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Growth and Development

 Both refer to dynamic processes  Terms often used interchangeably  Have different meanings

 Physical change and increase in size  Measure quantitatively  Examples: height, weight, head


 Increase in the complexity of function and

skill progression  Capacity and skill of a person to adapt to the environment  Examples: learning to walk, run, talk

Growth and Development

 Independent but interrelated  Growth first 20 years of life  Development during and after growth

Principles Related to Growth and Development

 Continuous, orderly, sequential processes  Same pattern of growth and development  Sequence predictable  Learning may affect  Each developmental stage has its own

characteristics  Cephalocaudal growth occurs from the head downward

Principles Related to Growth and Development

Principles Related to Growth and Development

 Development proceeds from simple to

complex.  Development becomes increasingly differentiated  Certain stages of growth and development more critical than others  Pace can be uneven

Factors Influencing Growth and Development

 Genetics  Temperament  Family  Nutrition  Environmental  Health  Culture

Stages of Growth and Development

 Neonatal (Birth to 28 days)
Behavior largely reflexive Develops to more purposeful behavior

 Infancy (1 month to 1 year)

Physical growth rapid

 Toddlerhood (1 to 3 years)
Motor development permits increased physical autonomy Psychosocial skills increase

Stages of Growth and Development

 Preschool (3 to 6 years)
World is expanding New experiences and social role tried during play Physical growth slows

 School Age (6 to 12 years)

Includes preadolescent period (10 to 12 years) Peer group increasingly influences behavior Physical, cognitive, social development increases Communication skills improve

Stages of Growth and Development

 Adolescence (12 to 20 years)
Self-concept changes with biologic development Values tested Physical growth accelerates Stress increases, especially in face of conflicts

 Young Adulthood (20 to 40 years)

A personal lifestyle develops Establishes a relationship with a significant other and a commitment to something

Stages of Growth and Development

 Middle adulthood (40 to 65 years)
Lifestyle changes due to other changes Example: children leave home, occupational goals change

 Older Adulthood (Young-old, 65 to 74 years)

Adaptation to retirement and changing physical abilities often necessary Chronic illness may develop

Stages of Growth and Development

 Middle-old (75 to 84 years)
Adapts to decline in speed of movement, reaction time, and increasing Dependence on others may be necessary

 Old-old (85 and over)

Increasing physical problems may develop

Freud s Stages of Development

 Oral  Anal  Phallic  Latency  Genital

Oral (Birth to 1 Years)

 Mouth center of pleasure (gratification and    

exploration) Security primary need Major conflict: weaning Feeding produces pleasure, sense of comfort, safety Feeding should be pleasurable and provided when required

Anal (1 to 3 Years)
 Anus and bladder source of pleasure (sensual

satisfaction, self-control)  Major conflict: toilet training  Toilet training should be a pleasurable experience

Phallic (4 to 6 Years)
 Genitals center of pleasure  Masturbation offers pleasure  Fantasy, experimentation with peers  Questioning adults about sexual topics  Major conflict: Oedipus/Electra complexes  Resolves when the child identifies with parent

of same gender

Latency (6 Years to Puberty)

 Energy directed to physical and intellectual    

activities Sexual impulses tend to be repressed Develop relationship between peers of the same gender Encourage child with physical and intellectual pursuits Encourage sports and other activities with same gender peers

Genital (Puberty and After)

 Energy directed toward full sexual maturity

and function  Development of skills needed to cope with the environment  Encourage separation from parents  Achievement of independence and decision making

Erikson s Eight Stages of Development

1. 2. 3. 4. 5. 6. 7. 8.

