Psychosocial Care of Older Adults PDF

PSYCHOSOCIAL CARE OF OLDER ADULTS GROUP 5 (BSN 3-B) PSYCHOSOCIAL refers to the complex interplay between psychological and social factors that influence an individual's well-being, development, and behavior. TOPIC TO DISCUSS Cognition and Perception Engagement in Life Self-Perception and S...

PSYCHOSOCIAL CARE OF OLDER ADULTS GROUP 5 (BSN 3-B) PSYCHOSOCIAL refers to the complex interplay between psychological and social factors that influence an individual's well-being, development, and behavior. TOPIC TO DISCUSS Cognition and Perception Engagement in Life Self-Perception and Self-Concept Coping and Stress Values and Beliefs Sexuality and Aging  COGNITION AND PERCEPTION Deals with the ways people gain information from the environment and the way they interpret and use this information. Perception includes the collection, interpretation, and recognition of stimuli, including pain. Cognition includes intelligence, memory, language, and decision making.  COGNITIVE AND INTELLIGENCE Fluid intelligence is the ability to perform tasks or make judgments based on unfamiliar stimuli. Crystallized intelligence (often called wisdom) is the ability to perform tasks and make judgments based on the knowledge and experience acquired throughout a lifetime. Casas  COGNITION AND LANGUAGE Language is a product of cogniti-e function. In both spoken and written forms, language allows humans to communicate ideas and thoughts. Sensory and cognitive problems can result in poor language development or loss of language skills. Damage to the language centers of the brain can result in aphasia, Casa  NURSING PROCESS FOR IMPAIRED VERBAL COMMUNICATION Speech Is the term used to refer to spoken language. Normal speech in older adults tends to be slower, softer, less fluent, less rhythmic, and breathier than in younger individuals, and it often has a tremulous quality. Language is a broad term that includes all modes of spoken or symbolic communication. allows us to send and receive messages from other humans Two regions of the brain play key roles in language and speech: Broca’s area, which is located in the posterior frontal lobe, and Wernicke’s area, which is located in the posterior temporal lobe. If either of these areas is damaged by trauma or oxygen deprivation for prolonged periods of time from occlusion or hemorrhage, serious language problems can occur.  APHASIA Abnormal neurologic condition in which language function is disordered or absent because of an injury to certain areas of the cerebral cortex. May be a result of stroke. It is the most common language problem seen in older adults  most common classification includes: receptive aphasia, which the person has difficulty understanding language; expressive aphasia, in which the person is unable to express himself or herself using language; and global aphasia, in which the person loses the ability both to understand language and to express himself or herself using language.  NURSING DIAGNOSIS Impaired verbal communication NURSING GOALS/OUTCOMES IDENTIFICATION (1) communicate needs with minimal frustration; (2) demonstrate an increased ability to communicate needs and feelings; and (3) express satisfaction with or acceptance of alternative methods of communication.  NURSING INTERVENTIONS/IMPLEMENTATION 1. Assess the older adult’s communication problems and abilities. 2. Identify specific approaches that are effective for each person. 3. Document in the care plan the selected techniques that facilitate communication. 4. Explain effective communication techniques to family members and friends 5. Teach verbally impaired older adults methods for their specific communicating needs 6. Consult with a speech therapist/pathologist to determine the most effective communication strategies.  NURSING PROCESS FOR PAIN The origin of some stimuli, such as pain, is within the body. Either physiologic damage or psychological distress can result in the sensation we call pain. Pain is a subjective perception. Older adults are at increased risk for pain because of the higher incidence of disease conditions with aging. Chronic or unrelieved pain can lead to behavior changes. Older persons who demonstrate anger, depression, or isolation from others should be evaluated for pain. Many older adults deny pain because they fear they will be avoided or they will lose their independence.  NURSING DIAGNOSES Acute Pain Chronic Pain NURSING GOALS/OUTCOMES IDENTIFICATION: (1) report an improved comfort level or decrease in pain; (2) verbalize the ability to cope with pain;and (3) demonstrate techniques that provide relief from pain  NURSING INTERVENTIONS/IMPLEMENTATION 1. Thoroughly assess the nature and severity of the pain 2. Provide comfort measures. 3. Avoid actions that increase pain. 4. Teach nonpharmacologic approaches to pain control. 5. Administer medications as ordered.  PQRST Method for Pain Assessment Onset Provocation or Palliation Quality, Region, Radiation or Referral, Severity, Timing  DISTURBANCE IN SENSORY PERCEPTION Casas  NURSING DIAGNOSIS Risk for Injury related to altered sensory perception Impair Verbal Communication related to disturbance in sensory in NURSING GOALS/OUTCOMES IDENTIFICATION 1. Remain free from injury; 2. demonstrate impro-ed ability to detect changes in the environment; 3. interact appropriately with the en-ironment; and 4. demonstrate the ability to compensate for deficits by using prosthetic devices and alternative senses. Casas  NURSING INTERVENTIONS/IMPLEMENTATION The following nursing interventions should take place in hospitals or extended- care facilities: 1. Ensure that all caregivers are aware of the person’s sensory problems. 