CARE OF THE OLDER PERSON (NURSING TOPIC)
PALLIATIVE CARE OF THE OLDER ADULT
· In life there is losses and gains. Loss and · Recovering patients or terminally ill patients are
death are universal experience. They discharged to home, convalescent home,
are unique events to the individual. nursing home and or Home Health. Nurses in
· Coping Mechanisms - determines a these type of care facilities are the care
person’s ability to face and accept loss. providers most often available to the family
· Grief - pattern of physical and during the crisis of impending death.
emotional responses to bereavement,
separation or loss. PIONEERS
· The grieving process is a natural
· Kubler - Ross, Glasser/ Strauss (1960s)
response to loss. The length of time
may vary from one person to another. · 1970s - death and dying became topics
of research and seminars.
· Illness and hospitalization frequently cause loss,
· Hospice care was also recognized
and at times can lead to death.
· 1980s - Grief Therapy was introduced- a
· Grief work - the process of adapting to program that assist the bereaved to deal
mourning a loss - serious emotional, mental and with the pain of loss (Bowldy and
social problems may occur if a person does not Worden). They also add insights on the
perform grief work. needs and care of the dying patient.
· Loss - obvious-death of a love one,
· Humans can anticipate death- variety of divorce, loss of a job, break-up. Some
responses: anxiety/ planning/ denial/ love/ may not be so obvious-aging
loneliness/ achievement/ lack of achievement.
· Actual loss—mastectomy
· Death affects- dying patient, family, friends, · Maturational loss - results from normal
significant others, caregivers. It can even affect a life transitions- loss of childhood
whole nation. dreams, leaving home for college or
marriage. Menopause- hair, teeth,
· The person’s style of dying reflects the person’s sight, hearing- youth.
style of living · Situational loss - one that occurs so
suddenly- loss of a job, sudden death,
· Changes in Health Care Related to Death and loss of self esteem
Dying. · Each loss is followed by Grieving.
Length of time may vary including the
· 1950s - common for patients to die at home. degree of grieving. Ex. Loss of a pet/
loss of a cousin.
· 1950s - 1980s - health care system became
highly mechanized - dying usually occurs in the · Grief - is a subjective response to actual
hospital. or anticipated loss.
· Bereavement- depressed reaction to
· When the DRG group came in the early ‘80s, the death of a loved one.
changes occurred. Patients who are at risk for · Mourning - culturally defined patterns
medical complications / and or needs recovery for the expression of grief (funerals,
time after surgery are the ones who are placed wakes, memorials, black dress/ white
in the hospital beds. dress, social withdrawals.
· Grief is a process - for some it may be
long, for others it may be short.
, Sometimes it can lead to a resolution of o Grieving can be unresolved
the hurt and reestablishment of one’s
life. When a person have gone through o Grieving can be complicated
the process of grieving – there are
instances when associated feelings o Grieving can be dysfunctional
return- smells, places, dates, clothing,
foods, holidays. 1. Individual got stock in the grieving
· After the process - closure. There are process
tasks that facilitate the passage from 2. Unable to express feelings
grief to closure.
· accepting the reality of lost. 3. Cannot find anyone who acts as a
listener
o experiencing the pain and grief
4. Suffers a loss that stirs up other
o adjusting to an environment
unresolved grieving
that no longer includes the
lost person. Object or aspect 5. lacks support and fails to believe that
of self he cannot work through it
o reinventing emotional energy · If loss is never resolved - there is no
into new relationships. resolution. The person needs counseling
or treatment.
· Anticipatory grief - the person can prepare for
the loss. Dying person and the family can cry STAGES of DEATH and DYING (Kubler – Ross)
together, attachment is often strengthened,
Behavior oriented
special effort to express affection and
appreciation. 1. Denial
2. Anger
· Sudden death is the most difficult grief to bear.
When sudden and violent, the lost is very 3. Bargaining
devastating. There could be emotions of guilt, 4. Depression
denial, anger. One impulse is to blame someone
5. Acceptance
or self.
· Thanatology - study of death and dying
· Blame and guilt can destroy a family -
· Supportive care/palliative
particularly if it is a death of a child. The other
care/compassionate care - must always
siblings also suffer. Support group-
be provided to patient and his family.
Compassionate Friends.
The 5 aspects of human functioning must always be
· Sense of presence - feeling the presence of the considered.
deceased person - dreams/ smell 1. Physical care
/wind/visions/voices/touch. This is known to
occur during the grief process or even beyond. Ø Basic needs
These are thought to be a conscious or Ø Elimination/ nutrition/hygienic
unconscious denial of the reality of death. needs
Ø Sleep and rest/ADL/pain
· Grief attack - unexpected reappearance of an
reduction
emotion- anniversaries or other special times.
