Older / Late Adulthood - Week 10

late adulthood age

65 - 74 years old (older adults)

medicare

a US federal health insurance program mainly or people aged 65 and older

• can cover some younger people with disabilities and certain serious conditions

nursing role

help older adults understand the importance of health factors

elimination pattern

• bladder and GI mobility goes down

• constipation major problem for seniors

• incontinence affects 50%: urge, mixed, stress with postvoid residual volume

women’s health

post menopause

• the absence of menstruation for a period of at least 1 year

• HRT / CAM

• hot flashes, vaginal dryness; mood swings

primary aging

gradual, inevitable changes/deterioration that occurs throughout life

• impaired senses

• slowed movement

• digestion slows

secondary aging

specific physical illnesses or conditions that become more common with aging but are often preventable

• result from poor health habits and disease

compression of morbidity

Shortening of the time a person spends ill or infirm before death; accomplished by postponing illness

• Due to improvements in lifestyle, medicine, and technological aids

• dependent on personal habits and systemic influences

theories of aging

1. biological

2. sociological

3. developmental

biological

1. immunity

2. neuroendocrine

3. gene

4. free radical (oxidative stress)

immunity

decline in function of immune system from oxidative stress

neuroendocrine

decline in function of the nervous endocrine and immune systems

gene

longevity assoc with a genetic trait

oxidative stress

(free radical)

• errors are a result of random damage from free radicals; they are unpaired unstable ions

sociological

1. activity

2. disengagement

3. role theory

4. continuity

5. age stratification

6. subculture

activity

activity as indicator of stressful aging

disengagement

individual slowly withdraws from former roles and activities

role theory

ability to adapt to changing roles through life is predictive of adjustment to changing roles of aging

continuity

normal aging, personality remains consistent

age stratification

relationship between age as part of social structure and aging people as a cohort

subculture

Older people have their own norms, habits, and beliefs and interact better among age peers than with other age groups.

developmental

1. erikson

2. peck

3. havighurst

4. tornstam

erikson

integrity vs. despair

information processing

• input

• output

input

• less sharp senses leads to reduced input

• brain fills in missed information but not always correctly

• interpretation of facial expressions may be impaired

• understanding of speech may be hampered

output

Gradual decline in output of primary mental abilities (e.g., verbal meaning, spatial orientation, inductive reasoning, number ability, word fluency) is normal.

prospective memory

• Remembering to perform a future task (remember to do something in the future)

• Diminishes with age

• May be aided with routines

working memory

• Ability to retain information for a brief period while performing mental operations on that information

• Needed to carry out tasks

• If older adults can take their time and concentrate, memory doesn’t fade

ex. remembering a phone number long enough to dial it

memory loss

• Normal memory loss can be associated with aging

• Temporary memory loss can be caused by depression or anxiety

• Preclinical manifestations of Alzheimer's disease

what causes temporary memory loss

depression and anxiety

dementia

an umbrella term for a range of cognitive disorders (includes alzheimers) that involve chronic or progressive decline in memory, thinking, and reasoning

(not normal part of aging, is chronic or progressive)

multi infarct dementia

death of brain tissue

alzheimers disease

most common form of dementia; progressive memory loss

• no cure but meds to treat

• role of plaques and tangles in the cortex (apart of not fully understood cause of disease)

mini mental slate exam

MMSE

• 30 point scale if you get lower than 23 then exam indicates impairment

non pharmacological strategies (dementia)

• routiness

• encourage self care

• calm unhurried approach

• safety interventions

symptoms of alzheimer’s

• forgetfulness

• inattentiveness

• disorganized thinking

• altered level of consciousness

• disorientation

progression of alzheimers

stage 1: forget recent events / new info

stage 2: generalized confusion, deficits in concentration and short term memory, speech becomes aimless and repetitive

stage 3: memory loss becomes dangerous, cause accidents

stage 4: full time care is needed, confusion not clear, unable to recognize their closest loved one

stage 5: unresponsive, identity and personality gone, recognize no one

Parkinson’s disease

a chronic, progressive disease that is characterized by muscle tremor and rigidity and sometimes dementia

• caused by a reduction of dopamine production in the brain

lewy body dementia

form of dementia characterized by an increase in lewy body cells in the brain

• symptoms include visual hallucinations, momentary loss of attention, falling, and fainting

preventing impairment (memory loss)

severe brain damage cannot be reversed, but the rate of decline and some symptoms can be treated

• Declining risk for NCD incidence or prevalence found in high-income countries

• Education, exercise, medication, brain exercises (puzzles), and good health may ameliorate mild losses and prevent worse ones.

• Avoidance of specific pathogens and toxins is critical.

• Early, accurate diagnosis leads to more effective treatment

vascular dementia

form of dementia characterized by sporadic and progressive, loss of intellectual functioning

• due to strokes and reduced blood flow

integrity vs. despair

integrity: acceptance of life “at peace”

fear of death and despair, feels life was in vain

• 3 substages

  • ego differentiation vs work role preoccupation

  • body transcendence vs. body preoccupation

  • ego transcendence vs. ego preoccupation

ego differentiation vs work role preoccupation

Achieve an identity apart from work

Body transcendence vs body preoccupation

Adjusting to normal aging changes

Ego transcendence vs ego preoccupation

Accepting death

grandparents role

• Frequently brings joy and happiness

• Enhances self-image, increases activity level, creates feelings of self-worth and usefulness, and contributes to the meaning and quality of life

depression

• older adult at highest risk

• Should not be automatically expected to appear in the older adult

• Late onset depression (first occurs after age 60-65)

• Side effects of medication may mimic depression

• Depression can trigger physical illness

• Treatment may include meds, self-help, CAM

sense of spirituality

• Influences motivation and lifestyle

• Different from religiousness

• Process of meaning-making

• Method of coping for many older adults

nursing role

• Promote spiritual health

• Spiritual assessment tools

• Open-ended questioning to encourage discussions

falls

95% of hip fractures caused by falls

• Leading cause of morbidity/mortality

• Causes: neuromuscular dysfunction, osteoporosis, stroke, sensory impairment

• Risk assessment and prevention are essential

osteoporosis

brittle bones

fall preventions

• environmental modifications

• physical activity and exercise

• health and safety measures

• behavioral and cognitive changes

polypharmacy

taking multiple medications (5+ drugs) is common in older adults with chronic conditions

• risks include

  • drug interactions or side effects

  • difficulty adhering to complex schedules

  • confusion or accidental misuse

prejudice

older adults categorized due to age, assumptions made, treated differently

1. elderspeak

2. destructive protection

elderspeak

A condescending way of speaking to older adults that resembles baby talk, with short and simple sentences, exaggerated emphasis, repetition, and a slower rate and higher pitch than used in normal speech

destructive protection

• Elders are discouraged from leaving home by some younger adults and the media.

• Rates of street crime and violent crime are lower for those over age 65 than for younger adults.

nursing applications

• Nurses in a position of providing care to older adults focus on health promotion

• giving immunizations and screenings

• nursing activities with the older adult often focus on the management of chronic conditions

elder mistreatment

• elder abuse

• victims more likely to be single women older than 75 who depend on caregiver for food/shelter

• abuser typically adult child with poor impulse control

• nurses to ID and report to state agencies or law enforcement

elder abuse

intentional or neglectful acts by caregiver which harms vulnerable adult

forms of elder abuse

physical abuse, neglect, emotional abuse, psychological abuse, verbal abuse and threats, financial abuse and exploitation, s*xual abuse, abandonment

single woman older than 75

most likely victim of elder abuse

abuser

adult child with poor impulse control