Infancy (birth to 18 months) Trust versus mistrust Early Childhood (18 months to 3 years) Autonomy versus shame and doubt Late Childhood ((3 to 5 years) Initiative versus guilt School-age (6 to 12 years) Industry versus inferiority Adolescence (12 to 20 years) Identity versus role confusion Young Adult (18 to 25 years) Intimacy versus isolation Adulthood (25 to 65 years) Generativity versus stagnation Maturity (65 years to death) Integrity versus despair

Infancy and Early Childhood


Learning to walk and talk Eat solid foods Control elimination Learning sex differences and modesty Achieving psychologic stability Learning to relate emotionally Learning to distinguish right from wrong Developing a conscience

Middle Childhood
 Learning physical skills for ordinary games  Building wholesome attitudes toward oneself  Learning to get along with peers  Learning appropriate gender social role  Developing fundamental skills in reading, writing, math  Developing concepts for everyday living  Developing conscience, morality, scale of values  Achieving personal independence  Developing attitudes toward social groups and institutions

Achieving more mature relationships with peers Achieving gender role Accepting one s own body Using the body effectively Achieving emotional independence from parents Achieving economic independence Preparing for an occupation Preparing for marriage and family life Developing intellectual skills and concepts for civic competence Achieving socially responsible behaviors Acquiring set of values and an ethical system

Early Adulthood
 Selecting a mate  Learning to live with a partner  Starting a family  Rearing children  Managing a home  Getting started in an occupation  Taking on civic responsibilities  Finding a congenial social group

Middle Age
 Achieving adult civic role and social      

responsibilities Establishing and maintaining an economic standard of living Assisting teenage children to become happy adults Developing adult leisure-time activities Relating oneself to one s spouse as a person Accepting and adapting to physiologic changes Adjusting to aging parents

Later Maturity
 Adjusting to decreasing physical strength and health  Adjusting to retirement and reduced income  Adjusting to death of spouse  Establishing an explicit affiliation with peers  Meeting social and civic obligations  Establishing physical living arrangements


Piaget s Cognitive Development Theory

 Preconceptual  Intuitive thought  Concrete operations  Formal operation

Piaget s Cognitive Development Theory

 Three Primary Abilities
Encounter and react to new situations by using the mechanisms already possessed

Process of change Cognitive processes mature to solve problems that were unsolvable

Adaptation, or coping behavior

The ability to handle the demands made by the environment

Kohlberg s Theory of Moral Development

 Addresses moral development in children and    

adults Focused on the reasons an individual makes a decision Moral development progresses through three levels and six stages Levels and stages are not always linked to a certain developmental stage Some people progress to a higher level of moral development than others

Fowler s Theory of Spiritual Development

 Describes faith as a force that gives meaning to a person s life  An interactive process between the person and environment  Influenced by the work of Piaget, Kohlberg, and Erikson  In each stage new patterns of thought, values, and beliefs added  Stages must follow in sequence  Faith stages are separate from the cognitive stages of Piaget  Evolve from a combination of knowledge and values

Developmental Tasks from Birth through Adolescence

 Neonates and infants (birth to1 year)
Adjustment to environment outside the uterus

 Toddlers (1 to 3 years)
Progress from no control to walking and speaking Control elimination Acquire information about environment

Developmental Tasks from Birth through Adolescence

 Preschoolers (4 and 5 years)
Physical growth slows Control of body and coordination greatly increases World enlarges with relatives, friends, etc.

 School-age children (6 to 12 years)

Deciduous teeth are shed Includes preadolescence (or prepuberty) Period ends with onset of puberty Skills learned are important for later life

Developmental Tasks from Birth through Adolescence

 Adolescents (12 to 18 years)
Physically and psychologically mature Acquire personal identity Ready to enter adulthood

Physical Development: Neonates and Infants

Doubles by 5 mo Triples by 12 mo

Gains 13.75 cm (5.5 in.) by 6 mo Additional 7.5 cm (3 in.) by 12 mo.

 Head and Chest Circumference

Head > chest at birth Head = chest 9-10 mo. Head < chest after 1 yr.

