Chapter 3 Common Health Problems of Older Adults

Question 1

What is the fasting growing subgroup in late adulthood?

Answer 1

The old old, sometimes referred to as the advanced older adult population.

Question 2

What are some common health issues and problems that often older adults in the community?

Answer 2

1. Decreased nutrition and hydration
2. Decreased mobility
3. Stress and loss
4. Accidents
5. Drug use and misuse
6. Mental health/behavioral health problems (including substance abuse)
7. Elder neglect and abuse

Question 3

What does OTC stand for?

Answer 3

Over-the-counter drugs

Question 4

What are the four subgroups of late adulthood?

Answer 4

65 to 75 years of age: the young old
75 to 84 years of age: the middle old
85 to 99 years of age: the old old
100 years of age or older: the elite old

Question 5

! Nursing safety priority

Action Alert

Answer 5

Perform nutritional screening for older adults in the community who are at risk for inadequate nutrition-either under-nutrition or obesity. Ask the individual about unintentional weight loss or gain, eating habits, appetite, prescribed and over-the-counter drugs, and current health problems. Determine contributing factors for older adults who have or are at risk for poor nutrition, such as transportation issues or loneliness. Based on these data, develop and implement a plan of care in collaboration with appropriate members of the healthcare team.

Question 6

! Nursing safety priority

Action Alert

Answer 6

Older adults sometimes limit their fluid intake, especially in the evening, because of problems associated with mobility, prescribed diuretics, and urinary incontinence. Teach older adults that fluid restrictions make them susceptible to dehydration and electrolyte imbalance is (especially sodium and potassium) that can cause serious illness or death. Incontinence may actually increase because the urine becomes more concentrated and irritating to the bladder and urinary sphincter. Teach older adults the importance of drinking 6 to 8 glasses of water a day plus other fluids as desired. Remind them to avoid excessive caffeine and alcohol because they can cause dehydration.

Question 7

Define “geriatric failure to thrive”

Answer 7

A complex syndrome including under-nutrition, impaired physical functioning, depression, and cognitive impairment.

Question 8

What does GFTT stand for you?

Answer 8

Geriatric failure to thrive

Question 9

Define “relocation stress syndrome”

Answer 9

Physiologic or psychosocial distress following transfer from one environment to another, such as after admission to a hospital or nursing home; also called “relocation trauma”

Question 10

Define “fallophobia”

Answer 10

In some older adults, the fear of falling and sustaining a serious injury.

Question 11

Define “presbyopia”

Answer 11

An age-related impairment of vision characterized by a loss of lens elasticity and the ability to accommodate. The near point of vision increases, and near objects must be placed farther from the eye to be seen clearly

Question 12

Define “polymedicine”

Answer 12

The use of many drugs to treat multiple health problems for older adults

Question 13

Define “polypharmacy”

Answer 13

They use multiple drugs, duplicative drug therapy, high-dosage medications, and drugs prescribed for too long a period of time. In other words, polypharmacy occurs when there is inappropriate or unnecessary prescribing that results in negative outcomes.

Question 14

What is a creatinine clearance test?

Answer 14

Creatinine clearance test measures the glomerular filtration rate of the kidneys. A commonly used formula for calculating creatinine clearance for men rather than directly measuring it is: (140 - Age in years) x Lean body weight in kg / Serum creatinine in mg / dl x 72

Question 15

What does ADES stand for?

Answer 15

Adverse Drug Events

Question 16

What are some Common Adverse Drug Events in older adults?

Answer 16

Edema
Severe nausea and vomiting
Anorexia
Dehydration
Dysrhythmias
Fatigue
Weakness
Dizziness
Syncope
Urinary retention
Diarrhea
Constipation/impaction
Hypotension
Acute confusion

Question 17

What are some examples of BEERS criteria for potentially inappropriate medication used in older adults?

Answer 17

meperidine (Demerol)
cyclobenzaprine (Flexeril)
digoxin (Lanoxin) (Should not exceed 0.125 mg daily except for atrial fibrillation)
ticlopidine (Ticlid)
fluoxetine (Prozac)
amitriptyline (Elavil)
diazepam (Valium)
promethazine (Phenergan)
ketorolac (Toradol)
Short-acting nifedipine (e.g. Procardia)
ferrous sulfate (Iron) (Should not exceed 325 mg/day)
chlorpropamide (Diabinese)
diphenhydramine (Benadryl)

Question 18

! Nursing safety priority

Drug Alert

Answer 18

Tricyclic antidepressants should not be used because they have anti-cholinergic properties that can cause acute confusion, severe constipation, and urinary incontinence. For older adults who may be prescribed this group of drugs, question healthcare provider and request an SSRI or other treatment.

Question 19

Define “legally competent”

Answer 19

A person 18 years of age or older, a pregnant or married minor, a legally emancipated (free) minor who is self-supporting, or a person not declared incompetent by a court of law.

