complexity of aging - dartmouth-hitchcock · complexity of agingcomplexity of aging ... sexuality,...
TRANSCRIPT
11
Complexity of AgingComplexity of Aging
Justin Montgomery, RN – BCGeriatric Nurse Practice and Education Associate, DHMC
22
ObjectivesObjectives
•• Discuss demographic trends and graying Discuss demographic trends and graying of Americaof America
•• Discuss the concept of ageism as it relates Discuss the concept of ageism as it relates to a personal attitude about agingto a personal attitude about aging
•• Describe key quality of life issues with Describe key quality of life issues with aging including spirituality, sexuality, and aging including spirituality, sexuality, and successful components of successful agingsuccessful components of successful aging
44
Graying of AmericaGraying of AmericaOlder adults are 12.8% of U.S. populationOlder adults are 12.8% of U.S. populationBy 2030 20% of population (71 million)By 2030 20% of population (71 million)
●● Living longer Living longer -- 77.8 years77.8 years●● Predominately women (3 to 2)Predominately women (3 to 2)●● More racially and ethnically diverseMore racially and ethnically diverse
Sub categories of agingSub categories of agingYoung old = 65Young old = 65--75 years75 yearsOld Old oldold = 75= 75--85 years85 yearsOldest old = 85+ years Oldest old = 85+ years -- fastest growing fastest growing
Centers for Disease Control and Prevention and The Merck CompanyCenters for Disease Control and Prevention and The Merck CompanyFoundation. Foundation. The State of Aging and Health in America 2007The State of Aging and Health in America 2007. . Whitehouse Station, NJ: The Merck Company Foundation; 2007.Whitehouse Station, NJ: The Merck Company Foundation; 2007.
66
Changing DemographicsChanging Demographics
•• Life expectancy:Life expectancy:–– 1900: 47 years1900: 47 years–– 1990: 76 years1990: 76 years–– 2050: 82 years2050: 82 years
•• Life expectancy (# of years if you reach a Life expectancy (# of years if you reach a certain age):certain age):–– 65: another 17 years65: another 17 years–– 75: another 11 years75: another 11 years–– 85: another 6 years85: another 6 years
77
Demographic Change: The Demographic Change: The Population PillarPopulation Pillar
•• Martha Farnsworth Martha Farnsworth Riche, former Director Riche, former Director of the US Census of the US Census Bureau noted this Bureau noted this phenomenonphenomenon……
•• This has real This has real implications for a implications for a variety issues, variety issues, including health careincluding health care
88
Global AgingGlobal AgingNine emerging global trendsNine emerging global trends
1.1. Overall aging populationsOverall aging populations2.2. Increasing life expectancy Increasing life expectancy 3.3. Rising number of oldest old Rising number of oldest old 4.4. Chronic diseases are major cause of Chronic diseases are major cause of
deathdeath5.5. Some total populations will shrink Some total populations will shrink 6.6. Changing family structures Changing family structures 7.7. Shifting patterns of work & Shifting patterns of work &
retirement retirement 8.8. Changing social insurance systems Changing social insurance systems 9.9. New economic challengesNew economic challenges
2006:500 million older adults
2030:1 billion older adults
One in every 8 people
Most rapid increases are in developing
countries
99
Projected Increases in Global Population by Age
Source: United Nations Department of Economic and Social Affairs. Population Division. World Population Prospects.The 2004 Revision. New York: United Nations, 2005.
1010
Source: United Nations Department of Economic and Social Affairs. Population Division. World Population Prospects.The 2004 Revision. New York: United Nations, 2005.
Young Children and Older People As A Percentage of Global Population
20%
15%
10%
5%
1212
Majority of U.S. Healthcare is Majority of U.S. Healthcare is for Older Adultsfor Older Adults
57% of all visits to generalist physicians57% of all visits to generalist physicians50% of hospital expenditures 50% of hospital expenditures 80% of home care visits 80% of home care visits 90% of nursing home care90% of nursing home care
Health costs for older adults is 3Health costs for older adults is 3--5 times greater 5 times greater than costs for those < 65 years.than costs for those < 65 years.
By 2030, 70% of new nursing grads will be caring By 2030, 70% of new nursing grads will be caring for an older adult in every health care setting.for an older adult in every health care setting.
