2270 WEEK 4

Healthy Aging and Person-Centred Care

Class Goals

  • Investigate the impact of loneliness and social isolation on the health and well-being of older adults.

  • Promote understanding of person-centred care which encompasses empathy, compassion, and therapeutic relationships in nursing practice.

  • Illustrate how social determinants shape the health of older adults.

  • Describe the specific impact of COVID-19 on older adults, especially within marginalized or vulnerable populations.

  • Explore the issues of sexuality in older adulthood.

  • Identify strategies aimed at reducing health disparities and promoting cultural safety.

Multiculturalism in Canada

  • Is Canada Multicultural?

    • Official multicultural policies were established federally in 1971.

    • The Canadian Charter of Rights and Freedoms adopted in 1982 upholds these policies.

    • Canada's population is quickly becoming more diverse with projections indicating that by 2036:

    • 25% - 30% will be immigrants.

    • 35% - 40% of the population will belong to visible minorities.

    • 30% of Canadians over the age of 65 are immigrants.

Relevance of Cultural Considerations

  • The need for cultural awareness in health care is increasingly recognized in Canada.

  • The importance of culturally competent and culturally safe health care systems is underscored, particularly in gerontological nursing due to the prevalence of older adult immigrants in Canada.

  • Culturally competent care is integral to the framework of person-centred care.

Culturally Competent Care in Gerontology

  • Interest in culture within gerontological nursing has become prominent due to:

    • The realization of a “gerontological explosion,” indicated by rapid increases in the number of older adults globally.

    • The impact of Canadian multiculturalism policies established in 1971.

    • Acknowledgment of health disparities among minority groups.

Gerontological Explosion

  • Defined as a swift rise in the number of older adults and a high proportion of older individuals in many countries.

Cultural Sensitivity and Competence

  • Nurses are expected to provide competent care while recognizing that life experiences, cultural perspectives, values, languages, and communication styles may differ.

  • Cultural sensitivity begins with an awareness of one’s own ethnocentrism.

  • Effective nursing requires cultural competence, which involves:

    • Understanding ethnicity, culture, language, and health belief systems.

    • Acquiring skills for optimal intercultural communication.

Global Health Context

  • Sustainable Development Goals (SDGs) aim to improve health for billions by 2023 through:

    1. One billion more individuals enjoying better health and well-being.

    2. One billion more people benefiting from universal health coverage.

    3. One billion more individuals better protected from health emergencies.

WHO Healthier Population Index Indicators

  • Progress towards SDG health targets is gauged using specific indicators:

    • Clean air.

    • Safe water.

    • Sanitation and infrastructure such as roads.

    • Issues surrounding tobacco, alcohol, obesity, domestic violence, child nutrition and development, trans-fats, and mental health.

COVID-19 Impact on Older Adults

  • Global data indicates no significant gender differences in the number of COVID-19 cases.

  • The mortality rate increases with age, peaking among those aged 80 years and older.

COVID-19 Statistics (as of May 1, 2021)

  • The 20 most affected high-income countries (HICs) account for:

    • 45% of global COVID-19 cases.

    • 12.4% of the worldwide population.

  • A transition in the distribution of cases and deaths is observed, shifting from high-resource to lower-resource settings.

Factors Contributing to Shifts in Distribution

  • Unequal vaccine distribution magnified by the emergence of new variants increases risk for lower-resourced environments.

  • Historical inequalities in healthcare access exacerbate vaccine disparities and perpetuate the pandemic, further entrenching existing inequalities.

Client Scenario

  • Client X: A single adult presenting with new onset symptoms of fatigue and shortness of breath.

    • Discussion point regarding potential steps to take and preventative measures.

Health Disparities Overview

  • Definition: Health disparities denote differences in disease burden among various groups.

  • A significant concern in Canadian health policy for over 45 years.

  • Common groups experiencing health disparities include:

    • Minorities.

    • Indigenous peoples.

    • LGBTQ communities.

    • Lower socioeconomic classes.

    • Individuals with disabilities.

Economic Status and Health

  • Economic status is identified as a primary social determinant contributing significantly to health disparities:

    • Members of visible minorities tend to face higher poverty rates.

    • Indigenous peoples and visible minorities particularly experience worse health outcomes.

Health Disparities and Older Adults

  • Among ethnic minorities:

    • Approximately 23% speak a mother tongue other than English/French (higher among older Canadians).

    • Cultural values and beliefs can significantly affect seeking healthcare.

    • Barriers include lack of interpretation services and culturally-specific programs.

    • Insufficient healthcare providers who comprehend diverse cultural needs.

Immigration and Health

  • Older adult immigrants often report poorer health compared to Canadian-born individuals.

  • Notably, a phenomenon termed the "healthy migrant effect" exists where recent immigrants generally exhibit better health than long-term immigrants, attributed to more favorable Canadian immigration policies.

Indigenous Health Considerations

  • A considerable number of older Indigenous peoples attended residential schools and continue to suffer long-term health impacts, including:

    • Chronic health conditions.

    • Mental health challenges.

    • Poor self-rated health outcomes.

  • Approximately 80,000 residential school survivors exist within Canada.

  • Additional experiences involve disruptions from the child welfare system, leading to intergenerational trauma.

Health Policy Implications

  • Health policies critically affect population health.

  • The impacts are inequitably distributed among:

    • Visible minorities.

    • Individuals living alone.

    • Females and those with lower education.

    • Sexual and gender minorities.

  • Among older adults, poverty rates are disproportionately higher for individuals identifying as visible minorities (20% poverty) and those living alone (13% poverty).

  • Solutions to disparities necessitate political will and an intersectional approach.

Intersectionality in Health Disparities

  • Mitigating health disparities mandates a focus on their root causes.

  • An intersectional approach evaluates various inequity sources and the multifaceted identities of older adults, which may include:

    • Age.

    • Race.

    • Ethnicity.

    • Indigeneity.

    • Gender identity.

    • Sexual orientation.

    • Language diversity.

    • Disability status.

    • Religious beliefs.

  • This concept acknowledges power dynamics that sustain inequities and highlights individual experiences.

Implications for Nursing Practice

  • Increased awareness regarding biases necessitates openness and self-reflection among nursing professionals.

  • Reflection Questions:

    • Do you recognize any personal biases?

    • Understanding that every individual possesses biases.

  • Embrace person-centred and culturally competent care principles.

  • Adopt practices infused with humility and compassion.

Loneliness and Social Isolation

  • Truth Regarding Loneliness:

    • Ageist views have contributed to rising loneliness figures.

    • Social media can distort perceptions of loneliness.

    • Individuals reporting loneliness often lack significant, meaningful relationships with others.

    • Objective assessments indicate a lack of contacts, family, or friends.

Definitions

  • Social Isolation: The objective absence of social contacts, family, or friends.

  • Loneliness: A subjective, unpleasant sensation experienced when one's social relationships lack either quality or quantity compared to personal desires. It encompasses complex feelings relating to the absence of intimate and social needs.

Loneliness versus Solitude

  • Loneliness differs from solitude, as the former denotes an undesirable state caused by insufficient social interaction while the latter can be a positive, chosen state.

Health Impacts of Loneliness and Social Isolation

  • Research equates the health impacts of social isolation and loneliness with other major health-related risk factors:

    • Smoking.

    • Inadequate physical activity.

    • Obesity.

    • Substance abuse.

    • Increased risk of injury and violence.

    • Lack of access to healthcare.

  • Findings imply that older adults facing these conditions may have reduced survival rates.

The Bi-Directional Nature of Loneliness and Health

  • The relationship between loneliness and health is bi-directional:

    • Poor health can exacerbate feelings of social isolation and loneliness.

    • Conversely, social isolation and loneliness can lead to negative health outcomes.

  • Social isolation and loneliness are increasingly acknowledged as critical public health issues.

Elderly Population Risk

  • Most at Risk Group:

    • Older adults, with 41% of Canadians aged 50 years and older at risk of social isolation, and up to 58% having experienced loneliness (as per NIA).

    • Factors contributing to diminishing traditional social support include:

    • Retirement.

    • Widowhood.

    • Death of friends or family.

    • Declining physical health, mobility, and chronic conditions like incontinence and sensory impairments.

Health Outcomes Related to Loneliness

  • People experiencing loneliness tend to report negative physical, mental, and financial health states.

  • The existence of a Ministry of Loneliness in the UK and warnings from the U.S. Surgeon General underscore increasing recognition of the issue.

Importance of Relationships

  • Healthy relationships serve as the foundation for emotional and physical well-being.

  • Loneliness represents a paradox; those feeling lonely often hesitate to disclose their feelings, which inhibits possible solutions.

  • Reference to "Hidden Brain Relationships 2.0: An Antidote to Loneliness" indicates sharing experiences as part of addressing loneliness.

Role of Technology

  • The rise in technology usage brings both opportunities and challenges in the context of loneliness:

    • Technology can facilitate connection when used positively, e.g., video calls vs. in-person interactions.

    • Potential for superficial connections versus meaningful relationships.

