Older Adults:

Aging in Place
Chapter 24

Introduction
The future older population is expected to be
better educated than the current one.
For community health nursing, the growing
aging pop. Will present opportunities for
nurses to work with communities to
strengthen and build programs and services
that focus on supporting the aging
populations highest functional level.
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introduction
The fundamental requirements for effective
nursing of any population:
1. Know the characteristics of the population.
2. Set aside stereotypes based on
misconceptions about the population.
3. Know the health needs of the population as
a basis for nursing intervention.
4. View the population from an aggregate,
public health perspective that emphasizes
health protection, health promotion, and
disease prevention.
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Global Demographics
In 1950, were 131 million people worldwide
over age of 65
By 1995, that number has increased to 313
million
Between 2000 and 2005 it should be double
It is estimated that there could be 1.4 billion
elderly worldwide by the year 2050

Dispelling AGEISM
Ageism is a Stereotyping (labeling) older
adults and perpetuating (maintaining)
false information and negative images and
characteristics regarding older information
adults is called ageism.

Misconceptions About Older

Adults
Misconception: Most Older Adults
Cannot Live Independently
Although over 900,000 seniors live in
assisted living residences and more than 1.1
million live in some type of senior housing
community.
About 30% live alone, and others live with
friends or in the homes of nonrelatives with
room and board (food, nourishment) provided
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Misconception: Most Older

Adults
Cannot Live Independently

Most elders who are vigorous (energetic,

vital) and functioning independently live in
their own homes.
Only 6% live in institutions such as skilled
nursing facilities, extended care facilities,
supervised living facilities, and Ault Daycare
centers, and not all of these are permanent
residents.

Misconception: Most Older

Adults
Cannot Live Independently
Many are recovering from illnesses or
undergoing rehabilitation after an injury or
surgery and will return to their living
situation in the community within weeks.

Misconception: Chronologic Age

Determines Oldness
Chronologic Age :
The number of years a person has lived
The aging process is quite distinct among
older people, and they age at widely
disparate rate.
Some people at age 85 years still play golf,
drive a car, and participate in social and
community activities;
others are frail and cannot move about well.

Misconception: Chronologic Age

Determines Oldness
Exercise, nutrition, vitamins, seat belt use,
and others are thought to play a role in
healthy aging.
Physical, social, and mental health
parameters, life experiences, and genetic
traits all combine to make aging an
individualized process

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Misconception: Most Elderly Persons

Have Diminished Intellectual Capacity
or Are Senile ()
Studies show that intelligence, learning
ability, and other intellectual and cognitive
skills do not decline with age.

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Misconception: Most Elderly Persons

Have Diminished Intellectual Capacity
or Are Senile
Cognitive deficits are caused by certain risk
factors.
Nutritional status has been singled out as a
physical health variable that influences
cognitive functioning, particularly memory
performance, regardless of a persons age.

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Misconception: Most Elderly Persons

Have Diminished Intellectual Capacity
or Are Senile
Speed of reaction tends to decrease with
age, but basic intelligence does not
In fact, some abilities are viewed
collectively as crystallized intelligence.
Wisdom, judgment, vocabulary, creativity,
common sense coordination of facts and
ideas, and breadth of knowledge and
experience actually improve with age

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Misconception: Most Elderly Persons

Have Diminished Intellectual Capacity
or Are Senile
Senility
although not a legitimate medical diagnosis,
is a term widely used by the lay public to
denote deteriorating mental
faculties(abilities, talent) associated with
old age.

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Misconception: All Older People

Are
Content and Serene(quiet, still)
The picture of Grandma sitting serenely in
her rocker with her hands folded in her lap
is misleading.
for most people, advancing age brings
increasing physical, social, and financial
problems to harass and worry them.

