Care of the Chronically Ill and the Older Persons ELECTIVE 2

BSN 14B June 22, 2011

Madeline N. Gerzon Level IV Clinical Instructor Davao Doctors College

Medical University of South Carolina/SC-Geriatric Education Center

Recap..
Myths of aging Theories of Aging
Psychosocial Sociological Biological

Medical University of South Carolina/SC-Geriatric Education Center

One aspect that is common to all forms of aging is Change.

Medical University of South Carolina/SC-Geriatric Education Center

Medical University of South Carolina/SC-Geriatric Education Center

Socio-economic Aspect of Aging Industrialization Urbanization Lack of facilities for older pop

Medical University of South Carolina/SC-Geriatric Education Center

Socio-economic Aspect of Aging

 Industrialization
Speed of production Early unemployment Longer pension years (critical economic

problem)

Medical University of South Carolina/SC-Geriatric Education Center

Medical University of South Carolina/SC-Geriatric Education Center

Socio-economic Aspect of Aging

 Urbanization
Shrinking to two-generation families Moving to cities Living arrangement issues Personality differences

Medical University of South Carolina/SC-Geriatric Education Center

Medical University of South Carolina/SC-Geriatric Education Center

Medical University of South Carolina/SC-Geriatric Education Center

Socio-economic Aspect of Aging

 Lack of facilities for older pop
More facilities for the younger age

group Few opportunities for health facilities, learning and practice activities. Less facilities to retrain for new jobs

Medical University of South Carolina/SC-Geriatric Education Center

The Aging Family

Medical University of South Carolina/SC-Geriatric Education Center

Post-Parental Period
 The post-parental - the middle years of adulthood, after the departure of children, but before retirement  The empty nest and the launching stage  For married parents this is characterized by a return to a two-person, married-couple household
Medical University of South Carolina/SC-Geriatric Education Center

Marital Status in the Middle Years

 A majority of 45 to 64 years old are married with a spouse present.  The percentages of people who are never married, divorced, and widowed are low relative to other categories.  The post-parental period lasts longer than any other in the marital life course.
Medical University of South Carolina/SC-Geriatric Education Center

Co-Residence in the Middle Years

 Co-Residence refers to adult children living in the same household as their parents.

Medical University of South Carolina/SC-Geriatric Education Center

Co-Residence in the Middle Years

 These factors contribute to earlier home-leaving:
Family instability Crowding Non-traditional family structure

Medical University of South Carolina/SC-Geriatric Education Center

Co-Residence in the Middle Years

 4/5 of adults leave home by age twentythree, but nearly half return home.  Boomerang kids leave home and then return, due to: Divorce Unwed motherhood Job loss Economic hardship
Medical University of South Carolina/SC-Geriatric Education Center

Grandparent Status
 Increased life expectancy has made grandparenthood a near universal experience in the U.S.

Medical University of South Carolina/SC-Geriatric Education Center

Grandparent Status
 Grandparenthood has become a transition of the middle years because:
Families are smaller; Children are spaced more closely; and Women are having their last child at

younger ages.

Medical University of South Carolina/SC-Geriatric Education Center

Medical University of South Carolina/SC-Geriatric Education Center

Grandparent Status
 Role expectations are not always clear.  Roles vary by social class and gender.  Grandmothers are likely to provide regular care.  Grandfather roles tend to be more affectionate than functional.

Medical University of South Carolina/SC-Geriatric Education Center

Grandparent Status
 Step-grandparent is a new role created by the frequency of divorce and remarriage in the U.S.  It is a role-less role since there are few role expectations associated with it.

Medical University of South Carolina/SC-Geriatric Education Center

Grandparent Status Grandparent visitation rights are a new phenomenon. Every state allows grandparents to petition for visitation.

Medical University of South Carolina/SC-Geriatric Education Center

Growth of the Elderly Population

 Early marriage and longer life have increased: The length of marriage The number of living generations The size of the kin network  The number of older persons has risen as average life expectancy has increased.
Medical University of South Carolina/SC-Geriatric Education Center

Medical University of South Carolina/SC-Geriatric Education Center

Medical University of South Carolina/SC-Geriatric Education Center

Marital Status in the Later Years

 As persons age, the percentage of widows and widowers increases.  More women are widowed than men.  For the elderly, marital and family relationships are primary sources of: Social involvement; Companionship; Fulfillment; and Happiness.
Medical University of South Carolina/SC-Geriatric Education Center

Intergenerational Relationships
 The sandwich generation are persons in the middle years who manage the demands of caring for their own children and aging parents  Intergenerational family relations are important, strong and resilient in the U.S.
Medical University of South Carolina/SC-Geriatric Education Center

Common Problems of Older Persons

 Health and care  Childrens problems  Income and standard of living  Abuse and neglect
Medical University of South Carolina/SC-Geriatric Education Center

Health and Health Care

 Older people prefer care by family members  Informal care by family members is the most common type

