Chapter 21 Lecture Access to Health Thirteenth Edition .docx

Chapter 21 Lecture
Access to Health
Thirteenth Edition
© 2014 Pearson Education, Inc.
Preparing for Aging,
Death, and Dying
Did you PREPARE and did you LEARN?
• Define aging and the concepts of biological,
psychological, social, legal, and functional age.
• List the characteristics of successful aging.
• Explain how the growing population of older adults will
affect society, including considerations of economics,
health care, living arrangements, and ethical and moral
issues.

• Explain the biological and psychosocial theories of aging
and summarize major physiological changes that occur
as a result of the normal aging process.
Did you PREPARE and did you LEARN?
• Describe unique health challenges faced by older adults
and strategies for successful and healthy aging that can
begin during young adulthood.
• Discuss death, the stages of the grieving process, and
strategies for coping with death.
• Explain the ethical concerns that arise from the concepts
of the right to die and rational suicide.
• Review the decisions that need to be made when
someone is dying or has died, including hospice care,
funeral arrangements, wills, and organ donation.
Redefining Aging
• Aging is a pattern of life changes that occurs as
one grows older.

• Gerontology is the study of individual and
collective aging processes.
– Biological age
– Psychological age
– Social age
– Legal age
– Functional age
What Is Successful Aging?
• Staying active, through leisure activities and regular
exercise.
• Maintaining a normal weight range.
• Eating a healthy diet containing low levels of saturated
fats, with plenty of fruits, vegetables, and whole grains.
• Participating in meaningful activities, such as

volunteering and other social activities.
• Avoiding smoking and consuming alcohol in moderation.
Older Adults: A Growing Population
• Today, there are 40.4 million people age 65 or
older in the United States.
• The older population is expected to be twice as
large in 2030, growing to 72.1 million.
• The needs of this generation will have a major
impact on the economy, housing market, health
care system, and Social Security.
Number of Americans 65 and Older
(in millions), Years 1900–2008, and

Projected 2010–2050
Health Issues for an Aging Society
• As the number of older Americans increases,
their financial and medical needs become
issues.
• More people will be drawing from Social Security
while fewer people contribute to the system.
• Health care costs to the individual will rise as
Medicare coverage becomes less adequate.
Health Issues for an Aging Society
• Housing and living arrangements will be a
problem for low-income elderly.
• A shortage of donor organs will present difficult

ethical questions.
Living Arrangements of Americans Age 65
and Older
Theories of Aging
• Biological theories
– Wear and tear
– Cellular
– Genetic mutation
– Autoimmune
Physical and Mental Changes of Aging
• Typical physical changes

– Skin
– Bones and joints
– Head and face
– Urinary tract
– Heart and lungs
– Eyesight
• Cataracts; glaucoma
• Macular degeneration
– Hearing
– Sexual changes
– Body comfort
Physical and Mental Changes of Aging
• Typical mental changes
– Mental function
– Memory
– Depression

– Dementias and Alzheimer's disease
Normal Effects of Aging on the Body
Is Memory Loss an Inevitable Part of Aging?
Alzheimer's Disease
• Alzheimer's disease is progressive brain
impairment that interferes with memory and
normal intellectual functioning.
• It is the most common form of dementia.
• It kills a person twice: first through the loss of
personhood and second through the
deterioration of body systems.

Alzheimer's Disease
• Progresses in stages
– The first stage involves forgetfulness and
memory loss.
– The second stage is characterized by
accelerated first-stage symptoms as well as
agitation, restlessness, and repetitive actions.
– In the final stage, disorientation is complete,
control of body functions is lost, and
dependence on others is complete.
Alcohol and Drug Use and Abuse
• People 65 years of age and above have the
lowest rates of drinking.
• Older people rarely use illicit drugs, but some do
overuse or misuse prescription drugs.

