Gerontology

Homesharing

Two or more people may share an apartment or house. Each person usually has a private bedroom and shares the other living spaces. These homes may be sponsored by faith-based groups or community agencies.

Physical Changes in the Middle Adult

Visual acuity diminishes, especially for near vision (presbyopia).

D

Vitamin ____ is considered moderately beneficial for helping prevent hip fractures and other broken bones in older adults

gerontology

study of all aspects of the aging process and their consequences

Senior retirement communities

A grouping of rental apartments or houses for residents who can take care of themselves and are mobile. Meals may be available in a central dining room, and housekeeping services may be offered (at additional cost). Social and recreational activities are usually offered.

NORC

A growing senior population in one community formed a new association called ______________. This collaboration necessitated the hiring of a geriatric care manager who helped the residents negotiate the health care system and enabled them to remain in their homes. In this setting, tasks are shared based on the abilities of their members

Accessory apartments

A separate apartment is constructed in part of an existing house, such as a basement or attic. This allows older adults to live independently and privately while not being alone.

objectively

A victim may deny abuse or choose not to report it because of shame, fear of abandonment, worry about retaliation, or dementia. All assessment data should be _____________ documented, including direct quotes from both parties

Kohlberg

According to ________________ , a middle adult may either remain at the conventional level or move to the postconventional level of moral development, especially if the individual has had sustained responsibility for the welfare of others and has consistently applied ethical principles developed in adolescence. At this level, the adult believes that the rights of others take precedence and takes steps to support those rights.

retirement

Affiliation with others of the same age allows older adults to share common interests and concerns and to find status among their peers. Some adults reside in ____________ communities that provide a multitude of opportunities for social engagement. It should not be assumed, however, that older adults want to associate only with others their age

empty nest syndrome

Although much has been written about the ________________ that occurs when the last child leaves home, most middle-aged parents welcome the increased space, time, and independence they have when active parenting ceases. As their involvement with and responsibility for children decrease, they may have an increased need to help care for aging parents and other family members. The physical aging or death of a parent makes one's own aging and inevitable death a reality.

disengagement theory

An early psychosocial theory, called the ___________________, maintained that older adults often withdraw from usual roles and become more introspective and self-focused. This withdrawal was theorized as intrinsic and inevitable, necessary for successful aging, and beneficial for both the person and for society

cane

An older adult is at high risk for accidents and falls and may need to curtail driving or use a _________ or other aid to remain mobile.

delirium

An older adult may also become confused when too many changes or losses occur at one time or when moved to a different environment. As many as 87% of critically ill older patients in an intensive care unit (ICU) setting experience an episode of __________ during a hospitalization

4%

Approximately ______ of older adults live in an institutional setting, but this number increases dramatically with more advanced age. Some people, however, choose to move for convenience, social relationships, or needed health care.

transcendence

As a person ages, spirituality and ______________ are a resource and a source of strength when faced with inevitable change and loss.

increases

As the number of older drivers______________, so do the challenges to promote safe driving and find alternatives to driving

Myth

Bladder problems are a problem of aging.

Genitourinary

Blood flow to the kidneys decreases with diminished cardiac output. The number of functioning nephron units decreases by 50%; waste products may be filtered and excreted more slowly. Fluids and electrolytes remain within normal ranges, but the balance is fragile. Bladder capacity decreases by 50%. Voiding becomes more frequent; two or three times a night is usual. A decrease in bladder and sphincter muscle control may result in stress incontinence or incomplete bladder emptying. About 75% of men over 65 years of age experience hypertrophy of the prostate gland; surgery may be required if urinary retention occurs. The older woman's genital tract experiences atrophy, decrease of secretions, and thinning.

Cardiopulmonary

Blood vessels become less elastic and often rigid and tortuous. Venous return becomes less efficient. Fatty plaque deposits continue to occur in the linings of the blood vessels. Lower-extremity edema and cooling may occur, particularly with decreased mobility. Peripheral pulses are not always palpable. Orthostatic hypotension can occur. The body is less able to increase heart rate and cardiac output with activity. Pulmonary elasticity and ciliary action decrease, so that clearing of the lungs becomes less efficient. Respiratory rate may increase, accompanied by diminished depth.

Breast cancer

Breast self-examination each month Breast clinical examination every 3 years to age 40, then every year Mammogram every year beginning age 40

Home modification

By making changes, older adults may be able to stay in their own homes. Examples of modifications are replacing doorknobs with handles, replacing faucet handles with levers, and installing grab bars in bathtubs.

