ANGELES UNIVERSITY FOUNDATION

COLLEGE OF NURSING
__________________________________________________________________________________

NCM 0114 - CARE OF THE OLDER PERSON

MODULE 2
Nursing Care of the Older Adults in Wellness
The World Health Organization (WHO) defines Healthy Aging “as the process of
developing and maintaining the functional ability that enables wellbeing in older age”.
To be well is to be a healthy being. Despite all of  the normal biophysical changes in an
aging person, wellness is achievable. However, on what basis can we say that aging
adult is well?   

In this module, wellness among the older adults would be the main concept which
would further cover (1) Assessment of the older adult’s wellness,  (2) Planning for
health promotion and maintenance (3) Implementing care as to physical and
psychosocial needs (4) Health care services available for older adults.   

Eight learning hours would be spent in this module and below are the details of
the content and the estimated time of completion.

At the end of the module, you should be able to:

LO3: Assess the health status of an older person client.

LO4: Formulate with an older person client a plan of care to address the identified health
conditions, needs, problems and issues based on priorities.

LO5: Implement safe and quality interventions to address the health needs, problems
and issues of the older person.

LO6: Use appropriate strategies and approaches to plan health programs for older
persons.

LO7: Evaluate outcomes of care rendered to the older person.

LO8: Institute appropriate corrective actions to prevent or minimize possible harm.

Disability: The impact that health problems have on an individual’s ability to perform
tasks, roles, and activities and it is often measured by asking questions about the
performance of activities of daily living (ADLs)

Frailty: a clinically recognizable state of increased vulnerability resulting from

aging-associated decline in reserve and function across multiple physiologic systems
such that the ability to cope with everyday or acute stressors is comprised1

Health Promotion: Activities aimed at improving or enhancing health

Health Screening: Population-wide efforts to detect early disease

1
"The Frailty Syndrome: Definition and Natural History - NCBI."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3028599/. Accessed 18 Aug. 2020.
 LEARNING GAP ASSESSMENT ( 15 minutes)

Before you begin this module, let us see what

you have learned in your Health Assessment
course about physical assessment. It will not
be graded but it will serve as a diagnostic
means the competency that must be
strengthened or supplied to you. The results
would be revealed to you immediately after the
assessment for you to know the learning gap
that needs to be filled-in. Click this link to
proceed to the assessment activity.

https://docs.google.com/forms/d/e/1FAIpQLSfl8p6iu2hehxP3Sb3I8bwAC4kX-GTglZ-Vb
YKo3j-NvKVeqA/viewform

Have you seen the results and your score? Congratulations if you answered all
questions correctly. If not, use it as a drive to learn more.

Get moving to progress in this learning journey.

Let’s get started with this learning prepared for your module. Be sure that you will view
these video links so that you will be able to answer the Learning Activity Sheet Number
3 for this course. Enjoy watching and learning!
FUNCTIONAL HEALTH PATTERN BY GORDON’S (3 minutes)
https://www.youtube.com/watch?v=6hV_C3M3T1s

FULMER SPICES: COMPREHENSIVE ASSESSMENT TOOL FOR OLDER ADULTS (21 minutes)
https://www.youtube.com/watch?v=vPawWPXp5eg

SPIRITUAL ASSESSMENT IN HEALTH CARE (9 minutes)

https://www.youtube.com/watch?v=SCO4a7cj5B8&t=322s

HI! START WORKING

ON YOUR LEARNING ACTIVITY SHEETS

ASSESSMENT OF THE OLDER ADULT’S WELLNESS

Comprehensive Assessment On Older Persons

Assessment is the most foundational and fundamental of the nursing process. It begins
upon the very first encounter of the nurse and the patient. It is simultaneous as the
nurse establishes rapport with the patient. It is described as the cornerstone of
gerontological nursing and its goal is to perform a systematic and integrated
assessment (Mauk 2018). It is a competency that must be developed in a student
nurse like you as you enhance what you have learned in your course in Health
Assessment. Since the health and health care needs of the older adults are complex
which come from age-related changes and possibly from age-associated illnesses and
other diseases adding hereditary factors as well as lifestyle.
Assessment to be holistic is classified into functional assessment, physical, cognitive,
psychological, social and spiritual. The nurse faces challenges in completing this
comprehensive assessment. Hence, the nurse should consider the following factors
that may affect assessment:

● Personal attitude towards older adults and

assessment
● The patient’s attitude
● Language
● Deficits
● Consent
● Time and energy level
● Environment

FUNCTIONAL ASSESSMENT

Functional Assessment is conducted to determine the older adult’s ability to perform

self-care, self-maintenance, and physical activities then out of these assessments a
plan of care is formulated to help the patient manage the disabilities identified. A
disability is any condition of the body or mind (impairment) that makes it more
difficult for the person with the condition to do certain activities (activity limitation)
and interact with the world around them (participation restrictions).2 There are
different tools that may assess functional ability which aim to address self-care
like basic activities of ADLs, higher level activities that are necessary for older
adults to live independently in the community (instrumental activities of daily
living).

Activities of Daily Living

Basic ADLs

The basic ADL include the following categories:

2
"Disability and Health Overview | CDC." https://www.cdc.gov/ncbddd/disabilityandhealth/disability.html.
Accessed 6 Aug. 2020.
● Ambulating: The extent of an individual’s ability to move from one position to
another and walk independently.
● Feeding: The ability of a person to feed oneself.
● Dressing: The ability to select appropriate clothes and to put the clothes on.
● Personal hygiene: The ability to bathe and groom oneself and to maintain dental
hygiene, nail and hair care.
● Continence: The ability to control bladder and bowel function
● Toileting: The ability to get to and from the toilet, using it appropriately, and
cleaning oneself.

Instrumental ADLs

The instrumental ADLs are those that require more complex thinking skills, including
organizational skills.

● Transportation and shopping: Ability to procure groceries, attend events, manage

transportation, either via driving or by organizing other means of transport.
● Managing finances: This includes the ability to pay bills and manage financial
assets.
● Shopping and meal preparation: ie everything required to get a meal on the table.
It also covers shopping for clothing and other items required for daily life.
● House cleaning and home maintenance: Cleaning kitchens after eating,
maintaining living areas reasonably clean and tidy, and keeping up with home
maintenance.
● Managing communication with others: The ability to manage telephone and mail.
● Managing medications: Ability to obtain medications and taking them as
directed.3

Examples of Functional Tools

❏ KATZ index of ADLs (Katz et al 1963)

- a widely used clinical and research instrument used to assess the ability to perform
self-care. It measures the 6 different functions of bathing, dressing, toileting, transfer
ability, continence and feeding ability.

❏ Barthel Index

3
"Activities of Daily Living (ADLs) - StatPearls - NCBI Bookshelf." 26 Jun. 2020,
https://www.ncbi.nlm.nih.gov/books/NBK470404/. Accessed 6 Aug. 2020.
- similar to the Katz index and evaluates self-care abilities. It also includes items r/t
mobility functions. It was originally developed for assessment of persons with
neuromuscular or musculoskeletal disorders in an inpatient rehabilitation setting.

❏ Lawton Instrumental activities

- constitutes a range of activities more complex than those needed for personal
self-care and aims to assess a person’s ability to function in his or her environment.
Eight areas are being evaluated:
o the individual’s ability to cook
o shop
o use the telephone
o manage medications
o manage finances
o transportation needs
o laundry
o housework

PHYSICAL ASSESSMENT

Conducting physical assessment applies the technical skills in assessing a person

which is done per system and from the cephalocaudal method but paying particular
attention to the knowledge of the normal changes in aging. Hence , it concretely
explains the significance of building your knowledge on these aspects of aging.

