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Chapter 10: Chapter 10: Promoting Promoting
Independence in Independence in Later LifeLater Life
Bonnie M. Wivell, MS, RN, Bonnie M. Wivell, MS, RN, CNSCNS
Maintaining Maintaining IndependenceIndependence
Many factors contribute to the Many factors contribute to the ability of older adults to continue ability of older adults to continue their independencetheir independence
Maintaining maximum independence Maintaining maximum independence while maintaining maximum QOLwhile maintaining maximum QOL
Influences of Environment Influences of Environment and Living Situationand Living Situation
Living skillsLiving skills Kohlman Evaluation of Living SkillsKohlman Evaluation of Living Skills
Self-careSelf-care Safety and healthSafety and health Money managementMoney management Transportation and phone useTransportation and phone use Work and leisureWork and leisure
Housing influencesHousing influences Assist with decisionAssist with decision Distribution of belongingsDistribution of belongings Fiscal considerationsFiscal considerations
Self-CareSelf-Care Maintaining interestsMaintaining interests Doing for othersDoing for others Frailty: general decline in physical Frailty: general decline in physical
function that may increase function that may increase vulnerability to illness and declinevulnerability to illness and decline ExhaustionExhaustion Grip strengthGrip strength Walking speedWalking speed Low caloric expenditureLow caloric expenditure
Role Role Changes/TransitionsChanges/Transitions
RetirementRetirement Health to illnessHealth to illness Loss of a spouseLoss of a spouse
Widows/WidowersWidows/Widowers DivorceDivorce
Role reversal: care provider to care Role reversal: care provider to care recipientrecipient
Driving a carDriving a car Strong emotional and psychological Strong emotional and psychological
implicationsimplications
Role Role Changes/TransitionsChanges/Transitions
IADLs = shopping, errandsIADLs = shopping, errands
ADLs = personal careADLs = personal care
Caregiving – often needed long Caregiving – often needed long before acceptedbefore accepted
Caregiving OptionsCaregiving Options SettingsSettings
Senior living complexSenior living complex Assisted livingAssisted living Paid caregiversPaid caregivers Extended care facilitiesExtended care facilities
FamilyFamily StressorsStressors
TimeTime CostCost
Use of humor can provide stress reliefUse of humor can provide stress relief
SocializationSocialization
Maintaining connection to othersMaintaining connection to others
RelationshipsRelationships
CompanionshipCompanionship
PsychoSocial and Spiritual PsychoSocial and Spiritual InfluencesInfluences
Stress managementStress management Expression of emotionExpression of emotion ExerciseExercise Deep breathingDeep breathing Day dreaming/Guided imageryDay dreaming/Guided imagery Progressive relaxationProgressive relaxation MeditationMeditation
Goal attainmentGoal attainment
Maximizing FunctionMaximizing Function
Many factors influence the ability of Many factors influence the ability of the older adult to maintain and the older adult to maintain and maximize functionmaximize function
““So you want to live to be 100. Well, So you want to live to be 100. Well, start with this: No smoking, no start with this: No smoking, no drinking, no chewing. And always drinking, no chewing. And always clean your plate. Well, you can drink clean your plate. Well, you can drink a little bit, but not much!”a little bit, but not much!”
Preventing Complications Preventing Complications of Existing Illness or of Existing Illness or
DiseaseDisease NutritionNutrition
SleepSleep
ExerciseExercise
Fall preventionFall prevention
Value of RehabilitationValue of Rehabilitation
GoalsGoals Promote independencePromote independence
Maximize functionMaximize function
Prevent complicationsPrevent complications
Promote quality of lifePromote quality of life
Use of/Alternatives to Use of/Alternatives to RestraintsRestraints
Personal strengthening and rehab programPersonal strengthening and rehab program Use of personal assistance devices such as Use of personal assistance devices such as
hearing aids, visual aids and mobility deviceshearing aids, visual aids and mobility devices Use of positioning devices such as body and Use of positioning devices such as body and
seat cushions, padded furnitureseat cushions, padded furniture Safer physical environment design, including Safer physical environment design, including
removal of obstacles that impede movement, removal of obstacles that impede movement, placement of objects and furniture in familiar placement of objects and furniture in familiar places, lower beds, adequate lightingplaces, lower beds, adequate lighting
Use of/Alternatives to Use of/Alternatives to RestraintsRestraints
Regular attention to physical and personal Regular attention to physical and personal needs, including toileting, thirst, hunger, needs, including toileting, thirst, hunger, socialization, and activities adapted to socialization, and activities adapted to current ability and former interestscurrent ability and former interests
Design of physical environment for close Design of physical environment for close observation of staffobservation of staff
Efforts to increase staff awareness of Efforts to increase staff awareness of person’s individual needs – including person’s individual needs – including assignment of staff particularly to the assignment of staff particularly to the person, in effort to improve function and person, in effort to improve function and decrease difficult behaviors.decrease difficult behaviors.
