Unit 16-Psychological Effects of Aging

Unit 16
Psychological Effects
of Aging
Nurse Aide I Course
DHSR Approved Curriculum-Unit 16 1

Psychological Effects Of Aging
This unit deals with the feelings,
emotional stress and psychological
adjustments that are part of the aging
process.
It explores the physical and
psychosocial needs of residents, and
teaches the skills that the nurse aide
will need to develop to provide
understanding and compassionate
care.
Psychological Effects Of Aging
(continued)
Other topics covered include:
age appropriate behavior, sexuality,
reality orientation, dementia,
Alzheimer’s disease, confusion and
developmental disabilities.

16.0 Discuss ways to meet the
resident’s basic human needs
for life and mental well-being.

Physical Needs For Survival And
Care To Be Given
• Oxygen
– elevate head of bed
– assist to sit up in chair
– report to supervisor if
resident is cyanotic or
short of breath
– assist with breathing
exercises
Care To Be Given
(continued)
• Food
– Feed residents unable to feed
themselves

Care To Be Given
(continued)
• Food
– Serve food
• with proper temperature
• in friendly manner
• in pleasant environment
• in appropriate amounts
– Make sure dentures are in place
Care To Be Given
(continued)
• Water
– make available within
resident’s reach
– provide fresh water at
periodic intervals

Care To Be Given
(continued)
• Shelter
– provide for warmth with
extra blankets
– be sure residents are
dressed properly
– avoid drafts or drafty
areas
Care To Be Given
(continued)
• Sleep
– Minimize noise and lights during
hours of sleep
– Give back rub to relax resident

Care To Be Given
(continued)
• Sleep (continued)
– Report complaints of pain to
supervisor
– Listen to concerns or worries the
resident may wish to express
– Leave night light on in the
resident’s room, if requested
Care To Be Given
(continued)
• Elimination
– Assist to bathroom as
needed
– Provide bedpan and/or
urinal
– Provide for privacy

Care To Be Given
(continued)
• Elimination (continued)
– Change soiled linen
immediately
– Following routine for
bowel and bladder
retraining as directed

Care To Be Given
(continued)
• Activity
– ROM exercises as
directed
– Turn and reposition
at least every two
hours

Care To Be Given
(continued)
• Activity
– Assist with activity as
directed
– Encourage movement
– Encourage interesting
recreational activities

Safety And Security Needs
• Provide for warmth
• Establish familiar surroundings
– explain procedures
– talk about “their” room
– keep your promises
– provide a safe environment
– promote use of personal
belongings
Safety and Security Needs
(continued)
• Maintain order and follow routines,
assisting resident to participate in
establishing routine as often as
possible

Safety and Security Needs
(continued)
• Assist to reduce fear and anxiety
– listen to resident’s worries and
report to supervisor
– ease concerns when possible
– check on residents frequently
• Avoid rushing and assist resident in
gentle manner

Love and Affection Needs
• Friendship
• Social Acceptance
• Closeness
• Meaningful
relationships with
others
• Love
• Sexuality
(continued)
• Belonging
– Need met by family/support
system
– Friends may meet this need

(continued)
The nursing staff as family:

• take time to greet residents when
you see them
• sit and visit for a few minutes when
time allows
• show interest in residents

(continued)
The nursing staff as family (continued):
• display human warmth with a gentle
touch
• show acceptance of an individual for
his or her unique qualities
• provide care in a kind, friendly,
considerate manner
Self-Esteem Needs
• Value, worth or opinion of oneself
• Seeing oneself as useful
• Being well thought of by others

Self-Esteem Needs
(continued)
• Nurse aide’s responsibilities
– call resident by proper name
– praise accomplishments
– discuss current issues
– request resident’s opinion
– show respect and approval

Need for Self-Actualization
(experiencing one’s potential)
• Cannot occur until all

other needs are met
• A feeling that a
person is what one
wants to be
• Rarely is this need
totally met
(continued)
• Ways to help residents to meet this
need:
– assist to participate in meaningful
activities
– assist to dress and help with
grooming
– encourage independence
– encourage socialization
(continued)
• Ways to help residents to meet this
need (continued):
– share goals with residents and
praise their success or
accomplishments
– know what resident has
accomplished in his/her lifetime
and talk about these things
Spiritual Needs
• Residents have the right

to worship and express
their faith freely.

