Prepared By:

Dr. Wafaa ElDesouky

College of Nursing2nd Semester-

AY 1429-1430(2008-2009)Community Health Nursing Department

Outlines1.Introduction

2 .Definition of terms3.Highlights of the Profile of Older

4 .Categorization of Aging Population5.The factors affecting of the quality of life of the

elderly6 .Health Status of Older Adults

7.TheRole Of The Geriatric Nurse8 .Implications for Health Care Delivery

The growth of the nursing profession as a whole,

increasing educational opportunities, demographic

changes, and changes in health care delivery

systems have all influenced the development of

various gerontologic nursing roles .

The following are the most commonly used terms and definitions :

Gerotological NursingIt is a specialized area of nursing that

focus on providing care of the elderly patients through the use of nursing process. When using it in planning care, the gerotological nurse considers the needs and characteristics unique to the older adults.

Gerontic NursingIs the nursing care services provided to

the aged to safe guard and increase health to the extent possible and provide comfort and care to the extent necessary.

( Lueckenotte 2000)

Senility:

A term for degenerative change in old people

including illness and weakness especially mental.

Or

Senility

Is the pathological & functional defect resulting

from aging process( Gloria 1993)

Aging:Is a process begin with conception and ends with death.

Geriatrics:

“Is the specialized branch of medicine that deals with the problems

and diseases of old age and aging people.”

Or

“It is the study and practice of medical problems and care of older

people with diseases .It focuses on diagnosis and treatment of

diseases common to aging”

Ageism:It is a process of systematic stereotyping and discrimination against people because they are old.( Roch 2001) Frail Elderly:

Persons whose physical or mental capabilities or support systems are reduced to the extent that they become completely dependent on there.

Life Expectancy:Is the expected death age based on mortality rates.

Life Span:Is he length of time, which the average person lives?

The elderly constitutes an importance subgroup of the

population.

In 1980 the United Nations estimated that 8.5 % of the world

population were elderly aged 65 years and over by the year

2025 this figure will be increased to 14 %.

In ( 2010) Saudi Arabia Pop. Aged 65+ constitute (2.5%)

Aging persons have unique characteristics and need they

have the right to receive high quality care

From 2000 until 2050, the world's population

aged 60 and over will more than triple from 600

million to 2 billion .

Most of this increase is occurring in developing

countries - where the number of older people

will rise from 400 million in 2000 to 1.7 billion by

2050 .

In (2010 ) 65 years and over represents to

( 2.5%) of the total population

male :363,241

female :343,750

Source:Central Intelligence Agency (CIA)of the United States with almanac-style information about the countries of the world .

Statistics of the Elderly in Saudi Arabia

According to Statistics of Ministry of Health andSocial Affairs (2009)Total No of the Elderly

Categorization of Aging Population:

According to WHO,the elderly population is categorize into the following groups:

The Elderly are a heterogeneous group ,whether they are classified as:

1-young old ( between 65 to less than75 Yrs),

2 -old is ( between 75&85Yrs) &

3 -old old (age 85 & more Yrs).

Another Classification in USAYoung-old: 65 – 75 yearsOld: 75 - 85 yearsOld-old: 85 – 100 yearsElite-old: >100 years (Centenarians: >40,000 persons in US over the age of

100. Projected that by the year 2020, there will be > 3 million).

1 -Health Refers to complete state of physical , mental & social

wellbeing not merely the absence of disease or

disability.

2 -Psychosocial & cultural Factors Values norms, customs ,beliefs & power of control who

make decision.

The factors affecting of the quality of life of the

elderly

3 -IncomeRefers to have enough money. So that one doesn’t go

without necessities or worry about the future .

4 -Sense of Belonging Refers to the relationship with family 7 friends & to

feeling a part of the community

5 -Making life meaning full

To find meaningful ways to use one’s time & to feel

that one is making contribution.

6 -Housing

The availability of appropriate & affordable housing

7 -Safety & securityrefers to living without fear of violence&

danger. So, it can achieved by the

availability of safer environment & prevent

elderly abuse

8 -Finally, Getting aroundThe availability of transportation & removing all

barriers ( the above mentioned factors ) that make

difficult for the elderly to get around. People ability to

get around may affect their capacity to communicate

with others, to do interesting things ,to do every day

chore such as shopping , to get health care & enjoy

his\ her life

)1 (Arthritis .)2 (Hypertension .)3 (Heart disease .

)4 (Hearing impairments .)5 (Cataracts .

)6 (Orthopaedic impairments .)7 (Sinusitis .

)8 (Diabetes mellitus .

**The three leading causes of death for older persons are:

1.Heart conditions ,2.Malignant neoplasms ,

3 .Cerebrovascular diseases )US Bureau of the Census, 2008 .(

Community Services Available For The Elderly:

1. Home health services.2. Alternative to institutions.• Day care centers.• Day hospitals.• Respite care.• Sheltered housing.3. Nursing home.4. Hospice.

1.Home Health Services:

Many elderly persons require both daily care from a home health

care professional and supportive assistance from health aids .

A professional nurse and a home health aid provide this care.

