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.
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
- 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
- Health promotion: “The process of enabling people to increase control over and improve their
- 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
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
9. Create a homelike environment that respects the dignity of each person.
- 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
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
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 &
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
- 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
- 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.
Theoretical Perspectives on Aging
- 1. Biological theories of aging
- 2. Sociological theories of aging
- 3. Psychological theories of aging
Biological theories of Aging
- 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.
- Nonstochastic: predetermined, each cell has a life expectancy
- Programmed theory : biological clock, the assumption that cells only have so many days
- Neuroendocrine theory : damage to immunity caused by “free radical theory” stress
causes this damage to immunity.
- Emerging : theories based on research
- 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
- 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
- Nutrition awareness
- Physical fitness
- Stress management
Successful healthy aging:
Socialization and social skills:
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