NCM 114: Care of the Older Clients - UNIT I PDF

NCM 114: CARE OF THE OLDER CLIENTS UNIT I: Concepts, Principles and Theories in the Care of Older Adult TERMINOLOGY Gerontology - Is a multidisciplinary and is concerned with physical, mental, and social aspects, and implications of ag...

NCM 114: CARE OF THE OLDER CLIENTS UNIT I: Concepts, Principles and Theories in the Care of Older Adult TERMINOLOGY Gerontology - Is a multidisciplinary and is concerned with physical, mental, and social aspects, and implications of aging. - Is concerned with the biological, psychological, economic, and social study of aging. - A holistic study of aging and how environment and aging affect a person. Geriatrics - Is a medical specialty focused on care and treatment of older persons. - Study and management of diseases of the elderly. Gerontologic nursing - This specialty of nursing involves assessing the health and functional status of older adults, planning and implementing health care and services to meet identified needs, and evaluating the effectiveness of such care. Comorbidity - The simultaneous presence of multiple chronic conditions Compression of morbidity - Hypothesis that serious illness and decline can be delayed or postponed so that an extended life expectancy results in more functional, healthy years Life expectancy - The length of time that a person can be predicted to live Life span - The maximum years that a person has the potential to live AGING IS A DEVELOPMENTAL PROCESS Aging is a natural process. - Constantly & continuously, every cell of every organism ages. - Aging is the continuum of events that occur from conception to death. - It is a process of becoming older. DEVELOPMENT PRINCIPLES 1. Development is lifelong. 2. Development depends on history and context. 3. Development is multidimensional & multidirectional and involves a balance of growth and decline. 4. Development is plastic rather than rigid. Despite the normality and naturalness of this experience, many people approach aging as though it were a pathologic experience, witnessed by comments that associate aging with: ▪ “Looking gray and wrinkled” ▪ “Losing one’s mind” ▪ “Becoming sick and frail” ▪ “Obtaining little satisfaction from life” ▪ “Returning to childlike behavior” ▪ “Being useless” Principle and Goal ▪ Health promotion, health protection, disease prevention, and treatment of disease with emphasis on the evidence- based best practices and current clinical practice guidelines. ▪ The goal for nurses who provide health care to older people is not only to improve the length of life, but to improve the quality of life. o Quality of life is achieved by dignity, respect, and advocacy. AGEISM - negative attitude towards aging and older adults - Stereotyping or discrimination against individuals or groups base on their age MYTH VS. FACT MYTH FACT Being old means being sick Fewer than 5% of people over the age of 65 are frail enough to require care in a skilled nursing facility Many older adults have chronic diseases but still function quite well Most older people are set in their Older people can learn new things and should be challenged to stay mentally active ways and cannot learn new things Healthy older adults find hobbies that they can enjoy to give life meaning and pleasure or take up new activities Health promotion is wasted on It is never too late to begin good lifestyle habits such as eating healthy diet and engaging older people in exercise Although it may not be possible to reverse all the damage caused by bad habits, it’s never too late to stop smoking cigarettes or drinking too much alcohol. Even people who quit smoking at older ages enjoy better health outcomes than those who continue to smoke Older adults do not pull their own Older people contribute greatly to society by supporting the arts, doing volunteer work, weight and are a drain in societal and helping with grand children resources Paid employment is not the only measure of value and productivity, and older people continue to make contributions to society into advanced old age and many continue working, volunteering and mentoring other ling after formal retirement Older people are isolated and Many older people join clubs and do volunteer work to stay active and connected lonely There are many ways to maintain contact with people and healthy older adults have a variety of great options for staying connected with others Older people have no interest in Although sexual activity does decrease in some older people, there are tremendous sex differences. Most often, the human need for affection and physical contact continues throughout life Characteristics of the Older Adult #1 Young-old: 60 to 74 years Middle-old: 75 to 84 years Oldest-old: 85+ Profile, interests, and health care challenges vary with each group. Characteristics of the Older Adult #2 Chronological age o Years lived since birth Functional age o Physical, psychological, and social function Perceived age o How others estimate age based on appearance Age identity o How