The early days after admission to a skilled nursing facility are often critical to the newcomer. The anxiety surrounding the older person’s separation from his home, personal possessions and the dread of what may await him, may eventually intensify.

It is this time when a facility should be expressing their concern for this individual’s state of mind and how they plan to deal with it. Without a well thought out care plan there can be an unintentional disruption to the newcomer’s previous life that may leave him no opportunity of moving forward and settling into a new environment.

Travel agencies try to persuade us that romance flourishes in the right setting. Advertisements barrage us with products that promise to make us sexy, glittering, powerful, desirable.

Although these messages are biased and superficial, they do touch upon the truth. There are circumstances that quicken our heartbeat and sharpen our appreciation for sensual possibilities. We feel good and want to share the feeling. We look good to each other and something very pleasant might well happen.

The role of the middle-aged offspring in caring for the elderly parent has been often described in social science research and popular magazines. Even as elders are being cared for, they are a source of support – emotionally, socially and financially – by providing living arrangements for the adult child who may be the caregiver.

The caregiver in an elderly couple is most frequently the wife, as women live longer than men and are usually younger than their spouses. If the woman is impaired, the husband will often become caregiver.

The emergence of a population group identified as the well elderly is the result of social and demographic progress in the industrial world. More elderly people are living longer and poverty, frailty, and dependence are not necessarily the com­mon characteristics attributed to most old people.

The future portends a healthier well elderly population who are better educated and physically as well as emotionally prepared. Society has, at present, begun utilizing their capabilities for the foreseeable future, thus guaranteeing a potentially rich human resource.

Virtually everyone remains capable of learning throughout their lives. There is no known age at which the elderly lose their ability to learn new things although due to illness and other medical issues, many can and do experience increased difficulties in learning.

It may appear as if the elderly have failed to grasp any new ideas. This is not because they have been unable to learn, but because they may choose not to risk making mistakes and looking foolish – a caution which the old share with younger people.

We often mistake an old person’s quiet withdrawal and lack of complaint as philosophic acceptance when, in fact, she is putting her best possible face on a bitterly disappointing, humiliating or frightening situation.

Either assumption, that it is normal to be unhappy or that old people are somehow happy about being unhappy, obstructs our view of the person’s true state of mind. Signs of distress deserve attention in old age as much as at any point in the lifespan.

“Professional education is acquired through the learning experience offered with courses preparing the student for the role of leader and teacher, and that can be implemented at a level of competency.” Eleanor C. Lambertsen, RN, Ed.D

Nurses play a critical role in caring for the sick and frail older adult, and in promoting healthy aging. Yet not only is there a general shortage of nurses in the United States, there are even fewer nurses who have specialized in geriatric skills. Of the 2.5 million registered nurses in the U.S., less than 15,000 are certified in geriatrics. And of the 111,000 advanced practice nurses, only 3,500 are geriatric nurse practitioners and/or clinical specialists.

We must realize that the comfort and well-being of an afflicted person can be improved even when a progressive disease process does exist. Environments can be adapted to allow for a measure of independence together with safety.

Instead of isolation, the person with a brain disease can be given the opportunity of continued social contact in a warm and friendly setting. I have personally seen women diagnosed with dementia, work confidently and competently in a kitchen provided for their use.

When a dying person senses that he is being abandoned and that others no longer feel he is worth their time and effort, he is likely to show very understandable mental and emotional reactions. He becomes demanding and agitated or more depressed. He thinks and talks in ways that may come across as peculiar to others.

For whenever patterns of communication deteriorate, it becomes increasingly difficult for an isolated person to speak logically. Unfortunately, reactions of this type often provoke responses that compound misery. Depressed because he feels abandoned, the terminally ill person may stop eating. Sensitive caregivers may recognize the psychosocial dynamics involved and increase their efforts to provide a sense of affection and security. Less sensitive people, however, may immediately resort to forced feeding through intravenous needles or gastrointestinal tubes. Or, they may decide the person is ready to die and let him go.

The following is a quote by the researcher, M. Schwab: “These early morning hours are terribly lonely…that’s when I have such a longing for someone who loves me to be there just to touch and hold me…and to talk to.”

Touch is the most important and neglected of our senses. An individual can survive without one or more of the other senses, but one cannot survive and live in any degree of comfort without the physical and emotional sense that touch is capable of offering.

Western clinicians are beginning to embrace Eastern healing modalities more than ever, especially in regard to patients with unrelieved pain. According to Maureen Foye, an RN, employed at the in-patient pain management program at Spaulding Rehabilitation Hospital in Boston, “Many people don’t understand the role that Eastern healing can play in the management of pain.” Foye began working with patients in severe pain after being exposed to the principles of therapeutic touch. She has now come full circle by instructing other practitioners in the value of these principles with plans to conduct further research into the clinical effectiveness of energy healing and therapeutic touch associated with the field of pain management.

