2. Objectives
• Describe normal roles and relationships.
• Discuss how patterns of roles and
relationships change with aging.
• Examine the effects of disease processes on
the ability to maintain roles and relationships.
• Identify older adults who are most at risk for
experiencing problems related to changes in
roles and relationships.
2
3. Objectives (Cont.)
• Describe methods of assessing changes in
roles and relationships.
• Select appropriate nursing diagnoses related
to role or relationship problems.
• Describe nursing interventions that are
appropriate for older individuals experiencing
problems related to changing roles and
relationships.
3
5. Role
• A socially accepted behavior pattern
• People tend to establish their identities and
describe themselves based on the roles they
play in life.
• Man, woman, husband, wife, adult, senior
citizen, parent, child, son, daughter, student,
teacher, doctor, nurse, worker, and housewife
are some common roles.
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6. Role (Cont.)
• People play many roles over a lifetime and
often must attempt to play several roles
simultaneously.
• Roles are identified, defined, and given value
by the society in which a person lives.
6
7. Relationships
• Connections formed by the dynamic
interaction of individuals who play
interrelated roles
• The way individuals occupying each role
interact with each other describes their
relationships.
• Can be short- or long-term, personal or
impersonal, intimate or superficial
• Changes over time and are affected by the
role changes of the people involved.
7
8. Homogeneous Society
• One in which all members share a common
historical and cultural experience
• Everyone knows the rules and everyone plays by
the same rules
• There is little confusion or conflict in a
homogeneous social system because the
symbols, behaviors, and relationships are
perceived in the same way by all members of the
society.
• Everyone knows the accepted roles and how
people in each role are expected to relate to each
other.
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9. Heterogeneous Society
• One in which the members of many diverse
subcultures with different historical and
cultural experiences must interact
• These subcultures may have their origin in
race, religion, ethnic heritage, or age.
• Roles and role expectations are not always
clear, and this lack of shared perceptions often
leads to misunderstandings, confusion, and
conflict.
9
11. Older Adults
• Must adjust to many predictable role and
relationship changes associated with aging
– Retirement
– Altered relationships with adult children
– Changes in housing
– Loss of valued possessions and friends because of
relocation or death
– Loss of spouse to death
– Loss of health or independence
11
12. Older Adults (Cont.)
• Many older adults resent the fact that society
forces them to retire.
• May resent need to continue working
• The more roles and relationships a person
develops at younger ages, the better will be
his or her ability to adjust when some of those
roles and relationships are lost.
12
13. • A developmental stage that may occupy 30 or more
years of one’s life
• Growing concern for economic support for retirees
• 44% of retirees work for pay at some point after
retirement
– Some because of economic need
– Some with to remain involved and productive
• Who is at economic risk?
– Women, those with disabilities, who have lacked
access to education or held low-paying jobs with
no benefits, and those who are not eligible for
Social Security
Retirement
13
14. • Retirement generally has positive effects on
life satisfaction and health, although this
varies depending on one’s circumstances
• The decision to retire is based on finances;
attitudes toward work, family roles, and
responsibilities; the job; access to health
insurance; age; health; and perceptions of
ability to adjust to retirement
Retirement Planning
14
15. Retirement
• To maintain a connection with those who are
still employed, many retired older adults
continue to think of themselves as a part of
their occupation
• There are some roles from which a person
cannot officially “retire.”
15
16. • Nurses may work with people in different phases of
retirement
– Participate in retirement education and counseling
programs
– Provide anticipatory guidance about transition to
retirement
– Identify those who may be at risk for lowered income and
health concerns
– Refer to appropriate resources
• Advocate for policies and conditions that allow older people
to maintain quality of life in retirement
Implications for Gerontological Nursing
and Healthy Aging
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18. • We are experiencing changes in family
composition compared with previous
generations
• Growing number of multigenerational
households
• Family members form the nucleus of
relationships for most older adults and their
support system if they become dependent
• As families change, roles or expectations of one
another may change as well
Families
18
19. • Traditional couples
• Divorces couples
• Nontraditional couples
• Elders and their adult children
• Never married older adults
• Grandparents
• Siblings
• Fictive kin
Types of Families
19
20. • Older adults like to hear about the successes
of their grown children
• Relationships between older adults and their
children may become strained as a result of
– Children of older adults are preoccupied with their
own spouses, children, and partners
– Elder parents being critical or judgmental about
the lives of their offspring
• Some older adults are fortunate to see their
own children on a regular basis
Elders and Adult Children
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21. Parenting
• Older adults do not give up the role of parent
just because their children are adults.
• Role conflict and altered family relationships
are likely to occur when older adults attempt
to continue to direct their children’s behavior
long after the children are adults.
21
22. • Demonstrate resilience in the challenges of
aging as a result of their independence
• Those who have lived alone most of their lives
often have supportive networks with siblings,
friends, and neighbors
• May have longer lifetime employment with
greater financial security for their age
• Number of single older adults will increase
because being single is more common in
younger years
Never Married Older Adults
22
23. • As a person ages, he or she becomes more
involved with siblings
• Siblings become increasingly close in supportive
relationships, especially among single or
widowed older adults living alone
• The strongest sibling bond is between sisters
• Loss of a sibling results in grieving but is also a
rehearsal for one’s own death
Siblings
23
24. Grand-parenting
• The role of grandparent is often described as
being much more pleasant than that of being a
parent.
