Promoting Healthy Adaptation to Aging PDF

c hap t e r 13 Promoting Healthy Adaptation to Aging http://evolve.elsevier.com/Williams/fundamental Objectives Upon completing this chapter, you should be able to do the following: Theory 1. Compare the biologic theories of aging. 2. State how a person might behave in light of the psychosocial...

c hap t e r 13 Promoting Healthy Adaptation to Aging http://evolve.elsevier.com/Williams/fundamental Objectives Upon completing this chapter, you should be able to do the following: Theory 1. Compare the biologic theories of aging. 2. State how a person might behave in light of the psychosocial theories of aging. 3. Identify four factors that contribute to longevity. 4. Discuss physical changes that occur as adults age. 5. Explain Schaie’s theory of cognitive development in the older adult. 6. Explain Erikson’s stage of psychosocial development in the older adult. Clinical Practice 1. Identify at least six signs and symptoms of normal aging. 2. Design an educational program to help older adults maintain physical health. 3. State three ways the nurse could help older adults maintain cognitive health. 4. Identify nursing problems related to changes in psychosocial health. 5. Guide the older adult’s family members regarding signs that the older adult needs assistance. Key Terms ageism (Ā-jĭsm, p. 178) aging (p. 172) benign senescence (bē-NĪGN sĕ-NĔ-sĕns, p. 174) biologic theories (p. 173) centenarians (sĕn-tĕn-ĀR-ē-ănz, p. 174) dementia (dē-MĔN-shē-ă, p. 176) demographic (dĕ-mō-GRĂ-fĭk, p. 174) ego integrity (p. 178) Concepts Covered in This Chapter • • • • • • • • • • • • • Caregiving Cognition Communication Coping Development Health promotion Infection Inlammation Learning Nutrition Safety Stress Teaching OVERVIEW OF AGING Aging (a continual process of biologic, cognitive, and psychosocial change) begins at conception. Although there is no way to escape it, we can learn to live with it. As a nurse, you will care for people of all ages, and 172 elder abuse (p. 179) gerontologists (jĕr-ŏn-TŎ-lŏ-jĭsts, p. 173) individualized aging (p. 172) life span (p. 173) longevity (lŏng-JĔ-vĭ-tē, p. 173) psychosocial theories (SĪ-kō-SŌ-shăl, p. 173) reminiscence (rĕ-mĭ-NĬ-sĕns, p. 178) wisdom (p. 177) many of your patients will be older adults. You are also aging, as are your family members and friends. Knowing about normal development in the later years of life will help you in many ways. Older adults are not all alike. Some are active, busy, and healthy; others are inactive because of illness and may be dependent on others. Being an older adult means different things to different people; it is your perception of aging that inluences your deinition of being old. QSEN Considerations: Patient-Centered Care Viewing the Older Adult as an Individual Individualized aging describes how older adults should be viewed as individuals, not as a stereotypical member of the group; for example, an older adult who has a chronological age of 85 may have a physiologic age of 65 because of healthy lifestyle habits and choices. Scientists are interested in learning how people can maintain a healthy body into advanced years. Research about healthy aging is ongoing, and results are changing our ideas. Many older adults have the potential for Promoting Healthy Adaptation to Aging CHAPTER 13 Box 13.1 • • • • • • • • • • • Myths About Older Adults Older adults are sick. Older adults cannot learn new things. It is too late for lifestyle changes to improve health. Genetics are the main factor in longevity. Older adults are not sexual. Older adults are a drain on society. Older adults are senile. Older adults are typically isolated from their families. Older adults usually live in nursing homes. Older adults are poor. Old people are unhappy. years of interesting and productive life. The later years of life can be exciting and rewarding. Most people do not mind growing older, especially if they are relatively healthy. Others fear that the later years of life will be painful, boring, and illed with illness. Overcoming the myths about aging (Box 13.1) can be a challenge for nurses when working with middle and older adults. Health Promotion/Health Promotion Points Healthy People Objectives: Older Adult • Increase the proportion of older adults who use the Welcome to Medicare beneit. • Increase the proportion of older adults who are up to date on a core set of clinical preventive services. • Increase the proportion of older adults with one or more chronic health conditions who report conidence in managing their conditions. • Increase the proportion of older adults who receive Diabetes Self-Management Beneits. • Reduce the proportion of older adults who have moderate to severe functional limitations. • Increase the proportion of older adults with reduced physical or cognitive function who engage in light, moderate, or vigorous physical activities. • Increase the proportion of the health care workforce with geriatric certiication. • Reduce the proportion of noninstitutionalized older adults with disabilities who have an unmet need for long-term services and supports. • Reduce the proportion of unpaid caregivers of older adults who report an unmet need for caregiver support services. • Reduce the rate of pressure injury-related hospitalizations among older adults. • Reduce the rate of emergency department (ED) visits due to falls among older adults. • Increase the number of states and the District of Columbia that collect and make publicly available information on the characteristics of victims, perpetrators, and cases of elder abuse, neglect, and exploitation. Source: www.healthypeople.gov/2020/topics-objectives/topic /older-adults/objectives Think Critically When are people considered old? What does it mean to be old? How do older adults view life? What are the concerns of older people? 