Physical Development: Neonates and Infants

 Anterior fontanel closes between 9 and 18 mo.  Posterior fontanel closes between 2 and 3 mo.  Vision
Birth - blinks in response to bright light 1 mo - focus on objects 4 mo - almost complete color vision, follows object in 180 arc 5 mo - reaches for objects 6-10 mo - focus on object and follow in all directions 12 mo - depth perception developed

Physical Development: Neonates and Infants

Intact at birth
Moro reflex to loud noises

2-3 mo - vocalize to sounds and voices 3-6 mo - looks for sounds, pause to listen, responds to angry/happy voices 6-9 mo - may look at named objects/people 9-12 mo - understands some words, uses gestures, say one or two words 12 mo - responds to simple commands

Physical Development: Neonates and Infants

 Smell and Taste
Intact at birth

Well developed at birth Poor temperature regulation Diffuse response to pain

Reflexes present at birth Disappear to permit voluntary movement

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Motor Development: Neonates and Infants

 Uncoordinated at birth  1 mo - lifts head when prone, head lag present  4 mo - minimal head lag  6 mo - sits without support  9 mo - reach, grasp, transfer object from

hand to hand  12 mo - fine motor skills begin to


Physical Development: Toddlers

 Lose the baby look by age 2  Gain 3 5 kg (7- 10 lb) between ages 1 and 3  Height spurts between ages 1 and 2, then slows  By 24 mo., head circumference 80% adult size  Vision continues to mature; 20/40 at age 2  Hearing, taste, smell, and touch increasingly developed  Fine and gross motor skills improve

Physical Development: Preschoolers

 Body appears out of proportion as extremities      

grow more quickly Weight gain generally slow Doubles birth length by age 5 20/30 normal vision at age 5 Hearing at optimal levels Shows taste preferences Motor abilities strengthen as child begins to master physical activities

Physical Development: School-age Children

 Major weight gain at age 9 12 (girls) and 10 12     

(boys) Growth spurt at age 10 12 (girls) and 12 14 (boys) 20/20 vision established between ages 9 11 Well-developed senses of hearing and touch Increased perspiration and other prepubertal changes Motor abilities well developed during this period

Physical Development: Adolescents

 Body parts reach adult size, beginning with

head, hands, and feet  Rapid growth in height and weight for boys, slower in girls  Glandular changes cause increased sweat and acne  Primary and secondary sexual characteristics develop

Psychosocial Development (Erikson)

 Neonates and Infants
Trust versus mistrust

Autonomy versus shame

Initiative versus guilt

 School-age Children
Industry versus inferiority

Identity versus role confusion

Cognitive Development (Piaget): Neonates and Infants

 Sensorimotor Phase
Perceptual recognition (4 8 mo.) Responds to new stimuli, remembers objects, looks for them (6 mo.) Concept of both space and time develops (12 mo.)

Cognitive Development (Piaget): Toddlers

 Completes Sensorimotor

Trial-and-error problem solving Solving problems mentally

 Preconceptual Phase (2 yr)

Learn sequence of time Develop some symbolic thought

Cognitive Development (Piaget): Preschoolers

 Intuitive Thought Phase
Still egocentric, but subsiding
Learn through trial and error Think of one idea at a time Do not understand relationships 5 yr count pennies, reading skills develop

Cognitive Development (Piaget): School-age Children

 Concrete Operations

Cooperative interactions Intuitive reasoning Cause-and-effect Concepts of money and time learned Reading skills well developed

Cognitive Development (Piaget): Adolescents

 Formal Operations Phase
Thinking beyond the present Idealistic thinking Abstract thinking

Moral Development (Kohlberg)

 Neonates and infants
No related stage Pleasure/pain Parent tone of voice, facial expressions

Preconventional level
Stage 1: Punishment and reward

Moral Development (Kohlberg)

Prosocial behavior Modeling moral behavior

 School-age children
Preconventional level
Stage 1: Punishment and reward Stage 2: Instrumental-relativist

Conventional level
Stage 3: Good boy-nice girl Stage 4: Law and order

Moral Development (Kohlberg)

Conventional Level (Young Adolescent) Postconventional or Principled Level

Spiritual Development (Fowler)


 School-age children



Assessment: Neonates and Infants

 Apgar scoring  Denver Developmental Screening Test (DDST-II)  Physical development
Growth in normal range Appropriately size fontanels Vital signs in normal range Ability to habituate to stimuli and clam self

 Motor development
Gross and fine skills in normal range Appropriate reflexes Symmetrical movements No hyper- or hypotonia

