Geriatric Nursing Flashcards

Question

True or False: Constipation is common among older adults and can lead to serious health issues.

Answer 1

* 35 to 50 g of fiber * At least 2 liters of fluid

Answer 2

Loneliness can lead to loss of appetite and poor nutrition.

Answer 3

Less body water content and decreased thirst ## Footnote Older adults may also limit fluid intake due to decreased mobility, prescribed diuretics, and urinary incontinence.

Answer 4

2 liters of water a day plus other fluids as desired ## Footnote Unless medically contraindicated, this helps prevent dehydration and electrolyte imbalances.

Answer 5

* Decreased risk for falls * Increased muscle strength and balance * Increased mobility * Increased sleep * Reduced or maintained weight * Improved sense of well-being and self-esteem * Decreased risk for constipation * Improved longevity * Reduced risks for diabetes, coronary artery disease, and dementia

Answer 6

Resistance exercise ## Footnote Aerobic exercise, such as walking, improves strength and endurance.

Answer 7

* Rapid environmental changes * Changes in lifestyle (retirement, physical incapacity) * Acute or chronic illness * Loss of significant others * Financial hardships * Relocation

Answer 8

Physical and emotional distress that can occur after moving from one setting to another ## Footnote Symptoms include sleep disturbances and emotional issues like anxiety and depression.

Answer 9

* Early consumer education * Trial of respite care prior to relocation * Establishing a liaison between acute and long-term care staff * Key consistent nurse for residents * Involving family and friends in care and schedule * Prolonged stay time for family, especially for the first week * Structured resident introduction to social activities

Answer 10

True ## Footnote They tend to take more opioids and benzodiazepines than men.

Answer 11

* Handrails * Slip-proof pads for rugs * Adequate lighting * Avoiding scatter rugs and clutter * Installing grab bars * Using nonslip bathmats * Raised toilet seats

Answer 12

Farsightedness that worsens with aging ## Footnote It may make walking more difficult for older adults.

Answer 13

Have frequent eye examinations ## Footnote This helps in updating glasses and maintaining safety.

Answer 14

Establishing and maintaining relationships is crucial for happiness ## Footnote Close, intimate, and stable relationships help older adults cope with crises.

Answer 15

Walking at least 30 minutes three to five times a week ## Footnote Indoor shopping centers can be used during winter for walking.

Answer 16

It can speed up the aging process and impair reserve capacity ## Footnote This lessens the ability of older adults to respond and adapt to changes.

Answer 17

Farsightedness that worsens with aging

Answer 18

* Macular degeneration * Cataracts * Glaucoma * Diabetic retinopathy

Answer 19

Have frequent eye examinations and update glasses or contact lenses

Answer 20

Decreased awareness of body orientation

Answer 21

Medication use

Answer 22

Stopping Elderly Accidents, Deaths, and Injuries (STEADI)

Answer 23

* Screen older adults for fall risk * Assess modifiable risk factors * Intervene with clinical and community strategies

Answer 24

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

Answer 25

The use of multiple drugs, duplicative drug therapy, and high-dosage drugs

Answer 26

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

Answer 27

Decreased liver size and liver blood flow

Answer 28

start low, go slow

Answer 29

High-dose opioid use is common among those with persistent pain and other mental health issues

Answer 30

* Forgetting to take medications * Poor communication with health care professionals * Varying ways of taking medications *Taking Complimentary or integrative therapies *Avoid taking drugs

Answer 31

Interview them using recommended questions regarding their medication regimens

Answer 32

An assessment tool for screening medication-related risks in older adults The physiologic changes of aging affect drug absorption, distribution, metabolism, and excretion, increasing the risk for adverse drug events, making medication assessment critical. "MODIFIED CAPS": M - Meperidine O - Oxycodone D - Digoxin I - (A letter that is missing from the drug names you provided, but let’s use I as a placeholder) F - Fluoxetine I - (Another placeholder for the I) E - (Another placeholder for the E) D - Diazepam C - Cyclobenzaprine A - Amitriptyline P - Promethazine S - Short-acting nifedipine

