Lesson 2B Implementation of Nursing Care of The Older Adult Psychosocial Care of Older Adult

COLLEGE OF HEALTH AND ALLIED PROFESSIONALS
NCM 114- GERONTOLOGY NURSING

LESSON GUIDE
LESSON 2B
Implementation of Nursing Care of the Older Adult
Psychosocial Care of Older Adults

Quality of life and successful aging are two central concepts in assessment and
care of older adults. Broadly speaking, quality of life encompasses all areas of everyday life:
environmental and material components as well as physical, mental, and social well-being
(Fletcher, Dickinson, & Philp, 1992).
Quality of life among older adults is highly individualistic, subjective, and
multidimensional in scope. With respect to what constitutes quality of life, what is
important to one person may be quite unimportant to another. Related to quality of life is the
concept of successful aging. Long associated with community living, successful aging has
traditionally been linked with physical health, independence, functional ability, and longevity.
However, other elements such as engagement in social life, self-mastery, optimism,
personal meaning in life, and attainment of goals have been suggested as vital to the idea of
successful aging (Reker, Peacock, & Wong, 1987; Rowe & Kahn, 1997). Elements of
successful aging can include self-acceptance, positive relationships with others, and
personal growth. A broad conceptualization of successful aging means broad applicability to
older adults with varying abilities and disabilities. If we can go beyond the idea of physical
health as the primary criterion for successful aging, then we can remove the labeling of frail
older adults as being “unsuccessful” in their aging (Guse & Masesar, 1999).
At the end of our discussion today, let us:
1. Identify the major areas to consider the Psychosocial Health of the Older Adult
2. Draw Implications of the concepts to better understand aging
3. Utilize the Concepts as we consider care on the Psychosocial aspect of the aging
process
I.PERCEPTION, COGNITION & LIFE ENGAGEMENT

Perception is the ability to capture, process, and actively make sense of the information that
our senses receive. It is the cognitive process that makes it possible to interpret our
surroundings with the stimuli that we receive throughout sensory organs.
Cognitive change as a normal process of aging has been well documented in the scientific
literature. Some cognitive abilities, such as vocabulary, are resilient to brain aging and may
even improve with age. Other abilities, such as conceptual reasoning, memory, and
processing speed, decline gradually over time.
Hearing
 Peripheral hearing sensitivity, as measured by the audiogram, is impaired in
around a third of 61–70 year olds
 Ageing can also affect suprathreshold auditory processing
LESSON GUIDE
Vision also declines in old age

 Hardening of the lens leads to presbyopia, which makes it more difficult to
focus on near objects.
 As well as age-related eye diseases such as cataracts, glaucoma and
macular degeneration, healthy ageing is linked to a thickening and yellowing
of the lens (Said and Weale, 1959; Ruddock, 1965).
 Ageing is also associated with changes in color perception (Page and
Crognale, 2005),
Old age also brings decline in a number of cognitive abilities, including working
memory, memory, attention, and executive control (Schaie, 1996; Hedden and
Gabrieli, 2004).
There is clear evidence for a link between perception and cognition in
old age, in terms of both their impact on task performance and their age-
related decline. While there are clearly common and general factors acting on both
sensory and cognitive decline, there also appears to be a more direct link between
impaired perception and cognitive decline. Degraded input leads to a higher load on
cognition, reducing resources available for cognitive processing. It has been
proposed that, over time, this sensory deprivation leads to cognitive decline
Perception and Cognition in the Ageing Brain: A Brief Review of the Short- and Long-Term Links
between Perceptual and Cognitive Decline Katherine L. Roberts 1 * and Harriet A. Allen2 1
Department of Psychology, University of Warwick, Coventry
DEMENTIA
Dementia is a general term that refers to progressive, degenerative brain dysfunction,
including deterioration in memory, concentration, language skills, visuospatial skills, and reasoning,
that interferes with a person’s daily functioning. Although dementia is much more common in older
adults than in younger persons, it is not considered a normal part of aging. The most common type
of dementia (see Box 10-2) is Alzheimer’s disease (AD), named after Dr. Alois Alzheimer, who first
described the condition about 100 years ago. AD did not begin to be commonly diagnosed and
systemically studied until the 1970s (Alzheimer’s Association, 2016). The most recent edition of the
Diagnostic and Statistical Manual for Mental Disorders (DSM-V) classified AD as one type of major
neurocognitive disorder, and this term is often used by mental health care providers (American
Psychiatric Association, 2013).
LESSON GUIDE
Researchers have tended to explain declines in social engagement with advancing

age in terms of either ageing-related changes in resources, or social motivation
(Windsor et al. 2011).
They acknowledge that shrinking networks in later life are in part due to the loss of
network members that occurs through the death of family and friends, and also focus
on how declining health and mobility (including restricted access to private and
public transport) can adversely affect social activity (e.g. Pinquart 2003).
Cognitive health is also likely to be an important resource in driving levels of social
activity engagement in older adulthood.
It is also likely that normal and pathological cognitive ageing curtails social
engagement. For example, dementia (particularly Alzheimer’s disease) is preceded
by a long pre-clinical phase characterised by milder cognitive deficits believed to
reduce capacity around activities of daily living as well as precipitating withdrawal
from social and leisure activities (Stoykova et al. 2011).
LESSON GUIDE
II. SELF PERCEPTION & SELF CONCEPT

