Promoting Wellness in Aging Females

     Introduction

In Module 3, some serious topics that most people are hesitant to talked about will be discussed. Elderly suicide and abuse, death and dying, and mobility and safety will be discussed.  In this paper, I will discuss interventions to avoid elderly suicide abuse. Safety and mobility interventions such as infection control, avoiding medication errors, and nutrition. I will also explain the important legal measures that need to be in place before a person dies such as Living Wills, Last Will and Testament, and Medical Power of Attorney.

     Module 3

MOBILITY AND SAFETY

1. Sufficient fluid intake:

1.Encourage fluids, 3.7L/day for men and 2.7L/ day for women (Eliopoulos, 2014).

2.Keep fluids easily accessible and provide foods that are high in fluid content such as sherbet, soup, and gelatin (Eliopoulos, 2014).

2. Adequate Nutrition:

1. Encourage patients to eat 5-7 servings of fruits and vegetables daily (Eliopoulos, 2014).

2.Adivise patient to avoid a high carbohydrate diet because it can stimulate an abnormally high release in insulin which could lead to hypoglycemia (Eliopoulos, 2014).

3. Sensory problems (visual or hearing):

1. For individuals with reduced peripheral vision, furniture should be arranged in the persons full range of view (Eliopoulos, 2014).

2.cleanning solutions, medications, and other hard to see products should be labeled in large letters to prevent errors (Eliopoulos, 2014).

4. Stable Body temperature:

1. When it cold: set the thermostat between 68- 70 degrees Fahrenheit, and wear layers loose fitting clothes around the house (Woods, 2015).

2. When it is hot: drink lots of fluids to avoid dehydration, and if the patient must go outside, advise them the go out early in the morning or in the evening (Woods, 2015).

5. Infection prevention:

1. Encourage patient to keep vaccine up-to-date (Eliopoulos, 2014).

2.   Caution patient to be careful not to create situations that predispose them to infection such as immobility, poor hygiene, and malnutrition (Eliopoulos, 2014).

6. Wise Medication habits:

1. Encourage patient to keep a current list of medications including prescriptions, OTC drugs, nutritional supplements, and herbal remedies. Show the physician the list of medications (Eliopoulos, 2014).

2. Encourage patient to periodically review drug doses with the health care provider to see if there have been any changes in the patient’s body function could lead to a reduced dosage (Eliopoulos, 2014).

7. Crime prevention:

1. Encourage patient when negotiating contracts and making important financial choices, to consult with trusted family members or professional before making a decision (Eliopoulos, 2014). 

2.Advise patient not to travel alone at night or early morning hours, and to use caution when opening doors to strangers (Eliopoulos, 2014).

8. Safe Driving:

1. Assist patient in identifying risks that reduce safe driving efforts such as poor vision, and medication use that reduce alertness (Eliopoulos, 2014).

2. Encourage patient to drive only during daylight hours, non-congested areas, and in good weather conditions (Eliopoulos, 2014).

ETHICAL AND LEGAL – Part 1

A medical POA is a trusted person who is appointed to make medical decisions for someone who is no longer competent or in an emergency. They make decisions on your behalf that is not listed in your living will.  This person merely fills in the gap. A living will is a document that list a set of medical wishes that person may want in case something happens and you are not able to speak for yourself.  A living will include topics like DNR orders, desired end of life treatments, and resuscitation orders. (Huntsberry-Lett, 2017). I think people should have both because you may have left something of the living will and the medical POA can ensure that you wishes is followed.  Also, if the family every doubt the medical POA decisions, the family will have something to reference.

A living will is a medical directive that allows you to tell your physicians the type of life sustaining directives they can perform, withhold and withdraw in the event that you are unable to make decisions.  A last will and testament is a legal document that outlines how an individual’s property and estate will be distributed when they die. It also allows for an individual to decide who will care for their children, and creates trusts for the spouse (Combs, 2013).

Yes, I have a living will. After my grandmother passed away in 2016 I realized how important it to have one to have your medical wishes fulfilled. My mother, father, and two sisters have copies of it. The last time I updated my living will was in May of 2018. You should update your living will yearly (Lone star Advocate, 2016).

I did not have a medical POA prior to this assignment. While filing out a medical POA, I realized how important it is to have one since it fills the gap between what is and is not included in the living will. I gave copies to my Mother, Father, and two sisters because I trust them, and I do not want them to be in the dark about my medical decisions.

A guardian is someone who is appointed by the court to make decision on an individual’s behalf who is not capable because of injuries, illness or disability (Rosenau).  The guardian is appointed if the person is considered incapacitated (the individual is unable to understand the facts about his or her financial, health care, or living situation well enough to make decisions about any or all of those matters, or clearly communicate his or her wishes about any or all of those matters) (Rosenau). No, someone cannot have both a guardian ad medical POA because an incapacitated person cannot make a valid decision of a POA. If the patient wants something different than what the guardian decides, the patient must present his or her concerns to a judge and let the courts decide which decision to follow (Texas Guide to Adult Guardianship). A guardian can be trusted family member, spouse, adult child, or parent. They must be at least 18 years old. If a patient made a living will less than 5 years prior to the guardianship, it is still in effect when the guardianship begins (Rosenau).

This assignment helped me be a better nurse because I can now educate my patient about advance directives and how important they are to have in the event they cannot speak for themselves.

Ethical and Legal -Part 2

If I was instructed to discharge a patient whose care is no longer being reimbursed, but I know the patient is not ready for discharge I would voice my concerns to the nurse manager and case manager. I would then, talk to my patient’s physician to see if there is anything he/she could do. If voicing my opinion and concerns does not work, I would research programs and resources that could help with the cost. If all my advances fail, I would discharge my patient, but I would do a lot of patient teaching and ensure that the patient can care for themselves or have a family member assist. I send my patient home with a lot of resources relating to their condition.

If my patient had a living will stating that he does not want to be put on any life-support machines, but the doctor responded to his low oxygen levels by intubating him and placing him on a respirator despite of his living will, I would first have a conversation with the doctor and re-inform of my patients living will decision. If the doctor does not correct the mistake I would notify my nurse manger and ethics committee of the doctor’s error.

SUICIDE IN THE ELDERLY POPULATION

1. What is the suicide rate in the elderly population in the USA?

18.98 out of every 100,00 is t suicide rate for the elderly in the U.S(American Foundation for Suicide Prevention, 2017).

2. Is the suicide rate the same for males and females in the USA?

No, suicides rates with women decrease after 60. The suicide rate for men increases as they age (Scheib, 2017).

3. Which elderly population is at the highest risk for suicide in the USA?

Elderly white men account for 29 suicides out of every 100,00 people (Scheib, 2017).

4. Around the globe, which country has the highest rate of elderly suicide?

China has the highest rate of elderly suicide. The Chinese suicide rate is 34.8 out of every 100,000(Bao-Liang, Chiu, & Yeates, 2016).

5. Which state has the highest rate of elderly suicide?

Nevada, the suicide rate is 29.97 out of every 100,000 people (CDC, 2014).

6. Which state has the lowest rate of elderly suicide?

The District of Columbia, the suicide rate is 7.71 out of every 100,00 people (CDC, 2014).

7. Which states have legal physician-assisted suicide?

The states that have legal physician assisted suicides is: California, Colorado, District of Columbia, Oregon, Vermont, Washington and Montana (Death with Dignity, 2018).

8.What are the Texas laws on assisted suicide? 

In Texas, it is against the law to assist or promote the commission of suicide against another (Texas Statutes Section 22.08).

9.What are the 5 top triggers in older adult suicide?

1. Physical discomfort (Lee et al, 2014).
2. Loss of family members or friends (Lee et al, 2014).
3. Conflicts with family or friends (Lee et al, 2014).
4. Loneliness (Lee et al, 2014).
5. Illness (Lee et al, 2014).

10.List 5 early indicators that an elderly person is thinking and planning to commit suicide

1. Social isolation (Mental Health America, 2015).
2. Feeling of marked hopelessness (Mental Health America, 2015).
3. Giving away most prized processions (Mental Health America, 2015).
4. Daring risky behavior (Mental Health America, 2015).
5. Personality changes (Mental Health America, 2015).