• It allows older adults to share their wisdom and
experiences with a new young generation.
• Because grandparents are often under less daily
stress and are not the primary disciplinarians of
the children, they are usually more relaxed and
have more time to spend on nonessential
activities, such as conversation and play.
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26. • Is experienced by most older adults
• Majority of grandparents derive great emotional
satisfaction from their grandchildren
• Older adults are increasingly caring for their
grandchildren
• Geographical distance is not affecting these
relationships as it once did (because of the Internet)
• More grandparents live closer to their grandchildren
and are involved in their grandchildren’s lives
Grandparents
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28. Spouse /marriage
• Many older persons have occupied the role of
spouse for 30, 40, or 50 or more years.
• A successful long-term marriage requires a
great deal of effort; the loss of this intensely
personal relationship triggers a high level of
emotional distress.
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29. • The most difficult adjustment one can face,
aside from the loss of a child
• Death of life partner is a loss of self
– Mourning for the lost partner
– Mourning for the loss of self associated
with one’s lifelong marriage or partnership
• Results in changes in almost every domain of
life
Death of Spouse
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30. Death of Spouse
• Many widows and widowers find their grief so
overwhelming that they cannot even continue
to perform normal activities of daily living.
• Has a significant impact on well-being:
physical, psychological, social, practical, and
economic
30
32. • As a person ages, he or she becomes more
involved with siblings
• Siblings become increasingly close in
supportive relationships, especially among
single or widowed older adults living alone
• The strongest sibling bond is between sisters
• Loss of a sibling results in grieving but is also a
rehearsal for one’s own death
Siblings
32
33. • Nonblood kin who serve as “genuine fake
families”
• Serve important roles, especially for those with
no close family relationships and those living
alone or in institutions
• Nurses and other primary care providers can
become fictive kin
Fictive Kin
33
34. Friends
• The loss of friends because of relocation or
death also results in changed social roles and
relationships.
• Older persons who outlive their families and
friends often feel that their lives are without
purpose.
34
35. • A significant source of support in late life
• Can promote health and well-being
• The social network may narrow as one ages
• Women tend to have more sustaining
friendships, contributing to resilience
• Nurses can
– Encourage older adults to sustain friendship
– Assist in building new friendships and social
networks
– Link older adults to resources for social activities
Friendships
35
36. Housing
• Many older adults change housing
arrangements out of choice or necessity.
• Moving to smaller accommodations
commonly necessitates the sale or distribution
of personal possessions accumulated over a
lifetime.
36
37. Health and Independence
• When older adults lose health and
independence, they lose control over their
own destiny.
• They are at the mercy of others (either family
or strangers) for care and sustenance.
37
38. • There is an elevated risk of morbidity and
mortality, particularly in early bereavement
• Perform grief and coping assessment
• Interventions
– Know the stages of transition
– Provide support
– Help build strength and confidence
Implications for Gerontological Nursing and
Healthy Aging
38
39. Nursing Process for Dysfunctional Grieving
• Grief is a strong emotion
– A combination of sorrow, loss, and
confusion that comes when someone or
something of value is lost
– Can come in response to the loss of a
person, role, relationship, health, or
independence
– Dysfunctional when the person has an
exaggerated or prolonged period of grief
39
40. Nursing Interventions for Dysfunctional
Grieving
• Establish a trusting relationship to encourage
verbalization of feelings regarding the change
or loss.
• Assess the source and acknowledge the reality
of the grief.
• Encourage older adults to participate in
activities of daily living.
• Identify sources of support.
40
41. Nursing Process for Social Isolation
and Impaired Social Interaction
• Social isolation, the sense of being alone, is a
common problem among older adults.
• Social isolation is the result of many factors and
can be unintentional or intentional.
• The more people are separated from family and
friends, the greater the likelihood of social
isolation will be.
41
42. Nursing Process for Social Isolation
and Impaired Social Interaction (Cont.)
• Assess the reason or reasons for the social
isolation.
• Promote social contact and interaction.
• Spend one-on-one time with the isolated
person.
• Initiate referrals.
42
44. Nursing Process for Interrupted Family
Processes
• When older persons or their families verbalize
concern or confusion related to a change in
roles or relationships, family dynamics should
be assessed.
• Alterations in family processes can occur at
any age but are most common when an aging
family member becomes dependent.
44
45. Nursing Interventions for Interrupted
Family Processes
• Assess interactions between older adults and
their families.
• Encourage all family members to verbalize
their feelings.
• Assist family members in identifying personal
and family strengths.
• Encourage family members to visit regularly.
45
46. Nursing Interventions for Interrupted
Family Processes (Cont.)
• Encourage the family to assist in care of older
family members.
• Assist families in identifying factors interfering
with normal interactions.
• Explore community resources.
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