NCM 114

CARE OF
OLDER
ADULTS

FINAL TERM
 Communicating
with Older Adults
 Communication is an important
skill that allows us to survive in
Topic 1 : and interact with our world.
Aging Changes
that Affect Through our ability to
Communicatio communicate, we express our
n need and wishes, understand the
needs and wishes of others,
negotiate adversity, and convey
our feelings.
 COMMUNICATION

• EXCHANGE OF INFORMATION
• Involves a sender of message, the message, receiver and the
feedback
• It can be verbal, non verbal, written, visual
• Verbal- use of words
• Non verbal- use of gestures, expressions
 SENSORY MODALITIES INVOLVED IN
COMMUNICATION

• Receiving information about the environment through our senses

(seeing, hearing, smelling, touching, tasting, and vestibular).

• Vision has an important role in communication, with approximately

70% of all sensory information coming through the eyes.

• Hearing is another prominent sense involved in the reception of

communication. Hearing not only allows us to determine the source
of the information, but also allows for interpretation of the meaning
of spoken words.
• Touch may be used as a substitute for sight, allowing a visually impaired
person to “read” his or her environment.

• Smell (olfaction) and taste (gustation) also seem to be unrelated to

communication. However, olfaction can trigger feeling and memories.

• Movement provides us with important information about our

environment. For some, movement combined with the sense of touch will
allow the receipt of information from the environment.

• Speech is the primary form of communication with our environment.

Speech involves both articulation and pronunciation.

• The brain has a major role in attending to new information, making

sense of and organizing information, and deciding on a response
NORMAL AND PATHOLOGICAL
AGE-RELATED CHANGES THAT
AFFECT COMMUNICATION

• Vision: with age, the lens

changes in color, becoming
more yellowed or amber, and
opaquer.

• Starting at the age of 50, the

pupillary reflex responds more
slowly, and the pupil does not
dilate completely (senile
miosis), making it more difficult
to see in lower light and thus
adapt to the dark quickly.
• Typical vision problems: poor
visual acuity or clarity,
presbyopia, photosensitivity

• Behavioral cues to visual

defects: one common symptom
is when people start to adjust the
distance at which they hold a
newspaper or book in front of
them when they read.

• Common visual problems:

macular degeneration, diabetic
retinopathy, glaucoma, cataract,
retinal detachment
•Hearing : types of hearing loss
conductive problems, sensorineural
problems, mixed hearing loss

• Speech and language: dysarthria,

verbal apraxia, aphasia, medical
conditions and procedures like COPD,
laryngectomy.

• Movement: Parkinson’s disease

• Cognitive changes: delirium,

dementia, Alzheimer’s disease

• Pathological psychological
changes: depression- anhedonia;
treatment is ECT.
 Topic 2 :

Therapeutic
Communication with Older
Adults
Communication is a core skill in
the health care professions.

We rely on our ability to

communicate effectively to gather
and share information as well as
to build relationships with
patients and families.

Learning and practicing the art of

communication is one key to
success as clinicians.
 ANATOMY AND PHYSIOLOGY OF
COMMUNICATION
• The term communication is used frequently in our language and
in our work. The term originates from the Latin word “commune”,
which means “to hold in common”

• Communication is the process or means by which an individual

relates experiences, ideas, knowledge, and feelings to another.

• Communication is a reciprocal process involving minimally two

people, a sender and a receiver.
 VERBAL AND NONVERBAL
COMMUNICATION
• Nonverbal communication refers to
behaviors or gestures that convey a
message without the use of verbal
language.
Vocal nonverbal communication
refers to the tone, pitch, speech rate,
or fluency of verbal communication.

Nonvocal nonverbal communication

refers to the use of facial gestures,
body posture, eye contact and touch
as a means of communication.
 ALTERNATIVE COMMUNICATION
AND ASSISTIVE TECHNOLOGY

• Assistive technology is “any item, piece

of equipment, or product system, that is
used to increase, maintain, or improve
functional capabilities of individuals with
disabilities”.

• an assistive listening device (ALD) is any

type of device that can help an
individual function better in day-to-day
living.
 CHALLENGES IN
COMMUNICATING WITH
OLDER ADULTS

• Memory or cognitive deficits

• Speech deficits or impairments (Aphasia)
• Speech impairments (Dysarthria)
• Visual impairments
• Hearing impairments
 COMMUNICATING WITH INDIVIDUALS WITH
MEMORY OR COGNITIVE DEFICITS
• INVITE, RESPECT- approach in non-threatening manner within
their visual field. Respect the patients belongings, ask before
moving objects. Show concern and have a conversation
• ENVIRONMENT-post a few pictures, calendar, daily schedule. Sit
and face the person you are speaking with. Maintain eye contact.
Respect space and converse in a quiet environment
• UNDERSTANDING- speak in normal tone. Use appropriate age
language. Start with a familiar topic.
• COMMUNICATION- show interest. Provide time for conversation.
Don’t laugh at responses, no matter how unusual.
 COMMUNICATING WITH INDIVIDUALS
WITH VISUAL IMPAIRMENTS
• INVITE,RESPECT- Gently call out the patient when entering the room and
identify yourself and anyone with you in the room. If the patient can see
shapes or outlines, stand near the patient.
• ENVIRONMENT- minimize distractions. Describe the environment and
where you are located in relation to the person. Explain if you will do
something. Make sure to not move objects frequently.
• UNDERSTANDING- Alert the patient if you will be touching them
• COMMUNICATION- oral communication with touch is more important
than nonverbal gestures that they cannot see, use appropriate tone of
voice.
 COMMUNICATING WITH INDIVIDUALS
WITH HEARING IMPAIRMENT
• INVITE, RESPECT- TO GET ATTENTION, TOUCH THE PERSON GENTLY,
WAVE OR USE ANOTHER PHYSICAL SIGN. STORE ASSISTIVE DEVICE
WITHIN REACH. Allow time for conversation
• ENVIRONMENT- if patient is on hearing aid, check to see if he is wearing
it. Minimize background noise. When speaking face the person directly,
so he can see your lips and facial expression.
• UNDERSTANDING- speak clearly in a low pitched voice, avoid yelling or
exaggerating speaking movements. Use short sentences. Don’t hesitate
to write notes to maximize understanding.
• COMMUNICATION- allow individual to be involved in making decision.
Ask question to clarify message.
 INTERNATIONAL
MODEL OF HEALTH
CARE
 • Overview :

Meeting the needs of a rapidly

Topic 1: growing older adult population is a
challenge worldwide.
Global
Models of  Comparing models of health care
around the world may provide
Health greater insights into how best to
Care meet the challenges the growth in
the aging population will create.
 • Japan has a universal health care
system. Insurance is provided through
INTERNATION the National Health Insurance or
AL MODELS through Employees’ Health Insurance
OF HEATH
CARE • Co-payments are required for hospital
and outpatient care,and may be
required for prescriptions. Copayments
are between 20% and 30% of the bill.

