Word College of Legazpi

College of Nursing and Midwifery

Legazpi City
Tel # (052) 4801239

Course Syllabus in Elective II 2020 – 2021

COLLEGE : School of Nursing

COURSE : Care of Older Adult
COURSE NUMBER : NCM 114
COOURSE DESCRIPTION: It deals with the concepts, principles, and techniques of
nursing care management of those with chronic illness and the older persons
COURSE CREDIT : 2 units lecture (36 hours), 1-unit RLE (51 hours)
PLACEMENT : Third Year, Second Semester
PRE – REQUISETS : NCM 113, Biochemistry, Anatomy & Physiology, Microbiology &
Parasitology, Nutrition with Diet Therapy, Nursing Informatics.
INSTRUCTOR : Ma. Luz M. Maristela MAN, RN.

PROGRAM OUTCOMES :

1. Apply knowledge of physical, social, natural and health sciences and humanities in
the
practice of nursing.
2. Perform safe, appropriate, and holistic care to individuals, families, population
groups,
and community utilizing nursing process.
3. Apply guidelines and principles of evidence – based practice in the delivery of care.
4. Practice nursing in accordance with existing laws, legal, ethical, and moral principles.
5. Communicate effectively in speaking, writing and presenting using culturally –
appropriate language.
6. Report/ document client care accurately and comprehensively.
7. Collaborate effectively with inter-, intra-, and multi-disciplinary and multi-cultural
teams.
8. Practice beginning management and leadership skills using systems approach in the
Delivery of client care
9. Conduct research with an experienced researcher.
10.Engage in lifelong learning with a passion to keep current with national and global
developments in general, and nursing and health developments in particular.
11.Demonstrate responsible citizenship and pride in being a Filipino.
12.Apply techno – intelligent care systems and processes in health care delivery.
13.Uphold the nursing core values in the practice of the profession.
14.Apply entrepreneurial skills in the delivery of nursing care.

LEVEL OUTCOME : At the end of the third year, given individuals, families, population
groups, and communities with physiologic and psychosocial health problems and
maladaptive patterns of behavior in varied health care settings, the students
demonstrate safe, appropriate and holistic care utilizing the nursing process.

COURSE OUTCOME : At the end of the course and with given relevant situations or
conditions, the learners will be able to:

1. Apply knowledge of physical, social, natural, health sciences and gerontological

nursing concepts.
2. Perform safe, appropriate, and holistic care to individuals, families, population
groups,
and community utilizing nursing process in the care of the older person
3. Apply guidelines & principles of evidence –based interventions in the care of the older
person.
4. Practice in accordance with existing laws, legal, moral principles & ethical aspects in
the care of the older person.
5. Communicate effectively in speaking, writing & presenting culturally – appropriate
Language during actual patient care and health education.
6. Report or document client care accurately, comprehensively & efficiently.
7. Collaborate effectively with the other health care teams.
8. Use appropriate strategies to plan for health programs and nursing service.
9. Conduct research with an experienced researcher.
10.Take responsibility for lifelong learning and personal development.
11. Demonstrate responsible citizenship and pride of being a Filipino.
12. Apply techno-intelligent care system and the current trends & issues in health care
delivery.
13. Adopt nursing core values in the practice of health assessment.
14. Apply entrepreneurial skills in management and leadership. (Not applicable)

EXPECTED INTENDED INTENDED

DIVINIAN NURSING COURSE
GRADUATE PROGRAM OUTCOME
ATTRIBUTES
(EDGA)
1. God fearing At the end of the At the end of the
course the students course the students
should be able to : should be able to :

Ensures a working Acts in recognition

relationship with the of moral and ethical
client and or responsibility;
support system integrates moral
based on trust values in his/her
2. Disciplined respect and shared day to day living
decision – making.

Obtains Exhibits disposition

 assessment data and appropriate
utilizing appropriate behavior in and out
data gathering of the classroom
methods and tools
3. Competent
Specifies client’s
status , conditions,
needs,
problems and
issues based on Has a meaningful &
priorities. comprehensive
knowledge of the
Assesses with the subject
client ( individual, matter/scientific
family, population concepts learned;
group and/ or can apply a wide
4. Responsible community) one’s range of science
steward health process skills; has
status/competence requisite skills to
seek employment
relevant to the field;
articulates and
5. Law abiding discusses the latest
development in
physical sciences?
Implements safe
and quality Practices values
6. Has passion interventions with that foster love and
towards the client to address concern for all
work the health need, creatures, the
problems and environment and
issues. Mother Earth.

Apply knowledge of Exhibits disposition

physical, social, and appropriate
natural and health behavior in and out
7. Service oriented sciences and of the classroom
humanities in the
practice of nursing
Shows passion and
Apply guidelines interest to what
8. Has good and principles of she/he is doing and
interpersonal skills evidenced – based learning especially
practice in the the physical science
delivery of care concepts and tries
to apply them in
 everyday life.
9. Resilient Work effectively in
collaboration with Demonstrates
inter, intra - and responsible
multi - disciplinary citizenship and
and multi - cultural priced of being a
teams Filipino
10. Effective leader
Apply knowledge of
physical, social, Manifest the
natural and health willingness to serve
sciences and his/her family,
humanities in the classmates,
practice of nursing teachers and the
community applying
the scientific
knowledge and
Practice beginning skills learned
management and
leadership skills in Works and learns
the delivery of client effectively even with
care using a system varied learning
approach tasks and
classmates of
Work effectively in diverse traits and
collaboration with learning
inter, intra and multi experiences
– disciplinary and Demonstrates
multi – cultural leadership skills by
teams being a role model
to his/her fellow
Divinian in terms of
Practice beginning academic
management and performance and
leadership skills in exemplary
the delivery of client character in and out
care using a system of the classroom
approach

LEARNING PLAN :

Learning Strategies
Learning Content/ Classroom T Related T Assess
Outcomes Topi A Le A m
c ar en
 ni t
ng
Ex
pe
rie
nc
e
(S
kil
ls
Le
ct
ur
e,
H
os
pit
al
an
d
C
o
m
m
un
ity
a. Familiarize with A. Self – Group 4 6 Feedbac
the different rules, Introduction activity: k
policies, and s learners
guidelines of the B. Course will
course. orientation enumerat
b. Deliver the course C. e their
requirements, Revi goals of
grading system ew the
and extensive of course
course outline. the recitation
c. Set the tone VM of VMGO
of GO
the second
semester

a. Integrate relevant I. Short 4 Workplac 6 Written

principles of Princi lectures e &
social, physical, ples in ba Oral
 natural and health the se exa
sciences and Care d- m
humanities in a of the as
given health and Older Interactive 4 se 6
nursing situation. Perso Discuss ss
b. Apply appropriate ns m
nursing concepts - en
and actions Welln t
holistically and ess Clinical
comprehensively. - wo
Health rk
promo Direct
tion ob
- se
Chroni rv
c ati
illness on
- Discussio
Recov n
ery of
and in
Rehab div
ilitatio id
n ua
- Quality l
of Life ca
II. se
Care s
of the
Older
Perso
ns
A.
Geron
tologic
al
nursin
g
conce
pts
B.
Factor
s that
affect
norma
l
functio
ning
of the
older
perso
ns
-
Demo
graphi
cs
of
Aging
-
Theori
es of
Aging
-
Socio
econo
mic
Aspec
ts of
Aging
- The
Aging
Family
, the
Well
Older
Perso
n,
Chang
es in
the
Older
Perso
n and
their
Implic
ations
to
Care
C.

Patter
ns of
 illness
of the
older
perso
ns
D.

Risk
factor
s
associ
ated
with
chroni
c
illness
a. Identify the A. Geriatric 6 Min 7 Reports
appropriate Stand -Assess i 1-3
gerontological ards ment – Un
assessment or of c sati
framework. Care l sfa
b. Formulate B. i cto
with the client Comp n ry
a plan of care rehen i 4-6
to address the sive c Sat
health geriatr a isfa
conditions, ic l cto
needs, asses e ry
problems and sment v 7-9
issues based C. a Su
on priorities. Nursin l per
c. Implement g u ior
safe and diagn a
quality osis t
interventions relate i
with the client d to o
to address the Welln n
health needs, ess, & e
challenges chroni x
and issues. c a
d. Provide illness m
health D.
education Proble
using ms
appropriate relate
framework/ d to
models to the
target clientele older
(individuals, perso
family, ns
population -6
group or Dimen
community). sions
e. Institute of
appropriate Health
preventive (Physi
measures to cal,
minimize Intelle
effects arising ctual,
from recent Emoti
condition. onal,
f. Evaluate Social
with the client ,
the health Spiritu
status/compet al and
ence and/or Enviro
process/ nment
expected al)
outcomes of -
nurse-client Safety
working E.
relationship. Needs
for
Self-
care,
life
suppo
rt,
health
maint
enanc
e
F.
Health
proble
ms in
chroni
c
illness
G.
Modali
ties of
 care
H.
Criteri
a for
evalua
tion
-
Indicat
ors for
wellne
ss
-
Respo
nses
to
care
I.
Curre
nt
trends
&
conce
rns in
the
care
of the
older
perso
ns
J.
Evide
nce-
based
interv
ention
s in
the
care
of the
older
perso
ns.
a. A. Practical 6 Objecti
Demonstrate Evide exam v
appropriate nce- e
evidence- based S
 based nursing interv t
care using a ention r
participatory s for u
approach specifi c
based on: c t
- Variety of proble u
theories and ms of r
standards the e
relevant to older d
health and perso C
healing ns: l
- Research - i
- Clinical Physi n
practice ologic i
- Client functio c
preferences ning a
- Client and a. l
staff Activit E
Safety y & v
- Customer care exerci a
standards se l
b. u
Nutriti a
on t
suppo i
rt o
c. n
Respir
atory
mana
geme
nt
d.
Tissue
perfus
ion
mana
geme
nt
e.
Electr
olyte
and
acid-
base
balanc
e
mana
geme
nt
f.
Skin/w
ound
mana
geme
nt
g.
Physic
al
comfo
rt
promo
tion
h.
Rest
and
Sleep
-
Intelle
ctual
a.
Analy
ze,
reaso
n and
solve
proble
ms
b.
Open-
minde
d,
eager
to
learn
c.
Under
stand
moral
s,
values
and
beliefs
-
Emoti
onal
a.
Expre
ssion
of
feeling
s
b.
Emoti
onal
assist
ance
c.
Stress
mana
geme
nt
d.
Settin
g
prioriti
es
e.
Feelin
g
good
about
onesel
f
f.
Flexibi
lity
and
adapt
ability
g.
Balan
ce of
work,
family,
friend
s and
other
obligat
ions
h.
Accep
ting
respo
nsibilit
y for
one’s
action
Social
a.
Comp
anions
hip or
belon
ging
b.
Comfo
rt,
suppo
rt and
encou
ragem
ent
c.
Reass
uranc
e of
self-
worth
d.
Help,
guida
nce,
advice
e.
Social
suppo
rt
syste
m
-
Spiritu
al
care
a.
Perso
nal
fulfillm
ent
b.
Belief
in a
higher
purpo
se
c.
Accep
ting
the
views
of
others
-
Enviro
nment
al
a.
Protec
tion of
natura
l
resour
ces
b.
Interc
onnec
ted -
ness
of all
living
syste
ms
c.
Helpin
g
comm
unity
B.
Safety
-
 Risk
reduct
ion
activiti
es
-
Mana
geme
nt of
the
enviro
nment
Objective A. Case 4 Mini 7 Reflection
Structured Cultur base – c pa
Clinical al learning l per
Evaluation factor i
s/ethni n
city i
such c
as a
regard l
for e
elders v
, a
perce l
ption u
of a
health t
B. i
Ethica o
l n
aspect e
s in x
the e
care r
of the c
older i
perso s
n e
C.
Nursin
g
interv
ention
s for
specifi
 c
proble
ms of
the
older
perso
ns
includ
e care
that
suppo
rt:
-
Bioeth
ical
comp
onent
s of
care
a. A. Report 4 OSCE 6 Oral
Demonstrate a Comm exa
working unity m
relationship resour
with the client ces
and/or support for
system based care
on trust, of
respect and older
shared perso
decision- ns
making using
appropriate
communicatio
n/interpersona
l techniques/
strategies.
a. Use A. Nursing Report 4 Multisou 6 Reflection
appropriate intervention outpu rc pap
technology s for t e er
to perform specific fe
safe and problems of e
efficient the older d
nursing persons b
activities. include a
b. care that c
Implement support: k
system of - Wellness
informatics a. Nutrition Sources:
to support support p
the delivery b. Activity at
of health and ie
care. exercise nt
c. Stress s,
manageme d
nt o
ct
or
s,
a
n
d
p
e
er
s
Topics

Module I. 0Principles in the Care of the Older Persons

- Wellness
- Health promotion
- Chronic illness
- Recovery and rehabilitation
- Quality of Life

Learning Outcomes
At the end of the chapter, the learners will be able to:
a. identify wellness and the dimensions of wellness
b. Identify the nurse’s role in the geriatric assessment process
c. identify appropriate guidelines for health promotion and disease prevention
d. Define several important terms related to nursing and the aging process.

Pre – test

1. Ow do you feel about aging? Do you dreed getting older, or look forward to it? Do
you see advanced age as a challenge or something to fear?
2. Have you ever cared for an elderly person before? If so, what was that
experience like? How do you feel about caring for older adults in your nursing
practice?
3. What do you think about nurses who work in nursing home? Have you ever
considered a career in gerontology? What are the positives you can see about
developing expertise in this field of nursing?

Introduction

Geriatrics and Gerontology are often used to mean the same thing. Geriatrics is the
branch of medicine that deals with the illness and care of the aged, while Gerontology is
the study of factors affecting the normal aging process and the effects of aging on
persons of all ages. Geriatric nursing focuses on the care of the sick elderly.
Gerontologic nursing includes not only the care of the sick elderly, but also health
maintenance, illness prevention, and the promotion of quality of life to assist the person
to grow to an ideal state of health and wellbeing. Simply stated, our role as health care
providers is to assist our elderly patients to get better, to maintain at their current status
– accepting declines – or to ease their dying. When an elderly person is admitted to the
hospital, it is essential to conduct as complete an assessment as possible. Not only
does a physical assessment need to be completed, but also all that is around the
patient needs to be assessed to allow the nurse to identify problem areas so that
appropriate planning can begin

Definitions

Gerontology is the study of the aging processes and individuals as they grow from
middle age through later life. It includes:
• the study of physical, mental, and social changes in older people as they age
• the investigation of the changes in society resulting from our aging population
• the application of this knowledge to policies and programs. As a result of the
multidisciplinary focus of gerontology, professionals from diverse fields call
themselves "gerontologists“
Geriatrics
• the specialty that concerns itself with the provision of nursing services to
geriatric or aged individuals.
• the study of health and disease in later life
• the comprehensive health care of older persons and the well-being of their
informal caregiver
Evidence-Based Practice - practice has moved from trial and error to following a
systemic approach that uses existing research for clinical decision-making= a process
known as evidence-based practice
Hospice - a lodging for travelers, young persons, or the underprivileged especially
when maintained by a religious order
- a program designed to provide palliative care and emotional support to the
terminally ill in a home or homelike setting so that quality of life is maintained, and family
members may be active participants in care
- a facility that provides such a program e - a home providing care for the sick or
terminally ill

DNR - at bedside is not valid without an official order . do not resuscitate.

Polypharmacy- The high prevalence of drugs consumed by older people and the
complexity of drug dynamics in old age require geria nurses to evaluate the effects of
drugs given .

Altered Pharmacokinetics- absorption, distribution, metabolism, and excretion of

drugs.
Geriatrics - Branch of medicine that deals with problems & diseases of old age, aging
people

Senescence - Process of aging within cells and organs accompanied by loss of organ
function

Ageism Prejudice towards any age group, t “the prejudices and stereotypes that are
applied to older people sheerly on the basis of their age....”

GEROPSYCHOLOGY – refers to specialist in psychiatry whose knowledge, expertise,

and practice are with the older population

SOCIAL GERONTOLOGY – is concerned mainly with the social aspects of aging

versus the biological or psychological
– also called genopharmacology, is unique branch in which pharmacists obtain special
training in geriatrics

FINANCIAL GERONTOLOGY – is another subfield that combines knowledge of

financial planning and services with a special expertise in the needs of older adults

GERONTOLOGICAL REHABILITATION NURSING – combines expertise in

gerontological nursing with rehabilitation concepts and practice.

