Geriatric Assessment PDF

GERIATRIC ASSESSMENT Instrumental Activities of Daily Living Shopping, Housekeeping, Accounting, Food comprehensive geriatric assessment preparation, Transportation multidimensional process...

GERIATRIC ASSESSMENT Instrumental Activities of Daily Living Shopping, Housekeeping, Accounting, Food comprehensive geriatric assessment preparation, Transportation multidimensional process driving or using the bus (transportation) AIMS using the telephone to recognize common geriatric disorder managing medications to plan effective treatment program buying groceries to improve overall health and functional preparing meals outcomes housework, laundry to reduce vulnerability to subsequent paying bills, managing money illness to improve quality of life Why are ADLs or IADLs Important? ADL impairment is a stronger predictor of Function, Function, Function hospital outcomes than admitting In real estate it's "location," in geriatric diagnoses, Diagnosis Related Group (DRG), assessment the focus is on function or other physiologic indices of illness Physical Functioning burden gait and balance functional decline ability to perform daily self-care length of stay activities institutionalization (nursing home Cognitive Functioning placement) memory, reasoning, and judgment death ability to perform "life-maintenance" Approximately 25% to 35% of older patients activities admitted to the hospital for treatment of Psychosocial Functioning acute medical illness lose independence in depression and mental health one or more ADLs adequate caregiver support Implications for discharge planning and financial resources post-acute care What Does Every Nurse Practitioner Need to Best Test is a "Real World" Performance Test Know easy to perform in an office/clinic/hospital overall functional assessment or room impression: big picture easy to evaluate (can do, can't do, or time to ask questions, but.. completion) don't just tell me, show me can be integrated into what you do already (performance-based testing) provide objective information about a make careful observations! person's actual function in daily living trust your gut, if something doesn't look assessment starts the minute you start right, it probably isn't observing the patient. screen and know when to refer for further evaluation Assessing Function Perform a task Asking About Function walk over to the exam table "Can you tell me what your typical day is like?" get on/off the exam table when do you get up? unbutton sleeve, take shirt off what do you do in the morning? put shirt back on, button sleeve, tie do you prepare your own meals? shoes how many meals do you usually eat? Standardized tests do you get out of the house? Shopping? Church? Assessing Physical Functioning: Gait and Risk how do you spend the rest of the day? for Falling do you watch TV? Read? 35-40% of community-dwelling older adults when do you go to bed? fall each year are you generally satisfied with how you 10 to 15% of falls result in a fracture or spend your days? other serious injury 72% of all fall-related deaths are in the age Activities of Daily Living 65+ population Dressing Approximately 40-70% of fallers develop Eating (feeding) fear of falling Ambulating (transferring) Toileting (continence) Risk Factor Relative Risk for Falls Hygiene (bathing) leg weakness 4.4 gait deficit 2.9  impaired ADL 2.3 3) Disorganized thinking 4) Change in the level of consciousness depression 2.2 Folstein MMSE cognitive impairment 1.8 Task Instructio Scoring Score Timed "Get Up and Go" Test n Patient sits in a chair, rises and walks ten feet (3 meters), turns, and returns to the date tell me the one point 5 chair orientatio date? ask each for Should be able to do this in 30 seconds functionally dependent (higher omitted season, items? date, day risk for falls) of week, Identifying fallers: Sensitivity and and Specificity = 87% month Abnormalities in mobility should prompt referral for physical therapy or a further place where are one point 5 diagnostic work-up orientatio you? ask each for n for state, Predicts ADL disability and nursing home omitted county, admission items? town, building, Chair Rise and floor Use a standard chair with arms or room Ask the subject to rise from the chair register name 3 one point 3 If they are able to do that, then ask them to three objects for each rise from the chair without the assistance objects slowly and item of pushing-off of the arms of the chair with clearly. correctly their hands Ask the repeated It may be helpful to have the subject fold patient to their arms across their chest during the repeat maneuver them. Proximal muscle weakness, including trunk repeating ask the one point 1 and proximal thighs, makes this maneuver a phrase patient to for if difficult and is a risk factor for falls say "no successful Can be timed (should take 5 points suggests depression Sensitivity 97% Specificity 85% Basic Geriatric Assessment 1) Functional Impairments Activities of Daily Living (ADLs) Instrumental Activities of Daily Living (IADLs) 2) Gait and Fall Risk Assessment Timed "Get Up and Go" Test Chair Rise Clock Drawing Test: 10 Minutes after 11 3) Cognitive Assessment Confusion Assessment Method (CAM) Mini-Cog Teach-back method 4) Depression Screen literature, continuing to read and One or Two-item questions put into practice the results of Geriatric Depression Scale (GDS) reliable and valid studies. Using evidence-based practice, ROLES OF GERONTOLOGICAL NURSE gerontological nurses can improve the quality of patient care in all A. Provider of Care settings. older adults often present with atypical symptoms that complicate GERIATRIC HEALTHCARE TEAM diagnosis and treatment. Thus, the nurse as a care provider should be Geriatricians educated about the common disease are fully trained physicians, M.D.s or D.O.s, processes seen in the older who specialize in treating the health population. This includes knowledge problems of elderly patients. of the backgrounds and statistics, to become a geriatrician, a doctor must first risk factors, signs and symptoms, complete a three-year residency and usual medical treatment, nursing become board-certified in either internal care through evidence-based medicine or family medicine. practice, and rehabilitation if applicable. Gerontologists B. Teacher - Gerontology is the scientific study of aging, an essential part of all nursing is as well as its effect on individuals and teaching. Gerontological nurses cultures. It's a multidisciplinary field, focus their teaching on modifiable including aspects of medicine, biology, risk factors. Many diseases of aging psychology and sociology and other can be prevented through lifestyle sciences. modifications such as a healthy diet, smoking cessation, appropriate Similarities: weight maintenance, increased Gerontologists and Geriatricians physical activity, and stress might work side-by-side in research or management. elder-care facilities, each bringing C. Manager specialized knowledge and skills to the plan gerontological nurses act as of care. managers during everyday care as between the two professions is that they balance the concerns of the geriatricians are fully-trained physicians, patient, family, nursing and the rest and provide direct treatment for age-related of the interdisciplinary team. Nurse disorders. managers need to develop skills in might work side-by-side in research or staff coordination, time elder-care facilities. each bringing management. assertiveness, specialized knowledge and skills to the plan communication, and organization. of care. Nurse managers may supervise other nursing personnel including The primary difference: licensed practical nurses (LPNs), GERIATRICIAN: geriatricians, registered certified nursing assistants (CNAs), nurses, social workers, psychologists and nurse technicians, nursing other caregivers can earn credentials in students, and other unlicensed gerontology through coursework and assistive personnel (UAP). continuing education. broadening and D. Advocate deepening their skills in caring for the as an advocate, the gerontological elderly. nurse acts on behalf of older adults GERONTOLOGIST: play a more supportive to promote their best interests and and educational role, though applied strengthen their autonomy and gerontologists might build long-term decision making. Advocacy may take relationships with their clients that include many forms, including active coordinating diet, exercise and cognitive involvement at helping to explain therapies. medical or nursing procedures to family members on a unit level. Gerontology Nurse - is a nursing specialist who Whatever the situation, works directly with older adults to provide them gerontological nurses remember with specialized care and a high quality of life. that being an advocate does not mean making decisions for older Geriatric Occupational Therapy for Older adults, but empowering them, Adults: Treatment Idea helping them remain independent E. Research Consumer Occupational Therapy (OT) this involves gerontological nurses being aware of current research  - also designed to assist individuals with progression, all with appropriate monitoring. All valuable skills they can use to remain these skills can be utilized for older adults before independent. injury happens. - occupational therapy (OT) is an allied health profession that involves the Treatment is individualized and goal driven, therapeutic use of everyday activities, or with appropriate precautions being occupations, to treat the physical, mental, followed. developmental, and emotional ailments that Gait training is an integral part of the impact a patient's ability to perform daily treatment process for many older adults tasks. with disabilities, and various assistive devices may be used to ensure safe Geriatric Occupational Therapy for Older Adults mobility. To provide some helpful insight into how OT operates, consider the scenario of PHYSICAL THERAPISTS someone who has suffered from a stroke. The responsibilities of a physical therapist include: (What does an occupational therapist do?) consulting with patients to learn about An article by the American Occupational their physical condition and symptoms. Therapy Association (AOTA) demonstrated diagnosing movement dysfunction and that stroke victims who receive regular OT developing a treatment plan. are far more likely to regain their teaching patients how to properly use independence and ability to perform therapeutic exercise techniques. everyday functions following treatment. providing stimulation or massage to As mentioned in another AOTA article, promote healing. many patients who participate in occupational therapy programs also suffer The goal of physical therapy: from some degree of depression. for seniors is to make daily tasks and activities easier. And to make seniors as The therapist's role independent as possible. is to facilitate the reintegration process, and among circumstances where physical to help the person get back to a healthy therapy can be valuable are for those: physical, mental, and emotional state. a. recovering from injuries such as a family caregivers can play a vital role in a broken hip loved one's recovery by encouraging parents b. osteoarthritis who may be reluctant to join OT sessions c. pain in all parts of the body such as because of misconceptions concerning its the knee, back, shoulder, wrist, etc. importance d. diabetes e. parkinson's disease Occupational Therapy Treatment Ideas f. alzheimer's disease for Geriatrics g. stroke one of the most important things you and h. vertigo your loved one can do before signing up for i. incontinence geriatric occupational therapy is to have j. multiple sclerosis realistic expectations about how long a k. cerebral palsy successful recovery will take. l. and many other conditions 5 Types of Occupational Therapy Activities for the first goal is to reduce pain and swelling Older Adults if there is any. 1. Relaxation techniques: tensing and then, a PT will apply various techniques to releasing muscle groups. increase flexibility, strength, coordination 2. Physical exercises: range of movement, and balance medicine ball training, and squatting. 3. Personal activities: personal care, Physical therapy has an important role in health dressing and undressing, and household care delivery, and is connected with maximizing tasks. function, preventing decline, decreasing pain, and 4. Cognitive exercises: loud reading, dual treatment. task activity, and neurobic exercise. 5. Recreational activities: playing indoor SPEECH THERAPIST games, storytelling, and social events. The goal of speech therapy for seniors is to increase functional communication, Physical therapists’ role cognitive skills and teach safe swallowing play an important role in the care of older by introducing diet modifications and adults who have physical disabilities special feeding techniques. Seniors may lose their ability to talk or Physical therapists are highly trained health care understand language—a condition known professionals, with expertise in movement and as aphasia-due to ailments like stroke, exercise. Physical therapy training includes Alzheimer's disease, Parkinson's disease or assessment, exercise prescription, and brain injury. Nursing Interdisciplinary Care Conference Team - an interdisciplinary approach involves team The mental facilities of the elderly change as a members from different disciplines working person ages, especially those that pertain to collaboratively, with a common purpose, to communication, like senses to memory. set goals, make decisions and share Older adults change a lot as they age, both resources and responsibilities. physically and mentally. They can lose their major senses, like sight, smell, hearing, and Therapeutic Recreation: taste, and lose the ability to move affecting The skilled nursing facility must provide.. their sense of touch. Their mental abilities An ongoing program, directed by a qualified decline as well, from memory recall professional, of activities designed to meet abilities, to the retention of new memories. the interests & the physical, mental & Because of this, they need a lot of repetition psychosocial wellbeing of each resident. and extra time to absorb and learn new things. COMMUNICATING WITH THE ELDERLY APPLICATION IN THE FIELD Key Points: the loss of senses affects the way things Communication is the cohesive force in every must be presented to older adults, and the human culture and the dominant influence in necessity of repetition and extra time to the personal life of every one of us." learn makes repeating instructions often The elderly tend to withdraw and disengage, and offering learning groups important. but this can be made better through Solution: interpersonal communication. utilize subtitles on movies shown, use a Communication is therapeutic and it gives microphone when speaking to a group, people a kind of strength, linking them to bring simple activities to those bed bound, their environment and helping to regulate offer large print for books or hymnals their own behaviors. It helps humans cope, offer instruction groups often for things like it helps us maintain alertness, and it helps technology or other hobbies us establish relationships with people in repeat instructions for activities even if it is our lives. offered frequently APPLICATION IN THE FIELD KEY TAKEAWAYS - because the elderly tend to withdraw from family members and friends are an others, communication may not be as important part of an older adult's naturally prevalent in their lives as healthcare, but institutionalized care can necessary. make these relationships difficult. Solution: physical changes in vocal patterns and morning coffee and social groups hearing abilities can add stress to current event discussions communicating for an elder. reading and writing groups one to one visit Family members and friends are an important part of an older adult's healthcare, but "The form and function of communication vary institutionalized care can make these with the basic personality types and age relationships difficult. characteristics of the persons involved." Disagreement is common between families Different personalities prefer to of residents and staff, centering on the way communicate in different ways, and to care for the older adult. Family members therefore, different communication can feel that they can't communicate mediums should be offered. Introverts are suggestions or complaints without affecting imaginative, creative and sensitive and tend the care given to their loved ones, and to express their emotions more freely. They many relatives may feel they are bothering prefer reading, writing, and listening to staff or that they'll appear stupid when they others. Extroverts are more social and ask questions. They often don't share prefer the company of others. They choose enough information about their loved one to objective subjects over abstract thoughts, allow the staff to care for them the best way and they prefer to talk and be active. possible. APPLICATION IN THE FIELD APPLICATION IN THE FIELD - both groups need and want though communication with family can be communication, it's just a matter of how. difficult. including them in activities and Solution: offering them support and education can Reading Groups and Book Club: offers