NCM-114-PRELIM-POINTERS-2 PDF

**WEEK 1-2 : Gerontology: Introduction to Aging** GERONTOLOGY - the study of aging and older adults. \- multidisciplinary GERIATRICS -- medical specialty focused on the care and treatment of older persons (e.g., diseases, disabilities) BABY BOOMERS -- people born from 1946 -- 1964. \- age 70 an...

**WEEK 1-2 : Gerontology: Introduction to Aging** GERONTOLOGY - the study of aging and older adults. \- multidisciplinary GERIATRICS -- medical specialty focused on the care and treatment of older persons (e.g., diseases, disabilities) BABY BOOMERS -- people born from 1946 -- 1964. \- age 70 and above. AGEISM -- stereotyping, prejudice, or discrimination against individuals because of their chronological age ( Butler, 1968). Gerontological Nursing -- advocating for the health of older adults at all levels of prevention. Individual Aging \- the process of growing older and the various changes that occur over time. ▪Chronological Age \- the actual number of years a person has lived, counted from birth. ▪Physical Age \- a.k.a. biological age. \- the condition of an individual's body influenced by both external and internal factors. ▪Functional Age - measures the individual's ability to perform everyday tasks and activities. Population Aging - Characterized by the increasing number of persons belonging to ages 60 years and above. Theory of Demographic Transition -- growth of populations over a long period of time characterized by three stages; 1\. Pre-transition stage- high birth and high death rates. \- Almost zero growth in the population \- High death rates mean people on average live shorter lives. 2\. Transition stage \- Death rates drop due to improvements in healthcare and sanitation, while birth rates remain high. This results in rapid population growth. 3\. Post-transition stage \- Birth rates begin to decline as families choose to have fewer children, leading to slower population growth. Global Terminologies in Gerontology 1\. Aging \- Definition: The process of becoming older, characterized by biological, psychological, and sociocultural changes. 2\. Longevity \- Definition: The length of time that individuals live, often studied in relation to health and life satisfaction among older adults. 3\. Life Course Perspective \- Definition: An approach that considers how various social, economic, and historical factors interact with an individual\'s biological aging over their lifetime. 4\. Aging in Place \- Definition: The ability of older adults to live in their own homes and communities as they age, with appropriate support and services. 5\. Active Aging \- Definition: A concept that emphasizes the continued participation of older adults in social, economic, cultural, and civic activities, contributing to their well-being. 6\. Cognitive Aging \- Definition: The study of how cognitive functions, such as memory and problem-solving abilities, change with age. 7\. Social Gerontology \- Definition: A subfield of gerontology that explores the social aspects of aging, including social support systems, networks, and the impact of societal factors on older adults. 8\. Eldercare \- Definition: The care of older adults, which may include personal assistance, health care, and social support services. Major Issues & Problems Affecting Older People ▪Transportation, both in urban & rural areas. ▪Safe, adequate, & comfortable housing. ▪Crime, abuse, & financial exploitation. ▪Inadequate access to quality health care and long-term care. ▪Multiple chronic illnesses ▪Inadequate financial resources ▪Limited family or friend support (outlive family & friends) **WEEK 3: II. DYNAMICS OF THE AGING PROCESS / THEORIES OF AGING** Framework of Life Course Acquisition Definition: Acquisition refers to the process of gaining skills, knowledge, experiences, and resources throughout life. This includes education, career development, relationship building, and emotional intelligence**.** Struggle Definition: Struggle encapsulates the challenges and adversities individuals face throughout their lives. These can be personal, social, economic, or related to health and wellbeing. Legacy Definition: Legacy refers to the impact individuals leave behind through their actions, relationships, and contributions to society. This can encompass what one passes on to future generations, both materially and in terms of values, traditions, and social connections. **Theories of Aging** **Biological Theories** - Biologic theories focus on physiologic processes and changes associated with aging, independent of external influences. - They aim to identify factors that initiate the aging process at molecular, cellular, and systemic levels. [Cross- *Linkage Theory*] The cross-linkage theory of aging posits that proteins become increasingly cross-linked with age, hindering metabolic processes and nutrient/waste transport. Primarily involves collagen, leading to decreased function and structural changes, exemplified by aging skin losing suppleness and elasticity. Cross-linkage agents include unsaturated fats, polyvalent metal ions (e.g., aluminum, zinc), and excessive radiation exposure; common medications may contain these agents. [Mitochondrial Free Radical Theory] Free radicals are byproducts of metabolism, potentially increased by environmental pollutants. Normally neutralized by enzymes and antioxidants; if not, they can damage cell membranes through lipid peroxidation. Damage to mitochondrial membranes can disrupt internal homeostasis, leading to cell death. [Hayflick Limit Theory] The theory suggests that life expectancy is species-specific, with human life expectancy estimated between 110 to 120 years. The Hayflick Limit Theory is also referred to as the \"Biologic Clock Theory,\" \"Cellular Aging Theory,\" or \"Genetic Theory.