Promoting the

Psychosocial and Spiritual

Health of the Older Adult
 Learning Outcomes
At the end of the unit, the learners should be able to:
•  identify characteristic tasks of the older adulthood;
•  describe the psychosocial development in older adulthood;
•  explain the changes in cognitive, spiritual, and moral development;
•  identify selected health problems associated with aging; and
•  propose health promotion activities in addressing the health problems
identified.
 Psychosocial Aging

• Personality Theory
• Developmental Task Theory
• Disengagement Theory
• Activity Theory
• Continuity Theory
 Psychosocial Development
(Erikson (1963)
EGO INTEGRITY VS. DESPAIR
Ego Integrity
•  Life with a sense of wholeness and derive
satisfaction from past accomplishments
Despair
•  Belief that one has made poor choices during life
and wish he/she could live life over
 Developmental Tasks of the Older Adult
(Peck, 1968)

•  Ego differentiation versus work-role

preoccupation
•  Body transcendence versus body
preoccupation
•  Ego transcendence versus ego
preoccupation
Developmental Tasks of Older Adult
- 65 to 75 Years
Adjusting to:
•  decreasing physical strength and health
•  retirement and lower and fixed income
•  death of parents, spouses and friends
•  new relationships with adult children
•  leisure time
•  slower physical and cognitive responses
•  keeping active and involved
•  making satisfying and living arrangements as aging progresses
Developmental Tasks of Older Adult
- 75 Years and Older
•  Adapting to living alone
•  Safeguarding physical and mental health
•  Adjusting to the possibility of moving into a
nursing home
•  Remaining in touch with other family members
•  Finding meaning in life
•  Adjusting to one’s own death
Promoting Psychosocial
Health
• Sensory Perception
• Self-concept
• Sexuality
• Spirituality and Moral
Development
• Stress and Coping
• Loss, Grieving, and Death
 •  Sensory Perception – refers to
Sensory Experience the process of receiving stimuli
•  Sensory Perception – involves
the conscious organization and
translation of stimuli into
meaningful information
•  Aspects of Sensory Process:
-  Stimulus
-  Receptor
-  Impulse conduction
-  Perception
 Sensory Deprivation

•  Excessive yawning, drowsiness, sleeping

•  Decreased attention span, difficulty concentrating, decreased problem
solving
•  Impaired memory
•  Periodic disorientation, general confusion, or nocturnal confusion
•  Preoccupation with somatic complaints, such as palpitations
•  Hallucinations or delusions
•  Crying, annoyance over small matters, depression
•  Apathy, emotional lability
Sensory Overload •  Complaints of fatigue,
sleeplessness
•  Irritability, anxiety, restlessness
•  Periodic or general disorientation
•  Reduced problem-solving ability
and task performance
•  Increased muscle tension
•  Scattered attention and racing
thoughts
Factors Affecting Sensory Function
in the Older Adult
•  Developmental Stage
•  Culture
•  Stress
•  Medications and Illness
•  Lifestyle and Personality
 Promoting Healthy
Sensory Function
•  Adjusting environmental stimuli
•  Preventing sensory overload
•  Preventing sensory deprivation
•  Managing acute sensory deficits
•  Using sensory aids
•  Promoting the use of other senses
•  Communicating effectively
•  Ensuring client safety
 Development of Self-Concept

Behaviors Indicating Positive Behaviors Indicating Negative

Resolution of Developmental Task Resolution of Developmental Task

•  Using past experience to assist •  Crying and being apathetic

others •  Not accepting changes
•  Maintaining productivity •  Demanding unnecessary
•  Accepting limitations assistance and attention from
others
Components of Self-Concept
 Factors that Affect the Development of
Self-Concept
•  Development
•  Family and Culture
•  Stressors
•  Resources
•  History of Success and Failure
•  Illness
 Promoting the Development of
Self-Concept

