PSYCHOSOCIAL-CARE IN ELDERLY:( COGNITION AND PERCEPTION)

There are several beliefs about older adults that are generally not true. They are:
1.Old people are sick and disabled.
2.Most old people are in nursing homes.
3.Senility comes with old age.
3.Old people are unhappy.
4.Old people get very tranquil or very cranky.
5.Old people are not interested in sex and are not able to have sexual
intercourse.
6.There are few satisfactions in old age.
7.By age 70, psychological growth is complete.
Nursing Care/Interventions

1.Learning about a patient’s family, work, hobbies, achievements, and life experiences.
2.Listening to patients sincerely with interest.

3. Building on lifelong interests and offering new activities/experiences for pleasure.

4. Accepting the patient’s discussion of their regrets and dissatisfactions.

5. Using humor to lighten the moment. Remember, humor must be appropriate

How Decline in the Five Senses Impacts Older Adults’ Ability to communicate:

Sight
Many changes happen to the eye with aging.

The iris, (a muscle which controls the size of the pupil) hardens, the lens yellow, and
depth perception and ability to focus are not accurate.

These changes require better lighting without glare, limited use of colors such as blues,
greens, and violets, and greater awareness of heights of curbs and steps.

Older persons may be unstable when first getting up, or may have problems with gait or
balance due to vision changes. Because of these changes, patients who wear contact
lenses or thick glasses may not see very well. You can help by:

1.Identifying yourself each time you enter a resident’s room, because he or she may not
be able to clearly see you.
2.Providing extra-large type on calendars or books for those residents needing these
aids.
3.Writing things down in large, clear lettering using a dark-colored pen on white or light
yellow paper.
4.Making sure residents wear their glasses when they are awake.
5.Telling residents when you move an object from a familiar place.
6.Describing the location of food on the plate as if it were a clock when serving food.
7.Using color contrasts to make images stand out.

8.Identify edges of steps with contrasting floor color.

Hearing:
 Hearing loss is often progressive with aging.
 High frequency sounds are the first to be lost. Some patients wear hearing aids.
 Others either cannot or will not wear them. Some are totally deaf.
 These changes require the caregiver to communicate in different ways.
  Some examples of changes may be these scenarios: If patient can’t hear at all
(and if you or they don’t know sign language), you will have to learn how to signal
them about what they want or need.
 Impaired hearing patients may not hear you enter their rooms, so they can be
easily startled. Keep this in mind and try to signal them as you enter, perhaps by
turning on the overhead light if it is off.
 If there is background noise, hearing-impaired patients will have even more
trouble hearing conversation.
 If patients have trouble hearing, look directly at them, lower the pitch of your
voice, and speak loudly, clearly, and a bit slower—but do not yell.
 Speak in short, concise sentences.
 Be aware of your facial expressions
Taste, Smell and Touch:
 Taste and smell are diminished due to a decreased number of taste buds and a
decrease in the number of cells for smell.
 This makes it even more important to allow the patient to eat foods they enjoy
(and can taste) and whenever they wish.
 Meal Time and the Senses:
 Meal time can be complicated if patients have problems with their five senses.
Communicating with older adults

There are ways to communicate and interact with elderly to maintain their dignity.
1. Don’t talk about them as if they weren’t in the same room.
2. Speak to them the same way you would speak to any adult
3. When possible, sit next to the patient instead of across the table from them.
4. Speak loudly and clearly to them so they will understand you—but do not yell.
5. When talking, be aware of your facial expressions.

Psychosocial Needs

Depression is often reversible with prompt and appropriate treatment. However, if left
untreated, depression may result in the onset of physical cognitive and social
impairment as well as delayed recovery from medical illness and surgery, increased
health care utilization and suicide.

Depression Scale (GDS)

Activity:

You are an 88 year-old with severe congestive heart failure that limits your tolerance to
activities. You also have macular degeneration, a common vision impairment which
interferes with your ability to see things directly but your peripheral vision is good. This
makes it difficult to read, watch television, or do your favorite hobby, scrap booking.
However, you can knit and crochet just by “feeling” the yarn or thread and remembering
the steps. Your spouse died two years ago and your two children live in other states
although your daughter calls at least once a week.

