Care for the older adults

Although the number of resources and dictionaries relating to general and public health have been

increased in the last few years, no internationally accepted definition describes providing health care for

older adults (Andrews et al., 2004). Care of the older adults means providing mental, physical, and

psychological care for aged people who have sixty-five years and more. It is necessary for schools of

nursing to consider care of adults as a core in their curriculum because it encourages nursing students to

provide holistic, consistency, competent, individualized, and humane care for adult patients (NLN board of

governors, 2011).

Both faculty and students will get advantages of including adult care in the curriculum of the

nursing program. Instructors will be able to expand their knowledge and skills in providing care for elderly.

They also will be able to collaborate with other faculty members and students to develop learning strategies

that can help students to succeed in this area of studying. Even students will get multiple benefits of studying

geriatric nursing in the school of nursing. First, this course will prepare the students to work in a variety of

setting such as homes, institutional, and hospitals. Second, it helps nursing students to learn how to identify

the adult patients needs, facilitate transitions in health care, and provide complex care for senior patients

with one or more chronic conditions. Third, it encourages the students to work effectively and collaborate

with each other to ensure safety in providing care for older patients. Last, it assists students to choose and

apply evidence based practice that related to providing care for older adults (Andrews et al., 2004)..

In this course, the students will study different concepts that include maintaining health for healthy

older adults, providing comprehensive geriatric assessment, treating disorders in the body systems, and

delivering care for complex illnesses.

 Concept: Care for the older adults

Educational program: four years BSN program

Competency (AND) Learner objectives Teaching strategies

Level 1 competency 1- The learner will identify 1- Raise your hand:

Understanding the the physiological Understanding the normal and expected

changes with aging changes with aging. changes associated with aging.

in older adults 2- The learner will discuss 2- Legal cheat sheets:

health. the changes in laboratory Discuss geriatric laboratory values

values in older adults. and interpretation of hematology

and liver enzymes

Level 2 competency: 1- The learner will apply 1- The six hats: methods that promote

Applying methods to methods to promote healthy lifestyle for older adults.

promote health for healthy lifestyle for older

older adults. adults. 2- Short clip: demonstration of proper

2- The learner will discover and improper exercises used for

some prober exercises older adults.

that used to improve

functional limitations in

older adults.

Level 3 competency: 1- The learners will identify 1- In class case study:

analyzing barriers some barriers to exercise Help the learners to identify the

and facilitators to in older adults. barriers to exercise in the case.

exercise in older 2- The learners will be able 2- In class case study:

adults. to explain some Let the students identify some

facilitators to exercise in facilitators methods to help the

older adults. patients in the case

Level 4 competency. 1- The learners will be able 1- Gig Saw: creating a safe

Evaluating geriatric to assess the needs of comprehensive geriatric assessment

patient needs for older adult patient. tools.

nursing care. 2- The learners will be able 2- Clinical assessment tool: providing

to determine the patient safe assessment tool for geriatric

needs by using patient.

comprehensive geriatric

assessment.

Interactive learning plans

Name of learning 1- Raise your hand:

activity
Understanding the normal and expected changes associated with aging.

Learning activity The learners will be asked to create a list of all old people in their families who
summary have more than 65 years old. They will then be asked to write down the changes
that occur in their health status and life style. The facilitator then will ask each
student to take one minute, and discuss what she/he wrote with other students in
the class. This activity will help the students to understand the normal and
expected changes associated with aging by providing real examples from their
own lives.
Domain of learning Cognitive: Understanding and comprehension
Affective: Receiving and responding to phenomena, valuing
Student- centered At the end of this activity, the learner will be able to identify the physiological
learning objective:
changes with aging.

Preparation This exercise is designed to be incorporated into a lecture when the content is
about a moment discussing the changes occur in old people life. All we need for
this activity is a piece of paper and pencil to documents the major points
discussed in the class.
Time allotted 1 minute to create list, 1 minute to complete the raise your hand portion. 5
minutes for post discussion.
Learning styles Information Presentation: Sight, Sound
Text Modality: Visual, Verbal
Approach: Active, Reflective
Understanding: Holistic
Reflective Debriefing takes place following the raise your hand. The facilitator will ask the
Debriefing Points learners to share their experience with old people in their families and discuss
(post learning changes occur in their lives.
activity)
Evaluation of At the end of the discussion, the students will take one minute to write what the
learning concept they learned in this activity and what are the most common changes
shared in the discussion.
Teacher Reflection This exercise can be easily incorporated into a lecture to reinforce the need for
consider the physiological changes occur in on senior people, and think of
methods to support these people in their lives.

