Successful Aging: Definitions, Characteristics, and Common Changes in Older Adults

1. What is successful aging?

Successful aging means remaining physically, psychologically, and socially engaged in meaningful ways defined by the individual. It includes physical, mental, and spiritual well-being, positive self-appraisal, greater life satisfaction, and a positive perception of one's status.

1. What 3 major characteristics are associated with successful aging?

1) Less disease and disability, 2) High levels of cognitive and physical functioning, and 3) Active social engagement.

1. How does adaptation relate to successful aging?

Aging is a progressive process of adaptation. Aging can be successful or unsuccessful depending on the person's ability to cope.

1. What influences successful aging?

A person's CHOICES influence successful aging.

1. What is another hallmark of successful aging?

Achieving a comfortable acceptance of impending death.

2. SATA: What are common SENSORY age-related changes in older adults?

Decreased elasticity of the lens = PRESBYOPIA; CN VIII changes = PRESBYCUSIS/hearing loss; decreased saliva and taste buds = decreased taste; decreased olfactory fibers = decreased smell; decreased perception of touch.

2. What is PRESBYOPIA?

Age-related decrease in the eye lens's elasticity, resulting in difficulty focusing on near objects.

2. What is PRESBYCUSIS?

Age-related HEARING LOSS associated with changes involving cranial nerve VIII (CN VIII).

2. SATA: What are common SKIN changes with aging?

Decreased collagen, decreased elasticity, decreased sweat-gland function, and increased susceptibility to heat.

2. SATA: What are common NEUROLOGICAL changes with aging?

Overall structural changes, neuron changes, neurotransmitter changes, vascular changes, plaques and tangles, and effects of free radicals.

2. SATA: What are common CARDIOVASCULAR changes with aging?

Enlargement of heart chambers/coronary cells; arteries become extended and twisted; cardiac valves increase in circumference and lose elasticity; SA node fibrosis; loss of pacemaker cells.

2. What autonomic nervous system changes occur with aging?

Orthostatic hypotension, increased norepinephrine concentrations, impaired sympathetic nerve response, and changes in peripheral vascular resistance.

2. SATA: What RESPIRATORY changes occur with aging?

Changes in alveoli, decreased lung elasticity, chest-wall changes, changes in respiratory measures, and decreased cough reflex.

2. SATA: What MUSCULOSKELETAL changes occur with aging?

Muscle atrophy, decreased muscle fibers, decreased bone mass/density, and sarcopenia.

2. What is SARCOPENIA?

Age-related decrease in muscle mass and function, including decreased walking speed and grip strength.

2. What ENDOCRINE change occurs with aging?

Decreased glucose tolerance.

2. What HEMATOLOGIC change occurs with aging?

Hemoglobin and hematocrit can be low-normal.

2. SATA: What GI changes occur with aging?

Delayed gastric emptying, decreased peristalsis, decreased muscle tone, and impaired drug metabolism. Liver size may decrease by about 50% along with decreased function.

2. Is decreased appetite considered a normal age-related GI change according to the PowerPoint?

NO. The slide specifically says "not appetite."

2. SATA: What GU changes occur with aging?

Decreased nephrons/GFR, decreased bladder muscle tone and elasticity, decreased estrogen/testosterone production, and enlarged prostate.

2. What is the most common bowel problem in older adults according to the aging PowerPoint?

Constipation.

2. What is immunosenescence?

Aging of the immune system.

2. Does personality normally change drastically with age?

NO. Personality generally does not undergo drastic changes simply because someone ages.

2. Why are older adults at increased risk for depression?

Because of the multiple LOSSES that can occur in later life.

2. Is the ability to learn seriously altered by normal aging?

NO. Learning ability is not seriously altered, but motivation, attention span, delayed transmission of information, perceptual deficits, and illness can affect learning.

2. What memory changes can occur with normal aging?

Reduced working memory and word-finding difficulty. A healthy older adult should still be able to repeat about 6-8 digits.

2. What happens to crystallized intelligence with aging?

Crystallized intelligence—knowledge accumulated over a lifetime—is generally MAINTAINED.

2. What happens to fluid intelligence with aging?

Fluid intelligence declines; intellectual responses to new information and creative capacity can decrease.

2. Does interest in sex automatically disappear in older adulthood?

NO. Interest in sex can extend well into late life, although various factors can interfere with sexual functioning.

3. What is the Functional Consequences Theory?

It emphasizes that POSITIVE functional consequences are possible despite age-related limitations.

3. What is a positive functional consequence?

A positive outcome that promotes or supports an older adult's highest level of functioning, independence, well-being, and successful aging.

3. SATA: Which findings would represent positive functional consequences/successful aging?

Maintaining independence, remaining physically active, maintaining cognitive function, staying socially engaged, adapting to age-related changes, having life satisfaction, and accepting impending death comfortably.

3. What would be a negative functional consequence?

An outcome that interferes with an older adult's functioning, independence, health, or quality of life.

4. What is polypharmacy?

The use of multiple medications. It is especially important in older adults because it increases the risk of adverse drug events and drug interactions.

