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Senior Health Dr. Meryem ERCEYLAN Contents Global Elderly Population Elderly Population in TURKIYE Culture and Elder Health Health Assessment of Older Adults Environmental Conditions Social Conditions Psychological Conditions Normal Aging Changes to Body Systems Health Promotion for Older Adults Glo...

Senior Health Dr. Meryem ERCEYLAN Contents Global Elderly Population Elderly Population in TURKIYE Culture and Elder Health Health Assessment of Older Adults Environmental Conditions Social Conditions Psychological Conditions Normal Aging Changes to Body Systems Health Promotion for Older Adults Global Elderly Population In worldwide, individuals aged 65 years or older are an important and growing segment of the population. Life expectancy is increasing; thus, larger numbers of people are reaching 65 years of age and older. Global Elderly Population According to the United Nations population estimates, the world population was 7 billion 975 million 105 thousand 156 people, and the elderly population was 782 million 998 thousand 642 people in 2022. According to these estimates, 9.8% of the world population was elderly population. Global Elderly Population Elderly Population in TURKIYE Elderly population became nearly 8 million persons While the proportion of the elderly population in the total population was 8.5% in 2017, it increased to 9.9% in 2022. According to the population projections, the proportion of elderly population was expected to be 12.9% in 2030, 16.3% in 2040 and 22.6% in 2060 Concept of Aging Aging is a natural process that affects all living organisms. The concept of aging is most often defined chronologically. Chronological age refers to the number of years a person has lived The young-old (aged 65 to 74 years), the middle-old (aged 75 to 84 years), the old-old (aged 85 to 99 years), and the elite-old (more than 100 years old) are four distinct cohort groups. Concept of Aging Functional age, on the other hand, refers to functioning and the ability to perform activities of Daily living (ADLs), such as bathing and grooming, and instrumental activities of Daily living (IADLs), such as cooking and shopping. After all, most older adults are more concerned with their functional ability than their chronological age. Assisting older adults to remain independent and functional is a major focus of nursing care. Culture and Elder Health As the older adult population is dramatically increasing in size, so too is it more diverse. Geographic origin, historical events, cohort position, and gender contribute to these cultural differences. Culture and Elder Health Culture refers to shared values, beliefs, and behavior by members of a society that serve as guides for interacting within the family, community, and country. Adherence to cultural values, beliefs, and behaviors is variable based on factors such as age, education, social and educational status, language use of the dominant culture, and setting such as urban or rural. Culture and Elder Health The meanings of health, illness, and health care practices as well as end-of-life issues are imbedded in values, beliefs, and practices of the culture of the older adult. Cultural competence and sensitivity indicate an understanding of the issues related to culture, race, gender, social class, and other factors and encompass knowledge, attitudes, and mutual respect. Health Assessment of Older Adults Many misconceptions surround older adults, especially concerning health and wellness. The truth is that the overwhelming majority of older adults lead independent lives even though they have chronic illnesses and some level of disability. Negative stereotypes of older adults are termed ageism and public health nurses should dispel misconceptions and ageism in their practice. Health Assessment of Older Adults Myths of Aging Older adults cannot live independently. Older adults are not happy. Older adults will have dementia or Alzheimer’s. Older adults are not productive. Older adults cannot enjoy physical activity. Older adults are not sexually active. Older adults refuse change. Health Assessment of Older Adults Overall, health and wellness of older adults are influenced by the individual degree of disability and physical illness, the ability to cope with difficulties, individual resilience and adaptability, and the level of familial and societal support for individual difficulties. Health Assessment of Older Adults It is the responsibility of the public health nurse to be able to assess the health status of older adults and to recommend support services where needed such that the older adults capitalize on their own abilities and minimize their difficulties. Health Assessment of Older Adults Public health nurses must be able to recognize social, psychological, and environmental issues that are more prevalent among older adults. Likewise, public health nurses need to recognize the physical signs and symptoms of normal aging with signs and symptoms that represent disease and injury. Health Assessment of Older Adults When assessing the older adult, public health nurses need to know the various effects environmental, social, psychological, and physical conditions have on the health of older adult populations. Environmental Conditions There are many environmental concerns for the older adult; but the most important are adequate food