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215 Cards in this Set
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Multiple Sclerosis
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Affects the brain and spinal cord.
Damage is caused by inflammation. Cause is unknown Autoimmune disorder |
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Multiple Sclerosis mostly affects
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Young females
Older population- 40s and 50s |
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Lesions from MS
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No pattern
Affects any area of the brain (visual, speech, motor, memory) extending outward from the ventricular surface within the: Brainstem Corpus callosum Cerebellum Spinal cord Lesions leave a "foot print" on where it was located. White areas on imaging Spreads and changes areas Volume of brain decreases |
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Symptoms of MS
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Periods of relapse and remittance
If you only have 1 attack you could most likely get back to normal, but once you get more and more it progresses. People at first don't seek help because it comes and goes. Tingling and stiffness goes to one side then to the other side Loss of balance Muscle spasms Numbness or abnormal sensation in any area Problems moving arms or legs Problems walking Problems with coordination and making small movements Tremor in one or more arms or legs Weakness in one or more arms or legs Bike riding would be easier than running because they are simply engaging just their legs. OUTWARD PHYSICAL signs seen first then EXECUTIVE signs. |
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Eye Symptoms of MS
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Double vision- lesion on one optic nerve and not the other.
Eye discomfort- feels like sand in their eye Uncontrollable rapid eye movements- nastagmus Vision loss- usually one eye |
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Numbness, Tingling and or Pain in MS
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Facial pain
Painful muscle spasms Tingling, crawling, or burning feeling in the arms and legs |
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Other brain and nerve symptoms in MS
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Decreased attention span, poor judgment, and memory loss
Difficulty reasoning and solving problems Depression or feelings of sadness Highest in depression out of these neuro disorders! Damage to areas that produce seratonin and dopamine. Dizziness and balance problems Hearing loss- asymmetrical, and especially with background noise. Slurred or difficult-to-understand speech Trouble chewing and swallowing |
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Fatigue in MS
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Debilitative
Present in two thirds of patients, with one half describing fatigue as the most disabling symptom. Common features of MS fatigue include -reduced energy -Malaise -motor weakness during sustained activity -difficulty maintaining concentration. Can be a side effect of the medications |
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Depression in MS
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The most common mood disorder, affecting more than half of patients.
Incidence of depression in MS is three times higher than the general population and more common even when compared with other chronic disease states SSRI Medication, not mood altering drugs. |
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Cerebellar Symptoms in MS
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Seen in one third of patients with MS.
Tremors can increase fatigue by causing an increase in energy consumption Aging is also associated with a decline in balance. HIGH RISK OF FALLING |
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Diagnosis of MS
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Relapsing-Remitting
-time shortens in between episodes -bigger footprints Decreases in the function of two different parts of the central nervous system (such as abnormal reflexes) at two different times. One side stronger than the other. A neurological exam (electrodes and electricity) may show reduced nerve function in one area of the body, or spread over many parts of the body. An eye examination may show: Abnormal pupil responses Changes in the visual fields or eye movements Decreased visual acuity Rapid eye movements triggered when the eye moves Tests to diagnose multiple sclerosis include: Lumbar puncture - increase white blood cell count Multiple MRI scans of the brain and spine Nerve function study (evoked potential test) |
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Scaling MS
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Perception not necessarily function
Combination of: functional ability perceived quality of life perceived disability (3) commonly used scales that assess the progression |
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Treatment of MS
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No Known Cure
More susceptible to sicknesses Medications used to slow the progression Steroids may be used to decrease the severity of attacks, but we get immune to them Medications to control symptoms. The following may also be helpful for people with MS: -Physical therapy, speech therapy, occupational therapy, and support groups -Assistive devices, such as wheelchairs, bed lifts, shower chairs, walkers, and wall bars -A planned exercise program early in the course of the disorder -A healthy lifestyle, with good nutrition and enough rest and relaxation -Avoiding fatigue, stress, temperature extremes, and illness -Changes in what you eat or drink if there are swallowing problems -Making changes around the home to prevent falls -Social workers or other counseling services to help you cope with the disorder and get assistance (such as Meals-on-Wheels) Household changes to ensure safety and ease in moving around the home are often needed. |
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Prognosis of MS
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The outcome varies, and is hard to predict.
Although the disorder is chronic and incurable, life expectancy can be normal or almost normal. The following typically have the best outlook: Females People who were young (less than 30 years) when the disease started People with infrequent attacks People with a relapsing-remitting pattern People who have limited disease on imaging studies The amount of disability and discomfort depends on: How often you have attacks How severe they are The part of the central nervous system that is affected by each attack Most people return to normal or near-normal function between attacks. Slowly, there is greater loss of function with less improvement between attacks. Over time, many require a wheelchair to get around and have a more difficult time transferring out of the wheelchair. More falls because lack of coordination. Those with a support system are often able to remain in their home |
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Amyotrophic Lateral Sclerosis - ALS
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Progressive neuromuscular disease.
BOTH SIDES Characterized by a progressive degeneration of motor nerve cells in the brain (upper motor neurons) and spinal cord (lower motor neurons). Does NOT impair a person's intellectual reasoning, vision, hearing or sense of taste, smell and touch. Cognition intact but cannot control themselves. Voluntary movements impaired. Reflective acts intact the longest. Disease of the nerve cells in the brain and spinal cord that control voluntary muscle movement |
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ALS affects
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Affects approximately 5 out of every 100,000 people worldwide.
10% of cases-caused by a genetic defect The younger the person is, the more likely linked to genetics. There are no known risk factors, except for having a family member who has a hereditary form of the disease No pattern with race, gender, ethnicity or socioeconomic status. We think more related to aging. |
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Incidence and Prevalence of ALS
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Most people who develop ALS are between the ages of 40 and 70.