173 THEORIES OF AGING There are numerous theories about aging. Some gerontologists (specialists in the study of aging people) claim that aging is primarily determined by genetics, whereas others are certain that environment and lifestyle play important roles. These factors seem to interact with other things to determine how long a person lives. Biologic theories (theories based on cellular function and body physiology) provide ways to look at the physical aging process. The biologic clock is one of these theories; this states that body cells are programmed to function for a speciic length of time after which they break down and die. When too many cells quit functioning, the person eventually dies. Advocates of the free-radical theory believe that cells are damaged by toxins, ions break off from ion pairs, and the resulting free radicals are unstable. This occurs in the environment, in waste products of metabolism, and from disease. These toxins are causes of free radicals, or oxidizing substances in the body. The use of antioxidant vitamins and lotions is supposed to counteract the harmful chemicals. The wear-and-tear theory states that body cells and organs eventually wear out, like machinery. In the immune system failure theory, the system loses its ability to protect the body from disease. Older people become more susceptible to diseases such as inluenza, which may kill them. The autoimmune theory is similar; here the body no longer recognizes itself and begins to attack itself and break down, as occurs in some types of arthritis. Think Critically Can you think of any health problems that could serve as examples of the biologic theories of aging? There are also psychosocial theories (theories related to socialization and life satisfaction). The disengagement theory suggests that it is normal for older people and society to withdraw from each other. Most gerontologists, however, no longer give credence to this concept. In contrast, the activity theory states that people who remain interested and active will continue to enjoy life and to live longer. Conversely, people who make no effort to contribute become less and less involved and shorten their life as a result. In the continuity theory, each individual continues to live and develop as the unique person he or she is. Individuals’ basic personalities do not change, and they cope with aging in ways similar to how they coped with other stages of life. LONGEVITY The life span (maximum years one is capable of living) for humans is 115 to 130 years. Longevity (length of life) has been increasing. In 1900, the average length of life in the United States was 47 years. The US Census 174 UNIT IV Developmental, Psychosocial, and Cultural Considerations Bureau (2012) projects the average life span to be 78.9 years. What is causing this increase? A major contributor to longer life is that people are healthier throughout their lives now than they were 100 years ago. Principles of hygiene have helped eliminate many illnesses. Health care and nutrition have improved, and anti-infective drugs are commonly used. Technology allows surgeons to perform intricate procedures and replace body parts. Education also contributes to longevity. People who are better educated practice preventive health care, and they may seek treatment earlier in the course of an illness. Lifestyle makes a signiicant difference in longevity. A healthy diet and lifestyle, including stress management and regular exercise, are crucial. Nonsmokers usually live longer than smokers do; people who abuse chemicals risk shortening their lives. Married people tend to live longer. A person’s personality seems to affect the length and quality of life. The optimistic, happy person generally lives longer. This is true even when a chronic illness is present. Gender has been a contributing factor to longevity in the past; women in the 20th century lived 6 to 7 years longer compared with men. Women continue to outlive men, and the duration varies by country: by about 4 years in the United States and by about 5 years in Canada (Central Intelligence Agency, 2014). This female-longevity advantage seems to disappear after age 90 (Jacobs, 2014). The inal factor in longevity is genetics. Studies of twins have suggested that heredity determines 20% to 30% of longevity in people who live to age 85. For centenarians (people 100 years old or older) genetics may be even more important perhaps because of differences in the T cells (Pellicano et al., 2014). Think Critically How long did your ancestors live? Has the longevity of your family been increasing? How long do you think you will live? DEMOGRAPHICS Demographic (statistics about populations) studies show that the number of older people in the United States grows every year. In 2013 nearly 45 million people were over age 65—14% of the total population. The number of older adults grew at a faster rate than the total population. Older women outnumber older men, but according to the US Census Bureau life expectancy is projected to increase more for men than for women in the coming years (Velkoff et al, 2014). The Administration on Aging (2014) predicts that we will have 98 million older adults by 2060. For purposes of study, the older adult population is often divided into three distinct groups: the “young old” are 65 to 74 years