Geriatric Nursing at a Glance
Edited by Dr. Sasmita Das
Consortium eLearning Network Private Limited A-118, 1st Floor, Sector 63, Noida, U.P., 201301
Published in India in 2020 by NOLEGEIN A-118, 1st Floor, Sector 63, Noida, U.P., 201301 NOLEGEIN is an imprint of Consortium eLearning Network Private Limited Printed at LAXMAN PRINT O GRAPHICS C-293, Sector-10, Noida-201301 All rights reserved. No part of this book may be reprinted or reproduced or utilized in any from or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system without permission in writing from the publisher.
FOREWORD It is my pleasure to be a reviewer for the book Geriatric Nursing at a Glance edited by Dr. Sasmita Das. This is a novel book in the area of nursing and the readers will definitely gain new insights into geriatric nursing. I highly recommend this book and am sure it will add value to the nursing world. Dr. Pravati Tripathy Dean, SUM Nursing College, Bhubaneswar, Orissa
The content of the book has been organized keeping in view the needs of undergraduate and postgraduate nursing students and the nursing faculty. The book focuses on the main problems of the elderly including the common health problems encountered by them. Geriatric Nursing Practice is a challenge for the present day nurses, since the aged population continues to grow. The author has focused on the important issues faced by nurses during clinical practice. While taking care of the elderly we must have a holistic focus on body, mind and spirit. Dr. Das has focused on the cognitive aspects of aging, psychological aging, the client-centred approach, role of family and the role of nurses as caregivers. Prof. Amarita Lenka M.Sc.(Nsg) Delhi University, CTCM & MPHC (U.K.), Principal, KINS KIIT Deemed to be University, Bhubaneswar, Odisha
Geriatric Nursing at a Glance is undoubtedly a valuable book. It is very helpful for nursing students.
Prof. Anasuya Pattnayak, Principal, Dreams College of Nursing, Bhubaneswar, Orrisa
This is a comprehensive book and deals with the problems faced while managing geriatric clients in detail. It will help the nursing students as well as teachers and other health professionals in understanding and caring for the elderly. The book deserves a wide circulation. Tapati Saha Professor, Additional Dean & HOD Community Health Nursing, SUM Nursing College, Bhubaneswar , Orrisa
TABLE OF CONTENTS About the Editor Preface Acknowledgement
Chapter 1: Nursing Assessmentâ&#x20AC;&#x201C; History and Physical Assessment in Ageing
Chapter 2: Demography: Myths and Realities
Chapter 3: Concepts and Theories of Ageing
Chapter 4: Cognitive Aspects of Ageing
Chapter 5: Normal Ageing
Chapter 6: Age-Related Changes in Body Systems
Chapter 7: Psychosocial Aspects of Ageing
Chapter 8: Stress and Coping in Older Adults
Chapter 9: Common Health Problems and Nursing Management
Chapter 10: Medications and the Elderly
Chapter 11: Psychosocial and Sexual Abuse of Elderly
Chapter 12: Role of Nurses in the Care of Elderly: Ambulation, Nutritional, Communicational, Psychosocial and Spiritual
Chapter 13: Role of Nurses as Caregivers of the Elderly
Chapter 14: Role of Family and Formal and Non-Formal Caregivers
Chapter 15: Use of Aids and Prosthesis (Hearing Aids, Denture): Legal and Ethical Issues
Chapter 16: Provisions and Programs for the Elderly
Chapter 17: Programmes and Health Services: Home and Institutional Care, Issues, Problems and Trends
Glossary of Terms
Professor (Dr.) Sasmita Das Professor (Dr.) Sasmita Das is currently working as an Associate Dean at SUM Nursing College, Siksha Oâ&#x20AC;&#x2122; Anusandhan (deemed to be university), Bhubaneswar. She did her graduation in nursing from Government College of Nursing, Berhampur; post-graduation in Medical Surgical Nursing (CVTN) from West Bengal University of Health Sciences, Kolkata and Doctor of Philosophy from SOA (DTU), Bhubaneswar. The author has published many research articles in various national and international indexed journals and also presented empirical papers in national and international conferences.
