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Course: Mental Health Nursing

Topic: The Psychological Needs of the Aging Population

The Nurses International Community

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COPYRIGHT

NI Privacy Policy and Terms of Use.

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Module Goals

Learners will be able to:

Discuss the theories of aging.
Discuss the biological, social and psychological aspects of aging.
Explain the benefit of reminiscence therapy and life review with the elderly.
Describe the various cultural considerations of the elderly.
Describe the nurse’s role in supporting individual’s adaptation to the aging process.

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Aging

The older adult population is growing rapidly globally.
Adults with serious mental illness over age 50 have high rates of comorbid medical conditions.
Have increased life expectancy and are more likely to be admitted to nursing homes and other long-term care facilities.
As the older adult population increases, the need for behavioral health services and systems to serve the aging population will continue to increase.

de Mendonça & Ivbijaro, 2013

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The Aging Process

Not defined by the number to years person has been living.
Associated with biological, environmental, behavioural changes, changes in social supports and networks.
Vulnerability increases.
Experiences life events associated with grief, loss, social isolation, cognitive and sensory impairment.

Substance Abuse and Mental Health Services Administration -SAMHSA, 2021

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The Aging Process

Process differs with the individual and is influenced by genetics, environment, diet, trauma ad lifestyle.
Are more prone to serious mental illness.
Greater exposure to trauma, increased risk of suicide.
Policies and practice considering determinants of health improves the health and wellbeing of older population.

Substance Abuse and Mental Health Services Administration -SAMHSA, 2021

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Aging Theory

Modern biological theories of aging:

Programmed Theories: Aging follows a biological timetable and is a natural process that is already programmed in our body.
Damage or error theories: Due to the assaults from environment which cause cumulative damage at the various level of life.

Jin, 2010

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Aging Theory: The Programmed Theory

Three sub-categories:

Programmed Longevity: Aging is the result of switching on and off of certain genes (genetic instability) in a sequence.
Endocrine Theory: Aging is regulated by different hormones in our body.
Immunological Theory: Body’s immune system declines over time which increases vulnerability to the environment, infections which cause age and death.

Jin, 2010

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Aging Theory: Damage or Error Theory

The damage or error theory include

Wear and Tear Theory: Cells and tissues eventually wear out from repeated use leading to age and eventually death.
Rate of Living Theory: Greater the use of oxygen basal metabolism shortens cell life.
Cross-linking Theory: Accumulation of cross-linked proteins or cross-linking reactions damages cells and tissues, slowing down bodily processes resulting in aging.

Jin, 2010

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Aging Theory: Damage or Error Theory

Free Radicals Theory: Superoxide and other free radicals in the environment cause damage to the macromolecular components of the cell, damages cells, and organs, to stop functioning.
Somatic DNA Damage Theory: Genetic mutations occur and accumulate with increasing age, causing cells to deteriorate and malfunction, aging results from damage to the genetic integrity of the body’s cells.

(Jin, 2010)

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Global Key Facts: Aging

The elderly population is rising rapidly.
The population of over 60 years will double by 2050.
Mental and neurological disorders among older adults account for 6.6% of the total disability for this age group.
55 million people live with dementia worldwide, and there are nearly 10 million new cases every year.

WHO, 2017

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Global Key Facts: Aging

Mental health and well-being are as important in older age as at any other time of life.
Approx 15% of adults aged 60 and over suffer from a mental disorder.
Depression is the most common mental health problem in older people and suicide rate tends to be higher.

WHO, 2017

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What Would a Nurse Do?

A client who is a professional model came to the clinic and said “Applying vitamin C serum on skin prevents aging.”

To what theory would the nurse attribute this statement?

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Biological Aspect of Aging

Each person experiences age-related changes based on multiple factors.

Primary Aging: Caused by non controllable biological factors such as molecular and cellular changes.

Secondary Aging: Caused due to controllable factors such as lack of physical exercise and poor diet.

Little, 2014

University of Minnesota Libraries Publishing, 2016

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Biological Aspect of Aging

Decline in functionality and quality of life
Impaired gait, balance, and physical strength
Low bone density, prone to fracture
Low metabolism, loss of appetite and digestion problems
Loss of bladder control
Might develop vision and hearing difficulties
Loss of teeth
Decreased sexual function
Skin becomes thinner, drier and less elastic, wrinkles
Hair thins and turn grey
Men prone to balding

Little, 2014

University of Minnesota Libraries Publishing, 2016

Contact info: info@nursesinternational.org

The effects of aging can feel daunting, and sometimes the fear of physical changes. The way people perceive physical aging is largely dependent on how they were socialized. If people can accept the changes in their bodies as a natural process of aging, the changes will not seem as frightening.