Physical Changes in the Middle Adult

Cardiac output begins to decrease.

caregiver

Careful observation of the relationship between the older adult and the _____________ may be the first evidence that the older adult is a victim of abuse. Pay attention to interactions involving voice tone, caring behaviors, and personal touch. If you suspect abuse, attempt to speak to the older adult in a private setting away from the caregiver.

infection

Confusion and cognitive impairment in an older adult should be viewed not as a normal consequence of aging but instead in relation to an acute problem such as ________________ or polypharmacy

Musculoskeletal

Decreases in subcutaneous tissue and weight commonly are found in the old-old. Muscle mass and strength decrease. Bone demineralization occurs; bones become porous and brittle. Fracture is more common. Joints tend to stiffen and lose flexibility, and range of motion may decrease. Overall mobility commonly slows, and posture tends to stoop. Height may decrease 1 to 3 inches.

pain

Delirium, sleep disturbances, cognitive changes, and diminished functional abilities may result when ________ is not managed adequately

65

Depression usually does not resolve without treatment and is frequently underdiagnosed. About 14% of people over the age of ____ experience significant periods of depression

Gastrointestinal

Digestive juices continue to diminish, and nutrient absorption decreases. Malnutrition and anemia become more common. With reduced muscle tone and decreased peristalsis, constipation and indigestion are common complaints. Diminished saliva production leads to dry mouth problems.

Special Senses

Diminished visual acuity (presbyopia) occurs, with increased sensitivity to glare, decreased ability to adjust to darkness, decreased accommodation, decreased depth perception, and decreased color discrimination. Cataracts may further obscure vision. Difficulty reading small print might result. Daytime or night driving might be compromised. Diminished hearing acuity (presbycusis) occurs, particularly diminished pitch discrimination in the presence of environmental noises. Cerumen buildup is common. As a result of hearing problems, the older adult may withdraw from social events. The senses of taste and smell are decreased. Sweet and salty tastes diminish first. Sensitivity to odors might be reduced. Problems with nutrition may result.

lifestyle

Dissatisfaction with not achieving career or family goals contributes to the stresses placed on the marriage. Extramarital affairs and divorce may result. Loss of a spouse or partner is more likely in the middle adult years. The loss is a major crisis and a threat to one's self-concept, as well as a major role change. Many changes may occur, including a reduced income, changes in __________ and social relationships, and the need for help to work through the loss and grief

health promotion activities

Eat a diet low in fat and cholesterol, including fruits, vegetables, and fiber; use sugar, salt, and sodium in moderation. Make regular exercise a part of life. Drink alcohol in moderation, if at all. Do not smoke.

80

Elder abuse most commonly occurs in women over _____ years of age. Physical abuse, sexual abuse, emotional or psychological abuse, neglect, abandonment, and financial or material exploitation are all types of elder maltreatment

Physical examination

Every 3 years to age 40 Every year from age 40 The Affordable Care Act provides free annual wellness visits for people enrolled in Medicare.

Oral cancer

Every year as part of medical or dental checkups

depression

Extreme or prolonged sadness in an older adult may be a warning sign of ________________. Death of a spouse or friends and changes in living environment and financial resources can precipitate feelings of _______________. There is usually a distinct change of behavior accompanied by other specific signs and symptoms of ______________, such as sleep disturbances, weight loss, difficulty with concentration, and suicidal thoughts or preoccupation with death

Vision

Eye examination, with a test for glaucoma, every year

traumatic brain injury

Falls may result in a _________________ (TBI), which accounts for 46% of fatal falls among older adults

psychological

Family members must also adapt to ______________ stressors such as changes in communications, changes in roles (e.g., an older mother becomes dependent), and changes in their own lifestyle as they become the caregivers.

symptoms

Family members must learn how to cope with the needs of the ill person. Included are personal hygiene, medication administration, special diets, elimination, activities of daily living, and recognition of ____________ that necessitate medical attention.

Physical Changes in the Middle Adult

Fatigue increases.

Physical Changes in the Middle Adult

Fatty tissue is redistributed; men tend to develop abdominal fat, women thicken through the middle.

Colorectal cancer

Fecal occult blood test every year Digital rectal examination (DRE) every year Flexible sigmoidoscopy every 3-5 years, or Colonoscopy with follow-up every 3-5 years depending on size of polyps start test for men and women at age 50

self reliant

Functional health includes a person's ability to remain _____________, to "make do," and to maintain a sense of independence and control over oneself and one's environment

Physical Changes in the Middle Adult

Gray hair appears, and men may lose hair on the head.

Physical Changes in the Middle Adult

Hearing acuity diminishes, especially for high-pitched sounds.

Physical Changes in the Middle Adult

Hormone production decreases, resulting in menopause or andropause.

long term care

Hospitalization costs continue to rise, and the price of high-quality, ______________ may well be beyond the patient's or family members' ability to pay.

emotional

If the older adult is chronically ill or cognitively impaired, the family caregivers face the need for daily caregiving, lack of freedom, and _____________ stress. When a person moves to a long-term care facility, the loss of one's home and possessions and the need to conform to the routines of institutional living can be traumatic for the person and family.

life review

In a sense, this is a way for an older adult to relive and restructure life experiences and is part of achieving ego integrity.Nurses can also use __________________ as a therapy to facilitate adaptation to present circumstances.

less

In older adults, all organ systems undergo some degree of decline in overall functioning, and the body becomes _________ efficient.

