The term “older adult” is generally defined as an individual age 65 years or older. Three subcategorizes of “older adult” have been identified: 65 to 74, 75 to 84, and 85 plus years. There are currently approximately 35 million older adults in the United States, or about one in every eight Americans. The number of older women outnumbers the number of older men.

Several biological or psychosocial theories are appropriate when studying the older adult. Biological theories of aging are classified as either stochastic or nonstochastic. Stochastic theories hypothesize that aging occurs randomly and persistently with time, through random error, free radicals, cross-links, “clinkers,” and wear and tear. Nonstochastic theories hypothesize that aging is predetermined through programmed cell changes or through changes in the neuroendocrine or immunologic systems.

Psychosocial theories propose that many factors other than genetics contribute to aging. Disengagement theory states that individuals withdraw from society with age and that society withdraws from them. Continuity theory proposes that an individual’s values and personality develop over a lifetime, but goals and individual characteristics remain constant. Activity theory states that an individual’s satisfaction with life depends on involvement in new interests, hobbies, roles, and relationships.

Common stereotypes of older adults are that they are ill, bald, hard of hearing, forgetful, rigid, grumpy, or boring, regardless of their competencies and individual characteristics. This type of stereotyping is known as ageism. The increase in the number of aged has led to concern about quality of life for older adults. Aspects of quality of life include (1) good health; (2) work; (3) travel, recreation, and hobbies; and (4) companionship.

Changes in older adults are developmental, physiological, and psychosocial. Common developmental tasks are (1) gaining insight or wisdom; (2) developing social skills and same-sex relationships; (3) becoming more open-minded and tolerant; (4) continuing participation in sexual behavior; (5) seeing one’s children transform into responsible, successful adults; (6) becoming a grandparent; (7) holding civic and community positions of responsibility; (8) achieving mastery of one’s occupation or skills; (9) developing new skills, hobbies, and interests; (10) renewing and deepening one’s relationship with one’s spouse, significant others, or friends; (11) gaining new knowledge and experiences; (12) accepting and adjusting to physical changes; (13) coping with aging parents, spouses, and friends; (14) adjusting to the death of a spouse; (15) adapting to major declines in health or physical ability; (16) adjusting to the loss of social role, prestige, occupation, income, or sense of usefulness; (17) getting accustomed to the loss of independent living; (18) adjusting to any kind of loneliness or loss without boredom or depression; and (19) accepting a fixed income.

Physiological changes that occur with aging include a decrease in the rate of cell mitosis, a deterioration of specialized nondividing cells, decreased elasticity and increased rigidity of connective tissue, and a decreased functional capacity. The rate of aging is influenced by genetic composition, lifestyle, previous adaptive responses to stressors, the presence of chronic illnesses, and environmental influences.

Physiological changes occur in all body systems. Neurological changes include a loss of visual acuity from presbyopia, cataracts, glaucoma, and age-related macular degeneration; hearing loss (presbycusis) from a general drying and wrinkling of the ear; decreased pain perception; decreases in taste perception and salivation; and a decrease in the sense of smell. Cardiovascular changes include a reduced elasticity of the heart muscle and arteries, resulting in an increase in systolic blood pressure; arteriosclerosis; thickening of the aortic and mitral values, resulting in heart murmurs; and a decreased cardiac output. Respiratory changes include a decreased functional respiratory reserve capacity; a decreased elasticity and tone of respiratory muscles; fewer functioning alveoli and number of cilia; and calcification of the chest wall and rib cage, resulting in decreased ability to expire air.

Gastrointestinal changes include a loss of teeth, a decrease in saliva and other GI tract juices, a decrease in peristalsis, shrinking of the mucosa, decreased absorption of nutrients, and a loss of sphincter control. Genitourinary changes include the loss of muscle tone in the bladder and urethra, resulting in urinary retention and bladder infection; decreased bladder capacity, resulting in nocturia and polyuria; diminished blood flow to the kidneys, resulting in a deceased glomerular filtration rate and functioning nephrons; and retention of fluids, resulting in chronic dehyrdration. Endocrine changes that occur with aging are slowing of metabolism; an alteration in pancreatic activity; and decreased serum growth hormone, estrogen, and testosterone. Reproductive changes include an inhibition in the number of sperm and in the force of ejaculation in males and a decrease in vaginal secretions and a thinning of the vaginal wall in women. During and after menopause, older women are more prone to osteoporosis, sleep disturbances, emotional symptoms, hot flashes, and diaphoresis.

Musculoskeletal changes that occur with aging are osteoporosis and kyphosis. Ligaments, tendons, and joints lose collagen and become more rigid and predisposed to tears. Integumentary changes occurring with age are thinning of the layers of skin, dryness of the skin, and “age spots,” or lentigo senilis, brown pigmented areas on the face, hands, and arms. Photoaging of the skin, caused by chronic ultraviolet radiation, is a common cause of skin cancer in older people. Fingernails become thick and brittle, the number of sweat glands decreases, and the amount of subcutaneous fat decreases.

Alterations in mental status do not occur in all older adults. There are several types of alterations. Acute confusion is a state of diminished awareness and attention of short duration, usually hours to weeks. Acute confusion involves disorientation to time, place, and person, and tends to worsen at night. Dementia is a chronic confusion, lasting months to years. Older adults with dementia exhibit personality changes difficulty with sequential speech and thoughts, and lack of orientation to reality. Alzheimer’s disease is a type of dementia that causes diminished intellectual abilities, confusion, and impaired judgment. Depression is an altered mood that lasts at least six weeks. Depressed individuals are alert and oriented, but experience exaggerated sadness, apathy, and preoccupation with negative thoughts.

The psychosocial changes that occur with aging are retirement, changes in normal roles, changes in living arrangement, and the loss of friends and family members. Changes in roles typically occur along with major life events, such as marriage, divorce, birth, death, relocation, and changes in retirement status. Elder abuse is a great concern when working with older adults. Elder abuse consists of physical abuse, neglect, psychological abuse, and exploitation.

Older adults are at risk for adverse drug reactions for several reasons. The physiological changes of aging lead to altered metabolism and excretion of drugs, resulting in accumulation of some medications Additionally, polypharmacy is more common in older adults, because they accumulate and take multiple medications or because physicians overprescribe or prescribe inappropriate medications. Compliance is another concern when working with older adults. The nurse must assess the client’s knowledge about the intended effects and side effects of a medication, ability to follow complicated dosing schedules and regimens, ability to pay for the medication, ability to open childproof containers, ability to remember when to take medication, ability to read small print, and need for assistance.

The nursing process is similar for older adults as it is for other age groups. Assessment should include assessment of the client’s caregiver and home situation. The history may be comprehensive and time-consuming, but it is an opportunity to show the client respect through careful listening. The physical examination begins with appraisal of the client’s physical condition but should also include the effects any physical changes have had on quality of life and activities of daily living. Nursing diagnoses common in older adults are impaired Physical Mobility, Activity Intolerance, Self-Care Deficit, Social Isolation, Risk for Loneliness, Ineffective Role Performance, Impaired Home Maintenance, and Acute Confusion. Expected outcomes should be realistic and should involve the input from the client and family. Three nursing interventions that are helpful when working with older adults are education, communication, and life review. Additional interventions include interventions to maintain the client’s physical health, support the client’s psychosocial well-being, promote a safe environment, and provide restorative care.