Process

OUR LADY OF FATIMA UNIVERSITY

QUEZON CITY

Timeline

NCMA 314 LECTURE & RLE

CARE FOR Step Three

OLDER ADULTS
Step Four

Step Six

Rose Ann C. Lacuarin

ACADEMICIAN HEAD

 Process
OUR LADY OF FATIMA UNIVERSITY
QUEZON CITY

Timeline
WEEK 15

Advocacy Programs Relevant

to the Care of Older Persons
WEEK 13

Research Agenda on Aging

MUSCULOSKELETAL

WEEK 16

Telehealth and the Older

Person

WEEK 14

Trends / Issues and Challenges

on the Care of the Older Persons
Gastritis, GERD, Constipation,
Cirrhosis, Pancreatitis

WEEK 17

Entrepreneural Opportunities

Rose Ann C. Lacuarin

ACADEMICIAN HEAD

 Week 13:
Research Agenda (Lecture)
OLDER ADULT Adequate healthcare services for the
Research Age
elderly may simply be beyond the reach of
Young Old - 60-74 many Asian countries
Middle Old - 75-84 They may not be able to afford a large
Old Old - 85 & older dependent elderly population.
Presently: 12.8% of population They might not have the necessary
2030: will increase to 20% of population institutions & financial systems in place
(e.g., efficient and well-managed pension
and healthcare programs)

FUTURE OLD - BABY BOOMERS

Born between 1946 and 1964

High-tech orientation
Most have children, but low birth rate
The Graying of America means fewer biologic children to
Percent of Total U.S. Population over assist them in old age
65 in 2030 Their income tends to be higher than
other groups
DEMOGRAPHICS OF AGING
Their leisure time is scarcer than
In 2005, 13% of the U.S. pop. was over other adults; they are more likely to
age 60 feel stressed
18.3 million aged 65–74 They exercise more frequently than
12.9 million aged 75–84 other adults
4.7% aged 85 or older Healthier old age attainable for baby-
boomers
This number is estimated to increase: Informed and educated
To 20 million in 2010 (6.8% of total), They are the best-educated
To 33 million in 2030 (9.2%), and generation ever
To almost 50 million in 2050 (11.6%) Toughest challenge for healthcare
(National Center for Health Statistics b/c look everything up on the internet
[NCHS], 2006). and come in “knowing” their
condition
By mid-21st century, old people will Have to help them sort out what is
outnumber young for the first time in right for them
history

ALL NATIONS HAVE AN AGING Predictions for baby-boomers

POPULATION They will have a highly active role in
their health care
The greatest increases will be in Their ability to access information
developing countries will keep them informed
Asian countries have less time to prepare They will not be satisfied with the
for aging -because aging is occurring conditions of today’s nursing
more rapidly than economic growth. homes

Rose Ann C. Lacuarin

ACADEMICIAN HEAD

 Research Agenda (Lecture)

Current nursing homes will not work for B. International: UN Program
this generation on Aging UN Programme on
Their blended families may need Ageing 
special assistance with caregiving
demands
Coordinating care with family members 1. (DISD Division for Inclusive Social
will pose problem as family is typically Development )
spread throughout country 2. (UNDESA United Nations Department of
Economic and Social Affairs).
A. National: NIH Publication 2030 The 2030 Agenda for Sustainable
Problems on Caring for Aging Baby Development and Older Persons
Boomers Preparing for an ageing population, vital
to the achievement of the integrated
Research study to Assess the coming 2030 Agenda, with ageing cutting across
challenges of caring for large numbers the goals on poverty eradication, good
of frail elderly as the Baby Boom health, gender equality, economic growth
generation ages. and decent work, reduced inequalities
and sustainable cities.
Study Design
1) measures of macroeconomic burden
are developed and analyzed. Older persons making key contributions in
the following interrelated areas:
2) the literatures on trends in disability,
payment approaches for long-term care, 1. Economic development
healthy aging, and cultural views of aging 2. Unpaid care work
are analyzed and synthesized, and 3. Political participation
4. Social capital
3.simulations of future income and assets
patterns of the Baby Boom generation are
developed

PRINCIPAL FINDINGS

The real challenges of caring for the elderly in

2030 will involve:
(1) making sure society develops payment and
insurance systems for long-term care that work
better than existing ones,
(2) taking advantage of advances in medicine
and behavioral health to keep the elderly as
healthy and active as possible,
(3) changing the way society organizes
community services so that care is more
accessible, and
(4) altering the cultural view of aging to make
sure all ages are integrated into the fabric of
community life.

Rose Ann C. Lacuarin

ACADEMICIAN HEAD

 Musculoskeletal (RLE)

Effects of Aging in Bones Process RISK FACTORS

Timeline
Environmental factors such as
pollution Smoking
ARTHRITIS
Family history of first-degree
Osteoarthritis relatives and illnesses such as
Degenerative joint disease involve bacterial and viral illnesses.
joint cartilage osteophytes/spurs Cigarette smoking is one of
1. Advanced age, Degenerative Joint modifiable risk factor that has been
disease shown to be highly related to
2. Previous joint damage rheumatoid arthritis (Carter et al,
3. Obesity 2015).
4. Wear and tear- of JOINT
CARTILAGE
5. Weightbearing joints- KNEE,
Lumbar, CERVICAL

SIGNS & SYMPTOMS

Pain, assymetrical, non systemic,

localized
Stiffness of joints <30mins in A.M MANAGEMENT
Heberden’s and Bouchard’s nodes
NSAIDS reduce inflammation
Methotrexate
Antimalarials
Gold therapy
Steroid
Nutritional therapy

NURSING MANAGEMENT

MANAGEMENT Splints to immobilize affected

extremity
Weight reduction
COLD packs - acute phase of pain
Topical analgesics
HEAT application - inflammation
Intra-articular steroids
subsides
PARACETAMOL, NSAIDS
Client education- remission.
NSAID
*COX 2 INHIBITORS Exacerbation
Celecoxib (Celebrex) Nutrition treatment
Etoricoxib (Arcoxia)

RHEUMATOID ARTHRITIS GOUT

Is an autoimmune disease of unknown Gout is the most common form

origin that affects 1% of the population of inflammatory arthritis.
worldwide, with females having a 2.5
times greater incidence than males.