2. Make appropriate sensory contact before beginning care. 3. Determine the best methods for communicating with older adults. 4. Modify the environment to reduce risks. 5. Verify that prostheses such as eyeglasses and hearing aids are functional. Interventions should take place in the home: 1. Modify the home environment to compensate for sensory changes. 2. Assist sensorially impaired people in developing techniques or acquiring devices that will help compensate for losses Casas Hearing-impaired people: Telling others that they are hard of hearing; focusing on the speaker and paying attention to what is being said; facing the speaker or asking the speaker to face them; asking the speaker to speak slowly and clearly but not to shout; and asking the speaker to repeat when information is not clear. Visually impaired person: Telephone dials Handheld or floor standing magnifying devices Computer settings Written materials Books on audiotape Talking clocks that fit Casas CHRONIC CONFUSION Casa  CONFUSION Confusion is defined as a mental state characterized by disorientation regarding time, place, or person that leads to bewilderment, perplexity, lack of orderly thought, and the inability to choose or act decisively and to perform activities of daily living. Casas  ACUTE CONFUSION Often called delirium, is characterized by disturbances cognition, attention, memory, and perception. This type of confusion is usually caused by a physiologic process that affects the autonomic nervous system. Casas  DEMENTIA Dementia is a slow, insidious process that results in progressive loss of cognitive function. Dementia is caused by damage to the cerebral cortex that is most commonly a result of disease conditions (e.g., Alzheimer disease; multiple infarcts of the cerebrum secondary to stroke, or other pathologic conditions of the brain. Casas  Nursing Diagnosis: Chronic Confusion NURSING GOALS/OUTCOMES IDENTIFICATION The nursing goals for older indi-iduals with chronic confusion are to... (1) remain free from injury; (2) assist in activities of daily living to the highest level possible; and (3) seek assistance when needed Casas  NURSING INTERVENTIONS/IMPLEMENTATION following nursing interventions should take place in hospitals or extended-care facilities: 1. Assess behavior on admission and at regular intervals 2. Provide assistive sensory devices. 3. Orient the person to person, place, and time, and provide any other important situational information, but do not force the issue, because it can lead to agitation. 4. Provide a structured environment that ensures safety yet enables the person to keep active as long as possible. 5. Provide continuity 6. Administer psychotherapeutic medications as ordered. 7. Avoid use of physical and chemical restraints. 8. Structure participation in activities of daily living. 9. Structure the environment to minimize disruption; avoid sudden changes of room or environment. 10. Develop a plan to deal with “acting out” behaviors. 11. Use effective communication skills. 12. Consult with family and the multidisciplinary. Casas  The following interventions should take place in the home: 1. Help the family accept the diagnosis. 2. Help the family adjust to the demands of providing care for a cognitively impaired older person. 3. Provide emotional support and help the familyidentify coping strategies. 4. Identify community resources. 5. Help families make arrangements for institutional placement, if necessary. 6. Encourage families to plan for end-of-life decisions. 7. Use any appropriate interventions that are used in the institutional setting Casas  Normal Self-perception SELF PERCEPTION and Self-concept AND SELF-CONCEPT Self-perception refers to the way individuals perceive and interpret their own behaviors, emotions, and characteristics. It is the process by which people come to understand themselves by observing their actions and internal states, often in relation to their surroundings. Self- perception helps individuals form judgments about who they are based on their experiences and behaviors. Self-concept is a broader and more stable set of beliefs and ideas about oneself. It encompasses an individual's self-identity, including their roles, attributes, abilities, and values. Self-concept is shaped over time by personal experiences, feedback from others, and social interactions, and it influences how people think, feel, and behave in various situations. It forms the overall understanding of who a person believes they are. We form our self-identities by comparing ourselves and our experiences with some ideal. This can be an internal ideal drawn from our personal values or an external ideal drawn from the society around us. Many people experience problems with self- worth because they always measure themselves against external standards. Contemporary standards are communicated repeatedly by advertising and the media. People who are young, thin, rich, successful, and attractive are idealized. Anyone who does not meet these superficial and artificial standards is somehow judged inferior and thus is viewed negatively by our society. Few people are able to meet all of the idealized criteria. This results in a large number of people (of all ages) in contemporary society who suffer from negative self-esteem.  