University of the Visayas

Cebu City, Philippines

College of Nursing Graduate Studies

Nsg. 512

NURSING CARE OF GERIATRIC AND INSTITUTIONALIZED CLIENT

Midterm Examination
Essay: Briefly discuss the following:

Question:
1. In your own view, what is Aging? What do you think the quality of life of the elderly?
Defend with citations (2005-2016) 20pts.
Answer:

Aging as a natural process of life is due to gradual changes in metabolic activity of

organs and disability in regeneration capacity of cells. Worldwide, the average life span of

people has been increasing. In my own view and opinion, ageing or aging is not merely the

process of becoming older. Its not just about the physical changes one goes through

normally as part of mortality. Aging, for me, is also the accumulation of life experiences,

knowledge & wisdom as the years went by. I believe that aging is not a destination but an

experience and a journey that one must undergo in order to know ones purpose in life.

Successful aging depends on how you managed your life through its ups and downs and how

well you prepared for your retirement physically, financially , mentally and emotionally.

According WHO, quality of life defined as an individuals perception of their position

in life in the context of the culture and values systems in which they live and in relation to

their goals, expectations, standards and concerns (Nejati V, Shirinbayan P et. Al 2008). Poor

economic, cultural, educational and health care conditions and also inadequate social

NINA HAMILI G. PIAO BSN RN

 University of the Visayas
Cebu City, Philippines
College of Nursing Graduate Studies

interactions can result in poor quality of life in elderly people (Mellor D, Russo S, McCabe

MP et. Al 2008). Chronic diseases such as diabetes mellitus, coronary heart diseases,

osteoporosis and cerebrovascular are most common diseases in elderly people. These

disturbances that cause medical, social and psychological problems can decrease physical

functions and the quality of elderlys in the community.

As well as, burden of diseases will be increased obviously (Lehnert T, Heider D et. Al

2011). According to the study by Care, Nursing & Jozef, Pavolof entitled

DETERMINANTS OF QUALITY OF LIFE IN THE ELDERLY, the results of their study

indicate the necessity of creating opportunities for the development and maintenance of social

contacts, the involvement of seniors in various leisure activities and in different programs or

voluntary activities. The screening for and treatment of depression and anxiety is very

important in improving quality of life in older adults, as is maintaining and improving self-

care in ADLs.

2. As a nurse, what will be the best practices in caring for the elderly client and its ethics?
(Evidenced based) 15 pts.
Answer: (Source: Journal of Hospice and Palliative Nursing March/April 2011, Volume
13 Number 2 , p 70 78)
According to Gallaghe & Long et. al , in their study "Advanced Dementia Care:

Demystifying Behaviors, Addressing Pain, and Maximizing Comfort", wherein they studied

Mrs T. who is an 83-year-old retired grade-school teacher with a history of Alzheimer disease

(AD), hypertension, congestive heart failure, and osteoarthritis.The general guidelines and

NINA HAMILI G. PIAO BSN RN

 University of the Visayas
Cebu City, Philippines
College of Nursing Graduate Studies

recommendations that specify pain assessment and management in persons with dementia are

as follows:

-The person's self-report of pain is the most accurate indicator of the existence and intensity

of pain. However, persons with advanced dementia may not able to report their pain. Be sure

to ask if they are having pain right now. However, no complaint of pain does not mean the

person does not have pain.

-Identify the causes of pain and discomfort. Review the person's history and medical record.

Look for established diagnoses of painful conditions or any new source of pain. Conduct a

physical examination and focus on any sites that may be producing pain.

-List and identify behaviors that are suggestive of pain. Examine when these behaviors occur.

Knowing the person is key during this assessment.

- Secure a report from the caregiver, family, or others caring for this person. List all

behaviors that suggest pain, the time of day, and what makes the behavior worse or better.

It is our moral and ethical responsibility to do our best to alleviate suffering. The

proliferation of tools to assess for pain and the numerous pharmacological and

nonpharmacological options for maximizing comfort in persons with advanced dementia

enhance our abilities to fulfill our professional commitments. Integrating the aforementioned

evidence-based approaches will empower caregivers to bring the best of themselves, blending

both the art and science of healthcare, to maximize comfort, enhance quality of life, and

elevate care practices for persons with advanced dementia.

NINA HAMILI G. PIAO BSN RN

 University of the Visayas
Cebu City, Philippines
College of Nursing Graduate Studies

3. What do you think the common end of life issues of the elderly persons? Explore.
(Support-Nursing Journals or any Journal Reading- 2006-2017) 10 pts

Answer: Source: (Sutton L.M.: Denmark-Wahnefried W., Clipp E.C. Management of

terminal cancer in elderly patients. Lancet oncology, 2007, 4, 149-157.) (Edmonds P.,
Rogers A. If only someone had told me. A review of patients dying in hospital. Clin Med
2006 3, 149-152.)