2.Alternative To Institutions:a.Day Care Centers: Day care centers serve the elderly who has some physical or mental limitation that interferes with totally independent living and who needs social, nutritional or recreational services.b. Day Hospitals:

Providing day health services to a person who can live at the home during the evening.

c.Respects Care Program: Provides care for the dependent elderly for several days to a week.

d.Sheltered Housing: It is an alternative living arrangement that

provide shelter and support services to the elderly who is independent

or semi independent and has some functional impairment or social deprivation but is otherwise healthy.

Disadvantages Of Alternative To Institutions:Problems of eligibility, cost, access and service limitation.

3.Nursing Home:Declining health, depleted physical, financial and human resources and increased dependency necessitate institutionalization in a nursing home.

Nursing home provides a long-term residential, intermediate or skilled nursing care, medical care ,

personal and psychological services. )In Saudi Arabia 10 Geriatric Nursing Homes

)9 For Males & one For Females(4.Hospice:

Is a community resource available for the care of the terminally ill. A hospice program has a family operation and is concerned with medical, nursing, spiritual and social care of the terminally ill.

The Role Of The Community Health Nurse In Geriatric Care:

.

Scope of Practice of gerntological nursing

National Gerontological Nursing Associations (NGNA) scope & standards of care:Emphasizes the need for competent care of older

adults so that professional nurses (RN’s) will be prepared to “meet the special needs of the increasing numbers of older adults, particularly those over 85 years of age, minorities, and those with decreased financial and social resources” (ANA, 2001,)

Roles of the Gerontological NurseGeneralist or SpecialistGeneralist

Various settings: home, hospital, nursing homesPerforms: planning, delivery, evaluation of care

SpecialistAdvanced preparation (MN or MSN)

Gerontological nurse practitioner (GNP)Gerontological nursing clinical nurse

specialists

The Role Of The Community Health Nurse In Geriatric Care:The Aim Of geriatric nursing care Is:

To use knowledge of the aging process to design nursing care andservices that help elderly people in achieving health longevity and independence.

The Role Of The community Health Nurse at The Home:

1.Assessment : Collecting data about the elderly is essential to

identify his needs and problems that have to be met.

A complete assessment include the following:1.Health Assessment of the client:

a-A health history (past history, family history, occupational history, sexual history, present health complaints) .

b-Physical examination (vital signs, blood pressure, height, weight, heart sounds, inspection of feet and nails, check device if used).

c-Examination of all medication taken. Nutritional assessment of diet history (adequacy of nutrients in diet, client knowledge about essential foods, foods to avoid, regularity of metal food likes and dislikes, fluid intake).

e-Assessment of daily living activity (self care ability, mobility, house keeping ability, exercises).f-Assessment of client ability to relax or reduce stress.

Continue:A complete assessment include the following:

2.Examination of the home for environment hazards, need for repairs, Safety measures.

3.determination of significant family members or neighbors in case of emergency.

4.Assessment of client knowledge about available community resources (meals on wheels, transportation, recreational facilities, volunteer opportunities, mobile library, home health

services, educational facilities) .5.assessment of client life style (friend, socialization with

others, interests, hobbies).6.Assessment of client neighborhood characteristics and

accessibility of services

Continue:2.Nursing Diagnosis:

The nurse analyzes information and develops nursing diagnosis. N.D. describes the client problems. Nursing diagnosis are recoded on the care plan and are the basis for setting and planning.

3.Planning:

Before the nurse can plan care, short and long term goals should be established. If possible the client

should help in setting these goals .Then, the nurse decides the nursing action to be taken.

Continue:4.Implementation:

The nurse puts the care plan into action. Nursing action and client responses are accurately and elderly charted.1. Daily observation of the client to assess his physical

condition, identify his needs and problems and takes necessary action.

2. Provide rehabilitation procedures to chronically ill or disabled elderly as good body alignment, bed positioning, transfer activities, range of motion exercises, bowel and bladder training, skin care.

3. Prepare and administer medication.4. Coordinate the care of the client so that he receives

personal care, therapies and recreation required.5. promote accident prevention.

Continue:4.Implementation:.

6.Educate the client about proper nutrition, self-care, and foot care, stop smoking, side effects of drugs and exercises.

7.Use comprehensive services available for the elderly.

8. Participate in planning and implementation of geriatric programs to improve elderly care.

5.Evaluation:The nurse reviews the goals and checks the client progress. The plan is updated with new nursing orders as necessary.

)1(Create roles that meet the needs of the older population

across the continuum of care .

)2 (Develop models of care delivery directed at all levels of

prevention, with special emphasis on primary prevention and

health promotion services in community based settings ;

)3 (Assume positions of leadership and influence not only in

institutions and settings where care is currently provided to

older persons .

References

1.Meiner S. Gerontologic Nursing. Fourth edition. St. Louis,

Missouri Mosby.2011.

2. Wallace M. Essential of gerontoloical Nursing, USA. Mosby, 2007

3.Administration on Aging (AOA), 2008. Administration on Aging

(AOA) : A profile of older Americans. Washington, DC, US

Department of Health and Human Services, The Agency, 2008

Any Questtions?…