Chapter 8 Considerations for the Older Adult Flashcards
What two factors affect life expectancy?
Gender & Age
True or False: Women live longer than men.
True
Most deaths occur in which age group?
Adults ages 65 or older
Leading Causes of Death Among Older Adults
Heart Disease
Cancer
Unintentional injuries
Chronic lower pulmonary diseases
Stroke
Alzheimer’s disease
Goal of Older Adult Care
Help older adults sustain maximum functional level & dignity despite physical, social, and psychological losses
Intrinsic Aging
Changes caused by the normal aging process that are genetically programmed and essentially universal
Cardiovascular Changes in the Older Adult
Myocardial hypertrophy->Decreased CO
Increased fibrosis/calcified tissues-> Reduced stroke volume
Calcium and fat deposits accumulate w/in arterial walls-> HTN & increased workload
Slower recovery response to stress or exercise
Likely to have dyspnea or neurologic symptoms associated with heart disease
Absence of chest pain is not a reliable indicator of the absence of heart disease
Optimal Blood Pressure
<130/88 mmHg
Nursing Interventions for Orthostatic Hypotension
Assess BP in 2 positions & educate patients to rise slowly
Avoid straining when having bowel mvmnt
Consider 5-6 small meals each day to min hypotension that can occur after a large meal
Avoid extreme temperatures
How does extremely high temperatures affect blood pressure?
Causes vasodilation-> BP drops
How does extremely low temperatures affect blood pressure?
Causes vasoconstriction-> BP rises
Respiratory System Changes in Older Adults
Diminished response efficiency
Reduced maximal inspiratory & expiratory force
Diseases manifest less typical symptoms (fatigue, lethargy, anorexia, dehydration
Lung mass decreases & residual volume increases
Smoking is the most significant risk factor
Nursing Interventions for Respiratory System Changes
Encourage regular exercise and appropriate fluid intake,
Encourage COVID shot and booster, pneumococcal vaccination, and yearly flu shot
Educate patient to avoid people who are ill
Remind hospitalized patients to cough and take deep breaths_ frequently
Integumentary System Changes in Older Adults
Epidural proliferation decreases-> dermis becomes thinner
Elastic fibers reduced-> collagen becomes stiffer
Subcut fat diminishes-> less likely to conserve body heat
Loss of resiliency with wrinkling and sagging ->Drier and more susceptible to burns, injury, and infection
Hair pigmentation may change
Balding may occur
Strategies to Promote Healthy Skin Function
Smoking cessation
Limit alcohol consumption
Avoid sun exposure & use sun protection factor of 15 or wear protective clothing
Use emollient skin cream
Avoid hot soaks in the bathtub
Maintain optimal _____________ and ______________
Reproductive System Changes in Older Adults
Less intense response to sexual stimulation
Decline in sexual activity , but no loss in sexual desire
Female Reproductive System Changes in Older Adults
Vaginal narrowing
Decreased elasticity & secretions
Involution of uterus & ovaries
Decreased tone
Changes can cause vaginal bleeding & painful penile-vaginal intercourse
Male Reproductive System Changes in Older Adults
Less firm testes but may continue to produce viable sperm up to 90 years of age
Diminished production of testosterone at about age 50 Decreased libido and ED may develop but likely associated with other factors
Nursing Interventions for Reproductive System Changes in Older Adults
Encourage use of water-soluble lubricants
Assess causes of decreased libido or ED
Show sensitivity, expert knowledge, and support during communication
Provide information on available non-pharmacologic, pharmacologic, and surgical methods
Consult w/provider to offer referral to a gynecologist, urologist, or sex therapist, if warranted
Genitourinary Changes in Older Adults
Increased susceptibility to UTIs
Changes may be a combo of aging & pathologic conds (HTN)
Decreased filtration rate
Diminished tubular function w/less efficiency in reabsorbing & concentrating the urine
Slower restoration of acid-base balance in response to stress
Male Genitourinary System Changes in Older Adults
Benign prostatic hyperplasia: gradual increase in urine retention and overflow incontinence
Female Genitourinary System Changes in Older Adults
Relaxed perineal muscles, detrusor instability (urge incontinence), urethral dysfunction (stress urinary incontinence)
Urgency/Frequency Syndrome
Decreased “warning time”, drops of urine lost w/laugh, cough, & position change
Nursing Interventions for Genitourinary Changes
Encourage adequate fluid intake helps to reduce the risk of bladder infections and helps to decrease urinary incontinence
Examples of bladder irritants
Caffeinated beverages, alcohol, & artificial sweeteners
GI System Changes in Older Adults
Decreased sense of thirst, smell, taste
Decreased salivation
Difficulty chewing and swallowing food
Delayed esophageal, gastric emptying
Diminished secretion of gastric acid and pepsin
-Due more to pathologic conditions rather than aging
(Reduces absorption of iron, calcium, and vitamin B12)
Reduced gastrointestinal motility-> Delayed emptying and early satiety
