Chapter 10: Promoting Independence in Later Life

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Chapter 10 Promoting Independence in Later Life

• Bonnie M. Wivell, MS, RN, CNS

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Maintaining Independence

• Many factors contribute to the ability of older
  adults to continue their independence
• Maintaining maximum independence while
  maintaining maximum QOL

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Influences of Environment and Living Situation

• Living skills
• Kohlman Evaluation of Living Skills
• Self-care
• Safety and health
• Money management
• Transportation and phone use
• Work and leisure
• Housing influences
• Assist with decision
• Distribution of belongings
• Fiscal considerations

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Self-Care

• Maintaining interests
• Doing for others
• Frailty general decline in physical function
  that may increase vulnerability to illness and
  decline
• Exhaustion
• Grip strength
• Walking speed
• Low caloric expenditure

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Role Changes/Transitions

• Retirement
• Health to illness
• Loss of a spouse
• Widows/Widowers
• Divorce
• Role reversal care provider to care recipient
• Driving a car
• Strong emotional and psychological implications

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Role Changes/Transitions

• IADLs shopping, errands
• ADLs personal care
• Caregiving often needed long before accepted

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Caregiving Options

• Settings
• Senior living complex
• Assisted living
• Paid caregivers
• Extended care facilities
• Family
• Stressors
• Time
• Cost
• Use of humor can provide stress relief

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Socialization

• Maintaining connection to others
• Relationships
• Companionship

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PsychoSocial and Spiritual Influences

• Stress management
• Expression of emotion
• Exercise
• Deep breathing
• Day dreaming/Guided imagery
• Progressive relaxation
• Meditation
• Goal attainment

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Maximizing Function

• Many factors influence the ability of the older
  adult to maintain and maximize function
• So you want to live to be 100. Well, start with
  this No smoking, no drinking, no chewing. And
  always clean your plate. Well, you can drink a
  little bit, but not much!

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Preventing Complications of Existing Illness or
Disease

• Nutrition
• Sleep
• Exercise
• Fall prevention

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Value of Rehabilitation

• Goals
• Promote independence
• Maximize function
• Prevent complications
• Promote quality of life

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Use of/Alternatives to Restraints

• Personal strengthening and rehab program
• Use of personal assistance devices such as
  hearing aids, visual aids and mobility devices
• Use of positioning devices such as body and seat
  cushions, padded furniture
• Safer physical environment design, including
  removal of obstacles that impede movement,
  placement of objects and furniture in familiar
  places, lower beds, adequate lighting

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Use of/Alternatives to Restraints

• Regular attention to physical and personal needs,
  including toileting, thirst, hunger,
  socialization, and activities adapted to current
  ability and former interests
• Design of physical environment for close
  observation of staff
• Efforts to increase staff awareness of persons
  individual needs including assignment of staff
  particularly to the person, in effort to improve
  function and decrease difficult behaviors.

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Use of/Alternatives to Restraints

• Living environment designed to promote relaxation
  and comfort, minimize noise, provide soothing
  music and appropriate lighting
• Provision of massage, art, movement activities
• Use of bed, chair and door alarms to alert to the
  need for assistance

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Financial Considerations

• Help as needed
• Medicare/Medicaid
• Food stamps
• Grants
• Church programs/pantries
• AARP and other aging agencies for the state or
  county

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Community Resources

• Know what is available in your own community
• Senior centers
• Wellness programs through hospitals
• Church groups for socialization and support
• VNA/Hospice when needed

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Community Resources

• Problem-based support groups
• Meals on Wheels
• Geriatric case management
• Eldercare facilities
• Community clinics

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Other Recommendations to Promote Healthy Aging

• Eat breakfast every day.
• Select high-fiber food like whole grain breads
  and cereals, beans, vegetables, and fruits.
• Have three servings of low-fat milk, yogurt or
  cheese a day. Dairy products are high in calcium
  and vitamin D and help keep your bones strong as
  you age. Or take a calcium and vitamin D
  supplement.

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Other Recommendations to Promote Healthy Aging

• Drink plenty of water. You may notice that you
  feel less thirsty as you get older, but your body
  still needs the same amount of water.
• Ask your health care provider about ways you can
  safely increase the amount of physical activity
  you do now.

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Other Recommendations to Promote Healthy Aging

• Fit physical activity into your everyday life.
  For example, take short walks throughout your
  day. You do not have to have a formal physical
  activity program to improve your health and stay
  active.
• Get enough sleep.
• Stay connected with family, friends and
  community.

