The Aging Individual

The Aging Individual 150 150 Tony Guo

The Aging Individual

Who are the old?

  • How one is considered old is largely based on one’s own variables, such as attitudes, mental health, physical health, or degree of independence, so there is no real definitive age.
  • How many old people are there in the US? Expected to number 77.0 million
  • If one considers age to be a determining factor, then as of 2015, there were 15.2 percent of the population over the age of 65.

 

Epidemiology

  • As of 2016, there were 70 percent of men and 46 percent of women age 65 years and older who were married.
  • Note, there were over three times as many widows as there were widowers.
  • The majority of individuals 65 years or older live alone, or with their spouses or with relatives
  • Approximately 4.6 million older persons live below the poverty level.
  • There were 9.6 million older Americans that were employed in 2016, and that number is increasing
  • As we get older, the number of days where activities are restricted increase; illness and injuries are the main cause.
  • Emotional and mental illness increase over the life cycle.

 

The aging process

  • Biologic changes occur as we get older, including decrease in functioning of all of our major body systems. Some of these include –
    • Skin
    • Cardiovascular system
    • Respiratory system
    • Renal system
    • GI system 
    • Musculoskeletal System
    • GI system
    • Immune System
    • Sensory system

 

Psychological Aspects of Aging

 

  • There are psychological changes as well.
  • Adaptation to loss and grief
  • Attachment to others
  • Maintenance of self-identity
  • What can make the difference between a good or poor outcome?

 

Psychiatric Disorders

  • Neurocognitive Disorders
  • Delirium
  • Depression –Usually diagnosed late in life
    • This creates pain, suffering poor quality of life, and spiritual anguish
    • Depression can be dangerous when the older person is also experiencing a chronic illness, loneliness, or losses (such as spouse, job, independence, home, finances, or health), and biggest risk factor for suicide
  • Schizophrenia
  • Anxiety Disorders
  • Personality Disorders

 

Social-Cultural Aspects of Aging

  • Elderly people in most cultures share some basic needs and interests
    • They want satisfying lives
    • They want protection from harm 

 

  • In some cultures; the aged are held in high esteem.  Is that true or not true in the American culture?
  • Do older Americans enjoy sex? What are some stereotypes about this?

 

Special Concerns of Elderly people

  • Retirement
  • Social implications
  • Economic implications
  • Long-term care
    • Potential need for services which may be predicted by a number of factors
  • Abuse
    • Current estimates are that 1 in 10 older adults in the US have been injured, exploited, or otherwise mistreated by someone who they depend on for protection or care
    • The abuser is often someone they know, such as a relative who lives with them, or it may be an assigned caregiver

 

Legal and ethical issues that affect the mental health of aging clients

  • Among the most important of many legal and ethical issues for practicing nurses to be familiar with are the following
    • Use of restraints
    • Decision making about health care
    • Elder abuse
    • End-of-life care

 

Use of Restraints

  • Can be both physical and chemical
    • Physical restraints
      • Manual methods, material, or equipment that inhibits free movement such as tightening a bedsheet to limit movement, raising side rails, applying wrist or waist restraints, or positioning a wheelchair to restrict movement
      • Can pose a risk of death through strangulation, or asphyxiation and lead to muscle loss, incontinence, pressure sores, agitation, and bone weakness when used for prolonged weakness, fall risk, anxiety, feeling of humiliation, and emotional withdrawal
      • They should be used for emergency purposes only when there is a threat to the safety of the resident or others, never as a means of controlling behavior or as punishment. It should be used only as a last resort.
    • Chemical restraints
      • Drugs given for the specific purpose of inhibiting a certain behavior or movement and that are not part of the normal treatment plan
      • Dangers found that the dangers included risk for diabetes and cerebrovascular events as well as doubled risk for mortality. 

 

Control of the Decision-Making process

  • Patient Self-Determination Act
    • Require that healthcare facilities provide clear, written information to every patient regarding his or her legal rights to make health care decisions, including the right to accept or refuse treatment.
    • It also establishes the right of a person to provide written treatment directions for clinicians in the event of a serious illness

 

  • Living will
    • Personal statement of how and where one wishes to die, and can be changed at any time by the individual, and activated when the person the person is terminally ill and incapacitated
  • Directive to Physician
    • Similar to the living will, but can be revoked orally at any time without regard to patient competency.
  •  Power of Attorney 
    • Differs from a living will in that a person is appointed to act as the patient’s agent.
    • Individuals do not have to terminally ill or incompetent to allow the empowered individual to act on their behalf

 

The Nursing Process

Assessment

  • No different than any other adult, just consider the changes that occur in the older person
  • Use caution however; age alone does not preclude these changes; each person must be assessed as a unique individual.

 

Nursing diagnosis 

  1. Risk for trauma/falls
  • Due to impaired physical mobility, Loss of muscle strength, disorientation, presence of illness, use of medications
  1. Hypothermia 
  • Age-related changes in thermoregulation and environment exposure
    • Reduction in body temperature below the normal range
    • Shivering
    • Cool skin
    • Pallor
    • Tachycardia
  1. Decreased cardiac output
  • Can lead to reduced brain oxygenation, and age-related diminished cardiac functions
  1. Disturbed sleep pattern
  • Unfamiliar surroundings and hospital routines/interruptions
  1. Risk for infection
  • Age-related changes in immune and integumentary systems and/or suppressed inflammatory response occurring with long-term medication use (e.g., steroids, analgesics, anti-inflammatory agents), slowed ciliary response, or poor nutrition
  1. Risk for impaired Skin integrity
  • Reduced subcutaneous fat and decreased peripherally capillary network in the integumentary system
  1. Constipation
  • Changes in diet, decreased activity, and psychosocial factors
  1. Depression
  • Loss of independence, loss of functional ability, cognitive impairment

 

Outcome

  • Outcomes should be measurable, concise, and time limited
  • The patient will not experience any falls.
  • The patient will not experience any falls in the facility for the remainder of their stay.

 

Planning and Interventions

  • Care is aimed at protecting the person from injury caused by physiologic changes or altered thought processes.
  • The nurse must however be mindful to protect the dignity and self-esteem of the older person
  • Reminiscence therapy is encouraged among the elderly to preserve memory

 

Evaluation

  • This is based on the accomplishment of the previously established outcome criteria

 

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