Rose Ann C. Lacuarin

ACADEMICIAN HEAD

 Musculoskeletal (RLE)
Evidence links the consumption of
Process
fructose-rich beverages with the risk of
OSTEOPOROSIS

The prevalence of osteoporosis in

Timeline
gout for both men and women
(CDC, 2015b). women older than 80 years is
Patients with gout have an 50%.average 75-year-old woman has
The
increased risk of cardiovascular lost 25% of her cortical bone and 40%
disease. Comorbid conditions such of her trabecular bone.
as hypertension, dyslipidemia, Most residents of long-term care
diabetes, and kidney disease may be WEEK 15have a low bone mineral
facilities
present in patients with gout density (BMD) and are at risk for
(Papadakis et al., 2015). bone fracture.
Given that the incidence of gout One third of all hip fractures occur
increases with age, its management among men, and men have a higher
can be complicated by other medical mortality rate than women after
conditions, and age-related changes sustaining a hip fracture (NPS
(Carter et al., 2015). Medicinewise, 2015).

ASSESSMENT
Low stature
1. Colchicine
Fracture
Decrease inflammation used Bone pain
acute attack DIAGNOSIS
2. Allopurinol 1. DEXA-scan
2. Detects bone mass density
Blocks formation of Uric Acid 3. X-ray studies- fracture
Inhibits xanthine oxidase
MEDICAL MANAGEMENT

3. Probenecid 1. Diet therapy

2. Drugs
enhance excretion of Uric Acid 3. Bisphosphonates
Ibandronate
DIET-FOOD TO AVOID SE: esophageal ulcers
Take- empty stomach in am, full glass H20
Foods high in PURINE Sit upright 30 mins after intake
Alcohol, Anchovies
Shellfish NURSING INTERVENTION
Organ meats Prevent injury
Isometric exercise to strengthen trunk
muscles
AVOID bending, strenuous lifting

Rose Ann C. Lacuarin

ACADEMICIAN HEAD

 Week 14:
Process
Trends / Issues and Challenges on the Care of the Older Persons

Timeline
Hold a master’s or higher degree in
EDUCATIONAL TRENDS IN
nursing.
GERONTOLOGICAL NURSING
Have been prepared as a nurse
--> Opportunities in gerontological nursing are practitioner in either of
somewhat correlated with education level. the following:
--> Many levels of preparation are available for WEEK
A GNP 15master’s degree in Program
nurses in gerontology such as: A formal postgraduate GNP track or
Special education in caring for adults program Within a school of nursing
during basic preparation (LPN, RN granting graduate-level academic
associate degree, diploma RN, or RN BSN credit
level. CLINICAL SPECIALIST IN
Post baccalaureate nurses choose a Clinical GERONTOLOGICAL NURSING
Nurse Specialist (CNS) or Geriatric Nurse The nurse must meet all the following
Practitioner (GNP) requirements:
Online programs for graduate or post- Currently hold an active RN license in the
master’s study and complete clinical hours in United States or its territories
their own geographic location Hold a master’s or higher degree in
Certifications in gerontology currently gerontologic nursing
available from the American Association of Hold a master’s or higher degree in
Colleges of Nursing (AACN) nursing with a specialization in
Working in long-term care facilities such as gerontologic nursing.
nursing homes, assisted living, independent Have practiced a minimum of 12 months
living centers, or adult day care, or in an acute after completion of the master’s degree
care hospital.
Meet the following requirements in
GERONTOLOGIC NURSE current practice:
The nurse must meet all of the following If a clinical specialist must have
requirements: provided a minimum of 800 hours (
Currently hold an active post-master’s) of direct client care or
Registered Nurse license in US or its territories clinical management in Gerontologic
Hold a baccalaureate or higher degree in Nursing within the past 24 months
nursing If a consultant, researcher, educator, or
Have practiced 2000 hours within past 3 years administrator, must have provided a
Have had 30 contact hours of continuing minimum of 400 hours
education applicable
LIFE CARE PLANNING
gerontology/gerontological nursing within the
past 3 years
The concept of life care planning was
GERONTOLOGIC NURSE first developed in the 1980s, to meet a
growing need for an informed
The nurse must meet the following document that presented actual
requirements: estimated costs of care for persons who
Currently hold an active RN license in the had experienced a catastrophic injury or
US or its territories accident.

Rose Ann C. Lacuarin

ACADEMICIAN HEAD

Trends / Issues and Challenges on the Care of the Older Persons

Process
Many settlements for those persons in
devastating accidents were made arbitrarily
The principles of life care planning
could also easily be extrapolated for use

Timeline
without actual calculation and with those seniors who have long-term
consideration of the multitudes of factors chronic health problems. A good
influencing these costs, such as doctors’ financial planner could provide a more
visits, equipment, medications, tests, cost of accurate and detailed projection of
caregiving, and potential complications over health care cost over a lifetime of
a lifetime.LCP is a comprehensive WEEK 15 or illness. The demand for
disability
document designed to help meet the long- professionals in gerontology and
term financial and health needs of a person rehabilitation is likely to grow quickly
experienced catastrophic injury. Life care with the aging baby boomer group.
planners generally develop plans for Gerontological nurses combine their
insurance companies or awyers knowledge in health care with some
representing individual clients, but the financial training to offer distinctive
ultimate goal is to promote the best services to the older age group.
outcome for the person for whom the life
care plan was written. FINANCIAL GERONTOLOGY

