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Week 2 – 3035 – Complex Care of Older Adults Introduction 

Theories regarding aging attempt to answer why and how people age, NOT the nursing care of older adults.

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Nursing theories attempt to explain relationships among core concepts of person, nursing, health, and environment.

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Discipline-specific nursing theories guide nursing care essential to promote wellness of older adults.

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Functional Consequences Theory is a framework to promote wellness, function, and quality of life for older adults.

Functional Consequences Theory 

This model reflects and incorporates the evolving understanding of wellness as an integral aspect of focused care for older adults.

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Goal: address unique relationships among concepts of person, health, nursing, and environment in context of promoting wellness for older adults.

Functional Consequences 

Definition: observable effects of actions, risk factors, and age-related changed that influence the quality of life or day-to-day activities. The effects relate to all levels of functioning, including body, mind, and spirit.

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Negative functional consequences: those that interfere with functioning or quality of life.

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Positive functional consequences: those that facilitate the highest level of functioning, least dependency, and best quality of life.

Functional Consequences Theory vs. Functional Assessment 

Theory is broader because it: Distinguishes age-related changes that increase vulnerability and risk, Focuses on consequences, Focuses on assessment of conditions that affect function, Leads to interventions to address the negative, Leads to wellness outcomes.

Concepts Underlying the Functional Consequences Theory 

Combinations of age-related changes and risk factors increase vulnerability to negative functional consequences.

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Nurse assess age-related changes, risk factors, and functional consequence, with particular emphasis on identifying factors that can be addressed through nursing interventions.

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Wellness outcomes enable functioning at their highest level despite the presence of agerelated changes and risk factors.

Functional Assessment 

Focuses on older adults ability to perform ADLs that affect survival and quality of life.

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Framework for research and method of planning health services.

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Important component in care of older adults.

Risk Factors 

Common sources of risk factors include diseases, environment, lifestyle, support systems, psychosocial circumstances, adverse medication effects, and attitudes based on lack of knowledge.

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Age-related changes, risk factors, older adult (person), nursing, health, and environment.

Age-Related changes 

Inevitable, progressive, and irreversible changes that occur and are independent of extrinsic or pathological conditions

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On the physiologic level, these changes are typically degenerative.

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On the psychological and spiritual levels, they include potential for growth.

Age-Related changes and risk factors 

Inherent physiologic processes that increase vulnerability to detrimental effects of risk factors

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Not limited to physiologic aspects – consider body-mind-spirit perspective.

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Holistic focus: identify age-related changes to improve/adapt to physiologic decline

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Build on wisdom for problem-solving skills to address risk factors.

The Concept of Older Adult/Person

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A complex and unique individual whose functioning, well-being, is influenced by the acquisition of age-related changes and risk factors.

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An adult does not become an older adult at a particular chronological age. Definition of an older adult is broader.

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Older adult: may not identify with social labels, such as elderly and senior.

Nursing 

Essential: get to know the older adult

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Involve older adults in decision making due to being experts in their own health

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Focus of nursing care: minimize negative effects of age-related changes and risk factors and promote wellness.

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When risk factors cause being dependent on others for daily needs, the caregivers are considered an integral focus of nursing care.

Health 

The ability to function at highest capacity, despite the presence on age related changes and risk factors.

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Determined by a person based on functional capacity perceived as important

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Not limited to physiologic function but encompasses psychosocial and spiritual function.

Environment 

External conditions that influence the body, mind, spirit, and function, which include the caregivers.

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Environmental conditions are risk factors when they interfere with function

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Environmental conditions are interventions when they enhance function.

Applying Theory to Promote Wellness 

Incorporate wellness outcomes to address personal aspirations for well-being of body, mind, and spirit.

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Major focus: educate both older adults and caregivers regarding interventions to eliminate risk factors or minimize their effects.

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Leads nursing interventions toward achieving wellness outcomes for improved quality of life for older adults.

Case Study: 1. According to the functional assessment theory, are these normal changes? 2. What concerns would the nurse have about the daughter’s statements, if any? 3. How can the nurse assist the daughter and the client?

Aging is Multidimensional 

Requires an interprofessional approach.

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Dominant question: how to live long and well?

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Aging well: Healthy aging, no illness and preserved function Active aging, high physical and cognitive function Productive aging, social participation and engagement

Successful aging, full concept of aging well

How Can we Live Long and Well? 

How long we live is addressed by measuring life span, life expectancy, and morbidity/mortality rates. Exploring relationships among aging, health, and disease.

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Research is focused on identifying ways to delay effects of aging and maintain high levels of functioning and quality of life.

