Nur 344 Exam 1: Ch. 1, 2, 3,5,6

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Textbook: Toward healthy Aging

Gerontology

The scientific study of the effects of time on human development, specifically the study of older persons
Includes several decades before death

Early studies of Aging

Early studies of aging were primarily based on institutionalized elders and applied to the general population, often portraying older adults as frail, a burden on society, and non-productive in the later years of life

Geriatrics

the term Geriatrics was coined by American physician Ignatz Nascher (1900) when he realized medical care of older people involved special considerations
-Aging has been seen as a biomedical problem that must be reversed, eradicated, or held at bay as long a possible. Inevitably, aging has been seen through distorted lens of disease
-However, we are finally realizing that aging and disease are separate entities although frequent companions
-most older adults reguard themselves as healthy, active, even working until 70-80 and enjoy meaningful relationships with their families

Chronological age

Chronology is becoming a less significant factor to consider in aging
"old" is a relative concept based on how one acts and feels physically, mentally, socially, and culturally
Chronological age: years lived
*ADLs and fuctional age are a more essential measure of age than chronological age

Biological, physical, and social age

Biological age: age of organ systems
Physical age: how old one feels
Social age: roles and relationships

Categories of old age

Become a senior citizen at age 65

Categories of old age:
young-old: 65-74
middle-old: 75-84
old-old: 85+

Todays elders

The parents of the baby boomers/children of the Great Depression
Some immunizations were available, however, most of them had all of the childhood diseases: measles, mumps, chickenpox, whooping cough etc
Malnutrition was high among poor, dental care was neglected, "Pigeon's chest" a malformation of the rib cage caused by vitamin D deficiency was common

Notch Babies

born between 1917-1921
few in number at birth, even fewer survived childhood, adolescence, and WWII
War and patriotism molded childhood
Exercise was not valued
high abuse of alcohol and cigarettes
Motivated and worked hard to get out of poverty, focused on giving their children what they had missed

Nonagenarians

older than 90 (Nonagenarians)
the group is expanding of those who remain mobile and active
Raised families during great depression, few received higher education or completed grade school, farmers, factory workers, unemployment was high
*great hardship and lifestyle disruption, many came to america in childhood

Centenarians

"elite-old"
bright, alert, unequaled personal history
appear to he healthy for a longer period of time, however, almost 50% of centenarians are in nursing homes-in part due to absence of living children, spouses, siblings
most are female (85%) and come from families where longevity is common-however, more likely to have mental or physical disabilities than men

The future old

The baby boomers
first wave of baby boomers turned 65 in 2011
they are informed, educated, understand the importance of preparing for old age early, expect a higher quality life than their elders.
Many are caregivers to older generations and have a personal understanding of the needs of elders
their main concerns are: health, finances, job security, sending children to college, and caring for their parents

To plan for the retirement of Baby Boomers, we must consider:

their diversity
the uncertain political and economic future
potential major shifts in lifestyle expectations
changing health care delivery and medical reimbursements
progress in technology
shifts in values and ethics that will profoundly affect daily life

Sandwich generation

Baby boomers who are taking care of their elderly parents and raising their own children/supporting children who struggle to live independently on their own (boomerang children-continually return) at the same time

Living arrangements

majority 80+ live independently
florida has the highest population of those over 65

Who will care for an aging society?

America's elder are workforce is very understaffed and unprepared to care for growing numbers of older adults
Demand for gerontological nurses and other HC professionals is critical
the HC workers interested ad prepared for the elderly is low
*less than 1% of RNs and 6% of advanced practice nurses are certified in gerontology
Eldercare workforce alliance, a grp of 28 national organizations is addressing these concerns

Gerontological nursing

Emerged w/in the last 60 years
before 1950s, it was considered to be apart of general nursing and was not specialized
Origins of gerontological nursing began in England with Florence Nightingale when she accepted a position in the Institution for the Care of Sick Gentlewomen in Distressed Circumstances
Nightingale's concern for frail and sick elderly was continued by Agnes Jones-a wealthy Nightingale trained nurse
They both improved the care and reduced the costs of the institution
Gerontological nurses play an important role in research, innovation care, and provision of services to the growing population of older adults across the globe

