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Older Adult Midterm I: Textbook, videos and lectures Summary

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NURS 1700U
A.De La Rocha

Older Adult Midterm 1 Notes February 14 - 90 minutes - 35 multiple choice questions - 5 short answer questions. - Sessions 1 to 5. - Review all readings and PowerPoints as well as handouts. Session 1 Terminology Geriatrics: branch of medicine dealing with physiological and psychological aspects of aging with diagnosis and treatments of diseases affecting older adults (Potter and Perry p. 378) Geronic nursing: nursing care of the older adults to be the art and practice of nurturing,  caring, and comforting rather than merely the treatment of disease.  Ageism: Butler (1969) defined ageism as “the prejudices and stereotypes that are applied to older people sheerly on the basis of their age…” This definition pigeonholes people and does not allow them to be individuals with unique ways of living their lives. Gerontological Nursing: Nursing—assessment of health and functional status of older  adults, diagnosis, planning, implementing and evaluating the effectiveness of such care. Gerontology: is study of all aspects of the aging process and its consequences Old age security pension: Canadian federal govt. pension provided to persons aged 65 and older who have lived in Canada for at least 10 years. Ebersole Textbook Notes - Psychologists have divided the “old” into three groups: the young­old, roughly 65 to 74 years  old; the middle­old, 75 to 84 years old; and the old­old, those over 85. A fourth group of persons,  those aged 100 years and older (centenarians), is growing rapidly.Currently, about 1.5% of the  population in Canada is at least 100 years old.  - The proportion of the population aged 65 and older has been steadily increasing since the early  1970s; this is because of a relatively low fertility rate of about 1.6 children per woman, and an  increased life expectancy in the 1900s. - Female Canadians born today have a life expectancy of 83 and males of 78.3 years - The proportion of the population is expected to increase dramatically as baby boomers born  between 1946 and the early 1960s age - Cohort = those born within the same decade and country and may share a common historical  context ex. men born between 1920 and 1930 were very likely to have been active participants in  WWII or the Korean War - Women born between 1920 and 1930 were raised with traditional values and roles and may  have never worked outside the home, or, been limited to housekeeping, teaching and nursing - In contrast, women born between 1940 and 1950 experienced social pressure to work outside  the home, and had more career opportunities as adults, partially as a result of the feminist revolution of  the 1960s and 1970s - Women usually live longer than men and live alone after widowhood - Men who survive their wives often remarry - The number of Aboriginal older adults is predicted to double by 2017 - Determinants of health: Recignized in 1974 by Marc Lalonde; socioeconomic, environmental,  and biological factors are equally/more important than health care in their influence on the health of the  Canadian population. - Health Canada has identified 12 key determinants: income and social status; social support  networks; education and literacy; employment and working conditions; social environments; physical  environments; personal health practices and coping skills; physical environments; personal health  practices and coping skills; healthy child development; biology and genetic endowment; health  services; gender; and culture. - Primary health care principles: accessibility, public participation, health promotion, appropriate  technology, and intersectoral collaboration - Accessibility: Health services are available to all Canadians regardless of age or geographic  location - Health promotion: “The process of enabling people to increase control over and improve their  health (CNA)” - Public participation: In gerontological nursing = individual older persons and their  communities are “active partners in making decisions about their health care and the health of their  communities” - Appropriate technology: “Includes methods of care, service delivery, procedures and  equipment that are socially acceptable and affordable” - Intersectorial collaboration: “Recognizes that health and well­being are linked to both  economic and social policy, experts in the health sector working with experts in other sectors (ex.  education, housing, employment, immigration); health professionals from various disciplines  collaborate and function interdependently to meet needs of Canadians - Older adults comprise 60% of medical­surgical patients and 46% of critical care patients  (Mezey, Stierle, Huba, et al., 2007). This means that all nurses working in acute care settings need to be  knowledgeable about aging and gerontological nursing.  - Exacerbations of persistent, chronic illnesses and injuries are often the cause of hospitalizations  for older adults. Older adults who experience episodic or acute illnesses frequently have multiple  persistent conditions and comorbidities and present many care challenges (Benedict, Robinson, &  Holder, 2006). Hospitals are dangerous places for older persons: 34% experience functional decline,  and iatrogenic complications occur in as many as 29 to 38%, a rate 3 to 5 times higher than in younger  patients (Inouye, Baker, & Leo­Summers, 2000; Kleinpell, 2007). Common iatrogenic complications  include functional decline, new­onset incontinence, malnutrition, pressure ulcers, drug interactions and  adverse effects, delirium, and falls.  - the majority of older adults live in the community. Only about 6% of older adults at any given  time reside in LTC Goals of Long­Term Care 1. Provide a safe and supportive environment for chronically ill and functionally dependent  people. 2. Restore and maintain the highest practicable level of functional independence. 3. Preserve individual autonomy. 4. Maximize quality of life, well­being, and satisfaction with care. 5. Provide comfort and dignity at the end of life for older persons and their families. 6. Provide coordinated interdisciplinary care to subacutely ill persons who plan to return to home  or a less restrictive level of care. 7. Stabilize and delay progression, when possible, of chronic medical conditions. 8. Prevent acute medical and iatrogenic illnesses and identify and treat them rapidly when they do  occur. 9. Create a homelike environment that respects the dignity of each person. Jean Watson - Jean Watson: University of Colorado degree in nursing and psychology, masters in psychiatric­ mental health nursing, PhD in educational psychology and counseling - Founder of the Centre for human caring in Colorado - Major elements of her theory: Carative Factors, Clinical Caritas Processes, transpersonal caring  relationship, the caring occasion/caring moment - Presmises and values:  oDeep respect for the wonders and mysteries of life. oAcknowledgment of a spiritual dimension t lif and internal power of the human care process,  growth, and change. oA high regard and reverence for a person and human life. oNonpaternalistic values that are related to human autonomy and freedom of choice. oA high value on the subjective­internal world of the experiencing person and how the person  (both patient and nurse) is perceiving and experiencing health­illness conditions. oAn emphasis is placed upon helping a person gain more self knowledge self­control, and  readiness for self­healing, regardless of the external health condition. oThe nurse is viewed as a co­participant in the human care process. oThere is an expanded view of the person and what it means to be humans­fully embodied, but  more than body physical; an embodied spirit; a transpersonal, transcendent, evolving  consciousness; unity of mindbodyspirit; person­nature­universe as oneness, connected. oAcknowledgment of the human­environment energy field­life energy field and universal field of  consciousness; universal mind. oPositing of consciousness as energy; caring – healing consciousness becomes primary for the  caring­healing practitioner. oCaring potentiates healing , wholeness. oCaring healing modalities (sacred feminine archetype of nursing) have been excluded from  nursing and health systems; their development and reintroductions are essential for postmodern,  transpersonal, caring­healing models and transformation. oCaring –healing processes and relationships are considered sacred. oUnitary consciousness as the worldview and cosmology, ie, viewing the connectedness of all. oCaring as a moral imperative to human and planetary survival. oCaring as a converging global agenda for nursing and society - A high value is placed on the relationship between the nurse and the person. -  Curative = curing patients, carative = distinct, caring aspect - Caring is not transmitted from generation to generation by genes, but is transmitted by the  culture of the profession as a way of coping with its environment - A caring environment is one that offers the development of potential while allowing the person  to choose the best action for himself at any given point in time (p 9) - The practice of caring is central to nursing - Transpersonal caring relationship: Goes beyond the objective assessment - Caring occasion/caring moment: “According to Watson (1988b, 1999), a caring occasion is  the moment (focal point in space and time) when the nurse and another person come together in such a  way that an occasion of human caring is created.  Both persons , with their unique phenomenal fields,  have the possibility to come together in human­to­human transactions.” - Caring consciousness is essential for the connection. mutuality between the two individuals The 10 carative factors: 1. The formation of a humanistic­altruistic system of values 2. The installation of faith­hope 3. The cultivation of sensitivity to one’s self and to others 4. The development of a helping­trust relationship 5. The promotion and acceptance of the expression of positive and negative feelings 6. The systematic use of the scientific problem­solving method for decision making 7. The promotion of interpersonal teaching­learning 8. The provision for a supportive, protective, and (or) corrective mental, physical, sociocultural,  and spiritual environment 9. Assistance with the gratification of human needs 10. The allowance for existential phenomenological forces - The development of a helping­trust relationship is closely related to the promotion and  acceptance of the expression of positive and negative feelings Clinical Caritas Processes (Ontological competencies) - Practice of loving