Posted: February 26th, 2023

Late Life Transitions

 

Late Life Transitions

Life

Transitions

Assignment PNUR1165

Assignment:
Life Transitions Assignment

Weighting:
20% of final grade

Course Outcomes:

7.0 Life Transitions

Discuss the various socioeconomic life transitions that the older adult will face in relation to: · Declining function · Shrinking social world · Widowhood · Late-Stage Divorce · Late-Stage remarriage · Grand parenting · Reduced income · Retirement, including the phases of retirement · Role changes · Awareness of mortality

Purpose of Life Transitions Assignment:
To interview an older adult (over the age of 65 years) on their late life transitions. Then discuss/analyze the relevant older adult life transitions as it compares/contrasts with the course content.

Instructions for Assignment:

1. Interview an older adult (someone over 65 years of age).  Note their approximate age.  This person can be a friend, relative, neighbor, parent, or grandparent or someone you have met in the community.  Acknowledge that you were instructed to interview an interesting person for your school assignment.

2. Develop your questions based on adult life transitions as it relates to a person’s lived experience.

3. When choosing a time for the interview, consider when the person feels most comfortable.

4. Consider the length of time you will be taking.

5. Assure the interviewee that they may refuse to answer any question.

6. Be empathic and nonjudgmental. Remember that the person is honoring you by sharing his/her life story.

7. Write a 4-6-page paper analyzing the person’s lived experience. Do not use their name or location to maintain confidentiality.

8. Choose 4 or 5 late-life transitions that apply to your interviewee’s lived experience to analyze.

9. Utilize APA format. The resources can be found at:

https://lib.conestogac.on.ca/apa-conestoga

10. The essay must include a title page, in-text citations, and a reference page.
(Do not reference the course slides).

11. All work is expected to be your original work in your own words.
All items copied from other sources must be quoted or paraphrased or summarized with appropriate citations or references. Academic honesty is expected and required of all Conestoga students. It is critical that you familiarize yourself with the Academic Offences Policy found in the Conestoga 

Student Guide

. 

12. This assignment
will be evaluated in terms of how you use the course content to interpret or explain what you described in the interview. What various life transitions occurred during this person’s older adult years?

13. Do not include the interview transcript in this assignment.

14. Review the rubric to ensure you have addressed all elements that will be evaluated.

15. Submit to the Assignment Submission Folder on eConestoga.

Instructions for Submission:

1. To be marked, this assignment must be submitted to the Assignment Submission Folder entitled “Life Transitions Assignment” in the PNUR1165 Adult Development and Aging Shell on eConestoga.

a. Click on “Course Tools” tab

b. Click on “Assignment”

c. Click on the Assignment Submission Folder called “Life Transitions Assignment”

d. Upload your file

e. Click “Submit”

2. Receive verification of a “Dropbox submission receipt” in your eConestoga inbox

a. Only the most recent submission to the Dropbox is kept to be marked

RUBRIC

Proficient

Capable

Developing

Needs Improvement

Proficient

Capable

Developing

Needs Improvement

Did not occur

STRUCTURE Structure and layout of scholarly paper

Assignment has a title page; Excellent introduction including a clearly defined thesis statement; One body paragraphs per topic; A clear succinct conclusion summarizing the content of the paper.

Assignment has a title page; Introduction utilizing a thesis statement; Body paragraphs; Conclusion does not summarize the content of the paper.

Assignment has a title page; Introduction thesis and statement not clear; Body paragraphs; Conclusion does not summarize the content of the paper

Assignment has a title page; Introduction is missing a thesis statement or statement unrecognizable; Body paragraphs contain multiple topics; Conclusion does not summarize the content of the paper.

Assignment is missing multiple components of a scholarly paper.

ANALYSIS Application of life transitions theory to information gathered in the client view.

Exceptional discussion. Linkages created from the interviewee’s lived experience to the course content with complete analysis (relating/comparing contrasting)

Comprehensive discussion. Linkages created from the interviewee’s lived experience to the course content with complete analysis (relating/comparing/ contrasting)

Fairly comprehensive discussion. Exploration of at least 2 topics linked to the course content. Further elaboration is required for analysis.