\" [Immunologic Theory] Altered immune regulation increases autoantibodies, heightening the risk of autoimmune diseases (e.g., systemic lupus erythematosus, rheumatoid arthritis). Reduced T-lymphocyte proliferation slows allergic responses in older adults. Decreased cytotoxic T cells result in more infections due to weaker responses to foreign materials. T lymphocyte dysfunctions lower responses to viral antigens and tumor cells, leading to an increased cancer risk in older adults. *Nursing Implications:* Caregivers should relate biological aging theories to the care of older adults to understand changes and differentiate between normal aging and pathological conditions. Two accepted biological aging concepts include: 1\. Limited replicative capacity of cells leading to damaged genes and oxidative damage. 2\. Free radicals cause cellular damage over time. *Health promotion strategies for older adults include:* Smoking cessation to reduce cell turnover and cancer risk. Education on sun exposure to minimize cell mutations leading to malignancies. Encouraging physical activity to maintain muscle strength and joint function, while also enhancing overall well-being. Suggested activities to promote functional independence include: Exercises to improve upper arm strength and hand dexterity. Daily walking to enhance circulation, manage weight, and replace fat with muscle tissue. **SOCIOLOGIC THEORIES** Sociologic theories focus on the changing roles and relationships of older adults and their social adaptations. These theories are influenced by the societal values at the time of their development. [ACTIVITY THEORY] Havighurst proposed that successful aging is linked to staying active, leading to the development of \"activity theory\" a decade later. Activity theory emphasizes that being active is essential for maintaining life satisfaction and a positive self-concept in older adults. The theory is based on three key assumptions: 1\. Activity is preferred over inactivity. 2\. Happiness is preferred over unhappiness. 3\. Older individuals are the best judges of their own success in achieving activity and happiness. [CONTINUITY THEORY] Suggests that individuals continue to behave and adapt based on their experiences and characteristics from earlier life stages. [Age Stratification Theory] Key aspects of the theory include: 1\. Individuals age as part of cohorts that progress socially, biologically, and psychologically. 2\. New cohorts are born, each with its unique historical experiences. 3\. Society is structured into various strata based on age and roles. 4\. Both individuals and roles within strata, as well as society itself, are continuously evolving. 5\. The relationship between aging individuals and society is dynamic rather than stagnant. [Person-Environment Fit Theory] Key personal competencies: Ego strength Motor skills Biological health Cognitive and sensory-perceptual *Nursing implications:* Older adults cannot be viewed as a uniform group; they can be categorized into distinct cohorts: young-old (65-74), middle-old (75-84), old-old (85+), and elite-old (100+), each with unique histories and variations based on culture, gender, health, and family status. Individual differences influence how older adults respond to stress, challenges, and social interactions, shaped by past experiences and beliefs. Nurses should respect individual responses while identifying maladaptive behaviors such as withdrawal, which may indicate underlying issues like depression. Planning suitable, realistic activities is essential for enhancing older adults\' self-confidence and promoting engagement, avoiding frustration and feelings of inadequacy. Understanding older adults\' past experiences and beliefs aids healthcare providers in offering meaningful patient care and education tailored to their needs. **PSYCHOLOGICAL THEORIES** - Psychological theories of aging posit that development continues throughout the lifespan, not ending at adulthood. - Transition occurs as individuals move from middle to later life, affecting roles, abilities, perspectives, and belief systems. [Maslow's Hierarchy of Human Needs ] - Maslow\'s theory posits that human behaviors are motivated by an internal hierarchy of needs, progressing through different levels. - Needs are structured as a pyramid, starting with basic physiological needs for survival (e.g., food) at the base. ***[Jung's Theory of Individualism ]*** - Carl Jung\'s theory outlines personality development in four stages: childhood, young adulthood, middle age, and old age. - The onset of middle age often triggers a \"midlife crisis,\" marked by questioning values, beliefs, and unrealized dreams, leading to emotional and behavioral turmoil. [Erik -- Erikson's 8 Stages of Life] 40-65: generativity vs stagnation 65 and older: integrity vs despair [Selective Optimization with Compensation] The adaptation process consists of three interacting elements: 1\. Selection: Restricting life to fewer functioning domains due to age-related losses. 