Health and Wellness in an Aging Society Chapter 1 Copyright © 2016 by Elsevier, Inc. All rights reserved. Health and Wellness in an Aging Society

Health Perspectives In medicine, absence of physical and psychiatric illness Measured in terms of accepted “norms” Function independently versus debility Population health status considerations are based on life expectancy, morbidity, and mortality Copyright © 2016 by Elsevier, Inc. All rights reserved.

Considerations Does defining health based on illness reflect: quality of life? functional limitations? contributions to community/society? movement toward self-actualization? Health is more than the absence of disease Copyright © 2016 by Elsevier, Inc. All rights reserved.

Healthy People 2020: Older Adults New areas focus on quality of life and wellness of the older adult Social well-being is recognized as an important aspect of mental health A wellness model based on a holistic paradigm is changing the perceptions of health and health care Copyright © 2016 by Elsevier, Inc. All rights reserved.

Gerontological Nurses Can shape the world of persons where they can thrive and grow old, not merely survive Wellness-based models whether acute or chronic: Maximize strengths Minimize limitations Facilitate adaptation Encourage growth Copyright © 2016 by Elsevier, Inc. All rights reserved.

Health Perspectives The Years Ahead While countries vary, persons over the age of 60 worldwide will double in 2050 The majority will be women Most of the elders worldwide will be poor and in need of support How can global conditions be changed to maximize and enrich the lives of elders across the world? Copyright © 2016 by Elsevier, Inc. All rights reserved.

Growth in the Number of Persons atleast 60 across the Globe Copyright © 2016 by Elsevier, Inc. All rights reserved.

Distribution of World Population Aged 60 and Over by Development Region: 1950-2050 Copyright © 2016 by Elsevier, Inc. All rights reserved.

Health Perspectives Aging  The term geriatrics was coined to recognize that medical care of persons in later life differed from other groups in the population  The first medical textbook about the “old” was published in 1914 with the focus that it must be reversed, eradicated, or delayed  Gerontology considers the nexus of time and human development Copyright © 2016 by Elsevier, Inc. All rights reserved.

Health Perspectives (Cont.) How Old Is Old? Each culture is different and a variety of terms are used to refer to the aging person: elder, senior citizen, granny, older adult, etc. From a functional perspective, it’s when the person is no longer able to perform usual activities Biological aging: outward expression of individual genetic makeup Chronological aging: varies around the world, but generally around 50-65 years As the average life expectancy rises this may change Copyright © 2016 by Elsevier, Inc. All rights reserved.

Life Expectancy at Birth, by Race and Sex: United States, 2010 Copyright © 2016 by Elsevier, Inc. All rights reserved.

Health Perspectives Super-Centenarians Those that are still alive at 110 years of age There are 200-300 worldwide, with 60 of those in the United States Survived outbreaks and pandemic diseases It is theorized that the reason these individuals have survived to this point is “rare and unpredictable” Copyright © 2016 by Elsevier, Inc. All rights reserved.

Health Perspectives (Cont.) Centenarians Those between the ages of 100 and 109 years Many people who would be of that age today died in WWII, were part of the Great Depression, and lived during the smallpox epidemic and other childhood diseases This age group is rising rapidly New research is identifying that genetic markers for disease are not activated until later in life for this group Copyright © 2016 by Elsevier, Inc. All rights reserved.

Number of Those Persons Over 100 per 10,000 Persons in the Population Copyright © 2016 by Elsevier, Inc. All rights reserved.

Health Perspectives Those In-Between Those between the centenarians and the baby boomers, born between 1915 and 1945 Includes Holocaust survivors Came of age during the civil rights movement, assassination of President Kennedy, the “Cold War,” and part of the Depression See Table 1-1 for communicable diseases during this time This group is growing at an exponential rate, with the greatest increase in Hispanics Copyright © 2016 by Elsevier, Inc. All rights reserved.

Health Perspectives (Cont.) The “Baby Boomers”  Youngest of the older generation, born between 1946 and 1964  The greatest number were born in 1946, when WWII ended  Great variation in life experiences among this group  Better access to medication and treatment  Immunizations became a standard of care from 1960 on, when the eldest boomer was 13 years old Copyright © 2016 by Elsevier, Inc. All rights reserved.

Ten Leading Causes of Noncommunicable Death Worldwide Copyright © 2016 by Elsevier, Inc. All rights reserved.

Wellness-Based Model Encompasses the idea that health is composed of multiple dimensions Wellness is expressed in the following dimensions of human experience within the context of culture: Functional Environmental Intellectual Psychological Spiritual Social Biological Copyright © 2016 by Elsevier, Inc. All rights reserved.

The Flower Model Copyright © 2016 by Elsevier, Inc. All rights reserved.

Wellness-Based Model for Healthy Aging Health is viewed on a continuum Healthy aging must be viewed from the prenatal period to death Epigenetics is leading to a new understanding of the impact of environment factors Health promoting strategies are important in achieving and maintaining the highest level of wellness on a continuum Preventative services are highly underutilized Copyright © 2016 by Elsevier, Inc. All rights reserved.

Disease Prevention and Health Promotion for Older Adults The National Prevention Council’s six priorities: Tobacco-free living Preventing drug abuse and excessive alcohol use Healthy eating Injury and violence-free living Reproductive and sexual health Mental and emotional well-being Need to empower people, create healthy and safe community environments, provide clinical and community preventative services, eliminate health disparities Copyright © 2016 by Elsevier, Inc. All rights reserved.

Copyright © 2016 by Elsevier, Inc. All rights reserved.

Prevention Primary Strategies that can and are used to prevent illness before it occurs Secondary Early detection of the disease or health problem that has already developed Tertiary Addresses the needs of persons who have their day-to-day wellness challenged, by slowing disease or limiting complications Copyright © 2016 by Elsevier, Inc. All rights reserved.

Promoting Healthy Aging: Implications for Gerontological Nursing Utilize a wellness model that includes biological, social, functional, environmental, psychological, and spiritual considerations across the continuum of wellness and care settings Objectives and interventions will vary for healthy older adults and those who are frail By listening closely nurses can hear what is most important to promote personal wellness Copyright © 2016 by Elsevier, Inc. All rights reserved.

Question 1 60 and older. 65 and older. 75 and older. 85 and older. The greatest increase in aging by group percentage is occurring among those: 60 and older. 65 and older. 75 and older. 85 and older. Copyright © 2016 by Elsevier, Inc. All rights reserved. ANS: D

Question 2 Minimize limitations Facilitate adaptation Gerontological nurses can shape the world of persons where they can thrive and grow old, not merely survive by utilizing which of the following wellness-based strategies? Minimize limitations Facilitate adaptation Maximize strengths All of the above Copyright © 2016 by Elsevier, Inc. All rights reserved. ANS: D