Week 1 Functionalability Asuka PDF

Welcome Health and Illness 2: The Older Adult Asuka Qiao RN, MN 1 Student Accessibility Services 2 Health and Illness 2: The Older Adult Assess Assess the impact of the normal aging process on the concepts included in this course. Analyze Analyze the interaction of age-related changes, risk factors...

Welcome Health and Illness 2: The Older Adult Asuka Qiao RN, MN 1 Student Accessibility Services 2 Health and Illness 2: The Older Adult Assess Assess the impact of the normal aging process on the concepts included in this course. Analyze Analyze the interaction of age-related changes, risk factors and functional consequences for older adults. Develop Develop nursing interventions to encourage, maintain and enhance independence (optimize their functional ability) in older adults. Value Value the individuality and personhood of older adults 3 Overview and Introduction to Course Course content UM learn Evaluations See um learn Structure of class Let’s think about what you already know about this topic Content Pair and share or group work Assignments, Quizzes and tests/exams Individual Aging assignment – 1% In class Group Learning activities Activity 1- 4% Activity 2A – 2.5%- random time Activity 2B – 2.5% random time Activity 3 – 5% Clinical Group Learning Activities 4 – 5% Individual Interview Assignment- hand in after interviewing older adult – 15% 1 quiz – 2.5% 2 quiz – 2.5% Midterm – 20 % Final – 40% Nursing Model A model is a way of representing a situation in logical terms in order to show the structure of the original idea and subject. (Mckenna, 1997) It is the simplified way of organizing a complex phenomenon. A model describes but doesn’t explain. 6 Life Course Theory- the social and historical context of a person’s life What happens in your younger life will affect what happens to you in later life (social and cultural context) People experience events differently and it will have different effects on them (different effect on their emotions, their physical selves and their psychological selves) Things can happen that can change the course of life (it is not predictable) 7 WEEK 1: STUDENT LEARNING OUTCOMES 1. Describe the role of the nurse in the care of the older adult. 2. Discuss how aging, age related changes, risk factors, health and functional ability are related 3. Discuss how culture and ageism impacts the experience of healthy aging and functional ability. 4. Apply the International Classification of Function, Disability and Health Model to understand functional ability 5. Identify a model of care that guides interventions to optimize function of the older adult. 6. Explain how Activities of Daily Living and Instrumental Activities of Daily Living are related to functional ability. 7. Distinguish the impact of acute illness and chronic illness on the ADL’s and IADL’s 8. Recognize functional abilities associated with the older adult’s ability to provide self care and live independently in a case study. 8 1. Describe the role of the nurse in the care of the older adult https://www.mcmasteroptimalaging.org/blog/detail/blog/2016/02/12/stroke-centre-or-local-hospital-in-an-emergency-just-call-911 9 Clinical Judgement Measurement Model (CJMM) Nursing process has been taught for many years Novice nurses continue to make serious errors in practice National Council of State Boards of Nursing (NCSBN) developed this CJMM to built on and expands the nursing process CJMM is the basis for the NCLEX new test items. 10 Clinical Judgement Measurement Model (CJMM) Recognizing Analyzing Prioritizing Generating Taking Evaluating Recognizing cues Analyzing cues Prioritizing hypothesis Generating solutions Taking actions Evaluating outcomes 11 A case study: Jessica is the nurse caring for Mr. Smith today. He is a patient that was admitted to the surgical-trauma unit after falling off of a ladder and fracturing his femur. Mr. Smith had surgery yesterday and is experiencing pain. When Jessica enters Mr. Smith’s room, she noticed that Mr. Smith was not happy and refused to get up walking. Jessica completes a comprehensive pain assessment. She assesses Mr. Smith' pain using the numeric pain scale and he rates his pain as a 7 out of 10. Mr. Smith also expressed concerns about not be able to pay rent due to missed work. Recognize Cues Analyze Cues Prioritize Hypotheses Generate Solutions Take Action Evaluate Outcomes Jessica give Mr. Smith PRN medication Hydromorphone 2mg. Mr. Smith stated comfort and was able to get up walking 1 hour later. Jessica also consulted social worker. 12 The role of the nurse in caring for the older adult Why to work with the older adult? Watch this video- 6 minutes https://www.youtube.com/watch?v=4mozfNEKdn4 13 2. Discuss how aging, age related changes, risk factors, health and functional ability are related 14 What is health? “Health is a state of complete physical, mental and social wellbeing, not merely the absence of disease or infirmity” (Giddens, 2021, p. 13) What is wellness? “ A state of being and feeling that one strives to achieve” (Boscart et al., 2023) What is illness? “Culture-bound syndromes or cultural idioms of distress” (Giddens, p. 29) 15 This Photo by Unknown Author is licensed under CC BY-SA-NC Health/Wellness and the Older Adult Wellness: “an optimal level of health, independent of their situation or functional ability” (Boscart et al., p. 6. 