Clinical guide age related
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Gerontologic Nursing FIFTH EDITION
Sue E. Meiner, EdD, APRN, BC-GNP President Consultant on Health Issues, Inc. McKinney, Texas; Formerly: Nurse Practitioner in Private Practice Las Vegas, Nevada; and Assistant Professor University of Nevada, Las Vegas Las Vegas, Nevada
3251 Riverport Lane Maryland Heights, Missouri 63043
Gerontologic Nursing, Fifth Edition ISBN: 978-0-323-26602-4 Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Copyright © 2011, 2006, 2000, 1996 by Mosby, an imprint of Elsevier Inc.
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Nursing Diagnoses: Definitions and Classifications 20122014, Herdman T.H. (ED). Copyright 2012, 19942012, National International; used by arrangement with John Wiley & Sons, Limited. In order to make safe and effective judgments using NANDA-I diagnoses it is essential that nurses refer to the definitions and defining characteristics of the diagnoses listed in this work.
Library of Congress Cataloging-in-Publication Data Gerontologic nursing (Lueckenotte) Gerontologic nursing / [edited by] Sue E. Meiner. Fifth edition. p. ; cm. Includes bibliographical references and index. ISBN 978-0-323-26602-4 (pbk. : alk. paper) I. Meiner, Sue, editor. II. Title. [DNLM: 1. Geriatric Nursing. 2. Agedpsychology. 3. Chronic Diseasenursing. 4. Long-Term Care. 5. Terminal Care. WY 152] RC954 618.97’0231dc23 2014034663
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Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions.
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I want to thank the many people that have contributed to the continued success of this book, especially the original editor (Annette G. Lueckenotte), and the contributors to this
and previous editions. The knowledge and time that was given was greatly appreciated. A special thanks to Jennifer J. Yeager, PhD, RN, and Ramesh C. Upadhyaya, RN, CRRN, MSN,
MBA, PhD-C, who were exceptionally helpful in this 5th edition.
Thanks to the entire team at Elsevier for the production of this book. Each phase of work was done with care and patience. Thank you for a job well done.
Love and thanks go to Bob Meiner, my husband of 43 years whose patience was unending during the revisions of this book. To the joys of my life – my daughters, Diane and Suzanne,
and grandsons, Tristyn and Braedyn, your love keeps me motivated.
Sue E. Meiner
A B O U T T H E A U T H O R
Sue E. Meiner, EdD, APRN, GNP-BC, began her nursing career in 1962 in St. Louis, Missouri. She began as a Licensed Practical Nurse (L.P.N.) prior to the availability of Associate Degree Nursing pro- grams in the Midwest. She graduated from the second class of the Associate in Applied Science degree (A.D.N.) program from St. Louis Community College (Meramec campus).
Continuing her education in nursing, she completed a Bachelor of Science in Nursing (B.S.N.) and a Masters of Science in Nursing (M.S.N.) from St. Louis University. Later she received her Doctor of Education (EdD) from Southern Illinois University at Edwardsville, and a Certificate as a Gerontological Nurse Practitioner from the Barnes-Jewish Hospital College of Nursing in St. Louis. Dr. Meiner held cer- tifications as both a Gerontological Clinical Nurse Specialist and a Gerontological Nurse Practitioner from the American Nurses Credentialing Center (A.N.C.C.) of the American Nurses Association (ANA). Additional courses toward counsel- ing were taken at Lindenwood College, St. Charles, Missouri. She has received numerous awards and has been asked to speak
at local, regional and national conferences and workshops. Dr. Meiner worked as a staff nurse in hospitals in the St. Louis area as well as home health nursing. Over time she worked as a hospital nursing supervisor and interim Director of Nursing. While her main clinical interest was in medical-surgical nurs- ing, she began to focus on the special care needs of the older adult. She has practiced nursing for over 50 years; however, the last 30 years have been heavily focused in geriatric nursing. She has taught nursing at the L.P.N., A.D.N., B.S.N., and M.S.N. levels of education. She has been the Director of Nursing Programs at the L.P.N. and A.D.N. levels. Before returning to full-time clinical practice in Las Vegas as a Nurse Practitioner, she taught the final course of clinical nursing at the masters level at the University of Nevada, Las Vegas, School of Nursing. Her clinical practice was directed at chronic and tertiary pain management, with a focus on the needs of the older adult. Dr. Meiner has engaged in the support of nursing through advo- cacy of both nurses and patients and their families by serv- ing part-time as a Forensic Nurse. She has been active in legal nurse consulting since 1988 and incorporated her company in the early 2000s. Throughout those 25 years, she provided case reviews and expert witness testimony at depositions and trials across the United States. She authored and edited, Nursing Documentation: Legal Focus across Practice Setting, in 2000, as well as authored, co-authored, or edited multiple textbooks, and has written multiple professional articles on nursing care and issues. During 5 years in the 1980s, she was elected to serve her community of Creve Coeur, MO as a Director of the Fire Protection District. In her free time, Dr. Meiner enjoys national and international travel and spending time with her family.