2. Emotional
· As a nurse one should be aware of her own
grief-your supportive role can be complicated if
Ø Assess level of anxiety of the
you are experiencing grief yourself particularly if
patient and family. Anger/
your patient is dying. You will have difficulty
guilt/acceptance/fear of
relating with your patient.
abandonment/fear of being
PALLIATIVE CARE OF THE OLDER ADULT
· In life there is losses and gains. Loss and · Recovering patients or terminally ill patients are
death are universal experience. They discharged to home, convalescent home,
are unique events to the individual. nursing home and or Home Health. Nurses in
· Coping Mechanisms - determines a these type of care facilities are the care
person’s ability to face and accept loss. providers most often available to the family
· Grief - pattern of physical and during the crisis of impending death.
emotional responses to bereavement,
separation or loss. PIONEERS
· The grieving process is a natural
· Kubler - Ross, Glasser/ Strauss (1960s)
response to loss. The length of time
may vary from one person to another. · 1970s - death and dying became topics
of research and seminars.
· Illness and hospitalization frequently cause loss,
· Hospice care was also recognized
and at times can lead to death.
· 1980s - Grief Therapy was introduced- a
· Grief work - the process of adapting to program that assist the bereaved to deal
mourning a loss - serious emotional, mental and with the pain of loss (Bowldy and
social problems may occur if a person does not Worden). They also add insights on the
perform grief work. needs and care of the dying patient.
· Loss - obvious-death of a love one,
· Humans can anticipate death- variety of divorce, loss of a job, break-up. Some
responses: anxiety/ planning/ denial/ love/ may not be so obvious-aging
loneliness/ achievement/ lack of achievement.
· Actual loss—mastectomy
· Death affects- dying patient, family, friends, · Maturational loss - results from normal
significant others, caregivers. It can even affect a life transitions- loss of childhood
whole nation. dreams, leaving home for college or
marriage. Menopause- hair, teeth,
· The person’s style of dying reflects the person’s sight, hearing- youth.
style of living · Situational loss - one that occurs so
suddenly- loss of a job, sudden death,
· Changes in Health Care Related to Death and loss of self esteem
Dying. · Each loss is followed by Grieving.
Length of time may vary including the
· 1950s - common for patients to die at home. degree of grieving. Ex. Loss of a pet/
loss of a cousin.
· 1950s - 1980s - health care system became
highly mechanized - dying usually occurs in the · Grief - is a subjective response to actual
hospital. or anticipated loss.
· Bereavement- depressed reaction to
· When the DRG group came in the early ‘80s, the death of a loved one.
changes occurred. Patients who are at risk for · Mourning - culturally defined patterns
medical complications / and or needs recovery for the expression of grief (funerals,
time after surgery are the ones who are placed wakes, memorials, black dress/ white
in the hospital beds. dress, social withdrawals.
· Grief is a process - for some it may be
long, for others it may be short.
, Sometimes it can lead to a resolution of o Grieving can be unresolved
the hurt and reestablishment of one’s
life. When a person have gone through o Grieving can be complicated
the process of grieving – there are
instances when associated feelings o Grieving can be dysfunctional
return- smells, places, dates, clothing,
foods, holidays. 1. Individual got stock in the grieving
· After the process - closure. There are process
tasks that facilitate the passage from 2. Unable to express feelings
grief to closure.
· accepting the reality of lost. 3. Cannot find anyone who acts as a
listener
o experiencing the pain and grief
4. Suffers a loss that stirs up other
o adjusting to an environment
unresolved grieving
that no longer includes the
lost person. Object or aspect 5. lacks support and fails to believe that
of self he cannot work through it
o reinventing emotional energy · If loss is never resolved - there is no
into new relationships. resolution. The person needs counseling
or treatment.
· Anticipatory grief - the person can prepare for
the loss. Dying person and the family can cry STAGES of DEATH and DYING (Kubler – Ross)
together, attachment is often strengthened,
Behavior oriented
special effort to express affection and
appreciation. 1. Denial
2. Anger
· Sudden death is the most difficult grief to bear.
When sudden and violent, the lost is very 3. Bargaining
devastating. There could be emotions of guilt, 4. Depression
denial, anger. One impulse is to blame someone
5. Acceptance
or self.
· Thanatology - study of death and dying
· Blame and guilt can destroy a family -
· Supportive care/palliative
particularly if it is a death of a child. The other
care/compassionate care - must always
siblings also suffer. Support group-
be provided to patient and his family.
Compassionate Friends.
The 5 aspects of human functioning must always be
· Sense of presence - feeling the presence of the considered.
deceased person - dreams/ smell 1. Physical care
/wind/visions/voices/touch. This is known to
occur during the grief process or even beyond. Ø Basic needs
These are thought to be a conscious or Ø Elimination/ nutrition/hygienic
unconscious denial of the reality of death. needs
Ø Sleep and rest/ADL/pain
· Grief attack - unexpected reappearance of an
reduction
emotion- anniversaries or other special times.
2. Emotional
· As a nurse one should be aware of her own
grief-your supportive role can be complicated if
Ø Assess level of anxiety of the
you are experiencing grief yourself particularly if
patient and family. Anger/
your patient is dying. You will have difficulty
guilt/acceptance/fear of
relating with your patient.
abandonment/fear of being
