Ch16

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 Beckmann Murray, Judith Proctor Zentner, and Richard Yakimo
Chapter 16
Later Maturity: Basic Assessment
and Health Promotion

Important TermsImportant Terms
 Aging: process of growing older
 Biological age: position with respect to
potential life span
 Social age: role and habits of person
 Psychological age: behavioral capacity of
person
 Cognitive age: age the person looks and
feels to self

Important Terms cont.Important Terms cont.
 Primary age: universal changes that occur
with getting older
 Second aging: consequences of particular
diseases
 Senescence: mental and physical decline
 Later maturity: last major segment of life
span
– Young old
– Oldest-old

Important Terms cont.Important Terms cont.
 Functional age: how well person functions
in environment in comparison with others
of the same chronological age
 Senility: derogatory term for physical and
mental deterioration; should not be used
 Gerontology: study of person in later
maturity and the aging process
 Geriatrics: medical specialty concerned
with care of person in later maturity

Later MaturityLater Maturity
 Sociopolitical or cultural perspective
– Offspring in creative period
– Mature adult assumes parental leadership
 Reaffirmation of social, moral, and ethical
standards
– Establishment of harmonious relationship with
oncoming generations
 Retrospective examination
– True nature of accomplishments and errors

Biological TheoriesBiological Theories
 Nongenetic cellular
 Physiological
 Genetic
– Oldest-old are probably endowed with genes
that protect them against certain diseases and
traits that keep cells in good working order
– Gender differences in disease and death exist

Psychosocial TheoriesPsychosocial Theories
 Continuity Theory
– Individual’s pattern of behavior are result of
lifetime of experiences
– Aging is the continuation of lifelong
adjustments or personality patterns
 Disengagement Theory
 Activity Theory

Developmental TheoriesDevelopmental Theories
 Erikson’s Epigenetic Theory
– Development depends on the resolution of the
ego integrity versus despair
 Peck’s theory
– Ego differentiation
– Body transcendence
– Ego transcendence
 Levinson’s theory
– Adult characterized by transition period

Sociologic TheoriesSociologic Theories
 Disengagement Theory
 Activity Theory
 Symbolic Interaction Theory
 Urban Ecological Model of Aging

AgeismAgeism
 Refers to any attitude, action, or
institutional structure
– Discriminates against individuals on the basis
of age
– Infers that elderly people are inferior to those
who are younger
 Ageism of the aged does occur

Society StereotypesSociety Stereotypes
 Stereotypes
– Asexual
– Unemployable
– Unintelligent
– Socially incompetent
 Educate and advocate to overcome myths
 Recognize that many older Americans feel
disrespected or unneeded

Multiple GenerationsMultiple Generations
 Increase in number of four- and five-
generation families.
 Causes “generation in the middle” to be
those entering retirement years
– May face diminishing personal resources
– May face caring for aged kin and younger
generations
 Utilize knowledge of relationships with
others during assessments

MarriageMarriage
 May lower mortality rate
 Remains major organizing force
– Spouses may not increase support of each
other
– Females may feel husband is not supportive
– Female who has been homemaker may feel
loss of privacy upon male retirement
– Couples who both worked outside the home
need to accommodate to life patterns of the
partner

Families and CareFamilies and Care
 Some cultures are more likely to have
elder live in home
 Assess number of children and quality of
interaction and support for elderly parent
– Most older parents expect help
– Most value help that keeps them autonomous
and self-reliant
– Geriatric Care Manager may be used if
offspring cannot care for parents

GrandparenthoodGrandparenthood
 Meaning can depend on initial time of
grandparenthood
 Grandparents may
– Be head of household
– Care for grandchildren full time
– Care for grandchildren part time
 Increase in number of grandparents and
great-grandparents
 Assess for availability of grandchildren

Social NetworksSocial Networks
 Friends, service providers, neighbors
– Promote socialization and life satisfaction
– Facilitate coping skills and mastery
– Provide practical aid
 Formal health-related support services
– Government and private agencies such as
maintenance services or chore services
 Supportive ties become smaller and more
unstable for old-old

Family or Informal CaregiverFamily or Informal Caregiver
 Caregiving experience depends on many
variables
 Caregiving particularly tough on spouse
 Intervention
– Communication and therapeutic relationship
– Stress management
– Crisis management
– Time management
– Adult education

PetsPets
 Great companions
 Therapeutic for elders
 Can offer assistance and security
 Beneficial effects on health and verbal
communication skills
 Need proper care

