Community Resources
Caregiver associations and support groups- Daycare services for seniors
Hospice and Palliative care programs
Disease-specific support groups and associations
Community health clinics
Geriatric case management
Goals of Community Resources
Providing Quality Health and Long-Term Care
o Integrated Network of Community Support for the Able Bodied Senior Citizens
o Managing of Older Persons with Alzheimer’s Disease
o Neighbourhood Support Services for Older Persons (NSSOP)
Ensuring Enabling and Supportive Environments
o Social Service and Community Support
o Housing and Enabling Environments
o Protection of the Rights of the Elderly
CHALLENGES: ISSUES AND GAPS
o Rising number of senior citizens who are victims of violence and abandonment
o Noncompliance of some residential buildings and establishments in terms of
making their facilities accessible to senior citizens
o RA 9257 or the “Expanded Senior Citizens Act of 2003”, many drug stores
and food establishments fail to extend the full benefit of the 20 percent senior
citizens’ discount.
Criteria for Evaluation
Indicators for Wellness
Physical wellness
Psychological/emotional wellness
Social wellness
Intellectual wellness
Spiritual wellness
Occupational wellness
Environmental wellness
Economic wellness
Cultural wellness
Climate Wellness
Governance and social justice wellness
Response to care
Standards and Criteria of Gerontological Nursing
Standard 1 - Uniqueness of Older People
Each older person is unique
Standard 2 - Functional Ability and Independence
The ability to function and maintain independence is significant for older persons
Standard 3 - Mastery of the Environment
A sense of mastery over the environment (or life situation) is essential for older persons.
Standard 4 - Gerontological Nursing Knowledge
Gerontological nursing practice is derived from a specific and evolving body of
knowledge pertaining to older person
Standard 5 - Sustaining Interpersonal Relationships
The development of sustaining interpersonal relationships facilitates older persons to
cope with their health care experiences
Standard 6 - Advocacy
Gerontological nurses advocate with older persons and on behalf of older persons to
protect their rights and responsibilities.
ETHICAL ASPECTS IN CARE OF OLDER PERSONS
What is Ethics?
Philosophical science dealing with morality of human conduct or action.
NURSING ETHICS
Concerned with moral principles that govern the conduct of nurses in his/her relationship
with physicians, colleagues, the nursing profession, and the community or public.
WHAT PRINCIPLES MAKE ACTIONS MORALLY RIGHT?
Advocacy
Autonomy
Beneficence/Non maleficence
Confidentiality
Fidelity
Fiduciary/responsibility
Justice
Quality of Life
Reciprocity
Sanctity of Life
Veracity
CURRENT TRENDS AND ISSUES IN THE CARE OF THE OLDER PERSON
Trends in Long-Term Care:
o “The broad range of medical, custodial, social, and other care services that assist
people who have impaired ability to live independently for an extended period”
o Geriatric Care Management:
Professional Geriatric Care Manager (PGCM) is a specialist who care for
older adults while encouraging as much independence as possible
Professional Geriatric Care Manager (PGCM) may perform the following services:
Conduct assessments
Develop care plans that address pertinent problems
Arrange, interview for and monitor in-home caregivers or other services
Act as a consultant for caregivers who live near or far
Review financial, health-related, legal issues
Provide referrals to other geriatric specialists
Intervene in times of crisis
Act as an advocate and/or liaison between families and service providers
Keep the family informed of any problems
Coordinate or oversee care
Assist with transition in living arrangements
Provide education and links to resources
Offer counselling or support
Some PGCMs offer guardianship, caregiving
Ethical concepts
Principles that facilitate decision making and guide our professional behavior. They
evolve from our beliefs and values, and therefore have their foundations in religion,
culture, and family expectations. Ethical decision making is driven by moral
reasoning – our determination of what is right and wrong.
NEEDS FOR SELF CARE, LIFE SUPPORT AND HEALTH MAINTENANCE
Encouraging Self-Care in Elderly Family members
It is a few strategies and idea which encourage elderly people to take care of
themselves, and to be proactive about their own health.
