Gerontology: Preparing for End of Life

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Table of Contents

Introduction
Literature Review
Intervention
Analysis
Conclusion
References

Introduction

Aging is a universal and natural biological process, characterized by gradual, multi-temporal, and steady progression, leading to a decrease in adaptive capacity, the viability of an individual and ultimately determining life expectancy. The social and psychological problems of older people, as well as certain aspects of human aging, are the subject of study in many branches of natural and social sciences. However, for most of them, these problems are not essential. Only gerontology, which is the modern and newly emerging science, puts the issues of old age and aging at the center of research. Simultaneously, it uses and applies the knowledge accumulated in other scientific fields, and specialties of various elder care professions. In this regard, gerontology is located at a junction of many scientific theoretical and practical knowledge. Each discipline introduces its development, achievements, and methods in solving the problems of an aging person and contributing to continuous improvement.

The urgency of the problem is manifested in the fact that isolation of the aging period and the development of gerontological issues are associated with a complex of socio-economic, biological, and psychological reasons. There is also accompanied by an increasing role of the human factor in the development of society, while the tendency of the elderly to increase in the demographic structure of society. At the end of life, a person undergoes both psychological and physiological events. Therefore, it is essential to understand these changes in order to able to assist and support older adults properly.

Literature Review

The lack of a genetic approach to the study of the psychology of adults has, until recently, been hampered by the study of age variation. It was believed that if a process of mental development did not end in childhood and adolescence, then with the onset of maturity, it is difficult for a person to rely on the capabilities of this process. It occurs because the mechanisms that ensure development stop functioning (Miller, Hedlund, & Soule, 2006). However, due to the emergence of new knowledge about the structure of development of the psychophysiological functions of an adult, this view was replaced by a different one. It is based on the position of continuity of an individual’s personal development and improvement as the main modes of existence. The formation of any function (physiological, psychophysiological, mental) occurs continuously from birth to old age, with different aspects of the features changing with varying degrees of intensity (Boerner, Carr, & Moorman, 2013). It indicates that a unified scientific theory of individual mental development cannot be built without marked improvement of its central section, which is the psychology of maturity and aging.

Moreover, it is necessary to remember that there is no clear definition of the boundaries of this stage of ontogenesis in psychology. As a rule, scientists distinguish between two age groups – from 60 to 75 years old and over 75 years old, which are not identical in their psychological and medical conditions (Miller et al., 2006). For people in the first group, the preservation of a sufficiently high level of activity is typical. The most significant problems for them are a violation of socio-psychological adaptation and the psychological discomfort caused by it (Gordon & Perri, 2015). For those in the second group, medical problems associated with poor health, weakness, and often the need for constant care come to the fore.

Mental changes observed in the process of aging are associated with the operations of involution in the central nervous system. A noticeable increase in reaction time is considered the most common and universal sign of the onset of aging. It is manifested in the reduction of strength and mobility of the vital processes (Boerner et al., 2013). It covers the majority of sensory functions, such as sight, hearing, taste, and touch (Boerner et al., 2013). Aging also involves the degradation of motor skills, perception of the new, memorizing, and all human behavior, including the ability to adapt to changing conditions (Carter, Solberg, & Solberg, 2017). Primary aging reduces the perceptual speed of solving problems, and the speed with which information is processed in the CNS (Boerner et al., 2013). Secondary aging affects not only the rate of perception but also logical reasoning, such as induction, solving abstract problems, regular operations (Miller et al., 2006). Finally, in the final period, the issues also affect other levels of intelligence, complementing the picture with changes in conceptual thinking.

Intervention

At the end of life, an individual’s existence should bring satisfaction and happiness. Therefore, it is critical to organize the supporting circle around older adults’ interests and their issues. Among the key points to be remembered when developing assistance work with older people is the uniqueness of individual experience, the need for a biological and psychological approach to old age (Boerner et al., 2013). It also involves the importance of the social environment with its support and mutual assistance, the public attitude to weakness in old age, and the concept of personal resources available to any person. Organizational and methodological assistance work with older adults includes the definition of the problem of the treatment of an older person to a social worker, diagnosis, and assistance planning (Miller et al., 2006). It additionally involves uniting efforts with other specialists in order to fully resolve the problem and supportive work with the family of an older person.