It occurs throughout the world with no racial, ethnic or socioeconomic boundaries. It affects as many as 30,000 in the United States, with 5,000 new cases diagnosed each year. Estimates suggest that ALS is responsible for as many as five of every 100,000 deaths in people aged 20 or older. ALS is most common among persons over age 60. The incidence of ALS is five times higher than Huntington's disease and about equal to multiple sclerosis |
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Symptoms of ALS
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Twitching and cramping of muscles, especially those in the hands and feet
Loss of motor control in the hands and arms Impaired use of the arms and legs Weakness and fatigue Tripping and falling Dropping things Uncontrollable periods of laughing or crying Slurred or thick speech and difficulty in projecting the voice As the disease progresses, symptoms may include: Shortness of breath Difficulty breathing Difficulty swallowing Paralysis Muscles contracted constantly Major calorie burn- they are usually very small and frail looking. Need a lot more support. BILATERAL No auditory issues or no sensory issues. |
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Diagnosis of ALS
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A medical history
Including strength and endurance. A physical examination : weakness, often beginning in one area. muscle tremors, spasms, twitching, or loss of muscle tissue (atrophy). The person's walk may be stiff or clumsy. Reflexes are abnormal. There are increased reflexes at the joints, but loss of the gag reflex. trouble controlling crying or laughing- "emotional incontinence." Tests that may be done include: Blood tests to rule out other conditions Breathing test to see if lung muscles are affected Cervical spine CT or MRI to be sure there is no disease or injury to the neck, which can mimic ALS Electromyography to see which nerves do not work properly Genetic testing, if there is a family history of ALS Head CT or MRI to rule out other conditions Nerve conduction studies Swallowing studies Lumbar puncture |
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Treatment of ALS
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No known cure
Drug treatment may slow the disease progression and prolongs life. Muscle relaxers More of "throw stuff at it and see what happens" type of treatment. Medications to control symptoms are also helpful. Physical therapy, rehabilitation, use of braces or a wheelchair, or other orthopedic measures may be needed to maximize muscle function and general health. G tube (gastrostomy) Nutritionist is very important. Breathing devices include machines that are used only at night, and constant mechanical ventilation. Patients should discuss their wishes regarding artificial ventilation with their families and doctors. |
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Prognosis for ALS
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Quick and progressive
Over time loss of the ability to function and care for themselves. Death often occurs within 3 - 5 years of diagnosis. |
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Parkinsons disease
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Progressive disorder of the nervous system
Affects several regions of the brain Substantia Nigra Regions of the brain that regulate involuntary functions Symptoms occur when neurons in the Substantia Nigra die or become impaired. Produce a chemical messenger called Dopamine Friends and family may notice that your face shows little or no expression and your arms don't swing when you walk. Speech often becomes soft and mumbling. |
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Parkinsons disease hormones
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A lack of dopamine- happy feeling and triggers involuntary system
Low norepinephrine levels. The presence of Lewy bodies. |
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Incidence and Prevalence
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Late onset disease
-Onset after age 50 years Early onset disease -Onset before age 50. Juvenile onset -Onset before age 20 More than 1 million people in North America and more than 4 million people worldwide. In the United States, occurs in approximately 13 per 100,000 people and about 50,000 new cases are identified each year. Higher incidence in Men Younger onset= more progression Cannot prove if genetic Higher life expectancy so now more parkinsons. |
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Causes of Parkinsons
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~15 percent- a family history of this disorder
Environmental factors- pesticides Drugs- mood altering (psychotrophic) |
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Symptoms of Parkinsons
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Tremor
Rigidity - stiffness similar to ALS patients. Bradykinesia- difficulty initiating movement (stutter in body and walking with a lot of effort) Postural instability - slump forward resulting in a lot of falls. They don't have reflexive feedback. Usually starts on one side of the body and then progresses to the other- time span differs Limb tremors because they are not attached to another body part on one side. |
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Secondary symptoms of Parkinsons
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Depression
Emotional changes Difficulty with swallowing and chewing Speech changes Urinary problems or constipation Skin problems- oil in skin Sleep problems Dementia or other cognitive problems Orthostatic hypotension. Muscle cramps and dystonia Pain Fatigue and loss of energy Akinesia Digestion issues with protein Temperature sensitivity- hard to regulate temp. Balance Heart rate- high or low Dyskinesia- head swinging Stuttering |
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Diagnosis of Parkinsons
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Case history and observance (need to see consistency)
No definitive test Parkinsonism Based on medical history and a neurological examination A diagnosis of Parkinson's is most likely if: At least two of the three cardinal Parkinson's signs and symptoms — tremor, slowing of motion and muscle rigidity Onset of symptoms on only one side of the body Tremor more pronounced at rest, for example, when your hands are resting in your lap Significant improvement with levodopa, a Parkinson's drug Once it starts its always there, no on and off. Levadopa- regulates gait and tremors Stage by where symptoms are. |
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Treatment of Parkinsons
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Medications:
Levodopa, Bromocriptine, Pramipexole, Ropinirole, & Carbidopa Surgery Deep Brain Stimulation (DBS)- stimulate motor cortex (one time test) symptoms may come back. Physical Therapy Exercise Speech Language Therapy Treat specific symptom Usually die of the symptoms not of pure parkinsons |
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Stress
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A risk factor for a host of health problems
- outside factor -inside factor -loss -fear -perception |
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The stress process model
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Perlin et, 1981
Focuses on classes of factors as they develop overtime Stressors Resources Health outcomes |
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Stressor
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Conditions that challenge or threaten individual’s capacities to respond in ways that preserve and protect personal wellbeing
Categories: -acute -chronic event that is causing the stress can be an actual thing or not can cause negative health outcomes (fatigue, depression, sickness) Hard to deal with illness May take a year for your immune system to get back to normal functioning. Could get bleeding ulcers |
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Acute
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"Next month it will be resolved"
There is a start and an end date You can get through it |
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Chronic
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Have to learn how to deal with it.
Need more resources DRAINING! Older adults get more chronic stress Need to change thought process |
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Resources
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What you use to deal with stress (can be good or bad)
Can be personal or social factor Buffer between you and the stressor Person Experience |
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Coping Efforts
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Active- plan developing to fix problem
Emotion- "could be worse" Not changing anything but helps a bit. (not good for acute) |
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Cognition
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includes thinking, learning, and memory
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1. Disease
2. Disuse 3. Aging |
cognitive impairments are primarily caused by these three factors:
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Delirium
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a transient state of fluctuating cognitive abilities often characterized by hallucinations, decreased ability to focus, increased confusion, and poor memory
-symptoms are difficult to recognize and usually are mistaken for dementia or depression |
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Orientation
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knowing who one is, where one is, and having adequate understanding of time
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Attention
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being able to sustain attention or focus on a task, alternating attention between two tasks, or dividing between two or more tasks
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Crystallized intelligence
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includes both basic knowledge and skills that accumulate over the course of life
-with age this remains intact and may even continue to improve |
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Fluid intelligence
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the ability to find meaning in confusion and solve new problems, to understand relationships of various concepts
-declines with age to a degree...older adults have more difficulty with complex multiple-step tasks |
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Primary memory
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has limited capacity and is based on incoming information that is either used or generally forgotten in a matter of seconds.
-does not seem to be affected by aging -this type of memory involves sustained attention and is of extremely short duration (unless rehearsal takes place) |
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Short-term memory
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involves remembering information for a short duration...for example being able to recall a seven-digit number for a few minutes
-does not seem to show decline, however the decline is more pronounced as the info increases in length and complexity |
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Working memory
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refers to being able to actively use or manipulate the information from the brain's short-term storage base during a task...for example: it involves recalling a phone number while dialing the number or retaining the steps of a new recipe while cooking
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Prospective memory
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enables a person to remember to do something in the future ex. appointments, medications, meetings
-learn to adjust memory losses gradually by making lists |
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Long-term memory
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permanent storage for example: autobiographical information, early life experiences, or repetitive information.
-this type of memory is least affected by age, although it may be difficult to conjure up the exact facts when needed |
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Episodic memory
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oriented toward the past and is hat most people think of when they think of the global term memory. conscious memory particularly involves remembering episodes or experiences in our lives.