delirium

Incidences of postoperative ______________ are more likely to occur with extended ICU stays and increased use of ventilators, increasing the risk of death

cognitive

Long-term memory usually remains intact. Dementia, Alzheimer disease, depression, and delirium might occur and cause __________ impairment

aerobic

Make exercise a part of daily activities. Multiple studies have demonstrated that regular ____________ exercise can reduce the risk for dementia and that resistance training may improve cognition

not true

Many people fear advancing age because of pervasive views that older people are poor, lonely, in frail health, and headed for institutionalization in a long-term care facility. These descriptors are _____________ for most older adults

self actualization

Maslow, in his hierarchy of human needs, describes the level of _______________ as the desire to become the most that one can be. A ___________________ person has realistic perceptions of self, is a problem solver, is usually spontaneous, needs time to focus on one's own individual potential, and views the world with a sense of appreciation.

herbal

Medication costs related to chronic illness typically continue for the rest of a person's life, with multiple medications being the rule rather than the exception. Polypharmacy, the use of many medications at the same time, can pose many hazards for older adults. Complicated regimens need careful review to minimize risks and complications and maximize benefits. Alternative therapies such as _________ remedies have the potential to interact with prescribed drugs and cause dangerous effects

difficult

Meeting the expenses of health care is often __________ for older adults and their families.

andropause

Men do not experience physical symptoms from the decreased levels of hormones, called _____________. Androgen levels diminish slowly; the man may have some loss of sexual potency but is still capable of reproduction.

slower

Middle adults are subject to physical and emotional health problems associated with lifestyle behaviors, developmental or situational crises, family history, and the environment. Both acute and chronic illnesses are more likely to occur, and recovery takes longer. This is a result of ____________ and more prolonged responses to stressors, more pronounced reactions to an illness, and the possibility of more than one illness being present at a time.

obesity and atherosclerosis

Middle adults tend to maintain previous eating patterns and caloric intake while being less physically active. This trend can result in _______________ and _________________ , with an increased risk for high blood pressure, coronary artery disease, renal failure, and diabetes.

healthy

Middle age does not automatically result in physical or emotional health problems. Many men and women remain _______________ throughout their lives, but knowing preventive health care practices and their special needs at this age can help middle adults have improved quality and quantity of life.

sandwich generation

Middle-aged adults may be caught in a _________________ Their children may be independent and married, with children of their own, or may be recent college graduates who have returned home to live. Difficulty finding employment coupled with the burden of student loans often necessitates the postponement of independent living.

schedules

Mild short-term (recent) memory loss is common but can be remedied by an older adult using notes, __________ , and calendars

Myth

Most older adults are isolated and lonely.

3/4, 1/3

Most older adults are satisfied with their lives, finding retirement and old age more enjoyable than they had anticipated. _________live in their own homes, __________ of these live alone. Most older adults maintain close ties with their families and have incomes above the poverty leve

Myth

Most older adults are sick.

daytime sleepiness

Most older adults gradually modify their lifestyle to accommodate for declining strength and health. They rest more frequently, although continued activity and exercise are important for maintaining all physiologic functions. The potential with this age group for sleep disorders accompanied by _____________________ contributes to slower response time, impaired memory, and behavior that may be mistaken for some form of cognitive impairment.

Myth

Most older adults live in long-term care facilities.

spouse

Most older adults prefer to live in their own home and find it difficult to move. Over half of this population lives with a __________ or partner, but this number decreases with increasing age and the death of the significant other

community

Most older people are not impaired but are functional in the _____________, thereby benefiting from health-oriented interventions.

self identity

Most theorists agree that a person's self-concept is relatively stable throughout adult life. An older adult who has a strong sense of ____________ and has successfully met challenges earlier in life will probably continue to do so. This person substitutes new roles for old roles and perhaps continues former roles in a new context. For example, business managers after retirement may continue to use their leadership talents in community or volunteer organizations.

65

Moving in with adult children creates changes in roles and authority. In 2010, approximately 1.94 million grandparents over the age of _____ lived in a home with a grandchild

Physical Changes in the Middle Adult

Muscle mass, strength, and agility gradually decrease.

passive

Neglect accounts for more than half of all elder maltreatment reports made to adult protective service agencies. It can be active or ___________ and occurs when a caregiver fails to adequately meet the physical, social, or emotional needs of an older adult, resulting in harm to that person.

sandwiched

Not all families can assist an aged member satisfactorily because of geographic distance, low income, poor health, strained marital relationships, or infringement on career or lifestyle. Adult children may feel _______________ between responsibilities for their own children and careers and the needs of older parents. It can be a guilt-ridden and emotionally draining time for all involved when an older adult's physical or emotional illness reverses roles (with the child now assuming the role of parent, while the parent becomes dependent as the "child") and strains family resources.

Myth

Old age begins at 65 years of age.

Myth

Old age means mental deterioration.

lower

Older adults are frequently prescribed ________ doses of opioid analgesics than younger adults, and poor clinical outcomes can result

Myth

Older adults are not interested in sex.