people feel or perceive their own age DEMOGRAPHICS OF AGING - There are currently around 901 million people aged 60 or over worldwide, representing 12.3 percent of the global population. By 2030, this will have increased to 1.4 billion or 16.5 percent, by 2050, it will have increased to 2.1 billion or 21.5 percent of the global population. - Old age is often considered from the economic perspective, with assumptions of what ageing population will cost. Yet wellbeing in later life is an accumulation of experiences throughout life. - As older adults increase there is also increase in the demand for health needs and health providers. Note: To determine that the country is aging, there should be at least 10% of the population of 60 years old and above in a country FEMINIZATION OF LATER LIFE - Male exposure to risk factors may account for the differences o Smoking, Vices and Occupational Risks - Increases in females exposures to risk factors will reduce difference in life expectancy - Women are known to live for at least 75 years old - May also occur due to transgenerational which means there are more born females than males The Philippines There are also policies and programs that recognize older people’s contribution, provide entitlements to access social services promote their full employment and maximize opportunities for their participation in national development. The government also recognizes the need to address older people’s specific need in terms of healthcare, housing and income security. While older people still face challenges in achieving income security and health status, the government is taking positive action, such as the Expanded Senior Citizens Act of 2010. Targeted old age allowance is still too limited to make any difference. In 2010, Expanded Senior Citizens Act of 2010 or RA 9994 An act granting addition benefits to Senior Citizens ▪ 20% discount in exception to VAT ▪ 5% discount for utility bills (electricity and water) ▪ Exception from training fees (seminars conducted by the government) ▪ Free medical and dental services in all DOH hospitals ▪ If the Senior Citizen is considered indigent, s/he will not be charged for Flu vaccines in DOH Hospitals; will be given educational assistance. ▪ Pensions from SSS, GSIS or PAG-IBIG ▪ Given death benefits of a minimum 2,000.00 from the DSWD ▪ Priority lanes in government agencies ▪ Some LGUs grant Php 100,000.00 to centenarians The Philippines has a young population with a small (6.8%) proportion of the population in the older ages (60+) In the Philippines, the number of older people is increasing rapidly, faster than growth in the total population. In 2000, there were 4.6 million senior citizens (60 years and older), representing about 6% of the total population. In two decades, this has grown to 9.4 million older people or about 8.6% of the total population. The World Population Prospects 2019 projects that by 2050, older people will make up around 16.5% of the total population By 2025, we would have 11.9 million older people accounting for about 10% of the total population. By then, the Philippines will be an aging population by UN definition. 2019 2050 Population aged 60 and above (total) 9,433,00 23,863,000 0 Population aged 60 and above (% of total 8.6 16.5 population) Older women aged 60+ (% of total 4.83 9.40 population) Life Expectancy (males) 67.08 71.88 Life Expectancy (females) 75.31 79.5 Old-Age Dependency Ratio Age (Age 65+ / 8.6 17.7 Age 15-64) Rural older people (% of total population) 6.48 Urban older people (% of total population) 6.54  Older persons living alone aged 60 and 5.4 above (% of total population) Old-Age Dependency Ratio –comparing number of adolescences to senior citizens LEGISLATIVE MILESTONES Republic Act No. 344 or the Accessibility Law of 1982 - Provides for the minimum requirements and standards to make buildings, facilities and utilities for public use accessible to persons with disability, including older persons who are confined to wheelchairs and those who have difficulty in walking or climbing stairs, among others Republic Act No. 7876 entitled “An Act Establishing a Senior Citizens Center in all Cities and Municipalities of the Philippines and Appropriating Funds Therefore” - Provides for the establishment of Senior Citizens Centers to cater to older persons’ socialization and interaction needs as well as to serve as a venue for the conduct of other meaningful activities. The DSWD in coordination with other government agencies, NGOs and peoples’ organizations shall provide the necessary technical assistance in the form of social and recreational services, health and personal care services, spiritual services, livelihood services and volunteer resource services. Office of the Senior Citizens Affairs Area where Senior Citizens can socialize and interact based on their needs as well as venues for meaningful activities Republic Act No. 8425 - Provides for the institutionalization and enhancement of the social reform agenda by creating the National Anti-Poverty Commission (NAPC). Through its multi-dimensional and cross-sectoral approach, NAPC provides a mechanism for older persons to participate in policy formulation and decision-making on matters concerning poverty alleviation o In 2015, there was a research conducted on how does senior citizen get their money aside from pensions. Results included are from children, farming and own jobs. Republic Act No. 10155 - Known as “The General Appropriations Act of 2012” - Under Section 28 mandates that all government agencies and instrumentalities should allocate one percent of their total budget to programs and projects for older persons and persons with disabilities Republic Act No. 9994 - Known as the “Expanded Seniors Citizens Act of 2010” - An act granting additional benefits and privileges to senior citizens, further amending Republic Act No. 7432 and otherwise known as “an Act to maximize the contribution of senior citizens to nation building, grant benefits and special privileges and for other purposes” - The RA 9994 provides health care services for poor older persons such as free medical services on government hospitals, discounted services on private hospitals and clinics, free vaccines, discounted medicines and mandatory PhilHealth Coverage. Presidential Proclamation No. 470, Series of 1994, declaring the first week of October of every year as “Elderly Filipino Week” - The government considers the older persons as national treasure as they are citizens who contributes in nation building Presidential Proclamation No. 1048, Series of 1999, declaring a “Nationwide Observance in the Philippines of the International Year of Older Persons” Executive Order No. 1054, Series of 2003 - Approved and directed the implementation of the program providing for group homes and foster homes for neglected, abandoned, abused, detached, and poor older persons and persons with disability The Department of Social Welfare Development (DSWD) has issued Administrative Order No. 4 Series of 2010, “Guidelines on the Home Care Support Services for Senior Citizens”, establishing community based health careservices for older persons. The Plan of Action on Ageing 1999 – 2004 - Included health promotion and disease prevention for adults by providing free flu vaccinations, osteoporosis screening and eye tests. The National Action Plan on Senior Citizens focused on aspects of quality of life such as living independently The Philippine Plan of Action for Senior Citizens (2011 - 2016) - Aims to ensure giving priority to community-based approaches which are gender-responsive, with effective leadership and meaningful participation of senior citizens in decision-making processes, both in the context of family and community. This plan of action aims to ensure active aging for senior citizens where preventive and promotive aspects of health are emphasized in communities and where health services are accessible, affordable and available at all times. Envisioning a population of senior citizens who are self-sufficient and self-reliant, this plan aims to promote financial security and financial independence of senior citizens by developing community-based local delivery systems to address their needs. IMPLICATIONS OF HEALTH AND NURSING CARE Increasing need for gerontological nurses. o An urgent need exists for gerontologic nurses to (1) create roles that meet the needs of older adults across the continuum of care; (2) develop models of care delivery directed at all levels of prevention, with special emphasis on primary prevention and health promotion services in community-based set tings; and (3) assume positions of leadership and influence not only in institutions and settings where care is currently provided to older adults but also in the political arena. Health and social agencies must anticipate future needs. Government payment of services in jeopardy in age of budget cuts. Baby boomers are the next wave of older adults. o Baby boomers, a group composed of persons born between 1946 and 1964, have begun entering their senior years and are changing the profile of the older population. They are highly diverse, are better educated, have fewer children, have had higher incomes, and are greater users of technology than previous generations. Gerontological nurses will be challenged to recognize diversity among older adults as they assist these individuals in health promotion and disease management activities. IMPACT OF AGING MEMBERS OF THE FAMILY Because of extended lifespans, the number of family members over age 65 is growing. More people are living with chronic conditions and need some degree of care or assistance. The number of people in the younger generations is de creasing in proportion to the number of older members. There is a growing number of widows who may be unprepared to provide for their own needs and will need assistance. The role of women is changing. As women increasingly must work outside the home, many are attempting to meet the demands of their parents as well as their homes, children, and workplaces