-can be long term or short term memory |
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Semantic memory
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-cumulative knowledge base about the world in general
-examples: mathematical facts, symbols and formulas, recall current events and worldly facts -tip of the tongue phenomenon, but vocab may even improve into old age |
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Procedural memory
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performance based, for example, remembering how to ride a bike or the steps of a recipe or self-care task
-this memory is often maintained into old age |
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Age-associated memory impairment (AAMI)
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-refers to memory skills that are lower than average, decreased memory
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Mild cognitive impairment (MCI)
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-lower than expected cognitive performance in memory or other cognitive tasks
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Issues that affect a person’s ability and style of learning:
Learners interest in learning |
a person needs to be interested in learning what the person has to say
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Issues that affect a person’s ability and style of learning:
Readiness |
they have to be ready to want to learn
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Issues that affect a person’s ability and style of learning:
Motivation |
give them acts of service and helping them (cleaning or doing their grocery shopping etc), socialization. More meaning and weight behind what were offering for the older population. Offering more intangible things (safety, security, love, well-being, etc)
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Issues that affect a person’s ability and style of learning:
self esteem |
Self-esteem is a biggie! Self-fulfilling prophecy. Self-efficacy once again (thinking I can do this, I’ve done this before) may have to be a cheerleader at times to motivate them
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Issues that affect a person’s ability and style of learning:
attitudes |
have to feel that it’s worthwhile and they have good intentions
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Issues that affect a person’s ability and style of learning:
culture |
some cultures don’t allow men to learn from women. Some cultures don’t accept using therapy if technology is involved
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Issues that affect a person’s ability and style of learning:
presence of illness |
pain or bigger problems…they may be more worried about their major health problems and be distracted from therapy
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Issues that affect a person’s ability and style of learning:
loss of grief |
being sad and feeling down
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Issues that affect a person’s ability and style of learning:
teachers knowledge |
be able to modify your approach because everyone is different
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Intelligence
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The person’s ability to learn, reason and understand
Intelligence levels off in the 50-60’s and decreases in the 70’s & 80’s Abilities we base intelligence scores on go down flexibility in memory and ability to use what you have changes Way you approach teaching changes depending on each person’s intelligence Have different intelligence in different areas IQ scores may get lower as they get older, but they can compensate better (they hide it) Ability to figure it out increases significantly |
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Compensate for changes by:
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changing the pace of the teaching
using memory aids elaboration well planned approach Accept the fact that were not going to remember everything People who make lists do better with using memory aids at an older age (encourage to have a calendar, use lists, etc) Elaboration- going from what you know to the unknown to build a bridge, comfortable with old knowledge and it’s easier to make that connection. Less effort to learn this way. Well planned approach- switching topics midstream doesn’t work well, need to be highly logical, make it flow well |
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Delayed Reaction Time
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More time is required to take in and process information
-Responding to multiple stimuli or demanding stimuli requires even more time If it is difficult or complex it should be taught in steps -Giving the person time to master each step before moving on Have to give them more time to do what you’re asking them to do Avoid learned helplessness… don’t make them feel rushed! They need to know how they’re going to benefit and give them time Break things down and do things in chunks for instructions or telling them information |
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Other Factors
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Meaningfulness of the material (show the patient why it’s meaningful)
Speed it is presented at (slow it down, about half the content for a young person is what you should present for an older person) Difficulty of the material Cautiousness of the learner (cautious to guess, don’t want to do something they’re not 100% sure of, would rather say idk than to guess and get it wrong) (let them know it’s ok to try and to be wrong) The learner’s health status (if you’re sick you won’t retain anything) Anxiety state of the individual (anxious about getting something wrong) |
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Sensory Memory
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An exact copy is retained for 1 to 2 seconds
Attention to information transfers it to short term memory when you first sense something, you sense a lot more than you actually remember, need to act on that (actively thinking about it) to get it from sensory to short term memory. In order to sense something you have to have the ability to hear, see, smell, etc. need to correct for all the sensory deficits |
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Short Term Memory
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Attention and retention of information is possible for 30 sec to 30 minutes
If attended to or rehearsed it goes to long term memory need to try to actively remember it, taking notes, talking about it, thinking about it several times. Small pieces of info do better getting to long-term memory |
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Long Term Memory
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Where info is stored for an extended or limited amount of time
stored for extended periods of time. For elderly, we have the hardest time going from short-term memory to long-term memory. Have to practice or rehearse it more, takes a lot more effort and time. Doing homework to practice, flashcards, reminder cards, writing it several times |
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Memory cont...
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Most change occurs in the short term memory
-Show lessened ability to move new info into long term memory -Also have greater difficulty in ability to retrieve the information Memory training programs -Use imagery, categorization, analysis of written material and repetitive practice (used to help with memory) More difficult to retrieve info from long term memory (file cabinet that is over full) Need to have that file cabinet organized or else you can’t find it easily The more info you get (more experiences, know more people, etc.) , the harder it is to organize it and find it (slows down retrieval) Cautious to guess people take even longer because they want to make sure it’s 100% right |
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Attention
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Ability to concentrate despite distraction
Sustained attention (sit down & focus on 1 thing) -Being able to maintain mental alertness -Remains intact as long as you remove fatigue factors Selective attention (listening to 1 person in a noisy environment…aware of it but can focus) (decreases for elderly) -a person can selectively pick out one message from a mixture of messages occurring simultaneously Divided attention (the mom attention, aware of what’s going on & can pay attention to both) (really hard for elderly) -A state in which the focus of attention is spread across more than one object or event. Both show declines when other (NEW) stimuli are presented simultaneously Attention span gets shorter when you age |
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Attention cont...
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Teaching sessions should be kept short
Presentations should consider one topic at a time and extraneous data removed (don’t integrate all info at 1 time) Learners should be encouraged to use past experience to learn new things Make sure you have the learner’s attention (cell phones make it more difficult) |
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Vision and ways to teach people with vision impairments
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Ways to teach older adults with visual impairments
Identify yourself to get their attention Facing the learners when speaking Don’t assume they have good vision! Using non-verbal cues and aids along with verbal messages Make sure vision correction devices are cleaned and being used correctly Use large distinct print- 18 to 20 min font Present one concept at a time Bullets encouraged instead of long run sentences Do not stand in front of a mirror or window 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 stimulate because it may cause a decrease in the desired out come and stress on the behalf of the learner Multi- sensory approach- use pictures, a model, a written copy, not just auditory |
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Speech and Language
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The learner may be feeling
-Fear of failure- respect that they have a fear, let them know you understand where theyre coming from. -Cautiousness -Anxiety over class participation or test taking- scared to do things in front of others. Make sure you create a non threatening environment -Avoid using tests -Reinforce and reassure generously -To motivate the patient the material needs to be meaningful and relevant |
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Depression
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Slows thinking and concentration
Muddles everything- hard to concentrate, think, remembering 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 Manage depression before teaching is the best |
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Learning Environment
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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 material to supplement when possible Also encourage family members to participate (as long it’s positive and not sabotaging the appointment) |
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Teaching Methods
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Group Instruction
-Highly supportive and secure setting Some may feel threatened if they do not want to share in public (not best for everyone) Can make them feel that they’re not alone Electronic Learning -CD’s, DVD’s, computers … -Allows learner to go at their own pace -Blended learning…eLearning and face to face instruction -May be helpful for reaching those who cannot get to your clinic or return multiple times -Some elderly would prefer a person to hear it from rather than a note, or CD or DVD |
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Cognition
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Thinking
Learning- old ways of learning are different now. They may not work when you get older. Memory- more deliberate action to get from short term to long term memory. Affected by education level, innate intelligence and sensory abilities- the process of learning or working through a problem is going to be harder than someone who has more education. Theyre better at getting through stages. |
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Innate intelligence
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natural knowing of something that helps you figure out things in life. Some ppl dont have that.
