Chapter 4 Life Transitions and Story

Terms to Know Ageism: applying prejudices to older adults due to their age Inner resources: strength within the person that can be drawn upon when needed Life review: a process of reminiscing or reflecting on one's life Retirement: the period in which one no longer works

Introduction Growing old is not easy. Multitude of changes during the aging process require Stamina Ability Flexibility Many factors affect older adults’ ability to cope with multiple changes of aging.

Ageism Prejudices and stereotypes applied to older adults based on age Ageism in society Biases against older adults Stereotypes and misconceptions Consequences of ageism: eroding dignity Need to heighten societal awareness of the realities of aging

Question Is the following statement true or false? Ageism is a concept described by Robert Butler several decades ago that is defined as “the prejudices and stereotypes that are applied to older people sheerly on the basis of their age…”

Answer True Rationale: Although older adults constitute the most diverse and individualized age group in the population, they continue to be stereotyped by many misconceptions that are not based on facts.

Changes in Roles and Relationships Changes in today’s nuclear family affect the roles and functions of the older adult within the family unit. Both negative and positive changes for older adults. Adjustment to changes in responsibilities and roles is a challenge of aging.

Parenting Changes in the parental role Sense of loss Historical role of wife and mother influenced today’s older women Changing roles for men influences our view of provider role of today’s older men Regular contact by children usually maintained Role adjustment can provide enjoyment

Grandparenting Grandparenting is a new role in life, as is step- grandparenting. Changes in family structure and activities bring new challenges. Active lifestyles of older adults require adaption by children and grandchildren. Grandparenthood: a learned role.

Grandparenting (cont.) Grandparents raising grandchildren Many older adults assume primary caregiving responsibilities for their grandchildren. Nurses can guide older adults as they contemplate assuming this new role. Organizations are available to assist those who choose the caregiving role.

Question Which statement is true related to the older adults’ role of being a grandparent? Stay-at-home grandmas are the norm. There are many similar styles of grandparenting. Grandparents are often not involved in the caregiving role. Grandparenthood is a learned role.

Answer D. Grandparenthood is a learned role. Rationale: Grandparenthood is a learned role, and some older individuals may need guidance to become effective grandparents.

Loss of Spouse Death of spouse is a common event that alters life Adjustments to widowhood: Task of living alone Developing alternative roles Income issues Loss of an intimate partner Choosing a new lifestyle

Retirement Loss of work role May need to adjust to a reduced income May be viewed as an undesirable state Occupational identity and social position/role in society Stereotypes of work roles Sense of identity may be effected Potential void in one’s life related to loss of the work role

Question Is the following statement true or false? Retirement is a major adjustment for an individual, and this transition is often an individual's first experience with the impact of aging.

Answer True Rationale: Retirement is especially difficult in Western society, in which worth is commonly measured by an individual's productivity, and unemployment is viewed as an undesirable state.

Phases of Retirement Preretirement phase Retirement phase Disenchantment phase Reorientation phase Retirement routine phase Termination of retirement

Nurses’ Evaluation of Retirement Nursing interventions are applicable to each phase of retirement. Nurses must evaluate own attitudes toward retirement. Nurses can be good role models of constructive retirement practices and attitudes.

Reduced Income Importance of financial resources Retirement income is less than half of earned income Social security income: intended as supplement but is often primary source of income Nursing implications Encourage financial preparations for old age Recognize the impact of economic welfare on health status

Changes in Health and Functioning Adjustment to new body image Affects on body image and self-concept Self-concept and roles Difficulty in acceptance of physical changes Illness and disability Societal expectations of the decline in function

Nursing Interventions for Decline in Function Educate about common changes of aging Promote optimum function Promote optimum health Prevent disease Preserve independence and dignity

Cumulative Effects of Life Transitions Shrinking social world Loss of social connections Risk of loneliness Facing fact of growing old Potential failure to thrive Nursing interventions for loneliness and isolation; engaging faith community

Awareness of Mortality Heightened awareness of reality of death Death is more tolerable if life has depth and meaning Signs of reality of mortality Accepting the increasing awareness of mortality

Question Which statement is true related to the shrinking social world of the older adult? There is a decreased risk of loneliness. Hearing deficits can foster loneliness. Children do not avoid older adult parents. Functional limitations have minimal impact.

Answer B. Hearing deficits can foster loneliness. Rationale: Hearing and speech deficits can foster loneliness. Changes associated with aging result in loss of social connections and increasing risk of loneliness as children are often grown and gone, and others who could allay loneliness may avoid the older individual as they find it difficult to accept the changes they see in the older adult.

Responding to Life Transitions Coping with life transitions Integrity versus despair Nursing interventions Life review Eliciting a life story Promoting self-reflection Strengthening inner resources

Life Review and Life Story Process of intentionally reflecting on past experiences Significance of life review Positive or painful experience Benefits to the younger generation Approaches used to elicit life stories

Self-Reflection Hallmarks of successful aging Knowledge of self Personal identity Body Mind Spirit

Self-Reflection (cont.) Writing as a facilitator of self-reflection Keeping a journal Writing letters and e-mails Reflecting through art Facilitates self-reflection and expression

Strengthening Inner Resources Physical, emotional, and spiritual resources that older adults may possess that enable them to survive to old age. Behaviors that exemplify survivor capabilities. Nursing interventions offer positivity to champion older adults’ inner strengths. Hope fosters empowerment.

Question Which intervention by the nurse facilitates empowerment of the older adult? Allowing care providers to make decisions Limiting options for living arrangements Including older adults in care planning Providing care in a long-term care facility

Answer C. Including older adults in care planning Rationale: In addition to being role models, nurses can facilitate empowerment by including older adults in care planning and caregiving activities to the maximum extent possible.