BereavementBereavement
 Does not permanently affect health status
for most seniors
 Elderly widow(er) has great increase in
psychological distress
 Widowhood affects
– Economic resources
– Social support systems
– Mortality
 Males have harder time adjusting

DivorceDivorce
 Provide emotional or crisis intervention
 Divorce may affect
– Economic position
– Children’s availability for care
 Divorce rate may rise in the future
 Number of elders cohabitating is
increasing

SinglehoodSinglehood
 Some elderly remain single and never
marry
– Developed adaptive mechanisms and social
support systems
 Some elders may be homosexuals
 Decline in functional capacity may require
person to move or be institutionalized
 Recognize special emotional and social
needs

Elder AbuseElder Abuse
 May be physical, psychological, financial,
or social
 Abuser is usually relative
 Examples of signs
– Physical injuries
– Undue confusion
– Conflicting explanation of senior’s condition
– Unusual fear exhibited by the senior
– Abnormal behavior of the caregiver

Causes and InterventionCauses and Intervention
 Causes include elder dependence,
economic stress, and family interaction of
violence
 Interventions
– Use astute observation of verbal and
nonverbal cues
– Use multidisciplinary team
– Be familiar with reporting laws

Characteristics of AgingCharacteristics of Aging
 Differences between male and females
 Senescent alterations can be either
premature or delayed
 Progression of aging in cellular tissues is
asymmetric
 Organ reserve lessons
 Relationship exists between sum of
common aging traits and length of survival

Physical ChangesPhysical Changes
 Skin loses elasticity
 Sweat glands atrophy
 Capillary beds diminish
 Nose and ears become larger and broader
and face gets more wrinkles
 Hair loss and graying continue
 Posture is one of general flexion

Neurological SystemNeurological System
 Loss of nerve cells
 Decrease in neurotransmitter production
 Shrinkage of neuron size
 Decrease in functioning neurons in gray
matter
 Altered brain waves and sleep pattern
 Decrease in response to vestibular and
kinesthetic stimuli

SensesSenses
 Loss of vision, color vision, and night
vision
 Age-related macular degeneration
 Hearing loss
 Decreased sensitivity
– Touch
– Taste
– Perception
– Smell

Body SystemsBody Systems
 Cardiovascular system
– Output decreases and walls of veins are
thicker
 Respiratory system
– Difficulty taking oxygen from atmosphere and
delivering it to parts of body
 Musculoskeletal system
– Loss of calcium from bone and bone loss
– Loss of muscular strenght and endurance

Body Systems cont.Body Systems cont.
 Urinary system
– Kidneys suffer loss in function and bladder
capacity diminishes
 Gastrointestinal system
– Decrease in total body water
 Endocrine system
– Decrease in response to some hormones
 Immune system
– Becomes less efficient

Reproductive SystemReproductive System
 Male changes
– Testosterone
decreases
– Sperm production
decreases
– Reduction in
frequency of
intercourse and
force of ejaculation
 Female changes
– Decline in estrogen
and testosterone
– Decrease in
secretions
– No reduction in
sexual desire or
excitability

CentenariansCentenarians
 Moderate diet
 Past and current history of work and
exercise
 Optimistic, happy, relaxed attitude
 Avoidance of stress
 Socialization
 Intellectual curiosity and spirituality

NutritionNutrition
 Caloric requirements lower than in early
life
 Elderly person likely to consume empty
calories
 Protein intake may be a problem
 Mineral and vitamin needs remain the
same as for person in midlife years

Nutrition cont.Nutrition cont.
 Teach elders and family
– Importance of balanced diet
– Importance of sufficient water intake
– Importance of making mealtime pleasant
– Importance of eating frequent, smaller meals
 Keep in mind elders are denied many
pleasures
 Monitor home situation as necessary
 Make referrals as necessary

RestRest
 Older adults should have frequent rest
periods
 Aging affects process of sleep
– Length of sleep
– Distribution of sleep in 24-hour day
– Sleep stage patterns
 Assess for insomnia and sleep apnea
 Review current sleep hygiene measures

Physical ActivityPhysical Activity
 Should be sensibly paced and gradually
increased
 30 minutes of daily exercise
recommended
 Elder should consult physician before
beginning program
 Use Activity Pyramid for client education
 Activity may combine use of cane, walker,
and scooter

Self-CareSelf-Care
 Healthy lifestyle includes resourcefulness,
self-care, self-efficacy, resilience, and
hardness
 Gender differences in longevity are
narrowing
 Chronic diseases are the cause of most
death
 Immunizations are recommended

