10.1 Older Adult Growth & Development Overview
Key Takeaways
- Normal aging changes are gradual and expected; sudden changes (confusion, fever, falls) are NEVER normal aging and must be reported.
- Erik Erikson's final stage, integrity vs. despair (age 65+), drives much of older-adult psychosocial care on the STNA exam.
- The Ohio STNA written exam is 79 multiple-choice questions, 90 minutes, 70% to pass, administered by Headmaster (D&S Diversified Technologies) for ODH.
- Promote independence and dignity: let residents do what they can for themselves rather than doing it for them.
10.1 Older Adult Growth & Development Overview
Most residents in Ohio long-term care are older adults, so this domain shows up across the State Tested Nurse Aide (STNA) exam. The Ohio written test has 79 multiple-choice questions with 90 minutes to finish, and you must score 70% or higher to pass; it is administered by Headmaster (D&S Diversified Technologies) for the Ohio Department of Health. The separate skills evaluation requires 3 or 4 randomly selected tasks (every key step plus 80% of non-key steps on each), and you have up to three attempts on each component within 24 months of finishing your training program.
Expect several items on what is normal aging versus what must be reported.
Gerontology is the study of aging, and the central professional idea for the STNA is that aging is universal but not uniform. Two 80-year-olds may have completely different abilities, so you assess the individual in front of you rather than the calendar. The exam repeatedly rewards aides who treat older adults as capable adults with a lifetime of experience, not as fragile or childlike. Every contact should preserve self-esteem, identity, and the right to make choices about daily life.
Normal aging changes by body system
Normal aging means gradual, expected decline that does not itself signal illness. The single most important distinction on the exam: normal changes happen slowly over years, while disease changes happen quickly (over hours or days). Knowing the normal baseline for each system tells you when to simply adapt your care and when to call the nurse.
| Body system | Normal aging change | What it means for care |
|---|---|---|
| Integumentary (skin) | Thinner, drier, less elastic skin; fragile blood vessels | Bruises easily; higher skin-tear and pressure-injury risk |
| Musculoskeletal | Loss of muscle mass and bone density; stiffer joints | Move slower, allow extra time, prevent falls |
| Cardiovascular | Heart pumps less efficiently; vessels stiffen | Tires faster; watch for orthostatic dizziness |
| Sensory | Reduced vision, hearing, taste, smell, touch | Face the resident, speak clearly, season food per orders |
| Genitourinary | Bladder holds less; kidneys filter slower | More frequent toileting; offer the bathroom often |
| Gastrointestinal | Slower digestion, less saliva, fewer taste buds | Encourage fluids/fiber to prevent constipation |
| Neurological | Slower reflexes and recall; sleep is lighter | Allow more time to answer; do not rush |
What is NOT normal aging
These are red flags to report to the nurse immediately, not signs of "just getting old":
- Sudden confusion or disorientation (often delirium, infection, or low oxygen)
- Severe memory loss that disrupts daily life (dementia is a disease, not normal aging)
- Incontinence that appears suddenly
- Loss of appetite, fever, or new pain
- Falls, weakness, or a sudden change in function
A helpful memory hook is that aging slows things down but should not break them down. Slower walking, lighter sleep, and needing reading glasses fit "slowing down." A fever, a sudden fall, chest pain, difficulty breathing, or a resident who was alert yesterday and is now disoriented fit "breaking down" and demand a report to the nurse. When a stem says a change happened "suddenly," "today," or "this morning," treat it as reportable rather than normal aging, regardless of the resident's age.
Erikson's developmental task: integrity vs. despair
The STNA exam uses Erik Erikson's eighth and final psychosocial stage, integrity vs. despair, beginning around age 65. The older adult reflects on life and either reaches ego integrity (acceptance, satisfaction, "my life had meaning," the virtue of wisdom) or despair (regret, bitterness, fear of death). Aides support integrity by listening to life stories (reminiscence), respecting choices, and encouraging meaningful activity. This is why reminiscing about the past is therapeutic, not a problem to redirect.
Late adulthood also brings real losses that affect mood and behavior: retirement and loss of work identity, the death of a spouse and friends, declining health, reduced income, and loss of a familiar home when moving to a facility. These losses can cause grief and depression, which are treatable, not inevitable. The aide's role is to encourage social connection, support hobbies and faith practices, and report withdrawal or hopelessness to the nurse so the resident can be evaluated. Recognizing the difference between normal life review and clinical despair is a recurring exam theme.
Promoting independence and dignity
The guiding rule is person-centered care: do with, not for. Let the resident wash the parts of the body they can reach, choose their own clothing, and feed themselves with adaptive utensils when possible. Doing a task the resident could do themselves promotes dependence, lowers self-esteem, and speeds functional decline.
Dignity is protected through concrete habits, not slogans. Always address residents by their preferred name rather than "sweetie" or "honey," knock before entering, explain what you are about to do, drape the body to expose only the area being cared for, and close doors and curtains during personal care. Honor cultural, religious, and personal preferences about food, dress, modesty, and daily routine. Residents in long-term care retain legal rights, including the right to privacy, to make choices, to be free from abuse and restraints, and to manage their own affairs.
Every older-adult exam item is filtered through these rights, so an answer that violates dignity or autonomy is rarely correct even when it is faster.
An 82-year-old resident bruises easily and her skin tears when transferred. The STNA recognizes this as:
A resident frequently talks about her childhood and her late husband. According to Erikson, supporting this reminiscing helps the resident achieve: