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Care of the Chronically Ill
and the Older PersonsELECTIVE 2
BSN 14B
June 22, 2011
Madeline N. Gerzon
Level IV Clinical Instructor
Davao Doctors College
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Recap..
Myths of aging
Theories of Aging
Psychosocial
Sociological
Biological
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One aspect that is
common to all forms ofaging is Change.
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Socio-economic Aspect of
Aging
Industrialization
UrbanizationLack of facilities for older pop
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Socio-economic Aspect of
Aging
Industrialization
Speed of productionEarly unemployment
Longer pension years (critical economic
problem)
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Socio-economic Aspect of
Aging
Urbanization
Shrinking to two-generation familiesMoving to cities
Living arrangement issues
Personality differences
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Socio-economic Aspect of
Aging
Lack of facilities for older pop
More facilities for the younger agegroup
Few opportunities for health facilities,
learning and practice activities.
Less facilities to retrain for new jobs
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The Aging Family
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Post-Parental Period
The post-parental - the middle years ofadulthood, after the departure of children,but before retirement
The empty nest and the launching stage
For married parents this is characterized bya return to a two-person, married-couplehousehold
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Marital Status in the
Middle YearsA majority of 45 to 64 years old are
married with a spouse present.
The percentages of people who arenever married, divorced, and widowedare low relative to other categories.
The post-parental period lasts longerthan any other in the marital life
course.
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Co-Residence in the
Middle Years
Co-Residence refers to adult children
living in the same household as their
parents.
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Co-Residence in the
Middle Years
These factors contribute to earlier
home-leaving:
Family instability
Crowding
Non-traditional family structure
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Co-Residence in the
Middle Years 4/5 of adults leave home by age twenty-
three, but nearly half return home.
Boomerang kids leave home and thenreturn, due to:
Divorce
Unwed motherhood
Job loss
Economic hardship
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Grandparent Status
Increased life
expectancy has made
grandparenthood a near
universal experience in
the U.S.
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Grandparent Status
Grandparenthood has become a
transition of the middle years because:
Families are smaller;
Children are spaced more closely; and
Women are having their last child atyounger ages.
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Grandparent Status
Role expectations are not always clear.
Roles vary by social class and gender.
Grandmothers are likely to provide regularcare.
Grandfather roles tend to be moreaffectionate than functional.
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Grandparent Status
Step-grandparent is a new role created
by the frequency of divorce and
remarriage in the U.S.
It is a role-less role since there are few
role expectations associated with it.
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Grandparent Status
Grandparent visitation rights are a
new phenomenon.
Every state allows grandparents to
petition for visitation.
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Growth of the
Elderly Population Early marriage and longer life have
increased:
The length of marriageThe number of living generations
The size of the kin network
The number of older persons has risen as
average life expectancy has increased.
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Marital Status in
the Later Years As persons age, the percentage of widows
and widowers increases.
More women are widowed than men. For the elderly, marital and family
relationships are primary sources of:
Social involvement;
Companionship;
Fulfillment; and
Happiness.
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Intergenerational
Relationships
The sandwich generation are persons
in the middle years who manage the
demands of caring for their own
children and aging parents
Intergenerational family relations areimportant, strong and resilient in the
U.S.
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Common Problems of
Older Persons
Health and care
Childrens problems
Income and standard of living
Abuse and neglect
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Health and Health Care
Older people prefer care by familymembers
Informal care by family members is themost common type
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Health and Health Care
Daughters are more likely than sons to
provide:Personal care
Assistance with mobility and daily living
Emotional support
Companionship
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Childrens Problems
The elderly are affected by their
childrens:Marital problems
Mental problems
Physical problems
Stress-related problems
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Income and
Standard of Living The percentage of elderly persons below
the poverty line is 1/3 what it was in 1970.
The economic status of the elderly hasimproved greatly, particularly whencompared to children.
Government programs and services for theelderly have expanded dramatically.
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Socialization in
Later LifeThe re-socialization needs of the
elderly are often ignored.
The family system fulfills many of theneeds and services of elder members.
The effectiveness of the family inmeeting cultural goals depends on thestructural opportunities available.
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Retirement
Retirement involves re-socializingpersons for new roles and lifestyles.
Decreases are common in:Health;
Income;
Status; and
Feelings of self-worth.
Being married acts as a buffer to these
problems.
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Dying and Death
For adult children, the death of aparent adversely affects:
Marital relationships
Physical health
Psychological well-being
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Dying and Death
The family and kin network are majorsources of decision making and social
support during the dying process.
Hospice offers an alternative tohospital care for dying people.
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Widows and Widowers
Widowhood is:
Disproportionately represented
among people over 65.
Associated with loneliness and social
isolation.
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Widows and Widowers
Losing a partner is more
psychologically detrimental formen.
Finances are the biggest challenge
for women.
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Widows and
Widowers
Adjustment to Widowhood is
Facilitated by:
Personal Autonomy
Close Friendships
A
Realistic Philosophy of LifeEconomic Security
Meaningful Personal Interests
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OLDER PERSONS AND
IMPLICATION TO CARETHE GRAYING POP
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Graying Pop
Growing numbers ofAmericans are
interested in wellness programs to
stay youthful, active, and healthy
More than one-third of all surgicalpatients are over 65 years of age
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Graying Pop
The prevalence of mental health
problems increases with age
Chronic diseases occur at a rate
four times greater in old age than
at other ages
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Graying Pop
Approx 40% of all elders will spend
some time in a nursing home during
their lives
Most beds in acute medical hospitals
are filled by elderly patientsOlder adults are the most significant
users of home health services.
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PHYSICALPHYSIOLOGICAL
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Normal Aging Changes
Integumentary
Thinner
Wrinkles
Drier
NervousSlowed reactions
Impaired senses
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Normal Aging Changes
Sensory
Vision (Night-blindness)
Hearing
Touch
Duller
Pain threshhold higher
Taste
Smell
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Normal Aging Changes
Respiratory
Decreased activity tolerance
More vulnerable to infection
Reproductive
Decreased hormone production
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Normal Aging Changes
Musculoskeletal
Osteoporosis
Pathologic fractures
Decreased muscle strength
CardiovascularArteries loss elasticity
Decreased response to stress
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Normal Aging Changes
GI
Decreased motility
Constipation
Urinary
Decreased nephron activityMore frequent voiding
Retention
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Normal Aging Changes
Endocrine
Hormones changesImmune
Decreased function
More susceptible to infection &
disease
Atypical S&S of infection
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Mental Health Disorders
Depression
Most common
Can be a reaction
Aggressive behavior
Abnormal anger, rage, or hostility
Causes
Rehabilitation
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