Gerontology

1. Gerontology

2. Income Sources • Work • Social Security • Future of social security • Based on income • savings/investments • Pensions • 2007 about 1/3 receive at least some pension • Ave Public: $16,629 • Ave Private: $7,200

3. Landmark Legislation • 1965: medicare & medicaid • 1967: age discrimination act • 1972: SSI & social security indexed to inflation. • 1972: Older adult nutrition act • 1990: ADA • 2006: Medicare drug act • 2012: Affordable care act

4. Politics/Lobbies • AARP • Major political force • NCSC:National Council of Senior Citizens • NASC:National Alliance of Senior Citizens • OWL: Older Women's League • GRAY PANTHERS • Public awareness & demonstrations

5. Wealth • Discuss in small groups • Frugal vs. Poor • Home ownership: Positive and negative • Income vs savings • Discretionary vs non-discretionary spending

6. Housing

7. Independent Housing • Fully independent • Intermittent caregivers • FT or live in caregivers • Family • Own house or apartment • Rented house or apartment • Gvt subsidized

8. Housing-Mostly Independent • Group housing • Can be independent or assisted • Senior Housing • Can be independent or assisted

9. Modified, Non-Institutional • Community based residential • Group housing • Can be independent or assisted

10. Other housing • Institutional • Assisted living • Skilled nursing • Combination • Life Lease • Life care

12. Medicare • Elderly and/or permanent disability • Comes with social security • Pays 80% UCR fees • Part A • Inpatient hospital • DRG's

13. More Medicare • B, C and D premiums are optional and taken out of SS check • Part B • 80% UCR Outpatient and MD office • Part C • HMO • Capitulation and co-pay • Part D • Drug benefit-varies wildly by plan

14. Medicare Part b outpatient and MD-80% ucr fees Part c-HMO Capitulation usually with fees Part d-drug benefits

15. ?????? • How many of you have ever been uninsured? • Without a 2ndary insurance you will owe 20% after medicare • How much does an office visit cost? • ER visit for chest pain?

16. Supplemental Insurance • Private medicare supplement insurance • Medicaid • Medi-cal in CA • Asset and income based • If you own a house and receive benefits after • the age of 55-the state takes your house • when you die

19. Impact on Family • Societal changes • Demographic changes • Smaller families • Sandwich generation • re-location • Cultural differences • Expectations re responsibility for care • Changes with acculturation

20. Impact on Family • Spending time with children • wisdom • Caregiver stressors • Physical • Emotional • financial

21. Abuse and Neglect • Self Neglect • Family or caregivers • Physical abuse [includes sexual] • Emotional abuse • Financial abuse • Neglect • Abandonment

22. From the Victim.... • Responses to abuse from the victim?

23. Support • Support groups • Respite care • Referrals • Alzheimer's [etc] association[s] • Council on aging • Senior's resource yellow pages • Social workers • Adult day health centers/senior centers

24. Theories on aging

25. Biological • Programmed • Biological clock • Gene theory • Harmful genes activate over time • Error theory • Progressive decline in accuracy of cell division

26. Biological • Free Radical • Byproducts of metabolism create damaging free radicals • Wear and tear • Immunological • Decreased immune function causes disease • Neuro-endocrine • Hormonal changes trigger aging- • like puberty signals sexual maturity

27. Psychosocial

28. Psychosocial • Disengagement • Systematically separated from society • Depression and withdrawal • Used to justify agism • “mutually beneficial” [sic]

29. Psychosocial • Activity theory • Mental and physical activity needed to thrive • Life course • Personality and personal adjustment through life • Erickson • Midlife crisis • Nursing implications

30. THEORY OVERVIEW • Physical: biology causes some limitations on life and life expectancy. Behavior and life choices also count. Nurses can help by promoting good health practices • Psychosocial: help explain the variety of behaviors in the aging population. Understanding these theories can help nurses recognize problems and provide nursing interventions that will help people age more successfully

31. Physiological changes [ch3] • Changes don’t occur without warning. • Early changes [ gestation> neonatal >childhood > puberty] dramatic • Adult-gradually over a continuum-subtle • Late teens through 30’s- • Body fully mature, fully & optimally functional • Changes less dramatic, more likely to be ignored

33. Changes continued • Through their 50’s & 60’s changes are more apparent • By their 70’s & 80’s changes are no longer deniable • Predictable • Onset with wide variation

34. Changes continued • Diseases more prevalent in the aging population • Cardio Vascular: Hypertension; Heart disease; stroke • Diabetes • Cancer • Diseases of ears and eyes • accidents

35. Causes of death • Heart disease • Cancer • Cardiovascular disease [primarily stroke] • Pneumonia • Often preceded by falls/surgery [immobility] • Bacterial • viral • COPD

36. skin • Decreased melanocyte activity • More pale • Clusters of melancytes= “age spots” “liver spots” • Seborrheic keratosis=raised wartlike macules • Cutaneous papilloma=small skin tags-often on the neck

37. Melanocyte

38. Seborrheic Keratosis

39. Cutaneous Papilloma

40. Skin……wrinkles • Decreased elastin fibers • Thinner dermal layer • Contributing factors • Increased exposure to sunlight • dry skin • menopause

41. Skin and Aging • Thinner skin • Decreased subcutaneous fat • increases risk for pressure areas • Decreased circulation • Doesn’t heal as well/quickly • Fragile blood vessels • Slower healing

44. Staging Pressure Ulcers

45. Staging Pressure Ulcers

49. hair • Pigment loss=gray hair • Distribution changes • Thinning • Finer scalp hair • Decreased presence @ axilla, pubis and legs • Hair @ eyebrows, nose and ears-longer, thicker and more coarse • Increased facial hair in women