Lifespan Development

Accepting Life’s Transitions Accepting Life’s Transitions Program Transcript NARRATOR: Is this how you think of old age? Or this? If you think of old\ age as a time of inevitable decline, you're probably relying on stereotypes tha\ t no longer hold true. The truth is, people are living longer all the time and rathe\ r than retiring to their rocking chairs, older people are enjoying healthy, active lives. Ho\ w do stereotypes about aging measure up to the truth? What are the real physi\ cal, social, and psychological changes that people should expect as they age?\ And how can the decisions you make now help ensure that you enjoy a healthy, productive old age?

Old age and ultimately death are the concluding stages of a process that\ begins when a single fertilized cell undergoes a number of divisions within the\ mother's uterus. As the tissues of the fetus become more specialized and a skeleton forms, the organs undergo a series of changes in preparation for birth. \ In infancy, babies grow rapidly. As their mental and muscular skills develop, they a\ re able to roll over, grasp objects, crawl, stand, and walk. In childhood, mental abilities increase and memory is strengthened as language skills develop and schoo\ ling begins. Adolescence begins with the onset of puberty, during which the s\ ex organs develop and a rapid growth spurt occurs.

Adulthood begins around the age of 20. By then, all body systems are ful\ ly mature and full height has been reached. After about age 30, traditional\ signs of aging begin to appear and become more pronounced between the ages of 40 \ and 65, the generally accepted beginning of old age. Old age itself is divided between the young old ages 65 to 74, the middle old, ages 75 to 84, and \ the old old, ages 85 and over.

Aging is defined as the life changes that occur as a person grows older.\ But since everyone ages differently, gerontologists, the people who study the aging process have developed several more specialized ways to measure age.

Biological age refers to the relative age or condition of a person's org\ ans and body systems. Chronologically, these athletes are in their 70s, but biologically their cardiovascular systems could be closer to those of people in their\ 40s.

Psychological age refers to a person's level of maturity, coping abiliti\ es, and capacity to adapt to life's challenges. Social age refers to a person's \ habits a nd rules relative to society's expectations. Your taste in music probably r\ eflects your social age, and your grandparents taste probably reflects theirs.

Legal age is used to determine rights and responsibilities such as votin\ g, driving a car, and eligibility for Social Security. And functional age refers to\ the way people compare to others of a similar age. Functional age is determined \ by such things as heart rate, skin thickness, hearing, and ability to perform ce\ rtain tasks.

How would you define the age of the older people you know in terms of these measurements?

1 Accepting Life’s Transitions Not only are there various ways of measuring how people age, but through\ out world cultures, different societies regard aging in various ways. In Asi\ an cultures, older people are regarded with great reverence and respect. Similarly in Native American culture, grandparents are respected as repositories of wisdom a\ nd knowledge to perform their vital function of passing down the culture's \ oral traditions from generation to generation.

When you hear your grandma says, I'm only going to tell you once, you better listen. And when you know she means what she's going to say, you want to\ listen. Because who else is going to sit there and tell you that story o\ ver and over and over again, but someone who has that grandmother's love. Children, they love that repetition. That's where those [INAUDIBLE] those fairy tales c\ ome in.

My grandmother would tell them the same way, with the same inflection, t\ he same emotion every single time. She was almost like a record when she told it.

And those stories were taught to her by her grandmother. So when her grandmother was born back in the early teens, 1815 or something like tha\ t, 1817, and where she heard them was probably from her grandmother. The dawn of \ time when that language even evolved.

Americans have tended to be a youth worshiping culture that dreads old a\ ge is a time of infirmity and decline. But actually, the vast majority of Americ\ ans enjoy full and productive lives throughout their older years. In fact, old age is a time for continued learning and emotional growth as well as deepening experience \ and knowledge. Nowhere is this more apparent than in the Elderhostel Program\ which gives older people a chance to continue lifelong learning.

PROFESSOR STEVEN WEISLER: Elderhostel is a one week long, typically one \ week long class that brings senior citizens-- they've changed the age limit recently, but it used to be that they were generally in their 60s and 70\ s, occasionally in their 80s, and rarely but importantly in their 90s, bring them to a college campus and offer a college level course. And I think that these \ are very intensive in the sense that you kind of compact what would normally take\ place in a regular college class over a longer period of time into just one week, with many, many hours each day. In fact, I think we calculated it out once an\ d it presents about 1/2 to 2/3 of a semester's worth of teaching in a week.

The program is really kind of a clearinghouse and also a great proponent\ of education for senior citizens. They are an active part of I think a more\ general lobbying group to try to claim fair share of resources and attention for\ seniors. I think that a particular attribute of this group that's so admirable is t\ he idea that education doesn't stop at any arbitrary point. And I think that our expe\ rience certainly bears that out.

