Care of the Older Persons PDF

CARE OF THE OLDER PERSONS DEMOGRAPHICS OF AGING THEORIES OF AGING 1 2  People are living longer  number of older people is the most rapidly expanding segment of the population As the older population increases, the number of people who live to a very...

CARE OF THE OLDER PERSONS DEMOGRAPHICS OF AGING THEORIES OF AGING 1 2  People are living longer  number of older people is the most rapidly expanding segment of the population As the older population increases, the number of people who live to a very old age is dramatically increasing The population of the Philippines will increase by 35.4% over the next two decades, reaching over 126 million by 2030. The proportion of the population aged 60 years and above is projected to exceed that of the population aged 0–14 years in 2065 3  In the Philippines, life expectancy at birth & at age 60 will increase for both women and men between 2010 & 2030 (Table 2). Over the next 20 years, life expectancy at birth will increase by 4.0 years for women & 4.7 years for men. The life expectancy gap between sexes will decrease from 6.6 years in 2010 to 5.9 years in 2030. For people who survive to age 60 in 2010, women can expect to live another 18.9 years and men another 15.8 years. 4 5 PROJECTED POPULATION OF THE PHILIPPINES:  As of January 1, 2023, the population was estimated to be 114,097,802 an increase of 1.58%. The current population of Philippines is 117,337,388- based on the projections of the latest United Nations data. The UN estimates the July 1, 2023 population at 117,337,368 6  Although the majority of older adults enjoy good health, in national surveys as many as 20% of adults 65 years of age and older report a chronic disability. Chronic disease is the major cause of disability; heart disease, cancer, & stroke continued to be the three leading causes of death in people 65 years of age & older 7  HEALTH STATUS OF THE OLDER ADULT Majority of deaths … 65 years of age & older … ½  heart disease & cancer – improvements in the prevention & early detection & treatment of diseases, there has been a noticeable impact on the health of people 65 years of age & older – In the past 50 years, there has been a decline in overall deaths &, specifically, deaths from heart disease and more recently cancer. These declines in limitations reflect recent trends in health promotion & disease prevention activities, such as – improved nutrition, – decreased smoking, – increased exercise, – early detection & treatment of risk factors such as hypertension & elevated serum cholesterol levels 8  HEALTH STATUS OF THE OLDER ADULT Older adults, although living longer, tend to do so with several chronic illnesses that are in need of long-term & consistent health care. Older adults tend to have comorbid illnesses, or more than one disease at a time Many chronic conditions commonly found among older people can be managed, limited, & even prevented. Older people are more likely to maintain good health & functional independence if encouraged to do so and if appropriate community-based support services are available Nurses are challenged to promote positive lifelong health behaviors among all populations because the impact of unhealthy behaviors & choices can result in chronic disease. 9 NURSING CARE OF THE OLDER ADULT geriatric nursing, gerontological nursing, & gerontic nursing have been used interchangeably to describe the role of nursing care of older adults – different meanings Geriatric nursing: nursing care of older people with health problems, or those requiring tertiary care Gerontological nursing: includes health promotion, education, & disease prevention (primary & secondary care) Gerontic nursing: not a commonly known term, encompasses both of these aspects (Hogstel, 2001). gerontological nursing knowledge  began in 1966 when the ANA first recognized geriatric nursing as a specialty 10 11  NURSING CARE OF THE OLDER ADULT: GERONTOLOGY Gerontological nursing is provided in – acute care, – skilled and assisted living, – the community, and – home settings. Goals: – promoting & maintaining functional status – helping older adults identify & use their strengths to achieve optimal independence Nurses who are certified in gerontology have specialized knowledge of the acute & chronic changes specific to older people. RN & CG  working with patients who are older understand that – aging is not synonymous with disease – the effects of the aging process alone are not the primary contributors to disability & disease 12  NURSING CARE OF THE OLDER ADULT: GERONTOLOGY As research and scientific knowledge increase, it is becoming apparent that aging is a highly complex process. Functional assessment is a common framework for assessing elderly people. – Age-related changes, as well as additional risk factors such as disease and the effects of medications, can result in a negative impact on function. – Assessing the functional consequences of aging & proposing practical interventions help maintain & improve the health of the elderly. – Goal: help older people maintain maximum functional level & dignity despite physical, social, & psychological losses. Early intervention can prevent complications of many health problems and help maximize the quality of life. 13  NURSING CARE OF THE OLDER ADULT: GERONTOLOGY Field of nursing that specializes in the care of the elderly The scientific study of the aging process, is a multidisciplinary field that draws from the biologic, psychological, & sociologic sciences. Geriatrics is the practice that focuses on the physiology, pathology, diagnosis, & management of the disorders & diseases of older adults. Because aging is a normal process, care for the