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Chapter 10: Promoting Independence in Later Life


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Title: Chapter 10: Promoting Independence in Later Life

Chapter 10 Promoting Independence in Later Life
  • Bonnie M. Wivell, MS, RN, CNS

Maintaining Independence
  • Many factors contribute to the ability of older
    adults to continue their independence
  • Maintaining maximum independence while
    maintaining maximum QOL

Influences of Environment and Living Situation
  • Living skills
  • Kohlman Evaluation of Living Skills
  • Self-care
  • Safety and health
  • Money management
  • Transportation and phone use
  • Work and leisure
  • Housing influences
  • Assist with decision
  • Distribution of belongings
  • Fiscal considerations

  • Maintaining interests
  • Doing for others
  • Frailty general decline in physical function
    that may increase vulnerability to illness and
  • Exhaustion
  • Grip strength
  • Walking speed
  • Low caloric expenditure

Role Changes/Transitions
  • Retirement
  • Health to illness
  • Loss of a spouse
  • Widows/Widowers
  • Divorce
  • Role reversal care provider to care recipient
  • Driving a car
  • Strong emotional and psychological implications

Role Changes/Transitions
  • IADLs shopping, errands
  • ADLs personal care
  • Caregiving often needed long before accepted

Caregiving Options
  • Settings
  • Senior living complex
  • Assisted living
  • Paid caregivers
  • Extended care facilities
  • Family
  • Stressors
  • Time
  • Cost
  • Use of humor can provide stress relief

  • Maintaining connection to others
  • Relationships
  • Companionship

PsychoSocial and Spiritual Influences
  • Stress management
  • Expression of emotion
  • Exercise
  • Deep breathing
  • Day dreaming/Guided imagery
  • Progressive relaxation
  • Meditation
  • Goal attainment

Maximizing Function
  • Many factors influence the ability of the older
    adult to maintain and maximize function
  • So you want to live to be 100. Well, start with
    this No smoking, no drinking, no chewing. And
    always clean your plate. Well, you can drink a
    little bit, but not much!

Preventing Complications of Existing Illness or
  • Nutrition
  • Sleep
  • Exercise
  • Fall prevention

Value of Rehabilitation
  • Goals
  • Promote independence
  • Maximize function
  • Prevent complications
  • Promote quality of life

Use of/Alternatives to Restraints
  • Personal strengthening and rehab program
  • Use of personal assistance devices such as
    hearing aids, visual aids and mobility devices
  • Use of positioning devices such as body and seat
    cushions, padded furniture
  • Safer physical environment design, including
    removal of obstacles that impede movement,
    placement of objects and furniture in familiar
    places, lower beds, adequate lighting

Use of/Alternatives to Restraints
  • Regular attention to physical and personal needs,
    including toileting, thirst, hunger,
    socialization, and activities adapted to current
    ability and former interests
  • Design of physical environment for close
    observation of staff
  • Efforts to increase staff awareness of persons
    individual needs including assignment of staff
    particularly to the person, in effort to improve
    function and decrease difficult behaviors.

Use of/Alternatives to Restraints
  • Living environment designed to promote relaxation
    and comfort, minimize noise, provide soothing
    music and appropriate lighting
  • Provision of massage, art, movement activities
  • Use of bed, chair and door alarms to alert to the
    need for assistance

Financial Considerations
  • Help as needed
  • Medicare/Medicaid
  • Food stamps
  • Grants
  • Church programs/pantries
  • AARP and other aging agencies for the state or

Community Resources
  • Know what is available in your own community
  • Senior centers
  • Wellness programs through hospitals
  • Church groups for socialization and support
  • VNA/Hospice when needed

Community Resources
  • Problem-based support groups
  • Meals on Wheels
  • Geriatric case management
  • Eldercare facilities
  • Community clinics

Other Recommendations to Promote Healthy Aging
  • Eat breakfast every day.
  • Select high-fiber food like whole grain breads
    and cereals, beans, vegetables, and fruits.
  • Have three servings of low-fat milk, yogurt or
    cheese a day. Dairy products are high in calcium
    and vitamin D and help keep your bones strong as
    you age. Or take a calcium and vitamin D

Other Recommendations to Promote Healthy Aging
  • Drink plenty of water. You may notice that you
    feel less thirsty as you get older, but your body
    still needs the same amount of water.
  • Ask your health care provider about ways you can
    safely increase the amount of physical activity
    you do now.

Other Recommendations to Promote Healthy Aging
  • Fit physical activity into your everyday life.
    For example, take short walks throughout your
    day. You do not have to have a formal physical
    activity program to improve your health and stay
  • Get enough sleep.
  • Stay connected with family, friends and

Chapter 11 Promoting Healthy Aging
  • Bonnie M. Wivell, MS, RN, CNS

Healthy People 2000 and 2010 Initiatives
  • Purpose
  • Health promotion
  • Document baselines
  • Set objectives
  • Monitor progress
  • Healthy People 2000 target goals
  • Met for mammogram screening and influenza
  • Fell short for
  • Pneumococcal vaccination
  • Physical activity, overweight, eating fruits and
  • Reducing hip fractures, and fall-related deaths
  • Toolkit for HP 2010 available at

