Exam 3: Gero Lecture 8 Flashcards
The most important capacity in humans
Communication
Meaningful communication and engagement includes:
healthy aging
prolongs lifespan
better response to healthcare interventions
Maintenance of optimal function
Good Communication –> basis for
accurate assessment
care planning
development of therapeutic relationships between nurse and older person
What is elder-speak?
Assume all older people can’t hear, understand, or comprehend
Very common between nurses and clients
Elder-speak may be characterized by what?
simplistic vocabulary and grammar
shortened sentences
slowed speech
elevated pitch and volume
inappropriate terms of endearment
speaking as if person is not there: talking over the patient, don’t do this with your pt there
using familiar/informal communication without permission
using the “royal WE”
Why Do We Use Elder-speak?
Tradition
Modeling by others
Unawareness
Intent to control
Insensitivity
What are the effects of Elder-speak?
The implicit message of incompetence then begins a negative feedback loop for older persons, who react with:
- decreased self-esteem
- depression, withdrawal
- assumption of dependent behaviors
What is the therapeutic communication with older adults?
Give more time/Silence
Possible slowed thought process
Must sort through many years of memories to answer
Closed ended
To get specific answers
May feel put on the spot
Examples?
Open ended
Allow for client elaboration
May be difficult for some
Not sure what you are asking/want to please
Examples?
Proper body positioning
Seek clarification
Pay attention to non-verbals
What are the major communication issues related to neuro?
Reception
Perception
Articulation
What is the reception communication issue related to neuro?
Neuro disorders
Anxiety
Hearing deficits
Changes in cognition
What is the perception communication issue related to neuro?
Neuro disorders
Dementia
Delirium
What is the articulation communication issue related to neuro?
Neuro disorders
Mechanical difficulties
Resp disease
Larynx disorders
What are the neuro comm difficulties?
Anomia
Aphasia
Dysarthria
What is the neuro comm difficulties –> anomia
Difficult word retrieval
What is the neuro comm difficulties –> aphasia
Impairment in processing language
Ability to speak and/or understand
Intelligence not affected
Damage to brain
CVA or head trauma
Often left side
What is the neuro comm difficulties –> dysarthria
Impaired ability to articulate speech
Damage to neurological system
What are the different kinds of aphasia?
Fluent
Non-fluent
Verbal
Anomic
Global
What is fluent aphasia?
Inability to perceive/understand speech
Reading and writing impaired
Receptive aphasia
What is non-fluent aphasia?
Impaired speaking
Speech is effortful
Expressive aphasia
What is verbal aphasia?
Difficult to get brain signals to speech muscles
Frequently occurs with aphasia
What is anomic aphasia?
Severe word finding difficulties
What is global aphasia?
Can’t understand or express
Says meaningless things
What are the nursing care/considerations for aphasia?
Can be frustrating to care for someone with aphasia
Person usually retains intellect
Adult level communication
Modifications
Sensitivity and patience
Continuity of care
Communication Strategies
What is dysarthria?
weakness of speech muscles
what are the causes of dysarthria?
Injury to brain
CVA, head injury, brain tumor, Parkinson’s, multiple sclerosis
What are the CM for dysarthria?
Have “slurred” or “mumbled” speech that can be hard to understand
Speak slowly
Talk too fast
Speak softly
Not be able to move your tongue, lips, and jaw very well
Sound robotic or choppy
What is the care for dysarthria?
Collaboration with SLPs for speech therapy
What is included in vision impairment?
2/3 with impairment > 65
Among top 10 causes of disability in US
Lower QOL and life expectancy
Low vision to legal-blindness
20/40 to 20/200
Nurses screen vision how? Eye Snellen chart, designated in certain areas and the floor SHOULD BE makered
What are the leading causes of vision impairment?
Age-related macular degeneration
Cataract
Glaucoma
Diabetic Retinopathy
Optic Nerve atrophy
What are the major implications for vision impairment?
Affects nearly all ADLs
↑ risk of Falls
↑ risk of cognitive decline
What is presbyopia?
Age related vision changes (may start in 40s)
Lens loses elasticity
Difficulty focusing on near objects
Readers, bi-focals
What is glaucoma?
Leading cause of blindness
Open and Closed angle
Angle controls outflow
Open angle most common and non-acute
Increase in intraoccular pressure (IOP)
What is the patho for glaucoma?
Imbalance between inflow and outflow of aqueous humor>pressure increases>vision impaired>possible blindness if not treated
What are the CMs for glaucoma?
Initially none (early dz)
Reduced peripheral vision (subtle at initially)
Tunnel vision
Blurred vision
Halos around lights
Eye or brow pain
What are the diagnostics for glaucoma?
Vision exam
Tonometry
- Tests IOP (intra-ocular pressure)
Other advanced exams
What are the treatments for glaucoma?
Reduce IOP
Surgery –> can tell when they have surgery
- Argon laser trabeculoplasty (ALT)
- Opens outflow channels
What are the medications for glaucoma?
