Chapter No. 3 4 Gerontological Nursing

Life Changes and Events in Old Age
CHAPTER NO. 3
GERONTOLOGICAL NURSING
Page 01
Introduction
Growing old maybe complex and complicated
because the older individuals may need to face many
life transitions like retirement, reduced income,
possible housing changes, frequent losses through
deaths of significant persons, and a declining ability to
function. In addition, these life events can be
accompanied by role changes that can influence
behavior, attitude, status, and psychological integrity.
Page 02
Learning Objectives
After reading this Chapter, you should be able to:
1. Discuss ageism and its consequences.

2. Discuss changes that occur in aging families in terms of
a. Changes in family roles and relationships: parenting

and, grandparenting.
b. Loss of spouse
c. Retirement: loss of work role, reduced income
3. Discuss the impact of aged-related changes in health

and functioning on roles.
Page 03
Learning Objectives
4. Describe cumulative effects of life changes and events:
shrinking social world, awareness of mortality.
5. Describe the responses of the older adults to life

changes and events: life review and life story, self-
reflection, strengthening inner resources.
6. List nursing measures to assist individuals in adjusting

to changes of aging.
Page 04
Terminologies:
Ageism. Applying prejudices to older adults due to their age.
Inner resources. Strength within the person that can be drawn upon when needed.
Life review. A process of reminiscing or reflecting on one's life.
Retirement. The period in which one no longer works.
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Ageism
The prejudices and stereotypes that are applied to older people sheerly on basis of
their age... "(Butler, Lewis and Sutherland, 1991).
Rather than showing appreciation for the vast contributions of older adults their
wealth of resources and wisdom, society is best with prejudices and lad adequate
provision for them, thus derogating their dignity.
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Older adults are oftentimes stereotyped by the following misconceptions:
• Old people are sick and disabled.

• Most old people are in the homes for the aged or nursing homes or homes of their children.
• Dementia comes with old age.
• People are either very tranquil or very cranky as they age.
• Old people have lower intelligence and are resistant to change.
• Old people are not able to have sexual intercourse and are not interest in sex.
• There are few satisfaction in old age.
Gerontological nurses and other concerned groups have the responsibility" increase societal
awareness of the realities of aging by giving information families and the public on the facts
regarding aging and the problems and right of older adults.
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Ageism may have consequences as follows:

•It leads to lack of understanding of older people by the younger people.
• It reduces the opportunities for the younger people to gain realistic
insights into aging.
• It predisposes aging persons to disappointments because they may
believe stereotypical views that old age in a time of purposelessness
and decline.
•It may be detrimental to achieving an opportunity for freedom, growth,
and contentment during old age.
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Changes in Family Roles and Relationships
1. Parenting
The dynamic parental role changes to meet the growth and development needs of both
parent and child. During middle and later life, parents must adjust to the independence of
their children as they become responsible adult citizens and they leave home. For
persons who have invested most of their adult lives nurturing and providing for their
offspring, may have significant impact Although parents who are freed from the
responsibilities and worries of rearing children have more time to pursue their own
interests, they are also freed from the meaningful, purposeful, and satisfying activities
associated with child-rearing, and this frequently results in a profound sense of loss.
Page 09
Changes in Family Roles and Relationships
2. Grandparenting
In addition to experiencing changes in the parenting role that come with many older adults
enter a new role as grandparents. Filipinos' extended life expectancy enables more people to
experience the role of grandparent and more years in that role than previous generations. Many
older Filipinos are grandparents, and:
• Most are baby boomers, a great number are likely to be college educated and employed than
previous generations of grandparents.
• They are spending more on grandchildren than previous generations (Metlife ,2011).
Grandchildren can bring considerable joy and meaning to the lives of older and adults. In turn,
grandparents who are not burdened with the same da rearing responsibilities of parents can
offer love, guidance, and enjoyment family's young.
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Grandparenthood is a learned role, and some older individuals may need guidance to
become effective grandparents. Older adults may need to be guided in thinking through
issues such as:
• Respecting their children as parents and not interfering in the parent-child relationship.
• Calling before visiting.
• Establishing rules for babysitting.
• Allowing their children to establish their own traditions within their family and not
expecting them to adhere to the grandparents' traditions.
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Loss of Spouse
The death of a spouse is a common event that alters family life for many older
persons. The loss of that individual with whom one has shared more love and life
experiences and more joys and sorrows than anyone else may be intolerable. The
death of a spouse affects more women than men. In fact, most women, will be
widowed by the time they reach their eighth decade of life. Unlike many of today's
younger women, who have greater independence through careers and changed
norms, most of today's older women have led family-oriented lives and have been
dependent on their husbands.
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Retirement
Retirement is another of the major adjustments of an aging individual. This

transition brings the loss of a work role and is often an individual's first experience
of the impact of aging. In addition, retirement can require adjusting to a reduced
income and consequent changes in lifestyle.
a) Loss of the Work Role
Retirement is especially difficult in urban areas, in which worth is commonly

measured by an individual's productivity. Work is often viewed as the dun required
for active membership in a productive society.
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Therefore, to provide holistic care, gerontological nurses must understand the realities
and reactions encountered when working with retired persons Although the experience of
retirement is unique for each individual, some reactions and experience tend to be fairly
common. The phases of retirement described by Robert Atchley decades ago continue to
offer insight into this complicated process:
• Preretirement Phase. When the reality of retirement is evident preparation for leaving
one's job begins, as does fantasy regarding the retirement role.
• Retirement Phase. Following the retirement event, a somewhat euphoric period begins, a
"honeymoon period in which fantasies from the preretirement phase are tested. Retirees
attempt to do everything they never had time for simultaneously A variety of factors (e.g.,
finances and health) limit this, leading to the development of a stable lifestyle.
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• Disenchantment Phase. As life begins to stabilize, a letdown sometimes a depression, is
experienced. The more unrealistic the preretirement fantasy, the greater the degree of
disenchantment.
• Reorientation Phase. As realistic choices and alternative sources of satisfaction are