and housing. First, the public health nurse must assess the ability of the older adult to pay for municipal services that include power, temperature control in the home, running water, food, medicines, and medical supplies. The public health nurse must recognize home safety hazards in the home that would make it easy for an older person to fall such as poor lighting, area rugs, and stairs. Safety concerns including fire hazards and lack of smoke detectors should be noted. The kitchen should be assessed for both safety and function. The public health nurse should note any small appliance in the home that is a potential risk for electrocution or fire. Environmental Conditions Within the living environment, the public health nurse should assess if there is food available and if food can be easily obtained from a local market or delivery service. The overall neighborhood of the older adult should be assessed for safety including the availability of transportation, access to needed services, and nearby neighbors, as well as reported crime and violence rates. Social Conditions Social support systems are vital to the health and wellness of older adults. Social support has been found to be extremely important in aging successfully and in promoting and maintaining overall long-term health by supporting engagement in life and by contributing to physical and cognitive functioning. Conversely, social isolation or disengagement is a risk factor of cognitive decline in cognitively intact elders. Social Conditions The public health nurse must ask about and identify those persons who are available to assist the client and provide social support. The public health nurse must also assess other resources of elders such as financial status. It is necessary then for the public health nurse to ask about and identify the economic status of the older adult and their ability to purchase food, housing, and medical services. Psychological Conditions Older adults who have the opportunity to participate in routine activities, stay involved in meaningful activities, and feel productive in life age successfully and have brighter healthier psychological outlooks than older adults who are limited by multiple debilitating illnesses and physical disabilities that prevent them from remaining active and at home. Psychological Conditions Short-term memory loss is common in older adults, which may affect their psychological health. It is the responsibility of the public health nurse to distinguish normal memory loss from more severe dementia or Alzheimer’s disease. Personal losses of family members and friends can lead older adults to have feelings of despair and depression Sleep disturbances can also contribute to depression. Severe depression is not a result of normal aging. Psychological Conditions Public health nurses should promote successful aging and overall happiness for the older adult client by encouraging older adults to continue physical activities and social engagements with friends and families. Public health nurses need to emphasize to older adults the necessity to maintain adequate nutrition, exercise, and rest along with health care prevention and maintenance Normal Aging Changes to Body Systems Physiologic changes are a normal part of aging. The degree to how quickly these changes occur varies among individuals. All of the vital systems are affected with age including cardiovascular, pulmonary, gastrointestinal, urinary, musculoskeletal, neurological integumentary, reproductive, and special senses Normal Aging Changes to Body Systems Cardiovascular System Coronary artery disease is the most common cause of death in older adults. Blood pressure rises with age, and the overall cardiac reserve diminishes. Arrhythmias, murmurs, and dilation of the abdominal aorta are also more common in older adults, which may lead to chronic cardiovascular disease. Stroke is the third leading cause of death and the number one cause of disability in older adults. Elevated blood pressure is the number one cause of stroke in older adults. Normal Aging Changes to Body Systems Pulmonary System There is a mild decline in pulmonary function including decreased elasticity of alveolar sacs and mucous transport resulting in shortness of breath. However, the majority of pulmonary dysfunction is caused by disease, primarily due to tobacco use, and is not associated with normal agerelated changes to the pulmonary system. Normal Aging Changes to Body Systems Gastrointestinal System Dental changes are the most universal, especially gum disease and tooth loss. Peristalsis slows through the gastrointestinal system, causing constipation, malabsorption, and esophageal reflux. Often, these conditions are caused by poor diets, drug effects, or underlying disease. The liver and pancreas reduce in size, but without disease their function remains adequate. Normal Aging Changes to Body Systems Urinary System Age reduces the peak bladder capacity, and the amount of residual urine increases. The amount of renal blood flow is halved, and the renal tubules are less able to concentrate urine, requiring the kidneys to work through the night when blood flow is increased. Symptoms among women resulting from these changes include nocturia, urgency, and incontinence. Prostatic hypertrophy is common among males resulting in nocturia, decreased urinary stream, and urinary hesitancy. Normal Aging Changes