PREFACE Geriatric care in India and other developing countries is in its nascent stage and needs to strike deeper roots if it is to flourish and prosper. This book is primarily intended for both the experienced and novice and geriatric care nurses to access necessary, to-the-point information that directly affects geriatric nursing practice. Many a student when he begins work in the geriatric field is in a quandary as to how he should go about in the geriatric field and this work is intended to provide him with the necessary guidance. The authorsâ&#x20AC;&#x2122; principal objective has been to briefly and clearly present some of the important issues they encountered in clinical practice. The text is unique and provides a foundation for care of elderly clients. The topics range from concepts of theories and cognitive aspects of aging to psychosocial aspects of aging, common health problems and client-centred nursing management, role of family for elderly people along with role of the nurse for caregivers of elderly and in using aids and prosthesis, provision and programmes for elderly privileges and home and institutional care of the elderly. The illustrations are distinctive as far as practicable in respect of both their nature and utilization. Improvement ideas in the chapter have been illustrated in order to facilitate and aid visualization of concepts. Each chapter presents specific questions that critical care nurses might ask and concludes with key points, bibliography and relevant internet sources. References have been cited to provide sources of additional information, which may be of interest to the reader. It is hoped that the book will benefit the readers, specially the undergraduate and postgraduate nursing students and the nursing students of diploma and post certificate courses also. Even the practicing nurses working in different healthcare settings can be benefitted in refreshing their knowledge and skill.
ACKNOWLEDGEMENT Each of the contributors from a variety of disciplines are acknowledged for their dedication and contributions to the care of geriatric clients and their families. Their expertise and hard work are evident in their chapters. I would also like to thank the patients and their families for taking part in community and clinical practices. They have been our best teachers and it is through our interactions with them, that we are reminded of the incredible knowledge that embodies geriatric nursing care. I am thus happy and pleased to congratulate the faculty of SUM Nursing College of SOA (DTU), Bhubaneswar for its joint efforts to bring up this book, which of course, was the need of the hour. I would also like to thank the publishers and authors for their contributions and the efforts they have made to trace copyright holders of the material printed in this book. Special thanks are due to the CCNE team (Mrs. Rekha Rani, Mr. Gourav Kumar, Ms. Akanksha Tyagi, Mr. Monil Arora), the layout and book cover designer (Mr. Gaurav Sharma), the Editor of the book (Mrs. Anubha Budhalakoti), and the promotion and marketing team for successfully launching this book in the market.
Nursing Assessmentâ&#x20AC;&#x201C; History and Physical Assessment in Ageing
Ms. Rashmimala Pradhan is currently working as an Associate Professor in Medical Surgical Nursing in SUM Nursing College, Bhubaneswar. She completed her graduation and post-graduation from Government College of Nursing, Berhampur. She has 16 years of teaching experience in nursing subjects at various schools and colleges of nursing and has published research articles in different national and international journals.
Chapter Contributed: Nursing Assessmentâ&#x20AC;&#x201C; History and Physical Assessment in Ageing
Geriatric Nursing at a Glance Learning Outcomes 1. 2. 3. 4. 5.
After completing this unit, you should be able to: Discuss the process of history taking of the elderly. Explain the methods used in assessing the elderly patients. Describe the various types of problems among the elderly people. Use a comprehensive geriatric assessment tool. List out the considerations required for the older people.
INTRODUCTION History remains the foundation of nursing care for the geriatric patient. History and physical assessment of older people is multidimensional. A multidisciplinary approach is used to evaluate an older personâ&#x20AC;&#x2122;s functional ability, cognition, mental health, physical health and socio environmental circumstances.