2023) Wellness is a state defined by the person themselves CANADIAN STATISTICS INDICATE THAT 70% OF PEOPLE OVER 65 SAY THEY ARE IN GOOD HEALTH WHILE IN 2019 ONLY 60% PEOPLE BETWEEN THE AGES OF 25 AND 34 REPORTED BEING IN GOOD HEALTH 16 Older Adult Definitions guide the interpretation of our experience : Complex and unique, knowing a chronological age does not describe the older adult, the experience of aging involves the interaction of internal and external factors Age – related changes Physiological changes are inevitable, irreversible, are not related to pathological conditions Psychological and spiritual changes offer opportunities for increasingly fulfilling life Risk Factors Conditions that increase the risk of the older adult to negative health (functional) Diseases, environment, lifestyle, psychosocial circumstances, adverse medications effects and attitudes based on lack of knowledge 17 Functional Ability Definition: “The cognitive, social, physical, and emotional abilities to carry out the normal activities of life. Normal daily activities include fulfilling usual roles in the family, workplace, community and maintain health and well being” (Sargent, 2021, p. 13). 18 Wellness and Scope of Functional Ability Full function Disability Function: the neutral or positive interaction between the person’s health and the performance of social and physical activities Disability: the negative aspects of the person’s health and social and environmental condition that is determining performance of the individual Impairment: refers to the physical abnormality that underlies the limitation 19 The relationship between wellness and functional ability in the healthy older adult and the older adult with chronic illness Risk Factors Older adult Age related changes Wellness/ Health in the older adult Functional Ability Chronic illness in the older adult 20 3. Discuss how culture and ageism impacts the experience of healthy aging and functional ability 21 Ageism According to Butler (1991) it is… “the prejudices and stereotypes that are applied to older people sheerly on the basis of their age…Ageism, like racism or sexism, is a way of pigeonholing people and not allowing them to be individuals with unique ways of living their lives.”(Hirst, pg. 243). “refers to the stereotypes (how we think), prejudice (how we feel) and discrimination (how we act) directed towards people on the basis of their age” (WHO, pg.xv). Global report on ageism. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO. Being young increases the risk of being ageist Being anxious about death increases the risk of being ageist Intergenerational experience reduce the risk of being ageist Factors that increase the risk of being a target are: Being care-dependent Working in high-tech or in the hospital sector Younger females are also at increased risk for ageism Determinants of Ageism Ageism and stereotypes Examples of myths about older adults: They are either very rich or very poor They are senile They are neither interested in nor have the capacity for sexual relations They are very religious They are unable to adapt to change They tend to be pretty much alike Far reaching consequences For older adults it is associated with a shorter life span, poorer physical and mental health, slower recovery from disability and cognitive decline Reduces quality of life The impact of ageism Increases social isolation and loneliness Restrict ability to express sexuality and increase the risk of violence and abuse against older people For younger people, ageism reduces their commitment to their workplace Ageism contributes to poverty and financial insecurity How does culture impact the experience of being old? What is culture? Age positive culture vs. Age negative culture Individualism vs. interdependence Negative stereotypes are internalized and increase risk at a population level 26 4. Apply the International Classification of Function, Disability and Health Model to understand functional ability 27 International Classification Model of Function guides the collection of a comprehensive assessment Video on factors impacting health and quality of life (2minutes) https://www.youtube.com/watch?v=q2SdjlFQn3I The International Classification of Functioning, Disability and Health Model (ICF model) Health professional use models to frame their understanding of how to help people optimize their well being and their functional ability. 29 5. Identify a model of care that guides interventions to optimize function 30 Shifting Perspectives Model of Chronic Illness Illness in the foreground: Symptoms flaring, facing limitations due to illness. Patient feel Anxious, sad, and or angry. Wellness in the foreground: feeling relatively well or engaged in an activity that takes mind off of the symptoms. Patient feel positive and hope Wellness is achieved by being motivated and engaging in health practices Adaptation of physical conditions and psychological conditions Shifting Perspective Model (pg. 233-234) 31 Shifting Perspectives Model of Chronic Illness Explains the individual’s response (insider’s perspective) to chronic illness and can guide the actions of health care professionals Focuses on the person’s perspective and recognizes that their perspective shifts Focus on health within illness Nurses recognize how the person with the chronic illness is responding to their disease Nurses support each perspective and optimize wellness in the foreground I can not walk up and down the stairs safely What is patient focusing on when they make these statements? I feel sad and lonely I do not feel like exercising 33 What is patient’s focusing on now? “I go online to be with my friends and exercise with them” “I am enjoying my life” “It is nice to have an exercise partner” “I can go up and down the stairs again” 34 6. Explain how Activities of Daily Living and Instrumental Activities of Daily Living are related to functional ability. 