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Analyze the overall impact of psychological change in late adulthood.

Transitions in Late Life: Mental Health Concerns

For this assignment, there are two parts.  You must address both parts in your paper:

Part I:  The psychological changes in adulthood are numerous.  Of the categories  listed below, focus on three changes, and examine the ways in which  older adult health is impacted by these changes.

  • Cognition
  • Memory
  • Personality
  • Retirement
  • Relationships
  • Marital transitions
  • Widowhood
  • Adjustment

Part II: As noted in your textbook, many of the  transitions in late life are characterized by loss: physical,  psychological, social, economic, and interpersonal losses.

  • Examine the mental effect of these losses and describe the positive aspects of late life transitions.
  • Analyze the overall impact of psychological change in late adulthood.
    • What impact do these issues have on the mental health of the elderly?
    • Explain how the risk for mental disorders increased as a result of such change.AGING:

      · The human lifespan seems to be limited to 80 -100 years (cross-cultural, multi-ethnic) with some exceptions (to 115+ years)

      · Life expectancy among genders and races (& socio-economic groups) varies due to standard of living, cultural behaviors (diet, risk taking behaviors, etc)

      · In general, women have higher life expectancy than men (possibly due to cardiovascular disease developing later in life).

      · Multiple theories of aging:

      · Somatic mutation theory:   cells are “programmed” to mutate & die after a limited number of divisions (ceiling to possible number of cell divisions of all human cells); possibly due to accumulated defects in mitochondria over time (cells can no longer extract energy from foodstuffs).

      · The molecular clock and the Hayflick Limit:  after each cell division, the chromosome becomes shortened at the telomere (the tip of the chromosome).   Eventually, the shortening is so great that the replicating enzymes can’t “read” the chromosome to replicate it, and the cell can no longer divide – this is sometimes called the “Hayflick limit” … this prevents cells from indefinite reproduction, otherwise called the “molecular clock”

      · Catastrophic theory:   also called the “complexity theory (really a “chaos” theory) of accumulated mistakes in DNA transcription & translation & the inability of the cells and organs to function together in response to the normal stresses of the environment.  This results in adaptive dysfunction and organ derangements leading to organism disease as well as the “normal” process of aging & death.  Helps explain associated neurological changes with advanced age.

      · Neuroendocrine theory:  the brain is “programmed” to stop producing needed supportive hormonal factors.

      · Extracellular degenerative theory:  accumulation of disease over time due to environmental factors.

      · Modifiable factors? Can we turn back the hands of time (or at least slow them down)?

      · Pay attention to diet

      · Fruit and vegetable consumption and mortality (Wang, et al., 2014, BMJ):  http://www.bmj.com/content/349/bmj.g4490 (Links to an external site.)Links to an external site.

      · Dietary protein sources and cancer (Farvid, et al., 2014, BMJ):  http://www.bmj.com/content/348/bmj.g3437 (Links to an external site.)Links to an external site.

      · The “Mediterranean” diet and telomere length (Crous-Bou, et al., 2014):  http://www.bmj.com/content/349/bmj.g6674 (Links to an external site.)Links to an external site.

      · Increase physical activity

      · Reduce exposure to environmental pollutants

       

      View this video: 2012 AMMG lecture: Telomeres and a new theory of aging (Links to an external site.)Links to an external site.

      Park, E. (2012, June, 9). 2012 AMMG lecture: Telomeres and a new theory of aging [Video file]. Retrieved from https://www.youtube.com/watch?v=m0DZ1-WVtao&feature=youtu.be

       

      Definitions of health:

      Definitions and perspectives on the concepts of health, wellness, and illness/disease, psychology topics in health/wellness/illness/disease.  Note that health is NOT simply an absence of disease.  See the World Health Organization (WHO) definition, adopted in 1948:  http://www.who.int/about/definition/en/print.html (Links to an external site.)Links to an external site..

