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.