Actions That Caregivers Can Use to Promote Self-Esteem Six Ways the Elderly Can Help older adults find interests, activities or hobbies, even learn a new Improve Self-Esteem by skill. Taking Control Encourage volunteering, social interaction, and participation in social gatherings. Seek guidance or mentoring from older adults and listen to their advice. 1. Take control of your attitude. Avoid “talking down” to older adults. 2. Take control of your Health Keep older adults informed, and encourage them to maintain control of their health. 3.Take control of your appearance Feedback from others affects our perception of ourselves. People who have caring friends and families tend to have higher levels of self-identity and 4. Take control of your time self-esteem. Strong families and friends provide support for one another. They help one another keep things in perspective by providing positive 5. Take control of your social feedback and buffering one another from an often negative world. A good life and relationship family and good friends play an important part in building and maintaining our self-esteem. Persons who lack supportive family and friends are likely to 6. Take interest in both old and have a poor perception of self and low self-esteem. Those who come from new activities. dysfunctional families or who are separated from loved ones run a high risk for poor self-perception and low self-esteem. These people are more likely to suffer from negative feedback because they lack the necessary support to provide balance Problems related to self-perception and self-esteem are not as obvious as are physical problems. By their very nature, self-perception and self-concept are subjective. Many people find it difficult to talk about their feelings, often finding themselves unable or unwilling to put their feelings into words. More often, our perceptions of self-worth and self-esteem are exhibited to others through behavior. Significant behaviors include the amount of attention paid to personal hygiene and grooming, the type and frequency of emotions exhibited, body posture, the amount and type of eye contact, and voice and speech patterns. People with very high self-esteem appear to be very much in control of themselves and their lives. They are usually well groomed, maintain an erect body posture, make eye contact with others, speak clearly in a normal tone of voice, and exhibit emotions appropriate to a given situation. Self-perception/self-concept and aging Erikson has identified the major task of late life as maintenance of ego integrity (the sense of self-worth) versus despair. Attitudes toward aging, the level of self-esteem throughout life, the extent of physical change caused by aging and illness, the presence or absence of emotional support systems, and the ability to maintain a degree of control—all of these have an impact on whether aging adults will be successful in accomplishing this task. Aging individuals develop their own perceptions of aging. It is difficult to see oneself getting old. Many older adults express dismay with the realization and can even identify a particular moment when they perceived themselves as old. One older woman recently attended her fiftieth high school reunion. She reported having a good time but wondered what she was doing with all of these “old people.” A subtle but real change in her self-perception occurred after that incident. Before then, she did not feel old; afterward, she was more aware of her age. Successful aging is not so much a matter of years lived or health status, but rather a matter of perception and attitude. Successful aging has sometimes been described as “mind over matter.” If you don’t mind, it doesn’t matter. Ageism is still prevalent in our youth-oriented society, which far too often portrays older adults as physically and mentally inept, nonproductive, and dependent. Considering these negative images of aging, it is easy to understand why many people do all within their power to avoid the physical signs of aging. It is difficult for some younger people to understand how radically the changes of age or illness can destroy self- image and self-esteem in older adults. Many younger persons feel that measures such as hair transplants or cosmetic surgery look absurd. They mock older adults, further lowering the aging person’s self-worth. It will be interesting to see what these insensitive people do as they age. One can only wonder what societal attitudes toward aging will be and how they will change as Baby Boomers move into old age.  