of age; the “middle old” are 75 to 84; and the “very old” are 85 and beyond. The federal Social Security system originally used age 65 as a marker for retirement. Today, seniors born in the years 1943–59 will qualify for full coverage at 66 years, and those born after 1960 will qualify at age 67. The qualiication age may extend further in the coming years. The young old are those who remain fairly healthy and active. You may not even recognize them as old when you see them in the shopping mall or restaurant. Many contribute to their community and may remain employed, at least part time. They are not much different from middle adults. The middle old are in a transition time. As people approach 80, they may become frail and are less able to be as active. The very old are the most rapidly growing group, and this group will continue to increase in the future. These are also the most dependent older adults. Centenarians are becoming more common. According to the last census taken, there were 53,364 centenarians in 2010 (US Census Bureau, 2015), with 20 men for every 100 women over age 100. Living a long and better life is everyone’s goal. The ancient Greeks were the irst to say they wanted to “die young, as late in life as possible.” Most centenarians enjoyed good health at least into their 90s. To live to be very old, you have to be healthy for most of your life. People are becoming healthier, better educated, and actively involved in their own health care and therefore are living longer. Think Critically Do you know any centenarians? What are they like? What does this mean for nursing and other health care providers? PHYSICAL CHANGES Physical declines happen to everyone. Benign senescence (normal physical changes of aging) begins early in adulthood, but often goes unnoticed until a problem develops. Changes mentioned in Chapter 12 continue. Table 13.1 summarizes the physiologic changes of aging. Heart and lungs gradually become less eficient. Bones become more fragile, and posture becomes bent. The skin is thinner and more fragile; a reduced amount of subcutaneous tissue causes older adults to complain of feeling cold. Older people often have smaller appetites. Vision continues to deteriorate; night driving becomes dificult. Hearing deicits may become more pronounced. Nearly half of the population over age 75 has some hearing loss. Various types of hearing aids can be helpful. The earlier a person with hearing dificulty obtains a hearing aid, the better the brain can adjust to it and provide a good quality of hearing. Changes in the brain also occur with normal aging. There may be less blood low. Neurotransmitters may be imbalanced. Any loss of brain cells caused by injury Promoting Healthy Adaptation to Aging CHAPTER 13 Table 13.1 175 Typical Changes of Aging, Potential Health Problems, and Helpful Nursing Responses BODY SYSTEM Cardiovascular SOME TYPICAL CHANGES Increased heart size Decreased cardiac output, causing less blood low to all organs; thickened heart valves and blood vessels; less elasticity of blood vessels; slower blood cell production and immune response POSSIBLE HEALTH PROBLEMS HELPFUL NURSING RESPONSE MIs, stroke, hypertension, and Assess for signs and sympinfection toms of MI, stroke, or other circulation or organ problems. Monitor for infection and encourage good hygiene and frequent hand washing. Respiratory Thickened alveolar walls, causing less elasticity Weakened respiratory muscles Decreased vital capacity and tidal volume Decreased number of cilia Respiratory failure, shortness of breath; lack of oxygen to meet body needs Monitor BP, respiratory function, oxygen saturation levels, and shortness of breath. Educate on oxygen therapy and the importance of exercise. Musculoskeletal Thinned intervertebral disks, decreased bone calcium, and smaller muscle mass Less elasticity of ligaments and tendons Degeneration of cartilage Osteoporosis, osteoarthritis, tendonitis, and rheumatoid arthritis Encourage exercise, range of motion, good diet high in calcium, and nutritional supplements as needed. Integumentary Thinner, drier skin Loss of subcutaneous fat Slowed rate of hair and nail growth Pressure injuries, resulting from friction/tears Educate on good skin care, use of moisturizers, and prevention of pressure injuries. Urologic Decreased bladder capacity and tone Loss of nephrons, slowed function of remaining nephrons Decreased sphincter control Urinary incontinence Assess and monitor for bladder control and need for medications. Neurologic Vision: presbyopia, slowed accommodation, cataract development, and decreased peripheral vision and depth perception Hearing: presbycusis, thicker eardrum, increased wax production, and decreased hair cells in inner ear Taste, smell, and touch: decreased number of receptors Balance: may be affected by decreased circulation Reflexes: slowed reaction time Slowed autonomic system responses Decreased sensory perceptions: safety risk, fall risk, and decreased appetite Educate on normal aging expectations and safety issues to prevent falls and other injuries. Endocrine Slowed production of all hormones Decreased metabolic rate Delayed insulin response Diabetic response, hyperthyroidism or hypothyroidism Monitor labs for abnormal hormone levels and need for hormone therapy. Gastrointestinal Decreased secretion of saliva and other digestive enzymes Slowed peristalsis Slowed liver and pancreatic functions Reduced absorption of nutrients Constipation, malnutrition, and anemia Educate patient on need for healthy diet and nutritional supplements. Reproductive Decreased hormone production; atrophy of ovaries, uterus, and vagina; benign prostatic hypertrophy Slowed sexual responses Menopause, andropause, infertility, decreased libido, and sexual dysfunction Monitor labs and symptoms to determine need for hormone therapy or other medications. MI: myocardial infarction. 