rnsg 1413 Aging

Mental Impairment in Older Adults

Dementia Alzheimer disease Sundowning syndrome Cascade iatrogenesis-as a related sequence of adverse events that are triggered by an initial medical intervention.

6 Leading Causes of Death in Middle Adulthood

1-Malignant neoplasms 2-Cardiovascular disease 3-Unintentional injury including poisoning, motor vehicle accidents, and falls 4-Diabetes mellitus 5-Chronic lower respiratory disease 6-Cerebrovascular causes

Middle Adulthood:

40 to 65

Developmental Tasks of Middle Adulthood 5 things

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

Disengagement theory:

An older adult may substitute activities but does disengage from society.

Elder Maltreatment

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 (Stark, 2012). Physical abuse, sexual abuse, emotional or psychological abuse, neglect, abandonment, and financial or material exploitation are all types of elder maltreatment (National Center on Elder Abuse, 2011).

Causes of Accidental Injuries in Older Adults

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

Basis for Teaching Plan for Older Adults

Chronic illness limits activities in almost HALF of older adults. Meeting expenses of health care is often DIFFICULT ---------Medication costs, hospitalization costs, and costs of special equipment and supplies Family members must learn to COPE with needs of the ill person. Family members must ADAPT to psychological stressors.

7. Explain the , cognitive changes in the older adult

Cognitive: does not change appreciably, may take longer to respond and react

Life Changes of the Middle Years --- 5 Key points

Employment Relationship with a spouse Relationships with adult children Relationships with aging parents Midlife transition

*Generativity vs. Self-Absorption and Stagnation (Middle Age) middle old adult 75-84.

Following the development of an intimate relationship, an adult focuses on supporting future generations. The ability to expand one's personal and social involvement is critical to this stage of development. Middle-age adults achieve success in this stage by contributing to future generations through parenthood, teaching, mentoring, and community involvement. Achieving generativity results in caring for others as a basic strength. Inability to play a role in the development of the next generation results in stagnation. Nurses help physically ill adults choose creative ways to foster social development. Middle-age people often find a sense of fulfillment by volunteering in a local school, hospital, or church.

Theories of Aging-- just theories-

Genetic: genes control "genetic clocks" Immunity: focuses on the functions of the immune system 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

Housing Options for Older Adults

Home modifications Homesharing Accessory apartments Elderly cottage housing opportunities Senior retirement communities Continuing care retirement communities Assisted living Board and care homes; nursing homes Adult family and group homes

Stage 5: Genital (Puberty Through Adulthood).

In this final stage sexual urges reawaken and are directed to an individual outside the family circle. Unresolved prior conflicts surface during adolescence. Once the individual resolves conflicts, he or she is then capable of having a mature adult sexual relationship. Freud believed that the components of the human personality develop in stages and regulate behavior. These components are the id, the ego, and the superego. The id (i.e., basic instinctual impulses driven to achieve pleasure) is the most primitive part of the personality and originates in the infant The ego represents the reality component, mediating conflicts between the environment and the forces of the id the superego, performs regulating, restraining, and prohibiting actions. Often referred to as the conscience, the superego is influenced by the standards of outside social forces (e.g., parent or teacher).

Kohlberg's theory of moral development

Kohlberg's theory of moral development expands on Piaget's cognitive theory. Kohlberg interviewed children, adolescents, and eventually adults and found that moral reasoning develops in stages. From an examination of responses to a series of moral dilemmas, he identified six stages of moral development under three levels

Moral and Spiritual Development of Older Adults

Kohlberg: Older adults have completed their moral development and most are at a conventional level Spiritually, an adult may be at an earlier level, often at the individuative-reflective level. Many adults demonstrate conjunctive faith and trust in a greater power. Self-transcendence is characteristic of later life.

Kohlberg's theory of moral development levels

Level I: Preconventional Reasoning. --Stage 1: Punishment and Obedience Orientation. --Stage 2: Instrumental Relativist Orientation. Level II: Conventional Reasoning. --Stage 3: Good Boy-Nice Girl Orientation. ---Stage 4: Society-Maintaining Orientation. Level III: Postconventional Reasoning. ---Stage 5: Social Contract Orientation. --- Stage 6: Universal Ethical Principle Orientation.

Integrity vs. Despair (Old Age). old- old adult 85- and older

Many older adults review their lives with a sense of satisfaction, even with their inevitable mistakes. Others see themselves as failures, with their lives marked by despair and regret. Older adults often engage in a retrospective appraisal of their lives. They interpret their lives as a meaningful whole or experience regret because of goals not achieved . . Because the aging process creates physical and social losses, some adults also suffer loss of status and function (e.g., through retirement or illness). These external struggles are met with internal struggles such as the search for meaning in life. Meeting these challenges creates the potential for growth and the basic strength of wisdom (Figure 11-1).

____________ is the disruption of this cycle, primarily because of the inability of the neurohormonal system to maintain its periodic stimulation of the endocrine system. The ovaries no longer produce estrogen and progesterone, and the blood levels of these hormones drop markedly. Menopause typically occurs between 45 and 60 years of age (

Menopause

5. Identify the myths and stereotypes of the older adult

Old age begins at 65 years. Most older adults are in long-term care facilities.- actually less than 15% Older adults are sick, and mental deterioration occurs.- -unless they have dementia this is not true. Just take your time and slow down. Older adults are not interested in sex.---not true 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

PIAGET

Period I: Sensorimotor (Birth to 2 Years). Period II: Preoperational (2 to 7 Years). Period III: Concrete Operations (7 to 11 Years). Period IV: Formal Operations (11 Years to Adulthood).

