Category: Elderly

Loneliness in America is a very pressing issue, especially in people 75 or older. This group of people paved the way for the things we have now. Loneliness is slowly taking over our loved ones, and it needs to be put to an end. For many people loneliness can feel like pain in the body and can lead to things like drug use or self-harm. The average person will agree to feeling lonely at some point in their lives. Loneliness is curable, and in many ways that you would never think of. Elderly people should not be going through these circumstances if they can be stopped.

Loneliness is defined as “being without company.” (Webster) People become lonely when they feel that they have no one to talk to, visit, or confide in. Family members and close friends may not notice the loss of connection but the person experiencing it does. It can be harmful to us in many ways such as alcoholism, suicide, drug use, and depression. Loneliness affects everyone in every age group but is more worrisome in our elders. They are feeling abandoned and disappointed in their children and grandchildren. Elders take lack of communication in a more personal way than we do.

The word loneliness first came into the world in the late 16th century. People then thought of loneliness as being too far away from other people. Being away and in the woods would trigger a fear that they would be harmed. Being away from people then meant that there was no protection against other humans or even wildlife. Preachers even used the term loneliness as a way to scare church goers away from sin. It was used in the same way hell, the desert, and their grave. (Worsley)

Though the word lonely has gotten away from the meaning “too far away” it is still a powerful word to this day. Loneliness is no longer compared to being in hell or being dead, it is being used in the same way as sorrow, or abandonment. It is not just staying away from other people or staying in the dangerous woods. It is a feeling of being away from other people even though you might be surrounded by them.

There are many ways to help our elders get out of this state of loneliness. One is as simple as taking time out of your day to talk to them. Research shows that the simplest smile and wave at someone can brighten their day tremendously. Going to see your loved ones more often could actually save their lives. They feel as though their children have abandoned them when they move away, or don’t call. When you show them attention or even let them teach you something. It works as a feeling of helpfulness, it makes them feel as though you still need them.

Another way we can help support our elders during this time of depression, is to introduce them to social media. Today social media is used as a source of communication in many families. Facebook is a platform where you can chat, upload pictures, and even call your loved ones. It may be harder to teach older people how to use all the features on the site but pays off in the end. It gives them a whole new way of communication they have never experienced.

Loneliness is nothing a little encouragement couldn’t help. Encouraging your elders to get out of the house more, or to join a new club could really help them. Sometimes all people need is that little push for things to change. There are still many ways to get them out of the house, such as a swimming classes or a book club.

Some people may say that our elders aren’t what we should be focusing on. But I completely disagree with that statement. Our elders are who have paved the way for what we have now. They fought hard for all of the privileges we have. They need to be protected for what little time they have left with us.

In conclusion our elders need help with the terrible feelings they are experiencing. There are many ways to stop this problem. Some are as simple as a talk and a hug. Others are as complex as teaching them how to use a new app. No matter what, they are falling deeper and deeper into this hole called loneliness. They need our help.

“Don’t ever get old”, my client said to me as I reached for her cane. As nurses, we should understand that aging comes with a lot of changes psychologically, cognitively, physically, and emotionally. Individuals become more vulnerable as they age, and their risks for injury and diseases increase. Older adults have different healthcare needs than infants and young adults because diseases and treatments affect them differently, thus they should receive care from health providers who are specially trained in geriatrics. As a future nurse, I have to understand and know how to apply specific practices in the care of older adults. Therefore, I conducted an interview to examine the life and daily activities of older adults, to apply my knowledge of the nursing process in their care, and to build my communication skills.

Mrs. A.P. was born in 1945 in the family of a Ghanaian farmer and an Italian. She is a Christian who describes herself as someone who loves to have fun, a woman who doesn’t like to settle for comfort, hardworking, ambitious, “not so smart but I try” and friendly. All of these she learned from her parents. She never misses a Sunday or Wednesday service at life Source Church. According to Mrs. A.P., the only religious practices she indulges in is the Easter and Christmas celebration, as she believes that these celebrations remind her of the love God has for her and her family. She has 3 children and lost her husband to cancer. Her children are all living, married, and with children of their own. Mrs. A.P. reflected and talked passionately about her memories with her siblings, her love for them, how she misses them, and how they died. In the course of telling me the story, she became emotional and cried till the end of the story. She is the first of 2 children of her parents. She takes much pride in her education, graduated from the University of Virginia with a degree in business administration, and graduated from the University of Maryland with a degree in Economics. Before getting these degrees, she had worked with a lot of small businesses and restaurants because she got her first big job with a small company. She worked there for a couple of years before she left and created her own business before retirement. My client manages her financial affairs herself, but she often seeks advice from her oldest son.

“At 75 I cherish the little things that I took for granted when I was young”, said Mrs. A.P. when I asked her about the important things in life. The time she gets to spend with her grandchildren and the times when the family comes together to celebrate the holidays together are the most important to her. She has a lot of significant events that have happened in her life, but she doesn’t remember them. She states her marriage as one of the events that she had vowed never to forget, hence why she has pictures of that day all over the living room and in some picture books on the bookshelf: “This is one day I wish to relive again”. As a person that hates surprises, Mrs. A.P. talked about the day her husband proposed to her and how she didn’t see it coming. She talked about the smile her father was wearing on his face when her husband got down on a knee and how it made her feel like her life had a purpose. However, losing her husband to cancer changed her life negatively. According to Mrs. A.P., his death was unexpected: “I always thought he would be here forever or I would go before him not him before me”. This changed her life as she started to do activities alone that they did together, which made loneliness and depression set in. The shock of his death has made her a daily visitor to the clinic nearby because she doesn’t want any health surprises.

Moreover, Mrs. A.P.’s children and grandchildren help her with grocery shopping, getting to appointments, and getting her prescriptions filled. She has a car of her own but doesn’t drive like she used to because of fear of road rage and her age. Whenever a worry or a difficult situation presents itself, she tends to call her oldest son to help, otherwise, she attends to it without help from anyone. She lives alone but gets visitors often. She is very independent and attributes the reason to always eating organic fresh foods and a little exercise, which made her strong over the years. Mrs. A.P.’s son moved her to a smaller house for fear that she might fall when climbing the flight of stairs that the other house had. He placed rugs in almost every part of the house, rails in the bathroom, a high toilet seat, perfect lighting, and space to reduce safety hazards and falls.

Mrs. A.P.’s typical day after breakfast, she reads a newspaper she finds on her lawn, watches TV, walks to her neighbor’s house who is also her friend, then returns to make dinner and watch some more TV. When her grandkids visit, she changes her schedule to revolve around them. She gets with her family at least 3 times a week, but they speak to her every day on the phone. To pass time, she reads books or newspapers, visits friends, and cooks. She loves to cook and wishes she had opened a restaurant where the chefs would use her recipes. She sees herself as that much of a great cook.

Furthermore, Mrs. A.P. defines health as a state of all-around well-being. Health to her means the presence and absence of sickness or anything that affects you as a person. In comparison to other adults her age, she feels she is doing better physically and mentally. She isn’t perfectly healthy but with her age comes a lot of obstacles health-wise that she has overcome or hasn’t experienced. Mrs. A.P. reports not having any difficulties performing instrumental activities of daily living, even though she uses a cane as she leaps. She gets constipated now and then with painful defecation because she doesn’t remember to always drink water, which is why she sees a doctor often. In the past, she was diagnosed with anxiety just months after the passing of her husband. Also, she talked about having trouble falling asleep. She takes over-the-counter laxatives that her son buys for her anytime she notices constipation.

In this stage of her life, Mrs. A.P. has become reserved. Aside from visiting her friends, grandchildren, and her children, grocery shopping with the grandkids, doctor appointments, and attending family birthday parties, she enjoys her alone time. She loves the amount of time she has had since retirement. She doesn’t have to answer to anybody, she gets to wake up when she wants, plan her own schedule and execute it however and whenever she wants. Compared to her younger years, she is very happy and satisfied with her life except that she still feels sad about her husband’s death: “I live for my grandchildren and my children, they bring me so much joy”. Mrs. A.P.’s future plan or goal is to live a healthy life to the end.

