Sunday, August 14, 2011

Answers to Psyche #4 Review from eLearn

Review Test #4 - Chapters 15-19

Chapter 15: Middle Adulthood (phys/cog)

  1. What is the general theory regarding decline in neural functioning?

- parts last to develop are first to decline

  1. What is happening with synaptogenesis and synaptic pruning in middle adulthood?

- decrease; wm and gm lessen

- decrease in frontal:motor/cog and parietal: sensory/touch

  1. Explain what the term climacteric means. (give an example for males and one for females.)

- period in middle adult where reproductive capacity declines/is lost

- Men - andropause: decreased testosterone/sperm

- Women - menopause: cessation of menses

  1. What is menopause? List and describe the 3 phases.

- cessation of menses: 1 full year

- Pre: menses irregular; anovulation (egg not released during ovulation)

- Peri: spikes and drops in Estrogen and Progesterone - leads to hot and cold flashes

- Post: cessation of menses (1 full year); E&P decreased - weight redistributed; skin elasticity, sagging breasts; drop in libido/vaginal secretions; loss of bone mass; mood swings

  1. What does the term osteoporosis refer to? Is it more common in men or women? (why?)

- loss of Ca+ from bone leading to porous bone

- more common in women because of decrease in estrogen; estrogen is good for bones

  1. Explain what the terms presbyopia and presbycusis mean? What area of the body does each effect?

- presbyopia: visual - inability/decline to see objects that are near

- presbycusis: audio - inability to hear high frequencies

***both primary aging; but secondary aging can increase presbycusis

  1. What is the number one cause of death for people in middle adulthood? Why are people with a type A personality at a higher risk? What are some other risk factors? Is this a primary or secondary aging effect?

- #1 cause: cardiovascular disease; type A more prone because of stress; other risk factors: smoking, diet, sedentary lifestyle; high fat diet;

- these are secondary aging effects

- primary would be: age

- Type A personality pattern is associated with greater risk of CVD; it includes competitive achievement striving, a sense of time urgency, and, sometimes, hostility or aggressiveness

- Some facets of Type A personality (especially hostility) produce higher risk

  1. What is the second leading cause of death in North America? Is this a primary or secondary aging effect?

- #2 cause of Death: Cancer; secondary aging

  1. Explain Denny’s model of aging (figure 14.5).

- proposes that changes with age on nearly any measure of physical or cognitive functioning follow a typical curve

- Unexercised abilities will generally have a lower peak level of performance; exercised abilities will generally have a higher peak

- Any skill (physical or mental) that is not fully exercised can be improved, even in old age, if the individual begins to exercise that ability

- With increasing age a high level of functioning requires more and more effort, until eventually every adult reaches a point at which even maximum effort will no longer maintain peak function

  1. Is it true that learning declines as age increases? Explain why or why not.

- Middle-aged adults seem to be just as capable as younger adults of learning and remembering new information

- Middle-aged students tend to be more academically successful than their younger peers, but this may be due to both motivational differences and the greater amount of background knowledge

- While research does not show significant differences in learning new job skills, employers believe young adults outperform older employees in this respect

  1. Women live longer than men but suffer from more disease and disability as they age. Explain this statement; how/why is it true?

- True

- women suffer from more disease and disability r/t living longer

- disability increased in women r/t arthritis (bone loss) due to decrease of estrogen in menopause which is essential for healthy bones

- men have higher instances of death from CVD and Cancer

Chapter 16: Middle Adulthood (soc/personality)

  1. Explain Erikson’s theory for middle adulthood

- Generativity vs. Stagnation - Middle-aged adults find meaning in contributing to the development of younger individuals

- Generativity: A sense that one is making a valuable contribution to society by bringing up children or mentoring younger people (teaching, mentoring, leading in civic, religious or charitable organizations)

- Generativity is positively related to mental health at this age, and is a more prominent theme for women than for men

  1. Why is the term “mid life crisis” less relevant to today’s middle aged adults? (compare life in the 60’s vs today)

- The term mid-life crisis was coined in the 1960s, when major events along life’s timeline were relatively lockstep and predictable, especially for men (school – work – retirement – death)

- Midway between school and death, a person’s perspective shifted from “time since birth” to “time left before death”