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Baby boomers

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Life span and life expectancy Life span is the maximum survival potential for a member Life expectancy is the predictable length of time that one is expected to live from a specific point in time

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Rectangularization of the curve and compression of morbidity

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Rectangularization of the curve is survival caused by various significant factors occurring at different points in time.

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Compression of morbidity is the onset of significant illness could be postponed, and life expectancy could not be extended to the same extent

Active Life Expectancy 

Ranging from inability to perform ADLs to full independent function, with concern toward improved functioning.

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Prevalence of functional impairment varies significantly by race and ethnic groups.

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Relationships among aging, disease, and death – like older adults becoming more immunocompromised and acquiring pneumonia.

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The aging process increases vulnerability to the pathologies that become the leading cause of death.

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Senescence: post reproductive period leading to increased probability of death and address questions about relationship between aging and death.

Studies of older adults who are healthy and long lived 

Compare them to our society

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Supercentenarians: oldest of the old – 110 or older.

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Predictors of healthy longevity: nutritional patterns with high intake of plant-based foods (fruits, vegetables, and nuts), high levels of physical activity and strong social networks.

How do we explain biologic aging? 

Biologic: theories of aging – aging process affecting all living organisms

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Gradual, progressive, decline in physiologic functioning

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Each theory attempts to explain a specific aspect of aging.

Overview of and conclusions about biologic theories 

Insight into inevitable consequences of normal aging as well as increased susceptibility to diseases

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Major advances in genetic science.

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All biologic theories of aging recognize aging as a multidimensional process directly influenced by interacting factors.

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No single theory can explain the complex phenomenon of aging.

Relevance to Nurses: 

Primary role is to identify and address modifiable factors that lead to diseases, disability, death, as well as health-promoting factors.

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Attitudes of health care professionals

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Perspective of “what do you expect, you’re old!” interferes with treatable conditions

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Attitude of hopelessness with subscribing to aging as a fatal disease.

Biologic Theories of Aging 

Basic age-related changes characterized as deleterious, progressive, intrinsic, universal, irreversible, and genetically programmed

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Include genetic, wear-and-tear, immunity, cross-linkage, free radicals, neuroendocrine, and apoptosis theories.

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Neuroendocrine theory: based on the understanding that the neuroendocrine system integrates body functions and facilitates adaptation to changes in both internal and external environments.

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Genetic theory: emphasizes the role of genes in the development of age-related changes

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Apoptosis theory: a noninflammatory, gene-driven, normal developmental process that occurs continuously throughout the life

Sociocultural Perspectives on Aging 

Explain how a society influences its old people and how old people influence their society

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Include disengagement, activity, subculture, age stratification, and person-environment fit theories

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Disengagement theory: a society and older people engage in a mutually beneficial process of reciprocal withdrawal to maintain social equilibrium

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Activity theory: postulates that older people remain socially and psychologically fit if they remain actively engaged in life

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Subculture theory: states that old people, as a group, have their own norms, expectations, beliefs and habits, therefore they have their own subculture.

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Age stratification theory: addresses interdependencies between age as an element of the social structure and the aging of people and cohorts as a social process

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Person-Environment fit theory: considers the interrelationships between personal competence and the environment.

Sociocultural Perspectives on Aging 

Subculture and age stratification theories: Subculture: older adults as a group have their own norms, expectations, beliefs, and habits Age stratification: interdependencies between age as an element of social structure and aging of people and cohorts as a social process.

Psychological Perspectives on Aging 

Framework for addressing certain psychosocial issues that are common among older adults

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Include human needs, life-course, and personality development, gerotranscendence, and gender theories

Human Needs Theory 

Five categories of basic human needs, ordered from lowest to highest: physiologic needs, safety and security, love and belongingness, self-esteem, and self-actualization

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Attainment of lower level needs takes priority over higher level needs.

LONG TERM CARE: NURSING HOME SETTING 

It is a location where nursing care and personal support can be provided to a number of in-need individuals. Their needs must meet certain criteria, defined by the Ministry of Health and Long-Term Care. It also comes at a cost, where it can range from $1800/month to $2600 depending on the amount of privacy you would like. There is also a waiting list that has been known to be very lengthy.

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The role of the nurse is to follow through with a plan of care determined by the interprofessional health team (physician, physiotherapist, nurse, etc.). We can help provide self-care, provide medications, act as a liaison between the patient and their needs, and the tending physician. We get to keep them company, watch their progress (or decline), provide encouragement, help maintain their sense of dignity and independence,

and that’s just naming a few. The role is ever-expanding, and all for the benefit of the patient. 

Hogarth Riverview Manor, St. Joseph’s Heritage (Bethammi Nursing Home) are two within Thunder Bay....