Some changes that warrant further investigation include the following: Depression and Aging Depression is more common in the aging Stopping normal routines population than often suspected or Neglected self-care recognized. Studies indicate the magnitude of the problem. It is estimated that among Unwillingness to talk people over age 65, depression is a problem Agitation and irritability for as many as 1% to 9% of community- Suspiciousness or unjustified fears dwelling elderly, 10% to 26% or more of long- term care residents, and 11% to 46% of Mood swings hospitalized older adults. Research estimates Isolation and withdrawal that only 1 in 6 elderly who suffer from depression is recognized and treated. Increased use of alcohol or mood-altering drugs Depression is more difficult to recognize Unexplained injuries because typical indicators may be similar to Verbalization of worthlessness those seen with a variety of medical disorders. Verbalization of suicidal thoughts Suicide and Aging The elderly make up about 12% of the total U.S. population, but they account for 17% of the suicides. Older adults at risk for suicide because of depression often present themselves to health care professionals with a variety of physical complaints. Many times, an elderly person has been seen by a health professional shortly before committing suicide (often the previous day), but the real significance of the complaints was missed. More elderly women experience depression but depressed older men and older adults with a history of affective disorders are most at risk for committing suicide. Severe emotional or physical pain, a recent loss, or stressful event such as diagnosis of a terminal disease are present in a large percentage of those who attempt to take their own lives.  Nursing Process for Disturbed Self-Perception and Self-Concept When an older adult has a poor self-concept, fears and anxieties increase. As control over one’s life decreases, self-esteem plummets even lower, and older adults fall victim to feelings of hopelessness and powerlessness, which lead to depression. Depression leads to isolation from others, further decreasing the sense of self-worth.  ASSESSMENT Does the person verbalize fears or concerns? Does the person verbalize hopelessness or Are these fears of a known or an unknown source? despair? Does the person verbalize loss of control over his Does the person spend most of the time or her life? alone, or does he or she interact with others? Has the person recently experienced significant Does the person accept directions from losses? caregivers passively, or does the person Has the person recently moved or been separated express the desire to make his or her own from significant others? What is the person’s general appearance and decisions? posture? Does the person exhibit aggression, anger, or Does the person make or avoid eye contact? demanding behaviors? Does the person verbalize concerns regarding Are there any signs of autonomic nervous changes in his or her appearance? system stimulation (e.g., increased pulse or Does the person make negative comments respiratory rate, elevated blood pressure, regarding himself or herself? diaphoresis)? Does the person avoid looking in the mirror or at Does the person manifest any behaviors altered body parts? typical of emotional upset (e.g., pacing, hand Does the person question his or her worth? wringing, crying, repetitive motions, tics, Does the person verbalize feelings of failure? aggressiveness)?  Are there changes in vocal quality (e.g., quivering)? Does the person complain of headaches? Does the person have difficulty focusing on activities, remembering things, or making decisions? Has the person experienced changes in eating or sleeping patterns? Has the person started to give away treasured possessions? Does the person use alcohol or other mood-altering drugs? Which drugs? How much? How often? Does the person verbalize the desire to end his  FRIGHT ANXIOUS FEAR WORRY DREAD AGITATION UNEASINESS Most common fears in Older adults include: fears of change disruption in their lives or routines loss of loved ones disease loss of independence Fear can also result in physiologic symptoms resulting from Sympathetic nervous system. Such symptoms include: dilated pupils palpitations dry mouth diaphoresis trembling diarrhea elevated BP urinary frequency increased HR & RR  Nursing Process for Fear Assessment Does the person verbalize fears or concern? Are these fears of a known or an unknown source? Has the individual recently experienced significant losses? Has the person recently moved or been separated from significant others?  Nursing Process for Fear Nursing Goals The nursing goals for fearful individuals are: identify specific fears identify coping strategies that were helpful in the past and use these when fears arise use strategies that help control fear  NURSING PROCESS NURSING INTERVENTIONS/IMPLEMENTATION 1. Provide opportunities for older adults to express their fears. fears are debilitating. It stop people from being able to take positive actions. 2. Remove or reduce the common sources of fear. fear of falling and fear of loud noises are common from the time of birth. 3. Provide explanation for all care procedures. Many activities and treatments that are familiar to nurses are extremly strange and frightening to older adults. ANXIETY  Mild anxiety can actually be good for people , even older adults. A little anxiety keeps people vigilant for potential hazards. A little anxiety provides the motivation for positive actions such as seeking health care. Those who have never experienced anxiety would have little reason to plan ahead or take precautions in life. However, persistent or high level anxiety can interfere with a person’s ability to perceive situations accurately and to respond to them appropriately.  ASSESSMENT/DATA COLECTION Does the person verbalize fears or concerns Does the person verbalize concerns regarding changes in appearance Does individual make or avoid eye contact? Does the person question his or her worth? Have there been changes in eating and sleeping pattern? Does the person verbalize the desire to end his or her life?  NURSING GOALS/OUTCOMES IDENTIFICATION The nursing goals for older adults diagnosed with anxiety are to: 1. Identify the methods that help reduce anxiety 2. experience fewer episodes of anxiety  NURSING INTERVENTIONS 1. Encourage older adults to verbalize their thoughts and feelings 2. Provide a quiet environment and reduce excessive stimulation 3. Provide distraction or diversion  NURSING PROCESS FOR HOPLESSNESS Hopelessness is a subjective state in which people ­feel unable to solve problems or establish goals. They feel that they have no alternatives or choices, even when they can actually control what occurs. Hopeless people express feelings or complete apathy in response to problems.  They are often heard making statement such as "What’s the use in trying; nothing will go right anyway" or "Nothing ever goes right for me." Self-destructive behaviors are common among hopeless older adults. Signs of hopelessness include: failure to eat. failure to take prescribed medication and, failure to follow up with medical care. In extreme cases, hopeless individuals may becomes suicidal.  NURSING DIAGNOSIS Hopelessness NURSING GOALS/OUTCOMES IDENTIFICATION The nursing goal for older adults diagnosed with hopelessness is to identify activities or interventions that promote hopefulness.  NURSING INTERVENTIONS/IMPLEMENTATIONS The following interventions should take place in hospitals, in extended-care facilities, and at home: 1. Visit older adults frequently and spend time exploring the factors that contribute to feelings of hopelessness. 2. Assess the potential for self-destructive behaviors or suicide.  Nursing Process for Powerlessness Powerlessness occurs when older adults feel they have lost control or what happens to them. Such feelings may result from: the loss of control of physical functions or body parts or from loss of a body parts Powerlessness is common with hospitalization or placement in an extended care facility. Nurses often contribute to feelings of powerlessness by taking over or taking charge of older adults.  The needs of the institution often take priority over the desires of the individuals. If the importance of older adults is not recognized by caregivers, the institution will completely control the lives of each individual. NURSING DIAGNOSIS Powerlessness NURSING GOALS/OUTCOMES IDENTIFICATION The nursing goals for older adults diagnosed with powerlessness are to:  (1) identify the actions in which they can exert control and (2) make decisions and have input in the plan of care. NURSING INTERVENTIONS/IMPLEMENTATION The following interventions should take place in hospitals, in extended-care facilities and at home: 1. Allow older adults to make choices whenever possible. 2. Encourage older adults to do as much as possible for themselves. 3. Adapt the environment to encourage independent activity. 4. Explain the reasons for any changes in the plan of care. 5. Avoid being overprotective of directive. 6. Respect older aduls' right to refuse. COPING AND STRESS Stress occurs when a person is faced with a real or perceived threat or experiences a significant or life-altering change. Stressors include: external physical threats internal or psychologic threats external social threats  The more stressors a person faces, the greater the level of stress will be. Stress occurs whether the threat or change is positive or negative. Each of us faces a steady stream of life events with which we must cope, some are temporary or minor events while others are major life events that are likely to cause significant stress that lasts for a longer period. When confronted with stressful events, the body undergoes predictable physiologic responses that prepare it to withstand the threat and to maintain homeostasis.The general adaptation syndrome described by Selye, describes the. collective responses of the body to stress. Cognitive Signs of Stress Stress affects the way we think, feel and act.Although some stress is normal and necessary,even beneficial, high stress levels can be physically and mentally exhausting. EMOTIONAL SIGNS complain of fatigue, tension & anxiety report a feeling that something is wrong appear distracted, irritable, short-tempered verbalize feelings of poor self-worth little capability of interacting with others experience signs of major depressive disorder verbalize suicidal thoughts BEHAVIORAL SIGNS avoid all interactions or tasks take on additional duties disorganized, make more errors, and leave tasks incomplete perform ritualistic actions aggressive behavior Stress and Illness Stress and illness are closely linked. Research has shown that both mental and physical illness results in stress and that stress increases the risk for both mental and physical illness. Stress and Life Events An older adult suffering from numerous chronic and acute conditions is under greater stress that one who is healthier. STRESS-REDUCTION and COPING STRATEGIES