Care of the Older Client (NCM 114a) 2024 PDF

Instructional Material for Online Teaching and Learning Care of the Older Client (NCM 114a) Department of Nursing BSN Level III, 2024 1 | MMSU-CHS-DEPARTMENT OF NURSING NCM 114  Subject/Course: NC...

Instructional Material for Online Teaching and Learning Care of the Older Client (NCM 114a) Department of Nursing BSN Level III, 2024 1 | MMSU-CHS-DEPARTMENT OF NURSING NCM 114  Subject/Course: NCM 114 (Care of the Older Client) Unit 1 Lesson Title: Concepts, Principles and Theories in the Care of the Older Adults A. Perspectives on Aging B. Demographics of Aging C. Impact of Aging Members in the Family D. Theories of Aging and its Nursing Implications Time Allotment: 4 hours Lecture Introduction of the Lesson and Presentation of Outcomes: ThisINSTRUCTIONAL MATERIAL FOR ONLINE TEACHING AND LEARNINGwill provide learners with the concepts, principles, theories and techniques in the care of older adults. The learners are expected to perform holistic nursing care of the older person wellness and chronic illness utilizing the nursing process. It is designed to be a rigorous and engaging undertaking that includes lecture, interactive activities, and shared learning opportunities for each learner. Learner’s engagement and participation will be a vital part of class sessions, lively and simulating discussions and activities will be the hallmark of the class. Improving the well-being of older person is an important public health goal. This has been developed for use by instructors to support learners as future health care providers in building their foundation needed in the care of older person. This is in order to ensure the provision of holistic care from the learners in the application of the inclined concepts. After completing this INSTRUCTIONAL MATERIAL FOR ONLINE TEACHING AND LEARNING, you will be able to: 1. discuss and integrate concepts, theories and principles of physical, social, natural and health sciences and humanities in the care of older adults; 2. provide safe, appropriate and holistic care to individuals, families and population groups utilizing the nursing process to older Adults. 2 | MMSU-CHS-DEPARTMENT OF NURSING NCM 114 Warm-up Activity (Motivation/ Pre-assessment): 1. Explain at least two theories of Aging. 2. Give at least one physiologic change of Aging from each 5 selected body systems. Presentation of Learning Inputs: I. CONCEPTS, PRINCIPLES and THEORIES IN THE CARE OF THE OLDERPERSON: 1. Perspectives on Aging 1. 1. Related Terms Aging The process of becoming older A process that is genetically determined and environmentally modulated A continuous process that occurs in the absence of disease An intrinsic, deleterious, universal, progressive and irreversible process Aging is a natural process but it is affected by many pathologic processes Degenerative changes associated with aging may predispose an individual to certain pathologies, and pathologic changes can hasten aging. rush aging Gerontology The study of the elderly and of the aging process itself and its consequences Geriatrics The branch of medicine concerned with the diagnosis, treatment and prevention of disease in older people and the problems specific to aging Elderly Refers to people who are over 65 years of age Aging begins after birth but becomes more evident at about 30 years of age. The process is irreversible but the rate and effects of aging vary greatly among individuals and do not necessarily match chronological age. Women live longer than men The average lifespan is increasing, creating a higher proportion of older individuals in the population. This is largely because of improved social and living standards, better nutrition and advancements in health care. Geriatric/Gerontological nursing nursing care of the elderly 3 | MMSU-CHS-DEPARTMENT OF NURSING NCM 114  A health service that incorporates generic nursing methods and specialized knowledge about the aged to establish conditions within the patient and within the environment that will do the following: 1. Increase health-promoting behaviors in the aged 2. minimize and compensate for health-related losses and impairments related to aging 3. Provide comfort and sustenance through the distressing and debilitating events of aging, including dying and death 4. Facilitate the diagnosis, palliation and treatment of disease in the aged (Gunter and Estes, 2010) Senescence Irreversible, deteriorating changes that occur as cells and organisms age, increasing vulnerability to fatal disease, dysfunction and death It refers to the period of life from old age to death Categorizing the aging population: by WHO Old-old = 85 years old and above = extreme aged/frail elderly Middle old = 75 – 84 y/o = late elderly /aged Young old = 65-74 y/o = early elderly 55-64 y/o = older population 1.2 HISTORICAL APPROACHES The Greeks were the first people to speculate on the causes of aging, several hundred years before the birth of Christ. Hippocrates characterized aging as an irreversible and natural event caused by a decrease in body heat Galen elaborated on this idea by saying that aging was caused primarily by changes in body’s “humor” that