Impact of Aging in the Family PDF

**Impact of Aging in the family** Mrs. Regis, 27/01/2025 - When family is not involved, it generally is because the older person has no living relatives nearby or there have been longstanding relationship problems - 85% of senior citizens will need in-home assistance at some point in...

**Impact of Aging in the family** Mrs. Regis, 27/01/2025 - When family is not involved, it generally is because the older person has no living relatives nearby or there have been longstanding relationship problems - 85% of senior citizens will need in-home assistance at some point in their lives. - 78% of in-home care is provided by unpaid family members and friends - 79% of people who need long-term care remain at home **Demographic and Social trends that affect families of older Adults** **Increasing aging population** - Since 1990, the percentage of Americans 65 + has more than tripled (from 4.1% in 1900 to 19.9% in 2015), and the number has increased more than 15 times (from 3.1 million to 47.8 million) - 65-to 74-year age group (27.6 million) was more than 12 times larger than in 1900; - 75- to 84-year group (13.9 million) was more than 17 times larger **Living arrangement** - In 2016, 59% of noninstitutionalized persons aged 65 and older lived with their spouses or partner. - 29% lived alone. - In 2015, approximately 1 million grandparents aged 60 and over provided the basic needs for one or more grandchildren under age 18 living with them. - Approximately 3.1% of the 65 + groups lived in an institutional setting such as nursing home or assisted living. This percentage increases with age (1% for 65-74 years to 9% for 85 and older) - Assisted living is a facility that meets the needs of the older person (e.g., wide doorways, grab bars in the bathroom, a call light). Various degrees of personal care assistance may be provided. - Adult day care - the older the adult who lives at home can attend a day care center that provides health and social services to the older person. While the older adult is at day care, the caregivers have s a respite from the daily care tasks. - Adult foster care and group homes - These programs offer services to individuals who can care for themselves but require some form of supervision for safety purposes. - Long-term care facilities or Nursing homes - when older adults can no longer care for themselves, often because of problems of mobility and memory impairment. **Disability and Activity** - The AOA measures disability based on limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLS) - According to data collected in 2013, 30% of noninstutionalized Medicare beneficiaries reported difficulty performing one or more ADLs, and 12% reported difficulty with one or more IADLS (AOA, 2017). **Katz Index of Independence in ADLS** **WHY**: Normal aging changes and health problems frequently show themselves as declines in the functional status of older adults. Decline may place the older adult on a spiral of iatrogenesis leading to further health problems. One of the best ways to evaluate the health status of older adults is through functional assessment which provides objective data that may indicate future decline or improvement in health status, allowing the nurse to intervene appropriately.  Best tool: **ADL - A mnemonic that can be used to remember is DEATH** - **D** - **Dressing**: including wearing clothes in an acceptable fashion. - **E** -- **Eating**: feeding self (not including meal prep) - **A** -- **Ambulation**: walking, sit to stand, getting in/out of cars/tub/bed/chairs - **T** -- **Toileting**: including using the facilities, then wiping/washing self without help - **H** -- **Hygiene**: bathing, grooming, brushing teeth Remember this is **DEATH**. The information from a functional assessment **Best tool:** The Lawton Instrumental Activities of Daily Living Scale (IADL) is an appropriate instrument to assess independent living skills (Lawton & Brody, 1969). These skills are considered more complex than the basic activities of daily living as measured by the Katz Index of ADLs (See Try this: Katz Index of ADLs). The instrument is most useful for identifying how a person is functioning at the present time, and to identify improvement or deterioration over time. **A simple way to remember what IADLs are, is to use the mnemonic SHAFT.