Objective 3 2023.pdf

Objective 3: Factors that Influence Health & Wellness Required Readings: Ch 1 (p. 5 – 8), Ch 7, Ch 22 (p. 374 – 379) Health & Wellness The state of complete physical, mental, and social wellbeing and not merely the absence of illness or infirmity Varies and is dependent on culture, & ones percepti...

Objective 3: Factors that Influence Health & Wellness Required Readings: Ch 1 (p. 5 – 8), Ch 7, Ch 22 (p. 374 – 379) Health & Wellness The state of complete physical, mental, and social wellbeing and not merely the absence of illness or infirmity Varies and is dependent on culture, & ones perception More common term today is ‘Holistic Health’, including all aspects of an individual Health In later life is related to functional abilities not just absence of disease. Ability to do what is important to the individual. Includes a person’s strengths, resilience, capabilities & resources- not pathology. This Photo by Unknown Author is licensed under CC BY-SA Striving for an optimal level of health. Wellness Independent of situation e.g. disability, functional ability, illness or terminal illness. Focus’ care on promotion of wellness even if outcome is not going to restore health. This Photo by Unknown Author is licensed under CC BY Growth Potential: Crisis as a Challenge (Fig 1-4) Components of Healthy Aging /Wellness (Fig. 1-3) Touhy, T.A., Jett, K., Boscart, V., & McCleary, L. (2019). Ebersole and Hess’ gerontological nursing & healthy aging. (2nd Canadian ed.). Toronto: Elsevier Canada Wellness: Psychological Self-efficacy, feeling in control of one’s life Taking responsibility for one’s own health Effective coping, health choices Wellness: Biological Age-related physical changes, lifestyle factors & genetics all influence wellness. Health promoting behaviors can modify & promote better physical health. *E.g. smoking cessation & physical fitness Wellness: Social Satisfying roles & relationships. Social support has positive impact on health. Older adults engaging in communities. (volunteering helps dispel ageist attitudes) Wellness: Environment Physical • Including structural living arrangements: e.g. Maintaining safe environment to prevent falls, air pollution. Social • Healthy relationships, effective role transitions. Wellness: Spiritual Spirituality & Religious practices are linked to positive health outcomes with respect to life expectancy, cardiovascular conditions, chronic conditions, disability & mental health. Faith & hope, a search for meaning, a sense of connection with others. Transcends the physical & psychosocial aspects of a person. Helps older adults cope with & understand difficulties in life. Illness & losses often influence older people to become more apt to reflect on religion / spirituality / beliefs. Spirituality & Aging The spiritual aspect of people’s lives transcends the physical & psychosocial to reach the deepest individual capacity for love, hope, and meaning. Nurses must be knowledgeable and respectful of the rites & rituals of various religions, cultural beliefs, and values. Spirituality must be considered a significant factor in understanding healthy aging. Spiritual Nursing Responses Relief of physical discomfort, which permits focus on the spiritual Comforting touch, which fosters nurse–patient connection Authentic presence Attentive listening Knowing the patient as a person Listening to life stories Sharing fears & listening to self-doubts or guilt Fostering connections with others Respecting religious traditions and providing for access to religious objects and rituals Referring the person to a spiritual counsellor Wellness: Cultural Affects health beliefs Health disparities Socio-economic challenges Nurses Role: Demonstrate cultural sensitivity, competence, & proficiency Reducing Health Disparities Stereotyping: • The application of limited knowledge about one’s person with specific characteristics to other persons with the same characteristics • Nurses should be aware of and work to diminish stereotypes. Cultural proficiency: • Ability to move smoothly between the world of the nurse and the world of the patient • Requires cultural awareness, sensitivity, knowledge, competence, & skills Cultural Awareness, Knowledge, & Skills Awareness • Openness and self-reflection; consider whether one holds any personal beliefs about such persons • Recognizing the presence of the “isms” such as racism and ageism Knowledge • Knowledge a nurse brings to a caring situation, what a nurse learns about older persons, their families, their communities, their behaviours, and their expectations Cross-cultural nursing • Developing a sense of mutual respect between the nurse and the older person • Providing the highest quality of care for ethnically diverse elders and enhancing healthy aging calls for a new or refined set of skills • Should come from the viewpoint of working with the patient not on the patient Cross Cultural Caring in Long-Term Care Setting Ensure that residents have access to professional interpreters if needed. Develop programs that reflect the diversity of residents and staff. Employ staff who reflect the diversity of residents or patients. As per the Canadian Gerontological Nursing Competencies (2010), providing relationship care (Standard IV) requires that nurses appreciate the influence of culture on how families and health care providers care in LTC facilities. Health-Illness Continuum A description of the progression of health. Healthy state on one end (high level wellness) with illness states on the other end (illness & death). Most will move