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Chapter 11 Promoting Healthy Aging

• Bonnie M. Wivell, MS, RN, CNS

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Healthy People 2000 and 2010 Initiatives

• Purpose
• Health promotion
• Document baselines
• Set objectives
• Monitor progress
• Healthy People 2000 target goals
• Met for mammogram screening and influenza
  vaccination
• Fell short for
• Pneumococcal vaccination
• Physical activity, overweight, eating fruits and
  vegetables
• Reducing hip fractures, and fall-related deaths
• Toolkit for HP 2010 available at
  http//www.health.gov/healthypeople/state/toolkit

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Medicare Coverage

• Nutrition therapy for persons with diabetes and
  kidney disease
• An initial physical examination that includes
  prevention counseling
• Smoking cessationfor those who have an illness
  caused by or complicated by tobacco use
• Comprehensive health promotion programs for
  beneficiaries with heart problems

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Health Behavior Change

• Theory that attempts to explain the processes
  underlying the learning of new health behaviors
• Health contract/calendar
• Initial assistance from clinician
• Relies on self-management capabilities of
  individual

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Recommendations for Healthy Aging

• Exercise
• 30 minutes on most days of the week
• Walking indoors in inclement weather
• Neighborhoods can contribute to less exercise
• http//topics.healthvideo.com/m/26757081/exercise-
  can-help-you-live-longer.htm
• http//topics.healthvideo.com/m/28352903/volunteer
  ing-could-be-healthy-for-the-elderly.htmehealthy-
  agingbrand_namehealthline
• Nutrition
• See Nutrition Bulls-eye
• Goal is to consume foods in center

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Mental Health

• http//medicalnewstoday.healthology.com/hybrid/hyb
  rid-autodetect.aspx?content_id2516focus_handle
  brand_namemedicalnewstoday
• Life review autobiography saved in print or on
  other media
• Stronger life satisfaction, promote feeling of
  well-being, improved self-esteem, reduced
  depression
• Depression
• Increases likelihood of death from cancer and
  heart disease
• Suicide older adults account for 25 of all
  suicide deaths

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Model Health Promotion Programs

• Healthwise
• Developed in Boise, Idaho
• Handbook in 17th edition
• 190 common health problems
• Chronic Disease Self-Management Program
• Nurse researcher at Stanford University SOM
• Peer-led, community based
• Project Enhance
• Enhance fitness
• Enhance wellness, which focuses on mental health

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Model Health Promotion Programs

• Ornish Program for Reversing Heart Disease
• Vegetarian diet
• Fat intake of 10 or less of total calories
• Moderate aerobic exercise 3 x/week
• Yoga and meditation an hour a day
• Support groups
• Smoking cessation
• Bensons Mind/Body Medical Institute
• MD affiliated with Harvard Medical School
• Relaxation response to stress
• Proper nutrition and exercise
• Reframe negative thinking patterns

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Model Health Promotion Programs

• Strong for Life
• Home based exercise program
• For disabled and nondisabled older adults
• Focuses on strength and balance
• Exercise video, trainers manual, and users
  guide

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The Boomers

• Longest-lived
• Best-educated
• Healthiest
• Most-engaged
• Largest cohort of retirees ever
• 35 million age 65 or older in 2000 to more than
  70 million in 2030

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Greenhouses

• Alternative to nursing homes
• Robert Wood Johnson Foundation grant
• Promote autonomy
• A home environment
• Own private room and bath
• Not in all states yet (under development in
  Akron, CO)
• Employee turnover rate is much lower than in
  nursing home
• Better pay
• Empowerment
• 15 staff ratio
• 120 RN ratio
• 1120 administrator ratio

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Watch Video

• YouTube
• Greenhouse alternative to nursing homes

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Chapter 22 Promoting Quality of Life

• Bonnie M. Wivell, MS, RN, CNS

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Quality of Life (QOL)

• Definition
• Complex concept
• Satisfaction/dissatisfaction with life
• A persons sense of well-being
• As we age, QOL is dependent on our ability to
  maintain autonomy and independence

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Ferrell and Grant QOL Model
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Successful vs. Active Aging

• Successful aging
• Person has avoided disease and disease-related
  disability
• Has a high level of cognitive and physical
  functioning that allows the individual to be
  engaged with life
• Active Aging
• Adopted by WHO in the late 1990s
• Supports autonomy, independence and activity
• Strategies that promote QOL decrease disabilities
  associate with chronic illness
• Increase elders participation in the social,
  cultural, economic, and political aspects of
  society
• Lower the cost of medical treatment
• Plan for old age and choose healthy lifestyles

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Determinants of Health

• Gender and culture
• Behavioral
• Physical activity
• Nutrition
• Smoking
• Alcohol use
• Medication adherence
• Personal
• Genetics and psychological factors
• Physical environment
• Neighborhoods and safe housing

• Social Environment
• Support
• Education
• Literacy
• Violence
• Abuse
• Economic
• Income
• Social protection
• Social Services
• Health promotion
• Disease prevention

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Helping the Patient Willing to Quit

• The 5 As
• Ask about use
• Advise to quit
• Assess willingness
• Assist with plan
• Action (provide help)

• The 5 Rs
• Relevance
• Risks
• Rewards
• Roadblocks
• Repetition

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Alcoholism in the Elderly

• Under-recognized
• 1/3 of older alcoholic persons developed the
  problem later in life
• 62 of community dwelling elderly found to drink
  alcohol
• Effects may be increased
• Pharmacologic changes associated with aging
• Alcohol and drug interactions may be more serious
• Physiological changes related to aging can alter
  the presentation of medical complications of
  alcoholism
• Beneficial but recommended that they limit intake
  to one drink per day

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Alcoholism in the Elderly (contd)

• Assess for
• Cognitive decline
• Non-adherence with appointments
• Psychiatric history
• Insomnia
• Poorly controlled HTN
• Frequent falls
• GI problems
• Nutritional deficiencies
• Delirium during hospitalization
• CA of the head, neck, esophagus, and liver are
  associated with chronic alcohol abuse