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Families will often have values that they cannot realize –the real
versus the ideal
Affective Function
Deals with the internal functions of the family – The psychosocial
protection and support of its members
It is a means to achieve the family tasks of
Physical care
Reproduction
Teaching
Personal growth and development, bonding, and providing purpose
and meaning
Healthcare practices
-level of health illness
-birth control and conception issues
-family dietary practices
-family shopping, planning, and preparation
-family sleep and rest
-family exercise and recreation
-family therapeutic and recreational drugs
-family self-care practices
-family environmental and hygiene practices
-family alternative therapies
←
← Seven Key Properties of the Concept Of Marginalization:
• Intermediacy
o The tendency of human boundaries to act both as barriers
and as connections
o Interpersonal barriers may be obstacles as well as sources for
protection
• Differentiation (isolation)
o The establishment and maintenance of distinct identities thru
boundary maintenance
ie. Gated communities
o Diversity can be stigmatized by the central ‘majority’ while
honored and celebrated by members of one’s group
• Power
o Influence exerted by those at the centre of a community over
the periphery and vice versa (mainstream, have advantages)
o When periphery come together as a group – can exert own
power that upsets the mainstream/centre, able to change
society
o Refers to the negative impact of domination as well as the
creative forces of coalition and solidarity
• Secrecy
o confining information to establish interpersonal bonds,
maintain trust and avoid betrayal
o Marginalized individuals may also keep secrets from
mainstream (ie/ no HIV, not pregnant, etc) – therefore must
establish trust with these individuals
o Can work other way as well – mainstream holding secrets (ie/
infection rates, drug errors) and not reporting to public
(parallels with power)
o Involves fear of betrayal and exclusion via tight interpersonal
bonding, yet also preserves trust and a sense of belonging
• Reflectiveness
o The fragmenting and conflicting psychic effects on
marginalized persons of discrimination, privatization,
isolation, invisibility and fragmentation and the interior work
that is required to understand and compensate for these
effects
o Thinking and trying to make sense of when you have been
marginalized
o Reveals how social processes cause internal fragmentation,
and awareness that can be demoralizing or empowering
depending on whether there is adequate support from others
• Voice
o The languages and forms of expression characterizing
marginalized subcultures
o Voice encompasses types of talk (ie/ mixed talk, back talk,
new talk) and ways of telling (ie/ narrative)
o Hearing people’s stories
o Carries implications of being silenced and misunderstood as
well as the possibility for positive, powerful expression
• Liminality
o Altered and intensified perceptions of time, worldview, and
self image that characterize and result from marginalizing
experiences
o Marginalization has a liminal quality in that it carries crucial
consequences for human development, maintenance of self-
esteem, health promotion and restoration
o Coming to the conclusion
o Characterizes experiences that are often filled with danger
and yet may be invaluable opportunities for change and
insight
←
← Marginalization on the external level can affect race, appearance,
ability etc. On the other end, practices such as smoking, religion,
occupation, sexual behaviours can be subjected to marginalization as well.
In addition, cultural identity can be affected as well, also political views,
illnesses, economic class. These are all axis of difference – gaps in society
where people fall and disappear. This happens in health care.
←
← Exploring the properties of marginalization exposes the linkages
between vulnerability and health for those living at the edge of society and
suggests that the health consequences of marginalization experiences result
not only from the perception of marginalized persons, but also from
contingencies of their environment.
←
← Vulnerability is the condition of being exposed to or unprotected from
health-damaging environments. It has both negative and positive
implications:
• Risk is the increased potential for developing illness as a result of
disproportionate exposure to damaging environmental factors
(negative)
• Resilience incorporates capacities gained from person-environment
interactions that foster survival (positive)
o Allows us to think things through better, understand the
politics etc
o It includes genetic predispositions and learned abilities of
persons and, as well, factors in their surroundings that
enhance their well-being
o There is significant variability in resilience among
marginalized persons across adverse circumstances
←
← Each of the properties of marginalization carries elements of risk and
resilience that have health consequences (see key properties).
←
← RNs who do not know the health-related responses of marginalized
persons may be inadequate in understanding and addressing problems
stemming from social alienation, economic deprivation and political
repression.
←
← The struggle for marginalized persons focuses on their needs for:
• Access to health resources
• Political and economic resources to ensure their basic needs
• The social legitimation and respect necessary to make decisions
affecting their health
←
← Marginalization provides a unique lens through which to view and
understand the health and health care of diverse populations.
←
← Marginalization impresses on us our need to approach members of
marginalized groups with an ear to their experiences and an eye to their
struggles.
←
← One key research strategy is to invite marginalized persons to talk at
length about the health problems they face, the obstacles that block their
access to health care and other resources, and what they think they need to
remedy their situations.
←
← This is rarely done in research or practice in any discipline.
