M&Y Communicating With Older People (Gen)

OBJECTIVES

  • At the end of the chapter, the reader will be able to:

    • Discuss concepts of normal aging.

    • Identify theoretical frameworks used in communicating with older people and their families.

    • Describe person-centred assessment strategies for older people.

    • Discuss supportive self-management care strategies with older people.

    • Describe person-centred care and communication strategies with people with cognitive impairment.

DEMOGRAPHY OF AGING

  • Older people represent the fastest-growing segment of the Canadian population, accounting for 15.6% of the population according to Government of Canada (2014).

  • The shift from fatal diseases to chronic diseases as the leading cause of disability and death.

  • Chronic diseases require long-term care and attention, necessitating coordinated care strategies (Institute of Medicine [IOM], 2008).

CONCEPTS OF AGING AND AGE-RELATED CHANGES

  • Aging is a universal life process characterized by numerous changes at various biological levels (da Costa et al., 2016).

    • Commonly, age 65 is identified as the start of late adulthood (Narang et al., 2013).

    • The age cohort classifications include:

    • Young old (65–74 years)

    • Old-old (75–84 years)

    • Oldest-old (85+ years) (Moody & Sasser, 2017).

  • 85% of individuals over age 65 will have at least one chronic disease; 50% will have more than one.

  • Chronological age is a straightforward measurement but does not encompass the social and psychological dimensions of aging (Moody & Sasser, p. 3).

PHYSIOLOGICAL CHANGES WITH AGING

  • Changes associated with aging:

    • Appearance changes, energy levels decrease.

    • Diminished organ function and weaker immune system.

    • Sensory losses and reduced functional capacity (e.g. mobility).

  • Increased recuperation time from injuries and illnesses due to diminished physiological reserve.

  • Wellness goals for older adults also include preventing significant functional loss (Gray-Micelli, 2017).

PSYCHOLOGICAL AND SOCIAL CHANGES

  • Changes in role responsibilities and life meaning can lead to reevaluation of time management for older people.

  • Positive changes may include life's transitions, such as becoming a grandparent, and the freedom to renew friendships and engage in meaningful activities.

  • Negative changes may involve loss of mobility, functional decline, social support, and increased financial stress.

CASE EXAMPLE

  • Pat:

    • A retired lawyer who volunteers at a library teaching English, thus deriving joy and enriching his life through social engagement.

SUCCESSFUL AGING

  • In Canada, healthy aging is defined as optimizing opportunities for physical, social, and mental health, allowing older individuals to actively participate in society without discrimination (Government of Canada, 2010).

  • Successful aging involves autonomy in decision-making, coping with daily life, living independently, and engaging in regular social interactions (Constanca, Ribeiro, & Teixeira, 2012).

  • Health promotion and social connections are vital components for thriving in later life.

  • Simulation Exercise 20.1 provides introspection on personal views of aging.

AGING AND HEALTH

  • Life expectancy projections: women at 88.8 years, men at 86.5 years. By 2030, approximately three-quarters of the population will be older adults (Government of Canada, 2014).

  • Aging increases the prevalence of chronic diseases and functional syndromes or “geriatric syndromes” which include:

    • Falls

    • Urinary incontinence

    • Pressure ulcers

    • Functional decline

    • Delirium (Brown-O’Hara, 2013; Gray-Miceli, 2017).

COMMUNICATION STRATEGIES FOR OLDER ADULTS

BARRIERS TO TREATMENT

  • Ageism, discrimination against older individuals, can manifest in health care decisions and access to treatments (Kagan, 2012).

  • Other barriers include navigating complex health systems and limited community resources, especially for dementia patients.

  • Older adults face increased emergency department visits and hospitalizations after age 65 (Canadian Institute for Health Information, 2016).

HEALTH ASSESSMENT

  • Older adults are increasingly health-conscious and better informed than previous generations.

  • Optimal health maintenance includes promoting social connectivity, physical activity, healthy eating, and minimizing risks of falls.

  • Barriers limiting health-promoting behaviors include socio-economic factors and personal circumstances (Kelly et al., 2017).