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Misconception: Older Adults

Cannot Be
Productive or Active
More than two thirds (between 65% and
68%) of the male work force retire before
age 65 years.
In contrast, the participation rate for
women between 45 and 64 years of age is
continually rising

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Misconception: Older Adults

Cannot Be
Productive or Active
Some reasons for early retirement include
health, availability of private
pension(income) benefits, social
expectations, and long held plans to do
something else with their time
These additional years give older adults
time for travel, volunteering, and hobbies.

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Misconception: All Older Adults

Are
Resistant to Change
People at any age can learn new
information and skills. Research indicates
that older people can learn new skills and
improve old ones, including how to use a
computer.
Learning occurs best in a self-paced,
supportive environment

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Misconception: Older Adults

Cannot Be
Productive or Active
The elderly have spent a lifetime adapting
to change, with varying measures of
success
The ability to change does not depend on
age but rather on personality traits
acquired throughout life or, sometimes, on
socioeconomic difficulties.

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Misconception: Social Security Will

Not
Be There When I Retire
The Social Security fund is healthy!
Although the government has borrowed
from it, the trust fund growth has been
sufficient to keep Social Security

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Characteristics of Healthy Older

Adults
The vast majority (94%) of the elderly ,
even with chronic disease or other
disabilities, are living outside institutions
and are relatively independent

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Characteristics of Healthy Older

Adults
No one knows conclusively all of the
variables that influence healthy aging, but
it is known that a lifetime of healthy habits
and circumstances, a strong social support
system, and a positive emotional outlook

Characteristics of Healthy Older

Adults
Wellness is influenced by many factors
including:
Personality traits
Life experiences
current physical health
Current social support
Personal health behaviors; smoking,
obesity.

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Characteristics of Healthy Older

Adults
Their ability to function is a key indicator of
health and wellness and is an important
factor in understanding healthy aging.
Good health in the elderly means
maintaining the maximum possible degree
of physical, mental, and social vigor

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Elder Abuse
Is define as the intentional or unintentional
hurting, either physical or emotional, of a
person who is age sixty or over.

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HEALTH NEEDS OF OLDER

ADULTS
1

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primary prevention activities

involve those actions that keep one healthy

Nutritional needs
Exercise needs
Economic security needs
Physiological needs

Nutritional Needs
People who have maintained sound dietary
habits throughout life have little need to
change in old age. Many have not
established such habits but may wish to.

Exercise Needs
Older adults need to exercise; Research
shows that exercise can slow the loss of
bone density and increase the size and
strength of muscles, including the heart

HEALTH NEEDS OF OLDER ADULTS

Physiological needs
Psychosocial needs: All human beings
have psychosocial needs that must be met for
their lives to be rich and fulfilling.
Major issues are:
Coping With Multiple Losses
Maintaining Independence
Social Interaction, Companionship, and
Purpose
Safety Needs
Spirituality, Advance Directives, and Preparing
for Death
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Health Needs of older adult

Secondary Prevention
early detection, screening

Tertiary Prevention
deals with diseases

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Alzheimer disease
It is characterized by:
a gradual loss of memory,
Decline in ability to perform routine tasks
Disorientation(weakening, diminishing)
Difficulty in learning
Loss of language skills
Impaired judgment and ability to plan
Personality changes

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Alzheimer disease
Probable cause of AD are many
Promising leads involve the role of
Neurotransmitters
Protein
Metabolism
Environmental toxins
genes

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Alzheimer disease
Eventually AD clients lose judgment and
reasoning, and safety becomes an issue as
the disease process continues.
Victims of AD may wander away from home
and cannot tell anyone exactly where they
live, or they may forget that a stove can get
hot and burn themselves while trying to
cook.

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Arthritis
Osteoarthritis is the most common form of
arthritis.
In this type of arthritis, the number of
cartilage cells diminishes,
Cartilage becomes ulcerated and thinned,
subchondral bone is exposed, and bony
surface rub together resulting in joint
destruction.

