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1Introduction toGerontological NursingNURS 4100 Care of the Older AdultFall 2013Joy Shepard, PhD(c), MSN, RN, CNE, BC
2Objectives Explain different ways older adults are viewed incontemporary society Describe major characteristics of toda...
3"Old age is like everything else.To make a success of it youvegot to start young." TheodoreRoosevelt"Anyone who stops lea...
4Aging: A Natural Process…NOT a disease!
5Defining Old AgeChronological age – Exact agefrom birthBiological age - Age determined byphysiology rather than chronol...
6Activities of Daily Living (ADLs) Basic: Bathing (hygiene,grooming) Dressing Eating Toileting Transferring(mobility...
7
8Characteristics of AgingPopulation “Typical” older person? Age 65 start of “oldage?” Energetic, vibrant,influential, d...
9Gerontological Nursing “The purpose of gerontological nursing isnot to save lives, but to prevent untimelydeath and need...
10Definition of Terms Ageism - Prejudice, negative stereotyping basedsolely on age Geriatrics - Branch of medicine that ...
11Definition of Terms Primary prevention – Activities directedtoward the protection from or avoidance ofpotential health ...
12Gerontological Nursing:Specialty Area Nursing – caring for the vulnerable Gerontological nursing – newest &youngest, m...
GerontologyGerontology: ComplexComplex FieldEncompassing ThreeThree Levels of Complexity 1. Normal agingchanges 2. Chron...
14Development ofGerontological Nursing 1904: First article on care of the aged publishedin the American Journal of Nursin...
15Development ofGerontological Nursing 1965: formation of the Administration on Aging,Older Americans Act, Medicare, & Me...
16Development ofGerontological Nursing Growth in the last few decades– Increase in gerontological nursing texts– Increase...
17Advanced Practice NursingRoles Gerontological Clinical Nurse Specialist Gerontological Nurse Practitioner Preparation...
Programs Adult-Gerontology Nurse Practitioner– ECU College of Nursing (Online) Adult-Gerontology Nurse Practitioner– UNC...
19In Great Demand… Challenges for thefuture– Gerontologicalnursing as adynamic specialty– Multitude ofopportunities– Deve...
20Geriatric Patients… TheCore Business of HealthCare
21An Aging Population Increased #’s older people, particularly “old-old” 41.4 million older adults in 2011 – 13.3% ofthe...
22
23An Aging Population As the aging population expands, it will affectall aspects of society (esp healthcare) Currently 1...
24Myths & Stereotypes of Aging
25Ageism Prejudice towards anyage group Defined as “theprejudices andstereotypes that areapplied to older peoplesheerly ...
True or False???To be old is to be sick?
27Myths & Stereotypes of Aging Many cultures: older people accorded respect American society is youth-driven– Aging syno...
28Myths of Aging “You can’t teach an old dog newtricks” “Dirty old man” Disease & disability are inevitablepart of agin...
29Myths of Aging Senility is a result of aging Incontinence is a result ofaging Older adults are no longerinterested in...
30*Realities of Aging*
31Myths of Aging Lead to: Ageism Reduced healthcare services Segregation of elders from mainstream society Nurse recru...
32The Older Adult Population
33Subsets of the Older AdultPopulation Young-old: 65-74 yrs Middle-old: 75-84 yrs Old-old: 85-100 yrs Centenarians: 10...
The Graying of the Population34
35Number of Old and Old-Old
Distribution of the Projected OlderPopulation by Age for the US: 2010 to 2050
37An Aging Population -Increased Life Expectancy Older adults currently 13% of U.S. population By 2030 – 20% of populati...
38First Wave of 76 Million BabyBoomers Started Turning 65in 2011!
39Age Distribution of U.S.Population
40Factors Influencing IncreasedLife Expectancy Advancements in disease control & healthtechnology (esp. vaccines & antibi...
41Life Expectancy: Race andGender Gap between women& men (narrowing) Gap between Whites& Blacks (narrowing)– Societal is...
43Marital Status & LivingArrangementsWomen more likely to be widowed,living alone in old ageMore than half of women ≥ 65...
44Aging Women Women outlive men, outnumbermen 4 to 3– Feminization of later lifeWomen predominate at older ages,proportio...
Gender Distribution of ElderlyAmericans, by Age Group, 2010
46Aging Men Shorter life expectancy,die at younger age More likely to remarry ifwidowed– Widows outnumberwidowers 5 to 1...