• There is also a health plan for people

over the age of 70 years.
• Currently, the elderly in Japan enjoys
the longest life expectancy in the world.
INTERNATIONAL
MODELS OF • Germany was the first country to establish
HEATH CARE a national health care program.

• Social insurance in Germany is a

mandatory transfer system whereby
employees and employers make equal
contributions for long term care (LTC),
social health insurance, pension funds,
unemployment, and worker’s
compensation.

• The goal of the LTC insurance law was to

provide relief from the financial burden of
long-term disability and illness.
INTERNATION
AL MODELS • The National Health Service (NHS) in England
(Great Britain) was established in 1948.
OF HEATH
CARE • It is a universal system of health care based on
clinical need rather than employment status;
care is free at point of care.

• The NHS is divided into two basic sections:

primary and secondary care.

• Primary care is usually the patient’s first

contact with a health care provider. Primary
care providers are independent contractors
with NHS and may be general practitioners,
dentists, pharmacists, or optometrists.
INTERNATION • The Canadian health care system, known
AL MODELS as medicare, provides universal coverage
at no cost at the point of case access.
OF HEATH
CARE • Each of the 10 provinces is responsible for
establishing, maintaining, and evaluating
the provision of health care services within
the province following national guidelines:
universal, portable, ability to access, and
publicly administered.

• The health care system in Canada is

funded primarily through tax monies.
SETTINGS FOR CARE IN THE UNITED
STATES
• Acute Care : The elderly care use acute care hospitals at
a rate greater than any other age group.
• In 2000, the elderly compiled nearly 40% of the discharges
and used almost one-half of the hospital days. Overall,
average lengths of stay for those 65 or older were longer
than for any other age group.
• Long-Term Care :“refers to health, mental health, social,
and residential services provided to a temporarily or
chronologically disabled person over an extended period of
time with a goal of enabling the person to function as
independently as possible”.
• Home care – is part of the continuum of long-term care. It
includes skilled nursing care and therapies, personal care
services, durable medical treatment, high technology
home services, and hospice.
• Assisted living – is another component of the long-term
care continuum. Assisted living facilities are not
substitutes for nursing home care; instead, they bridge the
care need between living independently at home and
nursing home care.
• Long-term care facility (Nursing Home) – may provide
both skilled nursing and intermediate care.
 HEALTH CARE IN THE PHILIPPINES
• a mix of public and private systems, characterized by diverse services that
range from primary to specialized care. The public sector, managed by the
Department of Health (DOH), provides health services through
government hospitals, rural health units, and barangay (community)
health stations.

• The Universal Health Care (UHC) Law, passed in 2019, ensures automatic
enrollment of all Filipinos in the National Health Insurance Program
managed by PhilHealth. It aims to enhance health care accessibility and
coverage for both inpatient and outpatient services. Despite this, out-of-
pocket expenses for many remain substantial.
HEALTH CARE
FOR ELDERLY
IN THE
PHILIPPINES
• Public Health Services: Senior citizens have
access to health services provided through
the Department of Health (DOH) and local
government units.

• PhilHealth Coverage: Elderly Filipinos are

automatically covered by the Philippine
Health Insurance Corporation (PhilHealth).

• The Expanded Senior Citizens Act ensures

free PhilHealth coverage for all senior
citizens, providing benefits for
hospitalization, diagnostics, and preventive
services.
• Community-Based Programs: The DOH
and local governments run community-
based health programs, such as regular
health check-ups, vaccination campaigns,
and wellness programs, to promote
active and healthy aging.

• Medicines and Discounts: Senior citizens

are entitled to a 20% discount and
exemption from the 12% value-added tax
on the purchase of medicines and
health-related services under the
Expanded Senior Citizens Act.
 LAWS PROTECTING
ELDERLY IN PHILIPPINES
• Republic Act No. 7432 (Senior Citizens Act of
1992):
• This law was the first major legislation that
recognized the rights and privileges of senior
citizens. It grants them benefits such as
discounts on purchases, priority lanes, and
other services.
 • Republic Act No. 9994 (Expanded Senior Citizens Act of 2010):
• This act amended the original Senior Citizens Act to expand the
benefits and privileges.
• It includes:
• Free PhilHealth coverage for all senior citizens.
• 20% discount and VAT exemption on purchases of essential goods
and services.
• Mandatory membership in PhilHealth even if they are not
pensioners.
• A 5% discount on water and electricity bills for households with
elderly individuals, provided they meet certain consumption limits.
• Access to affordable health services, social welfare programs, and
• Republic Act No. 11350 (National Commission of Senior
Citizens Act):

• This law created the National Commission of Senior Citizens,

an agency focused on ensuring the implementation of laws,
policies, and programs for the elderly. It is responsible for
monitoring and coordinating various initiatives for senior
citizens and safeguarding their rights and welfare.
• Republic Act No. 10868 (Centenarians Act
of 2016): This law recognizes and grants
benefits to Filipinos who reach the age of
100 and above, providing them with cash
incentives and recognition.
• Anti-Elder Abuse Laws: Various
laws and local ordinances address
elder abuse, neglect, and
exploitation.
• The government, through agencies
such as the Department of Social
Welfare and Development
(DSWD), provides support and
intervention services for abused or
neglected elderly individuals.
QUIZ NEXT
MEETING!!!
 • Overview :

Their needs for health care are best served

through a comprehensive collaborative
Topic 2: approach to assessment and care.
The
This collaboration is most frequently
Interdiscipli referred to as an interdisciplinary team.
nary Team
Working together within or between teams
or with professionals outside the team is
required to provide the most
comprehensive care for the individual.
 TEAMS
• Multidisciplinary teams function as
a group (multiple) of professionals
who work loosely in the same area
or with the same client.
Interdisciplinary teams are an
interconnected group of
professionals who have common
and collective goals.