C O N T R I B U T O R S A N D R E V I E W E R S
Dr. Jean Benzel-Lindley, PhD, RN Assistant Director of Nursing Nevada Career Institute Las Vegas, Nevada
Jacqueline Kayler DeBrew, PhD, MSN, RN Clinical Professor University of North Carolina at Greensboro Greensboro, North Carolina
Sabrina Friedman, EdD, DNP, FNP-C, PMHCNS-BC Associate Professor Azusa Pacific University Azusa, California
Laurie Kennedy-Malone, PhD, GNP-BC, FGSA Professor of Nursing University of North Carolina at Greensboro Greensboro, North Carolina
Cindy R. Morgan, RN, MSN, CHC, CHPN Associate VP of Hospice, Palliative Care &
Clinical Innovations Association of Home Health and Hospice Raleigh, North Carolina
Elizabeth C. Mueth, MLS, AHIP Resource Center and Archives Coordinator Missouri Baptist Medical Center Saint Louis, Missouri
Kathleen M. Rourke, PhD, MSN, RD, RN Associate Professor of Nursing Director of Graduate Program in Nursing Administration State University of New York Polytechnic Institute of
Technology Utica, New York
Deb Bagnasco Stanford, MSN, RN, CCRN Clinical Assistant Professor University of North Carolina at Greensboro Greensboro, North Carolina
Marie H. Thomas, RN, PhD, FNP-C, CNE Clinical Assistant Professor NP Coordinator School of Nursing University of North Carolina Charlotte Charlotte, North Carolina
Ramesh C. Upadhyaya, RN, CRRN, MSN, MBA, PhD-C Consultant, Acute and Home Care Licensure Section Division of Health Service Regulation Department of Health and Human Services Raleigh, North Carolina
Lois VonCannon, RN, MSN Clinical Associate Professor University of North Carolina at Greensboro Greensboro, North Carolina
Jennifer J. Yeager, PhD, RN Assistant Professor Tarleton State University Stephenville, Texas
Shelba Durston, MSN, RN, CCRN, SAFE Professor of Nursing San Joaquin Delta College Stockton, California San Joaquin General Hospital French Camp, California
Barbara Hulsman, RN, PhD Associate Professor Coordinator of Education Track Division of Graduate Studies in Nursing Indiana Wesleyan University Marion, Indiana
Roberta Imhoff, RN, BSN, MSN, CNE, CCRN Home Care Registered Nurse Sparrow Health System Lansing, Michigan Clinical Nursing Instructor Baker College of Owosso School of Nursing Owosso, Michigan
Laura Ann Jaroneski, MSN, RN, OCN, CNE Nursing Instructor Baker College of Clinton Township Clinton Township, Michigan
Shari Kist, PhD, RN, CNE Assistant Professor Goldfarb School of Nursing at Barnes-Jewish College Saint Louis, Missouri
Amy J. Ponder, RN, MSN Instructor University of Alabama at Birmingham Birmingham, Alabama
Gail Potter, RN, BScN, MDiv, MN, CGN(C) Nursing Faculty Selkirk College Castlegar, BC, Canada
Barbara D. Powe, PhD, RN, FAAN Director, Cancer Communication Science American Cancer Society Atlanta, Georgia
Elizabeth Sibson-Tuan, RN, MS, AACN, ANA Bay Area Clinical Coordinator Instructor Samuel Merritt University Oakland, California
Anne Van Landingham, RN, BSN, MSN Nursing Instructor Orlando Tech Orlando, Florida
Jeana Wilcox, PhD, RN, CNS, CNE Associate Dean for Undergraduate Programs Associate Professor of Nursing Graceland University School of Nursing Independence, Missouri
viii CONTRIBUTORS AND REVIEWERS
P R E FA C E
The field of gerontologic nursing has blossomed over the past decades as the population of baby boomers enters retirement age. The demand of health care for older adults is an ever- growing challenge. Age-appropriate and age-specific care is an expectation of current and future nurses across the globe. The varied issues related to health and wellness must be provided within a cost-effective and resource-sparse environment. The largest group of patients in hospitals (outside of obstetric and pediatric units) is older adults. Long-term and rehabilitation specialty facilities have predominantly older adults as residents. The specialty of gerontologic nursing is in greater demand now more than ever before.
Gerontologic Nursing, fifth edition, has been developed to provide todays students with a solid foundation to meet the future challenges of gerontologic nursing practice. This text- book provides comprehensive, theoretic, and practical informa- tion about basic and complex concepts and issues relevant to the care of older people across the care continuum. The extensive coverage of material provides the student with the information necessary to make sound clinical judgments while emphasiz- ing the concepts, skills, and techniques of gerontologic nurs- ing practice. Psychologic and sociocultural issues and aspects of older adult care are given special emphasis, but they are also integrated throughout the textbook, reflecting the reality of practice with this unique population. Care of both well and sick older people and their families and caregivers is included.
Intended for use by undergraduate nursing students in all levels of professional nursing programs, Gerontologic Nursing was developed for use in either gerontologic nursing or medical- surgical courses, or within programs that integrate gerontologic content throughout the educational program.
ORGANIZATION The 29 chapters in Gerontologic Nursing are divided into six parts. Part 1, Introduction to Gerontologic Nursing, includes four chapters that serve as the foundation for the remainder of the textbook. Chapter 1 introduces the student to the specialty by addressing historical developments, educational preparation and practice roles, future trends, and demographic factors rel- evant to the health and well-being of older people. Basic tenets of selected biologic, sociologic, and psychologic theories of aging and their relevance to nursing practice are presented in Chapter 2. Chapter 3 presents an overview of practice standards, legal issues, and relevant laws applicable to the care of older adults across the care continuum and describes the principles of values and ethics associated with the care of older people. Chapter 4 discusses the importance of a nursing-focused assess- ment, special considerations affecting assessment of older people, and strategies and techniques for collecting a compre- hensive health assessment. Functional, mental status, affective and social assessment tools and techniques are included.
Part 2, Influences on Health and Illness, includes chapters on cultural, family, and socioeconomic and environmental influ- ences. Health promotion and illness/disability prevention are also included. The final chapter in this part presents an in-depth look at various health care delivery settings. Chapter 5 presents cultural concepts within the contexts of aging and the health and illness experiences of older people. Roles and functions of families, common family issues and decisions in later life, and family caregiving are described in Chapter 6. Specific tools and techniques for working with aging families, including crisis intervention, are also explained. Chapter 7 presents an overview of socioeconomic and environmental factors that affect health and illness, including issues associated with resource availabil- ity. Advocacy by and for older adults is included. Chapter 8 introduces the concepts of health promotion, protection, and disease prevention as they apply to older adults and includes strategies for health promotion activities with this population. Chapter 9 presents issues and trends associated with the care of older people in acute, home, hospice, and long-term care settings.
Part 3, Wellness Issues, details the needs and nursing care of older adults in the areas of nutrition, sleep and activity, safety, and sexuality issues. Chapter 10 explores the role of nutrition in health and illness, including nutritional requirements, screen- ings and assessments, therapeutic diets, and other nutritional support and therapies. Age-related factors in maintaining a balance between sleep and activity and their effect on the older persons lifestyle are discussed in Chapter 11. Chapter 12 stresses the importance of a safe environment within the context of maintaining the older persons autonomy. Chapter 13 sensitively addresses the intimacy and sexuality needs of older adults, offering practical management strategies. Each chapter in this section presents the age-related changes in structure and func- tion and nursing interventions to promote healthy adaptation to the identified changes.
