Lifespan Development and Vital Signs

Chapter 7. Lifespan Development. Introduction. As an emergency medical technician, you must be aware of the obvious and not-so-obvious changes a person undergoes physically and mentally at various stages of life, and understand how some of these changes will substantially alter the way you perceive your patient's condition and, subsequently, how you manage his or her care. Vital signs are one example of such variations between age groups. Vital signs. In general, the younger the person, the faster his or her pulse and respiratory rates should be. Finding a pulse rate of 140 beats per minute and a respiratory rate of 60 breaths per minute is usually normal for an infant. However, for a 30-year-old adult, the same values would likely signal the presence of a life-threatening condition. Normal blood pressure values also vary widely between different age groups, but unlike pulse and respiratory rates, Blood pressure values tend to increase with age. Table 7-1 lists approximate normal vital signs for various age groups. Neonates, birth to one month, and infants, one month to one year. Unmatched by any other phase of life, the list of developmental changes occurring in the first year is long and substantial. These 12 months are often divided into two stages, neonate and infant, from birth to one month of age. A person is called a neonate. An in-depth discussion of the neonatal period is included in Chapter 34, Obstetrics and Neonatal Care. From one month to one year of age, a person is identified as an infant. Physical Changes Weight At birth, a neonate usually weighs between 6 and 8 pounds, 3 to 3.5 kilograms. The head accounts for about 25% of this weight. During the first week, A neonate's body weight decreases by 5% to 10% due to fluid loss. By the second week, the neonate begins to gain weight. From there on, infants grow at a rate of about 1 ounce, 30 grams, per day, doubling their weight by 4 to 6 months, and tripling it by the end of the first year. Cardiovascular System Prior to birth, fetal blood supply comes from the mother via the placenta. During the birthing process, Hormones and pressure changes help the neonate make the transition from fetal circulation to independent circulation. See Chapter 34, Obstetrics and Neonatal Care, for more information on fetal circulation. Pulmonary System Prior to taking his or her first breath, a neonate's lungs have never been inflated. As such, a neonate's first breath is forceful and is facilitated in part by the chest's passage through the birth canal. and the subsequent increase in intrathoracic pressure. Neonates are primarily nose breathers. Infants younger than 6 months are particularly susceptible to nasal congestion, which can lead to viral upper respiratory infections. If you respond to a call for a baby choking, make sure the nasal passages are clear of mucus and other obstructions. An infant's upper airway is quite different from that of an adult. The infant's tongue is larger in proportion to the size of the oral cavity. and the airway is proportionally shorter and narrower. As a result, airway obstruction is more common in infants than in older children and adults. Due to factors such as the proportionally oversized occiput, the increased flexibility of the trachea, and the infant's limited or absent ability to reposition himself or herself, it is crucial that the emergency medical technician preserve the airway's patency through proper positioning. hyperextending or hyperflexing the infant's head and neck can easily produce an airway obstruction the rib cage of an infant is less rigid and the ribs sit horizontally this explains the distinctive diaphragmatic breathing belly breathing typically seen in infants when providing bag mask ventilations to an infant be aware that the infant's lungs are fragile forceful ventilations and overinflation increase pressure in the lungs and can result in pressure induced trauma. referred to as barotrauma. The muscles that infants use to breathe are immature, and the number of alveoli in their lungs is relatively low. Fortunately, the amount of oxygen they need is also relatively low. When stressed, however, their respiratory system's ability to compensate is limited. They can hold out for a short time, but without expedient support, infants struggling to breathe can quickly tire, and become overheated and dehydrated. Thus, respiratory problems in the very young can quickly turn life-threatening nervous system although the human nervous system is remarkably well established at birth it has yet to fully mature However, in a healthy, full-term infant, certain reflexes are present at birth. The Moro reflex, commonly called the startle reflex, is illustrated when neonates are caught off guard, and startled, at which time they open their arms wide, spread their fingers, and appear to be grabbing for something. The palmar grasp reflex occurs when an object is placed into a neonate's palm, and he or she instinctively closes his or her hand around the object. Two other reflexes play an important role in feeding. The rooting reflex is displayed when something touches the neonate's cheek, and he or she intuitively turns his or her head in the direction of the touch. The sucking reflex is illustrated when a breastfeeding mother strokes her baby's lips with her nipple, prompting the child to latch on. At birth, the bones of the cranium are not yet fully developed or fused together. Instead, The gaps between these bones are connected by relatively flexible fibrous tissue. These areas, called fontanelles, allow the newborn's head to change shape slightly as it passes through the narrow birth canal. In the months that follow, the fontanelles begin to shrink as the cranial bones grow together and fuse, forming a unified, rigid structure. The posterior fontanelle normally closes by the third month. The anterior fontanelle closes between 9 and 18 months. When present, the fontanelles can provide the emergency medical technician with valuable information about the child's condition. For example, a depressed fontanelle may indicate dehydration, whereas a bulging fontanelle is often a sign that pressure inside the cranium has increased. Information on intracranial pressure is presented in Chapter 29, Head and Spine Injuries. At birth, neonates are unable to do much without assistance. They cannot roll from their backs onto their abdomens. and their eyes are incapable of focusing on objects beyond a very short distance. However, by two months of age, infants can track objects with their eyes and recognize familiar faces. At six months, they can sit upright and they begin to make cooing and babbling sounds. By the time an infant is 12 months of age, the infant can walk with minimal assistance and knows his or her name. Immune system. While still in the womb, The neonate's immune system is supported by the mother's antibodies, delivered through placental blood flow. Infants continue to carry some of this immunity. This passive immunity is further strengthened by antibodies contained in breast milk. Psychosocial Changes An infant's psychosocial development begins at birth, and continues to advance as the infant interacts with, and reacts to, his or her environment. Table 7-2 outlines typical ages at which major psychosocial changes are noticed. For most infants, the primary method used to communicate distress is crying. Parents are often able to discern the reason for their child's crying by simply listening to the tone of those cries. They can distinguish between a cry of anger, and one motivated by frustration, pain, fear, hunger, discomfort, or sleepiness. Another distinctive cry is one of distress. prompted by some unexpected event that has caused a situational crisis for the child. The pace at which infants develop relationships with their parents or caregivers varies greatly from one child to the next. Bonding, the formation of a close, personal relationship, is generally fostered by a secure attachment, which results when the infant understands that his or her parents or caregivers will respond to his or her needs. Having this confidence that his or her parents will provide a safety net inspires the child to venture out and explore By contrast anxious avoidant attachment is the result of recurring rejection Infants who acquire this form of attachment show little emotional response to their parents or caregivers and treat them as they would a stranger These children may compensate by developing an isolated lifestyle wherein they avoid having to depend on the support and care of others in older infants Separation anxiety is common. Characterized by clingy behavior and fear of unfamiliar places and people, it typically reaches its peak between the ages of 10 and 18 months. Crying as a means of protest is normal at this age. As they grow accustomed to their homes and families, infants have an inherent need for a secure, stable environment. An environment that is too unpredictable may trigger feelings of despair, causing the child to become withdrawn. This experience may even lead to trust issues later in life. Trust versus mistrust refers to the stage of psychosocial development beginning at birth, and concluding at approximately 18 months of age. As the name implies, it is a time when children learn whether they can trust the people around them. because infants depend entirely on their parents or caregivers. A crucial element in the formation of this trust is the quality of care the infant receives from them. When their needs are met consistently in a stable environment, children learn to trust those responsible for their well-being. Conversely, if their parents or caregivers are inconsistent, emotionally unavailable, or rejecting, children may develop a sense of mistrust. Toddlers, 1 to 3 years, and preschoolers. 3 to 6 years. Physical changes. The cardiovascular system of a toddler, ages 1 to 3 years, or preschooler, ages 3 to 6 years, is not dramatically different from that of an adult, figure 7-4 and figure 7-5. Their lungs continue to develop more terminal bronchioles, and alveoli to meet the ever-increasing oxygen demands of their growing bodies. However, the musculature of their lungs is not well developed. This anomaly prevents them from sustaining deep or rapid respirations for an extended period of time. One of the most important physiologic changes at this age is the loss of passive immunity. As toddlers spend more time around other children, they are exposed to a variety of viruses. Viral infections, colds, develop frequently, often manifesting with gastrointestinal distress or upper respiratory symptoms. In the process, however, These exposures initiate the development of antibodies, resulting in acquired immunity. Neuromuscular growth also makes considerable progress at this age. By performing activities such as walking, running, jumping, and playing catch, toddlers and preschoolers learn to use their muscles and expansive nervous system. This boost in physical activity supports an increase in muscle mass and bone density. The progression in how they play at this age demonstrates their transition from exclusively gross motor activity, for example, grabbing an object using the entire palm, to including fine motor skills, for example, picking up a crayon using only the thumb and forefinger. By the end of this stage, the weight of a preschooler's brain is roughly 90% of his or her adult weight. Another milestone during this stage is the maturation of the renal system, and the establishing of elimination patterns. that is toilet training physiologically by 12 to 15 months of age toddlers possess the neuromuscular capability to control the bladder however many are not psychologically prepared until about 18 to 30 months of age the average age when toddlers complete toilet training is 28 months psychosocial changes the psychosocial challenge for this age group is sometimes referred to as autonomy versus shame and doubt Through milestones such as speech development and toilet training, the child begins to attain a measure of self-sufficiency. However, toddlers and preschoolers are nevertheless very attached to their parents, deriving feelings of safety and security from their presence. Separation anxiety peaks between 10 and 18 months of age. By 36 months of age, most children have mastered basic language skills, understanding full sentences by the time they are 3 or 4 years of age. As they progress further through this stage, they make a transition from using language solely for the purpose of communicating what they want, to using it creatively and playfully. This is also the time when toddlers become more socially interactive with other children, playing games and, as a result, learning to control their own behavior, follow rules, and be competitive. Significant learning and development occur as the child observes other children. By age 18 to 24 months. Toddlers begin to understand the concept of cause and effect, and by observing their role models, they also learn to recognize gender differences. School-age children, 6 to 12 years, physical changes. From ages 6 to 12 years, a school-age child's physical traits and functions continue to mature at a relatively rapid pace. Most gain about 4 pounds, 2 kilogram, and grow 2.5 inches, 6 centimeter, each year. Baby teeth are replaced by permanent teeth, and brain activity in both hemispheres increases significantly. Psychosocial changes School-age children experience substantial psychosocial growth. During this critical time in human development, children learn various types of reasoning. With pre-conventional reasoning, the child's moral compass is directed by external forces, such as parental discipline. Whether a given behavior is right or wrong is judged by its consequences, punishment or incentive. When children reach the level of conventional reasoning, their behavior is more motivated by the approval of peers and society. They still accept the rules set by authority figures, but now they do so primarily because they perceive those rules as necessary for positive relationships and acceptance. For children who reach the third level, post-conventional reasoning, moral judgments are more abstract, with the individual beginning to follow an internalized moral compass, that is, conscience. This form of reasoning develops further during adolescence. During this stage, School-aged children begin to develop their self-concept and self-esteem. Self-concept is our perception of ourselves. Self-esteem is how we feel about ourselves and how we fit in with our peers. Adolescents, 12 to 18 years. Physical changes. In the adolescent, ages 12 to 18 years, vital signs begin to level off within the adult ranges, with a systolic blood pressure generally between 90 and 110 mmHg. a pulse rate between 60 and 100 beats per minute, and respirations that range from 12 to 20 breaths per minute. During the adolescent period, teens experience a 2- to 3-year growth spurt, that is, an increase in muscle and bone growth. Growth begins with the hands and feet, then moves to the long bones of the extremities, and finishes with growth of the torso. At the conclusion of the growth spurt, muscle mass and bone density have nearly reached adult levels. Girls tend to experience this growth at an earlier age than boys, finishing by about 16 years of age. Boys typically reach their growth peak by 18 years, generally becoming taller than girls. Another important milestone of adolescence is the maturation of the endocrine and reproductive systems. Secondary sexual development begins, along with enlargement of the external reproductive organs. Pubic and axillary hair appear. Vocal sound changes in range and depth. In girls, the deposit of adipose, fat, tissue causes the breasts and thighs to increase in size. Menstruation begins with menarche, the first menstrual bleeding. However, it is not uncommon for some girls to begin menstruation prior to adolescence. Along with these changes comes the capacity for reproduction. By the middle of adolescence, the male body can produce sperm, and the female body produces eggs. oocytes, psychosocial changes, conflict between young people and their parents is common at this stage. In seeking to express their independence, adolescents may begin to distance themselves from parents and siblings, desiring privacy and personal space. Most begin spending more time with friends and struggling to create a sense of identity. While trying on different personas, they may begin dressing in a certain style of clothing that fits their desired personality. Self-consciousness increases as both sexes become more concerned with their physical appearance and how they are perceived by peers. Multiple options for gender exist, allowing the adolescent to freely gender identify. Many adolescents are fixated on their public image and terrified of being embarrassed. At times, adolescents can be intensely emotional. Teenagers often find themselves caught between two worlds. They want to be treated like adults. yet they continue to want and need their parents' support. Rebellious behavior is common. Smoking, illicit drug use, unprotected sex, and other high-risk behaviors tend to peak at around age 14 to 16 years, along with antisocial behavior, and peer pressure. Even without these particular manifestations, the adolescent struggle toward independence can have devastating setbacks. Patience and support from family and friends are essential in assisting a young person's transition into adulthood. At this age, young people develop a code of personal ethics, influenced in part by their parents' ethics and values and partly by their peers, and personal experience. Early adults, 19 to 40 years, physical changes. Following adolescence, a person is classified as an early adult, age 19 to 40 years. The vital signs of early adults do not vary greatly from those seen throughout adulthood. Ideally, the human pulse rate will average around 70 beats per minute, the respiratory rate will stay in the range of 12 to 20 breaths per minute, and the systolic blood pressure will be approximately between 90 and 120 mmHg. From about 19 to 25 years of age, men and women typically reach their physical peak. Lifelong habits and routines are established. whether healthy or unhealthy, for example, diet, exercise, tobacco use. In the latter years of early adulthood, the effects of aging gradually become evident, that is, subtle wear and tear. Muscle strength decreases, and reflexes slow. The discs between vertebrae begin to settle, sometimes producing a decrease in height. Metabolism also decreases, while fatty tissue increases. Thus, without adjusting his or her diet and level of activity accordingly, the early adult may experience unwanted weight gain, while simultaneously finding it more difficult to lose weight than in previous years. Psychosocial Changes Most early adults spend these years focusing on family and career. settling down, getting married, starting a family, and striving for career achievement. Although immensely rewarding, these life events also bring about significant stress. Interestingly, despite the amount of stress and change, this age group enjoys one of the more stable periods of life psychologically. Middle adults, 41 to 60 years. Physical changes for a middle adult, age 41 to 60 years. The aging process continues to take its toll. Middle adults become more susceptible to vision and hearing loss, cardiovascular health becomes a growing concern, and the incidence of cancer increases. Women in their late 40s to early 50s enter menopause, the end of menstruation, and the ability to reproduce. Middle adults may experience increased cholesterol levels, decreased cardiac efficiency, and difficulties with weight control. However, Many of the effects of aging can be diminished with proper exercise and a healthy diet. Middle adults may also have conditions of which they are unaware, including diabetes and hypertension. Whereas the leading cause of death in all age groups younger than 44 years is unintentional injury, the leading cause of death in persons between ages 45 and 64 is cancer. Psychosocial changes. The pressure to accomplish their professional and relational goals. The need to adjust after their adult children leave the home, that is, empty nest syndrome, and the worries that come with assessing whether they will have the financial means to retire are among the many psychosocial challenges facing the middle adult. However, they have the physical, emotional, and spiritual reserves needed to overcome these challenges, and their health is generally stable. By this time, the parents of middle adults have become older adults, discussed in the next section. many of whom will require care and assistance in completing routine tasks of daily life. In the United States, many of these older adults receive such care at home, from family members. Therefore, in addition to supporting children departing for college, middle adults may experience an overlapping period during which they must also care for their aging parents. Older adults, 61 years and older, physical changes. Life expectancy is continually changing. In the early 1900s, the average human life expectancy was 47 years of age. In more modern times, that number has increased to approximately 78 years, with a maximum life expectancy of approximately 120 years. As a result, more and more people will live to become an older adult, age 61 years, and older. How long an individual lives is determined by many factors. including his or her birth year and country of residence. These two factors correlate with advances in public health, enhanced awareness of healthy eating habits, improved attitudes toward exercise, and access to ever-advancing medical care. Currently, older adults are staying active longer than their ancestors. Thanks to medical advances, they are often able to overcome numerous medical conditions, but may need multiple medications to do so. Cardiovascular System Cardiac function declines with age, due in large part to atherosclerosis, a condition characterized by the buildup of cholesterol and calcium along the inner walls of blood vessels, resulting in the formation of plaque. As plaque accumulates, the flow of blood through the affected vessels becomes restricted or blocked entirely. More than 60% of people older than 65 years have atherosclerotic disease. Additional cardiovascular effects of aging include a decrease in heart rate. A decline in cardiac output, the amount of blood pumped by the heart per minute, and diminished ability of the heart to increase cardiac output to meet the body's demands. These changes translate into a heart that is less able to cope with exercise or disease. In the event of a life-threatening illness, the body typically preserves blood pressure by increasing the heart rate. However, because cardiac muscle tends to weaken with age, the increased rate may cause damage to the heart. Combined with atherosclerosis of sufficient severity, the damage could prove fatal. Because the vascular system of the older adult becomes stiff, blood vessels are unable to dilate and contract as effectively. As a result, the diastolic blood pressure increases, and the heart must work harder to overcome vascular resistance to move blood throughout the body. Over time, the increase in workload can be detrimental to the heart. Human blood cells originate within bone marrow. But with advancing age, bone marrow is replaced by fatty tissue. Consequently, the loss of marrow equals a reduction in the body's ability to manufacture new blood cells. Alone. This change is not cause for alarm. However, in the presence of traumatic injury in which a relatively large volume of blood is lost quickly, the impeded ability to replace lost cells can have devastating effects. Respiratory system. In older adults, the airway increases in size. However, the surface area of the alveoli decreases, as do the elasticity of the lungs, and the strength of the intercostal muscles and diaphragm. Together. These factors make breathing more laborious for older adults. By the time the older adult is 75 years old, his or her vital capacity, the volume of air moved during the deepest inspiration and expiration, has declined to about 50% of that of a young adult. The chest becomes more rigid, yet more fragile. Instead of bending and flexing under stress, the calcified rib case is more susceptible to fracture. Normally, These changes in the respiratory system are gradual, often going unnoticed until the onset of a severe, life-threatening condition, in which case the lack of respiratory reserve becomes more pronounced. As the patient ages, the structures protecting the upper airway decrease in function. Cough and gag reflexes diminish along with the ability to clear secretions. The cilia that line the airway dwindle, and sensation within the airway declines. making it more difficult for the older adult to maintain upper airway patency. Thus, older adults are at greater risk of aspiration and airway obstruction. When a younger patient inhales, the airway maintains its shape, allowing air to enter. As the smooth muscles of the lower airway weaken with age, strong inhalation can cause the walls of the airway to collapse inward, producing inspiratory wheezing, lower flow rates, and air trapping in the alveoli. Incomplete expiration. Because of these reductions in function, and because the white blood cells of the airway are less aggressive toward invading organisms, the older patient is more susceptible to lung infections. Endocrine system. Endocrine function also declines with age. Glucose metabolism slows, while insulin production decreases. Sexually, men often continue to produce sperm long into their 80s. Although the rigidity of the penis typically diminishes over time, the size of a woman's uterus and vagina decreases. Hormone production in both sexes gradually declines, and although sexual desire may lessen, it does not ordinarily cease entirely. Digestive system Age-related changes in gastric and intestinal functions may inhibit nutritional intake and utilization. Tooth loss can make chewing more difficult. taste buds become less sensitive to salty and sweet foods and food in general may be perceived as bland and flavorless as the senses of smell and taste response begin to fade a decrease in saliva secretion impairs the body's ability to break down complex carbohydrates similarly gastric acid secretion diminishes peristalsis the process by which intestinal contractions move food along the digestive tract slows with age sometimes resulting in constipation and or suppressed feelings of hunger. And because blood flow to the intestines can drop by as much as 50%, the extraction of vitamins and minerals from digested food can also wane. Gallstones become increasingly common, and changes in the elasticity of the anal sphincter can lead to fecal incontinence. Renal system. Between the ages of 20 to 90 years, the kidneys will decrease in size by 20%. and their filtration capabilities will decline by as much as 50%. This is due in part to a decrease in blood supply to the nephrons of the kidneys. Nephrons filter blood within the kidney. In addition, the number of nephrons declines between the ages of 30 and 80 years. As a result of the changes, the renal system's ability to remove waste from the body declines, as does its ability to conserve fluids when needed. Nervous system By the time a person is 80 years of age, the brain has decreased in weight by as much as 10% to 20%. Motor and sensory neural networks are slower and less responsive. However, the brain's metabolic rate and oxygen consumption remain unchanged. And although it is generally true that the infant brain has a larger number of neurons than its adult counterpart, the adult brain is much more flexible. This is because the number of interconnections between neurons increases with age. These connections produce redundancies within the brain that permit the loss of neurons without a loss of knowledge or skill. However, although cognitive function remains intact throughout most of older adulthood, mental function often declines in the five years immediately preceding death. One consequence of the reduced number of neurons is the alteration of sleep patterns. Instead of sleeping through the night, the older adult may take a nap during the day, and be awake late at night. It is not uncommon for older adults to develop a biphasic, two-phased, sleep cycle, for example, sleeping from 0-100 to 0-600 hours, and then taking a nap from 1,200 to 1,500 hours, throughout life. The cranial vault is almost entirely occupied by the brain, the meningeal layers, and the cerebrospinal fluid between these layers. As such, there is virtually no empty space. However, in older adults, the age-related shrinkage of the brain creates a void between the brain and the outermost layer of the meninges. The resulting space gives the brain room to move inside the cranium. As such, any mechanism that causes a rapid or forceful shifting of the brain has the potential to result in the tearing of bridging veins subsequent bleeding into the open space may go unnoticed for some time the functioning of the peripheral nervous system slows with age sensations become diminished and may be misinterpreted nerve endings deteriorate and the ability of the skin to sense the surroundings becomes hindered hot, cold, sharp and wet objects all can create dangerous situations because the body cannot sense them quickly enough. Combined with prolonged reaction time, and slower reflexes, these sensory alterations may contribute to the higher incidence of falls, and trauma in older adults. Sensory changes Pupillary reaction and ocular movements become more restricted with age. The pupils are generally smaller in older patients. and the opacity of the eyes lens diminishes visual acuity and causes the pupils to be sluggish in their reaction to light visual distortions are also common in older people sickening of the lens makes it more difficult for the eye to focus especially at close range peripheral fields a vision narrow and increase sensitivity to glare constricts the visual field in late adulthood hearing loss is about four times more common than vision loss Changes in several hearing-related structures may lead to a loss of high-frequency hearing or even deafness. Even so, although it is often assumed that all older adults have difficulty hearing and seeing, many older adults have remarkably good vision and hearing. Some may need eyeglasses or hearing aids, but this does not mean they are almost deaf or nearly blind. Psychosocial changes Statistics indicate that 95% of older adults live at home. They may have the assistance of family, friends, or home health care, but they are shown to be relatively healthy, active, and independent. The increasing number of older adults in the United States as a result of the baby boom of the 1940s through the 1960s has produced a need for additional assisted living facilities. These facilities allow older adults to live in campus-based communities with people in their own age group, while enjoying the independence and privacy of their own apartment. and the security of nursing care, maintenance, and food preparation, if desired. Unfortunately, these facilities can be expensive. An additional and important consequence of congregate living facilities is the proximity of the residents to one another. Although having people close to each other is advantageous from a social interaction standpoint, it limits the natural social distancing that occurs when people live completely independently. Residents of these communities interact with one another and with caregivers on a close, regular basis, which has the disadvantage of enhancing the spread of contagious diseases such as influenza virus and coronavirus. Furthermore, residents of these facilities are necessarily more susceptible to the consequences of these diseases. This helps explain the disproportionate effect that epidemics and pandemics associated with these diseases have on older adults living in continuing care, assisted living. In nursing home communities, few things in life cause more worry and stress than money problems. Older adults, in particular, may worry about the rising cost of health care. At times, some may have to choose between paying for groceries or paying for medications. More than 50% of all single women in the United States who are 60 years of age or older are living at or below the poverty level. The financial struggle is compounded by the fact that currently, compared to past generations, families of older adults are less likely to assume responsibility for their aging family members. One challenge facing older adults is the growing realization of their mortality. Everyone dies, but for younger people. The concept of death is little more than an intellectual exercise with a distant connection to reality. By contrast, the death of a spouse, close friend, or other loved one with whom the older adult may have shared one half of a century or more his or her life, can be a strong reminder that death is not only inevitable, but close by. For some, the loss of loved ones leaves the older adult without a source of social support, and this places them at greater risk of isolation and depression. Fortunately, Many older adults are happy and actively participating in life. With good financial resources, and a good support system of family and friends, adults in their 80s can enjoy life, and continue to feel productive.

In general, the younger the person, the faster his or her pulse and respiratory rates should be. Finding a pulse rate of 140 beats per minute and a respiratory rate of 60 breaths per minute is usually normal for an infant. However, for a 30-year-old adult, the same values would likely signal the presence of a life-threatening condition.

Normal blood pressure values also vary widely between different age groups, but unlike pulse and respiratory rates, Blood pressure values tend to increase with age. Table 7-1 lists approximate normal vital signs for various age groups. Neonates, birth to one month, and infants, one month to one year. Unmatched by any other phase of life, the list of developmental changes occurring in the first year is long and substantial.

These 12 months are often divided into two stages, neonate and infant, from birth to one month of age. A person is called a neonate. An in-depth discussion of the neonatal period is included in Chapter 34, Obstetrics and Neonatal Care.

From one month to one year of age, a person is identified as an infant. Physical Changes Weight At birth, a neonate usually weighs between 6 and 8 pounds, 3 to 3.5 kilograms. The head accounts for about 25% of this weight. During the first week, A neonate's body weight decreases by 5% to 10% due to fluid loss. By the second week, the neonate begins to gain weight.

From there on, infants grow at a rate of about 1 ounce, 30 grams, per day, doubling their weight by 4 to 6 months, and tripling it by the end of the first year. Cardiovascular System Prior to birth, fetal blood supply comes from the mother via the placenta. During the birthing process, Hormones and pressure changes help the neonate make the transition from fetal circulation to independent circulation.

See Chapter 34, Obstetrics and Neonatal Care, for more information on fetal circulation. Pulmonary System Prior to taking his or her first breath, a neonate's lungs have never been inflated. As such, a neonate's first breath is forceful and is facilitated in part by the chest's passage through the birth canal.

and the subsequent increase in intrathoracic pressure. Neonates are primarily nose breathers. Infants younger than 6 months are particularly susceptible to nasal congestion, which can lead to viral upper respiratory infections.

If you respond to a call for a baby choking, make sure the nasal passages are clear of mucus and other obstructions. An infant's upper airway is quite different from that of an adult. The infant's tongue is larger in proportion to the size of the oral cavity. and the airway is proportionally shorter and narrower. As a result, airway obstruction is more common in infants than in older children and adults.

Due to factors such as the proportionally oversized occiput, the increased flexibility of the trachea, and the infant's limited or absent ability to reposition himself or herself, it is crucial that the emergency medical technician preserve the airway's patency through proper positioning. hyperextending or hyperflexing the infant's head and neck can easily produce an airway obstruction the rib cage of an infant is less rigid and the ribs sit horizontally this explains the distinctive diaphragmatic breathing belly breathing typically seen in infants when providing bag mask ventilations to an infant be aware that the infant's lungs are fragile forceful ventilations and overinflation increase pressure in the lungs and can result in pressure induced trauma. referred to as barotrauma. The muscles that infants use to breathe are immature, and the number of alveoli in their lungs is relatively low.

Fortunately, the amount of oxygen they need is also relatively low. When stressed, however, their respiratory system's ability to compensate is limited. They can hold out for a short time, but without expedient support, infants struggling to breathe can quickly tire, and become overheated and dehydrated.

Thus, respiratory problems in the very young can quickly turn life-threatening nervous system although the human nervous system is remarkably well established at birth it has yet to fully mature However, in a healthy, full-term infant, certain reflexes are present at birth. The Moro reflex, commonly called the startle reflex, is illustrated when neonates are caught off guard, and startled, at which time they open their arms wide, spread their fingers, and appear to be grabbing for something. The palmar grasp reflex occurs when an object is placed into a neonate's palm, and he or she instinctively closes his or her hand around the object. Two other reflexes play an important role in feeding.

The rooting reflex is displayed when something touches the neonate's cheek, and he or she intuitively turns his or her head in the direction of the touch. The sucking reflex is illustrated when a breastfeeding mother strokes her baby's lips with her nipple, prompting the child to latch on. At birth, the bones of the cranium are not yet fully developed or fused together. Instead, The gaps between these bones are connected by relatively flexible fibrous tissue. These areas, called fontanelles, allow the newborn's head to change shape slightly as it passes through the narrow birth canal.

In the months that follow, the fontanelles begin to shrink as the cranial bones grow together and fuse, forming a unified, rigid structure. The posterior fontanelle normally closes by the third month. The anterior fontanelle closes between 9 and 18 months. When present, the fontanelles can provide the emergency medical technician with valuable information about the child's condition.

For example, a depressed fontanelle may indicate dehydration, whereas a bulging fontanelle is often a sign that pressure inside the cranium has increased. Information on intracranial pressure is presented in Chapter 29, Head and Spine Injuries. At birth, neonates are unable to do much without assistance. They cannot roll from their backs onto their abdomens.

and their eyes are incapable of focusing on objects beyond a very short distance. However, by two months of age, infants can track objects with their eyes and recognize familiar faces. At six months, they can sit upright and they begin to make cooing and babbling sounds.

By the time an infant is 12 months of age, the infant can walk with minimal assistance and knows his or her name. Immune system. While still in the womb, The neonate's immune system is supported by the mother's antibodies, delivered through placental blood flow. Infants continue to carry some of this immunity.

This passive immunity is further strengthened by antibodies contained in breast milk. Psychosocial Changes An infant's psychosocial development begins at birth, and continues to advance as the infant interacts with, and reacts to, his or her environment. Table 7-2 outlines typical ages at which major psychosocial changes are noticed.

For most infants, the primary method used to communicate distress is crying. Parents are often able to discern the reason for their child's crying by simply listening to the tone of those cries. They can distinguish between a cry of anger, and one motivated by frustration, pain, fear, hunger, discomfort, or sleepiness. Another distinctive cry is one of distress.

prompted by some unexpected event that has caused a situational crisis for the child. The pace at which infants develop relationships with their parents or caregivers varies greatly from one child to the next. Bonding, the formation of a close, personal relationship, is generally fostered by a secure attachment, which results when the infant understands that his or her parents or caregivers will respond to his or her needs. Having this confidence that his or her parents will provide a safety net inspires the child to venture out and explore By contrast anxious avoidant attachment is the result of recurring rejection Infants who acquire this form of attachment show little emotional response to their parents or caregivers and treat them as they would a stranger These children may compensate by developing an isolated lifestyle wherein they avoid having to depend on the support and care of others in older infants Separation anxiety is common.

Characterized by clingy behavior and fear of unfamiliar places and people, it typically reaches its peak between the ages of 10 and 18 months. Crying as a means of protest is normal at this age. As they grow accustomed to their homes and families, infants have an inherent need for a secure, stable environment.

An environment that is too unpredictable may trigger feelings of despair, causing the child to become withdrawn. This experience may even lead to trust issues later in life. Trust versus mistrust refers to the stage of psychosocial development beginning at birth, and concluding at approximately 18 months of age. As the name implies, it is a time when children learn whether they can trust the people around them. because infants depend entirely on their parents or caregivers.

A crucial element in the formation of this trust is the quality of care the infant receives from them. When their needs are met consistently in a stable environment, children learn to trust those responsible for their well-being. Conversely, if their parents or caregivers are inconsistent, emotionally unavailable, or rejecting, children may develop a sense of mistrust.

Toddlers, 1 to 3 years, and preschoolers. 3 to 6 years. Physical changes.

The cardiovascular system of a toddler, ages 1 to 3 years, or preschooler, ages 3 to 6 years, is not dramatically different from that of an adult, figure 7-4 and figure 7-5. Their lungs continue to develop more terminal bronchioles, and alveoli to meet the ever-increasing oxygen demands of their growing bodies. However, the musculature of their lungs is not well developed. This anomaly prevents them from sustaining deep or rapid respirations for an extended period of time. One of the most important physiologic changes at this age is the loss of passive immunity.

As toddlers spend more time around other children, they are exposed to a variety of viruses. Viral infections, colds, develop frequently, often manifesting with gastrointestinal distress or upper respiratory symptoms. In the process, however, These exposures initiate the development of antibodies, resulting in acquired immunity.

Neuromuscular growth also makes considerable progress at this age. By performing activities such as walking, running, jumping, and playing catch, toddlers and preschoolers learn to use their muscles and expansive nervous system. This boost in physical activity supports an increase in muscle mass and bone density. The progression in how they play at this age demonstrates their transition from exclusively gross motor activity, for example, grabbing an object using the entire palm, to including fine motor skills, for example, picking up a crayon using only the thumb and forefinger. By the end of this stage, the weight of a preschooler's brain is roughly 90% of his or her adult weight.

Another milestone during this stage is the maturation of the renal system, and the establishing of elimination patterns. that is toilet training physiologically by 12 to 15 months of age toddlers possess the neuromuscular capability to control the bladder however many are not psychologically prepared until about 18 to 30 months of age the average age when toddlers complete toilet training is 28 months psychosocial changes the psychosocial challenge for this age group is sometimes referred to as autonomy versus shame and doubt Through milestones such as speech development and toilet training, the child begins to attain a measure of self-sufficiency. However, toddlers and preschoolers are nevertheless very attached to their parents, deriving feelings of safety and security from their presence.

Separation anxiety peaks between 10 and 18 months of age. By 36 months of age, most children have mastered basic language skills, understanding full sentences by the time they are 3 or 4 years of age. As they progress further through this stage, they make a transition from using language solely for the purpose of communicating what they want, to using it creatively and playfully. This is also the time when toddlers become more socially interactive with other children, playing games and, as a result, learning to control their own behavior, follow rules, and be competitive.

Significant learning and development occur as the child observes other children. By age 18 to 24 months. Toddlers begin to understand the concept of cause and effect, and by observing their role models, they also learn to recognize gender differences.

School-age children, 6 to 12 years, physical changes. From ages 6 to 12 years, a school-age child's physical traits and functions continue to mature at a relatively rapid pace. Most gain about 4 pounds, 2 kilogram, and grow 2.5 inches, 6 centimeter, each year.

Baby teeth are replaced by permanent teeth, and brain activity in both hemispheres increases significantly. Psychosocial changes School-age children experience substantial psychosocial growth. During this critical time in human development, children learn various types of reasoning.

With pre-conventional reasoning, the child's moral compass is directed by external forces, such as parental discipline. Whether a given behavior is right or wrong is judged by its consequences, punishment or incentive. When children reach the level of conventional reasoning, their behavior is more motivated by the approval of peers and society. They still accept the rules set by authority figures, but now they do so primarily because they perceive those rules as necessary for positive relationships and acceptance. For children who reach the third level, post-conventional reasoning, moral judgments are more abstract, with the individual beginning to follow an internalized moral compass, that is, conscience.

This form of reasoning develops further during adolescence. During this stage, School-aged children begin to develop their self-concept and self-esteem. Self-concept is our perception of ourselves.

Self-esteem is how we feel about ourselves and how we fit in with our peers. Adolescents, 12 to 18 years. Physical changes.

In the adolescent, ages 12 to 18 years, vital signs begin to level off within the adult ranges, with a systolic blood pressure generally between 90 and 110 mmHg. a pulse rate between 60 and 100 beats per minute, and respirations that range from 12 to 20 breaths per minute. During the adolescent period, teens experience a 2- to 3-year growth spurt, that is, an increase in muscle and bone growth.

Growth begins with the hands and feet, then moves to the long bones of the extremities, and finishes with growth of the torso. At the conclusion of the growth spurt, muscle mass and bone density have nearly reached adult levels. Girls tend to experience this growth at an earlier age than boys, finishing by about 16 years of age.

Boys typically reach their growth peak by 18 years, generally becoming taller than girls. Another important milestone of adolescence is the maturation of the endocrine and reproductive systems. Secondary sexual development begins, along with enlargement of the external reproductive organs. Pubic and axillary hair appear. Vocal sound changes in range and depth.

In girls, the deposit of adipose, fat, tissue causes the breasts and thighs to increase in size. Menstruation begins with menarche, the first menstrual bleeding. However, it is not uncommon for some girls to begin menstruation prior to adolescence.

Along with these changes comes the capacity for reproduction. By the middle of adolescence, the male body can produce sperm, and the female body produces eggs. oocytes, psychosocial changes, conflict between young people and their parents is common at this stage.

In seeking to express their independence, adolescents may begin to distance themselves from parents and siblings, desiring privacy and personal space. Most begin spending more time with friends and struggling to create a sense of identity. While trying on different personas, they may begin dressing in a certain style of clothing that fits their desired personality. Self-consciousness increases as both sexes become more concerned with their physical appearance and how they are perceived by peers. Multiple options for gender exist, allowing the adolescent to freely gender identify.

Many adolescents are fixated on their public image and terrified of being embarrassed. At times, adolescents can be intensely emotional. Teenagers often find themselves caught between two worlds. They want to be treated like adults. yet they continue to want and need their parents' support.

Rebellious behavior is common. Smoking, illicit drug use, unprotected sex, and other high-risk behaviors tend to peak at around age 14 to 16 years, along with antisocial behavior, and peer pressure. Even without these particular manifestations, the adolescent struggle toward independence can have devastating setbacks.

Patience and support from family and friends are essential in assisting a young person's transition into adulthood. At this age, young people develop a code of personal ethics, influenced in part by their parents' ethics and values and partly by their peers, and personal experience. Early adults, 19 to 40 years, physical changes. Following adolescence, a person is classified as an early adult, age 19 to 40 years.

The vital signs of early adults do not vary greatly from those seen throughout adulthood. Ideally, the human pulse rate will average around 70 beats per minute, the respiratory rate will stay in the range of 12 to 20 breaths per minute, and the systolic blood pressure will be approximately between 90 and 120 mmHg. From about 19 to 25 years of age, men and women typically reach their physical peak. Lifelong habits and routines are established.

whether healthy or unhealthy, for example, diet, exercise, tobacco use. In the latter years of early adulthood, the effects of aging gradually become evident, that is, subtle wear and tear. Muscle strength decreases, and reflexes slow.

The discs between vertebrae begin to settle, sometimes producing a decrease in height. Metabolism also decreases, while fatty tissue increases. Thus, without adjusting his or her diet and level of activity accordingly, the early adult may experience unwanted weight gain, while simultaneously finding it more difficult to lose weight than in previous years.

Psychosocial Changes Most early adults spend these years focusing on family and career. settling down, getting married, starting a family, and striving for career achievement. Although immensely rewarding, these life events also bring about significant stress.

Interestingly, despite the amount of stress and change, this age group enjoys one of the more stable periods of life psychologically. Middle adults, 41 to 60 years. Physical changes for a middle adult, age 41 to 60 years. The aging process continues to take its toll. Middle adults become more susceptible to vision and hearing loss, cardiovascular health becomes a growing concern, and the incidence of cancer increases.

Women in their late 40s to early 50s enter menopause, the end of menstruation, and the ability to reproduce. Middle adults may experience increased cholesterol levels, decreased cardiac efficiency, and difficulties with weight control. However, Many of the effects of aging can be diminished with proper exercise and a healthy diet.

Middle adults may also have conditions of which they are unaware, including diabetes and hypertension. Whereas the leading cause of death in all age groups younger than 44 years is unintentional injury, the leading cause of death in persons between ages 45 and 64 is cancer. Psychosocial changes.

The pressure to accomplish their professional and relational goals. The need to adjust after their adult children leave the home, that is, empty nest syndrome, and the worries that come with assessing whether they will have the financial means to retire are among the many psychosocial challenges facing the middle adult. However, they have the physical, emotional, and spiritual reserves needed to overcome these challenges, and their health is generally stable. By this time, the parents of middle adults have become older adults, discussed in the next section. many of whom will require care and assistance in completing routine tasks of daily life.

In the United States, many of these older adults receive such care at home, from family members. Therefore, in addition to supporting children departing for college, middle adults may experience an overlapping period during which they must also care for their aging parents. Older adults, 61 years and older, physical changes.

Life expectancy is continually changing. In the early 1900s, the average human life expectancy was 47 years of age. In more modern times, that number has increased to approximately 78 years, with a maximum life expectancy of approximately 120 years. As a result, more and more people will live to become an older adult, age 61 years, and older. How long an individual lives is determined by many factors.

including his or her birth year and country of residence. These two factors correlate with advances in public health, enhanced awareness of healthy eating habits, improved attitudes toward exercise, and access to ever-advancing medical care. Currently, older adults are staying active longer than their ancestors. Thanks to medical advances, they are often able to overcome numerous medical conditions, but may need multiple medications to do so.

Cardiovascular System Cardiac function declines with age, due in large part to atherosclerosis, a condition characterized by the buildup of cholesterol and calcium along the inner walls of blood vessels, resulting in the formation of plaque. As plaque accumulates, the flow of blood through the affected vessels becomes restricted or blocked entirely. More than 60% of people older than 65 years have atherosclerotic disease. Additional cardiovascular effects of aging include a decrease in heart rate. A decline in cardiac output, the amount of blood pumped by the heart per minute, and diminished ability of the heart to increase cardiac output to meet the body's demands.

These changes translate into a heart that is less able to cope with exercise or disease. In the event of a life-threatening illness, the body typically preserves blood pressure by increasing the heart rate. However, because cardiac muscle tends to weaken with age, the increased rate may cause damage to the heart.

Combined with atherosclerosis of sufficient severity, the damage could prove fatal. Because the vascular system of the older adult becomes stiff, blood vessels are unable to dilate and contract as effectively. As a result, the diastolic blood pressure increases, and the heart must work harder to overcome vascular resistance to move blood throughout the body.

Over time, the increase in workload can be detrimental to the heart. Human blood cells originate within bone marrow. But with advancing age, bone marrow is replaced by fatty tissue.

Consequently, the loss of marrow equals a reduction in the body's ability to manufacture new blood cells. Alone. This change is not cause for alarm.

However, in the presence of traumatic injury in which a relatively large volume of blood is lost quickly, the impeded ability to replace lost cells can have devastating effects. Respiratory system. In older adults, the airway increases in size. However, the surface area of the alveoli decreases, as do the elasticity of the lungs, and the strength of the intercostal muscles and diaphragm. Together.

These factors make breathing more laborious for older adults. By the time the older adult is 75 years old, his or her vital capacity, the volume of air moved during the deepest inspiration and expiration, has declined to about 50% of that of a young adult. The chest becomes more rigid, yet more fragile.

Instead of bending and flexing under stress, the calcified rib case is more susceptible to fracture. Normally, These changes in the respiratory system are gradual, often going unnoticed until the onset of a severe, life-threatening condition, in which case the lack of respiratory reserve becomes more pronounced. As the patient ages, the structures protecting the upper airway decrease in function.

Cough and gag reflexes diminish along with the ability to clear secretions. The cilia that line the airway dwindle, and sensation within the airway declines. making it more difficult for the older adult to maintain upper airway patency.

Thus, older adults are at greater risk of aspiration and airway obstruction. When a younger patient inhales, the airway maintains its shape, allowing air to enter. As the smooth muscles of the lower airway weaken with age, strong inhalation can cause the walls of the airway to collapse inward, producing inspiratory wheezing, lower flow rates, and air trapping in the alveoli. Incomplete expiration.

Because of these reductions in function, and because the white blood cells of the airway are less aggressive toward invading organisms, the older patient is more susceptible to lung infections. Endocrine system. Endocrine function also declines with age.

Glucose metabolism slows, while insulin production decreases. Sexually, men often continue to produce sperm long into their 80s. Although the rigidity of the penis typically diminishes over time, the size of a woman's uterus and vagina decreases. Hormone production in both sexes gradually declines, and although sexual desire may lessen, it does not ordinarily cease entirely.

Digestive system Age-related changes in gastric and intestinal functions may inhibit nutritional intake and utilization. Tooth loss can make chewing more difficult. taste buds become less sensitive to salty and sweet foods and food in general may be perceived as bland and flavorless as the senses of smell and taste response begin to fade a decrease in saliva secretion impairs the body's ability to break down complex carbohydrates similarly gastric acid secretion diminishes peristalsis the process by which intestinal contractions move food along the digestive tract slows with age sometimes resulting in constipation and or suppressed feelings of hunger.

And because blood flow to the intestines can drop by as much as 50%, the extraction of vitamins and minerals from digested food can also wane. Gallstones become increasingly common, and changes in the elasticity of the anal sphincter can lead to fecal incontinence. Renal system. Between the ages of 20 to 90 years, the kidneys will decrease in size by 20%.

and their filtration capabilities will decline by as much as 50%. This is due in part to a decrease in blood supply to the nephrons of the kidneys. Nephrons filter blood within the kidney.

In addition, the number of nephrons declines between the ages of 30 and 80 years. As a result of the changes, the renal system's ability to remove waste from the body declines, as does its ability to conserve fluids when needed. Nervous system By the time a person is 80 years of age, the brain has decreased in weight by as much as 10% to 20%. Motor and sensory neural networks are slower and less responsive.

However, the brain's metabolic rate and oxygen consumption remain unchanged. And although it is generally true that the infant brain has a larger number of neurons than its adult counterpart, the adult brain is much more flexible. This is because the number of interconnections between neurons increases with age. These connections produce redundancies within the brain that permit the loss of neurons without a loss of knowledge or skill. However, although cognitive function remains intact throughout most of older adulthood, mental function often declines in the five years immediately preceding death.

One consequence of the reduced number of neurons is the alteration of sleep patterns. Instead of sleeping through the night, the older adult may take a nap during the day, and be awake late at night. It is not uncommon for older adults to develop a biphasic, two-phased, sleep cycle, for example, sleeping from 0-100 to 0-600 hours, and then taking a nap from 1,200 to 1,500 hours, throughout life.

The cranial vault is almost entirely occupied by the brain, the meningeal layers, and the cerebrospinal fluid between these layers. As such, there is virtually no empty space. However, in older adults, the age-related shrinkage of the brain creates a void between the brain and the outermost layer of the meninges.

The resulting space gives the brain room to move inside the cranium. As such, any mechanism that causes a rapid or forceful shifting of the brain has the potential to result in the tearing of bridging veins subsequent bleeding into the open space may go unnoticed for some time the functioning of the peripheral nervous system slows with age sensations become diminished and may be misinterpreted nerve endings deteriorate and the ability of the skin to sense the surroundings becomes hindered hot, cold, sharp and wet objects all can create dangerous situations because the body cannot sense them quickly enough. Combined with prolonged reaction time, and slower reflexes, these sensory alterations may contribute to the higher incidence of falls, and trauma in older adults. Sensory changes Pupillary reaction and ocular movements become more restricted with age.

The pupils are generally smaller in older patients. and the opacity of the eyes lens diminishes visual acuity and causes the pupils to be sluggish in their reaction to light visual distortions are also common in older people sickening of the lens makes it more difficult for the eye to focus especially at close range peripheral fields a vision narrow and increase sensitivity to glare constricts the visual field in late adulthood hearing loss is about four times more common than vision loss Changes in several hearing-related structures may lead to a loss of high-frequency hearing or even deafness. Even so, although it is often assumed that all older adults have difficulty hearing and seeing, many older adults have remarkably good vision and hearing.

Some may need eyeglasses or hearing aids, but this does not mean they are almost deaf or nearly blind. Psychosocial changes Statistics indicate that 95% of older adults live at home. They may have the assistance of family, friends, or home health care, but they are shown to be relatively healthy, active, and independent. The increasing number of older adults in the United States as a result of the baby boom of the 1940s through the 1960s has produced a need for additional assisted living facilities. These facilities allow older adults to live in campus-based communities with people in their own age group, while enjoying the independence and privacy of their own apartment.

and the security of nursing care, maintenance, and food preparation, if desired. Unfortunately, these facilities can be expensive. An additional and important consequence of congregate living facilities is the proximity of the residents to one another.

Although having people close to each other is advantageous from a social interaction standpoint, it limits the natural social distancing that occurs when people live completely independently. Residents of these communities interact with one another and with caregivers on a close, regular basis, which has the disadvantage of enhancing the spread of contagious diseases such as influenza virus and coronavirus. Furthermore, residents of these facilities are necessarily more susceptible to the consequences of these diseases. This helps explain the disproportionate effect that epidemics and pandemics associated with these diseases have on older adults living in continuing care, assisted living.

In nursing home communities, few things in life cause more worry and stress than money problems. Older adults, in particular, may worry about the rising cost of health care. At times, some may have to choose between paying for groceries or paying for medications. More than 50% of all single women in the United States who are 60 years of age or older are living at or below the poverty level. The financial struggle is compounded by the fact that currently, compared to past generations, families of older adults are less likely to assume responsibility for their aging family members.

One challenge facing older adults is the growing realization of their mortality. Everyone dies, but for younger people. The concept of death is little more than an intellectual exercise with a distant connection to reality. By contrast, the death of a spouse, close friend, or other loved one with whom the older adult may have shared one half of a century or more his or her life, can be a strong reminder that death is not only inevitable, but close by.

For some, the loss of loved ones leaves the older adult without a source of social support, and this places them at greater risk of isolation and depression. Fortunately, Many older adults are happy and actively participating in life. With good financial resources, and a good support system of family and friends, adults in their 80s can enjoy life, and continue to feel productive.

Transcript for:Lifespan Development and Vital Signs

Transcript for:
Lifespan Development and Vital Signs