1. Promoting Healthy Adaptation to Aging
Chapter 13
Promoting Healthy Adaptation to Aging
As we age, we undergo many changes to which we must learn to adapt.
These include physical and cognitive changes as well as changes in our social network and interactions.
The challenges of aging are faced not only by an individual, but by families, communities, and society-at-large.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

2. Lesson 13.1 Aging Theories Theory
Compare the biologic theories of aging
State how a person might behave in light of the psychosocial theories of aging
Identify four factors that contribute to longevity
Discuss physical changes that occur as adults age
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

3. Lesson 13.1 Aging Theories Clinical Practice
Identify at least six signs and symptoms of normal aging
Design an educational program to help older adults maintain physical health
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

4. Overview of Aging
Aging: a continual process of biologic, cognitive, and psychosocial change that begins at conception
Many adults of the potential for years of interesting and productive life
Most people don’t mind growing older particularly f they are relatively healthy
Overcoming myths about aging can be a challenge for nurses
Our concepts of “old” changes throughout our life span. When you are younger than the age of 21, anyone older than 40 seems old.
When you become 40, anyone older than 65 may now seem old to you.
And when you become 65, you still may not think of yourself as old. Instead, “old” is someone older than 90.
Many factors, including personal health, affect our concepts and beliefs about aging. What do you think “old” means? Answers will vary.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

5. Myths About Older Adults
Older adults are sick.
Older adults cannot learn new things.
It is too late for lifestyle changes to improve health.
Genetics are the main factor in longevity.
Older adults are not sexual.
Older adults are a drain on society.
Older adults are senile.
Older adults are typically isolated from their families.
Older adults usually live in nursing homes.
Older adults are poor.
Older adults are unhappy.
Much of the information and statistics on the aged were based on older adults with numerous health problems.
Many of the beliefs about the aged were formulated years ago, before such a large percentage of the population reached maturity.
Longevity has increased drastically in the past 50 to 100 years. Our concepts of the aged are also starting to change in relation to this new reality of longer productive lives.
What are your beliefs about the elderly? Do you think any of your beliefs are irrational? Answers will vary.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

6. Theories of Aging
Some gerontologists claim that aging is primarily determined by genetics
Others believe environmental and lifestyle factors play key roles in aging
Biologic theories
Biologic clock theory
Cells programmed to live a certain amount of time, then break down and die
Free-radical theory
Cells are damaged by toxins in the environment, including the waste products from metabolism
The aging process is probably controlled by a combination of genetics and environment, of nature and nurture. However, we do not know the specifics of the process.
Many theories abound about the aging process itself.
It is assumed that if we could understand the biology of aging, we could control it. Do you believe this? Will we ever be able to avert aging? Answers will vary.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

7. Theories of Aging (cont’d)
Biologic theories
Wear-and-tear theory
Organs eventually wear out, like machinery
Immune system failure theory
System loses ability to protect body from disease and becomes more susceptible to diseases that eventually kill us
Autoimmune theory
Body no longer recognizes itself and begins to attack itself and break down
Numerous disease processes can be used to demonstrate any one of the biologic theories of aging. However, any one of the theories does not apply to all of the situations.
Although we understand many of the elements of biologic aging, we still do not understand how it all fits together nor what controls it all.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

8. Theories of Aging (cont’d)
Psychosocial theories
Disengagement theory
Normal for older people to withdraw from each other
Activity theory
People who are active and interested continue to enjoy life and live longer
Continuity theory
Individuals’ basic personalities remain constant; they cope with aging similar to how they coped with other stages of life
The disengagement theory is no longer a viable option for explaining aging.
Does the activity theory explain aging? Does it account for the biologic aspects of the aging process? Answers will vary.
The continuity theory does not attempt to explain biologic aging or even account for it. Instead, it addresses the psychosocial aspects of the aging process.
Do you agree with any aspect of the continuity theory? Answers will vary.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

9. Longevity Life span is 115 to 130 years
Longevity has changed since 1900
Average life span
47 years in 1900
78.9 years in 2012
Diet, lifestyle, stress management, regular exercise, personality (outlook on life), gender, marital status, and genetics are factors impacting longevity
In the age of antibiotics, infectious disease no longer is a prevalent killer in industrialized nations (although it still is in third-world countries).
What are the prevalent killers now? Chronic illnesses and diseases; e.g., cardiovascular disease, cancers.
Why do you think that the optimistic, happy person generally lives longer? Answers will vary.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

