NCM 114 – CARE OF THE ELDERLY

Transcribed by: Jannah Isha Z. Jani

BCI – College of Nursing

CONCEPTS, PRINCIPLES AND • Continued strain on nurses and other medical

professional
THEORIES IN THE CARE OF OLDER
ADULTS - PRELIMS
IMPACT OF AGING MEMBERS IN THE FAMILY

PERSPECTIVE ON AGING A REFLECTION BY A NURSING PROFESSOR:

AGING IS A COMPLEX PROCESS “Some years ago, as death was approaching for a 91-
year-old gentleman, his family gathered at the
• Chronologically, physiologically, functionally. hospital. His wife of 69 years asked that “the children”
CHRONOLOGICAL AGE come into the room. This sounded rather strange
because “the children "were all in their 60s, the
• Number of years a person has lived grandchildren were all mature adults, and the great-
• Reference when we speak or talk about aging grandchildren were fast approaching adulthood. It
sounded even stranger to me, because this older man
DEMOGRAPHY OF AGING ITS IMPLICATIONS FOR
was my grandfather, and my father was “the baby” of
HEALTH AND NURSING
the family.”
GLOBAL AGING
- Gloria Wold
• Population aging is the 21st century’s (1) The nurse and family interaction.
dominant demographic phenomenon. (2) Abuse or neglect by family.
• Rapid explosion of cohorts to the older ages • Physical abuse
are causing elder shares to rise throughout the ✓ neglect
world. • Emotional Abuse
• Unprecedented in human history • Financial Abuse
• Abandonment
AGING IN THE PHILIPPINES
• Responses to abuse
• The population of older Filipinos is increasing (3) Abuse by unrelated caregiver
significantly. (4) Support Groups
• In 2000–2010, Filipinos aged 60 and over had (5) Respite Care
the highest growth rate at 3.2%, compared
THEORIES OF AGING AND ITS IMPLICATION ON
with those in the age group 15–59 at 2.0%, and
NURSING
children (below 15) at 0.9%.
• Older Filipinos, recorded at 6 million in 2010, 1. Biological Theories
are projected to increase to 12 million by 2025 • Physiologic processes that change
(based on the medium-term assumption of with aging
the 2010 census - based population projection 2. Psychosocial Theories
by the Philippine Statistics Authority and Inter- • Behavior, Personality & Attitude
Agency Working Group on Population Change
Projections (2016).
NURSING IMPLICATIONS
AREAS NEEDING JUDICIOUS PLANNING AND
PHYSICAL/ BIOLOGICAL THEORIES
PREPARATION FOR THE RISE OF OLDER FILIPINOS
• Nursing can help individuals achieve the
• Health and general well-being
longest, healthiest lives possible by promoting
• Economic and social support
good health maintenance practices and a
• Long Term Care (LTC)
healthy environment.
HEALTH IMPLICATIONS: PHILIPPINES
PSYCHOSOCIAL THEORIES
• Many older Filipinos are in poor health
• It can help nurses recognize problems and
• Many older Filipinos have limited access to
provide nursing interventions that will help
healthcare.
aging individuals successfully meet the
• Long-term care is mostly in the hands of family developmental tasks of aging.
and kin

NURSING IMPLICATIONS: UNITED STATES

• Increase need for medical and nursing

professionals who understand and work with
elderly
NCM 114 – CARE OF THE ELDERLY
Transcribed by: Jannah Isha Z. Jani
BCI – College of Nursing

Aging is a natural process

According to World Health Organization, aging

is a course of biological reality which starts at
conception and ends with death. It has its own
dynamics, much beyong human control.

We will come to understand the details of

aging processes and associated physiological
changes.

PHYSIOLOGIC CHANGES OF AGING

INTEGUMENTARY SYSTEM RESPIRATORY SYSTEM

PHYSIOLOGIC RESULTS PHYSIOLOGIC RESULTS

CHANGE CHANGE
Decreased vascularity Increased pallor in skin Decreased body fluids Decreased ability to
of dermis humidify air resulting in
Decreased amount of Decreased hair color drier mucus
melanin (graying) membranes
Decreased sebaceous Increased dry skin; Decreased number of Decreased ability to trap
and sweat gland decreased perspiration cilia debris
function Decreased number of Increased risk for
Decreased Increased wrinkling macrophages respiratory infection
subcutaneous fat Decreased tissue Decreased gas
Decreased thickness of Increased susceptibility elasticity in the alveoli exchange; increased
epidermis to trauma and lower lung lobes pooling of secretions
Increased localized Increased incidence of Decreased muscle Decreased ability to
pigmentation brown spots (senile strength and endurance breathe deeply;
lentigo) diminished strength of
Increased capillary Increased purple cough
fragility patches (serile purpura) Decreased number of Decreased gas
Decreased density of Decreased amount and capillaries exchange
hair growth thickness of hair on Increased calcification Increased rigidity of rib
head and body of cartilage cage; decreased lung
Decreased rate of nail Increased brittleness of capacity
growth nails
Decreased peripheral Increased longitudinal CARDIOVASCULAR CHANGES
circulation ridges of nails;
increased thickening  Enlargement of heart chambers and coronary
and yellowing of nails cells
Increased Increased facial hair in  Increased thickening of heart walls, especially
androgen/estrogen ratio women in the left ventricle
 Vascular aging – arterial stiffness
SKELETAL SYSTEM
HEMATOPOIETIC AND LYMPHATIC SYSTEM
PHYSIOLOGIC RESULTS CHANGES
CHANGE
Decreased bone Increased osteoporosis;  Less efficient immune response
calcium increased curvature of ✓ Increased risk for infection
the spine (kyphosis)  Iron deficiency
Decreased fluid in Decreased height ✓ Risk for anemia
intervertebral disks  Slowed erythrocyte production
Decreased blood supply Decreased muscle ✓ Risk for anemia
to muscles strength  Reduced plasma volume
Decreased tissue Decreased mobility and ✓ Increased risk for dehydration
elasticity flexibility of ligaments
and tendons GASTROINTESTINAL CHANGES
Decreased muscle Decreased strength;
mass increased risk for falls PHYSIOLOGIC RESULTS
CHANGE
Increased dental carries Decreased ability to
and tooth loss chew normally;
NCM 114 – CARE OF THE ELDERLY
Transcribed by: Jannah Isha Z. Jani
BCI – College of Nursing