PO or eye gtts
Lower IOP by increasing drainage of AH or reducing AH production
Beta blocker gtt first line treatments
Nursing considerations for eye drop instillation? Check their heart rate, still works on their beta cells just as the HR medications. MUST MONITOR HR (-lol drugs). Make sure they are holding their eyes open and that the dropper isn’t touching the eye. Report ANY eye problems that they are having.
What are the preventions and interventions for glaucoma?
Prevention
Yearly eye exam for 65 and over
Report any eye s/sx immediately
African Americans at higher risk (yearly exams younger)
Intervention
Eye provider follow up
Ongoing questions and vision testing
Care surrounding medication mgmt
What is cataracts?
Oxidative damage to lens
- Protein and fat deposits
By age 80, more than half have a cataract
Usually bilateral
What are the CMs for cataracts?
Clouding of lens
Absent red reflex or appear black
Appearance of halos around objects * they are just seeing the outer parts of their eye, not the actual halo
Blurred vision
Yellow tint to vision
Sensitivity to glare
What are the diagnosis for cataracts?
Eye exam
History
What is the treatment for cataracts?
Surgical replacement of lens (plastic)
-When vision 20/50 or worse
-QOL or safety an issue
-Outpatient
-One eye at a time
-Nursing care pre-op
– Prepare for changes in vision post-op
– Avoid heavy lifting, straining, and bending
– Eye drops
– Eye shield
– Need help at home until they get out of their peri-op/post-op phases.
What is age related macular degeneration?
Leading cause of vision loss in 60 and over
Caucasians and Asians with highest risk
Dry (non-exudative)
– 90% of cases
Wet (exudative)
– More severe
What are the risk factors for age-related macular degeneration?
UV light
Cigarette smoking
Light-colored eyes
What is the patho for age-related macular degeneration?
Drusen deposits in retinal epithelium>atrophy and degeneration of macular cells>vision impairment
What are the CMs for age-related macular degeneration?
Blurred and dark vision
Scotomas
– Blind spots
Metamorphopsia
Vision distortio
What are the age-related macular degeneration diagnosis?
Drusen seen on opthalmoscopy
Fundus photography
IV angiography and fluorescein
What is the nursing care for age-related macular degeneration?
Promotion
After age 40 – dilated eye exam q2yr
After age 65 - eye exam yearly
Supplements/Diet
Vit C & E, beta-carotene, Zinc
Dark green leafy veggies
Smoking cessation: quit smoking
Manage HTN and DM
Sunglasses: even if it is cloudy
Hats
Safety eye wear: whenever doing outdoor activities
Interventions to utilize remaining vision
– Vision won’t return* once it is lost, it WILL NOT RETURN
What are the interventions to enhance vision?
Use contrasting colors
Black and white
Reds and oranges easiest to see
Assistive devices
Image magnification
Text-to-speech scanners
Tablets
General
Closer to objects
Large type
What colors are easiest to see?
reds and oranges
What is the communication and sensory impairments?
Hearing Impairment
– Worst to lose – as described by older people
Most common communication disorder
3rd most common chronic condition in older
Men more affected
Under-diagnosed and under-treated
QOL diminished
What happens with QOL diminishment?
Decreased function
Miscommunication
Depression
Falls
Low self-esteem
Cognitive decline
What is sensorineural?
Damage to inner ear or neural pathways
Presbycusis (age-related hearing loss)
High frequency sounds lost first
Difficulty filtering background noises (hospital)
Can’t hear women and children …WHY? Most women and children speak in a low pitch frequency tone
Treatment: hearing aids and cochlear implants
What is presbycusis (age related hearing loss)?
Most common hearing loss
Progressive and often permanent
Bilateral
1st Sign is difficulty hearing in noisy environment (restaurant)
Intolerant to loud noises
Difficulty in distinguishing between consonants
– Z, S, Sh, F, P, K, T, G
– Raised (louder) voices – make it worse
what is conductive?
Vibrations can’t get to tympanic membrane or TM impaired
What are the causes of conductive?
Infection, otosclerosis, perforated TM, fluid in middle ear
Cerumen impaction most common cause
– Cerumen thicker with age
– Higher risk: African American, hearing aids, men with increased ear hair
What is the treatment for conductive?
Eliminate underlying cause
What is tinnitus?
Abnormal sounds
Constant or intermittent
Worsens with age
Ringing, humming, buzzing, roaring, hissing, etc.
More common in men
What are the risk factors for tinnitus?
Presbycusis
Loud noises
Head and neck trauma
Tumors
Cerumen impaction
CV disease
Ototoxic meds
Med SEs
ASA most common
What is the treatment for tinnitus?
Hearing aids
– Amplify sounds to drown tinnitus
Electrostimulation, biofeedback, cochlear implants
Hypnosis, acupuncture, chiropractic, medication tx
What are the nursing interventions for tinnitus?
Identify when sounds are most irritating
Keep log/diary: things that are going on, what they are eating/taking, etc.
Reduce/eliminate: might need to be eliminated to help with the ringing in their ears
– ETOH, caffeine, cigarettes, stress, and fatigue
Refer to American Tinnitus Association
What is important about touch?