Financial gerontology is a growing

The best life care planners have a nearly
subfield of financial planning. FG is
equal mix between work for insurance
defined as “ the intellectual intersection
carriers and work for lawyers who present
of two fields, gerontology and finance,
patients, thus maintaining a neutral and
each of which has practitioner and
professional reputation for fairness.
academic components” which combines
CERTIFICATION the knowledge and skills associated
with financial planning and asset
The Certified Life Care Planner (CLCP) management with expertise in meeting
designation may be earned through 128 the unique needs of older adults.
continuing education hours, successful Certification for FG
completion of a sample life care plan, and
CHARTERED ADVISOR FOR SENIOR
passing an examination (MediPro
LIVING (CASL)
Seminars, 2004). The CNLCP (Certified
Nurse Life Care Planner) designation is A person with CASL certification assists
offered by the American Association of older persons with retirement savings,
Nurse Life Care Planners Certification pension and social security planning,
Board. It is similar to CLCP, but with health and long-term issues, estate
additional requirements, and is definitely planning and managing life course
designed for registered nurses with case transitions, family relationship and living
management experience. arrangement. A person must complete
five courses that take approximately 60-
FUTURE POTENTIAL 80 hours of study each. After the course
Life care planner may be a concept that the individual must pass a computerized
will be carried into the senior population. exam. Maintenance of the certification
Not only are seniors living longer, but they with continuing education credits. A
continue participating in higher risk code of ethics must also be agreed to in
activities today than in generations past writing prior to being granted the
designation.

Rose Ann C. Lacuarin

ACADEMICIAN HEAD

Trends / Issues and Challenges on the Care of the Older Persons

REGISTERED FINANCIAL TRENDS IN LONG-TERM CARE

GERONTOLOGIST (RFG)
The RFG certifications a similar Long-term care is the “broad range of
designation to the CASL, but is medical, custodial, social, and other care
offered through the American services that assist people who have an
Institute of financial Gerontology and impaired ability to live independently for
supported by the American Society an extended period”. The National
WEEK 15aging estimates that 6.4
Council on
on Aging. The Individual must
complete six courses, a learning million people all over the age of 65 and
requirement, and a comprehensive 50% of those over age 85 will need long-
examination. Course content is term care.
related to wealth span planning, Thirteen million persons in United States
ethics, and serving the older adult. currently report having long-term health
Compared to CASL courses, the needs. This number is expected to grow
curriculum appears more suited to to 22 million in the next decades. The
gerontologist than financial planners. nation spent $ 183 billion on long-term
care services in 2003 (American Health
CERTIFIED SENIOR ADVISOR (CSA) Care Association & National Center for
Assisted Living, 2005).
The CSA is a designation offered by In 2005, Medicaid spent nearly $95
the society of Senior Advisors. The billion on long-term care. Persons must
curriculum includes a large number pay for many long-term care expenses
of topics in aging, chronic illness, end from their savings and assets before
of life, and long-term care as well as being eligible for Medicaid. This has
Medicaid and financial planning. It is prompted new sources of funding for
self-study program that takes 2-6 future long-term health care needs.
months to complete. To obtain the
CSA, the person must also pass a LONG-TERM CARE INSURANCE
secured, computerized, final
Long –term care insurance is designed
comprehensive examination online
to cover individuals needing health care
that consists of 150 multiple choice
outside of the hospital, including
questions within 3 hours.
diagnostics testing, rehabilitation, and
custodial care. Reasons for purchasing
Recent trends in health promotion & disease long-term care insurance include
prevention activities, such as: worrying about being a burden to their
family, staying financially independent,
Improved nutrition,
having more choices for care if needed(
Decreased smoking,
such as remaining in the home),
Increased exercise, and
preserving their assets, and providing
Early detection & treatment of
peace of mind.
risk factors such as hypertension Adult day care
& elevated serum cholesterol Nursing Home care Respite
levels. Assisted living Caregiver training
Hospice Home health care
Home health coordinators

Rose Ann C. Lacuarin

ACADEMICIAN HEAD

Trends / Issues and Challenges on the Care of the Older Persons

EMERGING MODELS OF CARE GERIATRIC CARE MANAGEMENT

A Shift to Different Living Facilities Another emerging trend in

One of most significant changes in care gerontological nursing is the role of the
for older adults is the shift away from geriatric care manager.
nursing homes. As they have known The professional geriatric care manager
traditionally. (PGCM) is a specialist who helps families
Some predict that the only nursing WEEK 15older adults while encouraging
care for
homes that will survive will be excellent as much independence as possible.
ones. The institutional look of the older PGCMs may come from a variety of
nursing home that was modeled after backgrounds such as social work,
the hospital, with long hallways and a psychology.
sterile-looking environment, is Sociology, geriatrics, and nursing,
becoming unacceptable to many older nurses have emerged as natural leaders
adults as a place to live out their final in this growing field.
days. The educational background knowledge
Newer long-term care facilities promote of the aging process make this role an
private rooms, residents’ choices and excellent fit for nurses who seek a
control, and a more home-like position that affords independence and
environment that mirrors assisted living autonomy while using their skills.
facilities of today.
PGCM perform the following
CONTINUING CARE RETIREMENT
1. Conduct assessments
COMMUNITIES (CCRCs)
2. Develop care plans that address
Growing trend for older adults, services by pertinent problems
promoting aging in place through offering 3. Arrange, interview for, and monitor
various levels of care on a continuum that in-home caregivers or other services
might include independent living, assisted 4. Act as a consultant for caregivers
living, skilled care, and home health who live near or far
services all on one campus. The trend will 5. Review financial, health-related, or
be to bring services to the CCRCs versus legal issues
transferring persons to the next level of 6. Provide referrals to other geriatrics
care on the continuum (for example, specialists
sending them to the “nursing home” when 7. Intervene in times of crisis
their care demands increased). 8. Act as an advocate and/ or liaison
between families and service
GREEN HOUSES providers
9. Coordinate or oversee care
A movement to replace nursing homes with
10. Assist with transitions in living
more home-like environments, started through
arrangements, including
the vision of a physician named Bill Thomas,
recommending the most appropriate
consist of 10-12 residents in a home setting
settings and helping facilitate the
who enjoy private rooms and share a common
move
living space. This designed provide a full range
of care services, but in a friendly atmosphere
that reminds one of home.

Rose Ann C. Lacuarin

ACADEMICIAN HEAD

Trends / Issues and Challenges on the Care of the Older Persons

11. Provide education and links to
resources Process Gastritis, GERD, Constipation, Cirrhosis,
Pancreatitis

Timeline
12. Offer counseling and support
13. Some PGCMs also offer
guardianship, caregiving, and /or GASTRITIS
financial services.
Inflammation of the gastric mucosa is a
COMMUNITY LIVING DESIGNS common15
WEEK GI problem, accounting for
approximately 2 million
Another fascinating trend related to Visits to outpatient clinics annually in US
gerontological (Wehbi, Yang, Sarver et al., 2014). It
Nursing is the emergence of companies affects women and
completely devoted to the strategic Men about equally and is more common
planning,engineering, architecture, in older adults. Gastritis may be acute,
building, and marketing of community lasting several hours
living designs that are tailored to To a few days, or chronic, resulting from
today’s older adults. Older adults who repeated exposure to irritating agents or
choose to live in senior communities recurring episodes of acute gastritis.
expect to have access to transportation
MEDICATIONS
and needed services such as health
care, appropriate housing, and 1.Antacids
opportunities for socialization. Baby Neutralize stomach acid- Maalox
boomers are predicted to live in 2. Histamine H2 receptor antagonists
suburban communities versus urban or Decreases gastric acid Ranitidine
rural areas (Frey 2007), so the need for (Zantac)
age-appropriate and friendly retirement 3.Proton pump inhibitors(PPI)
communities is projected to increase. Nexium (Esomeprazole)
Lehning,Chun, and Scharlach (2007)
stated that: PREDISPOSING FACTORS
An aging –friendly community has Stress, smoking
three primary characteristics: Corticosteroids,
1) age is not a significant barrier to Alcohol, Aspirin
the maintenance of life-long interests NSAIDS
and activities;
2) supports and accommodations GERD
exist to enable individuals with age- Gastroesophageal reflux disease is a
related disabilities to meet basic fairly common disorder marked by
health and social needs; and backflow of gastric or duodenal
3) opportunities exist for older adults contents into the esophagus that causes
to develop new sources of fulfillment troublesome symptoms and/or mucosal
and engagement. injury to the esophagus.
Excessive reflux may occur because of
an incompetent lower esophageal
sphincter, pyloric stenosis, hiatal hernia,
or a motility disorder.

Rose Ann C. Lacuarin

ACADEMICIAN HEAD

Gastritis, GERD, Constipation, Cirrhosis, Pancreatitis (RLE)

The incidence of GERD seems to increase
with aging and is seen in patients with
irritable bowel syndrome and obstructive
airways disorders (asthma, COPD, cystic
fibrosis) (Robinson & DiMango, 2014),
Barrett esophagus, peptic ulcer disease,
and angina. GERD is associated with
tobacco use, coffee drinking, alcohol
consumption, and gastric consumption Esophageal varices
with Helicobacter pylori.
1. Dilated & tortous veins in submucosa
RISK FACTORS of esophagus
2. Cause: portal HPN,
1. SMOKING
3. Associated w/ liver cirrhosis
2. CAFFEINE
3. ALCOHOL Esophageal tamponade / balloon
4. INCREASED INTRAGASTRIC tamponade
PRESSURE Sengstaken- Blakemore or Minnesota
5. FATTY FOODS tubes
Monitor - respiratory distress
MEDICATIONS
INTERVENTIONS
1.Antacids
neutralize stomach acid- Maalox
1. VS ,LOC, NPO, NGT
2. H2 receptor blocker
2. O2, Blood Transfusion
gastric acid Ranitidine (Zantac) 3. Vasopressin iv- lowers pressure
3.Proton pump inhibitor(PPI) 4. Propranolol (Inderal)- reduces portal
Nexium (Esomeprazole) pressure

CIRRHOSIS ASCITES

Cirrhosis is a chronic disease Accumulation of plasma- rich fluid

characterized by replacement of w/n peritoneal cavity oncotic
normal liver tissue with diffuse pressure
fibrosis Cirrhosis – most common cause
That disrupts the structure and
function of the liver. The three types
of cirrhosis or scarring of the liver
Is alcoholic cirrhosis, post-necrotic
cirrhosis, and biliary cirrhosis. The
liver attempts to form new bile
Channels, hence there is an
overgrowth of tissue made up largely
of disconnected, newly formed
Bile ducts and surrounded by scar
tissue.

Rose Ann C. Lacuarin

ACADEMICIAN HEAD

 Gastritis, GERD, Constipation, Cirrhosis, Pancreatitis (RLE)

THERAPEUTICS SURGICAL MANAGEMENT

Diuretics Choledochostomy
Measure abdominal girth, weigh pt Incission to common duct for
Paracentesis removal of stones
Low salt diet

HEPATIC ENCEPHALOPATHY

INCREASE AMMONIA
Liver cannot convert ammonia to urea
BEHAVIORAL changes
Asterixis – flapping tremors of the hands
Fetor hepaticus – musty odor breath
POST OPERATION
MANAGEMENT
Care of T-Tube
Assess neuro status, vs, hand Semi-fowlers
writing, weight Avoid irrigation, clamping of T- tube
Diet: use of vegetable CHON
Meds: Neomycin , metronidazole,
lactulose PANCREATITIS

Acute pancreatitis affects people of all

CHOLELITHIASIS
ages, but the mortality rate associated
with acute pancreatitis with advancing
age (Wu & Banks, 2013). In addition,
the pattern of complications changes
with age.
Younger patients tend to develop local
complications; the incidence of multiple
organs dysfunction syndrome (MODS)
increases with age, possibly as a result
of progressive decreases in physiologic
RISK FACTORS function of major organs with
increasing age.
Cystic Fibrosis Close monitoring of major organ
Obesity, rapid wt loss function is essential, and aggressive
Low dose Estrogen therapy treatment is necessary to reduce
Ileal resection mortality from acute pancreatitis in the
older adult patient.
SIGNS & SYMPTOMS
CAUSES
Bleeding
Clay colored feces
Alcoholism
Dark orange urine
Biliary tract disease
Morphine
Unknown
Preferred analgesic agent for mgt of
acute pain
Rose Ann C. Lacuarin
ACADEMICIAN HEAD

