6.1 Aging Changes, Basic Human Needs, and Adjusting to Nursing Home Life
Key Takeaways
A bladder that holds less urine, thinner skin, slower reactions, and poorer near vision are normal aging changes, but confusion, dementia, depression, incontinence, and contractures are not.
Older adults may run a low or no fever even with a serious infection, so new confusion or loss of appetite must be reported.
Maslow's hierarchy runs from physiological needs through safety, love and belonging, and self-esteem to self-actualization, and lower-level needs are met first.
A newly admitted resident should be expected to feel a sense of loss; the aide restores control and familiarity by offering choices, protecting privacy, and encouraging personal belongings.
Families are a key source of emotional support, and residents keep the right to private visits and intimacy with a spouse or partner.
6.1 Aging Changes, Basic Human Needs, and Adjusting to Nursing Home Life
Prometric's Alabama outline lists age-related changes (cognitive, psychosocial, and physical) and the psychosocial needs of residents, including fundamental human needs such as Maslow's hierarchy, emotional support strategies, and ways to help residents cope with losses and adjust to nursing home placement. Credentia's NNAAP outline covers the same ground under Emotional and Mental Health Needs. The federal training curriculum also requires teaching the developmental tasks of aging and using the resident's family as a source of emotional support. The key skill is telling normal aging apart from signs of illness that you must report.
Normal Physical Changes of Aging
| Body system | Normal age-related changes | What it means for care |
|---|---|---|
| Skin | Thinner, drier, less fat underneath, slower healing, bruises easily | Pat dry, moisturize, lift instead of sliding, check water temperature carefully |
| Muscles and bones | Loss of muscle mass and bone density, stiffer joints, slower movement | Encourage activity and range of motion; prevent falls |
| Heart and blood vessels | Heart pumps less efficiently; blood pressure may drop when standing up | Have the resident sit on the edge of the bed before standing; watch for dizziness |
| Lungs | Less elastic lungs, weaker cough | Encourage deep breathing and position upright; report coughing or shortness of breath |
| Digestive system | Less saliva, fewer taste buds, slower movement of the bowel | Offer fluids and fiber; season food as the diet allows; watch for constipation |
| Urinary system | The bladder holds less urine, so residents urinate more often, including at night | Offer toileting regularly; keep the path to the bathroom lit |
| Senses and nerves | Poorer near vision, hearing loss for high-pitched sounds, slower reaction time, less sensitivity to heat, pain, and thirst | Face the resident when speaking, offer fluids often, guard against burns |
| Immune system | More infections; fever may be low or absent even with serious infection | Report subtle changes such as new confusion or loss of appetite |
Not normal aging: confusion, dementia, depression, incontinence, contractures, constant pain, and sudden changes in behavior or function. Each is a condition to report and treat, not something to accept as "just getting old." Prometric's own sample test asks which change is normal; the answer is a bladder that holds less urine, not dementia or contractures.
Cognitive and Psychosocial Changes
Normal aging slows recall and learning a little, but judgment, vocabulary, and long-term memory stay intact. Psychosocial changes are often larger than the physical ones. Older adults may face retirement and a smaller income, the deaths of a spouse and friends, the loss of a home and driving, and changing roles in the family. The psychologist Erik Erikson described the developmental task of late life as integrity versus despair: looking back on life and finding meaning. Listening to a resident's life story, asking about past work and family, and honoring their experience support that task.
Basic Human Needs: Maslow's Hierarchy
Abraham Maslow described human needs as levels. Lower-level needs must be met first, which is why an emergency involving breathing or safety always comes before a social activity.
| Level (lowest to highest) | Examples in a nursing home | How the aide meets the need |
|---|---|---|
| 1. Physiological | Air, water, food, elimination, rest, comfort | Offer fluids, help with meals and toileting, reposition, relieve discomfort |
| 2. Safety and security | Freedom from harm and fear; a predictable routine | Prevent falls, answer call lights, explain care before touching, keep routines |
| 3. Love and belonging | Family, friends, staff relationships, intimacy | Encourage visits and calls, introduce residents, respect privacy for couples |
| 4. Self-esteem | Feeling respected, capable, and useful | Use the resident's preferred name, encourage self-care, praise effort |
| 5. Self-actualization | Personal growth, faith, hobbies, meaning | Support religious practice, creative activities, and lifelong interests |
Adjusting to Nursing Home Placement
Moving into a nursing home usually means losing a home, many belongings, privacy, and control over daily life. Prometric's sample test makes this point directly: a nurse aide should expect a newly admitted resident to feel a sense of loss. Some residents grieve, become angry, withdraw, or feel abandoned by family. The aide's job is to restore as much control, privacy, and familiarity as possible.
Helping a New Resident Settle In
- Make a good first impression. Greet the resident and family by name, introduce yourself, and explain your role. Show the resident the room, the bathroom, the call light, and how the bed works.
- Handle belongings with care. Help put away and label personal items, complete the belongings inventory according to policy, and encourage photographs, a favorite blanket, or a familiar chair.
- Learn preferences. Ask about wake and sleep times, bathing preferences, favorite foods, and what the resident likes to be called, and pass this information to the nurse for the care plan.
- Give choices and control. Let the resident decide what to wear, when to bathe, and which activities to attend. Small choices restore dignity.
- Protect privacy. Knock before entering, close curtains during care, and give the resident private time with visitors.
- Introduce the community. Introduce roommates and tablemates, explain mealtimes and activities, and mention resident council meetings.
Emotional Support Strategies
- Listen actively and accept feelings; do not argue a resident out of grief or anger.
- Spend unhurried moments with residents who are lonely, even during routine care.
- Use the family as a source of support. Encourage visits, phone and video calls, and family participation in care planning and activities when the resident wishes.
- Respect intimacy and sexuality. Residents keep the right to private visits with a spouse or partner. Knock, wait, and give privacy. Report sexual behavior that involves a resident who cannot consent, because that may be abuse.
- Report warning signs such as refusing to eat, withdrawing from everyone, crying often, or saying life is not worth living (Section 6.3).
Which of the following is a normal age-related change?
A bladder that holds less urine
Joint contractures in the knees and hips
Dementia that develops slowly over several years
Wheezing when breathing at rest
A nurse aide is about to take a resident to a social activity when the resident's roommate begins to choke. According to Maslow's hierarchy, why does the roommate come first?
Breathing is a physiological need, which comes before belonging
Social activities are scheduled ahead of time and can never be delayed for any reason
Choking threatens self-esteem, which Maslow ranks above all social and safety needs
The roommate might complain later
A resident admitted yesterday says, "I had to sell my house, and now I don't even get to decide when I eat." Which response best helps the resident adjust?
Tell the resident that everyone gets used to the facility's meal schedule within a few days
Acknowledge the loss and ask about the resident's usual mealtimes and food preferences
Remind the resident that the facility's rules apply equally to every resident who lives there
Suggest that the resident let family members make daily decisions until they feel settled
Sections you finish are checked off in the contents.