NCMB314 Care of Older Adults Prelims PDF

NCMB314LEC | CACTUS KLX WEEK 1: CONCEPTS AND PRINCIPLES IN THE CARE OF OLDER ADULTS French women lived for 122 years (1994) GERONTOLOGY Factors that affect life expectancy: I...

NCMB314LEC | CACTUS KLX WEEK 1: CONCEPTS AND PRINCIPLES IN THE CARE OF OLDER ADULTS French women lived for 122 years (1994) GERONTOLOGY Factors that affect life expectancy: Is the broad term used to define the study of aging and/or the aged Improved Sanitation Advances in Medical care “Gero” – old age “Ology” – study of Implementation of preventive health services. o Older Age Group: § Young old – ages 65-74 CENTENARIANS § Middle Old – ages 75-84 Predominant in lower educated, more impoverished, widowed and more disabled § Old Old – 85 and up. populations. Weight less, take fewer medications, have fewer chronic diseases. GERONTOPHOBIA Feminization of Later Life Fear of aging Women comprise 55% of the older population Inability to accept aging adults in the society. Women have a longer life expectancy AGE DISCRIMINATION The average life expectancy of women in the United States is 81 years Emotional prejudice among the older adult. The average life expectancy of men in the United States is 75.2 years AGEISM The sex ratio changes Dislike of the aging and older adults. o 65-74 age group GERIATRICS § 100 females: 86 males Generic term relating to the aged, but specifically refers to medical care for the aged. o 75-84 age group GERONTOLOGICAL NURSING § 100 females: 72 males The aspect of gerontology that falls within the discipline of nursing and the scope of o 85 and older nursing practice. § 100 females: 49 males CLASSIFICATION OF GERIATRICS SITUATION OF OLDER ADULTS IN THE PHILIPPINES Young old A. The number of older people is growing ○ 65-74 y/o Elderly are expected to be compromised 7.7 % of total population in 2025 Middle old Life expectancy for both sexes is 68.5 years ○ 75-84 y/o For male it is 65.3 years and 72.0 for female (WHO 2017) Very old frail elderly Total population as of 2017 was 104, 256, 076 (WHO) ○ 85 and above B. Older people need care and support DEMOGRAPHICS OF AGING It increases the demand for health care services (DOH) LIFE EXPECTANCY: They suffer from both degenerative and communicable diseases US: 75.7 years old Leading cause of morbidity are infections Life Span: 115 years NCMB314LEC | MR. EDWIN MALIC 1 NCMB314LEC | CACTUS KLX C. Older people are struggle with poverty C. Wear and Tear Theory 31.4 % were living in poverty (DSWD) Cells wear out and cannot function with aging. more than half of older people are unemployed Like a machine which losses function when its parts wear off more males were employed 63.6 % than women 37.4 % majority of those D. Connective Tissue Theory / Cross link theory employed were involved in primary economic activities such as farming, With aging, proteins impede metabolic processes and cause trouble with forestry work, and fishing (NSO 2000, special report on senior citizens, getting nutrients to cells and removing cellular waste products. Manila) II. NON-STOCHASTIC THEORIES OF AGING Impact of Aging Members In the family Based on the genetically programmed events that cause cellular damage that Sadness accelerates aging of the organism Resentment A. Programmed Theory Relationship Cells divide until they are no longer able to and this triggers apoptosis or cell Work death. Self-time Shortening of the TELOMERES – the distal appendages of the chromosomes arm. WEEK 1: THEORIES OF AGING AND ITS NURSING IMPLICATIONS B. Gene/ Biological Clock Theory BIOLOGICAL THEORIES OF AGING Cells have a genetically programmed aging code. I. STOCHASTIC THEORIES C. Neuroendocrine theory Based on random events that cause cellular damage that accumulates as the Problems with the hypothalamus -pituitary-endocrine gland feedback system organism ages causes disease. A. Free Radical Theory Increased insulin growth factor accelerates aging. Membranes, Nucleic acids and proteins are damaged by free radicals which D. Immunologic/ Autoimmune Theory causes cellular injury, Aging is due to faulty immunological function, which is linked to general well- Exogenous Free radicals: Tobacco smoke, Pesticides, organic solvents, being. Radiation, ozone and selected Medications Health Teaching: THEORIES OF AGING ○ Decrease calories to lower weight PSYCHOSOCIAL THEORIES OF AGING ○ Maintain a diet high in nutrients using antioxidants Attempt to explain aging in terms of behavior, personality and attitude change. ○ Avoid inflammation 1. SOCIOLOGICAL THEORIES ○ Minimize accumulation of metals in the body that can trigger free changing roles, relationship, status and generational cohort impact the older adult’s radical reactions. ability to adapt. ○ Older adults are more vulnerable to free radicals. A. Activity theory B. Orgel/ Error Theory/ERROR CATASTROPHE Havighurst and Albrecht (1953) Errors in DNA and RNA synthesis occur