considered, the disenchantment with the new retirement routine can be replaced by
developing a lifestyle that provides some satisfaction.
• Retirement routine Phase. An understanding of the retirement role is achieved, and this
provides a framework for concern, involvement, an action in the older person's life Some
enter this phase directly after the honeymoon phase and some never reach it at all.
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Termination of retirement. The retirement role is lost as a result of either the resumption
of a work role or dependency due to illness or disability (Atchley, 1975, 2000)
Different nursing interventions may be required during each phase retirement:
Assisting aging individuals with their retirement preparation during the preretirement
phase is a preventive intervention that enhances the potential for health and well-
being in late life. As part of such practice good health habits such as following a
proper diet, avoiding alcohol, drug, and tobacco use and having regular physical
examinations.
Counseling regarding the realities of retirement may be part retirement preparation
whereas helping retirees place their newfound freedom into proper perspective may
be warranted during the honeymoon period of retirement phase
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Being supportive of retirees during the disenchantment phase without
fostering self-pity and helping them identify new sources of satisfaction may
facilitate the reorientation process.
Appreciating and promoting the strengths of the stability phase ma reinforce

an adjustment to retirement.
When the retirement phase is terminated due to disease or disability the

tactful management of dependency and the respectful appreciation of losses
are extremely important.
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b) Reduced Income
In addition to the adjustment in work role, retirement often requires older adults
to live on a reduced income. Financial resources are important at any age
because they affect our diet, health, housing, safety, and independence and
influence many of our choices in life.
Therefore, making financial preparations for old age many years before retirement
is extremely important. Nurses should encourage aging working people to
determine whether their retirement income plans are keeping pace with inflation.
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Changes In Health and Functioning

The changes in appearance and bodily function that occur during
the aging process make it necessary for the aging individual to
adjust to a new body image.
Colorful soft hair turns gray and dry, flexible straight fingers
become bent a painful, body contours are altered and height
decreases.
Stairs once climbed several times daily demand more time and
energy negotiate as the years accumulate.
As subtle, gradual, and natural as these changes may be, they are
notice and, consequently, affect body image and self-concept
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Interestingly, some persons in their seventies and eighties refuse to join a

senior citizen club because they do not perceive themselves as being "like
those old people therefore, the gerontological nurse needs to gain insight
into the self-concept of older persons by evaluating what roles they are
willing to accept and what roles they reject.
It is sometimes difficult for the aging person to accept the body's

declining efficiency Poor memory, slow response, easy fatigue and
altered appearance are among the many frustrating results of declining
function and they dealt with in different ways.
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Others try to resist these changes by investing in cosmetic surgery, be treatments,

miracle drugs and other expensive endeavors that diminish the budget but not the
normal aging process. Still, others exaggerate these effects and impose unnecessarily
restricted lifestyle on themselves. Societal expectations frequent determine the
adjustment individuals make to declining functions.
Common results of declining functions are illness and disability. Most olde people
have one or more chronic diseases, and more than one third hi serious disability that
limits major activities such as work and housekeep older adults often fear that illness
or disability may cause them to lose the independence
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Remember, gerontological nurses should help aging persons understand and face the
common changes associated with advanced age Factors that promote optimum
function should be encouraged, including;
Proper Diet
Paced Activity
Regular Physical Examination
Early correction of Health Problems
Effective stress management and avoidance of alcohol, tobacco, and drug abuse
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Cumulative Effects of Life Changes and Events in Old Age
1. Shrinking Social World

Many of the changes associated with aging result in loss of social connections and increasing
risk of loneliness.
Children are grown and gone, friends and spouse may be deceased, and others who could allay
the loneliness may avoid the older individual because they find it difficult to accept the
changes they see or to face the fact that they too will be old someday
Living in a sparsely populated rural areas can geographically isolate older persons, and fears of
crime when living in an urban area may prevent older adults from venturing outside their homes.
Hearing and speech deficits and language differences can also foster loneliness.
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1. Shrinking Social World
In addition, insecurity resulting from multiple losses in communication abilities can lead to
suspiciousness of others and a self-imposed isolation
At a time of many losses and adjustments, personal contact, love, extra support and attention-
not isolation are needed.
It is likely that failure to thrive will occur when older persons feel unwanted and unloved just as it
does in infants who display anxiety, depression, anorexia, and behavioral and other difficulties
when they perceive love and attention to be inadequate.
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Nursing Implications in Helping Older Persons Maintain Social Connections:
Nurses should attempt to intervene when they detect isolation and loneliness in an
older person. Various programs provide telephone/video call reassurance or home
visits as a source of daily human contact.
The person's faith community may also provide assistance.
Nurses can help the older adult locate and join social groups and perhaps even
accompany the individual to the first meeting.
A change in housing may be necessary to provide a safe environment conducive to
social interactions, such as a place where people speak the same dialects.
Page 25
Frequently pets serve as significant and effective companions for older adults.
The nurse can review and perhaps readjust the person's schedule to conserve energy
and maximize opportunities for socialization.
Medication administration should be planned so that during periods of social activity
analgesics will provide relief, tranquilizers will not sedate, diuretics will not reach their
peak, and laxatives will not begin working.
Fluid intake and bathroom visits before activities begin should be planned to reduce the
fear or actual occurrence of incontinence, activities for older adults should include
frequent break periods for bathroom visits. Page 26
Nurses should also understand that being alone is not synonymous with being lonely.
Periods of solitude are essential at all ages and provide the opportunity to reflect,
analyze, and better understand the dynamics of one's life.
Older individuals may want periods of solitude to reminisce and review their lives. Some
individuals, young and old, prefer and choose to be alone and do not feel isolated or
lonely in any way.
Nurses should always be alert to hearing, vision, and other health problems that may be
the cause of social isolation.
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2. Awareness of Mortality
Widowhood, the death of friends, and the recognition of declining functions heighten
older person's awareness of the reality of their own deaths.
During their earlier years, individuals intellectually understand they will no live forever,
but their behaviors often deny this reality. The lack of a will and burial plans may be
indications of this denial.
As the reality of mortality becomes acute with advancing age, interest in fulfilling
dreams, deepening religious convictions, strengthening family providing for the ongoing
welfare of family, and leaving a legacy are often apparent signs.
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The thought of impending death may be more tolerable if people understand that their
life has had depth and meaning Unresolved guilt, unachieved aspirations, perceived
failures, and other numerous aspects of "unfinished business" may be better understood
and perhaps resolved.
Although the state of old age may provide limited opportunities for excitement and
achievement, satisfaction may be gained in knowing that there were achievements and
excitements in other periods of life.
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The old woman may be wrinkled and may be frail, but she can still delight in remembering
how she once was courted by many fine, young gentlemen, or she was once crowned as the
beauty queen in their place. The retired old man may feel that he is useless to society now,
but he realizes his worth through the memory of wars he fought to protect his country and
the pride he feels in knowing he enabled his children to obtain an education and start in life.
Nurses can help older adults gain this perspective on their lives through some interventions
such as facilitating life review and eliciting a life story. promoting self-reflection and
strengthening the older adults inner resources.
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Responding to Life Changes and Events in Old Age:
When faced with ageism and multitude changes affecting relationships, roles,
and health, older adults may respond in a variety of ways. The older adult's
ability to cope and adjust to life changes determines whether they reach a
stage of integrity or fall to despair.
Nurses can help older adults respond to life changes and events by facilitating
life review and eliciting a life story, promoting self-reflection, and strengthening
older adults' inner resources.
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A. Life Review and Life Story
Life Review is the process of intentionally reflecting on past experiences in an effort

