FON Health and Wellness In The Older Adults Flashcards
What age does older adulthood start at
65
Young old=age 65-74
Middle old=age 75-84
Old old=age 85-99
Elite old=age 100+
Wellness involves
An individual operating at their optimal level of functioning 
With chronic illness
With dying
Wellness involves balances of
Emotional
Spiritual
Social
Cultural and
Physical satiates
Primary preventions are
- Diet/exercise (from book: Exercise to prevent cardiovascular desease, falls and depression. Diet w/o excessive sugar, fat, or alcohol)
- Injury prevention
- Disease prevention
- Smoking cessation (from book: to reduce risk of heart disease and improve lung function and cicrculation)
- Vaccination ( from book: flu vaccine, tetanus/diphtheria booster shots, shingles vaccine)
Secondary preventions are
- Early detection
- Early treatment
- Screening (from book screening for heart disease and hypertension, cancer, infectious disease, misuse of multiple meds., nutrition, oral health, osteoporosis, falls, depression, and social isolation)
Goals of US dept of health and human services USDHHS (Set forth by healthy people 2030)
Prevent health risks and avoidable disease, disability, and death
From book: improve health, function and quality of life for older adults.
Baby boomers
65 is no longer considered old
Born between 1946 & 1964 29% of population.
More than 1.5 million will live to 100+
Ageism
Prejudice against older adults
Negative response by younger people
systemic discrimination
Healthcare providers should eliminate
Negative attitude
Discriminatory practices
From the book
Box 33.2 purpose of Healthy people 2030 objective for older adults
Promote healthy outcomes for this population, The focus is specifically on individual behaviors to promote health such as Participation in physical activity self management of chronic diseases. Social environmental factors that promote health such as housing and transportation services. Health and social services available to older adults and their caregivers to assist him managing chronic conditions and long-term care needs.
Legislation affecting older adults
Social security act Of 1935
Older Americans act of 1965 ( from book: preserves rights and dignity of the nations older citizens, updated in 2006 to provide for low income minorities and older individuals who reside in rural areas)
National family caregiver support program in 2000 they added support for American (native) Indian elders
Affordable care act (Obama care) 2010
(Bolded) Biologic theories of aging
Programmed aging= Cells can no longer reproduce or regenerate themselves
Genetic factors= Inherited life expectancy
Immunologic/autoimmunity= immune system cannot differentiate between foreign cells and its own cells clients body is attacking its self
Psychosocial theory of aging
Activity theory (EXAM)
older adults benefit from social interactions
Substitute new roles= Family, recreation, volunteer
Psychosocial theories of aging
Continuity theory (personality stays the same)
Earlier life patterns must be maintained
Coping skills, social engagement, hobbies, and interests
Behavior should be consistent with younger years
Ericksons developmental stage:last stage (from book: late adulthood 65+)
Ego integrity versus anger and despair- last stage
(from book: Older adults try to make sense out of their lives by seeing life as meaningful or despairing at goals never reached and questions never answered)
Disengagement theory (Erickson)
Withdrawl from society ( fr. book: Prevents older adults from experiencing frustration when they can no longer function adequately and allows a young member to fulfill the now empty role)
Mutually gratifying 
Exchange theory(Erickson)
Decreased value between older adults and society ( fr. book: aging is reduced interaction between older adults and society as a result of a decrease in value that the interaction has for both☹️)
Biologic theories of aging: free radical
End products of metabolism (electrons) cause damage to cells
Antioxidants can counter this process (theory)
Biological theories of aging: wear and tear(exam)
Abuse of the body speeds up aging process
Cells where out from stress, chemicals, trauma, and disease
Caregiver stress
 overloaded
Stress related problems
Coping mechanisms
Sandwich generation (f. book: Individuals who care for their parents and children/grandchildren)
Respite care (fr. book: care from non family member to give caregiver a break)
Loss grief and depression
1.Significant psychosocial changes
Personal social and economic losses
Changes in roles and Retirement
Loss of significant others.
