Notes on Chapter 1–4: The Aging Population, Theories of Aging, Diversity, Life Transitions

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• The first exam is on September 8.

• Prepare for clinical this week and next week.

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• IF YOU ARE NOT WILLING TO LEARN, NO ONE CAN HELP YOU. IF YOU ARE DETERMINED TO LEARN, NO ONE CAN STOP YOU. – Zig Ziglar

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• Schedule: 30 to 50 minute focused study sessions with 10 minute breaks in between.

Chapter 1: The Aging Population

Learner Outcomes (Chapter 1)

• Develop the beginnings of a personal philosophy of aging. (What do you think about aging?) 2 pts

• Describe changing demographics, social issues, and economic issues related to aging in the United States. 3 pts

• Discuss the implications of the aging population for future health care. 3 pts

• Identify core values of the Silent/Traditionalists Generation and the Baby Boomer Generation. 2 pts

Chapter 1: Learning prep for today’s class (Page 6)

• Open the textbook.

• Pull up this presentation from Blackboard.

• Decide how you want to write out answers to today’s learner outcomes (Type? Handwrite?).

• Learner outcomes will be submitted on Blackboard by 11:59 pm Friday, August 29.

Page 7: Personal philosophy of aging

• 1. Develop the beginnings of a personal philosophy of aging. Write for 1 minute: "What do you think about aging?"

Page 8: Demographics, social, and economic issues (older population)

• 2. Describe the changing demographics, social, and economic issues related to the older population in the United States. What do you know from the reading?

Page 9: Older Adult Population snapshot

• 1 in 7 Americans are older adults. ext{Older adult population} = rac{1}{7} ext{ of the population}

• Age group breakdown:

  • Young-old: 65 ext{ to } 74 ext{ years}

  • Middle-old: 75 ext{ to } 84 ext{ years}

  • Old-old: 85+ ext{ years}

• Life Expectancy: ext{Life expectancy (for the average person born in the US)} ?

• Life Span: ext{Life span (currently ? ? ? for humans)}

Page 10: Social issues (dimensions to consider)

• Social Issues:

  • Gender

  • Marital Status

  • Race and Ethnicity

  • Living Arrangements

• Education

• Functional status

• CENT POST D (note: formatting in transcript unclear)

Page 11: Health Status (Social Issues)

• Chronic Illness – leading cause of death

• Comorbidity

• Heart disease #1 vs Cancer #2

• Health disparities in the older population

Page 12: Economic Issues

• Tax burden

• Income

• Employment

• Homeowners

• Asset rich and cash poor

• Social security = main income source for rac{1}{2} of older adults

Page 13: Health Insurance (Economic Issue)

• Medicare: For 65 and older who qualify for Social Security benefits

  • Part A: Provided by US Govt. covers mostly hospital and physician services

  • Part B: Purchased supplement covers lots of additional healthcare supplies & services

  • Part C (Medicare Advantage Plans): Supplemental coverage through private insurance plans in addition to Parts A and B

  • Part D (Medicare Advantage Prescription Drug Plan): Private insurance plans which include prescription drug benefits

• Medicaid: For the poor of any age

  • Pays for most nursing home care

• Long-term care insurance: few participants; best if purchased when young and before 65

Page 14: Implications of aging population for future health care (fill-in prompts)

• When compared to adults less than 65 y/o:

  • \text{hospital stays} → __

  • \text{comorbidity} → ___

  • \text{recovery rates} → ___

  • \text{healthcare costs} → ___

  • \text{_ _ for healthcare} → ___

Page 15: New learner outcome 4

• Identify core values of the Silent/Traditionalists Generation and the Baby Boomer Generation. See next 2 slides.

• How do Baby Boomers and Traditionalists like to communicate with their health care professionals?

Page 16: Traditionalists (Silent Generation) core values

• People born between 1923-1945.

• Parenting: Children were to be seen and not heard; parents alive during WWI and WWII; lived through Great Depression and WWII.

• Core Values: Dedication, hard work, conformity, law/order, patience, delayed reward, duty before pleasure, adherence to rules, honor; “Waste not, want not.”

