GERIA CHAPTER 12

• The longer a person occupies a particular role, the more familiar and, consequently, more comfortable the person becomes with it. The more comfortable people are in their roles and relationships, the harder it is to adjust to changes.
• Older adults must adjust to many predictable role and relationship changes associated with aging, including retirement, altered relationships with adult children, changes in housing, loss of valued possessions, loss of friends resulting from relocation or death, loss of a spouse to death, loss of health, and loss of independence.
• Grief - is a strong emotion. It is a combination of sorrow, loss, and confusion that comes when someone or something of value is lost.
• Grief affects--

  (1)thoughts,

  (2)emotions,

  (3)behavior and creates a wide range of (4)physical sensations.
• S/S: PHYSICAL ASPECT OF GRIEF

  ❑Persistent fatigue ❑Tightness in chest ❑Muscle weakness ❑Shortness of breath ❑Susceptibility to minor illnesses ❑Hypersensitivity to noise ❑Dry mouth ❑Headaches ❑Grinding teeth ❑Tension ❑Nausea ❑Hyperacidity ❑Dizziness
• S/S: EMOTIONAL ASPECT OF GRIEF

  ❑Anger ❑Anxiety ❑Ambivalence ❑Depression ❑Fear ❑Irritability ❑Loneliness ❑Numbness ❑Panic ❑Sadness ❑Guilt ❑Shock ❑Helplessness ❑Apathy
• S/S: COGNITIVE OF GRIEF

  ❑Confusion ❑Forgetfulness ❑Disorientation ❑Disbelief ❑Preoccupation ❑Decreased attention❑Inability to concentrate
• S/S: BEHAVIORAL: OF GRIEF

  ❑Absentmindedness ❑Crying ❑Decreased motivation ❑Restlessness ❑Social isolation ❑Inconsistency ❑Irritability ❑Diminished productivity ❑Sleep disturbances ❑Appetite disturbances
• Phases of Grieving:

  Shock and Numbness (First 2 Weeks) Feelings: Disbelief, denial, anger, guilt

  Searching and Yearning (2 Weeks to 4 Months) Feelings: Despair, apathy, depression, anger, guilt, hopelessness, self-doubt

  Disorientation (4 to 7 Months) Feelings: Depression, guilt, disorganization

  Reorganization (Up to 18 to 24 Months) Feelings: Sense of release, decreased sense of obsession with loss, renewed hope and optimism
• DISORIENTATION (4 to 7 months)

  Behaviors: Resistance to seeking help or reaching out to others, trying to live as if nothing happened, restlessness, imitability

  REORGANIZATION (up to 18 to 24 months)

  Behaviors: Renewed energy, reorganization of eating and sleeping habits, improved judgment, renewed interest in activities and goals for the future
• SHOCK AND NUMBNESS (first 2 weeks)

  Behaviors: Crying, searching, sighing, loss of appetite, sleep disturbance, limited concentration, muscle weakness, inability to make decisions, emotional outbursts

  SEARCHING AND YEARNING (2 weeks to 4 months)

  Behaviors: Restlessness, poor memory, impatience, lack of concentration, crying, social isolation, loss of energy
• SHOCK AND NUMBNESS (first 2 weeks)

  Behaviors: Crying, searching, sighing, loss of appetite, sleep disturbance, limited concentration, muscle weakness, inability to make decisions, emotional outbursts

  SEARCHING AND YEARNING (2 weeks to 4 months)

  Behaviors: Restlessness, poor memory, impatience, lack of concentration, crying, social isolation, loss of energy
• What simple actions promote TRUST?

  ✓Spend time with the person. ✓Actively listen to what the person says. ✓Address the person by name. ✓Smile. ✓Use a warm, friendly voice. ✓Make appropriate eye contact. ✓Respond honestly to questions. ✓Provide consistency of care. ✓Respect confidentiality. ✓Follow through on commitments
• NURSING DIAGNOSIS: Complicated grieving

  Related to Changes in Roles and Relationships in Older Adults

  I. Recent loss of a spouse, child, close friend, significant other, or cherished pet

  II. Recent loss of lifelong or valuable roles

  III. Recent major adjustment in his or her living situation Inability to perform familiar roles owing to loss of functional abilities
• NURSING RESPONSIBILITIES

  ▪Establish a trusting relationship to encourage verbalization of feelings regarding the change or loss.

  ▪Assess the source and acknowledge the reality of the grief.

  ▪Encourage older adults to participate in activities of daily living.

  ▪Identify sources of support. Although nurses can provide some support to grieving older persons, many others can also help.
• Social isolation, the sense of being alone, is a common problem among older adults. It is estimated that between 10% and 43% of older adults in the community experience social isolation
• Most social isolation is unintentional. Separation resulting from death is a common and unavoidable part of aging. Many older people simply outlive their families and friends. These people are likely to become isolated unless they establish new social outlets.
• Decreased physical mobility and limited finances can

  result in social isolation.
• Physical changes can restrict an older person’s ability to move about and make social contacts
• Financial limitations can lead to separation from others because of the lack of adequate money to buy appropriate clothing or transportation to social activities.
• NURSING DIAGNOSIS: Impaired social interaction

  ❑Promote social contact and interaction. Telephone calls and mail can be used to maintain contact with family and friends.

  ❑Spend one-on-one time with the isolated person. Those who cannot or will not participate in social interaction need extra attention from the nursing staff.

  ❑Initiate referrals.Often, the social worker, chaplain, or activities department can help socially isolated older adults identify acceptable social activities
• Nursing Diagnosis: Interrupted family processes

  ❑Encourage all family members to verbalize their feelings.

  ❑Assist family members in identifying personal and family strengths. ❑Encourage family members to visit regularly.

  ❑Encourage the family members to assist in older adult care.

  ❑Assist families in identifying factors that are interfering with normal interactions.

  ❑Explore community resources