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sensory
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being able to hear and see
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Episodic Memory
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Remembering episodes or experiences
Telling stories Younger people do better on test of episodic memory Being able to retell a story with detail. More older you get less specific. Not remembering or giving as much in episodic retelling. Happens because the file caninet gets fuller and fuller. What do ppl really want to know. May think you dont care about more details (hypotheis of why) |
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Semantic Memory
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Cumulative knowledge about the world in general
This represents your life long knowledge Gets better as you get older! Because you've experienced more and see how different things occur. Learn more different aspects of life. Youre knowledge in this area represents how youve lived your life. Ex. Small town america vs big city. Or small town america then getting online and learning more. Poor understanding doesnt mean bad semantic memory just havent learned it. |
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Procedural Memory
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Performance based
How to do something Maintained well into older age because it is over learned Doing something over and over and over again ex. Making coffee Procedural memory. Ppl with disabilities better with this |
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Crystallized Intelligence
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Language comprehension educational qualifications life and occupational skills
Wisdom Youre idea of how things work. SEMANTIC MEMORY Impacted by what youve experienced Older population good with this |
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Fluid Intelligence
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Speed and accuracy of information processing
Shows significant decline in older age How we learn new things/new info Late teens early 20s peak then slowly goes down into 30 then rapid into 50 n 60 Takes more effort for older ppl More practice and rehearsal needed Ppl who have good fluid intelligence the process would be quicker and they would be more open and it would require less effort vs someone with lower FI will have more repetitions, more effort and more mechanisms to teaching them- a slower process. |
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Fluid Intelligence cont...
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What can be done to improve?
Physical exercise- increase blood flow and stimulating the brain so remains healthier. Cognitive stimulation- learning a NEW skill or piece of information that you didnt have before. You are pushing yourself. As you get older you dnt use FI as much because you dont really have to as much as you do when you are younger. Get in a rut. Good nutrition-good health for the brain Increase level of education- seniors education program. |
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Healthcare Literacy
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The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions
Ability of a person to navigate the entire health care field. More questions. Literacy skills are a stronger predictor of an individual’s health status than age, income, employment status, education level, or racial/ethnic group The healthier you are the higher healthcare literacy is generally. |
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Healthcare Literacy cont...
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1/5 American adults reads at the 5th grade level or below
The average American reads at the 8th to 9th grade level Most health care materials are written above the 10th grade level So may not be understanding as much. People arent going to understand whats going on or change their behaviors. How do we change this? Explain more breaking it down and spending more time with them. Create your own pamphlets. Seeking opinions and checking for understanding. Make sure you ask questions in way that they need to give u a response to see how and if they understand. Dont just ask if they understand usually theyll say yes |
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Aging and Literacy
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More than 66% of US adults age 60 and over have either inadequate or marginal literacy skills.
With age-related decline, as well as potential chronic illness, this population is left more susceptible to increased morbidity due to inadequate communication. Need to check for understanding!! |
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Problems associated
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Low health literacy is an enormous cost burden on the American healthcare system annual health care costs for individuals with low literacy skills are 4 times higher than those with higher literacy skills
Problems with patient compliance and medical errors may be based on poor understanding of health care information. Only about 50% of all patients take medications as directed Asking them to change a lot of things and humans are lazy. Patients remember about forty percent of what we tell them. Check in and see if theyre doing what they need to do. "Show me how u do that" |
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Problems associated cont...
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Patients with low health literacy and chronic diseases, such as diabetes, asthma, or hypertension, have less knowledge of their disease and its treatment and fewer correct self-management skills than literate patients
Patients with low literacy skills were observed to have a 50% increased risk of hospitalization, compared with patients who had adequate literacy skills |
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Research suggests that people with low literacy
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Make more medication or treatment errors
Are less able to comply with treatments Lack the skills needed to successfully negotiate the health care system Are at a higher risk for hospitalization than people with adequate literacy skills Waiting until problem is more severe sometimes too late |
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Marriage and Quality of Life
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Primary predictor of global well-being and satisfaction with life
Men are more satisfied than women in marriages Women are more affected by the quality of their marriage Women need to feel like someone is listening to them. Men have highest satisfaction in marriage Women dont Women are pickier and need a higher amount of need for communication. More upset or unhappy when doesnt go both ways. |
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Later Years of Marriage
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More complaints and less idealization of partner
Reasons they decided to marry have deteriorated Fun, cute, wanna find a mate... Once get older those biological functions change and go away. As marriage progresses the idealization of ur partner being perfect decreases and higher acceptance and love |
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Empty Nest Syndrome
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Post-parental life
Many people dont successfully do well with this syndrome. They have not taken time for themselves that when they get to this point they dont know how to deal. Have no idea what you are besides being a parent. Dont know who spouse is because all the time was for kids. Alot of divorce around this time. However.... Described as time of freedom Better relationship with spouse Sense of accomplishment and contentment Can be described as the “second honeymoon” |
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Retirement
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Stressful for both parties in a couple
Stay at home mom vs working dad- moms looked down on more. Theyre home is work. They feel devalued cuz not respected for what theyre job was with a stay at home mom. Some get a part time job cuz dont know how to be home. Unstable marriages feel more strain “Good” marriages continue to improve Reidentifying themselves and figure out how to do things together. |
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Mutual Satisfaction
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Both are not always happy in the relationship or the same aspects of the relationship
Women tend to feel they do not get enough communication and Men tend to feel they do not get enough respect Respect can feel undermined when guys are questioned. Others want that imput As women are taught to be more outspoken these things will change hopefully in time and these feelings will change. |
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Convergence
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Initially people have “wife” tasks and “husband” tasks
If we have stereotypical roles it wont go well Need to have "who does what best" roles As we age these are more likely to become mutual tasks or become assigned based on familiarity with the task Lower class couples showed less convergence than mid to upper class The more rigid the role definition the more difficult it is to adjust to retirement Convergence- doing what your strengths are Over time skills and abilities will change More rigid roles are the harder transition to young, middle, old |
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Congruence
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Increases over time
In happy marriages people seem to become more similar over time More your ideas and beliefs become similar making sure you have a good coming together, more similarities. |
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Instrumentality vs. Expressiveness
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Instrumentality
Communicating for a purpose Expressiveness Refers to communicating b/c you want to talk but the listener does not need to hear the info Over time couples seem to come more to the middle, usually more towards expressiveness Women- talk, share, details! Men- communicate for "what do u need me to do" "what do i get" zone out in first five minutes if they feel the convo wont be important Eventually men and women learn to converge and compromise more. |
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Conflict Resolution
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Younger couples- highly engaged
Openly and directly deal with issues Very hopeful "theyll change this or that cuz they love me" Middle aged couples- analytical Problem solving, solution oriented comments Older couples- avoidance strategies Changing topics, making abstract remarks Change in strategies may be a result of decreased importance placed on conflict/problems Cant change them accept them and move on to bigger better problems. Need to think like this or will get frustrated if they dont change. |
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Characteristics of Successful Marriage
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High marital adjustment associated with even sharing of power
Need to feel like they're giving something in the relationship need to be dependent on each other to an extent. More support on each side More interdependence and equality Less traditional division of labor More support on both sides Women younger than man |
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Characteristics of Unsuccessful Marriage
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Less equality
Similar ages Wife has higher IQ than husband- men feel intimidated and less respected. Less frequent sex Decline in joint activities Fewer expressions of love/commitment Frequent disagreements |
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What do couples say?