SafetySafety
 Falls leading cause of death from injury
– Causes
– Prevention
 Promote home security
 Educate about safe decisions related to
driving
 Refer clients to information about ways to
modify home for safety

AccidentsAccidents
 Changes in hearing and sight can lead to
accidents
 Teach about proper care of self and
environment to reduce accidents
 Educate administrators about needs of
elderly related to environmental factors
such as rugs, walls, sign colors, and
doorways

Temperature and Pain SensorsTemperature and Pain Sensors
 Mildly cool temperatures can trigger
hypothermia
– Assess for hypothermia
– Teach preventative measures
 Hyperthermia may also occur
– Types: heat cramps, heat exhaustion, and
heat strokes
– Teach about symptoms and prevention

AssessmentAssessment
 Health history
 Physical examination
– Vital signs and weight
– Mobility and feet
– Hypertension
– Vascular disease
– Cancer
– Hearing and vision
– Frailty

Common DiseasesCommon Diseases
 Most prevalent: heart disease, cancer,
stroke
 Educate public about guidelines for
preventing common diseases
 Educate and counsel about sexual
expression
 Use a multidisciplinary team with casing
involving failure to thrive

Effects of DrugsEffects of Drugs
 Changes in brain structure and function in
aging process potentiate effect of alcohol
and other psychoactive drugs
 Educate about magnesium toxicity
 Be aware of adverse reactions and
inappropriate dosages
 Teach elders and family members to learn
as much as possible about medications

Cognitive DevelopmentCognitive Development
 Demonstrates crystallized intelligence
 Dependent on sociocultural influences, life
experiences, and broad education
 Fluid intelligence less apparent
 Cognitive tasks performed more slowly
 Highly developed judgmental functions
 Ability to be taught and remember
essential information

CreativityCreativity
 Practical creativity and problem solving
 Encourage family and staff to reinforce
elder’s creativity during activities
– Implementing during activities of daily living
– Implementing during instrumental activities of
daily living

Therapeutic InterventionsTherapeutic Interventions
 Reminiscence
– Process of informal sharing of bits and pieces
of the past that surface to the consciousness
and involve feeling related to the memories
– Affective and cognitive functions
 Life review
– Process involving deliberately recalling
memories about life events
– Guided and directed cognitive process

Mild Cognitive ImpairmentMild Cognitive Impairment
 Temporary memory problems or
forgetfulness
 Types
– Non-memory domain
– Multiple-domain
– Amnestic forms
 Educate the elder and family members on
strategies to compensate for age-related
forgetfulness

Emotional DevelopmentEmotional Development
 Older person experiences emotions at
least as intensely as young adult
 Older adults should great immunologic
impairment associated with depression or
negative feelings
 Less variability in emotional response
 Emotional response becomes less
unidimensional

PersonalityPersonality
 No specific personality changes occur as
result of aging
 Mature elderly continues to use multiple
intelligences
 Young-old: flexible, mature, less
vulnerable to harsh reality of aging
 Old-old: meditation, contemplation,
egocentricity, childlike perceptions

Self-ConceptSelf-Concept
 Old-old person may see self as weakened
and less worthwhile
 Physical changes in the body can cause
negative feelings
 Help elder keep intact, positive body
image
 Encourage talking about feelings
 Help elder stay well-groomed

Moral and Spiritual DevelopmentMoral and Spiritual Development
 Moral Development
– Post-Conventional Stage
– May exhibit signs of transcendence
 Spiritual Development
– Often spiritual leaders of community
– Prayer and meditation improve health
– Beliefs help person cope
– Some may experience spiritual
impoverishment

Tasks Related to AdaptationTasks Related to Adaptation
 Ego differentiation versus work-role
preoccupation
 Body transcendence versus body
preoccupation
 Ego transcendence versus ego
preoccupation

Adaptive MechanismsAdaptive Mechanisms
 Regression
 Emotional isolation
 Denial
 Rationalization
 Somatization
 Counterphobia
 Rigidity
 Sublimation
 Displacement
 Projection
 Insight
 Reminiscence

HoardingHoarding
 May be adaptive behavior
 Examples of reasons
– Life-long habit
– Save symbols of security or happier past
 Use interventions for hoarding behavior

Characteristics ofCharacteristics of
Adapted Older PersonAdapted Older Person
 Characteristics
– Equanimity
– Perseverance
– Self-reliance
– Meaningfulness
– Existential aloneness
 Use helpful approaches toward successful
aging

