Finals Geriatrics Nursing Notes PDF

FINALS: GERIATRICS NURSING_NCM 114 o This often creates a feeling of an incomplete bowel motion. PAURILLO, NJ...

FINALS: GERIATRICS NURSING_NCM 114 o This often creates a feeling of an incomplete bowel motion. PAURILLO, NJ Implementation: Constipation Implementation Implementation: Activity and Exercise Implementation: Elimination  A number of factors cause an older individual to limit his/her physical activity.  Digestive and urinary disorders are the usual health problems faced by older adults.  The most common concern in the aging is brittle bones in both the arms and legs.  Despite the fact that elderly individuals have more time to relax and enjoy their lives, problems with digestion  Basically, as we reach 30, bone marrow gradually tend to occur all of a sudden. disappears and calcium production is reduced.  One of the most common problems with aging  Bone marrow is the soft and spongy tissue found inside individuals is constipation. the large bones responsible for the production of platelets, and red and white blood cells.  As people get into their 60s, bowel habits change.  Changes in bone mass and bone marrow structure can  Painful and infrequent bowel movements are put an elderly at the risk for infection, osteoporosis and associated with hard and dry stools that can lead to other bone-related health issues. hemorrhoids and other health-related concerns. Common Barriers to Exercise in Older Adults Constipation Implementation: Sleep and Rest  Constipation is defined as having fewer than three bowel movements a week.  Sleep patterns change as we get older. Other than  Constipation also encompasses the passing of hard, dry physical changes, people in their later adulthood tend bowel motions (stools) that are infrequent, difficult to to have a difficult time falling asleep, and they have a pass, or both (Better Health Channel 2014). harder time staying asleep as they age.  Although research tells us that sleep does not decline Constipation in Elderly People: Reasons include: with age, several seniors are still complaining because  Side-effect of certain medications, e.g. medications for of changes in their sleeping pattern. pain, antidepressants, anticonvulsants, and  Sleep is a vital mechanism, regardless of your age. antihistamines  It has the ability to restore energy levels and heal both  A possible lack of interest with regard to eating physical and cognitive damage.  Slowing or weakening of the digestive system as a  A regular sleeping pattern of 7.5–9 hours per night is result of ageing and/or frailty. recommended to help people function at their best.  Poor diet or lack of adequate fluids in diet, and/or a  However, as we get older, a number of factors combine lack of exercise. and make this harder to achieve.  Urinary/stress incontinence is common in older adults. 5 Common Causes of Sleep Problems in Older Adults  Absence of teeth can make it difficult to eat regular meals.  Sleep problems due to an underlying medical problem  Snoring, Sleep Apnea, and other forms of Sleep-Related Common Types of Constipation in the Elderly Breathing Disorders. Sleep-related breathing disorders  Normal transit constipation (“SRBD”; it’s also sometimes called sleep-disordered o a common type of primary constipation. breathing) is an umbrella term covering a spectrum of o Though a stool passes through the colon at a problems related to how people breathe while asleep. regular pace, patients perceive difficulty in passing bowel motions. Psycho- Social Care of Older Adults  Slow-transit constipation o predominately affects women.  Restless leg syndrome (RLS) o Bowel movements are infrequent, limited in  Periodic Limb Movements of Sleep (PLMS). their urgency or straining is involved  Insomnia.  Pelvic floor dysfunction o patients are experiencing difficulty in Proven Ways to Treat Insomnia in Older Adults coordinating pelvic floor muscles or muscles  Insomnia is a very common complaint among family around the anus during defecation. caregivers and older adults. Fortunately,Nresearch has  shown that it’s possible to treat insomnia effectively, Psycho- Social Care of Older Adults: although it does often take a little time and effort. Cognition and Perception  Before going into the recommended treatments, sedatives should only be used as a last resort. That’s  Cognition describes processes such as remembering, because most medications that make people sleepy learning, solving problems and orientation. are bad for brain function, in both the short-term and  Perception refers to ways of obtaining information long-term. from our environment Some proven approaches to improving sleep in older adults Cognition and Perception:  Cognitive-behavioral therapy for insomnia (CBT-I). This Common Elderly Mental Health Disorders means special therapy that helps a person avoid negative thought patterns that promote insomnia,  Depression along with regular sleep habits, relaxation techniques,  Anxiety Disorders and other behavioral techniques that improve sleep.  Bipolar Disorders  Brief behavioral treatment of insomnia (BBTI). This is  Eating Disorders a shorter variant of CBT-I; it’s designed to be delivered Depression in 4 weeks. It also has a good track record in research.  Mindfulness meditation - is a mental training practice  Is a type of mood disorder that ranks as the most that teaches you to slow down racing thoughts, let go pervasive mental health concern among older adults. of negativity, and calm both your mind and body....  If untreated, it can lead to physical and mental Techniques can vary, but in general, mindfulness impairments and impede social functioning. meditation involves deep breathing and awareness of  Additionally, depression can interfere with the body and mind. symptoms and treatment of other chronic health  Exercise. Exercise is often thought of as a treatment for problems. insomnia.  