Maintaining SelfEsteem

1
Maintaining Self-Esteem Self-Efficacy
Gerontological Community Based Nursing
2
Review of Psychosocial Changes of Aging

• Personality
• Memory
• Learning
• Relationships
• Neurological changes of aging

3
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

4
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
• Cultural Assessment Tool page 268

5
Culture, Nursing Maslows Hierarchy of Needs

• Page 56

6
Families

• Roles
• What are they?
• What have they been?
• How are they changing?

7
Caregivers

• May include
• Family
• Friends
• Paid/unpaid workers
• giving back
• Can be very stressful

8
Elder Abuse

• Acts of physical or mental mistreatment that
  threatens or causes harm to an elderly
  personeither by action or inaction
• Examples

9
Elder Abuse

• Assault
• Putting an elderly person in fear of impending
  abuse or violence
• Does not include actual touching
• Usually consists of verbal or physical threats
• Battery
• Unwanted/offensive touching
• Beating, hitting, pushing or throwing objects
  that hit an elderly person
• May also be non-injurious touching

10
Elder Abuse

• Neglect
• Also called passive abuse
• Includes withholding of medication, medical
  treatment, food, and personal care
• Also includes behavior that ignores the persons
  obvious need even though the neglectful person is
  present

11
Elder Abuse

• Financial abuse
• Theft or conversion of money or anything of value
  belonging to an older person
• Those most commonly involved are relatives and
  care givers
• Theft may be by force, through deceit,
  misrepresentation, fraud or undue influence on
  decisions made by the elderly person

12
Elder Abuse

• Psychological Abuse
• Mental or emotional abuse
• May include name calling, verbal assault, threats
  of violence, neglect or institutionalization

13
Elder Abuse

• Self Neglect
• Generally a function of diminished physical or
  mental ability
• Includes not taking medication, avoiding medical
  treatment
• Being unable or unwilling to provide food and
  personal hygiene
• Ethical question how much should we intervene
  if the elderly person is competent and simply
  chooses not to perform this care?

14
Elder Abuse

• Sexual abuse
• Forced or exploitive sexual conduct or activity
• Demand for sexual favors by use of threat or force

15
Nursing Responsibilities

• Detecting the abuse
• Elderly are often reluctance to report abuse
  because they fear being abandoned
• Abuse is likely under-reported, underestimated
  and not well documented
• Reporting can be difficult because patients,
  families, caretakers are uncooperative or
  doubtful
• Psychological and sexual abuse are difficult to
  identify d/t lack of demonstrable evidence

16
Nursing Responsibilities contd

• Change in appetite or depression are common with
  all kinds of abuse and neglect.
• People who are victims of abuseespecially the
  elderlyare often reluctant to report

17
Nursing Responsibilities contd

• Reporting abuse and neglect
• Most states have mandatory reporting requirements

18
Nutrition and Aging

• Nutritional changes across the life span are not
  well documented/understood
• Between 8-16 of oler adults do not have regular
  access to a nutritionally adequate, culturally
  compatible diet
• US Dept of Halth and Human Services (200) states
  that between 2.5 and 4.9 million older adults
  suffer from hunger but federal programs reach
  only one third of those in need.

19
Nutrition and Aging

• Some age-related changes in the GI tract
  occurbut these changes are rarely the primary
  factors affecting poor nutrition
• More influential factors
• Changes in living situations
• Loss of a spouse
• Functional impairments
• Inadequate income
• Changes in health

20
Dietary Needs of the Older Adult

• Changes related to calorie, protein, fat, fiber,
  dietary supplements and water intake
• Calories
• Decreasing metabolic rate and physical activity
• Older adults require approximately 1600
  calories/day

21
Dietary Needs of the Older Adult

• Protein intake
• 1 g/kg of body weight
• 10-20 of daily calories from protein
• Fats
• 20-25 of daily caloric intake from fat
• Focus on foods low in saturated fat
• Fiber
• 20-35 grams of fiber daily
• High fiber foods
• Fiber supplements

22
Age related changes Affecting Digestion and
Appetite

• Some changes occur in sense of taste and smell
• Taste
• Ability to detect sweet taste remains intact
• Decline in ability to detect sour, salty and
  bitter tastes

23
Age related changes Affecting Digestion and
Appetite

• Smell
• Sense of smell declines with aging
• Significant effect on pleasure of eating
• Digestive system
• Remains adequate throughout life
• Minimal normal changesbut can be compounded by
  other pathological conditions
• Appetite
• Influenced by physical activity, functional
  limitations, smell, taste, mood, socialization
  and comfort.
• Physiologic changes neurotransmitter regulation

24
Additional Concerns

• Dentition
• Bowel Function
• Constipation

25
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

26
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 illnessmany of which are common in the
  older adult

27
Nursing Interventions for Chronic Illness

• See Chapter 16pg 331
• 5 Cs
• Competence
• Compassion
• Conscience
• Commitment
• Confidence

28
Chronic Cardiac Disorders

• Coronary Artery Disease
• Heart Failure
• Peripheral Vascular Disease

29
Chronic Respiratory Disease

• Chronic Obstructive Pulmonary Disease (COPD)
• Pneumonia
• Tuberculosis

30
Life Space Considerations

• Stress associated with moving from a
  long-established location.
• Usually to a setting that is more restrictive
• Moves often occur at times of crisis

31
Home

• 88 of elders want to remain in their homeage
  in place
• Independent living assisted living skilled
  nursing facilities

32
Staying at Home

• Remaining in their home may providee the older
  adult with a locus of control and a familiar
  enviroemtn that does not change rapidly.
• Considerations for staying at home
• Modifications and home safety
• Safety in the community
• Food, home maintenance
• issues
• Taxes, etc.

33
Continuum of Housing Options

• Housed with Family Members
• Granny Flat
• Senior retirement communities
• Federally assisted senior housing
• Shared housing
• Foster care
• Residential care facilities
• Assisted living facilities
• Subacute and rehab facilities
• Nursing homes