Chapter 23
An experienced nurse tells a less-experienced nurse who is working in a retirement home that older adults are different and do not have the same desires, needs, and concerns as other age groups. The nurse also comments that most older adults have "outlived their usefulness." What is the term for this type of prejudice? a) Harassment b) Whistle blowing c) EA d) Ageism
D
Activity and exercise?
-Assess ability to walk; ensure that assistive devices (such as 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 rugs. -Slow the pace of care, allowing extra time to carry out activities.
Nutrition?
-Assess frequency of bladder elimination as well as problems with incontinence. -Assess height. weight, eating patterns, and food choices. -Assess for malnutrition, especially in older adults impacted by cognitive, psychosocial, or social factors such as the 3Ds. isolation, limited income or access to nutritious food, and the need for assistance with food preparation of eating. -Assess swallowing ability. -Consider using supplements.
Elimination?
-Assess frequency of bladder elimination as well as problems with incontinence. -Assess normal times for bowel movements while considering 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.
Sexuality?
-Assist as necessary with hygiene, hair care, oral care, clean clothing and bathing, 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 cancer.
Psychosocial needs?
-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 roles 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?
-Discourage excessive napping. -Assess normal bedtime, time for rising, bedtime rituals, effect of pain, medications, anxiety, and depression.
Physiologic function?
-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.
What are the leading causes of death in middle adulthood?
-Malignant neoplasms -Cardiovascular disease -Unintentional injury including poisoning, motor vehicle accidents, and falls -Diabetes mellitus -Chronic lower respiratory disease -Cerebrovascular causes
Meeting developmental tasks?
-Promote continued development and maintenance of functional health by identifying unmet tasks, feelings of isolation, and physical or sensory limitations. -Assist in finding creative solutions to developmental tasks. -Collaborate with other health care providers to provide information and referral to community resources for the patient and family.
Cognitive function?
-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.
Expand on the physiological development of the older adult; primarily the musculoskeletal system.
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.
Describe Levinson psychosocial development of the middle adult.
1978 - 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 •Mid-life crisis •Value changes •May begin to make choices about their future and their retirement •May also begin to think about their legacy and what they are leaving behind for others
What are the roles of the nurse in promoting health of the middle adult?
1. Teaching 2. Serving as a role model 3. Encouraging self-care responsibilities - Health-related screenings, examinations, and immunizations 4. Promoting healthy activities - Diet low in fat and cholesterol, including fruits, vegetables, and fiber; use sugar, salt, and sodium in moderation. - Regular exercise - Alcohol in moderation, if at all. - No smoking
Describe the health of the older adult.
1. chronic illness 2. accidental injuries 3. dementia, depression, and delirium 4. elder maltreatment 5. polypharmacy
Describe spiritual development of older adults.
1. conventional level 2. individuate 3. conjunctive faith 4. gerotranscendence
What are 3 theories of aging?
1. genetics 2. neuroendocrine and immunity 3. stochastic theories
Describe Erikson's psychical development of the middle adult.
1963 - generativity versus stagnation Those who succeed (generativity) establish and guide the next generation, accept middle-age changes, adjust to the needs of aging parents, and reevaluate one's goals and accomplishments vs those who remain stagnant - becoming overly concerned with their own physical and emotional health needs Generativity is making a contribution to the world, being a positive change agent that will benefit others and future generations Stagnation is a failure to contribute and you may feel disconnected or uninvolved or unproductive
Describe Havighurst psychosocial development of the middle adult.
1972 - learned behaviors arising from maturation, personal motives and values, and civic responsibility Accept and adjust to physical changes, maintain a satisfactory occupation, assist children to become responsible adults, adjust to aging parents, relate to one's spouse or partner as a person
Describe Gould's psychosocial development of the middle adult.
1972 - 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). Looking inward and giving up on ideas from childhood and you begin to form a sense of your own identity
A nurse caring for older adults in a skilled nursing home observes physical changes in patients that are part of the normal aging process. Which changes reflect this process? Select all that apply. a) Fatty tissue is redistributed. b) The skin is drier and wrinkles appear. c) Cardiac output increases. d) Muscle mass increases. e) Hormone production increases. f) Visual and hearing acuity diminishes.
