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Pre-
assessment
OLDER ADULTHOOD: DISCUSSION OF PERCEPTIONS ABOUT
WELLNESS IN AGING AGING AND OLDER ADULTS
MILLER CH. 1
POTTER & PERRY CH. 24

https://www.istockphoto.com/photos/older-people-group 1 2

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Categories of ‘older age’

Who are ‘Older Adults’? (Boscart et al., p. 2)
Older Adult: Psychologists have divided the “old” into
 >65 y/o (Stats Can, etc.) categories:
 “an older adult includes people who are 55 years and older to ◦ Young–old, 65-74
include individuals who may have aged prematurely or have ◦ Middle–old, 75-84
shortened life expectancies” (RNAO, p. 90)
◦ Old–old, 85-94
Sometimes referred to as: ◦ Oldest-old, 94 -
 seniors, elders, elderly, geriatric population ◦ Centenarian - over 100
◦ (Canada 2020: 11,517)
◦ Super centenarian – over 110

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Older Adults in Canada Defining ‘Aging Well’

2020 Canada stats: Wellness
 connection between health, functioning, and quality of life
- 18% of Canadians are over 65 y/o (55% are baby
boomers) Subjective > objective
Active process of identifying areas for improvement and making
- 11,517 centenarians (growth rate 10x that of general changes to optimize wellness potential
population growth rate) continuum
Projections mind-body-spirit connection (holistic)
◦ 2025- seniors 1/5 of Canadian pop  reaching highest potential despite presence of age-related
changes
◦ 2059- seniors 1/4 of Canadian pop
NOTE: quality of aging = 25% genetics: 75%
Source: https://www150.statcan.gc.ca/n1/pub/91-215-x/91-215-x2020001-eng.htm
lifestyle/environment- Major opportunity for nursing!!!
https://www150.statcan.gc.ca/n1/daily-quotidien/200929/dq200929b-eng.htm

5 Strout et al. (2018). What are older adults’ wellness priorities? Health aging research, 67; e21.

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Attitudes Toward Aging and

Definitions for this course Older Adults
Geriatrics: Positive:
 a medical subspecialty focused on the medical  Respect, honour, valued for continuing contributions,
problems of older adults knowledge, guidance
Gerontology: Negative:
 the study of healthy and successful aging of older  ‘Ageing anxiety’- Ageing feared as the body losing
adults beauty, function, health
 Older adults dismissed for being ‘outdated’,
‘incompetent’, ‘irrelevant’, ‘burdensome’, dependent,
not able to contribute, unattractive

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Ageism Effects of Ageism

“the stereotyping of, and discrimination against,  Abuse and neglect of older adults
individuals or groups because of their age” (NIA, 2021,
 Social isolation of older adults
p. 29)
 Undermining of older adults’ self-esteem
 Ageism does NOT exist in all cultures
 many cultures promote intergenerational  Discrimination in health care resource distribution
interdependence and respect the wisdom and
 Age attribution in health care!!!!-
contribution of older adults ie. Indigenous peoples,
Chinese, Vietnamese, Filipinos, East Indians, WHAT ARE THE RISKS?
Japanese, Koreans How can we avoid age attribution?
Examples of ageism in the media and society?

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Debunking Myths: Characteristic

Trends of Older Adults in Canada
Common Myths about aging*** (Potter & Perry, p. 412)
80% of people aged 65 years & up live LTC Health Characteristics:
Widowhood or other life events always (-) impact  50% of persons >65 perceived health as good or excellent

Inevitable decline in all intellectual abilities  18% perceived health as fair or poor (StatsCan, 2021)
 Most older adults remain functionally independent
Cannot learn complex new skills
 Increasing chronic disease- 91% ≥1 chronic condition
Constipation and urinary incontinence – normal aging
 20-50% report some limitations in activities
Increased disability – linked to age r/t changes
Living arrangements:
Health promotion pointless – if chronic illness present
 93% live in private homes, 7% in institutions
Older adults are asexual Socioeconomic: (NIA, 2021, p. 39)
 14.5% living in low income, increasing number
Video dispelling ageist stereotypes** (3:00)  increased risk for single persons, women, >75yo, Indigenous, recent immigrants (no
CPP- sponsorship!!)
https://www.youtube.com/watch?v=hpBo2dl3PBc&feature=share  Older adults contribute significantly to society through volunteerism

