Unit 16 Psychological Effects of Aging

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Unit 16Psychological Effects of Aging

• Nurse Aide I Course

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Psychological Effects Of Aging

• This unit deals with the feelings, emotional
  stress and psychological adjustments that are
  part of the aging process.
• It explores the physical and psychosocial needs
  of residents, and teaches the skills that the
  nurse aide will need to develop to provide
  understanding and compassionate care.

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Psychological Effects Of Aging(continued)

• Other topics covered include age appropriate
  behavior, sexuality, reality orientation,
  dementia, Alzheimers disease, confusion and
  developmental disabilities.

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Human Needs
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Objective

• 16.0 Discuss ways to meet the residents basic
  human needs for life and mental well-being.

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Physical Needs For Survival And Care To Be Given

• Oxygen
• elevate head of bed
• assist to sit up in chair
• report to supervisor if resident is cyanotic or
  short of breath
• assist with breathing exercises

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Physical Needs For Survival And Care To Be
Given(continued)

• Food
• Feed residents unable to feed themselves

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Physical Needs For Survival And Care To Be
Given(continued)

• Food
• Serve food
• with proper temperature
• in friendly manner
• in pleasant environment
• in appropriate amounts
• Make sure dentures are in place

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Physical Needs For Survival And Care To Be
Given(continued)

• Water
• make available within residents reach
• provide fresh water at periodic intervals

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Physical Needs For Survival And Care To Be
Given(continued)

• Shelter
• provide for warmth with extra blankets
• be sure residents are dressed properly
• avoid drafts or drafty areas

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Physical Needs For Survival And Care To Be
Given(continued)

• Sleep
• Minimize noise and lights during hours of sleep
• Give back rub to relax resident

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Physical Needs For Survival And Care To Be
Given(continued)

• Sleep (continued)
• Report complaints of pain to supervisor
• Listen to concerns or worries the resident may
  wish to express
• Leave night light on in the residents room, if
  requested

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Physical Needs For Survival And Care To Be
Given(continued)

• Elimination
• Assist to bathroom as needed
• Provide bedpan and/or urinal
• Provide for privacy

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Physical Needs For Survival And Care To Be
Given(continued)

• Elimination (continued)
• Change soiled linen immediately
• Following routine for bowel and bladder
  retraining as directed

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Physical Needs For Survival And Care To Be
Given(continued)

• Activity
• ROM exercises as directed
• Turn and reposition at least every two hours

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Physical Needs For Survival And Care To Be
Given(continued)

• Activity
• Assist with activity as directed
• Encourage movement
• Encourage interesting recreational activities

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Safety And Security Needs

• Provide for warmth
• Establish familiar surroundings
• explain procedures
• talk about their room
• keep your promises
• provide a safe environment
• promote use of personal belongings

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Safety and Security Needs(continued)

• Maintain order and follow routines, assisting
  resident to participate in establishing routine
  as often as possible

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Safety and Security Needs(continued)

• Assist to reduce fear and anxiety
• listen to residents worries and report to
  supervisor
• ease concerns when possible
• check on residents frequently
• Avoid rushing and assist resident in gentle manner

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Love and Affection Needs

• Friendship
• Social Acceptance
• Closeness
• Meaningful relationships with others
• Love
• Sexuality

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Love and Affection Needs(continued)

• Belonging
• Need met by family/support system
• Friends may meet this need

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Love and Affection Needs (continued)

• The nursing staff as family
• take time to greet residents when you see them
• sit and visit for a few minutes when time allows
• show interest in residents

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Love and Affection Needs (continued)

• The nursing staff as family (continued)
• display human warmth with a gentle touch
• show acceptance of an individual for his or her
  unique qualities
• provide care in a kind, friendly, considerate
  manner

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Self-Esteem Needs

• Value, worth or opinion of oneself
• Seeing oneself as useful
• Being well thought of by others

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Self-Esteem Needs (continued)