Answer 33

Identifying driver safety issues and recommending interventions

Answer 34

* Discuss driving ability * Assess physical and mental deficits * Suggest community-based transportation options

Answer 35

Increased storage of lipid-soluble drugs leading to decreased plasma concentration

Answer 36

They can have a more dramatic effect and take longer to correct

Answer 37

polymedicine

Answer 38

Fear of dependency or cost of drugs

Answer 39

To take their medications exactly as prescribed

Answer 40

Using pill boxes or associating pill taking with daily events

Answer 41

To list multiple medications and related concerns that may be inappropriate for older adults.

Answer 42

* meperidine * oxycodone * cyclobenzaprine

Answer 43

The practice of prescribing multiple medications for the same indication without a clear distinction of when one should be administered over another.

Answer 44

Every 6 months or more often if an acute illness or exacerbation of a chronic disease occurs.

Answer 45

* Prescription drugs * Over-the-counter drugs * Herbs * Nutritional supplements

Answer 46

* Legal competence - 18 years of age or older. - Also applies to a pregnant or married minor. - A legally emancipated minor who is self-supporting. - Has not been declared incompetent by a court of law. * Clinical competence When a person is legally competent and can make appropriate decisions. - Decisional capacity determines clinical competence: 1. Identify problems 2. Recognize options 3. Make decisions - Behavioral/mental illnesses can affect both legal and clinical competence. Incompetence: - If a court determines that an individual is not legally competent, a guardian is appointed to make healthcare decisions. - Guardians can be family members or unrelated individuals. - If no family members are available, a guardian may be appointed by a local Area Agency on Aging, which provides services and resources for older adults.

Answer 47

* 18 years of age or older * Pregnant or a married minor * A legally emancipated minor who is self-supporting * Not declared incompetent by a court

Answer 48

The ability to identify problems, recognize options, make decisions, and provide rationale for decisions.

Answer 49

* Cognitive training * Physical activity * Mental activity * Social engagement * Proper nutrition

Answer 50

* Depression * Delirium * Dementia

Answer 51

Depression

Answer 52

A lack of the neurotransmitters norepinephrine and serotonin in the brain.

Answer 53

Geriatric Depression Scale—Short Form (GDS-SF) *Is available in multiple languages. *It consists of 15 questions to which the patient responds with "yes" or "no." *A score of 10 or higher is consistent with a possible diagnosis of clinical depression.

Answer 54

10 or higher

Answer 55

Sometimes called situational depression, can occur when there is a sudden change in a person’s life, such as an illness or loss * Stroke * Arthritis * Cardiac disease

Answer 56

A syndrome involving a slowly progressive cognitive decline, often referred to as chronic confusion. Global impairment of intellectual function

Answer 57

Delirium has an acute and fluctuating onset, while dementia is chronic and progressive.

Answer 58

* Hyperactive * Hypoactive * Mixed

Answer 59

To screen for delirium. - Acute onset and fluctuating course: Evidence of an acute change in mental status, with symptoms coming and going or changing in severity. - Inattention: Difficulty focusing attention or tracking what is being said. - Disorganized thinking: Disorganized or incoherent thinking and conversation. - Altered level of consciousness: Lethargy, hyperalertness, or difficulty in arousal. - Diagnostic Criteria: Requires acute onset and inattention, and either disorganized thinking or altered level of consciousness.

Answer 60

* Drug therapy * Infections * Fluid and electrolyte imbalances * Surgery * Nutritional deficiencies

Answer 61

They can reduce depressive symptoms and improve quality of life.

Answer 62

Usually includes drug therapy and psychotherapy.

Answer 63

* Early morning insomnia * Excessive daytime sleeping * Poor appetite * Lack of energy * Unwillingness to participate in social activities

Answer 64

Provide supplemental oxygen therapy to increase oxygen to the brain.

Answer 65

Acute confusion.

Answer 66

Use a calm voice to frequently reorient the patient.

