Urban-dwelling African American older adults are disproportionately victimized by systems, which relegate them to disparities in health, education, and economic security as well as inequitable access to resources that support overall wellness (Brown, 2010; Jackson et al., 2004; Kahn & Pearlin, 2006; Zhang et al., 2016). The COVID-19 pandemic of 2020–2021 revealed poorer outcomes and a “double jeopardy” for African American older adults who suffered poor health outcomes (Chatters et al., 2020). As a result, avenues to promote healthy aging through health and wellness literacy, self-empowerment, and social-community connections are critical (Chatters et al., 2020; Pourrazavi et al., 2020; Waites, 2013). A qualitative study was conducted with African American older adults in Detroit to understand how to promote health literacy and overall wellness for those who are aging in place. An empowerment-oriented wellness framework (Dunn, 1961; Dunn, 1977; Hettler, 1976) was employed. Findings indicated that these African American older adults aging in the urban communities strived to maintain their independence while recognizing that they may need some assistance as they age in place. While some elders defined themselves by their disability and expressed feelings of being pushed aside by family and society, many rejected stereotypes associated with aging and reinforced a sense of pride and empowerment. They called for programs to: 1) assist older adults with health literacy and a comprehensive understanding of overall wellness; and, 2) provide activities and tools to support proactive overall wellness; and 3) employ strategies that actively encourage social engagement as well as outreach to their less engaged peers. Participants also suggested that a strategy to enlighten younger generations about the “senior world,” and aging is also crucial.
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Ageism is the most prevalent form of prejudice, and it affects older adults and younger people similarly (Bratt et al., 2020). Ageism occurs when someone is discriminated against based on their age, and this can happen at both ends of the life span (Raymer et al., 2017). This chapter focuses on topics such as ageism and reverse ageism; age-related mental health concerns; the effects of race, class, ethnicity, gender, and sexual identity related to aging and ageism; and competencies related to working with older clients. Cultural concepts focusing on the liberation counseling framework are discussed, as are aging and counseling ethics. Topics are discussed in the context of the life span as a whole and looking at the client from a humanistic model. Implications for counseling students, educators, and practitioners are provided.
Older adults and their families are highly heterogeneous. This chapter addresses diversity both within and among older adult populations and considers ways to improve service provision through flexibility and awareness. The concepts of cultural competence and cultural humility are introduced, and strategies for increasing one’s level of cultural competence are explored. It is important to note that diversity is not only about race and ethnicity but also includes age, ability, gender, geographic location, religion, sexual orientation, socioeconomic status, and so forth. Similarly, different perspectives and backgrounds are found among professionals working throughout the field of aging. Activities in this chapter promote recognizing that diversity is not the sole domain or concern of marginalized groups, that everyone has a culture and a social lens through which they view the world, and that this lens influences not only their perspective but also the way they interact with those around them.
Older adults are not simply adults who have chronologically aged past 65, but rather individuals who undergo physiologic, psychologic, and sociologic changes along a dynamic continuum. As adults age, their organ systems experience a decline in their ability to respond to stressors (Olde Rikkert, et al, 2017). This decline is highly individualized based on the person’s exposure to multiple risk factors and chronic illnesses (Magnuson, et al., 2019; Olde Rikkert, et al., 2017). In fact, approximately 70% of older adults have either mild or no functional impairments. There are many myths surrounding the older adult and we are learning more and more about the health and resilience of people in this age group as the population increases. Some of the more prominent myths that need to be dispelled by health care professionals include depression and loneliness are part of getting older, older people need less sleep, older people are unable to learn new things, if a person lives long enough, they will develop dementia, there is a point where the risks of exercise outweigh the benefits for the older adult, and changing lifestyle is of little value in the older adult.
This chapter will provide an overview of palliative and end-of-life (
EOL) care for adolescent to older adult populations living with serious chronic illness and individuals with a cancer related diagnosis who may need palliative or EOLcare. The information presented will not provide in-depth discussion regarding treatments for specific disease; for that information, please see other chapters in the textbook.
Person-centered care (
PCC) is focused and organized around the health needs and expectations of people and communities rather than on diseases. PCCinvolves respecting the values, needs, and preferences of people and families and applying the best evidence toward a shared goal of optimal health and quality of life. The PCCapproach is particularly important in the care of older adults who may have multiple chronic diseases. Motivational Interviewing ( MI), as a person-centered counseling style, is one way of translating PCCinto practice. This chapter defines PCCand provides an overview of MI. The Spirit, Principles, and Core Skills of MIare reviewed. The goal is to provide AGNPstudents with communication tools that translate PCCinto practice. While PCCis applicable to all populations, this chapter will focus on older adults. Examples of MIwith older adults are provided.
Ensuring safe and effective medication management in older adults is critical to provide optimal care for this growing population. Older adults are more likely to have multiple chronic illnesses (multimorbidity) and as a result, experience polypharmacy (taking five or more medications). Additionally, with increased age comes changes in medication pharmacokinetic and pharmacodynamic properties that affect how this population responds to medications. These factors combined put this group at a very high risk for adverse drug events (
ADEs) and adverse drug reactions ( ADRs). Employing strategies such as performing a thorough medication review and reconciliation, avoiding potentially inappropriate medications, and deprescribing whenever possible, can help to improve the medication use practices for these patients. This chapter will describe risks associated with medication use in the older adult population, and strategies that can be used to combat these risks, in greater detail.
Adolescents to older adults seen in primary care can present with chief complaints related to neurological disorders (e.g., seizure, headache), so the NP must be prepared to address these issues and know when to refer to neurology. This chapter will focus on the assessment, diagnosis, and management of common neurological disorders that NPs may encounter in the primary care setting. These conditions include stroke, seizure disorders/epilepsy, headaches, movement disorders, a brief overview of normal pressure hydrocephalus and common symptoms such as dizziness and syncope. Dementia is a common neurological condition in older adults, but this will not be discussed in this chapter (see Chapter 10 for information about dementia).
This chapter will introduce the basics of the physical dermatology assessment for the advanced practice nurse, with the focus on the late adolescent through the continuum to the older adult patient. Basic anatomy of the skin will be reviewed, along with an introduction of examination techniques, primary and secondary lesions, and common skin disorders seen in this population.