Gerontological & Community

Based Nursing:

Culture & AgingCulture & Aging

Professor Adrianne MalteseProfessor Adrianne Maltese

Cultural changes in aging Cultural changes in aging populationpopulation

By 2060 – “ persons of color” to By 2060 – “ persons of color” to represent 50% of populationrepresent 50% of population

Hispanic, Asian & Pacific Islanders Hispanic, Asian & Pacific Islanders will have greatest increase.will have greatest increase.

Need to reduce health disparitiesNeed to reduce health disparitiesNurses to be culturally competent & Nurses to be culturally competent &

awareaware

Cultural awareness -> cultural Cultural awareness -> cultural competencecompetence

Awareness – the Awareness – the ability to recognize ability to recognize the presence of the presence of “isms” such as “isms” such as racism.racism.

Openness & self-Openness & self-reflection necessary.reflection necessary.

Robert Butler – Robert Butler – “ageism”“ageism”

Most reflective in Most reflective in Euro-American Euro-American cultureculture

Cultural Cultural competence- ability competence- ability to put cultural to put cultural knowledge to use in knowledge to use in assessment, assessment, communication, communication, negotiation and negotiation and interventionintervention

Use of cross-Use of cross-cultural nursing cultural nursing skillsskills

Culture and AgingCulture and Aging

Sensitivity to the knowledge of Sensitivity to the knowledge of similarities/differences between similarities/differences between people of different cultural people of different cultural backgrounds is vital to the backgrounds is vital to the establishment of positive relationships establishment of positive relationships and communication.and communication.Basic understanding of differing values, Basic understanding of differing values,

experiences, social networks, experiences, social networks, communication styles and perceptions of communication styles and perceptions of health/illnesshealth/illness

Cultural Implications and Cultural Implications and AgingAging

Ethnic elders often have health beliefs Ethnic elders often have health beliefs that are different from that of the that are different from that of the biomedical or Western health system biomedical or Western health system used by many health care used by many health care professionals in the U.S.professionals in the U.S.

Determination of elders’ health beliefsDetermination of elders’ health beliefsWorking with an Interpreter Working with an Interpreter

(box-4-3 p. 54)(box-4-3 p. 54)

What familial and cultural views of What familial and cultural views of aging and the elderly do you hold?aging and the elderly do you hold?

How would you alter care to meet How would you alter care to meet elders cultural needs?elders cultural needs?

Chronic IllnessChronic Illness

““Most disorders of aging are chronic ones Most disorders of aging are chronic ones that must be treated within a framework of that must be treated within a framework of lifestyle changes, living situation lifestyle changes, living situation adaptations, and attention to the whole adaptations, and attention to the whole person coping with the disorder”person coping with the disorder”

Burggraf, Barry 1996Burggraf, Barry 1996

““88% of older adults have at least one 88% of older adults have at least one chronic illness; 50% have at least chronic illness; 50% have at least two”(Zauszniewski et al, 2007)two”(Zauszniewski et al, 2007)

Most common – arthritis & hypertensionMost common – arthritis & hypertension

Wellness in Chronic IllnessWellness in Chronic Illness

Greatest factor in establishing a Greatest factor in establishing a sense of wellness in the face of sense of wellness in the face of chronic illness is adaptation.chronic illness is adaptation.

Nurses help patients assist clients Nurses help patients assist clients toward enriched capacity for living in toward enriched capacity for living in the shadow of chronic illness—many the shadow of chronic illness—many of which are common in the older of which are common in the older adultadult

Theoretical Frameworks Theoretical Frameworks for Chronic Illnessfor Chronic Illness

Maslow’s Hierarchy of Needs – goal Maslow’s Hierarchy of Needs – goal of wellness approach -> assist older of wellness approach -> assist older adult to meet as many of basic needs adult to meet as many of basic needs as possible.as possible.

Chronic Illness Trajectory- (Corbin & Chronic Illness Trajectory- (Corbin & Strauss 1988) view of living with a Strauss 1988) view of living with a chronic illness as a trajectory that chronic illness as a trajectory that traces the progression of a chronic traces the progression of a chronic illness through 8 phases.illness through 8 phases.

