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

es 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 doesnt 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 childs relationship with or towards their parents

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. May have longer life-time employment. Have greater financial security for their age. Number of single older adults have increased because being single is more common in younger years. Usually develop supportive systems with their siblings, friends, and neighbors Older adults have strong independence, & may not feel lonely or isolated if have activities, friends, work, etc.

Grandparents Grandparenting is experienced by most older adults. Grandparents receive emotional satisfaction. Older adults are increasingly caring for their grandchildren. Geographical distance is not affecting these relationships as it once did (because of the Internet). More grandparents live closer to their grandchildren and are more involved in the grandchildrens lives. 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, family tradition, and accumulated wisdom to the grandchildren

Siblings

GERONTOLOGY EXAM #5 NOTES As a person ages, he or she becomes more involved with siblings. Siblings become increasingly close in supportive relationships. Among single or widowed older adults living alone The strongest sibling bond is between sisters. Loss of a sibling results in grieving but is also a rehearsal for ones own death. Limited time with family get togethers, 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 ones own demise reminds you of how difficult it is, makes you more aware of your own life and how youre living

Relationships with Kin Kin includes aunts, uncles, cousins, nieces, and nephews. Maternal kin may be more emotionally close. Fictive kin are nonblood relationships but are important aspects of the family Fictive Kin can also be false family members- friends that are like a family member to you Surrogate family- family that has taken on roles of family members Fictive kin- nursing assistants, nurses, case managers, care givers, 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, termination, or job disability Grandparenthood Widowhood Becoming a caregiver

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 ones 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 persons 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

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- list of questions to address when deciding to retire or whether or not to continue to work (what do I want to do, who needs me, what am I best able to do, whats the meaning of my life, what should my life contribute, 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 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 ones 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 theyre 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 dont 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

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- 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.S. 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, there is less family members to provide for their care Sometimes children are sicker than their parents, and need a different caregiver ***Unlike children, 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 As their dementia progresses, the patient may cease to recognize a spouse or child- 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, financial burdens, time burdens

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 childs needs Financial resources Health of caregiver How child will be cared for after aging parents death

GERONTOLOGY EXAM #5 NOTES Older Adults as Caregiverscontd 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. Nurses perform a family assessment that identifies those who are family members and the functions of each member and includes a family medical history. Caregiver assessment includes stressors and benefits. Nurses perform a risk assessment of caregiver stress. Nurses use respite care. (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, etc.

Intimacy and Sexuality of Older Adults Commitment Affective intimacy

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, need to have relationships with family members, the need for formal caregivers, 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, gay, bisexual, and transgender. Biological, social, pyscologoical

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 Alzheimers 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