Risk Factors for Loneliness

  • Key risk factors include:

    • Age.

    • Choices regarding aging in place versus independence or isolation.

    • Relationships.

    • Immigration pitfalls such as social disruption, access to services, and language barriers.

    • Education level.

    • Gender dynamics.

Health Impact Overview

  • Loneliness and social isolation correlate strongly with negative health outcomes:

    • Mood disorders.

    • Dementia.

    • Cardiovascular diseases.

    • Malnutrition.

    • Increased risk of falls.

    • Premature mortality.

  • Associated behaviors may include:

    • Physical activity levels.

    • Nutritional habits.

    • Sleep patterns.

    • Substance use patterns.

Mental Health Considerations

  • Increased risks for:

    • Depression.

    • Anxiety.

  • Social networks influence cognitive health and associated decline.

Technology and Health Care

  • Discussion regarding the potential role of robots and AI in long-term care (LTC):

    • Pros and cons of AI replacing human nurses.

    • Introduction of AI entities, such as "Louise" or "Elizabeth," as virtual nurses.

Therapeutic Relationships in Nursing

  • The therapeutic nurse-patient relationship is built on key trust components, inclusive of:

    • Human touch.

    • Collaborative effort in care.

  • Emphasis on the necessity for clarity and compassion in communication.

Addressing Ageism in Nursing

  • Consideration of personal fears regarding aging prompts reflection on humility and shared humanity.

  • Engagement with the concepts of compassion versus empathy versus sympathy in patient care.

Distinctions among Compassion, Sympathy, and Empathy

  • Compassion:

    • Involves emotional engagement and understanding suffering, necessitating action to alleviate the suffering as perceived and desired by the other person.

  • Empathy:

    • Entails recognizing and sharing in another person's suffering, though it may also bear conditional aspects.

  • Sympathy:

    • Defined as a perspective of pity that fails to engage relational understanding, serving more for the observer's comfort without aiding the suffering individual.

Compassionate Nursing Practice

  • Focus areas include:

    • Compassionate and empathetic treatment during care with older adults.

    • Patients possess a keen sense regarding caregiver presence and attitudes.

    • Reflective questions regarding patient-nurse interactions and engagement.

The Art of Listening

  • Emphasize the intrinsic value of attentive listening, goes beyond mere compliance:

    • Listening constitutes half of the conversational exchange; lack of perceived attentiveness may inhibit information sharing.

    • Cultural examples highlight listening as a vital gift to provide.

    • Encourage open-mindedness and non-judgmental listening, creating space for patients' stories.

Compassion Fatigue in Health Care

  • Historical context depicts healthcare as complex and exhausting, resulting in potential burnout among caregivers:

    • Considerations that compassion could be a finite resource are challenged.

    • Evidence underlining that compassion can be a renewable resource rather than a finite one.

    • Utilizing compassion effectively can facilitate rejuvenation in various healthcare settings.

Practices of Presence

  • Engage in intentional presence through simple acts of kindness:

    • Recognize the impact even small gestures can make in reconnecting with oneself and the patients.

Sexuality and the Older Adult

  • Challenge ageist constructs that suggest older adults transition away from sexuality or become asexual:

    • Limited research primarily focuses on heterosexual white males.

    • Stereotypes portraying older individuals as devoid of sexual interest may evoke stigma for both providers and patients.

  • Developmentally, significant choices arise regarding sexual initiation and cessation as one ages.

Variables Impacting Sexuality

  • Factors influencing sexual health in older adults include:

    • Age-related hormonal changes, specifically levels of estrogen and testosterone.

    • Medical conditions that may affect sexual function.

    • Studies demonstrate that the sexual quality of life can improve with age, countering ageist notions of sexual decline.

Attitudes Toward Sexuality in Care Settings

  • Staff attitudes toward sexual health and expression are crucial in long-term care settings, particularly when considering decisions of cognitively intact versus impaired residents.

  • Many older adults maintain interest in sexual activity despite stereotypes to the contrary.

Factors Influencing Sexual Intimacy

  • Location and environment can significantly affect opportunities for sexual intimacy, especially for older LGBTQ adults.

  • Complications arise surrounding cognitive impairments, which can affect consent and sexual function.

Conclusion

  • It is essential for healthcare providers to actively address sexuality and gender diversity in aging, equipping themselves to handle the multifaceted aspects of sexual expression among older adults.

  • Strategies to overcome implicit biases are crucial for fostering inclusive and supportive environments for all patients.

Note: Adopting these considerations into nursing practice will lead to better outcomes for older adults, emphasizing the need for culturally competent, empathetic, and compassionate care across various healthcare settings.