ELDERLY SELF CARE -A PRESENTATION AT THE JOINT UPDATE COURSE

OF THE FACULTIES OF FAMILY MEDICINE, WACP & NATPOSTMED, AT ABUJA.

By DR ITA B. OKOKON

MB,BS [Ib];FMCGP;FWACP[Fam Med]

SNR LECTURER IN FAM MED – CMS, UNICALCHIEF CONSULTANT FAMILY PHYSICIAN – UCTH, CALABAR

CHIEF EXAMINER IN FAMILY MEDICINE [WACP] JUNE 8TH, 2015

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Outline• Preamble• Introduction• Definition• Expectations of Elderly Self Care• Disease prevention and management in the Elderly by self

care• Common conditions in the Elderly needing self-care• Health maintenance in the elderly by self-care [Health maintenance in the elderly by Family care]• Resources for elderly self-care• Elderly self-care skills• Conclusion• References

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Preamble• According to the 1991 Population Census, there were

4,598,114 persons aged 60years & above in Nigeria {5.2% of the total national population of 88,992,220}.[1]

• The 2006 Population & Housing Census gave an increased figure of 6,987,047 persons in that age bracket, out of the total population of 140,431,790 {Elderly population: 4.97%}. [2]

• The WACP is an international platform & in this regard we should be looking at international scenarios: The WHO states that there are about 700 million people aged 60 years and above, the world over. [3]

• It further indicates that by the year 2050, the world will be hosting about 2 billion persons in that age bracket; and added that, that number will be more than the number of the world’s number of children. [3]

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Introduction• The growing number of old persons presents many

challenges for the informal Caregivers and Health professionals.

• One of the inevitable consequences of the expansion in the elderly population is that many of these individuals will continue to live in their own homes even with functional declines in their advanced ages.[4-6]

• Self-care ability has been shown to be a crucial resource in the elderly and it may be a decisive factor for their managing daily life in their own homes.[7]

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Definition• There are numerous definitions of self-care but it is

essentially about patient autonomy or influence. Lifestyle and taking preventive actions are all aspects of self care that are essential in the elderly population.

• Self-care has been defined as: “the actions people take for themselves, their children and their families to stay fit and maintain good physical and mental health, meet social and psychological needs, and prevent illnesses or accidents, care for minor ailments and long term conditions, and maintain health and well being after acute illness or discharge from hospital.”[8]

• When the above is applied to the Elderly, it then comes out as the definition of Elderly self-care.

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Definition of Self Care contd.• Furthermore, the UK Department of Heath has

defined Self-care as: “Care taken by individuals towards their own health and well-being, and includes the care extended to their children, family and friends and others in neighbourhood and communities.”[9]

• In an earlier publication (2003), the same Department of Health had pointed out that Self care could be defined as: “That care administered by individuals suffering diseases, such as self-medication or self-checks.”[10]

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Disease prevention and management in the Elderly by self care• Disease prevention and management by self care in

the Elderly is a partnership between the elderly and the health care professional.

• The ability to engage in self care is dependent on certain factors, including: the specific age of the elderly concerned, stage of development, life experience, socio-cultural orientation, health and available resources. [11]

• Healthcare professionals providing care for the elderly need to identify self care skills or deficits in addition to personal characteristics and adapt treatment accordingly.

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Disease prevention and management in the Elderly by self care contd.• Elderly self care can be viewed as a practice performed by

the elderly for their own benefit, to maintain life and well-being and is a key element in the proper maintenance of these individuals for chronic pathologies.

• Self care requires behavioural modification which coupled with guidance and medication, would control the disease.

• Chronic diseases are long term conditions that develop slowly over time. There are among the most common and costly health problems facing the elderly population. Interestingly, a good number of them are preventable.

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Disease prevention and management in the Elderly by self care contd.

• Primary Prevention – When the elderly are guided to regularly present themselves for screening, certain disease conditions would be unveiled early and some lifestyle modifications could then be advised which would check such diseases.

• Secondary Prevention: With prompt diagnosis and treatment of the possible disease conditions, complications are prevented and improved quality of life would then result.

• Tertiary Prevention: Here the elderly are guided to know how to control the complications of certain diseases and how to rehabilitate themselves accordingly.

