NCM 214 Care of Older Adult Prelims PDF

NCM 214 CARE OF OLDER ADULT LECTURE PROF : JO ANN DELA CERNA BSN 3F (2023-2024) Chronological Age TERMINOLOGIES refers to the number of years a person has liv...

NCM 214 CARE OF OLDER ADULT LECTURE PROF : JO ANN DELA CERNA BSN 3F (2023-2024) Chronological Age TERMINOLOGIES refers to the number of years a person has lived Categories of old age: GERIATRICS Young- old (65- 74 years old) from the Greek word "geras", meaning old age and Middle- old (75- 84 years old) "iatro" meaning relating to medical treatment Old- old ( 85 years old and above) The branch of medicine that deals with the diseases PHYSIOLOGIC AGE and problems of old age also called as BIOLOGICAL age GERONTOLOGY a measure of how well or poorly one's body is from the Greek word "geron", meaning old man and functioning relative to one's calendar age "ology", the study of scientific study of the process of Function of the body systems aging and the problems of aged persons FUNCTIONAL AGE includes biologic, sociologic, psychologic, and person's ability to contribute to society and benefit economic aspects others and himself GERIATRIC NURSING Measures their capabilities and abilities the nursing care of older people with health Demographics of Aging problems, or those requiring tertiary care Statistical study of the size and distribution of older Addressing their health only adults GERONTOLOGICAL NURSING is the field of nursing that specializes in the care of older adults this specialty of nursing involves assessing the health and functional status of older adults Totality of a person FINANCIAL GERONTOLOGY a subfield that combines knowledge of financial planning and services with a special expertise in the needs of older adults SOCIAL GERONTOLOGY - Period of aging population:declining fertility and subfield of gerontology that focuses on the social much more focused on their career aspect of growing old GERONTOLOGICAL REHABILITATION NURSING combines expertise in gerontological nursing with rehabilitation concepts and practice GERONTOPHOBIA fear and refusal to accept older people into the mainstream of society GERASCOPHOBIA fear of getting old Ageism the negative stereotyping of aging and older persons Age Discrimination the practice of treating people differently simply - A global phenomenon of population growth of older because of their age adults  IMPLICATIONS OF INCREASING OLDER POPULATION available resources for older adults to live happy and healthy lives need for facilities to take care of older persons need for competent geriatric nurses - Decreasing mortality rate ; increasing life expectancy REASONS FOR LIVING LONGER 1. advances in medications to treat different illnesses immunizations to prevent diseases which lead to improved economic conditions 2. improved nutrition 3. new diagnostic techniques to assist in the early detection, treatment and management of a disease. HISTORY OF GERONTOLOGICAL NURSING 1900 the need for gerontological nursing specialty was identified 1904 first article on the nursing of the aged was published 1966 the Division of Geriatric Nursing Practice was established, giving nursing of the aged specialty status 1966: medical surg nursing , child health nursing 1904: ALM house charitable housing ; life of older adults along with other indigents and people will mental illness, orphans HISTORY OF GERONTOLOGICAL NURSING 1930 board and care homes were formed 1950 Newton published the first gerontological nursing text. 1962 landmark study: describing problems of hospitalized older adults 1 (Norton, Mclaren and Exton) ANA convened the first meeting of the Conference Group on Geriatric Nursing Practice 1966 Division of Geriatric Nursing was established 1962: in UK ; ANA witnessed and observed the condition of older adults FATHER OF 1966: becomes a specialty GERONTOLOGY 1969 VLADEMIR KORENCHEVSKY the standards and scope of gerontological nursing practice were developed 1970s the term Gerontological Nursing replaced the term Geriatric Nursing 1980 American Journal of Nursing publishes Geriatric Nursing Journal 1981 First international conference on Gerontological Nursing Born in Lida, Russia 1988 He was pioneer in the investigation of the problems First PhD program in gerontological nursing of aging established by Case Western Reserve University 1989 MOTHER OF ANA certification establishes for Clinical Specialist in GERIATRICS Gerontological Nursing DR. MARJORIE WARREN 1998 ANA certification available for advanced practice nurses as geriatric NP or gerontological clinical specialist 2009 - 2010 Geriatric Nursing Education Consortium and Advancing Care excellence for seniors FATHER OF GERIATRICS DR. IGNATZ LEO NASCHER was born on 28 October 1897 at 15 Scarborough Road, Stroud Green, Hornsey, London is one of the first geriatricians and considered the mother of modern geriatric medicine. ROLES OF A GERONTOLOGIC NURSE 1. Provider of Care Gives direct hands-on care to older adults in a variety Austrian-American doctor and gerontologist of settings. He proposed the term GERIATRIC in 1909 - Assess and diagnose ; actual and potential problems , plan the care , implements care and evaluate patient outcome - Know about the physiologic changes and common disorders which develops in older adults , usual treatment 2. Manager SETTINGS OF CARE Balances the concerns of the elder, family, nursing staff and the rest of the interdisciplinary team Plans and coordinates the care of the elderly 1. ACUTE CARE SETTING - Concerns of the family and nursing staffs, interdisciplinary team Acute Care Hospital - Skillful in managing, staff coordination , promote focuses on management of