• The term intradisciplinary team is

used to indicate that the work and
relationship are within the
discipline, but members may be at
different levels of preparation.
 COMMON DISCIPLINES INVOLVED
IN GERIATRIC TEAMS
 Audiologist
 Caregiver
 Title based on religion: Chaplain, Priest, Rabbi, Minister
 Client/Patient dietician
 Geriatrician Advanced Practice Gerontological Nurse Practitioner (GNP)
 Advanced Practice Gerontological Clinical Nurse Specialist (GCNS)
 Occupational therapist
 Physical therapist
 Pharmacist
 Physician
 Physician assistant
 Psychiatrist
 Psychologist
 Registered nurse
 Social worker
 Speech-language
 pathologist
• AUDIOLOGIST- assess earing including audiometric studies,
treatment for hearing loss
• CAREGIVER- depending on the degree of expertise
• RELIGIOUS WORKER (chaplain, priest, etc)- provide
support to the client/patient/family related to spiritual
needs
• CLIENT/PATIENT
• GERIATRICIAN- utilizes knowledge of normal aging as part
of assessment. Specializes in diagnosis and treatment of
elderly
• DIETICIAN- assess nutritional status and implements nutritional
plan
• Advanced Gerontological Nurse Practitioner- provides primary care
• OCCUPATIONAL THERAPIST- assess and treats functional, sensory
and perceptual deficits that impacts ADL. Assess need for assistive
device and cognitive deficits
• PHARMACIST- prepares and dispense medicines. Provide clinical
consultation and education for patient and geriatric team
• PHYSICAL THERAPIST- assess mobility and functional capacity of
elderly. Treatment include rehab, strengthening, mobility and use of
assistive device
• PHYSICIAN- dependent on area of residency, focus on disease
process related to aging
• PHYSICIAN ASSISTANT- midlevel practitioner
• PSYCHIATRIST- evaluate , treats and manages mental health
issues faced by the elderly
• Psychologist- assess, consults, intervene and manages
condition related to adaptation , bereavement, counseling and
treatment for clinical cognitive and behavioral needs
• REGISTERED NURSE- assess, plans, provides, coordinates and
evaluates care which focuses on health, optimal wellness, disease
prevention and advocacy
• SOCIAL WORKER- assist with coping and problem solving as
individuals and families adjust to and face changes with aging and
chronic illness. Provide counseling and psychotherapy
• SPEECH-LANGUAGE PATHOLOGIST-assess and treats
communication n disorders
• CLINICAL SPECIALIST IN GERON NURSING- provide directs and
influences care of older adult families in various settings
DOCUMENTATIO
N
IMPORTANCE OF DOCUMENTATION

Help the nurse identify, monitor, evaluate treatment or interventions.

Data needed for development of individualized care

Communication to ensure continuity of care, from one shift to

another, from one caregiver to another.

Basis for determining reimbursements in most settings.

 Documentation across
health care setting

• Documentation begins as soon as the

patient enters the health care system
and assessment begins.

• Documentation format might change,

but the purpose do not.
 DOCUMENTATION IN ACUTE CARE AND
ACUTE REHABILITATION CARE
SETTINGS
ELECTRINIC MEDICAL RECORD- is used for documentation

Computers are used – nurses have their own access and password.

Barcodes, fingerprints are scanned to access record

Use of checklist, flowsheet are standardized and are used as electronic format.

Documentation is done in a problem-oriented format.

NANDA, NIC , NOC IS WIDELY USED.

 Family care homes, assisted living facility,
nursing facilities.

In family homes and assisted living facilities-

DOCUMENTATI documentation occurs when a nurse have
been hired or is under a contract with a
ON IN LONG facility.
TERM CARE documentation include day to day care such as
FACILITIES eating, bowel movement, vital signs ,
medication, treatment, unusual changes

It can be in narrative format, flow sheets,

checklist
 • Care in this facility is by informal
caregivers such as family members and
others.
DOCUMENTAT
ION IN HOME
CARE • They will often develop their own
documentation system, to track
appointment, medication, and health
care provider instruction.
 FDAR

• FDAR stands for Focus, Data, Action, and Response.

• It is a structured documentation format used in nursing to
organize and communicate patient care effectively.
• FDAR notes are typically used to document patient
assessments, interventions, and responses to treatments,
ensuring that critical information is communicated clearly.
• Focus: The main issue, concern, or subject of the note. It can include a
diagnosis, symptom, behavior, or patient concern.
• Data: Objective and subjective information related to the focus. This includes
patient observations, assessment findings, and relevant test results.
• Action: The interventions, treatments, or nursing measures carried out in
response to the identified focus.
• Response: The patient’s reaction or outcome following the intervention. It
helps in evaluating the effectiveness of the nursing care provided.
EXAMPLE
• Focus: Shortness of breath (SOB) related to chronic obstructive pulmonary disease (COPD)
exacerbation.

• Data:
• Patient reported increased shortness of breath since early morning, with a respiratory rate
of 28 breaths per minute, and SpO2 at 88% on room air.
• Auscultation revealed bilateral wheezes and crackles.
• Patient appeared anxious and was using accessory muscles for breathing.
• Blood pressure: 150/90 mmHg; Heart rate: 110 bpm.
• Patient described difficulty completing sentences without pausing for breath.
• Action:
1.Administered prescribed oxygen therapy at 2L/min via nasal cannula.
2.Position adjusted to high Fowler’s to facilitate breathing.
3.Administered bronchodilator (nebulization with Salbutamol) as
ordered.
4.Provided relaxation techniques to help reduce anxiety (e.g., slow
deep breathing exercises).
5.Educated the patient about pursed-lip breathing to improve
ventilation.
• Response:
• Respiratory rate decreased to 22 breaths per minute, and SpO2
improved to 94% after 15 minutes of oxygen therapy.
• Patient expressed feeling more comfortable and was able to speak in
complete sentences.
• Anxiety level reduced, and the patient reported breathing was easier.
• Continues to use pursed-lip breathing effectively when reminded.
• Will continue to monitor respiratory status closely and adjust
interventions as needed.
Trends/Issues and
Challenges in the
Care of the Older
Persons
 • Overview:

Dozens of career options exist in

Topic 1: the field of gerontological nursing.
Trends that
Impact In addition to various job
descriptions, gerontological nurse
Gerontologi work in a variety of settings, from
the community with well elderly
cal Nursing to hospice with dying, and every
point in between along the
continuum of care.
 EDUCATIONAL TRENDS IN
GERONTOLOGICAL NURSING
• For advanced practice nurses, opportunities for further career development
are many, but often depend upon one’s geographic location.

