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3 Aging - Lecture notes 12
Nursing Process Ii (Broward College)
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Aging
If over the age of 65 in this society you’re considered old
In the 1800s they lived to be 47 yrs old.
In 1900s people died of TB, and pneumonia, and diarrhea
In 2004, people died of heart disease, stroke and cancer.
- Heart Disease is going down now.
If a woman can live to be 65, usually, they’ll live 3 years longer than their male counterpart that made it to
65, why?
In Hong Kong - 81, Switzerland - 80, Florida - 78. In other major cities they’re not living quite as long.
Turned out adopted children has same risk factor for cancer as their adoptive parents did. Not their biological
parents. It’s how we’re living that may be the key to longevity. The survivors are going to require most of our
care.
In the 1950s, lifestyle change. We play less, and we sleep less. When you sleep, you start restoring and
repairing so we’re giving ourselves less time to do that. Chronic stress shrinks the hippocampus (which is
responsible for short term memory). If you slice the brain transverse, that’s the hippocampus, it looks like
a butterfly.
Young old-60-74
Middle old75-84
Old 85 and above
Genetic-explain that life span depend on genetics
Wear and Tear-explain that organism wear out from increased metabolic function
Elderly people use a lot of prescription drugs
Aging is not the same as disease
Old People have increase of adverse effects from drugs
Chronic health problems cause independence
Make a list for seniors to stay healthy:
1) Keep blood sugar low – too many carbs is not a good idea
2) Keep blood pressure down – less than 115/75. For a test question, go with the book.
- For every 20 points more on systolic, the person is more likely to have a heart attack
- For every 10 points over diastolic, person more likely to have heart attack.
3) Keep LDL number down. (60-180)
4) For men 45- HDL. Women 55-HDL, b/c women have more fat tissue
5) You want the person not to smoke – 2nd hand smoke is prob too
6) Drink less – what’s ok? 12 ounces of beer/day. 5 ounces of wine/day, distilled spirits – 1.5 ounces/day.
- For men, 2 drinks are ok of these measurements.
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- For women, just one.
- Why the difference? There’s an enzyme in the digestive system of men, that women don’t – so men
can break it down better than the female.
7) Keep the weight down. Originally the monkeys we fed less came up with less cancer, heart problems,
living longer.
- 2100 calories for female.
- 2400 calories for men.
- 2000 is the best. Less is better.
- The reason is we really don’t need it. The core of our structure is prehistoric man. In those days, the
tiger didn’t pass the cage that frequently. That’s why we enjoy fats, sweets, etc. If the tiger
chased us
it would help us run. If it caught us, the salt would help us to stop bleeding. Keep the
weight down, and have fewer calories.
8) Eat 5-7 fruits and vegetables a day. The roughage will help you feel full. That doesn’t leave room for
other things you don’t need.
9) You need to exercise regularly (everyday is really good – 20 min a day, if you can go 30, that’s even better).
You can go 10 min. morn, afternoon, and night too. Why? Skeletal muscles help break down the
glucose. Muscle tone will support bone structure, and help maintain nutritional status you’re
looking for b/c you don’t want them with all that sugar in the system. It messes up the vessels. If
body keeps getting hit with sugar, pancreas can’t handle it, and they’ll get type 2 diabetes
10) Take a multivitamin. People who lived longer - Most of them started taking it over the age of 40.
11) They need to sleep 6-8 hrs. 8 is better. When you have a holiday, and you get out your alarm clock
for three days. That last day how many hours you slept, is actually how many you need.
When’s the best time to take a nap? Best time between 1-3 b/c melatonins starts to rise in the body,
and that makes you sleepy and you don’t want to mess up that level.
- In the seniors, their rem sleep cycle is a little less. But they haven’t found any consequences to that.
13) They need to keep their minds challenged. As the brains ages, the dendrites, and synapses change a bit.
If they haven’t learned to play chess, maybe they should learn. Join a group and learn some
new dance steps. They need to stay positive, look for something positive to say.
14) They need to stay social. Stay positive.
15) They need to keep oral health in check – your brain sits on top of oral cavity, you don’t want to wind
up with something systemic going there.
60-74 = Yound Old
75-84 = Middle Old
85 and above = Old Old
Characteristics of old people. (People start naming gray hair, short, and miserable) – exhibiting Ageism.
