Ch15

Health Promotion StrategiesHealth Promotion Strategies
Through the Life SpanThrough the Life Span
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Health Promotion Strategies Through the Life Span, Eighth Edition
Ruth Beckman Murray, Judith Proctor Zentner, and Richard Yakimo
Chapter 15
The Middle-Aged Person: Basic
Assessment and Health Promotion

Middle AgeMiddle Age
 Approximately 45-65 and even 70-75
years of age
 Physiologic and psychological age plays
role
 State of mind in U.S.

Generational GapGenerational Gap
 Baby Boomers
– Self-centered, narcissistic, highly confident
– Expect immediate gratification
– Carefree
– Difference in early middle-aged adult and late
middle-aged adult
 Generation is concerned about others
 Generation develops new patterns of
behavior based on changing world

Bridging Generation GapBridging Generation Gap
 Discuss that middle-aged persons have a
lot of experience to give to children about
dealing with technological changes
 Reaffirm that parents should teach the
value of commitment
 Explain that continuity of values exists in
the family
 Explain how to reduce conflicts with
offspring

Divorce of OffspringDivorce of Offspring
 Family crisis
 Adjustments difficult for parents of
offspring
– May feel failure
– May feel stress about offspring returning
home
– May worry about future relationship with
grandchildren

GrandparenthoodGrandparenthood
 Happy status and role if offspring has
established own home and family
 Stressful if offspring has returned home
with child or grandparent is young
 Help middle-aged couple set limits to be
able to pursue life goals
 Encourage grandparents who want to
secure visitation rights

MarriageMarriage
 Gradual rise in marital happiness during
middle adulthood
 Companionate love is stronger
 Couple likely to have friendship and
security
 Male and female both need support to
reinforce masculinity or femininity

Marital CrisisMarital Crisis
 Having little or no laughter, love, or
interest in relationship
 Feeling disappointed with self
 Seeking rebirth or changing directions
 Seeking escape from reality and superego
 Divorce has a greater impact on middle-
aged person
 Middle-aged person more adaptable in
face of divorce

Sustaining MarriageSustaining Marriage
 Explore ways to promote positive changes
 Refer to other resources
 Encourage “what if” conversations
 Encourage couples to vary schedules,
expectations, and roles
 Counsel to keep active and maintain
contact with others
 Encourage to use each other as resource

Middle-Aged CrunchMiddle-Aged Crunch
 Person in middle of two demanding
generations
– Offspring may still require attention and care
– Aging parents and relatives may require care
 Filial responsibility: Attitude of personal
responsibility toward the parents that
emphasizes duty, protection, care, and
financial support

Support for Aging RelativesSupport for Aging Relatives
 Visits and phone calls
 Information and assistance in decision
making
 Assistance with daily tasks
 Level of care may depend on
– Cultural differences
– Responsiveness of elderly family members

CaregivingCaregiving
 Prolonged assistance given to meet
physical and emotional needs of a person
with functional limitations or incapacity
without payment toward 24-hour care
 Many factors influence caregiving role
 Can have negative effects on physical,
emotional, and mental health of caregiver

Counsel for CaregiversCounsel for Caregivers
 Work through conflicts, feelings of
frustration, guilt, and anger
 Acquire greater understanding of person
being helped
 Acquire greater satisfaction from helping
 Understand physiologic, emotional,
cognitive and social needs of elders
 Participate in support groups
 Maintain personal health

Parental DeathParental Death
 Person feels finiteness and mortality of
self and others
 Person may recall childhood and recent
memories
 Person may mourn previously lost loved
ones or feel alone
 Person may delay grieving process due to
conflict
 Person may search spiritually

Family Development TasksFamily Development Tasks
 Maintain a pleasant and comfortable
home
 Assure security for later years
 Share household and other
responsibilities
 Maintain emotional and sexual intimacy as
a couple or regain emotional stability
alone
 Maintain contact with grown children and
their families

Family Developmental Tasks cont.Family Developmental Tasks cont.
 Meet the needs of elderly parents or other
relatives in such a way as to make life
satisfactory for both the parent(al) and
middle-aged generations
 Participate in community life beyond the
family
 Use competencies built in early stages to
expand or deepen interests and social or
community involvement

Widow(er)hood CrisisWidow(er)hood Crisis
 Major crisis
 Reaction may be different for sudden
death than death from longer period of
illness
 Gently test for readiness of shock of death
 Person may feel ambivalence or linger
around nursing center
 Remain available and supportive