Medical University of South Carolina/SC-Geriatric Education Center

Health and Health Care

 Daughters are more likely than sons to provide:
Personal care Assistance with mobility and daily living Emotional support Companionship

Medical University of South Carolina/SC-Geriatric Education Center

Childrens Problems The elderly are affected by their childrens:

Marital problems Mental problems Physical problems Stress-related problems
Medical University of South Carolina/SC-Geriatric Education Center

Income and Standard of Living

 The percentage of elderly persons below the poverty line is 1/3 what it was in 1970.  The economic status of the elderly has improved greatly, particularly when compared to children.  Government programs and services for the elderly have expanded dramatically.
Medical University of South Carolina/SC-Geriatric Education Center

Socialization in Later Life

 The re-socialization needs of the elderly are often ignored.  The family system fulfills many of the needs and services of elder members.  The effectiveness of the family in meeting cultural goals depends on the structural opportunities available.
Medical University of South Carolina/SC-Geriatric Education Center

Retirement
 Retirement involves re-socializing persons for new roles and lifestyles.  Decreases are common in:
Health; Income; Status; and Feelings of self-worth.

 Being married acts as a buffer to these problems.

Medical University of South Carolina/SC-Geriatric Education Center

Dying and Death For adult children, the death of a parent adversely affects:
Marital relationships Physical health Psychological well-being

Medical University of South Carolina/SC-Geriatric Education Center

Dying and Death

 The family and kin network are major sources of decision making and social support during the dying process.  Hospice offers an alternative to hospital care for dying people.

Medical University of South Carolina/SC-Geriatric Education Center

Widows and Widowers Widowhood is:

Disproportionately represented

among people over 65. Associated with loneliness and social isolation.

Medical University of South Carolina/SC-Geriatric Education Center

Widows and Widowers Losing a partner is more psychologically detrimental for men. Finances are the biggest challenge for women.
Medical University of South Carolina/SC-Geriatric Education Center

Widows and Widowers

 Adjustment to Widowhood is Facilitated by:
Personal Autonomy Close Friendships A Realistic Philosophy of Life Economic Security Meaningful Personal Interests
Medical University of South Carolina/SC-Geriatric Education Center

OLDER PERSONS AND IMPLICATION TO CARE THE GRAYING POP

Medical University of South Carolina/SC-Geriatric Education Center

Graying Pop
 Growing numbers of Americans are interested in wellness programs to stay youthful, active, and healthy  More than one-third of all surgical patients are over 65 years of age
Medical University of South Carolina/SC-Geriatric Education Center

Graying Pop The prevalence of mental health problems increases with age Chronic diseases occur at a rate four times greater in old age than at other ages
Medical University of South Carolina/SC-Geriatric Education Center

Graying Pop
 Approx 40% of all elders will spend some time in a nursing home during their lives  Most beds in acute medical hospitals are filled by elderly patients  Older adults are the most significant users of home health services.
Medical University of South Carolina/SC-Geriatric Education Center

PHYSICAL PHYSIOLOGICAL

Medical University of South Carolina/SC-Geriatric Education Center

Normal Aging Changes

 Integumentary
Thinner Wrinkles Drier

 Nervous
Slowed reactions Impaired senses
Medical University of South Carolina/SC-Geriatric Education Center

Medical University of South Carolina/SC-Geriatric Education Center

Normal Aging Changes

 Sensory
Vision (Night-blindness) Hearing Touch
Duller Pain threshhold higher

Taste Smell
Medical University of South Carolina/SC-Geriatric Education Center

Medical University of South Carolina/SC-Geriatric Education Center

Normal Aging Changes Respiratory

Decreased activity tolerance More vulnerable to infection

Reproductive
Decreased hormone production

Medical University of South Carolina/SC-Geriatric Education Center

Medical University of South Carolina/SC-Geriatric Education Center

Normal Aging Changes Musculoskeletal

Osteoporosis Pathologic fractures Decreased muscle strength

Cardiovascular
Arteries loss elasticity Decreased response to stress
Medical University of South Carolina/SC-Geriatric Education Center

Medical University of South Carolina/SC-Geriatric Education Center

Normal Aging Changes GI

Decreased motility Constipation

Urinary
Decreased nephron activity More frequent voiding Retention
Medical University of South Carolina/SC-Geriatric Education Center

Normal Aging Changes Endocrine

Hormones changes

Immune
Decreased function More susceptible to infection &

disease Atypical S&S of infection

Medical University of South Carolina/SC-Geriatric Education Center

Medical University of South Carolina/SC-Geriatric Education Center

Mental Health Disorders

 Depression
Most common Can be a reaction

 Aggressive behavior
Abnormal anger, rage, or hostility Causes

 Rehabilitation
Medical University of South Carolina/SC-Geriatric Education Center

Medical University of South Carolina/SC-Geriatric Education Center