NCM 214 Lec: Care of Older 08 L E C

O2
Adult 27
Jo Ann dela Cerna, RN, MN
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GERONTOLOGICAL NURSING PRACTICE

OUTLINE factors. signs and symptoms, usual

OUTLINE management and nursing care that
I Roles of a Gerontologic Nurse would be provided to them.
i. Provider of Care
ii. Manager
iii. Teacher 2. Manager
iv. Advocate • Plans and coordinate the activities as
v. Researcher well the care of the elderly
II Principles of Gerontological Nursing • A gerontologic nurse acts as a
Practice manager on their everyday practice
• Balances the concerns of the elder,
III Settings of Care family, nursing staff and the rest of the
health team (Geriatricians, nursing
i. Acute Care Hospital
aids, therapists)
ii. Intermediate Care • Must be a good leader, must know to
iii. Assisted Living balance things and manage time while
iv. Long Term Care Facility taking care of the elderly and their
v. Skilled Care concerns
vi. Home Health Care • Should have the skills on how to build
vii. Hospice Care relationships not only with the elderly
viii. Rehabilitation and health care team but also the
ix. CCRC family of the older adults
x. Independent Living • Be assertive but respects the right of
xi. Foster Care Home other people
• Supervise other nursing personnel
xii. Adult Day Care
3. Teacher
xiii. Green House Concept
• Provides instructions and health
IV Aging Theories teachings
• Organizes and provides instructions on
healthy aging, disease detection,
Roles of Gerontologic Nurse treatment and rehabilitation to older
patients and families
Roles of a Gerontologic Nurse • Focuses teachings on modifiable risk
1. Provider of Care factors and health promotions (Many
• Gives direct hands-on care to older
debilitating aging can be prevented
adults in a variety of settings. through lifestyle modification like
• Major role of the nurse is to assess
smoking cessation, appropriate weight
and diagnose actual and potential maintenance, healthy diet, exercise,
needs of the patient increased physical activity and stress
• Plans the care and evaluates the
management)
outcome appropriately • Educates client and family on how to
• Routinely assess the older adults,
access health care systems (Hospitals,
• Should be knowledgeable about the
Long term care facilities, Doctors,
changes that the older adults would Health insurances)
encounter as they age, not only the • Continuously educate the self
normal changes as well as • Participate in in-service education,
physiological changes that would continuing education and training of
bring upon disorders and include risk ancillary personnel as appropriate
4. Advocate