decreased nutritional  Taste Acuity

status  Smell
Decreased thirst Increased risk for  Touch
perception dehydration and
constipation ENDOCRINE SYSTEM
Decreased gag reflex Increased incidence of
choking and aspiration PHYSIOLOGIC RESULTS
CHANGE
Decreased muscle tone Increased incidence of
and sphincters heartburn (esophageal Decreased pituitary Decreased muscle
reflux) secretions (growth mass
hormone)
Decreased saliva and Decreased digestion
gastric secretions; and absorption of Decreased production Decreased metabolic
increased gastric pH nutrients; altered of thyroid-stimulating rate
absorption of some hormone (TSH)
medications that are Decreased insulin Increased risk for type 2
pH-dependent production or increased diabetes mellitus
Decreased gastric Increased flatulence, insulin resistance
motility and peristalsis constipation, and bowel Decreased production Increased blood
impaction of parathyroid hormone calcium levels (seen
Decreased liver size and Decreased ability to with osteoporosis)
enzyme production metabolize drugs,
leading to increased risk FEMALE REPRODUCTIVE SYSTEM
for toxicity  Menopause
 Vagina becomes narrower and shorter
URINARY SYSTEM CHANGES  Vaginal wall tends to become thin and
weaken and lose elasticity
PHYSIOLOGIC RESULTS
 Less vaginal discharge
CHANGE
 Vaginal pH would shift into alkaline
Decreased number of Decreased filtration rate
functional nephrons with decrease in drug environment
clearance MALE REPRODUCTIVE SYSTEM
Decreased blood supply Decreased removal of
body wastes; increased  Andropause
concentration of urine  Testes, decrease in size and weight
Decreased muscle tone Increased volume of  Decline in sperm production
residual urine  Prostate gland becomes thinner
Decreased tissue Decreased bladder
 Less intense orgasm and ejaculation
elasticity capacity
 Penis begins to show fibrous changes in
Delayed or decreased Increased incidence of
erectile tissue
perception of need to incontinence
void
Increased nocturnal Increased need to NURSING CARE OF
urine production awaken to void or OLDER ADULTS IN
episodes of nocturnal
incontinence WELLNESS - MIDTERMS
Increased size of Increased risk for
OBJECTIVES
prostate (male) infection; decreased
stream of urine; At the end of this topic, the students will be able to:
increased hesitancy and
frequency of urination 1. Demonstrate knowledge on nursing care of
older adult in wellness.
NERVOUS SYSTEM 2. Demonstrate competence in assessing older
adult client’s health status.
• Aging is associated with many neurological 3. Describe the client’s functional level using
disorders, as the capacity of the brain to Katz Index.
transmit signals and communicate reduces. 4. Explain mental status of the client using
 Loss of brain function MMSE.
 Multiple other neurodegenerative changes 5. Evaluate nutritional status of elderly using mini
 Cognition decline nutritional assessment.
 Memory Learning and intelligence 6. Formulate plan of care to address the
SENSORY SYSTEM; CHANGES ON SPECIAL SENSES identified health conditions, needs problems
and issues based on priorities.
 Hearing
NCM 114 – CARE OF THE ELDERLY
Transcribed by: Jannah Isha Z. Jani
BCI – College of Nursing

7. Participate in interactive discussion • The client’s situation determines the location

concerning dose-response relationship of and time when any of the scales or tools
drugs. should be administered, as well as the
8. Implement safe and evidenced-based quality number of times the client may need to be
interventions to address health needs, tested to enjoy to ensure accurate results.
problems and issues.
9. Create appropriate corrective actions to • Many tools are available, but the nurse should
prevent or minimize harm/injury to the client. use only those which are valid, reliable, and
relevant to the practice setting.
ASSESSMENT
KATZ INDEX
• Assess for potential health hazard to
identify risk factors for illness and injury. • Useful tool to describe the client’s functional
level.
• Risk Factors:
✓ Habits
✓ Lifestyle patterns
✓ Personal and family medical history
✓ Environmental conditions
• Comprehensive Geriatric Assessment
(CGA)
✓ Physical health
✓ Mental health
✓ Functional status
✓ Social functioning
✓ Environment

Psychological

Physical
Behavioral Environment
MINI STATE MENTAL EXAMINATION

Cognitive Social
Functional
Status

Gait/Balance Economic

Quality of
Physical
Life

FUNCTIONAL STATUS ASSESSMENT

• Functional status is considered a significant

component of an older adult’s quality of life.

• Functional status assessment is a

measurement of the older adult’s ability to
perform basic self-care tasks, or ADLs, and
tasks that require more complex activities for
independent living, referred to as IADLs.

