1 of 44

Course: Fundamentals of Nursing

Topic: Middle Adult and Older Adult

The Nurses International Community

Contact info: info@nursesinternational.org

2 of 44

COPYRIGHT

NI Privacy Policy and Terms of Use.

Contact info: info@nursesinternational.org

3 of 44

Module Goals

Learners will be able to:

Identify the needs of the middle adult.
Explain how the nurse can address the physiological /emotional/ developmental needs of the middle adult.
Identify the needs of the elder adult.
Explain how the nurse can address the physiological/ emotional/ developmental needs of the elder adult.

Contact info: info@nursesinternational.org

4 of 44

Introduction to Middle Adult

Baptist Health South Florida, 2021

Middle Adult: 40 yrs - 65 yrs
The term sandwich generation refers to adults in this age group who are often “sandwiched” between caring for their children and their own parents.
The middle-aged adult focuses on:

Children who will affect the future.
Making inroads in business, public service, the arts.
Building bridges.
Planting trees and gardens.

Contact info: info@nursesinternational.org

5 of 44

Physical Development in Middle Adulthood

Tyler, 2020

Primary Aging:

Biological factors, such as molecular and cellular changes, and oxidative damage are called primary aging.

Secondary Aging:

Aging that occurs due to controllable factors, such as an unhealthy lifestyle including lack of physical exercise and poor diet, is called secondary aging.

Contact info: info@nursesinternational.org

6 of 44

Physical Development in Middle Adulthood

Tyler, 2020

Physical Changes:

Hair: the hair follicles produce less melanin, and this causes the hair to become gray and thin.
Skin: dries and loses the underlying layer of fat, Loss of muscle tone and thinning skin can make wrinkles.
Sarcopenia: loss of muscle mass and strength that occurs with aging is referred to as sarcopenia.
Lungs: Thinning of the bones with age can change the shape of the rib cage and result in a loss of lung expansion.

Contact info: info@nursesinternational.org

7 of 44

Physical Development in Middle Adulthood

Tyler, 2020

Sensory Changes:

Vision:

Presbyopia, which is Latin for “old vision.”
It refers to a loss of elasticity in the lens of the eye that makes it harder for the eye to focus on objects that are closer to the person.
Scotopic sensitivity, the ability to see in dimmer light.
Some people experience dry eye syndrome.

Hearing:

Hearing problems increase during middle adulthood.

Contact info: info@nursesinternational.org

8 of 44

Health Concerns of Middle Age

Tyler, 2020

Heart Disease:

Include heart defects and heart rhythm problems, as well as narrowed, blocked, or stiffened blood vessels referred to as cardiovascular disease.
Atherosclerosis
Hypertension

Digestive Issues:

Heartburn, gallstone, sleep problems.

Contact info: info@nursesinternational.org

Risk Factors for Heart Diseases are:

Advanced Age-increased risk for narrowed arteries and weakened or thickened heart muscle.
Sex-males are at greater risk, but a female’s risk increases after menopause.
Family History-increased risk, especially if male parent or brother developed heart. disease before age 55 or female parent or sister developed heart disease before age 65.
Smoking-nicotine constricts blood vessels and carbon monoxide damages the inner lining.
Poor Diet-a diet high in fat, salt, sugar, and cholesterol.
Excessive Alcohol Consumption-alcohol can raise the level of bad fats in the blood and increase blood pressure
Stress-unrelieved stress can damage arteries and worsen other risk factors.
Poor Hygiene-establishing good hygiene habits can prevent viral or bacterial infections that can affect the heart. Poor dental care can also contribute to heart disease

9 of 44

Health Concerns of Middle Age

Climacteric: Fertility declines
Female Sexual and Reproductive Health:

Perimenopause refers to a period of transition in which a woman’s ovaries stop releasing eggs and the level of estrogen and progesterone production decreases.
Menopause is defined as 12 months without menstruation.

Male Sexual and Reproductive Health:

Erectile dysfunction refers to the inability to achieve an erection or an inconsistent ability to achieve an erection.