• For nurses with doctoral-level education, careers as faculty members abound.

• The PhD (doctor of philosophy in nursing) and DNS (doctor of nursing science)
are currently recognized as terminal nursing degrees by most universities.

• The PhD is a universal research degree recognized in most countries.

• Some nursing faculty members hold an EdD, an educational doctorate, with

coursework emphasizing curricular development and teaching.
• The DNP (doctor of nursing practice) is a clinical doctorate that is
gaining more popularity in combination with obtaining certification
as a nurse practitioner or other type of advanced practice nursing.

• Another role in graduate education for nurses has emerged, taking

on new meaning; this role is clinical nurse leader (CNL). The CNL is
a leader in the health care delivery system across all settings in
which health care is delivered, not just the acute care setting.
 POTENTIAL OPPORTUNITIES IN
GERONTOLOGICAL NURSING
• Many nurses will find their first jobs in acute care hospitals,
nurses historically change positions throughout their careers.

• The need for clinical nurse specialists in gerontology is likely to

increase, as is the need for geriatric nurse practitioners.
Because the baby boomer generation is known to be an
autonomous, well educated, informed consumer group, this
population cohort is more likely to demand a higher level of
education and expertise among care providers.
 LIFE CARE PLANNING

• life care plan (LCP) is defined as a comprehensive document

designed to help meet the long-term financial and health needs of a
person who has experienced a catastrophic injury.

• Life care planners generally develop plans for insurance companies

or lawyers representing individual clients, but the ultimate goal is to
promote the best outcome for whom the life care plan was written.

• A Certified Life Care Planner (CLCP) designation may be earned

through 128 continuing education hours, successful completion of a
sample life care plan, and passing an examination.
 FINANCIAL GERONTOLOGY

•Financial gerontology is a growing subfield of financial

planning. It is defined as “the intellectual intersection of two
fields, gerontology and finance, each of which has practitioner
and academic components”.

•Three certifications:

 Chartered Advisor for Senior Living (CASL)

 Registered Financial Gerontology (RFG)
 Certified Senior Advisor (CSA)
 EMERGING MODELS OF CARE

• The institutional look of the older nursing home that was modeled
after the hospital, with long hallways and a sterile-looking
environment, is becoming unacceptable to many older adults as a
place to live out their final days.

• Continue care retirement communities are the growing trend for older
adults. Another new concept is Green Houses, a movement to replace
nursing homes with more home-like environments.

• The professional geriatric case manager (PGCM) is a specialist who

helps families care for older adults while encouraging as much
independence as possible.
 COMMUNITY LIVING DESIGNS

• Another fascinating trend related to

gerontological nursing is the emergence of
companies completely devoted to the
strategic planning, engineering, architecture,
building, and marketing of community living
designs that are tailored to today’s older
adults
 • Overview:

Topic 2:
This chapter addresses
Appreciatin diversity issues in providing
g Diversity holistic nursing care for older
adults
and Sexual expression and
Enhancing romantic intimacy are viewed
Intimacy as a part of holistic care and
also are a major part of this
chapter.
DIVERSITY AND HOLISTIC
NURSING CARE
• Consider what may happen when nurses and other health care providers
impose their values and beliefs onto someone from another culture. A
growing body of research shows that patients whose culture is taken into
consideration have better outcomes than those whose culture is not
considered.

• One characteristic that must be considered is heritage.

• Heritage encompasses a person’s ethnic origin (ethnicity), nationality,

religion, and culture.

• Ethnicity (or ethnic origin) refers to what some have called race.
• Ethnically, a person may be, for example, African, European, Asian, or
Native American.

• Nationality refers to the geographic location of the person’s birth (or

the country with which he or she identifies); for example, a person
could be born and raised in Italy, but be of Egyptian descent.

• Religion refers to a belief system based on a higher power.

• Culture refers to the group to which the person belongs and which
influences the person’s values and beliefs. Culture may cut across
nationality, religion, and ethnicity because culture represents shared
beliefs.
• Diversity of Elders :

• Adults over 65 years old are much more diverse than any other
age group, because of the wide range of their life experiences,
lifestyles, and health status, and the variations in their
socioeconomic status.

• The increasing numbers of elders of color, and differences in

diets, leisure and health care beliefs present tremendous
challenges to nurses. Food is one example.
• Personal food habits are a part of cultural norms, yet the
nurse can recommend subtle changes that can have
profound effects on health. For example, switching from
regular soy sauce to a low sodium brand is culturally
sensitive but cuts salt intake by half. The nurse may need
to use pictures of foods to get a clear idea of what a
patient likes to eat.

• The wording a nurse uses may help. For example,

Seventh-Day Adventists believe that eating between
meals is an undesirable habit; thus, persons with
diabetes can be taught to divide their intake among five
or six small meals, rather than being told to include a
snack.

• Another aspect of diversity is religion and faith practices.

• Diversity in the Health Care Team :

• Traditionally, nurses have been primarily white and female;

however, the diversity of the health care teams who care for elders
is increasing dramatically, especially in race and ethnicity.

• These changes will have a profound impact on elder care.

• In order to ensure quality of care, we must promote diversity while
preventing stereotyping, become culturally competent, cope with
and overcome racism, overcome language barriers, and learn
effective health promotion strategies for those with varying
lifestyles.
• Diversity education for nursing staff should be included as a
part of routine educational programs in all schools of nursing
and all health care facilities.

• Providing Culturally Competent Care for Culturally

Diverse Patients :

• Walsh (2004) has developed a plan of care, based on NANDA

nursing diagnoses, that is culturally competent. The care plan
focuses on communication, health maintenance, health
education, nutrition, and family coping.
• Providing Spiritually Competent Care for Spiritually Diverse
Patients :

• Providing spiritual competent care goes hand in hand with providing

culturally competent care.