to Body Systems Musculoskeletal System There are many significant musculoskeletal changes that occur with aging. Muscle mass decreases by 30 percent leading to decreased strength and endurance. Normal aging also can result in slow foot reaction time The hands may be affected with the fingers loosing strength and the ability to grasp objects. Osteoporosis is the leading cause of musculoskeletal disability in women. Women older than age 60 should be screened regularly for bone density loss Sarcopenia is the normal loss of muscle mass and affects both men and women. Normal Aging Changes to Body Systems Neurological System Neurological changes can be profound causing numerous changes in function. The most important functional changes cause swaying when going from a sitting to standing position and the inability to stand without swaying with eyes closed. Some medications for cardiovascular disease and elevated blood pressure may enhance these types of side effects. Dehydration may also cause dizziness. Neurological symptoms should be assessed carefully examining medications and nutritional status. Normal Aging Changes to Body Systems Integumentary System Perspiration decreases, and then the skin becomes cool and dry. The skin has increased pigmentation, increased cherry angiomas, and wrinkling. Older adults become more susceptible to skin cancers. The hair becomes thinner and gray. Nails thicken and develop ridges. Normal Aging Changes to Body Systems Reproductive System: For post menopausal women, the ovaries and uterus atrophy. Vaginal secretions become scant, the vaginal mucosa becomes thin and friable resulting in painful intercourse and the need for lubrication, pubic hair decreases, and the breasts become more pendulous. Women may experience complaints with menopausal symptoms such as hot flashes, night sweats, and mood fluctuations. For older men, the prostate enlarges, while the size of testes decreases, and pubic hair thins. Sexual activity does put older adults at risk for developing sexually transmitted diseases and HIV infections, and older adults should be counseled in prevention Normal Aging Changes to Body Systems Special Senses: Beginning around 40 years of age, near vision changes, making it difficult to see objects at close distances. The most common complaint is the need for reading glasses. Light that is able to enter the eye decreases due to reduced pupil size, yellowing to the lens, and opacification of the lens. These changes result in the inability to discriminate blue from green, inability for the eye to adjust from a lighted room to a dark room, and sensitivity to glare. The most common complaint is difficulty in driving at night due to “night blindness.” Excessive opacification to the lens is considered a cataract, which may require surgical removal. Normal Aging Changes to Body Systems Special Senses: High-frequency hearing loss, called presbycusis, is common among older adults. Difficulty hearing sounds of words makes it difficult to interpret speech or to interpret what is being heard in noisy surroundings. Diminished sense of taste and smell may lead to overseasoning foods with salt or sugar. Diminished sensitivity to temperature may lead to overheating food and water temperatures, which increases the risk of burns either when showering or eating. Older adults should be cautioned to test water and food temperature with the wrist or arm and not the fingers and toes to avoid burns. Health Promotion for Older Adults Older adults should be encouraged to participate in illness prevention to improve quality of life throughout the latter years. Illness prevention recommendations for older adults include health screenings and immunizations, education regarding substance abuse, diet and exercise, sexuality, and preventing injuries. Health Promotion for Older Adults Health promotion is the process of enabling people to increase control over & improve their health by developing their resources to maintain or enhance well being. Health promoting is an action for health using knowledge, communication & understanding Health Promotion for Older Adults Health promotion involves making lifestyle and behavior changes in order to move toward optimal health. Health promotion efforts include: Increasing awareness of health issues Promoting healthier behaviors Creating supportive environments Developing preventive strategies Encouraging early detection and treatment Health Promotion for Older Adults Objectives of health promotion Increase quality and years of healthy life Maintain function Eliminate health disparities and promote independency Improve (enhance) quality of life Extend life expectancy → ↓ premature mortality caused by chronic& acute diseases Health Promotion for Older Adults Component of health promotion 1. 2. 3. 4. 5. 6. 7. 8. 