Maintaining ADLs in the elderly

1. Maintaining ADLs in the elderly Amanda Fulk (Nursing) Cheniqua Goode (Counseling) Sara Moon (DPT) Hala Salem (DH)

2. Definitions • ADLs: Activities of Daily Living • Includes: bathing, walking, toileting, oral hygiene, transferring, dressing, eating. • IADLs: Instrumental activities of daily living • managing money, shopping (groceries), telephone use, travel in community, housekeeping, preparing meals, and taking medications correctly. • Elderly: Has many, continually changing definitions • Those showing signs of age • Historically, elderly was defined as those age 65 and older. • The World Health Organization defines the elderly as a biological and social change to which each society defines the aging process.

3. Overview of Topic • By 2030, more than 70 million Americans will be 65 and over—comprising between 19%-20% of the total population • By 2050, those 60y/o + will outnumber those 15y/o and younger. • These aging populations are experiencing greater longevity which could lead to: • increased likelihood of experiencing lasting damages • increased rates of depression and suicide in the elderly • increased stress on health care systems • increased stress levels in the younger generations caring for their elderly loved ones

4. Normal aging The rate of aging differs for many reasons, mostly lifestyle, genetics, and disease state Physical aging: • Hearing • Eyesight • Taste • Touch and Smell • Bladder • Body fat • Bones • Brain • Heart • Arteries • Kidneys • Lungs • Metabolism • Skin • GI system Sexual Health: • Hormones decrease • Loss of long term partner, dating again for the first time in years. Increase in STDs in the elderly. Social and Emotional changes: • Loss of friends, family, spouse • Birth of grandchildren/ great grandchildren • Decision to stop driving. Feel more confined. Activity: • Overall degeneration of joints • Rest • Exercise and mobility • Safety changes • Decreased reaction times

5. Normal Aging from Counseling Perspective • Erik Erikson’s Psychosocial Life Stage • Individuals 60 and older • Ego Integrity versus Despair • Life Transitions • Retirement • Physical and Mental Changes • Situational Concerns • Living Arrangements (help with ADLs/IADLs) • Coping with Death of Partner (Loss of help with ADLs/IADLs) Horton-Parker & Brown (2002)

6. Mental Health Disorders in Elderly • Depression • Approximately 6% of U.S. citizens 65 and older have diagnosable depression • Suicide rate is highest among older adult population • General Anxiety • Characterize as both a symptom and mental health disorder • Anxiety prevalence rate of 19.7% in 65 and older age group • Alcohol Abuse and Dependence • Alcohol Abuse-too much consumption too often • Alcohol Dependence-increased tolerance with the inability to quit • Alzheimer’s Disease • Irreversible brain disorder manifesting after 60 • Causes major deficits in mental functioning Horton-Parker & Brown (2002) Kelly, S.D. (2003)

7. Family • Children usually a primary resource in old age • More children usually  the more support • Determine • how often their children see them • how they interact with each other • amount of assistance the children provide (cooking, cleaning, shopping, motivation, psychological support) • Determine the support of the spouse • some spouses are not very supportive of an ill partner. • May be financially dependent, possibly living with children and grandchildren.

8. Differences across ethnicities There are different views on defining elderly and what it means. Most Asian cultures view elderly as revered and are deeply respected. The oldest son has a major role in the decision making. Native American and African cultures also show respect and obedience towards their elders. In the US: Families are more spread apart, and therefore are unable to aid the aging generation The younger generations often stereotype the elderly population as chronically ill, unable to work, behind the times, slow-thinking, and as useless financial burdens on society.

9. Elderly and Poverty Poverty rates vary across the country and in different cultures Higher percentage of females than males that live in poverty African Americans and Hispanics also tend to live more poverishly than non-hispanic caucasions. 12% of Americans over the age of 65 live in poverty. Increase in dependency on government programs 2008- present.

10. Why Health Promotion? Maintaining independence in ADLs and IADLs will help diminish the negative effects of aging, by: • Increasing quality of life • ↓health disparities and dependency • ↓ premature mortality caused by chronic & acute diseases • ↓ depression rates • ↓ stresses on caretakers and healthcare system

11. Why Interdisciplinary Care Model? Failure of the unidisciplinary model in improving health outcomes, especially for elderly. Health care professionals should integrate each other’s knowledge. Mutual interprofessional respect. Sharing the same core competencies and health outcome goals.

12. Screening/History • Determine family/social support • Hobbies  to find motivation to maintain independence • Hxof falls  as a red flag to refer • Home environment See the assessment tool we put together for this population on blackboard.

