Late adulthood (from 65 years)

Psychosocial crisis: Ego Integrity vs Despair Someone who can look back on good times with gladness, on hard times with self-respect, and on mistakes and regrets with forgiveness will find a new sense of integrity and a readiness for whatever life or death may bring. A person caught up in old sadness, unable to forgive themselves or others for perceived wrongs, and dissatisfied with the life they've led, will easily drift into depression and despair. The fundamental question is, "What kind of life have I lived?" A positive outcome of this crisis is achieved if the individual gains a sense of fulfillment about life and a sense of unity within himself and with others. That way, he can accept death with a sense of integrity. Just as a healthy child will not fear life, the healthy adult will not fear death. A negative outcome of this crisis causes the individual to despair and fear death. Late Adulthood: 55 or 65 to Death Ego Development Outcome: Integrity vs. Despair Basic Strengths: Wisdom Erikson felt that much of life is preparing for the middle adulthood stage and the last stage is recovering from it. Perhaps that is because as older adults we can often look back on our lives with happiness and are content, feeling fulfilled with a deep sense that life has meaning and we've made a contribution to life, a feeling Erikson calls integrity. Our strength comes from a wisdom that the world is very large and we now have a detached concern for the whole of life, accepting death as the completion of life. On the other hand, some adults may reach this stage and despair at their experiences and perceived failures. They may fear death as they struggle to find a purpose to their lives, wondering "Was the trip worth it?" Alternatively, they may feel they have all the answers (not unlike going back to adolescence) and end with a strong dogmatism that only their view has been correct.

The Hayflick Limit Theory

Pictured: Dr. Leonard Hayflick The Hayflick Limit Theory of Aging (so called after its discoverer Dr. Leonard Hayflick) suggests that the human cell is limited in the number of times it can divide. Part of this theory may be affected by cell waste accumulation (which is described in the Membrane Theory of Aging). Working with Dr. Moorehead in 1961, Dr. Hayflick theorized that the human cells ability to divide is limited to approximately 50-times, after which they simply stop dividing (and hence die). He showed that nutrition has an effect on cells, with overfed cells dividing much faster than underfed cells. As cells divide to help repair and regenerate themselves we may consider that the DNA & Genetic Theory of Aging may play a role here. Maybe each time a cell divides it loses some blue-print information. Eventually (after 50-odd times of division) there is simply not enough DNA information available to complete any sort of division? We also know that calorie restriction in animals significantly increases their life-span. In essence less fed animals live longer. Is this because they are subject to less free radical activity (see the Free Radical Theory of Aging) and therefore less cellular damage? Or is it that insulin and glucose damage (see the Cross-Linking Theory of Aging and the Neuroendocrine Theory of Aging for details) is less prevalent in them than in overfed animals? The Hayflick Limit indicates the need to slow down the rate of cell division if we want to live long lives. Cell division can be slowed down by diet and lifestyle etc., but it is also surmised that cell-division can be improved with many of the protocols of the other aging theories described herein. The use of ribonucleic acids (RNAs, the building-blocks of DNA), improve cell repair processes, enhance cellular capabilities and increase the maximum number of cell divisions in animals and vitro tests. Human clinical studies with RNA supplements such as NeyGeront and RN13 indicate that there are a number of biological, physiological and practical improvements for geriatric patients. If laboratory results prove true also for the individual, then Carnosine will be another potent Hayflick Limit extender.

Pre-Conventional
The pre-conventional level of moral reasoning is especially common in children, although adults can also exhibit this level of reasoning. Reasoners in the pre-conventional level judge the morality of an action by its direct consequences. The preconventional level consists of the first and second stages of moral development, and are purely concerned with the self in an egocentric manner. In Stage one (obedience and punishment driven), individuals focus on the direct consequences that their actions will have for themselves. For example, an action is perceived as morally wrong if the person who commits it gets punished. The worse the punishment for the act is, the more 'bad' the act is perceived to be. This can give rise to an inference that even innocent victims are guilty in proportion to their suffering. In addition, there is no recognition that others' points of view are any different from one's own view. This stage may be viewed as a kind of authoritarianism. Stage two (self-interest driven) espouses whats in it for me position, right behavior being defined by what is in one's own best interest. Stage two reasoning shows a limited interest in the needs of others, but only to a point where it might further one's own interests, such as you scratch my back, and I'll scratch yours. In stage two concern for others is not based on loyalty or intrinsic respect. Lacking a perspective of society in the pre-conventional level, this should not be confused with social contract (stage five), as all actions are performed to serve one's own needs or interests. For the stage two theorist, the perspective of the world is often seen as morally relative.

