Ageing and its Impact on Health and Social Well-being

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Care of the Older Person

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

Defining ageing process



Where we live in the world



Our environment



Our lifestyle



Social factors



Inherited or genetic factors

4

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C

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s

T

h

e

a

g

e

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n

g

p

o

p

u

l

a

t

i

o

n



Life expectancy greatly increased

I

n

c

i

d

e

n

c

e

o

f

:



Disability, disease, mental illness

G

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V

a

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s



Physical environments



Social and economics influences



Behavioural Factors



Access to appropriate, effective health and social

services

5

P

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g

i

c

a

l

P

r

o

c

e

s

s

o

f

A

g

e

i

n

g



Hair loss



Muscle mass



Bones



Digestive System



Heart



Lungs



Reproductive Organs



Temperature Control



Senses



Eyes and Ears



Skin

6

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s

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c

a

l

D

i

s

e

a

s

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s

w

h

e

n

A

g

e

i

n

g



Eyes

–

Cataracts

–

Glaucoma



Mouth 

–

Gum disease

–

Loss of teeth

–

Oral health declines



Skin

–

Irritations

–

Moles / Warts

–

Varicose Veins

–

Shingles

7

P

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a

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D

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a

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s

w

h

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n

A

g

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g



Bones and Joints

–

Arthritis

–

Osteoporosis



Nervous System

–

Hypothermia

–

Multiple Sclerosis

–

Parkinson’s Disease



Dementia

–

Alzheimer's



Depression



Stroke

       -  

Blood clotting

8

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a

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Factors which can have a dramatic effect on the

older person:



Retirement



Financial problems



Increasing dependence can cause a loss of self

respect



Bereavement



Feelings of isolation



Physical decline

9

D

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f

f

e

r

e

n

t

a

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t

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g

/

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p

l

e

Greater demand on the care delivery / medical

services.

H

o

l

i

s

t

i

c

N

e

e

d

s

;



Physical



Psychological



Social



Environmental



Emotional



Spiritual

10

10

S

t

a

t

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t

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r

y

a

n

d

V

o

l

u

n

t

a

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y

A

g

e

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c

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s

p

r

o

m

o

t

i

n

g

w

e

l

l

b

e

i

n

g

S

t

a

t

u

t

o

r

y

A

g

e

n

c

i

e

s



GPs



Community Nursing Services



Local Authority



Dentists



Physiotherapists



Chemists



Chiropodists



Opticians



Paramedics



Hospitals



Residential Care



HSE

11

11

V

o

l

u

n

t

a

r

y

A

g

e

n

c

i

e

s



Local Support Groups / Community Services



Home Care



Red Cross



Meals on Wheels

P

r

i

v

a

t

e

A

g

e

n

c

i

e

s



BUPA, PPP, VHI, VIVAS

P

r

i

v

a

t

e

P

r

o

v

i

d

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r

s

:



Private hospitals



Orthodontists



Physiotherapists



Chiropodists

12

12

P

r

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p

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t

i

o

n

f

o

r

R

e

t

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m

e

n

t



Can be defined as the end of a working life



Compulsory retirement aged 66

R

e

t

i

r

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m

e

n

t

s

h

o

u

l

d

b

e

p

l

a

n

n

e

d

t

o

a

d

d

r

e

s

s

t

h

e

f

o

l

l

o

w

i

n

g

k

e

y

a

r

e

a

s

:



Pre-retirement courses



Healthcare issues



Financial provision



Housing



Social needs



Leisure provision/social interests

13

13

T

h

e

O

l

d

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r

P

e

r

s

o

n



Retirement is difficult in any group



You have a duty to uphold the rights of all clients in

their care setting



Everyone is entitled to the same level of care



Respect them



Treat them with dignity



Help them to maintain their independence

14

14

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2

-

W

o

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i

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W

i

t

h

t

h

e

O

l

d

e

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P

e

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s

o

n

H

o

l

i

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t

i

c

N

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e

d

s

:



Physical



Social



Emotional



Psychological



Recreational



Financial



Environmental



Spiritual.

15

15

16

16

M

a

s

l

o

w

’

s

H

i

e

r

a

r

c

h

y

o

f

H

u

m

a

n

N

e

e

d

s

A

c

t

i

v

i

t

i

e

s

o

f

D

a

i

l

y

L

i

v

i

n

g



Maintaining a safe environment



Communicating



Breathing



Eating and drinking



Elimination



Personal Hygiene and dressing



Controlling body temperature



Mobilising



Working and playing



Sleeping



Sexuality



Dying

17

17

P

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y

s

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c

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N

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s



Ability to mobilise decreases, therefore ability

to complete own personal hygiene is affected



Can be very difficult to accept help physically



Independence decreases



Access to equipment needed for personal care



Housing issues (bath/ shower accessibility)



Dignity and Respect



Skin care



Continence Care

18

18

S

o

c

i

a

l

N

e

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s



Ability to form and maintain relationships



Access to social situations



If social needs are not met loneliness and

isolation results

19

19

E

m

o

t

i

o

n

a

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N

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s



Focuses on feelings of the individual

–

Their ability to express, suppress



Development of a personal identity



Take responsibility for own actions



Recognised emotions

–

Laughter, happiness, anger, sadness, distress



Older people are a vulnerable group

–

Emotional needs are often neglected

20

20

P

s

y

c

h

o

l

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i

c

a

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N

e

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s

M

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a

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b

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n

g

:



The ability to think clearly, problem solve,

make rational decisions, perform particular

processes to do with intellect



The ability to express emotions, deal with

stress, cope with other demands, on the mind

– social, physical, mental, emotional



All needs are interlinked and can have an

effect on each other

21

21

R

e

c

r

e

a

t

i

o

n

a

l

N

e

e

d

s

N

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s

w

h

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c

h

p

r

o

m

o

t

e

m

e

n

t

a

l

a

c

t

i

v

i

t

y

/

s

t

i

m

u

l

a

t

i

o

n

:



Recreational activities



Stimulate: Physical, mental, emotional well being



N.B. Whilst there can be progressive deterioration in

physical capabilities there should be a positive effort to

promote recreational needs



Activities should be suitable to client group

–

i.e., age / skill appropriate, client involved

–

Clients know best what they want 

22

22

F

i

n

a

n

c

i

a

l

N

e

e

d

s

O

l

d

e

r

p

e

o

p

l

e

m

a

y

b

e

d

e

p

e

n

d

e

n

t

f

i

n

a

n

c

i

a

l

l

y

:



If they are in a lower sociological group



No pension provision



Suffer from illness/disability



If they live in isolation



No means of transport



Mental faculties are deteriorating



Receive assistance when over 70 but may not

meet needs

23

23

F

i

n

a

n

c

i

a

l

N

e

e

d

s

I

f

a

p

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r

s

o

n

c

a

n

n

o

t

d

e

a

l

w

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t

h

e

i

r

o

w

n

a

f

f

a

i

r

s

:



Appropriate legal steps must be taken



Assessment of mental ability carried out by GP

P

o

w

e

r

o

f

a

t

t

o

r

n

e

y

g

i

v

e

n

t

o

:



A relative, legal person, social service

departments (under guardianship arrangements

can deal with financial commitments)

24

24

E

n

v

i

r

o

n

m

e

n

t

a

l

N

e

e

d

s

The surroundings in which we live includes:



Noise, housing, social/physical context, noise,

air, water quality

–

Anything that affects peoples existence



People should, where possible be cared for in

own surroundings with family and community

support

–

With input from GP

–

Community/District Nurse, Practice Nurse, family

25

25

S

p

i

r

i

t

u

a

l

N

e

e

d

s



Spiritual needs have to do with beliefs



Carer’s have a duty to facilitate all religious

denominations



Older people like to practice their religion



How can the Spiritual needs be met



N.B. People who are spiritually fulfilled are

happy/contented/accepting

26

26

N

u

r

s

i

n

g

H

o

m

e

E

n

v

i

r

o

n

m

e

n

t



Physical context

–

Warmth, temperature, food, drinks, friendliness,

atmosphere.



