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The US Census Bureau classification of older Americans
- Older 55-64yrs
- Elderly 65-74yrs
- Aged 75-84yrs
- Very Old 85-Older
Gerontologist classification for elder Americans
- Young old 60-74yrs
- Middle old 75-84yrs
- Old Old 85 and older
Epidemiological status for the older population
Life expectancy in 2005 was 75.5yrs
By 2030 the numbers of elderly population will increase to 20%population
-The older the person the higher the % for them living in nursing homes
-Elderly woman specially elder hispanic have higher poverty rate than elder man
- Elderly people age 65 are still in th work force (5.5 million)
82% of individual65 yrs and older haveat least one chronic condition and 2/3 of them have more than one.
Most common occuring medical condition in the older
- Heart Disease
Biological Theories of aging
Biological includes molecular and cellular changes
- Genetic involunatary inherited process the development of free radicals, collagen,and increased frequency in the occurance of cancer and autoimmune disorders-mutation
- Wear and tear- body wears out on a schedule basis, free radicals are the waste product of metabolism, accumalte and cause damage the biological structure
- Enviromental- industrial- carcinogens, sunlight, trauma, and infection. (Seconadary factor for aging)
- Immunity- age ralted decline in the immune system. The ability to defend against foreign organism decreases and the development of autoimmune increases leading to the development of autoimmune disease such as rheumatoid arthritis and allegies to food and enviromental agents
- Neueroendocrine- slowing of certain hormones that have a impact on the CNS.
Psyhcological theory for the olderly
- social and psychological changes, several theories have attempted to desvribe how attitudes and behavior in the early phases of life afect people reactions during the late phase "Successful aging"
- The 5 major categories of aging for men
- 1. Mature men-healthy
- 2. Rocking men-healthy
- 3. Armored men-healthy
- 4. Angry men-not healthy
- 5. Self haters-not healthy
Developmental task theory- primary task of old age as being able to see ines life as having been lived with integrity and not despair with the feeling of regret.
Disengagement theory- the benif of the society is thought to be an orderly tranfer of power from old to young.
Activity theory- maintaing meaningful interactions with ther nd physical and mental well being
Continuity theory- (develppment theory)- this is motivated by the need preservation of self esteem, ego integrity, cognition function, and social support.
-its stated that conscientiousness (being organized and discipline ) increased throughout the age range studied with the largest increasing during the 20s. Agreeableness (bieng warm, generous, and helpful) increased most during the 30s. Neuroticism (being anxious and emotional labile ) decliened with age in woman but not in men. Opennes ( being receptive to new experience decline for both during age).Extraversion being outwardly expressive and interested in the enviroment decline for woman and do not change for men.
Skin changes as we age
Skin- the loss of elastin of the skin. changes in collagen causing it to wrinkle and sag, exposure to sunlight increases the changes for skin cancer, lost of subcutaneous cushion of adipose tissue, and lower supply of blood vessles to te skin resulting in delayed wound healing.
Cardiovascular system changes as we age
- the decline of cardiovascular system is thought to be the major determinant of decreased tolerance for ecercise and overall decline of energy reserve.
- - the aging heart hypertrophy with reduced ventricular comliance and decrease output leading to decrease blood flow to organs. Arteriosclerosis is frequent in the olderly and HR decreases
Respiratory system changes as we age
- Thoracic expansion is dimished by an increase in fibrous tissue and loss of elastin
- Pulmonary vital capacity decreases, and the amount of residual air increases.
- Fibrous scattered area interferes with O2 and CO2 exchanges
- Cough and Laryngeal reflexes decreases
- Decreased pulmonary blood flow
Muscular skeletal system changes as we age
- Skeletal aging involves the bonesm ligaments, and tendons have les limitation to activity
- Loss of muscle mass, occurs more slowly in men than woman
- Demineralization of the bones occurs at a rate of 1% per yr throughout life span for both gender, it increases 10% in woman around menapause making them more vulnerable to osteoporosis
- Muscle fibers become thinner and less elastic
- Dimished storage for glycogen
GI changes as we age
- Oral cavity, teeth show a reduction in dentite production
- shrinkage of fibrosis of root pulp, gigival retraction, and loss of bone density in alveolar ridges.
- Loss of peristalsis movement
- Decrease in gastric acid production
- Levelsof intrict factor may also decrease resulting in vitamin B12 malasorption
- Decrease in liver size and weight decreasing enzyme activity required to desactivate certain medications.
Endocrine system changes as we age
- Decrease of throid hormone decreasing basal metabolic rate.
- Decreased amounts of adrenocorticotropic hormone may result in less efficient stress response
- Impairement of glucose tolerance
GU system changes during changes as we age
- Decline of renal function from steady attrition of nephrons and sclerosis within the glmeruli over time
- Less blood flow to kidney
- Syndrome of inappropiate ADH secretions and levels of blood urea nitrogen and creatine may elevate slightly.
- For men enlargement of the prostate gland, prostatic hypertrophy associated with increased urinary retention or urinaryincontence
- Loss of os muscle and sphincter control
Immune system changes as we age
- changes in both cell mediated and antibody mediated immune responses
- the size of the thymus gland declines continuouslyfrom just beyond puberty t about 15% of its origial size at age 50
- the consequences are greater suspectibility to infection and diminished inflammatory response that results in healing
- autoimmune disorder increases
- higher incidents with cancer allowing to proliferate due to ineffectiveness of the immune system
Nervous system changes as we age
- Loss of neurons
- is Gyral atrophy in the frontal lobe and parietal lobes and widening of the sulci and ventricuar enlargements.
