Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Chapter 13 Late Adulthood Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Objectives Discuss the major goals of Healthy People 2020 as related to late adulthood. Identify common health concerns of late adulthood. Describe challenges and developmental tasks of late adulthood. Discuss lifestyle changes that may be necessary for late adulthood. Discuss the relationship of physical activity to the aging process and cognition. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Objectives (cont.) Define elder abuse and describe one means by which it can be prevented. Discuss the ways menopause may affect women in the late-adulthood phase of the life cycle. List the learning needs of later adulthood. Select appropriate teaching techniques to promote effective learning and coping for late adulthood. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Key Terms assistive devices autonomy competence disengagement elder abuse late adulthood polypharmacy relatedness Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Definition Encompassing the ages between 65 and 74 years Many people in the late-adulthood phase of the life cycle postpone retirement and remain active in the workforce Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Health Concerns Development of osteoporosis Risks for falls and fractures Poor awareness of healthy behavior options Increased risk of influenza and pneumonia Development of cataracts Increased loss of hearing Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Statistics In 2009 over 39.6 million Americans were 65 years or older By 2050, it is estimated that there will be over 86 million 65 years or older See Table 13-1. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Income Social security, pensions, personal assets, and earnings Covered by Medicare and private insurance Health Care Affordability Act of 2010 Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Education Level As of 2009, approximately 77% of people over 65 years of age were high school graduates and 15% of those over 75 were college graduates Understanding these statistics enables the health-care worker to plan for the needs and limitations of the elderly population they serve in the twenty-first century Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Challenges And Problems Access to health care Reduced income Changes in living arrangements Caregiver assistance Altered nutritional needs Assistive devices Preventing falls Polypharmacy Elder or dependent abuse Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Critical Thinking Question 1 When older adults have no health insurance, what are some options available to provide preventive health care? Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Critical Thinking Question 2 Changes in living arrangements for older adults may contribute to the “family sandwich” feeling in their children. What interventions could be devised to decrease stress in both children and parents? Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Critical Thinking Question 3 It is recommended that nurses or health care workers assess the living facilities of older adults for safety. Since a significant number of vulnerable seniors are never identified by a health care system, what could communities or health agencies do to identify more of this population? Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Critical Thinking Question 4 When assessing for elder abuse, the nurse must understand the legal limits of practice within his or her state. What are the legal mandates in your state for identifying, intervening, and reporting elder abuse? Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Psychosocial Development Many developmental tasks and related challenges Those with healthy attitudes and coping skills are able to find fulfillment and meaning in their lives Weight gain, dental problems, diminished eyesight and hearing, decreased mobility, and changes in body image are some issues that create difficulty See Box 13-1. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Psychosocial Issues Autonomy Competence Relatedness See Figure 13-1. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Grandparenting Enhances self-image, increases activity level, creates feelings of self-worth and usefulness, and contributes to the meaning and quality of life When grandparents become ill or disabled the roles can reverse and the older adult needs more assistance Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Critical Thinking Question 5 Many middle-aged and older adults are being placed in the role of “parent” to their grandchildren. What community resources are, or should be, available to provide assistance to both grandparent and child? Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Postmenopause Important developmental task of the older woman Defined as the absence of menstruation for a period of at least 1 year A natural occurrence in the life cycle Hormone replacement therapy (HRT) and Complementary and alternative therapy (CAM) Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Lifestyle Changes Hotflashes Vaginal dryness Mood swings Urinary leakage Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Driving Safety Undetected impairments Occupational and physical therapy License may be taken away Alternative transportation Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Critical Thinking Question 6 With increased longevity, more older adults are continuing to retain their driver’s licenses. Given the potential for cognitive and physical decline during these years, do think there should be stricter testing for the older adult for license renewal? A mandatory age for surrendering the license? Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Health Screenings Dental and eye checkups Physical evaluation that includes weight, blood pressure, thyroid, and blood glucose and lipid levels Assess for substance abuse, overmedication, sexual dysfunction, urinary incontinence Papanicolaou (Pap) smear and mammography Bone mass Cardiovascular Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Sexuality Most common cause of sexual dissatisfaction is the lack of a partner Men may develop erectile dysfunction Painful intercourse (dyspareunia) for women Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Memory Loss Normal memory loss can be associated with aging Temporary memory loss can be caused by depression or anxiety Preclinical manifestations of Alzheimer's disease See Boxes 13-2 and 13-3 and Table 13-2. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Emotional Health Emotions and emotional control develop during the growth and development process Disengagement Continues emotional learning and emotional competencies Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Depression Should not be automatically expected to appear in the older adult Late onset depression Side effects of medication may mimic depression Depression can trigger physical illness Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Clinical Disease Good health in older people is often defined as the absence of disease or disability Normal body changes resulting from aging, such as ovarian failure or menopause, place a risk on the cardiovascular, bone, and metabolic systems See Lifespan Consideration Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Physical Activity Exercise can significantly slow the aging process Resting metabolic rate decreases with age Muscle strengthening exercises Regular balance exercises May have a protective effect on cognitive function Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Teaching Techniques Learner must be motivated to learn Teaching must be relevant to the learner and appropriate to the developmental stage and abilities of the learner Learning is enhanced if mutual respect exists between teacher and learner Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.