Our Lady of Fatima University NCMB 314 PDF

BACHELOR OF SCIENCE IN NURSING: NCMB 314 - CARE OF THE OLDER ADULTS COURSE MODULE COURSE UNIT WEEK 1 1 1 Concepts, Principles, History and Theories in the...

BACHELOR OF SCIENCE IN NURSING: NCMB 314 - CARE OF THE OLDER ADULTS COURSE MODULE COURSE UNIT WEEK 1 1 1 Concepts, Principles, History and Theories in the Care of Older Adults Read PEO (Program Educational Objectives) ✓ Understand required learning resources; refer to unit terminologies for jargons ✓ Proactively participate in online discussions ✓ Participate in weekly discussion board (Canvas) ✓ Complete and submit course unit tasks At the end of this unit the students are expected to: Cognitive: 1. Explain the different ways in which older adults have been viewed throughout history. 2. Track historical landmarks and impact in the development of gerontological nursing in practice of the nursing profession as a specialty. a. Demographics Aging b. Longevity and sex difference c. Roles of the Gerontological Nurse 3. Identify the major theories of aging.  Affective: 1. Listen attentively during class discussions 2. Demonstrate tact and respect when challenging other people’s opinions and ideas 3. Accept comments and reactions of classmates on one’s opinions openly and graciously. 4. Develop heightened interest in studying “Care of the Older adults” Psychomotor: 1. Participate actively during class discussions and group activities 2. Express opinion and thoughts in front of the class Textbooks: Mauk, Kristen. (2010). Gerontological nursing: competencies for care.MA: Jones & Bartlett Publishers.610.7365 G31 2010 Eliopoulos (2018). Gerontological Nursing 9th Edition.Wolters Kluwer Meiner (2019). Gerontologic Nursing 6th Edition. ELS PERSPECTIVE OF OLDER ADULTS THROUGH HISTORY Historically, societies have viewed their elder members in a variety of ways. The members of the current older population in the United States have offered the sacrifice, strength, and spirit that made this country great. They were the proud GIs in world wars, the brave immigrants who ventured into a new country, the bold entrepreneurs who took risks that created wealth and opportunities for employment, and the unselfish parents who struggle to give their children a better life. They have earned respect, admiration, and dignity. Today older adults are viewed with positivism rather than prejudice, knowledge rather than myth, and concern rather than neglect. This positive view was not always the norm. In the time of Confucius, there was a direct correlation between a person’s age and the degree of respect to which he or she was entitled. The early Egyptians dreaded growing old and experimented with a variety of potions and schemes to maintain their youth. Opinions were divided among the early Greeks. Plato promoted older adults as society’s best leaders, whereas Aristotle denied older people any role in governmental matters. In the nations conquered by the Roman Empire, the sick and aged were customarily the first to be killed. And, woven throughout the Bible is God’s concern for the well-being of the family and desire for people to respect elders (Honor your father and your mother..Exodus 20:12).Yet the honor bestowed on older adults was not sustained. Medieval times gave rise to strong feelings regarding the superiority of youth; these feelings were expressed in uprisings of sons against fathers. Although England developed Poor Laws in the early 17th century that provided care for the destitute and enabled older persons without family resources to have some modest safety net, many of the gains were lost during the Industrial Revolution. No labor laws protected persons of advanced age; those unable to meet the demands of industrial work settings were placed at the mercy of their offspring of forced to beg on the streets for sustenance. THE HISTORY OF GERONTOLOGICAL NURSING The history and development of gerontological nursing is rich in diversity and experiences, as is the population it serves. There has never been a more opportune time than now to be a gerontological nurse. No matter where nurses practice, they will at some time in their career care for older adults. The health care movement is constantly increasing life expectancy; therefore, nurses must expect to care for relatively larger numbers of older people over the next decades. With the increasing numbers of acute and chronic health conditions experienced by elders, nurses are in key positions, and to promote positive aging. The development of gerontological nursing as a specialty is attributed to a host of nursing pioneers. The majority of these nurses were from the United States; however, two key trailblazers were from England. Florence Nightingale and Doreen Norton provided early insights into the “care of the aged”. Nightingale was truly the first geriatric nurse, Doreen Norton focused her career on care of the aged and wrote often about the unique and specific needs of elders. Landmarks in the development of gerontological nursing as a specialty: 1902 American Journal of Nursing (AJN) publishes first geriatric article by an MD 1950 First geriatric nursing textbook, “Geriatric Nursing (Newton), published First master’s thesis in geriatric nursing completed by Eleanor Pingrey Geriatric becomes a specialization in nursing 1952 First geriatric nursing study published in Nursing Research 1961 ANA recommends specialty group for geriatric nurses 1962 ANA holds first National Nursing Meeting on Geriatric Nursing Practice 1966 ANA forms a geriatric nursing division, First Gerontological Clinical Nurse Specialist master’s program begins at Duke University 1968 First RN (Laurie Gunter) presents at the International Congress of Gerontology 1969 Development of standards for geriatric nursing practice 1970 ANA creates the Standards of Practice for Geriatric Nursing 1973 ANA offers the first generalist certification in gerontological nursing 1975 First nursing journal for the care of older adults published : Journal of Gerontological Nursing by Slack,Inc. First nursing conference held at the International Congress of Gerontology. 