Now, we will review the physiological changes related to the aging process system by system. Generally, all of these changes are decreases, rather than increases, of functioning.

Sensory and neurological changes: Sensory and neurological changes include decreased vision, hearing, smell and touch, lowered reaction times and night blindness.
Cardiovascular system changes: Cardiac changes include decreases in cardiac output, stroke volume, venous return, and the cardiac output.
Musculoskeletal system changes: Musculoskeletal changes include decreased muscular tone and strength, the degeneration of joints and bones as the result of decalcification, and decreased intervertebral disc spaces which lead to some loss of height among the elderly.
Renal changes: Renal function among the elderly is also affected with aging. Some of these changes include decreased renal size, decreased renal blood supply, decreased creatinine clearance, decreased glomerular functioning, and decreased tubular functioning.
Hepatic function changes: Liver function is also altered as the result of the normal aging process. There is decreased hepatic blood flow and functioning. This change reduces hepatic metabolism and it can increase the concentrations of medications in the client’s body.
Integumentary system changes: Integumentary, skin, changes include the loss of skin turgor and elasticity, thinning and increased fragility of the skin, dry skin and hair, the presence of wrinkles, "age spots" and skin tags on the skin, faded and grey hair, thicker ear and nasal hair, thicker nails, and diminished sweat gland activity.
Respiratory system: Age related respiratory changes include decreases in lung expansion and air exchanges, dry and more fragile mucous membranes, a diminished cough reflex, and a decrease in the efficiency of the body's natural protective immune system which may place elders at greater risk for respiratory infections than their younger counterparts.
Changes in fluid and electrolyte balances: Some fluid and electrolyte alterations associated with the aging process are imbalances secondary to the decreased function of those hormones that regulate fluids and electrolytes, impaired thirst sensation, more diluted urine, and changes in the amount of total body water and intracellular fluids.

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Social and Psychological Aspect of Aging

Retirement
May retire, seek new hobbies/interests/forms of creations
Many find new groups and explore new activities
Others may find it difficult to adapt, loss of social roles and sense self worth
Each phase has challenges and fears
Challenge to embrace integrity over despair
Death of a spouse
Loss of independence
Abuse and maltreatment
Mental health conditions

Little, 2014

University of Minnesota Libraries Publishing, 2016

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Critical Thinking Question

Select the option that correctly describes the impact of aging on the human body:

Decreases in cardiac output, stroke volume, venous return, and the cardiac output
Impaired thirst sensation, more diluted urine
High metabolism, loss of appetite, digestion problems
Many find new groups and explore new activities

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Graying Society

Important life changes may make one feel uneasy, stressed, or sad.
These changes may include the death of a loved one, retirement, or dealing with a serious illness.
Many older adults will eventually adjust to the changes while others will have more trouble .
This may put them at risk for mental disorders such as depression and anxiety.

MedlinePlus, 2021

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Factors Affecting Mental Health in Later Life

Bereavement
Retirement
Loneliness
Physical Illness and disabilities
Dependency

Mental Health Foundation, 2021

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Retirement: Comes with the sense of loss (identity, social life, friend circle, colleagues), being old. It might also change the way one looks at theri life, relationship with partner while spending more time together.

Bereavement: Loss of anyone’s life can easily make one feel sad and the death of someone close to (partner/spouse) may make life devastating. Grief can affect us physically, mentally. People might feel crippled, hopeless and some people might even develop mental health issues.

Physical illness or disability: Being unable to perform activities of daily lives, not being able to walk or get out of bed without any pain or support, being unable to think properly, have sad feelings, being anxious can greatly affect the way we live our lives. Being physically and mentally weak effects the quality of life.

Medication: In old age, people tend to take more medications. Medications come with side effects like nausea, weakness, muscle weakness, loss of appetite, low mood, confusion.

Loneliness: Life becomes hard when one of the partner loses the spouse/partner, during old age most the people are left alone (children might have moved out/might have outlived children) generation gaps, thinking difference can make a person feel lonely.

Becoming a carer: Sometimes elderly becomes carer for the grandchildren or even their other partner which can make their life more exhausting.

Dependency: Elderly people become more vulnerable to any changes, life events. They have to depend on other for simple basic things like walking to washroom, feeding which might give them sense of being burden.