Almshouses

US almshouses (privately financed home for the poor) had "deplorable conditions, neglect, preventable suffering, contagion, and death from lack of proper medical and nursing care
1906-Lavinia Dock and others addressed in the American Journal of Nursing (AJN) the needs of the elderly chronically ill in almshouses, immediate need for trained nurses and pupil education in almshouses
in 1925: ANA advanced the idea of a speciality in the nursing care of the aged

Social Security Act 1935

federal monies were provided for old age insurance and public assistance for needy older people not covered by insurance
Social security funds could not be used to pay for care in almshouses or other public institutions (due to fear of almshouse placement)
During the next 10 yrs, many almshouses closed and boarding homes providing care to elderly increased-retired and widowed nurses often converted their homes into living quarters and gave care when their boarders became ill (these nurses were considered the first geriatric nurses and their homes were the first nursing homes)

Sarah Gelbach

in 1943, she wrote an article in the AJN recommending that nurses should not only have an aptitude for working w/ the elderly but also a specific education

First nursing textbook

Published by Newton and Anderson in 1950
First published nursing research on chronic disease and the elderly (Mack, 1952) appeared in the premiere issue of Nursing Research

Division of Geriatric nursing

1966 ANA formed a Division of Geriatric nursing
the first standards were published by the ANA in 1968- geriatric nursing was the first to establish standards w/in the ANA
in 1976, the name was changed to Gerontological Nursing Division
In 1984, the Council on Gerontological Nursing was formed and established certification for GNPs: Gerontological Nurse Practitioner and GCNSs: Gerontological Clinical Nurse specialist
Schools of nursing now includes gerontological nursing content in curricula
Continued need to increase faculty numbers w/ preparation in gerontological nursing

Gerontological Nursing Roles

may be a generalist or specialist
works in a variety of settings: hospital, home, subacute and longterm care facilities, etc
Gerontological Nursing specialist has advanced preparation at the master's level and developed an advanced clinical expertise

Advanced practice Gerontological Nurses (APGN)

Mission is to preserve function, enhance health, and enhance quality of life and dying
demonstrated skills in health outcomes and cost effectiveness
positive outcomes: increased patient and family satisfaction, decreased costs, less frequent hospitalizations/emergency room visits, improved quality of health care
less than 6% of all advanced practice nurses are certified as GNP or GCNS

Demographics of Aging

65+ makes up 12.6% of the population
of these, 42.2% are males and 57.8% are females
85+ is now the fastest growing segment of the population

Life Expectancy

increase in expected life expectancy due to reduced death rates of children and adults, new drugs, medical technology, and better disease prevention

Race

African Americans: 70.2 years for men and 77.2 years for females
Hispanics in US outlive whites by 2.5 years and blacks by nearly 8 years
The US has a slight decline in mortality due to an increase in the uninsured population

Education

Between 1970-2008 77.4% of elderly completed high school
20.5% have Bachelor's degree or higher
The baby boomers are more educated than the current old-old and future generations will continue the educational trend

Income and Unemployment

Households held by someone 65+ have a median income of $44,188
people living below the poverty line was 9.7% in 2008
Highest poverty rates were experienced by older Hispanic women and older African women
the US has one of the highest poverty rates for older women among industrialized countries
Factors causing poverty among older women include: unequal pay, occupational segregations, caregiving responsibilities, longer life expectancies, rising health care costs, and women work pattern all reduce pension earnings, public assistance benefits, and personal savings
An increasing number of people over 65 are returning to the work force
those working between 55-64 is expected to rise 36.5%
*Economic necessity

Global Aging

Western Europe and Japan have more older people than younger people
US has high infant mortality rate
Number of older people in the developing world will double in the next 20 years
In Botswana, the life expectancy is 27
Around the world, 100 million older people live on $1 a day : poverty, hunger, and lack of access to basic life necessities are common in developing countries
HIV/AIDS
Global policies need to meet income, health, and long term care needs for men and women throughout the world

Alzhiemers

Since the establishment of the National Institute of Aging in 1971, the study of Alzheimer's disease had been awarded the largest share of research dollars for aging. it remains a primary area of research concentration, with a considerable focus on etiology, prevention, and medications that may halt or slow the progression of the disease