176 UNIT IV Developmental, Psychosocial, and Cultural Considerations or illness will affect the body’s functions. The brain can adapt by growing more dendrites up to age 90 if the person is reasonably healthy. Brain changes are also important in trying to understand cognitive changes in older adults, such as sensory and memory losses. Think Critically What health problems might be associated with the changes identiied in Table 13.1? What nursing responses could be helpful? HEALTH CONCERNS Most people over 75 have at least one chronic health problem. Hypertension is the most common, affecting more than half of older adults, followed by arthritis and heart disease. Obesity contributes to joint problems by causing increased stress on joints; it also contributes to hypertension. For many older adults, these conditions do not prevent living active and full lives. Other common concerns include cancer, diabetes, asthma, chronic bronchitis or emphysema, stroke, and inluenza. The leading causes of death are heart disease, cancer, chronic lower respiratory disease, stroke, Alzheimer disease, diabetes, inluenza, and pneumonia (Federal Interagency Forum on Aging Related Statistics, 2012). Older people are often concerned about falling, especially about breaking a hip, and about being dependent on others. QSEN Considerations: Safety Accident Prevention Accidents may happen because of changes in depth perception, changes in gait, and slower reaction times. It is important to teach older people safety measures to prevent falls (see Chapter 40). Resistance training can improve balance and help prevent falls. Health Promotion/Health Promotion Points Fitness for the Older Adult • A itness program to promote strength and balance is an excellent way to decrease the risk of falls and to promote the ability to stay independent. • Many communities have special itness programs for older adults. Mental health in the older adult may be dificult to evaluate. Many treatable physical conditions, such as malnutrition, dehydration, infection, and misuse of medications, can lead to impaired cognition. A thorough examination should be done to make an accurate diagnosis. It is estimated that more than one million older adults experience depression, and older adults who have suicidal thoughts are more likely to act on them successfully compared with younger people with similar thoughts (Aziz & Steffans, 2013). Signs and symptoms of depression in the older adults are listed in Box 13.2. Depression can often be treated successfully with medications and counseling. Depression is a risk factor and possibly an early sign of dementia (degeneration of brain tissue). Dementia occurs in a small percentage of older adults, yet the incidence rises with age. Confusion, memory loss, and disordered thinking are early signs. This problem has numerous causes, from malnutrition to mini-strokes to Alzheimer disease (see Chapter 41). Between 5% and 15% of older adults have dementia; 60% to 80% of these people have Alzheimer disease (Alzheimer’s Association, 2015). HEALTH PROMOTION BEHAVIORS Eating a healthy diet helps delay physical aging. Encourage older adults to learn about nutrition and meal planning. Additional seasonings can counter the loss of taste buds. Some providers encourage a daily multivitamin. Eating is a social experience for many, so they should ind opportunities to share meals with others. Many communities offer communal dining; prepared meals can also be delivered to a home. Physical activity also postpones many effects of aging. Daily activity, whether walking, biking, or swimming, keeps the body functioning. Beneits from weight training include reduced risk of osteoporosis, hypertension, and diabetes, and increased ability to perform activities of daily living (ADLs). Exercise and Physical Activity: Your Everyday Guide from the National Institute on Aging, in English or Spanish, is available free online. It describes appropriate exercises to keep it and promote good balance. Another positive behavior is having regular physical examinations to monitor chronic conditions and to screen for new problems. Older adults may need encouragement to participate in their own health care management. The cost of health care is a concern to some, but programs designed for older adults help provide regular care. Older adults who smoke should be encouraged to quit. They may have been smoking for years, but the health beneits of quitting are signiicant, even in advanced years. Individual counseling, support groups, Box 13.2 • • • • • • • • • Signs and Symptoms of Depression in Older Adults Feeling sad or “empty” Feeling hopeless, irritable, anxious, or guilty Loss of interest in favorite activities Feeling very tired Not being able to concentrate or remember details Not being able to sleep or sleeping too much Overeating or not wanting to eat at all Thoughts of suicide, suicide attempts Aches or pains, headaches, cramps, or digestive problems Source: National Institute of Mental Health, 2015. www.nimh.nih.gov/health /publications/older-adults-and-depression/index.shtml Promoting Healthy Adaptation to Aging CHAPTER 13 and nicotine replacement have been shown to be effective. Alcohol use should also be limited because its effects may be greater in older adults and it may interfere