←
← ****POST MIDTERM NOTES****
←
←
←
←
←
Young Adults 14/04/2010 11:14:00
← PSYCHOSOCIAL DEVELOPMENT IN YOUNGER ADULTS
←
← Important to study this to be able to work with younger adults
appropriately.
←
← Cognitive Development
← Becoming mature in young adulthood involves:
• Intellectual growth
• Becoming more adaptive and knowledgeable about self
o More able to role situations
• Forming values
• Developing increasing depth in analytic and synthetic thinking,
logical reasoning and imagination
←
← The many different intelligences include:
• Academic aptitude
• Leadership ability
• Creative and performing arts abilities
• Ability to manage self, others and a career
←
← Developing social and interpersonal skills and personal friendships may
have a powerfully maturing affect on intellectual skills.
←
← Influences on learning include:
• Level of knowledge in society generally
• Personal values and perceptions and previously learned associations
• Level of education (also: where you got it, and from whom)
• Available life opportunities (chances and choices)
• Interests
• Participation by the learner
• The learning environment
• Life experiences
←
← Developmental Impact of Post Secondary Education
• People who acquire a degree:
o New socialization opportunities
o Advances in moral and social reasoning
o Increased ability to empathize with others
o An income advantage (more promotions, less unemployment,
higher status etc)
o More likely to get high status positions
o Viewed as more desirable employees
o Have better performance on formal operations and other
measures of abstract reasoning
←
← During their post-secondary education, students’ academic and
vocational aspirations change.
←
← Thus, it is critical that such education enables students to make
realistic assessment of their academic abilities.
←
← Relationships among authoritative parenting, academic performance
and social adjustment prior to entering post-secondary education, seem to
be critical to a student’s ability to benefit fully from the educational
experience.
←
← Some Characteristics of Formal Operations Thought:
• Creative in thought
• Begins at the abstract level: compares ideas with previous
memories, knowledge, or experience
• Mentally integrates many steps of a task, instead of thinking about
or doing each step as a separate unit
• Considers the multiplicity and relativism of issues and alternatives
to a situation, so the end result is a unique solution
• Can differentiate among many perspectives
• Is ‘objective’, realistic and less egocentric-thinking and learning are
problem-centred not just subject-centred
• Reality is considered only a part of what is possible; they can
imagine and reason about events that are not occurring in reality
but are possible
• The thought system works independent of context and can be
applied to diverse data
• Can evaluate the validity of a train of reasoning independent of its
factual content
• Generates hypotheses; makes deductions and observes to
disconfirm expectations
• A concrete proposition can be replaced by an arbitrary sign of
symbolic logic (ie/ p or q)
←
← Some theorists dispute Piaget’s idea that formal operations is the last
stage of cognitive development.
←
← These theorists suggest that normal problems of adult life, with their
inconsistencies, complexities, uncertainties and paradoxes, cannot always be
addressed well using formal operational logic.
←
← Thus, they propose new structures or new stages of thinking in
adulthood:
• Contextual Validity
o In this context, is it true? Does it work in the immediate
surroundings?
o Thinking skills are specialized and pragmatic (ie/ how to solve
problems associated with roles or jobs they hold)
o Thus, they trade deductive thinking (of formal operations) for
contextual validity
o Situation specific
• Dialectical Thought
o Whereas formal operations involves trying to find
fundamental fixed realities (basic elements, and immutable
laws)
o Talking to people to understand complexities, mess etc
o Dialectical thought attempts to describe processes of change
• Postformal Thinking
o Whereas formal operations involved problem solving, some
adults develop a further stage characterized by problem
finding
o This mode involves creativity
o It is effective for dealing with problems that do not have clear
solutions or problems with multiple solutions
o Only a small number of adults achieve this stage
←
← Emotional Development
←
← Love: the feeling of accompanying intimacy.
←
← Love and intimacy change over time.
←
← By the mid-20s, the person should be experienced in the emotion of
love.
←
← If there was deprivation or distortion of love in the home when s/he
was younger, the adult will find it difficult to achieve mature love in an
intimate relationship.
←
← By this time, the person should realize that one DOES NOT FALL in
love; one LEARNS TO LOVE & GROWS TO LOVE.
←
← Moral Development
←
← This is one of the grey areas that is very pertinent to nursing.
←
← The YA may be in either the CONVENTIONAL LEVEL or the
POSTCONVENTIONAL LEVEL of moral development (pg 222-223).