47
Marital Status of Older Adults48
49Income of Older Adults 8.7% live below poverty level “Fixed” income “Asset rich and cash poor” – What does thismean?...
Geographic Distribution: OlderAdults Greatest number(percentage wise):Florida, Maine, WestVirginia, Pennsylvania,Montana...
51
52Illness in the Older Population
53Health Status of Older Adults:Acute Conditions (p. 8)Relatively fewer acute illnesses (i.e.,infections & parasites, col...
54Illness in the Older Population Chronic illness – major concern for older adult Chronic illnesses – cause disabilities...
55Health Status of Older Adults:Chronic ConditionsChronic Conditions Major problem: increaseswith age Most have at least...
56Leading Chronic Conditions(Box 1-3, p. 8) 1. Arthritis 2. Hypertension 3. Hearingimpairments 4. Heart conditions 5....
QuestionThe leading chronic conditionassociated with older adults is: (A) Arthritis (B) Diabetes (C) Hearing impairmen...
58Question Is the following statement true or false? Chronic disorders most prevalent in theolder adult population are o...
CDC: Chronic Diseases are LeadingCauses of Death & Disability in U.S.*7 of 10 deaths each year are from chronic diseases*1...
 Heart diseaseHeart disease Malignant neoplasms (cancer)Malignant neoplasms (cancer) Chronic lower respiratory dz (COPD...
http://www.cdc.gov/nchs/data/databriefs/db64.pdf
63Question When planning a course about mortality rates fora group of elderly clients, emphasis should begiven to which o...
64Health Promotion & DiseasePrevention
65Health Promotion Health promotion: “the science and art of helping peoplechange their lifestyle to move toward a state ...
Healthy People 2020 Vision: A society in which all people live long, healthy livesA society in which all people live lon...
67Proposed Healthy People 2020 Goalsfor Older Adults Reduce the proportion of older adults who have moderate tosevere fun...
68Proposed Healthy People 2020 Goalsfor Older Adults Cont’d… Reduce the rate of pressure ulcer-related hospitalizations a...
6970% Physical Decline due toModifiable Risk FactorsInactivityPoor nutritionTobaccoAlcohol Lack of preventivecare
7070% Physical DeclineModifiable Through Physical activity Improved nutrition Smoking cessation Alcohol in moderation...
71QuestionName modifiable risk factors forphysical decline and illness in olderadults…Name non-modifiable risk factors f...
72Health Promotion & DiseasePrevention Chronic conditions developover time Older adults must bealerted to means ofpreven...
73Health Promotion and DiseasePrevention Nurses should be aggressive in health promotion efforts Older adults must be al...
Primary PreventionIn primary prevention, a disorderis actually prevented fromdeveloping…74
75Primary Prevention – HealthPromotion Behaviors Education: Patient, family, caregiver; health care provider– Falls preve...
76Primary Prevention – HealthPromotion Behaviors Eight hours of sleep a night Positive mental attitude– Encourage family...
Secondary PreventionIn secondary prevention, diseasethat has not yet become symptomaticis detected and treated early, the...
78Secondary Prevention – EarlyDiagnosis, Prompt Treatment Important components ofhealth maintenance practices– Self-care,...
Tertiary Prevention In tertiary prevention, an existing, usuallychronic disease is managed to preventcomplications or fur...
80Tertiary Prevention –Restoration, Rehabilitation Manage clinical diseases (esp chronic diseases) to preventthem from pr...
Question Which of the following is an example ofprimary prevention? A. Administering digoxin to treat heart failure B. ...
82Question The gerontological nurse is teaching 86-year-oldPatricia Smith and her family about exercise programsfor the e...
Question Which of the following describes secondaryprevention? A. aims to prevent disease from developing in the first p...
Question As they get older, men are more likely to bescreened for prostate cancer: 48% of men 50 to 59years as compared t...
Question While Medicare pays for some medical screenings for olderAmericans, nine of every ten adults over the age of 65 ...
86Prolongation of Frailty vsCompression of Morbidity?
87Functional Assessment of theOlder Adult
88Nursing Process and the OlderAdult Assessment– Health History– Physical Examination Goal: Individualize & tailor asses...
89Assessment of Function Three domainsThree domains: ADLs, IADLs, & mobility Systematic, focus on individual needs Two ...
