I.

MAJOR PHYSICAL CHANGES

A. Although there are predictable changes in the body associated with

adulthood and aging, many changes are in fact preventable. Normal
age-related changes should be differentiated from diseases; the
major chronic diseases in later adulthood include arthritis,
cardiovascular disease, and diabetes. These are also preventable,
particularly with control of diet and proper exercise.

B. Here is a brief summary of the changes that occur gradually

throughout adulthood:
1. Skin: Changes in elastin and collagen lead to wrinkling and sagging.
(“Photoaging” refers to sun damage due to sun exposure.)

2. Body build: Body experiences loss of bone mineral content, increase

in subcoteneous fat around the torso, loss of height.

3. Muscle mass: Body experiences loss of muscle mass (called

“sacropenia”).

4. Joints: There can be an increase in cartilage outgrowths and loss of

articular cartilage thickness.

5. Aerobic capacity: The maximum cardiac output may decrease.

6. Hormone changes: Climacteric involves the diminution of sex hormones; the
complete loss of fertility in women is called menopause.

7. Nervous sytem: Changes in circadian rhythms lead to increase in early rising.

There are also decreases in in numbers of neurons and synapses.

8. Vision changes: Presbyopia (far sightedness) and cataracts may occur.

9. Hearing Changes: Presbycusis ( loss of ability to hear high-pitched tones) is

another change.

10. Balance: Loss of balance can increase the risk of falling.

C. However, virtually all of these changes can be compensated for or
prevented through the following measures:

1. Physical Exercise: Participating in aerobic exercise stimulates

heart rate, and resistance training maintains muscle mass
and bone density.

2. Mental activity: Keeping mentally active can maintain brain

plasticity; people with higher levels of intellectual engagement
show fewer negative changes in mental activity.

3. Regulation of diet: Minimizing the intake of sugar reduces the

chances of developing metabolic syndrome and, hence, the risk
4. Avoidance of “bad habits”: Using sunscreen, wearing
sunglasses, not listening to loud music, not smoking, not
drinking can delay changes.
II. MAJOR COGNITIVE CHANGES

A. Throughout adulthood, individuals gradually increase their

response times, are less adept at solving fluid intelligence
problems, and have poorer episodic memory. However, many
cognitive functions are preserved, including semantic memory,
verbal (crystallized) intelligence, and procedural or implicit
memory. Moreover, older adults show increases in the quality
called wisdom, or practical knowledge about interpersonal
problems. Changes in driving ability occur due to changes in the
ability to make complex decisions, but many older adults regulate
their driving habits to compensate for these changes.
B. Cognitive changes are also linked to overall physical health.
There are steeper declines in memory for individuals who are
prone to diabetes, who do not exercise, and who do not participate
in intellectually stimulating activities. People’s belief’s about their
memory can also influence their performance, as can the amount
of psychological stress they experience.

C. Although considerable media attention is given to the increasing

prevalence of dementia, specifically Alzheimer’s disease, among
older adults, the large majority of people 65 and older do not suffer
from significant cognitive deficits.
D. Older adults show cognitive “plasticity”, the ability to
improve their functioning with practice, in many areas.
Most recently researchers are showing that playing
videogames can help maximize reaction time and visual
search. Cognitive intervention studies also show significant
transfer effects from exposure to training in memory,
reasoning, and spatial relations to activities of daily living.
III. SOCIAL, CULTURAL, AND EMOTIONAL ISSUES

