CARE FOR THE OLDER PERSONS

Aging - normal developmental process

 Occurring throughout the human lifespan
 Causes a mild progressive decline in body system functioning

CHRONOLOGICAL AGE
 Refers to the number of years the person has lived.
 Most commonly used objective method
 Chronological age serves as a criterion in society for certain activities, such as driving,
employment and the collection of retirement benefits
 Three categories
 Young old(65-74)
 Middle old(75-84
 Old old(85 and above)

PHYSIOLOGIC AGE
 Refers to the determination of age by body function

FUNCTIONAL AGE
 refers to a person's ability to contribute to society and benefit others and himself
-------------------------------------------------------------------------------------------------------------------------
 Fastest growing segment of the older population -- age 75
 Those who require help -- frail elderly
 Non-institutionalized adults ages 75-84 -- 25 % need help with daily activities.
 Aged 85 and older - - one half need help with daily activities

1. SOCIOLOGICAL THEORIES OF AGING

 Changing roles, relationships status, impact the older adult’s ability to adapt.

A. ACTIVITY THEORY
 Remaining occupied and involved is necessary to a satisfying late-life
B. DISENGAGEMENT THEORY
 Gradual withdrawal from society and relationships serves to maintain
social equilibrium and promote internal reflection
C. SUBCULTURE THEORY
 the elderly prefer to segregate from society in an aging subculture
sharing loss of status and societal negativity regarding the aged
D. CONTINUITY THEORY
 Personality - influences roles and life satisfaction and remains consistent
throughout life
 Past coping patterns recur as older adults adjust to physical, financial,
and social decline, and contemplate death.
E. AGE STRATIFICATION
 Individuals in different generations have different experiences that may
cause them to age in different ways
F. PERSON- ENVIRONMENT - FIT
 Function is affected by ego strength, mobility, health, cognition, sensory
perception, and the environment. Competency changes one’s ability to
adapt to environmental demands.

G. GEROTRANSCENDENCE
 The elderly transform from a materialistic/rational perspective toward
oneness with the universe. Successful transformation includes an
outward focus, accepting impending death, substantive relationships,
intergenerational connectedness, and unity with the universe.
2. PSYCHOLOGICAL THEORIES
 Explain aging in terms of mental processes, emotions, attitudes, motivation, and
personality development that is characterized by life stage transitions.

A. HUMAN NEEDS
 Five basic needs motivate human behavior in a lifelong process toward
need fulfillment. Maslow surmised that a hierarchy of five needs motivates
human behavior; physiologic, safety and security, love and belonging,
self-esteem, and self-actualization.
B. INDIVIDUALISM
 Personality consists of an ego and a personal and collective
unconsciousness that views life from a personal or external perspective.
Older adults search for life meaning and adapt to functional and social
losses.
C. STAGES OF PERSONALITY DEVELOPMENT
 Personality develops in eight sequential stages with corresponding life
tasks. The eighth phase, integrity versus despair, is characterized by
evaluating life accomplishments struggles include letting go, accepting
care, detachment ,and physical and mental decline
D. LIFE- COURSE/ LIFE SPAN DEVELOPMENT
 Life stages are predictable and structured by roles, relationships, values,
and goals. Persons adapt to changing roles and relationships. Age group
norms and characteristics are an important part of the life course
E. SELECTIVE OPTIMIZATION WITH COMPENSATION
 Individuals cope with aging losses through activity/role selection,
optimization and compensation. Critical life points are morbidity, mortality,
and quality of life. Selective optimization with compensation facilitates
successful aging.
CHRONIC ILLNESS
 Conditions or health problems associated symptoms or disabilities
o Require long term management (3 months or longer)
o Do not resolve spontaneously
o Consequence of conditions or unhealthy behaviors that began during early
childhood or young adulthood

A. HYPERTENSION
 Is a high blood pressure
 Is marked by an intermittent or sustained increase in the diastolic or systolic blood
pressure.