It's just I think arbitrary to decide that after a college degree is giv\ en, that education is over. And I think that our experience in Elderhostel has in\ dicated that in many ways, the older population of students has advantages compared to 2 Accepting Life’s Transitions the younger population. We noticed that for example, in older students w\ ho come to Hampshire, who quite frequently turn out to be extraordinary, it's al\ most as if that extra experience that you bring to the task of education turns out to be terrifically profitable in making for possibilities that are I think a l\ ittle bit more difficult for students who are 16, 17, 18 years old to sometimes come by\ .

One of the really exciting parts of teaching in Elderhostel is having st\ udents want you to stay longer, being excited when class runs over rather than distr\ essed, being full of questions, and also being not passive, but rather active r\ ecipients of the information. So that if you say something they don't like you find out about it rather quickly. They're very good about associating whatever it is that \ you're teaching with either life experiences or previous educational training t\ hat they've enjoyed over there sometimes many years.

There are age factors. But I think they're mostly all to the credit of t\ he elders, in the sense that they come with more ammunition. They come with more experience. They come with more perspective. I would say almost never do\ I believe that there is some limitation that's imposed by the age of the s\ tudents. I think time imposes limitations to be sure. But I think that they mostly \ have only advantages it seems to me.

NARRATOR: What might you be able to learn from the participants at an elderhostel? More and more people in the United States are viewing old age as a stage of life that offers continuing intellectual and emotional growth. \ At the same time, the age distribution of our population is also changing as greater\ numbers of people reach retirement age. As a result of the baby boom following World War II, during the 1960s over 35% of the population was under 18. Only a\ bout 10% was over 65.

Today those baby boomers are either planning their retirement parties or\ planning for retirement. By 2030, this generation will have reached old age, and thanks to modern nutrition and medical care, for the first time in histo\ ry the elderly population will outnumber the youthful population in this countr\ y. In addition, the elderly population will be older and live longer than ever\ before .

What social economic and ethical ramifications do you think the graying \ of America will have on our society?

No one knows exactly what causes our bodies to age. Perhaps the human bo\ dy, like any machine simply wears out. Perhaps our cells are programmed to reproduce only a certain number of times before they. Die perhaps the bo\ dy's immunity system is to blame, as our immune systems become less efficient\ and our bodies more prone to disease as we age. Or maybe the cells in the bo\ dy fail to function properly causing organs and systems to break down.

Whatever the biological causes of aging, some people seem to age more gracefully than others. According to many psychologists, successful agin\ g 3 Accepting Life’s Transitions involves maintaining a emotional as well as physical well-being. Th ose who are best able to cope with and adapt to challenges throughout their lives ar\ e most able to remain mentally healthy and engaged with friends and favorite pu\ rsuits as they age. A unique combination of physical and psychosocial factors caus\ es each of us to age at different rates and in different ways.

But in general terms, there are a variety of changes you can typically e\ xpect as you age. Many of the physical changes that accompany aging are visible a\ nd familiar the skin becomes thinner and more pale and loses elasticity. Wrinkles appear and deepen. Body fat is redistributed away from the limbs and int\ o the trunk region of the body. The lens of the eye yellows and loses transpar\ ency, while the pupil begins to shrink, leading to a need for bifocals and trifocals.

Hearing diminishes, along with the other senses.

Both men and women experience sexual changes as they age, but older peop\ le need not give up sexual pleasure and intimacy. Like everything else in o\ ur lives.

Our sexual expression may change, but not necessarily our desire for intimacy. It may make you uncomfortable to think of your parents and grandparents dat\ ing.

The truth is that sex remains an important part of life for people of al\ l ages.

Can anything be done to slow the physical effects of aging and avoid some of the diseases associated with old age? Absolutely. Remember the old standbys \ of good health, a balanced diet, regular exercise, managing stress, protect\ ing yourself from the sun, and avoiding tobacco and excessive alcohol use. A\ nd it's never too soon to start. Old age may seem a long way off, but the health\ habits you establish now will affect your health as you age, another excellent \ reason to stay healthy and fit.

One condition that you can do a lot toward preventing is osteoporosis, a disorder that results in weakened, porous, and easily fractured bones. It is caus\ ed by the loss of minerals, particularly calcium in the bones. Although osteoporos\ is is usually thought of as a disease of the elderly, it may already have begu\ n to affec t you. Several factors increase your risk for osteoporosis, sex, osteoporo\ sis occurs in both sexes, but is more common in women than in men, age, the risk increases with age, low bone mass, early menopause, thin small-framed body, race, whites and Asians are at higher risk than blacks, who usually have\ heavier bone mass, lack of calcium in your diet, lack of physical activity, ciga\ rette smoking, excessive alcohol or caffeine consumption, and heredity.