There are 2 Basic categories of coping style: (1)Problem -focused strategies which attempts to change or eliminate the stressful event or threat & (2)Emotion- focused strategies which attempts to change person's response to the stressful event or threat. To use a problem-solving method, a person must first identify and examine his or her stressors.Once identified, the individual can determine their importance.Only then can one explore alternative actions to reduce the stress. For example, the individual can continue to face the stressor (e.g.,an annoying co-worker) and live with the consequences (confrontational), change jobs (escape), decrease contact with the stressor (avoidance), or consciously work to change one’s attitude toward the annoying person (emotional distancing). The choice made is based on a deliberate decision. This method of taking a proactive stance (choosing an active response to control the situation as opposed to being reactive (reacting to the situation), gives the person a sense of control and empowerment. Stress is as much a fact of life for older adults as it is for the younger population. However, the amount and types of stressors do seem to change with aging Many of the stressors of older adults involve losses. Too many or too frequent stressors can overwhelm older adults The ability to cope with stress differs widely among older adults Because of the unchanging nature of the many stressors seen with aging, older adults are more likely to emotionally distance themselves from situations they cannot change. They are increasingly likely to seek support in spiritual or philosophic beliefs that help them cope with these uncontrollable situations.  NURSING INTERVENTIONS/IMPLEMENTATION (Ineffective Coping Stress) The following nursing interventions should take place The following interventions should take place in in hospitals or extended-care facilities: the home: 1. Maintain continuity of care to develop a stable, 1. Encourage the family to provide emotional support trusting relationship. to older adults. 2. Encourage older adults to verbalize their feelings. 2. Identify community resources that can provide 3. Ensure that older adults receive adequate nutri support to older adults and their families. tion, rest, and pain relief. 3. Use any appropriate interventions that are used in 4. Explain a variety of stress-reduction techniques. the institutional setting 5. Encourage older adults to participate in activities 6. Consult with mental health specialists, ministers, or counselors Relocation stress syndrome describes the physiologic or psychosocial stress that occurs when a person is transferred from one environment to another. Relocation stress is a common problem with aging and can occur with many types of relocation such as: From a private home to the home of a family member From home to an apartment or other shared living arrangement From one area of the city to another From home to a hospital From home to a long-term care facility From home to a hospital and then to a long-term care facility From one unit in the hospital or long-term care facility to another unit in the same facility From one room to another in a hospital or long-term care facility  Older adults who are required to change residence are likely to experience losses, fears, and concerns that increase stress. Loss of independence, loss of personal possessions, loss of friends and neighbors, fear of the unknown, and concern about the future all increase stress. Older adults experiencing relocation stress syn drome exhibit emotional, behavioral, and physical signs of stress. Most newly relocated older adults experience feelings of powerlessness, helplessness, and insecurity. They often verbalize unwillingness to relocate or dissatisfaction with the new living arrangements.  Some attempt to maintain control of the situation by demanding attention and verbalizing many needs. They may be more dependent on caregivers than their physical condition justifies. Others attempt to cope with the stress by becoming hostile or angry. Still, others cope by with drawing and isolating themselves from contact with staff, other residents, and even family. In addition to behavioral changes, recently relocated older adults are likely to experience physical signs of stress.  NURSING INTERVENTIONS/IMPLEMENTATION (Relocation Stress Syndrome) The following nursing interventions should take place The following interventions should take place in in hospitals or extended-care facilities: the home: 1. Encourage verbalization of feelings, fears, and 1. Allow older adults to participate in decision concerns about the move or change. making and planning for the change. 2. Discuss the reasons for the move or change. 2. Anticipate fears and concerns, and allow adequate 3. Include older adults in care planning. time to implement the change, when possible. 4. Encourage a positive attitude about the move or 3. Use any appropriate interventions that are change. used in the institutional setting 5. Maintain continuity of care to enhance feelings of trust. 6. Encourage the use of familiar objects and belong ings.  