Doing this through physical assessment would also involve the other members of the
healthcare team, especially physicians who are specialists that can help the nurse as
the initial case finder to determine the client’s needs and address it properly.

Now it’s time to practice what you have learned in your Health Assessment course and
your previous module on the normal changes in aging.

CIRCULATORY FUNCTION

FACTORS TO CONSIDER:

❏ Age related changes in the heart muscle and

blood vessels
❏ Lifestyle
❏ Limited exercise or physical activities
❏ Heredity

SUBJECTIVE DATA:

❏ Family history
❏ Current problems with chest pain or discomfort especially if associated with
exertion
❏ Current diagnoses or medications (prescribed, OTC or herbal)
❏ Sources of stress
❏ Adherence to current medical regimens

OBJECTIVE DATA

❏ Physical examination
❏ Blood pressure
❏ Listening to chest sounds
❏ Pulse rate

OTHER PROTOCOLS:

❏ Stress test
❏ Blood and serum tests
❏ Electrocardiogram
❏ echocardiogram

RESPIRATORY FUNCTION

FACTORS TO CONSIDER:

❏ Age related changes to bones, muscles,

lung tissue, and respiratory fluids
❏ Disease or injury
❏ Previous exposure to occupational or
environmental pollutants
❏ Restricted mobility or extended bed rest
SUBJECTIVE DATA:

❏ Current medications (prescribed , OTC or herbal)

❏ Hx of smoking behavior or exposure to environmental pollutants
❏ Current difficulties or anxieties associated with breathing
❏ Decreased energy to complete everyday tasks
❏ Frequent coughing
❏ Production of excessive sputum

OBJECTIVE DATA

❏ Posture
❏ Breathlessness
❏ Chest sounds
❏ Respiratory rate, depth, rhythm and volume

OTHER PROTOCOLS

❏ Blood and pulmonary function tests

❏ Chest x-rays
❏ Sputum analysis

GASTROINTESTINAL FUNCTION

FACTORS TO CONSIDER:

❏ Age related changes on the

gastrointestinal function
❏ Lifestyle
SUBJECTIVE DATA

❏ Usual diet and eating habits ( 24 hour recall and 3 day diary)
❏ Appetite and changes in appetite
❏ Occurrence of nausea, vomiting, indigestion, or other stomach discomforts
❏ Chewing or swallowing problem
❏ Visual impairment
❏ Sense of taste
❏ Problems with bowel function including diarrhea or constipation
❏ Prescribed medications being taken

OBJECTIVE DATA

❏ Fluid intake ❏ Body weight (gain or loss)

❏ Dietary intake ❏ BMI
❏ Fecal consistency ❏ Skin turgor
❏ Frequency of elimination ❏ Oral mucosa
❏ Characteristic of stools

The BMI of older adult is not absolute due to decrease muscle mass

OTHER PROTOCOLS

❏ Diagnostic testings like barium enema

❏ x-rays
❏ Stool analysis
❏ Examination of the colon

GENITOURINARY FUNCTION
FACTORS TO CONSIDER

❏ Age related changes

❏ Age related diseases such as hypertension and diabetes
❏ Lifestyle
❏ Prescribed medications

SUBJECTIVE DATA

❏ Difficulty in sensing that the bladder has emptied

❏ Urinary problem symptoms
❏ Presence of incontinence
❏ Intake of alcohol or caffeine
❏ For female, any presence of vaginal bleeding or any vagina discharge
❏ For male any presence of discharges or difficulty in urinating

OBJECTIVE DATA

❏ Inspection of genitalia and surrounding areas

❏ Palpation of bladder
❏ Characteristic and amount of urine output and frequency
❏ Fluid intake
❏ Skin turgor

OTHER PROTOCOLS

❏ Urine analysis
❏ Ultrasound
❏ X-ray

SEXUAL FUNCTION

FACTORS TO CONSIDER:

❏ Age related changes

❏ Lack of partner
❏ Chronic illnesses
❏ Medications
❏ Lack of privacy especially those living in
residential long-term care facilities

SUBJECTIVE DATA

❏ Sexual function changes or concerns

❏ For males, decrease in speed and duration of erection
❏ For females, decrease vaginal lubrication

Instead of asking if they are sexually inactive, instead ask about sexual
activity and if there are any changes or concerns in relation to sexuality and
sexual activity

OBJECTIVE DATA

❏ Blood pressure
❏ Peripheral pulses
❏ Sensation
❏ Status of the genitalia and prostate
❏ Size and texture of the testes
❏ Presence of the epididymis and vas deferens
❏ Any penile abnormalities, such as hypospadias and Peyronie plaques
OTHER PROTOCOLS

❏ Hormonal blood test (endocrine test)

❏ Urinalysis
❏ Paps smear
❏ ultrasound

NEUROLOGICAL FUNCTION

FACTORS TO CONSIDER:

❏ Age related changes

❏ Medical diagnosis r/t
neurological
system
❏ Medications

SUBJECTIVE DATA

❏ History or family history of stroke

❏ Any changes in memory or
spatial orientation

❏ Sleep problems
OBJECTIVE DATA

❏ Speech impairment
❏ Impairment in expression
❏ Swallowing impairment
❏ Memory assessment
❏ Orientation assessment
❏ Energy level
❏ Balance
❏ Sensation
❏ Motor functions

OTHER PROTOCOLS

❏ Blood chemistry EEG

❏ Cranial scans

MUSCULOSKELETAL FUNCTION

FACTORS TO CONSIDER:

❏ Age related changes

❏ Chronic diseases
❏ Medications
❏ Lifestyle

SUBJECTIVE DATA

❏ History of fall
❏ History of sore joints
❏ Interference of daily activities due to
pain
❏ Pain management
❏ Muscle weakness
❏ History of bone or muscle injury
❏ Complementary therapies

OBJECTIVE DATA

❏ Posture
❏ Balance
❏ Gait
❏ Use of assistive devices
❏ Body weight
❏ Facial expressions while moving or doing activities
❏ Footwear worn

OTHER PROTOCOLS

❏ Blood chemistry
❏ Up and Go Test

You may watch this video to have a better view of this test
ttps://www.youtube.com/watch?v=j77QUMPTnE0

NEED TO KNOW

The timed Up and Go test is a reliable measure of overall physical function and
mobility for older adults

SENSORY FUNCTION

FACTORS TO CONSIDER

❏ Age related changes

❏ Disease conditions

SUBJECTIVE DATA

❏ Visual changes
❏ Hearing problems
❏ Ringing on ears
❏ Feeling of numbness
❏ Taste satisfaction or smell

OBJECTIVE DATA
❏ Difficulty in reading
❏ Eye irritation or redness
❏ Difficulty in hearing
❏ Ear infection
❏ Ear discharge
❏ Change in appetite
❏ Presence of burns or skin injuries
❏ Poor oral hygiene

NEED TO KNOW

Two screening procedures for testing functional vision:

1. Ask the older adult to read a newspaper headline and story and observe for
difficulty and accuracy
2. Ask the older adult to read the prescription bottle and again observe for
difficulty and accuracy

OTHER PROTOCOLS

❏ Pain and light touch sensation test

❏ Visual acuity test through Snellen’s chart
❏ Weber and Rinne test
❏ Pure tone audiometry
❏ Tympanometry

