Nursing

1. Late (Old) Adulthood
Dr. Nadia K. Alaswad

2. Objectives
Construct Construct the major concerns of health promotion for late
adulthood
Categorize Categorize needs of late adulthood according to Maslow’s
Hierarchy
Classify Classify psychological & mental disorders in late adulthood
Point out Point out cognitive changes in late adulthood
Discuss Discuss psychosocial and social development in late adulthood
Illustrate Illustrate leading causes of death among late adulthood
Discuss Discuss between body systems changes in late adulthood
Define Define late adulthood

3. Outlines
Definition of late adulthood
Body systems changes in late adulthood
Leading causes of death among late adulthood
Psychosocial development in late adulthood
Social development in late adulthood
Cognitive changes in late adulthood
Psychological & mental disorders in late adulthood
Needs of late adulthood according to Maslow’s Hierarchy
Health promotion for late adulthood

4. Definition of late adulthood
The period that begins in the 60s and lasts until
death
• Late adulthood is the time of:
 –Adjusting to retirement
 –Decreasing strength and health
 –New social roles
 –Reviewing one’s life

5. Body systems changes in late
adulthood

6. COMMON CHANGES SYSTEM
Decreased accommodation to near/far vision (presbyopia),
difficulty adjusting to changes from light to dark, yellowing
of the lens, altered color perception
Loss of acuity for high-frequency tones (presbycusis),
thickening of tympanic membrane, sclerosis of inner ear,
buildup of earwax.
Often diminished; often fewer taste buds
Often diminished.
Decreased skin receptors
Decreased awareness of body positioning in space
Sensory
Eyes
Ears
Taste
Smell
Touch

7. COMMON CHANGES SYSTEM
Decreased cough reflex; decreased cilia; increased
anterior-posterior chest diameter; increased chest
wall rigidity; fewer alveoli, airway resistance;
increased risk of respiratory infections
Respiratory
Thickening of blood vessel walls; narrowing of vessel
lumen; loss of vessel elasticity; lower cardiac output;
decreased number of heart muscle fibers; decreased
elasticity and calcification of heart valves; decreased
baroreceptor sensitivity; decreased efficiency of
venous valves; increased pulmonary vascular
tension; increased systolic blood pressure;
decreased peripheral circulation.
Cardiovascular

8. COMMON CHANGES SYSTEM
Degeneration of nerve cells, decrease in
neurotransmitters, decrease in rate of conduction of
impulses.
Neurological
Loss of skin elasticity with fat loss in extremities,
pigmentation changes, glandular atrophy (oil,
moisture, sweat glands), thinning hair, with hair
turning gray-white (facial hair: decreased in men,
increased in women), slower nail growth, atrophy of
epidermal arterioles.
Integumentary

9. COMMON CHANGES System
Periodontal disease; decrease in saliva, gastric
secretions, and pancreatic enzymes; smooth muscle
changes with decreased esophageal peristalsis and
small intestinal motility; gastric atrophy, loss of
smooth muscle in the stomach, hemorrhoids, anal
fissures; rectal prolapse and impaired rectal
sensation.
Gastrointestinal
Decreased muscle mass and strength,
decalcification of bones, degenerative joint
changes, dehydration of intervertebral disks
Musculoskeletal

10. COMMON CHANGES SYSTEM
Fewer nephrons, 50% decrease in renal blood flow by
age 80, decreased bladder capacity, increase urine
residual
Male—enlargement of prostate
Female—reduced sphincter tone
Male—sperm count diminishes, smaller testes,
erections less firm and slow to develop
Female—decreased estrogen production,
degeneration of ovaries, atrophy of vagina, uterus,
breasts
Genitourinary
Reproductive

11. COMMON CHANGES SYSTEM
General—alterations in hormone production with
decreased ability to respond to stress
Thyroid—decreased secretions
Cortisol, glucocorticoids—increased anti-inflammatory
hormone
Pancreas—increased fibrosis, decreased secretion of
enzymes and hormones
Endocrine

12. Leading causes of death among late
adulthood
Heart diseases
Cancer
Chronic lower respiratory diseases
Stroke
Alzheimer's diseases
Influenza and pneumonia
 Renal diseases
 Accidents
Blood poisoning

13. Psychosocial development in late
adulthood
• Erikson called eighth or final stage of life is age of wisdom
• Ego Integrity The feeling that one’s life has been meaningful.
• Despair Feelings of regrets or bitterness about past mistakes, missed
opportunities, or bad decisions; a sense of disappointment in life
• Life review - involves looking back on one’s life experiences and evaluating
them and accepting life cycles
Integrity versus despair
individuals engage in a life review that is either positive (integrity) or negative
(despair)

