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Cognitive Development: Jean Piaget

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-Jean Piaget developed a cognitive theory that children developed in stages as they aged. -The two key components of this theory are Assimilation and Accommodation. -This is how thought develops into a more complex though process.

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Assimilation

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is the process that an individual takes information from their environment and processes it into pre-existing schemata

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Accomadation

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is when the information does not fit the preconceived idea and a new or expanded schema is developed

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Schemata

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are the mental plans that process information with preconceived ideas into categories

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Piaget's four stages of cognitive development are:

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-Sensorimotor Stage (birth to 2-years-old) -Preoperational Stage (2 to 7-years-old) -Concrete Operational Stage (7 to 11-years-old) -Formal Operational Stage (11-years and older)

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Sensorimotor Stage (birth to 2-years-old)

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-Basic reflexes -Begins to intentionally repeat an action -Initially movements are primarily reflexive -Perceptions center around own body -Objects are perceived as extensions of self -Differentiates goals and goal directed activities -Experiments with methods to reach goals -Rituals that become significant

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Preoperational Stage (2 to 7-years-old)

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-Language development -Role playing becomes important -Thinking is egocentric -Uses symbolism -Able to classify objects to one trait -Learns to reason about events in the here and now -Able to see relationships and to reason in the abstract

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Concrete Operational Stage (7 to 11-years-old)

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-Develop logical thinking -Difficulty understanding abstract concepts

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Formal Operational Stage (11-years and older)

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-Ability to think abstract concepts -Deductive reasoning and systematic planning emerge

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Faith Development: James Fowler (1940)

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-James Fowler developed his theory of faith development based on the works of Jean Piaget and Lawrence Kohlberg. -His theory is comprised of a pre stage and six stages, which can occur at any age but the order remains the same.

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James Fowlers Prestage

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Undifferentiated Faith: -Trust, hope, and love compete with threats of abandonment and environmental inconsistencies

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James Fowlers Stage 1

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Intuitive-Projective Faith (preschool): -Fantasy and reality get mixed up -Imitates parental behavior about religion and spirituality -No real understanding of spiritual concepts

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James Fowlers Stage 2

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Mythical-Literal Faith (school aged, 3 to 7): -Understand and accept the stories told to them in a literal way -Accepts the existence of a deity -Stories symbolize moral and religious beliefs -Appreciates other's point of view -Accepts concept of reciprocal fairness

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James Fowlers Stage 3

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Synthetic-Conventional Faith (adolescence/teenagers): -Adopts an all-encompassing belief system

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James Fowlers Stage 4

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Individuative-Reflective Faith (older adolescence/young adult): -Begin to critically examine their own beliefs

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James Fowlers Stage 5

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Conjunctive Faith: -Begin to see life as a mystery

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James Fowlers Stage 6

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Universalizing Faith: -Live their lives in full service of others.

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Moral Development: Lawrence Kohlberg (1927-1987)

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Kohlberg's Moral Development is adapted from the works of Jean Piaget. Each level of this theory represents an individual's ability to more adequately respond to moral situations or dilemmas. These three levels are also divided into 2 stages each.

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Kohlbergs Preconventional Level

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-misbehavior is viewed in terms of \"damage done\" Stage 1: Punishment or Obedience Orientation - Rules are fixed and absolute - Obeying rules is important to avoid punishment -A deed is wrong if punished, right if it is not Stage 2: Instrumental Relativist (Self-Interest) Orientation -Actions are based on how they serve their own interests -Right is defined as that which is acceptable and approved by self -When actions satisfy one's needs, they are right

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Kolbergs Stage 1: Punishment or Obedience Orientation

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- Rules are fixed and absolute - Obeying rules is important to avoid punishment -A deed is wrong if punished, right if it is not

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Kolbergs Stage 2: Instrumental Relativist (Self-Interest) Orientation

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-Actions are based on how they serve their own interests -Right is defined as that which is acceptable and approved by self -When actions satisfy one's needs, they are right