• Determination of the degree of functional

independence in these areas can identify a
client’s abilities and limitations, leading to
appropriate interventions.
NCM 114 – CARE OF THE ELDERLY
Transcribed by: Jannah Isha Z. Jani
BCI – College of Nursing

PAR-Q AND YOU experience and the philosophic system that

helps him or her function within society.

8. Activity/Exercise Pattern

• This pattern encompasses information related

to health promotion that encourages the older
adult to achieve the recommended 30
minutes daily of physical activity on most days
of the week.

9. Rest and Sleep Pattern

• This pattern encompasses the sleep and rest

patterns over a 24-hour period and their effect
on function.

10. Sexuality/Reproductive Pattern

GORDON’S 11 BASIC FUNCTIONAL HEALTH
PATTERNS FOR OLDER ADULTS • This pattern encompasses the older adult’s
behavioral expressions of sexuality.
1. Self-Perception/Self-Concept Pattern
11. Elimination Pattern
• This pattern encompasses a sense of personal
identity; body language, attitudes, and view of • This pattern encompasses bowel and bladder
self in cognitive, physical, and affective excretory functions.
realms; and expressions of sense of worth and PLANNING
emotional state.
• Exploring older adults’ personal ideas and
2. Roles/Relationships Pattern
beliefs concerning health needs
• This pattern encompasses the achievement of
• Reading current literature regarding latest
expected developmental tasks.
update for specific health promotion
• Basic needs for communication and
• Current health policy information that will
interactions with other people, as well as
safeguard client rights
meaningful communications and satisfaction
in relationship with others are examined. • Understanding and use of behavior change
theories
3. Health Perception/Health Management Pattern
IMPLEMENTATION
• This pattern encompasses the perceived level
of health and current management of any • Adopting a proactive stance toward an action
health problems. plan for health promotion of the older
individual
4. Nutritional/Metabolic Pattern
• Activities, locations, and means of
• This pattern encompasses evaluation of
disseminating health promotion
dietary and other nutrition-related indicators.
• Annual health promotion screening
5. Coping/Stress-Tolerance Pattern
• Program that provide vaccinations for older
• This pattern encompasses the client’s reserve
adult
and capacity to resist challenges to self-
integrity, and his or her ability to manage • Screening for cancer, diabetes, and other
difficult situations. condition
6. Cognitive/Perceptual Pattern • Monthly health talks provided in senior center
• This pattern encompasses self-management • Housing sites
of pain, presence of communication
difficulties and deficits in sensory function. • Continuing retirement communities

7. Value/Belief Pattern • Advocate and educate about health

promotion
• This pattern encompasses elements of
spiritual well-being that older adults perceive • Safe medication use
as important for a satisfactory daily living
NCM 114 – CARE OF THE ELDERLY
Transcribed by: Jannah Isha Z. Jani
BCI – College of Nursing

EVALUATION 3. Exercise regularly, maintaining the triad of

weight bearing, aerobic, and balance activities
• Determining effectiveness of care plan
4. Maintain a comfortable weight
• Check established goals 5. Get regular medical checkups

• Establish appropriate and realistic revised MAINTAIN INTELLECTUAL STIMULATION AND

goals and realistic steps to achieve them SOCIALIZATION

ASSESSMENT • Pursue hobbies and interests with passion.

A. Subjective Data • Strengthen family relationships

• Nursing History • Resolve intergenerational conflicts

✓ Close relationships with others; ability to • Engage in adult educational activities to
help in this situation. challenge your mind
✓ Expectations, goals and needs related to
health care. BE WISE IN FINANCIAL PLANNING

B. Objective Data • Plan in advance for retirement

• Psychological Assessment • Carefully manage investments and assets

✓ Cognitive Status • Assure adequate insurance coverage
✓ Use of Leisure
✓ Ego Functions • Decide on your future living arrangements

PLANNING FOR HEALTH PROMOTION, HEALTH WORK TO MAINTAIN DIGNITY AND GOOD HEALTH
MAINTENANCE AND HOME HEALTH IN OLD AGE

CONSIDERATIONS • Choose a physician knowledgeable in the

medical care of older adults.
1. Planning for Successful Aging
2. Home Care and Hospice • Choose a health care system that facilitates
3. Community-Based Services appointments and care for elders.
4. Assisted Living
• Communicate your goals of care to your family
5. Special Care Units
and physician.
6. Geriatric Units
• Express your advance directives in writing.
LEARNING OUTCOMES/OBJECTIVES
HOME CARE AND HOSPICE
• Formulate with the client a plan of care to
address the identified health conditions, Overview of Hospice:
needs problems and issues based on
What is Hospice?
priorities.
• From the word “Hospes”
PLANNING FOR SUCCESSFUL AGING
• Originally referred to shelter or way station for
STEPS
weary travelers
As we age, we make choices about our lifestyle, health • Today, means a concept of care that provides
care, personal pursuits, and our plans for old age. A comfort and quality of life to clients, and their
few "steps to successful aging" will help guide us to significant others, who are facing life’s journey
healthy and active golden years. associated with terminal illness
• A type of care and a philosophy of care which
1. Adopt and maintain healthy habits and
focuses on palliation of terminally ill patient’s
positive lifestyles
symptoms
2. Maintain intellectual stimulation and
a. Physical
socialization
b. Emotional
3. Be wise in financial planning
c. Spiritual
4. Work to maintain dignity and good health in
d. Social
old age
The primary goals of hospice care are to:
ADOPT AND MAINTAIN HEALTHY HABITS AND
POSITIVE LIFESTYLES 1. Provide comfort
2. Relieve physical, emotional, and spiritual
1. Avoid cigarette smoking
suffering
2. Have no more than one alcoholic beverage in
3. Promote the dignity of terminally ill persons
a 24-hour period
NCM 114 – CARE OF THE ELDERLY
Transcribed by: Jannah Isha Z. Jani
BCI – College of Nursing

Hospice care neither prolongs nor hastens the THE MODERN HOSPICE MOVEMENT
dying process
• In the 1950s, as medical technology
Is it a place? developed, most people died in hospitals. The
medical profession increasingly saw death as
• Hospice care is a philosophy or approach to
a failure
care rather than a place
• Physical pain associated with terminal illness
• Care may be provided in a person’s home,
was not a target of treatment
nursing home, hospital, or independent
• Dame Cicely Saunders, MD, founded St.
facility devoted to end-of-life care
Christopher’s Hospice in London in the 1960s,
Hospice is… in an effort to discover practical solutions to
alleviating human suffering.
• (Not necessarily) a place
• She introduced hospice in the US in a lecture
• A philosophy of care at Yale in 1963. This contact set off a chain of
• A structure for care events which resulted in the development of
What kind of treatment is provided through hospice hospice care as we know it
care? • 1972: Kubler-Ross testifies at the first national
hearings on the subject of death with dignity,
• Hospice care is holistic: which are conducted by the US Senate Special
• The healthcare team attends to practical Committee on Aging. In her testimony, Kubler-
needs, and assistance in addition to Ross, “We live in a very particular death-
emotional and spiritual needs and fear of denying society. We isolate both the dying and
dying the old, and it serves a purpose. They are
• Care is provided by an interdisciplinary team reminders of our own mortality. We should not
institutionalize people. We can give families
HISTORY OF HOSPICE CARE
more help with home care and visiting nurses,
• 11th century, around 1065 = the 1st hospice giving the families and the patients the
cares are believed to have originated when the spiritual, emotional, and financial help in
first incurably ill were permitted into places order to facilitate the final care at home.”
dedicated to treatment by crusaders • 1996: Major grant-makers pour money into
• 14th century – Order of Knights Hospitaller of funding for research, program initiatives,
St. John of Jerusalem opened the 1st hospice in public forums, and conferences to transform
Rhodes the culture of dying and improve care at the
• 17th century – Hospices were revived in France end of life
by the Daughters of Charity of Saint Vincent de
MYTHS OF HOSPICE
Paul
• 19th century – established also in UK where • A place
attention was drawn to the needs of the • Only for people with cancer
terminally ill. • Only for old people
• 1902-1905 – hospice care spread to other • Only for dying people
nations. (Australia, North America, Japan, • Can help only when family members are able
China, Russia) to provide care
• Cecily Saunders introduced the idea of • For people who don’t need a high level of care
specialized care for the dying to the United • Only for people who can accept death
States during a 1963 visit with Yale University. • Expensive
Her lecture, given to medical students, nurses, • Not covered by managed care
social workers, and chaplains about the • For when there is no hope
concept of holistic hospice care, included
photos of terminally ill cancer patients and REALITIES OF HOSPICE
their families, showing the dramatic
1. About 80% of hospice care takes place in the
differences before and after the symptom
home
control care
2. Hospices are increasingly serving people with
• 1965: Florence Wald, then Dean of the Yale
the end-stages of chronic diseases
School of Nursing, invites Saunders to
3. Hospices serve people of all ages
become a visiting faculty member of the
4. Hospice focuses as much on the grieving
school for the spring term
family as on the dying patients
5. Alternative locations or resources may be
available
NCM 114 – CARE OF THE ELDERLY
Transcribed by: Jannah Isha Z. Jani
BCI – College of Nursing

6. Hospice can be far less expensive than other ✓ Assesses patient and family anxiety,
end-of-life care. Most people who use hospice depression, role changes, caregiver
are over 65 and entitled to the Medicare stress
Hospice Benefit, which covers virtually all ✓ Provides general grief counseling
hospice services. 6. Chaplain
✓ Provides patient and family with
MEMBERS OF THE HOSPICE TEAM
spiritual counseling
1. Primary Physician ✓ Assists patient and family in sustaining
✓ Provides the hospice team with their religious practice and in drawing
medical history upon religious/spiritual beliefs
✓ Oversees medical care through regular ✓ Ensures that patient and family
communication with the hospice team religious or spiritual beliefs and
✓ Provides orders for medications and practices are respected by the hospice
tests, signs death certificate, etc. team
✓ Determines his or her level of ✓ Serves as a liaison with the
involvement on a case-by-case basis patient/family faith, community and
with the hospice medical director. clergy
2. Hospice Physician ✓ May conduct funeral and memorial
✓ Provides expertise in pain and services
symptom control at the end of life ✓ Provides hospice staff with spiritual
✓ Works closely with the hospice team care and counseling
and primary physician to determine 7. Volunteer
appropriate medical interventions ✓ Provides respite care to family
✓ Makes home visits on as needed basis members
✓ May oversee the plan of care, write ✓ May assist with light housekeeping or
orders, and consult with patient and grocery shopping
family regarding disease progression ✓ Helps patients stay connected with
and appropriate medical interventions community groups and activities
on a case-by-case basis ✓ Facilitates special projects
3. Nurse ✓ Provide community education and
✓ Visits patient and family in the home or outreach
nursing home on regular basis ✓ May assist with office work
✓ May provide on-call services
LEVELS OF CARE
✓ Assesses pain, symptoms, nutritional
status, bowel functions, safety, and • Routine home care
psychosocial-spiritual concerns ✓ Most common level of care provided
✓ Educates patient and family ✓ Interdisciplinary team members
✓ Educates and supervises nursing supply a variety of services during
assistants routine home care, including offering
✓ Provides emotional and spiritual necessary supplies. (Diapers, bed
support to patient and family pads, gloves, and skin protectants)
4. Home Health Aide • Continuous care
✓ Assists patient with activities of daily ✓ Is a service provided in the patient’s
living home
✓ Provides a variety of other services ✓ Intended for patients who are
depending on assessment of need experiencing severe symptoms and
5. Social worker need temporary extra support
✓ Attends to both practical needs and ✓ Provides services in the home a
counseling needs of patient and family minimum of 8 hours a day
✓ Arranges for durable medical • General inpatient care
equipment, discharge planning, ✓ Is an intensive level of care which may
funeral/burial arrangements be provided in a nursing home
✓ Serves as a liaison with community ✓ Intended for patients who are
agencies experiencing severe symptoms which
✓ Assist family in finding services to require daily interventions from the
address financial needs and legal hospice team to manage
matters ✓ Often, patients on this level of care
✓ Provides counseling have begun the “active phase” of dying
• Respite Care
NCM 114 – CARE OF THE ELDERLY
Transcribed by: Jannah Isha Z. Jani
BCI – College of Nursing

