Running head: ASSESSMENT OF THE OLDER ADULT 2

Assessment of an older adult: Community resources

Daffney Jones

PRNU 112

Vancouver Island University

ASSESSMENT OF THE OLDER ADULT 2

Assessment of the older adult: Community resources

As Canada’s aging population is on the rise, the core of nursing is becoming more

gerontologicaly focused. Eliopoulos (2018) states, “there was a significant growth in the number

of older people for most of the 20th century” (p.4). With this increase in older adults, as a nurse,

we must be competent and aware of the strengths and struggles of this diverse population. In this

paper, I will investigate the lifestyle of an older adult within our community. With the data

collected, I will show which determinants of health my client is exceeding in and which ones that

they might need support with. As preparation for a job in the community, I will also research and

provide appropriate resources that could help future clients who might be experiencing the same

issues my client was experiencing. While these resources may be transferrable to other older

adults in some scenarios, I must be careful not to stereotype and assume that all older adults

experiencing similar issues will benefit from the same resources: “although there may be similar

characteristics among members of a group, nurses must be careful to assess individual

characteristics, preferences, and practices and avoid stereotyping” (Eliopoulos, 2018, p.35).

The purpose of this paper is to assess, analyze and find appropriate resources to aid an

older adult experiencing disparities in the determinants of health. In addition to aforementioned

steps appropriate interventions will be planned.

Selecting and identifying a senior client

The client I decided to interview is an older adult woman aged 68 years, who lives on her

own. I decided to pick this individual because she is independent in her care and I would like to

learn how to provide resources to an older adult that mostly needs health promotion to maintain

her well-being and independence. She maintains a full-time job and meets regularly with friends
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to socialize. I would describe this client as an outgoing individual who enjoys keeping busy. She

lives far away from her family, but she is usually the one to initiate visits by travelling to them.

She describes herself as “fun-loving, energetic, adventuresome with a passion for creating

beautiful things. [She] loves my children and my grandchildren and I feel very fortunate.” This

client is rather active within her community and often spends her time off work looking for

projects related to her work. She has found a job that allows her to express herself and she says

“it keeps me busy and creative.” Some specific strategies I used to build professional rapport

with this client included asking how she would like to be addressed, planning the interview to fit

her schedule best, and allowing her the opportunity to choose the communication avenue. It

seemed like she was interested to start the interview, so the outline was forwarded to her so she

would be able to look over the questions and be prepared. According to Riley (2017),

“[distributing] the agenda several days before the meeting [can allow] so members can prepare

their best thoughts and ideas on the issues to be discussed” (p.249). Riley (2017), also suggests

that “when clients understand your purpose, they are more likely to be open and reveal

information rather than being guarded because they are uneasy about your intentions” (p.131).

With this information in mind, I was sure to explain, to the client, what Information would be

collected and why: this also allowed an opportunity for her to ask questions on how I would be

using her information and maintaining confidentiality. In a mutually agreed upon time we met

and signed the letter of consent which allowed her to also better understand how her information

would be used. You can find the letter of consent in the appendix.

I believe that my client was in the “integrity vs. despair” (“Erickson’s developmental

tasks” as cited by Eliopoulos 2018, p.18) stage found in older adults. According to Eliopoulos’s

citation of Erickson, “The challenge of old age is to accept and find meaning in the life the
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person has lived; this gives the individual ego integrity that aids in adjusting and coping with the

reality of aging and mortality” (2018, p.18). This client, in particular, proved very active within

her social life, work, and family: I interpreted these actions as adequate coping mechanisms to

her process of aging; placing her in the integrity definition. The theory of successful aging as

cited in Eliopoulos (2018), suggests that “people with high levels of personal control and

positive affect will experience higher levels of wellness in aging due to their abilities to

participate in health-promoting activities” (p.19). The theory of successful aging rang true for

this client: when asked do you feel you are a spiritual person? She replied, “I am more spiritual-

manifest. If I am thinking about something, like if I should do it, I put out some really good

thoughts and maintain positivity. You need to look for it to come back to you though, and be

proactive about what you need to do yourself.”