Tyler, 2020

Contact info: info@nursesinternational.org

10 of 44

Psychosocial Development : Generativity vs Stagnation

According to Erikson (1950, 1982) generativity encompasses procreativity, productivity, and creativity.
This stage includes:

The generation of new beings
New products, and
New ideas, as well as self-generation concerned with further identity development.

Believed that the stage of generativity, during which one established a family and career.
Stagnation occurs when one is not active in generative matters, however, stagnation can motive a person to redirect energies into more meaningful activities.

Tyler, 2020

Contact info: info@nursesinternational.org

11 of 44

Critical Thinking Question

List the various stressors of the middle age adult.

Contact info: info@nursesinternational.org

12 of 44

Stressors of the Middle Adults

Baptist Health South Florida, 2021

Divorce
Cost of college tuition for their children
Cost of caring for elderly parents
Cost of their own healthcare needs
Impending retirement and fixed-income
Death of spouse, family members, and friends

Contact info: info@nursesinternational.org

13 of 44

Safety Concerns of Middle Adults

Baptist Health South Florida, 2021

Motor vehicle accidents

(#1 cause of injuries)

Occupational injuries

Falls

Fractures and dislocations

Contact info: info@nursesinternational.org

14 of 44

Patient/ Family Education

Allow to verbalize concerns and fears regarding illness or injury.
Assess the learning preference of the adult client.
Some adults prefer written instructions and documentation; some prefer audiotapes or videotapes; some prefer a combination of learning methods.
Include the patient’s significant other or other family members in the teaching when appropriate.
Health education should include the importance of regular medical checkups and to take advantage of health screenings in the community.

Baptist Health South Florida, 2021

Contact info: info@nursesinternational.org

15 of 44

Patient/Family Education

Tyler, 2020

Exercise, Nutrition, and Weight

Exercise is a powerful way to combat the changes we associate with aging. Exercise builds muscle, increases metabolism, helps control blood sugar, increases bone density, and relieves stress.

Nutritional concerns:

Excess Sodium
Excess Fat
Added Sugar
Metabolism and weight gain
Obesity

Contact info: info@nursesinternational.org

16 of 44

Critical Thinking Question

What expected physical changes that occur during middle adulthood?

Contact info: info@nursesinternational.org

17 of 44

Late Adulthood

Stangor and Walinga, 2014

When people enter into their 60s and beyond:

The aging process leads to faster changes in the physical, cognitive, and social capabilities and needs.

Life begins to come to its natural conclusion, resulting in the final life stage.

Contact info: info@nursesinternational.org

18 of 44

Physical Changes in Aging

Tyler, 2020

Heart muscles thicken with age
Arteries become less flexible
Lung capacity diminishes
Kidneys become less efficient
Bladder loses its ability to store urine
Brain cells also lose some functioning
Other changes in late adulthood include:

Body changes
Skin, Hair and Nails
Height and weight
Sarcopenia

Contact info: info@nursesinternational.org

19 of 44

Sensory Changes in Late Adulthood

Tyler, 2020

Vision:
Presbyopia, dry eyes, and problems seeing in dimmer light.
Cataracts are a clouding of the lens of the eye.
Macular degeneration (the loss of clarity in the center field of vision) due to the deterioration of the macula, the center of the retina.
Glaucoma (the loss of peripheral vision) frequently due to a buildup of fluid in the eye that damages the optic nerve.

Contact info: info@nursesinternational.org

20 of 44

Sensory Changes in Late Adulthood

Hearing:

Presbycusis is a common form of hearing loss in late adulthood that results in a gradual loss of hearing.
Tinnitus, a ringing, hissing, or roaring sound in the ears.

Taste and Smell:

Presbyopia: loss of smell due to aging.
Anosmia: Total loss of smell.

Touch: May reduced or changed sensations of vibration, cold, heat, pressure, or pain.
Pain: According to Molton and Terrill (2014), approximately 60%-75% of people over the age of 65 reports at least some chronic pain.