←
← There are two stages to the conventional level (the most common in
adults):
• Stage 1
o Decisions and behaviour are based on concerns about others’
reactions
o Social groups, organizations, places of work etc
o Is capable of empathetic response
• Stage 2
o Obeys the law because it is the law or because respects
authority and the underlying morality of the law
o Social systems, government etc
←
← There are two stages to the postconventional level:
• Stage 1
o Adheres to legal views of society
o However, believes laws can be changed and people’s needs
change (general as well as relativistic)
o Can transcend views about social order and develop universal
principles about justice, equality and human rights
o “I’ll do something because it is morally and legally right, even
if it isn’t popular with the group”
• Stage 2
o Still operates as in stage 1 but incorporates injustice, pain
and death and an integral part of life
A much more universal focus
o “I’ll do something because it is morally, ethically and
spiritually right, even if it is illegal and I get punished and
even if no one else participates in the act”
←
← Self Concept & Body Image Development
←
← The person’s perception of self – physically, emotionally and socially –
is based on the following:
• Reactions of others (ie/ family, place of employment) that have
been INTERNALIZED
• Self-expectations
o Expectations we have put upon ourselves
• Perceived abilities
o Realistic or not?
• Attitudes
o Our self talk, how we talk to others, words
o What we say, does matter.
• Habits
• Knowledge
• Other characteristics
←
← A person’s behaviour depends on:
• Whether s/he feels positively or negatively about self
• Whether s/he believes others view him/her positively or negatively
• How s/he believes others expect the person to behave in this
situation
←
← A person discloses aspects of self depending on:
• Needs
• What is considered socially acceptable
• Reactions of others, and
• Past experience with self-disclosure
←
← Body image: a part of self-concept – a mental picture of the body’s
appearance
←
Body image includes:
• the surface, internal and postural picture of the body and
• values, attitudes, emotions and personality reactions of the person
in relation to the body as an object in space, separate from others
←
← Body image is flexible and subject to constant revision.
←
← Body image in the adult is a social creation.
←
← Normality is judged by appearance, and ways of using the body are
prescribed by society.
←
← Approval and acceptance are given for ‘normal’ appearance and
‘proper’ behaviour.
←
← In the adult, there is close interdependence between body image and
personality, self-concept, and identity.
←
← REFER TO PHOTOCOPIES FOR MORE NOTES ON YA’S.
←
Middle Aged Adults 14/04/2010 11:14:00
← PSYCHOSOCIAL CONCEPTS IN MIDDLE-AGE
←
← Most studies in adult cognition have been cross-sectional (vs
longitudinal).
←
← Thus many factors, other than age, have influenced results. Such
factors include:
• Amount of education
• Different experiences
• Fixed attitudes
• Number of years since finishing formal school
• Health status
• The kind of test given
• Speed requirements
←
← IQ tests may be irrelevant.
←
← Instead, we should test how people identify problems and use reason
and intuition to solve them.
←
← Some Information About Cognitive Development In Middle Age
←
← Reaction time or speed of performance:
• Studies suggest that it stays the same, or could diminish a bit
(however in late middle age, normal aging changes begin to occur)
←
← Memory:
• Some people have found no major differences
←
← Learning:
• Occurs in people of all ages
• People who are highly intelligent become more of a learner
• Capacity for intellectual growth should be unimpaired
←
← Problem-solving abilities:
• Ability should remain intact
• Use’s Piaget’s stage of formal operations (pg 221)
• Sometimes uses concrete operations for practical reasons (pg 220)
• Also uses post-formal thought (problem finding)
• Many patterns mark the development of intellectual skills:
o Represents experience symbolically
o Reflects on experience
o Imagines, anticipates, plans and hopes
o Develops an inner private world
o Recalls
o Monitor thoughts
o When solves a problem, can explain how (can give rational)
o More imaginatively productive
o Increasingly interested in other people and relationships
o Adaptable, independent, self-driven, conscientious,
enthusiastic and purposeful
o Reflects about personal relationships and thus understands
why other people feel and act as they do (empathy)
←
← Adult thought is characterized by dialectical thinking:
• Seeks intellectual stimulation, even crisis
• Welcomes contradictions and opposing views
• Creates a new order and discovers what is missing
• Struggled with morality, ethics, philosophy, religion and politics
←
← Creativity:
• People are less productive in total creative output in their 20s then
they are in their 30s and 40s
• Creativity is seen not only in famous people, but also in how people
approach situations, tasks and learning
←
← Continued learning:
• MA persons are frequently involved in continued learning
• Teaching methods that capitalize on learning strengths of mature
adults include:
o Active discussion and role play
o Help them to interpret, integrate, apply, analyze and
synthesize knowledge
o Validate with them that they can learn
o Environment conducive to learning (ie/ consider
environmental changes – normal aging changes)
←
← Work & Leisure
←
← Work is viewed differently by different middle-agers (ie/ older vs
younger)
←
← New categories of workers (different from the past)
• Free agents
• nomads
• Globalists
• Niche-finders
• Retreads
o Never without job and always learning/self-improving
• Corporate leaders
o New age bosses
←
← The time spent at the full-time job has increased over the past 20
years leading to a decline in leisure and in private life.