14. Social development
in late adulthood
• Friendships have been found to be more
important than family relationships in
predicting mental health.
• Unmarried older adults with a strong
network of friends fared better physically
and psychologically than other unmarried
older adults.
• Positive Psychology and Aging:
The more active and involved older adults
are, the more satisfied they are and the
more likely they are to stay healthy

15. Social Development
(cont.,)
Some mature adults experience an
increased spirituality.
Behaviors that negatively affect health,
such as refusing medications or
ignoring a sound medical advice
Religion may promote better health:
–Psychologically: supporting better coping
skills
–Help them face impending death
–Find and maintain sense of meaning
fulness in life
–Accept inevitable losses of old age

16. Cognitive
changes in late
adulthood
• A common misconception about
aging is that cognitive impairments
are widespread among older adults.
• Symptoms of cognitive impairment
such as
 disorientation, loss of language
skills, loss of the ability to calculate,
and poor judgment are not normal
aging changes and require further
assess late adulthood for
underlying causes.

17. Psychological & Mental Disorders in late adulthood
Depression
is one of the more common problems characterized by
intense sadness and hopelessness
.
May be a result of cumulative losses in life
.
Some psychological problems such as anxiety may be
caused by inappropriate drug doses
Women show more depression at 50 and 60 years of
age, but depression in men increases from 60 to 80

18. Psychological & Mental Disorders (cont.,)
Delirium
• Acute confessional state, is potentially
a reversible cognitive impairment an
acutely disturbed state of mind that
occurs in fever, intoxication, and other
disorders and is characterized by
restlessness, illusions, and
incoherence of thought and speech.

19. Psychological
& Mental
Disorders
(cont.,)
Delirium
(cont.,)
Physiological causes include
electrolyte imbalance; cerebral
anoxia; hypoglycemia; medication
effects; tumors; subdural
hematomas; and cerebrovascular
infection, infarction, or hemorrhage
Delirium in older adults sometimes
accompanies systemic infections
and is often the presenting
symptom for pneumonia or urinary
tract infection
.

20. Psychological & Mental Disorders (cont.,)
Parkinson Disease
It is a chronic, progressive
disease characterized by
muscle tremors, slowing of
movement, and facial
paralysis
Several treatments are
available
.

21. Psychological & Mental Disorders (cont.,)
Dementia
• A progressive loss of intellectual functioning
caused by repeated temporary obstruction of
blood flow in cerebral arteries
• More common among men with a history of high
blood pressure
• Recovery is possible
Impaired to be considered dementia:
1. Memory
2. Communication and language
3. Ability to focus and pay attention
4. Reasoning and judgment
5. Visual perception

22. Psychological & Mental Disorders
(cont.,)
Alzheimer Disease
• Progressive irreversible & brain
disorder.
• A common form of dementia that
is characterized by a gradual
deterioration of memory,
reasoning, language, and
eventually, physical function.

23. Psychological & Mental Disorders (cont.,)
Alzheimer Disease (cont.,)
• The symptoms of Alzheimer’s disease appear
gradually.
• Unusual forgetfulness.
• Trouble recalling particular words during conversation.
• First recent memory goes, then older memories;
Eventually, total confusion, inability to speak
intelligibly or to recognize family and friends.

24. Needs of late adulthood
according to Maslow’s
Hierarchy

25. Health promotion for late adulthood
overcome cognitive Changes
Changes in cognitive activity patterns can result in
disuse and lead to atrophy of skills.
Certain mental activities can benefit the
maintenance of cognitive skills.
Reading books, doing crossword puzzles, going to
lectures.
Research suggests that mental exercise may reduce
cognitive decline and lower the likelihood of
developing Alzheimer disease.

26.  The need for sleep may decrease, but short periods
of rest throughout the day may offset the loss.
 Social contact should persist.
 Individuals should maintain active interests.
 Regular health and dental checkups should
continue.
Health promotion for late adulthood (cont.,)

27. Health promotion for late adulthood (cont.,)
Screening activities (blood pressure, hearing and
vision test , mammography….)
Regular exercises
Weight reduction if overweight
Eating a low fat & well balanced diet
Smoking cessation

28. Health promotion for late adulthood (cont.,)
Immunization for seasonal influenza and
pneumococcal disease
Rest
Home care, street safety and injury prevention
Retirement planning

30. References
• Potter, P.C; Perry, A.G; Stockert, P.A & Hall, A.M (2013).
Fundamentals of nursing. 8th ed. Elsevier. Canada: Mosby,
pp 171-187
• www.psychology.ex.ac.uk
• Jerome, N. (2013). Application of the Maslow’s hierarchy
of need theory; impacts and implications on organizational
culture, human resource and employee’s performance.
Available at: International Journal of Business and
Management Invention www.ijbmi.org. 2 (3) PP.39-45