Tyler, 2020

Contact info: info@nursesinternational.org

21 of 44

Psychosocial Development in Late Adulthood

Erikson: Integrity vs. Despair:

This stage begins at approximately age 65 and ends at death.
During this stage, older adults reflect on their accomplishments and the person they have become.
If they feel they have led a successful life, they often feel satisfied and develop a sense of integrity.
Conversely, individuals who feel unsuccessful or do not feel they achieved their life goals often feel unsatisfied and may experience hopelessness and despair that can lead to depression.

Ernstmeyer, & Christman, 2021

Contact info: info@nursesinternational.org

22 of 44

Cognitive Development in Late Adulthood

Memory:

Changes in working Memory.
Changes in Long -term Memory.
Prospective memory rapidly declines: refers to remembering things we need to do in the future, such as remembering a doctor’s appointment next week or to take medication before bedtime.

Recall versus Recognition:

Older adults show roughly equivalent memory to young adults when assessed with a recognition task.
Starting at age 40 adults begin to show declines in recall memory compared to younger adults.

Tyler, 2020

Contact info: info@nursesinternational.org

23 of 44

Health Concerns in Late Adulthood

Tyler, 2020

Chronic Illnesses: Older women are more likely to have a chronic condition than are older men (83% vs. 88%) (CDC, 2009)

Cancer and Major Cardiovascular Disease (Stroke)
Heart Diseases
Arthritis
Osteoporosis
Kyphosis
Chronic Obstructive Pulmonary Disease (COPD)
Shingles
Parkinson’s disease
Alzheimer’s disease

Contact info: info@nursesinternational.org

24 of 44

Critical Thinking Question

What are the different challenges face by elderly people?

Contact info: info@nursesinternational.org

25 of 44

Challenges Facing the Elderly

Little, 2016

Declining Health
Loss of independence and
Social Isolation
Mistreatment and Abuse

A major social problem
Physical frailty renders elderly dependent on others for care (assistance with basic functions like eating and toileting).
Elder abuse: A caretaker intentionally deprives an older person of care or harms the person in his or her charge.

Caregivers can be family members, relatives, friends, health professionals, or employees of senior housing or nursing care.

Contact info: info@nursesinternational.org

26 of 44

Safety Issue of Late Adulthood

Baptist Health South Florida, 2021

Falls
Hypotension
Dizziness
Unsafe home environment
Loose carpets
Slippery tubs, showers and bathroom floors
Stairs
Bone Fractures
Osteoporosis

For the assessment of fall in detail can view this link: https://docs.google.com/presentation/d/1c4heRm8TsO5NaiJMOmdcU2O5pUgQRtN-/edit#slide=id.p1

Contact info: info@nursesinternational.org

27 of 44

Consideration in Late Adulthood

Retirement:

May experience a loss of identity when they retire because their work role was an important aspect of their life.

Social Isolation:

Retirement and the loss of daily interaction with coworkers, as well as death of family members and friends, can lead to social isolation in the aging population.

Modified Living Environment:

Modifications may be needed to the home environment to promote safety and independence.

Ernstmeyer, & Christman, 2021

Contact info: info@nursesinternational.org

28 of 44

Nurses Role in Caring for Older Adult

Assessment

Consider the potential impact of declining strength and physical functioning on their psychological status using Erikson’s developmental stage of “Integrity versus Despair.”

Consider the impact of chronic disease on their ability to function and complete Activities of Daily Living (ADLs).

Modification of communication techniques may require.

