Attitudes, Values, And Beliefs Towards Aging, Theories Of Aging, Advocacy, Stereotyping, Elder Abuse, Age-related Pathophysiological Disorders, And Oral Health In The Aged Client

Attitudes Towards Aging

Discuss common attitudes, values, and beliefs towards aging.

It is important for the nurses to be aware of their own values and attitudes towards the ageing and older adults. It is important to know that the older Australians are not a homogenous group, but have diverse cultural backgrounds. Attitude towards ageing include positive or negative depending on an individual’s tendency to stereotype individuals based on their age. Ageism is viewed negatively and contributes to the development of negative stereotypes about the older adults. It occurs when the younger people do not understand of identify older people as unique human beings. Instead, they generalise undesirable characteristics such as senile, old-fashioned, unproductive and inflexible to all the older adults. Most of the values and beliefs or older people significantly differ from the beliefs held by younger generation. Few older adults save or hoard items, including the articles that present health hazards because they value saving rather than wasting. Some of the older people expect that the caregivers address them formally, using their last name. Older people often have difficulty in understand why their family members do not accept their view and follow their directions. It results in misunderstanding and conflicts. Many older adults continue to pursue traditional religious practises, which have changed over time. For instance, many older adults Catholics avoid eating meat on Fridays. Older adults may have difficulty in understanding contemporary changes in the structure of organized religious, especially the current trend towards cooperation among religious groups (Bryant,et al., 2010). 

Identify and describe two theories of ageing.

The theories of aging cover the genetic, biochemical and physiological properties of the organism and the how these properties change with time. Genetic theories deal with the speculations regarding the identity of aging genes, accumulation of errors in the genetic machinery, programmed senescence, and telomeres. Biochemical theories are concerned with energy metabolism, generation of free radicals, the rate of living and the health of mitochondria. Physiological theories deal with the endocrine system and the role of hormones in regulating the rate of cellular senescence.

The DNA damage –repair theory: It is a stochastic theory related to the error catastrophe theory. It states that the cellular mechanism that repair the damage caused to DNA become deficient. This results in poor or altered transcriptional efficiency and ultimately leads to cellular breakdown. This theory is compelling since it is known that a decrease in the ability to repair damage to the genetic material is associated with aging.

Telomere theory of aging: It states that the gradual degradation of the repeated arrays of identical DNA motifs located at the ends of chromosomes lead to chromosomal instability and ultimately causes cell death. Recent evidence about age-related shortening of telomeres and presence of telomerase in cancer cells but not in normal somatic cell supports this theory.

Discuss the aspects of Advocacy, stereotyping and elder abuse and how these can impact the person.

Common stereotypes against the older adults suggest that they are sick, impotent, senile, useless, lonely, poor, and depressed, in spite of the fact that many older adults are intelligent, active, socially engaged and productive members of society. Elderly abuse includes physical, emotional, sexual and financial. Social isolation and lack of support are closely related to many types of abuse. Social isolation can arise from the older adult, the perpetrator or social circumstances. The older adults may self-isolate to maintain privacy, autonomy, control over their lives and to avoid imposition of unwanted services. Communication barriers and cultural differences can also lead to social isolation

Theories of Aging

Identify and describe at least four age related pathophysiological disorders and how these may affect the person

Tissue integrity and competency of systolic and diastolic functions normally depends on the extracellular collagen concentration. There is an abnormal increase in the extracellular fibrillar collagen with ageing, which contributes to myocardial stiffness and decreases compliance.

As the age advances, approximately 35 % of myocytes are lost and the left ventricular diastolic filling rate decreases to 50 % by the age of 80. The left ventricular end diastolic volume does not reduce with age due to the forceful contractility of the left atrium and this increases atrial contribution to ventricular filling and causes left atrial hypertrophy.

The beta-adrenergic responsiveness decreases with age reducing the maximum achievable heart rate. Due to decrease in maximum heart rate and reduction in contractility the exercise cardiac output may be reduced.

Several changes occur in the heart and vessels due to aging as a result of deregulation of molecular longevity pathways resulting in compromised function. Nearly 80% of older adults have aortic valvular sclerosis and moderate to severe aortic incompetence. Mitral annular calcification increases with aging and reduces the cardiac performance.