Use of/Alternatives to Use of/Alternatives to RestraintsRestraints
Living environment designed to Living environment designed to promote relaxation and comfort, promote relaxation and comfort, minimize noise, provide soothing minimize noise, provide soothing music and appropriate lightingmusic and appropriate lighting
Provision of massage, art, movement Provision of massage, art, movement activitiesactivities
Use of bed, chair and door alarms to Use of bed, chair and door alarms to alert to the need for assistancealert to the need for assistance
Financial ConsiderationsFinancial Considerations
Help as needed:Help as needed: Medicare/MedicaidMedicare/Medicaid Food stampsFood stamps GrantsGrants Church programs/pantriesChurch programs/pantries AARP and other aging agencies for the AARP and other aging agencies for the
state or countystate or county
Community ResourcesCommunity Resources
Know what is available in your own Know what is available in your own community:community: Senior centersSenior centers Wellness programs through hospitalsWellness programs through hospitals Church groups for socialization and Church groups for socialization and
supportsupport VNA/Hospice when neededVNA/Hospice when needed
Community ResourcesCommunity Resources
Problem-based support groupsProblem-based support groups Meals on WheelsMeals on Wheels Geriatric case managementGeriatric case management Eldercare facilitiesEldercare facilities Community clinicsCommunity clinics
Other Recommendations to Other Recommendations to Promote Healthy AgingPromote Healthy Aging
Eat breakfast every day.Eat breakfast every day. Select high-fiber food like whole grain Select high-fiber food like whole grain
breads and cereals, beans, vegetables, breads and cereals, beans, vegetables, and fruits.and fruits.
Have three servings of low-fat milk, Have three servings of low-fat milk, yogurt or cheese a day. Dairy products yogurt or cheese a day. Dairy products are high in calcium and vitamin D and are high in calcium and vitamin D and help keep your bones strong as you age. help keep your bones strong as you age. Or take a calcium and vitamin D Or take a calcium and vitamin D supplement.supplement.
Other Recommendations to Other Recommendations to Promote Healthy AgingPromote Healthy Aging
Drink plenty of water. You may Drink plenty of water. You may notice that you feel less thirsty as notice that you feel less thirsty as you get older, but your body still you get older, but your body still needs the same amount of water. needs the same amount of water.
Ask your health care provider about Ask your health care provider about ways you can safely increase the ways you can safely increase the amount of physical activity you do amount of physical activity you do now.now.
Other Recommendations to Other Recommendations to Promote Healthy AgingPromote Healthy Aging
Fit physical activity into your Fit physical activity into your everyday life. For example, take everyday life. For example, take short walks throughout your day. short walks throughout your day. You do not have to have a formal You do not have to have a formal physical activity program to improve physical activity program to improve your health and stay active.your health and stay active.
Get enough sleep.Get enough sleep. Stay connected with family, friends Stay connected with family, friends
and community.and community.
Chapter 11: Chapter 11: Promoting Promoting
Healthy AgingHealthy AgingBonnie M. Wivell, MS, RN, Bonnie M. Wivell, MS, RN,
CNSCNS
Healthy People 2000 and 2010 Healthy People 2000 and 2010 InitiativesInitiatives
Purpose:Purpose: Health promotionHealth promotion Document baselinesDocument baselines Set objectivesSet objectives Monitor progressMonitor progress
Healthy People 2000 target goalsHealthy People 2000 target goals Met for mammogram screening and influenza Met for mammogram screening and influenza
vaccinationvaccination Fell short forFell short for
Pneumococcal vaccinationPneumococcal vaccination Physical activity, overweight, eating fruits and vegetablesPhysical activity, overweight, eating fruits and vegetables Reducing hip fractures, and fall-related deathsReducing hip fractures, and fall-related deaths
Toolkit for HP 2010 available at Toolkit for HP 2010 available at http://http://www.health.gov/healthypeople/state/toolkitwww.health.gov/healthypeople/state/toolkit
Medicare CoverageMedicare Coverage
Nutrition therapy for persons with Nutrition therapy for persons with diabetes and kidney diseasediabetes and kidney disease
An initial physical examination that An initial physical examination that includes prevention counselingincludes prevention counseling
Smoking cessation—for those who have Smoking cessation—for those who have an illness caused by or complicated by an illness caused by or complicated by tobacco usetobacco use
Comprehensive health promotion Comprehensive health promotion programs for beneficiaries with heart programs for beneficiaries with heart problemsproblems
Health Behavior ChangeHealth Behavior Change
Theory that attempts to explain the Theory that attempts to explain the processes underlying the learning of processes underlying the learning of new health behaviorsnew health behaviors
Health contract/calendarHealth contract/calendar Initial assistance from clinicianInitial assistance from clinician Relies on self-management capabilities Relies on self-management capabilities
of individualof individual
Recommendations for Recommendations for Healthy AgingHealthy Aging
ExerciseExercise 30 minutes on most days of the week30 minutes on most days of the week Walking indoors in inclement weatherWalking indoors in inclement weather Neighborhoods can contribute to less exerciseNeighborhoods can contribute to less exercise http://topics.healthvideo.com/m/26757081/exehttp://topics.healthvideo.com/m/26757081/exe
rcise-can-help-you-live-longer.htmrcise-can-help-you-live-longer.htm http://topics.healthvideo.com/m/28352903/voluhttp://topics.healthvideo.com/m/28352903/volu
nteering-could-be-healthy-for-the-elderly.htmenteering-could-be-healthy-for-the-elderly.htme=healthy-=healthy-aging&brand_nameaging&brand_name==healthlinehealthline
NutritionNutrition See Nutrition Bull’s-eyeSee Nutrition Bull’s-eye Goal is to consume foods in centerGoal is to consume foods in center
Mental HealthMental Health http://medicalnewstoday.healthology.com/hhttp://medicalnewstoday.healthology.com/h
ybrid/hybrid-autodetect.aspx?content_idybrid/hybrid-autodetect.aspx?content_id=2516&focus_handle=&=2516&focus_handle=&brand_namebrand_name==medicalnewstodaymedicalnewstoday
Life review: autobiography saved in print or Life review: autobiography saved in print or on other mediaon other media Stronger life satisfaction, promote feeling of Stronger life satisfaction, promote feeling of
well-being, improved self-esteem, reduced well-being, improved self-esteem, reduced depressiondepression
DepressionDepression Increases likelihood of death from cancer and Increases likelihood of death from cancer and
heart diseaseheart disease Suicide: older adults account for 25% of all Suicide: older adults account for 25% of all
suicide deaths suicide deaths
Model Health Promotion Model Health Promotion ProgramsPrograms
Healthwise Healthwise Developed in Boise, IdahoDeveloped in Boise, Idaho Handbook in 17Handbook in 17thth edition edition 190 common health problems190 common health problems
Chronic Disease Self-Management Chronic Disease Self-Management Program Program Nurse researcher at Stanford University SOMNurse researcher at Stanford University SOM Peer-led, community basedPeer-led, community based
Project Enhance Project Enhance Enhance fitnessEnhance fitness Enhance wellness, which focuses on mental Enhance wellness, which focuses on mental
healthhealth
Model Health Promotion Model Health Promotion ProgramsPrograms
Ornish Program for Reversing Heart DiseaseOrnish Program for Reversing Heart Disease Vegetarian dietVegetarian diet Fat intake of 10% or less of total caloriesFat intake of 10% or less of total calories Moderate aerobic exercise 3 x/weekModerate aerobic exercise 3 x/week Yoga and meditation an hour a dayYoga and meditation an hour a day Support groupsSupport groups Smoking cessationSmoking cessation
Benson’s Mind/Body Medical Institute Benson’s Mind/Body Medical Institute MD affiliated with Harvard Medical SchoolMD affiliated with Harvard Medical School Relaxation response to stressRelaxation response to stress Proper nutrition and exerciseProper nutrition and exercise Reframe negative thinking patternsReframe negative thinking patterns
Model Health Promotion Model Health Promotion ProgramsPrograms
Strong for Life Strong for Life Home based exercise programHome based exercise program For disabled and nondisabled older For disabled and nondisabled older
adultsadults Focuses on strength and balanceFocuses on strength and balance Exercise video, trainer’s manual, and Exercise video, trainer’s manual, and
user’s guideuser’s guide
The BoomersThe Boomers
Longest-livedLongest-lived Best-educatedBest-educated HealthiestHealthiest Most-engagedMost-engaged Largest cohort of retirees everLargest cohort of retirees ever
35 million age 65 or older in 2000 to 35 million age 65 or older in 2000 to more than 70 million in 2030more than 70 million in 2030
GreenhousesGreenhouses Alternative to nursing homesAlternative to nursing homes
Robert Wood Johnson Foundation grantRobert Wood Johnson Foundation grant Promote autonomyPromote autonomy
A home environmentA home environment Own private room and bathOwn private room and bath
