Older adult

Melinda Marshall, MSN, RN Los Angeles City College Nursing 104

Potter, P. A. & Perry, A. G., (2009). Fundamental of nursing (7 th ed.). St Louis: Mosby-Elsevier. Chapter 14, pp. 191-214. Ochs, G. (2009) Study Guide and Skills Performance Checklist of Fundamental of Nursing (7 th ed.) St. Louis: Mosby-Elsevier complete the learning assignment for older adults. PowerPoint Slides

Students will able to: Discuss demographic trends related to older adults in the United States. Identify common myths and stereotypes about older adults. List the types of community-based and institutional health care services available to older adults. Identify selected biological and psychological theories of aging.

Discuss common development tasks of older adults. Describe common physiological changes of aging. Differentiate among delirium, dementia, and depression. Describe selected health concerns of older adults. Identify nursing interventions related to the physiological, cognitive, and psychosocial changes of aging.

The nurse is presenting information on nutritional guidelines at a senior community center. The nurse is going to discuss the recommendations for nutritional intake for healthy individuals during late adulthood. Which of the following foods should be eaten less? a. Fiber b. Protein c. Refined sugar d. Fruits and vegetables (vitamin A )

Physiological Cognitive Psychosocial Levels of functional ability Dependence vs. independence Strengths and abilities

A. Geriatrics The assessment of health and functional status B. Gerontology The study of all aspects of the aging process and its consequences C. Gerontological nursing Emphasizes nurturing, caring, and comforting, more than treatment of disease D. Gerontic nursing Focuses on the diagnosis and treatment of disease

Is ageism discrimination? What behaviors as a student RN would you employ when caring for older adults? What are some of things that affects the attitude of nurses toward older adults? pp. 193-194

Ill, disabled, and physically unattractive No interest in sex or interest in sexual activities is abnormal Forgetful, confused, rigid, bored and unfriendly Unable to learn and understand new information Mistaken ideas about living arrangements and finances.

Ageism is discrimination Against people because of increasing age Unopposed ageism potential undermine the self-confidence of the older adult Limit their access to care Distort caregivers’ understanding of the uniqueness of older adults Laws ban discrimination based on age Large proportion of older adults affects the consumer economy Older adults influence public policy

Nurses need to assess their attitudes toward older adults Nurses need to recognize and address ageism by questioning prevailing negative attitudes and stereotypes and emphasizing what really happens during the aging process.

Which of the statements made by a nurse best reflects an understanding of the negative impact of ageism regarding patient care? a. “If I don’t value the older patient, I will never be able to provide the care they are entitled too.” b. “Everyone regardless of age or position, always deserves effective, appropriate nursing care.” c. “As society we lose so much valuable wisdom and knowledge when we devalue our older members.” d. “If older patients do not feel valued, they are less likely to seek health care they need and deserve .”

Biological theories Stochastic Stochastic view aging as cellular damage over time Physical changes recognized as characteristics of the aging process Non-stochastic Genetically programmed physiological mechanisms within the body control the aging process

Psychological theories Disengagement Oldest psychological theory Based on withdrawal from customary roles Self-focused activities Activity Continuation of activities performed in middle-age Continuity or development Personality remains the same Behavior becomes more predictable with age Personality and behavior developed during a lifetime

Adjusting to decreasing health and physical strength Adjusting to retirement and reduced or fixed income Adjusting to death of a spouse Accepting self as an aging person Maintaining satisfactory living arrangements Redefining relationships with adult children Finding ways to maintain quality of life

Linked to the concept of development tasks appropriate for stages in life Health is a common loss Loss of significant other Sense of usefulness Socialization Income Independent living Adjustments to changes due to aging depends on the individual Be sensitive Offer support

Normal changes without disease Body systems Age Changes in appearance Functioning

Physiological changes Appearance Cosmetics Style of clothing Structural changes Retirement Continue education Volunteer activities Change in residence Relocation

Functional changes Refuse to ask for assistance with tasks Places older adults at a safety risk Some will avoid activities that are for older adults Require realistic review of strength and limitations

Refining relationships Adult Children Role reversal Control of decision making Dependence Conflict, guilt, and loss Balance becomes a challenge for adult children Increase debates

Which of the following statements made by an older adult patient poses the greatest concern for the nurse conducting an assessment regarding the patient’s adjustment to the aging process? a. “I use to enjoy dancing and jogging so much, but now I have arthritis in my knees so that it is hard for me to even walk.” b. “I’ve given my grandchildren money for college so they can live a better live than I had.” c. “Growing old certainly presents all sorts of challenges. I wish I knew then what I know now.” d. “As I age I’ve found it harder to do the things I loved doing but I guess it will all be over soon enough .”

Older adults are care for in: Private homes Apartments Retirement communities Adult day care centers Assisted living facilities Nursing centers Older adults need to help with decisions regarding which type of health care service is appropriate for them.

The interrelation between physical and psychological aspect of aging Effects of disease and disability on functional status Decreased efficiency of homeostatic mechanism Lack of standards for defining health/illness norms Altered presentation and response to specific disease

Initial nurse-patient encounter Quick and care head-to-toe assessment Reveal eye contract and facial expression appropriate to situation Facial wrinkles Gray hair Loss of body mass in extremities Increase body mass in trunk area

Loss of skin elasticity Loss of moisture Epithelial layer thins Spots and lesions on skin Changes in pigmentation

Loss of subcutaneous fat Missing teeth causes face to appear asymmetrical Vocal changes causes loss of power and range Visual acuity declines due to retinal damage, reduced pupil size, and loss of lens elasticity

Prebyopia decline ability of eyes to accommodate close detailed work Reduced ability to see in darkness and to adapt to abrupt changes in light Ambient light is necessary for tasks such as reading Increased sensitivity to the effects of glare Changes in color vision Difficult to distinguish between blue and green Dark color appear the same

Auditory changes Ignore early signs of hearing loss Common auditory acuity is prebycusis Prebycusis affects the ability to hear high-pitched sounds

Reduced salivary secretion Taste buds atrophy Loss sensitivity Lesser ability to differentiate between salty, sweet, sour, and bitter tastes Reduced in sense of smell

Decrease contractile strength of the myocardium results in a decrease in cardiac output Increased with anxiety Heart rate increase during exercising to compensate for decreased cardiac output Takes heart rate longer to return baseline

Systolic and diastolic blood pressure can be abnormal Hypertension is common in the older adults Hypertension is not normal to the aging process Weak peripheral pulses Cooler lower extremities Changes in upper extremities pulses is less common

Increase fatty issue to trunk Decrease tone and elasticity Slower peristalsis Alternation in secretion Constipation Flatulence (gas) Diarrhea

Men Urinary retention Frequency Incontinence Prostate cancer Urinary incontinence is abnormal for men and women Women Stress incontinence Related to weak perineal and bladder muscles Urge incontinence

Smaller muscle fiber Decreased muscle strength Decreased bone mass Osteoporosis major health concern Bone demineralization

Decrease neurons Slower voluntary reflexes Less ability to respond to multiple stimuli Alternations in quality and quantity in sleep

Physical, psychological, cognitive, and social domains Accepting and adjusting to changes Denial Overemphasize Overwhelming fear Functional status Refers to the older adults ability to safely perform his or hers ADL’s A sensitive indicator of health or illness Assess for sudden changes Changes can or may be related to the onset of illness

Educate older adults to: Promote an understanding of aging Effective coping in adjusting to lifestyle changes Promote the highest-level of function in all areas: Healthy, well-balanced diet Pace appropriate activities Regular office visits to see the doctor Avoid alcohol, illicit drugs, and tobacco

Is forgetfulness a myth? Abnormal changes with aging Symptoms of cognitive impairment included: Disorientation Loss of language skills Loss ability to calculate Poor judgment

Delirium Acute confusion r/t physiological causes: Electrolyte imbalances Cerebral anoxia Hypoglycemia Cerebrovascular infection, infarction, or hemorrhage Systemic infection such as urinary tract infection or pneumonia Environmental causes: Sensory deprivation Unfamiliar surroundings

Dementia Cognitive function deteriorates Generalized impairment of intellectual functioning Interferes with social and occupational functioning Ability to perform basic and instrumental activities of daily activities declines Gradual, progressive, and irreversible cerebral dysfunction Other causes include infection or trauma

Depression A mood disturbance Characterized by feelings such as sadness and despair Not a normal part of the aging process A treatable medical illness Dementia and depression increases family’s distress level

Transitions Role change Ages 55, 65, or 75 Major turning point in life Affects individuals other people Health status influences retirement

Choice Response Occurs after retirement Impairments reduce social interactions Rejection associated aging with unattractiveness Homeless, confused, incontinent, or institutionalized Geographic distance

In reviewing changes in the older adult, the nurse recognizes that which of the following statements is related to cognitive functioning in the older client is true? a. Delirium is usually easily distinguished from irreversible dementia. b. Therapeutic drug intoxication is a common cause of senile dementia. c. Reversible systemic disorders are often the implicated as a cause of delirium. d. Cognitive deterioration is an inevitable outcome of the human aging process.

Sexuality involves love, warmth, sharing, and touching. Sexual activity usually decline Libido does not decrease

Touch Sexual expression Part of intimacy Compliments traditional sexual methods Alternative to physical intercourse

Need to understand physical changes in sexual responses Provide privacy for any discussions Maintain a nonjudgmental attitude Use open-ended questions Closed-ended for specific activities and symptoms Assess medications use

Safety Single story homes or apartments Major impact on health Environment support or hinder physical or social functioning Furniture that promote ease into and out and provide back support

Health Promotion and Maintenance

Common causes of death: Heart disease Cancer Cerebrovascular diseases Frequent causes of death: Lung disease Accidents related falls Diabetes mellitus Kidney and liver disease

Health promotion and maintenance Teaching sessions on such topics: Physical exercising Nutrition Medication safety Home safety Breast and prostate exams Planning strategies to reduce risk and maintain chronic conditions Teach and counsel Individualized approach More effective for teaching health promotion activities

Heart disease leading cause of death Hypertension Coronary disease Linked to myocardial infarction, stroke and heart failure Coronary disease risk factors: Smoking Obesity Lack of exercise Stress Hyperipidemia Diabetes mellitus

Affects on nutritional needs: Activity level Clinical condition Activity level impacts total caloric intake

Therapeutic diet calorie requirements: Restrict fat Sodium Simple sugars Increase fiber Foods high in calcium, iron, vitamin A or vitamin C Good nutrition includes appropriate caloric intake and limited intake fat, salt, refined sugars, and alcohol

Safety Leading cause of death due to complications Patients over age 65 die from fall-related injuries Risk factors: Impaired vision Cardiovascular conditions such as postural hypotension or syncope Conditions affecting mobility such as arthritis Adverse medication reactions Poor lighting Slippery floor, stairs, and sidewalks

Two-third of older adults use prescription medication and non-prescription drugs One-third of all written prescription drugs are for older adults Most commonly prescribed medications are: Analgesics, Diuretics Cardiovascular drugs Sedative-hypnotics Nurse’s role with older adults on drug therapy is to ensure the greatest therapeutic benefit with the least harm

Assess their understanding about instructions for the medications Collaboratively work with the older adult to ensure safe and appropriate use of all medications Teach older adults the names of all their medications and desirable and undesirable benefits of medication Establish appropriate patterns for taking medication Encourage older adults to question the physician or pharmacist about all prescribed drugs and over-the counter (OTC) drugs

General preventive measures for nurses to recommend to older adults include: Participation in screening activities Regular exercise Weight reduction Nutrition Regular dental visits Smoking cessation Immunizations

At least 90% of older adults over 65 die from influenza Annual immunization are strongly recommended Pneumococcal pneumonia vaccine A second vaccine should be every five years Tetanus immunization, booster shot every 10 years

Respectful Attentiveness Positive attitude Kindness Compassion Gentle touch

Restore sense of reality Improve level of awareness Promote socialization Elevate independent functioning Minimize confusion Disorientation Physical regression

Alternative communication with confused older adults Accept description of time, place an person Do not challenge or argue Does not involve reinforcing misperception Reflect sensitivity to hidden meaning

Recall Past experiences Enjoy sharing the past Recollection Bring meaning and understanding to the present Resolve current conflicts Researching for positive resolutions Coping strategy Reflection Supports self-esteem Uncovers new meanings to past events

Use reminiscence to assess: Self-esteem Cognitive function Emotional stability Unresolved conflicts Future expectations Use in providing direct patient care Take time to ask questions Listening attentively Conveys respect and compassion

Social acceptable image Chronic illness Physical dependence Non objectionable appearance

Grooming Hygiene Combing hair Cleaning denture Shaving Changing clothes Be sensitive by controlling odors

Which statement made by an older adult, age 67 would reflects the best understanding of the nutritional guidelines for late adulthood? a.“I can prepare grilled chicken at least 10 different, delicious ways.” b.“When I entertain, I serve healthy foods like veggies and low-fat drip.” c. “I know I need to eat nutritiously, I have certainly been doing better.” d. “I take seriously the suggestions my health team give me on healthy eating.”

In reviewing changes in the older adult, the nurse recognizes that which of the following statements related to cognitive functioning in the older patient is accurate? a. Delirium is usually easily distinguished from irreversible dementia. b. Therapeutic drug intoxication is a common cause of senile dementia. c. Reversible systemic disorders are often implicated as a cause of delirium. d. Cognitive deterioration is an inevitable outcome of the human aging process

The nurse is aware that the major of older adults: a. Live alone b. Live in institutional settings c. Are unable to care from themselves d. Are actively involved in their community

Which of the following nursing questions is best directed toward the assessment of a normal finding regarding physiological changes in an older-adult patient? a. “Have you had your cholesterol tested lately.” b. “Do you see yourself as becoming forgetful?” c. “Are you experiencing any loss of libido?” d. “Any difficulty driving at night.”

A group of RN students are preparing to present an educational program to residences at an assisted-living facility with an age population of 68 to 78. Which teaching strategies would be appropriate for the learning needs of this age group? ( Select all that apply ) a. Speak in a slow, but well-articulated manner. b. Present a variety of ideas so as to have broad appeal c. Speak in a soft, low voice as to help the audience focus. d. Small groups allow for more speaker-listener interaction. e. End the program if there are signs of poor concentration or fatigue f. Present the material in a fast-paced manner to keep hold of their attention.

Which statement made by an older adult would reflect that the best understanding of the nutritional requirements of individuals at this developmental stage? a. “An apple a day is my motto; always has been.” b. “I eat everything, but just a little a bit of things like sweets.” c. “Fiber is more important than ever to my digestive system.” d. “I don’t need the fat so I’ve taken to drinking protein shakes.”

Older adult

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