INTEGUMENTARY FUNCTION

FACTORS TO CONSIDER

❏ Age related changes

❏ Mobility
❏ Nutritional intake/ Fluid intake
❏ Circulation status

SUBJECTIVE DATA
❏ Any skin problem or concerns
❏ Loss of sensation
❏ Itchiness
❏ Frequent bruising

OBJECTIVE DATA

❏ Skin breakdown ❏ Open sores

❏ Skin dryness ❏ Skin color
❏ Dryness ❏ Signs of infection
❏ Split/ torn fingernails or toenails

OTHER PROTOCOLS

❏ Complete blood count

❏ Allergy test
❏ Skin biopsy

ENDOCRINE AND METABOLIC

FUNCTION

FACTORS TO CONSIDER

❏ Age related changes

❏ Existing conditions
❏ Heredity
❏ Poor nutrition
❏ Obesity
❏ Inadequate physical activity
❏ Existing illnesses

SUBJECTIVE DATA

❏ Family history of diabetes

❏ Increased thirst and fluid intake
❏ Changes in weight and appetite
❏ Unusual sensitivity to cold

OBJECTIVE DATA
❏ Fatigue
❏ Vision problems
❏ Slow wound healing
❏ Headache
❏ Gastrointestinal problems
❏ Skin changes (dry or flaky)
❏ Fluid retention (edema and weight gain
❏ Forgetfulness
❏ Constipation
❏ Any presence of polyphagia, polydipsia, and polyuria

OTHER PROTOCOLS

❏ Fasting blood sugar

❏ Thyroid function test (T3, T4, TSH)

NEED TO KNOW

Hyperthyroidism is much more likely in the older years, but among older adults, the
typical symptoms of restlessness and hyperactivity may be lacking

HEMATOLOGIC AND IMMUNE FUNCTION

FACTORS TO CONSIDER

❏ Age related changes

❏ Food choices and food habits
❏ Lifestyle

SUBJECTIVE DATA

❏ History of blood loss

❏ Recent or current infection
❏ Sexual activity
❏ Vaccines taken

OBJECTIVE DATA
❏ Vital signs
❏ Color and quality of skin and nail beds
❏ Easy fatigability
❏ Blood in stools
❏ Signs of infection
❏ Weight loss
❏ Hydration status

OTHER PROTOCOLS

❏ Complete blood count

❏ Red blood cell count

COGNITIVE ASSESSMENT

Changes in cognition vary among older adults and it is claimed to be difficult to

separate from other comorbidities (physical or psychological conditions), other
age-related changes such as vision and hearing . In general, the older adults may
manifest a gradual and modest decline in short-term memory and may experience a
reduction in the speed with which new information is processed. When you talk about
cognition it is related frequently to the qualities of attention, memory, language,
visuospatial skills and executive capacity.

The most extensively used tool to assess cognition is the Mini Mental State
Examination (MMSE) which was created by Folstein, Folstein and McHigh in 1975. It
was made to differentiate organic from functional disorders and to measure change in
cognitive impairment but not intentionally developed as a diagnostic tool.

Nurses who would conduct this assessment would face challenges that are
combined with different factors that possibly would be interacting and examples of
these are physical and psychological comorbidities, age related changes, the side
effects of medications and changes in the environment. Adding up to these challenges
is the fear of the older adult and even his family especially on the thought of having
Alzheimer's disease. This nursing management must be individualistic and involve the
family for preferences or the older adults’ preferences previously expressed.
SUBJECTIVE DATA

Cognition. “ Have there been any noticeable changes in your memory or thinking?”
❏ Memory
❏ Communication
❏ Orientation
❏ Functional considerations

Perception.

❏ Sensory systems. “ Have you noticed any recent changes in your vision or
hearing? “
❏ Pain assessment. “ Do you have any pain?”

OBJECTIVE DATA

❏ Cognitive assessment. Ex Mini-Mental State Examination (MMSE)

❏ Sensory examination
❏ Pain assessment

RECOMMENDED READINGS

Assessing Cognitive Impairments Among Older Adults

https://www.nia.nih.gov/health/assessing-
cognitive-impairment-older-patients

Cognitive Assessment In The Elderly: A Review Of Clinical

Methods
https://academic.oup.com/qjmed/article/
100/8/469/1520553

PSYCHOLOGICAL ASSESSMENT

It is the assessment which determines the mental health of the older adults. Two
areas that you will learn as you perform this assessment.

Quality of Life

When you define what quality of life is, it is subjective in nature. It encompasses
all areas of everyday life: environmental and material components as well as physical,
mental, and social well-being as defined by Fletcher, Dickinson and Philip in 1992.
Among the older adults this is highly individualistic, subjective and multidimensional in
its scope. Successful aging is often associated with quality of life. The World Health
Organization defines it as an individual's perception of their position in life in the context
of the culture and value systems in which they live and in relation to their goals,
expectations, standards and concerns. It is a broad ranging concept affected in a
complex way by the person's physical health, psychological state, personal beliefs,
social relationships and their relationship to salient features of their environment. 4

There are two tools that may assess QOL and these are the WHOQOL-100 and
the WHOQOL-BREF

Depression

The most common mental health problem among older adults is clinical
depression. Most often it is undetected because the problem is often attributed to age
related changes, chronic physical illness and side effects of medications. Clinical
depression in the elderly is common according to some reports, but it doesn't mean that
it's normal. Globally, an estimated 350 million people suffer from depression and it
occurs in 7% of the general older population. Late-life depression affects about 6 million
Americans ages 65 and older.5

To meet the DSM-V criteria as to diagnosis of depression , an older adult must

experience five or more of the following symptoms during a 2-week period:

❏ Sadness
❏ Lack of enjoyment of previously enjoyed activities
❏ Significant weight loss
❏ Sleep disturbance
❏ Restlessness
❏ Fatigue
❏ Feelings of worthlessness
❏ Impaired ability to think clearly or concentrate
❏ Suicide ideation or attempt

To assess the older adult, the Geriatric Depression Scale may be used because
It is a widely used tool for assessing the condition.

4
"WHOQOL: Measuring Quality of Life - WHO."
https://www.who.int/healthinfo/survey/whoqol-qualityoflife/en/. Accessed 18 Aug. 2020.
5
https://www.thefilipinodoctor.com/health-care/health-articles/692/
SOCIAL ASSESSMENT

The most common feeling of older adults as they age is that their social networks
become smaller. Social functioning affects the health and disease outcomes and their
health status affects their ability to socialize and interact with others. According to Mauk
(2018), older adults who lack socialization have a higher morbidity and mortality.

SUBJECTIVE DATA

❏ Presence of social network

❏ Interaction between fellow older adults, family, friends, neighbors and community.

These general questions may identify areas of limitations in social contact and social
support

“ Is there any one special person you could call or contact if you needed help?”

“ In general, other than your children, how many relatives do you feel close to and have
contact with at least once a month?”

“ In general, how many friends do you feel close to and have contact with at least once
a month?”

OBJECTIVE DATA

❏ Social patterns and relationships

❏ Role assessment
❏ Signs of mistreatment

SPIRITUAL ASSESSMENT

PURPOSE: to determine the client’s life values and goals, philosophical beliefs, religious
beliefs,, and spiritual beliefs that influence his or her choices and decisions. Conflicts between
these values, goals, beliefs, and expectations that are related to health are assessed.

