NUR 304 Young, middle-aged, older adult

Young Adult Political Domain

Ability to vote: local, state, national elections Ability to be elected to local, state, national offices Opportunities for full engagement in political process Choices/options for support of specific or broad political issues

Classification of Young Adult

Age 18 - 35 (will never ask the age brackets on test) Extension of work/issues from adolescence into early years of young adulthood Health promotion, disease prevention strategies Healthiest period of life is adolescence Domains: biological, psychological, social, political, environmental, sexual, spiritual

Middle Aged Adult Classification

Age 35-65 Relative stability in job/career Sandwich generation Critical time for health-promotion lifestyles Major improvements in overall health Move to reduce effect of chronic illness (Healthy People 2020)

Older Adult Classification

Age of 65 and older Geriatrics - specialized branch of medicine focusing on treatment of the elderly Gerontology - study of the elderly and the aging process Focus on successful, healthy aging

Older Adult Physical Assessment

Age-related physiologic changes Functional status Mental status Components for a holistic assessment Nursing considerations Health promotion tips

Theories Related to Aging

Biological Genetic Wear and tear Neuroendocrine Free radical Cross-linkage Sociological Disengagement Activity Continuity Psychological Human Needs Evolving Evolutionary

Older Adult Immunizations

Center for Disease Control and Prevention: Summary for Recommendations for Adult Immunizations http://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html Center for Disease Control and Prevention: Screening Checklist for Contraindications to Vaccines for Adults

Young Adult Psychological Domain

Cognitive development - Jean Piaget Formal operations reasoning Ego development - Jane Loevinger Jean Piaget's cognitive development Kohlberg's moral development Sullivan's development of self esteem Movement through stages (Table 11-4) Moral development Intimacy versus isolation - Erik Erikson Early adulthood periods - Daniel Levinson Crises of young adulthood - Gail Sheehy

Young Adult Spiritual Domain

Commitment to religious or spiritual practices Engagement of children in religious beliefs/practices Range of levels of participation in organized religious faith versus less formal practices

Young Adult Environmental Domain

Continuation of environmental concerns from adolescence: automobile accidents, firearms, poisoning, sports injury, drowning, burns Occupational hazards Biological Respiratory Chemical Physical Safety Psychological

Young Adult Screening

Cost issues - presence of health insurance Substance use - tobacco, alcohol, marijuana, cocaine Sexually transmitted diseases Malignancies Breast self-examination (BSE) Papanicolaou (Pap) test Testicular self-examination (TSE)

Older Adult Psychological Domain

Depression Contributing factors Incidence among older adults Issues related to diagnosis Geriatric depression scale Stress Contributing factors Elder abuse Definition Prevalence Recognition of abuse Physical Sexual Emotional/psychological Psychological neglect Financial or material exploitation Self-neglect

Older Adult Fitness and Exercise

Education of elderly on benefits of exercise Maintain strength, prevent atrophy of muscles Inclusion of weight training, aerobics, calisthenics WALC model Walk, Address, Learn, Cues

Middle Adult Environmental Domain

Effects of tobacco use Effects of long term exposure to second hand smoke High-stress work environments Socioeconomic factors

Middle Aged Adult Psychological Domain

Erik Erikson - Generativity versus self-absorption Family relationships Spouse/partner Children Parents Extended family Career Career changes Retraining/education Mentorship Leisure time Hobbies Community service Transition/planning for retirement Facing one's mortality Financial security/insecurity Career implications Military service

Developmental Tasks of Aging

Erikson's last of eight stages Ego integrity versus despair Peck Extended Erikson's last stage into three tasks Havighurst Six stages of adjustment to physical, social, and environmental effects of aging Review Table 13-3 (p. 276)

Young Adult Sexual Domain

Establishing relationships as homosexual or heterosexual Assessment of sexuality and sexual partnerships Initiation of raising a family Economic Social Emotional Assessment and treatment for premenstrual syndrome