←
← Ways in which we are connected to work:
←
← Many MA women work outside the home; thus, they are ‘in the middle’
(sandwiched) in terms of demands on their time and energy
Emotional Development
Generativity: concern about providing for others that is equal to the concern
of providing for self
Characteristics:
• A sense of parenthood and creativity; of being vital in establishing
and guiding the next generation, the arts, or a profession; of feeling
needed and being important to the welfare of humankind
• The self seems less important
• The concepts of service, love of others, and compassion gain new
meaning and motivate action
• A sense of comfort in lifestyle, gratification from a job well done
and from what has been given to others
• Accepts the self and body (aging)
• Deep sincerity, mature judgment, empathy
• Values give stability and cause the person to be reflective and
cautious
APOCALYPTIC DEMOGRAPHY
While we should not discount the social importance of population aging we
should not overemphasize it either.
Apocalyptic Demography:
• Used to characterize the oversimplified notion that a demographic
trend – in this case, population aging – has catastrophic
consequences for a society
• Consists of 5 interrelated themes
o The negative portrayal of aging as a social problem that
needs fixing
o The homogenization of older persons – stereotyped
o Age blaming – blaming older adults for overusing social
programs and, therefore, for government debt/deficits
o Intergeneration injustice – older people are getting more than
their fair share of societal resources leading to severe
intergenerational conflict
o Intertwining of population aging and social policy (ie/ social
policy guided by deep cuts in order to accommodate the
growing number of older adults. Dismantle the welfare state
to counteract the societal burden of an aging population
←
← Evidence of attempts to dismantle:
• Attempts to privatize pensions
• Attempts to eliminate Old Age Security
• Attempts to reduce health care spending (and associated
privatization)
←
← Iatrogenic illness (aka unintended harm) – very big concept.
• Refers to all clinical situations in which our treatment/care,
physician care, and conditions – are harmful.
• Examples:
o The wrong drug (many drugs contraindicated, knowledge
about this is essential – or you are setting up for harm)
o An old drug
o A contaminated drug
o Interactions with drugs
o Antibiotics (superinfections)
• A lot of this is contributed due to system breakdown
←
← Adverse Events (AE) defined:
• Unintended injuries or complications that result in death, disability
or prolonged hospital stay that arise from health care management
←
← The researchers selected 4 hospitals in each of 5 provinces (BC, AB,
ON, QB & NS) and randomly reviewed charts for the year 2000. The results
indicated the AE rate being 7.5 per 100 hospital admissions. Among the
patients with AEs, events judged to be preventable occurred in 36.9% and
death in 20.8%. It was estimated that 1521 additional hospital days were
associated with AEs. The patients that had these AEs were significantly older
than those who did not. The overall incidence rate of AEs of 7.5% in our
study suggests that, of the almost 2.5 million annual hospital admissions in
Canada similar to the type studied, about 185 000 are associated with an AE
ad close to 70 000 of those are potentially preventable.
←
← In 2002, the Canadian government created the Canadian Patient
Safety Institute and many health care organizations have initiated efforts to
improve patient safety.
←
← FACTORS THAT MAKE OLDER ADULT CARE A COMPLEX
UNDERTAKING
← - Older adults’ great diversity/uniqueness
← - Other factors (ie/ few finances or social isolation) affect their health
and wellbeing
• Depression is very prevalent among older adults
← - Unique and complex relationships between normal aging changes,
and effects of disease and other abnormal conditions (ie/ effects of drugs
and other treatments)
← - Most have chronic conditions that uniquely affect acute illnesses,
reactions to treatments and quality of life
← - The causes of illness are more variable
← - Symptoms are physical diseases frequently overlap with symptoms
of psychological disease
← - Many older adults tend to underreport symptoms
← - The manifestations of illness, even acute illness, tend to be subtler
(vague and less visible) and less predictable in older adults. For example:
• Heart attack diagnosis
o Absence of pain
o Pain may radiate into left arm, neck and abdomen
o May become confused
o Low grade fever
• Older adults are likely to experience changes in their level of
functioning as manifestations of physiologic disturbances or adverse
medication effects
• An older adult with infection is much more likely to have mental
changes rather than an elevated temperature (also important to
know an older adults normal baseline temperature – could be
different than 37)
o UTIs affect 1 in 10 older adults making it the most common
infection among this population
Early S&S include:
Burning on voiding
Urgency (need to go now)
Might have fever
Incontinence
Confusion
Septicemia (blood poisoning)
o Pneumonia
May not exhibit chest pain
Fatigue
No cough
One of the leading causes of death
o Influenza
More susceptible due to depressed immune system
May not exhibit fever
Secondary infections can occur as well
o MI or ulcer
Can be missed
Absence of pain
←
← Multiple health conditions can coexist and muddle the ability to chart
the course of a single disease, or to identify the underlying causes of
symptoms.
←
← The risk for complications is high.
←
← Older adults may have multiple complaints, due to multiple coexisting
diseases.