90AssessmentHealth History– Nurse draws facts and interpretations fromolder client that will shed light on currenthealth ...
91AssessmentPhysical Examination• Nurse must beknowledgeable about normalphysical changes of aging inorder to conduct phys...
92Challenges in Health andFunctioning Adjustment to a new body image Effect on body image and self-concept Self-concept...
93Diagnoses Frequently Seen inthe Older Adult Impaired Physical Mobility Activity Intolerance Risk for Injury, Falls R...
94Important Qualities of theGerontological Nurse
95 “The care of old people requires just as much skill, tact,ingenuity, and patience as the care of children, andperhaps ...
96Important Qualities of theGerontological Nurse Ability to form atherapeutic relationshipwith elderly adults Appreciati...
97Therapeutic CommunicationOngoing,continuous,dynamic processIncludes verbaland nonverbalsignals
98Nonverbal Communication Nonverbal communicationcomposes up to 80% ofinformation exchange– Body language– Position– Eye ...
99Verbal CommunicationGuidelines Do not yell or speak tooloudly to patients– Yelling into a hearing aid canbe disturbing ...
100Verbal CommunicationGuidelines Touch if appropriateand acceptable Supplement withwritten instructions asneeded Avoid...
101Verbal CommunicationGuidelines Ask how the patientwould like to beaddressed Avoid demeaningterms such as sweetie,hone...
102Verbal CommunicationGuidelines Use open-ended statements– “Tell me more…” or “How doesthis affect you?” Avoid misunde...
Intro gerontological nursing_fall 2013 abridged
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Intro gerontological nursing_fall 2013 abridged

  1. 1. 1Introduction toGerontological NursingNURS 4100 Care of the Older AdultFall 2013Joy Shepard, PhD(c), MSN, RN, CNE, BC
  2. 2. 2Objectives Explain different ways older adults are viewed incontemporary society Describe major characteristics of today’s olderpopulation Discuss projected demographic changes in futuregenerations of older people and the implications forhealth care Describe the nursing process in care of older adults Discuss standards, major roles, principles, and futurechallenges for gerontological nurses
  3. 3. 3"Old age is like everything else.To make a success of it youvegot to start young." TheodoreRoosevelt"Anyone who stops learning isold, whether at twenty oreighty."Henry Ford
  4. 4. 4Aging: A Natural Process…NOT a disease!
  5. 5. 5Defining Old AgeChronological age – Exact agefrom birthBiological age - Age determined byphysiology rather than chronologyFunctional age – Age in terms offunctional performance
  6. 6. 6Activities of Daily Living (ADLs) Basic: Bathing (hygiene,grooming) Dressing Eating Toileting Transferring(mobility) Instrumental: Light housework Preparing meals Taking medications Shopping forgroceries or clothes Using the telephone Managing money
  7. 7. 7
  8. 8. 8Characteristics of AgingPopulation “Typical” older person? Age 65 start of “oldage?” Energetic, vibrant,influential, diverse Gerontology - identifiescommoncharacteristics,problems, diseaseprocesses, & concerns Nurse must considerindividual differences &characteristics whenplanning & implementingcare
  9. 9. 9Gerontological Nursing “The purpose of gerontological nursing isnot to save lives, but to prevent untimelydeath and needless suffering. Both thesegoals include respect for human dignity –the preservation of personhood as long aslife continues.” -Doris Schwartz, 1989
  10. 10. 10Definition of Terms Ageism - Prejudice, negative stereotyping basedsolely on age Geriatrics - Branch of medicine that deals withproblems & diseases of old age, aging people Gerontology – Comprehensive, multidisciplinarystudy of aging process & problems of older peoplewith holistic focus, including biologic, sociologic,psychological, spiritual, & economic issues Graying of America – Increased number olderadults in US Senescence - Process of aging within cells andorgans accompanied by loss of organ function
  11. 11. 11Definition of Terms Primary prevention – Activities directedtoward the protection from or avoidance ofpotential health risks Secondary prevention – Activities designedfor early diagnosis & treatment of diseaseor illness Tertiary prevention – Activities designed torestore disabled individuals to their optimallevel of functioning
  12. 12. 12Gerontological Nursing:Specialty Area Nursing – caring for the vulnerable Gerontological nursing – newest &youngest, most rapidly growing nursingspecialty ‘Nursing’s forgotten… little understoodspecialty’ Challenging practice areas: complex In just 50 yrs…. foremost concern of health care
  13. 13. GerontologyGerontology: ComplexComplex FieldEncompassing ThreeThree Levels of Complexity 1. Normal agingchanges 2. Chronic conditionsassociated with aging 3. Acuteexacerbations ofchronic conditions13