They could be spiffy, walking at a good clip. Skin could look decent. They may not have wrinkles. Their
situation is not synonymous with any diseases. A two year old can run. A 9 month old kid can’t run –
there’s nothing wrong with him. The changes in their body isn’t disease it’s just what happens
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Most of them don’t need assistance. 90% of them are independent. Living longer b/c of medical
technology, surgical procedures, drugs, ppl are aware of healthier lifestyle.
The baby boomers (1946-1964). There is going to be less money to take care of all these people. There are
3.4 workers contributing to that pot, by 2030, there will only be 2 workers or less there. There will be less
workers contributing to the pot.
For instance, the brain shrinks a little bit. It’s not Alzheimer’s, it’s normal. It’s not causing any
difficulty. Then take a young person who just had a car accident. That means if you’re older, their
brain actually has more room to swell up in the skull. – compared to their younger counterpart. If you
send the senior home vs the younger person, they’re not going to show complications until later
b/c their brain had more room.
Kidneys
- if you give them a strong antibiotic, you’ll shut kidneys down. They can’t filter something that heavy.
The systems that can really cross the line are the :
- Cardiovascular system (Hypertension, Coronary Artery Disease)
- Skeletal system (Osteoarthritis, Osteosclerosus)
- Skin (they didn’t really use sunscreen, so they might be coming up with skin cancers; basal cell ones)
Theories of Aging
- There’s a genetic clock (predetermined amount of cells; biological factors contribute to that.) and you’ll just
use them up.
- Wear and tear theory – like a copy machine, the more you use it, it’ll wear out a little bit
- Free radical ions (Holding The Most Weight) – when body creates energy, a byproduct is free electrons;
those electrons are looking to hook up with something. – The ions want to complete outer shell of
electrons, which can be that radical ion looking to hook up with someone. Oxidation is when a substance is
up an electron. The problem with that is the donor starts to exhibit wear. People who agree with this
theory will take antioxidants, they say – don’t worry about taking that cell over there, come hook up with
me.
Free Radicals can be from
Pituitary gland
- In chronic stress – Pituitary is getting tapped – releases ATCH – that taps adrenal glands – that activates
cortisone. (Helps with fight or flight) – this will cause memory issues, will start shrinkage. In
seniors, there is a higher cortisone level going on, unless their lifestyle can change it to some
degree.
SKIN
- Wrinkles
-Atrophy of fat
- Slow recoil
- Nerve receptors aren’t what they used to be.
- b/c subq fat is decreasing, they want to have a sweater on. As nurses, how does that affect the medicine
we’ll be giving them? That means if we put a patch on them, it’ll go into system quicker b/c there’s
less fat there. So you may have to change the dosage.
- Decreased sweat glands
- Decreased oil glands (wash with mild soaps (super fated soap) that have moisturizers in them) due to
that, elderlies should not bath daily. Skin is very dry, itchy, and scaly
- Pigmentation (age spots that are kemoral deposits)
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- They can get skin tags (chains/jewelry can get caught up in there)
- Acitinic Ketosis (exposure to the sun will increase this)
- Nails get thicker and grow slower
- Lose hair follicles. (Guys may start to lose hair under arms and pubic area. Women as well, but as women
lose estrogen, their testosterone level goes a little bit higher, and they may start to grow a
mustache. Research says that 3-4 cps of spearmint tea starts to compete for the testosterone
receptor and short circuits that situation. By age 50 hair follicle drop by 1/3
- Melanin in the skin starts to decline, which is why your hair gets gray.
- The capillaries have become very very fragile, so they can bleed easier. You have to be careful about how
you move senior around the hospital, b/c of that. Some of the drugs they take, will also contribute
to that where the side effects affect the capillaries.
-chemicals pass though skin more easily
-decrease ability to tolerate heat
EYES
- Arcus senilis-lipid around iris
- Lens starts to get a little cloudy – that yellowing of the eye causes (the colors blue and green will
become more difficult to see). Our street signs are green with white writing. So if you’re giving a
presentation to them, don’t use a green or blue marker.
- Cataracts is a clouding of the lens. If you’ll take glasses and put vasoline on it, that’s what happens. The only
thing after surgery that will happen is the light would bother you b/c the iris had to learn to work again.