Before this interview, I had been concerned about how my interviewee would react to the questions I had for her. Initially, I felt that she might not want to reveal a lot of information for fear of an invasion of privacy. In this period of the coronavirus, where people are being stigmatized after being sick, I felt that my interviewee might feel judged after telling her story. My major concern was that she was going to cancel the interview with me, and this made my anxiety level go up a little. During the interview, I was most comfortable when she was telling me about herself and her family. She talked about them with so much happiness and joy, smiling from ear to ear, you could tell how much love she has for them. When she spoke about her education and the jobs she had before retirement, I was comfortable here because I could relate to her. I believe knowledge is power and anybody that possesses it can rule the world if they choose to put it to good use. The way she spoke about her jobs and how she did anything to make sure her children went to good schools made me feel like I had to take up some responsibility in my life and this made me really comfortable. The area that made me least comfortable was when she spoke of the death of her husband. Anytime she mentioned her husband, this cloud of sadness engulfed the environment and she cried. I felt really bad because I was bringing up emotions that might have been buried or put aside. Although I offered my condolences and tried to comfort her, it still made me uncomfortable.

In a second interview, I would make the plans ahead of time in anticipation of disappointment. I would ask more questions that would make the interviewee feel safe and know that it is okay to open up. I would provide more privacy and create a good interactive field. I would provide some health promotion and education to enlighten my interviewee about some diagnosed health issues or ways to prevent those health issues.

Based on the interview data I collected from Mrs. A.P., my first nursing diagnosis is constipation related to decreasing in oral fluid intake as evidenced by painful defecation. My second nursing diagnosis is insomnia related to emotional discomfort, as evidenced by verbal reports of difficulty falling asleep. With the diagnosis of constipation, I would provide some interventions to my interviewee. I will teach and advise her to increase her intake of oral fluid to at least 8 glasses every day, this would prevent constipation and soften the stool. Also, I would advise her to increase her intake of dietary fiber because this would add bulk to the stool and make it easier. With the diagnosis of insomnia, I would encourage daytime physical activities and advise her to avoid strenuous activities at night time. This is because therapeutic activities can induce sleep, while strenuous activities increase stress and cause trouble falling asleep. Moreover, I would advise her to avoid taking daytime naps, as napping can change her normal sleep pattern.

Caring for older adults can pose a challenge because of the changes in their bodies due to aging. This interview will influence my nursing practice immensely. I am now aware that being in good health as an older adult is more than taking medications. They also require support to keep them going and give them hope. One of the specific practices I will include in my care for older adults is to assist with necessary good hygiene and also encourage self-care with activities such as hair care, mouth care, dressing, and bathing. I will collaborate with other healthcare professionals to provide information and excellent care to the patient and family. I will encourage the use of support systems such as family, friends, and pets. I will assess their swallowing ability to prevent aspiration. Ensure that the living environment is free of clutters or potential safety hazards to prevent falls or injuries. Discourage excessive napping in the daytime to promote a good nighttime sleep pattern. Include the patients and their families in the care plan to aid in speedy recovery.

Given these points, it is evident that my nursing practice toward older adults has been positively impacted by this interview. As nurses, our goal towards older adults is to assist them to be functionally independent and promote the patient to return to normalcy. I learned that medications and other treatments affect older adults differently than young adults, so as nurses we should be mindful of the pharmacological care, we render to them. By conducting this interview, I was able to build on my communication and interpersonal relationship skills. In my future nursing practice, I will actively listen to the concerns of my patients, build trust and rapport, and work towards goals that would benefit the patient. I have also learned that being sensitive to my patient’s experiences will make communication less challenging. Moreover, I am certain that the knowledge I gained from this experience would facilitate a positive contribution to my future nursing practice.

The chosen issue for this paper is cognitive changes in very old age. Cognition is the process of gaining knowledge through cultural experiences. This essay will focus on the aged 80 years and over and examine the cognitive function and reasons for cognitive decline in very old age. Jung and Haier’s (2007) parieto-frontal integration theory will research studies of human intelligence and reasoning. Christensen (2001) will define crystallized intelligence and examine a longitudinal study of crystallized intelligence, speed, and memory, as well as the results from this study. Kail and Cavanaugh (2014) will define plasticity in individuals. Ball, Berch, Helmers, Jobe, and Leveck (2002) will examine the plasticity of the brain and whether it changes over time. Miyake, Friedman, Emerson et al. (2000) defines executive control, and Cicerone, Berch, Helmers, Jobe, and Leveck (2006) research the processes of executive control. Nararro (2009) examines whether computer programs contribute to improving the cognitive functioning of very old people. Christensen (2011) studies research if poor health is related to cognitive decline in very old people. Anstey and Christensen (2000) research through longitudinal studies whether health and disease in very old aged people cause cognitive change. Christensen also researches three studies on whether there is an association between poor health and cognitive decline. Earles and Salthouse (1995) examine whether health has an impact on the cognitive speed of older people. Singer, Verhaeghen, Ghisletta, Lindenberger, and Verhaegen (2003) examine perceptual speed, memory, and fluency of people aged 70-100 using the Berlin Aging Study. Finally, the conclusion highlights the causes, transitions, and reasons for very old people and their cognitive function.

Jung and Haier (2007) developed the parieto-frontal integration theory based on 37 neuroimaging studies with 1557 participants who were tested for intelligence and reasoning. This involves the cerebral cortex in the brain, which interacts with the parietal lobe and frontal brain region. When this is linked with the white matter, this causes individual differences in reasoning in humans. It is true of very old age because their intelligence and reasoning have declined due to the interaction between the cerebral cortex, parietal lobe, frontal brain, and the nerve fibers that have deteriorated, this causes individuals as their intelligence and reasoning, to be affected due to these interactions. Hoffnung et al. define intelligence as the general ability to learn from experience, the ability to reason abstractly especially using language, and the ability to integrate old and new knowledge.

Cabeza and Nyberg (2000) reviewed brain function from cognitive neuroimaging of brain activity by lobe at the Brodmann areas (visual cortex). Humans process cognitive data through auditory and visionary methods. The temporal lobes and occipital lobes are significant to the early processing of sensory information. The sensory, perceptual, processing moves to the parietal cortex, mainly the supramarginal, superior parietal, where imagery, concepts, and ideas occur. This relates to very old people, as when their vision and hearing deteriorate, this affects the senses in the brain. Which causes the processing of this information to be affected and affects the person’s perception, thoughts, and ideas.

Cabeza and Nyberg (2000) found the parietal cortex interacts with frontal regions of the brain and is then used to examine the results of a particular problem. The anterior cingulate limits response selection and other important responses, and it is important for the white matter to pass fast data without errors from the posterior to the frontal brain. Hale et al. (1987) found an association with age, white matter, and cognitive decline. This makes the brain processes slow down. This relates to very old aged people, as this means age is a major factor in cognitive deterioration and reduction in functioning cognitive processes.

According to Christensen (2001), memory has two parts, procedural is long-term memory, and declarative is short-term memory. Procedural is defined as memory that isn’t recollected from an experience, such as a learned skill: walking. Declarative memory is information an individual recall, such as facts or events. Working memory is defined as temporarily holding information available for processing. Zelinski and Lewis (2003) found working memory consists of lists of words, speech, reasoning, and more, as working memory declines, these tasks decline as well. The reasoning is the process an individual user concludes. This relates to very old people as their working memory declines, it makes verbal communication and coming to conclusions more difficult as they are also declining.

Kail and Cavanaugh (2014) define plasticity as skills individuals acquire or improve on through the repetition of tasks, plasticity ranges from very young babies to very old aged people. Ball et al. (2002) found plasticity is the brain’s ability to change throughout life. This relates to this case as it supports that very old people can learn new abilities throughout their lifespan, such as training to improve perception.

Miyake, Friedman, Emerson et al. (2000) defined executive control as the ability an individual has to process and act on incoming information; this includes updating and changing thoughts and actions. According to Cicerone, Levin, Stuss et al. (2006), executive control is the ability to plan, monitor, activate, switch, control competing responses, and manipulate information in awareness. Salthouse (1996) defined processing speed as the time it takes for a person to gain insight and apply a decision; this decline with age. Cicerone, Levin, Stuss et al. found processing speed is an important process in cognitive function, but this decline with age. This means very old people process new information at a slower rate, and process and act on new information at a slower rate.

