Aging Clients With Psychosocial Needs
Elderly Americans are the fastest growing segment of the American population. By 2050, 1 in every 20 will be 85 years of age or older and 1 in every 5 will be retired.
Psychiatric syndromes—rather than discrete disorders—are more realistic as diagnostic entities in geriatric psychiatry. The most common of these syndromes are memory loss, depression, anxiety, suspicions and agitation, sleep disorders, and hypochondriasis.
Learning objectives
After studying this chapter, you should be able to:
Differentiate between the primary or intrinsic and secondary or extrinsic factors influencing the aging process.
Articulate Duvall’s developmental tasks of aging.
Compare and contrast the more common psychiatric–mental health disorders among Native Americans, African Americans, Hispanic, and Asian American elderly.
Describe at least four patterns of behavior or emotional reactions that elderly clients exhibit as a result of experiencing despair.
Define failure to thrive.
Identify at least three causes of loneliness in the elderly.
Compare and contrast dementia and dementia syndrome of depression.
Explain the elements of a comprehensive assessment of geropsychiatric clients.
Identify provider-, client-, and illness-related barriers to the assessment of elderly clients.
State the rationale for prescribing low doses of psychoactive agents for elderly clients.
Explain the purpose of the life-review process and of reminiscence.
Develop a list of nursing diagnoses commonly used when planning care for elderly clients ineffectively coping with the psychosocial aspects of aging.
Plan nursing interventions for elderly clients who, according to Maslow’s theory of motivation, demonstrate basic needs for survival, safety and security, love and belonging, self-esteem, and self-actualization.
Key Terms
Aging
Dementia syndrome of depression
Ego preoccupation
Ego transcendence
Failure to thrive
Polypharmacy
Primary aging
Reminiscence
Secondary aging
Self-actualization
The number of individuals over the age of 65 years (referred to as late adulthood) is rapidly expanding. In 2002, 35.6 million people in the United States were ages 65 years and older. It is estimated that by the year 2020, approximately 52 million persons will be 65 years of age or older, and by 2030 that number is expected to reach 71.5 million (Administration on Aging [AOA], 2003). Although data regarding the prevalence of mental disorders in elderly adults vary widely, in the year 2000, the number of mentally ill elderly persons was estimated to be about 9 million. This figure is expected to rise to 20 million by the middle of the 21st century. Diagnosing and treating older adults with first onset or chronic psychiatric disorders often presents more difficulties than treating younger individuals because older persons may have coexisting chronic medical conditions. For example, the most frequently occurring medical conditions in adults 65 years of age and over include hypertension, arthritis, heart disease, cancer, sinusitis, and diabetes. Psychiatric illnesses can be aggravated by concurrent medical problems and similarly, medical conditions and their associated disabilities can be aggravated by psychiatric illness (Sadock & Sadock, 2003).
The public has become increasingly sophisticated in its knowledge and expectations of older-adult health care. As a result, the health care profession has been required to pay greater attention to specialization, thereby responding to the increasing consumer demand. Public pressure is enhanced further when families themselves form organizations to better highlight these needs and focus attention on various areas. For example, the Alzheimer’s Association in the United States, formed in 1980, now has over 200 local chapters across the country (Alzheimer’s Association, 2003).
Nursing has also addressed the issue of health care for the elderly. The aging person, like any other younger human being, has certain psychosocial, physical, and environmental needs that he or she strives to satisfy throughout life. Therefore, an understanding of the aging person’s life experiences and goal achievements is necessary for the development of a therapeutic milieu to meet the aging person’s needs as he or she continues to achieve his or her goals.
The American Nurses Association (ANA) first acknowledged nursing of older adults as a specialty in 1966. In 1970, the ANA established the Standards of Geriatric Nursing Practice. In 1976, the title of the ANA’s Geriatric Nursing Division was changed to the Gerontological Nursing Division. Today, gerontologic and psychiatric–mental health advanced nurse practitioners, as well as clinical nurse specialists, address the psychosocial needs of the elderly.
The compelling importance of psychiatric–mental health nursing of the elderly stems from the growing number and proportion of the elderly and from gains in longevity and active life expectancy. As a result, old age occupies a larger proportion of the average person’s life. Consequently, the quality of life in old age and the impact of psychiatric–mental health problems on that quality of life are growing in relevance to the whole of a person’s life. This chapter reviews the history of geriatric psychiatry, etiology of aging, and the developmental tasks for this group, focusing on the psychosocial aspects of aging. It provides information related to elderly clients who are ineffectively coping with the psychosocial aspects of aging, including application of the nursing process. The reader is referred to specific chapters in the text for additional information regarding specific psychiatric disorders experienced by the elderly.
History of Geriatric Psychiatry
A literature search regarding the history of geriatric psychiatry revealed interesting information. According to the Bible (Psalms 31:9–12), King David experienced clinical symptoms of depression. Historians believe this story indicates that the beginning of geriatric psychiatry is rooted in biblical times.
The presence of mental health, dementia, and mental illness in Egyptian, Roman, and French societies has been documented as early as the 7th century BC. The statue of an Egyptian elder is engraved with a message that states the elder spent his life in happiness, without worry or illness. A Roman, Cicero, at the age of 62, wrote an essay on senescence in which he stated the problems and goals of older adults. He acknowledged ageism in Roman society and described the severe regression that can occur with dementia. Father Jean Cassien published a book that described paranoid psychosis in a French monk who committed suicide during a delusional state (Sadavoy, Lazarus, & Jarvik, 1991).
During the Middle Ages (400–1500 AD), several individuals published articles about mental health and the aging process. For example, Berios, author of Montpelier,
differentiated depression and dementia. In the late 1890s, Freud, in an article about sexuality and neuroses, stated that the application of psychoanalytic techniques to older people was ineffective because too much time would be required to reach a cure in older persons who no longer were concerned about their “nervous health.” About 20 years later, Abraham, in an article about psychoanalysis, described success in the employment of psychoanalytic techniques in the treatment of older adults. During the same time, Ferenczi described psychodynamic changes that he observed in older adults during therapy (Sadavoy, Lazarus, & Jarvik, 1991).
differentiated depression and dementia. In the late 1890s, Freud, in an article about sexuality and neuroses, stated that the application of psychoanalytic techniques to older people was ineffective because too much time would be required to reach a cure in older persons who no longer were concerned about their “nervous health.” About 20 years later, Abraham, in an article about psychoanalysis, described success in the employment of psychoanalytic techniques in the treatment of older adults. During the same time, Ferenczi described psychodynamic changes that he observed in older adults during therapy (Sadavoy, Lazarus, & Jarvik, 1991).
In 1906, Alzheimer published his classic description of dementia and Gaupp differentiated dementias from non-dementias or depression. In 1946, the Group for the Advancement of Psychiatry (GAP) was founded to collect and appraise significant data in the field of psychiatry. In 1950, this group published a paper regarding the problem of the aged patient in the public psychiatric hospital. During this same time period, the first geriatric psychiatric position emerged in England at the Bethlem Hospital (also known as Bethlehem Hospital), and between 1950 and 1951, an entire ward of the hospital was devoted to the psychiatric care of clients over the age of 60 years.
The 1960s to 1970s marked a significant worldwide interest in the field of geriatric psychiatry. The AOA was established in 1965; the National Institute of Mental Health (NIMH) sponsored research on mental health of the aging between 1960 and 1976; in 1977, U.S. President Jimmy Carter established a task force to address issues related to mental health and mental illness in late life; and by 1978, the need for an American organization with a focus on geriatric psychiatry was identified.
During the 1980s, assessment scales such as the Global Deterioration Scale, Geriatric Depression Scale, and a variety of brief mental status scales were developed. Research activity in the 1990s provided more knowledge about the relationship between mental health and aging than in all the history of psychogeriatrics before 1990 (Sadavoy, Lazarus, & Jarvik, 1991). In 1991, the American Board of Psychiatry and Neurology established geropsychiatry, which is now one of the fastest growing fields in psychiatry, as a subspecialty. Furthermore, the emergence of sophisticated diagnostic equipment (eg, magnetic resonance imaging, positron emission tomography scan) and the knowledge of pharmacodynamics and pharmacokinetics have played an important role in identifying and treating the psychosocial needs of the elderly (Sadock & Sadock, 2003).
Etiology of Aging
Aging has been defined as a process involving a gradual decline in the functioning of all the body’s systems (eg, cardiovascular, endocrine, genitourinary, and so forth) (Sadock & Sadock, 2003). Busse (1996) states that aging usually refers to the adverse effects of the passage of time, but it can also refer to the positive processes of maturation or acquiring a desirable quality. The adverse effects or processes of decline associated with growing old are separated into primary and secondary aging. Primary aging is intrinsic and is determined by inherent or hereditary influences. Secondary aging refers to extrinsic changes (defects and disabilities) caused by hostile factors in the environment, including trauma and acquired disease.
Primary or Intrinsic Factors of Aging
Primary or intrinsic factors of aging include biologic and physiologic changes that are influenced by one’s gender; ethnicity and race; intelligence and personality; familial longevity patterns; and genetic disease. These changes are the underlying basis for the biologic theories of aging. Table 30-1 summarizes the biologic theories of aging.
Gender
According to statistics provided by the AOA, women live longer than men by approximately 7 years and will continue to do so until the year 2050. By the year 2050, the composition of the U.S. population is estimated to differ markedly from that of today (AOA, 2001). Factors assumed to influence or contribute to women’s longevity include endocrine metabolism before menopause that protects against circulatory or cardiovascular diseases, higher activity level, less occupational stress, better weight control, and less use of tobacco.
Culture, Ethnicity, and Race
Although the life expectancy for whites is approximately 5 years longer than for all other races, the death rate for the white population older than age 75 years is higher than for all other races. Mortality from cancer
rises steeply with age and may contribute to the increase in death rate among white clients older than 75 years. The overall life expectancy of the Native American is shorter than that of all other U.S. races, at 65 years of age. Adherence to a set of cultural beliefs, values, and practices makes outside intervention for treatment of conditions such as malnutrition, alcohol abuse, and tuberculosis for Native Americans difficult at best (AOA, 2001; Sadock & Sadock, 2003, University of Missouri, 2003c).
rises steeply with age and may contribute to the increase in death rate among white clients older than 75 years. The overall life expectancy of the Native American is shorter than that of all other U.S. races, at 65 years of age. Adherence to a set of cultural beliefs, values, and practices makes outside intervention for treatment of conditions such as malnutrition, alcohol abuse, and tuberculosis for Native Americans difficult at best (AOA, 2001; Sadock & Sadock, 2003, University of Missouri, 2003c).
 Table 30.1 Biologic Theories of Aging | ||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ||||||||||||||||||||||||
Intelligence and Personality
Most older persons retain their cognitive abilities to a remarkable degree. However, persons with higher levels of intelligence appear to live longer than persons with lower levels of intelligence (AOA, 2001). This may be due, in part, to lifestyle choices of those with higher intelligence quotients (IQs). Such persons may remain physically active by participating in events that promote physical, mental, and social well-being, thereby contributing to longer life.
In addition, different personality types may affect longevity. Persons with type A personality may seldom relax or enjoy themselves because of a drive-to-succeed quality. They are prime candidates for heart attacks. In contrast, the person with type B personality is an easygoing individual who takes life in stride. Personality also influences the adoption of certain behaviors, such as overeating, tobacco dependence, and alcohol abuse, which impair physical health and shorten one’s lifespan.
Familial Longevity
Familial longevity patterns are indicators of potential lifespan. A 45-year-old man from a family with a record of long-lived great-grandparents, grandparents, and parents probably will live longer than a man of the same age whose family history includes heart attacks by his father and grandfather in middle age. Many conditions that contribute to a shortened lifespan can be prevented, delayed, or minimized with effective interventions such as regular medical checkups; minimal use of substances such as coffee, cigarettes, or alcohol; work satisfaction; healthy eating habits; and adequate exercise (Sadock & Sadock, 2003).
Genetic Influences
Genetic disease may also affect lifespan. For example, persons with Down syndrome, cystic fibrosis, or Tay-Sachs disease typically experience shortened lifespans. Genetic factors have also been implicated in disorders commonly occurring in older adults (eg, coronary artery disease, hypertension, arteriosclerosis). Although people have minimal, if any, control over intrinsic factors influencing the aging process, a high quality of life can possibly promote one’s sense of physical, mental, and social well-being (Sadock & Sadock, 2003).
Secondary or Extrinsic Factors
To some degree, people can control secondary or extrinsic factors of aging. Examples include:
Employment
Economic level
Education
Health practices and related diseases
Societal attitude
 Table 30.2 Psychological Theories of Aging | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
Income, economic level, and educational level partially determine how one lives. For example, people may not seek health care because of high medical–surgical costs, lack of insurance, or ignorance about contributing factors to or symptoms of various diseases. People who have a poor diet, experience poor living conditions, have a substance-abuse problem, or ignore or minimize health problems also are at risk for a shortened lifespan. These practices have a negative effect on health and have been proven to contribute to deaths at earlier ages. Finally, societal attitudes affect persons psychologically, thus affecting the aging process. Most persons seek the approval of society, behaving in a manner based on societal expectations. Such thinking could lead to a lifestyle that is detrimental to one’s health. For example, individuals in a busy law firm who believe it is necessary to drink alcoholic beverages when entertaining clients could develop a drinking problem (alcoholism) over a period of time. Older adults should seek intellectual, emotional, and physical stimulation to maintain an optimal level of health and longevity.
Developmental Tasks of Aging
Several theories have been proposed to explain aging on a psychological level. These theories are highlighted in Table 30-2. In addition, theorists have identified specific developmental tasks to be achieved by the older adult. Duvall (1977) lists developmental tasks of aging that influence the emotional needs of the elderly:
Establishing satisfactory living arrangements
Adjusting to retirement income
Establishing comfortable routines
Maintaining love, sex, and marital relationships
Keeping active and involved
Staying in touch with other family members
Sustaining and maintaining physical and mental health
Finding meaning in life
These tasks are summarized in the following sections. In addition, comparisons of the completion of these tasks by minority groups such as elderly Native Americans, African Americans, Hispanics, and Asian Americans (Asians and Pacific Islanders) are included.
Establishing Satisfactory Living Arrangements
Many factors influence this developmental task. The following questions are examples of some issues that the family and the aging client need to consider, related to satisfactory living arrangements:
Is the elderly person single, widowed, divorced, or married?
Does the elderly person have an incapacitating illness or handicap?
Does the elderly person require assistance or supervision with activities of daily living (ADLs)?
Are the grocery store, pharmacy, doctor’s office, and church located close by or within walking distance?
Is the elderly person able to stay in her or his own home, or does the person need to be relocated?
Loneliness, anxiety, depression, and other emotional reactions may occur if these needs are not met.
Native American Elderly
As a result of their limited adoption of mainstream society’s values and ways of life, living arrangements of elderly Native Americans may differ greatly from those of elders of other cultures. All members of a tribe care for the elderly, who may have lived on reservations their entire lives and may have been isolated from mainstream society. Consequently, the above-mentioned considerations for satisfactory living arrangements may not apply for the elderly Native American (University of Missouri, 2003c).
African American Elderly
Approximately 33% of African American elderly live in poverty. More than twice as many elderly African American males as elderly white males are divorced or separated. African American elderly females with declining health are frequently the sole head of household. If elders live with their children, family networks provide the main source of needed assistance later in life. The possibility of being institutionalized for physical or mental disabilities decreases (University of Missouri, 2003a).
Hispanic Elderly
Compared with white and African American elderly, more Hispanic elderly are found living within neighborhood communities or “barrios” with their children or other members of their extended family, rather than in nursing homes or other institutional settings. Unfortunately, these neighborhoods are often densely populated, economically depressed metropolitan areas in which high crime rates occur, posing a threat to the Hispanic elderly’s safety and security (University of Missouri, 2003b).
Asian American Elderly
The number of Asian American elders living below the poverty level (13%) is slightly higher than that of the white older population (10%). Approximately 80% of Asian American elderly live alone, as more adult married children work and become Westernized. This creates a pressing need for more affordable housing, congregate housing, and nursing facilities (American Association of Retired Persons [AARP], 2003; DuPuy, 2002).
Adjusting to Retirement Income
Retirement may be a time planned for relaxation and leisure activities, or it may pose a financial crisis. Not all people are fortunate enough to have a savings account and receive Social Security payments, retirement benefits, or some other form of supplemental income. Marriages may be strained by role changes related to retirement or to caring for a physically frail or cognitively impaired partner. Problems of adult children or grandchildren (eg, illnesses, unemployment) can burden retired elders, especially if families expect financial support, child-care help, or cohabitation. Many individuals who retire re-enter the work force when economic hardships occur. Adjusting one’s standard of living to a reduced income can be quite stressful for the elderly when the cost of living continues to rise (Sadock & Sadock, 2003; Miller, 2005).
Native American Elderly
The average Native American barely lives long enough to reach the age of eligibility for most age-related benefit programs. Time takes on new meaning for the elderly Native American. Time is measured according to natural phenomena such as seasonal change, and the “right time” is viewed as when one is ready. Living in the present takes precedence over planning for the future. As noted earlier, the average life expectancy of the Native American person is 65 years (University of Missouri, 2003c).
African American Elderly
African American male elders generally have fewer personal post-retirement resources than white males and are more dependent on Social Security and Supplemental Security Income. Many African American elderly males regard themselves as “unretired-retired” because they generally continue to work after retirement age unless they are forced to retire because of a physical or mental disability (University of Missouri, 2003a). No information is available concerning retirement and African American elderly females.
Hispanic Elderly
Many Hispanic elderly have confronted educational and employment barriers throughout their younger years. A history of unemployment or a lifetime of hard work in unskilled labor positions, with deficient or nonexistent retirement programs, prevents the accumulation of sufficient wealth to sustain them in their later years (University of Missouri, 2003b). Hispanic elders are less likely to receive Social Security than their African American and white counterparts. If eligible, they are more likely to receive the minimum benefit because of a history of low-paying jobs (AARP, 2003).
Asian American Elderly
Asian Americans are more likely than white elderly to continue working after age 65 years. Social Security is the only source of retirement income for 34% of elderly Asian Americans (Social Security Administration, 2003). The vast majority of Asian American seniors do not speak English as a first language, and often struggle with the bureaucracy of social service and Medicaid programs (Ho, 2002).
Establishing Comfortable Routines
Retirement is a time for the pursuit of leisure and for freedom from the responsibility of previous working commitments. It allows one to establish a comfortable routine such as participating in a weekly bowling league during the day, doing volunteer work, or developing new hobbies. Conversely, retirement may be a time of stress, especially for the “workaholic” or type A personality, who needs to be busy all the time. “All my husband does is get in my way. He’s always underfoot like a little puppy dog. I wish he were still working,” “I thought we’d do things together such as golf, bowl, or play bridge. He’s not interested in doing anything,” and “I don’t enjoy life any more. There’s nothing to look forward to now that I am retired,” are just a few comments by persons having difficulty adjusting to new routines during retirement. On the positive side, a senior citizen thoroughly enjoying retirement made the following comment: “I don’t know how I managed to work before. I don’t have enough time in the day to do everything.”
Native American Elderly
The lifestyle of elderly Native Americans differs greatly in comparison with the lifestyle of mainstream society. Elderly Native Americans believe that each being has its own unique function and place in the universe. God is part of everything, including the routine of daily living. In traditional families, part of the elderly Native American’s comfortable “aging routine” is spending time with members of the extended family and passing down one’s wisdom and knowledge to the young (University of Missouri, 2003c).
African American Elderly
Retired African American elderly grandparents are often compelled to act as substitute parents for orphaned grandchildren or grandchildren of single parents. Instead of the retirement time they had looked forward to, they may be faced with the task of raising young children again (University of Missouri, 2003a).
Hispanic Elderly
Hispanic elderly tend to view themselves as old much earlier in life (eg, 60 years of age as compared with age 65 years for African Americans and white Americans) and expect fewer remaining years of life than any
other group. Established negative attitudes and expectations about aging limit their ability to establish comfortable routines enjoyed by their elderly counterparts (University of Missouri, 2003b).
other group. Established negative attitudes and expectations about aging limit their ability to establish comfortable routines enjoyed by their elderly counterparts (University of Missouri, 2003b).
Asian American Elderly
Asian American men can expect to live to age 84 and women can expect to live to age 88. With longer life expectancies, they will live more years in retirement, allowing them the opportunity to establish a comfortable retirement routine. As a result of longer life expectancy, there is a demand for social and community outreach programs to provide bilingual, bicultural services (DuPuy, 2002).
Maintaining Love, Sex, and Marital Relationships
“Most older people want—and are able to lead—an active, satisfying sex life…When problems occur they should not be viewed as inevitable, but rather as the result of disease, disability, drug reactions, or emotional upset—and as requiring medical care” (National Institute on Aging, 1981).
Walker (1982, p. 171) states, “The notion that old age will be sexless has been proven false in study after study. Provided that they are healthy, elderly people are capable of an active sex life into their 80s and 90s. Sexual performance may be slowed somewhat with aging, but sexual pleasure and capacity remain intact.”
Sexual problems can arise in later years due to physiologic changes, fear of impotence, fear of a heart attack because of physical exertion, or boredom. An older widowed man is able to establish a new marital relationship more readily than an older woman because of the availability of women in his age group or younger women. Stereotypically, older women are generally frowned upon if they marry a much younger man.
Kanapaux (2003) addresses the issues of fear and stigma as homosexual seniors progress through this developmental stage. Although gay and lesbian clients may encounter negative reactions from service providers at all ages, the experience can be especially difficult for seniors. Overt discrimination by the public and medical professionals has caused them to adopt a strategy of keeping their sexual orientation hidden. Most gay and lesbian seniors have support networks; however, same-sex partners lack the rights given to family members in terms of visitations, decision-making, and care-giving. Senior Action in a Gay Environment (SAGE) is the nation’s oldest and largest social service agency for lesbian, gay, bisexual, and transgender seniors. SAGE has created a training guide for social service agencies to recognize the needs of gay and lesbian clients. Its mission is to eliminate the institutionalized homophobia that may exist within various organizations that provide services to elderly clients.
Native American Elderly
Self-disclosure about personal concerns (eg, love, sex, and marital relationships) to someone outside of the traditional family is not normally done by Native American elderly. The husband is the head of the household, although the wife has a voice in decision-making (University of Missouri, 2003c).
African American Elderly
African American elderly are the most unpartnered group in America. According to year 2000 census figures, 54% of African Americans have never married. Furthermore, approximately 36% of African Americans have divorced, compared with 34% of whites. The “sexual revolution” of the last two decades has wreaked havoc on African American relationships. Many African American men say they prefer companionship to long-term commitments (Peterson, 2000).
Supporting Evidence for Practice 30.1: Understanding the Effect of Aging and Socialization on Memory
Problem Under Investigation
What is the relationship among aging, social factors, lifestyle, and memory?
Summary of Research
Subjects included 497 participants aged 25 to 80 years who had participated in the Maastricht Aging Study, a longitudinal representative study of cognitive aging in the Netherlands. Memory change, memory anxiety, and memory capacity were evaluated. Lifestyle was measured by the number of hours per week the subjects spent in sports activities, how active the subjects perceived themselves to be, participation in voluntary organizations, and contact with available family and friends. Subjects were also asked if they had children, a partner, or a full-time or part-time job. A nine-item version of the Health Locus of Control instrument was used to obtain data. Results of the study indicated that better subjective memory was associated with youth, health, education, and internal orientation. Higher memory capacity was associated with younger age, fewer health problems, being female, frequent contact with family/friend, higher internal locus of control, and self-perception as active. Intact memory capacity was associated with being female and self-perception as active. Self-perception had greater impact than the hours per week the subject was engaged in activity. The researchers suggest that increasing an elder’s social activity may support successful aging.
Support for Practice
Psychiatric–mental health nurses working with older clients need to keep this study in mind and design nursing interventions to improve cognitive functioning and reduce anxiety about memory loss. Furthermore, the nurse should encourage elder clients to engage in physical and social activities.
Source:
Stevens, F. C. J., Kaplan, C. D., Ponds, R. W., Diederiks, J. P. M., & Jolles, J. (1999). How ageing and social factors affect memory. Age and Ageing, 28(4), 379–384.
Hispanic Elderly
Nearly twice as many Hispanic men as women age 65 years and older are married and living with their spouse, a pattern mirrored in the white older population. It appears that elderly Hispanic men have a more favorable chance of completing this developmental task than do elderly Hispanic women (ie, there are 71 men for every 100 women). About the same proportion of Hispanic and white women are widowed (AARP, 2003).