Name of learning Legal cheat sheets:

activity
Discuss geriatric laboratory values and interpretation in lab results

Learning activity At the beginning of the class, the class will be divided to four groups out of five
summary students in each group. The learners will be asked to get ten minutes to read the
article (Edwards, 2005). Then the facilitator will ask the groups to write the
 major interpretation in lab result in a cheat cheats, and discuss the difference
they found with their team members.
Domain of learning Cognitive: Understanding and comprehension
Affective: Receiving and responding to phenomena, valuing
Psychomotor: Naturalization (document).
Student- centered At the end of the class, the learner will be able to discuss the changes in laboratory
learning objective:
values in older adults

Preparation This activity will be incorporated in the class. The learners will be asked to read
the article interpreting laboratory values in older adults ((Edwards, 2005) at
the beginning of the class.
Time allotted 10 minutes to read the article and write the cheat sheet, 5 minutes for
discussion.
Learning styles Information Presentation: Sight, Sound
Text Modality: Visual, Verbal
Approach: Active, Reflective
Understanding: Holistic
Reflective Debriefing takes place following the reading and discussion, when learners
Debriefing Points discuss and understand the major changes in laboratory result for older people.
(post learning
activity)
Evaluation of At the end of the class, the students will take five minute to complete a test
learning about the interpretation in the laboratory values for older adults and they allow
to use their cheat sheet that they created in the class.
Teacher Reflection This exercise can be easily applied in the class. It helps the students to
understand the main difference in laboratory results for geriatric patient, and
they can keep the cheat sheet as a reference for them in the future.

Name of learning The six hats: methods that promote healthy lifestyle for older adults.
activity

Learning activity In teams of six hats, the learners will be given a case study of a person who
summary have 72 years old, living in a nursing home, and diagnosed with multiple
 chronic diseases. They will be asked to assume roles that articulate emotions,
overarching values, logic, creativity, optimism and pessimism and discuss how
these different perspectives relate to and impact on patient centered caring
(Herrman, 2008). Following this exercise there will be a class discussion to
explore common themes discussed, the facilitator will write the major points
discussed on a large sheet of paper for the class.
Domain of learning Cognitive: Knowledge, Comprehension, Application, Analysis, and Synthesis.
Affective: Receiving and Responding to Phenomena, Valuing, and Organizing.
Student- centered At the end of this activity, the learner will be able to apply methods to promote
learning objective:
healthy lifestyle for older adults.

Preparation Pre - assigned materials on the subject of health promotion for older adults. Six
hats each labeled with a perspective, a case scenario, large sheet of paper, tape,
and marker.
Time allotted 10 minutes to complete the learning activity
15 minutes for follow up classroom discussion
Learning styles Information Presentation: Sight, Sound, text
Text Modality: Visual, Verbal
Approach: Active, Reflective
Understanding: Holistic
Reflective Debriefing takes place during and after the discussion. What points have been
Debriefing Points identified? For example, need to include some physical activity such as walking
(post learning in the patients daily program.
activity)
Evaluation of evaluation of learning will be done when the facilitator leads a class discussion
learning of identified points and lists them per learner input.
Teacher Reflection Various methods can be used to promote older adults health. Viewing the
experience from all the perspectives will help the student to create different
methods to promote the health of older adults. Asking the class to identify
common point and listing them on paper for the class to see will reinforce the
learning and identify many of the point that may come into play when thinking
about this concept.
 Source:

Kennedy-Malone, L., Fletcher, K. R., & Plank, L. M. (2014). Advanced practice nursing in the

care of older adults. Philadelphia: F.A. Davis Company.

The case scenario is extracted from Kennedy-Malone, Fletcher, K. R., & Plank, L. M. (2014) book

page 29.