10. Demographics
In 2013, 45 million persons (14% of the population) were older than 65 years
By 2060, 98 million persons will be older than 65 years
Young old is 65 to 74 years; middle old is 75 to 84 years; very old is 85 years and older
Centenarians are becoming more common:
53,364 in 2010
20 men for every 100 women over age 100
The young old are those who remain fairly healthy and active. The middle old become more frail and are thus less able to be as active. The very old are the most dependent.
What factors influence the rapid growth in the aging population? More effective medications and treatments for diseases; better screening methods for diseases; access to clean drinking water, adequate food, and other life necessities, etc.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

11. Physical Changes Benign senescence Cardiovascular
Normal physical changes of aging
Begins occurring early in adulthood
Often goes unnoticed until a problem develops
Cardiovascular
Increased heart size, decreased cardiac output, less elastic blood vessels
How will these changes affect the older adult’s cardiovascular health? Refer to Table 13-1
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

12. Physical Changes (cont’d)
Respiratory
Thickened alveolar walls, weakened respiratory muscles, decreased vital capacity
Musculoskeletal
Thinned intervertebral disks, decreased bone calcium, smaller muscle mass, less elastic ligaments and tendons
Many physiologic processes of aging cannot be altered by lifestyle or medication.
However, some processes can be significantly affected by lifestyle choices and changes.
What lifestyle choices can impact health and longevity? Smoking, excessive alcohol consumption, preventive health screenings, diet, exercise, etc.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

13. Physiologic Changes of Aging
Integumentary
Thinner, drier skin; loss of subcutaneous fat, slower rate of hair and nail growth
Urologic
Decreased bladder capacity and tone
Loss of nephrons, decreased sphincter control
The external signs of aging are those caused by changes in the integumentary system. Unfortunately, these are the signs we often use to draw conclusions about age, and sometimes even personal worth.
Wrinkles have become a taboo in our youth-oriented society.
As the aged population continues to increase, society’s emphasis on youth also continues to grow. Use of antiaging formulas is prevalent in our society.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

14. Physiologic Changes of Aging (cont’d)
Neurologic
Presbyopia; cataracts; decreased peripheral vision; presbycusis; decrease in touch, smell, and taste receptors; slowed reaction time; balance may be affected
Endocrine
Slowed production of all hormones, decreased metabolic rate, delayed insulin response
Physical decline over the life span happens to everybody regardless of genes, diet, exercise, etc.
The brain changes with the normal aging process. Connections between neurons can become less reactive, and there can be loss of cells.
A decline in the sensory organs—eyes, ears, taste—is often noticed first by an individual as early as age 40.
What are the potential consequences of such declines in sensation? Visual problems may make it difficult to drive at night, reaction times are affected, hearing loss may make it difficult to hear the doorbell or phone, etc.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

15. Physiologic Changes of Aging (cont’d)
Gastrointestinal
Decreased secretion of saliva and other digestive enzymes, slowed peristalsis, slowed liver and pancreatic functions, reduced absorption of nutrients
Reproductive
Decreased hormone production; atrophy of ovaries, uterus, and vagina; benign prostatic hypertrophy; slowed sexual responses
Other than menopause, the changes in the reproductive function of older adults was rarely mentioned in the past.
Now we recognize that older adults continue to function sexually and have sex lives.
There is more information for people to turn to regarding specific problems in sexuality that the aged may face.
How do the media portray older adults with regard to reproduction and sexual function? Answers may vary.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

16. Health Concerns
Most people older than 75 have at least one chronic health problem
Hypertension—most common
Arthritis—second most common
Heart disease—third most common
Obesity—may contribute to arthritis and hypertension
Other—anemia, diabetes, cancer, malnutrition, cirrhosis, mental illness
Dementia (degeneration of brain tissue) in a small percentage of older adults
What are the leading causes of death in this population? Heart disease, cancer, chronic lower respiratory disease, stroke, Alzheimer disease, diabetes, influenza, and pneumonia.
Not only do these conditions cause death but much illness and disability prior to death.
The chronic health problems in the aging population place a significant burden on the health care system as this population grows.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

