Middle-Aged Adults Chapter 17 PDF

Middle-Aged Adults Chapter 17 By Rosemary Scofich Learning Outcomes Identify psychological Identify normal and spiritual changes biological changes Identify major causes that occur frequently that result as result of death in middle age of the aging process...

Middle-Aged Adults Chapter 17 By Rosemary Scofich Learning Outcomes Identify psychological Identify normal and spiritual changes biological changes Identify major causes that occur frequently that result as result of death in middle age of the aging process Discuss unique Identify health Analyze the influence health opportunities patterns in the of psychosocial related to middle-aged adults stressors occupations 2  Milestones in the Middle-Aged Adult Expanded responsibilities Transition in family life Increased productivity Significant biological changes Normal aging changes 3  Health Promotion for Middle-Aged Adults Overall Goals ▪Improve access to high-quality health services. ▪Promote and improve health and well-being for all age groups. ▪Reduce inequities across all racial and ethnic groups of Canadians 4  Biology and Genetics: Life Expectancy and Mortality Rates Middle adulthood: between 35−64 years of age Examples of general body changes Fat disposition, decreased Skin drier, wrinkles, Thinning, greying hair muscle mass and bone Hormonal changes coarsening facial features density changes 5 Common Health Problems: Middle-Aged Adult Kyphosis: angulation of posterior spine Osteoarthritis: degenerative joint disease Osteopenia: subnormal bone mineralization Osteoporosis: abnormal loss of bone density Osteoporosis Clinical Practice Guideline 7 Gender and Genetics Constipation: decreased stool frequency Menopause: cessation of menses Erectile dysfunction in males Life expectancy: o females: 83 yrs o males: 79 yrs Heart disease, cancer, accidents Biological sex and marital status o Men: higher mortality rate o Married people generally have better health.  Health Perception–Health Management Pattern Nutritional–Metabolic Pattern Elimination Pattern Gordon’s Activity–Exercise Pattern Sleep–Rest Pattern Functional Cognitive–Perceptual Pattern Self-Perception–Self-Concept Pattern Health Roles–Relationships Pattern Sexuality–Reproductive Pattern Patterns Coping–Stress Tolerance Pattern Values-Beliefs Pattern  Health Perception– Health Management Pattern Habits: self- Smoking, alcohol, overeating destructive Visible consequences Risk factors: Age, gender, ethnicity, personal risks Health-promotion needs behavioural and Health screening of diseases and behaviours Stopping self-destructive behaviours environmental Exercise 10  Nutritional–Metabolic Pattern Obesity (BMI more than 30; Diet high in saturated fat overweight: BMI 25–29) Substantially increased risk of Has effect on cardiovascular and chronic cardiovascular disease, cerebrovascular morbidity and diabetes, cancer mortality Risk increases with less education, Recommended total cholesterol is low income, ethnicity HDL less than 5.2 mmol/L; LDL Prevention and management greater than 0.9 mmol/L Fewer calories Lifestyle modifications, Exercise medications if needed Social support groups 11  Nutritional–Metabolic Pattern Recommendations: non-pregnant adults: 1000 mg; postmenopausal women without Calcium hormones: 1500 mg Absorption is enhanced by vitamin D. Stimulant; be aware of addiction potential Caffeine Controversy over health effects of moderate consumption Role in hypertension; increases fluids, High-sodium diet increases vascular resistance 12 Nutritional–Metabolic Pattern Alcohol abuse oDepressant; chronic use produces tolerance oIncreases risk of MVA, liver disease, cancer, heart disease, pancreatitis oCAGE tool oEarly detection and intervention can decrease long-term sequelae. Treatment is complex. Oral health oGingivitis: teeth brushing and flossing needed oDental hygiene and decay: check-ups, water fluoridation, sealants  CAGE Tool 14  Elimination Pattern Risk: age, sedentary lifestyle, lack of dietary bulk Constipation Dietary fibre is preferable to laxatives and fibre products Stress Risk: women who have had multiple births, incontinence little exercise 15  Activity–Exercise Pattern Exercise Initiating exercise Exercise benefits recommendations program Prevent or manage 30 minutes, 5 or more Target (220 - age x 0.75 chronic illness (heart, days per week, total 3– = BPM) diabetes, osteoporosis, 4 hours per week Choose activities depression, cancer) Continuous, rhythmic enjoyed in past (if Significant increase in exercise (e.g., walking, appropriate) life expectancy and jogging, swimming, Consider potential for quality of life bicycling) injury, proper equipment Exercise testing if high risk 16 Sleep–Rest Pattern Compared to young adults o Less time in deep sleep o Less sleep overall Healthful guidelines o Regularly scheduled o