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Factors Affecting Mental Health in Later Life

The above factors may lead to major mental health problems:

Dementia
Depression
Alcohol Misuse

Mental Health Foundation, 2021

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Reminiscence Therapy and Life Review

Most basic therapy.
Involves the discussion of past events, activities, experiences.
Uses tangible prompts like: photographs, music, videos, recorded sounds, objects.
Done in a group on one’s own.
Helps older people with depression.
May be suitable for people with dementia because long term memory is active in dementia clients.

Woods et al., 2018

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Benefits of Reminiscence Therapy and Life Review

Benefits can be long reaching

Helps to retrieve the link of familiarity
Preserves memories and brings family closer
Improves the quality of life, promotes physical health
Reduces symptoms of depression
Works through unresolved conflicts
Eliminates boredom and provides distraction
Improves communication skills
Reduces stress
Enhances self-Esteem

Cemental, n.d

Walsh, 2017

Contact info: info@nursesinternational.org

Helps to connect the rope of familiarity: In older age, life becomes overwhelming and people remain isolated from their identities and memories. Therefore, recalling memories and life might help them connect with memories and they may find themselves back.
Preserves memories and brings family closer: People Share memories with their family, therefore recalling the past events, activities and memories brings the family members closer. In addition to that recalling past experience help some valuable memories and experience to pass the the next generation.
Improves the quality of life: Elderly population who are able to recall the memories from the past can help them remind that once they live a very young life with a value added to it. It helps them to look their life from different dimension. Recalling achievements, success, brighter memories can help make them feel better and see the brighter side of the life. It also help them to share their stories to others and maintain a balance life.
Reduces Symptoms of Depression: Reflecting the life can give a great sense of accomplishment, satisfaction. While they remain busy sharing and recalling those memories often help them get distracted from the problems (physical, medical) and increases the self esteem.
Promotes Physical Health: Research have shown that client who recall the past are often found to be less worrying about medical conditions and often tend to have lowered blood pressure and heart rates.
Works Through Unresolved Conflicts: Looking back on old conflicts in their lives can help seniors find closure. After reviewing past experiences with a more mature understanding, many people can move forward to live in a more healthy present.
Eliminates Boredom and find a way to distractions : Often recalling life stories, events, memories can give a good feelings which eliminates boredom. Memories brings laughter, joy, sense of belonging.It is a good way to pass time at the age when someone is less mobile or is living in a nursing homes. Sometimes it also creates a space to communicate and share the stories with others, make new friends.
Improves Communication Skills: Sharing stories and event enhance the communication skills. When a client shares the stories they share the emotion attached to them as well. Research have shown that calling events creates a new pathways that helps with communication.
Reduces Stress: Recalling the life with someone help them to recall the success, achievements, laughter, happiness. Similarly it also help a person to verbalize the hidden positive or negative emotions, conflicts through stories or events and realize a new perspective of resolving those unsolved conflicts (if any).
Enhances Self-Esteem: Sharing past helps seniors to reflect their whole life that includes success, achievements, travels, appreciations. It also help them realize how much they have achieved in their life. Which might make them feel important, valued and capable. And attentively listening their life events make them feel important and valued and remain eager to share what they have lived.

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Activities that Promote Reminiscence

Looking at a scrapbook.
Looking at old photographs, family pictures, old magazines.
Listening to favorite music.
Smell of familiar scents, perfumes.
Watching old movies, TV shows, songs, videos.
Watching recorded videos.
Reconnecting with the activities that was loved once i.e. painting, drawing, knitting.

Geller, 2021

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Critical Thinking Question

Think about an older person who you know.

To what extent has this person experienced psychological aging?
To what extent has this person experienced social aging?
To what extent has this person experienced physiological aging?
Would you consider this person has achieved successful aging?

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Aging and Culture

The difficulty or relative ease with which people adapt to these changes is dependent in part on the meaning given to aging by their particular culture.
A culture that values youthfulness and beauty above all else leads to a negative perception of growing old.
A culture that reveres the elderly for their life experience and wisdom contributes to a more positive perception of what it means to grow old.

Little, 2014

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Aging and Culture

Highly respected members of the family in some cultures
Often heavily influence the decisions made within the extended family.
May serve as primary caretaker for grandchildren.
In some cultures the family will take care of ill or elderly relatives and friends at home.
In other cultures care may be provided in institutions.
Cultural competence may help to better meet the needs of diverse aging populations.
In some cultures, elderly are revered for their emotional intelligence, knowledge and wisdom.

Little, 2014

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Nurse’s Role in Supporting Healthy Aging Process

Provide person centred care:

Present in a very professional manner, incorporate values and expectations about the physical and mental aging.
Practice care that is culturally competent and foster an open and honest relationship.
Promote health and wellbeing of individuals and families to address any health inequity.