Psychological needs



Social needs



Emotional needs



Intellectual needs



Invasion of personal space

–

Often confuses people



Isolation, loneliness even when surrounded by people

27

27

R

o

l

e

o

f

H

e

a

l

t

h

c

a

r

e

A

s

s

i

s

t

a

n

t



To assist the trained nurse to carry out planned

care



To report any unusual findings to the trained nurse



To have an understanding of what needs to be

reported / recorded



To carry out basis “Care of the Person” duties



Encourage independence in all aspects of care



Assist clients to take part in social/recreational

activities



Orientate clients to time/place

28

28

R

o

l

e

o

f

H

e

a

l

t

h

c

a

r

e

A

s

s

i

s

t

a

n

t



Know how to communicate with clients.



Convey empathy, sympathy, patience, cheerfulness.



Know about confidentiality and how to observe it.



Have enthusiasm for the job



Be able to interpret body language/messages of

vulnerable clients



Be cheerful in the execution of tasks



Never show disapproval when doing tasks that are

difficult



Be a good listener

29

29

C

o

m

m

u

n

i

c

a

t

i

o

n

C

o

m

m

u

n

i

c

a

t

i

o

n

i

s

a

t

w

o

w

a

y

p

r

o

c

e

s

s



Sender – message – receiver



Some clients may feel vulnerable



Communication can be verbal, non-verbal



Client’s with vision difficulties



Client’s with speech difficulties

W

i

l

l

i

n

v

o

l

v

e

a

s

s

e

s

s

i

n

g

t

h

e

i

r

p

r

o

b

l

e

m



Deciding on the method of communication



Clients must be consulted on all aspects of their care



Families should also be included in care

30

30

C

o

m

m

u

n

i

c

a

t

i

o

n



Effective communication can be facilitated by showing

sympathy, empathy to client, family, friends



Be prepared to listen



Use open body language – be approachable



Be friendly, smile, show a caring attitude



Confidentiality – do not abuse



Refer to trained member of staff who can assist



Carer’s are not allowed to relay client details



Be polite to members of the multi disciplinary team and

assist wherever you can

31

31

E

m

p

o

w

e

r

m

e

n

t



Empowerment means giving control to the

client



Enabling them to take control of:

–

Their own lives

–

Own decisions

–

Choosing their own activities



In cases where a client finds difficulty or lacks

confidence then power can be shared between

client and carer

32

32

A

d

v

o

c

a

c

y

A

d

v

o

c

a

c

y

m

e

a

n

s

:



Representing the interests of another, speaking on their

behalf, presenting their case for them.

A

l

s

o

m

e

a

n

s

:



Encouraging, enabling clients to speak up for themselves, to

be assertive



People who require advocates are usually vulnerable

members of society e.g., older people, children, sick people,

poorer members of society, ethnic minorities people with

language or communication problems



Encouragement of the client to self express is assisting with

self advocacy and is a way of empowering

33

33

I

n

d

e

p

e

n

d

e

n

c

e



The ability to do things for self without help or

assistance from anyone else



Being able to control own environment, lifestyles,

choices, needs



Being dependent may feel like a burden



Carer’s should be encouraged to do for the client’s only

what they cannot do for themselves in order to

maintain independence



Decision making should always involve client and

family

34

34

I

n

d

e

p

e

n

d

e

n

c

e



An assessment of needs is necessary:

–

To find out what clients needs assistance with



Discussion is important to best identify needs



A skills assessment is necessary in case

equipment is required



Knowledge of previous lifestyle



Will help identify client and aspirations.

35

35

I

n

d

i

v

i

d

u

a

l

i

s

e

d

C

a

r

e

Specifically designed for the particular client



Involves the delivery of care using a holistic method;

Physical, emotional, spiritual, social, intellectual etc.



