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Centre for Gerontological Nursing

SN402
Gerontological Nursing
Promotion of Wellness for Older Adults

Prepared by Dr. Justina Liu,


RN, PhD
Intended Learning Outcomes
After this lecture, students should be able to
• Define and understand ageing from different perspectives
• Identify myths, ageism that affect older adults
• Defeat myths and ageism by understanding realities about older
adults
• Describe the relationship between ageing and wellness
• Discuss the concepts that underpin the Functional
Consequence Theory in older adults
• Define concepts of age-related changes, risk factors and
functional consequences as they related to nursing care of older
adults as well as individual, whole person and environment
aspects

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old people 老年人

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How do we understand being “OLD”?
• Influence of culture
The etymology of the Chinese word ‘old’

http://www.360doc.com/content/11/0623/14/6017453_129039816.shtml
How do we understand being “OLD”?
• Influence of general impression, daily experience
Ageing: historic trend of attitude
• Median age was less than 16 years old, old age was rare, old adults
1600s were being respected

1700s
• Gerontophobia: ageing was feared

1800s
• Idealization of youth

1940s
• Significant increases in life span, issues of ageing-related issues

1960s
• Perception of old age as a medical and social problem

1980s
• Gerontologists began focusing on successful ageing

2000s
• What is way forward?
Images of ageing
Stereotypes Ageism
• Poor health • Misunderstanding about
• Chronic diseases people as they age
• Dependent on others Butler, 1968

• Impaired function
Ageism (年齡歧視)

 Prejudices
What do youand Stereotypes
understand bythe are
‘ageism’?
applied to older people merely on the
basis of their age

 Common manifestations of ageism


include negative stereotypes of social
isolation, psychological rigidity, asexual
behaviour, economic and familial burden

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Ageism (年齡歧視)

Do you have ageist attitudes?


9 did I tell a joke….
Revised the Qs : How often
Effects of Ageism -Health care prioritization
How would you prioritize and rate the following health services from 1, 2, 3, ….
Intensive care for premature babies
Treatment for children
High technology surgery
Preventive screening services
Surgery to help people carry out everyday tasks
Health promotion / education services
Treatment for infertility
District nursing and community services
Psychiatric services
Long stay hospital care for elderly people
Treatment for people aged >75
Special care & pain relief for people who are dying
(Mak, Chau & Woo, 2013)

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Heterogeneity of an older population
Images of ageing
The Fact
• Majority (78%) of 85 years
old people rate their health
as “Good” despite the
presence of illnesses
Collerton et al, 2009

• Many are still completely


independent in their daily
functioning
Ageing – The fact
1. The elderly is just like the 5. Even the elders believe that it
young, they differ with each is a guilt and harmful to have
other. sex. But it is not true!!
2. Older people are unique 6. Elders just change slower
individual, each of them than the young, they are not
responds differently to inflexible.
society 7. Elder is unproductive because
3. Elders have many stressors: productivity linked with
• Poverty, physical decline money earning in our society.
• Isolation, grief, loss of social 8. Loneliness, because changes
status of family and friends.
4. Elders learn in a different
ways as the younger learners
because of their education Miller, 2015 Table 1-1 page 10.
background. Just probably
slower.
How old is old?
Aging is multidimensional

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Ageing – The definitions
How old is old? • ‘Old’ is a relative concept
• Classification of ageing:
• Young-old 65-74
• Middle-old 75-84
• Old-old (frailty) >85
Chronologic age : the length of time
The world’s oldest runner that has passed since birth;
Fauja Singh is 105 years old. Functional age : associate with levels
of functioning, contribute to society,
experience personal QoL.
(Miller, 2015 p. 4-5)

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Ageing and Wellness

• Ageing is inevitable
• Ageing is not negative as the people thought
• To browse ageing through the glasses of Wellness, ageing can
be a part of positive journey in our life
• How to live long and well?

