lifespan exam 2

adolescence

12-18 years

physical changes of adolescence

weight gain caused by increase in musculo-skeletal mass

asynchronous growth

growth spurt

increased sweat gland activity → breakouts and acne

stomach and intestines increase in size → increased appetite

braces often needed

volume of lungs increase and weight triples → improved respiratory

improved motor function and hand-eye coordination

heart doubles in size and heartbeat slows

lymphoid tissue decreases in size

sweat glands located in axillary, genital, and periumbilical areas lead to body odor

hair on head and limbs becomes coarser and darker

new hair under arms, on face, and over sex organs

GI tract grows and matures, allowing consistent elimination

all permanent teeth except for wisdom teeth by age 13-14

need 9+ hours of sleep

puberty

time between first onrush of hormones and full adult physical development

usually last 3-5 years

requires further years for psychosocial maturity

primary sex characteristics

organ necessary for reproduction

secondary sex characteristics

external features not necessary for reproduction

male puberty

hormonal changes between the ages of 10-13

thinning of scrotal sac, enlargement of testes

secondary sex characteristics

spermatogenesis

ejaculation proceeds fertility by few months

nocturnal emissions

height spurt AFTER spermarche

spermarche

boy’s first ejaculation of sperm

menarche

girl’s first menstrual period, signaling that she has begun ovulation

female puberty

breast buds are first sign of secondary sex characteristics

hormones begin to establish a pattern within a monthly cycle

height spurt BEFORE menarche

onset of puberty

pubertal hormones begin to accelerate between ages 8-14

girls develop ahead of boys

girls with increased body fat have earlier onset of puberty

overweight boys experience puberty quicker, but obesity slows it

malnutrition delays onset

stress hastens puberty

adolescence disorders

scoliosis - lateral S-shaped curvature of the spine, >15 degrees

turner syndrome (XO) - females with short stature, webbed neck, low-set ears, lack of sexual development, cardiac/renal anomalies, and learning disabilities

klinefelter syndrome (XXY) - thin, tall males with lack of sexual development, gynecomastia, and learning/behavior problems

adolescence nutrition

1600-1800 calories for females

1800-3200 calories for males

milk is essential for osteoporosis prevention

eating disorders

anorexia nervosa - relentless pursuit of thinness, self-starving, and weight loss

• lack of menstruation, low sex drive, brittle hair/nails, dry skin, constipation, cold

• compulsive exercise and preoccupation with food

bulimia - binge and purge by vomiting or using laxatives

• electrolyte imbalances, erosion of tooth enamel, weight fluctuations

binge-eating disorder - binges large quantities of food without purging

• social difficulties, alter mood, low self-esteem

• contributes to obesity

adolescent activity-exercise pattern

increase in lean mass, physical strength, and endurance

>60 minutes a day

>3 days a week

participation in organized sports

adolescent brain development

instinctual and emotional areas develop before the reflective ones do

intense emotions lead to shutdown of logical parts of the brain, especially around peers

adolescent brain is susceptible to impulses

increases myelination → lower reaction time

enhanced dopamine activity → pleasurable experiences promoted

synaptic growth → enhanced moral development & openness to new experiences/ideas

adolescence is best time to teach preventative measures

adolescent piaget stage

formal operational stage

• thinking becomes more complex and abstract

• systematic logic, egocentrism, and introspection

adolescent thinking

hypothetical thought - includes reasoning that uses propositions and possibilities that may not reflect reality

deductive reasoning (top-down reasoning) - involves reasoning from a general statement, premise, or principle through logical steps, to figures out specifics

inductive reasoning (bottom-up reasoning) - involves reasoning from one or more experiences or facts to a general conclusion

imaginary audience → involves thinking intensely about themselves and about what other people think of them

adolescent fables

personal fable - adolescent’s belief that their thoughts, feelings, or experiences are more unique than anyone else’s

invincibility fable - adolescent’s egocentric conviction that they cannot be overcome or harmed by anything that might defeat a normal mortal

adolescent kohlberg stage

postconventional stage

motivated by the need to conform and please others

later in adolescence, moral principles are based on one’s own individual thinking and beliefs

equating what is right with the idea of justice

adolescent erikson stage

identity vs. role confusion

• major task is achieving a stable self-identity

• previous tasks resurface as extent of success of earlier tasks predict current development