When an older adult gets into the assistance service department, he/she becomes a client. The appearance means that the support worker’s responsibility to commit actions for this client comes. The worker starts working with an elderly client by receiving answers to the questions on topics, such as problems, reasons, support circle, and the importance of the issue (Johnson, 2003). Due to these questions, it is possible to determine how many people were influenced by the subject, and what crisis event led an older person to help. Before taking follow-up actions, the supportive care worker needs to remove the client’s passivity in accepting the situation with appropriate questions and restore the initiative (Carter et al., 2017). If there is a need, to describe the full picture, the social worker seeks agreement on contact with other people, with the client’s family. An older client’s agreement to cooperate is an opportunity for further discussions, interviews, and family meetings.

The diagnosis of the problem begins with a short setup interview. It is estimated that the diagnosis requires at least an hour of interviews since the question must be clarified (Boerner et al., 2013). Such a discussion should be generalized, which means that it covers aspects of health, daily life, the emotional needs of the client, expressed in depression, anxiety or unhappiness, and feelings of dependence. Weighing all these facts and gives an understanding of the degree of difficulty of the problem. In social diagnosis, a significant place is occupied by obtaining information about the client.

Information can be obtained from a survey of a person, his living and leisure conditions, environment, as well as using questionnaires. For example, some questions are associated with the task of identifying the factors that pose a risk to one’s life (Carter et al., 2017). Another purpose of obtaining information may be the study of the social conditions of life of an older adult, for example, when cleaning his/her apartment or room (Gordon & Perri, 2015). Food features can also be a source of obtaining the necessary information about the client. It is crucial to get information about the family, friends, religious beliefs, and spiritual interests of an older person in order to create a complete picture necessary for making a correct social diagnosis.

Analysis

In old age, there is a shift to the negative side of the character traits inherent in people due to age-related changes. Thus, these personality shifts should be handled with care and assistance. For example, some people with disturbingly suspicious traits become even more suspicious, anxious, and assumptive, and the calculating ones develop pettiness and stinginess (Johnson, 2003). When all these features are accentuated, they end up with a constant fear of being robbed and becoming a beggar. The principle and hardness of installations are often transformed into intransigence, the rejection of a different opinion, give rise to a “war of generations”, conflicts with others (Gordon & Perri, 2015). Emotional incontinence sharpens to conflict, often to the complete loss of control over emotional reactions. Sensitivity can develop into persistent low self-esteem, and in the acute period, manifest itself in depression, feelings of inferiority, and mania of persecution.

At the same time, new personal characteristics do not appear in old age, neither moral nor social qualities of a person are lost. The cynical or psychopathic features that manifest themselves in the elderly have been in the bud and their youth (Johnson, 2003). Due to deteriorating health, manifestations of suspicion, anxiety, uncertainty about the future, and a decline in life and social perspective, older adults are more susceptible to panic. It is harder for them to adapt to changes in personal growth and society (Carter et al., 2017). At the same time, temporary decompensation of mental activity often occurs.

Along with these negative shifts in character, many people in old age experience positive changes. It is often possible to observe tranquility, a departure from petty interests, a transition from the hustle and bustle of life to the comprehension of core values. It also involves an adequate assessment of one’s new possibilities and the smoothing of different character traits (Johnson, 2003). By considering the changes in character in old age, it is impossible to strictly distinguish between the indicated tendencies, for both negative and positive changes can be observed in the same person.

People of late age are forced not only to adapt to changes in the social situation but also to respond to changes in themselves. It raises the question of self-esteem at a later age: how does an older adult assess himself and his existence in the light of new circumstances. Most scientists are of the opinion that memory impairment is the main sign of mental aging (Carter et al., 2017). Memory disorders are the first symptom of age-related organic psychoses of a later age. However, mnemonic disorders are also revealed in the picture of favorable mental aging, when throughout the entire period, all personal and social characteristics of a person remain unchanged. At the same time, the decline in memory functions associated with aging is not observed in all older people (Gordon & Perri, 2015). Modern studies indicate a discrepancy between the subjective complaints of the elderly to memory impairment and the actual ability to memorize.

Severe anxiety affects such parameters as logical memory and mental control. Scientists also note the uneven decline in various memory functions with age. In particular, long-term memory deteriorates faster than the amount of short-term and direct memory (Gordon & Perri, 2015). The gradual decrease in mental performance and the anticipated weakening of the operational mind are especially pronounced against the background of the clarity of the distant past. The logical-semantic memory remains intact, which helps the processing and storage of logical and systematic material, helping to overcome some of the shortcomings of the mechanical mind. Most scholars note that the problem of memory impairment is closely related to a proper attitude to the past, and the role of memories in the life of an elderly and older person (Boerner et al., 2013). Such an attitude to the past makes up a significant part of the mental life of an older adult. The phenomenon of unique, emotionally colored, views of the elderly to the past draws attention to itself (Gordon & Perri, 2015). Therefore, in working with older people, it is useful to apply the method of biographical interviewing in order to highlight the real events in the life of an older person. Such stimulation of memories helps older people to accept their lives, to understand that it was lived not in vain.

Conclusion

In conclusion, there a number of both emotional and physiological events occurring before an individual’s end of life. These personality shifts should shape the support and assistance procedures in order to bring them both a healthy mental state and physical condition. Psychological changes that occur in the process of aging, set as a primary task the study of the characteristics of the social behavior of the elderly. The problem of communication between older people, and their adaptation to new roles and living conditions not only exists but is also more significant for this age period compared to the previous one. Successful socialization of older people is one of the main requirements for maintaining a high quality of their life. The economic and medical problems faced by people of late age, but the level of medical care and material support does not correlate directly with the level of psychological comfort and the optimal lifestyle for a person.

Among the most critical problems associated with raising the level of their own lives, older people refer to loneliness, health, and economic issues. Thus, despite the relevance of high-quality medical care and material support, almost all older people are equally plagued by psychological problems. These issues include a violation of the usual way of life, lack of attention from society and loved ones, and loneliness. However, a characteristic feature of theoretical approaches to the problems of aging is the collective attempt of all to hide from the answer to the question posed by private reasoning or research. Nevertheless, there are ongoing improvements in the orientation of modern society to humanistic beginnings, and the growth of a common culture and consciousness. These changes deepen and actualize the task of theoretical and practical research of the phenomenon of old age and its social assessment. They also determine the demand for knowledge about the place and interaction of different age groups and their different socio-psychological characteristics.

References

Carter, C. S., Solberg, L. B., & Solberg, L. M. (2017). Applying theories of adult learning in developing online programs in gerontology. Journal of Adult and Continuing Education, 23(2), 197-205.

Boerner, K., Carr, D., & Moorman, S. (2013). Family relationships and advance care planning: do supportive and critical relations encourage or hinder planning? Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 68(2), 246-256.

Gordon, M. & Perri, G. (2015). Conflicting demands of family at the end of life and challenges for the palliative care team. Annals of Long-Term Care: Clinical Care and Aging, 23(1), 25-28.

Johnson, L. S. (2003). Facilitating spiritual meaning-making for the individual with a diagnosis of a terminal illness. Counseling and Values, 47(3), 230-240.

Miller, P. J., Hedlund, S. C., & Soule, A. B. (2006). Conversations at the end of life: The challenge to support patients who consider death with dignity in Oregon Actions. Journal of Social Work in End-of-Life & Palliative Care, 2(2), 25-43.

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