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PSY3128 Final: Psychology of Aging Final Notes

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Shirley Griffith

1 Final Notes Lectures 11-25 Chapters 2, 5, 8-13 February 15th, 2017 Lecture 11: Health and Prevention Average longevity: the average age you get to, the age at which a particular cohort will reach depending on their historical environment. Maximum Longevity: the oldest age to which an individual of a species could hope to live to. Active Life Expectancy: how long you can expect to live to as an active and independent individual. Dependent Life Expectancy: years of living after loosing your independence. Genetic factors for active and dependent life expectancy are not as important as environmental and lifestyle factors. These include the environment, toxins, SES, and lifestyle factors such as smoking, excessive bad behaviours, etc. → all of which interact Industrialized culture → women live (on average) seven years longer than men. Health should be considered the absence of chronic, acute, or physical diseases or disabilities. “Wellness” as a concept goes beyond just the absence of disease. Chronic illnesses more often occur in older people because of compounding factors over ones lifestyle. This can make it hard for individuals to carry out tasks. We always want to remember that illness is separate from chronic illnesses. The older you are the more likely it is that you will have a chronic illness. Activities of Daily Living (ADL): involves completing tasks like bathing, dressing, sleeping, eating → essentially things necessary for you to live. InstrumentalActivities of Daily Living: take more cognitive functioning, shopping, telephone, prepping meals, finances, etc. FunctionalAssessments of Health Status: to what degree of independence can an individual maintain. Behavioural risk factors for chronic illness: smoking, diet, etc. Third hand smoking; living in a house where smoke has been can (1) be detrimental to health, (2) decreases the market value of your house. Sclerosis: abnormal hardening of tissue, making it hard for the blood to pump to an area. Coronary Heart Disease: oxygen to the heart stops/slows and it starts to die. Hypertension: high blood pressure. - chronic suffering from abnormal elevated blood pressure. TIA: mini stroke or blockage of blood to the brain. Respiratory Diseases i. Chronic Obstructive Pulmonary Disease (COP): long term poor airflow ii. Bronchitis: inflammation of broccoli tubes iii. Emphysema: airsacs of the lungs are inflamed iv. Mesothelioma: cancer of mesothelmic tissue Can be from smoking, work, espethos, etc. Medication adherence: difficult when dealing with older adults because their medications change, they grow in and out of new pain/diseases, have to watch for how medications interact, they may forget or not want to take medication. 12% of the population is over 65, but 48% of all pharmaceuticals are taken by this population. Absorption: time needed for medication to reach the blood stream Metabolism: longer time for drugs to move through an old persons system Dosage effects young and old people differently. Polypharamacy: taking more than one kind of medication because you have multiple conditions. - over the counter or herbal medications can also interact and cause problems. Compression of Mortality: time between onset of a disability and death is compressed, happens because of an active lifestyle. Factors which predict disability: drinking, physical activity, social isolation, depression, feeling depressed, poor perceived health status. Cerebro Vascular Disease: can be very limiting. Models of Observing people in their environment: 1. Person-Environment Interaction: the fact that behaviour is a function of both the person and the environment. 2. Nahemow & (???)’s Competence and Environmental Press Model: Competence is the theoretical upper limit in your ability to function. Press is the effects the environment has on you. The press and the competence should balance in order for the individual to have the right level of strain without feeling inadequate. 2 3. Selective Compensation with Optimization (SOC): developed by Maltese.Adults that attempt to perserve and maximize things that are important to them. i. Selection: concentration on certain demands that you want or that are important to you. ii. Election: electing what you are selecting, which areas you are able to concentrate. iii. Optimization: you can maintain areas or capacities with concentration, modify the environment. Models and example of compensation: dancing is important to you so when you get old you should try to bring it into your life. Successful aging can be defined by goal attainment. This can’t be predicted in a generalized fashion but importance is based on the demands of functioning. March 6th, 2017 Lecture 14: Chapter 9 Episode 2 of Rage Against the Darkness: focuses on two sisters in their early 70s and how their relationship changes as age and dependency changes. - the older one was dependent and was eventually moved to a nursing home - the older one (Bunny) eventually develops health issues and depression because no one comes to visit her in the nursing home Sibling Relationships: receive less research than other types of relationships, such as spousal or parent-child. The type of relationship is mediated by how much involvement, contact, envy, and resentment they have for one another. i. Congenial/Loyal Relationship: average levels of contact, closeness, and involvement. There is low levels of envy and resentment. These individuals have a good relationship but are more focused on other relationships with children, spouses or friends. ii. Intimate Relationships: very close and extremely related, the individuals place more value on this than other relationships. iii. Apathetic: low on everything, no envy but also no degree of closeness. iv. Hostile: high on everything, the two are very involved but there is also a high degree of envy. Could develop in early life and evolve over time or could be caused by an incident. Congenial or loyal is the most common type of relationship, accounting of 2/3 of relationships. Friendships can provide us with intimacy, affection, support, opportunities for self-disclosure, etc. This is based on shared or communal nature. - mens relationships are more focused on activity - women are focused on socializing, talking, self-disclosure Reciprocity is important. Marital relationships in older adults: - more people are divorced today than at any other point in recent history - in the past it was difficult being a woman and unmarried - marriage was previously necessary for childrearing Canadian Marriage and Skip-Generation Households - first nations group is over-representing skip-generation households - 1/3 of individuals have two or more grandkids in their homes Grandparents: have varying contributions to their grandchild’s life - spread out more now so less common to have a very close relationship with your grandkids - 20% of older people are also caring for another senior (most likely to be a spouse or sibling) Types of Grandparents: i. Formal Grandparents: occasionally babysit, hands off relationship, most common ii. Fun-Seeking Role: relationship is fun, leisure activities, second most common iii. Surrogate: taking over a parenting role March 8th, 2017 Lecture 15: ElderAbuse Any action taking against older people, whether it is direct, indirect, intentional, non-intentional. i. PhysicalAbuse ii. SexualAbuse iii. PsychologicalAbuse iv. Neglect v. FinancialAbuse Risks: being frail, not having other close people in your life, being in a nursing home, being dependent on the caregiver, etc. This victim is often dependent on the person abusing them, making it difficult or scary to report. This could also be in reverse if the abuser is dependent on the older person, these cases are more likely to be violent because the dependent may use violence to get what they want. March 13th, 2017 Lecture 16: Long-Term Care Family caregivers can manage to a point but often get overwhelmed or unable to accommodate medical needs. Things can go wrong if home caregivers do not have adequate training — long term care options are sometimes necessary. Caregiver Burden: cost because of medical treatments or because you have to reduce your amount of paid work. - middle aged women are most likely to take this type of burden on Long-Term Care Coverage - individual mandates for veterans through the federal government - public institutions are covered by OHIP but most times do not have the same level of are as private institutions Community Support Programs: goal is to keep people in their homes as long as possible. i. Secondary Suite/Granny Flat ii. Assisted/Supportive Living Facility: help but not skilled nursing care 3 iii. Retirement Homes: private homes which give meals and laundry for functional adults, typically $2000-3000/month iv. Daily Nursing Care: need assistance with almost everything, basic living skills, washing, cognition, physical functioning, psychological issues, nutrition, regular medication, feeding. Issues may include but are not limited to: not wanting to split couples or families up, shortage of beds especially on reserves, difficulty accommodating individual customs and values, a lack of facilities directly within one’s community → making splitting families up difficult. - wandering is common especially among dementia patients and is extremely dangerous - staff in nursing homes are not paid as well as other health professionals → it is not attractive, highstatus, or for all personality types (requires someone with patience and empathy) March 15th, 2017 Lecture 17: Mental Health Issues March 20th, 2017 Lecture 18: Chapter 11, Mental Health Issues (Continued) Psychological Problems: outside the realm of normative psychological experiences DSM-5: the critical criteria for a clinical diagnosis → Not always accommodating the particular needs of older adults. → Diagnosing older adults can be challenging because of experiences unique to older adulthood. (ie. widowhood, chronic illness, different symptoms which result from illness or subsequent medication, you have to be sensitive to their unique challenges) - often times older adults have mental health issues but may not meet minimum diagnostic requirements - they should still be treated and accommodated for Major Depression: dysphoria/sadness, anhedonia/lack of