Late Adulthood and Family and Disablement in Adulthood
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44 Terms
“keeper of the meaning”
Links the past to the future by sharing traditons of the past with the next generation
Conservation and preservation of the culture in which one lives
Look through the lens of positve adaptation, mental health, and resiliency
handling stress and other psychological demands
Mental health improves with age in the absence of brain disease
Stressors decrease with aging
Although decreased, will take more tme to recover when compared to a young adult.
Mature defenses of stress
Strategies that maximize gratfcaton and allow moreconscious awareness of feelings, ideas, and consequences.
Altruism, suppression, andhumor
self-care
In the absence of disease, ADLs are performed IND well past 80 years of age
Compensate for age-related changes using AE, DME, increased time, or adapting the method.
medication toxicity
when people have too much of a drug in the bloodstream.
Caused by dehydration, medication nonadherence, and adverse drug reactions
medication reconcilliation
comparing a Pt’s meds to all the meds the Pt takes
household tasks
Can adapt or modify using AT/DME and/or environmental modifications
o Some Examples:
o Meal preparation: meal delivery services, microwave meals, kitchen AT (Air Fryer,
shut-off timers, adapted cutting board, Dycem, non-slip bowls
o Laundry: moving laundry to the first floor, HHA for laundry, rolling basket for apts,
reacher
o Sweeping: Roomba
o Garbage/recycling: adding handrails to exit the home
o Yard work: paid service or help from neighbors or family
o “Caring for others:” help from neighbors or family
occupational transition
a significant change in roles, rituals, and routines where occupationswill change, end, or are replaced with others.
• Older adult occupational transitions: workplace, ADL and IADLs, and driving.
long term transition planning
Planning an age to retire and when to move to a new location
acute transition planning
Unplanned change after a CVA, requiring a rehabilitative stay, early retirementor loss of job, and moving into an ALF
o Considerations for the caregiver/spouse as they transition to a health aide/nurse for their loved one. This will result in changes in interpersonalinteractions and their relationship.
o Lifestyle changes for prevention
workplace
Less of a focus
o Motivated by personal interest instead of career advancement
o Can cause economic hardship
o Retirement
o Have financial resources to manage or forced through workplace policies
o Higher SES = retire earlier; Lower SES = retire later
o Liberation stage: first year of retirement = freedom!
o Short lived
o “Retirees spend the next 2 to 15 years trying to reorient themselves to their post work lives!” (p. 425)
o Social implications: loss of identity, social networks, material wealth, and a structured day.
o May leave retired workers disillusioned and ready to consider a return to the workforce or
volunteer, unpaid labor
workforce re-entry
Leave long-term employment that has retirement benefits, but work part-time to maintain lifestyle
o “Downshift” into part-time work with less stress and responsibility
o Increased enjoyment when compared to the previous position
o Pay less
o Phased retirement: decrease the amount of time worked gradually for 5-15years. Allows for a more gradual transition and more abilities to work with decreased work demands
o Bridge Employment: paid work after retirement or when receiving a pension
o Career, noncareer, or re-careering
housing areas of consideration
• Home modifcations
• Earlier facilitates aging in place
• Universal design
• Common way to check homes for accessibility
• Cost implicatons of home modifcatons orsupervision/physical
assistance
housing options
• Home or downsizing
• Continuum Care Community
• Independent Living Facility or Senior Living
• Assisted Living Facility
• Long-Term Care, housed in nursing homes
cost/payment for housing
• Private pay or Medicaid waiver
• Medicare does not cover permanent living in facilities, only for rehab
relationships with adult children
Adult children provide modest and occasional forms of help
o Emotional support from adult children
o Physical support from adult children
o Use of social media to connect
relationships with spouse or partner
The significance of the relationship increases with aging. Partner is a source of support
o Older adults organize life around their spouse and the house
o Retirement reinforces marital satisfaction or amplifies difficulties
o Active sex life = increased QoL and increased marital satisfaction
widowhood
One of the most difficult transitions within the entire life course for the surviving spouse
o Acute transition to life roles that may have never been done