  14. 14. 14Development ofGerontological Nursing 1904: First article on care of the aged publishedin the American Journal of Nursing 1914: Dr. I. L. Nascher—“Father of Geriatrics”—first geriatric textbook 1935: Federal Old Age Insurance Law, or SocialSecurity 1950 – First geriatric nursing textbook 1962: First meeting of the ANA’s ConferenceGroup on Geriatric Nursing Practice
  15. 15. 15Development ofGerontological Nursing 1965: formation of the Administration on Aging,Older Americans Act, Medicare, & Medicaid 1966: Division of Geriatric Nursing—gerontological nursing as a nursing specialty 1976 – Professional Standards forGerontological Nursing Practice (ANA)– Certification – geriatric nurses– 1stcertification program by ANA
  16. 16. 16Development ofGerontological Nursing Growth in the last few decades– Increase in gerontological nursing texts– Increase in journal articles– Gerontological nursing education– Certification in gerontological nursing– Subspecialization– Hartford Institute for Geriatric Nursing
  17. 17. 17Advanced Practice NursingRoles Gerontological Clinical Nurse Specialist Gerontological Nurse Practitioner Preparation: unique principles, best practicesfor older adult– Broad knowledge base– Capacity for independent practice– Leadership– Complex clinical problem-solving abilities
  18. 18. Programs Adult-Gerontology Nurse Practitioner– ECU College of Nursing (Online) Adult-Gerontology Nurse Practitioner– UNC-Chapel Hill School of Nursing Adult Gerontological Nurse Practitioner Concentration– UNC-Greensboro School of Nursing Gerontological Nurse Practitioner– Duke University School of Nursing Adult-Gerontology CNS &Adult-Gerontology Critical Care CNS– Rush University (Online)
  19. 19. 19In Great Demand… Challenges for thefuture– Gerontologicalnursing as adynamic specialty– Multitude ofopportunities– Development of newpractice models
  20. 20. 20Geriatric Patients… TheCore Business of HealthCare
  21. 21. 21An Aging Population Increased #’s older people, particularly “old-old” 41.4 million older adults in 2011 – 13.3% ofthe population By 2030, adults ≥ 65 years, 20% ofpopulation 5.7 million 85+ population– 2040: 14.1 million– 2050: 19 millionSource: A Profile of Older Americans
  22. 22. 22
  23. 23. 23An Aging Population As the aging population expands, it will affectall aspects of society (esp healthcare) Currently 13.3% of U.S. population; consumedisproportionate amount of healthcareresources Aging-associated diseases – complicationsarising from senescense 2025: need an extra 260,000 full-time nurses totake care of aging populationSource: A Profile of Older Americans
  24. 24. 24Myths & Stereotypes of Aging
  25. 25. 25Ageism Prejudice towards anyage group Defined as “theprejudices andstereotypes that areapplied to older peoplesheerly on the basis oftheir age….”
  26. 26. True or False???To be old is to be sick?
  27. 27. 27Myths & Stereotypes of Aging Many cultures: older people accorded respect American society is youth-driven– Aging synonymous with death– Younger individuals – negative view of agingprocess– Fear & lack of exposure to older individualscontribute to ageism Older adults stereotyped: ill, bald, hard ofhearing, forgetful, rigid, grumpy, or boring
  28. 28. 28Myths of Aging “You can’t teach an old dog newtricks” “Dirty old man” Disease & disability are inevitablepart of aging Health promotion is wasted onolder people Elderly do not pull their ownweight Most people spend their lastyears in nursing homes
  29. 29. 29Myths of Aging Senility is a result of aging Incontinence is a result ofaging Older adults are no longerinterested in sexuality All elderly persons arefinancially impoverished
  30. 30. 30*Realities of Aging*
  31. 31. 31Myths of Aging Lead to: Ageism Reduced healthcare services Segregation of elders from mainstream society Nurse recruitment difficulties Health professionals must be diligent inavoiding age prejudice, as believingstereotypes can influence interactions betweenolder adults & caregivers
  32. 32. 32The Older Adult Population
  33. 33. 33Subsets of the Older AdultPopulation Young-old: 65-74 yrs Middle-old: 75-84 yrs Old-old: 85-100 yrs Centenarians: 100+ yrs Diversity rather thanhomogeneity
  34. 34. The Graying of the Population34
  35. 35. 35Number of Old and Old-Old
  36. 36. Distribution of the Projected OlderPopulation by Age for the US: 2010 to 2050
  37. 37. 37An Aging Population -Increased Life Expectancy Older adults currently 13% of U.S. population By 2030 – 20% of population Increasing life expectancy:– 1900: 47.3 years– 1930: 59.7 years– 1965: 70.2 years– Present: 78.7 years (2010)– 2050: projected to be 82.6 yrshttp://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_04.pdf
  38. 38. 38First Wave of 76 Million BabyBoomers Started Turning 65in 2011!