with aging. Remaining occupied and involved is necessary to satisfy late life. Activity engagement and positive adaptation. NCMB314LEC | MR. EDWIN MALIC 2 NCMB314LEC | CACTUS KLX B. Disengagement Theory B. Individualism Theory Cumming and Henry (1961) Jung (1960) Gradual withdrawal from society and relationships serves to maintain Personality consists of an ego and personal and collective social equilibrium and promote internal reflection. unconsciousness that views life from a personal or external C. Subculture Theory perspective. Rose (1965) Middle life crisis (at middle-aged person questions values, beliefs, and The elderly prefer to segregate from society in an aging subculture possible dream and left unrealized) sharing loss of status and societal negativity regarding the aged. as person ages chronologically the individual begins to search answer D. Continuity Theory from being outwardly focused to becoming more inward Havighurst (1960) successful aging also known as Development Theory person looks inward & value him/herself Personality influence’s role and life satisfaction and remains accepts past accomplishment and limitations consistent throughout life 4 PERSONALITY TYPES C. Stages of Personality Development ○ Integrated Erikson (1963) ○ Armored Defended Personality develops in eight sequential stages with corresponding life ○ Passive Dependent tasks. ○ Unintegrated Generativity vs self-absorption or stagnation E. Age Stratification Theory Ego integrity vs Despair Riley (1960) Society is stratified by age groups that are the basis for acquiring D. Life-course/Lifespan Development resources, roles, status and deference from others Life stages are predictable and structured by roles, relationships, F. Person-Environment Fit Theory values and goals. Lawton (1982) Function is affected by ego strength, mobility, health, cognition, NURSING IMPLICATION sensory perception and the environment. Aging and disease do not necessarily go hand in hand. Have a clear understanding between age related changes and those that may be 2. PSYCHOLOGICAL THEORIES pathologic Explain aging in terms of mental processes, emotions, attitudes, motivation, and Among biological theories two concept have gained wide acceptance personality development that is characterized by life stage transitions. o limited replicative capacity of certain cells A. Human needs o Free radical may cause damage to cells Maslow’s (1954) Gerontological nurse can promote health Five basic needs motivate human behavior in a lifelong process o helping smoking cessation (smoking increase rate of cell damage toward need fulfillment. o promotional activity (sun exposure) Self – Actualization NCMB314LEC | MR. EDWIN MALIC 3 NCMB314LEC | CACTUS KLX o to reduce radical damage nurse can advise patient to ingest varied nutritious Health Promotions Strategies diet & supplement with antioxidants such as Vitamin C and E o Avoid solar exposure o Prevention of atrophy of muscle o Dress appropriately for temperature. o Deep Breathing Exercise (increase the flow of oxygen in brain) o Lubricate skin. o daily walking o Maintain safe indoor temperature o encouraging preventive measures (annual influenza) o recognition of stress physical & psychological (music therapy, therapeutic MUSCULO SKELETAL SYSTEM touch, heat and cold application) Loss of bone density. Promote positive self-esteem tasks. loss of muscles strength and size. Nurses need to keep in mind that intellectual functioning remains intact in most older degenerative adults joint cartilage Employing Maslow's theory, the nurse recognizes essential needs must be met Subjective/Objective Data before self-actualization. (patient education will be more successful if patients are o Height loss prone to fracture. well rested) o kyphosis. Planning activities for older adult’s nurses need to remember that all individuals o backpain. enjoy feeling needed and respected. (Reviewing person’s lifetime through pictures o loss of strength, flexibility and endurance. Programs promoting interaction between older adult and young children o Joint pain As eyesight and manual dexterity diminish, many older adults enjoy the opportunity Health Promotion Strategies to cook or work in garden o Exercise regularly, By examining the past and being aware of significant event the health care provides o Eat high calcium diet. deeper understanding on why older adults act the way they do o Limit phosphorus intake. Helping older adult to adjust to limitation while accentuating positive attributes may o Take calcium and vit D supplement enable them to remain independent (family home care) RESPIRATORY SYSTEM WEEK 2: PHYSIOLOGIC CHANGES IN AGING Increase in lung rigidity and elastic recoil, INTEGUMENTARY SYSTEM Increase in residual lung volume. Decreased protection against trauma and sun exposure. Decrease in vital capacity. Decreased protection against extreme temperature. Decrease cough