ACE.S Teaching Strategies
The teaching strategies offered in this section are guidelines for faculty to develop encounters with older adults that are intentional and that incorporate all or some of the ACE.S Knowledge Domains and Essential Nursing Actions into student learning experiences. The teaching strategies are categorized according to their major focus in the context of the ACE.S Knowledge Domains, but each of them covers more than one of the knowledge domains and essential nursing actions.
Individualized Aging
Since the aging process is unique to each individual, assessing function and expectations of care is essential.
Through planned, intentional encounters with older adults, nursing students learn to promote human flourishing and to provide competent, individualized, and humanistic care. This teaching strategy focuses on assessment in long-term care clinical settings, and can be used with students in both beginning and advanced nursing courses.
According to the Centers for Disease Control and Prevention, the number of U.S. adults aged 65 years old or older will more than double to reach about 71 million by 2030. Many of these older adults will continue to live and enjoy life in their communities. Health promotion for older adults living in the community is directed at interventions and services to prolong independence and functional status. This teaching strategy can be used to enhance the learning of students in beginning prelicensure nursing courses.
The nursing process focuses on the prioritization of care based on the assessment of the problem followed by the formulation of a nursing diagnosis, then planning and implementing care, and finally evaluating the process. When nursing students think of the priorities of care they generally focus on a medical model. While prioritizing such important issues as the ABCs (airway, breathing, and circulation) is inarguably vital and often the catalyst for interface with the health care system, these issues are often not the priorities identified by the client. Many times client priorities are more closely linked to quality of life issues than to life sustaining issues, especially in the case of older adults.
This teaching strategy is designed to help students feel comfortable initiating conversations with older adults about risks they may be willing to take to achieve benefits that may improve quality of life. It also is meant to raise awareness of decisions older adults make which may be unconventional within the context of a best practices model, yet are consistent with the older person’s wishes, expectations, resources, cultural traditions, and strengths.
Sexuality is at the core of who we are and has an impact on our lives in so many ways. It does not stop once we hit the age of 60 or 70 or 90 or even 100 despite the myths and assumptions of society. Sexual desire does not necessarily dissipate with age, but the physical, cognitive, and psychosocial changes that can occur with aging may interfere with sexual outcomes.
Feeling productive, relevant, and independent are significant to the quality of life of most people. These qualities often become diminished with older adults as they are faced with maintaining dignity in the face of functional challenges. This teaching strategy focuses on working collaboratively with an older adult who has both physical and psychosocial challenges to find resources to maintain independence and strategize to optimize his quality of life.
Complexity of Care
The care of older adults requires specialized knowledge in the art and science of both nursing and medicine to manage the interplay of factors that influence quality of care.
Oral Health promotion for older adults requires interprofessional communication, collaboration, and teamwork.
More the two million older adults are abused in the United States each year according to the National Center on Elder Abuse. It is estimated that 90% of the abusers are family members or caregivers. With a growing aging population, the need for student nurses and nurse to correctly identify abused older adults is significant.
Geriatric syndromes have wide-ranging implications for patients. Geriatric syndromes increase the older adult’s vulnerability during transitions in care settings. Coordinated plans of care should be developed for older adults with geriatric syndromes.
Oral health is directly related to systemic health in all individuals, but particularly in older adults. Oral health has a significant impact on the overall health and well-being of individuals across their life span. Among older adults, poor oral health is associated with pain, loss of teeth, poor nutrition, increased risk for systemic conditions, and serious morbidity and mortality in the case of oral cancer. The projected aging of the US population, coupled with the increasing number of adults retaining their teeth, is creating an unprecedented need for oral health care among older adults.
The mental health needs of older adults encompass a wide range of presentations. Frequently these get pushed aside as addenda to the other complexities of care when they need to be prioritized to better optimize care of older adults. This teaching strategy looks at the most frequent mental health issues seen in older adults and creative ways to help students better grasp and address these issues.
Oral health promotion for older adults living in the community is directed at interventions and services to prolong functional status. Students will determine older adults’ oral health needs and barriers to receiving oral health care in the community using the ACE.S framework.
Oral health assessment for older adults is directed at integrating oral health into overall health. Students will determine plans to ensure that older adults receive oral health care.
This teaching strategy provides students with the opportunity to develop research-based sessions that address key clinical issues related to care of older adults in hospital and rehabilitation settings. This teaching strategy is based on a student-led, all-day conference that evolved over time at Community College of Philadelphia, and has become a much anticipated event in the Community College of Philadelphia Department of Nursing.
This case study is about an aging woman experiencing Down’s Syndrome (DS) and dementia. People with Down’s Syndrome are living longer than ever before. Since the 1980s their life expectancy has doubled and many now live into their 60s, most likely because of advances in medical treatment and improved living conditions.
Psychosocial issues, issues of transitions, and ethical dilemmas are often best portrayed with application to a storyline. This technique makes the topics more relevant and better helps students to connect. Storylines can prompt rich discussion and often resonate with the students’ experiences to allow them to better process the complexities of caring for older adults. Cinema footage can be used in clips or in their entirety to set the stage to meet the instructors’ specific objectives.
Older adults are among the nurse’s most complex clients. They represent a broad spectrum of strengths, needs, and expectations. Yet, nurses find themselves wondering if the care decisions they make produce the best outcomes for this population. This teaching strategy will use a monologue of a nurse who provided care for older adult, Doris, to address the need for effective situational decision making.
Vulnerability During Transitions
Older adulthood is dynamic as the person transitions from one form, state, activity, or place to another. Transitions have the potential to create upheaval and disequilibrium for older adults and their families.
Older adults, especially older adults with an underlying dementia are more vulnerable to developing delirium. The presentation of delirium characterized as an abrupt change in mental status caused by physiological consequences of a medical condition is very frightening to family caregivers. The change in the level of functioning, abrupt behavioral changes sometimes marked by psychosis and agitation, and altered confusion is devastating. It is not uncommon for caregivers to believe that the presentation of symptoms is a rapid acceleration of the dementia.
The Centers for Medicare and Medicaid Services lists “Falls” as a never event; non-reimbursable when occurring in hospital settings. Falls represent the leading cause of fatal injury in older adults (CDC, 2017). Older adults are among the patients at greatest risks for complications related to falls. Falls in community settings are the most common case of nonfatal trauma related hospital admissions. This teaching strategy will guide faculty to teach nursing students how to use nursing judgment when weighing the risks and benefits of preventing falls in older adults.
Older adults transitioning among care settings, such as from the hospital to home, especially those with multiple co-morbidities, are particularly vulnerable. Likewise, transitions are not necessarily limited to physical settings but can also include changes in activities, adjustment to the loss of a spouse or loved one, and changes in medication; all of which carry a vulnerability in optimizing health.
The complexities and challenges older adults and their families confront during end-of-life transitions can be overwhelming. The interdisciplinary health care team plays an important role in helping ensure each older adult has individualized, compassionate, humanistic, and dignified care at the end of life. The following teaching strategy can be used to introduce end-of-life care and enhance the learning of students in beginning and/or advanced pre-licensure nursing courses.
Myths about older adults often drive attitudes about caring for older adults. Many times there are negative connotations entangled in these myths and attitudes. Changing these attitudes and deflating the myths will make students better understand older adults and realize they are more alike than different despite the age disparity.
Continuing Care Retirement Communities (CCRC) provide varying levels of support to older adults. These CCRCs provide valuable teaching and learning opportunities for pre-licensure nursing students that enhance their understanding of older adults. This teaching strategy provides activities to help students better understand the complexity of care of older adults as a way to develop a sense of empathy and value for this population.