SUBJECTIVE DATA
❏ Introduction
❏ Values/beliefs
❏ Barriers
❏ Internal conflict
❏ Open-ended question

OBJECTIVE ASSESSMENT
❏ Documentation
❏ Spiritual distress

NEED TO KNOW

A spiritual assessment is equally important as assessing other body systems

OTHER PROTOCOLS

❏ FICA

❏ HOPE
 You have already completed your

learning tasks on the first part of this

module: THE COMPREHENSIVE

ASSESSMENT WITH THE OLDER

ADULTS. Be sure that you have

accomplished your Learning Activity

Sheet 3 at this link:

https://forms.gle/Fm87rGe4H3xpvMw29

PLANNING FOR HEALTH PROMOTION AND MAINTENANCE

In order to expound on the concept of health promotion, you must always have in
mind what health means. Recalling what you have learned with your previous courses,
how does the World Health Organization define health? Yes, it is the state of complete
physical, mental, and social well-being and not merely the absence of a disease or
infirmity. Is this observable among those who are already in their senior years? What
constitutes health in later life? Aging according to a study is positively influenced by
feeling joyous, staying independent, self-possessed contentment, and being financially
secured, in addition to being socially engaged and enjoying good physical and mental
health. It has also been mentioned that enhancing a physically active lifestyle, social
participation, and leisure activities as well as healthy eating habits and having a purpose
in life and intellectually engagement are all
important factors to promote aging well. 6
How do we promote health and maintain it
among the older adults?

6
"Perspectives of Older Adults on Aging Well: A Focus Group ...." 4 Nov. 2018,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6247475/. Accessed 24 Aug. 2020.
Health promotion are activities that aim to improve or enhance health. These activities
are composed of tasks in which an individual is able to proactively engage in to advance
or improve his or her health.

HEALTH PROMOTION

➢ any activity designed to improve health and well-being, and has been described
as “the central global strategy for improving health”

➢ also sometimes seen as a broad approach to improving health, including social,

political, and economic activities

➢ its goal is to help older people strive for their own highest levels of wellness
possible if they already have chronic illnesses
Barriers to Health Promotion for Older Adults

1. The misconception that older adults

cannot or will not change, as in the saying,

“You can’t teach an old dog new tricks.”

2. Lack of knowledge about the special

needs of the older adult.

HEALTH PROMOTION AND DISEASE PREVENTION

1. Primary Preventive Measures

a. Immunization programs

● Influenza
● Tetanus
● Pneumococcal

b. Smoking cessation
c. Alcohol limitation
d. Nutrition
e. Exercise
f. Safety
g. Stress management
h. Appropriate use of medications

2. Secondary Prevention

Screening program s (rectal examination, stool for occult blood, prostate examination,
cervical smear, breast examination, mammogram, oral cavity examination, vision
examination, blood pressure monitoring, thyroid function test, blood/urine sugar,
cholesterol screening)

3. Tertiary Preventive Measures

a. Facilitate proper positioning

b. Assist with range of motion exercises
c. Teach about mobility aids
d. Maintain and promote mental function

SUCCESSFUL AGING

❏ Decrease risk of disease and disease related disability

❏ Increase mental and physical function
❏ Active engagement in life

Theory of Successful Aging

In the theory developed by Flood in 2006 as mentioned by Mauk (2018) he claims

that aging well is defined by the extent to which older adults adapt to the cumulative
physical and functional changes the older adults experience. The theory explains that
an older adult’s perception about how well he is aging is primarily associated with
believing that one’s life has meaning and purpose; thus, spirituality is a central
ingredient. Furthermore, he proposed the following:

❏ Aging is a progressive process of adaptation

❏ Aging may either be successful or not successful, depending upon the person’s
ability to cope
❏ Successful aging is influenced by other people’s choices and
❏ Aging people experience changes, which uniquely characterize their beliefs and
perspectives in ways that differ from those of younger people

INDEPENDENCE
 The inability of the older adult to care for themselves is an issue with them
because they do not want to depend on someone else to cause a burden. Independence
is the ability of the older person to perform basic personal care tasks. To lose this
independence is somehow devastating to them because they have spent their lives
making decisions, working on a job and raising a family7 There are benefits that may be
obtained by the older adults as they enjoy independence:

★ can help in their physical and mental health

★ boost their confidence and self-esteem
★ improve their sense of purpose and quality in life8

Independence is an expression of the autonomy of an older adult. It is a challenge on

the side of the nurse and other healthcare providers to promote it among them because
mobility and health issues pose a hindrance. 9

Ways to help the older adults become independent:

1. Allow decision making

Here are some key factors to consider when it comes to decision-making:

● Don’t assume that a person is unable to make a decision for themselves
● Encourage them to make healthy life choices by presenting them with relevant
information and asking their opinion on major decisions, especially those that concern
them
● Choice and control can help older people maintain their existing skills
2. Empowerment
3.
To facilitate the decision-making process, you will need to take steps to empower the
older adults:
● Dedicate enough time for them to make a decision, and for the choice to be
facilitated
● Give them an active role in arranging engaging activities
● Know how to facilitate a decision in a safe and appropriate manner

7
"4 Reasons Independence Is Important for Seniors | VANTAGE ...." 26 Jul. 2018,
https://vantageaging.org/blog/independence-is-important-for-seniors/. Accessed 24 Aug. 2020.
8
"How to Promote Independence in the Elderly - Acts Retirement."
https://www.actsretirement.org/get-started/retirement-resources/tips-for-adult-children/promoting-indep
endence-in-the-elderly/. Accessed 24 Aug. 2020.
9
"What does 'independence' mean to older people?."
https://www.thegoodcaregroup.com/news/what-does-independence-mean-older-people/. Accessed 25
Aug. 2020.
● Reassure them that the choice is theirs to make

3. In practice

When a person’s ability changes, it’s easy to overlook some of the choices that feed into
their sense of independence. These are some of the ways you can make sure you’re
promoting independence in practice:

● Encourage them to do as much as they are able. If they can no longer perform a
whole task, let them to do what they can before assisting with what’s left
● Involve them in everyday decisions, like choosing their own meals or social
activities
● Give them as much agency as possible in larger decisions, such as care options
or adaptations to the home
● Familiarise yourself with their life story, so that you can help them draw on their
past experiences to inform current choices

QUALITY OF LIFE

Quality of life (QOL) is a broad multidimensional concept that usually includes

subjective evaluations of both positive and negative aspects of life.
(http://www.cdc.gov/hrqol/concept.htm)

➢ It is a broad ranging concept affected in a complex way by the person‘s:

➢ physical health, psychological state
➢ level of independence
➢ social relationships
➢ personal beliefs
➢ relationship to salient features of their environment

Watch this to better understand the care for the older adults

AN INTEGRATED CARE FOR OLDER PEOPLE (7 minutes)

https://www.youtube.com/watch?v=UIvnJJWyUuQ
 IMPLEMENTING CARE AS TO PHYSICAL AND PSYCHOSOCIAL NEEDS

IMPLEMENTING CARE AS TO PHYSICAL NEED

Aging and Skin Care

As a person grows older, the skin becomes thinner, it loses fats, it does not
appear plump and smooth as it was in the younger years. It is attributed to loss of
collagen. Veins and bones become so obvious and skin breakdown takes longer to heal.
The past years of being exposed in the skin is a factor as well in dryness, wrinkles, age
spots and even skin cancer.10 Although these matters are part of the internal and
external environment, care can be provided in order to address these aging changes.

