Nursing Chapter 23 Homework Retirement Majority Individuals The United States Over

CHAPTER 23 / Promoting Health in Older Adults 127

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1

Describe the demographic, socioeconomic, ethnicity, and health characteris-

tics of older adults in the United States.

Concepts for Lecture

1. There are demographic, socioeconomic, ethnic, and health character-

istics of older adults.

3.

Socioeconomic characteristics

(gender, marital status, education,

income, living arrangements): Women have a longer life expectancy

and are more likely to be widowed. Men are more likely to remarry.

Higher education is associated with a higher income. Educational

4.

Ethnicity characteristics:

The number of minority older adults is

increasing; however, the higher proportion of the older adult white

5.

Health characteristics: Chronic health problems and disabilities in-

crease as age increases. The vast majority (73%) of older Americans rate

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2

Identify the different categories of older adults as they range from 60 to 100

years of age.

Concepts for Lecture

1. The categories of older adults include young-old (60 to 74 years),

old-old (75 to 100 years), and centenarians (over 100 years).

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PROMOTING HEALTH IN OLDER ADULTS

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Discuss the implications of the characteristics

of older adults for nursing practice.

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Have students compare and contrast the

characteristics of older adults in the United

128 CHAPTER 23 / Promoting Health in Older Adults

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3

Describe ageism and its contribution to the development of negative

stereotypes about older adults.

Concepts for Lecture

1. Ageism describes the deep and profound prejudice in American

society against older adults. It is discrimination based solely on age,

and it exists among some professionals.

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4

Compare and contrast gerontology and geriatrics.

Concepts for Lecture

1. Gerontology is a term used to define the study of aging and older

2.

Geriatrics is associated with the medical care (e.g., diseases and

disabilities) of older adults.

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5

Describe the development of gerontological nursing and the roles of the ger-

ontological nurse.

Concepts for Lecture

1. Gerontological nursing involves advocating for the health of older

persons at all levels of prevention.

courses about nursing care of older adults.

Practicing gerontological nurses can obtain gerontological

nursing certification through the American Nurses Association.

Advanced practice in gerontological nursing requires a master’s

degree in nursing, of which there are two options: the gerontological

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Ask the students to develop a questionnaire

derived from Box 21 [AU/ED: pls check

number here] in the text—Evidence-Based

Practice: Do Attitudes on Aging Affect Well–

Being? Have the students

administer this questionnaire to fellow stu-

dents, faculty, and staff of your institution.

Review the results.

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Have students explain why the term

gerontological is used to describe the nursing

specialty instead of the term geriatric.

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Invite a panel of gerontological nurses,

clinical specialists, and nurse practitioners to

discuss their roles and specialties.

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• Arrange for several students to have an obser-

making. Being a research consumer requires the nurse to read the

latest professional literature for evidence-based practice to improve

the quality of nursing care for older adults.

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Describe the different care settings for older adults.

Concepts for Lecture

1. Gerontological nurses practice in many settings, including acute care

facilities, long-term care facilities, and the community.

Older adults are the majority of clients cared for in acute care.

Individuals who are 65 and older use the emergency department

vidual. The clients in this setting are often referred to as residents.

Long-term care includes many different levels of care, such as

assisted living, intermediate care, skilled care, and Alzheimer’s

dying individuals and their families. The majority of hospice clients

are older adults.

Rehabilitation may be found in several settings: acute care

hospitals, subacute or transitional care, and long-term care facilities.

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List the common biologic theories of aging.

Concepts for Lecture

1. Common biologic theories of aging include the wear-and-tear, endo-

3. Endocrine theories propose that events in the hypothalamus and

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Invite nurses who practice in various commu-

nity settings with older adults to discuss their

roles and the services offered in their settings.

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Arrange for the students to observe in an adult

community for older adults. Ask the adminis-

trator to discuss the various types of services

available in this setting.

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Discuss the hypotheses underlying the various

biological theories of aging.

4. Free-radical theories propose that free radicals, resulting from oxida-

5. Genetic theories propose that the cells are preprogrammed for a pre-

determined number of cell divisions. After this, cells die.

