Chapter 24: The Aging Individual PDF

**Chapter 24: The Aging Individual** - **Gerontology**: study of aging process - **Geriatrics**: branch of clinical medicine specializing in problems of the elderly population - **Geropsychiatry:** specializing in psychopathology of elderly population - Age Classifications per U....

**Chapter 24: The Aging Individual** - **Gerontology**: study of aging process - **Geriatrics**: branch of clinical medicine specializing in problems of the elderly population - **Geropsychiatry:** specializing in psychopathology of elderly population - Age Classifications per U.S. Census Bureau - Older: age 55-64, Elderly: 65-74, Aged: 75-84, Very old: over 85 - Gerontological classification - Young old: 60-74, Middle old: 75-84, Old-old: over 85 - **Epidemiology**: - Population of Americans over 65 years old - 1980-25.5million; 2016-49.2million; 2060-estimated 98 million - Marital Status - 2016: 70% men & 46% women 65 years & older married - 33% women are widowed; consistent with longer life expectancy in women - Living Arrangements - Majority live alone, with a spouse, or with relatives - 1 million Americans over 60 y/o are caregivers to one or more grandchildren - 3-9% live in institutions (increases with age) - Employment - Age Discrimination Act 1967 - Women over 65 y/o active in workforce: In 2000= 9.7% and increased in 2017 to 15.7 - Desire to stay active & productive vs need for income - **Application of psychological theories:** - Personality Theory - Some suggestion old age & early life personality traits are similar - Gene associated with conscientiousness may be linked to neurodegenerative diseases - Developmental Task Theory: Concept of transcendence - Disengagement Theory - Process of withdrawal from societal roles and responsibilities - Process is predictable, systematic, inevitable, and necessary for proper societal functioning - **Psychological aspects of aging:** - **Memory**: Short-term memory deteriorates. Lengthened memory scanning - **Intellectual functioning & learning ability** - Crystalized vs fluid abilities. No change in ability to learn - **Adaptation to Tasks of Aging:** Loss & grief. Attachment to others. Maintenance of self-identity. Death - **Psychiatric disorders in later life:** - Neurocognitive Disorders, Delirium, Depression, Schizophrenia, Anxiety - Substance Use Disorders, Sleep disorders - **Special concerns:** - Retirement - Social Implication - Economic Implications - Medicare/ Medicaid "medi-gap" - Long-term Care: 4% (1-9% range) over 65 y/o live in nursing homes - Suicide: In 2016, highest rates in age 45-54 & 2^nd^ highest in over 85 y/o - **KNOW Elder Abuse:** - 1 in 10 older Americans is victim of abuse - Only 45% report these crimes. Physical, sexual, emotional, neglect, or financial - Abuser is often related & may be assigned caregiver - At risk: under economic stress, substance use, personal experience of abuse/family violence, exhaustion/frustration within caregiver role - Most common victims are white women over 70 y/o - **KNOW ALL Identifying elder abuse:** - **Psychological abuse**: depression, withdrawal, anxiety, sleep disorders, increased confusion or agitation - **Physical abuse**: bruises, welts, lacerations, burns, punctures, evidence of hair pulling, skeletal dislocations and fractures - **Neglect:** consistent hunger, poor hygiene, inappropriate dress, consistent lack of supervision, consistent fatigue or listlessness, unattended physical or medical needs, or abandonment - **Sexual abuse**: pain, itching, bruising, or bleeding in genital areas, unexplained STDs - **Financial abuse**: disparity between assets & satisfactory living conditions, or complaints of sudden lack of funds for daily living expenses - **Assessment:** - Consider normal aging process & aging is different for everyone - Thought processes, orientation, states of confusion. Sensory capabilities (loss of hearing). Functional capabilities - **KNOW Sensory capabilities**: - Since hearing loss is common, nurse should lower the pitch of voice when talking & speak clearly - Looking directly into the face facilitates communication - Ask questions that require response using declarative sentence \[provides info or states a fact\] - Assess pt's adaptation to the dark, color matching & perception of color contrast - **Nursing dx:** - Physiological related focus: - Risk for trauma, Hypothermia, Decreased cardiac output - Ineffective breathing pattern, Risk for aspiration. Impaired physical ability, Imbalanced nutrition - Bowel/ bladder concerns, Disturbed sensory perception - Psychosocial related focus: - Disturbed thought process AEB short-term memory loss, confusion, or disorientation - Complicated grieving, Risk for suicide, Powerlessness; Risk for trauma (elder abuse) - Low self-esteem, Fear, Disturbed body image, Sexual dysfunction, Social isolation - **Outcomes:** - **Patient** - Not experienced injury. Manages own self-care with assistance - Maintains reality orientation consistent with cognitive level of functioning - Expresses positive feelings about self, past accomplishments, & hope for future - Compensates adaptively to diminished sensory perception - **Caregiver** - Problem-solve effectively. Adaptive coping skills for caregiver role stress - Openly express feelings. Express desire to join support groups - **KNOW Interventions**: - **Assure environmental safety** - Rearrange furniture, move items into/ out of reach - Lowest elevation for bed; use padded side rails & headboard - Room nearest RN station. Assist with ambulation. Use of nightlights - **Orientation:** Clocks, calendars, reminders. Simple explanations; speak slowly; do not shout - **Self-care: simple structure environment** - Provide assistance as needed. Promote independence when appropriate/Allow time to perform tasks. Provide guidance/ prompts as needed - **Caregivers** - Assess abilities to fulfill unmet needs - Provide information to assist caregivers w/ these responsibilities - Encourage attendance/ engaging in group support systems. Encourage to express feeling (anger) - **Self-esteem** - Patient to express feelings r/t loss of prior status. Assist with methods for memory deficits - Encourage communication - **Perception disturbances** - Encourage wearing glasses, hearing aids, prosthetics, and other adaptive devices - Use large print. Meaningful sensory stimulation. Lighting that distinguishes day/night - Locate food on a plate using a "clock system". Position self at eye level no more than 6 feet away - **KNOW Reminiscence therapy: box 24-2** - **Thinking & reflecting on the past** - May promote better mental health in old age. Increased self-esteem & less likely to suffer depression - **One-to-one setting** - Provides space to work through unresolved issues that may be too painful to discuss in group - **Group setting** - Share significant past events with peers. Share both positive & negative aspects - **Evaluation:** - Escaped injury from falls, burns, or other means of vulnerability because of age? - Can caregivers verbalize means of providing a safe environment for the client? - Maintain optimum reality orientation for cognitive functioning & distinguish between reality-based and non-reality-based thinking? - Caregivers verbalize ways in which to orient the client to reality, as needed? - Able to accomplish self-care activities independently to their optimum level of functioning? - Seek assistance for aspects of self-care that he or she is unable to perform independently? - Express positive feelings about himself or herself? - Does the client reminisce about accomplishments that have occurred in his or her life? - Does the client wear eyeglasses or a hearing aid, if needed, to compensate for sensory deficits? - Does the client use helpful aids, such as signs identifying various rooms, to help maintain orientation? - Can the caregivers work through problems and make decisions regarding care of the elderly client? - Can the caregivers demonstrate adaptive coping strategies for dealing with the strain of long-term caregiving? - Are the caregivers open and honest in the expression of feelings? - Can the caregivers verbalize community resources to which they can go for assistance with their caregiving responsibilities? Have the caregivers joined a support group?