Still, most older people live in a family setting. They live with a partner, children, brothers or sisters, or other family. Some live alone or with friends. Still others live in nursing centers. The need for nursing center care increases with aging.

Growth and development

Throughout life, people grow and develop. Growth is the physical changes that are measured and that occur in a steady, orderly manner. Growth is measured in height and weight. Changes in appearance and body functions also measure growth (Fig. 10-1).

Fig. 10-1 Body appearance changes during growth. (From Thibodeau GA, Patton KT: *The human body in health & disease,* ed 5, St Louis, 2010, Mosby.)

Development relates to changes in mental, emotional, and social function. A person behaves and thinks in certain ways in each stage of development. A 2-year-old thinks in simple terms. A 40-year-old thinks in complex ways. The entire person is affected.

Growth and development occur in a sequence, order, and pattern. Certain skills must be completed during each stage. A developmental task is a skill that must be completed during a stage of development. A stage cannot be skipped. Each stage is the basis for the next stage. Each stage has its own characteristics and developmental tasks (Box 10-1, p. 116).

Box 10-1

Stages of Growth and Development

Infancy (birth to 1 year)

• Learning to walk

• Learning to eat solid foods

• Beginning to talk and communicate with others

• Learning to trust

• Beginning to have emotional relationships with parents, brothers, and sisters

• Developing stable sleep and feeding patterns

Toddlerhood (1 to 3 years)

• Tolerating separation from parents or primary caregivers

• Gaining control of bowel and bladder function

• Using words to communicate

• Becoming less dependent on parents or primary caregivers

Preschool (3 to 6 years)

• Increasing the ability to communicate and understand others

• Performing self-care

• Learning gender (male, female) differences and developing sexual modesty

• Learning right from wrong and good from bad

• Learning to play with others

• Developing family relationships

School age (6 to 9 or 10 years)

• Developing social and physical skills needed for playing games

• Learning to get along with children of the same age and background (peers)

• Learning gender-appropriate behaviors and attitudes

• Learning basic reading, writing, and arithmetic skills

• Developing a conscience and morals

• Developing a good feeling and attitude about oneself

Late childhood (9 or 10 to 12 years)

• Becoming independent of adults and learning to depend on oneself

• Developing and keeping friendships with peers

• Understanding the physical, psychological, and social roles of one’s sex

• Developing moral and ethical behavior

• Developing greater muscular strength, coordination, and balance

• Learning how to study

Adolescence (12 to 18 years)

• Accepting changes in the body and appearance

• Developing appropriate relationships with males and females of the same age

• Accepting the male or female role appropriate for one’s age

• Becoming independent from parents and adults

• Preparing for marriage and family life

• Preparing for a career

• Developing the morals, attitudes, and values needed to function in society

Young adulthood (18 to 40 years)

• Choosing education and a career

• Selecting a partner

• Learning to live with a partner

• Becoming a parent and raising children

• Developing a satisfactory sex life

Middle adulthood (40 to 65 years)

• Adjusting to physical changes

• Having grown children

• Developing leisure-time activities

• Adjusting to aging parents

Late adulthood (65 years and older)

• Adjusting to decreased strength and loss of health

• Adjusting to retirement and reduced income

• Coping with a partner’s death

• Developing new friends and relationships

• Preparing for one’s own death

Late adulthood (65 years and older)

Late adulthood ranges from 65 years of age and older. The oldest-old are 85 years of age and older.

Gerontology is the study of the aging process. Geriatrics is the care of aging people. Aging is normal. It is not a disease. Normal changes occur in body structure and function. They increase the risk for illness, injury, and disability. Psychological and social changes also occur. Often changes are slow. Most people adjust well to these changes. They lead happy, meaningful lives. The developmental tasks of late adulthood are listed in Box 10-1, p. 116.

There are many myths about aging and older persons. A myth is a widely believed story that is not true. To provide good care, you need to know the facts about older persons and aging. See Box 10-2, p. 116 for some common myths and facts.

Box 10-2

Myths and Facts About Aging

Myth	Fact
All old people are the same.	Each person is unique. People age in different ways. Culture, religion, education, income, and life experiences affect aging. People develop throughout life.
Aging means illness and disability.	Older persons are at risk for health problems and disabilities. However, most are healthy. Not smoking, good nutrition, and exercise can reverse or slow many changes blamed on aging.
Older persons lose interest in sex.	Aging does not mean that sexual activity and expression must end. Many older people enjoy a fulfilling sex life. Sexuality is important throughout life. Intimacy, love, and companionship are needed.
Older people are lonely and isolated.	Most older people have frequent contact with their children. Older parents commonly live within 10 miles of their children. Most see a child at least once a week and take part in family activities. Regular contact with sisters and brothers is common. They can provide support and companionship. Many older persons have jobs, do volunteer work, and enjoy hobbies.
Mental function declines with age.	Older persons may receive and process information more slowly than younger people. However, people learn until very late in life. Many 90-year-olds have high levels of mental function.
Most older persons live in nursing centers.	In 2008, only 1,600,000 (4.1%) of the people 65 years and older lived in long-term care settings.
Old people are crabby and rude.	Some old people are crabby and rude. So are people of all ages. Older persons who are crabby and rude were probably crabby and rude when younger.