- The realization of the inevitability of death, along with other indicators of time passing, seemed to be a universal phenomenon that hit people during their 40s

- Now, however, the timing and nature of major life events have changed dramatically

  1. What is a role conflict? What is role strain? Give examples for each that are specific to middle adulthood.

- Role Conflict: any situation in which two or more roles are at least partially incompatible, either because they call for different behaviours or because their separate demands add up to more hours than there are in the day

o example: a 35 year old single mom going back to school

- Role Strain: the strain experienced by an individual whose own qualities or skills do not measure up to the demands of some role

o example: an adult trying to take care of an ill parent but not having the adequate knowledge, skill, or tools to perform task

  1. How does marital satisfaction change during middle adulthood? Why?

- Marital stability and satisfaction increase in mid-life, reaching higher levels than at any time since early marriage

- Why: skilled diplomacy - better problem solving; increased level of control; greater satisfaction with careers/finances - less stress

  1. Explain the term sandwich generation. How does this impact people in middle adulthood?

- Sandwich Generation: taking care of children and aging parents = caregiver strain/burden

- Caregiver Strain/Burden: affects time; stress of watching aging parent and watching disease process in parent; financial pressures

  1. Explain the term “empty nest syndrome.” Who is more likely to suffer from empty nest syndrome in today’s North American culture? Why is it less common in North American culture of today?

- empty nest syndrome: the loss a parent experiences when children leave home

- person’s who identify as a parent first or only as a parent experience stress during this time; they need to redefine themselves

- less common today b/c both parents are in work force and don’t solely identify themselves as a parent only

  1. List and describe the 3 types of grand parenting.

- Remote relationships: grandparents do not see their grandchildren often

- Companionate relationships: grandparents have frequent contact and warm interactions with grandchildren

- Involved relationships: grandparents are directly involved in the everyday care of grandchildren or have close emotional ties with them

  1. How can aging parents impact middle aged children (ie explain caregiver burden).

- Caregiver Strain/Burden: a term for the cumulative negative effects of caring for an elderly or disabled person

- Caregivers with good support networks (including a supportive spouse) and help from other caregivers experience fewer negative consequences

  1. What is occurring with job satisfaction in middle age? Why is it different for men and women?

- Work satisfaction is at its peak in these years, despite the fact that most adults receive few work promotions in middle age

- The quality of work performance remains high, despite declines in some cognitive or physical skills

- Middle-aged men begin to disengage from their work as a primary source of personal fulfilment or satisfaction, but are likely to be more pleased with the work itself

- If women begin to work steadily in their 30s and 40s, the middle adult years may be the time of the most rapid work advancement rather than simple maintenance of previous gains

  1. What is the difference between voluntary and involuntary career changers? List pros and cons for both types.

- Involuntary career changers:

o Example: Fired or Laid Off

o Experience more mental health disorders and physical illness (including higher levels of mortality)

o Financial stress and deterioration in marital relations are direct and indirect causes

o Level of impact is related to coping skills and strength of supportive relationships

o Reemployment reverses these trends

- Voluntary career changers leave one career to pursue another for a variety of internal reasons, such as finding a new job that is more fulfilling

o The tendency to change careers may have a genetic basis (McCall et al)

o Such changes are a by-product of personality

o Voluntary changers have a higher risk tolerance

o Change can still be stressful, resulting in the same effects noted in involuntary changers

  1. Recall the big 5 personality traits (OCEAN) what changes are seen and what aspects remain continuous?

see Table 9:2

Chapter 17: Late Adulthood (phys/cog)

  1. What does the term gerontology mean?

- the study of aging

  1. What is the average life expectancy for a human? Explain the difference between the Subgroups (young old, old-old, oldest-old) which is the largest growing demographic today?