Quality sleep o Occasional napping Cognitive-behavioural therapy for sleep problems Sleep apnea is a common disorder in adults o Disordered breathing during sleep o 2 types  Cognitive-Perceptual Pattern Intellectual ability— learning continues Adult continues to accumulate “learning” intelligence through life Piaget’s stage of Can process complex problems of reasoning formal operations Schaie’s factors that Focus on involvement, absence of chronic disease, flexibility, maintain cognitive family, complexity, favourable socioeconomic status, personal satisfaction, spouse with high cognitive function function 18 Cognitive–Perceptual Pattern: Perceptual Changes Presbyopia (farsightedness) Glaucoma: increased intraocular pressure Decreased visual sensitivity and peripheral vision Cataracts: opacity of lens Diabetic retinopathy Macular degeneration: deterioration of retina Presbycusis: loss of higher frequency hearing Diminished sense of taste Self-Perception–Self-Concept Pattern Levinson’s theory—“individual life structures” o Age-associated seasons—midlife transition o Struggles with meaning, value, direction of lives Erikson’s theory—generativity vs. stagnation o Generativity: sense of productivity, creativity, caring for others o Stagnation: lack of accomplishment, self-absorption Physiological changes o Effects on self-esteem: greying hair, wrinkles, body shape o Perimenopause and menopause: Mood swings, nervousness, fatigue, depression Hormonal therapy: indications and controversy Roles–Relationships Pattern “Midlife crisis” o Time of reassessment, turmoil, change Family o Family life cycle Families with children (ages 13–20) Families launching young adults Families from empty nest to retirement o Multiple responsibilities and stresses Children, aging parents, job, and civic responsibilities Single-parent families, adult children at home Over-involvement with children’s activities Roles–Relationships Pattern Work o Plays major role in level of wellness, self-esteem o 240,000 non-fatal work-related injuries yearly Two-or-more-job family o Role changes—family stress factors Nontraditional female and male roles Retirement planning and mid-career changes o Elements of employer health-promotion programs Roles–Relationships Pattern Caring for aging parents o Additional demands of caring for parents and children (sandwich generation) Divorce o Multiple family member adaptations needed o Potential psychological effects on children Death o Spouse: grief for loss of companionship, loss of future o Increased awareness of finite nature of life o Midlife review is common Sexuality–Reproductive Pattern High proportion of adults remain sexually active Pregnancy o Pregnancies in women over 35 are unintended— perimenopause Changes in reproductive system o Slower arousal, orgasms less intense, long refractory between erection and ejaculation, vaginal dryness, decreased libido Coping–Stress Tolerance Pattern Factors related to coping with stress and health outcomes o Stress hardiness—control, commitment, challenge o Tranquilizer use o Maturity of defenses against stress o Framingham Study: worry, conflict, anger, ambitiousness affect blood pressure Coping with death of a parent o Preparation helps feelings of control o Examples: living will, advance directive, durable power of attorney Environmental Processes: Biological Agents Transmitted through air or food and water Enter respiratory or gastrointestinal tract Examples o Hepatitis A: fecal–oral route, poor sanitation o Hepatitis B Bloodborne pathogen Occupational hazard: health providers o Pneumonia: vaccine available o Herpes zoster (Shingles) vaccine available Environmental Processes: Chemical Agents Contaminants from workplace industry o Pneumoconiosis (black lung disease)—coal o Mesothelioma—asbestos o Organic carcinogens: benzene, PVC, others Tobacco o Middle age: by 50 many have a 30+-year history o Risk of heart or lung disease and cancer increased o 2000 known chemicals in cigarettes tar, cyanide, formaldehyde, carbon monoxide Smoking Rates& Costs 28 Source: PHO, 2023  Radon A radioactive gas found naturally in the environment Odourless 16% of lung cancers deaths related to radon 29 Determinants of Health: Social Factors and Environment Culture and ethnicity o Different interpretations of health and illness o Immigrants: poverty, poor living conditions Economics o Net income may be at highest level; also have greater financial responsibilities Health care delivery system o Service agencies o Long wait times  Nursing Application Assess Individual health history Baseline health (employment physicals) Environmental hazards; workplace safety Target group health trends Screen for disease, health risks, behaviours Educate Emphasize self-health promotion Safety (fall prevention, fires, firearms, driving) Organizational health-promotion programs 31