2 CLASSIFICATIONS OF HYPERTENSION
1. Essential Hypertension
2. Secondary Hypertension - example is diabetes mellitus

3 Factors that affects the BP

1. Circulating blood volume - increased blood volume=increased bp
2. Peripheral vascular resistance - vasoconstriction=increased bp
3. Blood viscosity - increased blood viscosity=increased bp

B. CHRONIC OBSTRUCTIVE PULMONARY DISEASE

 Airflow limitation disease - characterized by a reduced airway lumen from mucosal
thickening
 Three forms: emphysema, chronic bronchitis, and asthma
 Chronic bronchitis - is marked by excessive production of tracheobronchial mucus
 Cigarette smoke or other pollutants
 Emphysema - distends or ruptures the terminal alveoli, causing a loss of elasticity.
 Long history of smoking
 Asthma - increase in bronchial reactivity to a variety of stimuli
 Bronchospasm and airway obstruction in conjunction with airway inflammation.
 Expiratory - wheezes
 Inspiratory - stridor

C. DIABETES
Pancreas → islets of langerhans
Alpha cells → glucagon = increased sugar
Beta cells → insulin = decreased sugar
Type I - IDDM (insulin dependent)
Type II - NIDDM (Oral Hypoglycemic Agents) [Metformin] - stimulates the
pancreas to produce more insulin)

D. CANCER
 Occurs as a malignant transformation (carcinogenesis) of normal cells, causing the cells
to enlarge and divide more rapidly than normal and lose their ability to function normally.

WARNING SIGNS OF CANCER

 Change in bowel or bladder habits
 A sore that does not heal
 Unusual bleeding or discharge
 Thickening or lump in the breast or elsewhere
 Indigestion and difficulty in swallowing
 Obvious change in wart or mole
 Nagging cough or hoarseness in voice
 Unexplained anemia- Monitor hemoglobin levels
 Sudden weight loss

E. DEMENTIA
 A broad term for a syndrome characterized by a general decline in higher brain
functioning, such as reasoning, with a pattern of eventual decline in ability to perform
even basic activities of daily living, such as toileting and eating
F. STROKE (APOPLEXY)
 Cerebrovascular accident (CVA) or brain attack
 Occurs when impaired circulation in the brain disrupts the supply of oxygen
 Recovery - depends on how quickly and completely circulation is restored.
 Recurrent attack – Fatal
24-72hrs – mild stroke; should be resolved on the 3rd day – full-blown stroke (paralyzed,
loss of sensation)
Muscular atrophy – PT is necessary

KEY PROBLEM AREAS EXPERIENCED BY PATIENTS WITH CHRONIC ILLNESS

1. Managing chronic illness involves more than treating medical problems
 psychological /social problems
 Threaten identity role changes, alter body image, disrupt lifestyles.
 Adaptation
 Ex: - Colon cancer (detected in the advanced stage)
 Rhabdomyosarcoma (cancer in skeletal muscles)
6mos – body will deteriorate
Rhabdo(skeletal) myo(muscle) sarcoma(cancer)

2. Chronic conditions - different phases

 Acute periods, stable/unstable periods, flare - ups remissions.
 Own regimen/types of management

3. Keeping chronic conditions under control requires persistent adherence to therapeutic

regimens.
 Develop complications/accelerating the disease process
 Culture, values/socioeconomic factors

4. One chronic disease can lead to the development of other chronic conditions

5. Chronic illness affects the entire family

 Role reversals
 Unfilled roles
 Loss of income
 Time required to manage the illness
 Decreases in family socialization activities

6. The management of chronic conditions is expensive.

 physical therapy is need to avoid muscle atrophy

7. Chronic conditions raise difficult ethical issues for patients, families, health care
professionals, and society.
 Cost controls
 Allocate scarce resources(e.g. organs for transplantation)
 When life support should be withdrawn
MANAGEMENT AND HEALTH EDUCATION
A.Hypertension: HTN → TIA (transient ischemic attack) → MI = altered tissue perfusion
(disrupted blood flow) → problems in the circulation → organ damage (low supply of o2)
MANAGEMENT
 Lower the BP: healthy diet, medications(antihypertensive drugs)
 ACE inhibitors (“pril”)
 Beta blockers (“olol”)
 Calcium channel blockers (“pine”)
 Diuretics
 Prevent organ damage
 Secondary hypertension - correcting the underlying cause and controlling
hypertensive effects.
 Ex: treat diabetes mellitus or renal failure

HEALTH EDUCATION
 Helping the patient learn to live with and control his hypertension
 Self-monitoring blood pressure cuff - record the reading twice weekly
 Establishing a daily routine - medication
 High-sodium antacids/ OTC cold and sinus medication (harmful vasoconstrictors)