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 • Acts on behalf of the older adults to
promote their autonomy and decision
making but does not meet we make
the decision for them instead we
empower and encourage them to still
make the decision helping them to
remain independent and retain their
dignity
• Having discussion of the elderly’s
rights and advance directives ( health
care decisions)
• Providing help in accessing
community resources
• Recognize and cope with necessary
changes in terms of the lifestyle
• Negotiate medical insurances
• Explain medical treatments and
procedures/ nursing procedures
5. Research Consumer / Researcher
• Gerontological nurses must
remain abreast or must be always
updated with current research
literature along with reading and
putting into practice any reliable
or valid studies.
• Continue education by attending
seminars, conferences,
workshops or participating in
organizations like organizations
for gerontological nursing.
• Being a researcher we participate
or collaborate with established
researchers. We can also share
our findings with other people to
help them provide appropriate
care to our older clients.
• Being a researcher also if we
come up with a research we can
actually publish our research.
• Updated with current research
literature
• Assists with data collection and
identification of appropriate research
sites
• Uses evidence based results
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Principles of Gerontological Nursing Practice
• Aging is a natural process
• Everybody will age.
• Common to all living organisms.
• Various factors influence the aging process
• of
Principles There are factors that
Gerontological could Practice
Nursing influence
the aging process like biological
function and physiological function.
Examples are your genetics,
environmental factors, health
behaviors, disease can also influence
aging process or even social
interaction.
• Nursing of the elderly requires unique
information and skills
• Some of the people in history were able
to come up with gerontological
nursing, geriatric nursing as an special
area of practice because our elderly
also requires unique care compared to
other ages
• There are common needs shared by the
eldery and all ages
• Gerontological Nursing’s goal is to promote
optimum levels of physical, psychological,
social and spiritual health.
• Gerontological nursing or nurse strives
to help to know our older adults
achieve wholeness referring to
physical, psychological and spiritual.
• Achieve Wholeness so that the older
adult can maintain his or her
independence as well as achieve that
level of functioning and along with that
achieve or maintain high quality of life
that is the goal of the gerontological
nursing.
CARE OF THE ELDERLY
Acute Care of the Elderly (ACE)
• Acute care of the elderly: it is a specialized
program that would address the needs of your
hospitalized older adults.
• Care given to our older adults who are
admitted in a health care facility, hospital.
Since hospitalized, definitely, we have also the
other members of the health team, like you
have your geriatrician, along with the nurse,
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 the pharmacists, dietician, in
multidisciplinary team approach.
• It creates an individualized care plan to reduce
hospital complications and decrease the risk of
any adverse event.
• Prevent functional and cognitive decline during
the duration in which your older adult is
hospitalized and to improve outcomes and
satisfaction.
• Target natin while hospitalized ang ating older
adult is being hospitalized, hindi siya magkaka-
develop ng complications in his/her hospital
stay and also provide a satisfactory outcome.
FOUR (4) KEY CONCEPTS/COMPONENTS:
1. A safe environment
• Uncluttered halls, carpeted floors, raised toilet
seats, a common lounge area
• Make sure that with the duration of his/her
hospitalization, we can still provide a safe
environment. (Examples are above) Dapat
walang nakakalat na materials sa hallways,
promoting mobility and preventing accidents
and injuries.
• Carpeted floors: to reduce the risk of slipping
(para di ma-slide) even in the bathroom, not
necessarily carpeted but has an anti-slipping
device
• Raised toilet seats to improve continence: As
seen in some bathrooms, there are side bars to
prevent accidents of the elderly.
• Common lounge area: even though they are
admitted, there is still that area provided for
them to socialize and decrease isolation.
2. Patient-centered interdisciplinary care
• We always provide patient-centered
interdisciplinary care: we as nurses coordinate
with other health team members as we provide
care to the elderly or to our older adults. This
would address issues that would also help them
meet their needs.
3. Discharge planning
• While in the duration that your elderly is in the
hospital, we can also come up with discharge
planning because our goal for our elderly will
be able to return to his/her former living status,
or he/she will be able to return to their
optimum level of functioning
4. Careful medical and nursing interventions
• Careful: to prevent adverse outcomes. Or
prevent/avoid iatrogenic problems: Problem/s
brought about by medical management. Yun
ang iiwasan natin that is why one of the
components is to provide careful medical and
nursing interventions.
Settings of Care
SETTINGS OF CARE
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a Acute Care Hospital
• An example of a setting under acute care of the
elderly is the acute care hospital.
(ACUTE: SUDDEN) Sudden but short or brief in
duration. When you say acute care hospital, it
provides short-term patient care. It is a facility
that focuses on management of acute
problems. Examples: trauma, accidents,
orthopedic injury; makasustain ug fracture
(common to elderly), serious circulatory and
respiratory problems. Oftentimes, the point of