      Research concepts:

      Correlational Research:  what is the difference between causality & association?  People often insist that experts tell us what “causes” an event or condition to occur.    To determine “association” between variables, correlational research is done.  However, this type of research can only indicate that there is (or isn’t) a relationship between the variables – not causality.  One story that helped me: “When you see a fire, firefighters are always there – does this mean that firefighters cause fires?” (of course they do NOT cause them – but firefighters are associated with fires)(see link at end of guidance)

      Clinical Research:   we are trying to come closer to the answer of “causality.”  This usually takes years of painstaking, well designed research trials by many investigators.  Today, most practitioners in the healthcare fields will require such research to make clinical decisions; this is called Evidence Based Practice (EBP).  We are expected to know how to “grade” the clinical research (strength of taxonomy) and interpret data from randomized clinical trials (RCTs)(see links at end of guidance).  Regarding RCTs:

      · Used to test an intervention (drug, lifestyle, surgery, etc.) and determine how an outcome is matched to the intervention

      · Used to determine risk factors associated with the development of disease

      · Requires matched cohorts of patients – matched as closely as possible by age, sex, clinical condition, lifestyle, possibly race/ethnicity, etc.

      · Requires the use of placebo to test on one cohort and active drug (or other intervention) on the other cohort

      · Usually it is “double-blind” (neither the investigator nor the subject knows if they are receiving a placebo or an active drug/intervention)

      · Usually it is “double-dummy” (midway through the experiment, the placebo and active cohorts are switched)

      · Clinicians expect that results obtained by properly “powered” (enough subjects to be able to perform statistical analysis on the results)

      The biopsychosocial approach to health and healthcare:

      The biopsychosocial model had two main authors – Roy Grinker (1954) and George Engel (1977).  Probably, Engel is more recognized in the USA as the “father” of this theory and approach to psychology.  In this paradigm (a paradigm is a way of thinking about something) we give equal importance to three aspects of health care: the biological, psychological, and social.

      This paradigm probably opened the door to evidence-based practice in psychology and psychiatry, as well as emphasizing the integration of psychopharmacology into care for neuropsychiatric conditions.  In addition, patient preferences and beliefs are also incorporated into management choices.   Thus, when thinking of medical topics, it is not just the diagnosis and management or cure of illness, but also how the patient views its value and the impact on desired functional capacity.

      This approach has been used to discuss many topics – everything from pain management, irritable bowel syndrome, and emergency department care.  For instance, in managing pain, it is not just the biological aspects (cause, location, intensity of pain) but also psychological (emotional distress, health beliefs) and social (functional impact).

      Health Behaviors and Behavior Change: Health behaviors are choices made by the individual or communities, and the study of motivations and beliefs that underlie these choices is part of health psychology.   We can focus on health behavior change using the biopsychosocial model; various theories are used to explain behavior change.  Two commonly-used “models” of behavior change are the Health Belief Model (HBM) and the Transtheoretical Model (TTM).  Using these models, we can analyze individual health choices in preventive care as well as management of illness and disease states.  See more about these two different “models” below.

      In Week 1, we look at factors affecting life expectancy and in many cases individual and community choices regarding health behaviors can greatly impact individual life expectancy.  For instance, deciding to quit smoking can have enormous positive effects on overall health, function in later years, and life expectancy.

      Health Belief Model (HBM):   The HBM contains three main concepts – readiness to act, cues to action, and self-efficacy.  Within readiness to act, four components are included:   perceived threat or benefit, describing them as susceptibility, severity, benefits and barriers.   Cues to action describe strategies that activate readiness.  Self-efficacy involves one’s confidence in being able to be successful in an action or endeavor.   This model can be applied to both acute and chronic illness as well as health promotion (preventive care).   There are limitations to this model, but it is very widely used.

