Nursing Guide: NUR341

Successful aging is an important concept, and one that has been the subject of much research. During the last 15 years, the emphasis of this research has shifted from formulating criteria for successful aging to describing the processes involved in successful aging. The main purpose of the present article is to review psychological models of successful aging. The model of Selective Optimization with Compensation (SOC-model) proves to be one of the leading models in this field. Although evidence about its value is accumulating, we argue that this model mainly focuses on how people react to losses and that proactive coping aimed at preventing potential threats to goals may also be a valuable strategy. We propose that proactive coping may be important for successful aging, since it results in a prolonged availability of resources for optimization and compensation processes and a delay in disengagement from important goals.

By 2050, the number of people in Australia aged over 85 is expected to quadruple. Yet, from a socio-psychological research perspective, little is known about the experiences of people who continue to live at home during late old age (85 years and over), a period when challenging problems associated with ageing escalate and threaten to compromise independence. Utilising a qualitative methodology, the subjective lived experience of 23 very old adults (19 women, four men, with a mean age of 90.7 years, range 85–101 years) who live independently in rural Australia were elicited. The aims of the research were to understand their thoughts and feelings about ageing in place at home, and what psychological, social and practical adaptive strategies they employ to cope with difficulties encountered during very old age. In-depth interviews were analysed in an interpretive phenomenological tradition of thematic analysis, interpretation of paradigm cases and interpretation of exemplars. Participants described how historical, cultural and environmental contexts shaped their everyday thoughts, activities and what was meaningful for them. The findings add to our understanding of the largely unnarrated lives of the very old, suggest a need for person-centred home-care assessment processes and aid significant others (family, friends and neighbours) to understand better what very old adults need to live independently.

COTA Australia is the peak national organisation representing the rights, needs and interests of older Australians. COTA Australia is the national policy and advocacy arm of the COTA Federation which comprises COTAs in each State and Territory. COTA Australia focuses on policy issues from the perspective of older people as citizens and consumers.

This article provides a brief examination of the prejudices and politics framing current public debate on population ageing in Australia and the possible implications of this for the allocation of required health and social sector resources. The role and responsibility of nurses and professional nursing organisations to engage in and influence public policy debate concerning the health and social care of older people
is highlighted.

Australia 2048: 25% of the population is aged 65 or over, the number of young people entering the workforce has
plummeted to a tenth of the level from 40 years ago and the demands for aged care services continues to grow.

Language carries and conveys meaning which feeds assumptions and judgments that can lead to the development of stereotypes and discrimination. As a result, this study closely examined the specific language that is used to communicate attitudes and perceptions of aging and older adults.

During the 1984 presidential debates, 73-year-old President Ronald Reagan was asked whether he was too old to serve—to which he famously replied, “I will not make age an issue of this campaign. I am not going to exploit, for political purposes, my opponent’s youth and inexperience.”

Providing patients with more person-centred care without increasing costs is a key challenge in healthcare. A relevant but often ignored hindrance to delivering person-centred care is that the current segmentation of the population and the associated organization of healthcare supply are based on diseases. A person-centred segmentation, i.e., based on persons' own experienced difficulties in fulfilling needs, is an elementary but often overlooked first step in developing efficient demand-driven care.

To ascertain and compare the perspectives of students and lecturers at Edinburgh Napier University and Hanze University of Applied Sciences, the Netherlands, regarding person-centred care. Method: Data were collected using face-to-face, structured interviews and analysed using a person-centred nursing framework. Findings: Participants believed that person-centred care should be incorporated within pre-registration nursing education. Conclusion: The way person-centred care is taught varied between the two universities. With the focus on high quality, compassionate care, it is important to identify how nursing curricula can promote these qualities.

Geriatric conditions such as functional impairment and dementia are common and frequently unrecognized or inadequately addressed in older adults. Identifying geriatric conditions by performing a geriatric assessment can help clinicians manage these conditions and prevent or delay their complications.

Ageing is a natural process. It is a part of life cycle that happens to everyone. It is reported that Singapore society is ageing. It is thus essential for healthcare professionals to recognise physical and emotional changes in the older adults. The ability to distinguish normality and abnormality in the older adults will allow the healthcare professionals to provide optimal care. Health assessment skills are imperative to formulating diagnoses leading to providing interventions in the right direction. This paper discusses changes that happen in the ageing process, and illustrates important considerations in the comprehensive health assessment of older adults to enhance the quality of care healthcare professionals provide.

When patients are discharged from hospital they are dependent on the professional and social care delivered by healthcare staff and also on the support provided by lay carers, family and friends. This article describes a method for determining the quality and extent of lay care that may be available to older people to ensure that their discharge is more successful in the long term.

