Occupational Therapy and Old Age Lifespan Development

Occupational Therapy
Old Age Lifespan Development

Erikson’s Final Stage
Ego-integrity versus despair:
Characterized by looking back over one’s life, evaluating
it, and coming to terms with it
Success at this stage:
- Integrity – fulfilled the possibilities that have come
their way
- Few or no regrets
- Sense of satisfaction and accomplishment

Erikson’s Final Stage
Ego-integrity versus despair:
Difficulty at this stage (lack of success):
- Looking back on one’s life with disappointment
- Regret over missed opportunities
- Have not accomplished what they wished
- Unhappy, depressed, angry (despair) over the way their
life turned out

Memory: Remembrance of Things Past – and Present
Episodic memory
- Specific life experiences
- Most memory losses
Semantic memory
- General knowledge and facts
- Typically unaffected by age
Short-term memory
- Declines gradually until age 70 (more pronounced)
- Information presented quickly and verbally is forgotten
sooner
- Newer information is more difficult to recall

Information-Processing Deficits
- Inability to inhibit irrelevant information and thoughts
declines
- Speed of processing declines
- Attention declines
- Less efficient retrieval methods

Coping with aging
Bernice Neugarten studied the different ways people cope
with aging:
- Disintegrated and disorganized personalities are unable
to accept aging, experience despair as they get older,
often end up in nursing homes or hospitalized
- Passive-dependent personalities lead lives filled with
fear of falling ill, fear of the future, fear of their own
inability to cope
- Defended personalities seek to ward off aging and
attempt to act young, exercising vigorously, and
engaging in youthful activities that could lead to
unrealistic expectations and disappointment

Coping with aging
- Integrated personalities cope comfortably with aging
and accept becoming older with a sense of dignity

Transition as a process of Grief
1. Shock or immobilization
2. Reaction and minimization (denial)
3. Self-doubt (awareness)
4. Accepting reality and letting go
5. Testing
6. Search for meaning
7. Integration

Kübler-Ross's five stages of grief
Denial:
- Denial is usually only a temporary defense for the
individual. This feeling is generally replaced with
heightened awareness of situations and individuals that
will be left behind after death.
Anger:
- Once in the second stage, the individual recognizes that
denial cannot continue. Because of anger, the person is
very difficult to care for due to misplaced feelings of
rage and envy. Any individual that symbolizes life or
energy is subject to projected resentment and jealousy

Bargaining:
- The third stage involves the hope that the individual
can somehow postpone or delay death. Usually, the
negotiation for an extended life is made with a higher
power in exchange for a reformed lifestyle.

Depression:
- During the fourth stage, the dying person begins to
understand the certainty of death. Because of this, the
individual may become silent, refuse visitors and spend
much of the time crying and grieving.
- This process allows the dying person to disconnect
themselves from things of love and affection. It is not
recommended to attempt to cheer an individual up that
is in this stage. It is an important time for grieving that
must be processed

Acceptance:
- This final stage comes with peace and understanding of
the death that is approaching. Generally, the person in
the fifth stage will want to be left alone. Additionally,
feelings and physical pain may be non-existent.
- This stage has also been described as the end of the
dying struggle

Ageism Prejudice Against Older People
- Negative attitudes about older people regarding
competence & attractiveness
- Identical behavior by an older person and a younger
one is interpreted differently.
- People use baby talk to address older people in nursing
homes
- Job discrimination
- Misinformation

Digestive System
- Produces less digestive juice
- Is less efficient in pushing food through the system
- The result is constipation
The Heart
- The arteries harden
- The blood vessels shrink
- Reduction in the capacity of the heart to pump blood
through out the circulatory system
- A 75-year-old’s heart pumps less than three-quarters of
the blood it pumped during early adulthood

The Peripheral Slowing Hypothesis
- The overall processing speed declines in the peripheral
nervous system.
- It takes longer for information to reach the brain.
- It takes longer for commands from the brain to be
transmitted to the body muscles
The Generalized Slowing Process
- Processing in all parts of the nervous system is less
efficient due to loss of neurons
- They are unable to receive efficiently information from
the environment to indicate a dangerous situation
- Their decision process may be slower and their ability
to remove themselves from harm is impaired

Vision
- Lens becomes less transparent and the pupils shrink
- The optic nerve becomes less efficient
- Distant object becomes less acute
- More light is needed to see
- It take longer to adjust to a change from light to
darkness and vice versa.
- Driving at night becomes difficult
- Reading becomes more of a strain

