Lecture 2F (Ageing, death & bereavement).pptx

Lecture 2F (Ageing, death & bereavement).pptx

• 1.
  Arts and Humanities Lecture2F: Behavioural Aspects of Development through Lifecycle (Death, Dying & Bereavement)
• 2.
  Introduction • Fastest growingsegment of the population--greater than 85 years of age--”old-old” • Britain--medical care of the elderly--”old-age medicine” • USA--no such term--care of ageing patients is called geriatrics & study of ageing is called gerontology--senior/mature citizens • Most deaths occur in the elderly population • Old Age: 65 Years Older  Old age milestone--65 years--eligible to collect pension & health insurance--a combination of employee, employer & government contributions  Benefits continue even after the individual’s death, for the person’s spouse & children  Age of retirement from work  The losses of ageing Perceived as less valuable because of diminishing youth, beauty, work & independence Loss of social status, loss by death of a spouse, family members or friends Must confront in the inevitable decline in their own health & strength Some face depression as a result of these losses, most stay positive, enjoy & contribute to life Positive aspect: Freedom from responsibilities--can focus on education & other
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  Old Age: 65Years & Older • Independence Vs Care by Others  Different cultures & religions--elderly people are cared for by the young  Less than 1/4th of the American elderly population are cared for by the young & even less spend their old age in nursing homes  Most elderly people live independently & care for themselves  Assisted Living: The elderly live in complexes consisting of apartments where they receive help with meals, shopping & housework--independent life for longer periods  Nursing homes: Provide inpatient care for about 5% of the elderly population--often costing more than $1000 per week--not covered by Medicare--a serious injury to an elderly person can effectively pauperize them • Cognitive Function in the Elderly  Idea that the elderly have significant cognitive impairment--unsupported stereotype  General memory & learning problems occur with ageing but do not interfere with the person’s ability to function independently  Dementia--uncommon disorder, occuring in <10% of the total elderly population  Prevelance of dementia does increase with age  Innovative pharmacological treatment: Drugs such as acetylcholinesterase inhibitors & drugs that block neurotoxic action of glutamate (Alzheimer’s Disease)--promising future
• 4.
  Old Age: 65Years & Older • Longevity  Average life expectancy at birth is 77 years (for men--75 years, for women--80 years)  These figures vary by gender & ethnicity  Demographic differences in life expectancy have been decreasing over the last few years, they still extend to more than 10 years between white women & African-American men  Longer life expectancy in Hispanic men--people who migrate to the United States are among the healthiest from their native countries  Women tend to live longer than men--comes with a disadvantage--elderly women have a higher risk of disability due to age than elderly men  Research suggests that longevity is associated with a family history of longevity  Also associated with continued physical & occupational activity, advanced education, work satisfaction the presence of social support systems such as marriage • Physical & neurological Changes in Ageing  Decline in physical strength & health + cardiovascular, renal, pulmonary, gastrointestinal, musculoskeletal & immune functions--eventually compromised  Ratio of body fat to muscle mass increases
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  Old Age: 65Years & Older • Neurological Changes during normal ageing  Decreased cerebral blood flow  Decreased brain weight  Appearance of amyloid plaques & neurofibrillary tangles (Different in Alzheimer patients)  Mild reductions in memory & learning speed  Intelligence remains approximately throughout life (in the absence of Dementia)  Decrease in the neurotransmitter availability through several mechanisms: Diminished secretion of major behavioural neurotransmitters Accelerated breakdown of major neurotransmitters due to increased concentration of monoamine oxidase Neurotransmitter receptors in the ageing brain may be less responsive Can contribute to an increased likelihood of developing psychiatric symptoms & of negative side effects associated with psychopharmacological treatment • Psycosocial changes in ageing  The common physical health problems associated with ageing are not only uncomfortable but they can also have serious emotional & social consequences The embarrassing problem of reduced bladder control--impaired ability to leave the house Age-associated loss in muscle strength & in sensory functions (vision & hearing)--reduced social interaction--social isolation--well known causes of depressive symptoms Another undetected serious social problem--abuse of cognitively or physically impaired elderly people by their care-takers
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  Old Age: 65Years & Older • Psychopathology in the elderly  Depression in the elderly—commonly characterized by memory loss & cognitive problems—may be misdiagnosed as dementia—pseudodementia  Must be diagnosed to prevent suicide risk—pseudodementia is highly responsive to treatment  Suicide—due to loss of social contact, depression or physical illness  Anxiety & fearfulness—also common in the elderly  Daytime confusion due to alcohol or benzodiazepine abuse & sleep disorders—exacerbate anxiety & depression  Can lead to delirium accompanied by delusions of the precursor type • Treatment of the disorders o Pharmacological interventions & practical suggestions of self-care o Financial constraints may prevent the elderly from getting the newer treatments o Supportive psychotherapy & Electroconvulsive therapy (seriously depressed elderly patients who are unresponsive to other treatments)
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  Death • The elderlyneed to face the loss of life itself—separation from family, friends & possessions • This requires one to pass through several psychological stages—the last including acceptance • Stages of Dying (people who anticipated death, go through only 2/3 of the stages. Others go through all simultaneously or in a specific order) o Denial: The patient unconsciously cannot accept the diagnosis & refuses to believe that she’s dying o Anger: Towards the physician & staff—the behaviour of the physician at this point is important o Bargaining: With God/higher Being to get rid of this negative event o Depression: Distance & detachment from others—continuous sadness & hopelessness— passes quickly o Acceptance: Deals calmly with fate & is even able to enjoy the remaining time with friends & family • These stages can also occur in youth as a consequence of losing a body part or abortion
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  Bereavement • Bereavement VsComplicated Bereavement o Great sadness at the loss of a loved one or anticipation of one’s death o Can also occur for any reason other than death o Both bereavement & complicated bereavement are initially characterized by shock & denial and include sadness, crying & other expressions of sorrow o Normal grief—these expressions subside after a year or two—commonly recur on special occasions—anniversary reactions o Denial & expressions of sadness in abnormal grief persist over days or even weeks—and may even intensify with time o Depression—ruled out because its successful treatment can make the last days of life rewarding for the patient & the family o Cultural differences in expressions of grief o Characteristics of normal grief can mimic symptoms of mental illness—illusions (normal grief) Vs frank illusions & hallucinations (abnormal grief)
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  Role of Physicians •Making the dying patient fully aware of the diagnosis & prognosis • Reassurance to the family & patients • Can be an important resource to the family before & after death • Excessively trained to differentiate between normal & abnormal grief • Support in the normal grief & treatment in the abnormal grief • Medically follow the bereaved members—the risk of mortality & morbidity is increased in close relatives • Sense of failure when physicians are unable to save a patient from death—important to realize this reaction to resist the emotional detachment & support the bereaved family