  • must trust in themselves while seeking independence from parents

  • use initiative to search for direction and purpose

  • use industry as they contemplate vocation and social/recreational choices

• can become confused as to which roles to adopt

• threats to identity can result in delinquent behavior and mental health issues

adolescent identity

identity achievement - person understands who they are as a unique individual

role confusion - adolescent does not seem to know or care what their identity is

foreclosure - adolescent adopts parents’ or society’s rules

moratorium - choice of social acceptable way to postpose making identity-achievements

parents provide less direct guidance, but this can result in conflict

teens turn to peer group rather than family to develop identity

developing a sexual identity is an important part of the adolescent’s sense of self

adolescent suicide

2nd leading cause of death among ages 10-24

behavioral changes → increased risk-taking, increased incidence of accidents, substance abuse, physical violence, decreased appetite, alienation, giving away personal items, and writing suicidal content

cognitive and mood changes → expression of hopelessness, increasing rage/anger, dramatic swings, sleep disorders, preoccupation with death, difficulty concentrating, hallucinations, and new interest in religion/cult

suicidal ideation - thinking about suicide, usually with some serious emotional and intellectual/cognitive overtones

parasuicide - any potential lethal action about the self that does not result in death

cluster suicides - several suicides committed by members of a group within a brief period of time

non-suicide self-injury (NSSI) has a 16.9% prevalence in adolescents

adolescent depression

dysthymia - depressed or irritable mood that extends for more than 2 years, but doesn’t interfere with activities or performance

major depressive disorder - alteration in mood that is disabling and interferes with normal activities for ≥2 weeks

changes in weight or appetite, insomnia or hypersomnia, decreased energy, loss of interest/pleasure in activities, difficulty concentrating, and preoccupation with death

young adulthood

ages 18-40

transition to adult roles and responsibilities

young adult piaget stage

formal operational stage

• thought is more perceptive and insightful

• logical reasoning

• can consider different possibilities and deal with hypothetical problems

  • dialectical thought

young adult levinson stage

during structure phase of young adulthood, significant choices such as career and marriage

during transitional stage, choices are reasoned and possibly changed

young adult kohlberg stage

postconventional stage

• define rights and morality in terms of self-chosen principles

• formal operational level must be achieved

• understanding other’s points of view, how one’s actions affect other, taking responsibility

• weight needs of society against individual desires

• adult responsibility, experiences, and education affect moral reasoning

• maturation of values appears first in emerging adulthood

young adult erikson stage

intimacy vs. isolation

• goal is increased competency and self-esteem

• learns to develop reciprocal intimate relationship → requites mutual trust

• more than just sexual relationships

• if identity is not achieved in adolescence, intimacy is difficult

• young adults either explore and experiment or prepare for future with firm commitments

• young adults and their parents often lead linked lives

  • helicopter parents - hover over their emerging adult child, ready to swoop down if any problem occurs

  • snowplow parents - clear every obstacle in their child’s path

• emerging adults make more friends than at any later period

• love grows from passion to intimacy to commitment, evolving into marriage and cohabitation

domestic violence

men and women can be victims, but men are less likely to report

violence against women reached epidemic proportions

intimate partner violence:

• phase I - tension building

• phase II - explosion

• phase III - honeymoon

signs include erratic prenatal/child care, bruises and lacerations in various stages of healing, self blame, history of substance abuse in partner, history of child abuse of victim, and minor battering incidents

can occur as situational partner violence or intimate terrorism

young adult marriage

¾ couples cohabitate before marriage

delayed until schooling done and career stabilized

when child is welcome and parents supported, healthy parenting styles result

young adult suicide

suicide is 2nd leading cause of death

risk factors include alcohol use, exposure to violence/suicide, and depression

more women attempt, but more men succeed

young adult depression

screening tool used is Patient Health Questionnaire-2 (PHQ-2)