Navarro et al. (2009) research elderly people using computer programs to increase their cognitive function: attention, language, perception, and memory. A program that has been developed for elderly people is the Brain Training Program. This relates to elderly people as computer programs can increase their attention span, being able to converse more rapidly, understand their perceptions, and able to memorize more effectively. Navarro et al. argue there are three ways to maintain cognitive function in the elderly: to keep physically and mentally active and to have good self-esteem. This relates to elderly people as they can slow the effect of cognition declining by keeping physically and mentally fit and having good self-esteem.

According to Christensen (2001), crystallized intelligence is defined as the continual learning of an individual throughout their lifetime. Christensen conducted a longitudinal study in Queanbeyan, Canberra with 887 participants aged 70 – 93 years. These participants were examined in 1991 for crystallized intelligence, speed, and memory. In this study, there were four aged groups. The results have shown that cognitive speed and memory performance were found to decline with age; in all four aged groups, crystallized intelligence had high levels of functioning throughout their lifespan. Crystallized intelligence declined a little in the four groups with participants older than 85 years. Memory declined considerably and increased at older ages, cognitive speed declined considerably in all age groups. This relates to very old age people, in which case cognitive speed and memory performance decline with age. Crystallized intelligence was at high levels of functioning and declined slightly with people over 85 years old. Memory declines in very old age.

Past research by Anstey and Christensen (2000) measures the impact health and disease have on aging from eight longitudinal studies. Elderly people reported their poor health and cognitive change. Two of the eight studies found health reasons for cognitive changes. Anstey and Christensen noted that lung function, glucose tolerance, atrial fibrillation, and cardiovascular disease were factors in cognition declining. The results have shown that poor health was associated with cognition declining faster and was partially responsible for the decline in cognition.

Christensen’s (2001) research of three studies of aging individuals did not find any convincing association between poor health and cognitive decline. One of these studies predicts there is a link between poor health and cognitive decline. Another one of the studies reports that high health was related to cognition improvement. There was a convincing connection found between lung function and worse cognitive outcomes. This relates to very old aged people, there is no real link between poor health and cognitive decline in very old aged people.

In contrast, Salthouse and Earles (1995) examined the role of health and the effects of cognitive speed on aging people. The measures are statistics from individuals who rated themselves on their health before and afterward. The results from individuals rated 15% and 20% as related to changes in their cognition, which means health reasons were not the main reason for individuals’ decline in cognition. This relates to very old aged people, that perhaps health issues are not fully the reason for cognitive decline.

In conclusion, the evidence suggests cognition is a natural part of the aging process. Jung and Haier prove that the parieto-frontal integration theory is a reliable model to use in determining those very old people have difficulty in reasoning due to their parietal lobe and frontal brain working slower and nerve fibers having deteriorated. Jung and Haier also prove, using the parieto-frontal integration theory, that very old people’s cerebral cortex, parietal lobe, and frontal brain interact and cause intelligence, reasoning, and communication to decline. The researchers suggest that very old people’s sensory areas work at a slower speed. Christensen also supports cognitive speed and memory decline with age. Together with Anstey, they argued that health problems were reasons for cognitive changes in very old adults. Christensen also evidenced that crystallized intelligence remains high and declines slightly from the age of 85. Applying the parieto-frontal integration theory to future studies is highly recommended in considering intelligence, reasoning, and communication in very old-aged people. It would be interesting moving forward for more research into very old people’s health on cognition, to see if there are any different response results.

People who come in age around 60 or 65 are considered elderly. Elderly people are those people who have an experience of their life and they have the best stories related to their life that one can hear. They also share their life stories from when they were in their young age and any interesting things ever happened to them. Attentive listeners are sometimes loved by elderly people as they listen carefully and respectfully to them because elderly people want someone who can hear their problems and their thoughts that help the old age people feel better. It is really a great thing, especially for those who lived in aged care as they don’t have a lot of visitors to talk to. In this essay, I am going to describe various facts that are related to the elderly. This report contains different types of sections related to barriers in working with old age people, effective communication ways, and understanding with elderly people.

Barriers to Working with Elderly People

During working with the elderly, there are some barriers that affect elderly people in some ways. The main barrier while working with elderly people is the communication barrier. Some of these barriers are defined below:

1. Communication barrier. While working in aged care, we can see that there are many old age people living who are from different cultures, religions, etc. Ultimately if they are from different countries or religions, then they have a different language. So, one can’t understand properly what the elderly person is saying if the next person can’t speak English. It may lead to some misunderstandings and a lack of facilities that many workers have to give them.
2. Lack of assistance. Some of the parents are left by their families lonely because of certain social and professional factors that keep older people insecure and it can turn into tension as well as anxiety. As a result of these circumstances, they treat other people rudely and aggressively.
3. Lack of cultural awareness. If elderly people living in aged care don’t have an awareness of different cultures, it leads to discrimination between everyone. Each people must have knowledge about every culture. And they must set one thing in their mind that they don’t need to let know about the culture of another person.
4. Lack of education. Due to a lack of education people have no more knowledge about everything. Also, it leads to gender inequality because if they are not educated, they don’t have an awareness of gender inequality.
5. Lack of technology skills. Technology is a most important factor for elders because with technology they can spend their free time, for example, using laptops, playing games, watching TV, and many more. If there are lack of technology skills, then it can lead to depression.

Communication Skills Required for Effectively Communicating with Elderly People

Sometimes communicating with the elderly can be challenging when they become aged, as they lose their senses with the age increment, which sometimes causes barriers during communication. Moreover, some other conditions are related to age, such as difficulties in hearing or vision. But still, with a little effort and thought, these barriers can be overcome. You will make sure when talking with the elders that you can be clearly heard and understood by them. We must talk with them very firmly, not the same as we talk with our own same age persons. For establishing positive relationships with elderly people, the most important thing is care, which is important for specific communication skills and strategies. Now, I am going to discuss some steps for effective communication.

• Eye contact. This is the most important factor while communicating with elderly people. It helps elderly people to describe their problems and issues easily. In this way, they know that you are giving your proper attention to the next person.
• Sitting style. Always make sure that sit in front of the next person at some distance in which elderly people feel comfortable. Don’t sit too close to the next person, because it makes them nervous. Everyone has a limit of distancing in which they feel comfy, so we must consider this fact while communicating with them.
• Listening. This is another important factor during a conversation. Always show the next person that you are listening to him/her attentively by using some words (hmm, oh, yeah). These kinds of things let elderly people know that you are listening actively to what they are saying.
• Communication skills. As I mentioned before, due the age factors elderly people may have hearing issues, so make sure that always speak at a speed and volume that can the elderly hear. Also, avoid background noises. Using, some gestures may also be very helpful.

Understanding with the Elderly

To overcome all those barriers, especially communication barriers, it is important to understand the elderly. They just need love and emotional support, because they are already living separately from their families. We have to understand their emotions and communicate with them in the way they like. Always do such kind of activities with them which they like. If they want to go outside to visit some places, then take them there. Through this, they realize that someone is there to look after them. We have to make a relationship with them like friends. These things make a good relationship between them and make the elderly feel free to discuss their problems with us.

Conclusion

Overall, many people have begun to live in smaller businesses and communities for a better lifestyle, and there is some distance from one another, which leads to the generation gap. In this situation, families neglect to take care of their elders, which is really a worrying thing. Older people be significant cultural resources and mentors for the young generation. For that reason, some organizations like government and non-governmental should inspire and raise awareness among young people about caring for the elders in their families. So, that elderly people can live with their families.

A disaster is a serious disruption, occurring over a relatively short time, of the functioning of a community or a society, involving widespread human, material, economic or environmental loss, which exceeds the ability of the affected community or society to cope using its own resources. The impacts of disasters vary from person to person. The primary reason for this varied impact is the difference in their vulnerabilities. Vulnerability, as the name suggests, is a condition determined by physical, social, economic, and environmental factors or processes that increase the susceptibility of an individual or a community to the impacts of hazards. Of the different sets of individuals, the ones that are on the higher vulnerability end are women, children, and the elderly.

