NCMB314: FINALS REVIEWER - WEEK 13 TO 17
NCMB314: Care of Older Adults
RESEARCH AGENDA
OLDER ADULT
• YOUNG OLD (60-74)
• MIDDLE OLD (75-83)
• OLD OLD (85 & OLDER)
• PRESENTLY: 12.8% OF POPULATION
• 2030: WILL INCREASE TO 20% OF
POPULATION
THE GRAYING OF AMERICA PERCENT OF TOTAL
U.S POPULATION OVER 65 IN 2023
DEMOGRAPHICS OF AGING
• IN 2005, 13% OF THE U.S POPULATION WAS
OVER AGE 60
- 18.3 MILLION AGED 65 – 74
- 12.9 MILLION AGED 75 – 84
- 4.7% AGED 85 OR OLDER
• THIS NUMBER IS ESTIMATED TO
INCREASE:
- TO 20 MILLION IN 2010 (6.8% OF TOTAL),
- TO 33 MILLION IN 2030 (9.2%), AND
- TO ALMOST 50 MILLION IN 2050 (11.6%)
Ø (NATIONAL CENTER FOR HEALTH
STATISTICS [NCHS], 2006).
• BY MID 21ST CENTURY, OLD PEOPLE WILL
OUTNUMBER YOUNG FOR THE FIRST TIME
IN HISTORY
ALL NATIONS HAVE AN AGING POPULATION
• THE GREATEST INCREASES WILL BE IN
DEVELOPING COUNTRIES
- ASIAN COUNTRIES HAVE LESS TIME TO
PREPARE FOR AGING-BECAUSE AGING IS
OCCURRING MORE RAPIDLY THAN
ECONOMIC GROWTH.
Ø ADEQUATE HEALTHCARE SERVICES
FOR THE ELDERLY
- THEY MAY NOT BE ABLE TO AFFORD A
LARGE DEPENDENT ELDERLY
POPULATION.
- THEY MIGHT NOT HAVE THE NECESSARY
INSTITUTIONS & FINANCIAL SYSTEMS IN
PLACE (E.G., EFFICIENT AND WELL –
MANAGED PENSION AND HEALTHCARE
PROGRAMS)
FUTURE OLD / BABY BOOMERS
- BORN BETWEEN 1946 AND 1964
- HIGH-TECH ORIENTATION
- MOST HAVE CHILDREN, BUT LOW BIRTH
RATE MEANS FEWER BIOLOGIC CHILDREN
TO ASSIST THEM IN OLD AGE
- THEIR INCOME TENDS TO BE HIGHER
THAN OTHER GROUPS
- THEIR LEISURE TIME IS SCARCER THAN
OTHER ADULTS; THEY ARE MORE LIKELY
TO FEEL STRESSED
- THEY EXERCISE MORE FREQUENTLY
THAN OTHER ADULTS
- HEALTHIER OLD AGE ATTAINABLE FOR
BABY-BOOMERS
INFORMED AND EDUCATED
• THEY ARE THE BEST EDUCATED
GENERATION EVER
• TOUGHEST CHALLENGE FOR
HEALTHCARE B/C LOOK EVERYTHING UP
ON THE INTERNET AND COME IN
“KNOWING” THEIR CONDITION
• HAVE TO HELP THEM SORT OUT WHAT IS
RIGHT FOR THEM
PREDICTIONS FOR BABY BOOMERS
• THEY WILL HAVE A HIGHLY ACTIVE ROLE
IN THE HEALTH CARE
• THEIR ABILITY TO ACCESS INFORMATION
WILL KEEP THEM INFORMED
• THEY WILL NOT BE SATISDIED WITH THE
CONDITIONS OF TODAY’S NURSING
HOMES
- CURRENT NURSING HOMES WILL NOT
WORK FOR THIS GENERATION
• THEIR BLENDED FAMILIES MAY NEED
SPECIAL ASSISTANCE WITH CAREGIVING
DEMANDS
- COORDINATING CARE WITH FAMILY
MEMBERS WILL POSE PROBLEM AS
FAMMILY IS TYPICALLY SPREAD
THROUGHOUT COUNTRY
NCMB314: FINALS REVIEWER - WEEK 13 TO 17
NCMB314: Care of Older Adults

A. NATIONAL: NIH PUBLICATION B. INTERNATIONAL:UN PROGRAM ON

AGING
- 2030 PROBLEMS ON CARING FOR AGING
BABY BOOMERS UN PROGRAMME ON AGING

• DISD
RESEARCH STUDY
- (DIVISION FOR INCLUSIVE SOCIAL
• TO ASSESS THE COMING CHALLENGES OF DEVELOPMENT)
CARING FOR LARGE NUMBERS OF FRAIL
ELDERLY AS THE BABY BOOM • UNDESA
GENERATION AGES.
- UNITED NATIONS DEPARTMENT OF
STUDY DESIGN ECONOMIC AND SOCIAL AFFAIRS).

1. MEASURES OF MACROECONOMIC Ø THE 2030 AGENDA FOR SUSTAINABLE

BURDEN ARE DEVELOPED AND
ANALYZED, DEVELOPMENT AND OLDER PERSONS

2. THE LITERATURES ON TRENDS IN - PREPARING FOR AN AGING POPULATION,

DISABILITY PAYMENT APPROACHES FOR
LONG TERM CARE, HEALTHY AGING, AND
CULTURAL VIEWS OF AGING ARE
ANALYZED AND SYNTHESIZED, AND
3. SIMULATIONS OF FUTURE INCOME AND
ASSETS PATTERNS OF THE BABY BOOM
GENERATION ARE DEVELOPED
PRINCIPAL FINDINGS
THE REAL CHALLENGES OF CARING FOR THE
ELDERLY IN 2030 WILL INVOLVE:
1. MAKING SURE SOCIETY DEVELOPS
PAYMENT AND INSURANCE SYSTEMS FOR
LONG TERM CARE THAT WORK BETTER
THAN EXISTING ONES,
2. TAKING ADVANTAGE OF ADVANCES IN
MEDICINE AND BEHAVIORAL HEALTH TO
KEEP THE ELDERLY AS HEALTHY AND
ACTIVE AS POSSIBLE,
3. CHANGING THE WAY SOCIETY ORGANIZES
COMMUNITY SERVICES SO THAT CARE IS
MORE ACCESSIBLE, AND
4. ALTERING THE CULTURAL VIEW OF AGING
TO MAKE SURE ALL AGES ARE
INTEGRATED INTO THE FABRIC OF
COMMUNITY LIFE.
VITAL TO THE ACHIEVEMENT OF THE
INTEGRATED 2030 AGENDA, WITH AGEING
CUTTING ACROSS THE GOALS ON
POVERTY ERADICATION, GOOD HEALTH,
GENDER EQUALITY, ECONOMIC GROWTH
AND DECENT WORK, REDUCED
INEQUALITIES AND SUSTAINABLE CITIES.
OLDER PERSONS MAKING KEY CONTRIBUTIONS IN
THE FOLLOWING INTERRELATED AREAS:
1. ECONOMIC DEVELOPMENT
2. UNPAID CARE WORK
3. POLITICAL PARTICIPATION
4. SOCIAL CAPITAL
TRENDS / ISSUES AND CHALLENGES ON THE
CARE OF THE OLDER PERSONS
EDUCATIONAL TRENDS IN GERONTOLOGICAL
NURSING:
• SPECIAL EDUCATION IN CARING FOR
ADULTS DURING BASIC PREPARATION
(LPN, RN ASSOCIATE DEGREE, DIPLOMA
RN, OR RN BSN LEVEL.
• POST BACCALAUREATE NURSES CHOOSE
A CLINICAL NURSE SPECIALIST (CNS) OR
GERIATRIC NURSE PRACTITIONER (GNP)
• ONLINE PROGRAMS FOR GRADUATE OR
POST-MASTER'S STUDY AND COMPLETE
CLINICAL HOURS IN THEIR OWN
GEOGRAPHIC LOCATION

• CERTIFICATIONS IN GERONTOLOGY
CURRENTLY AVAILABLE FROM THE
AMERICAN ASSOCIATION OF COLLEGES
OF NURSING (AACN)
NCMB314: FINALS REVIEWER - WEEK 13 TO 17
NCMB314: Care of Older Adults

• WORKING IN LONG-TERM CARE Ø HAVE PRACTICED A MINIMUM OF 12

FACILITIES SUCH AS NURSING HOMES, MONTHS AFTER COMPLETION OF THE
ASSISTED LIVING, INDEPENDENT LIVING MASTER'S DEGREE
CENTERS, OR ADULT DAY CARE, OR IN AN
ACUTE CARE HOSPITAL. Ø PROVIDED A MINIMUM OF 800 HOURS (
POST-MASTER'S) OF DIRECT CLIENT CARE
GERONTOLOGIC NURSE OR CLINICAL MANAGEMENT IN
GERONTOLOGIC NURSING WITHIN THE
• CURRENTLY HOLD AN ACTIVE PAST 24 MONTHS

• REGISTERED NURSE LICENSE IN US OR ITS Ø A CONSULTANT, RESEARCHER,

TERRITORIES. EDUCATOR, OR ADMINISTRATOR, MUST
HAVE PROVIDED A MINIMUM OF 400
• HOLD A BACCALAUREATE OR HIGHER HOURS
DEGREE IN NURSING.

• HAVE PRACTICED 2000 HOURS WITHIN LIFE CARE PLANNING

PAST 3 YEARS
Ø THE CONCEPT OF LIFE CARE PLANNING
• HAVE HAD 30 CONTACT HOURS OF WAS FIRST DEVELOPED IN THE 1980S, TO
CONTINUING EDUCATION APPLICABLE TO MEET A GROWING NEED FOR AN
GERONTOLOGY/GERONTOLOGIC INFORMED DOCUMENT THAT PRESENTED
NURSING WITHIN THE PAST 3 YEARS. ACTUAL ESTIMATED COSTS OF CARE FOR
PERSONS WHO HAD EXPERIENCED A
CATASTROPHIC INJURY OR ACCIDENT.
GERONTOLOGIC NURSE PRACTITIONER MANY SETTLEMENTS FOR THOSE
PERSONS IN DEVASTATING ACCIDENTS
WERE MADE ARBITRARILY WITHOUT
• CURRENTLY HOLD AN ACTIVE RN
ACTUAL CALCULATION AND
LICENSE IN THE US OR ITS TERRITORIES
CONSIDERATION OF THE MULTITUDES OF
FACTORS INFLUENCING THESE COSTS,
• HOLD A MASTER'S OR HIGHER DEGREE IN
SUCH AS DOCTORS' VISITS, EQUIPMENT,
NURSING.
MEDICATIONS, TESTS, COST OF
CAREGIVING, AND POTENTIAL
• HAVE BEEN PREPARED AS A NURSE
COMPLICATIONS OVER A LIFETIME.
PRACTITIONER IN EITHER OF THE
FOLLOWING:
CERTIFICATION
Ø A GNP MASTER'S DEGREE IN
PROGRAM
Ø THE CERTIFIED LIFE CARE PLANNER
(CLCP) DESIGNATION MAY BE EARNED
Ø A FORMAL POSTGRADUATE GNP
THROUGH 128 CONTINUING EDUCATION
TRACK OR PROGRAM WITHIN A
HOURS, SUCCESSFUL COMPLETION OF A
SCHOOL OF NURSING GRANTING
SAMPLE LIFE CARE PLAN, AND PASSING
GRADUATE-LEVEL ACADEMIC AN EXAMINATION (MEDIPRO SEMINARS,
CREDIT 2004). THE CNLCP (CERTIFIED NURSE LIFE
CARE PLANNER) DESIGNATION IS
CLINICAL SPECIALIST IN GERONTOLOGIC
OFFERED BY THE AMERICAN
NURSING ASSOCIATION OF NURSE LIFE CARE
PLANNERS CERTIFICATION BOARD. ITIS
Ø CURRENTLY HOLD AN ACTIVE RN
SIMILAR TO CLCP, BUT WITH ADDITIONAL
LICENSE IN THE UNITED STATES OR ITS REQUIREMENTS, AND IS DEFINITELY
TERRITORIES DESIGNED FOR REGISTERED NURSES
WITH CASE MANAGEMENT EXPERIENCE.
Ø HOLD A MASTER'S OR HIGHER DEGREE IN
GERONTOLOGIC NURSING

Ø HOLD A MASTER'S OR HIGHER DEGREE IN

NURSING WITH A SPECIALIZATION IN
GERONTOLOGIC NURSING.
NCMB314: FINALS REVIEWER - WEEK 13 TO 17
NCMB314: Care of Older Adults
FUTURE POTENTIAL
Ø LIFE CARE PLANNER MAY BE A CONCEPT
THAT WILL BE CARRIED INTO THE SENIOR
POPULATION. NOT ONLY ARE SENIORS
LIVING LONGER, BUT THEY CONTINUE
PARTICIPATING IN HIGHER RISK
ACTIVITIES TODAY THAN IN
GENERATIONS PAST. THE PRINCIPLES OF
LIFE CARE PLANNING COULD ALSO
EASILY BE EXTRAPOLATED FOR USE WITH
THOSE SENIORS WHO HAVE LONG-TERM
CHRONIC HEALTH PROBLEMS.
CERTIFICATION FOR FG
CHARTERED ADVISOR FOR SENIOR LIVING
(CASL)
- A PERSON WITH CASL CERTIFICATION
ASSISTS OLDER PERSONS WITH
RETIREMENT SAVINGS, PENSION AND
SOCIAL SECURITY PLANNING, HEALTH
AND LONG-TERM ISSUES, ESTATE
PLANNING AND MANAGING LIFE COURSE
TRANSITIONS, FAMILY RELATIONSHIP
AND LIVING ARRANGEMENT. A PERSON
MUST COMPLETE FIVE COURSES THAT
TAKE APPROXIMATELY 60-80 HOURS OF
STUDY EACH. AFTER THE COURSE THE
INDIVIDUAL MUST PASS A •
COMPUTERIZED EXAM. MAINTENANCE
OF THE CERTIFICATION WITH
CONTINUING EDUCATION CREDITS. A
CODE OF ETHICS MUST ALSO BE AGREED
TO IN WRITING PRIOR TO BEING GRANTED
THE DESIGNATION.
REGISTERED FINANCIAL GERONTOLOGIST
(RFG)
Ø THE RFG CERTIFICATIONS A SIMILAR
DESIGNATION TO THE CASL, BUT IS
OFFERED THROUGH THE AMERICAN
INSTITUTE OF FINANCIAL GERONTOLOGY
AND SUPPORTED BY THE AMERICAN
SOCIETY ON AGING. THE INDIVIDUAL
MUST COMPLETE SIX COURSES, A
LEARNING REQUIREMENT, AND A
COMPREHENSIVE EXAMINATION. COURSE
CONTENT IS RELATED TO WEALTH SPAN
PLANNING, ETHICS, AND SERVING THE
OLDER ADULT. COMPARED TO CASL
COURSES, THE CURRICULUM APPEARS
MORE SUITED TO GERONTOLOGIST THAN
FINANCIAL PLANNERS.
CERTIFIED SENIOR ADVISOR (CSA)
Ø THE CSA IS A DESIGNATION OFFERED BY
THE SOCIETY OF SENIOR ADVISORS. THE
CURRICULUM INCLUDES A LARGE
NUMBER OF TOPICS IN AGING, CHRONIC
ILLNESS, END OF LIFE, AND LONG-TERM
CARE AS WELL AS MEDICAID AND
FINANCIAL PLANNING. IT IS SELF-STUDY
PROGRAM THAT TAKES 2-6 MONTHS TO
COMPLETE. TO OBTAIN THE CSA, THE
PERSON MUST ALSO PASS A SECURED,
COMPUTERIZED, FINAL COMPREHENSIVE
EXAMINATION ONLINE THAT CONSISTS OF
150 MULTIPLE CHOICE QUESTIONS WITHIN
3 HOURS.
RECENT TRENDS IN HEALTH PROMOTION &
DISEASE PREVENTION ACTIVITIES, SUCH AS:
Ø IMPROVED NUTRITION,
Ø DECREASED SMOKING,
Ø INCREASED EXERCISE, AND
Ø EARLY DETECTION & TREATMENT OF RISK
FACTORS SUCH AS HYPERTENSION &
ELEVATED SERUM CHOLESTEROL
LEVELS.
TRENDS IN LONG – TERM CARE
LONG-TERM CARE IS THE "BROAD RANGE
OF MEDICAL, CUSTODIAL, SOCIAL, AND
OTHER CARE SERVICES THAT ASSIST
PEOPLE WHO HAVE AN IMPAIRED ABILITY
TO LIVE INDEPENDENTLY FOR AN
EXTENDED PERIOD".
LONG TERM CARE INSURANCE
• LONG -TERM CARE INSURANCE IS
DESIGNED TO COVER INDIVIDUALS
NEEDING HEALTH CARE OUTSIDE OF THE
HOSPITAL, INCLUDING DIAGNOSTICS
TESTING, REHABILITATION, AND
CUSTODIAL CARE. REASONS FOR
PURCHASING LONG – TERM CARE
INSURANCE INCLUDE WORRYING ABOUT
BEING A BURDEN TO THEIR FAMILY,
STAYING FINANCIALLY INDEPENDENT,
HAVING MORE CHOICES FOR CARE IF
NEED (SUCH AS REMAINING IN THE
HOME), PRESERVING THEIR ASSETS, AND
PROVIDING PEACE OF MIND.
NCMB314: FINALS REVIEWER - WEEK 13 TO 17
NCMB314: Care of Older Adults