Myth

Older adults do not deserve aggressive treatment for serious illnesses.

Myth

Older adults don't care how they look.

health care

Older adults use more _________________ than any other age group. The health care costs for those older adults with no chronic conditions averaged $5500 yearly but rise to $24,500 per year for older adults with five or more conditions

regaining

Older adults with reduced income may live in inadequate housing in neighborhoods with heavy traffic or high crime rates. They may be isolated from family members, and many live alone. Combined with the normal changes of aging and the effects of any illness, older people not only are at increased risk but also have a more difficult time ______________ health after an injury

socioeconomic

Older people are more vulnerable to physical, emotional, and ______________ problems than people in other age groups and may require special attention to health promotion and maintenance.

rigid

Older people may be incorrectly viewed as being ________ or narrow-minded, unable to learn, unreliable because of memory loss, too old to enjoy sexual pleasure, or child-like and dependent.

Obesity and depression

Other major health problems in the middle ages include rheumatoid arthritis, ____________, alcoholism, and ____________.

Cervical cancer

Pelvic examination with Papanicolaou (Pap) exam at least every 3 years Women who have had a total hysterectomy (removal of the uterus and cervix) do not need cervical cancer screening, unless the surgery was for cervical precancer or cancer. Women over age 65 to 70 with at least 3 normal Pap tests and no abnormal Pap tests in the last 10 years should consult with their health care provider about continuing cervical cancer screening.

dementia

People with ______________ are hospitalized more frequently than other older adults. The precipitating factor may be a medical-surgical problem or behavioral or psychiatric symptoms that occur with ______________.

neglect

Poor hygiene, inadequate nutrition, untreated injuries, and lack of assistance with care needs are indicators of __________.

General Status

Progressively decreasing efficiency of physiologic processes results in a fragile balance and hinders the body's ability to maintain homeostasis. Physical or emotional stressors cause the older adult to be more vulnerable because of decreased physiologic reserves. The older adult may continue to engage in all activities of middle age but intuitively adjusts to a modified pace and more frequent rest periods.

Prostate exam

Prostate-specific antigen (PSA) test every year (some advisory groups now do not recommend an annual PSA because results may be misleading; schedule should be discussed with physician) Digital rectal examination (DRE) every year Begin at age 45 if African American or a family history of prostate cancer. Screening is individualized based on health care provider and the person's concerns. start exam at age 50

vitamin D

Recommendations for prevention of falls in older adults now include an exercise component and ______________ supplementation. The U.S. Preventive Services Task Force recently reviewed the evidence and identified those interventions as effective in helping prevent falls in community-dwelling older adults

adaptability

Research has shown that most older adults do adjust and adapt to new roles, and most are satisfied with their lives and with what they have. Depending on the older adult's _________________ and supportive resources, older adulthood may be a time of happiness, peace, and understanding or of sorrow, conflict, and confusion.

income

Retirement brings a change in a person's concept of time. Many older adults must learn to occupy their leisure time in ways that maintain their self-esteem while being personally satisfying. Satisfaction with retirement is closely tied to __________ and the relationships one has outside of work. While many older adults have adequate retirement income, for others a lack of adequate income can affect their ability to meet their needs, such as for medical care and housing or social and creative interests.

respite

Retirement centers and senior citizens' housing have become common. For the family members of older adults who need health care, alternative methods of care have become available. Examples include _________ care facilities, which allow the family a needed rest by temporarily housing and caring for an ailing older family member, and daycare centers, which provide a safe, stimulating environment during the day when family caregivers must work. Nurses should be knowledgeable about what health care and social services are available in the patient's community so that the patient and family can be referred.

Fulmer SPICES tool

S - Sleep disorders P - Problems with eating or feeding I - Incontinence C - Confusion E - Evidence of falls S - Skin breakdown

Skin cancer

Self-examination every month Clinical skin examination every year

friends

Significant others, such as close __________ and neighbors, may also take on tasks formerly assumed to be the responsibilities of the traditional family.

Adult group homes

Smaller in scale than assisted-living facilities, these services provide a room, meals, and help with daily activities. They may be licensed or unlicensed. Costs average $33,000 per year for a private room; Supplemental Security Income (SSI) will help pay for those with very limited incomes.

E

Some authorities believe that nutrition plays an important role in maintaining the immune response; therefore, there is much interest in vitamin supplements (such as vitamin _____ ) that are believed by some to improve immune function.

family members

Some estimate that as many as two million people older than 65 years of age suffer from abuse, neglect, or exploitation that is inflicted by _________________ in 90% of cases. It is difficult to determine an accurate number of elder maltreatment incidents because 84% of elder abuse cases are never reported

economic

Special diets, special equipment, and medical supplies increase ______________ difficulties

Testicular cancer

Testicular self-examination every month

Immunizations

Tetanus, diphtheria (Td) or Tdap: 1-dose booster every 10 years of either Td or Tdap; Tdap recommended for adults 65 and older if in contact with a child <12 months of age Influenza: 1 dose every year Pneumococcal polysaccharide vaccine (PPV): 1 dose every year up to age 64 for those with medical indications; 1 dose for those unvaccinated by age 65, or who received the first dose more than 5 years previously (before age 65) Zoster vaccine, live (Zostavax): Recommended for adults 60 years and older to prevent herpes zoster (shingles)

Assisted living

The ability to function safely and independently at home depends a great deal on one's functional health, transportation, income, and family. An older adult, for example, may need assistance with home repairs, house cleaning, or grocery shopping. Architectural barriers, such as steps, may need to be modified. Easy access to medical and recreational facilities and churches may become more important. Many older adults in poor health can continue living at home with some assistance from visiting nurses or with the aid of other services, such as home-delivered meals and senior transportation. __________________ housing is becoming more common, providing such requirements as meals, health care services, and housekeeping services.

oversedation

The benzodiazepines are usually avoided because they may increase confusion and cause ______________. Delirium may be managed by incorporating a bundle of evidence-based strategies into routine care

Neurologic

The central nervous system responds more slowly to multiple stimuli. Hence, the cognitive and behavioral response of the older adult may be delayed. Rate of reflex response decreases. Temperature regulation and pain/pressure perception become less efficient. There may be a loss of sensation in the extremities. The older adult may also experience difficulty with balance, coordination, fine movements, and spatial orientation, resulting in an increased risk for falls. Sleep at night typically shortens, and the older adult may awaken more easily. Catnaps become common.

60

The first indications of AD usually occur after _______ years of age, and nearly half of 85-year-old adults have the disease. Scientists estimate that at least 5 million people have Alzheimer disease

physiologic

The greatest threat to the health of older adults is loss of the ________________ reserve of the various organ systems.

abuse

The increase in the number of older adults coupled with increasing lifespan has resulted in greater awareness about the problem of elder maltreatment, including _________ and neglect.

family

The increasing aging population has greatly strained a health care system that has traditionally focused on cures and acute disease processes. For an older patient with chronic disorders, the focus of care should include the patient's and ____________ goals and promote functional health and independent living to the greatest extent possible

Hispanics

The leading causes of illness and death for ___________Americans are heart disease, cancer, unintentional injuries (accidents), stroke, and diabetes. __________ have higher rates of obesity than non-Hispanic Whites. Asthma, chronic obstructive pulmonary disease (COPD), HIV/AIDS, suicide, and liver disease also are more common in this population

slower reaction

The loss of the privilege of driving has serious repercussions for older adults. Aging results in____________ times and changes in vision such as increased sensitivity to the glare from approaching headlights as well as alterations in peripheral vision

sexual

The need for love and belonging does not diminish with age and may become acute with the loss of one's spouse or partner through illness or institutionalization. Humans are sexual beings, and __________ behavior does not necessarily stop in old age.

fall

The older adult is at increased risk for accidental injury because of changes in vision and hearing, loss of mass and strength of muscles, slower reflexes and reaction time, and decreased sensory ability. Many older adults limit their activities because of fear of a ________ that might result in serious health consequences. ___________ are the most common cause of injuries and hospital admission in older adults. Approximately 30% to 40% of adults over 65 years of age living in the community ________ at least once per year

heart disease

The probability of a person becoming ill increases with age. Chronic health problems or disability also may result from acute illnesses or accidents such as fractures, pneumonia, motor vehicle accidents, and falls. The leading causes of death in older adults are ______________, cancer, and stroke

decrease

The risk for these common health problems often depends on a combination of lifestyle factors and aging. As one gets older, energy requirements _______________.

Physical Changes in the Middle Adult

The skin is drier.

generativity versus stagnation

The tasks of midlife continue or may resurface. Older adults still strive to guide the coming generations and to leave something behind___________________

sarcopenia

The term ___________ refers to the loss of muscle mass that frequently occurs in older adults; sarcopenic obesity describes the muscle loss combined with an increase in body fat as people age.This condition can result in loss of strength and function and a reduced quality of life that is significant for older adults. Resistance training and adequate dietary protein are management strategies that can prevent or reverse this process

cognition

The term _______________ indicates cerebral functioning, including the ability to perceive and understand one's world

identity continuity

The____________________ theory assumes that healthy aging is related to the older adult's ability to continue similar patterns of behavior from young and middle adulthood.

intimacy versus isolation

Their need for love and closeness continues

Physical Changes in the Middle Adult

There is a loss of calcium from bones, especially in perimenopausal women.

80%

There is growing evidence that aging is not synonymous with loss of function and disability. At least ______ of older adults have at least one chronic disorder, and most have at least two; yet their ability to adapt determines whether they are ill or healthy

Assisted living

These facilities generally provide housing, group meals, personal care and support services, and social activities in a social setting. Some health care may be provided. Costs vary from around $29,000 to $66,000 annually depending on location. Some states pay for personal care services for those with limited incomes.

