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Chapter 21 Lecture

Access to Health Thirteenth Edition

Preparing for Aging,

Death, and Dying

Did you PREPARE and did you LEARN?

• Define aging and the concepts of biological, psychological, social, legal, and functional age.

• List the characteristics of successful aging.

• Explain how the growing population of older adults will affect society, including considerations of economics, health care, living arrangements, and ethical and moral issues.

• Explain the biological and psychosocial theories of aging and summarize major physiological changes that occur as a result of the normal aging process.

Did you PREPARE and did you LEARN?

• Describe unique health challenges faced by older adults and strategies for successful and healthy aging that can begin during young adulthood.

• Discuss death, the stages of the grieving process, and strategies for coping with death.

• Explain the ethical concerns that arise from the concepts of the right to die and rational suicide.

• Review the decisions that need to be made when someone is dying or has died, including hospice care, funeral arrangements, wills, and organ donation.

Redefining Aging

• Aging is a pattern of life changes that occurs as

one grows older.

• Gerontology is the study of individual and

collective aging processes.

– Biological age

– Psychological age

– Social age

– Legal age

– Functional age

What Is Successful Aging?

• Staying active, through leisure activities and regular

exercise.

• Maintaining a normal weight range.

• Eating a healthy diet containing low levels of saturated

fats, with plenty of fruits, vegetables, and whole grains.

• Participating in meaningful activities, such as

volunteering and other social activities.

• Avoiding smoking and consuming alcohol in moderation.

Older Adults: A Growing Population

• Today, there are 40.4 million people age 65 or

older in the United States.

• The older population is expected to be twice as

large in 2030, growing to 72.1 million.

• The needs of this generation will have a major

impact on the economy, housing market, health

care system, and Social Security.

Number of Americans 65 and Older

(in millions), Years 1900–2008, and

Projected 2010–2050

Health Issues for an Aging Society

• As the number of older Americans increases,

their financial and medical needs become

issues.

• More people will be drawing from Social Security

while fewer people contribute to the system.

• Health care costs to the individual will rise as

Medicare coverage becomes less adequate.

Health Issues for an Aging Society

• Housing and living arrangements will be a

problem for low-income elderly.

• A shortage of donor organs will present difficult

ethical questions.

Living Arrangements of Americans Age 65

and Older

Theories of Aging

• Biological theories

– Wear and tear

– Cellular

– Genetic mutation

– Autoimmune

Physical and Mental Changes of Aging

• Typical physical changes

– Skin

– Bones and joints

– Head and face

– Urinary tract

– Heart and lungs

– Eyesight • Cataracts; glaucoma

• Macular degeneration

– Hearing

– Sexual changes

– Body comfort

Physical and Mental Changes of Aging

• Typical mental changes

– Mental function

– Memory

– Depression

– Dementias and Alzheimer's disease

Normal Effects of Aging on the Body

Is Memory Loss an Inevitable Part of Aging?

Alzheimer's Disease

• Alzheimer's disease is progressive brain

impairment that interferes with memory and

normal intellectual functioning.

• It is the most common form of dementia.

• It kills a person twice: first through the loss of

personhood and second through the

deterioration of body systems.

Alzheimer's Disease

• Progresses in stages

– The first stage involves forgetfulness and memory loss.

– The second stage is characterized by accelerated first-stage symptoms as well as agitation, restlessness, and repetitive actions.

– In the final stage, disorientation is complete, control of body functions is lost, and dependence on others is complete.

Alcohol and Drug Use and Abuse

• People 65 years of age and above have the

lowest rates of drinking.

• Older people rarely use illicit drugs, but some do

overuse or misuse prescription drugs.

• There is no single system to track all

prescriptions, so pharmacists may not know

about all of the drugs that a patient is taking.

Strategies for Healthy Aging

• Improve fitness

• Eat for longevity

– Calcium

– Vitamin D

– Protein

– Vitamin E, folic acid, iron, potassium, and

vitamin B12

• Develop and maintain healthy relationships

• Enrich the spiritual side of life

Understanding the Final Transitions: Dying

and Death

• Defining death

– Final cessation of vital functions.

