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Chapter: Medical Surgical Nursing: Health Care of the Older Adult

Cognitive Aspects of Aging

Normal Age-Related Changes and Health Promotion Activities



Cognition can be affected by many variables, including sensory impairment, physiologic health, environment, and psychosocial influences. Older adults may experience temporary changes in cognitive function when hospitalized or admitted to skilled nurs-ing facilities, rehabilitation centers, or long-term care facilities. These changes are related to differences in environment or in medical therapy, or to alteration in role performance.



When intelligence test scores from people of all ages are com-pared (cross-sectional testing), test scores for older adults show a progressive decline beginning in midlife. Research has shown, however, that environment and health have a considerable influ-ence on scores and that certain types of intelligence (eg, spatial perceptions and retention of nonintellectual information) de-cline, whereas other types do not (problem-solving ability based on past experiences, verbal comprehension, mathematical abil-ity). Cardiovascular health, a stimulating environment, high lev-els of education, occupational status, and income all appear to have a positive effect on intelligence scores in later life.


Learning and Memory


The ability to learn and acquire new skills and information de-creases in the older adult, particularly after the seventh decade of life. Despite this, many older people continue to learn and par-ticipate in varied educational experiences. Motivation, speed of performance, and physical status all are important influences on learning.


The components of memory, an integral part of learning, include short-term memory (5 to 30 seconds), recent memory (1 hour to several days), and long-term memory (lifetime). Ac-quisition of information, registration (recording), retention (stor-ing), and recall (retrieval) are essential components of the memory process. Sensory losses, distractions, and disinterest interfere with acquiring and recording information. Age-related loss occurs more frequently with short-term and recent memory; in the ab-sence of a pathologic process, this is called benign senescent for-getfulness. A nurse considers the process by which older adults learn when he or she uses the following strategies:

          Supplies mnemonics to enhance recall of related data


          Encourages ongoing learning


          Links new information with familiar information


          Uses visual, auditory, and other sensory cues


          Encourages learners to wear prescribed glasses and hearing aids


          Provides glare-free lighting


          Provides a quiet, nondistracting environment


          Sets short-term goals with input from the learner


          Keeps teaching periods short


          Paces learning tasks according to the endurance of the learner


          Encourages verbal participation by learners


          Reinforces successful learning in a positive manner


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