nursing care for older adults

Chronological age

the number of years lived

Biological age

predicted by the person's physical condition and by how well vital organ systems are functioning.

Psychological age

indicated by the person's ability and control in regard to memory, learning capacity, skills, emotions, and judgement.

Social age

measured by age-graded behaviours that conform to an expected social status and social roles within a particular culture or society.

Stochastic theories

describe changes that occur because of errors within cells DNA, such as oxidative stress

Non-stochastic theories

describe changes that occur because of predetermined or preprogrammed processes

Health promotion

the process of enabling people to increase control over and to improve their health

Physical Changes of Aging

more susceptible to bruising, less muscle mass, decreased cardiac output, hearing loss, vision changes, arthritis, menopause, osteoporosis, incontinence, decreased immunity,

Ageism

the stereotype, prejudice, and discrimination directed towards people due to their age.

Strategies to reduce ageism

Policy and law, education, and intergenerational contact

Hearing Impairment

Limits a person's opportunity to be part of an interaction, and this can lead to a sense of not being engaged or involved in conversations

Communication

the most important ability of human beings as it allows us to express our thoughts, feelings, likes, and dislikes through verbal and nonverbal means.

Elderspeak

a form of ageism in which younger people alter their speech on the assumption that all older adults have difficulty comprehending what is said to them.

Home Care

care that is provided in home-based settings rather than in a hospital or a LTC home which allows individuals to remain independent in the community

types of home care

home care services & home support services

Home support services

focus on facilitating ADLs and include non-medical services

Public Health Nurse

schools, churches, community health centres, and homes

Home Health Nurse

home, school clinic, shelters, and street

Community Health

health centres

Aging at home/place

the ability to live in one's own home and community

Aging in the right place

the ability to live in a dwelling with the closest fit to the person's culture, identity, needs and preferences, which may or may not be one's home

4 Pillars for AIRP

Health Promotion/chronic disease management, home/community care/Unpaid caregiver support, accessible/safer living environments, and social connections/reduce loneliness

National Institute on Aging

a public policy and research centre based at TMU which is dedicated to enhancing successful ageing across the life course

Naturally Occurring Retirement Communities

a neighborhood, apartment house, or larger area occupied mostly by older people who have aged in place, but without having been planned specifically for this population

Values guiding ageing in place

equitability, empathy, engagement, dignity, self expression, strength based, team based with a multidisciplinary approach, competency, respect, stewardship, and innovative

Quality of Life (QOL) framework for Aging in Canada

Recognizes that aging at home requires a holistic effort and a broad range of services and support, should help people live fulfilling lives at home, and successful aging at home policy will lead to improved quality-of-life indicators for older persons living in the community

4 As

availability, affordability, accessibility, and accountability

policy domains

health, prosperity, society, environment, and good governance

Prosperity

Income insecurity so we should utilize government benefits to facilitate income security

Health

health care workers in the home to enhance palliative care and health promotion

society

Affordable housing with grants/programs that provide longer-term funding for housing and support for caregivers

environment

Technology access, digital literacy, age-friendly communities, and local public transportation

good governance

s enacting legislation on home care e.g. implemented national quality standards as is often done for LTC and s includes prevention of mistreatment/abuse and convention on the rights of older persons

Nursing Role in enabling healthy ageing

Invest in a new national public awareness campaign and broad disease prevention, health promotion strategy and action plan

LTC Continuum

Continuum of care and support ranging from home care and community support services to those being providing in designated care settings like LTC homes, nursing homes or retirement homes (

residences

assisted living centres, nursing homes, and chronic and long term care hospitals and the three main components of facility based long-term care include providing accommodations, hospitality services, and health services

Types of LTC facilities

Independent living and retirement living, and long-term care

chronic

continuing for a long time

Long-term care

provides for the physical and psychological needs of clients who are no longer able to function independently

comprehensive Care Model

IP team, family physician, community

chronic care model

primary care based, supporting complex needs of clients living with more than one chronic condition

Expanded Chronic Care Model

acknowledges association between home care and communities e.g. family supports

Community-based LTC

Nursing care, personal support, housekeeping or meal preparatio, respite or day programs, palliative care, OT or PT, provision of necessary medical equipment and supplies

PSWs

provide essential direct care and assist with ADLs

function of PSWs

Observe and report any changes to physical or mental health, monitor vital signs and report changes, may include medication administration, emotional and social support to maintain independence, and support infection control

Palliative Care

An approach to care focused on improving quality of life for both the patient with a life-threatening illness and their family.