acute problems therapeutic communication, assertive and not afraid ○ trauma, accidents of change ○ orthopedic injuries 3. Teacher ○ serious circulatory or respiratory problems Organizes and provides instructions on healthy aging, Acute Care of the Elderly (ACE) disease detection, treatment and rehabilitation to older patients and families is a specialized program that addresses the needs of Educates client and family on how to access health hospitalized older adults in a multidisciplinary team care system approach - Modifiable risk factors , stress management to prevent functional and cognitive decline and to 4. Advocate improve outcomes and satisfaction Acts on behalf of the older adults to promote their - Individualized care plan to prevent undesirable best interest and strengthen their autonomy and effects , addressing their specific needs decision making - “Acute” sudden , short term care - We do not make decisions for them but empower - Reducing the length of stay in the hospital them Four (4) key concepts: - Helping them to remain independent 1. safe environment - Explain medical treatment and procedures uncluttered halls - Having discussion on the rights of the patient, living carpeted floors wills & living testaments raised toilet seats - Provide assistance on community sources, provisions A common lounge area , medical insurances 2. Patient- centered interdisciplinary care 5. Research Consumer/Researcher 3. Discharge planning abreast of current research literature on gerontologic 4. Careful medical and nursing Interventions nursing Assists with data collection & identification of 2. LONG TERM CARE FACILITIES appropriate research sites Uses evidenced- based results is the provision of health and personal care - Phd for gerontologic nursing assistance to clients who have chronic disease and - Using evidence based research disability Principles of Gerontological the individual is referred to as resident Nursing Practice different levels of care: assisted living. intermediate Aging is a natural process care, skilled care, Alzheimer's Unit Various factors influence the aging process - Person of any age who lost their ability to care for Nursing of the elderly requires unique information themselves and skills - Assisted living , skilled care There are common needs shared by the elderly and - With chronic disease all ages A. Assisted living Gerontological nursing's goal is to promote optimum older adults who do not feel safe living alone or levels of physical, psychological, social and spiritual require additional help with activities of daily living health the assisted living facility provides meals, weekly activities, and a pleasant environment to socialize with other residents - Need some of assistance, make them feel that help is Goals: to maximize independence, promote maximal readily available anytime function, prevent complications and promote quality of life B. Intermediate Care 5. COMMUNITY SETTINGS when residents require additional assistance and are no longer able to live independently. A. Continuing Care Retirement Community (CCRC) provides 24-hour nursing oversight considered to be the entry level into nursing home also known as a life plan community or life care care community - Protect adults from injury , nursing homes provides a continuum of care from independent living C. Skilled Care to skilled care B. Home Health Care Skilled Care Units or Skilled Nursing Facilities (SNFs), sometimes called subacute or transitional designed for those who are homebound due to care severity of illness or immobility are designed to provide for the needs of clients services are provided by a primary care provider and whose acuity levels require a higher level of nursing require skilled or rehabilitation nursing care. - Often transferred from a hospital for the purpose of C. Independent Living continuing therapy , continuous NGT, IVT, Colostomy D. Alzheimer's Units independent living arrangements take the form of senior housing, such as apartment complexes Units providing nursing care for elder clients in exclusively devoted to the elderly with high level of various stages of dementia independence preserve the functional status of the person through supportive care that fosters self-worth and D. Foster Care Homes/Group Homes socialization even within the context of diminishing cognitive capacity a comfortable living environment that does not - Impaired judgment , safety issues with older adults provide the high level of care of nursing homes, but - Should not be left alone gives seniors an option to live among peers. - Mild , moderate and severe type of dementia - Safe environment for older adults - Goal: person can still preserve his/her functional status E. Adult Day Care 3. HOSPICE CARE for older adults who are unable to remain at home care for dying persons and their families during the day without supervision. Goal: to provide the client with pain management used by family members who may work during the and with psychosocial and spiritual care through the day and wish to have their relatives safely cared for dying process in their absence. - Holistic interdisciplinary care to achieve quality of life - In a hospital, long term care facility GREEN HOUSE CONCEPT 4. REHABILITATION as conceived by Dr. William Thomas may be found in various degrees in several settings, to replace more than 100 nursing homes nationwide including the acute care hospital, subacute or with clusters of small, cozy houses, each housing 8 to transitional care, and LTCFs. 10 residents in private rooms, with private bathrooms and an open kitchen.  Primary purpose: to serve as a place where elders Immunologic can receive assistance and support with activities of SOCIOLOGICAL daily living and clinical care Activity Dis-engagement Levels of Care Subculture and its Goal Continuity Age Satisfaction 1. Aggressive Person-environment Fit Goal: Extension of life Gero-transcendence Interventions: aggressive chemotherapy, PSYCHOLOGICAL invasive testing, radical surgery Theory of Individualism 2. Modified Human Needs Goal: Extension of life with consideration of Stage of Personality Development the burden of treatment NURSING THEORY OF AGING Interventions : management of illness with Functional Consequences Theory medications, minimally invasive surgery, Theory of Thriving noninvasive testing. Theory of Successful Aging - Aggressive: cancer , undergo all of the treatment prescribed BIOLOGICAL - Modified : chemo but no surgery, financial burden, THEORIES not all of the treatments 3. Palliative Care View aging as occurring at molecular and cellular Goal: patient comfort with life extension as level secondary goal 2 CATEGORIES Interventions: Pain management, symptom A. Stochastic theories : random cell damage and control, gentle rehabilitation, holistic care accumulate over time, thus, causing aging 4. Hospice Care B. Nonstochastic : predetermined process Goal: Comfortable death - Progressive loss of function Interventions: Pain management, symptom - Physiologic and physical control, holistic care. - Life expectancy and death - Stochastic : statistical, episodic events which THEORIES OF happens to a person , unexpected events cause cell AGING damage ; causing aging - Nonchastic : aging is destined; inevitable , calculated Functions: , genetics; biological clock ; APOPTOSIS 1. attempt to explain the phenomenon of aging 2. provide a perspective from which to view aging STOCHASTIC THEORY 3. provide springboard research - Understand more process of aging 1. Free Radicals and Lipofuscin theories CLASSIFICATION Aging is due to oxidative metabolism and effects of free radicals BIOLOGICAL ○ damages protein, enzymes, and DNA Free Radical ○ we cells cannot regenerate themselves Orgel/error Lipofuscin : a lipoprotein by - product of oxidation Wear and Tear interferes with the diffusion and transport of Connective Tissue essential metabolites Programmed Cell Death Gene/biological Clock Neuroendocrine  - Structures are not connected - Free radicals : environmental factors, smoking, - Tissues become stiffened when crosslinked pesticides , highly reactive atom or molecule unpaired - Stiffening of tissues ; cataracts lens with eye stiffens electron seek to combine to other atoms’ OXIDATIVE - Skin protein; collagen ; cause of wrinkles PROCESS ; destroy cell membrane and dna cannot - Arteries ; crosslinking of protein in arteries cause regenerate by themselves atherosclerosis - Lipofuscin : age pigment same role with free radicals if they accumulate it interferes with diffusion and NONSTOCHASTIC THEORY transport 1. Programmed Cell Death Theory 2. Orgel / Error Theory proposes that there is impairment in the ability of the “the error catastrophe theory of aging” cell to continue dividing as cell's age various changes occurs naturally in its "Apoptosis" DNA and RNA Hayflick phenomenon/human fibroblast replicative proposes that error can occur in the transcription of senescence model: the cell's inability to further divide the synthesis of DNA and triggers apoptosis sequence of programmed cell May lead to aging or death of a cell death - British chemist - Programmed cell death is part of the normal - As cell age they accumulate error which causes cells developmental process to die and randomly induced events which leads to - Cells divide until they can no longer divide which can cellular damage ; radiation by x-ray lead to organ dysfunction - Error lead to aging 2. Programmed theory of Aging 3. Wear and Tear Theories Gene/Genetic/Biological Clock Theory Attributing aging to the repeated use and injury of proposes that animals and humans are born with a the body over time genetic program or a biological clock that proposes that cells wear out through exposure to predetermines the life span internal and external stressors, including trauma, cell has a genetically programmed aging code that is chemicals, and buildup of natural wastes. stored in the organism's DNA - Compares body to a machine, parts of the machine - All animals and humans are born in genetic program would wear out which predetermined the age - Effects of aging caused by damage done to body - Internal biological clock, genetic influences which overtime would predict cause and age of death - Wear out due to use and can no longer function 3. Neuroendocrine & Neurochemicals Theory 4. Cross - Linking Theory / Connective Tissue Theory aging is the result of changes in the brain and proposes that as cells age, biochemical reactions endocrine glands create strong bonds of cross linkages. between believes that neural and endocrine changes trigger proteins. cellular and physiologic aspects of aging primarily involves collagen - loss of elasticity. changes in the hormone secretion, such as the stiffness releasing hormones of the hypothalamus and the responsible for the ultimate failure of tissues and stimulating hormones of the pituitary gland organs - Estrogen, growth hormone and melatonin - Neuroendocrine lack of energy, decrease in metabolism , poor vascularity - Slow reaction to accept process and react to commands ; “behavioral slowing”  the older adult must come to terms with the reality of 4. Immunologic/Autoimmune Theory his life retrospectively - Unconsciousness : private feelings surrounding proposes declining functional capacity of the immune