Nursong 407 - Geriatric Healthcare
Chapter 2 – Promoting Wellness for the Older Adult: General Concepts
Gerontology and Geriatrics
- The terms are not interchangeable!
- Gerontology is concerned with the social, psychological, and biological aspects of aging.
- Geriatrics is the study of disease in the elderly.
Geriatrics
- First proposed as a distinct specialty in 1909 by Dr. Ignatz Nascher when he viewed aging as a physiological process and not mere deterioration.
- Geriatrics is concerned with the decline of major body systems in the elderly.
- A geriatric specialist treats disease in the elderly client and attempts to decrease the effects of aging on the body.
Gerontology
- Developed into an organized field in the 1940s.
- Acknowledged that there exist experts in the elderly in many fields and findings must be integrated.
- Studying the physical, mental and social changes in people as they age
- Study of physical process of aging
- Study of the effects of the aging population on society and the effects of society on the elderly
- Identification of appropriate treatment and management of the elderly
Responsibilities in gerontological nursing
- Use evidence-based information
- Unique needs of the patient
- Understanding of the process of aging
- Collaborate
- With older adults and their significant others
- Healthy aging through end of life
- Leadership
- Participate in interprofessional teams
- Patient-centered approach
Gerontological nursing recognized by ancc
- 2008—ANCC and National Council of State Boards of Nursing APRN Advisory Committee recommendation
- Merger of adult and gerontological Nursing
- 2015—Adult-Gerontology APN programs began being offered by graduate schools of Nursing
American association of colleges of nursing competencies for nurses who care for adults (2010)
- Incorporate professional attitudes, values, expectation about aging in providing person-centered care for older adults
- Include assessment of living environment as it influences the needs of older adults
- Recognize the variations of care, increased complexity, and increased use of health care resources by older adults
- Facilitate ethical and noncoercive decision making
- Facilitate safe and effective transitions across levels of care
- Implement strategies to prevent risk and promote quality and safety
Goal of the Campaign for action (2010)
National initiative of aarp
- All nurses must be competent in caring for older adults in all adult health care settings
Health, wellness, and health promotion
- Health
- The ability of older adults to function at their highest capacity
- Wellness
- The outcome of improved well-being and quality of life
- Health promotion
- Interventions for behavior change toward improved health and well being
Changes in health promotion programs
- Originally focused on disease prevention and health maintenance
- Now greater emphasis on personal responsibility for health
Health-enhancing behaviors for older adults
- Regular exercise of several types
- Optimal nutritional intake
- Adhering to recommended screening and prevention services
- Using stress reduction methods
- Maintain healthy relationships with others
- Adequate rest, diversion, enjoyment
- Maintaining spiritual growth
- Engage in holistic wellness practices
Misconceptions that limit older adults receiving prevention and screening services
- “Older adults are less responsive to health promotion interventions”
- “Preventive services are less effective after the oneself of chronic illness”
Types of health promotion interventions for older adults
- SCREENING PROGRAMS—Diabetes, hypertension, cancer
- RISK REDUCTION INTERVENTIONS—Falls, depression, heart disease
- ENVIRONMENTAL MODIFICATIONS—Modifications to improve level of functioning
- HEALTH EDUCATION—Exercise, nutrition, dental care
A note on vaccinations….