Identify at least three co-existing health problems associated with body systems of an aged person and describe the related pathophysiology.

Many older adults have multiple chronic conditions which increase the health risk and complicate the treatment.  Diabetes, arthritis and coronary heart disease are the co-existing health problems in most of the older adults.  Diabetes increases the risk of developing fatal coronary heart disease (CHD). Similarly, pain and stiffness associated with arthritis may aggravate a co-existing condition such as diabetes by limiting the physical activity. The primary pathophysiological factors that cause the development of diabetes in older adults are abnormal insulin secretion and resistance to insulin action. Abnormality in insulin secretion is related to alterations in insulin release, loss of pulsatility, loss of first-phase insulin secretion and decrease response to incretin hormones with aging. Abnormal insulin sensitivity is commonly seen with aging and is exacerbated by confounding factors such as higher body fat, and loss of fat-free mass. Older adults have normal insulin secretion but greater resistance to insulin-mediated glucose disposal. Arthritis is an inflammatory joint disorder associated with stiffness, oedema and pain. Rheumatoid arthritis is a serious condition. It is an autoimmune disease which not only affects the joints but also affects the connective tissue. Aging is related to structural and functional changes in the vascular wall. These include degradation of elastin, smooth muscle necrosis and an increase in collagen an and calcification, resulting in thickening of the arterial wall. It decreases vascular distensibility and elevated arterial stiffness. These changes cause the development of systolic hypertension, increased left ventricular afterload, left ventricular hypertrophy, increased myocardial oxygen demand and impaired coronary perfusion. Age relates arterial stiffness is an independent predictor of CHD events (Mauk, 2010).

Describe one age related physiological change to the oral health in the aged client and its associated disorder.

Normal aging encompasses many physiological changes in the oral cavity. However, these changes are secondary to chronic systemic disease and their treatment regimens. The function of the oral mucosa is to provide a host defence, mastication, swallowing, speech, and flavour perception. During normal aging process the oral mucosa thins, loses elasticity and has a diminished attachment to the underlying bone and connective tissues. Oral muscosal disease and lesions are common in older adults. Many elderly people have pigmented and benign soft-tissues and hard-tissue conditions. Many older adults have risk of developing oral fungal infections. Any mucosal lesion that persists for 3 to 4 weeks despite all attempts to remove suspected causes must be biopsied to determine a diagnosis (Petersen, et al., 2010).

Advocacy, Stereotyping, and Elder Abuse

Describe two nursing actions to enhance the oral health of the aged person.

Effective dental care for older people can greatly enhance quality of life. Patients with dentures should be advised to remove the dentures at night, clean and keep in water or a weak solution of Milton or proprietary cleanser to prevent development of candida-associated denture stomatitis. The nurse should encourage the older adults to undergo annual dental exams to identify early oral problems (Mauk, 2010).

Discuss the social, emotional and psychological symptoms that impact on the person’s ability to achieve maximum performance in ADLs. Consider and describe the impact on the person’s family and significant others.

Symptoms or the conditions that impact the person’s ability to achieve maximum performance in ADLs are: dementia, Alzheimer’s and depression affect the individual’s ability to think and act reasonably due to which the person cannot be safe living alone. Joints stiffness, arthritis and decreased flexibility and reduced muscle tone, painful joints causes mobility challenges. Safety risks, such as dim or poor lighting, shiny floors, spills that causes wetting of the floor are the possible hazards that may cause a person to trip or stumble. Slips, trips and falls can lead to serious injury, loss of independence, disability and even death. Reduced hearing and vision causes difficulty in participating in activities and conversations

The Person’s family and others may feel frustrated feel burden. Therefore, appropriate support services should be suggested to the elderly to prevent burden on the family (Mauk, 2010).

List and describe three health assessment tools that may be used to assess the mental physical and/or functional ability of the older person.

Functional assessment tools include a scale for measuring a person’s level of independence in performing specific ADLs and IADLs . ADLs include activities that are essential to personal care where as IADLs comprise the more complex activities that are essential in community living situations. ADLs include grooming, bathing, dressing, eating, elimination and mobility.

Mini-Cog is used to assess cognitive impairment. It has two elements: a) 3-item don’t forget and b) clock draw take a look at (CDT). Scorings from 0 to 3 are given for every distractor. A rating of 0 suggests dementia (no matter CDT results). A score of 3 shows absence of dementia (irrespective of CDT outcomes) (Mauk, 2010).