A. Families: Changes in families are occurring along with a decline in

the percentage of families consisting of a married couple living with their
biological children. As life expectancy increases, so do the number of
three-and-four-generation families. Reconstituted or blended families
are also increasing in prevalence. Major turning points in families
include the transition to parenthood when a couple has their first child
and the transition to the empty nest when grown children move out of
the home. However, the economic downturn of the late 2000s, more
adult children are moving back home to live with their parents. There are
also increasingly large numbers of “skip generation” households in
which grandparents take primary responsibility for the care of children.
Cultures vary in their emphasis on family relationships, with some ethnic
B. Jobs and Career Development: The most popular vocational
development theory, that of John Holland, proposes that people are
most satisfied in their jobs when there is a fit or match between their
personalities and the characteristics of the job. Changes in career
patterns are occurring as the economy continues to shift, with
increases in the unemployment rate, particularly for young ethnic and
racial minorities. At the other end of the age spectrum, retirees are
concerned about the stability of their pension or retirement payment
and pressures on the Social Security System. Women and men are
also facing the challenges of balancing work and family life, especially
when there are young children in the home.
C. Cultural Aspects of Aging: In many societies, older adults are
highly valued, but western industrialized nations typically hold
more negative views. For example, older actresses are not
regarded as being attractive and have a more difficult time being
cast in starring roles. However, attitudes seems to be shifting, and
there is greater cultural acceptance of older people in general,
including older leading ladies and other performers.
IV. PERSONALITY AND AGING

A. The middle crisis is a concept that is constantly being

discussed in the media, but researchers do not find that it
is a widespread phenomenon at all. Most people develop
gradually through adulthood without undergoing a distinct
transition in their 40s. The debate about whether
personality is stable versus whether it can change in
adulthood seems to have subsided as researchers
investigating long-term patterns of personality find
that shifts can occur even into the decades of the 80s and
beyond.
B. Socioemotional selectivity theory proposes that as endings
occur, people try to focus on their relationship that are
most positively fulfilling; consequently, as a theory of
aging, the theory proposes that older people prefer to
spend time with people who enhance their well-being.

C. Other personality theories of aging propose that as people

get older, they are able to manage their emotions, cope
more effectively with stress, and engage in fewer self-
defeating and acting-out behaviours.
V. OTHER ISSUES ON ADULTHOOD AND AGING

A. DEATH AND DYING

Dr. Elizabeth Kubler-Ross introduced the most

commonly taught system for understanding the process of dying in
her 1969 book, On Death and Dying. The book explored the
experience of dying through interviews with terminally ill patients
and described Five Stages of Dying: Denial, Anger, Bargaining,
Depression, and Acceptance.
FIVE STAGES OF DYING

