GERONTOLOGY EXAM #5 NOTES Chapter 24 Relationships, Roles, and Transitions Roles and Relationships Later in Life  Families  Types

of families  Traditional couples  Divorced couples  Nontraditional couples If older person happens to get remarried, they lose their spouses Social Security benefits This is a stigma for older adults Deterioration of health on 1 or both partners is a strain on the relationship Income, conflict with children, incompatibility sexual needs, mismatched needs and activity with socialization are also strains on the relationship Divorce has grieving process (sadness, fear, social adjustments, and disadvantages) If pt doesn’t live entire month, family has to pay back entire S.S. check – causes stress on family

Adult Children and Older Adults  Older adults like to hear about the successes of their grown children.  Relationships between older adults and their children may become strained as a result of:  Children of older adults are preoccupied with their own spouses, children, and partners.  Some older adults are fortunate to see their own children on a regular basis. Some have a hard time letting go of judgments of their children (parents are judgmental, keep telling their children what to do) Role reversal- older adult know as a confidant (friend) to their children: known as filial maturity – child’s relationship with or towards their parents

& may not feel lonely or isolated if have activities. Grandchildren report very meaningful relationship in their lives Relationships happen to get supported through internet Pg 380 box 24-1 Have more patience with children because they are less stressed and because of maturity and gained knowledge Provide continuity. Grandparents  Grandparenting is experienced by most older adults.  More grandparents live closer to their grandchildren and are more involved in the grandchildren’s lives. etc.  May have longer life-time employment. and accumulated wisdom to the grandchildren Siblings . work.  Have greater financial security for their age.  Grandparents receive emotional satisfaction.  Number of single older adults have increased because being single is more common in younger years.  Geographical distance is not affecting these relationships as it once did (because of the Internet). friends. friends.  Older adults are increasingly caring for their grandchildren. and neighbors Older adults have strong independence. family tradition. Usually develop supportive systems with their siblings.GERONTOLOGY EXAM #5 NOTES Never Married Older Adults  Demonstrate resilience in the challenges of aging as a result of their independence and may not feel lonely or isolated.

Limited time with family get togethers.friends that are like a family member to you Surrogate family.GERONTOLOGY EXAM #5 NOTES  As a person ages. nieces. he or she becomes more involved with siblings. friends Friendships can provide the commitment and support that are lacking in a family system Later-Life Transitions  Role transitions  Retirement (usually planned in advance) or can be unexpected as a result of illness.nursing assistants. case managers. or job disability  Grandparenthood  Widowhood  Becoming a caregiver .  Among single or widowed older adults living alone  The strongest sibling bond is between sisters. less and less time to spend with siblings when raising your own family Loss of a sibling for an older adult can be a rehearsal of one’s own demise – reminds you of how difficult it is. and nephews. makes you more aware of your own life and how you’re living Relationships with Kin  Kin includes aunts. nurses.  Maternal kin may be more emotionally close. care givers. cousins.family that has taken on roles of family members Fictive kin.  Siblings become increasingly close in supportive relationships.  Fictive kin are nonblood relationships but are important aspects of the family Fictive Kin can also be false family members.  Loss of a sibling results in grieving but is also a rehearsal for one’s own death. uncles. termination.

GERONTOLOGY EXAM #5 NOTES • • • Spousal caregiver Aging parents caring for developmentally disabled children Grandparents raising grandchildren  Becoming a recipient of care Role from independence goes to dependence and this is particularly difficult Retirement  A developmental stage that may occupy 30 or more years of one’s life  44% of retirees work for pay at some point after retirement  Some because of economic need  Some to remain involved and productive  Retirement planning  Financial resources  Family roles and responsibilities  Attitude toward work  Nature of the job  Access to health insurance  Health  Self-perceptions of ability to adjust to retirement Retirement has a lot to do with a person’s health and finances Work for desire to remain involved and productive (also is economically good) **To ease the transition to retirement is the ability to maintain a stable standard of living is very important .

list of questions to address when deciding to retire or whether or not to continue to work (what do I want to do. what’s the meaning of my life. what should my life contribute. what am I best able to do. can I afford to completely retire from paid work) Implications for Gerontological Nursing and Healthy Aging  Nurses may work with people in different phases of retirement  Participate in retirement education and counseling programs  Provide anticipatory guidance about transition to retirement  Identify those who may be at risk for lowered income and health concerns .GERONTOLOGY EXAM #5 NOTES Special Considerations In Retirement  Older women at particular risk  Work history sporadic and diverse  Retire earlier to meet family needs  Interrupted careers to meet family needs  Successful retirement adjustment depends on  Socialization needs  Energy levels  Health  Adequate income  Variety of interests  Amount of self-esteem derived from work  Presence of intimate relationships  Social support  General adaptability Pg 383 box 24-2 predictors of retirement satisfaction Pg 382 2nd column. who needs me.