ask about disinterest and feeling down over past 2 weeks

bipolar depression can occur

middle adulthood

ages 40-65

main task is generativity vs. stagnation

maintaining a positive self image is important

have to adjust to changing relationships

middle adulthood physical development

senescence - a gradual physical decline related to aging

rate of decline is variable within and between persons

every organ, system, and cell slows with age

• blood pressure increases with age

• maximum breathing function decreases with age

  • sleep is crucial

middle adulthood brain changes

neurons fire more slowly and reaction time lengthens

new neurons and dendrites appear, but others atrophy

neurogenesis allows new learning

analysis is more comprehensive

brain loss before age 65 has other causes

middle adulthood skin changes

collagen decreases

moisture and turgor decrease

loss of subcutaneous fat → wrinkles appear

by age 40, age spots, tiny blood vessels, and other imperfections visible

middle adulthood physical changes

hair turns gray and gets thinner/less dense

fat deposits increase → increase in weight and BMI

decreased bone density and mass → osteoporosis

height and agility decrease

body contour changes and decreased muscle mass

middle adulthood lifestyle changes

sedentary lifestyle results in decreased energy

lower capacity for physical work

decreased functional aerobic capacity and cardiac output

middle adulthood vision changes

peripheral vision narrows faster than frontal vision

color vision shifts from vivid to fded

myopia (nearsightedness) increases beginning in 20s

presbyopia (farsightedness). caused by less elastic lens and flatter cornea, increases in 50s

adjustments to darkness and glare take longer

glaucoma

increased ocular pressure and damage to optic nerve

• irreversible loss of peripheral vision → tunnel vision

cataracts

opacity of the lens

• clouded vision

macular degeneration

progressive deterioration of maculae of the retina

• loss of central vision

middle adulthood hearing changes

females lose less than males

presbycusis - higher frequencies lost earlier than lower frequencies

• associated with senescence and becomes apparent after age 60

middle adulthood women’s health

menopause - cessation of menstrual periods caused by hormonal changes

• 45-55 years of age

• 12 consecutive months without a period

• hot flashes, heart palpitations, headaches, decreased vaginal lubrication, fatigue, insomnia, and emotional instability

treatment is HRT or CAM

middle adulthood men’s health

sexual concerns of men related to role changes, work-related stress, sexual performance anxiety

andropause - testosterone levels decrease

• reduced sexual desire, erections, and muscle mass

mortality rates higher than for women

often delay seeking medical care

testosterone levels may lower LDL

middle adulthood oral changes

gingivitis is common cause of tooth loss

dental hygiene is related to overall health

oral cancers begin with changes to mucosa

poor access to oral care common with cost as main reason

kyphosis

angulation of posterior spine

osteroarthritis

degenerative joint disese

osteopenia

subnormal bone mineralization

osteoporosis

abnormal loss of bone density

constipation

decreased stool frequency

menopause

cessation of menses

health screenings for middle adulthood

vision → ≥ 2 years

dental → 1-2x a year

lipid and blood glucose monitoring

cardiovascular screening

colorectal cancer screening begins at age 45

women should get regular breast exams and pap smears

men should get regular testicular and prostate exams

middle adult piaget stage

formal operational stage at higher, most complex level

• creative intelligence - involves the capacity to be intellectual flexible and innovative

• analytical intelligence - involves mental processes such as abstract planning, strategy selection, focused attention, and information processing

• practical intelligence - intellectual skills in everyday problem solving

expertise and experience increase intelligence and can counteract age

expert cognition

selective expert

• notably more skilled and knowledgeable about a particular activity than the average person

intuitive cognition

• experts rely on their past experiences and immediate context

automatic cognition

• experts process most tasks automatically and act routinely, saving conscious thought for unfamiliar challenges

strategic cognition

• experts have more and better strategies, especially when problems are unexpected

flexible cognition

• experts are creative and curious, deliberately experimenting and enjoying the challenge when things do not go according to plan

coping methods

avoidant coping

• method of responding to a stressor by ignoring, forgetting, or hiding it

problem-focused coping

• strategy to deal with stress by tackling a stressful situation directly

emotion-focused coping

• strategy to deal with stress by changing feelings about the stressor rather than changing the stressor itself

middle adult kohlberg stage

conventional stage

• stage 3 (interpersonal) - personal wants and needs

  • stage 4 (law and order) - duties demanded by society

gilligan’s moral development

suggests that women have different process of morality

often more selfless and caring for familial responsibility

middle adult levinson stage

midlife transition (38-40) → reappraising one’s life, integrate polarities, and modify goals

