UNIT 11: ADVOCACY PROGRAMS RELEVANT TO THE CARE OF OLDER

PERSONS
Duration: 1 hour
Introduction
Older people have an advantage over other age groups. They probably have had
more experience with coping, problem- solving, and managing crises by the years they
have lived. Older persons have few delusions regarding what they are or what they are
going to be. They know where they have been, what take been through, and who they
are.
Such experiences have provided them with a unique strength that should be
appreciated. However, acknowledging this strength does not imply that psychiatric
illness is not a problem among the older population. More people than ever survive to
old age, and many bring to their later years the mental health problems they have
possessed throughout their lifetimes. Besides, the many losses and challenges of late-
life may exceed the physical, emotional, and social resources of some persons and
promote mental illness. By promoting mental health, detecting problems early, and
minimizing the impact of existing psychiatric issues, nurses can help older people
achieve optimal satisfaction and function.

OBJECTIVE
1. Recognize that aging changes are partially dependent upon an individual’s health
behaviors and preventive health measures.
2. List thee resources at the international, national, regional, and local levels to
assist older persons.

This module is divided into (3) three lessons

Lesson 1 Geriatric Health care Team
Lesson 2 Support Services and Advocacy for an older person
Lesson 3 Mental health programs

Lesson 11. 1 Geriatric Health care Team

Geriatric care usually consists of a team-based approach. This team evaluates

medical, social, and emotional needs, emphasizing common problems in older adults,
such as memory problems, falls, incontinence, and multiple medications. The goal of
this care team is to help older adults age gracefully.
 Geriatrician
 Gerontological nurse
 Physician assistant
  Social worker
 Pharmacist
 Nutritionist
 Physical therapist
 Occupational therapist
 Speech therapist health or help to treat the health issue they are experiencing.
 Adhere to departmental policies, procedures and objectives, ongoing quality
improvement objectives and safety, environmental, and infection control
standards.
 Maintain patient confidentiality.
 Record complete, timely, and legible medical records.

Social workers are concerned with assisting persons and their families, the groups,
and communities to improve the individual and collective well-being. The goals are to
help people develop their skills and their ability to use their resources and those of the
community to resolve problems.
 They receive services by telephone and in-person in assisting the clients.
 They are involved in beneficial activities for the clients.
 They assess and gather pertinent data.
 They offer information and supporting clients and their families.
 They are contacting and making referrals to other agencies and services.
 Maintaining accurate records and preparing reports.
 They are participating in training, supervision, and meetings.
 Watch for signs of child abuse.
 Provide crisis intervention.

A pharmacist is a person professionally qualified to prepare and dispense medicinal

drugs.
 Dispense Prescriptions
 is the "filling, licking and sticking
 Communicate with Prescribers
 they confirm the dosage and formulation (e.g., liquid or tablet) and
 Ensure Patients' Safety
 They check each patients’ medication record every time he or she gets a
new or refill prescription filled.
 Counsel Patients
 they train patients the dosages, follow up with patients to see if
medications are working, minimize side effects, and listen to their
concerns.
  Working with clients on Over-all Strength
 To maintain health requirements and take the prescribed medication,
help patients heal and avoid getting sick by sharing advice on using
nonprescription remedies, taking health supplements such as vitamins,
using herbal and natural health products, exercising, and maintaining a
good diet
 Dealing with the Insurance Companies
 Pharmacists working in a chain and independent pharmacies have to
submit insurance claims and work with private insurance companies.
 Perform Administrative Tasks
 Everyone in a pharmacy has some responsibilities for keeping patient
files up to date, making sure products and required reports get
generated and filed.
 Educate Health Provider Colleagues
 The doctors, nurses, and other healthcare providers follow the new
medications and drug therapy protocols
 Nutritionist - a person who studies or is an expert in nutrition.
 Advise and present a balanced nutritional strategy
 Discussing and advising on weight-management plans
 Assisting clients with nutritional goals and offering a sound dietary plan for
optimizing health
 Recognize appropriate behavioral-change modifications and nutritional
approaches for different ages and populations
 Physical therapists are the movement experts who improve quality of life through
prescribed exercise, hands-on care, and patient education.
 Physical therapists manage individuals of all ages, from newborns to people at
the end of life.
 Consulting with patients to learn about their physical condition and symptoms
 Diagnosing movement dysfunction and developing a treatment plan
 Teaching patients how to use therapeutic exercise techniques properly
 Providing stimulation or massage to promote healing
 Assisting patients with the use of equipment such as wheelchairs or walkers
 Maintaining patient records and keeping track of goals and progress
 Advising the patient and family about in-home treatment options and exercises
8. Occupational therapist is a branch of health care that helps people of all ages who
have physical, sensory, or cognitive problems.