Question 20

Define “guardian”

Answer 20

A person appointed to make healthcare decisions for a patient who is determined to not be legally competent.

Question 21

Define “clinically competent”

Answer 21

The condition of being legally competent and having decisional capacity.

Question 22

Define “depression”

Answer 22

A response to multiple life stresses, a single situation, the primary disorder, or a problem associated with dementia; this response can range from mild, transient feelings of sadness to a severe sense of helplessness and hopelessness.

Question 23

Define “Geriatric Depression Scale”

Answer 23

A valid and reliable screening tool to help determine if an older patient has clinical depression.

Question 24

Define “dementia”

Answer 24

A syndrome of slowly progressive cognitive decline with global impairment of intellectual function. Most common type is Alzheimer’s disease.

Question 25

Define “delirium”

Answer 25

An acute state of confusion, usually short-term and reversible within three weeks. Often seen among older adults in a hospital or other unfamiliar setting.

Question 26

! Nursing safety priority

Action alert

Answer 26

Acutely confused patients who are discharged from the hospital are at an increased risk for functional decline, falls, and incontinence at home. Therefore carefully assess older patients in any setting for acute confusion

Question 27

What does CAM stand for?

Answer 27

Confusion Assessment Method

Question 28

What is the confusion assessment method?

Answer 28

1. Acute onset and fluctuating course (e.g., Is there evidence of an acute change in mental status from the patient’s baseline?)
2. Inattention (e.g., Does the patient have difficulty focusing attention or keeping track of what is being said?)
3. Disorganized thinking (e.g., Is the patient’s thinking and conversation disorganized or incoherent?)
4. Altered level of consciousness (e.g., Is the patient lethargic, hyperalert, or difficult to arouse?)
   The diagnosis of delirium by the CAM is the presence of features 1 and 2 and either 3 or 4.

Question 29

Define “neglect”

Answer 29

In nursing, failure to provide for a patient’s basic needs.

Question 30

Physical abuse

Answer 30

The use of a physical force such as hitting, burning, pushing, and molesting the patient, that results in bodily injury.

Question 31

Define “financial abuse”

Answer 31

Mismanagement or misuse of the patient’s property or resources.

Question 32

Define “emotional abuse”

Answer 32

The intentional use of threats, humiliation, intimidation, and isolation to another person.

Question 33

What does Fulmer SPICES stand for?

Answer 33

S sleep disorders
P problems with eating or feeding
I incontinence
C confusion
E evidence of falls
S skin breakdown

Question 34

Define “fall”

Answer 34

And unintentional change in body position that results in the patient’s body coming to rest on the floor or ground.

Question 35

Define”nocturia”

Answer 35

The need to urinate excessively at night. Also called nocturnal polyuria.

Question 36

Define “restraint”

Answer 36

Any device (physical restraint) or drug (chemical restraint) that that prevents the patient from moving freely

Question 37

! Nursing Safety Priority
Drug Alert
Closely monitor older adults receiving antipsychotics for adverse drug events (ADEs). Assess patients for?

Answer 37

Anti-cholinergic effects, the most common problem, causing constipation, dry mouth, and urinary retention
Orthostatic hypotension, which increases the patient’s risk for falls and fractures
Parkinsonism including tremors, bradycardia, and a shuffling gait
Restlessness and the inability to stay still and anyone position
Hyperglycemia and diabetes mellitus, which occur more with drugs like risperidone (Risperdal) and quetiapine (Seroquel)

Question 38

! Nursing Safety Prioity

Action alert

Answer 38

Supervise unlicensed assistive personnel (UAP) for frequent turning in repositioning for the patient who is immobile. Assess the skin every 8 hours for reddened areas that do not blanch. Remind you UAP to keep the skin clean and dry. Use pressure-releaving mattresses, and avoid briefs or absorbent pads that can cause skin irritation and excess moisture.

Question 39

What are some of thebest practices for patient safety and quality care using restraint alternatives?

Answer 39

1. If the patient is acutely confused, reorient him or her to reality as often as possible
2. If the patient has dementia, use validation to reaffirm his or her feelings and concerns
3. Check the patient often, at least every hour
4. If the patient pulls tubes and lines, cover them with roller gauze or another protective device; be sure that IV insertion sites are visible for assessment
5. Keep the patient busy, with activity, pillow or apron, puzzle, or art project
6. Provide soft, calming music
7. Place the patient in an area where he or she can be supervised (if the patient is agitated, do not place him or her in a noisy area)
8. Turn off the television if the patient is agitated
9. Ask a family member or friend to stay with the patient at night
10. Help the patient to toilet every 2 to 3 hours, including during the night
11. Be sure that the patient’s needs for food, fluids, and comfort are met
12. If agency policy allows, provide the patient with a pet visit
13. Provide familiar objects or cherished items that the patient can touch
14. Document the use of all alternative interventions
15. If a restraint is applied, use the least restrictive device (e.g. mitts rather than wrist restraints, a roller belt rather than the vest)