CARE OF THE AGED IN CARE OF THE AGED IN THE COMMUNITYTHE COMMUNITY

ByBy

ISMAIL MAGAJI SUNUSIISMAIL MAGAJI SUNUSI

400L BN.Sc 400L BN.Sc

TABLE OF CONTENTSTABLE OF CONTENTS IntroductionIntroduction

The dimensions of ageingThe dimensions of ageing

Age structureAge structure

Ageing in nigeria Ageing in nigeria

Theories of agingTheories of aging

Physiological changesPhysiological changes

Psychological changesPsychological changes

End of life issues/careEnd of life issues/care

Care of the agedCare of the aged

Nurses role/responsibilities in care of the elderlyNurses role/responsibilities in care of the elderly

SUMMARYSUMMARY

RecommendationRecommendation

ConclusionConclusion

referencesreferences

INTRODUCTIONINTRODUCTION• The concept of age is simple one: it refers to the time elapsed since an individual was The concept of age is simple one: it refers to the time elapsed since an individual was

born (Horborn, 2007). This is sometimes known as chronological age.born (Horborn, 2007). This is sometimes known as chronological age.

• Ideas of age and ageing are often seen in biological and psychological terms. Birth, Ideas of age and ageing are often seen in biological and psychological terms. Birth,

developing to physical maturity, ageing and death are part of universal biological developing to physical maturity, ageing and death are part of universal biological

processes which affect all human beingsprocesses which affect all human beings

• Sociologists do no questions the idea that age and ageing are linked to biological and Sociologists do no questions the idea that age and ageing are linked to biological and

psychological development, but they argue that they cannot be fully understood without psychological development, but they argue that they cannot be fully understood without

reference to their social contextreference to their social context

• The meaning of old age varies from society to society.The meaning of old age varies from society to society.

• Age is not just of sociological importance because its meaning varies from society to Age is not just of sociological importance because its meaning varies from society to

society, but also because it is an aspect of stratificationsociety, but also because it is an aspect of stratification

THE DIMENSIONS OF AGETHE DIMENSIONS OF AGE

• Jane Pilcher argues that age can be understood as having three significant Jane Pilcher argues that age can be understood as having three significant

dimensions:dimensions:

FirsFirst, age has a ‘biological or physiological dimension, so that, over time, the t, age has a ‘biological or physiological dimension, so that, over time, the

appearance and physical capabilities of our bodies change quite dramatically’.appearance and physical capabilities of our bodies change quite dramatically’.

SecondSecond, ‘as human beings, we live in societies, each with culturally defined , ‘as human beings, we live in societies, each with culturally defined

expectations of how persons of particular ages are supposed to behave’. expectations of how persons of particular ages are supposed to behave’.

Therefore, the social interpretation of the biological process of ageing varies Therefore, the social interpretation of the biological process of ageing varies

between and within societies, meaning that different people will experience between and within societies, meaning that different people will experience

ageing in different ways.ageing in different ways.

ThirdThird, ageing always takes place within a particular historical period. A group , ageing always takes place within a particular historical period. A group

born in the same historical period is known as a born in the same historical period is known as a cohortcohort. By virtue of when they . By virtue of when they

were born, a cohort will tent to experience the same historical events and to were born, a cohort will tent to experience the same historical events and to

some extent the same opportunities and constraints.some extent the same opportunities and constraints.

AGE STRUCTUREAGE STRUCTURE• The experience of age may also be affected by the age structure of the The experience of age may also be affected by the age structure of the

populationpopulation

• The age structure of a population describes ‘the relative size of age groups The age structure of a population describes ‘the relative size of age groups

within a population at any time (Pilcher, 1995).within a population at any time (Pilcher, 1995).

• It is affected by the interaction between fertility, mortality, and migration.It is affected by the interaction between fertility, mortality, and migration.

• Mortality has a particular impact on the proportion of elderly in the Mortality has a particular impact on the proportion of elderly in the

population. If a higher proportion of adults survive into old age the age population. If a higher proportion of adults survive into old age the age

structure will become more top-heavy.structure will become more top-heavy.