Statistics related to natural disasters reveal that in the struggle for survival, the elderly are usually the last in the line and lost in the crowd, and therefore suffer the most. At the time of an emergency, the instant reflex of all able-bodied people would be self-protection, the safety of women and children, and the recovery of important documents or other valuables. Elderly people are left to look after themselves, or the focus shifts to them at the end. The severity of the impacts of emergencies and disasters on old people mostly depends on the characteristics specific to the elderly and the environment they live in, the type and severity of the existing hazards, disaster management strategies, and interactions between all of these.

They, in particular, can have difficulty adapting to sudden changes and coping with disasters. Aging by itself does not generate vulnerable conditions. Problems prominent in old age, such as the progressive loss of bodily function, can increase vulnerability. Decreased body strength, poor tolerance of physical activity, functional limitations, and decreased sensory awareness all contribute to a decrease in the coping capacity of the individual.

Age-related issues, for example, a decline in mobility, can increase older people’s vulnerability in two ways: one, by making it harder for them to maintain their houses and prepare for a potential disaster, and second, by making it harder to evacuate and protect themselves in an emergency situation. Mental health problems are common in old age and can make the disruptions associated with disasters seem much worse, leading to feelings of helplessness and, as a result, a poor ability to respond. Also, not all of the old people live in safe housing, especially in rural areas. Their houses tend to be older and structurally less maintained (if they are unable to effect repairs), which makes them more vulnerable to hazards.

It is usually very difficult for the affected elderly to get their share in the relief material and aid. They suffer the most as they do not get proper nutrition and medicines, and don’t get the proper required rest. Many old people die prematurely due to a devastated post-crisis life. Often, during the distribution of disaster relief material, older people are the last recipients, as they find it difficult to reach the point of relief distribution in time. In many cases, they even remain deprived of relief materials and help.

Something that affects an individual more than any other thing is the emotional stress induced due to catastrophic conditions. The loss of loved ones, home, and valuables in itself is too much for emotionally breaking down a mentally and physically healthy person. Its effect on an elderly person cannot be quantified. This emotional weakening could be fatal, as the person might lose the will to live, rather than adapt to new surroundings.

The impacts of these disasters can be minimized with proper disaster management strategies and evacuation plans. One of the effective methods could be a community-based disaster management (CBDM) framework, wherein all the people in the community can contribute their bits. The aim of CBDM is to reduce vulnerability and strengthen the coping capacity of people against any existing hazards in their immediate neighborhoods. As a whole community is involved in the strategy-making process, it is hence possible to cater to the special needs of those on the higher vulnerability end.

References

1. Terminology. UNISDR News, 2 Feb. 2017. http://unisdr.org/we/inform/terminology
2. Disaster Management. Helpage India. http://helpageindia.org/our-work/welfare-development/disaster-management
3. Good Health Adds Life to Years. Pan American Health Organisation, 2012. http://paho.org/hq/dmdocuments/2012/Disasters-English.pdf
4. Rath, Himanshu. ‘Disasters Can Take a Toll on Health’. Livemint, 10 Sep. 2018. http://livemint.com/Money/imBHbnavrswgNEflfCxq9K/Disasters-can-take-a-toll-on-the-elderly.html
5. Perappadan, Bindu. ‘Elderly the Worst Hit During Natural Calamities’. The Hindu, 29 Aug. 2018. http://thehindu.com/news/cities/Delhi/elderly-the-worst-hit-during-natural-calamities/article24805083.ece

In the film ‘The Way We Get By’ we meet three troop greeters: Bill, Joan, and Jerry. These retired elderly citizens have been doing a kind gesture to greet every troop plane arriving or departing from Bangor. We can take a glance behind the warm smiles, handshakes, and free cookies and discover a world wherein the seniors are worried in their very own struggles with aging, sickness, loneliness, and private loss. In this essay we will be focusing on the differences between normal, impaired, and optimal aging. Also looking into the relationship between the trooper greeters and their pets, the biopsychosocial perspective, how their lives are affected by physical aging and sleep issues, identity process theory, and the effects of retirement.

First, we meet Bill Knight, the oldest out of the three troop greeters. Bill is an 87-year-old World War II veteran that has been diagnosed with cancer. He is already being treated for it but at his age he does not believe he has much time left. He is becoming weaker both physically and mentally, he is also having a hard time paying bills since his wife passed. With all the Bill has going on he still shows up to greet the troops with a smile on his face. On the day he discovered he had cancer Bill turned into the primary greeter to arrive on the airport. We then meet Joanne Gaudet who is 76 years old. Joanne Gaudet has had multiple surgeries for her knees because of that and aging she was to use a walker. She’s evolved an extreme worry of falling all through Bangor’s icy winters. Living alone, Joanne disliked going out at night or while the weather was bad then she discovered troop greeting. Joan overcomes her fears and her physical pain to get to the airport regardless of the conditions. Lastly, we meet Jerry Mundy who is 74-years-old. Jerry Mundy has unexplained heart troubles, which may be once in a while irritated by way of the hours he pulls at the airport. He is a very nice charismatic guy but the loss of his son has made him feel very lonely. Now he shows up to greet and say goodbye to soldiers even though it brings him back memories of his son. He is always bringing smiles to all the soldiers he meets; he also lets them borrow his phone for any calls for free. Doing all this makes dealing with his loss much easier. He also starts to think about his death.

Everything they have gone through makes each of their lives unique and determines how well their mental health is, which leads to the biopsychosocial perspective. The idea of this perspective is to consider biological, psychological, and social factors when understanding health and they have all had very distinct lives. Bill lives on a farm and really misses his wife that died many years ago and what gives him the most pleasure in life currently is his participation in the troop greeters program. Joanne is a mother of eight and now she is enjoying her grandchildren. Although she loves to be part of the troop greeters, she still has other things in her life that make her just as happy. Unlike Bill, she has more social support. Jerry is still hurting from the loss of his son and now finds joy in this program as well while still getting support from his canine best friend. All three seniors share the conflicting feeling of wanting the soldiers to come back for good but also not wanting this program to end.

Bill, Joanne, and Jerry live a pretty lonely life and because of that they have social support with their pets. Jerry’s best friend is his dog and on a normal day they sit in Jerry’s truck outside the airport, watching for arriving military planes. Unlike Joanne, Bill and Jerry don’t have grandchildren to keep them busy so having relationships with pets helps them feel less alone and useful. Having pets allows them to cope in stressful situations, have good mental health, and to not feel so isolated. Other than greeting the troops, having a meaningful relationship with a pet gives them motivation to wake up in the morning.

Throughout the film we can see the physical changes they go through because of aging. Joanne is not only facing age but she has also had various knee surgeries that has made it a little more difficult for her to get around. We can see how the years are weighing all three of them down, it has become harder to get around. They become tired with doing much less than someone half their age can do, and need more sleep to get their energy back. Sleeping can be difficult as well; Joanne is in constant pain so she sleeps in a chair instead of her bed. She takes a lot of pills and tries to make the best of her physical vulnerabilities. Weather conditions make it even more difficult for them because of the fear of falling and not being able to get themselves up. We can also see the sickness age brings, like Jerry’s heart condition.

Living in a world that’s constantly changing can be very difficult when you become elderly. There’s always new things and ideas to learn about but as you get older it becomes harder to understand. Bills ideas are very patriotic and the way he perceives conflicts, such as war, is different from Joanne and Jerrys. Joanne shares her doubts about war and Jerry agrees with her on some topics. Although their views might not be the same, they all enjoy greeting and saying goodbye to the soldiers. Part of their identities has become being part of this program and if it were to be taken away from them it’d be a huge loss. Our whole lives were said to be busy: we have school and then we have to work for the rest of our lives and when it comes to retirement it can be bittersweet.

Retirement is the goal when you’re young and just starting to get your working life together. Most of us looked forward to being able to enjoy life without any work in it but what we don’t realize is how much we get used to the busy routine. Once we no longer have a schedule it starts to feel a little lonely, especially if you don’t have a family or friends to spend time with you. These troop greeters were looking for purpose because they have had it their whole lives. Greeting these soldiers has become their new routine, it makes them feel useful and wanted. They have made new reasons to get out of bed every day.

