Late+Life

=**Late Life**=


 * 1. Discuss the biology of aging.**

The process of physical deterioration starts as early as 25 affecting all body systems at different times and rates. The rate of ageing is dependent on genetics and environmental factors such as excessive sunlight exposure, smoking, alcohol, illegal drugs, and obesity. The most troubleing of normal life changes are changes in sleep, appetite, memory, and energy. Sleep is often less restful with shorter periods of REM sleep. Apitite is afected by reduced activity, diminished taste, and unappealing diet. Memory is mostly unaffected by healthy aging with some reduced short-term memory, but greater wisdom and reasonging abilitites. Energy levels often affected by level of activity, illness and medications.


 * 2. Define "catastrophic reaction.**

Some psychiatric disorders that may affect the elderly include: Cognitive Disorders (impairment in memory, language, attention), Anxiety Disorders, Depression, Somatoform Disorders (physical symptoms which cannot be explained by physical exam and laboratory tests), Alcohol and other substance abuse disorders, Psychosis, and __Catastrophic Reaction__ (Agitation that may be sudden or violent, secondary to awareness of one’s deficits (biological, psychological or social), usually under stressful conditions.


 * 3. Discuss the various attitudes toward retirement.**

Retirement is viewed differently depending on what point you are in your life. Advantagesof retirement is that it affords time to explore new interests, deepen older interests. The drwbacks of retirement stem from a need to adjust, need to delegate, becoming a “figurehead” to family and business, and decreased income. Some people view retirement as a Fantasy or “honeymoon” which often is followed by disappointment. Realistic plans and expectionons lead to the best outcome of retirement.


 * 4. Explain why a "paternalistic" role may be necessary in caring for an ill person.**

A “Paternalistic” role may be necessary if the patient is too ill to choose freely but would likely give ex post facto consent after the situation is resolved. Paternalism consists of making a decision about the future of a patient who is unable to act in his/her best interests because of coercion, exploitation, fear of retaliation or fear of abandonment. Paternalism is justified when it helps the patient break the cycle of abuse and dependency and helps the patient achieve improved mental and physical health.


 * 5. Summarize personality changes with aging.**

Stress resulting from aging or illness can exaggerate personality traits alreading inate in the person. Extra free time may allow the person to explore neglected parts of their life, while others may be unaccostomed to the free time. During this period one can come to terms with their mortality.


 * 6. Discuss the dependence of successful aging with use of coping mechanisms.**

Successful depends upon daily use of coping mechanisms to gain some degree of control over one’s life.
 * 1) __Altruism:__ unselfish concern for the well-being of others such as volunteer work.
 * 2) __Humor:__Healthy humor releases tensions.
 * 3) __Suppression:__Suppression is conscious postponement of expressing one’s unpleasant feelings when they are first experienced and are expressed at appropriate times.
 * 4) __Anticipation:__Anticipation is realistic planning for future action which might be difficult but necessary.
 * 5) __Sublimation:__Sublimation is expression of socially unacceptable impulses in an acceptable manner.


 * 7. Compare integrity and despair in the eighth stage of the life cycle.**

In Erikson's Eight Stages of the Life Cycle, Stage 8 is charicterized by Integrity versus despair (about age 60 years to death). Integrity is the result of intimacy, acceptance of one’s one and only life and significant people in it. Sense of satisfaction when reflecting on one’s life. Despair is existing “without hope”, ofteh the result of narcissism and failure to accept one’s life and people in one’s life. Deeply disgusted with the external world and contemptuous of persons and institutions.


 * 8. Describe the clinical presentation of older patients with alcohol and other substance abuse disorders.**

History of excessive drinking which began in young or middle adulthood. 20% of nursing home patients have alcohol dependence. Clinical presintation of alcohol dependance includes:
 * Confusion
 * Poor personal hygiene
 * Malnutrition
 * Depression
 * Falls
 * Effects of exposure
 * Sudden onset of delirium in patient hospitalized for medical illness
 * Unexplained gastrointestinal, metabolic or psychological problem


 * 9. Discuss obstacles to the recognition of depression in the elderly.**

Depression is a medical illness with bio-psycho-social components. Obstacles to the recognition of depression in the elderly:
 * Stigma associated with mental illness.
 * Emphasis on somatic complaints by the elderly.
 * Depressive symptoms are often attributed to age and physical illness.
 * Physical illness is erroneously considered “a good reason to be “depressed”.


 * 10. Explain the role of intimacy in elderly individuals.**

Every individual has feelings. Sexual feelings do not disappear as men and women age, feelings are just as strong and powerful in older people as in younger people. Older people do not have the ability or the opportunity to express their feelings. Intamacy is closeness between persons who are willing to share what and whom they are, and can be Physical, Psychological, Social or Spiritual. Intamacy and meaningful relationships are nececary to feel alive.