Front Cover 1
Facilitating Aging in 
2 
copyright 
3 
Contributors 4
Contents 8
Nursing Clinics Of 
 
11 
Foreword 
12 
References 13
Preface 
14 
Introduction 14
References 15
Aging in Place 18
Key points 18
Introduction 18
Aging in Place Defined 18
Realities of aging environments 19
Local crises in a global context 20
Life course perspective to address person-centered realities 21
Principles and Key Actions 21
Implementing a Life Course Model 22
Inclusion of the consumer/older person decision making 22
Technology as a core support structure 23
Interdisciplinary involvement 23
Placement of care coordination 24
Summary 24
Acknowledgments 24
References 24
Further readings 26
Improving Unsafe Environments to Support Aging Independence with Limited Resources 28
Key points 28
Unsafe exterior environments pose barriers to aging with independence 29
Neighborhood 29
House Exterior 29
Unsafe home interiors can pose even greater threats to aging with independence 29
Fall Risk and the Home Environment 30
Activities of Daily Living/Instrumental Activities of Daily Living and Environmental Factors 30
An innovative model for promoting aging with independence: the CAPABLE intervention 31
Three innovations of the CAPABLE model in action: a case example 33
The Client 33
The Client’s Functional Goals 33
Issues Affecting Goal Achievement and Resulting Interventions 33
Medication side effects 33
Pain and low mood 34
Lower extremity weakness 34
Lack of railings on stairways 34
Value Added by the CAPABLE Approach 34
Innovation 1: client-directed care 34
Innovation 2: addressing medical/functional issues through an RN/OT team 34
Innovation 3: treating housing as health 38
Lessons learned while implementing the CAPABLE model 38
Summary 38
References 39
Maintenance of Physical Function in Frail Older Adults 42
Key points 42
Background 43
Management 44
Evaluation/diagnosis 44
Recommendations for PA 45
Patient considerations to initiating and maintaining a routine of PA 45
Barriers 45
Facilitators 46
Summary of Recommendations 47
Summary 48
References 48
Maximizing ADL Performance to Facilitate Aging in Place for People with Dementia 52
Key points 52
Introduction 52
Evaluation of ADL 54
ADL Screening 54
ADL Assessment 55
Intervention 56
Therapeutic Relationship 57
Repetitive, Errorless Training 57
Cognitive Strategies 59
Assistive Technology 59
Caregiver Training 59
Future directions 61
Summary 61
References 61
The Older Adult with Diabetes 66
Key points 66
Introduction 66
How does PN develop? 67
How does neuropathy lead to diabetic foot ulcers? 67
How does neuropathy lead to a risk for falls? 70
What do I need to know about examining the foot and assessing the risk for falls? 71
What should I tell the client about prevention of foot ulcers and falling? 72
Summary 73
References 73
Medication Adherence in Older Adults 78
Key points 78
Nonadherence as a prevalent and costly problem 79
Definitions 79
Intentional versus unintentional nonadherence 79
What interventions have proved effective? 80
What about older adults specifically? 80
Are these studies meaningful? 81
How to measure adherence 81
Seeing the big picture—the World Health Organization framework 82
New directions: innovations in technology 83
Will older adults use the newer technology? 84
New directions: policy 88
New directions: creative solutions, unique populations 89
Implications for practice 90
References 91
Keeping Older Adults Safe, Protected, and Healthy by Preventing Financial Exploitation 96
Key points 96
Introduction 96
FE as an older adult health problem 98
FE Victims Are Health Care Clients in Need of Specific Types of Care 98
Health Caregivers and Employees as FE Offenders 99
Health Problems Arise as a Result of FE 100
FE Victimization Often Occurs Within the Health Care Context or Setting 100
FE Risks Are Tied to Older Adult Health 100
FE of minorities: African American elders 100
Underdetecting and underreporting FE 101
FE prevention intervention strategies 102
Summary 104
References 105
Anxiety and Stigma in Dementia 108
Key points 109
Dementia-related anxiety 109
Definition 109
Prevalence 109
Symptoms and Related Outcomes 110
Association with Other Behaviors 110
Causes 110
Insight and Anxiety 111
Relationship Between Stigma and Anxiety in Persons with Early-Stage Dementia 111
Research Findings on Anxiety and Stigma in Dementia 112
Case study—part 1 113
Clinical Implications for Health Care Professionals 113
Assessment 113
Stigma Impact Scale 114
Anxiety Level 114
Treatment 115
Educating Health Care Professionals 116
Caregiver Education and Support 116
Anxiety Interventions for PwD 116
Pharmacologic interventions 116
Psychosocial interventions 117
Cognitive behavioral therapy 117
Interventions for stigma 118
Public education about dementia 118
Educating Health Care Professionals/Providers 119
Case study: part 2 120
Interventions to Promote Aging in Place in Persons with Dementia Experiencing Anxiety 121
Special considerations for aging in place: transitional care and “live alones” 121
Summary 122
References 122
Nocturia in Older Adults 128
Key points 128
Introduction 128
Epidemiology of nocturia 129
Pathophysiology of nocturia 129
Diminished or Nocturnal Reduction in Bladder Capacity 129
Twenty-Four-Hour Polyuria 131
Nocturnal Polyuria 131
Altered Diurnal Variation in Renal Function 132
Alterations in Sodium and Water Reabsorption 133
Sleep disorders and nocturia 134
Less studied correlate of nocturia: disrupted sleep and circadian rhythm disorders 134
Clinical assessment 136
Treatment options 138
Which clinical end points are important? 139
Summary 140
References 140
Cancer Screening in the Older Adult 146
Key points 146
Population predictions 147
Decision making about cancer screening 147
Practice guidelines 147
Life expectancy and comorbidity 148
Biology of cancer related to life expectancy 148
Risks and benefits of cancer screening 151
Individual wishes and beliefs 153
To screen or not to screen 153
References 154
Index 158