PSYC 322: remaining content

retirement

the withdrawal of an individual from the labour force in later life

retirement: traditional models

• role theory

• continuity theory

• life course perspective

role theory (retirement)

loss of the work role requires adjustment post-retirement to a new principle role

• emphasis of occupation as large part of identity

strong identity link with job can lead to either: 

• difficult adjustment post-retirement

• relief post-retirement 

continuity theory (retirement)

retired individuals desired a maintenance of their self-concept and identity into retirement phase

• ex. professor emeritus

life course perspective (retirement)

dynamic transition influenced by a person’s entire life history, rather than a single event (macrolevel perspective)

• historical, social, and cultural context

• interdependent → retirement is influenced by/influences family and friends 

retirement: temporal process model

retirement usually consists of 3 broad and sequential phases

1. retirement plan

2. retirement decision making

3. retirement transition and adjustment

crisp retirement

leaving the workforce in one clean, unreversed move

blurred retirement

gradual transition via reduced work commitment exiting and re-entering the workplace

• bridge job (paid work after an individual retires)

temporal process model of retirement:

factors to consider before transition/adjustment

• cognitive and financial planning 

• decision-making

  • assessing when to retire, where

  • early retirement prior to pension/OAS eligibility

canadian pension plan (CPP)

monthly taxable benefit that replaces part of your income when you retire

• you contribute to it while you are working

old age security (OAS)

monthly taxable pension for eligible seniors aged 65+

temporal process model: transition and adjustment

changes in daily activiites, well-being

• bridge work, volunteer work, hobbies, social clubs, religious invovlement, travel, sports, informal caregiving 

what are the four key predictors of the temporal process model? 

1. individual attributes

2. job/organizational factors

3. family factors

4. socioeconomic contexts 

temporal proess model: individual attributes

gender → men tend to have more savings

age → younger individuals are less likely to plan for retirement

health → healthy more likely to work longer

income → low incomers less likely to plan

temporal process model: job/organizational factors

• greater stress, workload predicts earlier retirement

• retirement benefit plan

• workplace policies and norms 

temporal proess model: family factors

• spousal impact on planning

• care needs

• spouses’s retirement schedule 

temporal proess model: socioeconomic contexts

• retirement support varies in different countries

• universal health care → poorer health care for older adults may delay retirement

• strong economy and low levels of unemployment predict greater likelihood of bridge employment

resources-based dynamic model

focuses on explaining retirement adjustment as a longitudinal process during which retirees’ levels of adjustment may fluctuate

• resources: 

  • physical, cognitive, motivational, financial, social, emotional

  • they all contribute to what our retirement will look like

self asssessed health (SAH) and retirement

better health associated with later retirement, expected retirement

chronic illness/sickness absences and retirement

chronic illness/sickness absence associated with earlier retirement

true or false:

people who kept working saw health deteroriated when their job was psychologically stressful. However, individuals with very low job stress experienced improved health.

false

true or false

people who had more stessful jobs saw an increase in health after retirement

true

what are the factors associated with earlier retirement?

• spouse has pension

• job dissatisfaction

• being married

• race

• more positive attitude toward retirement

what are the factors associated with later retirement

• self-employment

voluntary retirement

individual has autonomy/choice over leaving the workforce

• means more autonomy/plans on what to do post-retirement

involuntary retirement

individual has less or no autonomy/choice over leaving the workforce (health reasons, layoffs, ageism)

• mandatory retirement at a certain age is largely illegal (eg. in Canada)

post-retirement:

well-being and activities → leisure pursuits

reduced risk of neurocognitive disorders, including alzheimer’s disease

• contribute to sense of identity

• provide focus and meaning in life

• help maintain health and cognitive functioning

• enable social connections to others

• ex. volunteering, exercise, travel

long-term care

entire continuum of care that ranges fom recieving in home help with daily tasks to institutionalized care (not just for the elderly)

examples of long-term care

• home-care

• assisted living

• nursing homes

true or false:

the majority of the population aged 65 and over live in colelctive dwellings, not private dwellings

false

home care and community based services

medical and social services that are available to people who are still living in their own homes

• provided by health care professionals, paid caregivers, and trained volunteers

examples of government programs

• assessment and case management

• personal care

• physiotherapy

• occupational therapy

• nursing care

• palliative care

eligibility for government programs from VCH

• canadian citizen, permanent or temporary resident

• BC resident for at least 90 days

• require care for health conditions in order to remain at home

true or false:

all home care recipients are seniors and older adults

false

benefits of home care

• maintained sense of identity

• maintained sense of control and autonomy

• familiarity of surroundings and community

• prevention or delay of institutionalization

• cost effective

assisted living services

government-regulated housing with a upportive environment to adults who:

• have physical and functional health challenges

• can live independently

• can make decisions on thier own behalf

three ideal attributes of assisted living/suported living

1. physical space has a residential feel/aesthetic

• personal space

• access to shared indoor and outdoors spaces

---

2. individualized attention prvodied to promote normal lifestyle of resident

• understanding of resident’s personal preferences and priorities

• allows residents to have control, choice, dignity and autonomy

---

3. meeting residents’ routine services and special needs

• assistance with activities of daily living

• meal provision

retirement homes

indepdent with some shared services

• mixed focus on health needs and independence/relieving daily tasks

• out of pocket

nursing home

government regulated type of medicl institution that provides a room, meals, skilled nursing and rehabilitative care, medical services, and protective supervision

residents of nursing homes

they have multiple health conditions and/or moderate/severe cognitive impairment (dementias)

• often frail

• temporary residents include those recovering from major injuries, illness, or surgery

what are factors that can help to make nursing homes feel more like a real home?

• individual given time and voice in placement decision

• defining home predominantly in terms of family and social relationships

• developing continuity via activities and living arrangements

• designing unique living situations

memory boxes

cues for episodic memory recall, wayfinding (working/long-term memory)

elder abuse

physical, sexual, and psychological abuse, financial exploitation, neglect, and violation of rights

• prevalent issue in nursing homes, particularly in traditional model of care

common frauds/scams involving older adults

• identity theft

• online scams

  • phising emails

• credit card fraud

• phone scams

traditional medical model of care

• hierarchical

• focuses on physical needs

• routines for residents and front-line wokrers

• efficient, standardized, cost-driven

• reuslts in residents often being isolated from family and community

culture change (model of care)

• voices of residents and carers respected/considered

• emotional needs

• enables continued growth

• restructuring of staff roles and responsibility

• encourages connections and contributions to family and community

culture change - eden alternative philosophy

emphasis on life; vibrance community, social bonding, purpose, and individualized care

culture change - green house projec

replacing large, traditional long-term nursing homes wards with small, self-contained homes

• stemmed out of COVID19 pandemic

pros of culture change models

• better quality of life

• lower levels of self-reported boredom and helplessness in residents

• reduced depression levels

• increased stream of revenue longer term

cons of cultural change models

• simpler practices with less staff involvement were adopted

• complex practices were adopted more in homes that fully embraced culture change practices vs. partial adoption

• need an initially bigger financial investment, more buyin, and planning

death

irreversible cessation of circulatory and respiratory functions

• OR when all structures of the brain have ceased to fucntion

brain death

cessation of brain functioning that regulate consciousness, essential functions

• coma (prolonged unconsciousness)

• brain ste reflexes permanently stop

• breathing permanently stops without aid

psychosocial death

conceptual forms of death related to dying process

invisible death

prefernece that the dying retreat from the family and spend their final days confined in a hospital setting

social death

process through which the dying become treated as “non-persons” by family or health care workers via social isolation

top causes of death in age group 1 to 24 years old

accidents

top causes of death in age group 25 to 44 years

other causes and accidents

top causes of death in age group 45 to 64

cancer

top causes of death in age group: 65 years and over

cancer and other causes

stages of adjusment to dying (kubler-ross model)

observation that people who are coping with knowledge of their own deterioration will go through these phases:

• denial, anger, bargaining, depression, and acceptance

• dynamic curve of emotional coping

• stalling at one stage might mean one isn’t ready to move onto next stages

pros of the stages of adjustment to dying (kubler-ross model)

• framework helps people understand that they are not alone in their feeling, somewhat unviersal

• helps individuals seek help/counselling

criticisms of the stages of adjustment to dying (kubler-ross model)

• there isn’t one way to face/respond to death

• order may not be the same

• does not consider other emotional states that could be present

goranson et al. (2017) reuslts

• analysis of patient blogs (individuals who are dying)

• increases in percentage of positive words as death nears

• no change for negativee words

• people in jail → last words, poetry, higher percentage of positive words

factors influencing the experience of death

• cultural factors

• trajectories

• individual differences

• social suport

• medical system

how do cultural factors influence the experience of death?

cultural perspectives can impact death ethos

death ethos

prevailing philosophy od death

• deduced through funeral rituals, treatment of the dying, belief in an afterlife, etc.

religion and fear of death

most studies that people with religious beliefs is positively associated with a greater fear of death/death anxiety compared to non religious people

• possible inverted u pattern

  • people who are really religious or completely no-religious have less fear

death apprehension theory (DA)

assumption that fear of death is unavoidable because:

• death is often accompanied by pain

• death brings an end to the pleasures of life including all of those derived from social and family relationships

what are the individual differences that influence the experience of death?