• Identifying areas of strength

• Enhancing self-esteem
 Sexual Health
•  Knowledge about sexuality and sexual behavior
•  Ability to express one’s full sexual potential, excluding all forms of
sexual coercion, exploitation and abuse
•  Ability to make autonomous decisions about one’s sexual life
within a context of personal and social ethics
•  Experience of sexual pleasure as a source of physical,
psychologic, cognitive and spiritual well-being
•  Capability to express sexuality through
communication, touch, emotional
expression and love
•  Right to make free and responsible
reproductive choices
•  Ability to access sexual healthcare for
the prevention and treatment of all
sexual concerns, problems and
disorders
 Development of Sexuality in Late
Adulthood
Characteristics Nursing Interventions and Teaching
Guidelines

•  Interest in sexual activity often continues. •  Elders often continue to be sexually active.
•  Sexual activity may be less frequent. •  Couples may require counselling about
•  Women’s vaginal secretions diminish and adapting their affection and sexual needs
breasts atrophy. to physical limitations
•  Men produce fewer sperm and need more
time to achieve an erection and to
ejaculate.
 Factors Influencing Sexuality

• Culture
• Religious Values
• Personal Ethics
• Health Status
• Medications
Promoting Sexual Health

•  Providing sexual health teaching

•  Breast and testicular self-
examination
•  Counselling for altered sexual
function
•  Dealing with inappropriate sexual
behavior
 Spirituality
•  Refers to that part of being human that
seeks meaningfulness through intra-, inter-,
and transpersonal connection
•  Involves a belief in a relationship with
some higher power, creative force, divine
being, or infinite source of energy
 Aspects of Spirituality
•  Meaning (having purpose, making sense of
life)
•  Value (having cherished beliefs and
standards)
•  Transcendence (appreciating a dimension
that is beyond the self)
•  Connecting (relating to others, nature,
Ultimate Other)
•  Becoming (involves reflection, allowing life to
unfold and knowing who one is)
 Spiritual Needs
•  Need for love •  Need for meaning to the fullness
•  Need for hope of life

•  Need for trust •  Need for values

•  Need for forgiveness •  Need for creativity

•  Need to be respected and valued •  Need to connect with God or

Higher Power, or a Being greater
•  Need for dignity
than oneself
•  Need to belong to a community
 Characteristics Indicative of
Spiritual Well Being
•  Sense of inner peace •  Humor
•  Compassion for others •  Wisdom
•  Reverence for life •  Generosity
•  Gratitude •  Ability to transcend the self
•  Appreciation of both unity and •  Capacity for unconditional love
diversity
 Defining Characteristics of
Spiritual Distress
•  Expresses lack of hope, meaning and purpose in
life, forgiveness of oneself
•  Expresses being abandoned by or having anger
toward God
•  Refuses interaction with friends and family
•  Sudden changes in spiritual practices
•  Requests to see a religious leader
•  No interest in nature, reading spiritual literature
 Concepts Related to
Spirituality

•  Religion
•  Faith
•  Hope
•  Transcendence
•  Forgiveness
Spiritual Development (Fowler, 1981)
Stage Description
Awareness of truth
Paradoxical – from a variety of
Consolidative viewpoints

Becoming an
Universalizing incarnation of the
principles of love
and justice
Stages of Faith (Westerhoff, 1976)
Stage Behavior

Owned Faith Puts faith into personal

and social action and is
willing to stand up for
what the individual
believes even against the
nurturing community.
Moral Development (Kohlberg, 1958)
Level Stage
Social Contract Legalistic
Orientation
-  The social rules are not the sole
basis for decisions and behavior
Postconventional because the person believes a
-  Lives autonomously and defines higher moral principle applies
moral values and principles that such as equality, justice, or due
are distinct from personal process.
identification with group values Universal Ethical Principle
-  Lives according to principles that Orientation
are universally agreed on and -  Decisions and behaviors are
that the person considers based on internalized rules, on
appropriate for life conscience rather than social
laws, and on self-chosen ethical
and abstract principles that are
universal, comprehensive and
consistent.
 Spiritual Practices Affecting Nursing
Care of the Older Adult
•  Holy days
•  Sacred writings
•  Sacred symbols
•  Prayer and meditation
•  Beliefs affecting diet and nutrition
•  Beliefs related to healing
•  Beliefs related to dress
•  Beliefs related to death
 Promoting Spiritual Health
• Providing presence
• Supporting religious practices
• Assisting clients with prayer
• Referring clients for spiritual
counseling
 Stress and Coping