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Arthritis
Classic symptoms include aching, stiffness,
and limited motion of the involved joint.
Discomfort increases with overuse and
during damp (wet) weather
It is the leading cause of physical disability
in older adults

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Cancer
which are characterized by the uncontrolled
growth and spread of abnormal cells,
steadily increase in incidence in aging
adults

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Depression
Depression in older adults is a major
problem. It is frequently related to the
experience of major multiple losses,
CHN can help elders prevent the
overwhelming signs and symptoms of
depression related to losses by working
with aggregates of elders in the community.

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Diabetes

Being diagnosed with DM can cause

depression or anger, and the community
health nurse must tailor educational
programs to meet individual client needs

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Cardiovascular Disease
Hypertension increases with age and affects
men more frequently than women. It
appears at an earlier age and is more
severe, with higher rates of morbidity and
mortality,

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Osteoporosis
the silent disease, is characterized by low
bone mass and deterioration of bone tissue
that leads to increased susceptibility to
fractures of hip, wrist, or vertebra

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Geriatrics
is the medical specialty that deals with the
physiology of aging and with the diagnosis
and treatment of diseases affecting the
aged.
Geriatrics focuses on abnormal conditions
and the treatment of those conditions

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Gerontology
refers to the study of all aspects of the
aging process, including economic, social,
clinical, and factors, and their effects on the
older adult and on society.
psychological Gerontology is a broad,
multidisciplinary practice, and gerontologic
nursing concentrates on promoting the
health and maximum functioning of older
adults

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Case Management and Needs

Assessment
involves assessing needs, planning and
organizing services, and monitoring
responses to care throughout the length of
the care giving process, condition, or
illness.

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Criteria for Effective Service

1- comprehension
Adequate financial support
Adult day care programs
Health care services (prevention, early
diagnosis treatment, rehabilitation)
Health education (including preparation for
retirement)
In-home services
Recreation and activity programs
Specialized transportation services
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Criteria for Effective Service

2- second criterion for a community service
delivery system is coordination.
3- A third criterion is accessibility.
should promote quality programs.

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Services for healthy older

adult
Maintaining functional independence should
be the primary goal of services for the older
population.
Health screening is another important
program for older adults
Health maintenance program may be
offered through a single agency

Living arrangement and care

options
Three types of living arrangements and care
options are available for elders:
1- seniors who remain in their own homes or
apartments need home care services
brought to them
2- seniors live with family members and go
to an adult day care center during the day
3- those that are short termrehabilitation
hospital for recovery and physical therapy
related to a hip fracture, or respite care

Day care and home care

services
The majority of older adults want to remain
in their own homes for the remainder of
their lives and be as independent and
control of their lives as possible.

Day care and home care

services
There increased emphasis on providing
needed services for elders at home. This
trend started several years ago when it
became evident that people improved more
quickly and at lower cost when they were
cared for as outpatients in their own homes.

Living arrangements based on

levels of care
Although only 6% of the elderly pop. Lives
in skilled nursing facilities, such
organizations remain the most visible type
of health services for older adults.
These facilities provide skilled nursing care
along with personal care that is considered
non skilled or custodial care(supervisory,
protective), such as bathing, dressing,
feeding, and assisting with mobility and
recreation

Living arrangements based on

levels of care
Intermediate care
facilities are less costly and still provide
health care, but the amount and types of
skilled care given are less than that
provided in skilled nursing facilities.
Frequently, older adults need assisted
living.

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Living arrangements based on

levels of care
Personal care homes (sometimes
called board and care home)

offer 24-houe basic custodial care, such as bathing,

grooming, and social support, but provide no skilled
nursing services.

Home can serve special pop. Those focusing on the

care of people with AD are physically designed with
clients safety and individual needs considered and
are staffed with paraprofessionals trained to meet
each persons needs.

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Living arrangements based on

levels of care
continuing care retirement
communities (CCRCs)
Sometimes referred to as total life centers,
allow seniors to age in place with flexible
accommodations designated to meet their
health and housing needs as these needs
change over time.

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Living arrangements based on

levels of care
Hospice and Respite Care Services
Respite care
is a service that is receiving increasing
attention. It is aimed primarily at
caregivers needs.

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