4. How common is polypharmacy in older adults according to the slides?

It occurs in more than 1/3 of older adults and in more than 1/2 when OTC medications are included.

4. SATA: How can nurses reduce polypharmacy and adverse drug events?

Always review the medication list; check the Beers list; determine whether each medication has a current indication or alternative; include OTC and herbal products; calculate creatinine clearance/monitor labs; consider drug-disease interactions; assess patient knowledge; provide teaching.

4. What should medication teaching include?

The medication's purpose, how to take it, and expected reactions.

4. What is the Beers Criteria/List used for?

To identify medications that may be potentially inappropriate or risky for older adults.

4. What are the MASTER RULES for drug therapy in older adults?

Minimize the number of drugs; consider alternatives; START LOW, GO SLOW; titrate therapy; educate the client; review medications regularly.

4. What does "start low, go slow" mean?

Start older adults on lower medication doses and increase/titrate cautiously because aging affects medication handling and increases risk for adverse effects.

5. SATA: What are INTRINSIC fall-risk factors?

Orthostasis; medications causing dizziness/drowsiness/orthostatic BP; diuretics; antihypertensives; antipsychotics; impaired balance; neuropathy; incontinence/urgency; vision impairment; infection such as UTI.

5. SATA: What are EXTRINSIC fall-risk factors?

Unsafe environmental/caregiver-related factors such as restraints, bedrails, poor supervision, unsafe clothing, and waxed or wet floors.

5. Why are falls especially serious in older adults?

Falls can cause fractures, rhabdomyolysis, death, immobility, loss of independence, increased hospital admissions, nursing-home placement, and fear of falling.

5. Are falls usually caused by only one factor?

NO. Falls in older adults are usually MULTIFACTORIAL.

6. What should a nurse do if an older adult is suspected of being abused?

Assess the older adult carefully, ensure safety, document objective findings, and REPORT suspected abuse according to required procedures/Adult Protective Services. Do not ignore suspected abuse.

6. What areas should the nurse assess when elder abuse is suspected?

Physical health, nutrition/hydration, injuries/bruises/physical harm, degree of frailty, pathological conditions, ADLs, psychosocial function, support resources, and environmental influences.

6. What are possible signs of elder abuse or neglect?

Dehydration, malnutrition, lacerations, bruises, fractures, dislocations, sprains, mental changes, poor hygiene, missing glasses/dentures, over- or undermedication, rarely being seen, and failure to thrive.

6. What are barriers that may prevent an older adult from reporting abuse?

Feelings of guilt/shame and fear of retaliation.

6. To whom does the elder-abuse PowerPoint say abuse can be reported?

Adult Protective Services.

7. What are the types of elder abuse?

Physical abuse, neglect, psychological/emotional abuse, exploitation, abandonment, sexual abuse, and self-neglect.

7. What is PHYSICAL elder abuse?

Direct physical assault resulting in injuries such as lacerations, welts, dislocations, or sprains; it can also include threats with a weapon.

7. What is NEGLECT?

Failure to meet an older adult's basic human needs, potentially causing life-threatening problems such as dehydration or malnutrition.

7. What is PSYCHOLOGICAL/EMOTIONAL elder abuse?

Inflicting pain through verbal or emotional means, including yelling, screaming, berating, emotional distancing, or isolation.

7. What is EXPLOITATION?

Theft, misappropriation, or misuse of an older adult's funds or property.

7. What is ABANDONMENT?

Desertion of an older adult by a caretaker.

7. What is SEXUAL elder abuse?

Rape or sexual harassment.

7. What is SELF-NEGLECT?

Behavior by an older adult that threatens their own health or safety.

8. What is AGEISM?

Stereotyping, discrimination, and prejudice against someone based solely on AGE.

8. Why is ageism harmful?

It prevents understanding of older people and reduces opportunities to gain realistic insights about aging.

9. What is a GERIATRIC SYNDROME?

A clinical condition in older adults that does not fit neatly into a disease category, is highly prevalent in old age, is multifactorial, is associated with multiple comorbidities and poor outcomes, and requires a multidimensional approach.

9. What is a simpler definition of a geriatric syndrome?

A symptom or GROUP OF SYMPTOMS common in geriatric patients that results from MULTIPLE CAUSES.

9. What are examples of common geriatric syndromes from the PowerPoint?

Urinary incontinence, falls, delirium, polypharmacy, and delirium superimposed on dementia.

10. What is the goal/aim of gerontological nursing?

To provide for HEALTH, LONGEVITY, and INDEPENDENCE at the HIGHEST LEVEL OF FUNCTIONING POSSIBLE.

10. What is gerontology?

The scientific study of the effects of aging and age-related diseases on humans, including biological, physiological, psychosocial, and spiritual aspects of aging.

10. What is gerontological nursing?

The scientific study and specialized nursing care of older adults.

11. What is the DISENGAGEMENT THEORY of aging?

As people age, they WITHDRAW from society and relationships; this withdrawal helps maintain equilibrium.

11. Disengagement theory is what type of aging theory?

A SOCIOLOGICAL theory of aging.