While watching this film I learned a lot of the feelings and though that go through elderly citizens. As a young adult who does not have much connection to the older generation it was interesting to see how individuals change over time and how they feel while it’s happening. These three troop greeters all had distinct lives but one way or another ended up in this program and it has brought them as much happiness as it brings the soldiers they are greeting. I learned how difficult life can be without support. There’re so many physical changes that come with age but there is just as many mental changes that we aren’t so aware of. I’m glad this film was made and I was able to understand the elderly just a little more.

Good balance in elderly who are living independently, capably, and proactively is an essential factor for cooking, traveling, doing household work, shopping, and activities of daily living.[1] Balance is essential for keeping going in a position, continuing to exist stable while going from one position to another, conducting daily living activities, and going freely in the community.[2]

Balance and postural stability are the general terms used to narrate the dynamic action by which the body’s position is preserved in equilibrium. When the body’s center of mass (COM) or center of gravity (COG) is sustained over the base of support (BOS), it results in maximum balance.[3]

It is a combination of vision, proprioception, vestibular sensation, the strength of muscle, and reaction time. As age increases, there is an accelerating mislaying of work of these systems which can subscribe to a balance shortfall.[4]The potential to balance can be hampered by disease, medications, and the task of aging.[5]

There are several factors that lead to impairment in balance in the elderly population, some of the factors are been discussed below. In a study, it is shown that elderly people have reduced flexibility and range of motion, which would hamper their ability to recover balance following an external disturbance.[5]

In a study “lower- extremity muscle force and balance performance in adults aged 65 years and older” it was suggested that the force-generating capacity of the distal musculature is important in the maintenance of balance in older adults.[6]Hence it is important to focus on the strength of the lower limb muscles as well for the improvement of balance in elderly.

India comprises the second largest geriatric population, which is about 1/8th of the total geriatric population of the world. As per the census 2011, 103.2 million people in India were of the age of 60 years or more, count for 8.6% of the total population. Among many health matters that are faced by the elderly, falls are a major issue.[7]

Falls are one of the most major issues in the elderly and have been considered the “geriatric giant”.[8]There are several exercise programs that are useful for fall prevention in the elderly. Some of them are the Otago home exercise program, a multi-system group exercise program incorporating a circuit of activities, Tai Chi balance training, pilates mat exercise, and virtual reality game exercise.[3]

Backward walking is something different from forward walking. During backward walking the leg reverses its movement direction and also travels in the opposite direction with virtually the same path as in forward walking.[9] A pre-stretch of the hamstring is seen prior to thigh reversal because of greater hip flexion and lesser hip extension in backward walking. Hence backward walking helps in providing stimulus to increase hamstring flexibility and reducing low back pain in persons with hamstring tightness.[10]

Backward walking appears to be a novel task. During backward walking, hip extension and flexion of the knee are greater as compared to forward walking. Increased extension of the hip joint and associated lumbar spine extension increasingly load the facet joints opening up the disc space, and resulting in the reduction of compressive force in the intervertebral disc. Hence backward walking intervention remarkably improve low back range of motion and leads to a reduction in low back pain.[11]

During backward walking, older adults displayed a notably improved range of motion of the ankle joint and stability. Ankle kinematics may be responsible for the result benefits related to decreasing the occurrence of falls in older adults and other populations at risk for falls following backward walking.[12] The demonstration has been done that backward walking helps in improving quadriceps strength and power and also decreases patellofemoral joint reaction force at the knee joints.[13]

During Backward walking there is enhanced cardiopulmonary demand as compared to forward walking at the same speed. It is also suggested that backward walking enhances energy expenditure to such a level that is sufficient to maintain cardiopulmonary fitness.[9] Backward walking is also responsible for improving balance in school-aged boys. As backward walking origin neural adaptations and progressive training induce adaptation of soleus H-reflex. During backward walking muscle synergy or neuromotor control, reorganization occurs in the lower limbs which could be the cause of improvement in balance.[14]

As backward walking improves muscle flexibility, lower limb range of motion, core muscle strength, and lower limb strength, these may lead to improvement in balance. Also, backward walking is cost-effective, easy to perform, and doesn’t require much assistance once the technique is being learned by the individual. Hence the objective of the study was to assess the effect of backward walking on balance and gait in healthy elder people.

Ethical clearance was taken from the Institution Sub Ethics committee. In this randomized controlled trial, 34 participants were randomly selected from the community as per inclusion and exclusion criteria. Simple random allocation was done to divide participants into two groups using the chit method. Written informed consent was taken from all the participants. The sample size was calculated using the software Primer, where it was derived to be 16 participants in each group with desired power: 0.800 and alpha: 0.05and it was calculated using previously done studies with mean and standard deviation as 18.1, 10.5 respectively. Considering the 5% dropout chance, 34 participants were recruited for the study.[15] The study setting was Dr. D.Y. Patil college of physiotherapy OPD, Pune, India. 34 participants in age groups between 60-70 years and of both genders, who were walking independently, (45-50 score on the berg balance scale ) and with a cognition level (of 24 and above on the mini-mental scale) were included in the study. Individuals with recent fractures and surgeries of lower limb and spine (past 6 months), neurological conditions (Parkinson’s, stroke, vertigo), use of any assistive walking device, visual and hearing impairment, medications that interfere with balance (antihistamine, Anti-depressant) were excluded from the study. Total 32participants (16 in each

The purpose of this study was to investigate the effectiveness of a backward walking exercise program on balance and gait in healthy elderly aged 60-70 years. Results showed that there was a highly significant improvement in the score of the timed up-and-go test. This shows that backward walking gives effective improvement in balance scores on the TUG outcome measure for most of the subjects. Balance gets affected with ankle flexibility and strength, so as ankle range and strength improves, balance improves. Backward walking improves ankle flexibility and strength. So study done by Janet S. Dufek, showed the beneficial effect of backward walking on balance.[12]Study done by Manisha Rathi et al (2014) shows that backward walking improved quadriceps strength significantly, as backward walking reduces compression forces on the patellofemoral joint and reduces the absorption of force at knee joint. This occurs due to reduced eccentric function of the quadriceps strength. It has been demonstrated that backward walking improves quadriceps strength.[9] Core strength is required for maintaining balance and backward walking improves core strength hence backward walking is effective in improving balance[16]

It is also suggested that hamstring flexibility and perhaps low back flexibility may increase when walking backward. As backward walking provides stimulus for increasing the length of the hamstring muscle. [11]

Similarly, Teres liu-Ambrose (2008) showed that the Otago home-based program which consists of resistance training and balance retraining showed significant improvement when assessed on timed up and go test and physiological profile and hence improved executive functioning and therefore reduces the risk of falls in older people.[15] A study done by Ladda Thiamwong (2013) concluded that 12 weeks of simple balance training program is effective in improving the balance of rural older adults when assessed on time up and go test. Fear of falling was also decreased in people who received balance training.[1]

When the balance was measured by using a multi-directional reach test (MDRT) results showed that there is a significant improvement in all the directions,e. forward direction, backward direction, left lateral, and right lateral direction followed by the backward walking program.

Similarly, Robert A. Newton concluded from his study that when the elderly performed the MDRT in a free surrounding which does not have the support of the wall. Whereas while performing FRT (functional reach test) subjects had the support of a wall for reaching a forward direction. This fact that there was no support of wall in MDRT could have led to a reduced mean measured in MDRT (8.89 in) as comparative to mean values observed in FRT (10.9 in.).[17]

The present study also showed that when gait speed assessment was done after 4 weeks of the backward walking program, it is found that backward walking showed significant improvement in improving gait speed.

