October 18, 2022

List and define the seven types of elder abuse that were identified by the National Center on Elder Abuse (NCEA). How would you approach the Ethical Dilemmas and Considerations that m

Nursing

After studying Module 1: Lecture Materials & Resources, discuss the following:

List and define the seven types of elder abuse that were identified by the National Center on Elder Abuse (NCEA).
How would you approach the Ethical Dilemmas and Considerations that might arise regarding Euthanasia, Suicide, and Assisted Suicide?

Submission Instructions:

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.

Chapter 4

Assessment of the Older Adult

Assessment is a crucial foundation of the nursing process which in turn is the foundation of nursing care.

Nursing-focused assessment of older adults occurs across all settings: hospitals, homes, long-term care facilities, senior centers, congregate living units, hospice facilities, and independent or group nursing practices.

Setting dictates the way data collection and analysis are managed.

Introduction

Identify strengths and limitations so that effective and appropriate interventions can be delivered to support, promote, and restore optimum function to prevent disability and dependence.

To ensure a patient-centered approach, take into consideration: the interrelationship between physical and psychosocial aspects of aging; an assessment of the nature of disease and disability and their effects on functional status; tailor the nursing assessment to the individual.

Purpose of Older Adult Assessment

Factors such as:

Reduced ability to respond to stress

Increased frequency and multiplicity of loss

Physical changes associated with normal aging

May combine to place older adults at high risk for loss of functional ability

Interrelationship Between Physical and Psychosocial Aspects of Aging

Aging does not necessarily result in disease and disability.

Chronic disease increases vulnerability to functional decline.

Self-reported vague signs and symptoms such as lethargy, incontinence, decreased appetite, and weight loss can indicate functional impairment.

Physical frailty is a major contributor to the need for long-term care.

The Effects of Disease and Disability on Functional Status

Difficult to differentiate normal age-related findings from indicators of disease or disability

Essential to determine what is “normal” versus what may be an indicator of disease or disability so that treatable conditions are not disregarded

Disease vs. Normal Aging

Decreased response to stress

Altered pharmacokinetic and pharmacodynamic responses to drugs

Decreased immune response

Increased risk for syncope

Increased insulin resistance and glucose intolerance

Assessment Concerns Due to Age-Related Changes

In times of physical and emotional stress, older people will not always exhibit the expected or classic signs and symptoms.

The characteristic presentation of illness in older adults is more commonly one of blunted or atypical signs and symptoms.

Presenting signs and symptoms may be unrelated to the actual problem.

Expected signs and symptoms may not be present at all.

Atypical Presentation of Illness

Delirium is one of the most common, atypical presentations of illness in older adults – sudden change in cognitive function

Dementia is a global, sustained deterioration of cognitive function which includes significant cognitive decline over time, deficits in learning and memory, language, executive function, attention, perceptual and motor skills, and social interactions.

Delirium predominantly affects attention and is typically reversible; dementia predominantly affects memory and is irreversible.

Delirium vs. Dementia

Complex because of multiple associated characteristics of delirium and dementia

Not uncommon for an ACS to be superimposed on dementia

Recognize that only subtle evidence may be present to indicate the existence of a problem

Families and friends can be valuable sources of data regarding the onset, duration, and associated symptoms.

Dementia Assessment

The overall atmosphere established by the nurse should be one that conveys trust, caring, and confidentiality.

Environment is important.

Consider patient needs

Cultural considerations (see cultural awareness box)

Nursing Assessment of the Older Person

Consider sensory and musculoskeletal changes

Provide an environment that gives the opportunity to demonstrate assets and capabilities that allow functioning within the limitations imposed by chronic disease

The Assessment Environment

Is a comprehensive, nursing-focused health assessment providing a subjective account of the current and past health status

Alerts the nurse to focus on key areas of the physical examination requiring further investigation

Topics for health teaching can be identified.

Can serve as a life review

Should include assessment of functional, cognitive, affective, and social well-being

The Nursing Health History

A goal-directed interviewing process helps the patient share the pertinent information.

Guided reminiscence can elicit valuable data and can promote a supportive therapeutic relationship.

Work with the patient to establish the organization of the interview

Consider personal space requirements

Use touch to convey respect, caring, and sensitivity

The Interviewer

Major factors that require special consideration while gathering the health history include: Sensory-perceptual deficits, anxiety, reduced energy level, pain, multiple and inter-related health problems, and a tendency to reminisce.

See Table 4.4 to management these factors

When using EMR face the patient, alternate inputting data with talking to maintain eye contact

The Patient

Health History Format (1 of 2)

Patient profile or biographic data

Family profile

Occupational profile

Living environment profile

Resources and support systems

Descriptions of typical day

Present health status

Medications

Immunization/health screening status

Allergies

Nutrition

Past health status

Family history

Review of systems

Health History Format (2 of 2)

The nurse knows that the best way to obtain an accurate assessment is to implement which of the following? (Select all that apply.)

a. Turn off the television or mute the sound.

b. Provide privacy by closing the curtains.

c. Ask only yes or no questions to keep older adult on task.

d. Request the patient's family wait in the waiting room.

e. Turn on the over-bed light to increase illumination.

