Imagine that you are a hospice volunteer and are helping late adult, terminally ill patients and their families. Use the theories of Lamers and Kubler-Ross to help you and the families better understand and deal with their circumstances. [300 words, 3 References, 3 Citations and Original writing please.] Additional Reference material provided.
PSY 828 Lectures 8 Invitation to the Life Span Read chapter 15 and epilogue. Objectives: Compare and contrast theories of psychosocial development in late adulthood. Compare and contrast Kubler-Ross’s and Lamers’s theories of dying and bereavement. Evaluate how to accomplish the developmental tasks of late adulthood. Late Adulthood and Death Introduction In this last module, socioemotional development in late adulthood is discussed, followed by an examination of the psychology of death, dying, and bereavement. Psychosocial Development in Late Adulthood Erikson’s eighth stage of integrity vs. despair occurs in this last stage of life. Erikson uses integrity as a way for the elderly to integrate their life, by reflecting on both successes and failures. Everyone has made mistakes, but the person who reaches integrity is able to see that his/ her life was not wasted (Miller, 2002). The person who has nothing but nagging regrets and feels his/her life was wasted has reached despair (Boeree, 2006). Butler agrees with Erikson that a life review is helpful; often, the person will uncover threads of meaning or God’s purpose for his/her life, as a review is conducted. The key process in resolving this crisis is introspection, as the elderly person delves deep within himself/herself to evaluate his/her strengths and weaknesses (Newman & Newman, 2010). Our society’s primary focus is the young. Disengagement theory expresses the view that society wants the elderly to retire and “get out of the way.” Thankfully, this attitude is changing, and activity theory expresses the idea that the elderly should remain as active as they wish, for as long as they wish. Research supports both of these theories − some elderly do, in fact, disengage, but others continue to be both physically and socially active, which is linked with longevity and life satisfaction (Berger, 2010). Until about 1980, people considered 65 the right time to retire. Since then, our society has witnessed many different popular retirement ages, both before 65 (e.g., 59½, 60, and 62) and after (e.g., 66 and 70). Businesses are replacing mandatory (or compulsory) retirements with voluntary (or discretionary) decisions and allowing workers to have greater decision-making power. Although most people are excited about retirement, the actual event is often followed by feelings of being “put out to pasture.” The best way to avoid “retirement shock” is by starting early and planning a list of things the person would like to do (“You Can Avoid ‘Retirement Shock,'” 1987). For many, work and purpose in life are intertwined, so retirement may be seen as nonproductive and stressful. Many people who retire often switch to a career with less pay and less status. Others stay busy with a part-time job, volunteer work, continuing education, religious involvement, and/or political activism (Berger, 2010). One prominent organization that advocates the concerns of senior citizens is AARP; their Web site (2009) states, “We are a nonprofit, nonpartisan membership organization that helps people 50 and over improve the quality of their lives.” Although the acronym stands for the American Association of Retired Persons, a person does not need to be retired to join AARP. Retirement also increases the time married couples have with each other, which also precipitates adjustment. For many couples, both partners have more egalitarian views of husband-and-wife roles; there is more androgyny in both sexes. Marriage is also a predictor of longevity and life satisfaction; divorce negatively affects longevity and life satisfaction (Santrock, 2009). One important characteristic found in long-term relationships is mutual respect (Berger, 2010). For most people, the death of one’s spouse is the most stressful event a person goes through (Holmes & Rahe, cited in Santrock, 2009). Since men have a shorter average life expectancy that women have (75 vs. 81 years), typically the surviving spouse is a widow who will live alone for several years. This often leads to a “reduction in status, income, social activities, and identity as someone’s wife” (Berger, 2010, p. 546). Widowers are even more vulnerable since many of them relied upon the wife for household functions. Following the wife’s death, widowers resist asking for help. Compared to widows, widowers are much more likely to remarry. There are four different styles of grandparenting; see Berger’s description of these (pp.549-550). The best adjustment is for grandparents to enjoy their new status and the grandchildren (Crandall, 2005). Many of them become actively involved by providing babysitting and financial help, but prefer to keep their distance regarding advice or discipline (Berger, 2010). Health and income, supported by an active lifestyle, are good predictors of life satisfaction. The Terman longitudinal study found that coping styles of work persistence and unbroken marriage are major predictors of life satisfaction in old age (Rybash, Roodin, & Santrock, 1991). As Newman and Newman (2010) put it, finding pleasure in retirement, finding pleasure in being a grandparent (and enjoying the grandchildren), and engaging in a moderate amount of reminiscence seem to be healthy activities that facilitate achieving integrity and coping with this last stage of life. According to Havighurst, the developmental tasks that a person must accomplish in this last stage of life are threefold. First, senior adults need to redirect their energy away from work and towards new roles and activities (such as using their skills as grandparents). Secondly, accepting one’s life is important. Most people find that they have set some goals they have failed to attain, so accepting the failures by placing them in perspective with the successes will help. Finally, developing a point of view about death is crucial, as seniors must have the capacity to accept the loss of their close relatives and friends, as well as their own death. It is important to accept death as part of the natural life cycle (Newman & Newman, 2010). This discussion has centered chiefly on healthy, elderly adults, who typically range in age from 60 to 85. Now the frail elderly, who typically belong in the “oldest old” category of 85 and up will be discussed. Gerontologists describe the typical activities of daily life (ADLs)and the instrumental activities of daily life (IADLs); these include activities such as eating, bathing, toileting, dressing, and moving from a bed to a chair. Other activities are listed in Berger (2010, Table 15.2, p. 554). The inability to perform these basic