  39. 39. 39Age Distribution of U.S.Population
  40. 40. 40Factors Influencing IncreasedLife Expectancy Advancements in disease control & healthtechnology (esp. vaccines & antibiotics) Lower infant & child mortality rates Improved sanitation (clean water & sewagedisposal) Better living conditions
  41. 41. 41Life Expectancy: Race andGender Gap between women& men (narrowing) Gap between Whites& Blacks (narrowing)– Societal issues– Concern for nursesGender /RaceWhites Blacks TotalFemales 81.3 78.0 81.1Males 76.5 71.8 76.2Total 79 75.1 78.7http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_04.pdf
  42. 42. 43Marital Status & LivingArrangementsWomen more likely to be widowed,living alone in old ageMore than half of women ≥ 65 arewidowedOlder men more likely to be married Potential for living alone increases with age
  43. 43. 44Aging Women Women outlive men, outnumbermen 4 to 3– Feminization of later lifeWomen predominate at older ages,proportions increase with advancingage– Health & socioeconomic problemsof elderly = problems of elderlywomen Study of gerontology – closely linked tostudy of women’s health Potential problems:– Widowhood– Living alone– Poor– Coping with loss of mate– Difficulty finding anotherlife companion– Lack of a caregiver– Financial problems
  44. 44. Gender Distribution of ElderlyAmericans, by Age Group, 2010
  45. 45. 46Aging Men Shorter life expectancy,die at younger age More likely to remarry ifwidowed– Widows outnumberwidowers 5 to 1 Fewer financialproblems than women– More likely to have worked 30years or longer, qualify for fullSocial Security benefits
  46. 46. 47
  47. 47. Marital Status of Older Adults48
  48. 48. 49Income of Older Adults 8.7% live below poverty level “Fixed” income “Asset rich and cash poor” – What does thismean? Median net worth twice national average relatedto home ownership Dependent on Social Security for more than halfof their income Women & minority groups poorer than whitemen
  49. 49. Geographic Distribution: OlderAdults Greatest number(percentage wise):Florida, Maine, WestVirginia, Pennsylvania,Montana Dramatic increases inpast decade: Alaska,Nevada, Arizona,Idaho, Georgia Lowest percentage:Alaska, Utah, Texas,Georgia, Colorado North Carolina? 50
  50. 50. 51
  51. 51. 52Illness in the Older Population
  52. 52. 53Health Status of Older Adults:Acute Conditions (p. 8)Relatively fewer acute illnesses (i.e.,infections & parasites, colds, orinfluenza)Lower death rates from acute illnessesAfter an acute illness…– Longer period of recovery– More complications
  53. 53. 54Illness in the Older Population Chronic illness – major concern for older adult Chronic illnesses – cause disabilities, complicatecare, need skilled nursing care 80% – at least one chronic illness (i.e., heartdisease, diabetes, arthritis, or hypertension) Many elderly people with two or more chronicillnesses (comorbid) Comorbidity: the presence of multiple chronicconditions simultaneously Challenge: reach highest functional capacity
  54. 54. 55Health Status of Older Adults:Chronic ConditionsChronic Conditions Major problem: increaseswith age Most have at least onechronic disease; manyhave several (comorbidity) Comorbidity: the presenceof multiples chronicconditions simultaneously Result: limitations in ADLs& IADLs Leading cause: disability &death