A, B, F
A nurse providing health services for a 55 plus community setting formulates diagnoses for patients. Which of the following nursing diagnoses would be most appropriate for many middle adults? a) Risk for Imbalanced Nutrition: Less Than Body Requirements b) Delayed Growth and Development c) Self-Care Deficit d) Caregiver Role Strain
D
A nurse is caring for an 80-year-old patient who is living in a long-term care facility. To help this patient adapt to the present circumstances, the nurse is using reminiscence as therapy. Which question would encourage reminiscence? a) "Tell me about how you celebrated Christmas when you were young." b) "Tell me how you plan to spend your time this weekend." c) "Did you enjoy the choral group that performed here yesterday? d) "Why don't you want to talk about your feelings?"
A
Expand on psychosocial development for the middle adult; primarily Erikson's Theory.
According to Erikson (1963), the middle-aged 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 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.
Expand on the psychosocial development of the older adult; primarily Havighurst's Theory.
According to Havighurst (1972), 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.
Conventional level?
According to Kohlberg: Older adults have completed their moral development and most are at a conventional level
Describe physiological development of the older adult.
All organ systems undergo some degree of decline, body less efficient More likely to develop complications and to recover more slowly May take longer to complete an activity or the activity may need to be modified
Dementia, depression, and delirium?
Alzheimer disease, Sundowning syndrome, Cascade iatrogenesis
Type of dementia in which discrete patches of brain tissue degenerate; this devastating disease eventually affects all body functions
Alzheimer's Disease (AD)
Expand on the psychosocial development of the older adult; primarily the disengagement theory.
An early psychosocial theory, called the disengagement theory, 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. Later studies showed that isolation is not desired or acceptable, and that as societal interactions decrease, healthy older adults increase their close relationships with family and friends. According to the activity theory, successful aging includes the ability to maintain high levels of activity and functioning. An older adult may substitute activities, but does not slow down or disengage from society. The continuity theory assumes that healthy aging is related to the older adult's ability to continue similar patterns of behavior from young and middle adulthood
A nurse caring for patients in a primary care setting refers to Erikson's theory that middle adults who do not achieve their developmental tasks may be considered to be in stagnation. Which patient statement is an example of this finding? a) "I am helping my parents move into an assisted-living facility." b) "I spend all of my time going to the doctor to be sure I am not sick." c) "I have enough money to help my son and his wife when they need it." d) "I earned this gray hair and I like it!"
B
A nurse is caring for older adults in a senior adult day services (ADS) center. Which findings related to the normal aging process would the nurse be likely to observe? Select all that apply. a) Patients with wrinkles on the face and arms due to increased skin elasticity b) A patient with skin pigmentation caused by exposure to sun over the years c) A patient with thinner toenails with a bluish tint to the nail beds d) A patient healing from a hip fracture that occurred due to porous and brittle bones e) Bruising on a patient's forearms due to fragile blood vessels in the dermis f) Decreased patient voiding due to increased bladder capacity
B, D, E
Following a fall that left an older adult temporarily bedridden, the nurse is using the SPICES assessment tool to evaluate for cascade iatrogenesis. Which are correct aspects of this tool? Select all that apply. a) S—Senility b) P—Problems with feeding c) I—Irritability d) C—Confusion e) E—Edema of the legs f) S—Skin breakdown
B, D, F
Describe the stochastic theories.
Based on randomness/errors Wear and tear - when organisms wear out from use Cross-linkage - chemical reaction produces damage to the DNA and cell death Free radical- molecules with separated high-energy electrons have adverse effects on adjacent molecules Based on oxidative stress and causes irreversible damage
Why is the older adult deemed a unique population?
Because of the amount of years they have lived, what they have seen and what they have done They have a wide range of knowledge based on the amount of years they have lived
Expand on the physiological development of the older adult; primarily the genitourinary system.
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 (nocturia). A decrease in bladder and sphincter muscle control may result in stress incontinence or incomplete bladder emptying (overflow incontinence). About 75% of men over 65 years of age experience benign (not cancerous) hypertrophy of the prostate gland (BPH); surgery may be required if urinary retention occurs. The older woman's genital tract atrophies and is associated with thinning and a decrease in vaginal secretions.