Not in all states yet (under development in Akron, Not in all states yet (under development in Akron, CO)CO)
Employee turnover rate is much lower than in Employee turnover rate is much lower than in nursing homenursing home Better payBetter pay EmpowermentEmpowerment 1:5 staff ratio1:5 staff ratio 1:20 RN ratio1:20 RN ratio 1:120 administrator ratio1:120 administrator ratio
Watch VideoWatch Video
YouTubeYouTube Greenhouse alternative to nursing Greenhouse alternative to nursing
homeshomes
Chapter 22: Chapter 22: Promoting Promoting
Quality of LifeQuality of LifeBonnie M. Wivell, MS, RN, Bonnie M. Wivell, MS, RN,
CNSCNS
Quality of Life (QOL)Quality of Life (QOL)
DefinitionDefinition Complex conceptComplex concept Satisfaction/dissatisfaction with lifeSatisfaction/dissatisfaction with life A person’s sense of well-beingA person’s sense of well-being
As we age, QOL is dependent on our As we age, QOL is dependent on our ability to maintain autonomy and ability to maintain autonomy and independenceindependence
Successful vs. Active Successful vs. Active AgingAging
Successful aging: Successful aging: Person has avoided disease and disease-related Person has avoided disease and disease-related
disabilitydisability Has a high level of cognitive and physical functioning Has a high level of cognitive and physical functioning
that allows the individual to be engaged with lifethat allows the individual to be engaged with life Active AgingActive Aging
Adopted by WHO in the late 1990sAdopted by WHO in the late 1990s Supports autonomy, independence and activitySupports autonomy, independence and activity Strategies that promote QOL decrease disabilities Strategies that promote QOL decrease disabilities
associate with chronic illnessassociate with chronic illness Increase elders’ participation in the social, cultural, Increase elders’ participation in the social, cultural,
economic, and political aspects of societyeconomic, and political aspects of society Lower the cost of medical treatmentLower the cost of medical treatment Plan for old age and choose healthy lifestylesPlan for old age and choose healthy lifestyles
Determinants of HealthDeterminants of Health Gender and cultureGender and culture BehavioralBehavioral
Physical activityPhysical activity NutritionNutrition SmokingSmoking Alcohol useAlcohol use Medication adherenceMedication adherence
PersonalPersonal Genetics and Genetics and
psychological factorspsychological factors Physical environmentPhysical environment
Neighborhoods and Neighborhoods and safe housingsafe housing
Social EnvironmentSocial Environment SupportSupport EducationEducation LiteracyLiteracy ViolenceViolence AbuseAbuse
EconomicEconomic IncomeIncome Social protectionSocial protection
Social ServicesSocial Services Health promotionHealth promotion Disease preventionDisease prevention
Helping the Patient Willing to Helping the Patient Willing to QuitQuit
The 5 AsThe 5 As Ask about useAsk about use Advise to quitAdvise to quit Assess willingnessAssess willingness Assist with planAssist with plan Action (provide Action (provide
help)help)
The 5 RsThe 5 Rs RelevanceRelevance RisksRisks RewardsRewards RoadblocksRoadblocks RepetitionRepetition
Alcoholism in the ElderlyAlcoholism in the Elderly Under-recognizedUnder-recognized 1/3 of older alcoholic persons developed the 1/3 of older alcoholic persons developed the
problem later in lifeproblem later in life 62% of community dwelling elderly found to drink 62% of community dwelling elderly found to drink
alcoholalcohol Effects may be increasedEffects may be increased
Pharmacologic changes associated with agingPharmacologic changes associated with aging Alcohol and drug interactions may be more seriousAlcohol and drug interactions may be more serious
Physiological changes related to aging can alter Physiological changes related to aging can alter the presentation of medical complications of the presentation of medical complications of alcoholismalcoholism
Beneficial but recommended that they limit intake Beneficial but recommended that they limit intake to one drink per dayto one drink per day
Alcoholism in the Elderly Alcoholism in the Elderly (cont’d)(cont’d)
Assess for:Assess for: Cognitive declineCognitive decline Non-adherence with appointmentsNon-adherence with appointments Psychiatric historyPsychiatric history InsomniaInsomnia Poorly controlled HTNPoorly controlled HTN Frequent fallsFrequent falls GI problemsGI problems Nutritional deficienciesNutritional deficiencies Delirium during hospitalizationDelirium during hospitalization
CA of the head, neck, esophagus, and liver CA of the head, neck, esophagus, and liver are associated with chronic alcohol abuseare associated with chronic alcohol abuse