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Late adulthood (>65 years)

Learning Guide - 10

Late adulthood : >65 years

65-74 years
75-84 years
85-100 years
>100 years

: the elderly (the young-old)


: the aged (the middle old)
: the extreme aged (the old-old)
:elite old

Text Book
Kozier & Erbs Fundamentals of Nursing
concepts, process and practice. 8 th
edition.
Chapter 23
Pages: 406 425.

Frail elderly
An individual who has significant
physiological and functional impairment,
whatever the age.

With the modern facilities and medical


care the life expectancy has increased to
72 years for male and 78.8 for female
(1993). The population of old age is
increasing day by day which leads to
more concern towards health care for
the old age people.

Gerontology : The study of all aspects of


aging process, including biologic,
psychological and sociologic factors.
Geriatrics : Medical specialty for the elderly
person.
Geriatric, gerontologic or gerontic nursing
: Nursing specialty for the care of the elderly
people.

Physical changes in old age

Sensation
Changes in sensory nerve endings
Decreased sense of touch, temperature
and pain.
High risk for burns and injuries.

Physical changes in old age

Skin
Loss of adipose tissue
Hollow or gaunt appearance of face and
hands,
Decreased tolerance to cold.
Muscle atrophy
Double chin, Sagging eye lids, Sagging ear
lobes,
Wrinkling, Sagging breast
Dryness
Itching
Decreased blood flow
Loss of elasticity, Pale appearance.

Physical changes in old age

Hair
Decreased blood flow
Hair loss
Baldness
Decrease in number of pigment
producing cells
Graying (loss of hair color)

Physical changes in old age

Temperature
Decrease in metabolic rate
Body temperature decreases. 35 0C (950F)
is considered as normal body
temperature for the aged clients.
Slow sweating and circulatory mechanisms
Poor heat tolerance.

Physical changes in old age


Eyes
Loss of orbital fat
Sagging eye lids
Poor tone of ocular muscles
Difficulty in concentrating gaze on an object
Easy fatigue to eyes
Nervous system changes reducing light entering pupils
Presbyopia
loss of visual acuity
difficulty with color vision
Arteriosclerosis
Decreased peripheral vision
Lens become opaque and less elastic
Cataract

Physical changes in old age

Ears
Changes in nerve tissue
thickening eardrum
Presbycusis

Physical changes in old age


Nose
Olfactory bulb at the base of brain
atrophies
Decreased sense of smell
Less stimulation by food

Physical changes in old age


Tongue
Number of taste buds grow small
Decreased taste sensation
Poor appetite
Poor nutrition

Physical changes in old age

Chest
Musculo-skeletal changes in chest wall
Reduced chest size
Decreased lung volumes and
capacities
Poor coughing
Reduced ciliary activity
High risk for respiratory infections.

Physical changes in old age


Respiration
O2 debt in muscles
Dyspnoea

Physical changes in old age

Cardio-vascular
Decreased heart size, cardiac output and
working capacity of heart
Heart rate is slow to respond to stress and
slow to return to normal
Shortness of breath on exertion
Pooling of blood in the systemic veins
Increased arteriosclerosis
Decreased of heart muscle and blood vessels
elasticity
Increased systolic BP and diastolic BP.
Orthostatic hypotension

Physical changes in old age

Urinary
Enlarged prostate gland
Urinary urgency and frequency in men
Weaker muscles supporting bladder and
weak urethral sphincter in females
Urinary urgency and frequency in women
Bladder capacity reduced
Reduced ability to empty
Nocturnal frequency
Retention of residual urine leading to cystitis

Physical changes in old age

Digestion
Decrease in digestive enzymes
Decreased number of absorbing villi in the
intestinal tract
Increase in gastric pH
Low absorption rate
Slow absorption of nutrients and medicines
Indigestion
Loss of muscle tone of intestines
Decreased peristalsis
Indigestion
Constipation.

Physical changes in old age


Posture
Atrophy of discs between vertebrae
Kyphosis (stooping posture)
Decrease in height.

Physical changes in old age

Extremities
Osteoporosis
Pathologic fractures
Degenerative joint changes
Stiff and restricted movements
Decrease in muscle fibers
Lack of strength
Easy fatigue
Slow pace
Wasted appearance

Physical changes in old age

Sexuality
Male
Decreased testosterone levels
Decreased rate and force of ejaculation
Decreased speed gaining erection

Female
Decreased secretion of ovarian hormones
Shrinking of uterus and ovaries
Atrophy of breasts
Decreased vaginal lubrication
Painful sexual intercourse.

