Mental Health Nursing: The Aging Population (Neeb's Chapter 21)

Fundamental Concepts of Aging

Aging is defined as a continuous process that begins at birth and represents the natural progression of getting older over time. It is not limited to the later stages of life but is an ongoing biological and social phenomenon that every individual experiences from the moment of birth.

Demographic and Social Trends

The population of older adults is experiencing significant growth and visibility in modern society. According to the Pew Report, by the year $2030$, every individual belonging to the Baby-Boomer generation will have reached at least $65$ years of age. Furthermore, data provided by the Department of Health and Human Services (DHHS) indicates a sharp increase in the aging demographic; the population of individuals aged $65+$ is projected to rise from $35\text{ million}$ in the year $2000$ to $55\text{ million}$ by the year $2020$. Despite these rising numbers and the challenges associated with the process, it is important to emphasize that most people aged $65$ and over remain intellectually intact and mentally healthy.

Challenges Involved With Aging

Aging presents several unique challenges that affect the physical, social, and economic well-being of the individual. Certain medical illnesses become more prevalent as people age. Physical changes include a diminishment in both visual and hearing acuity, which directly impacts the individual's safety. Older adults also face multiple significant losses that can alter their quality of life. These losses include the cessation of employment, loss of income, and changes in established lifestyles. Social challenges are equally profound, including the shrinking of social groups and the death or illness of a spouse and family members.

Ageism and Social Perception

Ageism is a specific and harmful form of discrimination based entirely on a person’s age. This phenomenon is rooted in the social assumption that most individuals over the age of $65$ are no longer capable of functioning effectively or contributing meaningfully to society. Such discrimination can lead to isolation and the marginalization of older adults who are otherwise capable and willing to participate in their communities.

Intimacy and Human Connection

A critical but often overlooked aspect of aging is the need for intimacy. The fundamental human requirement for closeness and connection never leaves an individual, regardless of age. However, there is a significant social stigma regarding older adults engaging in sexual activity or "living together." This creates a difficult dichotomy: the individual's inherent need for intimacy remains constant while their social support network—including friends and partners—may be diminishing due to widespread illness or death within their peer group.

Elder Abuse and Legislative Protection

Elder abuse is a grave concern within the aging population and can manifest in both physical and emotional forms. Disturbingly, this abuse is often perpetrated by family members or professional health-care providers entrusted with the individual's care. To address these issues and establish rigorous standards of care, the Omnibus Budget Reconciliation Act (OBRA) was enacted. OBRA is a federal act designed to provide and enforce specific standards of care for the older population to ensure their safety and dignity.

Cognitive and Psychological Disorders

Several illnesses and cognitive concerns are particularly prevalent in the aging population. Alzheimer’s disease is a major concern, characterized by an alteration in cognitive thinking and debilitating effects that are not reversible; biologically, it is marked by the presence of amyloid plaques and neurofibrillary tangles in the brain. Other cognitive and psychological concerns include Cerebrovascular accident (CVA) or stroke, depression, insomnia, and paranoid thinking. Aphasia, which involves the loss of ability to understand or express speech, is also a frequent complication.

Pharmacological and Medication Concerns

Medication management is exceptionally complex in older adults due to physiological changes. Pharmacokinetics—the process of how the body absorbs, distributes, metabolizes, and excretes medications—is generally slower in this population. This increase in drug processing time leads to significant concerns regarding medication compliance and the risk of the patient becoming toxic. Side effects are frequent and varied, including dry mouth, constipation, orthostatic hypotension, urinary complications, confusion or disorientation, fatigue, and mood swings. Furthermore, patients often face external hurdles regarding the affordability and availability of their necessary prescribed medications.

Restorative Nursing and Rehabilitation

Restorative nursing is a specialized branch of rehabilitation focused on maintaining the patient's dignity while achieving their maximum possible level of function. The primary goals of this program are to promote independence, enhance the patient's self-esteem, and allow the individual to maintain as much control over their life and activities of daily living (ADL) as possible. In many regions, skilled nursing facilities are required to provide a dedicated "restorative" team. This team must include at least one nursing assistant and one nurse who are both specially trained in restorative techniques. This program is an essential component of a facility's documentation and reimbursement requirements and is monitored closely by state and federal surveys that grade the facility based on the program's effectiveness.

Palliative and End-of-Life Care

Palliative care is specialized medical care for individuals facing serious, advanced illnesses. Its primary focus is the management of uncomfortable symptoms and the mitigation of stress for both the patient and their family. While it is often associated with end-of-life care, its broader goal is to provide the best possible quality of life through the management of pain, sedation, and opioid medications. Palliative care also addresses complex issues such as artificial nutrition and hydration, assisted suicide, and the coordination of complementary therapies. Nurses in this field must hone their communication skills and remain highly cognizant of the religious, cultural, ethical, and legal issues that surround heavy medication and end-of-life decisions.

Medical and Alternative Treatment Modalities

Medical treatment for the aging population must be specifically related to the individual's symptoms and diagnosis. Medications require careful monitoring for correct dosages, side effects, and patient compliance. Treatment plans may also include individual or group therapy and specialized socialization activities to combat isolation. In addition to traditional medicine, alternative care options may be employed based on the patient's ability to follow a regimen; these include nutritional supplements, massage, aromatherapy, and neurolinguistic programming (NLP).

Nursing Interventions and Patient Interaction

Effective nursing interventions for older adults are centered on respect and communication. Nurses should display patience and understanding while maintaining appropriate humor to build rapport. Key responsibilities include ensuring safety, setting collaborative goals with the patient, and promoting as much independence as the patient is able to exercise. Applying appropriate communication techniques is vital to ensuring the patient feels heard and valued throughout their care.

Questions & Discussion

The following reflection questions were presented to evaluate the understanding of the aging population:

1. Which agency claims the following: “The population of 65+ will increase from 35 million in 2000 to 55 million in 2020”?
   The correct answer is C: Department of Health and Human Services. Other options provided were (A) Medicare, (B) Medicaid, and (D) Centers for Disease Control (CDC).

2. Identify the challenge(s) of aging:
   The correct answer is E: All of the above. The challenges listed included (A) Spouse and family, (B) Employment, (C) Lifestyle, and (D) Social group.

3. The following are challenges to aging except:
   The correct answer is D: Too much intimacy. The list of actual challenges included (A) Alzheimer’s disease, (B) Medication concerns, (C) Elder abuse, and (E) Age discrimination.

4. Common medication side effects except for:
   The correct answer is A: Salivating. Common side effects identified were (B) State of confusion, (C) Constipation, and (D) Orthostatic hypotension.