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Health Promotion Health Promotion StrategiesStrategies

Through the Life SpanThrough the Life Span

Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Health Promotion Strategies Through the Life Span, Eighth EditionRuth Beckman Murray, Judith Proctor Zentner, and Richard Yakimo

Chapter 15The Middle-Aged Person: Basic Assessment and Health Promotion

Chapter 15The Middle-Aged Person: Basic Assessment and Health Promotion




Middle AgeMiddle Age

Approximately 45-65 and even 70-75 years of age

Physiologic and psychological age plays role

State of mind in U.S.




Generational GapGenerational Gap

Baby Boomers– Self-centered, narcissistic, highly confident– Expect immediate gratification– Carefree– Difference in early middle-aged adult and late

middle-aged adult Generation is concerned about others Generation develops new patterns of

behavior based on changing world




Bridging Generation GapBridging Generation Gap

Discuss that middle-aged persons have a lot of experience to give to children about dealing with technological changes

Reaffirm that parents should teach the value of commitment

Explain that continuity of values exists in the family

Explain how to reduce conflicts with offspring




Divorce of OffspringDivorce of Offspring

Family crisis Adjustments difficult for parents of

offspring– May feel failure– May feel stress about offspring returning

home– May worry about future relationship with

grandchildren




GrandparenthoodGrandparenthood

Happy status and role if offspring has established own home and family

Stressful if offspring has returned home with child or grandparent is young

Help middle-aged couple set limits to be able to pursue life goals

Encourage grandparents who want to secure visitation rights




Marriage Marriage

Gradual rise in marital happiness during middle adulthood

Companionate love is stronger Couple likely to have friendship and

security Male and female both need support to

reinforce masculinity or femininity




Marital CrisisMarital Crisis

Having little or no laughter, love, or interest in relationship

Feeling disappointed with self Seeking rebirth or changing directions Seeking escape from reality and superego Divorce has a greater impact on middle-

aged person Middle-aged person more adaptable in

face of divorce




Sustaining MarriageSustaining Marriage

Explore ways to promote positive changes Refer to other resources Encourage “what if” conversations Encourage couples to vary schedules,

expectations, and roles Counsel to keep active and maintain

contact with others Encourage to use each other as resource




Middle-Aged CrunchMiddle-Aged Crunch

Person in middle of two demanding generations– Offspring may still require attention and care– Aging parents and relatives may require care

Filial responsibility: Attitude of personal responsibility toward the parents that emphasizes duty, protection, care, and financial support




Support for Aging Support for Aging RelativesRelatives

Visits and phone calls Information and assistance in decision

making Assistance with daily tasks Level of care may depend on

– Cultural differences– Responsiveness of elderly family members




CaregivingCaregiving

Prolonged assistance given to meet physical and emotional needs of a person with functional limitations or incapacity without payment toward 24-hour care

Many factors influence caregiving role Can have negative effects on physical,

emotional, and mental health of caregiver




Counsel for CaregiversCounsel for Caregivers

Work through conflicts, feelings of frustration, guilt, and anger

Acquire greater understanding of person being helped

Acquire greater satisfaction from helping Understand physiologic, emotional,

cognitive and social needs of elders Participate in support groups Maintain personal health




Parental DeathParental Death

Person feels finiteness and mortality of self and others

Person may recall childhood and recent memories

Person may mourn previously lost loved ones or feel alone

Person may delay grieving process due to conflict

Person may search spiritually




Family Development TasksFamily Development Tasks

Maintain a pleasant and comfortable home Assure security for later years Share household and other responsibilities Maintain emotional and sexual intimacy as

a couple or regain emotional stability alone Maintain contact with grown children and

their families Decrease attention on child care tasks and

adapt to departure of the child(ren)




Family Developmental Tasks Family Developmental Tasks cont.cont.