  55. 55. 56Leading Chronic Conditions(Box 1-3, p. 8) 1. Arthritis 2. Hypertension 3. Hearingimpairments 4. Heart conditions 5. Visual impairments 6. Orthopedicimpairments
  56. 56. QuestionThe leading chronic conditionassociated with older adults is: (A) Arthritis (B) Diabetes (C) Hearing impairments (D) Hypertension (E) Orthopedic impairments
  57. 57. 58Question Is the following statement true or false? Chronic disorders most prevalent in theolder adult population are ones that canhave a significant impact on independenceand the quality of life
  58. 58. CDC: Chronic Diseases are LeadingCauses of Death & Disability in U.S.*7 of 10 deaths each year are from chronic diseases*1 of 2 adults (of all ages) at least 1 chronic illness*Obesity: major health concern: 1 in 3 adults*One-fourth of people with chronic conditions: At leastone ADL limitation*Arthritis: most common cause of disability: 19 millionAmericans report ADL limitationhttp://www.cdc.gov/chronicdisease/overview/index.htm#159
  59. 59.  Heart diseaseHeart disease Malignant neoplasms (cancer)Malignant neoplasms (cancer) Chronic lower respiratory dz (COPD)Chronic lower respiratory dz (COPD) Cerebrovascular dz (stroke)Cerebrovascular dz (stroke) Alzheimer’s diseaseAlzheimer’s disease Diabetes mellitusDiabetes mellitus Influenza/ pneumoniaInfluenza/ pneumonia Nephritis, nephrotic syndrome, nephrosis Accidents Septicemia 60Leading Causes of Death forPersons 65 Yrs of Age & Older(Table 1-3, p. 9)
  60. 60. http://www.cdc.gov/nchs/data/databriefs/db64.pdf
  61. 61. 63Question When planning a course about mortality rates fora group of elderly clients, emphasis should begiven to which of these topics because it is theleading cause of death for ages over 65?– A. Heart disease– B. Cancer– C. Infectious diseases– D. Accidents
  62. 62. 64Health Promotion & DiseasePrevention
  63. 63. 65Health Promotion Health promotion: “the science and art of helping peoplechange their lifestyle to move toward a state of optimalhealth" (American Journal of Health Promotion, 1986) Multidimensional, enhances wellness, self-actualization &individual fulfillment (Pender, 2002) Purpose:– Help older adults achieve a sense of well-being– Reduce premature mortality, enhance quality of lifeThe Health ContinuumBalance of physical, emotional, social, spiritual, and intellectual health
  64. 64. Healthy People 2020 Vision: A society in which all people live long, healthy livesA society in which all people live long, healthy lives Overarching Goals: Attain high quality, longer lives free of preventabledisease, disability, injury, and premature death Achieve health equity, eliminate disparities, and improvethe health of all groups Create social and physical environments that promotegood health for all Promote quality of life, healthy development and healthybehaviors across all life stages
  65. 65. 67Proposed Healthy People 2020 Goalsfor Older Adults Reduce the proportion of older adults who have moderate tosevere functional limitations. (Developmental) Reduce the proportion of unpaid caregivers ofolder adults who report an unmet need for caregiver supportservices. (Developmental) Increase the proportion of older adults with oneor more chronic health conditions who report confidence inmanaging their conditions. (Developmental) Reduce the proportion of noninstitutionalizedolder adults with disabilities who have an unmet need for long-term services and supports.