Nursing Research

Nursing research has significantly affected the quality of life of older people, federal funding is increasing
Some of the most important nursing nursing studies have investigated methods of caring for individuals with dementia, reducing falls, delirium, care transitions, and end of life care

Politics of aging

White House Conferences make recommendations to president and Affordable Care Act to help guide national aging policies
Patient Protection and Affordable Care Act 2010 has significant implications for health care delivery to older population
America is both a capitalistic and socialistic with healthcare moving into a high competitive marketing mode-life sustaining services are now designed for profit, although we simultaneously federally subsidize them

Health

the absence of disease
conformity to physical and mental norms indicates one's health status
the more observable the evidence, the more definite the degree of health that can be declared or the diagnosis that can be made

hollistic health movement

Dunn 1961:
Health in a holistic context is an integrated method of functioning that is oriented toward maximizing the potential of which the individual is capable within the environment in which he/she is functioning.
Holistic definition does not limit health to just its physical, mental, or social aspects but rather incorporates all these factors in the total picture

Population's health status

rely on life expectancy, morbidity, and death tables. These figures provide information about illness but does not reveal the extent to which the living are effected by these conditions or the health status. It does not consider that a person with health disorders, malignancies, and other conditions may function at a high level of wellness

Wellness

"Wellness is the best achievable balance between one's environment, internal and external, spiritual, social, cultural, and physical process"
-involves one's whole being: physical, emotional, mental, social, spiritual, and environments
-Person's definition of wellness must consider their cultural orientation-culture effects one's understanding of health and healthy behaviors

Wellness model

Refers to health as one aspect of wellness
suggests that every person has an optimal level of functioning for each position on the wellness continuum to achieve a good well being
If you are struggling with a chronic illness, you can still move toward higher level wellness is possible with support from others and motivation to find meaning in the situation
continuum rises and moves in positive direction

Health determinants

wellness model states that health is a consequence of multiple determinants: family, community, income, education, gender, race/ethnicity, place of residence, access to health care, exposure to toxins/pollutants

7 dimensions of wellness

1. physical: exercise, diet, avoidance of tobacco, drugs, alcohol
2. emotional: awareness and acceptance of one's own feelings and form interdependent relationships based on commitment, trust, and respect
3. spiritual: search for meaning and purpose in our lives, reflecting and connecting with universe
4. intellectual: expanding one's knowledge and skills through life
5. environment: caring for resources, creating living spaces, and practices that respect and support on the environment
6. occupational: doing something you love, contributing skills and talents to work that is personally meaningful
7. social: staying engaged in activities and relationships, making a better world for future generations

healthy aging

process of slowing down, physically and cognitively, while resiliently adapting and compensating in order to optimally function and participate in all areas of one's life
-multidimensional process and uniquely defined by each individual

Health in older adults

-for older adults, being healthy is characterized by the way an individual feels in context of illness, disability, and environment
-4 main components:
1. functional independence
2. self-care management of illness
3. positive outlook
4. personal growth and social contribution

Key strategies to improving health of older people

-healthy lifestyle behaviors
-injury prevention
-delivery of culturally appropriate clinical preventative services
-immunization and preventative screenings
-self management techniques for chronic illness

disability and chronic illness

the current generation of older people is generally healthier than earlier generations
-rates of disability are declining or stabilizing, but remain higher among racially and ethnically diverse older adults
- incidence of chronic illness increases with age, more than 80% of people over 70 experience at lease 1 chronic condition and 50% have multiple health problems
-most common chronic conditions are heart disease, HTN, cancer, arthritis, and diabetes
-prevention and management of chronic illness is a priority for HC professionals

Causes of Death

Heart disease, stroke, and cancer remain the leading causes of death
-Alzheimer's disease has surpassed diabetes as a leading cause of death
-genomic is involved in 9 out of 10 leading causes of death

4 preventable risk factors of death

smoking
High BP
Elevated glucose
obesity
*reduce life expectancy in men by 4.9 yr and women 4.1 yr
*only 4% of the population follows these healthy habits: diet, 30 min of exercise 5 days a week, no smoking

