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

Medicose Nursing Academy

1. Arts and Humanities Lecture 2F: Behavioural Aspects of Development through Lifecycle (Death, Dying & Bereavement)

2. Introduction Fastest growing segment 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 interests Erikson-- Ego Integrity Vs Despair --either pride in past accomplishments of sense of failure

3. Old Age: 65 Years & 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: 65 Years & 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

5. Old Age: 65 Years & 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

6. Old Age: 65 Years & 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 Pharmacological interventions & practical suggestions of self-care Financial constraints may prevent the elderly from getting the newer treatments Supportive psychotherapy & Electroconvulsive therapy (seriously depressed elderly patients who are unresponsive to other treatments)

7. Death The elderly need 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) Denial : The patient unconsciously cannot accept the diagnosis & refuses to believe that she’s dying Anger: Towards the physician & staff—the behaviour of the physician at this point is important Bargaining: With God/higher Being to get rid of this negative event Depression: Distance & detachment from others—continuous sadness & hopelessness—passes quickly 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

8. Bereavement Bereavement Vs Complicated Bereavement Great sadness at the loss of a loved one or anticipation of one’s death Can also occur for any reason other than death Both bereavement & complicated bereavement are initially characterized by shock & denial and include sadness, crying & other expressions of sorrow Normal grief —these expressions subside after a year or two—commonly recur on special occasions— anniversary reactions Denial & expressions of sadness in abnormal grief persist over days or even weeks—and may even intensify with time Depression—ruled out because its successful treatment can make the last days of life rewarding for the patient & the family Cultural differences in expressions of grief Characteristics of normal grief can mimic symptoms of mental illness— illusions (normal grief) Vs frank illusions & hallucinations (abnormal grief)

9. 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