• Nurse aides responsibilities
• call resident by proper name
• praise accomplishments
• discuss current issues
• request residents opinion
• show respect and approval

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Need for Self-Actualization (experiencing ones
potential)

• Cannot occur until all other needs are met
• A feeling that a person is what one wants to be
• Rarely is this need totally met

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Need for Self-Actualization (experiencing ones
potential) (continued)

• Ways to help residents to meet this need
• assist to participate in meaningful activities
• assist to dress and help with grooming
• encourage independence
• encourage socialization

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Need for Self-Actualization (experiencing ones
potential) (continued)

• Ways to help residents to meet this need
  (continued)
• share goals with residents and praise their
  success or accomplishments
• know what resident has accomplished in his/her
  lifetime and talk about these things

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Spiritual Needs

• Residents have the right to worship and express
  their faith freely.

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Spiritual Needs(continued)

• Guidelines for the nurse aide
• respect residents beliefs
• respect residents religious objects
• inform residents of the time and place for
  religious services

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Spiritual Needs(continued)

• Guidelines for the nurse aide (continued)
• assist resident to attend religious services
• provide privacy for members of the clergy and
  residents
• welcome members of the clergy

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Coping Mechanisms
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Objective

• 16.1 Identify eight defense mechanisms that could
  be used by a resident in response to stress.

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Coping Mechanisms

• Established early in life as part of personality
• List of defense mechanisms (unconscious
  behaviors)
• Projection - blaming others
• Rationalization - false reason for situation

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Coping Mechanisms (continued)

• List of defense mechanisms (unconscious
  behaviors) (continued)
• Denial - pretending a problem doesnt exist
• Compensation - making up for a situation in some
  other way

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Coping Mechanisms(continued)

• List of defense mechanisms (unconscious
  behaviors) (continued)
• Displacement - transferring feelings about one
  person to another person
• Daydreaming - escape from reality

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Coping Mechanisms(continued)

• List of defense mechanisms (unconscious
  behaviors) (continued)
• Identification - idolizing another and trying to
  copy him/her
• Sublimation - redirecting feelings to
  constructive activity

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Sexuality
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Objective

• 16.2 Recognize how age, illness and disability
  affect sexuality.

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Sexuality

• Expressed by individuals of all ages
• A way to show feminine or masculine qualities
• Clothing styles and colors
• Hairstyles
• Hobbies and interests
• Sexual habits (continue into
• old age)
• Gestures

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Sexuality(continued)

• May be expressed by
• Sexual intercourse
• Caressing, touching, holding hands
• Masturbation
• Is a right of all residents to experience

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Guidelines For The Nurse Aide In Dealing With
Resident Sexuality

• Assist to maintain sexual identity by dressing
  residents in clothing appropriate for men or
  women
• Assist with personal hygiene

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Guidelines For The Nurse Aide In Dealing With
Resident Sexuality(continued)

• Assist to prepare for special activities by
  dressing up
• selecting attractive clothing
• fixing hair in a special way
• applying cosmetics
• wearing a special perfume or aftershave

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Guidelines For The Nurse Aide In Dealing With
Resident Sexuality(continued)

• Help to develop a positive self-image
• Show acceptance and understanding for residents
  expression of love or sexuality
• provide privacy
• always knock prior to entering a room at any time
  
• assure privacy when requested

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Guidelines For The Nurse Aide In Dealing With
Resident Sexuality(continued)

• Never expose the resident
• Accept the residents sexual relationships

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Guidelines For The Nurse Aide In Dealing With
Resident Sexuality(continued)

• Provide protection for the non-consenting
  resident
• Be firm but gentle in your rejection of a
  residents sexual advances

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Possible Effects Of Injury Or Illness On Sexuality

• Disfiguring surgery may cause a person to feel
• unattractive and ugly to others
• mutilated and deformed
• unworthy of love or affection

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Possible Effects Of Injury Or Illness On
Sexuality(continued)