Two-query screener is used form assessing major depressive illness. The test is considered as negative if a patient responds no for both he questions.

Identify three specific nursing interventions that are relevant for the aged person and state the rationale for each intervention.

The risk of fall increases in older adults due to loss of muscle strength or cognitive difficulties, So, the nurse should use side rails to the bed, provide bed and chair alarm and heavy furniture that will not trip over when used as support (Cameron, et al., 2010). Dysphagia is more common in the older adults than in younger persons because of the presence of different types of neurological, neuromuscular, or oncological conditions. Patients having difficulty in swallowing should be provided liquids until he or she can swallow effectively as liquids can be easily aspirated. Thickened liquids form a cohesive bolus that can be easily swallowed with increased efficiency so a thickening agent can be added to liquids to obtain a soft consistency that is similar to nectar or honey depending on the degree of patient’s swallowing problems. Malignant lesions are more common in geriatrics than in younger adults so the nurse should carefully observe oral cavity and lips for abnormal lesions such as white or red patches, masses, ulcerations with an indurated margin, or a raised granular lesion (Mauk, 2010).

Age-related Pathophysiological Disorders

What is a poly pharmacy and what effects does this have on the aged person with a chronic condition?

Polypharmacy is stated as the concurrent use of many different drugs (Or) excessive use of drugs. Polypharmacy is a persistent issue while caring for older adults. The consequences of polypharmacy include adverse drug effects, drug-durg interaction, disease-drug interaction, nutraceutical-drug interaction and medication cascade effects. Medication cascade effect refers to the use of medication to treat the side effects of other medications. This further adds to the risk and complexity of medication use in older adults. Evidences suggest that nearly one-third of older adults who take atleast five medications will experience an adverse drug event each year and two-third of these patients require medical attention (Maggiore, et al., 2010).

List and describe three types of restraint. What are the legal ramifications of using restraint on a person displaying challenging behaviours.

Restraints are devices or chemicals that restrict the patient’s movement. They are used with the intention to subdue a patient’s activity. Types of restraining are: Cloth limb retrains, bedrails, chairs with locking lap trays and sedative drugs. Unnecessary or unprescribed restrains can lead to charges of false imprisonment, battery or both. Before using a restrain alternative measures for protecting the patients displaying challenging behaviors. If less restrictive alternatives are unsuccessful, then nurse must obtain a medical order before every instance in which they use restrain. When a restrain is applied to a person, the nurse should perform a regular assessment, provide fluids and nourishment to the patient and allow bowel and bladder elimination. When the patient is no longer a danger to self or others, the restraint must be removed (Mauk, 2010).

List and describe three available resource and support services for that may be accessed by the elderly that will assist them to remain independent.

The Australian Red Cross community care program provides some services and programs for older people to overcome social isolation and improve the quality of life and personal well-being. They provide MATES, meals on wheels; community visitors scheme, tele chat, telecross and red connect which is a personal alarm.

Home help act is a non-profit organization which provides in home support to the older adults, people with disabilities and frail aged.

Communities at work provide home and community support services which help to improve the quality of life (Mauk, 2010).

Reference:

Bryant, C., Bei, B., Gilson, K., Komiti, A., Jackson, H., & Judd, F. (2012). The relationship between attitudes to aging and physical and mental health in older adults. International Psychogeriatrics, 24(10), 1674-1683. Doi: 10.1017/S1041610212000774

Cameron, I. D., Murray, G. R., Gillespie, L. D., Robertson, M. C., Hill, K. D., Cumming, R. G., & Kerse, N. (2010). Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database Syst Rev, 1(1).

Maggiore, R. J., Gross, C. P., & Hurria, A. (2010). Polypharmacy in older adults with cancer. The oncologist, 15(5), 507-522. Reterived on 18 July, 2017 from https://theoncologist.alphamedpress.org/content/15/5/507.short

Mauk, K. (Ed.). (2010). Gerontological nursing: Competencies for care. Jones & Bartlett Learning.

Petersen, P. E., Kandelman, D., Arpin, S., & Ogawa, H. (2010). Global oral health of older people-call for public health action. Community dental health, 27(4), 257.