35 Exemplar: Degree of dependency in ability to manage ADL’s and IADL’s Measure tasks to do self care (Activities of Daily Living) Measure tasks related to being able to live independently (Instrumental ADL’s) 36 Self-care abilities: Interpreting functional abilities Activities of Daily Living (ADL’s) Basic self-care activities that are necessary for daily functioning, such as eating, toileting, ambulation, bathing, dressing and grooming Assess the degree to which someone can do these activities independently or requires assistance (dependence) Independent living abilities: Instrumental Activities of Daily Living more complex activities that are necessary for independent living and may include cleaning, doing yard work, shopping, managing money Interest in doing these skills is related to social and cultural factors Other measures of function (FIM) Mobility, cognition, social functioning and the ability to carry out ADL’s 37 Abilities of the person to do self care are Activities of Daily Living (ADL’s) wwww.aarp.com 38 Ability of the person to carry out Instrumental ADLs www.freestockphotos.biz Telephone Travelling/Driving Shopping Preparing meals Housework Medication Money 39 Collecting information on IADL’s and ADL’s Standardized tools facilitate the collection of reliable data. 40 Some comparison between measures of ADL’s Katz Index Ranks the degree to which a person is independent, or requires assistance or is dependent in 6 self care activities See Table 13-2: Katz Index of Independence in Activities of Daily Living Barthel Index More specific description of type of assistance required (e.g. can come to a sitting position but needs help standing from sitting position) Functional Independence Measure (FIM) Measures mobility, cognition, social functioning and ADL’s (more comprehensive but requires training – used for rehabilitation) 41 Katz Index of Independence in ADL Katz is a basic framework for ADL measures – not always sensitive to show small changes in function 42 Instrumental Activities of Daily Living (Boscart et al., 2023,figure 13.1, p. 198 See Box 13-1: Instrumental Activities of Daily Living) What is this tool measuring? Using the telephone Independent: Able to look up numbers, dial, and receive and make calls without help Assistance needed : Able to answer phone or call operator in an emergency, but needs a special phone or help in a getting number or dialing Dependent: Unable to use telephone 2. Travelling I: Able to drive own car or travel alone by bus or taxi A: Able to travel but not alone D: Unable to travel 3. Shopping 4. Preparing meals 5. Housework 6. Taking medication 7. Managing money 43 Used in personal care homes and homecare in Manitoba Completed 14 days after resident’s admission and quarterly and with changes in resident status Examples: Minimum Data Set Transferring Moving between surfaces Ability to get up and down off the toilet Dressing Extent of assistance required to dress and undress above the waist Extent of assistance required to dress and undress lower body 44 Minimum Data Set (MDS) Coding Independent Set up assistance Supervision Limited assistance Extensive assistance, 1 person Extensive assistances, 2 persons Total dependence, 1 person Total dependence, 2 persons 45 How does the information on ADL’s and IADL’s inform the care planning? Changes could mean the older adult has an acute condition The degree to which the older adult is dependent Homecare Caregiver involvement Consider need for equipment Determine if treatment such as rehabilitation has been effective (evaluation of care plan) Determining the degree of vulnerability or frailty Aging in place 46 Assessing the ADL’s and IADL’s Self –report or family report Observation of skills Performance based Preferred but time consuming Example- functional mobility – timed up and go (TUG) More research being conducting associating the ability to perform certain activities and overall health (walking speed, ability to balance) Methods of Assessing ADL’s and IADL’s Assess difficulty or dependency 47 Limitations of Standardized measures How is the information collected? From the patient, from the family or through observation Observation is the best way to determine the actual ability (in acute care or rehab this is a team approach – formalized by Occupational Therapy) Does not always identify the specific deficit therefore does not guide an appropriate intervention. Performance measures provide information on abilities to do ADL’s and IADL’s or address factors that need to be addressed (see mobility lecture) 48 7. Distinguish the impact of acute illness and chronic illness on ADL’s and IADL’s of the older adult 49 Why does an Older Adult’s ability to manage ADL’s (self care) and IADL’s change? Are they age-related changes? Is it related to a disease or illness Is it related to a chronic condition? 