– Death occurs when an individual has

sustained either irreversible cessation of

circulatory and respiratory functions or

irreversible cessation of all functions of the

brain, including the brainstem.

– Brain death has gained increasing credence.

The Dying Process

• Elisabeth Kübler-Ross identified the five

psychological states that people coping with

death often experience:

– Denial

– Anger

– Bargaining

– Depression

– Acceptance

Kübler-Ross's Stages of Dying

Corr's Coping Approach

• Corr suggests that there are unique challenges

and responses for the dying person and those

who love him or her:

– Physical

– Psychological

– Social

– Spiritual

Social Death

• The loss of being valued or appreciated by others can

lead to social death—a condition in which a person is not

treated like an active member of society.

– Dying patients are often moved to terminal wards.

– Inadequate pain control may contribute to a patient's

suffering and anger or hostility, making caregiver

assistance more difficult.

– A decrease in meaningful social interactions can strip

a person of his or her identity.

Coping with Loss

• Bereavement is the loss or deprivation experienced by a survivor when a loved one dies.

• Grief is a state of mental distress that occurs in reaction to significant loss.

• In disenfranchised grief, a person experiences a loss that cannot be openly acknowledged, publicly mourned, or socially supported.

• Mourning refers to culturally prescribed and accepted time periods and behavior patterns for the expression of grief.

What Is "Typical" Grief?

• An acute grief syndrome often includes

– Periodic waves of physical distress lasting 20

minutes to an hour

– A feeling of tightness in the throat

– Choking and shortness of breath

– A frequent need to sigh

– A feeling of emptiness in the abdomen

– A sensation of muscular weakness

– Intense anxiety

Worden's Model of Grieving Tasks

William Worden developed a more active grieving

model that defined four tasks that the individual

must complete in the grief-work process.

1. Accept the reality of the loss.

2. Work through the pain of grief.

3. Adjust to an environment in which the

deceased is missing.

4. Emotionally relocate the deceased and move

on with life.

Children and Death

• Siblings of a deceased child may have a particularly hard time with grief work because so much attention has been devoted to the dying child.

• Children experience more prolonged grieving periods.

• They may worry about whether they caused the death, whether they will die, or whether they will lose someone else.

Life-and-Death Decision Making

• The right to die: Some states legally allow

certain life-support techniques to be refused by

competent patients.

– Electrical or mechanical heart resuscitation

– Mechanical respiration

– Feeding via nasogastric tube

– Intravenous nutrition

– Gastrostomy

– Medication

The Right to Die

• As long as a person is conscious and

competent, he or she has the right to refuse

treatment.

• The living will and other advance directives are

designed to allow people to make decisions

about their care in advance of becoming

incapacitated.

Living Wills

• Be specific.

• Get an agent by completing a form known as a

durable power of attorney for health care or

health care proxy.

• Discuss your wishes in detail with your proxy.

• Deliver your directive to your doctor, agent,

lawyer, and family members.

Rational Suicide

• The concept of rational suicide is a reasoned, coherent process in which a person chooses death as a preferable alternative to unbearable pain.

• Active euthanasia involves ending the life of a person who is suffering greatly and has no chance of recovery.

• Passive euthanasia is the intentional withholding of treatment that would prolong life.

Making Final Arrangements

• Hospice care has the primary purpose of relieving the dying person's pain, offering emotional support to the dying person and his or her loved ones, and restoring a sense of control to the dying person, family, and friends.

• Funeral arrangements

– Wake or viewing

– Burial

– Cremation

– Organ or body donation

Organ Donors and Patients Needing and

Receiving Transplants, 1989–2009

Organ Donation

• Uniform donor cards are available through the U.S. Department of Health and Human Services and many health care foundations.

• Organ and tissue donation may provide a sense of fulfillment to a dying person, knowing that their organs may extend and improve someone else's life after their own death.

Assess Yourself–A Personal Inventory

• Go online to the Live It! section of

www.pearsonhighered.com/donatelle to take the "Are

You Afraid of Death?" assessment.

• After reading this chapter, has your view of the aged and

aging changed? Why or why not?

• As a result of your knowledge, do you think you might

change the way you relate to older people?

• Are you ready to think about writing an advance directive

and to consider or reject organ donation?