** - S - shopping - H - housekeeping or housework - A - accounting or managing money - F - food preparation - T -- Transportation/Telephones - IADLS, while physical in nature, involve **State of the senior housing industry** - 90% of the 65 + age group plans to stay in their current homes if possible. - Assisted living is becoming more popular, as adult children need more support in caring for their aging parents. - 90% on institutionalized seniors still reside in nursing homes, the rapidly increasing number of alternatives has caused the number of nursing homes to decrease. - The number of older adults living in continuing-care retirement communities (CCRCs) nearly doubled from 1997 to 2007, although occupancy rates have begun to decline with the decline in the housing market. **Caregiver workplace issues** - Caring for older adult family members is becoming the new normal for American families. - Family Medical leave act (FMLA) allows eligible employees up to 12 weeks of unpaid leave to care for a parent, spouse, or child, but caregiving for an older adult parent may take up to 20 hours per week for as many as 5 years. **The nurse plays an important role in the following:** - Providing an objective assessment of an older person\'s functional ability - Exploring ways to maintain an older relative in their home and the advantages and disadvantages of other living arrangement options - Helping families understand the older person\'s perspective of the meaning of home and the significance of accepting help or moving to a new **1.Changes in living arrangement** a. "What should we do?" when an older family member begins to have problems living alone. **Some helpful suggestions to the Family** 1. Deal with your relative\'s perceptions and feelings. a. be objective and be specific in describing your observations. 2. Approach your family member in a way that prevents him or her from feeling helpless. b. Try to present the need for assistance in a positive way, emphasizing how it will enable the person to live more I independently. 3. Suggest only one change or service at a time. c. If possible, begin with a small change. Most people need time to think about and accept changes. 4. Suggest a trial period. 5. Focus on your needs. - If an older person persists in asserting, \"I\'m okay. I don\'t need help,\" it may be helpful to focus on the family\'s needs rather than the older person\'s needs. 6. Consider who has "listening leverage." - An older person may "hear" the information better when it is shared by a certain family member, a close friend, or a doctor. **Mid -- 1980s... Assisted living facility** A home for older people or people with disabilities who can live fairly independently but need some help with everyday tasks such as preparing meals, bathing, and dressing. (Cambridge Dictionary) **2.Deciding About A Care Facility** 25 years ago... Two options available to older adults who could no longer live alone: a. Move in with their children b. Move into a long-term care facility **Continuing care retirement community** - comprehensive type of senior living option that may be a good choice for seniors who are still healthy but anticipate needing more care in the future. - more expensive than other senior living options. - Remaining on the same campus for the rest of their life even as their care needs -  Dealing with the family\'s feelings about placement is as important as stressing the need for long-term care. -  Many families view facilities negatively because of what they have seen in the media concerning neglect, abuse, and abandonment. - Guilt is a common feeling that families express when faced with care facility placement **Sources of feeling guilt** 1. Pressures and comments from others a. ("I would never place my mother in a care facility," or "If you really loved me, you would take care of me") 2. Family tradition and values b. "My family has always believed in taking care of its own -- and that means you provide care to family members at home" 3. The meaning of nursing facility placement c. "I'm abandoning my... 4. Promises d. "I promised mother I would always take care of dad" **3.Financial and Legal Concerns** - A family's objective should be to assist, not to take away control. - The goal is to choose the least intrusive intervention that will enable the older person to remain as independent as possible. - When a person has been diagnosed with Alzheimer\'s disease or a related disorder, it is critical that the family make financial and legal plans while the older person is able to participate. - At this point it would be appropriate to execute a general durable power of attorney, which appoints someone to act as agent for legal, financial, and sometimes health matters when the person is no longer able to do so. **4.End of life health care decisions** - The main interests of patients nearing the end of life are pain and symptom control, financial & health decision planning, funeral arrangements, being at peace with God, maintaining dignity and cleanliness, and saying goodbye (Auer, 2008). **\"Five Wishes,\"** - useful tool to help with end-of-life planning - an easy to-use legal document written in everyday language. - It is \"America\'s most popular living will!.\" **The Wishes are:** 1. The person I want to make health care decisions for me when I cannot. 2. The kind of medical treatment I want or do not want. 3. How comfortable I want to be. 4. How I want people to treat me. 5. What I want my loved ones to know.  