Human Development

¶ … Ljl Human Development Human Development -- the Elderly The purpose of this paper is to examine human development from the perspective of sociocultural concepts regarding the elderly as well as from the healthcare provider's view and heatlh care services delivery in the elderly population. Generally, in terms of the elderly and the cognitive aging which is experienced one assumes that is purely a time of decline in the areas of memory, linguistics and processes of attention as well as the problem-solving skills.

The decline is believed, and studies support the idea as well, that the cognitive decline begins sometime during the years of the person having reached the age of sixty. However, according to Schaie, 1993, while it is true that a few of the individuals mental abilities experience declines that most cognitive abilities experience only small declines. However, this small declines are sure to occur.

The Aging Process: One hypothesis that has been purported is that some of the declines experienced during the aging process may not be due to "regression" but instead may be attributed to "suboptimal cognitive" functioning of the elderly individual. That the aging cognitive functions seemingly undergo a destructuring process that appears with childlike reasoning is the basis for the regression theory.

Within this theory is the belief that "structures that support the reasoning mechanisms have been destroyed" and that the regression experienced is permanent and "irreversible." (Fontaine, 2000) Another hypothesis states that the declines observed in the cognitive abilities of the aging is in the individual's use of only part of the cognitive resources. The Health Care Provider's Consideration in Care for the Elderly Population: There are different resources that define the reservoirs of assets and capabilities that actually or potentially facilitate coping and adaptation processes according to Pearlin & Schooler, 1978.

First there are personal resources, secondly socioeconomic resources and finally psychological resources. Personal resources provide a useful framework for explaining variation of adjustment to major tasks and transitions across the life span (George, 1980; Jerusalem, 1993; Lowenthal, Thurnher & Chiriboga, 1975) Socioeconomic resources are objective assets that are highly visible and sanctioned by society and are usually related to one's education, occupation and income. (Zemach 1999).

They are powerful determinants of social class or statifications and differentially affect the individuals accessibility to vital factors such as knowledge, beneficial life conditions, protective environment, and health care services (Feinstein, 1993) It is generally agreed that health is a personal states that does not refer merely to absence of disease but also to objective and subjective aspects of physical and mental well-being.

(Stone, 1979) With that thought in mind, the health care provider must take many aspects of care for the elderly into mind and not just that which is physically relevant in the care of the elderly. The Elderly Population is Growing:: The number and percentage of elderly or older adults in the United States has more than tripled since 1990 and the growth of the population that are elderly is not expected to slow anytime soon. The U.S.

census of 2000 shows that 35 million individuals in the country are the age of 65 years or older and life expectancy is approximately 80 years of age on the norm demonstrated well by the fact that at least 9.2 million U.S. individuals are age 80 or older. The elderly population is facing with increased age the possibility of acute and chronic illnesses. Sensory, functional and cognitive illnesses are inclusive I these possible illnesses. The growth in the elderly population signals new demands for health care providers.

Dementia, incontinence, immobility as well as sexual dysfunction have been "accepted" as being the norm in the aging process. However, it is fortunate that finding through research have shed light on the aging process and this has led to "appropriate, age-specific care measures being developed and this is ongoing. (Elipoulos, 1999) Chronic illness is suffered by nearly 90% of elderly individuals with many suffering chronic illness. Heart disease, stroke and cancer are said to be the leading causes for death among the elderly population.

Decline in sensory and neural function is accredited for the accident prone injuries that are predominant among the elderly and according to Eliopoulos, 1999, falls account for the most common cause of fatal injurys for he elderly population. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) require that staff be specifically competent in the provision of health care for the patient groups of the elderly. The specific set of norms for the elderly requires knowledge in the area of assessment for correct interpretation of the complexities that exist.

The basic areas of competency required for providing healthcare to the elderly are inclusive of the physiology of aging, medication administration, pain management, prevention of pressure ulcers, wound management, elder abuse as well as safety measures. In order to provide better care for the elderly, Wessling 2002, relates that the medical-surgical nurse must understand the effects of the aging process so that when something deviates from the norm the provider knows what to do. According to The Sachs Group, 1999, elderly patients account for 47% of inpatient care for healthcare providers.

The Elderly Individual's Personal Social Network: As individuals reach the age that is termed elderly, the need for a construction of a personal social network becomes evident. According to a study written by Sluzki, 2000: "Our personal social network is stable but evolving relational fabric constituted by (a) family members (b) friends and acquaintances (c) work and study connections, and (d) relations that evolve out of our participation informal and information organizations -- social, religious, political, vocational, health-related, et cetera.

This social cocoon constitutes a key repository of our identity, our history, and our sense of fulfillment and satisfaction with life." Old age is what describes the stage when an individual has reached an advanced chronological age and is a reality of biological science.

According to Sluzki, old age is defined by: (a) The culture: Different collectives define a person as old at different chronologial ages; (b) By the changing of equilibrium between the bodily decay and the advancement of geriatric medicine people remain physically and hence emotionally fit at a later age as preventive and therapeutic medicine discovers new ways of delaying the unavoidable physical decay and of keeping older people healthy.

(c) By genetic lottery -- some families display generations of trend toward early death There are traits commonly shared by individuals of advanced age. The advanced aged is characterized by sensory acuity being reduced as well as a reduction in motor agility. There is also decline in cognitive functions that are in actuality more that of a steady slide instead of a marked drop in the functions.