Ernstmeyer, & Christman, 2021

Contact info: info@nursesinternational.org

29 of 44

Nurses Role in Caring for Older Adult

Ernstmeyer, & Christman, 2021

Assessment:

The SPICES tool focuses on areas of common problems for aging individuals and can lead to early intervention and treatment
The SPICES tool includes assessment of the following:

S: Sleep Disorders
P: Problems with Eating or Feeding
I: Incontinence
C: Confusion
E: Evidence of Falls
S: Skin Breakdown

For more information and sample:

https://hign.org/sites/default/files/2020-06/Try_This_General_Assessment_1.pdf

Contact info: info@nursesinternational.org

30 of 44

Nurses Role in Caring for Older Adult

Unexpected Findings

Cardiovascular system: New hypertension, Orthostatic hypotension, Vital signs out of normal ranges, Chest pain; new onset or changes in oxygenation.
Respiratory system: Labored Breathing.
Musculoskeletal system: New changes in strength or mobility, Unexpected falls, Sudden onset of unilateral weakness, facial drooping, or slurred speech.
Endocrine system: Changes in sleep patterns, unintended weight changes, Blood glucose levels out of range.

Ernstmeyer, & Christman, 2021

Contact info: info@nursesinternational.org

31 of 44

Health Promotion for Older Adult

Older adults are at higher risk for chronic health problems like diabetes, osteoporosis, and Alzheimer’s disease
In addition, 1 in 3 older adults fall each year, with falls being a leading cause of injury for this age group
Older adults are also more likely to go to the hospital for infectious diseases such as pneumonia
Nurses can ensure older adults get:

Preventive care, including vaccines to protect against the flu and pneumonia

Ernstmeyer, & Christman, 2021

Contact info: info@nursesinternational.org

32 of 44

Health Promotion for Older Adult

Other goals for older adults established by Healthy People 2030

Early detection of dementia with appropriate intervention
Decreased hospitalization for urinary infections, falls, and pneumonia
Decreased incidence of medication-related safety issues
Improved physical activity
Improved oral health
Decreased complications of osteoporosis and
Reduced vision loss from macular degeneration

Ernstmeyer, & Christman, 2021

Contact info: info@nursesinternational.org

33 of 44

Health Promotion for Older Adult

Common areas of health promotion for older adults

Nutrition:

Chewing can be a problem if there are difficulties with dentition
Lack of oral care, missing teeth, or poorly fitting dentures can cause individuals to avoid intake of healthy foods
Finances often impact nutritional intake
Nurses can initiate referrals to social workers in assistance with financial or promote community resources such as Meals on Wheels or senior citizen meal site centers
Regular dental care should be encouraged when working with older adults

Ernstmeyer, & Christman, 2021

Contact info: info@nursesinternational.org

34 of 44

Health Promotion for Older Adult

Physical Activity:

Musculoskeletal problems, such as impaired balance and arthritis, can impair an individual’s ability to walk or participate in regular exercise
Helping older adults find appropriate ways to maintain activity is an important nursing intervention.
Nurses can advocate for the older adult by encouraging them to regularly attend health care checks with their provider and discuss concerns that limit their activity.

Ernstmeyer, & Christman, 2021

Contact info: info@nursesinternational.org

35 of 44

Health Promotion for Older Adult

Ernstmeyer, & Christman, 2021

Safe Medication Use:

Older adults take multiple medications for chronic diseases which increases a person’s risk of adverse medication effects.
Prescription of multiple medication make older adult confused when attempting to safely manage their daily use.
The nurse can assist with helping client develop medication administration routines/practices

Contact info: info@nursesinternational.org

36 of 44

Health Promotion for Older Adult

Nurses Role in Polypharmacy:

Discuss with patients the need to:

Keep an accurate list of all medications, including generic and brand names, dosages, dosing frequency, and reason for taking the drug.
Keep a complete list of medical providers and their contact information.
Post the name and telephone number of the local pharmacy Instruction.

Azhagesan, 2017

Contact info: info@nursesinternational.org

37 of 44

Health Promotion for Older Adult

Nurses Role in Polypharmacy:

Teach patients about:

Each medication, including its name, appearance, purpose, and effects.
Potential adverse effects and interactions of each medication.
Importance of contacting the healthcare provider with concerns or questions.
Potential drug-related problems that warrant emergency care Importance of taking medications exactly as directed Importance of using only one pharmacy to obtain drugs.