[edit] Conventional
The conventional level of moral reasoning is typical of adolescents and adults. Persons who reason in a conventional way judge the morality of actions by comparing these actions to societal views and expectations. The conventional level consists of the third and fourth stages of moral development. In Stage three (interpersonal accord and conformity driven), the self enters society by filling social roles. Individuals are receptive of approval or disapproval from other people as it reflects society's accordance with the perceived role. They try to be a good boy or good girl to live up to these expectations, having learned that there is inherent value in doing so. Stage three reasoning may judge the morality of an action by evaluating its consequences in terms of a person's relationships, which now begin to include things like respect, gratitude and the 'golden rule'. Desire to maintain rules and authority exists only to further support these social roles. The intentions of actions play a more significant role in reasoning at this stage; 'they mean well...'[3] In Stage four (authority and social order obedience driven), it is important to obey laws, dictums and social conventions because of their importance in maintaining a functioning society. Moral reasoning in stage four is thus beyond the need for individual approval exhibited in stage three; society must learn to transcend individual needs. A central ideal or ideals often prescribe what is right and wrong, such as in the case of fundamentalism. If one person violates a law, perhaps everyone would - thus there is an obligation and a duty to uphold laws and rules. When someone does violate a law, it is morally wrong; culpability is thus a

significant factor in this stage as it separates the bad domains from the good ones. Most active members of society remain at Stage four, where morality is still predominantly dictated by an outside force.

[edit] Post-Conventional
The post-conventional level, also known as the principled level, consists of stages five and six of moral development. Realization that individuals are separate entities from society now becomes salient. One's own perspective should be viewed before the society. It is due to this 'nature of self before others' that the post-conventional level, especially stage six, is sometimes mistaken for pre-conventional behaviors. In Stage five (social contract driven), individuals are viewed as holding different opinions and values. Along a similar vein, laws are regarded as social contracts rather than rigid dictums. Those that do not promote the general welfare should be changed when necessary to meet the greatest good for the greatest number of people.[8] This is attained through majority decision, and inevitably compromise. In this way democratic government is ostensibly based on stage five reasoning. In Stage six (universal ethical principles driven), moral reasoning is based on abstract reasoning using universal ethical principles. Laws are valid only insofar as they are grounded in justice, and that a commitment to justice carries with it an obligation to disobey unjust laws. Rights are unnecessary as social contracts are not essential for deontic moral action. Decisions are not met hypothetically in a conditional way but rather categorically in an absolute way (see Immanuel Kant's 'categorical imperative'[13]). This can be done by imagining what one would do being in anyone's shoes, who imagined what anyone would do thinking the same (see John Rawls's 'veil of ignorance'[14]). The resulting consensus is the action taken. In this way action is never a means but always an end in itself; one acts because it is right, and not because it is instrumental, expected, legal or previously agreed upon. While Kohlberg insisted that stage six exists, he had difficulty finding participants who consistently used it. It appears that people rarely, if ever, reach stage six of Kohlberg's model. It is precisely this method of thinking which philosophers attempt to emulate with the theories of morality developed. The ultimate goal is to give reasoning that could be applied to anyone in any moral situation. [11]

Risk factors of Cervical Cancer

These factors may increase your risk of cervical cancer:

Many sexual partners. The greater your number of sexual partners and the greater your partner's number of sexual partners the greater your chance of acquiring HPV. Early sexual activity. Having sex before age 18 increases your risk of HPV. Immature cells seem to be more susceptible to the precancerous changes that HPV can cause. Other sexually transmitted diseases (STDs). If you have other STDs such as chlamydia, gonorrhea, syphilis or HIV/AIDS you have a greater chance of also having acquired HPV. A weak immune system. Most women who are infected with HPV never develop cervical cancer. However, if you have an HPV infection and your immune system is weakened by another health condition, you may be more likely to develop cervical cancer. Cigarette smoking. The exact mechanism that links cigarette smoking to cervical cancer isn't known, but tobacco use increases the risk of precancerous changes as well as cancer of the cervix. Smoking and HPV infection may work together to cause cervical cancer.