A.G a 72 years old man, living in a nursing home and diagnosed with coronary artery disease

(CAD). Hypertension (controlled). Impaired fasting glucose (IFG). Benign prostatic

hyperplasia, and mild degenerative joint disease (DJD). Since being diagnosed with impaired

fast glucose, he has cut back on soda consumption and is also seeing a dietitian for counselling.

He is a former smoker (last use 12 years ago) and admits to being a coach potato. Current

medications Lisinopril 20 mg (PO daily), Simvastatin 20 mg (PO daily) in the evening, and

Tamulosin 0.4 mg sublingually (PRN)for chest pain. He occasionally taking Tylenol Arthritis

pain or Aleve if (DJD) bother him. Vital signs are BP 134/72, HR 70 beat /m, RR 18 breath/m.

and body mass index 34.2. The last (FBG) = 125. The patient expresses frustration at the lack

of change in his fast glucose despite cutting back on soda.

Name of learning 3- Short clips: demonstration of proper and improper exercises used for
activity
older adults.

Learning activity Short video clips will be presented to show some exercises that used for older
summary adults in rehabilitation center. Thinking questions will be provided prior to
viewing the clip, and facilitator will then guide the class discussion following
the clip. learners will be asked some question about the effective exercises used
in the clip, and how these exercises can influence the old patient health.
Domain of learning Cognitive (application)
 Affective: Receiving, responding, organizing
Psychomotor, imitation, manipulation
Student- centered The learner will discover some prober exercises that used in rehabilitation center
learning objective:
to improve functional limitations in older adults

Preparation Arrangement of students from inside the classroom to act out and film different
proper and improper exercises used with older adults. A video camera, related
technological equipment, and associated software would be needed to do any
necessary editing and to organize the clips. A laptop computer than can project
to a larger screen in the classroom would be necessary.
Time allotted 3-7 minutes to look at the video clips. 10-15 minutes to discuss the proper and
improper communication strategies
Learning styles Information presentation: sight and sound.
Modality: visual & verbal
Approach: reflective
Understanding: holistic

Reflective Debriefing with students will take place after viewing the short clip and will be
Debriefing Points guided by provided thinking questions. The facilitator will ask the students to
(post learning reflect on what went well in the clip and what should have been done
activity) differently. The concern will be in identifying open- ended, older adult -
centered questions that are conducted in respectful way to maintain older
adults dignity.
Evaluation of Five minutes paper, at the end of the class. The students will be asked to
learning summarize what they learned from the clip, and list two proper and two
improper exercises used with older adults.
Teacher Reflection This learning activity is an excellent method to use for this learning objective. It
allows the students to differentiate between proper and improper exercises used
with adults, additionally, this clip allows students to engage in therapeutic
communication strategies and discuss their ideas with others.
Name of learning Case study:
activity
Help the learners to identify the barriers and facilitator methods in the

case studies.

Learning activity Divide the class into two groups equally and provide each group with a case
summary study, ask students to assess and analyze the patients situation based on
provided case. In addition to assessment of the patient, first group needs to
document barriers to exercise that they found in each case, and second group
need to identify some exercise facilitator methods used in the case. After that
each group will share the major points in their case study and the role of nurse
and anticipated intervention for the case provided.
Domain of learning Cognitive (understand, analyze, evaluate the case studies)
Affective: Internalizing (solve patient problem)
Psychomotor: Naturalization

Student- centered At the end of this learning activity, the student will be able to:
learning objective: 1- Identify some barriers to exercise in older adults.

2- explain some facilitators to exercise in older adults.

Preparation Divide the students in class into two groups and all they need is white posters
and pens to document the major points in the case studies provided and hang
them to the classroom wall with small strips.
Time allotted 20 minutes to assess and analyze the major points in the case studies. 10
minutes more to share and discuss the assigned case study with the other group.
Learning styles Information presentation: sight.
Modality: verbal
Approach: reflective
Understanding: holistic
 How is the content Prior the class, learning would include reading chapter 3 exercises in older
linked to prior adults from Kennedy-Malone, L., Fletcher, K. R., & Plank, L. M. (2014). The
learning activity content is built upon that knowledge by focusing on the barriers and
facilitators to exercise in each case.
Reflective Debriefing with students will take place after discussing the case studies and
Debriefing with will be guided by provided thinking questions. Students will be asked to reflect
learners on what are the main points (barriers- facilitators) in the provided case and what
is the nursing role and intervention for each case.
Evaluation of Five Minutes paper, the students will be asked to list four barriers and
learning facilitators to exercise in older adults.
Teacher Reflection This learning activity is an excellent method to enhance critical thinking and
decision making abilities in the students. It allows the students to analyze and
evaluate the case study and identify the barriers and facilitators in older
patients.