elderly cannot be limited to one discipline but is best provided through a cooperative effort. – An interdisciplinary approach to providing care combines expertise and resources to provide comprehensive geriatric assessment and intervention. – Nurses collaborate with the team to obtain appropriate services for patients and provide a holistic approach to care. 14  AGING The normal process of time-related change, begins with birth and continues throughout life Gradual process characterized by continued development and maturation The changes of aging begin as one enters middle adulthood The onset and the effect of those changes throughout the middle and older adult years are influenced by numerous biologic, psychosocial, & environmental factors. The physiologic changes of aging, first experienced in middle adulthood, become more obvious in older adults. Continued development throughout one’s adult life depends to a great extent on a person’s sense of self-concept and prior ability to adapt. Life expectancy: the average number of years that a person can be expected to live, has risen dramatically in the past 100 years 15  AGING The increasing lifespan of older adults makes it possible for an individual to spend up to 40 years in older adulthood. Consequently, gerontologists have broken this stage of life into three segments: – the young–old : aged 65 to 75 – the middle–old: 75–85, and – 85+ old: division of older adults into segments allows nurses to recognize the unique differences present in each stage of older adulthood in order to provide more effective care. 16  Myth: Older adults are of little benefit to society Older adults … sick people in hospital units & nursing homes… lie in beds & consume medications & resources, it is hard to imagine what benefit they are to society, & thus  considered to be a burden. rate of disability among older adults is continuing to decline steadily they are of great benefit, as they – provide & receive love, care, & support – function in professional roles as teachers, administrators, physicians, nurses, & clergy Instead of viewing older adults as a burden, – take the time to speak with them about their lives – Ask older adults about their favorite memories or regrets – ask for advice When given the opportunity, it is likely that nurses as well as the rest of society will learn a lot from older adults. 17 Myth: Older adults are a drain on society’s resources. older adults retire in their late years & collect Social Security payments & Medicare, it is assumed that they are over utilizing their resources. the vast majority wanted to work as long as possible. many retired older adults have taken on the role of custodial grandparents, majority of the retired older adults are significantly contributing to society in ways other than traditional employment 18 Myth: Older adults are cranky & disagreeable initial impressions of older people: – that older adults are cranky, disagreeable, & generally unlikable people true that there are many cranky & disagreeable older adults  there is an equal number of cranky & disagreeable younger adults CONTINUITY THEORY supports that individuals move through their later years attempting to keep things much the same & using similar personality & coping strategies to maintain stability throughout life. – Consequently, the coping strategies seen among older adults may be very similar to their younger characteristics. If there appears to be more difficult patients among older adults, it may be because older adults tend to approach their later years sicker than the younger population. remember that negative interactions with nurses may likely be a symptom of their illness, rather than a characteristic of aging – Like any other symptom, it is essential to identify the cause and treat it – In so doing, the older adult’s personality will be allowed to shine through, and they will likely treat you with the respect due to a caring and concerned professional 19 Myth: You can’t teach old dogs new tricks Patient teaching is a major component of the nursing role, regardless of which population is receiving care. In working with the older adult population, a large amount of care will be directed toward managing pathological diseases of aging that resulted from poor health practices acquired early in life and continued into older adulthood. But, this does not mean that these diseases cannot be treated, managed, and in some cases cured. Older adults are never too old to improve their nutritional level, start exercising, get a better night’s sleep, stop drinking & smoking, & improve their overall health and safety. the health risks of smoking may be reduced among all age groups and recommends that “geriatricians should counsel their patients who smoke, even the oldest, to quit” older adults may still benefit from health promotion activities, even in their later years. Further support to refute the myth that you can’t teach old dogs new tricks may be found in the record number of older adults increasing their education. – Older adults are increasingly returning to school & increasing their level of education Keeping intellectually active is regarded as a hallmark of successful aging 20 21 MYTH: OLDER ADULTS ARE ALL SENILE. Senile: used to describe older adults who were experiencing cognitive impairment. recently replaced  dementia, which describes a number of illnesses that result in cognitive impairment. It is commonly believed that older adults will develop dementia as they age. However, this is not always the case, as many older adults live well into their 10th decade as sharp as they were in their 20s & 30s Memory losses are common in older adulthood, but are often falsely labeled as dementia. Dementia is not a normal change of aging, but a pathological disease process. – a general term used to describe over 60 pathological cognitive d/o that develop as a result of disease, heredity, lifestyle, & perhaps environmental influences. – a chronic loss of cognitive function that progresses over a long-period of time. Alzheimer’s disease (AD) is the most common cause of dementia among older adults, making up about 50% of all dementia diagnoses. 