THEORIES OF AGING

1. THEORIES OF AGING

2. Psychological Theories • Maslow Human Needs • Five basic needs • Erickson’s Personality • Life stages relate to life tasks Grossman and Lange, 2006

3. Social Theories Based on social order, balance and harmony • Activity Theory • Necessary for satisfaction with life • Disengagement theory • Natural process • Gradual withdrawal Phelan, 2010

4. Biological Theories • Non-stochastic • Predicted damage • Stochastic • Random damage Grossman and Lange, 2006

5. Ageism “stereotypical, dehumanizing, negative constructions” (Phelan, 2010) Three domains • Cognitive • Beliefs and stereotypes • Affective • prejudice • Behavioral • Direct discriminatory practices • Indirect discriminatory practices Phelan, 2010

6. Assessment of Geriatric Needs • health history • physical assessment • laboratory studies • radiological testing • functional assessment of activities of daily living • cognitive assessment • skin assessment • social assessment • financial assessment

7. needs assessment fall risk assessment pressure ulcer assessment pain assessment nutritional screening Toofany, S. 2007 RISK ASSESSMENT TOOLS

8. SPICES • S is for Sleep Disorders • P is for Problems with Eating or Feeding • I is for Incontinence • C is for Confusion • E is for Evidence of Falls • S is for Skin Breakdown Fulmer, M. 2007

9. Research StudyGeriatric Workforce Enhancement Program • Train the trainer • Basic course • Advanced course • Outcomes • Participants impacted change Barba and Fay (2009)

10. Research StudyGerontological Enrichment Program • Risk factors for hospitalization • Adverse functional outcomes • Normal consequence of aging • Error in professional intervention • Environmental factors • Goals: • Improve care • improve knowledge • Support • Conference attendance • Journal readings • Presentations Parke, Ross, and Moss (2003)

11. Gerontological Clinical NursingResearch Study • Student insight: • enhanced knowledge • confidence in identifying differences between normal aging and illness conditions, cognitive changes, functional independence, common health challenges • improvements in ability to engage w/older adults, stronger communication skills • encouraged focus on attitudes about the aging population • more holistic approach – less task oriented • increased understanding of transition, loss, grief, vulnerability • improved outlook on comfort care and spirituality  • Staff Nurses insights: • impressed with knowledge of student nurse • ability to provide holistic assessment • students were able to effect change on unit Dahlke and Fehr (2010)

12. NICHE NICHE stands for Nurses Improving Care for HealthSystem Elders • GIAP • Tools Provided to the hospitals included: • Staff development tools • Nursing care models • Research-based clinicals Boltz, Capezuti, Bowar-Ferres, Norman, Secic, Kim, Fairchild, Mezey, and Fulmer 2008

13. Interpretation of information Quality geriatric care is: evidenced based ensures best practices includes a holistic assessment individualized to patient needs promotes patient decision making

14. Assessment of the Health Care Environment – National Patient Safety Goals • Improve accuracy of patient identification • Improve effectiveness of communication among caregivers • Improve the safety of using medications • Reduce the risk of healthcare acquired infections • Accurately and completely reconcile medications across the continuum of care • Reduce the risk of harm resulting from patient falls • Encourage patient’s active involvement in own care • Improve recognition and response to changes in a patient’s condition Munson Healthcare, 2009

15. Assessment of the Health Care Environment – National Patient Safety Goals • Improve accuracy of patient identification • Improve effectiveness of communication among caregivers • Improve the safety of using medications • Reduce the risk of healthcare acquired infections • Accurately and completely reconcile medications across the continuum of care • Reduce the risk of harm resulting from patient falls • Encourage patient’s active involvement in own care • Improve recognition and response to changes in a patient’s condition Munson Healthcare, 2009

16. Environment Assessment continued • Patient safety guide • Policy for medication issues: • Analgesics • Antibiotics • Anticonvulsants • Antidepressants • Anti-diabetic meds • Anti-manic meds • Anti-parkinson meds • Anti-psychotic meds • Anxiolytics • Cardiovascular meds • Cholesterol lowering agents Munson Healthcare 2009 • GI meds • Glucocorticoids • Hematinics • Laxatives • Muscle relaxants • Appetite stimulants • Osteoporosis meds • Platelet inhibitors • Respiratory meds • Sleep meds • Thyroid meds • Urinary incontinence meds

17. Iatrogenesis Common iatrogenic events can occur as a result of: • “Adverse reactions to medications • Adverse reactions to diagnostic, therapeutic and prophylactic procedures • Nosocomial conditions such as hospital-acquired infections, delirium, deconditioning, malnutrition, fecal impaction, incontinence and pressure ulcers • Falls or other accidental and environmentally-induced accidents, and • Harmful effects to patients related to the values, beliefs, prejudices, fears and attitudes of well intentioned, but ignorant providers ” Information quoted from Hartford Institute for Geriatric Nursing, Francis, 2oo8

18. Root Cause Analysis Fall risk assessment • Reasons why falls occur • Identification of high risk patients • Interventions • ARTT

19. Prevention of poor outcomes Improve knowledge base Continuing education in geriatrics Nurses trained in geriatrics Institution of National Patient Safety Goals especially those that focus on the elderly population CLABSI CAUTI SSI VAP Those associated with increase use of antibiotics Munson Healthcare, 2009

20. Who will Care for the Elderly • Shortage of nurses • 285,000 by 2020 • 500,000 by 2025 • Shortage of other healthcare providers including: • Nutritionists • Social workers • Pharmacists • physicians Houde and Melillo, 2009

21. Providing Quality Care for the Elderly: Statistics Current training in geriatrics • 30 of 670 BSN programs meet criteria for best educational courses in geriatrics • 23% required geriatrics course • 24% had an elective available to take • 49% integrate geriatrics with other courses This reflects less than 1% of the nation’s nurses having a certification in geriatrics Kovner, Mezey, and Harrington, 2002

22. Competence in Care for the Elderly Population • Nurses are trained for pediatrics, shouldn’t they also be for geriatrics? • Recommendations for staff trained in geriatrics at colleges, universities • Continuing education for nurses currently working with the elderly population • Some states already have mandates or policies in place regarding care of the elderly population • Arizona example

23. Characteristics of Optimal Care Nursing staff: competence in caring for patient population you serve support of patient autonomy facilitate positive discharge planning knowledge of how patients respond to meds , signs of infection

24. Recommendations • CMS (Centers for Medicare and Medicaid Services) • Survey studies • incentives • Institute of Medicine • Home health aides • Family members • Economist Intelligence Unit • Change the mindset about the elderly • Continue preventative care • Medication studies on the elderly • Continued training for health care professionals

25. Preventative Health care for the Elderly • Smoking cessation • Importance of exercise • Healthy Nutrition • Vision and hearing screening • Dental health Takahashi, Okhravi, Lim, and Kasten ,2004 • Screening for health issues • High blood pressure • High cholesterol • Osteoporosis • Cardiovascular care • Cancer screening • Immunizations

26. Family Caregiving Currently accounts for 80% of care provided: 44% by children 41% by spouse 10% by other relative 5% by non relative Recognizing need for help Caregiver strain Economist Intelligence Unit, 2009

27. Community or Home-Based Care • Illinois study • $117/day for ECF • $650/month for home care • Use of telemedicine • Community day cares Economist Intelligence Unit, 2009

28. Resources to Care for the Elderly • Commission on Aging • Chore services • Meals on Wheels • Area agency on aging • MI choice waiver program • Nursing home transition program • Care management • Care respite • Information on help with medications and co-pays • Dementia coalition • Medicare.gov website

29. Hartford Institute e-learning website www.hartfordign.org/Spotlight/eLearning • consultGeriRN • NICHE • Nursing home modules • Case studies

30. References • Ahlich, B. and Spinniken, K. (2010). Medication Issues of particular Relevance in Older Adults. Retrieved September 30, 2011 from http://mmcv-sms01.ad.mhc.net • Barba, B. & Fay, V. (2009). Does continuing education in gerontology lead to changes in nursing practice? Journal of Gerontological Nursing 35(4). Retrieved September 12, 2011 from CINAHL database.  • Boltz, M., Capesuti, E., Bowar-Ferres, S., Norman, R., Secic, M., Kim, H., Fairchild, S., Mezey M., and Fulmer, T. (2008). Changes in geriatric care environment associated with NICHE (nurses improving care for HealthSystem elders). Geriatric Nursing 29(3). Retrieved September 13, 2011 from CINAHL database • Boyce, P. (2003). Lighting for the elderly. Technology & Disability, 15 (3). Retrieved September 26, 2011 from CINAHL database  • Center on an Aging Society. (2005). Adult Children: The likelihood of providing care for an older parent. Retrieved October 2, 2011 from ihcrp.georgetown.edu/agingsociety/pdfs/ CAREGIVERS2.pdf • Dahlke, S. & Fehr, C. (2010). Implementing a gerontological clinical nursing practice with an interdisciplinary focus: lessons learned. Gerontology and Geriatrics Education 31(2). Retrieved September 13, 2011 from CINAHL database  • Ebersole, P., Hess, P., Touhy, T., Jett, K., and Luggen, A., (2008). Toward Healthy Aging (7th ed.). Mosby Elsevier: St. Louis, MO.  /

31. References continued • Economist Intelligence Unit (2009). Healthcare strategies for an aging society. The Economist. Retrieved October 2, 2011 from graphics.eiu.com/upload/.../Philips_Healthcare_ageing_ 3011WEB.pdf • Francis, D. (2008). Iatrogenesis. Retrieved from www.hartfordign.org/Spotlight/eLearning • Fulmer, T. (2007). How to try this: Fulmer SPICES. American Journal of Nursing. 107(10). Retrieved September 6, 2011 from consultgerirn.org/uploads/File/trythis/try_this_1.pdf • Garm, A. (2006). Promoting excellence in gerontological nursing. Nursing 2. Retrieved September 13, 2011 from CINAHL database • Grossman, S., and Lange, J. (2006). Theories of aging as basis for assessment. Medsurg Nursing 15(2). Retrieved September 24, 2011 from CINAHL database. • Hansen, Linda (2010). Analysis of Geriatric Needs. FSU Gerontological Nursing. • Hartford Institute for Geriatric Nursing (2008). E-learning center, retrieved September 6, 2011 from www.hartfordign.org/Spotlight/eLearning/ • Houde, S. & Melillo, K. (2009). Caring for an aging population. Journal of Gerontological Nursing 35(12). Retrieved 13, 2011 from CINAHL database • Kovner, C., Mezey, M., and Harrington, C. (2002). Who cares for older adults? Workforce implications of an aging society. Health Affairs 21(5). Retrieved September 6, 2011 from CINAHL database.

32. References continued • Messecar, D. (2008). Family Caregiving. Retrieved September 28, 2011 from www.hartfordign.org/Spotlight/eLearning/ • National Patient Safety Goals at Munson Medical Center. (2009). Retrieved September 30, 2011 from http://mmc- websrv.mhc.net • Nursing Scope and Standards of Practice (2004). American Nurses Association: Washington, DC •  Parke, B., Ross, D. and Moss, L. (2003). Creating a cultural shift: a gerontological enrichment program for acute care. Journal for Nurses in Staff Development 19(6). Retrieved September 13, 2011 from CINAHL database • Phelan, A. (2010). Socially constructing older people: examining discourses which can shape nurses’ understanding and practice. Journal of Advanced Nursing. Retrieved September 13, 2011 from CINAHL database • Smith, C. and Cotter, V. (2008). Age-related changes in health. National guideline clearing house. Retrieved September 24, 2011 from Hartford Institute for Geriatric Learning www.hartfordign.org/Spotlight/eLearning/ • Starns, M. (2011). Aging 2020 - Arizona Plan for an Aging Population. Retrieved September 25, 2011 from azgovernor.gov/aging/Documents/Aging2020Report.pdf   • Stolte, K. (1996). Wellness Nursing Diagnosis for Health Promotion. J. B. Lippincott Co.: Philadelphia, PA •  Takahashi, P., Okhravi, H., Lim, L., and Kasten, M. (2004). Preventative health care in the elderly population: a guide for practicing physicians. Mayo Clinic Proc. 79:416-427. Retrieved September 28, 2001 from CINAHL database   • Toofany, S. (2007). Tools to care. Nursing Older People 19(10). Retrieved September 13, 2011 from CINAHL database.