GERONTOLOGICAL NURSING - gerontology that falls within the discipline of nursing

and the scope of nursing practice. It involves nurses advocating for tb health of older
persons at all levels of prevention. The scope o practice includes all older adult: from
the time of “old age” until death. is the aspect of “The purpose of gerontological nursing
is not to save lives, but to prevent untimely death and needless suffering? Both
these goals include respect for human dignity - the preservation of personhood as long
as life continues.”

Baby Boomers (born between 1946 and 1964)are working past retirement. Baby
Boomers control over 80% of personal financial assets and more than 50% of
discretionary spending power. They are responsible for more than half of all consumer
spending, buy 77% of all prescription drugs, 61% of OTC medication and 80% of all
leisure travel.

Gerontic nursing—this term was developed by Gunter and Estes in 1979 is meant to
be more inclusive than geriatric / gerontologic nursing because it is not limited to
diseases scientific principles.
—this term has not gained wide acceptance but is viewed by some as a more
Appropriate description of the specialty.

Ageism—is a termed that was coined by Butler 1969 describe the deep & profound
prejudice in American society against older adults.
—age discrimination
Gero Psychology - branch of psychology concern w/ helping older persons & their
families to maintain wellbeing, overcome problems. & achieved maximum during later
life.
—study of pharmacology as relates to older adults.

Financial Gerontology—combines knowledge a financial planning & services w/

special expertise in the needs of older adults.

Development of Gerontological Nursing

• 1904: First article on care of the aged published in the American Journal of
Nursing
• 1914: Dr. I. L. Nascher—“Father of Geriatrics"— first geriatric textbook
• 1935: Federal Old Age Insurance Law, or Social Security
• 1950 - First geriatric nursing textbook
• 1962: First meeting of the ANA's Conference Group on Geriatric Nursing
Practice
• 1965: formation of the Administration on Aging, Older Americans Act,
Medicare, & Medicaid
• 1966: Division of Geriatric Nursing— gerontological nursing as a nursing
specialty
• 1976 - Professional Standards for Gerontological Nursing Practice (ANA)
• Certification - geriatric nurses
• 1sl certification program by ANA

WELLNESS?

Wellness is derived from our ability to understand, accept, and act upon our capacity to
lead a purpose-filled and engaged life. In doing so, we can embrace our potential
(physical, emotional, spiritual, intellectual, social, environmental, vocational) to pursue
and optimize life’s possibilities.
The wellness dimensions overlap and coordinate to provide rich environments for living.
Wellness becomes a framework that is valuable for serving the wants and needs of a
person engaged in life.

7 DIMENSIOS OF WELLNESS
 1. Emotional
Feelings are the lens through which people view the world, and the ability to be aware
of and direct one’s feelings helps to create balance in life. Coping with challenges and
behaving in trustworthy and respectful ways signal emotional wellness, attributes that
can be encouraged through peer counseling, stress management, humor/laughter and
personal histories.
2. Intellectual, cognitive
Engaging in creative pursuits and intellectually stimulating activities is a proven
approach to keeping minds alert and interested. There are many ways to stay
intellectually active, including taking college courses, journaling, painting or joining a
theater company, and challenging oneself with games and puzzles.
3. Physical
The goal of living independently is one shared by many people, and physical wellness is
necessary to achieve this. Lifestyle choices that can maintain or improve health and
functional ability include engaging in physical activity, choosing healthy foods with
adequate nutrition, getting adequate sleep, managing stress, limiting alcohol intake, not
smoking, making appointments for check-ups and following medical recommendations.
4. Professional, vocational
Work that utilizes a person’s skills while providing personal satisfaction is valuable for
society as well as the individual. Participating in the paid and unpaid workforce means
maintaining or improving skills and helping others. Older adults contribute to society as
experienced professionals, caregiver, mentors, teachers and volunteers. Leisure-time
vocations in the arts and through hobbies maintain vocational skills.
5. Social
Social interactions with family, friends, neighbors and chosen peer groups can be
valuable for maintaining health. Personal contact by joining clubs, traveling, visiting
friends and family, engaging in intergenerational experiences like making quilts with a
elementary school children is beneficial for everyone who it touched.
6. Spiritual
Living with meaning and purpose in life, guided by personal values, is key to feelings of
well-being and connection to the larger world. Group and individual faith-based
activities, personal meditation, mindful exercise (yoga, tai chi) and experiencing nature
can create the opportunity for spiritual growth.
7. Environmental
Surrounded by natural and man-made environments, good stewardship means
respecting resources by choosing “green” processes that re-use and recycle goods. It
also means looking at ways to bring people into the natural environment and encourage
active living through urban and property designs emphasizing walking paths, meditation
and vegetable gardens and similar options.
HEALTH PROMOTION

