Care of The Older Population: Sixth Edition

Population and Community
Health Nursing
SIXTH EDITION
CHAPTER
19
Care of the Older

Population
Population and Community Health Nursing, Sixth Edition

Mary Jo Clark
Copyright 2015, 2008

Pearson Education, Inc. All Rights Reserved
Current Statistics: U.S. Census

Bureau (2013)
People over the age of 65 years
comprised 13.4% of the U.S.
population in 2012
By 2050, the elderly are expected to
comprise more than 20% of the
population
Worldwide life expectancy is anticipated
to increase

Mary Jo Clark

As the World's Population Ages

Growing demand for health care
services that improve the
quality of life
Need to minimize health care
expenditures

Mary Jo Clark

Theoretical Perspectives on Aging

An exponential increase in mortality
with age
Physiological changes that typically lead
to a functional decline
with age
Increased susceptibility to certain
diseases with age
As many as 300 theoretical
perspectives exist
Mary Jo Clark

Biological Perspectives
Aging is a phenomenon experienced by
all members of a given species
A process of physical, progressive and
gradual, irreversible decline, that is
progressive and gradual, and
irreversible
The cross-linking/glycation hypothesis
The evolutionary senescence theory, the
genome maintenance hypothesis
continued on next slide
Mary Jo Clark

Biological Perspectives
A process of physical, progressive and
gradual, irreversible decline, that is
progressive and gradual, and
irreversible
The neuroendocrine hypothesis, the
replicative senescence hypothesis
The oxidative damage/free radical
hypothesis, and the rate of living theory

Mary Jo Clark

Psychological Perspectives
Effective aging requires development of
effective coping strategies over time
Jung's theory of individualism
Erik Erikson's stage theory of
development
Peck

Mary Jo Clark

Population Health Nursing and

Care of Older Populations

Mary Jo Clark

Sociological Perspectives
Focus on changes in roles and
relationships
Strongly influenced by cultural values
and attitudes
Theories tend to be mutually exclusive
and include:
Disengagement theory
Activity and continuity theories

Mary Jo Clark

Assessing the Health Status and

Needs of Older Populations
Biological determinants
Gender and aging
Presence of comorbidities
Normal changes in sensory modality

Mary Jo Clark

Assessing the Health Status and

Needs of Older Populations
Biological determinants
Gender and aging
The goal of population health nursing in
the care of the elderly
Foster healthy aging
Mitigate the adverse effects of aging
Prevent unnecessary deterioration in
function
Promote quality of life

Mary Jo Clark

Physiologic Function
Acute and chronic illnesses
Falls and injuries
Disability

Mary Jo Clark

Functional Status
(BADLs) (IADLs) (AADLs)
Pain
Barriers to effective pain management
include:
Lack of access to care or treatment
Lack of use of adaptive resources
Emotional distress and its effects on pain
and pain management
Mary Jo Clark

Functional Status
Pain
Barriers to effective pain management
include:
Knowledge deficits regarding pain
management
Age-related perceptions (pain is normal
in old age)
Poor communication with providers

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Functional Status
Incontinence
Immune status

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Table 19-4 Percentage of Adults over 65 Years of

Age with Selected Health Conditions, 2012

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Table 19-5
Types of Urinary Incontinence and

Distinguishing Features

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Table 19-6
Immunization Coverage Among U.S.

Adults, 2011

Mary Jo Clark

Assessing Biological Determinants Influencing

the Health of the Older Population

Mary Jo Clark

Psychological Determinants
Dementia
Stress, coping, and depression

Mary Jo Clark

Assessing Psychological Determinants

Influencing the Health of the Older Population

Mary Jo Clark

Environmental Determinants
Neighborhood factors
Pollution
Safety hazards

Mary Jo Clark

Assessing Environmental Determinants


Mary Jo Clark

Sociocultural Considerations
Living arrangements and family
responsibilities
Social support
Education, employment, and economic
status
Empowerment
Abuse and violence

Mary Jo Clark

Assessing Sociocultural Determinants


Mary Jo Clark

Assessing Medication Use in Older Adults

Mary Jo Clark

Table 19-7
Categories of Elder Maltreatment and

Common Perpetrators

Mary Jo Clark

Behavioral Determinants
Diet
Other consumption patterns (tobacco,
alcohol, drug use)
Physical activity
Sexuality
Medication use
Other health-related behaviors (safety
practices, driving, immunizations)
Mary Jo Clark

Assessing Behavioral Determinants Influencing

the Health of the Older Population

Mary Jo Clark

Health System Determinants

Health care access
Prescription drugs

Mary Jo Clark

Health System Determinants

Infrastructure support
Housing modifications
Transportation systems
Home health and care management
services
Durable medical equipment
Home telehealth services
Respite services
Clientprovider interactions
Mary Jo Clark

Assessing Health System Determinants


Mary Jo Clark

Table 19-9
Hazardous Medications for Older

Clients

Mary Jo Clark

Diagnostic Reasoning and Care of

Older Populations
Positive diagnosis
No further nursing intervention is
needed
Health status should continue to be
monitored
Negative diagnosis
Indicate need for intervention by nurses
and others in the community to resolve
identified problem
Mary Jo Clark