Occupational therapists
  help with barriers that affect a person's emotional, social, and physical needs. To
do this, they use everyday activities, exercises, and other therapies.
 Conducting physical and psychological assessments of clients and developing or
following a treatment plan.
 Assessing home and work environments of clients and deciding what
adjustments are needed.
 They are advising on adaptive equipment to help clients with daily activities.
 They are developing physical rehabilitation programs to help clients regain lost
skills.
 They are preparing clients for a return to work.
 They are educating caregivers and family members of clients on patient care.
 They are evaluating the results and progress of occupational therapy on clients.
 They are maintaining professional knowledge and the technical progress to
provide clients with the best treatment program available.
 They are complying with certification requirements.
 They are evaluating patient conditions regarding physical and primary mental
health.

Speech Therapists - are professionals who work with people of all ages to improve
communication techniques and treat swallowing disorders.
 Undertaking assessments.
 Planning and providing appropriate treatment.
 They were giving advice and support to patients, family members, and teachers.
 They are writing reports.
 They are maintaining records and case notes.
 They are liaising with doctors, physiotherapists, teachers, family members, and
careers.
 Other functions of Gerontological nurse
 The main objective of gerontological nursing is to improve the quality of life of
older adults.

A. Health assessment:
Daily activities of living. Activities related to the use of equipment or procedure
(telephone, bank account, food preparation)
A. Health screening
B. Promoting good nutrition
C. Promoting activity & exercise.

Preventive care of elderly

 A. Physical & mental safety is essential.
Gerontological nurse & caregiver should pay special attention to the following safety
measures:
A. Protection from an unhealthy environment.
B. Protection from mental tensions.

Special care of personal health

A. Protection from physical & mental injuries, threats & fatigue
B. They are providing rehabilitation services.
C. They are providing psychological support.

Title Lesson 2: Support services and advocacy for an older person

Duration: 1 hour
What is Advocacy? Advocacy is the process of standing beside someone and
supporting them to:
 understand and exercise their rights
 has their voice heard on the issues that are important to them?

An advocate:
 It takes the time to listen and understand your views and wishes
 Informs you of your rights and responsibilities
 Assists you in exploring your options and making informed decisions
 Supports you to raise your concerns and work towards a resolution
 Provides practical assistance such as help to write a letter or raise your concerns
at a meeting
 Speaks for you in situations where you don’t feel able to speak for yourself
 Increases your capacity to self-advocate

Home Care Services for Seniors

 While it may be hard to accept, most of us will require some type of care
assistance after 65.
 You may be used to handling everything yourself, dividing up duties with your
spouse, or relying on family members for little help around the home.
 But as you get older and your circumstances change, getting around and taking
care of yourself can become more and more difficult.
  If the idea of moving to a retirement community, assisted living facility, or nursing
home doesn’t appeal, home care services may be able to help keep you living in
your own home for longer.

Home care services include:

1. Household maintenance.
 Keeping a household dashing takes a lot of work. If you’re finding it hard
to keep up, you can look into the laundry, shopping, gardening,
housekeeping, and handyman services. If you’re having trouble staying on
top of bills and appointments, financial and healthcare management may
also be helpful.

2. Transportation.
 Transportation is a vital issue for older adults. Maybe you’re finding it hard
to drive or don’t like to go at night. Having access to trains, buses,
rideshare apps, reduced fare taxis, and senior transportation services can
help prolong your independence and maintain your social network.

3. Home modifications.
 If your mobility is becoming limited, home modifications can go a long way
towards keeping your existing residence comfortable and accessible.
Personal care.
 Help with the activities of daily living such as dressing, bathing, or meal
preparation, is called personal or custodial care. Home health aides can
provide personal care services that range from a few hours a day to
around-the-clock live-in care.