with prescribed medications and supplements. Some adults may need guidance in taking prescribed medications correctly. Health Promotion/Health Promotion Points Medication Regimen Aids for Older Adults • Using a weekly pill-minder box with compartments for each day, or for different times of each day, is a useful tool for helping the older adult take medications on time. • The pillbox is reilled weekly, and a list can be made to aid the person when illing the box. COGNITIVE ASPECTS OF AGING Schaie’s stage of cognitive development for older adults is called the reintegrative stage. This states that older adults are more selective about how they spend their time. They take time for interesting activities, but not for things that seem irrelevant. A woman who hosts family meals on special occasions may try new recipes and enjoy a cooking class; however, someone who lives alone and rarely entertains may not be interested in such activities. Discovering the interests of older people can provide clues to ways to stimulate and maintain their cognitive abilities. One person may enjoy crossword puzzles, and another may enjoy reading mysteries (Fig. 13.1). Healthy adults can maintain intelligence into advanced years. The speed of thinking may slow, but thinking processes remain intact. Many older adults who are ill or who have vision or hearing deicits do 177 not suffer cognitive dysfunction. They should be certain that glasses or hearing aids are in place before interacting with other people. WISDOM AND LEARNING Wisdom (having good judgment based on accumulated knowledge) is often credited to older adults because of their wealth of life experiences. Younger people can beneit by listening to the advice of older people. Some people assume older adults can no longer learn. This is not true. Subjects of interest can fascinate the older learner. They have more patience for learning. Many have learned to operate computers and enjoy using that technology. Elder hostel programs provide stimulating opportunities to learn and sometimes travel with other older adults. Patient Education Teaching the Older Adult Keep these points in mind when performing patient education for the older adult: • Provide motivation for the content to be learned. • Keep the topic relevant to the learner. • Assess readiness to learn and take advantage of “teaching moments” (when the learner is most receptive). • Use visual aids in large print and bright colors. • Provide good lighting in the room and on the materials. • Ensure the learner has reading glasses (clean) and hearing aid (turned on) if used. • Speak clearly, distinctly, and slowly in a normal tone. • Obtain feedback at intervals about what has been taught. • Relate learning to better autonomy, health, and activity. MEMORY ISSUES Some older adults have problems remembering recent events; this is short-term memory loss. They may not recall much of yesterday; however, longterm memory remains intact. They can remember many details of their younger life. Memory aids such as making lists or notes on a calendar can help keep life orderly. Health Promotion/Health Promotion Points Cognitive Stimulation in Older Adults Regular exercise of at least 30 minutes ive times a week helps decrease mental decline. Encourage older adults to engage in some sort of exercise program, even simply walking in the neighborhood. Exercise classes at the senior center or parks and recreation department are available in many communities. Even moderate activity and resistance training (for bed-bound older adults) has been shown to be beneicial. FIGURE 13.1 Going out with family provides cognitive stimulation. The more severe memory losses and dementias of aging are often the result of circulatory changes. People experiencing memory changes and their family members should not assume that such changes are inevitable. The older adult should be evaluated for nutritional status, hypertension, arterial health, 178 UNIT IV Developmental, Psychosocial, and Cultural Considerations endocrine disorders, and speciic neurologic problems. Sometimes underlying conditions can be treated and the memory problems will be resolved. EMPLOYMENT AND RETIREMENT The ability and desire to keep a job vary, depending partially on the older adult’s cognitive ability. Some types of work maintain a mandatory retirement age, particularly if the work involves public safety. In other situations, retirement is a matter of preference. Think Critically What suggestions could you give older adults to help them remain active after retirement? Some people are eager to leave a regular job and may retire in their 50s or early 60s. Some continue to work because they need the income or desire the social outlet. Retiring early requires planning for inances and other concerns. Other people enjoy working and want to continue beyond a traditional retirement age. About 9% of older adults are at poverty level according to income, and 26% are in the low-income group (Federal Interagency Forum on Aging Related Statistics, 2012). The percentage of older adults in the workforce continues to rise, and is expected to exceed 30% by 2022 (Pew Research Center, 2014). Workers who lose their jobs a few years before retirement may ind it hard to obtain other employment at similar wages. Ageism (discrimination because of age) is illegal in the United States. A worker who has lost a job in favor of a younger person simply because of age has recourse through the government and the courts. Think Critically Do you know anyone who lost a job in his or her 50s or early 60s? Were they able to ind