Symptoms include, sadness, problems sleeping, physical pain or discomfort, distancing from Medications that are less risky and are sometimes used activities previously enjoyed, and a general “slowing  Melatonin down.” o Melatonin is a hormone involved in the sleep- Signs and Symptoms wake cycle.  Ramelteon  Does not get dressed (often attributed to age related o is a synthetic drug that mimics the effect of inability) melatonin.  Does not answer the door or phone  Trazodone  Feelings of sadness and worthlessness o is an older weak anti-depressant that is mildly  Sudden outburst of agitation, crying and anger sedating. It has long been used by  Labile mood geriatricians as a “sleeping pill” of choice, as it  Sleeping too much or not enough is not anticholinergic and seems to be less  Increased appetite, decreased appetite risky than the alternatives.  Somatic complaints Psychosocial need of  Lack of concentration  Difficulty coping an elderly person  Memory issues  Assisting residents to meet their basic needs includes  Self-isolation their emotional and mental well-being, also called  Loss of interest or enjoyment psychosocial needs.  Talking about suicide  Therefore, psychosocial needs of the elderly involve Nursing interventions for Depression mental, social and physical needs among the aged  Nursing interventions for depression include Implementation: Psycho- Social Care of Older Adults standardized screening tools to assess the elderly for  Cognition and Perception depression or risk for depression.  Self-perception and Self Concept  These tools help identify key issues and enable health  Coping and Stress care professionals to intervene.  Values and Beliefs o Geriatric Depression Scale  Sexuality and Aging o The Nurses’ Global Assessment of Suicide Risk  o DSMV: Diagnostic Statistical Manual of o a full syndrome of manic or mixed symptoms; Mental Disorders the client may also have experienced periods o Client Centered Approach and Recovery of depression. Module  Bipolar II disorder o characterized by recurrent bouts of major Anxiety Disorders depression with the episodic occurrence of  Like depression, anxiety is a very common mood hypomania; this individual has never disorder among the elderly. experienced a full syndrome of manic or mixed  In fact, these two problems often appear in tandem. symptoms. Statistics from the CDC show that nearly half of older  Cyclothymic disorder adults with anxiety also experience depression. o the essential feature is a chronic mood  Anxiety in seniors is thought to be underdiagnosed disturbance of at least 2 years’ duration because older adults tend to emphasize physical  Bipolar disorder due to general medical condition problems and downplay psychiatric symptoms. o This disorder is characterized by a prominent  Women in this age group are more likely to be and persistent disturbance in mood (bipolar diagnosed with an anxiety disorder than men. symptomatology) that is judged to be the direct result of the physiological effects of a Symptoms and Signs of Generalized Anxiety Disorders in general medical condition (APA, 2000). Seniors  Substance-induced bipolar disorder o the bipolar symptoms associated with this  Excessive, uncontrollable worry/anxiety disorder are considered to be the direct result  Edginess, nervousness, or restlessness of the physiological effects of a substance  Chronic fatigue or tiring out easily (e.g., use or abuse of a drug or a medication,  Become irritable or agitated or toxin  Poor quality of sleep or difficulty falling/staying asleep  Tense muscles Clinical Manifestations Nursing Intervention: Anxiety  Heightened, grandiose, or agitated mood. The affect of a manic individual is one of elation and  Learning about anxiety.  euphoria- a continuous “high”.  Mindfulness.  Exaggerated self-esteem. Usual inhibitions are  Relaxation techniques. discarded in favor of sexual and behavioural  Correct breathing techniques. indiscretions.  Cognitive therapy.  Sleeplessness. Sleep patterns are disturbed; client  Behavior therapy. becomes oblivious to feelings of fatigue, and rest and  Counselling. sleep are abandoned for days or weeks.  Dietary adjustments  Pressured speech. Loquaciousness, or pressured  Exercise speech, is so forceful and strong that it is difficult to  Learning to assertive interrupt maladaptive thought processes.  Building self esteem  Flight of ideas. There is a continuous, rapid shift from  Medication one topic to another.  Reduced ability to filter out extraneous stimuli; easily Bipolar Disorders distractible. There is inability to concentrate because of Bipolar disorder a limited attention span; the individual is easily distracted by even the  can affect people of all ages, including older adults.  slightest stimulus in the environment. According to one study, 10 percent of new cases occur  Increased number of activities with increased energy. after the age of 50. In the past, it was believed that Motor activity is constant; the individual is literally bipolar symptoms "burn out and slowly moving at all times. disappear with age.  Multiple, grandiose, high risk activities, using poor  are mood disorders characterized by mood swings from judgement; with severe consequences. profound depression to extreme euphoria (mania), with intervening periods of normalcy. Medical Management of Bipolar Disorder Types of Bipolar Disorder  Psychotherapy  Electroconvulsive therapy  Bipolar I disorder  Diet   Activity. gaining weight or becoming fat, significantly disturbed perception of the shape or size of Pharmacological Management: Bipolar Disorder the body, and steadfast inability or refusal to  Anxiolytics, benzodiazepines. acknowledge the seriousness of the problem  Mood stabilizers such as lithium (manic episodes) or even that one exists.  