1
Q
What age range is middle adulthood?
A
40-65 years old
2
Q
Physical changes?
A
- Vision & hearing
- Cardiovascula
- Lungs
- Sexuality
3
Q
Sexuality changes?
A
- Perimenopause (8-10 years before menopause)
- Menopause (avg. age 52 years)
- Increase in sexually transmitted diseases
4
Q
What is Erikson’s developmental theory stage during middle adulthood?
A
Generativity vs Stagnation
Contributing to society and supporting the next generation.
5
Q
Chronic diseases
A
- Increase in middle adulthood
- Men: higher incidences of fatal chronic conditions (coronary heart disease, cancer, stroke)
- Women: Higher incidences of nonfatal diseases (arthritis, varicose veins, bursitis)
6
Q
What is the leading chronic disorder and what is the second?
A
- Arthritis
- HTN
7
Q
When is late adulthood?
A
60-120 years
8
Q
Most common cognitive impairments?
A
Dementia, delirium and depression
9
Q
Memory changes?
A
YES: Episodic and working memory
NO CHANGE: Semantic
10
Q
Glomerular filtration rate?
A
The rate at which the kidneys filter blood.
11
Q
Hypercapnia?
A
High levels of carbon dioxide in the blood.
12
Q
Hypoxia?
A
Low levels of oxygen supply to body tissues.
13
Q
Three sociological theories of aging?
A
- Activity Theory
- Continuity Theory
- Social Exchange Theory
14
Q
Erikson’s theory of eight stages of life…
A
- Middle adulthood: Stage 7, Generativity vs Stagnation
- Older adulthood: Stage 8, Ego integrity vs despair
15
Q
Havighurst’s Developmental Tasks
A
Infancy & Early Childhood (0–6 yrs): walk, talk, toilet train, form bonds, basic social skills
Middle Childhood (6–12 yrs): read/write/math, peer relationships, self-esteem, gender roles, values
Adolescence (12–18 yrs): identity, independence, peer relationships, career prep, morals, physical changes
Early Adulthood (18–40 yrs): intimate relationships, select mate, start family, career, manage home
Middle Adulthood (40–65 yrs): raise children, career productivity, leisure, aging parents, adjust to changes
Late Adulthood (65+ yrs): retirement, decreased income, cope with loss, maintain social ties, life review
16
Q
Cohort Effects
A
Changing historical times and social expectations influence how cohorts move through the lifespan
17
Q
Gender Effects:
A
Theories focus on men (e.g. career and work achievement)
18
Q
Cultural Effects
A
Middle-aged is not addressed in all cultures
19
Q
Culturally Competent Care
A
Having the skills to put cultural knowledge into assessment, communication, and intervention
20
Q
Cultural Safety
A
Recognition of power imbalances, the understanding of the nature of interpersonal relationships, and the awareness of institutional discrimination. (A & D, 2019)
21
Q
CNA Practice Standard
A
Nurses have an obligation to respect and value each person’s individual culture and consider how culture may impact an individual’s experience of health care and the health care system.
22
Q
Indigenous Cultural Safety, Cultural Humility, and Anti-Racism
A
- It starts with me
- Taking action
- Relational care
- Looking below the surface
23
Q
What is the First Nations Health Authority?
A
Established in 2013 as a health partner for over 200 First Nations communities in BC. Works to address service gaps, deliver programs, and champion culturally safe health care practices with health partners. Focuses on health promotion and disease prevention, collaborating with the Ministry of Health and health authorities.
24
Q
L.E.A.R.N.
(Culturally Sensitive Assessment)
A
- Listen
- Explain
- Acknowledge
- Recommend
- Negotiate
25
What are health inequities?
Health inequities:
Unfair, avoidable differences in health
Systemic
Linked to social disadvantage
Reinforce vulnerability
26
CNA Position
1. Health in All Policies approach is best to promote health equity.
2. Nurses must address SDOH in assessments and interventions.
3. All nursing practice should aim to reduce and eliminate health inequities.
4. Nursing education must teach root causes (political, economic, social factors).
27
Biomedical vs. Biopsychosocial Model
Biomedical model
Focuses only on disease and biology
Biopsychosocial model
Includes social, psychological, and environmental factors
28
6 Core Concepts
1. Self-Reflective Practice (It starts with me)
2. Building Knowledge Through Education
3. Anti-Racist Practice (Taking action)
4. Creating Safe Health Care Experiences
5. Person-Led Care (Relational care)
6. Strengths-Based and Trauma-Informed Practice
29
Cultural competence is:
* The ability to provide care that respects clients’ cultural beliefs, values, and practices.
* An ongoing process — not a one-time achievement.
* Based on awareness, knowledge, skills, and reflection.