1313
Older Adults in HospitalsOlder Adults in HospitalsOf all adult patients, people Of all adult patients, people >>65 make up:65 make up:
•• 47% with anemia47% with anemia•• 64% with heart disease, 78% with CHF64% with heart disease, 78% with CHF•• 66% with urinary tract infections66% with urinary tract infections•• 70% with pneumonia70% with pneumonia•• 46% of CCU patients 46% of CCU patients •• 50% of ICU days50% of ICU days•• 60% of all visits to cardiologists60% of all visits to cardiologists•• 63% of all visits to oncologists63% of all visits to oncologistsDeFrancesDeFrances CJ, Hall MJ, CJ, Hall MJ, PodgornikPodgornik MN. 2003 National Hospital Discharge Survey. Advance data MN. 2003 National Hospital Discharge Survey. Advance data
from vital and health statistics, no. 359. Hyattsville, MD: US Dfrom vital and health statistics, no. 359. Hyattsville, MD: US Department of Health and epartment of Health and Human Services, CDC, National Center for Health Statistics; 2005Human Services, CDC, National Center for Health Statistics; 2005..
1414
Chronic Diseases and Chronic Diseases and ComorbidityComorbidity Are CommonAre CommonAbout 80% of older adults have at least one About 80% of older adults have at least one
chronic conditionchronic conditionThe average 75 yr old has 3 chronic diseases The average 75 yr old has 3 chronic diseases
and takes and takes >> 5 Rx medications.5 Rx medications.
ComorbidityComorbidity:: condition existing simultaneously condition existing simultaneously but independently with another condition but independently with another condition ((ExampleExample: patient who has CHF : patient who has CHF andandosteoarthritis)osteoarthritis)
The Silver Book: Chronic Disease and Medical Innovation in an AgThe Silver Book: Chronic Disease and Medical Innovation in an Aging Nation. ing Nation. Alliance for Aging Research.Alliance for Aging Research.
1515
Where do they live? Where do they live? Where do they live? California California >3.7 million (10.4%)>3.7 million (10.4%)FloridaFlorida 2.9 million (8.2%)2.9 million (8.2%)New YorkNew York 2.5 million (7.0%)2.5 million (7.0%)TexasTexas 2.2 million (6.2%)2.2 million (6.2%)PennsylvaniaPennsylvania 1.9 million (5.3%)1.9 million (5.3%)OhioOhio >1 million (3.1%)>1 million (3.1%)IllinoisIllinois >1 million (3.1%)>1 million (3.1%)MichiganMichigan >1 million (3.1%)>1 million (3.1%)New JerseyNew Jersey >1 million (3.1%)>1 million (3.1%)
Source: Profile of Older Americans, 2003 edition, AdministrationSource: Profile of Older Americans, 2003 edition, Administration on Aging, US on Aging, US Department of Health and Human ServicesDepartment of Health and Human Services
cqr2
Slide 15
cqr2 Source: Profile of Older Americans, 2003 edition, Administration on Aging, US Department of Health and Human ServicesConchita Rader, 8/6/2004
1616
PhewwwPhewww……
““Sounds like Florida and California are going Sounds like Florida and California are going to have their hands full!to have their hands full!””
““II’’m sure glad Im sure glad I’’m nurse in Northern New m nurse in Northern New England!England!””