to resolve troublesome or traumatic life events and assess one's life in totality.
The significance of a life review in interpreting and refining our past experience as
they relate to our self-concept and help us understand and accept our life history
has been well discussed (Butler and Lewis, 1982; Webster and Height, 2002).
In gerontological care, life review has long been recognized as an important process
to facilitate integrity in old age.
Page 32
Life review can be positive experience because older adults can reflect, obstacles they have
overcome and accomplishments they have made.
It can provide the incentive to heal fractured relationships and complete unfinished business.
Life review, however, can be a painful experience for older adults who r the mistakes they've
made and the lives they've hurt.
The nurse can facilitate life review by eliciting the older adult's life story threads of life
experience that create the unique fabric of one's life, accumulated with aging.
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Eliciting life stories from older persons is not a difficult process. In fact, older adult's
welcome opportunities to share their life histories and life lesson to interested
listeners.
Nurses can encourage older adults to discuss and analyze the dynamic their lives, and
they can be receptive and accepting listeners.
Knowledge of life histories also enable caregivers to see their patients larger context,
connected to a past full of varied roles and experiences.
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A basic requisite to eliciting life stories is a willingness to listen. Often, ad request will be
sufficient to open the door to a life history. Activities to fac this process include the following:
• Tree of Life. Ask the older adult to write significant events (graduation, first job,
relocations, marriages, deaths, childbirths, etc.) from the pas each branch and then
discuss each.
• Time Line. Ask the older person to write significant events on or year when these
occurred and then discuss each.
• Life Map. Ask the older adult to write significant events on the map discuss each.
Page 35
• Oral History. Ask the older adult to start with his or her earliest and record the
story of his or her life into a tape/video recorder (suggest that the older person
make this recording as a gift for younger family members.) If the person needs
guidance in telling their history, often, a written outline or questions, or have
volunteer function as an interviewer.
For older adults who may require some facilitation, creative activities, such as
compiling a scrapbook can stimulate the process. This creative effort can be a
significant legacy from the old to the young.
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B. Self-Reflection
One of the hallmarks of successful aging is knowledge of self that is, an awareness
of the realities of who one is and one's place in the world. From infancy on, we
engage in dynamic experiences that mold the unique individuals we are.
The self, the personal identity an individual possesses, has several dimensions that
can basically be described as body, mind and spirit. The body includes physical
characteristics and functioning: the mind encompasses cognition, perception, and
emotions, and the spirit consists of meaning and purpose derived from a
relationship with God or other higher power.
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The Holistic Self
Page 38
B. Self-Reflection
Exploring and learning about one's true self are significant to holistic
health in older years. Examining and coming to terms with thoughts,
feelings, beliefs, and behaviors foster older adults reaching a state of
integrity rather than feeling despair over the lives they lived.
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Journaling
This may be done with pencil and paper or in a computer. The

process of writing often facilitates self-reflection.
Some people may make daily entries in their journals or diaries
that include details about their communications, sleep
patterns, mood, and activities, whereas others make periodic
entries that address major emotional and spiritual issues.
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Journaling
Nurses can assist individuals who have not kept journals and
diaries by guiding them in the selection of a blank book and
writing instrument.
Starters to journaling can be encouraged to begin by reflecting
on their lives and starting their journals/diaries with summary
of the past.
Suggesting that feelings and thoughts be written in addition to
the events of the day, can contribute to the process being one
that fosters self-reflection.
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Writing Letters and E-mails
Letters or e-mails are another means to reflect and

express feelings. Often, thoughts and feelings that
individuals may not feel comfortable verbalizing can be
expressed in writing.
For some older adults, letters of explanation and apology
to friends and fam with whom there have been strained
relationships can be a healing exercise.
Page 42
Older people can be encouraged to locate friends and family in

other parts the country for world with whom they have not had
contact for a while a to initiate communication concerning
what has transpired in their lives a current event.
Letters to grandchildren and other younger members of the
family can provide a means to share relevant family history
and offer special attention (man children love to receive their
own mail, indeed!) .
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Older adults may enjoy communicating by e-mail because of

the ease and relatively low cost If older adults do not own their
own computers, nurses refer them to local senior centers or
libraries that offer free or nominal cost access to the Internet
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Reflecting Through Art

