Chapter 15:
Very Old Age
(75 Until Death)
Very Old Age (75 Until Death)
• Chapter Objectives
– To identify very old age as a unique
developmental period for those of unusual
longevity; a stage with its own developmental
tasks and psychosocial crisis
– To describe some of the physical changes
associated with aging, including changes in
fitness, behavioral slowing, sensory changes,
and vulnerability to illness, and the challenges
these changes pose for continued
psychosocial well-being
Very Old Age (75 Until Death)
• Chapter Objectives (cont.)
– To develop the concept of an altered
perspective on time and history that emerges
among the long-lived
– To explore elements of the lifestyle structure
for the very old, especially living
arrangements and gender role behaviors
Very Old Age (75 Until Death)
• Chapter Objectives (cont.)
– To identify and describe the psychosocial
crisis of immortality versus extinction, the
central process of social support, the prime
adaptive ego quality of confidence, and the
core pathology of diffidence
– To apply research and theory to concerns
about meeting the needs of the frail elderly
Very Old Age (75 Until Death)
• A New Psychosocial Stage: Very Old Age
– Increasing numbers of people are living into
old age
– The 20th century was unique in history in that
a large percentage of people lived well
beyond their reproductive and childbearing
years into later adulthood and very old age
– The psychosocial stage of very old age
occurs after one has exceeded the life
expectancy for one’s birth cohort
– Old-old – among the very old those who have
suffered major physical or mental decrements
Very Old Age (75 Until Death)
• A New Psychosocial Stage: Very Old Age (cont.)
– Young-old – among the very old, those who
remain healthy, vigorous and competent
Very Old Age (75 Until Death)
• A New Psychosocial Stage: The Gender Gap
Among the Very Old
– Women outlive men in virtually all countries of
the world, but the differences are accentuated
in the developed countries
– Because those currently at the stage of very
old age are predominantly women, many of
the social issues of aging – especially poverty,
health care, the future of social security, and
housing – are also viewed as “women’s
issues”
Very Old Age (75 Until Death)
• Coping with the Physical Changes of Aging:
Fitness
– The theme of physical changes of aging can
be approached much like its counterpart in
early adolescence
– See a decline in fitness in late 20s and early
30s, but most people’s strength and capacity
for moderate effort are about the same at age
70 as they were at age 40
– Older people are less resilient after a period
of prolonged exertion
Very Old Age (75 Until Death)
• Coping with the Physical Changes of Aging:
Fitness (cont.)
– Commitment to physical fitness is important
for adults in order to face the later years in the
best possible physical condition
– In order to maintain optimal functioning and to
retard the degenerative effects of aging, very
old adults must continue to have frequent and
regular opportunities for physical exercise
Very Old Age (75 Until Death)
• Coping with the Physical Changes of Aging:
Behavioral Slowing
– One of the most commonly noted markers of
aging is a gradual slowing in repose to stimuli
– behavioral slowing
– The speed of behavior is a composite
outcome of the time it takes to perceive a
stimulus, retrieve related information from
memory, integrate it with other relevant stored
information, reason as necessary about the
required action, and then take action, whether
that means simply pressing a button or
performing a surgical procedure
Very Old Age (75 Until Death)
• Coping with the Physical Changes of Aging:
Behavioral Slowing (cont.)
– Processing load – the more domains of
information are called into play and the more
work is necessary to select response
categories
– Biological, learned, and motivational factors
have been identified to account for behavior l
slowing
– A common consequence of slowing is its
impact on cognitive functioning
Very Old Age (75 Until Death)
• Coping with the Physical Changes of Aging:
Behavioral Slowing (cont.)
– Since the slowing occurs gradually, most
adults compensate for it by making their
environments more convenient or by
changing their lifestyles
Very Old Age (75 Until Death)
Very Old Age (75 Until Death)
• Coping with the Physical Changes of Aging:
Health, Illness, and Functional Independence
– A mild but persistent decline in the immune
system is observed as a correlate of aging. As
a result, older adults are more susceptible to
infections and take a longer time to heal
– One of the most difficult health challenges of
very old age is a group of disorders referred
to as organic brain syndromes
– In contrast to negative stereotypes about later
life, the level of independent functioning
among adults 80 years old and older is high
Very Old Age (75 Until Death)
• Developing a Psychohistorical Perspective
– Very old adults are more aware of
alternatives; they can look deeply into both
the past and the future and can recognize that
opposing forces can exist side by side
– Through a process of creative coping
– Very old adults in each generation blend the
salient events of their past histories with the
demands on current reality – psychohistorical
perspective
Very Old Age (75 Until Death)
• Developing a Psychohistorical Perspective
(cont.)
– As society becomes more accustomed to
having a significant group of very old adults
functioning in the community, some scholars
anticipate that a culture of aging will emerge
in technological societies
– A psychohistorical perspective contributes to
the wisdom that the very old bring to their
understanding of the meaning of life
Very Old Age (75 Until Death)
• Traveling Uncharted Territory: Life Structures of
the Very Old
– Life begins in the 80s – one interpretation of
this adage is that because there are so few
norms for behavior and so few responsibilities
when one reaches very old age, one can do
whatever one wants
– Changes in role relationships, especially role
loss in later adulthood, present significant
challenges to the preservation of a coherent
self-concept
Very Old Age (75 Until Death)
Figure 15.5 Living Arrangements for Older Adults by Age and Sex:
2003
Very Old Age (75 Until Death)
• Traveling Uncharted Territory: Living
Arrangements
– Living Alone – increasing numbers of very old
women are establishing a new single lifestyle
in which they function as heads of households
– In the United States, living arrangements for
older women differ by race and ethnic group
with Asian American women more likely to live
with other family members than to live alone,
in comparison to white women of similar
economic and educational backgrounds
Very Old Age (75 Until Death)
• Traveling Uncharted Territory: Living
Arrangements (cont.)