2. Physical changes
Loss of independence and personal space
3. May have a successful coping strategies
4. May develop short or long term depression
Fatigue, sadness, insomnia, hopelessness
Anorexia, crying,agitation,hypochondria
The aging body
Integumentary system, Cardiovascular system
Gastrointestinal system, Urinary system
Respiratory system, Musculoskeletal system
Endocrine system, Reproductive system
Sensory perception, Nervous system
Integumentary system
- Age related changes
Dry skin
Lots of tone elasticity subdermal fat
Assessment
2. Common concerns
Puritis, Moles, nail abnormalities 
Pressure injury
Shearing forces
Nursing interventions
Gastrointestinal system
- Age related changes
Decreased saliva, gastric motility, and gag reflex
Oxford enzyme production and peristalsis
Liver function changes
 table 33.4 as pictured - Common concerns
Obesity and weight loss
Fluid access and deficit(Hedden: Kidneys not working well patient may have Edema or Ascites)
Appetite loss and food intolerance
Dysphasia and failure to thrive (Hedden: Chewing and swallowing) - Nursing interventions
Oral hygiene and nutritional support (Hedden:dry mouth)
Gastrointestinal system continued
- Common concerns
Cancer
Incontinence
Bleeding - Nursing interventions: ask Why is the nurse doing this?

Urinary system
- Age related changes
Decreased kidney function
Decreased a bladder capacity and tone
Prostate enlargement - Common concerns
Incontinence: Not a normal part of Aging
Painful penetration and during sex
Nocturia - Nursing interventions
Types of incontinence
Stress incontinence: Increased abdominal pressure
Urge incontinence: After need to void
Functional incontinence: Can’t get to bathroom
Treatment Options are exercise
Cardiovascular system
1.Age related changes
Loss of structural elasticity
Modifiable risk factors
Racial disparities
2. Common Concerns
Orthostatic hypotension
Hypertension
CAD & PVD peripheral artery disease and coronary artery disease
Dysrhythmias
Intermittent claudication which is pain and cramping in lower extremities
Nursing interventions: photo
Respiratory system
- Age related changes
Decreased elasticity
Hemoglobin with decreased 02 carrying capacity
Kyphosis
Table 33.7 (starred) photo - Common concerns
COPD: 3 types (Hedden: Bronchitis emphysema and asthma)
Pneumonia
Lung cancer - Nursing
Pulmonary hygiene
Smoking cessation
Musculoskeletal system
- Age related changes
Decrease in the number and size of muscle fibers
Decrease joint elasticity
Decreased estrogen levels - Common concerns
Arthritis
Fall prevention
Hip fractures
Osteoporosis
3. Nursing interventions
Endocrine system
- Age related changes
Decreased hormone production - How many concerns
Type two diabetes (DM adult onset)
Nursing interventions: education, foot injury prevention
3. Common concerns
Hypothyroidism ( photo fr. book for own info)
Reproductive system
1.Age related changes
Diminished levels of hormones
2. Common concerns
Sexual function
STI s (Increase)
3. Nursing interventions
Nervous system(exam)
- Age related changes: Varies, not always
Sleep patterns
Table 33.12 (photo) - Common concerns
Memory loss and proprioception changes(knowing where you are in space)
Delirium(temporary), senility, dementia(slow and progressive), depression
CVA and TIA(stroke and Mimi stroke) - Nursing interventions
Reality orientation pg 1108 (photo)
Special senses
- Age related changes
table 33.11(photo)
Vision
Hearing and balance
Taste and smell - Common concerns
Glaucoma
Cataracts
Presbycusis - Nursing interventions: access for sensory changes, alert all caregivers to sensory problems, determine most effective method of communicating with individual with Sensory impairment modify environment to remove passage and reduce risk verify that assistive devices such as hearing aids glasses are clean and functional
Types of dementia
- Alzheimer’s dementia (fr. Hedden Brain atrophy, Affects all type of memory, it is progressive cognition is affected, can be disoriented, cannot maintain attention, calculation language and motor or affected)
- Multi Infarct dementia
- Parkinson’s disease (HeddenTremors shuffle)
- Other diseases
Huntington’s disease
Creutzfeldt-Jakob disease (Hedden viral)
HIV associated dementia (viral)
Cognitive changes
- Aging has a little influence on cognition
- Only some older people experience some cognitive deficit
- Research indicates that most of the people
Retain their intelligence
And are capable of learning throughout their lives

Safety issues
- Falls
Leading cause of accidental death for people over 65 years of age - Polypharmacy
Five on my medications
Poly pharmacy
elder abuse and neglect
- Violence toward individuals over the age of 65
- Classifications of abuse
Physical and sexual
Psychological
Misuse of assets
Neglect - Indicators of elder abuse: Crying, fear, suspicion
Security concerns for the older adult 
- Finances
No retirement planning
Not Social Security eligible - Housing
Relocation
Downsizing
Senior housing - Medication
Illness responses
- Increased risk for
Drug reactions
Falls
Infection.
Disorientation of delirium
Weakness
Immobility
Incontinence - Development of such changes in behavior should be recognized documented and reported
Continuum of care
- Home care
- Assisted living
- Long term care facilities
- Hospice care
Preserving dignity
- Bill of rights(photo)
-  Make sure you go back and read the end of chapter 24 lifespan development
Home health nursing
- Remain in the comfort and security of their homes while receiving healthcare
- Feelings of self-worth and dignity
Family support
Familiar surroundings
Participation in the process
Types of home care agencies (photo)
- voluntary
Public nonpublic
Community-based - Official
State, county, city - Combination
Combined BOD (board of directors) - Hospital
- Proprietary
Privately owned company
Paid be BOD
For profit - Private and not for profit
- Other
Changes in home health care
Psychiatric nurse clinicians
Social workers
Hospice care
Nurse pain specialist
Pet care programs
Home IV therapy
Telehealth
Service components
Skilled nursing
Physical Therapy
Speech language therapy
Occupational therapy
Medical social services
Homemaker
Home health aide
Respiratory, nutrition, pharmacy, podiatry, dentistry, psychiatric
Skilled nursing
- Provided and directed by RN
2.Basic services may be provided by the LPN
Under the supervision of the RN - Service goals: Restorative, improvement, maintenance, promotion
- Nurses must be technically proficient, self-motivated, innovative independent
(Hedden: must be vigilant and recognize changes in patient status)
Role of LPN
- Skilled services
- Independent practice is not allowed
Self-direction, motivation, creativity, clinical proficiency, flexibility, compassion, empathy, and patience are all essential
Functions (photo)
Typical home health process
Referral
Admission
 Care plans
Visits
Documentation
Discharge planning
Quality assurance assessment and improvement
1. documentation
For outside organizations
For internal measures of improvements and policy revision
2. Reflect standards objectives and measurable outcomes
3. Include plans for mediation or improvement as an integral part of the process
Reimbursement sources
Medicare
Medicaid
Third party
Private pay
Other sources HMOs and PPOs
Home safety-Various pages
- Hazards-(fr. Class: Appliances, stove, tub, chemicals)
- Education
Injury prevention
 Health promotion across the lifespan
- Life expectancy
Average number of years an individual probably live
Based on statistics for others with similar characteristics - Infant mortality
Number of deaths in first 12 months of life
African-American and indigenous infants less than twice that of white infants
CDC link
Racism/colonization Not race/ingenuity
More black doctors Are needed
Growth and development
- Gross: Increase in size
- Development
Function (Hedden:infant gets control of shoulders before hands)
Gradual changes
Orderly series - Is it cephalocaudal: from head to toe
- Proximodistal: From the center to the outside of the body
- Patterns of growth
Genetics: Genes affect growth(nature)
Nutrition and environment(nurture)
The family
- Basic unit of society
-  two or more united individuals
Married
Blood
Adoption
Love
Social roles
Types of family
- Nuclear, extended, single parent, blended
- Social contract family and cohabitation
- Gender diverse gender expansive and gender inclusive
- LGBTQ+
- Queer or straight
- Adaptive grand families and foster
Family patterns
- How do family members relate to each other? who does what?