1717
Northern New EnglandNorthern New England
•• Leads the nation in the rate that the Leads the nation in the rate that the median age of the population is increasingmedian age of the population is increasing–– Vermont: is the fastest aging state & 2Vermont: is the fastest aging state & 2ndnd in in
median agemedian age–– Maine: 3Maine: 3rdrd fastest aging state & 1fastest aging state & 1stst in median in median
ageage–– New Hampshire: tied with Florida as 4New Hampshire: tied with Florida as 4thth
fastest aging state & 7fastest aging state & 7thth in median agein median age
1818
Well at leastWell at least……
““Our rural and hardy Northern New Our rural and hardy Northern New Englanders are in better shape to handle Englanders are in better shape to handle aging with minimal disabilitiesaging with minimal disabilities””
““Clean mountain air and shoveling snow Clean mountain air and shoveling snow ought to helpought to help…”…”
1919
Regional Health Status IndicatorsRegional Health Status Indicators
•• The leading cause and rate of death from heart The leading cause and rate of death from heart disease and chronic illness mirror national trendsdisease and chronic illness mirror national trends
•• Older adults in NH and VT report: Older adults in NH and VT report: –– NH: No physical activity in past month (68%), lack NH: No physical activity in past month (68%), lack
regular exercise (85%), high cholesterol (46%), regular exercise (85%), high cholesterol (46%), diabetes (15%), hypertension (52%), and overweight diabetes (15%), hypertension (52%), and overweight (54%)(54%)
–– VT: No physical activity in past month (69%), lack VT: No physical activity in past month (69%), lack regular exercise (83%), high cholesterol (46%), regular exercise (83%), high cholesterol (46%), diabetes (14%), hypertension (51%), and overweight diabetes (14%), hypertension (51%), and overweight (61%)(61%)
2020
Stats, data, #Stats, data, #’’s s ““oh myoh my””
•• What does all this data tell us?What does all this data tell us?–– Not only will we continue to get older, but the Not only will we continue to get older, but the
older will continue to get olderolder will continue to get older–– The older population has a high degree of The older population has a high degree of
heterogeneityheterogeneity–– We are not ready for this reality We are not ready for this reality –– aging in aging in
America is difficultAmerica is difficult–– Why?Why?
2121
Complete This PhraseComplete This Phrase……
•• ““I will be old whenI will be old when…”…”–– How will you know you are old How will you know you are old –– when when
will you be part of the tidal wave?will you be part of the tidal wave?–– What images come to mind as you What images come to mind as you
picture yourself oldpicture yourself old–– Name one thing that could happen to Name one thing that could happen to
you that will make you you that will make you ““feelfeel”” oldold
2222
More ImportantlyMore Importantly
•• How did you feel when you thought about How did you feel when you thought about ““being old?being old?””
•• Did you get excited?Did you get excited?•• Why do you think things are the way they Why do you think things are the way they
are when we think of the elderly and are when we think of the elderly and aging?aging?
•• Why does this matter?Why does this matter?
2323
Ageism : the prejudice, stereotyping, and scapegoating of people based solely on age.
Ageism : the prejudice, Ageism : the prejudice, stereotyping, and stereotyping, and scapegoatingscapegoating of of people based solely on age.people based solely on age.
• Fear of death
• Emphasis on youth culture
• Decline of productivity and economic potential
• Research only examines negative stereotypes of old age
• Nursing’s view of care of the elderly – follows culture
•• Fear of deathFear of death
•• Emphasis on youth cultureEmphasis on youth culture
•• Decline of productivity and Decline of productivity and economic potential economic potential
•• Research only examines negative Research only examines negative stereotypes of old agestereotypes of old age
•• NursingNursing’’s view of care of the s view of care of the elderly elderly –– follows culturefollows culture
“OVER the Hill”
“fuddy-duddy”
cqr1
2424
Myths about aging….Myths about agingMyths about aging……..
•“To be old is to be sick.”
•“You can’t teach an old dog new tricks.”
•“The secret to successful aging is to choose your parents wisely.”
•“Older people don’t pull their own weight.”
••““To be old is to be sick.To be old is to be sick.””
••““You canYou can’’t teach an old dog new tricks.t teach an old dog new tricks.””
••““The secret to successful aging is to The secret to successful aging is to choose your parents wisely.choose your parents wisely.””
••““Older people donOlder people don’’t pull their own weight.t pull their own weight.””
2525
IndividualityIndividuality
• “If you’ve seen one old person……you’ve seen one old person.” John Rowe M.D.
2626
Quality of Life (QOL)Quality of Life (QOL)
““Referring to an overall sense of wellReferring to an overall sense of well--being with a being with a strong relation to a person's health perceptions strong relation to a person's health perceptions and ability to functionand ability to function…”…”
CDC, 2006CDC, 2006
““A scientific measure of personal wellA scientific measure of personal well--beingbeing””Mirapex.comMirapex.com, accessed 2007, accessed 2007
What components of your day to day life makes What components of your day to day life makes up your sense of wellup your sense of well--being?being?
