Elder Theory

Slides-18
Part II
 Psychosocial Issues

• Isolation
• Lack of support
• Stressors of complicated diseases/ and or frequent
hospitalization
• Side effects of medications, corresponding symptoms
of acute and chronic disease
• Dementia/Delirium
 Assessment of Social Support
• If/When something goes wrong, who can help?
• At the rate things are going now, how long do
you see yourself as being able to manage?
• Who is your primary caregiver/support?
• Is the caregiver burdened?
• If yes, which aspects are most
burdensome?
• What resources have been accessed?
• What additional resources can be accessed?
 Elder Abuse
• Battering, verbal abuse,
exploitation, denial of rights,
forced confinement, neglected
medical needs, or other types of
personal harm, usually at the
hands of someone responsible for
assisting them in the activities of
daily living (*Primary caregiver).
• As violence in society increases,
likely increase in elder abuse—
check video out below**
 Figures
• Estimated > 2million abused or neglected
elders each year. Abuse is under-reported
(estimated. 80%), so more than this
• States spend $22 per child for CPS, but only
$2.90 per elder for elder protective services.
Although, 40% of reported abuse involves
elders!!! What does this say about our
society and how we value elders?
• Reporting is required by law—APS. Elders
are reluctant to report as fear worse/unsure
situation if they get moved.
 Dynamics

• Abuse is usually related to limited resources of:

time, money, coping, help, or substance abuse
• 46% is financial abuse.
• Psychological abuse also important.
• Neglect by self or other is most frequent type of
mistreatment.
 Dynamics cont.
• Largest # of elderly living at
home alone are women over
75 yrs of age—can be subject
to self-neglect. Also, to abuse
and exploitation by hired
caregivers.
• Verbal abuse and neglect is
significantly related to long-
standing problems in a
relationship.
 “Better Quicker”

• Philosophy of getting better quicker in

hospitals—patients are sent home earlier, with
more sophisticated needs, and more demands
on the family for care. This increases the stress,
can be resistance to care for pt. May get
inadequate care. Neglect?
 Families
• Families/CG’s at home
make up 80%-90% of
care currently given to
elderly--due to costs of
institutional care.
Government has been
unsupportive of these
people- they make
major contribution to
society.
 Advocacy
• You are the patient’s main advocate
• Report Elder Abuse– Adult Protective
Services (APS)
 Relationships
• Primary
• Secondary—see next two slides for both:
 Primary Relationships

• Family
• Spouse
• Parent-child
• Siblings
• Friends
• Grandparenthood
 Secondary Relationships
• Formal and Informal in Nature
• Groups—recreational and Volunteer
• Organizational activity

Volunteer
 Role Issues
• Transitions
• Retirement
• Spousal Loss
 Mental Health

• Mental health is not different in

later life, but the level of
challenge may be greater
• The most prevalent mental
health problems later in life are
anxiety, severe cognitive
impairment, and mood disorders
 Crisis and Stress Management
• Stress & Aging
• Common stressors
• Coping
 Stress and Coping in Late Life

Factors Affecting Stress

 Cognitive style, coping strategies, social

resources, personal efficacy, and personality

characteristics have all been found to be
significant to stress management
 Social relationships and social support are

particularly salient to stress management and

coping
 Factors influencing ability to manage stress (Box

28-3)
Copyright © 2016 by Elsevier, Inc. All rights reserved. 17
 Promoting Healthy Aging:
Implications for Gerontological
Nursing
Interventions
 Nurses can design individualized interventions to

enhance coping ability such enhancing characteristics of

resilience and resourcefulness
 Promote a sense of control, fostering social supports and

relationships, and connecting to resources

 Meditation, yoga, exercise, spirituality, and religiosity can

enhance coping ability

 Mind-body therapies are most helpful

 Reminiscence is useful in understanding coping style

Copyright © 2016 by Elsevier, Inc. All rights reserved. 18

 Depression
• Not a normal part of aging, most older
people are satisfied with their lives,
despite physical problems
• Important to understand the influence of
late-life stressors and changes and beliefs
of older people, society, and health
professionals may have about depression
and treatment
 Depression Screening
• Geriatric Depression Scale (GDS)
– full scale = 30 Y/N items
– short scale = 15 items**

Screening  Diagnosis
Refer for follow-up prn
Geriatric Depression Scale
 Nursing diagnoses/intervention

• Support Function rather than

dysfunction
• Improve present state of wellness
• Focus on client strengths
 Self-Actualization, Spirituality, and
Transcendence
 Older people are more in touch with their inner
psychological life than at any other point in the
life cycle
 Understanding the developmental phases in the
second half of life assists in understanding the
journey toward self-actualization (Box 36-1)
 The dramatic increase in the population has
been considered a problem to be solved in an
era of dwindling resources rather than a
resource to enrich society
Copyright © 2016 by Elsevier, Inc. All rights reserved. 23
 Gerotranscendence

 Gerotranscendence
 Human aging brings about a general
potential for gerotranscendence, a shift
from the material world to cosmic, and
(concurrent with that), life satisfaction

Copyright © 2016 by Elsevier, Inc. All rights reserved. 24

 Spirituality
 Indescribable need that drives individuals
throughout life to seek meaning and purpose in
their existence
 The spiritual aspect of people’s lives transcends
the physical and psychosocial to reach the
deepest individual capacity for love, hope, and
meaning
 Spirituality must be considered a significant
factor to understanding healthy aging

Copyright © 2016 by Elsevier, Inc. All rights reserved. 25

 Patient Centered-Care
• Definition: To recognize the patient or designee
as the source of control and full partner in
providing compassionate and coordinated care
based on respect for patient’s preferences,
values, and needs.

From: Cronenwett, L., et al. (2007). Quality and safety education for nurses.
Nursing Outlook, 55(3), 122-131