Quick Quiz!

ANS: A, B, E

Answer to Quick Quiz

Determines patient strengths and capabilities, as well as disabilities and limitations

Verifies and gains objective support for subjective findings

Gathers objective data not previously known

SPICES is an efficient acronym to help identify patient problems in six common areas which may lead to increasing mortality risk, increased cost, and longer hospitalizations.

Physical Assessment

Sleep disorders

Problems with eating or feeding

Incontinence (of bowel or bladder)

Confusion

Evidence of falls

Skin breakdown

SPICES

Be alert to the older patient’s energy level

Respect the patient’s modesty

Sequence the assessment to keep position changes to a minimum

Make sure the patient is comfortable

Explain each step in simple terms

Warn of any discomfort that might occur and probe painful areas last

Take advantage of “teachable moments”

General Guidelines

The ability to perform activities of daily living (ADLs) and instrumental activities of daily living (IADLs)

The Katz Index of ADLs

Specialized care units known as acute care for elders (ACE) units have been developed in hospitals around the country to better address these issues.

Functional Status Assessments

Determines the patient’s level of cognitive function (which implies all those processes associated with mentation or intellectual function)

Montreal Cognitive Assessment (MoCA)

The Mini-Cog

The Geriatric Depression Scale—short form GDS

Cognitive/Affective Assessment

Social function is correlated with physical and mental function.

An individual’s social well-being may positively affect his or her ability to cope with physical impairments and the ability to remain independent.

A satisfactory level of social function is a significant outcome in and of itself.

The relationship family plays a central role in the overall level of health and well-being.

Social Assessment

Results can validate history and physical examination findings and identify potential health problems not previously identified.

Laboratory Data

Chapter 2

Theories Related to Care of the Older Adult

No one definition or theory exists that explains all aspects of aging.

Several theories may be combined to explain various aspects of the complex phenomena we call aging.

Biologic, sociologic, and psychologic theories of aging attempt to explain and explore the various dimensions of aging.

No single gerontologic nursing theory has been accepted by this specialty.

Introduction

Help make sense of a particular phenomenon

Provide a sense of order

Give a perspective from which to view the facts

Provide a springboard for discussion and research

Purpose of Theories

Influenced by a composite of biologic, psychologic, social, functional, and spiritual factors

A continuum of events that occur from conception to death

Varies from individual to individual

Human Aging

Concerned with answering basic questions regarding physiologic processes that occur in all living organisms as they age chronologically

Include explanations of the following: (1) deleterious effects leading to decreasing function of the organism, (2) gradually occurring age-related changes that progress over time, and (3) intrinsic changes that may affect all members of a species because of chronologic age

Biologic Theories of Aging

Free radicals are byproducts of fundamental metabolic activities within the body.

Neutralized by enzymatic activity or natural antioxidants, but if they are not neutralized, they may cause cell damage.

Administration of antioxidants postpones the appearance of diseases such as cardiovascular disease and cancer and can influence the decline of the immune system and on degenerative neurologic diseases.

Mitochondrial Free Radical Theory

With age, some proteins become increasingly cross-linked impeding metabolic processes by obstructing the passage of nutrients and wastes between the intracellular and extracellular compartments.

Theory proposes that as a person ages and the immune system becomes less efficient, the body’s defense mechanism cannot remove the cross-linking agent before it becomes securely established.

Cross-linkage has been proposed as a primary cause of arteriosclerosis, decrease in the efficiency of the immune system, and the loss of elasticity often seen in older adult skin.

Cross-linkage theory

A cumulative effect of improper functioning of cells and eventual loss of cells in organs and tissues are therefore responsible for the aging phenomenon.

Life expectancy seen as preprogrammed, within a species-specific range

This biologic clock for humans was estimated at 110–120 years.

Sometimes called the “Biologic Clock Theory,” “Cellular Aging Theory,” or “Genetic Theory.”

Hayflick Limit Theory

As a person ages, the immune system functions less effectively immunosenescence.

Changes include a decrease in humoral immune response: Decreased resistance to a tumor cell challenge and the development of cancer, decreased ability to initiate the immune process and mobilize the body’s defenses against aggressively attacking pathogens, and heightened production of autoantigens, leading to an increase in autoimmune-related diseases.

Immunological Theory

Aging and disease do not necessarily go hand in hand.

There may be a limited replication capacity for certain cells that causes overexpression of damaged genes and oxidative damage to cells.

Free radicals may cause damage to cells over time.

To reduce free radical damage, advise patients to ingest a varied, nutritious diet and suggest supplementation with antioxidants such as vitamins C and E.

Implications for Nursing (1 of 2)

Encourage physical activity like walking to facilitate peripheral circulation and promotes the development of collateral circulation, help with weight control, the replacement of fat with muscle tissue, prevent muscle atrophy, and increase the sense of well-being.

Encouraging preventive measures such as annual influenza vaccination or a one-time inoculation with the pneumococcal vaccine

Recognize that stress, both physical and psychologic, has an impact on the aging process

Implications for Nursing (2 of 2)

Which of the those theories do you believe provides the best explanation for aging? Why?