• There is no single system to track all
prescriptions, so pharmacists may not know
about all of the drugs that a patient is taking.
Strategies for Healthy Aging
• Improve fitness
• Eat for longevity
– Calcium
– Vitamin D
– Protein
– Vitamin E, folic acid, iron, potassium, and
vitamin B12
• Develop and maintain healthy relationships
• Enrich the spiritual side of life

Understanding the Final Transitions: Dying
and Death
• Defining death
– Final cessation of vital functions.
– Death occurs when an individual has
sustained either irreversible cessation of
circulatory and respiratory functions or
irreversible cessation of all functions of the
brain, including the brainstem.
– Brain death has gained increasing credence.
The Dying Process
• Elisabeth Kübler-Ross identified the five
psychological states that people coping with
death often experience:

– Denial
– Anger
– Bargaining
– Depression
– Acceptance
Kübler-Ross's Stages of Dying
Corr's Coping Approach
• Corr suggests that there are unique challenges
and responses for the dying person and those
who love him or her:
– Physical
– Psychological
– Social
– Spiritual

Social Death
• The loss of being valued or appreciated by others can
lead to social death—a condition in which a person is not
treated like an active member of society.
– Dying patients are often moved to terminal wards.
– Inadequate pain control may contribute to a patient's
suffering and anger or hostility, making caregiver
assistance more difficult.
– A decrease in meaningful social interactions can strip
a person of his or her identity.
Coping with Loss
• Bereavement is the loss or deprivation experienced by a
survivor when a loved one dies.

• Grief is a state of mental distress that occurs in reaction
to significant loss.
• In disenfranchised grief, a person experiences a loss
that cannot be openly acknowledged, publicly mourned,
or socially supported.
• Mourning refers to culturally prescribed and accepted
time periods and behavior patterns for the expression of
grief.
What Is "Typical" Grief?
• An acute grief syndrome often includes
– Periodic waves of physical distress lasting 20
minutes to an hour
– A feeling of tightness in the throat
– Choking and shortness of breath
– A frequent need to sigh
– A feeling of emptiness in the abdomen
– A sensation of muscular weakness

– Intense anxiety
Worden's Model of Grieving Tasks
William Worden developed a more active grieving
model that defined four tasks that the individual
must complete in the grief-work process.
1. Accept the reality of the loss.
2. Work through the pain of grief.
3. Adjust to an environment in which the
deceased is missing.
4. Emotionally relocate the deceased and move
on with life.
Children and Death
• Siblings of a deceased child may have a
particularly hard time with grief work because so
much attention has been devoted to the dying
child.

• Children experience more prolonged grieving
periods.
• They may worry about whether they caused the
death, whether they will die, or whether they will
lose someone else.
Life-and-Death Decision Making
• The right to die: Some states legally allow
certain life-support techniques to be refused by
competent patients.
– Electrical or mechanical heart resuscitation
– Mechanical respiration
– Feeding via nasogastric tube
– Intravenous nutrition
– Gastrostomy
– Medication

The Right to Die
• As long as a person is conscious and
competent, he or she has the right to refuse
treatment.
• The living will and other advance directives are
designed to allow people to make decisions
about their care in advance of becoming
incapacitated.
Living Wills
• Be specific.
• Get an agent by completing a form known as a
durable power of attorney for health care or
health care proxy.
• Discuss your wishes in detail with your proxy.

• Deliver your directive to your doctor, agent,
lawyer, and family members.
Rational Suicide
• The concept of rational suicide is a reasoned,
coherent process in which a person chooses
death as a preferable alternative to unbearable
pain.
• Active euthanasia involves ending the life of a
person who is suffering greatly and has no
chance of recovery.
• Passive euthanasia is the intentional withholding
of treatment that would prolong life.
Making Final Arrangements
• Hospice care has the primary purpose of
relieving the dying person's pain, offering
emotional support to the dying person and his or
her loved ones, and restoring a sense of control

to the dying person, family, and friends.
• Funeral arrangements
– Wake or viewing
– Burial
– Cremation
– Organ or body donation
Organ Donors and Patients Needing and
Receiving Transplants, 1989–2009
Organ Donation
• Uniform donor cards are
available through the
U.S. Department of
Health and Human
Services and many
health care foundations.
• Organ and tissue

donation may provide a
sense of fulfillment to a
dying person, knowing
that their organs may
extend and improve
someone else's life after
their own death.
Assess Yourself–A Personal Inventory
• Go online to the Live It! section of
www.pearsonhighered.com/donatelle to take the "Are
You Afraid of Death?" assessment.
• After reading this chapter, has your view of the aged and
aging changed? Why or why not?
• As a result of your knowledge, do you think you might
change the way you relate to older people?
• Are you ready to think about writing an advance directive
and to consider or reject organ donation?

Chapter 21 Lecture Access to Health Thirteenth Edition .docx

Chapter 21 Lecture Access to Health Thirteenth Edition .docx

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Chapter 21 Lecture Access to Health Thirteenth Edition .docx