Expand on the physiological development of the older adult; primarily the cardiopulmonary system.
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.
A nurse is helping to prepare a calendar for an older adult patient with cognitive impairment. What is the leading cause of cognitive impairment in old age? a) Stroke b) Malnutrition c) AD d) Loss of cardiac reserve
C
A nursing instructor teaching classes in gerontology to nursing students discusses myths related to the aging of adults. Which statement is a myth about older adults? a) Most older adults live in their own homes. b) Healthy older adults enjoy sexual activity. c) Old age means mental deterioration. d) Older adults want to be attractive to others.
C
A nurse caring for adults in a provider's office researches aging theories to understand why some patients age more rapidly than others. Which statements describe the immunity theory of the aging process? Select all that apply. a) Chemical reactions in the body produce damage to the DNA. b) Free radicals have adverse effects on adjacent molecules. c) Decrease in size and function of the thymus results in more infections. d) There is much interest in the role of vitamin supplementation. e) Lifespan depends on a great extent to genetic factors. f) Organisms wear out from increased metabolic functioning.
C, D
Downward spiral or sequence of adverse events often triggered by a medical or surgical intervention during the hospitalization of an older adult
Cascade Iatrogenesis
Describe the old-old.
Challenges include sensory impairments, oral health issues, inadequate nutritional intake, and functional limitations
Describe the middle-old.
Challenges such as increased in solitary or sedentary lifestyle
Accidental injuries?
Changes in vision and hearing, Loss of mass and strength of muscles, Slower reflexes and reaction time, Decreased sensory ability, Combined effects of chronic illness and medications, Economic factors
Expand on cognitive development for the middle adult.
Cognitive and intellectual abilities of middle-aged adults change little from young adulthood. There often is increased motivation to learn, especially if the knowledge gained can be applied immediately and has personal relevance. Problem-solving abilities remain throughout adulthood, although response time may be slightly longer. This is not due to any decreased ability but, rather, to a longer search through more memories and to a desire to think a problem through before responding.
Gerotranscendence?
Describes the transformation of a person's view of reality from a rational, social, individually focused, materialistic perspective to a more transcendent vision.
Expand on the physiological development of the older adult; primarily the gastrointestinal system.
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.
Expand on the physiological development of the older adult; primarily the 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. As a result of these changes, the older adult may have difficulty reading small print, and daytime or night driving maybe compromised. Diminished hearing acuity (presbycusis) occurs, particularly diminished pitch discrimination in the presence of environmental noises. Cerumen (wax) buildup is common. As a result of hearing problems or amplification issues with hearing aids, 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 may be reduced. Problems with nutrition may result.
Expand on the psychosocial development of the older adult; primarily Erikson's Theory.
Erikson (1963) 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 lives. It is a time for realization of a wholeness perspective, with an inner search for meaning and order in the life cycle. - Older adults search for emotional integration and acceptance of the past and present, as well as acceptance of physiologic decline without fear of death. Older adults often like to tell stories of past events. This phenomenon, called life review or reminiscence, has been identified worldwide. - Reminiscence is a way for older adults to relive and restructure life experiences, often in relation to their current situation, and with the added benefit of the perspective provided by life experience and wisdom. - Although reminiscence therapy is often used in patients with mild to moderate dementia, reminiscence has value for older adults who do not have cognitive or memory impairments. - Nurses use reminiscence therapy to encourage reflection and facilitate adaptation to present circumstances. 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 to look 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. The tasks of midlife continue or may resurface. Older adults still strive to guide the coming generations and to leave something behind (generativity vs. stagnation). Their need for love and closeness continues (intimacy vs. isolation), as does a strong sense of who one is in relation to family and community (identity vs. role diffusion). - Because of physical and social changes associated with aging, older adults are repeatedly faced with the need to adapt and to again face already completed tasks.
Describe the immunity theory.
Focuses on the functions of the immune system - starts failing after younger adulthood - why you are more prone to infections as an older adult
---- the ability to carry out usual and desired daily activities
Functional Health
Middle adult age range?
Generally considered to be ages 40 to 65
Describe the genetic theory.