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Kohlbergs Conventional Level

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Stage 3: Social Conformity Orientation - Focused on living up to social expectations and roles - Conformity and being \"nice\" are emphasized Stage 4: Law and Order Orientation -Able to consider society as a whole -Following rules and doing one's \"duty\" is the focus

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Kolbergs Stage 3: Social Conformity Orientation

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- Focused on living up to social expectations and roles - Conformity and being \"nice\" are emphasized

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Kolbergs Stage 4: Law and Order Orientation

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-Able to consider society as a whole -Following rules and doing one's \"duty\" is the focus

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Kohlbergs Postconventional Level

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Stage 5: Social Contract Orientation - Begin to account for differing values -Laws important, but society as a whole should agree Stage 6: Universal Ethics Orientation -Follow internalized principles even if they conflict with society laws and rules

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Kolbergs Stage 5: Social Contract Orientation

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- Begin to account for differing values -Laws important, but society as a whole should agree

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Kolbergs Stage 6: Universal Ethics Orientation

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-Follow internalized principles even if they conflict with society laws and rules

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Carol Gilligan (1936)

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Gilligan asserts that women develop personally and morally different from men. She theorizes that women developed focusing on the connections and needs of others. Gilligan combined the sense of self or ego development from Freud with the moral development of Kohlberg and Piaget. Gilligan's three levels end with a transition period as they move from one level to the next.

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Carol Gilligan (1936) Levels of Development

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Level 1 - Selfishness -Only cares for themselves in order to survive Level 2 - Goodness -More care for other people, such as role of mother and wife Level 3 - Nonviolence - Acceptance of the principle of care for self and others

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Gilligan Level 1 Selfishness

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• Dependent on others • Concentrates on what is best for self • Recognizes connections to others • Makes responsible choices in terms of self and others

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Psychoanalytic Development Sigmund Freud (1856-1939)

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Sigmund Freud's developmental theory states that one's personality is established by the age of five. He theorizes that sexuality or pleasure seeking drives human behavior.

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Sigmund Freud Four Components

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-The unconscious mind -The Id -The Ego -The Superego

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Freuds Development Stages

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-Oral Stage (birth to 18-months-old) -Anal Stage (18-months to 3-years-old) - Phallic Stage (3 to 6-years-old) - Latency Stage (6 to 12-years-old) -Genital Stage (13 to 20-years-old)

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Oral Stage (birth to 18-months-old)

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-Primary source of interaction is with the mouth -Trust and comfort with others is developed through feeding -Center of pleasure is the mouth -Primary need: security -Major conflict: weaning

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Anal Stage (18-months to 3-years-old)

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-Primary focus is on controlling bladder and bowel movements -Developing control leads to a sense of accomplishment and independence. -Center of pleasure is the anus and bladder -Sensual satisfaction and self-control -Major conflict: toilet training

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Phallic Stage (3 to 6-years-old)

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-Primary focus is on the genitals -Begin to discover differences between males and females -Center of pleasure: child's genital (masturbation) -Major conflict: Oedipus and Electra complex

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Latency Stage (6 to 12-years-old)

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-Libido interests are suppressed -Intellectual and social interaction are important

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Genital Stage (13 to 20-years-old)

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-Strong sexual interest in the opposite sex is developed -Interest in the welfare of others grows

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Psychosocial Development Erik Erikson (1902-1994)

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Erikson's developmental theory expanded Freud's work by including cultural and social influences.