Part 4, Common Psychophysiologic Stressors, focuses on the special needs of older adults with pain, infection, cancer, chronic illness, and nursing care related to loss and end-of- life issues. Chapter 14 provides an overview of pain and the special issues surrounding pain management in older people. The importance and significance of immunity and factors affecting immunocompetence in aging, as well as associated common problems and conditions, are explored in Chapter 15. Chapter 16 examines the concepts of chronic illness and reha- bilitation in aging, as well as the related concepts of compli- ance, self-care, functional ability, psychosocial and physiologic needs, and the impact on family and caregiver. The nursing management of older adults with the most commonly occur- ring cancers is addressed in Chapter 17. Chapter 18 discusses the topics of loss and end-of-life issues. Differences between the loss and death experiences of older people and younger adults are reviewed. All of these chapters emphasize the nurses role
in effectively managing the nursing care of older patients with these problems.
Part 5, Diagnostic Studies and Pharmacologic Management, includes chapters on laboratory and diagnostic tests and phar- macologic management. Principles of laboratory testing in older adults, including age-related factors that influence labo- ratory values and age-specific values for hematologic, blood, and urine chemistry, are presented in Chapter 19. Chapter 20 contains current and comprehensive information on the critical issue of medications and the myriad of issues pertinent to drug use in this population. Substance abuse issues are included in this chapter.
Part 6, Nursing Care of Physiologic and Psychologic Disorders, contains nine chapters that detail nursing manage- ment of older adults with diseases or conditions of cardiovas- cular, respiratory, endocrine, gastrointestinal, musculoskeletal, urinary, cognitive and neurologic, integumentary, and sensory function.
In organizing the textbook every attempt was made to ensure a logical sequence by grouping related topics. However, it is not necessary to read the text in sequence. Material is cross-referenced throughout the text, and an extensive index is included. It is hoped that this approach provides the student with easy access to information of particular interest.
FORMAT The fifth edition has been revised and reflects the growth and change of gerontologic nursing practice and the learning needs of todays student. The presentation of content has been designed for ease of use and reference. Consistent chapter pedagogy has been retained in this edition, and the textbooks visual appeal has been carefully planned to make it easy to read and follow. Content that is traditionally covered in fundamental or medical- surgical nursing courses has been deleted. The clinical examples still depict nurses practicing in many different roles in a wide variety of practice settings, reflecting current practice patterns.
All body system chapters include an overview of age-related changes in structure and function. Common problems and con- ditions within each of the chapters are presented in a format that includes the definition, etiology, pathophysiology, and typ- ical clinical presentation for each. The Nursing Management of the problems and conditions is central to each of these chapters
and follows the five-step nursing process format of assessment, diagnosis, planning and expected outcomes, intervention, and evaluation. Nursing Care Plans for selected problems and con- ditions begin with a realistic clinical situation and emphasize nursing diagnoses pertinent to the situation, expected outcomes, and nursing interventions, all within an easy-to-reference, two- column format.
FEATURES Each chapter begins with Learning Objectives to help the stu- dent focus on the important subject matter. Patient/Family Teaching boxes are included where appropriate, providing key information on what to teach patients and families to enhance their knowledge and promote active participation in their care. Throughout the text, coupled with more content emphasizing health promotion and the needs of well older adults are Health Promotion/Illness Prevention boxes, which identify activities and interventions that promote a healthy lifestyle and pre- vent disease and illness. Nutritional Considerations boxes are found throughout the text to stress the importance of nutrition in the care of older adults. Evidence-Based Practice boxes are presented to emphasize the application of relevant study find- ings to current nursing practice and allow students to reflect on how to integrate evidence-based practice into everyday nursing practice. Cultural Awareness boxes are included where appli- cable to develop the students cultural sensitivity and promote the delivery of culture-specific care. At the conclusion of the body system and clinical chapters, Home Care boxes provide pragmatic suggestions for care of the homebound patient and family. Finally, each chapter concludes with a brief Summary, followed by Key Points that highlight important principles dis- cussed in the chapter. Critical Thinking Exercises at the end of every chapter stimulate students to carefully consider the material learned and apply their knowledge to the situation presented.
As the scope of gerontologic nursing practice continues to expand, so must the knowledge guiding that practice reflect the most current standards and guidelines. Every effort has been made to incorporate the most current standards and guidelines from the AHCRQ, ANA, CDC, TJC, NANDA-I, OBRA, and CMS.
Sue E. Meiner
The development of this fifth edition would not have been possible without the combined efforts of many talented profes- sionals who supported me throughout the entire process. The contributors were especially dedicated to reviewing the fourth edition, researching all of the information for current status of information as well as investigating any new and updated information on each of the topics selected.