help. quiet reading and social discussion Solution: Story Circle or Reminisce: each resident family education events has the opportunity to share a story or invite family members to everyday activities memory, and others can simply listen and family/caregiver appreciation events enjoy  facility orientation so family feels Social groups/ Interest Groups - encourage comfortable in the environment interactions and friendships through Physical changes in vocal patterns and frequent social interactions. hearing abilities can add stress to communicating with an elder. "...a close relationship is crucial to the Aging not only affects articulation, but 'will to live'." phonation, pitch and timing as well, Weak Though they tend to withdraw from many speech muscles, dentures, and receding social relationships as they age, the elderly gums can change the way an older person are much happier with a confidante; they speaks, causing them to lose acuity of have a strong need to confide emotions in diction and making them cut but certain another individual. Research shows that sounds all together. Voice tremors can friends are more important to psychological become more pronounced, stuttering can well-being than family. become an issue, and the speed and rhythm of speech is affected Presbycusis is APPLICATION IN THE FIELD also a common problem for the aging. though incredibly important to well-being, causing a large gap between what is being developing relationships through new said and what Is being heard. interactions are intimidating and risky for older adults. APPLICATION IN THE FIELD Solution: simply because someone is losing the Social/ Interest groups - offer regular social ability to speak. clearly or hear well should activities as an opportunity for elders to not exclude them from socialization. connect with others with similar interest Solution: New Resident Night "Get to Know Me" Work with the facility's speech therapist - events/ "Speed Friend-ing' (speed dating include exercises to strengthen speech method to getting to know someone) - muscles daily. encourage new interactions by getting Writing groups and charades - allow introductions out of the way emotions and thoughts to be expressed without the need to verbal communication "Interviewing and Interacting Emphatically" Subtitles on movies Interviewing is important in the healthcare Whiteboards, pictures, diagrams - allows industry to get pertinent information from the hard of hearing to participate in residents. To do so effectively, conduct programs and discussions interviews in a quiet and private environment, ask open-ended questions, KEY TAKEAWAYS encourage more thorough answers, and use "Perception is basic to interaction." language familiar with the interviewee. "...a close relationship is crucial to the 'will Display empathy- too formal or professional to live'." and you won't get the thorough information Interviewing and Interacting Emphatically you're looking for. Show respect, be reflective and validating, and welcome "Perception is basic to interaction." feedback. Humans behave based on their perception of themselves and others. The Tennessee APPLICATION IN THE FIELD Self-Concept Scale includes 5 ways the interviewing is an important skill to master elderly view themselves: physical self in the care planning process. (physical attributes), moral-ethical self Solution: (developed during earlier life), personal self staff role-playing to practice proper (self-esteem, health), family self (once head interview techniques of house, now dependent), social self (many frequent one-to-one visits prior to interview become withdrawn). Elders with a healthy to make sure both parties are comfortable self-perception display healthier behaviors with one another before asking important in everyday interactions questions APPLICATION IN THE FIELD KEY TAKEAWAY the elderly can struggle with a positive communication disorders constitute the self-image as they age nation's number one handicapping Solution: disability." beauty/spa/salon days - help elderly women feel positively about their physical "Communication disorders constitute the appearance nation's number one handicapping disability." focus on positive elder achievements in Several age-related conditions can cause or movies and programs contribute to poor communication. Natural reminisce - remember times when they physiologic changes in hearing, sight voice, were in charge of the fairy and speech processing take place as a person gets older, even if they had no difficulty communicating before. Among  these, declining hearing and sight may be as caregivers, we must do our best to make the most obvious, such as macular the older adult feel comfortable and degeneration or presbycusis, but changes respected. in voice (tremor, pitch, rate of speech) and Solution: language impairment caused by cognitive frequent one-to-one visits loss, dementia, illness, disease, or group conversation activities, including accidents causing brain damage, (such as staff stroke. cancer, or degenerative neurological resident council meetings - offers a safe, diseases) as well as conditions like aphasia, comfortable environment for residents to agnosia, apraxia or dysarthria may also voice concerns cause major difficulties. informal visits - residents often see staff only as caregivers, but they want to see us APPLICATION IN THE FIELD as friends. Not every interaction needs an illness and disease can cripple an older official purpose; sometimes, we can visit as person's ability to effectively communicate. a friend and simply sit and chat. Solution: work with the facility's speech therapist - Conclusion include exercises to strengthen speech Though several things can get in the way of muscles in daily activities healthy, effective, natural communication, writing groups and charades - allow many things can be done to ensure that emotions and thoughts to be expressed residents of a long-term care facility feel at without the need for verbal communication home and get the interaction they need and one-to-ones if group activities are desire. 1, as a staff member of an Activity uncomfortable. or Recreation Therapy department, can ease the struggles common in KEY TAKEAWAY communicating with the elderly and can Communication is a two-way street, and promote healthy interactions with the you must be a good listener and recognize residents I care for through thoughtful the challenges your speaker faces programming Communication is a two-way street, and you ETHICAL ISSUES ON CARE OF ELDERLY must be a good listener and recognize the challenges your speaker faces TERMINOLOGY: When communicating with the elderly, you Ethics: declarations of right or wrong and must listen, pay attention, maintain eye what out to be contact, and display an active posture. You Bioethics: application of ethics to matters have to find a reason for listening (so you of life and death naturally show a real interest in what they Ethical Dilemma: a difficult problem are saying), show respect through seemingly incapable of a satisfactory maintaining personal space, and get on eye solution; situation involving two equally level with the person you’re speaking with. unsatisfactory alternatives Be aware of your own non-verbal Nursing Ethics: application of ethical communication and body language, as well principles in nursing practice as keeping an eye on theirs. Slow down your speaking pace, using a nice relaxed decision making capacity tone, and lower the tone of your voice, but informed consent don’t necessarily raise your volume. refusal of treatment Develop an ability to rephrase, act out, and advance directive simply what you’re trying to express. Make major ethical principles sure you are in a quiet and comfortable psycho-social aspects of aging environment. A common age-related barrier is hearing loss (presbycusis), affecting how DECISION MAKING CAPACITY well older adults hear what you’re saying implies the ability to understand the nature and how you’re saying it, and vision loss and consequences of different options, (presbyopia), affecting how they "hear" your make a choice among those options, and nonverbal communication gestures, facial communicate that choice. expressions, and body language, as well as clinicians assess decision-making capacity. reading written messages and seeing signs required to give informed consent and symbols. Possibly the most frustrating may fluctuate over time from transient communication barrier occurs when the changes in ability to comprehend and message is heard, understood, and simply communicate ignored. Attitude issues due to a poor Competency - legal determination by a relationship between the two judge as to mental disability or incapacity; communicators can cause this. whether a person is legally fit and qualified to give testimony or execute legal APPLICATION IN THE FIELD documents.  