Life Transitions

Life Transitions

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“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

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

Simultaneous changes during the aging process require:

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.

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.

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.

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.

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.

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

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

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

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

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

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.

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.

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.

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

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

Question…Caregiving

Can you identify some NEEDS of spousal CAREGIVERS?

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

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.

Widows and Widowers

Three core features of grief:

Depression

Anxiety

Loneliness

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

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

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.

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.

Nonfamily Caregiver

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

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

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

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.

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

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

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

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https://www.youtube.com/watch?v=kYWlCGbbDGI

16 minute video on changing the conversation on grief and loss

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.

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.

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.

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.

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.

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

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.”