Self Care and the Older Adult

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Self Care and the Older Adult

• Week 4
• January 2007
• Pender Chapter 12 framework

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Nurses want to increase capacity for self care

• How do self care activities develop?
• Affected by
• Genetics
• Biological makeup
• Culture
• Life experience
• Health status

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Orems Self Care Features

• There are two features to self care
• Universal
• Developmental

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Universal Self Care

• Sufficient air
• Sufficient water
• Sufficient food
• Balance between activity and rest
• Balance between solitude and social interaction
• Protection from hazards
• Protection for human function and development

5
Developmental Self Care

• Maintain living conditions that support life
  processes and/or progress to higher levels of
  organization
• Nurses provide care to prevent recurrence of
  deleterious effects based on 3 questions
• What do clients need to know about their
  situation?
• What do clients want to know about the situation?
• How do nurses deliver the best health promotion
  and injury prevention messages for this client at
  this point in time?

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Nurses Role

• Nurses compensate for an individuals personal
  self care deficit
• Nurses partially compensate for an individuals
  personal / social self care deficit
• Nurses practice with a focus on education and the
  persons developmental needs

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In health promotion

• Three assumptions in this model
• Primacy of person
• Nurse is a consultant
• The client pursues health and controls their
  environment
• CAUTION Many families and individuals DO NOT
  HAVE this control over the physical and social
  environment.

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If nurses want clients to take charge of their
own health care, then nurses believe

• Clients are involved in solving health issues
• Clients make rational choices
• Clients develop skills and competencies and adapt
  to changes
• Client strive to master the environmental
  conditions that influence health
• Nurse and clients partner to promote public
  policy for building health communities
• Nurses and clients advocate for funding and
  planning to pay for self education for all

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Who is the Older Adult?

• Demographics
• Health Canada Goals for older adults
• Developmental Tasks of Aging
• Health Hazards of Aging
• Goals for Health Promotion
• How do knowledgeable nurses demonstrate health
  promotion with the older adult?

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Demographics

• See Maville Huerta Chapter 12
• Heterogenous group who will drive the changes in
  wellness/ illness care as the group size
  increases in this century
• Large age range spans 65 110 or older
• Pre elderly
• Young old
• Old
• Frail old

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Health Canada Goals for the Older Adult ( 2003)

• Nine Goals
• Injury prevention
• Promotion of physical activity
• Suicide prevention
• Reduce the costs of prescription drugs
• Reduce the economic crime victimization
• Improve quality of home life
• Address the shortage of geriatricians
• Improve the income levels of older adults
• Improve the affordability of rental housing

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Developmental Tasks

• Adjust to health status changes
• Adjust to retirement and income changes
• Adjust to death of partner and/or friends
• Accept self as an aging person
• Maintain satisfactory living arrangements
• Redefine relationships with adult children
• Find ways to maintain quality of life

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Health Hazards

• In this older adult age group, there is variety
  and disparity in many domains
• Developmental
• Biological
• Socio-economic
• Environmental

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Developmental

• Integrity versus Despair
• Sub sets
• Ego differentiation vs role preoccupation
• Body transcendence vs body preoccupation
• Ego transcendence vs ego preoccupation

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Your 100th Birthday party

• See Maville Huerta page 236
• Group pair share for answers to 4 questions

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Biological

• As the body ages, functions adjust in the
  biological domain
• Nutrition needs
• Fitness and exercise strategies
• Sleep patterns
• Sexuality

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Socio-economic

• The persons SES will affect all other domains
• Poverty
• Education levels are increasing in the older
  adults ( Do we need to re-write some client
  education materials font size, words etc)
• Drug benefits, screening costs , rehab costs

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Psychological Domain

• Stress versus eustress
• Stress reduction techniques
• Role of Spiritual support and belief system
• Culture
• Elder Abuse

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Assessment of Risk for Abuse

• In interview and health history
• Elder Abuse screening interview questions from
  Jarvis page 77 based on AMA Elder Abuse Screening
  Questions
• Table 12-6 in Maville Huerta

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Environmental

• In the environment the older adult is at risk for
  injury and to be causative in injury accident
• Driving
• Safety at Home and Fall Risk
• Polypharmacy and medication

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Goals for Health Promotion

• What do you define as goals for health promotion
  for this age group ? Consider BPG
• Nutrition and dehydration
• Exercise
• Smoking cessation
• Fall Risk
• Adverse medication reactions
• Continence of bowel and bladder
• Management of hypertension

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How do nurses demonstrate injury prevention and
health promotion with the older adult?

• How do nurses help?
• Nurses may act in all three of Orems roles
  compensatory, partially compensatory,
  educational/ developmental.
• LISTEN to the older adult regardless of your role
• What does this person consider important?
• DO NOT ASSUME PRIORITIES FOR THE PERSON
• Focus on activities to prevent, improve, reduce
  or eliminate problems. You will be involved in
  primary, secondary and tertiary levels of
  intervention for this population

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• Perceive the adults uniqueness
• Demonstrate procedural competence and recognize
  self care deficits for this person at this point
  in time
• Respect the older adults individuality

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Web based References for Nurses who care for
older adults

• RNAO Best Practice Guidelines
• www.hc-sc.gc.ca/seniors
• www.canadian_health_network.ca
• www.cgna.net