- Types of family patterns
Autocratic: Parents in control: Strict rules and expectations
Patriarchal or matriarchal
Democratic: joint decision making
Individually recognized
Negotiation, compromise, and growth - Stages of family development
Assumes that all families have parenting as their goal
Causes a family stress
- Chronic illness
- Scarcity of resources
- Violence
And the home
Outside of the home
Racism - Societal origins
Pandemic
Social determinants of health
Stress in kids
- Infant: Needs not met
- Toddlers: Can perceived stress family states (exam)
3.  School-age: School, Peers, parental expectations
4. Signs of stress
Box. 24.4 (photo)
Changes in behavior
Physical symptoms (stomach aches headaches)
Bedwetting
Regression to an earlier stage of development as in returning to thumbsucking
Piaget stages of cognitive development
- Sensorimotor (birth to age 2)
- Preoperational thought (2 to 7 years)
- Concrete operational thought (7 to 11 years)
- Formal operational thought (12+ years) (as per Hedden they can do a scientific problem solving, recognition of past, present, and future, they start questioning things)
Piaget sensorimotor stage
- Birth to age 2 (they put everything in their mouth, they play peekaboo)
- Reflexes develop into purposeful coordinated motor abilities
- Senses and interacts with the world around them
- Object permanence
- Mental representation (remember and imagine)
- Thinking develops
- Goal directed behavior (**)
Piaget preoperational thought stage
- Age 2 to 7 years (from Hedden: what can they get? world revolves around them, playground fights, learn to share)
- Egocentric thinking
Worlds only exist through their perspective
Gradually learns to appreciate other perspectives - Trial and error new traits: and characteristics (per Hedden symbols can represent objects)
- Present time only
- Can you use symbols to represent objects
- Logic, imagination, and intuition develops
- Simplified understanding: things are only 1 thing

Piaget concrete operational thought
- Age 7 to 11 years
- Application of logic and socialization
- Improved understanding of reality another perspective
- Improve the memory and multitasking
- Cause and effect; outcomes of behavior
- Basics of conversation and number classification
- Basic understanding of concrete rules
Per Rn Hedden: They have empathy I can see things from another view they form groups of friends, teams
Piaget formal operational thought
1.Age 12 years and up
2. Systemic scientific problem solving
3. Recognizes past present and future
4. Can think
Abstract
Hypothetical
What is possible?
5. Ethics, politics, social, moral issues
6. Play theoretical approach to experience
Ericksons stages of psychosocial development
Basic trust versus miss trust: infancy
autonomy versus shame and doubt: toddler
Initiative versus guilt: preschool. (Mimic parent)
Industry Versus inferiority: School-age (NH want to be productive and confident)
identity versus role confusion: adolescence (explore sexuality)
 intimacy versus isolation:young adulthood
Generativity versus stagnation: middle adulthood
Ego integrity versus despair: late adulthood
Communication and language wow
- Babbling
Three months
Sound exploration - Word recognition
One year
Single word speech (up)
Paired words (mommy milk)
Most meaningful words
They skip the words this, the, that
Nouns and verbs first
Communication in language continue
- Acquisition of language structure
Preschool age
Language explosion
50 words to 14,000 words
Critical age to learn languages - Development of new words and sentences
Age 6
Most subtle and then during preschool age
Comprehension
Chronological stages of development
Embryo and fetus third semester
Newborn third semester
Infancy
Toddler
Preschool
Schools age
Adolescence transition from childhood to adulthood
Early adulthood
Middle adulthood
Late adulthood
Infancy 1 to 12 months
Physical characteristics they triple birth by one year of age
Vital signs heart rate around 120 BPM at 2 months old, respiration rate average 30 BPMs
Motor development
Definition teething at 5 to 6 months
Psychosocial development
Cognitive an intellectual development
Nutrition: introduce 1 foot at a time
Sleep play activity and safety (SIDS alert)

Toddler 1 to 3 years
Physical characteristics: convex lumbar spine and potbelly