10 times stronger than verbal or emotional contact
Most neglected of the senses
What is the response to touch?
Procedural vs. non-procedural touch
Boundaries of touch is often cultural
Don’t assume one wants to be touched
A handshake (if appropriate) gives a lot of info
– Firm or soft, fast or hold on, warm or cold, sweaty or dry
What is touch deprivation?
Desire for touch more powerful in old age as other sensual experiences are diminished and direct sexual expression is not possible or available
Cause of illness may be greatly influenced by quality of tactile support received
Higher death rates more related to quality of human relationships than to degree of cleanliness, nutrition, physical disabilities on which we focus
What is the adaptation to touch deprivation?
Touch does not have to be performed by a person or other living thing
For the old, may be gained from self-contained stimulation of rocking or slowly stroking an animal’s fur or wearing something that provides sensory stimulation
Music and dancing seem to be two important mechanisms of enjoyment for older people
What is intimacy?
Encompasses more than just sexuality:
Commitment
Affective intimacy
Cognitive intimacy
Physical intimacy
Love and affection
Examples: Touch, holding, cuddling, being present
What is sexuality?
Specific type of intimate activity:
Sexual acts
Sexual desire
Activity
Attitudes
Body image
Gender-role activity
Acceptance and Companionship
What is the expectations for sexual health?
Cultural, biological, psychosocial, environmental factors influence sexual behavior of older adults
Factors affecting attitudes on intimacy and sexuality include family dynamics and upbringing, cultural and religious beliefs
How is sexual health redefined in older adulthood?
Sexuality in older person not about procreation
Emphasis shifts
companionship
physical nearness
intimate communication
physical pleasure-seeking relationship
What is the education and resources for LGBTQIA?
Older LGBTQIA people:
Less likely to seek out health services
Less likely to identify themselves as LGBT to health care providers
Often have differing or augmented healthcare needs
Older LGBT more likely to have kept their relationships hidden than younger people
What is the sexual health for LGBTQIA+?
National Gay and Lesbian Task Force Aging Initiative estimates that about 3 million Americans over the age of 65 are lesbian, gay, bisexual, and transgender, and likely to double by 2030
May face real or perceived discrimination in senior centers or long term care facilities
what are the assessment ?’s to include to obtain health history?
“Do you have a romantic partner?” not “Do you have a boyfriend/girlfriend or married?”
“How do you identify with regard to your sexuality?”
Don’t assume heterosexuality
What is the biological changes with aging in women?
Menopause
Dyspareunia (painful intercourse) from vaginal dryness and thinning of the vaginal tissue
What are the biological changes with aging in men?
Erectile dysfunction
Refractory period extended between episodes of intercourse
What is male sexual dysfunction?
Impotence (erectile dysfunction, or ED) - most prevalent sexual problem in men
Inability to achieve or sustain an erection sufficient for satisfactory sexual intercourse in at least 50% of attempts
What is erection is governed by?
interaction among hormonal, vascular, and nervous systems
problem with any of these can cause ED
For most older men, caused by underlying medical diagnosis and/or the treatment:
Endocrine problems
CV problems
Depression
Neurological problems
Phosphodiesterase (PDE) inhibitors such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) =
Revolutionized treatment for ED
ABSOLUTE – CONTRAINDICATION with nitrates/nitroglycerin – LIFE-THREATENING
What is the female sexual dysfunction?
Considered persistent impediment to person’s normal pattern of sexual interest, response, or both
Influenced by culture, ethnicity, emotional state, age, previous sexual experiences, as well as changes in sexual response with normal aging
What are the causes of female sexual dysfunction?
Physiologic changes - Menopause/hormonal changes - lower estrogen levels can make sexual activity less pleasurable
Women can experience arousal and orgasmic disorders resulting from drugs
Urinary incontinence may affect sexual activity
Water soluble lubricants, low-dose estrogens introduced into the vagina may also help restore tissues and restore lubrication
Describe HIV and older people?
Compromised immune system makes older adults more susceptible to HIV or AIDS than are younger persons
Contrary to popular belief, HIV/AIDS in elderly population is not result of blood transfusions alone nor is it confined to gay population
Older women at high risk for infection due to normal changes in vaginal tissue
Decreased immune response also makes older adults more susceptible to infection
Many symptoms mimic other disease conditions
Virus may be in late stages by time of diagnosis
Medicare in 2010 began covering HIV screening for high risk individuals
– All adults should have an HIV test at least once
Educational materials need to be developed for older adults
What is the PLISSIT model?
Guide for discussion of sexuality in older adults:
Permission
Limited Information
Specific Suggestions
Intensive Therapy
What are the nurse responsibilities to enhance healthy intimacy & sexuality in older adults?
Educator
Facilitator
Consultant
Counselor
Advocate: you are there to teach and help them; make sure they are responsible way
Assessment of any medical conditions or medications associated with poor sexual health
Counseling for older adult to adapt to natural physiological changes or body-image alterations from surgical procedures