←
← For any manifestation of illness in an older adult, there are usually 3
possible explanations. For example, changes in function (cognitive, physical
etc) are usually related to a combination of several of the following:
• Acute illness
o Pneumonia, heart failure
• Psychosocial factors
o Depression
Can happen from disease, drugs, life situations etc
• Environmental conditions
• Age-related changes
• A new chronic illness
o Diabetes
• An existing chronic illness
• An adverse effect of medication(s) or other treatments
o May be prescribed, self-prescribed, complementary,
alternative etc)
←
← Clinical Status:
• Hydration
• Nutritional status
• Daily practices
• Diseases
←
← Diagnoses often do not tell the whole story. Therefore it is more
helpful to think in terms of PRESENTING PROBLEMS. Common problems in
older adults include:
• Immobility
• Instability
• Incontinence
• Intellectual impairment (confusion)
• Infection
• Impaired vision/hearing
• Irritable colon
• Isolation (depression)
• Inanition (malnutrition)
• Impecunity (little or no money)
• Iatrogenesis
• Insomnia
• Immune deficiency
• Impotence
By the time illness in an older adult is identified and attended to, the
underlying physiologic disturbance may be in an advanced stage, and
additional complications may have developed.
Arterial stiffening
Reduced cardiovascular responsiveness to adrenergic stimulation
It’s more likely to occur after a consumption of warmer foods that are high
in carbohydrate content.
It contributes to:
• Falls
• Syncope (fainting)
• Hip fractures
• Myocardial infarction
• Stroke-related dizziness
• Frailty
• Malnutrition
←
← Recommendation: any older adult who falls, has syncope, or loses
consciousness should be evaluated for postprandial hypotension.
←
← ASSESSMENT:
• Initial reading before a meal
• Second and third readings at 15 minute intervals after the meal in
completed
←
← NORMAL FINDINGS
←
← A normal BP is less than 120 mmHg systolic BP, and less than 80
mmHg diastolic BP.
←
← The normal difference between lying/sitting and standing systolic BP is
20mmHg or less after standing for one minute.
←
← The normal difference between lying/sitting and standing systolic BP is
10mmHg or less after standing for one minute.
←
← THINGS TO REMEMBER WHEN TAKING BP IN OLDER ADULTS
←
← There may be an increase in variability of BP.
←
← Post prandial drop in BP may occur.
←
← An uncomfortably full bladder will increase BP.
←
← Many diseases and therapies can influence BP and cause postural
hypotension.
←
← Auscultatory gaps may be more common.
←
← Consistent differences in BP between arms may be more common in
older persons
←
← The incidence of arrhythmias increases with age.
←
← Pseudohypertension occurs predominantly in older persons.
←
← Self-measurement of BP may be difficult.
←
← TARGET ORGANS (OR END ORGANS):
←
← Those body organs (ie/ brain, eyes, kidneys) that are likely to be
damaged by untreated hypertension.
←
← HYPERTENSIVE TARGET ORGAN DAMAGE:
• Fundoscopic exam
• Left ventricular hypertrophy
• Hypercreatinemia
• CAD, PVD
• Abdominal aortic aneurism
←
← Examples of target organ damage:
• Cerebrovascular disease
o Transient ischemic attacks
o Ischemic or hemorrhagic stroke
o Vascular dementia
• Hypertensive retinopathy
• Left ventricular dysfunction (bigger)
• CAD
o MI
o Angina pectoris
o CHF
• Chronic kidney disease
o Hypertensive nephropathy (GFR <60 mL/min/1.73m^2)
o Albuminuria
• Peripheral artery disease
o Intermittent claudification
o Stroke (including transient ischemic attacks and/or vascular
dementia)
←
← NOTE: The absolute risk for all types of CV morbidity and mortality is
higher among persons with target-organ damage than among those without.
←
← ASSESSMENT FOR HYPERTENSION
←
← LAB TESTS:
• Hct, urinalysis for protein, blood and glucose; creatinine and/or
BUN; electrolytes; ECG; chest xray
←
← Assess BP in lying, sitting and standing positions (in that order).
Positional drops of less than 20 mmHg are normal.
←
← Assess physical and mental function at various BP levels.
←
← Use the two-step palpatory-ausculatory system as you have been
taught.
←
← Right size cuff.
←
← Fundoscopic exam (for arteriovenous nicking and toruousity,
hemorrhages and papilledema)
←
← Height and weight
←
← Examine neck vessels for bruits and distention.
←
← Inspect thyroid size.
←
← Auscultate lungs for pulmonary failure (chest xray as well)
←
← Evaluate heart size (left ventr), rate, precordial heave, murmurs,
gallops, arrhythmias.
←
← Inspect abdomen for aortic size, aneurysm, abdominal bruit and
kidney size.