✓ Referred as respite inpatient 6. Bereavement care must be provided to family

✓ Is a brief & periodic level of care a members
patient may receive 7. Research and education should be ongoing
✓ A unique benefit in that the care is
COMMUNITY-BASED SERVICES
provided for the needs of the family,
not the patient • There are healthcare options that allow older
✓ Is provided for a maximum of 5 days adults to live at home, while still providing
every benefit period important healthcare or personal care support
in the community.
OVERVIEW ON HOSPICE AND PALLIATIVE CARE
1. Adult Day Care Centers
Is Hospice the same as Home Health Nursing? 2. Program of All-inclusive Care for the
Elderly (PACE)
1. Any patient with a skilled medical care need is
3. Home-Based Primary Care (HBPC)
qualified to receive home health nursing care.
Hospice care, on the other hand, is limited to ADULT DAY SERVICES
persons with a terminal illness, with a life
expectancy of six months or less, and with a • An adult day care center, also commonly
focus on palliation not cure. known as adult day services, is a non-
residential facility that supports the health,
2. Patients in home health care receive visits nutritional, social, and daily living needs of
primarily from a nurse while patients care adults in professionally staffed, group
receive the services of an entire settings.
interdisciplinary whose area of expertise is • It serves as an emerging provider of
end-of-life care. transitional care and short-term rehabilitation
following hospital discharge.
What services does Hospice offer?
• Most centers operate 10 – 12 hours per day
For the Patient… and provide meals, meaningful activities, and
general supervision.
1. Providing care to the patient
• Operations in adult daycare centers are often
2. Medical care to relieve pain and other
referred to as social models (focusing on
symptoms arising from a life-limiting illness
socialization and prevention services) and/or a
3. Basic needs of daily living
health care model (including skilled
4. Counseling
assessment, treatment and rehabilitation
5. Assisting the patient with unfinished legal or
goals).
financial business and in making funeral
arrangements PROGRAM OF ALL INCLUSIVE CARE FOR THE
6. Religious care ELDERLY (PACE)
For Caregivers/Family Members… • PACE allows an older person to spend their
1. Counseling services day at the program and get medical care while
2. Respite care caregivers are at work.
3. Health education • The goal of PACE is to keep participants in the
4. Practical assistance community for as long as it is medically,
5. Assistance with cremation/burial socially, and financially feasible.
arrangements and with funeral/memorial
services • Provide complete care for the patient in a
6. Bereavement care variety of settings, such as at home or in the
hospital, an alternative living situation, or a
PRINCIPLES UNDERLYING HOSPICE (SAUNDERS – nursing home. It also allows for adult day care,
founder St. Christopher’s Hospice in London, respite care, transportation, medication
1996) coverage, rehabilitation (including
1. Death must be accepted maintenance physical and occupational
2. The patient’s total care is best managed by an therapy), hearing aids, eyeglasses, and a
interdisciplinary team whose members variety of other benefits.
communicate regularly with each other HOME BASED PRIMARY CARE (HBPC)
3. Pain and other symptoms of terminal illness
must be managed • HBPC programs provide care to high-risk,
4. The patient and the family should be viewed as medically vulnerable patients at home.
a single unit of care
5. Home care of the dying is necessary
NCM 114 – CARE OF THE ELDERLY
Transcribed by: Jannah Isha Z. Jani
BCI – College of Nursing