11.List 5 things that can be put in place as preventions against elderly abuse

1. Avoid isolating elders (Traxler, 2018).
2. Keep elders active (Traxler, 2018).
3. Don’t allow elders to live with people known to be violent, and those who use illicit drugs (Traxler, 2018).
4. Encourage elders to attend religious and community activities (Traxler, 2018).
5. Make sure the elders are aware of their own financial affairs (Traxler, 2018).

12.List 5 resources you can provide for the family and the patient.

 As a student nurse I can,

1. Provide the phone number and information about the National Suicide Prevention Lifeline (Texas Nurses Association, 2017).
2. Refer the patient to a mental health counselor (Texas Nurses Association, 2017).
3. Refer the patient to supports groups that suits their interest (Texas Nurses Association, 2017).
4. Provide the patient and the family information about Houston’s local crisis center for mental health and IDD (Texas Nurses Association, 2017).
5. Provide the patient information about the Texas Department of State Health Services Suicide Prevention website (Texas Nurses Association, 2017).

Consultant Questions

 The current medications Maxine takes is Lasix, Lantus glargine insulin, and metformin. Maxine goes to Walgreens to pick them up. Maxine did know about the law, but she only remembers the pharmacist teaching her the side effects, and usage of the medication when it was a new medication. She receives written instructions more than receiving education verbally from the pharmacist. Maxine feels that the instructions could be simplified and in larger print. When Maxine questions her medication, she calls her doctor’s office. Maxine feels that medication is necessary to continue do live with chronic diseases and have no problems complying with her medication schedule. Maxine only had her current medications, multivitamin, and vitamin D supplements in her medication bag. I was surprised to see how clean she kept her medication bag. I was expecting to see a lot of expired and discontinued medications. Maxine stated that she sometimes forgets if she took her medication for that day, so I brought her a pill container. The pill container has morning, afternoon and night columns, with Sunday through Saturday rows. With the pill container, we minimized the risk of Maxine forgetting to take her medication and stopped her from taking an extra dose of medication.

Maxine knows the difference between a Living Will, and Last Will and Testament. She also knows the difference between a Medical Power of Attorney and Living Will.  I was not expecting Maxine to know the difference but was happy she did.  Maxine does have a Living Will, and she feels is it very important to have to avoid her family having conflict when she passes away. She also has a Last Will and Testament but not a Medical Power of Attorney. Her husband, and her six children has copies of her Living Will. The last time she updated her Will was 6 years ago. I encourage Maxine that she should review and update her Living Will every year.

Maxine remembers going to a lot of funerals when she was young because she had a lot of elders in her family.  She remembers people dressed in all black and sobbing. Maxine stated that she disliked going to funerals because she did not like being around a lot of sadness. Maxine asked her mother when was young, why people cried at funerals, and was told that they were rejoicing since they were in a much better place.

Maxine stated she enjoyed being my consultant because the questions made her think about things she thought she forgot. A memory that Maxine will not is the day she had her first child, Spence. She stated to this day that was the worst pain she has ever endured.

My attitudes on aging was accurate and is unchanged. I have always viewed aging as beautiful process. The biggest misconceptions that was disband was I though all elders did not get enough exercise. Maxine proved that to be inaccurate since she walks 2-3 miles a day. I also thought that most of the elderly was grumpy and had attitudes because they could get away with it. Again, Maxine proved that to be wrong, Maxine was very gracious, kind and funny throughout encounters. Maxine and I interactions was knowledgeable, and positive. Most of time when I would come visit her, she would cook me a nice meal.I am happy that I got to know Maxine and I am satisfied with our relationship we have developed.