kindness and equanimity within the contest of caring consciousness  - Being authentically present and enabling and sustaining the deep belief system and subjective  life world of self and one being cared for - Cultivation of one’s own spiritual practices and transpersonal self, going beyond ego self,  opening to others with sensitivity and compassion - Developing and sustaining a helping­trusting, authentic caring relationship - Being present to, and supportive of, the expression of positive and negative feelings as a  connection with deeper spirit of self and the one being cared for  - Creative use of self and all ways of knowing as part of the caring process; to engage in the  artistry of caring­healing practices - Engaging in genuine teaching­learning experience that attends to unity of being and meaning,  attempting to stay within others’ frames of reference - Creating a healing environment at all levels (a physical and non­physical subtle environment of  energy and consciousness) - Assisting with basic needs, with an intentional caring consciousness, administering human care  essentials which potentiate alignment of mind­body­spirit - Opening and attending to spiritual­mysterious and existential dimensions of one’s own life­ death; soul care for self and the one being cared for  CGNA Competencies and Standards of Practice Standard I: Physiological Health Gerontological nurses assist clients to maintain homeostatic regulation through assessment and management of physiological care to minimize adverse events associated with medications, diagnostic or therapeutic procedures, nosocomial infections, or environmental stressors. Standard II: Optimizing Functional Health Gerontological nurses promote older adults to optimize functional health that includes an integration of abilities that involve physical, cognitive, psychological, social, and spiritual status (AACN & Hartford, 2000). Standard III: Responsive Care Gerontological nurses provide responsive care that facilitates and empowers client independence through life course changes. A responsive care approach recognizes that certain behaviours are not necessarily related solely to pathology, but instead may be related to circumstances within the physical or social environment surrounding well older persons and those with dementia and may be an expression of unmet need (Wiersman & Dupuis, 2007). Standard IV: Relationship Care Gerontological nurses develop and preserve therapeutic relationship care. Relationship- centred care is an approach that recognizes the importance and uniqueness of each health care participant's relationship with every other and considers these relationships to be central in supporting high-quality care, a high-quality work environment, and superior organizational performance (Safran, Miller & Beckman, 2006). Standard V: Health System Gerontological nurses are aware of economic and political influences by providing or facilitating care that supports access to and benefit from the health care delivery system. Systems to support and sustain practice changes should be in place, including ongoing education, policies and procedures, and job descriptions (Crandall, White, Schuldheis & Talerico, 2007). Standard VI: Safety and Security Gerontological nurses are responsible for assessing the client and the environment for hazards that threaten safety, as well as planning and intervening appropriately to maintain a safe environment (Potter, Perry, Ross-Kerr, & Wood, 2009). Source: Canadian Gerontological Nursing Association. (2010). Gerontological Nursing Competencies and Standards of Practice. Vancouver: Author. specific reference to care of older adults, recognizing that this population comprises the majority of patients in acute, home, and LTC facilities. The American Association of Colleges of Nursing (AACN) has established supplementary competencies for nursing care of older adults to complement standards for baccalaureate nursing education (AACN, 2010).  Aging Canadians (Health Canada Document) - The challenges of an aging Canadian society will require continued efforts to: oimprove health, well-being and independence in later life; ofacilitate the participation of older Canadians in economic and social life; ostrengthen the supportive environments within communities; and, osustain government programs benefiting Canadians of all ages. Older Adult Facts & Myths - Most seniors are women, and this is especially so in the ‘oldest of old’ age groups. In 2005, women accounted for 52% of ages 65-69 and almost 75% of ages 90+. - The majority of older adults do not live in Long Term Care Homes. According to the 2001 Census, 93% of seniors live in private households while only a small proportion (7%) live in Long Term Care Homes or hospitals. - Canada’s population is aging. From 1981 - 2005, the number of seniors in Canada increased from 2.4 to 4.2 million, and portion of the total population increased from 9.6% to 13.1%. - Dementia can be defined as the progressive decline in cognitive function due to damage or disease in the brain beyond what might be expected from normal aging. The most common form of dementia is Alzheimer’s disease. Alzheimer’s disease is not a normal part of aging. While age is the most significant known risk factor for Alzheimer’s disease, most people in fact do not develop the disease as they age. - According to Statistics