4. Health care
 Home service is provided at home by a trained individual such as
occupational therapists, social workers, or home health nurses
 Hospice care at home.

5. Day programs.
 Day programs or adult day care can help you keep busy with activities and
socialization during the day while providing a break for your caregivers.
Title: Lesson 3 Mental health programs

Duration: 1 hour

 The mental healthcare in the Philippines faces continued challenges, including

underinvestment, lack of mental health professionals, and vulnerable community
mental health services.

 The recent Mental Health Act legislation has – for the first time, provided a legal
framework for delivering comprehensive mental healthcare; economic restrictions
preventing people from accessing mental healthcare should be considered to
enable the population to access appropriate care when required equitably

 Increased investment is urgently needed to improve the training and recruitment

of psychiatrists, nurses, psychologists, social workers, and other multidisciplinary
team members, particularly as large numbers of skilled professionals continue to
emigrate.

 National information on mental health services in the Philippines indicates

substantial gaps and inconsistencies in the delivery of mental healthcare.

 The recently enacted Mental Health Act legislation provides a platform for
delivering comprehensive and integrated mental health services. There remain
many challenges in the provision of accessible and affordable mental healthcare.

 The Philippines has recently passed its first Mental Health Act (Republic Act no.
11036). The Act seeks to establish access to comprehensive and integrated
mental health services while protecting the rights of people with mental disorders
and their family members (Lally et al., 2019).

 The mental health remains poorly resourced: only 3–5% of the total health
budget expended on mental health, and 70% of this spent on hospital care (WHO
& Department of Health, 2006).

 The majority of mental healthcare provided in hospital settings, and there are
underdeveloped community mental health services. The National Center for
Mental Health was previously estimated to account for 67% of the available
psychiatric beds nationally (Conde, 2004).
 More recent data indicate that there are 1.08 mental health beds in general
hospitals and 4.95 beds in psychiatric hospitals per 100 000 population (WHO,
2014). There are 46 outpatient facilities (0.05/100 000 people) and four
community residential facilities (0.02/100 000) (WHO, 2014).

 There are only two tertiary care psychiatric hospitals: the National Center for
Mental Health in Mandaluyong City, Metro Manila (4200 beds), and the Mariveles
Mental Hospital in Bataan, Luzon (500 beds). There are 12 smaller satellite
hospitals affiliated with the National Center for Mental Health, located throughout
the country.

 Overcrowding, poorly functioning units, chronic staff shortages, and funding

constraints are ongoing problems, particularly in peripheral facilities. There are
no dedicated forensic hospitals, although forensic beds locate at the National
Center for Mental Health.

 There is one doctor for every 80 000 Filipinos (WHO & Department of Health,
2012); the emigration of trained specialists to other countries, mainly English-
speaking countries, contributes to this scarcity. The in psychiatry, where,
nationally, there are a little over 500 psychiatrists in practice. The ratio of mental
health workers per population in the Philippines is low, at 2–3 per 100 000 people
(WHO & Department of Health, 2006). This ratio is lower than in other Western
Pacific Rim countries with similar economic status, for example, Malaysia (4.9
mental health workers per 100 000 population) and Indonesia (3.1 per 100 000
people).

 Data indicate that there are 0.52 psychiatrists (Isaac et al., 2018) and 0.07
psychologists per 100 000 inhabitants, and 0.49 mental health nurses per 100
000 of the population (a reduction from 0.72 per 100 000 in 2011) (WHO, 2014).
The burden of mental disorders in the Philippines There is little epidemiological
evidence on mental disorders in the Philippines; however, some important data
are available. 14% of a population of 1.4 million Filipinos with disabilities have a
mental illness (Philippines Statistics Authority, 2010).

 The National Statistics Office identified that mental illness is the third most
prevalent form of morbidity. 0.4% had a diagnosis of schizophrenia, 14% of
Recent data from the Philippine Health Information System on Mental Health
identified that (from 14 public and private hospitals surveyed from 2014 to 2016)
42% of the 2562 surveyed patients for schizophrenia and from 0.12 to 1.09 per
100 000 in females (Redaniel et al., 2011). The most recent data from 2016
 identified an overall suicide rate of 3.2/100 000, with a higher rate in males
(4.3/100 000) than females (2.0/100 000) (WHO, 2018).