Vital signs heart rate 90 to 120 BPM (**)
Henry toilet training
Psychosocial development temper tantrums try to be independent
Cognitive and intellectual behavior
Nutrition: Dairy (food allergies)
sleep: 12 hours per night plus daytime nap
Preschool age 3 to 5 years
- Physical characteristics
Slow and steady growth
Farsighted vision that improves by age 4 - Vital signs: closer to adult numbers HR 70 to 110
- Psychosocial development
- Cognitive an intellectual development
- Nutrition:calcium proteins and phosphorus
- Sleep play activity and safety. They now tell little white lies
Safety rules for small children
Remove plants from reach: some medication’s are made from plants
Avoid pillows during sleep for infants
Avoid plastic coverings on mattresses
Car seat and booster seats
Keep crib size up a mattress is low
Avoid balloons and other Chocobo items like hard carrot grapes hard candy
Flame retardant close
Bodily autonomy
Abduction prevention
School age: age 6 to 12 years
Physical characteristics: growth is more gradual and subtle
Vital signs
Psychosocial development socialization skills
Cognitive an intellectual Development
Nutrition: related to activity level
Sleep play activity and safety: 10 to 12 hours of sleep per night

Adolescence 12 to 19 years (second major period Of active growth)
Physical characteristics: puberty
Vital signs: same as adults, Sense of identity, and body image
Cognitive development
Moral development: Uncomfortable in between
Nutrition: observe the signs and symptoms of eating disorders
Early adulthood: 20 to 40 years
- Physical characteristics
Optimal level of physical health - Psychosocial development
- Physical health
Need routine preventative healthcare visits - Safety
Middle adulthood 40 to 65 years
- Physical characteristics
Presbyopia
Presbycusis - Psychosocial development
Generatively: excepting responsibility for and offering guidance to the next generation - Nutrition
- Physical and dental examination
- Sleep and rest
What is culture
 Characteristics, knowledge, group of people, language, religion, cuisine,
Music and art, ethics and morals, clothing, marriage, family strangers/visitors, Growth????
confidence versus cultural humility
- Cultural competence☹️
I have become an expert on you - Cultural humility🙂
You are the expert on you
Self reflection
Ongoing education
Increased awareness of assumptions and biases (prejudices, partiality)
What is oppression (exam)
- Prejudice plus power
Institutionalized power
Historically formed
Perpetrated overtime - Who is doing the oppressing
Certain groups of people: certain identities
The oppressed can also be a oppressors
Dominant are privilege
Individuals institutional or cultural power - Where is this happening? (Everywhere)
Schools
Government
Healthcare institutions
What does oppression do? (exam)
- Create artificial hierarchy
- Somethings people traits are:
Normal, acceptable, desirable, value, supported - They become:
Dominant, privileged, power - other things people traits become:
Non-dominant, abnormal, marginalized, without value
What is anti-oppression? 
Not the same thing as diversity and inclusion
Challenges system of oppression
Advocacy and justice
Recognize oppression: decrease or eliminate effects
Equalize power imbalances
Important concepts
- Diversity: Range of human experiences
age race physical ability Neuro divergence religious nationality gender identity sexual identity ethnicity sexual orientation romantic attraction neurologic condition national origin ethical values etc. - Equity: just, impartial, and fair
Power is evenly distributed
Inequity is challenged **
Equity versus equality(exam)
Give what is needed
Important concepts
- inclusion: work and dignity of all people is recognized
Belonging, respect
Avoid tokenism
Values lived experiences - Justice: systemic fair treatment of all people
Policies, practices, attitudes, and actions
Equitable:
Access
Opportunities
Empowerment
Treatment
How comes
How to practice cultural humility (exam)
Engage with the populations we serve
Enhance alliances
Address disparities
Avoid tokenism and stereotypes
Avoid Microaggressions (Small actions;big effects)
Practice antiracism an anti-able ism
Learn about the effects of columnization
Practice person centered care
Create safe, respectful, trauma informed, environments of care
