Chapter 23
The Elder Population
Public health nurses spend a great deal of their time advocating for resources for the aged population, which generally encompasses those over the age of 65. Due to the dynamic success of our healthcare systems and technology, people are living longer; consequently, acuity is higher and the severity of illness may be significant. The United States is projected to have at least 71.5 million persons over the age of 65 by the year 2030. Currently, over 3.6 million older adults live below the poverty level, and minority elders are likely to be poorer than their caucasian counterparts.
Many older adults report that they have at least one chronic health condition and many have other co-morbidities, such as hypertension, arthritis, heart disease, cancer, diabetes, and sinusitis. Forty-two percent of the population aged 65 and older reported some type of long-lasting condition or disability (sensory, physical, mental, or self-care deficit), or difficulty performing ADLs, and reduced socialization.
Public health nurses are involved at the local, state, and national levels in organizations that advocate for education, research, and higher standards of healthcare for the elderly. One resource on aging issues is the White House Conferences on Aging. The American Association of Retired Persons (AARP) provides discounts, ancillary support, and resources for the elderly.
Several theories of aging have proven to lend guidelines when developing care for the aged. These theories, whether they be biological, psychological, or sociological, attempt to explain human motivation, self-realization, stages of psychological development, and compensation. The use of theories among the aged demands an eclectic approach since each person and situation varies and requires individualized care. The nurse must consider not only the client’s physical conditions but also economic, social, and psychological experiences as well.
As the consumer population ages, the diversity among the sub-groups becomes relevant to the care planned and received. A client’s culture or subculture reflects shared values, beliefs, and behavior that serve as guides for interacting within the family, community, and country. These concepts impact consumer perception of health, illness, and healthcare expectations.
Many aged persons are cared for in their home by family caregivers who serve the client the majority of the time. These caregivers often share responsibilities with others and care for the person free of charge. While it is estimated that 17% of households in the United States contain at least one caregiver who provides care to someone 50 years of age or older, 13% of caregivers themselves are aged 65 and older. The nurse must be aware of caregiver fatigue syndrome and the frustration of serving as the primary contact person for aclient’s care. Caregivers report that they have difficulty finding time for themselves, keeping the person they care for safe at home, balancing family responsibilities, and managing emotional and physical stress.
Many of the aged lead a relatively healthy lifestyle and are productive, even though they may be experiencing a chronic, debilitating disease. Nurses must be able to recognize the normal signs of aging in addition to the abnormal consequences of a disease process. Nurses must also take steps to assure that the elderly have adequate food and housing and that resources are accessed for those in need.