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