B. COPD
MANAGEMENT
 Corticosteroids - anti-inflammatory effects. Older adults (risk for adverse
reactions)
 Oxygen therapy(limited to 2 to 3 L/min)
 Adequate fluid intake (up to 2 to 3 L/day)
 Chest physiotherapy - mobilize secretions
 Stop smoking/avoid air pollutants
 Antibiotics -- recurrent infections
 Bronchodilators -- bronchospasm/facilitated mucus clearance
 Nebulizer treatments -- loosen and mobilize secretions
 Older adults- immunized -- influenza/pneumococcal pneumonia
 Drug therapy for asthma -- bronchodilators/anti-inflammatory drugs.
Vaccine: live attenuated = weakened
 9 mos: MMR(Measles,Mumps,Rubella) not administered to 9 mos
because of the absence of defenses--as a result: they acquire MMR

HEALTH EDUCATION
 Infection control breathing techniques, chest physiotherapy, drug therapy, diet regimens,
when to seek medical help.
 Advice the patient to avoid crowds and people with known infections
 Breathing techniques
 Explain oxygen therapy and proper use of equipment (nasal: 24%-40%(2-3 liters/min o2
delivery / face mask: 10 liters/min)
 Postural drainage and chest percussion
 Stress - not taking more than the prescribed amount of medication
 Report adverse reactions to the doctor immediately
 inhaler

Possible Nursing Diagnosis:

 Ineffective airway clearance
 Impaired gas exchange
 Ineffective breathing pattern
 Imbalanced nutrition: less than body requirements
 Activity Intolerance
 Risk for infection
 Deficient knowledge
C. DIABETES MANAGEMENT
 Optimal blood glucose levels/decreasing the severity/delaying the onset of complications
 Nutrition and exercise therapy
 Pharmacotherapy – oral anti-diabetic agent

HEALTH EDUCATION
 Care for the Heart
 Maintain normal weight; exercise regularly
 Monitor blood glucose levels
 Control BP and cholesterol level
 Care for the Eyes
 Early treatment may prevent further damage
 Care for the Teeth
 Regular dental check-ups to minimize dental problems – gum disease/
abscesses
 Care for the Skin
 Check skin daily for cuts and irritated areas
 Care for the Feet
 Diabetes can reduce blood flow to feet/dull their ability to feel heat, cold,
and pain.
 Check Urine
 Symptoms of kidney disease usually don’t appear until the problem is
advanced.
 Get regular check-ups
 Detect early signs of complications and start treatment promptly.

D. CANCER MANAGEMENT
a. Surgery
- Diagnostic surgery
- Surgery as primary treatment
- Prophylactic Surgery
- Reconstructive Surgery

b. Radiation therapy

c. Chemotherapy
- Antineoplastic agents

HEALTH EDUCATION
 Report side effect of treatment
 Explain procedures/treatments
 Encourage verbalization of feelings/concerns regarding the disease treatment
and future implications
 Follow-up care to detect recurrences early
 If appropriate – support services

E. DEMENTIA MANAGEMENT
1. Maintenance of optimal cognitive functions
 reduce environmental confusion
2. Maintenance of Physical safety
 Control of environment
 Monitor medication regimen
 Maximum independence and freedom.
3. Maintenance of optimal level of psychological functioning
 Enhance the quality of life
 Encourage quality of feeling/self
 Reduce anxiety provoking situations in daily routine
4. Attainment of an optimal exchange of ideas between the patient and others
 Interpretation of messages
 Ability to express messages
 5. Maintenance of maximum independence in activities of daily living.
 Facilitate daily performance of activities
 Safety in bathing
 Provide measures to remember places
 Use clothing that open easily
 Normal elimination
6. Maintenance of optimal level of nutrition
 Monitor intake and observe food habits
 Provide balanced diet
 Calm and pleasant atmosphere
 Regular mouth care
7. Maintain optimum personal hygiene
8. Maintenance of a balance of sleep and activIty
 Reduce night-time distractions
 Night lights
 Exercise and --
9. Enhancement of socialization and fulfillment of intimacy needs
 Family and friends
 Limit numbers of visitors
10. Provide rehabilitation
 Support retrain the existing skills
 Provide hearing aids
 Speech therapy(expressive aphasia)
 Impaired vision
 Bladder and bowel training

HEALTH EDUCATION
 Routine for all the patients activity
 Upset – redirecting his feelings
 Independence
 Teach about Alzheimer’s Disease
 Cause
 Signs and symptoms
 Expect deterioration (memory loss and physical deterioration).