References

• Bao-Liang, Z., Chiu, H., & Yeates, C. (2016, September 09). Rates and characteristics of elderly suicide in China, 2013–14. Retrieved November 15, 2018, from https://www.sciencedirect.com/science/article/pii/S0165032716308771
• Combs, R. (2013, February 13). What Is The Difference Between A Living Will And A Last Will and Testament? Retrieved November 15, 2018, from https://texaswillsandtrustslaw.com/2013/02/13/what-is-the-difference-between-a-living-will-and-a-last-will-and-testament/
• Elder abuse. (2018, June 8). Retrieved November 15, 2018, from http://www.who.int/news-room/fact-sheets/detail/elder-abuse
• Eliopoulos, C. (2014). Gerontological nursing. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
• Hoover, R. M., & Polson, M. (2014, March 15). Detecting Elder Abuse and Neglect: Assessment and Intervention. Retrieved November 15, 2018, from https://www.aafp.org/afp/2014/0315/p453.html
• How to Identify Elder Abuse and How to Report It. (2018, September 24). Retrieved November 15, 2018, from https://www.aplaceformom.com/blog/for-professionals/2-26-16-identifying-elder-abuse/
• How to Access and Use Death with Dignity Laws. (2018). Retrieved from https://www.deathwithdignity.org/learn/access/
• Huntsberry-Lett, A. (2017, December 27). The Difference Between POA, Durable POA and a Living Will. Retrieved November 15, 2018, from https://www.agingcare.com/Articles/difference-between-POA-durable-power-of-attorney-living-will-140435.htm
• Kregal, K. (n.d.). Body Temperature. Retrieved November 15, 2018, from https://healthyagingproject.org/aging-basics-tips/body-temperature/
• Lee, S. H., Tsai, Y. F., Chen, C. Y., & Huang, L. B. (2014). Triggers of suicide ideation and protective factors of actually executing suicide among first onset cases in older psychiatric outpatients: a qualitative study. BMC psychiatry, 14, 269. doi:10.1186/s12888-014-0269-9
• Preventing Suicide in Older Adults. (2015, April 28). Retrieved from http://www.mentalhealthamerica.net/preventing-suicide-older-adults
• Rosenau, K. (2017). Guardianship and Conservatorship. Retrieved from: https://www.lawhelp.org/dc/resource/guardianship-and-conservatorship-frequently-a
• Scheib, D. (2017, July 25). Suicide is a dismal topic to discuss, but remains an important subject to be aware of as it is the tenth leading cause of death in the United States…. Retrieved November 15, 2018, from https://www.seniorlivinglink.org/articles/senior-living-blog/post/high-suicide-rates-among-seniors-in-the-united-states
• Span, P. (2013, August 07). Suicide Rates Are High Among the Elderly. Retrieved November 15, 2018, from https://newoldage.blogs.nytimes.com/2013/08/07/high-suicide-rates-among-the-elderly/?_r=0
• Traxler, C. (2018, January 24). Preventing Elder Abuse – Learn How You Can Prevent Elderly Abuse. Retrieved November 15, 2018, from https://www.nursinghomeabusecenter.com/elder-abuse/prevention/
• Traxler, C. (2018, October 6). Elder Abuse Statistics – Statistics on Elderly Abuse Over Time. Retrieved November 15, 2018, from https://www.nursinghomeabusecenter.com/elder-abuse/statistics/
• Texas Health and Human Services Commission. (2013). Texas Guide to Adult Guardianship. Retrieved from: https://hhs.texas.gov/sites/default/files/documents/laws-regulations/legal-information/guardianship/pub395-guardianship.pdf
• Texas Penal Code § 22.08 (1994). Retrieved from: https://texas.public.law/statutes/tex._penal_code_section_22.08
• Valente, S. (2018) End of Life Care Fact Sheet. https://www.apa.org/pi/aging/programs/eol/end-of-life-factsheet.aspx
• What is Active Dying? (n.d.). Retrieved November 14, 2018, from https://www.crossroadshospice.com/hospice-caregiver-support/end-of-life-signs/what-is-active-dying/
• Woods, M. (2015, December 12). Health Library. Retrieved November 15, 2018, from https://hcahealthcare.com/hl/?/13365/Climate-Temperature-Troubles-With-Older-Adults–What-You-Need-to-Know
• (2016, July 12). Your Questions, Answered: Can I Update my Will? Retrieved from https://texaslegal.org/texaslegal-blog/questions-answered-can-update-will

Appendix

Death and Dying

1. State each of the stages of dying as described by Kubler-Ross.

• Denial
• Anger
• Bargaining
• Depression
• Acceptance

2. Give an example of at least 5 nursing measures that can be effective for the stage and explain why they would be effective, based on your research.