      Concept  Definition  Application
      Perceived Susceptibility One’s opinion of chances of getting a condition Define population(s) at risk, risk levels; personalize risk based on a person’s features or behavior; heighten perceived susceptibility if too low.
      Perceived Severity One’s opinion of how serious a condition and its consequences are Specify consequences of the risk and the condition
      Perceived Benefits One’s belief in the efficacy of the advised action to reduce risk or seriousness of impact Define action to take; how, where, when; clarify the positive effects to be expected.
      Perceived Barriers One’s opinion of the tangible and psychological costs of the advised action Identify and reduce barriers through reassurance, incentives, assistance.
      Cues to Action Strategies to activate “readiness” Provide how-to information, promote awareness, reminders.
      Self-Efficacy Confidence in one’s ability to take action Provide training, guidance in performing action.

      Modified from:  National Institutes of Health. (2005) “Theory at a Glance: A Guide for Health Promotion Practice” NIH number 05-3896.  Retrieved from http://www.sneb.org/2014/Theory%20at%20a%20Glance.pdf (Links to an external site.)Links to an external site.

      Transtheoretical Model (TTM) of Behavior Change (Stages of Change Model):

      The TTM is also called the “Stages of Change” model – since it describes individuals moving through specific stages of change:  precontemplation, contemplation, preparation, action, and maintenance.  Some descriptions of this model also include an additional final stage called termination, but this is not usually included in health-related behaviors.  One focus of the TTM is to describe interventional strategies that can influence the movement from one stage to the next.  The goal is to achieve maintenance.  Much research has been done regarding this model, and was originally applied by Prochaska to smoking cessation interventions.

      For instance, in smoking cessation, research has identified the amount of time typically spent in the different stages.  The information below is taken from one of your instructor’s publications on this topic (see reference list at end of this guidance):

      · Precontemplation:  currently smoking, will not consider quitting within the next six months

      · Contemplation:  currently smoking, will consider quitting with in the next six months

      · Preparation:  currently smoking, change is imminent, may even start some action (e.g., “cutting down” on cigarettes)

      · Action:  not smoking, high rate of relapse in this stage (needs more support)

      · Maintenance:   not smoking, greater confidence, less relapse risk, may help others to make the same change (quitting smoking)

      Life Expectancy & Longevity:

      Data for the United States is published annually by the Centers for Disease Control (CDC) on their website, National Center for Health Statistics (NCHS).  A publication is available for download that provides details of life expectancy data by type of illness, risk factors, healthcare services utilization, access to care & resources, and healthcare expenditures.  Comparisons are provided for the U.S.A. vs. other countries, as well as comparing subpopulations to determine if there are ethnic/racial disparities for various health outcomes.  Risk factors for illnesses are also compared, and data for each state is also included.

      To access the CDC website: https://www.cdc.gov/nchs/ (Links to an external site.)Links to an external site.

      For instance, the reduction in life expectancy for black males as compared to white males is explained by the following factors:  heart disease, homicide, cancer, stroke and even perinatal conditions (surrounding birth).  On the other hand, certain conditions were lower in black males vs. white males (suicide, unintentional injuries, chronic liver disease, chronic lower respiratory diseases, Parkinson’s disease).

      Why is it important for us to “track” this information?  If we are aware of healthcare disparities, we can write public policy to direct funds and initiatives to correct some issues.  Typically, overall, risk factors affecting longevity include the quality of medical care, behavioral risk factors (obesity, smoking, AIDS incidence), and other variables (education, income, health insurance coverage, medical expenditures).  We are of course thinking about this from the biopsychosocial perspective.

      Positive psychological factors include personality traits such as resilience and conscientiousness.  Social factors include social connectedness and the availability of social support.  There is evidence that social isolation can actually cause deleterious changes in physiology that are associated with worsening health.  Biological factors include genetics, and much research has been done on heritable factors in longevity – yes, if you come from a family with long-lived persons, your longevity will probably be good.  Please see the references section for more information.