Meet the needs of elderly parents or other relatives in such a way as to make life satisfactory for both the parent(al) and middle-aged generations

Participate in community life beyond the family

Use competencies built in early stages to expand or deepen interests and social or community involvement




Widow(er)hood CrisisWidow(er)hood Crisis

Major crisis Reaction may be different for sudden

death than death from longer period of illness

Gently test for readiness of shock of death Person may feel ambivalence or linger

around nursing center Remain available and supportive




Reaction to Death of Reaction to Death of SpouseSpouse

Effects on reaction– Personality and emotional makeup– Relationship between the couple– Religious, cultural, and ethnic background

Changes for person– Loss of companion, audience, or helper– Loss of financial support and secondary

materials– Returning to work force or giving up activities




WidowhoodWidowhood

Threat to self-concept and wholeness Threat to physical health Widow considered threat to females with

husbands Widower may be more vulnerable to

depression Widower more likely to remarry or have

companion




Tasks for Widow(er)Tasks for Widow(er)

Recognize reality of loss Express feelings Find significant methods to manage pain Incorporate prior relationships and

supportive relationships Maintain or develop positive self-concept Maintain or re-establish health




Widow(er) SupportWidow(er) Support

Listen Avoid shallow or unwanted advice Do practical tasks Assist in crisis resolution

– Encourage medical checkups– Identify support system– Utilize resources– Encourage trying new things– Encourage taking time to grieve




Climacteric for FemalesClimacteric for Females

Menopause: permanent cessation of menstruation preceded by gradually declining menstrual flow

Perimenopausal: years of gradual diminution of ovarian function and change in endocrine status from before menopause until a year after

Different views on menopause exist




Changes During MenopauseChanges During Menopause

Average age of onset: 51-52 years Changes in FSH secretion bring changes

to ovaries Changes in progesterone and estrogen Some discomforts may occur from

vasomotor, urogenital, or endocrine balance changes

Difficulties experienced during menopause may be related to life changes, recent loss, or stress




Reactions to MenopauseReactions to Menopause

Depression, irritability, and change in sexual desire

Females with heavy investment in childbearing may react more severely

Reactions vary across social classes and cultures, and availability of roles

Changes in health or emotional status may be based on individual differences in coping with stress or other behaviors




Hormone Replacement Hormone Replacement TherapyTherapy

Widely discussed and studied Educate clients about the benefits and

risks of hormone replacement therapy Monitor and assess regularly clients who

are using the therapy Offer other ways that symptoms of

menopause may be managed Refer to support groups and educational

materials




Climacteric for MalesClimacteric for Males

Hormonal fluctuations and physical and psychological changes

Do not lose reproductive ability Dissatisfaction at work and other losses

may add to the sense of crisis and aging Interventions may include healthy lifestyle

changes, various psychotherapies and behavior modification, hormone therapy, or medications for erectile dysfunction




Physical Characteristics Physical Characteristics ofof

Middle-Aged Person Middle-Aged Person Skin wrinkles and loss of elasticity Gray hair or loss of hair Compression of spinal column Presbyopia and gradual decrease in

hearing Decreased efficiency of heart and

elasticity of blood vessels Reduced breathing capacity




Nutritional NeedsNutritional Needs

Should be a reduction in caloric intake Reduced carbohydrates, foods with trans fat,

saturated fat, cholesterol, and “empty” calories Increase in Fiber, protein, calcium, Vitamin D,

phosphorus, magnesium, and fluoride Plenty of fluids need (not tea or coffee) Teach about daily diet and self-help groups while

considering client values




ExerciseExercise

Can include many types of activities Moderate exercise: 30 minutes a day at

least 5 days a week Vigorous exercise: 20 minutes three times

a week. Enhances quality of life and physical,

emotional, and mental health




Benefits of ExerciseBenefits of Exercise

Helps prevent– Cardiac disease– Hypertension– Obesity– Diabetes– Osteoporosis– Depression

Encourage back exercises and foot care to maintain ability to exercise




SleepSleep

7-8 hours of sleep recommended Middle-ager may awake several times

during the night Insomnia may be a sign of a more serious

underlying medication condition Parasomnias are conditions in which sleep

is disrupted by inappropriate activation– Sleep apnea is currently being widely studied




WorkWork

Resolve job conflict Participate in challenges Have a lower avoidable absenteeism rate Become an expert at what they are doing Use life experience and maturity on the job Less emotionally labile Value work




Work cont. Work cont.

