Nursing of the Elderly Trends and Issues

Geriatrics

Deals with the physiology of aging and with the diagnosis and treatment of diseases affecting the aged

Gerontology

The study of all aspects of the aging process, including the clinical, psychological, economic, and sociologic problems of older adults

Gerontophobia The fear of aging and the refusal to accept older adults into the mainstream of society

Both senior citizens and younger persons can fall prey to such irrational fears

Ageism

The dislike of aging and older people based on the belief that aging makes people unattractive, unintelligent, and unproductive

An emotional prejudice or discrimination against people based solely on age

Allows the young to separate themselves physically and emotionally from the old and to view older adults as somehow having less human value

Demographics

According to the U.S. Department of State, the number of people over age 65 is projected to exceed the number of children under age 5

In 2010 an estimated 40 million people age 65 or older lived in the United States

By 2050 this is expected to increase to 72 million people age 65 or older

One out of 5 or about 20% of the total population of the United States

Individuals older than 85 years of age now make up 4% of the entire U.S. population

Women currently outlive men by approximately 5 to 6 years

Women tend to live longer than men and whites tend to live longer than blacks although disparities seem to be declining

White women have the longest life expectancy, about 81 years

Baby Boomers

Consists of people who were born after World War II, between 1946 and 1964

Account for approximately one-third of all Americans today

Because of its size, this group has had, and will continue to have, significant influence on all areas of society

We are becoming an increasingly older society

Geopgraphic Distribution

The older adult population is not equally distributed throughout the United States

Climate, taxes, and other issues regarding quality of life influence where older adults choose to live

Population distribution data show that Florida leads the nation with 17.4% of its population being older than 65 years of age

Approximately 79% of older adults reside in metropolitan areas, with approximately 36% residing in principle cities

In 2012 72% of men over age 65 were married, compared to 45% of older women

The percentage of older adults who are separated or divorced has increased significantly, to 12%

The percentage of married individuals drops significantly as age progresses

By age 90, 80% of women were widows compared to only 49% of men

In 1970, only 28% of senior citizens had graduated from high school

By 2012, 81% are high school graduates or more and 24% have a bachelor’s degree or higher

Today’s older adult population is more technologically sophisticated

Some of the poorest people in the country are older adults, but so are some of the richest

In 2011, approximately 9% of the elderly population was statistically determined to be at or below the poverty level

Older women were more likely to be impoverished than men

Older minority women, particularly blacks and Hispanics, were more likely to live in poverty

As of 2011 the median income of males over age 65 was $27,707 while that for females was only $15,362

The median income of households headed by a person 65 years of age or older was approximately $48,538

The major sources of aggregate income for older adults include social security benefits earnings, asset income, pensions, and other earnings

Living situations

Most older adults live with a spouse or alone

Older individuals often try to keep their home despite the physical or economic difficulties in doing so; it represents independence and security

Some older individuals remain in their own houses and refuse to give them up long after it is safe for them to be alone

Independent or Assisted-Living Centers

Combine privacy with easily available services

Most consist of private apartments that are purchased or rented

Different levels of medical, nursing, and personal care services are available

Life lease

For a large initial investment and substantial monthly rental and service fees, older persons or couples are guaranteed a residence for life

Independent residents occupy apartment units, but extended-care units are attached to the apartment complex or located nearby for residents who require skilled nursing services

When the occupants die, control of the apartment reverts to the owners of the facility

Community based housing

For a monthly fee, this type of facility provides services such as room and board, help with activities of daily living, assistance with medications, yearly medical examinations, information and referrals, leisure activities, and recreational or therapeutic programs

Most of these facilities provide private or semiprivate rooms with community areas for dining and socialization

Nursing homes and extended care facilities

Provide room and board, personal care, and medical and nursing services

They are licensed by individual states and regulated by both federal and state laws

Medicare

The government program that provides health care funding for older adults and those with disabilities

Most Americans older than 65 years qualify for Medicare

Part A

Covers inpatient hospital care; extended care in a skilled nursing facility following hospitalization; some home health services and hospice services—but only after the patient pays an initial deductible and any co-pay expenses

Part B

Covers 80% of the “customary and usual” rates charged by physicians after deductibles are met