Fortunately, you can reduce your risk of osteoporosis by building the bone mass within your genetic limits. That means regular exercise of weight bearin\ g joints, maintenance of strength and flexibility, and calcium primarily from dair\ y products, leafy green vegetables, and other food sources. But don't wait for old age to increase your calcium intake. Do it now, because increasing calcium inta\ ke in childhood and early adulthood appears to be quite effective in reducing \ your risk.

4 Accepting Life’s Transitions While many of the physical diseases of old age can be avoided with good \ health habits, mental deterioration is not inevitable either. As the elderhostel \ participants prove, elderly people can learn and develop skills as well as younger pe\ ople.

What they might lack in speed, they make up for in practical knowledge a\ nd experience. The disorientation and memory failure that many associate wi\ th aging are often due to misuse of over-the -counter or prescription drugs or of diseases like Alzheimer's, which affects over 4 million Americans a year\ , and for which there is, as yet, no cure. However, a number of issues can affect the emotional strength of the elderly including the potential for depression\ and alcohol abuse, possible drug interactions, misprescribed drugs, and the \ efficacy of vitamin and mineral supplements.

One of the major challenges for our society as a whole and for families \ is caretaking. Virtually all elderly people eventually need assistance from\ children, other relatives, friends, and neighbors. In our busy society of two work\ ing parents who have waite d until later in life to have children, the care of an elderly parent must often be juggled with the care of young children, adding even more \ stress to the lives of people in what is sometimes called the sandwich generati\ on, middle -aged people caring for young children and for elderly parents at the sa\ me time. And what about when the elderly person needs more than just assist\ ance with errands and daily tasks? What about when he or she faces a terminal\ illness?

No one wants to think about death, especially the death of a loved one. But death is both inevitable and the final stage in the life process. As with atti\ tudes toward aging, different cultures view death in different ways. In Mexico for ex\ ample, death is seen as a passage to a better state of being. It is something to be celebrated rather than feared. In the United States, many Americans expe\ rience discomfort when faced with death and dying. On the one hand, they are fascinated by the large scale and impersonal deaths we see sensationaliz\ ed on the news and in films and television. But when confronted with a friend or a relative who is dying, many Americans avoid speaking about death. They a\ ct as if nothing is Ron or give false reassurances.

Such uneasiness wasn't always the case. Before the 20th centur y, when infections and accidents took the lives of people of all ages and when t\ he sick were taken care of at home, rather than in hospitals, people were far mo\ re used to, and hence more comfortable with, being in the presence of death than\ most of us are today. But as medical advancements changed the individual quality\ of life and the life span, so too did it change the role of hospitals.

BOB PICARD: We went to the hospitals just to die, and then we've become \ so sophisticated and so technologically advanced that in the '40s and '50s and '60s, we went to the hospitals and our hospital stays were very long. And if w\ e were dying, we may spend the last months, six weeks, eight weeks in a hospita\ l setting during the dying process. And one of the things that we did was make 5 Accepting Life’s Transitions sure that we're trained to make you better and we're going to give you a\ ll of these medicines and these sophisticated kinds of thing because that's what we \ do or that's what we do. Do no further harm as the Hippocratic oath.

NARRATOR: While no one second guesses the advances that have helped prolong life and prevent illness and disease, people have begun to quest\ ion using heroic measures to eke out a few more weeks for a terminally ill p\ atient, prolonging the dying process and the patient's pain and suffering. As more people reject the idea of a high tech death in a hospital, the growing h\ ospice offers an alternative.

BOB PICARD: Hospice is the care of the dying. Hospice is to allow people\ and assist people to die with dignity. And the focus of hospice is to allow people to be in the so-called preferred home environment after lots of things have al\ ready happened. Most of the patients that are on the hospice program are patie\ nts who have terminal illnesses. Most of them are cancer patients who h ave had a full range of treatment, chemotherapy, radiation therapy, all of the kinds of\ things that we offer cancer patients through a system. Cancer is not necessaril\ y a terminal illness, but in some cases that in fact is the case.

When two physicians have decided and the client, the patient, we call th\ em clients, and the patient has decided that there is not going to be any f\ urther treatment no matter what intervention is offered, when intervention take\ s place, then the issue becomes one of quality of life. And the patient decides that they would prefer not to have any further palliative treatment, palliative me\ aning any further-- I'm sorry let me back up a minute, any further curative treatment, they'\ re opting for what we call palliative treatment.

Palliative treatment basically is, keep me comfortable. Make my quality \ of life the best that we can on a day to day basis and no extraordinary measures, an\ d in a preferred home environment, although there are in-house hospice units for people who have no fami ly, no one to take care of them. But for the most part, it's in the home. We in the hospice programs are there to teach family, loved\ ones, significant others, caregivers, to assist someone who has a terminal ill\ ness, who is in fact dying. And we help them to help those to satisfy what their w\ ishes are, their wishes of dying with dignity, being in a preferred home environmen\ t, being with their loved ones, managing their pain, making them comfortable, and\ increasing the quality of life that they may have to the best that we possibly can.