• Many of these residents have multiple chronic ASSISTANCE WITH DAILY ACTIVITIES
conditions and require assistance with some
• Assistance for eating, bathing, dressing,
Activities of Daily Living (ADL)
toileting, and walking etc., are given to the
• Due to these problems, most of these residents who require it
residents are confined to their homes and
ACCESS TO HEALTH CARE
would otherwise have to live in a nursing home
• While independent living and assisted
• HBPC enables patients to continue living at
living are not medical models of senior
home while teams made up of physicians,
living care, some services are typically
nurse practitioners, nurses, social workers,
provided in these communities such as
case managers and pharmacists oversee their
medication management and maintaining
care at home.
records
ASSISTED LIVING
ENTERTAINMENT, ACTIVTIES, AND WELLNESS
• There are times when an older adult needs
• Most senior housing communities offer a
more assistance than can be provided in the
variety of activities and entertainment to
home when it comes to personal care. In many
engage residents and enhance their
cases, however, the older person still may not
quality of life, from book groups to planned
need the round-the-clock skilled nursing and
theatre outings to gardening clubs.
medical care that a nursing home provides.
Residents typically participate in activities
• In that case, an assisted living arrangement outside the resident as well
might be an option to consider in order to
MEALS
protect the older person’s independence and
privacy for as long as possible. • Senior living communities dining room
menus vary from day to day and from meal
• ASSISTED LIVING FACILITIES (ALFs)
to meal. Three nutritionally balanced
✓ Adult Care Facilities meals are provided each day, seven days a
✓ Residential Care Facilities week
✓ Older adults have a variety of choices in
SAFETY AND SECURITY
ALFs, ranging from smaller, simple home-
like environments, to larger, fancier • Senior living residences typically include a
accommodations. 24-hour emergency response system that
✓ This wide range in types of ALFs allows is accessible from the resident’s
people to choose a home that best suits apartment, along with security and
their needs, tastes, and financial situation. monitoring systems that prevent resident
✓ Most ALFs offer private rooms or wandering
apartments.
RESIDENT TRANSPORTATION
✓ Special care units that focus on
Alzheimer’s disease and other forms of • Most assisted living communities provide
dementia are also becoming more transportation as needed or desired by
common. resident for doctors’ appointments,
✓ ALFs are required to provide a variety of shopping, etc.
services, including:
➢ 24-Hour staffing to meet the COMMUNITY SPACE
scheduled and unscheduled • Common areas in senior living residences,
needs of residents (Note: This typically include dining rooms, often
does not mean that skilled nursing designed like upscale restaurants, small
must be available 24 hours a day.) café-type spaces for snacks and drinks,
➢ Social services wellness/fitness rooms, gaming rooms,
➢ Housekeeping and laundry and small libraries, parlors, and other
➢ Recreation and meals spaces for residents’ enjoyment
➢ Help with activities of daily
living (ADLs) Most older adults must pay for assisted living
➢ Health-related services (e.g., help themselves, although some states now may pay
with medication management) costs through Medicaid
➢ Transportation
Generally, care in an ALF is less expensive than in a
nursing home
NCM 114 – CARE OF THE ELDERLY
Transcribed by: Jannah Isha Z. Jani
BCI – College of Nursing

Part of this difference in cost is because ALFs • SOCIAL GERONTOLOGY: Relationship

provide less service and have less overhead and participation of elderly people
• GERIATRIC GYNECOLOGY: Post
In addition, ALFs generally have fewer regulations
menopausal women 65 years above
to observe (at least for now) and are therefore able
• EXPERIMENTAL GERONTOLOGY:
to operate with fewer expenses
Nutritional interventions of Aging
SPECIAL CARE UNITS • PREVENTIVE GERONTOLOGY:
Investigation of the effect of lifestyle in
• It is an inpatient unit within a healthcare
preventing dementia and frailty.
facility that is custom-designed, staffed, and
equipped to care for people with specific
NURSING CARE OF THE OLDER
health conditions.
ADULT IN CHRONIC ILLNESS
• They are usually in a physically separate space
from other patient populations. CHRONIC ILLNESS

• Examples of some of the SCU: • Disturbance in Sensory Perception

• Chronic Confusion
✓ Memory/Cognitive Care – for people
• Impaired Verbal Communication
with Alzheimer’s disease or other
types of dementia IMPLEMENTATION
✓ Neurological Care- those who have
Parkinson’s or Huntington’s disease or Physio-social care of older adults:
who have suffered a stroke • Cognition and Perception Engagement with
✓ Orthopedic Rehabilitation- for people Life Self-perception and Self-Concept
who have undergone orthopedic • Coping and Stress
surgery; include specialized
• Values and Beliefs
rehabilitation equipment and
treatment by experienced Physical Care of Older Adults:
rehabilitation professionals.
• Aging skin and mucous membranes
✓ Cardiac/Pulmonary Care- with heart
or lung issues; patients may receive • Elimination
specialized services like exercise • Activity and exercise
therapy, smoking cessation programs, • Sleep and rest
and education on lifestyle CORE ELEMENTS OF EVIDENCE-BASED
modification. GERONTOLOGICAL NURSING PRACTICE
✓ Hospice Care - for people approaching
the end of life Standards

GERIATRIC UNITS • Are desired, evidence-based expectations of

care that serve as a model against which
• The care of aged is called Geriatrics or clinical practice can be judged
gerontology. • Reflect the level and expectations of care that
• Gerontology – is the study of the physical and are desired and serve as a model against
psychological changes which are incidental to which practice can be judged
old age is clinical gerontology. • Thus, standards serve to both guide and
evaluate nursing practice
• Branches of geriatrics:
Standard for Practice for Gerontological Nursing
1. Gerontology
2. Clinical gerontology • Standard 1: Assessment
3. Social gerontology ✓ The gerontological nurse analyzes the
4. Geriatric gynecology assessment data to determine the
5. Experimental gerontology diagnoses or issues
6. Preventive gerontology • Standard 2: Diagnosis
✓ The gerontological nurse analyzes the
DEFINITION
assessment data to determine the
• GERONTOLOGY: Study of Aging and Older diagnoses or issues
Adults • Standard 3: Outcome identification
• CLINICAL GERONTOLOGY: Focuses on ✓ The gerontological nurse identifies
research on physiological changes expected outcomes for a plan
individualized to the adult or situation
• Standard 4: Planning
NCM 114 – CARE OF THE ELDERLY
Transcribed by: Jannah Isha Z. Jani
BCI – College of Nursing

✓ The gerontological nurse develops a ✓ Assist the older adult in evaluating,

plan to attain expected outcomes deciding, locating, and transitioning to
• Standard 5: Implementation environments that fulfill living and care
✓ The gerontological nurse implements needs
the identified plan ✓ Advocate for and protect the rights of
• Standard 5A: Coordination of Care the older person
✓ The gerontological nurse coordinates ✓ Facilitate discussion of and honor
care delivery advance directives
• Standard 5B: Health teaching and health
PRINCIPLES
promotion
✓ The gerontological registered nurse ✓ Scientific data regarding theories, life
employs strategies to promote health adjustments, normal aging, and
and a safe environment pathophysiology of aging are combined with
• Standard 5C: Consultation selected information from psychology,
✓ The gerontological advanced practice sociology, biology, and other physical and
registered nurse provides consultation social sciences
to influence the identified plan, ✓ Nursing principles are those proven facts or
enhance the abilities of others, and widely accepted theories that guide nursing
effect change actions
• Standard 5D: Prescriptive Authority and
Treatment ETHICO-LEGAL CONSIDERATION
✓ The gerontological advanced practice IN THE CARE OF OLDER ADULTS
registered nurse uses prescriptive
authority, procedures, referrals, Learning Objectives:
treatments, and therapies in
• Adhere to establish norms of conduct based
accordance with state and federal
on Philippine Nursing Law and other legal,
laws and regulations
regulatory and institutional requirements
• Standard 6: Evaluation
relevant to safe nursing practice
✓ The gerontological nurse evaluates the
• Adhere to ethico-legal considerations when
older adult’s progress toward
providing safe and quality nursing care of older
attainment of expected outcomes
adults
COMPETENCIES • Apply ethical reasoning and decision-making
process to address situations of ethical
• Having skill, knowledge, and ability to do distress and moral dilemma
something according to a standard
• To promote the highest possible quality of care LAWS AFFECTING SENIOR CITIZENS AND OLDER
to older adults PERSONS
• Basic Competencies of the Gerontological 1. RA 7432 – an act to maximize the contribution
Nurse include the ability to: of senior citizens to nation building, grant
✓ Differentiate normal from abnormal benefits, and special privileges and for other
findings in the older adult purposes. Approved on April 23, 1992, under
✓ Assess the older adult’s physical, the administration of Former Philippine
emotional, mental, social, and President, Corazon Aquino
spiritual status and function 2. RA 9257 or Expanded Senior Citizens Act of
✓ Engage the older adult in all aspects of 2003 – an act granting additional benefits and
care to the maximum extent possible privileges to senior citizens amending for the
✓ Provide information and education on Purpose Republic Act No. 7432. Approved on
a level and in a language appropriate February 26, 2004 under the administration of
for the individual Former Philippine President, Gloria
✓ Individualize care planning and Macapagal-Arroyo
implementation of the plan 3. RA 9994 or Expanded Senior Citizens Act of
✓ Identify and reduce risks 2010 – An act Granting Additional Benefits and
✓ Empower the older adult to exercise Privileges to Senior Citizens, Further
maximum decision-making Amending Republic Act No. 7432. Approved
✓ Identify and respect preferences on February 15, 2010 under the administration
arising from the older adult’s culture, of Former Philippine President, Gloria
language, race, gender, sexual Macapagal-Arroyo
preference, lifestyle, experiences, and
roles
NCM 114 – CARE OF THE ELDERLY
Transcribed by: Jannah Isha Z. Jani
BCI – College of Nursing

A. The grant of twenty percent (20%) discount CHALLENGES TO SUCCESSFUL MEDICATION

and exemption from the value-added tax REGIMENS FOR THE OLDER ADULT
(VAT)
• Right Drug
B. 5% discount in utilities provided that the
utility is named to the senior citizen and • Right Amount
will not exceed 100kwh/month and 30m3
• Right Route
MEDICATIONS OF OLDER ADULTS
• Right Times
• Normal aging is associated with certain
• Right Patient
physiological changes that can significantly
influence drug response. Both MAJOR ETHICAL PRINCIPLES
pharmacokinetics and pharmacodynamics
play a role in how a person will respond to a
drug

MEDICATIONS AND LABORATORY VALUES

• Today, the geriatric population (persons 65)

makes up about 13% of the general
population. That number is expected to
increase to greater than 20% by the year 2040.
• One national survey of noninstitutionalized
persons, published in 2002, found that 40% of
adults aged greater than 65 years used 5 or
more different medications per week and 12%
used 10 or more different medications.

THE EFFECT OF AGING ON DRUGS CARE FACILITIES

• How the person responds to drug: TYPE DEFINITION AND

✓ Absorption DESCRIPTION
✓ Distribution Short-Term
✓ pharmacodynamics – what the drug (Post-Acute)
Settings
does when they are in the body.
Inpatient • Provide intensive
• Drug-related problem in the elderly
Rehabilitation rehabilitation using a
✓ Adverse drug reaction facilities rehabilitation
✓ Food drug Interaction interdisciplinary team
✓ Polypharmacy approach in a facility’s
✓ Inappropriate prescribing inpatient hospital
✓ Compliance environment.
✓ Potentially Inappropriate medications • Patients must receive
for geriatric patients multiple therapy
disciplines at least 15
LABORATORY VALUES hours per week and
• Laboratory results for older adults may differ make measurable
improvement
from those of younger adults; that is, the
• Physician involvement:
reference ranges or “normals” may be
high (2-3 visits per week)
different. (Leaving tourniquet too long)
Skilled nursing • Provide services
• Laboratory values and medication facilities essential to the
administration go hand and hand. maintenance or
✓ Monitor compliance with medication restoration of health
administration. • Admission requires a 3-
✓ Check for the therapeutic and toxic night hospital stay
effect of medication in the blood. within the last 30 days
✓ Evaluate the body’s ability to • Physician involvement:
metabolize medication. moderate (required visit
✓ Evaluate the need for medication to treat every 30 days, but often
condition. more frequent as
medically necessary)
Chronic care • Care for patients with
hospitals hospitals complex care
NCM 114 – CARE OF THE ELDERLY
Transcribed by: Jannah Isha Z. Jani
BCI – College of Nursing

needs (ventilator and assistance with ADLs,

weaning) discharged and exercise in a group
from hospitals environment for
• Physician involvement: individuals with
high (on-site availability cognitive and/or
daily) functional impairments
Home health • Care for patients who • Physician involvement:
care are care confined to minimal (often initial
home and require medical summary
intermittent skilled required)
nursing care Program of All- • Provides
• Physician involvement: Inclusive Care comprehensive long-
low (as medically for the Elderly term services and
necessary when (PACE) supports to individuals
identified by the home aged 55 or older, are
healthcare team) eligible for nursing
Outpatient • Care for patients who home care, and can live
Rehabilitation can travel to a safely in the community.
programs rehabilitation location • Care coordinated by an
• Physician involvement: interdisciplinary team
minimal (as problems • Physician involvement:
are identified by the variable according to
rehabilitation specialist) the needs of the
Long-term participant but a
settings physician is often on site
Nursing homes • Provide room, meals, and may visit people in
personal care, 24-hour their homes
nursing carem Specialized • Provides specialized
medication dementia units care for people with
management, social dementia – often a
and recreational separate secured unit,
activities, and medical trained staffing, special
care to residents with programming, a
chronic conditions modified physical
• Physician involvement: environment, and family
moderate (required visit involvement
every 60 days and as • Physician involvement:
medically necessary) variable
Residential • Regulated under a Home • Home health aide or
care/assisted variety of assisted living care/personal homemaker/companion
living names (including care that provides
communities personal care homes, nonmedical care (help
group communities’ with ADLs, cooking,
homes, board and care shopping, laundry) to
homes, and others) enable older adults with
• Provide room, meals, chronic illnesses to
supervision, assistance remain at home.
with medications, some • Physician involvement:
personal care minimal
• May charge a base rate Hospice • For individuals certified
with added fees for as having a life
additional services expectancy of 6 months
• Physician involvement: or less.
low (required yearly and
as medically necessary)
Adult day care or • Provide meals,
adult day health recreation, health-
centers related services (e.g.,
medication
management; weight,
blood pressure, and
diabetes monitoring),
transportation,
NCM 114 – CARE OF THE ELDERLY
Transcribed by: Jannah Isha Z. Jani
BCI – College of Nursing

PALLIATIVE CARE

COMMON END OF LIFE DOCUMENTS

GOAL OF PALLIATIVE CARE

BILL OF RIGHTS OF LONG-TERM RESIDENTS

ORIGIN OF ADVANCE DIRECTIVES

PURPOSE OF ADVANCE DIRECTIVES

TYPES OF ADVANCE DIRECTIVES

CONTEMPORARY LONG TERM CARE NURSING

FACILITY

5 WISHES

POLST

END OF LIFE
NCM 114 – CARE OF THE ELDERLY
Transcribed by: Jannah Isha Z. Jani
BCI – College of Nursing

WHO CAN MAKE DECISIONS IF THE OLDER ADULT ➢ Advance Activities of Daily Living
IS NOT CAPABLE (AADL)

➢ Canadian Occupational Performance

Measure (COPM)

➢ Physical Performance Test (PPT)

✓ Physical Assessment
➢ System Assessment
SPIRITUALITY AMONG OLDER ADULTS ✓ Cognitive Assessment
➢ Mini Mental State Examination
(MMSE)
✓ Psychological Assessment

➢ Quality of Life and successful aging.

➢ Geriatric Assessment Scale

✓ Social assessment
✓ Spiritual assessment
✓ Other assessment
ETHICAL DILEMMAS
➢ Overweight and obesity

➢ BMI

✓ Developing an individualized Care plan

TEACHING OLDER ADULTS PROMOTING

INDEPENDENCE IN LATER LIFE

• CHANGES THAT AFFECT INDEPENDENCE IN

LATER LIFE

✓ Maintaining Independence

➢ Role changes transition

➢ Caregiving options
MEASURES TO HELP NURSES MAKE ETHICAL
DECISIONS ➢ Socialization

• Nurses should minimize their struggles in ➢ Psychosocial and Spiritual Influences

making ethical decisions by using critical
➢ Goal Attainment
thinking and employing the following
measures: • Maximizing function

➢ preventing complications of
existing disease.

• Fall Prevention

➢ Value of rehabilitation
➢ Use of and alternative restraints
➢ Financial Consideration
➢ Community resources
ASSESSMENT OF OLDER ADULTS

• Comprehensive Geriatric Assessment

✓ Functional Assessment - identify an older
adult’s ability to perform self-care, self-
maintenance, and physical activities, and
plan appropriate nursing interventions.
➢ Activities of Daily Living Tool (ADL)

➢ Instrumental Activities of daily Living

(IADL)
NCM 114 – CARE OF THE ELDERLY
Transcribed by: Jannah Isha Z. Jani
BCI – College of Nursing