other employment at a comparable income? How did they feel about that experience? Retirement brings with it major changes in many aspects of lifestyle: no alarm clock, no set schedule, no coffee break with co-workers, no need to dress neatly, no paycheck. People who have adequate inances may feel comfortable about retiring. Some travel extensively if health and inances permit. Many early retirees decide to begin a second career. Older adults may continue to work in family businesses. Others volunteer to keep themselves busy and involved. The contributions of older adults should not be underestimated. According to the Pew Research Center (Livingston, 2013), approximately 3 million children in the United States are being raised primarily by a grandparent. Again, attitude is important. People whose lives revolved around their work may have dificulty adjusting to retirement. Some become disillusioned with retirement and ind another job. Others become depressed, withdraw, and die. Recent retirees should be encouraged to set small daily or weekly goals until the adjustment has been made. HEALTH PROMOTION BEHAVIORS Behaviors that help with successful cognitive aging are the same behaviors that are encouraged throughout life. Having a positive attitude remains important. Some people are unhappy with their lives and unwilling to try to change. Encouragement is always appropriate. For example, you can remind them of their accomplishments, of their success in raising children, or even the accomplishment of living a long life. Active involvement in a job and community during earlier adulthood often carries into continuing involvement in hobbies, religious and service groups, and volunteerism in older adulthood. Remind older adults how much they have to offer their community. Using the brain by reading, doing puzzles, using a computer, and writing keeps the neural connections active and healthy. A computer game called “Brain Age” has been shown to improve cognition in older adults. The brain, like a muscle, should be exercised regularly. Even the physically limited older adult can maintain mental stimulation with a little effort. PSYCHOSOCIAL ASPECTS OF AGING Erikson’s stage of development for older adults is called ego integrity (state of being complete) versus despair (see Table 11.2). Older people naturally spend time thinking about their lives. If they ind their lives have been good, then they are satisied and have ego integrity. However, if they are unhappy about the way life has evolved, they will despair. Resolution to ego integrity may occur if you can help the person ind enough areas of satisfaction to outnumber the areas of regret. LIFE REVIEW This is the time for reminiscence (reviewing one’s life). If individuals accept that they have had good lives and that they have contributed to others, then they are satisied. People who were not successful at working through a developmental stage when younger may ind unhappiness with the way their lives progressed. Sometimes it is enough to realize that one did the best one could under the circumstances. Many psychologists consider this stage of life review important as a person faces mortality. Being content with accomplishments is important for selfworth at any stage of life. The older adult simply has more years about which to relect. FAMILY RELATIONSHIPS Families continue to be important in older adulthood. Married people seem to live longer than those who are alone do (Fig. 13.2). Widows usually adjust better than do widowers. According to the Federal Interagency Forum on Aging Related Statistics (2012), 39.9% of all women Promoting Healthy Adaptation to Aging CHAPTER 13 179 SOCIAL ACTIVITY Community involvement was discussed earlier relative to cognitive development; it is also important for psychosocial health. Older adults need to feel needed; this contributes to their self-concept and emotional health. Some volunteers and part-time workers choose those activities primarily for the social activity. Older adults experience a gradual loss of their peer group as friends and siblings die. These can be dificult times for the survivors; they continue to need support from their family and community. Those who have cultivated friendships with younger people fare best. FIGURE 13.2 Romance can exist in later life. over age 65 are widows; 12.7% of men in that age group are widowers. Many widowed, divorced, or single older adults continue to date, and some will remarry. Think Critically Widowers frequently die within 1 year of their wife’s death. Why do you think that is true? The majority of older adults who have children live within 40 miles of one child. Contact with that child usually occurs at least weekly. This is important because the older parent may need assistance with one or more aspects of daily life. The active older adult may contribute to extended family life by helping with childcare of grandchildren or great-grandchildren. Sometimes retired adults end up raising grandchildren. Adult children may have died or may be imprisoned, hospitalized, or otherwise unable to care for the children. This arrangement can bring both beneits and problems for the children and for the older adults. Approximately one out of every ten older adults is affected by elder abuse each year (Hoover & Polson, 2014). Those over age 80 have the greatest incidence, with the primary type being neglect. When it occurs in a family, it is for many of the same reasons abuse happens to children or spouses. Elder abuse may also occur in a long-term care setting. Legal and Ethical Considerations Reporting Elder