 Gastritis, GERD, Constipation, Cirrhosis, Pancreatitis (RLE)

PAIN Some older adults reduce their fluid intake

if they are not eating regular meals.
Epigastric , radiates to back Depression, weakness, and prolonged bed
Improves - fetal position rest also contribute to constipation by
SIGNS & SYMPTOMS decreasing intestinal motility and anal
sphincter tone.
Grey Turner’s spots Nerve impulses are dulled, and there is a
ecchymoses flanks decreased urge to defecate. Many older
Cullen’s sign people overuse laxatives in an attempt to
ecchymoses periumbilical area have a daily bowel movement and become
dependent on them.
PAIN RELIEF Chronic constipation profoundly impairs
quality of life comparable to other
Parenteral opiod
conditions such as diabetes, rheumatoid
Morphine
arthritis, and osteoarthritis (Bailes & Reeve,
NI
2013;Eliopolous, 2018)
NPO; NGT

CONSTIPATION

Visits to primary providers for treatment

of constipation are most common in
people 65 years and older. The most
common complaint they voice is the need
to strain at stool.

The aging processinevitably generates

changes in the colon; but the extent and
physiologic implications for defecation
remain unclear. People who have loose-
fitting dentures or have lost their teeth
have difficulty chewing and frequently
choose soft, processed foods that are
low in fiber.

Older adults tend to havedecreased food

intake, reduced mobility, and weak
abdominal and pelvic muscles, and they
are more likely to have multiple chronic
illnesses requiring multiple medications
(polypharmacy) that often cause
constipation.

Low-fiber convenience foods are widely

used by people who have lost interest in
eating.

Rose Ann C. Lacuarin

ACADEMICIAN HEAD

 Week 15:
Advocacy Programs Relevant to the Care of Older Persons
Who can access advocacy services?
Advocacy Programs Relevant to the
Care of Older Persons Anyone who is receiving or seeking to
receive government-funded aged care
The role of an advocate in health and services, including family and
social care is to support a vulnerable representatives, are entitled to access
or disadvantaged person and ensure advocacy services. This includes people
that their rights are being upheld in a who:
healthcare context.
Live in an aged care home
Health and social care advocacy means
Receive aged care services in their
supporting people who are unable to
own home
ensure their best interests are being
Receive transition care
taken care of.
Are helping someone who is
In the medical profession, activities
receiving aged care services.
related to ensuring access to care,
navigating the system, mobilizing LEGAL ADVOCACY
resources, addressing health inequities,
influencing health policy and creating Is a recognized strategy to address
system change are known as health social factors that influence the
advocacy. health of populations with complex
care needs. Such advocacy can
improve housing stability, increase
ADVOCACY SERVICES
access to public benefits that
--> Advocacy services support the rights support a host of social needs, assure
of anyone receiving or seeking to that medical and financial proxy
receive aged care services, and empower decision makers are in place, and
older people to make informed reduce psychosocial distress.
decisions about their care. An aged
Older adults are disproportionately
care advocate can assist things like:
likely to have complex medical needs.
Legal advocacy has been recognized
Interacting with the aged care system
as integral to the health and health
Transitioning between aged care services
care of older adults in the medical
Knowing and understanding their rights
Making decisions about the care they literature since 1988, and in current
receive Medicare quality metrics.
Options for having their aged care needs Yet, while emerging care models for
better met older adults with complex needs are
Resolving concerns or complaints with highly multidisciplinary, none
the aged care provider about the incorporate legal advocacy in their
services they receive design.
Speaking with their service provider at their Legal advocates are focused on
direction emergency legal needs such as loss
Increasing their skills and knowledge to of housing, neglect and exploitation,
advocate for them self. and loss of public benefits.

Rose Ann C. Lacuarin

ACADEMICIAN HEAD

Advocacy Programs Relevant to the Care of Older Persons

HEALTHY PEOPLE INITIATIVES Healthy People 2020 set overarching
goals to:
The federal government has been
establishing goals for healthy aging since Attain high-quality, longer lives
1980 when the U.S. Public Health free of preventable disease,
Service published the report disability, injury, and premature
Promoting Health/ Preventing Disease. death
Achieve health equity, eliminate
Objectives for the Nation. This 1980
disparities, and improve the health
report outlined 226 objectives for the
of all groups
nation to achieve over the following 10
Create social and physical
years. It was referred to by some as
environments that promote good
Healthy People 1990.
health for all
Promote quality of life, healthy
HEALTHY PEOPLE 2020
development, and healthy
Healthy People 2020 was the fourth behaviors across all life stages.
iteration of the Healthy People
Healthy People 2020 Law and
initiative. Launched in
Health Policy
December 2010, Healthy People
2020 set an ambitious yet The Healthy People 2020 Law
achievable 10-year agenda for and Health Policy project aimed
improving the nation’s health. to raise awareness of the impact
that legal or policy interventions
The vision for Healthy People 2020
can have on public health. The
was “a society in
project was a partnership between
which all people live long, healthy
ODPHP, CDC, the CDC Foundation,
lives.”
and the Robert Wood Johnson
Foundation.
Its mission was to:
Advancing Public Health Through
Identify nationwide health improvement
Law and Policy
priorities
Increase public awareness and
Law and policy are among the
understanding of the determinants of
most effective tools to improve
health, disease, and disability and the
health. Many of the greatest
opportunities for progress
public health successes in the
Provide measurable objectives and goals
United States are the result of legal
that are applicable at the national, state,
or policy interventions, such as
and local levels
smoke-free air laws and
Engage multiple sectors to take actions
mandatory seatbelt laws.
to strengthen policies and improve
Yet many people may not be
practices that are driven by the best
aware of the precise impact these
available evidence and knowledge
interventions and approaches can
Identify critical research, evaluation, and
have on population health.
data collection needs

Rose Ann C. Lacuarin

ACADEMICIAN HEAD

Advocacy Programs Relevant to the Care of Older Persons

LAW AND HEALTH POLICY 6 MODEL HEALTH PROMOTION

RESOURCES PROGRAMS
Project partners worked with subject
matter experts and federal 1. HEALTHWISE
stakeholders to develop a series of
Healthy People 2020 topic-specific The best-known older adult medical
reports, webinars, and other self-care program is Healthwise. It
evidence-based products such as provides information and prevention
infographics and success stories, or tips on 190 common health problems,
Bright Spots. with information periodically
updated.
These resources and publications
highlight laws and policies with the The Healthwise Handbook
potential to impact specific Healthy (Healthwise,2006)is now in its 17th
People 2020 topic areas and objectives, edition. This handbook includes
including Leading Health Indicators. physician-approved guidelines on
Review different resources produced by when to call a health professional for
the Law and Health Policy project: each of the health problems its cover.

Disability and Health 2, CHRONIC DISEASE MANAGEMENT

Healthcare-Associated Infections
Kate Lorig, a nurse-researcher at the
Health Equity
Standford University School of Medicine.
Healthy People 2030
This program has since evolved into a
Leading Health Indicators
curriculum that is applicable to a wide
Maternal, Infant, and Child Health
array of chronic diseases and conditions.
Mental Health and Mental Disorders
The program consists of six weekly
Nutrition and Weight Status
sessions about 2 ½ hours long each,
Oral Health
with a content focus on exercise,
Policy Levers
symptom management, nutrition,
Substance Abuse
fatigue and sleep management, use of
Model Health Promotion medications, managing emotions,
Programs for Older Adults community resources, communicating
One of the more recent efforts in with health professionals, problem
this regard has been organized by solving, and decision making. The
the Health Promotion Institute (HPI) program takes place in community
of the National Council in Aging. settings such as seniors centers,
HPI started by summarizing 16 churches, and hospitals.
model programs or best practices and The theoretical basis of the program has
compiling them into a loose-leaf been to promote a sense of personal
directory. The summarizes included
efficacy among participants by using
information on the planning process,
such techniques as guided mastery of
implementation of the program, and
skills, peer modeling,
program evaluations.

Rose Ann C. Lacuarin

ACADEMICIAN HEAD

Advocacy Programs Relevant to the Care of Older Persons

reinterpretation of symptoms, social
Dr. Ornish and his colleagues have
persuasion through group support, and
reported that as a result of their program,
individual self-managemant guidance.
blockages in arteries have decreased in
3. PROJECT ENHANCE size, and blood flow has improved in
as many as 82% of their heart
Senior Services of Seattle/King County patients( Gould et al.,1995). A five
began the Senior Wellness Project (later year follow-up of this program
renamed Project Enhance) in 1997 at the reported an 8% reduction in
North Shore Senior Center in Bothell, atherosclerotic plaques, while the control
Washington. group had a 28% increase.

It was a research-based health promotion 5. BENSON'S MIND / BODY

program that included a component of MEDICAL INSTITUTE
chronic care self-management that was
modeled after Kate Lorig’s program(Lorig Dr. Herbert Benson is a physician
et al.,1999) The program also included affiliated with Harvard Medical School,
health and functional assessments; and best known for his best-selling
individual and group counseling; books on the relaxation response and
exercise programs; a personal health for popularizing the term mind/body
action plan with the support of a nurse, medicine. For individuals feeling the
social worker, and volunteer health negative effects of stress, Benson’s
mentor; and support groups. program teaches them to elicit the
A randomized controlled study of relaxation response, a western version
chronically ill seniors reported a of meditation. The Benson-Henry
reduction in a number of hospital stays Institute for Mind/Body Medicine’s
and average length of stay, a reduction clinical programs treat patients with a
in psychotropic medications, and better combination response techniques,
functioning in activities of daily living. proper nutrition and exercise, and the
reframing of negative thinking patterns.
4. ORNISH PROGRAM FOR
REVERSING HEART DISEASE 6. STRONG FOR LIFE

Dr. Dean Ornish, a physician at the The Strong for Life Program is a
University of California at San Francisco home-based exercise program for
and founder of the Preventive Medicine disabled and nondisabled older adults.
Research Institute, has developed a program It focuses on strength and balance, and
for reversing heart disease that has been provides an exercise video, a trainer’s
replicated at several sites around the manual, and a user’s guide. The
country. program was designed by physical
therapists for home use by older adults,
Dr. Ornish (1992) has recommended a
and relies on elastic resistive bands for
vegetarian diet with fat intake of 10% or
strengthening muscles. The exercise
less of total calories, moderate aerobic
program led to high rate of exercise
exercise at least three times a week, yoga
adherence among older participants, as
and meditation an hour a day, group
well as increased lower extremity
support sessions, and smoking cessation.
strength, improvements in tandem gait,
and a reduction in physical
disability (Jette et al., 1999)
Rose Ann C. Lacuarin
ACADEMICIAN HEAD

 Week 16:
Telehealth and the Older Person
Telehealth allows patients across the However, many cognitive abilities,
lifespan to receive care remotely in a including semantic memory, reasoning,
manner that is often more accessible and problem solving, and executive
convenient than in-person care. functioning are preserved well into late
life. The relatively minor cognitive
A common misconception is that older
changes that occur with aging should
adults have either no interest in the use of
not prevent use of telehealth by older
technology or cannot use technology
adults.
platforms.
Even adults who experience conditions
SENSORY AND MOTOR CHANGES such as mild cognitive impairment (MCI)
can successfully learn new skills,
Most older adults experience age-related especially if they use compensatory
changes in vision, hearing, touch, strategies like making notes or using
perception, mobility, and balance. Many of reminders. This could include making
these declines begin at age 40. reminders about telehealth appointment
times in their calendar and using a series
For older adults, there may be
of written notes about how to start their
difficulties with light perception,
computer or tablet and launch a
sensitivity to glare, reduced acuity,
telehealth application.
and impaired focus on nearby
objects. STRATEGIES FOR PROVIDING
Discriminating between background TECHNOLOGY SUPPORT
noises becomes more difficult as we
Don’t assume older adults are
age, and low-level sounds are
uninterested in telehealth.Just as
muffled. And for some, there is
you do with all patients, meet older
increased risk of developing Tinnitus, adults where they are and talk about
which can make certain sounds the pros and cons of telehealth.
difficult to discern. Provide a clear explanation of what
There are also changes to muscle to expect and let them know that
strength and tone that make muscles most people experience a few
stiffer and less. “bumps” adjusting to new
technology but you’ve been able to
COGNITIVE CHANGES successfully work with people with
this modality.
Most older adults experience some Providing technology support
cognitive changes as a part of the requires additional resources early in
normal aging process, such as treatment but avoids delays on the
slowed speed of processing, day of the appointment, so plan to
difficulty in multitasking, and small provide additional instruction and
declines in episodic memory, which individual tech support. Though
generally do not interfere with telehealth platforms may not be
everyday functioning intuitive to older adults, many can
successfully use them.
Rose Ann C. Lacuarin
ACADEMICIAN HEAD

