1. Older Adults: Aging in Place
Chapter 24

2. Introduction
The future older population is expected to be better educated than the current one.
For community health nursing, the growing aging pop. Will present opportunities for nurses to work with communities to strengthen and build programs and services that focus on supporting the aging population’s highest functional level.

3. introduction
The fundamental requirements for effective nursing of any population:
1. Know the characteristics of the population.
2. Set aside stereotypes based on misconceptions about the population.
3. Know the health needs of the population as a basis for nursing intervention.
4. View the population from an aggregate, public health perspective that emphasizes health protection, health promotion, and disease prevention.

4. Global Demographics
In 1950, were 131 million people worldwide over age of 65
By 1995, that number has increased to 313 million
Between 2000 and 2005 it should be double
It is estimated that there could be 1.4 billion elderly worldwide by the year 2050

5. Dispelling AGEISM
Ageism is a Stereotyping (labeling) older adults and perpetuating (maintaining) false information and negative images and characteristics regarding older information adults is called ageism.

6. Misconceptions About Older Adults
Misconception: Most Older Adults Cannot Live Independently
Although over 900,000 seniors live in assisted living residences and more than 1.1 million live in some type of senior housing community.
About 30% live alone, and others live with friends or in the homes of nonrelatives with room and board (food, nourishment) provided

7. Misconception: Most Older Adults Cannot Live Independently
Most elders who are vigorous (energetic, vital) and functioning independently live in their own homes.
Only 6% live in institutions such as skilled nursing facilities, extended care facilities, supervised living facilities, and Ault Daycare centers, and not all of these are permanent residents.

8. Misconception: Most Older Adults Cannot Live Independently
Many are recovering from illnesses or undergoing rehabilitation after an injury or surgery and will return to their living situation in the community within weeks.

9. Misconception: Chronologic Age Determines Oldness
The number of years a person has lived
The aging process is quite distinct among older people, and they age at widely disparate rate.
Some people at age 85 years still play golf, drive a car, and participate in social and community activities;
others are frail and cannot move about well.

10. Misconception: Chronologic Age Determines Oldness
Exercise, nutrition, vitamins, seat belt use, and others are thought to play a role in healthy aging.
Physical, social, and mental health parameters, life experiences, and genetic traits all combine to make aging an individualized process

11. Misconception: Most Elderly Persons Have Diminished Intellectual Capacity or Are Senile (خرف)
Studies show that intelligence, learning ability, and other intellectual and cognitive skills do not decline with age.

12. Misconception: Most Elderly Persons Have Diminished Intellectual Capacity or Are Senile
Cognitive deficits are caused by certain risk factors.
Nutritional status has been singled out as a physical health variable that influences cognitive functioning, particularly memory performance, regardless of a person’s age.

13. Misconception: Most Elderly Persons Have Diminished Intellectual Capacity or Are Senile
Speed of reaction tends to decrease with age, but basic intelligence does not
In fact, some abilities are viewed collectively as crystallized intelligence. Wisdom, judgment, vocabulary, creativity, common sense coordination of facts and ideas, and breadth of knowledge and experience actually improve with age

14. Misconception: Most Elderly Persons Have Diminished Intellectual Capacity or Are Senile
Senility
although not a legitimate medical diagnosis, is a term widely used by the lay public to denote deteriorating mental faculties(abilities, talent) associated with old age.

15. Misconception: All Older People Are Content and Serene(quiet, still)
The picture of Grandma sitting serenely in her rocker with her hands folded in her lap is misleading.
for most people, advancing age brings increasing physical, social, and financial problems to harass and worry them.

16. Misconception: Older Adults Cannot Be Productive or Active
More than two thirds (between 65% and 68%) of the male work force retire before age 65 years.
In contrast, the participation rate for women between 45 and 64 years of age is continually rising

17. Misconception: Older Adults Cannot Be Productive or Active
Some reasons for early retirement include health, availability of private pension(income) benefits, social expectations, and long held plans to do something else with their time
These additional years give older adults time for travel, volunteering, and hobbies.

18. Misconception: All Older Adults Are Resistant to Change
People at any age can learn new information and skills. Research indicates that older people can learn new skills and improve old ones, including how to use a computer.
Learning occurs best in a self-paced, supportive environment

19. Misconception: Older Adults Cannot Be Productive or Active
The elderly have spent a lifetime adapting to change, with varying measures of success
The ability to change does not depend on age but rather on personality traits acquired throughout life or, sometimes, on socioeconomic difficulties.

20. Misconception: Social Security Will Not Be There When I Retire
The Social Security fund is healthy! Although the government has borrowed from it, the trust fund growth has been sufficient to keep Social Security

21. Characteristics of Healthy Older Adults
The vast majority (94%) of the elderly , even with chronic disease or other disabilities, are living outside institutions and are relatively independent

22. Characteristics of Healthy Older Adults
No one knows conclusively all of the variables that influence healthy aging, but it is known that a lifetime of healthy habits and circumstances, a strong social support system, and a positive emotional outlook

23. Characteristics of Healthy Older Adults
Wellness is influenced by many factors including:
Personality traits
Life experiences
current physical health
Current social support
Personal health behaviors; smoking, obesity….

24. Characteristics of Healthy Older Adults
Their ability to function is a key indicator of health and wellness and is an important factor in understanding healthy aging.
Good health in the elderly means maintaining the maximum possible degree of physical, mental, and social vigor

25. Elder Abuse
Is define as the intentional or unintentional hurting, either physical or emotional, of a person who is age sixty or over.

26. HEALTH NEEDS OF OLDER ADULTS
1- primary prevention activities
involve those actions that keep one healthy
Nutritional needs
Exercise needs
Economic security needs
Physiological needs

27. Nutritional Needs
People who have maintained sound dietary habits throughout life have little need to change in old age. Many have not established such habits but may wish to.