1. Denial: is a common defense mechanism used to protect oneself

from the hardship of considering an upsetting reality. Kubler-Ross
noted the patients would often reject the reality of the new information
after the initial shock of receiving a terminal diagnosis. Patients may
directly deny the diagnosis, attribute it faulty tests or an unqualified
physician, or simply avoid the topic in conversation. While persistent
denial may deleterious, a period of denial is quite normal in the
context of terminal illness and could be important for processing
difficult information. In some contexts, it can be difficult to distinguish
denial from a lack of understanding, and this is one of many reasons
that upsetting news should always bedelivered clearly and directly.
However, unless there is adequate reason to believe the patient
truly misunderstands, providers do not need repeatedly re-educate
patients about the truth of their diagnosis, though recognizing the
potential confusion can help balance a patient’s right to be
informed with their freedom to reconcile that information without
interference.
2. Anger: is commonly experienced and expressed by
patients as they concede the reality of a terminal illness, of
family member for contributing to risks or not being
sufficiently supportive, or of spiritual providers or higher
powers for the diagnois, injustice. The anger may also be
generalized and undirected, manifesting as a shorter
temper or a loss of patience. Recognizing anger as a
natural response can help health care providers and loved-
ones to tolerate what might otherwise feel like hurtful
accusations. However, they must take care not to disregard
criticism that may be warranted by attributing them solely
to an emotional stage.
3. Bargaining: typically manifests as patients seek some measure of
control over their illness. The negotiation could be verbalized or internal
and could be medical, social, or religious. The patients’ proffered
bargains could be rational, such as a commitment to adhere to
treatment reccommendations or accept help from their caregivers, or
could represent more magical thinking, such as with efforts to appease
misattributed guilt they may feel is responsible for their diagnosis. While
bargaining may mobilize more active participation from patients, health
care providers and caregivers should take care not to mislead patients
about their own power to fulfill the patients’ negotiations. Again,
caregivers and providers do not need to repeatedly correct bargaining
behaviour that seems irrational but should recognize that participating
too heartily in a patients’ bargains may distort their eventual
understanding.
4. Depression: is perhaps the most understandable of Kubler-
Ross’s stages, and patients experience it with unsurprising
symptons such as sadness, fatigue, and anhedonia. Spending
time in the first three stages is potentially an unconscious effort to
protect oneself from this emotional pain. While the patient’s action
may potentially be easier to understand, they may be more jarring
in juxtaposition to behaviors arising from the first three stages.
Consequently, caregivers may need to make a conscious effort to
restore compassion that may have waned while caring for patients
progressing through the first three stages.
5. Acceptance: describes recognizing the reality of a difficult diagnosis
while no longer protesting or struggling against it. Patients may choose
to focus on enjoying the time they have left and reflecting on their
memories. They may begin to prepare for death practically by planning
their funeral or helping to provide financially or emotionally for their
loved ones. It is often portrayed as the last of Kubler-Ross’s stages and
a sort of goal of the dying or grieving process. While caregivers and
providers may find this stage less emotionally taxing, it is important to
remember that it is not inherently more healthy that the other stages. As
with Denail, Anger, Bargaining, and Depression, the reason for
understanding the stages has less to do with promoting a fixed
progression and more to do with anticipating patient’s experiences to
allow more empathy and support for whatever they go through.
END-OF-LIFE ISSUES

A. Advance Directives- are legal documents that allow you to spell out
your decisions about enf-of-life care ahead of time. They give you a way
to tell your wishes to family, friends, and health care professinals and to
avoid confusion later on.
A living will tells which treatments you want if you are dying or
permanently unconscious. You can accept or refuse medical care. You
might want to include instructions on.

• The use of dialysis and breathing machines

• If you want to be resuscitated if your breathing or heartbeat stops
• Tube feeding
• Organ or tissue donations

A durable power of attorney for healthcare is a document that

names your health care proxy. Your proxy is someone you trust
to make health decisions for you if you are unable to do so.
B. Palliative Care- is the active holistic care of patients with advanced
progressive illness and includes areas other than oncology. Apart from,
managing pain and other symptoms, palliative care is aimed at
delivering psychological, social and spiritual support to patients and
their family to achieve the best quality of life

C. Hopices- is provided when a patient and physician have

determeined that they are no longer going to aggressively treat the
disease, yet they will aggressively manage pain and other symptoms.
The patient’s physician and hospice medical director certify that the
illness has a prognosis of six months or less. A question that ought to be
asked by the physician is “Would this patient survive this disease for
one year given it’s normal course?”
Hospices care focuses on the family members as the primary
caregivers, with the help of a skilled interdisciplinary team made up of
nurses, physicians, pharmacists, physical therapists, occupational
therapists, speech therapists, social workers, spiritual care providers,
aides, and many volunteers who provide services such as pet theraphy,
hand massage, and and respite for caregiver.

D. Assisted Suicide- A doctor assists a patient to commit suicide if they

request it. Intentionally helping a person commit suicide by providing
drugs for self-administration, at that person’s voluntary and competent
request. It is done in order to relieve intractable (persistent,
unstoppable) suffering.
B. Successful aging: As a positive and upbeat way to end
this unit, cover the topic of successful aging, defined as
maintaining physical health, cognitive vitality, freedom
from illness, and vital engagement with others. Many
productive and creative individuals have maintained their
contributions throughout their later years. You can also
emphasize the fact that the majority of older adults have
high levels of subjective well-being and have optimistic
views about their lives.
THANK YOU!