• Religion and spirituality are commonly used interchangeably, but they are
not the same. Religion is an organized worship or specific faith to which a
person subscribes, whereas spirituality is a broad term referring to feelings
of being connected with something higher than oneself, often wishing to be
called “religious”.

• Nurses are responsible for finding out each patient’s spiritual practices and
preferences as part of a holistic plan of care.
• Taking Lifestyle into Account When Promoting Health :

• Some older adults have always exercised and will continue to

do so if they can find a way to continue, despite the effects of
aging and changes due to chronic illness.
ENHANCING SEXUAL INTIMACY
• A basic human need of all ages is intimacy with others.

• Sexuality is seen as separate from health care concerns, rather

than integral to quality of life.

• Anxiety and fear of embarrassment prevent both patients and

nurses from bringing up sexual concerns. Further, we fear that we
may not have the resources to assist patients to overcome sexual
problems.
• Romantic Relationship in the Elderly :

• Elders differ greatly in their romantic relationships. Some

older adults have been in the same romantic relationship for
50 years and have developed a profoundly deep relationship.

• Some people become involved in a romantic relationship for

the first time after retiring. Some older adults have been
married many times; others not at all. Some have had literally
hundreds of partners over their lifetime; others only a few,
others one, and still others none.
• Some were nuns and priests or celibate for other reasons, and then
gave up being celibate in order to be in a romantic relationship. Some
elders have been gay or straight for their whole lives; others are
bisexual and were gay or lesbian relationship when younger, then later
got married and had children. The opposite is true as well.

• Gender identity may be an issue that a man or woman struggles with

all his or her life, and then acts on desire to become the opposite
gender when older.

• The loss of one’s romantic partner is common for older adults through
divorce and death. However, the sexual loss is overlooked by most of
society.
 SEXUAL DEVELOPMENT IN OLDER
ADULT
• Chronic illness have the potential to affect sexual function, and those
who are older who continue to have sex must adapt to many changes.
• Those in the old-old age group lived through several sexual
revolutions
• 1st – women gained the right to vote
• 2nd – published book after the world war III about sexuality
• 3rd- during 1960s, 1970s, birth control pill and legalization of abortion
• 4th- discovery of HIV AIDS AND promotion of safe sex and use of condom
TRIPHASIC HUMAN SEXUAL RESPONSE
AND CHANGES WITH AGING
• TRIPHASIC HUMAN SEXUAL RESPONSE- have 3 phases. Desire,
excitement and orgasm.
• Desire phase- include sensations that move to one seeking sexual
pleasure. Which is stimulated by endorphins and pleasure centers
• Excitement phase- occurs due to myotonia, increased in muscle
tone and vasodilation of the genital blood vessel. Sexual
excitement is controlled by sympathetic nervous system
• Orgasm- climactic release of genital vasodilation. It is an automatic
spinal reflex response.
Elders differ with the response with
these changes

Some couple adapt by increasing genital

fondling and caressing.

Other couple may welcome an end to

sex.

When an elder abstain from sex for

months, desire will eventually decrease.
 VAGINAL DRYNESS AND ERECTILE
DYSFUNCTION
Decrease of men ability to maintain erection and decrease of women to achieve
lubrication is considered normal consequences of aging.
Changes in sexual function begin at the age of 40.

Erectile dysfunction and vaginal dryness are associated with chronic illness.

ED- with age, diabetes, heart disease, hpn, gastric ulcers, arthritis, and use of
cardiac drugs and vasodilators
There is also a correlation of ED and smoking, passive exposure to cigarette
and obesity
Vaginal dryness is also correlated with same illness and lifestyle
habits.

Sildenafil (Viagra) , Vardenafil (Levitra) , tadalafil (Cialis), has

changed the norms of sexual dysfunction

Traditionally vaginal dryness have been treated with lubricants or

oral or cream in the form of estrogen.

Nurse should focus on patient education on adoption of healthy

behaviors as a step to overcome sexual dysfunction.
 PROMOTING SEXUAL
FUNCTION IN COMMUNITY-
DWELLING ELDERS
• Overcome fatigue and pain- key to feeling desire and to have
stamina to give and receive pleasure.
• Adopt new positions and learning new techniques for
lovemaking.
• Some websites resources are available to address the issue.
 EXTINGUISHING SEXUALLY
INAPPROPRIATE BEHAVIOR
• Most of incident report include masturbating in public,
inappropriate touching. Which constitutes sexual harassment
• The behavior may reflect power issue, loss of inhibitions due to
cognitive impairment.
• The goal of the nurse is to extinguish the behavior and maintain
dignity of the patient
• Nurses needs to confront the patient calmy and firmly
• Nurses Laughing and reacting violently or anger are likely to
encourage the behavior
 DEALING WITH MASTURBATION IN PUBLIC
PLACES IN HOSPITAL AND LONG-TERM FACILITY

The goal is to allow for privacy, and not draw

undue attention.
Provide privacy even if clients room are semi
private
Clients using explicit materials should do so in
private
 Patients displaying sexually explicit
materials on the unit or nursing home
• Nurses should set ground rules with patient concerning posters,
jokes, magazine.
• Those with naked bodies should not be accepted to be displayed in
the patient room as it is also a form of sexual harassment.
• Rules also apply to staff
• Get well cards that overtly encourage sexual relationship with patient
and nursing staff are also inappropriate
• If patient showed the materials, calmly tell patient why they are
inappropriate
• Use respect when approaching the patient
 MODULE 8
Advocacy Programs Relevant to the Care of Older Persons
 • Overview :

 Quality of life is a concept that has

many definitions; to date there is no
Topic 1: consensus regarding the meaning of
the term.
Promoting
Quality of  Given the concept’s multidisciplinary
nature, it has been defined as a
Life degree of satisfaction or
dissatisfaction with life.

