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Complexity of AgingComplexity of Aging

Justin Montgomery, RN – BCGeriatric Nurse Practice and Education Associate, DHMC

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ObjectivesObjectives

•• Discuss demographic trends and graying Discuss demographic trends and graying of Americaof America

•• Discuss the concept of ageism as it relates Discuss the concept of ageism as it relates to a personal attitude about agingto a personal attitude about aging

•• Describe key quality of life issues with Describe key quality of life issues with aging including spirituality, sexuality, and aging including spirituality, sexuality, and successful components of successful agingsuccessful components of successful aging

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The Baby Boomer Wave is ComingThe Baby Boomer Wave is Coming

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Graying of AmericaGraying of AmericaOlder adults are 12.8% of U.S. populationOlder adults are 12.8% of U.S. populationBy 2030 20% of population (71 million)By 2030 20% of population (71 million)

●● Living longer Living longer -- 77.8 years77.8 years●● Predominately women (3 to 2)Predominately women (3 to 2)●● More racially and ethnically diverseMore racially and ethnically diverse

Sub categories of agingSub categories of agingYoung old = 65Young old = 65--75 years75 yearsOld Old oldold = 75= 75--85 years85 yearsOldest old = 85+ years Oldest old = 85+ years -- fastest growing fastest growing

Centers for Disease Control and Prevention and The Merck CompanyCenters for Disease Control and Prevention and The Merck CompanyFoundation. Foundation. The State of Aging and Health in America 2007The State of Aging and Health in America 2007. . Whitehouse Station, NJ: The Merck Company Foundation; 2007.Whitehouse Station, NJ: The Merck Company Foundation; 2007.

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The Baby Boomer Tsunami is The Baby Boomer Tsunami is ComingComing

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Changing DemographicsChanging Demographics

•• Life expectancy:Life expectancy:–– 1900: 47 years1900: 47 years–– 1990: 76 years1990: 76 years–– 2050: 82 years2050: 82 years

•• Life expectancy (# of years if you reach a Life expectancy (# of years if you reach a certain age):certain age):–– 65: another 17 years65: another 17 years–– 75: another 11 years75: another 11 years–– 85: another 6 years85: another 6 years

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Demographic Change: The Demographic Change: The Population PillarPopulation Pillar

•• Martha Farnsworth Martha Farnsworth Riche, former Director Riche, former Director of the US Census of the US Census Bureau noted this Bureau noted this phenomenonphenomenon……

•• This has real This has real implications for a implications for a variety issues, variety issues, including health careincluding health care

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Global AgingGlobal AgingNine emerging global trendsNine emerging global trends

1.1. Overall aging populationsOverall aging populations2.2. Increasing life expectancy Increasing life expectancy 3.3. Rising number of oldest old Rising number of oldest old 4.4. Chronic diseases are major cause of Chronic diseases are major cause of

deathdeath5.5. Some total populations will shrink Some total populations will shrink 6.6. Changing family structures Changing family structures 7.7. Shifting patterns of work & Shifting patterns of work &

retirement retirement 8.8. Changing social insurance systems Changing social insurance systems 9.9. New economic challengesNew economic challenges

2006:500 million older adults

2030:1 billion older adults

One in every 8 people

Most rapid increases are in developing

countries

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Projected Increases in Global Population by Age

Source: United Nations Department of Economic and Social Affairs. Population Division. World Population Prospects.The 2004 Revision. New York: United Nations, 2005.

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Source: United Nations Department of Economic and Social Affairs. Population Division. World Population Prospects.The 2004 Revision. New York: United Nations, 2005.

Young Children and Older People As A Percentage of Global Population

20%

15%

10%

5%

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So, what does this mean?So, what does this mean?

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Majority of U.S. Healthcare is Majority of U.S. Healthcare is for Older Adultsfor Older Adults

57% of all visits to generalist physicians57% of all visits to generalist physicians50% of hospital expenditures 50% of hospital expenditures 80% of home care visits 80% of home care visits 90% of nursing home care90% of nursing home care

Health costs for older adults is 3Health costs for older adults is 3--5 times greater 5 times greater than costs for those < 65 years.than costs for those < 65 years.

By 2030, 70% of new nursing grads will be caring By 2030, 70% of new nursing grads will be caring for an older adult in every health care setting.for an older adult in every health care setting.

