E2: Older Adults Flashcards
What age is OA?
65+
Most OA are still…
active and contributing to society; very few live in long-term care facilities
What is the key to OA?
Help them live longer but fulfilled lives with dignity and independence
Why are there so many older adults?
- Improved standard of living
- Improved nutrition
- Progress in medical care
- Increased health consciousness
What are examples of how medical care has progress?
-Prevention and treatment of diseases like Influenza
-Medications
-Chemo and radiation
-Insulin
-Medical Technology like heart and lung machines used for bypass surgeries
-Catheters
-Stints
-Organ transplant
___% of men and __% of women are 65+
23% men
15% women
________ are the fastest growing segment in 85+ group
Centenarians
By, 2050, 1 million will be 100 years or older
Use most health care dollars __________
in last 7 years of life
What does the phrase “Graying of America” mean and its goal?
Care will continue to shift from hospitals to community
Goal: To maintain functional independence and delay entry into more formalized healthcare settings
-assisted living
-long term care
instead use daycares, at home care, aging in place, nonprofessional caregivers
Common chronic conditions in OA?
HTN
Arthritis
Heart disease
Cancer
Diabetes
Asthma
Chronic respiratory
stroke
What is the continuing Erikson developmental stage from MA to OA? Positive end results?
Generativity vs stagnation
-active involvement
-other absorption
-promotion of next generation
-capacity of care
What is the final stage of Erikson’s developmental stage in OA?
Integrity vs Despair
-acceptance of past life and life as it is now
-reconciliation for what was hoped for and what is now
-openness to life
-serenity, wisdom
-acceptance of death
-reflection and closeure
What is the roles and relationships of OA?
-children independent
-death or illness of loved ones
-retirement
-changes in health status
-becoming a grandparent or great
What are misconceptions of OA?
- Disease is normal and unavoidable (it is not normal and can be avoided)
- Health promotion is not important for OA since their lives are almost over (just as important and can gain same benefits as YA or MA)
- Damage to health resulting from inactivity or poor nutrition is irreversible (never too old to relinquish bad habits or develop healthier habits)
- Ageist beliefs about older adults (prevents older adults from living longer, healthier, & independent lives)
We can have an impact on morbidity by decreasing risk factors and improving health care, it would be possible to postpone the onset of chronic disease until an age is closer to death by:
- Exercise and diet
- Quit smoking
- Prevent falls
- Preventive care
The decline in health is in old age is primarily due to
unhealthy lifestyle choices in earlier years
Coping and stress in OA
-Decreasing physical strength
-Retirement and lower/fixed income
-Death of parents, spouse, friends
-New relationship with adult children
-Slower physical and cognitive responses
-Keeping active and involved
-Making satisfying loving arrangements
What are interventions for stress in OA
Support during coping & address spirituality
Older adult assessment:
A functional, physical, social and mental assessment of patient, caregivers, environment
What is the goals of older adult assessment?
-Minimize hospitalizations
-decrease over-prescription of meds
-maintain health
-Establish complete diagnosis that are frequently over looked (dementia, depression, hearing/ vision deficet, falls, poor nutrition)
Key principles of older adult assessment:
-Holistic view
-Individualized patient centered care
-Client/caregiver as an active partner
-Focus on functional ability (How you frame Q’s: “How do you manage stairs at home” not “Can you do stairs”
-Multidisciplinary
-Specialized knowledge (normal age related changes & appropriate lab values)
Health promotion in older adults includes
-Healthy weight
-Healthy diet
-Staying active
-Fall prevention
-Maintaining relationships
-regular medical checkups
-flu shot, pneumonia shot
-screenings
Important key to successful older adult assessment:
Use of special tools tailored for seniors
-allows for early detection
-predicts service needs
-instruments should always be evidence based with good validity and reliability
Describe the SPICES assessment
S leep Disorders
P roblems with eating and feeding
I ncontinence
C onfusion
E vidence of falls
S kin breakdown
We can make complex connections btwn things that may seem unrelated at first in older adults. This can make things clearer and help guide plans of care
Nursing strategies to help with respiratory changes
-Immunizations
-Smoking cessation
-Daily Exercise
-See HCP if short of breath, respiratory infection last >3 days, or can’t tolerate fluid for >1 day
Nursing strategies to help with cardiovascular changes
-Rest when feel tired or short of breath
-Daily exercise
-Wear socks to bed
-Check for orthostatic changes, instruct to change positions slowly
-Elastic socks for edema
Proper nutrition prevents
Cancer
Obesity
GI disorders
Nutrition provides _______ and should be _____
energy for activities of daily living
individualized plans
What are risk facts for poor nutrition?
