QUIZ 16 Gerontology Social - Biological and Psychological Aspects of Older Adults - PDF

# TEMA 16 ## Gerontología social: los aspectos biológicos y psíquicos de las personas mayores. Funciones del Auxiliar de Servicios Sociales en relación con las personas mayores. ### 1. Introducción a la Gerontología Social The Gerontology is the science that studies the process of aging in genera...

# TEMA 16 ## Gerontología social: los aspectos biológicos y psíquicos de las personas mayores. Funciones del Auxiliar de Servicios Sociales en relación con las personas mayores. ### 1. Introducción a la Gerontología Social The Gerontology is the science that studies the process of aging in general, dealing with clinical, biological, psychological, and sociological aspects. It is a study that covers all living beings, not limited to humans. Currently, Gerontology, as a science that deals with aging, is gaining importance due to the fact that the population of older adults in developed countries is growing considerably, generating what has come to be known as an "aging population". #### Sabías que... - As of January 1, 2022, the number of people 65 and older in Spain is 9,063,493, which represents 19.09% of *the entire population*. - According to projections by the National Statistics Institute (INE), in 2033, 25.2% of the population will be over 65 years old. - If the current rates of mortality reduction continue, the life expectancy at birth in 2033 will be 82.9 years for men and 87.7 for women. It is also important to note that women have a higher life expectancy than men. For women, it would be around 80-81 years; for men, around 75 years. The phenomenon of population aging brings about various implications in the economic, as in the social or healthcare spheres. This is where Geriatrics arises, which is part of Gerontology and deals with the study of diseases of the elderly and their potential treatments. Population aging leads to *a scenario where there* is less activity (retirement), a higher incidence and co-occurrence of disease (comorbidity), and greater frailty, dependence, and demand for resources. Therefore, its approach requires cooperation from different aspects: political, economic, healthcare, and social. ### 1.1. Aspectos biológicos de la persona mayor Speaking of biological aspects of older adults refers to aging as one of the variables shaping it. Aging focuses on the loss of organ function or on the loss of our body's capacity to react to stress, etc. Lopez Novoa describes it as follows: "aging is an intrinsic, progressive, and universal process conditioned by racial, hereditary, environmental, hygienic-dietary, and healthcare factors. It is multifactorial and does not follow a single law that explains it, and its main characteristic is a decrease in functional performance that translates into slowness or the inability to adapt to situations of biological, physical, psychological, environmental, and social overload." There are two groups of theories that try to explain the cause of aging: - **Exogenous theory**: proposes that environmental factors and aggressions, derived from diet, metabolism, etc., are those that deteriorate our body and lead us to age. - **Endogenous or genetic theory**: proposes that the rate at which we age is set in our genes from birth, and that environmental factors do not influence it at all. **Mixed theory**: synthesizes both proposals. In other words, it states that both environmental factors (external aggressions, free radicals, and byproducts of our chemical reactions, etc.) and internal genetic factors that determine the rate of aging influence the aging process. Aging involves a series of physiological characteristics that we will detail below: - Not all organs lose their function equally, and the changes that occur in them may vary greatly from one individual to another. - The older adult may be "apparently" healthy, but the loss of function is evident given the situation of illness, stress, etc. - When a *dysfunction occurs*, the body always tries to compensate for it. Physiological changes in the body of the older adult may differ from those in the young adult, which may alter the presentation of diseases that do not manifest in the young adult. - Physiological changes that occur with aging may contribute to the appearance of certain diseases. - Alterations in kidney and liver function with aging cause medications to be eliminated at a different rate than in young adults, so dosage adjustments are necessary. Some of the changes that occur in the body due to aging are as follows: **Cardiovascular system**: there is an increase in collagen fibers, with a tendency to calcification and fibrosis of the heart valves; accumulation of fat cells in the conduction tissue, and appearance of atherosclerosis in coronary and peripheral vessels. All of these changes contribute to the following alterations: - Less pumping capacity. - Problems with closing or opening the heart valves. - Predisposition to arrhythmia. - Episodes of angina. **Respiratory system**: the lungs of older adults are smaller, weighing approximately 20% less than those of young adults. Lung elasticity is lost. Ribs and vertebrae experience changes due to decalcification, lowering the vertebral column and producing *a wider, deeper thoracic cage, but one that is shorter*. There is a decrease in the diameter of the small airways and a decrease in the surface area for gas exchange, which produces deficient oxygenation. **Digestive system**: Teeth are worn down and become brittle because their vascularization decreases, and the enamel wears away, exposing the dentin. Many teeth are missing. Additionally, the gum mucosa thins out, which makes it difficult to adjust dentures. The muscles in the mouth lose tone. **Neuro-urinary system**: Kidney function decreases its reserve capacity and response to stressful situations. The kidneys of older people become smaller, about 25-40% in weight and volume, most notably in the renal cortex. The functioning glomeruli are reduced by 10% in *the seventh decade*. Kidney vascularization also decreases by about 10% every decade starting in the third decade. This is why *older people* are particularly prone to dehydration. In the bladder, there is observed difficulty with urination due to various factors, such as reduced bladder elasticity, poor muscle tone, and contraction of the external urinary sphincter, as well as weak pelvic floor muscles. All of these changes lead to partial obstruction, which can lead to infections and urinary incontinence. This is the most frequent clinical manifestation of lower urinary tract dysfunction in older adults. **Nervous system**: there is a loss of brain weight and volume with decreased neuron numbers, as well as an accumulation of certain substances (lipofuscin, amyloid...). There are also changes to cerebral blood vessels that develop *atherosclerotic lesions*(formation of plaques that narrow blood vessels) . Memory suffers a decrease in its capacity to store new knowledge. The reaction time is longer, and there is more difficulty in processing and manipulating new information. This results in less deep sleep and more frequent awakenings. **Sensory organs**: - **Eyes**: there is decreased visual acuity, sensitivity to colors, and accommodation capacity (adapting from dark to light, or vice versa). - **Ears**: earwax production decreases, *the tympanum loses elasticity*, and there are degenerative changes in the cochlea, which produce a decrease in auditory capacity, especially for high frequencies. **Genital system**: there is general atrophy in the ovaries, uterus, and vagina, with a decrease in the volume of secretion and blood flow, and a higher risk of infections. Testes are smaller and have a reduced capacity to produce sperm. The production of sperm is maintained until about 70 years of age. **Bones and joints**: the key point is *bone loss*, which makes the skeleton more vulnerable and increases the risk of fractures. Degenerative or arthritic changes in joints are very frequent and early, which lead to decreased range of motion and pain. **Skin**: there are also significant cutaneous changes, as in the nails. Nails are thinner and smaller, grow more slowly, and crack and tear more easily. In some cases, they thicken abnormally (hyperkeratosis), especially on the feet. **Oral health**: oral health is very important for the quality of life of the older adults. It causes pain, difficulty chewing and swallowing, as well as aesthetic and self-esteem problems that can, in extreme cases, lead to social isolation. The most common problems in the oral cavity of older adults are: cavities, tooth fractures, periodontal disease, and tooth loss. **Feet**: the feet are one of the most complex parts of the body and also one of the most neglected and least cared for parts. However, persistent pain in the feet can lead to disability for individuals, preventing them from carrying out their daily activities (household chores or work, shopping, etc.), which can even lead to social isolation. Although *disability* is the main factor for placing older adults in long-term care facilities, we must bear in mind that foot care is also an important aspect for health and physical mobility, as well as for social relationships. Therefore, it should be included in all programs for older adults. ### 1.2. Aspectos psíquicos de la persona mayor When we talk about the psychological aspects of older adults, we are referring to the entrance to the last stage of life, which is accompanied by physical and social changes that affect the psychological aspects of older adults. In older adults, physical changes related to aging are observable, as they limit their movements, change their outward appearance, and impair systems or organs associated with different functions. Social changes, such as retirement, are also easy to perceive. However, changes that occur in the field of psychology are perhaps less readily noticeable; although they have their consequences in *the realm of intellectual* and cognitive abilities (intelligence, memory, etc.), or in emotions (losing loved ones like friends or spouses is inevitable, as the approaching end-of-life becomes more tangible). Any change in a person's life brings about psychological changes that require time for acceptance of the new circumstances. However, most situations faced by older adults are challenging, and are marked by losses at the bio-psycho-social level. Depending on each individual's personal characteristics and the level of social support available, they will experience a higher or lower quality of life in this final stage. To understand psychological changes that are attributed to aging, it is important to take into account the interrelation between: - **Physiological decline**: these would be anatomical and functional changes in the brain structures. - **Changes in mental abilities**: (intellectual and cognitive). - **Changes in emotional state**: (experiencing losses, motivation, personality...). - **Changes at the social level**: (loss of roles, social status, and retirement...). - Some authors, such as Neuhaus and Neuhaus (1982), establish relevant aspects to achieve successful aging: - **Environmental and health factors**: satisfied individuals are those who are capable of fighting to stay healthy, accepting the progressive challenges of aging, incorporating physical exercise as an important aspect of well-being while also taking it into account. - **Social factors**: feeling satisfied with their life is important, as is being ready for retirement and having a strong social support network. - **Psychological factors**: those who feel most satisfied are those who view old age as another stage within the life cycle. - **Higher mental functions**: we define higher mental functions as those psychological processes that set us apart as a species. We can group them into: - intellectual functions - cognitive functions **"Intelligence"** refers to abilities that enable a person to adapt effectively to their environment. - **Did you know...?** Several studies have demonstrated that **there is no intellectual decline due to chronological age**. The decline only occurs when the person is affected by a condition that functionally limits them. However, there are authors who differentiate between two forms of intelligence: fluid intelligence and crystallized intelligence. - **Fluid intelligence**: it is the ability to develop and adapt quickly and efficiently to new situations. This form of intelligence decreases with age. - **Crystallized intelligence**: it is the ability to apply accumulated past experiences to the present situation. This form of intelligence does not decrease with age, but rather increases. The following changes related to psychological aspects occur as older adults age : - **Cognitive functions**: aging leads to changes in cognitive functions. When we say "cognitive functions," we are referring to the process we use to receive, store, and use the information that we receive. These cognitive functions include: - Perception - Memory - Attention - Reasoning - **Changes in perception**: any information received from the external environment suffers extensive decline. This affects mainly the two fundamental input channels: auditory and visual. With this functional decrease, older adults begin to experience difficulties in communication, which makes them feel insecure and can lead to social isolation. Even so, most older adults continue their activities normally, compensating for these setbacks with hearing aids, glasses, etc. - **Changes in memory**: memory can be divided into: - **Recent or short-term memory**: is the ability to recall recent events. The decrease in short-term memory is a characteristic of old age, as are slight forgetfulness. - **Remote or long-term memory**: it is the ability to recall past events, although new experiences are also stored in this form of memory. - **Changes in attention**: attention refers to the predisposition and willingness to be receptive to stimuli or information coming in. Attention suffers decline in both the visual and auditory senses, as perception is affected by aging. The same applies to the motivation of older adults, as they lose interest in external stimuli - which are the basis of their correct mental, physical, and social interactions (loss of loved ones, work, social life, among others). This is what we are referring to as "attentive decline." The impairment of attention affects other cognitive functions. - **Changes in reasoning**: Reasoning is closely tied to intelligence, and it degenerates as older adults age, which results in slower mental processing. Basically, this slowing down affects both cognitive processes as well as physical processes, so older adults will need more time to adapt to any situation. Mental performance is also influenced by other factors: - **Personal intelligence**: greater decline for those considered less intelligent. - **Education**: greater differences in performance among individuals with higher education and those with elementary education only. - **Professional activity**: greater decline for individuals that have been working in monotonous or low-stimulating jobs, compared to those whose line of work required higher intellectual stimulation. - **Changes in acceptance of self-image**: "self-image" is the image that each of us has of ourselves. It provides us with our identity and our role in the context of those that surround us. As older adults age, many of the activities and situations in which the individual was placed change, and their possibilities for relationships change as well. This makes many older adults lose their role, feel unsatisfied, and not accept their "new image". The factors most detrimental to the self-esteem of older adults are retirement, as well as the reactions or responses that they receive from society. - **Emotional and personality changes**: as the aging process progresses, we see emotional and personality changes. We consider emotional and personality changes to be those that happen in the emotional state of *the individual*. Their emotional maturity develops through life experiences. In older adults, these experiences are marked by losses: physical, professional, emotional (loved ones)... Furthermore, these losses are frequent in later years, and the challenges that come with aging are prevalent. Social changes bring with them increased tension (new social situation, for example), and this situation is further aggravated by decreased physical strength and other resources that are needed to overcome the obstacles in their path. The impact that these events have on the mood and emotions of older adults will depend on the support they receive from those surrounding them, as well as on their physical and mental well-being. If these conditions are satisfactory, *they will have the motivation and energy* to enjoy their environment. However, in adverse conditions, the tendency to depression increases. The most common condition in this stage of life is affective disorder. Personality traits, such as those that distinguish one person from another, are mental and emotional qualities. Many studies are available that address the adaptation of individuals as they age, differentiating between "well-adapted" individuals *and those that have trouble adapting*. - **"Well-adapted" personalities**: these are older adults who are realistic, content, and enjoy this stage of their life and are happy with it. They are active and interested in everything around them and see life in a positive way, even if they are more passive, but *they are equally adapted, feel content* with retirement, and they don't *feel the need for social obligations*. - **"Poorly adapted" personalities**: these are people who are angry, negative, and hostile, and who never feel happy about aging or about the approaching death. Or, those whose life's balance is negative: they feel guilty about everything and see death as the only way out of their unhappy situation. - **There are a lot of changes** that contribute to shaping the psychological aspects of older adults, but it is important to make note of the fact that one-third of older adults over 65 experience mental health problems. - **Affective disorders - depression**: depression is the psychological condition that is most common in older adults. It manifests either directly or indirectly, masked by complaints related to *hypocondriacal problems, or functional difficulties*. This mental health problem is often linked to suicide. There are many types of depression, but the following are common characteristics: - **Sad mood**: this sad demeanor is either present directly, or it is masked by somatic complaints or by symptoms of anxiety. - **Loss of interest**: they seem to lose interest in their surroundings and family. This situation sometimes makes the older adult feel guilty because they feel like they are being selfish. - **Sleep disturbances**: finding it difficult to fall asleep and waking up early. - **Eating disturbances**: *anorexia* (lack of appetite) and loss of weight. - **Motor disturbances** (inhibition-slowness, restlessness). - **Slowing of thought**: slowness of thought and the emergence of depressive ruminations (dwelling on ideas with nothing but a negative outlook), which can lead to delusional culpability and ruin. - **Significant impairment in attention, concentration, and memory**: that limit their daily activities. - **Anxiety disorders - Anxiety attacks and chronic anxiety**: Anxiety is a subjective state of indefinite fear, apprehension, and insecurity, accompanied by ongoing vigilance and physiological changes in the central nervous system: palpitations, sweating, dry mouth,* a subjective feeling of imminent danger, etc*. Anxiety attacks are characterized by sudden bursts of panic, accompanied by symptoms such as palpitations, trembling, pain, shortness of breath, choking, etc., which sometimes lead to agoraphobia (fear of leaving the house and of crowded spaces). These attacks typically last a few minutes, or a few hours. *Generalized anxiety disorder* *is* chronic and floating; *those affected* experience restlessness, fatigue, irritability, difficulty concentrating, and excessive worry that they find hard to control. Chronic anxiety disorders are much more frequent in older adults, which are manifested mainly by somatization (gastrointestinal problems, eating disturbances, frequent urination, restlessness, general ill-being, sweating in the hands, and hypochondriacal complaints). In many instances, this state of anxiety is merely a mask for depression. - **Obsessive-compulsive disorder**: obsessive-compulsive disorder is a type of anxiety disorder. *Those affected* experience obsessions and compulsions that they find difficult to control. Obsessions are *persistent thoughts, urges, or images* that cause anxiety or significant distress. Compulsions are defined as behaviors (for example, washing hands, putting things in order or checking things) or mental acts (for example, praying, counting, or repeating words silently) that are repetitive and that the individual is forced to carry out in response *to* an obsession or in accordance with certain rules that they are compelled to follow. The goal of these actions or mental operations is to prevent or reduce the distress, or to prevent some negative event or situation. Obsessive-compulsive disorders can first emerge in later stages of life due to the worsening of existing neurotic features, or also due to the patient's attempt to control an impairment or mental decompensation. - **Phobic disorders**: A phobia is defined as persistent and irrational *fear* *of* an object, activity, or situation specific to that object, activity, or situation. Individuals recognize that their fear is excessive or unreasonable in *relation to the actual danger posed by the object, activity, or situation*. Irrational fear and avoidance behaviors are present in various psychiatric disorders. However, the DSM-5 states that phobic disorder is only present when the specific or multiple phobias are the predominant feature of the clinical presentation, when they create significant discomfort for the individual, and when they are not due to another mental health condition. These *phobic presentations are frequent* in older adults, although if they are mild, they often go unnoticed by healthcare providers. The agoraphobic disorder is the most common, marked by fears that paralyze the individual and prevent them from going out, specifically to open spaces. - **Somatic symptom disorder and related disorders**: the main characteristic here is the presence of physical symptoms that stem from mental conflicts or stressful situations and are localized in different parts of the body. Common examples include: ulcers, intestinal problems, asthma, etc.. In older adults, these disorders are most often observed in the digestive system. This is often accompanied by anxiety disorder due to illness, which is characterized by excessive worry and fear of becoming seriously ill, based on the interpretation of physical