PSYCHOLOGICAL MODELS AND THEORETICAL FRAMEWORKS

ERIKSON’S EGO DEVELOPMENT MODEL

  • In later adulthood, ego integrity becomes the dominant psychosocial strength.

  • Ego Integrity: acceptance of one's life as necessary and meaningful, developed through self-reflection and social interaction.

  • Ego Despair: results from not accepting life's narrative, leading to emotional bitterness.

  • Wisdom represents the virtue of this stage, defined as a holistic understanding of life and the willingness to share knowledge (Erikson, 1980; Perry et al., 2015).

FUNCTIONAL CONSECQUENCES FRAMEWORK

  • A functional perspective helps assess individuals from high to low functioning.

  • Intervention focuses on promoting activities essential for self-regulation, such as self-care and mobility.

MASLOW'S HIERARCHY OF NEEDS

  • The model helps prioritize nursing actions, with physiological integrity at the base, followed by safety and security.

  • These basic concerns should be addressed before higher-order needs like love, belonging, esteem, and self-actualization (Maslow, 1954).

APPLICATIONS OF SELF-MANAGEMENT

  • Critical to chronic disease management plans, empowering individuals and families in managing health outcomes.

  • Introduces system level strategies and chronic disease initiatives (Health Council of Canada, 2012).

COMMUNICATION STRATEGIES IN ASSESSMENTS

  • New situations can induce confusion for older adults; addressing their needs requires sensitivity to avoid stereotypes associated with aging.

  • Family members can offer insights to provide context for health assessments, mitigating the anxiety of older patients.

  • Establish rapport and provide structured history-taking is vital for accurate assessment (Cenci, 2016).

ACCOMMODATING FOR SENSORY LOSS

  • Sensory changes like hearing and vision loss are common with aging and present challenges in health communication.

  • Hearing Loss Statistics: 10% of Canadians affected; 25% over 45; 50% over 65 (Connect Hearing, 2021).

    • Proactive strategies to minimize hearing loss effects include ensuring a distraction-free environment, clear speech, eye contact, and using hearing aids effectively.

    • Vision Loss: Common disorders like cataracts and glaucoma can dramatically affect quality of life.

    • Recommendations include using bright lighting, larger print materials, and regular eye exams.

COGNITIVE CHANGES AND DEMENTIA

  • Dementia, a progressive cognitive impairment condition, affects daily functioning of 50 million worldwide (World Health Organization, 2020).

  • Early assessment with tools like the Mini-Mental State Examination is crucial for identifying cognitive decline.

  • Common assessment challenges

    • Functional Status refers to the ability to perform ADLs and IADLs, which are vital for living independently.

PAIN MANAGEMENT IN OLDER PEOPLE

  • Pain is prevalent among older adults and often underreported due to misconceptions about aging.

    • Comprehensive pain assessment includes understanding quality, nature, and impacts of pain on the individual's life.

ELDER ABUSE AND ADVOCACY

  • Elder abuse, primarily neglect, involves mistreatment typically within caregiver relationships, necessitating vigilant reporting and intervention from nursing professionals.

    • Ensuring the rights of older people by helping them retain independence and access necessary care resources.

HEALTH PROMOTION STRATEGIES

  • Engaging older people in preventative and healthful practices such as nutrition, exercise, and social connectivity is essential for maintaining health (Budib et al., 2020).

  • Nurses must tailor health promotion initiatives to meet unique needs for different age groups, respecting individual preferences and cultural backgrounds.

SIMULATION EXERCISES 20.2-20.6

  • Extensive exercises to engage nursing students with practical scenarios reflecting the discussed theories, frameworks, and interventions pertaining to older adults.

SUMMARY

  • Older adults represent a growing segment of the population, with health being a priority that includes physical, social, and mental dimensions.

  • Communication with older adults, especially those with cognitive impairment, requires sensitivity, understanding, and specific strategies to promote dignity and enhance their overall quality of life.

  • As health care providers, nurses play a pivotal role in advocating for older adults and ensuring their needs are met effectively.