Gerontological Care Issues Chapter 34

1. Gerontological Care IssuesChapter 34

2. Key Concept • The manner in which a chronic condition is managed can make the difference between a high quality, satisfying life and one in which the person is a prisoner to a disease.

3. Chronic Conditions • Medical technology has helped many people survive illnesses that once would have killed them. • Greater numbers of people are reaching old age. • 80% of older adults possess at least one chronic disease.

4. Increase in Chronic Conditions • Nearly half of the older adults suffer from arthritis. • More than one third have hypertension. • Nearly one third have a hearing impairment. • More than one fourth have a heart condition. • Another one eighth have a deformity or orthopedic impairment. • Almost 10% have diabetes. • Approximately 1 in 12 have hemorrhoids or varicose veins.

5. Goals for Chronic Care • Chronic conditions cannot be cured, healing is of the utmost importance. • Healing implies the mobilization of the body, mind, and spirit to control symptoms, promote a sense of well being, and enhance quality of life. • People with chronic conditions can learn to live effectively with the disease and develop a sense of peace and inner harmony.

6. Nurses Role • The nurses role is to serve as a facilitator to the patient by stimulating the patient’s self healing capabilities by: • Creating a therapeutic human and physical environment. • Educating • Empowering • Reinforcing, affirming, and validating • Removing barriers to self-care and self-awareness

7. Goals of Chronic Care • Maintain or improve self-care capacity • Manage the disease effectively • Boost the body’s healing abilities • Prevent complications • Delay deterioration and decline • Achieve the highest possible quality of life • Die with comfort and dignity

8. Chronic Care

9. Assessment of Chronic Care Needs • Self-care capacities can vary considerably among persons who have chronic conditions. • The nurse needs to review the individuals capacity to fulfill each of the healthcare requirements. • A majority of patient’s with chronic conditions manage their conditions in a community setting, most likely with family support.

10. Assessment of Chronic Care Needs • The nurse cannot assume that the family members presence will guarantee compensation for the patients care deficits. • Caregivers do not always have the physical, mental, or emotional abilities to meet the patient’s care needs. • Care needs should be discussed with the caretakers and reviewed weekly for any changes.

11. Setting Goals • Setting goals is important in helping patients and families understand the realistic direction of the condition. • Acceptance of long-term goals may require acceptance of the reality of the condition.

12. Maximizing the Benefits of Chronic Care Chronic conditions demand long-term medical supervision, selection of a physician may become a significant issue for the patient. Factors to promote a positive physician-patient relationship include: • Accessibility of the physician • Sufficient allocation of time for office visits • Comfortable and appropriate patient-support

13. Choosing a Physician • Respect for patient’s involvement and decision making. • Consideration of needs of entire family unit • Openness to alternative and complementary therapies • Attitude of hope and optimism

14. Chronic Care Coach • Chronic care coach can be a friend, spouse, child, or someone with a similar condition. • The coach will provide support and assistance, provide feedback and reinforcement.

15. Functions of a Chronic Care Coach • Maintain regular contact with the patient. • Help the patient prioritize and organize care. • Remind the patient of appointments, activities. • Assessing patient in locating and using resources. • Encourage patient to comply with care demands. • Provide inspiration and hope.

16. Lifestyle Choices • Patient’s with chronic illnesses should commit to smart lifestyle choices. • Activities may include: • Compliance with prescribed treatment • Sound dietary practices • Regular exercise • Development of a healing attitude and mind-set to live positively with the illness.

17. Alternative Therapies • Alternative therapies use the body’s capacity to heal itself and place the patient in charge of the healing process. • E.g.-accupressure • accupuncture • aerotherapy • chiropathy • yoga • meditation • osteopathy

18. Defense Mechanisms • When a patient faces a situation that is too much to handle, the patient may use defense mechanisms to cope. They may include: • Denial • Anger • Depression • Regression These and other reactions indicate that the patient’s ego strength is threatened and extra support may needed.

19. Impact on Family • The impact on the entire family must be considered. • Extra cost must be considered. • Sacrifices made by family members.

20. Institutional Care • Only 5% of the older population is in a nursing home. • One half of older women and one-third of older men will spend some time in a long-term care facility during their lives. • Most families seek institutional care after attempting to care for their loved one at home.

21. Institutional Care • By the time the family seeks assistance, they are physically, emotionally, and socioeconomic resources can be depleted. • Effective chronic care is not an easy nursing challenge. • The patient’s comfort, independence, and quality of life are largely influenced by the type of services rendered.