- Little cerebral functioning is lost over time
- Mild gait disturbances, sleep disruptions, and decreased smell and taste perception
Visual changes as we age
- Vision- Visual acuity begins to decrease. Presbyopia-blurred near vision, caused by the loss of elasticity of the crystalline lens and results in compromised accomadation
- Cataracts-occurs when the lens of the eye becomes less resilient( due to the compression fibers) and increasingly opaque (as proteins lump together)
- color the iris may fade and the pupil may become irregular shape
- decrease secretions of the lacriminal gland
- the pupil may become constricted requiring more ligh while reading
Hearing changes as we age
- hearing changes change as we age, ear losses its snsitivity to discriminate sound because of damage to the hair cells of the cochlea
- its twice frequent in men than woman
Taste and smell changes as we age
- Taste sensitivity decreases and bitter taste sensation predominates
- sweet and salty taste diminished
- deterioration of the olfactory bulbs causes loss of smell
Touch and taste
- sensory nerve receptors on the skin continue to decrease
- ability to feel pain sensation decreases
Memory function as we age
- short term memory seems to be effected as we age but no the long term
- - the time required for memory scaning is longer for the older
- -a well mentally active person have a decline to this problem
Intellectual functioning remains intact but do become obsolete
The ability to learn is not diminished but just requires more time for the teaching
Adaption to the task of aging
- Loss and grief- the elderly experiences numerous of losses sometimes it can lead to bereavement overload, but if the individual can cope with this than it is adaptible
- Attachement to other- the need for attachement is good
- Maintainance of self identity
- Dealing with death
Psychiatric d/o in later life
- Dementia- most common
- Schizophrenia- usually occurs in the young but can occur as late onset after 60yrs
- Anxiety d/o- because concurrent with disability and the ANS is more fragile the olderly can react more to PTSD
- Personality d/o-not so common
- Sleep disorders-affect 50% of people age 65 and 66% of the person who lived in long term care facilities
- In must culture the aged are consider the most powerful the most engaged and the most respected member of society
-very common in latinos, asians (specially Japan), and AA
-but this is not the case for modern industrial societies
There is a lot of sterotyping in the idea that the elderly cannot engage in sexual activity or join the workforce
Physical changes associated with sexuality for the aging person
- Woman- Durin menapause (40-50yrs) ther is a decrease production of estrogen
- viginal walls become thinner and inelastic, the vigina itself shrinks, and lubrication decreases causing pain, burning sensation, pelvic aching, irritaiton when urinating leading to avoidance to sexual activity
- Men-Testosterone production declines beginning ages 40-60yrs, this leads to reduction of erections and require more direct genital stimulation
- firmness decreases in erection
- volume of ejaculation decreases and the force lessens
- tested become somewhat smaller
Menapause S &S, and therapy
- Usually they are given estrogen therapy but this can increases chances of breast cancer and endometrial cancer. To combat this later effect the person can take progesterone to decrease tje risk of estrogen induced endometrial cancer.
- S&S- hot flashes,night sweats, mood swings, sleeplessness, migraine headaches, urinary incontinence, and weight gain
People are retiring earlier for the reason that there is health problems, SS retirement and other persion benifts m attractive packages offered by companies and long held plans, or making money from their hobbies
-those peoplewho retired voluntary return to the workforce within 2yrs
Fewer than 5% of the population aged 65urs and older live in nursing homes and is increasing as the person ages
-tyical elderly nursing home resident is a white, female, widowed, with multiple chronic health conditions
- Granny Bashing
- Identified risk factors afge 70yrs and older being mentally ill and physically impaired and unable to meet daily ADL's
- It can be
- Granny dumping- abandoming the person in an ER, nursing homes or facilities
Factors that contribute to older abuse
- Longer Life- the 75yrs and older adults have higher chances
S&S of elderly abuse
- the person becomes withdraw, depressed, anxious, sleep disturbances, increased confusion and agitation
- Bruises, welts, lacerations, burns, punctures, evidence of hair pulling, skeletal fractures
- Consisting hunger, poor hygiene, inappropiate dressing, unattended physical problem, medical needs
- Sexual abuse- pain and itching in the genitalia area, vaginal, or anal areas, unexplained STD's
- Financial abuse- the person complaints of a sudden lack of sufficient funds
-Of all suicides commited 16% were elderly
-white men continue to be the ones with higher rates of suicide
Questions to ask if suspected suicide intentions in the client
- Have you thought life is not worth living?
- Have you consider harming yourself?
- Do you have a plan for hurting yourself?
- Have you ever acted on the plan?
- Have you ever attempted suicide?
A nurse should lower the pitch and loudness of his/hers voice when addressing the older person. Looking directly into the face o te older person when talking
Reminiscene therapy and life review with the elderly client
- It can be in group or one to one terapy
- -here the client is encourage to share past stories about their life...
- its said that this is good for the elder client to boost self esteem
- -the client is also encourage to keep a diary, pets, listen to music, eat special foods,pictures that bring back memories