efficiency Diminished secretion of natural oils and perspiration Subjective/Objective Data Subjective/Objective Data o Fatigue breathlessness with sustained activity. o Skins appear thin and wrinkled. o impaired healing of tissue as a results of decrease oxygenation. o complaint of injuries and bruises. o Difficulty in coughing up secretion o complain of intolerance to heat. Health Promotion Strategies o bone structure is prominence, dry skin o Exercise regularly. NCMB314LEC | MR. EDWIN MALIC 4 NCMB314LEC | CACTUS KLX o Avoid smoking. May require vaginal estrogen replacement. o Take adequate fluids to liquefy secretion. Gynecology /urology ff-up; use lubricant when intercourse, pelvic floor exercise o Receive yearly influenza immunization: o Avoid exposure to URTI GENITO-URINARY SYSTEM4 Male: benign prostatic hyperplasia CARDIOVASCULAR SYSTEM Female: relaxed perineal muscles; urethral dysfunction Heart valves become thicker, Subjective/Objective Data Heart muscle and arteries lose their elasticity, o Urinary retention, irritative voiding symptoms Accumulation of Ca and fat deposits, o Including frequency, feeling incomplete Veins become tortuous, o Bladder emptying urgency/frequency syndrome drop of urine lost when cough Less reserve and less response to stress Health Promotion Strategies Subjective/Objective Data o Seek referral to urology, ready access to toilet o Complaint of fatigue with increased activity. o Wear easily manipulated clothing. o Increase heart rate recovery time. o Drink adequate fluids o normal BP < or = to 140/90mmhg Health Promotion Strategies GASTROINTESTINAL SYSTEM o Lifestyle modification, Decrease salivation, o Exercise regularly. Difficulty swallowing food. o weight control. Delayed esophageal and gastric emptying. o avoid smoking. Reduced gastrointestinal motility o eat low fat low salt food. Subjective/Objective Data o BP control. o Complaint of dry mouth. o Medication compliance. o complaint of fullness, o Stress management o heartburn and indigestion. o constipation, flatulence and REPRODUCTIVE SYSTEM o Abdominal discomfort Female: vaginal narrowing and decrease elasticity; decrease vaginal secretion, Health Promotion Strategies slower sexual response o Use of ice chips, Male: decrease size of penis and testes; slower sexual response o mouth wash Subjective/Objective Data o eat high fiber o Female: painful intercourse; vaginal bleeding ff intercourse, delayed orgasm, o low fat diet vaginal itchiness and irritation o Limit laxatives o Male: delayed erection and achievement of orgasm, BPH o Toilet regularly Health Promotion Strategies o Adequate fluid NCMB314LEC | MR. EDWIN MALIC 5 NCMB314LEC | CACTUS KLX NERVOUS SYSTEM SKIN STRUCTURE AND FUNCTION Reduced speed in nerve conduction. Loss of thickness, elasticity, vascularity and strength that may delay the healing Increase confusion with physical illness and loss of environment cues. process and increase the risk of skin tear and bruising Reduced cerebral circulation Loss of subcutaneous tissue causing wrinkles and sagging of skin, which may affect Subjective/Objective Data self-esteem, temperature control and drug efficiency o Slower to respond and react. Loss of hair follicle along with thinning and graying o Learning takes longer. Increase hair density in the nose and ears particular in men w/c may clog external o faintness, ear canal and impaired hearing o frequent falls Thick nails with longitudinal lines Health Promotion Strategies Decrease sebaceous and sweat gland activity which affect thermoregulation and o Pace teaching. decrease sweating o Enhance sensory stimulation. Higher incidence and malignant skin growths o encourage slow rising from resting position Prevention and treatment of dry skin (xerosis) o Take short bath (5-10 mins) SPECIAL SENSES o Use gentle France free cleansers Vision: o Gently pat (rather than rub) the skin to dry o diminished ability to focus on close object, inability to tolerate glare; difficulty o Apply skin moisturizer immediately after drying adjusting to change of light intensity; decrease ability to distinguished colors o Use ointment or cream rather than lotion Hearing: o Skin care products should unscented and alcohol free o Decrease ability to hear high- frequency sounds o If needed, use humidifier to add moisture Taste and smell: o Apply sunscreen o decrease ability to taste and smell o Wear fabrics such as cotton Subjective/Objective Data o Stay hydrated o Vision: Holds object far away from face; complain of glare; poor night vision; confuses color PRESSURE INJURIES o Hearing: Give inappropriate response; Ask people to repeat words; strain Previously referred to as pressure ulcer forward to hear Nutrition and mobility and application of dressing (levin 1992) o Taste: Uses excessive sugar and salts Wound debridement Health Promotion Strategies Preventive Strategies o Vision: Wear eyeglasses; use sunglasses outdoor ;use large