psychological changes

Psychological changesPsychological changes

Prepared by:Prepared by:Dr. Soad HassanDr. Soad Hassan

Lecturer of Gerontological Lecturer of Gerontological Nursing Nursing

2217/4/201117/4/2011 Dr Soad HassanDr Soad Hassan

Most elderly people seems to be most vulnerable to psychological dysfunction when they experience change.

Affective function refers to the mood, emotions (such as happiness, sadness, fear, pain, anger, and confusion).

Cognitive function refers to memory, learning, and intelligence.

Cognitive and affective functioning affects the person’s self-esteem.


It is influenced by the way an individual It is influenced by the way an individual views the world and self. views the world and self.

A positive view of self and surrounding A positive view of self and surrounding environment promotes positive expression environment promotes positive expression of mood and emotions.of mood and emotions.

Affective functioningAffective functioning


11 - -SelfSelf--esteemesteem

It is the way a person views himself/herself. It is the way a person views himself/herself.

A positive view of self promotes health and A positive view of self promotes health and enables the person to cope better with the enables the person to cope better with the changes and challenges of growing older.changes and challenges of growing older.


Age related changes.Age related changes.losses that occur with aging losses that occur with aging Chronic diseases.Chronic diseases. Increased dependency .Increased dependency .Function impairment.Function impairment.Lack of control over the person environment Lack of control over the person environment

Factors contribute to a decreased in Factors contribute to a decreased in self-esteemself-esteem


22 - -PersonalityPersonality

The basic personality does not change as a The basic personality does not change as a result of aging process.result of aging process.

The personality will be consistent with that The personality will be consistent with that of earlier years.of earlier years.


33 - -DepressionDepressionDepression occurs 16-65% Depression occurs 16-65% of elders living in the of elders living in the community. community.

Depression including: sleep Depression including: sleep disturbance, lake of interest, disturbance, lake of interest, feelings of guilt, lack of feelings of guilt, lack of energy, decreased energy, decreased concentration and, loss of concentration and, loss of appetite.appetite.

Losses can lead to Losses can lead to depressiondepression..


Cognitive functioningCognitive functioning

Intelligent, learning, attention Intelligent, learning, attention and memory are all related to and memory are all related to cognitive functioning and how well cognitive functioning and how well the mind is able to reason and make the mind is able to reason and make sound judgments.sound judgments.


11 - -IntelligentIntelligentIntelligent is a mental alertness and includes Intelligent is a mental alertness and includes the ability to learn new material, make wise the ability to learn new material, make wise decisions, and deal with stressful situation.decisions, and deal with stressful situation.

Intelligent does not become less with age. Intelligent does not become less with age.

IQ test performance of older adults may be IQ test performance of older adults may be hindered because of sensory deficits or the hindered because of sensory deficits or the stress of being tested. These factors must be stress of being tested. These factors must be considered when assessingconsidered when assessing


22 - -MemoryMemoryRecent memory is defined as a recall of items Recent memory is defined as a recall of items learned more than a few minutes earlier, e.g. the learned more than a few minutes earlier, e.g. the day's new events, what was eaten for breakfast, the day's new events, what was eaten for breakfast, the date. Recent memory generally declines with age. date. Recent memory generally declines with age.

Remote memory is defined as a recall of items Remote memory is defined as a recall of items learned many years earlier, e.g. the dates of wars, learned many years earlier, e.g. the dates of wars, names of presidents, remote memory does not names of presidents, remote memory does not experience significant change with age.experience significant change with age.


3- Learning3- LearningLearning is the acquisition of new knowledge or Learning is the acquisition of new knowledge or skills.skills.

The ability of the mind to learn and retain new The ability of the mind to learn and retain new information remains unaltered, particularly when information remains unaltered, particularly when mind is stimulated through regular use.mind is stimulated through regular use.

The ability to solve complex problems decline The ability to solve complex problems decline with age.with age.

Hearing and visual deficits related to aging Hearing and visual deficits related to aging process can affect learning. process can affect learning.


44 - -Attention spanAttention spanThere is decrease in vigilance performance.There is decrease in vigilance performance.

Vigilance performance is the ability to retain Vigilance performance is the ability to retain attention longer than 45 minutes. attention longer than 45 minutes.

The elderly is more liable to distract (divert) The elderly is more liable to distract (divert) attention by irrelevant information and stimuli.attention by irrelevant information and stimuli.

Deficits in attention may affect learning and Deficits in attention may affect learning and memory.memory.


Social ChangesSocial Changes


The social changes that come with life are The social changes that come with life are change in life style, loss of other family change in life style, loss of other family members, neighbors and friends. members, neighbors and friends.

