Gerontology

Gerontology week 3

Gerontology

Income SourcesWorkSocial SecurityFuture of social securityBased on incomesavings/investmentsPensions2007 about 1/3 receive at least some pensionAve Public: $16,629Ave Private: $7,200Landmark Legislation1965: medicare & medicaid1967: age discrimination act1972: SSI & social security indexed to inflation. 1972: Older adult nutrition act1990: ADA2006: Medicare drug act2012: Affordable care actPolitics/LobbiesAARPMajor political forceNCSC:National Council of Senior CitizensNASC:National Alliance of Senior CitizensOWL: Older Women's LeagueGRAY PANTHERSPublic awareness & demonstrationsWealthDiscuss in small groupsFrugal vs. PoorHome ownership: Positive and negativeIncome vs savingsDiscretionary vs non-discretionary spendingHousing

Independent HousingFully independent Intermittent caregiversFT or live in caregiversFamily Own house or apartmentRented house or apartmentGvt subsidized

Housing-Mostly IndependentGroup housingCan be independent or assistedSenior HousingCan be independent or assistedModified, Non-InstitutionalCommunity based residentialGroup housing Can be independent or assistedOther housingInstitutional Assisted livingSkilled nursingCombinationLife LeaseLife care

MedicareElderly and/or permanent disabilityComes with social security Pays 80% UCR feesPart AInpatient hospitalDRG'sMore MedicareB, C and D premiums are optional and taken out of SS checkPart B80% UCR Outpatient and MD officePart CHMOCapitulation and co-payPart DDrug benefit-varies wildly by planMedicarePart b outpatient and MD-80% ucr feesPart c-HMO Capitulation usually with feesPart d-drug benefits

??????How many of you have ever been uninsured?Without a 2ndary insurance you will owe 20% after medicareHow much does an office visit cost?ER visit for chest pain?

Supplemental InsurancePrivate medicare supplement insuranceMedicaidMedi-cal in CAAsset and income basedIf you own a house and receive benefits after the age of 55-the state takes your house when you die

Impact on FamilySocietal changesDemographic changesSmaller familiesSandwich generationre-locationCultural differencesExpectations re responsibility for careChanges with acculturationImpact on FamilySpending time with childrenwisdomCaregiver stressorsPhysicalEmotionalfinancialAbuse and NeglectSelf NeglectFamily or caregiversPhysical abuse [includes sexual]Emotional abuseFinancial abuseNeglectAbandonment

From the Victim....Responses to abuse from the victim?SupportSupport groupsRespite careReferralsAlzheimer's [etc] association[s]Council on agingSenior's resource yellow pagesSocial workersAdult day health centers/senior centersTheories on aging

BiologicalProgrammedBiological clockGene theoryHarmful genes activate over timeError theoryProgressive decline in accuracy of cell divisionBiologicalFree RadicalByproducts of metabolism create damaging free radicalsWear and tearImmunologicalDecreased immune function causes diseaseNeuro-endocrineHormonal changes trigger aging-like puberty signals sexual maturityPsychosocial

PsychosocialDisengagementSystematically separated from societyDepression and withdrawalUsed to justify agismmutually beneficial [sic]PsychosocialActivity theoryMental and physical activity needed to thriveLife coursePersonality and personal adjustment through lifeEricksonMidlife crisisNursing implications

THEORY OVERVIEWPhysical: biology causes some limitations on life and life expectancy. Behavior and life choices also count. Nurses can help by promoting good health practicesPsychosocial: help explain the variety of behaviors in the aging population. Understanding these theories can help nurses recognize problems and provide nursing interventions that will help people age more successfully Physiological changes [ch3]Changes dont occur without warning.Early changes [ gestation> neonatal >childhood > puberty] dramaticAdult-gradually over a continuum-subtleLate teens through 30s-Body fully mature, fully & optimally functional Changes less dramatic, more likely to be ignored

Changes continuedThrough their 50s & 60s changes are more apparentBy their 70s & 80s changes are no longer deniablePredictableOnset with wide variation

Changes continuedDiseases more prevalent in the aging populationCardio Vascular: Hypertension; Heart disease; strokeDiabetesCancerDiseases of ears and eyesaccidentsCauses of deathHeart diseaseCancerCardiovascular disease [primarily stroke]PneumoniaOften preceded by falls/surgery [immobility]BacterialviralCOPD

skinDecreased melanocyte activityMore paleClusters of melancytes= age spots liver spotsSeborrheic keratosis=raised wartlike maculesCutaneous papilloma=small skin tags-often on the neckMelanocyte

Seborrheic Keratosis

Cutaneous Papilloma

SkinwrinklesDecreased elastin fibersThinner dermal layerContributing factorsIncreased exposure to sunlightdry skinmenopauseSkin and AgingThinner skinDecreased subcutaneous fat increases risk for pressure areasDecreased circulationDoesnt heal as well/quicklyFragile blood vesselsSlower healing

Staging Pressure Ulcers

Staging Pressure Ulcers

hairPigment loss=gray hairDistribution changesThinningFiner scalp hairDecreased presence @ axilla, pubis and legsHair @ eyebrows, nose and ears-longer, thicker and more coarseIncreased facial hair in women

nailsGrow more slowlyThickenedMore brittleRidges and linesToenails noticeably thickenedspecial tools to cut

etcSweat gland production decreases< ability to regulate temperatureOil production decreasesWalls of capillaries thinner & more fragilered, purple or brown areas on legs & armsTotal body fluid decreasesincreased risk for dehydration Decreased subcutaneous tissuebony facial appearancesagging tissueIncreased risk for hypothermiaCommon skin disorders-CancersCheck for changes in molesSizeShapeBoardersItch/bleedcolorBasal cell carcinomaBy age 70-20% non hispanic men have developed a non-melanoma cancerMelanoma-more deadlyIncreased risk in men

rosacea

rosacea

Seborrheic dermatitis

Seborrheic dermatitis

Seborrheic dermatitis