Health for older adults is a complex interaction of physical, functional, and psychosocial
factors. Clearly, it is not just the absence of disease, as many people diagnosed with a
chronic disease consider themselves to be healthy. Health may be considered a state of
physical, mental, and social functioning that realizes the potential of which a person is
capable (Edelman & Mandle, 2002). The World Health Organization (1946) has defined
health as “the state of complete physical, mental, and social well-being and not merely
the absence of disease and infirmity
Health promotion activities are those activities in which an individual is able to
proactively engage in order to advance or improve his or her health
Primary Prevention
These are activities designed to completely prevent a disease from occurring such as
immunization against pneumonia or influenza.
Secondary Prevention
Efforts are directed towards early detection and management of disease such as the
use of colonoscopy ( an exam used to detect changes or abnormalities in the large
intestine (colon) and rectum.) to detect small cancerous polyps.
Tertiary Prevention
Efforts are used to manage clinical diseases in order to prevent them from progressing
or to avoid complications of the disease as when beta blocker (are medications that
reduces blood pressure. Beta blockers work by blocking the effects of the hormone
epinephrine, also known as adrenaline.)

FOCUS OF HEALTH PROMOTION

A. Self - Management

What can nurses do to encourage clients to adopt health promoting behaviors and
manage their chronic illnesses? Kat Lorig, MD, has been instrumental in developing the
concepts of self – management and outlining the role of the health care provider in
fostering the client’s self-management of his or her chronic condition.

The Chronic Disease Self – Management Program (CDSMO)

This is a 17-hour course for patients with chronic diseases that is taught by trained
laypeople . the course goal is to reach patients to improve symptom management,
maintain functional ability and adhere to their medication regimen.
Five elements of self – management program (Lorig)
 1. Problem solving
– a client may identify several barriers to initiating an exercise program and list
strategies , for overcoming each barrier to arrive at a workable strategy
2. Decision making
- -helps arm clients with the information needed to make the decisions they need
to make on a daily basis.
3. Resource utilization
4. Forming a health care professional / client partnership
5. Taking action

B. Physical Activity

Functional decline in the elderly is attributable at least in part to physical activity.

Despite the well documented benefits of exercise in reducing blood pressure and
cholesterol, improving insulin resistance, reducing weight, strengthening bones, and
reducing falls, two thirds of adults between 65 and 75 years of age are inactive.
Physical inactivity causes increased health care costs to our nation.

Scientific evidence supports the effectiveness of moderate physical activity in :

1. Decreasing overall mortality

2. Decreasing coronary heart disease, the leading cause of death in the United
States.
3. Decreasing colon cancer
4. Decreasing incidence and improving management of diabetes mellitus
5. Decreasing incidence and improving management of hypertension
6. Decreasing obesity
7. Improving depression
8. Improving quality of life
9. Improving functional status
10. Decreasing falls and injury

C. Nutrition

Four of the leading causes of death in the United States ( cancer, diabetes, coronary
hearth disease, and cerebral vascular accidents ) are associated with unhealthy dietary
patterns. Elderly clients maybe at increased risk for poor nutrition due to the fact that
they have multiple chronic illnesses, may have tooth or mouth problems that may
interfere with their ability to eat, maybe socially isolated, may have economic hardships,
maybe taking multiple medications that can cause changes in appetite or
gastrointestinal symptoms, and may need assistance with self-care.