50 Changes in ADL’s and IADL’s Can occur quickly and be related to a disease process Can occur gradually related to chronic conditions Can be related to external situations that do not support optimal function 51 Changes in the ability to manage ADL’s and IADL’s Can be related to chronic conditions but vary depending on the extent of the disease and the opportunity to optimize function: Examples: Strokes Parkinson’s Arthritis Dementia Frailty 52 A chronic condition is managed rather than cured and requires the person to learn to live with the condition Chronic conditions Episodes of illness or sudden signs and symptoms of disease can be exacerbated by a chronic condition or can cause a new chronic condition For the older adult having a chronic illness is not as important as its effect on functioning 53 What is chronic illnesses? conditions that last 1 year or more and require ongoing medical attention or limit activities of daily living or both. Non fatal chronic illness (Osteoporosis) Serious, potentially fatal chronic conditions (Stroke) Frailty – a condition in which the body has few reserves, and any change can cause health problems 54 8. Recognize functional abilities associated with 7. Recognize functional abilities associated with the older adult’s ability to provide self care and live independently in a c the older study.adult’s ability to provide self care and live independently in a case study. Unfolding case study: Mrs. Limza Mrs. Limza had a stoke two months ago. Mrs. Limza’s stroke resulted in left sided upper body weakness. She can walk with a cane. Discharge plans to go home are underway. She lives in a one bedroom apartment. There can take an elevator to the apartment. Medications: Tylenol (am and pm), three meds for her HTN, two puffers for her COPD What are the goals of rehabilitation? Restore or improve ability to perform ADL’s Improve quality of life Comprehensive assessment including the patient and family Prevent iatrogenic disturbances Optimize function with use of assistive devices Mrs. Limza – Assessment pre-discharge Mrs. Limza was incontinent of urine two weeks ago of urine once but has not been incontinent since Once Mrs. Limza is set up she is able to brush her hair and her teeth alone. Mrs. Limza can transfer independently if she is at the correct height or if she is in a mechanical chair that moves her forward She asks for help to the bathroom but manages to wiping and repositioning her clothes as long as they do not have buttons Mrs. Limza requires assistance to dress the top part of her body and with putting on her shoes and tying up shoelaces Mrs. Limza needs physical help of one person going up and down the stairs Mrs. Limza needs assistance getting into the bathtub. Mrs. Limza’s daughter says she will keep an eye on her and help her with groceries, cooking, finances and getting around What are Mrs. Limza’s needs? Apply the Katz and Barthel index to the information you are provided How does this information lead to making a decision about what Mrs. Limza needs when she goes home? What other information would you want to collect to determine Mrs. Limza’s needs? What are Mrs. Limza’s needs? Cane or walker for left sided weakness A reaching stick to help put on shoes Assistance with dressing and bathing What other questions do you have about Mrs. Limza’s ability to manage independently? Post discharge Assessment: Recognize information about Limza’s ADL’s and IADL’s Mrs. Limza’s daughter states that she noticed it took her five times to stand up from the couch the other day. She just could not find the strength in her legs. You notice the smell of urine in the apartment and a wet spot on the couch. Mrs. Limza’s daughter states she is doing her grocery shopping this week and picking up frozen dinners for her mother. Mrs. Limza states she can manage her own food. You observe her make a sandwich for lunch. You notice that Mrs. Limza has a stain on her pink blouse. Mrs. Limza states the laundry machines are in the basement and a long way from the elevator. Mrs. Limza can describe phoning 911 in case of emergency or fire. Post discharge assessment What information do you collect about Mrs. Limza’ ability to manage her ADL’s and IADL’s? What additional information would you collect? The idea of what is healthy is influenced by culture. Wellness incorporates how the individual/family/community achieves balance Functional ability is foundational to understanding the wellness of the older adult By focusing on maintaining and improving the functional ability (intrinsic capacity) of the older adult health professionals: ◦ Can identify when the older adult is having difficulty and reduce risk for further decline ◦ Optimize opportunities in the environment to maximize function ◦ Recognize where the older adult might need assistance. Ageism influences the functional ability of the older adult ◦ Because health care providers can judge that functional decline is normal for the older adult and not investigate declines in functional ability ◦ Because older adults assume decline is normal and do not seek assessment ◦ Because institutions assume functional decline is normal The International Classification of Function identifies how factors impacting functional ability relate to each other. It guides a comprehensive assessment of the older adult. The shifting perspective model guides by incorporating the recognition that the person with chronic condition can optimize their wellness and function even with periods of illness. The assessment of ADL’s and IADL’s are part of a comprehensive assessment of the older adult. It is important to recognize changes in function (ADL’s and IADL’s) and determine the cause Message of Today’s Class