AGE IN INDIVIDUAL

DEFINTION

Aging can be defined as the time-related deterioration of the physiological functions

necessary for survival and fertility. Aging process is the process of growing old or developing
the appearance and characteristics of old age.

Classification of aging

Ø Objectively, ageing is a universal process that begins at birth and is specified by the
chronological age criterion
Ø Subjectively, aging is marked by changes in behaviour and self- perception and
reaction to biologic changes.
Ø Functionally, aging refers to the capabilities of the individual to function in society.
· Young Old (60 – 74 yrs),
· middle old (75-84 years),
· and old-old (above 85 years).
· The life expectancy of Indians are 65- 67 years

EPIDEMIOLOGICAL STATISTICS

The Population

In 1980, Americans 65 years of age or older numbered 25.5 million. By 2006, these numbers
had increased to 37.3 million, representing 12.4 percent of the population (Administration on
Aging. This trend is expected to continue, with a projection for 2030 at about 71.5 million, or
20 percent of the population.

Marital Status

In 2006, of individuals age 65 and older, 72 percent of men and 42 percent of women were
married. Forty-three percent of all women in this age group were widowed. There were over
four times as many widows as widowers because women live longer than men and tend to
marry men older than themselves.
Living Arrangements

The majority of individuals age 65 or older live alone, with a spouse, or with relatives. At any
one time, fewer than 5 percent of people in this age group live in institutions. This percentage
increases dramatically with age, ranging from 1.3 percent for persons 65 to 74 years, to 4.4
percent for persons 75 to 84 years, and 15.4 percent for persons 85 and older.

Economic Status

Approximately 3.4 million persons age 65 or older were below the poverty level in 2006.
Older women had a higher poverty rate than older men, and older Hispanic women living
alone had the highest poverty rate. Poor people who have worked all their lives can expect to
become poorer in old age, and others will become poor only after becoming old. However,
there are a substantial number of affluent and middle-income older persons who enjoy a high
quality of life.

Employment

With the passage of the Age Discrimination in Employment Act in 1967, forced retirement
has been virtually eliminated in the workplace. Evidence suggests that involvement in
purposeful activity is vital to successful adaptation and perhaps even to survival. In 2006, 5.5
million Americans age 65 and older were in the labor force (working or actively seeking
work).

Health Status

The number of days in which usual activities are restricted because of illness or injury
increases with age. The American Geriatrics Society (2005) reports that 82 percent of
individuals 65 and older have at least one chronic condition, and two-thirds have more than
one chronic condition. The most commonly occurring conditions among the elderly
population are hypertension, arthritis, heart disease, cancer, diabetes, and sinusitis.

CONCEPTS OF AGING

1. CHRONOLOGIC AGING
2. BIOLOGIC AGING
3. PSYCHOLOGIC AGING
4. SOCIAL AGING
 5. COGNITIVE AGING

CHRONOLOGIC AGING

Chronological age refers to the actual amount of time a person has been alive. In other words,
the number of days, months or years a person has been alive

BIOLOGIC AGING

Senescence or biological ageing is the gradual deterioration of function characteristic.

Biological aging refers to the physical changes that “slow us down” as human get into middle
and older years. For example: arteries might clog up, or problems with lungs might make it
more difficult for us to breathe. This aging is also known as physiologic aging.

PSYCHOLOGIC AGING

Psychological aging refers to the psychological changes, including those involving mental
functioning and personality that occur as human age. chronological age is not always the
same thing as biological or psychological age. Some people who are 65, can look and act
much younger than some who are 50. Psychological ageing may be seen as a continuous
struggle for identity, i.e. for a sense of coherence and meaning in thoughts, feelings and
actions. Success depends on a lucky synchronization of changes through life in different parts
of the personal self.

SOCIAL AGING

Social aging refers to changes in a person’s roles and relationships, both within their
networks of relatives and friends and in formal organizations such as the workplace and
houses of worship. Social aging differ from one individual to another. It is also profoundly
influenced by the perception of aging that is part of a society’s culture. If a society views
aging positively, the social aging experienced by individuals in that society will be more
positive and enjoyable than in a society that views aging negatively.