Young Adult Social Domain

Establishing separate residence from family of origin Emotional autonomy - facilitated by supportive family Move to initiation of a career College Professional schools Trades Military service Transition during adolescence/early adulthood Career through middle-aged time frame Co-habitation or marriage Increase in age for first marriage Decrease in divorce rate Establishing heterosexual or homosexual relationships Social response to homosexuality Intimate Partner Violence Assessment/recognition for signs/symptoms Awareness of intervention strategies

Middle Aged Adult Physical Domain

Female climacteric Perimenopause Menopause Male climacteric Andropause Changes in overall physical activity, e.g., loss of muscle strength

Middle Adult Genetic and Genomic Issues

Genetics - one gene disorder Genomics - multiple genes interacting with each and the environment Use of genetic testing and family history to guide health interventions Goal of Healthy People 2020 Online tool "My Family Health Portrait"

Older Adult Sex

Importance in holistic assessment Connection to another Erectile dysfunction Pharmacologic interventions Cautions Sexual orientation HIV and AIDS

Young Adult Rest

Inadequate sleep is a common problem ( ∼ 8 hours/night) Work related hours Social engagements Families with young children Effects of stress → reduction efforts Meditation Positive physiological changes ↓ Heart rate, blood pressure, respiratory rate ↑ Alpha brain waves

Middle Aged Adult Depression

Increase in occurrence with middle-aged adults Importance of assessment of mood disorders during regular health evaluations Studies have explored/identified: Associated alcohol or substance abuse Racial/ethnic differences Demographic characteristics

Young Adult Nutrition

Many issues influence nutritional habits Ethnic heritage Financial status Religious beliefs Personal likes/dislikes Over-weight/Obesity occurrence (20-39 years of age) 28% males; 36% females Increased risk for type 2 diabetes, hypertension, cardiac disease, gallbladder disease High-calcium content foods for females; supplements to obtain 1,200 - 1, 500 mg/day

Older Adult Risk Assessment

Nutrition Exercise Tobacco avoidance Injury prevention Immunizations Stress and mental health Oral care and skin care Sexuality

Middle Adult Risk Assessment

Nutrition Family History Exercise Addictive behavior Tobacco avoidance Mental health Immunizations Dental care Workplace exposures Sexuality

Middle Adult Occupational Safety

Occurrences for work-related deaths and injuries Assessment for Work-related potential for stress and violence Risk for back injuries Risk for exposure to biological hazards Risk for exposure to environmental carcinogens

Nursing Role Health Promotion and Early Detection

Pender's Health Promotion Model Individual characteristics and experience Behavior specific cognitions and effects Outcomes Educating about risk reduction and health promotion Importance of communication Build on developmental stage Use adult learning principles Motivation to learn Problem solving Immediacy Skill practice

Young Adult Biological Domain

Physical growth complete by age 20-25 Male growth extends into the mid twenties (not unusual for males to have another growth spurt once entering college) Building, maintaining body's health Nutrition Exercise Rest Screenings Substance abuse Alcohol, marijuana, cocaine, Sexually transmitted infections Malignancies

Older Adult Cultural Domain

Population trends Issues related to health promotion Diversity Disparities Literacy Communication Understanding

Middle Adult Dental Health

Positive effect of water fluoridation, fluoride toothpaste More middle-aged adults will maintain their natural teeth Over 70% of adults report seeing a dentist in past 12 months Impact of lack of health insurance

Middle Adult Tobacco Avoidance

Positive effects from smoking cessation in middle-age adults Ask Advise Assist Arrange

Older Adult Socioeconomic Domain

Poverty Characteristics in the older adult population General statistics Ethnicity Gender Geographic location Education Relationship to Health status Lifestyle Health insurance and preventive care Indications for health promotion Health care expenditures Factors related to increased costs Hospital and physician services, prescription drugs, and long-term care Out-of-pocket expenditures

Middle Adult Sleep

Recommended 6 to 8 hours/night Insomnia - difficulty falling asleep; difficulty staying asleep Problems with Daytime drowsiness Reduced concentration Work performance Recognition of sleep rituals

