Describe the characteristics of the aging process. Explain how some of the characteristics may lead to elder abuse (memory issues, vulnerability, etc.). Discuss the types of consideration a nurse must be mindful of while performing a health assessment on a geriatric patient as compared to a middle-aged adult.
Re: Topic 5 DQ 1
Characteristics of the aging process
As Green (2018) references in older adult physical assessments, we can expect some changes, but we should always research why the change is occurring. Wrinkled skin is common, but it could be because the patient is dehydrated which is a cause for concern. In addition, dementia is not considered a normal part of aging but can seem that many people in their later years have dementia of some sort.
Green (2018) uses a chart to differentiate between the normal and things that should cause concern; examples are:
Vital signs & appearance: normal range for any adult
- CONCERNS: hypertension, irregular heartbeat, sudden weight loss/gain
Integumentary: gray, thinning hair
- CONCERNS: bruising, irregular shaped moles, cut or abrasions
Head, Face, Neck: normal range of motion, hearing loss, teeth intact
- CONCERNS: pain with movement, asymmetry of eyes, difficulties swallowing/eating
Musculoskeletal: maintains gait, ROM in hands/fingers, very minimal difficulties doing ADLs, can do normal “chores” around the house
- CONCERN – loss of balance, poor coordination, atrophy, edema
What can lead to elder abuse (WHO, 2020)
Elder abuse can come in different forms like mental, physical, financial, and sexual abuse, plus neglect. While elder abuse is highly under-reported, it is a serious hazard.
- Financial – family members may be taking their family members money, house, car
- Physical – living in close quarters, stress levels can rise and lead to abuse
- Neglect – leaving a family member in dirty clothes, not providing adequate care or food, and over- and under medicating
Using dementia as an example, and having my father with the early onset, I see how hard it is for my family to have to cope with a new lifestyle. Things have changed and although we do not hit my father and he is able to still care for himself, we can get frustrated sometimes when he tells the same story for the 100th time; however, we try to gain patience and have coping strategies.
RN health assessment considerations on a geriatric patient vs middle-aged (differences): (Green, 2018)
· Sexual activity: protection, multiple partners?
· Any violence? Self-harm?
· Drugs/Alcohol abuse?
· Work hazards?
· Managing chronic conditions.
· Preforming ADLs?
· Driving? (Safety)
· End-of-life care.
· Cognitive assessment
· History (family/self)
There are many differences between middle and older aged patients, but it is important to conduct a head-to-toe assessment to find or compare to its baseline.
Green, S.Z. (2018). Health assessment: Foundations for effective practice. Retrieved from https://lc.gcumedia.com/nrs434vn/health-assessment-foundations-for-effective-practice/v1.1/
World Health Organization (WHO). (2020). Elder abuse. Retrieved from https://www.who.int/news-room/fact-sheets/detail/elder-abuse
Margodene Robinson 1 postsRe: Topic 5 DQ 1
Aging of a person is a universal and natural bio-psychological process, which is
characterized by gradualness, variability, and steady progression and affects, to one degree or
another, all levels of biological organization. Aging leads to a decrease in human vitality and
ultimately determines life expectancy. Outward signs of aging. With aging, the general size,
shape, and composition of the body, soft parts of the face, and integuments (skin and its
derivatives) change. The reduction in body length with aging is associated primarily with the
flattening of the intervertebral discs and an increase in a stoop, that is, the development of senile
kyphosis – the bending of the thoracic spine. The most pronounced increase in stoop after 65
years, but it can appear after 40 years, depending on the individual posture of the individual and
lifestyle. Bodyweight decreases markedly in old and senile age and especially in centenarians. At
the age of 36 to 60 years, for men, it is about 78.2 kg, for women – 66.2 kg; and at the age of 61–
74 years, it decreases to 66.5 and 60.6 kg, respectively. Age-related decrease in body weight in
men is more pronounced than in women. The exception is centenarians, where the difference is
insignificant. The amount of muscle tissue is greatest and relatively constant at the age of 20-30,
then it begins at first weak, and then it’s ever-increasing decrease, especially after 50 years. One
of the clear signs of aging is decreased muscle strength. Optimal grip strength in men and
women is achieved between the ages of 30 and 40. Its gradual decline begins in both sexes after
35 years, and by the age of 70–80, the strength indicators are approximately halved.