produced increased dryness and coldness. He also stated that aging was a lifetime process rather than an event occurring at the end of the life span Decreasing of fibers and progressive consolidation of earthy material within one’s body. ❖ It was not until 18th and 19th centuries that scientists began to investigate seriously the physiological and anatomical process of aging. Darwin stated that aging was due to decrease irritability of nervous and muscular tissues resulting in a failure of the body to respond to stimuli. Other theorist claimed that life was a vital force or an intrinsic energy that gradually decrease overtime and diminished to the point of death. ❖ After 1900, few scientist and researchers studied aging as a primary interest. In the early 1900s, C.S. Minot studied mortality rates with the use of mortality rates with the use of statistical analysis. ❖ Theories predominant during this period: The “autointoxication” theory, which stated that age was attributed to particular physiological systems or conditions, Maimonides (12th century) , a Jewish Philosopher postulated that life was predetermined and unalterable but that the life span could be prolonged by taking suitable precautions 4 | MMSU-CHS-DEPARTMENT OF NURSING NCM 114  Roger Bacon (13th century), a European, adhered to the Greek model of decreased heat and dryness related to aging but added that aging was a pathological process that could be halted by good hygiene. He further postulated that aging was a result of the wear and tear of living. Leonardo da Vinci (1452 – 1519) was the first person to identify physiological changes associated with aging by performing autopsies on old men and young children 11 31 % of Population of the Philippines. 109 , 035343 , The Philippines 2020 population is estimated at 109,581,078 people at mid-year according to UN data. The Philippines population is equivalent to 1.41% of the total world population. The Philippines ranks number 13 in the list of countries (and dependencies) by population. Population of 60 years old and above in the Philippines Filipinos aging 60 glo and above * May 2020 - 12 , 336 , 333 As of 2017, the Philippines' population aged 60 years old and above totaled 5,705,591 (5.7 million older persons). This is equivalent to about 6.9 percent of the total Filipino population. 2. Demographics of Aging: Based from the nationwide survey done in 2017: 1. Marital status of older persons: - more married males than females (married = M>F) - more singles females than males (single = F>M) - more widowed males than females (widows = M>F) 2. Living arrangement of older adults: - grandchildren – 61.8% - spouse – 59% - Daughter – 50.9% 3. Leading cause of morbidity: *50 years old and above - influenza, HPN, PTB, heart diseases, pneumonia, malaria, neoplasm, chicken pox *60 years old and above: -heart diseases, diseases of the vascular system, pneumonia, PTB, neoplasm, COPD, other.respiratory diseases, D.M., nephritis, Nephrotic syndrome, nephrosis and accident 4. Projected population for the year 2030: 21% of the population will be older than 65 years of Age. 3. Impact of Aging Members in the Family: a. Emotional Effects 5 | MMSU-CHS-DEPARTMENT OF NURSING NCM 114 PINK - Positive BluE-Negative  Caring for your aging parents prompts a range of impulses and emotions. Katie Thomas and Mishelle Segur, co-owners and directors of Hearts and Hands Counseling, say that common responses include "Guilt for not being able to do more for parents; anger for having to set aside your own needs or shift your priorities; and fear and anxiety, including anticipatory grief and fear of financial strain. NEGATIVE IMPACT “Caring for children and aging parents at the same time can make you feel as if you do not have the emotional strength and resources for everyone. Thomas and Segur also identify positive emotional effects of caring for aging parents, such as "enrichment that comes with relationships between grandparents and grandchildren; increased opportunity to pass on stories and knowledge to younger generations; and younger generations having a sense of being able to give back to parents and grandparents," resulting in a "greater connection" between family members. POSITIVE b. Financial Effects Caring for aging parents often means extra costs related to home health care, medical expenses not covered by insurance and extra insurance premiums for services such as long- term care. You also may need to take off extra time from work. Healthcare Finance News reports the results of The MetLife Study of Caregiving Costs to Working Caregivers, stating that individuals who care for elderly parents will lose an average of $280, 00 to $325,000 in wages, retirement benefits and Social Security benefits. Thomas and Segur say that some families explore options for financial support that can make family life more enjoyable, emphasizing that "there is no shame in utilizing what support is out there." Healthcare Finance News echoes this sentiment, adding that there are many employer resources and programs to ease financial stress and improve productivity in the workplace in such situations. d. Structural Effects When you live with your aging parents or assume a high amount of daily care for them, you experience a change in your family roles.