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Community Resources for Care of the

Older Adult

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Multipurpose Senior Centers community facilities that are primarily

used by relatively active and independent adults

Services:

health screeninghealth promotion and wellness programs

social, educational and recreational activities

congregate meals

information and referral services for older adults

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Adult Day Care Services: for older adults who are

physically frail, cognitively impaired, and require

assistance or supervision with ADLs.

Respite Care: provides short relief or time off for personsproviding home care to ill, disabled or frail older adult.

Homemaker Services: include such things as

housecleaning, laundry, food shopping, meal preparationand running errands.

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Nutrition Services: provide older adults with inexpensive,

nutritious meals at home or in group settings. Home

delivery programs such as Meals on Wheels and

Congregate meal sites.

Transportation Services: handled by volunteer drivers in

cars, bus, taxi or public van equipped to accommodate

wheelchairs.

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Telephone Monitoring and Friendly Visitors: provide

regular phone contact, check the safety and health of

older adults who live alone. Friendly Visitors make home

visits for the purpose of companionship, assistance with

correspondence, and needs assessment.

Personal Emergency Response Systems: are home

monitoring systems that allow older persons to obtain

immediate assistance in emergent situations such as

after a fall.

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Home Health Care

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Criteria:

Have a skilled care need

Be homebound

Unable to perform the skilled care aloneand have no one at home to provide care

Require only intermittent care

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Appropriate for those:

with chronic medical conditions

with chronic mental illness

needs continued treatment after discharge

from hospital

have terminal illness and want to die with

dignity in the comforts of their own home

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Benefits:

Less expensive than hospitalization

Faster recovery

Nosocomial infections are minimized

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End of Life Care of the Older

Adult

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End of Life

The time period preceding an

individuals natural death from a

process that is unlikely to be arrested

by medical care.

Begins six months before death

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Models of Care at End

of Life

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Hospice Care

Interdisciplinary model of care thatsurrounds and supports the patient,

the family, and significant others

through the final phase of a life

threatening illness

Criteria for Hospice:

A prognosis of 6 months or less based

on the clinical judgment of two

physicians.

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Comfort Measures Only

(CMO)

Preferred choice when the

patient,family and staff are in

agreement that the best care

for the patient is not to

prolong the dying process but

to keep the patient as

comfortable as possible.

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Palliative Care

Care of individuals with life

threatening illness that is not

limited to the 6 month window

period.

Include potentially curative

treatments as well as supportiveinterventions of Hospice Care.

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Main Approach

Management of pain and distressingsymptoms like nausea, bowel

function, sleep and nutrition

Multi disciplinary Team approach

with MD, RN, Social workers,

Nutritionist, Pharmacists, Chaplains

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Stages of the Dying Process

Denial: They must have the wrongpatient or lab result.

Anger: I cant believe this, I always took

care of others and this is my reward?

Why not someone else instead of me?

Bargaining: Ok doctor, I will give

chemotherapy another try if you can

guarantee that I will live another year.

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Stages of the Dying Process

Depression: Why should I bother taking

my medicines? Im helpless to fight

cancer. Its stronger than me.

Acceptance: Ok Im going to die so Id

better get my act together.Id like to

leave a few pieces of jewelries to mydaughter and books to my son.

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Phases of Grief

First Phase (Numb Shock): stupor,

withdrawal, nausea, insomnia

Second Phase (Emotional Turmoil) : alarm

or panic type reaction

Third Phase (Full effect of widowhood sets

in): regret, self doubt, despair, lifes purpose

is confusing

Fourth Phase (Reorganization): coping

strategies and positive outlook emerges

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Ethical Considerations

Ethics is the reflective, deliberative

process of examining our values and

beliefs and choosing a course of action

that upholds those values.

Nursing Ethics is a systematic analysis of

ethical issues emanating from nursingpractice , education and research.

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Moral PrinciplesApplicable to Care of

Older Adults

h i h Q li l h Old

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The Right to Quality Health Care: Older

adults have a right to the same standards

of health care as those in any other age

group.