Are you basically satisfied with your life?

Have you dropped many of your activities and interests?
Do you feel that your life is empty?
Do you often get bored?
Are you hopeful about the future?
Are you bothered by thoughts you cannot get out of your
head?
Are you in good spirits most of the time?
Are you afraid that something bad is going to happen to
you?
Do you feel happy most of the time?
Do you often feel helpless?
Do you often get restless and fidgety?
Do you prefer to stay at home rather than go out and do
things?
Do you frequently worry about the future?

Do you feel you have more problems with memory than

most?
Do you think it is wonderful to be alive now?
Do you feel downhearted and blue?
Do you feel pretty worthless the way you are now?
Do you worry a lot about the past?
Do you find life very exciting?
Is it hard for you to get started on new projects?
Do you feel full of energy?
Do you feel that your situation is hopeless?
Do you think that most people are better off than you are?
Do you frequently get upset over little things?
Do you frequently feel like crying?
Do you have trouble concentrating?
Do you enjoy getting up in the morning?

Do you prefer to avoid social occasions?

Is it easy for you to make decisions?
Is your mind as clear as it used to be?

ENGAGEMENT WITH LIFE-SELF PERCEPTION –SELF CONCEPT

 A self-concept is an understanding you have of yourself that’s based on your
personal experiences, body image, your thoughts, and how you tend to label
yourself in various situations.
 A self-concept can also be defined as an all-encompassing awareness you had
of yourself in the past; the awareness you have of yourself in the present, and
the expectations you have of yourself at a future time.
 Your self-concept is built upon perception — upon how you perceive yourself
based on the knowledge you have gained over a lifetime of experience.
 When it comes down to it, a self-concept is a perception you have of your image,
abilities, and in some ways a perception of your own individual uniqueness.
 This perception you have of yourself is based on the information you have
gathered about your values, life roles, goals, skills, and abilities over time.
 Your self-concept is somewhat a collection of beliefs you have about your own
nature, qualities, and behavior.
  It’s about how you think and evaluate yourself at any given moment in time.

Self Image
 Your self-image comes down to how you see yourself in the present moment.
 This includes the labels you give yourself about your personality and the beliefs
you have about how the external world perceives you.
 Anorexia may have a self-image that makes them believe they are obese,
however, in reality, that is far from the truth.
Self-Ideal
Your self-ideal is how you wish you could be at a future time. This is your ideal self or
the ideal person you envision of being and becoming.
Many times, how people see themselves and how they would like to see themselves
doesn’t quite match up. And this is precisely what causes problems and often leads to
self-sabotaging behavior patterns and emotional struggles.

Self-Esteem
Your self-esteem encompasses your current emotional experiences. Moreover, it refers
to the extent to which you like or approve of yourself or the extent to which you value
yourself.
You might, for instance, have a positive or negative view of yourself. When you have a
negative picture of yourself, you are seen as having low self-esteem. This often
manifests in a lack of confidence and pessimism.

On the other hand, when you have a favourable view of yourself you are seen as having
high self-esteem.
This often manifests in a confident disposition, self-acceptance, and optimism.
SELF PERCEPTION AND SELF-CONCEPT IN ELDERLY

 Depression is, unfortunately, a common occurrence among older adults. The fact
that their activities and social interactions are more limited, and their nearest and
dearest are often living far away, makes the adjustment to old age harder. Thus,
most elderly face problems with self-perception and self-concept.
 The theory of self-perception suggests that individuals infer opinions, attitudes,
and internal states mostly through observing the behavior and circumstances in
which they occur.
 On the other hand, self-concept is defined as the way an individual thinks,
evaluates and perceives his self.
 These two concepts change as an individual ages.
 It has been observed that healthy older adults have more positive self-
perception and self-concept compared to those who are lonely and suffer from
health issues. Consequently, healthcare providers, especially those who are the
primary caregiversm should encourage seniors to have a positive attitude
towards aging.
 This can help them increase their desire to live and make them more resilient to
disease and mental illness.
 Promoting a positive self-perception and self-concept entails a lot of effort on the
part of the caregiver.
 An older adult should be immersed in various social activities to regain a sense
of hope and excitement about life.
 This can be done by making strong social connections within the locality and
allowing the elderly to be involved in activities organized by various support
groups.
 Most older adults placed in assisted living facilities interact with and meet other
residents who share similar interests.
 For those who are living in their own home, joining church meetings, local
gathering and social celebrations are helpful ways to foster positive aging.
 Nonetheless, a healthy aging process involves meaningful relationships with the
family and significant others
 Older adults should not be left at home doing nothing.
 They should be encouraged to engage in family activities and gatherings that
minimize isolation.
 Self-perception and self-concept are directly affected by what the person does
every day, so planning in advance is essential to make various activities
possible.
COPING WITH STRESS

