Cultural implications for nursing care of the Amish

The Amish are a conservative Protestant religious sect with a unique set of culture and traditions. In order to provide culturally appropriate and sensitive health care, it is imperative for nurses and other health care providers to have a basic understanding of variations of Amish lifestyle from other cultural groups. Application of Giger and Davidhizar's Transcultural Assessment Model provides information and nursing implications to assist nurses and other health care personnel when caring for Amish clients.     

Psychological assessment of the Old Order Amish: Unraveling the enigma.

Old Order Amish define their existence as "in" but not "of" the world, expressing their spirituality in a culture currently unique among Christian sects. The mental health professional--"of" the world, by definition--faces the task of providing services to a sequestered people. This article examines the needed modifications in role, to accommodate expectations of equality, and respect for the boundaries that must always exist. Little professional literature--and almost none in recent years--addresses psychological interventions with the Amish. The challenge of providing services to this population illuminates the challenge of a sequestered people, the demands of cross-cultural service, and a humbling recognition of the limitations to existing psychological techniques and research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Aging

Aging, a wearing-out process which affects everything inanimate and animate, is accelerated by abuse of decelerated by care. The psychologic reaction of aging persons vary considerably. The concept of growing older is much more satisfactory and pleasant than the concept of being old, since the former is applicable to everyone regardless of age whereas the latter carries a finite significance as deterioration progresses. Chronologic age is much less important than biologic age. The desideratum is not longevity but rather a long, useful and meaningful life. Although heredity is of importance in longevity, it is a factor over which at present we have no control. However, we can influence the aging process according to whether we care for or abuse the body. The principal factors in accelerated aging, in order of importance, are: 1) tobacco use (particularly cigarette smoking), 2) lack of exercise, and 3) obesity. Conversely, abstinence from tobacco, exercise within tolerance, and avoidance of obesity not only decelerate aging but result in a better quality of life.     

Aging and the aged in Aesopic fables

Little attempt has been made to re-assess the attitudes to aging and old age of the ancient-medieval Greek-speaking world on the basis of the literary remains (which are common to both) since Richardson (1933). There are however some collections (proverbs, sayings, "purple passages" from literature and so forth) which include material revealing attitudes which are in fact quite different from those of today and which can even be surprising. One such collection, the large number of fables which more or less conform to the genre associated with Aesop, is here analyzed to isolate the texts which have to do with aging and the attitudes they reveal. Of the surprisingly few fables which touch upon the matter, most are distinctly complimentary. In most instances the elderly are seen to increase, rather diminish, in certain powers other than physical strength. Fables are found which characterize them as being astute, intelligent, crafty, loyal and, above all, capable of giving sound advice and good leadership when the situation requires it of them. The celebrated Fable of the Tortoise and the Hare, although it was not specifically interpreted in this way in ancient times, best sums up the general attitude: that dogged persistence (the characteristic of the elderly) will ultimately prove superior to all the erratic bursts of youthful speed anytime. Hence Cicero: "Old age is more spirited than youth, and stronger!"     

Aging and the visual system

The ocular aging process involves everyone. Misconceptions about visual changes from aging versus visual changes from a disease have resulted in needless vision loss for many in the older population. Lack of understanding and misinformation may cause a delay in seeking medical attention for diagnosis and treatment.     

Aging and the adrenal cortex

Aging in humans is accompanied by an increase in adrenal glucocorticoid secretion and a decline in adrenal androgen synthesis and secretion. The intense interest in adrenal function in aging individuals in recent years is in large measure related to the potential impact of cortisol excess in the development of cognitive impairment and hippocampal neuronal loss, and to the desire to provide hormone replacement and healthy aging. Although the preliminary data is tantalizing, solid scientific evidence are not at hand. It is apparent that both issues are extremely complex. Dehydroepiandrosterone (DHEA) and its 3 beta-sulfate are fascinating molecules, including their synthesis and actions in the brain. Recent studies have shown that DHEA-sulfate (DHEA-S), but not DHEA, activates peroxisome proliferator-activated receptor alpha (PPAR alpha) in the liver, an intracellular receptor belonging to the steroid receptor superfamily. Thus, DHEA-S may serve as a physiological modulator of liver fatty acid metabolism and peroxisomal enzyme expression, and thereby may contribute to the anticarcinogenic and chemoprotective properties of this intriguing class of endogenous steroids. The life-sustaining role of adrenal cortisol secretion and its regulation of metabolism via catabolic actions may be modulated by its partner DHEA and DHEA-S. During the anabolic growth period (childhood and early adulthood) the body is exposed to relatively high levels of DHEA/DHEA-S but to relatively or absolutely high levels of cortisol during infancy and the aging phase. The cortisol/DHEA-S ratio during the life span follows a U-shape curve, which may be telling us to explore these two critical adrenal steroids in tandem.     

