Nursing for Wellness in Older Adults
Chapter 1: Seeing Adults through the eye of Wellness
Rethinking Aging and Wellness
● Aging is commonly associated with inevitable decline (inaccurate)
● Contemporary view: aging includes both losses and gains (ex. Sharp mind but limited
function)
● Wellness in aging is holistic
○ Integrates physical, psychological, emotional, social, and spiritual dimensions
● Respect for individual diversity and personal narratives
● Takeaway: aging is a complex, individualized experience, not a single trajectory of
decline
● 1940’s life expectancy- 42 years
● Current life expectancy- roughly 80
● Reasons for increased life expectancy:
○ Medications
○ Access to medical care
● We have an aging population
Wellness and Successful Aging
● Halbert Dunn’s (1961) model: High-level wellness”
○ Maximizing potential and maintaining purposeful direction, promote autonomy
○ Ex. dr apts, meds, activity level, relationships
● Successful aging includes:
○ Maintaining physical health
○ Staying cognitively engaged
○ Finding meaning and purpose
○ Sustaining relationships and dignity
● Barriers to wellness:
○ Ageist beliefs ‘too old’ from patients and providers
○ Chronic illnesses overshadowing wellness goals
○ Systemic focus on treatment over prevention
○ Lack of pt education
○ Assumption pt can’t do things for themselves
● Nursing insight: promote wellness even amid illness or frailty
Considerations for a Geriatric Patient
● Code status
● Support system
● Activity level
● Diet (aspiration precautions?) (I/O?)
○ Input/output should be in report
○ Ex. drank (x)mL, ate 75% of meals, no B.M.
● Age
● Cognitive status
● Medications/tests
Myths, Misperceptions, Subjective Aging
● 3 common misconceptions- sickly, unwilling to learn, …..
● Subjective Age:
○ Most adults feel younger than their chronological age
○ Feeling younger linked to better health, higher functioning, greater life
satisfaction
○ This can keep them going/functioning
● Nursing role: replace myths with facts, shift attitudes, and validate personal experience
Practice Question:
● What is a myth that affects nursing care of older adults?
○ Answer: Gerontologists have discovered that by the age of 75 years, people are
quite homogeneous as a group
○ A myth is that genontologists have discovered that by the age of 75 years, people
are quite homogeneous as a group. Realities about aging are that most older adults
live independently, have high levels of self-reported health and function, rather
than on their chronological age. Ageism is more common in industrialized
societies and is highly influenced by stereotypes and cultural values.
Evolving Definition of Aging
● Chronological age
○ Socially constructed marker (Ex. medicare at 65)
○ Useful for policies but not predictive of health or needs
● Functional Age and Aging Categories
○ Gerontologists now focus on: functional ability, psychosocial status, life
satisfaction
● Labels like young and old can reinforce stereotypes
● Key message: age is complex-dependent; meaningful care requires deeper understanding
Nurses and Wellness
● How do nurses promote wellness
○ We encounter patients after they are already sick
○ Education for preventative measures
● Challenges:
○ Health systems prioritize disease, not prevention
○ Limited time and resources for holistic care
○ Older adults may feel hopeless or resilient
● Solutions:
○ Empower with education and empathy
○ Embed wellness in daily interactions
○ Recognize growth potential in later life
○ Advocate for person-centered care
Healthy People 2030
● Focuses on reducing health problems and improving quality of life for older adults
● By 2060, a quarter of the US population will be 65+
● Older adults are at higher risk for chronic health problems
○ Diabetes
○ Osteoporosis
○ Alzheimer’s disease
● 1 in 3 older adults fall per year
○ Falling is the leading cause of injury for this age group
● Physical activity can help older adults prevent both chronic and fall-related injuries
● Focus on preventative care (vaccines against flu and pneumonia) because older adults are
most likely to go to the hospital for some infections disease (including pneumonia which
is leading cause of death for older adults)
● Main goals: increase activity level and decrease health problems
● Stats that are getting worse: fall related deaths, adults 45+ having no teeth?
Rowe & Kahn’s Model of Successful Aging
● Low risk of disease/disability
● High physical and cognitive function
● Active life engagement
● Positive psychology: optimism, spirituality, self-efficancy
● Takeaway:
○ Successful aging is possible despite limitations
○ Defined by adaptation to new life/body, meaning, and continued engagement
● Most older adults live with their spouse at home (aging in place)
Final Thoughts
● Aging is not defined by decline, it is multifaceted and personal
● Wellness is achievable with right support, can live well
● Nurses adapt to each unique patient and give accurate knowledge, empathy, and
individualized care
● Call to action: break the cycle of decline
○ Be a wellness advocate
○ Challenge stereotypes
○ Support older adults living with purpose, dignity, vitality
Chapter 2: Health Inequities and Cultural Diversity
Intro
● Cultural diversity among older adults affects:
○ Values
○ Communication (language)
○ Health belieds
○ Health-related behaviors (Ex. diabetic who does not eat a good diet)
● Nurses must refrain from stereotypes (sick, forgetful) and generalizations
Population
● Population is becoming more diverse
● 2018- of adults 65+, 23% minority population
● 2060- of all adults 65+, 45% minority population
Health Inequities/Health Disparities
● Differences in how older adults get their healthcare n(health status)
● equity= accessible and easy to navigate
Social Determinants of Health
● Economic stability (how stable, fixed income)
● Education access and quality
● Health care access and quality
● Food insecurity (driving ability, access to good nutritious food)
● Unemployment and job security
● Housing
● Neighborhood and built environment
● Social support (social network, people they can rely on)
Health Literacy
● Major determinant of health outcomes and measure of quality of care
● Includes patient adherence, self-reporting, self-managing
● Low health literacy is associated with:
○ Decreased use of preventative services
○ Shorter life expectancy
○ Increase prevalence of multiple chronic diseases
○ Poor access to health care
○ Decreased adherence to prescribed medication regimen
○ Lower levels of self-reported functional status + physical/mental health
○ Decreased ability to self-manage chronic conditions (increased BP can lead to
stroke)
○ Increased hospitalizations and visits to E.R. departments
● Ways to improve health literacy:
○ Increase education (may include education for caregiver) (Ex. teach-back method)
○ Consider patient’s language, education background (ask open-ended questions)
○ Printing out instructions for cognitive deficit patients (leave contact number in
case they have questions)
○ Help schedule follow-up appointments
○ Find eligible outside resources
○ Consider pts control and access to medical equipment
● Healthy People 2030:
○ Goal for older adults to age in place
○ Decreased hospitalizations and decreased chronic conditions
Culturally Appropriate Care
● Demographic trend requires all health professionals must be culturally competent
● Ethnogeriatrics: integrates influence of race, ethnicity, and culture on health and
well-being of older adults
○ Ex. Mental health resources for refugees suffering from PTSD
● Nurses need to increase knowledge of different cultural groups in order to communicate
in a nonjudgmental attitude for care
○ “How can I best serve my patient” (follow trends in the community)
● Things that help to deliver culturally appropriate care:
○ Learning about pts culture that may impact their medical care
○ Ask open-ended questions
○ Using culturally appropriate language (Ex. interpreters)
○ Build trust, be sensitive to cultural differences
○ Show respect for cultural preferences
○ Assess and adapt plan of care to someone’s cultural needs (Ex. placenta eaters)
○ Educate yourself and self-reflect on own biases to give culturally competent care
○ Identify how you feel, reflect on your experiences
○ Focus on how to make your patient feel seen
● Culturally competent care starts with listening, respecting, and learning
Cultural Self-Assessment
● What self-identity influences my world view?
● How has my cultural background influenced me?
● What is my attitude toward people who:
○ Are immigrants?
○ Have difficulties with the English language?
○ Have difficulty communicating?
○ Have a cultural background different from my own?
● What are my attitudes about and experiences with health practices that differ from my
own?
● How well do I communicate and understand?