Assessment: Neonates and Infants

 Sensory development
Follows moving objects Responds to sound Coos, babbles, laughs Imitate sounds

 Psychosocial development
Interacts with parents through movement and vocalizations

 Development in activities of daily living (ADL)

Eats, drinks appropriate amounts Exhibits elimination patterns normal for age Exhibits normal rest and sleep patterns

Assessment: Toddlers
 Physical development
Physical growth in normal range Vital signs in normal range Vision, hearing within normal range

 Motor development
Achieves gross and fine motor milestones

 Psychosocial development
Achieves milestones

Assessment: Toddlers
 Development in ADL
Feeds self Eats variety of foods Begins to develop bowel and bladder control Rest and sleep patterns appropriate for age

Assessment: Preschoolers
 Physical development
Physical growth within normal range Vital signs in normal range Vision, hearing within normal range

 Motor development
Achieves gross and fine motor milestone

 Psychosocial development
Achieves milestones

Assessment: Preschoolers
 Development in ADL
Control of bowel and bladder functions Performs simple hygiene activities Dresses and undresses self Engages in bedtime rituals Demonstrates ability to put self to sleep

Assessment: School-age Children

 Physical development
Physical growth within normal range Vision, hearing within normal range Vital signs in normal range Demonstrate male or female prepubertal changes

 Motor development
Possesses coordinated motor skills for age

Assessment: School-age Children

 Psychosocial Development
Achieves milestones

 Development in ADL
Concern for personal cleanliness and appearance Expresses need for privacy

Assessment: Adolescents
 Physical development
Physical growth within normal range Demonstrates male or female sexual development within standards Vital signs within normal range for gender Hearing, vision within normal range

Assessment: Adolescents
 Psychosocial development
Interacts well with parents and others Likes self Has plans for future Choose lifestyle and interests that fit own identity Determines own beliefs and values Begins to establish a sense of identity in family Seeks help from appropriate people as needed

Assessment: Adolescents
 Development in ADL
Knowledge of physical development, menstruation, reproduction, and birth control Exhibits healthy lifestyle practice Demonstrates concern for personal cleanliness and appearance

Health Promotion Guidelines: Neonates and Infants

 Health examinations
Birth, 2 weeks, 2, 4, 5, and 12 mo

 Protective measures
Immunizations Fluoride supplementation as needed Screening for TB and PKU Prompt attention to illness Appropriate hygiene

 Infant safety
Importance of supervision Home environmental safety Feeding measures Appropriate toys

Health Promotion Guidelines: Neonates and Infants

Breast and formula feeding Solid foods Iron supplementation


 Sensory stimulation
Touch stimulation Visually stimulating toys Hearing loss screening and intervention

Characteristics Frequency Diarrhea

Health Promotion Guidelines

 Additional safety and health concerns for

Failure to thrive Infant colic Crying Child abuse including shaken baby syndrome Sudden infant death

Health Promotion Guidelines: Toddlers

 Health examinations
15, 18 months and then as recommended by physician

 Protective measures
Immunizations Screening for TB, lead poisoning Fluoride supplementation as needed

Health Promotion Guidelines: Toddlers

Supervision Teaching Home environment safety Outdoor safety Appropriate toys

Nutritious meals and snacks Mealtime manners Dental care

Health Promotion Guidelines: Toddlers

Toilet training

Sleep disturbances

Adequate space Toys for acting on behavior Motor and sensory stimulation

Health Promotion Guidelines

 Additional safety and health concerns for

Injuries Visual problems Respiratory and ear infections Dental caries

Health Promotion Guidelines: Preschoolers

 Health Examinations
Every 1-2 years

 Preschooler safety
Education Play safety Prevention of poisoning

 Protective measures
Immunizations Screening for TB, vision, hearing, dental Fluoride treatment

Health Promotion Guidelines: Preschoolers

Nutritious meals and snacks

Sleep disturbances

Proper hygiene

Group play activities Teach simple cooperative and interactive games Toys for dress-up

Health Promotion Guidelines

 Additional safety and health concerns for

Injuries Visual problems Dental caries Respiratory tract and ear infections
Communicable disease Congenital abnormalities correction