Many people find that painting, sculpting, weaving, threading beat
(bracelets, necklaces, rosaries) and other forms of creative
expression facilitate self-reflection and expression. It is important
that the process, not the finished product, be emphasized.
Arts and crafts classes and groups often are offered by local
organization dedicated to specific activities, schools, and senior
centers. Nurses can ass older adults in locating such groups in their
communities.
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C. Strengthening Inner Resources
The declines and dependencies that increasingly present in late life a cause us to view older
adults as being fragile and incapable. However, most old individuals possess significant inner
resources physical, emotional, spiritual-that have enabled them to survive to old age.
The characteristics reflective of survivor competencies of aging individuals are

exemplified as follows:
Assumption of responsibility for self-care.

Mobilization of internal and external resources to solve problems manage crises.
Development of support system via a network of family, friends, professional
individuals, and groups (e.g. social clubs, church volunteers)
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Sense of control over life events.

Adaptation to change
Perseverance in the face of obstacles and difficulties
Recovery from trauma.
Realization and acceptance of reality that life includes positive and negative life events.
Determination to fulfill personal, family, community, and work expectations despite
difficulties and distractions.
Recognition of limitations and competencies.
Ability to trust, love, and forgive and to accept trust. love, and forgiveness.
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Comprehensive and regular health assessment of health status and interventions to promote health
provide a solid base from which inner strengths can be nurtured. Nurses must begin this process by
examining and strengthening their own level of empowerment When nurses develop a mindset of
seeing possibilities despite fiscal and other constraints, they are better able to help older adults see.
possibilities despite potential constraints imposed by age and illness. In addition to being role
models, nurses can facilitate empowerment by:
Including and encouraging the active participation of older adults in care planning and caregiving
activities to the maximum extent possible.
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Avoiding ageist attitudes that can be communicated through the manner of speaking to
older adults (e.g. raising voice due to assumption all older people are hearing impaired and
using terms like "Lolo", "Lola", "Nanay". "Tatay") and practices (e.g., having signs like "Fall Risk" or
"Toilet q2h". "Talk towards the left ear only" in view of others and labeling clothing in a manner
that is visible to others).
Providing a variety of options to older people and freedom to choose among them.
Equipping older adults for maximum self-care and self-direction by educating, relating,
coaching, sharing and supporting them.
Advocating for older adults as they seek information, make decisions, and execute their own
selected self-care strategies.
Offering feedback positive reinforcement, encouragement, and support.
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Common Changes in Aging
CHAPTER NO. 4
Page 01
Introduction
Human aging, physiological changes that take place in the human body leading to
senescence, the decline of biological functions and the ability to adapt to
metabolic stress. In humans, the physiological developments are normally
accompanied by psychological and behavioral changes, and other changes
involving social and economic factors, also occur. Aging begins as soon as
adulthood is reached and is as much a part of human life as are infancy,
childhood and adolescence. Gerontology (the study of aging) is concerned
primarily with the changes that occur between the attainment of maturity and
the death of the individual.
Page 02
Learning Objectives
After reading this Chapter, you should be able to:
1. State common age-related changes to the body in terms of:

Cellular Changes. Nervous System
Physical Appearance Sensory Organs
Respiratory System Endocrine System
Cardiovascular System Integumentary System
Urinary System Immune System
Reproductive System Thermoregulation
Musculoskeletal System
Page 03
Learning Objectives
2. Describe psychological changes (changes to the
mind) experienced with age.
3. Discuss nursing actions to promote health and

reduce risks associated with age-related changes
(nursing implications of age-related changes).
Page 04
Terminologies:
Crystallized intelligence. Knowledge accumulated over a lifetime; arises from the
dominant hemisphere of the brain.
Fluid intelligence. Involves new information emanating from the non-dominant,
hemisphere, controls emotions, retention of nonintellectual information, crean
capacities, special perceptions, and aesthetic appreciation.
Immunosenescence. The aging of the immune system. Presbycusis. Progressive hearing
loss that occurs as a result of age-related changes to the inner ear. It is characterized by
difficulty in understanding high pitched sounds (e.g., women's voice).
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Terminologies:
Presbyesophagus. A condition characterized by a decreased intensity

of propulsive waves and an increased frequency of non-propulsive
waves in the esophagus.
Presbyopia. The inability to focus or accommodate properly due to
reduced elasticity of the lens.
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A. Changes to the Body
Cellular Changes
- Organ and system changes can be traced to changes at the basic cellular level.
- One example is, metabolism is decreased to about 95% of capacity by age 50,
and to 85% by age 70. This effect also ties in with a decrease in hormonal
secretions. A decrease in metabolism has several effects.
a. Toleration of cold is less.

b. A tendency to gain weight increases.
c. There is a decreased efficiency in the body's use of glucose.
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In addition, fewer functional cells in the body profoundly affect organ function. For
instance, by the age of 85, lung capacity has decreased by 50%; muscle strength by 45%
and kidney function by 30%.
Lean body mass is reduced, whereas fat tissue increases until the sixth decade of life.
Total body fat as a proportion of the body's composition increases.
Cellular solids and bone mass are decreased.
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Physical Appearance
- Men experience hair loss and both sexes may develop gray hair and wrinkles.
- As body fat atrophies, the body's contours gain a bony appearance along with
the deepening of the hollows of the intercostal and supraclavicular space orbits,
and axillae.
- Skinfold thickness is significantly reduced in the forearm and on the back of
the hands.
- Stature decreases, resulting in a loss of approximately 2 inches in height 80
years of age.
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Respiratory System
- Tip of the nose slightly rotates downward; septal deviations can occur.
- Mouth breathing during sleep becomes more common as a result, contributing to
snoring and obstructive apnea.
- Reduced chest wall compliance. This results from increased calcification of
coastal cartilage and decreased strength of intercostal and accessory muscles
and diaphragm.
- Reduced breathing capacity, reduced vital capacity, increased residual volume.
- Decreased cough reflex.
- Decreased residual volume.
- Decreased ciliary activity.
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In Capsule: Respiratory Changes in Aging
PO2 reduced as much as 15% between ages 20 and 80.

Loss of elasticity and increased rigidity.
Forced expiratory volume reduced.
Blunting of cough and laryngeal reflexes.
Alveoli fewer in number and larger in size.
Thoracic muscles more rigid.
Reduced basilar inflation.
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Cardiovascular System
- Throughout the adult years, the heart muscle loses its efficiency and
contractile strength, resulting in reduced cardiac output under conditions of
physiologic stress.
- Pacemaker cells become decreased in number, become increasingly irregular,

and the shell surrounding the sinus node thickens.
- The isometric contraction phase and relaxation time of the left ventricle are
prolonged; the cycle of diastolic filling and systolic emptying requires more
time to be completed.
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Cardiovascular System
Vascular System
• Decreased elasticity of blood vessels. This leads to increased blood

pressure (BP).
• Atherosclerotic plaques develop. This may result to ischemia.
• Decreased efficiency of baroreceptors (receptors that are sensitive to

changes in blood pressure).
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In Capsule: Cardiovascular Changes In Aging
More prominent arteries in head, neck, and extremities.
Valves become thicker and more rigid.
Heart pigmented with lipofuscin granules.
Less efficient 02 (oxygen) utilization.
Aorta becomes dilated and elongated.
Cardiac output decreases.

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Gastrointestinal System
- Tooth enamel becomes harder and more brittle with age. The tooth
brittleness of some older adults creates the possibility of aspiration of
tooth fragments.
- Gums become less elastic and less vascular. The gums recede from
remaining teeth, exposing areas of teeth not covered with enamel.
- Taste sensations become less acute with age because the tongue
atrophies, affecting the taste buds.
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In Capsule: Gastrointestinal Changes in Aging.
Decreased taste sensation.

Decreased esophageal motility.
Atrophy of gastric mucosa.
Decreased stomach motility, hunger contractions, and
emptying time.
Less production of hydrochloric acid, pepsin, lipase, and
pancreatic enzymes.
Fewer cells on absorbing surface of intestines.
Reduced intestinal blood flow
Liver smaller in size
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Urinary System
- The urinary system is affected by changes in the kidneys, ureters,

and bladder.
- The renal mass becomes smaller with age, with subsequent cortical
loss.
- Decreased blood flow to the kidneys. This causes reduction of

glomerular filtration rate (GFR).
- Reduced number of nephrons and decreased creatinine clearance.

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In Capsule: Urinary Tract Changes in Aging
Decreased size of renal mass.
Decrease in nephrons. -Decreased tubular function.
Between ages 20 and 90, renal blood flow decreases 53%,

and glomeruli's filtration rate decreases 50%.
Decreased bladder capacity. Weaker bladder muscles.
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Reproductive System
A. Male
As men age, the seminal vesicles are affected by smoothing of the
thinning of the epithelium, replacement of muscle tissue with
connective: and reduction of fluid-retaining capacity.
Prostatic enlargement occurs in most older men. Three fourths of

men aged 65 years and older have some degree of prostatism, which
causes problems with urinary frequency.
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Reproductive System
B. Female
The vaginal environment is more alkaline in older women and is accompanied by a

change in the type of flora and a reduction in secretions. Thus, there is reduced
vaginal lubrication.
The uterus shrinks and the endometrium atrophies, however the endometrium
continues to respond to hormonal stimulation for incidents of postmenopausal
bleeding in older women on estrogen therapy.
The fallopian tubes atrophy and shorten with age, and the ovaries atrophy and
become thicker and smaller. The ovaries can shrink to such a small size that they are
not palpable during an exam.
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Reproductive System
B. Female
Despite these changes, the older woman does not lose the ability to
engage in and enjoy intercourse or other forms of sexual pleasure.
Estrogen depletion also causes a weakening of pelvic floor muscles,

which can lead to an involuntary release of urine when there is an
increase in intra-abdominal pressure.
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Reproductive System
For both male and female older persons, there is minimal change in
amount of sexual response. Although, there is increase in time for full
sexual response.
There is increased refractory period in males.
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Refractory Period
In men, the penis becomes flaccid after an orgasm. A doesn't think

about sex or get aroused. His body does not respond to sexual
stimulation, and he is unable to reach an orgasm again, until the
refractory period is over.
Women do not have refractory periods the way men do. But fatigue
after orgasm can make them lose interest in sex temporarily. This can
happen after one orgasm or multiple orgasms.
Page 23
In Capsule: Changes in the Reproductive Structures In Aging
A. Male B. Female
Fluid - retaining capacity of seminal Fallopian tubes atrophy and shorten.

vesicles reduces. Ovaries become thicker and smaller.
Possible reduction in sperm count. Cervix becomes smaller.
Venous and arterial sclerosis of penis. Drier, less elastic vaginal canal.
Prostate enlarges in most men. Flattening of labia.
Endocervical epithelium atrophies.
Page 24
Musculoskeletal System
The kyphosis, enlarged joints, flabby muscles, and decreased

height of many older persons result from the variety of
musculoskeletal changes occurring with age.
Muscle fibers atrophy and decrease in number with fibrous

tissue replacing muscle tissue.
Overall muscle mass, muscle strength, and muscle movements

are decreased.
Page 25
Sarcopenia
the age-related loss of muscle mass, strength, and function, is
mostly seen in inactive persons.
Muscle tremor may be present and are believed to be assisting with

degeneration of the extrapyramidal system.
The tendons shrink and harden which causes a decrease in tendon
jerks.
Muscle cramping usually occurs, for various reasons.
Bone density decreases at a rate of 0.5% each year after the third
decade of life.
A deterioration of the cartilage surface of the joints and the
formation of points and spurs may limit joint activity and motion.
Page 26
In Capsule: Skeletal Changes in Aging
Shortening of the vertebrae.