12 Activities of Daily Living

–

Safe Environment 

- Elimination

–

Communication

- Dying

–

Breathing and Circulation

- Sleeping

–

Eating and Drinking

- Mobilisation

–

Washing and Cleaning

- Expressing Sexuality

–

Controlling Body Temperature

- Working and Playing

36

36

I

n

d

i

v

i

d

u

a

l

i

s

e

d

C

a

r

e

N

u

r

s

e

:



Select appropriate care needs of client



Write a care plan for each client



Sets realistic/achievable goals



Plan a review date – 3 / 6 months



Updating of plan if some changes in condition or rewrite if

total change/deterioration



Both short/long term care plans to be used



Filed properly



Records kept for seven years



All plans to be legal/dated/signed/upgraded

37

37

D

i

g

n

i

t

y

P

r

o

c

e

s

s

i

n

g

s

e

l

f

e

s

t

e

e

m

,

b

e

i

n

g

w

o

r

t

h

y

o

f

r

e

s

p

e

c

t

,

s

h

o

w

i

n

g

p

r

i

d

e

i

n

a

c

h

i

e

v

e

m

e

n

t



Dignity is a fragile concept and preserving it can be difficult



Needs mutual respect between clients and carer



Intimate tasks – to be performed in a private setting



Minimum number of people present



Notice on door to ensure privacy/dignity



Respect client feelings



Use prompts, confidence boosters appropriately.



Clients should be spoken to, not spoken of



Lack of patience can lead to a loss of dignity

38

38

C

h

o

i

c

e



As individuals we can make decisions about what

we wear, how we live, socialise, the type of work

we do, who to be with, where to go e.tc., gives us

a sense of self respect / self worth



As a carer you cannot “belittle” or disregard a

client’s wishes



You should “enable or facilitate” client’s where

possible



Facilitating choice means giving respect, being

patient, preserving dignity

39

39

C

o

n

s

t

r

a

i

n

t

s

o

n

C

h

o

i

c

e



Loss of dignity – may create vulnerability



Carer’s attitude – should be one of encouragement



Lack of time



Lack of patience



Criticism – do not criticise client’s choice



Lack of assistance



Not to have choice means that clients are

controlled/disempowered



Empowering is putting the ball back in the client’s court



Carer’s are in a position of power they should not abuse it

40

40

W

a

y

s

t

o

F

a

c

i

l

i

t

a

t

e

C

h

o

i

c

e

B

e

f

l

e

x

i

b

l

e

:



Allow choice of menu



Choice of clothing



Choice of where to dine



Choice of bedtime



Giving time to express feelings



Choice of entertainment



Allowing client’s to assist in formulating own care plan



Promotion of the theory / practice of self advocacy

41

41

R

e

s

p

e

c

t

a

n

d

D

i

g

n

i

t

y



Dignity means being worthy of respect and possessing pride

and self esteem



Dignity and respect go hand in hand i.e., all people must be

given respect in order that dignity needs are preserved



Respect means treating each person as individual,

tolerating point of view, allowing choice and facilitating

choice where vulnerable clients are involved



Giving respect to vulnerable clients means empowering

them, creating and maintaining their independence



It also means doing only for the client what they cannot do

for themselves

42

42

S

e

l

f

E

s

t

e

e

m

S

e

l

f

e

s

t

e

e

m

i

s

a

s

e

n

s

e

o

f

w

h

o

w

e

a

r

e

:



People have ambitions

–

A desire to be someone, to do certain things, have a set of

values and achieve certain things



Want to be unique and individual



Increasing self esteem can lead to a boost in

confidence and self worth



Low self esteem leads to a lack of confidence resulting

in depression and lack of confidence



Good self esteem is important to encourage

43

43

F

a

m

i

l

y

/

C

a

r

e

r

s

a

s

P

a

r

t

n

e

r

s

i

n

C

a

r

e



Client’s should be consulted in every aspect of

care



Family can help to make logical decisions



It helps family to think that they are still useful to

their loved ones



Help client feel loved



Helps create independence



Allows carer’s to do other work



We do not know best is something we need to

remember

44

44

C

a

r

e

r

s

E

f

f

e

c

t

i

v

e

n

e

s

s



Carer’s need to have a Purpose/ Aim



Job specific training



Being a member of the unit/ team



Responsibility



Having sufficient staff to perform required tasks



Staff relationships with each other



Good communication



Praise for care



Suggestions



Camaraderie

45

45

I

s

s

u

e

s

t

h

a

t

m

a

y

a

f

f

e

c

t

c

a

r

e

r

s



Constraints



Manipulative controlling behaviour



Negativity



Lack of confidence/loss of self confidence



Poor staffing levels



Lack of motivation



Poor management



Ineffective communication is unit/ team

46

46

H

e

a

l

t

h

P

r

o

m

o

t

i

o

n

f

o

r

O

l

d

e

r

C

l

i

e

n

t

s

Encourage health choices and contributes to:



General well being



Emotional well being



Gives a “feel good” factor



Identifies health related problems



Improves body function



Promotes exercise regimes/fitness



Prolongs life

47

47

H

e

a

l

t

h

P

r

o

m

o

t

i

o

n

f

o

r

O

l

d

e

r

C

l

i

e

n

t

s



Healthy eating:

–

Diet should consist of a balance of proteins,

carbohydrates, dairy products, fruit and vegetables,

oils/fats/sugars (small amounts)



Alcohol consumption:

–

Should be taken in moderation



Exercise:

–

It helps to improve joint function



Smoking:

–

Is harmful and should be discouraged

48

48

T

h

e

r

a

p

e

u

t

i

c

i

n

t

e

r

v

e

n

t

i

o

n

s



Would improve/enhance social interactions

–

Keeps mind/brain active and alert

–

Creates a social existence

–

Gives a sense of purpose/sets goals



There are often constraints

–

Difficulty in accessing therapists

–

Transport facilities

–

Mobility issues/ pain

–

No one to accompany them

–

Lack/loss of mental/intellectual skills

–

Money constraints – living on pension

49

49

T

h

e

r

a

p

e

u

t

i

c

i

n

t

e

r

v

e

n

t

i

o

n

s



Day care



Speech therapy



Occupational therapy



Physiotherapy



Chiropody



Preparation for retirement classes



There are alternative medicines/therapies which can

enhance conventional medicine (must be approved by

GP/ Pharmacist first)

50

50

U

n

i

t

3

-

C

a

r

i

n

g

f

o

r

O

l

d

e

r

P

e

o

p

l

e

w

i

t

h

S

p

e

c

i

f

i

c

N

e

e

d

s

51

51

P

e

o

p

l

e

w

i

t

h

C

o

g

n

i

t

i

v

e

N

e

e

d

s

C

o

g

n

i

t

i

v

e

:



Mental process involved with knowledge and understanding



Perception and thinking skills



Mental abilities may increase/decrease



Mental exercises and stimulation important

E

x

a

m

p

l

e

s

;

People who suffer from dementia;



Short term memory– first to decline



Eventually long term memory effected



Care and practice need to be adapted to meet needs

52

52

C

a

r

e

a

n

d

P

r

a

c

t

i

c

e

s



User friendly environment/ clutter free



Client’s room (Visual and sensual stimulation)



Higher concentration of staff



Appropriate activities for older person



Reminiscence tapes



Animals



Gardening



Arts/ Crafts/ Creative activities



Music therapy/ singing

53

53

S

e

n

s

o

r

y

I

m

p

a

i

r

m

e

n

t

(

S

i

g

h

t

)



Room to be user friendly



Things to be left in the same place



Talk regularly about environment – it helps



Library with talking books, large print or braille



Always introduce yourself



Ask permission of client



Even if a person cannot see other senses are

heightened

54

54

S

e

n

s

o

r

y

I

m

p

a

i

r

m

e

n

t

(

H

e

a

r

i

n

g

)

Remember client:



Can lip read – speak clearly – do not shout



Can use sign language



Use hearing aids

–

Always be patient

–

Make good eye contact

–

Identify individual needs

–

Use good body language



Remember clients need to communicate



Clients can often get impatient / aggressive

55

55

O

l

d

e

r

P

e

r

s

o

n

w

i

t

h

M

e

n

t

a

l

I

l

l

n

e

s

s



Mental health means the absence of mental illness

–

The ability to deal with life’s issues/traumas efficiently and

satisfactory



It involves using coping mechanisms that show

accurate perception of reality



Positive self esteem



Self actualisation goals



Personal autonomy



Covers social and emotional disability; i.e. loss of

social skills

56

56

M

e

n

t

a

l

I

l

l

n

e

s

s



Covers the following illnesses:

–

Anxiety state

–

Depression

–

Schizophrenia

–

Dementia



People may suffer loss of physical ability



Mental disability can be difficult to assess



Maintain a safe environment

–

Lack of understanding of danger



Communication

–

People may find it difficult

57

57

M

e

n

t

a

l

I

l

l

n

e

s

s



Activities of Daily Living are affected

–

People often self neglect/ reduced personal hygiene

–

Can show a loss of automatic skills

(Skills learned childhood)

–

Continence issue

–

Eating/drinking issues

–

Spiritual needs

–

Mobilising

–

Working and playing

–

Sleeping – clients often restless

58

58

M

e

n

t

a

l

I

l

l

n

e

s

s

O

t

h

e

r

i

s

s

u

e

s

:



Inappropriate behaviour

–

Confusional states



Emotional responses – often mixed up



Financial problems – often lose things

–

Can accuse carer’s or family of stealing



Stigma attached to mental illness



Mental illness  can cause stress to carer’s /

family

59

59

I

s

s

u

e

s

R

e

l

a

t

e

d

t

o

a

n

O

l

d

e

r

P

e

r

s

o

n

w

i

t

h

D

e

m

e

n

t

i

a

Dementia means brain failure

C

a

u

s

e

s

:



Multi-infarct dementia

–

There is interrupted or complete breakdown of blood supply to

the brain



Dementia of Alzheimer’s type

–

Where brain shrinks in size and there is a loss of brain tissue



Dementia causes change in behaviour pattern which

can lead to a number of disabilities or loss of functions.

60

60

S

i

g

n

s

a

n

d

S

y

m

p

t

o

m

s

o

f

D

e

m

e

n

t

i

a



Memory loss



Difficulty in performing simple everyday tasks



Loss of spatial awareness, orientation



Loss of basic skills/language skills



Aggressive behaviour



Resistive behaviour



Passive or unresponsive reactions



Emotional outbursts / Emotional response damaged



Constant repetition



Difficulty with communication

61

61

S

i

g

n

s

a

n

d

S

y

m

p

t

o

m

s

o

f

D

e

m

e

n

t

i

a



Inappropriate behaviour / can become introverted



Lack of understanding of danger



Inability to make a decision



Self neglect.



Neglect of home.



Apathy – not caring what happens around them.



Loss of social relationships.



Loss of family relationships.



Incontinence.



Difficulty in recognising people/places.

