Meeting the Health Needs of Older Clients Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Community Health Nursing, 5/e Mary Jo Clark

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Gerontological Nursing Con Gerontological Nursing: contributes to and often leads the interdisciplinary and multi- agency care of older people.

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Myths related to aging Most of the myths surround the concept of aging affect the psychological status of the aged person –Older persons cannot learn, change or grow emotionally –They are negative –Stooped posture

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Myths related to aging –Forgetfulness –Rigid helpless dependent and others that younger individuals try to joke about –Poor health –Unproductive and unattractive.

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Factors that influence the elderly health status 1.Human biology Maturation and aging that affect all body systems (eg. cardiovascular changes) 2.Environment Considerations Physical Psychological social

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Factors that influence the elderly health status 3.Behavioral Considerations 4.Health system Considerations

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Psychological environment Considerations To evaluate the cognitive status the nurse: –Evaluate long and short term memory –Power of concentration and judgment –Ability to engage in mathematical calculations To evaluate affective status the nurse: –Presence of depression –Presence of dementia –Saddened mood status

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Physical Environmental Considerations Safety hazards in the home or the community Adequate housing Availability of necessary goods and services Neighborhood shopping facilities

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Socio-cultural Environmental Considerations Changes in family roles and responsibilities Social support Economic and employment factors Abuse and violence –Increased incidence of financial and physical abuse

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Socio-cultural Considerations Social net work –Include number and frequency of contacts, the durability of network, geographical proximity and reciprocity( mutual help)

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Behavioral Considerations Diet and consumption patterns Physical activity Sexuality Medication use

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Behavioral Considerations Client independence –Personal activities Bathing Dressing Ambulation –Instrumental activities House keeping Taking medication Use of transportation

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Health System Considerations Demand on health care services Health care access Costs of health care for uninsured Lack of appropriate medical services Societal response to high costs of medications Client-provider interaction

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Health System Considerations Are health services sought to promote health as well as to cure illness? Are health services used effectively?, the CHN will explore the distance to health facilities used and the means of transportation

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Changing Dynamics in Families More older people are raising grandchildren Increased incidence of health problems for caregivers Impact of economic factors –Diminished access to care –Less utilization of health services –Employment and workforce retention of older population

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Nurse’s Role in Meeting the Health Needs of the Older Client Identify community resources Identify financial assistance resources Identify support networks

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Changes With Aging Heart conditions (hypertension, vascular disease, congestive heart failure, high blood pressure and coronary artery disease) Dementia, including Alzheimer's disease Depression Incontinence (urine and stool) Arthritis Osteoporosis Diabetes Breathing problems Frequent falls, which can lead to fractures

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Parkinson's disease Cancer Eye problems (cataracts, glaucoma, Macular Degeneration) As the body changes, other things to be aware of are: A slowed reaction time, which is especially important when judging if a person can drive. Thinner skin, which can lead to breakdowns and wounds that don't heal quickly A weakened immune system, which can make fighting off viruses, bacteria and diseases difficult Diminished sense of taste or smell, especially for smokers, which can lead to diminished appetite and dehydration

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. How to Teach the Elderly

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Educational Considerations Multi-sensorial presentations Multiple repetitions Reinforce verbal materials with written Memory aids Endurance or time considerations

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Thus You Have To: Screen for changes that may impair learning Adapt to alterations in cognitive processes – Before planning a teaching session, find out what the patient already knows about the topic Encourage her to provide examples of how she can make appropriate behavior changes.

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Mental capacity generally declines with aging due to a loss of neurons and decreased cerebral blood flow. This affects what's known as "fluid intelligence"— the ability to think abstractly and to see relationships across topics. Thus, watch for these behaviors: prolonged processing time, after-imaging (fixating on a word or idea after the other person has moved on to another topic), limited short-term memory, and "test anxiety."

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Start by giving an overview of what you will cover prior to each teaching session. let the patient control the time the teaching session is held Allow sufficient time for processing Take after-imaging into account Promote the formation of short-term memory Avoid creating "test anxiety.

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Use short, simple words and sentences. Speak slowly, clearly and loudly. Avoid visual or auditory distractions. Stick to one topic at a time Simplify and write down your instructions Use charts, models and pictures Frequently summarize the most important points Sit face to face with the patient. Listen without interrupting the patient. Give the patient a chance to ask questions.