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They liked each other
Strong sense of commitment to the relationship- work it out Looked for humor in situations- see things in a lighter view. High level of agreement on important matters- need congruency to last long term |
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Family : Adult Children and Parents
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Continuity
Studies have shown it is not stereotypical Moms even when 90 still want to be the mom when adult child needs to take over a bit more. If there was a bad relationship it wont get better as get older. |
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Sibling Relationship
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Older adults
Relationship is even more important for unmarried or widowed women As we get older sib relationships more important. Know your story Tighter bond Loosen with kids and marriage but gets back strong Widowed sib then sibs get more stronger bond |
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Change in image of grandparent
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Previously
Old person in rocking chair Currently Active, vital older adults, more role in raising grandchildren Changing role of older women More likely to maintain active lifestyle and friendships following death of spouse |
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Grandparent/ Grandchild Relationship
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Previously GPs saw relationship with GC as “pleasure without responsibility” [Albrecht, 1954]
Currently GPs take a more active role, especially when divorce, surrogate child care, and lower socioeconomic status GPs sometimes seen as Role models/mentors because parents more busy working Younger the grandparent the more active in childs life |
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Older vs Younger GP style
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Younger GPs tend to take more active role [child care disciple, advice] [Thomas, 1986]
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Degree of closeness with grandparent
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GMAs report closer relationships that GPAs
Women share more info, show more interest and detail GPA more instructional how to do something |
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Stats
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4.9 million children (7 percent) under age 18 live in grandparent-headed households.
Approximately 20 percent of these children (964,579) have neither parent present and the grandparents are responsible for their basic needs. Grandparents a lot of responsibility- paying for food and needs when in this time they need to be slowing down on that area and retirement. Worried if they wont be able to retire because children are expensive. Worried about their output and health. |
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Fundamental Concern
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Physical, financial and emotional condition of the GPs
Dont have the support network that someone younger would have. Need to find someone they can relate to but hard to. Lose friends Social probs, health probs, financial probs lead to isolation from social life |
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Challenge for GPs with surrogate role
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Stress-related illness- very high! Feel if something happens to them where will kids end up. Delay diagnosis or ignore it so illnesses sta ged and diagnosed later.
Social isolation Financial difficulties Minkler & Roe, 1996 [African-American GMAs study] GMAs likely to diminish their own health problems due to fear of GC placed in foster care Many working full- or part-time and need to obtain child care May also be caring for other family or community members- stretching themselves very thin. |
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Factors contributing to GP caregiving
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Alcohol and Drug Abuse
Neglect, Abuse, and Abandonment Death of a Parent HIV/AIDS Divorce Unemployment / Poverty Parental Incarceration Teen Pregnancy Welfare Reform |
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Types of Support
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Emotional
Family members Social groups- diminishing Financial-not making enough to take care of a child only themselves so harder to get aid. Difficult to obtain |
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GPs reported high levels of
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Anxiety
Depression Stress Frequent illness- because of stress more prolonged illnesses They still were willing to sacrifice their own needs to meet GCs’ needs |
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Family vs. Friend...
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Allan, 1979
3 ways to distinguish Friendship is a personal relationship that is seen as involving individuals as individuals not as members of a group or collective Lacks formality Allows person to be relaxed and be themselves Just involved with them because you like them Choice not an obligation |
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Family vs. Friend ..
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3 ways to distinguish
(2) Voluntary nature of relationship Free-choice!! Selection of individuals Joy is derived from the friendship itself not just an activity done with the person |
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Family vs. Friend .
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Allan, 1979
3 ways to distinguish (3) Non-exploitive nature of the relationship Friendship formed for itself not for ulterior motives Reciprocity Symmetry- need to feel both getting something |
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Later Life in Friendship
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Lifelong friendship
Closest confidants Understand each other well History that helps support each other Get rid of those who take a lot of effort keep those who you get something back from. |
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Qualities in Later in life Frienship
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Report more closeness than younger friendships
1 or 2 ppl vs 30 when young Do not have to have constant/frequent contact to remain friends- can be months and monthst but when together pick right back up |
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Factors in Later in life Friendships
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Matthews (1986)
(3) Factors that make friendship later in life unique (1) the physical reality of illness and death (2) the long shared histories of individuals (3) the importance of having friends one’s own age Little stuff gets pushed off because have more realization |
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Friendship Styles
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Different types dependent on the purpose of the friendship and personality of the person(s) involved in the friendship
Highly engaged person vs one friend person and expect you to have only them as a friend then person in middle more between both |
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Functions of Friendship
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Psychosocial Wellbeing
The strongest predictor of positive psychosocial wellbeing in older people is having at least one confidant. Someone who care about you Has a high level of involvement |
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cont...
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Homophily- someone else like you, similar values and backgrounds
Voluntary nature of relationship Relationships involve more people from their community than family relationships Self Disclosure- need to share things on both ends give and take Informal social support Support without guilt or obligation Consideration of inconvenience being experienced by friend/caregiver |
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Gender differences in friendship
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Women tend to be better off in friendship later in life
Men report fewer intimate friendships that are less supportive in nature May be related to societal expectations More difficulty if they havent had those friendship in the past More superficial friendships, less detail Find its a sign of failure if they have trouvle with something |
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cont...