Respect for the Individual Person:

Treating older adults with quality healthcare that is specifically designed to meet

their particular needs.

Autonomy or Self Determnination: Older

persons will be respected as decison

makers about their own care.

C fid i li Old d l b bl

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Confidentiality: Older adult must be able

to control his or her personal information.

Beneficence: Deciding with the patient

and the family what is most bebeficial

given the particular circumstances andfacilitating that action.

Distributive Justice: Equal satisfaction ofequal need, subject to the adequate

maintenance of useful functions.

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Common Ethical Dilemma in

Gerontological Nursing

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1. Decisional Capacity

Four Elements:Comprehension of information

presented

Understanding the options and their

possible consequence

Deliberating among the choices

consistent with own values and

beliefsCommunicating a choice

P i i l f D i M ki

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Principles of Decison Making

1. Substituted Judgment: family members

respect the patients wishes by makingdecisions in accordance with the patients

general values and past choices.

2. Best Interest:directs the surrogate to

decide what seems optimal for the

patients good when specific wishes are

unknown.

2 End of Life Issues

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2. End of Life Issues

A. Witholding or Withdrawing Treatment

Withdrawing life sustaining treatment hasbeen legally acceptable provided there is clear

and convincing evidence of the patients wishes to

avoid prolonging the dying process.

B. Assited Suicide

Oregon is the only state in which physician

assisted suicide is legal. The ANA has a position

statment recommending that nurses not

participate in assisted suicide.

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C. Euthanasia

An action taken to terminate someones lifeis currently considered legally and ethically

unacceptable.

Objections:

1. Termination of anothers life is homicide.

2. Deciding for others that their life is no longer of

value is difficult.

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3. Rationing of Services: Older adults are often not

offered the standard level of care because of

inherent bias.

4.Rights of Institutionalized Patients :Older adults

in LTC facilities experienced diminished choice,

control, dignity and privacy in institutionalized

setting.

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5. Cognitive Impairment :Persons with dementiahave a right to know their diagnosis

6. Research in Older Adults : Only research that

offers minimal risk or direct benefit should be

offered to the older adult specially those with

Cognitive Impairment.

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Specific Techniques to

Promote Ethical Decision

Making

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Values History

A form wherein the older adult identifies his values and

beliefs and then determine preferences about whether theywould want various health care procedures.

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Patient Self Determination Legislation (December 1991)

Encourage people to make and document their choices and decisions

about the type and extent of medical care they want to accept or

refuse should they become unable to make their wishes known.

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Advance Directives

Allows individuals to designate their wishes in writing so that they are

available in case they become unable to to express themselves ordveloped diminished decision making capacity.

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A. Durable Power of Attorney for Health Care

A document that is executed by competent individual s to describe their

desires regarding death delaying procedures . It also designates another

person as the individuals agent or designee to make health care

decisions for themselves (Health Care Proxy)

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B. Living Will

Oldest and most common form of advance directive

A document in which living individuals can stipulate what their wishes

are regarding life prolonging treatment or procedures if they develop

a terminal condition.

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C. Five Wishes

A unique document which provides information such as choosing a

health care agent but also asks questions to elicit the persons values

and wishes.

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C. Five Wishes

The person I want to make care deccisons for me when I cant

The kind of medical treatment I want or dont wantHow comfortable I want to be

How I want people to treat me

What I want my loved ones to know

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Ethics Committee

Mandated by JCAHO functions are generally education, policy

development, consultation or case review.

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Legal Issues

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Legal Guardianship: mechanism that allows a surrogate to exercise

individual rights for the older person who is no longer mentally

competent.

Payee Status: allows another to cash the older persons Social Security

Check.

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Elder Abuse: All states have mandatory reporting laws for suspected

abuse of the older persons in domestic and institutinal setting.

Restraint Use: Strategies for environmental modification and supervision

reduce the need for the use of restraints.

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thank you forlistening!