28. Exercise Needs
Older adults need to exercise; Research shows that exercise can slow the loss of bone density and increase the size and strength of muscles, including the heart

29. HEALTH NEEDS OF OLDER ADULTS
Physiological needs
Psychosocial needs: All human beings have psychosocial needs that must be met for their lives to be rich and fulfilling.
Major issues are:
Coping With Multiple Losses
Maintaining Independence
Social Interaction, Companionship, and Purpose
Safety Needs
Spirituality, Advance Directives, and Preparing for Death

30. Health Needs of older adult
Secondary Prevention
early detection, screening
Tertiary Prevention
deals with diseases

31. Alzheimer disease It is characterized by: a gradual loss of memory,
Decline in ability to perform routine tasks
Disorientation(weakening, diminishing)
Difficulty in learning
Loss of language skills
Impaired judgment and ability to plan
Personality changes

32. Alzheimer disease Probable cause of AD are many
Promising leads involve the role of
Neurotransmitters
Protein
Metabolism
Environmental toxins
genes

33. Alzheimer disease
Eventually AD clients lose judgment and reasoning, and safety becomes an issue as the disease process continues.
Victims of AD may wander away from home and cannot tell anyone exactly where they live, or they may forget that a stove can get hot and burn themselves while trying to cook.

34. Arthritis Osteoarthritis is the most common form of arthritis.
In this type of arthritis, the number of cartilage cells diminishes,
Cartilage becomes ulcerated and thinned, subchondral bone is exposed, and bony surface rub together resulting in joint destruction.

35. Arthritis
Classic symptoms include aching, stiffness, and limited motion of the involved joint. Discomfort increases with overuse and during damp (wet) weather
It is the leading cause of physical disability in older adults

36. Cancer
which are characterized by the uncontrolled growth and spread of abnormal cells, steadily increase in incidence in aging adults

37. Depression
Depression in older adults is a major problem. It is frequently related to the experience of major multiple losses,
CHN can help elders prevent the overwhelming signs and symptoms of depression related to losses by working with aggregates of elders in the community.

38. Diabetes
Being diagnosed with DM can cause depression or anger, and the community health nurse must tailor educational programs to meet individual client needs

39. Cardiovascular Disease
Hypertension increases with age and affects men more frequently than women. It appears at an earlier age and is more severe, with higher rates of morbidity and mortality,

40. Osteoporosis
the “silent disease,” is characterized by low bone mass and deterioration of bone tissue that leads to increased susceptibility to fractures of hip, wrist, or vertebra

41. Geriatrics
is the medical specialty that deals with the physiology of aging and with the diagnosis and treatment of diseases affecting the aged.
Geriatrics focuses on abnormal conditions and the treatment of those conditions

42. Gerontology
refers to the study of all aspects of the aging process, including economic, social, clinical, and factors, and their effects on the older adult and on society.
psychological Gerontology is a broad, multidisciplinary practice, and gerontologic nursing concentrates on promoting the health and maximum functioning of older adults

43. Case Management and Needs Assessment
involves assessing needs, planning and organizing services, and monitoring responses to care throughout the length of the care giving process, condition, or illness.

44. Criteria for Effective Service
1- comprehension
Adequate financial support
Adult day care programs
Health care services (prevention, early diagnosis treatment, rehabilitation)
Health education (including preparation for retirement)
In-home services
Recreation and activity programs
Specialized transportation services

45. Criteria for Effective Service
2- second criterion for a community service delivery system is coordination.
3- A third criterion is accessibility.
should promote quality programs.

46. Services for healthy older adult
Maintaining functional independence should be the primary goal of services for the older population.
Health screening is another important program for older adults
Health maintenance program may be offered through a single agency

47. Living arrangement and care options
Three types of living arrangements and care options are available for elders:
1- seniors who remain in their own homes or apartments need home care services brought to them
2- seniors live with family members and go to an adult day care center during the day
3- those that are short term…rehabilitation hospital for recovery and physical therapy related to a hip fracture, or respite care

48. Day care and home care services
The majority of older adults want to remain in their own homes for the remainder of their lives and be as independent and control of their lives as possible.

49. Day care and home care services
There increased emphasis on providing needed services for elders at home. This trend started several years ago when it became evident that people improved more quickly and at lower cost when they were cared for as outpatients in their own homes.

50. Living arrangements based on levels of care
Although only 6% of the elderly pop. Lives in skilled nursing facilities, such organizations remain the most visible type of health services for older adults.
These facilities provide skilled nursing care along with personal care that is considered non skilled or custodial care(supervisory, protective), such as bathing, dressing, feeding, and assisting with mobility and recreation

51. Living arrangements based on levels of care
Intermediate care
facilities are less costly and still provide health care, but the amount and types of skilled care given are less than that provided in skilled nursing facilities.
Frequently, older adults need assisted living.

52. Living arrangements based on levels of care
Personal care homes (sometimes called board and care home)
offer 24-houe basic custodial care, such as bathing, grooming, and social support, but provide no skilled nursing services.
Home can serve special pop. Those focusing on the care of people with AD are physically designed with client’s safety and individual needs considered and are staffed with paraprofessionals trained to meet each person’s needs.

53. Living arrangements based on levels of care
continuing care retirement communities (CCRCs)
Sometimes referred to as total life centers, allow seniors to “age in place” with flexible accommodations designated to meet their health and housing needs as these needs change over time.

54. Living arrangements based on levels of care
Hospice and Respite Care Services
Respite care
is a service that is receiving increasing attention. It is aimed primarily at caregivers’ needs.