 During emergency situations, stress and anxiety are the natural fight and flight
instincts of our body.
 These stressors can either be external (an intruder crawling through your
window) or internal (a financial problem within the family or worry over an older
adult with a mental or physical problem).
 Thus, when stressful challenges occur, our body senses danger and releases
stress hormones into the bloodstream which increases heart rate, breathing, and
other processes that prepare you to respond quickly.
 This natural reaction is also known as a stress response.
 According to research, long-term activation of the stress response can diminish
the immune system’s ability to fight disease and may also increase the risk of
physical and mental health issues.
 For instance, studies show that stress and anxiety that occur in older adults are
associated with physical problems like difficulty in carrying activities of daily living
and other health problems like coronary artery disease and a decreased sense of
well-being.
 Furthermore, stress is linked to causing or aggravating cancer, Alzheimer’s
disease, and multiple medical conditions like diabetes, heart disease and
arthritis, chronic pain and cognitive changes like declining short-term memory.

SIGNS OF STRESS

Although there are differences in how an individual responds to stress; most of the time,
he/she may feel the following symptoms.

 Anxiety or panic attacks

 Worry
 Sadness or depression
 Irritability and moodiness
 Feeling pressured or hurried
 Difficulty concentrating or making decisions
 Sleeping problems
 Physical symptoms like headaches, chest pain, and stomach problems
 Feeling overwhelmed and helpless
 Sexual dysfunction
 Drinking too much alcohol, misusing drugs or smoking a lot
 Not eating enough or eating too much
PREVENTING AND COPING WITH STRESS

 However, if you make an extra effort to deal with it, you can always smooth the
aging process.
 For families with an older adult, especially those with disabilities, it is very
important to be part of his/her daily routine.
 Encouraging the elderly to participate in community activities and social
gatherings will allow him or her to divert attention and enhance self-esteem and
alleviate stress.
 Older adults obviously have different interests than young people, so take time to
find out what will minimize the stress of the older person in your care and guide
them towards it! Whether it is ballroom dancing, church activities, or camaraderie
with friends or relatives, the end outcome is the same: reduced levels of stress
hormones in the body and a better quality of life.
  Healthy dietary habits and regular exercise will also help the elderly cope with
stress better.
 Taking a walk in the park or outside the house should be a part of his/her daily
routine to promote proper blood circulation and improve their psychological well-
being.
 However, if it becomes apparent that nothing you say or do works and the older
adult cannot handle stress well, seeking help and talking to a psychologist may
be beneficial.
 This healthcare professional will teach the elderly to manage their stress through
various different relaxation techniques and mental exercises that you may not be
familiar with. If the problem is more severe, they may refer the older adult to a
psychiatrist able to relieve their symptoms of stress and depression with
medication.

SEXUALITY IN AGING:
 Normal aging brings physical changes in both men and women. These changes
sometimes affect the ability to have and enjoy sex.
 A woman may notice changes in her vagina.
 As a woman ages, her vagina can shorten and narrow. Her vaginal walls can
become thinner and a little stiffer.
 Most women will have less vaginal lubrication, and it may take more time for the
vagina to naturally lubricate itself.
 These changes could make certain types of sexual activity, such as vaginal
penetration, painful or less desirable.
 If vaginal dryness is an issue, using water-based lubricating jelly or lubricated
condoms may be more comfortable.
 If a woman is using hormone therapy to treat hot flashes or other menopausal
symptoms, she may want to have sex more often than she did before hormone
therapy.