Prevention
You can reduce your risk of cervical cancer by taking measures to prevent HPV infection. HPV spreads through skin-to-skin contact with any infected part of the body not just intercourse. Use a condom every time you have sex in order to reduce your risk of contracting HPV. In addition to using condoms, the best ways to prevent cervical cancer are to:

Delay first intercourse Have fewer sexual partners Avoid smoking

Get vaccinated against HPV A new vaccine called Gardasil offers protection from the most dangerous types of HPV the virus that causes most cervical cancers. The national Advisory Committee on Immunization Practices recommends routine vaccination for girls ages 11 and 12, as well as girls and women ages 13 to 26 if they haven't received the vaccine already. The vaccine is most effective if given to girls before they become sexually active. Although the vaccine could prevent up to 70 percent of cervical cancer cases, it can't prevent infection with every virus that causes cervical cancer. Routine Pap tests to screen for cervical cancer remain important.

Have routine Pap tests Routine Pap tests are the most effective way to detect cervical cancer in the earliest stages. Work with your doctor to determine the best schedule for Pap tests. Current guidelines suggest:

An initial Pap test within three years of when you begin having sex or at age 21, whichever comes first. From ages 21 to 29, a regular Pap test every year or two. From ages 30 to 69, a regular Pap test every two or three years if you've had three normal Pap tests in a row. From age 70 on, you may stop having Pap tests if you've had three or more normal tests in a row and no abnormal results in the last 10 years.

If you're at high risk of cervical cancer, you'll need more frequent Pap tests. If you've had a hysterectomy, talk with your doctor about whether to continue getting Pap tests. If the hysterectomy was done for a noncancerous condition, such as fibroids, you may discontinue routine Pap tests, but not pelvic exams. If the hysterectomy was done for a precancerous or cancerous condition, your vaginal canal still needs to be checked for abnormal changes.

Incidence and Prevalence of Cervical Cancer Cancer of the cervix is the second most common cancer in women worldwide and is a leading cause of cancer-related death in women in underdeveloped countries. Worldwide, approximately 500,000 cases of cervical cancer are diagnosed each year. Routine screening has decreased the incidence of invasive cervical cancer in the United States, where approximately 13,000 cases of invasive cervical cancer and 50,000 cases of cervical carcinoma in situ (i.e., localized cancer) are diagnosed yearly. Invasive cervical cancer is more common in women middle aged and older and in women of poor socioeconomic status, who are less likely to receive regular screening and early treatment. There is also a higher rate of incidence among African American, Hispanic, and Native American women.

Signs and Symptoms of Cervical Cancer Early cervical cancer is often asymptomatic (does not produce symptoms). In women who receive regular screening, the first sign of the disease is usually an abnormal Pap test result. Symptoms that may occur include the following:

Abnormal vaginal bleeding (e.g., spotting after sexual intercourse, bleeding between menstrual periods, increased menstrual bleeding) Abnormal (yellow, odorous) vaginal discharge Low back pain Painful sexual intercourse (dyspareunia) Painful urination (dysuria)

Cervical cancer that has spread (metastasized) to other organs may cause constipation, blood in the urine (hematuria), abnormal opening in the cervix (fistula), and ureteral obstruction (blockage in the tube that carries urine from the kidney to the bladder).

Cervical biopsy for abnormal cervical cell changes Surgery Overview

A cervical biopsy removes part of the cervix so the tissue can be examined under a microscope. The amount of cervical tissue removed depends on the method used:

A simple cervical biopsy removes a small piece of tissue from the surface of the cervix. An endocervical biopsy (endocervical curettage) removes tissue from high in the cervix by scraping with a scoopshaped instrument (curet).

How it is done

A cervical biopsy is usually done in your health professional's office, a clinic, or a hospital as an outpatient procedure (you do not have to spend the night in the hospital). You will need to take off your clothes below the waist and drape a paper or cloth covering around your waist. You will then lie on your back on an examination table with your feet raised and supported by footrests (stirrups). Your health professional will insert an instrument with curved blades (speculum) into your vagina. The speculum gently spreads apart the vaginal walls, allowing the inside of the vagina and the cervix to be examined. A vinegar solution (acetic acid) may be applied to the cervix to show the abnormal areas. A cervical or endocervical biopsy may be done with an oral pain medication but without an injection of numbing medication (anesthetic) in the cervix (cervical block). Alternately, these procedures may be done with a cervical block as well as oral pain medication. An anesthetic ointment may be applied to your cervix before a biopsy. After the biopsy, a liquid (Monsel's solution) may be applied to stop bleeding. A cone biopsy (conization) is a more extensive form of a cervical biopsy. It is called a cone biopsy because a cone-shaped wedge of tissue is removed from the cervix. Both normal and abnormal cervical tissues are removed. For more information, see cone biopsy. A colposcope is used to magnify the tissues during these procedures.

What To Expect After Surgery

Most women are able to return to normal activity the day of or within 1 day after the biopsy.
After cervical biopsy

Some vaginal bleeding and a small amount of dark brown discharge are normal for about 1 to 2 weeks. Sanitary napkins should be used instead of tampons for 1 week. Sexual intercourse should be avoided for 1 week. Douching should not be done.

When to call your health professional

Call your health professional for any of these symptoms:

A fever Moderate to heavy bleeding (more than you would usually have during a menstrual period) Increasing pelvic pain Bad-smelling or yellowish vaginal discharge, which may indicate an infection

Why It Is Done
A cervical biopsy should always be done before surgical treatment is considered when abnormal tissue is seen on the vulva, vagina, or cervix, or if abnormal tissue is seen during colposcopy.

How Well It Works

Results of the abnormal Pap test, colposcopy, and cervical biopsy are compared and evaluated.

Normal. No abnormal tissue is found on the biopsy. Monitoring with Pap tests is done at regular intervals as recommended by your health professional. If the initial abnormal Pap test showed moderate to severe cell changes, additional testing, such as a cone biopsy, may be done to explain the different results found in the cervical biopsy. Abnormal. Abnormal tissue is found. Results may indicate: o Infection. The infection may be treated with medication if it is caused by bacteria or yeast. Repeat Pap tests may be done to monitor the success of the treatment. o Minor cell changes. Abnormal tissue may be monitored without treating it, or treatment may be done to destroy or remove the abnormal cells. Over half of minor cell changes become normal again on their own in 6 to 18 months. o Moderate to severe cell changes. Treatment is done to destroy or remove the abnormal cervical cells.

Cancer. Treatment is done to destroy or remove the tissue affected by invasive cancer.

If the results of the initial abnormal Pap test, colposcopy, and cervical biopsy do not agree:

Risks

Repeat Pap testing, with or without colposcopy, may be done to monitor the progression of the cell changes. A cone biopsy to destroy or remove the abnormal cells may be done if moderate to severe cell changes are indicated in the Pap test.

Vaginal bleeding can occur for up to 2 weeks after the cervical biopsy.

The Papanicolaou test (also called Pap smear, Pap test, cervical smear, or smear test) is a screening test used in gynecology to detect premalignant and malignant processes in the ectocervix. Significant changes can be treated, thus preventing cervical cancer. The test was invented by and named after Georgios Papanikolaou, but was also independently invented by Aurel Babe.[1] In taking a Pap smear, a tool is used to gather cells from the outer opening of the cervix (Latin for "neck") of the uterus and the endocervix. The cells are examined under a microscope to look for abnormalities. The test aims to detect potentially precancerous changes (called cervical intraepithelial neoplasia (CIN) or cervical dysplasia), which are usually caused by sexually transmitted human papillomaviruses (HPVs). The test remains an effective, widely used method for early detection of pre-cancer and cervical cancer. The test may also detect infections and abnormalities in the endocervix and endometrium. It is generally recommended that females who have had sex seek regular Pap smear testing. Guidelines on frequency vary, from annually to every five years. If results are abnormal, and depending on the nature of the abnormality, the test may need to be repeated in three to twelve months. If the abnormality requires closer scrutiny, the patient may be referred for detailed inspection of the cervix by colposcopy. The patient may also be referred for HPV DNA testing, which can serve as an adjunct to Pap testing.