MIDDLE-AGED ADULTS

(40-65 YEARS)
The middle years, from 40 to 65, have been called the years of stability and
consolidation. For most people, it is a time when children have grown and moved
away or are moving away from home. Thus partners generally have more time for
and with each other and time to pursue interests they may have deferred for years.
Maturity is the state of maximal function and integration, or the state of
being fully developed. Many other characteristics are generally recognized as
representative of maturity
Physical Changes of the Middle-Aged Adult
Appearance: Hair begins to thin, and gray hair appears. Skin turgor and moisture
decrease, subcutaneous fat decreases,
and wrinkling occurs. Fatty tissue is redistributed, resulting in fat deposits in the
abdominal area.
Musculoskeletal system: Skeletal muscle bulk decreases at about age 60.
Thinning of the intervertebral disks causes a decrease in
height of about 1 inch. Calcium loss from bone tissue is more common among
postmenopausal women.
Muscle
growth continues in proportion to use.
Cardiovascular system: Blood vessels lose elasticity and become thicker.
Sensory perception: Visual acuity declines, often by the late 40s, especially for near
vision (presbyopia). Auditory acuity for
highfrequency sounds also decreases (presbycusis), particularly in men. Taste
sensations also diminish.
Metabolism: Metabolism slows, and may result in weight gain.
Gastrointestinal system: Gradual decrease in tone of large intestine may
predispose the individual to constipation.
Urinary system: Nephron units are lost during this time, and glomerular filtration
rate decreases.
Sexuality: Hormonal changes take place in both men and women.
Psychosocial Development:
Middle-Aged Adult
The middle-aged adult:
Is in the generativity versus stagnation phase of Eriksons
stages of development.

 According to Havighurst, has the following developmental

tasks:
Achieving adult civic and social responsibility
Establishing and maintaining an economic standard of living
Assisting teenage children to become responsible and
happy adults
Developing adult leisure-time activities
Relating oneself to ones spouse as a person
Accepting and adjusting to the physiological changes of
middle age
Adjusting to aging parents
Balancing the needs of multiple constituencies (children,
parents, work, etc.)
Having work as a central theme.
According to Slater (2003), has the additional developmental
tasks of:
Inclusivity versus exclusivity
Pride versus embarrassment (in children, work, or creativity)
Responsibility versus ambivalence (making choices about
commitments)
Career productivity versus inadequacy
Parenthood versus self-absorption
Being needed versus alienation
Honesty versus denial (with oneself).
Cognitive Development
The middle-aged adults cognitive and intellectual abilities change very little.
Cognitive processes include reaction time, memory, perception, learning, problem
solving, and creativity. Reaction time during the middle years stays much the same
or diminishes during the latter part of the middle years. Memory and problem
solving are maintained through middle adulthood. Learning continues and can be
enhanced by increased motivation at this time in life. Genetic, environmental, and
personality factors in early and middle adulthood account for the large difference in
the ways in which individuals maintain mental abilities. The professional, social, and
personal life experiences of middle-aged individuals will be reflected in their
cognitive performance. Thus approaches to problem solving and task completion
will vary considerably in a middle-aged group.
Moral Development
According to Kohlberg, the adult can move beyond the conventional level to the
post-conventional level (see Chapter 21 ). Kohlberg believed that extensive
experience of personal moral choice and responsibility is required before people can
reach the postconventional level. Kohlberg found that few of his subjects achieved
the highest level of moral reasoning. To move from stage 4, a law and order
orientation, to stage 5, a social contract orientation, requires that the individual
move to a stage in which rights of others take precedence. In a study by Seiler,

