NCM 113 _ PRELIMS

✅➜❌✨ 1. STAGES OF OLDER ADULT

 3 PHASES/ STAGES
Aging Perspectives and Demography  Young old: 65 to 75 years (60-69)
 Middle old: 75 to 85 years (70-79)
Aging: Normal process of time-related change. Natural  Oldest old: above 85 years (fastest growing
phenomenon. We should be sensitive to what to call them up) (80 and above)
 Centenarians--> people over 100 years old
Ageism:
 A bias against older people 2. Global Aging
 Based perception solely on their chronological age not  United Nations (2020)
on their functional status  The global population aged 60 years old and above
 Stereotyping characteristics of elderly accounts to 962 Million
 Examples: weak, memory loss, poor, burden, dependent,  In USA, around 53.7 Million aging population
unreliable, lonely, with terminal illness or medical  Kaya nagrerecruit ng immigrant nurses
conditions because of the increasing aging population
 Increased the demand for healthcare
Geriatrics:
 The branch of medicine that is used to study old age 3. Life Expectancy
 Focuses on physiology, pathology, diagnosis, and  Average number of years a person is expected to
Medical management of the disorders and diseases of live
older adults  Life expectancy increased to
 Curative aspect, paggaling ng patient  Men: 75 yrs old
Gerontology:  Women: 80 yrs old
 Refers to the combined biologic, psychological, and 4. Life Span
sociologic study of older adults within their environment  Refers to the maximum number of years an
individual is expected to live in absence of diseases
Gerontologic nursing  U.S. Census (2010) have reported that Life span
 The field of nursing that specializes in the nursing elderly group can live until the age of:
process  men: 85 y/o
 Providing care for older adult  women: 87 y/o
 It includes assessment, nursing diagnosis, planning,
implementation, and evaluation of older adults 5. Aging in the Philippines
 All nursing settings from acute care, intermediate,  LIFE EXPECTANCY
skilled care, extended facilities, and also in community  In Philippines, it was estimated that there are
4.6 Million senior citizens
DEMOGRAPHICS OF AGING  For Filipinos:
 Stages/ Phases of Older Adult  57.4 years for males
 Global Aging  63.2 years for females
 Aging in the Philippines  By 2030, life expectancy is projected to
 Life Expectancy increase of 4.0 years for males and 4.7 years
 Life Span for females
 In Philippines, Whereas, the 80 years and
Aging older population is expected to increase by
 Starts at age 60 yearsold 0.4% from 2010 to 2030.
 Or Elderly, Older adult/person, Late adulthood, or  Age Structures
Senior Citizen  The Philippines resembles many other
 It is the fastest growing age group than the rest of developing countries
population  There is a greater proportion of younger
 Composed of 12.8%of the population Filipinos in comparison to Older Filipinos
 In 2030, it increase to 22% of population  In Philippines, it was estimated that there are
 Increasing aging population (very old people) 4.6 Million senior citizens (Less than 5% of the
Because of declining fertility rate and rising life population)
expectancy
 Baby boomers-born between 1940-1960 NURSING IMPLICATIONS
1. Nurses are challenged to develop strategies to address
high prevalence of chronic illness to aging population
2. Sufficiency and availability of health services
3. Assess their children who are face competing demands
to care for their aging parents while taking care of their
own dependent children
Health Care Cost
 Health care financing like government health programs
I. Medicare/Medicaid: major dominant payer in USA
that funds nursing homes costs, hospital services
cost
II. Philhealth: elderly enjoy 20% discount plus VAT
exemption during private hospital confinement
Life Care Plans
 Individualized document that assess and evaluate
elder’s present and future health care and living
needs
 Average cost Php 250,000- 1 Million
 Example: Sunlife, Manulife, PhilAm life
 Blue print for what is expected in long-term Care
 Standardized and efficient guidelines for medical and
ancillary quality-of-life services
 Provides information about factors affecting
individual’s health care and quality of life
 Provides guidelines for anticipated patient care needs
for family, insurance company, attorney, medical
professionals
Impact of Aging Members in the Family
Implications:
 The tradition of caring for the old still lingers in
Filipino family
 The Older Filipinos enjoy a significant amount of
care and support from their spouse and children
 Support: Family, emotional, financial,
Companionship
Republic Act (RA) 9994 or the Expanded Senior Citizen Act of
2010 Caring for the Older Persons by the Family
 To encourage their families and the communities
they live with to reaffirm the valued Filipino
tradition of caring for their senior citizens
 To provide a comprehensive health care for senior
citizens to foster their capacity to attain a more
meaningful and productive ageing.
Philippine Government’s Program for the Care of Older
Persons
 Home Care Support Services for Senior Citizens
Department of Social Welfare and Development
(DSWD)
 The need to improve capacities of family
members, kinship carers in caring for sick,
frail, bedridden or disabled elderly family
members
 To promote stronger family relationship and
social responsibility.
Communication Documentation in Older Person
Communication
 This refers to the transfer of information and message
from one person to another.
 It is an ongoing process of creating an interaction or
shared understanding between two people.
Modes of Communication
1. Verbal
2. Non-verbal
3. Written
VERBAL
 It refers to spoken words, message
 Most intimate contact: mode- terminating employee,
conflict confrontation
 Examples: face-to-face, conversation, one-on-one talk,
telephone call
NON-VERBAL
 These are nonverbal messages or meta-communication
 More powerful than spoken words, accompanies verbal
communication
 Examples: Elderly patient’s facial expressions, head nod,
gestures, body posture/movement, touch, eye contact,
voice tone

WRITTEN
 Most formal mode of communication
 It can be types, printed or hand written
 Examples: Letter, white board, pen and paper, patient’s
chart, nurses notes, doctor’s notes, physician order,
endorsement
Stages of Communication Cycle
Therapeutic Communication
 Nurse therapeutic relationship with a client is an
interpersonal helping process
 Simply developing a good bedside manner.
 Careful to respond to patient’s questions in a helpful
and caring manner.
 Correctly observe ,evaluate, and respond when patient
communicates with the nurse
The Art of Therapeutic Communication
 Nurse must relate their own experiences concerning
illness and death so that patient will be comfortable
 Nurses must use self- discovery, self- discussion and
self-awareness
 Nurse must develop skills, competence, and expertise
in effective communication to elderly patient
 Encourage to promote reflection, reading, and journal
writing
Guidelines for Communication with Patients’ Family
1. Simply being fully present during any opportunity for
questions, concerns, problems
2. Don’t make promises you cant keep.
3. Accept and respect the patient decision
4. Talk with patient, family members, friends, and
colleagues
5. Patient and family must be given adequate and
sufficient time to respond/speak/reply/absorb the news
6. Try not to overwhelm the patient with embarrassing or
personal
Techniques for Communication with Elders
ESTABLISHING THE SETTING:
1. Conducted in a safe, right, and conducive settings
2. Provide a comfortable environment, quiet peaceful area
3. Establish a relaxed, unhurried setting.
4. Sit-down when speaking to the patient.
5. Sit face-to-faceand maintain eye contact.
6. Provide for privacy.
7. Disclosure of important information in private areas
8. Avoid disturbances, distractions, unnecessary
interruptions, noise
TIPS FOR STAFF
 Schedule older patients earlier in the day
 Greet them to ensure they are comfortable
 Seat in quiet/comfortable area
 Keep patient relaxed/focused
 Physically escort patient
 Check from time-to-time
 Always say goodbye
Improving Communication Skills among Gerontology Nurses
Verbal Communication Skills
 Let the patient do the talking.
 Ask one question at a time.
 Summarize the most important points
 Give patient time to answer, to ask a question, to
express self
 Use language that is understandable to the patient.
 Avoid leading question. You want the patient to tell you
what he is feeling.
 Avoid how or why questions, they tend to be
intimidating.
 Avoid the use of cliché statement like “don’t worry”...
 Avoid question which require only a simple “yes” or
“no” answer.
 Avoid canned responses: “I know just how you feel.”
EFFECTIVE COMMUNICATION
1. Convey honesty, empathy and trustworthiness.
2. Must speak clearly, slowly, loudly, short, concise
3. Allow for extra time for older patients
4. Encourage simple conversation
5. Offer large-print books, easy to read
6. Provide mnemonics, sensory cues, chart, models,
pictures
7. Ask patient to wear reading glass, magnifier, hearing
aids
Improving Communication Skills among Gerontology Nurses
1. Have a clear, brief, simple, complete instruction.
2. Avoid speaking too fast or too slow.
3. Active and attentive listening is the key.
4. Use short, simple, common words/sentences.
5. Pronounce words correctly.
6. Encourage feedback, summarize, redundancy,
7. restate and repeating information.
8. The nurse needs to be sensitive to the emotional
feelings of patient
9. Offer therapeutic touch, handkerchief, tissue
Gerontologic Health Care Facilities
Health Care Institutions
I. Hospital
II. Specialty hospital
III. Health care facilities
A. Hospital
 An institution the primary function of which is to
provide inpatient diagnostic and therapeutic
services for a variety of medical and surgical
conditions
 General hospitals admit individuals requiring a
variety of services
  Ex. medical, surgical, obstetric, and paediatric.
B. Specialty hospital
 A hospital that admits only certain types of
patients or with specified illnesses or conditions.
 Other hospitals offer only specialty services
 Example: psychiatric, pediatric, lung, kidney, cardio,
psychiatric, and infectious diseases
C. Health Care Facilities
 Any facility or establishment that is engaged in
direct patient care on site.
 Example: Hospice care, nursing home, extended
facilities, and etc.
ACUTE CARE
HOSPITAL PROVIDING
 Short period of time, acute care, and episodic care
 It resolving/treating a new and acute illness.
 Short-term hospital stays (days to week),
shortened hospital stay environment.
 Professional care, home treatment, diagnostics,
emergency medical services.
 Central in planning services for the older adult
upon discharge: follow-up care, transportation,
home health aide and homemaking services, adult
day care
Goals:
1. health protection, health promotion and wellbeing of
the older adult
2. health-promotion strategies (smoking-cessation, stress-
management, weight-loss, or exercise)
Chronic Care
 The ongoing provision of care provides medical,
functional, psychological, social, environmental
and spiritual care services
 For patients with serious and persistent health
conditions
 To help optimize older adults’ functional
independence and well-being.
Ambulatory Care
 Institutional Organized Health Setting
 It provides outpatient basic health services
(surgeries and treatments)
 No overnight stay in hospital is required to
ambulatory patients.
Adult Day Care
 Or Day Therapy/Care Centers
 Non-residential facility that offers daily nursing
care and social opportunities
 It enables family members to carry on daily
activities while the older person is at the day care
center
 For adults who cannot be left at home alone but
do not need to be in an institution
Services: nursing care, treatment/medication, nutrition,
socialization, exercise programs, stimulation, counselling and
physical therapy.
 It facilitates continuity between day care and home
care.
 Provides transitional care-health, nutrition, daily
living needs
Community Support Services
 Goal:Community-based services helps the older
person maintain independence.
Informal sources of help
 Family, friends, church members, neighbors
 Senior centers have social support, health promotion
activities, and nutritious noontime meal services.
Community services
 It include telephone reassurance, friendly visitors,
home health aides, homemakers, home repair,
home-delivered meals, chore services,
employment resource
Examples: Respite Care, Adult Day Care Center, Home for the
Aged, Senior Center, Housing, Veteran’s Home Care Programs
Hospice Care
 It focuses on the promotion, improving or
maintaining of quality of life, palliative care,
supportive services, compassionate care to dying
patients
 Advanced, terminal, life-limiting illness, not going
to survive illness, last phase of incurable disease,
serious illness, a dying patient
 Patient needs to live life fully, live as comfortable
as possible, relief of symptoms, not saving life
 These are a dignified alternative for patient with an
end-stage disease who is not expected to live long.
 Providing physical, psychological, social, and
spiritual dimensions of care. Facilitate early
discussions about a patient’s wishes and goals and
for end-of-life care
Assisted Living Facility
 Provide supportive residential housing and
appealing housing alternative, home-like
environment
 Older adults with minor to moderate functional
impairment
 24-hour coverage supervision, three meals a day
w/ snacks
Services-->range from personal, health care, and recreational
services.
Costly-->monthly rate, additional costs
Nursing Home
 It specializes in services for older persons who can
no longer live independently or can no longer live
at home
  Provide specialized care to seniors with severe
illness, injuries.
 Sheltered environment providing long- term care
by registered nurses and nursing assistants.
Services-->geriatric assessment, rehabilitation, medical care,
and nursing services, therapy services, and residential
gerontological care
 Provides accommodation, basic care services,
domestic services, helps in activities of daily living
Skilled Nursing Facility
 Intermediate Nursing Care
 It provide 24-hour nursing care to older adults who
are unable to care for themselves.
Services-->medication administration, nursing care, wound
are, daily assessment, meals, and assistance with ADLs.
Other skilled services- physical therapy, respiratory therapy,
speech-language pathology services, and occupational
therapy rehabilitative. in the hospital.
Retirement Center
 Also known as Retirement Village, Continuing Care
Retirement Communities
 Full service communities offering long-term
contracts
 Continuum of care- retirement, assisted living
nursing services all on one campus”.
Purpose--> to facilitate aging in place.
Continuing Care Retirement Communities
Several levels of care--> independent living, assisted living,
periodic home care, skilled nursing, housing services, nursing
care, basic recreational services
Very expensive--> full daily rates for long- term nursing care,
purchase a home within the community and then pay a
monthly fee
Gerontologic Health Care Team
Gerontologist Geriartician
Or the Geriatric Health Care Team
 A medical doctor who specializes in the care of the
elderly
 Provides treatment of diseases affecting the older
adults as they age.
 It include diagnosing and treating a wide range of
conditions like dementia, alzheimer, cancer,
hearing/visual loss, osteoarthritis, osteoporosis,
diabetes, heart failure.
Gerontology Nurse Practitioner
 An advance nurse practitioner (ANP) or clinical
nurse specialist(CNS) with graduate level of
education (master and doctorate degree) in
gerontology
 Diagnose,treat and manage chronic illness while
coordinating care with physicians
Gerontology Nurse Practitioner
 Risk assessment, immunization, screening test,
examines patient, counseling, health check-up,
preventive care, provides prescription
Gerontology Nurse
 Nurse Gerontologist
 Nursing specialty that provides care for the
older adults
 Works in collaboration with older adults, their
families and communities.
 Focuses healthy aging, maximum functioning ,
quality of life
 Provides routine assessment, physical care,
administer medications, patient education,
explain therapeutic regimens
Nursing Assistant
 Personal care attendant (PCA),
 patient support assistant (PSA),
 Certified nursing assistant licensed practical nurse
(LPN),
 nursing assistant (NA)
 nursing aide
 nursing orderly
 Assistants in Nursing are health care staff who
assume delegated aspects of basic care.
 Some of these provider may have
standardized education while others do not.
 Take care patients in hospitals, long-term care
facilities, nursing homes
These tasks include -->bathing, assisting with feeding
collecting specimens and transporting individuals.
Delegate unregulated nursing roles-->take vital signs,
cleaning/sterilizing treatment area, serves meal/feeding
patient, bathing/dressing, personal grooming changing linen,
turning/moving patient,
Occupational Therapist
 Providing therapeutic support for older adults
experiencing sensory changes, motor disabilities,
physical injuries, impaired functioning
 Help someone recover by improving their ability
to do their day-to-day tasks or everyday routinary
activities
 Assists individuals with impaired functioning to
function better without assistance and with
independence
 Helps patients to perform skills needed for
activities of daily living (cooking, feeding, bathing,
dressing), occupation/work and everyday activities
(pick up, write, run)
Physical Therapist  They usually offer regularly scheduled religious
 Or Geriatric Physical Therapist, physiotherapist services.
 Helps patients promote and restore health by  The nurse is often instrumental in identifying the
restoring balance, improving mobility, movement, person’s desire for spiritual support
and exercise
 Assist older to recover from trauma, injuries,
paralysis
 Example: Stroke, arthritis, osteoporosis,
Alzheimer
 Reduce pain and prevent falls and contracture
 Work in nursing home, skilled nursing facility,
extended facility, community support service
agency

Dietician/ Nutritonist
 Nutritionist is a person w/ special knowledge about
nutrition and food.
 Dietitian has special knowledge about therapeutic
diets required to maintain health and to treat
disease.
 They are generally concerned with special diets in
the hospitals to meet the nutritional needs of
individuals
 Supervise the preparation of meals to ensure that
individuals receive the proper diet
 Recommends healthy diets and gives advice to
patients and families about balanced diets

Case Manager
 Role is to ensure that older adults receive sound
and appropriate care in the best setting.
 To ensure that the best care is delivered, oversees
the processes of care delivered
 This role is often being the most involved in the
person’s care.
 Serve as a patient, family and facility advocate
 Address individual’s concerns, needs; Manage
conflict, issues,problems

Medical Social Worker

 A social worker counsels patients and significant
others regarding problems, such as finances, family
condition, living arrangement, day-to-day living.
 Provides support and assistance to not unusual for
health problems
 They provide care by conducting psychosocial
assessments
 To identify mental and emotional distress, crisis,
psychosocial help

Spiritual Support Personnel

 Chaplains, pastors, clergy, rabbis, priests, spiritual
advisors
 Health care team attend the spiritual needs of the
patients.
 Services on a regular or on-call basis or full-time
chaplains,hospital-affiliated