Basic discussion. One topic is linked to the course content. The analysis may be superficial or not included.

Poor discussion. No linkage of the course content OR absence of analysis.

QUALITY OF SCHOLARLY REFERENCES Use of Scholarly resources to support thoughts and ideas in the analysis.

Scholarly resources utilized to support analysis are beyond the scholarly materials provided in the course.

Scholarly resources utilized to support analysis are provided within the course.

Scholarly resources are utilized to support some analysis, but one topic does not have a scholarly resource to support thoughts and ideas.

Scholarly resources are utilized to support some analysis, but two or more topics do not have a scholarly resource to support thoughts and ideas.

The absence of scholarly resources to support analysis, thoughts and ideas.

Did Not Occur

PRESENTATION Skill of pulling together information in a clear, organized and succinct manner for the reader

Excellent organization and presentation of discussion. Ideas are easy to follow.

Good organization and presentation of discussion. Ideas are easy to follow.

Fair organization and presentation of discussion. Most ideas are easy to follow.

Lacks organization and presentation of discussion. Ideas are difficult to follow.

Organization and presentation of discussion are not evident. Ideas are difficult to follow.

SCHOLARLY WRITING Grammar; Spelling; Sentence Structure

Exceptional scholarly writing with no errors in grammar, spelling, or sentence structure

Three or less errors in total for spelling, punctuation, grammar, and sentence/ paragraph structure.

Four to five errors in total for spelling, punctuation, grammar, and sentence/      paragraph structure.

Six to ten errors in total for spelling, punctuation, grammar, and sentence/      paragraph structure.

Eleven + errors in total for spelling, punctuation, grammar, and sentence/      paragraph structure.

APA Use of APA 7th edition for formatting scholarly paper. APA@conestoga

Correct use of APA references and citations.

Correct use of APA references and citations with 1-2 errors.

Use of APA references and citations with 3-4 errors.

Use of APA references and citations with 5-6 errors.

Significant errors in the use of APA references and citations with greater than 7 errors OR APA not used.

TOTAL /24

image1

Life Transitions
PNUR1165
 “Caterpillar turning into a butterfly process. © Mathisa S/Getty”
Role: img

Late

Life

Transitions

Unit outcomes
Examine family relationships in later life.
Discuss the various transitions that the older adult will face in relation to role changes, phases of retirement, reduced income, grandparenting, widowhood, shrinking social world, declining function and awareness of mortality.
Discuss the social determinants of health (World Health Organization – WHO) in relation to life transitions.

Late Life Transitions
A process during which people redefine their sense of self and develop self-agency in response to disruptive life events.

May occur predictably or by unanticipated events.

The speed and intensity of a major change may make the difference between a transitional crisis and a gradual and comfortable adaptation.

Various changes during the aging process demand multiple adjustments that require stamina, ability, and flexibility
Frequently more simultaneous changes are experienced in old age than during any other period of life
Older adults face retirement, reduced income, possible housing changes, frequent losses through deaths of significant persons, and a declining ability to function

4

Is Growing Old Easy?
Various role and life changes in aging
Retirement
Reduced income
Possible housing changes
Personal losses – spouse, friends
Declining ability to function – slow response, easy fatigue, altered appearance and fear of losing independence
“Empty nest”: children grown and moved out
Grand-parenting
Loneliness
Sandwich effect/Caregiving
Adjustment to one or more chronic diseases

REFRESHER!!
Various changes during the aging process demand multiple adjustments that require stamina, ability, and flexibility
Frequently more simultaneous changes are experienced in old age than during any other period of life
Older adults face retirement, reduced income, possible housing changes, frequent losses through deaths of significant persons, and a declining ability to function

5

Simultaneous changes during the aging process require:

6

Stamina

Ability

Flexibility

What is Family?

Family members, however they are defined, form the nucleus of relationships for the majority of older adults and the support system if they become dependent.

