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NURSING CARE OF THE OLDER ADULT
THE AGING EXPERIENCEChapter 2 (4th Edition)
PATI COX, RN, BSN, M.Ed.
OUTLINE
• INTRODUCTION– Definitions– Demographics – past/present/future– Impact of aging on nursing– Ethical considerations
ATTITUDES TOWARD AGING– History– Ageism
Outline cont.
• The NORMAL AGING PROCESS• Normal Physiological
Changes-All Systems
• Physiological Changes Not Common to Aging
– Changes– Common Chronic Diseases -4– Common Causes of Death - 3
Names Synonymous with Aging
• “Oldster”• “Elderly”• “Golden Years”• “Twilight Years”• “Senior
Citizens”• “Silver Haired”• “Grumpy”• “Sunset years”
Terminology
• Gerus – Greek for old age
• Geriatrics – the medical study of older adults
• Gerontology – the nursing study of the older adult
• Senility – state of being old ( mentally & physically) not an acceptable medical diagnosis
• Senescence – process of aging
• Aged – means old and usually refers to those over the age of 75
GENERAL INFORMATION
•Natural process•Each of us move through•Attitudes are changing
about aging with the “Baby Boomers”
• Issues that affect quality of life are receiving more attention
Demographics - Past
• Life expectancy – 1776 - 35 years– 1930 - 59.7 years– 1965 – 70.2 years
• Confuscious – 1000’s of years• Pioneers, Egyptians – youth to
young adult• 1 in 10 could expect to live to
65
TODAY’S AGEDTODAY’S AGED
• YOUNG OLD – 65-74• MIDDLE OLD – 75-84• OLD OLD – 85 + (Fastest growing
population)• Experiences –
– Great Depression– Antibiotics, Airplanes– Automobiles, Television,– Polio, Small Pox, TB– WWI, WWII, Kennedy,
Truman, Roosevelt, Eisenhower
– King
“The Graying of America”
• Life expectancy has increased dramatically
• 80% of American’s anticipate living to 65 or older
• 12.7% of total population• 1 in every 8 Americans is 65 or older• 65-74 age group is 8 times higher
than in 1900• 75-84 age group is 16 times higher• 85+ is 22 times higher-fastest
growing
The Graying of America
• Life expectancy in 2005 is anticipated at 76.9 years– Females –
– Caucasian (79) other 74.9– Males –– Caucasian ( 72.9) other 67.2– 2 million celebrated 65th birthday
(5574/day) – Overall – 76.4 years
“The Graying of America “ – Marital Status
• Marriage– Older men 74% – Older women 43%– Almost ½ of all
older women were widows (45%) 14% men
– 1 widower to 4 widows
• Divorced– 8%– #’s
0
10
20
30
40
50
60
70
80
Ma Wi Si Di
WomenMen
Key: Ma= Married; Wi = Widowed; Si = Single; Di = Divorced
The Graying of America - Income
• Average income was $19,168 = men
• Average income was $10,899 = females
• Households headed by 65+ average income = $32,854– Caucasians - $33,467– African Americans - $27,952– Hispanics - $24,330
Family Households 65+ Householder
0 5 10 15 20 25
Under 10,000
$10,000 - 14,999
$15,000 - 24,999
$25,000 - 34,999
$35,000 - 49,000
$50,000-74,999
$75,000 and over
Bar 1
13.9%
14.5%
18.4%
19.4%
21.7%
8.1%
4.0%
Poverty• 3.4 million (10.2%) below poverty level in
2000• Historic low was reached in 1999• 2.2 million (6.7%) were classified as
“near poor”• 1 of 12 (8.9%) Caucasian• 22.3% African American; 18.8% Hispanics• Older women (12.2%) Older men (7.5%)• Living alone or living with nonrelatives –
highest poverty rate• Highest poverty = Hispanic women living
alone or with nonrelatives (38.3%)
Employment
• 12.8% (4.2 million) 65 and over were in workforce in 2005
• 2.4 mill. Men and 1.8 mill. Women• 3 % of US Labor force
Education
• Educational level is increasing
• High school grads increased from 1970-2005 from 28% to 70%
• 16% had Bachelor’s degrees or more in 2005
