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Sector : HEALTH, SOCIAL AND OTHER COMMUNITY

DEVELOPMENT SERVICES
Qualification Title: CAREGIVING NC 2

Unit of Competency: PROVIDE CARE AND SUPPORT TO ELDERLY

Module Title: PROVIDING CARE AND SUPPORT TO ELDERLY

Technical Education and Skills Development Authority
CAREGIVING NC II
COMPETENCY-BASED LEARNING MATERIALS

List of Competencies

No. Unit of Competency Module Title Code

1. Provide care and Providing care and

support to infant and support to infant and HCS323301
toddlers toddlers

2. Provide care and Providing care and HCS323302

support to children support to children

3. Foster social, Fostering social,

intellectual, creative intellectual, creative and
HCS323303
and emotional emotional development
development of of children
children

4. Foster the physical Fostering physical

HCS323304
development of development of children
children

Provide care and Providing care and HCS323305

5.
support to elderly support to elderly

6. Provide care and Providing care and

HCS323306
support to people with support to people with
special needs special needs

7 Maintain healthy and Maintaining healthy and HCS323307

safe environment safe environment

8 Respond to emergency Responding to HCS323308

emergencies

9 Clean living room, Cleaning living room,

dining room, dining room, bedrooms, HCS323309
bedrooms, toilet and toilet and bathroom
bathroom

Date Developed: Document No.

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Date Revised:
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10 Wash and iron clothes, Washing and ironing HCS323310
linen and fabric clothes, linen and fabric

11 Prepare hot and cold Preparing hot and cold HCS323311

meals meals

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MODULE CONTENT

UNIT OF COMPETENCY: Provide care and support to the elderly.

MODULE TITLE: Providing care and support to the elderly.

MODULE DESCRIPTOR: This module covers the knowledge, skills and

attitudes required in providing support and assistance to maintain quality
care for the elderly to meet his/her daily needs including nourishment,
mobility, personal hygiene and other support within the plan of care. It also
includes, information sheets, self-checks, job sheets and performance
criteria checklist. Planning and preparation of the workshop based on CBT
principles will be practiced in this module.

NOMINAL DURATION: 150 Hours

LEARNING OUTCOMES:
At the end of this module you MUST be able to:
1. Establish and maintain an appropriate relationship with the elderly
2. Provide appropriate support to the elderly
3. Provide assistance with elderly’s personal care needs
4. Provide assistance with elderly’s personal care needs

ASSESSMENT CRITERIA:
1. Self introduction by the caregiver to the elderly client is done based on
established procedures.
2. Appropriate attitudes such as confidentiality, privacy, courtesy and
respect are adhered to and demonstrated towards the elderly based on
established procedures.
3. The elderly’s own interest, rights, freedom and decision-making are
supported and respected based on established procedures.
4. Short interpersonal exchanges with the elderly in establishing, developing
and maintaining rapport are encouraged
5. All support is provided to the elderly in accordance with the elderly’s
needs, rights, self determination and individual differences.
6. The elderly is encouraged and supported to participate in ceremonial,
cultural, educational, recreational, religious, social, and spiritual
activities as appropriately planned.
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7. Assistance is provided at all times in order to maintain a safe and healthy
environment, including minimizing physical dangers and risk of
infections based on established procedures.
8. Proper response to situations of risks to health and safety is provided and
maintained based on established procedures.
9. Personal preferences are identified in consultation with the elderly and a
plan for execution is mapped out based on established procedures.
10. The elderly is supported and encouraged in exercising their rights and
personal preferences without compromising their safety and those of
others and in accordance with established procedures.
11. Short interpersonal exchanges, clarifying meaning and maintaining
interaction to identify the elderly’s preferences are conducted based on
established procedures.
12. Time is scheduled to effectively listen to the elderly’s preferences to
maximize his/her well being.
13. The elderly’s personal care needs (aids to daily living) are identified and
assistance provided.
14. Specific concerns and difficulties in meeting some personal care needs
are identified, clarified and modified with the elderly in order to
effectively address such concerns and problem needs.
15. Assistive devices for providing assistance for the elderly are identified
and used as appropriate.
16. Organizational policies and practices for reporting are followed as
appropriate.
17. The elderly’s self esteem and confidence are enhanced.
18. Provisions for interaction between the elderly and the community are
researched and developed.
19. Developmental and progressing personal care needs are identified,
acknowledged and provided for as appropriate.
20. Empathy is demonstrated in supporting and caring for the elderly’s
feelings of grief and loss.

Date Developed: Document No.

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Date Revised:
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LEARNING OUTCOME NO. 2

Provide appropriate support to the elderly

Contents:

1. Common problems of the elderly and their ramifications

2. Safety risks to the elderly and contingency measures
3. Different religious, cultural, spiritual, physical, and ceremonial perspective
of the elderly
4. Relevant plan of care, roles and responsibilities of a caregiver

Assessment Criteria

1. All support provided to the elderly in accordance with the elderly’s needs,
rights, self determination and individual differences
2. The elderly encouraged and supported to participate in ceremonial,
cultural, educational, recreational, religious, social, and spiritual activities
as appropriately planned.
3. Assistance provided at all times in order to maintain a safe and healthy
environment, including minimizing physical dangers and risk of infections
based on established procedures.
4. Proper response to situations of risks to health and safety provided and
maintained based on established procedures.

Conditions

The participants will have access to:

1. Chatting in friendly manner

2. Inquiring about the elderly’s health
3. Short casual exchange
4. Effective communication
5. Dialogue
6. Question and answer / interview techniques

Assessment Method:

1. Hands-on
2. Direct observation
3. Practical demonstration

Date Developed: Document No.

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Learning Experiences

Learning Outcome 2
Provide appropriate support to the elderly

Learning Activities Special Instructions

If you feel you have understood
1. Read Information Sheet 5.2-1 on
Information Sheet 5.2-1, answer Self
the Common problems of the
check 5. 2-1.
elderly and their ramification
Check answers with the answer key.
2. Answer Self Check 5.2-1
You are required to get all answers
correct. If you got a perfect score,
you may proceed to Information
Sheet 5.2-2. If not, read information
sheet 5.2-1 again to answer all
questions correctly.
After reading Instruction Sheet 5.1-
3. Read Information Sheet 5.2-2:
1B, proceed in answering Self Check
Safety risks to the elderly and
5.1-1B. If you have questions, do not
contingency measures.
hesitate to ask for assistance from
your facilitator.
Check answers with the answer key.
4. Answer Self Check 5.2-2
You are required to get all answers
correct. If you got a perfect score,
you may proceed to Information
Sheet 5.2-3. If not, review
information sheet 5.2-2 to answer all
questions correctly.
Read thoroughly Information Sheet
5. Read Information Sheet 5.2-3:
Different Religious, Cultural, 5.2-3 and answer Self Check.
Spiritual, Physical and
Ceremonial Perspective of the
Elderly.
Check your answer with the answer
6. Answer Self Check 5.2-3
key. Repeat the process if you did
not reach the passing rate.
7. Read information sheet 5.2-4 on Read thoroughly Information Sheet
Relevant plan of care, roles and 5.2-4 and answer Self Check.
responsibilities of a caregiver

8. Answer Self Check 5.2-4 Check your answer with the

answer key. Repeat the process if
Date Developed: Document No.
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you did not reach the passing rate.
If you passed,
CONGRATULATIONS! You can now
proceed to the next LO3A:
PROVIDE ASSISTANCE WITH
ELDERLY’S PERSONAL NEEDS.

Date Developed: Document No.

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Date Revised:
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Information Sheet _5.2.1__

“Common problems of the elderly and their ramification”

Learning Objectives:
After reading this INFORMATION SHEET, YOU MUST be able to:
1. To identify the common problems affecting the elderly
2. To apply appropriate management in each problem.

COMMON HEALTH PROBLEMS OCCURING IN THE ELDERLY

Older people have limited regenerative abilities and are more prone to
diseases, syndromes, and sickness. At some point in the not too distant
future, Baby Boomers will have a large impact on the health care industry in
general. As the population age, seniors or the elderly, are much more likely
to suffer mobility health and disability problems thus placing a strain on
government finances and health care facilities.

`
A. CONFUSION/DEMENTIA:
What is dementia?
Dementia is a progressive brain dysfunction (in Latin ‘dementia’
means irrationality), which results in a restriction of daily activities and in
most cases leads in the long term to the need for care. Many diseases can
result in dementia, the most common one being Alzheimer’s disease.
Dementia is an acquired syndrome that affects daily life. There are 2
common definition of dementia. One defines dementia as a decline in
memory and at least one other cognitive function, e.g., paraxial, aphasia,
amnesia, or executive function (visual spatial skills, calculation skills and
judgment). The second defines dementia as a decline in 3 of 5 general areas
of cognitive function, e.g., memory, language, visuospatial skills, executive
function, and personality/mood.
Alzheimer’s disease (AD) is a progressive dementia, and the patient
often dies within 10 years of clinical diagnosis. Gradual onset and
containing decline characterize the course of AD. Risk factors include
advancing age, family history and Down syndrome.

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What are the symptoms of Alzheimer’s disease?
1. Confusion.
This behavior in particular causes us to become ‘estranged’ from
others and to be unpredictable in our interactions. Confusion can also
occur ‘acutely’ i.e. suddenly and limited in time – for example triggered
by a hospital stay, directly after heart surgery etc. it is difficult to
understand this estrangement and it cannot be explained away – on
the other hand everybody also experiences similar situation from time
to time: we forget, misplace, cannot remember names, cannot find our
car in the park and similar lapses. So both aspects are present:
dementia is not familiar but also not entirely alien to us.

1 Impaired memory and orientation.

2 Limitation of concentration.
3 Planning and judgment, personality changes and later also perceptual,
speech.
4 Walking disorder; in the final stage, various other body functions such as
swallowing and the excretion process are also affected
NOTE: During the course of Alzheimer’s diseases, patient lose their
independence in managing everyday life. There are affects on perception and
social relationship; people become more and more dependent on care.

What are the most common causes of Alzheimer’s diseases?

 The slowly progressing destruction of nerve cells in the brain leads to
the previously mentioned symptoms of Alzheimer’s diseases. It is a
natural phenomenon to lose a certain number of nerve cells during
ageing but this loss occurs much more rapidly in people suffering
from Alzheimer’s disease. As a result the brain of the patient does not
function normally any longer.
 The disease is caused by genetic changes (mutations) in the family. In
this case symptoms usually occur before the age of 60 and progress
rapidly.
 All currently mutation result in an overproduction of a protein which
destroy the nerve cells.
NOTE: The probability of developing Alzheimer’s disease increase with
advancing age. The probability is higher for woman and people having a
lower standard of education.

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What are the most important early indications of dementia?
1. Forgetfulness with effects at work:
Most people sometimes forget names or appointments. If this happens
more frequently and inexplicable states of confusion also occur, this
might be an indication for a decline in memory function.
2. Difficulties with familiar activities:
People who are very busy are sometimes absent-minded and for example
forget the pot on the stove. People with dementia possibly not only forget
the pot on the stove but also that they have cooked at all.
3. Language problems:
Most people sometimes experience difficulties in finding the right words.
Dementia suffered often cannot remember simple words and instead
they use inappropriate fillers, which make it difficult to understand the
sentences.
4. Problems with special and temporal orientation:
A lot of people sometimes forget e.g. the day of the week or they get lost
in unfamiliar surroundings. Dementia suffered might be in their own
street and no longer know where they are, how they got there and how
to get home again.
5. Impaired capacity of judgment:
People not always choose clothes suitable for the weather. Dementias
suffered sometimes wear totally inappropriate clothes. For example, they
wear a bathrobe while shopping or several blouses on top of each other
on a hot summer day.
6. Problems with abstract thinking:
For many people running a bank account is a challenge. Dementia
patients can often neither recognizes numbers not carry out sample
calculations.
7. Leaving things behind:
From time to time almost everybody leaves their keys or a wallet
behind. Dementia suffered however might put things in completely
inappropriate places, such as for example the iron in the fridge or a
watch in the sugar bowls. Afterwards they do not remember where they
put them.
8. Mood swing and behavioral changes
Everybody he mood swing. People with dementia may have very
sudden mood swing, often without discernible cause.
9. Personally change:
With advancing age the personality of most people change a little. People
affected by dementia may experience a very pronounced personality change
suddenly or over a longer period of time. Somebody who is generally friendly,
for example, becomes unexpectedly angry, jealous or timid.

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10. Loss of initiative:
Nobody continuously works with the same motivation. Dementia
patients sometimes loose the zest in their work and h interest in their
hobbies completely without enjoying new activities.

What are the stages of Dementia of the Alzheimer’s type?

Alzheimer’s disease can take very different courses. It is a slowly
unfolding, progressive disease, which is accompanied over time by changes
in the appearance of the patient. The disease is typically divided into three
stages. In medical terms, Alzheimer’s disease is divided into mild, moderate
and severe or early-stage, mid-stage and late-stage Alzheimer.
1. The mild stage is typically characterized by impairment of mental
abilities as well as mood swings.
2. In the moderate stage, behavior disturbances usually increasingly
develop.
3. Advance stage- physical problems are dominant.

ROLE AS A CAREGIVER
Many people who have dementia are cared for at home by partners or
other family members and friends. Taking care of someone with dementia
can be physically and emotionally draining, but tips and other help can
make it easier.
Make sure the home is safe
 Keep rooms uncluttered, with clear walkways. Lock up knives,
cleaning supplies, and other dangerous substances. Remove
throw rugs and consider installing carpet to help prevent
slipping. Install handrails, tub mats, and other assistive devices
in the bathroom. Provide good lightning, and put night-lights in
bedrooms, hallways, and bathrooms.
Maintain good nutrition
Offer food more often, including healthy midmorning and mid
afternoon snacks. If the person has trouble using a spoon or a
fork, serve finger foods. Serve one food at a time; choices can be
confusing. If the person is losing weight, consider offering a
liquid nutrition drink, such as Ensure.
Manage sleep problems
Keep the person awake and active during the day. Discourage
napping unless doing so causes more problems. Offer warm
milk or caffeine-free herbal tea before bedtime. A warm bath
close to bedtime may help the person relax
Manage blader and bowel control problems (incontinence)

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
Encourage the person to use the bathroom on a regular
schedule, such s every 2 hours. Mark the bathroom and toilet
clearly with signs; use pictures when the person can no longer
understand words. Consider using
 Consider using absorbent pads or briefs or adult diapers.
 If incontinence is a new problem, make sure it is not caused by
another condition, such as a urinary tract infection.
 Some people with dementia develop behavior problems, such as
aggression. These problems can be especially challenging for
caregiver. The following strategies may help.
Make the most of remaining abilities
 It is important to give the person tasks and activities that occupy him
or her without pushing too much. Tailor tasks to the person’s abilities.
For example, if cooking is no longer safe, ask for help in setting the
table or making simple dishes such as salad. Reinforce and support
the person’s efforts to remain independent, even if tasks take more
time or aren’t done perfectly.
Help the person avoid confusion
 Label often-used rooms, such as the bathroom, and objects. Keep
regular routines for daily activities such as meals, baths, and hobbies.
Keep furniture, lamps, pictures, and other objects in the same place.
Understand behavior changes
Strange or disruptive behaviors can be one of the most difficult
problems for caregivers. The person may do certain things repeatedly
or insist on unusual routines or activities. Think about whether the
person’s unusual behaviors might be motivated by an urge to
continue past activities or habits. If so, you may be able to find ways
to change the person’s environments and set up daily routines that
make these behaviors less of a problem.
Manage agitation
 Keep noise levels low and voices quiet. Develop simple daily routines
for bathing, dressing, eating, and other activities. Tell the person in
advance about changes in his or her regular schedule (trips, doctor
visits), and remind the person often of the upcoming event.

Manage wandering
Try to figure out why the person wanders. A person who wanders at a
certain time of day may always have taken a walk or gone to work at
that time. Lock outside doors, and use alarms and other devices to
alert you when the person wanders. Get a medical ID bracelet for the
person so that you can be contacted if he or she wanders away.
Communicate successfully

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 Use short, simple, familiar words and sentences. Explain your actions.
Be calm and supportive. Use eye contact and use touch to reassure.
Don’t argue. Offer reassurance and try to distract the person.

B. OSTEOPOROSIS
A decrease in bone density, along with increased brittleness of bone
make the elders prone to serious fractures, some of which may be
spontaneous and are called pathologic fractures. Osteoporosis occurs more
frequently in people in people with insufficient intake of dietary calcium, in
women after menopause, and in individuals who are immobilized or
physically inactive.
Interventions:
1. Have adequate calcium in diet
2. Provide milk/dietary product
3. Fish
4. Beans
5. Orange juice
6. Cereal or bread that have added calcium
7. Take calcium supplements
8. Get regular exercise
9. Avoid alcohol, quit smoking. Alcohol and smoking reduced bone
mass
10. Avoid large amounts of protein-rich or salty and caffeine foods. They
cause loss of calcium from the bone
11. Make the home safe to avoid accidents
12. Practice good posture
13. Use good body mechanics when lifting objects. Bend the knees
instead of the back
14. Do back exercise to improve posture
15. Avoid using a stool or bending over
16. Put items frequently used within easy reach
17. Use handrails when going up and down stairs
18. Hormonal Replacement Therapy (HRT) for menopausal women as
prescribed

C. POSTURAL HYPOTENSION

Clients who have been immobilized for even a few days may require
assistance with ambulation. The amount of assistance will depend on the
clients condition, including age, health status and length of inactivity.
Assistance may mean walking along sides the clients while providing
physical support. Some client experience postural hypotension on assuming
a vertical position from a lying position and may need information about
ways to control this problem. The client may exhibit some or all of the
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following symptoms: pallor, diaphoresis, nausea, tachycardia, and dizziness.
If any of these are present, the client should be assisted to a supine position
in bed and closely assessed.

Controlling Postural Hypotension:

1. Rest with the head of the bed elevated 8-12 inches. This position
makes the position change on rising less severe
2. Avoid sudden changes in position. Arise from bed in three stages:
a. Sit up in bed for 1 minute
b. Sit on the side of the bed with legs dangling for 1 minute
c. Stand with care, holding onto the edge of the bed or another
non movable object for 1 minute
3. Never bend down all the way to the floor or stand up too quickly after
stooping
4. Postpone activities such as shaving and hair grooming for at least 1
hour after rising
5. Wear elastic stockings at night to inhibit venous pooling in the legs
6. Be aware that the symptoms of hypotension are most severe at the
following times:
a. 30-60 minutes after a heavy meals
b. 1-2 hours after taking an antihypertension medication
7. Get out of a hot bath very slowly, because high temperature can lead
to venous pooling
8. Use a rocking chair to improve circulation in the lower extremities.
Even mild leg conditioning can strengthen muscle tone and enhance
circulation
9. Refrain from any strenuous activity that results in holding the breath
and bearing down. This valsalvar maneuver slows the heart rate,
leading to subsequent lowering of blood pressure.

D. URINARY INCONTINENCE- urinary incontinence is an undesirable

leakage of urine.

There are different types of incontinence.

1. Urge incontinence is caused by an overly sensitive bladder that feels
full even when there is only a small amount of urine present. The
bladder muscle contract unexpectedly, and, if the external urethral
sphincter is weak, urine is released. The symptoms of increased
frequency and urgency are present, often causing the person to
urinate more than twice a night or more than 7 times during the day.

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2. Stress incontinence is caused by an inability of the pelvic floor
muscles to hold the urethral sphincter closed. The symptoms of stress
incontinence include urine leakage with activities that cause increase
pressure on the abdominal muscle and bladder, such as coughing,
lifting, sneezing or getting up from a chair
3. Overflow incontinence occurs when the bladder stays full, either
from organ pressure (enlarged prostate) or because it stops
contracting because of medications or injured nerves. Urine leakage
occurs because of the constant pressure.
4. Bladder retention
 Dietary changes include decreasing consumption of caffeine,
aspartame (nutrasweet) and potassium-rich foods.

 Retrain the bladder, the pelvic floor muscles are contracted

every time urinary urgency is felt. The urine is held, longer
between each voiding, gradually increasing the time between
urination to 1,2 or 3 hours.

 Pelvic floor rehabilitation includes biofeedback and kegel

exercises. Kegel exercises should be done 5 times a day when
the patient is relaxed. The pelvic floor muscle should be
contracted and held for a count of 4 repeated 5 to 8 times.

E. HYPERTENSION
Blood pressure
Blood pressure is the force of blood against the walls of
arteries. Blood pressure is recorded as two numbers—the
systolic pressure (as the heart beats) over the diastolic pressure
(as the heart relaxes between beats). The measurement is
written one above or before the other, with the systolic number
on top and the diastolic number on the bottom. For example, a
blood pressure measurement of 120/80 mmHg (millimeters of
mercury) is expressed verbally as "120 over 80."

Normal blood pressure is less than 120 mmHg systolic and less
than 80 mmHg diastolic.

Hypertension increases your chance (or risk) for getting

heart disease and/or kidney disease, and for having a stroke. It is especially
dangerous because it often has no warning signs or symptoms. Regardless
of race, age, or gender, anyone can develop high blood pressure. It is
estimated that one in every four American adults has high blood pressure.
Once hypertension develops, it usually lasts a lifetime. You can prevent and
control hypertension by taking action.

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Prevention
You can take steps to prevent hypertension by
adopting a healthy lifestyle. These steps include
maintaining a healthy weight; being physically
active; following a healthy eating plan, that
emphasizes fruits, vegetables, and low fat dairy
foods; choosing and preparing foods with less salt
and sodium; and, if you drink alcoholic beverages,
drinking in moderation.

F. DIABETES MELLITUS

What is?
Diabetes is a chronic disease that occurs when the pancreas does not
produce enough insulin, or alternatively, when the body cannot effectively
use the insulin it produces. Insulin is a hormone that regulates blood sugar.
Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled
diabetes and over time leads to serious damage to many of the body's
systems, especially the nerves and blood vessels.

 Type 1 diabetes (previously known as insulin-dependent or

childhood-onset) is characterized by a lack of insulin production.
Without daily administration of insulin, Type 1 diabetes is rapidly
fatal.

 Symptoms include excessive excretion of urine (polyuria),

thirst (polydipsia), constant hunger, weight loss, vision
changes and fatigue. These symptoms may occur suddenly.

 Type 2 diabetes (formerly called non-insulin-dependent or adult-

onset) results from the body’s ineffective use of insulin. Type 2
diabetes comprises 90% of people with diabetes around the world, and
is largely the result of excess body weight and physical inactivity.

 Symptoms may be similar to those of Type 1 diabetes, but

are often less marked. As a result, the disease may be
diagnosed several years after onset, once complications have
already arisen.
 Until recently, this type of diabetes was seen only in adults
but it is now also occurring in obese children.

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 Gestational diabetes is hyperglycemia which is first recognized
during pregnancy.

 Symptoms of gestational diabetes are similar to Type 2

diabetes. Gestational diabetes is most often diagnosed
through prenatal screening, rather than reported symptoms.

What are the common consequences of diabetes?

Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and
nerves.

 Diabetic retinopathy is an important cause of blindness, and occurs as

a result of long-term accumulated damage to the small blood vessels
in the retina. After 15 years of diabetes, approximately 2% of people
become blind, and about 10% develop severe visual impairment.
 Diabetic neuropathy is damage to the nerves as a result of diabetes,
and affects up to 50% of people with diabetes. Although many
different problems can occur as a result of diabetic neuropathy,
common symptoms are tingling, pain, numbness, or weakness in the
feet and hands.

 Combined with reduced blood flow, neuropathy in the feet increases

the chance of foot ulcers and eventual limb amputation.

 Diabetes is among the leading causes of kidney failure. 10-20% of

people with diabetes die of kidney failure.

 Diabetes increases the risk of heart disease and stroke. 50% of people
with diabetes die of cardiovascular disease (primarily heart disease
and stroke).

 The overall risk of dying among people with diabetes is at least double
the risk of their peers without diabetes.

How can be the burden of Diabetes reduced?

Without urgent action, diabetes-related deaths will increase by more
than 50% in the next 10 years.

To help prevent type 2 diabetes and its complications, people should:

 Achieve and maintain healthy body weight.

 Be physically active - at least 30 minutes of regular, moderate-
intensity activity on most days. More activity is required for weight
control.

Date Developed: Document No.

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Early diagnosis can be accomplished through relatively inexpensive blood
testing.

Treatment of diabetes involves lowering blood glucose and the levels of other
known risk factors that damage to blood vessels. Tobacco cessation is also
important to avoid complications.

Interventions that are both cost saving and feasible in developing countries
include:

 Moderate blood glucose control. People with type 1 diabetes require

insulin; people with type 2 diabetes can be treated with oral
medication, but may also require insulin;
 Blood pressure control;
 Foot care.
G. RHEUMATOID ARTHRITIS

 Rheumatoid arthritis is an autoimmune disease that causes chronic

inflammation of the joints. Rheumatoid arthritis can also cause
inflammation of the tissue around the joints, as well as other organs
in the body.

Normal and Arthritic Joints

The joint inflammation of rheumatoid causes:

 Swelling
 Pain
 Stiffness
 Redness in the joints
 The inflammation of the rheumatoid disease can also occur in tissues
around the joints, such as the tendons, ligaments and muscles.

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H. OSTEOARTHRITIS (DEGENERATIVE ARTHIRITIS)

 What is osteoarthritis?

Osteoarthritis is a type of arthritis that is caused by the breakdown and

eventual loss of the cartilage of one or more joints. Cartilage is a protein
substance as a “cushion” between the bones of the joints.

 Before age 45, osteoarthritis occurs more frequently in males. After

age 55 years, it occurs more frequently in females.
 Osteoarthritis commonly affects the hands, feet, spine, and large
weight bearing joints, such as the hips and knees.

What causes osteoarthritis?

Primary osteoarthritis is mostly related to aging. With aging, the water
content of the cartilage increase and the protein makeup of cartilage
degenerates. Repetitive use of the joints over the years irritates and inflames
the cartilage, causing joint pain and swelling. Eventually, cartilage begins to
degenerate by flaking tiny crevasses.

 The early development of osteoarthritis of the knees among weight

lifters is believed to be in part due to their high body weight. Repeated
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trauma to joint tissue (ligaments, bones and cartilage) is believed to
lead to early osteoarthritis of the knees.

 Crystal deposits in the cartilage degeneration, and osteoarthritis. Uric

acid crystal causes arthritis in gout, while calcium pyrophosphate
crystal causes arthritis in pseudo out.

SIGN AND SYMPTOMS:

 Pain in the affected joint(s) after repetitive use. Joints pain is usually
worse later in a day.
 Swelling, warmth, and creaking of the affected joints.
 Pain and stiffness of the can also occur after long periods of inactivity,
for example, sitting in theater.
 In severe osteoarthritis, complete loss of cartilage cushion causes
friction between bones,
causing pain at rest or pain
with limited motion.

I. DIZZINESS

The word “dizzy” is used to

describe everything from feeling faint
or lightheaded to feeling weak or
unsteady. Dizziness that creates the
sense at you or your surroundings is
spinning or moving is called vertigo.

Signs and symptoms

Characteristics of dizziness may include:

 A sense that you or your surroundings are spinning or moving
(vertigo)
 A loss of balance
 Nausea
 Unsteadiness
 Wooziness
 Lightheadedness
 Faintness
 Weakness
 Fatigue

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APPROPRIATE MEASURE FOR THE ELDERLY

 Be aware of the possibility of losing your patient’s balance, which can

lead to falling and serious injury
 Let patient sit or lie down immediately when he feels dizzy
 Advice patient not to drive a car or operate heavy machinery if he
experience frequent dizziness
 Use good lightning if he get’s out of bed at night
 Walk with a cane for stability
 Advice patient to avoid using caffeine, alcohol and tobacco. Excessive
use of these substances can restrict blood vessel and worsen the signs
and symptoms.

What causes glaucoma?

Damage to the optic nerve is thought to b caused by increase pressure

in the eye (intraocular pressure, or IOP). This may result from excess fluids,
called aqueous humor, building up in the eye because the eye produces too
much or drains too little of the fluid. However many cases of glaucoma
develop without increased IOP. In these cases, decreased blood flow to the
optic nerve may cause the damage.
Glaucoma may develop after an eye injury, after eye surgery, from the
growth of an eye tumor, or as a complication of a medical condition such as
diabetes.
What are the symptoms?
 Vision loss.

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 You may not notice the vision loss until it is severe, because you’re
less affected eye at first makes up for the loss. Side ( peripheral) vision
is usually lost before central vision.
 Severe, including sudden, severe blurring of vision;
 Severe pain in or around the eye;
 Colored halos around lights;
 Eye redness;
 Nausea and vomiting.
 Watery eyes and sensitivity to light,
 Eye that look cloudy,
 Or eyes that look larger than normal

J. CEREBBROVASCULAR ACCIDENT

What is a cerebrovascular accident?

A cerebrovascular accident is also called a CVA, brain attack, or
stroke. It occurs when blood flow to a part of a brain is suddenly stopped
and oxygen cannot get to that part. This lack of oxygen my damage or kill
the brain cell. Death of a part of the brain may lead loss of certain body
functions controlled by the affected part.

What causes a cerebrovascular accident?

A piece of fatty plaque (debris) that is formed in a blood vessels breaks
away and flows through the bloodstream going to the brain. The plaque
blocks an artery which causes a stroke. This is called an embolic stroke.

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ISCHEMIC STROKE:
Caused by obstruction in an artery; begins in atherosclerosis (fatty
deposits) in the inner wall of an artery

 A thrombus (blood clot) formed in an artery (blood vessels) and

blocked Blood flows to the brain. It can occurs when a blood vessels is
injured by infection or trauma. This is called a thrombosis stroke.

 A tom artery in the brain, causing blood to spill out. This is called a
cerebral hemorrhage stroke. It often results from high blood pressure.

 Blockage of certain small blood vessels inside the brain.

What puts me at a higher risk to have a cerebrovascular accident?

 Cigarette smoking, cocaine use, or drinking to much alcohol.

 Diabetes (high blood sugar).
 You or a close family member has had a stroke.
 Atherosclerosis (hardening of the arteries ) or fatty cholesterol deposits
on artery walls.
 Heart diseases, such as coronary artery diseases.
 High blood cholesterol (fat)
 High blood pressure

What are the signs and symptoms of a cerebrovascular accident?

 Numbness (no feeling),

 Tingling, weakness,
 Paralysis (cannot move) on one side of the body. You may have trouble
walking, swallowing, talking, or understanding.
 Vision (sight) may b blurred or doubled.
 Severe headache, feel dizzy, confused

K. DEPRESSION

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Depression is a common condition among elderly women. Common
symptoms can include, but are not limited to:
 Disturbance in sleep, self-esteem, libido, appetite, interest, energy,
concentration, memory and movement.
 Feelings of guilt
 Suicidal thoughts, plans or attempts.
 Pain
 Feelings of worthlessness, hopelessness, in appropriates guilt,
prolonged sadness or unexplained crying spells, jumpiness or
irritability, loss of interest in and withdrawal from formerly enjoyable
activities, family, friends, work or sex.
 Intellectual problems such as unexplainable loss of memory or the
ability to concentrate; confusion and disorientation.
 Thought of death or suicide; suicide attempts needs help immediately
 Physical problems such as loss of appetite or a noticeable increase in
appetite; persistent fatigue and lethargy; insomnia or a noticeable
increase in the amount of sleep needed, ache and pain, constipation
or other physical ailments that cannot be otherwise explained.

DEPRESSION can be caused by several personal losses experienced in rapid

sequence, which is often the case of the elderly.

The elderly are also commonly taking many more medication that younger
people do. Some of these medications re known to be associated with
depression.

List of selected medications:

 Anti-cancer drugs
 Anti-inflammatory drugs
 Progesterone

Anti-depressants are used to treat depression, and they usually are fairly
successfully at improving the quality of life of the elderly patient.
Psychotherapy is often used in combination with anti-depressants, which
can include drugs in these classes:
 Tricyclics such as imipramine, desipramine, amitryptyline, and
nortriptyline
 Selective serotonin reuptake inhibitors (SSRIs) such as Prozac
 Monoamine oxidase inhibitors (MAOIs)

SIDE EFFFECTS OF THESE MEDICATIONS:

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 Blurred Vision
 Dry mouth
 Urinary retention
 Confusion
 Constipation
 Drowsiness
 Insomnia
 Cardiac arrhythmia
 Hypotension
 Gastrointestinal distress
 Weight fluctuation
 Sexual dysfunction

L. SLEEP PROBLEMS TO ELDERLY

Why is quality sleep so important for n older person?

To feel your best, you need a restful night of sleep, good nutrition and
exercise. You may be surprise at how good you feel when you get enough
sleep.
As we age, a good night’s sleep is especially important because:
 Sleep improves concentration and memory formation
 Sleep allows your body to repair any cell damage that occurred during
the day.
 Sleep refreshes your immune system and therefore helps to prevent
disease.
How does our sleep change as we age?
As you age, you may perceive unwelcome change in your sleep
patterns, such as:
 More fragmental sleep (more rapid sleep cycles)
 Decrease in deep sleep
 More awakening between sleep cycles

What are the usual causes of sleep problems as we go age?

If your patient is having trouble in sleeping well, consider some
common causes of sleep problems in the elderly:

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Poor sleep hygiene- the most common cause of insomnia in the elderly
is poor sleep habits or a poor sleep environment.
Example of poor sleep:
1. Hygiene is regular sleep hours
2. consumption of alcohol before bedtime
3. too much daytime napping

 Pain or medical illness- pain can keep you from sleeping well. In
condition, many
 common health condition are interfere with sleep: a frequent need to
urinate, asthma, diabetes mellitus, osteoporosis, nighttime heart
burn, menopause and Alzheimer’s
 Medication- seniors tend to take more medication than to younger
people. Combinations of drugs, as well as the side-effects of
individual, drugs, can impair sleep or even stimulate wakefulness.
 Lack of exercise- if you are too sedentary, you may not feel sleepy,
alternative, you may feel sleepy all of the time.
 Psychology stress or psychology disorders- significant life change like
the death of loved one or moving from a family home can cause stress,
Anxiety or sadness can also keep you awake, and sleeplessness can,
in turn cause more anxiety or depression.
 Sleep disorder- restless legs syndrome (RLS) insomnia, and sleep
disordered breathing such as snoring and sleep apnea occur more
frequently in older adults.

SLEEP TIPS

1. Exercise – Avoid a sedentary lifestyle and try to incorporate physical

activity into your daily routine.
2. Maintain good nutrition- proper diet is important for high-quality
sleep. Eating or drinking certain foods and drinks too close to bedtime
cam impair sleep.
3. keep a regularly sleep schedule- go to bed and wake up at the same
time everyday, even on weekdays.
4. Experiment with napping – Although napping too close to bedtime or
long naps, can interfere with nighttime sleeping, some people find that
short naps early in the day improve their overall feeling or being
rested.
5. Expose yourself to sunlight – get at least two hours of bring sunlight
each day. Exposure to sunlight increases your body’s production of
melatonin, which regulates your sleep wake cycles.
6. Separate yourself from snoring sleep partner – if your sleep partner
snore, consider ear plugs or white –nose machine, or sleep in separate
bedrooms.

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7. Go to bed early – adjust your bedtime earlier, to concur with when
you feel like going to bed
8. Limit smoking - Nicotine is a stimulate and can keep you awake. If
you cant quit smoking, avoid smoking with in three hours of bedtime
9. Develop bedtime rituals – create soothing bedtime rituals, such as
taking a hot bath or playing calm music.
10. Monitor your medications – Drugs you take for your medical
condition may be\interfering with your sleep.
11. Take care of your psychological health – stress and anxiety
can keep you awake.
12. Limit your use of sleeping aids and sleeping pills - Some over
the counter sleep aids and prescription sleeping pills have harmful
side effects, and most are not designed to be used long term.

DIET TIPS
1. Limit caffeine close to bedtime – coffee, tea, caffeinated soft drinks
and chocolate can all keep you awake. Depending upon your
sensibility, avoid caffeine in the late afternoon and evening. Some
people are still affected by caffeine 8 hours after ingesting it.
2. Avoid alcohol before bedtime – a night cap of alcohol may make you
feel sleepy, but your sleep will be disrupted later in the night. Don’t
used alcohol as a sleeping aid.
3. Satisfy your hunger bedtime- Have light snack sucks us crackers,
cereal and milk, or yogurt. Some people find that warm milk helps
them to sleep because it contains an amino acid that acts as a natural
sedative.
4. Avoid big meals or spicy foods just before bed time - you can get
heartburn or aggravate a heatedly hernia with large or spicy meals.
Try to eat dinner at lest three hours before bedtime, and don’t
consume too many calories.
5. Minimize liquid intake before bedtime- limit what you rink within
the hour and half before bedtime so that your sleep is not interruption
by needing to get up to go to the bathroom.

M. SIGNS AND SYMPTOMS OF COMMON ILLNESSES THAT GREATLY

AFFECT THE ELDERLY

COLDS

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The average adult may have three or four cold each year. Young
children are more susceptible, because their immune systems are not fully
developed. There are over 200 cold viruses with 30 percent attacking the
nose. These viruses, called rhinoviruses, infect people in late summer and
early fall. The other cold viruses are usually contacted n the winter and
spring. Cold symptoms begin within one or two days after exposure and may
include:

 Runny nose
 Sneezing and coughing
 Sore or scratchy throat
 Fever
 Muscle aches and pains
 Hoarseness or
 Headache
Cold may be transmitted through the air, by direct contact, or by an object
used by a cold sufferer. You can catch a cold by

 Exposure to sneezing or coughing by others.

 Shaking hands and then touching your eyes or nose.
 Handling objects held by someone with a cold.

MANAGEMENT:

 Antibiotic are ineffective in treating colds. Taking unnecessary

antibiotics may contribute to the development of disease resistant
bacteria. Rest is an important factor in recovering from a cold. There
are other things you can do at home to ease your discomfort. They
include
 Us a humidifier.
 Drink a lot of fluids.
 Take a pain reliever as needed. Do not give aspirin to children.

Instead, substitute a drug such as acetaminophen or ibuprofen to decrease

fever and muscle aches.

To avoid colds:
 Eat well and gets lots of sleep and exercise to keep up
 Wash your hands often with soap and warm water your resistance.
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 Keep your hands away from your nose, eyes, and mouth.

NOTE: Seek medical care if cold symptoms continue longer than two weeks
or become severe. You may be experiencing allergies or other medical
problems

C. ECZEMA Eczema I an allergic skin

disease. It may occur as a red, itchy,
scaly rash with tiny blisters. The
blisters break, ooze a clear fluid, and
then crust over.
 Eczema is an inflammation of
the skin and may be associated
with an allergic reaction,
although the cause is often
unknown.
 Children my get eczema on the
face, scalp, buttocks, thighs,
and upper body. Severe cases are common during infancy with many
children improving by age 2.
Adults usually have on the face, neck, inside he elbows, or behind the
knees. In adults, there is more scaling and less blister formation than that
seen in children. Dry skin, allergies, hot baths or showers, soap, scratchy
and tight clothing, rapid temperature changes can spark flare-ups, and
emotional upsets. Scratching the lesions may cause infection.
Tips for managing eczema include:
 Keep the skin moist and cool to avoid scratching.
 Try an over-the-counter 1 percent hydrocortisone cream for
small itchy areas.
 Take brief, daily baths or showers with lukewarm (not hot)
water.
 Bathe without soap or use a gentle soap or non-soap cleanser.
 Apply a lubricating cream or lotion after bathing and reapply
often.
 Take an oral antihistamine to relieve itching

 Avoid antihistamine or antiseptic creams and sprays.

 Sleep with a humidifier on in your bedroom.
 Avoid contact with allergens and irritants that increase
symptoms.
 Wash clothes and bedding in mild soap and rinse them twice.
 Do not use fabric softeners.
Seek medical care if you experience the following:

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 A rash on the face that is red, patchy, and combined with joint pain
and fever.
 Itching interferes with normal sleep patterns.
 Self-care does not work.
FLU
The flu is primarily spread between people indoors during the winter and
early spring. Many flu viruses exist and are passed from an infected person
to the nose or throat of others. The risk is greater wherever large numbers of
people gather in places like schools, nursing homes, shopping malls, and
large companies. The flu can cause a sudden onset of the following
symptoms:
 Fever and chills
 Muscle aches
 Sore throat and cough
 Nasal congestion and headaches, or
 Fatigue and weakness
Management:
1. Bed rest
2. Proper nutrition
3. Drinking lots of fluids
Antibiotics do not provide relief. Over-the-counter drugs may relieve
coughing, fever, and muscle aches.
People who are at risk for getting a serious case of the flu or a
complication from it should get a flu shot every year. This group includes:
 All people 65 years of age or older.
 Resident of long-term care facilities.
 Any child or adult, including pregnant women, who has a
serious long-term health problem with heart disease, anemia,
diabetes, asthma, lung disease, or kidney disease.
 People who are less able to fight infections because of a
hereditary disease, HIV infection, or cancer treatment with X-
rays or drugs.
 Children and teenagers 6 months to 18 years of age on long-
term aspirin treatment.
 Health care and community service workers.
 Any who wants to reduce his or her chance of catching the flu.
Note: Children under 9 years of age may need a second shot after one
month. The flu shot does not protect against other viruses or prevent
anyone from getting the flu if recently exposed. Its purpose is to lessen the
risk of getting the flu and severity if contracted.
PNEUMONIA
Pneumonia is an inflammation of the airways
and tissues of the lungs. It is due to infection.

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Bacteria, viruses, or chemicals cause the illness. It can follow or occur with
a cold, flu, or bronchitis.

Pneumonia is more common in infants, the elderly, and in those who

have low immunity to infection. The elderly do not always have symptoms
such as a fever or cough when they have it. A change in their usual
activities or functioning may be the only sign.
Symptoms include:
 Fever (101 to 106 degrees F.) and shaking chills.
 Coughing which may bring up yellow, green, rust-colored, or bloody
mucus.
 Pain in the chest when breathing or coughing
 Shortness of breath.
 Rapid and shallow breathing.
 Fatigue.
 Sweating and flushed color of skin.
 Loss of appetite or upset stomach.

Evaluating the patient’s breathing symptoms, chest X-ray, and mucus

samples identifies pneumonia.
Treatment
1. Bed rest
2. Fluids
3. Drugs
4. Oxygen is given when needed. Severe cases require hospital care

Pneumonia can be life threatening to the elderly. Others at risk are

people already weakened y disease. In a normally healthy person this
disease may feel like a bad cold.

NOTE: a vaccine may prevent Pneumoccal pneumonia, one type of

pneumonia. One shot provides lifelong protection for anyone receiving it.
People who are 65 or older should get this shot. Patients with compromised
immune systems, chronic illnesses, or those without a spleen are also
candidates for this shot.

COUGHING & COUGHS

Coughing is the body’s defense of removing foreign material or mucous
from the lungs and throat.
The two general classifications of cough are:

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1. Productive coughs (producing phlegm or mucous from the lungs)
2. Nonproductive coughs (dry and not producing any mucous or
phlegm).
Coughs are also divided into acute (less than 3 weeks’ duration) and
chronic (more than three weeks’ duration).
Some causes of coughing
Acute cough is most often caused by the common viral upper
respiratory tract infection. The cough is usually secondary to stimulation of
nasal, pharyngeal, and laryngeal mucosa receptors. This results from the
secretion of the nose and sinuses draining into the throat.

 A dry cough may follow viral illnesses and may last up to several
weeks.
 Chronic cough may be caused by a variety of underlying diseases
including asthma, cystic fibrosis, allergies, GERD and chronic post
nasal drip.
 Smoking is a major cause of chronic cough.
 Certain medication (ACE inhibitors for hypertension) cause coughing
as a side effect.

Treatment of coughs
 Treatment of a cough should be directed as the underlying cause of
the cough.
 Antitussives are useful in suppressing dry, hacking cough. (A
physician or pharmacist may recommend specific product.)
 Antitussives should not be given when the cough is productive
and the patient is bringing up mucus. If the cough is keeping
the patient awake at night, then their use at bedtime is indicted.
 Antihistamines and decongestants may be a good choice for
treating coughs associated with postnasal drip. (A physician or
pharmacist may recommend specific products.)
 Expectorants are useful to help break and bring up mucous. ( A
physicians or pharmacist may recommend specific products.)
 For patients with underlying disease states causing the cough,
treatment should first be based on treating the underlying
disease

A physician should be called if:

 The patient is producing green, yellow, or rusty colored sputum. This
is usually the result of an infection.
 The cough lingers more than 7 to 10 days after other symptoms have
cleared.
 Any cough last longer than two weeks.

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 A persistent fever is present or if the coughing up of blood occurs.

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SELF CHECK 5.2-1

Instructions:
A. Read the questions carefully. On your answer sheet, write the letter of
the correct answer.

1. It is the decrease in the bone density which increased brittleness of bone

that makes the older prone to serious fracture.
a. Constipation
b. Osteoporosis
c. Osteoarthritis
d. Incontinence
2. A type of urinary incontinence where it is a caused b an inability of the
pelvic floor muscle to hold the urethral sphincter closed. Leakage occurs
when there is a pressure on the abdominal muscle and bladder.
a. Urge incontinence
b. Stress incontinence
c. Overflow incontinence
d. Bladder retention
3. It is an autoimmune disease that causes chronic inflammation of the
joints and tissues around the joints as well as other organs of the body.
a. Rheumatoid arthritis
b. Hypertension
c. Osteoarthritis
d. Syncope
4. Also called “passing out”. Related to temporary insufficient blood flow to
the brain.
a. Dementia
b. Syncope
c. Dizziness
d. Diabetes mellitus
5. It is the chronic disease that occurs when the pancreas does not produce
enough insulin or alternatively when the body cannot effectively use the
insulin it produces.
a. Hypertension
b. Diabetes Mellitus
c. Glaucoma
d. Stroke

B. As a Caregiver, give your management to Alzheimer’s Disease (AD)

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Answer Key to 5.2-1

A.
1. b
2. b
3. a
4. b
5. b

B. ROLE AS A CAREGIVER
1. Make sure the home is safe.
2. Maintain good nutrition.
3. Manage sleep problems.
4. Manage bladder and bowel control problems. (incontinence)
5. Make the most of remaining abilities.
6. Help the person avoid confusion.
7. Understand behavior changes.
8. Manage agitation.
9. Manage wandering.
10. Communicate successfully.

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INFORMATION SHEET 5.2-2
“Safety risks to the elderly and contingency measures”

Learning objective:
After reading this INFORMATION SHEET, YOU MUST be able to provide
and maintain proper response to situations of risk to health.

Introduction:
Although caring for an elderly client is much the same as caring for the
younger client, you may be aware that the elderly often need special attention in
certain aspects of their care. You will have to be extra alert in the areas of safety
and exercise and in assisting with their medication. In addition, because an
elderly person is unable to report abuse or to find someone to talk to outside of
his home, you will have to be his voice. This is a very important role.
Because you may be the only person who sees the client regularly, you
will develop a special relationship with him and will be able to notice changes in
mood and activity. Report to your supervisor every change, no matter how slight
so that your client’s status can be assessed and monitored. Remember, your
overall goal as you care for your client is to preserve his independence, safe
worth and safety.

SAFETY
Safety for the elderly is always a prime concern. As their activity level
changes, do things that are considered safe. Poor eye sight, decreased reflexes
and poor hearing all contribute to accidents in addition, elderly attempt tasks
they cannot execute and, thus, cause themselves harm. In an effort to be
independent, a client may take unnecessary risks.
As people age, their ability to sense and then react to hot water is decreased.
Many elderly are severely burned each year because they cannot feel the
hotness of the water. Teach your client to test his washing or bathing water
before using it. If hot water has been run through a faucet, the faucet itself may
be hot enough to cause burn should someone touch it. Briefly run cold water
through the faucet after the hot water to cool the metal and prevent such burn.
It is easier to prevent accidents than to heal. People who fall and break
bone take months to heal and then may never regain full use of the limbs again.
The elders heal slower than the younger clients, so the prevention of falls for
your elderly clients even more important than your younger clients. Safety
remains one of your primary responsibilities as a caregiver.

Date Developed: Document No.

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Date Revised:
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Revision # 01
Help your clients maintain a safe environment in the following ways.
 Encourage your clients to discuss their capabilities realistically.
 Help provide good lighting with switches that are easy to operate.
 Encourage the use of banisters and properly installed grab bars.
 Encourage safe practices in the kitchen. Never let client wear long flowing
sleeves while cooking.
 Plan emergency exits.
 Help provide for smoke detectors.
 Encourage clients to discuss their driving capabilities with their
physicians.

EXERCISE
Health professionals now feel that planned exercise is important for
everyone. The benefits are many.
 A feeling of well being.
 Increases strength of bones.
 Increases cardiac and respiratory capability.
 Increased of strength and tone of muscle.
 Increase of weight.
 Decrease of blood pressure.
 Decrease of anxiety.
 Better sleep habits

All clients should consult their physician before they start an exercise
regime. They are many considerations before the proper regime is chosen, and
only a physician is able to make the most informed decision. Be sure to report
any change in a client’s level of exercise or you notice him having difficulty.

Many elderly clients experience changes in their sleep patterns. Among

the changes may be the total hours of sleep, and the effect of medication. Before
you suggest changes to your client’s routine, try to determine what the routine
was before his illness. In that way, you will be able to compare his former
activity with his present activity. Consider the following suggestions for your
client.
 Limit caffeinated drinks.
 Create a relaxing, pleasant atmosphere before going to sleep.
 Develop a regular sleep procedure.
 Limit naps and time spent without activity.
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 Create a regular exercise routine.
 Review medications.

Sleep is necessary to the body for optimum function. A rested client is

better able to take an active part in his care and interact with others in an alert
an calm manner
.
MEDICATION:

Elderly clients react to medications differently than the younger clients,

have several disease and disabilities and take several medications for each one.
The interaction often results in unexpected side effects. The following can also
be problems.
 The older body retains medications at different rate than does younger
body.
 Clients may stop taking medications to financial reason, forgetfulness or
because they hear or read some news about the drug.
 The kidneys and liver of an older client remove waste products more
slowly than the younger client.
 Older client often forget they have taken medication and repeat them.
 Some clients may save medications that become outdated and the start
taking them again.
 Older clients may have several physicians, Each of whom may not be
aware of all the medications that have been prescribed by other
physicians.
 Clients may not discuss their reaction to medications the physicians
because they feel the physician will be disappointed in their inability to
take the drug.

Your role as caregiver is to assist your clients in with a safe medication

schedule. Help your client maintain a foolproof, organized method of taking his
medications. Be sure all your clients medications are prescribed for him.
Borrowing medications can be dangerous!
Be sure your client knows why he is taking his medication and the
possible side effects.
When your client visits a physician, encourage him to take all his
medications with him. In that way, the physician will have a clear picture of the
medications your client is taking and can prescribe new ones accordingly.
Encourage your client to throw out old, outdated medications and to
return medications that are not his.
Many medications are now packed in childproof bottles. These bottles are
difficult for the older client to open. Help your client order his medications
packaged in containers easy for him to open and close. Clients often fail to take
their medication because they cannot open the bottle.

Date Developed: Document No.

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ABUSE

Abuse is improper treatment that affects a person physically or emotionally. It

is your legal responsibility to respect people’s right and to protect them from
physical or mental harm. Abuse of the elderly is especially disturbing because
the abused are often helpless to fight back and unable to call for help. There
may be many reasons for abuse but the result is always the same-an elderly
person is hurt or in danger.
Recognize various forms of abuse, and protect people from any physical or
mental harm. Following are legal definitions of abuse.

Abuse ----- mental, physical, sexual, medical or financial exploitation.

Assault--- an unlawful personal attack. It is by means of verbal threatening
Battery--- an attack where an actual blow is delivered
Defamation--- falsehoods that result in damage to person’s reputation
False documentation -- entries in person’s record that is not true or has been
altered
Negligence--failure to give assigned care or giving improper care that causes
harm
If a person in your care needs protection from abuse, be sure that you
know the care plan and rules or regulations that pertain to the situation. If you
suspect abuse, report your evidence immediately to your supervisor. If you have
any concerns about dealing about abuse in the work environment, seek advice
from appropriate person.
Example of abuse:

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1. Forcing, threatening, calling names, making fun of a resident.
2. Restraining a resident without doctors order
3. Inappropriate touching in sexual manners
4. Pushing, pinching, unnecessary roughness
5. Forcing utensils to residents mouth

Example of neglect:
1. Failing to provide appropriate care
2. Not following the plan of care
3. Not raising bed rails, leading someone to fall from bed
4. Serving the wrong meal
5. Failing o feed a resident or provide fluids
6. Not repositioning a client leading to complications.
If you observe abuse or neglect by anyone, you must report it. Otherwise
you will be held responsible and may be subject to dismissal.
Common signs of abuse or neglect:
 Bruises on a client that are hard to explain.
 Fear of one particular person.
 A request from a client not to be left alone with a particular person.
 Conflicting stories from family members.
 A “feeling” that things are not right.
 Lack of nourishment and care for the client.
 Lack of family concerns for the safety of the client.
 Exchange of abusive words between family members.
 Unexpected deterioration of the client’s health.
The accusation that a person is abusing an elderly client is serious. Do
not make it lightly. But do report immediately all activities you see that indicate
the possibility of abuse. Most states require that any case of suspected elder
abuse be reported. It is your responsibility to become familiar with the laws of
your state and the proper reporting agency in your area. Remember, most abuse
is inflicted by a family member. Be alert!

SAFETY FOR THE ELDERLY

Home Safety Tips

1. Slips and falls are the main source of injury for older people in the
home.
 Recommends the use of grab-bars and non-slip mats in the
bathtub, handrails on both sides of the stairs, and slip-resistant
carpets and rugs.
2. Burns occur from hot tap water and from open flame.

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 Recommends that consumers turn down the temperature of their
water heater to 120 0F to help prevent scald.
 Recommends the installation and maintenance of at least one
smoke detector on every floor of the home.
 Older consumer should consider purchasing nightwear that is
flame resistance and choose garments made of tightly woven fabrics
such as 100%polyester, 100%nylon or 100%wool.
3. Check all cords.
 Arrange furniture so that outlets are available for lamps and
appliances without the use of extension cords.
 If you must use an extension cord, place it on the floor where
people cannot step on it.
 Move the phone so that telephone cords will not lie where people
walk.
 Remove cords under furniture or carpeting.
 Replace damaged or destroyed cords.
 If the rating on the cord exceeded because of the power
requirements of one or more appliances being used on the cord,
change the cord to a higher rated one or unplug it.
 If an extension cord is needed. Use one having a sufficient amp or
wattage rating for each appliance.
4. Check all rugs and mats.
 Remove rugs and runners that tend to slide.
 Apply double-face adhesive carpet tape or rubber matting to the
back of rugs and runners.
 Purchase rugs that are slip-resistant
 Check rugs and mats periodically.
 Place rubber matting under rugs (rubber needs to be cut to size if
possible)
5. Check smoke detectors.
 Read the instruction that come with the smoke detector for advice
on the best place to install it.
 Make sure detectors are placed near bedrooms, either on the ceiling
or 6-12 “ below the ceiling or on the wall.
 Locate smoke detector away from air vents.
 Purchase a smoke detector if you do not have one.
 Check and replace batteries and bulbs according to the
manufacturer’s instructions.

6. Check electrical outlets and switches.

 Unplug cords from outlets and do not use the switches.
 Have an electrician check the wiring as soon as possible.
 Replace with a bulb of the correct type and wattage.
7. Check the emergency exit plan.
 Develop an emergency exit plan.
Date Developed: Document No.
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 Choose a meeting place outside your home so you can e sure that
everyone is capable to escape quickly and safely.
8. In the kitchen, check the range area, all electrical cords, lighting, the
stool, rugs and mats and the telephone area.
9. Check the gas range area.
 Store flammable and combustible items away from range and oven.
 Remove towels hanging on oven handles. If towels hang close to a
burner, change the location of the towel rack.
 If necessary, shorten or remove curtains which could reach heat
source.
 Roll back long, loose sleeves or fasten them with pins or elastic
bands while you are cooking.
 Use ventilation systems or open windows to clear air of vapors and
smoke.
 Move cords and appliances way from sink areas and hot surfaces.
10. Living room/family room
 In the living room/family room, check all rugs and runners,
electrical and telephone cords, lighting the fireplace and chimney,
the telephone area and passageway.
 Do not use the chimney until the blockage has been removed.
11. Check the bathroom
 Apply textured strips or appliqués on the floor of tubs and showers.
 Use non-skid mats in the tub and shower and on the bathroom
floor.
 Check existing bars for strength and stability and repair if
necessary.
 Always check water temperature by hand before entering bath or
shower.
 Taking baths, rather than showers, reduces the risk of a scald from
suddenly changing water temperatures.

ACCIDENTS

Causes:
 Falls
 Environmental hazard
 Fall from bed
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 Gait disturbance
 Balance disorder or weakness
 Pain related to arthritis
 Vertigo
 Medications or alcohol
 Acute illness
 Confusion and cognitive impairment
 Sedative-hypnotic and anxiolytic

A single fall is not always a sign of major problem and an increased risk for
subsequent falls. The fall may simply be an isolated event. However, recurrent
falls, defined as more than two falls in a six-month period, should be evaluated
for treatable causes. An immediate evaluation is required for falls that produce
injuries that are associated with a new acute illness, loss of consciousness,
fever or abnormal blood pressure.

Date Developed: Document No.

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SELF CHECK 5.2-2

Instructions:
A. Read the questions carefully. On your answer sheet, write the letter of
the correct answer.

1. It is the improper treatment that affects the person physically,

emotionally, sexually and mentally.
a. Abuse
b. Battery
c. Defamation
d. Assault
2. Negligence is defined as:
a. Failure to give assigned care or giving improper care that causes
harm
b. Entries in person’s record that is not true or has been altered
c. An unlawful personal attack
d. An actual blow is delivered
3. Which of the following is an example of neglect?
a. Forcing utensils to residents mouth
b. Not raising bed rails, leading patient to fall from bed
c. Unnecessary roughness
d. Restraining
4. Which among the following shows that the care provider is doing a
Battery Abuse to his client?
a. Inappropriate touching in sexual manner
b. Forcing, threatening and making fun of a resident
c. Pushing, pinching and unnecessary roughness
d. Failing to feed the resident
5. The first and foremost treatment of heat stroke.
a. Apply betadine
b. Bring victim to the bathroom and bathe him with cold water.
c. apply cool or tepid water to the skin (for example you may spray
the victim with cool water from the garden hose)
d. bring him to the hospital.
6. It is mental, physical, sexual, medical or financial exploitation.
a. Abuse
b. Battery
c. Assault
d. Neglect
7. It is an attack where an actual blow is delivered
a. Abuse
b. Battery
c. Assault
Date Developed: Document No.
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d. Neglect
8. It is an unlawful personal attack. It is by means of verbal threatening
a. Abuse
b. Battery
c. Assault
d. Neglect
9. It is an example of neglect
a. Fear of one particular person.
b. Serving the wrong meal
c. Failing o feed a resident or provide fluids
d. All of the above
10. It is an entry in person’s record that is not true or has been altered
a. False documentation
b. Battery
c. Assault
d. Neglect

B. Enumerate 10 home safety tips

Date Developed: Document No.

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Answer Key to 5.2-2
A.
1. a
2. a
3. b
4. c
5. c
6. a
7. b
8. c
9. d
10.a
B.
1. Slips and falls are the main source of injury for older people in the home.
2. Burns occur from hot tap water and from open flame.
3. Check all cords.
4. Check all rugs and mats.
5. Check smoke detectors.
6. Check electrical outlets and switches.
7. Check the emergency exit plan.
8. In the kitchen, check the range area, all electrical cords, lighting, the
stool, rugs and mats and the telephone area.
9. Check the gas range area.
10. Living room/family room

Date Developed: Document No.

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Date Revised:
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INFORMATION SHEET 5.2-3
“Different Religious, Cultural, Spiritual, Physical and
Ceremonial perspective of the elderly”

Learning objective:
After reading this INFORMATION SHEET, YOU MUST be able to
identify/recognize Individual Differences.

IDENTIFYING INDIVIDUAL DIFFERENCES

Actively encourage people in your care to express their beliefs, wishes and
view, as long as they do not interfere with the rights of others. Respond in a
manner that is supportive.

BELIEFS AND PREFERENCES

Acknowledged the individual beliefs about self, religion, politics, culture, ethics and
sexuality. Beliefs and references affect many activities of daily living.

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 Foods a person eats
 Clothing a person wears
 How a person worships
 Values and ethics
 Interactions with others
 Activities of daily living
 Feeling about death and
dying

Date Developed: Document No.

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It is important to recognize and accept other’s beliefs and lifestyles, even if
they clash with your own. Every person has the right to quality of life,
regardless of age, gender, physical or mental ability, race, culture, religion,
beliefs or lifestyle.
You can support individual beliefs in a variety of ways:
 Be sensitive to each person’s needs
 Support the right to practice individual’s beliefs
 Make sure your speech and actions do not offend anyone
 Address individuals in their preferred manner
 Consider beliefs and lifestyles when taking part in care planning
 Show respect for each person’s customs and possessions
 Show interest in each person’s beliefs
 Be willing to listen when a person wants to talk
 Never questions or make fun of another person
 Never try to force your belief on another person.
Carefully examine any feelings of hostility. Your beliefs affect your
behavior in a variety of indirect ways. Never allow your beliefs to interfere
with the quality of service for anyone in plan of care.
Learn all you can about religious, customs and beliefs, including
practices of clinic minorities in local area. Ask people to tell you about their
beliefs and traditions, or go to the local library for information.

RELIGIOUS CUSTOMS

Be familiar with religious customs. The more you know, the less likely
you are to accidentally hurt someone. People may have religious items in
their rooms (rosaries or prayer books). If you have to move this item, handle
them with care.Never place on top of bibles or other religious articles. Take
special care to religious medallions that are pinned to pillows anytime.
HOLIDAYS AND RITUALS
Be aware of the days that are celebrated with special rituals. People may
need extra help in dressing for holidays or they may need privacy for certain
rituals.

CLOTHING

Some religious have certain articles of clothing that should be treated with
respect
OODS

Some religious forbid certain foods. Know what is not allowed and offer
other choices. Be aware of special times that people may fast (go without
food) or eat only certain foods.
MEDICAL TREATMENTS

Be aware of any medical treatments that are not allowed because of religious
beliefs

CLERGY

If a person wants to see a clergy member, make sure your supervisor is

informed. Provide privacy whenever a clergy member visits.

SIX WAYS TO RECOGNIZE CULTURAL DIFFERENCE

1. Communication
Communication forms the bases of though for all cultural groups. Our cultural
background greatly influences the way in which we communicate with others.
2. Spatial Need

A person’s comfort level is directly related to personal space.

Understanding these differences can greatly minimize
misunderstandings. For instance, Latinos tend to stand closer to each
other, whereas white Europeans seem to prefer more space

3. Social Organizations

These are groups with whom we interact and associate ourselves that
directly affect our behavior. Their influence helps us become who and what
we are

4. Time Consideration
People are past, present, or future oriented
A. Past oriented individuals hold on to old values, traditions, and/or
beliefs.
B. Present oriented people may find it difficult to keep a schedule. They
may be late, or miss appointments. They feel they can recover at a
later time.
C. Future oriented individuals use the present to achieve future goals.
They believe that what is done today affects their future

5. Environment Control
Environmental control can be divided into two categories
A. External focus: Individuals believes that fate, luck, and/or chance
play great part in their controlling environment. Italians tend to have an
external focus: “ if I’m predestined to live a shorter life, my smoking won’t
shorten my life span.”
B. Internal focus: Individuals believe their behavior will affect their
future environment. White Europeans tend to have an internal focus: “if I
quit smoking now, I may have the chance to live a longer life”

6. Biological Variations
These variations distinguish the ways in which the genetic makeup of
members from a certain culture makes them more susceptible to certain
illnesses. For instance, many African Americans over the age of 40 are more
susceptible to hypertension, Hispanics to diabetes, and American Indians to
tuberculosis
COMPARING CULTURAL NORMS AND VALUES

Aspect of U.S. Health Care Other

Culture Culture Culture
1. Sense of self  Informal  Formal
and  Handshake  Hugs, bows,
Space handshakes

2.  Explicit, direct  Implicit, indirect

Communication communication communication
and  Emphasis on  Emphasis on
Language content –meaning context – meaning
found in words found around words
3. Dress and  “Dress for success”  Dress seen as a sign
appearance ideal of position, wealth,
 Wide range in and prestige
accepted dress  Religions rules
 More casual  More formal
1. Food and  Eating as a  Dining as a social
eating necessity – fast food experience
and  Religious rules
habits
5. Time and time  Linear and exact  Elastic and relative
consciousness time consciousness time
 Value on  Time spent on
promptness enjoyment of
 Time = money relationships
6. Relationship,  Focus on nuclear  Focus on extended
family, friends family family
 Responsibility for  Loyalty and
self responsibility to
 Value on youth, age family
seen as  Ag given status and
handicap respect
7. Values and  Individual  Group orientation
norms orientation  Conformity
 Independence  Preference for
 Preference for harmony
direct confrontation  Emphasis on
of conflict relationships
 Emphasis on task
8. Beliefs and  Egalitarian  Hierarchical
attituteds  Challenging of  Respect for
authority authority and social
 Gndder equity order
 Behavior and  Different roles for
action affect and men n women
determine the  Fate controls and
future predetermines the
future
9. Mental  Linear, logical  Lateral, holistic,
processes and  Problems-solving simultaneous
learning style focus  Accepting of life’s
 Internal locus of difficulties
control  External locus of
 Individuals control control
their destiny  Individuals accept
their destiny
10. Work habits  Reward based on  Rewards based on
and practices individuals seniority,
achievement relationships
 Work has intrinsic  Work s necessity of
value life

THREE PATIENT BEHAVIORAL PATTERNS

Regardless of cultural background, behavioral patterns are identifiable in all

patients.
Efficacious: healthcare practices may be beneficial even though they may
be different from modern Western practices. For example, using
acupuncture to treat reduces and reduces pain.
Neural: healthcare practices may offer no physiological benefit to the
patient, but rather an emotional and/or mental benefit. For instance, a
woman from the rural south when delivering a baby may put a knife
underneath the bed to cut the pain. The woman believes this help; so
psychologically, this belief does help the patient.
Dysfunctional: an obvious dysfunctional practice is eating the wrong food.
For instance, consuming over refined sugar and flour if definitely not
healthy.

Keeping in mind both behavioral patterns and cultural beliefs can aid in
determining the necessity of a patient-provider negotiated treatment plan.
CULTURAL GENERALIZATIONS

African American

 Address patients by their formal name, not by their first name,

especially for elderly patient

 Make direct eye contact.

 Explain reason for obtaining information, since there may be

reluctance to engage in personal disclosure.
Be cognizant of historic & basic distrust of health professionals by some
African Americans

Amish
 Amish as patient prefer to be on a first-name basis. They also prefer
health providers who will sit with them and discuss their health care
question one-on-one.
 Speaking with the community’s bishop or bishop’s representative may
be necessary when making decision about costs/benefits of care
option.
 The Amish may be using herbal products and remedies, both for
prevention and treatment.

The travel Amish generally stop school at eight-grade. Use appropriate

reading level materials and consider teaching with demonstrations, picture
stories, and role-modeling.
Chinese
 Ask his/her last name and how to address him/her (husband and
wife do not necessarily have the same last name).
 People from China may tent to b more formal than Americans.
 Inquire about food choices.
 Some Chinese patients believe in hot and cold food items to treat
disease.
 Treatment decisions are often made by family, rather than by the
individual patient.
 The patient may want conversations about treatment to take place
when family is present.
 Ask the patient if his/her preference.
 Patient’s believes symptoms relief should happen quickly, but they
may also think the illness is cured when the symptoms go away.
 Pointing out progress or improvement may make result more obvious
and act as an incentive for the patient to continue treatment.
 Be aware of the importance to Chinese patients in “saving face”.
 A response to yes/no question is likely to b “yes”, a nod, or “I know”.
 These responses may not indicate understanding; they may simply
mean that the patient has heard you.
 Ask the patient or family to repeat the information.
 Explain why blood drawing for tests is important.

Some Chinese patients believe that blood is the source of life or the entire body
and is not regenerated.

Muslim
 Be aware that Muslim patients may tend to demonstrate passivity in the
presence of an authority figure.
 Explain the need for requesting patient to disclose personal information.
 Muslim patients may be reluctant to share such content with others.
 Consider sharing some bit of personal information to gain the patient’s trust.
 Ask about including a family spokesperson rather than only communicating
with the patient.

Control the tendency to be “frank” when communicating a grave diagnose or

poor prognosis

Japanese
 Doctors are seen as authority figures and patient and their families may
hesitate to ask questions.
 Ask the patient or family members more than once if they have questions.
 Treatment decisions are often made by the family rather than by the
individual’s patient.
 The patient may want conversations about treatment to take place when the
family is present.
 Ask the patient if this is his/her preference.
 Patients, particularly the elderly, may not be accustomed to verbalizing their
emotions.
 However, they appreciate empathy, respect, and kindness.

Nonverbal communication is important

Mexican American
 Traditionally present-oriented.
 Tine viewed as relative to the situation.
 This flexibility allows for feeling of punctuality even when 15-20 minutes
late.
 Tendency to feel that something is very wrong if oxygen is required.
 Some spiritual amulets, religious medallions, or rosary beads may be
present near the patient.
Prayers are commonly practiced at the bedside of a dying patient

Russian
 In Russia, bad news is not given to patient may demand to hear the truth
but they do not want to hear the bad news.
 Talk to their relatives first.
 Be aware that Russian patients and families may ask for new treatments or
procedures.
 Patients expect doctors to explain, in detail, new tests or a new medicine.
 When explaining possible risks, complication an side effects of different
procedure, be cautious and optimistic.
 Some Russian patients may overreact.
 Russian patient may be distrustful of doctors.
 They may tend to disobey doctor’s orders such as not taking medications as
prescribed or combining them with Russians treatments.
 Russian patients may prefer alternative methods or treatment such as
massage or mud-therapy , a popular treatment in Russia.
 Some Russian patients may be more likely to follow through with a
homeopathic remedy versus traditional Western medicines.
 Psychiatric disease is viewed s disgraceful in Russia.
 Russian patient often do not provide answer regarding any family history of
psychiatric illness or past psychiatric treatments.

CEREMMONIAL, CULTURAL, EDUCATION, RECREATIONAL,

RELIGIOUS, SOCIAL AND SPIRITUAL ACTIVITIES OF THE ELDERLY
Caring for ill or elderly love ones requires tremendous amount of physical,
mental, emotional, and spiritual energy. As such caregivers should be mindful of
the psychosocial, cultural and spiritual aspects of health and illness as well as the
effects of these factors of themselves and their love ones.
For example: if spiritual matters have been an important part of your life
and or the life of your love ones it is important to provide opportunities for spiritual
experiences even you cant attend religious services
Some suggestion includes:

 Read passages from religious books.

 Arrange for a member of the clergy or a parish lay minister to visit.
 Play sacred music.
 Watch church services on television.
 Continue meaningful rituals, such as prayers before meals.
 Enjoy a sunrise or sunset together.
 Pray together.
 Sing familiar hymns.
 Use services and liturgies that the person remember

PERFORMING A ROLE AS A CLIENT’S ADVOCACY

Resident’s Bill of Rights

The American Hospital Association has published a booklet of
patients' rights. The patients' "bill of rights" is uniform in content at health-
care institutions around the country.

1. The patient has the right to considerate and respectful care.

2. The patient has the right to obtain from his or her physician complete
current information concerning diagnosis, treatment, and prognosis in
terms the patient can be reasonably expected to understand.
3. The patient has the right to receive from his or her physician information
necessary to give informed consent prior to the start of any procedure
and/or treatment.
4. The patient has the right to refuse treatment to the extent permitted by
law, and to be informed of the medical consequences of his or her action.
5. The patient has the right to every consideration of his or her privacy
concerning his or her own medical care program. Case discussion,
consultation, examination, and treatment are confidential and should be
conducted discreetly.
6. The patient has the right to expect that all communications and records
pertaining to his or her care should be treated as confidential.
7. The patient has the right to expect that within its capacity a hospital
must make reasonable response to the request of a patient for services.
8. The patient has the right to obtain information as to any relationship of
his or her hospital to other health-care and educational institutions
insofar as his or her care is concerned.
9. The patient has the right to be advised if the hospital proposes to engage
in or perform human experimentation affecting his or her care or
treatment.
10. The patient has the right to expect reasonable continuity of care.
11. The patient has the right to examine and receive an explanation of his or
her bill regardless of source of payment.
12. The patient has the right to know what hospital rules and regulations
apply to his or her conduct as a patient.
ELDERLY MUST BE TREATED WITH RESPECT AND DIGNITY AND FULL
CIVIL RIGHTS.

The Elderly (age 65 or older) are becoming more important as life expectancy
increases. Elderly must be treated with respect and dignity and with full civil
rights. Physical and financial abuse and neglect of the elderly are growing problems
in the community and in licensed care facilities. The elderly are vulnerable to abuse
by their own families, caregivers, licensed care facilities, court-appointed
conservators, and by people selling insurance and investments opportunities. Many
seniors do not have access to affordable health care and prescription medication.
Many belong to health maintenance organizations (HMOs) who fail to provide equal
access to medical care and durable medical equipment, the Medicare prescription
drug program, fails to provide the elderly with guaranteed access to their
prescription medication, universal health care is the ultimate solution to this
problem.
CIVIL RIGHTS FOR THE ELDERLY WHO HAVE UNIMPAIRED MENTAL
CAPABILITY, IRRESPECTIVE OF PHYSICAL CONDITION:

 Allow the elderly with adequate eyesight and physical coordination to

drive motor vehicle

 Provide financial assistance for indigent elderly to give them adequate

income to provide for their basic needs

 Require two medical declarations establishing lack of capacity by

appropriate medical specialist (psychiatrist, neurologist, neuro-
psychiatrist, gero-psychiatrist) to activate durable powers of attorney
and successor trustee powers

 Allow mentally competent elderly people the right to ask their

physician for assistance with ending their lives in the event of a
terminal medical condition by passing into California law the 1997
(revised in 1999) Oregon Death with Dignity Act articles 127, 897
(upheld in 2005 by the U.S Supreme Court

Promote and support Elderly’s rights

Promote and support each other’s right deserve quality care regardless of
beliefs, the mental or physical ability background, race, equality. Your personal
beliefs and preferences could not affect the quality of service.
Self-Check 5.2-3

Instructions:
A. Read the questions carefully. On your answer sheet, write the
letter of the correct answer.

1. You can support individual beliefs in a variety of ways, EXCEPT.

a. Be sensitive to each person’s needs
b. Support the right to practice individual’s beliefs
c. Show interest in each person’s belief
d. Insist what you know is right for your client
2. These are groups in whom we interact and associate ourselves that
directly affect our behavior. Their influence helps us become who and
what we are.
a. Spatial
b. Community
c. Social organizations
d. Rituals
3. People are past, present and future oriented. Past oriented means:
a. Past oriented individual hold on to old values, traditions and
beliefs
b. Past oriented individual may find difficult to keep a schedule. Thay
may be late or miss appointments and feel they can recover at later
time
c. Past oriented individual use the present to achieve future goal.
They believe that what is done today affects their future
d. Past oriented individual believes their behavior will affect the
future environment.
4. This culture believes that blood is the source of life or the entire body is
not regenerating.
a. Amish
b. Chinese
c. Muslim
d. Japanese
5. This culture feels that something is very wrong if oxygen is required. The
presence of spiritual amulets, religious medallions, or rosary in the
bedside is important.
a. Russian
b. Chinese
c. Japanese
d. Mexican-American
B. True or False
Instruction: Write “T” if the statement is true and write “F” if the
statement is false.

1. The patients' "bill of rights" is uniform in content at health-care

institutions around the country.
2. Healthcare practices may be beneficial even though they may be
different from modern Western practices.
3. You can support individual beliefs in a variety of ways.
4. Never allow the elderly with adequate eyesight and physical
coordination to drive motor vehicle.
5. The patient has no the right to expect reasonable continuity of care.
6. The patient has the right to expect that all communications and
records pertaining to his or her care should be treated as confidential.
7. The patient has the right to obtain from his or her physician complete
current information concerning diagnosis, treatment, and prognosis in
terms the patient can be reasonably expected to understand.
8. Future oriented individuals use the present to achieve future goals.
They believe that what is done today affects their future.
9. The patient has no right to receive from his or her physician
information necessary to give informed consent prior to the start of
any procedure and/or treatment.
10. Biological Variations distinguish the ways in which the genetic
makeup of members from a certain culture makes them more
susceptible to certain illnesses.

Answer Key to 5.2-3

A.
1. B
2. C
3. A
4. B
5. D
B.
1. T
2. T
3. T
4. F
5. F
6. T
7. T
8. T
9. F
10. T
References

1. COMPETENCY-BASED CURRICULUM

2. Training Regulations

3. Internet
Sample Data Gathering Instrument for Trainee’s
Characteristics
Please answer the following instrument according to the
characteristics described below. Encircle the letter of your choice that best
describes you as a learner. Blank spaces are provided for some data that
need your response.
Characteristics of learners

Language, Average grade in: Average grade in:

literacy and English Math
numeracy (LL&N)
a. 95 and above a. 95 and above
b. 90 to 94 b. 90 to 94
c. 85 to 89 c. 85 to 89
d. 80 to 84 d. 80 to 84
a. 75 to 79 e. 75 to 79

Cultural and Ethnicity/culture:

language a. Ifugao
background
b. Igorot
c. Ibanag
d. Pangalatoc
e. Muslim
f. Ibaloy
g. Others( please specify)_____________
Characteristics of learners

Education & Highest Educational Attainment:

general a. High School Level
knowledge
b. High School Graduate
c. College Level
d. College Graduate
e. with units in Master’s degree
f. Masteral Graduate
g. With units in Doctoral Level
h. Doctoral Graduate
Sex a. Male
b. Female
Age Your age: _____
Physical ability 1. Disabilities(if any)_____________________
2. Existing Health Conditions (Existing illness
if any)
a. None
b. Asthma
c. Heart disease
d. Anemia
e. Hypertension
f. Diabetes
g. Others(please specify) ___________________

Previous TM Certificates
experience with a. TQ certified
the topic b. TM graduate
c. TM trainer
d. TM lead trainer
Number of years as a competency trainer
______

Previous List down trainings related to Qualifications

learning ___________________________
experience ___________________________
___________________________
National Certificates acquired and NC level
Training Level
completed ___________________________
___________________________

Special courses Other courses related to Qualifications

a. Units in education
b. Master’s degree units in education
Characteristics of learners

c. Others(please specify)
_________________________

Learning styles a. Visual - The visual learner takes mental

pictures of information given, so in order
for this kind of learner to retain
information, oral or written, presentations
of new information must contain diagrams
and drawings, preferably in color. The
visual learner can't concentrate with a lot
of activity around him and will focus better
and learn faster in a quiet study
environment.
b. Kinesthetic - described as the students in
the classroom, who have problems sitting
still and who often bounce their legs while
tapping their fingers on the desks. They are
often referred to as hyperactive students
with concentration issues.
c. Auditory- a learner who has the ability to
remember speeches and lectures in detail
but has a hard time with written text.
Having to read long texts is pointless and
will not be retained by the auditory learner
unless it is read aloud.
Other needs a. Financially challenged
b. Working student
c. Solo parent
d. Others(please specify)
___________________________
FORM 1.1 SELF-ASSESSMENT CHECK

INSTRUCTIONS: This Self-Check Instrument will give the trainer necessary

data or information which is essential in planning training
sessions. Please check the appropriate box of your answer
to the questions below.
CORE COMPETENCIES
CAN I…? YE NO
S
Provide care and support to infants/toddlers
1.Comfort infants and toddlers
2.Bath and dress infants and toddlers
3.Feed infants and toddlers
4.Put infants and toddlers to sleep
5.Enhance social, physical, intellectual, creative and
emotional activities of infants and toddlers.
Provide care and support to children
1.Instill personal hygiene practice to children
2.Bath and dress children
3.Feed children
Foster social, intellectual, creative and emotional development of
children
1.Foster children’s independence and autonomy
2.Encourage children to express their feelings, ideas and
needs
3.Stimulate children’s awareness and creativity
4.Foster children’s self esteem and development of self
concept
Foster the physical development of children
1.Enhance physical activities of children
2.Create opportunities for children to develop a wider range
of
physical development
3.Provide experience to support physical development of
children
Provide care and support to elderly
1.Establish and maintain an appropriate relationship with
the
elderly
2.Provide appropriate support to the elderly
3.Provide assistance with elderly’s personal care needs
4.Provide care and support to people with special needs
Provide care and support to people with special needs
1.Establish and maintain appropriate relationship with
people with special needs
CORE COMPETENCIES
CAN I…? YE NO
S

2.Aprovide appropriate support to people with special needs

3Assist in maintaining weel being of people with special
needs
4.Assist people with special needs to identify and meet their
needs
5. Assist people with special needs in maintaining an
environment that enables maximum independent living
Maintain a healthy and safe environment
1.Maintain a clean and hygienic environment
2.Provide a safe environment
3.Supervise the safety of cliets
Respond to emergency
1.Implement procedure for infection control
2.Respond to emergencies and accident
3.Administer medication within guidelines
4.Respond to threats and situation of danger
Clean living room, dining room, bedrooms, toilet and
bathroom
1.Clean surfaces and floors
2.Clean furnishing and fixtures
3.Clean furnishing and fixtures

4.Clean toilet and bathroom

5.Sanitize room
6.Maintain clean room environment
Wash and iron clothes, linen and fabric
1.Remove stains
2.Prepare washing equipment and supplies
3.Perform laundry
4 .Perform laundry
5.Iron clothes, linens and fabrics
Prepare hot and cold meals
1.Prepare ingredients according to recipes
2.Cook meals and dishes according to recipes
3.Present cooked dishes
4.Prepare sauces, dressings and garnishes
CORE COMPETENCIES
CAN I…? YE NO
S

5.Prepare Appetizers
6.Prepare desserts and salads
8.Prepare sandwiches
9.Store excess foods and ingredients
10.Convert unconsumed cooked food

Note: In making the Self-Check for your Qualification, all required competencies
should be specified. It is therefore required of a Trainer to be well- versed
of the CBC or TR of the program qualification he is teaching.
Evidences/Proof of Current Competencies

Form 1.2: Evidence of Current Competencies acquired related to

Job/Occupation

Current
Proof/Evidence Means of validating
competencies
1. Provide care and National Certificate in Submitted an
support to infants Caregiving, Certificate of authenticated copy of
/toddlers Employment and National certificate
Certificate of Achievement Certificate of Employment
and Certificate of
Achievement
2. Provide care and National Certificate in Submitted an
support to Caregiving, Certificate of authenticated copy of
children Employment and National certificate
Certificate of Achievement Certificate of Employment
and Certificate of
Achievement
3. Foster social, National Certificate in Submitted an
intellectual, Caregiving, Certificate of authenticated copy of
creative and Employment and National certificate
emotional Certificate of Achievement Certificate of Employment
development of and Certificate of
children Achievement
4. Foster physical National Certificate in Submitted an
development of Caregiving, Certificate of authenticated copy of
children Employment and National certificate
Certificate of Achievement Certificate of Employment
and Certificate of
Achievement
5. Provide care and National Certificate in Submitted an
support to elderly Caregiving, Certificate of authenticated copy of
Employment and National certificate
Certificate of Achievement Certificate of Employment
and Certificate of
Achievement
6. Provide care and National Certificate in Submitted an
support to Caregiving, Certificate of authenticated copy of
people with Employment and National certificate
special needs Certificate of Achievement Certificate of Employment
and Certificate of
Achievement
7. Maintain a National Certificate in Submitted an
healthy and safe Caregiving, Certificate of authenticated copy of
environment Employment and National certificate
Certificate of Achievement Certificate of Employment
and Certificate of
Achievement
8. Respond to National Certificate in Submitted an
emergency Caregiving, Certificate of authenticated copy of
Employment and National certificate
Certificate of Achievement Certificate of Employment
and Certificate of
Achievement
9. Clean living National Certificate in Submitted an
room, dining Caregiving, Certificate of authenticated copy of
room, bedroom, Employment and National certificate
toilet and Certificate of Achievement Certificate of Employment
bathroom and Certificate of
Achievement
10. Wash and iron National Certificate in Submitted an
clothes, linens Caregiving, Certificate of authenticated copy of
and fabrics Employment and National certificate
Certificate of Achievement Certificate of Employment
and Certificate of
Achievement
11. Prepare hot National Certificate in Submitted an
and cold meals Caregiving, Certificate of authenticated copy of
Employment and National certificate
Certificate of Achievement Certificate of Employment
and Certificate of
Achievement
Identifying Training Gaps

From the accomplished Self-Assessment Check (Form 1.1) and the

evidences of current competencies (Form 1.2), the Trainer will be able to
identify what the training needs of the prospective trainee are.