9. Exercise Nutrition Rest & sleep Periodic medical check up High risk behavior Spiritual well-being Psychosocial well-being Safety measures Stress management Component of health promotion 1. Exercise Physical Benefits of exercise Psychological Social Component of health promotion 1. Exercise Physical benefits of exercise 1) Consumption of body fat 2) Improve cardio-vascular capacity( by↑ blood flow---- - keep tissue healthy 3) Control hypertension& blood sugar 4) Improve respiratory function 5) Improve joint flexibility 6) Improve pattern of sleep & rest 7) ↑ independency 8) Improve sense of well –being & relaxation 9) Maintain mind’s function 10) Promote sense of normality 11) Peristaltic movement Component of health promotion 1. Exercise Psychological benefits of exercise 1. Improve mood state 2. Improve self-image 3. Reduce stress & anxiety 4. Enhance sleep 5. Improve depressive state of elderly 6. Improves Cognitive Function 7. Helps with memory and concentration 8. Improves mood Component of health promotion 1. Exercise Social benefits of exercise 1. Improve social interaction & relation with other 2. Improves Social Function 3. Increases independence 4. Increases social networks and involvement 5. Enables person to participate in and enjoy social activities more Component of health promotion 1. Exercise Role of the nurse during exercise I- Assessment done at the beginning of exercise program include: 1. History & physical examination (CVS, resp, musculoskeletal & neurological system) 2. Renal & liver function tests 3. ECG,& exercise stress test 4. Assess range of motion & use of assistive devices. 5. Assess environmental hazards II-Set a regular time to exercise each day Component of health promotion 2. Nutrition It is neglected especially those living alone or with low income. Factors affecting nutritional status: 1. 2. 3. 4. Age related changes Psychosocial factors Economic factors Cultural factors Component of health promotion 2. Nutrition Factors affecting nutritional status: Age related changes ↓ Taste & smell ↓ Visual acuity Loss of teeth & poor fitting denture ↓ Gastric secretion→ influence in absorption of B12, folic acid& iron. Food remain longer time in stomach + ↓ gastric secretion will lead to indigestion &feeling of fullness. Component of health promotion 2. Nutrition Factors affecting nutritional status: Psychosocial factors Depression is common ( losses, death, retirement, change of body appearance, impaired vision &poor physical fitness) this will lead to lack of interest in eating& anorexia and ↓ food intake. Living alone also will lead to lack of incentive to cook &eat. Component of health promotion 2. Nutrition Factors affecting nutritional status: Economic Factors Low income Limited access to food and food choices Inadequate facilities to food storage and preparation Component of health promotion 2. Nutrition Factors affecting nutritional status: Cultural factors Eating habits may miss certain food group as vegetarians. Component of health promotion 2. Nutrition Important of nutrition It has been estimated that 10 to 25 percent of elderly people suffer from poor nutrition Poor nutrition can contribute to: – Heart disease – Cancer – Diabetes – Depression – Anemia – Frailty – Obesity – Osteoporosis – Isolation Component of health promotion 2. Nutrition Barriers to Good Nutrition Disability Changes in appetite Difficulty shopping Difficulty cooking Depression or anxiety Nausea Medication side effects Dental problems Swallowing problems Poor vision Financial problems Social isolation Transportation problems Other medical conditions Component of health promotion 2. Nutrition Overcoming Barriers to Good Nutrition Chewing problems – juices, canned fruits, creamed or mashed vegetables, eggs, cooked cereals Difficulty shopping – Look into grocery delivery or shopping services, ask friends, family, church members for help Difficulty cooking – Try microwaveable meals, group dining programs Poor appetite – Eat with others, ask doctor if medicine side effects could be causing problems, try different spices Financial concerns – Use coupons, share with someone, try low-cost options such as beans, bean soups, whole grain cereals, look into food bank programs or other community assistance For expert help – Talk to doctor about a referral to a registered dietician Component of health promotion 2. Nutrition Nurse Role Assessment involves: nutritional history, physical examination, anthropometric measurements, biochemical evaluation, cognitive & mood evaluation Health history related to nutrition Anthropometric measurement Client and family education Component of health promotion 3. Rest& sleep Person spend 1/3 of his life in sleep Sleep is time for cell growth& repair Elderly need 5-7 hrs at night Importance of Rest& sleep: 1. Conserve energy 2. Provide organ respite (rest) 3. Restore the mental alertness& neurological efficiency 4. Relieve tension 5. Emerge feeling of well being Component of health promotion 3. Rest& sleep Important Things to Know About Ageing and Sleep Older people usually sleep as much each day as younger adults. Older people often take daytime naps as well as sleeping at night. Age increases the risk of some sleep disorders. Medical conditions that arise with ageing can disrupt sleep. Sleeping pills are best used only for short periods of time. Try to go to bed and get up at the same time each day Component of health promotion 3. Rest& sleep Self-Care at Home cont……. Maintain a regular wake-up time. Maintain a regular time to go to sleep. Avoid or decrease daytime naps. Exercise daily but not immediately before bedtime. Use the bed only for sleeping or sex. Do not read or watch television in bed. Do not use bedtime as worry time. Avoid heavy meals at bedtime. Component of health promotion 3. Rest& sleep Self-Care at Home cont……. Avoid or limit alcohol, caffeine, and nicotine before bedtime. Maintain a routine period of preparation for bed, (for example, washing up and brushing teeth). Control the nighttime environment with comfortable temperature, quietness, and darkness. Wear comfortable, loose-fitting clothes to bed. If unable to sleep within 30 minutes, get out of bed and perform a soothing activity, such as listening to soft music or reading, but avoid exposure to bright light during these times. Get adequate exposure to bright light during the day. Component of health promotion 3. Rest& sleep Nursing measures adopted to promote sleep 1. Engage in exercise program 2. Avoid exercise within 3-4 hr. of bedtime. 