Transcript NURSING CARE OF THE OLDER ADULT THE AGING

NURSING CARE OF THE
OLDER ADULT
THE AGING EXPERIENCE
Chapter 2 (4th Edition)
PATI COX, RN, BSN, M.Ed.
OUTLINE
INTRODUCTION
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Definitions
Demographics – past/present/future
Impact of aging on nursing
Ethical considerations
ATTITUDES TOWARD AGING
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–
History
Ageism
Outline cont.
• The NORMAL AGING PROCESS
• Normal Physiological Changes
-All Systems
• Physiological Changes Not
Common to Aging
– Changes
– Common Chronic Diseases -4
– Common Causes of Death - 3
Names Synonymous with Aging
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“Oldster”
“Elderly”
“Golden Years”
“Twilight Years”
“Senior Citizens”
“Silver Haired”
“Grumpy”
“Sunset years”
Terminology
• Gerus – Greek for old
age
• Geriatrics – the
medical study of
older adults
• Gerontology – the
nursing study of the
older adult
• Senility – state of
being old ( mentally
& physically) not an
acceptable medical
diagnosis
• Senescence – process
of aging
• Aged – means old and
usually refers to those
over the age of 75
GENERAL INFORMATION
• Natural process
• Each of us move through
• Attitudes are changing about
aging with the “Baby Boomers”
• Issues that affect quality of life
are receiving more attention
Aging begins @
Birth
DEMOGRAPHICS
PAST
Demographics - Past
• Life expectancy
– 1776 - 35 years
– 1930 - 59.7 years
– 1965 – 70.2 years
• Confuscious – 1000’s of years
• Pioneers, Egyptians – youth to
young adult
• 1 in 10 could expect to live to 65
DEMOGRAPHICS
TODAY
TODAY’S AGED
• YOUNG OLD – 65-74
• MIDDLE OLD – 75-84
• OLD OLD – 85 +
(Fastest growing
population)
• Experiences –
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Great Depression
Antibiotics, Airplanes
Automobiles, Television,
Polio, Small Pox, TB
WWI, WWII, Kennedy,
Truman, Roosevelt,
Eisenhower
– King
“The Graying of America”
• Life expectancy has increased
dramatically
• 80% of American’s anticipate living to
65 or older
• 12.7% of total population
• 1 in every 8 Americans is 65 or older
• 65-74 age group is 8 times higher than
in 1900
• 75-84 age group is 16 times higher
• 85+ is 22 times higher-fastest growing
The Graying of America
• Life expectancy in 2005 is
anticipated at 76.9 years
– Females –
– Caucasian (79) other 74.9
– Males –
– Caucasian ( 72.9) other 67.2
– 2 million celebrated 65th birthday
(5574/day)
– Overall – 76.4 years
The Graying of America
• 50,545 persons 100 (+) in 2005
• 35% increase from 1990 (37,306)
“The Graying of America “ – Marital Status
• Marriage
80
– Older men 74%
– Older women 43%
– Almost ½ of all older
women were widows
(45%) 14% men
– 1 widower to 4
widows
70
60
50
40
30
20
• Divorced
– 8%
– #’s
Women
Men
10
Ma Wi Si
Di
0
Key: Ma= Married; Wi = Widowed;
Si = Single; Di = Divorced
The Graying of America - Income
• Average income was $19,168 = men
• Average income was $10,899 = females
• Households headed by 65+ average
income = $32,854
– Caucasians - $33,467
– African Americans - $27,952
– Hispanics - $24,330
Family Households 65+ Householder
$75,000 and over
13.9%
$50,000-74,999
14.5%
$35,000 - 49,000
18.4%
$25,000 - 34,999
Bar 1
19.4%
$15,000 - 24,999
21.7%
$10,000 - 14,999
8.1%
Under 10,000
4.0%
0
5
10
15
20
25
Poverty
• 3.4 million (10.2%) below poverty level in
2000
• Historic low was reached in 1999
• 2.2 million (6.7%) were classified as “near
poor”
• 1 of 12 (8.9%) Caucasian
• 22.3% African American; 18.8% Hispanics
• Older women (12.2%) Older men (7.5%)
• Living alone or living with nonrelatives –
highest poverty rate
• Highest poverty = Hispanic women living alone
or with nonrelatives (38.3%)
Employment
• 12.8% (4.2 million) 65 and over were
in workforce in 2005
• 2.4 mill. Men and 1.8 mill. Women
• 3 % of US Labor force
Education
• Educational level is
increasing
• High school grads
increased from 1970-2005
from 28% to 70%
• 16% had Bachelor’s
degrees or more in 2005
DEMOGRAPHICS
FUTURE
Future – “The Graying of America”
• By 2010-2030 = 20-22% =
70 million (twice # in 2000)
• Baby Boomers will reach 65
• Growth slowed somewhat in
the 1990’s due to the low
birth numbers in the Great
Depression – 1930’s
Future – “The Graying of America”
• Minority Population
– 25.4% of elderly population in 2030 (219%)
– 16.4% in 2000
– Caucasian – 65+ will increase 81%
– Hispanics – 65+ will increase 328%
– African Americans – 65+ will increase 131%
– American Indians, Eskimo – 65+ will
increase 147%
– Asian & Pacific Islanders – 65+ will increase
285%
Number of Person’s 65+ 1900-2030
80
70
60
50
40
30
20
10
0
1900 1960 1980 1990 2000 2010
2020 2030
Future – “The Graying of America”
• Factors that affect age
distribution of population
–Decreased mortality
• Better education, health, etc
–Decreased fertility
• Baby Boomer females marry later,
career oriented, fewer children
Impact on Nursing Care?