A study done by Lien Quach (2011) has shown that there is a relationship between gait speed and risk of falls in community-dwelling older adults. He suggested that people walking with faster and slower gait speeds are at risk of falls. Such that people with slower gait are more prone for inside falls, whereas people with faster gait are at high risk of outside falls, presumably where they are uncovered to environmental danger. Lastly, a reduction in gait speed is an important risk factor for future falls. It is well-recognized that a slow gait is related to risk of falls. The decrease in gait speed may give a signal for a reduction in physical functioning, risk for diseases, or reduction in motor control centers in the frontal lobe.[18]

D. L. Sturnieks (2008) showed that older adults tend to walk slowly as compared to younger populations. He told it’s not clear whether the reduction in speed is due to physical limitations or an adaptive strategy for safety improvement. These spatiotemporal gait patterns are more profoundly found in fallers than non-fallers. As age advances, kinetic and kinematic alteration occurs in older people such as reduction in hip range of motion, increased anterior pelvic tilt, reduced ankle power generation capacity, increased hip extension.[4]

In contradiction to this study, Wei-Ya Hao (2011) showed that followed by 12 weeks of a backward walking program in school-aged boys, the gait speed decreased as compared to forward walking.[15]

When step length and stride length assessment was done after 4 weeks of the backward walking program, it is found that backward walking showed significant improvement in improving step length. Similar results were observed by Elizabeth T. in her study (2007).[19]

Thus in our study, we found that all subjects were able to perform backward walking. There were no complaints of falls or any kind of discomfort while performing backward walking. Thus, our study conclude that backward walking was effective in improving balance and gait in healthy elderly.

In this study, a small sample size was taken. A short duration of backward walking was given to subjects thrice a week. There was no follow-up taken on whether the participants are continuing the exercises or not and the effects will remain further. Further study can be done with a long duration of backward walking. Studies can be done to know the effect of backward walking on people who complain of impaired balance. Future studies can be done on backward walking with footwear and without footwear to understand the effect of backward walking on joint forces on the incline surfaces.

In an exclusive interview with an aging adult, to learn about the process of aging and what it means as an aging adult, I interviewed a man who is sixty-seventh years old. To protect this man’s privacy, I would give this person a fictitious name of Geron67. The interview lasted roughly two hours and it was a face-to-face interview.

Life Story

Geron67 is 67 years old. He is a Caucasian man. He was born and raised in the United States. He informed me that he was a strong man who has never had any health problems until six years ago when he had to take prescription medication. Geron67 is the youngest of two sisters and one brother. They all grew up in a small town in New Mexico. Geron67’s father died of a heart attack when he was in his 50s, his mother died from cancer. He was an auto mechanic when he was young and quit his job when he was 55 years old. He explained that he started to have back pain that prevented him from doing the job. Geron67 was married. He has no children. His wife died in an auto accident. When I asked him what was the most meaningful event that he can think of, he said he remembered he had a great family before the death of his wife. He felt a little sad while talking about his wife. He mentioned that he was depressed since his wife’s death 20 years ago. I asked him what he wanted people to remember about him and he said that he wanted people to remember him when he was young who had great finances and a happy family, but not as an old man trying to survive on a daily basis.

Changes of Aging

When asked if he has any change or concern regarding aging, he mentioned that finances are his primary concern. He said that he had a great job and was not worried about finances. Now he barely pays the rent for his apartment. Geron67 explained that he currently works at minimum wage in order to pay for his monthly rent, smokes, and drinks alcohol. He said he did not smoke or drink when he was young. He began smoking and drinking after his wife’s death. He felt depressed and uncontrolled about alcohol consumption. He feels lonely because he does not have any friends, family, or relatives around. He expressed that he is also facing trouble in taking proper care of himself. His nutritional diet is fast food that is high in fat and low nutritional value because they are easy to get and cheap rather than cooking. He is overweight, has hypertension, and suffers from stress. In addition, he noticed his oral health changes significantly as his teeth keep losing. He said his health insurance does not cover dental health. Finally, he started to feel worried due to his recent high blood sugar level. He wants to live in his apartment instead of a nursing home because he wants to be independent and autonomous as an older adult. He expressed that the nursing home will make him feel lonely, which will contribute to the rapid decline in health. When I asked Geron67 what is his view on aging, he replied: “I believe in God. God can give me this body. God can take it away. I am not scared to die. I don’t see aging as a positive or a negative, but just a normal, natural process”. He said the undesired effect of aging comes with aches, pain, and illnesses. As we continued with the conversation, I noticed that he does have concerns about aging, it became obvious when he mentioned his financial issues as well as he admitted his poor performance in everyday activities compared to what he was 10 years ago. He said he developed back pain when he was about 55 years old. Now, he is worried because he has hypertension and high blood sugar. He expressed that old age is nothing fun but pain, ache, and illnesses. I asked him how he would be able to maintain healthy aging and wellness. His response was that he is ‘not a good example’ and he admitted that he is very disappointed in what he has done with his health, including smoking, drinking alcohol, being overweight, and not eating right. When I asked if he would consider exercise to promote a healthy aging lifestyle, he said that he understands exercising to promote a healthy aging lifestyle, but he has no motivation for exercise. There were a few times in the past that he wanted to give up drinking alcohol. He had actively participated in a rehab program. He said he lost weight and felt great while in the program. I believe that if Geron67 had guidance and encouragement to get involved in a social network centered around physical and mental activity, he would find himself in a much easier position to make some healthy lifestyle changes.

Coping with Chronic Disorders

Geron67 is having a problem with nutritional status. He struggled with finances, which resulted in eating cheap, unhealthy food, skipping meals, drinking alcohol, obese without exercising. His poor nutritional health and lifestyle result in nutritional changes, in addition to hypertension and high blood sugar level. He did not reveal his values for hypertension and blood sugar. He said the doctor told him to take prescription drugs for hypertension. He just takes these medications as said. He said he was diagnosed with hypertension when he was around 45 years old. He was recently diagnosed with high blood sugar. He started to worry about his health status, but he does not do anything to cope with the chronic disorders besides taking the prescription medications as directed. He said he does not want to change his lifestyle habits, such as lower salt intake, exercise, restriction on diet, no alcohol intake, and positive lifestyle changes. He believes that his life could be drastically different if he motivates to make the change, but he said had chosen to live his life a certain way.

Conclusion

It was great to have an interview with Geron67. I learned a lot about the lifestyle of certain older adults throughout the interview process. Geron67 has some health concerns, but he remains active and alert as evidenced by his acknowledging the importance of exercise, a proper diet, and hypertension control through medication. He is obviously at risk for poor nutrition, depression, and loneliness. The interview was at times difficult when he was expressing disappointment with himself and how he has treated his body. I also observed him and was concerned as he discussed his loneliness, depression, illnesses, pain, and financial struggles that he is facing at his current age. Throughout the interview process, I found it was imperative that I maintained an understanding, empathetic and realistic outlook on what he was trying to tell me in order to provide a level of comfort and reassurance. At the close of the interview, he expressed that he can see that he is currently living an unhealthy lifestyle. He should commit to changing and promoting a positive, healthy lifestyle to cope with his chronic disorders. Being an aging adult, many of the concerns and depression are stemmed from poor nutritional health, a fear of loss of autonomy, loneliness, and financial hardship. Despite his decisions to take part in changing his unhealthy lifestyle habits or not, he will need strong support and advice from healthcare professionals. As a nurse, our main goal is to educate and give the best support to the elderly like Geron67 in fulfilling their aging process.

Body System Changes

Throughout our lives, our bodies begin to change in ways that result in a decline. The elderly population may think these changes are not normal, but in most cases, the changes that occur are typical with aging. Our bodies most often undergo similar stress, but some of these changes depend on lifestyle and genetics. When the human body ages, the cardiovascular, respiratory, and integumentary systems decrease in functioning. Nurses must be able to diagnose and assess, implement safety measures, and provide education to be better humanity as they age.

Cardiovascular Changes (p. 647)

The cardiovascular system undergoes several changes as the body ages. The cardiovascular system is important because it supplies the body with oxygen and blood to vital organs and tissues. The cardiovascular system has two major functions which include perfusion and gas exchange. Without these two vital functions, the cardiovascular system is failing (Ignatavicius et al., 2018).

As a result of aging, sometimes the heart cannot keep up with the demand the body puts in place. The baroceptors that sense pressure change become less sensitive. These baroceptors help keep blood pressure in a normal range. The lack of sensitivity of these baroreceptors puts them at a risk for orthostatic hypotension because the blood pressure drops when changing from a sitting to a standing position. The arteries become thicker and stiffer causing an increase in blood pressure to compensate for the stiffened arteries. The vascular resistance in the cardiovascular system increase due to the aging effects on the arteries. Due to this, the left ventricle atrophies because of pumping at a greater resistance (Ignatavicius, Workman, Rebar, & Heimgartner, 2018).