print book ;use o Identify the patient at risk for pressure injuries magnifiers for reading o Daily skin infection o Hearing: Recommended hearing examination; enunciate clearly; speak with o Turning the patient low pitch voice; use nonverbal cues Assessment tool for pressure injuries o Taste: Encourage use of lemon, spices and Herbs o Norton Scale, Braden Scale NCMB314LEC | MR. EDWIN MALIC 6 NCMB314LEC | CACTUS KLX Basic principle of pressure injury management TASTE AND SMELL o Eliminate or minimize precipitating factors such as pressure, friction shearing Alteration of smell and taste result from alterations in the oral mucosa and tongue and poor nutrition Decrease reduction in cell number, damage to cell and diminished level of o Provide nutritional support and monitor a clear moist wound environment with neurotransmitter adequate circulation and oxygenation Additionally, recognition of odors declines dramatically with age Taste losses result from disease state of the nervous and endocrine system SENSORY FUNCTION Nutritional and upper respiratory conditions, viral infection and medication Vision Xerostomia (dry mouth) is the most common change in the sense o eyelids lose tone and internal eye o Pupils decrease in size and loses to constrict TOUCH o Health Promotion Involves tactile information on pressure, vibration and temperature § Have an eye examination Sensitivity to light touch diminished in older adult § Be sure to have adequate lightning § Wear sunglass CARDIOVASCULAR FUNCTION § Choose eye healthy food Aging alters CV system both structurally and physiologically § Quit smoking Heart rate decreases § Be active and keep healthy way Left ventricular wall thickens- increase oxygen demand § Chronic disease maintenance Decrease cardiac output and cardiac reserve Hearing and Balance Conduction system o External ear o SA and AV node become fibrotic with age o Middle ear o Common aging changes reflected by ECG o Inner ear- organ of balance Vessel o Age related changes in external ear may be seen in auricle it become larger o Calcification of vessel o Auditory canal narrows o Elasticity in the vessel wall decreases, w/c cause thickening and rigidity o Decrease vestibular sensitivity o Fluctuation in blood pressure o Health Promotion/Illness Prevention Response to stress and exercise § Notify physician of any pain, discharge redness, swelling, dizziness, o Decrease cardiac output and cardiac reserve diminish the older adult ringing in ears or loss of hearing response to stress § See physician for early detection and appropriate treatment of hearing o Reduced stress response affect the body's reaction to exercise difficulties and ear disease o During stress stimulation heart rate increase move slowly, once elevated it § Maintain prescribe hearing aids, assistive listening device and take longer to return medication Risk Factors for CV Disease o Non modifiable § male gender § age NCMB314LEC | MR. EDWIN MALIC 7 NCMB314LEC | CACTUS KLX § Hereditary GASTROINTESTINAL FUNCTION o Modifiable Gingival retraction § Cigarette smoking/ tobacco use Decrease taste buds, decreased sense of smell § Hypertension or on hypertension drugs Decrease volume of saliva § Physical inactivity Atrophy of gingival tissue § Overweight/ obesity Alteration in assessment findings § DM o Loss of teeth, presence of dentures, difficulty in chewing o Diminished sense of taste RESPIRATORY FUNCTION o Dry oral mucosa Ribs become less mobile and chest wall compliance decrease o Poor lifting dentures Increase Rigidity and stiffness of the thoracic cage ESOPHAGUS Increase work of breathing o Lower esophageal sphincter pressure decreased, motility decreased Lung becomes less elastic o Alteration in assessment findings Muscle strength decline with age it becomes more difficult to exert inspiratory and § Epigastric distress expiratory forces § Dysphagia Factors affecting lung function § Potential for hiatal hernia and aspiration o Exercise and Mobility ABDOMINAL WALL o Smoking o Thinner and less taut o Smoking cessation o Decrease in number and sensitivity of sensory receptors o Obesity o Alterations in assessment findings o Anesthesia and Surgery § More visible peristalsis, easier palpation of organs, less sensitivity to Health Promotion/Illness Prevention surface pain o Avoid cigarette smoking and secondhand smoke STOMACH o Avoid environment with air pollutant o Atrophy of gastric mucosa, decrease in blood flow o Avoid allergen o Alterations in assessment findings o Maintain a healthy diet § Food intolerance, signs of anemia as result of cobalamin o Exercise malabsorption decrease gastric emptying o Keep immunization up to date SMALL INTESTINE o Use mask o Slight decreases in secretion of most digestive enzyme and motility o Incorporate stress management activities o Alteration in assessment o Ensure early diagnosis and treatment of resp. tract infection § Complains indigestion, slowed