Mental Health Nursing: Neeb's Chapter 21 - The Aging Population - QUIZ 4

Concepts and Definitions of Aging

Definition of Aging:
* The process of aging is defined as the process of getting older.
* Aging is a lifelong progression that officially begins at birth.

Social Trends and Demographics of the Aging Population

Growth of the Aging Population:
* According to the Pew Report, by the year $2030$ , every individual within the Baby-Boomer generation will have reached at least $65$ years of age.
* Data from the Department of Health and Human Services (DHHS) indicates a significant demographic shift: the population of individuals aged $65+$ is projected to increase from $35 \text{ million}$ in the year $2000$ to $55 \text{ million}$ in the year $2020$ .
Mental Status of Older Adults:
* Contrary to some stereotypes, the majority of individuals aged $65$ and over remain intellectually intact and are considered mentally healthy.

Physical and Social Challenges Involved with Aging

General Health and Sensory Challenges:
    * There is an increased prevalence of certain illnesses within the older population.
    * Acuity in both vision and hearing tends to diminish as individuals age.
    * General safety becomes a primary issue for the aging population.
Experience of Loss:
    * Aging often involves multiple types of significant losses, including:
        * Employment and Income: Retirement can lead to changes in financial status.
        * Lifestyle: Shifts in physical ability or financial status may alter daily living habits.
        * Social Groups: The death or relocation of peers can reduce social circles.
        * Spouse and Family: Emotional loss through the death of a partner or family members.
Ageism:
* Definition: Ageism is defined as discrimination based specifically on an individual's age.
* Societal Assumptions: It involves the incorrect assumption that most people over the age of $65$ are incapable of functioning effectively or contributing meaningfully to society.
Intimacy and Sexuality:
    * The fundamental human need for intimacy does not dissipate with age.
    * There remains a significant Social Stigma surrounding older individuals engaging in sexual activity or choosing to live together.
    * The Intimacy Dichotomy: A conflict exists where the internal need for intimacy remains constant while the external social group physically diminishes due to illness or death.
Elder Abuse:
    * Abuse can manifest in various forms, specifically Physical or Emotional abuse.
    * Abuse is frequently perpetrated at the hands of family members or professional health-care providers.
    * Omnibus Budget Reconciliation Act (OBRA): This is a federal act established to provide mandated standards of care for the older population to prevent neglect and abuse.

Cognitive and Mental Health Challenges

Alzheimer’s Disease:
    * Characterized as an alteration in cognitive thinking.
    * It has debilitating effects on the individual.
    * The condition is not reversible.
    * Biological markers include the presence of plaques and tangles within the brain.
Other Cognitive and Mental Concerns:
    * Cerebrovascular Accident (CVA): Commonly known as a stroke.
    * Depression: A significant mental health challenge in the aging.
    * Insomnia: Disruptions in sleep patterns.
    * Aphasia: Communication difficulties often following brain injury or stroke.
    * Paranoid Thinking: Potential for increased suspiciousness or delusional thought patterns.

Medication Concerns and Pharmacokinetics

Pharmacokinetic Changes:
* The process of pharmacokinetics (how the body moves and processes drugs) is notably slower in older adults.
Medication Management Issues:
    * Compliance: Difficulty in adhering to prescribed medication schedules.
    * Toxicity: Slower metabolism and excretion increase the risk of medications reaching toxic levels in the bloodstream.
    * Affordability and Availability: Seniors often face barriers regarding the cost and physical access to their medications.
Common Medication Side Effects:
    * Dry mouth.
    * Constipation.
    * Orthostatic Hypotension: A drop in blood pressure when standing up.
    * Urinary complications.
    * Confusion and disorientation.
    * Fatigue.
    * Mood swings.

Restorative Nursing and Palliative Care

Restorative Nursing:
    * Context: This is considered a branch of rehabilitation.
    * Primary Focus: Maintaining the patient's dignity while helping them achieve their maximum possible level of function.
    * Core Goals: Promoting independence, enhancing the patient's self-esteem, and allowing the individual to maintain as much control over their daily living activities and life as possible.
    * Staffing Requirements: Most skilled nursing facilities are mandated to provide at least one designated nursing assistant and one nurse who are specifically trained for the restorative team.
    * Administrative Importance: Restorative programs are essential for a facility's documentation and reimbursement requirements; state and federal surveys use these programs to grade the facility.
Palliative Care:
    * Definition: Specialized medical care for people with serious illnesses, focusing on managing uncomfortable symptoms and the stress associated with advanced illness.
    * End-of-Life Care: A major component of palliative care involves supporting patients in their final stages of life.
    * Goal: To provide the best possible quality of life for both the patient and their family.
    * Key Issues Addressed: Pain management, symptom control, use of sedation and opioid medications, decisions regarding artificial nutrition and hydration, assisted suicide, and coordination of complementary therapies.
    * Nursing Responsibilities: Nurses must sharpen their communication skills and be highly cognizant of the religious, cultural, ethical, and legal issues surrounding heavy medications and assisted suicide.

General Care and Treatment Modalities

Medical Treatment:
    * Care is tailored to specific symptoms and official diagnoses.
    * Medications require rigorous monitoring for correct dosage, side effects, and patient compliance.
    * Interventions may include group therapy, individual therapy, or designated socialization activities.
Alternative Care:
    * Treatment is based on symptoms and the patient's capacity to follow a specific regimen.
    * Examples:
        * Nutritional supplements.
        * Massage therapy.
        * Aromatherapy.
        * Neurolinguistic Programming (NLP).
Nursing Interventions:
    * Show fundamental respect at all times.
    * Collaborate with the patient to set realistic goals.
    * Display constant patience and understanding.
    * Utilize appropriate humor to maintain rapport.
    * Prioritize and ensure physical safety.
    * Promote independence to the full extent of the patient's ability.
    * Apply appropriate communication techniques tailored to the older adult.

Questions & Discussion

Reflection Question 1: Which agency claims the following: “The population of $65+$ will increase from $35 \text{ million}$ in $2000$ to $55 \text{ million}$ in $2020$ ”?
* Answer: C. Department of Health and Human Services.
Reflection Question 2: Identify the challenge(s) of aging:
* Options: A. Spouse and family, B. Employment, C. Lifestyle, D. Social group.
* Answer: E. All of the above.
Reflection Question 3: The following are challenges to aging except:
* Options: A. Alzheimer’s disease, B. Medication concerns, C. Elder abuse, D. Too much intimacy, E. Age discrimination.
* Answer: D. Too much intimacy (The text notes that the need remains, but the social stigma and loss of social circles creates a dichotomy, rather than "too much" intimacy being the challenge).
Reflection Question 4: Common medication side effects except for:
* Options: A. Salivating, B. State of confusion, C. Constipation, D. Orthostatic hypotension.
* Answer: A. Salivating (Dry mouth is the actual common side effect).