PSYCHOSOCIAL THEORIES: Older Adult

Activity Theory of Aging

A theory that suggests that the elderly who are most successful while aging are those who maintain the interests and activities they had during middle age. Social Withdrawal; Introspection.

P.573 A Unique population /Ageism

Ageism Ageism is a form of prejudice, like racism, in which older adults are stereotyped by characteristics found in only a few members of their group. Fundamental to ageism is the view that older people are different and will remain different; therefore, they do not experience the same desires, needs, and concerns as other adults. Our industrial technologic world places a high priority on productivity, and some may think that older employees or retired people have outlived their usefulness.

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 slowdown 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 theory that suggests that aging produces a gradual withdrawal from the world on physical, psychological, and social levels.

Elder Abuse Facts

Based on recent studies, it is estimated that 10% of adults aged 60 or older who live in the community are abused (Lachs & Pillemer, 2015). Adult children and spouses are the most likely perpetrators. Perpetrators are more likely to be male, have a history of substance abuse, have mental or physical health issues, have had run-ins with the police, live socially isolated, have financial problems, and report increased stress. Victims are more likely to be women, young-old, lower income, or isolated, with a lack of social support (only 1 out of every 23 cases of EA is reported to the appropriate protective services

Interviewing the Elderly Client

Confront your own views on aging Explain types of questions first Inform of right not to answer Comfortable environment Therapeutic communication Calm, unrushed manner Keep interview on track-collect data.- Use low pitch to speak with elderly Absorption of thiamine b-12, folate is reduced.

Dementia

Dementia, Delirium, and Depression Nurses and the health care team need to be attuned to abnormal processes that may occur in older adults. Often referred to as the "3Ds," dementia, delirium, and depression require specific assessment and management. DEMENTIA When a serious mental impairment occurs, the effect on the patient and family can be devastating. The term dementia refers to various organic disorders that progressively affect cognitive functioning. Dementia is chronic and usually develops gradually. Most people think of AD when dementia is mentioned, but dementia may also occur more suddenly following a stroke or other vascular event. Referred to as vascular dementia, this form is often related to hypertension, and is the second most common type of dementia. Other dementias include Lewy body dementia and frontotemporal disorders. Differentiating the specific type of dementia affecting an older adult may be difficult, and many people have a form of mixed dementia consisting of two or more types (National Institute on Aging, 2017a). Of the dementias that affect older adults, Alzheimer's disease (AD) is the most common degenerative neurologic illness and the most common cause of cognitive impairment (National Institute on Aging, 2017a). It is irreversible and progresses from deficits in memory and thinking skills to an eventual inability to perform basic self-care (National Institute on Aging, 2017a). The first indications of AD usually occur in a person's mid-60s, and nearly half of 85-year-old adults have the disease. Scientists estimate that at least 5 million people have AD

Depression info

Depression occurs in 7% of the older adult population worldwide, and is both underdiagnosed and undertreated (World Health Organization, 2016). Symptoms of depression are often inappropriately attributed to normal aging, drugs, the progression of chronic disease, or cognitive decline

Havighurst's Theory of Development

Described learned behaviors as developmental tasks 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.

Erickson 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.

Depression

Extreme or prolonged sadness in an older adult may be a warning sign of depression. Depression is not a normal part of aging. Death of a spouse or friends and changes in living environment and financial resources can precipitate feelings of grieving that, if unresolved, may result in depression. There is usually a distinct change of behavior accompanied by other specific signs and symptoms of depression, such as sleep disturbances, weight loss (sometimes gain), difficulty with concentration, irritability or anger, loss of interest in once pleasurable activities, vague pains, crying, fatigue, and suicidal thoughts or preoccupation with death

Older Adult and the Health Care System- Gerontology

Gerontology is the scientific and behavioral study of all aspects of aging and its consequences. Normal changes that occur with aging result from complex interactions among genetics, biological systems, and physical and social environments.

Cardiac

Heart disease is the leading cause of death for African American men and women. The prevalence of hypertension in Blacks in the United States is the highest in the world, with age-adjusted numbers reflecting 45% prevalence in non-Hispanic Black men and 46.3% prevalence in non-Hispanic Black women. Hypertension is associated with stroke, heart disease, and other vascular diseases. Non-Hispanic Black adults 20 years of age and older are diagnosed with diabetes almost twice as often as their White counterparts. Those who report less than a high school education have an even higher prevalence of diabetes (Benjamin et al., 2017). African Americans have the highest mortality rate of any minority for most major cancers. Black women have the highest death rates of all racial and ethnic groups for breast cancer; colorectal and prostate cancers are more common and faster growing (prostate) in Black men than in other racial or ethnic groups

Often, a medical or nursing intervention can trigger a sequence of adverse events in a frail older adult. This downward spiral and decline is referred to as cascade iatrogenesis.

Here is an example of cascade iatrogenesis: 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.

Social Roles/ Social Isolation

If an older adult cannot adjust and form new relationships, social isolation can become a problem. Social isolation is a sense of being alone and lonely as a result of having fewer meaningful relationships. It may occur because of declining health or income, transportation problems, or ageism. Whatever the cause, prolonged social isolation has been associated with declining health and higher mortality rates.

Physiologic Development

In older adults, all organ systems undergo some degree of decline in overall functioning, and the body becomes less efficient. Body functions that require integrated activity of several organ systems are affected the most. For example, aging of the cardiac muscles causes fluid retention in both peripheral tissues and the lungs, causing swelling of the legs and making breathing more difficult. The most commonly encountered chronic disorders are hypertension, arthritis, heart disease, cancer, diabetes, and sinusitis

Psychosocial Development

Most theorists agree that a person's self-concept is relatively stable throughout adult life. An older adult who has a strong sense of self-identity 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

Life Review/ Reminiscence

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.