Changes of Older Adulthood 7 things

Physical strength and health- muscle deterioration- exercise to maintain not to necessarily gain Retirement and reduced income Health of spouse Relating to one's age group Social roles Living arrangements Family and role reversal

7. Explain the physiological, changes in the older adult

Physiologic: all organ systems undergo some degree of decline, body less efficient

Explain the physical and psychosocial changes in middle adulthood

Physiologic: gradual internal and external physiologic changes occur Cognitive: little change from young adulthood- if you don't use it you lose it Psychosocial: time of increased personal freedom, economic stability, and social relationships

Goal of Nursing Care. 5 things

Promote independent function. Support individual strengths. Prevent complications of illness. Secure a safe and comfortable environment. Promote return to health.

7. Explain the psychological changes in the older adult

Psychosocial: Self-concept is relatively stable throughout adult life.

. Explain the health concerns in middle adulthood

Rheumatoid arthritis Obesity Alcoholism Depression

Assessment Tool: SPICES

S - Sleep disorders P - Problems with eating or feeding I - Incontinence C - Confusion E - Evidence of falls S - Skin breakdown (Fulmer & Wallace, 2012)

Freud's psychoanalytical model of personality development 5 stages

Stage 1: Oral (Birth to 12 to 18 Months). Stage 2: Anal (12 to 18 Months to 3 Years). Stage 3: Phallic or Oedipal (3 to 6 Years). Stage 4: Latency (6 to 12 Years). Stage 5: Genital (Puberty Through Adulthood).

Role of the Nurse in Promoting Health- What do we TEACH them ?

Teach the dangers of substance abuse, smoking, and alcohol consumption. Teach adults to eat a diet low in fat and cholesterol. Teach the importance of regular exercise.

e. Changes in special senses-

neuropathy, cant see as well- Fall risk

Period IV: Formal Operations (11 Years to Adulthood). PIAGET

The transition from concrete to formal operational thinking occurs in stages during which there is a prevalence of egocentric thought. This egocentricity leads adolescents to demonstrate feelings and behaviors characterized by self-consciousness: a belief that their actions and appearance are constantly being scrutinized (an "imaginary audience"), that their thoughts and feelings are unique (the "personal fable"), and that they are invulnerable

Erikson's eight stages of life

Trust vs. Mistrust (Birth to 1 Year). Autonomy vs. Sense of Shame and Doubt (1 to 3 Years). Initiative vs. Guilt (3 to 6 Years). Industry vs. Inferiority (6 to 11 Years). Identity vs. Role Confusion (Puberty). Intimacy vs. Isolation (Young Adult).Young old adult- 60-74 Generativity vs. Self-Absorption and Stagnation (Middle Age) 75-84 Integrity vs. Despair (Old Age). old- old adult 85- and olde

4. Discuss the demographics of the older adult population

Young-Old Adult: 60-74 Middle-Old Adult:75-84 Old-Old Adult:85 and older Erickson's Integrity vs Despair Havinghurst

g. Genitourinary

changes kidneys only have 60% of function by this age and this means that meds stay in their system longer (age 60-70)

The __________occurs in men in their late 40s or early 50s (see Chapter 35). Decreased levels of androgens cause climacteric. Throughout this period and thereafter a man is still capable of producing fertile sperm and fathering a child. However, penile erection is less firm, ejaculation is less frequent, and the refractory period is longer.

climacteric

f. Gastrointestinal changes-

constipation

what are the 3 D's ?

dementia, deliria, depression

h. Neurological changes-

dementia, delirium

Freud's psychoanalytical model of personality development

development states that individuals go through five stages of psychosexual development and that each stage is characterized by sexual pleasure in parts of the body: the mouth, the anus, and the genitals. Freud believed that adult personality is the result of how an individual resolves conflicts between these sources of pleasure and the mandates of reality

Erikson:

ego integrity versus despair and disgust; life review

c. Cardiovascular changes-

enlarging, valves are leaky, high BP, always move around.

The psychosocial changes in the middle adult involve ____

expected events such as children moving away from home and unexpected events such as a marital separation or the death of a close friend. You need to ASSESS for major life changes and the IMPACT that the changes have on the middle adult's state of health. Include individual psychosocial factors such as COPING MECHANISMS and sources of SOCIAL SUPPORT in your assessment.

----As people age, their ability to adapt, not the time it takes for them to adapt, is the key determinant for whether they will be____________-

ill or healthy.

Erikson's theory of psychosocial development

individuals need to accomplish a particular task before successfully mastering the stage and progressing to the next one. Each task is framed with opposing conflicts, and tasks once mastered are challenged and tested again during new situations or at times of conflict (Hockenberry and Wilson, 2015). Erikson's eight stages of life are described here.

Havighurst:

major tasks are maintenance of social contacts and relationships

d. Respiratory changes-

respiratory depression, pneumonia

b. Musculoskeletal changes-

they are not maintaining their muscles -lift weights after 40

Integumentary changes--

they don't have as much adipose tissue and skin is thinner, if they are having CO problems then there is less blood going to the skin. Not as much perfusion, skin thins and dries because we don't have the moister, and wrinkles.

Sudden confusion can be caused by As a result an older adult with a

urinary tract infection (UTI) sometimes presents with confusion, incontinence, and only a slight elevation of body temperature (within normal limits) instead of having fever, dysuria, frequency, or urgency. Some older adults with pneumonia have tachycardia, tachypnea, and confusion with decreased appetite and functioning, without the more common symptoms of fever and productive cough. Instead of crushing, substernal chest pain and diaphoresis, some older adults experience a sudden onset of dyspnea often accompanied by anxiety and confusion when having a myocardial infarction.