the law presumes that all adults are Living Will - a form that states the type of competent and have decision-making medical treatment you want to receive as capacity to make health care decisions. you near the end of your life and if you can may fluctuate over time. no longer speak for yourself cognitive impairment can lead to automatic Health Care Power of Attorney - allows incapacity. you to name a person to make treatment no "gold standard" for capacity decisions for you when you can’t speak for determination. yourself. This person can be a spouse, partner, parent, friend or someone you Verification of Decision Making Capacity trust to make health decisions for you. required when a person is refusing or giving consent for treatment and/or executing an Do Not Resuscitate advance directive: in the event of a cardiopulmonary arrest, ability to voice a choice or cardiopulmonary resuscitation is preference administered to every patient unless a DNR adequate disclosure order is written in the medical record by the understanding of information: recall physician information; manipulate when advanced directives exist and information; appreciate situation qualifying conditions are present, these voluntary consent directives are followed by the physician consistency the attending physician discusses the decision with the patient, family members, INFORMED CONSENT or others involved in the care of the patient can make a choice if the patient can not validly participate in understand and appreciate the issues the decision making, the physician rationally manipulate information attempts to obtain consensual opinions of make a stable and coherent decision all interested parties concerning what the age-related factors: patient's wishes would be hearing and visual impairments consent of the family is not necessary if the impaired communication: written decision is made by the patient - family and verbal disagreement is not sufficient to override values and beliefs the patient's choice fluctuating or diminished the physician writes the DNR order on the decision-making capacity patient's medical record by completing the "Resuscitative Treatment" REFUSAL OF TREATMENT when orders have been written to limit the right to refuse treatment even if refusal specific resuscitative treatments, the hastens or results in their death. patient continues to receive full and requisite capacity must be determined: consistent medical and nursing efforts in all can make a choice other aspects of healthcare management understand and appreciate the if the patient is mentally incompetent, issues decisions not covered by advance directives rationally manipulate information are reached by appropriate surrogate make a stable and coherent decision decision makers as identified by Arkansas Law ADVANCE DIRECTIVE if conflict or dilemmas arise, the Ethics Patient Self-Determination Act (PSDA) mandates: Committee assists in clarifying available 1. Provide all adult patients with written options and improving communications information concerning care decisions nursing communicates DNR status during 2. Ask patients whether they have an advance shift reports and verified by checking the directive. medical record 3. Maintain policies re: discussions of advance place a "DNR" on the MedAct directive. nursing shift supervisor is notified of all 4. Honor advance directive. patients with a DNR status 5. Educate patients about advance directive. place the purple DNR armband on the 6. Conduct community education patient 7. Do not discriminate the order to limit resuscitative treatments is subject to regular review and is amended or Why is an Advance Directive important? rescinded at any time as deemed an advance directive is important when appropriate by the physician you’re badly hurt or have a serious illness when a DNR is written on the medical that keeps you from making medical record no resuscitative treatment is done decisions for yourself. It tells your doctors such as CPR or ACLS and other health care workers what type of all other care is consistently delivered to all care you would like to have patients Two Parts of Advance Directive  limited resuscitative interventions are ways in which the code guides in the indicated on the "Resuscitative Treatment" resolution of dilemmas. order form Work in groups to clarify ethical decision DNR orders for those undergoing making and reach a consensus on anesthesia require complete explanation standards of ethical conduct. and set guidelines for the patient, family, Collaborate with the National Nurses and staff prior to the scheduling of a Association, co-workers, and others in the surgical procedure continuous application of ethical standards orders for DNR must be rewritten following in nursing practice, education, surgery management, research and policy. MAJOR ETHICAL PRINCIPLES 2. NURSES AND PRACTICE AUTONOMY - right to self-determination, Nurses carry personal responsibility and independence, and freedom. accountability for ethical nursing practice, JUSTICE - obligation to fair to all people 20 and for maintaining competence by BENEFICENCE - duty to act for the benefit engaging in continuous professional of others; "doing good" theory development and lifelong learning. NONMALEFICENCE - do no harm; protect Nurses maintain fitness to practice so as patient from harm if they cannot protect not to compromise their ability to provide themselves quality, safe care. patient abandonment (the desertion Nurses practise within the limits of their of an older person by an individual individual competence and regulated or who has assumed responsibility for authorised scope of practice and use providing care and support for an professional judgement when accepting and individual, or by a person who has delegating responsibility. guardianship and administration Nurses value their own dignity, well-being responsibilities for an older person.) and health. To achieve this requires positive personal relationships with patient practice environments, characterised by impaired practice professional recognition, education, VERACITY - honest and trustworthy in reflection, support structures, adequate dealing with people. resourcing, sound management practices SUBSTITUTED JUDGEMENT STANDARD - and occupational health and safety. surrogate decision make Nurses maintain standards of personal BEST INTEREST STANDARD - decision conduct at all times. They reflect well on based on what healthcare providers and/or the profession and enhance its image and families decide is best for that person public confidence. In their professional role, nurses recognise and maintain personal Values and Codes of Ethics relationship boundaries. Personal Values Nurses share their knowledge and expertise Professional Values and provide feedback, mentoring and Code of Ethics supporting the professional development of student nurses, novice nurses, colleagues The ICN Code of Ethics for Nurses is a guide for and other healthcare providers. action based on social values and needs. It will Nurses are patient advocates, and they have meaning only as a living document if applied maintain a practice culture that promotes to the realities of nursing and health care in all ethical behaviour and open dialogue. settings in which nursing care is delivered. Nurses may conscientiously object to participating in particular procedures or To achieve its purpose the code must be nursing or health-related research but understood, internalised and used by nurses in all must facilitate respectful and timely action aspects of their work. It must be available to to ensure that people receive care students and nurses throughout their study and appropriate to their individual needs. work lives. Nurses maintain a person's right to give and withdraw consent to access their Nurses can therefore: personal, health and genetic information. Study the standards under each element of They protect the use, privacy and the Code. confidentiality of genetic information and Personally reflect on what each standard human genome technologies. means. Think about ways to apply ethics to Nurses take appropriate actions to the personal domain of nursing practice, safeguard individuals, families, education, research, management, communities and populations when their leadership or policy development. health is endangered by a coworker, any Discuss the code with co-workers and other person, policy, practice or misuse of others. technology. Use a specific example from experience to Nurses are