← Aging is a holistic (all aspects), natural and expected process that
occurs from conception, until death. The rate, type, and degree of holistic
changes experienced during the lifespan are highly individualized
←
← Holistic changes are affected by:
• Determinants of health
o Genetic factors
o Diet
o Health
o Stress
o Lifestyle
o Knowledge
o Gender expectations
←
← Therefore, we can see that aging is multifactorial and very complex.
←
← There are individual variations in aging among older adults, and there
are differences in the pattern of aging of various body systems within the
same person – with some similarities as well.
←
← GENERAL CHANGES
← - The body has fewer functional cells, overall
← - Lean body mass decreases
• fat tissue increases (until 6th decade of life)
← - ICF decreases
• 10% decrease in older people
• leads to dehydration
← - Grey hair and wrinkles
← - Body contours gain a bony appearance (due to lower muscle mass)
along with deepening of hollows (axilla, supraclavical, prominent ribs, orbits)
← - Loss of tissue elasticity
• Collagen proteins change
← - Loss of subcutaneous fat content (causing elderly to feel cold)
• Tissue and skin move against each other and cause shears (position
extremely important)
← - Stature decreases
• immobility causes calcium to leave
• very susceptible to UTIs, pneumonia, blood clots etc
←
← CHANGES IN HEART AND BLOOD VESSELS
← - Heart size doesn’t significantly change with age
• if it does, there is a problem
o valve problems
o narrow aorta
o athlerosclerosis
← - Valves become thicker and more rigid (still working though)
• left sided heart failure – pulmonary edema (backflow of blood)
• right sided heart failure – CHF
← - Reduction in CO (HR x SV) under physiological stress
← - Lower SV
← - No change in resting rate
← - Lower sensitivity of blood pressure regulating baroreceptors
← - Vessels in the head, neck and extremities become more prominent
(due to thin subcutaneous layer)
←
← CHANGES IN THE LUNGS
← *Remember: Ventilation Diffusion Transportation
← - The rib cage becomes more rigid
• the anterior-posterior diameter increases (often demonstrated by
kyphosis)
← - Thoracic inspiration/expiration muscles are weaker
• thus, increased residual air in lungs
← - Lungs become smaller and more rigid – less recoil
← - Risk of aspiration is increased due to the blunting of cough/laryngeal
prominences
← - Decreased ciliary action
← - These changes cause lung expansion, insufficient basilar inflation and
decreased ability to expel foreign/accumulated matter.
←
← *Note: In older adults, the fact that they have lower O2 effects the fact
that they take another breath. Unlike the typical causes which is CO2.
←
← CHANGES IN THE GI SYSTEM
← - Healthy gums indicate an overall, healthy body (due to many blood
vessels etc)
← - Should not lose teeth with age
← - Less acute taste
• Sweet suffers, vs sour and salty
• Older people more prone to Type 2 Diabetes
← - Saliva level is down 1/3 (chew well!)
← - Thirst sensation can be blunted, and since ICF already down 10%
can easily dehydrate
← - ADH changes in elderly people can also cause more dilute urine
←
← ESOPHAGUS
← - Decreased motility
← - Slightly dilated
← - Longer time to empty
← - Potential for aspiration
← - Weaker cough muscles
← - Relaxation of esophageal/cardiac sphincter
← - Reduced gag reflex
←
← *Note: Older individuals should not lie down directly after eating (up to
an hour after) – and 5-6 smaller meals a day is better than 3 large ones!
Chewing, less distractions (conversations, phone calls etc).
←
← STOMACH
← - Reduced motility/action
← - Reduction in hunger contractions
← - Less acid in stomach (higher pH)
← - Less pepsin (protein breakdown)
← - Cardiac sphincter may be looser
←
← INTESTINES
← - Atrophy (small)
← - Fewer cells on the absorption size
• absorption challenges with iron, calcium, Vitamin B, B12 and D
← - Normal aging shouldn’t cause constipation
• Reduced foods, lack of fluids
• Less bulk in diet
• Reduced awareness of need to defecate
←
← *Note: Laxatives are NOT harmless.
←
← LIVER
← - Smaller in size
← - Function is the same and tested with the Liver Function Test
← - Drugs take longer to metabolize
←
← URINARY SYSTEM
← - Decrease in renal mass
← - Reduction in the number of nephrons
← - Reduction in renal blood flow
← - Reduction in GFR (10% down per decade after 40)
← - Creatinine, a product of muscle metabolism is measured in 3 ways:
• urinalysis
• blood serum (if high, indicated kidney problems)
• creatinine clearance (collecting urine for 24 hours)
←
← CREATININE CLEARANCE = (140 – AGE) x LEAN WEIGHT [KG] / 72 x
C.C.