AGEING IN NIGERIAAGEING IN NIGERIA

• Worldwide, statistics show that there are dramatic increases in the Worldwide, statistics show that there are dramatic increases in the

number and proportion of older personsnumber and proportion of older persons

• In 1950, there were 205 million persons aged 60 or over, throughout In 1950, there were 205 million persons aged 60 or over, throughout

the world.the world.

• Nigeria with a population of 140million (NPC 2006) is the most Nigeria with a population of 140million (NPC 2006) is the most

populated nation in Africa and the ninth in the world. (UN2005).populated nation in Africa and the ninth in the world. (UN2005).

• Life expectancy at birth stands at 51.6 yearsLife expectancy at birth stands at 51.6 years

CONT…CONT…

• Nigeria is culturally heterogeneous with over 350 ethnic-linguistic groups, with Nigeria is culturally heterogeneous with over 350 ethnic-linguistic groups, with the predominant ones being the Hausa, Yoruba and Igbo.the predominant ones being the Hausa, Yoruba and Igbo.

• In almost forty seven years of independence from colonial administration In almost forty seven years of independence from colonial administration Nigeria is yet to enact a National Policy on the care and welfare of older Nigeria is yet to enact a National Policy on the care and welfare of older persons.persons.

• At this moment there is no Social Security Scheme policy in old age.At this moment there is no Social Security Scheme policy in old age.

• To achieve the target of halving poverty by the year 2015 according to the To achieve the target of halving poverty by the year 2015 according to the Millennium Development Goals (MDGs) and improving the living condition of Millennium Development Goals (MDGs) and improving the living condition of older persons in Nigeria there is the need for an urgent redirection and refocus older persons in Nigeria there is the need for an urgent redirection and refocus on the issues of ageing in Nigeria and the sub-Saharan region of Africa as there on the issues of ageing in Nigeria and the sub-Saharan region of Africa as there are dramatic changes in ageing in the developing countries.are dramatic changes in ageing in the developing countries.

THEORIES OF AGEINGTHEORIES OF AGEING

• In the past half-century, scientists have proposed numerous theories of why In the past half-century, scientists have proposed numerous theories of why people age.people age.

• More recently, as both the absolute number and the population percentage of More recently, as both the absolute number and the population percentage of elders increase, there is renewed scientific interest in why people age, and what elders increase, there is renewed scientific interest in why people age, and what factors affect the physical, psychological, and social sciences, and many in factors affect the physical, psychological, and social sciences, and many in gerontological nursing.gerontological nursing.

• Clearly, there are more questions as to how people age than there are answersClearly, there are more questions as to how people age than there are answers

• At this point, it is helpful to distinguish between normal or usual aging (the At this point, it is helpful to distinguish between normal or usual aging (the typical aging course, with concomitant diseases and disabilities) and successful typical aging course, with concomitant diseases and disabilities) and successful aging (the aging course without disease)aging (the aging course without disease)

• Some of the theories that explain the physical aging include Some of the theories that explain the physical aging include

CONT…CONT…

• Disengagement Theory of Old Age;Disengagement Theory of Old Age;

Developed by Elaine Cumming and William E. Henry (1961).Developed by Elaine Cumming and William E. Henry (1961).

They argued that the disengagement of people from social roles was necessary They argued that the disengagement of people from social roles was necessary and beneficial for society.and beneficial for society.

Cumming and Henry claim that, as people age, they lose ego energy- that is, Cumming and Henry claim that, as people age, they lose ego energy- that is, they lose vitality. They become less capable of performing work roles, civic they lose vitality. They become less capable of performing work roles, civic roles (such as doing voluntary work or being active in politics) and any other roles (such as doing voluntary work or being active in politics) and any other roles for which physical well-being is necessaryroles for which physical well-being is necessary

• Evolutionary theoriesEvolutionary theories

Evolutionary theories argue that aging results from a decline in the force of Evolutionary theories argue that aging results from a decline in the force of natural selection.natural selection.

CONT..CONT..• Cellular theoriesCellular theories

The Cellular Senescence Theory of aging was formulated in 1965 when cell senescence was described The Cellular Senescence Theory of aging was formulated in 1965 when cell senescence was described as the process that limits the number of cell divisions normal human cells can undergo in cultureas the process that limits the number of cell divisions normal human cells can undergo in culture

This “limit in replicative capacity” occurs after a characteristic number of cell divisions and results in This “limit in replicative capacity” occurs after a characteristic number of cell divisions and results in terminally arrested cells with altered physiologyterminally arrested cells with altered physiology ..

• Free radical theoryFree radical theory

The Free Radical Theory of aging was first proposed in 1957. The Free Radical Theory of aging was first proposed in 1957.

All organisms live in an environment that contains free radical-containing reactive oxygen species All organisms live in an environment that contains free radical-containing reactive oxygen species (ROS); (ROS);

The Free Radical Theory supposes that free radical reactivity is inherent in biology and results in The Free Radical Theory supposes that free radical reactivity is inherent in biology and results in cumulative damage and senescence.cumulative damage and senescence.

In fact, elevated levels of both oxidant-damaged DNA and protein are found in aged organisms. In fact, elevated levels of both oxidant-damaged DNA and protein are found in aged organisms. Although it is clear that oxidative damage accumulates with aging, it is not clear whether this process Although it is clear that oxidative damage accumulates with aging, it is not clear whether this process contributes to aging in all organisms.contributes to aging in all organisms.

PHYSIOLOGICAL CHANGESPHYSIOLOGICAL CHANGES• As person ages, a number of physical change occur; some are visible, some are As person ages, a number of physical change occur; some are visible, some are

not. In general, lean body mass is reduced, fat tissues increases, and bone mass not. In general, lean body mass is reduced, fat tissues increases, and bone mass decreasesdecreases

• . Extracellular fluid remains constant; however, intracellular fluid decreases and . Extracellular fluid remains constant; however, intracellular fluid decreases and leads to reduced total body fluid. Thus, elders are at risk for developing leads to reduced total body fluid. Thus, elders are at risk for developing dehydration (Eliopoulos, 2005).dehydration (Eliopoulos, 2005).

• IntegumentaryIntegumentary::

Obvious changes occur in the integumentary system (skin, hair, nails) with age. Obvious changes occur in the integumentary system (skin, hair, nails) with age.

• NeuromusculoskeletalNeuromusculoskeletal: :

With aging comes gradual reduction in the speed and power of skeletal or With aging comes gradual reduction in the speed and power of skeletal or voluntary muscle contractions and sustained muscular effort. voluntary muscle contractions and sustained muscular effort.

• Sensual /PerceptualSensual /Perceptual: :

Each of the five senses becomes less efficient in older adulthoodEach of the five senses becomes less efficient in older adulthood

CONT…CONT…

• PulmonaryPulmonary: :

Respiratory efficiency is reduced with ageRespiratory efficiency is reduced with age

• CardiovascularCardiovascular::

The working capacity of the heart diminishes with age.The working capacity of the heart diminishes with age.

• GastrointestinalGastrointestinal::

Age-related in the gastrointestinal system include: Periodontal disease, which Age-related in the gastrointestinal system include: Periodontal disease, which can lead to tooth loss, xerostomia, Decreased esophageal motilitycan lead to tooth loss, xerostomia, Decreased esophageal motility

• UrinaryUrinary: :

The excretory function of the kidney diminishes with ageThe excretory function of the kidney diminishes with age

• GenitalsGenitals: :

Degenerative changes in the gonads are gradual in men. In women the Degenerative changes in the gonads are gradual in men. In women the degenerative changes in the ovaries are noticed by the cessation of menses in the degenerative changes in the ovaries are noticed by the cessation of menses in the middle age during the menopausemiddle age during the menopause

PSYCHOLOGICAL CHANGESPSYCHOLOGICAL CHANGES

• According to Erikson, the developmental task at this time is ego According to Erikson, the developmental task at this time is ego integrity versus despair. People who attain ego integrity view life with a integrity versus despair. People who attain ego integrity view life with a sense of wholeness and derive satisfaction from past accomplishments. sense of wholeness and derive satisfaction from past accomplishments. They view death as an acceptable completion of life. People who They view death as an acceptable completion of life. People who develop integrity accept “one’s one and only life cycle” (Erikson, develop integrity accept “one’s one and only life cycle” (Erikson, 1963). By contrast, people who despair often believe they have made 1963). By contrast, people who despair often believe they have made poor choices during life and wish they could live life over.poor choices during life and wish they could live life over.