active participants in the identify ethical dilemmas and standards of promotion of patient safety. They promote conduct as outlined in the code. Identify ethical conduct when errors or near misses  occur, speak up when patient safety is practice safely and ethically in the designated role threatened, advocate for transparency, and and setting. work with others to reduce the potential of errors. Confidentiality: It refers to the duty of the nurse Nurses are accountable for data integrity to to refrain from sharing patient information with support and facilitate ethical standards of third parties unrelated to the patient's care. care. Confidentiality is a limited duty, sometimes it may NURSES AND THE PROFESSION be overridden by law or regulation, e.g. mandated Nurses assume the major leadership role in reporting of specific diseases. determining and implementing evidence-informed, acceptable standards of Conscientious Objection: Refusing to participate clinical nursing practice, management, in required action, or seeking exemption from research and education. participation in classes or interventions (e.g. Nurses and nursing scholars are active in abortion, gender assignment surgery, organ expanding research-based, current transplantation.) they threaten a person’s sense of professional knowledge that supports moral integrity. It also includes refusal to evidence-informed practice. participate in an action or intervention perceived to Nurses are active in developing and be inappropriate for a specific patient or it ignores sustaining a core of professional values the patient's wishes. Nurses, through their professional organisations, participate in creating a Co-workers: Nurses and other health and positive and constructive practice non-health related workers and professional environment where practice encompasses clinical care, education, research, Environmental Justice: It seeks an equitable management and leadership. This includes distribution of benefits (e.g., pure water, green environments which facilitate a nurse's spaces, clean air), and a safe and equitable ability to practice to their optimal scope of distribution of burdens (e.g. toxic waste disposal, practice and to deliver safe, effective and noise, factory air pollution). It includes timely health care, in working conditions sustainability, representative participation, and the which are safe as well as socially and avoidance of environmental discrimination. economically equitable for nurses. Nurses contribute to positive and ethical Equity: It is an aspect of social justice. It refers to organisational environments and challenge an absence of systemic disadvantages that result unethical practices and settings. Nurses in health disparities for particular segments of collaborate with nursing colleagues, other society. Equity is essential to the full recognition of (health) disciplines and relevant human rights. communities to engage in the ethical creation, conduct and dissemination of peer Ethics: A branch of philosophy. Applied normative reviewed and ethically responsible research ethics is most commonly used in health care and and practice development as they relate to professional ethics. It helps to determine the patient care, nursing and health. "ought" at the social, community or individual Nurses engage in the creation, level. It also addresses broad social issues such as dissemination and application of research human rights, global cooperation, climate change, that improves outcomes for individuals, global pandemics, social-structural disparities. families and communities. Nurses prepare for and respond to Evidence-Informed Practice: Evidence-informed emergencies, disasters, conflicts, epidemics, practice (EIP) is a process for making informed pandemics, social crises and conditions of clinical decisions. Research evidence is integrated scarce resources. The safety of those who with clinical experience, patient values, preferences receive care and services is a responsibility and circumstances. (Woodbury & Kuhnke 2014) shared by individual nurses and the leaders of health systems and organisations. This Family: A social unit composed of members involves assessing risks and developing, connected through blood, kinship, emotional or implementing and resourcing plans to legal relationships. mitigate these. Fitness to Practice: Having the skills, knowledge, ICN CODE OF ETHICS FOR NURSES health and character to do one's job safely and Advocate: Actively supporting a right and good effectively. (UK NMC 2021) cause; supporting others in speaking for themselves or speaking on behalf of others who Genetics: The study of single genes, genetic cannot speak for themselves. Advocacy is variation and heredity in organisms. ultimately carried through with consent from the person themselves. Genomics: The study of the complete set of a person's genes, the genome. To find variations that Competence: The integrated knowledge, skills, affect health, drug response, interactions among judgement and attributes required of a nurse to genes or with the environment. Human Rights: They are inherent to all persons, Privacy: It is the right to freedom from intrusion regardless of nationality, sex, national or ethnic into one's personal mailers, information, or one's origin, colour, religion, language, or any other physical body status. They range from the most fundamental - the right to life - to the rights to food, education, Related Groups: Other nurses, health care work, health, healthy living conditions, and liberty. workers or other professionals providing service to (Adapted from OHCHR n.d.) an individual, family or community and working National Nurses Associations (NNAs): Any toward desired goals. professional national nursing group that clarifies, researches, educates and promotes the continued Self Determination: The right to have one’s development of nurses and nursing. autonomous decisions respected. Self-determination is not absolute. It may be Nurse: The nurse is a person who has completed a limited by cognitive or affective incapacity, age of programme of basic, generalised nursing education majority, potential for harm to oneself or others, or and is authorised by the appropriate regulatory the infringement of the liberty of others. authority to practice nursing in his/her country. Basic nursing education is a formally recognised Self-reflection: The ability to evaluate one's own programme of study providing a broad and sound thoughts, plans and actions in relation to ethical foundation in the behavioural life and nursing responsibilities and ethical guidelines. sciences for the general practice of nursing, for a leadership role, and for post-basic education for Social Determinants of Health: The conditions in specialty or advanced nursing practice. The nurse which people are born, grow, live, work and age is prepared and authorised (1) to engage in the of health. These circumstances are shaped by the general scope of nursing practice, including in the distribution of money. power and resources at promotion of health, prevention of illness and care global, national and local levels. The social of physically ill, mentally ill, and disabled people of determinants of health are mostly responsible for all ages and in all healthcare and other community health inequities, i.e. the unfair and avoidable settings; (2) to carry out healthcare teaching; (3) to differences in health status seen within and participate fully as a member of the healthcare between countries. (WHO 2020) team; (4) to supervise and train nursing and healthcare auxiliaries; and (5) to be involved in Social Justice: achieving equity and equality for research. (ICN 1987) society and the profession (ICN Strategic Plan 2019-2023). Social justice is a form of fairness Nurse manager: A nurse manager is responsible requiring an impartial distribution of social goods for the daily operations of a nursing unit and and benefits and an equally impartial distribution supervising the nursing personnel in a particular of social burdens and affirms universal human unit or department. rights. Social inequalities may exist only in order to benefit the least advantaged in society. Social Personal Information: Information obtained justice applies to all persons whether citizen or during professional contact that is private to an non-citizen individual or family, and which, when disclosed, may violate the right to privacy, cause Social Media: It is an umbrella term used to inconvenience, embarrassment, or harm to the describe social interaction through individual or family technology-based tools, many of which are online. This includes, but is not limited to internet forums, Person-Centered Care: Valuing and respecting the blogs, and networking sites such as Facebook, characteristics, attributes and preferences of the Twitter, Instagram and Linkedln. (Institute of patient, such as cultural and religious beliefs, and Business Ethics 2019)| incorporating them into the planning and implementation of nursing care, services or Sustainable Development Goals: The Sustainable programmes design. Development Goals are the blueprint to achieve a better and more sustainable future for all people. Professional Relationship: A professional They address the global challenges we face, relationship is an ongoing interaction between two including those related to poverty, inequality, people that observes a set of established climate change, environmental degradation, peace boundaries or limits that is deemed appropriate and justice. The 17 Goals are all interconnected under governing ethical standards. and, in order to leave no one behind, it is important that we achieve them all by 2030. (UN Primary Health Care: It is a whole-of-society n.d.) approach to health and well-being centred on the needs and preferences again was families and Values: Values in nursing are those ends sought communities. It addresses the broader by both the profession and in nurse - patient determinants of health and focuses on the relationships. These include, for example, health, comprehensive and interrelated aspects of dignity, respect, compassion, equity, inclusivity. physical, mental and social health and well-being. Note that some values (ends) are also obligations (WHO 2019) (actions) and attributes of character (virtues). Ethical Dilemmas Decision-Making Models g. the utilization of services in hotels and collect, analyze, and interpret the data similar lodging establishments, restaurants state the dilemma and recreation centers consider the choices of action h. admission fees charged by theaters, cinema analyze advantages and disadvantages of houses and concert halls, circuses, each course of action carnivals, and other similar places of make the decision culture, leisure and amusement; and evaluate the effectiveness of the decision i. funeral and burial services for the death of senior citizens PSYCHO- SOCIAL ASPECTS OF AGING fear of aging- changes in roles. How can senior citizens avail of the discount retirement and perceived non-productive privileges from business establishments? sense of negative feelings. A senior citizen, or a duly authorized common stressors of old age- normal aging representative, must present an ORIGINAL changes that impairs physical functioning, AND VALID senior citizens identification activities and appearance, disabilities due card issued by the Office of Senior Citizens to chronic illness, social and environment Affairs (OSCA) in the city or municipality losses related to loss of income and where he/she or the purchase booklet for decreased ability to perform precious roles basic necessities/prime commodities, when and activities lack of social interaction. applicable. Can bedridden or incapacitated senior citizens LAWS AFFECTING SENIOR CITIZENS/OLDER avail of discounted purchases through a PERSON representative? Yes, but senior citizens can send their duly Republic Act No. 9994: Expanded Senior authorized representative to purchase their Citizens Act of 2010 medicines and grocery items only. However, Who are considered as Senior Citizens? the representative must carry the senior any Filipino citizen who is a resident of the citizen's OSCA ID, the senior citizen's Philippines, and who is sixty (60) years old purchase booklet, a document specifically or above. authorizing the representative, and a it may apply to senior citizens with "dual doctor's prescription when necessary. citizenship" status provided they prove their However, discounted food purchases cannot Filipino citizenship and have at least six (6) be by proxy or through a representative months residency in the Philippines. owing to the limitation that it should be for Senior citizens are entitled to the following: the exclusive use and enjoyment, or a) discount privileges, "personal consumption" of the senior citizen b) free services, only. c) exemptions, Does the 20% discount apply to food d) incentives, supplements prescribed by an attending e) government financial assistance, and physician? f) priority in express lanes. No, the 20% discount on drug and medicine purchases does not extend to food or food Discount Privileges granted to Senior Citizens: supplements, even if prescribed by a doctor a) 20% discount on the purchase of certain for an elderly. goods and services, Vitamins and minerals specifically b) special 5% discount on prime commodities prescribed by an attending physician for an and basic necessities, elderly for the prevention, treatment or c) 5% utility discount on electric and water diagnosis of a disease or illness can be consumption, and considered as medicine or drug purchases d) 50% discount on electric, water and subject to the 20% discount. telephone consumption of senior citizens The FDA came out with guidelines that centers and residential or group homes classified health supplements such as food and therefore are not covered by the senior What transactions by senior citizens are citizen discount privilege. covered by the 20% discount and Food supplements that are prescribed by VAT-exemption? doctors to senior citizens should also be a. the purchase of medicines subject to a 20% discount since this will b. the professional fees of attending physician provide full support to the improvement of c. the professional fees of licensed the total well-being of the elderly. professional health workers providing home health care services Government assistance that will directly d. medical and dental services, diagnostic and benefit senior citizens: laboratory fees a) Monthly Social Pension of P500 to be given e. actual fare for land transportation travel to indigent senior citizens; and f. actual transportation fare for domestic air b) Death Benefit Assistance of P2,000 to be transport services and sea shipping vessels given to the nearest surviving relative who  cared for the deceased senior citizen until bedridden and/or ailing senior citizen such his/her death. as but not limited to milk, adult diapers, c) Mandatory PHILHEALTH coverage. underpads, bed pans, alcohol, cotton, tissue, wet wipes, and other similar items. Indigent Senior Citizen - refers to any elderly who is frail, sickly or with disability, and without HB-639: AN ACT PROVIDING FOR FREE LEGAL pension or permanent source of income, ASSISTANCE FOR SENIOR CITIZENS, AMENDING compensation or financial assistance from his/her FOR THE PURPOSE REPUBLIC ACT NO. 7342, AS relatives to support his/her basic needs, as AMENDED BY REPUBLIC ACT NO. 9994, determined by the Department of Social Welfare OTHERWISE KNOWN AS 'AN ACT TO MAXIMIZE and development (DSWD) in consultation with the THE CONTRIBUTION OF SENIOR CITIZENS TO National Coordinating and Monitoring Board. NATION BUILDING, GRANT BENEFITS AND SPECIAL PRIVILEGES AND FOR OTHER Based on the law, indigent senior citizens This bill recognizes the need of senior or those 60 years old and above are entitled citizens to be provided free legal services. to monthly pension, however, due to limited government resources only those 77 and HB-595: AN ACT DIRECTING PUBLIC HOSPITALS above were covered by the law up to 2014. OWNED BY THE NATIONAL GOVERNMENT TO A series of administrative orders issued by GRANT FREE HOSPITALIZATION TO INDIGENT the Department of Social Welfare and AND QUALIFIED SENIOR CITIZENS Development (DSWD) since 2010-2014 This proposal provides free hospitalization prioritized only those who are 77 years old to qualified senior citizens who are 70 yrs. and above. old and above, provided, that they are In 2012, DSWD issued AO No.4 classifying indigents indigent seniors aged 76 and below as "potential social pensioners." The release of NATIONAL POLICIES ON OLDER PEOPLE the P500 pension is subject to "availability of funds." Senior citizens from remote areas Republic Act No. 344 or the Accessibility Law of can hardly avail of the pension. 