Gerontological & Community Based Nursing:

1. Gerontological & Community Based Nursing: Culture & Aging Professor Adrianne Maltese

2. Cultural changes in aging population • By 2060 – “ persons of color” to represent 50% of population • Hispanic, Asian & Pacific Islanders will have greatest increase. • Need to reduce health disparities • Nurses to be culturally competent & aware

3. Awareness – the ability to recognize the presence of “isms” such as racism. Openness & self-reflection necessary. Robert Butler – “ageism” Most reflective in Euro-American culture Cultural competence- ability to put cultural knowledge to use in assessment, communication, negotiation and intervention Use of cross-cultural nursing skills Cultural awareness -> cultural competence

4. Culture and Aging • Sensitivity to the knowledge of similarities/differences between people of different cultural backgrounds is vital to the establishment of positive relationships and communication. • Basic understanding of differing values, experiences, social networks, communication styles and perceptions of health/illness

5. Cultural Implications and Aging • Ethnic elders often have health beliefs that are different from that of the biomedical or Western health system used by many health care professionals in the U.S. • Determination of elders’ health beliefs • Working with an Interpreter (box-4-3 p. 54)

6. What familial and cultural views of aging and the elderly do you hold? How would you alter care to meet elders cultural needs?

7. Chronic Illness “Most disorders of aging are chronic ones that must be treated within a framework of lifestyle changes, living situation adaptations, and attention to the whole person coping with the disorder” Burggraf, Barry 1996 • “88% of older adults have at least one chronic illness; 50% have at least two”(Zauszniewski et al, 2007) • Most common – arthritis & hypertension

8. Wellness in Chronic Illness • Greatest factor in establishing a sense of wellness in the face of chronic illness is adaptation. • Nurses help patients assist clients toward enriched capacity for living in the shadow of chronic illness—many of which are common in the older adult

9. Theoretical Frameworks for Chronic Illness • Maslow’s Hierarchy of Needs – goal of wellness approach -> assist older adult to meet as many of basic needs as possible. • Chronic Illness Trajectory- (Corbin & Strauss 1988) view of living with a chronic illness as a trajectory that traces the progression of a chronic illness through 8 phases.

10. Phases of Chronic Illness Trajectory 1.) Pretrajectory – preventative phase 2.) Trajectory onset - definitive phase 3.) Crisis Phase 4.) Acute Phase 5.) Stable Phase 6.) Unstable Phase 7.) Downward Phase 8.) Dying Phase

11. Shifting Perspective Model of Chronic Illness(Paterson 2001) • Model views living with chronic illness as an ongoing- continuously shifting process – person moves between wellness or illness in the foreground. • Insider perspective of chronic illness – • Concept of client as “partner - in – care” • Focus on health within illness

12. The 5 “C’s of Caring” (Simone Roach 1992) • Competence • Compassion • Conscience • Commitment • Confidence • So how do we utilize these caring concepts?

13. Common Disorders of Ageing Cardiovascular & Respiratory disorders

14. Common Chronic - Cardiovascular Disorders • Hypertension – Most common – Goal 120/60 mm Hg • Coronary Artery Disease –> risk for “silent MI” • Heart Failure – a result of CHD (65 -75% of hospitalized persons – dx of HF 80% were > 65 years old • Peripheral Vascular Disease

16. Assessment -Cardiovascular • Obtain pertinent history • Monitor vital signs • Lab results • Kidney functions • Assess cardiac & respiratory function • Conduct mental status exam Examine changes in clients abilities: • ADL’s, • Quality of sleep • Dyspnea (shortness of breath)

17. Goals for elders with CVD Goals: relief of symptoms Improve/maximize function/ quality of life Reduce morbidity/mortality Slow progression of dysfunction

18. Interventions-CVD • Education/teaching life-style changes/diet • Monitor s/sx of CHF • Monitor fluid intake/output/diet • Monitor weight daily/biweekly/weekly • Ausculate heart & lung sounds • Monitor lab values • Cardiac rehab programs • Provide comfort measures- in end-of life care if palliative/hospice care is indicated

19. Monitor risk for exercise related orthostatic hypotension r/t ↓in baroreceptor responsiveness • Exercise in climate controlled environment • Alter lifestyle – smoking, diet, emotions

20. Coronary Heart disease

21. Chronic Respiratory Disease • Chronic Obstructive Pulmonary Disease (COPD) • Pneumonia • Tuberculosis

22. Chronic Respiratory Disease • Infectious – Acute – Chronic Respiratory diseases • Can involve upper or lower respiratory tract • Obstructive (prevents airflow out r/t narrowing of respiratory structures) vs. Restrictive (decreased lung capacity r/t limited expansion of lungs)

23. Chronic obstructive Pulmonary Disease - COPD • By 2020 3rd leading cause of death • Includes asthma, bronchitis, emphysema • Activity intolerance r/t obstructive airways

24. View of COPD

25. People with COPD can still lead productive lives. Coughing Wheezing Chest tightness Shortness of breath COPD - elderly

26. Pneumonia • Bacterial vs. viral – Lower respiratory tract • Inflammation of lung tissue • Pneumonia & Influenza – 4th leading cause of death persons > 65 years old. • Community vs. nosocomial • Predisposed with comorbid alcoholism, asthma, COPD, heart disease

27. Assessment of elder clients with Respiratory Disorders • Assess & monitor: Oxygen saturation level Cough- onset/characteristics/sputum production Subjective reports of dyspnea Functional & mental status exam Effects on functional status & quality of life (refer to Box 20-8 Ebersole text)

28. Goals for clients with Respiratory disorders Goals: stabilize disease reduce risk of exacerbations/hospitalizations Promote maximal functioning Prevent disability

29. Interventions – for elder clients with respiratory disorders • Utilize interdisciplinary team • Provide education regarding- Safe use of Oxygen; Safe exercises; Coping strategies; stress reduction • Nutrition/Diet – monitor intake /weight loss • Monitor activity & exercise tolerance • Educate re: medications/inhalers (mouth care) • Discuss rehabilitation programs/strategies

30. Mycobacterium tuberculosis

31. Constitutes a large proportion of TB cases in the U.S. Many have latent TB infection Immune function declines Increased risk of developing active TB disease Employees in long-term care facilities at risk of occupational exposure to TB. TB disease in elder population

32. Nurse’s responsibility to screening for TB using the two step TB skin test (TST) or blood assay for Mycobacterium tuberculosis (BMAT) Cannot admit to LTC unless adequate environmental controls are available TB screening

33. Caring concepts