← (if women, multiply by 0.85)
←
← - In older adults, give lowest possible medication doses
← - Serum monitored closely
←
← *(140 – AGE) x (LEAN WEIGHT (KG) / 72 x SC (to estimate for an
older adult)
←
← BLADDER
← - UTIs very common in older adults
← - Frequent urination (less elasticity)
← - Urgency, nocturia
← - Complete emptying ability is not good
←
← *Note: Keep in mind to discover what an older persons normal
temperature is. Since metabolic rate decreases with age, a normal
temp will not necessarily be 37.
←
← - Micturition reflex (signal delay)
← - Incontinence is NOT normal
• tumours
• diabetes
• drug induced
←
← - Stress incontinence:
← - Urgency incontinence:
← - Overflow incontinence:
← - Reflex incontinence:
← - Functional incontinence:
←
WEEK TWO NOTE BEGINS
CHANGES IN THE REPRODUCTIVE/SEXUAL SYSTEMS
- Males have lower sperm count, but do not lose ability to engage. ¾ males
over 65 have benign prostate (enlarged) but may be harmful as well – but
even if it isn’t it can cause physical damage (problems in excretion ie/
frequency (crimped ureter) – good to have it ruled out
- Women may lose subcutaneous fat, hair and a flatter labia (due to less
tissue). Uterus shrinks (but if on hormone replacement therapy the
endometrial lining may still respond – but needs to be ruled out as bleeding
may be other things). Vaginal canal is more alkaline (pH higher) – bacteria
likes these environments so older women more at risk for infections.
Decreased secretions (use water-soluble lubricant). Women, also do not lose
ability to engage/enjoy.
Sexual dysfunctions are often a symptom of something more serious.
Many sexual problems were identified as possible red flags of underlying or
imminent medical conditions.
WOMEN:
Cystocile- cyst on the bladder
Heart disease
Respiratory disease- COPD
Arthiritis
Diabetis
Stroke
Alcoholism
Sleep Habits
Sensory Organs
• Eyes/Vision
o Presbyopia (normal aging [begins around 40] –
farsightedness due to less elasticity of the eye lens). May not
occur as quickly in people who are generally nearsighted.
o vision field narrows (regular vision checks – can be caused
from glaucoma – starts from outside, is high pressure in the
eye, can be treated with eye drops or surgery) – risk for
developing glaucoma is increased
o Age related macular degeneration (AMD – losing centre vision
first)
o Pupil is less responsive to light (may need more light)
o Lens becomes stiffer/more opaque – cataracts
More prevalent in individuals near the equator
o Yellowing of the lens- may have trouble differentiating
between blues, greens and purples[DO NOT USE THESE
COLOURS FOR PRESENTATIONS!]
o Vision depth can become distorted
o Dark and light adaptation takes longer (risk for falls-
encourage leaving a light on inside the house, and sensor
lghts outside house)
o Reduced lacrimal secretions (dryer eyes)
o Blinking reflex may become slower
o Arcus senilis – a narrow, opaque band surrounding the iris
(older age)
o Corneal sensitivity is diminished (protective reflex of the eye
may be slower- wear protective eye wear when gardening,
mowing the lawn, etc.)
o Visual acuity decreases with age(sharpness of vision)***don’t
say this for a normal aging change of the eyes-be more
specific
o Age macular degeneration, first lose central vision
o
-macula
-dry involves the cells, wet involves the vesicles
• Ears
o Presbycusis (gradually loss of hearing with age) – due to
changes in the inner ear
Can also be affected by other things such as noise,
vibration
First lose the high pitched soft sounds (s,f,ph,th)
Speech could sounds distorted to them
Many factors contribute to presbycusis (such as
continues exposure to loud noise)
o Thicker hairs in ear canal with aging can affect hearing
o Wax also thickens with age (cerumen) due to increased
amounts of keratin
o Equilibrium/balance affected with aging – slower reflexes etc
• Smell
o About ½ older people lose some ability of their smell
• Taste
o 1/3 less saliva
o can be reduced – overseasoning (salt, sugar etc)
• Touch/Sensation
o May be reduced
o Change positions frequently – delays in feeling pain etc.
o Watch hot water (>43 C,), room temperature (24 C – never
lower [below 21 – hypothermia]) – elderly more susceptible
to cold temperatures (can lead to confusion, death)
←
← CHANGES IN THE IMMUNE SYSTEM
• Ability to fight infection/protect yourself becomes weaker in older
adults (health protection is important!)
o May exhibit atypical signs/symptoms of disease – actually
S&S given by the older adult will be vague/ atypical and
subtle
o Encourage getting flu vaccine, pneumovax vaccine etc.
o Encourage hand washing etc.
←
← THERMOREGULATION
• Normal body temperature may be lower – good to know baseline so
you can monitor based on their normal temperature.
