CARE OF OLDER PERSON (RLE)

WEEK 1

AGING – normal physiologic process

GERONTOLOGICAL NURSING – Specialty of nursing

practice pertaining to the caring of older adults.

GERONTOLOGICAL NURSING - works in collaboration

with:

• Other older adults

• Families
• Communities

It aims to support:
• Healthy aging
• Maximum functioning
• Quality of life

GERIATRICS

• The study of old age including its physiology,

pathology, diagnosis, as well as management
of disorders and diseases.

GERONTOLOGY

• A combined biologic, physiologic study or

older adults.

The increasing number of old people is like a

DEMOGRAPHICS OF AGING challenge and opportunity both
Aging is a process not a disease

FACTORS INFLUENCING AGING

• Heredity
• Nutrition
• Health status
• Life experiences
• Environment
• Activity

CHANGES IN AGING

• Physiological
• Psychological-social
• Cognitive
PHYSICAL CHANGES: WEEK 2

• These happen to everyone. THEORIES OF AGING

• The rate and degree of change vary with each
person. I. Biologic theories
• They depend on II. Psychosocial theories
 Diet III. Developmental theories
 Health
 Exercise
 Stress BIOLOGIC THEORIES OF AGING - explains why the
 Environment physical changes of aging occur.
 Heredity and other factors.
• Quality of life does not have to decline. • Programmed theory/ Biological clock theory
• Body processes slow down. • The run out of program theory
• Energy level and body efficiency decline. • Gene theory
• Changes are slow over many years. • Molecular theory
• Often they are not seen for a long time. • Cellular theories
• Normal aging does not mean loss of health.
PROGRAMMED THEORY
 Individuals have a genetic program
specifying an unknown but
PSYCHOLOGICAL-SOCIAL CHANGES
predetermined number of cell
• Growing old can threaten self-esteem and divisions.
independence.  Example:
• Social roles change-some are now being cared  atrophy of the thymus,
for by their children  menopause
 skin changes
 graying of the hair
 Aging has a biological timetable or
How people cope with aging depends on: internal biological clock
• Health status
• Life experiences RUN OUT OF PROGRAM THEORY
• Finances  Every person has a limited amount of
• Education genetic material that will run out over
• Social support systems time.
 When genes matures there are no
more programs to be played and as
cells age
1. Physical reminders of growing old include:  There may be chance of inactivation
 graying hair, of genes that cannot be turned
 wrinkles,
 and slow movements. GENE THEORY
2. Adjusting to the death of a partner,  Suggests the possibility of one or
3. Family members and friends are common. more genes that, over time, become
4. The person faces his or her own death. active and cause the regular aging
changes and life span limitations.
 The presence of imperfect genes
activated over lengthy periods of time
causes organism failure.
 Two gene types:
1) supports growth and vigor
2) supports senescence and
deterioration.
WEEK 3-4 The PROCEED phase

HEALTH PROMOTION & HEALTH MAINTAINANCE
FOR OLDER ADULTS
PURPOSE OF HEALTH PROMOTION AND DISEASE
PREVENTION:
 To reduce the potential years of life lost in
premature mortality and ensure a higher
quality of remaining life.
Stands for Policy, Regulatory, and Organizational
Constructs in Educational and Environmental
Development, - examines implementation and
evaluation.
This model is particularly useful in planning health
education programs

3. Health Promotion Model.

This model presumes an active role by the
HEALTH PROMOTION & DISEASE PREVENTION participant in developing and deciding the
ACTIVITIES: context in which health behaviors will be
modified.
1. Primary prevention – prevention of disease
before it occurs.
Three basic categories :
2. Secondary prevention – detection of disease
1) older adult’s characteristics and life
at an early stage.
experiences,
3. Tertiary prevention – care of the established
2) their perceived personal decision-
disease
making (self-efficacy),
4. Quaternary prevention – limiting disability
3) the effect of the plan of action on
caused by chronic symptoms.
health-promoting behaviors
Primary prevention

 Exercise
 Passive/active immunization against disease
 Health protecting education & counseling BARRIERS TO HEALTH PROMOTION AND DISEASE
 Fall prevention program PREVENTION

Secondary Prevention 1. Older adults’ unwillingness to participate

• Socioeconomic factors,
• Screening test for cancer
• Beliefs and attitudes of both patients
Tertiary prevention and providers
• Access to resources.
• Restoring the person’s highest function • Generally, individuals who are
younger, married, have fewer health
Quaternary prevention
problems and have better cognitive
• Reduce any loss of function through status are more likely to participate in
adaptation primary and secondary health-
promoting activities.