22 Myth: Depression is a normal response to the many losses older adults experience with aging Older adults have the highest rates of depression frequent occurrence of loss  once used to explain the large incidence of depression among older adults While it is true that situational life events (retirement, relocation, loss of spouse, financial constraints, & illness, play a role in the development or severity of depression) recent research on depression indicates that there is more to the development of depression than the experience of loss the many physiological changes in older adults  more susceptible to the effects of pathophysiology than any other age group – depression rates are highest among older adults with coexisting medical conditions – 12% of older persons hospitalized for problems such as hip fracture or heart disease are diagnosed with depression – Other factors  presence of alcohol or drug abuse, past suicide attempts, and family history of depression and suicide 23 Myth: Older adults are no longer interested in sex older adults no longer have any interest or desire to participate in sexual relationships  sexuality is mainly considered a young person’s activity, often associated with reproduction, society doesn’t usually associate older adults with sex youth- oriented society … many consider sexuality among older adults to be distasteful & prefer to assume sexuality among the older population doesn’t exist. Sexuality continues throughout the lives of older adults The need to continue sexuality & sexual function should be as highly valued as other physiological needs. But for multiple reasons, most of society believes that sexuality is not part of the aging process. Consequently, nurses and other HCP do not assess sexuality and few intervene to promote the sexuality of the older population. Reasons for nurses’ lack of attention to sexuality of older adults include lack of knowledge, as well as general inexperience and discomfort. 24 25 Myth: Older adults smell age-old belief that older adults have poor personal hygiene… impacted the mind of many nursing students & HCP today true that there are older adults who have bad personal hygiene  not the majority of the population – number of sweat glands actually diminishes as people age  less perspiration among older adults – Urinary & bowel incontinence occurs more commonly among older adults, but these are pathological changes of aging & are highly treatable. – If an older adult smells of urine or feces  are very ill & their illnesses are not being effectively managed Increased attention to older adult’s care will likely result in improved management of hygiene, incontinence, & associated disorders. 26 Myth: The secret to successful aging is to choose your parents wisely This comical phrase leads society to believe that little can be done to slow the aging process, because it is all set out in a non-modifiable genetic plan dictated by lineage This myth is dangerous, because it leads older adults & CG to believe that little can be done to slow or compensate for normal changes of aging or to prevent & treat pathological medical problems – While genetics certainly are responsible for some of the aging process, they become less & less important as older adults age – As life continues, the role of environment & health behaviors significantly replaces the role of genetics in determining the onset of normal and pathological aging Rowe & Kahn (1997) report that approximately – 1/3 of physical aging & ½ of cognitive function is a result of genetic input from parental influences – 2/3 of physical aging & ½ of cognitive function to be influenced by environmental factors & health behaviors – Consequently, there is a lot that individuals can do to prevent the onset of both normal and pathological aging processes. 27 Myth: Because older adults are closer to death, they are ready to die & don’t require any special consideration at end of life When society learns of the death of a young child or adult, the level of grief & astonishment for the loss of a young life is extraordinary & difficult to contain. This grief and astonishment often is associated with a life that was too short, or taken too suddenly. death of an older adult, or have the opportunity to work with an older adult at the end of life, it is often assumed that the older adult is prepared for their death because of their advanced age – leads HCP to offer less than aggressive treatment for disease & to neglect essential components of end-of-life care for the older adult It is important to remember that while death among older adults may occur after a long life, older adults are not necessarily ready for death. – require equal & specialized attention to physical, psychological, social, & spiritual tasks at the end of life End of life is often a difficult time for many older adults, but it also presents the opportunity to complete important development tasks of aging, such as – mending fences with loved ones – disengaging from social roles, and – transcending from this life into another existence RN  important role in helping older adults to complete these development tasks that can make the difference between experiencing a good or bad death. 28