Open Resources for Nursing (Open RN)
Ageism
Gerontology is the study of the social, cultural, psychological, cognitive, and biological aspects of aging. There are many stereotypes and negative attitudes about aging adults that persist in the US and around the world. This bias can be linked to a general lack of knowledge about the aging process and misunderstandings about older adults. Because of these influences, many individuals have anxiety about aging that can lead to negative stereotypes of older individuals. This is known as ageism, which is the stereotyping and discrimination against individuals or groups on the basis of their age.[1]
Ageism among nurses and other health care professionals puts older people at risk. Research has demonstrated that ageism in health care negatively impacts older adults’ overall health, well-being, and quality of care received. Ageism results in increased risks of mortality, poor functional health, and slower recovery times from illness. Negative perceptions about aging can also lead to poor mental health and depression.[2] As you read this chapter, think about your own attitudes about aging and how these beliefs may impact the care you provide.
Read more at “What is Ageism in Healthcare and What Can We Do About It?” by GoodRx Health.
Integrity Versus Despair
Aging individuals must continually adjust to changes in health and physical strength, lifestyle changes as a result of retirement, the loss of significant others, and changing roles and relationships with family members and friends. As a result, older individuals may find it difficult to accept the changes associated with aging. Nurses can support older adults in maintaining a positive self-image and outlook by considering Erikson’s theory of development. Erikson’s theory of development describes the stage of older adulthood as “Integrity versus Despair.” This stage begins at approximately age 65 and ends at death. During this stage, older adults reflect on their accomplishments and the person they have become. If they feel they have led a successful life, they often feel satisfied and develop a sense of integrity. Conversely, individuals who feel unsuccessful or do not feel they achieved their life goals often feel unsatisfied and may experience hopelessness and despair that can lead to depression. Nurses can assist older adults in developing a sense of integrity by encouraging the client to reminiscence about previous positive life events and relationships and cultivate a positive mindset of guiding the next generation.[3]
Many older adults, especially those with declining health due to chronic disease, acknowledge that changes in their health status and mobility threaten the autonomy and independence they previously experienced throughout adulthood. As a result, many older adults strive to be autonomous, so they are not overly reliant on others for their daily care. They often engage in self-management activities in response to changes in their health and physical strength, ranging from simple daily tasks, such as medication management, to more complex tasks, such as relocating to new residences that are better suited to their changes in physical and mental health. Research has found that when older adults are faced with declines in their physical health and/or cognitive abilities, they often draw upon experiences and skills acquired in earlier adulthood for the purpose of self-managing their new conditions. They reflect on their resilience used to overcome significant challenges faced in earlier adulthood and then apply skills and knowledge gained through previously productive activities to managing their new health changes. However, not all older adults have sufficient personal and external resources to devote towards successful self-management of their health conditions. Nurses can assist older adults by personalizing health self-management strategies that emphasize their existing skill sets and knowledge.[4]
Other Considerations
Retirement
In addition to the physiological changes that occur with aging, older adults vary in their level of activity. For example, many older adults continue working into their seventies and beyond. Individuals may choose to continue to work because of their sense of purpose or because of a need for income. Some older individuals experience a loss of identity when they retire because their work role was an important aspect of their life. Retirement can bring a sense of freedom and adventure, as well as a need to find new identity and purpose.
Social Isolation
Retirement and the loss of daily interaction with coworkers, as well as death of family members and friends, can lead to social isolation in the aging population. Social support impacts a person’s health and quality of life and should be included as part of the assessment. It is helpful for nurses to be familiar with community resources that provide socialization opportunities and provide referrals for clients in need of additional services.
Modified Living Environment
Although many aging adults live in assisted living facilities or skilled nursing centers, many older adults prefer to live at home. Modifications may be needed to the home environment to promote safety and independence. For example, grab bars, elevated toilet seats, and other modifications may be needed in the bathroom, along with good lighting, minimization of clutter, and removal of rugs throughout the home. Assessment of the home environment for safety and ease of mobility is an important aspect of home care nursing.
