Chapter 14: Older Adults Flashcards by Delia Archer

___________ often has little relation to the reality of aging for an older adult.

Chronological age

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What is a factors that contributes to the projected increase in the number of older adults are the aging of the baby-boom generation and the growth of the population segment over age 85?

Older adults will increase to 72.1 million

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Older adults also vary widely in their levels of _______ ability. Including inability to perform ______, confusion, becoming withdrawn, and inability to make decisions regarding _____.

ADLs
Functional
Needs

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Aging does not inevitably lead to ________ and _________. Most older people remain functionally independent despite the increasing prevalence of _______ disease.

disability
dependence
chronic

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This part of the nursing process provides valuable clues to the effects of a disease or illness on a patient’s functional status.

Nursing assessment

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Chronic conditions add to the _______ of assessment and care of the older adult. Most older persons have at least one ______ condition, and many have multiple conditions.

complexity

chronic

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Although the interaction of these physical and psychosocial factors is often serious, do not ______ that all older adults have signs, symptoms, or behaviors representing _______ and _______ or that these are the only factors you need to ________.

assume
disease and decline
assess

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Some people ________ older adults as ill, disabled, and physically unattractive.

stereotype

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Although many older adults have chronic conditions or have at least one disability that limits their performance of activities of daily living (ADLs), What percent of noninstitutionalized older adults assess their health as excellent or very good?

39.1%

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What is a word that is synonymous with people believing that older adults are forgetful, confused, rigid, bored, and unfriendly and that they are unable to understand and learn new information.

Ageism

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Although changes in vision or hearing and reduced energy and endurance sometimes affect the process of learning, older adults are _______.

Lifelong learners

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Specialists in the field of gerontology view _______, the oldest of the old, as having an optimistic outlook on life, good memories, broad social contacts and interests, and tolerance for others.

centenarian

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Use teaching techniques to compensate for _______ changes, provide additional ____ for remembering and responding, and present _______ rather than abstract material to facilitate learning by older adults.

Sensory
Time
Concrete

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Other effective teaching techniques draw on the older adult’s past _______ and correspond to his or her identified ________ rather than to the content areas that the ____________ believes are important.

experiences
interests
health care professional

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In a society that values attractiveness, energy, and youth, these myths and stereotypes lead to the ________ of older adults.

Undervaluing

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Some people equate worth with ________; therefore they think that older adults become _________ after they leave the workforce. Others consider their knowledge and experience too outdated to have any _________ value. These ideas demonstrate ________, which is
discrimination against people because of ___________ age, just as people who are racists and sexists discriminate because of skin color and gender.

Productivity
Worthless
Current
Ageism
Increasing

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According to experts in the field of gerontology, ________ ageism has the potential to undermine the ________ of older adults, limit their access to care, and distort caregivers’ understanding of the _________ of each older adult. Older adults who have a positive image about aging actually live ______ years longer than those with a negative image. Nurses can help promote a positive ________ regarding the aging process when working with these patients.

unopposed
self-confidence
uniqueness
7.5
perception

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Many older adults lived through or were born during the ________ of 1929. They also experienced two world wars and wars in Korea, Vietnam, and the Persian Gulf and are now experiencing the war on terrorism. Older adults have seen changes in health care as the era of the family physician gave way to the age of ________. After witnessing the government initiatives establishing the Social Security
system, Medicare, and Medicaid, older adults are currently living with the changes imposed by _______ and the uncertainty of the future of Social Security and Medicare. Living through
all of these events and changes, they have stories and examples of ______ to share.

Great Depression
specialization
health care reform
coping with change

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It is critical for you to learn to respect older adults and actively _______ them in care decisions and activities.

involve

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The time has come for nurses to recognize and address ageism by ______ prevailing negative attitudes and stereotypes and _______ the realities of aging as they care for older adults in all care settings.

questioning

reinforcing

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This biological theories of aging view aging as the result of random cellular damage that occurs over time. The accumulated damage
leads to the physical changes that are recognized as characteristic of the aging process.

Stochastic theory

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This biological theories of aging views aging as the

result of genetically programmed physiological mechanisms within the body that control the process of aging.

Non-stochastic Theory

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The psychosocial theories of aging, developed during the 1960s, explain changes in behavior, roles, and relationships that come with aging. These theories reflect the values that the theorist and society held at the time the theory was developed. Name the four theories?

Disengagement Theory
Continuity Theory
Gerotranscendence
Activity Theory

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This is the oldest psychosocial theory, it states that aging individuals withdraw from customary roles and engage in more introspective, self-focused activities. What psychosocial theory of aging is this?

Disengagement theory

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This theory considers the continuation of activities performed during middle age as necessary for successful aging. What psychosocial theory of aging is this?

Activity Theory

This theory suggests that personality remains stable and behavior becomes more predictable as people age. The personality and behavior patterns developed during a lifetime determine the degree of engagement and activity in older adulthood. What psychosocial theory of aging is this?

Continuity Theory aka Developmental Theory

The more recent theory of proposes that the older adult experiences a shift in perspective with age. The person moves from a materialistic and national view of the world to a more cosmic and transcendent one, causing an increase in overall life satisfaction. What psychosocial theory of aging is this?

Gerotranscendence Theory

The more common _______ related to old age are of health, significant others, a sense of being useful, socialization, income, and independent living. How older adults adjust to the changes of aging is highly __________. For some adaptation and adjustment are relatively _____. For others coping with aging changes requires the _________ of family, friends, and health care professionals. Be ________ to the effect of losses on older adults and their families and be prepared to offer __________.

``` Losses individualized easy assistance sensitive support ```

Adjusting to decreasing health and physical strength Adjusting to retirement and reduced or fixed income Adjusting to death of a spouse, children, siblings, friends Accepting self as aging person Maintaining satisfactory living arrangements Redefining relationships with adult children and siblings Finding ways to maintain quality of life What are these examples of?

Developmental tasks for older adults

The extent and timing of aging changes vary from individual to individual; but, as body systems age, changes in _______ and ________ occur. These changes are not associated with a disease; they’re _______. The presence of ______ sometimes alters the timing of the changes or their impact on daily life.

appearance functioning normal disease

Some people find it ______ to accept their aging. This is apparent when they ________ their ages when asked, adopt ________ styles of clothing, or attempt to hide physical evidence of aging with ________. Acceptance of personal aging does not mean ______ into inactivity, but it does require a __________ review of strengths and limitations.

``` Difficult understate younger cosmetics Retreat Realistic ```

Others elders deny their aging in ways that are potentially ________. Some older adults deny functional _______ and refuse to ask for help with tasks that place their safety at great ________. Others _______ activities designed for their benefit such as senior citizens’ centers and senior health promotion activities and thus do not receive the _______ these programs offer.

``` problematic declines risk avoid benefits ```

Older adults retired from employment outside the home have to cope with the loss of a _________. Older adults who worked at home and the spouses of those who worked outside the home also face _______.

work role | role changes

Some may ________ retirement as a time to pursue new interests and hobbies, volunteer in their community, continue their education, or start a new career. Retirement plans for others may include changing residence by moving to a different city or state or to a different type of ________ within the same area. Reasons other than retirement also lead to changes of _______. Ex. physical impairments may require relocation to a smaller, single-level home or __________.

welcome housing residence Nursing home

A change in living arrangements for the older adult usually requires an extended period of _______, during which assistance and support from health care professionals, friends, and family members are necessary.

adjustment

Deaths represent both _______ and reminders of personal _______. Coming to terms with them is often difficult. By assisting older adults through the _______ process, you help them resolve the issues posed by these deaths.

losses mortality grieving

A variety of issues sometimes occur when the part child roles are reversed in old age, including but not limited to _______ of decision making, dependence, ________, guilt, and loss. How these issues surface in situations and how they are resolved depend in part on the ______relationship between the older adult and their adult children. All the involved parties have past experiences and powerful emotions.

Control Conflict Past

When adult children become their parents’ caregivers, they have to find ways to ______ the demands of their own children and _______ with the many challenges of family caregiving. As adult children and aging parents ______ the aspects of changing roles, nurses are in the position to act as _______ to both the parents and the children. The aim is to help older adults find ways to maintain their __________.

``` balance careers negotiate counselors quality of life ```

Some family caregivers consider nursing center placement when in-home care becomes increasingly _______ or when _________ (recovery) from hospitalization requires more assistance than the family is able to provide. Although the decision to enter a nursing center is never final and a nursing center resident is sometimes discharged to home or another less-acute facility, many older adults may view the nursing center as their _______ residence.

difficult convalescence final

What is the best way to evaluate the quality of a nursing center in a community?

The patient and family to visit that facility and inspect it personally.

With _________ assessment information regarding strengths, limitations, and resources, the nurse and the older adult identify _____ and ________. Together they select _________ to maintain the older adult’s ________ abilities and create an environment for ________ and ________ well-being. A _______ assessment requires the nurse to actively engage older adults and provide them enough _______ to share important information about their health.

``` Comprehensive Needs Problems Interventions Physical Psychosocial Spiritual Thorough Time ```

Nursing ______ takes into account five key points to ensure an age-specific approach: (1) the interrelation between _______ and _______ aspects of aging, (2) the effects of disease and disability on ________ status, (3) the decreased efficiency of _______ mechanisms, (4) the lack of standards for health and illness ______, and (5) altered _______ and ________ to a specific disease.

assessment 1. physical and psychosocial 2. functional 3. homeostatic 4. norms 5. presentation and response

A ________ assessment of an older adult takes more time than the assessment of a younger adult because of the longer life and medical history and the potential complexity of the history. During the physical examination allow _______ as needed or conduct the assessment in several _______ because of the reduced ______ and limited of some frail older adults. Remember to review both ________ and _______ carefully with the patient.

``` comprehensive rest periods sessions energy endurance prescribed and over-the-counter medications ```

Sensory changes also affect ______. Your choice of communication techniques depends on ____ or ______ impairments of the older adult. If older adults are unable to understand your visual or auditory cues, assessment data may be _________. Ex, if an older adult has difficulty hearing a nurse’s questions, inappropriate _______ might lead the nurse to believe that the person is ________.

``` data gathering visual or hearing inaccurate or misleading responses confused ```

Sit or stand at ______, in front of the patient in full view. Face the older adult while speaking; do not cover your ______. Provide diffuse, bright, nonglare ________. Encourage the older adult to use his or her familiar assistive devices such as _______. These techniques help older adults with what type of impairment?

``` eye level mouth lighting glasses or magnifiers Visual Impairment ```

________ deficits, if present, affect the accuracy and completeness of an assessment.

Memory

Use tact when involving another person in the assessment interview. The additional person _______ the answers of the older adult with the consent of the older adult, but the older adult remains the ______ of the interview.

supplements | focus

During assessment use caution when interpreting the signs and symptoms of diseases and ________. Historically researchers have used ______ populations to establish these signs and norms. However, the classic signs and symptoms of diseases are sometimes absent, blunted, or atypical in older adults. This is especially true in the case of ________ infection, pain, acute ________ and ___________.

``` Laboratory Values Younger Bacterial Myocardial Infarction Heart Failure ```

The masquerading of disease is possibly caused by age-related changes in organ systems and ______ mechanisms, progressive loss of physiological and _____ reserves, or _______ acute or chronic conditions.

homeostatic functional coexisting

As a result the older adult with a urinary tract infection may present with _______, ________, and an elevation of __________ (within normal limits) instead of having fever, dysuria, frequency, or urgency as seen in younger adults.

confusion incontinence body temperature

Some older adults with pneumonia have ________, _________, and confusion with decreased _______ and functioning, ___________ the more common symptoms of fever pulmonary, renal, and metabolic function.

tachycardia tachypnea appetite without

It is important to recognize _______ indicators of an acute illness in older adults. Note changes in _____ status, occurrence and reason for ______, _________, decrease in ________, loss of function, _______, and incontinence because these may be indicators not presented in _______. A key principle of providing age-appropriate nursing care is timely detection of these _______ of illness so early treatment can begin.

``` early mental falls dehydration appetite dizziness younger adults cardinal signs ```

________Status changes changes commonly occur as a result of disease and psychological issues. Some mental changes are often drug related, caused by drug ______ or ______ drug events. A _____ can be a common event for an older adult and can be injury producing and costly.

Mental toxicity adverse fall

Problems with the cardiac, respiratory, musculoskeletal, neurological, urological, and sensory body systems can present with a _____ as a chief symptom of a new-onset condition.

fall

_______ is common in older adults because of decreased oral intake related to a ________ thirst response and less free _____ as a consequence of a decrease in ______ mass. When _____ and ______ accompany the onset of an acute illness, the older adult is at risk for further complications.

``` Dehydration reduced water muscle vomiting diarrhea ```

Decrease in ______ is a common symptom with the onset of pneumonia, heart failure, and urinary tract infection.

appetite

Loss of _______ ability occurs in a subtle fashion over a period of time; or it occurs suddenly, depending on the ________. nurses play an essential role in early identification, referral, and treatment of health problems.

functional | underlying cause

Thyroid disease, infection, cardiac or pulmonary conditions, metabolic disturbances, and anemia are common causes of _______ decline.

functional

Therefore older adults engaged in ADLs usually consider themselves _____; whereas those who have physical, emotional, or social impairments that limit their activities perceive themselves as _____.

healthy | ill

An initial inspection reveals if eye contact | and facial expression are _______ to the situation.

appropriate

Facial wrinkles, gray hair, loss of body mass | in the extremities, and an increase of body mass in the trunk. These are examples of what kind of aging changes?

universal aging changes

With aging the skin loses resilience and ______. The epithelial layer thins, and elastic collagen fibers shrink and become _____. Wrinkles of the face and neck reflect lifelong patterns of muscle activity and facial expressions, the pull of gravity on tissue, and diminished elasticity. Spots and lesions are often present on the skin. Smooth, brown, irregularly shaped spots (age spots aka ________) initially appear on the backs of the hands and on forearms. Small, round, red or brown cherry ________ occur on the trunk. ___________ lesions or keratoses appear as irregular, round or oval, brown, watery lesions. You would look for these signs of aging when assessing what body system?

``` Moisture Rigid senile lentigo angiomas Seborrheic Integumentary ```

Years of sun exposure contribute to the aging of the skin and lead to premalignant and malignant lesions. You need to rule out these three malignan- cies related to sun exposure when examining skin lesions?

Melanoma Basal cell carcinoma Squamous cell carcinoma

The facial features of the older adult may become more pronounced from loss of _______ and skin elasticity. Facial features appear _______ because of missing teeth or improperly fitting dentures. In addition, common vocal changes include a ____ in pitch and a ____ of power and range.

subcutaneous fat asymmetrical Rise Loss

______ is the most prevalent risk factor for impaired hearing. Exposure earlier in life exacerbates hearing loss in old age.

Noise

________ attempts such as turning up the volume on televisions or avoiding social conversations.

Compensatory

A common age-related change in auditory acuity is _______. Before the nurse assumes presbycusis, it is necessary to inspect the external auditory canal for the presence of ________. Impacted cerumen, a common cause of diminished hearing _________, is easy to treat.

presbycusis Cerumen Acuity

_________ affects the ability to hear high-pitched sounds and sibilant consonants such as s, sh, and ch.

Presbycusis

Salivary _______ is reduced, and taste buds ______ and lose | sensitivity. The sense of ______ also decreases, further reducing taste.

secretion atrophy smell

The older adult is less able to differentiate among what four tastes?

salty, sweet, sour, bitter

Health conditions, treatments, and/or medications can alter _____. It is often a challenge to promote _____ in an older patient because of the loss of smell and changes in taste.

Taste | Optimal nutrition

Respiratory muscle strength begins to ________, and the anteropos- terior diameter of the thorax __________. Vertebral changes caused by _________ lead to dorsal _______, the curvature of the tho- racic spine.

decrease increases Osteoporosis Kyphosis

Calcification of the ______ cartilage causes decreased mobility of the ______. The chest wall gradually becomes ______. Lung expansion _______, and the person is less able to cough ______.

``` costal ribs stiffer decreases deeply ```

If ________ or chronic obstructive lung disease is present, breath sounds become _______. With these changes the older adult is more susceptible to ________ and other bacterial or viral infections.

kyphosis distant pneumonia

Decreased ______ strength of the myocardium results in decreased ___________. The decrease is ______ when the older adult experiences anxiety, excitement, illness, or strenuous activity. The body tries to __________ for decreased cardiac output by ________ the heart rate during exercise. However, after exercise it takes ________ for the older adult’s rate to return to baseline.

``` contractile cardiac output significant compensate increasing Longer ```

Systolic and/or diastolic blood pressures are sometimes abnormally ______. Although a common chronic condition, ________ is not a normal aging change and predisposes older adults to heart failure, stroke, renal failure, coronary heart disease, and peripheral vascular disease.

High | Hypertension

Peripheral pulses frequently are ______, although still palpable, in the lower extremities. Older adults sometimes complain that their lower extremities are ______, particularly at night. Changes in the peripheral pulses in the upper extremities are ______ common.

Weaker Cold Less

As _______ production diminishes, the milk ducts of the breasts are replaced by fat, making breast tissue less firm. _________ of glandular tissue, coupled with more fat deposits, results in a slightly smaller, less dense, and less nodular breast.

estrogen | Atrophy

___________, enlarged breasts in men, is often the result of medication side effects, _________ changes, or obesity. Both older men and women are at risk of ______ cancer.

Gynecomastia hormonal breast

Aging leads to an increase in the amount of fatty tissue in the ______. As a result, the abdomen increases in _____. Because muscle tone and elasticity decrease, it also becomes more _______.

trunk size protuberant

Gastrointestinal function changes include a slowing of _________ and alterations in secretions. The older adult experiences these changes by becoming less ______ of certain foods and having discomfort from delayed gastric _________. Alterations in the __________ tract lead to constipation, flatulence, or diarrhea.

peristalsis tolerant emptying lower gastrointestinal

Female menopause is related to a reduced ___________ of the ovaries to pituitary hormones and a resultant _________ in estrogen and progesterone levels.

Responsiveness | Decrease

_________ begins to decline during the fourth decade and continues into the ninth.

Spermatogenesis

However, the changes in reproductive structure and function _______ affect libido; sexual desires, thoughts, and actions.

Do not

In men there is no definite cessation of ______ associated with aging.

fertility

Less frequent ______ activity often results from illness, death of a sexual partner, or decreased socialization.

sexual

_________ of the prostate gland is frequently seen in older men. This enlarges the gland and places pressure on the neck of the bladder.

Hypertrophy

Prostatic hypertrophy results in difficulty initiating and maintaining a __________.

urinary stream

As a result of ________ urinary retention, frequency, incontinence, and urinary tract infections occur.

Benign Prostatic Hypertrophy

Benign prostatic hypertrophy is different from cancer of the _______.

Prostate

This is the second most common cause of cancer death in men over age 50?

Prostate Cancer

Urinary incontinence is a normal part of aging? | True or False

False It is abnormal.

Men may be afraid to discuss ________ with their physician because of embarrassment and because they think that it is a “woman’s disease.”

Urinary incontinence

Older women, particularly those who have had children, experience ___________, an involuntary release of urine that occurs when they cough, laugh, sneeze, or lift an object. This is a result of a weakening of the ________ and ________muscles.

stress incontinence | perineal and bladder

With aging muscle fibers become ________. Muscle strength diminishes in _______ to the decline in muscle mass.

smaller | proportion

Postmenopausal women experience a greater rate of bone _________ than older men. Older men with poor ________ and decreased _______ are also at risk for bone demineralization.

demineralization Nutrition Mobility

Women who maintain __________ intake throughout life and into menopause have less bone demineralization than women with low intake.

calcium

A decrease in the number and size of neurons in the nervous system begins in the middle of the second _______.

Decade

________________, chemical substances that enhance or inhibit nerve impulse transmission, change with aging as a result of the decrease in neurons.

Neurotransmitters

All voluntary reflexes are ________, and individuals often have less of an ability to respond to multiple stimuli.

Slower

In addition, older adults frequently report alterations in the quality and the quantity of sleep, including difficulty _______ asleep, difficulty ________ asleep, difficulty falling asleep again after ______ during the night, waking _______ in the morning, and excessive daytime _____. These problems are believed to be caused by age-related changes in the ___________ cycle.

``` falling staying waking too early napping sleep-wake ```

____________ is a major public health threat.

Osteoporosis

Beginning in the 30s, ________ and _______ decline in men and women. Older adults who _______ regularly do not lose as much bone and muscle mass or muscle tone as those who are _______.

bone density and bone mass exercise inactive

_____________ status in older adults includes the day-to-day ADLs involving activities within physical, psychological, cognitive, and social domains.

Functional

A decline in function can often be linked to illness or disease and its degree of ________. However, ultimately it is the complex relationship among all of these areas that influences an older adult’s ________ abilities and overall ________.

chronicity functional well-being

Some ______ the changes and continue to expect the same ________ from themselves, regardless of age. Conversely some overemphasize them and prematurely ________ their activities and __________ in life.

deny performance limit involvement

Educate older adults to promote __________ of age-related changes, appropriate lifestyle adjustments, and effective coping.

understanding

A healthy, well-balanced diet; paced and appropriate activity; regularly scheduled visits with a health care provider; regular participation in meaningful activities; use of stress management techniques; and avoidance of alcohol, tobacco, or illicit drugs are factors that affect ________.

the highest level of function in all the areas

The fear of becoming ________ is an overwhelming one for the older adult who is experiencing _________ decline as a result of aging.

dependent | functional

ADLs (such as bathing, dressing, and toileting) and IADLs (such as the ability to write a check, shop, prepare meals, or make phone calls) are essential to independent living; therefore carefully assess whether or not the older adult has changed the way he or she completes these tasks. What do problems completing ADLs indicate?

It is a sensitive indicator of health or illness in the older adult.

__________ and ___________ therapists are | your best resources for a comprehensive assessment.

Occupational | Physical

A sudden change in function, as evidenced by a decline or change in the older adult’s ability to perform any one or combination of ADLs, is often a sign of the onset of an _________ (e.g., pneumonia, urinary tract infection, or electrolyte imbalance) or worsening of a _________ (e.g., diabetes or cardiovascular disease)

acute illness | chronic illness

When you identify a decline in a patient’s function, focus your nursing interventions on _________, ___________, and ___________ the older adult’s functional status to maintain independence while preserving ________.

maintaining restoring maximizing dignity

Forgetfulness as an expected consequence of aging is a ______.

myth

_________ in the number of brain cells, deposition of _______ and _______ in cells, and changes in ___________ levels occur in older adults both with and without cognitive impairment.

Reduction lipofuscin amyloid neurotransmitter

Disorientation, loss of language skills, loss of the ability to calculate, and poor judgment are not normal aging changes and require you to further assess patients for underlying causes. What are these symptoms of?

Cognitive Impairment

There are standard assessment forms for determining a patient’s mental status, including the ______________, __________, and _________.

Mini-Mental State Exam (MMSE) Confusion Assessment Method (CAM) NEECHAM Confusion Scale (NCS)

The three common conditions affecting cognition are?

delirium dementia depression

This acute confusional state, is potentially a | reversible cognitive impairment that often has a physiological cause.

Delirium

Physiological causes include electrolyte imbalances; cerebral anoxia; hypoglycemia; medication effects; tumors; subdural hematomas; and cerebrovascular infection, infarction, or hemorrhage. These cause what cognitive impairment?

Delirium

_________ in older adults sometimes accompanies systemic infections and is often the presenting symptom for pneumonia or urinary tract infection.

Delirium

Sometimes this is also caused by environmental factors such as sensory deprivation or unfamiliar surroundings or psychosocial factors such as emotional distress or pain.

Delirium

Sleep deprivation is another possible reason for a patient having ________.

delirium

_________ is an additional risk factor that | greatly increases the risk for delirium, and it is possible for both to occur in a patient at the same time.

Dementia

The presence of ______ is a medical emergency and requires prompt assessment and intervention.

delirium

Nurses are at the bedside 24/7 and in a position to recognize ________ development and report it.

delirium

__________ is a generalized impairment of intellec- | tual functioning that interferes with social and occupational functioning.

Dementia

This is an umbrella term that includes Alzheimer’s disease, Lewy body disease, frontal-temporal dementia, and vascular dementia.

Dementia

Nursing management of older adults with any form of ________ always considers the safety and physical and psychosocial needs of the older adult and the family.

dementia

Older adults sometimes experience late-life _______, but it is not a normal part of aging.

Depression

__________ is the most common, yet most undetected and untreated, impairment in older adulthood.

Depression

Institute medical measures to correct underlying physiological alterations. • Maximize safe function. Keep a routine, limit choices (e.g., clothes for dressing, what to eat), allow for rest. • Provide unconditional positive regard. Be respectful. Nonverbal communication also should be positive. • Use behaviors to gauge activity and stimulation. Watch for facial signs of anxiety. • Teach caregivers to listen to the behaviors that show stress (e.g., verbalizations such as repetition). • Modify the environment. • Promote social interaction based on abilities. Make sure that the environment is safe for mobility and promote way-finding with pictures or cues. Try to identify patients who wander and remove the cause (e.g., pain, thirst, unfamiliar surroundings, new noises). • Compensate for any sensory deficits (e.g., hearing aids, glasses, dentures). • Encourage fluid intake (make sure that fluids are accessible) and avoid long periods of giving nothing orally. • Be vigilant for drug reactions or interactions; consider onset of new symptoms as an adverse reaction. • Activate bed and chair alarms. • Provide ongoing assistance to family caregivers; educate them in nursing care techniques and inform them about community resources. This is an example of what type of nursing care?

Nursing Care of Cognitively Impaired Older Adults

Co-occurring diseases may include stroke, dementia, Parkinson’s disease, heart disease, cancer, and pain-provoking diseases such as arthritis. Loss of a significant loved one or a nursing center admission may precipitate _________.

depression

_____________ is treatable and includes medication, psychotherapy, or a combination of both.

Clinical depression

Of special note, suicide attempts in older adults are often __________.

Successful

But the universal loss for older adults usually revolves around the loss of ________ through death. It is important to assess both the nature of the psychosocial changes that occur in older adults as a result of life transitions and the loss and the ________ to the changes.

relationships | adaptations

Many often mistakenly associate retirement with _________ and seclusion. In actuality it is a stage of life characterized by _________ and role changes. This requires letting go of certain ________ and structure and developing new ones.

passivity transitions habits

The __________ stresses of retirement are usually related to role changes with a spouse or within the family and to loss of the work role. Sometimes problems related to social ________ and __________ are present.

psychosocial isolation finances

Meaningful retirement __________ is critical as the population continues to age. Retirement affects more than just the retired. It affects the spouse, adult children, and even grandchildren.

planning

Loss of the work role has a major impact on some retired persons. When so much of life has revolved around work and the personal relationships at work, the loss of the work role can be devastating. _________ is often rooted in the work role, and with retirement individuals need to construct a new identity.

Personal identity

When the spouse is still working, the _______ person faces time alone. There may be new expectations of this person.

retired For example, a working spouse might have new ideas about the amount of housework expected of the retired person.

Problems develop when the plans of the retired person _______ with the work responsibilities of the working spouse. The roles of the retiree and the working spouse need clarification.

conflict

___________ may expect the retired person to always babysit for the grandchildren, forgetting that this is a time for the retired person to pursue other personal interests.

Adult children

In the adjustment to retirement the older adult has to develop a personally meaningful schedule and a supportive social network. Factors that influence the retired person’s satisfaction with life are _______ and _______.

health status | sufficient income

The nurse can help the older adult and family prepare for _________ by discussing with them several key areas, including relations with spouse and children; meaningful activities and interests; building social networks; issues related to income; health promotion and maintenance; and long-range planning, including wills and advance directives.

retirement

________ is sometimes a choice, the result of a desire not to interact with others. It is also a response to conditions that inhibit the ability or the opportunity to interact such as the lack of access to transportation.

Isolation

In the _______ to retirement the older adult has to develop a personally meaningful schedule and a supportive social network. Factors that influence the retired person’s satisfaction with life are ________ and _________.

adjustment health status sufficient income

retirement

_________ is sometimes a choice, the result of a desire not to interact with others. It is also a response to conditions that inhibit the ability or the opportunity to interact such as the lack of access to __________.

Isolation | transportation

An older adult’s ________ increases in the absence of the support of other adults, as occurs with loss of the work role or relocation to unfamiliar surroundings.

vulnerability

You assess patients’ potential for __________ by identifying their social network, access to transportation, and willingness and desire to interact with others. Your findings assist you in helping a lonely older adult _______ social networks and __________ patterns of isolation.

social isolation rebuild reverse

_________ such as daily telephone calls by volunteers or needs for activities such as social outings also meet socialization needs.

Outreach programs

Sexuality involves love, warmth, sharing, and touching, not just the act of _______. Sexuality plays an important role in helping the older adult maintain ________.

intercourse | self- esteem

Knowing an older adult’s sexual needs allows you to incorporate this information into the nursing ________.

care plan

Not all nurses feel comfortable counseling older adults about sexual health and intimacy-related needs. Be prepared to refer older adults to an ___________.

appropriate professional counselor.

_______ questions inviting the older adult to explain sexual activities or concerns elicit more information than a list of _______ questions about specific activities or symptoms. Include information about the _______ of sexually transmitted infections when appropriate.

open- ended closed-ended prevention

The goal of your assessment of a patient’s environment is to consider resources that promote ________ and _________.

independence and functional ability

The ______ affects older women more than men, a trend that will probably continue in the future. In spite of these experiences, it is wrong to assume that the older adult is comfortable with the idea of death.

death of a spouse

The environment can support or hinder physical and social functioning, enhance or drain energy, and complement or tax existing physical changes such as vision and hearing. For example, furnishings with _____, _____, and _____ colors are easiest for older adults to see. Shiny waxed floors may appear to be ____ or have a hole in them.

red orange yellow wet

It must be easy to get into and out of and provide back support. Test dining room chairs for comfort during meals and for height in relation to the table. Armrests make it easier for patients to get in and out of a chair because they can use their arms to assist in lifting. These are what part of the nursing process?

Implementation of Assistive Devices

Knowledge of the grieving process, excellent communication skills; understanding of legal issues; familiarity with community resources; and awareness of one’s own feelings, limitations, and strengths as they relate to care of those confronting ________ are critical.

death

Impaired sensory function, reduced mobility, and cognitive changes all contribute to reduced interaction with others and can place the older adult at risk for _______.

isolation

Older people have a wide variety of attitudes and beliefs about death, but fear of their own death is ________. Rather they are concerned with fear of being a burden, experiencing suffering, being alone, and the use of life-prolonging measures. The stereotype that the death of an older adult is a ______ does not apply to every older adult.

uncommon | blessing

Older adults often prefer transferring out of a wheelchair to another chair for meals because some styles of wheelchairs do not let older adults sit close enough to the table to eat comfortably. This is what part of the nursing process?

Implementation of Assistive Devices

Raising the table to clear the wheelchair arms brings the table closer to the older adult but makes it too high for comfortable use. To make getting out of bed easier and safer, the height of the bed needs to allow the older adult’s feet to be flat on the floor when he or she is sitting on the side of the bed. This is what part of the nursing process?

Implementation of Assistive Devices

When assisting older adults with ___________, assess their activity level, financial status, access to public transportation and community activities, environmental hazards, and support systems.

housing needs

_________ of the grieving process, excellent communication skills; understanding of legal issues; familiarity with community resources; and awareness of one’s own feelings, limitations, and strengths as they relate to care of those confronting death are critical.

Knowledge

The national initiative ______ has a number of major goals affecting the older adult population, including increasing the number of older adults with one or more chronic conditions who report confidence in maintaining their conditions, reducing the proportion of older adults who have moderate-to-severe functional limitations, reducing the number of emergency department visits resulting from falls among older adults, increasing the number of older adults who live at home but have unmet long-term services and support; and increasing the proportion of older adults with reduced physical or cognitive function who engage in light, moderate, or vigorous leisure-term physical activities.

Healthy People 2020

For the older adult, previous health care experiences, personal motivation, health beliefs, culture, and non health-related factors such as transportation and finances can create barriers to ___________.

participation

Although various interventions cross all three levels of care ______, _______, and ______ some approaches are unique to each level.

health promotion, acute care, and restorative care

Researchers have not fully identified the factors that lead to good health in advanced age, but three important factors seem to be .

genetics, good health habits, and preventive measures

The ADL limitations most often reported include walking, showering and bathing, getting in and out of bed and chair, dressing, toileting, and eating. There is a strong relationship between ______ status and reported _______ status.

disability | health

* Participation in screening activities (e.g., blood pressure, mammography, Pap smears, depression, vision and hearing testing, colonoscopy) * Regular exercise * Weight reduction if overweight * Eating a low-fat, well-balanced diet * Moderate alcohol use * Regular dental visits * Smoking cessation * Immunization for seasonal influenza, tetanus, diphtheria and pertussis, shingles, and pneumococcal disease Those who die from influenza are predominately ________. What part of the nursing process is this?

older adults Implementation: Teaching. General preventive measures for you to recommend to older adults

_________ establish baseline data that you use to determine wellness, identify health needs, and design health maintenance programs.

Initial screenings

Following initial screening sessions, share with older adults information on _____, ______, _____, and ______. You can also provide information on specific conditions such as hypertension, arthritis, or self-care procedures such as foot and skin care.

nutrition exercise medications safety precautions

____________ is the leading cause of death in older adults. Hypertension is a silent killer because often the person is unaware that his or her blood pressure is elevated.

Heart disease

Common cardiovascular disorders are _________ and _________.

hypertension and coronary artery disease.

The nurse’s role is to focus interventions on maintaining and _______ patients’ function and quality of life. You can help older adults become ________ to make their own health care decisions and realize their optimum level of health, function, and quality of life.

promoting | empowered

Barriers for _________ include beliefs and attitudes about which services and programs to provide, their effectiveness and the lack of consistent guidelines, and absence of a coordinated approach.

health care providers

A key role of the nurse is to help older adults understand the meaning of the loss and _____ with it. Older people have a wide variety of attitudes and beliefs about death, but fear of their own death is ______. Rather they are concerned with fear of being a burden, experiencing suffering, being alone, and the use of life-prolonging measures. The stereotype that the death of an older adult is a _______ does not apply to every older adult.

cope uncommon blessing

Older adults have difficulty distinguishing between _____, _____, and ______ shades. Door frames and baseboards should be a color that contrasts with the color of the wall to improve _______ of the boundaries of halls and rooms. Stairs should have a color contrast at the edge of the step so the older person knows where the stair ends. Glare from highly polished floors, metallic fixtures, and windows is ______ for the older adult to tolerate.

``` green blue pastel perception difficult ```

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