Vision Cataracts
- Cloudy or opaque areas of the lens of the eye that
interfere with passing light
- Can be surgically removed • Intraocular lens implants
can replace old lens
Vision Glaucoma
- Occurs when pressure in the fluid of the eye increases,
either because the fluid cannot drain Or because too
much fluid is produced
- It can be corrected with drugs or surgery
- It must be detected early enough

Hearing
- 50% of adults over 75 have hearing loss
- High frequencies are the hardest to hear
- Hearing aids would be helpful 75% of the time, but
only 20% of people wear them
- Hearing aids amplify all sounds so it is difficult to
discern conversations
- Some people withdraw from society because they feel
left out and lonely

Genetic Preprogramming Theories of Aging
- Our body’s DNA genetic code contains a build-in time
limit for the reproduction of human cells
- Genetic materiel has a “death gene” that is
programmed to direct the body to deteriorate and die •
There is some sort of timer in the hypothalamus and
the pituitary gland.
- The pituitary gland releases a hormone after puberty
that begins the process of decline throughout the rest of
the lifespan at a programmed rate

Wear-and-Tear/Stochastic Theories of Aging 1
- As cells age, they are less efficient in disposing of
wastes. Extra substances, particularly a fatty substance
called lipofusein, accumulate in blood and muscle cells.
Eventually, these substances take up space and slow
down normal cell processes.

- As cells age, they are less efficient in disposing of
wastes. Extra substances, particularly a fatty substance
called lipofusein, accumulate in blood and muscle cells.
Eventually, these substances take up space and slow
down normal cell processes.
- In the course of normal use of oxygen for virtually
every cellular process, small, highly charged, unpaired
electrons are left over. These free radicals react with
other chemical compounds in the cell and may
interrupt normal cell functioning

- It is known that ultraviolet light in sunshine can
damage the DNA in skin cells. In this case, the cell
either repairs itself or dies and is replaced. In older
people such repairs are less efficient.
- Sometimes connective tissue, or the cross-links between
cells, is affected. It loses some of its flexibility and
become rigid. Also, the immune system becomes less
efficient

Wear-and-Tear Theories of Aging
- The mechanical functions of the body simply wear out
with age
- The body’s constant manufacture of energy to fuel its
activities create byproducts, which eventually reach
such high levels that they impair the body’s normal
functioning
- Longevity can be extended by eliminating the toxins
produced by the body

Age Stratification Approaches to Late Adulthood
- Age stratification theories suggest that economic
resources, power, and privilege are distributed
unequally among people at different stages of the life
course.
- Such inequality is particularly pronounced during late
adulthood.
- Age stratification theories help explain why aging is
viewed more positively in less industrialized societies

Successful Aging
- Disengagement theory suggests that successful aging is
characterized by gradual withdrawal.
- Activity theory argues that successful aging occurs
when people maintain their engagement with the world.
- Continuity theory takes a compromise position,
suggesting that what is important is maintaining a
desired level of involvement.

Disengagement Theory
- On a physical level, elderly people have lower energy
levels and tend to slow down progressively.
- Psychologically, they begin to withdraw from others,
showing less interest in the world around them and
spending more time looking inward.
- On a social level, they engage in less interaction with
others, in terms of both day-to-day, face-to-face
encounters and participation in society as a whole.
- Older adults also become less involved and invested in
the lives of others.

Outcomes of disengagement are largely positive:
- According to this view, the gradual withdrawal of
people in late adulthood permits them to become more
reflective about their own lives and less constrained by
social roles
- People can become more discerning in their social
relationships, focusing on those who best meet their
needs. Disengagement can be liberating

Outcomes of disengagement are largely positive:
- Decreased emotional investment in others can be
viewed as beneficial.
- By investing less emotional energy in their social
relationships with others, people in late adulthood are
better able to adjust to the increasing frequency of
serious illness and death among their peers

Activity Theory
- Activity theory suggests that successful aging occurs
when people maintain the interests and activities they
pursued during middle age and resist any decrease in
the amount and type of social interaction they have
with others.
- Specific nature and quality of the activities in which
people engage are likely to be more critical than the
mere quantity or frequency of their activities.

Activity Theory
- Some people view the ability to moderate their pace as
one of the bounties of late adulthood. For them, a
relatively inactive, and perhaps even solitary, existence
is welcomed.
- Happiness and satisfaction from high level of
involvement
- Adaptation to inevitable changes
- Continuing/replacing previous activities

Continuity Theory:
- A Compromise Continuity theory suggests that people
simply need to maintain their desired level of
involvement in society in order to maximize their sense
of well-being and self-esteem.
- Highly active and social people will be happiest if they
largely remain so.
- Those more retiring individuals, who enjoy solitude and
solitary interests, will be happiest if they are free to
pursue that level of sociability.