In June 2013 the National Institute for Health and Care Excellence updated and replaced its 2004 clinical guideline 21 (CG21) on falls with clinical guideline 161 (CG161). Two priorities were outlined in the latter: preventing falls in older people (unchanged from CG21) and preventing falls in older people during a hospital stay (new). CG161 is for health and social care clinicians who care for older people who have fallen or who are at risk of falling. It provides clinicians and commissioners with evidence to implement effective care pathways and recommendations on the assessment and prevention of falls in older people. The amalgamation of the two guidelines has resulted in some disconnection. This article summarizes the evidence and supports clinicians in the interpretation of the revised falls guideline.

Care of the older person has become more specialised in Ireland particularly since the introduction of national and international healthcare standards. In this regard, older people are receiving more evidence-based quality care when living in long-term healthcare facilities in Ireland. Assessment and management of falls is currently high on the quality agenda in terms of measuring quality outcomes. Clinical practice is being standardised using evidence-based practice and research. Residential care nurses caring for older people in Ireland are required to demonstrate clinical competence when assessing and managing falls in the residential care setting. Healthcare legislation, policy and in-service education, occurring in both the public and private sector, require a multidisciplinary-team approach. This article addresses the nursing priorities regarding falls assessment and management strategies that residential nurses should consider when caring for the older person at risk of falling.

Understanding what to look for, what is normal and what needs to be referred to a specialist, gives community nurses confidence in assessing older skin. Skin health checks should become a normal part of health surveillance in primary care. This article reviews some of the most common changes that occur as skin ages, drawing attention to features that indicate possible malignancy as well as briefly indicating some common changes due to dry skin and disease processes. The principles of sun protection, including some helpful products, and skin treatment to aid hydration and maintain health are discussed.

Background Chronic pain experienced by residents in long-term care is a common complaint that is often underdiagnosed and inadequately treated. This in part may be due to poor nursing practice in pain assessment. Aim To identify factors predicting nurses' performance of pain assessment among older long-term care residents. Furthermore, it will examine the relationship between ageist attitudes and practices and attitudes about pain assessment of older adults. Methods A descriptive correlation survey was carried out among 104 nurses working in a long-term care facility. The survey measured nurses' pain assessment practices and attitude about pain assessment, and attitudes to older people. Linear regression was used to examine associations between the variables. Findings Our results show that nurse assessment is directly and positively correlated with their general knowledge about pain obtained in pre-service nursing studies, but not with knowledge obtained during in-service training. Nurses with a positive, non-ageist attitude towards older adults are more likely to have higher levels of awareness of the need to perform pain assessment. Key conclusions and implications for practice Concerning implementation, we suggest increasing pain assessment training as part of pre-service nursing education. The necessary training should focus on improving attitudes towards older adults, removing negative myths associated with them and increasing appreciation of the importance of pain assessment.

This article summarises and critiques various tools available for the assessment of pain in older people with cognitive impairment. Definitions of pain are numerous and are not always relevant to people with cognitive impairment because these individuals are often unable to describe or communicate their pain. This makes it difficult for healthcare professionals to assess the absence or presence of pain in these patients. The aim of this article is to establish which of the available pain assessment tools are most appropriate for use in older people with cognitive impairment. From a review of the literature, the authors conclude that pain assessment in older people with any degree of cognitive impairment is complex and there is no gold standard.

Determination of a patient's capacity for medical decision making can be simple or complex, depending on the issue being considered; likewise, the degree of capacity required to make decisions varies with the complexity of the situation. A capacity examination is a focused and impartial evaluation of mental status and medical, surgical, psychiatric, and psychosocial histories. The examination is composed of several basic steps, beginning with an assessment of the patient's ability to communicate, followed by determination of his or her understanding of the proposed care, followed by the patient's rationale for decisions about that care. When a patient is deemed to lack capacity, mechanisms should be in place to ensure the patient receives the care needed. This article provides an overview of the concept of capacity, how it is determined, and how to proceed when the patient is found to lack it.

A health assessment of an older person is an in-depth assessment of a patient aged 75 years and over. It provides a structured way of identifying health issues and conditions that are potentially preventable or amenable to interventions in order to improve health and/or quality of life.

Older people in hospital provides clinicians with evidence-based information and simple strategies to minimise the risk of functional decline for older people in hospital. It is underpinned by the principles of person-centred practice.

Physiological changes occur as we age that affect our appearance, and our abilities to function and respond to daily living activities. Julie Swann continues the ageing anatomy series.