1982 Starting April 2015, indigent senior citizens - provides for the minimum requirements aged 65 and above will now receive the and standards to make buildings, facilities, Social Pension. and utilities for public use accessible to Only indigent senior citizens are persons with disability, including older mandatorily covered by the national health persons who are confined to wheelchairs insurance program of PhilHealth. and those who have difficulty in walking or Proper authorities may also cause the climbing stairs, among others. cancellation or revocation of the business permit, permit to operate, franchise and Republic Act No. 7876 "An Act Establishing a other similar privileges granted to any Senior Citizens Center in all Cities and person, establishment or business entity Municipalities of the Philippines and that fails to abide by the provisions of this Appropriating Funds Therefore" Act. - provides for the establishment of Senior If the offender is a Citizens Centers to cater to older persons' corporation/organization, the official/s socialization and interaction needs as well directly involved shall be liable. as to serve as a venue for the conduct of other meaningful activities. The DSWD in Sec. 5 par. (a) of RA 9994 provides government coordination with other government assistance on employment of senior citizens: agencies, NGOs and people's organizations "Senior citizens who have the capacity and shall provide the necessary technical desire to work, or be re-employed, shall be assistance in the form of social and provided information and matching services recreational services, health and personal to enable them to be productive members of care services, spiritual services, livelihood society. Terms of employment shall conform services and volunteer resource services. with the provisions of the Labor Code, as amended, and other laws, rules and Republic Act No. 8425 - An Act regulations." Institutionalizing the Social Reform and For SSS pensioners below 65 years old, Poverty Alleviation Program re-employment means stoppage of pension. - provides for the institutionalization and enhancement of the social reform agenda HB-1449: AN ACT INCREASING THE SUBSIDY by creating the National Anti-Poverty AND BENEFITS ACCORDED TO SENIOR CITIZENS Commission (NAPC). Through its OF THE SENIOR CITIZEN'S ACT OF 2010 AND multi-dimensional and cross-sectoral AMENDING SECTIONS 4 AND 5 THEREOF FOR approach, NAPC provides a mechanism for THAT PURPOSE older persons to participate in policy It includes grocery items which are not formulation and decision-making on covered by doctor's prescription but are matters concerning poverty alleviation. necessary for the caregiving of the frail, Republic Act No. 10155 - "The General Comfort. Older adults need comfort from Appropriations Act of 2012" family members as it can be lonely at their - under section 28 mandates that all age. government agencies and instrumentalities Peace of mind. The family will not worry should allocate one percent of their total about their older adult family as they can agency budget to programs and projects for see the care that is being given in their own older persons and persons with disabilities. home. They will feel secure that their relative is being cared for. PRESIDENTIAL PROCLAMATIONS AND Family involvement. The family will be EXECUTIVE ORDERS there every step of the way regarding their older adult's care. They will have updates Presidential Proclamation No. 470, Series of on the status and can participate in giving 1994 care. - declaring the first week of October of every year as "Elderly Filipino Week" HOSPICE FACILITIES Have structured activities and older people Presidential Proclamation No. 1048, Series of are given time to socialize with others. 1999 "You matter because of who you are. You - declaring a "Nationwide Observance in the matter to the last moment of your life, and Philippines of the International Year of we will do all we can, not only to help you Older Persons" die peacefully but, but also to live until you die" (Dame Cicely, founder of the first Executive Order No. 105, Series of 2003 modern hospice) - approved and directed the implementation Coordination Care. Inpatient facility, of the program providing for group homes doctors, nurses, pharmacists, clergy and and foster homes neglected, abandoned, funeral directors. Basically, a team of abused, detached, and poor older persons healthcare professionals. and persons with disabilities. Respite care. To provide short term relief for primary caregivers. This can be DSWD Administrative Order No. 4 series of arranged for just an afternoon, several days 2010 or weeks so that the direct caregiver can - "Guidelines on the Home Care Support also rest. Services for Senior Citizens", establishing Bereavement care. Bereavement is the community based health care services for time of mourning after a loss. The hospice older persons. care team works with surviving loved ones, helping them through the grieving process. CURRENT TRENDS AND ISSUES IN THE CARE OF ELDERLY DROP IN/DROP CARE CENTERS Some day care centers offer limited medical Home Care: Living on their Own and alternative health such as music, art therapy, support group and counselling, The care provided should be nursing care is also provided, with that in person-centered. Catering to the unique day care centers, caregivers drop in their needs of older adults might be difficult elderly relatives and pick them up at the however, we must remember that they need end of the day our help. Dignity is important, especially to them so make it a point to understand What Services and Amenities Are Provided in an them and be a confidant. Adult Day Care? Report all forms of abuse accordingly as Some adult day centers offer limited older adults may be quick-tempered. One medical and alternative healthcare, such as: way to help them open up is to explore music or art therapy ways to understand communication support groups or counseling disabilities as they are having a hard time nursing care and remember that old people desire a good physical, occupational and speech quality of life. therapies dental care Advantages of Home Care Services for Families vision and hearing care Home health care is a beneficial choice foot care for many families. Always remember that older adults want to be Respite from caregiving. Help relieve Personalized care. It will cater their stress, exhaustion, anxiety related to unique needs. The tredtment wit be caregiving. Not only will you get to take a rocused on the patient. break from caregiving, you can have Faster recovery. Older adults recover predictable hours where you can work, faster in the presence of family members. attend to your personal needs or run errands.  Remedy for Boredom. One of the chief 6 WAYS NURSES CAN ADVOCATE FOR benefits for older day care is that it will PATIENTS allow them to participate in stimulating 1. ENSURE SAFETY activity and stretch their wings. The brain One of the nurses' primary likes change and outside programs offer an responsibilities. option for families and loved ones must also Ensure that the patient is safe when be considered. being treated in the healthcare An antidote to Loneliness. Second reason facility and by the time they are that daycare may bring a smile to your discharged by communicating with loved one's face is the opportunity to public health nurses or social interact with others. Seniors who seldom workers who will continue in see anyone outside of their family often feel delivering continuity of care so it loneliness, a condition associated with can be arranged before they go depression. home. Cure for Aimlessness. Retirement can be a 2. GIVE ELDERLY A VOICE curse for elderly adults who no longer have Take note that they are vulnerable, concrete reason to leave the house. As days especially when they are sick. bleed together it is easy for older adults to Must be present when the doctor fall into rot which may lead to everything explains their diagnosis and from poor nutrition to depression and treatment options for us to help increase the risk of dementia. them ask questions, give feedback, Additional access to crucial services. It and translate information from makes it easier for older adults to take care medical jargons. of their health issues. Sometimes, because of their condition, they can't comprehend RETIREMENT LIVING/HOME/VILLAGE right away so the nurse acts as a In retirement, always remember that communicator staying at home as you age has an 3. EDUCATE advantage of keeping you in a familiar place It is important to give health where you know your neighbors and the education to the elderly particularly community. You can take advantage of how to manage their current chronic home care services to make modifications condition to improve the quality of or repairs to make your life easier and their everyday life safer. Example: Nurses can teach how to take their prescribed medication in In the Philippines, sometimes it is really a reality a way it will be most effective for that we must question do we have: them and will allow them to feel Better housing? Can an old individual in better during treatments such housing live comfortably? 