 SELF PERCEPTION ( SELF EFFICACY) a person's view of his or her self or of any of
the mental or physical attributes that constitute the self.
 SELF CONCEPT an idea of the self constructed from the beliefs one holds about
oneself and the responses of others
 Self-concept is a more complex construct than self-efficacy. While self-

efficacy refers to an individual’s judgments of their own abilities, self-
concept is more general and includes both cognitive (thoughts about) and
affective (feelings about) judgments about oneself (Bong & Clark, 1999)
https://positivepsychology.com/ .
Influence of the Self-Perception of Old Age on the Effect of a Healthy Aging

Program Víctor Manuel Mendoza-Núñez 1,*, Elia Sarmiento-Salmorán 1, Regulo
Marín-Cortés 2, María de la Luz Martínez-Maldonado 1 and Mirna Ruiz-Ramos
findings support the benefit of health promotion in changing attitudes held by

the elderly towards old age and health self-care and self-recognition
relationship between positive self-perception and the improved scores of self-
efficacy of care for health, self-esteem, nutrition, sleep hygiene and health. In
contrast, negative self-perceptions of aging after intervention correlated
III. COPING & STRESS

According to Evans (1984)
 old age and that their occurrence causally increases the prevalence of illness
in old age.
 elderly population encounters these and other loss events, resolution of life
events may be hampered by their relative social status in relation to younger
age groups.
 Dowd (1980) has argued that declining resources in old age entails
negotiating from weakness at a time when resources are exchanged for less
than they would be for a younger person.
While the potentially adverse consequences of stress are universal and apply across
the lifespan, there are at least several reasons why elderly persons are particularly
vulnerable.
 Diminishing Resources
 Powerlessness in the elderly.
LESSON GUIDE
 Social pressures
 Ageing immune system
Stress, Coping & Ageing by Bernard Lau, 1994
SPIRITUALITY
Spirituality encompasses but is not limited to religiosity (Barnum, 2011; Touhy & Jett,
2014).
Spirituality is highly personal, whereas religions involves organizational ties (Barnum,
2011). -
“In planning holistic nursing care; thus, it is important to consider all dimensions of
the concept perceived by the older client. Shelly and Miller, in their book Called to
Care: A Christian Worldview for Nursing (2006), caution that “the spiritual world is
not neutral” (p. 97). By putting this term in full context, the nurse will gain a better
understanding of spirituality in view of (1) the client’s relationship with himself or
herself (intrapersonal), (2) the client’s relationship with others (interpersonal), and (3)
the client’s relationship with another higher entity greater than himself or herself
(transpersonal).
 In the first spiritual dimension, the focus is on the individual and how that
individual feels about and relates to himself as a human being.
 In the second dimension of spirituality, the individual references core
values and uses them as standards to guide behaviors and relationships
with other people.
 In the third dimension of spirituality, the view is broadened to focus on the
relationship between the individual and a greater entity or power (God,
Deity, Allah, Mother-Earth, Nature, etc.), a higher other. this third dimension
relies strongly on the individual’s faith and confidence in self within the context
of a “bigger picture” that transcends life on earth as we know it, viewing life
purpose in an even larger context (Koenig, 2006).
SEXUALITY
Sexuality in older age is influenced by numerous physiological changes that occur as
part of the ageing process in both men and women, as well as by multiple
psychosocial and socioenvironmental factors (56).
Because older age is also a period of increased risk of disease, these underlying
changes will often be complicated by the need to deal with diseases that may have
physical effects on sexual function.
LESSON GUIDE
Thus, a recent survey of middle-aged and older people in 29 countries identified the
most common dysfunctions among women
 as a lack of sexual interest (21%),

 inability to reach orgasm (16%) and
 lubrication difficulties (16%) (58).
Among men, the most common dysfunctions appeared to be
 difficulty in achieving or maintaining an erection (37%),

 lack of interest in sex (28%),
 climaxing too quickly (28%),
 anxiety about performance (27%) and
 an inability to climax (20%).
PSYCHOSOCIAL CARE IDENTIFY KEY AREAS ON HEALTH PROMOTION &
EDUCATION
 LIFE 
ENGAGEMENT IN
PERPETION&
COGNITION
ABILITIES
 SELF 
PERCEPTION
 SELF CONCEPT
 SPIRITUALITY 
 STRESS & 
COPING
 SEXUALITY 
What I How
What
need to can I do
What I else do I
do with it and
know? need to
what i do it
know?
know? well?

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COLLEGE OF HEALTH AND ALLIED PROFESSIONALS

NCM 114- GERONTOLOGY NURSING

Psychosocial Care of Older Adults

I.PERCEPTION, COGNITION & LIFE ENGAGEMENT

Vision also declines in old age

Researchers have tended to explain declines in social engagement with advancing

II. SELF PERCEPTION & SELF CONCEPT

 Self-concept is a more complex construct than self-efficacy. While self-

Influence of the Self-Perception of Old Age on the Effect of a Healthy Aging

findings support the benefit of health promotion in changing attitudes held by

III. COPING & STRESS

 as a lack of sexual interest (21%),

 difficulty in achieving or maintaining an erection (37%),

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