A special recognition goes to the editorial and production team at Elsevier. This team of professionals worked extremely hard to assist me in meeting the deadlines. I want to say a very special Thank you so much for all of the encouragement and dedicated work on this book.
Sue E. Meiner
A C K N O W L E D G M E N T S
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PA R T 1 Introduction to Gerontologic Nursing
1 Overview of Gerontologic Nursing, 1 FOUNDATIONS OF THE SPECIALTY OF GERONTOLOGIC NURSING, 1
History and Evolution, 1 Professional Origins, 2 Standards of Practice, 2 Roles, 3 Terminology, 4
DEMOGRAPHIC PROFILE OF THE OLDER POPULATION, 4
The Older Population, 5 Highlights of the Profile of Older Americans, 5 Gender and Marital Status, 6 Race and Ethnicity, 6 Living Arrangements, 6 Geographic Distribution, 6 Education, 7 Income and Poverty, 7 Employment, 7
HEALTH STATUS OF OLDER ADULTS, 8 Self-Assessed Health and Chronic Disease, 8 Functional Status, 8 Health Care Expenditure and Use, 9 Implications for Health Care Delivery, 9 Acute Care Setting, 9 Nursing Facilities, 10 Home Care, 10 Continuum of Care, 10
IMPACT OF AN AGING POPULATION ON GERONTOLOGIC NURSING, 11
Ageism, 11 Nursing Education, 11 Nursing Practice, 12 Nursing Research, 13
2 Theories of Aging, 16 BIOLOGIC THEORIES OF AGING, 17
Stochastic Theories, 17 Nonstochastic Theories, 19 Emerging Theories, 19 Implications for Nursing, 20
SOCIOLOGIC THEORIES OF AGING, 22 Disengagement Theory, 22
Activity Theory or Developmental Task Theory, 22 Continuity Theory, 23 Age Stratification Theory, 23 PersonEnvironment Fit Theory, 23 Implications for Nursing, 23
PSYCHOLOGIC THEORIES OF AGING, 24 Maslows Hierarchy of Human Needs, 24 Jungs Theory of Individualism, 25 Eight Stages of Life, 25 Selective Optimization with Compensation, 26 Implications for Nursing, 26
MORAL AND SPIRITUAL DEVELOPMENT, 27
3 Legal and Ethical Issues, 29 PROFESSIONAL STANDARDS: THEIR ORIGIN AND LEGAL SIGNIFICANCE, 29
OVERVIEW OF RELEVANT LAWS, 30 Sources of Law, 30 Federal and State Laws, 30 Health Insurance Portability and Accountability Act of 1996 (HIPAA), 31
ELDER ABUSE AND PROTECTIVE SERVICES, 31
NURSING FACILITY REFORM, 33 OBRAs Three Major Parts, 33 Provision of Service Requirements, 33 Proposed Legislative Changes, 37
AUTONOMY AND SELF-DETERMINATION, 37 Do Not Resuscitate Orders, 38 Advance Medical Directives, 39 Legal Tools, 39 Decision Diagram, 40 Conflicts between Directives and Family Desires, 41
THE PATIENT SELF-DETERMINATION ACT, 42 Background: The Cruzan Case, 42 Clear and Convincing Proof, 42 The Four Significant Provisions of the PSDA, 43 Nurses Responsibilities, 43 Problems and Ethical Dilemmas Associated with Implementation of the PSDA, 43
VALUES HISTORY, 44
NURSES ETHICAL CODE AND END-OF-LIFE CARE, 44 Ethical Dilemmas and Considerations, 45 Experimentation and Research, 46 Organ Donation, 46 Ethics Committees, 46
C O N T E N T S
REFERENCES, 48 APPENDIX 3A, 50 Values History Form, 50
SECTION 1, 50 A. Written Legal Documents, 50 B. Wishes Concerning Specific Medical
Procedures, 50 C. General Comments, 51
SECTION 2, 51 A. Your Overall Attitude toward Your Health, 51 B. Your Perception of the Role of Your Doctor and
Other Health Caregivers, 51 C. Your Thoughts about Independence and
Control, 51 D. Your Personal Relationships, 52 E. Your Overall Attitude toward Life, 52 F. Your Attitude toward Illness, Dying, and
