Nursing Older Adults and Promotion of

Wellness

Continuum of Care for Older Adults

NUR104 2017
Nursing Older Adults

Nurses are the primary health carers of older

adults
Nurses require skills and knowledge to meet the
health care needs of the older adult
Nurses assess older adults comprehensively
Nurses provide wellness promotion services
Nurses provide evidence-based care to older
adults
Gerontology and Geriatrics
Professional specialisation
Address unique needs
Traditionally focused on
Problems associated with ageing
Now focus on
Quality of life
Optimal health and functioning
Gerontological Nursing
Innovativemodels of care
Opportunities for advanced practice
nurses
Many resources for information about
evidence-based practice
 Gerontology and geriatrics are areas of
professional specialisation that have
evolved since the mid-1940s to address
the unique needs of older adults.
Health,Wellness and Health
Promotion

Essentialfor preventing chronic conditions,

reducing mortality and improving quality of
life
Major national initiatives focus on health
promotion
Types of Health Promotion
Interventions

Screening programs
Risk reduction interventions
Environmental modifications
Health education
Transtheoretical Model of Health
Promotion

Addresses the many disease prevention

and health promotion interventions that
require a change in health-related
behaviours
Five specific stages in accomplishing
behaviour changes: precontemplation,
contemplation, preparation,action and
maintenance
Precontemplation

Unaware of the problem

No intention of changing his or her
behaviours within the next 6 months
Contemplation

An intention to change in the foreseeable

future
Ask questions and to seek information
about the short- and long-term risks and
benefits of various behaviours
Contemplation Interventions

Information about the risks and benefits

Exploring how to begin establishing
personal goals
Preparation

Ambivalence about the unhealthy

behaviour
Acknowledges the need for change,
expresses serious intent to adopt the
healthier behaviours within the next
month, and begins to identify strategies
Benefit from support from family and
friends
Action

Occurs when the person has already

made the behaviour change, but the
changes have been practiced for less than
6 months
Reinforcing the progress that has been
made as well as identifying any barriers to
continuing the healthy behaviours
Maintenance

Healthy behaviours for 6 months or

longer
Reinforcement of progress and positive
feedback about the healthier behaviours
A nursing model for promoting
wellness in older adults
The Functional Consequences Theory explains the
unique relationships among the concepts of
person, health, nursing and environment in the
context of promoting wellness for older adults

Nursing theory for wellness-focused care of older

adults

Unique relationships among the concepts of

person, health, nursing and environment in the
context of promoting wellness for older adults
 Functional consequences
Functional consequences: Observable effects of
actions, risk factors and age-related changes that
influence the quality of life or day-to-day activities.
The effects relate to all levels of functioning,
including body, mind and spirit

Negative functional consequences: Those that

interfere with functioning or quality of life

Positive functional consequences: Those that

facilitate the highest level of functioning, the least
dependency and the best quality of life
Concepts underlying the
Functional Consequences Theory
Combinations of age-related changes and risk
factors increase the vulnerability to negative
functional consequences

Nurses assess the age-related changes, risk factors

and functional consequences, with particular
emphasis on identifying the 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
 Wellness outcomes

When positive functional consequences are the

result of nursing interventions
 Age-related changes

Inevitable, progressive and irreversible changes

that occur and are independent of extrinsic or
pathological conditions

On the physiological level, these changes are

typically degenerative

On psychological and spiritual levels, they include

potential for growth
 Risk factors
are conditions that increase the vulnerability of
older adults to negative not positive functional
consequences.

Conditions that increase the vulnerability to

negative functional consequences

Common sources of risk factors include diseases,

environment, lifestyle, support systems,
psychosocial circumstances, adverse medication
effects and attitudes based on lack of knowledge
 Older adult

A complex and unique individual whose

functioning and wellbeing are influenced by the
acquisition of age-related changes and risk
factors
When risk factors cause them to be dependent on
others for daily needs, their carers are considered
an integral focus of nursing care
 Nursing

The focus of nursing care is to minimise the

negative effects of age-related changes and risk
factors and to promote wellness outcomes
Goals are achieved through the nursing process,
with particular emphasis on health promotion and
other nursing interventions that address the
negative functional consequences
 Health

The ability to function at their highest

capacity, despite the presence of age-related
changes and risk factors
It is not limited to physiological function and
encompasses psychosocial and spiritual
function. Thus, it addresses well-being and
quality of life
 Environment

External conditions, including carers, that

influence the body, mind, spirit and functioning
Environmental conditions are risk factors when
they interfere with function, and they are
interventions when they enhance function
Applying the theory to promote
wellness
Incorporate wellness outcomes to address
personal aspirations for wellbeing of body, mind
and spirit

Educate about interventions to minimise risk

factors or their effects

Rewarding when approached from a holistic

perspective
Development of a Continuum of
Care for Older Adults

Many new models of care emerged to

address diverse health care needs of
older adults.
Terms such as ageing in place, continuum
of care, and long-term care are used to
describe the focus of various settings of
care for older adults
 Australia and New Zealands
governments are continually creating
new models of care to address the
increasing demand on health care
services by the older adults.
 Australia - nationalised, complex
comprehensive aged care system.
Australian Government is the main
regulator, funder and provider of long-term
residential and community aged care
services.
New Zealand does not have an aged care
specific system.The District Health Boards
have an integral role in the funding of long-
term residential and community aged care.
Acute care
Acute care for elders (ACE) units address
the complex needs of hospitalised older
adults
Subacute care units address the medically
complex needs of hospitalised older
adults
The hospital-at-home model delivers care
for older adults with complex medical
needs that can be addressed in a home
setting
Acute Care Settings -Transitional
Care

Providecoordination and continuity

when patients move from one setting to
another
 Long Term Residential Aged Care
Are licensed residential institutional settings
Provide a combination of nursing and personal care services
for long-term residents
Reasons
Combination of a gradual decline in functioning due to
chronic conditions
Lack of caregivers who can provide the care at home
Level of dependency has increased and special care units
established e.g. Dementia Specific Units
Nurses assume teaching and leadership roles
Models of Long-Term Residential
Aged Care

The Eden Alternative

http://www.edeninoznz.com.au/html/
s01_home/home.asp
http://www.embracia.com.au/aged-care/
Question
Is the following statement True or False?

Nurses have important roles in health

promotion interventions, which are
essential for preventing chronic
conditions, reducing mortality and
improving quality of life for older adults.
 References
S. Hunter, 2016. Millers Nursing for Wellness in Older
Adults: Theory and Practice. 2nd edn. Lippincott, Williams &
Wilkins, Philadelphia.