- Shingles—one shot, 60 years and older
- Pneumococcal—one shot
- Influenza—annually
- Tdap—every 5-10 years
Stages of change model (transtheoretical model)—the nurse as a change agent
- Precontemplation: offer information, help patient identify benefits of change
- Contemplation: indicate that benefits outweigh the disadvantages
- Preparation: provide positive reinforcement
- Action: help identify and find strategies to overcome obstacles
- Maintenance: reinforcement and positive feedback
Community-based services for older adults
- Health promotion
- programs
- Faith Com-munity Nursing
- Respite care
- Adult Day Centers
Home based services—skilled home care
- Person must be homebound
- Services must be ordered by primary care provider
- Must need skilled Nursing or rehabilitative services
- Must require intermittent (not full-time) care
- Meant to be short term—teach self-care activities to patient and family
Home based services—nonmedical home care
- Companions, homemakers, home health aides
- Meal preparation
- Light housekeeping
- Assisting with personal care
- Accompanying to medical appointments
- Grocery shopping, errands
Nursing homes
- For individuals who need help with several ADLs
- Must have continuous, on-site supervision by RN or LVN
- Must provide dental, podiatry, medical specialty, and rehabilitative services
To qualify for skilled nursing home care
- Must have been hospitalized for at least 3 consecutive days within past 30 days
- Must have a physician referrals
- Must require daily skilled care
- Medicare will cover all or part of the care for up to 100 days so long as the person continues to require it
Long term care
- Chronically ill
- Need significant care with daily activities
- Usually occur after a gradual decline in functioning
Person-centered care in nursing homes
- Part of “culture change” in Nursing homes
- Promote dignity
- Honor individual preferences:
- Choices about sleep and wake times
- Access to organizational leaders
- Consistent staffing assignments
“interprofessional collaboration”
- Health care team consists of:
- Geriatrician
- Gerontological RNs
- Pharmacist
- Social worker
- Speech, physical, occupational therapists
- Mental health professionals
- The Nurse is instrumental in coordinating collaboration
- Responsible for seeking resources and initiating contact
- 2016—National League for Nursing recommended that content of interprofessional collaboration be incorporated in Nursing curriculum
Quality and safety education for nurses
(qsen)
- The QSEN Collaboration was founded in 2005
- A national movement that guides Nurses to redesign their own care delivery so that they can provide high quality, safe care
- Assure that Nurses have knowledge, skills, and attitudes (KSAs) to continually improve the quality and safety of the systems in which they work
The role of the caregiver
- Caregiver burden—the negative functional consequences experienced by family members when caring for dependent older adults
- Increased risk of burden—lower socioeconomic status, living with the patient, self-reported depression, social isolation, financial stress, lack of choice in assuming the caregiver role
Assessing the health of older adults is complex!
- Older adults often have one or more chronic condition
- Older adults manifest illness obscurely and less predictably
- Each manifestation of illness usually has several possible explanations
- Treatment is often directed toward the symptoms
- Cognitive impairments can make diagnosis difficult
- Often, the pathology is in an advanced stage having heretofore been subtle
- Myths and misconceptions may allow one to attribute symptoms to aging
Strengths and limitations of “SPICES”
- Acronym is easily remembered
- Simple system to identify problems
- Triggers more complete assessments
- Should NOT be used to replace a complete Nursing assessment
What functional assessment tools measure
- Activities of daily living (ADLs)—tasks associated with meeting one’s basic needs
- Bathing
- Dressing
- Dietary intake
- Transfer mobility
- Elimination
- Instrumental activities of daily living (IADLs)—more complex tasks, essential in community-living situations
- Shopping
- Laundry
- Transportation
- Money and medication management
- Meal preparation
- Telephone use
Function-focused care
- Evaluate underlying capabilities
- Interventions to optimize and maintain abilities
- Increase physical activities
DRIVING SAFETY IN THE
OLDER ADULT
- Older adults are more likely to have higher rates of at-fault crashes
- Older adults have a higher fatality rate per mile
- Older adults have a much higher rate of poor outcomes in accidents
- Driving cessation is associated with increased depressive symptoms and social isolation
Risks for unsafe driving
- Age-related changes in vision, musculoskeletal function, central and autonomic nervous systems
- Medical conditions
- Cognitive impairment
- Functional limitations
- Medication use
- Alcohol consumption
Assessing the older adults perception of his or her driving
- Do you have any concerns about your ability to drive?
- Have you adjusted your driving patterns to avoid certain situations?
- Has anyone else expressed concerns about your driving?
- Have you ever become lost while driving?
- Have you been in any accidents during the past couple of years?
- Have you had any citations related to unsafe driving?
Referrals for driving evaluation
- Driving evaluation programs for interventions for improved safety
- Driver education programs (AARP, AAA)
- California DMV
Types of prevention:
- Primary—Methods to avoid occurrence of disease either through eliminating disease agents or increasing resistance to disease. Examples include immunization against disease, maintaining a healthy diet and exercise regimen, and avoiding smoking.
- Secondary—Methods to detect and address an existing disease prior to the appearance of symptoms. Examples include treatment of hypertension (because it is a risk factor for many cardiovascular diseases), cancer screenings.
- Tertiary—Methods to reduce the harm of symptomatic disease, such as disability or death, through rehabilitation and treatment. Examples include surgical procedures that halt the spread or progression of disease.