Community Nursing – Senior health

Chapter 19 Senior Health Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Aging is a natural process that affects all living organisms.  Chronological age ➢ The young-old (ages 65-74) ➢ The middle-old (ages 75-84) ➢ The old-old (ages 85 and older) ➢ The elite-old (more than 100 years old)  Functional age ➢ Functional ability and the ability to perform activities of daily living (ADLs) ➢ A better measure of age than chronological age Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Why Do People Age?  Biological theories ➢ ➢  Events that occur randomly and accumulate over time (stochastic theories) Predetermined aging (nonstochastic theories) Psychosocial theories: how one experiences late life (behavioristic) ➢ ➢ ➢ Disengagement theory—withdrawal, decreased interaction Activity theory—remaining active and involved is necessary to maintain life satisfaction Continuity theory—continue through life as in previous years Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Demographic Characteristics       Americans are living longer than ever before and the older population will continue to grow. Older population is becoming more diverse. Number of seniors differs by geographic location. Older women outnumber older men. Older men are more likely than older women to be married. Educational attainment has increased among older adults. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Demographic Characteristics (Cont.)      Older women are more than twice as likely as older men to live alone. Older adults want to live in their own home for as long as possible—“age in place.” Alternative housing options are available with services to help seniors. With aging, a good percentage of income is spent on health care. The proportion of the older population living in poverty has decreased but is affected by gender, marital status, race, and ethnicity. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Psychosocial Issues and Role Changes Affecting Seniors      Retirement Relocation Widowhood Loss of family and friends Possibly raising their grandchildren Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Physiological Changes of Aging   Occur in all body systems Rate and degree of changes are highly individualized  Influenced by: ➢ Genetic factors ➢ Diet ➢ Exercise ➢ The environment ➢ Health status ➢ Stress ➢ Lifestyle choices ➢ And many other elements Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Wellness is different than “good health.” Wellness exists at one end of a continuum with illness at the other end. Health promotion programs focus on helping individuals to maintain their wellness, prevent illness, and manage any chronic illnesses that the individual may have. Preventive health services are valuable in improving the individual’s health status to maximum wellness potential. – Nies & McEwen (2015) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Recommended Health Practices       Encourage recommended health care screenings and examinations. Encourage physical activity and fitness. Evaluate the nutritional status and needs of older adults. Monitor chronic illnesses. Monitor medication use. Monitor and accommodate sensory impairments. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Recommended Screenings and Exams for Health Promotion and Disease Prevention For All Older Adults  Complete physical: Annually  Blood pressure: Annually ➢  Blood glucose: Annually ➢  More often if diabetic or at risk Serum cholesterol: Every 5 years ➢  More often if hypertensive or at risk More often if at risk Fecal occult blood test: Annually Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Recommended Screenings and Exams for Health Promotion and Disease Prevention (Cont.) For All Older Adults  Sigmoidoscopy: Every 3 to 5 years OR  Colonoscopy: Every 10 years ➢    More often if high risk Visual acuity and glaucoma screening: Annually Dental exam: Annually for those with teeth; cleaning every 6 months (every 2 years for denture wearers) Hearing test: Every 2 to 5 years Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 Recommended Screenings and Exams for Health Promotion and Disease Prevention (Cont.) For All Older Women  Breast self-exam: Monthly  Clinical breast exam: Annually  Mammogram: Every 1 to 2 years if age 40 or older ➢  Pelvic exam and Pap smear: Annually

➢   Check with HCP if 74 years+ Check with HCP about discontinuation at 65 or older with three consecutive negatives exams and no abnormal in previous 10 years and not otherwise at risk Digital rectal exam: Annually with pelvic exam Bone density: Once after menopause ➢ More often if at risk Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Recommended Screenings and Exams for Health Promotion and Disease Prevention (Cont.) For All Older Men  Digital rectal exam and prostate exam: Annually  Prostate-specific antigen (PSA) blood test: Annually Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Immunizations for Older Adults http://www.cdc.gov/vaccines/schedules/downloads/adult/mmwradult-schedule.pdf. Immunizations for All Older Adults  Tetanus, diphtheria, pertussis: Every 10 years  Influenza (flu) vaccine: Annually  Pneumonia vaccine: Once after age 65

➢    Ask physician about booster every 5 years Hepatitis A and B: For those at risk Herpes zoster (shingles): One-time dose Varicella: If evidence of lack of immunity and significant risk for exposure Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 Encourage Physical Activity and Fitness  Physical activity … ➢ ➢ ➢ ➢ ➢ ➢   Improves functional status Reduces blood pressure and cholesterol Decreases insulin resistance Prevents obesity Strengthens bones Reduces falls Walking is one of best forms of exercise. Barriers: Pain, fatigue, lack of access to safe areas, impairment in sensory function and mobility Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 Assess Nutritional Status  Poor nutrition in older adults is common. ➢    Obesity in adults over 70 years and older has been increasing. Normal physiological changes related to aging affect nutritional status. Income, functional status, medications, social isolation, transportation, and dependence on others affect nutrition as well. Recommend myplate.gov for assessment of eating patterns. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 Nutrition Checklist for Seniors: Warning Signs of Poor Nutritional Health D isease E ating poorly T ooth loss/mouth pain E conomic hardship R educed social contact M ultiple medications I nvoluntary weight loss/gain N eed assistance in self-care E lder years (>80 years old) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 Monitor Chronic Illnesses     Chronic disease is the leading cause of death among persons 65 years and older. The prevalence of chronic disease increases with aging; many older adults have at least two chronic conditions. The most common conditions are arthritis, hypertension, and diabetes. Chronic illness is a major cause of disability and may cause limitations with activities of daily living (ADLs and IADLs). Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18 Monitor Medication Use       Older adults consume more than one third of all Rx drugs, as well as many OTC drugs and “folk” remedies. Age-related changes influence the effects of drugs. Polypharmacy may lead to drug interactions and dangerous adverse reactions.

Most emergency hospitalizations for adverse drug events are caused by a few commonly used medications. Closely monitor medication use in homes to ensure safety. Older adults should be educated about potential adverse reactions, including drug-drug and drug-food interactions. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19 Monitor and Accommodate Sensory Impairment  Visual impairment impacts social abilities, depression, falls, and communication. ➢  Hearing loss one of most common conditions affecting older adults. ➢   Cataracts, macular degeneration, diabetic retinopathy, and glaucoma Presbycusis and tinnitus Dental problems are neglected because of inadequate dental care, limited mobility and transportation, poor nutrition, myths, lack of finances and reimbursement. Incontinence affects quality of life and is a symptom of underlying problems. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20 Elder Safety and Security Needs      Falls Traumatic brain injury (TBI) Driver safety Residential fire-related injuries Cold and heat stress disorders    Elder abuse Crime Psychosocial disorders ➢ Anxiety disorders ➢ Depression ➢ Substance abuse ➢ Suicide ➢ Alzheimer’s disease Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 21 Alzheimer’s Disease Community Nursing – Senior health

   Slowly progressive brain disorder: begins with mild memory loss; progresses through stages to total incapacitation and eventually death. Diagnosing is difficult; often reached after all other conditions ruled out. Assessment tools include: ➢ Mini-Cog, MIS, and GPCOG ➢ Clock drawing  No cure and limited treatment options are available. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 22 Alzheimer’s Disease (Cont.)   Behavioral and physical changes create many challenges for caregivers. Management strategies include: ➢ ➢ ➢ ➢ ➢ Appropriate use of available treatment options Management of coexisting conditions Coordination of care among professionals and caregivers Participation in activities and adult day care programs Support groups and support services Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23 Spirituality    Involves “finding core meaning in life, responding to meaning, and being in relationship with God/Other” (Manning, 2013) Spirituality has health benefits—resilience Nurses should address spiritual needs and concerns as part of holistic care. ➢ Interventions include nurses’ presence, active listening, caring touch, reminiscence, prayer, hope, nonjudgmental attitude, facilitation of religious practices, referral to spiritual care experts. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 24 End-of-Life Issues  Patient Self-Determination Act (PSDA) Community Nursing – Senior health

➢ ➢ Federal law enacted in 1990 Requires health care facilities that receive Medicare and Medicaid funds to ask patients on admission if they possess advance directives. • Living wills • Durable power of attorney • DNR (do-not-resuscitate) order Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 25 Nurse’s Role in End-of-Life Issues      Discuss and educate patients about end-oflife issues. Inform other members of the health care team about advance directives. Make sure that the document is visible and accessible in the patient’s chart. Encourage patients to discuss their wishes with their family. Encourage patients to discuss with physician so it becomes part of medical record. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 26 • Name DQ Rubric 2019 • • Description Rubric Detail Levels of Achievement Criteria Proficient Competent Novice Introduction and quality of discussion’s Argument Weight 60.00% 100.00 % It is consistent with application in research related to its context. Clarity of ideas. Comprehensive, indepth and wide ranging. 70.00 % The topic has a partially weak association to clarity of ideas and related topic. Relevant but not comprehensive. 15.00 % Unable to address any part of the question and/or topic. Little relevance/some accuracy. Objectivity of Tone, overall quality & Review of Literature in APA 6th format within past 7 years Weight 10.00% 100.00 % Tone is consistent, addressed professionally and objectively. Evidence in literature supports arguments. 70.00 % The tone is not consistently objective. Some observations, some supportive evidence used. 15.00 % No objectivity in tone. No evidence of literature review provided. Lacks evidence of critical analysis, poor to no use of supportive evidence. Grammar / Writing Skills Weight 7.50% 100.00 % Excellent mechanics, sentence structure and organization with no grammatical mistakes. 70.00 % Some grammatical lapses , uses emotional responses in lieu of relevant points. 0.00 % Poor grammar, weak communication, lack of clarity. Peer Reply #1 Weight 7.50% 100.00 % Demonstrates an exceptional ability to analyze and synthesize student work, asks meaningful extending questions. 70.00 % Some ability to meaningfully comment on other students work and ask meaningful questions. 0.00 % No peer response Peer Reply #2 Weight 7.50% 100.00 % 70.00 % 0.00 % No Peer response Levels of Achievement Criteria Overall APA Use Weight 7.50% Proficient Competent Demonstrates an exceptional ability to analyze and synthesize student work, asks meaningful extending questions. Some ability to meaningfully comment on other students work and ask meaningful questions. 100.00 % Demonstrates an exceptional ability to apply 6th edition APA standards. 70.00 % Some ability to to apply 6th edition APA standards. i.e. use of in-text citation, reference structure, quoting,etc. Novice 0.00 % No adherence to 6th edition APA standards. . Community Nursing – Senior health