back and forth. Older adults have greater tendency to be on the illness end. Personal Health Practices & Coping Skills Health Services Income & Social Status Determinants of Health Biology & Genetic Endowment Social Support Networks Employment Working Conditions Physical Environment Healthy Child Development Education 12 Key Determinants of Health Income & Social Status • Seniors have lowest income compared with other age groups • Especially for women who are unattached, outlive husband, large % didn’t pay into CPP (didn’t work outside the home) • Those with low income have more physical & mental problems than those with more economic resources. • Those with middle to upper incomes are more likely to report excellent to very good health than those with lower incomes. Determinants of Health Social Support Networks • Linked to health, protective factor against depression Education & Literacy • The more educated, the lower prevalence of chronic conditions Employment & Working Conditions Social Environments • Quality of relationships/support Physical Environments • Living conditions Determinants of Health Personal health practices/Coping skills Healthy child development Biology & Genetics Health services Gender Culture Determinants of Health Lalonde report (1974) claimed that socioeconomic, environmental, & biologic factors are equally or more important in influencing health than health care. *Income and poverty have a major impact on health. *In effort to promote healthy aging, nurses must consider the impact of the determinants of health when planning care. Types of Aging Chronological Social Biological Psychological Developmental Theories of Aging Theory Sociological Theories Psychological Theories • An explanation, rationale or hypothesis used to support a particular view. • Attempt to explain and predict changes in roles and relationships in middle/late life, with an emphasis on adjustment. • Presuppose that aging is one of the many developmental processes experienced between birth and death. Sociological Theories of Aging Disengagement Theory: • Time when the older adult & society engage in mutual separation from each other (e.g. retirement). • Disability may impact engagement from others (this is not an expected pattern of disengagement). • Adjustment is key. Sociological Theories of Aging Activity Theory: • Staying active is the key to successful aging. • Research supports that physical activity, staying socially engaged, maintaining productive roles lead to better health outcomes. • (e.g. volunteering) Sociological Theories of Aging Continuity Theory • As a person ages, there is consistency in patterns of behaviour that represents ‘who the person is’. • Continuity is a fluid concept. It doesn’t mean that change doesn’t occur, however, the person is able to adapt to changes of aging, and there is consistency of patterns over time. • Example: Person enjoys decorating is more likely to take up a new activity within the same domain (painting), rather than an activity in another domain (sport). Sociological Theories of Aging Age- Stratification Theory • Society is structured and organized by age groupings. • Specific birth cohorts (i.e baby boomers) have shared historical periods and similar lived conditions/experiences, thus have similar traits. Modernization Theory • Focuses on social changes that have resulted in the devaluation of older adults and their contributions to society. • Prior to industrialization, the older adult was revered for their wisdom and given the highest of status. Due to modernization, the status and thus the value of older adults are lost to society when their labour is no longer considered useful. Psychological Theories of Aging Jung’s Theories of Personality • One of the first psychologists to regard the second half of life as having a purpose of its own – a time for inner discovery, growth, self awareness and reflection. • Suggested a shift from extroverted (oriented to external world) to introverted (oriented to subjective inner world). • During mid life people begin to question their own dreams, values, and priorities. Psychological Theories of Aging Developmental • Erikson’s: The last stage of life • ‘Ego Integrity versus Despair’ • Looking back at your life and feeling satisfied instead of having regrets Gerotranscendence • A gradual move away from a value of a material world to a cosmic world. • Life’s challenges bring about this shift. • Associated with wisdom and spiritual growth. Cognition & Aging Cognition is the process of acquiring, storing, sharing, and using information Cognitive reserve (CR) based upon concept of neuroplasticity Cognitive function includes the following 12 categories: • Attention Span • 2. Intelligence • 3. Learning Ability • 4. Orientation • 5. Problem-solving • 6. Reaction Time 7. Concentration 8. Judgement 9. Memory 10. Perception 11. Psychomotor Ability 12. Social Intactness Normal Cognition & Aging Despite aging changes in the brain & in neuronal activity / transmission – the aging brain remains resilient. Older adults are able to function & compensate. Cognition remains intact – in the area of language, attention span, comprehension. Age associated memory impairment (AAMI). Age associated sensory losses (obj. 10) Basic intelligence remains unchanged For older adults: teaching & new learning is most effective - when connections are related to past experiences and familiar knowledge. Normal Cognition & Aging ‘Use it or Lose it’ is important to maintain brain health and cognitive function. Cognition is enhanced with mental stimulation (neuroplasticity). Memory: • The ability to retain or store information & retrieve it when needed. • Three components (immediate recall, short term memory – minutes to days, & remote/long-term memory • Regular input & exercise of the brain necessary to maintain intact cognitive function • Some researchers believe that the aging brain needs to be regularly stimulated in order to keep cognitive function sharp. Age-Related Cognition Functions (fx) Cognitive fx remains stable • Attention span, language & communication skills, comprehension & discourse, & visual perception. Cognitive skills decline • Verbal fluency, logical analysis, selective attention, object naming & complex visuospatial skills. What do we know about basic intelligence? It remains unchanged with increasing age. Verbal abilities do not change. Limited literacy skills influence learning. Older persons should be provided with opportunities for continued learning. Intelligence & Aging Crystallized Intelligence • Knowledge & abilities acquired throughout life. The knowledge ‘crystallizes’. • Remains stable, older adults are able to learn & acquire new knowledge. • Example: Many older adults are computer savvy, use technology accessing health information. Fluid Intelligence • Related to learning & problem-solving in new situations. • Ability to draw conclusions about complex relationships. • Abstract thinking. • Flexibility in thinking & ability to adapt. • Declines with aging. Intelligence & Learning New learning must be relevant & have some recognizable importance to the older adult. Consider culture, language & education background. Ensure teaching tool is appropriate e.g. printed brochures, computer websites. Assess for readiness to learn, anxiety, past education. Cognitive Stimulation Techniques: •Mnemonics •Cognitive games (chess, scrabble) involves strategy & concentration •Montessori – based activities (often used with dementia) breakdown task into steps, simple to complex, use of repetition, use of external cues Health Literacy The ability to access, understand & act on information concerning health 6 out of 10 adult Canadians do not have proficient health literacy. Consequences: poorer health outcomes. Nursing Implications: Health education materials should not be higher level than grade 5. Use a ‘teach-back’ method (Box. 7.8) Present information in small chunks & then ask the person to restate / explain what they are supposed to do. Social Isolation “A state in which the individual lacks a sense of belonging socially, lacks engagement with others, has a minimal number of social contacts & they are deficient in fulfilling quality relationships”. (Nicholson, 2009, p. 1346) Social Isolation & Aging More senior women live alone than men, longer life expectancy. Men who are alone tend to marry more often. Some seniors chose to be alone. Income reduced. Transportation issues. Age-related sensory changes with hearing & sight make communication challenging. Retirement - some are more disengaged from society. Social Isolation: Risk Factors Ageist attitudes: How? Chronic Illness (e.g. mobility limitations, declining health, hearing loss). Living situation (living alone, children moved away, living in rural areas, institutionalization i.e. LTC). Changes in life roles (e.g. loss of spouse & or significant others). Economic factors (e.g. retirement, loss of network, reduced income). Psychological factors (e.g. depression, substance abuse, lack of engagement in social activities), loneliness perception of disconnectedness. Sexual orientation. Social Isolation: Impact on Health Loneliness Depression, Suicide Illness (e.g. cancer, common cold, heart disease, cognitive decline) Premature death Negative health behaviors: poor diet, smoking, increase in substance use. Events: falls, hospitalizations, rehospitalizations, institutionalization. Overall decline in health: resulting in an increase risk for illness & death. Nursing Strategies: Social Isolation Assessment: (verbal & non-verbal), risk factors? Involve family & significant others. Build relationship with individual. Ask questions to determine how they are feeling, coping with changes or losses, how they describe the quality of their life, relationships with family & friends, their living arrangement. Listen to what is being said, or not said. Take time & show interest in getting to know the person, how he spent his life, commend them on their contributions to family or society. Be respectful & caring Nursing Strategies: Social Isolation Encourage involvement in activities / community, e.g. programs for 50+, volunteering. Intergenerational activities. Pet therapy Technology. Encourage relationships with peers & contact with family. https://www.youtube.com/watch?v=z5a1mNs5HnE Technology & Older Adults Digital health, using smart phone apps or wearable devices to monitor health e.g. B/P, blood glucose, oxygen levels Emergency response devices Cameras: monitor safety by observing quality of care in LTC Social media, virtual video applications Technology & Older Adults Benefits: • Technology enables older adults to age in place • Promotes a feeling of connectedness, thus reducing social isolation even for older adults with limited mobility • Provide speedy information - maintaining healthy lifestyles Disadvantages: • Overuse – technology is not a replacement for human interaction, may increase loneliness / social isolation Barriers • Cost • Lack of guidance (? Ageism) • Lack of knowledge, too complex • Feelings of inadequacy • *Despite this – many older adults have embraced technology