The idea of family evokes strong impressions of whatever an individual believes the typical family should be.
As recently as 100 years ago a family was defined as parents, there grown children and their grand children. This has since changed with moving to larger cities.

Approximately 38% of todays families are couples with no children.

With divorce rates and remarriage, blended families, lone parent families we now have no typical Canadian family definition.

A long standing myth is that most families abandon their older members in institutions. While I won’t deny that this does happen for the most part older family members are able to maintain close relationships with other family members.

7

Traditional Couple

The traditional couple in Canada is a husband and wife or common-law partnership.

Although this relationship is often the most binding if it extends into late life, the chance of a couple going through old age together is slim.

About 76% of Canadians aged 65 an older are living with a spouse.

Among those aged 65 and older 75% of men and 50% of women live with a spouse.

Older women are more likely to be widowed as 80% of older widowed people are women.

Often second partnerships will not marry do to economic and inheritance reasons.

In general being married has been paired with positive health benefits, life satisfaction and well being.

8

Non-traditional couples
Difficult to determine an accurate number.

From studies conducted in 2014 just under 3% of 18-54 year old’s identified as gay, lesbian or bisexual. This is likely an underrepresentation as there is still fear about publicly self-identifying.

Currently less then 1% of Canadians aged 65 and older are identifying as having a same-sex partnership.

We expect these numbers to increase.
Although these couples may not be seen as often they are still there. They may hide the truth do to longstanding discrimination and fear. We must be cognizant of the fact that what the older generation experienced was most likely drastically different from what a younger person today will experience.

Some older gay/lesbian adults identify their experience as being invisible in senior organizations, health care and society.

Discrimination and prejudice are experienced.

Most research has centered around gay or lesbians we know even less about the experience of bisexuals and trangendered.

Pictures
Male couple who have been partners for 30 years
Women in their 90’s getting married when it was made legal in their state in the US.
9

Divorce and the older adult

Older couples are becoming less likely to stay in an unsatisfactory marriage.

Single Cruise
Single and Mingle Groups at Church

Even as recently as 50 years ago divorce was very ostracizing and isolating. In todays world divorce is much more common.
In 2016 10% of older Canadians were divorced or separated.
People are less willing to stay in an unhappy relationship.
As nurses we need to acknowledge this fact and incorporate it into our assessments.

10

Siblings

Siblings can become particularly important when they are part of the support system, especially among single or widowed older adults who are living alone.

Sibling relationship in the elderly is another poorly researched areas. What we do know is that about 80% of Canadian elderly have at least one sibling and that siblings can be a strong part of your support system. This is particularly true for the never-married, widowed and without children.
-long history of memories
-same generation
-similar backgrounds.
The strongest sibling bond is thought to be that between sisters.

About 6% of todays older people have never been married.
The loss of a sibling can be a huge impact and bring an awareness of ones own mortality.

11

Retirement

May occupy 30 years of one’s life and involve many internal stages
Transitions are blurring because numerous pursuits and opportunities may occur after one has “retired.”
Numerous patterns and styles of retiring have produced more varied experiences in retirement.

Historically we had a compulsory retirement at the age of 65 years. Now Canada does not have a mandatory retirement age.
13% of Canadians age 65 and older are still employed.

The Canadian government estimates about 24% of people approaching retirement will not have enough money to sustain their current living standard.

Socialization needs
Energy levels
Health
Adequate income
Variety of interests
Amount of self-esteem derived from work
Presence of intimate relationships
Social support
General adaptability

12

Effects of Retirement
Self-worth

Identity

Social position

LOSS of work role, first experience r/t impact of aging
IMPACT on EACH?
Worth is commonly judged by an individual’s productivity
Occupational identity is largely responsible for an individual’s social position
Individual’s identity is threatened with retirement
When one’s work is one’s primary interest, activity and source of social contacts, separation from work leaves a significant void in one’s life

13

Retirement: Loss of Work Role
Adjusting to a reduced income
May be viewed as an undesirable state
Occupational identity and social position/role in society
Stereotypes of work roles
Potential void in one’s life related to loss of the work role