• Chronic illness and certain medications can
  affect sexual functioning

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Possible Effects Of Injury Or Illness On
Sexuality(continued)

• Disorders that cause impotence
• diabetes mellitus
• spinal cord injuries
• multiple sclerosis
• alcoholism

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Possible Effects Of Injury Or Illness On
Sexuality(continued)

• Surgery can have both physical and/or
  psychological effects
• removal of prostate or testes
• amputation of a limb
• removal of uterus
• removal of ovaries
• removal of a breast
• colostomy
• ileostomy

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Possible Effects Of Injury Or Illness On
Sexuality(continued)

• Disorders affecting the ability to have sex
• stroke
• nervous system disorders
• heart disease

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Possible Effects Of Injury Or Illness On
Sexuality(continued)

• Disorders affecting the ability to have sex

• chronic obstructive pulmonary disease
• circulatory disorders
• arthritis or conditions affecting mobility/
  flexibility

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Developmental Tasks of Aging
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Objective

• 16.3 Identify developmental tasks associated with
  aging.

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Developmental Tasks Of Aging

• Adjustment to
• retirement
• reduced income
• death of friends
• death of spouse
• physical changes
• loss of independence

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Developmental Tasks Of Aging(continued)

• Creating new friendships and relationships
• Loss of vitality
• Integrating life experiences
• Preparation for death

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Depression
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Objective

• 16.4 Identify symptoms of depression and define
  the nurse aides role in caring for a depressed
  resident.

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Depression

• Reasons for depression
• Loss of independence
• Death of spouse or friend
• Loss of job or home
• Decreased memory
• Terminal illness

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Common Signs And Symptoms Of Depression

• Change in sleep pattern
• Loss of appetite and weight loss
• Crying, withdrawal from activities, appearing sad

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Nurse Aides Role In Caring For The Depressed
Resident

• Listen to feelings
• Encourage to reminisce
• Involve in activities
• Encourage friends and family to visit
• Report changes in eating, elimination or sleeping
  patterns

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Nurse Aides Role In Caring For The Depressed
Resident(continued)

• Avoid pitying the resident
• Help to focus on reality
• Monitor eating and drinking
• Promote self-esteem
• Report observations to supervisor

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Issues Involving Care Of The Elderly
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Objective

• 16.5 Identify the issues to be considered when
  elderly are unable to provide for their own needs
  in their own homes.

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Issues Involving Care Of The Elderly

• Amount of care needed
• Cost
• Nutritional needs
• Relationship with family/support system
• Location of family/support system
• Medical care needs

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Issues Involving Care Of The Elderly(continued)

• The elderly person may experience
• Living with a group of people
• Less independence
• Structured lifestyle
• Less privacy
• Difficulty adapting to change

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Issues Involving Care Of The Elderly(continued)

• Decision made by individual or family for
  long-term care may cause stress

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Emotional Support For Residents
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Objective

• 16.6 Utilize the residents family or established
  support system as a source of emotional support.

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Emotional Support for Residents

• Family/support system meets needs for
• Safety
• Security
• Love
• Belonging
• Esteem

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Emotional Support for Residents(continued)

• Family/support system provides
• Comfort
• Support
• Relief from loneliness

• Contact with familiar people and things
• Mental stimulation
• Reasons to live

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Ways To Promote Family Involvement

• Include in care conferences
• Encourage to do some or all of personal grooming
• Provide outside picnic areas, playground
  equipment, gardens

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Ways To Promote Family Involvement(continued)

• Provide area for family/support system parties
• Invite families to scheduled activities
• Encourage to assist with feeding if appropriate

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Ways To Promote Family Involvement(continued)

• Encourage to bring special foods or beverages for
  resident if allowed
• Encourage time together

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Responsibilities of the Nurse Aide when Dealing
with Family/Support System Members

• Greet the family/support system
• Address family members by name
• Make family and friends feel welcome
• Provide for privacy
• Keep lines of communication open