pleasure, insomnia, headaches, fatigue, diffuse pain, manifestation of illness. → 6.7% of the population receives a diagnosis Mood Disorders: major depression, bipolar, distemia (continuous low levels of depression). Rates of sub-clinical depression occur in (estimate) 20% of older adults. Rates in a medical setting can be as high as 30%. If you have a chronic health problem which results in a lack of independence or ability — depression would be a common reaction to this issue. As a clinician you have to be aware of the differences in age and symptoms. Professionals who are not trained in an older adults should not be practicing on them — however, many times psychiatrists can treat older adults without any new or specialized training. Seeing a private mental health professional can be expensive, cost/time ineffective. Lack of vitamins B12 or D can look like depression symptoms. Rational Suicide: when the person is mentally able and capable to make the decision for themselves. Late Onset Stress Symptomology: symptoms related to combat which emerge later in life (similar to PTSD, just late onset) Post Traumatic Stress Disorder - prevalent among survivors of war or major disaster, war, police, first responders Schizophrenia: often diagnosed or onset is in early adulthood, most people in late adulthood with schizophrenia have been managing it for their entire lives. (Those with erratic or unmanageable symptoms don’t make it to older adulthood). - lower life expectancy, so it is not prevalent in older adults - those who took antipsychotics in the 1950s SubstanceAbuse - effects 4.4% of Canadians 15 years and older - starts in late teens and early 20s but increasingly beginning in older adulthood - 6-10% of older adults have substance abuse problems - typically goes untreated so statistics are compounded - most common type in older adulthood is prescription drug abuse - second most common is alcohol abuse - older adults are much less likely to consume street drugs unless they had an addiction which began in early adulthood - metabolizing and excreting alcohol changes as you get oder — you may not have the same level of tolerance as you did when you were younger, this can be harmful if someone relapses in later life Chapter Two: Models of Development Identity Process Theory: identity continues to change through adulthood in a dynamic manner. Your identity creates a set of schemas through which you observe the world. IdentityAssimilation: tendency to interpret new experiences in terms of your existing identity. You won’t change your identity with new experiences, instead you interpret outward/ uncontrollable factors. For example, doing poorly on a test won’t make you think you are a bad student, you will just think the test was unfair. IdentityAccommodation: make changes in their identities in response to experiences. Identity Balance: dynamic equilibrium that occurs when people tend to view themselves consistently but can make changes the called for by experiences. Tied to self efficacy — which is a persons feeling of competence. 4 Selective Optimization and Compensation Model (SOC): adults attempt to preserve and maximize their abilities which are of central importance and out less effort into maintaining those that are not. Older people make conscious decisions regarding how to spend their time and effort in the face off looses in cognitive and physical resources. Chapter Five: Health and Prevention 89% of seniors have at least one chronic condition, 37% have at least four.Arthritis and rheumatism effect 44%, heart diseases effects 23%, 21% have diabetes, and 29% of new diabetes cases were diagnosed in 65+. Health is the state of complete physical, mental, and social well being — not merely the absence of disease. Activities of Daily Living: minimum requirements InstrumentalActivities of Daily Living: ability to use the telephone, go shopping, manage finances, etc. These activities are not required for survival but are still important. Risks for chronic diseases in seniors: smoking, physical inactivity, unhealthy diet, harmful alcohol use → raised blood pressure/sugar, raised abnormal blood lipids, obesity → cardiovascular disease, diabetes, cancer, chronic respiratory disease Diseases of the Cardiovascular System i. Atherosclerosis: fatty deposits collect at an abnormally high rate, substantially reducing the width of the arteries and the circulation of the blood. ii. Arteriosclerosis: general term for the thickening and hardening of the arteries. iii. Myocardial Infraction: blood supply to the hear stops and the tissue dies iv. Hypertension: abnormally heightened blood pressure v. Congestive Heart Failure: unable to pump enough blood to meet the needs of the body Cancer: leading cause of death in Canada, 1 in 4 people will die from it.All cancer is genetically caused and reflects damaged genes. Risk factors include exposure to sun, cigarette smoking, diet (red meat is related to colon cancer, pickled or dried foods is related to stomach cancer), and environmental toxins. Disorders of the Musculoskeletal System i. Arthritis: general term for conditions affecting the joints and surrounding tissues — causing pain, stiffness, and swelling in joints. ii. Osteoarthritis: most common form of arthritis, effecting the hips, knees, neck, lower back, and small joints of the hands. Obesity is a risk factor because it puts increased pressure on joints. Exercise can be used to reduce pain but in extreme situations surgery is needed to maintain mobility. iii. Osteoporosis: occurs when the bone mineral density reaches a point that is more than 2.5 standard deviations below the mean of a young, white woman. 