HEALTH PROMOTION AND CARE OF THE OLDER ADULT

Lifespan Considerations: Older Adulthood

• Older adulthood is divided into four subgroups: young-old (65-74), middle-old (75-84), old-old (85-99), and elite-old (100+).
• "Frail elderly" refers to individuals over 75 with health concerns.
• Centenarians are those aged 100+.
• Chronological age isn't always a reliable indicator of health or behavior; some individuals may exhibit "old" characteristics in their 50s.
• Increased longevity and active lifestyles are common in older adults.

Demographics of Older Adults

• In 2015, 47.9 million people aged 65+ resided in the US (14.9% of the population).
• The population of older adults is growing at twice the rate of the overall population.
• By 2050, estimates predict 83.7 million people over 65 in the US (23.55% of population).
• Approximately 54% of older adults are women.
• Predictions show persistent majority of older adults are non-Hispanic Whites (56%) with significant Hispanic (21.2%) and Non-Hispanic African American (12.5%) populations.
• US Life expectancy in 2015 was 79.3 years (rank 30th globally), increasing by almost 10 years in the last 50.

Wellness, Health Promotion, and Disease Prevention in Older Adults

• Wellness encompasses emotional, spiritual, social, cultural, and physical well-being, even during chronic illness/dying.
• Nurses help older adults adapt to life situations to achieve wellness balance.
• Health promotion emphasizes individual strengths and abilities.
• Primary prevention focuses on exercise, avoiding smoking, balanced diet, and vaccinations (flu, Td, zoster, pneumococcal-PCV13, and PPSV23).
• Secondary prevention aims at early detection/treatment of conditions: heart disease, hypertension, cancer, infections, polypharmacy, nutrition, oral health, osteoporosis, falls, social isolation, (Table 33.1).

Healthy Aging: Myths and Realities

• Ageism is prejudice against older adults, often stemming from negative stereotypes.
• Aging doesn't automatically lead to senility or dementia (6%-8% over 65, and 1/3 over 85).
• Common myths include:
• All old people are senile.
• Forgetfulness indicates declining mental capacity.
• Older adults are isolated.
• Most older adults live in nursing homes.
• Older adults are universally fatigued.
• Older adults are universally ill/disabled.

Theories of Aging

• Biological theories attempt to explain the aging process (programmed aging, genetic factors, immunologic factors, free radical, wear and tear)
• Psychosocial theories explain responses of older adults in late adulthood. (Erikson's Developmental Stages, Disengagement Theory, Exchange Theory, Activity Theory, Continuity Theory). (Box 33.4)

Legislation Affecting Older Adults

• Key legislation impacting older adults includes the Social Security Act (1935), Older Americans Act (1965 - amended 2006), and the National Family Caregiver Support Program (2000), and the Patient Protection and Affordable Care Act (ACA).
• The ACA aims to improve healthcare access by paying preventive services to Medicare and providing discounts to eligible seniors for prescription medications.
• The ACA has raised concerns regarding costs to beneficiaries and insurers.

Psychosocial Concerns of Older Adults

• Caregiving stresses: Caregivers face time constraints, risk stress disorders (depression, anxiety), potential for family conflicts, and sandwich generation challenges (caring for elders and children).
• Loss, grief, and depression: Older adults experience losses across various aspects of life (personal, social, and economic).
• Coping with loss and grief requires addressing isolation and self-pity, helping others, joining groups, activities, adopting pets, maintaining independence, and maintaining a sense of humor.
• Depression symptoms are common in older adults; misdiagnosis is possible.
• End-of-life care: Nurses meet the holistic needs (physical, spiritual, psychosocial)of dying patients, including their families, respecting cultural/religious beliefs. Nurses follow the Patient Self-Determination Act (PSDA) and advance directives (living wills, durable powers of attorney, DNR orders).

Additional Information

• Box 33.1 details traits of a healthy person.
• Box 33.3 lists common myths associated with aging