Patient Adulthood and Nursing Education for Developmental Stages

Afza.Malik GDA

 Nursing Education for Middle Age  and Old Age Adults 

Patient Adulthood and Nursing Education for Developmental Stages

What Is Middle Aged Adulthood,What Is Older Adulthood and Developmental Stages 

What Is Middle Aged Adulthood (41-64 Years of Age) and Nursing Education 

    Just as adolescence is the link between childhood and adulthood, so midlife is the transition period between young adulthood and older adulthood. Middle-aged Americans make up about one fourth of the population, and this current cohort has typically been labeled the baby boom generation. Although middle aged adulthood was once one of the most neglected age periods, baby boomers, who now make up this cohort, are receiving increasingly more attention from developmental psychologists and health-care providers.

    This emphasis is occurring not only because they constitute the largest cohort of any current generation but also because current middle-aged adults are the best educated, most affluent generation in history, and they have the potential to enjoy a healthier life than ever before because of medical discoveries that can stave off the aging process. In just one century, the average life expectancy has increased by 30 years (Crandell et al., 2012; Santrock, 2017).

    Thus, the concept of what has been thought of as middle age is being nudged upward. As more people live longer, middle age is now coming later in life than ever before. Adults are no longer considered to be “over the hill” when they celebrate their 40th birthday. Middle age for many healthy adults is starting later and lasting longer. Remember, chronological age is one factor, but biological, psychological, and social age must also be considered (Newman & Newman, 2015; Santrock, 2017).

    During middle age, many individuals are highly accomplished in their careers, their sense of who they are is well developed, their children are grown, and they have time to share their talents, serve as mentors for others and pursue new or latent interests. This stage is a time for them to reflect on the contributions they have made to family and society, relish in their achievements, and reexamine their goals and values (Newman & Newman, 2015)..

What Is Older Adulthood (65 Years of Age and Older) and Nursing Education

    The percentage of middle aged adults in the United States has tripled since 1900, and in 2011, the first wave of baby boomers turned 65 years of age. Older persons constitute approximately 15% of the US population now, but by 2030, the number of those older than age 65 will increase to 21%, or approximately 74 million Americans. Those aged 85 and older make up the fastest growing segment of the population in the country today, and that segment is expected to more than triple by 2060, rising to approximately 20 million (Federal Inter agency Forum on Aging Related Statistics, 2016) . 

    With more than 45% of the 2010 federal budget allocated for Medicare, Medicaid, and Social Security, a considerable portion of this country's fiscal resources is used for programs that support those 65 years and older (Crandell et al. 2012).

    Some developmental have in recent years begun to categorize older adults into distinct divisions based on different age ranges. For example, Santrock (2017) identifies three groups of older adults: the young old (65-74 years of age), the old old (75-84 years of age), and the oldest-old (85 years and older). Newman and Newman (2015) have identified the last stages of aging into two categories: later adulthood (60-75 years) and elder hood (75 years until death). 

    These new distinctions recognize a shift in health and productivity levels of people in the later years according to biological and social trends conditions, and many, especially in the later years, have multiple conditions. On average, they are hospitalized longer than persons in other age categories and require more teaching overall to broaden their knowledge of self care. 

    In addition, it is approximated by the USDHHS that as of 2016, the educational profile of older Americans is as follows: 54% of Hispanics, 77% of Black Americans, 80% of those of Asian descent, and 90% of Caucasians older than 65 years of age have a high school education; this percentage is 84% for the aggregate. These numbers have increased significantly since 1970, when only 28% of older adults had a high school diploma. 

    However, currently, only 28% of them have a college degree at the bachelor's level or higher (USDHHS, 2016). Lower educational levels in some ethnic groups, sensory impairments, the disuse of literacy skills once learned, and cognitive changes in the population of older adults may contribute to their decreased ability to read and comprehend written materials (Best, 2001).

    For these reasons, their patient education needs are generally greater and more complex than those for persons in any of the other developmental stages. Numerous studies have documented that older adults can benefit from health education programs. Their compliance, if they are given specific health directions, can be quite high. 

    Given the considerable health-care expenditures for older people, education programs to improve their health status and reduce morbidity would be a cost effective measure (Behm et al., 2014: Best, 2001; Mauk, 2014; Robnett & Chop, 2015).Because American society values physical strength, beauty, social networking, productivity, and integrity of body and mind, people fear the natural losses that accompany the aging process. 

    Growing older is a normal event, yet the inevitable continuation of human development that results in biological, psychological, and social changes with the passage of time is a reminder of mortality. Nurses and nurse educators must recognize that a significant number of older persons respond to these changes by viewing them as challenges rather than defeats. 

    Many aspects of older adulthood can be pleasurable, such as becoming a grand parent and experiencing retirement that gives one time to pursue lifelong interests, as well as freedom to explore new avenues of endeavor (Santrock, 2017).Ageism describes prejudice against the older adults. This discrimination based on age, which exists in most segments of American society, perpetuates the negative stereotype of aging as a period of decline (Gavan, 2003; Miller & Stoeckel, 2016). 

    Ageism, in many respects, can be compared to the discriminatory attitudes of racism and sexism (Crandell et al.. 2012). This bias interferes with interactions between the older adult and younger age groups and must be counteracted because it “prevents older people from living lives as actively and happily as they might” ( Ahroni , 1996, p. 48). Given that the aging process is universal, eventually everyone is potentially subject to this type of prejudice. 

    New research that focuses on healthy development and positive lifestyle adaptations, rather than on illnesses and impairments in the older adults, can serve to reverse the stereotypical images of aging. Education to inform people of the significant variations that occur in the way that individuals age and education to help the older adults learn to cope with irreversible losses can combat the prejudice of ageism as well (Crandell et al., 2012).

    The teaching of older persons, known as geragogy, is different from teaching younger adults (andragogy) and children (pedagogy). For teaching to be effective, geragogy must accommodate the normal physical, cognitive, and psychosocial changes that occur during this phase of growth and development (Best, 2001; Miller & Stoeckel, 2016). Until recently, little had been written about the special learning needs of older adults that recognized the physiological and psychological aging changes that affect their ability to learn. 

    Age changes, which begin in young and middle adulthood, progress significantly at this older adult stage of life. These changes often create obstacles to learning unless nurses understand them and can adapt appropriate teaching interventions to meet the older person's needs. The following discussion of physical, cognitive, and psychosocial maturation is based on findings reported by numerous authors ( Ahroni , 1996, Best, 2001; Crandell et al., 2012; Gavan, 2003; Hinkle, 2014; Mauk, 2014; Santrock, 2017 ; Weinrich & Boyd, 1992).

The Developmental Stages of Adulthood

    Andragogy, the term used by Knowles (1990) to describe his theory of adult learning, is the art and science of teaching adults. Education within this framework is more learner centered and less teacher centered; that is, instead of one-party imparting knowledge to another. the power relationship between the educator and the adult learner is much more horizontal (Curran, 2014). 

    The concept of andragogy has served for years as a useful framework in guiding instruction for patient teaching and for continuing education of staff. Recently, based on emerging research and theory from a variety of disciplines, Knowles and colleagues (2015) discussed new perspectives on andragogy that have refined and strengthened the core adult learning principles that Knowles originally proposed.

The following basic assumptions about Knowles's framework have major implications for planning, implementing, and evaluating teaching programs for adults as the individual matures:

1. The adult's self-concept moves from one of being a dependent personality earner to being an independent, self-directed human being.

2. He or she accumulates a growing reservoir of previous experience that serves as a rich resource for learning.

3. Readiness to learn becomes increasingly oriented to the developmental tasks of social roles.

4. Adults are best motivated to learn when a need arises in their life situation that will help them satisfy their desire for information.

5. Adults learn for personal fulfillment such as self-esteem or an improved quality of life,

    A limitation of Knowles's assumptions about child versus adult learners is that they are derived from studies conducted on healthy people. IIIness and injury, however, have the potential to significantly change the cognitive and psychological processes used for learning (Best, 2001).

    The period of adulthood constitutes three major developmental stages-the young adult stage, the middle-aged adult stage, and the older adult stage. Although adulthood, like childhood, can be divided into various developmental phases, the focus for learning is quite different. Whereas a child's readiness to learn depends on physical, cognitive, and psychosocial development, adults have essentially reached the peak of their physical and cognitive capacities.