• Reduced ability to respond to cold temperatures (due to reduced
sub-Q tissue, and decreased muscle mass)
• Differences in responses to heat
• Narrow window of safety – too high, too low = can get very sick
(core and environmental is important)
• May not be able to sweat as much when hot (decreased CO – lower
ability to shunt blood around etc)
←
← Principle for prescribing to older adults is to prescribe half the dose –
since it takes longer to excrete, wait twice as long to increase it, and monitor
very closely. Start slow, go slow.
←
← CHANGES IN THE INTEGUMENTARY SYSTEM
← SKIN
• Skin may become dryer, less elasticity
• Skin can be affected by multiple factors; smoking, sun exposure,
etc.
• Elderly people bathe less frequently
• Use of skin cream (to seal in moisture)
• Fragile – caution about damage to skin (shearing when immobile)
o Can wear socks inside out (prevents seams from rubbing
against/irritating skin)
o Encourage proper nail care (clipping etc – prevents fungal
infections)
o Cotton socks – allow feet to breathe better
• Subcutaneous fat is lost – elderly now more vulnerable to hot/cold
temperatures
o As lost, wrinkles result, sagging, lines (normal)
o Non-normal effects result from smoking
• Skin condition enhancement occurs by rehydration (1500 mL fluid a
day)
• The skin immune response declines
o More prone to skin and nailbed infections (nailcare is
important)
o Encourage handwashing, use of gloves in the garden etc
• Benign (harmless) neoplasms (tissue growth) as can malignant
ones
o Need to know normal vs abnormal changes in the skin
o Encourage regular skin checks
o Melanoma is on the increase-can be anywhere on the body
←
← HAIR
• Less colour in hair – may get white/grey
• Hair loss
o Some diseases cause this (hyper/othyroidism)
• Losing eyebrows/hair
o Hypothyroidism
• Thinning of the hair on the head, and in the axilla (armpits) and
pubic area as well
• Hair may grow a little slower than it used to
• Hair in nose and ears may become thicker (think: mechanical
obstruction – oxygen, hearing aid etc)
o Higher amount of keratin in the wax – gets stiffer with age
(blockage in the ear)
o Hearing tests are a good idea
• Growth of facial hair (in women)
o Can also be due to non-aging factors such as medications,
hormonal imbalances
• Increased growth of eyebrow hair, ear hair and nostril hair (in men)
o Think: if giving oxygen can be drying – make sure to be
checking and using appropriate system to ensure client’s
comfort (patency – ensure everything is OPEN)
←
← NAILS
• Iron deficiency – curved nail
• COPD – flattened nails (clubbed nails)
• Normal changes:
o Nails grow slower
o More fragile
o Little more brittle
←
← Infection control is extremely important with care of nails and skin
(preventing portal of entry for infection). Nutrition and hydration enhances
condition of skin. Avoid the shearing effect of immobility – and bathe a little
less frequent to prevent drying out of the skin.
←
← PERSPIRATION
• Older adults may not perspire as much as they used to – cannot
cool down as easy as younger adults
• Decreased number/function of sweat glands
←
CHANGES IN THE MIND-**causes of confusion can add to this note
in 2050
• Can be affected by a lot of abnormal things
o Health status, genetic factors, education, activity (level),
physical and social changes (meanings given), losses, sensory
impairments (normal or abnormal), feelings, self-attitude,
social isolation
←
PERSONALITY
• Should not change (drastically) with age
• If it does change – consider underlying events (ie/ medication,
retirement, depression [very prevalent in older adults], new
diagnosis, etc.)
• Self attitudes, issues people are dealing with, loss, health status
may affect personality – but with normal aging should not change
drastically
• If it does – time to investigate a little further
MEMORY
• Retrieval time may take a little longer (long term memory)
o Especially if not used routinely
• Benign(harmless) forgetfulness (normal)-
INTELLIGENCE
• In the past, most studies were done cross-sectionally (comparing
younger to older people – not fair)
• Now using longitudinal studies (following the same people over
time)
• Basic Intelligence:
o Structure of facts and knowledge
o Supposed to be maintained with normal aging
• Crystalized Intelligence
• Fluid Intelligence
o Problem solving, non-intellectual performance, creative
capacities, process of thinking
o Can decline with normal aging
LEARNING
• Myth: Can’t teach an old dog new tricks
• Because of this myth older adults are not taught as much as they
should be (ie/ medications)
• Unlearning/relearning may be difficult and take some time
• Speed may be slower (unraveling) but once unraveled can keep up
• Need more teaching resources – and shaping teaching regarding
communication, older adults etc
ATTENTION SPAN
• May be more distracted- may only last about 45 minutes (ie/ noise
in the hallway)
• In terms of presenting information – may wish to break things up
(have a break etc)
• Longer approach
←
← *Confusion is NOT normal.
←
← AGE RELATED CHANGES IN ACUTE CARE FACILITIES
• Hospitals are considered dangerous places for older adults
• With meds, give lowest possible dose – monitor accordingly and
increase minimally if needed
• Age adjusted lab tests