Australian College of Nursing, 2019

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Nurse’s Role in Supporting Healthy Aging Process

Promote and demonstrate a positive view of aging.
Maximize the health outcomes through knowledge of aging process, age related conditions, illnesses.
Demonstrate respect and empathy for the older clients.
Communicate effectively; use verbal, non verbal communication styles.
Assess the barriers to receiving and providing information.
Acknowledge and accept individual differences.
Promote reflective practice skills.

Australian College of Nursing, 2019

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Nurse’s Role in Supporting Healthy Aging Process

Maintain knowledge of the age care systems and available resources and services.
Recognize the complex acute, chronic, comorbid physical and mental conditions associated to the older adults.
Perform comprehensive assessments.
Acquire skills to provide optimal pain management and palliative care.

Australian College of Nursing, 2019

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Nurse’s Role in Supporting Healthy Aging Process

Assess the living environment and community of the older adult for meeting functional, physical, cognitive, psychological and social needs.
Empower the client.
Prevent, identify and manage geriatric syndromes.
Implement strategies to promote safe and quality care.
Minimize or prevent risks.
Promote physical, mental, spiritual and functional well being by utilizing available resources.
Advocate for the client as needed.

Australian College of Nursing, 2019

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Critical Thinking Question

Recall a moment where you have tried reminiscence to encourage yourself

Explain when and how did you apply it.
Explain how it helped you.

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Red Flags

Physical or cognitive decline associated with impaired functioning or disability is not a normal part of the aging process.

While the rates of some chronic physical or mental conditions, such as arthritis or dementia, depression, increase with age, these conditions should not be viewed as a normal part of aging.

Substance Abuse and Mental Health Services Administration -SAMHSA, 2021

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Red Flags

Changes in mood or energy level
A change in eating or sleeping habits
Withdrawing from the people and activities one enjoy
Feeling unusually confused, forgetful, angry, upset, worried, or scared
Feeling numb or like nothing matters
Having unexplained aches and pains
Feeling sadness or hopelessness
Smoking, drinking, or using drugs more than usual
Anger, irritability, or aggressiveness
Having thoughts and memories that one can't get out of one’s head
Hearing voices or believing things that are not true
Thinking of harming oneself or others

MedlinePlus, 2021

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References

Australian College of Nursing (ACN). 2019, ‘The role of nurses in promoting healthy ageing – Position Statement’, ACN, Canberra.

Cemental, R. (n.d). Caring Senior Service: 9 Reasons Why Reminiscing Can Benefit Seniors. https://www.caringseniorservice.com/blog/9-reasons-why-reminiscing-can-benefit-seniors

de Mendonça Lima, C. A., & Ivbijaro, G. (2013). Mental health and wellbeing of older people: opportunities and challenges. Mental health in family medicine, 10(3), 125–127.

Jin K. (2010). Modern Biological Theories of Aging. Aging and disease, 1(2), 72–74.

Geller, H. (April 1, 2021). Elder Care Alliance: Benefits of Reminiscence Therapy for the Aging. https://eldercarealliance.org/blog/benefits-of-reminiscence-therapy/

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References

Little, W. (2014). Introduction to Sociology – 1st Canadian Edition. Victoria, B.C.: BCcampus. https://opentextbc.ca/introductiontosociology/

MedlinePlus. (2021). Health Topics: Older Adult Mental Health Condition. https://medlineplus.gov/olderadultmentalhealth.html

Mental Health foundation. (August 23, 2021). Mental Health in later Life. https://www.mentalhealth.org.uk/a-to-z/m/mental-health-later-life

Substance Abuse and Mental Health Services Administration (SAMHSA). Psychosocial Interventions for Older Adults With Serious Mental Illness. SAMHSA Publication No. PEP21-06-05-001. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2021.

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References

Walsh, D. (2017). Hospice of Southwest Ohio: The benefits of reminiscence therapy for seniors. https://www.hswo.org/news/the-benefits-of-reminiscence-therapy-for-seniors

Woods, B., O'Philbin, L., Farrell, E. M., Spector, A. E., & Orrell, M. (2018). Reminiscence therapy for dementia. The Cochrane database of systematic reviews, 3(3), CD001120. https://doi.org/10.1002/14651858.CD001120.pub3

World Health organization. (2017). Mental health of older adults. https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults

University of Minnesota Libraries Publishing. (2016). Social Problems. By University of Minnesota, licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. https://open.lib.umn.edu/socialproblems/part/chapter-6-aging-and-ageism/

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