LONG – TERM CARE INSURANCE

• ASSIST WITH TRANSITIONS IN LIVING
Ø NURSING HOME CARE ARRANGEMENTS, INCLUDING
Ø ASSISTED LIVING RECOMMENDING THE MOST
Ø HOSPICE APPROPRIATE SETTINGS AND HELPING
Ø HOME HEALTH FACILITATE THE MOVE
Ø ADULT DAY CARE
Ø RESPITE • PROVIDE EDUCATION AND LINKS TO
Ø CAREGIVER TRAINING RESOURCES
Ø HOME HEALTH CARE COORDINATORS
• OFFER COUNSELING AND SUPPORT
EMERGING MODELS OF CARE
• SOME PGCM ALSO OFFER GUARDIANSHIP,
A SHIFT TO DIFFERENT LIVING FACILITIES CAREGIVING, AND / OR FINANCIAL
SERVICES.
- ONE OF MOST SIGNIFICANT CHANGES IN
CARE FOR OLDER ADULTS IS THE SHIFT COMMUNITY LIVING DESIGN
AWAY FROM NURSING HOMES.
Ø FASCINATING TREND RELATED TO
CONTINUING CARE RETIREMENT GERONTOLOGICAL NURSING IS THE
COMMUNITIES (CCRCS) EMERGENCE OF COMPANIES
COMPLETELY DEVOTED TO THE
- GROWING TREND FOR OLDER ADULTS, STRATEGIC PLANNING, ENGINEERING,
SERVICES BY PROMOTING AGING IN ARCHITECTURE, BUILDING, AND
PLACE THROUGH OFFERING VARIOUS MARKETING OF COMMUNITY LIVING
LEVELS OF CARE ON A CONTINUUM THAT DESIGNS THAT ARE TAILORED TO TODAY'S
MIGHT INCLUDE INDEPENDENT LIVING, OLDER ADULTS.
ASSISTED LIVING, SKILLED CARE, AND
HOME HEALTH SERVICES ALL ON ONE AN AGING – FRIENDLY COMMUNITY HAS THREE
CAMPUS. PRIMARY CHARACTERISTICS:

• GREEN HOUSES 1. AGE IS NOT A SIGNIFICANT BARRIER TO

• GERIATRIC CARE MANAGEMENT (PGCM) THE MAINTENANCE OF LIFE-LONG
INTERESTS AND ACTIVITIES;
PGCM PERFORM THE FOLLOWING:
2. SUPPORTS AND ACCOMMODATIONS EXIST
• CONDUCT ASSESSMENTS TO ENABLE INDIVIDUALS WITH AGE-
RELATED DISABILITIES TO MEET BASIC
• DEVELOP CARE PLANS THAT ADDRESS HEALTH AND SOCIAL NEEDS; AND
PERTINENT PROBLEMS
3. OPPORTUNITIES EXIST FOR OLDER
• ARRANGE, INTERVIEW FOR, AND ADULTS TO DEVELOP NEW SOURCES OF
MONITOR IN-HOME CAREGIVERS OR FULFILLMENT AND ENGAGEMENT.
OTHER SERVICES
TELEHEALTH AND THE OLDER PERSON
• ACT AS A CONSULTANT FOR CAREGIVERS
WHO LIVE NEAR OR FAR - ALLOWS PATIENTS ACROSS THE LIFESPAN
TO RECEIVE CARE REMOTELY IN A
• REVIEW FINANCIAL, HEALTH-RELATED, MANNER THAT IS OFTEN MORE
OR LEGAL ISSUES ACCESSIBLE AND CONVENIENT THAN IN –
PERSON CARE.
• PROVIDE REFERRALS TO OTHER
GERIATRICS SPECIALISTS - A COMMON MISCONCEPTION IS THAT
OLDER ADULTS HAVE EITHER NO
• INTERVENE IN TIMES OF CRISIS INTEREST IN THE USE OF TECHNOLOGY
OR CANNOT USE TECHNOLOGY
• ACT AS AN ADVOCATE AND / OR LIAISON PLATFORMS.
BETWEEN FAMILIES AND SERVICE
PROVIDERS

• COORDINATE OR OVERSEE CARE

NCMB314: FINALS REVIEWER - WEEK 13 TO 17
NCMB314: Care of Older Adults

A. SENSORY AND MOTOR CHANGES Ø THERE ARE SOME OLDER ADULTS WHOSE
COGNITIVE IMPAIRMENTS MAY BE TOO
- MOST OLDER ADULTS EXPERIENCE AGE ADVANCED TO USE TELEHEALTH
RELATED CHANGES IN VISION, HEARING, SUCCESSFULLY (FOR INSTANCE, IN
TOUCH, PERCEPTION, MOBILITY, AND SEVERE DEMENTIA). HOWEVER, SOME
BALANCE. MANY OF THESE DECLINES OLDER ADULTS WITH MILD FORMS OF
BEGIN AT AGE 40. DEMENTIA CAN USE TELEHEALTH
EFFECTIVELY WITH SOME
Ø FOR OLDER ADULTS, THERE MAY BE MODIFICATIONS OR ADJUSTMENTS. FOR
DIFFICULTIES WITH LIGHT PERCEPTION, INSTANCE, THEY MAY NEED A FAMILY
SENSITIVITY TO GLARE, REDUCED MEMBER' S ASSISTANCE TO SET UP THE
ACUITY, AND IMPAIRED FOCUS ON TELEHEALTH ACCOUNT OR TO GET THE
NEARBY OBJECTS. TELEHEALTH SESSION STARTED.

Ø DISCRIMINATING BETWEEN C. STRATEGIES FOR PROVIDING

BACKGROUND NOISES BECOMES MORE TECHNOLOGY SUPPORT
DIFFICULT AS WE AGE, AND LOW-LEVEL
SOUNDS ARE MUFFLED. AND FOR SOME, Ø DON'T ASSUME OLDER ADULTS ARE
THERE IS INCREASED RISK OF UNINTERESTED IN TELEHEALTH.
DEVELOPING TINNITUS, WHICH CAN
MAKE CERTAIN SOUNDS DIFFICULT TO Ø JUST AS YOU DO WITH ALL PATIENTS,
DISCERN. MEET OLDER ADULTS WHERE THEY ARE
AND TALK ABOUT THE PROS AND CONS OF
Ø THERE ARE ALSO CHANGES TO MUSCLE TELEHEALTH. PROVIDE A CLEAR
STRENGTH AND TONE THAT MAKE EXPLANATION OF WHAT TO EXPECT AND
MUSCLES STIFFER AND LESS. LET THEM KNOW THAT MOST PEOPLE
EXPERIENCE A FEW "BUMPS" ADJUSTING
B. COGNITIVE CHANGES TO NEW TECHNOLOGY BUT YOU'VE BEEN
ABLE TO SUCCESSFULLY WORK WITH
Ø MOST OLDER ADULTS EXPERIENCE SOME PEOPLE WITH THIS MODALITY.
COGNITIVE CHANGES AS A PART OF THE
NORMAL AGING PROCESS, SUCH AS Ø PROVIDING TECHNOLOGY SUPPORT
SLOWED SPEED OF PROCESSING, REQUIRES ADDITIONAL RESOURCES
DIFFICULTY IN MULTITASKING, AND EARLY IN TREATMENT BUT AVOIDS
SMALL DECLINES IN EPISODIC MEMORY, DELAYS ON THE DAY OF THE
WHICH GENERALLY DO NOT INTERFERE APPOINTMENT, SO PLAN TO PROVIDE
WITH EVERYDAY FUNCTIONING. ADDITIONAL INSTRUCTION AND
HOWEVER, MANY COGNITIVE ABILITIES, INDIVIDUAL TECH SUPPORT. THOUGH
INCLUDING SEMANTIC MEMORY, TELEHEALTH PLATFORMS MAY NOT BE
REASONING, PROBLEM SOLVING, AND INTUITIVE TO OLDER ADULTS, MANY CAN
EXECUTIVE FUNCTIONING ARE SUCCESSFULLY USE THEM. CONTACT THE
PRESERVED WELL INTO LATE LIFE. THE OLDER ADULT OVER THE TELEPHONE
RELATIVELY MINOR COGNITIVE PRIOR TO THE APPOINTMENT TO PROVIDE
CHANGES THAT OCCUR WITH AGING VERBAL INSTRUCTIONS, TEST THE
SHOULD NOT PREVENT USE OF TELEHEALTH PLATFORM, AND ENSURE
TELEHEALTH BY OLDER ADULTS. THE OLDER ADULT UNDERSTANDS AND IS
COMFORTABLE WITH THE TECHNOLOGY.
Ø EVEN ADULTS WHO EXPERIENCE SUPPORT STAFF MAY BE ABLE TO DO THIS
CONDITIONS SUCH AS MILD COGNITIVE STEP. ADDITIONAL BENEFITS INCLUDE
IMPAIRMENT (MCI) CAN SUCCESSFULLY INCREASING OLDER ADULTS' ACCESS TO
LEARN NEW SKILLS, ESPECIALLY IF THEY CARE AND PROMOTING TREATMENT
USE COMPENSATORY STRATEGIES LIKE CONTINUITY BY OVERCOMING BARRIERS
MAKING NOTES OR USING REMINDERS. TO IN-PERSON SESSIONS.
THIS COULD INCLUDE MAKING
REMINDERS ABOUT TELEHEALTH
APPOINTMENT TIMES IN THEIR
CALENDAR AND USING A SERIES OF
WRITTEN NOTES ABOUT HOW TO START
THEIR COMPUTER OR TABLET AND
LAUNCH A TELEHEALTH APPLICATION.
NCMB314: FINALS REVIEWER - WEEK 13 TO 17
NCMB314: Care of Older Adults

Ø PRIOR TO THE APPOINTMENT, PROVIDE Ø USE CLARIFYING AND REFLECTIVE

OLDER ADULTS WITH WRITTEN TECHNIQUES TO AVOID
INSTRUCTIONS FOR USING TELEHEALTH MISCOMMUNICATION AND
(YOU MAY FIND THIS BENEFICIAL FOR ALL MISINTERPRETATION OF THE OLDER
YOUR PATIENTS). INSTRUCTIONS THAT ADULT'S EMOTIONS. CLARIFY
USE CONCISE LANGUAGE, A LARGER AMBIGUOUS BODY LANGUAGE
FONT SIZE, AND INCLUDE SCREEN SHOTS VERBALLY WITH THE
OF EACH STEP OF THE PROCESS MAY BE ACKNOWLEDGEMENT THAT TELEHEALTH
PARTICULARLY HELPFUL. CAN MAKE COMMUNICATION MORE
DIFFICULT (E. G., "I WANT TO MAKE SURE I
Ø OLDER ADULTS USING TELEHEALTH UNDERSTAND HOW YOU ARE FEELING.
TECHNOLOGY WILL BENEFIT FROM
VISUAL PRESENTATION MODIFICATIONS • MEETING OVER VIDEO CAN MAKE THAT
(E.G., RAISE DISPLAY/SCREEN MORE DIFFICULT SINCE I CAN'T SEE YOU
ILLUMINATION, USE MATTE SURFACES COMPLETELY. YOU SEEM TO BE
INSTEAD OF GLOSSY SURFACES). FRUSTRATED-IS THAT HOW YOU ARE
FEELING?").
Ø AUDITORY ENHANCEMENTS MAY ALSO
HELP THE USER EXPERIENCE (E.G., Ø IMPLEMENTING THESE STRATEGIES
ADJUST VOLUME SETTINGS, OFFER COULD INCREASE THE LIKELIHOOD OF
CLOSED CAPTIONING OPTIONS WITH OLDER ADULTS SUCCESSFULLY
ENHANCED TEXT SIZE, CONSIDER THE ENGAGING IN AND BENEFITING FROM
USE OF HEADPHONE SETS). TELEHEALTH.

Ø YOU CAN PROVIDE THESE SUGGESTIONS E. USING TELEHEALTH TO CARE FOR THE
IN THE INITIAL WRITTEN INFORMATION ELDERLY
OR DISCUSS DURING THE SETTING UP
SESSION. • WHEN WE THINK OF DIGITAL
TECHNOLOGY, WE TEND TO THINK OF
Ø WHEN USING A VIDEO PLATFORM, A YOUNGER INDIVIDUALS USING THEIR
NEUTRAL, NOT "BUSY" VISUAL SMARTPHONES AND OTHER DIGITAL
BACKGROUND FOR YOU WILL ENSURE DEVICES. BUT THIS LINE OF THINKING
THE OLDER ADULT WITH VISUAL DOESN'T NECESSARILY APPLY TO
CHALLENGES IS BETTER ABLE TO FOCUS TELEHEALTH. OLDER GENERATIONS CAN
ON YOU AND NOT OTHER STIMULI IN THE USE TELEHEALTH TECHNOLOGY TO
BACKGROUND. SIMILARLY, REDUCING IMPROVE THEIR ACCESS TO CARE AND
NOISE ON THE PROVIDER'S END REDUCES REDUCE THE COST OF HEALTHCARE
AUDITORY INTERFERENCE FOR THE SERVICES.
PATIENT. BE AWARE OF NOISES SUCH AS
HVAC, WHITE NOISE GENERATORS, AND • THE NUMBER OF AMERICANS AGE 65 AND
OTHER SOUNDS AND SEEK TO MINIMIZE OLDER IS RISING DRAMATICALLY.
THESE WITH THE POSITION OF YOUR ESTIMATES SHOW THIS DEMOGRAPHIC
EQUIPMENT AND THE USE OF WILL RISE FROM 46 MILLION TODAY TO 98
HEADPHONES. MILLION BY THE YEAR 2060. WITH MORE
ELDERLY PATIENTS SEEKING CARE,
D. STRATEGIES FOR ESTABLISHING FAMILIES WILL HAVE TO MAKE DIFFICULT
RAPPORT DECISIONS WHEN FIGURING OUT HOW TO
BEST CARE FOR THEIR LOVED ONE.
- DIRECTLY ACKNOWLEDGE THAT
TELEHEALTH SESSIONS CAN FEEL
AWKWARD. REASSURE OLDER ADULTS
THAT MOST PEOPLE FEEL INCREASINGLY
COMFORTABLE OVER TIME.

Ø ATTEMPT TO LOOK DIRECTLY AT THE

CAMERA AS MUCH AS POSSIBLE TO MIMIC
EYE CONTACT.
NCMB314: FINALS REVIEWER - WEEK 13 TO 17
NCMB314: Care of Older Adults

F. THE NEED FOR AFFORDABLE ELDERLY • TRANSITIONAL CARE FOR HEART

CARE
Ø ELDERLY PATIENTS TEND TO HAVE
COMPLEX HEALTHCARE NEEDS AS THEY
MANAGE A RANGE OF CONDITIONS AND
DISEASES. BUT GETTING ACCESS TO
HEALTHCARE CAN BE A CHALLENGE FOR
MANY ELDERLY PATIENTS, ESPECIALLY
FOR THOSE THAT LIVE IN RURAL AREAS.
AROUND 7 MILLION OLDER ADULTS ARE
CONSIDERED HOMEBOUND OR HAVE
TROUBLE LEAVING THEIR HOME
WITHOUT HELP.
• WITHOUT A LOVED ONE TO HELP THEM OR
A DEDICATED DRIVER, THESE
INDIVIDUALS MAY BE UNABLE TO VISIT
THEIR HEALTHCARE PROVIDER IN
PERSON, LEAVING THEM WITH FEW
ALTERNATIVES UNLESS THEY HAVE
ACCESS TO TELEHEALTH SERVICES.
G. HOW TELEHEALTH CAN IMPROVE
ACCESS TO ELDERLY CARE
Ø TELEHEALTH GIVES PATIENTS THE
OPTION TO CONSULT WITH THEIR
HEALTHCARE PROVIDER REMOTELY
USING LIVE VIDEO, AUDIO AND INSTANT
MESSAGING ON A TELEMEDICINE APP.
THIS REDUCES THE NEED FOR IN-PERSON
VISITS AND CONSULTATIONS, MAKING IT
EASIER FOR AT-HOME CAREGIVERS TO
MEET THE NEEDS OF THEIR LOVED ONES.
H. TELEHEALTH CAN HELP FAMILIES AND
ELDERLY PATIENTS IN THE FF WAYS:
Ø REDUCE THE BURDEN AND COST OF
CERTAIN TRAVEL EXPENSES
Ø REDUCE THE NUMBER OF UNNECESSARY
HOSPITAL VISITS
Ø REDUCE THE STRESS PUT ON AT HOME
CAREGIVERS
Ø IMPROVE OVERALL PATIENT
SATISFACTION
I. USING TELEHEALTH TO CARE FOR THE
ELDERLY
• PALLIATIVE CARE: AT HOME CAREGIVERS
CAN USE TELEHEALTH TO REPORT ON THE
CONDITION OF THEIR LOVED ONE AS
THEIR HEALTH CONTINUES TO
DETERIORATE WHILE RECEIVING
VALUABLE FEEDBACK AND ADVICE FROM
HEALTHCARE PROFESSIONALS.
FAILURE: AT HOME CAREGIVERS CAN USE
TELEHEALTH TO STAY ON TOP OF THEIR
LOVED ONE'S TREATMENT REGIMEN
FOLLOWING AN EPISODE OF HEART
FAILURE, INCLUDING DISPENSING
MEDICATIONS, DIET, PHYSICAL ACTIVITY,
AND MANAGING STRESS LEVELS.
• CHRONIC DISEASE MANAGEMENT:
TELEHEALTH HELPS AT-HOME
CAREGIVERS REPORT ON THE CONDITION
OF THEIR LOVED ONE, GIVING
HEALTHCARE PROVIDERS INSIGHT INTO
HOW THEIR DISEASE IS PROGRESSING
OVER TIME. CAREGIVERS CAN USE
TELEHEALTH TO STAY ON TOP OF
MEDICATIONS, DIETARY INFORMATION,
AND MENTAL AND PHYSICAL CHANGES.
• PRIMARY CARE FOR FRAIL INDIVIDUALS:
PATIENTS THAT HAVE TROUBLE MOVING
OR LEAVING THE HOUSE CAN USE
TELEHEALTH TO CONSULT WITH
HEALTHCARE PROFESSIONALS ON A
VARIETY OF PRIMARY HEALTHCARE
ISSUES AND CONCERNS, INCLUDING
JOINT PAIN, MUSCLE STIFFNESS,
MEDICATIONS, AND ACCIDENT
MANAGEMENT AND PREVENTION.
J. BENEFITS AND LMITATION
- AS THE COVID-19 PANDEMIC CONTINUES,
DEPRESSION AND ANXIETY ARE ON THE
RISE. AS A RESULT, MENTAL HEALTHCARE
PROVIDERS ARE BEING PUSHED TO
PROVIDE CARE TO MORE PATIENTS,
WHILE KEEPING THEMSELVES, THEIR
STAFF, AND PATIENTS SAFE.
- MANY ARE TURNING TO TELEHEALTH AS
A WAY TO PROVIDE TREATMENT TO
PATIENTS WHEN THEY CAN'T BE SEEN IN
PERSON. THE INTEGRATION OF
TELEHEALTH INTO TRADITIONAL
MEDICINE COULD REACH FAR BEYOND
THE PANDEMIC AND INTO THE FUTURE.
- TELEHEALTH DOES HAVE ITS POSITIVES
AND NEGATIVES, THOUGH. WHEN
IMPLEMENTING A PLAN FOR SENIORS AND
TELEHEALTH, HEALTHCARE PROVIDERS
SHOULD CONSIDER BOTH THE BARRIERS
AND OPPORTUNITIES TO CONDUCT THE
MOST EFFECTIVE TELEHEALTH VISITS
FOR THEIR PATIENTS AND THEMSELVES.
NCMB314: FINALS REVIEWER - WEEK 13 TO 17
NCMB314: Care of Older Adults