Categories of Ethic Groups
● Blacks or African Americans
● Hispanic Americans or Latinos
○ Includes Cuban Americans, Puerto Ricans, Mexican Americans
● Asians and Pacific Islanders in the US
○ Includes Japanese Americans, Asian Americans, Filipino Americans, Chinese
Americans
● American Indians and Alaska Natives
● Older adults in rural areas
● Homeless older adults
● Lesbian, gay, bisexual, transgender, or questioning older adults (LGBTQ)
Trends
● Increase average age of homeless individuals
● Over 50% of homeless adults are 50+
● Contributing factors:
○ Lack of access to Medicare, Social Security, and subsidized housing (ages 50-64)
○ Born between 1954-1963- elevated risk of homelessness
○ No access to mental health services
○ Disabled veterans, frail, can’t live on their own, fall through the cracks
● Health disparities:
○ Higher morality and disability rates
○ Increased chronic and mental illness
○ Early onset of geriatric syndromes (Ex. falls, frailty)
○ Use resources and ask questions to identify/correct health disparities
LGBTQ Older Adults
● Definition: umbrella term for individuals with diverse sexual orientations and gender
identities
● Shared common experiences
● Social stigma and isolation- families may be unaware
● Exposure to discrimination and stereotypes
● Growing demographic, small but increasing population
● Growing focus on unique health needs and disparities
● Research gaps: topics, gaps in literature, unique health needs
Ethnogeriatrics
● Definition: the study of how ethnicity and culture influence the aging process and the
healthcare of older adults
● Core Focus Areas:
○ Cultural beliefs and practices
○ Health disparities and access to care
○ Communication styles and language barriers
○ Family dynamics and caregiving traditions
● Why It Matters
○ Because it is important to the patient
○ Growing diversity among older adults
○ Reducing healthcare disparities
○ Providing culturally competent care
● Open-ended questions
○ Must be inquisitive, open-ended, non-judgemental
Culturally Competent Care in Ethnogeriatrics
● Principles:
○ Respect cultural values and health beliefs
○ Adapt care plans to cultural context
○ Promote equity in healthcare delivery
● Applications in practice:
○ Use interpreters and culturally appropriate materials
■ Interpreters over family members to give factually accurate information
○ Assess social determinants of health (Ex. income, education)
○ Include family in care decisions when culturally appropriate
● Outcome
○ Better patient engagement, satisfaction, and health outcomes
Addressing Disparities to Promote Healthy Aging
● Improve access to medicare/medicaid services
○ Invest in mobile and telehealth solutions
○ Expand medicare/medicaid services
● Culturally competent care:
○ Train providers to understand diverse aging experiences
○ Language and translation support
● Community-based support (social determinants of health)
○ Senior centers, nutrition programs, home care
○ Social connection initiatives to reduce isolation
○ Nurses pick up on disparities and are advocates for patients
○ Always look for ways to increase social connection
● Policy action
○ Address social determinants like housing, transportation, and food insecurity
○ Contact case manager and/or social worker
5 Takeaways
● Make good use of ancillary services
○ Interpreters, case managers, social workers
● Knowing when to listen and adapt plan of care
○ Recognize cultural/language barrier, cognitive status
● Learn trends as it relates to diverse populations in your community
○ Ex. uptick in unknown language, educate yourself
● Cultural sensitivity and self reflection
○ “Am I harboring any feelings?”
● Consider a client's social determinants and health literacy
○ Ask questions to get information to in order to deliver the care the patient needs
○ Goal of asking an open ended question: improve overall health
● Must adapt plan of care!!
Chapter 3: A Nursing Theory for Wellness-Focused Care of Older Adults
Theories
● Regarding age try to answer why and how people age
○ NOT the nursing care of older adults
● Attempt to explain relationships among nursing, health, environment
● Discipline-specific theories guide care to promote wellness
● Functional consequences- framework to promote wellness, function, QOL
● Nursing theories describe, explain, predict nursing care based on scientific evidence
Questions to Answer
● What is the purpose of nursing theories
● What is the functional consequences theory
● What are mid-range theories
● Name 2 of the 7 covered in the text
● What nursing theories support functional consequences theory
Functional Consequences Theory
● Explains the unique relationships among the concepts of person, health, nursing, and the
environment in the context of promoting wellness
● Shows and incorporates the understanding of wellness as an integral part of focused care
● Assess the patient as a whole (comorbidities, environment) to promote wellness
● Goal: address the unique relationships among the concepts of person, health, nursing, and
environment in context of promoting wellness
Functional Assessment
● Where is the environment you are assessing them in
● Focuses on older adult’s ability to perform activities of daily living that affect survival
and quality of life
● Framework for research and method of planning services
● Important component in care of older adults
Geriatric Assessment
● Should be done:
○ Annually at physical
○ After hospitalization for an acute illness
○ When placed in a skilled nursing or assisted living facility
○ After a sudden change in physical, social or psychological function
● Assessment tools