2 million Canadians have osteoporosis, placing the individual at a greater risk for bone fracture.Adequate amounts of calcium in dairy, dark greens, vegetables, tofu, or fortified foods can help prevent bone density loss. Diabetes: the individual is unable to metabolize glucose. Type-2 shares many of the same risks as cardiovascular disease. Treatment and prevention is controlling glucose intake, blood pressure, and blood lipids. Respiratory Diseases i. Chronic Obstructive Pulmonary Disease (COPD): group of diseases that involve the obstruction of the airflow into the respiratory system. Related to chronic bronchitis and emphysema. ii. Elastes: release of an enzyme cause by smoking which results in COPD Neurocognitive Disorders i. Mild Cognitive Impairment: signifies risk for developing a more serious neurocognitive disorder. ii. Amnesia: profound memory loss. iii. Alzheimers Disease: individual suffers progressive and irreversible neuronal death. Worldwide this effects 5% of men and 6% of women over the age of 60. i. Stages 1. NotAlzheimers: forgetting things occasionally or being hazy on details. 2. Early-Stage: short term memory loss, some loss in newly learned information, functioning normally at home but having difficulty in social situations. Loosing information on recent events or familiar tasks. 3. Middle-Stage: completely forget conversations, loss of self awareness, noticeable memory lapses, disoriented, difficulty sleeping. 4. Late-Stage: personality changes, agitated, delusional, paranoid, repeat complete conversations, may not know the names of close friends and families, speech impairment, complete shot-term memory loss. ii. Psychological Symptoms: changes in cognitive functioning which are not related or attributable to aging. iii. Biological Changes: - - Amyloid plaques are a generic name for protein fragments that collect together in a specific way to form insoluble deposits of beta-amyloid amyloid precursor protein (APP) is embedded in the neuron’s membrane and is routine trimmed by secretases - inAlzheimers disease, something with secretases goes wrong and fragments that have been cut clump together - these supposedly have the ability to kill neurons - capase theory proposes that beta-amyloid stimulates the production of substances called capsizes, enzymes that are lethal to neurons → this causes apoptosis which leads to neuronal death and impaired cognitive functioning - the second major change related toAlzheimer’s is neurofibrillary tangles - made up of a protein called tau which play a role in the maintenance of stability in axonal structure, these start to break down and form tangled clumps of tau proteins iv. Proposed Causes: the existence of plaques and tangles in the brain is not a sure sign that an individual will have cognitive symptoms → showing that this disorder is affected by environmental and biological factors. Genetic theory began to emerge as an explanation when family lines and dispositions toAlzheimer's were tracked i. Early onset familialAlzheimers: if people in your family got the disease around 40/50 you were more likely to as well ii. Late onset familialAlzheimers: only 5% of these cases are familial linked Other potential causes - apolipoprotien E (ApoE) gene on chromosome 19 is linked to distributing cholesterol in the body and could have a role in plaque formation - more links on chromosome 21 - presenilin genes (PS1 and PS2) encourage theAPP to increase its production of beta-amyloid which causes neurofibrillary tangles and beta-amyloid plaques - decreased cognitive reserve inAlzheimer’s patients — a lessened ability to compensate for lost cognitive reserve v. Diagnosis: specific behavioural criteria from psychiatrists and clinical psychologists vi. Treatments: antioxidant rich food, medications, no cure iv. Vascular Neurocognitive Disorder: progressive loss in functioning due to damage to the arteries supplying blood to the brain. The most common type is a multi-infarct (MID): which causes transient ischemic attacks (basically mini strokes) 5 v. Parkinson’s Disease: variety of motor disturbances, can be managed using L-dopa but this drug looses its effect and causes toxic buildup vi. Neurocognitive Disorder with Lewy Bodies: similar toAlzheimer’s but causes loss of memory, language, calculation, and reasoning. Lewy bodies are tiny spherical structures consisting of deposits of protein found in dying nerve cells in damaged regions — related to Parkinson’s. vii. Pick’s Disease: severe atrophy of frontal and temporal lobes. viii.Reversible Neurocognitive Disorders: caused the presence of another medical condition but does not destroy brain tissue. If the medical issue is left untreated it could cause permanent damage. ix. Normal Pressure Hydrocephalus: rare but can cause dementia, urinary incontinence, cognitive impairment