Psychosocial development (Erikson)


Developmental task : Ego integrity versus
despair.
People who attain ego integrity view life with a
sense of wholeness and derive satisfaction
from their past achievements. They view life as
an acceptable completion of life.
People who despair often believe they have
made poor choices in life and wish they could
live life over.
According to Robert Butler integrity is bringing
serenity (peacefulness) and wisdom and
despair is inability to accept ones fate. Despair
brings about feelings of frustration,
discouragement, and a sense of ones life has
been worthless.

Developmental tasks of older adults


Adjusting to decreasing physical strength and
health.
Adjusting to retirement and reduced income.
Adjusting to the death of ones spouse.
Establishing an explicit affiliation with ones age
group.
Meeting social and civic obligations.
Establishing satisfactory living arrangements.
Establishing satisfactory relationship with adult
children.
Finding meaning in life.

Cognitive changes
Decreased perception. ie. Decreased ability
to interpret the environment. Decreased
intellectual capacity and cognitive ability.
Memory impairment. Difficulty in learning
new facts or skills.
Dementia: A permanent and progressive
organic mental disorder that is
characterized by personality changes,
confusion, disorientation, deterioration of
intellectual functioning, impaired memory,
judgment and impulses. One type of
dementia is alzheimers disease.

Developmental stressors
Memory impairment
Primary memory (short-term memory/working
memory): Not affected much.
Secondary (recent memory): Much affected.
Tertiary memory (long-term memory):
Memories of childhood. Not affected. Elderly
people are much interested in talking about
their past. This is called reminiscing.
To promote the memory of the elderly person
nurses can encourage their clients to write
lists, use diary or calendar.
Encourage use of remainders and alarms.

Spiritual development (Fowler)


According to Fowler (1985) some people
enter a 6th stage of spiritual development
Universalizing. People whose spiritual
development reaches this level think and act
in a way that exemplifies love and justice.

Spiritual development
(Murray and Zenter, 1993)
Elderly people contemplate new religious
and philosophical views and tries to
understand ideas missed previously or
interpreted differently. They develop a sense
of worth by sharing experiences or views.
In contrast , the elderly person who has not
matured spiritually may feel impoverishment
or despair as the drive for economic and
professional success wanes.

Spiritual development (Carson)


According to Carson (1989) the elderly person
finds comfort, solace, and affirmation in
religious activities. Religion has a new meaning
for them. Most of them have strong religious
convictions and continue to attend services. It
helps them to find meaning of life and to deal
with difficulties.
The old-old person who can not attend formal
services continues religious participation in a
more private manner, most of them watching
services through TV, and contributing money to
religious activities.

Developmental stressors

Decreasing physical strength


Changes in the sense organs
Retirement
Economic changes
Relocation
Facing death and grieving

Health Promotion
1 Regular health check-up (yearly).
2 Protect from hypothermia

Warm protective clothes in cold


weather.

Extra blankets at night.

Woolen socks and gloves.

Maintain room temperature using


heaters.

High calorie, balanced diet.

Health Promotion
3

Nutrition
1200 cal/day
8 glasses of water a day
Balanced diet with vit. A, B, C, D and
Calcium and Iron.
Soft cooked, easily chewable food.
Use properly fitting dentures and enhance
oral hygiene.

Health Promotion
4

Elimination
To avoid constipation
Adequate roughage in the diet
Regular exercise
8 glasses of water a day
Nocturnal frequency
Limit fluid intake at night
Avoid natural diuretics-coffee and alcohol
Treat urinary tract infections
Correction of cystocele, rectocele or uterine
prolapse.

Health Promotion
5

Activity and exercise


Wear proper fitting shoes.
Avoid slippery floor
Walk in well lighted areas
A regular exercise program is recommended
such as walking, swimming, cycling or
golfing
Start exercise programs slowly
Stop exercise if feel difficulty in breathing,
palpitations, tired or dizzy

Health Promotion
7 Rest and sleep
Requires 6 hours of sleep at night
Limit day time naps
Increase day time activities
8 Independence and self esteem
Encourage activities as much as possible

Health Promotion
9 Prevent elder abuse
Types of abuse

Physical hitting, slapping, burning

Psychological threatening

Financial abuse taking their money

Neglect withholding food, medicines

Personal rights restraining, isolating

Sexual abuse
Nurses when come across with such abuse
situations must report it.