Wellness
Wellness
• “integrated method of functioning that is oriented toward
maximizing each person’s potential, while maintaining a
continuum of balance and purposeful direction within the
person’s environment.”
• Wellness DOES NOT ONLY focus on physical health and
functioning
• It includes also the concepts of:
• Relationship between mind, body and spirit
• Importance of older adults having a purpose in life
• Communicating with others
• Maintaining personal dignity
• Contributing to society Miller, 2016, p. 2
• Quality of life
Wellness and ageing
• Ageing:
• Time cannot be reverted
• Physiological changes can be retarded (a little) but not stopped
• Wellness:
• Not just about time and physiological change
• Living longer associates with issues to be settled
• Ageing and welling
• Functional age fits the concept of the wellness better
• Wellness embrace a boarder meaning, a holistic approach
Wellness and Nursing Care of Older Adults
• Addressing the body-mind-spirit interrelatedness of each
adult
• Identifying and challenging ageist attitudes
• Assessing each older adult from a whole-person perspective
• Incorporating wellness / positive intervention outcomes
(such as improving mobility, sleep quality, appetite, QoL,
independence, social involvement) as a standard care
• Recognizing older adults’ potential and their ability to
master self-care skills and behaviours
• Concept of wellness should be provided to caregivers of
older adults.
Functional Consequences Theory
explains the unique
relationships among the
concepts of person, health,
nursing, and environment in the
context of promoting wellness
for older adults.

Miller, 2015, p.41

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Functional Consequences
• Functional Consequences: observable effects of actions, risk
factors, and age-related changes that influence the quality
of life or day-to-day activities. The effects relate to all levels
of functioning, including body, mind, and spirit.
• Negative Functional Consequences: those that interfere
with functioning or quality of life
• Positive Functional Consequences: those that facilitate the
highest level of functioning, least dependency, and best
quality of life
• Focuses on older adult’s ability to perform activities of daily
living that affect survival and quality of life
• Framework for planning health services
• Important component in care of older adults
Key elements of Functional Consequences Theory
1. Holistic nursing care addresses the body-mind-spirit
interconnectedness of each older adults and recognizes that wellness
encompasses more than physiological functioning
2. Preventive gerontology practice - address the age-related changes
(primary ageing) and their impacts to their functioning
• identify the modifiable factors that are associated with secondary
ageing
• Distinguishes between age-related changes and risk factors that
interfere with a person’s function
3. Emphasizes factors that affect a person’s function rather than merely
identifying one’s functional level (modifiable, compensable, supportive
devices)
4. Focus on functional consequences that can be addressed.
5. Lead to wellness outcomes: promote optimal health, functioning
(Functional longevity), QoL of older people

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Question
What are positive functional consequences?
A.Observable effects of actions, risk factors, and age-related changes that
influence quality of life or day-to-day activities of older adults
B. The effects that relate to all levels of functioning, including body, mind,
and spirit
C. Those that interfere with older adult’s functioning or quality of life
D.Those that facilitate highest level of functioning, least dependency, and
best quality of life
Indicative Reading:
Miller, C. A. (2015). Nursing for Wellness in Older Adults (6th ed.). Philadelphia: Lippincott.
[Chapter 1, 4]

Lecture Highlights
1. What are the different definitions of ageing ?
2. Which definition is mostly appropriated in wellness-oriented nursing care?
3. How do myths / ageism affect older adults ?
4. What are the realities / facts to describe older adults?
5. How to employ Functional Consequence Theory as a framework to guide
nursing care for older people so as to promote their wellness?

Post / pre-class activities: Study the case

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Case study
• A community care nurse is caring for a 70-year-old woman whose
daughter assists with her everyday care at home. The daughter
shares with the nurse that her mother is constantly complaining
about losing control of her bladder from time to time, not being
able to get well, and that she is having issues with moving her
bowels frequently. The daughter further states that she does not
understand why her mother is complaining about these normal
aging problems.
• According to the functional consequence theory, are these
normal changes?
• What concerns would the nurse have about the daughter’s
statements, if any?
• How can the nurse assist the daughter and the client?

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