• Other issues related to psychological changes during old age include;Other issues related to psychological changes during old age include; Retirement, Economic changes, Grandparenting, RelocationRetirement, Economic changes, Grandparenting, Relocation : :

MAINTAINING INDEPENDENCE AND SELF-MAINTAINING INDEPENDENCE AND SELF-ESTEEM:ESTEEM:

• Although it may be difficult for younger family members to watch an older person Although it may be difficult for younger family members to watch an older person

completing tasks, in a slow, determined way, elders need this sense accomplishmentcompleting tasks, in a slow, determined way, elders need this sense accomplishment ..• To maintain the elder’s sense of self-respect, nurses and family members need to To maintain the elder’s sense of self-respect, nurses and family members need to

encourage them to do as much as possible for themselves, provided that safety is encourage them to do as much as possible for themselves, provided that safety is

maintained.maintained.

• END OF LIFE ISSUES/CAREEND OF LIFE ISSUES/CARE

In medicine, nursing and the allied health professions, In medicine, nursing and the allied health professions, end-of-life careend-of-life care refers to health refers to health

care, not only of patients in the final hours or days of their lives, but more broadly care of care, not only of patients in the final hours or days of their lives, but more broadly care of

all those with a terminal illness or terminal condition that has become advanced, all those with a terminal illness or terminal condition that has become advanced,

progressive and incurable.progressive and incurable.

CARE OF THE AGEDCARE OF THE AGED• There are three (3) main elements to providing the fundamentals of CARE in a safe There are three (3) main elements to providing the fundamentals of CARE in a safe

and effective way to older people: These elements are; people, process and placeand effective way to older people: These elements are; people, process and place

• PeoplePeople: Nurses who are efficient and able to deliver safe, effective, quality care by : Nurses who are efficient and able to deliver safe, effective, quality care by being: Competent Assertive: Reliable and dependable Empathetic, compassionate being: Competent Assertive: Reliable and dependable Empathetic, compassionate and kindand kind

• ProcessProcess: Delivering quality care which promotes dignity by nurturing and : Delivering quality care which promotes dignity by nurturing and supporting the older person’s self-respect and self-worth through: supporting the older person’s self-respect and self-worth through: Communication, Assessment of need Respect for privacy and dignityCommunication, Assessment of need Respect for privacy and dignity

• PlacePlace: Diverse environments in the community or hospital where care is provided : Diverse environments in the community or hospital where care is provided for older people which isfor older people which is

Committed to equality and diversityCommitted to equality and diversity

AppropriateAppropriate

Resourced adequatelyResourced adequately

Effectively managedEffectively managed

CONT…CONT…

• PHYSICAL CARE PHYSICAL CARE like consultations, preventing injuries and exercise. like consultations, preventing injuries and exercise.

• PSYCHOLOGICAL CARE PSYCHOLOGICAL CARE

Endeavour to empathise and be particularly careful to listen to their reply and investigate Endeavour to empathise and be particularly careful to listen to their reply and investigate any claims or accusations.any claims or accusations.

If the problem persist it is important to seek help from senior staff and/or the medical If the problem persist it is important to seek help from senior staff and/or the medical officer and/or the family, quicklyofficer and/or the family, quickly

Don’t hesitate to call for help from the facility’s designated SECURITY staff if any Don’t hesitate to call for help from the facility’s designated SECURITY staff if any real danger persists. real danger persists.

Always remember to SUPPORT the STAFF MEMBER and OTHER PEOPLE Always remember to SUPPORT the STAFF MEMBER and OTHER PEOPLE INVOLVED and arrange a time to allow them to recount their part in the incident and INVOLVED and arrange a time to allow them to recount their part in the incident and ventilate their subsequent feelingsventilate their subsequent feelings. .

