Wellness, Home Health and Elders: Definitions, Trends and Models

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Wellness, Home Health and Elders Definitions,
Trends and Models

• Emily K. Schulz, PhD, PhD, OTR/L, CFLE
• OT 665

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Trends

• In Elderly Population Over Time

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Population Growth of Elders Over Time by
Percentage
http//www.aoa.gov/aoa/STATS/AgePop2050Chart-pct.h
tml
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Population Growth of Elders Over Time by Age
http//www.aoa.gov/aoa/STATS/AgePop2050Chart-numbe
rs.html
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Healthy People 2010

• Leading Health Indicators

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Healthy People 2010

• What Are the Leading Health Indicators?
• The Leading Health Indicators will be used to
  measure the health of the Nation over the next 10
  years.
• Each of the 10 Leading Health Indicators has one
  or more objectives from Healthy People 2010
  associated with it.
• As a group, the Leading Health Indicators reflect
  the major health concerns in the United States at
  the beginning of the 21st century.
• The Leading Health Indicators were selected on
  the basis of their ability to motivate action,
  the availability of data to measure progress, and
  their importance as public health issues.

http//www.healthypeople.gov/LHI/lhiwhat.htm
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Healthy People 2010

• The Leading Health Indicators are
• Physical Activity Overweight and Obesity
• Tobacco Use Substance Abuse
• Responsible Sexual Behavior Mental Health
• Injury and Violence Environmental Quality
• Immunization Access to Health Care
• http//www.healthypeople.gov/LHI/lhiwhat.htm

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10 Minute Activity

• Alone, with a partner, or a group, look at the
  list of leading health indicators from Healthy
  People 2010.
• Write a list of health care needs elders have
  based upon that list.
• Next to that list, write resources elders will
  need to meet their health care needs.
• Next, write what OT can do to help with this.
• Be prepared to share your respo nses with the
  larger group.

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Responses to 10 Minute Activity
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Definitions

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Definition of Terms

• Wellness State of Physical and Psychological
  Well-being
• Health State of well-being optimal capacity for
  effective performance of valued tasks.
• Health PromotionInterventions designed to
  promote maximal health, rather than to remediate
  disease. (Bonder Wagner, 2000, p. 524 531).

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Definition of Well Elders

• Well Elders- age 65 and older, who have not
  been hospitalized within the last 6 months, and
  who are independent in all basic activities of
  daily living (Ralston et al, 2001, p.60).

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Definition of Frail Elderly

• The frail or vulnerable elderly, defined as those
  with more than four times the risk for death or
  functional decline over a two-year period, are
  estimated to be between 21 and 32 percent of
  Americans over age 65. They are the largest
  consumers of health care.
• http//www.acponline.org/college/pressroom/elderly
  _care.htm

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Definition of Ill Elders

• Persons 65 years or older, requiring
  hospitalization for a medical condition.

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Definition of Functional Performance and
Assessment

• Assessment Gathering of information to
  categorize, appraise, estimate, judge, and
  evaluate. (Bonder Wagner, 2000, p.522).
• Functional Performance Ability to engage in
  activities that are important to the individual
  within his or her environment. (Bonder Wagner,
  2000, p.525).

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Definition of Functional Independence Measure
(FIM)

• FIM Widely used functional assessment that
  includes self-care, sphincter control, transfers,
  locomotion, communication, and social cognition
  (Bonder Wagner, 2000 p. 525).

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Factors that Promote Wellness

• Genetic make up
• Exercise
• Diet
• Social engagement
• Spirituality
• Perceived control
• Coping strategies
• Valued life activities

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Factors that Promote Wellness -Genes

• Genetic make up
• Some families are genetically pre-disposed to
• Type II diabetes,
• Alzheimers disease,
• heart disease,
• some cancers,
• Huntingdon's disease

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Factors that Promote Wellness -Exercise

• Exercise
• Can prevent
• heart disease, osteoporosis, arthritis, diabetes,
  hypertension, and cerebrovascular disease
  possibly some forms of cancer
• Physiological benefits -
• regulate glucose levels, stimulates adrenalin and
  noradrenalin, improves sleep, increase muscle
  strength, better aerobic and cardiovascular
  capacity, flexibility, balance, coordination
  improves, regulation of movement velocity
• Psychological benefits
• relaxation, stress and anxiety reduction,
  increase well being, mental health, cognition,
  skill acquisition.

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Factors that Promote Wellness - Diet

• Diet
• good nutrition is important
• Problems- for elders
• Malnutrition (limited protein in take)
• dehydration,
• excessive alcohol intake
• difficulty affording food
• difficulty grocery shopping and
• Difficulty with meal prep

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Factors That Promote Wellness -Social Engagement

• Social engagement
• Those with good social networks function better
  than those who are isolated fewer hospital
  visits, lower mortality rates
• Connectedness with others important
• Social interaction sometimes difficult to
  maintain friends and family die, move away
• Intergenerational activities very important
• Pets for those who are socially isolated
• Use of telephone and computers help to bridge the
  gap.

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Factors That Promote Wellness -Spirituality

• Spirituality
• Currently, for most elders, their spirituality
  will coincide closely with their religious
  beliefs
• Overwhelming evidence supports that spirituality
  promotes wellness in elders
• Dont force religion on elders
• Do offer opportunities for voluntary expression
  of religious beliefs.
• Listen carefully to elders about this important
  topic and support them in this area of interest.