As well there is a shifting in the individual's responsibility within the familial realm in that as the old adage states, "The parents becomes the child and the child becomes the parent." Breakdown of Social Skills and the Social Network: Socially the elderly individual experience changes in a progressive breakdown of the skills required for social interaction as well as social bonds.

This is experienced in the following ways: (a) Death of members of social network (b) Increased difficulty in the ability to interact or attend to social tasks (c) Decreased ability in making new social contacts and maintaining those already established This leads to a reduction in the substance and opportunity for social interaction.

According to Lansford, Sheriman & Antonucci, 1998, "This emptiness is in many cases counterbalanced by the retention and sometimes even intensification of select friendships." Decreased Autonomy in the Elderly: The elderly individual also deals with a reduction in terms of socioeconomic power due to the general lessening of the income among elderly individuals. Although there are exceptions, the norm is that the income of the individual of advanced age will be substantially less than the income of their productive working years.

This decrease in income is complicated by a rise in the healthcare costs that are generally associated with advanced age. Also, other expenditures in the areas of home assistance care for cooking, cleaning, laundry and other maintenance needs is decreased due to the individuals decreased capacity for performance of these duties for themselves. This decrease in autonomy is thrust upon the elderly individual and leave many feeling that they are a burden to their family and caretakers.

The general reaction upon realizing the need for a support network causes individuals to respond in a several ways. The first response is for the individual to move to the town where their children reside. This can be positive in many ways. However, this situation can also be very complicated for the individual who, in asserting their autonomy, manages to stir up old angst within the family over issues long past.

This within itself is the reason that many individuals opt for the mature community settings that are excellent for those not yet ready for the full time care of a nursing facility. Negative Societal Treatment of the Elderly Individual: Society generally tends to treat the advanced age individual in a manner that is "trivializing and infantalizing" to the individual's perception.

Because so many of the elderly don't have their drivers license, and many don't need to have one, and also need care to the extent that they are unable to attend to the toiletry task on their own.

This is something that is alienating and regressive and plays a part in the cognitive and emotional deterioration of the elderly : they see themselves through the eyes of others, and fulfill the assumption (Golander, 1995, Whitborne, Culgin & Cassidy, 1995) The Role of the Healthcare Worker: It is fortunate that in view of the many losses "that accompany the retraction of the personal social network of the elderly tend to be minimized by our culture, by health and mental care worker and by the elderly themselves.

To make explicit and to legitimize the impact of the subject's diminished sources of identity, history, and both emotional and intellectual validation has a profound therapeutic value." (Sluzki, 2000) According to a report in Geriatric Times: "Palliative care focuses primarily on the relief of suffering.

Multidisciplinary teams of doctors, nurses and social workers also strive to help patients achieve the best quality of life possible and help families cope with the psychological, emotional and spiritual issues that these illnesses involve." (Kanapaux, 2004) The problem, this report reveals is the lack of training provided to medical students in this area of treatment.

The care that is provided through palliative care extends beyond that normally provided as palliative care is all encompassing and is termed to be a "highly skilled, medically driven process." (Kanapaux, 2004) Delirium doulas: In an article entitled Delirium doulas .. Sarah H. Kagan, Critical Care Nurse states that Delirium, or that of elderly cognitive functional shift is one that places great demands upon the personal, social, cultural, financial and medical environment of the individual as well as leaving a ripple upon the environment itself.

The disease derived it's name from the word Adoula (doo'la) which is defined as: a non-professional or layperson who is the provider of physical, emotional, and informational support to women in labor and the women's partners. (Kagan) Other medical fields have doulas such as the intensive care unit with an innovative model with the purpose of defining optimum care for critically ill adults. So doulas is the term used for purposes of this writing as well.

Delirium is defined as "disturbance of consciousness, attention, cognition, and perception" that reveals itself over a period of time, fluctuating by hours or days and is thought to "complicate the hospital course of 2.3 million patients" on an annual basis costing to the tune of $4 billion a year. The Graying of the Boomers The Baby-Boomer generation that was born in the middle of the 20th century is beginning to gray. The reason this is worth mentioning is due to the mega-load of individuals that comprise the boomers crowd.

Another factor that is attributed to the overwhelming population count of the boomers is that the life span of an individual is much longer than was previously known and that has effected the population increase of elderly as well. According to the Administration on Aging the adults that were 6 years old or older equaled a whopping 25.6 million, accounting for 12.3% of the United States population.

The Agency for Healthcare Research and Quality states that the hospitals discharged 12, 36, 530 adults 65 years of age and older in 2002 which accounts for 35% of the total amount of hospital discharges reported in the United States that year. Another factor incredibly is that the age group of adults that are 85 years old or older is the fastest growing group in any of the age groups.

Goals in Patient Care Involving Delirium: Optimal care of those with the complications of delirium is inclusive of first giving consideration to the duration and initial prevention of possibilities of iatrogenic injury, offering emotional support to patient and their family, maintenance of pre-hospital functional status, and providing enhancement to the quality of life after hospital discharge. The elderly population when hospitalized is a double-risk for death and at a triple-risk requiring for nursing.