Quick Quiz!

Answers will vary.

Answer to Quick Quiz

Focus on changing roles and relationships

Early research was carried out largely on institutionalized and ill older persons, which skewed the information collected.

Contemporary research is being conducted in a variety of more naturalistic environments, reflecting more accurately the diversity of the aging population.

Sociologic Theories of Aging

Theory sees activity as necessary to maintain a person’s life satisfaction and positive self-concept.

Even with illness or advancing age, the older person can remain “active” and achieve a sense of life satisfaction.

Activity Theory

The theory proposes that as people age, they try to maintain or continue previous habits, preferences, commitments, values, beliefs, and the factors that have contributed to their personalities.

Continuity Theory

Theory views the aging person as an individual element of society and also as a member, with peers, interacting in a social process.

Attempts to explain the interdependence between older adults and society and how they constantly influence each other in a variety of ways

Age Stratification Theory

Each individual has personal competencies (ego strength, motor skills, individual biologic health, and cognitive and sensory–perceptual capacities) that assist the person in dealing with the environment

Competencies may change with aging, thus affecting the older person’s ability to interrelate with the environment.

Person-Environment Fit Theory

Remember that all older adults cannot be grouped collectively as just one segment of the population.

Four distinct cohort groups and the individuals within each of these cohort groups have their own history:

Young-old: 65–74 years old

Middle-old: 75–84 years old

Old-old: more than 85 years old

Elite-old: more than 100 years old

Implications for Nursing (1 of 2)

Older adults respond to current experiences based on their past life encounters, beliefs, and expectations.

It is within the nurse’s scope of practice to identify maladaptive responses and intervene to protect the integrity of the person.

Helping older adults adjust to limitations while accentuating positive attributes may enable them to remain independent with a high quality of life during later years.

Implications for Nursing (2 of 2)

The basic assumption of the psychologic theories of aging is that development does not end when a person reaches adulthood but remains a dynamic process throughout the life span.

As people age, various adaptive changes help them cope with or accept some of the biologic changes.

The adaptive mechanisms include memory, learning capacity, feelings, intellectual functioning, and motivations to perform or not perform activities.

Psychologic Theories of Aging

Human motivation is viewed as a hierarchy of needs that are critical to the growth and development of all people.

When people achieve fulfillment of their elemental needs, they strive to meet the needs on the next level, continuing until the highest order of needs is reached.

Maslow’s Hierarchy of Human Needs

According to this theory, a person’s personality is visualized as oriented either toward extroversion or toward subjective, inner experiences introversion.

A balance between these two forces is essential for mental health.

The onset of middle age the person begins to question values, beliefs, and possible dreams left unrealized—“ midlife crisis.”

Successful aging is when a person looks inward accepts past accomplishments and limitations.

Jung’s Theory of Individualism

Major focus in this theory is on an individual’s ego structure, or sense of self, especially in response to the ways in which society shapes its development

In each of the eight stages, a “crisis” occurs that affects the development of the person’s ego and the way a person masters any particular stage influences future success or lack of success in mastering the next stage of development.

In 1968, Peck expanded Erikson’s original theory regarding the eighth stage of older adulthood.

Erikson’s Eight Stages of Life

This theory’s central focus is that individuals develop certain strategies to manage the losses of function that occur over time.

This general process of adaptation consists of three interacting elements: selection, optimization, and compensation.

The lifelong process of selective optimization with compensation allows people to age successfully.

Selective Optimization With Compensation

Older adults should be encouraged to engage in a “life review” process by using techniques such as reminiscence, oral histories, and storytelling.

Understand that in each stage of life, specific developmental tasks need to be achieved.

Keep in mind that intellectual functioning remains intact in most older adults.

Remember all individuals enjoy feeling needed and respected and being considered contributing members of society.

Implications for Nursing

Successful aging is “an individual’s perception of a favorable outcome in adapting to the cumulative physiologic and functional alterations associated with the passage of time, while experiencing spiritual connectedness, and a sense of meaning and purpose in life.”

Guides the gerontologic nurse in the provision of mental, physical, and spiritual nursing interventions aimed at promoting positive coping and successful aging.

Theory of Successful Aging

Identifies health as a dynamic state directed at improving the person’s overall sense of well-being

Health is multidimensional in nature and influenced by the person’s environment.

Health Promotion Model

Comfort is “the immediate experience of being strengthened through having the needs for relief, ease, and transcendence met in four contexts of experience (physical, psychospiritual, social, and environmental).”

The theory recognizes the importance of patient involvement in identifying their needs.

Comfort is the holistic outcome of nursing interventions.

Comfort Theory

Important for the nurse to acknowledge the spiritual dimension of a person and support spiritual expression and growth

Spirituality no longer merely denotes religious affiliation; it synthesizes a person’s contemplative experience.

Illness, a life crisis, or even the recognition that one’s days on earth are limited may cause a person to contemplate spirituality.

Moral Spiritual Development

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List and define the seven types of elder abuse that were identified by the National Center on Elder Abuse (NCEA). How would you approach the Ethical Dilemmas and Considerations that m

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