Transcript Chapter 30
Chapter 30Aging Clients with Psychosocial Needs Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Elderly Americans are the fastest growing segment of the American population. The likelihood that an American who reaches the age of 65 will survive to the age of 90 has nearly doubled over the past 40 yearsfrom just 14% of 65-year-olds in 1960 to 25% at present. By 2050, 40% of 65-year-olds are likely to reach age 90. Experience Corps, 2009 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives After studying this chapter, you should be able to • Differentiate between the primary (intrinsic) and the secondary (extrinsic) factors influencing the aging process • Articulate Duvall’s developmental tasks of aging • Compare and contrast the more common psychiatric– mental health disorders among Native Americans, African Americans, Hispanic, Asian American, and Arab American elderly • Describe at least four patterns of behavior or emotional reactions that elderly clients exhibit as a result of experiencing despair Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives (cont.) • Recognize failure to thrive • Identify at least three causes of loneliness in the elderly • Compare and contrast dementia and dementia syndrome of depression • Explain the elements of a comprehensive assessment of geropsychiatric clients • Identify provider-, client-, and illness-related barriers to the assessment of elderly clients Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives (cont.) • Discuss the rationale for prescribing low doses of psychoactive agents for elderly clients • Explain the purpose of life-review process and reminiscence • Develop a list of nursing diagnoses commonly used when planning care for elderly clients ineffectively coping with the psychosocial aspects of aging • Plan nursing interventions for elderly clients who, according to Maslow’s theory of motivation, demonstrate basic needs for survival, safety and security, love and belonging, self-esteem, and selfactualization Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Etiology of Aging • Primary, or intrinsic, factors of aging: – Gender – Culture, ethnicity, and race – Intelligence and personality – Familial longevity – Genetic influences • Secondary, or extrinsic, factors Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Developmental Tasks of Aging Compare the completion of these tasks by groups such as elderly Native Americans, African Americans, Hispanics, and Asian Americans (Asians and Pacific Islanders): • Establishing satisfactory living arrangements • Adjusting to retirement income • Establishing comfortable routines • Maintaining love, sex, and marital relationships Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Developmental Tasks of Aging (cont.) • Keeping active and involved • Staying in touch with other family members • Sustaining and maintaining physical and mental health • Finding meaning in life Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Psychodynamics of Aging • Anxiety • Somatic complaints • Loneliness • Paranoid reactions • Guilt • Dementia • Late-life depression • Delirium Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nursing Process • Assessment • Nursing diagnoses • Outcome identification • Planning • Implementation • Evaluation Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment • Assessment setting • The interview • Assessment tools Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Special Assessment Concerns • Pain • Polypharmacy • Sleep–rest activity (insomnia) • Involuntary weight loss Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Barriers to Assessment • Provider-related barriers • Client-related barriers • Illness-related barriers • Transcultural considerations Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Diagnoses • Acute confusion • Adult failure to thrive • Anxiety • Ineffective coping • Disturbed sleep pattern • Ineffective health maintenance • Risk for loneliness • Powerlessness • Risk for relocation stress Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Outcome Identification Outcomes generally focus on the following: • Issues of loss or grief • Social isolation • Alteration in affect or mood • Low self-concept • Changes in behavior or cognition • Special concerns related to pain, disturbance in sleep– rest activity, and involuntary weight loss Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Planning Plans of care are developed that help achieve the following: • Maximize the older person’s independence • Assist with the basic human needs • Meet emotional needs • Maintain life with dignity and comfort until death Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation • Assistance with basic human needs • Need for survival • Pain management • Stabilization of sleep–rest activity • Interventions for involuntary weight loss Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation (cont.) • Need for safety and security • Need for love and belonging • Need for positive self-esteem • Need for self-actualization – Life-review process – Reminiscence – Grief work – Psychotherapy Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation (cont.) • Medication management – Adverse effects – Drug–drug interactions • Continuum of care – Assisted-living facilities – Adult daycare centers – Community mental health centers – Senior centers Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Evaluation The elderly client who responds to nursing care will demonstrate the following: • Positive outcomes without interference of barriers • Meeting of psychosocial needs • Family or a significant other involvement Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Key Terms • Aging • Polypharmacy • Dementia syndrome of depression • Primary aging • Ego preoccupation • Ego transcendence • Failure to thrive • Reminiscence • Secondary aging • Self-actualization Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Reflection According to the Experience Corps, by the year 2050, 40% of 65-year-old elder adults are likely to reach the age of 90. • What variables influence this increased lifespan? ? Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins