Week 3 Transitions, Family Relationships & Home Assessment PDF

Week 3 Transitions, Family Relationships & Home Assessment © DURHAM COLLEGE OR ITS LICENSORS 2022 Copyright This presentation and all its content is copyright and is owned by Durham College or its Licensors (2022). © DURHAM COLLEGE OR ITS LICENSORS 2022 Learning Objectives...

Week 3 Transitions, Family Relationships & Home Assessment © DURHAM COLLEGE OR ITS LICENSORS 2022 Copyright This presentation and all its content is copyright and is owned by Durham College or its Licensors (2022). © DURHAM COLLEGE OR ITS LICENSORS 2022 Learning Objectives 1.Describe various theoretical perspectives on aging such as social, psychological, spiritual and cognitive theories 2.Identify key transitions in the life of the older adult 3.Identify how relationships & roles change as an adult ages 4.Discuss issues related to sexuality & intimacy for the older adult 5.Identify home hazards for the older adult 6.Participate in a virtual simulation experience focusing on client safety, communication, relationships and community resources available for older adults living in the Durham Region © DURHAM COLLEGE OR ITS LICENSORS 2022  Week 3 Transitions © DURHAM COLLEGE OR ITS LICENSORS 2022 Transitions Transition A process of convoluted passage during which people re-define their sense of self and develop self agency in response to disruptive life events. Moving through these transitions is a normal process of older adult growth and development Developmental transitions include retirement or becoming grandparents Situational transitions include widowhood, becoming a caregiver or moving to a senior's residence or downsizing Health-Illness transitions include chronic illness and the transition between hospital to home or home to long term care © DURHAM COLLEGE OR ITS LICENSORS 2022 Transitions Transitions can be planned and predictable such as retirement or moving, or they can be sudden and surprising, such as widowhood or a new diagnosis. The speed and intensity of a transition as well as whether it is anticipated or not, can influence how one transitions to the next phase of their life. This can lead to a transitional crisis or a gradual, comfortable and controlled adaptation. © DURHAM COLLEGE OR ITS LICENSORS 2022 Transitions When transitions result from loss, this can be very difficult For example: if you enter retirement by choice vs. if you are terminated and forced to take early retirement. Another example is when a person suffers a loss of a partner after a long illness you may have time to adjust versus if a person suffers a loss of their partner suddenly or tragically. Factors that influence transitions: Personal meaning Socioeconomic status Expectations Emotional reserve Knowledge Physical reserve Planning Community & Social Conditions In each transition, there is often both gains and losses, however the ideal transition occurs when the gains out weigh the losses. The most difficult transitions are when they involve losses rather than gains © DURHAM COLLEGE OR ITS LICENSORS 2022 Retirement Retirement has been a period of rest for a few years between work until death. Now people are living longer, and retirement could occupy 30 years or more. The federal government estimates that approximately 24% of older adults will not have sufficient income to maintain their standard of living as they enter retirement. Health, income, and social environment influence how well one transitions to retirement © DURHAM COLLEGE OR ITS LICENSORS 2022 Retirement Historically retirement has been a period of rest for a few years between the rigors of work until death. Now with advancing medical technologies, people are living longer and we recognize that retirement is a developmental stage that could occupy 30 years or more. Older adults are now facing the prospect of working longer as they are worried about the possibility of outliving their retirement savings. The federal government estimates that approximately 24% of older adults will not have sufficient income to maintain their standard of living as they enter retirement. There are many factors that influence how well one transitions to retirement. These factors include health, income, and social environment. Health and financial status can affect an older adults ability and decisions regarding how and when to retire. Many older people are seeking employment to continue to support themselves after retirement. © DURHAM COLLEGE OR ITS LICENSORS 2022 Retirement Planning Important to plan for retirement Most retirement programs targeted to employees who have high levels of education, occupation or government employees Contributes to inequities as one ages There are three