entry in your acute care hospital is the point of
entry into the healthcare system for your older
adults.
• In this setting, your gerontological nurse
focuses on nursing care of acute problems.
Your acute care hospital provides short-term
patient care.
Intermediate care
• Provides 24-hour per day direct nursing contact
• The facility under your intermediate care is
considered to be the entry level into nursing
home care.
• ICF (referring to intermediate care facility) is a
type of a healthcare facility that is designed to
provide custodial care: care as well as services
that would assist or help our older adults in the
activities of their daily living. Your ICF is a
facility that would provide custodial care.
• Typically used by older adults who are disabled.
Disabled or non-acutely ill
• Not able to take care of themselves because of
a physical or mental infirmity
• Provides less intensive care than what is
offered at a hospital
Assisted living
• Long-term care
• Assisted living is an example of your long-term
care
• Long-term care in a long-term care facility
• Assisted living: they are placed in a community.
This is a community setting
• Assisted living communities are designed to
feel home-like and in residences
• Pag nasa long-term care facilities, older adults
are termed as “residents”
• Residents typically live in their own apartment:
meron silang own apartment or suite
• Older adults who are able to live independently
but needs/desire for some levels of assistance
in terms of their activities of daily living
• Provides sense of security to those who live
alone because they know that help is available
anytime and knows that someone will check on
them routinely although they are living alone
but needs assistance to a certain degree
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Long Term Care Facility
• Traditionally referred to as nursing homes,
long-term care facilities provide support to
persons of any age who have lost some or all of
their capacity
• Lost some of their capacity for self-care due to
illness, disabilities or even dementia. Though
they are not acutely ill, the residents of Long
Term Care Facility like your hospitalized
patients, they require 24 hours nursing care.
Skilled Care
• “Skilled care units” or “skilled nursing facilities”
(SNFs)
• For older adults chronically ill
• These facilities are intended for taking care of
adults who have chronic illness. For older
adults requiring more intensive nursing care.
• Skilled nursing facility is actually an in-
patient rehabilitation in a medical treatment
center. It provides care to our older adults with
chronic illness.
• Skilled nursing care facilities would provide 24
hours or round the clock assistance not only
with activities of daily living but as well as with
health care. Kasi nga diba ito yung mga older
adults with chronic illness.
a. SUBACUTE/
TRANSITIONAL CARE
• Patients who require
more intensive
nursing care than the
traditional nursing
home can provide, but
less intensive than the
acute care hospital.
• For older adults
with/coming from an
acute episode and
then after that they
still require mga
therapy or they are
being transferred
from the hospital to
continue their
recovery in that
transitional care
facility.
• Meaning galing sila sa
acute episode na
discharge na sila kasi
diba sabi natin sa
acute care, a short
term care that is
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provided. Now when
they will be
discharged and they
require for example
therapy or when it is a
care that is provided
to them where in they
can continue with
their recovery.
b. ALZHEIMER'S UNIT
• Units dedicated to the
major phases of
Alzheimer’s disease
(AD).
• It addresses the need
of your patient having
Alzheimer’s
• Alzheimer’s is one of
the types of dementia.
Of course due to
impared diba pag
Dementia, Alzheimer’s
there is impared
judgment. So due to
impared judgment it
may pose safety issues
for this older person.
That is why they
should not be left
alone.
• There is a special
facility intended for
our older persons
having Alzheimer or
dementia.
• The goal of your
dementia care is to
preserve the
functional status of
your demented person
via supportive care
that would foster still
their self work and
with that they can still
socialize even within
the context of
diminishing na the
cognitive capacity.
HOME HEALTH CARE
• For older adults requiring a longer period of
observation or care from nurses
• Designed for those who are homebound due to
severity of illness or immobility
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 • Home health care, from that word nasa bahay.
But that “bahay” of the elderly becomes a long
term care facility. Because this is designed for
those who are homebound. Hindi na nila
kayang magpa admit kaya sa bahay nalang or
ayaw nilang magpa admit “gusto ko dito lang
ako sa bahay”.
• So this includes mga skilled nursing care and
therapist, personal care services. These
services may be provided by one agency or
group of agencies.
• So home health care may be free standing or
hospital based, when you say free standing this
would include visiting nurses, or it would
include mga official agencies ng ating
government. So pag sinabi mo namang facility
based, it could be an example of hospital
based or agencies based in skilled nursing
facilities or rehabilitation.
HOSPICE CARE
• Caring for dying person and their families
• Of course gerontological nurses may also
choose to work in hospice, meaning providing
care for our dying older adults and their
families
• So the concept here of your hospice care is
centered on holistic interdisciplinary care that
would help our dying person live until they die.
• So a member of your health team members
would work together as they provide quality of
care for patients in their last days ba or in their
last months, weeks, or even last hours of their
lives.
• So hospice care is in the variety of settings.
