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Course Sample:
The news is everywhere. The growth of the population of older adults is escalating rapidly and will continue to do so due to the aging "baby boomer" population. Other factors such as improvement in health care and general living conditions also have had a significant effect on longevity. Life expectancy has increased from 47 years in the early 20th century to 77 years for those born in 2001 (CDC, 2004). The State of Aging and Health in America 2007 by the CDC states that "longer life spans and aging baby boomers ? will combine to double the population of Americans aged 65 and older during the next 25 years. By 2030, there will be 71 million American older adults accounting for roughly 20% of the U.S. population" (CDC, 2007). The leading causes of death in all age groups are now chronic diseases and degenerative illnesses and over a third are preventable.
Epidemiology
According to the U.S. Census Bureau statistics indicate that the percentage of people age 65 and over will reach 82 million or 20.3 % of the population by the year 2050. That figure is up from only 12 million or 8.2% in 1950. In addition the number of people between 18 and 64 who will be caring for the elderly population is declining. (CDC, 2003). Other statistics indicate that older adults represent 40% of all acute hospital admissions and take 25% of prescription drugs.
"Projections indicate that the rate of growth for the total population from now to 2050 will be slower, but older age groups will continue to grow more rapidly than the total population (1). By 2029, all of the baby boomers (those born in the post World War II period 1946-1964) will be age 65 years and over. As a result, the population age 65-74 years will increase from 6% to 10% of the total population between 2005 and 2030 (data table for Figure 1). As the baby boomers age, the population 75 years and over will also rise from 6% to 9% of the population by 2030 and continue to grow to 12% in 2050. By 2040 the population age 75 years and over will exceed the population 65?74 years of age."(CDC, 2006).
Definition of aging/elderly, senior citizen
Some of the terminology used to describe the elderly population may be "frail" or "able" elderly. The young old (65-74), middle-old (75-84) and old-old (over 85 years) are other categorizations used. Defining the terms aging or elderly is complex not only because of the subjective nature of the task but also because of long standing myths about "getting older" and because of cultural and societal interpretations. Each individual has their own interpretation of the meaning of the word "old". Physiological changes that may be related to genetic differences also add to the complexity of defining the terms "old or aged". Both nursing and medical research are making increased efforts to differentiate between the normal aging processes and pathology.
Myths about aging
Ageism is a form of labeling older people based simply on their advanced age. Typical ageism remarks like "He's just an old slow poke on the road and shouldn't be driving" or shouting at an older person because one believes all elderly are hard of hearing, are just a couple of examples of how the older adult is often viewed by younger people. Ours is a culture that highly values youth often to the point of a negative reflection on the elderly. These ageist views contribute to a low self esteem and dependency by some older folks.
Cultural differences
In caring for the elderly nurses must be aware of the influence of cultural differences. As nurses we provide care to clients from a wide range of ethnic backgrounds. Recognizing and understanding the differences related to culture yet avoiding stereotyping is necessary to provide quality care to all elderly clients regardless of family tradition. Treating each elderly client as a unique individual with unique needs is paramount. Also healthcare professionals need to be sensitive to the traditions and concerns of families as they are frequently closely involved in the care of their elderly relatives.
Some of the specific cultural issues that health care providers must be alert to include the following:
- Communication: In the United States there are over 150 different languages spoken with Spanish making up the largest percentage. Although health care providers (HCP) are not expected to be fluent in a variety of languages, there are signals that a client may give that indicate a communication problem. Look for absence of questions or non verbal cues such as a blank expression or avoidance of eye contact.
- Personal space: Invasion of personal space (that distance between the client and the HCP) may be perceived as a threat to one person and an expression of warmth and care by another.
- Eye contact: People from diverse cultures such as Asian, Native American, Indo-Chinese, Arab and Appalachian may interpret direct eye contact as impolite or aggressive and may avert their own eyes when talking with nurses or other HCPs. Hispanic clients may maintain downcast eyes as a sign of respect.
- Touch: The meaning a client attributes to physical examination of the body is culturally as well as sociologically determined. In some Hispanic and Mid Eastern cultures male HCPs are prohibited from touching or examining certain parts of the female body. Also in some cultures it is inappropriate for females to provide nursing care for male clients. A client's sense of modesty must be considered regardless of the cultural difference.
- Observance of religious or civil holidays: HCPs need to consider special holidays of their clients when scheduling appointments or procedures.
- Diet: The meaning associated with food varies widely throughout different cultures. HCPs should be aware of the specific dietary practices of their clients. Certain cultures prohibit certain foods and beverages. Being aware of the dietary restrictions is especially important as diet plays such an important role in the management of many illness (diabetes, hypertension, gastrointestinal disorders).
Eliopoulos, 1993.
Gender and genetic differences
Life expectancy differs somewhat among males and females as well as with racial background. White women live longer than white males. White males have a longer life expectancy than black males. The ratio of older men to older women declines with each advancing decade. More older women live alone than older men.
Theories of Aging
Erik Erikson (1982) described developmental tasks for each of eight stages of life. He described the tasks of the final stage, old age, as Integrity vs. Despair. By accepting the challenges of old age and finding a meaning in one's life, Erikson believed that the individual had gained integrity. On the other hand feelings of anger, bitterness and depression can lead to despair.
Other theories of aging include activity theory that encourages older people to continue their midlife lifestyle regardless of advancing age and that society should accept that older people can continue their occupation or interests rather than advocating reduction in activities.
Peck expanded on Erikson's theory by stating that the tasks of old age needed to include specific challenges. These included developing ego satisfaction from one's self rather than one's role or occupation; finding joy through psychological pleasures rather than dwelling on health or physical limitations; and, achieving satisfaction through reminiscence of life's accomplishments rather than preoccupation with limited years remaining
(Eliopoulos, 1993).
Nurses can play an important role in helping their elderly clients adjust to the physiological and psychosocial changes required so that they may develop a sense of satisfaction regarding the life they have lived and the attitudes that nurses display toward aging can have a significant impact on this adjustment. Understanding the normal physiological changes that occur with the aging process helps the health care professional view aging as a process of continued development and an opportunity to promote a sense of purpose and meaning in elderly patients' lives.
Physiological Changes and Abbreviated Assessment Procedures
Normal physical changes occur as we grow older but the type of alteration and the degree and rate of these changes are very individualized. Genetic, environmental, dietary, health, and stress are among many factors that influence how different people age physically. Common physical changes include those in the sensory organs, cardiovascular system, respiratory, hormonal adaptations, and immune system.
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