HLTEN515A IMPLEMENT AND MONITOR NURSING CARE FOR OLDER ADULTS

Successful ageing
Successful ageing requires individuals to constantly adapt to a wide range of challenges as many changes occur throughout one s life. Discuss the social challenges elderly individuals are confronted with.

Ranjodh

The concept of "wellness" has been associated with successful ageing and is often confused with the notion of health. Wellness represents balance among the environment, emotional, spiritual, social, physical and cultural aspects of the individual's life. Health is a part of wellness. New definitions of successful ageing continue to be developed as research and practice with the older adult population progresses. Gerontologists debate the factors which lead to ageing well. Many concepts have been studied over the last half of the twentieth century. Early research on ageing reflected the concern with adapting to the physical, psychological, and social losses of ageing. Cumming and Henry (1961) posed the disengagement theory at a time when life expectancy was shorter and mandatory retirement was in place. They posited that older persons naturally and voluntarily withdrew from society as they lost ability and interests while society simultaneously pulled back from them so that their death would not be so disruptive to the social group.

Many positive studies have taken place since 1961. Theories and perspectives such as activity, continuity, consolidation, and busy ethic developed to describe the diversity of interests and tendency of older persons to remain active and engaged in different ways. Scientists have verified the wide diversity within populations and have taken different focuses to study older adults. Some suggested that personal goals lead an individual from one stage to another. Others measured actual ability of older adults to function or perform. Some examined successful aging with an emphasis on adding meaning or richness, Still others explored the idea of control or power over one's course of life while Other psychological approaches suggested coping, choice and adapting as predictors of success. Subjective and objective aspects of aging well are important in our

discussion of successful ageing. One can perceive experiences positively or negatively. Levels of life satisfaction tend to be stable over time. Life satisfaction is strongly related to health, socioeconomic status and relationships with family and friends. Persons who age well are likely to perceive their objective circumstances as rewarding and positive. We expect life satisfaction and positive perceptions of ageing to follow financial security, ability to function, freedom from chronic disease, and quality relationships with friends and family. These elements and our perceptions of them, however, are complex and vary greatly among individuals. How we view ourselves in later life influences our perception of well being. "Stronger" persons survive stresses. "Hardier" individuals those with a strong self efficacy are more apt to retain control, feel competent, seek opportunity in challenges, have compassion, maintain a sense of humor. How we approach life or define our role may affect how satisfied we feel. We may react to life through the eyes of others rather than creating and advocating for our own value and role. Hence, an older adult may define how successful he/she is by the criteria and judgments of others. There are many factors that illustrate that large numbers of population is at high risk for not ageing successfully, financial problems (and lack of health insurance) will limit access to medical care, the absence or limited prenatal care may create lifelong and costly health problems, social and economic circumstances currently place minority elders at higher risk for poverty, malnutrition, and substandard housing and poor health, Older women who live alone are more likely to be poor than are couples or older men. These factors make a compelling argument that all persons do not have equal chances to age well. The circumstances of elderly individuals reflect an accumulation of opportunities and lifestyles. Hence, a large and growing population

is at risk for not ageing well due to lack of access to services and opportunities along the life cycle. Populations underserved and at greatest risk include low income older persons especially women, Minority elderly, Frail and impaired older persons, Abused/neglected elders, rural elderly, mentally retarded and developmentally disabled older adults, homeless individuals, Older adults living alone and/or homebound.The delivery of health care is complex and fragmented at best. There is poor coordination among ambulatory, acute and long-term care. Populations which have lifelong risks for ageing poorly are further in jeopardy with a system that may not respond and restricts choice and access. The health care delivery system continues to change. This uncertainty, particularly the instability of reimbursements and eligibility and entitlement criteria in our federal and state governments, portends further challenges to choice and access.