The valves in the heart undergo calcification causing them to become stiff, these include the mitral and aortic valves. When these valves become stiff, the heart has to work harder to pump blood which increases blood pressure. The conduction system in the heart sends signals causing contraction. Within the conduction system, the pacemaker cells decrease, but unlike the conduction system, the sinoatrial node includes aspects that increase such as fat and fibrous tissue. The time for conduction to occur increases. The atrial myocardium and the bundle of His contain few muscle fibers (Ignatavicius et al., 2018).

The left ventricle of the heart increases in size. This is a result of the left side of the heart having to pump with greater resistance. The left ventricle also becomes stiff and less flexible. Another change also associated with the left ventricle includes the diastolic filling decreasing in speed (Ignatavicius et al., 2018).

A condition that comes with aging is hypertension. Hypertension is a medical term used to define high blood pressure. Hypertension occurs because the heart has to pump with greater force and pressure to meet the needs of the body. This condition happens when the body ages because the heart becomes stiffer causing the blood to be pumped through the body with greater pressure (Ignatavicius et al., 2018).

Respiratory Changes (p. 513)

Similar to the cardiovascular system, the respiratory system ages with the human body as well. The respiratory is important to our daily functioning in life because it allows our bodies to have the right amounts of oxygen. Although most of these changes that occur are normal, some of them result from disease and ingestion of pollutants over the course of a person’s life (Ignatavicius et al., 2018).

One of the important aspects of the respiratory system are the alveoli. Within the alveoli, the exchange between oxygen and carbon dioxide occurs. Changes that occur in the alveoli include decreased surface area, a decrease in the ability to cough, recoiling decreases, and the airways begin to close (Ignatavicius et al., 2018).

Comparable to the alveoli, the lungs are important to the functioning of this system. The changes that transpire within the lungs include a decrease in the efficiency of exchange between carbon dioxide and oxygen, the vital capacity decreases, and the elasticity of the lungs decreases. Within the lungs, the residual volume increases. The decrease in vital capacity and increase in residual volume are result in the reduction of lung elasticity (Ignatavicius et al., 2018).

The pharynx and larynx also play an important role in this important system. The pharynx acts as a passageway for the respiratory system and the larynx is the body’s voice box which includes vocal cords. The changes occurring with these parts include a loosening of the vocal cords and a degeneration of muscles. The cords in the larynx begin to lose elasticity and the cartilage of the airways is lost (Ignatavicius et al., 2018).

The pulmonary vasculature helps with oxygenation in the respiratory system. Within this, the older adult is at an increased risk for hypoxia. Also, there is a decrease in pulmonary capillary blood volume and the vascular resistance to blood flow increase. The aging adult may not be able to exercise as well due to the body not being able to react to hypoxia and hypercarbia like it should. Hypoxia is decreased oxygen in the tissues and hypercarbia is an increased level of carbon dioxide in the blood (Ignatavicius et al., 2018).

The muscles encompassed in the respiratory muscles decrease; these muscles include the diaphragm and the intercostals. Due to these decreases, the older adult is more prone to infection as a result of a decrease in effectiveness in cilia and a decline in the presence of immunoglobulin A. The chest wall contains several other changes in the respiratory system. These alterations are comprised of a decrease in the mobility of the chest wall, the shortening of the thorax, and the anteroposterior increases causing a barrel chest, which causes the chest to appear more rounded (Ignatavicius et al., 2018).

Chronic obstructive pulmonary disease, COPD, is a common disease that occurs with aging. COPD is a disease that affects the airways and the alveoli. The airways become inflamed, making it hard to breathe (Hanania, Sharma, & Sharafkhaneh, 2010). Those affected with COPD may show signs of trouble breathing, breathing through their mouth using a technique called pursed-lip breathing, and looking extremely fatigued (Ignatavicius et al., 2018).

Integumentary System Changes (p. 434)

As we age, the outside of the body transforms and begins showing several changes that can be embarrassing to some people. An important risk associated with skin changes is exposure to the sun. Beginning with the hair and nails, a decrease in the number of hair follicles present and active melanocytes in the follicle occur. The rate of hair growth also decreases. The glands in the body are decreased as well. This includes a decrease in sebum production and eccrine and apocrine gland activity (Ignatavicius et al., 2018).

The layers of the skin, known as the epidermis, dermis, and subcutaneous layer, start to decrease in function during the aging process. The epidermis is the top layer of skin, and it is the first line of defense when it comes into contact with environmental factors. With the epidermis, this layer becomes thin causing the skin to tear more easily. This becomes difficult because the elderly can get infections in the skin due to it being more susceptible to tears. There becomes a decrease in cell division, melanocyte activity, and vitamin D production. Melanocytes are important in skin pigmentation. The epidermis becomes more permeable to substances and there is a flattening of the junction between the epidermis and the dermis that begins to form. Since the skin becomes thinner with age, the top layer of skin, the epidermis, becomes more permeable, allowing more things to enter into the body (Ignatavicius et al., 2018).

The dermis is the next layer of skin that endures changes. The dermis is important because it gives the skin its flexibility and strength. With aging, there becomes a decrease in blood flow and vasomotor responsiveness. The blood supply is important in the dermis because it allows oxygen exchange and provides heat. Along with the epidermis, the dermis becomes thin and the elastic fibers become to degenerate. Since the dermis is responsible for the skin’s flexibility, the decrease in elastic fibers is detrimental. This causes the skin to look as if it is hanging. The nerve endings begin to decrease their function and reduce in number. The dermis contains a vast number of nerve endings that are important to the body’s senses. With a decrease in these nerves, the elderly can be more prone to injuries. The subcutaneous layer of skin is closest to the bones and contains fat cells which insulate the body and provide it with padding for protection. The subcutaneous layer of the skin decreases in thickness along with the epidermis and dermis (Ignatavicius et al., 2018).

Nursing Implications

Assessment

Cardiovascular system. During the cardiovascular system assessment, the nurse should look at the patient’s skin, position, and level of consciousness. The patient’s skin should show adequate circulation, meaning having an appearance of rosy color and having a warm temperature. If the skin appears to be bluish this could mean cyanosis (Ignatavicius et al., 2018).

In order to check the patient’s level of consciousness, the nurse should ask for the patient’s name, where they are, and what is the date. Depending on the patient’s answers will determine if they are orientated (Ignatavicius et al., 2018).

Assessing the patient’s blood pressure, heart rate, and rhythm are also important to cover with the cardiovascular system. Increased blood pressure is normal as the person ages but assessing the rhythm for any abnormal sounds such as murmurs needs to be completed as it could lead to underlying problems of the heart (Ignatavicius et al., 2018).

Respiratory system. Assessment of the respiratory system entails several different components. Starting with the nose, look at symmetry, color, drainage, and swelling. Deviation of the septum is normal in patients. A deviated septum has a crooked appearance and the septum is the bone that divides the two nostrils. The pharynx can be examined by using a tongue depressor to look for symmetry, edema, and drainage. The neck should be free of masses, swelling, and bruises. Lymph nodes can be palpated for tenderness, shape, size, and consistency. The trachea should be midline and should be assessed for tenderness and mobility (Ignatavicius et al., 2018).

The chest should be assessed looking for scars, discolorations, and lesions. The way the chest rises and also the breath rate and rhythm should be observed. The shape of the chest is important; the anteroposterior diameter should be less than the lateral diameter (Ignatavicius et al., 2018).

Integumentary system. During the integumentary system assessment, the focus is going to be on the patient’s skin and appearance. Assessing the skin needs to be performed in a symmetric fashion. The areas to focus on including the extremities, nails, hair, and mucous membranes. Areas of skinfolds on the body need to be examined closely due to being a warm environment for bacteria to thrive (Ignatavicius et al., 2018).

Lesions on the skin need to be examined as well. They can be assessed by using the ABCDE pneumonic. A is the asymmetry of shape, B is border irregularity, C is color variation within one lesion, D means diameter greater than 6 mm, and E is evolving or changing in any feature including shape, size, and color. These examinations are important to look at especially for noticing changes in the older patient’s skin that they might not have noticed before (Ignatavicius et al., 2018).