Access to treatment
 Prohibitive economic conditions and the inaccessibility of mental health services
limit access to mental healthcare in the Philippines. Further, perceived or
internalized stigma is a barrier to help-seeking behavior in Filipinos (Tuliao &
Velasquez, 2014), just as is the case in Western populations (Lally et al., 2013).

 There is a cultural drive to ‘save face’ when there is a threat to or loss of one's
social position, and as such, Filipinos may have difficulty in admitting to mental
health problems or seeking help. There is a strong sense of family in the
Philippines.

 When issues are socially related, Filipinos will turn to family and peer networks
before seeking medical help (Tuliao, 2014). There are little data on prescription
rates and the use of psychotropic medications in treating mental disorders.

 2005 WHO Health Survey indicated that only a third of people with a diagnosis of
schizophrenia were receiving treatment or screening (although antipsychotic
medication was as the treatment)

The Philippines Department of Health Medication Access Program for Mental Health list
of essential psychotropic medications
 First-generation/typical antipsychotics → chlorpromazine, haloperidol (oral and
long-acting injectable), fluphenazine decanoate
 Second-generation/atypical antipsychotics → clozapine, olanzapine, quetiapine,
risperidone
 Antidepressants → fluoxetine, sertraline, escitalopram
 Mood stabilizers → lithium carbonate, valproic acid, carbamazepine, lamotrigine
 Anticholinergics → biperiden, diphenhydramine
 Benzodiazepine → clonazepam
 Cholinesterase inhibitor → donepezil
 NMDA receptor antagonist → memantine

MENTAL HEALTH PROGRAM (DOH)

Description
 Mental health and well-being is a concern of all. Addressing concerns related to
MNS contributes to the attainment of the SDGs. Through a comprehensive
mental health program that includes a wide range of promotive, preventive,
 treatment, and rehabilitative services; that is for all individuals across the life
course, especially those at risk of and suffering from MNS disorders; integrated
into various treatment settings from the community to facilitate implemented from
the national to the barangay level; and backed with institutional support
mechanisms from different government agencies and CSOs, we hope to attain
the highest possible level of health for the nation because there is no Universal
Health Care without mental health

Vision
 A society that promotes the well-being of all Filipinos, supported by
transformative multi-sectoral partnerships, comprehensive mental health policies
and programs, and a responsive service delivery network

Mission
 To prevent mental, psychosocial, and neurologic disorders, substance abuse,
and other forms of addiction, and reduce the burden of disease by improving
access to quality care and recovery to attain the highest possible level of health
to participate fully in society.

Objectives
1. To promote participatory governance and leadership in mental health
2. To strengthen coverage of mental health services through multi-sectoral
partnership to provide high-quality service aiming at the best patient experience
in a responsive service delivery network
3. To harness the capacities of LGUs and organized groups to implement promotive
and preventive interventions on mental health
4. To leverage quality data and research evidence for mental health
5. To set standards for compliance in different aspects of services

Program Components
1. Wellness of Daily Living
 All health/social/poverty reduction/safety and security programs and the
like are protective factors in general for the entire population
 Promotion of Healthy Lifestyle, Prevention, and Control of Diseases,
Family wellness programs, etc.
 School and workplace health and wellness programs 2. Extreme Life
Experience
2. Provision of mental health and psychosocial support (MHPSS) during personal
and community-wide disasters
3. Mental Disorder
 4. Neurologic Disorders
5. Substance Abuse and other Forms of Addiction
 Provision of mental, neurologic, and substance use disorders at the primary
level from assessment, treatment, and management to referral; and provision
of psychotropic drugs provided for free.
 Enhancement of mental health facilities under HFEP

Partner Institutions
 NGOs (DOLE, DSWD, DepEd, Tesda, CHED, DILG), NGOs (WHO, PPA,
PAP, PNA, PLAE, AWIT Foundation, WAPR, NGF)
 Policies and Laws DOH Administrative Order No. 8 Series of 2001 The
National Mental Health Policy DOH Administrative Order No. 2016-0039
 Revised Operational Framework for a Comprehensive National Mental Health
Program Republic Act No. 11036 Mental Health Act