F. STROKE MANAGEMENT
 Unobstructed airway/ventilated
 Vital signs/ neurologic examination
 Administration of IV fluids and electrolytes, and nasogastric intubation
 Surgery – depends on its cause and extent – craniotomy – hematoma
 Drug therapy may include anticonvulsants – seizures
 Stool softeners
 Corticosteroids – cerebral edema
 Acetaminophen – fever
 Antihypertensives – high blood pressure
 Analgesics - headache

HEALTH TEACHINGS
 Teach the family and the patient about CVA
 Explain: dx tests, tx, rehab program
 Surgery – patient/family understand – procedure/consequences
 Self-care skills
 Speech therapy - ASAP
 Special diet – dietitian – explain to patient
 Explain ff. Prescribed exercise programs.
 Appropriate home safety equipment such as ramps and grab bars for the toilet and bath-
tub
 Teach the patient and family – purpose, dosage and possible adverse effects of ALL
prescribed medication
CHANGES IN THE OLDER PERSON AND THEIR IMPLICATIONS TO
CARE
- Aging changes in cardiovascular structure

Vascular Aging
 Aged arteries become extended and twisted. With age, arteries started to dilate and
stiffen, leading to hypertension.
Cardiac Aging
 Enlargement of the heart chambers and coronary cells with age, as does increased
thickening of the heart walls, especially in the left ventricle. Ventricles in the heart also
begin to thicken and stiffen in correlation with continued steady production of collagen

RESPIRATORY SYSTEM CHANGES

Alveoli
- the volume blood distributed to pulmonary circulation declines with age due to a decreasing
number of capillaries per alveolus – impairs efficient passage of oxygen from the alveoli to
the blood

Lung Elasticity
- With age, there is a decrease in the lungs’ elasticity, which in turn causes a change in the
elastic recoil properties of the lungs. Loss of elastic recoil causes the lungs to close
prematurely, trapping air inside and preventing the lungs from emptying completely.

Chest Wall
- The chest wall becomes stiffer with advancing age, decreasing the case with which the
thoracic cavity can expand. The stiffness of the chest reduces its ability to expand during
inhalation and contract during exhalation.

GASTROINTESTINAL CHANGES

Pharynx and esophagus

 Overall, the GI system appears to be relatively preserved in aging with only minor
changes. The two GI areas most affected by age are the upper tract and the colon.
Stiffening of the esophageal wall affect the older patient’s ability to swallow. Dysphagia,
reflux, heartburn, an chest pain are common complaints.

The Large intestine

 Constipation more common in elderly: the rectrum, a colonic structure that is located
before the anus, shows age-related increase in fibrous tissue. This increase reduces the
rectum’s ability to stretch as feces pass through

URINARY STRUCTURAL CHANGES WITH AGE

Kidneys
 Shrinks in length and width. Changes in renal blood flow and glomerular filtration rate
(GFR) account for a majority of functional disability in the kidneys with age.

Bladder
 With age, the bladder decreases in size and develops fibrous matter in the bladder wall,
changing its overall stretching capacity ad contractibility

Urination
 The amount of urine expelled from the body decreases with age

REPRODUCTIVE SYSTEM CHANGES

Ovaries
 Atrophy to such small size; that they can become impalpable during an exam
Uterus
 Age-related decreases in uterine endometrial thickening during menstrual cycles occur
as the result of decreased estrogen and progesterone levels – decline in menstrual flow

Vagina
 becomes shorter and narrower and the vaginal walls tend to thin and weaken. As a
result, the vagina become very dry, causing intercourse to be very painful

Menopause
 Menopause transition is defined by declines in estradiol along with the onset of variable
menstrual cycle. Periods of amenorrhea trigger the move into the late stages

Glands
 The biggest concern in older males is changes in the prostate gland. The lining and
muscle layer of the prostate gland become thinner with age, probably due to the reduced
blood flow to the area. Benign prostatic hypertrophy (BPH) - remains very common
among aging males.
 Now: Benign Prostatic Hyperplasia- increased in the number of cells
Penis
 Begins to show fibrous changes in erectile tissue around the urethra starting in the 30’s
and 40’s. This fibrosis in erectile tissue - increase in the amount of time it takes to
achieve an erection in older males.
Testes
 Decrease in both size and weight but with high variability among men
 Decline in sperm production occurs in aging males, the production never ceases, as a
result, the older male remains fertile

Andropause
 A decline in testosterone levels and eventually deficiency significant enough to cause
clinical symptoms
 Unlike menopause, this occurs gradually over time and does not occur in all aging
males. Symptoms include: low libido, strength, and stamina; increased irritability; and
cognitive changes.