Low income and Low social support (maybe wife died and always made the meals)
What are potential problems that could be affecting nutritional patterns
-GI function
-Decreased smell
-Vision
-Taste
-Oral and dental issues
-Swallowing problems
-Medications
What are nutrition interventions?
- Assess contributing factors
- Education about nutrition
- Food assistance programs
What are the changes in elimination patterns?
-Bladder retains tone but capacity decreases
-incontinence (leads to depression, UTI, skin breakdown, embarrassment, social isolation, NOT NORMAL)
-Constipation (decreased mobility, sedentary lifestyle, medications)
Management for incontinence
-kegel exercise
-Pilates
-Scheduling
-Intake management (don’t drink right before bed)
-decrease caffeine
-disposable undergarments
Management for constipation
Exercise
increase fiber
increase fluid
caution against daily laxatives
What are the benefits of exercise?
-Decrease falls
-increase strength
-reduce arthritis pain
-reduce depression
-improve longevity
-reduce risk for diabetes and cardiovascular disease
-maintain weight
-lowers blood pressure
-lower cholesterol
-decreases constipation
-sleep better
-better digestion
-increase muscle tone
-increase flexibility and balance
-Opportunity for socialization
-Stress management
What advice should you give to a older person to start exercising?
-Pre-exercise evaluation
-Start off slow and gradually increase
What are the changes in sleep patterns?
-common complaint of not sleeping well
-less time in REM sleep
-Difficulty staying & falling asleep
-commonly due to stress, meds, poor habits, or sleep disorder
Are cognitive problems a normal part of the aging process?
NO
Confusion is normally associated with ______
physiological problems like UTI or pneumonia
-meds
-dehydration
-electrolyte imbalance
-stress
-disease state
-unfamiliar environment
How should you care for someone who has dementia?
Goal is to increase quality of life and decrease morbidity and cost
-keep routine
-calm and gentle
-encourage self care
-reduce sensory over load
-reminiscence and life review
Is benign forgetfulness a normal part of aging?
YES, little impact on day to day life
What are characteristics of normal short term memory loss?
-Forgets, then remembers
-Forgets unimportant events
-May repeat stories over time
-uses mental retracing
-reminders
-notes to compensate
-some decline in abstraction, calculation, word fluency, spatial orientation, inductive reasoning
What cognitive changes are NOT normal?
-confusion
-disorientation
-inappropriate behavior
-loss of ability to follow directions
-can’t concentrate
What assessment findings indicate impaired hearing?
-leaning forward
-cupping ear
-turning 1 certain ear
-misunderstanding
What are communication techniques for hearing impairment
-reduce background noise
-do not shout (loud and clear)
-Face speaker directly
What assessment findings indicate visual changes?
-mismatched clothing
- bruising
-increased car accidents
Describe the sexual and reproductive patterns of OA?
-OA need intimacy, love, touch, as an expression of closeness and is an integral part of sexuality
-susceptible to STIs
-normal and healthy aspect of life
What an cause depression in OA?
-chronic illness
-impaired functional ability
-losses
Depression if not treated can lead to
suicide
The highest rate of suicide is seen in
men >75 years
__ in ___ older adults fall each year
1 in 3
What are causes of falls?
-Neurological
-Osteoporosis
-stroke
-sensory impairment (vision)
What should you do if a patient falls?
Evaluate why it happened
Ask pt how it happened
Look at injury
Tell HCP
Incident report
A face injury is usually due to
vertigo or syncope
A broken wrist is usually do to
losing balance
What are biological agents common in OA?
Influenza
Pneumonia
Cancer (more than half of cancers in this age group)
Define Polypharmacy
-Use of multiple medications
-Often duplicate for same health problem
-1/3 of all older adults take 5 or more prescriptions
-Substance abuse is a growing problem
How is alcohol intake in OA?
-use underestimated/ hidden
-underdiagnosed
-Elderly more vulnerable to effetcs of alcohol
What is older adult abuse?
-Intentional or neglect that leads to harm
-Physical, emotional, verbal, sexual, financial and abandonment
Who is at highest risk for older adult abuse?
older women dependent on a caregiver
As a nurse to prevent older adult abuse we need to make sure we are
Turning our pts Q2, ambulating, offer toileting often, hourly rounding