The common end of life issues of the elderly persons are the following:

Dying patients frequently do not receive basic nursing care or assistance with eating

and drinking

Alternatively staff may focus on meeting physical needs at the expense of

psychological and spiritual care

Older people are less likely to receive appropriate pain control than their younger

counterparts. This is especially so for patients with dementia. They are less likely to

take opioids for pain due to cultural beliefs

Older people areless likely to receive hospice care

In care homes end of life care may be impeded by inadequate staff training, poor

symptom control and lack of psychological and emotional support

Comorbidity and drug reactions make symptom control more difficult

4. What is the impact of sexuality among elderly clients? 15 pts Read and summarize an
article-from any journal-recent dates)
(Source: Sexuality in older age: essential considerations for healthcare professionals
Age and Ageing, Volume 40, Issue 5, 1 September 2011, Pages 538543 by Abi Taylor &
Margot A. Gosney)
This article described the fact that many elderly people enjoy an active sex life and

examined the evidence against the general perception of an asexual old age. It offered an

NINA HAMILI G. PIAO BSN RN

 University of the Visayas
Cebu City, Philippines
College of Nursing Graduate Studies

overview of the evidence for healthcare professionals who had not previously considered the

sexuality of their older patients. It also described some of the sexual problems faced by older

people, especially the difficulties experienced in disclosing such problems to healthcare

professionals. It examined why healthcare professionals routinely avoided discussing sexual

problems with older patients, and how this can be improved. It also offered some

recommendations for future research in the area, as well as a word of caution regarding the

temptation of over-sexualising the ageing process.

This article also gave recommendation on how health care providers can help improve the sex

lives of older people. These are:

Screen for sexual problems in a private environment and allow adequate time.

Be sensitive to patient preferences regarding gender of HCP.

Educate patients on lifestyle choices.

Be aware of own prejudices and subconscious feelings; do not make assumptions.

In conclusion, sexual problems in older people should be managed sensitively and practically

by HCPs, with respect to individual differences in sexual interest and activity.

5. Can you identify the differences of the mental health of an adult and elderly clients?
What are the challenging behavior of the elderly client? 20 pts. Make one reaction
from any journal of Nursing Care-Elderly.
According to the WHO, over 20% of adults aged 60 and over suffer from a mental or

neurological disorder (excluding headache disorders) and 6.6% of all disability (disability

adjusted life years-DALYs) among over 60s is attributed to neurological and mental

NINA HAMILI G. PIAO BSN RN

 University of the Visayas
Cebu City, Philippines
College of Nursing Graduate Studies

disorders. Mental health and emotional well-being are as important in older age as at any

other time of life. Neuropsychiatric disorders among the older adults account for 6.6% of

the total disability (DALYs) for this age group. Approximately 15% of adults aged 60 and

over suffer from a mental disorder.

Multiple social, psychological, and biological factors determine the level of mental

health of a person at any point of time. As well as the typical life stressors common to all

people, many older adults lose their ability to live independently because of limited

mobility, chronic pain, frailty or other mental or physical problems, and require some form

of long-term care. In addition, older people are more likely to experience events such as

bereavement, a drop in socioeconomic status with retirement, or a disability. All of these

factors can result in isolation, loss of independence, loneliness and psychological distress in

older people.

If you compare it to adult clients whose age may range from 18-59 years old, they

dont get to experience as much mental and physical fatigue as older clients.

REACTION: (Suffering and mental health among older people living in nursing
homesa mixed-methods study Jorunn Drageset, Elin Dysvik, Birgitte Espehaug,
Gerd Karin Natvig and Bodil Furnes
Older adults, those aged 60 or above, make important contributions to society as

family members, volunteers and as active participants in the workforce. While most have

good mental health, many older adults are at risk of developing mental disorders,

neurological disorders or substance use problems as well as other health conditions such as

NINA HAMILI G. PIAO BSN RN

 University of the Visayas
Cebu City, Philippines
College of Nursing Graduate Studies

diabetes, hearing loss, and osteoarthritis. Furthermore, as people age, they are more likely to

experience several conditions at the same time.

Mental health problems are under-identified by health-care professionals and older people

themselves, and the stigma surrounding mental illness makes people reluctant to seek help.

Mental health has an impact on physical health and vice versa. For example, older adults

with physical health conditions such as heart disease have higher rates of depression than

those who are medically well. Conversely, untreated depression in an older person with

heart disease can negatively affect the outcome of the physical disease.

Older adults are also vulnerable to elder abuse - including physical, sexual,

psychological, emotional, financial and material abuse; abandonment; neglect; and serious

losses of dignity and respect. Current evidence suggests that 1 in 10 older people experience

elder abuse. Elder abuse can lead not only to physical injuries, but also to serious,

sometimes long-lasting psychological consequences, including depression and anxiety.

6. Suggest some outstanding techniques in communication of an elderly client. 20 pts.

Effective communication requires the following:

1. The need or desire to share information

2. Acceptance that there is value and merit in what the other person has to say, demonstrated

by a willingness to treat the other person with genuine dignity and respect

3. Understanding of factors that may interfere with or become barriers to communication

NINA HAMILI G. PIAO BSN RN

 University of the Visayas
Cebu City, Philippines
College of Nursing Graduate Studies

4. Development of the skills and techniques that facilitate effective interchange of

information

Do's

Identify yourself.

Address the person using the name he or she desires (e.g., Mrs. Smith and Bill).

Speak clearly and slowly in a low tone of voice.

Get to know the person.

Listen empathetically.

Pay attention to body languageyours and theirs.

Use touch appropriately and frequently.

Don'ts

Assume that the person knows who you are.

Use baby talk or patronizing names such as sweetie or honey.

Shout.

Make generalizations about older people.

Pay too much attention to tasks and forget the person.

Ignore non-verbal messages as insignificant.

Be afraid to use touch as a method of communication.

NINA HAMILI G. PIAO BSN RN

 University of the Visayas
Cebu City, Philippines
College of Nursing Graduate Studies

NINA HAMILI G. PIAO BSN RN