NSG 4067 Gerontologic Nursing

Gerontologic Nursing

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Introduction

Function-focused care interventions concentrate on function areas such as incontinence, mobility, cognitive, self-care as well as psychosocial and include the below elements: teamwork, individualized assessment, goal setting, staff education and documenting outcomes to remove the cycle of dependency among residents and promote functioning of individuals (Su et al., 2019). Older people require extensive assistance in relation to toileting, locomotion, dressing, personal hygiene, mobility and eating since they fall under the category of groups considered to be functionally disabled (Resnick et al., 2020).

The Comprehensive Older Person’s Evaluation Tool 

Due to the advanced age of Peter Ken (68 years) a Comprehensive Geriatric Assessment (CGA) tool was used to assess his overall specific aspects functioning. The assessment was done on 10th day of December 2020. CGA provided comprehensive information on cognitive, clinical and functional domain of the case. It integrates social adaptability, mental health, environmental conditions, physical health and functional status (Aronoff et al., 2020). The single measurement instruments used include general questionnaire, gill frailty instrument, frailty risk index, cumulative illness rating scale for geriatrics, fried frailty instrument, ADL index, IADL index, rapid disability rating scale and Berg Balance Scale. 

 Biologic Theory 

The best applicable theory of aging to Peter Ken case is Immunological Theory proposed by Roy Walford in 1964. He argued that as age of human beings advance, their capability to combat harmful diseases decrease. The immune system is projected to weaken over a period of time increasing the vulnerability to contagious illnesses and eventually the individual age and die (Sholl et al., 2020). This theory further suggest that as one advance in age, antibodies become less effective and lose ability to effectively combat new diseases causing stress to body cells which eventually die (Johnson et al., 2019). Immunological theory best fits Peter Ken case’s life experience because at the moment, he is presently suffering from multiple new infections and diseases such as atherosclerosis and neurodegenerative diseases indicating that his immune system is weak.

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 Stages of Change Model

Change models can be executed using four main stages namely: pre-contemplation, contemplation, preparation, and action. Individuals in this stage do not think seriously on how to change since they do not see any problem with their body state (Krebs et al., 2018). Any adverse results of their condition is outweighed by their perceived benefits so they are comfortable maintaining the status quo. Ken is going through a normal ageing process hence this cannot be considered as negative experience. Nevertheless, issues of atherosclerosis and neurodegenerative diseases threw him into ‘contemplation stage’ where he has started to experience some adverse health effects and at this stage he is aware about his condition but ambivalent about adopting the next condition to improve (Raihan and Cogburn., 2020). The best intervention at this stage is to move Ken to the preparation stage where he will be guided and presented with the needed information to support him in eliminating the uncertainty. 

At preparation stage individuals make some progress to change behaviour. They believe that it is necessary to change and start embracing it. Ken could have gathered some information about how to seek specialized medical care to improve his condition from close family members, self-help books, change-oriented programs and counseling (Pietrabissa et al., 2017). The intervention at this stage would be to refer Ken to a specialist for his condition and seek their medical attention. In ‘action’ stage of change the person is highly involved in adopting the change of their behaviour. The individual is expected to totally abstain and get out of the adverse condition for duration of less than six months (Raihan and Cogburn., 2020). At this stage Ken has undergone treatment of atherosclerosis and neurodegenerative diseases and is willing to receive further support and assistance.

Conclusion

Function-focused care and screening is important in evaluation of older people’s capacity to carry out a number of daily activities and self-care. Comprehensive older person’s assessment tool provided comprehensive information on cognitive, clinical and functional domain of the case and the single measurement instruments were very effective in determination of all the parameters under study. Ken could respond to most of the questions asked and perform activities required by various tools in spite of his condition which was well captured and elaborated by Immunological Theory. As a result the four phases of change model were employed to give recommendations on interventions needed to improve atherosclerosis and neurodegenerative conditions in Ken.
References

Aronoff-Spencer, E., Asgari, P., Finlayson, T. L., Gavin, J., Forstey, M., Norman, G. J., ... & Agha, Z. (2020). A comprehensive assessment for community-based, person-centered care for older adults. BMC Geriatrics, 20, 1-12. 

Johnson, A. A., Shokhirev, M. N., & Shoshitaishvili, B. (2019). Revamping the evolutionary theories of aging. Ageing Research Reviews, 55, 100947.  

Krebs, P., Norcross, J. C., Nicholson, J. M., & Prochaska, J. O. (2018). Stages of change and psychotherapy outcomes: A review and meta‐analysis. Journal of Clinical Psychology, 74(11), 1964-1979.

Pietrabissa, G., Sorgente, A., Rossi, A., Simpson, S., Riva, G., Manzoni, G. M., ... & Castelnuovo, G. (2017). Stages of change in obesity and weight management: factorial structure of the Italian version of the University of Rhode Island Change Assessment Scale. Bulimia and Obesity, 22(2), 361-367.

Raihan, N., & Cogburn, M. (2020). Stages of Change Theory. In StatPearls [Internet]. StatPearls Publishing.

Resnick, B., Boltz, M., Galik, E., Fix, S., Holmes, S., Zhu, S., & Barr, E. (2020). Testing the Implementation of Function-focused Care in Assisted Living Settings. Journal of the American Medical Directors Association.

Sholl, J. (2020). The sciences of healthy aging await a theory of health. Biogerontology, 1-11.

Su Jung, L. E. E., Mi So, K. I. M., & You Jin, J. U. N. G. (2019). The effectiveness of function-focused care interventions in nursing homes: a systematic review. The Journal of Nursing Research, 27(1), 1.