Finding different work can be difficult Many plan to work past retirement age Many feel they are overworked (middle-

aged female) Discuss work stability and work’s effect on

physical, mental, and emotional health Help clients improve time management

skills




RetirementRetirement

Some may retire early Many continue to work

– Views of self and society– Desire to contribute and avoid boredom– Desire to be financially prepared

Explore with client various options and examine how to make options happen




Cognitive Stage and Cognitive Stage and LeadershipLeadership

Cognitive stage favors positions of leadership

Qualities – High level of education or success– Realistic goals and self-concept– High frustration tolerance– Inclination to praise and reinforce behavior– Understanding of group needs– Ability to delegate authority




Leisure TimeLeisure Time

May include couple and personal interests May include volunteerism Contributes to physical, emotional, and

social health Many mix learning, work, and play Some middle-aged adults may not know

how to use extra free time Help review function and types of leisure




Influences on Cognitive Influences on Cognitive AbilityAbility

Neurons become more intertwined Both hemispheres of brain increasingly

used for logical reasoning and intuitive tasks

Many show ability by returning to school to earn degrees




Cognitive ProcessesCognitive Processes

Reaction time: remains the same or diminishes

Perception: experience important Memory: quantitative changes may occur Learning and problem solving: remain

unimpaired Creativity: greater ability Concrete and Formal Operations and

Problem Finding Stage




Cognitive ThoughtCognitive Thought

Use of multiple intelligences Use of reflection Monitoring for logic and continuity Producing images, thoughts, and

combination of ideas Representing experience symbolically Having intellectual curiousity




Cognitive DevelopmentCognitive Development

More flexible and creative More productive in total creative output

and better quality output Help middle-aged adults begin new

ventures in life and continue learning Use methods that capitalize on the

learning strengths of mature adults




Emotional DevelopmentEmotional Development

Demonstrates less evidence of fear, anger, and hatred than the young adult

Less impulsive in response to emotion Less negative feelings Period of self-assessment and greater

introspection Transitional period in which the person

perceives life as time left to live rather than since birth




Self-ConceptSelf-Concept

Realignments of attitudes about self Person may realize he or she looks and

feels older Mature person

– Accepts change and realizes it is impossible to return to youth

– Feels good about self Reaffirm strengths of middle-aged person




Moral and Spiritual Moral and Spiritual DevelopmentDevelopment

Integrates new concepts from widened sources

Likely to return to religious groups for strength, comfort, and joy

Development is advanced when the person has an experience of sustained responsibility and welfare for others

Without development person may feel despair in old age




GenerativityGenerativity

Generativity is a concern about providing for others that is equal to the concern of providing for the self.

Person uses personal strengths, vigor, and experience to meet the needs of the community and others

Person may be a mentor to a young adult




Self-AbsorptionSelf-Absorption

If generativity is not achieved, the person may be self-absorbed or regress to adolescent behavior

Person hates the aging body and feels neither secure nor adept at handling self– Impaired and less socially organized

intellectual skills and value systems– Avoids concern for others




MaturityMaturity

Doing what is appropriate for age, situation, and culture

Psychic interests broaden and are less selfish

Staying power Restructures or processes information in

the light of experience Uses knowledge and expertise in a

directed way to achieve desired ends.




Other TheoristsOther Theorists

Jung

Gould

Levinson

Sheehy

Vaillant

Neugarten




Adaptive MechanismsAdaptive Mechanisms

Adult socialization Ongoing learning and adaptation The healthy and adaptive person

– Copes with ordinary personal upheavals and life’s frustrations and disappointments with only temporary disequilibrium

– Participates enthusiastically in work and play




Adaptive Mechanisms cont.Adaptive Mechanisms cont.