○ Katz Index of Independence in Activities of daily living
■ Bathing
■ Dressing
■ Toileting
■ Transferring
■ Continence
■ Feeding
○ PULSES (perfect score = 6 = fully independent)
■ Physical condition
■ Upper extremities
■ Lower extremities
■ Sensory function
■ Excretory function
■ Social and mental staus
○ SPICES (for chronically ill pts, extended care facilities)
■ Sleep: sleep disturbances, insomnia, daytime napping
■ Problems with Eating/Feeding: changes in appetite, weight loss, or
difficulty swallowing
■ Incontinence: urinary or fecal
■ Confusion: cognitive changes, memory loss, disorientation
■ Evidence of Falls: history of recent falls or fear of falling
■ Skin breakdown: pressure sores, ulcers, other skin problems
● Components
○ Physical, psychological, and socioeconomic factors interact to influence health
and functioning
○ Comprehensive evaluation requires an assessment in each domain
■ RN
■ Primary MD
■ Speech pathologist
■ Dietitian
■ Social services
■ Meals on wheels
○ Function ability should be the central focus of the evaluation to determine overall
health, well-being, and the need for social services
● Book: parameters for a comprehensive geriatric assessment
● Variables affecting holistic geriatric assessment
○ Evaluation of the environment
○ Accuracy of health history
○ Social history
○ Psychological history
○ Home environment
○ Culture and education
Functional Consequences Theory vs. Functional Assessment
● Functional consequences theory is broader because it
○ Distinguishes age-related changes that increase vulnerability and risk
○ Focuses on consequences
○ Focuses on assessment of conditions that affect function
○ Leads to interventions to address the negative functional consequences
○ Leads to wellness outcomes
● Consequences of aging to assess
○ Diminished functioning organs
○ Sensory changes (vision, hearing)
○ Reaction time
○ Loss of muscle mass
○ Decreased metabolism
○ Decreased thirst mechanism (can lead to dehydration and electrolyte imbalance)
○ Decreased mobility (osteoarthritis)
○ Medications related to psychological changes
Age-Related Changes and Risk Factors
● Inevitable, progressive, and irreversible changes that occur are independent of extrinsic
or pathologic conditions
● On the physiologic level, the changes are degenerative
● On the psychosocial and spiritual levels, they include potential for growth
● Inherent psychologic processes that increase vulnerability to detrimental effects of risk
factors
● Body-mind-sporit perspective
● Holistic focus: identify age-related changes to improve/adapt to physiologic decline
● Build on wisdom for problem-solving skills to address risk factors
Positive Functional Changes
● Obtaining better sense of self
● Spirituality
Risk Factors
● Conditions that increase vulnerability to negative functional consequences
● Sources of risk factors include:
○ Diseases
○ Environment
○ Lifestyle
○ Support systems
○ Psychosocial circumstances
○ Adverse medication effects
○ Attitudes based on lack of knowledge
The Concept of Older Person/Adult
● A complex and unique individual whose functioning, well-being, is influenced by the
acquisition of age-related changes and risk factors
● An adult does not become an older adult at a specific age
○ Definition of older adult must be BROAD
● Older adulthood: may not identify with social labels, such as elderly or senior
Nursing Care for Older Adults
● Essencial: get to know the older adult
● Involve older adults in decision making (experts in their own health)
● Focus of nursing care: minimized negative effects of age-related risk factors, and promote
wellness
● When risk factors cause being dependent on others for daily needs, the caregivers are
considered an integral focus of nursing care
Concepts of Health and Wellness
● Health / Wellness
● The ability to function at highest capacity, despite the presence of age-related changes
and risk factors
● Determined by the a person based on functional capacity perceived as important
● Not limited to physiologic function by encompasses psychosocial and spiritual function
● Self-transcendence: a closely related concept that is used in reference to a person’s
highest potential for well-being (theory of self-transcendence)
Concept of Environment
● External conditions that influence the body, mind, spirit, and function which includes the
caregivers
● Environmental conditions are risk factors when they interfere with function
● Environmental conditions are interventions when they enhance function
● Nurse must be leadership to provide care in an environment that is based on
interprofessional collaboration
Wellness Theory
● Incorporate wellness outcomes to address personal aspirations for well-being of body,
mind, and spirit
● Major focusL educate both older adults and caregivers regarding interventions to
eliminate risk factors or minimize their effects
● Leads nursing interventions towards achieving wellness outcomes for improved QOL
Additional Theories
● Focus has gradually expanded to include promoting wellness during all stages of health
and illness, including end-of-life-care
● Additional theories are rooted not only in nursing, but also other disciplines
● Mid-range theories -
Chapter 4: Theoretical Perspectives on Aging Well
Definitions:
● Healthy aging: no illness and preserved cognitive function
● Active aging: high physical and cognitive function
● Productive aging: social participation and engagement
● Successful aging: full concept of aging well
● Effective aging: the capacity to manage age-related life challenges
● Optimal aging: high levels of well-being and enjoyment
How can we live long and well?
