1. NURSING CARE OF THE OLDER ADULT THE AGING EXPERIENCE Chapter 2 (4 th Edition) PATI COX, RN, BSN, M.Ed.

2. OUTLINE INTRODUCTION –Definitions –Demographics – past/present/future –Impact of aging on nursing –Ethical considerations ATTITUDES TOWARD AGING –History –Ageism

3. Outline cont. The NORMAL AGING PROCESS Normal Physiological Changes -All Systems Physiological Changes Not Common to Aging –Changes –Common Chronic Diseases -4 –Common Causes of Death - 3

4. Names Synonymous with Aging “Oldster” “Elderly” “Golden Years” “Twilight Years” “Senior Citizens” “Silver Haired” “Grumpy” “Sunset years”

5. Terminology Gerus – Greek for old age Geriatrics – the medical study of older adults Gerontology – the nursing study of the older adult Senility – state of being old ( mentally & physically) not an acceptable medical diagnosis Senescence – process of aging Aged – means old and usually refers to those over the age of 75

6. GENERAL INFORMATION Natural process Each of us move through Attitudes are changing about aging with the “Baby Boomers” Issues that affect quality of life are receiving more attention

7. Aging begins @ Birth

8. DEMOGRAPHICS PAST

9. Demographics - Past Life expectancy –1776 - 35 years –1930 - 59.7 years –1965 – 70.2 years Confuscious – 1000’s of years Pioneers, Egyptians – youth to young adult 1 in 10 could expect to live to 65

10. DEMOGRAPHICS TODAY

11. TODAY’S AGED YOUNG OLD – 65-74 MIDDLE OLD – 75-84 OLD OLD – 85 + (Fastest growing population) Experiences – –Great Depression –Antibiotics, Airplanes –Automobiles, Television, –Polio, Small Pox, TB –WWI, WWII, Kennedy, Truman, Roosevelt, Eisenhower –King

12. “The Graying of America” Life expectancy has increased dramatically 80% of American’s anticipate living to 65 or older 12.7% of total population 1 in every 8 Americans is 65 or older 65-74 age group is 8 times higher than in 1900 75-84 age group is 16 times higher 85+ is 22 times higher-fastest growing

13. The Graying of America Life expectancy in 2005 is anticipated at 76.9 years –Females – –Caucasian (79) other 74.9 –Males – –Caucasian ( 72.9) other 67.2 –2 million celebrated 65 th birthday (5574/day) –Overall – 76.4 years

14. The Graying of America 50,545 persons 100 (+) in 2005 35% increase from 1990 (37,306)

15. “ The Graying of America “ – Marital Status Marriage –Older men 74% –Older women 43% –Almost ½ of all older women were widows (45%) 14% men –1 widower to 4 widows Divorced –8% –#’s Key: Ma= Married; Wi = Widowed; Si = Single; Di = Divorced

16. The Graying of America - Income Average income was $19,168 = men Average income was $10,899 = females Households headed by 65+ average income = $32,854 –Caucasians - $33,467 –African Americans - $27,952 –Hispanics - $24,330

17. Family Households 65+ Householder 13.9% 14.5% 18.4% 19.4% 21.7% 8.1% 4.0%

18. Poverty 3.4 million (10.2%) below poverty level in 2000 Historic low was reached in 1999 2.2 million (6.7%) were classified as “near poor” 1 of 12 (8.9%) Caucasian 22.3% African American; 18.8% Hispanics Older women (12.2%) Older men (7.5%) Living alone or living with nonrelatives – highest poverty rate Highest poverty = Hispanic women living alone or with nonrelatives (38.3%)

19. Employment 12.8% (4.2 million) 65 and over were in workforce in 2005 2.4 mill. Men and 1.8 mill. Women 3 % of US Labor force

20. Education Educational level is increasing High school grads increased from 1970-2005 from 28% to 70% 16% had Bachelor’s degrees or more in 2005

21. DEMOGRAPHICS FUTURE

22. Future – “The Graying of America” By 2010-2030 = 20-22% = 70 million (twice # in 2000) Baby Boomers will reach 65 Growth slowed somewhat in the 1990’s due to the low birth numbers in the Great Depression – 1930’s