Older Adult Spiritual Domain

Relationship to stress and coping Erikson's developmental stage of integrity versus despair Socialization opportunities NANDA diagnoses Spiritual distress Potential for enhanced spiritual well-being

Middle Adult Sexual Domain

Review of sexual activity/partners Assessment for sexually transmitted diseases Screening for HIV if sexually transmitted disease evident Evaluation for anemia, overall physical functioning

Middle Adult Exercise and Nutrition

Rise in obesity in United States 2000 to 2009 Effects of regular physical activity to reduce risk for variety of diseases Effects of physical activity to improve muscular and bone strength Counseling to progress physical activity at appropriate pace

Middle Adult Culturally Competent Care

Role of family versus focus on individual Recognition/understanding of cultural preferences Sensitivity and preparation for language needs Translation Language preferences Awareness of ethnic effects on illnesses/conditions

Middle Adult Sociological Domain

Role of parenting children who are moving into young adulthood Role of monitoring status/care for aging parents Focus on career/job responsibilities Pregnancy for women over 40 Parenting grandchildren

Young Adult Exercise

Role of regular activity to prevent disease, e.g., coronary heart disease, hypertension, obesity Positive psychological effect Focus on short-term effects; risks for injury Common activities: running, walking, swimming, cycling

Older Adult Environmental Domain

Safety in driving for older adults Importance of mobility Elderly drivers and accidents Risk factors affecting driving safety Driving tips for older adults Safety at home Leading cause of deaths and injuries in home Modifications and tips for home safety General Stair use Kitchen Bathroom Monitoring devices Medication safety Extent of medication usage Polypharmacy Drug interaction possibilities Medication guidelines Importance of keeping medication list Safety and Assisted Living Facilities (ALFs) ALFs defined Various names of ALFs Types of services offered Regulations/licensures/certifications Nursing homes ALFs Elderly and Disaster Preparedness Effects of Poverty Chronic health conditions Depression Risk Assessment

Assessment Middle-Aged Adult

Screening considerations Sensitivity of test - ability to correctly give positive result Specificity of test - accuracy to correctly give negative result Recommended screening tests for females Blood pressure Cholesterol Height and weight Smoking status/alcohol use Mammography Pap Smear Colonoscopy Recommended screening tests for males Blood pressure Cholesterol Height and weight Smoking status Colonoscopy Alcohol/substance use

Middle Adult Spiritual Domain

Significance of spiritual life in daily, regular life practices Impact of spiritual/religious life on choices for health care Middle-aged adults may align more strongly with religious directives

Older Adult Sleep

Sleep characteristics and patterns Common sleep disturbances Factors associated with dysomnia Psychological Physical Pharmacological Measures to promote sleep Effective steps for implementation

Older Adult Nutrition

Social situation has effect - living alone Physical effects of poor nutrition Financial influences Choices of food Social resources

ALFs and safety issues

Staff Adequate Qualified Types of residents Resident characteristics Suggested preclusions for admission to an ALF Suggestions for families in choosing an ALF The Joint Commission's ALF safety goals

Skin Cancer Prevention

Sunscreen At all times for activities outdoors Adequate amounts with re-application as often as needed, e.g., hourly while swimming With cloud cover - 80% of UV radiation penetrates cloud cover Avoid sun exposure between 10:00AM to 4:00PM Sunglasses that UV requirements Sunscreen alone may not prevent melanoma

Older Adult Population Trends

United States 1776 to projections for 2050 Changes in life expectancy Managing of chronic illnesses Global trends World's older population should triple by 2050 Baby boomers Born between 1946 and 1964 Effects on health care

Health Promotion Measures forMajor Deviations from Health

Vision and hearing Diabetes mellitus: Groups at risk Ages 20-44 and over 65 Obesity Racial and ethnic groups Cancer Groups at risk Gynecologic cancers Importance of oral and lymphatic system assessment Osteoporosis Age (55 and older); low body weight (< 154lb)

Demographics of Older Adults

Who are the older adults? Age Feel-age Cognitive age Stereotype age Comparative age Self-perceived age Heterogeneity of age identity groups 65-74 75-84 85 or older