❏ Limit time in the sun

❏ Use sunscreen with SPF (sun protection factor)
❏ Wear protective clothing
❏ Drink right amount of water if not contraindicated
❏ Eat nutritious foods
❏ Avoid stress

Maintaining Fluid Balance and Nutrition Needs

Nutrition and Aging

❏ Caloric Intake
❖ Studies have shown that caloric needs in healthy individuals decrease at a rate of
approximately 5% for each decade between ages 55 and 75 years and 7% for each
decade after age 75.
❖ As the proportion of muscles and fats changes, the basal metabolic rate (the rate
at which the body uses calories) decreases
❖ The normal decrease in physical activity commonly seen with aging further slows
the rate at which the body burns calories.

Nutrients

1. Carbohydrates

10
"Skin Care and Aging | National Institute on Aging." 20 Aug. 2020,
https://www.nia.nih.gov/health/skin-care-and-aging. Accessed 25 Aug. 2020.
➢ The American Heart Association recommends that 55%-60% of calories should
come from carbohydrates with emphasis on complex which appears to be appropriate
for the aging population

➢ Complex CHO usually contains significant amounts of soluble fiber, a substance

humans cannot digest, which forms bulk and aids bowel elimination.

➢ The soluble fiber in complex CHO has been shown to reduce blood cholesterol

2. Proteins

➢ The need for protein remains constant or may increase slightly with aging to
compensate for the loss of lean body tissue
➢ RDA for women 50 years older is 50g /day
➢ RDA for men 50 years older is 65g/ day
➢ Red meats, poultry, fish, eggs, and dairy products are good sources of complete
proteins, which contain all the amino acids needed for making and repairing tissues.
➢ High-fat CHONs should be restricted such as steak, ham, organ meats, egg yolks,
hard cheese, and whole milk for they may contribute to plaque formation and
atherosclerotic changes in the blood vessels.

3. Fats

➢ Should be limited to approximately 25% to 30% of the total daily caloric intake

4. Vitamins

______ correlated with an increased risk of fractures

______ plays a role in maintaining immune function; delays the onset of Alzheimer’s
______ contributes to excessive bone demineralization or osteoporosis
______ contributes to weakness, dry mouth, skin changes & delayed tissue healing
______ can result in neurologic changes that affect sensation, balance, and memory
______ correlated with neurologic and immunologic problems
______ contribute to poor wound healing, dry skin and night blindness

5. Minerals

❏ Calcium

★ necessary for nerve impulse transmission and conduction, muscle contraction

(including cardiac function), and blood clotting
★ extremely high levels of calcium can result in shock, kidney failure, and even
death

❏ Phosphorous

★ Needed for normal neuromuscular functioning, metabolism of CHO, regulation of

acid-base balance, and other physiologic processes
★ Inadequate intake may result to weight loss or anemia

❏ Iron

★ Deficiency results in anemia; however the normal changes of aging or other

disease processes may resemble the symptoms of anemia; hence recognition is
prevented.

❏ Sodium

★ Should be restricted for older people who have hypertension, renal failure, or
cardiac condition

❏ Potassium

★ Not as abundant in the diets of older people

★ Hypokalemia is often a common problem in older people
★ Many diuretic and antihypertensive medications deplete the body of potassium.

❏ Zinc
★ Liver cirrhosis, kidney disease, malignant cancers and alcoholism may lead to
zinc deficiency

6. Water

❏ Older individuals typically have less body fluid than do younger adults
❏ The total amount of body fluids decreases by approximately 8% to 10% in older
adults
❏ The amount of water in the bloodstream remains relatively constant with aging,
but older adults tend to have less fluid in the intracellular and interstitial spaces than do
younger people which result to loss in skin turgor and wrinkling
❏ 2000 to 3000 ml of fluid per day is required
Factors Affecting Nutrition in the Elderly

❏ Chronic health factors

➢ Alcoholism
➢ Sensory changes
➢ Pain
➢ Medications
➢ Problems with chewing, swallowing or digesting
➢ Malabsorption

Elimination

The most common problems encountered by the older adults in elimination are
constipation, diarrhea and incontinence both bladder and bowel. Incontinence
contributes to their problem with self-esteem.

There must be constant monitoring so that you can be of help to the older adult.
Factors must be correctly identified so that correct management would be planned and
implemented.

❏ Diet ❏ Life style

❏ Fluid intake ❏ Medications
❏ Activity

Activity and Exercise

The activity-exercise health pattern deals with behaviors related to exercise, activity,
leisure, and recreation.

Activity – is anything that requires the expenditure of energy (some require expenditure
while some require a great expenditure)

Physical activity requires a complex interaction of physiologic processes, primarily

those of the neurologic, musculoskeletal, cardiovascular, and respiratory systems.
Anything that interferes with the coordination of these systems can alter the ability to
participate in physical activity.

Activity and Aging

❏ Most people in advancing age experience some changes in the ability to perform
or tolerate activity, and this ability varies widely among older adults.
❏ The first change noticed by most aging persons is a decrease in the rate or speed
of activity.
❏ Normal aging does not interfere with the transmission of nerve impulses, but it
does slow the speed of nerve transmission.
❏ A loss of muscle mass can interfere with activities that require muscular strength
( moving furniture, lifting bags of groceries, shoveling snow etc)
❏ Agility, the ability to move quickly and smoothly, decreases with age.
❏ Dexterity, the ability to perform fine manipulative skills, is also likely to decrease.
❏ Decreased stamina is typically seen in aging which is most often a result of
decreased oxygen supply to body tissues.

Exercise Recommendations for Older Adults

1. Aerobic or endurance exercise

★ promote cardiovascular and respiratory function

★ includes activities that can be done at home such as walking, biking, or square
dancing, using treadmill, rowing machines, steps, swimming

2. Resistance and conditioning exercise

★ help maintain muscle mass

★ can be done using exercise balls, inexpensive elastic stretch bands, or weights,
stretching
★ caution should be used when doing standing exercises if the older person has
balance problems

Benefits of Exercise for Older Adults

○ maintain independence ○ Improve cardiovascular status

○ retain mobility ○ maintain or improve musculoskeletal
○ prevent or reduce depression function
○ encourage sleep ○ prevent obesity
○ improve self-esteem ○ decrease stress level
○ improve appetite ○ expand social network
○ enhance appreciation for life

Nursing Problems Concerning Activity

❏ Impaired Physical Mobility

Risk Factors:

● Intolerance of physical activity because of medical conditions that decrease

endurance or strength
● Pain
● Neuromuscular or musculoskeletal conditions
● Cognitive impairment (Alzheimer’s or dementia)
● Severe anxiety or depression
● Prescribed bed rest
● Restrictive devices (restraints, casts, splints, and immobilizers)

Nursing Goals:

1. Increase participation in physical activities that maintain strength and

mobility
2. Maintain normal anatomic position and function in all joints
3. Remain free from joint contractures and foot drop
4. Maintain or increase strength and mobility using assistive devices

Nursing Interventions:

1. Identify the prescribed activity level

2. Continue to assess stress and joint mobility
3. Perform physical mobility activities in conjunction with daily care.
4. Provide good body alignment and frequent position changes
5. Avoid unnecessary restraint that limits physical mobility

6. Consult with the physical therapist to determine a suitable activity/ exercise

plan that maintains muscle strength and joint mobility.

