Older Folk

• Older Adulthood


  Begins at about age 65 and continues until death
• Subgroups of older adulthood

  • Young-old 65-74 years
  • Middle-old 75-84 years
  • Old-old 85-99 years
  • Elite-old 100 years or older
• Chronologic age is a very poor indicator of old age

  
• Primary prevention


  • Vaccinations
  • Pneumococcal after 65
  • Shingles after age 60
  • Td booster q 10 yrs
  • Yearly flu shot
• Secondary prevention


  • Screening for heart disease, HTN, CA
  • Polypharmacy
  • Social isolation
  • Table 33-1
  • Box 33.1
• Primary Prevention


  To prevent illness
• Secondary Prevention


  Early detection and treatment of disease
• Tertiary Prevention


  Treat symptoms and slow progress of disease/disability

  
• Healthy People 2000 set forth the goals of the U.S. Department of Health and Human Services to prevent health risks, unnecessary disease, disability, and death
• Healthy People 2030 is a strategy for improving the health of Americans by improving the health, function, and quality of life through 10-year national objectives for improving the health of all Americans
• Current knowledge about aging and the aging process is limited

  
• Biologic theory - why body ages

  • Heredity/genetics-role in longevity and health concerns heart disease, diabetes,...
  • Health conditions-refers to a way a person has taken care of the body
  • Activity level/Smoking habits-overweight, poor oxygenation, poor circulation, constipation, heart problems
• Psychosocial theory - reasons for response and interaction older adults have with society

  • Environment-philosophical, cultural, socioeconomic
• Biologic theories of aging (Box 33.4)

  • Programmed Aging
  • Genetic Factors
  • Immunologic
  • Free Radical
  • Wear and Tear

  
• Psychosocial theories of aging (Box 33.4)

  • Erickson's Developmental Stages
  • Disengagement Theory
  • Exchange Theory
  • Activity Theory
  • Continuity Theory

  
• Ageism


  Stereotyping, prejudice, and discrimination against people based on their age

  
• Ageism is similar to racism and sexism

  
• Legislation that affects older adults

  • Social Security Act of 1935
  • Older Americans Act of 1965
• The Older Americans Act of 1965 established Medicare and Medicaid and had objectives to preserve the rights and dignity of our nation's older citizens
• The Older Americans Act of 1965 provided for meals-on-wheels and other nutrition programs, in-home services, transportation, legal services, elder abuse prevention and caregivers support
• Stresses of caregivers


  • Depression, anxiety, feeling overloaded
  • Conflict between family members and elderly
  • Caring for aging parents as well as children (sandwich generation)
• Community resources for caregivers include adult day care and respite care
• Depression


  Common for older adults, can be short-term or long-term
• Significant psychosocial changes for older adults may include personal, social, and economic losses, changes in roles and retirement, loss of significant others, and physical changes like loss of independence and space
• Coping strategies to deal with grief or isolation


  • Avoid isolation, help others, adopt a pet, retain sense of humor
• Symptoms of depression


  • Fatigue, sadness, insomnia, hypochondriac
• Inactivity is the most important contributor to declining physical, mobility, and function in older adults
• Positive lifestyle for older adults


  • Get up and move
  • Proper nutrition
• Changes in the integumentary system

  • Skin dry and thin
  • Age spots
  • Loss of tone and elasticity
  • Loss of fat-wrinkles
  • Hair grays and thins
  • Nail changes-ridges increase of Ca deposits, thicker and more brittle, turn yellow
• Yellow nails can indicate a fungal infection
• Clubbing of nails indicates pulmonary or cardiac disease
• Other integumentary changes


  • Wounds heal more slowly
  • Pruritus due to reduced glandular secretions and moisture
  • Pressure ulcers from fragile skin compressed between bony prominences
  • Cartilage continues to grow until the day you die
• Basal cell carcinoma is caused by intense sun exposure typically leading to sunburn
• Other integumentary issues


  • Skin infections/inflammation
  • Dermatitis
  • Bruising/skin tears
  • HAI infections
• Most moles are benign, but sun exposure as a child and tanning beds are major risk factors for developing moles that can become cancerous
• Actinic keratosis are small, rough, raised areas on the skin that have been exposed to the sun for a long time and may develop into skin cancer
• Changes in the gastrointestinal system

  • Decreased saliva and diminished gag response
  • Lack of intrinsic factor leading to pernicious anemia
  • Abdominal muscles weaken
  • Decrease in peristalsis
  • Loss of appetite, delayed swallowing time, choking on saliva, dining alone
• One-third to one-half of health problems in older adults are related to dietary issues
• Dietary issues in older adults

  • Obesity is common, need to consume less food but ensure quality nutrition
  • Rapid weight loss may indicate illness, gradual loss is normal
  • Dehydration is common, minimum 1500 mL/day fluids needed