17. Health Concerns (con’t)
Mental health may be difficult to evaluate
More than one million older adults experience depression
Older adults who have suicidal thoughts are more likely to act on them successfully compared with younger people with similar thoughts
Depression is a risk factor and early sign of dementia
Dementia occurs in small percentage of older adults, but the incidence increases with age
Between 5% and 15% of older adults have dementia; 60% to 80% of these people have Alzheimer disease
What treatable conditions can lead to impaired cognition? Malnutrition, dehydration, infection, and misuse of medications
What are the early signs of dementia? Confusion, memory loss, and disordered thinking are early signs
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

18. Health Promotion Behaviors
Eat a healthy diet
Add seasonings to counter loss of taste
Take a daily multivitamin
Participate in physical activity regularly
Get physical examinations regularly
Do not smoke
Limit alcohol use
Older adults should be encouraged to learn about nutrition and meal planning.
Daily activity, whether walking, biking, or swimming, keeps the body functioning.
Older adults may need encouragement to participate in their own health care management.
Why should alcohol use be limited? Alcohol use should also be limited because its effects may be greater in older adults and it may interfere with prescribed medications and supplements.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

19. Question 1
Biologic theories are based on cellular function and body physiology. Which biologic theory proposes that cells are damaged by toxins in the environment?
Free radical theory
Wear-and-tear theory
Biologic clock
Immune system failure theory
Answer: 1
Rationale: The free radical theory states that toxins are causes of free radicals. The wear-and-tear theory states that body cells break down and die. The biologic clock theory states body cells are programmed for a specific length of time and then break down and die. The immune system failure theory states that the system loses the ability to protect the body from diseases.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

20. Question 2
Longevity has been increasing. In 1900, the average length of life in the United States was 47 years. In 2004, the projected average life span was 77.9 years. All of the following are factors contributing to longer lives except:
people are healthier now than they were 100 years ago.
happy people generally live longer.
people are better educated and actively involved in their own health care.
health care drugs have had little to do with the increased life span because all drugs have side effects that over time decrease the life span.
Answer: 4
Rationale: Health care has improved greatly over the past 100 years. Prescribed drugs are in common use, and technology has allowed physicians to perform more difficult procedures easier and quicker.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

21. Question 3
Most people older than the age of 75 have at least one chronic health concern. Which of the following is not a health concern of the older adult?
Hypertension
Arthritis
Heart disease
Menopause
Answer: 4
Rationale: Menopause is a concern of the middle adult, not the older adult. Hypertension, arthritis, and heart disease are the three most common concerns of the older adult.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

22. Lesson 13.2 Development in the Older Adult
Theory
Explain Schaie’s theory of cognitive development in the older adult
Explain Erikson’s stage of psychosocial development in the older adult
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

23. Lesson 13.2 Development in the Older Adult
Clinical Practice
State three ways the nurse could help older adults maintain cognitive health
Identify nursing problems related to changes in psychosocial health
Guide the older adult’s family members regarding signs that the older person needs assistance
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

24. Cognitive Aspects of Aging
Schaie’s reintegrative stage of development
Older adults selective about how they spend their time
Intelligence can be maintained into advanced years
Speed of thinking may be slow but thinking processes remain intact
Vision or hearing deficits are not cognitive dysfunction
Learning can continue throughout adulthood regardless of age.
It is important that the mind continues to be stimulated and challenged.
Cognitive decline is accelerated by mental stagnation.
What types of activities help exercise the mind? Crossword puzzles, card games, jigsaw puzzles, needlepoint/knitting, board games, reading, etc.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

25. Wisdom and Learning
Older adults are often regarding as wise because of their wealth of life experiences
Wisdom is defined as having good judgment based on accumulated knowledge
Older adults are still capable of learning and often have more patience for learning
Many older adults have learned to operate computers
Describe ways older adults can be engaged or provided with stimulating learning opportunities.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