pillars of financial security in retirement: 1.Federal Old Age Security and Guaranteed Income Supplement program (GAINS) http://www.servicecanada.gc.ca/eng/services/pensions/oas/payments/index.shtml 2.Canada Pension Plan (based on individual pay in model) http://retirehappy.ca/how-much-will-you-get-from-canada/ 3. Private savings plans, RRSP, employer sponsored pension plans © DURHAM COLLEGE OR ITS LICENSORS 2022 Retirement Planning It is important for older adults to plan ahead to ensure they are able to retire comfortably. Retirement preparation and education programs are usually targeted towards employees who have high levels of education, occupation, or government employees. This contributes to inequities in access to information and therefore how much money people have come retirement. Often those with the least resources for retirement are in most need of planning education and support. © DURHAM COLLEGE OR ITS LICENSORS 2022 Divorce Historically was considered a stigmatizing event, nurses may forget that New trend is older couples are less likely to stay in a unsatisfactory marriage Marital breakdown may be more devastating in old age as it is often unanticipated Go to 3.2 DC © DURHAM COLLEGE OR ITS LICENSORS 2022  Week 3 Relationships © DURHAM COLLEGE OR ITS LICENSORS 2022 Relationships In Canada there is no longer a "typical" family. Many new features of Canadian families that have an impact on adults as they age Discuss different relationships & how they may be impacted as a person ages Individuals or Couples without children Divorced older adults Blended Families Multigenerational families Grandparents with formal and informal parental roles for their grand-children. As families change, the role of family members and expectations of one another also change © DURHAM COLLEGE OR ITS LICENSORS 2022 Relationships It is important to note that 38% of todays families are couples without children. This will have an impact on older adults as they age, as they may not have the support of their children as they age. Changes to family structures may include high divorce and re-marriage rates resulting in households of blended families with children from previous and new marriages. Multigenerational families are also becoming more common in Canada. In many circumstances, grandparents are assuming formal and informal parental roles for their grand © DURHAM COLLEGE OR ITS LICENSORS 2022 Widowhood Thirty four percent of women and 11% of men age 65 years and older are widowed. The rate is lower for men because men are more likely to remarry after their spouse dies Losing a partner after a long, close and satisfying relationshipTable 25.2 is one in of the most difficult transitions a person can face. Ebersole & Hess' Gerontological There are 4 Dimensions of Grief Reactions nursing & healthy Affective – Depression, anxiety, anger, irritability aging in Canada (3rd Ed.). Cognitive – Thoughts of deceased, Helplessness Four Dimensions Behavioural – Agitation, fatigue, social withdrawl of Grief Physiological / Somatic - Loss of appetite, Energy loss, Reactions © DURHAM COLLEGE OR ITS LICENSORS 2022 2SLGBTQI+ Older Adults Less than 1% of Canadians aged 65 years and older are in same-sex partnerships. These relationships in older age will become more common in future generations Longstanding discrimination and fear may prevent LGBTQ individuals from disclosing their sexual orientation, gender identity & / or relationships to health care providers. Many LGBTQ individuals have non-relatives who become family. This may have implications for health care planning (eg: Next of Kin, Advanced Directives & Substitute Decision Makers) Gerontological nurses can improve accessibility and create a welcoming, safe environment for older LGBTQ persons © DURHAM COLLEGE OR ITS LICENSORS 2022 Intimacy Intimacy is a “warm, meaningful feeling of joy” (Boscart et al., 2023) Intimacy involves the need for close friendships, relationships with family, friends, and formal caregivers; spiritual connections; and knowing that one matters in another person’s life” (Steinke, 2005) Components of Intimacy Commitment Affective intimacy Cognitive intimacy Physical intimacy Interdependence © DURHAM COLLEGE OR ITS LICENSORS 2022 Sexual Health Reflect on some of our societal beliefs about sexuality and aging? Sexuality is defined by the World Health Organization as “A central aspect of being human throughout the lifespan, and encompasses sex, gender, identities and gender roles, sexual orientation, eroticism, pleasure, intimacy and reproduction." Despite this positive and affirming definition of sexuality, society still holds significant stereotypes and stigma towards sexuality and older adults. © DURHAM