•What will
the impact
be?
Impact on Nursing
• Spend ¾ (75%) caring for the elderly
• Most nurses will be classified as a
“geriatric” nurse
• 65% of patients in acute care; 83%
home care; and 92% long term care
• 85 + will have greatest health care
needs
• Elderly will become more politically
active
• Will care for individuals with significant
histories & life experiences
Ethical Considerations
• ¼ of medical care $ is
spent in the last month of
life
• Treatment considerations
• Ethic committees to assist staff in
making difficult decisions ( not just in
hospitals, but in nursing homes, etc)
Attitudes Toward Aging
• History & Cultures
– Western – Embarrassed &
tolerance
– Eastern- Extended Family & well
respected
– Are we changing our attitudes
toward the aged?
What are
characteristics
of the Elderly ?
Ageism
Discrimination
against individuals as
they age or grow old
Forms of ageism
• Paternalism or Infantilism
– Talk to older adult as if child
– Refer to them as
• “sweetie”
• “honey”
• “dearie”
MYTHS or
TRUTHS
about the Elderly
How much do you really know about
the aged population?
What Did you use to BE?
“I still Am”
Trends Making Life Better
• Health Care
• Housing
• Education Aspects
• Advocacy Groups
Housing
•95% remain in
own home
•5% are
institutionalized
Living Arrangements
• Over ½ (55%) noninstitutionalized
persons live with spouse
• 633,000 Grandparents aged 65+
maintained households in which
grandchildren were present
• Institutionalized –
– 65-74 = 1.1%
– 75-84 = 4.7%
– 85+ = 18.2%
Housing in 2005
• 80% were owners – 20% renters
• The average year of construction of the
home was 1962
• Average value of homes in 1999 –
96,442
• 76% owned their homes free and clear
Living Arrangements – 65+
2005
Women
19%
40%
41%
Living with Spouse
Living Alone
Other
Living Arrangements 65+
2005
10%
MEN
17%
Living with Spouse
Living Alone
Other
73%
Geographical Distribution
• Approx. ½ (52%) of elderly live in 9 states:
– California; Florida; New York; Texas; Pennsylvania; Ohio;
Illinois; Michigan; New Jersey
• 14% or more of total population
– Florida Pennyslvania ;West Virginia; Iowa Rhode Island;
Maine; South Dakota; Arkansas
• States with Lowest Poverty Rates for Elderly
– Mississippi; Louisiana; District of Columbia; Alabama;
Tennessee; Arkansas; New Mexico; Kentucky; West
Virginia; New York; Texas
• Most elderly lived in Metropolitan areas = 77.5% while 23%
lived in nonmetropolitan areas
• Less likely to change residence than any other age group.
– When moving – most move to same city as children or
same state
Health , Health Care, Disability
• 26.1% elderly assessed their health as fair or
poor; little difference between sexes; ethnic
races rated their health much more fairer or
poorer than Caucasians
• In 2002, more than ½ (55%)of elderly
population reported with @ least 1 disability
• 4 times the # of days of hospitalization
• Average Length of Stay = 6 days (4.1 <65 yr)
• 11% spent on health care (5% < 65)
• More physician visits
Percent with Disabilities, by Age
80
70
60
50
40
30
20
10
% with
any
disability
% with
% need
severe assistance
disability
0
65-69
70-74
75-79
80+
Chronic Health Problems
• 28.8% reported a limitation
caused by a C.H.P (65-74)
• 50.6% of those 75 & older
reported they were limited due to a
C.H.P.
• Four most common C.H.P.
– Arthritis (53%)
– Hypertension (42%)
– Heart Disease (40%)
– Cataracts (23%)
Advocacy Groups
• Gray Panthers
– www.graypanthers.org
• AARP
– www.aarp.org
• Veteran’s
10 Leading Causes of Death
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Cancer
Heart Disease
Cerebrovascular Disease (Stroke)
Influenza, Pneumonia
Ateriosclerosis, Diabetes Mellitus
Accidents, Bronchitis, Asthma
Emphysema, Cirrhosis of Liver
Nephritis, Nephrosis