Long term care

These facilities provide skilled nursing care and/or long-term care, including meals, personal care, and medical care. Bedrooms and bathrooms may be shared. Costs average $66,000 per year, but many are more expensive. Medicare provides only short-term coverage following a hospitalization. Medicaid provides coverage for low-income, low-asset people.

social isolation

This may occur because of declining health or income, transportation problems, or ageism. Whatever the cause, prolonged _________________ has been associated with declining health and higher mortality rates.

CCRC

This type of housing community offers several options and services, depending on the needs of the resident. Residents usually begin by living independently in apartments, and then move to an assisted-living facility on the same grounds. A skilled nursing center is also part of the community and available when needed. Sometimes called "aging-in-place" models, this type of housing tends to be expensive.

Bone density

Those at risk: postmenopausal women, maternal history of hip fracture, fracture after age 50, tall height at age 25

assisted living

Those who live alone are at greatest risk for loss of independence and increased need for ________________ or long-term care.

Dentition

Tooth decay and loss continue for most older adults. Eating habits may change, particularly if the older adult lacks teeth or has ill-fitting dentures.

medications

Treatment of delirium may include stopping unnecessary ______________, as well as interventions to resolve infection and metabolic alterations. Medications that reduce agitation may be prescribed in certain circumstances.

counseling

Treatment of depression usually involves psychotherapy or _______________ along with antidepressant medication. In an older adult, hopelessness rather than sadness is more often associated with suicidal intent. Alcohol or prescription drug abuse is most often associated with suicides in this age group

Nutrition

WHATS THE AREA OF CONCERN FOR: Assess for lost or damaged teeth; ensure that dentures fit properly. Provide foods appropriate to the patient's ability to chew. Assess height, weight, eating patterns, and food choices. If weight is being lost, assess income, storage, and transportation. Assess swallowing ability. Consider using supplements.

Psychosocial needs

WHATS THE AREA OF CONCERN FOR: Be aware that illness, hospitalization, or changes in living arrangements are major stressors. Assess and support sources of strength, including cultural and spiritual values and rituals. Encourage use of support systems: family, friends, community resources, and pets. Set mutual goals and encourage the patient's role in making decisions about care. Encourage life review and reminiscence. Encourage self-care. Consider the patient's background, interests, capabilities, values, culture, and lifestyle when planning care.

Sleep and rest

WHATS THE AREA OF CONCERN FOR: Discourage excessive napping. Assess normal bedtime, time for rising, bedtime rituals, effects of pain, medications, anxiety, and depression.

Physiologic function

WHATS THE AREA OF CONCERN FOR: Maintain physiologic reserves. Maintain ongoing assessments for early detection of problems. Review perceptions of current health status, health problems, and prescribed or over-the-counter medications. Include nursing care that maintains physical status, such as skin care and planned rest and activity.

Activity and exercise

WHATS THE AREA OF CONCERN FOR:Assess ability to walk; ensure that assistive devices (such as a walker or cane) are available. Consider effects of illness, surgery, medications, and changes in diet and fluid intake on strength and motor function. Ensure an uncluttered environment with good lighting; suggest using a night light and removing throw rugs. Slow the pace of care, allowing extra time to carry out activities.

Elimination

WHATS THE AREA OF CONCERN FOR:Assess frequency of bladder elimination as well as problems with incontinence. Assess normal times for bowel movements, changes in activity, privacy, and medications. Ensure that the floor is not cluttered, the toilet is easily accessible, lighting is adequate, and privacy is provided. Suggest having safety bars installed in the bathroom. Review diet for necessary fluid and fiber content.

Sexuality

WHATS THE AREA OF CONCERN FOR:Assist as necessary with hygiene, hair care, oral care, clean clothing and bedding, makeup, and shaving. Maintain a clean, odor-free environment. Demonstrate genuine caring: ask preferred name, listen carefully, and respect belongings. Discuss safer sex if appropriate. Discuss water-soluble lubricants with women; refer men for evaluation if erectile dysfunction is a concern.

Cognitive function

WHATS THE AREA OF CONCERN FOR:Slow pace of activity and wait for responses. Be sure eyeglasses and hearing aids are used; ensure that lenses are clean and batteries are strong.

depression

When assessing behavioral changes, remember that an older adult with dementia may also develop delirium or ______________.

immobility

When illness occurs, increased physical and emotional stress places an older adult at risk for complex reactions. An older adult is more likely to develop complications and to recover more slowly. For instance, an older patient with a hip fracture is at high risk for pneumonia and skin breakdown because of ___________, a decreased ability to expel pulmonary secretions, and thinner, more fragile skin.

anxious

When it becomes obvious for safety reasons that an older driver should stop driving altogether, it is best if family members address their concerns with their older adult in an honest, forthright manner. Losing driving privileges is disheartening and can cause older adults to feel ____________ and lonely, which may be viewed as another negative consequence of aging.This lack of independence may also result in less opportunity for activities or interactions with friends and family.