Abuse All licensed professionals are required to report any signs of or suspected abuse to a law enforcement agency. Social services personnel or law enforcement oficials will conduct an investigation. LIVING ARRANGEMENTS Many older adults prefer to live in their own homes as long as they are physically able. Others choose to rent an apartment when they cannot maintain a house and yard. More than half of older adults lived with a spouse in 2014 (Administration on Aging, 2014). About 28% of noninstutionalized older adults lived alone (more women than men); many of these older adults need some assistance at times. About 2.2 million grandparents age 65 or over lived in households with grandchildren present in 2014. That number continues to grow. One recent trend in living arrangements is an increase in the number of multigenerational households where a grandparent and another generation live under the same roof (Pew Research Center, 2013). A small number of adults over age 65 live in institutional settings (3.4% overall); however, with each decade of life, this number increases, reaching about 10% for those over age 85 (Administration on Aging, 2014). As more people live to be older adults, it is important for them to remain healthier longer. Although this is beginning to happen, people over age 85 remain the frailest and will probably continue to need help with daily activities. As that group grows, more nurses and other health care workers will be needed to give care. HEALTH PROMOTION BEHAVIORS Older adults have several psychosocial challenges to face. They need to accept and adjust to a changing body. Family roles change, especially if one spouse becomes ill or dependent on the other or dies. There are changes in the use of time because of retirement. Finally, older adults have to face their own mortality. The helpful behaviors for these adjustments continue to revolve around maintaining an optimistic outlook, staying as physically it as possible, and remaining involved with others. Those who face the future with a hopeful, positive attitude will cope better with aging. Older adults should be encouraged to make a living will and to designate someone to make health care decisions for them in case they cannot. Completing a durable power of attorney for inancial arrangements is recommended. Each state has guidelines and forms that can be obtained from lawyers or health clinics. The 180 UNIT IV Developmental, Psychosocial, and Cultural Considerations ofice of the patient’s primary care provider should be given a copy of the documents. Older adults with children should involve them in planning. If there are no children, another relative, a younger friend, or a trusted lawyer can be named as their trustee. WHEN A PARENT NEEDS HELP It is not easy for adult children to admit that a parent needs their assistance. Sometimes the nurse can help stimulate a conversation about the future and offer resources for the family. Some older adults recognize that they need help and initiate discussion with their children or others. They may decide to move to a smaller apartment or into an assisted living facility. Others deny their aging and resist making any changes until a crisis arises. This denial is an understandable way of maintaining their dignity and self-esteem. PLANNING AHEAD Experts recommend adult children keep communication lines open with their parents. The parent may need encouragement to discuss alternative living arrangements or other needed changes. Adult children should try to: • Plan ahead: Discuss possibilities and make plans with the parent before a crisis occurs. This way decisions will be mutually agreeable and less traumatic. • Include everyone: Siblings should share in planning and decision making. No one adult child should feel wholly responsible. • Find important information: This includes knowing about the parent’s inancial situation, current medical care and medications, and alternative housing possibilities. If parents are reluctant to discuss changes, they may need more time to think about it. Consider the choices and seek out resources. Box 13.3 Signs That an Older Adult Needs Help • Neglected personal hygiene, irregular dressing, and soiled clothing • Altered eating habits in the past year resulting in weight loss; decreased appetite or missed meals • Neglected home and less than desirable sanitary conditions • Inappropriate behavior such as being unusually loud or quiet, being paranoid, being agitated, or making phone calls at all hours • Frequent falls, burns, or injuries • Social isolation and cessation of activities previously important • Altered relationship patterns such that friends and neighbors express concern • Inability to ind the right words • Forgetfulness resulting in unpaid bills, unopened mail, missed appointments, or hoarding money • Confusion about medications • Unusual purchases such as more than one subscription to the same magazine or increased buying from television advertisements OBSERVING CHANGES Safety is a basic need. Adult children must make decisions for parents who are no longer able to care for themselves safely. If older adults show signs of deteriorating behavior, it is time for adult children to make some of those decisions for them (Box 13.3). RESOURCES FOR FAMILIES Many communities provide services for older adults including adult day services, chore services, transportation, counseling, companionship programs, exercise and rehabilitation programs, and telephone reassurance services. To learn what is available in your community, begin with the yellow pages or the