Phases of Chronic Illness Phases of Chronic Illness TrajectoryTrajectory

1.) Pretrajectory – preventative phase1.) Pretrajectory – preventative phase2.) Trajectory onset - definitive phase2.) Trajectory onset - definitive phase3.) Crisis Phase3.) Crisis Phase4.) Acute Phase4.) Acute Phase5.) Stable Phase5.) Stable Phase6.) Unstable Phase6.) Unstable Phase7.) Downward Phase 7.) Downward Phase 8.) Dying Phase8.) Dying Phase

Shifting Perspective Model of Shifting Perspective Model of Chronic Illness(Paterson 2001)Chronic Illness(Paterson 2001)

Model views living with chronic illness as Model views living with chronic illness as an ongoing- continuously shifting an ongoing- continuously shifting process – person moves between process – person moves between wellness or illness in the foreground.wellness or illness in the foreground.

Insider perspective of chronic illness –Insider perspective of chronic illness –Concept of client as “partner - in – care”Concept of client as “partner - in – care”Focus on health within illnessFocus on health within illness

The 5 “C’s of Caring”The 5 “C’s of Caring” (Simone Roach 1992 (Simone Roach 1992))

CompetenceCompetenceCompassionCompassionConscienceConscienceCommitmentCommitmentConfidenceConfidence

So how do we utilize these caring So how do we utilize these caring concepts?concepts?

Common Disorders of Common Disorders of AgeingAgeing

Cardiovascular & Respiratory Cardiovascular & Respiratory disordersdisorders

Common Chronic - Common Chronic - Cardiovascular DisordersCardiovascular Disorders

Hypertension – Most common – Goal Hypertension – Most common – Goal 120/60 mm Hg120/60 mm Hg

Coronary Artery Disease –> risk for Coronary Artery Disease –> risk for “silent MI” “silent MI”

Heart Failure – a result of CHD (65 -Heart Failure – a result of CHD (65 -75% of hospitalized persons – dx of 75% of hospitalized persons – dx of HF 80% were > 65 years oldHF 80% were > 65 years old

Peripheral Vascular DiseasePeripheral Vascular Disease

Assessment -CardiovascularAssessment -Cardiovascular

Obtain pertinent history Obtain pertinent history Monitor vital signsMonitor vital signs Lab resultsLab results Kidney functionsKidney functions Assess cardiac & respiratory functionAssess cardiac & respiratory function Conduct mental status examConduct mental status examExamine changes in clients abilities: Examine changes in clients abilities: ADL’s,ADL’s, Quality of sleepQuality of sleep Dyspnea (shortness of breath) Dyspnea (shortness of breath)

Goals for elders with CVDGoals for elders with CVD

Goals: Goals:

relief of symptomsrelief of symptoms

Improve/maximize function/ quality of Improve/maximize function/ quality of lifelife

Reduce morbidity/mortalityReduce morbidity/mortality

Slow progression of dysfunctionSlow progression of dysfunction

Interventions-CVDInterventions-CVD

Education/teaching life-style changes/dietEducation/teaching life-style changes/diet Monitor s/sx of CHFMonitor s/sx of CHF Monitor fluid intake/output/dietMonitor fluid intake/output/diet Monitor weight daily/biweekly/weekly Monitor weight daily/biweekly/weekly Ausculate heart & lung soundsAusculate heart & lung sounds Monitor lab valuesMonitor lab values Cardiac rehab programsCardiac rehab programs Provide comfort measures- in end-of life Provide comfort measures- in end-of life

care if palliative/hospice care is indicatedcare if palliative/hospice care is indicated

Monitor risk for exercise related Monitor risk for exercise related orthostatic hypotension r/t orthostatic hypotension r/t ↓in ↓in baroreceptor responsivenessbaroreceptor responsiveness

Exercise in climate controlled Exercise in climate controlled environmentenvironment

Alter lifestyle – smoking, diet, Alter lifestyle – smoking, diet, emotionsemotions

Coronary Heart diseaseCoronary Heart disease

Chronic Respiratory DiseaseChronic Respiratory Disease

Chronic Obstructive Pulmonary Chronic Obstructive Pulmonary Disease (COPD)Disease (COPD)