functions makes a person frail, rendering him/her dependent on others for help. This increases the stress and risk of depression for overwhelmed caregivers. In turn, this creates an increased risk of elder abuse. Many middle-aged adults caught in the filial crisis of caring for their aging parents while also rearing their own children are horrified by the stories they have heard about the conditions of nursing homes. Choosing a good nursing home depends on five factors: 1) licensure and training of staff, 2) cleanliness and safety of the facility, 3) quality and quantity of social activities available, 4) residents’ freedoms involving visiting hours, privacy, and use of phone, and 5) costs (both hidden and overt) (Centers for Medicare and Medicaid Services, 2008; Santrock, 2009). There are also other viable alternatives for senior care, including independent living, assisted living, and home care. There are Web sites that explain the differences between Residential Care, Assisted Living, Nursing Homes, and Respite Care (“New Lifestyles,” n.d.). Death, Dying, and Bereavement Thanatology is the study of “death and dying, especially of the social and emotional aspects” (Berger, 2010, p. 565). Death actually consists of three stages: 1) a person can be successfully resuscitated from clinical death (cessation of breathing and heart rate), whereas 2) brain death means that the person’s body can be kept alive, even while he/she is in a vegetative state. 3) The third stage, organ death, means that the tissues and organs have deteriorated past the point of no return (“First Aid Topics,” 2010). Since 1980, brain death has been the favored definition of death (Corr, Nabe, & Corr, 2005; Berger, 2010). Several authors have written of people’s attempts to delay/forestall death (for example, see Becker’s Pulitzer-prize-winning book, The Denial of Death). One controversial attempt to cheat death is cryonics, in which a person’s body is frozen and preserved shortly after death. As of August, 2010, 98 humans and 62 pets have been placed in cryostasis (Cryonics Institute, 2010). To avoid controversies like the Terri Schiavo case (Terri Schindler Schiavo Foundation, 2010) or the “mercy killings” (also called physician-assisted suicides) of Dr. Jack Kevorkian (“Jack Kevorkian,” 2008), each person could draw up a living will. Passive euthanasia (allowing the patient to die with DNR − Do Not Resuscitate − instructions) can be mandated by a living will; however, active euthanasia (actively ending the patient’s life to prevent further suffering) is currently considered murder in all states except Oregon (Corr et al., 2000). Many societies believe in an afterlife, and nearly all religions have customs and rituals associated with death. Many people have reported near-death experiences (NDEs), where they report that they have actually gone to their next destination before being resuscitated. Examples of books in this area include Raymond Moody’s (2005) Life After Life and Don Piper’s (2004) 90 Minutes in Heaven (Piper & Murphy, 2004). Frequently, people who experience NDE’s experience a sense of well being, detachment from their physical body, and, in some cases, a light (Corr, et al., 2000). However, not all visits to the afterlife are pleasant; one nursing student at Grand Canyon University shared an experience of witnessing a clinically-dead hospital patient suddenly sit up and scream, “I’m burning! I’m burning!” He then collapsed back onto the bed, dead (Dr. Larry Barron, personal communication, 2010). Children may experience the death of a grandparent, as well as other important individuals in their lives (e.g. pets). These experiences with death are unique to each child (Corr et al., 2000). Maria Nagy has researched three stages of death understanding. In the reversibility stage, preschool children see death as reversible; they do not understand its permanence. In the second stage, personification, death is seen as a person who swings a scythe and cuts people down. This stage occurs from 6 to 9, and overlaps with Piaget’s concrete operational stage. The highest stage, developing around age 9, sees death as universal: the child realizes that everyone, including himself/herself, will eventually die. When asked what causes death, 6-year-olds responded with a concrete, graphic array of answers, including “guns, knives, and big rocks.” Eleven-year-olds responded with answers such as “old age and disease.” It is important that adults tell children the truth about a loved one’s death. Euphemisms such as “Daddy has gone on a long trip” or “Daddy is asleep” can scar the child about traveling or sleeping. Also, one’s religious concepts should be used, but stated carefully; statements like “God took Daddy” can create anger towards God (adapted from Harris, 1991). Kubler-Ross (1969) has reported five stages of death and dying for both the terminally ill person and his/her family (see Berger’s discussion of these stages on page 575). After the person’s death, the survivors may go through several of these stages again (a process called bereavement). Lamers has a similar theory by describing survivors’ reactions of grief as constituting 1) loss, 2) protest (similar to Kubler-Ross’s stages of denial and anger), 3) despair (similar to depression), and 4) recovery, which usually takes 6-12 months. Complicated (or atypical) grief is much more serious, and may occur if the person is experiencing prolonged grief (of several years), severe depression (with thoughts of suicide), some sort of psychosomatic disorder, and/or over-activity (being active is good, but the person needs time to deal with the reality of the death) (“Hospice of Keokuk County,” 1981). Hospice is a relatively new, alternative method of helping dying clients and their families. Hospice care may occur in the patient’s home, in hospitals, or in special facilities called hospices. The purpose is not to prolong life by any means, but to provide palliative care (by controlling pain and helping the person’s last few months to be as comfortable and meaningful as possible). The program is designed to meet the “physical, psychological, social, and spiritual needs” of both terminally ill patients and their families (“Hospice of Mahaska County,” 1981). Conclusion Several critical issues relevant to senior citizens were discussed in this module, including retirement, grandparenting, life satisfaction, death of a spouse, and frail elderly. The topic of death and dying was also discussed, with a focus on definitions of death, near-death experiences, Nagy’s stages, Kubler-Ross’s stages, and hospice care. The examination of the life cycle has ended. It is hoped that this course will help to make your own journey through life’s stages more meaningful. References AARP. (2009). Retrieved December 20, 2010 from http://www.aarp.org/ Becker, E. (1973). The denial of death. 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