CURRENT TRENDS IN PROVIDING AND
RECOGNIZING APPROPRIATE CARE TO
THE OLDER ADULT
Presented by: Cecilia S. Trinidad, MSN, RN
Objectives
1.
Contrast the general characteristics of the older
adult with regard to health status as compared to
the general population.
2.
Identify nursing considerations when providing
culturally sensitive care to older adults from
diverse backgrounds.
3.
Distinguish major health issues associated with
aging.
4.
Explain new assessment tools utilized in caring for
older adults.
Facts about Aging

The older population--persons 65 years or older—numbered 43.1 million in
2012 .

They represented 13.7% of the U.S. population, about one in every seven
Americans.

The number of older Americans increased by 7.6 million or 21% since 2002,
compared to an increase of 7% for the under-65 population.

However, the number of Americans aged 45-64 – who will reach 65 over the
next two decades – increased by 24% between 2002 and 2012.

In 2012, there were 24.3 million older women and 18.8 million older men, or a
sex ratio of 129 women for every 100 men

At age 85 and over, this ratio increases to 200 women for every 100 men.

About 3.6 million persons celebrated their 65th birthday in 2012. Census
estimates showed an annual net increase between 2011 and 2012 of 1.8
million in the number of persons 65 and over.

Between 1980 and 2012, the centenarian population experienced a larger
percentage increase than did the total population. There were 61,985 persons
aged 100 or more in 2012 (0.14% of the total 65+ population). This is a 93%
increase from the 1980 figure of 32,194.
Aging: Myth or Fact?
MYTH:
FACT:
Most older people are pretty much
alike.
They are a very diverse age group.
They are generally alone and lonely.
Most older adults maintain close
contact with family.
They are sick, frail, and dependent on
Most older people live independently.
others.
They are often cognitively impaired
For most older adults, if there is
decline in some intellectual abilities, it
is not severe enough to cause problems
in daily living.
They are depressed.
Community dwelling older adults have
lower rates of diagnosable depression
than younger adults.
They become more difficult and rigid
with advancing years.
Personality remains relatively
consistent throughout the lifespan.
They barely cope with the inevitable
declines associated with aging.
Most older people successfully adjust to
the challenges of aging.
Ten Leading Chronic Conditions
Aged 65 years and Older
1.
Arthritis
2.
High Blood pressure
3.
Hearing impairment
4.
Heart conditions
5.
Visual impairments (including cataracts)
6.
Deformities or orthopedic impairment
7.
Diabetes mellitus
8.
Chronic sinusitis
9.
Hay fever and allergic rhinitis (without asthma)
10.
Varicose Veins
Source: Centers for Disease Control and Prevention, Chronic Disease Prevention and
Health Promotion. Retrieved April 14, 2013 from
http://www.cdc.gov/chronicdisease/index.html
Leading Cause of Death for
Persons 65 and older

Heart disease

Malignant neoplasms (cancer)

Chronic lower respiratory disease

Cerebrovascular disease

Alzheimer’s disease

Diabetes mellitus

Influenza and pneumonia

Nephritis, nephrotic syndrome, nephrosis

Accidents

Septicemia
Source: National Center for Health Statistics (2012). Table 7, Death and death rates for
10 leading causes of death in specified age groups: U.S, preliminary 2010. National Vital
Statistics Reports, Vol. 60, No.4.
Future Growth of the Aging
Population

The population 65 and over has increased from 35.5
million in 2002 to 43.1 million in 2012 (a 21% increase).
(See Figure 1)

Is projected to more than double to 92 million in 2060.
By 2040, there will be about 79.7 million older persons,
over twice their number in 2000.

People 65+ represented 13.7% of the population in the
year 2012 but are expected to grow to be 21% of the
population by 2040.

The 85+ population is projected to triple from 5.9
million in 2012 to 14.1 million in 2040.
Figure 1 – Population Growth Projections
Note: Increments in years are uneven.
Source: U.S. Census Bureau, Population Estimates and Projections, 2012
Diversity of the Older Population
FIGURE 1-8 Population Age 65 Years and Over, by Race and Hispanic Origin: 2008 and Projected 2050. (Redrawn from
Federal Interagency Forum on Aging-related Statistics: Older Americans 2010: key indicators of well-being, Washington
DC, 2010, U.S. Government Printing
Office.)
Marital Status

In 2013, older men were much more likely to be
married than older women--71% of men, 45% of women
(Figure 2).