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Older Adults in HospitalsOlder Adults in HospitalsOf all adult patients, people Of all adult patients, people >>65 make up:65 make up:

•• 47% with anemia47% with anemia•• 64% with heart disease, 78% with CHF64% with heart disease, 78% with CHF•• 66% with urinary tract infections66% with urinary tract infections•• 70% with pneumonia70% with pneumonia•• 46% of CCU patients 46% of CCU patients •• 50% of ICU days50% of ICU days•• 60% of all visits to cardiologists60% of all visits to cardiologists•• 63% of all visits to oncologists63% of all visits to oncologistsDeFrancesDeFrances CJ, Hall MJ, CJ, Hall MJ, PodgornikPodgornik MN. 2003 National Hospital Discharge Survey. Advance data MN. 2003 National Hospital Discharge Survey. Advance data

from vital and health statistics, no. 359. Hyattsville, MD: US Dfrom vital and health statistics, no. 359. Hyattsville, MD: US Department of Health and epartment of Health and Human Services, CDC, National Center for Health Statistics; 2005Human Services, CDC, National Center for Health Statistics; 2005..

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Chronic Diseases and Chronic Diseases and ComorbidityComorbidity Are CommonAre CommonAbout 80% of older adults have at least one About 80% of older adults have at least one

chronic conditionchronic conditionThe average 75 yr old has 3 chronic diseases The average 75 yr old has 3 chronic diseases

and takes and takes >> 5 Rx medications.5 Rx medications.

ComorbidityComorbidity:: condition existing simultaneously condition existing simultaneously but independently with another condition but independently with another condition ((ExampleExample: patient who has CHF : patient who has CHF andandosteoarthritis)osteoarthritis)

The Silver Book: Chronic Disease and Medical Innovation in an AgThe Silver Book: Chronic Disease and Medical Innovation in an Aging Nation. ing Nation. Alliance for Aging Research.Alliance for Aging Research.

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Where do they live? Where do they live? Where do they live? California California >3.7 million (10.4%)>3.7 million (10.4%)FloridaFlorida 2.9 million (8.2%)2.9 million (8.2%)New YorkNew York 2.5 million (7.0%)2.5 million (7.0%)TexasTexas 2.2 million (6.2%)2.2 million (6.2%)PennsylvaniaPennsylvania 1.9 million (5.3%)1.9 million (5.3%)OhioOhio >1 million (3.1%)>1 million (3.1%)IllinoisIllinois >1 million (3.1%)>1 million (3.1%)MichiganMichigan >1 million (3.1%)>1 million (3.1%)New JerseyNew Jersey >1 million (3.1%)>1 million (3.1%)

Source: Profile of Older Americans, 2003 edition, AdministrationSource: Profile of Older Americans, 2003 edition, Administration on Aging, US on Aging, US Department of Health and Human ServicesDepartment of Health and Human Services

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Slide 15

cqr2 Source: Profile of Older Americans, 2003 edition, Administration on Aging, US Department of Health and Human ServicesConchita Rader, 8/6/2004

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PhewwwPhewww……

““Sounds like Florida and California are going Sounds like Florida and California are going to have their hands full!to have their hands full!””

““II’’m sure glad Im sure glad I’’m nurse in Northern New m nurse in Northern New England!England!””

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Northern New EnglandNorthern New England

•• Leads the nation in the rate that the Leads the nation in the rate that the median age of the population is increasingmedian age of the population is increasing–– Vermont: is the fastest aging state & 2Vermont: is the fastest aging state & 2ndnd in in

median agemedian age–– Maine: 3Maine: 3rdrd fastest aging state & 1fastest aging state & 1stst in median in median

ageage–– New Hampshire: tied with Florida as 4New Hampshire: tied with Florida as 4thth

fastest aging state & 7fastest aging state & 7thth in median agein median age

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Well at leastWell at least……

““Our rural and hardy Northern New Our rural and hardy Northern New Englanders are in better shape to handle Englanders are in better shape to handle aging with minimal disabilitiesaging with minimal disabilities””

““Clean mountain air and shoveling snow Clean mountain air and shoveling snow ought to helpought to help…”…”

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Regional Health Status IndicatorsRegional Health Status Indicators

