Lecture 10:

Developmental Theories,
Assessment and Health Promotion:
Elderly
HS1207 / HS5507 / HS5329 -
Health Promotion across the Lifespan
 Learning Outcomes

At the end of the lesson, student will be able to:

• Discuss the importance of maintaining a safe

environment for the elderly.
• Identify the factors that threaten the safety & security of
the elderly.
• List anticipatory guidance on safety & security.
 Phases of Adulthood

Phase Age

Early adulthood 20-40 yrs

Middle adulthood 40-65 yrs

Late adulthood Over 65 yrs

(Ramont & Towle, 2010)

Classification of Old Age
Psychosocial Development
Erikson’s 8 Stages of Psychosocial Development
 Integrity vs. Despair
• Begins as the aging adult begins to tackle the problem of
his / her morality
• Often triggered by life events
– Eg. Retirement, loss of spouse, friends and acquaintances,
changes to major roles in life
• Reflect back on their life

• Ego / Integrity
– Proud with sense of fulfilment and satisfaction
• Despair
– Feel life is wasted and experience many regrets
 Normal Physical Changes
in the Elderly
• Cardiovascular system
– Stiffening of blood vessels and arteries
– Causes heart to work harder to pump blood in the body
– Heart muscles change to adjust to the increase workload
– Increase risk of hypertension and other heart problems

• Musculoskeletal system
– Bones shrink in size and density, making elderly susceptible to
fracture
– Muscles lose strength, endurance and flexibility
– Affects coordination, stability & balance
(Mayoclinic, 2010)
 Normal Physical Changes
in the Elderly

• Gastrointestinal system
– Structural changes in large intestines, medical conditions and
medications can result in constipation
• Medical conditions: Diabetes
• Medications: Diuretics and iron supplements
– Other contributing factors: Lack of exercise, not drinking enough
water and low-fiber diet

(Mayoclinic, 2010)
 Normal Physical Changes
in the Elderly
• Genitourinary system
– Bladder becomes less elastic, resulting in need to urinate more
often
– Weakened bladder and pelvic floor muscles make it difficult to
empty bladder or cause incontinence
– Enlarged or inflamed prostate in men can cause difficult
emptying and incontinence

• Nervous system
– Brain undergo changes that may have minor effects on memory
and thinking skills
– Overall reduction in processing speed
(Mayoclinic, 2010)
– Slowed down by presence of irrelevant information
 Normal Physical Changes
in the Elderly
• Sensory system
– Impaired vision – difficulty focusing on objects that are close up
– More sensitive to glare and have trouble adapting to different
levels of light
– Common eye conditions in elderly:
• Cataract, retinopathy, presbyopia
– Altered sense of taste and smell

• Oral health
– Gums pull back from teeth
– Medications can cause dry mouth making the elder more
vulnerable to decay and infection (Mayoclinic, 2010)
 Normal Physical Changes
in the Elderly
• Weight
– Metabolism slows down with age
– Can gain wait if same amount of food intake daily with less
exercise

• Skin
– Becomes thinner, less elastic and more fragile
– Decrease in fatty tissue below skin
– Dry skin due to decreased production in natural oils
– Other skin changes – wrinkles, age spots and skin tags

(Mayoclinic, 2010)
 Age Spots

• Flat, grey, brown or black

spots
• Very common in those older
than age 40
• Ranges in size and usually
appear on areas most exposed
to the sun
– E.g. face, hands and arms.
• May darken with sun exposure
• True age spots is not
cancerous and don't need
treatment
 Seborrheic Keratoses

• Tan, brown or black growths

have a wart-like or waxy
appearance

• Range in size from very small

to more than 1 inch (3
centimetres) across

• Cause unknown

• Is not cancerous, but can

resemble skin cancer
Cherry Angiomas

• Small, harmless cherry-red

bumps
• Common during and after
middle age
• Created by dilated blood
vessels
• Cause unknown
 Skin Tags

• Small, soft, skin-coloured

growths that protrude from skin
• Harmless
• Seen on neck, armpit or groin
• Cause unknown
Skin
tag
Safety & Security of the Elderly
Anticipatory Guidance for Elderly
 Aims of Anticipatory Guidance
in the Elderly

• Ensures quality of life

• Enhances general well being & competency

• Promotes independence

• Prevents untoward incidences

– E.g., Falls
 Health Education

• Annual health check

• Seek medical attention to treat cause of health problems

• Care giver support and training to prevent burnt out

– E.g. maid, children
 Environmental Factors
• Safe housing environment
- Use grab bars, non-slip tiles, large print for instructions on
medications
- Adequate lighting, handrails
- Uncluttered floor
• Lift landing floor and lifts in good working order
- Reduce dependence on care
• Avoid relocation
- Elderly do not adapt to changes easily and needs time to adjust
• Respect the elderly’s needs
• Refer to community resources
– e.g. Home modification service
Criminal Victimization
 Anticipatory Guidance
for Crime Victimization

• Avoid wearing flashy jewelry in public places

• Keep doors locked
• Use peephole
– Never let strangers in or let them know if elderly is alone at
home
• Beware of phone tricks
• Consider a pet
• Keep money in the bank
The Straits Times - November 21, 2001
Elder Abuse
Elder Abuse

25
 Anticipatory guidance
* Routine dental care
* Balanced diet and proper way of
cooking
* Motivate eating by creating a
pleasant eating environment
* Encourage eating in small friendly
groups
* Support services:
- meals on wheels
 References
Health Promotion Board Singapore. (2021, August 16). Useful information for
http://www.hpb.gov.sg

Meiner, S. E. (2011). Gerontologic Nursing (4th ed). Elsevier Mosby.

Miller, C. A. (2012). Nursing for wellness in older adults (6th ed). Wolters Kluwer|
Lippincott Williams & Wilkins.