Health Promotion Guidelines: School-age Children

 Physical development
As recommended

 Protective measures
Immunizations Screening for TB Periodic vision, speech, hearing, dental screening Fluoride treatment Sexual education

Health Promotion Guidelines: School-age Children

Sports safety Education

 Play and Social

Organized group activities Parental expectations Parental responsibilities

No skipped meals Balanced diet Obesity

Health Promotion Guidelines

 Additional safety and health concerns for

school-age children
Communicable Diseases Dental Cavities Injuries Obesity

Health Promotion Guidelines: Adolescents

 Health Examinations
As recommended

 Protective measures
Immunizations Periodic screenings for TB, vision, hearing, dental screening Accurate sexual information

Health Promotion Guidelines: Adolescents

 Safety Issues
Motor vehicle safety Sports safety Substance abuse Emotional disturbances

 Nutrition and exercise

Health snacks Appropriate food intake and exercise

Health Promotion Guidelines: Adolescents

 Social Interaction
Positive relationships Peer group activities Home environment Family responsibilities and participation

Health Promotion Guidelines

 Additional safety and health concerns for

Consequences of Risky Behavior
Injury Sexually transmitted disease Teen pregnancy

Psychological and Emotional Challenges

Addiction Schizophrenia may appear Suicide

Infectious Diseases

Baby Boomers
 Years 1945-1964  An individualistic outlook  Workaholic orientation  Respect at work, but feel role overload

Generation X
 Gen Xers  Born 1965-1978  Frequently raised in two-worker households  Less impressed with corporate values  More skeptical  Resist authority  Enjoy challenges and opportunities to creatively

problem solve

Generation Y
 Millennials  Born 1979-2000  Part of an increasingly multi-cultural America  Technologically sophisticated (and

dependent)  Enjoy public affirmations of efforts

Young Adults (20 Physical Changes

 Prime physical years


 Musculoskeletal system well developed and

coordinated  Other body systems functioning at peak efficiency  Choices affect weight and muscle mass  Physical changes in pregnant and lactating women

Middle-aged Adults (40-65): Physical Changes

 Appearance changes  Skeletal muscle bulk decreases  Thinning of intervertebral discs  Calcium loss from bone  Blood vessels lose elasticity and become thicker  Decline in visual acuity  Presbyopia  Presbycusis  Decreased taste sensation  Gradual decrease in tone of large intestine may lead to constipation  Urinary system affected as glomerular filtration rate decreases  Hormonal changes affect sexuality-menopause, climacteric

Young Adults: Developmental Tasks

 Havighurst Development Tasks:
Selecting a mate Learning to live with a partner Starting a family Rearing children Managing a home Getting started in an occupation Taking on civic responsibility Finding a congenial social group

 Nelson and Barry (2005) Characteristics

Separation from parents Exploration of new identities Personal discovery and self discovery High risk behaviors

Middle-age Adults: Developmental Tasks

 Havighurst Developmental Tasks:
Achieving adult civic and social responsibility Establishing and maintaining an economic standard of living Assisting teenage children to become responsible and happy adults Developing adult leisure-time activities Relating oneself to one s spouse as a person Accepting and adjusting to the physiologic changes of middle age Adjusting to aging parents Balancing the needs of multiple constituencies Maintaining work as a central theme

Middle-age Adults Developmental Tasks

 Slater (2003) additional developmental tasks
Inclusivity versus exclusivity Pride versus embarrassment (in children, work, or creativity) Responsibility versus ambivalence (making choices about commitments) Career productivity versus inadequacy Parenthood versus self-absorption Being needed versus alienation Honesty versus denial (with oneself)

Young Adults: Cognitive Development

 Use formal operations  May demonstrate

postformal thought  Reaction time

Middle-age Adults: Cognitive Development

 Little change in cognitive and

intellectual abilities  Maintain memory and problem solving  Continues learning  Influence of genetic, environmental, and personality factors

Kohlberg: Moral Development

 May enter Postconventional Level
Define morality in terms of personal principles

 May progress to Stage 5

Believes rights of others take precedence

 Recent research demonstrates

Moral development continues throughout adulthood Few attain stage 5 before age 40

Young Adults: Fowler s Spiritual Development

 Individuating reflective period (after 18 years)  Focuses on reality  May ask philosophical questions regarding

spirituality  May be self-conscious about spiritual matters  Religious teaching from childhood accepted or redefined

Middle-age Adults:Fowler s Spiritual Development

 Less dogmatic about religious beliefs  Religion offers more comfort than previously  Often rely on spiritual beliefs to deal with

illness, death, and tragedy  After 30 years some reach the paradoxicalconsolidative stage
View truth from a number of viewpoints

Young Adults Selected Health Problems

 Injuries  Suicide  Hypertension  Substance abuse  Eating disorders

(including smoking)  Sexually transmitted infections (STI)

(obesity)  Violence  Abuse of women  Certain malignancies (testicular cancer and cervical cancer)

Middle-age Adults Selected Health Problems

 Injuries  Cancer
Cancer of the lung and bladder (men) Breast cancer followed by cancer of the colon and rectum, uterus, and lung (women)

 Cardiovascular disease  Obesity  Alcoholism  Mental health

Anxiety Depression

Young Adults Assessment

 Physical development
Weight, vital signs, vision and hearing Knowledge and attitudes about sexuality

 Psychosocial development
Independence from parents Self-concept Direction in life Family interactions Coping skills Relationship with significant other Emotional, social, and economic responsibilities Values

 Development in ADL

Middle-age Adults Assessment

 Physical development
Weight, vital signs, vision and hearing Knowledge and attitudes about sexuality Changes in eating, elimination, exercise

 Psychosocial development
Response to physical changes Comfort with self Independence Changes in family roles Relationship with life partner Interests Civic involvement Philosophy of life

 Development in ADL
Preventive health practices

Young Adults Health Promotion Topics

 Health tests and screening
Routine physical examinations as recommended Immunizations Dental, vision, hearing screenings Breast and testicular examinations Papanicolaou smear Screening for cardiovascular disease, TB, smoking

Motor vehicle safety Sun protection Workplace and water safety

 Nutrition and exercise

Adequate iron intake Proper nutrition and exercise

 Social interactions
Positive personal relationships Occupational long and short term goals

Middle-age Adults Health Promotion Topics

 Health tests and screening
Routine physical examinations as recommended Immunizations Dental, tonometry screening Breast, testicular examinations Screening for cardiovascular disease Screening for colorectal, breast, cervical, uterine, and prostate cancer Smoking history and counseling

Middle-age Adults Health Promotion Topics

Motor vehicle safety Workplace safety Home safety measures

 Social interactions
Midlife crisis Interest Retirement planning

 Nutrition and exercise

Adequate protein, calcium, vitamin D Proper nutrition and exercise to prevent cardiovascular disease Exercise program

Categories of Elders

Characteristics of Elders
Longer life spans Fastest growing age group is 85 years and over

Women have longer life expectancy Men more likely to remarry Educational level gradually increasing Lower incomes Most live in community settings Poverty level more likely when living alone

Number of minority elders increasing Elder Hispanic fastest growing subpopulation

Characteristics of Elders
Chronic health problems and disabilities increase 73% rate health as good, very good, or excellent 20% report disability and most have chronic disease

 Discrimination based solely

on age  Exists among some professionals  Negative stereotypes based on myths and incorrect information


Gerontology and Geriatrics

The study of aging and older adults Multidisciplinary Specialized area within various disciplines including nursing

Associated with the medical care of the elderly

Gerontological Nursing
 Historical development  Certification through the American Nurses

Association  Advanced practice in nursing  Roles

Provider of care Teacher Manager Advocate Research consumer

National Gerontological Nursing Association

Care Settings for Older Adults

 Acute care facilities
Intensive care units Emergency department Rehabilitation

Hospice Home health care Nurse-run clinics Adult day care

 Long-term care facilities

Assisted living Intermediate care Skilled care Alzheimer s units Hospice Rehabilitation