STRUCTURE OF HISTORY TAKING General principles Interviewing techniques Socio-demographic data Chief complaints (with durations) History of present health condition (illness) History of past illness Family history (blood relatives) Personal and social history
HISTORY TAKING General Principles of History Taking To gather a complete and accurate history by seeking active co-operation. Skill in interviewing affects both getting correct information and quality of Page 5
Nursing Assessmentâ&#x20AC;&#x201C; History and Physical Assessment in Ageing the relationship with the patient. The purpose of the interview is explained which encourages an exchange of information between the nurse and the elderly patient. The patient must understand the questions asked by the nurse. Interviewing Techniques Provide privacy and a quiet place as much as possible and see that the patient is comfortable. With a courteous greeting, begin the interview. Body movements, facial expressions and tone of voice should be pleasant, non-judgemental and unhurried. Behave like a sensitive listener. Avoid re-assuring the client prematurely. It may be necessary to probe the patient for obtaining more information through history. Write all the information in a chronological order (Nettina, 2010).
Figure 1.1. History Taking Through Interview. Page 6
Demography: Myths and Realities
Krishna Kumari Samantaray is currently working as an Assistant Professor in SUM Nursing College, Siksha Oâ&#x20AC;&#x2122; Anusandhan (deemed to be university), Bhubaneswar. She did her graduation in nursing from SUM Nursing College, Bhubaneswar and post-graduation in community health nursing from SUM Nursing College, Bhubaneswar.
Chapter Contributed: Demography: Myths and Realities
Geriatric Nursing at a Glance
1. 2. 3. 4. 5. 6.
Learning Outcomes At the end of the chapter, the students will be able to: Define aging demographics. Explain the scope of demography. Discuss the importance of demography. Define macro demography. Identify the demographic facts of aging. Describe the myths and realities related to the elderly.
INTRODUCTION Aging is a compulsory phase that comes in every individual’s life. Ageing, in an individual is an observable outcome of the development of demographic evolution. As a result of this unavoidable progression, the developed countries of the world have already experienced its impact and the developing countries are going to face the same view and results. Countries towards development have more old aged people because these countries contribute to the growing population (Barik and Arokiasamy, 2013).
CONCEPTS Demography is one of the branches of social sciences which deals with the statistical study of population. It involves the study of the composition, size and distribution of population in response to birth, the aging process, death and migration. Demography is the most essential component that determines the changes in the population. It describes the population at various levels: local, regional, national and global. Demography is derived from two Ancient Greek words, demos meaning ‘the people’ and graphy means ‘measurement’ Wikipedia, 2018..... Page 61
Demography: Myths and Realities DEFINITIONS Demography is ‘the study of statistics such as births, deaths, income, or the incidence of disease, which illustrate the changing structure of human populations’. Oxford, 2018..... Demography deals with the ‘systematic study of human population, in response to their structure, size and their growth’.
Van De Walle, Multilingual Demographic Dictionary, 1982... In the view of Frank Lorimer, ‘Demography includes both demographic analysis and population studies. A broad study of demography studies involves both qualitative and quantitative aspects of population.’ Divisha, 2017..... ‘Demography is a numerical study of the size, composition, division of human population and their obvious outcome throughout the lifetime by the compulsory processes in response to fertility, mortality, marriage, morbidity, migration and social mobility’. Donald J. Bougue.....
DEFINITION OF AGING DEMOGRAPHICS Aging It is defined as the progressive and comprehensive impairment of functions of the body resulting in loss of adaptive responses and in a growing risk of all ageing associated disease. Kirkwood, 1996..... Demographic aging is otherwise known as aging in population, it refers to the distribution of the old-aged in a population. Mannivannan, 2017.....
SCOPE OF DEMOGRAPHY Demography describes the wide range of studies about the statistical description and analysis of the human population which includes size, Page 62
Concepts and Theories of Ageing
Ms. Sujyotsna Jena is currently working as an academician in SUM Nursing College, Siksha ‘O’ (deemed to be university), Bhubaneswar. She did her Graduation in Nursing from Cuttack College of Nursing, Cuttack and post-graduation in Medical Surgical Nursing (Cardiovascular and Thoracic Nursing) from SUM Nursing College, Siksha ‘O’ (deemed to be university), Bhubaneswar.
Chapter Contributed: Concepts and Theories of Ageing
Geriatric Nursing at a Glance
Learning Outcomes 1. 2. 3. 4.
Understand the dimensions and concepts of ageing. Identify the different theories of ageing. Analyse the diversities of growing age. Apply the gained knowledge in the field of elderly care.
