GERONTOLOGICAL NURSING

Intro to Gerontological PIONEERS IN GERONTOLOGICAL NURSING

Nursing ➢ Florence Nightingale

What is Gerontological Nursing? o First geriatric nurse

✓ Nursing sub-specialty for older patients o Care of Sick Gentlewomen in Distressed
✓ Used to be called GERIATRIC NURSING Circumstances
➢ Doreen Norton
GERONTOLOGICAL NURSING VS. GERIATRIC
o Focused career on care of the aged
NURSING
o Described advantages of learning geriatric
▪ Gerontological Nursing care in basic education
o Focus on aging and the aged (old people) - Learning patience, tolerance,
▪ Geriatric Nursing understanding and basic nursing skills
o Focus on medical care of the aged - Witnessing the terminal stages of
disease and importance of skilled
---------- Gerontological Nursing ----------
nursing care
✓ The history and development of Gerontological - Preparing for the future
Nursing is rich in diversity and experiences - Recognizing the importance of
✓ Focus is on increasing life expectancy rehabilitation
✓ Increasing numbers of acute & chronic health - Being aware of the need to undertake
conditions research
✓ Nurses provide disease prevention & health
promotion
✓ Promote positive aging SCOPE AND STANDARDS OF GERONTOLOGICAL
NURSING PRACTICE
History:
SCOPE
▪ Specialty formed in the early 1960’s by ANA
• Assessment
▪ Standards for Geriatric Practice; Veterans
• Diagnosis
Administration funded GRECC’s at VA medical • Outcome Identification
centers (1970’s) • Planning
• Implementation
▪ Scope and Standards of Gerontological Nursing • Evaluation
Practice (1980’s)
▪ Established Hartford Foundation Institute of STANDARDS

Geriatric Nursing at NYU Division of Nursing

• Quality of Care
(1990’s) • Performance Appraisals
• Education
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• Collegiality CONTINUUM OF CARE

• Ethics
• Collaboration o Acute Care Hospital
• Research
✓ Often the point of entry into the healthcare
• Research Utilization
system
✓ Nurses care for older adults
Definitions of “old”
✓ Admits older people except in L&D, post-
▪ Chronological age partum & paediatrics
✓ young-old: 65 - 74 o Acute Rehabilitation
✓ middle-old: 75 - 84 ✓ Found in several settings including acute
✓ old-old (frail elderly): 85+ care hospitals, subacute care (transitional
care), & LTCF’s \
Cultural terms: elder, senior, older adult, elderly
✓ Goals are to maximize independence,
▪ Biological age promote maximal function, prevent

Previous Stereotypes of the Aged complications, & promote quality of life

within a person’s strengths & limitations
• Television
o Home Health Care
• Media
• Newspapers ✓ For home-bound due to severity of illness or
• Film industry
immobility
• Commercials in magazines and on TV
• Greeting card/birthday cards ✓ Usually done by a visiting nurse

PRACTICE SETTINGS ✓ Long Term Care Facility

✓ Referred to as nursing homes
o Acute Care Hospital
✓ Provides support to persons of any age who
o Long-Term Care
lost some or all capacity for self-care
• Assisted Living
✓ Nurses provide planning & oversee
• Intermediate Care
• Subacute or Transitional Care residents
• Skilled Care
✓ Maintain the functional & nutritional status
• Alzheimer’s Care
• Hospice of residents while preventing complications
of impaired mobility
o Rehabilitation
o Hospice
o Community
✓ To care for the dying and their families
• Home Health Care
• Foster Care or Group Homes ✓ Centered on holistic, interdisciplinary care
• Independent Living to help the dying “live until they die”
• Adult Day Care
✓ Provide quality care until the last months,
weeks, days or hours of their life
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✓ Respite Care ✓ Older people retain control of ADL’s

✓ Provides care to give caregivers a break
✓ Can be done in a daycare center, at home, o Adult Daycare
or ALF’s ✓ For older adults who are unable to remain at
home unsupervised
o Continuing Care Retirement Community (CCRC) ✓ Used by family members who care for the older
✓ Provides continuum of care from person in their homes
independent living to skilled care all within ✓ Community based program designed to meet
a single campus, with levels of care adjusted the needs of functionally and/or cognitively
to individual needs impaired adults through individual plan of care
✓ Patients can move seamlessly among in protective setting
independent living, assisted living, skilled ✓ Programs may be sponsored to provide
care, or long term care as their condition socialization, meals, & therapeutic activities
warrants

ROLES OF THE GERONTOLOGICAL NURSE

o Assisted Living Facilities
✓ Alternative for those who don’t feel safe • Provider of Care

being alone • Teacher

✓ For those who needs help with ADL’s • May • Manager

be connected to a LTCF • Advocate

✓ Provides healthy meals, planned activities, • Research Consumer
places to walk & exercise, and pleasant
surroundings
------------ THEORIES OF AGING -----------
✓ Foster Care or Group Homes
✓ For those who can do ADL’s but with issues Sociological Theories

safety that requires supervision ✓ Changing roles, relationships, status and

✓ Offers more personalized supervision in a generational cohort impact the older adult’s ability
smaller, more familylike environment to adapt. SOCIOLOGICAL THEORIES OF AGING
✓ Green House Concept
✓ Primary purpose is to serve as a place
SOCIOLOGICAL THEORIES OF AGING
where elders can receive assistance and
support with ADL’s & clinical care without
the assistance becoming the focus of ▪ Activity Theory
existence ➢ Havighurst and Albrecht (1953)
GERONTOLOGICAL NURSING

✓ Conceptualized activity engagement & ✓ Health and mobility are key

positive adaptation to aging determinants of social status
✓ Remaining occupied and involved is a ▪ Continuity Theory
necessary ingredient to satisfying late ➢ Havighurst, Neugarten & Tobin (1968)
life ✓ Suggests that personality is well-
✓ Associates activity as a means to developed by the time one reaches old-
prolong middle age & delay the age & tends to remain consistent across
negative effects of old-age life span

▪ Disengagement Theory ✓ Past coping patterns occur as older

➢ Cumming & Henry (1961) • Contrast to adults adjust to physical, financial, &
activity theory social decline and contemplate death
✓ Conceptualized that aging is ▪ Age Stratification Theory
characterized by gradual ➢ Riley and associates (1972)
disengagement from society and ✓ Society is stratified by age groups that
relationship are the basis for acquiring resources,
✓ Withdrawal from society & relationship roles, status, & deference from others.
serves to maintain social equilibrium & ✓ Age cohorts are influenced by their
promote internal reflection historical contexts& share similar
✓ Outcome is a new equilibrium ideally experiences, beliefs, attitudes, &
satisfying to both individual and society expectations of life course transitions
▪ Person-Environment Fit Theory
▪ Subculture Theory ➢ Lawton (1982)
➢ Rose (1965) ✓ Introduced functional competence in
✓ Views older adults as a unique relationship to the environment
subculture within society formed as a ✓ Conceptualized that function is affected
defensive response to society’s negative by ego strength, mobility, health,
attitudes & the loss of status that cognition, sensory perception & the
accompanies aging environment
✓ Conceptualized that the elderly prefer ✓ Competency changes one’s ability to
to segregate from society in an aging adapt to environmental needs
subculture sharing loss of status and ▪ Gerotranscendence Theory
societal negativity regarding the aged. ➢ Tornstam (1994)
GERONTOLOGICAL NURSING

✓ Proposed that aging individuals undergo ✓ Personality consists of an ego and personal
a cognitive transformation from a and collective unconsciousness that views
materialistic, rational perspective life from a personal or external perspective.
toward oneness with the universe Older adults search for life meaning & adapt
✓ Successful transformations include a to functional & social losses
more outward or external focus, ▪ Stages of Personality Development
accepting impending death without ➢ Erikson (1963)
fear, an emphasis of substantive ✓ Personality develops in 8 sequential stages
relationships, intergenerational with corresponding life tasks. The 8th
connectedness & spiritual unity with phase, Integrity vs. Despair, is characterized
the universe by evaluating life accomplishments;
✓ Activity & participation must be the struggles including letting go, accepting
result of one’s own choices which care, detachment, & physical & mental
differs from one person to another, & decline
control over one’s life in all situation is ➢ Peck (1968) Refined the 8th phase into three
essential for the person’s adaptation to challenges
aging Psychological Theories ✓ Ego differentiation vs. work role
✓ Explain aging in terms of mental reoccupation
processes, emotions, attitudes, ✓ Body transcendence vs. body preoccupation
motivation and personality ✓ Ego transcendence vs. ego preoccupation
development that is characterized by
life stage transitions ▪ Life Course (Life Span) Paradigm
➢ Bühler (1933)
✓ Blend key elements in psychological
PSYCHOLOGICAL THEORIES OF AGING
theories (life stages, tasks, & personality
▪ Human Needs Theory development) with sociological concepts
➢ Maslow (1954) (role behavior & interrelationship between
✓ Five basic needs motivate human behavior individual & society)
in a life-long process toward need fulfilment ✓ Life course is unique to each individual
✓ The needs are prioritized such that more ✓ Divided into stages with predictable
basic needs take precedence before the patterns Structured based on one’s role,
complex needs relationships, internal values, & goals
▪ Theory of Individualism ✓ Goal achievement is associated with life
➢ Jung (1960) satisfaction
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✓ Cells divide until they are no longer able to; this

▪ Selective Optimization with Compensation Theory triggers apoptosis or cell death
➢ Baltes (1987) ▪ Gene/Biological Clock Theory
✓ Individual copes with the functional losses ✓ Cells have a genetic programmed aging code
of aging through activity/role selection, ▪ Neuroendocrine Theory
optimization, & compensation ✓ Problems with the Hypothalamus-Pituitary-
✓ Critical life points are morbidity, mortality, Endocrine Gland Feedback System causes
& quality of life disease; increased insulin growth factor
✓ Facilitates successful aging increase aging

▪ Immunological Theory
BIOLOGICAL THEORIES
✓ Aging is due to faulty immunological
▪ Stochastic Theories function which is linked to general well
✓ Based on random events that cause cellular being
damage that accumulates as organism ages
▪ Nonstochastic Theories
NURSING THEORIES OF AGING
✓ Based on genetically programmed events
▪ Functional Consequences Theory
caused by cellular damage that accelerates ✓ Environmental and biopsychosocial
aging of the organism consequences impact functioning. Nursing’s
▪ Free Radical Theory role is to minimize ageassociated disability in
✓ Membranes, nucleic acids, and proteins are order to enhance safety and quality of living
damaged by free radicals which causes cellular
injury and aging ▪ Theory of Thriving
▪ Orgel/Error Theory ✓ Failure to thrive results from a discord between

✓ Errors in DNA and RNA synthesis occur with the individual and his or her environment or

aging relationships. Nurses identify and modify

▪ Wear & Tear Theory factors that contribute to disharmony among

✓ Cells wear out and cannot function with aging • these elements

Connective Tissue/Cross-Link Theory

✓ With aging proteins impede metabolic
processes and cause trouble with getting
nutrients to cells and removing cellular waste
products
▪ Programmed Theory
GERONTOLOGICAL NURSING

Communication ✓ may communicate danger

✓ It is an important skill that allows us to survive  OLFACTION

in and interact with our world ✓ may trigger feelings or memories
✓ We express our needs and wishes, understand ✓ GUSTATION
needs and wishes of others, negotiate adversity, ✓ may convey meanings
and convey our feelings
▪ MOVEMENT
Note: The ability to communicate depends on ✓ provides important information on
physiological and psychological processes environment
✓ elicits information if used with other senses
 PHYSICAL ✓ uses non-verbal gestures & facial expressions
• Listening
• Speaking  SPEECH
• Gesturing ✓ primary form of communication
• Reading ✓ requires both visual & auditory input, motor
• Writing output, & central processing
• Touching ✓ involves articulation & pronunciation
• Moving
 DISABILITY
 PSYCHOLOGICAL ✓ plays a major role in affecting communication
• Attention
• Memory NORMAL & PATHOLOGICAL
• Self-awareness AGE-RELATED CHANGES THAT AFFECT
• Organization COMMUNICATION
• Reasoning
✓ The number of individuals with sensory deficits
increases with age
SENSORY MODALITIES INVOLVED IN
COMMUNICATION
 VISION (age-related changes in the eyes)
 VISION
o The Lens
✓ 70% of all information coming through the eyes
✓ Changes in color (yellowed or amber; opaque)
✓ visual information makes interaction sensible &
✓ Begins to change after age of 40
add meaning to verbal messages

o The Iris & Pupil

 HEARING
✓ Slower pupillary reflex at age 50
✓ Reception of communication
✓ Pupil does not dilate completely (senile miosis)
✓ Major source of communication is the content
✓ At age 60, 70% less accommodation of light
of auditory information
✓ The non-verbal auditory information includes
TYPICAL VISION PROBLEMS
the pitch (tone) and timber (quality)
• Poor visual acuity
• Presbyopia
 TOUCH
• Sensitivity to light & glare
✓ substitute for sight
• Senile miosis
✓ conveys meaning for anger or love
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• Problems with color contrast o Retinal Detachment

BEHAVIORAL CUES TO VISUAL DEFECTS

▪ Adjustment of distance
▪ Squinting or focusing
▪ Difficulties in ADL’s

COMMON VISUAL DISEASES

o Macular Degeneration
(Wet Macular Degeneration) – can be cured if treated HEARING (age-related changes in hearing)
early
TYPES OF HEARING LOSS

1. Conductive Problems (outer to inner)

- Reduction of sound transmission
2. Sensorineural Problems (inner to cortex)
(Dry Macular Degeneration) –may be permanent - Caused by genetics & acquired factors
3. Mixed Hearing Loss
- Mixture of sensorineural& conductive

PATHOLOGICAL CHANGES TO HEARING

▪ Persistent exposure to noise pollution

o Diabetic Retinopathy
✓ Damage due to environmental noise or
pressure changes
✓ Can be temporary or permanent
✓ Can result to tinnitus
▪ Exposure to ototoxic substances
✓ Medications
✓ Poisons
o Glaucoma ▪ Medical conditions
✓ Acute trauma
✓ Cardiovascular diseases (smoking)
✓ Chronic viral or bacterial infection
✓ Measles, mumps, or meningitis

INDICATIONS OF HEARING LOSS

o Senile Cataracts • Inattentiveness / inappropriate responses

• Repetitions
• Complains of “mumbling”
• Increased reaction to loud sounds
• Increased or unusually loud speech
• Tilting / cocking of head
• Volume up
GERONTOLOGICAL NURSING

2 Types of Aphasia
COMMUNICATION TIPS

1. Do not shout 1. Receptive (fluent) aphasia

2. Use touch or visual cues - Inability to comprehend spoken or written
3. Use gestures or objects language but intact expressive ability
4. Limit background noise
- Due to damage in the Wernicke’s area
 SPEECH AND LANGUAGE (meaning)

o NORMAL AGING CHANGES 2. Expressive (non-fluent) aphasia

✓ Decreased respirations
✓ Change in laryngeal structure
✓ Reduced saliva
✓ Loss of teeth
✓ Decreased elasticity & muscle tone
✓ Cognitive changes
PATHOLOGICAL CHANGES
o Dysarthria
✓ Disturbed articulation due to disturbance in
control of speech muscle
✓ May be related to stroke, brain tumors,
degenerative & metabolic diseases, or
toxins
✓ May lead to anarthria (severe form)
o Verbal Apraxia
✓ A neurological disorder caused by damage
to the parietal lobe which results in
difficulties executing mouth & speech
movements
✓ Person has intention & capacity to move
muscles for speech, but have no volitional
control over the muscles
o Aphasia
✓ Most common speech disorder usually
following after stroke (left hemisphere)
✓ Inability to express or understand the
meaning of words
- Inability to produce language but intact
language comprehension
- Due to damage in the Broca’s area (speech
production)
COMMUNICATION TIPS
1. Low distractions
2. Position yourself in close proximity
3. Use multiple forms of communications
4. Use short uncomplicated sentences
TOUCH / SOMATOSENSORY SYSTEM
✓ The skin responds to external stimuli
✓ Interpreted as softness, pain, or heat
✓ Reduction in tactile and vibration sensation;
decreased sensitivity to warm or cold stimuli
✓ Sensitivity is reduced more in the fingertips
than in other location
✓ Somatosensory information plays an important
role in ensuring safety
IMPACT OF SOMATOSENSORY DEFICITS ON
COMMUNICATION
✓ Imposes danger due to loss of sensation
✓ May use other senses to identify characteristics
& quality of objects
✓ Can cause other forms of disorders
COMMUNICATION TIPS
1. Use verbal explanations to describe physical
activities
2. Encourage older adults to revert to other
activities that capitalize on their current
strength and abilities
GERONTOLOGICAL NURSING