o High levels of social engagement facilitate healthy aging
grandparenting
Provide free childcare or housing for younger children and their kids
o Raising grandchildren as a grandparent = increased stress, decreasedfeeling of reward, decreased self-rated health, increased depression when compared to similar-aged peers
relationships with friends
Social network shrinks with retirement
o Reliance more on a spouse for friendship
o Single adults or widows tend to keep the same friendships
o Friends expire
community life
QoL in late adulthood is supported by physical fitness, and social engagement
o Volunteer activities common 65-70 years old
o If desired, most will volunteer as long as they are able
o Reduces with aging as a result of health mgt, increased time needed for ADLs, and transportation limitations
o Caregiving and care receiving roles
o Community service
o Child care to grandchildren
recreation and leisure
Most older adults choose volunteer positions where they are needed overleisure they are interested
o Leisure competence: knowing what leisure activities are meaningful and
rewarding for you as an individual
o May enjoy a long-deferred goal like traveling the world
o May become an expert in an interest like golf
religion and spirituality
Not much change in late adulthood. Many will retain involvement until unable to do so
o Associated with an improved perception of physical and psychological well-being
political life and citizenship
AARP promotes the political power of older Americans
o Gray power: organized influence elderly people as a groupexerts, especially for social or political purposes or ends
o The most used resource is TV for political information
o Barriers: transportation and health
o Facilitators: early voting, absentee voting, provided transportation
common causes of disability in adulthood
OA or RA
LBP or spine problems
Cardiovascular disease
acquired disability in early and middle adulthood
o Loss of desired life roles
o Loss of identity (an identity was already well formed)
o Visible vs invisible and physical vs mental impact social reactions
o Adults with physical disabilities participate less in work and social activities due to:
o Accessibility: public transport or buildings
o Stereotyped images
o Disability impacts education, work and employment, and economic life
o Decreased participation = negative impact on QoL
o Consistently require adaptations and accommodations to remain as IND
experience of having congenital/developmental disability in adulthood
Atypical development since early childhood
o Individuals with I/DD have problems in participation that
are unique to their I/DD
o More likely to have HTN, CAD, OA, DM II, and chronic pain
o More likely to live sedentary lifestyles, rely on aging
parents for IADL tasks and transportation.
o Continue in role of the “child”
education for people with disabilities
Continue in role of the “child”
o Choices can have a lasting effect on one’s adult lifestyle
o People with disabilities may be limited in ability to complete asecondary education due to decreased executive function
o Access is impacted by financial resources, quality of foundational education, intrinsic abilities, social policy, interests, and motivations
o Free public education through age 21 for people with disabilities, then supportis more limited
o People with low self-expectations or negative experiences
work and employment for people with disabilities
About 20% of individuals with disabilites work compared to 70% of individuals without disabilites
Individuals with disabilites leave work at a rate 5 tmes higher than individualswithout disabilites
Individuals with disabilites have disproportonate levels of poverty due to lowemployment partcipaton and earning ratesn, underemploymentn, and low levels offederal disability cash benefts
Disability fraud: collecting disability benefits when not disabled
developmental niche
an environment where the individual can function optimally
o Involves cooperation of individuals, their family, potential employers, social service agencies, and community organizations
sheltered workshop
a facility-based workplace that provides a supportive environment where people with disabilities can acquire job skills and vocational experience.
o Goals vary between assessment and rehab to transition to general labor market tolong-term placement in the workshops
o Gives an ability to leave the home and socialize with others
o Most common: private nonprofit enterprises that provide services such as recycling materials into crafts, paper shredding, and food service
integrated employment
Paid work in the general labor market wherethe proportion of workers with disabilities does not exceed the naturalproportion in the community.