7. Verify that the individual is suitably dressed for activity and that he or she
has the proper footwear

8. Provide pain medication in a timely manner so that maximal benefits from the
medication occur when greatest physical effort is expected

9. Verify that the individual knows the correct method for using assistive devices
and that he or she does, in fact, use them for activity. Explain proper use if needed.

10. Encourage wheelchair-bound patients to move by using their arms or feet whenever
possible

11. Provide adequate assistance during ambulation

❏ Activity Intolerance

Risk Factors:
● Sedentary lifestyle
● Decreased sense of self-worth, self-esteem, or independence
● Generalized weakness, immobility, restriction to bed rest
● Problems related to oxygenation
● Cognitive impairment (Alzheimer’s disease or dementia)
● Malnourishment

Nursing Goals:

1. Demonstrate an increased ability to tolerate activity

2. Identify factors that contribute to activity intolerance

Nursing Interventions:

1. Identify factors that contribute to activity intolerance

2. Identify the activities that older adults view as essential or desirable
3. Plan activities so that older adults progress from easier activities to those that
are more demanding
4. Encourage older adults to pace activities throughout the day, alternating periods
of activity with periods of rest
5. Monitor vital signs to assess the physiologic response to activity
6. Teach methods of conserving energy
7. Teach older adults and their families methods of reducing stress

Safety Needs

Internal Risk Factors

● Changes in visual acuity

More difficult to read labels with small print which make it difficult for older adults to
read the directions on prescriptions

Implication:
______________________________________________________________________________________
________________________________________________________________

● Changes in auditory acuity

Reduces an older person’s ability to detect and respond appropriately to warning calls,
whistles, or alarms
Implication:
______________________________________________________________________________________
________________________________________________________________

● Changes in the sense of smell and taste

Implication:
______________________________________________________________________________________
________________________________________________________________

Common physiologic changes that affect safety include the following:

❏ Altered balance
❏ Decreased mobility
❏ Decreased flexibility
❏ Decreased muscle strength
❏ Slowed reaction time
❏ Gait changes
❏ Difficulty lifting the feet
❏ Altered sense of balance
❏ Postural changes

** conditions affecting the cardiovascular, nervous, and musculoskeletal systems are

most likely to contribute to safety problems

NEED TO KNOW

Cognitive changes or emotional disturbance and depression may be overlooked as

risk factors for falls or injury. These disturbances reduce the older person’s ability to
recognize and process information. Distracted or preoccupied older adults are less
likely to pay full attention to what is happening or what they are doing. This lack of
attention and caution increases the risk for accidents and injury.

External Risk Factors

● Environmental hazards include everything that surrounds older adults.

❏ Fire hazards
❏ Home security
❏ Vehicular accidents
❏ Thermal hazards
● Falls are the most common safety problems in older adults.

Reducing the risk for falls:

❏ Prepare safe surroundings

❏ Allow adequate time to complete an activity or task
❏ Wear proper-fitting footwear
❏ Use assistive devices if needed
❏ Ask for help when necessary

Sleep and Rest

Normal Sleep and Rest

_________________ or ____________________rhythm is a sleep pattern that repeats

approximately every 24 hours. It is a cycle that occurs in response to the day-night cycle
of the sun.

Sleep is under the control of the ______________________system.

Sleep and Aging

As a person ages, the levels of hormones associated with sleep change. Decrease in
________________(which regulates the sleep-wake cycle) and ___________ hormone (which
promotes sleep) lead to a shifting in circadian rhythm, causing many elderly people to
feel sleepy earlier in the evening and to awake earlier in the morning.

Risk Factors Related to Sleep or Rest Problems in Older Adults

● Pain
● Chronic respiratory or cardiovascular problems
● Frequent elimination
● Nocturnal movement disorders
● Anxiety, depressions, or delirium
● Drugs likely to interfere with sleep
● Excessive environmental stimuli
● Excessive caffeine, alcohol, or tobacco use
● Sedentary lifestyle

Characteristics of Selected Medications Used to Promote Sleep

 CLASSIFICATION EXAMPLES PRECAUTIONS

Sedative/ hypnotics

GABA Receptor Agents Zolpidem Tartrate May cause morning drowsiness,

headache, hangover, dizziness or
paradoxical excitement

Benzodiazepines Flurazepam, Likely to cause daytime sedation

Temazepam, and short-memory impairment in
Lorazepam older adults, particularly with
long-acting forms; associated with
increased risk for falls;
paradoxical excitement may
occur; must be avoided in
individuals with sleep apnea;
legislation restricts use in nursing
home settings

Tricyclic Diphenhydramine May result in agitation, confusion,

orthostatic hypotension, urinary
retention, and arrhythmias; can
make the quality of sleep less
restful; not preferred for older
adults

Antidepressants Amitriptyline, Potential side effects include

desipramine, urinary retention, constipation,
nortriptyline orthostatic hypotension, and
confusion; risk for cardiac
arrhythmias, fatigue, headache,
blood dyscrasias, altered blood
glucose readings, nausea, and
photosensitivity
Antidepressants, SSRI, Imipramine, Affect amount (increase or
MAOI Fluoxetine, decrease) of REM sleep; danger of
Buspirone overdose; daytime hangover;

Teaching to Promote Adequate Sleep

★ Establish a regular bedtime and wake-up time, and follow the schedule as closely
as possible
★ Develop a daily exercise program, preferably early in the day and outdoors
★ Avoid naps or limit them to no more than 30 mins and no later than early
afternoon
★ Avoid beverages containing caffeine such as coffee, cola, tea, hot chocolate, etc
★ Avoid use of alcohol and tobacco, particularly in the evening
★ Avoid eating large meals late at night
★ Try taking a warm bath or shower
★ Use relaxation breathing or meditation techniques. Try listening to audiotapes
with relaxing music
★ Establish a restful sleep environment with a comfortable bed, good pillow and
covers, shades or curtain to block out light, comfortable temperature etc
★ If sleep cannot be achieved after 30 mins, tell the patient not to be upset. Instruct
them to get up. Read, watch TV or do something relaxing until they feel tired then go
back to bed.

IMPLEMENTING CARE AS TO PSYCHOSOCIAL NEEDS

Cognition And Perception

● Perception includes the collection, interpretation, and recognition of stimuli,

including pain

● Cognition includes, intelligence, memory, language, and decision making

** cognition and perception are intimately connected to the functioning of the central
nervous system and the senses of vision, hearing, touch, smell and taste

Example:
The older patient’s window was lighted by the rays of the sun (sense of vision).
This stimulus passed into the cerebral cortex wherein recognition and interpretation
occurred; hence, the older person rose up from his bed to take his morning shower.

Age-related Cognitive Changes

Stable locus of control

Fluid intelligence thought to decline; crystallized intelligence to remain stable
Intelligence scores correlate with educational level
Diminished short-term memory; remote memory may be stable
Less efficient processing, storage, and encoding of information.

