Week 1: Health And Wellness In An Aging Society Flashcards
What is aging?
Described in term of chronology (now less significant) by measurement of time since birth.
Aging is a relative concept based on how
One acts and feels from a physical, mental, social and cultural perspective.
The Babyboomers
Born between 1946 to 1964.
Biological Theories of Aging: “senescence”
Complex genetically regulated interactive process of change in every living organism.
Biological Theories of Aging: Cellular Functioning
Changes to cells that decrease ability to replicate attributed to aging, especially mitochondria.
Programmed Aging Theory
- Cells have limited replication
- Suggest that aging is the result of predictable cellular death
- Cells and organisms have a genetically predetermined life span known as the “hayflick limit” or biological clock
Error Theory*
Based on changes at the cellular level are random and unpredictable.
What are the types of error theories?
- Wear and tear
- Oxidative stress
- Free radical
- Mutations
- Telomeres and aging
Wear and Tear Theory*
- Cellular errors a result of “wearing out” over time from continued use.
- Associated with internal and external stressors (associated with free radicals).
- Causes a progressive decline in cellular function or increased cellular death.
Oxidative Stress Theory
- Increased ROS (reactive oxygen species) is referred to as “oxidative stress” or “oxidative damage”.
- Increased by external factors (pollution, cigarette smoke) and internal factors (inflammation).
- Is random, unpredictable, and variable among individuals.
Free Radical Theory
- End products of cellular metabolism, such as atoms, molecules, or ions.
- Chemically unstable and cause damage to normal cell functioning.
- With aging it is suggested that there is an imbalance between the accumulation of free radical damage and what the body is able to neutralize.
- Supplemental antioxidants: more is not better (Box 3-2).
- Consider diet that includes natural antioxidants like the Mediterranean diet.
Telomeres and Aging
Telomeres are located at the ends of the DNA strand and appear to have a maximum length until they undergo senescence.
The length of the telomere may affect
Longevity
Immunity
Overall health
The presence of the enzyme, telomerase, ensures
The reproductive ability of the telomere.
Telomere shortening is influence by a
Number of factors, especially lifestyle choices (box 3-4)
Autoimmune Theory
- Aging is a programmed accumulation of damage and decline in the function of the immune system—“immunosenescence”
- Decreased ability of lymphocytes to withstand oxidative stress
- T cells thought to be responsible for increasing age-related autoimmune disorders
Teaching for Oxidative Stress Theory
- Avoid environmental pollutants and unnecessary radiation.
-Watch for research on the use and presence of antioxidants - Avoid stress
Teaching for Autoimmune Theory
- Avoid stress
- Minimize the potential for infection: wash hands frequently, updated immunizations, and avoid those who are ill
Psychosocial theories of aging
- Persons are multidimensional
- Life should be considered in totality to understand aging
Theories are classified as
- First Generation
- Second Generation
- Third Generation
First Generation Theories
Explain and predict changes in middle and late life, focusing on adjustment.
Second Generation Theories
Expanded and built upon first generation theories
“Alternative theoretical perspectives”
Third Generation Theories
Understanding the human meanings of social life in context to everyday life.
What are the first generation psychosocial theories?
- Role Theory
2. Activity Theory
Role Theory
Socially and culturally constructed expectations of behaviors at times in one’s life and in pre-established roles.
Activity Theory*
Attempted to predict and explain how individuals adjusted to age-related changes by looking at one’s level of activity and productivity.
What are the second generation psychosocial theories?
- Disengagement Theory
- Continuity Theory
- Age-Stratification Theory
- Social Exchange Theory
- Modernization Theory
- Gerotranscendence Theory
Disengagement Theory
Withdrawal of elders from their roles and activities earlier in life necessary to allow transfer of power to younger generations
Continuity Theory
Suggests that individual tends to develop and maintain consistent pattern of behavior, substituting one role for similar one as one matures.
Age-Stratification Theory
- Goes beyond individual to age structure of society.
- Aging is best understood in the context of individuals as members of a cohort.
Social Exchange Theory
- Based on consideration of cost-benefit model of social participation.
- As one ages he/she has fewer economic resources to contribute to society.
- Leads to loss of social status, self-esteem, and political power.
Modernization Theory
Attempts to explain social changes resulting in devaluing of both contributions of elders and elders themselves.
Gerotranscendence Theory
- Persons withdraw, not from society, but to have time to self-reflect, explore inner self, contemplate the meaning of life, and move away from the material world.
- Aging is seen as a movement toward wisdom.
- Marker of successful aging.
Nursing Assessment: Role theory
-Currently held roles, role satisfaction, and emerging roles.
-Individual’s and family’s expectations of age norms and effect on self-esteem.
-Effect of changes in health on usual roles and activities.
-Cultural beliefs and expectations related to
roles, activity, as well as both engagement and disengagement related to these
Nursing Assessment: Activity Theory
-Current level of activity and satisfaction with such.
-Effect of changes in health on usual roles and activities.