12. Does late-life depression cause a positive or negative functional outcome?

NEGATIVE functional outcome.

12. What happens when an older adult has depression AND chronic illness?

They experience more serious NEGATIVE functional consequences.

13. SATA: What negative functional consequences can result from SMOKING?

Smoking contributes to repeated injury/"wear and tear" on the body and therefore contributes to unsuccessful aging and reduced physical functioning.

13. Which aging theory specifically uses smoking as an example?

WEAR AND TEAR THEORY. The slide lists smoking, poor diet, and substance use as contributors to repeated bodily injury over time.

14. What is Erikson's developmental stage for adults older than 65?

EGO INTEGRITY vs. DESPAIR.

14. What indicates EGO INTEGRITY in an older adult?

Acceptance of one's life and life experiences, a sense that life has meaning, and acceptance of aging/death rather than regret and despair.

14. What would indicate DESPAIR?

Regret, dissatisfaction, hopelessness, or feeling that one's life lacked meaning or that it is too late to change it.

15. What is the medical term for age-related hearing loss?

PRESBYCUSIS.

15. Presbycusis is associated with changes in which cranial nerve according to the slide?

Cranial nerve VIII (CN VIII).

15. What is the medical term for age-related difficulty focusing on near objects?

PRESBYOPIA.

16. SATA: What are ATYPICAL grief responses in older adults?

PHYSICAL SYMPTOMS; IMMOBILIZATION; INSOMNIA; DECREASED APPETITE; and INCREASED/REAPPEARING PRE-EXISTING ILLNESS.

16. Is psychosis listed as an atypical grief response in the PowerPoint?

NO.

16. What are TYPICAL grief responses listed in the PowerPoint?

Shock, denial, anger/guilt, depression, understanding, and acceptance.

17. What is the WEAR AND TEAR theory?

A stochastic biological theory stating that aging occurs because of REPEATED USE AND INJURY of the body over time.

17. What lifestyle factors are examples of wear and tear?

Smoking, poor diet, and substance use.

17. Is wear-and-tear theory stochastic or non-stochastic?

STOCHASTIC.

18. What do the ANA Standards of Gerontological Nursing recognize?

The interrelationship among cultural, spiritual, economic, psychological, and biological factors; multiplicity of losses; grief work needed to accept losses; atypical responses to disease/treatment; accumulated disabling effects of multiple chronic illnesses; and cultural values/social attitudes toward older adults.

18. According to ANA, what needs should gerontological nursing encompass?

Physical, psychosocial, spiritual, and other felt needs of older adults.

18. According to ANA, what type of care should gerontological nurses provide?

Evidence-based, PERSON-CENTERED health care to older adults and their families across health-care settings.

18. Who can specialize in gerontological nursing?

A licensed RN or advanced-practice nurse with specialized gerontological knowledge and skills needed to manage and provide person-centered care.

19. What are the COMMON CHARACTERISTICS of geriatric syndromes?

They are highly prevalent in older adults, MULTIFACTORIAL, associated with multiple COMORBIDITIES, associated with poor outcomes, do not fit neatly into one disease category, and require a MULTIDIMENSIONAL approach.

19. Why is critical thinking important when caring for patients with geriatric syndromes?

Because geriatric syndromes frequently have vague/atypical presentations and multiple causes rather than one obvious disease process.

20. What is FUNCTIONAL urinary incontinence?

The bladder/urinary system itself is NORMAL, but the person cannot toilet normally because of PHYSICAL, COGNITIVE, or ENVIRONMENTAL barriers.

20. Give an example of functional incontinence.

An older adult with dementia has a normally functioning bladder but cannot recognize/find/use the toilet appropriately.

20. What is STRESS incontinence?

Incontinence caused by weak pelvic muscles when abdominal pressure increases, such as during laughing.

20. What is URGENCY incontinence?

Incontinence associated with causes such as UTI, prostate problems, or tumor.

20. What is OVERFLOW incontinence?

Incontinence caused by bladder-neck obstruction, medications, or weak bladder muscle.

20. What is NEUROGENIC incontinence?

Incontinence caused by disturbance of the neural pathway, such as cerebral-cortex problems or multiple sclerosis, sometimes causing inability to sense bladder signals.

20. What is MIXED incontinence?

A combination of more than one type of urinary incontinence.

21. SATA: What are causes of DELIRIUM?

INFECTION; MEDICATIONS; WITHDRAWAL; undertreatment of PAIN; FLUID/ELECTROLYTE imbalances; HYPOXIA; TRAUMA; SURGERY/ANESTHESIA.

21. What is one of the most important things to suspect when an older adult suddenly becomes confused?

An underlying acute problem such as INFECTION, medication effects, hypoxia, fluid/electrolyte imbalance, pain, trauma, withdrawal, or recent surgery/anesthesia.

22. What is DELIRIUM?

An ACUTE, potentially LIFE-THREATENING confusional state with a FLUCTUATING course.

22. What are characteristics of delirium?

Acute onset, fluctuating course, altered level of consciousness, possible illusions/hallucinations, sleep-wake disturbance, and psychomotor agitation or depression.