• Denial- Encourage the patient to express his feelings of how he feels about dying. The nurse can open the floor to allow honest, effective communication. Instead of trying to figure out the conflicting messages and defenses a patient may give while in the denial stage, the nurse should accept it and be sensitive.
• Anger- If the dying patient is being judgmental, critical, or rude towards the nurse, the nurse should not take it personal. The nurse should associate the behavior with the anger stage of dying, and continue to make the environment as comfortable as possible for the patient.
• Bargaining- Nurses should discuss the patient feelings about whether their bargain was honored or not. (Eliopoulos, 2014).
• Depression- The nurse can reassure the family that this kind of depression is normal and necessary for the patient to progress toward having peace and acceptance of their death. (Eliopoulos, 2014).
• Acceptance- The nurse can use nonverbal communication such as touching, clearing out the noisy patient room when they seem stress and comforting measures such as hugging if appropriate. The nurse can teach the family how to understand and support the dying patient.

3. List actions that nurses could advise widows and widowers to take following the death of a spouse.

• The nurse could advise the widows or widowers to seek professional help if they are having a hard time coping with the death of their husband/wife.
• They should have their family around them, so they can act as a support system. The nurse should encourage the widower/widows to maintain a healthy lifestyle.

4. Include agencies that must be notified, sources of support, meal planning, etc.

• The nurse should notify the family and the physician when the patient passes away.
• The nurse show watch for impending signs of death so that the family could have an adequate amount of time to spend with the patient.
• The Social security, administration, financial/banking institutions, credit bureaus and insurance companies after a death.

5. What is active dying? Where do most deaths occur?

Active dying is the final stage of death. Active dying lasts roughly three days.  Signs/symptoms of active dying is a drop-in blood pressure, urinary and bowel incontinence, long pauses in breathing, cold extremities, irritable moods, and changes in the patient’s skin color (Crossroads hospice and palliative care, 2018). Most deaths occur in acute care hospitals (Valente, 2018).

Elder Abuse

1. Identify at least six of these risk factors for elder abuse and briefly explain your rationale based on your research.

• Physical, functional, or cognitive problems in caregivers can prevent them from providing proper care (WHO, 2018).
• Alcoholism, or drug abuse in the older person or the caregiver may be associated with abuse and neglect (WHO, 2018).
• Social isolation of the elderly person may increase the risk for mistreatment (WHO, 2018).
• Dependency on elder, the caregiver financially depending on the elder they are caring for increases risk of abuse (WHO, 2018).
• Poor health and mental disorder of the elder increases chances of abuse because they are assumed to be helpless (WHO, 2018).
• Sharing a living space with caregiver (WHO, 2018).

2. List at least 3 reasons for the risk of legal problems being high in gerontology nursing and explain your answers.

• Malpractice, nurses deviate from the standard of care such as medication errors and failing to notify physician in a timely matter of patients changing condition. (Eliopoulos, 2014).
• Confidentiality, a lot of medical professions have asses to the patient’s’ medical information that could easily fall in the wrong hands (Eliopoulos, 2014).
• Patient consent, it is easy for a consent to be looked over since some procedures have become routine, or a patient is not mentally capable of signing a consent for procedure, but they signed the consent anyway (Eliopoulos, 2014).

3. What are the guidelines for elder abuse treatment?  For example: what role will different agencies play? What are the actions to take once elder abuse is suspected and detected?

  Once elder abuse is suspected a nurse should perform a Head -toe assessment. The caregiver should note of his or her changes in behavior, take photographs of injuries, note descriptions of the victim’s injuries, note statements from the victim and note statements from any witnesses (A place for my mom, 2018). After the assessment and interviews, the physician needs to contact the local services and APS to determine the next steps (Hoover & Polson, 2014).

4. What are the top 5 places elder abuse occurs the most? 5. What percentage of elder abuse occurs in each place?

• Family members (90%) (Traxler, 2018).
• Nursing facility (44%) (Traxler, 2018).
• Friends and neighbors (16.9%) (Traxler, 2018).
• Home care aides (14.9%) (Traxler, 2018).
• Long-term care facilities (9%) (Traxler, 2018)