Between ages 20 to 70, height decreases approximately 2 inches.
Bones become more brittle.
Slight knee flexion.
Decrease in bone mass and bone mineral.
Slight kyphosis.
Slight hip flexion.
Slight wrist flexion.
Impaired flexion and extension movements.
Prostate enlarges in most men.
Page 27
Nervous System
There is a decline in brain weight and a reduction in blood flow to the however,
these structural changes do not appear to affect thinking and be (Rabbit et al.,
2007).
Degeneration and atrophy of neurons. This causes loss of memory, es recent
memory. In addition, there is decreased muscle coordination, de ability to perform
fine motor activities (activities done by the fingers).
Kinesthetic sense lessens. There is slower response to changes in balance, a factor
contributing to falls.
The hypothalamus regulates temperature less effectively. The elderly has low
tolerance to cold. They do not develop fever easily, in the presence of infection.
Brain cells slowly decline over the years, the cerebral cortex undergoes some loss
of neurons, and there is some decrease in brain size and weight, particularly after
age 55 years.
Page 28
In Capsule: Neurologic Changes in Aging
Decreased conduction velocity.
Slower response and reaction time.
Decreased brain weight.
Decreased blood flow to brain.
Changes in sleep pattern.
Page 29
Sensory System
Each of the five senses becomes less efficient with advanced age,
interfering with varying degrees with safety, normal activities of daily
living, and general well-being.
A. Vision
Presbyopia, the inability to focus or the loss of accommodation is due to reduce elasticity of the
lens. It begins in the fourth decade of life.
This vision problem causes most middle-aged and older adults to need corrective lenses to
accommodate close and detailed work. These increased risk to accidents.
Alterations in the blood supply of the retina and retinal pigmented epithelium can cause macular
degeneration, a condition in which there is loss of central vision.
Changes in the retina and retinal pathway interfere with critical flicker fusion (the point at which a
flickering light is perceived as continuous rather that intermittent). This affects safety in driving as
well as crossing streets with traffic lights.
Page 30
B. Hearing
Presbycusis is progressive hearing loss that occurs as as a result of age-related changes to
the inner ear, including loss of hair cells, reduced blood supply, decreased flexibility of
basilar membrane, degeneration of spiral ganglion cells, and reduced production
endolymph.
Hearing can be further jeopardized by an accumulation of cerumen in the m ear, the higher
keratin component of the cerumen as one ages contributes to problem.
The acoustic reflex which protects the inner ear and filters auditory distract from sounds
made by one's own body and voice, is diminished due to a weaker and stiffening of the
middle ear muscles and ligaments.
On the whole, degeneration of the cochlea and auditory pathways result to of hearing of
high-pitched sound and difficulty in speech discrimination.
C. Taste and Smell

Approximately, half of older persons experience some loss of their ability to smell.
It decreases with age because of a decrease in the number sensory cells in the
nasal lining and fewer cells in the olfactory bulb of the Brain.
Atrophy of the tongue with age can diminish taste sensations, although there is no
evidence that the amount of responsiveness of the taste buds decreases.
Reduced saliva production, poor oral hygiene, medications and conditions such as
sinusitis can also affect taste.
D. Touch
A reduction in the number and changes in the structural integrity of touch
receptors occurs with age.
Tactile sensation is reduced as observed in the reduced ability of older persons to

sense pressure and pain and differentiate temperatures.
These sensory changes can cause misperceptions of the environment and, as a

result, profound safety risks.
In Capsule: Effects of Sensory Changes in Aging
A. Sight
Opaquer lens.
Decreased pupil size.
More spherical cornea
Loss of color sensitivity (blue hues especially purple, green).
Decreased dark adaptation.
Decreased peripheral vision Reduced sensitivity to glare.
B. Hearing
Atrophy of hair cells of organ of Corti.

Tympanic membrane sclerosis and atrophy.
Increased cerumen and concentration of keratin.
Degeneration of cochlea and auditory pathways. This results to loss of
hearing of high-pitched sound and difficulty in discrimination speech.
C. Smell
Impaired ability to identify and discriminate among odors.
D. Taste
High prevalence of taste impairment, although most likely due
to factors other than normal aging.
E. Touch
Reduction in tactile sensation.
Endocrine System
The thyroid gland undergoes fibrosis, cellular infiltration, and increased

nodularity. The resulting decreased thyroid gland activity causes a lower
base metabolic rate, reduced radioactive iodine uptake, and less
thyrotropin secretion and release.
ACTH secretion decreases with age, thus secretory activity of the adrenal
gland also decreases.
Gonadal secretion declines with age, including gradual decreases in

testosterone, estrogen, and progesterone.
In Capsule: Endocrine Changes in Aging
Decreased utilization of insulin. Higher blood glucose levels

than normal general adult population are not unusual in
nondiabetic older people.
Cessation of progesterone secretion and decreased, then

plateau of estrogen These changes lead to menopause.
Integumentary System
Diet. general health, activity, exposure, and hereditary factors influence the
normal course of aging of the skin.
Collagen fibers become coarser and more random, reducing skin elasticity.
The dermis becomes more avascular and thinner.
As the skin becomes less elastic and drier and more fragile, and as
subcutaneous fat is lost, lines, wrinkles, and sagging become evident Skin
becomes irritated and breaks down more easily.
Scalp, pubic hair and axillary hair thins and grays due to a progressive loss of
pigment cells and atrophy and fibrosis of hair bulbs, hair in the nose and in the
ears become thicker.
In Capsule: Integumentary Changes in Aging
Loss of subcutaneous supporting tissues. This causes the skin to wrink sag,
and sensitive to pressure and trauma.
Decreased sebaceous secretions.
Thinning and graying hair. This causes alteration in body image.
Skin pigmentation (age spots) develop in areas of the body exposed to sun.
Immune System
The aging of the immune system, known as immunosenescence, include depressed