and difficulty walking — caused by obstruction in the flow of cerebrospinal flood which causes the fluid to accumulate in the brain x. Subdural Haemotoma: blood clot puts pressure on brain tissue usually as the result of a head injury. xi. Delirium: acute cognitive disorder that is characterized by temporary confusion, sudden onset. xii. Polypharamcy: cognitive effects of a person taking multiple prescription medications xiii.Wernicke’s Disease: acute condition caused by chronic alcohol abuse, involving delirium, eye movement disturbances, balance problems. If left untreated it could develop into Korsakoff syndrome. Chapter Eight: Personality Historical Ideas on Personality i. Hippocrates described the “melancholic” temperament as one in which the person was suffering from chronically disturbed bodily quilts. ii. Freud identified the neurotic personality as the prototype of psychopathology and mental illness. iii. Mental health professionals long ago abandoned the phrase neurosis to describe the syndrome of extreme sadness and worry. Instead, psychological disorder involving depressed moods and highly anxious states fall into several categories of the diagnostic nomenclature system. Psychodynamic Perspective on Personality: Freud is credited for having discovered the unconscious aspect of psychology. - unconscious motives and impulses express themselves in people’s personalities and behaviour - Freudian ideas as the important o nearly development and the ways in which people cope with emotions such as fear, anxiety, and love Ego Psychology - in Freudian theory the mind is made up of three structures → ID, Ego, and Superego - the ID refers to biological instincts which could include the need to hurt, kill, and exert power - superego attempts to control the ID’s instinct, and mediates between the rational thought of the ego and primal ID - in ego psychology it is believed that the ego plays an active role in determining personality Psychodynamic Theory: (includes 3x sub-theories) Ego Psychology, Theory of Defence Mechanisms,AdultAttachment Theory Erikson: proposed that the go matured through a set of stages where the ego is pushed and pulled based on the environment to produce an un/favourable outcome.After one issue is resolved, we move onto the next stage. i. Identity achievement vs. role diffusion: defining yourself typically through puberty. - James Marcia developed the identity status interview which examines the individuals level of commitment to identity issues and the degree of exploration the individual used to arrive at this commitment - based on this you can have four different levels of “identity achievement” 1. identity achievement — strong commitments following a period of exploration 5. Foreclosed — commitments but no exploration 6. Moratorium — actively exploring different commitments 7. Identity Diffuse — no strong commitments with/without exploration - this theory showed that you could have strong commitments without much logic behind them - people with “identity achievement” status seem to be balanced in their thinking, mature in their relationships, and thoughtful about their life options ii. Generativity vs. stagnation: showing care and concern for guiding the net generation, higher in parents as it is almost a for-sure way of establishing the next generation. - a balance shifts from about yourself to concern for others - a shift from the “noisy ego” to the “quiet ego” iii. Overall psychological development: 1. Inventory of Psychosocial Development (IPD): the questionnaire used in the RochesterAdult Longitudinal Study to measure psychosocial development over many stages & how they changed over time. For example, those who started out with low levels of intimacy in college had a steeper growth curve and matched individuals who had higher levels of intimacy in college by 31. (Basically, they caught up.) 2. Five Pathways ThroughAdulthood i. Authentic Road — achieves solid identity commitments through exploration and change ii. Triumphant Road — overcomes challenges and is resilient iii. Straight and Narrow Way — maintains consistent life pattern is defensive about change iv. Meandering Way — fails to settle on a course in life, constantly searching for identity v. Downward Slope — shows self defeating behaviour and makes poor decisions 3. Personality is continuous and can change based on the situation. Social roles influenced development through late mid-life in women who were brought up conservative and educated in a liberal school — showed increased self-control, assurance, independence, and decreased personally perceived femininity Lovinger’s 1976 Theory: in the field of ego psychology and related to Erikson’s stages, but incorporating how people thing as well as the structure of personality. i. Conformist Stage: very basic understanding of themselves, other people, and the reasons for following societies rules. ii. Conscientious-Conformist Stage: (where most adults are) first have an internalized sense of right and wrong and are able to be aware of their own motives as well as those of other people. iii. Conscientious Stage: people develop a true conscience, one that is an internalized understanding of societies rules and the reasons for those