K. MENTAL HEALTHCARE PROVIDER, N. TO OVERCOME THESE OBSTACLES, HE

OLDER ADULTS, AND TELEHEALTH RECOMMENDS THAT PROVIDERS
CONSIDER USING THE 4MS
- THE AMERICAN ACADEMY OF FAMILY FRAMEWORK
PHYSICIANS (AAFP) DEFINES
TELEHEALTH AS "ELECTRONIC AND • ADDRESS WHAT MATTERS TO THE
TELECOMMUNICATIONS TECHNOLOGIES PATIENT IN TERMS OF THEIR GOALS,
AND SERVICES USED TO PROVIDE CARE PREFERENCES AND PRIORITIES
AND SERVICES AT A DISTANCE. "
• WHAT MEDICATIONS THEY CURRENTLY
- TELEPSYCHIATRY IS A SPECIFIC FORM OF TAKE
TELEHEALTH THAT, ACCORDING TO THE
AMERICAN PSYCHIATRIC ASSOCIATION • THEIR LEVEL OF COGNITIVE IMPAIRMENT
(APA), "CAN INVOLVE DIRECT OR MENTATION
INTERACTION BETWEEN A PSYCHIATRIST
AND THE PATIENT" AND INCLUDE • THEIR LEVEL OF MOBILITY
"PSYCHIATRISTS SUPPORTING PRIMARY
CARE PROVIDERS WITH MENTAL HEALTH • "USING THE 4MS FRAMEWORK IS A
CARE CONSULTATION AND EXPERTISE. " SIMPLE WAY TO PERSONALIZE
TELEMEDICINE AND MAKE IT MORE
L. WHY IS MENTAL TELEHEALTH SUPPORTIVE OF OLDER PATIENTS,"
IMPORTANT FOR OLDER PATIENTS? SOLBERG WRITES.

- AT THE TOP OF THE LIST IS ACCESS,
ACCORDING - TO THE APA. DURING THE
PANDEMIC, ACCESS IS VITAL, ESPECIALLY
SINCE SOME SENIORS MAY BE
IMMUNOCOMPROMISED. ADDITIONALLY,
BRINGING CARE TO THE PATIENT'S HOME
OR LOCATION VIA TELEHEALTH MAY
OPEN POSSIBILITIES FOR THOSE WHO
LIVE IN REMOTE OR RURAL AREAS TO
CONNECT MORE EASILY WITH MENTAL
HEALTHCARE SPECIALISTS.
M. THE APA SUGGEST SEVERAL OTHER
BENEFITS OF TELEHEALTH INCLUDING
• HOW TO MAKE TELEHEALTH EASIER FOR
OLDER PATIENTS
ENTREPRENEURAL OPPORTUNITIES
NURSE ENTREPRENEUR
- NURSES USE THEIR PROFESSIONAL
NURSING EXPERIENCE AND EDUCATION
TO START THEIR OWN BUSINESS IN THE
HEALTHCARE INDUSTRY
• DEVELOP AND SELL A HOME HEALTH
PRODUCT.

• "HELP INTEGRATE BEHAVIORAL HEALTH • OFFERING INDEPENDENT NURSING

CARE AND PRIMARY SERVICES, SUCH AS PATIENT CARE,
NURSING EDUCATION, HOME HEALTH
• ARE, LEADING TO BETTER OUTCOMES AND/OR CONSULTING SERVICES.

• REDUCE THE NEED FOR TRIPS TO THE
EMERGENCY ROOM
• REDUCE DELAYS IN CARE
• IMPROVE CONTINUITY OF CARE AND
FOLLOW-UP
• REDUCE THE NEED FOR TIME OFF WORK,
CHILDCARE SERVICES, ETC. TO ACCESS
APPOINTMENTS FAR AWAY
Ø NURSE WHO USES THEIR TRAINING,
KNOWLEDGE AND MEDICAL EXPERTISE
AS A NURSE TO CREATE AND DEVELOP
THEIR OWN BUSINESSES WITHIN THE
HEALTHCARE FIELD.
- NURSE ENTREPRENEURS BEGIN THEIR
CAREERS BY COMPLETING THEIR
ASSOCIATE'S DEGREE IN NURSING OR
BACHELOR OF SCIENCE IN NURSING
DEGREE AND PASS THE NCLEX-RN EXAM.

• REDUCE POTENTIAL TRANSPORTATION

BARRIERS, SUCH AS LACK OF
TRANSPORTATION OR THE NEED FOR
LONG DRIVES

• REDUCE THE BARRIER OF STIGMA"

NCMB314: FINALS REVIEWER - WEEK 13 TO 17
NCMB314: Care of Older Adults

- WHILE AN ADVANCED DEGREE IS NOT SKILLS AND QUALIFICATIONS ARE BENEFICIAL

REQUIRED FOR NURSE ENTREPRENEURS FOR NURSE
TO START THEIR OWN BUSINESS, MANY
NURSES MAY CONSIDER A DUAL • ADN OR BSN DEGREE AND VALID RN LICENSE
MASTER'S DEGREE PROGRAM
• PROFESSIONAL NURSING SPECIALTY
- IN ADDITION TO THE STANDARD NURSING EXPERIENCE
EDUCATION, NURSE ENTREPRENEURS
• BASIC BUSINESS SKILLS AND KNOWLEDGE
BENEFIT SIGNIFICANTLY FROM
LEARNING IMPORTANT BUSINESS SKILLS • GOOD COMMUNICATION SKILLS
SUCH AS MARKETING, ACCOUNTING AND
MANAGERIAL TECHNIQUES. • ABILITY TO WORK INDEPENDENTLY AND
WILLINGNESS
PROGRAM GOALS

• AN INITIATIVE OF DOLE, IN
COLLABORATION WITH BON-PRC, DOH,
PNA, UPCN, OHNAP AND OTHER
GOVERNMENT AND NON-GOVERNMENT
ENTITIES TO PROMOTE NURSE
ENTREPRENEURSHIP BY INTRODUCING A
HOME HEALTH CARE INDUSTRY IN THE
PHILIPPINES

KEY PROGRAM COMPONENTS

• THE PROJECT AIMS TO ENGAGE • NURSE ENTREPRENEURS HAVE THE

UNEMPLOYED NURSES ON FREEDOM TO SET THEIR OWN HOURS AND
COOPERATIVES AND ENTREPRENEURIAL THE FLEXIBILITY TO DETERMINE THEIR
MANAGEMENT OF NURSES' CLINICS THAT OWN WORK ENVIRONMENTS BASED ON
OFFERS REDUCED COST OF PRIMARY AND THE COMPANY THEY ESTABLISH.
HOME HEALTH CARE SERVICES TO
INDIGENT OR POOR RURAL CERTIFICATIONS OR CREDENTIALS
COMMUNITIES.
- A NURSE ENTREPRENEUR MAY FIND
• THE SELECTION OF AREAS MUST CERTAIN CERTIFICATIONS VALUABLE
CONSIDER THE BUSINESS VIABILITY OF BASED ON THE NATURE OF THEIR
ENTREPRENEURSHIP. BUSINESS.

• ENTREPRENURSE NURSES SHALL NURSE ENTREPRENEUR DO

ORGANIZE AMONG THEMSELVES AS AN
INSTITUTION AND/OR ORGANIZATION
(COOPERATIVE) MANNING AND RUNNING
A BUSINESS ENTERPRISE.
• THE COOPERATIVES DEPLOY LICENSED
NURSES TO POOR RURAL COMMUNITIES
WITH LITTLE OR NO ACCESS TO
BASICHEALTH CARE AND WITH
SUBSTANTIAL POPULATIONS OF SICK,
ELDERLY AND DISABLED PATIENTS ON A
ONE NURSE PER MONTH PER VILLAGE
BASIS.
• THE RESPONSIBILITIES OF A NURSE
ENTREPRENEUR USUALLY INCLUDES
ACTIVITIES RELATED TO RUNNING A
BUSINESS INCLUDING ACCOUNTING,
MARKETING OR SALES, AND DEVELOPING
A CUSTOMER BASE.
ROLES AND DUTIES OF A NURSE ENTREPRENEUR
• USE NURSING EDUCATION AND EXPERIENCE
• PROMOTE THE BUSINESS, INCLUDING
ADVERTISING AND SALES EFFORTS.

• THE NURSES WILL ACT BOTH AS HEALTH
EDUCATOR AND HEALTH CARE PROVIDER.
THEIR SERVICES WILL BE COMPENSATED
NO LESS THAN P1,000 PER VISIT BY THE
LGU, PHILHEALTH, HMOS, BY THE
PATIENTS THEMSELVES ON A PER VISIT
BASIS, OR FROM GRANTS FROM LOCAL
AND FOREIGN DONORS.
• HIRE AND MANAGE EMPLOYEES TO ASSIST IN
RUNNING THE BUSINESS
• TEND TO THE FINANCIAL SIDE OF RUNNING A
BUSINESS.
• PROVIDE HEALTHCARE PRODUCTS OR NURSING
SERVICES
NCMB314: FINALS REVIEWER - WEEK 13 TO 17
NCMB314: Care of Older Adults