- Presbyopia (is far sightedness) as they get older they get more far sightedness b/c the eye shape
changes. Due to decreased in elacticity
- Myopia (near sightedness) affect younger people. eye is elongated, the rays come IN FRONT of the retina,
but as they get older, that Elongated shape of the eye fills out a little bit, and they become FAR SIGHTED
(Presbyopia). SO they say before I was near sighted, and now I’m far sighted. And that is true.
-yellowing of lens
Less ability to accommodate to darkness
EARS
- Otosclerosis (the bone in the ear that looks like stirrup – if that has a problem with atrophy, you’ll get
hearing probs.) Genetically there are some things where even in a younger person that bone can
start to have some atrophy, but in the general population you see it happen later. They might need
a hearing aid, or they can put an artificial stirrup in there to get back the conductivity.
-happen mostly in white male
- Presbycusis – hearing loss due to changes in inner ear and a thickening of the ear drum.. Hearing loss usually
happens in left ear first. The sound that goes first, is the high pitch, so you don’t have to yell at
them. Whisper words in the person’s ear from the “shush” sounds first. Like church, shoe, etc…..
MOUTH AND NOSE
- Medicare in some states does not include money for preventative dental work. But you need to go
once every 6 months to get cleaned.
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- Some meds can dry mouth or make sensitive to gum bleeding. Dilantin can have hypertrophy of the gums.
Anticoagulants can have bleeding issues. If they’re on Antibiotics, look at the tongue to see if they’ve
gotten rid of the good bacteria too. We inadvertently took away some of normal flora.
- Some baby boomers will have worn enamel. They can have vertical cracks. Elongated tooth necks, gums
have receded. The drills they had when they were younger they weren’t as advanced as they are
now, when they drilled a cavity they had a crater filled with mercury. Maybe that filling has shifted
in time.
- Taste buds can decline some – mouth wash in hospital doesn’t have alcohol in it b/c mouth can get dry.
- Be sure to feel the lymph nodes if the person is having a
toothache? Alitosis, decrease salivation, dry mouyh
REPIRATORY SYSTEM
Loss of elasticity around alveoli sac , pt will take shallow frequent breath
- With emphysema, alveoli have lost some of that elasticity. When they go to blow out, some of that CO2
stays with them, and they could get respiratory acidosis. That could happen with a senior with no
disease process, just a little more wear and tear on the alveoli. We’ll probably need some blood
gases. Alveoli can also become thicker, and it will lessen their ability to diffuse oxygen. After surgery,
you’re concerned about what the anesthetic did to them, work with them to take the deep breaths
b/c of muscle tone may not be as easy to take the deep breath vs. a young person.
CARDIOVASCULAR
Decreased stroke volume
Decreased cardiac output—drop by 1% every year after age 30
Arteries become calcified
- Arteriosclerosis (arteries lost elasticity), - Atherosclerosis (vessel has plaque) – both decrease circulation.
You can have changes in myocardium; tissue there can become more fibrous. Your
hope is
they weren’t loading up on ice cream, but it can make them more prone to arrhythmias.
- Peripheral arteries – check those pulses. If you don’t feel any, you need to let your instructor
know. Drop in tissue perfusion
Increase peripheral resistance—increase bp
Intermited
Weak peripheral pulse
Decrease in circulation causes the hand and feet to fell cooler
MUSCLE
Osteoporosis-loss of bone tissue due to demineralization
Make pt more vulnerable to fracture
- Osteoclasts = reabsorption of bone
- Osteoblasts = formation of new bone
- There’s usually both going on in balance. When that balance starts to shift, you can have:
- Osteopenia – reabsorption is starting to exceed the formation (cycle is becoming a little unbalanced) – you
would take a bone density test., usually people about 50 yrs old start taking the test (both men and
women).
1200-1500 mg is good for calcium. Also take some Vitamin D with it.
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- Side effect of calcium is indigestion (gassy and bloated) – calcium citrate, and calcium carbonate doesn’t
annoy the people as much with the gassy feeling. You must take a tablet with vitamin D so it can be absorbed.
Calcium with vitamin D should be taken to prevent osteoporosis
- When they get osteoporosis, process is so disturbed, bone is spongy and more susceptible to bone
breaks, and they’re more likely to come up with a broken bone.