Planning to Meet the Health Needs of

Older Populations
Major emphases on successful aging
and promotion of self-care

Mary Jo Clark

ANA (2010) Guide to Community

Preventive Services
Reducing out-of-pocket costs for care
Increasing annual wellness visits
Providing routine reminders for
immunizations and recommended
screening tests
Using "small" media (e.g., newspapers,
radio) to raise health awareness
Tailoring health-related messages to
individual needs and risk factors
Mary Jo Clark


Preventive Services
Initiating standing orders to prevent
missed opportunities for preventive
services
Reducing structural barriers to access
to care (e.g., distance, hours of
operation, availability of respite
services)

Mary Jo Clark


Preventive Services
Expanding access to care beyond
traditional health care sites to
community locations
Proving for "one-stop shopping" for
health care services

Mary Jo Clark

Health Promotion
Imperative for several reasons
The fastest-growing segment of the
population
Exhibit the highest prevalence of chronic
illness

Mary Jo Clark

Behavior-related Interventions
Should occur at three levels
Individual: educate clients to take steps
to modify dietary and physical activity
behaviors to promote health
Community: change environmental
factors that influence health-related
behaviors

Mary Jo Clark

Should occur at three levels
National: undertake comprehensive
campaigns to address widespread
behavior change among either clients or
health care providers

Mary Jo Clark

Maintaining independence
Life resolution
Nutrition
Physical activity and rest
Caregiver health promotion

Mary Jo Clark

Table 19-10
Activities to Promote Caregiver Health

Mary Jo Clark

Illness and Injury Prevention

Several barriers to illness and injury
prevention in older populations
Lack of insurance coverage and out-ofpocket costs for preventive services
Lack of providers knowledgeable about
geriatric prevention needs

Mary Jo Clark

Illness and Injury Prevention

Several barriers to illness and injury
prevention in older populations
Lack of coordination of services
Low health literacy and education levels
including language difficulties
Existence of multiple comorbidities that
require complex management

Mary Jo Clark

Risk Factor Modification

Smoking cessation
Effective management of existing
health conditions (obesity, diabetes,
hypertension)
Immunization
Incontinence prevention

Mary Jo Clark

Injury and Abuse Prevention

Fall prevention education should
emphasize health and independence
Safe driving
Home and neighborhood safety
Prevention of elder abuse and neglect

Mary Jo Clark

Risk Factors for Abuse: Individual

Level
Presence of mental illness, substance
abuse
High levels of hostility
Poor preparation for caregiving
activities
Assumption of caregiving
responsibilities at an early age
Inadequate coping
Exposure to maltreatment as a child
Mary Jo Clark

Risk Factors for Abuse:

Relationship Level
Financial or emotional dependence on
the elder
Disruptive behavior on the part of the
elder
Lack of formal and informal support
systems

Mary Jo Clark

Risk Factors for Abuse:

Community Level
Limited or unavailable formal support
services

Mary Jo Clark

Risk Factors for Abuse: Societal

Level
Social tolerance for aggressive behavior
A culture in which individuals are given
great freedom to make decisions for
others
Social expectations related to family
caregiving responsibility
Stoic beliefs, philosophies, and negative
attitudes toward aging and elders
Mary Jo Clark

Resolution of Existing Problems

Screening
Dealing with common health problems

Mary Jo Clark

Common Health Problems Among

Elderly
Skin breakdown
Constipation
Urinary and fecal incontinence
Sensory loss
Mobility limitations
Pain

Mary Jo Clark

Common Health Problems Among

Elderly
Cognitive impairment
Depression
Social isolation
Abuse and neglect
Substance abuse
Inadequate financial resources

Mary Jo Clark

Disease Self-management
Requires a combination of supportive
care, self-management, maintenance of
function, and prevention of further
disability
Chronic illness requires an increasing
burden of self-management

Mary Jo Clark

The American College of Preventive

Medicine (2011) SIMPLE
SSimplify the regimen as much as
possible, breaking it into simple steps
that fit with the client's lifestyle. Use
adherence aids such as pill dispensers
or organizers.

Mary Jo Clark


IImpart knowledge that will foster
adherence, such as the purpose of the
regimen, potential consequences of
nonadherence, and so on, and involve
the client and family in decision
making.

Mary Jo Clark


MModify client beliefs and behaviors
if possible, focus on positive benefits of
adherence and address fears and
concerns honestly. Provide positive
reinforcement.

Mary Jo Clark


PProvide communication and trust.
Make sure that clients understand the
treatment regimen and related
instructions and provide emotional
support for needed lifestyle changes.
Engage in active listening and allow
time for questions.

Mary Jo Clark


LLeave one's bias aside. Examine
attitudes toward clients of different
backgrounds and their effects on
providerclient relationships. Develop
an understanding of clients' cultural
beliefs and attitudes. Use culturally
appropriate interventions.