13. Physical Findings • PT: Decrease in: strength, vision, proprioception, balance, sensation, and coordination. May also see vestibular issues • DH: Poor dental health, bad breath, dry mouth, infections, tooth loss, etc. • Nursing: Decline in general health- increase in complications with disease. Decrease in mobility, nutrition, self-care, and immune system. • Counseling: Appearance, manner of dress, hygiene, mood affect, level of distress, eye contact, thought processess/content, attention/concentration

14. Counseling • Help elderly cope with challenges of ADLs/IADLs • Provide cognitive-behavior therapy that addresses depression surrounding… • Loss of ADLs/IADLs • Loss of social support • Loss of mental and physical changes • Address alcohol abuse/dependence • Address anxiety • Collaborate with primary physician and other health-care professionals

15. Dental Hygiene • Unmet oral health needs in elderly may lead to: • Periodontal diseases ( most frequent) • Dental caries • Soft tissue inflammation • Xerostomia ( dry mouth condition) • Edentiulism • Maintaining the oral health in elderly: • Will eliminate pain and discomfort. • Will maintain function so that quality of life can be optimized. • Will Minimize the oral-facial pain, infections, edentulousness, and tooth loss .

16. Nursing Health Promotion: Vaccinations and screenings Patient education Creating a plan for the patient and family Health Assessment head to toe assessment Maintaining up to date medications Home life appropriate

17. Physical Therapy • Falls are a huge problem in the elderly • 1/3 aged 65+ will fall per year • Less than half will talk to healthcare providers about it • Leading cause of hip fractures and traumatic brain injuries in this population • Our number 1 goal is safety! • Screen for falls risks- Help stop falls before they happen • Besides fall prevention, PT in the elderly population also includes: • Teaching individuals how to move as ‘normal’ as possible after health complications such as stroke, joint replacements/surgeries, and amputations (usually as a complication to diabetes in this population) • Increasing tolerance to activity during/after cardiopulmonary conditions in order to return to ‘normal life’

18. Referals: When and to whom • PT: most elderly are referred to PT • during or after a hospitalization (surgery, trauma, medical condition- fall, MI, CVA, Respiratory distress, etc) • from a physician after patient complains of dizziness, arthritis pain, difficulty ambulating, or a history of falls. • DH: When patient reports difficulty swallowing, gum or tooth pain, sensitivity to hot/cold, dry mouth, or bad breath. • Nursing: • Geriatric Nurse Practitioner- primary care provider. Important to refer patients to utilize resources. • Health promotion and maintenance of medications • Health education- vaccinations • Home health nursing- to visit the patient at home to decrease risks, ensure adherence to medications, teaching for families. Goal to keep patient out of emergency room and hospitals. Preventative care. • Hospice nursing- palliative care to keep the patient comfortable and at home in last six months of life. • Counseling • Referred by physician, social worker, family for treatment of depression, anxiety, and alcohol abuse/dependence surrouding ADLs/IADLS • Referred by physician during or after hospitalization, during office visit (physical/check-up) • Referred by social worker during house visit, investigating elder abuse, assisting with benefits • Referred by family (children, spouse/partner, etc.) noticing changes in client/patient

19. CONCLUSION An interdisciplinary approach is vital to the overall health and well-being of our nation’s aging population. None of us are taught or trained to handle all the needs on our own. Please take a look at the link below. I hope you all can agree that this is the direction health care should be going. http://www.youtube.com/watch?v=eAtUcHn-VqU

20. References: 1. Area Agency on Agency of Pasco-Pinellas, Inc. (n.d.). Retrieved February 8, 2013, from http://www.agingcarefl.org/ 2. Centers for Disease control and Prevention. (2012). Falls among older adults: an overview. Retrieved February 13, 2013, from http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html 3. Culturally competent care, how different cultures view elders. (n.d.). Retrieved February 13, 2013, from Pearson Education website: http://wps.prenhall.com/wps/media/objects/3918/4012970/NursingTools/ch23_CultViewElders_407.pdf 4. Gorman M. Development and the rights of older people. In: Randel J, et al., eds. The ageing and development report: poverty, independence and the world's older people. London, Earthscan Publications Ltd.,1999:3-21. 5. Horton-Parker, R.J. and Brown, N.W. (2002). The unfolding life: Counseling across the lifespan. Westport, CT: Greenwood Publishing Group, Inc. 6. Kelly, S.D. (2003) Prevalent mental health disorders in the aging population: Issues of comordity and functional disability. Journal of Rehabilitation, 69(2), 19-25. 7. Life in the USA. (n.d.) American Attitudes Toward the Elderly. Retrieved February 13, 2013, from http://www.lifeintheusa.com/aging/attitude.htm 8. Murray, Zentner, and Yakimo. "Health Promotion Strategies Through the Life Span." 8th edition. 609-683 Resources: [you tube videos and screening tools from each discipline] • http://www.youtube.com/watch?v=7xrzppr7VcIhttp://www.youtube.com/watch?v=QN5pj03aiqg