- Males: 82; average 80 yr old more likely to live to 90

- Females: 87; average 80 year old more likely to live to 92

- Subgroups:

o young-old: 60-75

o old-old: 75-85

o oldest-old: 85+

***oldest-old fastest growing r/t: From 1981 to 2000, the over-65 population in Canada increased by about two-thirds, and the over-85 population almost tripled

  1. Explain figure 16.1 (age and perception of health) how does ones perception of health change as they age?
See Figure 17:1

- The majority of older Canadian adults across all three age subgroups regard their health as good or excellent

- Poor health is proportionately higher than in younger groups

- Fair or poor health is self-reported by 32 % of those over 75 years of age

- Health is the single largest factor determining the trajectory of an adult's physical or mental status over the years beyond 65

- An optimistic view helps seniors recover better from illnesses such as stroke

- Chronic illness at age 65 is predictive of more rapid declines in later life

  1. What do the acronyms ADL and IADL stand for (give examples)

- Activities of Daily Living (ADLs): self-help tasks such as bathing, dressing, and using the toilet

- Instrumental Activities of Daily Living (IADLs): more complex daily living tasks such as doing housework, cooking, and managing money

  1. Explain some theories related to longevity (biological, genetic theories)

- Hayflick limit:the theoretical proposal that each species is subject to a genetically programmed time limit after which cells no longer have any capacity to replicate themselves accurately

- Telomere: string of repetitive DNA at the tip of each chromosome in the body that appears to serve as a kind of timekeeping mechanism

o The number of telomeres decreases each time a cell divides

o If there is a crucial number of telomeres, disease or death may come quickly once that number is passed

  1. What are some factors that can influence longevity? Do genetics play a role in predicting longevity? (recall twin studies)

- Individual Heredity

o There is a large range of individual differences in how long people live

o Some general tendency toward longevity is clearly inherited

o Identical twins are more similar in length of life than are fraternal twins

o Adults whose parents and grandparents were long-lived are also more likely to live longer

- Health Habits:

o The same health habits are important now as in earlier years

§ Smoking, low levels of physical activity, significant under- or over-weight predict increased death risk

o Smoking limits longevity: 65-year-old male smoker can expect to live six years less than a non-smoker and a female smoker will live 8.5 years less

o Smokers are also more likely to suffer disease related disabilities—by age 65 more than half of all smokers will have a disability (compared to one-third of non-smokers)

o Physical exercise is clearly linked to greater longevity and lower rates of diseases such as heart disease, cancer, osteoporosis, diabetes, gastrointestinal problems, and arthritis

§ Delays admission to nursing homes

§ Improves strength and motor skills after only 12 weeks of exercise

§ helps maintain higher levels of cognitive performance among the elderly

o Physical exercise is even more important in later years than in youth

o As much as half of the decline in physical (and perhaps cognitive) function can be prevented through improved lifestyle, especially exercise

o Still, only 27% of older adults are active enough to see these benefits

o Canada’s Physical Activity Guide recommends 30 to 60 minutes of exercise daily, that can be accumulated in segments of 10 minutes or longer

o Obesity in this age group is rising (19% for men, 27% for women)

  1. What are the 4 changes seen in the aging brain? Which is the most significant? Explain.

- Four main changes occur in the brain:

o a reduction of brain weight

o a loss of grey matter

o a loss of density in the dendrites

o slower synaptic speed

- Most significant: loss of density of dendrites results in slowing of synaptic speed, slowing of reaction time

  1. How do the senses (vision, hearing, smell and touch) change with age?

- Vision

o Presbyopia (farsightedness) increases

o An enlarged "blind spot" on the retina reduces field of vision

o The pupil does not widen or narrow as much or as quickly resulting in more difficulty seeing at night and responding to rapid changes in brightness

o Diseases of the eye (in a minority of people) such as cataracts or glaucoma, further diminish visual acuity and adaptability

o Younger people cope better with changes in vision

o Vision loss has a greater impact on an elderly person’s sense of well-being

- Hearing:

o Presbycusis isn’t usually functionally limiting until late adulthood

o Men lose more hearing than women do, likely due to more occupational exposure

o The ability to hear high-frequency sounds (part of human speech) is diminished

o Word discrimination becomes problematic, especially under noisy conditions

o Tinnitus, a persistent ringing in the ears, increases

o Severe hearing loss is associated with social and psychological problems

o Physical changes in the ear contribute to problems

- Taste, Smell, and Touch:

o The ability to taste the four basic flavours does not seem to decline over the years of adulthood

o Other changes in the taste system do affect taste:

o less saliva

o flavours seem blander, but this may be a result of a loss of the sense of smell

o The sense of smell clearly deteriorates in old age

o Loss of smell/taste can result in nutrition problems

o A loss of sensitivity to touch, cold and heat can have safety implications

  1. What does the term dementia mean? What is the leading cause of dementia?

- Dementia: a neurological disorder involving problems with memory and thinking that affect an individual’s emotional, social, and physical functioning