ADVOCACY PROGRAMS RELEVANT TO THE WHO CAN ACCESS ADVOCACY SERVICES

CARE OF OLDER PERSON
- ANYONE WHO IS RECEIVING OR SEEKING
Ø THE ROLE OF AN ADVOCATE IN HEALTH TO RECEIVE GOVERNMENT- FUNDED
AND SOCIAL CARE IS TO SUPPORT A AGED CARE SERVICES, INCLUDING
VULNERABLE OR DISADVANTAGED FAMILY AND REPRESENTATIVES, ARE
PERSON AND ENSURE THAT THEIR RIGHTS ENTITLED TO ACCESS ADVOCACY
ARE BEING UPHELD IN A HEALTHCARE SERVICES. THIS INCLUDES PEOPLE WHO:
CONTEXT. HEALTH AND SOCIAL CARE
ADVOCACY MEANS SUPPORTING PEOPLE • LIVE IN AN AGED CARE HOME
WHO ARE UNABLE TO ENSURE THEIR
BEST INTERESTS ARE BEING TAKEN CARE • RECEIVE AGED CARE SERVICES IN THEIR
OF. IN THE MEDICAL PROFESSION, OWN HOME
ACTIVITIES RELATED TO ENSURING
ACCESS TO CARE, NAVIGATING THE • RECEIVE TRANSITION CARE
SYSTEM, MOBILIZING RESOURCES,
ADDRESSING HEALTH INEQUITIES, • ARE HELPING SOMEONE WHO IS
INFLUENCING HEALTH POLICY AND RECEIVING AGED CARE SERVICES.
CREATING SYSTEM CHANGE ARE KNOWN
AS HEALTH ADVOCACY.
LEGAL ADVOCACY
ADVOCACY SERVICES
- IS A RECOGNIZED STRATEGY TO ADDRESS
Ø ADVOCACY SERVICES SUPPORT THE SOCIAL FACTORS THAT INFLUENCE THE
RIGHTS OF ANYONE RECEIVING OR HEALTH OF POPULATIONS WITH COMPLEX
SEEKING TO RECEIVE AGED CARE CARE NEEDS. SUCH ADVOCACY CAN
SERVICES, AND EMPOWER OLDER PEOPLE IMPROVE HOUSING STABILITY, INCREASE
TO MAKE INFORMED DECISIONS ABOUT ACCESS TO PUBLIC BENEFITS THAT
THEIR CARE. AN AGED CARE ADVOCATE SUPPORT A HOST OF SOCIAL NEEDS,
CAN ASSIST THINGS LIKE: ASSURE THAT MEDICAL AND FINANCIAL
PROXY DECISION MAKERS ARE IN PLACE,
• INTERACTING WITH THE AGED CARE AND REDUCE PSYCHOSOCIAL DISTRESS.
SYSTEM
™ OLDER ADULTS ARE
• TRANSITIONING BETWEEN AGED CARE DISPROPORTIONATELY LIKELY TO HAVE
SERVICES COMPLEX MEDICAL NEEDS. LEGAL
ADVOCACY HAS BEEN RECOGNIZED AS
• KNOWING AND UNDERSTANDING THEIR INTEGRAL TO THE HEALTH AND HEALTH
RIGHTS CARE OF OLDER ADULTS IN THE MEDICAL
LITERATURE SINCE 1988, AND IN CURRENT
• MAKING DECISIONS ABOUT THE CARE MEDICARE QUALITY METRICS.
THEY RECEIVE ADDITIONALLY, SINCE 1965, THE OLDER
AMERICANS ACT HAS PROVIDED LEGAL
• OPTIONS FOR HAVING THEIR AGED CARE ASSISTANCE AS AN “ESSENTIAL SERVICE”
NEEDS BETTER MET AMONG OTHER AGING SUPPORTS SUCH AS
NUTRITION, TRANSPORTATION, AND IN-
• RESOLVING CONCERNS OR COMPLAINTS HOME CARE. UNDER THE ACT, STATE
WITH THE AGED CARE PROVIDER ABOUT AREA AGENCIES ON AGING MUST
THE SERVICES THEY RECEIVE PROVIDE LEGAL SERVICES FREE TO
ADULTS OLDER THAN AGE 60 WITH THE
• SPEAKING WITH THEIR SERVICE “GREATEST SOCIAL OR ECONOMIC NEED.”
PROVIDER AT THEIR DIRECTION
™ YET, WHILE EMERGING CARE MODELS
• INCREASING THEIR SKILLS AND FOR OLDER ADULTS WITH COMPLEX
KNOWLEDGE TO ADVOCATE FOR THEM NEEDS ARE HIGHLY MULTIDISCIPLINARY,
SELF. NONE INCORPORATE LEGAL ADVOCACY
IN THEIR DESIGN. THIS IS IN SOME WAYS
NOT SURPRISING AS CLINICIANS ARE NOT
TRAINED TO RECOGNIZE OR ADDRESS
LEGAL NEEDS OF OLDER PATIENTS, AND
OLDER PATIENTS ARE UNABLE TO SELF-
DIAGNOSE THEIR LEGAL PROBLEMS,
NCMB314: FINALS REVIEWER - WEEK 13 TO 17
NCMB314: Care of Older Adults
THUS MAKING IT UNLIKELY THAT THEY
WILL ARTICULATE LEGAL NEEDS AS SUCH
TO HEALTH CARE PROVIDERS, SOCIAL
WORKERS, OR CASE MANAGERS.
™ IN ADDITION, FUNDING MECHANISMS FOR
HEALTH CARE AND SOCIAL SERVICES—
ESPECIALLY CIVIL LEGAL SERVICES—ARE
HIGHLY SOLOED AND DEEPLY
ASYMMETRICAL. HISTORICAL
UNDERINVESTMENT IN CIVIL LEGAL
SERVICES FOR THE POOR HAS LED TO A
SHORTFALL IN THE LEGAL WORKFORCE
SERVING THIS POPULATION. THIS MAY
PROVIDE ANOTHER EXPLANATION FOR
WHY LEGAL ADVOCACY HAS NOT BEEN
PARTICULARLY VISIBLE TO HEALTH
SYSTEMS: LEGAL ADVOCATES ARE
FOCUSED ON EMERGENCY LEGAL NEEDS
SUCH AS LOSS OF HOUSING, NEGLECT
AND EXPLOITATION, AND LOSS OF PUBLIC
BENEFITS. ALTHOUGH THESE NEEDS
COULD BE BETTER SERVED THROUGH
PREVENTIVE AND PRIMARY LEGAL
ADVOCACY DELIVERED HOLISTICALLY IN
COORDINATION WITH OTHER SOCIAL
SERVICES AND HEALTH CARE, FUNDING
LEVELS HAVE NOT ENABLED SUCH AN
APPROACH.
HEALTHY PEOPLE INITIATIVES
ITS MISSION WAS TO:
™ THE FEDERAL GOVERNMENT HAS BEEN
ESTABLISHING GOALS FOR HEALTHY
AGING SINCE 1980 WHEN THE U.S. PUBLIC
HEALTH SERVICE PUBLISHED THE REPORT
PROMOTING HEALTH/ PREVENTING
DISEASE OBJECTIVES FOR THE NATION.
THIS 1980 REPORT OUTLINED 226
OBJECTIVES FOR THE NATION TO
ACHIEVE OVER THE FOLLOWING 10
YEARS. IT WAS REFERRED TO BY SOME AS
HEALTHY PEOPLE 1990.
™ A DECADE LATER, IN 1990, ANOTHER10-
YEAR NATIONAL EFFORT, HEALTHY
PEOPLE 2000, WAS INITIATED BY THE U.S.
PUBLIC HEALTH SERVICE IN ANOTHER
EFFORT TO REDUCE PREVENTABLE DEATH
AND DISABILITY FOR AMERICANS. A
THIRD EFFORT IS CURRENTLY UNDER WAY
WITH THE HEALTHY PEOPLE 2010
INITIATIVE; HOWEVER THE NUMBER
OBJECTIVES HAS INCREASED TO 467, AND
THESE ARE DISTRIBUTED OVER 28
PRIORITY AREAS.
™ THERE ARE SOME NOTABLE BENEFITS TO
THE HEALTHY PEOPLE INITIATIVES. ON
THE POSITIVE SIDE, THESE INITIATIVES
GIVE RECOGNITION TO HEALTH
PROMOTION RATHER THAN FOCUSING
EXCLUSIVELY ON WARS ON DISEASE (E.G.
TABULATING THE NUMBER OF DEATHS
FROM CANCER OR HEART DISEASE, AND
THEN ORGANIZING A CAMPAIGN AGAINST
THEM). THE HEALTHY PEOPLE
INITIATIVES ARE HEALTH ORIENTED, AND
AS SUCH THEY RECOGNIZE THE
COMPLEXITY OF THE SOCIOECONOMIC,
LIFESTYLE, AND OTHER NONMEDICAL
INFLUENCES THAT IMPACT OUR ABILITY
TO ATTAIN AND MAINTAIN HEALTH.
HEALTHY PEOPLE 2020
™ HEALTHY PEOPLE 2020 WAS THE FOURTH
ITERATION OF THE HEALTHY PEOPLE
INITIATIVE. LAUNCHED IN DECEMBER
2010, HEALTHY PEOPLE 2020 SET AN
AMBITIOUS YET ACHIEVABLE 10-YEAR
AGENDA FOR IMPROVING THE NATION’S
HEALTH.
™ THE VISION FOR HEALTHY PEOPLE 2020
WAS “A SOCIETY IN WHICH ALL PEOPLE
LIVE LONG, HEALTHY LIVES.”
• IDENTIFY NATIONWIDE HEALTH
IMPROVEMENT PRIORITIES
• INCREASE PUBLIC AWARENESS AND
UNDERSTANDING OF THE DETERMINANTS
OF HEALTH, DISEASE, AND DISABILITY
AND THE OPPORTUNITIES FOR PROGRESS
• PROVIDE MEASURABLE OBJECTIVES AND
GOALS THAT ARE APPLICABLE AT THE
NATIONAL, STATE, AND LOCAL LEVELS
• ENGAGE MULTIPLE SECTORS TO TAKE
ACTIONS TO STRENGTHEN POLICIES AND
IMPROVE PRACTICES THAT ARE DRIVEN
BY THE BEST AVAILABLE EVIDENCE AND
KNOWLEDGE
• IDENTIFY CRITICAL RESEARCH,
EVALUATION, AND DATA COLLECTION
NEEDS
NCMB314: FINALS REVIEWER - WEEK 13 TO 17
NCMB314: Care of Older Adults
HEALTHY PEOPLE 2020 SET OVERARCHING GOALS
TO:
• ATTAIN HIGH-QUALITY, LONGER LIVES
FREE OF PREVENTABLE DISEASE,
• DISABILITY, INJURY, AND PREMATURE
DEATH
• ACHIEVE HEALTH EQUITY, ELIMINATE
DISPARITIES, AND IMPROVE THE HEALTH
OF ALL GROUPS
• CREATE SOCIAL AND PHYSICAL
ENVIRONMENTS THAT PROMOTE GOOD
HEALTH FOR ALL
• PROMOTE QUALITY OF LIFE, HEALTHY
DEVELOPMENT, AND HEALTHY
BEHAVIORS ACROSS ALL LIFE STAGES
HEALTHY PEOPLE 2020 LAW AND HEALTH POLICY:
• THE HEALTHY PEOPLE 2020 LAW AND
HEALTH POLICY PROJECT AIMED TO
RAISE AWARENESS OF THE IMPACT THAT
LEGAL OR POLICY INTERVENTIONS CAN
HAVE ON PUBLIC HEALTH. THE PROJECT
WAS A PARTNERSHIP BETWEEN ODPHP,
CDC, THE CDC FOUNDATION, AND THE
ROBERT WOOD JOHNSON FOUNDATION.
• THESE ORGANIZATIONS WORKED WITH
SUBJECT MATTER EXPERTS AND FEDERAL
STAKEHOLDERS TO CREATE REPORTS,
WEBINARS, AND PRODUCTS TO
HIGHLIGHT LAWS AND POLICIES WITH
THE POTENTIAL TO IMPACT SPECIFIC
HEALTHY PEOPLE 2020 TOPIC AREAS AND
OBJECTIVES.
ADVANCING PUBLIC HEALTH THROUGH LAW AND
POLICY
• LAW AND POLICY ARE AMONG THE MOST
EFFECTIVE TOOLS TO IMPROVE HEALTH.
MANY OF THE GREATEST PUBLIC HEALTH
SUCCESSES IN THE UNITED STATES ARE
THE RESULT OF LEGAL OR POLICY
INTERVENTIONS, SUCH AS SMOKE-FREE
AIR LAWS AND MANDATORY SEATBELT
LAWS.1 YET MANY PEOPLE MAY NOT BE
AWARE OF THE PRECISE IMPACT THESE
INTERVENTIONS AND APPROACHES CAN
HAVE ON POPULATION HEALTH.
LAW AND HEALTH POLICY RESOURCES
• PROJECT PARTNERS WORKED WITH
SUBJECT MATTER EXPERTS AND FEDERAL
STAKEHOLDERS TO DEVELOP A SERIES OF
HEALTHY PEOPLE 2020 TOPIC-SPECIFIC
REPORTS, WEBINARS, AND OTHER
EVIDENCE- BASED PRODUCTS SUCH AS
INFOGRAPHICS AND SUCCESS STORIES,
OR BRIGHT SPOTS. THESE RESOURCES
AND PUBLICATIONS HIGHLIGHT LAWS
AND POLICIES WITH THE POTENTIAL TO
IMPACT SPECIFIC HEALTHY PEOPLE 2020
TOPIC AREAS AND OBJECTIVES,
INCLUDING LEADING HEALTH
INDICATORS.
REVIEW DIFFERENT RESOURCES PRODUCED BY
THE LAW AND HEALTH POLICY PROJECT:
• DISABILITY AND HEALTH
• HEALTHCARE-ASSOCIATED INFECTIONS
• HEALTH EQUITY
• HEALTHY PEOPLE 2030
• LEADING HEALTH INDICATORS
• MATERNAL, INFANT, AND CHILD HEALTH
• MENTAL HEALTH AND MENTAL
DISORDERS
• NUTRITION AND WEIGHT STATUS
• ORAL HEALTH
• POLICY LEVERS
• SUBSTANCE ABUSE
MODEL HEALTH PROMOTION PROGRAMS FOR
OLDER ADULTS
- ONE OF THE MORE RECENT EFFORTS IN
THIS REGARD HAS BEEN ORGANIZED BY
THE HEALTH PROMOTION INSTITUTE (HPI)
OF THE NATIONAL COUNCIL IN AGING. HPI
STARTED BY SUMMARIZING 16 MODEL
PROGRAMS OR BEST PRACTICES AND
COMPILING THEM INTO A LOOSE-LEAF
DIRECTORY. THE SUMMARIZES INCLUDED
INFORMATION ON THE PLANNING
PROCESS, IMPLEMENTATION OF THE
PROGRAM, AND PROGRAM EVALUATIONS.
NCMB314: FINALS REVIEWER - WEEK 13 TO 17
NCMB314: Care of Older Adults
SIX MODEL HEALTH PROMOTION PROGRAMS
- THAT HAVE BEEN FOCUSED ON OLDER
ADULTS AND HAVE RECEIVED NATIONAL
ATTENTION, RECEIVED FEDERAL
FUNDING AND FOUNDATION SUPPORT TO
EVALUATE THEIR EFFECTIVENESS AND TO
ENCOURAGE THEIR REPLICATION.
1. HEALTHWISE
Ø THE BEST-KNOWN OLDER ADULT
MEDICAL SELF-CARE PROGRAM IS
HEALTHWISE. IT PROVIDES INFORMATION
AND PREVENTION TIPS ON 190 COMMON
HEALTH PROBLEMS, WITH INFORMATION
PERIODICALLY UPDATED. THE
HEALTHWISE HANDBOOK
(HEALTHWISE,2006)IS NOW IN ITS 17TH
EDITION. THIS HANDBOOK INCLUDES
PHYSICIAN-APPROVED GUIDELINES ON
WHEN TO CALL A HEALTH PROFESSIONAL
FOR EACH OF THE HEALTH PROBLEMS ITS
COVER.
Ø WITH THE ASSISTANCE OF A $2.1 MILLION
GRANT FROM ROBERT WOOD JOHNSON
FOUNDATION, HEALTHWISE DISTRIBUTED
ITS MEDICAL SELF-CARE GUIDE TO 125,000
IDAHO HOUSEHOLDS, ALONG WITH TOLL
FREE NURSE CONSULTATION PHONE
SERVICE AND SELF-CARE WORKSHOPS.
THIRTY-NINE PERCENT OF HANDBOOK
RECIPIENTS REPORTED THAT THE
HANDBOOK HELPED THEM AVOID A VISIT
TO THE DOCTOR. BLUE CROSS OF IDAHO
REPORTED 18% FEWER VISITS TO THE
EMERGENCY ROOM BY OWNERS OF THE
GUIDE.
2. CHRONIC DISEASE MANAGEMENT
™ KATE LORIG, A NURSE-RESEARCHER AT
THE STANDFORD UNIVERSITY SCHOOL OF
MEDICINE, AND HER MEDICAL
COLLEAGUES HAVE BEEN EVALUATING
COMMUNITY-BASED, PEER-LED,CHRONIC
DISEASE SELF- MANAGEMENT
PROGRAMS FOR MORE THAN TWO
DECADES, BEGINNING WITH THE
ARTHRITIS SELF-MANAGEMENT
PROGRAM (LORIG ET AI.,1986) THIS
PROGRAM HAS SINCE EVOLVED INTO A
CURRICULUM THAT IS APPLICABLE TO A
WIDE ARRAY OF CHRONIC DISEASES AND
CONDITIONS.
™ TYPICALLY, EACH PROGRAM INVOLVES
ABOUT A DOZEN PARTICIPANTS, LED BY
PER LEADERS WHO HAVE RECEIVED 20
HOURS OF TRAINING. THE PEER LEADERS,
LIKE THE STUDENTS, ARE
™ TYPICALLY OLDER AND HAVE CHRONIC
DISEASES THAT THEY CONTEND WITH.
THE PROGRAM CONSISTS OF SIX WEEKLY
SESSIONS ABOUT 2 1⁄2 HOURS LONG EACH,
WITH A CONTENT FOCUS ON EXERCISE,
SYMPTOM MANAGEMENT, NUTRITION,
FATIGUE AND SLEEP MANAGEMENT, USE
OF MEDICATIONS, MANAGING EMOTIONS,
COMMUNITY RESOURCES,
COMMUNICATING WITH HEALTH
PROFESSIONALS, PROBLEM SOLVING,
AND DECISION MAKING. THE PROGRAM
TAKES PLACE IN COMMUNITY SETTINGS
SUCH AS SENIORS CENTERS, CHURCHES,
AND HOSPITALS.
™ THE THEORETICAL BASIS OF THE
PROGRAM HAS BEEN TO PROMOTE A
SENSE OF PERSONAL EFFICACY AMONG
PARTICIPANTS BY USING SUCH
TECHNIQUES AS GUIDED MASTERY OF
SKILLS, PEER MODELING,
REINTERPRETATION OF SYMPTOMS,
SOCIAL PERSUASION THROUGH GROUP
SUPPORT, AND INDIVIDUAL SELF-
MANAGEMANT GUIDANCE.
3. PROJECT ENHANCE
™ SENIOR SERVICES OF SEATTLE/KING
COUNTY BEGAN THE SENIOR WELLNESS
PROJECT (LATER RENAMED PROJECT
ENHANCE) IN 1997 AT THE NORTH SHORE
SENIOR CENTER IN BOTHELL,
WASHINGTON. IT WAS A RESEARCH-
BASED HEALTH PROMOTION PROGRAM
THAT INCLUDED A COMPONENT OF
CHRONIC CARE SELF – MANAGEMENT
THAT WAS MODELEDAFTER KATE LORIG’S
PROGRAM(LORIG ET AL.,1999) THE
PROGRAM ALSO INCLUDED HEALTH AND
FUNCTIONAL ASSESSMENTS; INDIVIDUAL
AND GROUP COUNSELING; EXERCISE
PROGRAMS; A PERSONAL HEALTH ACTION
PLAN WITH THE SUPPORT OF A NURSE,
SOCIAL WORKER, AND VOLUNTEER
HEALTH MENTOR; AND SUPPORT GROUPS.
A RANDOMIZED CONTROLLED STUDY OF
CHRONICALLY ILL SENIORS REPORTED A
REDUCTION IN A NUMBER OF HOSPITAL
STAYS AND AVERAGE LENGTH OF STAY, A
REDUCTION IN PSYCHOTROPIC
MEDICATIONS, AND BETTER
FUNCTIONING IN ACTIVITIES OF DAILY
LIVING.
NCMB314: FINALS REVIEWER - WEEK 13 TO 17
NCMB314: Care of Older Adults