INTRODUCTION ‘Ageing’ is a phase which every individual faces in their life. The process of ageing begins right from birth and ends with death. After completion of the active growth period under hormonal influence, human beings enter the adulthood phase when growth is replaced by metabolic equilibrium between anabolism and catabolism. Although aware of these unpleasant natural changes occurring throughout one’s life every human being wants to preserve youth. Scientists, health personnel, specialists, sociologists, psychologists’ individuals, all have been trying to understand this process of ageing; some with an effort to understand the society and some with an effort to preserve youth. In this process, many have tried to define ageing. With changing concepts, many theories have evolved to define growing age. The study of ageing has been termed as gerontology. Gerontologists have defined ‘ageing’ as the changes that accumulate throughout the lifespan. Ageing can also be defined as the gradual progressive functional decline of an individual through each passing year of one’s life (What is Aging? Definitions and Concepts in Gerontology, no date). Ageing adults encounter physiological, psychological, social and economic challenges. Declining physical and cognitive functioning may necessitate supportive care which drains financial resources and ability. Coping with retirement, role changes, losing loved ones, declining quality of life, increasing disability, pondering death are few of the challenges faced by an ageing adult (Lange and Grossman, no date). This chapter will help to understand the different concepts and identify the major theories of ageing. This will help to analyse and understand the diversities Page 81
Concepts and Theories of Ageing of old age and the changes occurring in various levels, hence facilitating in the field of elderly care.
CONCEPTS OF AGEING Multi-Dimensional Ageing Ageing is multi-dimensional, but according to gerontologists, age and ageing have at least four dimensions. The most common and discussed dimension is chronological ageing. Ageing starts soon after birth and the number of years that have passed since someoneâ&#x20AC;&#x2122;s birth is the chronological age. The second dimension is biological ageing. It refers to the physical and physiological changes accumulated throughout oneâ&#x20AC;&#x2122;s life. The third dimension refers to psychological ageing. It includes mental functioning and personality as we age. The fourth dimension is social ageing. It refers to the changes in the social role and responsibilities within the family, relatives, friends, work place and society that take place as we age (Gerontology and the Concept of Aging, 2016). Depending upon the various dimensions of understanding ageing, various concepts and theories have been put forward. Ageing â&#x20AC;&#x201C; an Evolutionary Contradiction Ageing or senescence is a condition of physiological function deterioration with advancing age, characterised by increase in mortality and decrease in fecundity. According to a leading hypotheses, an increasing risk of death due to environmental causes is determined by molecular and cellular level damage repairs that accumulate over time and the combination of limited resources. Hence, selection favours the traits that empower the early life performance of an individual although the same traits may negatively change in advancing age after passing on the traits to the next generation (Kirkwood, 1977; Williams, 1957). Scientists and philosophers have struggled to solve the ageing mystery for centuries. In 1889, August Weismann formalized the modern theoretical framework of the mechanisms of Darwinian evolution. He suggested that selection favours the evolution of death mechanism ensuring survival of species by making space for the next generation. With passing years these theories were proved wrong as long-lived individuals produced more offsprings than shortlived individuals. Later in 1940s and 1950s, evolutionary biologists argued that Page 82
Cognitive Aspects of Ageing
Neethu Maria Joseph is currently working as an Assistant Professor in SUM Nursing College, Siksha Oâ&#x20AC;&#x2122; Anusandhan (deemed to be University), Bhubaneswar. She did her graduation in nursing from Government College of Nursing, Thiruvananthapuram and post-graduation in Medical Surgical Nursing (Neurosciences Nursing) from Manipal College of Nursing, Manipal.
Chapter Contributed: Cognitive Aspects of Ageing
Geriatric Nursing at a Glance
Learning Outcomes 1. 2. 3. 4. 5. 6. 7. 8. 9.
At the end of the chapter, the students will be able to: Describe the factors affecting cognition in elderly. Explain the normal changes in cognition in elderly. Define Mild Cognitive Impairment (MCI). Discuss the etiology and pathophysiology of MCI. Define dementia. Discuss the etiology and pathophysiology of dementia. Identify the various techniques used to assess cognitive impairment. Describe the management of patients with cognitive impairment. Formulate nursing care for the patient with cognitive impairment.