2. Patient barriers unrelated to health beliefs

MODELS OF HEALTH PROMOTION include:
1. ONPRIME Model • lack of transportation
The acronym stands for: • financial limitations
 Organizing • Ethnic and cultural factors may have a
 Needs resources assessment negative effect on healthcare–seeking
 Priority setting behaviors
 Research • Older adults have differences in their
 Intervention willingness to engage in health-
 Monitoring promoting activities.
 Evaluation
With advancing age, they may have
2. The PRECEDE/PROCEED Model less interest in engaging in health
The PRECEDE phase, promotion activities for the purpose
Stands for Predisposing, Reinforcing, and of lengthening life and a greater
Enabling Constructs in interest in engaging in these activities
Education/Environmental Diagnosis and only if they improve their current
Evaluation - examines life quality, health quality of life.
goals, and health problems
THE NURSE’S ROLE IN HEALTH PROMOTION AND  means for disseminating
DISEASE PREVENTION health promotion information
to a group of older adults
1. Requisite Knowledge
• The knowledge needed for health
promotion and disease prevention
activities includes an understanding 5. Evaluation
of basic human needs.  Determining the effectiveness of your
care plan.
2. Assessment – looking at potential health  Example: Was the patient able
hazards to identify risk factors for illness or to achieve the mutually
injury. established goals?
Contributing risk factors:  The nurse should consider
1) Habits why these goals were or were
2) Lifestyle patterns not achieved and negotiate
3) Personal & medical history with the patient to establish
4) Environmental conditions appropriate and realistic
revised
Basic functional health patterns of older adults that
are important to assess:

1. Self-perception or self-concept pattern SUPPORTING EMPOWERMENT OF OLDER ADULTS

2. Roles or relationships pattern
 The use of an individualized approach and the
3. Health perception or health management
empowerment of older adults to make their
pattern
own healthcare decisions will help them
4. Nutritional or metabolic pattern
achieve their optimal level of health, function,
5. Coping or stress-tolerance pattern
and quality of life.
6. Cognitive or perceptual pattern
7. Value or belief pattern
8. Activity or exercise pattern
9. Rest or sleep pattern  Several nurses have volunteered to give flu
10. Sexuality or reproductive pattern shots to older adults at a senior center.
11. Elimination pattern
 When the line to receive the injections slows
3. Planning down, one nurse notices a table of four older
• The role of nursing in promoting women playing cards.
health among older adults relies on
organized planning.  None of the women approached the flu shot
• Planning involves understanding and registration table.
use of the social–ecologic model, as
well as behavior change and behavior 1. What actions, if any, are appropriate
change theories such as the theory of for the volunteer nurses in this
self-efficacy situation?
2. Does the fact that the nurses are
Self-efficacy theory volunteers change any potential
“The stronger the individual’s belief course of action?
that he or she can perform a behavior
and the stronger his or her belief in a
positive benefit to performing the
behavior, the more likely he or she is
to engage in the given activity”.

4. Implemantation
• Begins by adopting a proactive stance
toward an action plan for the health
promotion of older adults.

Examples of implementing a proactive

stance:
 Seeking activities,
 locations,
WEEK 4-5

Conversations might be difficult for people who have

sensory loss, leading to:

 Frustrations – anxiety – further emotional

difficulties expressed in:
 Anger – to self or others
 Withdrawal from social efforts
 Embarrassment