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Expectations of Elderly Self care

1. Empowering patients: Greater self care is seen as a positive opportunity for patients to take

control of their illnesses, that have been increasingly lost to the Health professionals.- Empowerment is encouraging people to participate as equal partners in decisions about the healthcare they receive.2. Demand management: Self care is seen as a means of bridging the growing gap between demand and supply of care by managing demand of formal healthcare. These certainly reduce the number of hospital visits.

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Expectations of Elderly Self care contd.3. Improvement of Outcomes: Self care also serves

as a means of improving outcomes of patient care especially for the elderly. Patients who

administer care to themselves following their doctors’ advice tend to have better outcomes. - Higher coping and self care abilities are positively

related to good mental health and perception of high quality of life in the older people

- Depressive moods and feelings of loneliness are found to be negatively related to self care

behaviours.

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Common conditions in the Elderly Requiring Self care• There are several conditions in the elderly that require a high

level of self-care to improve the outcomes of the illnesses. • These illnesses can be divided into: 1. Physical illnesses and 2. Mental illnesses1. Physical Illnesses: - Hypertension - Heart Failure - Diabetes - Osteoarthritis - Bronchial asthma - Emphysema - Malignancies - Chronic bronchitis

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Common conditions in the Elderly Requiring Self care contd.2. Mental Illnesses: The mental illnesses that

require self care include the following: - Dementia - Depression

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Health maintenance in the elderly by self care and self care skills• Maintaining optimum levels of health can be achieved by

the use of self care skills in the elderly.• Management of certain conditions require health

education which would serve as an adjuvant to the treatment of these conditions.

• Problems on the skin necessitating care – [12] -Hair losses color, and hair loss occurs -Skin becomes less elastic and dry -Itching is common -Dark yellow or brown colored spots appear (Senile lentigenes)

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Health maintenance in the elderly by self care and self care skills

• Problems on the skin necessitating care contd. - Fatty tissue layer of skin diminishes

- Lines and wrinkles appear - Nails become thick, tough, and brittle - Increased sensitivity to temperature

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Health maintenance in the elderly by self care and self care skills contd. Care of the skin: - Use mild soap - Bath oils or lanolin lotion - Bath or Shower once or twice a week - Brush Hair daily - Shampoo as often as needed for cleanliness

and comfort - Care for sore or injuries immediately - Socks, sweaters, lap blankets, and layers of clothing will help alleviate the feeling of coldness

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Health maintenance in the elderly by self care and self care skills contd.

• Circulatory System Care Because of the need for oxygen and nutrients, the elderly may experience:– Weakness– Dizziness– Numbness in hands and feet– Palpitation

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Health maintenance in the elderly by self care and self care skills contd.

• Circulatory System care contd.With circulatory changes, encourage the elderly

to:– Avoid strenuous exercise or over exertion– Religiously observe periods of rest– Moderate exercise, according to individual’s tolerance

Prevent thrombi formation– Support stockings, anti-embolism hose– NOT to wear tight bands around legs– If confined to bed, ensure regular turning

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Health maintenance in the elderly by self care and self care skills contd.

• Circulatory System care contd. With Hypertension DASH (Dietary approach to stop hypertension should be counseled on)– Diet low in salt– Decrease fat intake– Exercise as recommended by physician

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Health maintenance in the elderly by self care and self care skills contd.

• Respiratory Changes creating need for care - Respiratory muscles become weaker - Rib cage more rigid - Alveoli gets thinner and less elastic which decreases

exchange of gases (with resultant emphysema) - Bronchioles lose elasticity - Changes in larynx lead to higher pitched and weaker voice - Chronic diseases may decrease the efficiency of

the respiratory system even more severely

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Health maintenance in the elderly by self care and self care skills contd.

• Respiratory Changes creating need for care contd.

• Changes may cause the elderly to experience:–Dyspnea with• Difficulty coughing up secretions• Increased susceptibility to infections such as

a cold or pneumonia

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Health maintenance in the elderly by self care and self care skills contd.

• Respiratory Care - Alternate activity with periods of rest - Proper body alignment and positioning - Sleep in cardiac position - To use 2 or 3 pillows - Avoid polluted air - Breath deeply and cough frequently

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Health maintenance in the elderly by self care and self care skills contd.