Psychological and social changes

Graying hair, wrinkles, and slow movements are physical reminders of growing old. These changes affect self-esteem. They threaten self-image and feelings of self-worth. They also threaten independence.

Social roles also change. A parent may depend on an adult child for care. Retirees need activities to replace the work role. Adjusting to the death of a partner, family members, and friends is common. The person faces his or her own death.

People cope with aging in their own way. How they cope depends on health status, life experiences, finances, education, and social support systems.

Retirement

Age 65 is the usual retirement age. Some retire earlier. Others work into their 70s. Retirement is a reward for a life-time of work. The person can relax and enjoy life (Fig. 10-2). Travel, leisure, and doing what one wants to are retirement “benefits.” Many people enjoy retirement. Others are not so lucky. They are ill or disabled. Poor health and medical bills can make retirement very hard.

Fig. 10-2 A retired couple enjoys golf as a leisure time activity.

Work helps meet love, belonging, and self-esteem needs. The person feels fulfilled and useful. Friendships form. Co-workers share daily events. Leisure time, recreation, and companionship often involve co-workers. Some retired people want to work. They have part-time jobs or do volunteer work (Fig. 10-3).

Fig. 10-3 This retired woman is a nursing center volunteer.

Reduced income

Retirement usually means reduced income. Social Security may provide the only income.

The retired person still has expenses. Rent or house payments continue. Food, clothing, utility bills, and taxes are other expenses. Car expenses, home repairs, drugs, and health care are other costs. So are entertainment and gifts.

Reduced income may force life-style changes. Examples include:

• Limiting social and leisure events

• Buying cheaper food, clothes, and household items

• Moving to cheaper housing

• Living with children or other family

• Avoiding health care or needed drugs

• Relying on children or other family for money or needed items

Severe money problems can result. Some people plan for retirement. They have savings, investments, retirement plans, and insurance. They are financially comfortable during retirement.

Social relationships

Social relationships change throughout life. (See Caring About Culture: Foreign-Born Persons.) Children grow up and leave home. They have their own families. Some live far away from parents. Older family members and friends die, move away, or are disabled. Yet most older people have regular contact with children, grandchildren, family, and friends. Others are lonely. Separation from children is a common cause. So is lack of companionship with people their own age (Fig. 10-4, p. 118).

CARING ABOUT CULTURE

Foreign-Born Persons

Some older persons speak and understand a foreign language. Communication occurs with family and friends who speak the same language. They also share cultural values and practices. These relatives and friends may move away or die. The person may not have anyone to talk to. He or she may not be understood by others. The person feels greater loneliness and isolation.

Fig. 10-4 Older people enjoy being with others of their own age.

Many older people adjust to these changes. Hobbies, religious and community events, and new friends help prevent loneliness. Some community groups sponsor bus trips to ball games, shopping, plays, and concerts.

Grandchildren can bring great love and joy (Fig. 10-5). Family times help prevent loneliness. They help the older person feel useful and wanted (Fig. 10-6).

Fig. 10-5 An older man reads with his grandchild.

See Focus on Communication: Social Changes.

FOCUS ON COMMUNICATION

Social Changes

The social changes of aging can cause loneliness. If nursing center care is needed, the loneliness can seem even greater. The person may be in the same building with other people. However, those people do not replace relationships with family and friends. To help the person feel less lonely, you can:

• Suggest that the person call a family member or friend. Offer to assist with finding phone numbers and dialing.

• Keep the phone within the person’s reach. This helps him or her place or answer calls with ease.

• Suggest that the person read cards and letters. Offer to assist.

• Visit with the person a few times during your shift.

• Introduce new residents to other residents and staff.

Children as caregivers

Some children care for older parents. Parents and children change roles. The child cares for the parent. This helps some older persons feel more secure. Others feel unwanted, in the way, and useless. Some lose dignity and self-respect. Tensions may occur among the child, parent, and other household members. Lack of privacy is a cause. So are disagreements and criticisms about housekeeping, raising children, cooking, and friends.

Death of a partner

As couples age, the chances increase that a partner will die. Women usually live longer than men. Therefore many women become widows.

A person may try to prepare for a partner’s death. When death occurs, the loss is crushing. No amount of preparation is ever enough for the emptiness and changes that result. The person loses a lover, friend, companion, and confidant. Grief may be very great. The person’s life will likely change. Serious physical and mental health problems may result. Some lose the will to live. Some attempt suicide.

Physical changes

Physical changes occur with aging (Box 10-3). They happen to everyone. Body processes slow down. Energy level and body efficiency decline. The rate and degree of change vary with each person. They depend on such factors as diet, health, exercise, stress, environment, and heredity. Changes are slow over many years. Often they are not seen for a long time.