1. Care of older adults in the community
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2. Chapter outline
Compare the major future, advantages, and disadvantages of several residential options available for older adults
Assist older adults and their families in making an informed choice when relocation to another setting
Describe factors influencing the provision of long-term care
Identify the common health problems that effect elders
Identify interventions to improve care for older adults
Discuss interventions to improve transitions of care and outcomes for older adults
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3. Introduction
Older adults find it difficult to fully comprehend the insecurity when moving from one side to another during late life.
The major point for community health nurse is to understand this and help older people in making this transition easier.
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4. Residential options in later life
Most of older people prefer to stay at their own homes when they receive care, rather than re-locate
Homes provide the highest possible level of independence
The ability to stay at home depends on appropriate support for changing needs
Developing elder-friendly communities can enhance the health of older adults
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5. Residential options in later life (cont)
Older people by choice or by need move from one type of residence to another
In this case a number of options exist, especially for those with financial ability
It ranges from (figure 1) :
- staying at one’s home
- senior retirement communities
- assisted living settings
-Nursing facilities
The role of nurse here is to be aware of these different options in the local community
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6. Figure 1: continuum of residential options based on level of Assistance needed
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7. Shared housing
Could be with younger family members with or without a spouse
Could be in the same place with sharing commonalities as kitchen or bathrooms
Or could be a separate building added to the house (granny flat)
Studies shows that older adults with shared housing feels more secure and less lonely
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8. Community care
It is providing interdisciplinary care at their older person own home
Is an option for older people who wants to live independently
It included providing all types of care: medications, eyeglasses, transportation to care facilities, urgent care and preventive care
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9. Adult day services
Defined as community-based group programme designed to provide social and some health services to adults who need supervised care in a safe setting during the day
Services are divided to four categories:
1- social (meals, recreation)
2- medical health (therapeutic interventions)
3- specialized: such as services provided to those with special needs like dementia
4- education and support not just for the elder, but for the caregiver
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10. Adult day services (cont)
It is also important to safe cost, because it provides needed care for elderly in their homes, especially for those who need long-term care
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11. Foster care
It is providing 24 hours supervision, protection, and personal care in a homelike setting
It is providing care for a small group from one to six in a homelike and family like environment with a primary caregiver
Elderly in this type of setting have physical or mental impairment and needs 24 supervision
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12. Residential care facilities
It describes non-medical community based housing that houses two or more unrelated adults and provides services such as meals, medication and supervision or reminders, activities, transportation or assistance of activities of daily livings
This type of facility is for elders who need more care than is available in shared housing
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13. Assisted living
Long-term care choice for older adults who need mare than an independent living environment, but do not need the 24 hours skilled nursing care
It may be a share room or a single occupancy unit with a private bath, kitchenette, and communal meals
An example is a 86 years old lady who is mobile but needs assistance with 2 ADLs
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14. Continuing care retirement communities
includes a wide range residential options: from single family homes to skilled nursing facilities, all in one location
Having all levels of care in one location allows community members to make the transition between levels of care less distributive, so less anxity and suffering for the older adult
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15. Population-specific communities
It is moving to some communities that older adults find welcoming
This include communities that emphasizes a particular type of activity, like a kind of sport
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16. Community-base and home-based care
Most of ill elder persons are living in the community not hospitals
Community based care is more preferred because older people prefer to age in place.
Nurses in the home setting provide comprehensive assessment and care management
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17. Community-base and home-based care (cont…)
They may provide of supervise care of elders with a variety of care needs
Including chronic wounds, intravenous therapy, tube feeding, unstable medical conditions, and complex medication regiments
Examples nursing homes, retirement communities, residential care facilities, day health programmes
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18. Nursing home Settings for the delivery of 24 hours care
It is for those needing specialized care
It is a mix of hospitals, rehabilitation, hospice and dementia specific units
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19. Characteristics of a nursing home
Nursing homes has two levels of care
1- skilled nursing care(subacute care)
2- chronic care (long-term or custodial)
Nursing homes provide care for patients who may not need the intense care provided in hospitals, but still need a skilled 24 hour nursing care
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20. Characteristics of a nursing home (cont…)
Residents of nursing homes are predominantly women, 80 years or older, widowed and dependant
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21. Rehabilitation and restorative care services
Rehabilitation is a philosophy, not a place or set of specific services.
It seeks to improve the individual quality of life in any way, no matter how small, in relation to physical, emotional, or spiritual well-being; and ultimately return that individual to a residence of his choice and at minimal personal risk
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22. Rehabilitation and restorative care services (cont..)
Older adults in other long-term care or acute care needs access to rehabilitation to improve function and prevent disability
Restorative nursing programmes are important after discharge from acute care in order to restore ADLs
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23. Members of the rehabilitation team
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24. Quality of care and cost of nursing homes
Care for frail elders is a labour-intensive, costly and requires specialized knowledge
Reasonable workload, enhanced education and adequate training are essential for high quality of care
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25. Problems in nursing homes
Few nurses are interested in working there
Nursing homes are often blamed for all the societal problems associated with aging
Lack of support
Inadequate salaries
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26. Difference between acute care and long-term care
Illness
High technology
Short term
Episodic
One-dimensional
Medical model
Cure
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27. Difference between acute care and long-term care
Function
High touch
extended
interdisplinary model
Ongoing
Multidimensional
Paraprofessional and family
care
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28. Improving transitions across the continuum of care
Transition: moving of patients from one health care practitioner or setting to another as their condition changes
In this case gaps in care could happen, like inadequate education, medication error, limited access to essential services
Because of inadequate care and poor transition after discharge from hospitals: 34% are re-hospitalized within 90 days of discharge
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29. Improving transitional care (cont..)
