Life Span:

Older
Adults
Chapter 10
Demographics
Older adulthood
–Fastest growing age group
– In 1900, 4.1% of U.S. population was over 65. By 2013, life expectancy
had increased, & older adults made up 14% of the population.

–By 2060 will be 24% of the population

–Population pyramid (fewer young, more old)
– Age distribution of population is illustrated in pyramid with
youngest age group (0–4) at the base & oldest age group
(85+) at the peak, men on left of the figure & women on the
right. The shape of a population pyramid changes to rectangle
in developed countries with fewer births and increased life
expectancy.
Stages of Development

Older adulthood
Begins at age 65

Young-old (65–74 years old)

Middle-old (75–84 years old)

Oldest-old (above 85 years old)

 Older adulthood
Young-old Middle-old
–Physical & psychological –Developmental challenge is an
adaptations to retirement are increasingly solitary, sedentary
paramount in this age group. lifestyle.
–Face barriers to health like
–Although physical activity
lack of supplemental insurance
declines, there is some
for health screening; physicals
that are not covered under evidence that older adults
Medicare, self-perception of represent the fastest-growing
aging, changes in physical segment of participants in
activity, & being in a competitive sports, with a rise
deconditioned state by not in the 80+-year-old finishers at
participating in exercise before road races such as the New
retirement. York City marathon.
 Oldest –old
 Developmental challenges are sensory impairments, oral health, inadequate
nutritional intake, functional limitations.
Hearing. Nearly half of older men & more than one-third of older women
reported difficulty hearing. This was higher for 85+ than for young-old &
middle-old.
Vision. Of the 85+, 27% reported trouble seeing.
Edentulism. Of those over 85, 34% reported edentulism (having no natural
teeth). This tends to be income related: 42% of older adults below the poverty
line reported edentulism, whereas for those above the poverty line, incidence
was only 23%.
Nutrition. Edentulism compromises an already inadequate nutritional intake
of older adults & fosters a diet of “soft” foods that may be higher in fats,
carbohydrates, & calories. This occurs at a time when they need to decrease
intake of these foods to combat obesity & counter decreased activity levels.
Functional limitations. Ability to stoop/kneel, reach overhead, walk 2-3
blocks, lift 10 lbs are common parameters for determining functional abilities
of older adults. 40% of men reported they were unable to perform at least one
of these activities. More than half of women were unable to perform at least
one activity. There were minimal to no differences across ethnic & racial
groups.
 Stages of Development (cont’d)
Older adulthood Frailty
– Fastest-growing age • A syndrome, or a set of characteristics,
group that describes a heightened state of
vulnerability for developing adverse health
– Most health problems are
outcomes.
chronic
• A multisystem reduction in the person’s
– Chronic disorders affect physiological capacity.
independent living
• The point at which the human organism
– Frail (fragile) elderly is believed to have its least capacity for
survival, & will fail in response to a minor
internal or external insult.
• For example, a frail older adult might die
merely as a result of falling ill to an upper
respiratory infection (such as a cold).
 Theories of Aging
Genetic theories Cellular malfunction
–propose that cells have a –a malfunction in cell causes changes in
preprogrammed, finite number of cellular DNA, leading to problems with cell
cell divisions replication.
–Time of death is determined at –Can be the result of chemical reaction
birth. with DNA, an abundance of free radicals
that damage cells & impair their ability to
–Genetic messages within various function normally (free-radical theory), or
cells of body specify how many buildup of toxins over time that cause cell
times the cell can reproduce, thus death (toxin theory)
defining the life of that cell.

Wear and tear Autoimmune reaction

–repeated insults & accumulation –Cells change with age
of metabolic wastes eventually –Over time the changes result in
cause cells to wear out & cease the immune system’s perceiving
functioning some cells as foreign substances &
triggering an immune response to
destroy the cells.
 Age-Related Physical Changes
Musculoskeletal: Decreased: muscle strength, body/bone mass, joint mobility, Increase fat deposit
Cardiovascular: Decreased cardiac output, increased peripheral resistance, systolic BP
Respiratory: Decreased elasticity of chest wall, intercostals muscle strength, cough reflex,
increased anteroposterior diameter of chest, rigidity of lung tissue
Gastrointestinal: Decreased saliva production, GI motility, gastric acid production
Integumentary: Decreased skin elasticity, nail growth, increased dryness of skin, thinning of skin
layers, nail thickening, hair thinning
Genitourinary: Decreased glomerular filtration rate, blood flow to kidneys, bladder capacity,
vaginal lubrication, hardness of erection
Neurological: Decreased nerve cells, neurotransmitters, REM sleep, blood flow to CNS
Endocrine: Decreased insulin release, thyroid function, estrogen, and testosterone
Sensory: Decreased visual acuity (presbyopia, or impaired near vision) & depth perception,
tear production, pupil size, accommodation, acuity of smell & taste, hearing of high- frequency
sound, sense of balance changes in pain sensation, increased glare sensitivity, thickening of
lens of the eye, changes in pain sensation
Cognitive: Decreased short-term memory, increased reaction time, information processing time
Personality: Increased cautiousness, retirement, widowhood, grandparenthood
Leading Causes of Death
6 of the 7 leading causes of death are chronic diseases. These
are long-term illnesses that are rarely cured, but many can be
prevented or modified with healthy behavioral interventions.

1.Heart disease
2.Cancer
3.Chronic lower respiratory diseases
4.Stroke
5.Alzheimer’s disease
6.Diabetes mellitus
7.Accidents
8.Influenza and pneumonia
9.Nephritis, nephritic syndrome, nephrosis
10.Septicemia
 Alzheimer’s disease
– is the primary form & is considered progressive

– Increasing age is the greatest known risk factor for Alzheimer’s

disease.