7.

Immunological theories propose that the immune system becomes less

efficient, causing decreased resistance to infectious diseases and viruses.

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Describe the usual physical changes that occur during older adulthood.

Concepts for Lecture

1. There are numerous normal physical changes associated with aging

2.

Integumentary:

Changes include increased skin dryness, pallor, and

fragility; progressive wrinkling and sagging of the skin; brown “age

3.

Neuromuscular:

Older adults experience decreased speed and pow-

4.

Sensory-perceptual:

Aging leads to loss of visual acuity, increased

sensitivity to glare, decreased ability to adjust to darkness, arcus

5.

Pulmonary:

Changes associated with aging include decreased abil-

6.

Cardiovascular:

Older adults are more likely to experience reduced

cardiac output and stroke volume (particularly during increased

7.

Gastrointestinal:

Changes include delayed swallowing time, increased

tendency for indigestion, and increased tendency for constipation.

8.

Urinary:

Aging may be accompanied by reduced filtering ability of

9.

Genitals:

Typical changes include prostate enlargement (benign) in

men and multiple changes in women (shrinking and atrophy of the

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Obtain or make items to simulate some of the

normal physical changes that occur with aging

(e.g., glasses to simulate visual disturbance).

Obtain various walkers, quad canes, and

wheelchairs. Have students attempt to maneu-

ver around campus using these items, with

10.

Immunological:

The older adult is more likely to have decreased

11.

Endocrine: Insulin resistance is increased.

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List the common psychosocial theories about aging.

Concepts for Lecture

1. The disengagement theory was developed in the early 1960s by

Cumming and Henry. It proposed that aging involves mutual

withdrawal (disengagement) between the older person and others in

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Describe developmental tasks of the older adult.

Concepts for Lecture

1. According to Erikson, the developmental task of the older adult is

ego integrity versus despair. Individuals who attain ego integrity

view life with a sense of wholeness and derive satisfaction from past

2.

Additional developmental tasks:

• From 65 to 75 years, older adults adjust to decreasing physical

strength and health; to retirement and to lower and fixed income;

to death of parents, spouses, and friends; to new relationships with

adult children; to leisure time; to slower physical and cognitive

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Invite a panel of nursing professionals who

work with older adults to discuss how they use

psychological theories of aging in their

nursing practice.

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Review Peck’s three developmental tasks and

give examples of behaviors that demonstrate

positive and negative resolution of these tasks.

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132 CHAPTER 23 / Promoting Health in Older Adults

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Describe psychosocial changes that the older adult adjusts to during the aging

process.

Concepts for Lecture

1. Psychosocial changes that the older adult adjusts to during the aging

process include retirement, economic change, grandparenting,

relocation, maintaining independence and self-esteem, facing death,

and grieving.

in retirement.

Economic change:

The financial needs of older adults vary con-

siderably. Adequate financial resources enable the older adult to re-

main independent. Problems with income are often related to low

retirement benefits, lack of pension plans for many workers, and the

ty, financial hardships, and potential deteriorating health.

Relocation:

A variety of factors may lead to relocation.

The house or apartment may be too large or too expensive, work in-

volved in maintaining the house may be burdensome or impossible,

or the person may need living arrangements all on one floor or more

Facing death and grieving:

When a mate dies, the remaining

partner inevitably experiences feelings of loss, emptiness, and lone-

liness. Some widows and widowers remarry, particularly widowers

because they are less inclined to maintain a household. More women

than men face bereavement because women usually live longer.

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Invite a panel of older adults to discuss how

they adapted to the psychosocial changes of

retirement, economic changes, grandparent-

ing, relocation, and, if appropriate, death of a

friend or spouse.

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• Discuss how the institution assists older adults

CHAPTER 23 / Promoting Health in Older Adults 133

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Explain changes in cognitive abilities that occur during the aging process.

