Psychological changes

Prepared by:
Dr. Soad Hassan
Lecturer of Gerontological
Nursing
 Most elderly people seems to be most vulnerable
to psychological dysfunction when they experience
change.

Affective function refers to the mood, emotions

(such as happiness, sadness, fear, pain, anger,
and confusion).

Cognitive function refers to memory, learning, and

intelligence.

Cognitive and affective functioning affects the

person’s self-esteem.

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 Affective functioning
It is influenced by the way an individual
views the world and self.

A positive view of self and surrounding

environment promotes positive expression
of mood and emotions.

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 Self-esteem -1

It is the way a person views himself/herself.

A positive view of self promotes health and

enables the person to cope better with the
changes and challenges of growing older.

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Factors contribute to a decreased in
self-esteem
Age related changes.
losses that occur with aging
Chronic diseases.
Increased dependency .
Function impairment.
Lack of control over the person environment

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 Personality -2

The basic personality does not change as a

result of aging process.

The personality will be consistent with that

of earlier years.

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 Depression -3
Depression occurs 16-65%
of elders living in the
community.

Depression including: sleep

disturbance, lake of interest,
feelings of guilt, lack of
energy, decreased
concentration and, loss of
appetite.

Losses can lead to

depression.
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 Cognitive functioning

Intelligent, learning, attention

and memory are all related to
cognitive functioning and how well
the mind is able to reason and make
sound judgments.

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 Intelligent -1
Intelligent is a mental alertness and includes
the ability to learn new material, make wise
decisions, and deal with stressful situation.

Intelligent does not become less with age.

IQ test performance of older adults may be

hindered because of sensory deficits or the
stress of being tested. These factors must be
considered when assessing
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 Memory -2
Recent memory is defined as a recall of items
learned more than a few minutes earlier, e.g. the
day's new events, what was eaten for breakfast, the
date. Recent memory generally declines with age.

Remote memory is defined as a recall of items

learned many years earlier, e.g. the dates of wars,
names of presidents, remote memory does not
experience significant change with age.

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 3- Learning
Learning is the acquisition of new knowledge or
skills.

The ability of the mind to learn and retain new

information remains unaltered, particularly when
mind is stimulated through regular use.

The ability to solve complex problems decline

with age.

Hearing and visual deficits related to aging

process can affect learning.
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 Attention span -4
There is decrease in vigilance performance.

Vigilance performance is the ability to retain

attention longer than 45 minutes.

The elderly is more liable to distract (divert)

attention by irrelevant information and stimuli.

Deficits in attention may affect learning and

memory.
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 Social Changes

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The social changes that come with life are
change in life style, loss of other family
members, neighbors and friends.

The main social problems, which confront

elderly persons, are:
- social isolation
- finance
- loneliness
- rejection and loss of purpose in life.
- deterioration in housing standard and
poor nutritional level.
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 Retirement-1
A change in work role comes with retirement.

It changes the way time is managed and daily

activities are carried out.

Retirement alters identity, status, financial

problem, lack of self-satisfaction and self-
esteem and sometimes friendships.

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 Widowhood -2
A common event that alters family life for the
aged is the death of a spouse.

The spousal role composed of many sub roles,

such as companion, sexual partner, confidante,
cook, house-keeping, and care provider.

Loss of spouse is a highly stressful experience.

Death of a spouse affects more women than men
because most older men will marry again .
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 Loneliness -3
Loneliness is the feeling of emotional
isolation, being locked inside oneself and
unable to obtain the warmth and comfort
from others.

Any loss that creates a deficit in intimacy

and inner personal relationships can lead to
loneliness.

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Role change (role reversal) -4

Numerous role changes occur with the

aging process, but the transitions expected
by most elders are related to the work role
and the role of spouse or partner.

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 Multiple losses -5

Aging is associated with major physical,

psychological and sociologic losses as well
as a reduced ability to adapt and compensate
for stressors.