• struggles with meaning and value which can become midlife crisis

structure phase → family, career, and retirement planning

middle adult erikson stage

generativity vs. stagnation

generativity - sense of productivity, creativity, and caring for others

stagnation - lack of accomplishment, self-absorption

sandwich generation → caring for parents and children

• fulfilling marriage helps with self esteem

work generativity very important

big five

openness

conscientiousness

extroversion

agreeableness

neuroticism

openness

the degree to which one is imaginative, curious, artistic, creative, open to new experiences

conscientiousness

the degree to which one is organized, deliberate, conforming, self-disciplined

extroversion

the degree to which one is outgoing, assertive, active

agreebleness

the degree to which one is kind, helpful, easygoing, generous

neuroticism

the degree to which one is anxious, moody, self-punishing, critical

late adulthood

ages 65-74

late adulthood women’s health

post menopause is an important developmental task of older women

defined as the absence of menstruation for a period of at least one year

hormone replacement therapy (HRT) and complementary & alternative medicine (CAM)

symptoms includes hot flashes, vaginal dryness, and mood swings

urinary leakage due to decreased estrogen and multiple pregnancies

primary aging

gradual, inevitable changes/deterioration that occurs throughout life

• heart pumps more slowly

• vascular network is less flexible

• lungs and kidneys function less effectively

• digestion slows

• healing takes longer from illnesses and accidents

• slowed movement

• impaired senses

secondary aging

specific physical illnesses or conditions that become more common with aging but are often preventable

results from poor health habits and disease

• hypertension

• diabetes

• coronary artery disease

• risk of decubitus ulcer

memory

prospective memory - remembering to perform a future task

• diminishes with age but may be aided with routines

working memory - ability to retain information for a brief period while performing mental operations on that information

• needed to carry out taks

• help with time and concentration

dementia

umbrella term for cognitive disorders

chronic or progressive → not normal

• mini-mental state exam (MMSE) used to assess out of 30 points

  • non-pharmacological strategies can be helpful

alzheimer’s disease

most common form of dementia

progressive memory loss

symptoms → forgetfulness, inattentiveness, disorganized thinking altered level of consciousness, perceptual disturbances, sleep-wake disorders, psychomotor disturbances, and disorientation

caused by a combination of factors

abnormal buildup of plaques and tangles in the cortex

no cure but medication and non-pharmacological approaches

stage 1 → forget recent and new information

stage 2 → generalized confusion

stage 3 → memory loss becomes dangerous

stage 4 → full-time care needed

stage 5 → unresponsive

frontal lobe dementia

deterioration of the frontal lobe and amygdala

parkinson’s disease

chronic, progressive disease with muscle tremor and rigidity

lewy body dementia

increase of lewy body cells in the brain, causing hallucinations

late adult erikson stage

integrity vs. despair

ego integrity - acceptance of life and ‘at peace’ OR fear of death and despair, feels life was ‘in vain’

ego differentiation vs. work role preoccupation → achieve an identity apart from work

body transcendence vs. body preoccupation → adjust to normal aging changes

ego transcendence vs. ego preoccupation → accepting death

loss of former roles (child, sibling, spouse)

retirement provides more free time, but comes with challenges

late adulthood depression

older adults are at highest risk → medical conditions, losses, and physical changes

risk increases as functioning is impaired

should not be automatically expected in older adults

treated by medication, self-help, and CAM

suicide is highest in elderly

late adulthood risks

falls are the leading cause of morbidity/mortality

• caused by neuromuscular dysfunction, osteoporosis, stroke, sensory impairment

polypharmacy

osteoporosis

impaired hot/cold perception

driving can be dangerous

elder abuse

intentional or neglectful acts by caregiver which harms vulnerable adult

elder prejudice

older adults categorized due to age → assumptions made and treated differently

• elderspeak - a condescending way of speaking to older adults that resembles baby talk

• destructive protection - elders are discouraged from leaving homes