Continuity Theory:
- Old Age can influence their happiness and satisfaction.
Those who view late adulthood in terms of positive are
apt to perceive themselves in a more positive light than
those who view old age in a more pessimistic and
unfavorable way.
- Good physical and mental health is important in
determining overall sense of well-being

Retirement
- Just as important to prepare psychologically for
retirement as it is to prepare financially.
- Some important considerations include the climate at
work and the opportunities for future growth in one’s
career, relationships with family members, and
community ties and activities.
- It’s important for older adults to keep in mind that they
don’t just retire from work, but they also retire to a new
lifestyle.

Retirement
- Planning for what that lifestyle will be like—whether it
will include part-time work, volunteer work, travel, or
other activities, for example—can make a difference in
adjustment to retirement

Retirement
According to Atchley, people pass through stages in the
process of retirement:
- At first there is a honeymoon period , in which former
workers engage in a variety of activities, such as travel,
that were previously hindered by full-time work.
- Disenchantment may occur when retirees conclude that
retirement is not all they thought it would be.
- Reorientation is the stage where retirees reconsider
their options and become engaged in new, more
fulfilling activities.

Retirement
- A retirement routine stage occurs when retirees come to
grips with the realities of retirement and feel fulfilled in
this new phase of life.
- The final stage is the process of termination where the
retiree either goes back to work or health deteriorates
so badly that the person can no longer function
independently.
- Not everyone passes through each stage and the
sequence is not universal.

Caring for an Aging Spouse
Wide variety of reactions, both positive and negative:
- Feel great frustration and even despair
- View caring for an ailing and dying spouse in more
positive light, regarding it in part as a final opportunity
to demonstrate love and devotion
- Feel quite satisfied as a result of fulfilling what they see
as their responsibility to their spouse
- Find initial experience emotionally distressful but
distress declines as they successfully adapt to stress of
care giving

Caring for an Aging Spouse
In most cases, caregiver is wife:
- Just under three-quarters of people who provide care to
a spouse are women.
- Part of the reason is demographic: Men tend to die
earlier than women, and consequently they contract the
diseases leading to death earlier than women.
- A second reason, though, relates to society’s traditional
gender roles, which view women as “natural”
caregivers. As a consequence, health care providers
may be more likely to suggest that a wife care for her
husband than that a husband care for his wife.

Symptoms of Stress (BASIC-ID)
- Behavior: Driving erratically, restlessness, social
withdrawal
- Affect: Emotions, moods, anger, anxiety, fear
- Sensations: Dizziness, nausea, clammy hands
- Imagery: Nightmares, flashbacks, bad memories
- Cognitions: Thoughts, opinions, judgements
- Interpersonal: Aggressive or passive communication
- Drugs/biological: Smoking, lack of exercise, poor diet,
alcohol abuse

Coping and adaptation
Coping: “process of managing the external and internal
demands that strain our actual or perceived resources.”
Environment-focused
- Modify Situation- rescheduling appointments, using
adaptive equipment
- Escape or avoid situation- ending a relationship,
decreasing work responsibilities

Coping and adaptation
Emotional Focused
- Development- yoga classes, relaxation, or new support
systems
- Alter perceptions and assessment-reconsider goals,
change unrealistic expectations or beliefs

Interventions
Behavior
- Behavior rehearsal
- Self-monitoring and recording
- Exposure programmed
- Skills development
- Modelling’
- Therapeutic drama
- Reinforcement programs
- Stimulus control
- Risk taking exercises

Interventions
Affect:
- Anger expression/management
- Anxiety management
- Feeling identification
Sensation:
- Biofeedback
- Relaxation training
- Meditation

Interventions
Cognition:
- Challenging faulty inferences
- Challenging negative assumptions and thoughts
- Positive self-statements
- Coping statements
- Problem-solving training
- Self-acceptance training
- Thought-stopping
- Affirmations
- Accepting appropriate anxiety

Interventions
Interpersonal:
- Assertion training
- Communication training
- Contracting
- Social skills training
- Friendship/intimacy training
Drugs/Biology:
- Self-care
- Lifestyle changes
- Smoking- cessation programs
- Alcohol reduction programs

Lifestyle redesign program
- Rather than focusing on the delivery of individual
activities or interventions Lifestyle Redesign takes a
wider approach believing that positive changes can
only be sustained if they are embedded within what a
person does on a day to day basis.
- Rather than focusing on the delivery of individual
activities or interventions Lifestyle Redesign takes a
wider approach believing that positive changes can
only be sustained if they are embedded within what a
person does on a day to day basis.