symptoms. Individuals with this disorder are constantly seeking medical attention and visit healthcare providers frequently. They have extensive medical records. Additionally, they experience a progressive decline in their social life and daily activities. - **Delirium and dementia**: Dementia is defined as the loss of intellectual abilities, serious enough to affect everyday functioning and social relationships, and accompanied by memory loss and other changes in *cortical function*, affecting judgment, reasoning, and abstract thinking, while consciousness is unchanged. Alzheimer's disease is one of the most common types of dementia. - **There is a tendency* on the part of healthcare providers to fall into the trap* of treating* older adults with a paternalistic approach. This approach only serves to prolong their stay in institutions and reinforces their existing behaviors. Another common mistake is that healthcare professionals have an *intolerant, rejecting, and miscomprehending attitude* toward their illness. These attitudes are fueled by the difficulties and frustrations that older adults often experience. ### 2. Funciones del Auxiliar de Servicios Sociales en relación con las personas mayores One of the functions *of an auxiliary social services worker*, in terms of direct care, is to provide auxiliary services to the user and to act on the socio-healthcare conditions of their environment. In other words, to be part of a professional team at long-term care centers for specialty and primary care. Within the different functions that they carry out, we can distinguish four areas of intervention: - **Support**: it includes *therapeutic and preventive care*. The work here involves providing auxiliary care to the client. - **Teaching**: it includes work in training programs with other professionals, as well as teaching for self-caring in older adults. - **Administrative**: This work involves participating in the planning, organization, and evaluation of the objectives of the department, as well as of the institution or center where they work. - **Research**: this work involves collaborating with the team on research activities. Some of the *general procedures* *in which this professional participates* are: - Provide assistance to cover the user's personal needs. - Promote and maintain the user's well-being by offering security and promoting self-esteem. - Maintain a hygienic environment and ensure its safety. - Utilize, maintain, and preserve the materials used. - Participate in the planning, review, or adaptation of care plans for users. - Observe, *keep a record of* and store all data relevant to care plans. - Participate in team meetings. - Collaborate on research projects within the team. -* Collaborate in* the development of education programs for health awareness. ***Assisted living facilities*** are residential homes whose main objective is to facilitate the development of an independent lifestyle for older adults (for as long as possible), preventing them from being placed in a long-term care facility. Assisted living facilities provide housing and supervision for older adults whose housing situation is inadequate or who do not have their own home. Assisted living facilities are intended for older adults who are capable of managing their own activities and who are not dependent on anyone else. They are small living units or congregate living facilities that are supervised by a social services agency, either public or private, which is in charge of providing for the needs of their residents. The auxiliary social services worker's duties and responsibilities in assisted living facilities are those described above, and in more specific terms they include: 1. **Welcoming users, accompanying them, and providing general facility information**: - Gather all the documentation for each user, providing each one of them with the information that they need (medical records, social services records, etc.). - **Administrative support**: involves filling out lists, user forms, controlling admission, and other aspects. - Provide information to the user about the general aspects of the facility (rules, services, organization, schedules). 2. **Provide help with basic tasks and simple manual or mechanical activities**: - **Assistance with Basic Activities of Daily Living (BADL)**: provide support to the user during their ADL, when needed. For example, assisting with personal hygiene tasks, taking part in care tasks provided by registered nurses, *receive food trays,* and help to get users ready for their meals. 3. **Tasks related to the functioning of the facility**: - If instructed by the supervisor, supervise the general condition of the facilities. - Manage keys to the apartments. - Answer the phone, and manage alarm systems. - Control the entry and exit of users and visitors. - Record any relevant incidents in the incident log. - Provide information to users and assist them with administrative procedures. 4. **Participation of the multidisciplinary team**: - Share information with the rest of the team. - Collaborate with the technical team in the coordination of professionals who participate in the care of users. - Participate in team meetings to explain the different interventions and activities carried out. - Collaborate in the development and review of the facility's policies. 5. **Activities assigned by the administration of the facility**: within this scope.  **Bibliography**: - EDAE Executive Education: *Technical Assistant for Geriatric Nursing*. Madrid, 2010. - Filardo Llamas, C.: *Social Work for Older Adults,* Social Work Documents, no. 49.  - Rodríguez Moreno, S. y Castellano Suárez, A: *Clinical and Psychosocial Intervention for Older Adults*. Canary Islands Institute for Social and Health Studies and Promotion. 1995.