Answer 67

Collaborate with interprofessional team Remove or treat risk for causative factors Use calm voice to frequently reorient Music Doll or stuffed animal

Answer 68

Short Michigan Alcoholism Screening Test—Geriatric Version A 10 yes/no question test used to detect alcohol use or alcoholism in older adults. It is available in English and Spanish. It can be self-administered or administered by a clinician A "yes" answer to a question is worth one point. "Do you drink to take your mind off your problems?" "When you feel lonely, does having a drink help?"

Answer 69

A total score of two or more points.

Answer 70

*Alcohol use screening * Have you ever tried to CUT down on your drinking? * Have people ANNOYED you by criticizing your drinking? * Have you ever felt bad or GUILTY about your drinking? * Have you EVER had a drink first thing in the morning to settle your nerves or to get rid of a hangover?

Answer 71

* Physical abuse- Use of physical force that results in bodily injury * Financial abuse- Mismanagement or misuse of property or resources * Emotional abuse- Intentional use of threats, humiliation, intimidation, isolation *Neglect Caregiver fails to provide basic needs for an older adult. Teach about “scams” Refer and report

Answer 72

* Bruises in clusters or regular patterns * Burns * Unusual hair loss * Multiple injuries, especially fractures.

Answer 73

* Elder Abuse Suspicion Index * Elder Assessment Instrument * Indicators of Abuse Screen * Questions to Elicit Elder Abuse * Hwalek-Sengstock Elder Abuse Screening Tool.

Answer 74

Refer the older adult to the appropriate service.

Answer 75

To improve care for hospitalized older adults and generate evidence-based practice guidelines.

Answer 76

* Sleep disorders * Problems with eating or feeding * Incontinence * Confusion * Evidence of falls * Skin breakdown. Developed as part of the NICHE project to identify serious "marker conditions" that can lead to longer hospital stays, higher medical costs, and even deaths for older adults "Geriatric vital signs" tool for identifying these key issues:

Answer 77

* Pain * Chronic disease * Environmental noise and lighting.

Answer 78

Poor clinical outcomes, including death.

Answer 79

Identify causes for incontinence or retention.

Answer 80

Acute confusion that may be avoidable and often reversible when the causes are resolved.

Answer 81

Review the most recent serum electrolyte levels.

Answer 82

An unintentional change in body position or descent resulting in the body coming to rest on the floor or ground.

Answer 83

* Morse Fall Scale * Hendrich II Fall Risk.

Answer 84

Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders.

Answer 85

*Respect their strong religious and spiritual beliefs. *Their health continues to lag behind that of non-Hispanic whites due to several factors, including language barriers, inadequate health insurance, and lack of health care access. *Many nurses do not know Spanish.

Answer 86

-Elevated risk for disability from chronic disease, mental distress, and overall poor health. - Engage in risky unhealthy behaviors, potentially leading to more hospitalizations and an earlier need for long-term care -Fear of rejection or discrimination may cause them to hide their gender identity and/or sexual orientation from health care providers

Answer 87

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

Answer 88

* Fractures * Head trauma

Answer 89

All inpatient health care settings must use admission and daily fall risk assessment tools and a fall reduction program for high-risk patients.

Answer 90

A recent history of falling.

Answer 91

* Morse Fall Scale * Hendrich II Fall Risk Model (HIIFRM)

Answer 92

* History of falls * Advanced age (>80 years) * Multiple illnesses * Generalized weakness or decreased mobility * Gait and postural instability * Disorientation or confusion * Use of certain drugs * Urinary incontinence * Communication impairments * Major visual impairment * Alcohol or substance use * Location of patient’s room * Change of shift or mealtime

Answer 93

The patient’s activities and behavior, preferably every 30 to 60 minutes.

Answer 94

Every 30 to 60 minutes.

Answer 95

Any device or drug that prevents the patient from moving freely and must be prescribed by a primary health care provider.

Answer 96

To prevent injury if the patient falls out of bed.

Answer 97

Psychoactive drugs used to control behavior, often overused in hospital settings.