Anticonvulsants  Bulimia Nervosa. o Bulimia nervosa, often simply called bulimia, is  Antipsychotics, 2nd generation an eating disorder characterized by recurrent  Antipsychotics, 1st generation episodes (at least twice a week for 3 months)  Antipsychotics, phenothiazine of binge eating followed by inappropriate  Antiparkinsons agents, dopamine agonists compensatory behaviors to avoid weight gain Nursing Interventions: Bipolar Disorder such as purging, fasting, or excessively exercising.  Providing for safety. A primary nursing responsibility is to provide a safe environment for client and others; for Binge-Eating Disorder (BED). clients who feel out of control, the nurse must establish  Binge-eating disorder external controls emphatically and nonjudgmentally. - is another eating disorder characterized by  Meeting physiologic needs. recurrent episodes of binge eating but it is not  Decreasing environmental stimulation may assist client associated with the recurrent use of inappropriate to relax; the nurse must provide a quiet environment compensatory behaviors as in bulimia nervosa, and without noise, television, and other distractions; does not occur exclusively during the course of  finger foods or things client can eat while moving bulimia nervosa, or anorexia nervosa methods to around are the best options to improve nutrition. compensate for overeating, such as self-induced  Providing therapeutic communication. Clients with vomiting. mania have short attention spans, so the nurse uses  Pica simple, clear sentences when communicating; they - Pica is an eating disorder that involves persistent may not be able to handle a lot of information at once, eating of non-nutritive substances such as hair, so the nurse breaks information into many small dirt, and paint chips for a period of at least one segments. month.  Promoting appropriate behavior. The nurse can direct  Rumination disorder their need for movement into socially acceptable, large - Rumination disorder is characterized by repeatedly motor activities such as arranging chairs for a and persistently regurgitating food after eating, community meeting or walking. but it’s not due to a medical condition or another  Managing medications. Periodic serum lithium levels eating disorder such as anorexia nervosa, bulimia are used to monitor the client’s safety and to ensure nervosa, binge-eating disorder, or that the dose given has increased the serum lithium avoidant/restrictive food intake disorder. level to a treatment level or reduced it to a  Avoidant/Restrictive Food Intake Disorder (ARFID). maintenance level. - Avoidant or restrictive food intake disorder is an eating or feeding disturbance characterized by Eating Disorders persistent failure to meet appropriate nutritional  are characterized by a repeated disturbance of eating or energy needs due to having no interest in eating or eating-related behavior that results in the altered regarding food with certain sensory characteristics, consumption or absorption of food and that such as color, texture, smell or taste; or fear of significantly diminishes physical health or psychosocial choking. functioning  Other Specified Feeding or Eating Disorder (OSFED).  Eating disorders can be viewed on a continuum, with - Other specified feeding or eating disorders or clients with anorexia nervosa eating too little or (OSFED) are eating behaviors that cause clinically starving themselves, client with bulimia eating compelling distress and impairment in areas of chaotically, and clients with obesity eating too much. functioning, but do not meet the full criteria for any of the other feeding and eating disorders. Types of Eating Disorders Nursing Interventions  Anorexia Nervosa o life-threatening eating disorder characterized Establishing nutritional eating patterns. by the client’s refusal or inability to maintain a  When clients can eat, a diet of 1200 to 1500 calories minimally normal body weight, intense fear of per day is ordered, with gradual increases in calories  until clients are ingesting adequate amounts for height,  Most older adults placed in assisted living facilities activity level, and growth needs; interact with and meet other residents who share  the nurse is responsible for monitoring meals and similar interests. snacks and often initially will sit with a client during  For those who are living in their own home, joining eating at a table away from other clients. church meetings, local gathering and social  after each meal or snack, clients may be required to  celebrations are helpful ways to foster positive aging. remain in view of staff for 1 to 2 hours to ensure that  Nonetheless, a healthy aging process involves they do not empty the stomach by vomiting. meaningful relationships with the family and significant others. Identifying emotions and developing coping strategies.  Older adults should not be left at home doing nothing.  The nurse can help clients begin to recognize emotions  They should be encouraged to engage in family such as anxiety or guilt by asking them to describe how activities and gatherings that minimize isolation. they are feeling and allowing adequate time for  Self-perception and self-concept are directly affected response. by what the person does every day, so planning in advance is essential to make various activities possible. Dealing with body image issues.  