theories of aging there are many theories of aging. it is important to understand some theories of...
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DESCRIPTIONPsychological Theories Maslow Human Needs Five basic needs Erickson’s Personality Life stages relate to life tasks Grossman and Lange, 2006 We are all familiar with Maslow’s hierarchy of needs which include 1.physiologic needs 2. safety and security 3. love/belonging 4. self-esteem 5. self-actualization. For the aging population it is suggested that the order may be changed to honor the person’s wishes at different times relating to health. It is important for all persons involved in the care of the elderly person to understand that different needs are more important at different times. Erickson’s Personality theory focuses on development of the individual person. The elderly person can go through a stage that is described as “ego integrity vs despair”. In this stage, the person evaluates the accomplishments of their life – people who were satisfied with their achievements tended have a greater sense of contentment than those who were not.
THEORIES OF AGING There are many theories of aging. It is important to understand some theories of aging as they relate to taking care of the elderly. Psychological Theories
Maslow Human Needs Five basic needs Ericksons Personality Life stages relate to life tasks Grossman and Lange, 2006 We are all familiar with Maslows hierarchy of needs which include1.physiologic needs 2. safety and security 3. love/belonging 4. self-esteem 5. self-actualization.For the aging population it is suggested that the order may be changed to honor the persons wishes at different times relating to health.It is important for all persons involved in the care of the elderly person to understand that different needs are more important at different times.Ericksons Personality theory focuses on development of the individual person.The elderly person can go through a stage that is described as ego integrity vs despair. In this stage, the person evaluates the accomplishments of their life people who were satisfied with their achievements tended have a greater sense of contentment than those who were not. Social Theories Based on social order, balance and harmony
Activity Theory Necessary for satisfaction with life Disengagement theory Natural process Gradual withdrawal The social theory is believed to have been founded after the second world war when society felt people had certain positions in society.Balance and harmony was maintained by preserving the social order.Two theories were developed from this basis.Self- identity, which is similar to Ericksons life stages theory, states that people must move through the stages of their life.The focus is that the person must remain active to counteract the aging process and maintain a healthy life style. While social participation is essential to a healthy aging process, decreased functional or cognitive status can impact involvement. Being aware of limitations and learning alternative activities would be important to facilitate social participation at the level of involvement a person can achieve.The disengagement theory beliefs are based on evidence that the older person gradually with draws from events in their life first from society and then from family before death.Some believe that this theory allows for other family members to take over the duties that the older person used to perform.As workers in the health care field, it is important to recognize how one begins to withdraw and support the person as well as their loved one through this time. Phelan, 2010 Biological Theories Non-stochastic Stochastic Predicted damage
Random damage Grossman and Lange, 2006 Two biological theories are stated above. The non-stochastic (stowkastic) theory is that all people age it happens over time and is predictable. Stochastic theory believes events that occur during a persons lifetime cause random damage and leads to aging.Some people believe that both of these theories are correct to a certain point, for instance one can have co-morbidities such as heart disease or diabetes which cause their body to deteriorate over time and maybe at a faster rate but a healthy person can suddenly age when in their 70s. Ageism stereotypical, dehumanizing, negative constructions (Phelan, 2010) Three domains Cognitive Beliefs and stereotypes Affective prejudice Behavioral Direct discriminatory practices Indirect discriminatory practices Phelan, 2010 We must touch on ageism which is typically viewed as prejudice or stereotyping of older adults.Phelans definition as stated above is stereotypical, dehumanizing, negative constructions.The three domains are listed above.Cognitive beliefs are that youth or youthfulness are more valued. Affective domain is the prejudicial attitudes towards the aging for example an elderly person is viewed as a burden to society.Behavioral can be direct or indirect such as avoiding to care for the elderly. This can also be seen as a fatalistic attitude in which one believes because the person is old, he or she doesnt deserve the best care. As health care professionals, it is important that we recognize our own feelings about the aging population to process our own thoughts and feelings and to provide the best care for our patients. Assessment of Geriatric Needs