Physical health

-exercise
-change unhealthy diet and alcohol patterns
-participate in treatment and management of illness and disability
-use assistive devices and supports to maintain mobility

Psychosocial health

-adopt a positive attitude
-get priorities in order
-avoid dwelling on problems
-capitalize on previous success or participation in activities
-match activities with interests, needs, limitations
-express feelings or concerns
-have fun :)

Cognitive health

-learn new things
-take classes
-keep abreast of current events
-participate in activities

Interpersonal health

-volunteer
-join groups
-share expertise and experiences

Primary prevention of disease

*Prevention of a disease before it happens
-healthy lifestyle behaviors: regular exercise, no smoking, low fat diet etc)
-stress management
-active social engagement
-cognitive stimulation

Secondary disease prevention

*detection of a disease at its early stage
-evidence based screening guidelines developed for older adults
-patient protection and affordable health care act of 2010 has expanded coverage for preventative services under the Medicare program
-*any Medicare-covered service recommended with a grade A or B by the US Preventative Services Task Force must be fully covered by medicare with no cost-sharing for the patient.
-Annual wellness visits and personalized prevention plan
-personalized prevention plan includes health risk assessment, updated medical history, list of current providers providing care, list of meds, height, weight, bp, screening schedule for appropriate preventative services over 5-10 yr, and list of risk factors w/ treatments

Medicare Coverage preventative services

-one time "welcome to medicare" physical exam
-adult immunizations
-cardiovascular screening
-colon cancer screening
-breast cancer screening and mammogram
-pap test
-bone mass measurements
-diabetes screening/supplies
-glaucoma tests
-foot exams: those w/ diabetes

implications for gerontological nursing

gerontological nurses use holistic approach to enhance wellness in older people
-focus is maximizing strength, minimizing limitations, facilitating adaption, and encouraging growth for all older people
-**healthy aging does not mean absence of disease, it means achieving highest level of personal wellness no matter the health condition
-promote healthy behaviors and healthy development at every stage of life

Aging

defined chronologically or years since birth, however, every culture has its own definition of when someone becomes a senior citizen

Social aging

-determined by role ex: retiree, wise woman/man of clan, status of parent or grandparent
-Transition into the status of "senior citizen" may often be marked by ritual or celebration ex: invitations to join groups such as the American Association of Retired Persons (AARP) or qualifications for senior discounts
-People qualify for old age benefits at 65

Biological aging

referred to as senescence
exceedingly complex, genetically regulated, interactive process of change
*Expression of declining functional capacity of most basic structures in cells, which in turn affects functioning of organism

Cellular functioning

survival of any organism depends on successful cellular reproduction (mitosis)
-cells become increasingly complex, they accumulate damage resulting in errors seen in replication- these changes are visible in the traits we associate w/ aging
*Changes to cell that decrease ability to replicate attributed to aging

Programmed theories of Aging

Aging is the result of predictable cellular death
-the cell and organism have genetically determined life spans
*Hayflick limit or biological clock
-cells could be preserved indefinitely if kept at subzero temp and continue replication when thawed

Neuroendocrine Control or Pacemaker Theory

describes aging as programed decline in functioning of the nervous, endocrine, and immune systems. it is not the cells that die it is their ability to reproduce, a process referred to as "replicative senescence"

Immunity Theory

presents aging as programed accumulation of damage and decline of functioning of the immune system or "immunosenescence"
The damage is the result of oxidative stress
T-cells thought to be responsible for increasing age-related auto-immune disorders (immune system fights itself)

Error Theory

propose that the aging phenotype is the result of an accumulation of random errors in the synthesis of DNA and RNA. With each replication, more errors occur until the cells are no longer able to fully function and changes become visible

Wear and Tear Theory

one of the earliest theories of aging
proposes that the cell errors are the result of "wearing out" over time b/c of continued use.
Cells are aggravated by harmful effects of internal and external stressors-pollutants, injurious metabolic by-products, now known as free radicals
-A progressive decline in cellular function or increased cellular death