62

62

I

s

s

u

e

s

R

e

l

a

t

e

d

t

o

a

n

O

l

d

e

r

P

e

r

s

o

n

w

i

t

h

D

e

m

e

n

t

i

a

People are unable to care for themselves once clinical

diagnosis has taken place usually



Full time care (24/7) is required



Finance – what funding is available



Support – Alzheimer’s/Carer’s Association



Staffing levels – carefully worked out care plan



Transport – can only go out with assistance



Medication – often refuses medication which would help



Behaviour – coping with different types of behaviour is

demanding

63

63

F

e

e

l

i

n

g

s

o

f

t

h

e

O

l

d

e

r

P

e

r

s

o

n

w

i

t

h

D

e

m

e

n

t

i

a



Increasing loss of functions / Unable to perform personal tasks

–

Impact loss of self esteem / respect / dignity



Feel useless/ burdensome/ Fear of being a burden to family



Resent carer’s / family / help



Fear of complete loss of skills



Fear of what will happen eventually

      -   Loss of independence/ Unable to make own decisions



Fear of pain / suffering



Fear of death



Fear of isolation



Fear of not being understood

64

64

C

a

r

e

r

s

F

e

e

l

i

n

g

s

t

o

w

a

r

d

s

a

n

O

l

d

e

r

P

e

r

s

o

n

w

i

t

h

D

e

m

e

n

t

i

a



Carer may feel anger

–

At losing client

–

At lack of ability to cure them

–

At medical profession

–

At own ability to do anything curative



Carer may feel depressed

–

At impending loss

–

Watching suffering client



If main Carer is husband or wife – discuss

65

65

C

o

n

d

i

t

i

o

n

s

t

h

a

t

R

e

q

u

i

r

e

I

m

m

e

d

i

a

t

e

A

t

t

e

n

t

i

o

n



Cardiac arrest/ Pain in left arm/ chest



Choking



Difficulty with breathing/ blue around lips



Fractures / Falls



Epileptic seizures



Stroke



Unexplained unconsciousness



Burns/scalds



Electric shock



Poisoning



Severe bleeding

66

66

T

y

p

e

s

o

f

L

o

s

s

I

m

m

e

d

i

a

t

e

L

o

s

s

:



No time to prepare



Wishes not known



Quickly adopt coping mechanisms



No time to say goodbye/finalise things

L

o

s

s

f

o

l

l

o

w

i

n

g

c

h

r

o

n

i

c

i

l

l

n

e

s

s

:



More time to adjust/ go through grief



Time to say goodbye



Family arguments can be resolved



Express wishes



Help sort out physical, emotional, spiritual, social and financial need

67

67

I

n

d

i

v

i

d

u

a

l

N

e

e

d

s

o

f

a

D

y

i

n

g

O

l

d

e

r

P

e

r

s

o

n

a

n

d

t

h

e

i

r

F

a

m

i

l

i

e

s

D

e

a

t

h

i

s

p

a

r

t

o

f

l

i

f

e



Important that the person dies with dignity and respect



In an environment where all needs are met i.e.: physical,

emotional, physiological, social, spiritual



Each death is an individual experience unique to the person



Client to be allowed to make choices about care needs (if

possible)



Care plans to have an input from client / family



Give time and space to grieve



Dying is a process/journey everyone must make alone

68

68

F

i

v

e

S

t

a

g

e

s

o

f

G

r

i

e

f

1.

D

e

n

i

a

l

o

r

i

s

o

l

a

t

i

o

n

(Often won’t believe diagnosis)

2

.

A

n

g

e

r

(

W

h

y

m

e

?

)

3

.

B

a

r

g

a

i

n

i

n

g

(

P

r

o

m

i

s

e

t

o

b

e

g

o

o

d

/

B

u

y

i

n

g

t

i

m

e

)

4

.

D

e

p

r

e

s

s

i

o

n

(

N

e

e

d

s

t

o

g

r

i

e

v

e

/

C

o

m

e

t

o

t

e

r

m

s

w

i

t

h

i

n

e

v

i

t

a

b

l

e

)

5

.

A

c

c

e

p

t

a

n

c

e

(

L

a

s

t

s

t

a

g

e

/

S

t

a

t

e

o

f

c

a

l

m

n

e

s

s

/

s

e

r

e

n

i

t

y

)

69

69

F

i

v

e

S

t

a

g

e

s

o

f

G

r

i

e

f



The family and the dying person will go through

similar stages of grief – through not necessarily

at the same stage at the same time



This can often cause problems



Carer’s need to help clients and family members

to cope with the circumstances surrounding

death



In order to help others Carer’s need to look at

their own anxieties, fears and attitudes they may

have about death

70

70

C

o

p

i

n

g

w

i

t

h

D

e

a

t

h



It is physically and emotionally demanding



It helps to discuss death prior to it happening



Every situation is unique



Carer’s need to be trained / education in the dying

process



“De-brief” with Management for care staff



Counselling specifically for care staff/ families

71

71

C

o

p

i

n

g

w

i

t

h

D

e

a

t

h

A

s

p

e

c

t

s

o

f

c

a

r

e

t

o

b

e

a

d

d

r

e

s

s

e

d

:



Pain



Watching skin integrity



Indigestion



Nausea /vomiting



Diarrhoea / constipation



Urinary tract infections



Difficulty in swallowing



Dyspnoea/ Breathing difficulties



 Sore Mouth/Dry Mouth



D

e

l

i

r

i

u

m

/

a

l

t

e

r

e

d

s

t

a

t

e

o

f

c

o

n

s

c

i

o

u

s

n

e

s

s

72

72

A

s

p

e

c

t

s

o

f

N

u

r

s

i

n

g

C

a

r

e



Communication



Emotional support



Spiritual needs



Dealing with fear – client and family

73

73

H

e

l

p

i

n

g

t

h

e

F

a

m

i

l

y

o

f

t

h

e

B

e

r

e

a

v

e

d



Allow family to talk and express fears



Assist with formulating care plan



Assist with physical / spiritual needs – if desired



Give them area/ space to talk privately



Make refreshments



Accommodate phone calls



Advise where they can go for counselling



Allow time to speak to Doctor



After death allow time to mourn



Spend time with the deceased

74

74

A

f

t

e

r

d

e

a

t

h

h

a

s

o

c

c

u

r

r

e

d

Respectfully carrying out duties after Death;



Treat the deceased body with respect



Once breathing has stopped the nurse will check for signs of

life before calling GP to come and confirm death has occurred

N

u

r

s

e

C

h

e

c

k

S

i

g

n

s

o

f

l

i

f

e

a

r

e

:



Breathing:  Stops



Heartbeat / Pulse: few beats, then stops



Level of consciousness: pupils fixed and no reaction after

death has occurred



Muscle tone: flaccid/floppy



Response to stimuli: none

75

75

A

f

t

e

r

D

e

a

t

h

d

u

t

i

e

s

f

o

r

C

a

r

e

r

s



Note time of death



Close eyelids



Disconnect any tubing



Put teeth in



Close mouth/ jaw



Replace any dressings with clean ones



Change continence pads



Change any soiled personal or bed cloths



Place hands by sides



Cover loosely with clean sheet



Close door for privacy



Call Minister of religion (if not already there)



Leave for one hour

76

76

L

a

y

i

n

g

o

u

t

a

B

o

d

y

Nowadays bodies are usually laid out in a Mortuary



If this doesn’t happen



Body to be bathed and dressed in pre-selected clothing



Wrapped in sheet



If in nursing home/hospital body is tagged with name

for identification



All procedures to be carried out according to nursing

home / hospital / company policy / procedures



Any religious rights to be facilitated where reasonably

practicable

77

77

L

a

y

i

n

g

o

u

t

a

B

o

d

y



Allow family to stay with deceased



Try to assist in any practical way that is possible



Duties to be carried out quietly, efficiently and with

respect



Once body is declared dead by GP the family can

contact the undertaker



What happens the body remains the nurses / carer’s

responsibility until he/she leaves the Nursing home /

hospital

78

78

U

n

i

t

4

–

C

a

r

e

S

e

t

t

i

n

g

s



Community Nurse



Nursing Home



Home Help/ Private Carer



District Nurse



Emergency Services



Retirement Villages



Hospices



General Hospitals



Residential Homes



Psychiatric Hospitals

79

79

S

e

r

v

i

c

e

s

f

o

r

O

l

d

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Education

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Retirement / Leaving the Workplace

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Leisure

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Public Health Nurse

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Occupational Therapist

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Physiotherapist

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Voluntary Groups

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Day Care Centres

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Respite Care

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It is important that the Older Person feels safe and secure to avail of any

of these services available.

The registered body responsible for the safety and upkeep of standards in

healthcare in Ireland is HIQA (Health Information and Quality Authority)



Statutory Responsibility

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Setting standards for health and social services

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Monitoring health quality

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Health technology assessments

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Health information

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Social Services Inspectorate

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Openness and transparency

Focus on outcomes

Person-centredness

Evidence-based practice

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;



Medical department



Environmental health department



Occupational health department

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