The nurse can help clients to accept a more normal Coping and Stress body image; this may involve client agreeing to weigh more than they would like, to be healthy, and to stay  We all need to face different kinds of mental stress in out of the hospital various stages of life. Chronic and excessive stress are  help clients to identify areas of personal strength that harmful and can cause physical or mental problems. are not food related broaden client’s perceptions of Therefore we should all understand more about stress themselves. and learn appropriate coping strategies for our physical and mental wellbeing. Self-Perception and Self-Concept  During emergency situations, stress and anxiety are the  Depression is, unfortunately, a common occurrence natural fight and flight instincts of our body. among older adults. The fact that their activities and social interactions are more limited, and their nearest  These stressors can either be external (an intruder and dearest are often living far away, makes the crawling through your window) or internal (a financial adjustment to old age harder. Thus, most elderly face problem within the family or worry over an older adult problems with self- perception and self-concept. with a mental or physical problem). Self-perception  Stress is the feeling of being overwhelmed or unable to  suggests that individuals infer opinions, attitudes, and cope with mental or emotional pressure. internal states mostly through observing the behavior and circumstances in which they occur.  Stress responses help your body adjust to new situations. Self-concept  is defined as the way an individual think, evaluates and  Stress can be positive, keeping us alert, motivated and perceives his self. ready to avoid danger. Nursing Management: SIGNS OF STRESS Self-Perception and Self Concept  Anxiety or panic attacks  Worry  Promoting a positive self-perception and self-concept  Sadness or depression entails a lot of effort on the part of the caregiver.  Irritability and moodiness  An older adult should be immersed in various social  Feeling pressured or hurried activities to regain a sense of hope and excitement  Difficulty concentrating or making decisions about life.  Sleeping problems  This can be done by making strong social connections  Physical symptoms like headaches, chest pain, and within the locality and allowing the elderly to be stomach problem involved in activities organized by various support  Feeling overwhelmed and helpless groups.  Sexual dysfunction   Drinking too much alcohol, misusing drugs or smoking a  It can influence our judgments and behavior- that is lot why healthcare workers have to be aware of a person’s  Not eating enough or eating too much values when taking care of them. Physiological BELIEF  Insomnia, nightmare  Beliefs come from real life experiences, but are often  Loss of appetite, palpitation forgotten and start to influence us subconsciously.  Frequent Urination  They can significantly affect the quality of our work and  Muscle Pain and Tiredness personal relationships with colleagues and friends, and they play a major role in our identity. Emotional And Psychological  Beliefs may be influenced by our morals, culture and  Anxiety religious affiliations.  Fear  Healthcare staff working with the elderly often have their own pre-existing beliefs and stereotypes about  Frustration, depression issues like sexuality, health, alcohol, drug abuse, aging  Restlessness and disabilities, people’s rights and many others.  Poor concentration  Forgetfulness Psycho- Social Care of Older Adults: Sexuality and Aging Stress management  As adults aged and changed so does their sexual behavior. Sex may not be the same as it was in their  The elderly can share their difficulties and feelings in 20’s, but it can still be fulfilling if sexual health is facing stress, and their way of coping, with those they preserved. can confide (e.g. relatives and friends).  Older adults who live with their partners can enjoy and  This helps to ventilate emotions and facilitate the maintain a satisfying sexual life through proper learning of different strategies of coping with stress. communication.  An active social life, healthy lifestyle and relaxation  Partners should share thoughts on their lovemaking exercises are all useful ways to handle stress. and help each other understand the needs that have to  Healthy dietary habits and regular exercise will also be met. help the elderly cope with stress better.  Taking a walk in the park or outside the house should Nursing Care of the Older Adult in Chronic Illness be a part of his/her daily routine to promote proper blood circulation and improve their psychological well- A. Disturbance in Sensory Perception being. B. Chronic Confusion C. Impaired Verbal Communication  Engaging in volunteer work is a means to help those who are less fortunate. It also helps to boost self- Nursing Care of the Older Adult in Chronic Illness confidence and broaden one's outlook in life.  Positive thinking, such as appreciating one's Disturbance in Sensory Perception achievements and strengths, can help to enhance self- Macular degeneration confidence and to cope with stress.  The elderly can seek help from professionals in case of  Dry macular degeneration is a common eye disorder need. Smoking, drinking and substance abuse are among people over 50. harmful and should never be used as ways to cope with  It causes blurred or reduced central vision, due to stress. thinning of the macula. The macula is the part of the retina responsible for clear vision in your direct line of Values and Beliefs sight. VALUE Common Clinical Presentation  Values are standards, principles or qualities that a  Reduced visual acuity person upholds.  