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Barriers to older male friendships
Men are socialized to be competitive- wanna be better than the next guy Lack skills to maintain intimate friendships Men don’t show affections easily Men have a need to be in control of a relationship As a result most male friendships are work/role/activity related |
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Friendship in Nursing homes
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Physical (bed bound or isolated) and Mental barriers exist
Environmental barriers Can be rich with communicative interactions depending on nursing home situations Tied to who you have friendships with and access to - in your housing wing. (Memory care, dementia ) Determinates of friendship Lucidity- able to share and discuss things Ability to speak- people who dont speak as much its harder to be friends with Ability to see- recognize, engage |
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Retirement as a new concept
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Usually only in well developed countries- third world countries cannot afford it.
They way we retire is different than how people in Europe retire and other countries. Must have enough workers to support the needs of the country Must have enough money set aside to pay for them not working Must have a positive attitude towards older people not working- need to want to give people what they deserve. First time in history where there will be 5 generations of people in the work force. Problematic because younger people will not be able to move up in work force cuz older people have them and wont leave. Started because they needed the older people to get out so they can get a younger and faster clientele. They started allowing them to have their peace and not have to work til they died. But.... Wont support them so thats here social security and retirement funds came into play. |
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Patterns of retirement
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Partial Retirement- slowing down your schedule. Doing the same job but not as many days. Job sharing and splitting hours. Very popular, can stay active but have more time to rest and maintain most but not all benefits. Not as stressful because have been doing it
Bridge Jobs- need to leave their field but cannot afford to completely retire so get another job in another field. Alot of places where theyre forced to leave “Unretirement”- retire but then realize they cant afford to or dont want to stop working so they go back to job. (Same job) |
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Economic Status of aged adults
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Substantially lower cash incomes
7.9% live below poverty level % may be significantly higher with recent economic changes and new definitions of poverty- when you retire you dont make as much as you did when you were working so need to change lifestyle. More women than men 85+ population: 16% men and 23% women- historic pattern of women not getting paid as much as men/ take time off for children Percentage in poverty varies by ethnic group Caucasian: 10% Hispanic: 23% Black: 34% |
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Poverty Line
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"absolute poverty line"
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 provide the food, shelter and clothing needed to preserve health. Traditional 12/13000 dollars Many flaws dont take into consideration people in household only what youre making. "Orshansky Poverty Thresholds“ 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 New supplemental Poverty Formula |
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Supplemental Poverty Line
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Takes into consideration:
Child care Housing Medical Treatment Utilities Will increase the number of people of over the age of 65 yrs under the poverty line from 9.7% to 18.7% |
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Economic Status of Aged Adults
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Financial problems may result in emotional problems
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Retirement Income
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Tripod Structure
- Social security - has become larger source of elder income than employment program income Private Pensions -Moderate increase Individual savings or other assets -Income from assets has dramatically increased |
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Effect of Social Security
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Has helped institutionalize and promote retirement
Makes retirement a social legitimate transition ans life cycle. Has provided a reliable source of income of older Americans. Created financial disincentives to continued employment |
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Retirement Income
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Has significantly increased
But... the elderly have not shared equally in the increase Disadvantaged: jobs don’t allow them to collect maximum money benefits, pensions, or to accumulate wealth -Low wages with negligible fringe benefits -Poor job security -Race and gender issues |
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Retirement Income
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Elderly women
-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 of 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 Women have cumulative disadvantage of persistent patterns of pay inequity |
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Tripod: SSI
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Biggest source of income for those over 65
16% of US population of retired elderly, disabled, and family dependents receive SS payments Current eligibility requirements 65 years old ( if born before 1937; 67 yo: 1960 or later ) 62 for partial benefits ( reduced by 20 to 30%) Wage earning history in a job covered by social security Be married to a spouse with that history |
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SSI example
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$20,000
At your current earnings rate, if you stop working and start receiving Social Security benefits... At age 62, your monthly benefit will be about...$826.00. At full retirement age (67 Years and 00 Month(s) for you), your monthly benefit will be about...$1,173.00. At age 70, your monthly benefit will be about...$1,455.00. |
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Tripod : Pensions
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Contractual plan by employer to provide regular income payments to employees after they have left employment [typically retirement]
Become widespread after WWII Not universal for elderly ~ 45% of households over 65 have private pensions plans Proportion is declining |
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Tripod : Pensions
Different types of plans |
Defined Benefit
Defined Contribution Cash balance |
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Tripod: Pensions
Defined Benefit Plan |
certain amount of money will be promised for the remainder of your life
Promises a specific or defined amount of pension for the remainder of life Company has to set aside funds to cover this |
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Tripod: Pensions
Defined Contribution Plan |
Employers, employees, or both contribute money-for ex. they give 3% and you give 3% and you get the combination
Amount 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 |
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Tripod: Pensions
US employers are not required to provide pensions... |
If they do, they have to satisfy the legal requirements
retiring is your own responsibility |
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Tripod: Pensions
Employment Retirement Income Security Act |
Employment Retirement Income Security Act [ERISA, 1974]
Protection for workers and retirees Regulates private pension plans and provides protection against loss of benefits to retired workers -Protection is not absolute -Pension can be terminated if company goes out of business or merges with another company -Employers are not required to include those that work < 20 hours/week -Problem for recent tremendous growth of part-time employment |
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Tripod: Pensions
Pension Benefit Guaranty Corporation [PBGC] |
Federal agency established to protect pensions when companies cannot meet their obligations
Has a deficit of $34 billion (2012) in underfunded obligations in the future for bankrupt or financially ailing companies Could be major problem for future generations Does not include healthcare benefits |
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Tripod: Pensions
Vesting Rights |
The period in which the employee must meet the employer’s eligibility requirements to collect pension
If leave a job before becoming vested [typically five years], not eligible for benefits Critics have proposed a pension portability plan so pension rights can be transferred when changing jobs |
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Tripod: Pensions
Early Retirement Benefits |
Early Retirement Benefits
Typically eligible at 55 or 60 Age is likely to increase with increase in SSI benefit age May be used to encourage older workers to retire to save jobs for younger workers in a system of “downsizing” Employees who opt to retire early may face a reduction in employer sponsored health benefits at a later date |
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Tripod: Pensions
Tax Incentives |
IRA: can accumulate money until retirement on a tax-deductible and tax-deferred basis
KEOGH and 401K: KEOGH- for self employed individuals Same basic purpose No income limitations |
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Tripod: Assets and Savings
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Assets
Accumulated over a lifetime Reflect life circumstances Tangible: home Financial: stocks Second to SS as a source of elder income ~ ¼ of retirement income Older households tend to have more assess and more accumulated wealth than younger adults At least until the age of ~ 80 |
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Tripod: Assets and Savings
Net Worth |
Total value of assets
-Real estate -Savings -Personal property minus debt |
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Tripod: Assets and Savings
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Reverse Mortgage
-Conversion of accumulated value of home into regular monthly income guaranteed by a bank for the remainder of life ( or years that it is predicted you will live) --Bank claims ownership of home upon death When home ownership is removed from equation, net worth of elder is ~ $23,000 -interest bearing checking -Savings -Stocks/bonds -Other real estate |
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Tripod: Assets and Savings
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Distribution of assets differs dramatically according to social class, gender, and ethnicity
Difference for men and women is not great, but for married couples it is great Supports the idea of the importance of marriage for financial well-being in later life Median net worth of caucasian households is 3-4 times greater than that of older blacks |
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Medicare
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Part A-if you work and you get to the age of 65 you qualify for Part A
Part B Part C Part D |
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Part B
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Covers 80% of costs associated with office visits and related services when a prescribed or referred by a physician--you pay 20% of bill
Premium has increased to $104.90 per month in 2013 for the lowest income levels Goes up as income increases Has a deductible ( currently $147.00) covered: doctors visits, MRIs, bloodwork, CT scans Vision, hearing, and dental is NOT covered |
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Part C
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Supplemental insurance that helps pay for the % not paid for in Part B
Additional monthly premium required to pay you can chose which Part C you want...5 % 10% with Part C you can pay to have dental...premium just goes up with everything you want covered |
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Part D
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Prescription
In the beginning you have an amount of money to pay out of pocket (depends), once you meet that deductible, you meet where the drugs are paid for, once you use a lot as in $3,000 worth of prescription, you have to pay out of pocket (depending on plan), then you move into a period of coverage again until you get to the point where you’ve exceeded coverage again Think of donut Additional premium required |
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Where to live?