 As people age, their quality of life is dependent

upon their ability to maintain autonomy and
independence
 QUALITY OF LIFE MODELS
Physical Well-Being and
• Quality of life has been linked with Symptoms
successful aging and active aging.
Psychological
Well-Being
Quality of Life
• Successful aging means that a Social
person has avoided disease and Well-Being
disease-related disability and has
a high level of cognitive and Spiritual
Well-Being
physical functioning that allows
the individual to be engage with
life.
 ACTIVE AGING

• The term active aging was adopted by the WHO in the late
1990s to allow inclusion of additional factors related to healthy
aging. Such an approach requires thinking to shift from “needs-
based” to “rights-based” in treatment as an individual grows
older.

• This supports an individual’s right to receive interventions to

enhance autonomy, independence, and activity.

• Active aging can enhance and ensure one’s quality of life in later
years.
• The World Health Organization has identified determinants of
health that affect aging and the quality of life of individuals,
communities, and nations.

• Healthy aging is influenced by gender and culture in addition to

the following determinants:
Behavioral (physical activity, nutrition, smoking, alcohol
ingestion, and medication adherence)
Personal (biological and genetic impact of the aging
process)
 Psychological (intelligence and cognitive capacity)
 Physical environment (neighborhoods and safe housing)
 Social environment (social support, violence and abuse,
education and literacy)
 Economic (income and social protection)
 Social services (respect and dignity for older persons)
 BEHAVIORAL DETERMINANTS
-PHYSICAL ACTIVITY-
Contributes to muscle strength, flexibility, balance, cardiovascular health,
positive mood and improve cognition

Found to prevent falls

Improve brain function

Physical inactivity leads to decline in physical function and recreational and

social opportunities
 BEHAVIORAL DETERMINANTS
-NUTRITION-

Proper nutrition Will lead to Enhance skin

may delay or additional years of integrity and
prevent chronic health, productivity prevents skin
diseases in later life and high functioning breakdown
 • Accounts to death from heart diseases, lung
cancer, COPD, STROKE
• Patient who uses tobacco should be offered
BEHAVIORAL at least one of the following:
DETERMINANTS • 1. willing to quit, should be provided with
treatments that are identified effective
-SMOKING- • 2. patient who are unwilling to quit should
provide with brief intervention that is
designed to increase their motivation to quit
• PLEASE SEE TABLE 19-2 FOR STRATEGIES IN HELPING PATIENT WILLING
TO QUIT
 • 60% OF Community dwelling adults ages 60-
94 were found to drink alcohol
• In elderly the effect of alcohol may increase
due to pharmacologic changes associated
BEHAVIORAL with aging
DETERMINAN • Interaction between alcohol and drugs, is
TS serious among elderly
-ALCOHOL- • The National institute for alcohol abuse
considers one drink per day to be maximum
amount for people over the age of 65
• Binge drinking is significant problem and is a
high social and economic cost
 BEHAVIORAL DETERMINANTS
-MEDICATION ADHERENCE-

• MEDICATION non adherence remains a major health problem esp.

among elderly
• Nonadherence include: not having prescription filled, taking incorrect
dose, taking meds at wrong time, forgetting to take dose, stopping
therapy too soon due to cost, logical decision, or side effects unknown to
physician
• Medication nonadherence is considered as “invisible epidemic”
• Strategies to improve adherence should be done
 PERSONAL
DETERMINANTS
-GENETICS-

• Determinants related to personal factor refer to

biological and genetic impact to aging
• Rate of aging and maximum life span vary among
species
• Up to 25% of variation in human lifespan is
inheritable
• Very long life, to beyond age 90 appear to have an
even stronger genetic basis
 Intelligence and cognitive capacity
are strong predictors of active aging
and longevity

PSYCHOLOGI Decline in cognition functioning are

CAL triggered by disuse (lack of practice)
FACTORS and illness such as depression
Coping style determine how well
people adapt to transitions of aging
 PHYSICAL ENVIRONMENT
DETERMINANTS
-SAFE HOUSING-
Safe, adequate housing and neighborhood are
essential to the well being of young and old

For old people, location, include proximity to family

member, services, transportation can mean the
difference between positive social interaction and
isolation
 SOCIAL ENVIRONMENT DETERMINANTS
-SOCIAL SUPPORT-
• Important factor in promotion and maintenance of health
• Study found that older adults who were socially engaged
with others and with their communities and who used
additional information in solving daily problems shows
greater cognitive vitality
• Social disengagement is a risk factor in cognitive decline
• Active lifestyle improve social relations
 SOCIAL ENVIRONMENT DETERMINANTS
-VIOLENCE AND ABUSE-

• Older people who are frail or live alone may feel vulnerable to
crimes such as theft and assault
• A common form of violence is elder abuse committed by family and
caregivers
• Violence occur at all economic level
• Neglect of the elderly is also a form of abuse
• Which can be checked by observing the individual’s body and skin
for open areas and bruise
 SOCIAL ENVIRONMENT
DETERMINANTS
-EDUCATION AND LITERACY-
Low level of education and illiteracy are associated with
increased risk for disability and death as people agel

Higher rates if unemployment

Employment problem among older workers are rooted

in their relatively low literacy skill
 ECONOMIC DETERMINANTS
-INCOME AND SOCIAL PROTECTION-
Reduce poverty at all ages

Poor people of all ages are at risk for ill health and disability

Older people who need assistance rely on family support

, informal service transfers, personal savings

Social insurance in other country provide protection to all citizens

 SOCIAL SERVICES DETERMINANTS

Refer to integrated coordinated and cost effective efforts

organized to provide health care

Services should include respect and dignity for older

person

Health system need to focus on health promotion,

disease prevention and equitable access to care.
QUIZ NEXT
MEETING!!!
 • Overview :

Topic 2:  The nursing profession has changed

significantly since the days of Florence
Gerontologi Nightingale.

cal Nurse as  Exciting breakthroughs in patient care occur

daily, and with those come greater
Managers responsibilities for professional nurses.

and  Nurse managers and leaders have additional

Leader challenges in caring for older adults with
complex needs.

 As the number of elderly persons in the

population increases, so will the number of
caregivers who will need to be managed.
 THE NURSE MANAGER
• The nurse manager provides clinical and managerial leadership to
assure that all staff can identify the customers they serve;
understand the aim of the work to serve those customers; and
has the education, methods and resources to accomplish their
performance objectives.