Concepts for Lecture

1. Piaget’s phases of cognitive development end with formal opera-

tions; however, research on cognitive ability and aging is currently

es; however, the effect of these changes on the cognitive functioning

of the adult is not yet known. Lifelong mental activity, particularly

stimuli from the environment), storage in short–term memory (also

includes recent memory), and encoding, in which the information

leaves short-term memory and enters long-term memory. In older

adults, retrieval from long–term memory can be slower, especially if

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13

Compare and contrast Kohlberg’s and Gilligan’s theories of moral reasoning

in older adults.

Concepts for Lecture

1. According to Kohlberg, moral development is completed in the early

2. Gilligan challenged Kohlberg’s stages as not being applicable

to women. She believed that women base moral judgment on

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• Ask the students to suggest methods to assist

individuals with perceptual problems such as

decreased hearing and vision in order to live

safely in their environment.

•

Ask the students to suggest methods to assist

• Ask students to give examples of how they

would modify teaching to assist older adult

clients to learn information required for

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• Have the students debate the concepts underlying

Kohlberg’s and Gilligan’s theories of moral

development in terms of differences between

genders.

•

Discuss the statement that “the values and

belief patterns that are important to older

adults may be different than those held by

younger people” as a potential reason for in-

3. Older adults begin to make moral decisions that are consistent with

4.

Values and belief patterns that are important to older adults may be dif-

ferent than those held by younger individuals because they developed

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Describe how spirituality and aging interact.

1. Older adults can contemplate new religious and philosophical views

and try to understand ideas missed previously or interpreted differ-

ently. They may derive a sense of worth by sharing experiences or

2.

Involvement in religion often helps older adults resolve issues related to

the meaning of life, to adversity, or to good fortune. It may also be an

important coping resource, leading to enhanced well-being.

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15

Describe selected health problems associated with older adults.

Concepts for Lecture

1. Health problems the older adult may experience include injuries,

chronic disabling illnesses, drug use and misuse, alcoholism, demen–

tia, and older adult abuse. Leading causes of death in individuals age

65 and over are heart disease, cancer, cerebrovascular disease

required. Driving, particularly at night, requires caution because ac-

commodation is impaired and peripheral vision is diminished.

Driving in fog or other hazardous conditions should be avoided.

disease, hearing and vision alterations, and cognitive dysfunction.

Acute diseases may create chronic health problems. Examples in-

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Invite a group of older adults from various

religious and spiritual groups to discuss the in-

fluence of their beliefs on coping with health

as well as psychosocial issues related to aging.

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• Have the students investigate the state’s laws and

reporting requirements for older adult abuse.

•

Have the students investigate the services

offered by the state’s department on aging.

•

Have the students locate respite services in the

community.

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• Compare and contrast dementia and delirium

in terms of possible causes, signs, and

symptoms seen in clients clinically.

CHAPTER 23 / Promoting Health in Older Adults 135

clude pneumonia, fractures, and trauma from falls or motor vehicle

crashes.

drugs and herbal remedies, taking medication at the wrong time, or

taking someone else’s medication. Another potential misuse occurs

when multiple primary care providers prescribe medication and the

client fails to tell each what has been previously prescribed.

Additionally, the pharmacodynamics of drugs are altered in older

be differentiated from delirium, an acute and reversible syndrome.

The most common causes of delirium are infection, medications, and

dehydration. The most common type of dementia is Alzheimer’s dis-

ease (AD). The symptoms of AD may vary somewhat but are pro-

gressive and exhibit a steady decline in cognitive and physical

sive neglect. Older adult abuse or neglect may occur in private

homes, senior citizens’ homes, nursing homes, hospitals, and long–

term care facilities. Many abusers are either sons or daughters; oth-

ers include spouses, other relatives, and health care providers.

Older adults at home may fail to report abuse or neglect because

136 CHAPTER 23 / Promoting Health in Older Adults

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List examples of health promotion topics for older adulthood.

Concepts for Lecture

1. Health promotion topics and guidelines for older adults include safe-

ty, nutrition and exercise, elimination, and social interaction.

Safety:

Topics include home safety measures to prevent falls,

fire, burns, scalds, and electrocution; working smoke and CO detec-

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• Have the students investigate state driver’s

license requirements for older adult clients.

•

Have the students investigate driver

re-education programs for older adults.

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