Asian American Elderly
The developmental task of maintaining love, sex, and marital relationships may not be completed by many Asian American elders, especially elderly women. According to research, the majority of Asian American elderly women are widowed and living in isolation. A smaller proportion remain single in their later years (AARP, 2003; Ho, 2002).
Keeping Active and Involved
Butler and Lewis (1982) have identified special characteristics that demonstrate the ability of the elderly to keep active. These characteristics include the desire to leave a legacy; the desire to share knowledge and experience with younger generations; the ability to demonstrate an increased emotional investment in the environment; a sense of immediacy or “here-and-now” due to the decreased number of years left; the ability to experience an entire life cycle; increased creativity and curiosity; and a satisfaction with life. Physical illness may prevent a client from being active and becoming involved with others. The theory of disengagement assumes that society expects and older people desire to disengage or remove themselves from important activities such as employment, a figurehead role in the family, and civic responsibility. Supporting Evidence for Practice 30-1 highlights a study addressing the relationships among aging, social factors, lifestyle, and memory.
Active senior citizens may participate in volunteer employment programs such as Retired Senior Volunteer Program (RSVP), Service Corps of Retired Executives (SCORE), Volunteers in Service to America (VISTA), Peace Corps, Foster Grandparents Programs, and Senior Opportunities and Service (SOS) programs.
Native American Elderly
Keeping active and involved can be a challenge for elderly Native Americans because more than 80% of elderly Native Americans do not have telephones. The majority also do not receive newspapers or have television sets. According to tradition, knowledge and experience is shared with younger generations; however, there is minimal involvement with the outside world. Life-cycle events are marked by special rituals. Tribal and family ties are strong, contributing to a sense of belonging to a social group (Boyle, 2003; University of Missouri, 2003c).
African American Elderly
In general, elderly African Americans do not participate in social or recreational activities that are outside
the realm of their individual cultural traditions, backgrounds, or experiences. Spirituality, faith in God, and increased participation in religious activities play an important role in elderly African Americans’ ability to keep active and involved during the aging process (University of Missouri, 2003a).
the realm of their individual cultural traditions, backgrounds, or experiences. Spirituality, faith in God, and increased participation in religious activities play an important role in elderly African Americans’ ability to keep active and involved during the aging process (University of Missouri, 2003a).
Hispanic Elderly
Of all minority older persons age 65 years and older, Hispanic elderly are the least educated. Approximately 10% have had no education, and only 27% have graduated from high school. Language and transportation barriers, living in isolated areas, living on an inadequate income, and functional limitations can contribute to lack of motivation, thus preventing Hispanic elderly from becoming active and involved within the community (AARP, 2003).
Asian American Elderly
Although a large number of recent Asian American elderly immigrants are high-school graduates and are well educated professionally, cultural and language differences may provide barriers to their ability to remain active and involved in their communities (AARP, 2003).
Staying in Touch With Other Family Members
A 94-year-old woman placed in a nursing home by her family made this statement: “I cry inside every day. Each time they come to visit me, I beseech them to take me home… All I want…is to hold my daughter’s hand and be surrounded by those people and things I love.”
The following poem appeared in a local newspaper along with a drawing of a forlorn-looking elderly woman sitting alone in her home:
Next year.
They said they’ll come down for Christmas next year.
Excuses again.
It’s warm today.
Too warm for Christmas anyway.
I don’t think I can wait another year.
—Larry Moore, 1983
This verse depicts the loneliness experienced by many elderly people without family or a substitute support system, especially on holidays, anniversary dates, and birthdays.
Loneliness can lead to depression and thoughts of suicide. The elderly are considered to account for approximately 25% of suicides reported yearly (American Psychiatric Association [APA], 2000; Blazer, 1996). Persons who meet the developmental tasks of maintaining love, sex, and marital relationships, and who keep active and involved, probably would be able to cope with separation from family members more readily than those who choose to disengage themselves from society.
Native American Elderly
Most elderly Native Americans have large extended families and are able to stay in touch with family members. Sharing of responsibilities by family members, respect for others, and allowing for individual freedom are integral parts of the Native American lifestyle. Generosity is valued, especially in helping family members and others who are less fortunate (University of Missouri, 2003c).
African American Elderly
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