Genes control "genetic clocks" Genetic clocks determine the occurrence and the rate of the metabolic process and our longevity is determined by our genes This means that death is determined at birth
---- is a branch of medicine that focuses on the study of health and disease later in life
Geriatrics
---- combines the basic knowledge and skills of nursing with a specialized knowledge of aging in both illness and health
Gerontologic Nursing
Nursing specialty concerned with the care of the older adult
Gerontologic nursing
---- is the scientific and behavioral study of all aspects of aging and its consequences
Gerontology
Expand on psychosocial development of the middle adult; primarily Gould's Theory.
Gould (1978) viewed ages 35 to 43 as a time when adults look inward. He considered ages 43 to 50 as a time when adults accept their lifespan as having definite boundaries, and have a special interest in spouse, friends, and community. He viewed ages 50 to 60 as the period when adults experience increased feelings of self-satisfaction, value the spouse as a companion, and become more concerned with health.
Describe the physiologic development of the middle adult.
Gradual internal and external physiologic changes occur These are normal changes: related to hormones, fatty tissue distribution, skin becomes drier, wrinkles start to appear, grey hair or hair loss appear (hair loss in men), decrease in muscle mass, strength and agility, and increased fatigue
Conjunctive faith?
Integrating faith and truth to see the reality of their own belief in which they trust a greater power and believe in the future
Describe the neuroendocrine theory.
Involves the pituitary and hypothalamus (control mechanisms for entire body and as we age these fail and lead to death)
Expand on psychosocial development of the middle adult; primarily Levinson's Theory.
Levinson theorized that the middle adult may choose either to continue an established lifestyle or to reorganize his or her life in a period of midlife transition.
Describe the cognitive development of the middle adult.
Little change from young adulthood Often during this time, you have an increased motivation to learn
Describe cognitive development of the older adult.
May take longer to respond and react Mild short-term memory loss is common Long-term memory usually remains intact
Elder maltreatment?
Physical abuse, sexual abuse, emotional or psychological abuse, neglect, abandonment, and financial or material exploitation As many as two million people older than 65 years of age suffer from abuse, neglect, or exploitation, inflicted by family members in 90% of cases
Expand on the physiological development of the older adult; primarily 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 period.
Individuate?
Reflective level
Describe psychosocial development of the older adult.
Self-concept is relatively stable during adult life Disengagement theory Erikson: ego integrity versus despair and disgust; life review Havighurst
Expand on psychosocial development of the middle adult; primarily Havighurst's Theory.
The developmental tasks of the middle adult described by Havighurst (1972) are 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 his or her spouse or partner as a person.
The use of many medications at the same time, known as ----, can pose many hazards for older adults.
polypharmacy
Describe the older adult.
Society labels an older adult as a person that is 65 years old. Older adult period is often divided: 1. young-old (ages 60-74 years) 2. middle-old (ages 75 to 84 years) 3. old-old (ages 85 years and older)
Describes a phenomenon when a person habitually becomes confused or disoriented with darkness
Sundowning Syndrome
Older adults are at risk of ageism. What is this?
Term that is used to define stereotyping of older people A form of prodigious where older people are treated differently than younger people
Expand on the physiological development of the older adult; primarily the neurologic system.
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.
Expand on physiologic development of the middle adult.
The hormonal changes that take place in midlife affect men and women differently. Women undergo menopause, a gradual decrease in ovarian function, with subsequent depletion of estrogen and progesterone. This change usually occurs between 40 and 55 years of age. 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 osteoporosis and heart disease. The process can last for several years; afterward, the woman can no longer become pregnant. Men do not experience physical symptoms from the decreased levels of hormones, called andropause. Androgen levels diminish slowly; the man may have some loss of sexual potency, but is still capable of reproduction. 1. fatty tissue is redistributed; men tend to develop abdominal fat, women thicken through the middle 2. the skin is direr 3. wrinkle lines appear on the face 4. gray hair appears, and mean may lose hair on the head 5. cardiac output begins to decrease 6. muscle mass, strength, and agility gradually decrease 7. there is a loss of calcium from bones, especially in perimenopausal women 8. fatigue increases 9. visual acuity diminishes, especially for near vision (presbyopia) 10. hearing acuity diminishes, especially for high-pitched sounds (presbycusis) 11. hormone production decreases, resulting in menopause or andropause
Describe the young-old.