Fischer, and Voegtli (2011) a 1-week training session in moral decision making was
implemented. The session demonstrated a significant improvement in the moral
awareness, processing, and compensatory action that improved an individuals
decision-making processes.
Spiritual Development
Not all adults progress through Fowlers stages to the fifth, called the paradoxicalconsolidative stage. At this stage, the individual can view truth from a number of
viewpoints. Fowlers fifth stage corresponds to Kohlbergs fifth stage of moral
development. Fowler believes that only some individuals after the age of 30 years
reach this stage. In middle age, people tend to be less dogmatic about religious
beliefs, and religion often offers more comfort to the middle-aged person than it did
previously. People in this age group often rely on spiritual beliefs to help them deal
with illness, death, and tragedy.
Health Risks
Many middle-aged adults remain healthy; however, the risk of developing a health
problem is greater than that of the young adult. Leading causes of death in this age
group include motor vehicle and occupational injuries, chronic disease such as
cancer, and cardiovascular disease. Lifestyle patterns in combination with aging,
family history, and developmental stressors (e.g., menopause, climacteric) and
situational stressors (e.g., divorce) are often related to health problems that do arise
INJURIES
Changing physiological factors, as well as concern over personal and work-related
responsibilities, may contribute to the injury rate of middle-aged people. Motor
vehicle crashes are the most common cause of unintentional death in this age
group. Decreased reaction times and visual acuity may make the middle-aged adult
prone to injury. Other unintentional causes of death for middle-aged adults include
falls, fires, burns, poisonings, and drownings. Work-related injuries continue to be a
significant safety hazard during the middle years.
CANCER
Cancer is the leading cause of death in middle adulthood (Edelman & Mandle, 2010,
p. 596). The patterns of cancer types and incidences for men and women have
changed during the past several decades. The ACS (2014) states that men have a
high incidence of cancer of the lung, prostate, and colon. In women, lung cancer is
highest in incidence, followed by breast cancer and colon cancer. Screening
guidelines for early detection of cancer are constantly evolving as new data are
analyzed.
CARDIOVASCULAR DISEASE

Heart disease and cancer are the leading causes of death during middle adulthood
(Edelman & Mandle, 2010, p. 595). Risk factors for heart disease include smoking,
obesity, hypertension, hyperlipidemia, diabetes mellitus, sedentary lifestyle, a
family history of myocardial infarction or sudden death in a father less than 55
years old or in a mother less than 65 years old, and the individuals age.

OBESITY
Middle-aged adults who gain weight may not be aware of some common facts about
this age period. Decreased metabolic activity and decreased physical activity mean
a decrease in caloric need. The nurses role in nutritional health promotion is to
counsel clients to prevent obesity by reducing caloric intake and participating in
regular exercise.
ALCOHOLISM
The excessive use of alcohol can result in unemployment, disrupted homes, injuries,
and diseases. It is estimated that 4 million people in the United States are
dependent on alcohol and can be considered alcoholics. Alcohol use may
exacerbate other health problems. Nurses can help clients by providing information
about the dangers of excessive alcohol use, by helping the individual clarify values
about health, and by referring the client who abuses alcohol to special groups such
as Alcoholics.
MENTAL HEALTH ALTERATIONS
Developmental stressors, such as menopause, the climacteric, aging, and
impending retirement, and situational stressors, such as divorce, unemployment,
and death of a spouse, can precipitate increased anxiety and depression in middleaged adults. Clients may benefit from support groups or individual therapy to help
them cope with specific crises.
Health Promotion Guidelines for Middle-Aged Adults
HEALTH TESTS AND SCREENING
Annual physical examination
Immunizations as recommended, such as a tetanus booster
every 10 years, and current recommendations for influenza
vaccine
Regular dental assessments (e.g., every 6 months)
Tonometry for signs of glaucoma and other eye diseases every
2 to 3 years or annually if indicated