Normal Aging Process

Peak years of physiological function late from teen to age 30yrs, Subtle changes related to aging, but not notice until 40 or 50 years of age, In 70-80 years the physiological changes that happen with normal aging are significant and no longer deniable. *Termed normal because they represent alteration in body structure and function that occur gradually throughout the life span. Normal developmental event and patterns of aging vary dramatically among older adults.Each older adult exhibits unique and diverse aging characteristics. Normal aging and disease are separate entities

ADJUSTING TO CHANGES IN OLDER ADULTHOOD

Physical Strength and Health, Retirement and Reduced Income, Spise or Partner Health, Relating to thteir own Age Group,

Polypharmacy

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. Polypharmacy, drug duplication, and unmonitored or unreported use of nonprescription medications can lead to negative outcomes. Pharmacists and other members of the interprofessional health care team need to educate and counsel older adults on these potential issues to minimize the risk for adverse effects, toxicities, and drug-drug interactions

Delirium Prevention

Prevention is the first step in managing delirium. Incidences of delirium are more likely to occur with six key risk factors: cognitive impairment, sleep deprivation, immobility, visual or hearing impairment, and dehydration

Sarcopenia

Sarcopenia is the loss of muscle mass that frequently occurs in older adults as part of the natural aging process. The clinical definition ofsarcopenia has been expanded to include a decrease in muscle mass that is assessed by handgrip strength, and a decrease in physical function that is assessed by gait speed. Sarcopenic obesity describes the muscle loss combined with obesity (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.

SPICES

S—Sleep disorders P—Problems with eating or feeding I—Incontinence C—Confusion E—Evidence of falls S—Skin breakdown has proved effective in identifying common problems experienced in older adults that can lead to negative outcomes. Although not a tool specifically used for the assessment of dementia or delirium, it provides information on hospitalized older adults that may assist in preventing and detecting common complications. The acronym SPICES facilitates assessment and information gathering.

Older adult information

The greatest threat to the health of older adults is loss of the physiologic reserve of the various organ systems. When illness occurs, increased physical and emotional stress place 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 adult with a hip fracture is at high risk for pneumonia and skin breakdown because of immobility, a decreased ability to mobilize pulmonary secretions, and thinner, more fragile skin.

Elder Abuse

The increase in the number of older adults coupled with increasing lifespan has resulted in greater awareness about the problem of elder abuse (EA), which is defined as, "an intentional act or failure to act by a caregiver or another person in a relationship involving an expectation of trust that causes or creates a risk of harm to an older adult"

Loss of Driving Privileges

The loss of the privilege of driving has serious repercussions for older adults. Aging results in slower reaction times and changes in vision, such as increased sensitivity to the glare from approaching headlights as well as alterations in peripheral vision. Certain adjustments can prolong an older adult's ability to drive safely. These include driving only during daylight hours and avoiding travel at stressful times such as morning and evening rush hours. Keeping a safe distance from the car ahead and a watchful eye on unsafe weather conditions are also helpful. 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. The U.S. Department of Transportation is an additional resource; state branches may request that an older driver be retested based on identification of a concern from a health care provider, a police or accident report, or written expressed concern from a family member. As the number of older drivers increases, so do the challenges to promote safe driving and find alternatives to driving (National Highway Traffic Safety Administration, n.d.). Losing driving privileges is disheartening and can cause older adults to feel anxious 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. The availability of alternative means of transportation should be explored. 1441 Some older adults take advantage of transportation services through their communities, or even use Lyft or Uber

The Middle Adult

The middle adult years often are a time of increased personal freedom, economic stability, and social relationships (Fig. 23-1 on page 566). This is also a time of increased responsibility and an awareness of one's own mortality. The middle adult realizes that his or her life may be half or more past and may feel many things are still undone. This realization can lead to a developmental crisis and situational stressors. Several theories regarding the developmental tasks of middle adulthood are described below.

Role of the Nurse in Promoting Health and Preventing Illness (SEE BOX )

The nurse should teach the older adult patient and family general healthpromotion activities. This is important because older people often believe themselves "too old" to worry about nutrition, exercise, health screenings, and immunizations. In addition to the recommended screenings, examinations, and immunizations

Accidental Injuries - 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 fall that might result in serious health consequences. Falls are the most common cause of injuries and hospital admission in older adults. More than 25% of older adults fall each year, but less than half tell their health care providers (CDC, 2016). Fear of falling and indicators of frailty have been shown to

Chronic Illness

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 pneumonia, fractures, motor vehicle accidents, and falls. The leading causes of death in adults aged 65 and older are heart disease, cancer, chronic respiratory disease, stroke, AD, and diabetes

Cognitive Development

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.

Disengagement Theory of Aging

The theory that suggests that successful aging is characterized by a gradual withdrawal from the world on physical, psychological, and social levels

Continuity Theory

a theory focusing on how people adjust to retirement by continuing aspects of their earlier lives. Preserve Old Ways; Predictable.

psychosocial development

domain of lifespan development that examines emotions, personality, and social relationships

sundowning syndrome,

sundowning syndrome, in which an older adult habitually becomes confused, restless, and agitated after dark. Wandering may occur, and coping may be negatively affected by hallucinations, delusions, or paranoia.

Delirium

temporary state of confusion, is an acute illness with a specific, underlying cause that can last from hours to weeks and resolves with treatment of the identified underlying cause. Delirium may not have one specific cause, and in older adults may be due to drug interactions, circulatory or metabolic problems, nutritional deficiencies, or a worsening illness that triggers inflammatory processes and disrupts neurotransmitters. During acute illness, older adults are particularly at risk for delirium because of their decreased cognitive reserve