Risk Factors Related to Cognition and Perception in Older Adults

❏ Vision problems total blindness, presbyopia, macular degeneration, cataracts,

hemianopsia, detached retina, diabetes, glaucoma, and significant refractive factors)
❏ Hearing problems (presbycusis, otosclerosis, and conductive sensorineural
deafness)
❏ Dementia (in Alzheimer’s disease)
❏ Disturbed cerebral circulation (stroke, aneurysm, and head injury)
❏ Drugs that affect the sensorium (alcohol, narcotic analgesics, tranquilizers,
sedatives, and hypnotics)
❏ Disturbed neurologic function resulting in decreased levels of consciousness
❏ Disturbed metabolic states (hypoglycemia and metabolic alkalosis)
❏ Environments with either inadequate or excessive sensory stimulation

Nursing Goals for Perception Problems

1. Demonstrate improved ability to detect changes in the environment

2. Interact appropriately with the environment
3. Demonstrate the ability to compensate for deficits by using prosthetic devices
and alternative senses

Nursing Interventions

1. Ensure that all caregivers are aware of the person’s sensory problems
2. Make appropriate sensory contact before beginning care
3. Determine the best methods for communicating with older adults
4. Modify the environment to reduce risks
5. Verify that prostheses such as eyeglasses and hearing aids are functional

Nursing Goals for Cognition Problems

1. Patient remain free from injury
2. Assist in activities of daily living to the highest level possible
3. Seek assistance when needed

Nursing Interventions

1. Assess behavior on admission and at a regular interval.

2. Provide assistive sensory devices.
3. Orient the person to person, place, and time, and provide any other important
situational information
4. Provide a structured environment that ensures safety yet enables the person to
keep active as long as possible.
5. Provide continuity.
6. Administer psychotherapeutic medications as ordered
7. Avoid use of physical and chemical restraints
8. Structure participation in activities of daily living
9. Structure the environment to minimize disruption; avoid sudden changes of room
or environment
10. Develop a plan to deal with “acting out” behaviors
11. Consult with family and the multidisciplinary team

Self- Perception and Self-concept

Self-identity – the attitude and perception people have about themselves, their abilities,
and their self-worth

Erikson has identified the major task of late life as maintenance of ego integrity (the
sense of self-worth) versus despair.

Factors that may affect in accomplishing this task:

● Attitudes towards aging

● Level of self-esteem throughout life
● Extent of physical change caused by aging and illness
● The presence or absence of emotional support systems
● The ability to maintain a degree of control

Note: Self-perception and self-concept are very (subjective, objective) in nature. Most
often perception of self-worth and self-esteem are exhibited to others through behaviors
like:
● The amount of attention paid to personal hygiene and grooming
● The type and frequency of emotions exhibited
● Body posture
● Amount and type of eye contact
● Voice and speech patterns

Risk Factors Related to Self-Perception and Self-Concept in Older Adults

● Conditions that result in change of body appearance (burns, obesity, skin lesions,
chemotherapy, disfiguring endocrine disorders such as acromegaly or Cushing’s
disease, surgical removal of body parts)
● Inability to control bodily functions
● Significant losses (of significant others, possessions, social roles, financial
status)
● Recent relocation (particularly if involuntarily)
● Chronic pain

Engagement in Life

Role - is a socially accepted behavior pattern. It is identified, defined, and given value by
the society in which a person lives

Relationships – are connections formed by the dynamic interaction of individuals who

play interrelated roles.

Risk Factors Related to Changes in Roles and Relationships in Older Adults

● Recent loss of a spouse, child, close friend, significant other, or cherished pet
● Recent loss of lifelong or valuable roles
● Recent major adjustment in his or her living situation
● Inability to perform familiar roles owing to loss of functional abilities

Predictable role and relationship changes with aging:

❏ retirement
❏ altered relationships with adult children
❏ changes in housing
❏ loss of valued possessions
❏ loss of friends resulting from relocation or death
❏ loss of spouse to death
❏ loss of health
❏ loss of independence
Coping and Stress

Stress occurs when a person is faced with a real or perceived threat or experiences a
significant or life-altering change.

Stressors include:

external physical stress (extreme heat or cold, noise, or physical trauma

1. internal or psychological threats (thoughts and feelings)

2. external social threats ( job pressures or changeable social relationships)

Physical Signs of Stress

BODY SYSTEM CHANGE SEEN WITH STRESS

Cardiovascular Sensation of racing or pounding heart. Elevated pulse

rate. Increased BP. Cold, clammy hands and feet.
Increased blood glucose level to provide energy for
muscles.

Respiratory Increased respiratory rate and depth. Possible

hyperventilation with a tingling sensation in the
extremities, faintness, dizziness, and even convulsions
if the acid-base is seriously altered

Musculoskeletal Increased blood glucose level to provide energy for

muscles. Increased muscle tension in the back, neck,
and head. Complaints of tension headaches, teeth
grinding, and backaches.

Gastrointestinal Decreased peristalsis and decreased production of

digestive enzymes. Loss of appetite, nausea,
abdominal distention, vomiting and heartburn. May
contribute to development of gastric or duodenal
ulcers. Decreased peristalsis resulting in excess
 intestinal gas and constipation, but diarrhea is also
quite common.

Urinary Decreased urine production but increased urinary

frequency

Cognitive Signs of Stress

** Mild stress results in an increased state of alertness. Some individuals are able to
pay attention to details, to learn, and to solve problems.

While persons experiencing severe stress are likely to miss obvious details and might
forget even the most basic information. Problem solving ability is severely affected.
Under stress, people are likely to develop tunnel vision, in which they become narrowly
focused on one aspect of a problem and ignore other important facts. These individuals
are likely to act irrationally or impulsively and make poor choices. Some are incapable of
making decisions at all.

Emotional Signs of Stress

❏ complaints of fatigue, tension and anxiety

❏ often report a sense of foreboding or a feeling that something is wrong
❏ appear distracted, irritable, short-tempered, or even angry
❏ people on high level of stress often verbalize feelings of poor self-worth or low
self-esteem
❏ When stress becomes severe, people may experience signs of clinical
depressions or even verbalize suicidal thoughts.

Behavioral Signs

People attempt to cope with stress in different ways. Some avoid all interactions
or tasks that might increase their stress level. Whereas others take on additional duties
in an attempt to block out the source of their distress. People under stress tend to be
disorganized, make more errors and leave tasks incomplete. They may appear and even
sound muddled.

The thoughts, statements, and actions of stressed people often jump around in a
scattered or disconnected manner. They may pace, hum, perform other ritualistic
actions such as finger drumming, key jangling, or toe tapping. Temper tantrums,
shouting, and other aggressive behavior can occur without warning.

Coping Mechanisms

Coping mechanisms are neither good nor bad; they become dysfunctional only when
used excessively or inappropriately as a way of avoiding dealing with the stressors.

Stress Reduction and Coping Strategies

Two basic categories of coping style:

1. Problem-focused coping strategies – attempt to change or eliminate the

stressful event or threat.
2. Emotion-focused strategies – attempt to change the person’s response to the
stressful event or threat.

The type of strategy used depends on the personal significance of the event and the
perceived ability to alter the outcomes.

1. Avoid or escape the stressor(s)

2. Confrontation, cognitive and problem solving methods are effective means
stressors cannot be avoided, when their personal significance is high, or when the
person believes he or she can affect the outcome.

How to use the Problem-solving method?

➢ Identify and examine the stressor

➢ Determine its significance to the individual
➢ Explore alternative actions to reduce the stress

Example: A caregiver is working with an annoying co-worker (stressor)

The individual can continue to face the stressors and live with the consequences
(confrontational) , change jobs (escape), decrease contact with the stressor (avoidance)
or continuously work to change one’s attitude toward the annoying person (emotional
distancing).