Telehealth and the Older Person

Contact the older adult over the telephone STRATEGIES FOR ESTABLISHING
prior to the appointment to provide verbal RAPPORT
instructions, test the telehealth platform,
and ensure the older adult understands Directly acknowledge that telehealth
and is comfortable with the technology. sessions can feel awkward. Reassure
older adults that most people feel
Support staff may be able to do this step.
increasingly comfortable over time.
Additional benefits include increasing
older adults’ access to care and promoting Attempt to look directly at the
treatment continuity by overcoming camera as much as possible to mimic
barriers to in-person sessions. eye contact.
Use clarifying and reflective
Prior to the appointment, provide older
techniques to avoid
adults with written instructions for using
miscommunication and
telehealth (you may find this beneficial for
misinterpretation of the older adult’s
all your patients). Instructions that use
emotions. Clarify ambiguous body
concise language, a larger font size, and
language verbally with the
include screen shots of each step of the acknowledgement that telehealth
process may be particularly helpful. can make communication more
difficult (e.g., “I want to make sure I
Older adults using telehealth technology understand how you are feeling.
will benefit from visual presentation Implementing these strategies could
modifications (e.g., raise display/screen increase the likelihood of older adults
illumination, use matte surfaces instead of successfully engaging in and
glossy surfaces). benefiting from telehealth.

Auditory enhancements may also help the USING TELEHEALTH TO CARE FOR
user experience (e.g., adjust volume THE ELDERLY
settings, offer closed captioning options
with enhanced text size, consider the use When we think of digital technology,
of headphone sets). we tend to think of younger
You can provide these suggestions in the individuals using their smartphones
initial written information or discuss during and other digital devices. But this line
the setting up session. of thinking doesn’t necessarily apply
When using a video platform, a neutral, to telehealth. Older generations can
not “busy” visual background for you will use telehealth technology to improve
ensure the older adult with visual their access to care and reduce the
challenges is better able to focus on you cost of healthcare services.
and not other stimuli in the background. The number of Americans age 65 and
Similarly, reducing noise on the provider’s older is rising dramatically. Estimates
end reduces auditory interference for the show this demographic will rise from
46 million today to 98 million by the
patient. Be aware of noises such as HVAC,
year 2060. With more elderly patients
white noise generators, and other sounds
seeking care, families will have to
and seek to minimize these with the
make difficult decisions when figuring
position of your equipment and the use of
out how to best care for their loved
headphones.
one.

Rose Ann C. Lacuarin

ACADEMICIAN HEAD

Telehealth and the Older Person

THE NEED FOR AFFORDABLE Transitional Care for Heart Failure
ELDERLY CARE At-home caregivers can use
telehealth to stay on top of their
Elderly patients tend to have complex loved one’s treatment regimen
healthcare needs as they manage a range of following an episode of heart
conditions and diseases. But getting access failure, including dispensing
to healthcare can be a challenge for many medications, diet, physical activity,
elderly patients, especially for those that live and managing stress levels.
in rural areas. Around 7 million older adults
are considered homebound or have trouble Chronic Disease Management:
leaving their home without help. Telehealth helps at-home caregivers
report on the condition of their
Without a loved one to help them or a loved one, giving healthcare
dedicated driver, these individuals may be providers insight into how their
unable to visit their healthcare provider in disease is progressing over time.
person, leaving them with few alternatives Caregivers can use telehealth to
unless they have access to telehealth stay on top of medications, dietary
services. information, and mental and

physical changes.
HOW TELEHEALTH CAN IMPROVE
ACCESS TO ELDERLY CARE Primary Care for Frail Individuals
Patients that have trouble moving
Telehealth gives patients the option to
or leaving the house can use
consult with their healthcare provider
telehealth to consult with
remotely using live video, audio and instant
healthcare professionals on a
messaging on a telemedicine app. This
variety of primary healthcare issues
reduces the need for in_x0002_person
and concerns, including joint pain,
visits and consultations, making it easier for
muscle stiffness, medications, and
at-home caregivers to meet the needs of
accident management and
their loved ones.
prevention.

Telehealth can help families and BENEFITS AND LIMITATIONS

elderly patients in the following ways:
As the COVID-19 pandemic
continues, depression and anxiety
Reduce the burden and cost of certain travel
are on the rise. As a result, mental
expenses
healthcare providers are being
Reduce the number of unnecessary hospital
pushed to provide care to more
visits
patients, while keeping themselves,
Reduce the stress put on at-home caregivers
their staff, and patients safe.Many
Improve overall patient satisfaction
are turning to telehealth as a way to
Palliative Care provide treatment to patients when
At-home caregivers can use telehealth to they can’t be seen in person. The
report on the condition of their loved one as integration of telehealth into
their health continues to deteriorate while traditional medicine could reach far
receiving valuable feedback and advice beyond the pandemic and into the
from healthcare professionals. future.