Sources:
The first case study is derived from:
http://www.tcd.ie/medicine/ilw/physiotherapy/Older-Adult-Case-Study-Notes-
Post-Workshop.pdf

The second case study is derived from:

Kennedy-Malone, L., Fletcher, K. R., & Plank, L. M. (2014). Advanced practice

nursing in the care of older adults. Philadelphia: F.A. Davis Company.

First case:

Lisa, a widow for the past four years, is 86 years old. She lives alone in a two story
house on the farm and leases the land out. She has a reasonably good income.
She was always a hardworking woman helping out on the family farm. She has had
varied interests throughout her life and particularly likes music, reading and art
and cooking. She has a son Tom and a daughter Julie, both of who live about 4
miles away from her. Tom, her eldest son is 60 and has his own wife and two
children, both of who work in local construction companies. Tom had recent tests
 confirming he has osteoarthritis, particularly affecting his right hip. He plans to
take a break from work and have a hip replacement in the coming months. Lisa no
longer drives and depends on Tom to drive her places, including shopping, Mass,
the local bank, GP visits, the village library and visiting friends. There is little in the
way of local transport which passes her farm. Lisa has been having increasingly
poor health over the past five years. She has a diagnosis of compression fractures
of the T12 L2 vertebrae, which she sustained from a fall at home in the
bathroom. Her past medical history includes osteoporosis, hypertension,
peripheral neuropathy and her mobility has reduced considerably since she
fractured her right hip last year as a result of a fall while getting out of bed. She
uses a walker to ambulate outside and sometimes uses it in the house but more
often relies on a stick and holding the furniture. Her memory has been
deteriorating over the past couple of years which concerns the family and this
problem is made worse by the fact that she denies any problems about her
memory and gets frustrated and annoyed with any of her family who try to
convince her that this is the case. Julie has shown her the evidence of burned
pots, things left on the floor, a tap left running, little food in the fridge and her
lack of attention to keeping the house clean. Tom tries to keep his mothers
memory as active as possible by asking questions about recent events and
prompting her until she gets the answer right. Her family have also noticed that
she has some difficulty finding words in conversation and she sometimes asks the
same question repeatedly, which frustrates her children. Lisa appears to be able
to manage to dress herself but her personal hygiene is questionable. To date she
has refused outside help with anything. Now however, the family feel that unless
she has this help she will not be able to stay living on her own. They have gone to
her GP asking for advice on what to do.

Second case:
J.S. is a 66- year old African American women who presents to your practice for
a well- adult physical checkup. She is widowed and works part- time as a mental
health technician to support herself. Family history includes father decreased from
a stroke at age 50 years. Mother living with hypertension and type 2 diabetes
 mellitus, a half- sister decreased with breast cancer, and a brother with pancreatic
cancer and coronary artery disease and end- stage renal disease secondary to type
diabetes mellitus. J.S has not seen a health care provider for several years,
because she had no health insurance. Now she has Medicare, so she is coming in
for care. She is a former smoker who quit 5 years ago, after smoking one pack per
day since age 20 years. She has four grown children all of whom live nearby, and
has eight grandchildren. Vital are blood pressure (BP) 150/92, heart rate (HR) 76
(reg). respiratory rate 18 breaths per minute (afebrile), and body mass index (BMI)
32,1.