Loss of central visual field and  Values serve as a guide in our lives to make decisions  ontrast sensitivity and live the way we think we should. Implications for Rehabilitation  A value is usually formed by a particular belief related to a person’s behavior.  Difficulty with tasks requiring visual detail such as reading,   inability to recognize faces, distortion or disappearance Common Clinical Presentation of the visual field straight ahead, loss of color and  Degeneration of optic disc contrast perception, mobility difficulties related to loss of depth and contrast cues.  Loss of peripheral visual fields Diabetic retinopathy Implications for Rehabilitation  Diabetic retinopathy is a diabetes complication that  Mobility and reading problems caused by restricted affects eyes. visual fields, people suddenly appearing in the visual field seen as “jack-in-the-box.”  It caused by damage to the blood vessels of the light- sensitive tissue at the back of the eye (retina). Nursing Care of the Older Adult in Chronic Illness  At first, diabetic retinopathy might cause no symptoms or only mild vision problems. Chronic Confusion Common Clinical Presentation  Chronic confusion, in contrast, is a long-term, progressive, and possibly degenerative process and  Reduced visual acuity occurs over months or years. Both categories can befall  Scattered central scotomas in any age group, gender, or clinical problem  Peripheral and midperipheral Scotomas  Chronic confusion is progressive and variable in nature  Macular edema and may usually involve problems with memory recall, problem-solving, language, and attention. Implications for Rehabilitation  Also, there can be difficulties with perception,  Difficulty with tasks requiring visual detail such as rationalizing, judgment, abstract thinking, reading, distorted central vision, fluctuating vision, loss communication, emotional expression, and the of color perception, mobility problems resulting from performance of routine tasks. loss of depth and contrast cues.  Depression, brain infections, tumors, head trauma, multiple sclerosis, abnormalities resulting from Cataract hypertension, diabetes, anemia, endocrine disorders,  Cataracts are the clouding of the lens of the eye, which malnutrition, and vascular disordersare examples of is normally clear. illnesses that may be linked with chronic confusion.  Most cataracts develop slowly over time, causing Impaired Verbal Communication symptoms such as blurry vision.  Cataracts can be surgically removed through an  Communication with a mentally or physically impaired outpatient procedure that restores vision in nearly person can be a difficult and frustrating task, but good everyone. communication skills can prevent catastrophic reactions. Common Clinical Presentation  In dealing with persons with limited physical or mental abilities, it is important to listen, speak clearly and  Reduced visual acuity slowly and use non-verbal communication (body  Light scatter language) to help convey your message.  Sensitivity to glare  The following article includes tips for communicating  Altered color perception with (1) the hearing impaired; (2) the deaf;  Loss of contrast sensitivity  (3) the visually impaired; (4) aphasics; and (5) those  Image distortion with Alzheimer's Disease and related disorders.  Possible myopia- Communicating with the hearing impaired Implications for Rehabilitation  If the person wears a hearing aid and still has difficulty  Usually remedied by lens extraction and implantation, hearing, check to see if the hearing aid is in the except in extreme cases. If not managed by person’s ear. Also check to see that it is turned on, replacement. adjusted and has a working battery. If these things are  Difficulty with detail, bright and changing light, color fine and the person still has difficulty hearing, find out perception, contrast perception; some mobility when he/she last had a hearing evaluation problems caused by loss of perception of depth and  Wait until you are directly in front of the person, you distance, sensitivity to glare, loss of contrast have that individual’s attention and you are close Glaucoma enough to the person before you begin speaking.   Be sure that the individual sees you approach, - Ask the person how best to communicate. What otherwise your presence may startle the person. techniques or devices can be used to aid communication; Face the hard-of-hearing person directly and be on the same - Allow the aphasic to try to complete his/her level with him/her whenever possible; If you are eating, chewing thoughts, to struggle with words. Avoid being too or smoking while talking, your speech will be more difficult to quick to guess what the person is trying to express; understand; Keep your hands away from your face while talking; - Encourage the person to write the word he/she is Recognize that hard-of-hearing people hear and understand less trying to express and read it aloud; well when they are tired or ill; Communicating with persons with Alzheimer’s Disease or Communicating with the deaf related disorders  Communicating with the deaf is similar to  Always approach the person from the front, or within communicating with the hearing impaired; his/her line of vision – no surprise appearances;  Write messages if the person can read;  Speak in a normal tone of voice and greet the person as  Use a pictogram grid or other device with illustrations you would anyone else; to facilitate communication;  Face the person as you talk to him/her;  Be concise with your statements and questions;  Minimize hand movements that approach the other  Utilize as many other methods of communication as person; possible to convey your message (i.e. body language);  Avoid a setting with a lot of sensory stimulation, like a  Spend time with the person, so you