1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 30Aging Clients with Psychosocial Needs

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Elderly Americans are the fastest growing segment of the American population. The likelihood that an American who reaches the age of 65 will survive to the age of 90 has nearly doubled over the past 40 yearsfrom just 14% of 65-year-olds in 1960 to 25% at present. By 2050, 40% of 65-year-olds are likely to reach age 90. Experience Corps, 2009

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives After studying this chapter, you should be able to Differentiate between the primary (intrinsic) and the secondary (extrinsic) factors influencing the aging process Articulate Duvall’s developmental tasks of aging Compare and contrast the more common psychiatric– mental health disorders among Native Americans, African Americans, Hispanic, Asian American, and Arab American elderly Describe at least four patterns of behavior or emotional reactions that elderly clients exhibit as a result of experiencing despair

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives (cont.) ‏ Recognize failure to thrive Identify at least three causes of loneliness in the elderly Compare and contrast dementia and dementia syndrome of depression Explain the elements of a comprehensive assessment of geropsychiatric clients Identify provider-, client-, and illness-related barriers to the assessment of elderly clients

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives (cont.) ‏ Discuss the rationale for prescribing low doses of psychoactive agents for elderly clients Explain the purpose of life-review process and reminiscence Develop a list of nursing diagnoses commonly used when planning care for elderly clients ineffectively coping with the psychosocial aspects of aging Plan nursing interventions for elderly clients who, according to Maslow’s theory of motivation, demonstrate basic needs for survival, safety and security, love and belonging, self-esteem, and self- actualization

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Etiology of Aging Primary, or intrinsic, factors of aging: –Gender –Culture, ethnicity, and race –Intelligence and personality –Familial longevity –Genetic influences Secondary, or extrinsic, factors

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Developmental Tasks of Aging Compare the completion of these tasks by groups such as elderly Native Americans, African Americans, Hispanics, and Asian Americans (Asians and Pacific Islanders) ‏ : Establishing satisfactory living arrangements Adjusting to retirement income Establishing comfortable routines Maintaining love, sex, and marital relationships

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Developmental Tasks of Aging (cont.) ‏ Keeping active and involved Staying in touch with other family members Sustaining and maintaining physical and mental health Finding meaning in life

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Psychodynamics of Aging Anxiety Loneliness Guilt Late-life depression Somatic complaints Paranoid reactions Dementia Delirium

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nursing Process Assessment Nursing diagnoses Outcome identification Planning Implementation Evaluation

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment Assessment setting The interview Assessment tools

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Special Assessment Concerns Pain Polypharmacy Sleep–rest activity (insomnia) ‏ Involuntary weight loss

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Barriers to Assessment Provider-related barriers Client-related barriers Illness-related barriers Transcultural considerations

14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Diagnoses Acute confusion Adult failure to thrive Anxiety Ineffective coping Disturbed sleep pattern Ineffective health maintenance Risk for loneliness Powerlessness Risk for relocation stress

15. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Outcome Identification Outcomes generally focus on the following: Issues of loss or grief Social isolation Alteration in affect or mood Low self-concept Changes in behavior or cognition Special concerns related to pain, disturbance in sleep– rest activity, and involuntary weight loss

16. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Planning Plans of care are developed that help achieve the following: Maximize the older person’s independence Assist with the basic human needs Meet emotional needs Maintain life with dignity and comfort until death

17. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation Assistance with basic human needs Need for survival Pain management Stabilization of sleep–rest activity Interventions for involuntary weight loss

18. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation (cont.) Need for safety and security Need for love and belonging Need for positive self-esteem Need for self-actualization –Life-review process –Reminiscence –Grief work –Psychotherapy

19. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation (cont.) Medication management –Adverse effects –Drug–drug interactions Continuum of care –Assisted-living facilities –Adult daycare centers –Community mental health centers –Senior centers

20. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Evaluation The elderly client who responds to nursing care will demonstrate the following: Positive outcomes without interference of barriers Meeting of psychosocial needs Family or a significant other involvement

21. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Key Terms Aging Dementia syndrome of depression Ego preoccupation Ego transcendence Failure to thrive Polypharmacy Primary aging Reminiscence Secondary aging Self-actualization

22. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Reflection According to the Experience Corps, by the year 2050, 40% of 65-year-old elder adults are likely to reach the age of 90. What variables influence this increased lifespan? ?