Canada’s Report, A Portrait of Seniors in Canada, younger people are more likely to report that they felt sad or depressed than older age groups. - According to the Statistics Canada’s A Portrait of Seniors in Canada, older adults report more positive assessments of their finances than individuals in younger age groups. - Over the last decade the number of older adults working in paid employment settings has increased. - The proportion of people who volunteer their time to charities or other non-profit organizations tends to decline with age. - Seniors were three times less likely than non-seniors to experience victimization - If you have an older relative with Alzheimer’s Disease, you are not necessarily going to develop the disease yourself. - Gambling is as common an occurrence among older Ontario adults as it is among younger adults - The majority of older adults do not live alone. The majority of older adults live with a spouse, with children or grandchildren, or in a collective dwelling - The majority of older adults do not live below the poverty line. Session 2 Theoretical Perspectives on Aging - 1. Biological theories of aging - 2. Sociological theories of aging - 3. Psychological theories of aging Biological theories of Aging Stochastic theories - Accumulation of errors, change in DNA - Wear and tear theory : cells wear out over time, internal and external stressors. Harmful effects, cells may die, stress may cause errors. For example runners/swimmers wearing out knees and shoulders - Cross linkage theory : cells stiffen due to glucose and proteins present. for example skin becomes dry - Free radical theory : unpaired ions, extra charge, free to attach to other molecules. This causes damage, as a young person you can neutralize this but older adults cannot. For example smog and pesticides. Non-stochastic theories - Nonstochastic: predetermined, each cell has a life expectancy - Programmed theory : biological clock, the assumption that cells only have so many days to live - Neuroendocrine theory : damage to immunity caused by “free radical theory” stress causes this damage to immunity. - Emerging : theories based on research Sociological theories - Sociological theories of aging attempt to explain and predict changes in roles and relationships in middle and late life, with emphasis on adjustment - Activity theory: remaining as active as possible, the better you will age - Disengagement theory: not accepted anymore, thought that older adults let go for equilibrium - Continuity theory: continue to live the same lifestyle as they age - Symbolic interaction theory: aging as a result of interaction with environment - Age-stratification theory: having something in common - Social exchange theory: giving back to family and or community - Modernization theory: explanation of how older adults are devalued due to tech advances Psychological theories of aging - Jung : aging process of inner discovery, in the later half of life, more time to reflect, have self- awareness. A persons personality become extrovert - Erickson : later age group wanting to contribute more to society - Peck : Integrity of a person. Ego VS Work - Maslow : medical model, pyramid, list of needs. Developmental tasks for older adults - - Adjusting to decreasing health and - physical strength Maintaing satisfactory living arrangements - Adjusting to retirement and reduced or - fixed income Redefining relationships with adult children - Adjusting to death of a spouse - - Accepting self as aging person Nursing Theory ­ How to Support the Process of Ageing (Article) - An important purpose of theories is to challenge practice, create new approaches to practice and remodel the structures of rules and principles - Most nursing theorists see human aging from a developmental perspective, but do not discuss what aging implies. In only a few theories are some important aspects of nursing care of older people discussed, but no concrete instructions are given on how to apply these to nursing care - There is a need to develop a nursing care model that takes into consideration of human aging Session 3 Healthy aging - Self-responsibility - Nutrition awareness - Physical fitness - Stress management Successful healthy aging:  - S ocial - B iological - P sychological - S piritual - C ultural - E nvironmental FANCAPES: Fluids: Aeration: Nutrition: Communication: Activity: Pain: Elimination: Socialization and social skills: Functional Assessments Katz Index ACTIVITIES (0  INDEPENDENCE (1 point) DEPENDENCE (0 points) or 1 point) NO supervision, direction, or  WITH supervision, direction,  personal assistance personal assistance, or total care   (1 point) Bathes self completely or  (0 points) Needs help with bathing  Bathing needs help in bathing only a single  more than one part of the body, or  part of the body (i.e., back, genital  getting in or out of the tub or shower.  area, or disabled extremity). Requires total bathing. Dressing (1 point) Gets clothes from closets  (0 points) Needs help with dressing  and drawers and puts on clothes and  or needs to be completely dressed. outer garments complete with  fasteners. May have help tying shoes. Toileting (1 point) Goes to toilet, gets on and  (0 points) Needs help transferring to  off, arranges clothes, cleans genital  the toilet or cleaning self, or uses 
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