VALUES AND BELIEFS Values and Beliefs are uniquely human ideas that sets us apart from any other animals as such they are essential part of our identity. Values and Beliefs affect every aspect of our lives, including the experience of life and death and the way we understand and manage death. COMMON VALUES AND BELIEF OF OLDER ADULTS Economic Values Cultural Values 1. They value financial independence - Cultural values and beliefs unite, 2. They were taught to be frugal and families, neighborhoods, and mindful of resources. communities. 3. Some older adult save or hoard items. Spiritual or Religious Values 1. It has huge impact on the way one Interpersonal Values 1. Today's older adults raised in an experiences life events, including the era where interpersonal related to health. communication was more formal. 2. Older adults were brought up at 2. Older people often cannot times when organized religion played understand why their families do not an important role in society. automatically accept what they say and follow their direction. NURSING PROCESS FOR SPIRITUAL DISTRESS Spiritual Distress -refers to the impaired ability to find meaning and purpose in life, often due to illness or other challenging circumstances, which can lead to feelings of despair, loss of dignity, and a lack of desire to go on living.  NURSING PROCESS FOR SPIRITUAL DISTRESS NURSING GOALS AND OUTCOMES NURSING INTERVENTIONS Identify and verbalize sources of 1. Determine whether there are special values and concerns spiritualpractices and/ or restrictions Specify the spiritual assistance 2. Identify significant people who provide desired spiritual support. Discuss values and regarding spiritual 3. Determine whether there is any way practices nurses Express feelings of spiritual Comfort can aid older adults in meeting their spiritual needs. 4. Provide opportunities for the older adults to to express his/her spiritual needs and concern 5. Determine spiritual objects that have meaning to the older adults ;. obtain these if possible. 6. Provide opportunities for spiritual guidance with respect for privacy 7. Encourage contact with spiritual counselor in times of crisis  SEXUALITY AND AGING Age-related changes significantly affect older adults' sexual practices, with normal physiologic changes slowing down sexual response time. However, the ability to enjoy various sexual expressions remains throughout life. Some changes may lead to sexual dysfunction, a persistent impairment of a person's usual pattern. Older adults benefit from holistic care focusing on promoting sexual health, ensuring they can enjoy various expressions of sexuality. AGE-RELATED CHANGES IN WOMEN Older women experience normal changes in the reproductive system related to the decreased levels of progesterone and estrogen. Approximately one-third of women over the age of 65 experience discomfort during intercourse (dyspareunia) related to postmenopausal changes, such as (1) irritation of the external genitals (pruritus vulvae); (2) thinning and dryness of the vaginal walls (atrophic vaginitis); and (3) alteration in the levels of normal microorganisms in the vagina, resulting in an increased risk for vaginal yeast infections. In many instances, dyspareunia can be treated with over-the-counter topical preparations (see Complementary and Alternative Therapies). AGE-RELATED CHANGES IN MEN Older men experience a normal delayed reaction to sexual stimuli. They require a longer time to achieve an erection, and the erection is often less firm than it was at a younger age. Male orgasm takes longer to achieve and has a shorter duration than at a younger age. Ejaculation is less forceful and a smaller volume of seminal fluid is released. Loss of erection occurs quickly after orgasm. In general, the time between orgasms increases and orgasm may not occur with every episode of sexual intercourse. The most common sexual dysfunction in older men is erectile dysfunction (ED). ED is the inability to achieve or maintain an erection sufficient for a satisfactory sexual intercourse in more than 50% of attempts  IMPACT OF ILLNESS ON SEXUAL HEALTH Illness of one or both partners is a common cause of changes in sexual well-being of older adults. For example; Joint pain resulting from arthritis can interfere with sexual activity. Cardiac problems may interfere with normal sexual activity, although this is often more from fear than from actual danger. Sexual activity does not need to be suspended because of stroke, as sex is not likely to cause another stroke. Hysterectomy (removal of the uterus) and Mastectomy (removal of a breast) do not change sexual functioning, although loss of these organs may make the woman feel less desirable or make her fear that she will be viewed as less desirable. Finally, it is important to recognize that Incontinence itself does not interfere with physical aspect of sexual function but may cause the affected individuals to avoid sexual activity because of embarrassment. EFFECTS OF ALCOHOL AND MEDICATIONS ON SEXUAL HEALTH Alcohol and medications can have a profound impact on sexual function in older adults. Excessive alcohol intake results in delayed orgasm in women and loss of the ability to achieve or maintain an erection in men. A wide range of medications and drugs (Table 16-1) can lead to sexual problems for both men and women. Changes in the medication or the dosage may help resolve the problem. Interestingly, some antiparkinsonian medications actually enhance sexual desire but not necessarily the