•  Accepting decreasing physical

abilities and health
•  Accepting changes in residence
•  Adjusting to retirement and
reduced income
•  Adjusting to death of spouse and
friends
 Effects of Stress

•  Physical – can threaten the person’s physiologic homeostasis

•  Emotional – can produce negative or non-constructive feelings
about the self
•  Intellectual – can influence a person’s perceptual and problem
solving abilities
•  Social – can alter a person’s relationships with others
•  Spiritual – can challenge one’s beliefs and values
 Psychologic Indicators
of Stress

•  Anxiety
•  Fear
•  Anger
•  Depression
•  Unconscious ego defense
mechanisms
Coping

•  Problem-focused coping – refers to efforts to improve a

situation by making changes or taking some action
•  Emotion-focused coping – includes thoughts and actions that
relieve emotional distress
•  Adaptive coping – helps the person to deal with stressful events
and minimizes distress associated with them
•  Maladaptive coping – can result in unnecessary distress for the
person and others associated with the person or stressful event
Effective coping is influenced by…

• the number, duration, and intensity of the stressors

• past experiences of the individual
• support systems available to the individual
• personal qualities of the individual
Promoting Adaptive
Coping with Stress
•  Exercise
•  Nutrition
•  Rest and Sleep
•  Time Management
•  Minimizing Anxiety
•  Mediating Anger
•  Use of Relaxation Techniques
•  Crisis Intervention
 Loss, Grieving and Death

• Loss of an aspect of oneself – a body part, a

physiologic function, or a psychologic attribute
• Loss of an object external to oneself
• Separation from an accustomed environment
• Loss of a loved and valued person
•  Grief – total response to the emotional experience related to loss
manifested in thoughts, feelings and behaviors, associated with
overwhelming distress or sorrow.
•  Bereavement – subjective response experienced by the
surviving loved ones after the death of a person with whom they
have shared a significant relationship
•  Mourning – behavioral process through which grief is eventually
resolved or altered
 Stages of Grieving / Bereavement
Kubler Ross Engel Sander

•  Denial •  Shock and disbelief •  Shock

•  Anger •  Developing •  Awareness of loss
•  Bargaining awareness •  Conservation /
•  Depression •  Restitution Withdrawal
•  Acceptance •  Resolving the loss •  Healing: the turning
•  Idealization point
•  Outcome •  Renewal
Factors Influencing Loss
and Grief Responses
•  Age
•  Significance of the loss
•  Culture
•  Spiritual beliefs
•  Gender
•  Socioeconomic status
•  Support system
•  Cause of loss or death
 Promoting Adaptive Coping
with Loss