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Erik Erikson's Stages

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-Trust vs. Mistrust (birth to about 18 months) -Autonomy vs. Shame and Doubt (about 18-months to 3 years-old) -Initiative vs. Guilt (3 to 5-years-old) -Industry vs. Inferiority (6 to 11-years-old) -Identity vs. Confusion (adolescence) -Intimacy vs. Isolation (young adulthood) -Generativity vs. Stagnation (adulthood) -Ego Integrity vs. Despair (late adulthood)

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Trust versus Mistrust (birth to 1 year old)

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o Positive resolution: Learn to trust others o Negative resolution: mistrust, withdrawal, estrangement

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Autonomy versus Shame and Doubt (1 to 3 years old)

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o Positive resolution: Self-control w/o loss of self-esteem and the ability of cooperate and express oneself o Negative resolution: compulsive, self-restraint or compliance, willfulness and defiance

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Initiative versus Guilt (4 to 6 years old)

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o Positive resolution: learns to become assertive and has the ability to evaluate one's own behavior o Negative resolution: Pessimism, fear of wrongdoing, over-control, and over-restriction.

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Robert Havighurst (1900-1991)

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Educational research was Robert Havighurst's background where he learned that developmental tasks occur at certain ages. He identified six major stages in life.

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Havighurst Developmental Tasks

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-Infancy and early childhood (0 to 6-years-old) -Middle childhood (6 to 13-years-old) -Adolescence (13 to 18-years-old) -Young adulthood (19 to 30-years-old) -Middle adulthood (30 to 60-years-old) -Later maturity (60-years-old or over)

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Havighurst Developmental Tasks: Infancy and early childhood (0 to 6-years-old)

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o Eat solid foods, walk, talk, control elimination of wastes, relate emotionally to others, distinguish right from wrong, develops a conscience o Learns sex differences and sexual modesty o Achieve personal independence and form simple concepts of social and physical reality

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Havighurst Developmental Tasks: Middle childhood (6 to 13-years-old)

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Physical skills for ordinary games, get along with same age children, develop wholesome self-attitudes, learn appropriate gender social roles, and develop conscience, morality, and values

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Havighurst Developmental Tasks: Adolescence (13 to 18-years-old)

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More mature relationships with both genders, emotional independence from adults including parents, achieve their own gender social role, prepare for marriage, social responsible behavior desired and achieved

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Havighurst Developmental Tasks: Young adulthood (19 to 30-years-old)

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Select a mate, live with a partner, begin a family, raise children, begin occupation, civic responsibility, become part of a social group

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Havighurst Developmental Tasks: Middle adulthood (30 to 60-years-old)

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Achieve civic and social responsibility, adult leisure activities, assist children to become well-adjusted adults, satisfaction in occupational career, adjust to aging of themselves and their parents

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Havighurst Developmental Tasks: Later maturity (60-years-old or over)

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Adjust to retirement and reduced income, death of a spouse, and decreasing strength and health.

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Factors Influencing Growth and Development

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-Genetics -Gender -Age -Individual Preferences and Patterns -Physical Condition -Cultural and Spiritual/Religious Beliefs -Socioeconomic Factors -Environmental Factors -Psychological Factors -Nutrition -National Health Initiatives

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Genetic Factors

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Physical characteristics are inherited. Genes can influence development of diseases such as diabetes and cancer. As genetic research evolves there may be more information known linking genetics to disease

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Gender Factors

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Males and females develop at different paces once puberty begins. Girls begin puberty 9 to 13 years of age, whereas boys begin puberty at 9 to 14 years old. Social groups, cultural, and spiritual mores play a large part in the social development of all individuals.

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Age Factors

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Several developmental tasks that must be attained across the life span and depend on other tasks being accomplished first (such as the need to crawl before walking and being able to walk before running).

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Individual Preferences and Patterns Factors

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As individuals progress through their own growth and development stages, individual preferences begin to emerge.

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Physical Condition Factors

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The ability to perform developmental tasks associated with normal growth depend on the individual having the physical ability to carry them out. Cognitive impairments may impair or block milestones across the life span. This includes the use of language, motor skills as well as other important physiologic development tasks.

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Cultural and Spiritual/Religious Beliefs Factors

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As individuals progress through their lives, cultural and spiritual beliefs systems can play a major role in their personality development. Each stage presents an individual with differing experiences that will shape their cultural and spiritual beliefs. Some life experiences may cause a temporary or even permanent suspension of these beliefs.