immune response which can cause infections to be a significant of older adults.
Responses to influenza, parainfluenza, pneumococcus, and tetanus vaccines less
effective (although vaccination is recommended because of the serious potential
consequences of infections for older adults).
Inflammatory defense declines, and often, inflammation presents atypically older
individuals (i.e., low-grade fever and minimal pain).
Regular physical activity can enhance immune function, including exercises such
as yoga and t'ai'chi, which are low impact and have a positive effect on immunity.
Thermoregulation
Normal body temperatures are lower in later life than in younger years. Mean body
temperature ranges from 96.9 F to 98.3 F orally.
Rectal and auditory canal temperatures are the most accurate and reliable
indicators of body temperature in older adults.
At the other extreme, differences in response to heat are related to impaired

sweating mechanisms and decreased cardiac output.
Alterations in response to cold and hot environments increase the risks for
accidental hypothermia, heat exhaustion, and heat stroke.
A. Changes to the Mind
Sensory organ impairment can impede interaction with the

environment a other people, thus influencing psychological status
Feeling depressed and socially isolated may obstruct maximum

psychologic function.
Psychological changes in the older individuals may be observed in

personality, memory, intelligence, learning, and attention span.
Personality
Drastic changes in basic personality normally do not occur as one ages.
Excluding pathologic processes, the personality will be consistent with those

earlier years; possibly, it will be more openly and honestly expressed. For
example, the kind and gentle person was most likely that way when young, the
other hand, the cantankerous older person was not mild and meek in earlier years.
Changes in personality traits may occur in response to events that alters attitude,
such as retirement, death of a spouse, loss of independence, income, reduction,
and disability.
Morale, attitude, and self-esteem tend to be stable throughout the life span.
Memory
Retrieval of information from long-term memory can be slowed, particularly if the
information is not used or needed on a daily basis.
The ability to retain information in the consciousness while manipulating

information working memory function is reduced.
Older adults can improve some age-related forgetfulness by using memory aids
(mnemonic devices) such as associating a name with an image, making notes or
lists, and placing objects in consistent locations.
Memory deficits can result from a variety of factors other than normal aging.
Intelligence
Basic intelligence is maintained; one does not become more or less intelligent
with age.
Crystallized intelligence, which is the knowledge accumulated over a lifetime

and arises from the dominant hemisphere of the brain, is maintained through
the adult years; this form of intelligence enables the individual to use past
learning and experience for problem solving.
High levels of chronic psychological stress have been found to be associated

with an increased incidence of mild cognitive impairment (Wilson et. Al., 2007).
Learning
Learning ability is not seriously altered with age. However, there are various
factors that can interfere with the older person's ability to learn, such as,
motivation, attention span, delayed transmission of information to the bin
perceptual deficits, and illness.
Differences in the intensity and duration of the older person's physiologic
arousal may make it more difficult to extinguish previous response and acquire
new material.
Learning occurs best when the new information is related to previously learn
information.
Although little difference is apparent between the old and the young in verbal
abstract ability, older persons do show some difficulty with perceptual motor.
Attention Span
Older adults demonstrate a decrease in vigilance performance (i.e., the ability
retain attention longer than 45 minutes). They are more easily distracted by
irrelevant information and stimuli and are less able to perform tasks that
complicated or require simultaneous performance.
Nursing Implication of Age-Related Changes

An understanding of common aging changes is essential to ensure compete
gerontological nursing practice. Such knowledge can aid in promoting practices enhance
wellness, thereby reducing risks to health and well-being. Differentiate the normal from
unusual findings in older adults and the atypical presentation of illness can be invaluable
in identifying pathology and obtaining treatment in a timely manner.
Nurses caring for older adults must realize that despite the numerous changes commonly
experienced with age, mostolder adults function admirably well and live normal,
satisfying lives. Although nurses need to acknowledge factors that can alter function
with aging, they should also emphasize the capabilities and assets possessed by older
adults and assist persons of all ages in achieving a healthy aging process.
Nursing Actions Related to Age-Related Changes
Age-Related Change Nursing Action
Prevent dehydration by ensuring fluid intake of at least 1,500 ml daily

Reduction in intracellular fluid
unless contraindicated
Decrease in subcutaneous fat content, Ensure adequate clothing is worn to maintain body warmth; maintain
decline in natural insulation room temperatures between 70F (21℃) and 75F (24 ℃)
Use thermometers that register below 95F (35 ℃ ); assess baseline

Lower Oral Temperatures norm for body temperature when patient is well to be able to identify
unique manifestations of fever.
Allow rest between activities, procedures; recognize the longer time period
Decreased cardiac output and required for heart rate to return to normal following a stress on the heart
stroke volume; increased and evaluate the presence of tachycardia accordingly; ensure blood
peripheral resistance. pressure level is adequate to meet circulatory demands by assessing
physical and mental function at various blood pressure levels.
Decreased lung expansion,

activity, and recoil; lack of basilar Encourage respiratory activity that promotes deep breathing; recognize
inflation; increased rigidity of that atypical symptoms and signs can accompany respiratory infection;
lungs and thoracic cage; less monitor oxygen administration closely, keep oxygen infusion under 4 ml,
effective gas exchange and unless otherwise prescribed.
cough response
Encourage daily flossing and brushing; ensure

patient visits dentist annually; inspect oral cavity
Brittleness of teeth; retraction of gingiva
periodontal disease, jagged-edged teeth, other
pathologies.
Observe for overconsumption of sweets and salt;

Reduced acuity of taste sensations be sure foods are served attractively, season food
healthfully.
Offer fluids during meals; have patient drink before

swallowing tablets and capsules, and examine cavity
Drier oral cavity
after administration to ensure drugs have been
swallowed.
Assess for indigestion; encourage five to six small

Decreased esophageal and gastric motility;
meals rather than three large ones; advise patient not
decreased gastric acid
to lie down for at least 1 hour following meals.
Encourage toileting schedule to provide

Decreased colonic peristalsis; duller neural adequate time for bowel elimination; monitor
impulses to lower bowel frequency consistency, and amount of bowel
movements.
Ensure age-adjusted drug dosages are

prescribed; observe for adverse response to
Decreased size of renal mass, number of
drugs; recognize that urine testing for glucose
nephrons, renal blood flow, glomerular filtration
can be unreliable, urinary creatinine clearance
rate, tubular function
are decreased, blood urea nitrogen level is
higher.
Assist patient with need for frequent toileting;

Decreased bladder capacity ensure safety for visits to bathroom during the
night
Observe for signs of urinary tract infection; as

Weaker bladder capacity
patient to void in upright position
Enlargement of prostate gland Discuss pros and cons of testing with physician
Advise patient in safe use of lubricants for

Drier, more fragile vagina
comfort during intercourse
Increased alkalinity of vaginal canal Observe for signs of vaginitis
Atrophy of muscles; reduction in muscle Encourage regular exercise, advise patient to

strength and mass avoid straining or overusing muscles .
Instruct patient in safety measures to prevent falls

Decreased bone mass and mineral content and fractures, encourage good calcium intake and
exercise
Avoid interruptions at night, assess quantity and

Less prominent stages III and IV of sleep
quality of sleep
Ensure patient has ophthalmologic exam annually,

Decreased visual accommodation; reduced
use night lights, avoid drastic changes in level of
peripheral vision; less effective vision in dark and
lighting, ensure objects used by patient are within
dimly lit areas
visual field.

Avoid using shades of greens, blues, and violets
Yellowing of lens
together
Decreased corneal sensitivity Advise patient to protect eyes
Ensure patient has audiometric exam if problem

Presbycusis exists, speak to patient in normal tone, low-
pitched Voice
Ensure patient changes positions before tissue

reddens, inspect body for problems that patient
Reduced capacity to sense pain and pressure
may not sense; recognize unique responses to
pain
Protect patient from exposure to infectious

diseases recommend pneumococcal, tetanus, and
Reduced immunity
annual influenza vaccinations; promote good
nutritional status to improve host defenses
Advise patient to avoid excess calorie

Slower metabolic rate
consumption
Advise patient to avoid high carbohydrate intake,

Altered secretion of insulin and metabolism of
observe for unique manifestations of hyper- or
glucose
hypoglycemia
Flattening of dermal epidermal junction; reduced

thickness and vascularity of dermis; degeneration Use principles of pressure ulcer prevention.
of elastin fibers
Recognize need for less frequent bathing, avoid

Skin drier
use of harsh soaps; use skin softeners.
Allow adequate time for patient to respond,

Slower response and reaction time
process information, and perform tasks.
Thank You for Listening.

Reference:
Gerontological Nursing
Concepts and Clinical Applications
First Edition 2021
Written by: Josie Quiambao - Udan

Chapter No. 3 4 Gerontological Nursing

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Life Changes and Events in Old Age

1. Discuss ageism and its consequences.

a. Changes in family roles and relationships: parenting

3. Discuss the impact of aged-related changes in health

5. Describe the responses of the older adults to life

6. List nursing measures to assist individuals in adjusting

Life review. A process of reminiscing or reflecting on one's life.

Retirement. The period in which one no longer works.

Older adults are oftentimes stereotyped by the following misconceptions:

• Old people are sick and disabled.

Ageism may have consequences as follows:

Retirement is another of the major adjustments of an aging individual. This

a) Loss of the Work Role

Retirement is especially difficult in urban areas, in which worth is commonly

• Reorientation Phase. As realistic choices and alternative sources of satisfaction are

Different nursing interventions may be required during each phase retirement:

Appreciating and promoting the strengths of the stability phase ma reinforce

When the retirement phase is terminated due to disease or disability the

Changes In Health and Functioning

Interestingly, some persons in their seventies and eighties refuse to join a

It is sometimes difficult for the aging person to accept the body's

Others try to resist these changes by investing in cosmetic surgery, be treatments,

Cumulative Effects of Life Changes and Events in Old Age

1. Shrinking Social World

Cumulative Effects of Life Changes and Events in Old Age

1. Shrinking Social World

Nursing Implications in Helping Older Persons Maintain Social Connections:

Nursing Implications in Helping Older Persons Maintain Social Connections:

Nursing Implications in Helping Older Persons Maintain Social Connections:

Cumulative Effects of Life Changes and Events in Old Age

Cumulative Effects of Life Changes and Events in Old Age

Cumulative Effects of Life Changes and Events in Old Age

Responding to Life Changes and Events in Old Age:

A. Life Review and Life Story

Life Review is the process of intentionally reflecting on past experiences in an effort

A. Life Review and Life Story

A. Life Review and Life Story

A. Life Review and Life Story

A. Life Review and Life Story

This may be done with pencil and paper or in a computer. The

Writing Letters and E-mails

Letters or e-mails are another means to reflect and

Writing Letters and E-mails

Older people can be encouraged to locate friends and family in

Writing Letters and E-mails

Older adults may enjoy communicating by e-mail because of

Reflecting Through Art

C. Strengthening Inner Resources

The characteristics reflective of survivor competencies of aging individuals are

Assumption of responsibility for self-care.

C. Strengthening Inner Resources

Sense of control over life events.

C. Strengthening Inner Resources

C. Strengthening Inner Resources

1. State common age-related changes to the body in terms of:

3. Discuss nursing actions to promote health and

Presbyesophagus. A condition characterized by a decreased intensity

A. Changes to the Body

a. Toleration of cold is less.

A. Changes to the Body