– The majority of very old men, about 70%, are
married and live with their spouses
Very Old Age (75 Until Death)
• Traveling Uncharted Territory: Interstate
Migration and Housing Options
– Although most older adults remain in their
home communities, the trend toward
interstate migration has increased since the
mid-1960s
– Differences in lifestyle, health, interest, ability
to perform daily activities, marital status, and
income enter into the very old person’s
preference for housing arrangements
Very Old Age (75 Until Death)
• Traveling Uncharted Territory: Interstate
Migration and Housing Options (cont.)
– The majority of older adults live in urban
areas, and 31% of them live in inner-city
neighborhoods
Very Old Age (75 Until Death)
• Traveling Uncharted Territory: Institutional Care
& Assisted Living
– About 1.6 million adults over age 65 live in
nursing homes
– The likelihood of a person living in a nursing
home increases when there is no family
member who can help manage his or her
daily living needs
Very Old Age (75 Until Death)
• Traveling Uncharted Territory: Institutional Care
& Assisted Living (cont.)
– The fastest growing component of the
Medicare program is community-based long
health care which provides medical and social
services to those who are chronically ill and
are eligible for institutionalization but who
nevertheless, live in the community
Very Old Age (75 Until Death)
• Case Study: Mr. Z
– Thought Questions
• Imagine that you were having lunch with Mr. Z.
What questions would you want to ask him?
• What are the physical challenges of aging with
which Mr. Z must cope?
• Why might Mr. Z be living in a nursing home?
• How could you describe Mr. Z’s psychohistorical
perspective?
• What are the unique, creative adaptations that
characterize Mr. Z’s story?
• In what sense is the nursing home optimizing Mr.
Z.’s functioning?
Very Old Age (75 Until Death)
• Traveling Uncharted Territory: Gender-Role
Definitions, Evaluating the Concept of Sex-Role
Convergence
– Sex-role Convergence – a transformation of
sex-role orientation in which men and women
become more androgynous and more similar
in gender orientation during later life
– Affliliative Values – the values placed on
helping or pleasing others, reflected in the
amount of time spent and the degree of
satisfaction achieved in such actions
Very Old Age (75 Until Death)
• Traveling Uncharted Territory: Gender-Role
Definitions, Evaluating the Concept of Sex-Role
Convergence (cont.)
– Instrumental Values – the values place on
doing things that are challenging, reflected in
the amount of time spent and the degree of
satisfaction achieved in such actions
Very Old Age (75 Until Death)
• Traveling Uncharted Territory: Gender-Role
Definitions, Romance & Sexuality and Ageism &
Sexuality
– Older men and women tend to be tied to
many of the sex-role standards of their
historical cohort
– Today’s very old adults are also likely to be
uncomfortable about sexuality and dating
– Sexuality, intimacy, and romance remain
important among older married couples
– Older adults continue to have negative ageist
social attitudes about sexual activity that may
inhibit their sexual behavior
Very Old Age (75 Until Death)
• The Psychosocial Crisis: Immortality Versus
Extinction
– Immortality is when a person transcends
death through a sense of symbolic continuity
• One may live on through one’s children, sensing a
connection and attachment to the future through
one’s life and the lives of one’s offspring
• One may believe in an afterlife or in a spiritual
plane of existence that extends beyond one’s
biological life
• One may achieve a sense of immortality through
creative achievements and their impact on others
Very Old Age (75 Until Death)
• The Psychosocial Crisis: Immortality Versus
Extinction (cont.)
– Immortality is when a person transcends
death through a sense of symbolic continuity
(cont.)
• One may develop the notion of participation in the
chain of nature
• One may achieve a sense of immortality through
experiential transcendence
Very Old Age (75 Until Death)
• The Psychosocial Crisis: Immortality Versus
Extinction (cont.)
– Extinction - feared that the end of life is the
end of all continuity
– The possibility of ending one’s life with a
sense of extinction is reflected in the public
health concern about suicide among the
elderly
Very Old Age (75 Until Death)
• The Central Process: Social Support
– The Benefits of Social Support –
socioemotional support and instrumental
support contribute to maintaining well-being
and fostering the possibility of transcending
the physical limitations that accompany aging
– The Dynamics of Social Support – most older
adults continue to see themselves as involved
in a reciprocal, supportive relationship with
their friends
– The Social Support Network – is usually
family members in later life
Very Old Age (75 Until Death)
• The Prime Adaptive Ego Quality and the Core
Pathology
– Confidence – a conscious trust in oneself and
in the meaningfulness of life
– Diffidence – the inability to act, due to
overwhelming self-doubt
Very Old Age (75 Until Death)
Figure 15.6 Levels of Dependency and Types of Care
Very Old Age (75 Until Death)
• Applied Topic: Meeting the Needs of the Frail
Elderly
– Defining Frailty
• Difficulties in the activities of daily living (ADLs) or
difficulties in managing instrumental activities of
daily living (IADLs)
– Supporting Optimal Functioning
• Is what a person is capable of doing when he or
she is motivated and well prepared
Very Old Age (75 Until Death)
• Applied Topic: Meeting the Needs of the Frail
Elderly (cont.)
– The Role of the Community
• Interventions at the community level may be
necessary to meet the safety, health, and social
needs of some older adults who want to remain in
the community
– The Role of Creative Action
• Older adults can alter the structure of their
environment to enhance their sense of well-being