Increased incidence of gallstones and common bile duct stones
Practices that Promote GI Health
Regular brushing and flossing and regular dental care
Drinking adequate fluids
Eating small, frequent meals high in fiber and low in fat Avoiding heavy activity or lying flat after eating
Avoid use of laxatives and antacids
Nutritional Health Considerations for Older Adults
Require fewer calories
Require more nutrient-rich, healthy diet
Unintentional weight loss may affect ability to maintain health and fight illness
Factors that Contribute to Malnutrition in Older Adults
Apathy
Immobility
Depression
Loneliness
Poverty
Inadequate knowledge
Poor oral health
Nutritional Health Nursing Actions
Consider budgetary constraints and physical limitations
Identify nutritional problems
Work within patient’s own framework of knowledge of their health status
Recommend a reduced fat diet, sufficient protein, vitamins, minerals, and dietary fiber for health and prevention of disease
Factors that Affect Sleep Quality
Respiratory problems during sleep
Restless leg syndrome
Nocturia
Pain
Osteoarthritis
Heart Failure
Incontinence
Prostatic hyperplasia
Menopause-related problems
Alzheimer’s disease or Dementia
Depression or Social Isolation
Restless Leg Syndrome
A condition characterized by a nearly irresistible urge to move the legs, typically in the evenings
Consequences of Poor Sleep
Cognitive decline
Increase risk for falls
Daytime fatigue
Reduced physical and mental health
Reduced quality of life
Poor ICU outcomes
Nursing Interventions for Sleep
Assess and identify sleep problems
Provide health education on sleep hygiene behaviors (sleep schedule)
Alterations in Bone Remodeling Lead To:
Loss of bone density
Loss of muscle strength, size
Deterioration of muscle fibers and cell membranes Degenerated joint cartilage
Musculoskeletal Changes in Older Adults
Height loss
Prone to fractures
Kyphosis
Back pain
Loss of strength, flexibility, & endurance
Joint pain
When does progressive bone loss occur?
Before age 40 w/out exercise
How often should older adults exercise?
3x a week (weight-bearing exercises)
Nursing Actions for Musculoskeletal Systems
Encourage participation in a regular exercise program
Recommend bone density screenings
Take calcium & vitamin D supplements as prescribed
Benefits of Regular Exercise Program Participation
Increased strength, aerobic capacity, flexibility, and balance
-Hospitalized patients benefit from getting OOBas soon as possible and in-hospital activity
Nervous System Changes in Older Adults
Difficult to maintain homeostasis
Decreased nerve cells
Nerve impulses conducted slower (takes longer to respond-> falls, injuries, & driving errors)
Reduced cerebral circulation (gait and balance affected)
Sudden onset on confusion may be 1st symptom of an infection/change in physical condition (pneumonia, UTI, med interactions)
Nursing Actions for Nervous System Changes
Advise older adults to allow longer time to respond to stimulus and to move more deliberately
Encourage adequate nutrition and absorption of B12, especially those following a vegetarian diet
Sensory Deprivation
Absence of stimuli in the environment/ inability to interpret existing stimuli
Vision Changes in Older Adults
Diminished ability to focus on close objects; inability to tolerate glare, difficulty adjusting to changes of light intensity; decreased ability to distinguish colors
Poor night vision & “dry eye”
Most common eye diseases are cataracts, glaucoma, diabetic retinopathy, and age-related macular degeneration
What is the primary cause of vision loss in adults 65 years or older?
Macular degeneration (MD)
Presbyopia
Diminished ability to focus on close objects
Cataracts
Clouding of the eye lens
Glaucoma
Vision loss due to increased pressure on the optic nerve
Macular degeneration
Loss of central vision
Nursing Actions for Vision Changes in the Older Adults
Wear eyeglasses & use sunglasses outdoors
Avoid abrupt changes from dark to light
Use adequate indoor lighting
Avoid nighttime driving
Use contrasting colors for color coding
Hearing Changes in Older Adults
Presbycusis
Tympanic membrane thinning & loss of resiliency
Difficulty w/sound discrimination especially w/ noisy environment
Presbycusis
Decreased ability to hear high-pitched sounds
Nursing Actions for Hearing Changes in Older Adults
Recommend hearing screenings
Reduce background noise
Directly face client
Enunciate clearly
Speak w/low-pitched voice, use nonverbal cues, rephrasing
Taste & Smell Changes in Older Adults
Decreased ability to taste & smell
-Excess use of sugar & salt
Nursing Actions for Taste & Smell Changes in Older Adults
Encourage use of lemon, spices, & herbs
Encourage smoking cessation
Ageism
Prejudice/discrimination on the basis of someone’s age
Coping
Patterns and ability to adapt to stress develop over course of lifetime and remain consistent later in life
Nursing Strategies to Promote Cognitive Function
Supply Mnemonics
Encourage ongoing learning
Link new information with familiar information
Use visual, auditory, and other sensory cues
Encourage use of prescription glasses &hearing aids
Provide glare-free lighting and quiet, nondistracting environment
Set short-term goals
