Late adulthood is a period of various biological changes which can impact on an individual’s health and ability to function as easily in society. The stereotypical changes of this stage are paler less elastic skin resulting in wrinkles, thinning hair gradually turning from grey to white, weaker bones, muscle loss, and vision and hearing impairments e. g. cataracts and difficulty with word discrimination. There are changes to the brain also, such as the loss of dendrites which causes a reduction in brain weight and volume and slower synaptic speeds resulting in slower reaction times (Bee 1998, p. 53). Their immune system slows down as well, becoming less effective, and making them more prone to illness (Fernandez 2010, p. 794). Alzheimer’s disease is the most common cause of dementia and is a change in the brain structure due to the tangling of dendritic fibres in the brain causing severe memory loss and personality changes (Bee 1998, p. 459). Overall, the elderly are more likely to have a chronic illness and disabilities which may impact upon their ability to bathe, walk, feed themselves, prepare meals, shop, dress themselves, and even live independently (Bee 1998, p. 56). This stage of life is characterised by a number of stresses and is a time of reflection. An individual’s changing work status, in particular when they retire, can be a source of stress as work is a major component of adult life and they now have to find other activities to fill their day. There is also the uncertainty of their financial future and whether they will have enough to live comfortably off (Fernandez 2010, pp. 853-855).
Their health or partner’s health may be another source of stress for them, especially if it results in a caring role being required to complete everyday tasks; and the knowledge that their life is coming to an end (Fernandez 2010, pp. 867-868). Fernandez (2010, p. 851) states that late adulthood is a “… time of looking back and taking stock of where we’ve been, what we’ve accomplished, and whom we have touched. ” This results in a process called ‘Life Review’ which is gradually looking back at past experiences analysing and evaluating them to develop more secure and complex self concepts (Bee 1998, p. 02). Social interaction is an important part of life, continuing on in late adulthood and is associated with good health and life satisfaction. The elderly have frequent contact with family, finding strong emotional and practical support through them, especially adult children, and tend to have lower levels of institutionalisation with couples and relatives providing a high level of care and assistance to each other (Bee 1998, pp. 484-490). Friendships play an important role in late adulthood, with many enjoying time with friends more than with family (Fernandez 2010, p. 43). They provide companionship, intimacy, acceptance, opportunities for laughter, sharing of activities, links to a larger community, and protection from the psychological consequences of loss (Berk 1998, p. 609). In late adulthood where and with whom individuals are going to live is an issue they face. There are a number of options available to the elderly such as mobile homes, age segregated villages/communities, institutions, with family, or in their own home (Kalish 1975, pp. 97-99).
Deciding which option is the most suitable for an individual can be influenced by a variety of things, such as health, disability, socio-economic status (SES) and culture. Mobile homes such as caravans suit those looking for a low cost and informal arrangement, however, those that have a mobility affecting disability or very poor health may not be suited to this option as they are usually small and on outskirts of towns (Kalish 1975, p. 98). Age segregated villages/communities include retirement homes that provide independent living arrangements or some support depending on the individual’s needs (Johnson 1960, p. 7). They tend to be in semi-isolated areas (making it hard for those with serious health issues to access medical attention), and are quite expensive (only those of high SES tend to be able to afford them) (Kalish 1975, pp. 98-99). The most common institution for the elderly is a nursing home, which cares for those who need considerable attention due to severe physical or mental disabilities (approximately 5% of the aged population) (Kalish 1975, p. 99). Some residents are unable to feed, dress or bathe themselves, are incontinent or unaware of where or even who they are (Kalish 1975, p. 9). Medicare subsidises some of the costs, but not enough, meaning some individuals are still unable to cover the costs (Kalish 1975, p. 99). Family members provide the most long term care, whether that is a spouse, partner or adult children (Berk 1998, p. 575). It is more common for an elder of an eastern culture to live with their children and extended family, even if healthy, than for an elder from a western culture. Most individuals, even with a moderate disease or health problem, don’t live with relatives, but in their own house (Bee 1998, pp. 82-483). Living in their own home provides the greatest personal control, but those living alone are often poverty stricken and have unmet needs (Berk 1998, p. 601). This is where the Government and charity organisations help; they both provide small homes at low costs in suitable areas, as well as providing services such as home help (cleaning mainly), home visiting, and Meals on Wheels (Johnson 1960, p. 48). Elder abuse is a very real and serious issue that occurs during the late adulthood stage of life.
There are many different types of elder abuse, including physical abuse (use of physical force resulting in injury, pain or impairment), sexual (non-consensual sexual contact), emotional/psychological (inflicting anguish, emotional pain or distress), neglect (failure to fulfil obligations or duties to an elder), financial exploitation (improper use of an elder’s funds, property or assets), and medical abuse (failing to provide adequate medical treatment or misusing medications) (Biggs 1995, pp. 6-37). It can also be intentional (conscious and deliberate attempt to inflict harm) or unintentional (inadvertent action resulting in harm, usually due to ignorance, inexperience, lack of desire or inability to provide proper car) (CSAP’s Prevention Pathways 2004). Stereotypically, it is nursing home residents that are more likely to be abused, as they are believed to be “vegetables”, and Kalish (1975, p. 9) states that health care professionals sometimes describe feeding the resident using the expression, “watering the vegetables” which highlights this view and often leads to elder abuse as a way of degrading the elder and punishing them for needing attention and help. Unfortunately many nursing staff receive little or no in-service training and receive a very poor wage, so they feel out of their depths and do not enjoy the tasks required of them, which increases the risk of elder abuse as they feel frustrated, especially if the elder’s abilities are declining and need more care (Kalish 1975, p. 00). This leads to very few long term facilities providing intellectual or sensory stimulation. The more staff fail to stimulate the residents, the more they have to do for them, and the more the residents sink into despondency, creating more stress and frustration for the carers; becoming a viscous cycle (Kalish 1975, p. 100). The lack of stimulation itself, could be a form of unintentional neglect, as their intellectual needs are not being met.