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Options:
Home Relatives Retirement Complex/Community-anyone over the age of 55 Assisted Living-more apartment-like and there is more connection between units, you can select what care you need...for ex. someone taking your blood (not completely dependent) Nursing Home-complete support |
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Caregiving
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More than 65 million people in US is currently an informal caregiver 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 caregiver Only 8% receiving care are getting it just from formal care providers The typical family caregiver is a 49-year-old woman caring for her widowed 69-year-old mother who does not live with her. She is married and employed. Approximately 66% of family caregivers are women. More than 37% have children or grandchildren under 18 years old living with them. |
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What do they do?
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Many tasks…depending on the level of the pt they are helping
Starts usually as a distance relationship…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 difficultly the person is having May evolve to toileting, dressing, eating, bathing, other basic care elements Some also become more directly involved with medical treatments…giving meds, injections, changing dressing |
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Who becomes the caregiver?
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Personality factors, family dynamics, quality of the relationship prior
Personality-Usually the person who can’t say no Some people are comfortable with certain aspects of caregiving but not all Incontinence is often a main reason a person is admitted into a nursing home Those who seek alternative care often feel guilty |
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The choice must be supported
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Acknowledge that not everyone is meant to be a caregiver
Also some of the people 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-communicate that (helpful people can overdue sometimes) |
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Physical Impact of Caregiving
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Caregivers suffer from serious, clinically 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 |
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Psychological Well being
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Clinical depression-start to isolate themselves, withdraws from things that kept their happiness
Reported increased feelings of stress Lower levels of subjective wellbeing Lower levels of self efficacy-feel like they can’t do things and feel inaffective |
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Social Impact
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Decrease in the 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 have 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 outside help when they could use it the most May feel unworthy or guilty if they do something for themselves |
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Financial Implications
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May have to quit or reduce the amount 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 |
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Benefits of Caregiving
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May be personally rewarding, boosting 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 |
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For the care receiver
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They get to stay in their own home or with family
They feel comfort and familiar Love |
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How can health care professionals support care givers?
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Encourage collaboration 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 just the caregiving routine Use adult daycare facilities to give a break and allow the pt to socialize as well Caregiver needs to be encouraged to take mini-breaks or vacations-get to live their own life HCP need to recognize the contribution 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 |
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Elder Abuse
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Authorities often do not see it as a crime or cannot differentiate it from age-related illness or disability
8 reports of elder abuse for every 1000 elders Majority occurs at the hands of adult children or spouses Usually occurs as a result of elder dependency and care giver stress. If the caregiver has a negative view towards the elderly this contributes significantly They are not going to get better or be any better if you help them or not Abusers usually have little or poor knowledge of the aging process or illnesses. |
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Elder Abuse cont...
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Late 1970s: First recognized as a social problem
Inconsistent and shifting definitions Advisory committee of experts Analyzed and revised definitions Physical abuse Sexual abuse Emotional abuse Financial abuse Abandonment Neglect Self-neglect-not doing things for themselves |
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Physical Abuse
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The use of physical force that may result in:
Bodily injury Physical pain Impairment Includes physical punishments of any kind |
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Sexual Abuse
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Non-consensual sexual contact of any kind with an elderly person
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Emotional or Psychological Abuse
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Infliction of:
Anguish Pain Neglect |
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Financial or Material exploitations
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The illegal or improper use of an elder’s
Funds Property Assets |
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Abandonment
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The desertion of an elderly person by a person who had physical custody or otherwise had assumed responsibility for providing care for an elder
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Neglect
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Refusal or failure to fulfill any part of a person’s obligation or duties to an elder
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Self - Neglect
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The behaviors of an elderly person than 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 threaten his/her health or safety |
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Reported cases of elder abuse
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Represent the “tip of the iceberg”
Difficult to study because of Difficulty obtaining reliable information from both the victims and the perpetrators Victim’s fear of social stigma or reprisal Societal ageism Lack of knowledge of the victims as far as where to turn for help Lack of information and intervention protocols for treatment professionals |
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Abuse and Neglect
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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 |
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Abuse and Neglect
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Estimates of the frequency of elder abuse range from 2 to 10% (Lachs & Pillemer, 2004).
One in 14 incidents, excluding self-neglect, come to the attention of authorities (Pillemer & Finkelhor, 1998). The overall reporting of financial exploitation is only 1 in 25 cases, suggesting at least five million financial abuse victims each year (Wasik, 2000). One large survey of staff working in nursing homes found that 36% had observed physical abuse and 81% witnessed psychological abuse (Pillemer & Moore, 1989) |
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Abuse and Neglect
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Complex problem
More than one type of abuse may occur at the same time ~ ¾ of cases |
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Abuse and Neglect
Who are perpetrators? |
Who are the perpetrators?
90%: 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 [mostly likely perpetrator Less overt forms of abuse Subtle indignities Insensitivities Overuse of medications |
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Who are the perpetrators?