COGNITIVE AGING

Cognitive ageing is the decline in cognitive processing that occurs as people get older. Age-
related impairments in reasoning, memory and processing speed can arise during adulthood
and progress into the elder years. Cognitive aging is concerned with the basic processes of
learning and memory as well as with the complex higher- order processes of language and
intellectual competence or executive functioning. The concept of cognitive aging, a term that
describes a process of gradual, longitudinal changes in cognitive functions that accompany
the aging process.

THEORIES OF AGING

A number of theories related to the aging process have been described. These theories are
grouped into two broad categories:

1. Biological
2. Psychosocial.

BIOLOGICAL THEORIES

Biologic theories of aging attempt to explain why the physical changes of aging occur.
Researcher try to identify which biologic factor have the greatest influence on longevity.

1. THE PROGRAMMED THEORY/ BIOLOGICAL CLOCK THEORY

The programmed theory proposes that every person has a “Biologic clock” that starts ticking
at the time of conception. In this theory each individual has a genetic program specifying an
unknown but predetermined number of cell divisions. As the program plays out, the person
experiences predictable changes such as atrophy of the thymus, menopause, skin changes and
greying of the hair. Aging has a biological timetable or internal biological clock.

2. THE RUN OUT OF PROGRAM THEORY

Every person has a limited amount of genetic material that will run out over time. All events
are specifically programmed into genome and are sequentially activated. After maturation
genes have been activated there are no more programs to be played and as cells age there may
be chance of inactivation of genes that cannot be turned on.

3. GENE THEORY

The gene theory proposes the existence of one or more harmful genes that activate overtime,
resulting in the typical changes seen with aging and limiting the life span of the individual.
Organism failure occurs in later life because of the presence of imperfect genes activated over
lengthy periods of time. Two gene types, one supports growth and vigor, and the other
supports senescence and deterioration.
 4. MOLECULAR THEORIES

The aging is controlled by genetic materials that are encoded to predetermine both growth
and decline.

Ø The error theory

Ø The somatic mutation theory
5. THE ERROR THEORY

The error theory proposes that errors in ribonucleic acid protein synthesis cause errors to
occur in cells in the body, resulting in a progressive decline in biologic function. Error theory
Aging is a result of internal or external assaults that damage cells or organs so they can no
longer function properly.

6. THE SOMATIC MUTATION THEORY

The somatic mutation theory proposes that aging result from deoxyribonucleic acid (DNA)
damage caused by exposure to chemicals or radiation and this damage causes chromosomal
abnormalities that lead to disease or loss of function later in life. Exposure to x-ray radiation
and or chemicals induces chromosomal abnormalities.

7. CELLULAR THEORIES

The cellular theories propose that aging is a process that occurs because of cell damage.
When enough cells are damaged, overall functioning of the body is decreased.

a) The free radical theory

b) The crosslink or connective tissue theory
c) Clinker theory
d) The wear and tear theory
a) THE FREE RADICAL THEORY

Denham Harman 1956. The term free radical describes any molecule that has a free electron,
and this property makes it react with healthy molecules in a destructive way. Free radical
molecule creates an extra negative charge. This unbalanced energy makes the free radical
bind itself to another balanced molecule as it tries to steal electrons. Balanced molecule
becomes unbalanced and thus a free radical itself. Diet, lifestyle, drugs (e.g. tobacco and
alcohol) and radiation
 b) THE CROSSLINK OR CONNECTIVE TISSUE THEORY/
GLYCOSYLATION THEORY OF AGING

Cell molecules from DNA and connective tissue interact with free radicals to cause bonds
that decrease the ability of tissue to replace itself. The results in the skin changes typically
attributed to aging such as dryness, wrinkles, and loss of elasticity. Fibrous tendons,
loosening teeth, diminished elasticity of arterial walls and decreased efficiency of lungs and
GI tract. It is the binding of glucose (simple sugars) to protein, (a process that occurs under
the presence of oxygen) that causes various problems. Senile cataract and the appearance of
tough, leathery and yellow skin.

c) THE CLINKER THEORY

The clinker theory combines the somatic mutation, free radical and cross link theories to
suggest that chemicals produced by metabolism accumulate in normal cells and cause
damage to body organs such as the muscles, heart, nerves and brain.

d) THE WEAR AND TEAR THEORY

Body is similar to a machine, which loses function when its parts wear out. As people age,
their cells, tissues and organs are damaged by internal or external stressors. Good health
maintenance practices will reduce the rate of wear and tear, resulting in longer and better
body function.

