Global Ageing and Its Impact

Global Ageing

• A growing number of older adults worldwide
• Implication on society: economic strain, increased healthcare demand, and the need for societal policies
• A significant demographic shift
• Increasing numbers of older individuals worldwide

Impact of Ageing Population

• Chronic diseases and mental health issues are more prevalent
• Rising healthcare costs
• The need for a sustainable pension
• Risk of social isolation in older adults

Ageism

• Discrimination and stereotypes against older adults
• Barriers in healthcare access and social engagement
• Promoting awareness and changing attitudes towards ageing are crucial

Culturally and Linguistically Diverse (CALD) Ageing Population

• Older adults from CALD backgrounds face unique challenges
• Language barriers and cultural misunderstandings in healthcare settings
• Tailored services are required to respect cultural values and practices

Cultural Competence

• The ability to engage effectively across different cultures
• Understanding one's own cultural bias and valuing diverse perspectives in care practices

Cultural Safety

• Respecting cultural identities
• Prevent actions that might diminish or disempower individuals due to their cultural background

Nursing Process in Older Adult Health

• Complex assessments due to multiple comorbidities
• Holistic approach
• Use critical thinking and evidence-based practices
• Understanding age-related physiological changes

Improving Quality of Life for Older Adults

• Education Workshops on health literacy and chronic condition management. Technology-based training for digital engagement.
• Workforce. Training for healthcare workers in geriatric care and culturally competent approaches. Attracting more professionals to aged care.
• Physical and Mental Health. Community-based fitness programs tailored to older adults. Mental health support groups to address loneliness and depression.
• Leisure Opportunities. Social events and outings to encourage community engagement. Creative arts programs for self-expression.
• Transport Opportunities: Accessible transportation services for seniors. Collaboration with local authorities to improve mobility.

Cultural Diversity

• Culture is the ideas, customs, and social behaviors of a specific group
• It is important to acknowledge and respect cultural diversity in community programs and healthcare

Contemporary Ageing Issues: Delirium

• Hypoactive Delirium: Decreased activity and responsiveness, often unrecognized
• Mixed Subtype Delirium: A combination of hyperactive and hypoactive symptoms

Risk Factors for Delirium

• Increasing Age: Delirium is more common in the elderly
• Previous History of Delirium: Recurrence is more likely in those who have experienced delirium before
• Pre-existing Cognitive Impairment: Conditions like dementia and depression raise the risk of delirium
• Underlying Medical Conditions: Various health issues can contribute to delirium
• Infection: Common triggers, particularly for older adults
• Sensory Impairments: Reduced vision or hearing can make confusion worse
• Polypharmacy: An increased risk associated with taking multiple medications
• Certain Medications: Narcotics, benzodiazepines, NSAIDs, and anticholinergics carry a higher risk
• Indwelling Urinary Catheters: Increased risk
• Physical Restraint: Can worsen confusion
• Alcohol-Related Health Problems: Delirium is a possible consequence of alcohol abuse

Delirium Assessment Tools

• Confusion Assessment Method (CAM): Widely used diagnostic tool
• The 4AT: A quick screening tool
• The Delirium Rating Scale (DRS): Used to assess delirium severity

Managing Delirium

Environmental Strategies

• Reduce Noise: A calm environment will promote relaxation
• Single Room Accommodation: Encourages rest and reduces confusion
• Visual Prompts: Signs and displays can help with orientation
• Familiar Environment: Create a homelike setting for comfort
• Family Involvement: Encourage visits to provide emotional support

Clinical Strategies

• Medication Review: Evaluate and adjust medications as needed
• Ensure Adequate Sleep: Promote healthy sleep habits
• Nutrition and Hydration: Ensure proper food and fluid intake
• Sensory Aids: Provide glasses or hearing aids
• Avoid Indwelling Catheters: Minimize invasive procedures
• Encourage Mobility: Promote independence
• Monitor Bowel Function: Regular checks to prevent constipation
• Pain Management: Address pain effectively