Rose Ann C. Lacuarin

ACADEMICIAN HEAD

Telehealth and the Older Person

Telehealth does have its positives and • Reduce the need for time off work,
negatives, though. When implementing childcare services, etc. to access
a plan for seniors and telehealth, appointments far away
healthcare providers should consider
both the barriers and opportunities to • Reduce potential transportation barriers,
conduct the most effective telehealth such as lack of transportation or the need for
visits for their patients and themselves. long drives

Mental Healthcare Providers, Older • Reduce the barrier of stigma”

Adults, and Telehealth Usage
To overcome these obstacles, he
The American Academy of Family
recommends that providers consider
Physicians (AAFP) defines telehealth as
using the 4Ms Framework:
“electronic and telecommunications
technologies and services used to • Address what MATTERS to the patient in
provide care and services at- terms of their goals, preferences and
a_x0002_distance.” priorities
• What MEDICATIONS they currently take
Telepsychiatry is a specific form of
• Their level of cognitive impairment or
telehealth that, according to the
MENTATION
American Psychiatric Association (APA),
“can involve direct interaction between • Their level of MOBILITY
a psychiatrist and the patient” and • “Using the 4Ms Framework is a simple way
include “psychiatrists supporting to personalize telemedicine and make it
primary care providers with mental more supportive of older patients,” Solberg
health care consultation and expertise.” writes.
At the top of the list is access, • How to Make Telehealth Easier for Older
according to the APA. During the Patients
pandemic, access is vital, especially
since some seniors may be
immunocompromised. Additionally,
bringing care to the patient’s home or
location via telehealth may open
possibilities for those who live in remote
or rural areas to connect more easily
with mental healthcare specialists.

The APA suggests several other

benefits of telehealth including:
• “Help integrate behavioral health care and
primary
• are, leading to better outcomes
• Reduce the need for trips to the emergency
room
• Reduce delays in care
• Improve continuity of care and follow-up

Rose Ann C. Lacuarin

ACADEMICIAN HEAD

 Week 17:

Entrepreneural Opportunities
NURSE ENTREPRENEUR 1. ADN (Associate Degree in Nursing) or
BSN degree and valid RN license
Nurse entrepreneurs use their 2. Prior professional nursing experience
professional nursing experience and within the relevant area of specialty
education to start their own business in 3. Basic business skills and knowledge (e.g.,
the healthcare industry. Businesses accounting, marketing, ability to manage
established by nurse entrepreneurs may
include developing and selling a home staff)
health product or medical device, or 4. Good communication skills for interacting
offering independent nursing services, with customers, patients and employees
such as patient care, nursing 5. Ability to work independently and
education, home health and/or willingness to take on personal financial
consulting services. A nursing career
risk
path that offers independence and
autonomy, becoming a nurse In general, nurse entrepreneurs have
entrepreneur requires creativity, hard completed a minimum of the ADN or
work and strong business skills. BSN degree and have attained an RN
license in the state in which they live. A
As in other nursing careers, aspiring background in business is also highly
nurse entrepreneurs begin their valuable for nurses who wish to start
careers by completing their Associate's their own businesses. This may include
Degree in Nursing or Bachelor of informal training or mentoring in
Science in Nursing degree and pass the business skills, taking a few courses in
NCLEX-RN exam. In addition to the business, or attaining a business degree.
standard nursing education, nurse Many nursing schools across the country
entrepreneurs benefit significantly from offer dual programs which deliver MSN
learning important business skills such as and MBA degrees simultaneously.
marketing, accounting and managerial
techniques. Certifications or Credentials
Then an aspiring nurse entrepreneur Needed?
often begins work as a professional nurse
in order to learn the industry and
discover business opportunities within it. There are no specific certifications or
credentials required for becoming a
While an advanced degree is not required nurse entrepreneur. However, a nurse
for nurse entrepreneurs to start their own entrepreneur may find certain
business, many nurses may consider a certifications valuable based on the
dual master's degree program in nursing nature of their business. For instance,
and business administration, in which a nurse who runs a home health
students complete their Master's of company and provides patient care
Science in Nursing and Master of may wish to hold the Basic Life
Business Administration degrees Support Certification (BLS) from the
simultaneously. American Heart Association or
American Red Cross.
Nurse entrepreneurs work for Nurse entrepreneurs may work in a
themselves and therefore the skills variety of settings, including in
required for this position vary offices running their own business, as
depending on the nature of the an independent nurse contractor in
individual business venture, but in hospitals or clinics, in home
general the following skills and healthcare visiting patients, or as a
qualifications are beneficial for nurse nurse educator. Nurse entrepreneurs
entrepreneurs: have the freedom to set their own
hours and the flexibility to determine
their own work environments based on
the company they establish.

Rose Ann C. Lacuarin

ACADEMICIAN HEAD

Entrepreneural Opportunities

Nurse Entrepreneur Do

A nurse entrepreneur uses his or her

background in professional nursing to
start their own business within the
healthcare industry. Business ventures
established by registered nurses run
the gamut from medical devices and
home health products to independent
nursing services such as patient care,
nursing education, home health
services and consulting work.
The day-to-day responsibilities of a nurse
entrepreneur depends upon the specific
venture, but usually includes activities
related to running a business including
accounting, marketing or sales, and
developing a customer base.

Roles and Duties of a Nurse

Entrepreneur

Use nursing education and experience to

establish their own business venture
within the healthcare field
Promote the business, including
advertising and sales efforts to
attract and retain customers
Hire and manage employees to assist in
running the business as needed
Tend to the financial side of running
a business, including accounting,
payroll and tax issues
Provide healthcare products or
nursing services which may include
direct patient care, education or
consulting services depending on the
nature of the business

NURSE ENTREPRENEURAL

An increasing number of nurses are enjoying

the benefits of self-employment. While
salary can vary widely based on the
specifics of their business ventures,
many nurse entrepreneurs are also
independent nurse contractors who set the
terms of their own services and negotiate
their salary with a healthcare facility, such
as a hospital or nursing home. While not
as certain as traditional employment, a
career as a nurse entrepreneur can be
more profitable than a standard RN
position.

Rose Ann C. Lacuarin

ACADEMICIAN HEAD