- Exercise is important. Lifting weights like a two pounder. Walking is very best exercise.
NEUROLOGICAL
Brain l
At 80, u lose 7% of brain mass
- Short term memory is sensitive to hypoxia. At middle age we lose a small percent of the brain cells due to
decrease in blood flow and a decrease in the O2, which leads to a decrease in the reaction time in
the nerves conductivities. At middle age we begin to lose a small percentage of brain cells due to a
decrease in blood flow and O2. Lessens reaction time due to decrease in nerves conductivity..
- They can have heart attack with no chest pain, or appendicitis with no pain, and pneumonia with no fever
b/c those nerves are responsible for sending off that impulse for pain. If the other thing with temp.
if you get temp of 95 in the morning, you should be concerned with 99 in afternoon. It’s a sufficient
jump. Their healing is a little slower, the movement of those cells to get to the healing processes is
a challenge.
67 year old man calls for help b/c he fell while trying to get up from a chair. He tells you he’s had strong
pains in his back for about an hour. He tries to get up, but his legs were too weak to do that. They feel a
little numb to him. They would not work. Now the pain is even worse in the back. His wife thinks he broke
his back. He cannot move his legs, so he thinks he’s had a stroke. He had a high blood pressure for 15 years
and has taken medicine for it. He smokes 2 packs a day. Has an enormous stomach. And his Dr told him he
has poor circulation in the legs. His BP is 102/60, P is 120. R is 18. He’s alert, coherent. PERRLA. His legs
are beginning to look a little mottled (color is getting a little blue). Lung sounds clear.
- Check for bruit in the abdomen. Check the aorta. If he has abdominal aneurysms, the
pressure from that will give him back pain. B/c of the cutoff there, you won’t get peripheral
pulses.
- If you’ve got a lot of cortisone going on, high levels. If the level is going to stress, will there be enough for
the immune system? Maybe not. So that’s how you get that immune difficulty.
Compensatory Mechanisms
Elderly pt have lower temperature due to decrease
BMR Temp of 99.5 can represent a fever
Delayed wound healing
GASTROINTESTINAL
- Everything slows down.
Decrease in nutrient absorption
- Diverticulosis problems first (if they’re not taking roughage, and they’re not drinking water, then the fecal
material may stay in that chamber longer, and they’re not evacuating it – and a consequence of that is that
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they could have some out-pouching in the intestines from the pressure of that material staying in there
longer. That happens in the later adult years. If by some chance it becomes inflamed, that leads to
Diverticulitis.
- Lots of time people that just have fruits and vegetables added to their system; their Diverticulosis will
not become problematic.
- At age 50 Dr. may do colonoscopy every 5 years. Frequency may increase to every 3 or 4 years if they
found any polyps. They grow slowly, if they snip it out, it doesn’t turn into a cancerous growth.
- Nutrition: Make a triangle
- on the bottom line: Exercise, Less alcohol, Take Vitamins, Eat less calories.
- 2nd line: Whole grain, plant oils, olive oil
- 3rd line: Colorful Fruits and vegetables,
- 4th line: Poultry, eggs, fish (bigger the fish, more chances of mercury) – fish is good b/c it’s
easier to digest. Digestive system has muscle – and if they’re not what they used to
be, fish
may be easier to eat. If they’re vegetarians, they’ll need beans and stuff to get
protein.
- 5th line: Dairy products or calcium substitutes
- 6th line: Refined carbs (sugar, white carbs) and Red Meat
- Things towards the top, person should be taking less often.
- To see if someone is border malnourished. You need to check their albumin (norm values 2.8-3.2) means
borderline or mild malnourished. If they’ve had some denture or teeth issues, it may also contribute to
them being malnourished.
URINARY
Drug toxicity is due to decrease glomerular filtration or creatine clearance of 50% or below.
Urie tested for urine may be negative even with high blood sugar
As little as 200ml of urine can lead to frequency
Decreased Kidney Size, Decreased Bladder capacity, muscle tone decrease, bladder tone decrease
all contribute to urinary retention.
30-80 kidney function lowers by 50%
- If Bowman’s capsule is not filtering out that well, the BUN is not filtering that well, you’ll get an increased
BUN level.