ABSTRACT Cognitive ageing refers to the changes in the cognition of the elderly due to increasing age. Normally, ageing negatively affects memory, attention, perception and executive functions, although much changes do not occur in the domain of language. These changes vary from individual to individual and the main risk factors are supposed to be genetic, lifestyle changes, cerebral changes, inflammation, psychiatric morbidity and dietary pattern. Pathologically, ageing can lead to mild cognitive impairment (MCI) and dementia. Measures need to be taken to prevent and reduce the impact of impairments so as to help them cope with cognitive ageing.
INTRODUCTION With age, body system functions start to deteriorate. Owing to the structural and functional changes in the brain, it is common in an elderly person to develop impairments in movement and coordination, sensory perception, cognition and executive functions (Tobergte and Curtis, 2013), including problem-solving, behavioural modification, strategic planning or decision making (Elliott, 2003). Page 107
Cognitive Aspects of Ageing Cognition consists of six main domains: memory, attention, planning and abstract reasoning, language, perception and psychomotor skills (Eysenck, 2006). Cognitive ageing is a term that refers to the changes in the cognitive functions of an elderly. Some of the mental functions start to decline from adolescence and some of them show very little decline throughout the lifetime. The normal as well as pathological changes in cognition will be discussed in this chapter.
EPIDEMIOLOGY OF COGNITIVE IMPAIRMENT Globally, it is estimated that the number of persons with dementia will reach 75.63 million by 2030 and 135.46 million by 2050 (WHO, 2015). In 2001, 60.1% of the people with dementia were from developing countries. It is projected that this number will be increased to 71.2% in 2040 (Ferri and Prince, 2005). . According to the Alzheimer’s Association, more than 4 million population in India suffers from some form of dementia. Different studies have been done countrywide to assess the prevalence of dementia. Among the rural population, it was found to vary from 0.84 to 3.39%. Studies among the urban population in different regions revealed that prevalence in western India was 2.44–4.1%, in northern India 1.83%, in eastern India 0.8–1.28% and in southern India 3.6% (Das, Ghosal and Pal, 2012).
RISK FACTORS AND PROTECTIVE FACTORS AFFECTING COGNITION IN ELDERLY Cognitive decline is not the same in all individuals. It varies from one person to the other. The age of onset of cognitive decline differs among individuals. In some persons, memory deficit can be seen towards the late 60s, but some might have a good memory even in their 80s. Also, there might be differences in the cognitive domains that are affected. Some might find it difficult to make prompt decisions, others might face trouble in paying attention to details (Deary et al., 2009; Glisky, 2007). Page 108
Mrs Kalyani Rath is an Associate Professor at the Kalinga Institute of Nursing Sciences, KIIT (deemed to be university), Bhubaneswar, Odisha. She has completed her masters in obstetric and gynaecological nursing from Berhampur University. She has 18 years of teaching experience in various colleges and schools of nursing in different parts of India. She has published research articles in various national and international journals.
Chapter Contributed: Normal Ageing
Geriatric Nursing at a Glance
Learning Outcomes 1. 2. 3. 4.
This chapter is designed to enable the students to learn Basic concepts of ageing. Explain the theories of ageing. Identify major physiological, cognitive, psychological, moral and spiritual changes. Describe common myths and stereotypes that perpetuate ageism.
INTRODUCTION Biological ageing is the continuous decline of functional activities in meeting the gradual demands in the course of time. Accumulation of damage at the cellular level results in biological ageing which is determined by many factors such as environmental, biological, psychological and genetic. Loss of function leads to imbalance of homeostasis and decreases the ability to adapt to internal and external stress which tends to increase the vulnerability to disease and death. Ageing is the result of a damage accumulation process at the cellular level and molecular level. This process occurs throughout life. Ageing can be defined as decreased functional activities at the cellular, tissue and organ level. Biological ageing is also known as senescence. Senescence refers to cellular senescence when an individual enters into middle age. The onset of ageing is influenced by biological, physiological and environmental and social factors. It is very difficult to define ageing. It is just a part of a life cycle. The ageing process does not start at the same time for everyone. Ageing is not a pathological condition; it is a fact of life.
