HLTEN 515A

1. HLTEN 515A DELIVER NURSING CARE TO OLDER CLIENTS

2. Session one Introduction to the Unit and subject overview & assessment requirements Self reflection/attitudes towards aging exercise activity & discussion Demographics and social impact Positive aging

3. ALWAYS REMEMBER Contained within the body of a frail elderly person is a 25 year old trying to get out

4. ….contained within the body of a frail elderly person is a 25 year old trying to get out

5. Definitions of ageing • The words “ageing” & “old age” are highly subjective. • “Ageing” is defined as the time from birth to the present for a living individual. • “Old” is defined as having lived for a long time & often it is synonymous with negative terms such as “antiquated” & “ancient”

6. Life expectancy Life expectancy is defined as the predictable length of time that one is expected to live from a specific point in time e.g. from birth. Life Span is defined as the maximum survival potential for a species, for humans the life span is between 110 & 120 years

7. Workbook activity: • Your attitudes about ageing- complete the following statements: • A person can be considered old when… • When I think about getting old… • Growing old means… • When I grow old I will lose my… • Seeing an old person makes me feel… • Old people always… • Old people should… • The best thing about getting old is… • The worst thing about getting old is…

8. The Ageing process The ageing process is complex & can be described as: - • Chronologicalage – age in years the person has lived (commonly used objective data). In Australia 65 is the accepted age for becoming a senior citizen – today many people are challenging this determination.

9. The Ageing process • Physiological age –determined by body function. Although age-related changes effect every person, it is not possible to pinpoint when these changes actually occur. • It is not a useful method of determining age

10. The Ageing process • Functional age – this refers to a person’s ability to actively contribute to society & benefit him/herself & others. • This is based on the fact that not all individuals of the same chronological age function at the same level.

11. The Ageing process • Psychological age — a person’s ability to adapt that is shaped by emotions, intellectual capacity and motivation. How old do you feel?? • Social age — Society’s expectation for a particular age group – see next slide

12. World Masters Games Sydney 2009 12

13. The Ageing process • Ageing is a normal process, accompanied by changes in body structure and function • No two people age at exactly the same rate or in exactly the same way. • The effects of ageing differs widely. While approximately 85% of older adults experience chronic conditions, only about 20% experience significant impairment in their ability to function.

14. Ageing process • Some people may be chronologically older but remain physically fit, mentally active & productive members of society on the other hand • Others may be chronologically young, but physically or functionally old.

15. Characteristics common to the frail elderly Often include:- • Poor mental & physical health • Low socioeconomic status • Predominantly female • Possibly isolated living conditions • More & longer lengths of stay in hospital • More money spent on health care & medication/s

16. Demographics / stats • Fastest growing population group • Life expectancy of about 120 not increased • 1935 life expectancy • Males: 64, Females: 69 • In 2004, life expectancy was 78.1 years for men and 83 years for women • 2004 life expectancy (agedcareconnect.com.au.) • Males 78.1, Females 83 • 76% of all elderly living alone are single or women

17. Demographics / stats • 1900 – 4% of Australians over 65 • 2004 – 13% of Australians over 65 • 1.9 million people were aged 70 and over • 1.5% of Australians over 85 • 2050 – 26% of Australians over 65 • 6-8% of Australians over 85 • Over the next 20 years the number of Australians who are 70 and over will grow at a rate 3.3 times faster than the total population.

18. Demographics / stats • The male retirement age of 65 was set in 1909, when the average male lifespan was around 58 years • Between 1980 and 2005, the total number of age pensioners increased from 1.3 million to 1.9 million. Currently, almost 78 per cent of people of Age Pension age receive the full or partial Age Pension (or service pension equivalent).