o Part-time or full-time, 10-15 hrs/wk
o Advantages: better financial outcomes, increased opportunities for personal growth, compliance with the paradigm shift from fitting people into programs to adapting services to people’s needs, adherence to the values of social justice, fulfillment of the preferences of people with I/DD and their caregivers, and greater social interaction
o These types serve around 20% of adults with I/DD
o Area of growing need as individuals with I/DD need extra training to be successful ina job position
social life with disabilities
Social and physical barriers to participation
o Disability communities advocate for inclusion andfull participation of individuals with disabilities
o Special Olympics
o Paralympics
o Social model of disability
o Social media advocates
o Public advocates
aging individuals with IDD stop leisure
Typically a gradual cessation of leisure activities
o Loss of coping strategies and social identity
o Decreased capability to perform activities at desired levels of satisfaction
o Effort required by the person and their caregiver
o Environmental and transportation barriers
o Leisure interests may need individual solutions instead of UD
o Stigma or discrimination
o Lack of access to travel and social activities
o Resources for adapted leisure are lacking
o OT/PT and RecreationalTherapy
political life and citizenship for people with disabilities
Disability rights movement: organized political and social action movement to raise public awareness and secure equal opportunities and rights for people with disabilities
o Access to education, voting, housing, employment, health care, informedconsent, PHI, and strict supervision for restraints
o Self-advocacy: people with disabilities should be able and allowed to speak forthemselves
o Remain the most vulnerable and isolated members of societydespite all gains
o Self-advocacy would reduce this by giving tools and experiences to take greater control over their own lives
domestic life for individuals with IDD
Housing
o Often a parent’s decision
o Over 75% live at home with parents, 25% of which are over 60 years old
o Group homes, ALFs, ILFs, or LTC
Delicate balance between protecting people with I/DD and supporting IND
o Transportation access
o Personal safety
o Exploited for sexual favors or money
o Domestic violence
o Social victimization
o Up to 25% male and 50% female individuals with I/DD have experienced some form ofsexual abuse
family relationships with IDD
o Parental adaptation to caregiving is a lifelong process
o Parents and siblings are the most common caregivers
o Caregivers may feel limited in their own aspirations due to having a child that ‘never grows up’
o Others may define their identity in being a caregiver
intimate relationships with IDD
Individuals with IDD experience the same hormone levels and sexual attraction as their age peers
o Relationships can be positive and healthy
o Tend to choose partners with the same lived experiences
o Group homes, ALFs, and LTC offer double rooms for relationships
most common IDD
autism, Down syndrome, fragile X syndrome, and fetal alcohol spectrum disorder
challenging behaviors with IDD
o Being able to regulate behavior in a social environment is directly predictable to being able to maintain employment and live in community housing
o As behaviors increase, cost and need for caregiversincreases
social interaction with IDD
May/may not also have a physical impairment impacting participation
o Recreation and leisure, religion and spirituality, and political life and citizenship
o Barriers
o Transportation
o Access
o Behaviors limiting social interaction or community settings
o Facilitators
o Social programming
o Safe and accepting social network
o Supportive environment
ADL & IADL supports
Adult day service centers and home health agencies
o Not universally available, especially in rural areas
o Most are private pay and can get expensive
o Some are grant-funded
residential care communities
- Functional and behavioral impairments are the primary reason for institutionalization
o Need for residential care increases with age
o Universally available
o Medicaid can cover services at specific locations
o ALFs and nursing homes
o Institutionalization is considered negative
o Impose environmental and cultural constraints
- Hospices
Goal is to maintain QoL and optimize comfort
o Therapy referrals would aim toward these goals
functional and physical requirements to age in place/community housing
o Ability to walk 1,203 feet to complete an errand in the community
o Gait speed of 1.2m/s
o Need to carry an average of 6.7lb package
o Need to be able to negotiate stairs, curbs, slopes, gravel, grass, and unevenpavement
o Need to perform postural transitions including head turns, reaching, looking up,moving backward, and twisting
personal losses of instituitionalization
o Loss of control over daily life decisions
o Loss of privacy
o Loss of relationships
o Inability to contribute support to family and friends
o Decreased activity levels