~ RE-STRUCTURE the FAMILY in Thomas and Segur describe this as a "shift in family structure and hierarchy related to matriarch or patriarch no longer being in their role." When this occurs, "someone new [has] to take their place. “This shift can cause guilt and stress, as family members work to find a place in the new family dynamic, but it can also result in more open communication among family members. In her article "Caregiving From a Distance," Carol Heffernan describes how some families positively communicate their needs and responsibilities when managing caregiving. The caregivers speak with aging parents about where they believe they need support. Grandparents, parents and children get creative. Brainstorming about how to utilize community resources such as church groups, social service organizations and community groups. In these cases, the family structure shifts to being less hierarchical and more cooperative. 6 | MMSU-CHS-DEPARTMENT OF NURSING NCM 114  c. Physical Effects Prioritizing parents' care can ease their pain and worry, but might impact your health. The Family Caregiver site summarizes some of the physical effects of caregiving for aging parents. The time and effort of keeping up with parents' care means you may visit your doctors less, resulting in undiagnosed problems or conditions getting worse. Caregiving for a parent with dementia can cause chronic stress and illness. Time pressure might result in caregivers and their children skipping exercise and eating more convenience foods, which contribute to poor fitness and weight gain. Everything from mild depression to severe and chronic depression can inflict caregivers, which can cause premature aging and shorten their life span. Families who share responsibilities and secure outside help experience less stress and have the time and resources to maintain their health and relationships with all members of the family. d. Positive Effects In an article "Caring for Elderly Parents: How to Feel Positive," Dr. Amy D’Aprix, life transition consultant, observes that our thoughts frame our emotional state. When you care for aging parents, you might feel as if you are in a rut. This in turn affects your family life, creating an environment of bitterness and resulting in more criticism and complaining. However, some families have the opposite experience by creating what she describes as a positive "wiring" in their brains to produce more potentially positive outcomes. These people reflect on what makes them feel good for caring for their aging parents. They consider what moments in their days make them smile. They revel in the moments with loved ones that increase their sense of self-worth and they end up creating closer bonds with both the older and younger generations. * For additional knowledge, please read: Meiner, Sue E. and Annette G. Lueckenotte.2017. Gerontologic Nursing.3rd ed. Singapore: Mosby Inc. 1. JAFETY DIGNITY Quiz will be uploaded before the scheduled quiz through MvLE.. 2. 3 INDEPENDENCE 4. PRIVACY 5. COMMUNICATION 7 | MMSU-CHS-DEPARTMENT OF NURSING NCM 114  4. Theories of Aging and its Nursing Implications : Biological Theories 1. The DNA and Genetics Theory ▪ Telomerase Theory of Aging 2. Neuro-endocrine Theory 3. The Free Radicals Theory 4. The Membrane Theory of Aging 5. The Hayflick Limit Theory 6. The Mitochondrial Decline Theory 7. The Cross-linking Theory Psychosocial Theories 1. Disengagement Theory 2. Activity Theory 3. Continuity Theory 4. Life-Course Theory ▪ Erickson’s Developmental Stages ▪ Peck’s Developmental Tasks of Aging A. Biological Theories Addresses the anatomic and physiologic changes occurring with age 1. The DNA(molecule that’s carrier of genetic information –Deoxyribonucleic acid) and Genetics Theory Postulates that DNA regulates the rate at which we age However this theory also assumes that DNA as a genetic clock can be greatly influenced with regards to its rate of timing such as in case of exposure to toxins, pollution, radiation, etc. Aging is caused by changes in the expression of genes regulating both development and aging ▪ *Telomerase Theory of Aging ( *a DNA polymerase involved in the formation of telomeres and the maintenance of telomere sequences during replication) It postulates that telomeres (either of the ends of a chromosome , which possesses special properties, among them a polarity that prevents their reunion with any fragment after a chromosome appears as a straight filament) shorten every time a cell divide This shortening of telomeres is believed to lead to cellular damage, hence aging 2. Neuro-endocrine Theory This theory postulates that aging occurs as a response to the exhaustion of certain organs of the body , particularly the hypothalamus, which is primarily responsible in the regulation of hormone production in the body When the hypothalamus begin to lose its ability to regulate hormone levels, cortisol (s steroid hormone produced naturally by the adrenal gland prescribed typically for inflammation) is released which further damages the hypothalamus in the long