14
What is one of the first questions many people ask when meeting someone new? “What do you do?”

Phases of Retirement
Remote: Future anticipation with little real planning
Near: Preparation and fantasizing regarding retirement
Honeymoon: Euphoria and testing of the fantasies
Disenchantment: Letdown, boredom, sometimes depression
Reorientation: Developing a realistic and satisfactory lifestyle
Stability: Personal investment in meaningful activities
Termination: Loss of retirement role resulting from illness, return to work or death

15

Retirement Planning

Decisions to retire are often based on

Financial resources
Attitude toward work
Chronological age
Health
Self-perceptions of ability to adjust to retirement

16

Special Considerations in Retirement
“Three-Legged Stool”

Pensions
Savings
Investments

Only 10% of people in the lowest income bracket contribute to RRSP whereas 60% of those in the highest income bracket.

Older Canadians can earn any amount without endangering their Canadian pension plan benefits.
If they earn more then 73, 756$ a portion of their Old age Security Benefit will need to be repaid.

The Canada Pension Plan (CPP, or QPP as it is known in Quebec) is available to eligible workers at age 65, or up to five years sooner at a reduced rate. You pay into the program when working. It is intended to replace up to 25% of your full-time income upon retirement.

The amount received from the CPP is related to the amount contributed. For the OAS the amount received is not dependent on work history

For 2020, the maximum CPP retirement benefit for new recipients age 65 will be $1,175.83 per month, which represents approximately a $20 increase over the previous year.

The Old Age Security (OAS) pension is a monthly payment available to seniors aged 65 and older who meet the Canadian legal status and residence requirements. You may need to apply to receive it. If you live in Canada and you have a low income, this monthly non-taxable benefit can be added to your OAS pension.

Old Age Security. The Old Age Security pension (or OAS or OAS-GIS) is a taxable monthly social security payment available to most Canadians 65 years of age or older with individual income less than $122,843. As of January 2018, the basic amount is C$586.66 per month.

17

Question

Is the following statement true or false?
Retirement is a major adjustment for an individual, and this transition is often an individual’s first experience with the impact of aging.

18

Answer
True.

Retirement is especially difficult in Western society, where an individual’s productivity commonly measures worth, and unemployment is viewed as an undesirable state.

19

Reduced Income
Income is a Social Determinant of health

One in six of all older adults live in poverty
Importance of financial resources
Adjustments with a reduced income

This Photo by Unknown Author is licensed under
CC BY-NC

20
The social determinants of health (SDH) are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems. 

Caring for Spouses
Elderly spouses caring for disabled partners have special needs and may face many role changes.

Someone must be available to give reinforcement, encouragement, and relief to the caregiver.

Caregiving can be seen as a way to ”give back” to a loved one. It can bring both joy and stress

Over the age of 60 spouses provide the most care. Of those living with a spouse with disabilities about 80% are providing care for them. Sometimes they will neglect their own health needs to care for their spouse.

Need to monitor for caregiver burnout.

For spouses poor relationship with the person before they became ill was associated with greater burden, as was caring for someone who has agitation and sleep problems.

Older family caregivers are at risk for more negative consequences. The caregiver will need supports to provide reinforcement, encouragement and relief.

Day programs
Respite programs

21

Question…Caregiving
Can you identify some NEEDS of spousal CAREGIVERS?

Family caregiving is associated with an increase of stress, depression and anxiety.

22

Widows and Widowers

One of the most difficult transitions one can face, yet one of the most common an older adult will face.
Significant event that alters family life
Mostly women
Involves grief, the psychological and physical reactions to the loss, as well as the process of grieving and coping with the loss.

35% of women and 11% of men age 65 or older are widowed.

This is one of the most difficult transitions a person can face.

23

Widows and Widowers

Three core features of grief:

Depression
Anxiety
Loneliness

24

Loss of A Spouse

Many adjustments:
Living alone
Developing alternative roles such as the tasks partner previously did e.g. cooking, finances
Income issues
Adjust to the loss of a sexual partner
Shrinking social world
Choosing a new lifestyle

25

Grand-parenting
Grand-parenting as a new role in life
Changes in family structure and activities bring new challenges
Active lifestyles of older adults require adaption by children and grandchildren
Grandparenthood as a learned role

26
About 80% of Canadians age 65 and older are grandparents.
Most grand-parents receive a great amount of joy and emotional satisfaction from their grand-children.