significant events system as the basis of aging - Older adult realizes that life provides series of (immunosenescence-age related decrease in choices ; many older adults have state of function) contentment thymus gland and bone marrow-affected by the - Retrospectively : self reflection of past events adapt aging process to physical decline and loss of significant others focus on the role of thymus gland, the weight and size of the thymus gland decrease with age as thus 2. Psychosocial Developmental Task the body's capability for T-cell differentiation (Erik Erikson) ("thymic involution") - Immunocompetence declines with age primary task of old age is being able to see one's life - Immunocompetence to immunosenescence as having been lived with integrity - Thymus gland and bone marrow most affected part In the absence of achieving the sense of having lived - As people age they develop autoimmune disorders well, the older adult is at risk for having preoccupied and susceptibility to diseases, infection, cancer with feelings of regret or despair - “Ego integrity vs despair” Metabolic theory of Aging/Caloric Restriction - Integrity ; sense of wholeness & wholeness , accepting death is a natural part of life it has been demonstrated that caloric restriction - Despair : sense of worthlessness, make wrong extends lifespan by delaying the onset of age - decisions there is fear of death related diseases two hallmarks : modulation of mitochondrial activity ROBERT PECK’S and a decrease in oxidative damage THEORY - Most successful intervention that would extend life span of person A. Ego differentiation vs Role preoccupation - Delays aging progression and delays onset of age ➔ to develop satisfaction from oneself as a related disorders person rather that parental and occupational role PSYCHOLOGICAL It is finding ways to affirm self work outside work , THEORIES before one reaches retirement they should develop varying activities and interests to affirm self worth Focus on behaviour and attitude changes that even after retirement accompany advancing age B. Body transcendence vs Body preoccupation - Biggest assumption the development does not end ➔ to enjoy life in the face of physical as they reach to adulthood it remains throughout the discomfort associated with aging lifespan Transcendence viewing oneself more than the physical body will be able to tolerate pains, 1. Personality Theory/Theory Of Individualism discomforts , establish meaningful relationships and creative activities, psychological pleasure, developing Jung defines personality as being composed of an interest, favorite music rather than being observed in ego or self-identity with a personal and collective physical limitations unconsciousness C. Ego transcendence vs Ego preoccupation “individuation"- is a journey of self-exploration and ➔ to achieve satisfaction through the inner discovery reflection on one’s past life and last stage of life is a time of looking backward rather accomplishment rather than be preoccupied than forward with the finite number of years left to live Going beyond oneself thinking of future generations rather than their death  2. Activity Theory The direct opposition to the disengagement theory 3. Human Needs Theory (ABRAHAM MASLOW) People need to be active if they are to age ➔ Needs are prioritized such that more basic needs like successfully physiological functioning or safety take precedence By remaining active, the older people stays young over personal growth and lively and does not withdraw from society - Motivation theory in psychology which motivates because of age parameters human behavior - People who achieve optimal age stay active - Before any higher level needs start at the most basic satisfying age level they must be satisfied first before going to the - By staying active delays next level - Maintenance of regular activities 4. Robert Havighursts’s Theory 3. Continuity Theory later maturity is Havighurst’s term for older adults Dispels both disengagement and activity theory 6 specific tasks for older adults Proposes how a person has been throughout life is ○ adjusting to decreased physical strength how that person will continue to be through the and health remainder of life ○ adjusting to retirement and reduced income As people age they try to maintain or continue ○ adjusting to the loss of a spouse previous habits, preferences, values,belief ○ establishing a relationship with one’s age - Kung ganyan before, ganyan ka na all throughout group - If used to eat a lot it will remain until you go old ○ adapting to social roles in a flexible way establishing satisfactory living arrangements 4. Subculture Theory - Adjust to physical health, retirement, reduced income Views older adults as unique subculture within society SOCIOLOGICAL Formed as a defensive response to society’s negative THEORIES attitudes and the loss of status that accompanies ➔ Focuses on the changing roles and relationships of aging older adults to the environment and the environment - Cultural group in a large culture , to the older adult - Growing awareness not a social category but a social - Relates to various social relationships group with a common beliefs and issues which separates them 1. Disengagement Theory - Response to ageism Views aging a process in which society and the - Older adult are accepted and more comfortable with individual gradually withdraw from each other to their age groups the mutual satisfaction and benefits of both ○ Individual- freed from societal roles & focus 5. Age Stratification Theory on themselves Society is stratified into different age categories that ○ Society -orderly means of transferring