NURSES ROLES/RESPONSIBILITIES IN CARE OF NURSES ROLES/RESPONSIBILITIES IN CARE OF THE ELDERLYTHE ELDERLY

• Integrate advanced knowledge and experience in delivering safe, effective Integrate advanced knowledge and experience in delivering safe, effective quality care to geriatric clients in primary care.quality care to geriatric clients in primary care.

• Demonstrate competence in managing the health/illness status of geriatric Demonstrate competence in managing the health/illness status of geriatric clients in primary care. clients in primary care.

• Monitor and ensure quality health care for geriatric clients in primary care.Monitor and ensure quality health care for geriatric clients in primary care.

• Engage in counseling, communication, collaboration and teaching in a Engage in counseling, communication, collaboration and teaching in a manner that reflects caring, advocacy, ethics and professional standardsmanner that reflects caring, advocacy, ethics and professional standards

• Conceptualize one’s individual role as a primary care nurse practitioner Conceptualize one’s individual role as a primary care nurse practitioner and one’s personal philosophy of primary care practice.and one’s personal philosophy of primary care practice.

SUMMARYSUMMARY

• Geriatric nurses are educated to understand and treat the often complex Geriatric nurses are educated to understand and treat the often complex

physical and mental health needs of older peoplephysical and mental health needs of older people

• Jane Pilcher argues that age can be understood as having three significant Jane Pilcher argues that age can be understood as having three significant

dimensions:dimensions:

• The experience of age may also be affected by the age structure of the The experience of age may also be affected by the age structure of the

population. population.

• Nigeria with a population of 140million (NPC 2006) is the most populated Nigeria with a population of 140million (NPC 2006) is the most populated

nation in Africa and the ninth in the world. (UN2005).nation in Africa and the ninth in the world. (UN2005).

• In the past half-century, scientists have proposed numerous theories of why In the past half-century, scientists have proposed numerous theories of why

people age. people age.

• Nurses who work in the field of geriatrics, also known as gerontology, focus Nurses who work in the field of geriatrics, also known as gerontology, focus

on caring for older adults. on caring for older adults.

• Care of the aged in the community is an important aspect of nursing practiceCare of the aged in the community is an important aspect of nursing practice

RECOMMENDATIONSRECOMMENDATIONS

• Capacity building for family and professional care-giving is Capacity building for family and professional care-giving is

mandatory. This will enhance appropriate caring and remove mandatory. This will enhance appropriate caring and remove

inappropriate coping strategies for the severe cases of age - relates inappropriate coping strategies for the severe cases of age - relates

illnessesillnesses. . • Population aging will demand greater service of some health related Population aging will demand greater service of some health related

occupationsoccupations

• Some persons will need different equipment to enhance their Some persons will need different equipment to enhance their

functions status and promote independencefunctions status and promote independence

CONCLUSIONCONCLUSION

• The concept of age is simple one: it refers to the time elapsed since an individual The concept of age is simple one: it refers to the time elapsed since an individual

was born (Horborn, 2007). This is sometimes known as chronological age.was born (Horborn, 2007). This is sometimes known as chronological age.

• Ideas of age and ageing are often seen in biological and psychological termsIdeas of age and ageing are often seen in biological and psychological terms

• There are three(3) main elements to providing the fundamentals of CARE in a There are three(3) main elements to providing the fundamentals of CARE in a

safe and effective way to older people: These elements are; people, process and safe and effective way to older people: These elements are; people, process and

placeplace

• Caring for the physical and psychological aspects of an elderly person can be Caring for the physical and psychological aspects of an elderly person can be

challenging, but consulting with professionals, using prevention, and exercise challenging, but consulting with professionals, using prevention, and exercise

can make the elderly person's life more rewarding.can make the elderly person's life more rewarding.

• Nurses are known to play an important role in the care of elderly in the Nurses are known to play an important role in the care of elderly in the

community.community.

THANK YOU FOR LISTENINGTHANK YOU FOR LISTENING