Prioritize the most important information
Keep education period short
Pace learning tasks
Encourage verbal participation
Reinforce successful learning in a positive manner
Polypharmacy
The use of multiple medications on a regular basis
Med Absorption Changes in Older Adults
May be affected by changes in gastric pH & decrease in GI motility
Med Distribution Changes in Older Adults
May be altered due to decrease in body water & increase in body fat
“Start low, go slow”
Need adjustment of med dosage based on age
Nursing Implications for Pharmacologic Aspects
Assess knowledge of medications and use
Identify patient’s beliefs and concerns about the medication
Review need for medication, coordination of prescriber
Keep medication regimen as simple as possible
Factors that Affect Compliance
Number of medications prescribed
Complexity of the regimen
Difficulty opening containers
Inadequate patient education
Financial cost
Disease or medication interfering with patient’s life
Nursing Actions for Mental Health Issues in Older Adults
Recognize, assess, refer, collaborative, treat, & support older adults who exhibit s/s of depression, substance, abuse, delirium, or dementia
Delirium
Acute, confused state that begins w/disorientation
Alzheimer’s Disease (AD)
A progressive, irreversible, degenerative neurologic disease that begins insidiously & is characterized by gradual loss of cognitive func & disturbances in behavior & affect
Causes of Alzheimer’s Disease
Genetics
NT changes
Vasc abnormalities
Stress hormones
Circadian changes
Head trauma
Presence of seizure disorders
Clinical Manifestations of Alzheimer’s Disease
Progressive dementia
Memory failure
Personality disturbance
Loss of intellectual func assoc w/ cerebral cortical atrophy
Beta-amyloid plaque formation
Intraneuronal neurofibrillary tangles
Early-Stage Alzheimer’s Disease
Lasts 1-3 years
Memory loss
Poor judgement & poor problem-solving
Difficulty adapting to new environments & challenges
Agitation/apathy
Middle-Stage Alzheimer’s Disease
Lasts 2-10
Difficult w/recent & remote memory
Apraxia
Irritability
Depression
Restlessness
Difficulty swallowing
Occasional incontinence
Communication difficulties
Motor disturbances
Forgetfulness
Psychosis
Late-stage Alzheimer’s Disease
Loss of all mental abilities & ability to care for self
End-stage Alzheimer’s Disease
Loss of all voluntary activity
What is the most common mood disorder among older adults?
Depression
Subtle Signs & Symptoms of Depression
Fatigue
Diminished memory & concentration
Feelings of worthlessness
Sleep disturbances
Appetite disturbances with excessive weight loss or gain
Restlessness
Impaired attention span
Suicidal ideations
Non-pharmacological Nursing Measures for Depression
Exercise, bright lighting, increasing interpersonal interactions, cognitive therapy, and reminiscence therapy
Nursing Interventions for Depression
Monitor closely to avoid med toxicity, hypotensive events, and falls
Monitor for side effects
Provide adequate patient education
Offer support and encouragement
Provide strategies to maintain safety, such as changing positions slowly and maintaining adequate hydration
Geriatric Syndromes
Common conditions that tend to be multifactorial and do not fall under discrete disease categories
Examples of Geriatric Syndromes
Falls
Delirium
Frailty
Dizziness
Urinary incontinence
Geriatric Triad
Includes changes in cog status, falls, & incontinence
Causes for Impaired Mobility
Strokes
Parkinson’s disease
Diabetic neuropathy
Cardiovascular compromise
Osteoarthritis
Osteoporosis
Sensory deficits
Nursing Actions for Impaired Mobility
Encourage older adult to stay as active as possible
Active ROM and strengthening exercises with unaffected extremities
Passive ROM exercises on the affected extremities
Active ROM (Range-of-Motion)
Pt moves a part of their body w/out outside assistance
Passive ROM (Range-of- Motion)
An outside force causes mvmnt of the joint
Nursing Actions for Falls
Implement fall prevention measures for hospitalized patients
Encourage patient/family to make lifestyle and environmental changes to prevent falls:
-Adequate lighting - Grab bars in bathtub, shower or near toilet - Properly fitted clothing and shoes -Identify trip hazards: rugs, small objects, or pets
Geriatric Syndromes: Increased Susceptibility to Infection
Altered pain & febrile responses (mental confusion, increased respirations, tachycardia, and a change in skin color)
Altered emotional impact
Altered systemic response
What is the most common form of abuse against older adults?
Neglect
Nursing Actions for Elder Abuse
Be alert to possible elder neglect abuse
Assess during health history
Implement preventative action when caregiver strain is evident
Provide resources to family or patient for early detection and intervention
Interdisciplinary approach to help caregiver develop self-awareness, increased insight, and understanding of disease and aging process
Medicare
Federally funded health insurance for those 65 yrs or older
Medicaid
Joint federal & state program that gives health coverage to some people w/limited income & resources
Advance Directives
Legal document providing instructions for care (living will) or names a proxy decision maker