8. THE NEUROENDOCRINE THEORY

Prof Vladimir Dilman and Ward Dean, this theory elaborates on wear and tear by focusing on
the neuroendocrine system. This system is a complicated network of bio-chemicals that
govern the release of hormones which are altered by hypothalamus. The hypothalamus
controls various chain-reactions to instruct other organs and glands to release their hormones
etc. The hypothalamus also responds to the body hormone levels as a guide to the overall
hormonal activity. Accordingly, as ages the secretion of many hormones declines and their
effectiveness is also reduced due to the receptors down- grading.

9. IMMUNOLOGIC THEORY

The immunologic theory proposes that aging is a function of changes in the immune system.
The immune system weakens over time, making an aging person more susceptible to disease,
increase in autoimmune disease and allergies, Over time, cells involved in immune function
are less self- regulatory, resulting in cells being misidentified as foreign material and being
attacked by the immune system’s own defenses. Eg: rheumatoid arthritis (RA) and lupus.

10. THE MITOCHONDRIAL DECLINE THEORY

The power producing organelles. Their primary job is to create Adenosine Triphosphate
(ATP) and they do so in the various energy cycles that involve nutrients such as Acetyl-L-
Carnitine, CoQ10 (Idebenone), NADH and some B vitamins etc. Enhancement and protection
of the mitochondria is an essential part of preventing and slowing aging.

11. THE MEMBRANE THEORY OF AGING

Professor Imre Zs. It is the age-related changes of the cells ability to transfer chemicals, heat
and electrical processes that impair it. As older the cell membrane becomes less lipid (less
watery and more solid). This impedes its efficiency to conduct normal function and in
particular there is a toxic accumulation.

PSYCHOSOCIAL THEORIES

Psychosocial theories of aging attempt to explain changes in behaviour, roles and relationship
that occur as individual age. This attempt to predict and explain the social interactions and
roles that contribute to successful adjustment to old age in older adults.

1) The disengagement theory

2) The activity theory
3) The continuity theory
4) The subculture theory
1) DISENGAGEMENT THEORY

Cummings and Henry(1961) states that aging people withdraw from customary roles and
engage in more introspective, self-focused activities. The disengagement theory was
developed to explain why aging process separate from the mainstream of society. This theory
proposes that older people are systematically separated, excluded, or disengaged from society
because they are not perceived to be of benefit to the society as a whole. This theory further
proposes that older adults desire to withdraw from society as they age, so the disengagement
is mutually beneficial.
 2) THE ACTIVITY THEORY

This theory proposes that activity is necessary for successful aging. Active participation in
physical and mental activities helps maintain functioning well into old age. Purposeful
activities and interactions that promote self-esteem improve overall satisfaction with life,
even at the older age. The continuation of activities performed during middle age is necessary
for successful aging (Lemon, Bengston and Peterson, 1972).

3) THE CONTINUITY THEORY

The continuity theory (Neugarten, 1964) state that personality remains the same and the
behaviours become more predictable as people ages. Personality and behaviour pattern
developed during a life time determine the degree of engagement and activity in older
adulthood. Personality is a critical factor in determining the relationship between role activity
and life satisfaction.

4) THE SUBCULTURE THEORY

Rose (1965) theorized that older adults from a unique subculture within society to defend
against society’s negative attitude toward aging and the accompanying loss of status. Older
adults are a subculture with their own norms and beliefs. The subculture occurs as a response
to loss of status. In the subculture, individual status is based on health and mobility, instead
of on education, occupation and economic achievement.

THE NORMAL AGING PROCESS

1. Biological aspects of aging

2. Psychological aspects of aging
3. Sociocultural aspects of aging
4. Sexual aspects of aging

A. Biological aspects of aging

Individuals are unique in their physical and psychological aging processes, as influenced by
their predisposition or resistance to illness; the effects of their external environment and
behaviours; their exposure to trauma, infections, and past diseases; and the health and illness
practices they have adopted during their life spans. As the individual ages, there is a
quantitative loss of cells and changes in many of the enzymatic activities within cells,
resulting in a diminished responsiveness to biological demands made on the body.

Changes in Vision

Decreased peripheral vision Decreased night vision Decreased capacity to distinguish color
Reduced lubrication resulting in dry, itchy eyes.