intestinal transit, delayed absorption of o Adhere to medical regimen for chronic respiratory illness fat-soluble vitamins o Maintain clear environment LIVER o Maintain adequate hydration o Decreased size and lower in position o Decrease in protein synthesis, ability to regenerate decreased NCMB314LEC | MR. EDWIN MALIC 8 NCMB314LEC | CACTUS KLX o Alteration in assessment findings PERSONALITY § Easier palpation o Drastic changes in basic personality normally do not occur as one age § Decrease drug metabolism o Excluding pathologic processes, the personality will be consistent with that of LARGE INTESTINE, ANUS, RECTUM earlier years o Decreased anal sphincter tone and nerve supply to rectal area o The alleged rigidity of older persons is more a result of physical and mental o Decreased muscular tone, decreased motility limitations than a personality change o Increase in transit time, sensation to defecation decrease o Changes in personality traits May occur in response to events that alter self - o Alteration in assessment findings attitude, such as retirement, death of spouse, loss of independence, income § Fecal incontinence reduction, and disability § Flatulence, abdominal distention, relaxed perineal musculature o Morale, attitude, and self -esteem tend to be stable throughout the life span. § Constipation, fecal impaction MEMORY PANCREAS o The three type of memory are short term, lasting from 30 seconds to 30 o Pancreatic duct distended, lipase production decreased, pancreatic reserve minutes; long term, involving that learned long ago; and sensory, which is impaired obtained through the sensory organs and lasts only a few seconds o Alteration in assessment findings o Retrieval of information from long -term memory can be slowed, particularly if § Impaired fat absorption, decreased glucose tolerance the information in the consciousness while manipulating other information - COMMON G.I. SYMPTOMS working memory function -is reduced. o Nausea and vomiting o Older adults can improve some age -related forgetfulness by using memory o Anorexia aids (mnemonic devices) such as associating a name with an image, making o Abdominal pain notes or lists, and placing objects in consistent locations o Diarrhea INTELLIGENCE o Constipation o Basic intelligence is maintained; one does not become more or less intelligent o Fecal incontinence with age o The ability for verbal comprehension and CHANGES TO THE MIND o arithmetic operations are unchanged Psychological changes can be influenced by o High levels of chronic psychological stress have o general health status o been found to be associated with an increased incidence of mild cognitive o genetic factors impairment o educational achievement LEARNING o activity and o Although learning ability is not seriously altered with age, other factors can o physical and social changes interfere with the older person's ability to learn, including motivation, attention o Sensory organ impairment can impede interaction with the environment and span, delayed transmission of Information to the brain, perceptual deficits, other people and illness. o Feeling o depressed and socially isolated may obstruct psychological function NCMB314LEC | MR. EDWIN MALIC 9 NCMB314LEC | CACTUS KLX o Because generally a greater problem to learn new habits when old habits 2. PHYSICAL HEALTH exist and must be unlearned, relearned, or modified, older persons with many History and physical examination should include problems common years of history may have difficulty in this area. among older people ATTENTION SPAN Problems with vision, hearing, continence, gait, and balance o Older adults demonstrate a decrease in vigilance performance (i.e. the ability 3. COGNITION AND MENTAL HEALTH to retain attention longer than 45 minutes). They are more easily distracted by Several validated screening tests for cognitive dysfunction (e.g. Mental irrelevant information and stimuli and are less to perform tasks that are status examination) and for depression (e.g., Geriatric Depression Scale, complicated or require simultaneous performance. Hamilton Depression Scale) can be used 4. SOCIOENVIRONMENTAL SITUATION WEEK 3: NURSING CARE OF THE OLDER ADULT IN WELLNESS The patient’s social interaction network, available social support, COMPREHENSIVE GERIATRIC ASSESSMENT resources, special needs and the safety and convenience of the patient’s Is a multidimensional process designed to assess the functional ability health environment are determined (physical, cognitive, and mental), and socioenvironmental situation of older people. Such factors influence the treatment approach used. A checklist can be used to assess home safety. ASSESSMENT CAN HAVE THE FOLLOWING BENEFITS Improved care and clinical outcomes Greater diagnostic accuracy Improved functional and mental status Reduced mortality Decreased use of nursing homes and acute care hospitals Greater satisfaction with care THE PRINCIPAL DOMAINS ASSESSED ARE: 1. FUNCTIONAL ABILITY Ability to do activities of daily living (ADL’s) and instrumental ADLs (IADL’s) ADLs include eating, dressing, bathing, transferring between bed and a chair, using the toilet, and controlling bladder and bowel IADLs enable people to live independently and include preparing meals, doing housework, taking drugs, going on errands, managing finances, and using a telephone NCMB314LEC | MR. EDWIN MALIC 10 NCMB314LEC | CACTUS KLX Clients are scored yes/no for independence in each of the six functions. 