health history physical assessment laboratory studies radiological testing functional assessment of activities of daily living cognitive assessment skin assessment social assessment financial assessment The first step in caring for any person, especially an elder, would be a thorough assessment that includes health history as well as a physical assessment including laboratory studies and radiological testing as needed. Included would also be a functional assessment of activities of daily living, a cognitive assessment and a skin assessment Many tools have been developed to help assess risks of the elderly. A few are listed above. Social and financial assessments are also important. A holistic nursing assessment includes nursing knowledge, skills and experience coupled with listening, observing, measuring, interpreting and recording the data collected about the elders biological, psychological, social and spiritual needs. RISK ASSESSMENT TOOLS needs assessment fall risk assessment
pressure ulcer assessment pain assessment nutritional screening Toofany, S. 2007 An assessment specific to risks that the elderly population face is also important.Included in the needs assessment is the assessment of the home situation as well as any financial needs.The rest of the assessment tools are self explanatory. SPICES S is for Sleep Disorders
P is for Problems with Eating or Feeding I is for Incontinence C is for Confusion E is for Evidence of Falls S is for Skin Breakdown Fulmer, M A quick assessment tool with an acronym for easy recall would be the SPICES assessment found at the Hartford web site. This tool is focused on assessing the elderly population for issues that are common to them. Research Study Geriatric Workforce Enhancement Program
Train the trainer Basic course Advanced course Outcomes Participants impacted change Barba and Fay (2009) The Geriatric Workforceenhancement project was a train the trainer program designed to train nurses in geriatrics so they could take the information back to their workplace and teach others.The basic course focused on age related changes, common health problems and other issues of the aging population.The advanced course was designed to help nurses who wished to seek a certification in geriatrics.The outcomes of this program showed that nurses felt more confident taking care of the geriatric population and helped staff to make changes that impacted quality of care for the patients and their families. Research Study Gerontological Enrichment Program
Risk factors for hospitalization Adverse functional outcomes Normal consequence of aging Error in professional intervention Environmental factors Goals: Improve care improve knowledge Support Conference attendance Journal readings Presentations Parke, Ross, and Moss (2003) This literature study showed how older adults are at risk when hospitalized. This hospital identified risk factors for the older population which included functional decline (presumed from decreased activity), med errors, erroneous use of meds, adverse reactions to meds or treatments, risk of infections. The goals were to improve outcomes of the older patient, decrease risks associated with hospitalization and improve knowledge of the staff taking care of the elderly patient.At the end of the study, support was given to continue the education of the staff by providing opportunities for conference attendance, time to study journals and providing on-going training for new staff at orientations. Gerontological Clinical Nursing Research Study
Student insight: enhanced knowledge confidence in identifying differences betweennormal aging and illness conditions, cognitive changes, functional independence, common health challenges improvements in ability to engage w/older adults, stronger communication skills encouraged focus on attitudes about the aging population more holistic approach less task oriented increased understanding of transition, loss, grief, vulnerability improved outlook on comfort care and spirituality Staff Nurses insights: impressed with knowledge of student nurse ability to provide holistic assessment students were able to effect change on unit Dahlke and Fehr (2010) In this study, student nurses learned about caring for older adults in multiple units that were designed to meet the needs of the elderly population.Some of the reasons this program was developed included:student nurses were learning from seasoned nurses who lacked formal gerontological nursing education and identification of ageism. Both the students and the staff on the units provided some insight to the benefits of this program as shown above. NICHE NICHE stands for Nurses Improving Care for HealthSystem Elders
GIAP Tools Provided to the hospitals included: Staff development tools Nursing care models Research-based clinicals Boltz, Capezuti, Bowar-Ferres, Norman, Secic, Kim, Fairchild, Mezey, and Fulmer 2008 This study involved 8 hospitals where NICHE provided the hospital with tools to make the environment more responsive to the needs of the geriatric population. The study first measured nurses knowledge through use of a survey entitled Geriatric Institutional Assessment Profile.After the institution of tools, as listed above, nursing care of the geriatric population improved but knowledge itself did not. Interpretation of information
Quality geriatric care is: evidenced based ensures best practices includes a holistic assessment individualized to patient needs promotes patient decision making It is important to have nurses trained in geriatrics that are aware of the special needs this patient population has.Knowledge of how this patient population responds