COLLEGE OR ITS LICENSORS 2022 Sexuality & intimacy in LTC As dementia progresses, intimacy Determination of a cognitively impaired and sexuality issues may present person's ability to consent to participation in a sexual activity challenges: involves consideration of: Ability to consent to sexual 1. The person's mental capacity, activity 2. The risks and benefits of such activity Capacity will require accurate for the person assessment and documentation 3. What constitutes voluntary participation. Practice standards and applicable laws must guide nursing practice If the person does not have the capacity to consent to sexual activity, the LTC home has a duty to protect that person from abuse and harm  Nurses Role Older Adults who date and have new sexual partners are at highest risk The major role for nurses is in: Education and counselling about sexual function, Adaptations for age-related changes and Chronic conditions and the maintenance of sexuality for the older adult It is important to open the door to conversations with older adults about their sexual needs Nurses must become comfortable with taking a complete sexual history, talking about sex and STIs with older patients, and providing education about condom use and safer sex practices. Stats Along with better health and active aging comes sex! A nationally representative sample of 3,005 Americans between 57 and 85 years of age revealed that nearly three quarters of seniors aged 57 to 64 were sexually active; while more than half of seniors aged 65 to 74 and more than a quarter aged 75 to 85 reported being sexually active. 6 This increased activity has also led to increases in drug use and sexually transmitted infections (STIs). 4,7,8 A study in the UK demonstrated that the rates of chlamydia, genital herpes, genital warts, gonorrhoea and syphilis infections are rising among those aged 45 years and older, while in the US, persons aged 50 and over accounted for 15% of new HIV/AIDS diagnoses and 24% of persons living with HIV. 8 Of interest, a recent US study showed that the risk of STIs were higher among recently widowed men compared to recently widowed women in the age group 67 to 99 years. 9 The elevated rate of sexual activity coupled with the increasing rates of STIs may be surprising to some, as common thinking is that sexual activity and desires gradually diminish with age. Thus, one would expect to see a lower risk of STIs.10 Pharmacological advances such as Viagra, Cialis and Levitra, as well as progesterone and estrogen products, however, have led to increased sexual activity later in life, which has led to the increased spread of STIs among this age group. 33,9 http://www.cpha.ca/en/about/digest/39-4/15.aspx © DURHAM COLLEGE OR ITS LICENSORS 2022 Types of Caregiving Spousal Caregiving Aging Parents caring for developmentally disabled Read about Types of Caregiving on pgs 402- children 406 in Ebersole & Hess' Grandparents raising grandchildren Gerontological nursing & healthy aging in Canada Long distance caregiving (3rd Ed.). 1 in 5 adults 45 and older provided unpaid care to an older adult with a health or physical limitation. Without this help the cost of providing care would stagger the health care system. Caregivers frequently experience depression and physical and emotional exhaustion © DURHAM COLLEGE OR ITS LICENSORS 2022 Caring for Older Adults Many adult children take on caregiving roles for their older adult parents as they age. You are most likely to be a caregiver to an older parent if you are: The closest female relative (by location) A relative or friend with medical, financial or legal training A family member or friend who has been financially successful A member of an ethnic family or community with cultural © D U R H A Mexpectations C O L L E G E O R I T S L I C E Nthat S O R S 2 0include 22 care of Caring for the Caregiver Caregivers must make time for themselves as they take on balancing work and family responsibilities, managing emotional and physical stress, talking to the health care team, making end of life decisions, supporting ADL’s, managing complex medications and equipment, Take time to listen and support the caregiver. As a nurse it is important to take the time to listen and support the caregiver Caregivers may need access to information and community resources Information for Caregivers Rview BOX 25.2 - 10 Strategies to Reduce Caregiver Stress in Ebersole & Hess' Gerontological nursing & healthy aging in Canada (3rd Ed.). © DURHAM COLLEGE OR ITS LICENSORS 2022 DC Connect 3.3 Video Watch video and answer questions © DURHAM COLLEGE OR ITS LICENSORS 2022  Week 3 Home Assessment (Please go to DC Connect Module 3.4) © DURHAM COLLEGE OR ITS LICENSORS 2022