Reaction to Death of SpouseReaction to Death of Spouse
 Effects on reaction
– Personality and emotional makeup
– Relationship between the couple
– Religious, cultural, and ethnic background
 Changes for person
– Loss of companion, audience, or helper
– Loss of financial support and secondary
materials
– Returning to work force or giving up activities

WidowhoodWidowhood
 Threat to self-concept and wholeness
 Threat to physical health
 Widow considered threat to females with
husbands
 Widower may be more vulnerable to
depression
 Widower more likely to remarry or have
companion

Tasks for Widow(er)Tasks for Widow(er)
 Recognize reality of loss
 Express feelings
 Find significant methods to manage pain
 Incorporate prior relationships and
supportive relationships
 Maintain or develop positive self-concept
 Maintain or re-establish health

Widow(er) SupportWidow(er) Support
 Listen
 Avoid shallow or unwanted advice
 Do practical tasks
 Assist in crisis resolution
– Encourage medical checkups
– Identify support system
– Utilize resources
– Encourage trying new things
– Encourage taking time to grieve

Climacteric for FemalesClimacteric for Females
 Menopause: permanent cessation of
menstruation preceded by gradually
declining menstrual flow
 Perimenopausal: years of gradual
diminution of ovarian function and change
in endocrine status from before
menopause until a year after
 Different views on menopause exist

Changes During MenopauseChanges During Menopause
 Average age of onset: 51-52 years
 Changes in FSH secretion bring changes
to ovaries
 Changes in progesterone and estrogen
 Some discomforts may occur from
vasomotor, urogenital, or endocrine
balance changes
 Difficulties experienced during menopause
may be related to life changes, recent
loss, or stress

Reactions to MenopauseReactions to Menopause
 Depression, irritability, and change in
sexual desire
 Females with heavy investment in
childbearing may react more severely
 Reactions vary across social classes and
cultures, and availability of roles
 Changes in health or emotional status
may be based on individual differences in
coping with stress or other behaviors

Hormone Replacement TherapyHormone Replacement Therapy
 Widely discussed and studied
 Educate clients about the benefits and
risks of hormone replacement therapy
 Monitor and assess regularly clients who
are using the therapy
 Offer other ways that symptoms of
menopause may be managed
 Refer to support groups and educational
materials

Climacteric for MalesClimacteric for Males
 Hormonal fluctuations and physical and
psychological changes
 Do not lose reproductive ability
 Dissatisfaction at work and other losses
may add to the sense of crisis and aging
 Interventions may include healthy lifestyle
changes, various psychotherapies and
behavior modification, hormone therapy,
or medications for erectile dysfunction

Physical Characteristics ofPhysical Characteristics of
Middle-Aged PersonMiddle-Aged Person
 Skin wrinkles and loss of elasticity
 Gray hair or loss of hair
 Compression of spinal column
 Presbyopia and gradual decrease in
hearing
 Decreased efficiency of heart and
elasticity of blood vessels
 Reduced breathing capacity

Nutritional NeedsNutritional Needs
 Should be a reduction in caloric intake
 Reduced carbohydrates, foods with trans fat,
saturated fat, cholesterol, and “empty” calories
 Increase in Fiber, protein, calcium, Vitamin D,
phosphorus, magnesium, and fluoride
 Plenty of fluids need (not tea or coffee)
 Teach about daily diet and self-help groups while
considering client values

ExerciseExercise
 Can include many types of activities
 Moderate exercise: 30 minutes a day at
least 5 days a week
 Vigorous exercise: 20 minutes three times
a week.
 Enhances quality of life and physical,
emotional, and mental health

Benefits of ExerciseBenefits of Exercise
 Helps prevent
– Cardiac disease
– Hypertension
– Obesity
– Diabetes
– Osteoporosis
– Depression
 Encourage back exercises and foot care
to maintain ability to exercise

SleepSleep
 7-8 hours of sleep recommended
 Middle-ager may awake several times
during the night
 Insomnia may be a sign of a more serious
underlying medication condition
 Parasomnias are conditions in which sleep
is disrupted by inappropriate activation
– Sleep apnea is currently being widely studied

WorkWork
 Resolve job conflict
 Participate in challenges
 Have a lower avoidable absenteeism rate
 Become an expert at what they are doing
 Use life experience and maturity on the
job
 Less emotionally labile
 Value work

Work cont.Work cont.
 Finding different work can be difficult
 Many plan to work past retirement age
 Many feel they are overworked (middle-
aged female)
 Discuss work stability and work’s effect on
physical, mental, and emotional health
 Help clients improve time management
skills

RetirementRetirement
 Some may retire early
 Many continue to work
– Views of self and society
– Desire to contribute and avoid boredom
– Desire to be financially prepared
 Explore with client various options and
examine how to make options happen

Cognitive Stage and LeadershipCognitive Stage and Leadership
 Cognitive stage favors positions of
leadership
 Qualities
– High level of education or success
– Realistic goals and self-concept
– High frustration tolerance
– Inclination to praise and reinforce behavior
– Understanding of group needs
– Ability to delegate authority

Leisure TimeLeisure Time
 May include couple and personal interests
 May include volunteerism
 Contributes to physical, emotional, and
social health
 Many mix learning, work, and play
 Some middle-aged adults may not know
how to use extra free time
 Help review function and types of leisure

Influences on Cognitive AbilityInfluences on Cognitive Ability
 Neurons become more intertwined
 Both hemispheres of brain increasingly
used for logical reasoning and intuitive
tasks
 Many show ability by returning to school to
earn degrees

Cognitive ProcessesCognitive Processes
 Reaction time: remains the same or
diminishes
 Perception: experience important
 Memory: quantitative changes may occur
 Learning and problem solving: remain
unimpaired
 Creativity: greater ability
 Concrete and Formal Operations and
Problem Finding Stage

Cognitive ThoughtCognitive Thought
 Use of multiple intelligences
 Use of reflection
 Monitoring for logic and continuity
 Producing images, thoughts, and
combination of ideas
 Representing experience symbolically
 Having intellectual curiousity

Cognitive DevelopmentCognitive Development
 More flexible and creative
 More productive in total creative output
and better quality output
 Help middle-aged adults begin new
ventures in life and continue learning
 Use methods that capitalize on the
learning strengths of mature adults

Emotional DevelopmentEmotional Development
 Demonstrates less evidence of fear,
anger, and hatred than the young adult
 Less impulsive in response to emotion
 Less negative feelings
 Period of self-assessment and greater
introspection
 Transitional period in which the person
perceives life as time left to live rather
than since birth

Self-ConceptSelf-Concept
 Realignments of attitudes about self
 Person may realize he or she looks and
feels older
 Mature person
– Accepts change and realizes it is impossible
to return to youth
– Feels good about self
 Reaffirm strengths of middle-aged person

Moral and Spiritual DevelopmentMoral and Spiritual Development
 Integrates new concepts from widened
sources
 Likely to return to religious groups for
strength, comfort, and joy
 Development is advanced when the
person has an experience of sustained
responsibility and welfare for others
 Without development person may feel
despair in old age

GenerativityGenerativity
 Generativity is a concern about providing
for others that is equal to the concern of
providing for the self.
 Person uses personal strengths, vigor,
and experience to meet the needs of the
community and others
 Person may be a mentor to a young adult

Self-AbsorptionSelf-Absorption
 If generativity is not achieved, the person
may be self-absorbed or regress to
adolescent behavior
 Person hates the aging body and feels
neither secure nor adept at handling self
– Impaired and less socially organized
intellectual skills and value systems
– Avoids concern for others

MaturityMaturity
 Doing what is appropriate for age,
situation, and culture
 Psychic interests broaden and are less
selfish
 Staying power
 Restructures or processes information in
the light of experience
 Uses knowledge and expertise in a
directed way to achieve desired ends.

Other TheoristsOther Theorists
 Jung
 Gould
 Levinson
 Sheehy
 Vaillant
 Neugarten

Adaptive MechanismsAdaptive Mechanisms
 Adult socialization
 Ongoing learning and adaptation
 The healthy and adaptive person
– Copes with ordinary personal upheavals and
life’s frustrations and disappointments with
only temporary disequilibrium
– Participates enthusiastically in work and play

Adaptive Mechanisms cont.Adaptive Mechanisms cont.
 The healthy and adaptive person
– Experiences adequate satisfaction in a stable
relationship
– Expresses a reasonable amount of emotion
– Serves as a role model of maturity
 Counsel to prevent or overcome
maladaptive mechanisms
 Validate actions and refer to other
resources as necessary