Name of learning Gig Saw: creating a safe comprehensive geriatric assessment tools.
activity
Learning activity Students will be divided up into groups and each given a piece of the
summary assessment to rework to include older adult approach, such as General
Demographic Data, HEENT, Chest and Lungs, Heart, Peripheral Vascular,
Abdomen, Neuro Musculoskeletal, Skin Integrity, and activity. Each group
will be charged with assessing subjective and objective data in their
assessment area. Each group will then post their assessment area for the class
to see. As a class we will look at each section and modify any areas if needed.
The class will organize the content of the assessment and create the
document. The instructor then types up the assessment and redistributes it to
the class for reference in the future.
Domain of learning Cognitive: Understanding, Comprehension, Application, Analysis, and
Synthesis. Psychomotor: Manipulation and Precision Affective: Receiving and
Responding to Phenomena, Valuing, and Organizing.
Student- centered At the end of the class, the learners will be able to assess the needs of older
learning objective: adult patient
Preparation Some type of assignment card for each to be assessed for the groups, large
sheet of paper, markers, tape.
Time allotted 20 minutes for group work, 20 minutes for post discussion and modification
Learning styles Information presentation: sight, sound, text.
Modality: visual, verbal
 Approach: active, reflective
Understanding: holistic

How is the content Prior the class, learning would include reading chapter 3 exercises in older
linked to prior adults from Kennedy-Malone, L., Fletcher, K. R., & Plank, L. M. (2014). The
learning activity content is built upon that knowledge by focusing on the barriers and
facilitators to exercise in each case.
Reflective Post learning will take place during the discussion to modify the assessment
Debriefing with tool. This will allow the learner to holistically see how the traditional
learners assessment can be reworked to include older adult care.
Evaluation of Completing an assessment instrument that will be useable in a clinical
learning experience for students will evaluate the level of learning that has been
achieved. The facilitator will be able to assess at presentation time and when
the class discussed possible modification if the learners have meet the
objectives.
Teacher Reflection Jig Saw is a good method to help the students understand the comprehensive
older adults assessment. It includes all pieces of assessment, and breaks down
the content area into manageable pieces for the learners and then brings it
together to form a greater project.

Name of learning Clinical assessment tool: providing safe assessment tool for geriatric patient.
activity
Learning activity This activity is designed to apply in the clinical setting. The student will use the
summary pre designed geriatric assessment tools to evaluate the person cared for.
Post activity, the learner will present the results of the assessment to the
clinical instructor who will assist them if necessary to synthesize and
implement their care plan.
Domain of learning Cognitive: Application, Synthesis, Analysis and Evaluation Affective: Receiving
and Responding to Phenomena, Valuing, Organizing and Conceptualizing.
Psychomotor: Imitation, Manipulation, Precision and Articulation
Student- centered The learners will be able to determine the patient needs by using comprehensive
learning objective: geriatric assessment.
Preparation Provide written instructions about using the assessment tool, for example, it is
expected that the assessment will be completed within 20 minutes of the start
of patient care and report to the clinical instructor. Provide students with a
copy of the assessment
Time allotted 30 minutes for group work, 15 minutes for post discussion and modification
Learning styles Information presentation: sight, sound, text.
Modality: visual, verbal
Approach: active, reflective
Understanding: holistic

How is the content Prior the class, learning would include reading chapter 3 exercises in older
linked to prior adults from Kennedy-Malone, L., Fletcher, K. R., & Plank, L. M. (2014). The
learning activity content is built upon that knowledge by focusing on the barriers and
facilitators to exercise in each case.
Reflective Debriefing takes place following the presentation of the care notes during one
Debriefing with on one discussion with the clinical instructor. Evaluation of Learning (How will
learners it be accomplished?)
Evaluation of Written report to the clinical instructor will help to evaluate the students
learning understanding for the assessment tool.
Teacher Reflection This assessment provides an overview for geriatric patient assessment. It allows
the students to engaged fully in the clinical setting. Also, it helps the learners to
interact with the clinical instructor in an effective way.

References:

Andrews, G, Faulkner, D., & Andrews, M. (2004). A GLOSSARY OF TERMS FOR

 COMMUNITY HEALTH CARE AND SERVICES FOR OLDER PERSONS. World health

organization,5, 4th ser. Retrieved August 14, 2017, from

http://www.who.int/kobe_centre/ageing/ahp_vol5_glossary.pdf

Kennedy-Malone, L., Fletcher, K. R., & Plank, L. M. (2014). Advanced practice

nursing in the care of older adults. Philadelphia: F.A. Davis Company.

NLN Board of Governors. (2011, April). CARING FOR OLDER ADULTS. Retrieved August 14,

2017, from http://www.nln.org/docs/default-source/about/nln-vision-series-%28position-

statements%29/nlnvision_2.pdf?sfvrsn=4