 Breast examination annually by primary care provider

Testicular examination annually by primary care provider
Screenings for cardiovascular disease (e.g., blood pressure
measurement; electrocardiogram and cholesterol test as
directed
by the primary care provider)
Screenings for colorectal, breast, cervical, uterine, and prostate
cancer (see cancer screening guidelines in Chapter 30 )
Screening for tuberculosis every 2 years
Smoking: history and counseling, if needed
SAFETY
Motor vehicle safety reinforcement, especially when driving at night
Workplace safety measures
Home safety measures: keeping hallways and stairways lighted
and uncluttered, using smoke detectors, using nonskid mats
and handrails in the bathrooms
NUTRITION AND EXERCISE
Importance of adequate protein, calcium, and vitamin D in diet
Nutritional and exercise factors that may lead to cardiovascular
disease (e.g., obesity, cholesterol and fat intake, lack of vigorous
exercise)
An exercise program that emphasizes skill and coordination
SOCIAL INTERACTIONS
The possibility of a midlife crisis: encourage discussion of
feelings,
concerns, and fears
Providing time to expand and review previous interests
Retirement planning (financial and possible diversional
activities),
with partner if appropriate
OLDER ADULT
ATTITUDES TOWARD AGING
Because of the increase in numbers, nurses will be caring for older adults at some
point. It is important for nurses to be aware of their own values and attitudes toward
aging, and examine whether myths or stereotypes influence those attitudes.
Ageism
The term ageism is used to describe negative attitudes toward aging or older adults
(Mauk, 2014, p. 10). Ageism is discrimination based solely on age. Popham,
Kennison, and Bradley (2011) found that young adults distanced themselves from
older adults to shield themselves from being aware of their own mortality. These
individuals engaged in activities that made them feel strong, increased their energy,
and diminished their vulnerability. Luns (2010) research revealed that students who

were exposed to the older population through frequency and quality of interactions
were positively influenced and were more likely to make careers of elder care.
GERONTOLOGICAL NURSING
The older adult population is characterized by unique and diverse individuals who
may require a variety of health care professionals to meet their health care needs.
Gerontology is a term used to define the study of aging and older adults.
Gerontology is multidisciplinary and is a specialized area within various disciplines
such as nursing, psychology, and social work. Geriatrics is associated with the
medical care (e.g., diseases and disabilities) of older adults.

CARE SETTINGS
FOR OLDER ADULTS
Gerontological nurses practice in many settings. Older adults are the primary users
of health care services that range from acute care facilities to rehabilitation, longterm care, and the community (Eliopoulos, 2014). Regardless of the setting, older
adults require health assessment and promotion.
Acute Care Facilities
Preventing nosocomial infections (e.g., urinary tract infections, pneumonia).
Preventing therapy-related problems (e.g., confusion, sleeplessness, dehydration,
decreased nutrition).
Treating the health problem that resulted in the older adults admission plus
assessing for potential undiagnosed health problems (e.g., depression, drug and/or
alcohol abuse).
Preventing complications (e.g., decubitus ulcer).
Long-Term Care Facilities
Long-term care is the provision of health care and personal care assistance to
clients who have a chronic disease or disability (Li & Jensen, 2011). Long-term care
facilities are also known as nursing facilities. Nursing facility is a new term that
includes providers of care who are certified by Medicare and institutions previously
referred to as intermediate care.
Hospice
Gerontological nurses may also work in hospice and care for dying clients and their
families. The majority of hospice clients are older adults. Hospice requires a great

deal of patience, expertise, understanding, interdisciplinary communication, and

compassion skills on the part of gerontological nurses. The goal of hospice care is to
provide the client with pain management and with psychosocial and spiritual care
through the dying process (End-of-Life Nursing Education Consortium Core
Curriculum, 2013).
Rehabilitation
Gerontological rehabilitation nursing combines expertise in gerontological nursing
with rehabilitation concepts and practice. Nurses working in gerontological
rehabilitation often care for older adults with chronic illnesses and long-term
functional limitations (e.g., orthopedic surgery, stroke, or amputation). This
rehabilitative care may be found in several settings: acute care hospitals, subacute
or transitional care centers, and long-term care facilities.