19. Demographics / stats • A person aged 70 has a 36 per cent chance of needing high-level aged care during his/her life In 2004–05 the occupancy rate for aged care homes was 95.3 per cent. • At 30 June 2005 the average age of residents was 83.5 years. • The average length of stay is 34.4 months, with 37 per cent of people staying less than 1 year, and 20 per cent staying more than 5 years

20. Demographics / stats • Up to 200,000 people aged over 65 are estimated to have some form of dementia. This is expected to rise to around 265,000 by 2020 and 500,000 by 2050 • Dementia is one of three major factors precipitating entry into residential aged care • The 2003 Survey of Disability, Ageing and Carers found that over 61 per cent of people aged 70 and older reported living with a disability compared with 20 per cent for the population as a whole

21. Demographics / stats • For those Australians 65 years and over, 7 per cent were current smokers; 8 per cent had risky or high alcohol intake; 75 per cent were sedentary or had low exercise levels; 35 per cent had one or less serves of fruit per day, and 82 per cent had 4 or less serves of vegetables per day. • Being overweight or obese was highest in older Australians between 55 and 64 years of age, compared to all other age groups, at 72 per cent for men and 58 per cent for of women

22. Demographics / stats • As at 30 June 2005 there were 183,395 allocated residential type places, of which 161,165 places were operational. • There are an estimated 110,000 residential aged care workers in Australia • 93% of residential aged care workers are women lhmu.org.au

23. Percentage of world elderly 2000(United Nation Population Division)

24. Percentage of world elderly 2050(United Nation Population Division)

25. Expected population growth 65+(United Nation Population Division)

26. Baby boomer influence: Percentage of aged: • Currently 12-13% population 65+ years • Start to peak 2030 22% population 65+years • Various parts of Europe: Sweden, U.K., and Germany already 20% of population 65+ • factors that account for the rapid increase in Australia’s over 65 populations: include Migration, fertility rates(reduced) and mortality

27. Indigenous Australians • Unfortunately, despite all the advances in our knowledge base, and provisions for health services and education, our indigenous Australians continue to have one of the lowest life expectancies in the world • 17 years less than white Australians

28. Successful Ageing • Rule of thirds • 1/3 decline due to disease • 1/3 decline due to lack of use • 1/3 decline due to ageing • Aim of successful ageing is to minimise the ‘disease’ and ‘lack of use’ decline (Sloan 1992)

29. What is Positive Ageing? • Positive Ageing is a strategy to maximise the quality of life and social recognition of senior Victorians. Seniors play many vital roles in our community, as family members, carers, volunteers, neighbours, workers and consumers. Positive Ageing will strengthen recognition of these roles. • In 2004/05 the Victorian Government provided $5.1 Million over four years for Positive Ageing initiatives to support current and future seniors.

30. What is Positive Ageing? • Positive Ageing is underpinned by Five principles. • Senior Victorians should have: • Confidence that their rights will be upheld, their autonomy accepted and their dignity respected. • Certainty that they are valued and listened to for their past, current and future contributions. • Opportunities to fully participate in their communities. • Access to information, support and services to maximise their independence and maintain their health and wellbeing. • Government services and communities which are responsive to their particular needs and interests and which recognise the increasing diversity of our community.

31. Social Changes: Current elderly vs. future elderly • Current elderly a have different culture to future elderly (you may agree or disagree with the following statements) • The current elderly: • Less formal education • Different gender roles • Different technological world • Less intercultural mixing • Greater emphasis on staying married • Less birth control • Greater belief in the power and knowledge of health workers • Women tend to take on caring role

32. Various social changes related to Aging • Generally people are living longer with better health • Better managed care • Older people may • Live 20 years or more post retirement • Experience economic issues • Have more leisure time • Have time to spend with partner • Be a source of living history • Take on a grandparent’s role • Can you think of any more?