Changes in Hearing Sensitivity to loud noises

Difficulty locating sound More prone to wax build up that can affect hearing

Supporting Changes to Hearing

Reduce extra noise when trying to have a conversation Place yourself so the person can see
you and fairly close- increased volume not always helpful Make sure you have the person’s
attention before speaking Have doctor check for and remove wax if needed Arrange for
hearing assessment and provide support to use a hearing aid if needed.

Changes in Smell and Taste

Decreased taste buds and secretions Decreased sensitivity to smell.

Supporting Changes in Smell and Taste

May enjoy smaller attractive meals-helps to be able to smell food preparation At risk of
eating spoiled food.

Changes in Skin

Decrease in moisture and elasticity More fragile- tears easily Decrease in subcutaneous fat
Decrease in sweat glands -less ability to adjust body temperature. Tactile sensation decreases-
not as many nerves May bruise more easily

Supporting Changes in Skin

Use moisturizers, bath oils can make bath tub slippery As a care provider keep nails short Pat
gently when helping to dry after bathing Bottom of feet may be sore, pay attention to
footwear May feel cooler than others but be more at risk of sun stroke Use sun screen, hats,
long sleeves Be careful with such things as hot water bottles.
Changes in Metabolic System

Decrease in ability to adapt to stress Decrease in metabolic rate Decrease in thyroid-gland

related to calcium absorption and energy level.

Supporting Changes in the Metabolic System

May feel cold so provide what is necessary for the person to feel comfortable but avoid
overheating May need calcium and vitamin D supplements to prevent osteoporosis.

Changes in Elimination

Bladder atrophy- inability to hold bladder for long periods Constipation can become a
concern because of slower metabolism Men can develop prostate problems causing frequent
need to urinate Incontinence make occur because of lack of sphincter control.

Supporting Changes in Elimination

Maintain routines Plan ahead-know where washrooms are when you go out Decrease caffeine
intake Eat lots of fiber and do some exercise Put bowel elimination protocols in place if
needed Provide appropriate supplies and emotional support.

Changes to the Respiratory System

Decreased volume and expansion of lungs may lead to decreased function Susceptible to lung
infections, increases if someone is inactive Swallowing impairments can cause aspiration

Supporting Changes in the Respiratory System

Planning activities with shorter duration May need more rest periods Reposition person
frequently if they are unable to move on they own. Consult a doctor if person consistently
coughs during or after a meal.

Changes in the Cardiovascular System

Heart works harder to maintain oxygen levels in the body Cholesterol may accumulate on the
walls of the arteries Decreased ability to replace fluids lost while breathing.
Supporting Changes in the Cardiovascular System

People may become fatigued more easily because of the above changes, may need more rest
Blood pressure should be monitored as recommended by health care professionals Reposition
person frequently if unable to move on their own so fluids don’ t build up- physiotherapy
may be needed Assure adequate fluid intake and seek medical help quickly if you think the
person may be dehydrated.

Changes in Bones and Joints

Decreased height due to bone changes Bones more brittle – risk of fracture Changes of
absorption of calcium Pain from previous falls or broken bones Joints less lubricated – may
develop arthritis.

Supporting Changes in Bones and Joints

Need light exercise including some weight bearing if possible Take precautions to prevent
falls May need calcium and Vitamin D supplements- ensure a balanced diet Monitor and treat
pain appropriately Allow more time as the person may need to do things more slowly.

Changes to the Nervous System

Sleep /wake cycle changes at 60/70 may need 1or 2 less hours of sleep at night but sleep may
not be as restful people get about 20% less oxygen to the brain which affects balance.

Supporting Changes to the Nervous System

Discourage long naps and caffeinated products later in the day – encourage the same patterns
and rituals at bedtime.

Changes in Cognitive Ability

Don’t lose overall ability to learn new things but there are changes in the learning process
Harder to memorize lists of names and words than for a younger person Sensory and motor
changes as well as cognitive ability may affect ability to respond – hard to know which is
which.
 B. Psychological Aspects of Aging

Memory Functioning

Age-related memory deficiencies have been extensively reported in the literature. Although
short-term memory seems to deteriorate with age, perhaps because of poorer sorting
strategies, long-term memory does not show similar changes. Nevertheless, with few
exceptions, the time required for memory scanning is longer for both recent and remote recall
among older people. This can sometimes be attributed to social or health factors (e.g., stress,
fatigue, illness), but it can also occur because of certain normal physical changes associated
with aging (e.g., decreased blood flow to the brain).