Community
Gerontological nurses provide nursing care in many types of community settings.
Nurses often assess the older clients needs and then try to match the need with a
community resource. Examples of the different community areas in which
gerontological nurses practice include the following:
Home health care
Home care is designed for those who are homebound due to the severity of illness
or disability. The Medicare guidelines describe these clients as homebound and
unable to leave the home without a considerable amount of effort. Services are
provided by a primary care provider and require skilled or rehabilitation nursing.
Research has shown that providing home health services to older adults prevents
hospital readmissions (Miller, 2012).
Nurse-run clinics
These clinics focus on managing chronic illness. Nurses follow up with either
telephone contacts or home visits within a week after discharge from a hospital.
Again, this often helps decrease hospital readmissions.
Adult day care
The older adult may receive adult day care where the focus is on social activities
and health care. The level of nursing care can vary (e.g., bathing, medication
administration, wound dressing). Family caregivers who may need to work during
the day or need some respite from the continual care often use these services. This
is an alternative to institutionalizing an older adult.

Common Biological Theories of Aging

Wear-and-tear theory: Proposes that humans, like automobiles, have vital parts
that run down with time, leading to aging and death.
Proposes that the faster an organism lives, the quicker it dies.
Proposes that cells wear out through exposure to internal and external stressors,
including trauma, chemicals,
and buildup of natural wastes.
Endocrine theory: Proposes that events occurring in the hypothalamus and
pituitary are responsible for changes in hormone
production and response that result in the organisms decline.
Free-radical theory: Proposes that unstable free radicals (groups of atoms) result
from the oxidation of organic materials, such as
carbohydrates and proteins. These radicals cause biochemical changes in the cells,
and the cells cannot regenerate
themselves.
Genetic theory: Proposes that the organism is genetically programmed for a
predetermined number of cell divisions, after
which the cells/organism dies.
Proposes that when damage to the protein synthesis occurs, faulty proteins will be
synthesized and will
gradually
accumulate, causing a progressive decline in the organism.
Cross-linking theory: Proposes that the irreversible aging of proteins such as
collagen is responsible for the ultimate failure of
tissues
and organs.
Proposes that as cells age, chemical reactions create strong bonds, or crosslinkages, between proteins.
These bonds cause loss of elasticity, stiffness, and eventual loss of function.
Immunologic theory: Proposes that the immune system becomes less effective
with age, resulting in reduced resistance to
infectious
disease and viruses.
Proposes that a decrease in immune function may result in an increase in
autoimmune responses, causing
the body to produce antibodies that attack itself.
Normal Physical Changes Associated with Aging
INTEGUMENTARY
Increased skin dryness: Decrease in sebaceous gland activity and tissue fluid
Increased skin pallor: Decreased vascularity
Increased skin fragility: Reduced thickness and vascularity of the dermis; loss of
subcutaneous fat
Progressive wrinkling and sagging of the skin: Loss of skin elasticity, increased
dryness, and decreased
subcutaneous fat
Brown age spots (lentigo senilis) on exposed body parts: Clustering of
melanocytes (pigment-producing cells)

Decreased perspiration: Reduced number and function of sweat glands

Thinning and graying of scalp, pubic, and axillary hair: Progressive loss of pigment
cells from the hair bulbs
Slower nail growth and increased thickening with ridges: Increased calcium
deposition
NEUROMUSCULAR
Decreased speed and power of skeletal muscle contractions: Decrease in muscle
fibers
Slowed reaction: time Diminished conduction speed of nerve fibers and decreased
muscle tone
Loss of height (stature): Atrophy of intervertebral disks, increased flexion at hips
and knees
Loss of bone mass: Bone reabsorption outpaces bone reformation
Joint stiffness: Drying and loss of elasticity in joint cartilage
Impaired balance: Decreased muscle strength, reaction time, and coordination,
change in
center of gravity
Greater difficulty in complex learning and abstraction: Fewer cells in cerebral cortex
SENSORY/PERCEPTUAL
Loss of visual acuity: Degeneration leading to lens opacity (cataracts), thickening,
and
inelasticity
(presbyopia)
sensitivity to glare and decreased ability to adjust to darkness: Changes in the
ciliary muscles; rigid pupil sphincter; decrease in pupil size
Partial or complete glossy white circle around the the cornea (arcus senilis): Fatty
deposits
Progressive loss of hearing (presbycusis): Changes in the structures and nerve
tissues in the inner ear; thickening
of the eardrum
Decreased sense of taste, the tip of the tongue: Decreased number of taste buds in
the tongue because of tongue
atrophy
Decreased sense of smell: Atrophy of the olfactory bulb at the base of the brain
(responsible
for smell perception)
Increased threshold for sensations of pain, touch, and temperature: Possible nerve
conduction and neuron changes
PULMONARY
Decreased ability to expel foreign or accumulated matter: Decreased elasticity and
ciliary activity
Decreased lung expansion, less effective exhalation, reduced vital capacity, and
increased residual volume: Weakened thoracic muscles; calcification of costal
cartilage, making
the rib cage more rigid with increased anterior-posterior diameter;
dilation from inelasticity of alveoli

Difficult, short, heavy, rapid breathing (dyspnea) following intense exercise:

Diminished delivery and diffusion of oxygen to the tissues to repay the normal
oxygen debt because of exertion or changes in both respiratory and vascular tissues
CARDIOVASCULAR
Reduced cardiac output and stroke volume, particularly during increased activity or
unusual demands; may result in shortness of breath on exertion and pooling of
blood in the extremities:
Increased rigidity and thickness of heart valves (hence, decreased
filling/emptying abilities); decreased contractile strength
Reduced elasticity and increased rigidity of arteries Increased calcium deposits in
the muscular layer
Increase in diastolic and systolic blood pressure Inelasticity of systemic arteries and
increased peripheral resistance
Orthostatic hypertension: Reduced sensitivity of the blood pressureregulating
baroreceptors
Psychosocial Aging
A number of theories have attempted to explain psychosocial aging.
These theories focus on behavior and attitude changes during the aging
process. One of the earliest, disengagement theory, developed
in the early 1960s proposed that aging involves mutual withdrawal
(disengagement) between the older person and others in the older
persons environment (Tabloski, 2014). It has been widely criticized
for the assumption that disengagement is appropriate for the older
adult. According to Havighursts activity theory (1972), the best
way to age is to stay active physically and mentally. The continuity theory
proposes that people maintain their values, habits, and behavior
in old age.

1. Ego differentiation versus work-role preoccupation

2. Body transcendence versus body preoccupation
3.

Ego transcendence versus ego preoccupation.

Retirement
The ability to retire at the age of 65 is becoming increasingly more challenging for
older adults based on the changes within the U.S. labor force. Economic risk has
risen in the past several years. Todays seniors may lack the assets needed to retire.
Complicating this situation are rising health care costs and inadequate monthly
income to meet the needs of seniors (Polivka, 2013). Older adults may find that
their retirement income has not kept up with inflation. They may need to continue
working to meet medical, insurance, and housing costs.

E-HEALTH
In retirement, seniors may take a class to learn to use a computer or they may retire
having already learned computer skills. The term e-health is used to describe the
use of technology in the delivery of health care and health information. Seniors
have been the fastest growing age group using the Internet. They are now ranked
as the fastest growing users of social media.
Economic Change
The financial needs of older adults vary considerably. Although most need less
money for clothing, entertainment, and work, and although some own their homes
outright, costs continue to rise, making it difficult for some to manage. Food and
medical costs alone are often a financial burden. Adequate financial resources
enable the older person to remain independent.
Grandparenting
Grandparents traditionally provide gifts, money, and other forms of support (e.g.,
babysitting) for younger family members. They also provide a sense of continuity,
family heritage, rituals, and folklore (Giger, 2013). However, the rate of
grandparents being the primary caregiver for their grandchildren is increasing. The
major reasons for grandparents raising grandchildren include substance abuse,
incarceration, teen pregnancy, emotional problems, and parental death. The terms
used to describe families in which grandparents serve asthe parents are kinship
families, grandfamilies, or skipped-generation families.
Relocation
Assisted living. This is a facility that meets the needs of the older
person (e.g., wide doorways, grab bars in the bathroom, a call
light). Various degrees of personal care assistance may be provided.
Adult day care. The older adult who lives at home can attend a day
care center that provides health and social services to the older
person. While the older adult is at day care, the caregiver has a respite from the
daily care tasks.
Adult foster care and group homes. These programs offer services to
individuals who can care for themselves but require some form of supervision for
safety purposes.
Maintaining Independence
and Self-Esteem

