Later Life, Aging, and End-of-Life Care – Key Vocabulary

Definition & Terminology

• “Old age” = socially–constructed life-phase rather than a fixed biological state

  • UN benchmark: individuals \ge 60\;\text{years} considered “old”

  • Common labels: seniors, senior citizens, older adults, elderly, elders

Age Categories & Demographic Trends

• Young-old (60\text{s}\,-\,70\text{s})

  • Usually healthy, relatively affluent, active

• Old-old (80\text{s}\,-\,100+)

  • Higher frailty, lower SES, greater care-needs

• Global shift

  • Longevity ↑, fertility ↓ ⇒ population aging

  • Impending caregiver shortage for Baby-Boom cohort

Core Theories of Socio-Emotional Aging

• Socio-Emotional Selectivity Theory (Carstensen)

  • With shrinking time horizons, priorities shift from future-oriented goals to emotionally–meaningful experiences

  • Key features

  • Relationship selectivity & pruning of superficial ties

  • Positivity effect: preference for positive > negative stimuli in attention & memory

  • Deliberate curation of activities → stress ↓, happiness ↑

• Erikson’s Stage 8: Integrity vs Despair (\ge 65)

  • Life review yields either integrity (wisdom, fulfillment) or despair (regret, meaninglessness)

Retirement

• Financial Context

  • U.S. Social Security = safety-net, not comfort-income

  • Pension decline post 2008 recession; personal savings essential

  • German model: generous state replacement (≈ \tfrac{3}{4} previous earnings); early retirement options (60 women, 63 men)

• Decision Drivers

  • \textbf{Money}, physical ability, job satisfaction, age discrimination

• Psychological Adjustment

  • Bridge / “Encore” work → better mental & physical health (Wang 2009)

  • Predictors of positive experience: good health, meaningful goals, marriage, financial security, viewing retirement as a new phase

  • Risk factors: involuntary exit, poor health, low income

Physical Changes in Later Life

• Skeletal & Muscular

  • Bone thinning → height ↓ by ≈ 2\;\text{in} by 80, kyphosis, ↑ risk of osteoarthritis & osteoporosis

• Chronic Disease Prevalence (U.S. 2007\text{–}2009)

  • Arthritis 50\%, hypertension 34\%, heart disease 32\%

• Sensory Decline

  • Vision: presbyopia; dark-adaptation ↓; glare ↑; cataracts, glaucoma, macular degeneration

  • Hearing: presbycusis – high-frequency loss (men > women); background-noise masking

  • Taste buds ↓ 50\% by 80 ⇒ nutrition risk

• Other Systems

  • Cardiac efficiency ↓, lung capacity ↓, immune senescence, weaker voice, essential tremors, sleep disorders (> 50\%), urinary incontinence, mobility impairment (affects 14\% aged 60!–!74; 50\% ≥ 85)

  • Reaction-time slowing (information-processing speed ↓)

Cognitive Aging & Memory Systems

• Memory taxonomy

  • Procedural ⇒ most resilient

  • Semantic ⇒ moderately resilient (crystallized knowledge)

  • Episodic ⇒ most vulnerable

• Autobiographical Pattern

  • Reminiscence bump: superior recall for adolescence/early adulthood + recent past, poorest for mid-life interval

• Compensation Strategies

  • Selective Optimization with Compensation (SOC): select, optimize (rehearse), compensate (external aids)

  • Mnemonics; memory self-efficacy belief

Dementia Spectrum

• General prevalence: 10\% at 65 → 50\% at 85

• Alzheimer’s Disease (AD)

  • Accounts for 50!–!80\% of dementias

  • Neuropathology: neural atrophy, extracellular β-amyloid plaques, intracellular neurofibrillary tangles; APOE-ε4 allele risk marker

  • 5 Clinical stages: mild memory loss → total unresponsiveness

• Vascular Dementia: cumulative micro-strokes; step-wise decline

• Prevention/Management

  • Aerobic exercise, Mediterranean diet, cognitive stimulation, side-sleeping (CSF clearance), structured environments, external memory aids

• Caregiver Issues

  • High burden: wandering, aggression, role reversal, depression; importance of support groups & respite

Long-Term Care Continuum

• Nursing Homes (LTCFs)

  • 24-hr ADL/IADL support; residents largely female & ≥ old-old; quality varies (≈ 25\% substandard)

  • Frontline care by Certified Nursing Assistants (low-pay, high workload)

• Alternatives

  • Continuing-Care Retirement Communities (CCRCs)

  • Assisted Living Facilities (ALFs)

  • Adult Day Programs (often inter-generational)

  • Home-Health Services

Socio-Economic, Ethnic & Biological Modifiers

• SES Health Gap: affluent live longer, healthier (fetal programming, bidirectional poverty–illness loop)

• Ethnicity

  • Black–White life-expectancy gap now ≈ 4 yrs (down from 8 yrs 1950); higher CVD in Blacks, higher suicide in Whites

  • Hispanic Paradox: despite poverty, better aging outcomes than African Americans

• Gender

  • Women outlive men (XX backup genes, estrogen antioxidation, lower testosterone exposure)

  • “Jogging-female-heart” hypothesis; eunuch longevity data (≈ +20 yrs vs. intact males)

Mental Health in Later Life

• Depression affects ≈ 15\% ≥ 60; highest suicide rates in \ge 65 group

• Drivers: internalized ageism, isolation, chronic illness, fear of crime

• Caution, risk-aversion & preference for routine (“set in ways”) linked to fluid-IQ decline

End-of-Life Care

• Palliative Care: comfort-focused, dignity-oriented; can coexist with curative treatment; often cost-effective