4. ORNISH PROGRAM FOR REVERSING USER’S GUIDE. THE PROGRAM WAS

HEART DISEASE DESIGNED BY PHYSICAL THERAPISTS FOR
HOME USE BY OLDER ADULTS, AND
™ DR. DEAN ORNISH, A PHYSICIAN AT THE RELIES ON ELASTIC RESISTIVE BANDS
UNIVERSITY OF CALIFORNIA AT SAN FOR STRENGTHENING MUSCLES. THE
FRANCISCO AND FOUNDER OF THE EXERCISE PROGRAM LED TO HIGH RATE
PREVENTIVE MEDICINE RESEARCH OF EXERCISE ADHERENCE AMONG OLDER
INSTITUTE, HAS DEVELOPED A PROGRAM PARTICIPANTS, AS WELL AS INCREASED
FOR REVERSING HEART DISEASE THAT LOWER EXTREMITY STRENGTH,
HAS BEEN REPLICATED AT SEVERAL SITES IMPROVEMENTS IN TANDEM GAIT, AND A
AROUND THE COUNTRY. DR. ORNISH REDUCTION IN PHYSICAL DISABILITY
(1992) HAS RECOMMENDED A (JETTE ET AL., 1999)
VEGETARIAN DIET WITH FAT INTAKE OF
10% OR LESS OF TOTAL CALORIES, TERMINOLOGIESL:
MODERATE AEROBIC EXERCISE AT LEAST
THREE TIMES A WEEK, YOGA AND ADVOCACY
MEDITATION AN HOUR A DAY, GROUP
SUPPORT SESSIONS, AND SMOKING - PUBLIC SUPPORT FOR OR
CESSATION. RECOMMENDATION OF A PARTICULAR
CAUSE OR POLICY. "THEIR ADVOCACY OF
™ DR. ORNISH AND HIS COLLEAGUES HAVE TRADITIONAL FAMILY VALUES"
REPORTED THAT AS A RESULT OF THEIR
PROGRAM, BLOCKAGES IN ARTERIES
HAVE DECREASED IN SIZE, AND BLOOD
FLOW HAS IMPROVED IN AS MANY AS 82%
OF THEIR HEART PATIENTS( GOULD ET
AL.,1995). A FIVE YEAR FOLLOW-UP OF
THIS PROGRAM REPORTED AN 8%
REDUCTION IN ATHEROSCLEROTIC
PLAQUES, WHILE THE CONTROL GROUP
HAD A 28% INCREASE.

5. BENSON’S MIND / BODY MEDICAL INSTITUTE

™ DR. HERBERT BENSON IS A PHYSICIAN

AFFILIATED WITH HARVARD MEDICAL
SCHOOL, AND BEST KNOWN FOR HIS BEST-
SELLING BOOKS ON THE RELAXATION
RESPONSE AND FOR POPULARIZING THE
TERM MIND/BODY MEDICINE. FOR
INDIVIDUALS FEELING THE NEGATIVE
EFFECTS OF STRESS, BENSON’S PROGRAM
TEACHES THEM TO ELICIT THE
RELAXATION RESPONSE, A WESTERN
VERSION OF MEDITATION. THE BENSON-
HENRY INSTITUTE FOR MIND/BODY
MEDICINE’S CLINICAL PROGRAMS TREAT
PATIENTS WITH A COMBINATION
RESPONSE TECHNIQUES, PROPER
NUTRITION AND EXERCISE, AND THE
REFRAMING OF NEGATIVE THINKING
PATTERNS.

6. STRONG FOR LIFE

™ THE STRONG FOR LIFE PROGRAM IS A

HOME-BASED EXERCISE PROGRAM FOR
DISABLED AND NONDISABLED OLDER
ADULTS. IT FOCUSES ON STRENGTH AND
BALANCE, AND PROVIDES AN EXERCISE
VIDEO, A TRAINER’S MANUAL, AND A