Most older Americans thrive on independence. It is important to them to be able to

look after themselves even if they have to struggle to do so. Although it may be
difficult for younger family members to watch an older person completing tasks in a
slow, determined way, older adults need this sense of accomplishment
Facing Death and Grieving
Survivor coping ability improves when the person is aware that
death and bereavement can lead to growth (Ebersole et al., 2012). This coping can
result from the anticipatory grief related to the premature detachment from the
person who is dying. It is the goal of the gerontological nurse to support those who
are grieving.
COGNITIVE ABILITIES AND AGING
Piagets phases of cognitive development end with the formal operations phase.
However, considerable research on cognitive abilities and aging is currently being
conducted. Intellectual capacity includes perception, cognitive agility, memory, and
learning.
Perception
Perception, or the ability to interpret the environment, depends on the acuteness of
the senses. If the aging persons senses are impaired, the ability to perceive the
environment and react appropriately is diminished.
Cognitive Agility
In older adults, changes in cognitive abilities are more often a difference in speed
than in ability. Overall the older adult maintains intelligence, problem solving,
judgment, creativity, and other well-practiced cognitive skills. Intellectual loss
generally reflects a disease process such as atherosclerosis, which causes the blood
vessels to narrow and diminishes perfusion of nutrients to the brain.

Memory
1. Momentary perception of stimuli from the environment referred to as sensory
memory.
2. Storage in short-term memory (information held in the brain for immediate use
or what one has in mind at a given moment). An example of this type of memory is
when you call information for a telephone number and remember the number only
for the brief time needed to dial the number. Short-term memory also deals with

activities or the recent past of minutes to a few hours that is often referred to as
recent memory.
3. Encoding during which the information leaves short-term memory and enters
long-term memory, the repository for information stored for periods longer than 72
hours and usually weeks and years. Memories of childhood friends, teachers, and
events are stored in long-term memory. Older people who remember the flowers in
their wedding bouquet or the names of the boys on their dance card are drawing
from long-term memory
Learning
Older people need additional time for learning, largely because
of the problem of retrieving information. Motivation is also important. Older adults
have more difficulty than younger ones
in learning information, they do not consider meaningful; therefore, the nurse
should be particularly careful to discover what is meaningful to the older adult
before attempting client education.
SPIRITUALITY AND AGING
Older adults can contemplate new religious and philosophical views and try to
understand ideas missed previously or interpreted differently. The older person may
derive a sense of worth by sharing experiences or views. In contrast, the older adult
who has not matured spiritually may feel impoverishment or despair as the drive for
economic and professional success lessens. Many older adults take their faith and
religious practice very seriously, and display a high level of spirituality. It would be a
mistake, however, to assume that religiosity increases with age. Todays older
adults grew up in a time when religion was much more important than it is for
younger people today.
Injuries
Injury prevention is a major concern for older people. Falls are a leading cause of
morbidity and mortality among older adults (Edelman & Mandle, 2010, p. 635).
Because vision is limited, reflexes are slowed, and bones are brittle, caution is
required in climbing stairs, driving a car, and even walking. Driving, particularly
night driving, requires caution because accommodation of the eye to light is
impaired and peripheral vision is diminished.