- Experience in occupation produces radiating not linear
change
- Occupational self analysis is possible
- When people understand the elements of occupation,
they gain a toolkit with which to re-design their lives
- Occupation is the impetus that propels people forward
- Active coping is a leant skill that can positively affect
physical and mental wellbeing

- Activity and health
- Maintaining mental well-being (sleep, keeping mentally
active, memory)
- Maintaining physical well-being (nutrition, pain,
keeping physically active)
- Occupation in the home and community (transport,
new learning, technology)

- Safety in and around the home
- Personal circumstances (dealing with finance, social
relationships, maintaining friendships, dining as an
activity, interests and pastimes, spirituality)

- Lifestyle Redesign enables patients to design, practice,
and ultimately enact a personalized, sustainable health-
promoting daily routine that is tailored to address CD
risk factors as well as promote health and well-being
more generally
- Lifestyle focused (activity based)
- Group & individual sessions
Goal: Assist each participant to develop
- A personally feasible, healthy lifestyle
- Sustainable within the fabric of his or her everyday
routines

Lifestyle Redesign
Becoming hyper-cognizant of activity
- Notice and name activities
- Learn the relationship of activities to health & well-
being
Activity Pattern Analysis
- Self-reflect
- Identify barriers
- Identify options and alternative

Lifestyle Redesign
- Select personalized healthy activity options
- Make changes in daily routines
- Practice habits and routines
Personalized Health Plan Engagement
- My Attitudes
- My Behaviors
- My Health Status
- My Needs
- Other Key Information

Personalized Engagement Plan
Should be:
- Introduced early as part of the group session
- Reviewed regularly at individual sessions
Includes:
- Personal inventory of strength and weaknesses
- Inventory of relevant personal factors
- Goals worksheet
- Daily health-promoting routine planner

Personalized Engagement Plan
 Acquiring knowledge of factors related to occupation
that promote health and happiness
 Performing a personal inventory and reflecting on
one’s fears and occupational choices, interest, life
goals, etc.
 Overcoming one’s fears by taking incremental risks in
the real world of activity in small steps over time
 Weaving together the outcomes of the prior steps to
develop and sustain a health-promoting daily routine

Mechanisms of Change
- Knowledge Acquisition
- Internalization
- Habit formation

The need for comprehensive life management programs in
primary care
- Symptom management vs. prevention
- Keeping body systems in good health throughout life
- Changing activity patterns early
- Increasing the overall conditioning of the body
- Reducing inflammation before disease onset

Several practice principles for social work with older
adults can be recommended:
- When working with an older adult, take into account
the person's life history.
- Develop self-awareness of your views on aging and how
different theoretical perspectives may influence your
practice.
- Be conscious that age-related social roles change over
time and that they vary for different cohorts.
- Identify areas in which you can assist an elder client in
preventing future problems, such as health-related
difficulties.

- Develop an understanding of and skills to assess the
difference between the physical, biological,
psychological, and socioemotional changes that are
part of normal aging and those that are indicative of a
problematic process. Develop an understanding of how
such factors may affect the intervention process.
- Develop an understanding of the different types of
families in later life. Because older adults continue to
be part of their families, it may be beneficial to work
with the entire family system.

- Develop an understanding of the retirement process
and how individuals adjust differently to this new life
stage.
Carefully assess an elderly persons caregiving network.
- Be conscious of the difficulties that the caregiving
situation poses for both the caregiver and the care
recipient.
- Be conscious of the potential for caregiver burnout and
familiarize yourself with local caregiver support
options.

Develop an understanding of the process of
institutionalizing an older adult.
- Be careful not to label it as an act of abandonment.
Rather, be aware that institutionalization is stressful for
all involved and is typically done only as a last resort.
- Develop an understanding of the process of adaptation
to nursing home placement and skills to assist an older
adult and his or her family with that adaptation.
- When assessing the need for service, be conscious of
the availability of formal and informal support systems.

- Develop an understanding and knowledge of the formal
service delivery system.
- Avoid treating older persons as if they were incapable
of making decisions simply because they may not be
able to carry out the decision. Rather, involve them to
the maximum extent possible in any decisions relating
to their personal life and care, even if they are not able
to carry out the related actions

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