of are the basis for acquiring sources, roles, status, and power/role old to young deference from others in society - Leave their role in the society Age cohorts are influenced by the historical context - Maintain social balance in which they live - Benefits both society and older adult - Society is stratified into age categories - Older adults are happy when their societal roles - People in similar age groups have similar experiences diminish and gradually withdraw - Age cohort group of people bonded together - Free from any societal roles and responsibilities - Reflect with their life accomplishments 6. Person-Environment-Fit Theory ➔ Proposed that the capacity to function in one’s environment is an important aspect of successful aging ➔ Functional competence is affected by ego strength, 2. Theory of thriving motor skills, biologic health, cognitive capacity, and Thriving- ongoing process of growing through sensory-perceptual capacity continuous human environment interactions, ➔ Modifications in homes or residential settings can resulting in social, physical, and psychological support independence resilience and growth - The performance of desired activities when an 3 interacting factors in thriving continuum- the appropriate match between the persona and person, the human environment and nonhuman environment are compatible environment - Interaction between individuals and environment Thriving is achieved when the 3 factors are in where they affect each other concordance - “Lawon” proponent Failure to thrive occurs when there is discordance between the individual and his or her environment or 7. Gerotranscendence Theory relationships Aging entails a transition from rational, - Person : complex social, physical, psychological materialistic perspective to a cosmic and - Human en: internal and external ,values beliefs transcendent vision - Non human en: physical and ecological surroundings They are less concerned with their physical bodies, - Achieve then they are mutual engagement with 3 material possession, meaningless relationship and factors self-interest - failure to thrive : discordance = inability to find A life of more significance and a greater connection meaning in one's life , problems in social relations, with others social and cognitive functions Accepting impending death without fear - Thornstamp 3. Theory of Successful Aging - Newest theory Integrates Roy Adaptation Model with the - Transition to oneness with the universe gerotranscendence theory and other aging - Successful transformation ; acceptance of death with literature no fear Successful aging is not only about the older adult’s SOCIOLOGICAL THEORIES physical and mental, and spiritual well being but also NURSING THEORIES self-appraisal OF AGING Flood hypothesizes that people with high level of personal control and positive affect will experience 1. Functional Consequence Theory higher level of wellness in aging Theory for promoting wellness in older adults Nurses can aid older adult to achieve high level and Integrate theories from aging and holistic nursing personal control over their lives to achieve positive Promote “WELLNESS” as a nursing diagnoses to view of their lives. foster a sense of value and dignity - Sister callista roy MANAGEMENT: - Man as biopsychosocial being adapting to external ○ Nursing roles is risk reduction internal level ○ to minimize age-associated disability in - Whole individual order to enhance safety and quality of living - Not only successful aging in physical , self appraisal, - Needs that are unique to older individuals self analysis - To maintain maximum care to related to age related - Positive mindset ; having positive view in life greater factors satisfaction as they age - Advocates that nurses promotes wellness - Interconnectedness between body mind and spirit - We provide nursing interventions to provide wellness ASSESSMENT OF to promote positive functional consequences OLDER ADULT TOOLS FOR ASSESSMENT 0.1 BIOLOGICAL ASSESSMENT A. Assessment of Physical Health Pain is common among older patients as a result of B. Functional Status chronic conditions, as well as acute illness, and is 0.2 PSYCHOLOGICAL ASSESSMENT often called the sixth vital sign. A. Cognitive Assessment - Pain is the 6th vital sign ; body is telling something is B. Affective Assessment happening 0.3 SOCIOLOGICAL ASSESSMENT - Challenge when they have dementia tool to help us A. Social Network Assessment assess - Sociological assessment - Socio support network VISUAL SCALE FOR DOCUMENTING - Sociological aspect of an older person PAIN INTENSITY BIOLOGICAL ASSESSMENT A. Faces Pain Scale (FPS) A. Assessment of Physical (General) Health Depicts a series of facial pictures that change with the intensity of pain level, particularly the brow, 01. SICKNESS IMPACT PROFILE mouth and eyes 02. PAIN ASSESSMENT - Evaluate overall health and well being of older adult 0.1 SICKNESS IMPACT PROFILE A 136-item behaviourally-based, health status questionnaire To evaluate effect of diseases on physical and - The Wong-Baker Faces Pain Scale emotional functioning - Pain in children - Sample in community center adults show good validity - Series of facial expressions change in the intensity of pain level B. Visual Analog Scale (VAS) Provide a numerical rating of pain, usually on a scale from 0 to 10, with being the worst possible pain and 0 representing no pain at all - 12 categories - Yes and no responses - NO = ZERO , no physical changes - YES = 1 POINT - 100 = poor health status major impact of the illness - Validated subjective - Evaluate the effect of the present of the disease in - Choose the best score they feel emotional