General guidelines for dietary counselling include :

 Limit alcohol to one drink a day for women, two daily for men
 Limit fat and cholesterol
  Maintain balanced caloric intake
 Ensure adequate daily calcium especially for women
 Older adult should consume vit B12 in crystalline form which can be derived from
fortified cereals and supplements
 Older adult who have minimal exposure to sunlight or who have dark skin need
supplemental vitamin D. Daily vit D intake should be 400 - 600 IU and can be
derived from fortified foods or supplements.
 Include adequate whole grains, fruits, and vegetable
 Drink adequate water

Tobacco use it is estimated that 4.5M Americans aged 65 and older smoke cigarettes
and that smoking accounts for one out of every 5 U.S. death.

A practice guideline to guide clinicians to help their patients quit smoking has been
developed . they outline 2 different interventions , the 5 As for clients who are ready to
quit smoking , and the 5Rs for those who need additional motivation before they are
ready to quit.

The 5 As

1. Ask about smoking status at each health care visit

2. Advise client to quit smoking
3. Assess client’s willingness to quit smoking at this time
4. Assists client to quit using counselling and pharmacotherapy (treatment of
disease with medicine)
5. Arrange for follow – up within one week of scheduled quit date.

The 5R’s

1. Relevance means asking the client to think about why quitting may be personally
relevant for him.
2. Risks of smoking are identified by the client
3. Rewards of quitting are identified by the client
4. Roadblocks or barriers to quitting are identified by the client
5. Repetition of this process at every client visit. More people who successfully quit
smoking require multiple attempts.

D. Safety

Falls are the leading cause of unintentional injury death in older adults. Elderly adults
are susceptible to falls as a result of postural instability, decreased muscle strength, gait
disturbances and decreased proprioception, visual and cognitive impairment, and
polypharmacy. Environmental conditions that contribute to falls are slippery surfaces,
stairs , irregular surfaces, poor lighting , incorrect footwear, and obstacle to pathways.
Balance and strengthening exercises, home safety modifications, and elimination of
high-risk medication had been the focus of full risk prevention strategies. Four
CHRONIC ILLNISES

A disease that is ongoing or recurring . some type of cancer as well as AIDS has
recently been designated as chronic disease. The prevalence of chronic diseases
increases with age. Four of the leading causes of death among elderly are chronic
diseases such as heart disease, stroke, cancer, and diabetes. Older women report
higher numbers of chronic disease such as hypertension, asthma, chronic bronchitis
and arthritis, men report more heart disease, cancer, diabetes and emphysema. Ethnic
and racial differences also exist in prevalence of chronic diseases. older blacks report
higher levels of hypertension and diabetes than non-Hispanic whites. Both diabetes and
hypertension are increasing among older Americans. (Federal Interagency Forum,
2004).
Older men are more likely to experience moderate or severe memory impairment than
older women.

Factors affecting the cause include:

 heredity,
 lifestyle (stress, diet, exercise etc.) and even environmental factors
Those who are suffering from a chronic illness and also have a disability can find it hard
to understand what is going on and do not know how to maintain their illness. / Disability

Recovery and rehabilitation

Special facilities exist to provide subacute care to patients with complex health needs.
These patients may be head injured or ventilators, require aggressive rehabilitation after
injury or surgery, or require the services and intensive treatments from specialists such
as physical therapists, occupational therapists, dietitians, and physiatrists. Usually
rehabilitation in these facilities is covered by the patient's private insurance or Medicare.

Quality of Life

Quality of life and successful aging are two central concepts in assessment and care of
older adults. Broadly speaking, quality of life encompasses all areas of everyday life:
environmental and material components, and physical, mental, s and social well-being
(Fletcher, Dickinson, & s Philp, 1992). Quality of life among older adults is highly
individualistic, subjective, and multi - dimensional in scope. With respect to what
constitutes quality of life, what is important to one person may be unimportant to
another. Related to quality of life is the concept of successful aging.
Quality of life (QOL) is the general well-being of individuals and societies, outlining
negative and positive features of life. It consists of the expectations of an individual or
society for a good life. These expectations are guided by the values, goals and socio-
cultural context in which an individual life. It serves as a reference against which an
individual or society can measure the different domains of a personal life.[citation
needed] The extent to which one's own life coincides with a desired standard level - or,
put differently, the degree to which these domains give satisfaction and as such
contribute to one's subjective well-being - is called[by whom?] life satisfaction.