Younger grand-parents and grand-parents who live near their grand-children are more likely to be involved in the grand-children’s lives.

About 75% of grand-parents provide financial assistance to their adult children or grand-children.

Approximately 11% of grandparent live in the same house hold as the grand children.

Grandparents Raising Grandchildren
More grandparents have become primary caregivers of grandchildren.
Some parents are unable to provide the care needed because of:
Teen pregnancy, imprisonment, joblessness, military deployment, drug and alcohol addictions, illness, death, or other social problems
More common among First Nation people at a rate of 17%, compared to only 3% in the general Canadian population.

We have had a 20% increase in the last 10 years

Caregiving by grand-parents is more common among indigenous people.

27

Long Distance Care-giving

More children move away from home for education or employment and do not return.
May include friends, hired or volunteer caregivers from a church or agency
Caregivers not only provide substantial physical care,but may also be involved in social activities such as dining, concerts, and faith-related events.

A care manager can be hired to do everything a family member would do if able.

1 in 5 Canadian provide care for a parent or in-law that live an hour or more away.

Distance caregivers incur more expenses for caregiving and have higher incomes.

This is perhaps one of the more difficult situations and has many unique challenges.

28

Nonfamily Caregiver

29

May include friends and hired or volunteer caregivers from a church or agency.

Caregivers not only provide substantial physical care, but may also be involved in social activities such as dining, concerts, and faith-related events.

Challenges in Health and Functioning

Adjustment to a new body image
Effect on body image and self-concept
Self-concept and roles
Acceptance of bodily changes
Declining function resulting in illness and disability
Loss of independence

30

Cumulative Effects of Life Transitions
Shrinking social world:
Loss of social connection
Risk of loneliness
Potential failure to thrive
Awareness of one’s own mortality

31

Question
Which of the following statements is true and related to the shrinking social world of the older adult?

There is a decreased risk of loneliness
Hearing deficits can foster loneliness
Children avoid older adult parents
Functional limitations have minimal impact

32

Answer
Hearing deficits can foster loneliness
Hearing and speech deficits can foster loneliness. Changes associated with aging result in loss of social connections and increasing risk of loneliness as children are often grown and gone and others who could allay loneliness may avoid the older individual as they find it difficult to accept the changes they see in the older adult.

33

Responding to Life Transitions

Coping with life transitions: Integrity versus Despair
Nursing interventions:
Life review
Eliciting a life story
Promoting self-reflection
Strengthening inner resources

34

Social Determinants of Health
World Health Organization (WHO)
“The social determinants of health are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.”

Social & Economic Environment
Physical Environment
Person’s Individual Characteristics and Behaviours

Self-Care Skills for the Older Adult

Independence
A sense of control in their life
Good self-esteem

36

In Summary
Life transitions are inevitable
No two older adults transition through older age the same
Nurses need to be aware of an older adult’s late life transitions as they often influence health and care
There are things you can do as a nurse to support an older adult’s late life’s transitions

Grief and Loss
PNUR1165

16 minute video on changing the conversation on grief and loss

38

Unit Outcomes
Differentiate between loss and grief.
Explain the different types of grief.
Describe the experience of grief as a response to loss.
Compare the symptoms associated with ‘normal’ grief and pathological grief.
Identify nursing assessments and interventions required to effectively intervene in the older adult’s coping with loss and grief.

2
Loss, Grief, Bereavement
Loss, dying, and death are universal, incontestable events of human experience that cannot be stopped or controlled.
Grief is the individual’s response to loss, everyone grieves differently
Mourning includes those behaviours used to incorporate loss into one’s life.

40

Types of Loss

Actual Loss

The response to a situation.

Death, job, etc.