Altruistic BehaviorAltruistic Behavior
 Promote by
– Listening
– Support
– Encouragement of activities
– Teaching and counseling
– Referral to organizations that can use
person’s talents, time, and financial resources

Midlife CrisisMidlife Crisis
 Refers to a major and revolutionary
turning point in one’s life
– Involving changes in commitments to career
or spouse and children
– Accompanied by significant and ongoing
emotional turmoil for both the individual and
others
 More common in males
 Use cognitive-behavioral statements

Midlife Crisis cont.Midlife Crisis cont.
 Causes
– Has not resolved the identity crisis of
adolescence and achieved mature intimacy
– Fears the passage of time
– Cannot handle the meaning of life’s routine
and changes

Developmental TasksDevelopmental Tasks
 Maintain or establish healthful life patterns
 Help growing and grown children as well
as aging family
 Create a pleasant, comfortable home
 Find pleasure in generativity and work
 Maintain a standard of living related to
values, needs, and financial resources
 Prepare for retirement

Developmental Tasks contDevelopmental Tasks cont
 Achieve mature social and civic
responsibility
 Accept and adjust to the physical changes
 Make an art of friendship
 Use leisure time creatively and with
satisfaction
 Acknowledge time for fulfillment is shorter
 Continue to formulate a philosophy of life

ImmunizationsImmunizations
 Educate about the need to maintain
recommended immunizations and a
personal record of type and date
 Middle-aged clients may receive tetanus
diphtheria toxoid or influenza, hepatitis B,
and pneumonia vaccines
 Refer clients to websites and other
resources for updated lists of
recommended vaccines.

Health IssuesHealth Issues
 Females
– Eating disorders
– Breast cancer
– Autoimmune and
gastrointestinal
diseases
– Osteoporosis
– Depression
– Cardiac disease
 Males
– Accidental death
and disability from
accidents
– Tendancy to smoke
and drink
– Tendancy to avoid
medical care or
preventative
services

AccidentsAccidents
 Fractions and dislocations are the leading
cause of injuries for both genders
 Occupational-related accidents and falls in
the home are causes of injury and death
 Teach about safety as it relates to
remodeling a home, maintaining a yard, or
establishing a work center
 Reinforce personal/family planning for
gradual failing of physical abilities

Holistic CareHolistic Care
 Educate about major health problems of
middle age
 Educate about important routine tests
(BDI; FOBT; FIT)
 Educate about measures to promote
health
 Help client find ways to deal with stressors
 Teach about medication management
 Refer client to resources

More Health CareMore Health Care
 Educate about gender differences for
disease incidence and presentation
– Educate males and females to take aspirin
daily to reduce risk of heart attack
– Educate about psychosocial and physical
factors for cardiac and cardiovascular disease
 Use concepts from the Transtheoretical
Model of Change
 Use cognitive behavioral therapy

Common Health ProblemsCommon Health Problems
 Atherosclerosis
 Hypertension
 Coronary artery
disease and stroke
 Cancer
 Asthma
 Impaired vision
and hearing
 AIDS
 Obesity
 Arthritis
 Osteoporosis

CancerCancer
 Males: prostrate, lung, colon, rectum, and
bladder
 Females: lung, breast, colon, and rectum
 Encourage yearly screenings
 Explore emotional concerns about having
cancer
 Refer clients to resources as necessary
 Teach clients about the importance of the
mind-body connection

Assessment and CareAssessment and Care
 Remember that the momentum of life and
multiple societal roles for the middle-ager
may leave little time to focus on personal
health unless there is an illness crisis
 Emphasize that middle-agers role model
and teach young adult offspring and their
children about health promotion skills and
resources and familial health history

Examples of Nursing DiagnosesExamples of Nursing Diagnoses
 Anxiety
 Disturbed body
image
 Caregiver role
strain
 Decisional conflict
 Defensive coping
 Fatigue
 Risk for loneliness
 Risk for impaired
religiosity
 Social isolation
 Ineffective role
performance
 Anticipatory
grieving

Self CareSelf Care
 Express feelings about life situations
 Express a supportive or positive attitude
 Foster positive self-esteem
 Access resources and learn self-care
skills
 Consider safe alternative and
complementary therapies
 Integrate health-promotion activities into
life

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