As we look at the increasing numbers in population of the ...



Chapter 20 Evaluation and Care of the Geriatric Patient

Psychosocial Development

Many different theories of psychosocial development have evolved which apply to late adulthood. One thought is that adults continue to grow, mature, and behave as they have their entire life. Another believes that older adults want to achieve their complete potential. One well described theory by Erik Erikson involves integrity versus despair. This encompasses the belief that older adults look back on their life with reflection, either satisfied with their achievements or in despair about them.

Other psychological and social development involves specific age, gender, race, and financial status. The following table describes the factors related to aging. Public opinion is often influenced by these factors. When screening a senior patient these all need to be kept in mind. Again, aging is not synonymous with illness.

Psychosocial Facts Related to the Older Adult

|Employment and Retirement |The traditional retirement age of 65 no longer is standard. More seniors are retiring younger, |

| |when financially able. Priorities are re-evaluated, not necessarily ranking work as a priority.|

|Volunteer Work |Due to commitments to their community, seniors often choose to begin volunteering after |

| |retirement. This is important for maintaining social relationships within the community. |

|Involvement in Politics |Seniors are more politically active than any other age group with 60% registered to vote. |

|Marriage |Age 65-74: 4.3 % never married, 65.7% married, 20.7% widowed, 9.3% divorced |

| |Age 75-84: 4.2% never married, 50.1% married, 40.3% widowed, 5.4% divorced |

| |Age 85 and older: 4.9% never married, 30.7% married, 61.1% widowed, 3.3% divorced |

|Friendships |There is a relationship between friendships developed late in life and the level of self-esteem|

| |of the patient. |

In order to address the needs of the growing number of older persons, the Older Americans Act (OAA) was established in 1965. The OAA offers programs to assist the lives of older people, addressing topics of housing, income, health, employment, and retirement.

Field Smarts

If employed in a geriatric practice, be familiar with the OAA. As social topics often are related to the health of the patient, understanding assistance that might benefit your patient may be helpful in their health care.

Some important tips to assist the health professional when talking to a patient with hearing difficulties are:

• Speak slowly while facing the patient. The patient who has learned to adapt to hearing limitations will benefit from watching lips while listening.

• Evaluate any extraneous noises in the environment. Elimination of these may be all that is needed to improve communication.

• Do not mumble or rest chin on hand when speaking. This often muffles speech.

• Be patient. Do not speak to the caregiver in place of the patient due to impatience.

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