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Socioeconomic Factors

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Poverty can impair growth and development across the life span. Limited access to proper nutrition, education, health care and other necessary resources result from living in poverty.

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Environmental Factors

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Environmental factors such as living in crowded or substandard housing and violent neighborhoods place individuals at a great disadvantage when it comes to growth and development.

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Psychological Factors

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Psychological factors and ineffective coping mechanisms can lead to substance abuse and/or alcoholism which in turn can contribute to other negative impacts including child, spouse, and elder abuse. Alcohol and drug abuse during pregnancy may result in congenital anomalies. These factors may influence the ability of an individual to provide and address personal care needs adequately.

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Nutrition

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Proper nutrition is vital during pregnancy as well as throughout the entire life span. Folic acid deficiency is linked to neural tube defects. Federal, state, local, and community initiatives attempt to address adequate nutrition for pregnant women, children, and the population at large. The demand for these services often outweighs the available funding for these organizations.

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National Health Initiatives

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National health initiatives, such as \"Healthy People 2020\", by the U S Department of Health and Human Services, outline objectives for improving the health of all Americans for the next 10 years. It addresses 31 specific focus areas or topics such as access to health services, adolescent health, dementia, diabetes, early and middle childhood to name a few. It is updated every decade.

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Patterns of Health Problems: Infant

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-An infant spans the age of 1 month through 1 year. -Fetal alcohol spectrum disorder (F A S D), low birth rate (L B W), neural tube defects (N T Ds), failure to thrive (F T T) and sudden infant death syndrome (S I D S) are all issues that can affect newborns. -Access to prenatal care and newborn care helps detect and prevent health issues that may have lifelong consequences. -Another major concern is child abuse, child neglect, or mistreatment.

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Infants designated as failure to thrive may fall into one of three categories:

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• organic failure to thrive which results from a physical cause such as congenital heart defects, • nonorganic failure to thrive is related to psychological factors such as lack of nurturing, • idiopathic which is unexplained by the usual organic and environmental etiologies.

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Patterns of Health Problems Toddler

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- Injuries are the leading cause of death in toddlers (1 to 3 years of age). -Children are curious and like to explore with unrestricted freedom. -Young children have limited coordination and are unable to protect themselves. -Motor vehicle crashes contribute to a large number of accidental deaths in the toddler age group. Many of these injuries are the result of improper use of lack of car seats. -Without adequate access to healthy food choices inadequate nutrition can result. -Additionally, since they are now beginning to make their own choices, other influences than their parents/care givers can affect the choice of foods.

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Patterns of Health Problems Preschooler

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-A preschooler is defined as a child between ages 3 to 6. -Adherence to recommended immunization schedules protects children from potentially life-threatening diseases. -Injuries may increase because of activities such as riding bicycles or running after balls. It is important for parents to \"practice what they preach\". -Accidents and injuries are the leading cause of death for preschoolers. -Lead poisoning is another concern for this age group and is primarily associated with social economic status. -Dental caries are related to poor diet choices and inadequate dental hygiene.

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Role of the Nurse in Promoting Health and Preventing Illness: Infant

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Safety, nutrition, hygiene, elimination, growth and development, and health needs change as an individual grows. The R N emphasizes these key points when teaching care givers. These are critical to the safety, health, and development of all children Growth and development: Each child will progress differently through the milestones. Refer to the Denver Development Screening Test (D S S T), a widely used tool to assess the developmental progress of children from birth through the age of 6. Infants need constant care and affection and the opportunity to explore things and interact with others.

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Infant Safety

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There are several areas that need to be addressed: • In the house, risks to the infant's safety include stairs and electrical outlets; infants are also at risk while on an elevated surface, such as chair, bed (other than crib), table. • Caregivers need to be taught to put baby \"back\" to bed by laying them on their backs. • Small objects, such as food and toys, can be choking hazards. Suffocation with toys and pillows in the crib is also a threat. • Other dangers include burns caused by the sun, hot water, or microwaved food. • Caregivers need to be taught how to properly use infant car seats.

