--with people of common problems, have nurses we might not be comfortable doing) Encourage them to take breaks and ask for help |
|
|
What do Caregivers do?
|
May tasks: depending on the level of the pt. they are helping
Starts usually as a distance relationsihp: just phone support or infrequent visits. Evolves into maintaining home environment-- cleaning, laundry, grocery shopping, family budget, yard work, transportation Role expands based on how much difficulty the person is having (May evovle to toileting, dressing, eating, bathing, other basic care elements) Some also become more directly involved with medical treatments--giving meds, injections, changing dressing |
|
|
Who becomes caregiver?
|
Personality factros, family dynamics, quality of the relatinoship prior
Some people are comfortable with certain aspects of caregiving but not all Incontinuence is often a main reason a person is admitted into a nursing home Those who seek alternative care often feel guilty |
|
|
The choice must be supported
|
Acknowledge that not everyone is meant to be a caregiver
Also some of the pople who need care may not feel comfortable with their children or family members taking care of them Unwanted caregiving can put a significant strain on the relationship |
|
|
Physical impact of caregiving
|
Caregivers suffer from serious, clinicaly measurable health consequences --> Decreased immune system function,
Greater risk of infection and poorer wound healing Adverse changes to blood pressure Greater risk for developing cardiovascular disease |
|
|
Psychological Wellbeing
|
Clinical depression
Reported increased feelings of stress Lower levels of subjective wellbeing Lower levels of self efficacy |
|
|
Social Impact
|
Decrease in the c caregivers own personal time and social interactions
Less time to be with their family, socializing, doing hobbies, inability to take vacations As the pt's need increases the caregiver may feel they ahve to be "on call" all the time Alzheimer's care can equate to 80 hrs a week Leads to a sense of social isolation and less outisde help when they could use it the most May feel unworthy or guilty if they do something for themselves |
|
|
Financial Implications
|
May have to quite or reduce the amt. of time working
May have to become financially responsible for the care recipient May cause the person to not be able to save for their future |
|
|
Benefits of Caregiving
|
May be personally rewarding, boosing their own self esteem (feel useful and needed)
Give a more positive attitude toward life Allows for quality time to strengthen the bond of the relationship |
|
|
How could health care professionals support caregivers
|
Encourage collaberation with the family and fair distribution of duties
Encourage frank and open discussions on a regular basis Let the caregiver know that it is better to ask for help than to exhaust themselves to the point of illness Encourage spending time with the person besides jus the caregiving routine Use adult daycare facilities to give a break and allow the pt to socialize as well Caregiver needs to be encourage to take mini-breaks or vacations HCP need to recognize the contribute the caregivers make Caregivers need to be reassured that the feelings they are experiencing are normal for the situation Should be encouraged to seek out support groups |
|
|
Physical Abuse
|
The use of physical force that may result in: bodily injury, physical pain, impairment, includes physical punishments of any kind
|
|
|
Abandonment
|
The desertion of an elderly person by a person who had physical custody or otherwise had assumed responsibility for providing care for an elder
|
|
|
Neglect
|
Refusal or failure to fulfill any part of a person's obligation or duties to an elder
|
|
|
Self-Neglect
|
The behaviors of an elderly person that threaten his/her own health and safety
Definition excludes a situation in which a mentally competent older person (understands the consequences of his/her decisions) makes a conscious and voluntary decision to engage in acts that threathen his/her health or safety |
|
|
Reported Cases of elder Abuse
|
Represent the "tip of the iceberg"
Difficult to study bc of: Difficulty obtaining reliable info. from both the victims and the perpetrators Victim's fear of social stigma or reprisal Societal ageism Lack of knowlege of the victims as far as where to turn for help Lack of information and intervention protocos for treatment professionals |
|
|
Abuse and Neglect
|
Physical violence, chronic verbal aggression and neglect present among a small segment of the elderly population.
Approximately 5 million 65+ yo are abused annually 84% never reported Self neglect most often (37%); Caregiver neglect (20.4%); Financial exploitation (14.7%) Oldest Old most vulnerable Estimates of the frequency of elder abuse range from 2 to 10% One in 14 incidents, excluding self-neglect, come to the attention of authorities The overall reporting of financial exploitation is only 1 in 25 cases, suggesting at least 5 million financial abuse victims each year One large survery of staff working in nursing homes found that 36% had observed physical abuse and 81% witnessed psychological abuse |
|
|
complex problem of abuse and neglect
|
more than one type of abuse may occur at the same time (~ 3/4 of cases)
|
|
|
Who are the perpertrators?
|
90% are family members:
Spouses (58%) or adult children (24%). Most likely to be abused by the person with whom the elder lives Non-family caregivers: Nursing home staff, nurses aids: have the least training and most client contact (most likely perpetrator), |
|
|
less overt forms of abuse:
|
subtle indignities
insensitivites overuse of medications |
|
|
Who are perpetrators?? others
|
Financial Abuse: Acquaintances who try to separate the elders from their money and/or other resources. Those in a positon of grust include: persons with a formal financial relationship. Bankers, accountants. All of whom are obliged to serve the best interests of the elder and to avoid conflict of interest and self-dealing.
|
|
|
Financial Abuse
|
Typicall use persuasion, misrepresentation or psychological manipulation to get victim to:
change will grant expensive gifts deed over home or other real estate make perpetrator beneficiary of a trust Organizations: Fradulent investment opportunities Pyramid schemes Credit repair schemes Phony charities Insurance Frauds |
|
|
Telemarketing Fraud
|
Significant and growing problem
Estimated over $40 billion annually Elderly may be a target of schemes because they are: Easiliy accessibly (often at home) More likely to be socially isolated Lacking someone with whom to discuss things More likely to suffer from cognitive impairment More trusting Less likely to recognize and report fraud |
|
|
The Self as a perpetrator
|
Self-neglect: Inability to perform essential self-care activities
Gambling: marketing to elderly (free transporation, cheap meals, social activites) |
|
|
Risk Factors for Abuse
|
Female
80+ Dementing illness of care receiver Abusing caregiver |
|
|
Double Directional Violence
|
Caregiver and care receiver are both abusive
Especially occurs with demented patients |
|
|
Empirical Evidence: Victim Characteristics
|
Older
Female Dependen Alcohol abuser Socially isolated History of past abuse Marital or family conflicts Difficult behavior Demanding Unappreciative Unrealistic expectations |
|
|
Elder Abuse Policy
|
No national policy:
Each states legislates its own policies on what constitues abuse and how and by whom it is to be addressed 42 states have mandatory reporting whenever there is evidence of abuse |
|
|
Intervention
|
Approach is similar to child abuse
Mandatory reporting by professionals Educating professionals about potentially abusive situations Educating the public about normal aging processes Helping families develop and nurture informal support systems Linking families with support groups Teaching families stress-management techniqes Arranging comprehensive care resources Providing counseling for troubled families Encouraging the use of respite care and day care Informing families about resoruces for meals, transportation, in-home care Utilizing the long-term ombudsman program to address quality of life issues in long-term care Encouraging caregivers to pursue individual interest for self-care |
|
|
Protective Placement
|
Similar to child abuse cases but it punishes the victim and counters the victims right to self-determination
Ofteb results in nursing home placement while leaving perpetrator free-- may lead to lack of reporting or denial in intervention |