ability to perform sexually  LOSS OF A SEX PARTNER Loss of intimate partner is one of the most common causes of decreased sexual activity in older adults. Multiple studies identified the inability to find a sexual partner as one of the most frequently stated reason for unsatisfactory sexual life among singles older than 65. Moreover, social norms may suggest to older women that sexual interest in men is not socially acceptable. Older men more frequently voice an interest in sex, although older women often express a desire for companionship and love. MARRIAGE AND OLDER ADULTS The traditional view that older adults think of sex in marriage is changing, as Baby Boomers matured during a more sexually experimental time in the U.S. It is crucial to be culturally sensitive regarding marriage and sexuality in a culturally diverse society. Family responses to marriage or remarriage among older adults vary, with some families accepting the need for affection and meaning in later life, while others view it as unacceptable. Children may fear displacement from their parent's affection or inheritance issues. Regardless of family responses, older people have the right to determine what is best for themselves.  CAREGIVERS AND THE SEXUALITY OF OLDER ADULTS Sexuality is a difficult area to address at any age. Young people may not be comfortable with the thought of sexual activity among seniors believing that it is somehow offensive or abnormal. Similarly, health professionals may harbor personal biases or may lack necessary skills to address the sexual needs of older adults in a therapeutic manner. In addition, older adults are often reluctant to discuss their own sexuality. SEXUAL ORIENTATION OF OLDER ADULTS The exact number of lesbian, gay, bisexual, and transgendered(LGBT) persons over age 65 is unknown. Studies indicate that about 3 million Americans over age 65 are LGBT. This figure is expected to double by 2030. Female LGBT are likely to be overrepresented in these numbers because of general population trends and the greater impact of HIV/AIDS-related deaths on the male population. LGBT older people face the "double stigma" related to their age and sexual orientation. SEXUALLY TRANSMITTED DISEASE Older adults often are not considered when sexually transmitted diseases(STD) are discussed even though nearly 20% of all HIV/AIDS cases in the U.S. are people older than 50. Human immunodeficiency virus(HIV) is commonly overlooked because older adults are not considered to be at high risk for HIV infection. This is one of the possible reasons why the incidence of HIV in older people is rising faster than in those of 24 years of age and younger. NURSING PROCESS FOR SEXUAL DYSFUNCTION ASSESSMENT/DATA COLLECTION Is the person sexually active? If the person is sexually active, do they have any difficulties or discomfort during sexual activity? Does the person have any discharge or drainage from the genitals? RISK FACTORS Does the person have any diseases or RELATED TO SEXUAL disabilities DYSFUNCTION that interfere with sexual activity? IN OLDER ADULTS Are there any emotional issues, such as depression, that interfere with sexual interest or activity? Loss of partner Does the person take any medications that Problems with may physical mobility interfere with sexual activity? Institutional setting What level of sexual activity does the person Physical illness or a desire? reaction to Does the person have any real or perceived barriers therapeutic to sexual activity? medications Does the person have adequate privacy for sexual activity? Nursing Care Plan 16-1 Sexual Dysfunction Mr. Silver, age 89, has a history of hypertension and diabetes. Mrs. Silver, age 87, has severe osteoarthritis and congestive heart failure. Both are residents of Pine Grove Care Center. They have been married for 67 years. Because of space constraints, they have been assigned to separate rooms. Mr. Silver spends a great deal of time at Mrs. Silver’s bedside, where he holds her hand and talks to her. Both often verbalize the wish to hold and touch more intimately. They both state, “I wish we just had some privacy around here.” NURSING DIAGNOSIS Sexual Dysfunction DEFINING CHARACTERISTICS Lack of privacy Separation from significant other Altered body function related to age and disease processes PATIENT GOALS/OUTCOMES IDENTIFICATION Mr. and Mrs. Silver will identify methods for satisfying their need for sexual expression. NURSING INTERVENTIONS/IMPLEMENTATION 1. Allow opportunities for both parties to verbalize their feelings about continuing sexual contact. 2. Attempt to arrange for a shared room, if this is agreeable to both parties. 3. Develop a method, such as hanging a “Do Not Disturb” sign, for ensuring private time for the couple, while recognizing the need for access in case of emergency. 4. Assist with hygiene needs so that both parties are physically clean and attractive. 5. Verbalize an understanding of the continued need for physical closeness throughout life. EVALUATION Mr. and Mrs. Silver are observed spending time privately in Mrs. Silver’s room with the door closed. After these visits, Mr. Silver states that “It feels good just to touch, share a kiss, and be together quietly for a while. It isn’t how I thought we’d end up, but it’s better than nothing.” You will continue the plan of care.