Nurses use some strategies for efficiently DRIVING

communicating with elderly people who may not
 Older adults value the independence of
hear or see as well as they once did.
driving, changes that happen with age may
alter a person’s ability to drive safely.
 Talking with an older person about his or her
EFFECTIVE COMMUNICATION WITH THE ELDERLY: driving is often difficult.
For many older adults, “giving up the keys”
1. Face-to-face conversation - eliminates any
means a loss of freedom of choice and
possible background distractions and lets the
movement.
elder know that they have the nurse’s full
attention.
2. Maintaining eye contact - allows the elder to
read facial expressions more, along with ELDERLY ABUSE
eradicating any outside distractions.
Mistreatments of older adults can be by family
3. Communicate Clearly - Speak at a volume
members, strangers, health care providers,
(normal tone) and pace that the other person
caregivers, or friends.
can understand. Be aware of any sensory
problems they may have. TYPES:
4. Listen - Make it known that you are listening
to them by responding to what they are 1. Physical
saying. A simple nod, smile, or word of 2. Emotional
acknowledgment is sometimes enough. This 3. Neglect
may make them feel that they are important. 4. Abandonment
5. Be patient - their reactions may be a little 5. Sexual abuse
slower, you may not be able to get your point 6. Financial abuse
immediately.
6. Make them feel comfortable – make sure that VULNERABLE OLDER ADULTS
they have a comfortable seat with back rest.  Older adults with disabilities
7. Older adults with different background have
 Memory problems or dementia
different expectations – be sensitive to
 Adults dependent with ADLs.
cultural differences that can affect
communication with older adults.

Financial abuse also includes:

 Financial neglect: ignoring or avoiding an

COMMUNICATING SENSITIVE TOPICS
ADVANCE CARE PLANNING
 Explore ways to help older adults to make an
advanced plan of care decisions.
 Choosing a health care proxy – one who
makes the decision if the older person cannot
do it by him/herself.
 e.g., surrogate or representative for
the client
 Preparing a living will
older adult’s financial needs or
responsibilities, such as paying rent or
mortgage, medical expenses or insurance,
utility bills, or property taxes.
 Financial exploitation: the misuse,
mismanagement, or exploitation of property,
belongings, or assets of older adults.
EXAMPLE: using an older adult’s assets
without consent, under false pretenses, or
through intimidation or manipulation
 Health care fraud: a form of financial abuse
committed by health care providers, hospital
staff, or other health care workers.
EXAMPLE:
 Intentionally overcharging, billing
twice for the same service,
  Charging for care that wasn’t and taking the time to get to know their older adult
provided patients.
 Falsifying Medicaid or Medicare
claims.

SIGNS OF ABUSE: (even if older adults will not LONG-TERM CARE

disclose their situation, signs may lead nurses to
conclude such a situation)
1. Withdrawn or act agitated or violent
2. Have unexplained pressure marks, bruises,
burns, cuts, or scars
3. Displays trauma symptoms, such as pacing
back and forth.
4. Develop conditions that can be avoided, such
as bedsores.
5. Sloppy appearance, such as unwashed hair,
soiled clothes, or poor oral hygiene.
6. Experience sudden and unexpected financial
losses or unpaid bills.
7. Lack or no personal health care items such as
glasses, a walker, dentures, or hearing aid.
8. Have hazardous, unsafe, or unclean living
conditions
 Effective communication is crucial for patient
care, particularly in long-term care (LTC)
facilities.
 Family dynamics change during nursing
home admission, causing stress, guilt, anger,
exhaustion, financial burdens, mistrust, and
confusion.
 There is a risk of miscommunication between
the new caregivers and the family.. -
Minimizing such a communication gap will
result in improved patient and family
satisfaction

END OF LIFE

End-of-life care in hospitals

In a hospital setting, nurses and medical

professionals understand the needs of a dying
person. That can be very reassuring to both the
patient and their family.

 Patients receive regular care,

 Some hospitals have palliative and hospice
care teams that can assist with managing
uncomfortable symptoms at the end of life,
such as digestive issues or pain.
 Doctors and nurses help with making medical
decisions for patients or families.

End-of-life care in nursing homes or other care

facilities

 Patients in nursing homes or long-term care

facilities receive end-of-life care there.
 Patients may already have a relationship with
staff who work there, which can help make
the care feel more personalized than in a
hospital

HEALTH CARE COST

Ageism – may lead to under treatment or over

treating older adult patients.

Ageism is the practice of discriminating against and

categorizing senior citizens.

It is essential that elderly individuals feel at ease with

their caregivers. Healthcare professionals can assist
in preventing many of the problems by being patient