While external circumstances stymie ageing well for particular populations, factors within culture and family may do so also. Familial lifestyle habits such as eating, smoking, and lack of exercise may limit healthy ageing prospects. Values and cultural customs may influence lifestyle. Family relationships and responsibilities may also limit health-seeking behaviors. Culture and family influence our support network and relationships. Research has proven the value of social supports in ageing well. The desire to be in relationship with others is different for each of us as one person may be very outgoing and another less so. It is not the number of family or friends but the quality of relationships that sustains us. As we go through adult life differently, we move in and out of circles of family and friends. In the later stages of life we face the loss of some of these, but we do not lose the desire or the need for them. There is a myth that

most older adults are isolated and alone. There are such older adults; however they are by no means the majority. To understand this we need to differentiate between two different types of loneliness which are social isolation - people are dissatisfied and lonely because they lack a social network of friends and acquaintances, and emotional isolation - people are dissatisfied and lonely because they lack a single intense relationship. If we lack the kind of relationship we desire, we can be lonely despite having other, quite rewarding social interactions. The loneliest people are adolescents and young adults. Loneliness actually declines with age at least until people are well into the later stages of old age, when it may begin to increase. Although this association between youth and loneliness goes against our stereotype of the elderly lonely, it is not really so surprising when we think about it. Young people face the enormously difficult task of defining their own identity as individuals. Without a solid sense of self, it is all too easy to feel unappreciated and unloved by others. Moreover, young people are constantly having to develop new relationships as they go through schools and into employment settings and each new social situation creates the possibility of feeling lonely. Finally, it may be that younger people have greater expectations about their relationships than do older people, who have learned to live with less than perfect understanding and compatibility.

Loneliness can be transformed into a constructive experience. One such transformation involves turning loneliness into solitude by using alone time to engage in pleasurable behaviors. It is also possible that learning to be alone with oneself can contribute to selfknowledge, which may strengthen our capacity for establishing intimate relationships with others. It is suggested that healthy personal growth consists of establishing a

balance between satisfying relationships with others and a secure base of satisfaction within ourselves. Nearly 60 percent of those aged 65 - 74 are married and live with a spouse in an independent household. Forty-three percent of women aged 65 and older are married and living with a spouse as compared to 75 percent men. Women represent 80 percent of the older adults living alone. Couples throughout marriage must learn to adapt to changing expectations. As a couple ages the tension between autonomy and equitable exchange may be heightened. One milestone that may tax the couple is retirement. Negotiating new roles, expectations, and time spent together, are all tasks to be dealt with. However, once negotiated, increased time together and with friends can increase marital satisfaction. Marital satisfaction is highest among those recently married, lower during the childrearing years, and higher in the later stages. The strongest predictor of marital satisfaction in later life is the couple's satisfaction in the early stages of marriage. Happy marriages have more equality and joint decision making -- including sharing of household duties. The work of Hansson and Carpenter (1994) has contributed a great deal to understanding the importance of relational competence. They identify four functions for relational competence which is to encourage individual to conceptualize relationship positively, aid in constructing satisfying relationships, enable persons to access relationships and enhance and maintain important relationships to make more meaningful, accessible & enduring. They also identify skills that aid one in relational competence: initiating & making demands upon relationships such as self-confidence, assertiveness, social interest,

communication skills, empathy, social awareness, listening skills, flexibility.

The family is the primary support for older people. There are changes in the modern family that may impact the family relationships of older adults. Without family visits or attention, the elderly may fall into a depression, or feel all alone. A big part of any elder care is to give emotional support. Studies show that this can improve life expectancy by several years, and create a more positive and optimistic environment for the aged. If you need help with ideas with providing elderly care for your family members, you could ask for ideas at your local retirement community, or take the time to ask your family member what he or she would like help with. Simply taking a walk can be all a person needs for that positive lift. However, the family members can play an important part of this aspect of elder care in that they can monitor the health of their loved ones with frequent visits, and be alert enough to notice if something seems wrong. Early detection of health problems is usually the best way to treat them, which could lead to a longer and happier life overall for ageing family members.

References
Generations, In-depth view of Issues in Ageing: Reasons to Grow Old: Meaning in Later Life. (2000). 23(4) pp. 1-96

Bond, L. A., S. J. Cutler, and A. Grams (1995). Promoting Successful and Productive Ageing. Thousand Oaks, CA: Sage Publications, Inc.

Successful Aging: The Second 50 - on-line article from Monitor on Psychology, a publication of the American Psychological Association, vol. 31, No. 1, Jan. 2000.

http://cas.umkc.edu/casww/sa/whatissa.htm

http://www.australianwebmaster.com/general/9041-importance-family-support-elderlywell-being.html

http://www.novelguide.com/a/discover/eoa_04/eoa_04_00395.html

http://www.meaning.ca/archives/archive/art_successful-aging_P_Wong.htm

http://cas.umkc.edu/casww/sa/WhatisSA.htm