23. Future – “The Graying of America” Minority Population –25.4% of elderly population in 2030 (219%) –16.4% in 2000 –Caucasian – 65+ will increase 81% –Hispanics – 65+ will increase 328% –African Americans – 65+ will increase 131% –American Indians, Eskimo – 65+ will increase 147% –Asian & Pacific Islanders – 65+ will increase 285%

25. Number of Person’s 65+ 1900-2030

26. Future – “The Graying of America” Factors that affect age distribution of population –Decreased mortality Better education, health, etc –Decreased fertility Baby Boomer females marry later, career oriented, fewer children

27. Impact on Nursing Care ? What will the impact be?

28. Impact on Nursing Spend ¾ (75%) caring for the elderly Most nurses will be classified as a “geriatric” nurse 65% of patients in acute care; 83% home care; and 92% long term care 85 + will have greatest health care needs Elderly will become more politically active Will care for individuals with significant histories & life experiences

29. Ethical Considerations ¼ of medical care $ is spent in the last month of life Treatment considerations Ethic committees to assist staff in making difficult decisions ( not just in hospitals, but in nursing homes, etc)

30. Attitudes Toward Aging History & Cultures –Western – Embarrassed & tolerance –Eastern- Extended Family & well respected –Are we changing our attitudes toward the aged?

31. What are characteristics of the Elderly ?

32. Ageism Discrimination against individuals as they age or grow old

33. Forms of ageism Paternalism or Infantilism –Talk to older adult as if child –Refer to them as “sweetie” “honey” “dearie”

34. MYTHS or TRUTHS about the Elderly How much do you really know about the aged population?

35. What Did you use to BE ? “I still Am”

36. Trends Making Life Better Health Care Housing Education Aspects Advocacy Groups

37. Housing 95% remain in own home 5% are institutionalized

38. Living Arrangements Over ½ (55%) noninstitutionalized persons live with spouse 633,000 Grandparents aged 65+ maintained households in which grandchildren were present Institutionalized – –65-74 = 1.1% –75-84 = 4.7% –85+ = 18.2%

39. Housing in 2005 80% were owners – 20% renters The average year of construction of the home was 1962 Average value of homes in 1999 – 96,442 76% owned their homes free and clear

40. Living Arrangements – 65+ 2005 41% 19% 40% Women

41. Living Arrangements 65+ 2005

42. Geographical Distribution Approx. ½ (52%) of elderly live in 9 states: –California; Florida; New York; Texas; Pennsylvania; Ohio; Illinois; Michigan; New Jersey 14% or more of total population –Florida Pennyslvania ;West Virginia; Iowa Rhode Island; Maine; South Dakota; Arkansas States with Lowest Poverty Rates for Elderly –Mississippi; Louisiana; District of Columbia; Alabama; Tennessee; Arkansas; New Mexico; Kentucky; West Virginia; New York; Texas Most elderly lived in Metropolitan areas = 77.5% while 23% lived in nonmetropolitan areas Less likely to change residence than any other age group. –When moving – most move to same city as children or same state

43. Health, Health Care, Disability 26.1% elderly assessed their health as fair or poor; little difference between sexes; ethnic races rated their health much more fairer or poorer than Caucasians In 2002, more than ½ (55%)of elderly population reported with @ least 1 disability 4 times the # of days of hospitalization Average Length of Stay = 6 days (4.1 <65 yr) 11% spent on health care (5% < 65) More physician visits

44. Percent with Disabilities, by Age

45. Chronic Health Problems 28.8% reported a limitation caused by a C.H.P (65-74) 50.6% of those 75 & older reported they were limited due to a C.H.P. Four most common C.H.P. –Arthritis (53%) –Hypertension (42%) –Heart Disease (40%) –Cataracts (23%)

46. Advocacy Groups Gray Panthers –www.graypanthers.org AARP –www.aarp.org Veteran’s

47. 10 Leading Causes of Death Cancer Heart Disease Cerebrovascular Disease (Stroke) Influenza, Pneumonia Ateriosclerosis, Diabetes Mellitus Accidents, Bronchitis, Asthma Emphysema, Cirrhosis of Liver Nephritis, Nephrosis