Mary Jo Clark


EEvaluate adherence. Ask about
adherence at each encounter and
identify and address barriers to
adherence. Periodically review
medication containers and prescription
renewal dates.

Mary Jo Clark

Health Restoration: Rehabilitation

Population health nurse role at
individual level
Referral for rehabilitation services
Encouraging clients to participate fully
in rehabilitation programs
Monitoring the effects of rehabilitation

Mary Jo Clark

Health Restoration: Rehabilitation

aggregate level
Advocate for availability and adequate
funding for these services

Mary Jo Clark

Health Restoration: Palliative Care

Refer individual for services and
monitor their effectiveness
Advocate for the availability and
affordability of services for all segments
of the population
Provide care to older clients and others
with incurable conditions
Develop palliative care services and
advocate coverage
Mary Jo Clark

End-of-life Care: Specific

Considerations
Formulation of advance directives
Personal preparation for death
Actual care of the dying client

Mary Jo Clark

End-of-life Care: Personal

Considerations
Dealing with preparatory grief
Management of pain and other
symptoms
Dealing with anxiety and depression
Meeting spiritual needs
Assisting family members with their
feelings

Mary Jo Clark

Implementing Care for Older

Populations
Two major considerations
Political advocacy
Health education

Mary Jo Clark

Population Health Nurse Strategies to

Circumvent Hearing Loss
Use lower-pitched voice

Face the listener while speaking
Employ nonverbal teaching techniques
Use clear, concise terminology
Encourage client to use a hearing aid
Minimize background noise
Reemphasize important points
Supplement with written materials
Mary Jo Clark

Population Health Nurse Strategies to

Circumvent Visual Deficits
Suggest use of glasses, a magnifying
glass, and large print
Use black lettering on white or yellow
paper
Provide adequate lighting, eliminate
glare

Mary Jo Clark

Implementing Health Education Plans for

Older Adults
Repeat material more frequently, use
memory aids
Teach at a slower pace
Allow more time for responses on the
part of the client
Keep teaching sessions short (10 to 15
minutes per session)

Mary Jo Clark

Implementing Health Education Plans for

Older Adults
Schedule at times of the day when
learners are rested and comfortable
Do not impose time limits
Break learning down into small,
progressive steps
Allow for rest periods as needed

Mary Jo Clark

Evaluating Health Care for Older

Populations
individual level
Assess the client's health status and the
effects of interventions at each level of
health care (promotion, prevention,
resolution, and restoration) in improving
health status

Mary Jo Clark

Evaluating Health Care for Older

Populations
aggregate level
Accomplishment of relevant national
health objectives

Mary Jo Clark


Care of The Older Population: Sixth Edition

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Population and Community

Care of the Older

Population and Community Health Nursing, Sixth Edition

Copyright 2015, 2008

Current Statistics: U.S. Census

Population and Community Health Nursing, Sixth Edition

Copyright 2015, 2008

As the World's Population Ages

Population and Community Health Nursing, Sixth Edition

Copyright 2015, 2008

Theoretical Perspectives on Aging

Copyright 2015, 2008

Copyright 2015, 2008

Population and Community Health Nursing, Sixth Edition

Copyright 2015, 2008

Population and Community Health Nursing, Sixth Edition

Copyright 2015, 2008

Population Health Nursing and

Population and Community Health Nursing, Sixth Edition

Copyright 2015, 2008

Population and Community Health Nursing, Sixth Edition

Copyright 2015, 2008

Assessing the Health Status and

continued on next slide

Copyright 2015, 2008

Assessing the Health Status and

Population and Community Health Nursing, Sixth Edition

Copyright 2015, 2008

Population and Community Health Nursing, Sixth Edition

Copyright 2015, 2008

Copyright 2015, 2008

continued on next slide

Copyright 2015, 2008

Population and Community Health Nursing, Sixth Edition

Copyright 2015, 2008

Table 19-4 Percentage of Adults over 65 Years of

Population and Community Health Nursing, Sixth Edition

Copyright 2015, 2008

Types of Urinary Incontinence and

Population and Community Health Nursing, Sixth Edition

Copyright 2015, 2008

Immunization Coverage Among U.S.

Population and Community Health Nursing, Sixth Edition

Copyright 2015, 2008

Assessing Biological Determinants Influencing

Population and Community Health Nursing, Sixth Edition

Copyright 2015, 2008

Population and Community Health Nursing, Sixth Edition

Copyright 2015, 2008

Assessing Psychological Determinants

Population and Community Health Nursing, Sixth Edition

Copyright 2015, 2008

Population and Community Health Nursing, Sixth Edition

Copyright 2015, 2008

Assessing Environmental Determinants

Population and Community Health Nursing, Sixth Edition

Copyright 2015, 2008

Population and Community Health Nursing, Sixth Edition

Copyright 2015, 2008

Assessing Sociocultural Determinants

Population and Community Health Nursing, Sixth Edition

Copyright 2015, 2008

Assessing Medication Use in Older Adults