run 8 | MMSU-CHS-DEPARTMENT OF NURSING NCM 114  Alterations in neuroendocrine control of homeostasis result in aging-related physiological changes 3. The Free Radicals Theory Free radicals are highly unstable chemicals which arise from an atom which has an unpaired electron in its outermost orbit Free radicals are known to disrupt the structure of cell membranes and the integrity of the cell as a whole Oxidative metabolism produces highly reactive free radicals that subsequently damage lipids, proteins, and DNA 4. The Membrane Theory of Aging According to this theory of aging, it is the age-related changes of the cell’s ability to transfer chemicals, heat and electrical processes that impair it in the long run As one grows older, the cell membrane becomes less lipid which in turn impedes its efficiency to conduct normal function and in particular leads to toxic accumulation ▪ Lipid – serve as body energy reserves This cellular toxins is referred to aslipofuscin (a class of fatty pigments consisting mostly of oxidized fats that are found in abundance in the cells of adults) and as we grow older lipofuscin deposits become more present in the brain, heart, lungs as well as in the skin 5. The Hayflick Limit Theory This theory suggest that the human cell has a limited ability to divide When the cell reaches its maximum limits in terms of cellular division, the cell ceases to divide and hence, eventually dies Fibroblasts will divide about 50 times in the test tube. After they stop dividing, these senescent cells also change in function , releasing enzymes that could cause cancer later in life 6. The Mitochondrial Decline Theory The mitochondria is considered as the powerhouse of the cell wherein their primary job is to create ATP ((adenosine triphosphatase – an enzyme in the skeletal muscles and other tissues that catalyzes the hydrolysis of adenosine triphosphate to adenosine diphosphate and inorganic phosphate) for the normal functioning of the body ▪ ATPase- involved in obtaining energy for cellular metabolism and in muscle contraction Chemically speaking, under normal circumstances, the mitochondria are fiery furnaces and subject themselves to a lot of free radical damage; furthermore they also lack most of the defenses found in other parts of the body, such that as we age, the mitochondria becomes less efficient and fewer in number 7. The Cross-linking Theory Also referred to as Glycosylation Theory of Aging (the formation of linkages with glycosyl groups covalently attaching a CHO to another molecule) ▪ Glycosyl – a radical formed from a saccharide such as glucose 9 | MMSU-CHS-DEPARTMENT OF NURSING NCM 114  This theory postulates that the binding of simple sugars (glucose with protein causes various problems It proposes that as cells age, chemical reactions create strong bond or cross linkages between proteins. These bonds cause loss of elasticity, stiffness and eventual loss of function Once this binding has occurred, the CHON becomes impaired and is unable to perform as efficiently as before Diabetes is often viewed as a form of accelerated aging and the age-related imbalance of insulin and glucose tolerance leads to numerous problems; these have been called Syndrome X 8. Theories Presuming a Pre-existing Master Plan Suggests the presence of biologic clock governed by a series of chemical events These theories postulate that there is programmed cell death and that hormones accelerate some aging processes and can slow down other processes. The trend is more towards hormones being a possible cause of age changes ▪ a. Wear and Tear Theory Body tissues become worn out from use and cannot continuously renew itself Humans like automobiles have vital parts that run down with time, leading to aging and death Accumulation of normal injury ▪ b. Rate-of-Living Theory Postulates that rapid expenditure of energy precipitates early aging and slow expenditure results in slow aging The faster an organism lives, the quicker it dies Assumes a fixed rate of metabolic potential for every living organism ▪ c. Waste Product Accumulation Theory Suggests that a kind of cellular constipation results if cell accumulates more wastes than can be disposed of immediately Cells wear out thru exposure to internal and external stresses including trauma, chemicals and buildup of natural wastes ▪ d.Cross-linking Theory of Aging Suggest that with age, some body CHONs become cross-linked and may impede metabolic processes A.k.a. Protein modification Protein changes result in advanced glycation end products (AGEs) that crosslink with other molecules, impairing function 9. Current Thinking and Old Ideas: ▪ Most biogerontologists believe that several mechanisms are operating at the same time to cause aging. There is probably not a single cause of death but many causes 10 | MMSU-CHS-DEPARTMENT OF NURSING NCM 114  Current thinking includes: o a. The Vital Substance Theory – we are all born with a certain amount of vital substance and as it is consumed, we age and die o b. The Genetic Mutation Theory – Several types of gene mutations are known to occur, some are good and some are harmful o c. The Reproduction Exhaustion Theory – There is a