-Cultural beliefs and expectations related to
roles, activity, as well as both engagement and disengagement related to these
Nursing Assessment: Disengagement Theory
Cultural beliefs and expectations related to roles, activity, as well as both engagement and disengagement related to these
Nursing Assessment: Continuity Theory
-Usual life patterns and personality & attention to change as indication of potential problem
Nursing Assessment: Age Stratification Theory
Knowledge of historical context of individual and potential influence on perception and responses
Nursing Assessment: Social Exchange Theory
Complexity of social support and network
Nursing Assessment: Modernization Theory
- Opportunities for contributions of knowledge to society.
- Sense of self and self-worth
Healthy Aging* Definition
“…the process of slowing down, physically and cognitively, while resiliently adapting and compensating in order to optimally function and participate in all areas of one’s life (physical, cognitive, social, and spiritual).” (Hansen-Kyle, 2005, p. 52)
Wellness Based Model
The concept of wellness incorporates all aspects on one’s being within the context of culture. (Functional, environmental, intellectual, psychological, spiritual, social and biological)
Wellness Based Model for Healthy Aging: Characteristics
- Health is viewed on a continuum.
- Healthy aging must be viewed from the prenatal period to death.
- Epigenetics is leading to a new understanding of the impact of environment factors.
- Health promoting strategies are important in achieving and maintaining the highest level of wellness on a continuum.
- Preventative services are highly underutilized.
Physical Wellness is enhance through
Regular physical activity
Diet and nutrition
Avoidance of tobacco, drugs, and excessive alcohol consumption
Emotional Wellness includes
- Awareness and acceptance of one’s feelings.
- Ability to form relationships based on mutual commitment, trust, and respect.
- Positive self image and enthusiastic about life.
- Ability to cope effectively with stress.
Spiritual Wellness includes
- Recognizes the search for meaning and purpose in our lives.
- Taking time to reflect and connect with the universe.
Intellectual Wellness includes
Expanding one’s knowledge and skills throughout life.
Discovering new skills and interests.
Challenging oneself through creative stimulating mental activities.
Occupational Wellness includes
Doing what you love.
Contributing your unique gifts, skills, and talents to work that is personally meaningful and rewarding.
Balancing work with leisure time.
The National Prevention Council’s six priorities for disease prevention and health promotion in older adults include
- Tobacco-free living
- Preventing drug abuse and excessive alcohol use
- Healthy eating
- Injury and violence-free living
- Reproductive and sexual health
- Mental and emotional well-being
Physical health promotion for older adults involves
- Engaging in physical activity.
- Changing unhealthy food and alcohol patterns.
- Participating in treatment and management of illness and disability.
- Using assistive devices and supports to maintain mobility.
Psychosocial Health Promotion in older adults involves
- Adopting a positive attitude.
- Getting priorities in order.
- Avoiding dwelling on problems.
- Capitalizing on previous success or participation in activities.
- Match activities with interests, need, limitations.
- Expressing feelings or concerns.
- Having fun!
Cognitive health promotion in older adults involves
- Learning new things.
- Taking classes.
- Keeping abreast of current events.
- Participating in activities.
Interpersonal health promotion in older adults involves
- Volunteering
- Joining groups
- Sharing expertise and experiences
Types of Prevention
Primary
Secondary
Tertiary
Primary Prevention
Strategies that can and are used to prevent illness before it occurs (i.e exercise, diet, smoking cessation).
Secondary Prevention
Early detection of the disease or health problem that has already developed (i.e. annual physical exam, DEXA scan).
Tertiary Prevention
Addresses the needs of persons who have their day-to-day wellness challenged, by slowing disease or limiting complications.
What are key strategies for improving the health of older people?
- Healthy lifestyle behaviors.
- Injury prevention.
- Delivery of culturally appropriate clinical preventive services.
- Immunizations and preventive screenings.
- Self-management techniques for chronic illnesses.
Chronic Illness
- Incidence increases with age.
- More than 80% of adults over age 70 have at least one chronic condition and 50% have multiple health problems.
What are the most common chronic conditions in older adults?
Heart disease Hypertension Cancer Arthritis Diabetes
Implications for Gerontological Nursing: Assessment
- Listening is key to assessment as the nurse tries to understand situation and person
- Health beliefs
- Cultural beliefs
LEARN Model
- Guides nurse in clinical setting while interacting with elders of any ethnicity
- Nurse increases cultural sensitivity and will provide more culturally competent care
LEARN Model: L
Listen to what the patient has to say
LEARN Model: E
Explain your perception of the problem
LEARN Model: A
Acknowledge the similarities and differences of perception.
LEARN Model: R
Recommend a plan of action that takes into account both perspectives
LEARN Model: N
Negotiate a plan that is mutually acceptable.
Designing Interventions in Gerontological Nursing
Develop plan of action that considers perspective of both elder/family and nurse/health care system and to negotiate outcome that is mutually acceptable.
Barriers to quality care range from those related to
- geographical location
- age
- gender
- race
- ethnicity
- sexual orientation
Ethnocentrism
The belief that one’s ethnic group is superior to that of another’s
Stereotyping
Application of limited knowledge of a race, ethnicity, age or culture to an individual.
Cultural blindness
Prevents the nurse from providing sensitive and effective care.
Cultural competence
Acceptance that all persons are deserving of respect
Cross-cultural knowledge
Optimize health care and minimize frustration and conflict between older patients and other HCP
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