- Be careful about Creatinine. Muscles make creatinine. So if that muscle tone is not quite what it used to
be, you already have a lower number for the creatinine. So if you’re comparing them to their
younger counterpart, and you’re looking for that number to rise, it’s already low. So, if you’re going
by the same yard stick as a younger person, you’ll be off target b/c it’s already low.
- Prostate (Prostatic Specific Antigen) – (PSA) test – a number above 10mg/mL – there’s a question about
what’s going on. The test can be misconstrued easily. They shouldn’t be running test if person had
ejaculation 2days before, they also shouldn’t have done a digital rectal exam right before the blood
- draw either b/c that will give them a false reading.
If u put a foley in elderly pt with prostate enlargement and meet rersistant, just pause when it relaxes you can
continue.
If they had prostate cancer, there are three possibilities how it grows
1) Latent; there’s no harm will come to the person; they’d get hit by a bus beforehand to kill them.
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2) Progressive, if untreated they could meet their death.
3) Aggressive, even with interventions, it spreads and metastasis where their demise comes quickly.
- But they can’t determine this by just one reading; they’ll need more tests to decide.
Reproduction
- Does older men have same sexual libido? Yes.
-sexual phase
- For women
Decrease hormonal production
Breast change, fat will replace
tissue Decrease in vaginal
lubrication Clitoris and vagina shrink
Increase risk for breast cancer, years ago they used to just put them on hormone replacement with estrogen.
- Now do we do that? No. They can’t be on hormone replacement therapy forever. If they started in
their late 50s, it’s time to stop it in their middle 60s. Because It’s putting too much estrogen in their
system. Women will have issues with gall bladder, heart attacks, pulmonary emboli, and they
weren’t having breast cancer because of it, but they were diagnosing the breast cancer later – b/c
the changes the hormones were making in their breast tissue was making the tissue not respond
well on x-rays, so they were catching the tumors later vs. earlier. The more estrogen a woman has
floating around in their system.
- Realize for all signs and symptoms of menopause they can treat the symptoms. The found that
wearing cotton as opposed to nylon, it breathes better. Ice water can kind of short circuit the
hot flashes.
- Ask them male/female about their health. What concerns do you have? In what way has your sexual
relationship with your partner changed? What interventions or information can I provide to help you
with
your sexual feelings? Some of the people before and during baby boomers weren’t spoken to about sex.
Even buying Kotex was like a
private thing. When they were in their prime and they were choosing
their partners, the only real venereal disease was syphilis – they’re not thinking about all the stuff younger
people have to think about today. So if they’ve lost their partner and now they’re out dating, they might
need some updating. Sometimes the practitioners are younger, and for the woman who’s going through
menopause and dryer – is there anything over the counter they can use for that? Some of the names are
more disturbing like “Astroglide”.
- As you get atrophy over the vagina, that area is not able to produce Lactobacillus, which is like an acidy
content, and bacteria does not like an acid environment so it makes the women LESS able to fight off
some infections. The main culprit would be E. coli.
- So practice good hygiene.
- AIDS is on the rise with senior citizens, and other STDs
Male—testes decrease in size but does not affect fertility
-erection is slower to achieve but last longer
BRAIN
Cognitive ability does not change much with aging
Person still continues to learn and personality and intelligence remain consistent
St memory may be affected but long term remain intact
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Serious mmental impairement
Dementia-a variety of organically disorder
Onset is slow and often heated by pt or family
Degeneration of brain tissue that is irriversable and cannot be cured.
Various situations can give rise to dementia. It can be vascular, it can be from another disease
(Parkinson’s, alcoholism), and we’re getting better at able to diagnose it. Those vascular issues
To make a long story short about the care:
(Not going to test us on the nursing care we need to give to these people)
Alzheimers - this isn’t a little shrinkage at the synapse; this is a problem with the neurons
1 – Early Onset - Regular Adult/No Cognitive Deficit
2 – Early Onset – Mild Forgetfulness
3 – Early Onset – Pt not able to handle something too heavy
4 – Moderate - An 8 yr old to an adolescent; person would have trouble balancing their bank book
5 - Moderate – 5 to 7 yrs old
6 - Severe – 48 month old person
7 - Severe – 15 month old
After 7-15 years they need supervision
With these pts. do passive range of motion exercises. Give them human contact. Sometimes in LTC
facilities, they’ll get a group of them together and have them touch each other’s’ hands with lotion to get
the human contact going.