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Infant Nutrition

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Breastfeeding, especially for first time mothers, can be a highly stressful and emotional. Providing education and support are equally important. Mothers should be taught: • how to breastfeed • when to introduce solid food • not to add sugar, salt, or honey • how to wean

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Infant Hygiene

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There are specific hygienic needs that need to be reviewed with parents in order for them to provide the appropriate care. These include: • Umbilical cord care for newborns • Bathing • Diaper changing

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Infant Elimination

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Parents need to recognize abnormal stool patterns and when to contact the pediatrician if the need arises.

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Infant Growth and Development

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Health needs involves scheduling well-baby checkups with a pediatrician monitors a child's health needs. Some issues include: • Schedule immunizations and keep a record (see previous chart) • Provide fluoride supplements if not in water • Arrange for lead screening, if appropriate • Promote no smoking in house or car with baby • Contact primary healthcare provider for any signs of infection, especially respiratory • Ensure well-child checks are scheduled

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Role of the Nurse in Promoting Health and Preventing Illness: Toddler

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Teaching caregivers remains important as an infant grows to become a toddler. Safety, nutrition, and other key developmental tasks and safety issues need to be identified and monitored

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Toddler Safety

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As the child begins to walk, new safety issues become a concern. Suggestions to improve home safety: • Safety locks are installed on doors, cabinets, and outlets, to keep toxic and other harmful materials away • Continued use of the car seat; it must be properly modified to fit as the child grows. • Gates are used to prevent stair climbing • Small items, such as toys, balloons, and hard candy, are kept away to prevent choking since children this age put everything into their mouths! • Ensure that plastic bags or mini-blind cords are not accessible to prevent suffocation, Help the toddler understand simple safety terms such as good, bad, hot, cold

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Toddler Nutrition

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Continues to be an important part of the physical and mental growth and development of a toddler. Some considerations: • Finger foods are best, messiness is normal • Nutritious foods are essential • It is normal for a toddler to not eat for short periods • Allergies for foods may begin to be detected

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Toddler Hygiene

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The toddler may begin to develop self care habits and needs to understand that proper hand washing is important. Additionally, deciduous or baby teeth are forming; routine dental care and regular checkups are important.

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Toddler Elimination

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Readiness for toilet training must be present in order for the toddler to learn. Nocturnal enuresis may continue.

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Toddler Growth & Development

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A toddler begins to be independent in daily endeavors (eating, toileting, and dressing). \"No\" is a normal response and sharing is not yet developed.

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Toddler Health Needs

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It is important to continue immunization and well-child checkups. Lead screening should be done, if appropriate. Since toddlers can develop respiratory illness easily, is it important not to smoke around the child.

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Role of the Nurse in Promoting Health and Preventing Illness: Preschooler

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Teaching caregivers continues to be important as the toddler grows older. Safety, nutrition, hygiene, and other key developmental tasks need to be identified and monitored.

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Preschooler Safety

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Continue to keep safety locks on doors, cabinets, and outlets, Teach children to be cautious of strangers. Keep them away from small items such as toys, balloons, and hard candy. Educate them also about car, traffic, and bicycle safety.

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Preschooler Nutrition

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Provide nutritional snacks and allow children to eat by their own pattern

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Preschooler Hygiene

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Specific hygienic needs at this stage include: • Hand washing • Bathing • Dental care: Tooth brushing and flossing

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Preschooler Elimination

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Some lingering nocturnal enuresis may continue

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Preschooler Growth & Development

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It is important for caregivers to understand: • Play is central • Speech development is crucial • Bad dreams or nightmares are normal • Masturbation is normal but the child needs to learn that it is unacceptable in public

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Preschooler Health Needs

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In addition to continuing well-child checkups, immunization, and lead screening, a preschooler will also need vision testing and dental checkups.