9. Do you prefer to stay at home, rather than going out and doing things? Yes No A score of 6 indicates full function, 4 indicates moderate impairment, and 10. Do you feel that you have more problems with your memory than normal? Yes 2 or less indicates severe functional impairment. No 11. Do you think it is wonderful to be alive now? Yes No 12. Do you feel worthless the way you are now? Yes No 13. Do you feel full of energy? Yes No 14. Do you feel that your situation is hopeless? Yes No 15. Do you think that most people are better off than you are? Yes No A score of > 5 suggests depression Total Score Ref. Yes average: The use of Rating Depression Series in the Elderly, in Poon (ed.): Clinical Memory Assessment of Older Adults, American Psychological Association, 1986 GORDON’ 11 BASIC FUNCTIONAL HEALTH PATTERNS OF OLDER ADULT 1. Self-Perception/Self-Concept Pattern A sense of personal identity; body language, attitudes, and a view of self- cognitive, physical, and affective realms; and expressions of sense of worth and emotional state Should be explored with direct questions, asked with sensitivity Emotional patterns can be identified during the exploration of perceptual Any score of 24 or more (out of 30) indicates a normal cognition. Below patterns this, scores can indicate severe (≤ 9 points), moderate (10-18 points) or Subjective: Determine the client’s feelings about his or her competencies mild (19-23 points) cognitive impairment and limitations, withdrawal from previous activities, self-destructive actions, excessive grieving, and increased dependency on others. GERIATRIC DEPRESSION SCALE (GDS) SCORING INSTRUCTIONS Objective: Identify verbal and nonverbal cues related to the above Instructions: Score 1 point for each bolded answer. A score of 5 or more suggests subjective data. depression 2. Roles/Relationship Pattern 1. Are you basically satisfied with your life? Yes No This pattern encompasses the achievement of expected developmental 2. Have you dropped many of your activities and interests? Yes No tasks 3. Do you feel that your life is empty? Yes No Basic needs for communication and interactions with other people, as 4. Do you often get bored? Yes No well as meaningful communications and satisfaction in relationship with 5. Are you in good spirits most of the time? Yes No others are examined. 6. Are you afraid that something bad is going to happen to you? Yes No Subjective: Determine family structure, history of relationships, social 7. Do you feel happy most of the time? Yes No and interactions with friends and acquaintances 8. Do you often feel helpless? Yes No NCMB314LEC | MR. EDWIN MALIC 11 NCMB314LEC | CACTUS KLX Objective: Examine the family dynamics of interdependent, dependent, 7. Value/Belief Pattern and independent practices among members. This pattern encompasses elements of spiritual well-being that the older 3. Health Perception/ Health Management Pattern adult perceives as important for a satisfactory daily living experience and Perceived level of health and current management of any health the philosophic system that helps him or her function within society. problems Subjective: Identify the older adult’s values and beliefs about spirituality, Subjective: Determine the level of understanding of any treatments or with a special emphasis on how this influences health promotion therapy required for management of health deficits or activities; include behaviors assessment of performance of activities of daily living (ADLs) and/or Objective: Determine what is important in the older adult’s life to support instrumental activities of daily living (IADLS) coping strategies Objective: Observe for cues that indicate effective management of 8. Activity/Exercise Pattern deficits, including the physical environment in which the client resides. This pattern encompasses information related to health promotion that 4. Nutritional/Metabolic Pattern encourages the older adult to achieve the recommended 30 minutes daily This pattern encompasses evaluation of dietary and other nutrition-related of physical activity on most days of the week indicators Subjective: Screen for safety related exercises and physical activity, Subjective: Determine the older adult’s description, patterns, and using screening measures such as the physical activity readiness perception of food and fluid intake and adequacy for maintaining a questionnaire (PAR-Q) healthy body mass index. Objective: Obtain vital signs and conduct cardiopulmonary and Objective: Observe general appearance and various body system musculoskeletal system assessments. indicators of nutritional status. Note height, weight, and fit of clothes. 