 MOVEMENT ACTIVITIES OF DAILY LIVING / INSTRUMENTAL

✓ An important ability that fosters independence ACTIVITIES OF DAILY LIVING
and promotes interaction & understanding of
the environment ▪ ADLs are basic tasks one perform to survive
✓ It is a function of many variables: ✓ Impairment in ADLs are more severe
- Posture ▪ IADLs are more complex tasks
- Balance ▪ ADLs & IADLs are used to assess functioning
- Flexibility ✓ Impairment is most common among
- Tone elderlies
- Strength
- Sensory integration RISK FACTORS FOR IMPAIRMENT OF ADLs AND IADLs
- Reflexes • Age
- Motor planning • Gender – female
• Chronic diseases
MOVEMENT DISORDER IN OLDER ADULTS • Cognitive impairment
• Lack of exercise
o Parkinson’s Disease • Subjective health problems
✓ A chronic neurodegenerative condition • Low socioeconomic status
characterized by impairment of the nerves
that control movement MEASURING ADLs/IADLs
✓ Major symptoms include: ✓ Presence or absence of medical diagnosis
• Tremors ✓ Self-report
• Rigidity & stiffness ✓ Direct observation
• Slowness of movement
• Postural instability COMPENSATING FOR ADL/IADL IMPAIRMENT
✓ Assistive devices
• Impaired balance & coordination
✓ Easy to wear clothing
❖ Other symptoms may include:
✓ Handrails
- Memory problems
✓ Ready to cook meals
- Depression
- Hallucinations
PHYSIOLOGICAL CHANGES IN
- Mild vision loss
COMMUNICATIONCOGNITIVE CHANGES
HOW PARKINSON’S DISEASE AFFECT
TWO TYPES OF INTELLIGENCE
COMMUNICATION
1. Fluid Intelligence
✓ Speech may become slurred, soft, hoarse, or
✓ Acquisition of new information
have an inappropriate rhythm
✓ Crystallized Intelligence
✓ Writing may become smaller, shaky, and
✓ Accumulation of knowledge over life span
difficult to read
✓ Facial expression may be lost
FLUID INTELLIGENCE vs. CRYSTALLIZED INTELLIGENCE
FLUID INTELLIGENCE
o Disability
o Decline over time
✓ A decrease in the performance of ADLs and
✓ Information processing speed
IADLs independently can have a negative impact
✓ Divided attention
on the older adult’s quality of life
GERONTOLOGICAL NURSING
✓ Sustained attention
✓ Visuospatial tasks
✓ Abstraction
✓ Mental flexibility
✓ Rapid naming ability
✓ Long term memory
2. CRYSTALLIZED INTELLIGENCE
o Remain stable
✓ Verbal comprehension
✓ Verbal expression
✓ Vocabulary
✓ Wisdom
✓ Expertise
PATHOLOGICAL COGNITIVE CHANGES – DELIRIUM
▪ Common in hospital settings
▪ Prevalent in the terminally ill
▪ Definition (accdg. to DSM-MHD)
❖ Disturbance of consciousness
with reduced ability to focus,
sustain, shift attention
❖ A change in cognition or
development of perceptual
disturbance that is not better
accounted for by a preexisting,
established or evolving
dementia
❖ Disturbance develops over a
short period of time and tends
to fluctuate over the course of
the day
❖ There is evidence from history,
physical examination or
laboratory findings that the
disturbance is caused by several
different possible events
▪ It could easily be misinterpreted as any number
of disorders including psychotic disorders,
dementia and mood disorders with psychotic
features
- Good to excellent recovery if
correctly identified but unlikely in
the geriatric population
❖ It is associated with increased
risk of developing medical
complications and functional
decline
▪ Can be life threatening leading to coma,
seizures and eventual death
▪ Clients with delirium often experiences
hallucinations
❖ Tends to be disoriented and confused
▪ Communications is often fraught with
misinterpretation and inappropriate responses
GUIDELINES FOR COMMUNICATION
1. Keep discussions simple and questions concise
2. Use large-print calendars and clocks to assist
with orientation to time
3. Pictures of family members and loved ones
4. Well-lit place
5. Frequent reassurance
6. No restraints
7. Distraction and soothing conversation
PATHOLOGICAL COGNITIVE CHANGES – DEMENTIA
✓ A progressive illness that impairs social and
occupational functioning
✓ Criteria for Dementia:
- Cannot recall new or previously learned
information
- Memory problems must be present
❖ With one or more of the
following:
- Apraxia (impaired
movement)
- Aphasia (inability to
comprehend)
- Agnosia (inability to
interpret)
- Disturbed executive
functioning
TYPES OF DEMENTIA
1. Irreversible Dementia
✓ Inability to cure or reverse the symptoms with
medical or psychological treatment
GERONTOLOGICAL NURSING
2. Reversible Dementia (Pseudodementias)
✓ Potential for reversibility depending on
etiology and treatment availability
o ALZHEIMER’S DISEASE
✓ The most common type of Dementia in
older adults 60 years & up (50%-60%)
✓ This is one disease that has no definite
diagnosis until after autopsy; disease of
“rule out”
✓ Progression of dementia in 3 stages
3 STAGES OF DEMENTIA TYPE ALZHEIMER’S
o Stage 1 (2-4 years leading up to and including
diagnosis)
✓ Progressive memory loss & confusion
✓ Mood & personality changes
✓ Loss of spontaneity & initiative
✓ Decreased concentration abilities
✓ Impaired judgment & thinking
o Stage 2 (2-8 years)
✓ Increasing memory loss & confusion
✓ Poor impulse control with frequent
outbursts
✓ May display aggressive behavior
✓ Hallucinations or delusions
✓ Aphasia & confabulations
✓ Agraphia&agnosia
✓ Wandering & restlessness
✓ Hyperorality
o Stage 3 (1-3 years)
✓ Loss of weight or binge eating
✓ Loss of self-care skills
✓ Incontinence
✓ Progressive decrease in ability to respond to
environmental stimuli
✓ Multiple physical health problems &
eventual death
IMPACT OF DEMENTIA ON COMMUNICATION
o Early stages
✓ Frustrations, embarrassment, & can be
upset about inability to communicate
✓ Reduction in social contact & reduced
feelings of self-worth
✓ Moderate to severe
✓ Agitation
✓ Easy irritability
COMMUNICATION TIPS
1. Be calm, reassuring & confident
2. Get the person’s attention before starting a
conversation
3. Orient the person to yourself and the person’s
name
4. Reduce or eliminate background noise
5. Provide clear and simple instructions for tasks
6. Frequently remind the person of the task he is
doing
7. Use concrete or familiar words
8. Encourage discussion of significant life events
9. Establish familiar environment
PSYCHOLOGICAL CHANGES IN COMMUNICATION
MENTAL ILLNESS
o DEPRESSION
✓ A very serious condition associated with
increased risk of death, a greater number of
medical conditions, higher healthcare costs,
& longer hospital stays
✓ Risk of suicide is common/highest among
older Caucasian men
✓ May also affect family members &
caregivers of depressed elders
SYMPTOMS OF DEPRESSION
• Sadness
• Anhedonia
• Significant weight loss or gain
• Increased or decreased sleep
• Psychomotor agitation or retardation
• Fatigue or loss of interest
• Feelings of worthlessness or guilt
• Impaired ability to concentrate or think
GERONTOLOGICAL NURSING

• Recurrent thoughts of death or suicide ideation

or attempts

UNIQUE CHARACTERISTICS IN ELDERLY

▪ Multiple medical conditions

▪ Life transitions & change in status and role
▪ Loss of family members & friends

Questions:

- Is it normal for an elderly to experience

depression?

- Is depression a normal part of aging?

What causes Depression in older adults?

✓ Chemical changes in the brain & chemical
imbalance
✓ Experiences of helplessness
✓ Negative views of oneself, the world and others
✓ Exposure to severe and prolonged stress
✓ Or maybe…some combination of all these
explanations

TREATMENT OF DEPRESSION

▪ Medications
- Anti-depressants
▪ Talk therapy
- Psychiatrists or Psychologists
▪ Electroconvulsive therapy
- Electrical shock

IMPACT ON COMMUNICATION
▪ Loss of inclination to interact (withdrawn)
▪ Social isolation

NURSE’S ROLE

▪ Self-awareness
▪ Encourage the elder to engage in minor
activities
▪ Be respectful & understanding
▪ Offer your availability for communication
▪ Use memory aids
GERONTOLOGICAL NURSING

THERAPEUTIC PURPOSES

COMMUNICATION WITH  It has to be expressed in terms of human

OLDER ADULTS behavior.
 It should be specific enough able to relate it to
actual communication behavior.
If the interaction facilitates growth, development,
 It should be consistent with the ways in which
maturity, improved functioning, or improved coping…
people do communicate
it is considered therapeutic.

DEFINITION of COMMUNICATION COMMUNICATION PROCESS

THREE ELEMENTS OF COMMUNICATION PROCESS
• Imparting, conveying or exchange of ideas,
knowledge, meanings, etc. among individuals  Perception - activation of receiver’s sensory end
through the medium of a sign of some kind organs

• “A process by which two or more people  Evaluation - results to cognitive (informational

exchange ideas, facts, feelings, ‘common part)& effective (relationship aspect) responses
understanding’ of meaning, intent, and use of a
message’ (Paul Leagens)  Transmission - feedback

• Communication of ideas, facts, feelings, and STRUCTURAL MODEL OF COMMUNICATION

information is very vital for facilitating human
interactions

ELEMENTS

• Consists of 6 small messages:

 What do you mean to say?
 What do you actually say?
 What the other person hears?
 What the other person thinks that he
hears? ANATOMY &PHYSIOLOGY OF COMMUNICATION
 What the other person says?
 What you think the other person says? • The Cortex
 Primary repository of cognition
OBJECTIVES  Language production - ability to speak
• The Speech Center – cortical center
 Awareness of information  Language development
 Action information  Speech production
 Continuing information
 Updating information
GERONTOLOGICAL NURSING