are not rushed or big room where many people may be sitting or talking, under pressure. a high-traffic area or a very noisy place Communicating with the visually impaired  Maintain eye contact and smile. A frown will convey negative feeling s to a person;  If you are entering a room with someone who is  Be respectful of the person’s personal space and visually impaired, describe the room layout, other observant of his/her reaction as you movecloser. people who are in the room, and what is happening; Maintain a distance of one to one and a half feet  Tell the person if you are leaving. Let him/her know if initially; others will remain in the room or if he/she will be  If a person is a pacer, walk with him/her, in step with alone; him/her while you talk;  Use whatever vision remains;  Use distraction if a situation looks like it may get out of  Allow the person to take your arm for guidance; hand. A couple of examples are: if the person is about  When you speak, let the person know whom you are to hit someone of if he/she is trying to leave the addressing; home/facility.  Ask how you may help: increasing the light, reading the  Use a low-pitched, slow speaking voice which older menu, describing where things are, or in some other adults hear best; way.  Ask only one question at a time. More than one question will increase confusion; Communicating with Aphasics  Repeat key words if the person does not understand  Aphasia the first time around; - is a total or partial loss of the power to use or  Nod and smile only if what the person said is understand words. It is often the result of a stroke understood. or other brain damage. Expressive aphasics are able to understand what you say; receptive aphasics are not. Some victims may have a bit of both kinds of the impediment.  For expressive aphasics, trying to speak in like having a word "on the tip of your tongue" and not being able to call it forth. Some suggestions for communicating with individuals who have aphasia follow: - Be patient and allow plenty of time to communicate with a person with aphasia; - Be honest with the individual. Let him/her know if you can’t quite understand what he/she is telling you; Planning for Health Promotion, Health Maintenance and Home researchers and others to think about what can we do, as Health Consideration individuals and as a society, to foster optimal or successful aging. PLANNING Home Health Care  is a deliberative, systematic phase of the nursing process that involves decision making and problem  is just what it sounds like: health care services solving” delivered in the comfort of your own home.  Formulating client goals and designing the nursing  Nurses, aides and volunteers visit the patient in the interventions required to prevent, reduce or eliminate home to help treat an illness, injury or chronic the clients health problems. condition Planning ;Successful Aging” at Mid-life Examples of skilled home health services include o We Baby Boomers are pretty competitive, so  Wound care for pressure sores or surgical wounds we are eager to prove we can age well  Patient and caregiver education Kathryn Betts Adams Ph.D., M.S.W  Intravenous or nutrition therapy  Injections Health Considerations  Monitoring of serious illness and unstable health status  Planning for successful aging  Physical rehabilitation  Home care and Hospice  Speech therapy  Community based services  Dietary assistance  Assisted living  Monitoring of blood pressure, temperature, heart rate  Special Care units and breathing  Geriatric units  Supervising of prescription and other drugs  Pain management Planning for Successful Aging  Safety management in the home 1. Steps to Successful Aging  Education about self-care - Adopt and maintain healthy habits and positive  Care coordination and communication lifestyles: Avoid cigarette smoking. The goal is to TREAT - Maintain intellectual stimulation and socialization: Pursue hobbies and interests with passion,  An illness or injury, helping the patient get better, particularly those such as dancing that are social regain their independence, and become as self- 2. Planning for Successful Aging sufficient as possible, says Medicare. - Be wise in financial planning  Patients are typically assigned a home health care team - Work to maintain dignity and good health in old that comprises a nurse, physical therapist, home health age aide to assist with personal care, social worker for Successful aging short-term counseling, and dietitian to provide healthy meal guidance. Rowe and Kahn coined the term successful aging in 1996  Home health care - can be just for the short term until the patient  Researchers, presented their well-known definition feels they no longer need help; or, it can extend that emphasized the interaction of three into the long-term especially where chronic related elements: conditions are concerned.  It can also extend into hospice care in the future. 1. Avoidance of physical illness and disability,  Palliative care 2. Maintenance of high physical and cognitive function - is also provided within home health care and is a 3. Continuing engagement in social and productive component of hospice care as well, which is where the confusion arises.  It seems rather straightforward to say we will be successful if we are healthy, high functioning, and Hospice Care socially engaged; however, this original definition was  When a patient has six months or less to live, the important because it moved the conversation from transition to hospice care is made. However, you don’t what is normal to what is optimal in later life and have to wait for your loved one’s physician to opened the door for recommend hospice care.   