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Long- term communal living with other people who are strangers

requires a great deal of adjustment on the part of the resident. Feelings of lack
of control over self or environment can contribute to mental and emotional
problems in older adults, especially in the nursing home setting.

Loneliness and depression are also common problems for many nursing
home resident, especially among those with some degree of immobility and
those with few, if any visitors and no other support system.

Aging in Cross-Cultural Context


Defining the Elderly

Just as all societies classify individuals by socially important


characteristics (such as gender and kinship status), all societies also classify
persons according to age. For all current cultures for which data are available,
each has at least one category of “old”. However, the specific chronological
time at which a person enters this category of “old” varies widely among
different cultures, ranging from about 45 to 75 years of age. [Cogwill, DO: Aging
Around the World. Wadsworth, Belmont, CA, 1986.]]

In part, differences in the age at which people are considered results


variations in criteria that are used by societies for determining who is aged.
Four major dimensions are used either singly or, more often, in combination for
classifying persons as elderly. These are physical, functional, symbolic, and
temporal criteria.

Physical Criteria
Occasionally, a society will consider individuals as being old when they
manifest common physical traits related to aging such as gray hair, wrinkles, or
tooth loss. However, usually these physical criteria are used in combination
with other criteria.

Functional Criteria
In some societies, people are determined to be old when they can no
longer carry out their normal adult role functions. Generally this occurs in men
when they can no longer engage in productive economic activity; women are so
categorized when they can no longer accomplish household tasks.

Symbolic Criteria
A person may be defined as aged after the occurrence of some socially
symbolic event. Among several groups, a person is considered old when the
first grandchild is born.

Temporal Criteria
This classification is based on actual chronological age or, in age-graded
societies, on the chronology of one’s age- set.
Thus, a number of different methods exist for assessing and ascribing age.
Analyzing criteria from 57 countries around the world, Glascock and Feinman
[ Glascock, AP and Feinman, SL: Social asset or social burden: Treatment of the aged in non-
industrialized societies. In Fry, CL (ed)
(ed): Dimensions: Aging, Culture, and Health. Praeger, New
York,, 1981.] determined that the most common criterion was changed in social
role in combination with chronological age), followed by change in functional
status ( in combination with social role).

It is important to note that these criteria are not static. For example, in
1962 Samoans considered persons to be old when they were unable to care for
themselves or contribute to the welfare of the household. However, by 1976
many Samoans had become more chronologically oriented, indicating that old
age begins at age 60 or 65. [Holmes, L and Rhoads, E: Aging and change in Samoa. In
Sokolovsky, J (ed): Growing Old in Different Socities: Cross-Cultural Perspectives. Wadsworth,
Belmont, CA, 1983.] As societies change, so also do the criteria for classifying
persons as elderly.

Gerontological Nursing by: Mickey Stanley


Patricia Gauntlett Beare

Assessment Scales
The use of standardized questionnaires sometimes can be useful to
screen patients for depression, to help educate patients and caregivers about
depression, and to follow the course of depressive symptoms over time. A
number of instruments to measure depressive symptoms may be useful in the
primary care setting. For the most part, these questionnaires are sensitive but
not specific. Most persons with clinically significant depression score above the
recommended threshold, but many persons who score above the recommended
threshold do not have depression. If the cutoff score is set at a lower level,
more older patients are identified as being potentially depressed, but
evaluation is needed to determine whether clinically significant depression is
present.

Two questionnaires used to evaluate elderly persons for depression are


the 30-item Geriatric Depression Scale (GDS) and the 20-item Center for
Epidemiologic Studies Depression Scale, Revised (CES-D-R).

Geriatric Depression Scale


The GDS was constructed to eliminate somatic items, such as sleep
disturbance, that might not be specific to depression among older persons. The
GDS is commonly used to assess depression among older persons but may not be
valid when moderate cognitive impairment is present. The GDS is scored by
counting 1 for each answer corresponding to depressive symptoms. A score of
11 or greater indicated clinically significant depression. A short version of the
GDS consists of the 15 items from the same standardized set of questions. For
the short version, a score of 5 or greater may indicate clinically significant
depression.
Geriatrics By: Alan M. Adelman
Mel P. Daly

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