- Dementia is the leading cause of institutionalization of the elderly in Canada, especially women

  1. What is Alzheimer’s disease?

- A very severe form of dementia

- Early onset is slow, with subtle memory difficulties and repetitive conversation, and disorientation in unfamiliar settings

- Memory for recent events goes next

- Memory for long ago events and well rehearsed cognitive tasks are retained until late in the illness, as they can be accessed by many alternative neural pathways

- Eventually failure to recognize family members, inability to communicate, and inability to perform self-care occurs

- Changes in appetite regulation may result in significant overeating

- Facial expressions and emotions of others are difficult to process

- Some can not control their own emotions, and display sudden bursts of anger or rage, or become excessively dependent

- As many as 40% may be depressed

  1. What are some issues with diagnosing Depression in late adulthood? What does the term dysthymia mean?

- Mental health is low in early adulthood and slowly improves with age, but depression is a complex issue in the elderly

- Diagnosis, Definitions and Prevalence:

o Signs of depression in older adults may be dismissed as old-age “grumpiness” by family members (ageism)

o Depression is often left untreated by health professionals

o Depression can be mistaken for dementia because both share symptoms of confusion and memory loss

o Depressed mood (Geriatric dysthymia) may be mistaken for clinical depression

o Geriatric dysthymia does not usually progress to clinical depression and is related to life stresses

o Clinical depression is less common, but when it occurs, problems are of long duration and are severe enough to interfere with the ability to carry out normal activities

  1. What happens to memory in late adulthood?

- Among the young old (aged 65-75), cognitive changes are still fairly small

- But the old old and the oldest old show average declines on virtually all measures of intellectual skill, with the largest declines evident on any measures that involve speed or unexercised abilities

- Short Term Memory Function

- The more any given cognitive task makes demands on working memory (short term memory), the larger the decline with age

- Younger adults outperform older adults on retrospective memory tasks (remembering something that has happened recently)

- Older adults outperform younger adults on prospective memory tasks in a natural setting, such as their home (remembering an event in the future, like a doctor’s appointment)

o Older adults under-perform on such tasks when in a controlled laboratory setting where there are no external memory cues, such as a calendar or reminder note

- Strategy Learning

o The learning process takes longer for older adults; however, when allowed more time, older adults' performance was more similar to that of younger participants

- Everyday Memory

o On virtually all "everyday" tasks older adults recall less well than younger adults

- Task-specific prior knowledge gives the elderly some recall advantage

- Preliminary Explanations

o Older adults take longer to register some new piece of information, encode it, and retrieve it

Chapter #18: Late Adulthood (soc/cog)

  1. What is Erikson’s final stage of psychosocial development?

- Ego integrity versus despair stage: the last of Erikson’s psychosocial stages, in which older adults must achieve a sense of satisfaction with their lives

- Ego integrity: the feeling that one’s life has been worthwhile

- Reminiscence: reflecting on past experience

o Reminiscence is a positive emotional experience for older adults, that is often seen as a way of communicating their experiences to younger individuals

  1. Explain the differences between the activity theory and the disengagement theory.

- Older adults maintain high levels of performance by focusing on their strengths, and compensating for weaknesses

- Activity theory

o the idea that it is normal and healthy for older adults to try to remain as active as possible for as long as possible

o The most active adults have the most life satisfaction, are healthiest and have the highest morale

- Disengagement theory

o the theory that it is normal and healthy for older adults to scale down their social lives and to separate themselves from others to a certain degree

o Disengagement theory has three aspects:

§ Shrinkage of life space

§ Increased individuality

§ Acceptance of these changes

- The third aspect of disengagement theory is controversial, since it implies a personality change

- Most elders continue to have social involvement

  1. What is the successful aging paradigm? Explain the three components

- Staying Healthy and Able:

o Older people reap the consequences of behavioural choices they made when younger

o When an older adult suffers a stroke or fractures a bone, his willingness to engage in the sometimes painful process of rehabilitation significantly affects his degree of recovery

o Those who believe they can achieve rehabilitation goals are most motivated to participate, and most likely to succeed