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Responsibilities of the Nurse Aide when Dealing
with Family/Support System Members(continued)

• Understand that family and friends will do or say
  things to try and please the resident
• Use tact in dealing with family complaints and
  requests that you cannot honor

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Responsibilities of the Nurse Aide when Dealing
with Family/Support System Members(continued)

• Assist families to understand the facility and
  how it works
• Provide explanations for family questions or
  report to supervisor to assist the family with
  questions

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Responsibilities of the Nurse Aide when Dealing
with Family/Support System Members(continued)

• Reassure family as they cope with residents
  actions, problems and concerns

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Dementia
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Objective

• 16.7 Identify the symptoms displayed by residents
  with dementia.

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Dementia (Group Of Symptoms)

• Defined as a progressive loss of mental
  functioning

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Dementia (Group Of Symptoms)(continued)

• Two categories of dementia
• 1st Category Primary
• No known cause
• Irreversible
• May be treated but not completely cured

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Dementia (Group Of Symptoms)(continued)

• Two categories of dementia
• 1st Category Primary
• Examples of diseases causing dementia
• Alzheimers disease
• Parkinsons disease
• Huntingtons Chorea (genetic)

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Dementia (Group Of Symptoms)(continued)

• Two categories of dementia
• 2nd Category Secondary
• Usually has known cause
• Treatable
• Reversible to some degree

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Dementia (Group Of Symptoms)(continued)

• Two categories of dementia
• 2nd Category Secondary
• Examples of secondary causes of dementia
• depression
• minor stroke
• thyroid dysfunction
• medication induced

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Symptoms Of Dementia

• Confusion
• Inability to reason accurately
• Recent memory loss
• Detailed long-term memory
• Repetitious speech
• Self-centered behavior
• Agitation
• Disorientation
• Confabulation

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Alzheimer's Disease
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Objective

• 16.8 Review the psychosocial characteristics and
  care needs of a person with Alzheimers disease.

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Alzheimers Disease

• Defined as a progressive, 3-stage, incurable
  disease that involves changes in brain tissue
• Responsible for about half of the dementia seen
• Symptoms usually occur in people 50-69 years of
  age

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Alzheimers Disease(continued)

• Affects more women than men
• Always ends in death 3-15 years after symptoms
  begin

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Alzheimers Disease Signs And Symptoms

• Irreversible loss of memory
• Speech and writing difficulties
• Disorientation
• Difficulty walking
• loss of balance
• short steps
• spatial disorientation

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Alzheimers Disease Signs And
Symptoms(continued)

• Deterioration of mental functions
• Unable to make decisions
• Loss of ability to make judgments
• Changes in behavior
• restless
• angry
• depressed
• irritable

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Alzheimers Disease Signs And
Symptoms(continued)

• Possible seizures
• Coma and death

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Alzheimers Disease Considerations For Care

• Assist to be as active as possible
• Encourage in activities of daily living
• Orient to reality
• Protect from injury

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Alzheimers Disease Considerations For
Care(continued)

• Maintain calm, consistent environment
• Complete ADL at the same time each day
• Use reality orientation

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Alzheimers Disease Considerations For
Care(continued)

• Same caregivers assigned to resident
• Involve in simple, limited activities
• Follow routines
• Treat with patience and compassion

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Alzheimers Disease Considerations For
Care(continued)

• Support family
• Communicate with simple phrases
• Dont pose questions or ask to make choices

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Confusion
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Objective

• 16.9 Discuss disorders that cause confusion for
  residents.