Consequences of Delirium

• Increased risk of mortality
• Potential for long-term cognitive impairment
• Lengthened hospital stays
• Acute pain experienced alongside chronic pain

Pain in Older Adults

Categories of Pain

• Nociceptive Pain: Caused by inflammation, fractures, ischemia, or infection. Sharp, aching, or throbbing pain. Treatment includes pharmacological and non-pharmacological approaches
• Neuropathic Pain: Caused by lesions or diseases affecting the nervous system. Burning, shooting, or tingling pain. Treatment is primarily pharmacological, with psychological approaches often playing a role

Pain Assessment in Older Adults

• Key Considerations: Under-reporting of pain due to stoicism or cognitive impairments. Other ways to describe pain, like soreness or tenderness

Assessment Components:

• History: Gather information from any caregivers or family members
• Physical Examination: A thorough examination is required
• Functional and Psychological Status: Assess how pain impacts daily activities and mental health
• PQRST Approach:
  • P: What Provokes the pain or what Palliates it?
  • Q: What is the Quality of the pain?
  • R: Does the pain Radiate?
  • S: How severe is the pain?
  • T: When did the pain begin and how long does it last?

Indicators of Pain in Cognitive Impairment

• Physical Symptoms: Gait impairments, immobility, skin breakdown
• Behavioral Signs: Responsive behavior, family concerns

Non-Verbal Pain Cues

• Facial expressions
• Vocalizations
• Physical changes (e.g body posture)
• Protective behavior

Pain Assessment Tools

• ABBEY pain Scale
• PAINAD: Pain Assessment in Advanced Dementia
• PACSLAC: Pain Assessment for the Cognitively Impaired
• Brief Pain Inventory

Consequences of Unrelieved Pain

• Depression
• Anxiety
• Decreased socialization
• Sleep disturbances
• Impaired mobility

Pain Management Strategies

Non-Pharmacological Approaches

• Heat and cold therapy
• Transcutaneous Electrical Nerve Stimulation (TENS)
• Mind-body techniques (relaxation, meditation)
• Massage and Tai Chi
• Distraction techniques
• Acupuncture and acupressure

Pharmacological Approaches

• Non-Opioid Analgesics: Paracetamol, NSAIDs

End-of-Life Care

Nursing Care Considerations

• End-of-Life Recognition: Nurses should recognize signs of death, such as pain, agitation, dyspnea, and altered consciousness
• Actions to Take: review medications, implement comfort care strategies, communicate with the family, discontinue non-essential interventions

Important Aspects for Dying Individuals

• Knowledge of what to expect
• Control and choice over care
• Dignity and privacy
• Relief from distressing symptoms
• Access to information and emotional/spiritual support
• Opportunity to say goodbye

Advance Care Planning

• Helps individuals express their values and preferences regarding future medical care (Sudore et al., 2017)
• Key considerations:
  • Future medical care decisions
  • Desired treatments and procedures
  • Durable power of attorney
  • Living will

Conclusion

• Palliative care neither hastens nor prolongs death
• Start at diagnosis
• Prepares individuals for the final phase of life
• Ensures compassionate care and support for families

Grief

• Definition: Emotional reaction to loss characterized by pain and suffering
• Symptoms:
  • Physical: Heart palpitations, headaches, fatigue
  • Emotional: Anxiety, sadness, irritability, crying
  • Cognitive: Difficulty concentrating, forgetfulness, disorientation
  • Behavioral: Withdrawal, altered sleeping patterns
• Adjustment Challenges: Adapting to changes following a loss

Explore the significant implications of global ageing, including the economic strain and increased healthcare demand. This quiz covers the challenges faced by older adults, especially from culturally diverse backgrounds, and highlights the importance of cultural competence. Test your knowledge on ageism, chronic diseases, and the need for sustainable policies for the ageing population.