Alternative to nursing homes and professional care facilities
How can you encourage self-care for an elderly relative?
Be open - elderly people feel more secure if they understand their own conditions and
symptoms
Don’t think that just because a person is old, he is incapable
Don’t rush - be patient and give the relative time to do the task on his own
Make use of enhancements and equipment
Talk to the care-giving staff - tell the people that you are attempting to encourage self-
care
Address those areas that are problems
Be proactive - involvement in your elderly relative’s self-care
To maintain good health for elderly adults
Plan a healthy diet
Exercise for at least 30 minutes each day
Schedule appointments with your doctor
Maintain a busy social life
Challenge your brain to keep it agile
Health problem in Chronic Illness
Heart disease
HPN
Arthritis
Diabetes
Depression
Asthma
Irritable bowel syndrome (e.g. diarrhea)
Problems with Chronic Conditions
on-going physical symptoms
The need to take medication regularly
Managing work and sustaining an income despite their condition
Psychological problems
Different Levels of Care
Senior Communities
Continuing Care
Assisted Living
Board and Care
Skilled Nursing
Offers extensive nursing services for the residents. Admission must be initiated by a
person’s physician, who recommends that a patient enter either ‘rehab care’ or a ‘special
care’ facility
o Rehab care- Located in hospitals or nursing homes
o Rehab care programs – “Level 1” or transitional care
Intensive medical care for patients who are expected to regain functional
capacity and return home
o Special care – Two types of special care facilities: those involved with unique
medical issues (sometimes called “Level 2” care); those which manage
behavioural problems that may arise from dementia
Principles in the Care for older persons
Wellness
o A multidimensional state of being describing the existence of positive health in an
individual as exemplified by quality of life and a sense of well-being.
o Halbert L. Dunn – “lifestyle approach for pursuing physical and psychological
well-being”
o Bill Hettler - six dimension wellness model: physical wellness, emotional
wellness, spiritual wellness, intellectual wellness, occupational wellness, and
social wellness
Six dimension of Wellness Model
Physical dimension of Wellness
o Need for regular physical activity
o Discouraging the use of tobacco, drugs and excessive alcohol consumption
o Good physical wellness - combination of good exercise and eating habits
Emotional Dimension of wellness
o awareness and acceptance of your feelings
o Ability to form relationships with other based on mutual commitment, trust and
respect
Spiritual Dimension of Wellness
o Meaning and purpose in life
Intellectual Dimension of Wellness
o Creative, stimulating mental activities
o Well-rounded person expands their knowledge or skills
Occupational Dimension of Wellness
o Personal satisfaction in your life through work
Social Dimension of Wellness
o Contributing to your environment and community
Why is Wellness important?
Increased quality of life
Longer and healthier life
Active social interaction
Mental and emotional health
Active part of the workforce
Financial independence
To practice wellness activities in daily life
Eating
Bathing
Walking
Talking
Reading
Health Promotion
The process of enabling people to increase control over their health and its determinants
and thereby improve their health
o Primary prevention (e.g. health teaching)
o Secondary Prevention (e.g. early detection and prevent further contamination)
o Tertiary Prevention (e.g. preventing further disability)
Chronic Illness
Is a human health condition or disease that has long-lasting effects.
Recovery and Rehabilitation
A return to a normal condition
Is a treatment or treatments designed to facilitate the process of recovery from injury,
illness or disease to as normal a condition as possible
Factors influence the rehabilitation potential of the geriatric population
Coping strategies
Spiritual well-being
Positive social support
Self-efficacy
Self-belief
Quality of Life
A degree of satisfaction or dissatisfaction with life, a person’s sense of well-being, and
dimensions such as health function, comfort, emotional response, economics,
spirituality, and social support.
