Behavioral science

Khatuna Dondoladze
The challenges of early and middle
adulthood.
Aging, death, and bereavement

Behavioral Science, 8th edition, Barbara Fadem, 2021, Wolters

Kluwer Health.
ADULTHOOD:

Adulthood begins around 20 years old and has three distinct stages: early, middle, and late.

• EARLY ADULTHOOD: 20–40 YEARS

• MIDDLE ADULTHOOD: 40–65 YEARS
• LATE ADULTHOOD: from the 60s onward
EARLY ADULTHOOD: 20–40 YEARS

 REAPPRAISAL PERIOD
 ADULT BECOMES INDEPENDENT
 PERIOD OF INTIMATE RELATIONSHIP, marriage,
children
 No intimate relationship = emotional isolation in
future
MIDDLE ADULTHOOD: 40–65 YEARS

 Peak of position of power and authority

 Sense of productivity or a sense of emptine
 In men: midlife crisis (40-45):
 A change in profession
 A change in lifestyle
 Infidelity, separation, divorce.
 Increased use of alcohol or other drugs.
 Depression
MIDDLE ADULTHOOD: 40–65 YEARS

 Physiological changes:
In men:
 muscle strength
 physical endurance
 sexual performance
MIDDLE ADULTHOOD: 40–65 YEARS

 Physiological changes:
In women - menopause
 Few physical problems - Vasomotor instability:
called hot flashes
Aging
Demographics:

• The fastest growing segment of the population is people over age 85.
• Differences in life expectancies by gender and ethnicity have been
decreasing over the past few years.
• Between 2015 and 2050, the proportion of the world's population over 60
years will nearly double from 12% to 22%.
• By 2020, the number of people aged 60 years and older will outnumber
children younger than 5 years.
• In 2050, 80% of older people will be living in low- and middle-income
countries.
• The pace of population ageing is much faster than in the past.
• All countries face major challenges to ensure that their health and social
systems are ready to make the most of this demographic shift.
Gerontology:
the study of aging, and geriatrics, the care of aging people
 Management of the chronic illness of aging (hypertension, cancer,
diabetes…)
 Aim = keep elderly patients mobile and active.

fractures = loss of mobility = disability and death in the elderly

preventing falls, prevention and management of osteoporosis are

important foci in management: exercise, calcium and vitamin D
 Somatic and neurologic changes

1. Strength and physical health gradually decline:

• impaired vision, hearing, and immune responses;

• decreased muscle mass and strength;
• increased fat deposits;
• decreased renal, pulmonary, and gastrointestinal function;
• reduced bladder control;
• decreased responsiveness to changes in ambient temperature.
Somatic and neurologic changes

2. Changes in the brain occur with aging.

 decreased brain weight and cerebral blood flow.
 Decrease - Amyloid (senile) plaques and neurofibrillary tangles, risk of
neurocognitive disorder due to Alzheimer’s disease
 Neurochemical changes:
 decreased availability of neurotransmitters such as norepinephrine,
dopamine, acetylcholine;
 increased availability of monoamine oxidase;
 decreased responsiveness of neurotransmitter receptors.
Cognitive changes

 decreased learning speed

 Little memory problems is normal

Psychological changes

 satisfaction and pride in one’s past accomplishments = sense of ego integrity

 a sense of despair and worthlessness

 Psychopathology:
 Depression
 Suicide

Loss of family members, decreased social status,

Psychological changes

 Loss of sleep, poor sleep quality

 Anxiety – fear of a physical illness
 Alcohol abuse
 Changes in metabolism: ex. Antihistamines can cause delirium
“life expectancy” vs “longevity”

 Life expectancy- can mean how many years you have left to
live, or at what age you will die, or how long people born in
the same year are on average currently expected to live.
 Longevity' simply means 'long life'.
 Life expectancy varies by gender and ethnicity:
longest-lived group is Hispanic American women and the
shortest-lived group is African-American men
2. Factors associated with longevity include:
a. genetic
b. physical activity.
c. education.
d. Social support systems
STAGES OF DYING AND DEATH

Kubler-Ross and colleagues developed a five stage

model of death and dying. These stages have different
emotional responses that people go through in Elizabeth Kübler-Ross

response to the knowledge of death. They are

commonly referred to by an acronym of DABDA and
are:
1. Denial
2. Anger
3. Bargaining
4. Depression
5. acceptance
STAGES OF DYING AND DEAT
STAGES OF DYING AND DEAT
1.Denial – The first reaction is denial. In this stage, individuals believe the diagnosis is somehow mistaken, and
cling to a false, preferable reality.

2.Anger – When the individual recognizes that denial cannot continue, they become frustrated, especially at
proximate individuals. Certain psychological responses of a person undergoing this phase would be: "Why me?
It's not fair!"; "How can this happen to me?"; "Who is to blame?"; "Why would this happen?".

3.Bargaining – The third stage involves the hope that the individual can avoid a cause of grief. Usually, the
negotiation for an extended life is made in exchange for a reformed lifestyle. People facing less serious trauma
can bargain or seek compromise. Examples include the terminally ill person who "negotiates with God" to attend a
daughter's wedding, an attempt to bargain for more time to live in exchange for a reformed lifestyle or a phrase
such as "If I could trade their life for mine".

4.Depression – "I'm so sad, why bother with anything?"; "I'm going to die soon, so what's the point?"; "I miss my
loved one; why go on?"
During the fourth stage, the individual despairs at the recognition of their mortality. In this state, the individual may
become silent, refuse visitors and spend much of the time mournful and sullen.

5.Acceptance – "It's going to be okay."; "I can't fight it; I may as well prepare for it."
In this last stage, individuals embrace mortality or inevitable future, or that of a loved one, or other tragic event.
People dying may precede the survivors in this state, which typically comes with a calm, retrospective view for the
individual, and a stable condition of emotions.
BEREAVEMENT (NORMAL GRIEF) vs COMPLICATED BEREAVEMENT (DEPRESSION)
Physician’s response to death

 support to the dying patient and the patient’s family.

 how much patient wants to know about the condition?
 patient’s permission to tell the family the diagnosis
 Physicians must be emotionally detached from the
patient.