Drug Abuse and Misuse

Older adults take an average of 31.1 prescriptions per year (Mauk, 2014, p. 419).
Added to this, older adults may purchase over-the counter (OTC) drugs to remedy

common discomforts related to aging, such as constipation, sleep disturbance, and

joint pain. During
the past few years, the use of vitamins, food supplements, and herbal remedies has
increased. These agents fall under the category of OTC drugs and are often not
reported by clients as part of their medicine regimen. An accurate assessment
should include a listing of all these agents. Many of these agents have not had
adequate testing for effectiveness, side effects, or interactions with other
medications.
Alcoholism
There are two types of older alcoholics: those who began drinking alcohol in their
youth and those who began excessive alcohol use later in life to help them cope
with the changes and problems of their older years. Approximately one third of older
alcoholics are late-onset drinkers (after age 60) and that number includes a higher
number of Women. Chronic drinking has major effects on all body systems, causes
progressive liver and kidney damage, damages the stomach and related organs,
and slows mental response, frequently leading to injuries and death. Clients with
alcoholism should not be stereotyped or prejudged by the nurse. Rather, they
should be accepted, listened to, and offered help.
Dementia
Dementia is a progressive loss of cognitive function. It is critical that dementia be
differentiated from delirium, which is an acute and reversible syndrome. Both may
be characterized by changes in memory, judgment, language, mathematic
calculation, abstract reasoning, and problem-solving ability. The most common
causes of delirium are infection, medications, and dehydration. The most common
type of dementia is Alzheimers disease (AD), of which the cause is unknown.
Mistreatment of Older Adults
Mistreatment of older adults may affect either gender. However, the victims most
often are women over 75 years of age who are physically or mentally impaired and
dependent for care on the abuser. The abuse may be physical, psychological, or
emotional in nature. Sexual abuse, financial abuse, violation of human or civil rights,
and active or passive neglect have also been documented.

Health Promotion Guidelines for Older Adults

HEALTH TESTS AND SCREENING
Total cholesterol and high-density lipoprotein measurement
every
3 to 5 years until age 75
Aspirin, 81 mg, daily, if in high-risk group
Diabetes mellitus screen every 3 years, if in high-risk group
Smoking cessation
Screening mammogram every 1 to 2 years (women)
Clinical breast exam annually (women)
Pap smear annually if there is a history of risk factors (exposed
to diethylstilbestrol [DES] before birth, weakened immune
system from HIV infection, organ transplant, chemotherapy,
or chronic steroid use), abnormal smears or previous hysterectomy
for malignancy (American Cancer Society, 2012)
Women 65 years and older who have had normal cervical
results
should not be tested for cervical cancer. Women with
a history of a serious cervical pre-cancer should continue to
be tested at least 20 years after the diagnosis, even if testing
continues
past age 65 (American Cancer Society, 2013).
Annual digital rectal exam
Annual prostate-specific antigen (PSA)
Annual fecal occult blood test (FOBT)
Sigmoidoscopy every 5 years; colonoscopy every 10 years
Visual acuity screen annually
Hearing screen annually
Depression screen periodically
Family violence screen periodically
Height and weight measurements annually
Sexually transmitted infection testing, if in high-risk group
Annual flu vaccine if over age 65 or in high-risk group
Pneumococcal vaccine at age 65 and every 10 years thereafter
Single dose of shingles vaccine for adults 60 years of age
or older
Tetanus booster every 10 years
SAFETY
Home safety measures to prevent falls, fire, burns, scalds, and
electrocution
Working smoke detectors and carbon monoxide detectors
in the home
Motor vehicle safety reinforcement, especially when driving
at night
Older driver skills evaluation (some states require for license
renewal)

 Precautions to prevent pedestrian accidents

NUTRITION AND EXERCISE
Importance of a well-balanced diet with fewer calories to
accommodate
lower metabolic rate and decreased physical
activity
Importance of sufficient amounts of vitamin D and calcium to
prevent osteoporosis
Nutritional and exercise factors that may lead to cardiovascular
disease (e.g., obesity, cholesterol and fat intake, lack of
exercise)
Importance of 30 minutes of moderate physical activity daily;
20 minutes of vigorous physical activity three times per week
ELIMINATION
Importance of adequate roughage in the diet, adequate exercise,
and at least six 8-ounce glasses of fluid daily to prevent
constipation
SOCIAL INTERACTIONS
Encouraging intellectual and recreational pursuits
Encouraging personal relationships that promote discussion
of feelings, concerns, and fears
Assessment of risk factors for maltreatment
Availability of social community centers and programs for
seniors