Nursing care of the older adult in wellness

NCM 114 CARE OF THE OLDER ADULT

MODULE 2

NURSING CARE OF THE OLDER ADULT IN WELLNESS

A. ASSESSMENT
• SUBJECTIVE DATA
• NURSING HISTORY
• FUNCTIONAL HEALTH PATTERNS
• OBJECTIVE DATA
• PSYCHOLOGICAL ASSESSMENT
• PHYSICAL ASSESSMENT

B. PLANNING FOR THE HEALTH PROMOTION, HEALTH MAINTENANCE AND

HOME HEALTH CONSIDERATIONS
1. PLANNING FOR SUCCESSFUL AGING
2. HOME CARE AND HOSPICE
3. COMMUNITY – BASEDSERVICES
4. ASSISTED LIVING
5. SPECIAL CARE UNITS
6. GERIATRIC UNITS

C. IMPLEMENTATION
1. PHYSICAL CARE OF OLDER ADULT’S AGING SKIN AND MUCOUS MEMBRANES
- ELIMINATION
- ACTIVITY AND EXERCISE
- SLEEP AND REST
2. PSYCHO – SOCIAL OF OLDER ADULTS
- COGNITION AND PERCEPTION
- ENGAGEMENT WITH LIFE
- SELF – PERCEPTION AND SELF – CONCEPTS
- COPING AND STRESS
- VALUES AND BELIEFS
- SEXUALITY AND AGING
a. assessment

• Assessing Older Adults

- Medical
- Screening Physical Exam

Subjective Specific to Elders

• Family History
• Social History
• Review of Systems
• Medicare Wellness Visits
- Family History
 - List of Current Providers
- A written plan for screenings
- List of risk factors and conditions for which preventive interventions are being applied
• Objective Specific to Elders
- Orthostatic BP
- Visual and Hearing
- Musculoskeletal
- Neurological

Medication Review
• De – Prescribing
- Look for and recognize opportunities to stop a medication.
- Do annual med review
- Review all existing medications before starting another
- Harm outweighs benefit
- Minimal or limited effectiveness
- No documentation indication
- Not being taken or taken inappropriately

Nutrition and Dental

• Nutrition
- Inquire about recent weight loss
- Notice a BMI ˂ 20
- When relevant
 24 hour recall
 Malnutrition assessment
 Dietician
 Ability to plan and prepare meals
 Depression screen

Dental
• Tooth decay or loss
• Poor fitting dentures
• When relevant
- Dental referral

Hearing and Vision

• Hearing
- Whisper Test
- Self – report hearing loss
- Weber and Rinne
- Ear exam
- When appropriate
 ENT
 Audiologist
Hearing and Vision
• Vision
- Self - report vision change
- Eye Exam
- Snellen Chart
- Ophthalmology referral

Pain and Urinary Incontinence

•Pain
- Inquire about pain
- When appropriate
 Pain inventory
 Coping patterns
 Falls

Pain and Urinary Incontinence

• Urinary Incontinence
- Change in bladder habits
- Inquire if lost urine > 5 times in past year
- When appropriate
 Prostate exam
 Vaginal exam
 Formal UI evaluation

Mental
Cognitive, Emotional and Spiritual
• Cognitive Status
- Self – report of Memory deficit
- Mini – cog
- When appropriate
 MMSE
 Dementia evaluation
 Delirium evaluation
 Depression screen

Mental
Cognitive, Emotional and Spiritual
• Emotional and Spiritual Status
- Spiritual – recent change
- When appropriate
 In depth interview
 Spiritual advisor
 Chaplain
 Depression

Mental
Cognitive, Emotional and Spiritual
• Emotional
- PHQ – 2
- When appropriate
 Geriatric Depression Screen
 PHQ – 9

Physical
• Functional- Gait and Balance
- Self – report of ADL and IADL
- When appropriate
 Formal Evaluation
 Referral to PT/OT
 Get up and Go
 Gait Speed
 Orthostatic BP

Physical
• Falls
- History of Falls or Trips
- When appropriate
 Fall work – up
 PT evaluation

Environment
• Social, Financial Status
• Environmental Hazards

Care Performance
• Life Sustaining Measures
• b. Planning for health promotion, health maintenance and home health considerations
1. Planning for successful aging
Healthy ("successful") aging is achievable, with sound planning for old age. A positive
attitude will enable us to overcome illness and personal losses while looking forward to days to
come.

Steps to Successful Aging:

1. Adopt and maintain healthy habits and positive lifestyles:
• Avoid cigarette smoking
• Have no more than one alcoholic beverage in a 24 hour period
• Exercise regularly, maintaining the triad of weight bearing, aerobic, and balance activities.

2. Get regular medical checkups

• Maintain intellectual stimulation and socialization
• Pursue hobbies and interests with passion, particularly those such as dancing that are
social
• Strengthen family relationships
• Resolve intergenerational conflicts
• Engage in adult educational activities to challenge your mind

3. Be wise in financial planning:

• Plan in advance for retirement
• Carefully manage investments and assets
• Assure adequate insurance coverage
• Decide on your future living arrangements

4. Work to maintain dignity and good health in old age:

• Choose a physician knowledgeable in the medical care of older adults.
• Choose a health care system that facilitates appointments and care for elders.
• Communicate your goals of care to your family and physician.
• Express your advance directives in writing.

• 2. Home Care and Hospice

2. Home Care and Hospice

• Many health care services are often provided in the familiar and supportive setting of home
- where most patients prefer to be, given the choice. The home care option reduces
unnecessary hospital stays, and perhaps most importantly, delivers personalized, one-on-one
attention from a dedicated, multidisciplinary health care team straight to the doorstep.

Two of the most commonly known home health care specialties are home health and
hospice.
a. Home health services are short-term medical services ordered by a doctor and provided at
home to help adults and seniors recover or rehabilitate from an injury, illness, surgery, or
hospitalization or to help them learn how to better manage a chronic condition such as diabetes
or COPD.

b. Hospice care services provide clinical, social, emotional, and spiritual care and support for a
patient and their immediate family members near the end of life. As part of hospice, the care
team provides palliative care - designed to keep the patient as comfortable as possible with a
variety of interventions to reduce and manage pain and other symptoms.

3. Community – Based Services

• Community-based supports and services (CBSS) are designed to help community-dwelling
older adults remain safely in their homes and delay or prevent institutionalization. CBSS
provide (and act as a link to) specific resources for older adults and their caregivers that
include wellness programs, nutritional support, educational programs about health and aging,
and counseling services for caregivers, as well as general assistance with housing, finances,
and home safety. CBSS also provide opportunities for community and civic engagement
through various volunteer programs and can enhance individuals’ skills and attitudes “to live
 in and gain more control over local aspects of their communities”.

4. Assisted living
• Assisted living is a residential option for older adults who want or need help with some of
the activities of daily living - things like cooking meals, getting to the bathroom in the middle
of the night, keeping house, and traveling to appointments.
• Assisted living facilities offer the safety and security of 24-hour support and access to care.
Day or night, help is only a phone call away. However, privacy and independence are
encouraged. A good facility will develop a personalized plan that meets the needs and
accommodates the disabilities, while giving the freedom to do what client can for his/herself.
5. Special Care Units are Inpatient units specifically designed, staffed and equipped for the
continuous observation and treatment of critically ill patients, including all types of intensive
care units, as well as intermediate care or step-down units.
Types of units are the following:
• Intensive Care Units
• Coronary Care Units
• Cardiac Telemetry Units
• Step – down Units (Intermediate Care units)
• Isolation Units
• Reverse Isolation Units

6. Geriatric Units are Units with private rooms specializes in the care of individuals age 65 or
older.
• C. Implementation
1. Physical Care of Older Adults
• Aging skin and mucous membranes
- Age-related changes in the skin mean older people are at increased risk of skin
breakdown, and should be supported to maintain good skin health.
- Skin health is essential to the wellbeing of older people and a fundamental aspect of
nursing care.

Nursing Intervention/Implementation includes:

• Regular assessment of the skin health of older patients.
• To promote self-care among older patients
• And to encourage the client to use of appropriate products.

• Elimination
- Changes in elimination expected as the person ages:
 Bladder atrophy- inability to hold bladder for long periods.
 Constipation can become a concern because of slower metabolism.
 Men can develop prostate problems causing frequent need to urinate.
 Incontinence may occur because of lack of sphincter control.

Nursing Intervention/Implementation for changes in elimination among Older adults:

• Maintain bowel routines and place client on bowel elimination protocols if necessary.
• Advised to decrease caffeine intake.
• Advised to increase fiber and fluid intake.
• To promote exercise.
• To provide appropriate supplies and emotional support.

• Activity and Exercise

- Physical activity in older adults can decrease morbidity and mortality, reduce disability,
and improve quality of life (Elsawy & Higgins, 2010).
- An exercise program is a key component for improved health and reduced morbidity for
home healthcare patients.

Nursing Intervention/Implementation includes:

• Educating and engaging patients and caregivers in an exercise routine that will be beneficial
to the patient's health and well-being.
• A simple assisted range-of-motion routine can provide an improved health status and feelings
of well-being.

Nursing Intervention/Implementation includes:

• Providing education on the benefits of a home exercise routine and utilizing the resources
available, such as physical therapists and caregivers can help the patient maintain a
therapeutic activity routine.
• An exercise routine can improve a patient's health condition and reduce utilization of
healthcare resources and the number of healthcare encounters.

• Sleep and Rest

Sleep patterns often change as one ages, waking up tired every day and disturbed sleep patterns
are not considered a part of normal aging. Adequate sleep is essential to good health and to
quality of life for all persons, including the elderly.

Nursing Intervention/interventions includes:

• Maintain a regular routine and sleep – wake schedule every day, including weekends.
• Maintain a regular exercise schedule.
• Have a safe and comfortable place to sleep.
• Use the bedroom only for sleeping.
• Get exposure to natural light for several hours per day.
• Reduce the use of caffeine, alcohol and tobacco, especially late in the day.
• Develop a bedtime routine for each night.

2. Psycho – social of Older adults

• Cognition and Perception
The cognitive-perceptual health pattern deals with the ways people gain information from the
environment and the way they interpret and use this information. Perception includes the
collection, interpretation, and recognition of stimuli, including pain. Cognition includes
intelligence, memory, language, and decision making. Cognition and perception are intimately
connected to the functioning of the central nervous system and the special senses of vision,
hearing, touch, smell, and taste.

Nursing Interventions/Implementation: takes place in the hospitals or extended – care facilities.

• Ensures that all caregivers are aware of person’s sensory problems.
• Make appropriate sensory contact before beginning of care.
• Determine the best methods for communicating with older adults.
• Modify the environment to reduce risks.
• Verify the prosthesis such as eye glasses and hearing aids are functionals.

Nursing Interventions/Implementation: takes place in home.

• Modify the home environment to compensate for sensory changes.
• Assist sensorially impaired person in developing techniques or acquiring devices that will
help compensate for losses.

• Engagement with life

Successful psychological aging is reflected in the older person’s ability to adapt to physical,
social and emotional losses and to achieve contentment, serenity and life satisfaction. Because
changes in life patterns are inevitable over a lifetime, the older person intends resiliency and
coping skills when confronting stresses and change. A positive self - image enhances risk taking
and participation in new, untested roles.

• Self – Perception and Self – Concept

Positive self-perceptions of aging have been associated with a variety of health outcomes among
older adults including increased longevity, better functional health, higher likelihood of recovery
from severe disability, and enhanced physical recovery following an acute myocardial infarction.

• Self – Perception and Self – Concept

A negative self-perception of aging is an indicator of risk for future disability in ADL. Factors
such as a low-economic status, living alone, multiple chronic medical conditions, and depressive
feelings contribute to a negative self-perception of aging.
• The older adult needs a positive self-concept in order to live a fulfilled, complete life. Older
adults need to have a sense of self based on experience rather than on judgements of others,
whether peers, family or society in general.
• Coping and Stress
Coping patterns and the ability to adapt to stress are developed over the course of a lifetime and
remain consistent later in life. Experiencing success in younger adulthood helps a person develop
a positive self – image that remains solid through even the adversities of old age.

• Values and Beliefs

Many older adults rely strongly on their spiritual beliefs for comfort during stressful times.

• Sexuality and Aging

- With aging, that may mean adapting sexual activity to accommodate physical, health, and other
changes.
- There are many different ways to have sex and be intimate—alone or with a partner. The
expression of sexuality could include many types of touch or stimulation. Some adults may
choose not to engage in sexual activity, and that's also normal.
- Normal aging brings physical changes in both men and women. These changes sometimes
affect the ability to have and enjoy sex. Some illnesses, disabilities, medicines, and surgeries can
affect your ability to have and enjoy sex. Older couples face the same daily stresses that affect
people of any age. They may also have the added concerns of illness, retirement, and lifestyle
changes, all of which may lead to sexual difficulties.
• As a Health Care provider, advice the client to talk openly with his/her partner, and try not to
blame his/herself or their partner.
• Advised to talk with a therapist, either alone or with partner. Some therapists have special
training in helping with sexual problems.
• If client have a long-term partner, take time to enjoy each other and to understand the
changes both are facing.

• Mental and Psychosocial support for Older adults/Seniors

- Keep in regular contact with loved ones via telephone, e – mail, social media or video
conference.
- Keep regular routines and schedules as much as possible for eating, sleeping and activities that
older adults may enjoy.
- Practice simple daily physical exercise to do at home to maintain mobility.
- Find out how to get practical help if needed. Learn how to: arrange transportation, have food
delivered, asked for medical assistance, order goods and services online.
- Make sure to have a one - month supply or longer of regular medicines.
- Ask family members, friends or neighbors for help, if needed.