Spiritual Needs
(continued)
• Guidelines for the nurse aide:
– respect resident’s beliefs
– respect resident’s religious
objects
– inform residents of the time
and place for religious
services
Spiritual Needs
(continued)
• Guidelines for the nurse aide
(continued):
– assist resident to attend
religious services
– provide privacy for members
of the clergy and residents
– welcome members of the
clergy
16.1 Identify eight defense
mechanisms that could be used
by a resident in response to
stress.

Coping Mechanisms
• Established early in life as part of
personality
• List of defense mechanisms
(unconscious behaviors)
– Projection - blaming others
– Rationalization - false reason for
situation

Coping Mechanisms
(continued)
(unconscious behaviors) (continued)
– Denial - pretending a problem
doesn’t exist
– Compensation - making up for a
situation in some other way

Coping Mechanisms
(continued)
– Displacement - transferring
feelings about one person to
another person
– Daydreaming - escape from
reality

Coping Mechanisms
(continued)
– Identification - idolizing another
and trying to copy him/her
– Sublimation - redirecting feelings
to constructive activity

16.2 Recognize how age, illness and
disability affect sexuality.

Sexuality
• Expressed by individuals of all ages
• A way to show feminine or
masculine qualities
– Clothing styles and colors
– Hairstyles
– Hobbies and interests
– Sexual habits (continue into
old age)
– Gestures
Sexuality
(continued)
• May be expressed by:
– Sexual intercourse
– Caressing, touching,
holding hands
– Masturbation
• Is a right of all residents
to experience
Guidelines For The Nurse Aide In
Dealing With Resident Sexuality
• Assist to maintain
sexual identity by
dressing residents in
clothing appropriate
for men or women
• Assist with personal
hygiene
(continued)
• Assist to prepare for special
activities by “dressing up”
– selecting attractive clothing
– fixing hair in a special way
– applying cosmetics
– wearing a special perfume
or aftershave
(continued)
• Help to develop a positive self-image
• Show acceptance and understanding
for resident’s expression of love or
sexuality
– provide privacy
– always knock prior to entering a
room at any time
– assure privacy when requested
(continued)
• Never expose the resident
• Accept the resident’s sexual
relationships

(continued)
• Provide protection for the non-
consenting resident
• Be firm but gentle in your rejection
of a resident’s sexual advances

Possible Effects Of Injury Or
Illness On Sexuality
• Disfiguring surgery may
cause a person to feel:
– unattractive and ugly to
others
– mutilated and deformed
– unworthy of love or
affection
(continued)
• Chronic illness and
certain medications
can affect sexual
functioning

(continued)
• Disorders that cause impotence
– diabetes mellitus
– spinal cord injuries
– multiple sclerosis
– alcoholism

(continued)
• Surgery can have both physical and/or
psychological effects
– removal of prostate or testes
– amputation of a limb
– removal of uterus
– removal of ovaries
– removal of a breast
– colostomy
– ileostomy
(continued)
• Disorders affecting the ability to
have sex:
– stroke
– nervous system disorders
– heart disease

(continued)
• Disorders affecting the ability to
have sex:
– chronic obstructive
pulmonary disease
– circulatory disorders
– arthritis or conditions
affecting mobility/
flexibility
16.3 Identify developmental tasks
associated with aging.

Developmental Tasks Of Aging
• Adjustment to:
– retirement
– reduced income
– death of friends
– death of spouse
– physical changes
– loss of independence
Developmental Tasks Of Aging
(continued)
• Creating new friendships
and relationships
• Loss of vitality
• Integrating life
experiences
• Preparation for death

16.4 Identify symptoms of
depression and define the
nurse aide’s role in caring for a
depressed resident.

Depression
• Reasons for depression
– Loss of independence
– Death of spouse or friend
– Loss of job or home
– Decreased memory
– Terminal illness

Common Signs And Symptoms Of
Depression
• Change in sleep pattern

• Loss of appetite and
weight loss
• Crying, withdrawal from
activities, appearing
sad

Nurse Aide’s Role In Caring For
The Depressed Resident
• Listen to feelings
• Encourage to reminisce
• Involve in activities
• Encourage friends and family to visit
• Report changes in eating,
elimination or sleeping patterns

Nurse Aide’s Role In Caring For
The Depressed Resident
(continued)
• Avoid pitying the resident
• Help to focus on reality
• Monitor eating and
drinking
• Promote self-esteem
• Report observations to
supervisor
16.5 Identify the issues to be
considered when elderly are
unable to provide for their own
needs in their own homes.

Issues Involving Care Of
The Elderly
• Amount of care needed
• Cost
• Nutritional needs
• Relationship with family/support
system
• Location of family/support system
• Medical care needs
The Elderly
(continued)
• The elderly person may experience:
– Living with a group of people
– Less independence
– Structured lifestyle
– Less privacy
– Difficulty adapting to change
The Elderly
(continued)
• Decision made by
individual or family for
long-term care may
cause stress

16.6 Utilize the resident’s family or
established support system as
a source of emotional support.

Emotional Support for Residents
• Family/support system meets

needs for:
– Safety
– Security
– Love
– Belonging
– Esteem
Emotional Support for Residents
(continued)
• Family/support system provides:
– Comfort
– Support
– Relief from loneliness
– Contact with familiar
people and things
– Mental stimulation
– Reasons to live
Ways To Promote Family
Involvement
• Include in care conferences
• Encourage to do some or
all of personal grooming
• Provide outside picnic
areas, playground
equipment, gardens

Involvement
(continued)
• Provide area for family/support
system parties
• Invite families to scheduled activities
• Encourage to assist with feeding if
appropriate

Involvement
(continued)
• Encourage to bring
special foods or
beverages for
resident if allowed
• Encourage time
together

Responsibilities of the Nurse Aide
when Dealing with Family/Support
System Members
• Greet the family/support system
• Address family members by name
• Make family and friends feel
welcome
• Provide for privacy
• Keep lines of communication open
System Members
(continued)
• Understand that family and friends
will do or say things to try and
please the resident
• Use tact in dealing with family
complaints and requests that you
cannot honor
System Members
(continued)
• Assist families to understand the
facility and how it works
• Provide explanations for family
questions or report to supervisor to
assist the family with questions

System Members
(continued)
• Reassure family as they cope with
resident’s actions, problems and
concerns

16.7 Identify the symptoms
displayed by residents with
dementia.

Dementia (Group Of Symptoms)
• Defined as a
progressive loss of
mental functioning

(continued)
• Two categories of dementia
– 1st Category: Primary
• No known cause
• Irreversible
• May be treated but not
completely cured

(continued)
– 1st Category: Primary
• Examples of diseases causing
dementia
–Alzheimer’s disease
–Parkinson’s disease
–Huntington’s Chorea (genetic)
(continued)

– 2nd Category: Secondary
• Usually has known cause
• Treatable
• Reversible to some degree

(continued)
– 2nd Category: Secondary
• Examples of secondary causes of
dementia
– depression
– minor stroke
– thyroid dysfunction
– medication induced
Symptoms Of Dementia
• Confusion
• Inability to reason accurately
• Recent memory loss
• Detailed long-term memory
• Repetitious speech
• Self-centered behavior
• Agitation
• Disorientation
• Confabulation
16.8 Review the psychosocial
characteristics and care needs
of a person with Alzheimer’s
disease.

Alzheimer’s Disease
• Defined as a progressive, 3-stage,
incurable disease that involves
changes in brain tissue
• Responsible for about half of the
dementia seen
• Symptoms usually occur in people
50-69 years of age

Alzheimer’s Disease
(continued)
• Affects more women than men
• Always ends in death 3-15 years
after symptoms begin

Alzheimer’s Disease:
Signs And Symptoms
• Irreversible loss of memory
• Speech and writing difficulties
• Disorientation
• Difficulty walking
– loss of balance
– short steps
– spatial disorientation
Signs And Symptoms
(continued)
• Deterioration of mental functions
– Unable to make decisions
– Loss of ability to make judgments
– Changes in behavior
• restless
• angry
• depressed
• irritable
Signs And Symptoms
(continued)
• Possible seizures
• Coma and death

Considerations For Care
• Assist to be as active as
possible
• Encourage in activities
of daily living
• Orient to reality
• Protect from injury

(continued)
• Maintain calm,
consistent
environment
• Complete ADL at the
same time each day
• Use reality orientation

(continued)
• Same caregivers
assigned to resident
• Involve in simple,
limited activities
• Follow routines
• Treat with patience and
compassion
(continued)
• Support family
• Communicate with
simple phrases
• Don’t pose questions
or ask to make
choices