Post interview investigation

Although this client may be viewed as healthy and independent, I was able to pick up on a few

things that were of concern. There were four priority problem health patterns I was able to

recognize from Gordons framework: health perception and management, role relationship

pattern, coping and stress tolerance, and nutrition and metabolic patterns.

Starting with health perception and health management, the client experienced a

myocardial infarction in 2014 and her cardiologist said “the valve is eroding and calcifying” and

was “severe.” During treatment of her heart attack, she found out that she was type two diabetic.

These two severe health issues I related to health services as a determinant of health. Having

services that can help this client though the challenges of managing two serious medical

diagnoses, will be beneficial and very important to the management and maintenance of this

client’s independence. Williams & Hopper state that “diabetes is a serious disease that can cause
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complications such as blindness, kidney failure, heart attacks, and strokes” (2015, p.915). This

client already has started an exercise regimen, stating “I go to the gym, walk, and attend aqua

fit.” William & Hopper (2015), state that “exercise also improves blood lipid levels and

circulation, which is important for the person with diabetes who already has an increased risk of

cardiovascular disease” (p.922). Since type two diabetes can progress, this client has her blood

glucose checked every three months and her feet examined at the same time. She also “sees her

cardiologist once per year.”

Role relationship pattern seemed to be the next area of concern from the data collected

from my assessment. This client seemed to be struggling with adapting to the new roles she

played in her family life and also in her friend group. She states,

“Well I think I am the head of the family: grandma and great grandma. I find that it is a very

daunting role. I would like to be twenty places at once, but I cannot be. I find it really

difficult to see everyone, and with work it can be really difficult. It is even harder because

everyone is growing up and doing their own things now. One thing I have had to relearn is

to take a step back from being great grandma and allow my daughter (now a grandma) to

step into that role.” Eliopoulos explains that “older women centered their lives in their

families, from which they derived their sense of fulfillment” (2018, p.39). Eliopoulos also

suggests that “if older adults adjust to their new role as parents of independent, adult

children, they may enjoy the freedom from previous responsibilities and the new

developments in their family relationships” (2018, p. 39). As this client had voiced, it is a

change to allow her children to grow into the parent role. Eliopoulos also agrees that older

adults should “[respect] their children as parents and not interfering in the parent-child

relationship” (2018, p.40). I believe that the health determinant of gender fits this health
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pattern appropriately. When this client was a young adult, the child rearing was commonly

left to the women and I believe that she filled this role for many years. As she steps back

and attempts to allow her own children to become grandparents, I believe it is a different

experience that she might need adjusting to.

Coping and stress tolerance is another area of concern for this client. She has noticed that

“friends and people that are important to me are leaving, so it is important that I keep myself

busy and appreciate my friends and family because the [social] circle keeps getting smaller and

smaller.” Eliopoulos notes that at a time of many losses and adjustments, personal contact, love,

extra support, and attention – not isolation- are needed” (2018. p.45). The determinant of health

I thought most closely linked to coping and stress was the social safety net. According to the

World Health Organization, “Social support networks – greater support from families, friends

and communities is linked to better health” (2019). As a nurse, we “should attempt to intervene

when [we] detect isolation and loneliness in an older person” (Eliopoulos, 2018, p.45).

Nutrition & metabolic concerns were deemed important because of her medical diagnosis

of diabetes. Although she deems her nutrition as “healthy,” a referral to a dietician would most

likely be best to aid in the teaching of a personalized diet for her diabetes. I linked this health

pattern to education as the most relatable health determinant. Learning changes for older adults;

Eliopoulos explains, “learning occurs best when the new information is related to previously

learned information” (2018, p.68). In order to start an educational intervention, William &

Hopper suggest that “it is especially important to assess each patient’s knowledge of diabetes and

its care so that appropriate teaching can be done” (2015, p. 932).