  66. 66. 68Proposed Healthy People 2020 Goalsfor Older Adults Cont’d… Reduce the rate of pressure ulcer-related hospitalizations amongolder adults. Increase the proportion of the health care workforce with geriatriccertification. Increase the number of States and Tribes that publicly reportelder maltreatment and neglect. Increase the proportion of older adults with reduced physical orcognitive function who engage in light, moderate, or vigorousleisure-time physical activities. Reduce the rate of emergency department visits due to fallsamong older adults.Healthy People 2020: The Road Ahead
  67. 67. 6970% Physical Decline due toModifiable Risk FactorsInactivityPoor nutritionTobaccoAlcohol Lack of preventivecare
  68. 68. 7070% Physical DeclineModifiable Through Physical activity Improved nutrition Smoking cessation Alcohol in moderation Prevention of injuries fromfalls Improved use Medicare-covered preventive services
  69. 69. 71QuestionName modifiable risk factors forphysical decline and illness in olderadults…Name non-modifiable risk factors forolder adults…
  70. 70. 72Health Promotion & DiseasePrevention Chronic conditions developover time Older adults must bealerted to means ofpreventing disease andreducing risks Important components ofhealth maintenance:– Knowledge of self-care– Participating in screeningtests Nurses intervene usingthree levels of prevention– Primary– Secondary– Tertiary
  71. 71. 73Health Promotion and DiseasePrevention Nurses should be aggressive in health promotion efforts Older adults must be alerted to means of preventingdisease & reducing risks– Take advantage preventive health services– Make healthy lifestyle changes Preventive care: most effective strategy to reducerisk of disability & chronic illness– HP 2020 goal: “Attain high quality, longer lives free ofpreventable disease, disability, injury, and prematuredeath”
  72. 72. Primary PreventionIn primary prevention, a disorderis actually prevented fromdeveloping…74
  73. 73. 75Primary Prevention – HealthPromotion Behaviors Education: Patient, family, caregiver; health care provider– Falls prevention– Pressure ulcer prevention Immunizations– Influenza, pneumococcal, tetanus/diphtheria, hepatitis B Maintain body weight (± 10% age-adjusted normal weight) Regular physical activity (as appropriate) Nutritional assessment & guidance– Well-balanced diet↑ Fiber, calcium, vitamin D Avoidance of tobacco Alcohol in moderation
  74. 74. 76Primary Prevention – HealthPromotion Behaviors Eight hours of sleep a night Positive mental attitude– Encourage family members to participate in positive lifereview with elderly client At least one friend to trust & confide in Self-discipline to enjoy pleasant things in moderation Relaxing & pleasant activities to look forward to Limiting exposure or avoiding known carcinogens
  75. 75. Secondary PreventionIn secondary prevention, diseasethat has not yet become symptomaticis detected and treated early, therebyminimizing serious consequences…77
  76. 76. 78Secondary Prevention – EarlyDiagnosis, Prompt Treatment Important components ofhealth maintenance practices– Self-care, screening– Regular visits PCP– Reduce cholesterol– Monitor blood pressure Appropriate diagnostic,screening tests:– Fecal occult blood test– Glaucoma screen (tonometry &visual field testing)– Fasting glucose– Colonoscopy– Prostate exam: PSA & DRE– Mammogram– Pap test, pelvic– Bone mass screening
  77. 77. Tertiary Prevention In tertiary prevention, an existing, usuallychronic disease is managed to preventcomplications or further damage. For example,tertiary prevention for people with diabetesfocuses on tight control of blood sugar, excellentskin care, frequent examination of the feet, andfrequent exercise to prevent heart and bloodvessel disease…79
  78. 78. 80Tertiary Prevention –Restoration, Rehabilitation Manage clinical diseases (esp chronic diseases) to preventthem from progressing– Aim: optimal functioning; avoid disability & complications Rehabilitation (physical, occupational, speech, recreationaltherapy)– Short-term placement or– Aggressive in-home rehabilitation Appropriate services/ aids to increase independence– Walkers, canes, homemaker/ home health aid, visiting nurse Disaster relief– Safe housing, counseling, physical care
  79. 79. Question Which of the following is an example ofprimary prevention? A. Administering digoxin to treat heart failure B. Obtaining a smear for a screening test C. Using occupational therapy to help a patientcope with arthritis D. Vaccinating an older adult during the fluseason
  80. 80. 82Question The gerontological nurse is teaching 86-year-oldPatricia Smith and her family about exercise programsfor the elderly. Which of the following statements aboutarthritis is an example of tertiary preventive care?– A. Exercise cures arthritis– B. Exercise can help control and manage the symptoms ofarthritis and prevent complications– C. Exercise is important for healthy joints and it alsostrengthens the surrounding muscles– D. Exercise helps prevent arthritis from developing
  81. 81. Question Which of the following describes secondaryprevention? A. aims to prevent disease from developing in the first place B. aims to detect and treat disease that has not yet becomesymptomatic C. directed at those who already have symptomatic disease,in an attempt to prevent further deterioration, recurrentsymptoms and subsequent events D. set of health activities that mitigate or avoid theconsequences of unnecessary or excessive interventions inthe health system
  82. 82. Question As they get older, men are more likely to bescreened for prostate cancer: 48% of men 50 to 59years as compared to 56% of men 80 years andolder. The nurse concludes that this is: A. An example of ageism and negative stereotyping B. An illustration of the belief that primary preventionstrategies should be promoted in the older adult population C. A proper allocation of scarce health care resources D. A societal trend based on higher numbers of aging men
  83. 83. Question While Medicare pays for some medical screenings for olderAmericans, nine of every ten adults over the age of 65 gowithout screenings, such as bone mass screenings, colorectalcancer screening, glaucoma screenings, mammograms, andpap tests and pelvic examinations. Findings show that primarycare providers are less aggressive when recommendingpreventive measures to the elderly. The nurse concludes that this is: A. An example of ageism B. An illustration of the belief that tertiary prevention strategies arewasted on elders C. A proper allocation of scarce health care resources D. Correct, since there is no need for aggressive screening measureswithin this age group
  84. 84. 86Prolongation of Frailty vsCompression of Morbidity?