Intellectual Functioning

There appears to be a high degree of regularity in intellectual functioning across the adult age
span. Crystallized abilities, or knowledge acquired in the course of the socialization process,
tend to remain stable over the adult life span. Fluid abilities, or abilities involved in solving
novel problems, tend to decline gradually from young to old adulthood. The age of their
formal educational experiences is reflected in their intelligence scoring.

Learning Ability

The ability to learn is not diminished by age. The ordinary slowing of reaction time with age
for nearly all tasks or the over-arousal of the central nervous system may account for lower
performance levels on tests requiring rapid responses. Ability to learn continues throughout
life, although strongly influenced by interests, activity, motivation, health, and experience.
Adjustments do need to be made in teaching methodology and time allowed for learning.

Adaptation to the Tasks of Aging

Loss and Grief

Individuals experience losses from the very beginning of life. By the time individuals reach
their 60s and 70s, they have experienced numerous losses, and mourning has become a
lifelong process. Because grief is cumulative, this can result in bereavement overload, which
has been implicated in the predisposition to depression in the elderly.
Attachment to Others

Social network contribute to well-being of the senior by promoting socialization and

companionship, elevating morale and life satisfaction, buffering the effects of stressful
events, providing a confidant, and facilitating coping skills and mastery.

Maintenance of Self-Identity

Self-concept and self-image appear to remain stable over time. Factors that have been shown
to favour good psychosocial adjustment in later life are sustained family relationships,
maturity of ego defenses, absence of alcoholism, and absence of depressive disorder.

Dealing with Death

Death anxiety among the aging is apparently more of a myth than a reality. Various
investigators who have worked with dying persons report that it is not death itself, but
abandonment, pain, and confusion that are feared. What many desire most is someone to talk
with, to show them their life’s meaning is not shattered merely because they are about to die.

Psychiatric Disorders in Later Life

The later years constitute a time of especially high risk for emotional distress. Several
psychosocial risk factors predispose older people to mental disorders. These risk factors
include loss of social roles, loss of autonomy, the deaths of friends and relatives, declining
health, increased isolation, financial constraints, and decreased cognitive functioning.

Dementia

Dementing disorders are the most common causes of psychopathology in the elderly. About
half of these disorders are of the Alzheimer’s type, which is characterized by an insidious
onset and a gradually progressive course of cognitive impairment. No curative treatment is
currently available. Symptomatic treatments, including pharmacological interventions,
attention to the environment, and family support, can help to maximize the client’s level of
functioning.

Delirium

Delirium is one of the most common and important forms of psychopathology in later life. A
number of factors have been identified that predispose elderly people to delirium, including
structural brain disease, reduced capacity for homeostatic regulation, impaired vision and
hearing, a high prevalence of chronic disease, reduced resistance to acute stress, and age-
related changes in the pharmacokinetic and pharmacodynamics of drugs.

Depression

Depressive disorders are the most common affective illnesses occurring after the middle
years. The incidence of increased depression among elderly people is influenced by the
variables of physical illness, functional disability, cognitive impairment, and loss of a spouse.
Hypochondriacal symptoms are common in the depressed elderly. Suicide is more prevalent
in the elderly, with declining health and decreased economic status being considered
important influencing factors. Treatment of depression in the elderly individual is with
psychotropic medications or electroconvulsive therapy.

Schizophrenia

Schizophrenia and delusional disorders may continue into old age or may manifest
themselves for the first time only during senescence. Late-onset schizophrenia (after age 60)
is not common, but when it does occur, it often is characterized by delusions or hallucinations
of a persecutory nature. The course is chronic, and treatment is with neuroleptics and
supportive psychotherapy.

Anxiety Disorders

Most anxiety disorders begin in early to middle adulthood, but some appear for the first time
after age 60. The fragility of the autonomic nervous system in older persons may account for
the development of anxiety after a major stressor. Because of concurrent physical disability,
older persons react more severely to posttraumatic stress disorder than younger persons. In
older adults, symptoms of anxiety and depression often accompany each other, making it
difficult to determine which disorder is dominant.