Death, 52 G. Your Religious Background and Beliefs, 52 H. Your Living Environment, 53 I. Your Attitude Concerning Finances, 53 J. Your Wishes Concerning Your Funeral, 53
OPTIONAL QUESTIONS, 53
SUGGESTIONS FOR USE, 53
4 Gerontologic Assessment, 54 SPECIAL CONSIDERATIONS AFFECTING ASSESSMENT, 55
INTERRELATIONSHIP BETWEEN PHYSICAL AND PSYCHOSOCIAL ASPECTS OF AGING, 55
NATURE OF DISEASE AND DISABILITY AND THEIR EFFECTS ON FUNCTIONAL STATUS, 56
Decreased Efficiency of Homeostatic Mechanisms, 56 Lack of Standards for Health and Illness Norms, 56 Altered Presentation of and Response to Specific Diseases, 57
TAILORING THE NURSING ASSESSMENT TO THE OLDER PERSON, 59
THE HEALTH HISTORY, 60 The Interviewer, 60 The Patient, 65 The Health History Format, 66 The Physical Assessment Approach and Sequence, 70 Equipment and Skills, 71
ADDITIONAL ASSESSMENT MEASURES, 71 Functional Status Assessment, 71 Cognitive or Affective Assessment, 75 Social Assessment, 78
LABORATORY DATA, 80
PA R T 2 Influences on Health and Illness
5 Cultural Influences, 83 DIVERSITY OF THE OLDER ADULT POPULATION IN THE UNITED STATES, 83
CULTURALLY SENSITIVE GERONTOLOGIC NURSING CARE, 84
Awareness, 86 Knowledge, 86 Cultural Concepts, 86 Beliefs about Health and Illness, 89 Transcending Cultural Concepts, 91
SKILLS, 92 Handshake, 92 Eye Contact, 93 Interpreters, 93
PUTTING IT TOGETHER, 93 Leininger, 93 The Explanatory Model, 94 The LEARN Model, 95
6 Family Influences, 97 ROLE AND FUNCTION OF FAMILIES, 97
COMMON LATE-LIFE FAMILY ISSUES AND DECISIONS, 99
Changes in Living Arrangements, 99 Making a Decision About a Care Facility, 100 Financial and Legal Concerns, 101 End-of-Life Health Care Decisions, 102 The Issue of Driving, 103 Family Caregiving, 103
INTERVENTIONS TO SUPPORT FAMILY CAREGIVERS, 106 Education, 106 Respite Programs, 107 Support Groups, 108 Family Meetings, 110
WORKING WITH FAMILIES OF OLDER ADULTS: CONSIDERATIONS AND STRATEGIES, 110
Identifying Who the Patient Is and Who the Family Is, 110 Assessing the Family, 111 Encouraging Families to Plan in Advance of Need, 113 Involving the Older Person in Decision Making, 114 Validating Feelings, 114 Addressing Feelings of Guilt, 115 Emphasizing Goodness of Intent of Actions, 115 Recognizing the Nurses Role as Permission Giver, 115 Recommending a Decision-Making Model to Families, 116
7 Socioeconomic and Environmental Influences, 120 SOCIOECONOMIC FACTORS, 121
Age Cohorts, 121 Income Sources, 121 Poverty, 123 Education, 124 Health Status, 125 Insurance Coverage, 125 Support Systems, 126 Benefits and Entitlements, 127 Area Agencies on Aging, 128 Conservators and Guardians, 128
ENVIRONMENTAL INFLUENCES, 128 Geographic Location of Residence, 129 Transportation, 129 Housing, 129 Criminal Victimization, 132
ORGANIZATIONS OF OLDER ADULTS, 138
ORGANIZATIONS OF PROFESSIONALS WORKING IN THE FIELD OF AGING, 138
ORGANIZATIONS OF BOTH PROFESSIONALS AND OLDER ADULTS, 138
8 Health Promotion and Illness/ Disability Prevention, 139 ESSENTIALS OF HEALTH PROMOTION FOR AGING ADULTS, 139
MODELS OF HEALTH PROMOTION, 141
BARRIERS TO HEALTH PROMOTION AND DISEASE PREVENTION, 141
Health Care Professionals Barriers to Health Promotion, 141 Older Adults Barriers to Health Promotion, 141
HEALTH PROTECTION, 142
DISEASE PREVENTION, 142 Primary Preventive Measures, 142 Secondary
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