Perceived Loss

a loss that is experienced by one person but cannot be verified by others, psychological losses

Dreams, goals, plans, independence, freedom, etc.

Types of Loss

Anticipatory Loss

Loss experienced prior to the event happening

Downsizing of a business (loss of job), loss of a loved one with major neurocognitive impairment, death of a loved one by terminal illness, etc.

Sources of Loss

Aspects to the Self

Changes to body image

Divorce (loss of financial security, home, daily routines, role as spouse)

Physical / Mental changes or illnesses

External Objects

Loss of inanimate objects (money, car, personal belongings)

Loss of animate objects (pets)

Sources of Loss

Familiar Environment

Separation of familiar surroundings and people

Child’s first day of school

Selling of family home

Retirement

Loved Ones

Loss of loved ones through illness,
separation, or death.

3
The Grieving Process
Physical and psychological manifestations of acute grief (when it is first felt)
Middle period in which the manifestations of grief (e.g., despair, depression) affect the person’s day-to-day functioning
Ending phase where the person learns to adjust to life in a new way without that which has been lost.

5
Loss Response Model
Source: Jett, K. F. (2004). The Loss Response Model, unpublished manuscript. Adapted from Giacquinta, B. (1977). Helping families face the crisis of cancer. American Journal of Nursing, 77 (10),1585–1588.

46

Factors That Influence Grief
Age (childhood, early and middle adulthood, late adulthood)
Significance of loss
Culture
Spiritual beliefs
Gender
Socioeconomic status
Support systems
Cause of loss or death

“Normal” Grief Symptoms
EMOTIONAL

Shock and disbelief
Profound sadness
Loneliness / Abandonment
Anger, Resentment
Fear / Anxiety
Guilt
Mild depression

PHYSICAL

Fatigue
Nausea
Lowered immunity
Weight loss or weight gain
Aches and pains
Insomnia

Pathological Grief Symptoms
Prolonged symptoms resulting in severe functional impairment.
Increase risk of developing
Posttraumatic Stress Disorder (PTSD)
Anxiety disorders
Major depression
Suicidal ideas

Factors That Affect Coping With Loss

The ability of the individual or family to find ways to deal with the stress.
The ability to move from a state of chaos and disequilibrium to one of reorder, equilibrium, and peace.
People with good coping mechanisms are more likely to effectively deal with grief.

Let’s Reflect…
What are your thoughts and feelings about loss and grief?

Implications for Gerontological Nursing
Assessment
Goal is to differentiate those likely to cope effectively from those at risk for ineffective coping so that appropriate interventions can be planned
Includes questions about recent significant life events, life or religious values, and relationship to that which has been lost and that which has been gained

52

53

9
Interventions for Gerontological Nursing

Gently establish rapport.
Acknowledge pain and suffering
Be ready to listen.
Encourage griever to talk and tell story of relationship as it had been.
Explore support system
Provide resource and support information

In Summary
“There is not a typical response to loss, as there is no typical loss.
Our grieving is as individual as our lives.”

Elisabeth Kübler-Ross

image2

image3

image1

image4

image5

image6.gif

image7

image8

image9

image10

image11

image12.svg

.MsftOfcThm_Accent1_Fill_v2 {
fill:#465359;
}
.MsftOfcThm_Accent1_Stroke_v2 {
stroke:#465359;
}

image13

image14

image15

image16

image17

image18

image19

image20

image21

image22

image23

image24.emf

image25

1

Late Life Transitions

Adetutu Joan Omo Olaoye

Practical Nursing Student, Conestoga College

PNUR 1165: Adult Development and Aging

Hellen Jarman

Feb 12th 2023

Definition of Transition

Lived Experience

Types Of Transitions

Detailed Transitions of Interviewee

Nursing Strategies

Summary and Conclusion

References

Definition Of Transition

In General, to transition means to change.

Lived Experience

My Interviewee is a 70-year-old female currently residing in Long Beach, California in the United States and the interview was conducted over the phone.

For the purpose of confidentiality, I would be using only her initials.

T.N., remembers her childhood days like they were yesterday. She