ill

When one's spouse or partner becomes _______, numerous and difficult adjustments must be made. An older adult may face new roles for the first time, such as cooking meals or handling family finances. These role changes come at a time when stress is already high. Giving physical care can be an overwhelming task if the other spouse or partner is also frail or in poor health. Adaptations may be needed in living conditions and lifestyle, and one spouse may need to plan social and recreational events alone.

independence

With severe illness, loss of________________ can occur. The loss of health is difficult to adjust to because it affects every aspect of life.

osteoporosis and heart disease

With the cessation of ovulation, menstrual periods stop either gradually or abruptly, causing many women to experience hot flashes, mood swings, and fatigue. The loss of estrogen also increases the risk for ______________ and ______________The process can last for several years; afterward, the woman can no longer become pregnant.

menopause

Women undergo ___________ , a gradual decrease in ovarian function, with subsequent depletion of estrogen and progesterone.This change usually occurs between 40 and 55 years of age.

Physical Changes in the Middle Adult

Wrinkle lines appear on the face.

Integument

Wrinkling and sagging of skin occur with decreased skin elasticity; dryness and scaling are common. Balding becomes common in men, and women also experience thinning of hair; hair loses pigmentation. Skin pigmentation and moles are common, although the skin may become pale because of loss of melanocytes. Nails typically thicken, becoming brittle and yellowed. The blood vessels in the dermis become more fragile, causing increased bruising and purpura (hemorrhaging into the skin).

Sexual

_______ abuse involves nonconsensual sexual contact of any kind with an elderly person

Pain

___________ should not be assumed to be a normal consequence of aging, but it is often experienced by older adults and frequently is undertreated.

Social roles

____________ change with the developmental tasks and adjustments of older adulthood, but the need to feel valued, useful, and productive continues. Older adults may develop new hobbies or increase their involvement in community, church, or family affairs

Alzheimer disease

_____________ is the most common degenerative neurologic illness and the most common cause of cognitive impairment. It is irreversible and progresses from deficits in memory and thinking skills to an eventual inability to perform even the simplest of tasks

Emotional

_______________ abuse occurs when threats, intimidation, or isolation result in anguish for the elder person, while financial abuse involves exploitation or misuse of another's property.

The Geriatric Depression Scale

_________________ , a 15-question screening tool, can be used effectively in older adults in any setting. When combined with a mental health assessment by a professional, it can facilitate a diagnosis of depression

Alzheimer disease

__________________ affects brain cells and is characterized by patchy areas of the brain that degenerate. It is a progressively serious and ultimately fatal disorder. At first, forgetfulness and impaired judgment may be evident. Over a period of several years, the person becomes progressively more confused, forgetting family and becoming disoriented in familiar surroundings.

American Indian

___________________ have an infant mortality rate 60% higher than that of Whites. Leading causes of death and illness are heart disease, cancer, accidents, diabetes, and stroke. They also have a higher risk for mental health issues including suicide, as well as obesity, substance abuse, and SIDS

Chronic illness

___________________ in middle adults has a major effect on self-concept and may precipitate changes in life structure. For example, after a serious heart attack, a man may face changes in his family role, his earning capacity, and his social relationships. Such changes usually cause great stress.

Crosslinkage

a chemical reaction that produces damage to the DNA and cell death. As one ages,_______________ accumulate, leading to essential molecules in the cell binding together and interfering with normal cell function.

identity versus role diffusion

a strong sense of who one is in relation to family and community

delirium

a temporary state of confusion

fluid retention, hard

aging of the cardiac muscles causes ___________ in both peripheral tissues and the lungs, causing swelling of the legs and making breathing more ____________.

African American

are 30% more likely to die from heart disease than non-Hispanic White men. _______________ adults are diagnosed with diabetes and die from diabetes almost twice as often as White adults. ________________ have the highest mortality rate of any minority for most major cancers. Lung, prostate, and gastric cancer are also more prevalent in this group, who account for 43% of HIV/AIDS cases

Asian

are most at risk for cancer, heart disease, stroke, accidents, and diabetes. Tuberculosis is 11 times more common in this group than the White population. _______ American women have the highest life expectancy (85.8 years) of any ethnic group in the United States

ageism

attitudes that stereotype the older adult on the basis of chronologic age

sundowning syndrome

describes a phenomenon when a person habitually becomes confused or disoriented with darkness

cascade iatrogenesis

downward spiral and decline is referred to as ___________________. An episode of confusion and wandering at night may lead to a fall that results in a hip fracture. During the resulting hospitalization, the insertion of an indwelling catheter can precipitate a urinary tract infection that requires use of an antibiotic and possibly the development of antibiotic-resistant organisms.

cascade iatrogenesis

downward spiral or sequence of adverse events often triggered by a medical or surgical intervention during the hospitalization of an older adult

accomplishment

events that may accompany aging can threaten a person's self-concept. Depending on the person's outlook on life and past ability to cope, events such as retirement, loss of health or income, loss of ability to operate a motor vehicle, and isolation can be devastating. For example, a retired teacher whose sense of identity was closely tied to career may suddenly be in the position of having lost friends, income, and sense of _____________, and may consequently feel a great loss of control and self-identity.

hypertension, sinusitis

he most commonly encountered chronic disorders are ___________ , arthritis, heart disease, cancer, diabetes, and ____________ .