• Nervous System Changes necessitating careBlood flow to brain decreases and there is a

progressive loss of brain cells - Interferes with:– Thinking - Reacting– Interpreting - Remembering

Senses of taste, smell, vision, and hearing are diminished

Nerve endings less sensitive– Decreased ability to respond to pain and other stimuli

Decrease in taste& smell frequently affects appetite

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Health maintenance in the elderly by self care and self care skills contd.• Nervous System Changes necessitating Care contd.Changes in vision– Problems reading small print– Seeing objects at a distance– Decrease in peripheral vision Cataract– Decrease in night vision Glaucoma– Increased sensitivity to glare

Changes in hearing– Hearing loss usually gradual– Person may speak louder than usual– Ask for words to be repeated– Not hear high frequency sounds– May not hear well in crowded places

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Health maintenance in the elderly by self care and self care skills contd.

• Nervous System Changes necessitating Care contd.

Decreased sensation to pain making other stimuli more susceptible:– Burns– Cold fingers and toes– Cuts– Fractures– Muscle strain and other injuries

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Health maintenance in the elderly by self care and self care skills contd.

• Digestive Changes Fewer digestive juices and enzymes produced Muscle action becomes slower and peristalsis decreases Teeth are lost Liver function decreases Dysphagia is frequent, complaint of:

– Less saliva– Slower gag reflex– Loss of teeth– Poor fitting dentures

Slower digestion of food– indigestion

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Health maintenance in the elderly by self care and self care skills contd.

• Digestive ChangesDecreased peristalsis– Increase flatulence (gas)– Constipation

Decreased sensation of taste– Poor appetite– Poor diet

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Health maintenance in the elderly by self care and self care skills contd.

• Digestive CareGood oral hygieneRepair or replace damaged teethRelaxed eating atmosphereHigh-fiber high-protein foods with different tastes

and texturesSeasoning to improve tasteIncreased fluid intake

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Health maintenance in the elderly by self care and self care skills contd.

• Urinary Changes Kidneys decrease in size and become less efficient Bladder becomes less efficient – may not hold as much urine anymore– may not empty completely– Incontinence

• Urinary Care Increased fluid intake Decrease fluid intake before bedtime Regular trips to the bathroom Easy to remove clothing Absorbent pads for females

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Health maintenance in the elderly by self care and self care skills contd.

• Endocrine Changes Increased production of some hormones and decrease of

others Immune system less effectiveBasal Metabolic Rate (BMR) decreases Intolerance to glucose• Endocrine CareProper exerciseAdequate restMedical care for illnessBalanced dietHealthy lifestyle

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Health maintenance in the elderly by self care and self care skills contd.

• Reproductive ChangesDecrease of estrogen/progesterone in female– Thinning of vaginal wall– Decrease vaginal secretions– Inflammation of vagina common– Weakness in supporting tissue:– Uterine prolapse– Breasts sag when fat redistributed

Decrease in Testosterone in males– Slow production of sperm– Response to sexual stimuli slower– Testes smaller and less firm

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Health maintenance in the elderly by self care and self care skills contd.

• Male and Female– Sexual desire may or may not decrease

Advantages of sex in elderly– Improves muscle tone and circulation– Pain from arthritis seems to decrease• Reproductive Care

Understand physical and psychological sexual needs of the elderly– Encourage married couples to be in the same room– Give privacy to consenting elderly

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Health maintenance in the elderly by self care and self care skills contd.

• Psychosocial ChangesSome individuals cope with psychosocial changes,

and others experience extreme frustration and mental distress

• Fears of a sick elderly:– Death– Chronic illness– Loss of function– Pain

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Health maintenance in the elderly by self care and self care skills contd.

• Dealing with fears created by an illness:– Listening– Patience– Understanding– Provide support

Health maintenance in the elderly by Family care

Family members must also be guided to know that when the elderly can no more attend to self, they have a place.

Features of Confusion and Disorientation– Talking incoherently– Not knowing their name– Not recognizing others– Wandering aimlessly– Lacking awareness of time or place– Displaying hostile and combative behavior– Hallucinating– Regressing in behavior– Paying less attention to personal hygiene– Inability to respond to simple commands or instructions 35

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Health maintenance in the elderly by Family care contd.

Causes of temporary confusion/disorientation– Stress and/or depression– Use of alcohol or chemicals– Kidney disease– Respiratory disease– Liver disease– Medication

Diseases:– CVA– Cause: Transient ischaemic attacks (TIA) - ministrokes

which result in temporary periods of diminished blood flow to the brain.