30
Cultural Competence vs Cultural Safety
Cultural Competence:
Provider-focused
Developing knowledge and skills
Cultural Safety:
Determined by the client
Focuses on power imbalance and systemic issues
31
Gerontological Nursing Standards
1. Relational Care
2. Ethical care
3. Evidence-informed Care
4. Aesthetic/Artistic Care
5. Safe Care
6. Socio-politically Engaged Care
32
Ageism
Term to describe prejudicial attitudes towards:
* Older people, old age, and the ageing process
* Discriminatory practices against older people
* Institutional practices and policies that perpetuate stereotypes about older people (Robert Neil Butler – 1969)
33
Stereotypes
unfair ideas or judgments held widely based on characteristics of others
34
Prejudices
negative opinions without ground or sufficient knowledge
35
Discrimination
seeing a group as different based on prejudices or stereotypes
36
Stigmatize
identify or label in negative terms
37
Types of ageism
Personal: learned, family & media influences, apply to others and self
Institutional: the workplace, healthcare
Intentional: taking advantage of vulnerabilities of older people e.g. scams, elder abuse
Unintentional: implicit bias, jokes, elder speak
38
Dementia-ism
stereotyping based on perceived cognitive impairment & incompetence
39
Most common forms of abuse:
**Emotional Abuse**: using words or actions to control, isolate, intimidate or dehumanize someone; acts that undermine self-worth
**Financial abuse**: acting without consent in a way that benefits the person at the expense of the older person, through threats, intimidation, or deceit
**Physical abuse**: use of physical force that either injures or risks injuring the older adult
**Neglect:** withholding or failing to adequately provide necessities or care for a dependent older adult
40
Decade of Healthy Ageing 2020-2030
Global call to address ageism
Intergenerational connections & education
41
Ways Forward:
* **Awareness**: Acknowledge our attitudes and prejudices about ageing and older people.
* **Behaviours**: Identify and challenge ageist behaviours.
* **Connections**: Engage with people of all ages for intergenerational collaboration. (WHO, 2016)
* **Inclusion**: Involve older adults in research and programme planning on ageing (Kagan, 2020)
42
ASSESSMENT
43
What are nursing interventions for apathy, withdrawal, and loneliness?
Involve in small group or 1:1 activities
Spend time engaging with the person to validate their importance
44
How should nurses respond to memory loss in cognitively impaired patients?
Use patience (expect repeated questions)
Provide cues to trigger memory
45
What is sundowning?
Increased confusion, restlessness, and insecurity later in the day, especially after dark.
46
What are possible causes of sundowning?
Fatigue
Lack of sensory stimulation
Darkness
Fewer people around
47
Nursing interventions for sundowning?
Keep active during the day
Encourage short afternoon nap if fatigued
Allow safe walking
Redirect with quiet music, magazines, stuffed animals
Minimize evening noise and stimulation
48
What is the first step when addressing restlessness, irritability, or responsive behaviours?
Rule out physical causes (pain, hunger, thirst, loneliness).
49
Mental health: most prevalent
anxiety, dementia, depression
50
Dementia
a slow progressive impairment
- irreversible
51
Depression
a mood disorder
– potentially reversible
52
Delirium
an acute disorder
– potentially reversible
53
DSM V replaced “Dementia” with
Major Neurocognitive Disorder
54
(MCI)
Mild Cognitive Impairment
55
Major Neurocognitive Disorder
Evidence of significant cognitive decline in memory or other cognitive ability that interferes with independence in everyday activities (IADLs)
56
Mild Neurocognitive Disorder:
Evidence of modest cognitive decline, but impairment does not interfere with complex activities
57
Aphasia
Impaired ability to communicate through oral or written language:
Difficulty word finding
Vague speech
Difficulty comprehending spoken or written language
Unintelligible speech or muteness
58
Apraxia
impaired ability to execute motor functions despite motor abilities and sensory function e.g. Dressing
59
Agnosia
loss of ability to recognize persons or things
-may not recognize everyday objects or familiar people
-may not associate objects with their purpose i.e. keys
60
Executive Function
planning, organizing, sequencing, abstracting i.e. higher level functions/complex behaviours:
- difficulty with new tasks or situations with new and complex information
- new learning is impossible
61
Most common cognitive impairment?
Alzheimer's Dementia
## Footnote
Brain changes:
-abnormal amyloid “protein plaques”
-neurofibrillary tangles “protein tau”
-low brain weight
Causes cognitive, functional, emotional, and behavioural impairments.
62
2nd most common dementia?