•• The leading cause and rate of death from heart The leading cause and rate of death from heart disease and chronic illness mirror national trendsdisease and chronic illness mirror national trends

•• Older adults in NH and VT report: Older adults in NH and VT report: –– NH: No physical activity in past month (68%), lack NH: No physical activity in past month (68%), lack

regular exercise (85%), high cholesterol (46%), regular exercise (85%), high cholesterol (46%), diabetes (15%), hypertension (52%), and overweight diabetes (15%), hypertension (52%), and overweight (54%)(54%)

–– VT: No physical activity in past month (69%), lack VT: No physical activity in past month (69%), lack regular exercise (83%), high cholesterol (46%), regular exercise (83%), high cholesterol (46%), diabetes (14%), hypertension (51%), and overweight diabetes (14%), hypertension (51%), and overweight (61%)(61%)

2020

Stats, data, #Stats, data, #’’s s ““oh myoh my””

•• What does all this data tell us?What does all this data tell us?–– Not only will we continue to get older, but the Not only will we continue to get older, but the

older will continue to get olderolder will continue to get older–– The older population has a high degree of The older population has a high degree of

heterogeneityheterogeneity–– We are not ready for this reality We are not ready for this reality –– aging in aging in

America is difficultAmerica is difficult–– Why?Why?

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Complete This PhraseComplete This Phrase……

•• ““I will be old whenI will be old when…”…”–– How will you know you are old How will you know you are old –– when when

will you be part of the tidal wave?will you be part of the tidal wave?–– What images come to mind as you What images come to mind as you

picture yourself oldpicture yourself old–– Name one thing that could happen to Name one thing that could happen to

you that will make you you that will make you ““feelfeel”” oldold

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More ImportantlyMore Importantly

•• How did you feel when you thought about How did you feel when you thought about ““being old?being old?””

•• Did you get excited?Did you get excited?•• Why do you think things are the way they Why do you think things are the way they

are when we think of the elderly and are when we think of the elderly and aging?aging?

•• Why does this matter?Why does this matter?

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Ageism : the prejudice, stereotyping, and scapegoating of people based solely on age.

Ageism : the prejudice, Ageism : the prejudice, stereotyping, and stereotyping, and scapegoatingscapegoating of of people based solely on age.people based solely on age.

• Fear of death

• Emphasis on youth culture

• Decline of productivity and economic potential

• Research only examines negative stereotypes of old age

• Nursing’s view of care of the elderly – follows culture

•• Fear of deathFear of death

•• Emphasis on youth cultureEmphasis on youth culture

•• Decline of productivity and Decline of productivity and economic potential economic potential

•• Research only examines negative Research only examines negative stereotypes of old agestereotypes of old age

•• NursingNursing’’s view of care of the s view of care of the elderly elderly –– follows culturefollows culture

“OVER the Hill”

“fuddy-duddy”

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Slide 23

cqr1 Traxler (1980) "The Theoretical Basis of Ageism"Conchita Rader, 4/3/2004

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Myths about aging….Myths about agingMyths about aging……..

•“To be old is to be sick.”

•“You can’t teach an old dog new tricks.”

•“The secret to successful aging is to choose your parents wisely.”

•“Older people don’t pull their own weight.”

••““To be old is to be sick.To be old is to be sick.””

••““You canYou can’’t teach an old dog new tricks.t teach an old dog new tricks.””

••““The secret to successful aging is to The secret to successful aging is to choose your parents wisely.choose your parents wisely.””

••““Older people donOlder people don’’t pull their own weight.t pull their own weight.””

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IndividualityIndividuality

• “If you’ve seen one old person……you’ve seen one old person.” John Rowe M.D.

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Quality of Life (QOL)Quality of Life (QOL)

““Referring to an overall sense of wellReferring to an overall sense of well--being with a being with a strong relation to a person's health perceptions strong relation to a person's health perceptions and ability to functionand ability to function…”…”

CDC, 2006CDC, 2006

““A scientific measure of personal wellA scientific measure of personal well--beingbeing””Mirapex.comMirapex.com, accessed 2007, accessed 2007

What components of your day to day life makes What components of your day to day life makes up your sense of wellup your sense of well--being?being?

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Issues affecting QOLIssues affecting QOL

•• FunctionFunction–– Physical activityPhysical activity–– IndependenceIndependence

•• ConnectednessConnectedness–– SocialSocial–– IntellectualIntellectual

–– MacArthur Foundation Study of AgingMacArthur Foundation Study of Aging

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SpiritualitySpiritualitySpirituality

• Spirituality vs. religion– Purpose and meaning in life vs. organized

groups

• Research– Connection between faith and health– 82% believe prayer assists healing– 75% use religious beliefs as a means of

coping– 63% want doctors to ask about spirituality

•• Spirituality vs. religionSpirituality vs. religion–– Purpose and meaning in life vs. organized Purpose and meaning in life vs. organized

groupsgroups

•• ResearchResearch–– Connection between faith and healthConnection between faith and health–– 82% believe prayer assists healing82% believe prayer assists healing–– 75% use religious beliefs as a means of 75% use religious beliefs as a means of

copingcoping–– 63% want doctors to ask about spirituality63% want doctors to ask about spirituality

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Credit Where Credit is DueCredit Where Credit is Due

•• Andrew Weil, M.D. Andrew Weil, M.D. Healthy AgingHealthy Aging p 227p 227““Despite all the evidence to the contrary, some part Despite all the evidence to the contrary, some part

of me feels the same as it always has since my of me feels the same as it always has since my earliest memories of childhood. Obviously, that is earliest memories of childhood. Obviously, that is not my body, which now looks and feels different not my body, which now looks and feels different from what it was ten years ago, let alone fifty. from what it was ten years ago, let alone fifty. Nor can it be my mind, which has learned so much Nor can it be my mind, which has learned so much and stored so much experience in more then half a and stored so much experience in more then half a century. I call it the unchanging essence: that century. I call it the unchanging essence: that part of the self that is unaffected by time.part of the self that is unaffected by time.””

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Unchanging EssenceUnchanging Essence

““I always think that II always think that I’’m still this 13m still this 13--year old year old boy that doesnboy that doesn’’t really know how to be an t really know how to be an adult, pretending to live my life, taking adult, pretending to live my life, taking notes for when Inotes for when I’’ll really have to do it.ll really have to do it.””

““Before SunriseBefore Sunrise”” Ethan HawkeEthan HawkeTaken from Taken from ““Maturity and AgingMaturity and Aging””

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Spiritual AssessmentSpiritual AssessmentSpiritual Assessment– Instruments

• Stoddard’s spiritual assessment instrument– Spiritual Interventions

• Acknowledge role of religion and spirituality• Inquire about religious or spiritual beliefs and

practices• Refer to clergy• Provide spiritual counseling• Pray for or with the patient

–– InstrumentsInstruments•• StoddardStoddard’’s spiritual assessment instruments spiritual assessment instrument

–– Spiritual InterventionsSpiritual Interventions•• Acknowledge role of religion and spiritualityAcknowledge role of religion and spirituality•• Inquire about religious or spiritual beliefs and Inquire about religious or spiritual beliefs and

practicespractices•• Refer to clergyRefer to clergy•• Provide spiritual counselingProvide spiritual counseling•• Pray for or with the patientPray for or with the patient

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Your Unchanging EssenceYour Unchanging Essence

•• Ask yourselfAsk yourself……–– What gives my life meaning?What gives my life meaning?–– For what am I grateful?For what am I grateful?–– What have I learned of love and how well What have I learned of love and how well

have I learned to lovehave I learned to love–– What will give me strength as I die? What is What will give me strength as I die? What is

my relationship with that which will give me my relationship with that which will give me strength?strength?

–– Who am I?Who am I?

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Myths about sexualityMyths about sexualityMyths about sexuality

• “Sexual desires diminish with age”• Issues/facts:

• Little available information / attention to older adults’ sexuality

• sexual patterns persist throughout their lives• Societal view restricts the sexuality of older

adults• Staff discomfort about sexual expression

among older adults – regarded as behavioral problem

•• ““Sexual desires diminish with ageSexual desires diminish with age””•• Issues/facts:Issues/facts:

•• Little available information / attention to older Little available information / attention to older adultsadults’’ sexuality sexuality

•• sexual patterns persist throughout their livessexual patterns persist throughout their lives