1976 ANA Geriatric Nursing Division changes name to Gerontological Nursing Division 1981 ANA division of Gerontological Nursing publishes statement on scope of practice 1982 Development of Robert Wood Johnson Teaching Home Nursing Program 1983 First university chair in gerontological nursing in the United States (case western reserve) 1987 ANA revises Standards and Scope of Gerontological Nursing Practice 1988 First Phd program in gerontological nursing established 1989 ANA certification established for Clinical Specialist in Gerontological nursing 1998 ANA certification available for geriatric advanced practice nurses as geriatric nurse practitioners or gerontological clinical nurse specialist  Gerontology – is the broad term used to define the study of aging and/or the aged. - “Gero” – old age “Ology”- study of ▪ Older Age Group: ▪ Young old – ages 65-74 ▪ Middle Old – ages 75-84 ▪ Old Old – 85 and up. - Gerontophobia – fear of aging. Inability to accept aging adults in the society. - Age Discrimination – emotional prejudice among the older adult. - Ageism – dislike of the aging and the older adult. Geriatrics – generic term relating to the aged, but specifica lly refers to medical care for the aged. Gerontological Nursing – the aspect of gerontology that falls within the discipline of nursing and the scope of nursing practice. Demographics of Aging ▪ “Graying of America” - a phenomenon faced by all nations, not only the U.S. ▪ Demographic Tidal Wave or A pig in a Python – a bulge in the population moving slowly through times. (1946 -1964 : Baby Boomer) 1 out of 8 Americans age: 65 years old and up. 1997 – approximately 10% of the world’s population (Ag e 60 and above) It is expected that by 2025, the number of persons 65 and older in the United States will increase from 12% of the population (by 2000) to 19% In 2005, 13% of the U.S. population was over age 60 ▪ 18.3 million aged 65–74 ▪ 12.9 million aged 75–84 ▪ 4.7% aged 85 or older This number is estimated to increase: ▪ To 20 million in 2010 (6.8% of total), ▪ To 33 million in 2030 (9.2%), and ▪ To almost 50 million in 2050 (11.6%) (National Center for Health Statistics [NCHS], 2006). By mid-21st century, old people will outnumber young for the first time in history. All Nations have an aging population. The greatest increases will be in developing countries. Asian countries have less time to prepare for aging -because aging is occurring more rapidly than economic growth. Adequate healthcare services for the elderly may simply be beyond the reach of many Asian countries. They may not be able to afford a large dependent elderly population. They might not have the necessary institutions & financial systems in place (e.g., efficient and well-managed pension and healthcare programs) (“The Future of Population in Asia: Asia's Aging Population”; Sidney B. Westley and Andrew Mason; January 2005) Why The Increase? ▪ Improved sanitation ▪ Advances in medical care ▪ Implementation of preventive health services ▪ In 1900s, deaths were due to infectious diseases and acute illnesses ▪ Older population now faced with new challenge o Chronic disease o Health care funding ▪ Average 75y/o has 3 chronic diseases & uses 5 types of medications ▪ 95% of health care expenditures for older Americans are for chronic diseases ▪ Changes in fertility rates o Baby boom after WWII (1946 – 1964) ▪ 3.5 children per household o Older population will explode between 2010 to 2030 when baby boomers reach age 65 IMPACT of the Baby Boomers In anticipating needs and services for future generations of older adults, gerontological nurses must consider the realities of the baby boomers, those born between 1946 and 1964, which will be the next wave of senior citizens. Their impact on the growth of the older population is such that it has been referred to as a demographic tidal wave. Baby boomers began entering their senior years in 2011 and will continue to do until 2030.Although they are a highly diverse group, representing people as different as Bill Clinton, Bill gates and Cher, they do have some clearly defined characteristics that set them apart from other groups: ▪ Most have children, but this generation’s low birth rate means that they will have fewer biologic children available to assist them in old age. ▪ They are better educated than preceding generations. ▪ Their household incomes tend to be higher than other groups, partly due to two incomes (three out of four baby boomer women are in the labor force). ▪ They favour a more casual dress code than previous generations of older adults. ▪ They are enamored with “high-tech” products and are likely to own and use a home computer. ▪ Their leisure time is scarcer than other adults, and they are morte likely to report feeling stressed at the end of the day.  ▪ As inventors of the fitness movement, they exercise more frequently than other adults. Some assumption can be made concerning the baby boomer population as senior adults. They are informed consumers of health care and desire a highly active role in their care; their ability to access information often enables them to have as much knowledge as their health care providers on some health issues. They are most likely not going to be satisfied with the conditions of today’s nursing homes and will demand that their long-term care facilities be equipped with bedside Internet access, gymnasiums, juice bars, pools, and alternative therapies. Their blended families may need special assistance because of the potential caregiving demands of several sets of stepparents and step grandparents. Plans for services and architectural designs must these factors into consideration. LIFE EXPECTANCY: ▪ US : 75.7 years old ▪ Life Span : 115 years ▪ French women lived for 122 years (1994) o Factors that affects life expectancy: ▪ Improved Sanitation ▪ Advances in Medical care ▪ Implementation of preventive health services. ▪ CENTENARIANS o Predominant in lower educated more impoverished, widowed and more disabled population. o Weight less, take fewer medication, have fewer chronic disease. Feminization of Later Life ▪ Women comprise 55% of the older population ▪ Women have a longer life expectancy ▪ The average life expectancy of women in the United States is 81 years ▪ The average life expectancy of men in the United States is 75.2 years ▪ Male exposure to risk factors may account for the differences ▪ Increases in female exposures to risk factors will reduce difference in life expectancy Majority of older adults enjoy good health But national surveys reveal that: 20% of adults 65y/o & above report a chronic disability. Chronic Conditions in Seniors ▪ 80% have at least one chronic condition ▪ Two of the three leading causes of death declined by one third o Heart disease and stroke Majority of deaths (US) occur in people 65y/o & older ▪ 50% of deaths--caused by heart disease & cancer ▪ In the past 50 years --- a noted decline in overall deaths  Due to the improvements in the prevention & early detection & treatment of diseases ▪ Heart disease & cancer are two top causes of death, regardless of age, race, gender or ethnicity ▪ Positive health reports declined with advancing age ▪ African American and Hispanic or Latinos - less likely to report good health than their Caucasian or Asian counterparts. Majority of people 75y/o & over ▪ remain functionally independent, and ▪ the proportion of older Americans with limitations in activities is declining (CDC, 2007a). 70% of Physical Decline Related to Modifiable Risk Factors  ▪ Smoking ▪ Poor nutrition ▪ Physical inactivity ▪ Failure to use preventative and screening services ▪ Reason for the decline in limitations to activity of Older Adult : Ageing population in the Philippines According to Global Age Watch Index published by “Help Age”, the number of older people in the Philippines is increasingly rapidly. In fact, it is growing faster that growth in the total population. Consider that in 2000, there were an estimated 4.6 million senior citizens (defined by law in the Philippines as an individual who is 60 years old or older). This represented about 6% of the total population. Percentage has been increasing to grow to 6.5 million older people making up about 6.9% of the total population in ten years. The National Statistics Office (NSO) projects that by 2030, older people will make up around 11.5% of the total population. There will be increased demand for health services when there are increased in population. The leading cause of morbidity is usually infection due to ageing of the body’s immune system. Visual impairment, difficulty in walking, chewing, hearing, osteoporosis, arthritis and incontinence are the common health related problems. The average life expectancy was 66 years in males and 73 years in females. Older women compromised 53.8% of population aged 60 plus. By 2050, we expect our elderly to rise to 23,633,000 (15.3% of total population). THEORIES OF AGING PSYCOSOCIAL THEORIES OF AGING - Attempt to explain aging in terms of behaviour, personality and attitude change. 1. SOCIOLOGICAL THEORIES - changing roles, relationship, status and generational cohort impact the older adult’s ability to adapt. a. Activity theory - Havighurst and Albrecht (1953) - Remaining occupied and involved is necessary to satisfy late life. - Activity engagement and positive adaptation. b. Disengagement Theory - Cumming and Henry (1961) - Gradual withdrawal from society and relationships serves to maintain social equilibrium and promote internal reflection. c. Subculture Theory - Rose (1965) - The elderly prefer to segregate from society in an aging subculture sharing loss of status and societal negati vity regarding the aged. d. Continuity Theory - Havighurst (1960)  - also known as Development Theory - Personality influences role and life satisfaction and remains consistent throughout life. - 4 Personality types: ▪ Integrated ▪ Armored Defended ▪ Passive Dependent ▪ Unintegrated e. Age Stratification Theory - Riley (1960) - Society is stratified by age groups that are the basis for acquiring