and physical functioning - Showing the visual analog ; - Impact of the disease in the functioning of older adult - Used to older adults with dementia and difficulty in - Higher the number it will determine the impact communicating B. Functional Status 0.2 PAIN ASSESSMENT 0.1 GET UP AND GO TEST 0.2 KATZ INDEX OF ADL 0.3 FANCAPES - Ability of the person to perform normal tasks that are required for living - Objective data since it can observed - Decline or improvement of health status - THE ADL - IALD : instrumental - activities needed to live independently , transportation, medications, management of their finances 0.1 TIMED UP AND GO TEST A simpler measure of gait and balance is the “get up and go” test, which can be completed in a couple of minutes. Mobility,balance, risk for fall assessment Timer used in the test to go and the client will stand - Independence ; 1 full function highly and walk from the chair 10 meters away then go - Dependence ; 0 back to the chair and sit down - 6 = fully functional highly independent With walking assistant devices for walking - 4 = moderate impairment needs assistance If need assistance when walking : not recommended - 2 or less = severe functional impairment highly for them dependent Used regular footwear Result INSTRUMENTAL ACTIVITY OF DAILY LIVING ○ 10 seconds or less - normal mobility SCALE (IADLS) ○ 11 - 20 seconds : within normal limits for Represent a range of activities more complex than frail, for disabled clients self-care task ○ >20 seconds : person needs assistance One that measure complex activities such as: needs further eval ○ Using telephone ○ >30 seconds : prone to fall ○ Shopping ○ Preparing food 0.2 KATZ INDEX OF ADL ○ Housekeeping ○ Doing laundry The Katz Index of ADLs (Katz et al.,1963) is a ○ Using transportation well-known, widely used clinical and research ○ Taking medication instrument used to assess ability to perform ○ Handling finances self-care. More complex activities  person is preparing the food, presence of visual and neurological impairment interfere with the person’s ability to prepare - Communication : sending and receiving verbal and non verbal communication, sight and sound acquity, tongue , larynx , pharynx, read, write spoken language - Activity : ability to ambulate ADLS, coordination and balance - Pain : physical pain, mental. Spiritual pain , anxiety produce pain take note where pain is from , pain in terms of a loss of loved one - Elimination : bowel and bladder, urine and stool , urinary continence, constipation , protective garments, medication that affect eli - Social Skills : socialization , ability to form friendships,ability to negotiate with the society PSYCHOLOGICAL ASSESSMENT A. Cognitive Assessment - 0-8 0.1 MINI MENTAL STATE EXAM (MMSE) - Lower the score = higher level of dependence 0.2 MINI COG TEST - Identify adults who needs help - depression, dementia; decrease quality of life, cognitive and affective should be independently 0.3 FANCAPES assessed because they may be associated with one another Focuses on physical functioning and evaluates the individual’s ability to meet his or her needs and how 0.1 MINI MENTAL STATE EXAM (MMSE) much assistance is needed to meet the needs. F- fluid The Mini-Mental State Examination (MMSE) is the A- aeration (oxygenation) most widely used brief screening instrument to N- nutrition detect cognitive impairment. C- cognition, communication - used to test cognitive function, memory, attention, A- activity/abilities language, visual, spatial P- pain - quiz 17 item E- elimination - detect cognitive impairment and function S- skin/socialization - Orientation: what day , time - Evaluates frail elderly - Memory :2 simple objects within his or her - FLUID : hydration status ability of the person to surroundings obtain adequate fluids independently, any - Maximum score of 30 medications they are taking which affects their intake - Objects and identify , follow the drawing below and output Classification - Aeration : oxygen exchange , respiration status, rate No cognitive impairment : 24 - 30 and depth when they are performing activities, Mild cognitive impairment ; 18-23 breath sounds, medications given to them to their Severe cognitive impairment ; 0-17 condition 23 or less = dementia , Schizophrenia - Nutrition : height and weight BMI , type , amount of food older adult is consuming , dentures, gums and the teeth, affect nutrition , alterations in diet related to culture, economic resources , know and worth the  - 1st element “3 word recall” ; repeat 3 unrelated words you mentioned - 2nd element “Clock drawing test “: provide piece of paper - Examiner mention 3 unrelated words ; ask older adult to recall ; test short term memory 1st signs of dementia , challenges their memory after doing clock drawing test - Proceed to clock drawing test ○ test verbal understanding turning words into actions ○ visual memory ; remembering what a clock looks like; ○ planning and understanding drawing takes planning ○ testing the abstract thinking ; how they understand 10 past 11 0.2 MINI COG TEST A brief, cognitive screening test that is frequently used to evaluate cognition in older adults in various settings. - Instruct older adult to draw clock, showing a specific time - 10 past 11 ; verbal understanding , turning words into action, visual memory remembering what a clock - Tool for assessing whether someone is showing looks like, difficult to remember what a clocks look signs of dementia , alzheimer’s like, planning, abstract thinking 10 past 11 how to - Cognitive, thinking ability, draw longhand and shorthand HOW TO EVALUATE SOCIOLOGICAL ASSESSMENT Remembered 3 words = Negative for cognitive impairment A. Social Network Assessment Remembered 0 words = positive for cognitive 01. LUBBEN SOCIAL NETWORK SCALE impairment - Social interaction network, environmental safety Remember 1-2 words plus normal clock drawing = negative for cognitive impairment 0.1 LUBBEN SOCIAL NETWORK SCALE Remember 1-2 abnormal clock drawing test = positive for cognitive impairment This measure is a questionnaire to assess the type, size, closeness, and frequency of contacts in a B. Affective Assessment respondent’s current social network. 