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Others
Financial abuse Acquaintances who try to separate the elders from their money and/or other resources Those in a position of trust 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 |
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Financial Abuse
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Typically 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 Fraudulent investment opportunities Pyramid schemes Credit repair schemes Phony charities Insurance frauds |
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Telemarketing Fraud
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Significant and growing problem
Estimated over $40 billion annually Elderly may be a target of schemes because they are: Easily accessible 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 |
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The self as perpetrator
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Self-neglect: Inability to perform essential self-care activities
Gambling: marketing to elderly Free transportation Cheap meals Social activities |
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Risk Factors for abuse
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Female
80+ Dementing illness of care receiver Abusing caregiver |
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Situational Stress Model
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Abuse results when over-burdened caregivers suffering from overwhelming stress related to caregiving take out frustrations on care receiver
Empirical evidence has not supported this-people won’t tell on themselves |
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Transgenerational Violence
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Violent behavior is learned within the family is transmitted from one generation to the next
Little evidence to support this |
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Double directional violence
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Caregiver and care receiver are both abusive
Especially occurs with demented patients |
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Psychopathology of the Perpetrator
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Problem behaviors related to abuse-individuals who have not been able to keep jobs (aren’t always the appropriate people to do the job)
Mental disorders Substance abuse Dependency on care receiver Wolf & Pillemer, 1989 ~ 2/3 of perpetrators of physical abuse were dependent on their victims |
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Social Exchange Theory
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Idea of reciprocity or a fair distribution of rewards within relationships
Elder may feel devalued due to ageism and have lower social status implying less attractive partner in relationship or even a burden Must provide higher levels of compensation as part of exchange bargain “ugh you need your bed changed again” eventually this builds up and they feel they shouldn’t complain anymore |
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Empirical Evidence: Caregiver characteristics
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Substance abuse
Cognitive impairment Lack of caregiving experience Economic difficulties Abused as a child Stress Social isolation Blaming others Lacking empathy Hypercritical attitude Lack understanding Unrealistic expectations Financial dependency Other family or marital conflicts Reluctant to give care |
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Empirical Evidence: Victim characteristics
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Older
Female Dependent Alcohol abuser Socially isolated History of past abuse- abusing or being abused Marital or family conflicts- separated from family Difficult behavior Demanding Unappreciative Unrealistic expectations of caregiver |
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Elder Abuse Policy
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No National policy for elder abuse
Each states legislates its own policies on what constitutes abuse and how and by whom it is to be addressed (determined by each state) 42 states have mandatory reporting whenever there is evidence of abuse |
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Intervention
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Approach is similar to child abuse
Mandatory reporting by professionals If professional report suspected abuse are they violating privacy or confidentiality? How serious do the signs have to be to prompt reporting people against their will? What happens if the accusations turn out to be false? Could reporting abuse only make it worse? |
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Intervention
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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 techniques Arranging comprehensive care resources Providing counseling for troubled families Encouraging the use of respite care and day care Informing families about resources for meals, transportation, in-home care Utilizing the long-term-care ombudsman program to address quality of life issues in long-term care Encouraging caregivers to pursue individual interest for self-care |
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Protective Placement
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Similar to child abuse cases but it punishes the victim and counters the victims right to self-determination
Often results is nursing home placement while leaving perpetrator free May lead to lack of reporting or denial in intervention |
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End of Life Decisions
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Becoming more common
Debate about “right to die” choices Forgoing life-sustaining treatment to assisted suicide With increased cost of medical care, may see movement from individuals claiming to have the right to die to health care providers or policy makers suggesting some people have the “duty to die” to stop futile medical treatment that uses up scarce resources Patient’s beset interest may or may not coincide with the interests of the family or health care providers |
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Late- Life suicide
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Refuse treatment or just let death occur
Are elderly mentally competent to make “rational” decision? Depression rate in elderly is high May be in grieving stages [Kubler-Ross] Inability to make rational decision in any stage but acceptance Suicide rate among elderly is nearly 50% higher than the rate for the general population |
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Voluntary Suicide
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Elderly die for fear of becoming burden to families
Someone diagnosed with a life changing disorder (ex) |
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Anomic Suicide
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Person feels hopeless or cut off from any sense of meaning
of life Later in life They do not know where they fit in to life Role loss Death of spouse Loss of social position |
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Egoistic Suicide
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Prolonged sense of not belonging
Old-old who have out-lived most of close relatives 100's Why am i still here? Waiting to die. |
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Suicide General Rule
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General rule
Rate tends to peak after age 65 Estimates are uncertain because there are 100 suicide attempts for every completed suicide Among elderly, 80% who threaten will follow through Among the ill, there is no way to determine how many will end their lives by medical non-compliance or other forms of self-neglect (are they confused or do they really wanna go through with it |
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Different rates for subgroups of elderly
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Rate for blacks is 60% that of whites (whites more suicide)
-Does not increase in older age -Minorities less because seem to be more close knit Men more likely than women -Difference gets bigger with advancing age -Because usually only talk to one person vs. women who talk to more people about their problems |
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Characteristic conditions preceding late-life suicide
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Loneliness; social isolation
Little economic resources Presence of illness or disability Depression |
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Legal Issues
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Ethics of death and dying began to be discussed in late 1960s
Brain death – when does it occur? Karen Ann Quinlan [1976] In a coma at age 21 Parents requested mechanical respirator be discontinued as an “extraordinary means” of sustaining life On appeal, Supreme Court rule “right to privacy” to permit withholding or withdrawing life sustaining treatment Went into nursing home after respirator turned off and lived nine more years |
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Right to die legislation
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Stimulated by Quinlan case
Right to accept or reject treatment Right can be exercised by another person on behalf of someone who has become legally incompetent Guardian at litem- should have same thoughts and feelings as you do |
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Advanced Directive
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Legal documents that allow you to convey your decisions about end of life care ahead of time. Say what you are okay with and what you are not. Never a complete form.
They provide a way for you to communicate your wishes to family, friends and health care professionals, and to avoid confusion later on. A living will tells how you feel about care intended to sustain life. You can accept or refuse medical care. There are many issues to address, including (may change it with life) The use of dialysis and breathing machines If you want to be resuscitated if breathing or heartbeat stops Tube feeding Organ or tissue donation |
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Living Will
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Used to guarantee patient’s wishes have been followed but doesn’t answer all end of life decisions
Do the terms of the will fit the current situation? Ex. Will says discontinue care if have something terminal; patient has a stroke that was extensive and irreversible but not in a coma. Is irreversible the same as terminal? |
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Healthcare Proxy and Medical Durable Power of Attorney
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Person who has the authority to make medical decisions on another person’s behalf.
Should be able to understand the treatment choices and most importantly know the person’s values, and would support their decisions. legally entitled to refuse or discontinue treatment Courts have repeatedly determined that termination of life sustaining treatment is not homicide, suicide or assisted suicide |
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Hospice
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Federal program for end of life care
Limited to patients with prognosis of 6 months or less Focus in on managing symptoms of illness rather than curative treatments Covered benefit under Medicare [1983]- will provide you anything, medication addiction isnt a issue A change in philosophy from individual centered to family/community centered Palliative Care- comfort, doing what we can so last days of your life you arent hurting. Family centered, how do we treat the group/family. Have grief counselors. Home or hospice center. Hospice center- no visiting hours, lots of space, pull out couches etc vs. a hospital You choose where you want to be (home or hospice center) |
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Successful Theories of Aging
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Stay mentally and physically active
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+ Add a hint
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