The main social problems, which confront The main social problems, which confront elderly persons, are:elderly persons, are:

- social isolation- social isolation - finance- finance - loneliness- loneliness - rejection and loss of purpose in life.- rejection and loss of purpose in life. - deterioration in housing standard and - deterioration in housing standard and

poor nutritional level. poor nutritional level.


11--RetirementRetirementA change in work role comes with retirement. A change in work role comes with retirement.

It changes the way time is managed and daily It changes the way time is managed and daily activities are carried out.activities are carried out.

Retirement alters identity, status, financial Retirement alters identity, status, financial problem, lack of self-satisfaction and self-problem, lack of self-satisfaction and self-esteem and sometimes friendships.esteem and sometimes friendships.


A common event that alters family life for the A common event that alters family life for the aged is the death of a spouse.aged is the death of a spouse.

The spousal role composed of many sub roles, The spousal role composed of many sub roles, such as companion, sexual partner, confidante, such as companion, sexual partner, confidante, cook, house-keeping, and care provider.cook, house-keeping, and care provider.

Loss of spouse is a highly stressful experience. Loss of spouse is a highly stressful experience. Death of a spouse affects more women than men Death of a spouse affects more women than men because most older men will marry again .because most older men will marry again .

22 - -WidowhoodWidowhood


33 - -LonelinessLonelinessLoneliness is the feeling of emotional Loneliness is the feeling of emotional isolation, being locked inside oneself and isolation, being locked inside oneself and unable to obtain the warmth and comfort unable to obtain the warmth and comfort from others. from others.

Any loss that creates a deficit in intimacy Any loss that creates a deficit in intimacy and inner personal relationships can lead to and inner personal relationships can lead to loneliness. loneliness.


44 - -Role change Role change ((role reversalrole reversal))

Numerous role changes occur with the Numerous role changes occur with the aging process, but the transitions expected aging process, but the transitions expected by most elders are related to the work role by most elders are related to the work role and the role of spouse or partner. and the role of spouse or partner.


55 - -Multiple lossesMultiple losses

Aging is associated with major physical, Aging is associated with major physical, psychological and sociologic losses as well psychological and sociologic losses as well as a reduced ability to adapt and compensate as a reduced ability to adapt and compensate for stressors.for stressors.


Examples of some lossesExamples of some lossesLoss of job (retirement)Loss of job (retirement)Loss of status Loss of status Change roleChange roleLoss related to normal age-related changesLoss related to normal age-related changesDecreased incomeDecreased incomeIncrease expenditure on medical servicesIncrease expenditure on medical servicesLoss of significant personLoss of significant personLoss of housingLoss of housingDecreased the ability to adapt and compensate for Decreased the ability to adapt and compensate for stressorsstressorsLimitations impose as a result of multiple chronic Limitations impose as a result of multiple chronic diseasesdiseases


Awareness of MortalityAwareness of MortalityWidowhood, death of friends, and the Widowhood, death of friends, and the recognition of declining functions make older recognition of declining functions make older person more aware of the reality of their own person more aware of the reality of their own death.death.

Attitudes about death vary with aging.Attitudes about death vary with aging.

The elderly tend to think and talk about death, The elderly tend to think and talk about death, but they find the prospect of death less but they find the prospect of death less frightening.frightening.


Psychosocial problemsPsychosocial problems

Poor adjustment to role Poor adjustment to role changeschangesPoor adjustment to Poor adjustment to lifestyle changeslifestyle changesFamily relationship Family relationship problemsproblemsGriefGriefLow self-esteemLow self-esteemAnxiety and depressionAnxiety and depressionAggressive behaviorAggressive behavior

LonelinessLonelinessIsolationIsolationProblems with sexualityProblems with sexualityElderly abuseElderly abuseWithdrawing and Withdrawing and having a negative having a negative attitude toward life in attitude toward life in generalgeneral


Developmental tasks needed for Developmental tasks needed for successful agingsuccessful aging

1.1. Adjusting to declining health and physical strength.Adjusting to declining health and physical strength.

2.2. Adjusting to retirement and reduce incomeAdjusting to retirement and reduce income3.3. Adjusting to death of a spouse.Adjusting to death of a spouse.4.4. Establish associations with others in the same Establish associations with others in the same

age.age.5.5. Maintaining a satisfactory living arrangement.Maintaining a satisfactory living arrangement.6.6. Adapting to changes in social roles.Adapting to changes in social roles.


Role of the gerontological nurse to Role of the gerontological nurse to promote psychosocial adaptationpromote psychosocial adaptation

1.1. The psychosocial The psychosocial assessment is an assessment is an essential essential component of the component of the overall health overall health assessmentassessment


2- 2- Nursing intervention to enhance mental Nursing intervention to enhance mental alertnessalertness

Allow the client to do as many tasks for himself as Allow the client to do as many tasks for himself as possible.possible.

Encourage use of the mind in problem solving.Encourage use of the mind in problem solving.