9. Rest and Sleep Pattern 5. Coping/Stress-Tolerance Pattern This pattern encompasses the sleep and rest pattern over A 24-hour This pattern encompasses the client’s reverse and capacity to resist period and their effect on function challenges to self-integrity, and his or ability to manage difficult situations Subjective: Assess usual sleep patterns, including bedtime and arousal Subjective: Assess ways to handle big and little problems that occur in time, quality of sleep, sleep environment, and distribution of sleep hours everyday life. within a 24-hour period Objective Observe for the use of coping skills and stress reducing Objective: Have a client keep a sleep diary that includes naps and rest techniques and note their effectiveness periods 6. Cognitive/Perceptual Pattern 10. Sexuality/Reproductive System This pattern encompasses self-management of pain, presence of This pattern encompasses the older adult’s behavioral expressions of communication difficulties, and deficits in sensory function sexuality Subjective: Inquire about difficulties with sensory function and Subjective: Assess client’s satisfaction or dissatisfaction with current communication, as well as the assessment of any cognitive changes. circumstances related to sexual function and intimacy, including Objective: Assess usual patterns of communication and note the client’s perceived satisfaction or dissatisfaction with sexuality or sexual ability to comprehend experiences. NCMB314LEC | MR. EDWIN MALIC 12 NCMB314LEC | CACTUS KLX Objective: Discuss current sexual relationship. When non is present, o Ostomies or tubes of any kind elicit the meaning this has for the client’s overall emotional and physical o Draining wounds well-being. o After wound debridement or irrigation and debridement of pressure injury 11. Elimination Pattern o Pain Management This pattern encompasses bowel and bladder excretory functions o Intravenous antibiotics Subjective: Assess lifelong elimination habits and excretory selfcare o PIC line routines o IV Chemo Objective: Perform abdominal and rectal examination; external genitalia o Multiple medication or a major medication change and pelvic examination may be indicated o Ventilator dependence o Low air loss bed or other complex medical equipment HOME CARE AND HOSPIECE Consists of multiple health and social services delivered to recovering, chronically ill, HOSPICE AND PALLIATIVE CARE or disabled individuals in their place of residence PALLIATIVE Three main category of home care providers o Therapy aimed to relieving or reducing the intensity of uncomfortable o Home care organization symptoms o Medicare-certified agencies include hospice and free standing HOSPICE o Have a skilled care need o Refer to a particular agency or program o Be homebound (The Philippine Society of Hospice and Palliative Medicine) o Be unable to perform the skilled care alone and have no one in human to Medical care for people with an anticipated life expectancy of 6 months or less, when provide care cure isn’t an option, and the focus shifts to symptom management and quality of life> o Require only intermittent care An interdisciplinary team of professionals trained to address physical, psychosocial, o Facility based home health agencies and spiritual needs of the person; the team also supports family members and other High risk client indicators for home care services intimate unpaid caregivers o Unexpected readmission to hospital within 15-30 days Like palliative care, hospice provides comprehensive comfort care as well as support o Frequent readmissions for the family, but, in hospice, attempts to cure the person’s illness are stopped. o Alteration of health care problems or management Hospice is provided for a person with a terminal illness whose doctor believes he or o Changes in mental status she has six months or less to live if the illness runs its natural course. o Nonadherent behavior before or during hospitalization o Terminal or preterminal condition COMMUNITY BASED SERVICES o Seen in the hospital by physical, occupational or speech therapist. Assessment of functional status aids in determining the type of service needs to o After amputation remain home o After hip or knee replacement A score on a functional status test that indicates impairment does not necessarily o New assistive device indicate the need of institutionalization, but it means older adults need assistance. o Foley Catheter etc. o Enteral or parenteral feeding NCMB314LEC | MR. EDWIN MALIC 13 NCMB314LEC | CACTUS KLX AREA AGENCIES ON AGING HOMEMAKER SERVICES o Older American Act (OAA) of 1965 to remove