Personality Disorders

Personality disorders are uncommon in the elderly population. The incidence of personality
disorders among individuals over age 65 is less than 5 percent. Most elderly people with
personality disorder have likely manifested the symptomatology for many years.
Sleep Disorders

Sleep disorders are very common in the aging individual. Sleep disturbances affect 50 percent
of people age 65 and older who live at home and 66 percent of those who live in long-term
care facilities. Increased prevalence of sleep apnea, depression, dementia, anxiety, pain,
impaired mobility, medications, and psychosocial factors such as loneliness, inactivity, and
boredom. Sedative-hypnotics, along with non-pharmacological approaches, are often used as
sleep aids with the elderly. Changes in aging associated with metabolism and elimination
must be considered when maintenance medications are administered for chronic insomnia in
the aging client.

C. Sociocultural Aspects of Aging

Old age brings many important socially induced changes, some of which have the potential
for negative effect on both the physical and mental well-being of older persons. In American
society, old age is defined arbitrarily as being 65 years or older because that is the age when
most people have been able to retire with full Social Security and other pension benefits.

Elderly people in virtually all cultures share some basic needs and interests. There is little
doubt that most individuals choose to live the most satisfying life possible until their demise.
They want protection from hazards and release from the weariness of everyday tasks. They
want to be treated with the respect and dignity that is deserving of individuals who have
reached this pinnacle in life; and they want to die with the same respect and dignity.

D. Sexual aspects of aging

Sexuality and the sexual needs of elderly people are frequently misunderstood, condemned,
stereotyped, ridiculed, repressed, and ignored. Americans have grown up in a society that has
liberated sexual expression for all other age groups, but still retains certain Victorian
standards regarding sexual expression by the elderly. Negative stereotyped notions
concerning sexual interest and activity of the elderly are common. Some people even believe
it is disgusting or comical to consider elderly individuals as sexual beings.

Physical Changes Associated with Sexuality

Many of the changes in sexuality that occur in later years are related to the physical changes
that are taking place at that time of life.
Changes in Women

Menopause may begin anytime during the 40s or early 50s. During this time there is a
gradual decline in the functioning of the ovaries and the subsequent production of estrogen,
which results in a number of changes. The walls of the vagina become thin and inelastic, the
vagina itself shrinks in both width and length, and the amount of vaginal lubrication
decreases noticeably. Orgastic uterine contractions may become spastic. All of these changes
can result in painful penetration, vaginal burning, pelvic aching, or irritation on urination.

Changes in Men

Testosterone production declines gradually over the years, beginning between ages 40 and
60. A major change resulting from this hormone reduction is that erections occur more slowly
and require more direct genital stimulation to achieve. There may also be a modest decrease
in the firmness of the erection in men older than age 60. The refractory period lengthens with
age, increasing the amount of time following orgasm before the man may achieve another
erection. The volume of ejaculate gradually decreases, and the force of ejaculation lessens.
The testes become somewhat smaller, but most men continue to produce viable sperm well
into old age.

SPECIAL CONCERNS OF THE ELDERLY POPULATION

Retirement

Reasons often given for the increasing pattern of early retirement include health problems,
Social Security and other pension benefits, attractive “early out” packages offered by
companies, and long-held plans. Retirement has both social and economical implications for
elderly individuals. The role is fraught with a great deal of ambiguity and is one that requires
many adaptations on the part of those involved.

Long-Term Care

The concept of long-term care covers a broad spectrum of comprehensive health care that
addresses both illness and wellness and the support services necessary to provide the
physical, social, spiritual, and economic needs of persons with chronic illnesses, including
disabilities. Long-term care facilities are defined by the level of care they provide. They may
be skilled nursing facilities, intermediate care facilities, or a combination of the two. Some
institutions provide convalescent care for individuals recovering from acute illness or injury,
some provide long-term care for individuals with chronic illness or disabilities, and still
others provide both types of assistance.

Elder Abuse

Abuse of elderly individuals, which at times has been referred to in the media as “granny-
bashing,” is a serious form of family violence. The abuser is often a relative who lives with
the elderly person and may be the assigned caregiver. Typical caregivers who are likely to be
abusers of the elderly were being under economic stress, substance abusers, themselves the
victims of previous family violence, and exhausted and frustrated by the caregiver role.
Identified risk factors for victims of abuse included being a white female age 70 and older,
being mentally or physically impaired, being unable to meet daily self-care needs, and having
care needs that exceeded the caretaker’s ability.

Factors that Contribute to Abuse

A number of contributing factors have been implicated in the abuse of elderly individuals.

Longer Life

The 65-and-older age group has become the fastest growing segment of the population. The
75 and older age group is the one most likely to be physically or mentally impaired, requiring
assistance and care from family members. This group also is the most vulnerable to abuse
from caregivers.