Internet. Your state agency on aging coordinates information. The federal Administration on Aging can also provide information. AARP has information about services for older adults. Promoting Healthy Adaptation to Aging CHAPTER 13 181 Get Ready for the NCLEX Examination! Key Points • The majority of older Americans are in reasonably good health and living independently. Americans are living longer. • There are biologic theories of aging and psychosocial theories of aging. • Many factors contribute to longevity, including maintaining a healthy lifestyle, appropriately using the health care system, genetics, and education. • Young old adults are ages 65 to 74; middle old adults are ages 75 to 84; very old adults are age 85 and beyond. Centenarians are people age 100 and older. • Leading causes of death in older adults are heart disease, cancer, chronic lower respiratory disease, stroke, Alzheimer disease, diabetes, inluenza, and pneumonia. • Exercise for increasing strength and balance helps prevent falls and promotes longer independence. • Older adults can beneit by improving their diets and increasing their physical activity. A positive attitude helps all aspects of aging. • Schaie’s stage for older adults is the reintegrative stage; older adults are careful about how they spend their time and take time only for things that interest them. • Short-term memory may weaken with age, but memory aids can help. Although mental processing slows, given time, the older adult can do as well as a younger adult can. • The age of retirement varies widely. Older adults are a growing segment of the US part-time labor force, whereas others engage in volunteering. • Erikson’s stage for older adults is ego integrity versus despair. Older adults reminisce, and if life has been satisfactory, they have ego integrity. • Family relationships remain important. Role changes occur when a spouse becomes ill, dependent, or dies. • Many older adults prefer living in their own home as long as possible. Multigenerational households are becoming more common. • Adult children of older adults should remain aware of their parents’ status and be prepared to help if the parents are no longer able to care for themselves safely. Additional Learning Resources SG Go to your Study Guide for additional learning activities to help you master this chapter content. Go to your Evolve website at http://evolve.elsevier .com/Williams/fundamental for additional online resources. Online Resources • Administration on Aging, www.aoa.gov. • AARP (organization geared for people over age 50), www.aarp.org. • Centers for Disease Control and Prevention, Healthy Aging, www.cdc.gov/aging. • Site for, about, and by caregivers, www.caregiver.com. Review Questions for the NCLEX Examination Choose the best answer for each question. 1. Demographers in the United States predict increasing numbers of older people because: (Select all that apply.) 1. The baby boomers are healthier with age than were previous generations. 2. Medical technology is extending life for many, especially those with heart disease. 3. Most people today are much happier than previous generations were. 4. There are more wealthy people who can afford quality health care. 5. More vitamins and supplements are available to delay aging. 2. Natalie and her parents live with Natalie’s grandparents, second-generation Italian immigrants, on several acres of rural farmland. The family runs a pasta manufacturing plant on the property. This is an example of: 1. An intergenerational household. 2. A suburban household. 3. A single-family household. 4. Economic hardship. 3. To fulill Erikson’s psychosocial stage, older adults can be encouraged to: 1. Play with their grandchildren. 2. Continue with hobbies and light exercise. 3. Remain employed as long as possible. 4. Review their lives, recalling accomplishments. 4. The important behaviors that can help an older adult to age successfully include: 1. Moving closer to a child. 2. Remaining physically and mentally active. 3. Limiting exercise to conserve strength. 4. Eating at least 2000 calories daily. 5. To help parents plan for possible future changes, adult children should: 1. Investigate alternative housing arrangements. 2. Keep communication lines open within the family. 3. Choose a nursing home for the parent. 4. Consult with the parent’s primary care provider. 6. Depression in older adults: (Select all that apply.) 1. Is a natural part of aging. 2. Has been linked to high suicide rates in seniors. 3. Is best treated with medication and counseling. 4. Can be easily diagnosed by a health care professional. 5. May be the result of a chronic illness or loss of body function. 7. Signs of elder abuse include: (Select all that apply.) 1. Fear of caregivers. 2. Bruises and cuts in various stages of healing. 3. Timid and withdrawn behavior. 4. Forgetfulness. 5. Disheveled appearance. 182 UNIT IV Developmental, Psychosocial, and Cultural Considerations Critical Thinking Activities Read the clinical scenario and discuss the questions with your classmates. One of your home care patients is an 82-year-old woman with arthritis and type 2 diabetes. She had a hip replacement 3 months ago after a fall and has recently returned to her apartment after rehabilitation in a long-term care facility. You are to assist her with her hygiene needs and monitor her medications. 1. What are some observations you could make to assess her cognitive abilities and stage of development? 2. How might you assess her psychosocial development? 3. What could you do to assist her in adjusting to this stage of her life?