0.1 GERIATRIC DEPRESSION SCALE 0.1 GERIATRIC DEPRESSION SCALE The Geriatric Depression Scale is widely used by nurses to assess symptoms of depression - gauge social isolation, differentiate isolated vs non isolated - Available range of support available to the adult - Lowest score = 0 - highest score = 5 - Find the sum of all the items - Higher score= more social engagement 0-60 - Lower score= degree of isolation - Asses depressive symptoms Administration Best Practices : - 30 questions answerable with yes or no - 1 point for either yes or no ❖ DO NOT: INTERPRETATION Use the word “test” or “memory” ○ 0-9 : normal ○ Instead: “We’re going to do ○ 10-19 : mild depression something that requires some ○ 20-30 : severe depression concentration” - The group who has the highest depression and Never use the words “dementia” or suicide are males “Alzheimer’s disease” Allow patient to give up or prematurely skip questions Deviate from standardized instructions Offer multiple choice answer  Be soft on scoring Older patients may have traditional health beliefs Never use the words “dementia” or “Alzheimer’s and behaviors disease” Culture affects all dimensions of health and Screening tools are not diagnostics well-being , so nurse must consider patient's culture AVOID: when delivering nursing care Being unnecessarily wordy - To provide proper nursing care Over explaining or rationalizing the process DO: CULTURAL COMPETENCE Focus on health and well being Smile and relax the ability of the nurse to effectively deliver health “Test or memory” : cause anxiety or fear care services that meet the social, cultural, and Allow give up ; for them to cooperate linguistic needs of patients. Use brief simple sentences - Set of cultural behaviors and attitudes integrated to the professionals to be able to work competently in CULTURE & diverse cultural settings ADULT CARE - Example : discussing food preferences,share in prayer with the older adult, not judging or disregarding their - Increasing population of adult diverse culture belief - Plays impact on overall health status; affect how we STAGES provide care to older adults CULTURAL COMPETENCE - Culturally competent 1st Stage : ETHNOGERIATRICS UNCONSCIOUS INCOMPETENCE Component of geriatrics that consider the influence common to beginning nurses, assumption that of ethnicity, and culture on the health and well-being everyone is the same care to culturally diverse of older adults patient populations. - Ethnicity : state of belonging to a social group with - assumption that everyone should be provided with same cultural group the same care - Healthcare for older adult from diverse cultural or 2nd Stage : ethnic background CONSCIOUS INCOMPETENCE ETHNOGERONTOLOGY nurse begins to understand the vast differences between patients from many cultural backgrounds, process the study of aging and population groups in but lacks the knowledge to provide competent care reference to race, national origin, and cultural - starting to obtain knowledge about different cultures practices. where you are going to provide proper intervention - Health practices, values and beliefs 3rd Stage : - To avoid assumptions, prejudice, bias to older adults CONSCIOUS COMPETENCE from different ethnicity knowledge regarding various cultures is actively CULTURE obtained, but this knowledge is not easily integrated into practice, because the nurse is somewhat the sum total of the way of living uncomfortable with culturally diverse interventions Includes set of norms, values, beliefs and attitudes - knowledge is actively obtained but not practiced is that shapes and influences perception and behavior not integrated , uncomfortable with culturally diverse Why consider culture? interventions Cultural group differ in their explanations of disease and treatment including what is the proper, preferred and effective treatment  4th Stage : What does your culture/religion teach you about UNCONSCIOUS COMPETENCE aging? Naturally integrate knowledge and culturally FACTORS TO INCREASE CULTURAL appropriate interventions COMPETENCE - naturally integrated practice and knowledge; automatically providing culturally congruent care to A. Awareness patients B. Knowledge ACCULTURATION C. Skills 1. AWARENESS degree to which individuals have moved from their original system of cultural values and beliefs toward a conscious effort to recognize the bias we express in a new system our interactions with others - acquires, adjust and adapts to new environment Openness and self-reflection - acquire the culture of new environment Cultural awareness CULTURAL ACCULTURATION - Increase one's awareness should have openness and self reflection blending of two distinct culture through long periods - Cultural awareness= sensitive about differences that of interaction exists between culture ,your perception of illness and - outcome of acculturation, long periods of interaction, treatment are different from them complete adaption of new culture, rejection of the old identity 2. KNOWLEDGE Steps in becoming understanding of culturally health related values, Culturally Competent beliefs and