•• Societal view restricts the sexuality of older Societal view restricts the sexuality of older adultsadults

•• Staff discomfort about sexual expression Staff discomfort about sexual expression among older adults among older adults –– regarded as behavioral regarded as behavioral problemproblem

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Myths about sexualityMyths about sexualityMyths about sexuality

• “Sexual intercourse is mainly a younger person’s activity for the purpose of procreation”

• Issues/facts• Older adults need to touch and be

touched• Older adults may have difficulty accepting

and understanding sexuality• Health care professionals do not facilitate

expression of sexuality

•• ““Sexual intercourse is mainly a younger Sexual intercourse is mainly a younger personperson’’s activity for the purpose of s activity for the purpose of procreationprocreation””

•• Issues/factsIssues/facts•• Older adults need to touch and be Older adults need to touch and be

touchedtouched•• Older adults may have difficulty accepting Older adults may have difficulty accepting

and understanding sexualityand understanding sexuality•• Health care professionals do not facilitate Health care professionals do not facilitate

expression of sexualityexpression of sexuality

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Sexuality: changesSexuality: changesSexuality: changes

Hormones• Lack of testosterone in men (male

menopause)

• Lack of estrogen, progesterone and androgen in women

HormonesHormones•• Lack of testosterone in men (male Lack of testosterone in men (male

menopause)menopause)

•• Lack of estrogen, progesterone and Lack of estrogen, progesterone and androgen in womenandrogen in women

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Sexuality: changesSexuality: changesSexuality: changesPhysiological Changes

• Male: increased time for erection and ejaculation, lower semen volume, longer period between ejaculations; fatigue, loss of muscle mass, depression, and decline in libido

• Female: follicular depletion in ovaries, fewer and shortened orgasmic contraction, labium atrophy, shortened orgasmic phase, dyspareunia; breast tissue replaced with fatty tissue

Physiological ChangesPhysiological Changes•• MaleMale: increased time for erection and : increased time for erection and

ejaculation, lower semen volume, longer ejaculation, lower semen volume, longer period between ejaculations; fatigue, loss of period between ejaculations; fatigue, loss of muscle mass, depression, and decline in muscle mass, depression, and decline in libidolibido

•• FemaleFemale: follicular depletion in ovaries, fewer : follicular depletion in ovaries, fewer and shortened orgasmic contraction, labium and shortened orgasmic contraction, labium atrophy, shortened orgasmic phase, atrophy, shortened orgasmic phase, dyspareuniadyspareunia; breast tissue replaced with fatty ; breast tissue replaced with fatty tissuetissue

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SexualitySexualitySexualitySexual Problems

• Medical Conditions: cardiac problems, diabetes, neurological disorders, arthritis

• Medications and treatments may interfere with sexual response

• 50% of older males have erectile impotence

• Clients > 60 with AIDS has increased

Sexual ProblemsSexual Problems•• Medical Conditions: cardiac Medical Conditions: cardiac

problems, diabetes, neurological problems, diabetes, neurological disorders, arthritisdisorders, arthritis

•• Medications and treatments may Medications and treatments may interfere with sexual responseinterfere with sexual response

•• 50% of older males have erectile 50% of older males have erectile impotenceimpotence

•• Clients > 60 with AIDS has increasedClients > 60 with AIDS has increased

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Assessing SexualityAssessing Sexuality

•• Can you tell me how you express your sexuality?Can you tell me how you express your sexuality?

•• What concerns or questions do you have about What concerns or questions do you have about fulfilling your continuing sexual needs?fulfilling your continuing sexual needs?

•• In what ways has your sexual relationship with In what ways has your sexual relationship with your partner changed as you have aged?your partner changed as you have aged?

•• What interventions or information can I provide What interventions or information can I provide to help you to fulfill your sexuality?to help you to fulfill your sexuality?

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SummarySummary

• Graying of America• Ageism• Myths• Successful, creative aging• Spirituality and assessment• Sexuality: myths, issues, and normal

changes

•• Graying of AmericaGraying of America•• AgeismAgeism•• MythsMyths•• Successful, creative agingSuccessful, creative aging•• Spirituality and assessmentSpirituality and assessment•• Sexuality: myths, issues, and normal Sexuality: myths, issues, and normal

changeschanges

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Questions?Questions?