Part C

”Advantage” plan, which allows beneficiaries to receive Medicare benefits through private insurance companies that are able to demonstrate cost savings

Part D

Prescription drugs are distributed through local pharmacies and administered by a wide variety of private insurance plans

Supplemental Medicaid (Title 19)

May be available for those older adults who meet certain financial need requirements

Many of those who have assets do not qualify; they are left with a Medicare gap (or “medigap”) that they must pay themselves

Many older people buy private medical insurance—often at unreasonable prices—to pay medical bills that are not covered by Medicare

Advanced Directives

Two formal types of advance directive are recognized in most states

Durable power of attorney for health care

Transfers the authority to make health care decisions to another person

Living will

Informs the physician that the individual wishes to die naturally if he or she develops an illness or receives an injury that cannot be cured

These written documents are designed to help guide the family and medical professionals in planning care

Impact of aging on the family

It is estimated that 80% of older adults who need care will receive assistance from their families

Middle-aged family members often become the caregivers

Typically, sons contribute financially, but the brunt of the emotional and physical care burden falls to daughters

Children often take older parents into their homes when the older parents can no longer maintain their own houses or apartments

Average caregiver age is 48.

66% of caregivers are female.

16% of American workers function as caregivers.

Self Neglect Defined as failure to provide for self because of a lack of ability or lack of awareness

More likely to be seen when an older person has few or no close family or friends, but it can occur despite their presence

Most likely to be recognized by neighbors and reported to the police, public health nurse, or social worker

Often connected with some form of mental illness or dementia

.

Abuse or Neglect by the family

Physical abuse

Any action that causes physical pain or injury

Neglect

A passive form of abuse in which caregivers fail to provide for the needs of the older person under their care

Emotional abuse

Includes behaviors such as isolating, ignoring, or depersonalizing older adults

Financial abuse

The resources of an older person are stolen or misused by a person whom the older adult trusts

Abandonment

Occurs when dependent older persons are deserted by the person(s) responsible for their custody or care under circumstances in which a reasonable person would continue to provide care

Abuse by un-related caregivers

People who are hired to provide for the safety and well-being of older adults can sometimes become their greatest threat

There are specific federal and state laws designed to prevent undesirable persons from contact with vulnerable people, such as the young and the older adult population

Sometimes people with criminal records, inadequate training, or other serious shortcomings manage to gain employment, despite safeguards

Nurses who supervise other caregivers must constantly be on the lookout for abusive behaviors

Any indication of abuse in an institutional setting must be reported as soon as it is suspected so that appropriate action can be taken and the abusive person removed

The importance of this nursing responsibility cannot be stressed enough

Support groups

Caregivers who want or need to share their experiences and frustrations have started forming support groups to help each other cope with stress

Support groups allow caregivers to share their feelings and learn new strategies for improving their coping skills

Respite care

Allows the primary caregiver to have time away from the constant demands of caregiving, thereby decreasing caregiver stress and the risk for abuse

Gives the primary caregiver the opportunity to attend his or her place of worship, go shopping, conduct personal business, obtain medical care, and participate in other activities that most people take for granted

Credits:

Created with images by FelipeAugusto - "human black and white person" • Ben_Kerckx - "man read cigar" • Gaertringen - "hands aged elderly" • Steve Slater (used to be Wildlife Encounters) - "An elderly couple taking time out for a snack and watching passers by" • .through my eyes. - "never stop." • werner22brigitte - "emotional couple tango" • pedrosimoes7 - "Portuguese Intersindical Demonstration : Celebrating" • mcohen.chromiste - "The Beach Promenade / Promenade au bord de l'eau" • mcohen.chromiste - "Old Woman's Walk, Plaza Corredera, Cordoba" • Witizia - "hand elderly woman wrinkles" • Patrick Doheny - "The Trials of the Elderly" • tofslie - "Awesome" • Jundy Tiu - "Elderly" • Pexels - "beard close-up elderly" • geralt - "bauer books jura" • runneralan2004 - "Senior citizens at Las Terrazas" • Images_of_Money - "Healthcare Costs" • MDGovpics - "Healthcare Reform Initiative Announcement" • ProgressOhio - "P1020731" • Senator Mark Warner - "advance-directive"

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