Trying to adapt to all of the physical and psychological changes such as retirement or certain healthcare issues like the lack of supplemental insurance for health screenings or physicals that aren't covered by Medicare There self perception of aging and changes in physical activity
Expand on the cognitive development of the older adult.
The term cognition indicates cerebral functioning, including a person's ability to perceive and understand his or her world. Cognition does not change appreciably with aging. In fact, intelligence increases into the 60s, and learning continues throughout life. It is normal for an older adult to take longer to respond and react, particularly in new or unfamiliar surroundings. Knowing this, the nurse should slow the pace of care and allow older adults extra time to ask questions or complete activities. Mild short-term (recent) memory loss is common but can be remedied by an older adult using notes, schedules, and calendars. Long-term memory usually remains intact. Dementia, Alzheimer's disease (AD), depression, and delirium may occur and cause cognitive impairment. These conditions are discussed later in relation to the health of the older adult.
What are some major health problems of the middle adult?
These depend on combinations of lifestyle factors and aging -Obesity and Arteriosclerosis - increased risk for high blood pressure, coronary artery disease, renal failure, and diabetes -Smoking and alcohol consumption -greater risk for cancer, chronic respiratory diseases, and liver disease. -Depression
Describe the psychosocial development of the middle adult.
Time of increased personal freedom, economic stability, and social relationships Time of increased responsibility and awareness of one's own mortality Realizing that life is already half lived which leads to stress
Expand on the physiological development of the older adult; primarily 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.
Expand on the physiological development of the older adult; primarily integumentary system.
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).
In contrast to the disengagement theory of psychosocial aging, the ---- theory purports that successful aging includes the ability to maintain high levels of activity and function.
activity
Attitudes that stereotype the older adult on the basis of chronologic age
ageism
A temporary state of confusion
delirium
Organic impairment of intellectual functioning, gradually leading to interference with social or occupational functioning, memory, and often personality integration
dementia
Erickson identified ---- integrity versus despair and disgust as the last stage of human development, which begins at about 60 years of age.
ego
Intentional act or failure to act by a caregiver or another person in relationship involving an expectation of trust that causes or creates a risk of harm to an older adult Includes physical abuse, sexual abuse/contact, emotional/psychological abuse, neglect, and financial abuse/exploitation
elder abuse (EA)
True or False More than 45% of older adults fall each year, but less than half tell their health care providers.
false
True or False There is growing evidence that aging is synonymous with loss of function and disability.
false
According to Erickson's theory, the middle adult years are a period of ---- versus stagnation, a time to reevaluate one's goals and accomplishments.
generativity
Age-associated changes in the immune system, also known as ----, are thought to be responsible for the increase in infections and cancer as adults age.
immunosenscence
Universal phenomenon identified by Butler as a review of one's life through one's recollections
life review
The adult between the ages of 40 and 60 years
middle adult
Refers to adults over age 65
older adult
The use of many medications at the same time
polypharmacy
Period in a chronic illness when the disease is present, but the person does not experience symptoms of the disease
reminiscence
Sense of aloneness because of decreasing relationships with others, resulting from attitudinal, geographic, financial, or illness-related factors
social isolation
True or False As of 2015, 80% of older adults aged 65 to 74 ad 68% of older adults over age 85 rate their health good, very good, or excellent.
true
True or False Cognitive and intellectual abilities of middle adults change little from young adulthood.
true
True or False The leading causes of chronic illnesses in the middle adult years are rheumatoid arthritis, obesity, alcoholism, and depression.
true
List some developmental tasks of middle adulthood.
•Accept and adjust to physical changes. •Maintain a satisfactory occupation. •Assist children to become responsible adults. •Adjust to aging parents. •Relate to one's spouse or partner as a person.
A few days after your patient returns to her home, your youngest daughter (who is 8 years of age) becomes very upset and tearful. Upon questioning, she indicates she doesn't want your great-aunt to be put in a long-term care facility because she's old. How would you respond to her concerns and what other information could you teach your daughter regarding older adults?