• Aphasia - an acquired loss or impairment of  Emphasis of certain words

language
“What we say and HOW we say it is essential for
 Broca’s aphasia
therapeutic communication.”
characterized by non-fluent speech;
speech perception is not affected, and
• Non-vocal nonverbal
language comprehension is normal
communication
 Wernicke’s aphasia
This refers to the use of:
deficits in the comprehension of
 Physical appearance
language; speech is fluent, but it may
 Facial expressions
appear to not make sense to listeners
 Body posture
• Speech Structures
 Amount of eye contact
 Diaphragm
 Hand gestures / Touch
 Intercostal muscles
 Larynx
“Non-verbal communication speaks louder than
 Vocal cords
words.”
 Tongue
 Facial & oral muscles
COMMUNICATION IN HEALTH CARE
• Types of communication in health care (patient
 Dysarthria - difficulty in producing
perspective)
sounds or words
• Instrumental or task-focused
communication
KINDS OF COMMUNICATION • Behavior necessary for assessing &
solving problems
• Verbal Communication • Formal & structured (i.e.
 communication that involves speech and admission interviews, health
language assessment, discussion of
 All words a person speaks advanced directives, or patient-
▪ Communicates family education)
o Beliefs and values • May include informal
o Perceptions and meaning conversations
▪ Can convey • Affective communication
o Interest and understanding • Focuses on how the health care
o Insult and judgment provider is caring about the
o Clear or conflicting messages patient and their feelings and
o Honest or distorted feelings emotions
• Non-verbal Communication • More informal; can develop
 behaviors or gestures that conveys a emotional & personal relationship
message without the use of verbal • Important in long term health care
language relationships
 Can be either of two (2) forms:
• Vocal nonverbal communication
this refers to:
 Tone of voice
 Pitch
 Speech rate
 Fluency of verbal
communication
GERONTOLOGICAL NURSING
BASIC PRINCIPLES IN MAKING PATIENT CONTACT
• According to Satir (1976), there are 5 principles
in “making contact” in communicating with
patients:
 Invite
 Arrange Environment
 Maximize Communication
 Maximize Understanding
 Follow Through
 Inviting
 This would say to the other person that
you are interested in them & sharing
time with them
 Strategies:
- Arrange time for a conversation
rather than an assessment
- Greet the elderly by name
- Ask non-threatening open-
ended questions
 Remember:
Start a conversation and NOT an
interrogation
 Arranging the Environment
 Prepare a communication-conducive
environment
 Strategies:
▪ Provide comfort
▪ Provide privacy
▪ Minimize distractions
 Can be done in a nurse’s or patient’s space
▪ Face to face; 3-6 feet apart
▪ Ask permission to move or touch
anything (if in patient’s space)
▪ Consider disability of the elderly
 Maximizing Communication
 Use appropriate language to deliver health
literacy
 Strategies:
▪ Assess literacy & comprehension
▪ Use appropriate language
▪ Show respect by addressing client
with surname
▪ Avoid “terms of endearment”
Mistakes occur when we make assumptions
and fail to validate understanding.
 Maximizing Understanding
 Learning to listen is essential to good
communication; listening differs from
hearing
 Strategies:
▪ Understand meaning and context
in which they are spoken
▪ Be open-minded & provide
opportunities to share thoughts
▪ Allow time to communicate and
focus attention to conversation
Minimizing distractions not only helps the
individual to whom we are communicating,
but also helps us maintain focus.
 Follow Through
 Words backed by actions develop trust
 Strategies:
▪ Intend to do what has been said
(follow up)
▪ Build relationship based on trust
and concern
Trust & concern is critical to optimal health
outcomes.
CHALLENGES IN COMMUNICATING WITH OLDER
ADULTS
 Memory or Cognitive Deficits
 Speech Deficits or Impairment (Aphasia)
 Speech Impairments (Dysarthria)
 Visual Impairments
 Hearing Impairments / Deaf
TECHNIQUES IN COMMUNICATING WITH OLDER
ADULTS
 Identify yourself.
 Be aware of how you present yourself.
 Look directly at patient.
 Speak slowly and distinctly.
GERONTOLOGICAL NURSING

 Explain what you are going to do before you do

it.
 Listen to the answer the patient gives you.
 Show patient respect.
 Do not talk about the patient in front of him or
her.
 Be patient!
 Older patients:
• Often do not feel much pain
• May not be fully aware of important
changes in their body systems
• You must be especially vigilant for
objective changes.
 When possible, give patients time to pack a few
personal items before leaving for hospital.
 Locate hearing aids, glasses, and dentures
before departure.