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Factors That Promote Wellness Perceived Control
and Coping Strategies

• Perceived control and coping strategies
• Feeling in control of life choices is very
  important
• Having positive coping strategies in place also
  important

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Factors That Promote Wellness Valued Life
Activities

• Valued life activities
• Familiar activities
• Easy to do - automatically
• Bring back positive memories
• Continuity in life

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WHO - ICF

• Model

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World Health Organization (WHO) and ICIDH-2, or
ICF

• The World Health Organization (WHO) published new
  guidelines to classify health and disability in
  2001.
• These guidelines replaced the former
  International Classification of Impairments,
  Disabilities, and Handicaps (ICIDH)
  classifications, which viewed disability from a
  medical model perspective, and as being a problem
  with the individual person.
• These guidelines and the new OT Practice
  Framework coincide well with each other

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World Health Organization (WHO) and ICIDH-2, or
ICF

• The new guidelines were formerly called ICIDH-2.
• They have been re-named The International
  Classification of Functioning, Disability and
  Health (ICF), as of May 22, 2001.
• The newest Frameworks of Practice for
  Occupational Therapy, which replace Uniform
  Terminology III, correspond closely to this new
  ICF document from WHO.

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ICF Overview
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ICF Definitions of Components
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World Health Organization - ICFKey Constructs of
Functioning Disability(Adapted from work done
by Donald J. Lollar, EdD. Centers for Disease
Control and Prevention Disability and Health
Branch)

• Body Function Activities Participation
• BODY PERSON SOCIETY
• Function/ Activities Participation
• Structure (Limitation) (Restriction)
• Severity, Localization, Difficulty with and
  degree
• Duration without assistance
• ENVIRONMENTAL FACTORS
• BARRIERS (Physical Social) FACILITATORS
  (Physical Social)

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Current WHO Understanding of Interactions Between
the Components of ICF
Health Condition (Disorder or Disease)
Body Functions and Structures
Activity
Participation
Environmental Factors
Personal Factors
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Current WHO Understanding of Interactions Between
the Components of ICF with Concepts from
Philosophical Base
Health Condition (Disorder or Disease)
Body Functions and Structures
Activity
Participation
(Occupation)
(Biological Psychological Factors)
Environmental Factors
Personal Factors
(Social Physical Environment)
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10 Minute Activity

• Alone, with a partner, or a group, write a list
  of changes in body structures in older persons.
• Next to that list, write how those changes in
  body structures affect the way older persons
  perform activities.
• Be prepared to share your responses with the
  larger group.

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Responses to 10 Minute Activity
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Practice in Home Health Care

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Home Health

• Cost-effective
• Must be confined to the home
• Under the care of a physician
• Established plan of care reviewed by the
  physician
• Need skilled nursing services, PT, or OT on an
  intermittent basis or OT ongoing
• Intermittent care fewer than 7 days a week or
  les than 8 hours of each day for 21 days or less.

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Home Health

• Common conditions
• Chronic obstructive disorders
• Cerebrovascular disorders
• Circulatory disorders with complications
• Pneumonia and pleurisy
• Nutritional/metabolic disorders
• Hip/femur fractures
• Major small/large bowel disease
• Coronary bypass with cardiac complications
• Major joint limb reattachment of lower extremity

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Home Health

• Common conditions
• Chronic obstructive disorders
• Cerebrovascular disorders
• Circulatory disorders with complications
• Pneumonia and pleurisy
• Nutritional/metabolic disorders
• Hip/femur fractures
• Major small/large bowel disease
• Coronary bypass with cardiac complications
• Major joint limb reattachment of lower extremity

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Home Health Care - Three Types of Community
Program Sites

• Home Health Agencies
• Independent Living Centers
• Private Practice (Contract Workers)

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Treatment Team - Home Health

• OTRs OTAs
• Public Health Nurses
• Physical Therapists
• Speech Therapists
• Home Health Nurses
• Social Workers
• Home Health Aides - 70 of services
• Client
• Family

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Key Concepts in Community Care Home Health

• The value of the home environment
• A holistic approach
• Skills needed to work in home health care
• independence,
• flexibility,
• adaptability,
• ingenuity
• good communication,
• organization
• good time use.

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Key Concepts in Community Care Home Health

• Knowledge base
• Client centered
• (support client in own environment, work on
  problem-solving skills of clients),
• community-based rehabilitation
• (targets community to provide equal opportunity
  for clients with disabilities)
• independent living
• (self-help, peer-support, research, direct
  service, referral services, advocacy for
  individuals with disabilities).

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Key Concepts in Community Care Home Health

• Networking
• with other professionals,
• paraprofessionals,
• community resources,
• family members
• Friends
• Cultural Issues
• Diversity,
• Cultural Competence

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Issues and Trends Home health

• Educating Students for Home Health Care
• Marketing Occupational Therapy Services in Home
  Health Care
• Mental Health Home Care - emerging
• Rural Outreach Programs
• Issues of Personal Safety

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10 Minute Activity

• You have been assigned to provide OT services to
  someone living in a rough neighborhood.
• You are afraid of getting attacked or mugged.
• What steps can you take to protect yourself?

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Responses to 10 Minute Activity
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Questions and Answers

• ?