The UK population is ageing and a significant proportion of older people experience persistent pain. However, pain assessment in this group can be challenging, particularly when the older person has cognitive or communication impairment. Nurses working in primary and secondary care should take a more proactive role to help overcome patient, professional and institutional barriers to pain assessment and management. This article examines the age-related physiological changes that complicate the prescribing and administering of analgesic drugs in older patients and necessitate careful patient monitoring. It outlines the principles of medication administration for pain management in older people and provides examples of assessment tools that can be used in older patients.

This article explores the issue of polypharmacy in older adults. The physiological changes in organ function in older people and the effect of this on pharmacokinetics and pharmacodynamics are discussed. The risks of adverse drug reactions and adverse drug interactions linked to polypharmacy are explored. Strategies to achieve optimal prescribing in older people are considered.

The aim of this article is to explore prescribing and medicines management in older people. The author discusses the physiological changes that occur as people age and how these changes affect the use of drugs in this group. Additionally, inappropriate prescribing with specific reference to polypharmacy in older people is explored. Finally, drugs that should be used with care are highlighted.

The UK population is ageing and a significant proportion of older people experience persistent pain. However, pain assessment in this group can be challenging, particularly when the older person has cognitive or communication impairment. Nurses working in primary and secondary care should take a more proactive role to help overcome patient, professional and institutional barriers to pain assessment and management. This article examines the age-related physiological changes that complicate the prescribing and administering of analgesic drugs in older patients and necessitate careful patient monitoring. It outlines the principles of medication administration for pain management in older people and provides examples of assessment tools that can be used in older patients.

This article explores the issue of polypharmacy in older adults. The physiological changes in organ function in older people and the effect of this on pharmacokinetics and pharmacodynamics are discussed. The risks of adverse drug reactions and adverse drug interactions linked to polypharmacy are explored. Strategies to achieve optimal prescribing in older people are considered.

The objective of this paper is to review articles published in 2013 examining drug-related problems in the elderly and comment on their potential impact on clinical practice.

Senior citizens commonly take multiple medications and lack knowledge about proper use and side effects. They often have no access to health professionals to clarify any misconceptions about their medications. Nursing students often learn pharmacology in the classroom with no opportunity to apply the knowledge as it is learned. Within one community, a creative strategy was developed to meet the learning needs of both groups. At a local senior center, clients with drug-knowledge deficits or compliance difficulties were identified. Pharmacology nursing students were then assigned to collect drug histories from these clients. Following analysis of gathered data, students were required to develop individualized drug teaching tools for their assigned client. Through these activities, the learning needs of both groups were met.

New models of funding for primary care have opened opportunities for ways of caring for complex frail older patients. Severity of frailty is an important factor, and more severe frailty should prompt consideration of using an alternate model of care for a senior.

In Central Norway a generic care pathway was developed in collaboration between general hospitals and primary care with the intention of implementing it into everyday practice. The care pathway targeted elderly patients who were in need of home care services after discharge from hospital. The aim of the present study was to investigate the implementation process of the care pathway by comparing the experiences of health care professionals and managers in home care services between the participating municipalities.

The Dutch health care system faces huge challenges with regard to the demand on elderly care and the competencies of nurses and physicians required to meet this demand.At present, the main focus of health care in the Netherlands lies on illness and treatment. However, (frail) elderly need care and support that takes their daily functioning and well-being into consideration as well. Therefore, health care professionals, especially those professionals working in primary care such as GPs and practice nurses, will be challenged to a paradigm shift in emphasis from treating illness to promoting health (healthy ageing).

With increasing age and longevity, the rising number of frail elders with complex and numerous health-related needs demands a coordinated health care delivery system integrating cure, care and welfare. Studies on the effectiveness of such comprehensive chronic care models targeting frail elders show inconclusive results. The CareWell-primary care program is a complex intervention targeting community-dwelling frail elderly people, that aims to prevent functional decline, improve quality of life, and reduce or postpone hospital and nursing home admissions of community dwelling frail elderly.

Population aging leads to increased burden of chronic diseases and demand in public health. This study aimed to assess whether the score of Primary Health Care (PHC) is associated with a) the model of care - Family Health Strategy (FHS) vs. traditional care model (the Basic Health Units; BHU); b) morbid conditions such as - hypertension, diabetes mellitus, mental disorders, chronic pain, obesity and central obesity; c) quality of life in elderly individuals who received care in those units.

The purpose of this educational resource is to illustrate that by using a more person-centred care approach, undergraduate healthcare students can improve both the quality of their practice and the wellbeing of the person with dementia.