Many patients with chronic pain tend to isolate themselves. A major focus of the program is to therefore, create community among her patients.

Ageism and Aging are stereotyping and discriminating against individuals or groups on the basis of their age. The term was coined in 1971 by Robert Butler to describe discrimination against seniors, and patterned on sexism and racism. Butler defined “ageism” as a combination of three connected elements. They are prejudicial attitudes toward older people, old age, and the aging process. There are also other discriminatory practices against older people, such as institutional practices and policies that perpetuate stereotypes about older people.

Contrary to common and more obvious forms of stereotyping such as racism and sexism, ageism is more resistant to change. For instance, if a child believes in an ageist idea against the elderly with few people correcting him, then as a result, he will continue to grow into an adult believing in ageist ideas. In other words, ageism can become a self-fulfilling prophecy.

In almost every book or article on aging, one idea continues to be stressed: longevity is desirable if accompanied by a life of high quality. But, I continue to ask, what makes for such a good life? Most of us want love, meaningful work, safety and security, energy and health, and to varying degrees, power, fame, freedom and wealth, and we want to live in a society that supports these goals.

How can we measure quality of life? There is no simple answer. It is an amorphous concept, constantly changing with the historical period and one’s culture, personal background, stage of life, and socioeconomic status. A person’s definition of quality of life is and should be highly individualized and objective.

An old woman has been admitted to an institution with a probable diagnosis of dementia and uncommunicative. She doesn’t speak nor appear to understand. However, it soon becomes clear that she can speak and understand.

Silence is, however, her way of punishing the family whom she regards as insensitive to her needs. “They are all living in my house and they treat me like a poor relation. Boss me around all the time!”

There can be much satisfaction in sharing with an elderly person his reflections on the past. Directly or indirectly, it is part of our history as well. Apart from the facts we could glean, it deepens our understanding of life’s experiences. Together with the old person, we feel the transformation from child to youth to adult and beyond.

In this way, an old person who opens his mind and feelings to us is a unique text on human development and aging.

The elderly are often less vulnerable than they appear. They may attribute their health to exercise, religion and a positive attitude. It is well known that genetics, good health practices and a certain degree of luck are involved. The very process of enduring beyond the average life span indicates personal survival capacities beyond those of the ordinary person.

In our era, however, this is complicated by the fact that many would have died of various disorders, having now been kept alive through sophisticated medical technology. Therefore, among the oldest-old we find two distinct groups: those hardy souls genetically meant to endure for a century, and the extreme frail who walk a “tightrope” between survival and death.

A resident in a facility where I was the Director of Nursing, claimed the reason he and his wife got married while in their late eighties, was the following,” It was a marriage of convenience. Rather than using a cane or a walker, we can lean on each other.”

Mobility is the capacity one has for movement. In infancy, it is a major mode of learning and interacting with the environment. Throughout life, it remains a significant means of contact, sensation, exploration, pleasure, and control. In old age one moves more slowly and purposefully, sometimes with more caution.

No single principle of mental health can guarantee that a person will pass through the challenges and perils of a long life without experiencing distress, loss, suffering, and human error that are part of most lives. However, it is within our abilities to reduce the depth and frequency of suffering and to help each other when our own resources are temporarily overrun.

In old age, distress can be more acute since immediate problems bring to mind earlier difficulties. The old person may be haunted by memories of stressful events and relationships as far back as early childhood. Tormented by both past and present, they may feel helpless. At the same time, there may be fewer resources available to cope with problems in the immediate situation, fewer people to share experiences with, less physical and financial control over the environment and so on.

Three new items have been added to Section N of the MDS, that will have a major impact on the policies and processes you have used in the past regarding medication reconciliation and administration.

• N2001: Drug Regimen Review (Assessed on Admission)
• N2003: Medication Follow-up (Assessed on Admission)
• N2005: Medication Intervention (Assessed on Discharge)

Although this new item may seem to be commonplace in your facility already, there are scenarios which frequently arise, that may interfere and render your processes inadequate. These fundamental concepts will be required for Medicare Part A covered residents but are considered a best practice for any payer source.

There is another common change in us as we grow older: we slow down. This change is probably most obvious in our physical activity. But it is part of our mental life as well. Psychomotor speed, as psychologists often call it, is required by many activities. This is the pace at which we carry out all steps of an action, from sizing up the situation, figuring out what we want to do about it, and finally doing it.

Activities and tests that place a premium upon speed often show the old person at a marked disadvantage. He does however perform as well as younger people. But does performance in those circumstances reflect intelligence? When activities or mental tests are designed so that speed is not a significant factor, then the difference between old and young becomes much slighter. The old person reveals his ability to learn, think, remember and solve problems when not being rushed and when allowed to proceed at his own pace.