      Additional Resources:

      1. American Academy of Family Practice. (2007). SORT: The strength-of-recommendation taxonomy (Links to an external site.)Links to an external site.. Retrieved from:   http://www.aafp.org/dam/AAFP/documents/journals/afp/sortdef07.pdf

      2. Bogg, T., & Roberts, B. W. (2013). The case for conscientiousness: Evidence and implications for a personality trait marker of health and longevity (Links to an external site.)Links to an external site.. Annals of Behavioral Medicine, 45(3),  278-288.  doi:10.1007/s12160-012-9454-6

      3. Brooks-Wilson, A. R. (2013). Genetics of healthy aging and longevity (Links to an external site.)Links to an external site.. Human Genetics, 132(12), 1323-1338.  doi:10.1007/s00439-013-1342-z

      4. Cherry, K. (2016, May 11). Correlational studies: A closer look at correlational research (Links to an external site.)Links to an external site.. Very Well. Retrieved from:  http://psychology.about.com/od/researchmethods/a/correlational.htm

      5. If you would like to see the original 1977 article by George Engel mentioned above, see (you can download the full PDF of the article):

      a. Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine (Links to an external site.)Links to an external site..  Science, 196(4286), 129-136.  doi:10.1126/science.847460

      6. Ghaemi, S. N. (2009). The rise and fall of the biopsychosocial model (Links to an external site.)Links to an external site..  British Journal of Psychiatry, 195(1), 3-4doi:10.1192/bjp.bp.109.063859

      7. Glanz, K., Rimer, B. K., & Viswanath, K. (2008). Main constructs (Links to an external site.)Links to an external site.. In Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.), Health behavior and health education: Theory, research, and practice.  Retrieved from http://www.med.upenn.edu/hbhe4/part2-ch3-main-constructs.shtml

      8. Virginia Tech Continuing and Professional Education. (n.d.). The transtheoretical model (Stages of change) (Links to an external site.)Links to an external site.. In Behavioral Change Models.  Retrieved from:  http://www.cpe.vt.edu/gttc/presentations/8eStagesofChange.pdf

      9. Woody, D., DeCristofaro, C., Carlton, B. G. (2008, August).  Smoking cessation readiness: Are your patients ready to quit? (Links to an external site.)Links to an external site. Journal of the American Academy of Nurse Practitioners, 20(8), 407-414. doi:10.1111/j.1745-7599.2008.00344.x

      10. World health organization – WHO definition of health (Links to an external site.)Links to an external site.. (2003). Retrieved from http://www.who.int/about/definition/en/print.html

      11. Yang, C. Y., McClintock, M. K., Kozloski, M., & Li, T. (2013). Social isolation and adult mortality: The role of chronic inflammation and sex differences (Links to an external site.)Links to an external site.. Journal of Health and Social Behavior, 54(2), 183-203. doi:10.1177/0022146513485244

      Course Text: Ferrini, A. & Ferrini, R. (2013). Health in the later years (5th ed.). New York, NY. McGraw-Hill.

      AGING:

      ·

      The human lifespan seems to be limited to 80

      100 years (cross

      cultural, multi

      ethnic)

      with some exceptions (to 1

      15+ years)

      ·

      Life expectancy among genders and races (& socio

      economic groups) varies due to

      standard of living, cultural behaviors (diet, risk taking behaviors, etc)

      ·

      In general, women have higher life expectancy than men (possibly due to cardiovascular

      dise

      ase developing later in life).

      ·

      Multiple theories of aging:

      o

      Somatic mutation theory:

      cells are “programmed” to mutate & die after a

      limited number of divisions (ceiling to

      possible number of cell divisions of all

      human cells); possibly due to accumulated defects in mitochondria over time

      (cells can no longer extract energy from foodstuffs).

      o

      The molecular clock and the Hayflick Limit:

      after each cell division, the

      chromoso

      me becomes shortened at the

      telomere

      (the tip of the

      chromosome).

