Care of the Chronically Ill and the Older Persons ELECTIVE 2

Listen to the aged

For they will tell you about living and dying. For they will enlighten you about problem-solving, sexuality, grief, sensory deprivation, and survival. For they will teach you how to be courageous, loving and generous.
~Irene Burnside, 1975~

RECAP
Definition Why study Geria/Gero? Epidemiology Core Values

CORE VALUES & PRINCIPLES OF GERIATRICS and GERONTOLOGICAL NURSING Health promotion Health protection Disease prevention Treatment of diseases

Nurses help via three levels of prevention Primary Health Promotion

Education, nutritional assessment and guidance, exercise prescriptions, avoidance of tobacco, moderation of alcohol and limiting exposure or avoiding known carcinogens

Nurses help via three levels of prevention

Secondary- Early Diagnosis & Prompt Treatment Screening questions and health assessment, referral for examination and testing & disease cure and aggressive treatment to limit disability and disease progression.

Nurses help via three levels of prevention

Tertiary- Restoration and Rehabilitation Multidisciplinary rehabilitation (Physical, occupational, speech and recreational therapy), short term placement in rehabilitation facilities or aggressive in-home rehabilitation, appropriate services and aids to increase independence ( walkers, cane)

THEORIES OF AGING

Purpose Of Nursing Theory

Defines our practice The geron/geria nursing must be comprehensive yet consider individual differences Tells how and why phenomena are related

Purpose Of Nursing Theory

Leads to prediction Provides process and understanding Must be holistic and take into account all that impacts on a person throughout a lifetime of aging

Myths of Aging

AgingThe Pros
In some societies, old age is revered for the wisdom and knowledge
But, most people would prefer somehow to keep the option of not experiencing all the effects of growing old.

AgingThe Cons
Characterized by loss of teeth, taste and of the pleasures of eating and drinking. Visiting the dentist, an activity not looked forward to by most Greater physical and emotional challenge for the elderly.

Myths of Aging
Being old means being sick Older people are set in their ways and cannot learn new things
You cant teach an old dog new tricks

Myths of Aging
Health promotion is wasted on older people Elderly do not pull their own weight

Myths of Aging
Dirty old man Disease and disability are an inevitable part of aging

Myths of aging lead to:

Ageism is the disliking of aging and older people based on the belief that aging makes people unattractive, unintelligent and unproductive.

Myths of aging lead to:

Reduced healthcare services Segregation of elders from mainstream society Nurse recruitment difficulties

Theories of Aging

Aging Theories
Cultural, spiritual, regional, socioeconomic, educational, environmental factors, and health status impact the older adults perceptions and choices about their health care needs

Aging Theories
Limited work has been done to identify nursing-specific aging theories Aging is a distinct discipline that requires aging theories that have an interdisciplinary perspective

Types of Theories
Psychosocial Sociological Biological

Types of Theories
Psychosocial theories
Attempt to explain aging in terms of behavior, personality, and attitude change

Types of Theories
Encompass psychological and sociological theories
Psychological: How mental processes, emotions, attitudes, motivation, and personality influence adaptation to physical and social demands

Types of Theories
Erik Erikson
Generativity vs. stagnation Busy with creative and meaningful work "be in charge fear of inactivity meaninglessness Mid-life crisis self-absorbed and stagnate

Types of Theories

Erik Erikson
Integrity vs. despair
Happiness and content Fulfilled with a deep sense that life has meaning Made a contribution to life perceived failure - despair

Ego Integrity versus Despair

INTEGRITY DESPAIR

Maslows Hierarchy of Human Needs Theory

Maslows theory
Although Maslow doesnt specifically address old age, it is clear that physical, economic, social, and environmental constraints can impede need fulfillment of older adults.

Types of Theories
Sociological theories
How changing roles, relationships, and status within a culture or society impact the older adults ability to adapt
Vgotsky

Types of Theories
Sociological theories
Activity theory central theme that remaining active in old age is desirable
Disengagement theory characterized by gradual withdrawal from society and relationships (reciprocal withdrawal)

Types of Theories
Sociological theories
Continuity Theory Successful aging involves maintaining or continuing previous values, habits, preferences, family ties, and all other linkages that formed basic underlying structure of adult life.

Types of Theories
Biological theories
Explain the physiologic processes that change with aging

Types of Theories
Biological theories
Senescence progressive deterioration of body systems that can increase risk of mortality

Types of Theories Biological theories

Senescence
process by which the capacity for cell division, growth and function is lost over time, ultimately leading to an incompatibility with life process of senescence terminates in death.

Types of Theories
Biological theories
Free Radical Theory aging caused by effects of free radicals Wear and Tear Theory cumulative changes occurring in cells age and damage cellular metabolism

Wear and Tear

DNA Theories
Human Genome Project Telomeres

Immunity Theory
Immune response

Immune self-regulatory Body defenses

Types of Theories Biological theories

Programmed theories
Genetic codes containing instructions for the regulation of cellular reproduction and death

Hayflick Limit Theory

Nursing Theories
Need to take human aging into consideration Need to develop a more situationspecific theory of aging to guide practice

Functional Consequences Theory

A guiding framework that would address older adults with physical impairment and disability Nursings role is to minimize ageassociated disability in order to enhance safety and quality of living

Theory of Thriving
Based on the concept of failure to thrive and application of thriving to the experience of well-being among frail elders living in nursing homes

Theory of Thriving
Nurses identify and modify factors that contribute to disharmony among a person and his or her physical environment and personal relationships