Alternate-Level of Care

refers to when a patient is occupying a bed in a care setting (e.g., hospital) and does not require the intensity of resources/services provided

Resident Bill of Rights

ensure that residents of these homes receive safe, consistent, and high-quality resident-centered care in settings where residents feel at home, are treated with respect, and have the supports and services they need for their health and wellbeing.

The need for a paradigm shift

will create opportunities for LTC that better reflect and support the desires and preferences of Canadians to age in the right place

Culturally Competent Care

realization of a "gerontological explosion", impact of Cdn policies of multiculturalism (est. in 1971), and the recognition of health disparities for members of minorities

Gerontological explosion

rapid increases in number of older adults, and high proportion of older adults in most countries across the globe

Sustainable Development Goals

One billion more people enjoying better health and well-being, one billion more people benefiting from universal health coverage, and one billion more people better protected from health emergencies

Health disparities

the differences in disease burden between groups of people

Indigenous Peoples

Many older Indigenous peoples in Canada attended residential schools and are still experiencing lasting health effects

Intersectionality

considers the intersection of sources of inequity and older adults' multiple identities

Social isolation

objective lack of contacts, family, or friends

Loneliness

an unpleasant sensation felt when a person's social relationships are lacking in quality and/or quantity compared to what they desire

Risk Factors for loneliness

Age, egeing in place vs. independent/isolation, relationships, immigration → social disruption, access services, language, education, and gender

Impact of loneliness

Mood disorders, dementia, cardiovascular disease, malnutrition, falls and premature mortality

Sympathy

pity-based response to a distressing situation and is characterized by a lack of relational understanding and the self-preservation of the observer

Empathy

acknowledge suffering but to feel with the person and attempt to understand them in the process

Compassion

taking action to alleviate a persons suffering

Compassion Fatigue

A stress disorder characterized by gradual lessening of compassion over time.

Sexuality and the Older Adult

Stereotypes of older adults being asexual or less-than-sexual beings may cause personal embarrassment and stigma concerns for patients and providers

Variables

Age-related changes e.g. libido, changes in hormone levels e.g. estrogen and testosteroneedical co, and medical condition

Technology

causes concerns about the impact of loneliness on health to grow

Immigration

Older adults who are immigrants may experience worse health than their Canadian-born counterparts

healthy migrant effect

concept that recent migrants tend to be healthier than their native born counterparts

Integumentary System: Age-Related Changes

fewer nerve cells, reduced circulation, decrease in collagen, less subcutaneous fat, and reduced sweat glands

Neurological, Mood, & Behaviours: Age-related Changes

more difficulty learning new things, thinking is a bit slower, sleep pattern changes, and reaction time has increased

Sensory impairements with age

difficulty focusing on near objects; poor night vision; eyes are drier, decreased ability to hear high frequency sounds, less able to follow conversations, slower processing of auditory information, thicker earwax, tympanic membrane thins and stiffens, vestibular system may lead to dizziness, and sense of smell and taste have diminished

Respiratory: Age-related changes

Stiffer chest wall, less lung muscle strength, and harder to inflate the lungs, decreased gas exchange, decreased effective cough response and cough reflex, and easier to lose breath when working harder than normal, which leads to less ability to tolerate exercise

Cardiovascular: Age-related changes

The heart needs to work harder due to changes, including thicker heart muscles, stiffer arteries and heart valves, less cardiac reserve, which leads to more tiredness, shortness of breath, and a slow recovery from activity, and higher risk for a drop in blood pressure and light-headedness when changing positions

Musculoskeletal: Age-related changes

Less muscle mass & coordination, weakness and diminished exercise tolerance, less cartilage-forming cells, more joint damage, cartilage erodes, changes in how one stands, height, and range of motion (limited), more joint instability, less flexibility, and less mobility

Gastrointestinal: Age-related changes

Less able to taste and feel thirst, decrease lean body mass and water stores, risk of dehydration, less calories needed but same nutritional needs, decreased strength of chewing muscles & loose dentures can affect nutrition, dry mouth with decreased saliva, and swallowing muscles are less effective which causes risk of swallowing difficulty

Genitourinary (Kidneys): Age-related changes

Kidney size may decrease due to less blood flow causing reduced ability to regulate Na and H2O, higher risk of electrolyte imbalance, water retention in body, and dehydration, and renal function is usually adequate to meet demands, but may be challenged with illness, fever, and co-morbidities

Genitourinary (Bladder): Age-related changes

Decreased bladder capacity, incomplete emptying after voiding, may experience more frequent voiding and need to void at night, the sensation of needing to void maybe delayed, weaker pelvic floor muscles, decreased estrogen leading to tissue shrinkage and less lubricating secretions, shorter and vulnerable urethra, and larger prostate

Safety: Age-related Changes

Decreased immune response, increase risk for infection due to age related changes, reduced immunity, fever with infections is less likely, delay in elevated WBC with infection may occur, and less able to regulate heat

Appropriate polypharmacy:

medication therapy has been optimized and all medications are prescribed to achieve the therapeutic objective

Inappropriate polypharmacy

the use of more medications than are needed or using medications where the risk of harm outweighs the benefit

Deprescribing

the planned and supervised process of dose reduction or stopping of medication

Medication reconciliation

Comparing the prescribed medications to the medications the patient is actually taking which helps prevent adverse drug reactions that occur because of miscommunication at times of transition in care

Mobility

Refers to a person's ability to move about freely

Bedrest

an intervention that restricts patients to bed for therapeutic reasons

deconditioning

the loss of muscle strength from inactivity

immobility

decreases apetite causing deficiency in calories and protein and the body excretes more nitrogen than it ingests in proteins = negative nitrogen balance so thee is tissue catabolism, weight loss, decreased muscle mass, and weakness

GI effects due to immobility

difficulty in passing stools and over time, intestinal function becomes depressed, dehydration occurs, absorption ceases, and fluid and electrolyte disturbances worsen

effects of immobility on respiratory

Site of the blockage determines the severity and lung lobe or even whole lung may collapse and decreases oxygenation, prolong recovery, and add to discomfort

effects of immobility on cardiovascular

orthostatic hypotension, dizziness, light-headedness, nausea, tachycardia, pallor, or fainting with a change from lying/sitting to standing position

Muscle & Bone/MSK

Disuse atrophy, impaired calcium metabolism, and joint abnormalities

disuse atrophy

pathological reduction in normal size of muscle fibres

joint contracture

an abnormal and possibly permanent condition characterized by fixation of a joint

effects of immobility on GU

increased risk of UTi and renal calculi

Pressure injury

localized damage to the skin and/or underlying soft tissue as a result of prolonged ischemia

Braden Scale

sensory perception, moisture, activity, mobility, nutrition, friction and shear

Geriatric Syndromes

common clinical conditions that don't fit into specific disease categories but have substantial implications for functionality and life satisfaction in older adults

effects of Geriatric Syndromes

increased mortality, disability, decreased financial resources, longer hospitalization, and diminished quality of life

Frailty

when the ability of older adults to cope with everyday or acute stressors is compromised

Falls

Event which results in a person coming to rest inadvertently on the ground or floor or other lower level, with or without injury

Gait changes with aging

A narrower standing base, wider side to side swaying when walking, slower responses, greater reliance on proprioception, diminished arm swing, increased care in gait, and steps are slower