ECHO

homes are small portable cottages that are placed (most often) in the yard of an adult child's home. These units typically cost $28,000 or more, but do allow living independently but close to support.

Erikson

identified ego integrity versus despair and disgust as the last stage of human development, which begins at about 60 years of age. Older adults continue to look forward but now also look back and begin to reflect on their life. It is a time for realization of a "wholeness" perspective, with an inner search for meaning and order in the life cycle.

Self-transcendence

is a characteristic of later life that helps one expand beyond personal limits to reach out to others and the environment and a greater awareness of others' beliefs and values. Integration of the past and future in the present facilitates acceptance of where one is in life without regretting past mistakes or fearing the future

Ego integrity

is facilitated when an older adult has successfully accomplished tasks earlier in life. Older adulthood can be a time for the person to look backward with pride and without regrets and forward with optimism and enthusiasm. A person who regrets the past and sees current problems as insurmountable, however, may despair. This person may view life as a series of unresolved problems and missed opportunities and feel worthless or hopeless. A despairing person may want to do things over but fears the lack of time before death.

Havighurst's Theory

learned behaviors arising from maturation, personal motives and values, and civic responsibility. To successfully master this developmental stage, the middle adult must accept and adjust to physical changes, maintain a satisfactory occupation, assist children to become responsible adults, adjust to aging parents, and relate to one's spouse or partner as a person.

functional health

level of health defined by one's ability to carry out usual and desired daily activities

The leading causes of death in the middle adult years

malignant neoplasms; cardiovascular disease; unintentional injury including poisoning, motor vehicle accidents, and falls; diabetes mellitus; chronic lower respiratory disease; and cerebrovascular causes The leading causes of death in the middle adult years

reality orientation

method of care used to promote awareness of reality in confused or disoriented patients

gerontologic nursing

nursing specialty concerned with the care of the older adult

dementia

organic impairment of intellectual functioning, gradually leading to interference with social or occupational functioning, memory, and often personality integration

physical

pain, impairment, or deliberate physical injury to an older adult. Hitting, assault of any kind, slapping, and restraining are all examples of forms of ___________ abuse.

Fowler

paradoxical-consolidative state of spiritual development. ___________ believed that only some people reach this stage and only after 30 years of age. Most middle adults are less rigid in their beliefs and have increased faith in a supreme being as well as trust in spiritual strength

older adult

refers to adults over age of 65

REACH

represent an effort by the CDC to establish community-based, culturally appropriate programs and eliminate health disparities among racial and ethnic groups. African Americans, American Indians, Hispanics/Latinos, Asian Americans, Alaska Natives, and Pacific Islanders all benefit from these programs. Currently __________ funds 50 communities and six minority-serving national organizations

social isolation

sense of aloneness because of decreasing relationships with others, resulting from attitudinal, geographic, financial, or illness-related factors

liver disease

smoking and alcohol consumption put the person at greater risk for cancer, chronic respiratory diseases, and ________________.

PACE

the Program of All-Inclusive Care for the Elderly, in which adults age 55 years or older who meet specific criteria can receive comprehensive interdisciplinary care. They also receive support to live in the community as long as possible. Approximately 80_______ programs are active around the country

middle adult

the adult between the ages of 40 and 60 years; also called middle adulthood

Havighurst

the major tasks of old age are primarily concerned with the maintenance of social contacts and relationships. Successful aging depends on a person's ability to be flexible and adapt to new age-related roles. The person must find new and meaningful roles in old age while being reasonably comfortable with the social customs of the times.

Erikson's theory

the middle adult is in a period of generativity versus stagnation. The tasks are to establish and guide the next generation, accept middle-age changes, adjust to the needs of aging parents, and reevaluate one's goals and accomplishments. Adults who do not achieve these tasks tend to focus on themselves, becoming overly concerned with their own physical and emotional health needs.

polypharmacy

the use of many medications at the same time

Levinson's Theory

theorized that the middle adult may choose either to continue an established lifestyle or to reorganize one's life in a period of midlife transition.

Alzheimer disease

type of dementia in which discrete patches of brain tissue degenerate; this devastating disease eventually affects all body functions

life review

universal phenomenon identified by Butler as a review of one's life through one's recollections

reminiscence

universal phenomenon identified by Butler as a review of one's life through one's recollections

Gould's Theory

viewed the middle years as a time when adults look inward (ages 35 to 43); accept their lifespan as having definite boundaries, and have a special interest in spouse, friends, and community (ages 43 to 50); and increase their feelings of self-satisfaction, value spouse as a companion, and become more concerned with health (ages 50 to 60).