HOME HEALTH CARE ACROSS LIFESPAN

Who is an elderly : Legally , an elderly person is a person of sixty-five years of age or above .

Definition of ageing : many academic discipline try to define ageing as they understand :

a. Biological ageing : This refers to changes in structure and functions of the body that occur
over the life span ,This includes all the changes that occur in an individual due to biological
activities of the cells , tissues , organs and the system in the body during the life span .
b. Functional ageing : This refers to the capacities of individuals to function in the society when
compared with those of others of the same age . Here productivity is used to define the age
of the individual . It is the society that determines whether one is an elder or not .
c. Sociological ageing : This refers to the roles and social habits of the individual in the society .
This definition is closely related to functional ageing .
d. Psychological ageing : This refers to behavioural changes , alteration in self-perception and
reactions to the biological changes that occur in the body of the individual over time . In this
case , it is the attitude of the individual that determines his/her age . This gives rise to youth
at heart

HOME HEALTH CARE FOR THE ELDERLY

Home health care helps older adults live independently for as long as possible , even with an illness
or injury . It covers a wide range of services and can often delay the need for long-term nursing
home.

Home health care may include occupational and physical therapy , speech therapy , and skilled
nursing . It may involve helping older adults with activities of daily living , such as bathing , dressing
and eating . It can also include assistance with cooking , cleaning ,other house keeping and
monitoring ones regimen.

PROBLEMS OF THE ELDERLY (Physical and psychological changes in the elderly)

The aging process is universal but not uniform .

Physical changes :

1. Mobility disability – This is associated by social isolation , falls and depression . One third of
people over age 85 with a disability live alone .
2. Disability in activities of daily living – Disability rates are relatively high among adults over
age 85 . Rates of disability in activities like dressing , bathing , and cooking .
3. Falls : Falls are a major cause of morbility and disability among older adults . 30 – 40% of
adults over age 70 fall each year and rates are particularly high for older adults in long term
care facilities .
4. Frailty is defined as special vulnerability to stressors and is suggested by weakness , slowness
exhaustion , and weight loss .
5. Continence : Thirty percent of women over age 65 and 50% of older adults in nursing
facilities have urinary incontinence . Common causes for incontinence among women
include overactive bladder , stress incontinence and functional incontinence

Psychological changes :
1. Cognitive aging – Mild short term memory loss, word finding difficulty and slower processing
speed are normal parts of aging that are often noticeable by age 85 .Changes from normal
brain aging can affect driving safety and increase risk for financial exploitation .
2. Dementia - Rates of dementia increase with age
3. Ageism – is a prejudice and discrimination that is directed at older people. Older people are
viewed more negatively than younger people on a variety of traits , particularly those
relating to general competence and attractiveness.
4. Elder abuse -
5. Depression – Depression is not a normal consequence of aging . Grief can be a normal
response to life events that occur with aging such as bereavement , retirement /loss of
income and loss of physical , social , or cognitive function from illness. Depression is even
more common among institutionalised older adults and those with disabilities .
6. Social / environmental – Being married and being wealthy predict longer survival . The
benefit of marriage seems stronger for men than women . Alternatively , social isolation
predicts mortality and other adverse outcomes in older adults .
7. Medical decisions -Starting or stopping medications , ordering , screening tests , sending
people to the hospital , and advising families about placement or end of life care are
complex discussions which health providers have with older people . Often family members
play a central role in these complex discussions . The patient may have hearing impairment ,
cognitive impairment , or communication impairment .
8. Polypharmacy – is defined as the use of concomitant use of five or more medications by a
single parent .
9. Hospitalization – Hospitalization are common among older people and associated with
functional decline . Providing more acute care in the home could help to prevent hospital
complications such as functional decline and iatrogenic infection. Attention to transitional
care and rapid post-hospital medical follow –up visits can minimize medication errors and
re-hospitalisation .
10. Institutional placement – Many older adults value their ability to continue living in their own
homes as they age . Home – based interventions may slow the progression of disability and
prevent the need for institutionalization .
11. Advance directives - Many older adults with multiple chronic conditions will die within a few
years . Advance directives on life – sustaining therapies such as cardiopulmonary
resuscitation , mechanical ventilation and tube feeding enable patients to exert some
control over their end of life care .
12. Chronic health conditions – HIV/AIDS and other sexually transmitted
diseases ,Malnutrition ,oral health ( cavities , and tooth decay ) , substance abuse , bladder
control and constipation ,cardiovascular diseases , cancer ,diabetes mellitus , osteoporosis,
arthritis , sensory
changes ( hearing loss), Eye problems( presbyopia, dry eyes, cataracts ,glaucoma ,macula
degeneration , diabetic retinopathy ,retinal detarchment ) .