So think about what you’d do for a 5 yr old, or 8 yr old? If it comes to a point where memory isn’t coming
back
– VALIDATION is important – just say, “Tell me about your husband. What was his name? Where did you
live?
What state? For some reason, that was on their mind, so you validate the journey.
When they start to deteriorate, families keep journals and pictures so they can validate their lives.
Receptive aphasia – person is having trouble with the information coming in.
Expressive apashia – info comes in, but you can’t communicate it out
Global aphasia. – Both combined
Type of organic brain syndrome-Delirium is different than
Alzheimer’s/Dementia. We were talking about compensatory mechanisms.
– Pt. could have UTI, and you might not notice it until it got really bad and then got septic. Then
systemic. The clue is if they were fine yesterday, or fine last night, and this morning they’re
as
loony
as the mad hatter. If you can find out where problem is, rectify it, that delirium will go
away. It’s
reversible.
Dementia is NOT reversible.
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- The main culprit in many situations is too many meds. So, if you’re taking three meds that do
the same thing, just make it one, so their body has less to filter out.
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- If you’re looking at creatinine levels and they’re really off, they may need to titrate dose of medicine down.
B/c system cannot titrate heavy duty drug.
- Suspect a UTI, they’ll be a urinalysis. – Suspect a respiratory problem; listen to the lungs. - Any
probs with elimination? Maybe they’re a diabetic. Changes in environment? Some of these things
can be turned around.
Due to agism doctors does not always treat depression, suicide rate goes up
If you think about the music you listen to at between 18-mid 20s, those are the mountain top years.
Whatever music was popular when that senior who has the debilitating disease, whatever music was popular
to them when they were at that age – it will trigger that kind of memory of the words. So if you find out the
music they liked during that time frame, it will help them. Make sure you don’t talk over them. Talk to them.
They’re still going to experience pain. There was a study where an Indian is stabbing me in the shoulder. SO
a nurse heard it and moved his shirt, and his Bursitis was acting up, but he couldn’t find the right words to
say it.
They’re going to have trouble with the third dimension of sight. Going to have trouble where table cloth and
white plate meet each other to distinguish. Rooms where the floor and ceiling are the same color (white) will
make it hard for them to navigate.
A lot of people can become upset with all these changes going on with their body, even though they’re
idiopathic (not illness causing). So don’t get caught up in all the pathology or anatomy of it, you want to ask
them how they feel about all these changes. There are some people that are happy that they survived to
this age, and there are other people that are really upset about it, and they’ve gotten so depressed that
maybe within a month’s time of visiting their healthcare professional, they’ll commit suicide.
They’ll feel Sadness, decreased energy, oversleeping or insomnia, or they’re very irritable, loss of focus, anxiety
attacks. 2 or more of these symptoms for 2 weeks or more, they should be seeing a healthcare professional
for assistance. If they say something about suicide, you should be running to telephone to get some assistance.
There are drugs that these people (seniors) should not get:
- Indocin you can give for osteo/rhemuotoid arthritis. It can increase effects of Digoxin. Indocin
can block the actions of an antihypertensive drug in a senior, such as Endriol. Indocin will
decrease the effect of Lasix in a senior citizen.
THEORIES
Erikson – she likes it. They’re excited about whatever accomplishments they have. Children, Occupation. But
then there are some that feel despair. They’ve met developmental challenges. Adjustments to retirement,
their health, to their significant other’s health. Maybe they’ve had to move to smaller dwellings. There
could be social isolation. If people move here, they have family members in the north, and they can’t get to
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soon enough. Or it could be their personality. (We say, it’s so sad they don’t have any visitors, but we
don’t know what they were like as younger people.)
Living arrangements – a lot of people are living on their own.
- At major universities, when students would go home, they’d have dorms that were empty. So
they started running programs for seniors, so they could live in the dorm. So the seniors liked it,
so when the young folks came back, the seniors wanted to live in the college community, they had
all those resources they had access to, concerts, theatrical productions, than the administers
realized it was a nice mesh, and they were educating people to serve these elderly as clients and
more and more seniors are going to college towns.
Activity-may substitute activity don’t slow down activity.
Disengagement Theory –
Developmental Tasks
Love and belonging does not diminish
N
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