Integrity versus Self-Despair or DisgustIntegrity versus Self-Despair or Disgust
 Integrity
– Allows feedback on a long life
– Refined characteristics of maturity
– Achieving wisdom and an enriched
perspective about life and people
– Creative
 Influences include historical situation,
family environment, marital status, and
individual development

Self-Despair and DisgustSelf-Despair and Disgust
 Person wants another chance to redo life
 Causes
– Early negative self-concept
– Lack of confidante or companion
– Declining physical health status

Enhancing IntegrityEnhancing Integrity
 Use consultative role
 Ask person’s counsel about various
situations that relate to him or her
 Have the person reminisce and engage in
life-review
 Use therapeutic communication and
counseling
 Use touch and relaxation techniques
 Be a confidante

Developmental TasksDevelopmental Tasks
 Adjust to the aging process
 Decide how to live remaining years
 Redefine physical and social life space
 Continue a supportive relationship with
significant other
 Adjust living standards to retirement
income or supplement retirement income
 Maintain assigned functions and tasks

Developmental Tasks cont.Developmental Tasks cont.
 Maintain maximum level of health and
care
 Maintain contact with family
 Establish or maintain friendships
 Maintain interest in people in social, civic,
and political responsibility
 Pursue new interests and maintain former
activities

Development Tasks cont.Development Tasks cont.
 Find meaning in life after retirement and in
facing inevitable illness and death of
oneself, spouse, and other loved ones
 Work out values, life goals, and a
significant philosophy of life
 Reassess criteria for self-evaluation
 Adjust to the death of spouse and other
loved ones.

RetirementRetirement
 Many Baby Boomers say they will
continue to work part-time rather than
completely retire
 Older employees
– May be released because of cost
– Benefit employer because of knowledge

Retirement cont.Retirement cont.
 Factors for well-being in retirement
– Length of time retired
– Stable health status
– Adequate income and health care
– Activity in variety of programs or organizations
– Higher education level and ability to pursue
goals
– Extended social network
– Satisfied with living arrangements

LeisureLeisure
 Leads to emotional and social
development
 Elders enjoy interaction with others
 Volunteer role can be rewarding
 American Association for Retired Persons
is studying impact on people in a more
technologically complex but fragmented
society

Planning and PolicyPlanning and Policy
 Should not be bound by ageism
 Should not be bound by myths about
people in later maturity
 Discuss current trend of intentional
communities
– Values
– Reasons
– Risks and benefits

Community ResourcesCommunity Resources
 Adult day care
 Aftercare
 Congregate nutrition sites
 Friendly visiting
 Home health services
 Homemaker or chore services

Extended Care FacilityExtended Care Facility
 More homelike than before
 Requires certification from state agency
 May include
24-hour nursing services
– Supervision by physician
– Specialized services
– Hospital affiliation
 Help clients select long-term care facility
and know their rights

Assisted LivingAssisted Living
 More residential and social
 Alternative to institutionalization
 RN starts flow of resources
 Resident has more independence,
individuality, choice, and privacy
 Refer to information about assisted living
 Be aware some choose Geriatric Care
Management

Translocation Stress SyndromeTranslocation Stress Syndrome
 Physical and emotional deterioration as a
result of changes or movement
 Reduce impact
– Enlist understanding about need for move
– Allow elder to be involved in decision making
– Consult with agency staff about adapting
routines to accommodate client’s practices
– Encourage family and friends to visit and
communicate regularly

Well Elderly and Action GroupsWell Elderly and Action Groups
 Well elderly making contributions to
society
 Action groups organized among older
citizens through community projects
– Help isolated elderly
– Use surveys
– Influence federal and local planning

Future Trends in CareFuture Trends in Care
 Health care delivery
 Distribution of income over a long life span
 Sustaining adequate social involvement
 Coping with organizational systems
 Use of leisure
 Employment and attendant problems

Quality of CareQuality of Care
 Overcome ageism and look for wellness
 Use theories of aging
 Use verbal and nonverbal skills,
therapeutic relationship, and therapeutic
speech
 Work toward crisis resolution
 Use reminiscence and referral
 Involve family and significant other

Examples of Nursing DiagnosesExamples of Nursing Diagnoses
 Imbalanced nutrition
 Powerlessness risk
for ineffective
protection
 Risk for relocation
stress syndrome
 Impaired skin
integrity
 Distorted sleep
pattern
 Social isolation
 Impaired
swallowing
 Impaired urinary
elimination
 Impaired walking

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