Cross-linkage Theory

describes aging as the result of accumulated damage from errors associated w/ cross-linked proteins
For unknown reasons, cellular glucose attaches to protein.
Initiated by blood glucose in process of glycosylation or glycation
Once attached, a chain of bonding or "cross-linking" between the protein and glucose causes them to be thick and stiff, forming AGEs: Advanced Glycation End-products
evidenced by stiffened joints and decreased skin elasticity

Oxidative Stress/Free Radical Theory

errors are result of random damage from free radicals
*Free radicals are molecules that contain unpaired ions and therefore an extra electrical charge. They exist momentarily but are highly reactive to molecules in the cell membrane. As free ion charge latches onto other molecules, damage occurs, especially to the membranes of unsaturated lipids such as the mitochondria
*mitochondrial DNA is most effected by charges

Epigenics

human genome project
how genes are are influenced by the environment, lifestyle, role, and other factors

Telomeres

Repeated sequences on chromosomes essential for cellular reproduction
Shorten with every cell cycle
Hypothesized to be contributory to senescence of the cells
Enzyme telomerase counteracts this effect
Manipulation of telomeres has potential to affect development and treatment of disease and aging itself

Promoting Healthy Aging Consistent with Biological Theories of Aging

Exercise on soft surfaces, use good body mechanic (Wear and Tear)
Avoid skin dryness and joint stiffening (Cross-link)
Avoid environmental pollutants and unnecessary radiation (Oxidative stress), second hand smoke,
Monitor research related to the effects of unsaturated fats and heavy metals on cell health (Cross-Link)
Monitor research on use and presence of antioxidants (Oxidative stress)
Avoid stress (Oxidative stress, Immunity)
Minimize the potential for infection: frequent hand washing, immunizations, avoid those who are ill (Immunity)

Role Theory

proposes the ability of an individual to adapt to changing roles over life course is a predictor of adjustment to personal aging.
As individuals evolve through the various stages in life, so so their roles. As one role is completed, another is taking place ex: a parent becoming a grandparent

Age Norms

culturally and socially constructed expectations of what is deemed acceptable behavior

Popular culture continues to challenge role theory and age norms
Older adults, both men and women, are assuming roles and behaviors unimagined when role theory first proposed

Activity Theory

Havinghurst and Albrecht 1953
activity is an indicator of successful aging, the focus is on the individual's need to maintain a productive life for it to be a happy one (life satisfaction and positive self-concept)
Popular because it is consistent with Western society's emphasis on work, wealth, and productivity

Disengagement Theory

proposed oposite of activity theory
the natural course of aging should slowly w/draw the individual from his/her former roles and activities to allow for the transfer of power to the younger generations.
Necessary for the maintenance of social equilibrium
Probably provided the basis for age discrimination
Challenged both socially and legally
Elder participation now considered beneficial to society

Continuity Theory

an individual tends to develop and maintain a consistent pattern for behavior, substituting one role for a similar one as a person matures
Personality influences role and activities we choose and level of life satisfaction
Successful aging associated with ability to maintain and continue previous behavior and role, or find suitable replacement

Age-stratification theory

proposed that social aging can be best understood by the consideration of an individual as a member of an age group, with similarities to the other group members
Goes beyond individual to age structure of society

Modernization Theory

attempts to explain the social changes that have resulted in the devaluing of both the contributions of elders and elders themselves.
The status and value of elders is lost when their labors are no longer considered usedful, kinship networks are dispersed, the information they hold is no longer pertinent to the society in which they live
Proposed that these changes are the result of advancing technology, urbanization, and mass education

Cohort effects

Experiences shared by a group of persons from an existential, chronological, or most often, historical perspective; i.e. active participants of World War II.
A powerful tool for understanding aging within a global context

Jung's Theories of Personality

Jung proposed a theory of the development of personality throughout life: childhood to old age
Personality is either extroverted and oriented toward external world or introverted and oriented to subjective inner world of individual
Aging is a movement from extroversion to introversion, beginning at midlife individuals begin to question their dreams, values, and priorities

Erikson

8 developmental stages
Theorized a predetermined order of development and specific tasks that were associated w/ specific periods across the life span
Successful mastery of one task is needed for movement to the next stage of maturity
task of middle age is generatively (contributing to future generations)
failure to accomplish this stage causes stagnation

