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Aquilino (2006) suggests that the task in early adulthood may be to maintain enough of a bond so that there will be a foundation for this relationship in later life blood pressure too low symptoms perindopril 2 mg overnight delivery. Those who are successful can often move away from the "older-younger" sibling conflicts of childhood heart attack the alias club remix cheap 2mg perindopril with amex, toward a more equal relationship between two adults hypertension patho discount perindopril. Siblings that were close to each other in childhood are typically close in adulthood (Dunn hypertension in african americans trusted 8mg perindopril, 1984, 2007), and in fact, it is unusual for siblings to develop closeness for the first time in adulthood. Intimate relationships are more difficult if one is still struggling with identity. Achieving a sense of identity is a life-long process, as there are periods of identity crisis and stability. These intimate relationships include acquaintanceships and friendships, but also the more important close relationships, which are the long-term romantic relationships that we develop with another person, for instance, in a marriage (Hendrick & Hendrick, 2000). A major interest of psychologists is the study of interpersonal attraction, or what makes people like, and even love, each other. Similarity: One important factor in attraction is a perceived similarity in values and beliefs between the partners (Davis & Rusbult, 2001). We can feel better about ourselves and our choice of activities if we see that our partner also enjoys doing the same things that we do. Having others like and believe in the same things we do makes us feel validated in our beliefs. This is referred to as consensual validation and is an important aspect of why we are attracted to others. Source: Self-Disclosure: Liking is also enhanced by self-disclosure, the tendency to communicate frequently, without fear of reprisal, and in an accepting and empathetic manner. Friends are friends because we can talk to them openly about our needs and goals and because they listen and respond to our needs (Reis & Aron, 2008). If we open up about our concerns that are important to us, we expect our partner to do the same in return. Proximity: Another important determinant of liking is proximity, or the extent to which people are physically near us. Research has found that we are more likely to develop friendships with people who are nearby, for instance, those who live in the same dorm that we do, and even with people who just happen to sit nearer to us in our classes (Back, Schmukle, & Egloff, 2008). Proximity has its effect on liking through the principle of mere exposure, which is the tendency to prefer stimuli (including, but not limited to people) that we have seen more frequently. The effect of mere exposure is powerful and occurs in a wide variety of situations. Infants tend to smile at a photograph of someone they have seen before more than they smile at a photograph of 280 someone they are seeing for the first time (Brooks-Gunn & Lewis, 1981), and people prefer sideto-side reversed images of their own faces over their normal (nonreversed) face, whereas their friends prefer their normal face over the reversed one (Mita, Dermer, & Knight, 1977). This is expected on the basis of mere exposure, since people see their own faces primarily in mirrors, and thus are exposed to the reversed face more often. We have an initial fear of the unknown, but as things become familiar, they seem more similar and safer, and thus produce more positive affect and seem less threatening and dangerous (Harmon-Jones & Allen, 2001; Freitas, Azizian, Travers, & Berry, 2005). Familiar people become more likely to be seen as part of the ingroup rather than the outgroup, and this may lead us to like them more. Zebrowitz and her colleagues found that we like people of our own race in part because they are perceived as similar to us (Zebrowitz, Bornstad, & Lee, 2007). Friendships In our twenties, intimacy needs may be met in friendships rather than with partners. This is especially true in the United States today as many young adults postpone making long-term commitments to partners, either in marriage or in cohabitation. The kinds of friendships shared by women tend to differ from those shared by men (Tannen, 1990). Friendships between men are more likely to involve sharing information, providing solutions, or focusing on activities rather than discussion problems or emotions. Men tend to discuss opinions or factual information or spend time together in an activity of mutual interest. Friendships between women are more likely to focus on sharing weaknesses, emotions, or problems.