GERONTOLOGY EXAM #5 NOTES  Refer to appropriate resources  Advocate for policies and conditions that allow older people to maintain quality of life in retirement Pg 383 box 24-3.phases of retirement Retirement can be a time to pursue interests that may have been neglected while being busy fulfilling obligations Death of Spouse  76% of women over 85 years are widowed  Death of life partner is a great loss of self  Mourning for the lost partner  Mourning for the loss of self associated with one’s lifelong marriage/partnership  Results in change  Change in social status  Change in economics  Change in self-image Spouses typically die within a year after their spouse dies Women have a tendency to be more social They have a higher support group then men do (when they’re widowed) Several phases for adjustment to widowhood for both men and women pg 384 box 24-4 Can be a loss of social status in the community (ex: if spouse was a leader in the communitythey attended things together and now without them they don’t attend) Recognize need to coordinate with family the need for care and concern Implications for Gerontological Nursing and Healthy Aging  Assessment  Grief and coping assessment .

and need a different caregiver ***Unlike children.  Approximately 66% of family caregivers are women  Informal caregivers may include  Friends  Paid and unpaid workers  Volunteers  Caregiving may present financial burdens  Caregiving considered a major public health issue As baby boomers age.they may be going through the grieving process – this takes time Coping Personal growth Continuing bonds Health risk Caregiving  Families and other unpaid caregivers provide 80% of care for older adults in U. there is less family members to provide for their care Sometimes children are sicker than their parents.S. abused older adults cannot be removed from their situations without their permission  Helping the abuser to manage the situational stress is more effective Educate the abuser on how to manage their stress .GERONTOLOGY EXAM #5 NOTES • • • •  Interventions  Know the stages of transition  Provide support  Help build strength and confidence Some family members will think that the widower is suffering from depression.

the patient may cease to recognize a spouse or child. financial burdens.this is very devastating to the family member The parent still remains the parent. and the fact that the parent becomes a child becomes very demeaning to their children Impact of Caregiving  Caregivers considered to be “the hidden patient”  Increased levels of depression and anxiety  Poorer self-reported physical health  Compromised immune function  Increased mortality  Potential sources of problems  Competing role responsibilities  Advanced age of the caregiver  High-intensity caregiving needs  Insufficient resources  Poor self-reported health  Living in the same household with the care recipient  Dementia of the care recipient  Prior relational conflicts Caregivers rely on less informal support If have appositive relationship with care recipient have less stress and find care giving more meaningful Caregivers have a lot of needs Pg 387 box 24-6 Care giving is a transition period for the caregiver Problems posed are how to change their own roles. time burdens .GERONTOLOGY EXAM #5 NOTES As their dementia progresses.

GERONTOLOGY EXAM #5 NOTES Caregivers of persons with dementia can experience greater emotional and physical stress The state benefits when a family member can care for an aging relative Impact of Caregiving  Positive aspects of caregiving  Enhanced self-esteem and well-being  Personal growth and satisfaction  Finding or making meaning through caregiving Spousal Caregiving  Spouses provide the majority of care for spouses with disabilities  Many may have significant health problems  Often neglected in deference to needs of spouse  Spouse may need physical care beyond the capabilities of the spousal caregiver  Less likely to receive assistance from family  Spousal caregivers more prone to  Loneliness  Depression  Increased risk of stroke  Increased risk of dying **Because of the pressure that is on them with taking care of their spouse **Spousal caregivers provide more intensive time consuming care than any other family caregiver .

GERONTOLOGY EXAM #5 NOTES Spousal Caregiving  Wives (anticipating loss of their spouse)  May need to learn to  drive  manage money  make decisions by themselves  Husbands  May need to learn to  Cook  Shop  Do laundry  Provide personal care to their wives Adult day care/ respite care/ home health aides to help people get assistance from and to give the family a break Older Adults as Caregivers  Caring for developmentally disabled adult children  Challenges include • • • • Difficulty in physically meeting disabled child’s needs Financial resources Health of caregiver How child will be cared for after aging parent’s death .

Intimacy and Sexuality of Older Adults  Commitment  Affective intimacy .  Nurses perform a risk assessment of caregiver stress.  Nurses use respite care.  Caregiver assessment includes stressors and benefits.GERONTOLOGY EXAM #5 NOTES Older Adults as Caregivers—cont’d  Grandparents raising grandchildren  Caused by • • • • • • • • Child abuse Teen pregnancy joblessness Imprisonment Military deployment Drug and alcohol addictions Illness Death Implications for Gerontological Nursing and Healthy Aging  Nurses are the primary care providers for older adults and their families. (temporary residence care for the patient that provides relief for the primary caregiver) Nurses are Care managers take care of the older adult if family lives in different state by providing care. making appointments.  Nurses perform a family assessment that identifies those who are family members and the functions of each member and includes a family medical history. etc.

social. bisexual. need to have relationships with family members. and transgender. Biological. gay. pyscologoical . the need for formal caregivers.GERONTOLOGY EXAM #5 NOTES  Cognitive intimacy  Physical intimacy  Interdependence  Sexuality allows a general affirmation of life  Social sphere of sexuality  Psychological domain of sexuality Includes 5 major relational components Means close to the need to have that close friendship. and spiritual connection Ability to form satisfying relationships with others Intimacy needs over time happen to change with the older adult Intimacy and Satisfying social relationships happen to remain an important component of a healthy adult Sexual Health  Influencing factors  Expectations  Activity cultural influences  Biological changes with age  Sexual dysfunction  Chronic Illness  Alternative sexual lifestyles include lesbian.

GERONTOLOGY EXAM #5 NOTES Sexuality in Long-Term Care Facilities  Forms of intimacy in the nursing home  Diseases  Alternate relationships  Dementia and intimacy and sexual activity *need permission from older adult (their children that have the power of attorney).for in the Alzheimer’s unit if they have cognitive functional loss Implications for Gerontological Nursing and Healthy Aging  Nurse has responsibility to  Help maintain the sexuality of older people by offering opportunity for discussion  Be an educator and provide information and guidance  Assessment • • • Includes knowing own feelings about sexuality Ask elders about their sexual satisfaction PLISSIT model for sexual discussion  Interventions • • • • • Education regarding age-associated changes in sexual function Compensating for age-associated changes Effective management of acute and chronic illness Removal of barriers Interventions to promote sexual health in cognitively impaired More susceptible to HIV AIDS has been called the great imitator .