● How long we live addressed by:
○ Measuring life span, life expectancy, morbidity, and mortality rates
○ Explore relationships among aging, health, and disease
● Research focused on
○ Identifying ways to delay effects of aging, maintain high levels of functioning,
and quality of life
● Baby boomers
○
Life span/Life expectancy
● Life span: maximum survival potential for a member of a species (there may be outliers)
○ Influenced by genetics
○ Max life span potential is 113 years
■ Will not change unless a scientific breakthrough in delaying aging were to
happen
● Life expectancy: predictable length of time that one is expected to live from a specific
point in time
○ Influenced by environmental factors and lifestyle choices
○ Ex. smoking, drug use, diet/exercise, living location, occupation (think factory)
● Active life expectancy: ranging from inability to perform ADLs to full independent
function
○ Concern toward improved functioning
● Prevalence of functional impairment varies significantly by race and ethnic groups
● Relationships among aging, disease, and death
○ Age-associated disease inevitable- important question
○ “The aging process increases vulnerability to the pathologies that become the
leading cause of death”
● Senescence: postreproductive period leading to increased probability of death and address
questions about the relationship between aging and death
● Blue zones: places where elderly live longer, more productive, more satisfying lives
○ Study diet/activity levels, reasons they live longer
○ How do we increase longevity and be productive and satisfied
● Supercentralians: oldest old- 110+ years old
● Predictors of health longevity: nutritional patterns with high intake of plant-based foods
(fruits, veggies, nuts
Rectangularization of the curve
● Distribution of lifespan is becoming more rectangular
● More people are living to an older age, variation in lifespan is decreasing and becoming
more predictable
● Reasons: improved survival rates at older ages due to advancements in healthcare,
technology, and lifestyle
Compression of Morbidity
● Reduction in length of time during which people experience significant illness or
disability in their later years
● Delaying onset of major health issues (chronic diseases) to as late as possible
● Goal is to not extend life, but ensure that individuals experience fewer years of suffering
due to illness
● We want people to live longer, but with fewer years spent in poor health
● Involves preventative health, better medical care, and healthier lifestyles to limit time
spent suffering from age-related illnesses
Biologic theories of aging: basic aging processes affecting all living organisms
● How do cells age?
● What triggers the process of aging?
● Biologic aging: gradual, progressive decline in physiologic functioning (wear and tear)
● Theories in book
Conclusions about biological theories
● Insight into inevitable consequences of normal aging as well as increased susceptibility to
diseases
● Major advances in genetic science
● All biologic theories of aging recognize aging as a multidimensional process directly
influenced by interacting factors
● No single theory explains the complexities of aging
Relevance to nurses
● Primary role: identify, address modifiable factors that lead to diseases, disability, death,
as well as health-promoting factors
● Attitudes of healthcare professionals
○ Perspective of “what do you expect, you’re old” interferes with treatable
conditions
○ Attitude of hopelessness with subscribing to aging to a fatal disease
○ Nurses are teachers and advocates
● Pertinent concept from biologic theories of aging
○ Biological theories address questions about basic age-related changes
○ Sociocultural theories explain how society influences its old people and vice versa
and include disengagement, activity, subculture, age stratification and
person/environment fit theories
● Psychological theories
○ Include human needs, life-course and personality development,
gerotranscendence, and gender theories
○ Psychological theories address certain psychosocial issues that are common
■ Psychological perspectives on aging: framework for addressing certain
psychosocial issues that are common among older adults
■ Include human needs, life-course and personality development,
gerotranscendence, and gender theories
■
Biologic Theories of Aging
● Basic age-related changes characterized as deleterious, progressive, intrinsic, universal,
irreversible, and genetically programmed
● Include genetics, wear and tear, immunity, cross linkage, free radical, neuroendocrine
and apoptosis theories
● Wear and tear theory
○ Body can be likened to a machine that is expected to function well during the
period of its warranty, but that will wear out at a fairly predictable time
● Cross linkage theory
○ Proposes that molecular structures that normally are separated may be bound
together through chemical reactions
● Free radical theory
○ Postulates that although most organisms have several mechanisms of antioxidant
defense, damage to cells cannot be avoided and increases with age
● Program theory
○ The life span of each animal species is predetermined by a genetic program,
which allows for a maximum of about 110 years in humans. Abnormal cells, such
as cancer cells, are not subjected to this predictable pattern
● Caloric restriction
○ Numerous animal studies have found that reducing caloric intake by about
30-40% without causing malnutrition results in enhanced ability to protect cells,
increased resistance to stress and overall longer and healthier life expectancy.