– Most persons with the disease are older adults.

– The odds of developing Alzheimer’s disease doubles about

every 5 years after age 65.

– About half the adults age 85 and older have Alzheimer’s disease
 Other Health Problems of the Aging Adult
Polypharmacy
– the use of multiple medications, is a risk factor for acute confusion,
delirium, & depression in older adults.
Depression
– Medical problems can cause depression in older adults either
directly or as a psychological reaction to the illness.
– Any chronic medical condition, particularly if it is painful, disabling,
or life-threatening, can lead to depression or make depression
symptoms worse.
Ageism
– age-based discrimination
– Negative expectations for older adults can cloud nursing
assessments, planning, and interventions.
 Cognitive Development
– Reaction time slows in older adults, & short-
term memory declines
Normally, memory
declines; intelligence – it takes longer to respond to a stimulus
does not. – it takes more time to process incoming
information
Dementia
– older adults learn new material more slowly
– Common in 85+
group (about 50%) – there is no loss of intelligence as a person
– Not “normal” aging ages
– Alzheimer disease – Loss of short-term memory is more common
the primary form than loss of long-term memory

– older adults may remember incidents from

many years ago in vivid detail but may have
trouble recalling what they did earlier in the
day.
Dementia is irreversible, progressive decline in mental abilities
that affects about 1 in 5 of adults older than age 70.
It involves both memory impairments & a disturbance in at least
one other area of cognition such as the following:
Aphasia (loss of ability to communicate)
Apraxia (loss of ability to carry out purposeful movements)
Agnosia (impaired ability to recognize or identify objects). Can lead to
inability to recognize family members or even one's own reflection in
mirror
Disturbance in executive functioning (ability to organize, manage, make
decision)

Dementia makes it more & more difficult for the older adult to
remember things, think clearly, communicate w/ others, or take
care of himself.

Can cause mood swings & even change his/her personality &
behavior
 Assessment Specific
Young-old
•Daily routines, social interactions, and short- and long-term goals.
This helps determine the degree to which the person has adapted
to retirement.
•Level of fitness and the level of effort for physical activity. This
and the following point are essential to determine before
beginning a program of routine exercise.
•Chronic conditions: How a chronic condition affects pt’s ability to
do regular physical activities safely, and to what extent.
•Barriers to exercise
•Pt’s self-confidence in ability to maintain an exercise program
Analysis/Diagnosis: All Older Adults

– Frail Elderly Syndrome

– Risk for Frail Elderly Syndrome

– Nutrition Deficit: Less than Body Requirements

– Risk for Impaired Growth and Development

Outcomes/Evaluation: All Older Adults

– Maintain the person’s ability to function

independently for as long as possible.

– Arrange for appropriate care.

– Teach pts & caregivers how & when to call for

professional help.
 Interventions: Young-Old

Physical activity
It is also important to teach & help pt plan for physical exercise.
A sedentary lifestyle increases risk of aging-related diseases &
premature death.
DNA changes occur partly as a result of stress & oxidative
damage to cells.
By reducing stress, exercise may reduce some of these
oxidative changes & slow the aging process.
–Regular aerobic physical activity
–Muscle-strengthening activities
–Balance-promoting activities
–Adapted physical activities
Interventions: Interventions:
Middle-Old Oldest-Old

– Health crisis may lead to – Supportive environment

– Modified adapted activity
decreased functional
– walking, flexibility exercises, yoga,
ability tai chi, water aerobics
– Encouragement – Nutrition
– Whole grains, dark green & orange
– Support
vegetables & legumes, all types of
fruits & vegetables, & fat-free &
– Planned program of
low-fat dairy products are among
activity the food groups most needing
inclusion in this age group’s diet to
combat obesity & inactivity.
Housing for Older Adults
– Aging in place
– Elder-friendly residences
– Elder-friendly communities
– Naturally occurring retirement communities
– Retirement communities
– Continuing care retirement communities (CCRC)
– Assisted-living facilities
– Nursing homes
 Aging in place: Aging in place means  Retirement communities: Purchase of a home in
that as they age, persons live in their a retirement community usually includes services
own residences and receive supportive such as home maintenance and repair;
services for their changing needs, landscaping; snow, leaf, and trash removal; some
rather than moving to another location home utilities; security; home fire and theft
type of housing. insurance; recreational amenities, such as pool,
spa, walking track, and golf and tennis facilities;
 Elder-friendly residencies: and planned activities for an annual association
Accommodations have been made to fee.
the physical structures, such as wide
doorways, to allow for assistive devices  CCRC or life care communities: These
such as walkers and wheelchairs. communities offer a wide range of living
accommodations from residential living (cottages,
 Elder-friendly communities: Livable cluster homes, apartments), assisted living, skilled
communities (elder friendly) “actively nursing care, rehabilitation, and dementia care on
involve, value, and support older a large campus-like setting.
adults”.
 Assisted living facilities (ALFs): These are
 Naturally occurring retirement congregate residential settings that provide or
communities (NORC): When persons coordinate personal services, 24-hour supervision
“age in place” within a specific and assistance (scheduled and unscheduled),
apartment building or a activities, and health-related services. ALFs are
community/street of single-family not aging-in-place environments. State regulations
homes, that area is referred to as a and level of services preclude residents from
NORC. Persons within a NORC have staying in an ALF when their needs become
aged together. More often than not, they greater than the resources and services provided.
have, over the years, developed access
to services needed to maintain the  Nursing homes: These facilities provide skilled
highest quality of life for all within the and unskilled nursing care for older adults and
NORC. adults with disabilities.