kozier & erb's fundamentals of nursing, 8e berman, snyder, kozier, erb copyright 2008 by...

Kozier & Erb's Fundamentals of Nursing, 8eBerman, Snyder, Kozier, ErbCopyright 2008 by Pearson Education, Inc.

Chapter 23

Promoting Health in

Elders

Copyright 2008 by Pearson Education, Inc.

Learning Outcomes

1. Identify the different categories of elders as they range from 65 to 100 years of age.

2. Describe the demographic, socioeconomic, ethnicity and health characteristics of elders in the U.S.

3. Describe ageism and its contribution to the development of negative stereotypes about elders.

4. Compare and contrast gerontology and geriatrics.


Learning Outcomes

5. Describe the development of gerontological nursing and the roles of the gerontological nurse.

6. Describe the different care settings for older adults.

7. List the common biological theories of aging.8. Describe the usual physical changes that occur

during older adulthood.9. List the common psychological theories about

aging.10. Describe the developmental tasks of the older

adult.


Learning Outcomes

11. Describe psychosocial changes that the older adult adjusts to during the aging process.

12. Explain changes in cognitive abilities while aging.

13. Compare and contrast Kohlberg and Gilligan’s theories of moral reasoning in elders.

14. Describe spirituality and aging.15. Describe selected health problems associated

with older adults.16. List examples of health promotion topics for

older adulthood.


Categories of Elders

• Young-old – 65 to 75 years

• Old– 75 to 85 years

• Old-old– 85 to 100 years

• Elite old– Over 100 years


Characteristics of Elders

• Demographic– Longer life spans– Fastest growing age

group is 85 years and over

• Ethnicity– Number of minority

elders increasing– Elder Hispanic fastest

growing subpopulation

• Socioeconomic– Women have longer life

expectancy– Men more likely to

remarry– Educational level

gradually increasing– Lower incomes– Most live in community

settings– Poverty level more

likely when living alone


Characteristics of Elders

• Health– Chronic health problems and disabilities

increase– 73% rate health as good, very good, or

excellent– 20% report disability and most have

chronic disease


Ageism

• Discrimination based solely on age

• Exists among some professionals

• Negative stereotypes based on myths and incorrect information

Ageism

http://socrates.berkeley.edu/~aging/ModuleAgeism.html


Gerontology and Geriatrics

• Gerontology– The study of aging and older adults– Multidisciplinary – Specialized area within various

disciplines including nursing

• Geriatrics– Associated with the medical care of the

elderly


Gerontological Nursing

• Historical development – became a subspecialty in the 1980s

• Certification through the American Nurses Association

• Advanced practice in nursing • Roles

– Provider of care– Teacher– Manager– Advocate– Research consumer

NationalGerontologicalNursing Association

http://www.ngna.org/all.php?l=home&w=1680


Care Settings for Older Adults

• Acute care facilities– Intensive care units– Emergency department– Rehabilitation

• Long-term care facilities– Assisted living– Intermediate care– Skilled care– Alzheimer’s units – Hospice– Rehabilitation

• Community– Hospice– Home health care – Nurse-run clinics – Adult day care


Biological Theories of Aging

• Wear-and-tear• Endocrine• Free-radical• Genetic• Cross-linking• Immunological theories Merck Manual

Biology of Ageing

http://www.merck.com/mrkshared/mmg/sec1/ch1/ch1d.jsp


Physical Changes

• Integumentary• Neuromuscular• Sensory-perceptual• Pulmonary• Cardiovascular• Gastrointestinal• Urinary• Genital• Immunological• Endocrine system


Integumentary Changes

• Skin dryness, pallor, fragility• Wrinkling and sagging• Age spots• Decreased perspiration• Thinning, graying of body hair• Slower growth and thickening of nails


Neuromuscular Changes

• Decreased speed and power of muscles

• Slowed reaction time• Loss of height• Loss of bone mass• Joint stiffness• Impaired balance• Greater difficulty with complex

learning/abstraction


Sensory-Perceptual Changes

• Loss of visual acuity• Increased sensitivity to glare• Decreased ability to adjust to

darkness• Arcus senilis• Presbycusis• Decreased sense of taste and smell• Increased threshold for pain, touch,

and temperature


Pulmonary Changes

• Decreased ability to expel accumulated matter

• Decreased lung expansion• Less effective exhalation• Reduced vital capacity• Increased residual volume• Dyspnea with exertion


Cardiovascular Changes

• Reduced SV and CO• Reduced elasticity• Increased rigidity of arteries• Increased SBP and DBP• Orthostatic hypotension


Gastrointestinal Changes

• Delayed swallowing time• Increased indigestion• Constipation


Urinary Changes

• Reduced filtering• Impaired renal function• Less effective concentration of urine• Urgency and frequency• Nocturia• Retention


Genital Changes

• Prostate enlargement• Atrophy of vulva, cervix, uterus,

fallopian tubes, ovaries• Reduction in vaginal secretions• Changes in vaginal flora• Changes in sexual functioning


Immunological Changes

• Decreased immune system function• Lowered resistance to infection• Poor response to immunizations• Decreased stress response


Endocrine Changes

• Increased insulin resistance


• Disengagement theory (Cumming and Henry)– Mutual withdrawal between elder and elder’s

environment

• Activity theory (Havighurst)– Best way to age is to stay physically and

mentally active

• Continuity theory (Atchley)– People maintain values, habits, and behaviors

as they age

Psychological Theories about Aging


Developmental Tasks

• Erikson– Ego integrity versus despair

• Peck– Ego differentiation versus work-role

preoccupation– Body transcendence versus body

preoccupation– Ego transcendence versus ego

preoccupation


Additional Developmental Tasks

(65-75 years)• Adjusting to

– decreasing physical strength and health– retirement – lower and fixed income– death of parents, spouses and friends– new relationships with adult children– leisure time– slower physical and cognitive responses

• Keeping active and involved • Making satisfying living arrangements


Additional Developmental Tasks

(75 years and older)• Adjusting to

– living alone– possibility of moving into a nursing home– one’s own death

• Safeguarding physical and mental health

• Remaining in touch with other family members

• Finding meaning in life


Psychosocial Changes

• Retirement• Economic change• Grandparenting• Relocation• Maintaining

independence and self-esteem

• Facing death and grieving


Cognitive Abilities

• Formal operations (Piaget)• Intellectual capacity

– Perception – ability to interpret the environment

– Cognitive agility – intelligence, problem solving, judgment, and creativity

– Memory – perception and storage– Learning – need longer


Kohlberg Theory of Moral Reasoning

• Based on concepts of justice, objectivity, and preservation of right

• Believed moral development complete in early adult years

• Does not decline with age


Gilligan Theory of Moral Reasoning

• Focused on women• Based theory on connectedness to

others and the value of relationships


Moral Reasoning

• Values and belief patterns– Influence of time period – Foreign-born or first-generation citizens– Cultural background– Life experience– Gender– Religion– Socioeconomic status


Spirituality and Aging

• Can contemplate new religious and philosophical views

• Understanding ideas missed previously or interpreted differently

• May derive sense of worth by sharing experiences or views

• Many take faith and religious practice very seriously

• Display a high level of spirituality• Importance of religion in youth


Benefits to Spirituality

• Helps resolve issues related to– Meaning of life– Adversity– Good fortune

• May be an important coping resource• May feel impoverished or despair if

not matured spiritually


• Injuries• Chronic disabling illnesses• Drug use and misuse• Alcoholism• Dementia• Elder abuse

Older AdultsSelected Health Problems


Health Promotion Topics

• Safety• Nutrition and exercise• Elimination• Social interaction


Health Promotion


ScenarioReview the scenario and then respond to the questions that follow.

Georgia is an 87 year old woman who lives by herself in the home where she and her husband raised their four children. Lately she has been feeling increasingly anxious and 'jumpy'. It is possible that it has something to do with living alone, although she has lived alone since her husband died four years ago. Georgia is having some difficulty making ends meet on her fixed income. As an example, she knows that her house needs major repairs, including a new roof, and she has no idea how she will be able to pay for these repairs.Her children have been urging her to sell the house and move to a smaller place, perhaps an apartment or a residence for independent seniors. However, she does not want to leave the neighborhood where she has lived for 45 years. Even though many of her friends in the area have died or moved away, she still feels at home there.


Scenario Continued

• Georgia is an active member of a church in her neighborhood, but she is not sure how she will be able to get there, as the city where she lives just announced that they are eliminating Sunday bus service by the end of the year. Some of her friends with cars may be willing to take her, but she is hesitant to ask as she does not want to be seen as a 'burden'.

• In response to her growing feelings of anxiety, Georgia has made an appointment with her doctor.

• Maybe he can prescribe some medication that will help her to feel calmer.


Scenario (continued)

What are the health issues faced by this individual?

Insufficient hours for family care

Culture shock

Low income



Georgia lives alone and has sufficient contact with her children.Go back and re-visit the scenario, then try again.



Georgia’s culture has not really changed over the years.

Go back and re-visit the scenario, then try again.



Georgia is on a fixed income (pension) and this maybe a problem in terms of unexpected expenses (likethe roof repair).

Go to the next slide and look at possible strategies.



Georgia may benefit from referral to a self-help/mutualaid group, or to a women’s group or senior center. Itmay be helpful to explore partnering options with her Church groups to handle household repairs and otherhandyman tasks. Support of her self esteem and promotionof her independence will be significant.


Resources• Audio Glossary• Institute for Brain Aging and Dementia Information and links for active seniors• MEDLINEplus---Health Information Information and resources on dementia• Administration on Aging Information provided by the government on aging• The National Council on Aging Links and information for senior citizens on various aging topics• AARP: American Association of Retired People AARP's official Web site


Resources

• The Jean Piaget SocietyInformation on the society of knowledge and development

• SAVE: Suicide Awareness Voices of EducationEducational links and information focusing on suicide

• CDC's National Center for HIV, STD, and TB PreventionCDC developed site dedicated to providing information on sexually transmitted diseases.

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