4. PROTECT SENIORS RIGHTS Better hygiene? Is it very risky? (pertaining Protecting the rights by knowing to dirty toilets, showers etc.) their wishes. It includes Better water source? How safe is the water communicating those difficult family for the elderly? members who might disagree with the patient's choices and could ADVOCACY PROGRAMS RELEVANT TO THE upset the patient. CARE OF OLDER PERSONS AND MENTAL 5. DOUBLE CHECK FOR ERRORS HEALTH Double check so they can catch, stop and be able to fix errors, flag What is advocacy in aged care? conflicting orders/information or An advocate is an impartial person who can some oversights by physicians and help you understand and stand up for your other caring for the patient. rights in the aged care system. 6. CONNECTS ELDERLY TO RESOURCES Nurse. Advocates support the patient's best There are times when our clients interests while respecting the family's need collaboration or coordination important role. outside, particularly when they are We must give assistance and support- already due for discharge. making sure that they have a say in Important to assist them in looking decision-making which may affect the on where to go in finding some management of the healthcare, providing support or resources inside or them options to have patient-care needs outside where it can be met and helping one' Nurses are the best resource of the complaints and concerns. community so one must be aware of The best way to serve the patients is to the sources that we can recommend have that sincerity and compassion in like financial support, manpower, dealing with elderly clients. transportation needs etc. Hence, elderly need to be advocated because they complications, and achieving highest also have rights and many older people need the possible quality of life. support of an advocate to get the services they Sarcopenia - age-related loss of muscle need and have their rights respected. mass Introduction The prevalence of disability among older adults is increasing as greater numbers of people survive on-fatal conditions that leave them with residual disabilities. Some will need rehabilitation, which involves therapies developed by physicians and SUPPORT SERVICES FOR OLDER ADULTS therapists focused on returning individuals A few geriatric-care homes cater to older to their previous level of functions. people. Statistics from DSWD in 2019 Restorative care falls within the scope of shows that around 33 homes for the aged- nursing and can be provided in any setting. Disability can have an impact on every facet 4 are government-owned facilities and 29 of a person's life. The nurse's role is to are accredited non-governmental provide support by educating patients, organizations or private social welfare providing assistance with exercises, agencies. providing and guiding patients in They are also under the barangays or local government units who manage a temporary therapeutic activities, and assuring patients shelter which is attached to DSWD. properly with the use of equipment. Despite the disproportionate ratio of homes for the aged and the number of older Rehabilitative and Restorative Care Rehabilitative Care involves therapies Filipinos, this is not yet a major problem developed by physicians and therapists since the family continues to be the primary focused on returning individuals to their provider of support for its members as it is previous level of function. Usually the need one of our practices as a closely-tied family. for rehabilitative services after a problem There is a stigma attached to the institutionalization of older patients in has occurred that affects function, such as home-care facilities as intergenerational stroke, fracture, or prolonged state of family solidarity remains strong and immobility. Skilled Rehabilitative Care involves co-residents with family members is still services offered by physical, occupational, the most common living arrangement in the and speech therapists. Philippines. Many of the effects of aging and disabilities REHABILITATIVE AND RESTORATIVE CARE cannot be eliminated or significantly improved. Damaged lungs, amputations, Terminologies cannot be eliminated or significantly Activities of Daily Living (ADLs) - improved. For these individuals, restorative activities such as toileting, feeding, care is beneficial. Restorative Care is primarily offered by dressing, grooming, bathing, and nursing staff and does not require a ambulating medical order. It can occur in any setting Assistive Technology - technological tools that enable a person to maximize and includes efforts to help individuals: maintain their current level of independence function Disability - inability to perform activities improve their functional ability normally prevent decline and complications Frailty - condition in which a person has promote the highest possible quality poor endurance and weakness of life Handicap - limitation to fulfill a role Instrumental Activities of Daily Living (IADLs) - tasks required for community Frailty living, such as shopping, meal preparation, It describes a clinical state in which the laundry, housekeeping, use of telephone, person has poor endurance, fatigue, low money management, medication activity level, reduced speed in ambulation, management weak grip strength, and increased risk for Rehabilitative Care - therapies developed adverse outcomes (Buckinx et al.,2015). by physicians and therapists focus on Some of the frailty is the result of returning individuals to their previous level sarcopenia - age related changes to the of function skeletal muscle tissues. Restorative Care - care that assists people The following factors can contribute to in maintaining or improving current level of sarcopenia: immobility and lack of exercise function, avoiding decline and poor blood flow to the muscles  increased levels of proinflammatory The severity of the disability can be less cytokines a important to rehabilitation efforts than the increased production of oxygen free attitude and coping capacity of disabled radicals or impaired detoxification patients and their families. a decline in anabolic hormones Previous attitudes, personality, and lifestyle malnutrition have a strong influence on reactions to reduced neurological drive disability. Individuals who relish Older adults who are frail are at high risk independence and refuse to let illness slow for falls, disability, hospitalization, nursing their lifestyles will respond to disability home admission, and death. Early differently from those who use real or recognition and intervention for symptoms exaggerated ills for other gains. of frailty (e.g., correcting weight loss and The family's response to the disabled assisting with muscles-strengthening person will also influence that person's exercises) can prevent or delay some of the reactions. frailty older adults experience. Previous attitudes, personality, experiences, Term Definition Examples and lifestyle influence reactions to a disability. Disability inability to inability to cut perform an food due to Losses Accompanying Disability activity in a arthritic Many losses may accompany disability, normal fingers. such as the loss of function, role, income, manner. Abnormal status, independence, or perhaps a body gait related to part. Disabled persons mourn these losses, hemiplegia. often demonstrating the same reactions Frailty three or more self-care experienced during the stages of dying. of the neglect due to They may deny their disabilities by making following weakness, unrealistic plans and not complying with symptoms: fatigue. their care plans. One day they may progressive Frequent falls optimistically state that their disability has weight loss, due to slow walking unsteady gait given them a new perspective in live, yet the speed, low grip and weakness very next day they tearfully question what strength, they have to live for. fatigue, low Disability can be accompanied by many activity levels. losses, including formation, role, income, Impairment psychological, loss of limb status, independence, and anatomic physiologic, or due to structure. anatomic loss amputation. or abnormality Altered Principles of Rehabilitative Nursing thought The principles guiding gerontological process nursing care are of particular significance related to in rehabilitative and restorative care and dementia. include the following actions: Handicap limitation in forfeiture of increase self capacity ability to participation eliminate or minimize self-care fulfil role in family limitations (possible activities due act for or do for when the person is consequence to altered unable to take action for himself or of disability or cognition