2727
Issues affecting QOLIssues affecting QOL
•• FunctionFunction–– Physical activityPhysical activity–– IndependenceIndependence
•• ConnectednessConnectedness–– SocialSocial–– IntellectualIntellectual
–– MacArthur Foundation Study of AgingMacArthur Foundation Study of Aging
2828
SpiritualitySpiritualitySpirituality
• Spirituality vs. religion– Purpose and meaning in life vs. organized
groups
• Research– Connection between faith and health– 82% believe prayer assists healing– 75% use religious beliefs as a means of
coping– 63% want doctors to ask about spirituality
•• Spirituality vs. religionSpirituality vs. religion–– Purpose and meaning in life vs. organized Purpose and meaning in life vs. organized
groupsgroups
•• ResearchResearch–– Connection between faith and healthConnection between faith and health–– 82% believe prayer assists healing82% believe prayer assists healing–– 75% use religious beliefs as a means of 75% use religious beliefs as a means of
copingcoping–– 63% want doctors to ask about spirituality63% want doctors to ask about spirituality
2929
Credit Where Credit is DueCredit Where Credit is Due
•• Andrew Weil, M.D. Andrew Weil, M.D. Healthy AgingHealthy Aging p 227p 227““Despite all the evidence to the contrary, some part Despite all the evidence to the contrary, some part
of me feels the same as it always has since my of me feels the same as it always has since my earliest memories of childhood. Obviously, that is earliest memories of childhood. Obviously, that is not my body, which now looks and feels different not my body, which now looks and feels different from what it was ten years ago, let alone fifty. from what it was ten years ago, let alone fifty. Nor can it be my mind, which has learned so much Nor can it be my mind, which has learned so much and stored so much experience in more then half a and stored so much experience in more then half a century. I call it the unchanging essence: that century. I call it the unchanging essence: that part of the self that is unaffected by time.part of the self that is unaffected by time.””
3030
Unchanging EssenceUnchanging Essence
““I always think that II always think that I’’m still this 13m still this 13--year old year old boy that doesnboy that doesn’’t really know how to be an t really know how to be an adult, pretending to live my life, taking adult, pretending to live my life, taking notes for when Inotes for when I’’ll really have to do it.ll really have to do it.””
““Before SunriseBefore Sunrise”” Ethan HawkeEthan HawkeTaken from Taken from ““Maturity and AgingMaturity and Aging””
3131
Spiritual AssessmentSpiritual AssessmentSpiritual Assessment– Instruments
• Stoddard’s spiritual assessment instrument– Spiritual Interventions
• Acknowledge role of religion and spirituality• Inquire about religious or spiritual beliefs and
practices• Refer to clergy• Provide spiritual counseling• Pray for or with the patient
–– InstrumentsInstruments•• StoddardStoddard’’s spiritual assessment instruments spiritual assessment instrument
–– Spiritual InterventionsSpiritual Interventions•• Acknowledge role of religion and spiritualityAcknowledge role of religion and spirituality•• Inquire about religious or spiritual beliefs and Inquire about religious or spiritual beliefs and
practicespractices•• Refer to clergyRefer to clergy•• Provide spiritual counselingProvide spiritual counseling•• Pray for or with the patientPray for or with the patient
3232
Your Unchanging EssenceYour Unchanging Essence
•• Ask yourselfAsk yourself……–– What gives my life meaning?What gives my life meaning?–– For what am I grateful?For what am I grateful?–– What have I learned of love and how well What have I learned of love and how well
have I learned to lovehave I learned to love–– What will give me strength as I die? What is What will give me strength as I die? What is
my relationship with that which will give me my relationship with that which will give me strength?strength?
–– Who am I?Who am I?