3. Relaxation techniques (progressive relaxation, meditation, imaging, biofeedback,

and self-hypnosis)

Values and Beliefs

❏ Values and beliefs have their origins in the individual’s religion, philosophy, family,
culture, and society.
❏ Values and beliefs are essential to the human spirit
❏ Values and beliefs affect all aspects of a person’s life and play an important role
in promoting health and coping with illness
❏ Values and beliefs influence how we live and how we die

Common Values and Beliefs of Older Adults

Economic Values

How would you compare the economic values of an elder who grew up in scarcity
versus a person who grew up in an affluent life?

______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

Intrapersonal Values

Values depend on how these elders were raised. Example is an elder who was
raised valuing respect and obedience to elders. They often cannot understand why their
families do not automatically accept what they say and follow their directions.

What is the possible effect of divergent values within a family?

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

What can be the role of a nurse if there is a conflict within the family concerning
values and beliefs? __________________________________________________________________

_____________________________________________________________________________________

Cultural Values

Unite families, neighborhoods, and communities. Shared cultural values define an

authority structure, establish norms for language and communication, and establish a
basis for decision making and lifestyle choices.
 Nurses need to work at developing an understanding of diverse cultural values
and beliefs to provide appropriate care. Textbooks and articles are helpful but it is
usually better to have a direct, honest, conversation with the individuals, their families,
and significant others to identify their unique cultural beliefs and perspectives.

Spiritual or Religious Values

Spirituality is based on recognition that there is a relationship between the person and
transcendent supreme being, a life force, an ultimate reality, or an undefined something
that is greater than ourselves.

❏ Spiritual beliefs can motivate us to take actions or to avoid certain actions

❏ Spiritual beliefs give meaning to life and to all of the positive and negative
experiences that occur during a lifetime
❏ Spiritual beliefs can inspire positive or negative emotions
❏ Decisions regarding the end of life, including the use of high-technology
interventions, living wills, euthanasia, or physician-assisted suicide are usually based on
religious beliefs and value system. This decision must be respected by health care
providers, even when their own beliefs and values are different.
❏ Survival may be less important to an older person than the violation of long-held
beliefs.

Sexuality and Aging

❏ Sexuality is a part of life and does not cease to exist simply because a person is
aging
❏ Individuals who have had an active sex life in younger years are likely to continue
to do so as they age
❏ Sexual touching, fondling, and intercourse remain a part of the lives of many
active older people.
❏ Sexuality is more than just a physical drive, it provides opportunity for the aging
person to express and receive affection, connection, and emotional bonding.

Factors that Affect Sexuality of Older Adults

1. Normal changes in women are related to decreased levels of progesterone and

estrogen.
● Common changes that may result in discomfort or pain during intercourse
(dyspareunia) include:
● Irritation of the external genitalia (pruritus vulvae)
● Thinning and dryness of the vaginal walls (atrophic vaginitis)
● Alteration in the levels of normal microorganisms in the vagina, resulting in an
increased risk for vaginal yeast infection
2. Erectile dysfunction in men
3. Illness and decreased sexual function
4. Alcohol and medications
5. Loss of sexual partner

Caregivers and the Sexuality of Older Adults

★ Sexuality is a difficult area to address at any age because of the perception that it
is somehow offensive or abnormal or private.
★ Fear, shame, or embarrassment over what younger persons may think causes
many older people to hide their sexual interest and activity even from health care
professionals.
★ It is best for caregivers to address issues dealing with sexuality in private and to
ask open-ended questions such as:

“ Are you concerned about how your sexuality has changed with age?

“ Are you satisfied with your sex life?”

★ Caregivers need to indicate a willingness to listen and allow adequate time to

discuss any concerns or questions that arise.

HEALTH CARE SERVICES FOR OLDER ADULTS

1. Home care and Hospice

It is a service provided to an older person requiring observation or nursing care

upon discharge from a medical facility. It is a service designed for those who are
homebound due to severity of illness or immobility. In order to reimburse the allowable
expenses, the acquisition of the service must be medically necessary, intermittent, and
must be ordered by a healthcare provider.

2. Community-based Services

It is a service designed to help community-dwelling older adults remain safely in

their homes and delay or prevent institutionalization. It also provides (and acts as a link
to) specific resources for older adults and their caregivers that include wellness
programs, nutritional support, educational programs about health and aging, and
counseling services for caregivers, as well as general assistance with housing, finances,
and home safety. additionally , it provide opportunities for community and civic
engagement through various volunteer programs and can enhance individuals’ skills
and attitudes “to live in and gain more control over local aspects of their communities”11

3. Assisted Living

Its service provides assistance and monitoring of older residential adults for
whom independent living is no longer appropriate but do not need 24-hour nursing
home care. It varies by facility and the older adult’s needs.

4. Special Care Units

These units were established in 1960 intended for the care of older adults with
dementia. Its growth fueled up until this present time. SCUs were also established in
many nursing homes because it was recognized that their presence improved the image
of the nursing home and helped to attract privately paying patients.12

5. Geriatric Unit

It is a unit in the hospital intended to care for the older adults. These people
might be under investigation on their active treatment and rehabilitation.

Functions:
1. accept new geriatric patients, whether short-term or long-term, and selected
patients transferred from other wards.
2. To provide facilities for the investigation and treatment of geriatric patients
3. To provide observation wards for the primary investigation and medical
treatment of all elderly psychiatric patients, except those obviously needing admission
to a mental hospital.
4. To afford earlier rehabilitation of the elderly by more adequate and prolonged use
of physiotherapy.
5. To discharge all rehabilitated patients from its wards, and to resettle them where
necessary, in resident homes. 6. To arrange the prompt transfer to long-stay annexes of
all really irremediable patients. 13

11
"Community-Based Supports and Services for Older Adults: A ...."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4339950/. Accessed 25 Aug. 2020.
12
"Nursing Homes: Special Care Units - Aging, Social ...."
https://medicine.jrank.org/pages/1244/Nursing-Homes-Special-Care-Units.html. Accessed 26 Aug. 2020.
13
"The Role of a Geriatric Unit in a General Hospital - NCBI."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2479666/pdf/ulstermedj00168-0013.pdf. Accessed 26
Aug. 2020.
You have already completed your Module 2. Please do not forget completing

your learning tasks. Prepare for your summative evaluation. God bless you

References

Eliopoulos, C. (2018). Gerontological nursing (9th ed.). Wolters Kluwer.

Hirst, S. P., Lane, A.M., Miller, C.A. (2015). Miller’s nursing for wellness in older adults.
(Canadian ed.). Wolters Kluwer.
Mauk, K. (2018). Gerontological nursing competencies for care (4th ed.). Jones &
Bartlett Learning.
Meiner, S.E. (2015). Gerontologic nursing (5th ed.). Missouri, Elsevier Mosby.
Touhy, T and Jett, K. (2018). Ebersole and Hess’ Gerontological nursing & healthy aging
(5th ed.). Elsevier.
Prepared by:

Debbie Q. Ramirez, RN, PhD Mary Angelica P. Bagaoisan, RN, MAN

NCM 0114 Instructor NCM 0114 Instructor

Contributor for Academic Year 2021-2022

Rolando L. Lopez Jr., RN, MN

NCM 0114 Instructor

Peer Reviewed by:

Jasleen S. Yumang RN, MN

NCM 0114 Instructor

Reviewed and Evaluated by:

Anna Lyn M. Paano, MAN Sherwin M. Quizon RN, MN

Level 3 Academic Coordinator Level 3 RLE Coordinator

Approved by:

Zenaida S. Fernandez, RN, Ph.D

Dean, College of Nursing