Gerontological

1
Gerontological Community Based Nursing

• Culture Aging
• Professor Adrianne Maltese

2
Cultural changes in aging population

• By 2060 persons of color to represent 50 of
  population
• Hispanic, Asian Pacific Islanders will have
  greatest increase.
• Need to reduce health disparities
• Nurses to be culturally competent aware

3
Cultural awareness -gt cultural competence

• Awareness the ability to recognize the presence
  of isms such as racism.
• Openness self-reflection necessary.
• Robert Butler ageism
• Most reflective in Euro-American culture

• Cultural competence- ability to put cultural
  knowledge to use in assessment, communication,
  negotiation and intervention
• Use of cross-cultural nursing skills

4
Culture and Aging

• Sensitivity to the knowledge of
  similarities/differences between people of
  different cultural backgrounds is vital to the
  establishment of positive relationships and
  communication.
• Basic understanding of differing values,
  experiences, social networks, communication
  styles and perceptions of health/illness

5
Cultural Implications and Aging

• Ethnic elders often have health beliefs that are
  different from that of the biomedical or Western
  health system used by many health care
  professionals in the U.S.
• Determination of elders health beliefs
• Working with an Interpreter
• (box-4-3 p. 54)

6

• What familial and cultural views of aging and
  the elderly do you hold?
• How would you alter care to meet elders cultural
  needs?

7
Chronic Illness

• Most disorders of aging are chronic ones that
  must be treated within a framework of lifestyle
  changes, living situation adaptations, and
  attention to the whole person coping with the
  disorder
• Burggraf, Barry 1996
• 88 of older adults have at least one chronic
  illness 50 have at least two(Zauszniewski et
  al, 2007)
• Most common arthritis hypertension

8
Wellness in Chronic Illness

• Greatest factor in establishing a sense of
  wellness in the face of chronic illness is
  adaptation.
• Nurses help patients assist clients toward
  enriched capacity for living in the shadow of
  chronic illnessmany of which are common in the
  older adult

9
Theoretical Frameworks for Chronic Illness

• Maslows Hierarchy of Needs goal of wellness
  approach -gt assist older adult to meet as many of
  basic needs as possible.
• Chronic Illness Trajectory- (Corbin Strauss
  1988) view of living with a chronic illness as a
  trajectory that traces the progression of a
  chronic illness through 8 phases.

10
Phases of Chronic Illness Trajectory

• 1.) Pretrajectory preventative phase
• 2.) Trajectory onset - definitive phase
• 3.) Crisis Phase
• 4.) Acute Phase
• 5.) Stable Phase
• 6.) Unstable Phase
• 7.) Downward Phase
• 8.) Dying Phase

11
Shifting Perspective Model of Chronic
Illness(Paterson 2001)

• Model views living with chronic illness as an
  ongoing- continuously shifting process person
  moves between wellness or illness in the
  foreground.
• Insider perspective of chronic illness
• Concept of client as partner - in care
• Focus on health within illness

12
The 5 Cs of Caring (Simone Roach 1992)

• Competence
• Compassion
• Conscience
• Commitment
• Confidence
• So how do we utilize these caring concepts?

13
Common Disorders of Ageing

• Cardiovascular Respiratory disorders

14
Common Chronic - Cardiovascular Disorders

• Hypertension Most common Goal 120/60 mm Hg
• Coronary Artery Disease gt risk for silent MI
• Heart Failure a result of CHD (65 -75 of
  hospitalized persons dx of HF 80 were gt 65
  years old
• Peripheral Vascular Disease

15
(No Transcript)
16
Assessment -Cardiovascular

• Obtain pertinent history
• Monitor vital signs
• Lab results
• Kidney functions
• Assess cardiac respiratory function
• Conduct mental status exam
• Examine changes in clients abilities
• ADLs,
• Quality of sleep
• Dyspnea (shortness of breath)

17
Goals for elders with CVD

• Goals
• relief of symptoms
• Improve/maximize function/ quality of life
• Reduce morbidity/mortality
• Slow progression of dysfunction

18
Interventions-CVD

• Education/teaching life-style changes/diet
• Monitor s/sx of CHF
• Monitor fluid intake/output/diet
• Monitor weight daily/biweekly/weekly
• Ausculate heart lung sounds
• Monitor lab values
• Cardiac rehab programs
• Provide comfort measures- in end-of life care if
  palliative/hospice care is indicated

19

• Monitor risk for exercise related orthostatic
  hypotension r/t ?in baroreceptor responsiveness
• Exercise in climate controlled environment
• Alter lifestyle smoking, diet, emotions

20
Coronary Heart disease
21
Chronic Respiratory Disease

• Chronic Obstructive Pulmonary Disease (COPD)
• Pneumonia
• Tuberculosis

22
Chronic Respiratory Disease

• Infectious Acute Chronic Respiratory diseases
• Can involve upper or lower respiratory tract
• Obstructive (prevents airflow out r/t narrowing
  of respiratory structures)
• vs. Restrictive (decreased lung capacity r/t
  limited expansion of lungs)

23
Chronic obstructive Pulmonary Disease - COPD

• By 2020 3rd leading cause of death
• Includes asthma, bronchitis, emphysema
• Activity intolerance r/t obstructive airways

24
View of COPD
25
COPD - elderly

• People with COPD can still lead productive lives.
• Coughing
• Wheezing
• Chest tightness
• Shortness of breath

26
Pneumonia

• Bacterial vs. viral Lower respiratory tract
• Inflammation of lung tissue
• Pneumonia Influenza 4th leading cause of
  death persons gt 65 years old.
• Community vs. nosocomial
• Predisposed with comorbid alcoholism, asthma,
  COPD, heart disease

27
Assessment of elder clients with Respiratory
Disorders

• Assess monitor
• Oxygen saturation level
• Cough- onset/characteristics/sputum production
• Subjective reports of dyspnea
• Functional mental status exam
• Effects on functional status quality of life
• (refer to Box 20-8 Ebersole text)

28
Goals for clients with Respiratory disorders

• Goals
• stabilize disease
• reduce risk of exacerbations/hospitalizations
• Promote maximal functioning
• Prevent disability

29
Interventions for elder clients with
respiratory disorders

• Utilize interdisciplinary team
• Provide education regarding-
• Safe use of Oxygen Safe exercises
• Coping strategies stress reduction
• Nutrition/Diet monitor intake /weight loss
• Monitor activity exercise tolerance
• Educate re medications/inhalers (mouth care)
• Discuss rehabilitation programs/strategies

30
Mycobacterium tuberculosis
31
TB disease in elder population

• Constitutes a large proportion of TB cases in the
  U.S.
• Many have latent TB infection
• Immune function declines
• Increased risk of developing active TB disease
• Employees in long-term care facilities at risk of
  occupational exposure to TB. 

32
TB screening

• Nurses responsibility to screening for TB using
  the two step TB skin test (TST) or blood assay
  for Mycobacterium tuberculosis (BMAT)
• Cannot admit to LTC unless adequate environmental
  controls are available

33
Caring concepts