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Gerontological & Community Based Nursing:. Culture & Aging Professor Adrianne Maltese. Cultural changes in aging population. By 2060 – “ persons of color” to represent 50% of population Hispanic, Asian & Pacific Islanders will have greatest increase. Need to reduce health disparities

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gerontological community based nursing

Gerontological & Community Based Nursing:

Culture & Aging

Professor Adrianne Maltese

cultural changes in aging population
Cultural changes in aging population
  • By 2060 – “ persons of color” to represent 50% of population
  • Hispanic, Asian & Pacific Islanders will have greatest increase.
  • Need to reduce health disparities
  • Nurses to be culturally competent & aware
cultural awareness cultural competence
Awareness – the ability to recognize the presence of “isms” such as racism.

Openness & self-reflection necessary.

Robert Butler – “ageism”

Most reflective in Euro-American culture

Cultural competence- ability to put cultural knowledge to use in assessment, communication, negotiation and intervention

Use of cross-cultural nursing skills

Cultural awareness -> cultural competence
culture and aging
Culture and Aging
  • Sensitivity to the knowledge of similarities/differences between people of different cultural backgrounds is vital to the establishment of positive relationships and communication.
    • Basic understanding of differing values, experiences, social networks, communication styles and perceptions of health/illness
cultural implications and aging
Cultural Implications and Aging
  • Ethnic elders often have health beliefs that are different from that of the biomedical or Western health system used by many health care professionals in the U.S.
  • Determination of elders’ health beliefs
  • Working with an Interpreter

(box-4-3 p. 54)

What familial and cultural views of aging and the elderly do you hold?

How would you alter care to meet elders cultural needs?

chronic illness
Chronic Illness

“Most disorders of aging are chronic ones that must be treated within a framework of lifestyle changes, living situation adaptations, and attention to the whole person coping with the disorder”

Burggraf, Barry 1996

  • “88% of older adults have at least one chronic illness; 50% have at least two”(Zauszniewski et al, 2007)
  • Most common – arthritis & hypertension
wellness in chronic illness
Wellness in Chronic Illness
  • Greatest factor in establishing a sense of wellness in the face of chronic illness is adaptation.
  • Nurses help patients assist clients toward enriched capacity for living in the shadow of chronic illness—many of which are common in the older adult
theoretical frameworks for chronic illness
Theoretical Frameworks for Chronic Illness
  • Maslow’s Hierarchy of Needs – goal of wellness approach -> assist older adult to meet as many of basic needs as possible.
  • Chronic Illness Trajectory- (Corbin & Strauss 1988) view of living with a chronic illness as a trajectory that traces the progression of a chronic illness through 8 phases.
phases of chronic illness trajectory
Phases of Chronic Illness Trajectory

1.) Pretrajectory – preventative phase

2.) Trajectory onset - definitive phase

3.) Crisis Phase

4.) Acute Phase

5.) Stable Phase

6.) Unstable Phase

7.) Downward Phase

8.) Dying Phase

shifting perspective model of chronic illness paterson 2001
Shifting Perspective Model of Chronic Illness(Paterson 2001)
  • Model views living with chronic illness as an ongoing- continuously shifting process – person moves between wellness or illness in the foreground.
  • Insider perspective of chronic illness –
  • Concept of client as “partner - in – care”
  • Focus on health within illness
the 5 c s of caring simone roach 1992
The 5 “C’s of Caring” (Simone Roach 1992)
  • Competence
  • Compassion
  • Conscience
  • Commitment
  • Confidence
  • So how do we utilize these caring concepts?
common disorders of ageing

Common Disorders of Ageing

Cardiovascular & Respiratory disorders

common chronic cardiovascular disorders
Common Chronic - Cardiovascular Disorders
  • Hypertension – Most common – Goal 120/60 mm Hg
  • Coronary Artery Disease –> risk for “silent MI”
  • Heart Failure – a result of CHD (65 -75% of hospitalized persons – dx of HF 80% were > 65 years old
  • Peripheral Vascular Disease
assessment cardiovascular
Assessment -Cardiovascular
  • Obtain pertinent history
  • Monitor vital signs
  • Lab results
  • Kidney functions
  • Assess cardiac & respiratory function
  • Conduct mental status exam

Examine changes in clients abilities:

  • ADL’s,
  • Quality of sleep
  • Dyspnea (shortness of breath)
goals for elders with cvd
Goals for elders with CVD


relief of symptoms

Improve/maximize function/ quality of life

Reduce morbidity/mortality

Slow progression of dysfunction

interventions cvd
  • Education/teaching life-style changes/diet
  • Monitor s/sx of CHF
  • Monitor fluid intake/output/diet
  • Monitor weight daily/biweekly/weekly
  • Ausculate heart & lung sounds
  • Monitor lab values
  • Cardiac rehab programs
  • Provide comfort measures- in end-of life care if palliative/hospice care is indicated
Monitor risk for exercise related orthostatic hypotension r/t ↓in baroreceptor responsiveness
  • Exercise in climate controlled environment
  • Alter lifestyle – smoking, diet, emotions
chronic respiratory disease
Chronic Respiratory Disease
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Pneumonia
  • Tuberculosis
chronic respiratory disease22
Chronic Respiratory Disease
  • Infectious – Acute – Chronic Respiratory diseases
  • Can involve upper or lower respiratory tract
  • Obstructive (prevents airflow out r/t narrowing of respiratory structures)

vs. Restrictive (decreased lung capacity r/t limited expansion of lungs)

chronic obstructive pulmonary disease copd
Chronic obstructive Pulmonary Disease - COPD
  • By 2020 3rd leading cause of death
  • Includes asthma, bronchitis, emphysema
  • Activity intolerance r/t obstructive airways
copd elderly
People with COPD can still lead productive lives.



Chest tightness

Shortness of breath

COPD - elderly
  • Bacterial vs. viral – Lower respiratory tract
  • Inflammation of lung tissue
  • Pneumonia & Influenza – 4th leading cause of death persons > 65 years old.
  • Community vs. nosocomial
  • Predisposed with comorbid alcoholism, asthma, COPD, heart disease
assessment of elder clients with respiratory disorders
Assessment of elder clients with Respiratory Disorders
  • Assess & monitor:

Oxygen saturation level

Cough- onset/characteristics/sputum production

Subjective reports of dyspnea

Functional & mental status exam

Effects on functional status & quality of life

(refer to Box 20-8 Ebersole text)

goals for clients with respiratory disorders
Goals for clients with Respiratory disorders


stabilize disease

reduce risk of exacerbations/hospitalizations

Promote maximal functioning

Prevent disability

interventions for elder clients with respiratory disorders
Interventions – for elder clients with respiratory disorders
  • Utilize interdisciplinary team
  • Provide education regarding-

Safe use of Oxygen; Safe exercises;

Coping strategies; stress reduction

  • Nutrition/Diet – monitor intake /weight loss
  • Monitor activity & exercise tolerance
  • Educate re: medications/inhalers (mouth care)
  • Discuss rehabilitation programs/strategies
tb disease in elder population
Constitutes a large proportion of TB cases in the U.S.

Many have latent TB infection

Immune function declines

Increased risk of developing active TB disease

Employees in long-term care facilities at risk of occupational exposure to TB.

TB disease in elder population
tb screening
Nurse’s responsibility to screening for TB using the two step TB skin test (TST) or blood assay for Mycobacterium tuberculosis (BMAT)

Cannot admit to LTC unless adequate environmental controls are available

TB screening