Gerontological Considerations in Family Health Nursing with voiceover

Gerontological Considerations in Family Health Nursing : 

Gerontological Considerations in Family Health Nursing NSG 432 Module 4 Winter 2012

Older Adults : 

Large group getting larger! Now about 12% of U.S. population is >65 years By 2030, expect 20% to be >65 years “old old” (> 85 years) is fastest growing component (will rise from 5.8 million to 19 million people in U.S.) Present trends continue… Majority female Variable incomes – many are low-income 20% of Social Security recipients depend on SS exclusively Most with one or more chronic illnesses 25% have conditions that interfere with ADLs or IADLs Older Adults

Implications : 

Older adults account for >50% of hospital days Medicare is biggest driver of federal deficits Families are still the greatest source of care for older adults We have to make care-giving for families as effective and rewarding as possible Implications

Family Structures : 

As life span lengthens, family life stretches Multiple generations alive at once Child-parent relationships last for 6+ decades Sibling relationships last 8+ decades As family size shrinks, fewer are able to be caregivers ‘sandwich’ generation gets crunched hard Some gender/ethnic group based variability in living arrangements Family Structures

Sexuality in Older Adults : 

Interest in being sexually active extends into 80’s Level of interest a function of Health Availability of partners Psychological factors Sexuality in Older Adults

Families remain connected : 

Elders are less isolated than most assume Most families have close relationships between generations Ambivalence does exist! Conflict does exist! Complexity is the norm Families are still chief source of care for most elders (>80%) Fewer than 40% use paid care in any form Families remain connected

Support for family care : 

See Table 15-1 on p 424 Sources of Home and Community based services Adult day care, companion services, home health care/home care, chore services, meals on wheels, respite care, senior centers, transportation services, case managers for hire Transition between levels of care-giving in the home setting can be gradual or abrupt The greater the surprise, the greater the stress Support for family care

Family Care : 

Most caregivers are middle aged Most caregivers are female Can be a few hours/wk to round the clock Can last for a few years to decades Culture influences are present Spouse vs daughter, nuclear family vs extended, social support vs formal family support Family Care

Older adults as caregivers : 

For grandchildren For adult children with mental or developmental or physical illnesses Many Iraq/Afghanistan wounded vets are cared for by parents Family member often unprepared for caregiver role Older adults as caregivers

Caregiver support : 

See p 430, tables 15-2 and 15-3 Always assess caregiver needs Care planning Identifies resources to support caregiver Provides explicit support for caregiver addressing her/his physical and emotional needs Is interdisciplinary Is sensitive to culture of client and caregiver Caregiver support

Acute Care : 

Hospitalization is a direct, independent threat to the well being of elders Loss of conditioning, delirium, functional decline Must protect against Functional decline – loss of ability to perform ADLs, IADLs Loss of cognitive capabilities Worsening sensory impairments Need to do baseline assessments with standardized tools on admission Acute Care

3 D’s : 

Dementia Slow onset loss of cognitive abilities, usually starting with short term memory. Detect early. Many strategies to delay progression. Delirium Usually rapid onset. Sx include inattention, disorganized thinking, altered LOC Infection, meds, dehydration, fluid/electrolyte imbalances are often triggers Usually reversible High morbidity/mortality if undetected/untreated Depression Under-recognized, undertreated in elders 3 D’s

Resources : 

Many tools for baseline assessment See table 15-4 on p 432 Many models for improving care of elders in acute care See table 15-5 on p 433 Be pro-active Watch for ‘adult orphans’ Elders with no family Will need extra attention & supports Resources

Formal Care Options : 

Foster Care Room & board, 24 hour help/supervision & assistance with ADLs Group homes (board & care) A few to 20 residents Private or shared rooms Not much direct medical care delivered Formal Care Options

Assisted Living : 

Congregate care Tries to mimic home like environment Provides for autonomy, privacy, sense of community Provides limited assistance with ADLs but cover IADLs Built on a social model, not medical model Difficulties arise when resident’s medical needs grow too great More/better care is associated with presence of RN on staff (no surprise there!) Assisted Living

CCRCs : 

Continuing Care Retirement Communities “life care communities” Multiple levels of care in one location. Residents progress through levels as they lose functionality. Entry fees, monthly fees, often complex financial structures Variable quality levels (from $$ to $$$$$$) Usually resident makes a long term commitment to stay CCRCs

Nursing Homes : 

Skilled nursing facilities (SNFs) 24 hour nursing care provided Usually rehabilitative (PT, OT, speech) Stays are short (post-surgical recovery) or longer Highly regulated by state regs Services usually reimbursement driven (medicare, medicaid) Elderly poor and/or disabled often placed for chronic care by state programs See www.medicare.gov -- nursing home compare for quality indicators, comparisons Nursing Homes

Person Centered Care : 

Term for movement to provide less ‘institutional’ care in nursing home setting See p 15-8 for characteristics Give residents more choice & control Help maintain social & community connections Empower direct care workers to be pro-active and independent in their practices Person Centered Care

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