 As men get older, impotence (also called erectile dysfunction, or ED) becomes
more common.
 ED is the loss of ability to have and keep an erection. ED may cause a man to
take longer to have an erection. His erection may not be as firm or as large as it
used to be.
 The loss of erection after orgasm may happen more quickly, or it may take longer
before another erection is possible. ED is not a problem if it happens every now
and then, but if it occurs often, talk with your doctor.
What Causes Sexual Problems Elderly?

Some illnesses, disabilities, medicines, and surgeries can affect your ability to have and
enjoy sex.
Arthritis. Joint pain due to arthritis can make sexual contact uncomfortable.
 Exercise, drugs, and possibly joint replacement surgery may help relieve this pain.
Rest, warm baths, and changing the position or timing of sexual activity can be helpful.
Chronic pain. Pain can interfere with intimacy between older people. Chronic pain does
not have to be part of growing older and can often be treated.
But, some pain medicines can interfere with sexual function. Always talk with your
doctor if you have side effects from any medication.
Dementia. Some people with dementia show increased interest in sex and physical
closeness, but they may not be able to judge what is appropriate sexual behavior.
Those with severe dementia may not recognize their spouse or partner, but they still
desire sexual contact and may seek it with someone else.
It can be confusing and difficult to know how to handle this situation. Here, too, talking
with a doctor, nurse, or social worker with training in dementia care may be helpful.
Diabetes. This is one of the illnesses that can cause ED in some men. In most cases,
medical treatment can help. Less is known about how diabetes affects sexuality in older
women.
Women with diabetes are more likely to have vaginal yeast infections, which can cause
itching and irritation and make sex uncomfortable or undesirable.
Yeast infections can be treated.
Heart disease. Narrowing and hardening of the arteries can change blood vessels so
that blood does not flow freely.
As a result, men and women may have problems with orgasms.
For both men and women, it may take longer to become aroused, and for some men, it
may be difficult to have or maintain an erection.
People who have had a heart attack, or their partners, may be afraid that having sex will
cause another attack.
Even though sexual activity is generally safe, always follow your doctor's advice. If
your heart problems get worse and you have chest pain or shortness of breath even
while resting, your doctor may want to change your treatment plan.
Incontinence. Loss of bladder control or leaking of urine is more common as people,
especially women, grow older.
Extra pressure on the belly during sex can cause loss of urine.
This can be helped by changing positions or by emptying the bladder before and after
sex.
The good news is that incontinence can usually be treated.
Stroke. The ability to have sex is sometimes affected by a stroke.
A change in positions or medical devices may help people with ongoing weakness or
paralysis to have sex.
Some people with paralysis from the waist down are still able to experience orgasm and
pleasure.
Depression. Lack of interest in activities you used to enjoy, such as intimacy and
sexual activity, can be a symptom of depression.
It's sometimes hard to know if you're depressed.
Surgery. Many of us worry about having any kind of surgery—it may be even more
troubling when the breasts or genital area are involved. Most people do return to the
kind of sex life they enjoyed before surgery.
Hysterectomy is surgery to remove a woman's uterus because of pain, bleeding,
fibroids, or other reasons.
Often, when an older woman has a hysterectomy, the ovaries are also removed.
Deciding whether to have this surgery can leave both women and their partners worried
about their future sex life.
If you're concerned about any changes you might experience with a hysterectomy, talk
with your gynecologist or surgeon.
Mastectomy is surgery to remove all or part of a woman's breast because of breast
cancer.
This surgery may cause some women to lose their sexual interest, or it may leave them
feeling less desirable or attractive to their partners.
Prostatectomy is surgery that removes all or part of a man's prostate because of
cancer or an enlarged prostate. It may cause urinary incontinence or ED. If you need
this operation, talk with your doctor before surgery about your concerns.
Medications. Some drugs can cause sexual problems. These include some blood
pressure medicines, antihistamines, antidepressants, tranquilizers, Parkinson's
disease or cancer medications, appetite suppressants, drugs for mental problems, and
ulcer drugs. Some can lead to ED or make it hard for men to ejaculate.
Some drugs can reduce a woman's sexual desire or cause vaginal dryness or difficulty
with arousal and orgasm.
Alcohol. Too much alcohol can cause erection problems in men and delay orgasm in
women.