Encourage use of numbers and calculations. Encourage use of numbers and calculations.

Encourage creative activities (e.g. painting, story Encourage creative activities (e.g. painting, story telling).telling).

Encourage the discovery of new talents and abilities.Encourage the discovery of new talents and abilities.


3- 3- Nursing intervention when caring for a client with a shortNursing intervention when caring for a client with a short--term term memory lossmemory loss

Identify yourself each time there is an interaction with the client.Identify yourself each time there is an interaction with the client.

Give instructions in simple, direct terms.Give instructions in simple, direct terms.

Repeat instructions several times.Repeat instructions several times.

Explain every thing that is happening, even if the client does not Explain every thing that is happening, even if the client does not seem to understand.seem to understand.

Perform only one activity at a time.Perform only one activity at a time.

Report any sudden confusion. Report any sudden confusion.


4- Nursing intervention when teaching an older 4- Nursing intervention when teaching an older person new informationperson new information

Assess current knowledge. Assess current knowledge. Evaluate for any visual or hearing deficit. Make Evaluate for any visual or hearing deficit. Make sure the hearing aid is working or glasses are sure the hearing aid is working or glasses are available, if indicated.available, if indicated.Determine the person's ability to learn.Determine the person's ability to learn.Identify any language barrier.Identify any language barrier.Determine if the information to be taught is Determine if the information to be taught is thought to be important or relevant to the thought to be important or relevant to the elderly person.elderly person.


Begin by reviewing familiar information and Begin by reviewing familiar information and then more to new information.then more to new information.Teach the spouse or family member as well as Teach the spouse or family member as well as the elderly person if possible.the elderly person if possible.Plan teaching over several days, with small Plan teaching over several days, with small increments of information presented at one increments of information presented at one time.time.Actively involve the client in the learning Actively involve the client in the learning process.process.Allow time for feed back to evaluate knowledge Allow time for feed back to evaluate knowledge


55 - -Nursing role to increased self-esteemNursing role to increased self-esteemDevelop a trusting relationshipDevelop a trusting relationship

Treat the elderly with dignity and respectTreat the elderly with dignity and respect

Allow sufficient time for the performance Allow sufficient time for the performance of daily activities of self-careof daily activities of self-care

Encourage verbalizationEncourage verbalization

Practice active listeningPractice active listening


Give positive reinforcement for progress.Give positive reinforcement for progress.

Use reminiscence therapy (encourage the Use reminiscence therapy (encourage the elderly to recall or remember past events). elderly to recall or remember past events).

Be alert for opportunities to include the patient Be alert for opportunities to include the patient in decision making.in decision making.

Use verbal and non verbal communication Use verbal and non verbal communication

Encourage socializationEncourage socialization..


66 - -Nursing intervention that foster positive Nursing intervention that foster positive personality traits in elderlypersonality traits in elderly

Accept the elderly.Accept the elderly. Identify the positive characteristic of each Identify the positive characteristic of each

elderly.elderly. Encourage verbalization.Encourage verbalization. Reward positive behavior.Reward positive behavior. Avoid a judgmental attitude.Avoid a judgmental attitude.


7- Adjusting to retirement It is easier if activities that will It is easier if activities that will

become prominent after retirement are become prominent after retirement are begun during the working years. begun during the working years.

Therefore, adjustments to retirement are Therefore, adjustments to retirement are influenced by pre-retirement plan and influenced by pre-retirement plan and engaging in other activities before engaging in other activities before withdrawing completely from their work.withdrawing completely from their work.


9- Find a new role9- Find a new role Such as a grandparent role. The Such as a grandparent role. The

grandparent role is generally one that grandparent role is generally one that brings great satisfaction and brings great satisfaction and contentmentcontentment. .


10- Facilitating maximum independence

Make sure that the person has access to all necessary Make sure that the person has access to all necessary assistive devices and personal accessories.assistive devices and personal accessories.

Allow enough time for the person to perform tasks at Allow enough time for the person to perform tasks at her or his own place her or his own place

Make sure that the environment has been adapted as Make sure that the environment has been adapted as much as possible to compensate for sensory losses and much as possible to compensate for sensory losses and other functional impairments.other functional impairments.


11- Intervention that promotes social support

Use interventions to deal with hearing Use interventions to deal with hearing impairments and other communication barriers.impairments and other communication barriers.Encourage participation in group activities.Encourage participation in group activities.For people in wheelchairs, especially those who For people in wheelchairs, especially those who cannot move independently, position the chairs cannot move independently, position the chairs in a way that promotes social interaction.in a way that promotes social interaction.For nursing home residents, plan tables and For nursing home residents, plan tables and room arrangements in such a way that social room arrangements in such a way that social relationships are fostered relationships are fostered


Thank you Thank you

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