burst of reproductive activity then a period of rapid aging followed by death B. Psychosocial Theories Attempts to explain the thought process and behavior of aging persons 1. Disengagement Theory Refers to an inevitable process in which many of the relationships between a person and other members of the society are severed and those that are maintained are altered in quality Aging involves mutual withdrawal between the older person and others in the elderly person’s environment. This withdrawal relieves the elderly of some society’s pressure and gradually decreases the number of people with whom the elderly person interacts Withdrawal from society may either be initiated by the aging person or by the society itself and that such withdrawal may either be partial or total Inevitable withdrawal of the person and society from each other 2. Activity Theory Developed by Robert Havighurst in 1960s Emphasizes the importance of maintaining of regular activities, roles and social pursuits The best way to age is to stay active physically and mentally Postulates that persons who achieve optimal age are those who stay active As role change, the individual finds substitute activities for these roles 3. Continuity Theory – people maintain their values, habits and behavior in old age Proposed in relation to the Disengagement Theory wherein they postulated that “basic personality, attitudes and behaviors remain constant throughout the life span This theory states that older adults try to preserve and maintain internal and external structures by using strategies that maintain continuity As a person grows older, he or she is likely to maintain continuity in habits, preferences, commitment; implies that there are many possible adaptations to aging 4. Life-Course Theory: a. Erickson’s Developmental Stages 11 | MMSU-CHS-DEPARTMENT OF NURSING NCM 114  o Young Adulthood (20 – 30) ▪ Intimacy vs. Isolation o Middle Adulthood (30 – 60) ▪ Generativity vs. Stagnation o Older Adulthood (60+) ▪ Integrity vs. Despair ▪ Area of resolution and Behavior Intimacy – capacity for relationships VS Isolation – impersonal relations b. Havighurst stated that for older people to progress they must meet the following tasks: 1) Adjust to declining health and physical strength 2) adjust to retirement and reduced income 3) Adjust to the death of a spouse or family members 4) Adjust to living arrangements different from what they are accustomed 5) Adjust to pleasures of aging i.e. increased leisure and playing with grandchildren c. Peck’s Developmental Tasks of Aging (Peck – believes that although physical capabilities and functions decrease with old age, mental and social capacities find to increase in the latter part of life) 1) Ego Differentiation vs. Work-Role Preoccupation An adults identity and feelings of worth are highly dependent on that person’s work role on retirement, some people experience feelings of worthiness, unless they derive their sense of identity from a number of roles so that one such role can replace the work role or occupation as a source of self esteem 2) Body Transcendence vs. Body Preoccupation This task calls for the individual to adjust to decreasing physical capacities and at the same maintain feelings of well-being. Preoccupation with declining body function reduces happiness and satisfaction with life. 3) Ego Transcendence vs. Ego Preoccupation 12 | MMSU-CHS-DEPARTMENT OF NURSING NCM 114  ❖ Ego transcendence – the acceptance with fear of one’s death as inevitable. This acceptance includes being actively involved in one’s own future beyond death ❖ Ego preoccupation – results in holding on to life and a preoccupation with self-gratification. Assignment: Physiologic Changes in Aging affecting various Systems of the body (Individual Written Output) Quiz will be uploaded before the scheduled quiz through MvLE. References: Linton. Adrianne Dill and Helen W. Lach.2017. Matteson and McConnell’s Gerontological Nursing: Concepts and Practice. 3rd ed. W.B. Saunders Co. Meiner, Sue E. and Annette G. Lueckenotte.2017. Gerontologic Nursing.3 rd ed. Singapore: Mosby Inc. Activities (Formative Assessment): Quiz will be uploaded before the scheduled quiz through MvLE. Wrap-up Activity: General Conclusions Based from the Presented Theories of Aging ▪ That none of the theories proposed can claim sufficient evidence to account for the aging effects that are witnessed and experienced in humans ▪ The bottom line is that we do not know exactly why we age, however we do know that longevity has increased and by that, the possibility that the aging process has slowed ▪ The common theme in all the theories here is: Change such that as molecules, cells and organ systems continue to live, they change ▪ An interesting observation about change: When it is considered in earlier life, it is referred to and discussed as development and later in life when change is considered it is referred to as aging Assessment (Post-Assessment): Long exam will be uploaded before the scheduled exam through MvLE. --------------------------------------------------------------------------------------------------------------- 13 | MMSU-CHS-DEPARTMENT OF NURSING NCM 114