NURSING CARE OF

THE OLDER ADULT IN

WELLNESS
 ASSESSMENT
PRINCIPLES OF GERIATRIC ASSESSMENT:

• describes the health evaluation of the older

patient

• it places high value upon functional status

• it includes both evaluation and management

FRAILTY: a state of vulnerability to poor resolution of

homeostasis after a stressor event and is a
consequence of cumulative decline in many
physiological systems during a lifetime
 COMPREHENSIVE
GERIATRIC ASSESSMENT
A systematic evaluation of a frail older person

COMPONENTS:
• Data gathering
• Discussion among team
• Development of the treatment plan
• Implementation of the treatment plan
• Monitoring
• Revising the treatment plan
 COMPONENTS OF
GERIATRIC ASSESSMENT
 SUBJECTIVE DATA
• Information gathered from the person's
point of view
• May include:
⚬ Fear
⚬ Anxiety
⚬ Frustration
⚬ Pain
• Best described in the individual's own
words
Ex.
“I'm so afraid of what will happen to me
here.”
“It hurts so much I could die!”
 SUBJECTIVE DATA
NURSING HISTORY
• The first phase of a comprehensive
nursing-focused health assessment
• Provides a subjective account of the
older adults’ current and past health
status
• Data obtained can alert the nurse to
focus on critical areas of the physical
examination that require further
investigation
• Done via interview
 SUBJECTIVE DATA
NURSING HISTORY
COMPONENTS:
• Medical History
• Drug History
• Alcohol, smoking and recreational
history
• Nutrition History
• Mental Health History
• Social History
• Advanced Directives
• Functional Health Patterns
 FUNCTIONAL HEALTH
PATTERNS
• Disorders may manifest solely as
functional decline.
• Standard questions may not apply.
• Guide questions for functional Health
patterns
⚬ “How long have you been unable to
do your own shopping?”
⚬ “Do you still go for medical
consultation alone?"
⚬ “Who does marketing/grocery for
you?”
 FUNCTIONAL
STATUS
ASSESSMENT
KATZ INDEX FOR ADL'S
• Tool widely used to determine
the results of treatment and
the prognosis in older and
chronologically ill people
• Describes the patient’s
functional level at a specific
point and objectively measures
the effects of the treatment
intended to restore function
 FUNCTIONAL STATUS ASSESSMENT
BARTHEL INDEX
• The rate in self-care abilities. It is the most
appropriate index for rehabilitation settings for
documenting improvement in performance and
ability.
GUIDELINES:
• Record what a patient does, not what a patient
could do.
• The main aim is to establish the degree of
independence from physical or verbal help.
• The need for supervision renders the patient
independent. but occasionally, longer periods will
be relevant
• Middle categories imply that the patient supplies
over 50 percent of the effort.
• The use of aids to be independent is allowed.
• A patient's performance should be established
using the best available evidence. Asking the
patient, friends/ relatives, and nurses are the usual
sources, but direct observation and common sense
 FUNCTIONAL
STATUS
ASSESSMENT
IADLs (Instrumental Activities of
Daily Living Scale)
• It represents a range of activities
more complex than the self-care
tasks.
• It’s useful in identifying people
living in the community who
need help, which enables the
nurse to match services and
other resources of support for
clients.
 OBJECTIVE DATA
• It is the observation/or data gathered by
the health care provider (nurse, doctor,
health attendant)
• It may verify the subjective information
given by the older adult
• It may reveal problems that were
previously unrecognized
• Assess the patient’s ability to perform ADL
(bathing, toileting, dressing, continence,
and feeding)
Ex.
• swollen knees/joints
• Low blood pressure reading/high BP
 OBJECTIVE DATA
PHYSICAL ASSESSMENT
INSPECTION PALPATION AUSCULATION PERCUSSION
• Most • Used to • Use sense of • A technique
commonly evaluate many hearing that whereby the
used method parts of a involves the size, position
• It begins the physical use of a and density of
first time we assessment stethoscope or structures
see the older (pulse, temp, other sound under the skin
adult tumors, amplifier are assessed
• Pay close tenderness) (Doppler) by tapping the
attention to • Use of touch • Quality, Pitch, area and
details • Use fingertips Intensity, listening to the
• Use of senses • Light touch to Duration, resonance of
(eyes, smell, deep pressure Frequency the sound
 PSYCHOSOCIAL
ASSESMENT
• It is performed to determine whether
the older person is alert and aware of
the surroundings or has some level of
confusion, delirium or dementia
• It is best assessed by direct observation
and by standardized assessment tools
MINI-COG • Assessment tool that can identify cognitive impairments (DEMENTIA)
that can be tracked over time
 PSYCHOSOCIAL
ASSESMENT
Examples of Online Psychological Assessment
Tools
• Mini-Mental State Examination (MMSE)
• General Practitioner Assessment of
Cognition (GPCOG)
• Eight-item Informant Interview to
Differentiate Aging and Dementia (AD8)
• Cornell Scale for Depression in Dementia
• Functional Activities Questionnaire
• Clinical Dementia Rating Scale
• Informant Questionnaire on Cognitive
Decline in the Elderly (IQCODE)
• Confusion Assessment Method
 ASSESSMENT OF CONDITION CHANGE IN OLDER
ADULTS
FULMER SPICES FANCAPES
• can be used routinely during • used when a nurse suspects
assessments to identify that an actual emergency or
and/or prevent potential serious problem is present
problems and to monitor or might be developing
health status over time
F - fluid
S - sleep disorders A - aeration (oxygenation)
P - problems with eating or N - nutrition
feeding C - cognition, communication
I - incontinence A - activities/abilities
C - confusion P - pain
E - evidence of falls E - elimination
S - skin/socialization
PLANNING FOR HEALTH PROMOTION,
HEALTH MAINTENANCE AND HOME
HEALTH CONSIDERATIONS
 PLANNING FOR SUCCESSFUL
AGING
SUCCESSFUL AGING
• It is the process of growing older while
maintaining physical health, cognitive
abilities, and strong social
relationships.
 PLANS FOR SUCCESSFUL
AGING
• Receiving timely and effective medical care.
• Maintaining a healthy weight.
• Eating nutritious meals.
• Getting the right amount of sleep.
• Consistently getting adequate exercise.
• Avoiding excessive use of alcohol, smoking and other
non-healthy habits.
• Maintaining social stimulation.
• Maintaining mental stimulation.
 HOW TO AGE
SUCCESSFULLY BASED ON
THE 3 COMPONENTS
Physical Health

Mental well being

Strong social relationship

 PHYSICAL HEALTH
• See a doctor: When the older adult is feeling ill, take advantage of
preventative health measures, such as a yearly check-up, flu shot,
and age-appropriate exams.
• Staying active: Exercise is essential for maintaining good health
and can be incorporated into the elderly's lifestyle regardless of
physical abilities. Chair exercises, for example, are a great way for
those with limited mobility to be active.
• Make Healthy Food Choices: Proper nutrition greatly affects
successful aging. Try meal planning, meal service, or speaking to a
nutritionist for help making the right choices. The meals in
supportive living communities are designed to be healthy, so take
advantage of dining services if you’re already enjoying community
life.
• Getting enough sleep: at least 7-8 hours. This can reduce the risk
of certain health issues
 MENTAL WELL-BEING
• Take on a Challenge: Anything that promotes mental stimulation,
such as reading, puzzles, problem-solving games, and learning a new
hobby are all ways to exercise the brain.
• Work Part-Time or Volunteer: This will keep the mind engaged with
the outside world.
• Invest in a Memory-Training App: This will keep one connected to
ever-changing technology, which helps the brain continue to adapt
and sharpen one's memory.
• Engaging in Spiritual Activities: Spirituality is a major part of who you
are as a person. Stay active in your faith-based community or
pursue your own traditions to stay connected with your beliefs
• Staying positive: A positive outlook on life and aging is a crucial
factor in mental health and successful aging because it allows for
happiness despite any negative factors you’re experiencing.
 STRONG SOCIAL
RELATIONSHIPS
Connecting with others is perhaps the area that older adults themselves list as the
most fundamental component of successful aging.

• Maintain Old Friendships and Make New Ones: It is important to keep in touch with
your friends and make new friends. Share your experiences with friends you've
known for years or discover new similarities between neighbors in your community.
• Travel When You Can: Traveling expands the mind, engages the body, and allows
you to enjoy time with many different people. Cruises are a great option, as are
programs that help adults travel even if they are physically limited.
• Laughter: Laughter works as a natural feel-good medicine for one's entire body.
Watching a funny movie, seeing a comedian or enjoying stories with a friend will be
helpful.
• Taking a Class or Joining a Group: Getting involved in group-based activities will
allow one to share experiences with others and expand ones own horizons as one
learns a new skill.
HOME CARE AND HOSPICE CARE
HOME CARE AND HOSPICE
CARE
Hospice provides Home health care is
comfort care to a patient curative, intended to
with advanced illness help patients recover
when curative medical from injury or illness, or
treatments are no longer progress toward
effective or preferred. improved functionality.
 HOME CARE
• is the provision of medically related professional paraprofessional
services and equipment to individuals and their families in their place
of residence for the purpose of promoting, maintaining, or restoring
health or of minimizing the effects of illness and disability.

FOCUS:
Patient improvement

GOAL:
Return to independent functioning
CHARACTERISTICS:
• Skilled or compassionate care
• Involves family care
• Co-ordination with all disciplines
• Independent decision maker
• Accountability

SERVICES PROVIDED:
• physical therapy,
• occupational therapy or
• wound care following a hospital stay
or surgery
WHO IS ELIGIBLE FOR HOME
HEALTH CARE?
• those who have a need for short-term skilled nursing
that is normally provided at a clinic or hospital.
Patients must be homebound to receive home health
 MEMBERS OF A HOME
HEALTH CARE TEAM
• Nurses
• Physical Therapists
• Occupational Therapists
• Social Workers
• Speech Pathologists
• Physicians.
ROLES OF A HOME HEALTH
CARE NURSE
• Advocacy
• Coordinator
• Educator
 BENEFITS OF HOME CARE

• Comfort
• Cost
• Personalized care
• Independence
• Freedom
• Dignity
• Peace of mind
• Security
• Family support
 HOSPICE CARE
• Hospice care focuses on quality of life for those who have been
diagnosed with a terminal illness and have a prognosis of six months
or less.

GOAL:
to achieve comfort and have the best quality of life through the end of
life
REMEMBER!
Hospice care doesn’t mean “giving up,” rather it’s choosing to focus on
quality of life, spending time with family and doing things that are
important to you with the time you have left instead of spending time in
and out of the clinic/hospital getting tests and treatments that are no
longer helping
 HOSPICE CARE VS
PALLIATIVE CARE
HOSPICE:
• Is provided when an individual has a life expectancy of six months or less
• Is intensive comfort care rather than curative care; individuals choose to focus
on quality of life and forgo curative treatments
• Provides the medications for the terminal diagnosis and related conditions,
equipment, and supplies
• Includes 24/7 access via phone to a team of health care professionals
• Offers volunteer support to patients for companionship
• The foundation of hospice care is to provide comfort and symptom management
through high-quality care at the end of one’s life. The focus of care shifts from
aggressive to comfort care for the patient through the use of medication to keep
the patient comfortable when hospice services are started.
 TOP 10 TIPS IN CARING FOR
THE OLDER ADULT
• Keep care at home if possible.
⚬ Try to find care providers who are willing to provide care for your loved one
outside a hospital setting and in the home. For some care providers, this
may mean home visits, for others it could mean telehealth appointments.

• Coordinate your care.

⚬ Try to coordinate services among all those providing care for your loved one
—both formal and informal. This means everyone from the primary care
physician to the person who may come in once a week to clean the house.
 TOP 10 TIPS IN CARING FOR
THE OLDER ADULT
• Make care regimens person-centered.
⚬ Encourage your loved one to make their own decisions about the type of
care they receive and when and where they would like to receive it.

• Enable social inclusion.

⚬ Create opportunities for your loved one to play an active role in your family
and in your community. Isolation can be a major cause of emotional distress
for older people
 TOP 10 TIPS IN CARING FOR
THE OLDER ADULT
• Stay up to date on the latest technology.
⚬ Keep abreast of new technologies that can improve every aspect of care
your loved one receives. These may be as simple as FaceTime appointments
with your doctor or as advanced as safety monitoring systems connected to
a coordinated care network.

• Investigate your insurance options.

⚬ Explore long term care insurance options in detail and find the one that is
right for your situation.
 TOP 10 TIPS IN CARING FOR
THE OLDER ADULT
• Take care of the caregivers.
⚬ Recognize the challenges inherent in caring for a loved one in need and
make use of any resources available to you in these efforts. This may
include online support networks, opportunities to spend time away from your
loved one, or rejuvinating activities to help relieve stress and tension.

• Learn and practice mindful communication.

⚬ Don't be afraid to have what can be a tough conversation about end of life
care with your loved one. Make use of the tools and resources available
online to talk with your loved one about the kind of treatment they receive
and where they would like to receive it
 TOP 10 TIPS IN CARING FOR
THE OLDER ADULT
• Educate yourself.
⚬ Try to keep up to date with the latest innovations in elder care and best
practices in long term care.

• Create a safe environment.

⚬ Make sure the environment in which your loved one lives encourages their
independence and autonomy, mitigates and risk of injury or harm, and feels
like a personalized home environment
 COMMUNITY BASED
SERVICES
• CBAS (Community-Based Adult Services) is a community-based
day health program that provides services to older adults with
chronic medical, cognitive, or behavioral health conditions and/or
disabilities that make them at risk of needing institutional care.
• It provides (act as a link to) specific resources for older adults
andtheir care givers that include wellness programs,
nutritionalsupport, educational programs about health and aging,
andcounselling services for caregivers, as well as general
assistancewith housing, finances and home safety.
 6 WAYS TO PERSUADE
SENIORS TO BE ACTIVE
SOCIALLY
Emphasize Their Desire To Help

Your loved one may not want to go to a party for his or her own benefit but may be
eager to do anything he or she can to make your life easier. Try asking your loved
one to help you host an event for a close family member, such as a grandchild. You
could also ask your loved one to accompany you to a movie or lunch. Your loved
one may be more likely to say yes to an invitation if he or she knows his or her
presence will make you feel better.
 6 WAYS TO PERSUADE
SENIORS TO BE ACTIVE
SOCIALLY
Do something completely new.

After years of going to the same places, your loved one may just be bored. Help
your loved one get out of the house by suggesting doing something he or she
hasn’t done before. If your loved one has always loved movies, take him or her to
an outdoor film showing in your community. Alternatively, ask your loved one to try
out a new restaurant or visit a park that’s been renovated. Your loved one will
encounter new people during your adventure and may even find a new favorite
place to visit.
 6 WAYS TO PERSUADE
SENIORS TO BE ACTIVE
SOCIALLY
Ask Them To Be Teachers Or Mentors

Many adults get their socialization needs met at work, and this becomes an issue
after retirement. If your loved one has become a homebody since retiring, suggest
returning to the workforce as a volunteer or mentor. Being able to choose when to
help is important for helping your loved one stay relaxed, but he or she may also
find engaging with people in a workplace or charitable organization provides the
chance to make new friends.
 6 WAYS TO PERSUADE
SENIORS TO BE ACTIVE
SOCIALLY
Invite Them To Join In Conversations

Seniors sometimes get overlooked at group events where younger people may be
so caught up in the excitement that they don’t notice a quieter senior. Your loved
one may also feel awkward about memory loss when trying to speak. Help your
loved one stay social by including him or her in your conversations when you notice
him or her sitting alone.
 6 WAYS TO PERSUADE
SENIORS TO BE ACTIVE
SOCIALLY
Play Matchmaker

Your best friend may also have a senior parent who is lonely. Alternatively, your
loved one may need a caregiver to help at home, and hiring a professional senior
care companion is the perfect way to meet a variety of your parent’s needs. Be
willing to make a few arrangements to help your loved one meet new people to
spend time with each day.
 6 WAYS TO PERSUADE
SENIORS TO BE ACTIVE
SOCIALLY
Develop Their Hobbies And Interests

Look for people with whom your parent has something in common. Help your loved
one find groups of people who engage in the same hobbies your parent does.
Whether it’s joining a book club or attending a woodworking class, your loved one
will have a reason to spend time with like-minded people on a regular basis.
 ASSISTED LIVING

• Assisted living is a residence for older people or people with

disabilities who require help with some of the routines of daily
living as well as access to medical care when needed. Such
people, or their families, may choose assisted living facilities so
that professional help is on hand.
• In terms of the level of care provided, assisted living is a step
below a nursing home or skilled nursing facility. They are
regulated by state laws, which vary by state.atypically
understaffed, leading to negligent care.
 KEY TAKEAWAYS FOR
ASSISTED LIVING
• Assisted living provides skilled help and nursing for older people and
people with disabilities in a residential setting.
• They are designed for people who want some degree of independence
and access to help as needed.
• Residents may stay for as little as a month or long-term.
• Those who need assistance with ADLs can opt for in-home, assisted
living, or nursing home care.
 UNDERSTANDING ASSISTED
LIVING
• •Assisted living generally allows more independence and costs less
than nursing home care, but is more expensive than an independent
living facility. The assisted living setting is similar to a personal
residence, compared to a nursing home's hospital-like setting. Assisted
living is suitable for individuals who cannot manage on their own but
want to maintain
 SPECIAL CARE UNITS

• A special care unit (SCU) is an inpatient unit within a healthcare

facility that is custom-designed, staffed, and equipped to care for
people with specific health conditions. They are usually in a
physically separate space from other patient populations.
• Standing facilities or units within nursing facilities that specialize
in the care of people with Alzheimer’s disease and other types of
dementing illnesses. Behavioral manifestations of dementia are
managed in the environment without the use of chemical or
physical restraints whenever possible.
 GERIATRIC UNITS
• The term geriatrics originates from the Greek γέρων geron,
meaning "old man,” and ιατρός iatros meaning "healer".
• It aims to promote health by preventing, diagnosing and treating
disease in older adults.
• focus on diseases of aging and issues that arise with advanced
age, understanding the impact of medical conditions and
medication on older adults.
• Nurses focus on treatment and nursing care of acute problems
such as those occurring from trauma, accidents, orthopedic
injuries, respiratory ailments, or serious circulatory problems. The
purpose of care is to prevent complication and to assist with
survival