behavior "older adult's attitudes toward caregiving, decision identification of cultural biases making and death ritual Acquire knowledge regarding population-specific, - Increase knowledge by becoming familiar health related cultural values, beliefs and behaviors Explore disease incidence, prevalence and mortality 3. SKILLS rates among cultural groups Cultural history Communication skills Acquisition of cultural competence Cultural skills - Examine first your personal beliefs and impact of it in Cross - cultural skills the professional practice ○ ability to develop plan of actions and - Equip knowledge on particular culture negotiate an outcome - Common disorders in cultures - Mutual respect between the nurse and elderly Sample Cultural - Working with them the elderly History Question - Active listening, observe non verbal communication 80% of communication is non verbal In what country were you born? - Cultural skills : ability to explain your perception How long have you been in this country? without judgment acknowledging the differences What language did you first learn to speak? - Cross cultural skills - plan of action that would take What language is used at home? both perceptions into account How do you identify yourself (ethnic/racial background or culture)? What is the role of spirituality, faith or religion in your life? What customs or traditions are important to you?  TOOLS TO OBTAIN INFORMATION IN A - To develop personalized span of care CULTURALLY SENSITIVE MATTER - Demographics ;regional , age, sex - Ideas ; explain their ideas on concepts of health and The Explanatory Model of illness : Kleinman and illness associates - Views ; treatment preference, treatment avoidant The LEARN Model : Berlin & Fowkes practices - Expectations ; what are their expectations for their The Explanatory Model For Culturally Sensitive healthcare provider Assessment - Religion ; can affect the provision of care - Speech ; identify health literacy needs - Environment : identify home environment ; schedule, home activities 3 Prominent Health Care Belief System three theoretical belief categories Beliefs about health, disease causation, and appropriate treatment are grounded in culture 1. MAGICORELIGIOUS THEORY (Personalistic System) Health, illness, and effectiveness of treatment are believed to The LEARN Model be caused by the action of a higher power Health is viewed as blessing or reward Illness as punishment for breaching rules, breaking a taboo, displeasing the source of power View illness as possession by an evil spirit Beliefs about illness and disease caused by wrath of God (Pentecostal and Fundamental Baptist Church) Examples of magical causes of illness: ○ Voodoo : Caribbean ○ Hexing or Spell : African, Mexican American ○ Gaba : Filipino Treatment: praying, meditating, fasting, wearing of amulet - Framework for cross cultural communication - Gods, deities , no human - Taboos : eating porks , displeasing the source of D-I-V-E-R-S-E power A Mnemonic for Patient Encounters - “If it's god’s will i will recover” - “ there is a purpose for everything” D - emographics I - deas (health and Illness) V - iews of healthcare treatments E - xpectation R - eligion 2. BALANCE and HARMONY THEORY S - peech (Naturalistic/Holistic System) E - nvironment  HISPANIC/LATINO holds that the forces of nature must be maintained in balance or harmony Older adults are held in high esteem. Stems from ancient civilization of China, India and Old age is viewed as a positive time in the life of the Greece older adult. Health as a sign of balance - Accomplished many things in older adults illness result from disturbances in balance or - Care for them is provided by the extended family disharmony NATIVE AMERICAN - human life is one aspect of life that must be balance with nature traditionally, elders are respected - Physical, mental, emotional and spiritual aspect they assume roles as teachers and caretakers of the young must be in balance to be healthy p - Illness results in the imbalance or disharmony of the CHINESE individuals nature INTERVENTIONS : restore balance and harmony the tradition of "filial piety" ○ balance between "Yin and Yang" : the value of total respect for the family, especially Traditional Chinese Medicine the elders. ○ Hot and Cold theory" : Hispanic - Oldest son has the obligation towards the family and Background expected to care for older parents ○ Ayurvedic medicine : India - Excess heat treatment is cold VIETNAMESE - Mother who given birth warm blankets & food , childbirth is cold condition older adults are highly respected - Personalized care plan carriers of tradition, knowledge, and wisdom. the leaders and decision makers in the family and 3. BIOMEDICAL or often sought for advice WESTERN PERSPECTIVE - Age is an asset and not a reliability - Sought advice for problems Life and life processes are controlled by physical and biochemical processes KOREAN Health is the a state of optimal functioning as well as the absence of the disease value filial piety Illness is caused by germs, bacteria, viruses, or a children are taught to respect older adults whether breakdown of the human machine (the body) they are right or wrong Treatment: medical interventions (medications, - Sons are inheriting family business medical procedures, surgery) - 2 family holidays ; 60th and 70th birthday DIFFERENT CULTURAL VIEWS OF OLDER ADULTS BLACK / AFRICAN AMERICAN Older adults are respected and obeyed To survive to old age is often considered an accomplishment Grandparents are involved in the support and care of their grandchildren. - Achievement when they grow old - Grandmothers involved with their grandchildren