Main Information•Take a Test•Change Your Account Information

AGE SPECIFIC CHARACTERISTICS AND NEEDS THROUGHOUT THE LIFE SPAN

Author: Alene Burke RN, MSN
6 Contact Hours

To take the test:
If you are not registered:

DESCRIPTION:

The purpose of this course is to provide health care providers with the multiple and complex knowledge necessary to provide care and modify care according to the age specific, developmental, characteristics and needs of patients and family members.

OBJECTIVES:

At the conclusion of this course, the learner will be able to:

1. Incorporate physical, psychosocial, developmental and cognitive age-related needs and characteristics into your roles and responsibilities for the following age groups:
    • Infant
    • Toddler
    • Preschool child
    • School age child
    • Adolescent
    • Young adult
    • Middle aged adult
    • Old adult

2. Incorporate safety, pharmacological, nutritional and other age-related characteristics and needs into your roles and responsibilities for the following age groups:
    • Infant
    • Toddler
    • Preschool child
    • School age child
    • Adolescent
    • Young adult
    • Middle aged adult
    • Old adult

3. Articulate and integrate age-related expectations into the planning, implementation, continuation and evaluation of care.

INTRODUCTION
The Need to Integrate Age Specific Competency Into All Aspects of Care

The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) requires that all members of a health care facility who have patient contact be competent in age specific characteristics and needs. In other words, pharmacists, physical therapists, social workers, laboratory technicians, clinical dietitians, radiology technicians, registered nurses, licensed practical nurses, nursing assistants, care technicians and others are required to meet all of the Joint Commission's requirements related to age specific characteristics and needs, as dictated by the individual's particular job (JCAHO, 2004).

JCAHO requires, among other things, that all individuals with patient contact receive education and training related to the characteristics and needs of the age groups they come in contact with. If a nurse is employed in pediatrics and is responsible for the care of children from infancy to the age of twelve, the nurse must receive education and training for that age-range of children. However, if a nurse is employed at a medical center that cares for all age groups and is expected to float to all areas of the facility based on need, then the nurse must receive education and training for all age groups that are cared for in that facility. It is expected that this education and training include the characteristics and needs throughout the life span (JCAHO, 2004)

If a laboratory technician works in a pediatric hospital, she or he is required to receive education and training related to the ages of the children in that hospital. The rationale underlying the JCAHO requirements for age specific competency is related to the need to modify all aspects of care according to the characteristics and needs of the client. This is in accordance with modifications made with regards to any other of the client's needs, characteristics and preferences. Once the education and training are provided, JCAHO requires that this be documented on the employee's education record.

In addition to the initial training for age specific characteristics and needs, the Joint Commission on Accreditation of Healthcare Organizations (2004) requires that anyone with patient contact be continuously assessed for age specific competency. Every employee must be evaluated by her supervisor on how well she has modified various aspects of care for each age group.

Although JCAHO does not require Competency Checklists, it does require that all employees be assessed for competency with measurable, specific criteria. In order to accomplish this goal most organizations develop lists of competencies for evaluation - including those related to age specific characteristics and needs. A few organizations have been able to successfully compress job descriptions and competency criteria into one document.

THE AGE GROUPS ALONG THE LIFE SPAN

It is not always clear when one age category ends and another begins. Traditional adult age categories include young adult, middle age adult and older adult with only minor variations found in the literature. According to researcher and writer Gail Sheehy, there has seen a shifting of age group stages because children are growing up faster and adults are taking longer to grow old. Sheehy has redefined the traditional adult age groups as Provisional Adulthood (18-30), First Adulthood (30-45) and Second Adulthood (after the age of 45). (Sheehy, 1995)

Although the literature varies to some extent regarding the ages at which each group begins and ends, for the purpose of this course the age groups throughout the life span are defined as follows:

Age Group	Age Span
Infant	Birth to one year
Toddler	One to three years
Preschool child	Three to five years
School age child	Five to twelve years
Adolescent	Twelve to eighteen years
Young Adult	Eighteen to forty four years
Middle Age Adult	Forty five to 65 years
Old Adult	Over 65

As with all human characteristics, there is no clear-cut beginning or end to age groupings. Additionally, although the characteristics and needs may be typical for the specific age group this does not necessarily mean that all individuals in the age group have the same characteristics and needs. For example, a 68-year old man may not have any evidence of sensory impairment and may in fact be an exception to the rule about sensory deficits for the Old Adult. Age specific characteristics are not considered hard and fast rules but instead reliable guidelines that should be considered when providing care to clients of all different ages.

DEVELOPMENTAL NEEDS OF THE AGE GROUPS

The work of Erik Erikson (1963), a developmental psychologist and author of Childhood and Society has been accepted as the classic and universally accepted framework for exploring the developmental characteristics and needs of age groups throughout the life span. Erikson has identified and defined eight major stages with accompanying tasks that must be met and resolved in order for the individual to progress through the life span in a complete and fulfilling manner. If for any reason an individual is unable to resolve the tasks associated with her age, she can suffer from incomplete and unresolved issues relating to personal development (Erikson, 1963).

Health care providers must take into consideration the major developmental challenges facing the patients they are caring for and adjust the care accordingly. For example, adolescents are often coping with the challenges associated with identity formation. Not only can hospitalization and serious illness affect an adolescent's sense of self it can also separate her from her peer group, a major force at this stage of life for defining who she is and how she acts and reacts.

Age Group	Task	Lack of Resolution
Infant	Development of trust	Mistrust Failure to thrive
Toddler	Autonomy Self control & will power	Shame & doubt Low tolerance to frustration
Preschool	Initiative Confident Has purpose & direction	Guilt Fear of punishment
School Age Child	Industry Self confidence Competency	Inferiority Fears about meeting expectations
Adolescent	Identity formation Devotion & fidelity Sense of self	Role confusion Poor self concept
Young Adult	Intimacy Affiliation & love	Isolation Avoidance of relationships
Middle Age Adult	Generativity Production Concern about others	Stagnation Self absorption Lack of concern about others
Old Adult	Ego integrity Wisdom Views life with satisfaction	Despair Life is meaningless

COGNITIVE DEVELOPMENT ALONG THE LIFE SPAN

Jean Piaget, a developmental psychologist, is considered by many to be the primary source on how humans from birth until age twelve develop in terms of cognitive or learning abilities. Piaget developed his theories after hundreds of hours directly observing children of all ages. His research suggests that children are able to process information and learn according to their age. Cognitive development, according to Piaget, is nearly complete by the age of fifteen when the child is able to think in an abstract manner. Piaget defined several stages of cognitive development - pre-operations, concrete operations and formal operations.

Pre-Operations. During the preoperational stage, the young child is not yet able to use abstract thinking or perform concrete operations like adding and subtracting using marbles or other concrete objects.

Concrete Operations. During the stage of concrete operations the child is still unable to use abstract thinking. For example, he or she is able to add simple numbers using marbles or other concrete objects without a thorough understanding of exactly what the numbers represent and what the meaning of addition is. The number five, for example means that there are five concrete objects that the child is able to hold and manipulate concretely.

Formal Operations. During the stage of formal operations the child has fully developed, complex, logical abstract thought and is able to manipulate abstract concepts.

For members of the healthcare team, cognitive and learning development has many implications. Most obvious is the area of patient and family teaching. There are also implications in terms of diversion and entertainment, including the selection of games and television programs. The following age-related cognitive concepts should be considered:

Age	Stage	Features
Up to 2 years	Sensorimotor thought	6 substages Physical manipulation of objects
2 to 7 years	Preoperational symbolic functioning	Language development
7 to 11 years	Concrete operations	Logical reasoning Can solve concrete problems
11 to 15 years	Formal operations	Fully developed, complex, logical abstract thought Manipulation of abstract concepts

From birth until about the age of 2, young children learn how to separate themselves from the environment. They begin to manipulate concrete objects and to understand some of the meaning behind symbols. During the Preoperational Stage starting around age 2, preschool children begin to use and develop language and vocabulary and are better able to converse with others. They learn to count and begin to understand the concepts underlying numbers. They test and try things with trial and error. They learn well with discovery, trial and error. They ask a lot of "why" questions and are very inquisitive. They also begin to be able to draw conclusions, particularly when they are given materials and aids such as concrete objects to manipulate and use.

Young preschool children also think about the results of their actions and begin to manipulate objects. After this stage, about age 7, children move into the Concrete Operation Stage and begin to perform mental operations and logical reasoning. Intellectual development is usually completed between the ages of 12 and 15, a time period referred to by Piaget as the Abstraction Stage. During this time the child learns to think in an abstract way and no longer needs concrete items to manipulate. At this point, Piaget believes that children have completed the development of their cognitive processes (Schuster & Ashburn, 1992)

SAFETY NEEDS THROUGHOUT THE LIFE SPAN

The need for safety, one of our most basic of human needs, is of paramount importance to health care providers for all age groups of patients. During all phases of growth and development for the child and during the late years, safety needs are the greatest. For example, because infants are in the oral phase of development they tend to place small and inappropriate objects in their mouths. Within the home and within the health care facility attention to safety is important in order to prevent choking and accidental poisoning.

Other childhood characteristics that make safety a primary concern include lack of impulse control, lack of good judgment, intense curiosity, inability to recognize dangers and the need to develop autonomy.

For the aging adult sensory loss and cognitive impairment are among the degenerative losses that place older adults in danger of accidents. Confusion, loss of hearing and vision, poor judgment and the inability to recognize dangers are some of the reasons why healthcare providers must maintain a safe environment for the elderly.

PHARMACOLOGY THROUGHOUT THE LIFE SPAN

Pharmacology dosage and route considerations vary according to the characteristics of virtually all age groups except for the young and middle-aged adult. For the infant, toddler, preschool and school age child dosage is determined according to the weight of the child in kilograms. By the time the child reaches adolescence most adult dosages are appropriate. As is the case with all medication administration, nurses must be knowledgeable about the medications they are administering and should question or clarify any medication orders that are unclear or possibly inappropriate.

For children, the oral route of administration is preferred. Obviously, young infants unable to swallow solids must be given liquid forms of a medication by mouth. Pharmacological implications for the infant, toddler and sometimes even the preschool child involve close monitoring of the effects of medication. In these age groups absorption and metabolic rates may be unpredictable.

For the aging adult there are special pharmacological considerations based on some of the distinguishing characteristics of this age group. Muscle atrophy, decreased bone density, diminished blood flow, decreased tissue elasticity, decreased peristalsis, and slowing of the basal metabolic rate leads to changes in physical functioning. As with young children, aging adults may have unpredictable absorption of medications and require close monitoring. A general rule to follow with the elderly is the start low (dose) and go slow.

If a swallowing disorder is present the method of delivery of medications must be modified. There are two common practices for patients with a swallowing disorder - crushing the medication and the use of a liquid form of the medication. There are, however, some medications that cannot be crushed. Time release or extended release capsules, enteric-coated tablets, sublingual medications, effervescent tablets and foul tasting medications should not be crushed. If crushing a tablet or capsule is contraindicated it is a good idea to consult with a pharmacist to determine whether an oral, liquid form is available.

NUTRITION AND HYDRATION THROUGHOUT THE LIFE SPAN

Nutritional needs and considerations vary somewhat throughout the life span. Caloric requirements are greatest during infancy and adolescence and for young adults or adolescents who are pregnant or lactating. Infants require iron supplements and fat from whole milk. Infants should be introduced to solid foods at about 4 to 6 months of age starting with cereal. New foods should be added slowly so that any intolerance can be determined.

Toddlers enjoy finger foods and will begin to use utensils and cups instead of bottles or caregiver feeding. Preschool children will begin to develop food preferences and will also begin to develop the manual dexterity and skill necessary to use utensils. School age children prefer fast foods and dining with friends. Adolescents, despite their increased need for calories, protein, calcium, iron, iodine and B complex vitamins, demonstrate irregular eating patterns, a preference for fast food and snacks. It is also during adolescent years that eating disorders (bulimia and anorexia nervosa) and trendy diets may emerge.

In the absence of pregnancy or lactation, the nutritional needs of the young and middle-aged adult are relatively constant except for a diminishing need for calories due to the slowing of the metabolic rate seen in the later portion of the middle years. For the aging adult, fewer calories are required as appetite and digestive processes diminish. Other factors that must be considered for this age group include the financial ability to maintain adequate nutrition, dentition, physical limitations and the ability to get to and from the grocery store. "Meals on Wheels" may be a resource for the homebound elderly patient.

OTHER AGE RELATED IMPLICATIONS: PATEINT EDUCATION, DISCHARGE PLANNING, MOTIVATIONAL TECHNIQUES, SELF CARE, CIMMUNICATION AND THE IMPACT OF ILLNESS AND HOSPITALIZATION

There are many other aspects of care that must be modified based on age characteristics including patient/family education, discharge planning, motivational techniques, ability to participate with care, communication techniques and the impact of illness or hospitalization on the patient. For example, an infant is cognitively unable to learn or question, therefore, the focus of family teaching is the caregiver. Toddlers, on the other hand, have an ability to learn and ask questions. Since they have a short attention span and are concrete thinkers, any teaching with the toddler should consist of short, concrete explanations at their level of understanding. Very often dolls and puppets are useful teaching aides for the toddler.

Discharge planning is also impacted by age specific characteristics and needs. Community resources are often age related. For example, resources such as Alcoholics Anonymous have different groups for teens and adults. Reporting mechanisms and agencies for age related abuse also vary. Elder abuse/neglect and child abuse/neglect are assessed and addressed by different agencies. As we attempt to motivate our patients for a learning activity our choice of technique should also be appropriate for the age of the client. For example, a school age child may enjoy reading a book at the appropriate reading level while an adolescent may enjoy group learning with peers, particularly if they have a common illness or health care concern. A patient's level of involvement and participation in care is also influenced by age. For example, although the school age and preschool child may have an opinion, decision-making is legally placed with the caregiver. At the other end of the continuum of life, the aging adult may be limited physically and/or cognitively and unable to be involved in any physical and/or decision making aspects of their care.

The meaning of illness and the impact of hospitalization upon the patient vary according to the age of the patient. For the infant, illness and hospitalization means separation from the primary caregiver. For the school age child it means missing school. For the adolescent it means separation from the peer group. For the young adult an illness may jeopardize a job. For the older adult, illness may bring up issues relating to mortality and physical decline.

AGE SPECIIFIC COMPETENCIES THROUGHOUT THE LIFE SPAN

The following sections will review specific age related competencies and characteristics for each of the age categories previously discussed.

Infant (birth to one year)

Toddler (one to three years)

Preschool Child (three to five years)

School Age Child (five to twelve years)

Adolescent (twelve to eighteen years)

Young Adult (eighteen to forty four)

Middle Aged Adult (forty five to sixty five)

Old Adult (over sixty five)

Conclusion
In order to provide quality care to all of our patients it is necessary to modify aspects of care according to a variety of characteristics and needs specific to the individual patient. Some of these modifications require that we consider such differences among patients as culture, personal preferences, religious affiliation and age specific characteristics. Keep in mind that it is unwise to stereotype and categorize patient needs according to chronological age or any other label, including those characteristics related to the various age groups throughout the life span should be considered and used as guidelines for modifying and individualizing care in order to attain the best possible outcome for the patient.

Copyright © 2005 Alene Burke

REFERENCES

Alspach JG. (1996) A Framework for Assessing Age Related Competency: Distinguishing Attributes of Various Age Groups. Pensacola, Florida: National Nursing Staff Development Organization.

Erikson E. (1963). Childhood and Society, 2nd Edition. New York: WW Norton.

Joint Commission on Accreditation of Healthcare Organizations. (2004). Comprehensive Accreditation Manual for Hospitals.

Lippincott Manual of Nursing Practice, Seventh Edition. (2001). Lippincott, Williams and Wilkins.

Schuster C and Ashburn S. (1992). The Process of Human Development: A Holistic Life Span Approach. Boston: Lippincott.

Sheehy G. (1995). New Passages: Mapping Your Life Across Time. New York: Ballantine Books.

Tierney LM, McPhee SJ and Papadakis MA, ed. (2003), Current Medical Diagnosis and Treatment: New York.

Contact Hours: 6
Price: $34.50
Course Title: AGE SPECIFIC CHARACTERISTICS AND NEEDS THROUGHOUT THE LIFE SPAN
Course Number: 20-50397

To take the test:
If you are not registered:

Copyright 2005 Alene Burke & Associates   Privacy and Security Policy
For more information please contact us at Alene@AleneBurke.com
Please direct any questions about this site to the webmaster

Site Design by Lucille Design