Nursing Education and Older Adults and Developmental Needs
Aspects of Development In Older Adults
Physical Changes and Development Stages
With age advancing, so many physical changes occur that it becomes difficult to establish normal boundaries. As a person grows older, natural physiological changes in all systems of the body are universal, progressive, decrement. and intrinsic. Alterations in physiological functioning can lead secondarily to changes in learning ability. The senses of sight, hearing, touch, taste, and smell are usually the first areas of decreased functioning noticed by adults (Miller & Stoeckel, 2016).
The sensory perceptive abilities that relate most closely to learning capacity are visual and auditory changes. Hearing loss, which is very common beginning in the late 40s and 50s, includes diminished ability to discriminate high-pitched, high-frequency sounds. Visual changes such as cataracts, macular degeneration, reduced pupil size, decline in depth perception. and presbyopia may prevent older persons from being able to see small print, read words printed on glossy paper, or drive a car.
Yellowing of the ocular lens can produce color distortions and diminished color perceptions.Other physiological changes affect organ functioning and result in decreased cardiac output, lung performance, and metabolic rate; These changes reduce energy levels and lessen the ability to cope with stress. Nerve conduction velocity is also thought to decline by as much as 15%, influencing reflex times and muscle response rates.
The inter relatedness of each body system has a total negative cumulative effect on individuals as they grow older. Aging affects the mind as well as the body. Cognitive ability changes with age as permanent cellular alterations invariably occur in the brain itself, resulting in an actual loss of neurons, which have no regenerative powers. Physiological research has demonstrated that people have two kinds of intellectual ability crystallized and fluid intelligence.
Crystallized intelligence is the intelligence absorbed over a lifetime, such as vocabulary, general information, understanding social interactions, arithmetic reasoning, and ability to evaluate experiences. This kind of intelligence increases with experience as people age. However, it is important to understand that crystallized intelligence can be impaired by disease states, such as the dementia seen in Alzheimer's disease. Fluid intelligence is the capacity to perceive relationships, to reason, and to perform abstract thinking.
Degenerative Changes In Older Adults
This kind of intelligence declines as degenerative changes occur. The decrease in fluid intelligence results in the following specific changes:
1. Slower processing and reaction time. Older persons need more time to process and react to information, especially as measured in terms of relationships between actions and results. However, if the factor of speed is removed from intelligence tests, for example, older people can perform as well as younger people. In performance of activities of daily living when speed is not a factor, older adults can demonstrate their true abilities to function well and independently (Kray & Lindenberger, 2000).
2. Persistence of stimulus (afterimage). Older adults can confuse a previous symbol or word with a new word or symbol just introduced.
3. Decreased short-term memory. Older adults sometimes have difficulty remembering events or conversations that occurred just hours or days before. However, long-term memory often remains strong, such as the ability to clearly and accurately remember
4.Something from their youth. Increased test anxiety. People in the older adult years are especially anxious about making mistakes when per forming, when they make an error. they become easily frustrated. Because of their anxiety, they may take an ordinate amount of time to respond to questions, particularly on tests that are written rather than verbal.
5. Altered time perception. For older persons, life becomes more finite and compressed. Issues of the here and now tend to be more important, and some adhere to the philosophy, “I'll worry about that tomorrow.” This way of thinking can be detrimental when applied to health issues because it serves as a vehicle for denial or delay in taking appropriate action.
Cognitive Changes In Older Adults
Despite the changes in cognition caused by aging, most research supports the premise that the ability of older adults to learn and remember is virtually as good as ever if special care is taken to slow the pace of presenting information, to ensure relevance of material, and to give appropriate feedback when teaching.
Erikson (1963) labels the major psycho-social developmental task at this stage in life as ego integrity versus despair. This phase of older adulthood includes dealing with the reality of aging, the acceptance of the inevitability that all persons die, the reconciling of past failures with present and future concerns, and developing a sense of growth and purpose for those remaining years (Table 5- 2). The most common psychosocial tasks of aging involve changes in lifestyle and social status based on the following circumstances.
Illness or death of spouse, relatives, and friends the moving away of children, grandchildren, and friends Relocation to an unfamiliar environment such as an extended-care facility or senior residential living center
After Erikson's death in 1994, a ninth stage of psychosocial development, hope and faith versus despair was published by his wife in the book The Life Cycle Completed (Erikson & Erikson, 1998). This new final stage was developed from notes that Erikson left behind, along with the conversations he had with his wife. It addresses those individuals reaching their late 80s and older, identifying that aging individuals need to accept greater assistance as their bodies age.
The goal is to find a renewed awareness of self in accordance with this need for additional care while eventually achieving a new sense of wisdom that is less materialistic and moves the individual beyond physical limits (Crandell et al., 2012; Erikson & Erikson, 1998 ). Although this additional stage has been published for some time, it has not been incorporated into the literature discussing Erikson's stages of development. However, Brown and Lowis (2003) conducted a study that did provide some evidence of a distinct differentiation between stages eight and nine in aging individuals.
Depression, grief, loneliness, and isolation, once thought to be common traits among older adults, have now been found by researchers to vary from less frequent to no more frequent than the incidence rate found in middle adulthood. This situation arises because older adults overall have fewer economic hardships and in creased religiosity. However, depressive symptoms do increase in the oldest-old and are thought to be associated with more physical disability, more cognitive impairment, and lower socio-economic status.
For those who experience major depression (the “common cold” of mental disorders), the most likely predictors are a previous history of depression, lack of perceived social support, poor health, disability, and losing members of the established social network (Santrock, 2017). These losses, which mean a threat to one's own autonomy, independence, and decision making, resulted in isolation, financial insecurity, diminished coping mechanisms, and a diminished sense of identity, personal value, and societal worth.
With aging, some individuals, particularly the oldest-old, begin to question their perception of a meaningful life that is, the potential for further enjoyment, pleasure, and satisfaction. Depressive symptoms in the oldest-old, especially men, are thought to be associated with more physical disability, more cognitive impairment, and lower socioeconomic status (Federal Interagency Forum on Aging Related Statistics, 2016; Santrock, 2017).
Biological Aging and Social Cultural Factors In Old Age
Separate from biological aging but closely related are the many sociocultural factors that affect how older adults see themselves as competent individuals (Crandell et al., 2012; Leifer & Hartston, 2013; Newman & Newman, 2015: Santrock, 2017). The following traits regarding personal goals in life and the values associated with them are significantly related to motivation and learning:
1. Independence
The ability to provide for their own needs is the most important aim of older persons, regardless of their state of health. Independence gives them a sense of self-respect, pride, and self-functioning so as not to be a burden to others. Health teaching is the tool to help them maintain or regain independence.
2. Social acceptability
Winning approval from others is a common goal of many older adults. It is derived from health. a sense of vigor, and feeling and thinking young. Despite declining physical attributes, the older adult often has residual fitness and functioning potentials. Health teaching can help to channel these potentials.
3. Adequacy of personal resources
Resources, both external and internal, are important considerations when assessing the older adult's current health and wellness status. Life patterns, which include habits, physical and mental strengths, and economic situation, should be assessed to determine how to incorporate teaching to complement existing regimes and resources (financial and support system) with new required behaviors.
4. Coping mechanisms
The ability to cope with change during the aging process is indicative of the person's readiness for health teaching, Positive coping mechanisms allow for self-change as older persons draw on life experiences and knowledge gained over the years. Negative coping mechanisms indicate an individual's focus on losses and show that his. or her thinking is immersed in the past. The emphasis in teaching is on exploring alternatives, determining realistic goals, and supporting large and small accomplishments.
5.Meaning of life
For well-adapted older persons, having realistic goals allows them the opportunity to enjoy the smaller pleasures in life, whereas less well adapted individuals may be frustrated and dissatisfied with personal inadequacies. Health teaching must be directed at ways older adults can maintain optimal health so that they can derive pleasure from their leisure years.
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