The aging brain

THE MUSCLE
 Sarcopenia- associated with tremendous increase in functional disability
 reduction in muscle mass occurs to atleast some degree in all elderly
person as compared to healthy, physically active young adults

THE SKELETAL SYSTEM

 Estrogen deficiency
- key contributor to bone loss and bone loss accelerates in women after menopause due to
a decline in estrogen levels.
- plays a role in bone loss among men – due to a decline in levels of estrogen, not
testosterone

 Osteoporosis
- Results from reductions in bone quantity and strength that are greater than the usual age-
related reduction. Bones of those with osteoporosis are very porous- containing numerous
holes or empty pockets- prone to fracture.

THE SENSORY SYSTEM

 Touch
  The ability to touch and distinguish texture and sesnsation tends to
decline with age due to a decrease in the number and alteration in the
structural intergrity of touch receptors or meissener’s corpuscles and
pressure receptors or Pacinian corpuscles. Receptors that are related to
the sense of touch are also known as mechanoreceptors
 Smell
 A decrease in the number of olfactory neurons and weakening of olfactory
neural pathways to the brain lead to a reduction in the ability to identify
and distinguish aromas. A decrease in the sense of smell is referred to a
hyposmia
 Taste
 Aging causes a decrease in taste also known as hypogeusia, usually
more noticeable around the age of 60 with more severe declines
occurring after the age of 70

 Vision
 Most common visual concerns -Presbyopia: the inability to focus on
nearby objects such as newsprint (farsightedness)

 Hearing
 Age-related hearing loss occurs as a result of changes in the inner ear.
Aging changes that cause hearing loss include the alteration and decline
in the ability to hear high frequency sounds, and the ability to discern.
 Age-related hearing loss, also known as prebycusis – most common
sensory deficit in the older population

INTEGUMENTARY SYSTEM
- The greatest changes in aging skin – dermis. There is a general thinning of the dermal layer,
with loss of thickness averaging 20% in older persons. This thinning of the dermis is due in
large part to a general loss of collagen – approximately 1% loss per year in adulthood.

IMMUNE SYSTEM
 Immunosenescence: aging of the immune system
 Assoc. With increased incidence of infectious diseases such as bronchitis
and influenza
 Implicated in the increased incidence of tumors and cancer that occurs
with age.

CULTURAL FACTORS/ETHNICITY

 Ethnicity
 Refers to race; ex. African, Asian etc.
 Nationality
 Refers to geographic location of the person’s birth (or country he
identifies)

DIVERSITY OF ELDERS
 Wide range of life experiences
 Lifestyles
 Health status
 Socioeconomic status
 Religion

PATTERNS OF HEALTH AND DISEASE IN THE OLDER ADULT

A. Diseases that occur to varying degrees in most older adults
a. Cataracts
b. Arteriosclerosis – hardening of the blood vessels
c. BPH
B. Diseases with increased incidence with advancing age
a. Neoplastic disease
b. DM
c. Dementia disorders

C. Diseases that have more serious consequences in the elderly

a. Pneumonia
b. Influenza
c. Trauma

D. Very common chronic diseases

a. Arthritis
b. Hypertension
c. Heart disease

E. Functional disability
a. 32% of persons over 65 years have some limitations of functions
b. 25% of persons over 65 years require help with at least one ADL or IADL

GERIATRIC ASSESSMENT
 “A multidisciplinary diagnostic process intended to determine a frail older person’s
medical, functional, and psychosocial status and limitations in order to develop a plan for
treatment and long-term follow up
 Diagnose and develop an overall plan of care for treatment and long term follow up
 Optimizes interdependence and prevent future disabilities

 Functional Assessment

a. Identify an older adults ability to:

- Perform self-care, maintenance, and physical activities

b. Disability
- Impact that health problems have on an individual’s ability to perform tasks, roles, and
activities

 Physical Assessment
- With a “systems” approach, reviews each body system first by taking a history – then
physical examination

1. Circulatory Function
- Family history, current problems w/ chest pains/discomfort(exertion); current diagnoses and
associated medications; otc and herbal medicines; sources of stress; adherence to medical
regimen
- PE, BP, chest sound, and pulse rate
- Exercise stress test, blood and scrum tests, ECG and imaging tests, and assessing the
condition of the heart and blood vessels