resources, roles, status and deference from others. f. Person-Environment Fit Theory - Lawton (1982) - Function is affected by ego strength, mobility, health, cognition, sensory perception and the environment. II. Psychological theories - Explain aging in terms of mental processes, emotions, attitudes, motivation, and personality development that is characterized by life stage transit ions. a. Human needs - Maslow’s (1954) - Five basic needs motivate human behaviour in a lifelong process toward need fulfilment. - Self – Actualization b. Individualism Theory - Jung (1960) - Personality consists of an ego and personal and collective unconsciousness th at views life from a personal or external perspective. c. Stages of Personality Development - Erikson (1963) - Personality develops in eight sequential stages with corresponding life tasks. The eighth phase, integrity versus despair, is characterized by evaluating life accomplishments; struggles include letting go, accepting care, detachment, and physical and ment al decline. d. Life-course/Lifespan Development - Life stages are predictable and structured by roles, relationship, values and goals. BIOLOGICAL THEORIES OF AGING - Explains that physiologic processes that change with aging. I. STOCHASTIC THEORIES - Based on random events that cause cellular damage that  accumulates as the organism ages. a. Free Radical Theory - Membranes, Nucleic acids and proteins are damaged by free radicals which causes cellular injury, - Exogenous Free radicals: Tobacco smoke, Pepticides, organic solvents, Radiation, ozone and selected Medications. - Health Teaching: ▪ Decrease calories in order to lower weight ▪ Maintain a diet high in nutrients using anti -oxidants ▪ Avoid inflammation ▪ Minimize accumulation of metals in the body that can trigger free radicals reactions. - Older adults are more vulnerable to free radicals. b. Orgel/ Error Theory - Errors in DNA and RNA synthesis occurs with aging. c. Wear and Tear Theory - Cells wears out and cannot function with aging. - Like a machine which losses function when its parts wears off. d. Connective Tissue Theory / Cross link theory - With aging, proteins impede metabolic processes and cause trouble with getting nutrients to cells and removing cellular waste products. II. NON STOCHASTIC THEORIES OF AGING - Based on the genetically programmed events that cause cellular damage that accelerates aging of the organism. a. Programmed Theory - Cells divide until they are no longer able to and this triggers to apoptosis or cell death. - Shortening of the TELOMERES – the distal appendag es of the chromosomes arm. - TELOMERASE – an enzyme, “cellular fountain of youth” b. Gene/ Biological Clock Theory - Cells have a genetically programmed aging code. c. Neuroendocrine theory - Problems with the hypothalamus -pituitary-endocrine gland feedback system causes disease. - Increased insulin growth factor accelerates aging. d. Immunologic/ Autoimmune Theory - Aging is due to faulty immunological function, which is linked to general well-being. Age Discrimination – emotional prejudice among the older adult. Ageism – a negative attitude toward aging or older person. Apoptosis - a process of programmed cell death marked by cell shrinkage. Baby boomers – alarge group of people born between 1946 and 1964, in the time after the Second World War. Centenarian- someone who is 100 years of age or older. Elderly – usually described as those persons age 65 or over. Free radicals- chemical species that arise from atoms as single unpaired electrons Geriatrics –medical care for the aged. Gerontological Nursing – A specialty within nursing practice where the clients/patients/residents are older persons. Gerontology – is the broad term used to define the study of aging and/or the aged. Graying of America - similar to the aging of America, referring to the increase in numbers of older Americans. Nonstochastic theories of aging - theories stating that a series of genetically programmed events occur to all organisms with aging Stochastic theories of aging – theories stating that random events occurring in one’s life cause damage that accumulates with aging Telomerase- an enzyme that regulates chromosomal aging by its action on telomeres Philippine Journal of Nursing Journal of Gerontological Nursing Websites: Lecturio Video Aging Process www.ebscohost.com www.doh.gov.ph http://www.pna-pjn.com Study Questions: I. Compare the similarities and differences between Global aging and Aging in the Philippines. Mauk, Kristen. (2010). Gerontological nursing: competencies for care.MA: Jones & Bartlett Publishers.610.7365 G31 2010 Eliopoulos (2018). Gerontological Nursing 9th Edition.Wolters Kluwer Meiner (2019). Gerontologic Nursing 6th Edition. ELS Miller (2019).Nursing for Wellness in Older Adults 8th Edition. Wolters Kluwer Touhy ( 2018). Ebersole and Hess Gerontological Nursing and Health Aging Filit (2017). Brocklehurts Testbook of Geriatric Medicine and Gerontology Patińo, Mary Jane. (2016). Caregiving volume 1. Manila: Rex Book Store. F 649.1 P27 2016,v.1, c1 Doenges, Marylinn E. (2002). Nursing care plans: guidelines for individualizing patient care, 6th ed. Philadelphia: F. A. Davis Company. R 610.73 D67 2002, c5 Meiner, S. E. (2007). Gerontological Nursing 3rd Edition. Quezon City. pp. 310-311, 371. Wold, Gloria Hoffman. (2012). Basic geriatric nursing, 5th ed. MO: Elsevier.618.970231 W83 2012, c1