Biological Theories of Aging

 Wear-and-tear  Endocrine  Free-radical  Genetic  Cross-linking  Immunological theories
Merck Manual Biology of Ageing

Physical Changes

Integumentary Neuromuscular Sensory-perceptual Pulmonary Cardiovascular Gastrointestinal Urinary Genital Immunological Endocrine system

Integumentary Changes
 Skin dryness, pallor, fragility  Wrinkling and sagging  Age spots  Decreased perspiration  Thinning, graying of body hair  Slower growth and thickening of nails

Neuromuscular Changes

Decreased speed and power of muscles Slowed reaction time Loss of height Loss of bone mass Joint stiffness Impaired balance Greater difficulty with complex learning/abstraction

Sensory-Perceptual Changes

Loss of visual acuity Increased sensitivity to glare Decreased ability to adjust to darkness Arcus senilis Presbycusis Decreased sense of taste and smell Increased threshold for pain, touch, and temperature

Pulmonary Changes
 Decreased ability to expel accumulated     

matter Decreased lung expansion Less effective exhalation Reduced vital capacity Increased residual volume Dyspnea with exertion

Cardiovascular System Video

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Cardiovascular Changes
 Reduced SV and CO  Reduced elasticity  Increased rigidity of arteries  Increased SBP and DBP  Orthostatic hypotension

Gastrointestinal System Video

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Gastrointestinal Changes
 Delayed swallowing time  Increased indigestion  Constipation

Genitourinary and Renal System Video

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Urinary Changes
 Reduced filtering  Impaired renal function  Less effective concentration of urine  Urgency and frequency  Nocturia  Retention

Genital Changes
 Prostate enlargement  Atrophy of vulva, cervix, uterus, fallopian

tubes, ovaries  Reduction in vaginal secretions  Changes in vaginal flora  Changes in sexual functioning

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Immunological Changes
 Decreased immune system function  Lowered resistance to infection  Poor response to immunizations  Decreased stress response

Endocrine Changes
 Increased insulin resistance

Psychological Theories about Aging

 Disengagement theory (Cumming and Henry)
Mutual withdrawal between elder and elder s environment

 Activity theory (Havighurst)

Best way to age is to stay physically and mentally active

 Continuity theory (Atchley)

People maintain values, habits, and behaviors as they age

Developmental Tasks
Ego integrity versus despair

Ego differentiation versus work-role preoccupation Body transcendence versus body preoccupation Ego transcendence versus ego preoccupation

Additional Developmental Tasks (65-75 years)

 Adjusting to
decreasing physical strength and health retirement 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 living arrangements

Additional Developmental Tasks (75 years and older)

 Adjusting to
living alone possibility of moving into a nursing home one s own death

 Safeguarding physical and mental health  Remaining in touch with other family

members  Finding meaning in life

Psychosocial Changes
 Retirement  Economic change  Grandparenting  Relocation  Maintaining

independence and selfesteem  Facing death and grieving

Cognitive Abilities
 Formal operations (Piaget)  Intellectual capacity
Perception Cognitive agility Memory Learning

Kohlberg Theory of Moral Reasoning

 Based on concepts of justice, objectivity, and

preservation of right  Believed moral development complete in early adult years  Does not decline with age

Gilligan Theory of Moral Reasoning

 Focused on women  Based theory on connectedness to others and

the value of relationships

Moral Reasoning
 Values and belief patterns
Influence of time period Foreign-born or first-generation citizens Cultural background Life experience Gender Religion Socioeconomic status

Spirituality and Aging

 Can contemplate new religious and philosophical     

views Understanding ideas missed previously or interpreted differently May derive sense of worth by sharing experiences or views Many take faith and religious practice very seriously Display a high level of spirituality Importance of religion in youth

Benefits to Spirituality
 Helps resolve issues related to
Meaning of life Adversity Good fortune

 May be an important coping resource  May feel impoverished or despair if not

matured spiritually

Older Adults Selected Health Problems

 Injuries  Chronic disabling illnesses  Drug use and misuse  Alcoholism  Dementia  Elder abuse

Health Promotion Topics

 Safety  Nutrition and exercise  Elimination  Social interaction

Health Promotion