Azhagesan, 2017

Contact info: info@nursesinternational.org

38 of 44

Health Promotion for Older Adult

Psychosocial Well-Being:

Often experience loss of significant others, family members, and friends which increases the risk for social isolation and depression.
Poor mobility and transportation issues can also add to social isolation.
Male older adults experience multiple losses, their risk for suicide increases.
Nurses can provide information about community resources and outreach programs to promote social interaction for individuals experiencing isolation.

Ernstmeyer, & Christman, 2021

Contact info: info@nursesinternational.org

39 of 44

Health Promotion for Older Adult

Nurses can support older adults in maintaining a positive self-image.

Respect and provide empathy for the older person.

Assist older adults in developing a sense of integrity by encouraging the client to reminiscence about previous positive life events and relationships and cultivate a positive mindset of guiding the next generation.

Assist older adults by personalizing health self-management strategies that emphasize their existing skill sets and knowledge.

Ernstmeyer, & Christman, 2021

Contact info: info@nursesinternational.org

40 of 44

Adapting Client Education

Modify education methods depending on the individual’s knowledge, skills, and abilities.

Provide verbal, written, or electronic resources as needed, while cnsidering any sensory, cognitive, or functional impairments.

The goal of client education is to:

improve their understanding, motivation, and engagement in self-management and promote their quality of life.

Ernstmeyer, & Christman, 2021

Contact info: info@nursesinternational.org

41 of 44

Case Study

Mr. Yang is an 87-year-old client admitted to the medical surgical floor due to a recent fall at home. His wife reports that the client has become increasingly frail and unsteady. Utilizing the SPICES tool, develop a list of assessment questions for Mr. Yang to determine potential problems.

Contact info: info@nursesinternational.org

Sleep: What length of rest periods do you have during the night? Do you rise frequently? How many times per night? Do you nap during the day? Where do you sleep?

Problem with Eating: Do you notice difficulty swallowing foods or beverages? Do you choke after swallowing? Do you ever experience a sensation of food being caught in the throat?

Do you experience frequent urination? Do you feel a sense of urgency or that you will not reach the bathroom in time to void? Do you feel that you are able to empty your bladder completely?

Who are you? Where are you? Who is the President? Do you ever experience difficulty remembering why you entered a certain room? Do you find yourself forgetting things or people you previously knew? Do your loved ones report that you have memory issues?

Have you experienced a recent fall? What are the bruises on your arms or legs attributed to? Do you feel unsteady or stumble when first arising out of bed?

Do you have any open areas on your skin? Do you have areas of redness that do not go away? Are you able to reposition yourself frequently or do you rely on the assistance of others?

42 of 44

References:

Azhagesan, c.(2017). Nurses Role in Polypharmacy. Nursing Healthcare and International Journal. Medwin Publisher. https://medwinpublishers.com/NHIJ/NHIJ16000123.pdf

Baptist Health South Florida, (2021). Care of Middle Adult 40 yrs-65 yrs. https://baptisthealth.net/search?query=care+for+middle+adult&referrerPageUrl=https%3A%2F%2Fbaptisthealth.net%2Fen

Ernstmeyer, K., & Christman, E. (Eds.). (2021). Open RN Nursing Fundamentals by Chippewa Valley Technical College is licensed under CC BY 4.0.

Contact info: info@nursesinternational.org

43 of 44

References:

Little, W. 2016. Introduction to Sociology-2nd Canadian Edition under a Creative Commons Attribution 4.0 International License, except where otherwise noted. https://opentextbc.ca/introductiontosociology2ndedition/

Stangor, C., & Walinga, J. (2014).Introduction to Psychology – 1st Canadian Edition licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. https://opentextbc.ca/introductiontopsychology/

Tyler, S. (2020). Human Behavior and the Social Environment I. licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. https://uark.pressbooks.pub/hbse1/

Contact info: info@nursesinternational.org

44 of 44

Please go to

My Learning Experience

to provide feedback on your experience.

Thank you, and come back soon!

Contact info: info@nursesinternational.org