Aging and degeneration in the lumbar intervertebral disc

1. The maintenance of the nucleus pulposus matrix in the adult human disc is dependent on the functional integrity of the cartilage end plate cells. 2. Cartilage end plate senescence is followed by compensatory cartilaginous metaplasia of annulus fibrosus cells. 3. It is proposed that disc narrowing and collapse are related to metabolic failure of matrix production by end plate and annulus fibrosus cells. 4. Calcium pyrophosphate dihydrate crystal deposits, a visible manifestation of a metabolic abnormality, are found frequently in the annulus fibrosus and cartilage end plates of elderly patients with degenerative disc disease.     

Aging and the revelation effect.

Previous research by M. W. Prull, L. L. Light, M. E. Collett, and R. F. Kennison (1998) has shown that older adults are not susceptible to a memory illusion referred to as the revelation effect. The authors examined the robustness of Prull et al.'s findings by having participants solve a word fragment (Experiment 1) or an anagram (Experiment 2) prior to the recognition memory decision. In both experiments, younger and older adults showed a reliable revelation effect. These results simultaneously challenge both the conclusion that older adults are not vulnerable to the revelation effect and the conclusion that aging is associated with increasing susceptibility to memory illusions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Aging and the central nervous system

This review of the literature on aging and the central nervous system attempts to cover the basic perameters investigated at both human and infrahuman levels for the better part of the last century. The results have indicated that there is a rather considerable lack of consistency in the data both within the frame of reference of a single species, and with regard to intraspecies comparisons. We have suggested that possible reasons for the contradictory findings would rest upon variability in techniques employed but, perhaps more importantly, on the failure of investigators in this area to standardize terminology. It is suggested that such a standardization might well be one of the more useful things to be accomplished in order to facilitate the interpretation of future work. The literature review first dealt with gross, i.e., macroscopic changes in brain morphology that could correlate with age, and then covered changes at the microscopic level. Finally, a brief review of the literature with regard to the biochemistry of aging was carried out. Implications of the data were noted where appropriate.     

The Amish way of death: A study of family support systems.

Discusses the fact that coping with death is becoming increasingly difficult in society today. Science and technology have replaced belief and ritual, most deaths take place in institutional settings rather than in the home, and the high rate of mobility of the nuclear family lessens the opportunities for experiencing life and death within an extended-network support system. The author considers that the centrality of the family in Amish society and the unchanged function of the family unit present a rare opportunity to study relational support systems that have been successful in coping with death for the past 400 yrs. 24 Amish families were interviewed in 5 areas: family structure, group structure, funeral customs and rituals of mourning, personal experience with death, and personal feelings about death. Implications are presented for psychosocial issues in contemporary society in terms of improving the quality of life and death for the dying, their families, and the professionals involved in their care. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Aging alters zonation in the adrenal cortex of men

Whereas aging has been shown to be associated with striking reductions in circulating levels of adrenal androgens in humans, the alteration in adrenal function that occurs in aging has not been identified. We sought to determine if there are changes in the zonation of the adrenal in aging men by performing histomorphologic analyses of adrenal specimens that had been obtained at autopsy following sudden death due to trauma. We evaluated adrenals from 21 young men (20-29 yrs) and 12 older men (54-90 yrs); inclusion criteria required the presence of medullary tissue in the specimen and fixation within the first 24 hrs postmortem. Sections stained with H/E were examined microscopically and areas of the cortex that included adjacent medullary tissue were chosen for quantitative evaluation by use of a computerized image analysis system. The average width (arbitrary units, pixels) of the zona reticularis and that of the combined zonae fasciculata/glomerulosa were determined from sections stained for reticulum fibers. The zona reticularis represented 37.1 +/- 1.9% of the total cortical width in the young men, which was significantly greater than that of the older men (27.1 +/- 3.3%, P = 0.0082). The zona fasciculata/glomerulosa to zona reticularis ratio in the young men (1.84 +/- 0.15) was significantly less that that of the older men (3.29 +/- 0.47, P = 0.0011). There was no significant difference in the total width of the cortex in young compared to older men. These data suggest that aging results in alterations within the cortex of the adrenals in men such that there is a reduction in the size of the zona reticularis and a relative increase in the outer cortical zones. A reduced mass of the zona reticularis could be responsible for the diminished production of dehydroepiandrosterone and dehydroepiandrosterone sulfate that occurs during aging.     

Aging and mitochondria

Aging is a complex physiological phenomenon and several different theories have been elaborated about its origin. Among such theories, the 'mitochondrial theory of aging', which has gained a large support, indicates the accumulation of somatic mutations of mitochondrial DNA leading to the decline of mitochondrial functionality as one of the driving forces for the process itself. In this review data on rat and man from our laboratory and from recent literature have been thoroughly examined and compared in order to provide the 'state-of-the-art' on the role of mitochondria in aging. Alterations of structure and expression of mitochondrial genome with aging, to find out the eventual relevant changes of mitochondrial biogenesis, have been studied in rat whereas the relationship between cytochrome c oxidase activity and 'common deletion' has been studied in man. Results on the effect of acetyl-L-carnitine on the mitochondrial functionality are also reported.