In addition blood pressure basics buy cheap perindopril 4 mg, he believed that the tortured creative person was a myth and that creative people were very happy with their lives prehypertension at 19 order cheap perindopril on line. According to Nakamura and Csikszentmihalyi (2002) people describe flow as the height of enjoyment blood pressure high diastolic purchase perindopril 4 mg online. Tacit knowledge is knowledge that is pragmatic or practical and learned through experience rather than explicitly taught blood pressure readings chart generic 8 mg perindopril overnight delivery, and it also increases with age (Hedlund, Antonakis, & Sternberg, 2002). It does not involve academic knowledge, rather it involves being able to use skills and to problem-solve in practical ways. Tacit knowledge can be understood in the workplace and used by blue collar workers, such as carpenters, chefs, and hair dressers. Middle Adults Returning to Education Midlife adults in the United States often find themselves in college classrooms. In fact, the rate of enrollment for older Americans entering college, often part-time or in the evenings, is rising faster than traditionally aged students. Students over age 35, accounted for 17% of all college and graduate students in 2009, and are expected to comprise 19% of that total by 2020 (Holland, 2014). In some cases, older students are developing Source skills and expertise in order to launch a second career, or to take their career in a new direction. Whether they enroll in school to sharpen particular skills, to retool and reenter the workplace, or to pursue interests that have previously Figure 8. The mechanics of cognition, such as working memory and speed of processing, gradually decline with age. However, they can be easily compensated for through the use of higher order cognitive skills, such as forming strategies to enhance memory or summarizing and comparing ideas rather than relying on rote memorization (Lachman, 2004). Although older students may take a bit longer to learn material, they are less likely to forget it quickly. Older adults have the hardest time learning material that is meaningless or unfamiliar. Older adults are more task-oriented learners and want to organize their activity around problem-solving. Results indicated that older students were more independent, inquisitive, and motivated intrinsically compared to younger students. Additionally, older women processed information at a deeper learning level and expressed more satisfaction with their education. To address the educational needs of those over 50, the American Association of Community Colleges (2016) developed the Plus 50 Initiative that assists community college in creating or expanding programs that focus on workforce training and new careers for the plus-50 population. Since 2008 the program has provided grants for programs to 138 community colleges affecting over 37, 000 students. The participating colleges offer workforce training programs that prepare 50 plus adults for careers in such fields as early childhood educators, certified nursing assistants, substance abuse counselors, adult basic education instructors, and human resources specialists. These training programs are especially beneficial as 80% of people over the age of 50 say they will retire later in life than their parents or continue to work in retirement, including in a new field. Gaining Expertise: the Novice and the Expert Expertise refers to specialized skills and knowledge that pertain to a particular topic or activity. In contrast, a novice is someone who has limited experiences with a particular task. Everyone develops some level of "selective" expertise in things that are personally meaningful to them, such as making bread, quilting, computer programming, or diagnosing illness. Expert thought is often characterized as intuitive, automatic, strategic, and flexible. Novice cooks may slavishly follow the recipe step by step, while chefs may glance at recipes for ideas and then follow their own procedure. This is because they are able to discount misleading symptoms and other distractors and hone in on the most likely problem the patient is experiencing (Norman, 2005). Consider how your note taking skills may have changed after being in school over a number of years. Chances are you do not write down everything the instructor says, but the more central ideas. You may have even come up with your own short forms for commonly mentioned words in a course, allowing you to take down notes faster and more efficiently than someone who may be a novice academic note taker.

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Develop Treatment Plan Develop and implement an ongoing treatment plan with defined goals arteria networks corp discount perindopril 8mg with mastercard. Treat Co-Morbid Conditions Provide appropriate treatment for comorbid medical conditions heart attack left or right purchase perindopril 8 mg visa. Provide End-of-Life Care Provide appropriate end-of-life care blood pressure medication grapefruit cheap 4mg perindopril, including palliative care as needed blood pressure questionnaire buy discount perindopril 4mg on-line. Integrate Medical Care & Support Integrate medical care with education and support by connecting patient and caregiver to support organizations for linguistically and culturally appropriate educational materials and referrals to community resources, support groups, legal counseling, respite care, consultation on care needs and options, and financial resources. Capacity Evaluations Use a structured approach to the assessment of patient capacity, being aware of the relevant criteria for particular kinds of decisions. Elder Abuse Monitor for evidence of and report all suspicions of abuse (physical, sexual, financial, neglect, isolation, abandonment, abduction) to Adult Protective Services, Long Term Care Ombudsman, or the local police department, as required by law. The number of those afflicted is increasing annually as the population continues to age. Following the aging of the baby boomers, prevalence will escalate rapidly and is expected to double by 2020. The burden on families and the health care system will be substantial as one out of every eight baby boomers develops this disease. It assumes that a proper diagnosis has been made using reliable and valid diagnostic techniques. However, many of the activities recommended in the Guideline do not require a physician and can be done by other members of the treatment team (care managers, nurses, community support organizations) working closely with the patient and caregiving family. Pay particular attention to the special needs of early-stage patients, involving them in care planning and referring them to community resources. Discuss implications with respect to work, driving, and other safety issues with the patient. Recommend interventions to protect and promote continuing functioning, assist with independence, and maintain cognitive health including physical exercise, cognitive stimulation and psychosocial support. The advisability of routine screening tests, hospitalization, and invasive procedures, including artificial nutrition and hydration, will depend upon previously discussed care plan and the severity of the dementia. Functional assessment includes evaluation of physical, psychological, and socioeconomic domains. Proxies or patient surrogates can complete a number of these instruments when necessary (Bucks, Ashworth, Wilcock, & Siegfried,; Byrni, Wilson, Bucks, Hughes, & Wilcock,). It will also provide realistic goal setting and treatment planning information and allow early supportive interventions to be initiated (Ham,). Recommendation: Conduct and document an assessment and monitor changes in daily functioning, including feeding, bathing, dressing, mobility, toileting, continence, and ability to manage nances and medications. Assessment: Cognitive Status Cognitive status should be reassessed periodically to identify sudden changes, as well as to monitor the potential bene cial or harmful e ects of environmental changes, speci c medications, or other interventions. Proper assessment requires the use of a standardized, objective instrument that is relatively easy to use, reliable (with less variability between di erent assessors), and valid (results that would be similar to gold-standard evaluations). Expected annual rates of cognitive decline and the in uence of education and language on respondent scores vary among cognitive screening tests. Recommendation: Conduct and document an assessment and monitor changes in cognitive status using a reliable and valid instrument. It is tempting to attribute changes in function to the dementing illness, but one must be vigilant for the presence of new medical conditions such as thyroid disease (which may present as weight loss or gain) and known medical conditions such as poorly compensated heart failure, which may declare itself with a change in behavior. It is an urgent medical condition because it is o en a sign of a serious underlying medical illness, requiring comprehensive evaluation to identify the underlying cause so that prompt corrective action can be taken (McCusker et al. It is important to monitor for signs and symptoms that may indicate the presence of other comorbid disease states. Reversible causes must be sought when a patient demonstrates rapid cognitive deterioration (Fillit et al. A generic symptom such as excess drowsiness may be an indicator of medication e ect or infection, as well as the result of dementia-related disruption of the normal sleep-wake cycle. Recommendation: Conduct and document an assessment and monitor changes in comorbid medical conditions, which may present with sudden worsening in cognition, function, or as change in behavior. Assessment: Behavioral Symptoms, Psychotic Symptoms, and Depression Behavioral Symptoms.