Effects of ageing on the body systems

1. Integumentary system :
-skin appear thin , pale and translucent.
-collagen which make up the major portion of the dermis is decreased leading to
decreased elasticity and strength .
-Decreased vascularity and increased fragility make the older adults less resistant to
sharing forces and more prone to ulcers,
-There is reduced fatty tissue and loss of hair follicles leading to impairment in the ability
to maintain body temperature.
2. Musculoskeletal system :
- There is change in stature and posture , there is a decrease in height ( 1.2 – 4cm )
mainly due to compression in the spinal column.
- There is lengthening and broadening of the ears and nose . The long bones of the body
are not affected by ageing .
-There are changes in the body tissues as a result of stress, vitamin D intake ,
parathyroid hormones and calcium , these lead to changes in the bone mass and
metabolism.
- There is increase in bone absorption within the vertebral bodies , wrist and hip due to
decrease in calcium levels .
- The muscles become atrophied with more fibrous changes in musculoskeletal and
nervous system leading to slower movement and decrease in strength .
3. Cardiovascular system :
- The valves of the heart become thick and stiff, this leads to cardiac murmurs
- There is an increase in systolic blood pressure
- Blood coagulability increases with age .
4. The respiratory system :
- There is decreased rigidity of the chest wall, weakening of the diaphragm and
intercostals muscles .
- There is also atrophy of the pharynx and larynx
- There is decreased maximum breathing capacity, leading to impaired gaseous
exchange
- The bronchus becomes more regid , decreased ciliary action leading to increased cough
mechanism
5. Gastro intestinal system:
- There is decreased secretion ,absorption and motility leading to constipation ( although
this is most likely caused by decreased fluid intake , insufficient bulk and lack of
exercise )
- After the age of 50 , the liver begins to shrink and enzyme production is decreased ,
hence changes in liver are particularly important when considering drug therapy ,
especially those drugs that are metabolised by the liver . lower drug dosage in the
elderly is a common rule .
6. Genito - urinary system :
- There is decrease in filtration surface area with a progressive loss of renal mass and
kidney weight
- Renal blood flow progressively decreases from 12000ml/min to 60011ml/min by age 80
- There is decreased glomerular filtration rate
- Creatinine clearance decreases with age and should be carefully monitored before
administration of drugs dependent on renal functions .
7. Endocrine system :
- The most common disorders associated with the endocrine system are thyroid
dysfunction and diabetes mellitus .
- The most common effects of hypothyroidism are : depression , myoglia , constipation
and dry skin .
8. Neurological system :
 - Age related changes in the autonomic nervous system interfere with the ability of the
hypothalamus to regulate heat production and heat loss
- Sleep pattern also changes with age .
9. Sence organ :
- visual : Presbyopia , cataracts, glaucoma etc
- Hearing : presbycusis ( loss of hearing )
10. Reproductive system :
- Male : testosterone production decreases
- Testes decrease in size
- Sperm count decreases and seminal fluid has a diminished viscosity
- Female : Estrogen production decreases with menopause ,and breast tissue diminishes
- The uterus decrease in size and mucus secretion ceases
- Uterine prolapses: many occur as a result of muscle weakness .

Societal attitudes towards the elderly

Ageism : is prejudice and discrimination that is directed at older people . This view
suggests that older people are less in command of their mental faculties . Older people
are viewed more negatively than younger people on a variety of traits particularly those
relating to general competence and attractiveness.
Elder abuse :There are several types of abuse of older people that are generally
recognised as being elder abuse , including : physical e.g hitting , punching , slapping ,
burning , pushing , kicking , restraining , false imprisonment / confinement , or giving
excessive or improper medication as well as withholding treatment and medication .

Meeting the special needs of the elderly ( class activity )

The needs that the elderly have while ageing may include :
1. Financial security
2. Personal security and safety
3. Health care and health challenges
4. Mental health
5. Self actualization

The Role of the nurse in home care of the elderly

The home health nurse functions as a case manager through a multidisciplinary approach .The nurse
formulates the care plan based on the nursing process of assessing , diagnosing , planning ,
implementing and evaluating . The roles of the nurse include :

- Providing health rehabilitative and palliative therapies .Health promotional behaviours are
viewed as a very important consequence of these therapies
- Educating the patient and care givers about the illness or disability and mutually identify
health care needs
- Developing patient and care giver competence , decision making ,and judgment in self care
management at home
- Faster positive patient and care giver adjustment to coping mechanism for changed life-
style , role and self concept as a result of illness or disability
- Reintegrating the patient and care giver back into the family , community and social support
system .
Services rendered by the nurse :

- Nursing procedures such as wound care ( refer previous notes on wound care )
- Short and long term patient care : short term care usually last for few weeks while long term
care usually last for several months or years, following a chronic disease or injury .
- Assistance with activities of daily living and instrumental activities of daily living
- Monitoring of and education on chronic and non- chronic disease
- Health assessment
- Nutrition and feeding
- Ambulation
- Disease prevention and management
- Prevention of ageism and elder abuse

HOME HEALTH CARE OF CHILDREN

Pediatric home health care allows children to receive care from licensed professionals in their own
environment , often out of prolonged hospital stay.