REHABILITATION
• May be found in various degrees in several
settings, including the acute care hospital,
subacute or transitional care, and LTCFs (long
term care facilities).
• So the goal here is to restore again diba yung
ating tinatawag na gerontological
rehabilitation nursing, the goal here is to
restore and maintain the optimum level of
functioning as well as independence and also
prevent complications and promote quality of
life.
CONTINUING CARE RETIREMENT COMMUNITY (CCRC)
• Most older adults live in the community, with
only about 5% at any given time are residing in
nursing homes.
• CCRC is also known as “Life Plan Community or
Life Care Community” so it delivers an
independent living and healthy lifestyle with
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access to onsite higher level of care should
medical needs progress.
• It provides a continuum of care from
independent living to skilled care. So this
continuum care would ensure the residents
that they have the stability of remaining in
place, in the place they call home. So it allows
them to age in that place in a familiar
surrounding and with familiar people.
• Add: Yung dormitory natin sa school is
originally for our retired nuns and priests, it
was donated by PME Priests. Now, sa ground
floor doon nakatira ang mga dominican nuns.
INDEPENDENT LIVING
Community Setting
- independent living arrangements take the form of
senior housing, such as apartment complexes
exclusively devoted to the elderly.
- This one, when you try to compare it with assisted
living, the difference is that sa independent, capable
pa ang elderly. They generally do not need assistance
with ADLs
- Available in the community and long-term facilities
like in Bago Aplaya, Good Shepherd.
- Capable elderly but wala nang nagbabantay
or asikaso
FOSTER CARE HOMES/ GROUP HOMES
- for elderly who can do most of their ADLS but may
have safety issues (because of their fragility) and
require supervision with some activities such as
dressing or taking medications.
- more personalized supervision in a smaller, more
family-like environment than a traditional nursing
home
- Provides a comfortable living environment and
it does not provide the high-level of care but
gives the elderly to live with the peers
- More independent compared to traditional
nursing homes
ADULT DAY CARE
- for older adults who are unable to remain at home
during the day without supervision.
-used by family members who may work during the
day and wish to have their relative safely cared for in
their absence.
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 age?” “how do we age?”. This attempts to
- Just like day care centers for children explain or answer these questions.
• With theories of aging, these would help us
GREEN HOUSE CONCEPT make that sense of order and gives a
perspective from which we view aging.
- Dr. William Thomas came up with this concept • With our theories of aging, it will provide a
together with Robert Wood Johnson Foundation to springboard or a point of reference for
replace 100 nursing homes with: discussion and research.
- clusters of small, cozy houses, each housing 8 to 10
residents in private rooms, with private bathrooms FUNCTIONS:
and an open kitchen. 1. attempt to explain the phenomenon of aging
- limited rooms for the elderly 2. provide a perspective from which to view aging
3. Provide a springboard research
• Primary purpose: to serve as a place where elders
can receive assistance and support with activities of THEORIES OF AGING CLASSIFICATIONS
daily living and clinical care 1. BIOLOGICAL - this would address the
- Provide a sense of well-being for elderlies anatomical or even to the physiological
while providing high quality changes occurring in age.
individualized/personalized care • FREE RADICAL
- Still in a community setting • ORGEL/ERROR
• WEAR AND TEAR
To further understand Green House Concept, watch • CONNECTIVE TISSUE
this https://youtu.be/7E9NlSQDPcE • PROGRAMMED
Transcription: • GENE/BIOLOGICAL
Londonderry village of Palmyra is a church based • CLOCK
Aging Theories
senior living community known for its innovative and • NEUROENDOCRINE
high-quality nursing care since 2007. The village is the • IMMUNOLOGIC
only community in PA to adapt the greenhouse model
of residents centered care. Londonderry village has 2. SOCIOLOGICAL - it pertains to interaction,
created a new way of living in the community while relationship of the older adults.
receiving necessary nursing care. Resident elders enjoy • ACTIVITY THEORY
all private rooms and home-cooked food while • DIS-ENGAGEMENT THEORY
forming meaningful relationships with other members • SUBCULTURE THEORY
of the House. It's very different than your typical • CONTINUITY THEORY
nursing home. Living in a greenhouse is so much more. • AGE SATISFACTION THEORY
You're here to thrive and live as long as you can live in • PERSON-ENVIRONMENT FIT
a good environment. It's like family now. Family elders • GERO-TRANSCENDENCE
are encouraged to set their own schedules, express
their own choices, relax in the living room, enjoy the
spacious covered patio, participate in a music therapy 3. PSYCHOLOGICAL - refers to thought processes.
session or take part in a table game or activity. There Along with that is the behaviors of our aging persons.
is no shortage of things to do or people to be around • THEORY OF INDIVIDUALISM
and caring for the elders in mind, body and spirit…. • HUMAN NEEDS
Londonderry village is extending its ability to provide • STAGE OF PERSONALITY DEVELOPMENT
care letting even more elders experience the unique
advantages of the greenhouse lifestyle. Londonderry *Additional with our theories of aging, we also have
village uniting comfort, security and innovation for the nursing theories related to aging.*
best in nursing care.
NURSING THEORY OF AGING
AGING THEORIES 1. Functional Consequences Theory
2. Theory of Thriving

• Theory is defined as a rational type of abstract

thinking about a certain phenomenon. In
relation to aging, aging is actually a human 1. BIOLOGICAL THEORIES
phenomenon so the the aging theories • View aging as occurring at molecular and
attempts to answer questions like “Why do we cellular level

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 • It attempts to explain the physical or the
physiological process of aging. This include
alterations in the structure and functions,
development, longevity(life expectancy), as
well as death. Again, it attempts to answer the
questions “Why people age differently?” “Why
people age differently overtime?” “What
factors affect life expectancy or longevity?”
“Factors that would affect resistance to
organisms or cellular alterations or death?”
• The primary question being addressed here
relates to the factors that will trigger the actual
aging process in an organism.
2 Categories:
1. Stochastic theories - random assault. Also
called as “Statistical Perspective Theories”.
Meaning, it identifies episodic events. These
events that happen throughout one's lifetime
that would cause random assault or cell
damage. Kumbaga, through the persons’
lifecourse…may nangyare. It’s a sudden attack
and then if it accumulates overtime, it will
cause aging.
2. Nonstochastic - predetermined process. Views
aging as a series of predetermined process. Naka
program na. At this point in time, meroong
mangyayare in that particular structure.
Predetermined events happening to all organisms in a
timeframework. Example is apoptosis (programmed
cell death) wherein a certain point of time,
mamatay ang cell.
Stochastic Theory
1. Free Radicals and Lipofuscin theories
a. Aging is due to the effects of free radicals
i.Damages protein, enzymes, and DNA
ii.The cells cannot regenerate themselves
Notes:
• Aging is due to oxidative metabolism, AND
the effects of free radicals.
• Free radicals are produced when the body
uses oxygen.
• Free radicals are natural byproducts of on-
going biochemical reactions in the body,
which includes metabolic processes, and
immune system processes.
• Free radicals will eventually damage the
growth, development, and the survival of cells
in the body because they’re reactive nature
allows them to engage in unnecessary
reactions causing cellular impairment, and
eventually injury, especially when they are
present in inappropriate amounts.
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b. Lipofuscin – a lipo protein byproduct
of oxidation
i.Interferes with the diffusion and transport of essential
metabolites
Notes:
• Lipofuscin is also known as the “age pigment”.
• Lipofuscin accumulates progressively over
time in the lysosomes, in the post-mitotic cells.
• “Mitotic” refers to cell division.
• Lipofuscin can be found in the liver,
heart muscles, retina, adrenals, nerve cells, as
well as in ganglion cells.
2. Orgel/Error Theory
a. As a cell ages, various changes (errors) occur
naturally in its DNA and RNA (resulting in cell death, or
as we know it as aging).
b. Proposes that error can occur in the
transcription of the synthesis of DNA
c. May lead to aging or death of a cell
d. “The Error Catastrophe Theory Of Aging”
Notes:
• Leslie Eleazer Orgel, was the proponent
responsible for this theory, which was
proposed way back in the 1960s.
• Originally, the theory was called “The Error
Catastrophe Theory Of Aging”.
3. Wear and Tear Theories
a. Attribute aging to the repeated use and injury
of the body over time
b. Proposes that cells wear out through
exposure to internal and external stressors, including
trauma, chemicals, and buildup of natural wastes
Notes:
• Repeated use of your body results in injury
overtime; cumulative changes occuring in
cells, age and damage cellular metabolism.
• The wear and tear theory would describe the
body, as just like that of a machine; if a
machine is used continuously, eventually the
parts of the machine wears out, ultimately
breaking down in the end.
• For example: as we use our laptops overtime,
it becomes slow and eventually it becomes
unusable as it breaks down.
• The Wear and Tear theory of Aging, believes
that the effects of aging caused by damage
done to the cells and body systems overtime,
would wear out. Once they wear out, they
would no longer be able to function efficiently.
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4. Cross-Linking Theory/Connective Tissue
Theory
a. Proposes that as cells age, chemical reactions
create strong bonds, or cross-linkages, between
proteins.
b. Primarily involves collagen – loss of elasticity,
stiffness
• Responsible for the ultimate
failure of tissues and organs.

Notes:
• The Cross-Linking theory proposes that
overtime more and more proteins, DNA and
other structural molecules in the body would
develop inappropriate attachments to others.
• They create links to structures that are
normally separated, or normally that are not
connected, this is known as “cross-links”.
• Cross-link molecules do not function properly;
as they accumulate in the body, such as
cartilages, lungs, arteries, tendons, can cause
problems.
• When cross-linking occurs, the tissues become
stiffened, and when tissues stiffen, they do not
function properly.
• For example in cataracts, the lens of the eyes
stiffen.
• In a study, it has been found that collagen has
been partially involved in the formation of
wrinkles.
• Some studies also believe that cross-linkages
of proteins found in the walls of the arteries,
accounts for atherosclerosis, which increases
heart attack or stroke.

References:

Prof. Dela Cerna PPT and Lecture

YouTube: https://youtu.be/7E9NlSQDPcE

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