Future – “The Graying of America”
•By 2010-2030 = 20-22% = 70 million (twice # in 2000)
•Baby Boomers will reach 65•Growth slowed somewhat in the 1990’s due to the low birth numbers in the Great Depression – 1930’s
Future – “The Graying of America”
• Minority Population– 25.4% of elderly population in 2030 (219%)– 16.4% in 2000– Caucasian – 65+ will increase 81%– Hispanics – 65+ will increase 328%– African Americans – 65+ will increase
131%– American Indians, Eskimo – 65+ will
increase 147%– Asian & Pacific Islanders – 65+ will
increase 285%
Future – “The Graying of America”
•Factors that affect age distribution of population–Decreased mortality
•Better education, health, etc
–Decreased fertility•Baby Boomer females marry later, career oriented, fewer children
Impact on Nursing
• Spend ¾ (75%) caring for the elderly• Most nurses will be classified as a
“geriatric” nurse• 65% of patients in acute care; 83%
home care; and 92% long term care• 85 + will have greatest health care
needs• Elderly will become more politically
active• Will care for individuals with
significant histories & life experiences
Ethical Considerations
•¼ of medical care $ is spent in the last month of life
• Treatment considerations• Ethic committees to assist staff in
making difficult decisions ( not just in hospitals, but in nursing homes, etc)
Attitudes Toward Aging
• History & Cultures– Western – Embarrassed &
tolerance– Eastern- Extended Family &
well respected– Are we changing our
attitudes toward the aged?
Forms of ageism
•Paternalism or Infantilism– Talk to older adult as if child– Refer to them as
• “sweetie”• “honey”• “dearie”
Living Arrangements
• Over ½ (55%) noninstitutionalized persons live with spouse
• 633,000 Grandparents aged 65+ maintained households in which grandchildren were present
• Institutionalized –– 65-74 = 1.1%– 75-84 = 4.7%– 85+ = 18.2%
Housing in 2005
• 80% were owners – 20% renters• The average year of construction
of the home was 1962• Average value of homes in 1999 –
96,442 • 76% owned their homes free and
clear
Geographical Distribution
• Approx. ½ (52%) of elderly live in 9 states:– California; Florida; New York; Texas; Pennsylvania;
Ohio; Illinois; Michigan; New Jersey• 14% or more of total population
– Florida Pennyslvania ;West Virginia; Iowa Rhode Island; Maine; South Dakota; Arkansas
• States with Lowest Poverty Rates for Elderly– Mississippi; Louisiana; District of Columbia;
Alabama; Tennessee; Arkansas; New Mexico; Kentucky; West Virginia; New York; Texas
• Most elderly lived in Metropolitan areas = 77.5% while 23% lived in nonmetropolitan areas
• Less likely to change residence than any other age group.– When moving – most move to same city as children
or same state
Health , Health Care, Disability• 26.1% elderly assessed their health as fair
or poor; little difference between sexes; ethnic races rated their health much more fairer or poorer than Caucasians
• In 2002, more than ½ (55%)of elderly population reported with @ least 1 disability
• 4 times the # of days of hospitalization• Average Length of Stay = 6 days (4.1 <65
yr)• 11% spent on health care (5% < 65)• More physician visits
Percent with Disabilities, by Age
0
10
20
30
40
50
60
70
80
% withany
disability
% withsevere
disability
% needassistance
65-6970-7475-7980+
Chronic Health Problems• 28.8% reported a limitation
caused by a C.H.P (65-74)• 50.6% of those 75 & older
reported they were limited due to a C.H.P.
• Four most common C.H.P.– Arthritis (53%)– Hypertension (42%)– Heart Disease (40%)– Cataracts (23%)
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