Vascular dementia
## Footnote
Death of nerve cells nourished by the
diseased vessels
Cognitive impairment, behaviour changes,
sensory-motor deficits
Sudden onset and step-wise progression
AD + Vascular dementia = “mixed dementia”
Risk Factors: BP, diabetes, smoking, obesity, cholesterol
63
Lewy Body Dementia
Presence of abnormal protein deposits inside nerve cells – Lewy bodies
Detailed visual hallucinations
Fluctuations in cognitive ability in early stages
Parkinsonian features e.g. shuffling gait, rigidity
64
Fronto-Temporal Dementia:
Neurogenerative conditions ->atrophy of frontal & temporal lobes
Young onset e.g. (30-60 yrs)
Early sx: personality changes, apathy, repetitive clapping, language impairment, disinhibition
65
Early signs of dementia?
Short-term memory loss
Decreased language understanding – requests for repetition
Mood swings – more easily upset
Hallucinations
66
Diagnostic Investigations for dementia
Memory clinic
Medical History
Physical exam
CT/MRI
Psychiatric/psychological evaluations
Lab tests
MMSE
**MOCA (Montreal Cognitive Assessment)
FAST (Functional Assessment Scale)**
67
Delirium
Syndrome characterized by sudden onset of altered behaviour & mental status
Transient state, symptoms can fluctuate
Medical emergency often unrecognized
68
Symptoms of delirium
Difficulty with attention
Disoriented
Sensory disturbances i.e. Hallucinations
Sleep-wake disturbances
Changes in psychomotor activity
Anxiety, fear, irritability, euphoria, apathy
69
Hypoactive vs Hyperactive delirium
a. Hyperactive: agitation, constant motion, non-purposeful or repetitive movements
b. Hypoactive: inactive, withdrawn, decreased motor and verbal responses
c. Mixed: fluctuating
70
Risk factors for delirium
Dementia
Age > 65 yrs
Polypharmacy
History of delirium
Chronic illnesses
Recovery from surgery
71
Common causes for delirium
Drug toxicity
Infection
Pain
Dehydration
Acute illness
Exacerbation of
chronic disease
Substance abuse
Psychosocial problems
72
Depression
At least 2 weeks of depressed mood or loss of interest/pleasure in nearly all activities and additional symptoms:
Change in appetite, weight, sleep, activity
Feelings of worthlessness, guilt
Difficulty thinking, making decisions
Recurrent thoughts of death, suicidal ideation
Impairment in social, occupational functioning
73
Pharmacological Intervention for dementia
1. Cholinesterase inhibitors (e.g. Aricept/donepezil) breaks down acetylcholine to support memory and learning
- approached for people with all stages of dementia but most typically at early stages
2. Glutamate blocker (Memantine/Ebixa) blocks excess glutamate which disrupts brain signalling
-used only for people in mid to advanced stage of dementia when Cholinesterase inhibitors cause too many side effects
3. Lecanemab (Leqembi) – first disease modifying treatment approved by Health Canada in Oct 2025
-treat people with MCI and early stage AD who are non-carriers of ApoE 4 and have confirmed amyloid pathology
-functions by identifying and clearing amyloid protein buildup
-thinking and memory declines were decreased by about 30% in studies
-amount of amyloid protein was decreased
-risk of brain swelling and bleeding
74
Xerostomia
dry mouth
75
Dysphagia
difficulty swallowing
76
Hypodermoclysis
Subcutaneous fluid administration
— Giving fluids into the subcutaneous tissue instead of a vein.
77
78
Types of incontinence
Urge
Stress
Overflow
Functional
Mixed
Total
79
Sleep Patterns in old age
Age-related changes to sleep-wake rhythm:
Decrease time in deep sleep stages
**Increased time in stage 1 – lightest level sleep**
**Decreased time in REM sleep**
More time in bed
More awakenings
Longer to fall asleep
More daytime napping
80
Polymyalgia rheumatic
inflammatory disease
Similar to OA in presentation; increased risk over 50 and women
81
Rheumatoid arthritis
autoimmune disease
Destroys cartilage and bone in joint; often small joints of wrist, knee, ankle and hand
NSAIDs initially; RA specific meds
82
Gout:
inflammatory disease
Accumulation of uric acid crystals in a joint, acute attack
Hot, red, painful joint e.g. great toe
83
Intrinsic factors to falls
Ageing
History of falls
Fear of falling
Gait & Balance problems
Sensory deficits - vision
Chronic conditions: arthritis, stroke, diabetes
Parkinson’s disease
Dementia
84
Extrinsic factors
No handrails on stairs
Poor design of stairs
No grab bars in bathroom
Poor lighting
Tripping hazards
Uneven surfaces
Medications
Improper use of assistive devices
Restraints
85
S. A. F. E.
Safe environment
Assist with mobility
Fall risk reduction
Engage patient and family
86
The “4 Ps”
Pain?
Peri-needs?
Positioning?
Possessions?
NURS 104
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