3. Spend time out door in the sunlight each day but avoid period between 12 Md to 3 PM sunshine exposure. 4. Engage in relaxing activities near bedtime. 5. Avoid tobacco at bedtime 6. Avoid drink any caffeinated beverages before mid afternoon. 7. Limit fluid intake after the dinner hour if nocturia is a problem. 8. Limit daytime naps to 30 minutes or less. 9. Avoid using the bed for watching TV, writing bills, and reading Component of health promotion 4. Periodic medical examination Importance of Periodic medical examination: 1. 2. 3. 4. 5. Assess elderly level of well-being Detect early signs of disease Educate client how to promote his health Reinforce + ve promoting & protecting behaviors If examination done at home, it permit evaluation of environment ( hazards care giver…) Component of health promotion 4. Periodic medical examination Types of health screening Dental check up Once / year( annually) Fecal occult blood& sigmoidoscopy Annually Vision including glaucoma test Every 2 years Hearing Evaluate periodically Cholesterol level Every 5 years Cancer screening Annually Mammography for women nunder 70 y Digital rectal examination 1-2 years Annually Component of health promotion 5. High Risk Behavior It is behavior that damage physical health. It includes: 1. Over the counter medication (multiple medications ) 2. Smoking 3. Caffeine Component of health promotion 5. High Risk Behavior Multiple medication Older people consume many medication-------- ↑adverse drug reaction The most common over the counter medication: Analgesics, laxatives& antacids followed by cough products, eye wash& vitamins. Component of health promotion 5. High Risk Behavior It is behavior that damage physical health: Smoking Nicotine & toxic substances in cigarette has impact on detoxication process in the body------- cell damage& variety of diseases as cancer, respiratory, CVD, ↑ risk of osteoporosis Cessation of smoking improves cerebral blood flow& ↑ pulmonary function Component of health promotion 5. High Risk Behavior Caffeine Found in coffee, tea, soft drinks, chocolate It is mood elevator It stimulates sympathetic nervous system ↑motor activity ↑ muscle capacity & alertness ↑ Rapid pulse ↑ calcium excretion Component of health promotion 6. Spiritual Well- being Spiritual well-being is the practice and philosophy of the integral aspects of mental, emotional and overall wellbeing. Spiritual well-being is a state in which the positive aspects of spirituality are experienced, incorporated and lived by the individual and reflected into ones environment. Component of health promotion 6. Spiritual Well- being Signs of spiritual distress: Doubt Despair Guilt Boredom Expression of anger toward god Component of health promotion 6. Spiritual Well- being Benefits: The practice and incorporation of Spiritual Wellbeing into one’s life influences and includes benefits for ones; Emotional Wellbeing, Physical Wellbeing, and Mental Wellbeing. Component of health promotion 6. Spiritual Well- being Some of the measurable benefits that people experience from spiritual wellbeing counseling and groups include: A feeling of being more contented with their life’s situation Greater enjoyment of self time, finding an inner peace Greater ability to take control of and resolve their life’s issues A greater sense of satisfaction in their activities and life situations Ability to take a more active part in life rather than standing still and watching it pass by Ability to build more intimate, loving and lasting relationships A greater feeling of purpose and meaning in their life Component of health promotion 7. Psychosocial Well- being Psychosocial changes may alter an individual relationship with others. Physical wellbeing depend on: Psychosocial wellbeing Social structure Personal relationships In Later years many adjustment are necessary Role of the nurse in health promotion Assessment to his physical health, Psychosocial Well- being, lifestyle pattern, hobbies, high risk behaviors, knowledge, believes& attitudes that affect health & wellbeing. Assess health needs Assess social , environmental & cultural influences on health behaviors Lifestyle modifications is a comprehensive approach for effective change in heath promotion behaviors Nurse role should directed toward helping elderly to cope with his function level ------delay disabilities & impairments. Role of the nurse in health promotion Nurse identify environmental hazards & make necessary modifications Identify social needs & encourage participation & social support groups. Nurse should inform elderly & caregivers about aging process, common disorders & disabilities , different services available Encourage elderly to take better care to them, avoid high risk behaviors,& hazards affecting their health. Regular and continuous evaluation is important aspect of nurse’s role.