26. Memory Issues
Short-term memory loss: some older adults may have problems remembering recent events
Long-term memory usually remains intact
Severe memory losses and dementias may be the result of circulatory changes, malnutrition, or other underlying problems
Besides short-term memory decline, older adults may have other subtle changes such as word-finding (finding the right word they want to say when they are talking).
Research is demonstrating a relationship of decline in memory function to decline in endocrine function, such as in menopause.
If memory loss is acute or profound, the person should be evaluated for underlying disease processes.
Can memory be improved? Yes, to a degree with various activities and exercises for building memory
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

27. Employment and Retirement
Ability and desire to keep a job an individual decision, depending on the cognitive ability of the older adult
Some people eager to leave a regular job and may retire in their 50s or early 60s
Other people enjoy working and want to continue beyond a traditional retirement age
Some types of work maintain a mandatory retirement age, particularly if the work involves public safety. In other situations, retirement is a matter of preference.
A worker who has lost a job in favor of a younger person has recourse through the government and the courts
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

28. Psychosocial Aspects Stage of Ego Integrity vs. Despair (Erikson)
Older adults satisfied with past life usually happy
Families important to the older adult
Married older adults live longer than single adults; 39.9% of women and 12.7% of men older than 65 are widows
Most older adults live within 40 miles of at least one of their children
Older adults need to feel needed
Social activities and community ties are important
What other roles do older adults play at this point in life? If grandparents they may also be caregivers to the young; if spouse is ill or disabled they may become primary caregivers to the aged.
Identify ways to support older adults as their friends and siblings die.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

29. Living Arrangements Many prefer to live in their own home
About 28% of noninstutionalized older adults lived alone (more women than men)
About 2.2 million grandparents age 65 or over lived in households with grandchildren present
Increasing number of multigenerational households
3.4% of adults over age 65 and 10% of adults over age 85 live in institutional settings
Older adults want to feel needed. They want to stay involved with others. However, social isolation can grow, especially in those older than 80.
What contributes to social isolation in people older than 80? Inability to drive, less physical stamina to participate in events, loss of spouse and friends, etc.
What effect does the growing population of those older than 80 have on the health care system? Growing need for long-term care facilities, assisted living facilities, nursing/ancillary personnel, Medicare dollars to support chronic illnesses, etc.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

30. Health Promotion Behaviors
Encourage a positive attitude
Hobbies, religious and service groups, and volunteerism
Using the brain keeps the neural connections active and healthy
Reading, doing puzzles, using a computer, and writing
The brain is like a muscle in one way: it should be exercised regularly.
Even the older adult who is physically limited can maintain mental stimulation with a little effort.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

31. When a Parent Needs Help
May be difficult for adult children to admit that a parent needs help
Discuss possibilities before a crisis occurs; include siblings in the discussions
Locate important information
Financial, medical, and insurance information
Safety is a basic need; observe for changes
Elder abuse is prevalent in our society but it is often missed.
Emergency room personnel are usually trained in the assessment of signs of abuse, and even trained to screen for elder abuse.
What is the cause of elder abuse? Frustration, stress, anger of adult children or other caregivers can mount when caring for an elderly parent or relative
A growing issue in our society is older children (older than 50) caring for even older parents (older than 80). Often the caregivers have physical and cognitive issues of their own and are challenged by those of the parent.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

32. Signs That an Older Person Needs Help
Neglected personal hygiene, irregular dressing, soiled clothing
Significant weight loss
Home neglect
Inappropriate behavior
Frequent falls
Social isolation
Altered relationship patterns
Inability to find the right words
Unpaid bills, hoarding money
Confusion about medications
Making unusual purchases
Interventions for these problems vary, as do the causes. Some are easily corrected, others are long-term challenges.
What type of interventions would be appropriate in these situations? Checking up on a neighbor or friend, assisting with some household chores on a regular basis, taking to doctor appointments, etc.
Often it is one event that tips the scales between independence and dependency. This can be something as simple as breaking a hip in a fall. The physical spiral downward can proceed from that point.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

33. Question 4
Linda is a nurse who is trying to teach her mother, an older adult, ways to improve her life. She tries to encourage her mother to do all of the following except:
improve her diet.
practice preventive health care.
maintain a positive attitude.
decrease physical activity.
Answer: 4
Rationale: An increase, not a decrease, in physical activity can improve the older adult’s life. A good diet and positive attitude will also enhance the older adult’s life.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.