A resource, that I believe will be helpful to this client, include diabetes teaching classes.

Williams & Hopper (2015) state that “patients with newly diagnosed diabetes may be anxious
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and overwhelmed. Instruction may need to be repeated several times before they understand”

(p.933). Diabetic management and health promotion classes are offered through island health and

can be found at this link: https://www.islandhealth.ca/our-locations/diabetes-education-

centres/victoria-dia.betes-education-centre. The classes offered are free and have drop in

availabilities which may work best for this client’s busy work schedule. This client has

secondary education and I believe that this will be an appropriate level for her health literacy.

The second resource I found was found at this link:

http://www.islandhearttoheart.ca/programs.html. In these classes you learn about the heart and

how it works, diet, medication and their side effects in people who take heart medication. I chose

this as the client mentioned more than once that she has a hard time finding medication that

meets her needs. She noted that she experiences vertigo and even allergic reactions to some of

the medication. Ultimately a review would be done of her medications and this can happen by a

referral to a pharmacist or her prescriber. Both of these classes will be beneficial to her physical

and social health as she will meet other people experiencing similar health problems. Williams &

Hopper state that “the involvement of family or significant others is also important for the

successful treatment and well-being of the person with diabetes” (2015, p. 934).

Reflection

I found that the client was most supported in housing. Fortunately, this client has

sufficient funds to secure a private residence that is appropriate for her needs. If she was to

become dependent on others for portions of her care it is central and easily accessible for health

care professionals and family to access. She lived in a basement suite that allowed her to have

social contact with the other residents in the house. As an older single lady, she states “I have

never had trouble finding housing as I appeal to most landlords as a suitable tenant.”
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In contrast, I found that this client was challenged by the health determinant employment

and working conditions. As much as this client enjoyed her job, she also stated that “it makes it

difficult to plan family visits.” This client also stated she wish she was able to take more of a

part-time approach to work but since the workplace is low on staff, she feels she is the one to

“take up the slack.” This client, in particular, had retired from her job a couple years earlier, and

then decided to take on a new job as it was something that allowed her “creative side to flow.”

Eliopoulos found that “when work is one’s primary interest, activity, and source of social

contacts, separation from work leaves a significant void in one’s life” (2018, p.42). Hence, the

return to the workforce, albeit without newfound challenges.

Conclusion

In summary, I found that although many aspects of this client’s life were viewed as

positive, there were parts of the same components that were actually a disadvantage to her

health. I learned that “reminiscing is a culturally universal phenomenon of aging. It is a great

way for the older adult to reassess life experiences and further develop a sense of

accomplishment, fulfillment, and reward in life” (Eliopoulos, 2018, p. 47). And she often did this

when making big decisions or when faced with a loss. I also learned that there are plenty of

resources that are available in person and online for cardiovascular diseases and diabetes.

Assessment of the older adult needs to be personalized, taking into account lifestyle, schedules

and capabilities of each individual: reading comprehension, transportation abilities, familial and

social supports. By personalizing your approach, respecting where the older adult may be at in

their learning capabilities, and assessing what they know about managing and prevention of

health problems, you can create customized care plans that the older adult will feel capable with

and confident that it is best meeting their needs.

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References

Eliopoulos, C. (2018). Gerontological Nursing (9th ed.). China: Wolters Kluwer.

Island heart to heart. (2019) Retrieved from: http://www.islandhearttoheart.ca/programs.html

Riley, J.B. (2017). Communication in nursing (8th ed.). St. Louis, Missouri: Elsevier.

Victoria Diabetes education centre. (2019) Retrieved from: https://www.islandhealth.ca/our-

locations/diabetes-education-centres/victoria-diabetes-education-centre

Williams, L.S., Hopper, P.D. (2015). Understanding medical surgical nursing (5th ed.).

Philadelphia: PA: F.A. Davis Company.

World health organization. (2019). The determinants of health. Retrieved from

https://www.who.int/hia/evidence/doh/en/