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A third vision problem that increases with age is glaucoma blood pressure log sheet printable discount perindopril express, which is the loss of peripheral vision blood pressure limits cheap perindopril online, frequently due to a buildup of fluid in eye that damages the optic nerve arteria carotis interna cheap perindopril 8 mg with visa. As you age the pressure in the eye may increase causing damage to the optic nerve blood pressure chart for children cheap perindopril 8mg without a prescription. The exterior of the optic nerve receives input from retinal cells on the periphery, and as glaucoma progresses more and more of the peripheral visual field deteriorates toward the central field of vision. Cataracts, Macular Degeneration and Glaucoma Glaucoma is the most common cause of blindness in the U. African Americans over age 40, and everyone else over age 60 has a higher risk for glaucoma. There is no cure for glaucoma, but its rate of progression can be slowed, especially with early diagnosis. Reducing eye pressure lowers the risk of developing glaucoma or slow its progression in those who already have it. Hearing: As you read in Chapter 8, our hearing declines both in terms of the frequencies of sound we can detect, and the intensity of sound needed to hear as we age. Older adults may also notice tinnitus, a ringing, hissing, or roaring sound in the ears. The exact cause of tinnitus is unknown, although it can be related to hypertension and allergies. The incidence of both presbycusis and tinnitus increase with age and males have higher rates of both around the world (McCormak, Edmondson-Jones, Somerset, & Hall, 2016). Your balance is controlled by the brain receiving information from the shifting of hair cells in the inner ear about the position and orientation of the body. With age this function of the inner ear declines which can lead to problems with balance when sitting, standing, or moving (Martin, 2014). Taste and Smell: Our sense of taste and smell are part of our chemical sensing system. Normal taste occurs when molecules that are released by chewing food stimulate taste buds along the tongue, the roof of the mouth, and in the lining of the throat. Given that the loss of taste buds is very gradual, even in late adulthood, many people are often surprised that their loss of taste is most likely the result of a loss of smell. Our sense of smell, or olfaction, decreases more with age, and problems with the sense of smell are more common in men than in women. These cells are stimulated by two pathways; when we inhale through the nose, or via the connection between the nose and the throat when we chew and digest food. It is a problem with this second pathway that explains why some foods such as chocolate or coffee seem tasteless when we have a head cold. Touch: Research has found that with age, people may experience reduced or changed sensations of vibration, cold, heat, pressure, or pain (Martin, 2014). Many of these changes are also aligned with a number of medical conditions that are more common among the elderly, such as diabetes. The ability to detect changes in pressure have been shown to decline with age, with it being more pronounced by the 6th decade and diminishing further with advanced age (Bowden & McNelty, 2013). Yet, there is considerable variability, with almost 40% showing sensitivity that is comparable to younger adults (Thornbury & Mistretta, 1981). However, the ability to detect the roughness/smoothness or hardness/softness of an object shows no appreciable change with age (Bowden & McNulty, 2013). Those who show increasing insensitivity to pressure, temperature, or pain are at risk for injury (Martin, 2014). Pain: According to Molton and Terrill (2014), approximately 60%-75% of people over the age of 65 report at least some chronic pain, and this rate is even higher for those individuals living in nursing homes. Although the presence of pain increases with age, older adults are less sensitive to pain than younger adults (Harkins, Price, & Martinelli, 1986). Farrell (2012) looked at research studies that included neuroimaging techniques involving older people who were healthy and those who experienced a painful disorder. Results indicated that there were age-related decreases in brain volume in those structures involved in pain. Especially noteworthy were changes in the prefrontal cortex, brainstem, and hippocampus.

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