Research has not been applied to humans
● Immunosenescence theory
○ Age-related decline of the immune system, increase the susceptibility of older
people to diseases
Sociocultural Theories
● Disengagement theory: a society and older people engage in a mutually beneficial
process of reciprocal withdrawal to maintain social equilibrium
● Activity theory: postulates that older people remain socially and psychologically fit if
they remain actively engaged in life
● Subculture theory: states that old people, as a group, have their own norms, expectations,
beliefs, and habits; therefore, they have their own subculture
○ Older adults (as a group) have own norms, expectations, beliefs, and habits
● Age stratification theory: addresses the interdependencies between age as an element of
the social structure and aging of people and cohorts as a social process
○ Interdependencies between age as an element of social structure and aging of
people and cohorts as a social process
● Person-environment fit theory: considers the interrelationships between personal
competence and the environment
○ Interrelationships between personal competence and environment
● Place identity (place attachment): people form affective. Cognitive, behavioral, and social
bonds to their environments, thereby transforming “space” into “place” (ex. My home,
my neighborhood)
● Residential normalcy: people who feel comfortable and in control of their environment at
home may not feel the need to change anything
● Emerging subculture theories: increasing diversity
● Relevance of sociocultural theories of aging to nurses
Human Needs Theory
● Five categories of basic human needs, ordered from lowest to highest
○ Physiologic needs
○ Safety and security needs
○ Love and belongingness
○ Self-esteem
○ Self-actualization
Life-Course and Personality Theories
● Changes in habits are not always bad, but need comprehensive health geriatric
assessment
● Both types emphasize that old age is part of a lifelong developmental process
● Life-course theories address old age within the context of the life cycle
● Personality development theories identify personality types as predictive factors
Psychological Theories of Successful Aging
● Selection, optimization, and compensation
○ Proposed to explain successful aging based on the dynamic model of development
as continuous process of specialization and loss
● Socioemotional selectivity theory
○ Proposed to explain emotional well-being during older adulthood
● Strength and vulnerability integration theory
○ Experience age-related gains as well as losses in emotion-related process, and
overall older adults maintain a positive level of emotional experiences
● Gerotranscende theory
○ Human aging is a process of shifting from a rational and materialistic
metaperspective to a more cosmic and transcendent vision
● Feminist gerontology, double jeopardy, quadruple jeopardy, sociology of knowledge of
aging
○ Compare and contrast male and female performance data
○ Examine the nature of change in gender roles
○ Study the relationship between gender role differences and social roles and social
power
Relevance of Psychological Theories of Aging to Nurses
● Nurses can use psychological theories to address response to losses and continued
emotional development, and devote time and energy to life review and self-understanding
● Reminiscence: positive experiences, help patient’s response to loss
Theories that Evolved Out of Social Movements
● Feminist gerontology: aging is examined from perspectives of older women and
addresses issues such as gender inequalities regarding diseases, caregiving roles, and
economic status
● Double jeopardy: black women experience two types of bias- that is, those associated
with racism and sexism
● Quadruple jeopardy: being black, female, old, and poor exponentially increases the risk
of being failed by society and social welfare support
● Social competence/breakdown model of aging: ageism and stereotypes related to the
problems