2. Respiratory Function
- Current medications/history of smoking behaviour and exposure to environmental pollutants
- Assess: current difficulties and anxieties associated with breathing, decreased energy to
complete everyday tasks, frequent coughing, and production of excess sputum.
- Observation of posture and breathlessness, and listening to chest sounds
- Pulmonary function test, chest X-ray, and sputum analysis

3. Gatrointestinal Function
- Usual diet: appetite changes; nausea, vomiting, indigestion, stomach discomforts; problems
with bowel function (constipation and diarrhea)
- Barium enemas (Lower GI series [LGIS]) or barium swallow (UGIS) and x-rays, stool
analysis examination of the colon
- Oral health assessment – overlooked with older adluts
- Oral health practices including brushing, flossing, and regular contact with a dentist

4. Genitourinary Function (sometimes neglected)

- Abnormal bleeding, vaginal discharge, urinary symptoms, pelvic examination and pap
smears
- Older men- enlarged prostate
- Chronic Renal failure – complication of age-related dses (diabetes and hypertension)
- Incontinence – not a normal part of aging
- Health history – previous or current difficulties related to the frequency and voluntary flow of
urine during either the day or night; medication use
- Urine analysis tests for blood, bacteria, and other components

5. Neurological Functions
- Medications, medical diagnoses related to the neurological system (history or family history
of stroke)
- Previous and current impairments in speech, expression, swallowing, memory, orientation,
energy level, balance, sensation, and motor function
- Sleep disturbance, tremors, and seizures

6. Musculoskeletal Function
- The most commonly reported illness among older adults is osteoarthritis (weigh-bearing joint
hips/knees)
- Observation of posture and walking can assist in asking the appropriate questions:
 Does the older adult favour one side of the body while walking?
 Are assistive devices such as canes and walkers being used?
 Canes and walkers should be at the appropriate height in
relation to body height

7. Sensory Function
- Diminished vision and hearing – greatest impact on odlers adults – negative effects on
social interaction – social and psychological health
- The ff 2 screening procedures are simple tests for functional vision
 Ask the older adult to read a newspaper headline and story
 Ask the older adult to read the prescription bottle
- Hearing loss is a major concern for many older adults
 The ff question is useful in assessing ear and hearing problems:
 Are you experiencing a hearing problem or any ear pain,
ringing in the ears or discharge?
- Older adults wearing hearing aids – regularly assessed and monitored

8. Integumentary Function
- Skin problems and concerns and inspecting the skin
- Skin injury = close monitoring and treatment
- Rashes, itching, dryness, frequent bruising, and any open sores
- Color, hydration, circulation, and intactness
Wellness

Nutrition support

Constipation
 Fluid intake- reluctant because of their lose sphincter – incontinence
 Diet- fiber intake
 Ambulation
 Stool softener
 Toilet training

Iron with vitamin C/citrus fruits

Less fat less sugar less oil

Control cholesterol levels

Activity and exercise

Considered exercise if heart rate is increased

3 components:
Warm-up – low to moderate intensity levels 10-15 mins
Actual exercise -
Cool down

Stress management

Promoting healthy lifestyle

Enhancing coping strategies
Teaching relaxation techniques

Physiologic
Science of the function of a living system

 Activity and exercise

 Nutrition support
 Respiratory management
 Tissue perfusion management – evident varicosities
 Electrolyte and acid-base balance management – increased or decreased potassium
have same effect on ECG or electrical conductivity of the heart
 Skin and wound management
 Physical comfort promotion
Adipose – thermo regulators; the more adipose tissue, the warmer

Behavioral
Actions or reaction of a person or animal in response to external or internal stimuli
Manner of behaving or conducting oneself on one’s best behaviour with careful good manners

 Coping assistance
 Patient education
 Spiritual care

Safety
Control of recognized hazards to achieve an acceptable level of risk.
Can take the form of being protected from the event or from exposure to something that causes
health or economic losses.
Can include protection of people or of possessions.
  Risk reduction activities
 Management of the environment – fall hazards

Bioethical
Study of ethical and moral implications of new biological..

Principles
1. Principle of beneficence and nonmaleficence – beneficence - “do what’s good”;
nonmaleficence – “do no harm”
2. Principle of justice – fairness; equality vs. equity
3. Principle of Autonomy – decides for himself with no interfering variables/influence
4. Respect for the sanctity of human life-
5. Veracity and fidelity – veracity – truthfulness; fidelity – faithfulness or loyalty to
the commitment that you made to the patient and self

Oct 25 - eclass
2 scenarios depicting the principles to elderly
1-2 questions

Slides