Widows accounted for 36% of all older women in 2013.

There were more than three times as many widows (8.7
million) as widowers (2.3 million).

Divorced and separated (including married/spouse
absent) older persons represented only 13% of all older
persons in 2013.

However, this percentage has increased since 1980,
when approximately 5.3% of the older population were
divorced or separated/spouse absent.
Martial Status of Persons 65+
Source: U.S. Census Bureau, Current Population Survey, Annual
Social and Economic Supplement, 2013.
Racial and Ethnic Composition

In 2012, 21.0% of persons 65+ were members of racial or
ethnic minority populations

9% were African- Americans (not Hispanic),

4% were Asian or Pacific Islander (not Hispanic),

.5% were Native American (not Hispanic),

.1% were Native Hawaiian/Pacific Islander, (not Hispanic),
and;

0.7% of persons 65+ identified themselves as being of two
or more races.

Persons of Hispanic origin (who may be of any race)
represented 7% of the older population.
Source: U.S. Census Bureau, Population Estimates.
Geographic Distribution

The proportion of older persons in the population varies
considerably by state with some states experiencing
much greater growth in their older populations (Figures
4 and 5).

In 2012, over half (59%) of persons 65+ lived in 12
states:

California (4.6 million); Florida (3.5 million); Texas (2.8
million); New York (2.8 million); Pennsylvania (2.0
million); and Ohio, Illinois, Michigan, North Carolina, New
Jersey, Virginia, and Georgia each had well over 1 million
Sources: U.S. Census Bureau, Population Estimates; American
Community Survey; and Current Population Survey, Annual
Social and Economic Supplement.
Figure 4
Figure 5
Income

The median income of older persons in 2012 was
$27,612 for males and $16,040 for females. From 2011
to 2012.

Median money income (after adjusting for inflation) of
all households headed by older people rose .1% but this
was not statistically significant.

Households containing families headed by persons 65+
reported a median income in 2012 of $48,957 ($50,701
for non-Hispanic Whites, $33,913 for Hispanics, $40,348
for African-Americans, and $56,378 for Asians).

About 5% of family households with an elderly
householder had incomes less than $15,000 and 67% had
incomes of $35,000 or more .

The major sources of income as reported by older
persons in 2011 were Social Security (reported by 86% of
older persons).
Poverty

Over 3.9 million elderly persons (9.1%) were below the
poverty level in 2012.

This poverty rate is statistically different from the poverty
rate in 2011 (8.7%).

Another 2.4 million or 5.5% of the elderly were classified as
"near-poor" (income between the poverty level and 125% of
this level).

Older women had a higher poverty rate (11%) than older
men (6.6%) in 2012.

Older persons living alone were much more likely to be poor
(16.8%) than were older persons living with families (5.4%).

The highest poverty rates were experienced among older
Hispanic women (41.6%) who lived alone and also by older
Black women (33%) who lived alone.
Education

The educational level of the older population is increasing.

Between 1970 and 2013, the percentage of older persons who had completed high
school rose from 28% to 83%.

About 25% in 2013 had a bachelor's degree or higher.

The percentage who had completed high school varied considerably by race and
ethnic origin in 2013:


87% of Whites (not Hispanic),

76% of Asians,

71% of African-Americans,

60% of American Indian/Alaska Natives (in 2012), and

51% of Hispanics.

The increase in educational levels is also evident within these groups. In 1970,
only 30% of older Whites and 9% of older African-Americans were high school
graduates.
Source: U.S. Census Bureau, Current Population Survey, Annual Social and Economic
Supplement.
Health Care

In 2012, almost all (93%) non-institutionalized persons
65+ were covered by Medicare. (See breakdown below)
Source: U.S. Census Bureau, Current Population Survey,
Annual Social and Economic Supplement
Disability and Activity
Limitations

Some type of disability (i.e., difficulty in hearing,
vision, cognition, ambulation, self-care, or independent
living) was reported by 36% of people age 65 and over in
2012.

The percentages for individual disabilities ranged from
almost one quarter (23 percent) having an ambulatory
disability to 7 percent having a vision difficulty (Figure
9).

Some of these disabilities may be relatively minor but
others cause people to require assistance to meet
important personal needs.