Safety measures

Cardiovascular system. The aging population can help prevent further damage to their heart and other parts of their cardiovascular system by performing some safety measures. They should monitor their blood pressure regularly. Keeping up on this can help them know their baseline, and also help them determine if they have significant changes going on in their body such as increased heart rate. Other safety measures include exercising, healthy diet, and also to quit smoking as this can damage the blood vessels and heart (“Heart Health and Aging,” 2018).

Respiratory system. Safety measures used by those who are aging can help keep their lungs from getting further damage. Exercise is important to perform for the respiratory system. Exercise can help your lungs stay active and in tune by walking a few times a week. If an elder person smokes, this should be stopped because smoking damages the lungs and could possibly end up with cancer. The air someone breathes in is also important to the respiratory system. If they are breathing in a lot of air with pollutants in it, this could damage their lungs severely. Keeping their house clean, which includes dusting and sweeping, can decrease the number of irritants and pollutants that enter their respiratory tract (Hanania, et al., 2010).

Integumentary system. Keeping the elderly safe with their skin is significant. Older patients who are in the hospital need to be turned at least every two hours to avoid producing bed sores. Their skin is susceptible to these sores since it is so thin, and it can tear easily. They also might need help when transferring to the bed to a chair or from the chair to their bed. Handling these patients with slow movements and calmness can result in a much easier transition. Protection of open skin lesions need to be implemented for older adults because they can become more at risk for infections. The aging adult also needs to be properly cared for and treated with gentleness related to their skin as it can tear easier (Ignatavicius et al., 2018).

Education

Cardiovascular system. The aging adult should be taught about changing positions slowly. This includes lying to sitting and sitting to standing. This education is important because they are at risk for orthostatic hypotension which could possibly result in injuries. (Ignatavicius et al., 2018). Educating the patient on how to keep the heart healthy includes concepts of exercise, no smoking, and ensuring proper checkups to their primary care physicians. Teaching these ideas to the aging population can help with the further deterioration of the cardiovascular system (“Aging,” 2019).

Respiratory system. Keeping the respiratory system in good shape is important for the elderly and proper education can ensure that. Having the patient turn, cough, and deep breathing can help the alveoli. The use of an incentive spirometer should be taught to the older adult. Teaching them to put mouth around mouthpieces tightly, suck in like a straw, and hold their breath for as long as possible can allow the lungs to expand. When the elderly patient is able to sit upright, it can allow for easier breathing. Since aging adult can be prone to osteoporosis, they should be taught to have an adequate intake of calcium, especially women (Ignatavicius et al., 2018).

Integumentary system. Educating elderly patient on how to care for their skin as they age is important. Due to the skin becoming thinner, the patient should be handled with care to reduce tears caused by friction. They should also be taught to wear sunscreen and hats to protect the skin from the sun due to the decrease in melanocyte activity (Ignatavicius et al., 2018).

Patients should be taught to use moisturizers while the skin is still moist, keep bath water at a moderate temperature to prevent burns, and to use soaps that contain high fat. Elderly patients need to also increase their vitamin D intake since their production of it in their bodies is decreased (Ignatavicius et al., 2018).

References

1. Aging changes in the heart and blood vessels: MedlinePlus Medical Encyclopedia. (2019, October 2). Retrieved October 29, 2019, from https://medlineplus.gov/ency/article/004006.htm.
2. Hanania, N. A., Sharma, G., & Sharafkhaneh, A. (2010, October 28). COPD in the Elderly Patient. Retrieved from https://www.medscape.com/viewarticle/730813 2.
3. Heart Health and Aging. (2018, June 1). Retrieved October 29, 2019, from https://www.nia.nih.gov/health/heart-health-and-aging.
4. Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.

Considering the advancement in the field of medicine, the average life expectancy of an individual has increased from 60 to 69 years on average. For most of us today, the major concern is being able to maintain the same lifestyle after retirement as we are living today. But, is it really possible? Yes, it is! And, this is what we call financial freedom. The basis for this worry is the following questions: ‘How much money do I need?’, ‘Where should I invest to get the best returns?’, and ‘What is the best method without compromising on my present lifestyle?’. Retirement planning is just not about finances, it is also about the emotions involved after the big shift in lifestyle.

Study reveals that millennials are considered to spend the most on lifestyles and experiences. To this, Warren Buffet rightly states: “Do not save what is left after spending; instead spend what is left after saving”.

To begin with, you need to check your monthly expenses, your current income, and your liabilities after which you need to keep aside some contingency funds. In general, people who have retired tend to keep large amounts for contingency as a result of insecurity. There could be many unforeseen expenses that they could face after retirement, and hence they put aside an amount to look after their needs in the future. Financial planners advise that this money can be invested more appropriately for better productivity. With medical expenses increasing rapidly, the most important aspect given the present circumstances is to create a high healthcare budget. Some employers allow their employees to continue with the existing health insurance at the time of retirement, which needs to be re-confirmed at the time of retirement. When you are at that age, there are extensive medical check-ups, and buying a health plan is not always affordable. Retirement planning is a well-planned and lengthy process. The best time to start planning for your retirement is always ‘now’ rather than wasting time thinking and pushing it further. When you are young, you have a high-risk appetite that yields a high rate of return. So, this is the right time to start investing for life corpus post-retirement.

For most of us, the first thought of understanding steady income through investments would be through real estate or bank fixed deposits. While ensuring the safety and return of the capital, such investments assure income only over the product’s duration (except the annuity product). Although real estate investments do generate income and aid in the long term to beat inflation, there are some disadvantages that one must consider before making it. Considering the urgent need for cash, it is important to realize that it is not that easy to sell off property. Moreover, there could be regulatory or personal issues in the sector that may cause risks to liquidity and affect the investment. Ideally, if the need arises, one should invest in real estate not later than five to ten years before retirement. It is easy to get a loan when you are young, which has tax benefits during the years you’re earning the most. In case of a deficit in cash flow after retirement, reverse mortgaging your house and property (the current age requirement is over 60 years) can substitute an annuity plan while the owner continues to occupy the place. It is never too late to continue learning or developing new skills. Starting a small business is also a reasonably safe option. This will not only keep you occupied but also help build an occupation.

Considering the critical analysis, it is wise to take the help of the services of a qualified financial planner for a retired couple when there are technical and legal aspects involved. Certified financial planners are updated with the latest financial resources and thus will ensure optimal utilization of all resources to assure a lifelong income for the client without taking undue risks and stipulate the investments in the right way. They will also leave avenues for liquidity and help in estate planning. They also help in understanding your risk appetite at that point in time. Investing at this stage is like a tripod that requires a balance of liquidity, growth, as well as regular income.

There are some golden habits recommended by experts that every individual could consider implementing. The first one is to save a certain amount from your income. Experts at Happyness Factory earnestly advise at least 20% of the income to be invested in retirement corpus. It is one of the easiest steps to follow. If you are an employee in an organization, there is a forced saving of 12 % of your basic income and equal contribution by your employer flows into the provident fund. Even a contribution of a small amount can inflate the retirement corpus. The study states that along with the provident fund, individuals should also consider various other methods of investment like mutual funds, which are highly advisable as a corpus towards their retirement planning goal. Financial coaches suggest starting your SIP in mutual funds and automating the service by giving an ECS mandate to your bank. This would help keep your retirement plan on track. The second recommendation is that income and investment growth should grow together. “The more you give the more you receive” – as said by Robert Kiyosaki, in financial terms would mean a more rate of return. In addition, the corpus should remain untouched till you retire. To make sure that you don’t face a shortage of money, it is suggested to withdraw a limited amount in the initial years after retirement. The key to this is to withdraw only up to 5% from your corpus in the initial 5 years and then later gradually increase the withdrawal limit to 10 %, meaning that at the age of 80 it would be safe to withdraw 20%. And finally, at the onset of retirement, experts also advise allocating your assets to the beneficiaries by making a will to have a peaceful retirement. Write a will so that your assets are protected. Issue power of attorney to a confidante who can manage things on your behalf if you fall ill.

In conclusion, planning for retirement is extremely important. There are various ways of investing money for every age group and thus the experts accordingly suggest a customised plan of investments as per your goals. “A penny saved is a penny earned” is a quote often attributed to Benjamin Franklin, a quote that many successful people believe to be the mantra of their success. Earn, invest and spend wisely to have a steady and happy retirement.