POPULATION DISTRIBUTION Ageing of Population Most evolutionary biologists define ageing as an age-dependent or ageprogressive decline in intrinsic physiological function leading to an increase Page 139
Normal Ageing in mortality rate and decrease in age-specific reproductive rate (Flatt, 2011; Medawar, 1955; Rose, 1991; Tatar, 2001). Ageing of the population is one of the indicators of socio-economic development of a society. However, an ageing population is a matter of concern because with ageing there is breakdown in independence, that is the individual gradually becomes dependent physically, functionally, socially and economically. The breakdown in independence varies with each individual depending upon various socio-economic and cultural factors from within and outside the individual, family and society. World Population In the 50 years ranging from 1950 to 2000, the world's elderly population (60 years of age and above) had increased from 200 million to 603 million or from 8 to 9.9 percent of the total world population. According to the United Nations medium-variant predictions, there would be steady and rapid increase in the elderly population in the world. The proportion of the elderly population is expected to increase from 9.5 percent in 1955 to 14.6 percent in 2025. In absolute numbers, it will increase from 542 million in 1995 to 1170 million in 2025. Of these, more than 50 percent of them would be living in developing countries. It is estimated that by the year 2020, 700 million elderlies will be found in developing countries. Currently, there would be about 671 million elderlies in the world. Among the elderly population the number of people aged 80 and above is increasing very fast. It has increased from 13 million in 1950 to 61 million in 1995. According to a UN projection it would further increase to 1054 million by 2150. This rising trend is seen all over the world but most of the worldâ&#x20AC;&#x2122;s elderlies are living in the developing countries. SEARS Ageing Population During the 1980s and 1990s life expectancy at birth in most of the member countries of the South East Asia Region of WHO (SEAR) has increased steadily. In 1983, only three out of 10 member countries had reported 60 years of life expectancy at birth, whereas in 1997, 7 out of 10 had reported life expectancy above 60 years. It was estimated that the proportion of elderly people (60 years of age and above) in SEAR countries would increase from 1.7 percent in 1995 to 3.1 percent in 2025. The absolute number of elderlies would increase from 98 million in 1995 to 251 million in 2015. Page 140
Age-Related Changes in Body Systems
Neethu Maria Joseph is currently working as an Assistant Professor in SUM Nursing College, Siksha Oâ&#x20AC;&#x2122; Anusandhan (deemed to be university), Bhubaneswar. She did her graduation in Nursing from Government College of Nursing, Thiruvananthapuram and post-graduation in Medical Surgical Nursing (Neurosciences Nursing) from Manipal College of Nursing, Manipal.
Chapter Contributed: Age-Related Changes in Body Systems
Geriatric Nursing at a Glance
Learning Outcomes At the end of the chapter, the students will be able to 1. Explain the changes in the cardiovascular system in the elderly. 2. Explain the changes in the respiratory system in the elderly. 3. Describe the changes in the central nervous system in the elderly. 4. Explain the changes in the gastrointestinal system in the elderly. 5. Discuss the changes in the genitourinary system in the elderly. 6. Describe the changes in the endocrine system in the elderly. 7. Explain the changes in the integumentary system in the elderly. 8. Describe the changes in the musculoskeletal system in the elderly. 9. Explain the changes in the hematopoietic system in the elderly. 10. Explain the changes in the reproductive system in the elderly.
INTRODUCTION` As a person passes through infancy, childhood, adolescence, adulthood and old age, the body undergoes massive changes. Even though these changes are inevitable in human life, the intensity of these changes varies from individual to individual. All the body systems are affected as their functional capacity is reduced gradually, thus decreasing the working efficiency. With the general decline in bodily functions, degenerative diseases and occurrence of cancer is increasing. The specific changes that occur in each of these body systems in a normal ageing adult will be discussed in this chapter.