Strategies, Action Points and Timeline

 Governance
 Service coverage
 Advocacy
 Evidence
 Regulation

Program Accomplishments/Status
1. Passage of the Republic Act No. 11036 dated June 20, 2018 "An Act
Establishing a National Mental Health Policy to enhance the Delivery of
Integrated Mental Health Services, Promote and Protecting the Rights of Persons
Utilizing Psychiatric, Neurologic and Psychosocial Health Services, Appropriating
Funds Therefore and for Other Purposes."
2. DOH Administrative Order No. 2016-0039 dated October 28, 2016 " Revised
Operational Framework for a Comprehensive National Mental Health Program."
3. National Mental Health Program Strategic Plan 2018-2022
4. Harmonized MHPPS Training Manual
5. Development of the Implementing Rules and Regulation of the RA No. 11036,
also known as The Mental Health Act
6. Conduct of the Advocacy Activities such as 2nd Public Health Convention on
Mental Health, Observance of the World Health Day, World Suicide Prevention
Day, National Mental Health Week, and Mental Health Fairs
7. Training on Mental Health Gap Action Programme
8. Conduct of The National Prevalence Survey on Mental Health
9. Establishment of the Medicine Access Program for Mental Health
In the Philippines
1. 2004 WHO study, up to 60% of people attending primary care clinics daily, is
estimated to have one or more MNS disorders.
2. 2000 Census of Population and Housing showed that mental illness and mental
retardation rank 3rd and 4th respectively among the types of disabilities in the
country (88/100,000
3. Data from the Philippine General Hospital in 2014 show that epilepsy accounts
for 33.44% of adults and 66.20% of pediatric neurologic outpatient visits per
year.
4. Drug use prevalence among Filipinos aged 10 to 69 years old is at 2.3%, or an
estimated 1.8 million users, according to the DDB 2015 Nationwide Survey on
the Nature and Extent of Drug Abuse in the Philippines
5. 2011 WHO Global School-Based Health Survey has shown that in the
Philippines, 16% of students between 13-15 years old have ever seriously
considered attempting suicide, while 13% have attempted suicide one or more
times during the past year.
6. The incidence of suicide in males increased (Redaniel, Dalida and Gunnell,
2011)
7. Intentional self-harm is the 9th leading cause of death among the 20-24 years
old (DOH, 2003).
8. A study conducted among government employees in Metro Manila revealed that
32% out of 327 respondents had experienced a mental health problem in their
lifetime (DOH 2006).
9. Based on Global Epidemiology on Kaplan and Sadock’s Synopsis of Psychiatry,
2015 and Kaufman’s Clinical Neurology for Psychiatrists, 7th edition, 2013
A. Schizophrenia ---1% .....1 Million B. Bipolar ---1% .... 1 Million C. Major
Depressive Disorder ---17% .... 17 M D. Dementia --- 5% (of older than 65) .....
E. Epilepsy ---0.06% .... 600,000

FINAL REQUIREMENT:
Make an NCP of a patient with Anxiety disorders.

Prescribed:
 Kristen L. Mauk Gerontological Nursing; Competencies for Care; Philippine
Edition; 2nd Edition;

OTHER REFERENCES
  Janice L. Hinkle, Kerry H. Cheever Brunner & Suddath’s Textbook of Medical-
Surgical Nursing 14th Edition; Lippincott Williams and Wilkin’s The Lippincott
Manual of Nursing Practice 5th edition

Resources:
 American Association of Retired Persons (AARP) Elder Law Forum
 http://www.aarp.org/research/legal-advocacy/ American Bar Association
Senior Lawyers Division
 http://www.abanet.org/srlawyers/home.html Elder Justice Coalition
 http://www.elderjusticecoalition.com Hartford Institute for Geriatric Nursing
Mistreatment and Abuse Assessment.
 http://consultgerirn.org/uploads/File/trythis/try_this_15.pdf National Academy
of Elder Law Attorneys http://www.naela.com National Center on Elder Abuse
 http://www.ncea.aoa.gov National Senior Citizens Law Center
 http://www.nsclc.org Nursing Home Abuse/Elder Abuse Attorneys Referral
Network

Recommended Readings
Recommended readings associated with this chapter can be Visit
 http://thepoint.lww.com/Eliopoulos9e to access the list of recommended tasks
and additional resources related to this chapter.