      Eventually, the shortening is so great that the replicating enzymes

      can’t “read” the chromosome to replicate

      it, and the cell can no longer divide

      this is sometimes called the

      “Hayflick limit” …

      this prevents cells from

      indefinite reproduction, otherwise called the “molecular clock”

      o

      Catastrophic theory:

      also called the “complexity theory (really a “chaos”

      the

      ory) of accumulated mistakes in DNA transcription & translation & the

      inability of the cells and organs to function together in response to the normal

      stresses of the environment.

      This results in adaptive dysfunction and organ

      derangements leading to orga

      nism disease as well as the “normal” process of

      aging & death.

      Helps explain associated neurological changes with advanced age.

      o

      Neuroendocrine theory:

      the brain is “programmed” to stop producing needed

      supportive hormonal factors.

      o

      Extracellular degenerat

      ive theory:

      accumulation of disease over time due to

      environmental factors.

      ·

      Modifiable factors? Can we turn back the hands of time (or at least slow them down)?

      o

      Pay attention to diet

      §

      Fruit and vegetable consumption and mortality (Wang, et al., 2014,

      BMJ

      ):

      http://www.bmj.com/content/349/bmj.g4490

      (Links to an external

      site.)Links to an external site.

      §

      Dietary protein sources and cancer (Farvid, et al., 2014,

      BMJ

      ):

      http://www.bmj.com/content/348/bmj.g3437

      (Links to an external

      site.)Links to an external site.

      §

      The “Mediterranean” diet and telomere length (Crous

      Bou, et al.,

      2014):

      http://www.bmj.com/content/349/bmj.g6674

      (Links to an external

      site.)Links to an external site.

      o

      Increase physical activity

      o

      Reduce exposure to environmental pollutants

      AGING:

       The human lifespan seems to be limited to 80 -100 years (cross-cultural, multi-ethnic)

      with some exceptions (to 115+ years)

       Life expectancy among genders and races (& socio-economic groups) varies due to

      standard of living, cultural behaviors (diet, risk taking behaviors, etc)

       In general, women have higher life expectancy than men (possibly due to cardiovascular

      disease developing later in life).

       Multiple theories of aging:

      o Somatic mutation theory: cells are “programmed” to mutate & die after a

      limited number of divisions (ceiling to possible number of cell divisions of all

      human cells); possibly due to accumulated defects in mitochondria over time

      (cells can no longer extract energy from foodstuffs).

      o The molecular clock and the Hayflick Limit: after each cell division, the

      chromosome becomes shortened at the telomere (the tip of the

      chromosome). Eventually, the shortening is so great that the replicating enzymes

      can’t “read” the chromosome to replicate it, and the cell can no longer divide –

      this is sometimes called the “Hayflick limit” … this prevents cells from

      indefinite reproduction, otherwise called the “molecular clock”

      o Catastrophic theory: also called the “complexity theory (really a “chaos”

      theory) of accumulated mistakes in DNA transcription & translation & the

      inability of the cells and organs to function together in response to the normal

      stresses of the environment. This results in adaptive dysfunction and organ

      derangements leading to organism disease as well as the “normal” process of

      aging & death. Helps explain associated neurological changes with advanced age.

      o Neuroendocrine theory: the brain is “programmed” to stop producing needed

      supportive hormonal factors.

      o Extracellular degenerative theory: accumulation of disease over time due to

      environmental factors.

       Modifiable factors? Can we turn back the hands of time (or at least slow them down)?

      o Pay attention to diet

       Fruit and vegetable consumption and mortality (Wang, et al., 2014,

      BMJ): http://www.bmj.com/content/349/bmj.g4490 (Links to an external

      site.)Links to an external site.

       Dietary protein sources and cancer (Farvid, et al., 2014,

      BMJ): http://www.bmj.com/content/348/bmj.g3437 (Links to an external

      site.)Links to an external site.

       The “Mediterranean” diet and telomere length (Crous-Bou, et al.,

      2014): http://www.bmj.com/content/349/bmj.g6674 (Links to an external

      site.)Links to an external site.

      o Increase physical activity

      o Reduce exposure to environmental pollutants

 

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