¶ … GERONTOLOGICAL & GRIATRIC NURSING Nursing Paper-Gerontological & Griatric Nursing

End of Life Issues and the Elderly

(2) "Identify and discuss the role of the nurse in providing family centred care to an elderly client who is palliative and living at home with his/her spouse or another family member."

Palliative care is an approach to provide a coordinated medical, nursing, and allied health service to address the patient's physical, social emotional and spiritual needs for people with progressive incurable illness. Palliative care seeks to deliver allied health service within the environment of person's choice to improve quality of life for both an ill person and the family or friends. In the United States, Europe and other part of the world, number of people reaching the advanced age and having the need of specialities for the management of pain control continues to increase. (Royal College of Nursing, 2004).

Meanwhile, a nurse plays vital roles in providing family centred care to an elderly palliative client living at home with his or her spouse or family member.

Nurses' roles to an elderly palliative client are as follows:

Relief client from physical symptoms

Providing quality of life-care for an elderly patient

Family support

Assisting the client to achieve good death or dying well

Reducing client isolation, fear or anxiety

Relief of social isolation

Relief metal anguish

Maintaining independent patient

Improve quality of life for a client until death

Communication support

Providing essential information to a client and family member.

Additionally, Lugton, & McIntyre (2006) reveal that a nurse provides the following family centred care to an elderly palliative client living at home with his or her spouse or another family member:

Intensive care: A nurse manages the physical, spiritual, psychological, and social problems of a dying person and his family.

Collaborative sharing: A nurse supports the client by providing counselling, caring, knowledge, and information that client and family member require for the management of elderly palliative client.

Continuous giving: A nurse role is also to provide his or her own self-care needs for the dying person.

Nurses bring unique set of qualities and skills to support and care for the people facing the end of life. Nurses also provide support for the family and communities offering palliative care to elderly population. In the United States and other advanced countries, people reaching the ages of 65 and older often suffer with problem of various severities. Typically, older people are at the risks of adverse drug reactions as well as having iatrogenic illness. Thus, nurses provide consultative and ongoing care for clients in order to manage patient's illness. Additionally, nurses provide roles in alleviating the suffering of the clients; a nurse provides specialist care in implementing pain management as well as assisting the elderly client dealing with grief, dying and death. A nurse also assists a client to have a peaceful and dignified death and provides support for the family member in dealing with the loss of one of their family members. (Davies & Higginson 2004).

Moreover, a nurse provides therapeutic relationship with elderly patients and their family as well as providing spiritual, emotional, psychological care for clients. (Canadian Nurses Association, 2008). A report provided by Pallium Project (2005) reveals that nurse's role for the family centred care "is to relieve suffering and improve the quality of life for persons who are living with or dying from advanced illness, or are bereaved" (P 3). In addition, a palliative nurse establishes a therapeutic relationship with elderly patients and their family as well as advocating for the clients and families and listens actively to patient's need. Listen to patient's needs is an integral part of communication. Effective communication with clients is one of the fundamental nurse's roles. Nurses need to provide information to client and the family in order to make decision about care. Through communication, nurses educate a client and the family member about the complexity of the patient's illness. Effective communication...

8). Essentially, information sharing is the basic step in providing, planning care and the role of nurse is to treat a patient, and family as unit and a nurse encourages them to share information about the present and future priority of the patient care.
2. Activity, Mobility, Rest, Pain, Sleep, and the Elderly

2. "Discuss sleep apnea within the elderly population."

Sleep apnea is a sleep disorder characterized by pause in breathing during sleep. The abnormal pause may last from few seconds to minutes. Impact of sleep apnea among elderly population could lead to several effects such as morbidity and lower quality of life. Economic impact is much more pronounced among the elderly population since many of them are at retiring age.

There are three types sleep apnea: Central sleep apnea, obstructive sleep apnea and mixed or complex sleep apnea, which is the combination of obstructive and central apnea. Regardless of type, individuals having sleep apnea mostly have difficulties in breathing and an elderly person having sleep apnea is likely to develop stroke than elderly person without sleep apnea. Prevalence of sleep apnea among the elderly population ranges between 20% and 50%, and possibility of developing sleep apnea increases with age and sleep apnea is more common among the elderly population between 70 and 80 years. (Ganga, Thangaraj, Puppala et al. 2010).

Clinical features of sleep apnea shows that elderly population with sleep apnea have tendency of developing elevated postprandial glucose levels, low density lipoprotein, total cholesterol, haemoglobin A1C, and triglycerides. In addition, destructive sleep is another clinical feature for elderly patients. An elderly patient has the tendency of developing multiple comorbidities. In addition, elderly patients with sleep apnea always have difficulties to stay awake and struggle to maintain attention and many sleep apnea patients always involve in motor accidents and generally having excessive daytime sleep and lower quality of life.

Sleep apnea among the elderly population is one of the causes of cardiovascular death, stroke, and infarct. Bliwise, et al. (1988) argue that it is unclear why older population are particularly susceptible to such symptoms, however, natural death during sleep is common among the aged population with sleep apnea. Possible factor accounting for mortality of aged population during sleep is due to the impaired respiration. Among the aged population with sleep apnea, 9 out of 10 could develop cyclic brady/tachycardia and cardiac arrhythmias. Ganga et al. (2010) support this argument by pointing out that effect of sleep apnea among elderly population could range from congestive heart failure, hypertension, and atrial fibrillation to coronary artery disease and these symptoms have been the major causes of death in the elderly population.

Several reasons have been attributed to the cause of sleep apnea among elderly population. Anatomic reason has been the factor behind sleep apnea among elderly population. As people getting older, negative pressure reflex in men decrease. In women, pharyngeal lengthening is the cause and preferential deposition of fat is the cause in both sexes. A change in pharyngeal anatomy has also been observed with elderly population, soft palate length and pharyngeal dilator are very common with women. All these symptoms could make elderly population to develop the risks of sleep apnea. (Malhotra, Huang, Fogel et al. 2006). Loss of teeth, effect of multiple medication, and absence of partners has also been attributed to the cause of sleep apnea among elderly population.

Despite the effects of sleep apnea among the elderly population, there is still a challenge in the diagnosis of sleep apnea. Polysomnogram (PSG) is the most effective method of diagnosing sleep apnea; however, the test is costly, time consuming, labor intensive and technically demanding. While PSG is effective, the system could not be used as a screening tool for large population.

Ambulatory device is another method for diagnosing sleep apnea. This test device is less costly and "easier to operate…