A screen with text on it Description automatically generated  A screen with text on it Description automatically generated **5.Family Caregiving** - Primarily provided by the adult children of the older person.\\ **The types and levels of family caregiving:** 1. **Routine Care**-regular assistance incorporated into the daily routine of the caregiver 2. **Back-up Care**-assistance with routine activities provided only at the request of the main caregiver 3. **Circumscribed Care**-participation provided on a regular basis within boundaries set by the caregiver (i.e., taking Mom to get her hair and nails done every Saturday) 4. **Sporadic Care**-irregular participation at the caregiver\'s convenience 5. **Dissociation** -potential caregiver does not participate at all in care **Providing care to frail, dependent older adults** - Many caregivers are spouses, - 52% of all parental caregiving is still provided by daughters or daughters-in-law - type of care provided for parents by women is different from that provided by men. - Women are most likely to handle the more time-consuming and stressful tasks such as housework, hygiene, medications, and meals. - Men are more likely to handle matters such as home maintenance, yard work, transportation, and finances - A family member with a dementing illness such as Alzheimer\'s disease will require increasing levels of support and assistance as the disease progresses. The need may progress to where help is required 24 hours a day. - Caregivers of patients with dementia often exhibit symptoms of tiredness and depression because of the high levels of stress (Clark & Diamond, 2010). **Interventions to support family caregivers** 1. **Education** - health care professionals ask the family what they want to know, as well as providing them with information they need to know - Managing stress - 10 Symptoms of Caregiver Stress - How to manage stress  A screen with text on it Description automatically generated **10 Ways to Manage Stress** 1. Understand what is happening as soon as possible 2. Know what community resources are available. 3. Become an educated caregiver. 4. Get help from family, friends, and community resources. 5. Take care of yourself (diet, exercise, plenty of sleep). 6. Manage your level of stress through relaxation techniques or talk to your doctor. 7. Accept changes as they occur and be prepared for changing needs. 8. Make legal and financial plans. 9. Give yourself credit, not guilt. 10. Visit your doctor regularly. **6 General Categories of Caregivers Needs:** - Caregivers need information about the progression, signs, symptoms, and outcomes of medical conditions\.... - getting support from other family members, - identifying how much and what type of help family members can give. - Family members often need to know how to effectively communicate their concerns to older persons who are competent as well as how to communicate with those who are unable to understand or communicate. - Many caregivers need information about the range of community services, the types of help that are available, how to access services, and care facility options. - making legal and financial plans, and considering changes in the current caregiving situation, including possible nursing facility placement. **adult sons comments\...** The hardest thing about dealing with Alzheimer\'s disease is learning to relate in new ways and accepting my dad as he is today. What a difference it made for me when I learned in the caregiver class to \"step into my dad's world,\" rather than keep asking him questions about things he simply could not remember. Our times together are now much more enjoyable for the both of us. **Two major goals of caregiver education should be to** 1. Empower caregivers 2. Increase caregiver confidence and competence - Sharing printed information (e.g., handouts the nurse has prepared, - pamphlets, articles) and programs is another important way to provide education. - Workbooks can provide caregivers with a step-by-step guide for taking action. - Educational materials should be easy to read, with bullet points, definitions of difficult terms, illustrations etc - Another resource for families is the Internet. **Interventions to support family caregivers** 1. **Education** 2. **Respite Program** - allow caregivers planned time away from their caregiving role. 1. shared responsibility for caregiving 2. caregiver support (Alzheimer\'s Association, 2013b). 3. **Support groups** a. Discovering that they are not alone may provide much needed emotional relief to some caregivers b. May provide an acceptable outlet for socializing 4. **Family Meetings** c. A family meeting should be held as early as possible after the need for caregiving arises. d. Calling distant family members to get their input and keeping them informed may help them feel involved in the decision making. A family member should not be excluded because of distance, personality, family history, or limited resources.