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 Examples of some losses
Loss of job (retirement)
Loss of status
Change role
Loss related to normal age-related changes
Decreased income
Increase expenditure on medical services
Loss of significant person
Loss of housing
Decreased the ability to adapt and compensate for
stressors
Limitations impose as a result of multiple chronic
diseases
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 Awareness of Mortality
Widowhood, death of friends, and the
recognition of declining functions make older
person more aware of the reality of their own
death.

Attitudes about death vary with aging.

The elderly tend to think and talk about death,

but they find the prospect of death less
frightening.
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 Psychosocial problems
Poor adjustment to role Loneliness
changes Isolation
Poor adjustment to Problems with sexuality
lifestyle changes
Elderly abuse
Family relationship
problems Withdrawing and
having a negative
Grief attitude toward life in
Low self-esteem general
Anxiety and depression
Aggressive behavior
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 Developmental tasks needed for
successful aging
1. Adjusting to declining health and physical strength.
2. Adjusting to retirement and reduce income
3. Adjusting to death of a spouse.
4. Establish associations with others in the same
age.
5. Maintaining a satisfactory living arrangement.
6. Adapting to changes in social roles.

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 Role of the gerontological nurse to
promote psychosocial adaptation

1. The psychosocial
assessment is an
essential
component of the
overall health
assessment

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 2- Nursing intervention to enhance mental
alertness

Allow the client to do as many tasks for himself as

possible.

Encourage use of the mind in problem solving.

Encourage use of numbers and calculations.

Encourage creative activities (e.g. painting, story

telling).

Encourage the discovery of new talents and abilities.

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3- Nursing intervention when caring for a client with a short-term
memory loss

Identify yourself each time there is an interaction with the client.

Give instructions in simple, direct terms.

Repeat instructions several times.

Explain every thing that is happening, even if the client does not
seem to understand.

Perform only one activity at a time.

Report any sudden confusion.

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4- Nursing intervention when teaching an older
person new information

Assess current knowledge.

Evaluate for any visual or hearing deficit. Make
sure the hearing aid is working or glasses are
available, if indicated.
Determine the person's ability to learn.
Identify any language barrier.
Determine if the information to be taught is
thought to be important or relevant to the
elderly person.
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 Begin by reviewing familiar information and
then more to new information.
Teach the spouse or family member as well as
the elderly person if possible.
Plan teaching over several days, with small
increments of information presented at one
time.
Actively involve the client in the learning
process.
Allow time for feed back to evaluate knowledge

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Nursing role to increased self-esteem -5
Develop a trusting relationship

Treat the elderly with dignity and respect

Allow sufficient time for the performance

of daily activities of self-care

Encourage verbalization

Practice active listening

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 Give positive reinforcement for progress.

Use reminiscence therapy (encourage the

elderly to recall or remember past events).

Be alert for opportunities to include the patient

in decision making.

Use verbal and non verbal communication

Encourage socialization.
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 Nursing intervention that foster positive -6
personality traits in elderly
 Accept the elderly.
 Identify the positive characteristic of each
elderly.
 Encourage verbalization.
 Reward positive behavior.
 Avoid a judgmental attitude.

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 7- Adjusting to retirement

It is easier if activities that will

become prominent after retirement are
begun during the working years.

Therefore, adjustments to retirement are

influenced by pre-retirement plan and
engaging in other activities before
withdrawing completely from their work.

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 9- Find a new role

Such as a grandparent role. The

grandparent role is generally one that
brings great satisfaction and
contentment.

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 10- Facilitating maximum independence

Make sure that the person has access to all necessary

assistive devices and personal accessories.

Allow enough time for the person to perform tasks at

her or his own place

Make sure that the environment has been adapted as

much as possible to compensate for sensory losses and
other functional impairments.

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11- Intervention that promotes social support

Use interventions to deal with hearing

impairments and other communication barriers.
Encourage participation in group activities.
For people in wheelchairs, especially those who
cannot move independently, position the chairs
in a way that promotes social interaction.
For nursing home residents, plan tables and
room arrangements in such a way that social
relationships are fostered
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 Thank you

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