Medicare Coverage
  • Nutrition therapy for persons with diabetes and
    kidney disease
  • An initial physical examination that includes
    prevention counseling
  • Smoking cessationfor those who have an illness
    caused by or complicated by tobacco use
  • Comprehensive health promotion programs for
    beneficiaries with heart problems

Health Behavior Change
  • Theory that attempts to explain the processes
    underlying the learning of new health behaviors
  • Health contract/calendar
  • Initial assistance from clinician
  • Relies on self-management capabilities of

Recommendations for Healthy Aging
  • Exercise
  • 30 minutes on most days of the week
  • Walking indoors in inclement weather
  • Neighborhoods can contribute to less exercise
  • http//
  • http//
  • Nutrition
  • See Nutrition Bulls-eye
  • Goal is to consume foods in center

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Mental Health
  • http//
  • Life review autobiography saved in print or on
    other media
  • Stronger life satisfaction, promote feeling of
    well-being, improved self-esteem, reduced
  • Depression
  • Increases likelihood of death from cancer and
    heart disease
  • Suicide older adults account for 25 of all
    suicide deaths

Model Health Promotion Programs
  • Healthwise
  • Developed in Boise, Idaho
  • Handbook in 17th edition
  • 190 common health problems
  • Chronic Disease Self-Management Program
  • Nurse researcher at Stanford University SOM
  • Peer-led, community based
  • Project Enhance
  • Enhance fitness
  • Enhance wellness, which focuses on mental health

Model Health Promotion Programs
  • Ornish Program for Reversing Heart Disease
  • Vegetarian diet
  • Fat intake of 10 or less of total calories
  • Moderate aerobic exercise 3 x/week
  • Yoga and meditation an hour a day
  • Support groups
  • Smoking cessation
  • Bensons Mind/Body Medical Institute
  • MD affiliated with Harvard Medical School
  • Relaxation response to stress
  • Proper nutrition and exercise
  • Reframe negative thinking patterns

Model Health Promotion Programs
  • Strong for Life
  • Home based exercise program
  • For disabled and nondisabled older adults
  • Focuses on strength and balance
  • Exercise video, trainers manual, and users

The Boomers
  • Longest-lived
  • Best-educated
  • Healthiest
  • Most-engaged
  • Largest cohort of retirees ever
  • 35 million age 65 or older in 2000 to more than
    70 million in 2030

  • Alternative to nursing homes
  • Robert Wood Johnson Foundation grant
  • Promote autonomy
  • A home environment
  • Own private room and bath
  • Not in all states yet (under development in
    Akron, CO)
  • Employee turnover rate is much lower than in
    nursing home
  • Better pay
  • Empowerment
  • 15 staff ratio
  • 120 RN ratio
  • 1120 administrator ratio

Watch Video
  • YouTube
  • Greenhouse alternative to nursing homes

Chapter 22 Promoting Quality of Life
  • Bonnie M. Wivell, MS, RN, CNS

Quality of Life (QOL)
  • Definition
  • Complex concept
  • Satisfaction/dissatisfaction with life
  • A persons sense of well-being
  • As we age, QOL is dependent on our ability to
    maintain autonomy and independence

Ferrell and Grant QOL Model
Successful vs. Active Aging
  • Successful aging
  • Person has avoided disease and disease-related
  • Has a high level of cognitive and physical
    functioning that allows the individual to be
    engaged with life
  • Active Aging
  • Adopted by WHO in the late 1990s
  • Supports autonomy, independence and activity
  • Strategies that promote QOL decrease disabilities
    associate with chronic illness
  • Increase elders participation in the social,
    cultural, economic, and political aspects of
  • Lower the cost of medical treatment
  • Plan for old age and choose healthy lifestyles

Determinants of Health
  • Gender and culture
  • Behavioral
  • Physical activity
  • Nutrition
  • Smoking
  • Alcohol use
  • Medication adherence
  • Personal
  • Genetics and psychological factors
  • Physical environment
  • Neighborhoods and safe housing
  • Social Environment
  • Support
  • Education
  • Literacy
  • Violence
  • Abuse
  • Economic
  • Income
  • Social protection
  • Social Services
  • Health promotion
  • Disease prevention

Helping the Patient Willing to Quit
  • The 5 As
  • Ask about use
  • Advise to quit
  • Assess willingness
  • Assist with plan
  • Action (provide help)
  • The 5 Rs
  • Relevance
  • Risks
  • Rewards
  • Roadblocks
  • Repetition

Alcoholism in the Elderly
  • Under-recognized
  • 1/3 of older alcoholic persons developed the
    problem later in life
  • 62 of community dwelling elderly found to drink
  • Effects may be increased
  • Pharmacologic changes associated with aging
  • Alcohol and drug interactions may be more serious
  • Physiological changes related to aging can alter
    the presentation of medical complications of
  • Beneficial but recommended that they limit intake
    to one drink per day

Alcoholism in the Elderly (contd)
  • Assess for
  • Cognitive decline
  • Non-adherence with appointments
  • Psychiatric history
  • Insomnia
  • Poorly controlled HTN
  • Frequent falls
  • GI problems
  • Nutritional deficiencies
  • Delirium during hospitalization
  • CA of the head, neck, esophagus, and liver are
    associated with chronic alcohol abuse