Dependency

Dependency appears to be the most common precondition in domestic abuse. Changes

associated with normal aging or induced by chronic illness often result in loss of self-
sufficiency in the elderly person, requiring that they become dependent on another for
assistance with daily functioning. Long life may also consume finances to the point that the
elderly individual becomes financially dependent on another as well. This dependence
increases the elderly person’s vulnerability to abuse.

Stress

The stress inherent in the caregiver role is a factor in most abuse cases. Some clinicians
believe that elder abuse results from individual or family psychopathology.
Learned Violence

Children who have been abused or witnessed abusive and violent parents are more likely to
evolve into abusive adults.

Identifying Elder Abuse

Ø Indicators of psychological abuse include a broad range of behaviours such as the

symptoms associated with depression, withdrawal, anxiety, sleep disorders, and
increased confusion or agitation.
Ø Indicators of physical abuse may include bruises, welts, lacerations, burns, punctures,
evidence of hair pulling, and skeletal dislocations and fractures.
Ø Neglect may be manifested as consistent hunger, poor hygiene, inappropriate dress,
consistent lack of supervision, consistent fatigue or listlessness, unattended physical
problems or medical needs, or abandonment.
Ø Sexual abuse may be suspected when the elderly person is presented with pain or
itching in the genital area, bruising or bleeding in external genitalia, vaginal, or anal
areas, or unexplained sexually transmitted disease.
Ø Financial abuse may be occurring when there is an obvious disparity between assets
and satisfactory living conditions or when the elderly person complains of a sudden
lack of sufficient funds for daily living expenses.

APPLICATION OF THE NURSING PROCESS

Assessment

Assessment of the elderly individual may follow the same framework used for all adults, but
with consideration of the possible biological, psychological, sociocultural, and sexual
changes that occur in the normal aging process.

Physiologically Related Diagnoses

v Risk for trauma related to confusion, disorientation, muscular weakness, spontaneous

fractures, falls.
 v Hypothermia related to loss of adipose tissue under the skin, evidenced by increased
sensitivity to cold and body temperature below 98.6 degrees.
v Decreased cardiac output related to decreased myocardial efficiency secondary to age-
related changes, evidenced by decreased tolerance for activity and decline in energy
reserve.
v Ineffective breathing pattern related to increase in fibrous tissue and loss of elasticity
in lung tissue, evidenced by dyspnea and activity intolerance.
v Risk for aspiration related to diminished cough and laryngeal reflexes.

Psychosocially Related Diagnoses

v Disturbed thought processes related to age-related changes that result in cerebral

anoxia, evidenced by short-term memory loss, confusion, or disorientation.
v Complicated grieving related to bereavement overload, evidenced by symptoms of
depression.
v Risk for suicide related to depressed mood and feelings of low self-worth.
v Powerlessness related to lifestyle of helplessness and dependency on others,
evidenced by depressed mood, apathy, or verbal expressions of having no control or
influence over life situation.
v Low self-esteem related to loss of pre-retirement status, evidenced by verbalization of
negative feelings about self and life.

SUMMARY

Care of the aging individual presents one of the greatest challenges for nursing. The growing
population of individuals aged 65 and older suggests that the challenge will progress well into
the 21st century. n some cultures, the elderly are revered and hold a special place of honor
within the society, but in highly industrialized countries such as the United States, status
declines with the decrease in productivity and participation in the mainstream of society.
Individuals experience many changes as they age. Physical changes occur in virtually every
body system. Psychologically, there may be age-related memory deficiencies, particularly for
recent events.

BIBLIOGRAPHY

1. Gail Stuart, ‘Principles and Practice of Psychiatric Nursing’, 8 th Edition, Mosby

Publication.
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Publication, New Delhi.

3. Lalitha, ‘Textbook of Psychiatric Nursing’, 1st Edition, 2004, Bangalore.

4. Neeraja, ‘Essentials of Mental Health and Psychiatric Nursing’, 1 st Edition,

Volume I, JayPee Publication.

5. James Scully, ‘Psychiatry’, 3rd Edition, B.I. Waverly Ltd, New Delhi.

6. American Psychiatric Association, ‘Diagnostic Statistical Manual of Mental

Disorders’, 4th Edition, American Psychiatric Association, 2000.