• Nurse managers are specialists who undertake a multitude of

tasks including dealing with others on a daily basis, and ensuring
quality nursing care, patient and family satisfaction, and staff
retention, commitment, and contentment.
• Steps to Patient Satisfaction:
Identify a clear objective
Identify the right people
Identify the right approach
Walk the talk (leaders participating)
Role model politeness or PTAS (please, thank you, action, smiles)
Involve the entire team
Recognize that little things means a lot 8. Convey compassion and
pride in work.
Practice the satisfaction Cs:
Cheerfulness - Courtesy - Cleanliness - Call-lights - Coaching -
Collaboration - Communication - Commitment - Confidentiality -
Compassion
• Nurse managers can address issues such as staff turnover and job
satisfaction by examining research results from studies that
demonstrate success in addressing these problems.

• Using evidence-based practice in this way, nurse managers can

create a working environment more likely to improve quality of care.

• Characteristics of Effective Nurse Managers :

Organized / Consistent /Fair /Optimistic / Goal-
oriented / Flexible / Creative / Resourceful /
Professional / Standard-setter / Trustworthy / Honest /
Empowered / Nonthreatening
• OPTIMISM- provide a professional, positive atmosphere
within the workplace, such as leading by example.
• Encourage a positive attitude among others and
modeling it outwardly in word and actions involves
constant self-direction of the nurse manager own
thoughts and attitudes

• Exhibit a professional attitude

• PROFESSIONALISM- encompasses the
manner of appearance, language, and
behavior.
• The way a manager dress, speaks and
even his posture can influence how
receptive others will be to that manager.
• Needs to maintain an image that display
confidence, competency, and
completeness of the manager’s role.
• Responsible for maintaining ethical
standard
• Acts as role model for others
ORGANIZATION-can be defined as relating people and
things to each other in such a way that they are
combined and interrelated into a unit capable of being
directed toward organizational objective.
Prioritization is important

Starting each day with a to do list, ranked by order of

importance will help the manager stay on track.
• CREATIVITY- calls for imagination
• Keeping staff involved and excited about work and
changes requires the use of critical and creative
thinking.
• Encourage the staff to offer their unique ideas and
suggestion
• Cultivating those suggestion is the responsibility of the
manager
FLEXIBILITY- daily dilemmas require flexibility

Unexpected situation require not only flexibility but also ability to

reorganize as needed

Nurse manager would benefit to have a back up plan to

accommodate unforeseen changes that is inevitable
INTEGRITY- suggest honesty and trustworthiness

This infers that a person is dependable, punctual, fair and

consistent

Nurse manager should treat all staff members equally

Showing favoritism will develop a stressful and divided

environment
SKILLS OF NURSE
MANAGER
DELEGATING- is simply defined as giving authority to a specific
person for a special task.

Process of delegation: assess, plan, delegate, supervision,

evaluation

Right task, right circumstances, right

Five rights of delegation: person, right direction, right
supervision
• TEAM BUILDING- the nurse manager promotes team building
by enhancing each team member skills and abilities,
encouraging individuals to use their skills productively and
confidently.

• Nurse manager needs to know the strength and weaknesses of

each member

• Be firm decision maker, provide experiences that promote

employee growth, give positive reward for desired behavior
and let employee have as much control and independence as
possible within the limits of the organization
• GOAL SETTING- a nurse manager sets goals and specific
objectives to reach them.
• Goals should be measurable, realistic, time-limited, and
mutually established.
• Short and long term goal should be defined.
• Short term goal- could be hourly, daily, weekly, monthly
• Long term goal- are more detailed and may encompass
yearly or even longer time span
FACILITATING CHANGE- maintaining competency related to
current changes within the company.

Changes may be instituted based on feedback from team

members

Providing clear direction with any changes will help to reduce

the negative responses generally associated with change
• STRESS MANAGEMENT- the nurse manager most difficult
responsibility
• Stress has a tendency to filter down from one person to
another
• Each individual perceive stress differently

• DECISION MAKING AND CONFLICT RESOLUTION- nurse

manager are expected to make intelligent, informed
decisions when conflict arise. Obtain the vital info to avoid
blame. “ No blame culture”
• EXPERTISE- Should have specialized knowledge in the
area of expertise of the job.
• This helps in being able to relate to the staff and set
realistic goals for quality patient care.
• Nurse manager should have a solid clinical background.

• COMMUNICATION- effective and correct

communication is vital in meeting the everyday
demands of the job.
• LISTENING- the nurse manager needs to provide the
individual with his or her undivided attention and good
eye contact. The nurse manager must act and look
interested.
• Must show outward support to prevent staff member
from avoiding to communicate when needs arises.

• INSPIRING TRUST- working together and obtaining

open, honest relationship to build trust.
SETTINGS- practice variety of setting, each which has
description and responsibility related to specific field of
involvement.

Within different setting, managers may hold variety of

position .

In a skilled nursing environment, the nurse manager is

responsible for overseeing the total care of the patients.
• Skills of Nurse Managers
 Team building
 Maintaining balance in the workplace
 Prioritizing
 Setting realistic goals
 Delegating
 Multitasking
 Decision making
 Using excellent judgment
 Empowering others
 Facilitating change
• The Delegation Process :

• Delegating is a process that, much like the nursing process or any other
critical thinking process, involves several steps: assessment, planning,
delegation, supervision, and evaluation.

• Five Rights of Delegation

 Right task
 Right circumstances
 Right person
 Right direction/communication
 Right supervision
THE NURSE LEADER
• A leader is a person who holds a position of authority, who
influences people, and who has the ability to direct and guide
others. “Leaders have the ability to take people to places they’ve
never gone before . . . successful leaders enroll rather than sell
people on their vision”.

• Effective management requires leadership skills, and effective

leadership requires management skills.
 Comparisons Between Managers and Leaders
MANAGERS LEADERS
Administer Innovate
Ask how and when Ask what and why
Focus on systems Focus on people
Do things right Do the right things
Maintain Develop
Rely on control Inspire trust
Short term perspective Long term perspective
Accept status quo Challenge status quo
Have eye on the bottom line Have eye on the horizon
Imitate Originate
Classic “good soldiers” Own person
A copy The original
LEADERSHIP STRATEGIES
• Two types of leadership are notable: transactional and transformational

• Transactional leadership involves the system of “contingent reward

and management by exception” versus Transformational leadership
that emphasized “charisma, consideration, and intellectual stimulation”.