PneumoniaPneumoniaTuberculosisTuberculosis

Chronic Respiratory DiseaseChronic Respiratory Disease

Infectious – Acute – Chronic Infectious – Acute – Chronic Respiratory diseasesRespiratory diseases

Can involve upper or lower respiratory Can involve upper or lower respiratory tract tract

Obstructive (prevents airflow out r/t Obstructive (prevents airflow out r/t narrowing of respiratory structures) narrowing of respiratory structures)

vs. Restrictive (decreased lung capacity vs. Restrictive (decreased lung capacity r/t limited expansion of lungs)r/t limited expansion of lungs)

Chronic obstructive Pulmonary Chronic obstructive Pulmonary Disease - COPDDisease - COPD

By 2020 3By 2020 3rdrd leading cause of death leading cause of death Includes asthma, bronchitis, Includes asthma, bronchitis,

emphysemaemphysemaActivity intolerance r/t obstructive Activity intolerance r/t obstructive

airwaysairways

View of COPDView of COPD

COPD - elderlyCOPD - elderly

People with COPD People with COPD can still lead can still lead productive lives.productive lives.

CoughingCoughing WheezingWheezing Chest tightnessChest tightness Shortness of breathShortness of breath

PneumoniaPneumonia

Bacterial vs. viral – Lower respiratory Bacterial vs. viral – Lower respiratory tracttract

Inflammation of lung tissueInflammation of lung tissuePneumonia & Influenza – 4Pneumonia & Influenza – 4thth leading leading

cause of death persons > 65 years old.cause of death persons > 65 years old.Community vs. nosocomialCommunity vs. nosocomialPredisposed with comorbid alcoholism, Predisposed with comorbid alcoholism,

asthma, COPD, heart diseaseasthma, COPD, heart disease

Assessment of elder clients with Assessment of elder clients with Respiratory DisordersRespiratory Disorders

Assess & monitor:Assess & monitor:Oxygen saturation levelOxygen saturation levelCough- onset/characteristics/sputum Cough- onset/characteristics/sputum

productionproductionSubjective reports of dyspneaSubjective reports of dyspneaFunctional & mental status examFunctional & mental status examEffects on functional status & quality of Effects on functional status & quality of

lifelife(refer to Box 20-8 Ebersole text)(refer to Box 20-8 Ebersole text)

Goals for clients with Respiratory Goals for clients with Respiratory disordersdisorders

Goals:Goals:

stabilize diseasestabilize disease

reduce risk of reduce risk of exacerbations/hospitalizationsexacerbations/hospitalizations

Promote maximal functioningPromote maximal functioning

Prevent disabilityPrevent disability

Interventions – for elder clients Interventions – for elder clients with respiratory disorderswith respiratory disorders

• Utilize interdisciplinary teamUtilize interdisciplinary team• Provide education regarding-Provide education regarding-

Safe use of Oxygen; Safe exercises;Safe use of Oxygen; Safe exercises;

Coping strategies; stress reductionCoping strategies; stress reduction• Nutrition/Diet – monitor intake /weight lossNutrition/Diet – monitor intake /weight loss• Monitor activity & exercise tolerance Monitor activity & exercise tolerance • Educate re: medications/inhalers (mouth Educate re: medications/inhalers (mouth

care)care)• Discuss rehabilitation programs/strategiesDiscuss rehabilitation programs/strategies

Mycobacterium tuberculosisMycobacterium tuberculosis

TB disease in elder TB disease in elder populationpopulation

Constitutes a large Constitutes a large proportion of TB cases proportion of TB cases in the U.S.in the U.S.

Many have latent TB Many have latent TB infectioninfection

Immune function Immune function declinesdeclines

Increased risk of Increased risk of developing active TB developing active TB diseasedisease

Employees in long-Employees in long-term care facilities at term care facilities at risk of occupational risk of occupational exposure to TB.exposure to TB.   

TB screeningTB screening

Nurse’s responsibility Nurse’s responsibility to screening for TB to screening for TB using the using the two step TB two step TB skin test (TST) skin test (TST) or or blood assay for blood assay for Mycobacterium Mycobacterium tuberculosis (BMAT)tuberculosis (BMAT)

Cannot admit to LTC Cannot admit to LTC unless adequate unless adequate environmental environmental controls are availablecontrols are available

Caring conceptsCaring concepts