Quality of Life Model
Physical well-being
QUALITY OF LIFE Psychosocial
Spiritual
Social
Determinants of Health
1. Behavioral Determinants
Physical Activity
Nutrition
Smoking
Alcohol
Medication Adherence
2. Personal Determinants
2. Psychological Determinants
2. Physical Environment Determinants
2. Social Environment Determinants
2. Economic Determinants
2. Social Services Determinants
PRINCIPLES OF PALLIATIVE CARE
Provides relief from pain and other distressing symptoms
Affirms life and regards dying as a normal process
Intends neither to hasten nor postpone death
Integrates the psychological and spiritual aspects of patient care
Offers a support system to help patients live as actively as possible until death
Offers a support system to help the family cope during the patient’s illness and in
their own bereavement
SUPPORT SYSTEM DURING PATIENT’S ILLNESS
Safe and effective care environment
Health promotion and maintenance
Psychosocial integrity
Physiological integrity
ESSENTIAL COMPONENTS OF PALLIATIVE CARE
Effective symptoms control
Effective communication with patient and families
Rehabilitation to maximize independence
Continuity of care and coordination between services
Terminal care
Support in bereavement
…. Research
NURSES’ ROLE IN PALLIATIVE CARE
Direct care
Advocate
Counselor
Collaborative role
ISSUES AND TRENDS IN PALLIATIVE CARE
DNR – Do not resuscitate
Active euthanasia
DEATH – the time at which life ends
DYING – in or associated with the process of passing life or ceasing to be
PURPOSE
To explore issues of death and dying in elders
To learn about OT’s role in treating those with terminal illness in palliative care
To learn some ways to address the spiritual needs of the dying
TREATMENT OF NON-TERMINAL vs. TERMINAL CLIENTS
1. Non-Terminal
- Helping clients to lead long, balanced, independent lives.
2. Terminal
- Helping clients to live in the moment, have quality of life, live out last of days
engaged in activities they enjoy doing
TYPES OF DEATHS
1. Necriobiosis
Is the death of cells over the lifespan of an organism. After necrobiosis the
cells is replaced with a new one in a continual process throughout a
human’s life
2. Necrosis
When cells die at once. Necrosis is death of an organ or part of an organ.
In medicine this is infarction
3. Clinical Death
No breathing, and no brain activity characterize clinical death. Clinical
death begins at the very onset of the symptoms of death.
4. Brain Death
Death when respiration and other reflexes is absent
5. Somatic Death
Is characterized by the continuance of cardiac activity and respiration,
and eventually leads to the death of all body cells from lack of oxygen
2 ATTITUDES TOWARDS DEATH
Denial of Death
Acceptance of Death
Note: Kublerr Ross’ Death and Dying Grieving Process
1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance
5 FEATURES OF A GOOD DEATH
Kellehear
An awareness of dying by the individual and others
Social adjustments and personal preparations for the death
Public preparations
Work change
Making farewells formally and informally
SPIRITUAL CARE
Addressing Spiritual needs at the end of the Life
1. Hope – goal-directed and allows a person to live well in the present and move
towards the future with trust.
Appropriate Hopes for Elderly (?)
- Connectedness with others
- Gaining courage from not being alone
- Receiving loving caregiving from others
HOW TO PROVIDE HOPE
Active listening to the person
Find out, if possible, what is meaningful to him/her in terms of hope
Help him/her to reframe hopes as needed, and only when person is ready to
discuss it
Refer to a clergy member/chaplain
ADVANCE DIRECTIVE
- An advance directive tells the doctor what kind of care you would want to
have if you become unable to make medical decisions.
A Good advance directive
- Describes the kind of treatment you would want depending on how sick you
are
TYPES OF ADVANCE DIRECTIVE
1. Living will
- It is a written, legal document that describes the kind of medical treatment/s
or life sustaining treatments you would want if you were seriously or terminally
ill. A living will doesn’t let you select someone to make decision for you
2. Durable Power of Attorney (DPA) for Health Care
- States whom you have chosen to make health care decisions for you. It
becomes active any time you are unconscious or unable to make medical
decisions
3. Do not resuscitate (DNR) order
- Is another kind of advance directive which is a request (CPR) if your heart
stops or if you stop breathing
HOW CAN I WRITE AN ADVANCE DIRECTIVE
Use a form provided by your doctor
Write your wishes down by yourself
Call your health department or state department on aging to get a form
Call a lawyer
Use a computer software package for legal documents
