Learning Objectives
By the end of this section, you will be able to:
- Identify growth and development patterns for the older adult
- Explain how individuals adjust to the changes of older adulthood
During older adulthood, individuals experience physiological, psychological, and psychosocial changes. Physiological changes often result in physical changes that older adult (adults 65 years of age or older) can feel and see. When physiological and physical changes manifest in declining health status or progression of chronic diseases, these changes also affect psychological well-being and social interactions. These individual changes may alter how older adults interact with others, function in the community, and maintain a sense of belonging. Older adults may struggle with discrimination based on one’s age, new or progressive diseases, and cognitive changes. Adjusting to these many changes requires resiliency to maintain a sense of individual health.
Older Adult Stage
Older individuals undergo a range of physiological, physical, and psychological transformations. These may have little effect on older adults’ day-to-day life or on how they function. For older adults, these developmental changes are often accentuated by underlying health problems and may contribute to worsening overall health. Changes that are physiological are those bodily functions happening at a cellular level, and the presence of chronic disease also plays a role in the psychological changes that older adults experience. Changes that are psychological are those relating to the mind and emotions. The psychosocial factors relate to interactions between individuals, such as relationship changes, financial issues, living situations, and SDOHs. These factors interplay with physical and psychological changes to create challenges and rewards for older adults.
Physiological Development
Older adults experience a wide range of physical changes that are outward expressions of change in the body during this developmental period. In addition to visible physical changes, older adults experience internal physiological changes that affect metabolism, energy level, hormone balance, and disease progression (Table 41.1). Physical developmental changes in older adults affect every organ system in the body. Nurses can anticipate many typical and expected physical changes in older adults; though, each individual progresses through physiological and physical changes at a different rate.
| Organ System | Expected Physiological Changes | Possible Physical Changes |
|---|---|---|
| Cardiovascular |
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| Respiratory |
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| Musculoskeletal |
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| Genitourinary |
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| Gastrointestinal |
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| Integumentary |
|
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| Endocrine |
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| Immune |
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| Sensory |
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| Reproductive |
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Psychological Development
Psychological changes vary widely in older adults. Psychological transitions relate to accepting the aging process, the development of acute or progressive cognitive impairments, and the occurrence of mental health disorders. According to the National Institute on Aging (2021), some cognitive impairments are related to acute medical issues, while others develop into progressive loss of brain function resulting in cognitive decline, known as dementia. Psychological problems may also develop in response to grief and loss. These include loneliness, anxiety, and depression. Other triggers for depression include changing body image, decreased social interaction, decreased physical activity level, loss of driving ability, chronic health conditions, and medications.
Psychosocial Development
Psychosocial changes in older adults vary depending on health and social circumstances and relate to adjustments in changing family and community dynamics. Social factors that may affect psychosocial interactions include changes in living situations, death of family or friends, and the effects of ageism (a form of prejudice and stereotyping related to a person’s chronological age) in the community. Health factors such as decreased mobility, chronic disease, and cognitive decline can negatively impact social interactions with others. Psychosocial changes can also be triggered by retirement. Worrying regarding retirement timing and long-term financial security is common in older adults. Retirement and changes in work abilities also correlate with ageism and societal retirement pressures.
As an individual progresses through adulthood, psychosocial factors also relate to relationships with children and significant others and may involve role reversal, a circumstance where children take on the role of caregiver, and older adults take on a more dependent role. Individuals with many health issues require frequent assistance from family and other caregivers for many years, while others live independently and without assistance until very old age. Role reversal can be challenging for the older adult and for the children who provide care. Role reversal is not a universal transition in older adulthood. Older adults without children or those with strained parent-child relationships may not have the option for direct family care. In many families, children may not have the time, resources, or proximity to provide individual care to their aging parent. In these cases, older adults do not experience role reversal but may experience strain regarding securing the necessary resources and care.