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Patterns of Health Problems School-aged

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Communicable diseases are prevalent in school-aged children (6 to 12 years) as they are exposed to other children in the school setting. The rate of obesity has risen drastically in this age group over the past 20 to 30 years. This has led to increases in hospitalization and chronic illnesses later in life.

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Patterns of Health Problems Adolescent and Young Adult

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Health problems that may occur in Adolescent and young adults (13 to 39 years old) are accidents, suicide, substance abuse, S T Ds, violence, and abuse. Suspicion of anything that may indicate that a suicide, violence, or abuse is occurring or imminent should be reported immediately. Education regarding accident prevention, S T D prevention, and substance abuse prevention should be targeted to this vulnerable group.

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Role of the Nurse in Promoting Health and Preventing Illness School Age

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Since accidents are the leading cause of death for school aged children, individual and family teaching about safety measures to take to reduce accidents is the primary focus. Two other points to consider are peer pressure and exposure to contagious diseases. Open communication along with education is helpful when caring for children of this age group.

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School Age Safety

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Some of the areas where accidents can occur are: • Poisonings • Car safety • Bicycle safety • Internet safety • Gun safety • Water safety • Fire safety - teach \"stop, drop and roll;\"

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School Age Nutrition

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School aged children require sufficient calories for activity and for physical growth. Additionally: • Ensure sufficient Calcium and Vitamin D, which is needed for bone growth. • Provide healthy choices • Limit \"fast foods\" • Do not insist on a \"clean plate\", eating should stop when hunger is satisfied; meals should be viewed as pleasant • Ensure a healthy breakfast is consumed.

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School Age Hygiene

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Spread of microbes and disease is prevalent in this age group • Teach good handwashing technique • Do not share things that come in contact with someone's skin, like hats and combs, to reduce lice infections • Teach girls to wipe from front to back after urinating to reduce urinary infections.

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School Sexual Development

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Physical sexual maturity begins and children will be interested in and explore their own and others genitalia. • Give accurate information and answer questions honestly • Include discussions concerning sexually transmitted diseases, pregnancy, and forms of protection. • Monitor computer and T V use for inappropriate sexual material.

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School Age Growth & Development

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As school aged children age, they will tend to move away from same sex/age friends to expand their circle of friends and acquaintances. • Limits and consequences for behavior are important. • Applying rigid rules with peers during games is common • Ensure positive reinforcement to ensure children know they are valued and loved.

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School Age Health Needs

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Immunizations and how to deal with peer pressure are the priority health needs for the school aged child. • Maintain immunization schedule, including boosters • Physical activity is very important • Teach how to handle peer pressure, such as just \"say no.\" • Continue the well child checkups including vision exams

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Role of the Nurse in Promoting Health and Preventing Illness: Adolescent and Young Adult

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Appropriate family relationships are very important in this age group as are independence and self-sufficiency. This may be in conflict with appropriate and safe decision making.

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Adolescent and Young Adult Safety

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Motor vehicle accidents, homicide and suicide account for most of the deaths in these groups. • Driver education classes are recommended, including education on drinking/drugs/distracted driving and accidents/death • Address changes in behavior and/or sudden change in friends or drop in grades • Other safety courses such as gun safety, water safety, sports safety are recommended

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Adolescent and Young Adult Nutrition

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Increased nutritional needs continue as physical growth also continues through adolescence. Eating disorders may also develop. • Ensure proper foods are offered and provide education and encouragement related to proper nutrition. • Provide counseling for extreme under and overweight individuals • Limit fast food intake • In addition to proper nutrition, appropriate amount of sleep and exercise is also important and should be emphasize and encouraged for this age group.

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Adolescent and Young Adult Sexual Development

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Full development of secondary sex characteristics occurs during adolescence. Sexual activity may lead to pregnancy and/or sexually transmitted diseases. • Ensure there is open, honest discussion of appropriate sexual behavior and consequences

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Adolescent and Young Adult Growth & Development

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Peer group influence and acceptance are vital in this age group. As the adolescent ages into young adulthood, full time employment, and living away from the family home occurs. • Open communication is important as risk-taking behavior is common • Encourage independence and provide support and guidance with future plans and goal setting.