If an older adult requires more care than family members are able to provide at home, nurses provide valuable information about available care options and make referrals to social workers and case managers. There are a wide variety of community-based resources to enhance care for older adults. Local aging and disability resource centers (ADRCs) can help facilitate referrals based on specific needs of the older adult. Examples of other resources include adult day centers, home health agencies that provide in-home personal care and nursing services, community-based residential facilities (CBRFs), and residential care apartment complexes (RCACs). If an older adult requires 24-hour nursing care, placement in a nursing home (also referred to as a skilled nursing facility) may be required. Use the following box to read more information about nursing home resources provided by the Centers for Medicare and Medicaid (CMS).
Learn more about nursing home resources by reviewing the Nursing Home Resource Center provided by the Centers for Medicare and Medicaid (CMS).
- Merz, C. C., Stark, S. L., Morrow-Howell, N. L., & Carpenter, B. D. (2016). When I'm 64: Effects of an interdisciplinary gerontology course on first-year undergraduates' perceptions of aging. Gerontology & Geriatrics Education, 39(1), 35-45. https://doi.org/10.1080/02701960.2016.1144600 ↵
- Burnes, D., Sheppard, C., Henderson, C. R., Wassel, M., Cope, R., Barber, C., & Pillemer, K. (2019). Interventions to reduce ageism against older adults: A systematic review and meta-analysis. American Journal of Public Health, 109(8), e1-e9. https://doi.org/10.2105/AJPH.2019.305123 ↵
- This work is a derivative of StatPearls by Orenstein and Lewis and is licensed under CC BY 4.0 ↵
- Perry, T. E., Ruggiano, N., Shtompel, N., & Hassevoort, L. (2014). Applying Erikson's wisdom to self-management practices of older adults: Findings from two field studies. Research on Aging, 37(3), 253-274. https://doi.org/10.1177/0164027514527974 ↵
Learning Activities
(Answers to "Learning Activities" can be found in the "Answer Key" at the end of the book. Answers to interactive activity elements will be provided within the element as immediate feedback.)
Scenario A
You are a nurse providing care for Mrs. Lyn, a 47-year-old client admitted with metastatic lung cancer receiving hospice care. The client's condition has declined significantly over the past week; she is actively dying. Over the last 24 hours, Mrs. Lyn has declined rapidly and is now unresponsive but appears to be resting comfortably. You enter the client's room and find Mr. Lyn weeping at the client's bedside.
- What actions would you take to comfort Mr. Lyn?
- Mrs. Lyn develops labored breathing. What medication is helpful to administer to treat dyspnea at end of life?
- Mrs. Lyn's breathing becomes less labored with medication, but her respiratory rate becomes irregular. Mr. Lyn tells the nurse, "My daughter lives six hours away and would like to be here when the time comes. How much longer does she have to live?" What is the nurse's best response?
- The daughter arrives and seems hesitant to talk to or touch her mother. What tasks can the nurse coach family members to do at the end of a client's life?
- Mrs. Lyn dies the following evening. What postmortem care should the nurse provide?
Scenario B
Terry, a 42-year-old male client, was recently diagnosed with advanced colon cancer and underwent a colon resection a few days ago. While changing his colostomy bag, he comments to the nurse, “I still can’t believe this is happening to me.”
- According to Kubler-Ross’ theory of grief/loss, what stage of grief is Terry currently experiencing?
- The nurse responds, “This is a difficult time for you.” Terry replies, “Yes, it is. My parents want me to do every kind of experimental treatment possible, but I just want to live my life until the time comes.” The nurse asks, “You have some tough decisions to make. Has anyone talked to you about palliative care yet?” Terry asks, “I’ve never heard of palliative care. What is it?” How would you explain palliative care to him?
- Terry states, “I don’t want my parents telling my doctor what to do. It is my decision.” The nurse asks, “Do you have any advance directives in place?” Terry responds, “What are advance directives?” How would you explain advance directives to Terry?
- The nurse identifies “Grieving related to anticipatory loss as evidenced by disbelief and feeling of shock” as a nursing diagnosis for Terry. Identify a SMART outcome.
- The nurse plans interventions to enhance Terry’s coping. List sample nursing interventions that may help Terry to cope with this new diagnosis.
Test your knowledge using this NCLEX Next Generation-style bowtie question. You may reset and resubmit your answers to this question an unlimited number of times.[1]
