What assists them in offering spiritual support to patients

Chapter 4

Psychosocial, Spiritual, and Cognitive Aspects of Aging

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  • Early theories were attempts to explain and predict the changes in middle and late life with an emphasis on adjustment
  • Adjustment was seen as an indication of success
  • Based primarily on “face validity”
  • Major first-generation theories
  • Role
  • Activity

Psychosocial Aging Theories

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  • The ideal of life is to remain as active as possible
  • Activity is possible when living in a stable society
  • The older person has
  • Access to positive influences and significant others
  • Opportunities to participate in the broader society if he or she chooses to

Activity Theory

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  • Disengagement
  • Continuity
  • Age stratification
  • Social exchange
  • Modernization
  • Developmental
  • Gerotranscendence

Second-Generation Theories

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    • In the natural course of aging the person does, and should, slowly withdraw from society to allow the transfer of power to the younger generations
    • This is necessary for the maintenance of social equilibrium
    • Provided the basis of age discrimination
    • An elder’s withdrawal is no longer an indicator of successful aging

 

Disengagement Theory

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  • People develop and maintain a consistent pattern of behavior over a lifetime
  • Aging reflects a continuation of the patterns of roles, responsibilities, and activities
  • Successful aging is associated with one’s ability to maintain and continue previous behaviors and roles or to find suitable replacements

Continuity Theory

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  • Believes in age categories of older adults as young, middle aged, and old
  • Historical content is the key to the age-stratification theory
  • Social and cultural expressions of age are examined

Age-Stratification Theory

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  • As one ages, one has fewer and fewer economic resources to contribute to the society, resulting in loss of social status, self-esteem, and political power
  • Only those who are able to maintain control of their financial resources have the potential to remain fully participating members of society and anticipate successful aging

Social Exchange Theory

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  • Value in older adults is lost when their skills are no longer considered useful
  • Is due to technology, urbanization, and mass education
  • Modernization has had a notable effect on cultures such as those in China and Japan

Modernization Theory

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  • Erikson’s hierarchy presents predetermined order of developmental stages and tasks
  • Erikson’s last stage of life is to look back and reflect (ego integrity or despair)
  • Successfully completing this phase means looking back with few regrets and a general feeling of satisfaction

Developmental Theories

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  • Aging is an ever-evolving process that alters one’s view of reality, sense of spirituality, and meaning beyond the self
  • The person withdraws from society to give time for self-reflection and contemplation
  • Wisdom is achieved through personal transformation, and transcendence is a marker of successful aging

Gerotranscendence

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A 75-year-old patient has remained unmarried and childless. She shares with you that she feels her life has little meaning and no one cares if she lives or dies. She wishes she had made different choices so that she was now not alone. The issue the patient needs to resolve is

premature disengagement.

ego integrity versus despair.

inability to provide continuity.

overinvolvement in gerotranscendence.

 

Question

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  • C—During ego integrity versus despair, people reflect back on the lives they have lived and come away with either a sense of fulfillment from a life well lived or a sense of regret and despair over a life misspent.

Answer

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  • The life story
  • Reminiscing
  • Any recall of the past
  • Provides a pleasurable experience, increases socialization, provides cognitive stimulation, improves communication, facilitates personal growth, and can decrease depression scores
  • Life review
  • A formal therapy technique than reminiscence
  • Takes a person through his or her life in a structured and chronological order

Third-Generation Theories

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    • Provide the gerontological nurse with useful information and a background for enhancing healthy aging and adaptation
    • Nurses have a unique opportunity to use multiple approaches to understanding aging and coming to know the person in uniqueness
    • Nurses have a voice in testing, modifying, and discussing psychosocial theories and frameworks and how they apply to worldwide diversity

 

Implications for Gerontological Nursing and Healthy Aging

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A nurse caring for an 80-year-old patient would like to use reminiscence as therapy. Which question best encourages reminiscence?

What is your favorite food?

How many children do you have?

Does your religion provide you comfort?

What are some of your favorite childhood memories?

Question

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  • D—Asking to the patient to recall past events in an open-ended manner best encourages the older adult to relive life experiences.

Answer

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  • Spirituality is a broader concept than religion
  • It encompasses a person’s values or beliefs; search for meaning; and relationships with a higher power, with nature, and with other people
  • As people age and move closer to death, spirituality may become more important
  • Spiritual belief and practices play a central role in helping older adults cope with life challenges and are a strength in the lives of older adults

Spirituality and Aging

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  • An individual’s perception of hurt associated with the part of his or her person that seeks to transcend the realm of the material
  • May be manifested by anger, guilt, blame, hatred, expressions of alienation, turning away from family and friends, inability to derive pleasure, and inability to participate in religious activities

Spiritual Distress

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  • Using evidence-based guidelines for promoting spirituality provides a framework for spiritual assessment and interventions
  • Older adults want nurses to address spiritual needs
  • Spiritual assessments include FICA (Faith, Importance or Influence, Community, and Address) and the Brief Assessment of Spiritual Resources and Concerns
  • The Joint Commission requires spiritual assessments in hospitals, nursing homes, and any care setting for older adults

Implications for Gerontological Nursing and Healthy Aging

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  • Nurses must consider
  • What gives their own life meaning and value
  • What assists them in offering spiritual support to patients
  • Taking care of nurses’ own spiritual needs help them to better meet the patient’s spiritual needs

Nurturing the Spirit of the Nurse

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  • Cognition is the process of acquiring, storing, sharing, and using information
  • Its components include language, thought process, memory, execution of function, judgment, attention, and perception
  • Cognition can remain stable or decline with aging

Cognition and Aging

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  • Fluid intelligence consists of skills that are biologically determined and independent of experience or learning
  • Crystallized intelligence is the knowledge and abilities acquired through education and life
  • Older people perform more poorly on performance scales (fluid intelligence), but scores on verbal scales (crystallized intelligence) remain stable.

Fluid and Crystalized Intelligence

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  • The ability to retain and store information and thus retrieve the information when needed
  • Immediate memory
  • Short-term memory
  • Long-term memory
  • Familiarity, previous learning, and life experiences can compensate for memory loss
  • Age-associated memory impairment (AAMI) is memory loss that is considered normal in light of person’s age and educational level

Memory

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  • Paying attention to cognitive health is just as important as attention to physical and emotional health
  • Nurses need to educate people about strategies to enhance cognitive health and brain plasticity
  • Following a healthy diet
  • Participating in physical activities
  • Participating in stimulating activities
  • Being social

Implications for Gerontological Nursing and Healthy Aging (Cont.)

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  • Must be relevant information
  • New learning must relate to what the older person already knows
  • Literacy level and cultural variations play a role
  • Many older adults have computers and make up the fastest growing age group who owns them

Learning Late in Life

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  • Share resources available for older adults who want to learn computer skills and adaptations that can be made to make computers as user-friendly as possible
  • Teach patients how to evaluate the reliability and validity of health information on the Internet

Implications for Gerontological Nursing and Healthy Aging (Cont.)

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