3333
Myths about sexualityMyths about sexualityMyths about sexuality
• “Sexual desires diminish with age”• Issues/facts:
• Little available information / attention to older adults’ sexuality
• sexual patterns persist throughout their lives• Societal view restricts the sexuality of older
adults• Staff discomfort about sexual expression
among older adults – regarded as behavioral problem
•• ““Sexual desires diminish with ageSexual desires diminish with age””•• Issues/facts:Issues/facts:
•• Little available information / attention to older Little available information / attention to older adultsadults’’ sexuality sexuality
•• sexual patterns persist throughout their livessexual patterns persist throughout their lives
•• Societal view restricts the sexuality of older Societal view restricts the sexuality of older adultsadults
•• Staff discomfort about sexual expression Staff discomfort about sexual expression among older adults among older adults –– regarded as behavioral regarded as behavioral problemproblem
3434
Myths about sexualityMyths about sexualityMyths about sexuality
• “Sexual intercourse is mainly a younger person’s activity for the purpose of procreation”
• Issues/facts• Older adults need to touch and be
touched• Older adults may have difficulty accepting
and understanding sexuality• Health care professionals do not facilitate
expression of sexuality
•• ““Sexual intercourse is mainly a younger Sexual intercourse is mainly a younger personperson’’s activity for the purpose of s activity for the purpose of procreationprocreation””
•• Issues/factsIssues/facts•• Older adults need to touch and be Older adults need to touch and be
touchedtouched•• Older adults may have difficulty accepting Older adults may have difficulty accepting
and understanding sexualityand understanding sexuality•• Health care professionals do not facilitate Health care professionals do not facilitate
expression of sexualityexpression of sexuality
3535
Sexuality: changesSexuality: changesSexuality: changes
Hormones• Lack of testosterone in men (male
menopause)
• Lack of estrogen, progesterone and androgen in women
HormonesHormones•• Lack of testosterone in men (male Lack of testosterone in men (male
menopause)menopause)
•• Lack of estrogen, progesterone and Lack of estrogen, progesterone and androgen in womenandrogen in women
3636
Sexuality: changesSexuality: changesSexuality: changesPhysiological Changes
• Male: increased time for erection and ejaculation, lower semen volume, longer period between ejaculations; fatigue, loss of muscle mass, depression, and decline in libido
• Female: follicular depletion in ovaries, fewer and shortened orgasmic contraction, labium atrophy, shortened orgasmic phase, dyspareunia; breast tissue replaced with fatty tissue
Physiological ChangesPhysiological Changes•• MaleMale: increased time for erection and : increased time for erection and
ejaculation, lower semen volume, longer ejaculation, lower semen volume, longer period between ejaculations; fatigue, loss of period between ejaculations; fatigue, loss of muscle mass, depression, and decline in muscle mass, depression, and decline in libidolibido
•• FemaleFemale: follicular depletion in ovaries, fewer : follicular depletion in ovaries, fewer and shortened orgasmic contraction, labium and shortened orgasmic contraction, labium atrophy, shortened orgasmic phase, atrophy, shortened orgasmic phase, dyspareuniadyspareunia; breast tissue replaced with fatty ; breast tissue replaced with fatty tissuetissue
3737
SexualitySexualitySexualitySexual Problems
• Medical Conditions: cardiac problems, diabetes, neurological disorders, arthritis
• Medications and treatments may interfere with sexual response
• 50% of older males have erectile impotence
• Clients > 60 with AIDS has increased
Sexual ProblemsSexual Problems•• Medical Conditions: cardiac Medical Conditions: cardiac
problems, diabetes, neurological problems, diabetes, neurological disorders, arthritisdisorders, arthritis
•• Medications and treatments may Medications and treatments may interfere with sexual responseinterfere with sexual response
•• 50% of older males have erectile 50% of older males have erectile impotenceimpotence
•• Clients > 60 with AIDS has increasedClients > 60 with AIDS has increased
3838
Assessing SexualityAssessing Sexuality
•• Can you tell me how you express your sexuality?Can you tell me how you express your sexuality?
•• What concerns or questions do you have about What concerns or questions do you have about fulfilling your continuing sexual needs?fulfilling your continuing sexual needs?
•• In what ways has your sexual relationship with In what ways has your sexual relationship with your partner changed as you have aged?your partner changed as you have aged?
•• What interventions or information can I provide What interventions or information can I provide to help you to fulfill your sexuality?to help you to fulfill your sexuality?
3939
SummarySummary
• Graying of America• Ageism• Myths• Successful, creative aging• Spirituality and assessment• Sexuality: myths, issues, and normal
changes
•• Graying of AmericaGraying of America•• AgeismAgeism•• MythsMyths•• Successful, creative agingSuccessful, creative aging•• Spirituality and assessmentSpirituality and assessment•• Sexuality: myths, issues, and normal Sexuality: myths, issues, and normal
changeschanges