Simplify post hospital medication regiments
Improve family information about medications prior to discharge
Schedule follow up appointments
Follow up discharge with home visits
Assess of informal support
Referrals to appropriate community rescores
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30. Common health problems among elder
1. Chronic health conditions
According to the National Council on Aging, about 92 percent of seniors have at least one chronic disease and 77 percent have at least two.
Heart disease, stroke, cancer, and diabetes are among the most common and costly chronic health conditions causing two-thirds of deaths each year.
The CDC recommends meeting with a physician for an annual checkup, maintaining a healthy diet and keeping an exercise routine to help manage or prevent chronic diseases.
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31. Obesity is a growing problem among older adults and engaging in these lifestyle behaviors can help reduce obesity and associated chronic conditions.
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32. 2. Cognitive health
Cognitive health is focused on a person’s ability to think, learn and remember.
The most common cognitive health issue facing the elderly is dementia, the loss of those cognitive functions. Approximately 47.5 million people worldwide have dementia—a number that is predicted to nearly triple in size by 2050.
The most common form of dementia is Alzheimer’s disease with as many as five million people over the age of 65 suffering from the disease in the United States.
According to the National Institute on Aging, other chronic health conditions and diseases increase the risk of developing dementia, such as substance abuse, diabetes, hypertension, depression, HIV and smoking. While there are no cures for dementia.
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33. 3. Mental health
According to the World Health Organization, over 15 percent of adults over the age of 60 suffer from a mental disorder. A common mental disorder among seniors is depression, occurring in seven percent of the elderly population.
Unfortunately, this mental disorder is often underdiagnosed and undertreated. Older adults account for over 18 percent of suicides deaths in the United States.
Because depression can be a side effect of chronic health conditions, managing those conditions help. Additionally, promoting a lifestyle of healthy living such as betterment of living conditions and social support from family, friends or support groups can help treat depression.
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34. 4. Physical injury
Every 15 seconds, an older adult is admitted to the emergency room for a fall. A senior dies from falling every 29 minutes, making it the leading cause of injury among the elderly.
Because aging causes bones to shrink and muscle to lose strength and flexibility, seniors are more susceptible to losing their balance, bruising and fracturing a bone.
Two diseases that contribute to frailty are osteoporosis and osteoarthritis. However, falls are not inevitable. In many cases, they can be prevented through education, increased physical activity and practical modifications within the home.
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35. 5. Malnutrition
Malnutrition in older adults over the age of 65 is often underdiagnosed and can lead to other elderly health issues, such as a weakened immune system and muscle weakness.
The causes of malnutrition can stem from other health problems (seniors suffering from dementia may forget to eat), depression, alcoholism, dietary restrictions, reduced social contact and limited income.
Committing to small changes in diet, such as increasing consumption of fruits and vegetables and decreasing consumption of saturated fat and salt, can help nutrition issues in the elderly. There are food services available to older adults who cannot afford food or have difficulty preparing meals.
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36. 6. Sensory impairments
Sensory impairments, such as vision and hearing, are extremely common for older Americans over the age of 70. 
According to the CDC, one out of six older adults has a visual impairment and one out of four has a hearing impairment.
Luckily, both of these issues are easily treatable by aids such as glasses or hearing aids. New technologies are enhancing assessment of hearing loss and wearability of hearing aids.
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37. 7. Bladder control and constipation
Incontinence and constipation are both common with aging, and can impact older adults quality of life.
In addition to age-related changes, these may be a side effect of previous issues mentioned above, such as not eating a well-balanced diet and suffering from chronic health conditions.
The Mayo Clinic suggests maintaining a healthy weight, eating a healthy diet and exercising regularly to avoid these elderly health issues. There are often effective medical treatments, and older adults should not be embarrassed to discuss with their physicians.
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38. Roles of community health nursing
CHN comes in closest contact with the sick elderly and his/her family.
Besides basic nursing care, CHN plays an important role in ensuring that treatment recommended by the other members of the health care team.
Often where therapist staff are lacking, CHN doubles her/his role as a therapist.
CHN is alerted to any change in the elderly's condition and initiates early referral for appropriate care.
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39. It is therefore important that the CHN has a basic knowledge of some of the important age related anatomical and functional changes.
CHN also plays an important part in promoting preventive health services such as active case finding and health education.
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40. Key points
A familiar and comfortable environment allows an elder to function at his or her highest capacity
Nurses must be knowledgeable about the range residential options
Nursing homes are an integral part of the long-term care system providing acute and chronic care
Nurses play a key role in ensuring optimal outcomes during transitional care
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41. Thank you
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