16.9 Discuss disorders that cause
confusion for residents.

Confusion
• Symptom or side effect of many
disorders
• Disorders causing confusion
– Stroke
– Arteriosclerosis
– Dementia
– Alzheimer’s Disease
– Huntington’s Chorea
Confusion
(continued)
• Other Causes
– Drug reactions
– Depression
– Environmental changes
– Vision and/or hearing loss
– Dehydration
– Poor nutrition
– Decreased oxygen levels in blood
– Head injury
Confusion
(continued)
• Condition can be
permanent or
temporary

Reality Orientation Used
For Confusion
• Includes:
– Facing resident and
speaking clearly and
slowly
– Greeting the resident by
name with each interaction
– Identifying yourself with
each interaction
For Confusion
(continued)
• Includes:
– Explaining care in simple
terms prior to giving care
– Frequently orienting the
resident to the day,
month, date, and time
– Giving short, simple
instructions
For Confusion
(continued)
• Includes:
– Encouraging residents
to wear glasses or
hearing aides
– Communicating with
touch and clear and
simple comments and
questions
For Confusion
(continued)
• Includes:
– Encouraging use of
radio, television,
newspapers, and
magazines
– Maintaining resident’s
routine
For Confusion
(continued)
• Includes:
– Giving only one
direction at a time
– Keeping the
environment calm
and relaxed

For Confusion
(continued)
• Includes:
– Providing clocks,
calendars and bulletin
boards to remind
residents of time and
activities
– Discussing current topics
For Confusion
(continued)
• Includes:
– Reminiscing
– Showing resident
self-image in mirror
– Providing recreational
activities which
reinforce reality
orientation
For Confusion
(continued)
• Includes:
– Dressing residents
during the day and
assisting them to stay
on a day-night
schedule

16.10 Identify basic skills the nurse
aide will need to use when
caring for residents with
developmental disabilities.

Developmental Disabilities
• Diagnoses
– Mental retardation
– Cerebral palsy

(continued)
• Guidelines for Care
– Treat the individual with respect
and dignity
– Encourage residents to:
• make personal choices
• do as much as possible for
themselves

(continued)
• Guidelines for Care (continued)
– Encourage residents to:
• use age appropriate personal
skills
• achieve their potential
• interact with others

• Guidelines for Care
– Do not:
• act as resident’s parent
• create dependency
• label or categorize residents
– Do provide privacy
– Do build resident’s self-esteem

16.11 Identify ways to assist
residents with cognitive
impairments.

Ways To Assist Stressed
Residents
• Listen to concerns
• Observe and report
nonverbal messages
• Treat with dignity and
respect
• Attempt to understand
behavior

Ways To Assist Stressed
Residents
(continued)
• Be honest and trustworthy
• Never argue with
residents
• Attempt to locate source
of stress
• Support efforts to deal
with stress
Ways To Assist Demanding
Residents
• Attempt to discover
factors responsible for
behavior
• Display a caring attitude
• Listen to verbal and
nonverbal messages
• Give consistent care

Ways To Assist Demanding
Residents
(continued)
• Spend some time with
the resident
• Agree to return to see
the resident at a
specific time and keep
your promise

Ways To Assist Agitated
Residents
• Encourage to talk
about fears
• Remind resident of
past ability to cope
with change
• Encourage to ask
questions about
concerns
Ways To Assist Agitated
Residents
(continued)
• Involve in activities that

promote self-esteem
• Observe for safety and
to prevent wandering
away
• Assign small tasks
• Use reality orientation
Ways To Assist Residents
Displaying Paranoid Thinking
• Reassure the resident that you will
provide for his or her safety
• Realize behavior is based on fear
• Avoid agreeing or disagreeing with
comments
• Provide calm environment
• Involve in reality activities
Ways To Assist Combative
Residents
• Display a calm manner
• Avoid touching the
resident
• Provide privacy for
out-of-control residents
• Secure help if
necessary

Ways To Assist Combative
Residents
(continued)
• Do not ignore threats
• Protect yourself from
harm
• Listen to verbal
aggression without
argument


Unit 16-Psychological Effects of Aging

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Unit 16-Psychological Effects of Aging

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Unit 16

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The nursing staff as family:

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• Cannot occur until all

• Residents have the right

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• Change in sleep pattern

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• Family/support system meets

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• Two categories of dementia

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