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Adolescent and Young Adult Health Needs

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Continue with immunizations; providing education about safe sex and how to deal with peer pressure. • Physicals and routine eye exams should continue as recommended. • Breast self exam (B S E) and testicular self exam (T S E) are introduced and encouraged. • Knowing the importance of proper sexual health, such as having an annual Pap test and pelvic exam, along with knowing the issues related to S T D's.

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Patterns of Health Problems Middle Adult

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-The primary health issues for middle adults are accidents, cancer, cardiovascular disease, obesity, alcoholism, and mental health problems. -As individuals age, energy requirements decrease. However, caloric intake and eating habits generally continue at the same level as when they were younger. This leads to increased body weight which in turn puts them at risk for high blood pressure, coronary artery disease and diabetes. Increased risk for cancer, liver disease, kidney disease, and chronic respiratory disease is associated with smoking and alcohol consumption

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Patterns of Health Problems Older Adult

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-Accidents continue to be a health concern for the older adult. Additionally, chronic disabling illness, drug use/abuse, alcoholism, dementia, and elder abuse are issues this group may face. -Accidents may occur due to changes in vision, hearing, and strength. A reduction in reflexes and other sensory abilities play a part. Falls are the most common form of injury in the older adult. Falls may lead to fractures that result in long term disability or even death. -Chronic illnesses such as heart disease, hypertension, arthritis, diabetes, and cancer incidence increases with age. Acute illnesses and accidents may lead to chronic health problems in the older adult.

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Role of the Nurse in Promoting Health and Preventing Illness: Middle Adult Middle Adult (40 - 65)

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-There is a gradual decline in physiologic functioning, both internal and external, which is a normal change related to the aging process. - Some physical changes include redistribution of fatty tissue, drying of the skin, graying of hair, and the appearance of wrinkles. -Cardiac output and muscle mass are diminished resulting in an increase in fatigue. -Hearing ability, sight, and hormone production also decrease.

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Middle Adult Middle Adult (40 - 65) Social Concerns

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Changes in employment may occur and concerns about retirement become more focused. Relationships with spouse, children, and parents may change.

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Middle Adult Middle Adult (40 - 65) Health Concerns

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-Acute and chronic illnesses are more common with longer recovery times. -Chronic illness is a major stressor on an individual's self-esteem and concept. -Preventive health measures are beneficial. -Aging is not synonomous with a chronic illness diagnosis.

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Role of the Nurse in Promoting Health and Preventing Illness: Older Adult (65+)

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Adapting to an ever changing world is a key skill that an older adult must possess. Ageism is a form of prejudice that manifests itself in the belief that older people are different and do not experience the same emotions the rest of the population does.

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Older Adult (65+) Health Concerns

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-Hypertension, strokes, and other heart disease are the most common physiologic health problem. -Functional ability relates to the ability to manage self- care independently. -Accidents are an issue that must be addressed for the older adult. Physiologic changes put them at higher risk for accidental injuries. Fall is the most common injury. -Finally, mental impairments such as dementia, depression, and delirium can be devastating to the patient as well as the family. Sundowning is a syndrome where the older adult becomes more confused as night falls. Ensuring adequate lighting helps to address this concern.

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Older Adult (65+) Social concerns

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-Cognitive ability does not change with aging. It is normal however for an older adult to take more time to become familiar with new information or surroundings. -There may be a mild loss of short-term memory, but aids such as taking notes and using a calendar can overcome that issue. -Adjusting to changes such as decreased physical strength, health, retirement and reduced income, the ill- health of a spouse, and changes in socialization and social roles is crucial for the older adult. -Independence is the goal for the older adult and living arrangements should reflect this whenever possible. There may be role reversal when adult children must be the caretaker for the parent. Adapting to these changes may present a challenge but can be accomplished.

Excelsior College Foundations in Nursing Practice Module 1

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