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Confusion

• Symptom or side effect of many disorders
• Disorders causing confusion
• Stroke
• Arteriosclerosis
• Dementia
• Alzheimers Disease
• Huntingtons Chorea

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Confusion(continued)

• Other Causes
• Drug reactions
• Depression
• Environmental changes
• Vision and/or hearing loss
• Dehydration
• Poor nutrition
• Decreased oxygen levels in blood
• Head injury

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Confusion(continued)

• Condition can be permanent or temporary

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Reality Orientation Used For Confusion

• Includes
• Facing resident and speaking clearly and slowly
• Greeting the resident by name with each
  interaction
• Identifying yourself with each interaction

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Reality Orientation Used For Confusion(continued
)

• Includes
• Explaining care in simple terms prior to giving
  care
• Frequently orienting the resident to the day,
  month, date, and time
• Giving short, simple instructions

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Reality Orientation Used For Confusion(continued
)

• Includes
• Encouraging residents to wear glasses or hearing
  aides
• Communicating with touch and clear and simple
  comments and questions

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Reality Orientation Used For Confusion(continued
)

• Includes
• Encouraging use of radio, television, newspapers,
  and magazines
• Maintaining residents routine

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Reality Orientation Used For Confusion(continued
)

• Includes
• Giving only one direction at a time
• Keeping the environment calm and relaxed

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Reality Orientation Used For Confusion(continued
)

• Includes
• Providing clocks, calendars and bulletin boards
  to remind residents of time and activities
• Discussing current topics

109
Reality Orientation Used For Confusion(continued
)

• Includes
• Reminiscing
• Showing resident self-image in mirror
• Providing recreational activities which reinforce
  reality orientation

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Reality Orientation Used For Confusion(continued
)

• Includes
• Dressing residents during the day and assisting
  them to stay on a day-night schedule

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Developmental Disabilities
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Objective

• 16.10 Identify basic skills the nurse aide will
  need to use when caring for residents with
  developmental disabilities.

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Developmental Disabilities

• Diagnoses
• Mental retardation
• Cerebral palsy

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Developmental Disabilities(continued)

• Guidelines for Care
• Treat the individual with respect and dignity
• Encourage residents to
• make personal choices
• do as much as possible for themselves

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Developmental Disabilities(continued)

• Guidelines for Care (continued)
• Encourage residents to
• use age appropriate personal skills
• achieve their potential
• interact with others

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Developmental Disabilities

• Guidelines for Care
• Do not
• act as residents parent
• create dependency
• label or categorize residents
• Do provide privacy
• Do build residents self-esteem

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Caring For Residents With Cognitive Impairment
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Objective

• 16.11 Identify ways to assist residents with
  cognitive impairments.

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Ways To Assist Stressed Residents

• Listen to concerns
• Observe and report nonverbal messages
• Treat with dignity and respect
• Attempt to understand behavior

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Ways To Assist Stressed Residents(continued)

• Be honest and trustworthy
• Never argue with residents
• Attempt to locate source of stress
• Support efforts to deal with stress

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Ways To Assist Demanding Residents

• Attempt to discover factors responsible for
  behavior
• Display a caring attitude
• Listen to verbal and nonverbal messages
• Give consistent care

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Ways To Assist Demanding Residents(continued)

• Spend some time with the resident
• Agree to return to see the resident at a specific
  time and keep your promise

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Ways To Assist Agitated Residents

• Encourage to talk about fears
• Remind resident of past ability to cope with
  change
• Encourage to ask questions about concerns

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Ways To Assist Agitated Residents(continued)

• Involve in activities that promote self-esteem
• Observe for safety and to prevent wandering away
• Assign small tasks
• Use reality orientation

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Ways To Assist Residents Displaying Paranoid
Thinking

• Reassure the resident that you will provide for
  his or her safety
• Realize behavior is based on fear
• Avoid agreeing or disagreeing with comments
• Provide calm environment
• Involve in reality activities

126
Ways To Assist Combative Residents

• Display a calm manner
• Avoid touching the resident
• Provide privacy for out-of-control residents
• Secure help if necessary

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Ways To Assist Combative Residents(continued)

• Do not ignore threats
• Protect yourself from harm
• Listen to verbal aggression without argument

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THE END