Life-Stage Context
Role Reversal and the Aging Adult
The concept of role reversal between older adults and their adult children is complex and challenging. Role reversal is the idea that a child takes on a parenting role while a parent takes on a child’s role. Caring for an aging parent, particularly one with dementia or other chronic illnesses requiring intense physical or emotional caregiving, may seem like a role reversal. While it might appear as a role reversal, with the child now taking on a caregiving role for their parent, some experts argue that this is not a role reversal. Instead, they propose the concept of a role shift, emphasizing the older adult’s identity as a parent and the caregiver’s identity as a child are maintained. In this way, it acknowledges a change in responsibilities without completely altering the fundamental identities within the parent-child relationship. Nurses must maintain caution when thinking of care in a role-reversal pattern, as it can inadvertently remove dignity and respect from the older adult who has lived a full and complex life. Think of this as providing respectful care rather than “parenting” the older adult.
Adjusting to Changes in Older Adulthood
Older adults make conscious and unconscious changes in their daily lives to cope with the physical, psychological, and psychosocial changes that face them. Some changes are progressive, requiring permanent alterations in lifestyle, while others are temporary, requiring in-the-moment coping mechanisms. Progressive changes, such as muscle loss, pain, and cognitive decline, require individuals to make adaptations including using assistive devices in their home, relying on others for transportation, and using outside caregiver services. More temporary changes, such as an illness, injury, or death of a family member, may require short-term coping mechanisms, such as attending physical therapy, adjusting to facilitate the healing process, and coping with acute grief.
Strength and Mobility
Older adults can maintain strength and mobility through intentional, continued physical activity and strength training. However, many older adults experience a progressive decline in mobility related to joint pain related to arthritis, reduced flexibility, and changes in bone structure, which can increase their risk of falls. Older adults can adapt to these changes by recognizing early signs of mobility decline and maintaining daily physical movement, adapting physical exercise to fit their abilities. Maintaining bone health is also crucial and can be achieved through exercise and good nutrition. Weight-bearing activities such as walking, jogging, dancing, and resistance training stimulate bone remodeling and help prevent bone loss. Adequate intake of calcium and vitamin D is essential for maintaining strong and healthy bones. Dairy products, leafy green vegetables, fortified foods, and supplements can be valuable sources of these nutrients.
Older adults may experience varying levels of pain and fatigue. While pain may relate to prior injuries, joint deterioration, or chronic diseases, maintaining strength and mobility can limit the effect of pain in day-to-day life. A sedentary lifestyle either beginning in older adulthood or continuing through life leads to an overall loss of muscle strength and muscle mass that can in turn lead to generalized fatigue. Efforts to maximize mobility within their individual ability can help reduce pain and fatigue.
Nutrition
Many changes develop for older adults surrounding nutrition. Changes associated with older adulthood that affect nutrition include the following:
- decreased hunger sensation
- decreased appetite
- decreased taste sensation
- decreased thirst response
- change in nutrient absorption
- decline in oral health
Changes in dietary habits can have cascading effects on the functioning and health of multiple organ systems, such as the heart, kidneys, and liver. Older adults can focus on incorporating functional foods to boost nutrition, maintain vitamin and mineral intake, regulate elimination, improve skin integrity, and increase energy levels (Jones, 2002). These functional foods are nutrient-dense foods that benefit health and functioning in ways other than maintaining calorie and energy intake and include such foods as fruits, vegetables, yogurt, and nuts (Jones, 2002; Temple, 2022). For example, fruits not only provide simple sugars, fluid, and calories for nutrition, but they also provide additional benefits in the form of soluble fiber that promotes healthy digestion and elimination. Yogurt and other fermented foods provide healthy caloric intake but also provide probiotic cultures to help maintain healthy intestinal microbial balance (Leeuwendaal et al., 2022).
Cognition
Older adults must adapt to psychological and cognitive changes. Individuals experiencing mild cognitive impairment (MCI), which is prevalent in older adults, present with forgetfulness, short-term memory loss, and thinking impairment, such as difficulty recalling names or words. Mild cognitive impairment affects self-esteem, independence, social interactions, and an individual’s ability to perform self-care. It is often distressing to older adults. The National Institute on Aging (2021) explains that in some individuals, MCI may progress to worsening or progressive dementia, particularly in those with multiple chronic health conditions. However, not all MCI is progressive, and older adults in good health can minimize the effects of MCI by maintaining an active lifestyle, interacting in social situations, reading, and learning skills.
