Please respond to your peer’s posts, from an FNP perspective. To ensure that your responses are substantive, use at least two of these prompts:

• Do you agree with your peers’ assessment?
• Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
• Share your thoughts on how you support their opinion and explain why.
• Present new references that support your opinions.

Please be sure to validate your opinions and ideas with citations and references in APA format. Substantive means that you add something new to the discussion, you aren’t just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature.Be sure to review your APA errors in your reference list, specifically you have capitalization errors in some words of the titles.Include the DOI. Also, be sure you are italicizing titles of online sources.No more than 200 words maximum.

• Discuss how you will prepare the client and caregivers for these changes.
• Include in your discussion education, resources and support groups that are available for the client and the caregivers.
• Describe a client that you have cared for, and how you managed functional changes for the client and family.

LaTara’s response:

Functional changes are most apparent in those with advanced age 85 years or older and impacts the individual, as well as family members. Education is the key to handling functional changes in the elderly, and in supporting the caregiver and extended family members.

• Discuss how you will prepare the client and caregivers for these changes.

When caring for older adults as a clinician or as a caregiver, predicting the future and then planning for the most likely aging trajectories are key steps. Clinicians and the public health community need to develop a culture of sensitivity to the needs of this population and its subgroups. I will provide education to the patient and there loved ones about sensory changes, cognitive changes, and weakness which may be subtle or may be severe in the heterogeneous population of people over age 85 (Kaspar, Gabrian, Brothers, Wahl, & Diehl, 2019). Preparation will be administered regarding falls, prevalence of cardiovascular disease, and potential for difficulty with activities of daily living which are common but not universal. Furthermore this patient will be advised on possible hearing and vision loss which are a part of normal aging as is decline in immune function. They will be tested and assessed for cardiovascular disease, osteoporosis and dementia, osteoarthritis, diabetes, and related mobility disability that will increase in prevalence as the population ages and becomes more overweight.

• Include in your discussion education, resources and support groups that are available for the client and the caregivers.

These population changes have considerable public health importance. Caregiver support, services in the home, assistive technologies, and promotion of home exercise programs as well as consideration of transportation and housing policies are recommended (Wadley, Crowe, Mansiske, Cook, Unverzagt, Rosenberg, & Rexroth, 2017).

• Describe a client that you have cared for, and how you managed functional changes for the client and family.

Where I am employed we typically take care of patients in the age population due to falls. Falls are a major cause of morbidity and disability among older adults. 30–40% of adults over age 70 fall each year and rates are particularly high for older adults in long-term care facilities (Wadley, Crowe, Mansiske, Cook, Unverzagt, Rosenberg, & Rexroth, 2017). When providing care for my patient status post a fall I advised the patient and caregivers that with assistance I encourage physical activity, vitamin D supplementation, balance exercise, and a home safety assessment as a part of a multifactorial fall prevention program. This has shown to reduce the incidence of falls significantly.

Kaspar, R., Gabrian, M., Brothers, A., Wahl, H.-W., & Diehl, M. (2019). Measuring Awareness of Age-Related Change: Development of a 10-Item Short Form for Use in Large-Scale Surveys. Gerontologist, 59(3), e130–e140. https://doi.org/10.1093/geront/gnx213

Wadley VG, Crowe M, Marsiske M, Cook SE, Unverzagt FW, Rosenberg AL, & Rexroth D. (2017). Changes in everyday function in individuals with psychometrically defined mild cognitive impairment in the Advanced Cognitive Training for Independent and Vital Elderly Study. Journal of the American Geriatrics Society, 55(8), 1192–1198. https://doi.org/10.1111/j.1532-5415.2007.01245.x

Nora’s Response:

Through this course, as well as my personal life, I am seeing so many different sides to the natural aging process. There are so many different “versions” of the aging population. There are those that are adapting well to the aging process, and those that are suffering through it with chronic or acute illnesses. As patients with advanced age continue to pass 85 years of age, education for the patient and their caregivers will be vital to their wellness. As providers we can discuss what is considered “normal” aging at this time and how we will prepare for it. Patients and caregivers may need to be made aware of resources that they have never had to use before as the patient ages. Safety and patient cognition are going to be of importance. If the patient lives alone, we can offer physical therapy assessment in the home environment to assess for safety needs. We would want to teach methods of fall prevention such as removing throw rugs, avoiding stairs, and installing adequate lighting in the home. Preventing falls is of great importance since “a fall can result in severe injuries, such as fractures, causing longstanding pain, lower quality of life, disability and even death” (Mohammed, 2017). It would also be of value to have a physical therapist assess the patient while they are doing normal activities of daily living to see if they are being carried out safely. One such assessment could include that of the functional reach test. “A decrease in functional reach indicates impaired balance” (Mohammed, 2017). This could help caregivers guide decision making to further services in the home or transition to another living scenario.

Furthermore, assessing memory and risk factors for dementia will be key as patients move into their later years. Although there is a profound affect on the patient, family members sometimes are left out in the process of anticipatory guidance related to such big life changes. Family members express that “they experienced loss, guilt and shame, but also feelings of relief…” (Graneheim, Johansson, & Lindgren, 2013) when making adjustments to living environments as their family member aged. In my own experience in caring for patients going through Alzheimer’s, I have found that it is the caregiver who is left to deal with the guilt, loneliness, and depression associated with such big life changes. What I was not prepared for was how this looks when the caregivers themselves are also elderly. Providing resources such as community support groups or encouraging the caregivers to be seen by their primary care physicians to meet their individual needs at this time may be vital to the success of the life transition.

Reference:

Graneheim, U. H., Johansson, A., & Lindgren, B.-M. (2013). Family caregivers’ experiences of relinquishing the
care of a person with dementia to a nursing home: insights from a meta-ethnographic study. Scandinavian
Journal of Caring Sciences, 28(2), 215–224. doi: 10.1111/scs.12046

Mohammed, R. (2017). Effect of Functional Task Training versus Traditional Strengthening Exercises in
Improving Functional Reach among Elderly Population. Indian Journal of Physiotherapy and Occupational
Therapy – An International Journal, 11(3), 227. doi: 10.5958/0973-5674.2017.00109.5

Reicherter, E.A. & McCombe Waller, S. (2014). Professional practice opportunities: Preparing students to care
for an aging population. Journal of Physical Therapy Education, 28(2), 60-68. doi: 10.1097/00001416-
201401000-00009