Peck

proposed three discrete tasks that, when achieved, would result in an ego integrity or even maslow's self-actualization
1. ego differentiation vs role preoccupation: person no linger defines themselves by work role but individual personhood
2. body transcendence vs body preoccupation: body changes are accepted part of life vs area of focus
3. ego transcendence vs ego preoccupation: person sees self as part of greater whole rather than individual looking for attention

Maslow

hierarchy of needs
high levels can not be met w/out meeting lower level needs:
(5) Self-actualization: seeking, compassion, spirituality, fulfillment, finds satisfaction w/ role and level of activity possible, shares wisdom
(4) Self esteem: image, identity, control, composure, confidence
(3) Belonging: love, empathy, affiliation, support, companionship
(2) Safety and security: environmental safety, preventative health strategies, caution, planning, protection
(1) Biological and physiological needs: air, water, food, activity, healthy environment

Areas of Nursing Assessment Consistent with Psychosocial Theories of Aging

Currently held roles, role satisfaction, and emerging roles (Role)
Individual's and family's expectations of age norms and effect on self-esteem (Role)
Current level of activity and satisfaction with such (Activity)
Effect of changes in health on usual roles and activities (Role, Activity)
Cultural beliefs and expectations related to roles, activity, and both engagement and disengagement related to these (Role, Activity, Disengagement)
Usual life patterns and personality and attention to change as indication of potential problem (Continuity)

Areas of nursing assessment cont.

Knowledge of historical context of individual and potential influence on perception and responses (Age stratification)
Complexity of social support and network (Social exchange)
Opportunities for contributions of knowledge to society (Modernization)
Sense of self and self-worth (Modernization)
Ability to meet spiritual and existential needs (Gerotranscendence)

The Gerontological explosion

in the US, the % of people of racial/ethnic groups other than european white has greatly increased. It is projected that by 2050 people from the statistical minority will become the emerging majority. Not yet a majority, the current minority over 65 will increase to 42% in 2050
The greatest period growth will be between 2010 and 2030

Growth of Minority Groups in U.S. Population

1970: 16%
1998: 27%
2050: 50%

Health disparities of older adults

refers to differences in the state of health and in health outcomes between groups of people
Health inequity: excess burden of illness, Barriers to quality care range from those related to geographical location to age,
gender, race, ethnicity, sexual orientation
Those especially vulnerable: older women, men and women of color, and the poor
*people of color have difficulties receiving same care as whites

Examples of Health Disparities

African Americans (Compared with Whites)
50% more likely to have stroke
Transient ischemic attack: 62% fewer get anticoagulation
50% more likely to die of stroke
20% more likely to die of heart disease
1.5 times more likely to have hypertension
2.5 times more likely to have diabetes
30% more likely to have diabetes-related amputations

Reducing Health Disparities: Cultural awareness

Cultural awareness
Self-level: requiring self-understanding of one's experiences and values
Ability to work with and build relationships with a member from another cultural group
Recognition of factors beyond culture, such as health, safety, and poverty, that affect members of a cultural group
-by increasing awareness, nurses learn of their biases, prejudices, attitudes, and behaviors towards person different than themselves

Reducing Health Disparities: Cultural knowledge

Cultural knowledge
Both what nurse brings to caring situation and what nurse learns about older adults, their families, their communities, their behaviors, and their expectations
Essential knowledge includes elder's way of -life (ways of thinking, believing, acting)
-can minimize frustration and cultural conflict, allows nurse to more appropriately and effectively improve client health outcomes
-Should NEVER yield assumptions
-includes appropriate use of terms, race, culture, and ethnicity

Culture

shared and learned beliefs, expectations, and behaviors of a group

Acculturation

Acculturation: person from minority or marginalized culture adopts that of dominant or majority culture