•Age is not the determinant in long-term care facility admissions; self-care ability and personal safety are the deciding factors. •Most older adults are not ill. •While response time may increase, neither intelligence nor personality decrease due to aging. •Older adults see themselves similarly as they did as young adults but with older bodies. •Most adults are not isolated and lonely; they are active in social and community activities. •Older adults have not outlived their usefulness. If they are seriously ill, they deserve the type of medical treatment they desire/decide to have.
Your patient has requested information from you regarding how she could preserve her physical health. What information would you offer?
•Consume foods low in fat and cholesterol, and increased fiber; use sugar, salt, and sodium in moderation. •Make regular exercise a part of life. •Use alcohol in moderation, if at all. •Do not smoke. •Discuss use of dietary supplements, such as vitamin D.
List some life changes of the middle years.
•Employment •Relationship with a spouse •Relationships with adult children •Relationships with aging parents •Midlife transition
Describe the role of the nurse in promoting health and preventing illness. Teach the patient and family general health-promotion activities
•Encourage recommended screenings, examinations, and immunizations •Eat a diet that includes all food groups; is low in fat, saturated fat, and cholesterol; balances calories with physical activity; has recommended amounts of fruits, vegetables, and grains; and uses sugar and salt in moderation. •Make exercise a part of daily activities. •Discuss with your primary physician whether to include a vitamin D supplement as part of your daily routine. (Vitamin D is considered moderately beneficial for helping prevent hip fractures and other broken bones in older adults) •Drink alcohol in moderation •Do not smoke
According to Erikson's theory, what would be the result if your patient didn't achieve the life tasks of the generativity versus stagnation period?
•Focusing primarily on herself •Becoming overly concerned with her personal, physical, and emotional health needs
What are some common myths of aging and the older adult?
•Old age begins at 65 years. •Most older adults are in long-term care facilities. •Older adults are sick, and mental deterioration occurs. •Older adults are not interested in sex. •Older adults do not care how they look and are lonely. •Bladder problems are a problem of aging. •Older adults do not deserve aggressive treatment for illnesses. •Older adults cannot learn new things.
What are some common myths related to aging?
•Old age begins at 65 years. •Most older adults are in long-term care facilities. •Older adults are sick, and mental deterioration occurs. •Older adults are not interested in sex. •Older adults do not care how they look and are lonely. •Bladder problems are a problem of aging. •Older adults do not deserve aggressive treatment for illnesses. •Older adults cannot learn new things.
What are some implications for health care?
•Older adults use more health care than any other age group •Meeting the expenses of health care is often difficult for older adults and their families •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 multiple medications at the same time. •Hospitalization costs continue to rise, and the price of high-quality, long-term care may well be beyond the patient's or family members' ability to pay. •Special diets, special equipment, and medical supplies increase economic difficulties •Family members must learn how to cope with the needs of the ill person •Family members must also adapt to psychological stressors such as changes in communications, changes in roles and changes in their own lifestyle as they become the caregivers
Your patient continues to voice concerns regarding her physical abilities and what she might expect. What information would your teaching include?
•Physical or emotional stressors that create additional vulnerability due to the older adult's decreased reserves •The need to keep involved in activities but to modify pace and include more frequent rest periods •Additional moisture and care for increasingly fragile skin •Decreased muscle mass and strength •Stiffening joints, decreased range of motion •Slowing mobility, height decrease •Increasing balance difficulties •Decrease in nighttime sleep •Decreased senses of taste and smell •Potentially increased incidence of indigestion and constipation
Describe adjusting to the changes of older adulthood.
•Physical strength and health •Retirement and reduced income •Health of spouse •Relating to one's age group •Social roles •Living arrangements •Family and role reversal
Describe the role of the nurse in promoting health and preventing illness. Nursing Actions to Promote Health in Older Adults
•Physiologic function •Cognitive function •Psychosocial needs •Nutrition •Sleep and Rest •Elimination •Activity and exercise •Sexuality •Meeting developmental tasks
What are the goals of nursing care for the aging adult?
•Promote independent function •Support individual strengths •Prevent complications of illness •Secure a safe and comfortable environment •Promote return to health
What are the goals of nursing care?
•Promote independent function •Support individual strengths •Prevent complications of illness •Secure a safe and comfortable environment •Promote return to health