33. Session 2 Physiology of aging

34. Ageing process As a person ages he/she undergoes a number of physiological changes which affect not only how they look, but how they function & respond to daily living. Overall, the changes in the later span of life involves a general slowing down of all organ systems due to a gradual decline in cellular activity. • Physiological changes associated with ageing are: • Gradual • Universal • Irreversible • Involuntary

35. Normal Physiological Changes of Ageing- NUTRITION • Protein, vitamin & mineral requirements remain the same, but kilojoules requirements lessen. • Decreased renal function  increased risk of dehydration & renal calculi • Loss of calcium & nitrogen (in non-ambulant persons) • Decreased enzyme activity & gastric secretions

36. Normal Physiological Changes of Ageing- NUTRITION • Reduced pepsin & hydrochloric acid secretion decreases absorption of calcium & Vitamins B1 & B2 , C & K • Decreased salivary flow & sense of taste reduced appetite & increases intake of sweets & spicy foods • Decreased intestinal motility & peristalsis of large intestine.

37. Normal Physiological Changes of Ageing- NUTRITION • Thinning of tooth enamel  brittle teeth • Decreased biting force • Diminished gag reflex

38. Normal Physiological Changes of Ageing-SKIN • The skin loses underlying subcutaneous fat & oil glands, causing wrinkles and reduced elasticity. • Loss of collagen & elastin  decreased rate of skin replacement. Woman’s skin show signs of ageing about 10 years earlier than men because it’s thinner & drier

39. Normal Physiological Changes of Ageing- integumentary system: SKIN • Other contributing factors are nutrition, exposure to the sun, heredity, & hormones. With these changes comes an increased susceptibility to hypothermia, bruising & pressure ulcers. • Mucous membranes become dry & sweat glands output decreases  more susceptible to hyperthermia.

40. Normal Physiological Changes of Ageing- integumentary system: SKIN • Folds, lines, wrinkles may appear • Skin fragility • Hyperplastic skin conditions include senile keratosis (dry, harsh skin) & senile angioma (benign tumour of dilated blood vessels due to weakened capillary walls)

41. Normal Physiological Changes of Ageing- integumentary system: Skin • Cosmetic implications • Melanocyte production decreases however localised proliferation are common & cause brown spots (senile lentigo) on areas exposed to the sun

42. Normal Physiological Changes of Ageing- integumentary system: Hair • Pigmentation decreases hair turns white or grey • Hairthins as melanocytes declines  by age of 70, hair is baby fine again, balding may occur • Hormonal changes cause pubic hair loss • Facial hair may increase in post menopausal women & decrease in men

43. Normal Physiological Changes of Ageing- integumentary system: Nails • The nails become thicker due to reduced blood flow to the connective tissues. • They grow at different rates • Thickening of nails & longitudinal ridges, flaking, brittleness & malformations may increase • Toenails may discolour

44. Normal Physiological Changes of Ageing-EYES & VISION • Starting in the 40’s, the pupil begins to decrease in size & in response time to light. • The pupil becomes smaller & the person requires three times the amount of illumination as a younger person to see. • Focusing takes longer with an increase in nearsightedness, making small print harder to read.

45. Normal Physiological Changes of Ageing-EYES & VISION • Night vision decreases & depth of perception • The eyes sit deeper in their sockets & eyelids lose elasticity  baggy & wrinkled • Lacrimal apparatus loses fatty tissue  decreases quantity of tears & evaporation occurs more rapidly

46. Normal Physiological Changes of Ageing-EYES & VISION • The cornea loses it’s lustre & flattens • The iris fades or develops irregular pigmentation • The vitreous can degenerate  opacities & floating vitreous debris & can also detach from the retina • The lens enlarges & loses transparency • As cones deteriorate  impaired colour vision especially in the blue & green ranges

48. A gradual yellowing of the lens resulting in loss of transparency Cataract surgery is an outpatient procedure with a very high success rate.  Due to the lack of modern medical technology in the developing world, it is also the world's leading cause of blindness.  Cataracts

49. Is a degenerative disease of the macula.  There is no way yet of repairing the vision that has been lost, but if detected early laser surgery can help slow the progression of the disease.  (AMD) is the leading cause of vision loss in people over age 65. Aged-related macular degeneration

50. The fluid pressure inside the eye increases, leading to loss of side vision and eventually total blindness.  The increased pressure destroys the optic nerve.  With early detection, it can be kept under control with pressure reducing eye drops and surgery.  Chances of developing it increase with age.  Glaucoma