Maintaining SelfEsteem

1
Maintaining Self-Esteem Self-Efficacy
Gerontological Community Based Nursing
2
Review of Psychosocial Changes of Aging

• Personality
• Memory
• Learning
• Relationships
• Neurological changes of aging

3
Culture and Aging

• Culture/Ethnicity
• Cultural Awareness
• Cultural Knowledge

4
Cultural Implications and Aging
5
Culture, Nursing Maslows Hierarchy of Needs
6
Families

• Roles
• What are they?
• What have they been?
• How are they changing?

7
Caregivers

• May include
• Family
• Friends
• Paid/unpaid workers
• giving back
• Can be very stressful

8
Elder Abuse

• Acts of physical or mental mistreatment that
  threatens or causes harm to an elderly
  personeither by action or inaction
• Examples

9
Elder Abuse

• Assault
• Putting an elderly person in fear of impending
  abuse or violence
• Does not include actual touching
• Usually consists of verbal or physical threats
• Battery
• Unwanted/offensive touching
• Beating, hitting, pushing or throwing objects
  that hit an elderly person
• May also be non-injurious touching

10
Elder Abuse

• Neglect
• Also called passive abuse
• Includes withholding of medication, medical
  treatment, food, and personal care
• Also includes behavior that ignores the persons
  obvious need even though the neglectful person is
  present

11
Elder Abuse

• Financial abuse
• Theft or conversion of money or anything of value
  belonging to an older person
• Those most commonly involved are relatives and
  care givers
• Theft may be by force, through deceit,
  misrepresentation, fraud or undue influence on
  decisions made by the elderly person

12
Elder Abuse

• Psychological Abuse
• Mental or emotional abuse
• May include name calling, verbal assault, threats
  of violence, neglect or institutionalization

13
Elder Abuse

• Self Neglect
• Generally a function of diminished physical or
  mental ability
• Includes not taking medication, avoiding medical
  treatment
• Being unable or unwilling to provide food and
  personal hygiene
• Ethical question how much should we intervene
  if the elderly person is competent and simply
  chooses not to perform this care?

14
Elder Abuse

• Sexual abuse
• Forced or exploitive sexual conduct or activity
• Demand for sexual favors by use of threat or force

15
Nursing Responsibilities

• Detecting the abuse
• Elderly are often reluctance to report abuse
  because they fear being abandoned
• Abuse is likely under-reported, underestimated
  and not well documented
• Reporting can be difficult because patients,
  families, caretakers are uncooperative or
  doubtful
• Psychological and sexual abuse are difficult to
  identify d/t lack of demonstrable evidence

16
Nursing Responsibilities contd

• Change in appetite or depression are common with
  all kinds of abuse and neglect.
• People who are victims of abuseespecially the
  elderlyare often reluctant to report

17
Nursing Responsibilities contd

• Reporting abuse and neglect
• Most states have mandatory reporting requirements

18
Aging and cultural effects
19
Nutrition and Aging

• Nutritional changes across the life span are not
  well documented/understood
• Healthy People 2010 had several goals related to
  nutrition in older adults including
• Counseling and education
• Dental care
• Healthy weight
• Blood cholesterol levels

20
Nutrition and Aging

• Some age-related changes in the GI tract
  occurbut these changes are rarely the primary
  factors affecting poor nutrition
• More influential factors
• Changes in living situations
• Loss of a spouse
• Functional impairments
• Inadequate income
• Changes in health

21
Dietary Needs of the Older Adult

• Changes related to calorie, protein, fat, fiber,
  dietary supplements and water intake
• Calories
• Decreasing metabolic rate and physical activity
• Older adults require approximately 1600
  calories/day

22
Dietary Needs of the Older Adult

• Protein intake
• 1 g/kg of body weight
• 10-20 of daily calories from protein
• Fats
• 20-25 of daily caloric intake from fat
• Focus on foods low in saturated fat
• Fiber
• 20-35 grams of fiber daily
• High fiber foods
• Fiber supplements

23
Age related changes Affecting Digestion and
Appetite

• Some changes occur in sense of taste and smell
• Taste
• Ability to detect sweet taste remains intact
• Decline in ability to detect sour, salty and
  bitter tastes

24
Age related changes Affecting Digestion and
Appetite

• Smell
• Sense of smell declines with aging
• Significant effect on pleasure of eating
• Digestive system
• Remains adequate throughout life
• Minimal normal changesbut can be compounded by
  other pathological conditions
• Appetite
• Influenced by physical activity, functional
  limitations, smell, taste, mood, socialization
  and comfort.
• Physiologic changes neurotransmitter regulation

25
Additional Concerns

• Dentition
• Bowel Function
• Constipation

26
Chronic Illness

• Most disorders of aging are chronic ones that
  must be treated within a framework of lifestyle
  changes, living situation adaptations, and
  attention to the whole person coping with the
  disorder
• Burggraf, Barry 1996

27
Wellness in Chronic Illness

• Greatest factor in establishing a sense of
  wellness in the face of chronic illness is
  adaptation.
• Nurses help patients assist clients toward
  enriched capacity for living in the shadow of
  chronic illnessmany of which are common in the
  older adult

28
Nursing Interventions for Chronic Illness

• See Chapter 16pg 331
• 5 Cs
• Competence
• Compassion
• Conscience
• Commitment
• Confidence

29
Chronic Cardiac Disorders

• Coronary Artery Disease
• Heart Failure
• Peripheral Vascular Disease

30
Chronic Respiratory Disease

• Chronic Obstructive Pulmonary Disease (COPD)
• Pneumonia
• Tuberculosis

31
Life Space Considerations

• Stress associated with moving from a
  long-established location.
• Usually to a setting that is more restrictive
• Moves often occur at times of crisis

32
Home

• 88 of elders want to remain in their homeage
  in place
• Independent living gt assisted living gtskilled
  nursing facilities

33
Staying at Home

• Considerations for staying at home
• Modifications and home safety
• Safety in the community
• Food, home maintenance
• issues
• Taxes, etc.

34
Continuum of Housing Options

• Housed with Family Members
• Granny Flat
• Senior retirement communities
• Federally assisted senior housing
• Shared housing
• Foster care
• Residential care facilities
• Assisted living facilities
• Subacute and rehab facilities
• Nursing homes