Retirement and Finances
As adults move through the aging process, they notice both social and financial changes that affect their daily lives. Retirement is a turning point for many adults that can significantly change how they see themselves and their societal value. For some, retirement signifies the end of a career and a time to enjoy more time with family and hobbies. Others may find retirement lonely or need more direction and focus. This can lead to depression if older adults do not have a support system. Financial changes include modifying spending patterns, revising budgets to align with savings goals, and making adjustments to accommodate changes in tax situations. Many older adults struggle financially and depend on government aid to maintain their expected lifestyle. The cost of prescriptions may increase if chronic diseases progress, leading to the need for additional medications, or if newer, more expensive medications become necessary for the treatment of the disease. Some seniors may need to decide between food and medication purchases. As a result, they may cut pills in half to save money, only to worsen their disease/illness.
Relationships and Grief
Relationships change drastically during the later adult stage of life. Some older adults may find that they rely on their children for assistance. Others may find great joy in providing care for young grandchildren. In addition, as generations age, older adults experience more loss of same-age counterparts in their friend groups and extended family. The death of a spouse, friends, and family are often significant turning points for many older adults. Older adults must learn to cope with grief and learn the signs of depression to get help when needed.
Ageism and Stereotypes
Ageism is a form of prejudice and stereotyping related to a person’s chronological age. Ageism can apply at any age but is most common in older and younger adults. Ageism has negative effects on the developmental changes of older adults and can lead to the following:
- anxiety
- increased mortality risk
- slower recovery time
- poor mental health
- depression
By respecting older adults and monitoring their behavior during interactions to avoid talking down to them or using oversimplified speech not required for them to understand, nurses create an environment of mutual respect between older adults and nurses. Experiencing a sense of respect within the community helps older adults maintain autonomy, independence, and a sense of belonging and purpose. Ageism can also be a self-directed sense of diminished self-worth due to aging. In this context, ageism is not just imposed by others; it can also manifest as an individual’s own sense of reduced self-worth or value attributed to the aging process. It highlights the impact of societal attitudes and stereotypes about aging on an individual’s self-perception and self-esteem, contributing to a negative view of one’s worth as they grow older. Nurses can help individuals recognize their value, encouraging others to see them as functioning members of society.
Patient Conversations
Addressing Ageism
Scenario: Jane is an active 73-year-old who enjoys swimming, hiking, walking her dog, and volunteering at the animal shelter. She follows up for her annual wellness exams and screening tests but takes no prescription medications. Darien works as a nurse in the primary care medical office, where Jane is a patient. While Darien measures her vital signs, Jane brings up a struggle she is experiencing.
Nurse: Do you have any specific questions for the healthcare provider today?
Patient: I have been struggling with some poor attitudes at my volunteer job lately. Some of the younger employees seem to think I can’t properly care for the animals. They say I should not be outside on the walking trails with the dogs for fear of falling.
Nurse: I can understand why this is distressing for you, considering how active and strong you are. You are likely experiencing ageism, which is when someone is stereotyped based on their age. This is unfortunate, but there are a few things that you can do to help others understand that all people age differently, and older age does not mean frailty.
Patient: Great, I’d love to hear your tips.
Nurse: First, by understanding your coworkers and their values, you can create a stronger bond, especially since you have a common bond of affection for animals. Second, putting yourself in the position of a mentor will significantly improve their respect for you. Give them great tips to help them interact with a difficult animal or the trick to get the shy cat to curl up in their lap. Another idea is to be very vocal about your active lifestyle and how walking the animals helps keep you strong and fit. By remaining positive and curious, you’ll show by example that older adults are happy, open, and able to learn. You may also be able to connect with some of your youngest coworkers by being conscious of ageism toward younger adults and always showing respect for these younger individuals.