The healthy and adaptive person– Experiences adequate satisfaction in a stable

relationship– Expresses a reasonable amount of emotion – Serves as a role model of maturity

Counsel to prevent or overcome maladaptive mechanisms

Validate actions and refer to other resources as necessary




Altruistic BehaviorAltruistic Behavior

Promote by– Listening– Support– Encouragement of activities– Teaching and counseling– Referral to organizations that can use

person’s talents, time, and financial resources




Midlife CrisisMidlife Crisis

Refers to a major and revolutionary turning point in one’s life– Involving changes in commitments to career

or spouse and children– Accompanied by significant and ongoing

emotional turmoil for both the individual and others

More common in males Use cognitive-behavioral statements




Midlife Crisis cont.Midlife Crisis cont.

Causes– Has not resolved the identity crisis of

adolescence and achieved mature intimacy – Fears the passage of time– Cannot handle the meaning of life’s routine

and changes




Developmental TasksDevelopmental Tasks

Maintain or establish healthful life patterns Help growing and grown children as well

as aging family Create a pleasant, comfortable home Find pleasure in generativity and work Maintain a standard of living related to

values, needs, and financial resources Prepare for retirement




Developmental Tasks contDevelopmental Tasks cont

Achieve mature social and civic responsibility

Accept and adjust to the physical changes Make an art of friendship Use leisure time creatively and with

satisfaction Acknowledge time for fulfillment is shorter Continue to formulate a philosophy of life




ImmunizationsImmunizations

Educate about the need to maintain recommended immunizations and a personal record of type and date

Middle-aged clients may receive tetanus diphtheria toxoid or influenza, hepatitis B, and pneumonia vaccines

Refer clients to websites and other resources for updated lists of recommended vaccines.




Health IssuesHealth Issues

Females– Eating disorders– Breast cancer– Autoimmune and

gastrointestinal diseases

– Osteoporosis– Depression – Cardiac disease

Males– Accidental death

and disability from accidents

– Tendancy to smoke and drink

– Tendancy to avoid medical care or preventative services




AccidentsAccidents

Fractions and dislocations are the leading cause of injuries for both genders

Occupational-related accidents and falls in the home are causes of injury and death

Teach about safety as it relates to remodeling a home, maintaining a yard, or establishing a work center

Reinforce personal/family planning for gradual failing of physical abilities




Holistic CareHolistic Care

Educate about major health problems of middle age

Educate about important routine tests (BDI; FOBT; FIT)

Educate about measures to promote health

Help client find ways to deal with stressors Teach about medication management Refer client to resources




More Health CareMore Health Care

Educate about gender differences for disease incidence and presentation– Educate males and females to take aspirin

daily to reduce risk of heart attack– Educate about psychosocial and physical

factors for cardiac and cardiovascular disease Use concepts from the Transtheoretical

Model of Change Use cognitive behavioral therapy




Common Health ProblemsCommon Health Problems

Atherosclerosis Hypertension Coronary artery

disease and stroke Cancer Asthma

Impaired vision and hearing

AIDS Obesity Arthritis Osteoporosis




CancerCancer

Males: prostrate, lung, colon, rectum, and bladder

Females: lung, breast, colon, and rectum Encourage yearly screenings Explore emotional concerns about having

cancer Refer clients to resources as necessary Teach clients about the importance of the

mind-body connection




Assessment and CareAssessment and Care

Remember that the momentum of life and multiple societal roles for the middle-ager may leave little time to focus on personal health unless there is an illness crisis

Emphasize that middle-agers role model and teach young adult offspring and their children about health promotion skills and resources and familial health history




Examples of Nursing Examples of Nursing DiagnosesDiagnoses

Anxiety Disturbed body

image Caregiver role

strain Decisional conflict Defensive coping Fatigue

Risk for loneliness Risk for impaired

religiosity Social isolation Ineffective role

performance Anticipatory

grieving




Self CareSelf Care

Express feelings about life situations Express a supportive or positive attitude Foster positive self-esteem Access resources and learn self-care skills Consider safe alternative and

complementary therapies Integrate health-promotion activities into

life

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