Conditions commonly treated with pediatric home health care

- Complications from prematurity

- Cardiac disease
- Chronic pulmonary or respiratory illness
- Neurodegenerative disease
- Genetic disorders
- Developmental disorders
- Serious injury recovery
- Childhood cancer
- Nutritional deficiencies
- Respiratory conditions

Assisting with Infant Care

The term infant care refers to the social welfare service concerning support for nursery facilities and
home care.

Infant care focus on the “thrive 5”, five conditions to ensure an infant in the first year of life has
what is needed for healthy development . Those conditions include :

- Environmental stimulation
- Nutrition
- Neighbourhood safety
- Positive care giving
- Regular circadian rhythms ( circadian rhythm is the 24hour internal clock in our brain that
regulates cycles of alertness and sleepiness by responding to light changes in our
environment ) and sleep.

FAMILY CENTERED CARE FOR CHILDREN

When caring for children with developmental disabilities , it is important not to regard the
child as an individual patient . Family is a childs primary support and a constant element in
their life . Family centered care recognises that family members have their own needs that
 family members have their own needs that enable them to give this support and provide a
safe and nurturing environment .
Family-centered care occurs when :
1. Health care professionals recognise that all families are unique and understand their
personal circumstance, expertise, values,traditions and perspectives
2. Families share knowledge of their child and are active in the decision-making process ,
helping identify goals for the child.
3. Interventions consider who in the family is best able to support a child
4. Family members are a constant unit in the care team
5. Families are free to ask questions and receive information and guidance to help them
support their child
6. Referrals to additional support services are available if needed including parent support
groups
7. Health care professionals assess if family members need physical or emotional support
in order to support their child as caring for a child with developmental disabilities can be
physical and emotionally exhausting .

Benefits of family centred care :

- Improved health care decision making , based on better information and collaboration
between professionals and families
- Greater parent confidence of children and adolescents to better manage their own health
care independently
- Opportunities for healthcare professionals to learn from families about the actual workings
of a health care services and system.
- More efficient and effective use of a professionals time and health care resources .
- Improved communication between healthcare professionals .

Tips for achieving family centered care

1. Leadership – leadership personnel within healthcare providers need to be committed to

family centered care by understanding what it means , setting targets and holding staff
accountable as well as providing adequate resources and support .
2. Family engagement – family centered care is a collaborative partnership and meeds to be
developed with active participation and decision making from families.
3. Training – to ensure that all staff and health care professionals have a shared understanding
of family centered care , staff will require education and training
4. Monitoring –in order to maintain family centered care and achieve organisational goals , it is
important to measure , monitor and report . Ongoing evaluation of family centered care
should include feedback from parents and family members ,surveys and focus groups.

HOME HEALTH CARE FOR WOMEN AND PREGNANT MOTHERS

 - Prenatal , antenatal care , postnatal care
- Home delivery
- Family planning services

HOME HEALTHCARE ACROSS DISEASE CONDITIONS

- chronic diseases – cancers , hypertension ,diabetes

- infectious diseases - tuberculosis

For the above topics , please refer previous notes on community health nursing 1 and 2

Assignment : Gender based violence and its prevention

PRESENTATION TOPICS

- Mental health – anxiety , depression , psychosis

- Developmental disability- cerebral palsy , autism ,learning disability, hearing and visual
disability.
- Physical disability- neurological impairment( after stroke , dementia ),fractures ,
amputation, blindness , deafness.
- Definitions : Nursing homes , long term care , skilled care ,custodial care
- Plurality of terminologies used to describe nursing homes
- Historical evolution of the concept of nursing home
- Nursing care facilities and services ; assisted living facilities , adult day care homes ,
subacute care facilities , long-term care facilities , rehabilitation hospital facilities , skilled
nursing facilities , care homes , geriatric homes , hospice home facilities and maternity
homes .
- General health promotion activities : nutritional / feeding challenges ,grooming ( bathing
, oral care , dressing ,toileting etc )
- Ambulation – getting out of bed , use of wheel chair
- Safety and prevention of accidents –falls , burns , choking , fire etc
- Infection prevention and control .