• The first strategy enables the leader to see past the present. The
second strategy is based on using good communication techniques to
inform and convince others of the same vision the leader has. The third
strategy, leaders use is trust through positioning. The final strategy is
called deployment of self.
LEADERSHIP STYLES

• Authoritarian leadership involves the leader making the

decisions with little input from the staff.

• Conversely, persons with democratic leadership style welcome

the input of staff and general believe that their opinions and vote
are important.

• A laissez-faire leader is much more relaxed and tends to “go

with the flow”.
 POSITIVE AND
NEGATIVE BEHAVIOR
ASSERTIVE BEHAVIOR
• In addition to desirable characteristics previously discussed, assertive behaviors are
associated with good nurse managers. “Being assertive means being positive, direct and
genuine.”

• Body language is important in assertiveness. Eye contact is one of the first indications
that show interest and true listening. Speaking effectively is also an art. Tone of voice is
another form of nonverbal communication. The ideal posture when exercising
assertiveness is standing or sitting straight at a comfortable distance from the other
person (generally 2-4 feet away and outside the other person’s personal space). A final
language skill in assertiveness is timing.

• Assertive behavior relies on the use of “I” statements and not “you” statements. This
allows for no blame to be placed intentionally.
EXAMPLES OF ASSERTIVE BEHAVIOR
• Standing up for one’s rights no matter what the circumstances
• Correcting the situation when one’s rights are being violated
• Seeking respect and understanding for one’s feeling about a particular
situation or circumstance
• Interacting in a mature manner with those found to be offensive,
defensive, aggres- sive, hostile, blaming, attacking, or otherwise
unreceptive
• Direct, upfront (not defensive or manipula- tive) behavior; those using
assertive behavior confront problems, disagree- ment, or personal
discomforts head on, and their intent is unmistakable to others
• Verbal “I” statements, where individuals tell others how they feel about
a situation, circumstance, or the behavior of others Taking the risk of
being misunderstood as being aggressive, abrasive, or attacking
• Being able to protect one’s rights while protecting
and respecting the rights of others
• Risk-taking behavior that is not ruled by fear of
rejection or disapproval but is directed by the rational
belief that
“I deserve to stand up for my rights”
• Rational thinking and the self-affirmation of personal
worth, respect, and rights
A healthy style in which to conduct inter-
• personal relationships
Finding a “win-win” solution in handling
• problems between two individuals
 NONASSERTIVE BEHAVIOR
• a passive demonstration of how one deals with situations.

• People who display nonassertive behavior have a

tendency to deny or avoid voicing opinions, thoughts, or
desires regardless of their value.

• Insufficient confidence, guilt, or fear may prohibit

contributing quality ideas, often allowing the nonassertive
person to avoid conflict, approach the problems, deal with
the issues, and come to a conclusion.
 AGGRESSIVE BEHAVIOR

• can be destructive whereas assertive behavior can be

constructive.
• Aggression involves over-reacting emotionally to a
situation.
• This type of behavior is turned inward to produce outward
boasting of self above others.
• Defensiveness may be a response to aggres- sion
• Aggressive behavior may include, but is not limited to,
sarcasm, insulting, blam- ing, threatening, and even
name-calling
• Aggression is dangerous and self- centered. Controlling
others gives the aggressor the edge and makes him or
her feel important.
 INTIMIDATION

Another negative behavior is intimidation,

which is directly involved with aggression and should not be

encouraged or used as a means to get one’s own way.

Sometimes other team members will use intimidation as a tactic to

influence a nurse’s behavior.
 TACTICS USED IN INTIMIDATION
• Threatening to use power or control to manipulate others
• Using coercion or force. Making oneself seem more powerful than others
• one is Emotionally distancing oneself from others to appear more
powerful
• Using verbal and nonverbal cues to scare others into doing a desired
behavior
• Using negative and even abusive verbal and nonverbal behaviors to get
people to comply with one’s wishes
• Using physical size, stature, and strength to gain respect and obedience
Using punishments such as firing and poor evaluations to manipulate
the behavior of others
• Using quick temper, anger, or rage to get one’s way
• Holding your knowledge, level of education, or
number of degrees over the heads of others to
get them to listen Acting in such a way as to
discourage questions about one’s decisions,
opinions, or directives
Using money, wealth, or status to hold power
over others
• Ensuring loyalty by threats of withdrawing
support, love, caring, interest, or approval of
others
• Using dictatorial behaviors to control others
TELEHEALTH
AND OLDER
PEOPLE
 • Telehealth offers a
convenient and cost-
effective way to deliver
TELEHEALTH health care services to
ACCESS FOR older adults who may have
substantial health care
OLDER needs or mobility and
PATIENT transportation limitations
that make getting to a
health care provider’s office
difficult.
• Older adults may be less comfortable using a
computer or smartphone or experience
physical or cognitive barriers that reduce their
ability to access telehealth such as limitations
in hearing or vision or cognitive impairments.

• There are a growing number of resources

available to help patients address hearing and
visual limitations, including screen readers,
voice-to-text programs, or programs with
closed captioning options.
 PREPARING FOR TELEHEALTH
APPOINTMENTS WITH OLDER ADULTS
• Walk them through their home setup- Assign a staff
member to contact the patient before the telehealth
visit to walk through the process for starting the visit.
• Check to make sure the patient’s technology device is
working by verifying they are connected to the internet
and their phone is sufficiently charged.
• The staff member should also confirm if the patient’s
device can be used for a video call.
• Review technology
basics. The staff
member should also
make sure the patient
knows how to check into
the telehealth visit,
position their camera,
check lighting, and
adjust audio settings to
the right volume and
• Audio-only or phone-
based telehealth
appointments. May be
necessary if the patient
doesn’t have a device that
supports video or has a
slow WiFi connection.
Audio-only appointments
work well for:
• Follow up appointments
• Reviewing lab or test results
• Medication changes or
refills
• Enlist additional help
from a caregiver or
family member.
• Before the visit, ask your
patient if they would like a
family member or caregiver
to participate and help
during the appointment.
• A support person can assist
in getting the patient online
for their appointment,
troubleshoot any
technology challenges, and
facilitate communication.
QUIZ NEXT
MEETING!!!