barriers to independent living Include such things as housecleaning, laundry, food shopping, meal preparation, and for older individuals and to ensure the availability of appropriate services for running errands those in need MULTIPURPOSE SENIOR CENTERS NUTRITION SEVICES o Services includes, health screening, health promotion and wellness Provide older adults with inexpensive, nutritious meals at home or in group settings programs, social, educational, and recreational activities, congregate meals, Congregate meals sites provide meal in group setting (seniors service center) information and referral services o Funded by OAA and agencies such as united way. TELEPHONE MONITORING AND FRIENDLY VISITORS To provide venues for social activities the elderly, the Department of Public Works and Highways (DPWH0 has built five (5) new buildings for senior citizens in Nueva PERSONAL EMERGENCY RESPONSE SYSTEM Ecija. Home monitoring system that allows older person to obtain immediate assistance a Based on Section 4 of RA 7876, all cities and municipalities in the country are small device worn on the body required to establish a senior citizens center with an area of 500 square meters. ASSISTED LIVING ADULT DAY CARE SEVICES Rental housing arrangement that provides room, meal, utilities, and laundry and Most people who use adult day care programs are physically frail cognitively housekeeping services for a group of residents. impaired or both and require supervision or assistance It helps delay institutionalization for older adults who require some supervisions but CHARACTERISTICS OF OLDER ADULT IN ACUTE CARE who do not need continuous care RISK OF HOSPITALIZATION Blessed Home Adult Daycare Assisted Living (Paranaque) o Adverse drug reactions (polypharmacy) inappropriate number of medications Taguig City Center for the Elderly 8am – 5pm FALLS o 79% of all adverse inpatient incidents are related to fall RESPITE CARE o 65 or older experience most fall Provides short term relief or time off for persons providing home care to ill, disabled o 10% fall more than once during hospital stay or frail older adults INFECTION Adult day care services are form of respite provided outside home o UTI is the second most frequent Respite care is often provided at home or institutional settings (hospital, nursing o GI tract infection (risk for colonization and infection w/ antibiotic- facility) resistant strains) May be provided on a regular schedule (4 hours a week) or for longer time intervals HAZARDS OF IMMOBILITY Life Care Residence Philippines o Prone to rapid loss of muscle NCMB314LEC | MR. EDWIN MALIC 14 NCMB314LEC | CACTUS KLX 5 NURSING HOMES IN THE PHILIPPINES FOR DIFFERENT ELDERLY NEEDS o Home Health Care also arranges home and company vaccinations against RAINTREE CARE COVID-19, influenza, pneumonia, MMR (measles, mumps, and rubella), o Known as a “premiere senior residence in the country”, RainTree Care Hepatitis B, cervical cancer, and tetanus. specializes in caring for the elderly with dementia and Alzheimer’s disease, a progressive condition that affects a person’s memory and thinking. RainTree combines Filipino values and German Expertise in geriatric care through the help of Geriatric Care Expert Cornelia Daubenbuechel and her team. LIFE CARE o Life Care, the first and only assisted living facility in the Philippines, incorporates IT in delivering assisted living lifestyle to the elderly. Its team assists seniors in Activities of Daily Living (ADLS), including meal preparations, bathing and grooming, dressing, toileting, and memory care through various programs and activities. It also offers processing of Special Resident Retiree’s Visa for those who want to live permanently in the Philippines. MABUHAII NURSING HOME o Derived from the Filipino word “mabuhay”, a happy greeting to visitors, Mabuhaii Nursing Home welcomes the elderly and their family to experience belongingness within the community. This senior care facility embodies the nurturing character of Filipinos with its variety of services ranging from short- term to long-term care GOLDEN GROVES o Golden Groves Assisted Living provides 24/7 care for the elderlies, especially those who need supervision and rehabilitation. Seniors may also opt to stay at Golden Groves for just a day and then return home through its Adult Daycare service, which will also let elderlies try the services first before committing to long-term stay. Golden Groves is led by two doctors namely Dr. Ross Groves and Dr. Carmichael Fong, who were both trained at Arizona, USA. HOME HEALTH CARE o For some of our dear elderlies, the comfort of home is incomparable. This is why Home Health Care provides house calls with the help of its private duty caregivers (service starts at PHP 1,000 for a 7:00 a.m. to 7:00 p.m. duty), nurses (PHP 1,500), physical therapists (1,100/one-hour session), and doctors (PHP 5,500). NCMB314LEC | MR. EDWIN MALIC 15