Despite the stereotypical view of nursing homes, it is in fact those who live in their own homes or with family who are abused the most, and it is the family that are usually the abusers, especially sons (Biggs 1995, p. 41). Victims of psychological or physical abuse tend to be physically well but have emotional problems while the abusers tend to have issues with alcohol and/or mental illness and live with the victim and are usually dependent on them (Biggs 1995, p. 43).
Victims of neglect are usually very old and mentally or physically impaired with very little social support, and the abuser suffers chronic and continuing stress (Biggs 1995, p. 43). Those who are unmarried with limited support are at more risk of being financial exploited, with the abuser having financial problems or dependent on the victim for finances and accommodation (Biggs 1995, p. 43). In 1993 the Commonwealth Government established the Working Party on the Protection of Frail Older People in the Community to protect the rights of residents in nursing homes (Biggs 1995, p. 53).
Interestingly, mandatory reporting legislation that America has was rejected by most states in Australia at first and it wasn’t until July 2007 that compulsory reporting of unlawful sexual contact or unreasonable use of force was brought in, but this still doesn’t cover all elder abuse and only applies to residents of an Australian Government subsidised aged care facility (Aged Rights Advocacy Service 2012). Erik Erikson was a German psychoanalyst who developed an eight stage psychosocial development theory; this essay will focus on his last stage, ego integrity versus despair (Fernandez 2010, p. 21). The basic concept of this stage is the question ‘Was my life meaningful? ’ and involves looking back on one’s life to determine this. The hope is that the individual will come to terms with and accept who they are and have been, the choices they have made, and the opportunities they have gained and lost, and their impending death and thus achieve the virtue of wisdom (Bee 1998, p. 501). If they don’t come to terms with their life they develop despair, where they feel dissatisfied with their life and feel it is too late to change it (Berk 1998, p. 88). For example, someone who has very poor health and is reliant on others to help care for them may feel like a burden and have a sense of hopelessness resulting in them continuing to live alone as they do not wish to put others out. While someone else may view it as they’ve lived a long healthy life up until now and they have a loving family who is willing to help them in their old age, leaving them with a sense of fulfilment and satisfaction, and will happily move in with relatives.
Another example might be living in a retirement home, some elderly may come to resent the age segregation and feel like society has pushed them to the outskirts to die, while others may feel stronger social connections, higher morale and a general higher life satisfaction due to the close proximity of others of similar age. Erikson’s theory is valuable in providing a guideline by which to understand this stage, but is it as clear cut as having integrity or despairing?
Maxine Walaskay classified elderly into one of four categories, integrity achieved (aware of their ageing and accept the life lived); despairing (negative evaluation of life); foreclosed (content with their current life but resist self exploration); and dissonant (just beginning to evaluate their life) (Bee 1998, p. 501). Walaskay’s classification seems to say that not all individuals in this life stage look back on their life and evaluate it, that those in the foreclosed category base it on where their life is at now, so it would seem that Erikson’s theory does not apply to everyone in this life stage.
Stress as a transaction theory looks at a stimulus only becoming a stressor when it is perceived that way by the individual, and whether they believe they have the resources to cope. In terms of elder abuse it would focus on the increasing dependency of the elder and a burden of care giving as the cause of stress thus increasing the risk of abuse (CSAP’s Prevention Pathways 2004).
It proposes that there are factors influencing the risk of elder abuse in terms of elder related (physical or emotional dependency, poor health, impaired mental status and a ‘difficult’ personality), structural related (emotional strain, social isolation and environmental problems) and carer related factors (life crisis and burn out or exhaustion) (Biggs 1995, p. 25). For example an institutionalised resident’s dementia worsens making them more reliant on the carer, leading to more stress as the carer may not feel they have the capabilities to handle increased roles and this may cause them to abuse the resident.
Another example could be an only child suffering extreme financial distress due to gambling debts, who lives with their mentally impaired mother and feels they cannot pay their own debs so they fraudulently use their mother’s funds. This theory looks at the relationship between the dependency of the elder and the stress this creates resulting in abusive behaviour, which research has been unable to prove (Biggs 1995, p. 30).
According to this theory, by reducing the level of care giving stress, the likelihood of elder abuse would decrease as well, but this doesn’t take into account other factors that may be attributing to the abuse such as power roles (being physically and mentally more powerful and degrading and abusing the elder as a way to exert and maintain that power), and even a history of violence (if the elder was abusive earlier in their life and the abused becomes their carer, such as a wife or child, then the carer may have learnt that behaviour and carry it on by abusing the elder).
There are many biological, psychological and social factors that impact individuals in the late adulthood stage of life, which can contribute to issues they face such as the influence of an individual’s health, ability to function effectively in society and social networks on where and with whom to live and the occurrence of elder abuse. The two theories, Erikson’s ego integrity versus despair and the stress as a transaction theory help provide some guidelines to examine the issues of living arrangements and elder abuse faced by individuals in this stage of life. Reference List
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