  85. 85. 87Functional Assessment of theOlder Adult
  86. 86. 88Nursing Process and the OlderAdult Assessment– Health History– Physical Examination Goal: Individualize & tailor assessmentsand interventions to each patient Functional abilities should be a centralfocus of comprehensive assessment
  87. 87. 89Assessment of Function Three domainsThree domains: ADLs, IADLs, & mobility Systematic, focus on individual needs Two approaches: asking & observing Basis for care planning, goal setting, &discharge planning Eligibility to obtain many services
  88. 88. 90AssessmentHealth History– Nurse draws facts and interpretations fromolder client that will shed light on currenthealth status and health concerns– Eliciting data requires time & patience on thepart of both the nurse and client– Nurse may interview client & client’s supportmembers
  89. 89. 91AssessmentPhysical Examination• Nurse must beknowledgeable about normalphysical changes of aging inorder to conduct physicalexamination• Client may need assistancewith disrobing or positionchanges• Be alert to potential for injury
  90. 90. 92Challenges in Health andFunctioning Adjustment to a new body image Effect on body image and self-concept Self-concept and roles Acceptance of bodily changes Declining function resulting in illness anddisability Loss of independence
  91. 91. 93Diagnoses Frequently Seen inthe Older Adult Impaired Physical Mobility Activity Intolerance Risk for Injury, Falls Risk for Infection Self-Care Deficits Social Isolation Risk for Loneliness Acute, Chronic Confusion Imbalanced Nutrition Impaired HomeMaintenance Ineffective RolePerformance Ineffective HealthMaintenance Ineffective TherapeuticRegimen Management
  92. 92. 94Important Qualities of theGerontological Nurse
  93. 93. 95 “The care of old people requires just as much skill, tact,ingenuity, and patience as the care of children, andperhaps more, because one must keep in mind that oldpeople cannot be treated like children and thatfeebleness of physical and mental powers is notaccompanied by forgetfulness of early experiences. Agenuine affection, gentleness, sympathy, andimagination sufficient to grasp the patient’s point of vieware necessary.” Jessie Breeze, private duty nurse, 1909
  94. 94. 96Important Qualities of theGerontological Nurse Ability to form atherapeutic relationshipwith elderly adults Appreciation of theuniqueness of elders Clinical competencein basic nursing skills Good communicationskills Knowledge of physical &psychosocial changesthat occur with age Ability to work with &supervise others
  95. 95. 97Therapeutic CommunicationOngoing,continuous,dynamic processIncludes verbaland nonverbalsignals
  96. 96. 98Nonverbal Communication Nonverbal communicationcomposes up to 80% ofinformation exchange– Body language– Position– Eye contact– Touch– Tone of voice– Facial expression
  97. 97. 99Verbal CommunicationGuidelines Do not yell or speak tooloudly to patients– Yelling into a hearing aid canbe disturbing and painful Try to be at eye level Minimize backgroundnoise
  98. 98. 100Verbal CommunicationGuidelines Touch if appropriateand acceptable Supplement withwritten instructions asneeded Avoid complicatedexplanations
  99. 99. 101Verbal CommunicationGuidelines Ask how the patientwould like to beaddressed Avoid demeaningterms such as sweetie,honey, or dearie Use caring responsesand careful listening
  100. 100. 102Verbal CommunicationGuidelines Use open-ended statements– “Tell me more…” or “How doesthis affect you?” Avoid misunderstandings byclarifying– “I’m not sure what you mean…” Encourage reminiscing

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