- Successful aging has three components:

o Good physical health

§ Good health must be maintained through middle to late adulthood

o The retention of mental abilities

§ engaging in cognitively stimulating activities and hobbies helps older adults retain mental abilities

o A continuing engagement in social and productive activities

§ remaining social active is critical; social contacts that involve helping others are especially important

§ volunteer activities can help by engaging retired adults in productive pursuits

o An additional aspect of successful aging is an individual's subjective sense of life satisfaction

§ older adults must learn how to adjust expectations such that life satisfaction remains high

- The elements of successful aging are interdependent

  1. Explain elder abuse (in your response include forms of abuse, who is more likely to abuse, risk factors)

A hidden, but growing problem:

- Recently, 7% of Canadian elders reported emotional abuse, such as yelling, insulting, threatening, or ignoring; 1% reported financial exploitation and 1% reported being physically or sexually violated

- Male abusers are more likely to commit physical abuse, whereas female abusers are more likely to fail to provide needed aid (neglect)

- Just over two-thirds of all the reported instances of elder abuse involve a non-family member or an unknown person

- The remaining 28% of abuse cases entail family violence and of these cases, 43% of elderly men reported abuse by their adult children and elderly women reported being victimized equally often by their adult children (37%) as by their spouse

- Risk factors for abuse include the following:

o Mental illness or alcoholism in the abuser

o Financial dependency of the abuser on the victim

o Social isolation

o External stresses

  1. How does marital satisfaction change in late adulthood?

- Marital satisfaction is higher in the late years, but is based more on loyalty, familiarity, and mutual investment in the relationship r/t:

o Higher levels of pleasure and lower levels of conflict are reported

o Spend more time with each other than with family or friends, and many provide a remarkable degree of care and assistance to their spouses

  1. How do relationships with adult children change?

- Canadian studies show that between two-thirds and three-quarters of older parents said their children see them at least once a week

- Close family ties are maintained with telephone calls, letters, and e-mail

- Aging parents are most likely to need support with activities that involve physical activity (e.g., lifting, bending)

- Good relationships and regular contact with adult children can add to an elderly adult's quality of life, but are not necessary for it

- Relationships with children involve roles and expectations that may add stress to a senior’s life

Chapter 19: Death, Dying

  1. Define and explain the terms: clinical death, brain death, social death, palliative care, hospice care.

clinical death

o a period during which vital signs are absent but resuscitation is still possible

o Presumably, near death experiences occur in this state

brain death

o absence of vital signs, including brain activity; resuscitation is no longer possible

o the person is considered legally dead

social death

o the point at which family members and medical personnel treat the deceased person as a corpse

o family and friends must begin to deal with the loss

palliative care

o a form of care for the terminally ill that focuses on relieving patients’ pain, rather than curing their diseases

o palliative care programs are offered in home, hospice centres and in hospitals

hospice care

o A holistic approach to care for the terminally ill that emphasizes individual and family control of the process of dying

o death should be viewed as normal, not to be avoided

  1. What are the three certainties surrounding death that everyone comes to understand?

- irreversible

- that it comes to everyone

- it means a cessation of all function

  1. How does age change ones perception of death and dying? Explain the perception of death from the perspective of a young child, adolescent, young adult, middle aged adult and one in late adulthood.

- Children, teenagers, and adults of different ages differ in their understanding of these aspects of death

- young child

o do not understand that:

§ death is irreversible

§ it comes to everyone

§ it means a cessation of all function

o Teaching young children about the nature of biological life helps them understand what causes death and why it is irreversible

o At about school age, most children seem to understand both the permanence and universality of death

- adolescent

o understand the finality of death better than children do, and, in an abstract sense, they understand that death is inevitable

o Personal fable: a hypothetical life story created for himself or herself by an adolescent

o The personal fable contributes to the frequency of teenagers' potentially fatal risky behaviours and to unrealistic beliefs about personal death that may contribute to adolescent suicide

- early adult


- middle aged adult

o The sudden loss of a loved one appears to shake a young adult's belief in their unique invulnerability and, as a result, is often more traumatic for younger, than for older, adults

o Personal experience changes perception of death

§ Experience with death (for example in a healthcare profession) may make it less fearful

§ Loss of a loved one frequently leads to suicidal thoughts

o The deaths of relatively young public figures challenge young people's beliefs in unique invulnerability

§ Young adults look for reasons that death came early to these people, but won’t affect themselves

- middle and late adulthood

o A death changes the roles and relationships of everyone else in a family, as well as the people beyond the family

o Death brings permanent changes in families and social systems

o In middle age, many individuals switch the way they think about time, from "time since birth" to "time until death”

o Those middle-aged and older adults who continue to be preoccupied with the past are more likely to be fearful and anxious about death

  1. Describe the irrational fear that North American culture has created surrounding death and dying (utilize Wong’s perspective in your explanation). How can religion affect this perspective (religious vs atheist)?

- Wong suggests that our fear of death stems from six existential uncertainties

o The finality of death

§ cessation of all hope

o The uncertainty of what follows

§ = fear

o Annihilation anxiety or fear of non-existence

§ incomprehensible that we can cease to exist from a state of being

o The ultimate loss

§ we lose everything we’ve ever valued

o Fear of the pain and loneliness in dying

§ fear of dying alone or in pain

o Fear of failing to complete life work

§ meaningless existence

§ not being able to complete life’s mission or calling

- Fear of Death Across Adulthood:

- For young adults, the sense of unique invulnerability probably prevents intense fears of death

- Middle-aged adults are most fearful of death

- In middle-age, a belief in one's own immortality begins to break down, resulting in increasing anxiety about the end of life

- By late life, the inevitability of death has been accepted, and anxieties are focussed on how death will actually come about

- Older adults are more likely to fear the period of uncertainty before death than they are to fear death itself

- Religious beliefs may moderate fears of death

o Death is seen as a transition from one form of life to another

o The belief that God exists increases with age

  1. Explain Kubler Ross’s stages of death and dying. What criticisms have been made regarding this theory?

- Denial

o Many people confronted with a terminal diagnosis react with some form of denial, a psychological defence that may be useful in the early hours and days after such a diagnosis

- Anger

o Anger often expresses itself in thoughts that life is not fair, but may also be expressed toward God, or toward doctors, nurses, or family members

- Bargaining

o The patient in stage 3 tries to make "deals" with doctors, nurses, family, or God

- Depression

o When bargaining fails as a result of declining physical status, the patient becomes depressed and sinks into long-lasting depression

- Acceptance

o Kübler-Ross views this depression as a necessary preparation for the final step of acceptance since a person must grieve for all that will be lost with death. When such grieving is finally done, the individual is ready to die

- Criticisms & Alternative Views

o Methodological problems:

§ Kübler-Ross's observations might be correct only for a small subset of dying individuals

o Cultural Specificity:

§ Cultures vary considerably in what they believe to be a “good death”

o Exhibitions of denial, anger and bargaining may seem to indicate a lack of faith in religious people who are dying, so may be actively avoided

o The Stage Concept

§ Many clinicians and researchers have found that not all dying patients exhibit these five emotions, let alone in a specific order

§ Schneiderman suggests themes to the dying process, rather than stages

§ Corr suggests 4 tasks for the dying person

§ Health professionals may be able to help the dying person achieve these tasks

  1. Explain the experiment conducted by Greer on Women with breast cancer. What did he conclude?

- Greer classified women's attitudes three months after they were diagnosed with breast cancer:

o Denial (positive avoidance)

o Fighting spirit

o Stoic acceptance (fatalism)

o Helplessness/hopelessness

o Anxious preoccupation

- Those whose initial reaction was either denial or fighting spirit were less likely to die of cancer

  1. What is euthanasia? Explain the difference between active and passive euthanasia. What is a living will? Why is it important?

- Euthanasia - also known as “mercy killing”

o Passive euthanasia:

§ the withholding of life supporting interventions

o Active euthanasia (also called assisted suicide):

§ hastening death by active means

- Living Wills

§ Most people agree that individuals should be able to determine the degree to which life-support technology will be used to delay their own deaths

§ All Canadian provinces except New Brunswick have legislation that recognizes the directives expressed in living wills

§ Living wills usually contain two elements:

· A proxy directive (who will act for you if you can not act for yourself)

· An instruction directive (choices you have made about end-of-life care)