The topography of subcutaneous fat deposition changes, that is, its distribution in
different parts of the body. From the cheeks, fat masses move to the lower part of the face. The
cheekbones are sharper. Fat is collected on the chin and neck, deposited in the chest and
abdomen. Every “zone” of the organism is covered by aging: skin, hair, organs of movement.
Age-related changes in the neuroendocrine system, which plays a major role in the regulation of
metabolic processes and vital functions, are of leading importance in the aging of the whole
organism. The number of nerve cells – neurons – noticeably decreases from the age of 50-60. The
brain weight of men 20-30 years old is, on average, 1394 g, and at 90 years old – only 1161 g.
Age-related changes in human mental activity depend not only on universal biological processes
and individual (constitutional) characteristics or state of health. Social factors play an essential
role: the narrowing of the sphere of human activity and the resulting predominance of negative
emotions that accelerate aging, pessimism, sadness, passive or hostile life position. Of particular
importance are such objective circumstances as the loss of loved ones, fear of illness, loneliness,
poor financial situation, etc.
Elder abuse can be defined as any act or form of neglect that, in a relationship of trust,
causes pain or harm to an elder. The most common forms of abuse are physical violence,
psychological violence, and financial abuse. In many cases, victims experience more than one
form of abuse. It could be an isolated incident or repeated behavior. The person who mistreats an
elder is often in a position of power and influence over the elder. In some situations, abuse can
be related to addiction (drugs, alcohol, or gambling), mental health issues, family violence, or
ageism. The abuser can then seek to intimidate, isolate, dominate, or influence his victim. Often,
victims of abuse know the person who is abusing them. This could be a family member, a friend,
someone who sees to the basic needs of the senior or provides basic services, or a caregiver in a
facility. In many cases, the abuser depends on his victim for money, food, or shelter. Most
seniors who are abused are able to make their own decisions. However, anyone can be a victim
of abuse, regardless of their family situation or relationships, background, age, race, culture, or
ethnicity. Seniors are reluctant to say that they are being abused by someone they trust because
they feel ashamed or embarrassed. They may also fear retaliation or fear having to leave their
home or community. A sense of loyalty to the family may also explain their reluctance to break
the silence. It is also very often the case that seniors are unaware that there are people and
organizations that can help them.
The difficulties in recruiting health professionals particularly affect the geriatrics and
gerontology sector. This problem is situated in a more general context of a shortage of caregivers
observed and quantified for several years and whose causes are multifactorial. The aging of the
population and the increase in the number of old people, irreversible phenomena, are frightening.
While for a large number of people, the advance in age continues without major handicaps, the
representation of old age is generally associated with disabling deficits, which reinforce the
negative image conveyed by caregivers. We are witnessing a very subtle form of racism, which
results in a frequent mismatch between the needs of these people and the service offered.
The lack of attractiveness in this sector is not new in the old hospices, which received all
the infirm and incurable old men indifferently. The activity of professionals in geriatrics is
generally mentioned under the angle of constraints, and yet the satisfactions exist and feed the
motivations of those who know how to demonstrate their involvement in defense of this
discipline. Today the sectors of geriatrics and gerontology are structured and aim, among other
objectives, to improve the qualification of professionals. This development opens up prospects in
terms of both quality and quantity for the gerontology professions, for a permanent readjustment
of support for the elderly, a transversal mission common to all professionals regardless of the
place of practice. Medical and paramedical professions: caregiver, nurse, nursing manager,
geriatrician, physiotherapist, psychologist, psychomotor therapist, occupational therapist, speech
therapist. Social professions: social worker, medico-psychological aid, facilitator, social service
assistant. Specialized educators choose to practice in gerontology. Careers in the social sector,
whether in an institution or at home, relate more to the medico-social sector, but we find there, as
in the health sector, the medical and paramedical professions. If the question of motivations is at
stake for all the professions exercised in the gerontology sector, we will more particularly
mention the “just in time” professions: nurse, caregiver, a social worker.