• Facilitating grief work

• Providing emotional support
 Development of the
Concept of Death

•  Fears prolonged illness

•  Encounters death of family
members and peers
•  Sees death as having multiple
meanings (freedom from pain,
reunion with deceased family
members)
 Legal Issues Related to Death
•  Advance healthcare directives
•  Autopsy or postmortem examination
•  Certification of death
•  Do-not-resuscitate orders
•  Euthanasia
•  Inquest
•  Organ donation
 Nursing Responsibility for Dying
Patients
•  Assist to a peaceful death
•  Provide relief from loneliness, fear and depression
•  Maintain client’s sense of security, self-confidence, dignity
and self-worth
•  Help the client accept losses
•  Provide physical comfort
•  Meeting the physiologic needs
•  Providing spiritual support
•  Supporting the family
Adaptation to the Tasks
of Aging
 Retirement
•  65 Years Old – mandatory age of retirement
•  R.A. 10911 – Anti-age Discrimination in
Employment Act
•  Unemployed Elderly versus Employed
Elderly
•  Pursuing projects or recreational activities
deferred for a long time
•  Spending much time resting, sleeping, and
getting up when they please
•  Finding outlets such as jobs, community
projects, travel, volunteer services,
intellectual or recreational pursuits, or
hobbies
Economic Change
•  Financial needs of the elderly vary.
•  Most of the elderly need less money for
clothing, entertainment, work, and
household management costs.
•  Food and medical costs become a
financial burden to the elderly.
•  Adequate financial resources enable the
elderly to remain independent.
•  Problems with income are often related
to low retirement benefits, lack of
pension plans and the increased length
of the retirement years.
Relocation
•  The house or the apartment may
be too large or too expensive.
•  The work involved in maintaining
the house may become
burdensome or impossible for the
aged person or couple.
•  Some elders with decreased
mobility want living arrangements
that are all on one floor or need
more accessible bathroom
facilities.
•  Some need to move nearer to
their children for general support
and supervision.
•  Some may be seeking a more
moderate climate with better
recreational facilities geared to a
more leisurely lifestyle.
•  Some must relocate to long-term
facilities or nursing homes when
they can no longer care for
themselves due to problems of
mobility and memory impairment.
 Living Conditions Available for the
Older Adult
•  Assisted living – provides various degrees of personal care
assistance
•  Adult day care – provides health and social services
•  Adult foster care and group homes – programs that offer
services to elderly who can care for themselves but require some
form of supervision for safety purposes
 Maintaining Independence and
Self-esteem
•  Most elders thrive on independence.
•  It is important for the elderly to be able to look after themselves even if they
have to struggle to do so.
•  To maintain the older adult’s sense of self-respect, family members should
encourage them to do as much as possible for themselves, provided that
safety is maintained.
•  Aging people need to be recognized for their unique individual
characteristics, which leads them talking about past accomplishments, jobs,
deeds, and experiences.
•  Most elders are willing to listen to
suggestions and advice, but they do
not want to be ordered around.
•  Older people appreciate
thoughtfulness, consideration, and
acceptance of their waning abilities.
•  The values and standards held by
older people need to be accepted,
whether they are related to ethical,
religious, or household matters.
 Maintaining Relationship with Others
Interpersonal relationships contribute to well-being of the
elder by:
•  Promoting socialization and companionship
•  Elevating morale and life satisfaction
•  Buffering the effects of stressful events
•  Providing a confidant
•  Facilitating coping skills and mastery
Facing Death and
Grieving •  Great bonds of affection and
closeness develops during the
period of aging together and
nurturing each other.
•  When a spouse dies, the
remaining partner inevitably
experiences feelings of loss,
emptiness, and loneliness.
•  Some widows and widowers
remarry.
•  More women than men face bereavement and
solitude because women usually live longer.
•  Older people are often reminded of the brevity of
life by the death of friends.
•  Moving to a retirement home that has other
people in similar circumstances and organized
social activities can help the older person cope.
Psychosocial Risk Factors that
Predispose the Older Adults to
Mental Disorders

•  Loss of social roles

•  Loss of autonomy
•  Deaths of friends and relatives
•  Declining health
•  Increased isolation
•  Financial constraints
•  Decreased cognitive functioning
Psychiatric Disorders in
Later Life
•  Dementia
•  Delirium
•  Depression and Suicide
•  Schizophrenia
•  Anxiety Disorders
•  Personality Disorders
•  Sleep Disorders
•  Substance-Related Disorders
•  Elder Abuse
Psychosocial Development
Assessment Guidelines for the
Older Adults
•  Manage retirement years in a satisfying manner.
•  Participate in social and leisure activities.
•  Have a social network of friends and support persons.
•  View life as worthwhile.
•  Have high self-esteem.
•  Gain support from value system and/or spiritual
philosophy.
•  Accept and adjust to the death of significant others.
Psychosocial Health
•  Encouraging intellectual and
Promotion Guidelines
for Older Adults recreational pursuits
•  Encouraging personal
relationships that promote
discussion of feelings,
concerns, and fears
•  Availability of social
community centers and
programs for seniors