Be an advocate and research all healthcare options on  For example, a registered nurse may be available for your own, and keep the lines of communication open. on-site health services, medical assessment and  Hospice care is designed to provide pain management, monitoring, and to help with medication management. symptom control, psychosocial support, and spiritual  In general, adult day care is not covered by Medicare, care to patients and their families when the illness although some costs may be covered by Medicaid or cannot be cured. other insurers.  The nation’s hospices serve more than 1.5 million Assisted Living people every year and their family caregivers, as well, according to the Hospice and Palliative Care Association  There are times when an older adult needs more of New York State. assistance than can be provided in the home when it  The focus with hospice is caring, not curing. comes to personal care.  It can take place in the patient’s home, a nursing home  In many cases, however, the older person still may not or in a hospice care facility. need the round-the-clock skilled nursing and medical  Many people assume hospice is only called in the final care that a nursing home provides moments of life.  In that case, an assisted living arrangement might be an  However, studies show that pain and symptom option to consider in order to protect the older management is more effective when delivered earlier person’s independence and privacy for as long as in the disease process. possible.  Fully covered by Medicare, Medicaid, and most private  Assisted living facilities (ALFs) have many names, insurance plans and HMOs, hospice is more about living including & adult care facilities or residential care than dying. facilities  That’s because it is meant to provide the best quality of  ALFs are licensed by state. Since ALFs are not licensed life possible for patients whose prognosis leads doctors by the federal government, the services provided and to believe they will not live past six months. quality controls vary by state.  They are often in pain, particular with end-stage  More than 500,000 people live in ALFs, and this diseases like cancer, in addition to the discomfort number is expected to grow as our population ages. brought about by previous treatments like  Even though ALFs offer a social model of care (not a chemotherapy. medical one), they provide residents with a support  While hospice is thought of as solely a last option for staff and meals, as well as assistance with activities of the dying, patients sometimes improve and can be daily living such as dressing and bathing. discharged from hospice.  Older adults have a variety of choices in ALFs, ranging from smaller, simple home-like environments, to Community-Based Services larger, fancier accommodations.  There are healthcare options that allow older adults to  This wide range in types of ALFs allows people to live at home, while still providing important healthcare choose a home that best suits their needs, tastes, and or personal care support in the community. financial situation.  Most ALFs offer private rooms or apartments. Community-Based Services: Adult Day Care Centers  Special care units that focus on Alzheimer’s disease and  Adult day care centers are community-based options other forms of dementia are also becoming more that have become fairly common. common.  They provide a wide range of social and support Assisted Living: Provide a variety of services which includes: services in a group setting.  Most adult day care centers are set up in either  24-Hour staffing to meet the scheduled and churches or community centers. unscheduled needs of residents (Note: This does not  Adult day cares are commonly used to care for people mean that skilled nursing must be available 24 hours a who need supervision and help with activities of daily day.) living (for example, patients with dementia) while  Social services primary caregivers are at work.  Housekeeping and laundry Recreation and meals  They may also serve as a form of respite (or a  Help with activities of daily living (ADLs) "break") for caregivers.  Health-related services (e.g., help with medication  Providers of adult day care may offer a variety of management) services, ranging from basic non-medical care to more  Transportation advanced medical services.  Other services vary considerably from state to state. For example, depending on licensing requirements,  giving and managing medications may be handled by Sheltered Housing unskilled, skilled, or fully licensed nursing staff.  Sheltered housing is often in a home that offers  It is important to understand that Assisted Living personal-care support, housekeeping services, and Facilities are operated as social models of healthcare. meals. As such, government oversight and regulatory inspections are through the State Department of Social  Social work services and coordination for activities can Services, not the Department of Public Health. be added to these programs.  Charges to clients are based on a sliding scale, which may cost up to 30% of income. Types of Assisted Living Continuing-Care Retirement Communities Types of Assisted Living  Some older adults may choose to live in a continuing-  Group Home care retirement community (CCRC).  Adult Foster Care  These communities usually have a variety of living  Sheltered Housing options, ranging from apartments or condominiums, to  Continuing-Care Retirement Communities assisted living and then to skilled nursing home care.  