• Hospice

  • Home-based, multidisciplinary; philosophy akin to natural childbirth movement (“death as human event”)

  • Barriers: denial, late physician referral, limited family support

• Advanced Directives

  • Living Will

  • Durable Power of Attorney for Health Care (DPAHC)

  • Do Not Resuscitate (DNR)

  • Do Not Hospitalize (DNH)

• Euthanasia Spectrum

  • Passive: withdrawal of life-sustaining treatment (legal in most regions via directives)

  • Active / Physician-Assisted Suicide: direct hastening of death; legal only in select jurisdictions (e.g., Belgium, Netherlands, Luxembourg; some U.S. states for PAS)

  • Ethical concerns: slippery slope, coercion, religious doctrines

Historical & Cultural Context of Death

• Pre-20th C: deaths rapid, home-based, communal; infectious diseases predominant

• Modern era: chronic illnesses, technological life-extension → protracted dying, hospital setting, death anxiety ↑

• Thanatology: interdisciplinary study of death/dying; Kübler-Ross 5-stage model (Denial → Anger → Bargaining → Depression → Acceptance) – useful but non-universal; “middle knowledge,” hope & cultural variation noted

Successful Aging Principles (Summary)

• Maintain social support & emotionally meaningful ties

• Exercise body & mind; manage chronic disease proactively

• Cultivate financial & psychological readiness for retirement

• Bolster self-efficacy; adopt SOC & compensatory strategies

• Plan end-of-life preferences early (directives, hospice awareness)

• Recognize change as constant; adapt through lifelong learning & purpose

Definition & Terminology

• “Old age” = a socially–constructed life-phase rather than a fixed biological state, meaning its definition and associated roles vary significantly across cultures and historical periods. It is not solely determined by chronological age but by societal perceptions and expectations.

  • UN benchmark: individuals \ge 60\;\text{years} considered “old,” used for statistical and policy purposes globally.

  • Common labels: seniors, senior citizens, older adults, elderly, elders, often used interchangeably but can carry different connotations.

Age Categories & Demographic Trends

• Young-old (60\text{s}\,-\,70\text{s}):

  • Usually healthy, relatively affluent, and active, often engaged in leisure, volunteer work, or part-time employment.

  • Characterized by continued independence and social participation.

• Old-old (80\text{s}\,-\,100+):

  • Higher frailty, lower socioeconomic status (SES), and greater care-needs, often requiring assistance with daily activities and experiencing more chronic health conditions.

  • May face increased social isolation and reduced mobility.

• Global shift:

  • Longevity \uparrow (due to improved healthcare, nutrition, and sanitation), fertility \downarrow (due to changing social norms, education, and access to contraception) \Rightarrow leading to rapid population aging worldwide.

  • Impending caregiver shortage for the Baby-Boom cohort, as the proportion of older adults to working-age individuals increases, placing strain on social security and healthcare systems.

Core Theories of Socio-Emotional Aging

• Socio-Emotional Selectivity Theory (Carstensen):

  • With shrinking time horizons (perception of less time remaining), priorities shift from future-oriented goals (e.g., career advancement, acquiring new knowledge) to emotionally–meaningful experiences (e.g., deepening existing relationships, pursuing activities that bring immediate emotional satisfaction).

  • Key features:

    • Relationship selectivity & pruning of superficial ties: Older adults become more selective about their social partners, prioritizing close, emotionally supportive relationships and letting go of less meaningful ones.

    • Positivity effect: A preference for positive > negative stimuli in attention & memory. Older adults tend to focus on and remember positive information more than negative information, contributing to greater emotional regulation and well-being.

    • Deliberate curation of activities \rightarrow stress \downarrow, happiness \uparrow: Older adults intentionally choose activities that are emotionally satisfying and reduce exposure to emotionally challenging situations.

• Erikson’s Stage 8: Integrity vs Despair (\ge 65):

  • Life review: An extensive process of reflecting on one's life experiences, accomplishments, and failures.

  • This review yields either integrity (a sense of wisdom, fulfillment, and acceptance of one's life as having been meaningful) or despair (feelings of regret, bitterness, and meaninglessness over unachieved goals or unresolved conflicts).

Retirement

• Financial Context:

  • U.S. Social Security = safety-net, not comfort-income. It provides a foundational income but is typically insufficient to maintain pre-retirement living standards.

  • Pension decline post 2008 recession; personal savings essential. Many defined-benefit pension plans have been replaced by defined-contribution plans (e.g., 401ks), shifting investment risk to individuals.

  • German model: generous state replacement (\approx \tfrac{3}{4} previous earnings); early retirement options (60 women, 63 men), highlighting different national approaches to retirement security.

• Decision Drivers:

  • \textbf{Money}, physical ability, job satisfaction, and age discrimination are primary factors influencing the decision to retire. Economic necessity often forces continued work, while declining health or dissatisfaction can hasten it.

• Psychological Adjustment:

  • Bridge / “Encore” work (part-time or different roles post-retirement) \rightarrow better mental & physical health (Wang 2009), providing purpose, social engagement, and supplemental income.

  • Predictors of positive experience: good health, meaningful goals (e.g., volunteering, new hobbies), marriage/strong social support, financial security, and viewing retirement as a new phase of life rather than an end.

  • Risk factors: involuntary exit (e.g., job loss, mandatory retirement), poor health, and low income.

Physical Changes in Later Life

• Skeletal & Muscular:

  • Bone thinning (osteopenia/osteoporosis) \rightarrow height \downarrow by \approx 2\;\text{in} by 80. This also leads to kyphosis (a forward curvature of the spine,