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Health maintenance in the elderly by Family care contd. Dementia– Loss of mental ability characterized by a decrease in

intellectual ability, loss of memory, impaired judgment, personality change, and disorientation.

• Acute dementia– When the symptoms are caused by temporary reason:

High fever, dehydration, hypoxia may be incriminated.• Chronic dementia– When symptoms are caused by permanent,

irreversible damage to brain cells

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Health maintenance in the elderly by Family care contd.

• Alzheimer’s Disease [12] – A type of dementia that causes progressive changes in brain cells:

Early stages - Memory loss - Mood & personality changes - Depression - Poor judgment - Confusion regarding time & place - Inability to plan and follow through with Activities of Daily Living (ADLs)

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Health maintenance in the elderly by Family care contd.

• Alzheimer’s Disease contd.Middle Stages- - Night time restlessness - Mood swings increase - Personal hygiene ignored - Weight fluctuates - Paranoia and hallucinations - Full time supervision needed

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Health maintenance in the elderly by Family care contd.

• Alzheimer’s Disease contd.Late stages - Total disorientation - Incoherent - Unable to communicate with words - Loses control of bladder and bowel functions - Develops seizures - Loses weight despite eating a balanced diet - Becomes totally dependent - Lapses into a coma - Dies

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Resources for Elderly Self Care

• The major Human Resources for Elderly self care include: Family members and the Health professionals – doctors, nurses, physiotherapists and dieticians.

• Health professionals help by providing proper orientation through education of the elderly and the Family members.

Health education is very vital and emphasizes the partnership between the elderly and Health care professionals.

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Barriers to Elderly Self care• These include: 1. Healthcare professionals – Healthcare professionals are not open to self care in our environment because they doubt the Elderlies’ abilities to make decisions for themselves. 2. Family Members – Unless when guided, family members are not aware of their responsibilities regarding care of the elderly 3. The Elderly themselves – Some elderly persons do not believe that they are expected to do anything about themselves. In general, therefore, ignorance and poverty are the most

critical barriers to Elderly self care in Nigeria and the West African Sub-Region.

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Conclusion• The alarming growth of the Elderly population by the

day, has been high-lighted.• The need for us as clinicians to embrace the

enhancement of Elderly self care as a stitch-in-time, before we are overwhelmed by the teeming numbers of the Elderly that are expected in the no distant future, has been echoed in the background of this presentation.

• It is concluded with the hope, that this presentation will ignite the flame of concern-cum-interest, for further devising means of attention to Elderly problems by all Family Physicians in the West African sub-Region.

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THANK YOU FOR YOUR LISTENING

DR. ITA B OKOKON

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References1. National Population Commission. Population Census of the Federal Republic of Nigeria: Analytical Report at the National level. NPC. Abuja, Nigeria. 1998.2.National Population Commission. Nigeria Demographic and Health Survey, 2008. Abuja, Nigeria. 2009.3. Caring for the Elderly – slide share. http://www.slideshare.net/abbypsych/caring-for-the-elderly . Accessed on 20th May, 2015.4. Burholt V, Naylor D. The relationship between rural community type and attachment to place for older people living in North Wales, UK. Eur J Aging 2005;2:109-19.

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References5. Dale B, Saevareid HI, Kirkevold M, Soderhamm O. Formal and informal care in relation to activitiesof Daily Living and Self-perceived health among older care dependent individuals in Norway. Int J people Nurs 2008;3: 194-203.6. Ryan AA, McCenna H. Impact of Community care in enabling older people with complex needs to remain at home. Int J older people Nurs 2009;4:22-32. 7. Hoy B, Wagner L, Hall EOC. Self-care as a health resource of elders: an integrative review of the concept. Scand J Caring Sci 2007;21:456-66.8. Working Partnership Programme (WPP), Self care- a new way of thinking. 2006, Department of Health: London.

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References9. Department of Health. Self care – A real choice: Self care support – practical option. 2005, Department of Health, London. 12p.10. Department of Health. A vision for pharmacy in NHS. 2003, TSO; London.11. Marilia BM, Maria JS, Janaina FVC, Marcos VL. Assessment of self care competence of elderly people with diabetes. Rev Esc Enferm USP. 2013;47(2):409-14. 12. Geriatric care. www.nd.gov/cte/programs/health-careers/ppt/geriatrics.ppt Accessed on 20th May, 2015.