    The emphasis for adult learning revolves around differentiation of life tasks and social roles with respect to employment, family, and other activities beyond the responsibilities of home and career (Boyd, Gleit, Graham, & Whitman, 1998). In contrast to childhood learning. which is subject centered, adult learning is problem centered. The prime motivator to learn in adulthood is being able to apply knowledge and skills for the solution of immediate problems. 

    Unlike children, who enjoy learning for the sake of gaining an understanding of themselves and the world, adults must clearly perceive the relevancy of acquiring new behaviors or changing old ones for them to be willing and eager to learn. In the beginning of any teaching-learning encounter, therefore, adults want to know how they will benefit from their efforts at learning (Knowles et al., 2015).

    In contrast to the child learner, who is dependent on authority figures for learning, the adult is much more self-directed and independent in seeking information. For adults, past experiences are internalized and form the basis for further learning. Adults already have a rich resource of stored information on which to build a further understanding of relationships between ideas and concepts (Conlan, Grabowski, & Smith, 2015). Compared to children, adults grasp relationships more quickly, but they do not tolerate learning isolated facts as well. 

    Because adults already have established ideas, values, and attitudes, they also tend to be more resistant to change. In addition, adults must overcome obstacles to learning very different from those faced by children. For example, they have the burden of family, work, and social responsibilities, which can diminish their time, energy, and concentration for learning. Also, their need for self-direction may present problems because various stages of illness, as well as the healthcare setting in which they may find themselves, can force dependency. 

    Anxiety, too, may negatively affect their motivation and ability to learn, especially if the content is perceived as difficult (Kinkead, Miller, & Hammett, 2016). Furthermore, some adults may feel too old or too out of touch with the formal learning of the school years to learn new things. If past experiences with learning were not positive, they may also shy away from assuming the role of learner for fear of the risk of failure (Boyd et al., 1998).

    Although nurse educators can consider adult learners as autonomous, self directed, and independent, these individuals often want and need structure, clear and concise specifics, and direct guidance. As such, Taylor, Marienau, and Fiddler (2000) label adults as “paradoxical” learners.

    Only recently has it been recognized that learning is a lifelong process that begins at birth and does not cease until the end of life. Growth and development are a process of becoming, and learning is inextricably part of that process. As a person matures, learning is a significant and continuous task to maintain and enhance one's self (Knowles, 1990; Knowles et al., 2015). Social scientists now recognize that adulthood “is not a single monolithic stage sandwiched between adolescence and old age” (Crandell et al., 2012, p.403).

A variety of reasons explain why adults pursue learning throughout their lives. Basically, three categories describe the general orientation of adults toward continuing education (Knowles et al., 2015; Miller & Stoeckel, 2016):

1. Goal oriented learners engage in educational endeavors to achieve clear and identifiable objectives. Continuing education for them is episodic and occurs as a recurring pattern throughout their lives as they realize the need for or an interest in expanding their knowledge and skills. Adults attend night courses or professional workshops to build their expertise in a specific subject or for advancement in their professional or personal lives.

2.Activity-oriented learners selected educational activities primarily to meet social needs. The learning of content is secondary to their need for human contact. Although they may choose to participate in support groups, special interest groups, or self-help groups, or attend academic classes because of an interest in a topic being offered, they join essentially out of their desire to be around others and converse with people in similar circumstances retirement, parenting, divorce, or widowhood. Their drive is to alleviate social isolation or loneliness.

3.Learning-oriented learners view themselves as perpetual students who seek knowledge for knowledge's sake. They are active learners throughout their lives and tend to join groups, classes, or organizations with the anticipation that the experience will be educational and personally rewarding.

    In most cases, all three types of learners initiate the learning experience for themselves. In planning educational activities for adults, it is important to determine their motivations for wanting to be involved. That is, it is advantageous for the nurse educator to understand the purpose and expectations of the individuals who participate in continuing education programs. Armed with that knowledge, the nurse educator can best serve learners in the role of facilitator for referral or resource information, thereby embracing the adults' state of independence and interdependence (Musinski, 1999).

    Obviously, there are many differences between child and adult learners . As the following discussion clearly reveals, there are also differences in the characteristics of adult learners within the three developmental stages of adulthood.

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