CARDIOVASCULAR SYSTEM Common cardiovascular diseases associated with aging are hypertension and coronary artery disease (CAD). However, even in healthy ageing, changes occur in the structural and functional aspects of the heart and vasculature. Page 161
Age-Related Changes in Body Systems Structural Changes in the Heart Increased cardiac mass is observed in the elderly. This might be attributed to left ventricular hypertrophy (Ferrari, Radaelli and Centola, 2003; Jackson and Wenger, 2011). Although, in general, there is reduction in the number of cardiac myocytes due to necrosis and increased susceptibility to oxidative stress (North and Sinclair, 2012), the remaining cells of the myocardium undergo hypertrophy (Jackson and Wenger, 2011). As a result, there will be increase in thickness of the ventricular myocardium (Strait and Lakatta, 2012). There will be loss of cells from the sinoatrial (SA) node and Bundle of His due to apoptosis. However, the number of cells in the atrioventricular node is not altered (Cheitlin, 2015). Myocardial fibres and specialised fibres constituting the Bundle of His undergo fibrosis. Along with fibrosis, calcification is also a noted alteration (Cheitlin, 2015). This leads to reduction in the compliance of ventricles causing left ventricular dysfunction (Jackson and Wenger, 2011). Old heart • Oxidative stress • Cardiomyocyte • Fibrosis • Necrotic/apoptotic cells • Ischemic area • Senescent progenitor and myocyte hypertrophy
Figure 6.1. Structural Changes in the Heart in the Elderly. Page 162
Psychosocial Aspects of Ageing
Miss Smita Manjusha Das is an M.Sc. in paediatric nursing. She has vast experience in clinical practices and teaching. Currently she is working in Sum Nursing College, Bhubaneswar. She has published various articles in national and international journals. She has lifetime membership of TNAI and SOMI. She has attended and organized various workshops, seminars, symposiums and conferences at the national and international level.
Chapter Contributed: Psychosocial Aspects of Aging
Geriatric Nursing at a Glance Learning Objectives 1. 2. 3. 4. 5.
This chapter is designed to enable the reader to Define the aging process. Explain the psychosocial theory of aging. Describe the psychosocial dysfunction due to aging. Determine the psychosocial problems in the daily life of old aged persons. Describe the role of nurses to promote the psychosocial adaptation of the old aged persons.
INTRODUCTION Psychosocial refers to the interrelation between the social factor and individual thought and belief. Aging is a process of life. Psychosocial reflects the ability of older individuals to adapt to physical, emotional and social losses and to get satisfaction in life. According to Abraham Maslow’s human need theory there are five stages of need that is physiologic need, safety and security, love and belongingness, self-esteem and self-actualization. Elderly persons are self-actualized persons who have autonomy, independence and integrity. Psychological traits differ from age to age. Most elderly people seem to be most vulnerable to psychological dysfunction when they experience change. Affective function refers to the mood and emotions (such as happiness, sadness, fear, pain, anger and confusion). Cognitive function refers to memory, learning and intelligence. Cognitive and affective functioning affect the person’s self-esteem.
PSYCHOSOCIAL DEVELOPMENTAL THEORY There are various theories to represent the psychosocial development of aging. They are 1. Erik Erikson’s psychosocial theory 2. Disengagement psychosocial theory 3. Activity psychosocial theory 4. Continuity psychosocial theory 5. Socioemotional psychosocial theory Page 189
S. No. 1.
Nine postulates have been developed by Henry and Cumming and they are follows:
yy In 1961 the disengagement theory was developed by social scientists Elaine Cumming and William Earle Henry. yy This theory proposed that the old aged people will withdraw from every interaction and relationship in their system. yy Disengagement Theory of Aging Postulates:
Name of the Theory Description Erik Erikson’s theory yy It was proposed in the 20th century. yy According to Erikson, personality development occurs in eight stages from birth to old age. yy According to him the psychosocial development that occurs among old is ‘integrity vs. despair’. yy Old people feel proud of their achievement and develop a sense of integrity but when they became a failure or are unsuccessful they think their life has been wasted and this gives rise to a sense of despair. yy Coping is a very important skill for the aging process so as to move ahead in life and not be ‘stuck’ in the past.
Psychosocial Aspects of Aging Table 7.1. Psychosocial Theory of Aging (Smith, 2015)