We have a full range of social service providers who are hospice trained\ psychiatric nurses, and all of the other disciplines that may or may not\ be needed, whether it be physical therapist, occupational therapist. Again \ we are striving for maximizing activities of daily living, making them the best\ that we possibly can. Also included in that of course, is a medical director who\ is usually in our case, is a medical specialist who is trained in oncology, board c\ ertified in oncology, understands pain control, and sort of directs the team from the c\ linical 6 Accepting Life’s Transitions perspective. All of the decisions that are made for this patient, each i\ ndividual patient, and they really are individual, are made in a team approach. So\ that on a weekly basis a team comes together, discusses the client, the psychosoci\ al factors in that home, patient's pain status, patient's comfort level, an\ d decisions are made on how we can best serve that patient.

Patients who are terminally ill and dying can be made comfortable. We can improve their quality of life, despite what the media has been saying in\ the last six months to a year. It is possible, for not so much extension of life \ but the quality of life as quote described by the patient and as elicited by the\ patien t.

That's probably the most important thing that we do. We follow the direc\ tion of the patient who is terminally ill.

NARRATOR: Quality of life. Until almost 30 years ago not much thought wa\ s given to a patient's quality of life while dying. But in 1969, Doctor Elizabeth Kubler-Ross began to open our minds to the thoughts and emotions of the \ dying.

Kubler-Ross identified a process of five psychological stages that termi\ nally ill patients often experience as they approach death. Denial, usually experi\ enced as shock and disbelief. Anger at having to approach death while other pe\ ople remain healthy. Bargaining, thinking something like, if I'm allowed to l\ ive I promise I'll become a better person. Depression, accompanied by feelings\ of worthlessness and guilt over being responsible for loved ones loss and s\ uffering.

And finally, Acceptance, as patients stop battling with their emotions a\ nd begin to let go of life.

Further research in the field suggested that many people experiencing a \ major loss also go through some or all of Kubler-Ross's stages during the grie\ ving process. Others added to Kubler-Ross's work, describing the grieving pro\ cess as a series of sorrowful feelings that include loneliness and guilt, follow\ ed by a gradual upswing of feelings that allow one to integrate the loss into one's life and move on. While various theories about the actual process exist, everyone\ agrees that what's important is that grief is acknowledged and that the difficu\ lt process of grief work occurs, allowing survivors to accept the death and cope with the memories of the deceased.

Many people find solace in the culturally prescribed behaviors for expre\ ssing grief or mourning. Archaeological evidence shows that the earliest human\ s placed flowers on the bodies of the dead prior to burial. From that time onward, people have arranged funerals and other rituals to help survivors cope w\ ith death. Many such traditions have religious origins which can provide com\ fort and support for both the dying and the bereaved. Coping emotionally with death can be a long difficult process, but a number of practical and legal issues \ also surround dying death and death. For example, many people feel that they \ should be allowed to die if their life becomes dependent on mechanical life sup\ port systems.

7 Accepting Life’s Transitions A person who is conscious and competent has the right to refuse mechanic\ al life support. But sometimes, people are in a coma or otherwise unable to spea\ k on their own behalf. If you know that you do not want to receive artificial\ life support, make that wish known now by filling out a health care directive and by appointing \ a family member or friend to act as your health care agent or proxy to c\ arry out your wishes in case you are not able to make them known yourself. In add\ ition, you might also consider whether you want your organs donated for transplant.

Although some people oppose organ transplants, others experience a sense\ of fulfillment, knowing that their organs may extend and improve someone el\ se's life or that their bodies may be used to further medical science.

Another important and hotly debated issue is rational suicide or mercy k\ illing. Do people have the right to end their lives if their condition becomes into\ lerable?

Should loves ones or physicians and nurses be allowed to assist the pers\ on who wants to die? Where should the line be drawn between withdrawing life su\ pport and acting directly to cause death? A 1997 Supreme Court ruling held tha\ t State legislatures, rather than the federal government should be allowed to de\ cide whether or not to ban assisted suicide. Currently, most states ban the p\ ractice.

But that could change if the right to die movement continues to grow. Wh\ ere do you stand on the issue of rational suicide?

Planning for one's death may seem strange and unreal, but remember, you have the ability to control a great deal about how you age. And with knowledg\ e and forethought, you also have the ability to control how you approach death\ , the final stage of the life process. How do you feel about the aging process?

Accepting Life ’s Transitions Content Attribution Accepting Life’s Transitions [Video]. (1998). Used by permission of\ Films Media Group 8