• Social behavior: Very socially interactive as adults.

Page 17: Baby Boomers core values

• People born between 1946-1964.

• Raised by traditionalists; very social childhood with other children.

• Core Values: Optimistic, workaholics, team orientation, personal gratification, prefer face-to-face involvement, health & wellness, and youth forever.

• Phrasing: “Live to work”; enjoys small talk greetings.

Chapter 2: Theories of Aging

Learning goals

• 5. Discuss selected major theories of aging

• 6. Discuss nursing implications

• Theories to know: Free Radical Theory; Disengagement Theory; Activity Theory; Continuity Theory; Functional Consequences Theory; Theory of Thriving; Theory of Successful Aging

Page 19: Why theories matter

• Concepts, theories, and models are the nursing knowledge base.

• Previous nursing knowledge allows progress in the field.

Page 20: Your Turn – Think, Pair, Share

• Read your assigned theory and discuss (3 min)

• Share theory description and implications (30 sec)

Page 21-22: Theories on Aging – quick mapping

• Biological Theories: Free Radical Theory (Row 1) – p. 14

• Sociological Theories: Disengagement Theory (Row 2) – p. 17

• Activity Theory (Row 3) – p. 17-18

• Continuity Theory (Row 4) – p. 18

• Functional Consequences Theory (Row 5)

• Theory of Thriving (Row 6)

• Theory of Successful Aging (Row 7)

Chapter 3: Diversity

• Culturally competent care

• Code of Ethics calls for nurses to take a stand against social injustice

• 7. Identify nursing care modifications needed to accommodate an older adult patient with these ethnic backgrounds

Page 24: What is culture? Why does it matter?

• How culture affects:

  • Seeking medical attention

  • Treatment choices

  • Spread of disease

  • Language barriers or understanding barriers

  • Trust

Page 25: Hispanic older adults (8% and rising)

• Health beliefs: health/illness actions influenced by God; good behavior -> wellness; prayer and religious symbols important

• Traditional practitioners may be used

• Older adults held in high esteem; nursing homes often avoided; delaying medical care common

• Hispanic vs Latino (Latinx): distinction noted

Page 26: Black Americans (9% of older pop)

• Survival to old age seen as triumph of strength, resourcefulness, faith

• Higher poverty risk: Black older Americans ~2x more likely to live in poverty vs other older adults

• Trust issues with health services due to prejudice (historical context like the Tuskegee study)

• Higher prevalence of hypertension, heart disease, cancer, diabetes; higher death rate

Page 27: Asian Americans (4%)

• Diverse group; subgroups:

  • Chinese: traditional medicine, aging as blessing, family care for elders

  • Japanese: high respect for elders, family care, traditional practices

• Other Asian groups share similar beliefs

Page 28: Native Americans (less than 1%)

• 500+ tribes; Indian Health Service exists

• Perspectives: health may be seen as punishment or trial; stoic demeanor; death rituals may be required

Page 29: Jewish Americans (2.4% of all ages; 30% of that 2.4% are over 65)

• Religion plays a large role; Sabbath may affect procedures; Kosher diet rules; rabbi involvement in decisions affecting life/death; high education prevalence (~57% college educated)

Page 30: Muslims (less than 1% of older adults)

• Faith: Allah and Muhammad; Quran; respect for mothers; family care for elderly; halal diet; no pork; fasting considerations; gender dynamics in treatment may cause discomfort; prayer 3x daily facing Mecca

Page 31: LGBTQIA+ older adults

• Often called the “invisible population”; ~0.06% of older population identifies here; expected to double by 2030

• Mental health indicators: ~1/3 report depression; ~1/2 have a disability

• Higher risk for victimization and negative coping; many do not disclose gender identity to physician (~>20%)

Page 32: Cultural Competence – steps

• Clinical safety issue

• 1st step: Check your own biases; own it

• Get curious and learn; do not assume

• Ask patients directly

• Adapt care with qualified interpreters

• Collaborate with the team

• Advocate

Chapter 4: Life Transitions and Story

Learning outcomes (Chapter 4)

• 8. Define ageism and its consequences. 1.5 pts

• 9. Describe the cumulative effects of life transitions. 2 pts

10. Describe nursing measures to assist in adjusting to aging: 4 pts

• a. Facilitating a life review

• b. Eliciting a life story

• c. Promoting self-reflection

• d. Strengthening inner resources

Page 34: Define Ageism

• Prejudice and stereotypes applied to older adults based on age

• Erodes dignity; makes older adults feel small and insignificant

Page 35: Self-perceptions of aging

• How do older adults perceive themselves?

  • Chronological age

  • Functional age

  • Perceived age

  • Age identity

• How do you perceive older adults?

• Ageism

Page 36: Myths of aging (summary list)

• Majority of past age 65 are senile → false; about 5 ext{%} of those 65+ have chronic brain dysfunction

• All cultures have ageist views

• Younger people as default advisers; older people in nursing homes are common myths; actual nursing home share ≈ 5 ext{%}

• Older people are boring → true: not true; older adults have many stories and desire to share

• Older people are all alike → false; they are diverse

• Older people are unhappy → not universal; many report happiness and health

Page 37-38: Cumulative effects of life transitions (continued)

• Shrinking social world; risk of loneliness; physical isolation; hearing/speech deficits; insecurity; self-imposed isolation

• Nursing responses: encourage social interaction; telephone reassurance; home visits; safe environment; overcome obstacles to socializing; social media

• Effects include: loss of spouse; death of friends; declining functions; mortality awareness; fulfilling dreams; deepening religious convictions; strengthening family ties; providing for ongoing family needs; leaving a legacy

Page 39-42: Nursing measures to assist aging

• A. Facilitating a life review

  • Nursing measures: discuss negative feelings openly; refer to counselors/therapists; encourage connection with younger family members; prompt to elicit life story; therapeutic process of reflecting on experiences

• B. Eliciting a life story

  • Nursing measures: prompt with writing prompts; listen; assist documenting the story in chosen method

• C. Promoting self-reflection

  • Self-awareness as a hallmark of successful aging; questions to ask: Who am I? What is my place? What is my purpose? What do I desire? Holistic view: physical, mental, emotional, spiritual; journaling, writing letters, emails, art reflection

• D. Strengthening inner resources

  • Focus on strengths; empowerment; active participation in care planning and caregiving; avoid ageist attitudes; speak in normal voice (avoid elder speak); give freedom to choose; coaching, sharing, supporting; advocate for autonomy; offer positive reinforcement and hope

Elderspeak (Page 43)

• Term coined in the 1980s to describe baby talk directed at older adults

• Examples: pet names ("sweetie", "honey", "dear"); use of first-person plural ("Are we ready?"); high-pitched/singsong voice; slow or exaggerated speech; repetition; short, simple sentences; questions framed as statements; nonverbal cues

Consequences of Elderspeak (Page 44)

• Lowered self-esteem

• Depression

• Withdrawal from social interactions

• Dependent behavior reinforced by stereotypes

• Do NOT use elderspeak. Ethical implication: aligns with ANA Code of Ethics

Page 45: How to talk to old people

• Resource: https://youtu.be/Qm8qKdp-Als

Core ideas to study from this transcript (quick reference)

• Demographics and age group definitions: Young-old (65–74), Middle-old (75–84), Old-old (85+), with population notes like 1 in 7 Americans

• Economic health safety nets: Medicare Parts A–D, Medicaid, long-term care insurance

• Health status and disparities in older adults: chronic illnesses, comorbidity, higher risk groups

• Cultural competence in nursing: check biases, use interpreters, collaborate, advocate

• Life transitions and anti-ageism strategies: life review, life story, self-reflection, inner resources; avoid elderspeak and its harmful effects

• Theoretical foundations: overview of Free Radical, Disengagement, Activity, Continuity, Functional Consequences, Theory of Thriving, Theory of Successful Aging

• Diversity considerations across major ethnic groups and faith traditions, plus LGBTQIA+ considerations

• Practical nursing implications for communication across generations and cultures, including ethics and patient-centered care