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Addressing nurses’ Addressing nurses’

attitudes about older adults attitudes about older adults
Listen to the older adults that you care for- Self-awareness of beliefs, attitudes
experiences, self-identities, beliefs, hopes Activities:
Continuous education about older adults, characteristic 1. Over your next clinical and time out of school, take note of how
trends, statistics, impact of social determinants of older adults are portrayed, treated, spoken about and to. Note
health whether these interactions and images are negative, positive, or
neutral.
Gerontological nursing: 2. Rephrase the 20 questions in the Ageism Survey (Fig. 1-2, p. 7)
 be knowledgeable about normal age-related changes and ask yourself how often you have done any of those activities.
and pathological conditions

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Wellness-Based
Model for
Figure 1-2
Healthy Aging
The Ageism Survey is being used to measure
the prevalence and identify types of ageism.
(Used with permission from Palmore, E.
[2000]. The ageism survey [6th ed.]. Durham,
NC: Duke Centre for the Study of Aging.)

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Wellness-Based Model for Nurses promoting wellness

Healthy Aging in older adults
• Health across a continuum Nursing principles of wellness promotion in older adults:

• Healthy aging viewed from prenatal period to death 1. Nurses must have the knowledge to distinguish normal age-
related changes and risk factors that can be treated or even
• Epigenetics gives new understanding of the impact of prevented.
environment factors 2. Nurses can address health risk factors through a wellness lens
by collaborating with clients to find ways to improve functioning
• Health promoting strategies key to achieving and and quality of life.
maintaining the highest level of wellness on a
continuum What guides us in this carrying out these principles in care?
• Functional Consequences Theory for Promoting Wellness in
• Preventative services are highly underutilized (NSN, 2020)
Older Adults
• Ex. Vaccines, falls prevention initiatives

National Institute on Aging. (2020). National seniors’ strategy: ENSURING CANADIANS ARE SUPPORTED TO ENGAGE IN WELLNESS AND
PREVENTION ACTIVITIES THAT ENABLE HEALTHY AGEING https://nationalseniorsstrategy.ca/the-four-pillars/pillar-2/wellness-and-prevention/ 17 18

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Concepts Underlying the Functional

Consequences Theory (P & P, p. 415)
Combinations of age-related changes and risk factors increase
vulnerability to negative functional consequences.
Nurses assess age-related changes, risk factors and functional
consequences, with particular emphasis on identifying factors
that can be addressed through nursing interventions.
Wellness outcomes enable functioning at their highest level
despite the presence of age-related changes and risk factors.

Miller. Fig 3-1. p. 38 20

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Age-related changes
(see common examples: P & P, Table 24-1, p. 416) Risk Factors
progressive changes cannot be reversed or altered What are RISK FACTORS?
a person can compensate for their effects to achieve or optimize Conditions that are likely to occur in older adults & have a
wellness outcomes detrimental impact on their health and functioning
physiological age-related changes are degenerative/decline Place the older adults as vulnerable negative functional
consequences
Psychological and spiritual changes have the potential for
growth and development Characteristics:
Nsg focus regarding age-related changes Cumulative and progressive
 Focus on aspects that can be strengthened to compensate for Exacerbated by age-related changes
the physiological decline
Commonly attributed to age-related changes (age-attribution)
Build on wisdom for problem solving skills to address risk factors
Reversible and treatable!!

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Risk Factors Functional Consequences

What are the types of risk factors? Effects on a person’s:
Environment • ability to perform activities of daily living (ADLs)

Physiological (disease related processes) • level of health

Psychosocial • degree of quality of living

Caused by:
Medication effects
• Actions
What do we do about risk factors? • Adult’s compensation to age-related changes (use of reading glasses)
 prevention focused interventions • Adult’s deliberate change in behaviour/lifestyle
• Nursing interventions
 management focused interventions
• Age-related changes
• Risk factors

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Nursing within Wellness Health within the Wellness

Promotion Model Promotion Model
Deliver person-centred care** “the ability of older adults to function at their highest
Essential: get to know the older adult. capacity, despite the presence of age-related changes
and risk factors” (Miller, p. 42)
Involve older adults in decision making due to being experts in
their own health.  individually defined wellbeing and quality of life:
Metaphysics; self-image, self-esteem
Focus of nursing care: minimize negative effects of age-related
changes and risk factors, and promote wellness. Spirituality; connections with faith based
organizations
When risk factors cause the older adult to be dependent on
others for daily needs, the caregivers are considered an integral Biological; community meals and exercise
focus of nursing care. Social connection development
Environmental connections; nature access

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Environment within the

Practice case studies
Wellness Promotion Model (Hirst et al, 2015)
“all aspects of the setting in which care is provided, including A nurse is caring for a 70-year-old woman whose daughter assists with
caregivers” (Miller, p. 42) her everyday care at home. The daughter shares with the nurse that her
mother is constantly complaining about losing control of her bladder
Ex. from time to time, not being able to see well and having issues with
 Accessibility of a home moving her bowels frequently. The daughter further states that she does
not understand why her mother is complaining about these normal aging
 Transportation availability problems.
 Cost of food A. According to the functional assessment theory, are these normal
changes?
 Caregiver approach to care
B. What concerns would the nurse have about the daughter’s
 Others? statements, if any?
C. How can the nurse assist the daughter and the client?

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Summary
Nurses asses the age-related changes, risk factors, and functional
consequences, with particular emphasis on identifying the factors
Introduction to
Health Promotion
that can be addressed through nursing interventions.
Wellness outcomes enable older adults to function at their higher
level despite age-related changes and risk factors.
Nurses educate older adults and caregivers about interventions to
minimize risk factors and their effects. Priorities
A holistic approach to nursing care of older adults is seeing
opportunities for wellness in physical, psychological, and spiritual FOR OLDER ADULTS
aspects of function.

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Priorities for Health-aging & Health

Promotion for Older Adults Social Isolation
1. social connectedness Key behaviours (intrinsic Social Isolation: “the lack of a sense of belonging, social
capacity) engagement, and quality relationships” (P&P, p. 420)
2. physical activity Causes of social isolation: personal choice or lack of social
1. physical activity opportunities, abuse of older adults
3. healthy eating
2. nutrition Risk factors to experience social isolation: (NIA, 2020, p. 33)
4. falls prevention
Key environmental risks: geographic rural/remote dwelling, no longer driving,
5. tobacco control
(PHAC, 2006)
1. Emergency situations having multiple chronic illnesses

1. health literacy 2. Elder abuse living alone

(WHO, 2015, p. 69-74) outliving partners and friends
2. fall prevention
(NIA, 2020)
Have low income
Need to empower people, create healthy and safe community Changing family structure
environments, provide clinical and community preventative services,
eliminate health disparities Critical life transition (retirement, bereavement)
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Potential consequences of Approach to combat social

social isolation (NIA, 2020,p. 33-35) isolation
For the older adult: Value the role, contribution, and needs of older adults
Decline in health, wellbeing, cognitive functioning; loneliness
Age-friendly, inclusive, communities, workplaces, and
Abuse of older adult health & social services
Engagement in smoking, drinking, unhealthy diet Outreach programs:
Increased risk of falls, heart disease, stroke, depression, Meals on wheels
anxiety suicide
Significant predictor of DEMENTIA & DEATH
Volunteer opportunities for older adults
Social activity connections; call ins
*Social INCLUSION is a significantly PROTECTIVE factor against Religious institutions
dementia & death
Colleges
For the community: Libraries
loss of contribution and participation from older adult
(volunteering, wisdom, leadership)

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Examples of commonly used,

Health Literacy complicated terms (Davis, 2015)
the ability to access, understand, and use health information to Hypertension
make decisions about health promotion, maintenance, and
improvement Annually
 88% of older adults (>65yo) do NOT have the health literacy skills
to support them in making health care decisions!!! (CCL, 2008) Diet
Factors contributing to low health literacy skills: Cardiovascular
 client disinterest or lack of self-efficacy to change/learn
Diabetes
 cultural and language differences
Hygiene
 lower levels of education
 lower social economic status Oral
 hearing or vision impairment
 decreased computer literacy or use with increased age What are examples of plain language?
 HC communication approach and delivery

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Affects of low health literacy for Using a “universal precautions

older adults (Peng et al., 2015) approach” (Davis, 2015)
Risks for older adults with low health literacy: Structuring the delivery of care as if everyone may
 lower use of preventative and health promotive services have limited health literacy:
 poorer health outcomes;
◦ You cannot tell by looking.
challenges managing tx regime for chronic conditions ◦ Higher literacy skills ≠ understanding.
 medication adherence problems ◦ Anxiety can reduce ability to manage health
 lack of understanding of disease and tx information.
 increased risk for hospitalization ◦ Everyone benefits from clear communications
 lower health related Quality of Life ◦ Look for clues of lower health literacy**
 increased mortality

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Approaches to Improve Health Approaches to Improve Health

Literacy with Older Adults Literacy with Older Adults (cont.)
Modify the environment: Modify spoken communication (cont.):
 quiet room, sit facing the client, check for client use use multiple forms of communication
of visual and hearing aids, use low and slow tone/pace Written, printed handouts/forms, 3-D props, grade 6
of voice reading level
Modify spoken communication:  have a family note taker or nurse to offer to write
abbreviate notes
 plain language, avoid jargon
 encourage client to ask questions
 be specific and concrete:
what the client “needs to know” “needs to do”
 focus on 3-5 key points and summarize them

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Health literacy:
Discussion- health literacy
Confirming understanding (Davis, 2015)
Use of open ended questions: X “do you understand?” Looking back, have there been instances when you suspected, or
Ask me 3: (patient to confirm patient understanding) now suspect, that a patient might have low health literacy? What
were the signs?
What is my main problem?
Do we do things in our nursing practice that make it easier for
What do I need to do? patients with low literacy to understand services and information?
Why is it important for me to do it? ◦ Consider the entire process of patient care
Teach back: (nurse to confirm patient understanding) What strategies could all of us adopt to minimize barriers and
“How will you use this medication? What will you do when you get misunderstanding for low literacy patients with low health literacy?
home?”

Watch video summary (6:20):

https://www.youtube.com/watch?v=YTxmRkpiEUU

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Immunizations
**increase older adults’ awareness and health
literacy about importance of vaccines

Health Promotion/Illness Recommended vaccines:

Prevention Guidelines for Older Seasonal Flu (annually)

Adults Pneumococcal (schedule varies by age)

Varicella and Herpes Zoster (after 50 y/o)
Tetanus and Pertusis (q 10 years)
Covid-19

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Exercise Secondary Illness Prevention

Recommendations for Exercise (CSEP, 2021): Screening: (CTFPHC, 2019)
Moderate to vigorous aerobic physical activities (150 min/week) BP and BMI at each primary care provider visit
Muscle strengthening activities using major muscle groups Cholesterol every 5 yrs
(2+/week)
Colorectal cancer:
Physical activities that challenge balance
 Fecal occult blood testing every 2 yrs, none >74y/0, or
sigmoidoscopy Q 10 yrs
Women:
Breast screening: q2-3 yrs (people with no risk)
No paps >70y/o (with 3 negative previous pap results)

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Tertiary Illness Prevention Summary

Weight reduction Age and wellness linked
Management of hypertension Whole person perspectives- mind, body, spirit, social
Smoking cessation connections
Alcohol misuse cessation ◦ Goal to maximize potentials and mitigate limitations
Beware of and dispel myths
Demographic realities
◦ Age across a spectrum of experience and years
◦ Growing population
◦ Increasing complexity of needs

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