Transitions and Family Relationships in Aging

Week 3: Transitions, Family Relationships & Home Assessment

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Learning Objectives

• Describe various theoretical perspectives on aging (social, psychological, spiritual, and cognitive).
• Identify key transitions in the life of an older adult.
• Identify how relationships and roles change as an adult ages.
• Discuss issues related to sexuality and intimacy for older adults.
• Identify home hazards for older adults.
• Participate in a virtual simulation experience focusing on client safety, communication, relationships, and community resources for older adults in the Durham Region.

Transitions

• Transition: A process of redefining self and developing agency in response to life events. Moving through these transitions is normal for older adults.
• Developmental Transitions: Retirement, becoming grandparents, situational transitions (widowhood, becoming a caregiver, moving to a senior's residence or downsizing)
• Health-Illness Transitions: Chronic illness, transition between hospital and home, or home to long-term care.
• Transitions can be planned (retirement, moving) or sudden and surprising (widowhood, new diagnosis).
• The speed and intensity of a transition, as well as whether it's anticipated, can affect the transition process.
• It can lead to a transitional crisis or a gradual, controlled adaptation.

Factors that Influence Transitions (Resulting From Loss)

• Personal meaning, Socioeconomic status, Expectations, Knowledge, Emotional reserve, Physical reserve, Planning, Community & Social Conditions.
• The ideal transition involves more gains than losses. Difficult transitions involve more losses than gains.

Retirement

• Historically, retirement lasted a few years between work and death.
• Now, with longer lifespans, retirement could last 30 years or more.
• The federal government estimates that approximately 24% of older adults may not have sufficient income to maintain their standard of living upon retirement.
• Health, income, and social environment influence how successfully individuals transition to retirement.
• People are living longer and seeking employment to support themselves financially after retirement.

Retirement Planning

• Important to plan for retirement.
• Most retirement programs target employees with high levels of education, occupation, or government employment.
• This creates inequities as people age, as those with fewer resources often need more support for retirement planning. Three pillars of financial security are: (1) Federal Old Age Security and Guaranteed Income Supplement. (2) Canada Pension Plan. (3) Private Savings/RRSPs/Pension Plans.

Divorce

• Historically, divorce was considered a stigmatizing event, potentially not discussed due to the stigma associated with it.
• A current trend is that older couples are less likely to stay in unsatisfying marriages.
• Marital breakdowns can be particularly devastating in old age due to their often unanticipated nature.

Relationships

• In Canada, there is no longer a "typical family"; multiple structures and situations exist.
• Discuss how the various factors involved in relationship structures and compositions can impact older adults.
• Examples include: Individuals or couples without children, Divorced older adults, Blended families, Multigenerational families, Grandparents with formal and informal parental roles.
• As families change, the roles and expectations of family members also change. Important to note that 38% of today's families are couples without children. Changes to family structures may include high divorce and re-marriage rates, resulting in blended families with children from previous and new marriages. Multigenerational families are becoming more common.

Widowhood

• 34% of women and 11% of men aged 65 and older are widowed. The rate is lower for men due to men being more likely to remarry.
• Losing a partner after a long, satisfying relationship is a significant life transition.
• Four dimensions of grief reactions: Affective (depression, anxiety, anger, irritability), Cognitive (thoughts of deceased, helplessness), Behavioral (agitation, fatigue, social withdrawal), and Physiological (loss of appetite, energy loss).

2SLGBTQI+ Older Adults

• Less than 1% of Canadians aged 65 and older are in same-sex partnerships.
• These relationships will become more common in future generations.
• Longstanding discrimination and fear may prevent LGBTQ individuals from disclosing their sexual orientation, gender identity, or relationships to healthcare providers.
• Many LGBTQ individuals have non-relatives who become family

Intimacy

• Intimacy is a "warm, meaningful feeling of joy" (Boscart et al., 2023) involving close friendships, family relationships, and knowing one matters to others.
• Components of intimacy include commitment, affective intimacy, cognitive intimacy, physical intimacy, and interdependence.

Sexual Health

• Reflect on societal beliefs about sexuality and aging.
• Sexuality is a central aspect of being human throughout the lifespan, encompassing sex, gender, identities, gender roles, sexual orientations, eroticism, pleasure, intimacy, and reproduction (WHO).
• Despite a positive definition of sexuality, significant stereotypes and stigma remain.

Sexuality & Intimacy in Long-Term Care (LTC)

• As dementia progresses, intimacy and sexuality issues may present challenges.
• Determining a cognitively impaired person's ability to consent to sexual activity involves assessing mental capacity, risks and benefits, and voluntary participation.
• LTC homes have a duty to protect residents from abuse and harm if they lack the capacity to consent to sexual activity.

Nurses' Role

• Older adults dating and having new partners are at high risk.
• Nurses play a crucial role in education and counselling about sexual function, adapting to age-related changes, and promoting open conversations about sexual needs.
• Nurses should be comfortable taking a complete sexual history and providing education about STIs and safe sex practices.

Stats

• Some statistics about Americans having better health and active aging.

Types of Caregiving

• Spousal Caregiving, Aging parents caring for developmentally disabled children, Grandparents raising grandchildren, Long-distance caregiving.

Caring for Older Adults

• Many adult children take on caregiving roles for aging parents.
• Factors that increase the likelihood of being a caregiver include being the closest female relative, having friends or family with medical, financial or legal expertise, being from a financially successful/resourceful family, or part of a community with cultural expectations of caring for elders.

Caring for the Caregiver

• Caregivers must balance work, family, and caregiving responsibilities.
• Nurses should support caregivers by offering resources, education, and listening/emotional support, for both emotional and physical well-being.

DC Connect 3.3 Video

• Watch video and answer questions.

Home Assessment

• Go to DC Connect Module 3.4 for the home assessment.