There is a strong relationship between disability status
and reported health status.

Presence of a severe disability is also associated with
lower income levels and educational attainment.
Persons Age 65+ with a Disability
Source: U.S. Census Bureau, American Community Survey.
Definition of Terms
 Culture:
shared and learned beliefs,
expectations, and behaviors of a group
 Acculturation:
person from minority or
marginalized culture adopts that of
dominant or majority culture
 Ethnicity:
social differentiation based
on cultural criteria
Values and Beliefs

Values and beliefs have their origins in the individual’s
religion, philosophy, family, culture, and society

Affect all aspects of our lives and play an important role
in promoting health and coping with illness

Many experts believe that most of our values are wellestablished by the time we reach 10 years of age.

People see the world through their own value and belief
structure and use this structure as a filter by which they
judge other people and events

Misunderstanding and conflict often occur when people
with two different or contradictory sets of values
interact
Economic Values

Many of today’s older adults were strongly affected by
the Depression of the 1930s

They were taught the value of a dollar and to “waste
not, want not”

May experience intense feelings of shame if forced to
accept charity

May save or hoard items, even items that present health
hazards, because they value saving rather than wasting

May store an excessive number of personal belongings
and clutter up their homes until these belongings
become a safety hazard

May refuse to see a doctor or wait until they are
seriously ill because they are concerned about the cost
Intrapersonal Values

Many older adults were raised valuing respect and
obedience to elders

They often cannot understand why their families do not
automatically accept what they say and follow their
directions

The more divergent the values of the various family
members, the more likely there are to be
misunderstandings and conflict
Cultural Values

Shared cultural values define an authority structure,
establish norms for language and communication, and
establish a basis for decision making and lifestyle
choices.

A heterogeneity of cultures creates a vibrant and
dynamic society, but also creates many opportunities for
prejudice and misunderstanding.

Many older adults have lived in this country for years
but still identify more with their ethnic group or country
of origin than with the dominant society.
Health Disparities and
Older Adults

Types


Barriers to quality care range from those related to
geographical location to age, gender, race, ethnicity, sexual
orientation.
Examples of Health Disparities

African Americans (Compared with Whites)

50% more likely to have stroke

Transient ischemic attack: 62% fewer get anticoagulation

50% more likely to die of stroke

20% more likely to die of heart disease

1.5 times more likely to have hypertension

2.5 times more likely to have diabetes

30% more likely to have diabetes-related amputations
Health Disparities and Older
Adults (continued)


Mexican Americans

2 times more likely to have diabetes mellitus (DM)

Get 36% fewer prescriptions after myocardial infarction
Native Americans


5.7 times more likely to have DM than whites living in Hawaii
Reducing Health Disparities

Cultural awareness

Self-level: requiring self-understanding of one’s experiences and
values

Ability to work with and build relationships with a member from
another cultural group

Recognition of factors beyond culture, such as health, safety, and
poverty, that affect members of a cultural group
Health Disparities and Older
Adults (continued)

Reducing Health Disparities


Cultural awareness

Self-level: requiring self-understanding of one’s experiences
and values

Ability to work with and build relationships with a member
from another cultural group

Recognition of factors beyond culture, such as health, safety,
and poverty, that affect members of a cultural group
Cultural knowledge

Both what nurse brings to caring situation and what nurse
learns about older adults, their families, their communities,
their behaviors, and their expectations

Essential knowledge includes elder’s way of life (ways of
thinking, believing, acting)
Major Health Issues called
Geriatric Syndromes and what
are they?
 Conditions,
not diseases
 Common in the elderly
 Typically:
 Multifactorial
 Share risk factors
 Linked with functional decline,
increasing frailty and poor
health outcomes
Geriatric Syndromes
 There
are five conditions most
commonly considered as
geriatric syndromes:
Pressure
ulcers
Incontinence
Falls
Functional
Delirium
decline and
Others considered

These are additional geriatric
syndromes but do also contribute to
this syndrome.
 Malnutrition
 Eating
and feeding problems
 Sleeping
 Dizziness
problems,
and syncope and
 Self-neglect
Assessing older patients

Signs and symptoms of geriatric syndromes are what
often are the chief complaints of older adults thus
leading them to seek help from their provider.

If not treated successfully can consume large amount of
healthcare resources.

Create frustration not only for the patient but family as
well.