2\. Optimization: Engaging in behaviors to enrich life. 3\. Compensation: Developing alternative adaptations to compensate for losses caused by aging. *Nursing implications:* Nurses should plan activities that validate older adults' contributions to society, like recording oral histories or creating murals, which also facilitate intergenerational knowledge transfer. Programs promoting interactions between older adults and young children can foster feelings of being valued and provide meaningful physical contact, reducing stress. **WEEK 4-5: PHYSIOLOGIC AND PSYCHOSOCIAL ASPECTS OF AGING** **Growth** is physical change and increase in size. It can be measured quantitatively. Indicators of growth include height, weight, bone size, and dentition. **Development** is an increase in the complexity of function and skill progression. Principles of Growth and Development a\. Growth and development are continuous processes influenced by maturational, environmental, and genetic factors. b\. All humans follow a predictable pattern, but timing and individual effects vary. c\. Learning can aid or hinder maturation based on what is learned. d\. Each developmental stage (e.g., Piaget\'s sensorimotor stage) has specific characteristics. e\. Growth follows a cephalocaudal direction (head to feet) and a proximodistal direction (center to outward). f\. Development progresses from simple to complex tasks, requiring coordination and integration of multiple actions. g\. Differentiated development evolves from generalized responses to skilled, specific reactions. h\. Certain growth stages, like the first 10-12 weeks postconception, are critical for avoiding anomalies. i\. Growth rates vary, with significant growth during infancy and asynchronous development observable at different life stages. Stages of Growth and Development of Older Adults - Young-old (65-74 years) Adaptation to retirement and changing physical abilities is often necessary. Chronic illness may develop. Assist clients to keep physically and socially active and to maintain peer group interactions. - Middle-old (75-84 years) Adaptation to decline in speed of movement, reaction time, and increasing dependence on others may be necessary. Assist clients to cope with loss (e.g., hearing, sensory abilities and eyesight, death of loved one). Provide necessary safety measures. Old-old (85 older) - Increasing physical problems may develop. - Assist clients with self-care as required and maintaining as much independence as possible. Normal Physical Changes in Aging Integumentary \- Increased skin dryness \- Increased skin pallor Increased skin fragility \- Increased skin fragility \- Progressive wrinkling and sagging of the skin \- Brown "age spots" (lentigo senilis) on exposed body parts (e.g., face, hands, arms) \- Decreased perspiration - Thinning and graying of scalp, pubic, and axillary hair \- Slower nail growth and increased thickening with ridges Neuromuscular \- Decreased speed and power of skeletal muscle contractions \- Slowed reaction time \- Loss of height (stature) \- Loss of bone mass \- Joint stiffness \- Impaired balance \- Greater difficulty in complex learning and abstraction Sensory/Perceptual \- Loss of visual acuity \- Increased sensitivity to glare and decreased \- Partial or complete glossy white circle around the periphery of the cornea (arcus senilis) \- Progressive loss of hearing (presbycusis) \- Decreased sense of smell \- Increased threshold for sensations of pain, touch, and temperature Pulmonary \- Decreased ability to expel foreign or accumulated matter \- Difficult, short, heavy, rapid breathing (dyspnea) following intense exercise Cardiovascular \- Reduced cardiac output and stroke volume, particularly during increased activity or unusual demands; may result in shortness of breath on exertion and pooling of blood in the extremities \- Reduced elasticity and increased rigidity of arteries \- Increase in diastolic and systolic blood pressure \- Orthostatic hypertension Gastrointestinal \- Delayed swallowing time \- Increased tendency for indigestion \- Increased tendency for constipation Urinary \- Reduced filtering ability of the kidney and impaired renal function \- Less effective concentration of urine \- Urinary urgency and urinary frequency \- Tendency for nocturnal frequency and retention of residual urine Genitals \- Prostate enlargement (benign) in men \- Multiple changes in women (shrinkage and atrophy of the vulva, cervix, uterus, fallopian tubes, and ovaries; reduction in secretions; and changes in vaginal flora) \- Increased time to sexual arousal \- Decreased firmness of erection, increased refractory period (men) \- Decreased vaginal lubrication and elasticity (women) Immunologic \- Decreased immune response; lowered resistance to infections \- Poor response to immunization \- Decreased stress response Endocrine \- Increased insulin resistance \- Decreased thyroid function Factors Influencing Growth and Development Genetics/Genetic Inheritance \- refers to the traits and characteristics that you get from your parents at the moment you are conceived, which is when a sperm fertilizes an egg. Temperament \- refers to the natural way people respond to their surroundings and experiences---essentially, how they react to life's ups and downs. Family \- A family is like a safe home base where a child can grow and learn. It provides love and support, which helps the child feel secure and confident. Nutrition \- Adequate nutrition means getting the right types and amounts of food that your body needs to be healthy. Environment \- many environmental factors---including living conditions, family financial status, climate, and community---can have a big impact on a child\'s growth and development. Health \- Illnesses, injuries, congenital conditions, and the stress of hospitalization can all hinder a child's ability to grow physically, emotionally, and socially. Culture \- The types of food provided, the way children are raised, the values taught, and the traditions celebrated all contribute to shaping who they are and how they interact with the world. **PSYCHOSOCIAL ASPECTS OF AGING** **Psychological Development** - Refers to the pattern of psychological and social changes that occur throughout a person's life. Psychosocial Aging - Refers to the psychological aspects of the aging process. - It encompasses the changes in cognitive, emotional, and social functioning that occur as individuals grow older, as well as how they adapt to these changes within their societal context. ### ### Developmental Tasks of Older Adults **60 TO 75 YEARS** Adjusting to decreasing physical strength and health Adjusting to retirement and lower fixed-income Adjusting to the death of parents, spouses, and friends Adjusting to new relationships with adult children Adjusting to leisure time Adjusting to slower physical and cognitive responses Keeping active and involved Making satisfying living arrangements as aging progresses **75 YEARS AND OLDER** Adapting to living alone Safeguarding physical and mental health Adjusting to the possibility of moving into a nursing home Remaining in touch with other family members Finding meaning in life Adjusting to one's own death Psychosocial Assessment - Psychosocial assessments differ from routine physical assessments, often seen as formal tests for personality and psychiatric needs rather than integral components of holistic nursing care. - Critical components of psychosocial assessments include mental status, decision-making capacity, affective function, reality orientation, and social support, which nurses must assess based on individual circumstances. Purpose of Physical Assessment: \- Detecting Health Problems: Early identification of asymptomatic or unacknowledged health issues. \- Signs of Dysfunctions: Recognizing symptoms of psychosocial dysfunction such as anxiety, depression, memory issues, and changes in mental status. \- Identifying Stressors: Finding stressors and risk factors that can be addressed through interventions to improve cognitive, emotional, or social functions. \- Information on Personality: Gathering details about the individual's usual personality traits, coping strategies, and cognitive abilities. \- Social Supports: Identifying existing social supports and resources that can be enhanced or strengthened. \- Personal Goals: Understanding the older adult\'s personal goals related to psychosocial wellness to guide care and interventions Methods of Assessment: Nurses gather psychosocial assessment information through interviews with older adults and caregivers, as well as through observation in various healthcare settings. Setting Differences: In acute care, assessments are performed at admission to establish a baseline, while in long-term care, assessments are ongoing and often discussed in team meetings. Informal Assessment: Much information is collected informally during routine care, allowing nurses to address psychosocial issues as part of holistic care. Additional Sources: When cognitive function is impaired, obtaining information from family members and nursing assistants who spend significant time with residents is crucial. Effective Tools: Building a trusting relationship, active listening, intuition, sensitivity, and communication skills are vital for conducting effective psychosocial assessments. Communication Challenges: Nurses may find it difficult to discuss sensitive psychosocial issues due to their intimate care duties; establishing rapport through personal sharing can ease these conversations. Introducing Formal Assessments: Formal mental status assessment tools should be introduced only after the older adult feels comfortable, using gentle prompts to discuss memory or cognitive concerns without causing discomfort. Age-Related Life Events - Retirement - Relocation - Chronic Illness and Functional Impairments - Widowhood - Death of friends - Ageist Attitudes Factors that Influence Psychosocial Function - Religion and spirituality are increasingly important resources for older adults - Cultural factors influence the definition and perceptions of all aspects of psychosocial functioning. *Nursing Interventions for Psychosocial Wellness:* - Enhancing self-esteem - Promoting a sense of control - Involving older adults in decision-making - Addressing role loss - Encouraging life review and reminiscence - Fostering social support - Addressing spiritual needs - Leading healthy aging classes - END -