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GERONTOLOGICAL NURSING

TEACHING OLDER ADULTS ✓ Accessible teaching methods

✓ Time and money

✓ Educating the older adults presents significant

challenges to health care providers, as they are BARRIERS TO OLDER ADULTS’ LEARNING
more affluent, better educated , and healthier than 1. Chronic illnesses
the group before them. 2. Normal aging changes
3. Health disparities
✓ Nurses in all settings are expected to provide
4. Literacy levels
education to patients & families
5. Cultural diversity
✓ Healthcare educators are expected to provide
topics of interest not only to older adults, but also TECHNOLOGY FOR OLDER ADULTS’ LIFELONG
to adults and family members. LEARNING
✓ Computer literacy programs
PRINCIPLES OF ADULT LEARNING ✓ Telemedicine
✓ Multimedia
➢ Lifelong learning
◼ “ongoing, voluntary, and self-motivated”
CULTURAL DIVERSITY & HEALTH DISPARITIES
pursuit of knowledge for either personal or
AMONG OLDER ADULTS
professional reasons
⚫ Diversity in terms of:
◼ it not only enhances social inclusion, active
citizenship, and personal development, but ➢ Age
also self-sustainability ➢ Race
➢ Ethnicity
➢ Gender
THEORIES OF ADULT LEARNING ➢ Socioeconomic status

1. Adult Learning Theory (Knowles, 1984) ⚫ Disparities in:

2. Theory of Self-Efficacy
3. Social Cognitive Theory ➢ Illnesses
➢ Diseases

OLDER ADULTS AND LIFELONG LEARNING

IMPLICATIONS FOR GERONTOLOGICAL
⚫ Many (about 69%) still plan to work after EDUCATION
retirement
⚫ The older adult cohort is not a homogenous group
⚫ Positions as second career
⚫ It is composed of persons of different cultures,
✓ Teaching races, education levels, and socioeconomic
✓ Office support statuses
✓ Crafts
✓ Retail sales
✓ Health care
STRATEGIES FOR TEACHING OLDER ADULTS
⚫ Concerns for post-retirement career and learning INDIVIDUALLY

✓ Age discrimination ⚫ One-on-one instruction

GERONTOLOGICAL NURSING

➢ At bedside ⚫ MAXIMUM INDEPENDENCE = MAXIMUM QUALITY

➢ In the home OF LIFE
➢ In group settings

⚫ Advance preparation of program presentation INFLUENCES OF ENVIRONMENT & LIVING

SITUATION
⚫ Environment focused on older adult audience
✓ Living Skills
➢ Senior centers
✓ Housing
➢ Independent or assisted living facilities
✓ Self-care
➢ Support groups
➢ Churches
➢ Social gatherings ROLE CHANGES/TRANSITIONS

⚫ Use the principle of adult learning theory ➢ Retirement

➢ Health Transition
⚫ Use multiple teaching modalities ➢ Loss of Spouse
➢ Role Reversal
⚫ Accommodate unique physical needs
➢ Driving
⚫ Make presentations elder-friendly ➢ IADL’s
➢ Basic ADL’s
➢ Caregiving
PROMOTING INDEPENDENCE IN LATER LIFE
➢ Health, personality, state of mind, and emotional, PSYCHOSOCIAL & SPIRITUAL INFLUENCES
physical and spiritual support all have a place in
1. Socialization
the adjustments one makes to the aging process.
2. Spiritual Influences
3. Goal Attainment

--------- ADAGES OF AGING ---------

MAXIMUM FUNTION
⚫ Self-care and health promotion are important in
maintaining independence ⚫ Preventing Complications of Existing Illness or
Disease
⚫ Level of physical activity decreases with aging
➢ Nutrition
⚫ High functional ability is not absolutely necessary ➢ Sleep
for high quality of life ➢ Exercise

⚫ Fall Prevention
SUCCESSFUL AGING
➢ Assessment / Prediction
⚫ The ability to maintain three key behaviors: ➢ The Value of Rehabilitation
✓ Low risk of disease and disease-related ➢ Deterrents
disability ✓ Use of restraints
✓ High mental and physical function
✓ Active engagement of life ✓ Alternative to restraints

⚫ Financial Consideration
MAINTAINING INDEPENDENCE ⚫ Community Resources
GERONTOLOGICAL NURSING

IMPLICATIONS FOR NURSING CARE

⚫ Nurses are where the elderlies are, and they are
important resources for older persons in promoting
continued independence into later life.