Form 1.3 Summary of Current Competencies Versus Required

Competencies

Required Units of Current Training

Competency/Learning Competencies Gaps/Requirement
Outcomes based on CBC s
5. Provide care and support to elderly
1.Establish and
maintain an
1.Establish and maintain appropriate
an appropriate relationship with
relationship with the the
elderly elderly
2.Provide
2.Provide appropriate appropriate support
support to the elderly to the elderly
3.Provide assistance with 3.Provide assistance
elderly’s personal care with elderly’s
needs personal care needs
4.Provide care and support 4.Provide care and
to people with special support to people
needs with special needs

Using Form No.1.4, convert the Training Gaps into a Training Needs/
Requirements. Refer to the CBC in identifying the Module Title or Unit of
Competency of the training needs identified.
Form No. 1.4: Training Needs

Training Needs Module Title/Module of

Instruction
(Learning Outcomes)
5.1 Explaining the concepts and principles 5. Providing care and support to
of basic nursing care of the elderly elderly
5.2 Identifying appropriate physical,
emotional, spiritual and intellectual
needs.
5.3 Providing assistance in promoting the
appropriate needs for roles,
responsibilities, rights, freedom and
activities of elderly.
5.4 Providing adequate nutrition and
elimination
SESSION PLAN

Sector : HEALTH SOCIAL & OTHER COMMUNITY DEVELOPMENT SERVICES

Qualification : CAREGIVING NC II
Unit of Competency : PROVIDE CARE AND SERVICES TO ELDERLY
Module Title : PROVIDING CARE AND SERVICES TO ELDERLY
Learning Outcomes:
1. Establish and maintain an appropriate relationship with the elderly
2. Provide appropriate support to the elderly
3A. Provide assistance with elderly’s personal care needs
3B. Provide Assistance with Elderly’s Personal Care Needs

A. INTRODUCTION
This module covers the basic knowledge, skills and attitudes required in providing support and assistance to maintain
quality care for the elderly to meet his/her daily needs including nourishment, mobility, personal hygiene and other
support within the plan of care.
B. LEARNING ACTIVITIES
LO 1: Establish and maintain an appropriate relationship with the elderly
Learning Content Methods Presentation Practice Feedback Resources Time
Explain the Read information
Modular Answer self- Check Information
concepts and sheet 5.1-1 on
Group discussion check 5.1- answers sheet
principles of basic Proper Care
Self-paced instruction 1 with answer 5.1-1
nursing care of the for Elders
key 5.1-1
elderly

Date Developed: Document No. NTTA-TM1-01

Trainers Methodology Level I July 2010 Issued by:
Page 27 of 250
Templates Developed by: NTTA
NTTA
Revision # 01
Relevant plan of care, Modular Read information Answer self- Check Information
roles and Group discussion sheet 5.1-2 on check 5.1- answers sheet
responsibilities of Self-paced instruction Relevant plan of 2 
with answer 5.1-2
caregiver care, roles and key 5.1-2
responsibilities
of caregiver
Process of Aging Modular Read the Answer self – Answer key Information
Group discussion information check 5.1- 5.1-3 sheet
Self-paced instruction sheet 5.1-3 3 5.1-3

LO 2: Provide appropriate support to the elderly

Common problems of Modular Read information Answer self- Answer key Information
the elderly and their Group discussion sheet 5.2-1 on check 5.2-1 5.2-1 sheet
ramification Self-paced instruction Common 5.2-1
problems of the
elderly and their
ramification
Safety Risks to the Modular Read information Answer self- Answer key Information
elderly and Group discussion sheet 5.2-2 on check 5.2-2 5.2-2 sheet
contingency measures Self-paced instruction the Safety Risks 5.2-2
to the elderly
and contingency
measures
Different Religious, Modular Read information Answer self- Answer Information
Cultural, Spiritual, Group discussion sheet 5.2-3 on check 5.2-3 key5.2-3 sheet
Physical and Self-paced instruction Different 5.2-3
Ceremonial Religious,
Perspective of The Cultural,
Date Developed: Document No. NTTA-TM1-01
Trainers Methodology Level I July 2010 Issued by:
Page 28 of 250
Templates Developed by: NTTA
NTTA
Revision # 01
Elderly Spiritual,
Physical and
Ceremonial
Perspective of
The Elderly
Relevant plan of care, Modular Read information Answer self- Answer Information
roles and Group discussion sheet 5.2-4 on check 5.2-4 key5.2-4 sheet
responsibilities of a Self-paced instruction Relevant plan of 5.2-4
caregiver care, roles and
responsibilities
of a caregiver

LO 3 A: Provide assistance with elderly’s personal care needs

Types, uses, Modular Read information Answer self- Answers key Information
specifications and Group discussion sheet 5.3A-1 check 5.3A-1 5.3A-1 sheet
maintenance of Self-paced instruction Types, uses, 5.3A-1
bathing specifications
paraphernalia and
maintenance of
bathing
paraphernalia

Procedures of bathing, Modular Read Task sheet Perform task Performance Task sheet
dressing, mobility, of Group discussion 5.3A-1: sheet 5.3A-1 Criteria 5.3A-1
the elderly Self-paced instruction Procedure in 5.3A-1
bathing

Proper care of the Demonstration Read Answer Answer key Information

elderly during ADL
Date Developed: Document No. NTTA-TM1-01
Trainers Methodology Level I July 2010 Issued by:
Page 29 of 250
Templates Developed by: NTTA
NTTA
Revision # 01
(Activities of Daily Modular information self-check 5.3A-3 sheet
Living) sheet 5.3A-2 5.3A-3 5.3A-3

Principles and Demonstration Read information Perform task Performance Task Sheet
procedures in Modular sheet 5.3A-3 sheet 5.3A-5 Criteria 5.3A-5
administering Read Task Sheet 5.3A-5
medicines for the 5.3A-5
elderly Principles and
procedures in
administering
medicines for the
elderly

LO3 B: PROVIDE ASSISTANCE WITH ELDERLY’S PERSONAL CARE NEED

Depending on the  Modular Read Information Answer self – Answer key Information
work, roles and  Group Discussion sheet 5.3B-1 check 5.3B-1 sheet
services provided, 5.3B-1 5.3B-1
specific knowledge of
particular groups or
issues may be
required like:
Alcohol and other
drugs
Cultural and
linguistic diversity

Date Developed: Document No. NTTA-TM1-01

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Page 30 of 250
Templates Developed by: NTTA
NTTA
Revision # 01
Risk of self esteem
harm
Women / Men
Community education
Mental health

Common problems of Modular Read Information Answer self – Answer key Information
the elderly and their Group Discussion sheet 5.3B-2 check 5.3B-2 sheet
ramification 5.3B-2 5.3B-2

Different cultural Group Discussion Read information Answer self – Answer key Information
requirements and Modular Sheet 5.3B-2 check 5.3B-3 sheet
preferences 5.3B-3 5.3B-3

Factors giving risk to Group Discussion Read information Answer self – Answer key Information
grief and loss in the Modular Sheet 5.3B-4 check 5.3B-4 sheet
elderly 5.3B-4 5.3B-4

Safety risks to the Group Discussion Read information Answer self – Answer key Information
elderly Modular Sheet 5.3B-4 check 5.3B-4 sheet
5.3B-4 5.3B-4

C. ASSESSMENT PLAN
 Written Test
 Performance Test
 Oral Interview
D. TEACHER’S SELF-REFLECTION OF THE SESSION

Date Developed: Document No. NTTA-TM1-01

Trainers Methodology Level I July 2010 Issued by:
Page 31 of 250
Templates Developed by: NTTA
NTTA
Revision # 01
PARTS OF A COMPETENCY-BASED LEARNING MATERIAL

References/Further Reading

Performance Criteria Checklist

Operation/Task/Job Sheet

Self Check Answer Key

Self Check

Information Sheet

Learning Experiences

Learning Outcome Summary

Module
Module Content
Content

Module
List of Competencies
Content

Module Content

Module Content

Front Page
In our efforts to standardize CBLM,
the above parts are recommended for
use in Competency Based Training
(CBT) in Technical Education and
Skills Development Authority (TESDA)
Technology Institutions. The next
sections will show you the
components and features of each part.

Date Developed: Document No. NTTA-TM1-07

Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 32 of 61
Developed by: NTTA
Templates NTTA
Revision # 01
(Qualification Title)
COMPETENCY-BASED LEARNING MATERIALS

List of Competencies

No. Unit of Competency Module Title Code

Provide care and Providing care and

1. support to infant support to infant and HCS323301
and toddlers toddlers

Provide care and Providing care and HCS323302

2.
support to children support to children

Foster social,
Fostering social,
intellectual, creative
intellectual, creative and HCS323303
3. and emotional
emotional development
development of
of children
children

Foster the physical

Fostering physical HCS323304
4. development of
development of children
children

Provide care and Providing care and HCS323305

5.
support to elderly support to elderly

Provide care and Providing care and

HCS323306
6. support to people with support to people with
special needs special needs

Maintain healthy and Maintaining healthy and HCS323307

7
safe environment safe environment

Responding to HCS323308
8 Respond to emergency
emergencies

Clean living room,

Cleaning living room,
dining room, HCS323309
9 dining room, bedrooms,
bedrooms, toilet and
toilet and bathroom
bathroom

Date Developed: Document No. NTTA-TM1-07

Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 33 of 61
Developed by: NTTA
Templates NTTA
Revision # 01
Wash and iron clothes, Washing and ironing HCS323310
10
linen and fabric clothes, linen and fabric

Prepare hot and cold Preparing hot and cold HCS323311

11
meals meals

Date Developed: Document No. NTTA-TM1-07

Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 34 of 61
Developed by: NTTA
Templates NTTA
Revision # 01
MODULE CONTENT

UNIT OF COMPETENCY: Provide care and support to the elderly.

MODULE TITLE: Providing care and support to the elderly.

MODULE DESCRIPTOR: This module covers the knowledge, skills and

attitudes required in providing support and assistance to maintain quality
care for the elderly to meet his/her daily needs including nourishment,
mobility, personal hygiene and other support within the plan of care. It also
includes, information sheets, self-checks, job sheets and performance
criteria checklist. Planning and preparation of the workshop based on CBT
principles will be practiced in this module.

NOMINAL DURATION: 150 Hours

LEARNING OUTCOMES:
At the end of this module you MUST be able to:
5. Establish and maintain an appropriate relationship with the elderly
6. Provide appropriate support to the elderly
7. Provide assistance with elderly’s personal care needs
8. Provide assistance with elderly’s personal care needs

ASSESSMENT CRITERIA:
1. Self introduction by the caregiver to the elderly client is done based on
established procedures.
2. Appropriate attitudes such as confidentiality, privacy, courtesy and
respect are adhered to and demonstrated towards the elderly based on
established procedures.
3. The elderly’s own interest, rights, freedom and decision-making are
supported and respected based on established procedures.
4. Short interpersonal exchanges with the elderly in establishing, developing
and maintaining rapport are encouraged
5. All support is provided to the elderly in accordance with the elderly’s
needs, rights, self determination and individual differences.
6. The elderly is encouraged and supported to participate in ceremonial,
cultural, educational, recreational, religious, social, and spiritual
activities as appropriately planned.
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7. Assistance is provided at all times in order to maintain a safe and healthy
environment, including minimizing physical dangers and risk of
infections based on established procedures.
8. Proper response to situations of risks to health and safety is provided and
maintained based on established procedures.
9. Personal preferences are identified in consultation with the elderly and a
plan for execution is mapped out based on established procedures.
10. The elderly is supported and encouraged in exercising their rights and
personal preferences without compromising their safety and those of
others and in accordance with established procedures.
11. Short interpersonal exchanges, clarifying meaning and maintaining
interaction to identify the elderly’s preferences are conducted based on
established procedures.
12. Time is scheduled to effectively listen to the elderly’s preferences to
maximize his/her well being.
13. The elderly’s personal care needs (aids to daily living) are identified and
assistance provided.
14. Specific concerns and difficulties in meeting some personal care needs
are identified, clarified and modified with the elderly in order to
effectively address such concerns and problem needs.
15. Assistive devices for providing assistance for the elderly are identified
and used as appropriate.
16. Organizational policies and practices for reporting are followed as
appropriate.
17. The elderly’s self esteem and confidence are enhanced.
18. Provisions for interaction between the elderly and the community are
researched and developed.
19. Developmental and progressing personal care needs are identified,
acknowledged and provided for as appropriate.
20. Empathy is demonstrated in supporting and caring for the elderly’s
feelings of grief and loss.

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LEARNING OUTCOME NO. 2

Provide appropriate support to the elderly

Contents:

1. Common problems of the elderly and their ramifications

2. Safety risks to the elderly and contingency measures
3. Different religious, cultural, spiritual, physical, and ceremonial perspective
of the elderly
4. Relevant plan of care, roles and responsibilities of a caregiver

Assessment Criteria

5. All support provided to the elderly in accordance with the elderly’s needs,
rights, self determination and individual differences
6. The elderly encouraged and supported to participate in ceremonial,
cultural, educational, recreational, religious, social, and spiritual activities
as appropriately planned.
7. Assistance provided at all times in order to maintain a safe and healthy
environment, including minimizing physical dangers and risk of infections
based on established procedures.
8. Proper response to situations of risks to health and safety provided and
maintained based on established procedures.

Conditions

The participants will have access to:

7. Chatting in friendly manner

8. Inquiring about the elderly’s health
9. Short casual exchange
10. Effective communication
11. Dialogue
12. Question and answer / interview techniques

Assessment Method:

4. Hands-on
5. Direct observation
6. Practical demonstration

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Learning Experiences

Learning Outcome 2
Provide appropriate support to the elderly

Learning Activities Special Instructions

If you feel you have understood
9. Read Information Sheet 5.2-1 on
Information Sheet 5.2-1, answer Self
the Common problems of the
check 5. 2-1.
elderly and their ramification
Check answers with the answer key. You are
10. Answer Self Check 5.2-1
required to get all answers correct. If you got
a perfect score, you may proceed to
Information Sheet 5.2-2. If not, read
information sheet 5.2-1 again to answer all
questions correctly.
After reading Instruction Sheet 5.1-1B,
11. Read Information Sheet 5.2-2:
proceed in answering Self Check 5.1-1B. If
Safety risks to the elderly and
you have questions, do not hesitate to ask for
contingency measures.
assistance from your facilitator.
Check answers with the answer key.
12. Answer Self Check 5.2-2
You are required to get all answers
correct. If you got a perfect score,
you may proceed to Information
Sheet 5.2-3. If not, review
information sheet 5.2-2 to answer all
questions correctly.

13. Read Information Sheet 5.2-3: Read thoroughly Information Sheet

Different Religious, Cultural, 5.2-3 and answer Self Check.
Spiritual, Physical and
Ceremonial Perspective of the
Elderly.
Check your answer with the answer
14. Answer Self Check 5.2-3
key. Repeat the process if you did
not reach the passing rate.
15. Read information sheet 5.2-4 Read thoroughly Information Sheet
on Relevant plan of care, roles 5.2-4 and answer Self Check.
and responsibilities of a
caregiver

16. Answer Self Check 5.2-4 Check your answer with the answer
key. Repeat the process if you did
not reach the passing rate. If you
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passed, CONGRATULATIONS! You
can now proceed to the next LO3A:
PROVIDE ASSISTANCE WITH
ELDERLY’S PERSONAL NEEDS.

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Information Sheet _5.2.1__

“Common problems of the elderly and their ramification”

Learning Objectives:
After reading this INFORMATION SHEET, YOU MUST be able to:
1. To identify the common problems affecting the elderly
2. To apply appropriate management in each problem.

COMMON HEALTH PROBLEMS OCCURING IN THE ELDERLY

Older people have limited regenerative abilities and are more prone to
diseases, syndromes, and sickness. At some point in the not too distant
future, Baby Boomers will have a large impact on the health care industry in
general. As the population ages seniors, or the elderly, are much more likely
to suffer mobility health and disability problems thus placing a strain on
government finances and health care facilities.

`
N. CONFUSION/DEMENTIA:
What is dementia?
Dementia is a progressive brain dysfunction (in Latin ‘dementia’
means irrationality), which results in a restriction of daily activities and in
most cases leads in the long term to the need for care. Many diseases can
result in dementia, the most common one being Alzheimer’s disease.
Dementia is an acquired syndrome that affects daily life. There are 2
common definition of dementia. One defines dementia as a decline in
memory and at least one other cognitive function, e.g., paraxial, aphasia,
amnesia, or executive function (visual spatial skills, calculation skills and
judgment). The second defines dementia as a decline in 3 of 5 general areas
of cognitive function, e.g., memory, language, visuospatial skills, executive
function, and personality/mood.
Alzheimer’s disease (AD) is a progressive dementia, and the patient
often dies within 10 years of clinical diagnosis. Gradual onset and
containing decline characterize the course of AD. Risk factors include
advancing age, family history and Down syndrome.

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What are the symptoms of Alzheimer’s disease?
2. Confusion.
This behavior in particular causes us to become ‘estranged’ from
others and to be unpredictable in our interactions. Confusion can also
occur ‘acutly’ i.e. suddenly and limited in time – for example triggered
by a hospital stay, directly after heart surgery etc. it is difficult to
understand this estrangement and it cannot be explained away – on
the other hand everybody also experiences similar situation from time
to time: we forget, misplace, can not remember names, cannot find
our car in the park and similar lapses. So both aspects are present:
dementia is not familiar but also not entirely alien to us.

5 Impaired memory and orientation.

6 Limitation of concentration.
7 Planning and judgment, personality changes and later also perceptual,
speech.
8 Walking disorder; in the final stage, various other body functions such as
swallowing and the excretion process are also affected
NOTE: During the course of Alzheimer’s diseases, patient lose their
independence in managing everyday life. There are affects on perception and
social relationship; people become more and more dependent on care.

What are the most common causes of Alzheimer’s diseases?

 The slowly progressing destruction of nerve cells in the brain leads to
the previously mentioned symptoms of Alzheimer’s diseases. It is a
natural phenomenon to lose a certain number of nerve cells during
ageing but this loss occurs much more rapidly in people suffering
from Alzheimer’s disease. As a result the brain of the patient does not
function normally any longer.
 The disease is caused by genetic changes (mutations) in the family. In
this case symptoms usually occur before the age of 60 and progress
rapidly.
 All currently mutation result in an overproduction of a protein which
destroy the nerve cells.
NOTE: The probability of developing Alzheimer’s disease increase with
advancing age. The probability is higher for woman and people having a
lower standard of education.

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What are the most important early indications of dementia?
11. Forgetfulness with effects at work:
Most people sometimes forget names or appointments. If this happens
more frequently and inexplicable states of confusion also occur, this
might be an indication for a decline in memory function.
12. Difficulties with familiar activities:
People who are very busy are sometimes absent-minded and for example
forget the pot on the stove. People with dementia possibly not only forget
the pot on the stove but also that they have cooked at all.
13. Language problems:
Most people sometimes experience difficulties in finding the right words.
Dementia suffered often cannot remember simple words and instead
they use inappropriate fillers, which make it difficult to understand the
sentences.
14. Problems with special and temporal orientation:
A lot of people sometimes forget e.g. the day of the week or they get lost
in unfamiliar surroundings. Dementia suffered might be in their own
street and no longer know where they are, how they got there and how
to get home again.
15. Impaired capacity of judgment:
People not always choose clothes suitable for the weather. Dementias
suffered sometimes wear totally inappropriate clothes. For example, they
wear a bathrobe while shopping or several blouses on top of each other
on a hot summer day.
16. Problems with abstract thinking:
For many people running a bank account is a challenge. Dementia
patients can often neither recognizes numbers not carry out sample
calculations.
17. Leaving things behind:
From time to time almost everybody leaves their keys or a wallet
behind. Dementia suffered however might put things in completely
inappropriate places, such as for example the iron in the fridge or a
watch in the sugar bowls. Afterwards they do not remember where they
put them.
18. Mood swing and behavioral changes
Everybody he mood swing. People with dementia may have very
sudden mood swing, often without discernible cause.
19. Personally change:
With advancing age the personality of most people change a little. People
affected by dementia may experience a very pronounced personality change
suddenly or over a longer period of time. Somebody who is generally friendly,
for example, becomes unexpectedly angry, jealous or timid.

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20. Loss of initiative:
Nobody continuously works with the same motivation. Dementia
patients sometimes loose the zest in their work and h interest in their
hobbies completely without enjoying new activities.

What are the stages of Dementia of the Alzheimer’s type?

Alzheimer’s disease can take very different courses. It is a slowly
unfolding, progressive disease, which is accompanied over time by changes
in the appearance of the patient. The disease is typically divided into three
stages. In medical terms, Alzheimer’s disease is divided into mild, moderate
and severe or early-stage, mid-stage and late-stage Alzheimer.
4. The mild stage is typically characterized by impairment of mental
abilities as well as mood swings.
5. In the moderate stage, behavior disturbances usually increasingly
develop.
6. Advance stage- physical problems are dominant.

ROLE AS A CAREGIVER
Many people who have dementia are cared for at home by partners or
other family members and friends. Taking care of someone with dementia
can be physically and emotionally draining, but tips and other help can
make it easier.
Make sure the home is safe
 Keep rooms uncluttered, with clear walkways. Lock up knives,
cleaning supplies, and other dangerous substances. Remove
throw rugs and consider installing carpet to help prevent
slipping. Install handrails, tub mats, and other assistive devices
in the bathroom. Provide good lightning, and put night-lights in
bedrooms, hallways, and bathrooms.
Maintain good nutrition
Offer food more often, including healthy midmorning and mid
afternoon snacks. If the person has trouble using a spoon or a
fork, serve finger foods. Serve one food at a time; choices can be
confusing. If the person is losing weight, consider offering a
liquid nutrition drink, such as Ensure.
Manage sleep problems
Keep the person awake and active during the day. Discourage
napping unless doing so causes more problems. Offer warm
milk or caffeine-free herbal tea before bedtime. A warm bath
close to bedtime may help the person relax
Manage blader and bowel control problems (incontinence)
 Encourage the person to use the bathroom on a regular
schedule, such s every 2 hours. Mark the bathroom and toilet
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clearly with signs; use pictures when the person can no longer
understand words. Consider using
 Consider using absorbent pads or briefs or adult diapers.
 If incontinence is a new problem, make sure it is not caused by
another condition, such as a urinary tract infection.
 Some people with dementia develop behavior problems, such as
aggression. These problems can be especially challenging for
caregiver. The following strategies may help.
Make the most of remaining abilities
 It is important to give the person tasks and activities that occupy him
or her without pushing too much. Tailor tasks to the person’s abilities.
For example, if cooking is no longer safe, ask for help in setting the
table or making simple dishes such as salad. Reinforce and support
the person’s efforts to remain independent, even if tasks take more
time or aren’t done perfectly.
Help the person avoid confusion
 Label often-used rooms, such as the bathroom, and objects. Keep
regular routines for daily activities such as meals, baths, and hobbies.
Keep furniture, lamps, pictures, and other objects in the same place.
Understand behavior changes
Strange or disruptive behaviors can be one of the most difficult
problems for caregivers. The person may do certain things repeatedly
or insist on unusual routines or activities. Think about whether the
person’s unusual behaviors might be motivated by an urge to
continue past activities or habits. If so, you may be able to find ways
to change the person’s environments and set up daily routines that
make these behaviors less of a problem.
Manage agitation
 Keep noise levels low and voices quiet. Develop simple daily routines
for bathing, dressing, eating, and other activities. Tell the person in
advance about changes in his or her regular schedule (trips, doctor
visits), and remind the person often of the upcoming event.

Manage wandering
Try to figure out why the person wanders. A person who wanders at a
certain time of day may always have taken a walk or gone to work at
that time. Lock outside doors, and use alarms and other devices to
alert you when the person wanders. Get a medical ID bracelet for the
person so that you can be contacted if he or she wanders away.
Communicate successfully
 Use short, simple, familiar words and sentences. Explain your actions.
Be calm and supportive. Use eye contact and use touch to reassure.
Don’t argue. Offer reassurance and try to distract the person.

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O. OSTEOPOROSIS
A decrease in bone density, along with increased brittleness of bone
make the elders prone to serious fractures, some of which may be
spontaneous and are called pathologic fractures. Osteoporosis occurs more
frequently in people in people with insufficient intake of dietary calcium, in
women after menopause, and in individuals who are immobilized or
physically inactive.
Interventions:
19. Have adequate calcium in diet
20. Provide milk/dietary product
21. Fish
22. Beans
23. Orange juice
24. Cereal or bread that have added calcium
25. Take calcium supplements
26. Get regular exercise
27. Avoid alcohol, quit smoking. Alcohol and smoking reduced bone
mass
28. Avoid large amounts of protein-rich or salty and caffeine foods. They
cause loss of calcium from the bone
29. Make the home safe to avoid accidents
30. Practice good posture
31. Use good body mechanics when lifting objects. Bend the knees
instead of the back
32. Do back exercise to improve posture
33. Avoid using a stool or bending over
34. Put items frequently used within easy reach
35. Use handrails when going up and down stairs
36. Hormonal Replacement Therapy (HRT) for menopausal women as
prescribed

P. POSTURAL HYPOTENSION

Clients who have been immobilized for even a few days may require
assistance with ambulation. The amount of assistance will depend on the
clients condition, including age, health status and length of inactivity.
Assistance may mean walking along sides the clients while providing
physical support. Some client experience postural hypotension on assuming
a vertical position from a lying position and may need information about
ways to control this problem. The client may exhibit some or all of the
following symptoms: pallor, diaphoresis, nausea, tachycardia, and dizziness.
If any of these are present, the client should be assisted to a supine position
in bed and closely assessed.

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Controlling Postural Hypotension:
10. Rest with the head of the bed elevated 8-12 inches. This
position makes the position change on rising less severe
11. Avoid sudden changes in position. Arise from bed in three
stages:
a. Sit up in bed for 1 minute
b. Sit on the side of the bed with legs dangling for 1 minute
c. Stand with care, holding onto the edge of the bed or another
non movable object for 1 minute
12. Never bend down all the way to the floor or stand up too quickly
after stooping
13. Postpone activities such as shaving and hair grooming for at
least 1 hour after rising
14. Wear elastic stockings at night to inhibit venous pooling in the
legs
15. Be aware that the symptoms of hypotension are most severe at
the following times:
a. 30-60 minutes after a heavy meals
b. 1-2 hours after taking an antihypertension medication
16. Get out of a hot bath very slowly, because high temperature can
lead to venous pooling
17. Use a rocking chair to improve circulation in the lower
extremities. Even mild leg conditioning can strengthen muscle tone
and enhance circulation
18. Refrain from any strenuous activity that results in holding the
breath and bearing down. This valsalvar maneuver slows the heart
rate, leading to subsequent lowering of blood pressure.

Q. URINARY INCONTINENCE- urinary incontinence is an undesirable

leakage of urine.

There are different types of incontinence.

5. Urge incontinence is caused by an overly sensitive bladder that feels
full even when there is only a small amount of urine present. The
bladder muscle contract unexpectedly, and, if the external urethral
sphincter is weak, urine is released. The symptoms of increased
frequency and urgency are present, often causing the person to
urinate more than twice a night or more than 7 times during the day.
6. Stress incontinence is caused by an inability of the pelvic floor
muscles to hold the urethral sphincter closed. The symptoms of stress
incontinence include urine leakage with activities that cause increase

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pressure on the abdominal muscle and bladder, such as coughing,
lifting, sneezing or getting up from a chair
7. Overflow incontinence occurs when the bladder stays full, either
from organ pressure (enlarged prostate) or because it stops
contracting because of medications or injured nerves. Urine leakage
occurs because of the constant pressure.
8. Bladder retention
 Dietary changes include decreasing consumption of caffeine,
aspartame (nutrasweet) and potassium-rich foods.

 Retrain the bladder, the pelvic floor muscles are contracted

every time urinary urgency is felt. The urine is held, longer
between each voiding, gradually increasing the time between
urination to 1,2 or 3 hours.

 Pelvic floor rehabilitation includes biofeedback and kegel

exercises. Kegel exercises should be done 5 times a day when
the patient is relaxed. The pelvic floor muscle should be
contracted and held for a count of 4 repeated 5 to 8 times.

R. HYPERTENSION
Blood pressure
Blood pressure is the force of blood against the walls of
arteries. Blood pressure is recorded as two numbers—the
systolic pressure (as the heart beats) over the diastolic pressure
(as the heart relaxes between beats). The measurement is
written one above or before the other, with the systolic number
on top and the diastolic number on the bottom. For example, a
blood pressure measurement of 120/80 mmHg (millimeters of
mercury) is expressed verbally as "120 over 80."

Normal blood pressure is less than 120 mmHg systolic and less
than 80 mmHg diastolic.

Hypertension increases your chance (or risk) for getting

heart disease and/or kidney disease, and for having a stroke. It is especially
dangerous because it often has no warning signs or symptoms. Regardless
of race, age, or gender, anyone can develop high blood pressure. It is
estimated that one in every four American adults has high blood pressure.
Once hypertension develops, it usually lasts a lifetime. You can prevent and
control hypertension by taking action.

Prevention
You can take steps to prevent hypertension by
adopting a healthy lifestyle. These steps include
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maintaining a healthy weight; being physically active; following a healthy
eating plan, that emphasizes fruits, vegetables, and low fat dairy foods;
choosing and preparing foods with less salt and
sodium; and, if you drink alcoholic beverages,
drinking in moderation.

Treatment of High Blood Pressure

It is important to take steps to keep your blood
pressure under control. The treatment goal is blood
pressure below 140/90 and lower for people with
other conditions, such as diabetes and kidney disease. Adopting healthy
lifestyle habits is an effective first step in both preventing and controlling
hypertension. If lifestyle changes alone are not effective in keeping your
pressure controlled, it may be necessary to add hypertensive medications.

S. DIABETES MELLITUS

What is?
Diabetes is a chronic disease that occurs when the pancreas does not
produce enough insulin, or alternatively, when the body cannot effectively
use the insulin it produces. Insulin is a hormone that regulates blood sugar.
Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled
diabetes and over time leads to serious damage to many of the body's
systems, especially the nerves and blood vessels.

 Type 1 diabetes (previously known as insulin-dependent or

childhood-onset) is characterized by a lack of insulin production.
Without daily administration of insulin, Type 1 diabetes is rapidly
fatal.

 Symptoms include excessive excretion of urine (polyuria),

thirst (polydipsia), constant hunger, weight loss, vision
changes and fatigue. These symptoms may occur suddenly.

 Type 2 diabetes (formerly called non-insulin-dependent or adult-

onset) results from the body’s ineffective use of insulin. Type 2
diabetes comprises 90% of people with diabetes around the world, and
is largely the result of excess body weight and physical inactivity.

 Symptoms may be similar to those of Type 1 diabetes, but

are often less marked. As a result, the disease may be
diagnosed several years after onset, once complications have
already arisen.
 Until recently, this type of diabetes was seen only in adults
but it is now also occurring in obese children.

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 Gestational diabetes is hyperglycemia which is first recognized
during pregnancy.

 Symptoms of gestational diabetes are similar to Type 2

diabetes. Gestational diabetes is most often diagnosed
through prenatal screening, rather than reported symptoms.

Impaired Glucose Tolerance (IGT) and Impaired Fasting Glycaemia

(IFG) are intermediate conditions in the transition between normality and
diabetes. People with IGT or IFG are at high risk of progressing to type 2
diabetes, although this is not inevitable.

What are the common consequences of diabetes?

Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and
nerves.

 Diabetic retinopathy is an important cause of blindness, and occurs as

a result of long-term accumulated damage to the small blood vessels
in the retina. After 15 years of diabetes, approximately 2% of people
become blind, and about 10% develop severe visual impairment.
 Diabetic neuropathy is damage to the nerves as a result of diabetes,
and affects up to 50% of people with diabetes. Although many
different problems can occur as a result of diabetic neuropathy,
common symptoms are tingling, pain, numbness, or weakness in the
feet and hands.

 Combined with reduced blood flow, neuropathy in the feet increases

the chance of foot ulcers and eventual limb amputation.

 Diabetes is among the leading causes of kidney failure. 10-20% of

people with diabetes die of kidney failure.

 Diabetes increases the risk of heart disease and stroke. 50% of people
with diabetes die of cardiovascular disease (primarily heart disease
and stroke).

 The overall risk of dying among people with diabetes is at least double
the risk of their peers without diabetes.

How can be the burden of Diabetes reduced?

Without urgent action, diabetes-related deaths will increase by more
than 50% in the next 10 years.

To help prevent type 2 diabetes and its complications, people should:

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 Achieve and maintain healthy body weight.
 Be physically active - at least 30 minutes of regular, moderate-
intensity activity on most days. More activity is required for weight
control.

Early diagnosis can be accomplished through relatively inexpensive blood

testing.

Treatment of diabetes involves lowering blood glucose and the levels of other
known risk factors that damage to blood vessels. Tobacco cessation is also
important to avoid complications.

Interventions that are both cost saving and feasible in developing countries
include:

 Moderate blood glucose control. People with type 1 diabetes require

insulin; people with type 2 diabetes can be treated with oral
medication, but may also require insulin;
 Blood pressure control;
 Foot care.

Other cost saving interventions includes:

 Screening for retinopathy (which causes blindness);

 Blood lipid control (to regulate cholesterol levels);
 Screening for early signs of diabetes-related kidney disease.

These measures should be supported by a healthy diet, regular physical

activity, maintaining a normal body weight and avoiding tobacco use.

T. RHEUMATOID ARTHRITIS

 Rheumatoid arthritis is an autoimmune disease that causes chronic

inflammation of the joints. Rheumatoid arthritis can also cause
inflammation of the tissue around the joints, as well as other organs
in the body.

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Normal and Arthritic Joints

The joint inflammation of rheumatoid causes:

 Swelling
 Pain
 Stiffness
 Redness in the joints
 The inflammation of the rheumatoid disease can also occur in tissues
around the joints, such as the tendons, ligaments and muscles.

U. OSTEOARTHRITIS (DEGENERATIVE ARTHIRITIS)

 What is osteoarthritis?

Osteoarthritis is a type of arthritis that is caused by the breakdown and

eventual loss of the cartilage of one or more joints. Cartilage is a protein
substance as a “cushion” between the bones of the joints.

 Before age 45, osteoarthritis occurs more frequently in males. After

age 55 years, it occurs more frequently in females.
 Osteoarthritis commonly affects the hands, feet, spine, and large
weight bearing joints, such as the hips and knees.
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What causes osteoarthritis?
Primary osteoarthritis is mostly related to aging. With aging, the water
content of the cartilage increase and the protein makeup of cartilage
degenerates. Repetitive use of the joints over the years irritates and inflames
the cartilage, causing joint pain and swelling. Eventually, cartilage begins to
degenerate by flaking tiny crevasses.

 The early development of osteoarthritis of the knees among weight

lifters is believed to be in part due to their high body weight. Repeated
trauma to joint tissue (ligaments, bones and cartilage) is believed to
lead to early osteoarthritis of the knees.

 Crystal deposits in the cartilage degeneration, and osteoarthritis. Uric

acid crystal causes arthritis in gout, while calcium pyrophosphate
crystal causes arthritis in pseudo out.

SIGN AND SYMPTOMS:

 Pain in the affected joint(s) after repetitive use. Joints pain is usually
worse later in a day.
 Swelling, warmth, and creaking of the affected joints.
 Pain and stiffness of the can also occur after long periods of inactivity,
for example, sitting in theater.
 In severe osteoarthritis, complete loss of cartilage cushion causes
friction between bones,
causing pain at rest or pain
with limited motion.

V. DIZZINESS

The word “dizzy” is used to

describe everything from feeling faint
or lightheaded to feeling weak or
unsteady. Dizziness that creates the
sense at you or your surroundings is
spinning or moving is called vertigo.

Signs and symptoms

Characteristics of dizziness may include:

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 A sense that you or your surroundings are spinning or moving
(vertigo)
 A loss of balance
 Nausea
 Unsteadiness
 Wooziness
 Lightheadedness
 Faintness
 Weakness
 Fatigue

APPROPRIATE MEASURE FOR THE ELDERLY

 Be aware of the possibility of losing your patient’s balance, which can

lead to falling and serious injury
 Let patient sit or lie down immediately when he feels dizzy
 Advice patient not to drive a car or operate heavy machinery if he
experience frequent dizziness
 Use good lightning if he get’s out of bed at night
 Walk with a cane for stability
 Advice patient to avoid using caffeine, alcohol and tobacco. Excessive
use of these substances can restrict blood vessel and worsen the signs
and symptoms.

What causes glaucoma?

Damage to the optic nerve is thought to b caused by increase pressure

in the eye (intraocular pressure, or IOP). This may result from excess fluids,
called aqueous humor, building up in the eye because the eye produces too
much or drains too little of the fluid. However many cases of glaucoma
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develop without increased IOP. In these cases, decreased blood flow to the
optic nerve may cause the damage.
Glaucoma may develop after an eye injury, after eye surgery, from the
growth of an eye tumor, or as a complication of a medical condition such as
diabetes.
What are the symptoms?
 Vision loss.
 You may not notice the vision loss until it is severe, because you’re
less affected eye at first makes up for the loss. Side ( peripheral) vision
is usually lost before central vision.
 Severe, including sudden, severe blurring of vision;
 Severe pain in or around the eye;
 Colored halos around lights;
 Eye redness;
 Nausea and vomiting.
 Watery eyes and sensitivity to light,
 Eye that look cloudy,
 Or eyes that look larger than normal

W. CEREBBROVASCULAR ACCIDENT

What is a cerebrovascular accident?

A cerebrovascular accident is also called a CVA, brain attack, or
stroke. It occurs when blood flow to a part of a brain is suddenly stopped
and oxygen cannot get to that part. This lack of oxygen my damage or kill
the brain cell. Death of a part of the brain may lead loss of certain body
functions controlled by the affected part.
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What causes a cerebrovascular accident?
A piece of fatty plaque (debris) that is formed in a blood vessels breaks
away and flows through the bloodstream going to the brain. The plaque
blocks an artery which causes a stroke. This is called an embolic stroke.

ISCHEMIC STROKE:
Caused by obstruction in an artery; begins in atherosclerosis (fatty
deposits) in the inner wall of an artery

 A thrombus (blood clot) formed in an artery (blood vessels) and

blocked Blood flows to the brain. It can occurs when a blood vessels is
injured by infection or trauma. This is called a thrombosis stroke.

 A tom artery in the brain, causing blood to spill out. This is called a
cerebral hemorrhage stroke. It often results from high blood pressure.

 Blockage of certain small blood vessels inside the brain.

What puts me at a higher risk to have a cerebrovascular accident?

 Cigarette smoking, cocaine use, or drinking to much alcohol.

 Diabetes (high blood sugar).
 You or a close family member has had a stroke.
 Atherosclerosis (hardening of the arteries ) or fatty cholesterol deposits
on artery walls.
 Heart diseases, such as coronary artery diseases.
 High blood cholesterol (fat)
 High blood pressure

What are the signs and symptoms of a cerebrovascular accident?

 Numbness (no feeling),

 Tingling, weakness,
 Paralysis (cannot move) on one side of the body. You may have trouble
walking, swallowing, talking, or understanding.
 Vision (sight) may b blurred or doubled.
 Severe headache, feel dizzy, confused

X. DEPRESSION

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Depression is a common condition among elderly women. Common
symptoms can include, but are not limited to:
 Disturbance in sleep, self-esteem, libido, appetite, interest, energy,
concentration, memory and movement.
 Feelings of guilt
 Suicidal thoughts, plans or attempts.
 Pain
 Feelings of worthlessness, hopelessness, in appropriates guilt,
prolonged sadness or unexplained crying spells, jumpiness or
irritability, loss of interest in and withdrawal from formerly enjoyable
activities, family, friends, work or sex.
 Intellectual problems such as unexplainable loss of memory or the
ability to concentrate; confusion and disorientation.
 Thought of death or suicide; suicide attempts needs help immediately
 Physical problems such as loss of appetite or a noticeable increase in
appetite; persistent fatigue and lethargy; insomnia or a noticeable
increase in the amount of sleep needed, ache and pain, constipation
or other physical ailments that cannot be otherwise explained.

DEPRESSION can be caused by several personal losses experienced in rapid

sequence, which is often the case of the elderly.

The elderly are also commonly taking many more medication that younger
people do. Some of these medications re known to be associated with
depression.

List of selected medications:

 Anti-cancer drugs
 Anti-inflammatory drugs
 Progesterone

Anti-depressants are used to treat depression, and they usually are fairly
successfully at improving the quality of life of the elderly patient.

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Psychotherapy is often used in combination with anti-depressants, which
can include drugs in these classes:
 Tricyclics such as imipramine, desipramine, amitryptyline, and
nortriptyline
 Selective serotonin reuptake inhibitors (SSRIs) such as Prozac
 Monoamine oxidase inhibitors (MAOIs)
SIDE EFFFECTS OF THESE MEDICATIONS:

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 Blurred Vision
 Dry mouth
 Urinary retention
 Confusion
 Constipation
 Drowsiness
 Insomnia
 Cardiac arrhythmia
 Hypotension
 Gastrointestinal distress
 Weight fluctuation
 Sexual dysfunction

Y. SLEEP PROBLEMS TO ELDERLY

Why is quality sleep so important for n older person?

To feel your best, you need a restful night of sleep, good nutrition and
exercise. You may be surprise at how good you feel when you get enough
sleep.
As we age, a good night’s sleep is especially important because:
 Sleep improves concentration and memory formation
 Sleep allows your body to repair any cell damage that occurred during
the day.
 Sleep refreshes your immune system and therefore helps to prevent
disease.
How does our sleep change as we age?
As you age, you may perceive unwelcome change in your sleep
patterns, such as:
 More fragmental sleep (more rapid sleep cycles)
 Decrease in deep sleep
 More awakening between sleep cycles

What are the usual causes of sleep problems as we go age?

If your patient is having trouble in sleeping well, consider some
common causes of sleep problems in the elderly:

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Poor sleep hygiene- the most common cause of insomnia in the elderly
is poor sleep habits or a poor sleep environment.
Example of poor sleep:
4. Hygiene is regular sleep hours
5. consumption of alcohol before bedtime
6. too much daytime napping

 Pain or medical illness- pain can keep you from sleeping well. In
condition, many
 common health condition are interfere with sleep: a frequent need to
urinate, asthma, diabetes mellitus, osteoporosis, nighttime heart
burn, menopause and Alzheimer’s
 Medication- seniors tend to take more medication than to younger
people. Combinations of drugs, as well as the side-effects of
individual, drugs, can impair sleep or even stimulate wakefulness.
 Lack of exercise- if you are too sedentary, you may not feel sleepy,
alternative, you may feel sleepy all of the time.
 Psychology stress or psychology disorders- significant life change like
the death of loved one or moving from a family home can cause stress,
Anxiety or sadness can also keep you awake, and sleeplessness can,
in turn cause more anxiety or depression.
 Sleep disorder- restless legs syndrome (RLS) insomnia, and sleep
disordered breathing such as snoring and sleep apnea occur more
frequently in older adults.

SLEEP TIPS

13. Exercise – Avoid a sedentary lifestyle and try to incorporate

physical activity into your daily routine.
14. Maintain good nutrition- proper diet is important for high-
quality sleep. Eating or drinking certain foods and drinks too close to
bedtime cam impair sleep.
15. keep a regularly sleep schedule- go to bed and wake up at the
same time everyday, even on weekdays.
16. Experiment with napping – Although napping too close to
bedtime or long naps, can interfere with nighttime sleeping, some
people find that short naps early in the day improve their overall
feeling or being rested.
17. Expose yourself to sunlight – get at least two hours of bring
sunlight each day. Exposure to sunlight increases your body’s
production of melatonin, which regulates your sleep wake cycles.
18. Separate yourself from snoring sleep partner – if your sleep
partner snore, consider ear plugs or white –nose machine, or sleep in
separate bedrooms.
19. Go to bed early – adjust your bedtime earlier, to concur with
when you feel like going to bed
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20. Limit smoking - Nicotine is a stimulate and can keep you
awake. If you cant quit smoking, avoid smoking with in three hours of
bedtime
21. Develop bedtime rituals – create soothing bedtime rituals,
such as taking a hot bath or playing calm music.
22. Monitor your medications – Drugs you take for your medical
condition may be\interfering with your sleep.
23. Take care of your psychological health – stress and anxiety
can keep you awake.
24. Limit your use of sleeping aids and sleeping pills - Some over
the counter sleep aids and prescription sleeping pills have harmful
side effects, and most are not designed to be used long term.

DIET TIPS
6. Limit caffeine close to bedtime – coffee, tea, caffeinated soft drinks
and chocolate can all keep you awake. Depending upon your
sensibility, avoid caffeine in the late afternoon and evening. Some
people are still affected by caffeine 8 hours after ingesting it.
7. Avoid alcohol before bedtime – a night cap of alcohol may make you
feel sleepy, but your sleep will be disrupted later in the night. Don’t
used alcohol as a sleeping aid.
8. Satisfy your hunger bedtime- Have light snack sucks us crackers,
cereal and milk, or yogurt. Some people find that warm milk helps
them to sleep because it contains an amino acid that acts as a natural
sedative.
9. Avoid big meals or spicy foods just before bed time - you can get
heartburn or aggravate a heatedly hernia with large or spicy meals.
Try to eat dinner at lest three hours before bedtime, and don’t
consume too many calories.
10. Minimize liquid intake before bedtime- limit what you rink
within the hour and half before bedtime so that your sleep is not
interruption by needing to get up to go to the bathroom.

Z. SIGNS AND SYMPTOMS OF COMMON ILLNESSES THAT GREATLY

AFFECT THE ELDERLY

COLDS

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The average adult may have three or four cold each year. Young
children are more susceptible, because their immune systems are not fully
developed. There are over 200 cold viruses with 30 percent attacking the
nose. These viruses, called rhinoviruses, infect people in late summer and
early fall. The other cold viruses are usually contacted n the winter and
spring. Cold symptoms begin within one or two days after exposure and may
include:

 Runny nose
 Sneezing and coughing
 Sore or scratchy throat
 Fever
 Muscle aches and pains
 Hoarseness or
 Headache
Cold may be transmitted through the air, by direct contact, or by an object
used by a cold sufferer. You can catch a cold by

 Exposure to sneezing or coughing by others.

 Shaking hands and then touching your eyes or nose.
 Handling objects held by someone with a cold.

MANAGEMENT:

 Antibiotic are ineffective in treating colds. Taking unnecessary

antibiotics may contribute to the development of disease resistant
bacteria. Rest is an important factor in recovering from a cold. There
are other things you can do at home to ease your discomfort. They
include
 Us a humidifier.
 Drink a lot of fluids.
 Take a pain reliever as needed. Do not give aspirin to children.

Instead, substitute a drug such as acetaminophen or ibuprofen to decrease

fever and muscle aches.

To avoid colds:
 Eat well and gets lots of sleep and exercise to keep up
 Wash your hands often with soap and warm water your resistance.
 Keep your hands away from your nose, eyes, and mouth.

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NOTE: Seek medical care if cold symptoms continue longer than two weeks
or become severe. You may be experiencing allergies or other medical
problems

C. ECZEMA Eczema I an allergic skin

disease. It may occur as a red, itchy,
scaly rash with tiny blisters. The
blisters break, ooze a clear fluid, and
then crust over.
 Eczema is an inflammation of
the skin and may be associated
with an allergic reaction,
although the cause is often
unknown.
 Children my get eczema on the
face, scalp, buttocks, thighs,
and upper body. Severe cases are common during infancy with many
children improving by age 2.
Adults usually have on the face, neck, inside he elbows, or behind the
knees. In adults, there is more scaling and less blister formation than that
seen in children. Dry skin, allergies, hot baths or showers, soap, scratchy
and tight clothing, rapid temperature changes can spark flare-ups, and
emotional upsets. Scratching the lesions may cause infection.
Tips for managing eczema include:
 Keep the skin moist and cool to avoid scratching.
 Try an over-the-counter 1 percent hydrocortisone cream for
small itchy areas.
 Take brief, daily baths or showers with lukewarm (not hot)
water.
 Bathe without soap or use a gentle soap or non-soap cleanser.
 Apply a lubricating cream or lotion after bathing and reapply
often.
 Take an oral antihistamine to relieve itching

 Avoid antihistamine or antiseptic creams and sprays.

 Sleep with a humidifier on in your bedroom.
 Avoid contact with allergens and irritants that increase
symptoms.
 Wash clothes and bedding in mild soap and rinse them twice.
 Do not use fabric softeners.
Seek medical care if you experience the following:
 A rash on the face that is red, patchy, and combined with joint pain
and fever.
 Itching interferes with normal sleep patterns.
 Self-care does not work.
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FLU
The flu is primarily spread between people indoors during the winter and
early spring. Many flu viruses exist and are passed from an infected person
to the nose or throat of others. The risk is greater wherever large numbers of
people gather in places like schools, nursing homes, shopping malls, and
large companies. The flu can cause a sudden onset of the following
symptoms:
 Fever and chills
 Muscle aches
 Sore throat and cough
 Nasal congestion and headaches, or
 Fatigue and weakness
Management:
4. Bed rest
5. Proper nutrition
6. Drinking lots of fluids
Antibiotics do not provide relief. Over-the-counter drugs may relieve
coughing, fever, and muscle aches.
People who are at risk for getting a serious case of the flu or a
complication from it should get a flu shot every year. This group includes:
 All people 65 years of age or older.
 Resident of long-term care facilities.
 Any child or adult, including pregnant women, who has a
serious long-term health problem with heart disease, anemia,
diabetes, asthma, lung disease, or kidney disease.
 People who are less able to fight infections because of a
hereditary disease, HIV infection, or cancer treatment with X-
rays or drugs.
 Children and teenagers 6 months to 18 years of age on long-
term aspirin treatment.
 Health care and community service workers.
 Any who wants to reduce his or her chance of catching the flu.
Note: Children under 9 years of age may need a second shot after one
month. The flu shot does not protect against other viruses or prevent
anyone from getting the flu if recently exposed. Its purpose is to lessen the
risk of getting the flu and severity if contracted.
PNEUMONIA
Pneumonia is an inflammation of the airways
and tissues of the lungs. It is due to infection.
Bacteria, viruses, or chemicals cause the
illness. It can follow or occur with a cold, flu, or
bronchitis.

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Pneumonia is more common in infants, the elderly, and in those who
have low immunity to infection. The elderly do not always have symptoms
such as a fever or cough when they have it. A change in their usual
activities or functioning may be the only sign.
Symptoms include:
 Fever (101 to 106 degrees F.) and shaking chills.
 Coughing which may bring up yellow, green, rust-colored, or bloody
mucus.
 Pain in the chest when breathing or coughing
 Shortness of breath.
 Rapid and shallow breathing.
 Fatigue.
 Sweating and flushed color of skin.
 Loss of appetite or upset stomach.

Evaluating the patient’s breathing symptoms, chest X-ray, and mucus

samples identifies pneumonia.
Treatment
5. Bed rest
6. Fluids
7. Drugs
8. Oxygen is given when needed. Severe cases require hospital care

Pneumonia can be life threatening to the elderly. Others at risk are

people already weakened y disease. In a normally healthy person this
disease may feel like a bad cold.

NOTE: a vaccine may prevent Pneumoccal pneumonia, one type of

pneumonia. One shot provides lifelong protection for anyone receiving it.
People who are 65 or older should get this shot. Patients with compromised
immune systems, chronic illnesses, or those without a spleen are also
candidates for this shot.

COUGHING & COUGHS

Coughing is the body’s defense of removing foreign material or mucous
from the lungs and throat.
The two general classifications of cough are:
3. Productive coughs (producing phlegm or mucous from the lungs)
4. Nonproductive coughs (dry and not producing any mucous or
phlegm).
Coughs are also divided into acute (less than 3 weeks’ duration) and
chronic (more than three weeks’ duration).
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Some causes of coughing
Acute cough is most often caused by the common viral upper
respiratory tract infection. The cough is usually secondary to stimulation of
nasal, pharyngeal, and laryngeal mucosa receptors. This results from the
secretion of the nose and sinuses draining into the throat.

 A dry cough may follow viral illnesses and may last up to several
weeks.
 Chronic cough may be caused by a variety of underlying diseases
including asthma, cystic fibrosis, allergies, GERD and chronic post
nasal drip.
 Smoking is a major cause of chronic cough.
 Certain medication (ACE inhibitors for hypertension) cause coughing
as a side effect.

Treatment of coughs
 Treatment of a cough should be directed as the underlying cause of
the cough.
 Antitussives are useful in suppressing dry, hacking cough. (A
physician or pharmacist may recommend specific product.)
 Antitussives should not be given when the cough is productive
and the patient is bringing up mucus. If the cough is keeping
the patient awake at night, then their use at bedtime is indicted.
 Antihistamines and decongestants may be a good choice for
treating coughs associated with postnasal drip. (A physician or
pharmacist may recommend specific products.)
 Expectorants are useful to help break and bring up mucous. ( A
physicians or pharmacist may recommend specific products.)
 For patients with underlying disease states causing the cough,
treatment should first be based on treating the underlying
disease

A physician should be called if:

 The patient is producing green, yellow, or rusty colored sputum. This
is usually the result of an infection.
 The cough lingers more than 7 to 10 days after other symptoms have
cleared.
 Any cough last longer than two weeks.
 A persistent fever is present or if the coughing up of blood occurs.

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SELF CHECK 5.2-1

Instructions:
Read the questions carefully. On your answer sheet, write the letter of
the correct answer.

6. It is the decrease in the bone density which increased brittleness of bone

that makes the older prone to serious fracture.
a. Constipation
b. Osteoporosis
c. Osteoarthritis
d. Incontinence
7. A type of urinary incontinence where it is a caused b an inability of the
pelvic floor muscle to hold the urethral sphincter closed. Leakage occurs
when there is a pressure on the abdominal muscle and bladder.
a. Urge incontinence
b. Stress incontinence
c. Overflow incontinence
d. Bladder retention
8. It is an autoimmune disease that causes chronic inflammation of the
joints and tissues around the joints as well as other organs of the body.
a. Rheumatoid arthritis
b. Hypertension
c. Osteoarthritis
d. Syncope
9. Also called “passing out”. Related to temporary insufficient blood flow to
the brain.
a. Dementia
b. Syncope
c. Dizziness
d. Diabetes mellitus
10. It is the chronic disease that occurs when the pancreas does not
produce enough insulin or alternatively when the body cannot effectively
use the insulin it produces.
a. Hypertension
b. Diabetes Mellitus
c. Glaucoma
d. Stroke

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Answer Key to 5.2-1

A.
6. b
7. b
8. a
9. b
10. b

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TASK SHEET _____
Title:

Performance Objective: Given (condition), ,you should be able to

(performance) following (standard).

Supplies/Materials :

Equipment :

Steps/Procedure:
1.
2.
3.
4.

Assessment Method:

Performance Criteria Checklist ______

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CRITERIA
YES NO
Did you….
Provide support to the elderly in accordance with the
elderly’s needs, rights, self determination and individual
differences.
Encourage and support the elderly to participate in
ceremonial, cultural, educational, recreational, religious,
social, and spiritual activities as appropriately planned.
Provide assistance at all times in order to maintain a safe
and healthy environment, including minimizing physical
dangers and risk of infections based on established
procedures.
Provide and maintain proper response to situations of risks
to health and safety based on established procedures.

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JOB SHEET _____
Title:

Performance Objective: Given (condition), ,you should be able to

(performance) following (standard).

Supplies/Materials :

Equipment :

Steps/Procedure:
1.
2.
3.
4.

Assessment Method:

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CRITERIA
YES NO
Did you….

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Evidence Plan

Competency
Provide care and support to elderly
standard:
Unit of
Providing care and support to elderly
competency:
Ways in which evidence will be collected:
[tick the column]

Third party Report

Demonstration &
Observation &

Portfolio

Written
The evidence must show that the trainee…
 Worked within roles and responsibilities in a
manner which accommodates and accepts
individual differences of the elderly

Established and maintained appropriate relationship

with the elderly
 Provided appropriate support and assistance with
the elderly’s personal care needs
 Understood and adhered to own roles and
responsibilities
 Understood accountability and responsibility of
supervisors and colleagues

 Consulted with the elderly, including asking

questions, observing, listening and suggesting

 Recognized and understood the elderly’s rights

and personal preferences including the ability to
list the elderly’s preferences.

Demonstrated a non-judgmental attitude to the

different emotional, psychological and spiritual
needs of the elderly in all communications
NOTE: *Critical aspects of competency

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TABLE OF SPECIFICATION

# of
Objectives/Content
Knowledge Comprehension Application items/
area/Topics
% of test

Common problems of
X(10%) X (5%) X(5%) 20%
the elderly and their
ramification
Safety Risks to the
elderly and X(10) X(5%) X(15%) 30%
contingency
measures
Different Religious,
Cultural, Spiritual,
Physical and X(5%) X(5% X(10% 20%
Ceremonial
Perspective of The
Elderly
Relevant plan of care,
roles and
responsibilities of a X(10%) X(10%) X(10%) 30%
caregiver

TOTAL X(35%) X(25%) X(40%) 100%

Date Developed: Document No. NTTA-TM1-07

Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 91 of 61
Developed by: NTTA
Templates NTTA
Revision # 01
Performance Test

Specific Instruction for the Candidate

Qualification: Caregiver

Unit of Competency Provide care and support to elderly

General Instruction: Given the necessary tools, materials and equipment,

you are required to provide care and support in accordance with accepted
institutional standard.

Specific Instruction:
1. Establish and maintain an appropriate relationship with the elderly
2. Provide appropriate support to the elderly
3A. Provide assistance with elderly’s personal care needs

Date Developed: Document No. NTTA-TM1-07

Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 92 of 61
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Templates NTTA
Revision # 01
QUESTIONING TOOL
Satisfactory
Questions to probe the candidate’s underpinning knowledge
response
Extension/Reflection Questions Yes No
1. Do you know the procedures of bathing and dressing the
elderly?  
2. Do you know the principles and procedures in taking vital
signs?  

3.  
4.  
Safety Questions
5. Do you know the safety risks to the elderly  
6.  
7.  
8.  
Contingency Questions
9. Different cultural requirements and preferences  
10.  
11.  
12.  
Job Role/Environment Questions  
13.  
14.  
15.  
16.  
Rules and Regulations  
17.  
18.  
19.  
20.  
The candidate’s underpinning  Satisfactory  Not
knowledge was: Satisfactory

Date Developed: Document No. NTTA-TM1-07

Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 93 of 61
Developed by: NTTA
Templates NTTA
Revision # 01
Templates for Inventory of Training Resources
Resources for presenting instruction
 Print Resources As per TR As per Remarks
Inventory
1. CBLMs
2. Manufacturer manuals text
books
 Non Print Resources As per TR As per Remarks
Inventory
1. Power point presentation
2. E- learning materials

Resources for Skills practice of Competency #1

______________________________
 Supplies and Materials As per TR As per Remarks
Inventory
Alcohol
All purpose detergent soap
Soap
Diaper (adult)
Garbage bags
Bathing paraphernalia (adult)
 Tools As per TR As per Remarks
Inventory
Carpet 4 ft. x 8 ft. 1 pc.
Clothes brush 1 pc.
Clothes humper 1 pc.
Clothes rack 1 pc.
Gown (hospital) 1 unit

Date Developed: Document No. NTTA-TM1-07

Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 94 of 61
Developed by: NTTA
Templates NTTA
Revision # 01
Hot water bag 1 pc.

Ice cap 1 pc.

Crutches (adjustable) 1 pc
Grooming kit (hairbrush. comb, nail 1 set
cutter, nail brush)
Hand towel 5 pcs.
Feeding utensils (adult) 1 set
Measuring cup 1 set
Medical tray 1 unit
Rubber sheets 6 pcs
Soap dish 10 pcs.
Tong (plastic/ rubber) 1 pc
 Equipment As per TR As per Remarks
Inventory
Refrigerator 1 unit
Bed Ordinary 1 pc.
Bed surgical 1 pc.
Bp apparatus, aneroid 2 pcs
Bp apparatus, mercurial 2 pcs
Coffee maker 1 unit.
Sphygmomanometers 1 pc.
Stethoscope 1 pc.
Operational telephone unit 1 unit
Thermometer (Oral, Axilla, 10 sets
Tympanic)
Bread toaster 1 unit
Washing machine – Heavy Duty 1 unit
Drier 1 unit
Weighing scale 1 pc.
Wheel chair 1 pc.

Date Developed: Document No. NTTA-TM1-07

Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 95 of 61
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Templates NTTA
Revision # 01
Vacuum cleaner – Heavy Duty 1 unit

Commode 1 pc.

Cane or walker 1 pc.

Dressing trolley w/ 1 unit

 cotton balls
 medicine glass
 thermometer
 wound dressing set
First aid kit 1 set
Dummy (adult) ** 1
- use for bathing
Dummy for CPR (adult) ** 1

Note: In the remarks section, remarks may include for repair, for
replenishment, for reproduction, for maintenance etc.

Date Developed: Document No. NTTA-TM1-07

Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 96 of 61
Developed by: NTTA
Templates NTTA
Revision # 01
FI
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Date Developed:
R Document No. NTTA-TM1-07
Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 97 of 61
Developed by: NTTA
Templates NTTA
Revision # 01
Supervise
Work-Based
Learning

Date Developed: Document No. NTTA-TM1-07

Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 98 of 61
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Templates NTTA
Revision # 01
FORM 1.1 SELF-ASSESSMENT CHECK

INSTRUCTIONS: This Self-Check Instrument will give the trainer necessary

data or information which is essential in planning training
sessions. Please check the appropriate box of your answer
to the questions below.
CORE COMPETENCIES
CAN I…? YE NO
S
Provide care and support to infants/toddlers
1.Comfort infants and toddlers
2.Bath and dress infants and toddlers
3.Feed infants and toddlers
4.Put infants and toddlers to sleep
5.Enhance social, physical, intellectual, creative and
emotional activities of infants and toddlers.
Provide care and support to children
1.Instill personal hygiene practice to children
2.Bath and dress children
3.Feed children
Foster social, intellectual, creative and emotional development of
children
1.Foster children’s independence and autonomy
2.Encourage children to express their feelings, ideas and
needs
3.Stimulate children’s awareness and creativity
4.Foster children’s self esteem and development of self
concept
Foster the physical development of children
1.Enhance physical activities of children
2.Create opportunities for children to develop a wider range
of
physical development
3.Provide experience to support physical development of
children
Provide care and support to elderly
1.Establish and maintain an appropriate relationship with
the
elderly
2.Provide appropriate support to the elderly
3.Provide assistance with elderly’s personal care needs
4.Provide care and support to people with special needs
Date Developed: Document No. NTTA-TM1-07
Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 99 of 61
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Templates NTTA
Revision # 01
CORE COMPETENCIES
CAN I…? YE NO
S

Provide care and support to people with special needs

1.Establish and maintain appropriate relationship with
people with special needs
2.Aprovide appropriate support to people with special needs
3Assist in maintaining weel being of people with special
needs
4.Assist people with special needs to identify and meet their
needs
5. Assist people with special needs in maintaining an
environment that enables maximum independent living
Maintain a healthy and safe environment
1.Maintain a clean and hygienic environment
2.Provide a safe environment
3.Supervise the safety of cliets
Respond to emergency
1.Implement procedure for infection control
2.Respond to emergencies and accident
3.Administer medication within guidelines
4.Respond to threats and situation of danger
Clean living room, dining room, bedrooms, toilet and
bathroom
1.Clean surfaces and floors
2.Clean furnishing and fixtures
3.Clean furnishing and fixtures

4.Clean toilet and bathroom

5.Sanitize room
6.Maintain clean room environment
Wash and iron clothes, linen and fabric
1.Remove stains
2.Prepare washing equipment and supplies
3.Perform laundry
4 .Perform laundry
5.Iron clothes, linens and fabrics
Date Developed: Document No. NTTA-TM1-07
Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 100 of 61
Developed by: NTTA
Templates NTTA
Revision # 01
CORE COMPETENCIES
CAN I…? YE NO
S

Prepare hot and cold meals

1.Prepare ingredients according to recipes
2.Cook meals and dishes according to recipes
3.Present cooked dishes
4.Prepare sauces, dressings and garnishes
5.Prepare Appetizers
6.Prepare desserts and salads
8.Prepare sandwiches
9.Store excess foods and ingredients
10.Convert unconsumed cooked food

Note: In making the Self-Check for your Qualification, all required competencies
should be specified. It is therefore required of a Trainer to be well- versed
of the CBC or TR of the program qualification he is teaching.

Date Developed: Document No. NTTA-TM1-07

Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 101 of 61
Developed by: NTTA
Templates NTTA
Revision # 01
Evidences/Proof of Current Competencies

Form 1.2: Evidence of Current Competencies acquired related to

Job/Occupation

Current
Proof/Evidence Means of validating
competencies
1. Provide care and National Certificate in Submitted an
support to infants Caregiving, Certificate of authenticated copy of
/toddlers Employment and National certificate
Certificate of Achievement Certificate of Employment
and Certificate of
Achievement
2. Provide care and National Certificate in Submitted an
support to Caregiving, Certificate of authenticated copy of
children Employment and National certificate
Certificate of Achievement Certificate of Employment
and Certificate of
Achievement
3. Foster social, National Certificate in Submitted an
intellectual, Caregiving, Certificate of authenticated copy of
creative and Employment and National certificate
emotional Certificate of Achievement Certificate of Employment
development of and Certificate of
children Achievement
4. Foster physical National Certificate in Submitted an
development of Caregiving, Certificate of authenticated copy of
children Employment and National certificate
Certificate of Achievement Certificate of Employment
and Certificate of
Achievement
5. Provide care and National Certificate in Submitted an
support to elderly Caregiving, Certificate of authenticated copy of
Employment and National certificate
Certificate of Achievement Certificate of Employment
and Certificate of
Achievement
6. Provide care and National Certificate in Submitted an
support to Caregiving, Certificate of authenticated copy of
people with Employment and National certificate
special needs Certificate of Achievement Certificate of Employment
and Certificate of

Date Developed: Document No. NTTA-TM1-07

Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 102 of 61
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Achievement
7. Maintain a National Certificate in Submitted an
healthy and safe Caregiving, Certificate of authenticated copy of
environment Employment and National certificate
Certificate of Achievement Certificate of Employment
and Certificate of
Achievement
8. Respond to National Certificate in Submitted an
emergency Caregiving, Certificate of authenticated copy of
Employment and National certificate
Certificate of Achievement Certificate of Employment
and Certificate of
Achievement
9. Clean living National Certificate in Submitted an
room, dining Caregiving, Certificate of authenticated copy of
room, bedroom, Employment and National certificate
toilet and Certificate of Achievement Certificate of Employment
bathroom and Certificate of
Achievement
10. Wash and iron National Certificate in Submitted an
clothes, linens Caregiving, Certificate of authenticated copy of
and fabrics Employment and National certificate
Certificate of Achievement Certificate of Employment
and Certificate of
Achievement
11. Prepare hot National Certificate in Submitted an
and cold meals Caregiving, Certificate of authenticated copy of
Employment and National certificate
Certificate of Achievement Certificate of Employment
and Certificate of
Achievement

Date Developed: Document No. NTTA-TM1-07

Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 103 of 61
Developed by: NTTA
Templates NTTA
Revision # 01
Identifying Training Gaps

From the accomplished Self-Assessment Check (Form 1.1) and the

evidences of current competencies (Form 1.2), the Trainer will be able to
identify what the training needs of the prospective trainee are.

Form 1.3 Summary of Current Competencies Versus Required

Competencies

Required Units of Current Training

Competency/Learning Competencies Gaps/Requirement
Outcomes based on CBC s
5. Provide care and support to elderly
1.Establish and
maintain an
1.Establish and maintain appropriate
an appropriate relationship with
relationship with the the
elderly elderly
2.Provide
2.Provide appropriate appropriate support
support to the elderly to the elderly
3.Provide assistance with 3.Provide assistance
elderly’s personal care with elderly’s
needs personal care needs
4.Provide care and support 4.Provide care and
to people with special support to people
needs with special needs

Date Developed: Document No. NTTA-TM1-07

Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 104 of 61
Developed by: NTTA
Templates NTTA
Revision # 01
Using Form No.1.4, convert the Training Gaps into a Training Needs/
Requirements. Refer to the CBC in identifying the Module Title or Unit of
Competency of the training needs identified.

Form No. 1.4: Training Needs

Module Title/Module Duration

Gaps
of Instruction (hours)
5.1 Explaining the concepts 5. Providing care 150 hours
and principles of basic and support to elderly
nursing care of the elderly
5.2 Identifying appropriate
physical,emotional,
spiritual and intellectual
needs.
5.3 Providing assistance in
promoting the appropriate needs
for roles, responsibilities, rights,
freedom and activities of elderly.
5.4 Providing adequate
nutrition and elimination

Date Developed: Document No. NTTA-TM1-07

Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 105 of 61
Developed by: NTTA
Templates NTTA
Revision # 01
TRAINING PLAN

Qualification: _______CAREGIVER NC 2____________

Faciliti Da
Trainee V Asse
Mode es/ te
s’ Training e ssme
of St Tools an
Training Activity n nt
Train aff and d
Require /Task u Meth
ing Equip Ti
ments e od
ment me

Date Developed: Document No. NTTA-TM1-07

July 2010 Issued by:
Trainers Methodology Level I Date Revised:
February 2012 Page 106 of 61
Templates Developed by: NTTA
NTTA
Revision # 01
Technical Education and Skills Development Authority
___(your institution)___

TRAINEE’S RECORD BOOK

I.D.

Trainee’s No._______________
Date Developed: Document No. NTTA-TM1-07
July 2010 Issued by:
Trainers Methodology Level I Date Revised:
February 2012 Page 107 of 61
Templates Developed by: NTTA
NTTA
Revision # 01
is to fill in the column “Task Required” and “Date
Accomplished” with all the activities in accordance with the
training program and to be taken up in the school and with
NAME: ___________________________________________________ the guidance of the instructor. The instructor will likewise
indicate his/her remarks on the “Instructors Remarks”
column regarding the outcome of the task accomplished by
QUALIFICATION: CAREGIVER NC 2_______ the trainees. Be sure that the trainee will personally
accomplish the task and confirmed by the instructor.
TRAINING DURATION :___________150________________ It is of great importance that the content should be
written legibly on ink. Avoid any corrections or erasures and
maintain the cleanliness of this record.
TRAINER: __________________________________________________
This will be collected by your trainer and submit the
same to the Vocational Instruction Supervisor (VIS) and shall
form part of the permanent trainee’s document on file.

THANK YOU.

Instructions:
This Trainees’ Record Book (TRB) is intended to serve as
record of all accomplishment/task/activities while undergoing
training in the industry. It will eventually become evidence
that can be submitted for portfolio assessment and for
whatever purpose it will serve you. It is therefore important
that all its contents are viably entered by both the trainees
and instructor.
The Trainees’ Record Book contains all the required
competencies in your chosen qualification. All you have to do
Date Developed: Document No. NTTA-TM1-07
July 2010 Issued by:
Trainers Methodology Level I Date Revised:
February 2012 Page 108 of 61
Templates Developed by: NTTA
NTTA
Revision # 01
Date Developed: Document No. NTTA-TM1-07
July 2010 Issued by:
Trainers Methodology Level I Date Revised:
February 2012 Page 109 of 61
Templates Developed by: NTTA
NTTA
Revision # 01
NOTES:

__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
Date Developed: Document No. NTTA-TM1-07
July 2010 Issued by:
Trainers Methodology Level I Date Revised:
February 2012 Page 110 of 61
Templates Developed by: NTTA
NTTA
Revision # 01
Unit of Competency: PROVIDE CARE AND SERVICES TO
ELDERLY

NC Level I
Learning Task/Activity Date Instructors
Outcome Required Accomplished Remarks
1. Establish
and maintain
an appropriate
relationship Unit of Competency: 2 PERFORM MINOR CONSTRUCTION
with the elderly WORKS
2. Provide
appropriate
NC Level I
support to the
elderly Learning Task/Activity Date Instructors
3A. Provide Outcome Required Accomplished Remarks
assistance with
Perform
elderly’s
piping lay
personal care
outs
needs
Cut pipes
3B. Provide
through
Assistance with
walls and
Elderly’s
floors
Personal Care
Needs
____________________ ______________________
__________________ ___________________ Trainee’s Signature Trainer’s
Signature
Trainee’s Signature Trainer’s Signature

Date Developed: Document No. NTTA-TM1-07

July 2010 Issued by:
Trainers Methodology Level I Date Revised:
February 2012 Page 111 of 61
Templates Developed by: NTTA
NTTA
Revision # 01
Date Developed: Document No. NTTA-TM1-07
July 2010 Issued by:
Trainers Methodology Level I Date Revised:
February 2012 Page 112 of 61
Templates Developed by: NTTA
NTTA
Revision # 01
Unit of Competency: 3 MAKE PIPING JOINTS AND
CONECTIONS

NC Level I Unit of Competency: 4 PERFORM SINGLE UNIT PLUMBING

Learning Task/Activity Date Instructors INSTALLATION AND ASSEMBLES
Outcome Required Accomplished Remarks
Fit-up NC Level I
joints and
Learning Task/Activity Date Instructor
fittings for
Outcome Required Accomplishe s Remarks
PVC pipe
d
Perform
threaded Prepare for
pipe joints plumbing works
and Install pipe and
connections fittings
Caulk Install hot and
joints\ cold water supply
_____________________ ______________________ Install/assemble
Trainee’s Signature Trainer’s Signature plumbing fixtures

_____________________ ____________________
Trainee’s Signature Trainer’s Signature

Date Developed: Document No. NTTA-TM1-07

July 2010 Issued by:
Trainers Methodology Level I Date Revised:
February 2012 Page 113 of 61
Templates Developed by: NTTA
NTTA
Revision # 01
Unit of Competency: 5 PERFORM PLUMBING REPAIR AND
MAINTENANCE WORKS

NC Level I
Learning Task/Activity Date Instructors
Outcome Required Accomplished Remarks
 Clear
clogged
pipes
clear
clogged
fixtures
______________________ ____________________
Trainee’s Signature Trainer’s Signature

Date Developed: Document No. NTTA-TM1-07

July 2010 Issued by:
Trainers Methodology Level I Date Revised:
February 2012 Page 114 of 61
Templates Developed by: NTTA
NTTA
Revision # 01
TRAINEE’S PROGRESS SHEET

Name : JUAN DELA CRUZ Trainer :

Nominal
Qualification : Machining NC I :
Duration
Training Training Date Date Trainee’s Supervisor’s
Units of Competency Rating
Activity Duration Started Finished Initial Initial

Total
Note: The trainee and the supervisor must have a copy of this form. The column for rating maybe used either by giving a numerical rating or
simply indicating competent or not yet competent. For purposes of analysis, you may require industry supervisors to give a numerical rating for
the performance of your trainees. Please take note however that in TESDA, we do not use numerical ratings

Date Developed: Document No. NTTA-TM1-07

July 2010 Issued by:
Trainers Methodology Level I Date Revised:
February 2012 Page 115 of 61
Templates Developed by: NTTA
NTTA
Revision # 01
Average Ratings

PREPARATION Average
1. Workshop layout conforms
with the components of a
CBT workshop
2. Number of CBLM is
sufficient
3. Objectives of every training
session is well explained
4. Expected activities/outputs
are clarified
General Average

Date Developed: Document No. NTTA-TM1-07

Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 116 of 61
Developed by: NTTA
Templates NTTA
Revision # 01
Facilitate
Learning
Session

Date Developed: Document No. NTTA-TM1-07

Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 117 of 61
Developed by: NTTA
Templates NTTA
Revision # 01
Training Activity Matrix

Venue
Facilities/Tools Date &
Training Activity Trainee Remarks
and Equipment (Workstation/ Time
Area)
Prayer
Recap of Activities 8:00 AM
All to 8:30
Unfreezing Activities AM
trainees
Feedback of Training

Rejoinder/Motivation
observations
(List down all
on the
Facilities/Tools
(Specific Activities of progress of
and Equipment Name of
each Trainee for the each trainee
needed for the Workstation1
day here) for the day
workstation and
will be
activities here)
written here
observations
(Specific Activities of (List down all
on the
each Trainee here) Facilities/Tools
progress of
and Equipment Name of
each trainee
needed for the Workstation 2
for the day
workstation and
will be
activities here)
written here
observations
(List down all
on the
Facilities/Tools
(Specific Activities of progress of
and Equipment Name of
each Trainee for the each trainee
needed for the Workstation 3
day here) for the day
workstation and
will be
activities here)
written here
observations
(List down all
on the
Facilities/Tools
(Specific Activities of progress of
and Equipment Name of
each Trainee for the each trainee
needed for the Workstation 4
day here) for the day
workstation and
will be
activities here)
written here
Date Developed: Document No. NTTA-TM1-07
Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 118 of 61
Developed by: NTTA
Templates NTTA
Revision # 01
Date Developed: Document No. NTTA-TM1-07
Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 119 of 61
Developed by: NTTA
Templates NTTA
Revision # 01
Date Developed: Document No. NTTA-TM1-07
Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 120 of 61
Developed by: NTTA
Templates NTTA
Revision # 01
Minutes of the Meeting Template

Minutes of the Meeting

Focus Group Discussion

Date: ________________________
Agenda:
Competency-based Training Delivery
Present:
1. ____________
2. ____________
3. ____________
4. ____________

CBT Concerns Discussions Resolutions/Agreement

1. CBT Layout
2. Monitoring of
Attendance
3. Utilization of work
area
4. Orientation
a. CBT
b. Roles
c. TR
d. CBLM
e. Facilities
Date Developed: Document No. NTTA-TM1-07
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Methodology Level I Date Revised:
February 2012 Page 121 of 61
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Revision # 01
f. Evaluation system
5. RPL

6. Teaching methods
and technique
7. Monitoring of
learning activities
a. Achievement
chart
b. Progress chart
8. Feedback
9. Slow learners
10. Other
concerns

Training Evaluation Report

1. Title of the Report

2. Executive summary

3. Rationale

4. Objectives

5. Methodology

6. Results and discussion

This is the body of the report. It should contain the following
parts:
Data interpretation
Data analysis

Date Developed: Document No. NTTA-TM1-07

Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 122 of 61
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Conclusion

7. Recommendation

Date Developed: Document No. NTTA-TM1-07

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February 2012 Page 123 of 61
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Revision # 01
Maintain
Training
Facilities

Date Developed: Document No. NTTA-TM1-07

Trainers July 2010 Issued by:
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February 2012 Page 124 of 61
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Revision # 01
Template #1
OPERATIONAL PROCEDURE
Equipment Type
Equipment Code
Location
Operation Procedure:

Date Developed: Document No. NTTA-TM1-07

Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 125 of 61
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Templates NTTA
Revision # 01
Template #2
HOUSEKEEPING SCHEDULE
Qualification Station/Bldg Welding (WAF)

Area/Section

In-Charge

Schedule for the 2nd Semester, 2011

Responsible Daily Ever Weekly Every Month Remarks
ACTIVITIES y 15th ly
Person
other Day
Day
1. Clean and check welding
equipment/ accessories
from dust and oil; dry and
properly laid-out/
secured/stable
2. Clean and free welding
booths and welding
positioners from
dust/rust /gums, used
Mig wire stubs and metal
scraps
3. Clean and arrange
working tables according
to floor plan/lay-out;
check stability
4. Clean and check floor,
walls, windows, ceilings
• graffiti/dust/rust
• cobwebs and
outdated/unnecessary
objects/items
• obstructions
• any used
materials/scraps
(slugs, stubs) spilled
liquid
• open cracks (floor)
5. Clean and check work
shop ventilation and
illumination by dusting
lamps/bulbs, replacing
non-functional lamps and
keeping exhaust clean
6. Clean and check computer
set -monitor, CPU,
keyboards, mouse – free,
unnecessary markings,
dust; cables and plugs are
in order; well-arranged; all
items functional
7. Clean, inspect air
conditioning equipment:
• keep screen and filter
free from dust/rust
• Check selector knobs
if in normal positions

Date Developed: Document No. NTTA-TM1-07

Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 126 of 61
Developed by: NTTA
Templates NTTA
Revision # 01
and are functional
• Check if drainage is
OK
8. Clean, check and maintain
Tool Room
• Free of dust, not damp
• Tools in appropriate
positions/locations
• With visible
labels/signage
• Logbook and forms are
complete, in order and
updated
• Lights, ventilation –
OK
10. Clean and check Rest
Room
• Urinals, bowls, wash
basins, walls and
partitions are free
from stains, dirt, oils,
graffiti and
unnecessary objects;
• Ceilings free from
cobwebs and dangling
items
• Floor is kept dry; no
broken tiles or
protruding objects
• Equipped with dipper
and pails; properly
located after use
• Water systems is
functional: no
dripping/damaged
faucets or pipes
• Drainage system is
working, no water-
clogged areas
• No offensive odor
• Lights /Ventilation –
OK
9. Clean and check wash
area:
• Walls/Floors- –free
from oils, molds,
broken tiles, gums,
stains or graffiti
• Drainage system is
functional
• Water system
functional; no dripping
faucets or leaking
pipes
• Free from unnecessary
objects (mops, rags)

Date Developed: Document No. NTTA-TM1-07

Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 127 of 61
Developed by: NTTA
Templates NTTA
Revision # 01
10. Clean and maintain work
shop surroundings by
sweeping/ removing fallen
leaves, branches, debris
and other refuse,
impounded water, clearing
pathways of obstructions

11. Disposal of waste

materials
(Follow waste segregation
system)

Template #3
GMAW WORKSHOP HOUSEKEEPING SCHEDULE
DAILY TASK YES NO
Dispose segregated waste; clean garbage cans

Sweep floors; if wet, wipe dry

Wipe and clean whiteboards

Clean and arrange working tables

Clean and check mounting of machines/equipment

Before leaving, collect stubs and other welding wastes.

WEEKLY TASK YES NO

Clean posters, visual aids and update accomplishment/Progress Charts

Clean bulbs/lamps/ceilings/walls

Clean/Wash of windows/glasses/mirrors

Clean and check tools, machines, supplies, materials

Sanitize garbage receptacles

Empty water collector; clean body of Water Dispenser

MONTHLY TASK YES NO

Conduct inventory

Clean and arrange tool room

Inspect electrical system; clean cables, wires

Clean instructional materials & modules; arrange and put in order

Inspect and clean air-conditioning equipment filter; clean body

Date Developed: Document No. NTTA-TM1-07

Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 128 of 61
Developed by: NTTA
Templates NTTA
Revision # 01
Template #4
WELDING EQUIPMENT MAINTENANCE SCHEDULE*
8 HOURS 50 Hours 100 HOURS
•  •


Date Developed: Document No. NTTA-TM1-07

Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 129 of 61
Developed by: NTTA
Templates NTTA
Revision # 01
Template #5
EQUIPMENT MAINTENANCE SCHEDULE
EQUIPMENT TYPE
EQUIPMENT CODE
LOCATION
Schedule for the Month of March
MANPOWER Daily Every Weekly Every Monthly Remarks
ACTIVITIES Other 15th
Day Day

1. Check panel board,

and circuit breakers’
electrical connections,
cables and outlets
 Clean and kept dry
 Parts are well-
secured/attached
 Properly labeled
2. Check Mig gun (nozzle,
contact tip, diffuser)
and ground cable:
 Clean and kept dry
 Parts are well-
secured/ attached
 Inspect for
damages and
replace parts if
necessary
3. Check adjustment
lever’s if functional
(amperages/speed); if
not, calibrate

4. Check Gas cylinder

outfit for any
abnormality
 Gate valve
 Co2 regulator
 Gas hose Fittings
 Fittings
5. Check/Clean wire
feeder (rollers, wire
speed/spool
adjustment); remove
used oil, dust; keep
dry.

6. Run the equipment for

5 minutes and observe
for unusual noise or
abnormal operation; if
repair is necessary,
send to technician.

Date Developed: Document No. NTTA-TM1-07

Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 130 of 61
Developed by: NTTA
Templates NTTA
Revision # 01
Template #6

WORKSHOP INSPECTION CHECKLIST

Qualification
Area/
In-Charge
Section

YES NO INSPECTION ITEMS

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

Remarks:

Inspected by: Date:

Date Developed: Document No. NTTA-TM1-07

Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 131 of 61
Developed by: NTTA
Templates NTTA
Revision # 01
Template #7
EQUIPMENT MAINTENANCE INSPECTION CHECKLIST
Equipment Type :
Property Code/Number :
Location :
YES NO INSPECTION ITEMS

Remarks:

Inspected by: Date:

Date Developed: Document No. NTTA-TM1-07

Trainers July 2010 Issued by:
Methodology Level I Date Revised:
February 2012 Page 132 of 61
Developed by: NTTA
Templates NTTA
Revision # 01