If problem isn’t addressed appropriately the older adult
has a tendency to do one or all of the following:

Change healthcare providers or specialties

Visit various ERs and clinics

Have multiple turn-stile admissions
Why an assessment is so
important

In older adults it is especially for those over 85+ years
of age.

Assessment tools that should be used are:

Fulmer SPICES (S is for Sleep Disorders; P is for problems
with Eating or Feeding; I is for Incontinence; C is for
Confusion; E is for Evidence of Falls and S is for Skin
Breakdown) is an efficient and effective instrument for
obtaining the information necessary to prevent health
alterations in the older adult patient (Fulmer, 1991;
Fulmer, 1991; Fulmer, 2001).
Why an assessment is so
important (continued)

ACES Tool which enables nurses to translate their
knowledge regarding aging, complexity of care and
vulnerability during life transitions.

A is for assess function and expectations

C is for Coordinate and Manage Care

E is for use of evolving knowledge

S is make situational decisions.

Katz Index of Independence

Modified Caregiver Strain Index

Hendrich II Fall Risk Model

Assessing and Managing Delirium in Older Adults with
Dementia.
Why an assessment is so
important (continued)

Mental Status Assessment of Older Adults: The Mini-Cog™

The Lawton Instrumental Activities of Daily Living (IADL)
Scale

Working with Families of Hospitalized Older Adults with
Dementia
Practice Prevention

Use best-practice exemplars to help identify early on
care to older adults

When done from an interdisciplinary team approach and
using strong research to support findings it can only help
improve outcomes.

Focusing on maintaining function, dignity and individual
control will promote health and quality of life.
LEARN Model

L
Listen to what the patient has to say

E
Explain your perception of the problem

A
Acknowledge the similarities and differences of
perception

R
Recommend a plan of action that takes into
account both perspectives

N
Negotiate a plan that is mutually acceptable.
Source:
Berlin, E. & Fowkes, W.A.(1983). A teaching framework for crosscultural health care. Western Journal of Medicine, 139:934–938. Available from:
http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1011028&blobtype=pdf
Dementia versus Normal
Aging
Questions???????
Thank You
References

Berlin, E. & Fowkes, W.A.(1983). A teaching framework for cross-cultural health
care. Western Journal of Medicine, 139:934–938. Available from:
http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1011028&blobtype=pdf

Brown-O’Hara, T. (2013). Geriatric syndromes and their nursing implications for nursing.
Nursing 2013, 1-2 online education.

Centers for Disease Control and Prevention, Chronic Disease Prevention and Health Promotion.
Retrieved: November 14, 2014 from http://www.cdc.gov/chronicdisease/index.html

Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey. U.S. Census
Bureau, Current Population Survey, Annual Social and Economic Supplement; "Income, Poverty,
and Health Insurance Coverage in the United States: 2012," P60-245, issued September, 2013.

Coleman, E. A., Smith, J. D., Raha, D., Min, S. J. (2005). Posthospital medication discrepancies:
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
Fried, L. P., Fernucci, L., Darer, J., Williamson, J. D., Anderson, G. (2004). Untangling the
concepts of disability, frailty, and comorbidity: implications for improved targeting and care.
Journal of Gerontology: Medical Sciences 59(3) 255-263.

Hartford Institute of Geriatric Nursing, New York University, http://www.hartfordign.org

Inouye, S. K., Studenski, S., Tinetti, M. E., Kuchel, G. A. (2007) Geriatric syndromes: clinical,
research, and policy implications of a core geriatric concept. Journal of the American
Geriatric Society 55:780-791.
References

Ironside, P.M. Tagliareni, M.E., McLaughlin, B., King, E., Mengel, A.
(2010). Fostering geriatrics in associate degree nursing education: an
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
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
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
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
Profile of Older Americans: 2013 was developed by the Administration
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
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References

Rice, K. L., Bennett, M., Gomez, M., Theall, K. P., Knight, M.,
Foreman, M. D. (2011). Nurses' recognition of delirium in the
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
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
Saka, B., Kaya, O., Ozturk, G. B., Erten, N., Karan, M. A. (2010).
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
U.S. Census Bureau, American Community Survey. Centers for
Medicare and Medicaid Services, Medicare Current Beneficiary
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
U.S. Census Bureau, the National Center for Health Statistics, and
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
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