• age

• personality

• coping strategies

• stressors

• previous experiences with death

true or false:

male individuals fear death more than males

false

true or false

fear of personal death mediated the relationship between neuroticism and anxiety in men during COVID

true

near death experiences (NDE)

profound subjective experiences reported by people who were near death or clincially dead but resuscitated

• decreased fear of death

how does social support influence the experience of death?

atittudes surrounding deaht and social aspects

• carers wanting more support than they received from family

• attitudes surrounding death and scial aspects

  • dying alone/isolated

curative/disease focus model of care

• diagnosis

• treatment

• finding a cure

• extending life

palliative/hospice care focus

• patient and family-led end-of-life goals

• balance treatment/care with goals

• interventions to assist in reaching end-of-life goals

• focus on quality of life and closure

good palliative care strives to:

• manage pain and other distressing symptoms

• helps patients live as actively as possible

• uses a team approach the needs of patients and their families

• offers a support system to help the family cope during the patient’s illness

• integrates the psychological and spiritual aspects of patient care

• enhance quality of life

hospice care

extends palliative care into the terminal/tertiary stages of aging

• end-of-life

• focus on quality of life

temel et al. (2010) findings

• relationship between palliative care and depression + survival rate

• reduction in depression scores across different measures

• higher survival rate

true or false:

only 16-30% of canadians receive palliative care

true

barriers of palliative care

• lack of patient understanding and/or awareness

• limited resources and funding

• limited training and few specialized doctors

• reluctance to discuss dying and palliative care

• recent immigrants, POC, indigenous people

• homeless population

category 1 of palliative care development

no known palliative care activity

• nothing is established to support

category 2 of palliative care development

capacity-building palliative care activity

• no palliative service established, but shows evidence of potential to develop one

category 3a of palliative care development

isolated palliative care provision

• development of palliative care activism that has gaps, not well supported

category 3b of palliative care development

generalized palliative care provision

• development of palliative care activism in several locations with the growth of lcoal support in those areas

category 4a of palliative care development

palliative care services at a preliminary stage of integration to mainstream health care services

category 4b of palliative care development

palliative care services at an advanced stage of integration to mainstream health care services

advanced care planning

decisions for end-of-life treatment that are discussed, documented, and communicated between the patient, family, and care providers

living wills/advanced directives

document that describes your preferences for future care if you are unable to speak for yourself

potential options to ensure that treatment is consistent with one’s final requests

• refusal or withdrawal of treatment

• palliative sedation for comfort

• medical assistance in dying (MAID)

do not resuscitate orders (DNR)

directs health care workers not to use resuscitation if the patient experiences cardiac or pulmonary arrest

palliative sedation for comfort

• intentional administration of sedative medication to reduce a patient’s level of consciousness

• intention is not to cause or hasten death

• must be accompanied by the withdrawal of artificial hydration and nutrtition

two types of MAID in canada

1. clinician adminstered MAID

2. self-administered MAID

clinician administered MAID

a physician or nurse practitioner can directly administer a substance that causes the death of the person who has requested it

self-administered MAID

a physician or nurse practioner can give or prescribe to a patient a substance they can self-adminster to cause their own death

eligibility criteria for MAID

2 independent health care professionals need to evaluate an individual

• eligible for govt-funded health insurance

• 18+ years

• grevious or irremediable condition

• voluntary request for MAID

• give informed consent to receive MAID

grevious or irremediable medical condition

1. serious and incurable illness, disease

2. an advanced state of irreversible decline in capability

3. experience unbearable physical or mental suffering from illness, disease, disability, or state of decline that cannot be relieved under conditions that one considers acceptable

4. natural death has become foreseeable and have signed a wiaver approving of MAID

three edge cases that provide challenges to MAID

1. mature minors

2. advanced requests because their condition will limit their future decision-making ability

3. those who have a mental disorder as their sole underlying medical condition

health care professionals’ perspectives on MAID: roles

• consulting patients and/or staff with requests

• assessing eligibility, administering/dispensing the lethal drugs

• providing aftercare to bereaved relatives

• regulatory oversight

health care professionals’ perspectives on MAID: challenges

• lack of clear guidelines/protocols

• role ambiguity

• evaluting capacity/consent

• conscientious objection

• lack of interprogessional collaboration