Quality of life includes everything from physical health, family, education, employment,
wealth, safety, security to freedom, religious beliefs, and the environment. QOL has a
wide range of contexts, including the fields of international development, healthcare,
politics and employment. Health related QOL (HRQOL) is an evaluation of QOL and its
relationship with health. Quality of life should not be confused with the concept of
standard of living, which is based primarily on income.

Quality of Life Model

The Ferrell and Grant quality of life moot. was developed using qualitative methodology.
Factor analysis of patient data used to cluster related elements into four domains of
quality of life: health and functioning, psychological/spiritual, social, and economic, and
family.
The Ferrell and Grant model identifies the four concepts of quality of life: physical well-
being, psychological well-being, social well-being, and spiritual well-being. WHO defines
health as a state of complete physical, mental, and social well-being (WHO, 1958).
These are all components of quality of life. So, is there a distinction between health and
quality of life? The WHO has integrated health and quality of life into a program called
active aging. This program is designed to help people remain independent and active as
they age. Active aging encourages older individuals to continue to work according to
their capacity and to delay disabilities and chronic diseases.

physical
well-bein
and
syptoms

quality of social well -

psychologic
al well -
being life being

spiritual
well being

 physical well-being and symptoms

Functional ability, strength/fatigue, sleep/rest, nausea, appetite, constipation
 psychological well – being
  social well – being
Caregiver burden, roles and relationships, affection/sexual function, appearance
 spiritual well being
Suffering, meaning of pain, religiosity, transcendence

Post Test

1. A new patient is not satisfied with the conditions of the nursing home, takes a
highly active role in her healthcare, and because of her ability to access information
is as knowledgeable as her care providers on some issues. This patient is most
likely:
a. A young female baby boomer that just turned 65.
b. An older woman between 75-85 years old.
c. A woman over the age of 85 years old.
d. A woman over the age of 95 years old.
2. Nurses need to understand the aging process in order to help their patients:
a. Live longer with their long-term disabilities.
b. Maintain youth and delay the onset of old age.
c. Accept the limitations imposed by genetic tendencies toward cellular
degeneration.
d. Postpone the negative consequences of the aging process.
3. Gerontological nursing is a complex specialty. Which of the following most
contributes to this fact?
a. Elderly are generally compromised in their health status.
b. Cost for the elderly costs more than care for younger patients.
c. Numerous health conditions can overlap in the elderly.
d. Complications after surgery or illness result in death in most cases.
4. A client may identify several barriers to initiating an exercise program and list
strategies , for overcoming each barrier to arrive at a workable strategy
a. Problem solving
b. Decision making
c. Resource utilization
d. Physical activity
5. The general well-being of individuals and societies, outlining negative and positive
features of life.[1] It consists of the expectations of an individual or society for a
good
life.
a. Quality of life
b. Chronic diseases
c. Ageism
d. Recovery and rehabilitation
6. A disease that is ongoing or recurring . some type of cancer as well as AIDS has
recently been designated as chronic disease
a. Chronic illness
b. Quality of life
c. Social well – being
 d. Safety
7. Activities designed to completely prevent a disease from occurring such as
immunization against pneumonia or influenza
a. Primary Prevention
b. Secondary prevention
c. Tertiary prevention
d. Rehabilitation and recovery
8. When a person uses behavior modification procedures to change his or her own
behavior, or occurs when a person engages in a behavior at one time to control the
occurrence of another behavior (target behavior) at a later time.
a. self-management.
b. Chronic illness
c. Social well being
d. Psychological well being
9. Engaging in creative pursuits and intellectually stimulating activities is a proven
approach to keeping minds alert and interested.
a. Intellectual, cognitive
b. Spiritual
c. Emotional
d. Social
10. Ability to understand, accept, and act upon our capacity to lead a purpose-filled and
engaged life.
a. Wellness
b. Emotion
c. Gerontology
d. polypharmacy