Ethnicity

social differentiation based on cultural criteria

Orientation to Time

Concept and use of time is culturally constructed and has significant implications in the use of health care
Listen closely to the elder and find out which orientation has the most value to him or her and find ways to work with it rather than expect person to conform
future orientation: prevent today, ill people will make appointment in future, delay will not necessarily effect the outcome
present: believe treatment should begin when problem is perceived, prevention not appropriate
past: health in present based on past actions (some believe problems w/ ancestors and failure to preform rituals may cause illness)

orientation to family and self

white americans of european discent: highly value autonomy and individuality, identity bound to self first
familism: identity of a member of a collectivist culture is drawn from family ties, family is more important than the individual (aa)

intensity of relationship

High Context: he/she will inquire about nurse's health, family, work and nurse is expected to return same and appear genuinely interested in the person
address health care needs after
body language is more important than words
quality of relationship between nurse and person is more important than the needs of the person
Low context:
task oriented, relationship between nurse and pt has little significance

Cohort Effect

shared experiences w/ people of similar age, ethnic background, or country origin

Obstacles to cultural knowledge: Ethnocentrism

belief that one's own ethnic group is superior to that of another ethnic group

Stereotyping

the application of limited knowledge about one person w/ specific characteristics to other persons w/ the same general characteristics and in doing so, limits the heterogeneity of any group
-can limit understanding of the uniqueness of the individual and impose unrealistic expectations

Reducing Health Disparities

Appropriate use of communication and language is foundational skill and intimately tied to concept of self
Communication is issue not only of language but also of idiom, style, jargon, voice tone, inflection, body language
-interpreter: must have medical knowledge, keep sentences short, avoid metaphors, tell nurse word for word what pt says

Unspoken word

handshake, eye contact, use of silence

Gender: older women

older women are fastest growing segment of population, esp. those 85+
social status varies: women who live alone most likely white, never married, no children or outlived them or their husbands
older women at economic disadvantage
women live longer than their male cohorts and are subject to higher number of chronic disease

older men

*health issues main concern
lung cancer, COPD, prostate cancer, men die faster than women, black men have shortest life span

LEARN Model

L Listen to what the patient has to say
E Explain your perception of the problem
A Acknowledge the similarities and differences of perception
R Recommend a plan of action that takes into account both perspectives
N Negotiate a plan that is mutually acceptable.

Agism

Stereotyping and discriminating against people due to age.
Prevalent in the United States, where aging has a negative image
Ageist attitudes, myths, and stereotyping behaviors interfere with effective communication with older adults

Elderspeak

A form of ageism where speech patterns are changed based on assumption that older people have difficulty communicating and understanding.
Similar to "baby talk" that is used to communicate with very young children

Therapeutic Communication with Older Adults

Older adults may need more time to respond because they are drawing information from a larger life experience.
Listening carefully, clarifying, and patience are important communication strategies with older adults.

hearing Impairment

Underdiagnosed and undertreated in older adults
Most common communicative disorder of older adults
Third most prevalent chronic condition in older Americans
Screening for hearing impairment is an important aspect of physical assessment in older adults
Associated with:
Miscommunication
Depression
Falls
Loss of self-esteem

Conductive hearing loss

Conductive
Reduced ability of sound to be transmitted to inner ear
Cerumen impaction most common cause

Sensorineural hearing loss

Sensorineural
Hearing loss from damage to inner ear or neural pathways to the brain
Presbycusis most common form of hearing loss in the United States

Visual impairment

Blindness and visual impairment are major causes of disability in older adults
Associated with cognitive and functional decline, decreased quality of life, and depression
Associated with increased risk for injury and falls

Touch

Adaptively used for awareness and protective responses
Compensates for other sensory impairments
Intensifies bonding and defines boundaries of self
An important therapeutic intervention by nurses
Touch sensitivity diminishes with aging
Can predispose older adults to skin damage and development of pressure ulcers
Loss of thermal sensitivity can lead to burns and/or frostbite injuries
Adding texture to the older adult's surroundings can enhance safety and increase interaction with environment

Neurological disorders

Reception
Affected by anxiety, disease process, hearing deficits, and altered level of consciousness
Perception
Affected by stroke, dementia, delirium
Articulation
Caused most commonly by cerebral infarction with neuromuscular effects

Aphasia

Most common language disorder caused by cerebral infarction
Varying types depending on area of neurologic insult
Can cause profound communication difficulties and negatively impact quality of life
Speech therapy an important rehabilitative aspect of care

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