Memory Care Assisted Living  Often, older adults enter the CCRC in the more independent living areas. Group Homes  If they become more disabled, they may progress to  Group homes are houses or apartments where two or the assisted living and skilled care areas. more unrelated people live together. Health care in CCRCs is generally provided using three  These include domiciliary care (where older adults financial models: remain in the community by moving in with a - The all-inclusive model. This provides total health caregiver), single-room occupancy residences, board- care coverage, including long-term care. and-care homes, and some group living situations. - The fee-for-service model, in which payments  Group homes vary in the types of residents who live match the level of care. there. For example, many can accommodate people - The modified coverage model, which covers long- with chronic mental illness or dementia. term care to a predetermined maximum amount.  Most group homes are run as for-profit businesses, and Most CCRCs require an entry fee, which may or some states require licensing. may not be refundable, plus a variable monthly fee  Residents share a living room, dining room, and kitchen to pay for rent and supportive services. but usually have their own bedrooms. - Monthly fees vary, depending on the level of care being provided.  Advantages of this arrangement include a lower cost of - Older adults generally pay to live in these living and ability to socialize with peers. communities, though some facilities have beds for  Independence and ability to function are supported - skilled care that are funded by Medicare or through the interdependence and relationships of the Medicaid. residents.  Opportunities for socialization are increased, reducing Memory Care Assisted Living social isolation. Resident-to-staff ratios may also be higher than in other supported-living environments.  These are specialized assisted living facilities or homes that specialize in the care of older adults with Adult Foster Care Homes dementia.  Since they are not long-term care facilities, but have  Foster care homes generally provide room, board, and increased staffing ratios, they operate similarly to long- some help with activities of daily living. term care nursing homes.  This is provided by the sponsoring family or other paid  However, they focus on assessing and treating caregivers, who usually live on the premises. residents with social and medical needs specific to  Adult foster care has the advantage of maintaining frail dementia and cognitive impairment. older adults in a more home-like environment.  Some memory care assisted living facilities are stand-  Regulations for foster care vary by state, and some alone, while others are associated with a CCRC or other states require licensing. ALF.  Some states will cover costs of adult foster care  Some memory units are locked to ensure safety of the through their Medicaid programs residents within the community.  Perhaps the longest experience with adult foster care is in the state of Oregon, where it is used as an alternative to long-term care and institutional living.   Most older adults must pay for assisted living adult or pediatric medicine, especially if they are themselves, although some states now may pay costs critically ill. through Medicaid.  Geriatric medicine was not included in the curricula of  Generally, care in an ALF is less expensive than in a undergraduate or advanced medical training until nursing home. Part of this difference in cost is because recently, so not all critical care physicians are oriented ALFs provide less service and have less overhead. to the specific needs of geriatric patients.  In addition, ALFs generally have fewer regulations to  Despite the fact that many critically ill patients are observe (at least for now) and are therefore able to older, the training of critical care teams still lacks a operate with fewer expenses. geriatric focus.  Older adults admitted to intensive care units can suffer Special Care Units from severe infections, such as MRSA (Methicillin-  A special care unit (SCU) is an inpatient unit within a resistant Staphylococcus aureus) or systemic fungal healthcare facility that is custom-designed, staffed, and infections, and may need special post-operative equipped to care for people with specific health analgesia. conditions.  People age 75+ may need assessment by special  They are usually in a physically separate space from instruments to predict their ICU prognosis. One other patient populations quotation has said;geriatric ICUs are the future  Traditionally found in hospitals, SCUs also are becoming increasingly common within assisted living and skilled nursing facilities in the U.S. SCU or nursing home include 1. Memory/cognitive care - for people with Alzheimer’s disease or other types of dementia; offer a safe, secured environment, as well as specialized therapeutic programs for those who have memory issues. 2. Neurological care - for those who have Parkinson’s or Huntington’s disease or who have suffered a stroke; care services may include physical, speech, occupational, and swallowing therapies. 3. Orthopedic rehabilitation - for people who have undergone orthopedic surgery; include specialized rehabilitation equipment and treatment by experienced rehabilitation professionals. 4. Cardiac/pulmonary care - for those with heart or lung issues; patients may receive specialized services like exercise therapy, smoking cessation programs, and education on lifestyle modification. 5. Hospice care - for people approaching the end of life; provide a compassionate environment focused on physical and emotional comfort for the patient, as well as their loved ones. Geriatric Units  is a special intensive care unit dedicated to management of critically ill elderly. Origin  Geriatric intensive care units began because the world population is aging. Geriatric medicine is distinct from