rules. The final three stages involve an increasing sense of individuality and self-determination. iv. Individualistic Stage: appreciation and respect for individuality. v. Autonomous Stage: more clearly articulated sense of self. vi. Integrated Stage: sense of self and resolved all individual conflicts. → combines ego psychology and moral development Categories of Defence Mechanisms by Vaillant 1. Psychotic i. Delusional Projection: attributing one’s own bizarre ideas and feelings to others ii. Denial: disclaiming the existence of feeling, action, or event 6 iii. Distortion: significantly exaggerating and altering the reality of feelings and events 2. Immature i. Projection: attributing unacceptable ideas and feelings to others ii. Hypochondriasis: expressing psychological conflict as shown through physical complaints iii. Acting Out: engaging in destructive behaviours that express inner conflicts 3. Neurotic i. Displacement: transferring unacceptable feelings to a safer object ii. Repression: forgetting about a troubling feeling or event iii. Reaction Formation: expressing the opposite of their true feelings 4. Mature i. Altruism: turning unacceptable feelings into helpful behaviour ii. Sublimation: expressing unacceptable feelings in a productive activity iii. Humour: making it into a joke, being able to laugh at an unacceptable situation → The use of mature defence mechanisms increases with age. AdultAttachment Theory: proposes that the early bond between the infant and caregiver sets the stage for all the individuals future significant relationships. i. SecureAttachment: feel confident about themselves and confident that others will treat them well. ii. AnxiousAttachment Style: imagine that their partners will also abandon them. iii. AvoidantAttachment Style: fear of abandonment is so intense that they stay away from close relationships all together. Older adults are less likely to experience anxious attachment. - attachment style can change in a few months Trait Perspective: personality is based on the assumption that the organization of the personal disposition known as traits guide a person’s behaviour. i. Five Factor Model (“Big Five”): openness, conscientiousness, extraversion, agreeableness, neuroticism. Measured most accurately by the NEO-PI-R questionnaire. ii. Aging & the Big Five - high degree of consistency with age - maintain their relative positions along traits in comparison with their age peers, ie. highs stay high and lows stay low - individuals increase in social dominance, conscientiousness, emotional stability, social vitality, and openness to experience through the age of 40 - Correspondence Principle: people experience particular life events that reflect their personality traits, once these events occur they further their affect on the person’s personality. - meta-analysis on six personality traits 1. Social Vitality: stable and decreases around 60 2. Agreeableness: increases 3. Emotional Stability: increases until 40 and then plateaus 4. Social Dominance: increases tip 40 then plateaus 5. Conscientiousness: increases 6. Openness to Experience: increases until 20, plateaus, then decreases at 60 iii. Health and Personality Traits 1. TypeABehaviour Pattern: a collection of traits that include being highly competitive and achievement orientated. Predisposed for heart diseases 2. Neuroticism/Anxiety: serve as risk factors for cardiovascular disease. 3. Being low in conscientiousness might lead people to be more careless about many aspects of life, including health — as a result developing higher BMIs. High conscientiousness predicted lower mortality risk and high levels of self discipline. 4. Low scores on neuroticism, high scores on the activity facet of extroversion predicted lower mortality. 5. Lower mortality related to high levels of openness. 6. High neuroticism and low conscientiousness related to a higher risk ofAlzheimers disease. Social CognitiveApproaches to Personality: how social interactions influence personality, how personality influences social interactions. Socio-emotional selectivity: proposes that throughout adulthood, people structure the nature and range of their relationships to maximize gains and minimize risks. Relationships have two functions: (1) informational rewards/gaining knowledge, (2) emotional rewards and maximizing positive feelings. - friendships that serve a relational function, you seek people who who help you feel good about yourself and your life - this is explained through affect regulation where other people can help mediate your emotions and behaviour Cognitive Perspective: people are driven by the desire to predict and control their experiences. Cognitive self theories → people regard events in their lives from the standpoint of how relevant these are to their own sense of self. - people high on self efficacy believe that they can be successful, and this belief can stimulate them to higher performance than they would otherwise show Theories: i. Possible Selves: we are motivated to achieve a hope for self and avoid the feared self. ii. Coping and Control: older adults may be more capable of coping with stress. a. Problem-Focused Coping: people attempt to
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