Answer 98

* Antipsychotic drugs * Antianxiety drugs * Sedative-hypnotic drugs

Answer 99

Predicting pressure injury risk.

Answer 100

* Assess older adults for risk * Implement evidence-based interventions * Coordinate care with the interprofessional health care team

Answer 101

Every 8 hours.

Answer 102

Breakdown in communication and coordination of care.

Answer 103

They should be easy to read, in large print, and accurate.

Answer 104

To ensure understanding of discharge instructions and consistent follow-up appointments.

Answer 105

It emphasizes quality and safety education for nurses.

Answer 106

Try all other alternatives.

Answer 107

Acute confusion that has a sudden onset and fluctuating course. *Often due to infections or poor oxygenation.

Answer 108

* Anticholinergic effects * Orthostatic hypotension * Parkinsonism * Restlessness * Hyperglycemia

Answer 109

Use the least restrictive device and follow facility policy.

Answer 110

[nocturia]

Answer 111

Chronic confusion ## Footnote Dementia is not a normal part of aging.

Answer 112

No ## Footnote Confusion is not considered a normal aspect of aging.

Answer 113

Alcohol abuse or alcoholism ## Footnote Those identified with problems should be referred to appropriate resources.

Answer 114

Family caregivers ## Footnote Neglect and abuse are serious problems in this population.

Answer 115

The reaction of an older adult when transferred to a different environment ## Footnote It is important to assess and intervene to minimize this problem.

Answer 116

* Young old * Middle old * Old old * Elite old ## Footnote Awareness of these subgroups aids in patient-centered care.

Answer 117

Falls ## Footnote This concern is prevalent in both community and inpatient settings.

Answer 118

They predispose older adults to toxic effects of medication ## Footnote Drugs are absorbed, metabolized, distributed, and excreted more slowly.

Answer 119

* Errors when self-medicating * Avoiding needed medications * Problems understanding their medication regimen ## Footnote These issues raise safety concerns.

Answer 120

Sleep and rest ## Footnote Promoting adequate sleep is essential for older adults' health.

Answer 121

SPICES assessment tool ## Footnote This tool helps in preventing or managing health problems early.

Answer 122

* Urinary incontinence ## Footnote Dementia and relocation stress are not usual physiologic changes.

Answer 123

Old people are sick and disabled. Most old people go to nursing homes. Senility comes with old age. Old people are unhappy and dependent. Old people can't learn. Old people are no longer sexually active. People get "cranky" or "passive" with old age.

Answer 124

Baby Boomers: Born between 1945-1964, Age 65 starting in 2010. Sandwich Generation: Caregivers caring for parents and children simultaneously.

Answer 125

*Decreased risk for falls. A large study found that older adults with severe mobility limitations experienced increased falls compared to those with adequate mobility. Increased muscle strength and balance. Resistance exercises help maintain muscle mass. *Aerobic exercise like walking improves strength and endurance. *Increased sleep *Reduced or maintained weight *Improved sense of well-being and self-esteem *Decreased risk for constipation *Improved longevity *Reduced risks for diabetes, coronary artery disease, and dementia

Answer 126

*Encompasses the capacity to perform ADLs and maintain mobility, which are essential for an older adult's independence and quality of life. *Various factors, including physiologic changes, health conditions, accidents, cognitive status, and environmental transitions, can affect functional ability

Answer 127

"CARTELS" C: Changes in lifestyle Shifts in habits or daily routines that may impact health and well-being. A: Acute or chronic illness Physical or mental health conditions that can impact the ability to function or affect quality of life. R: Rapid environmental changes Significant changes in surroundings, like moving to a new home or changes in the climate. T: Transition/Relocation Moving from one living situation to another, such as transitioning to a long-term care facility. E: Elder veterans' special needs Additional care and attention that may be required by older adult veterans due to their service. L: Loss of loved ones Grief and mourning following the death of family members, friends, or close companions. S: Special needs of older adult veterans Veterans' unique health care needs, both physical and mental, based on military service.

Answer 128

*Relationships with others *Work or Retirement *Medicare coverage options Programs: *National Aging in Place Council *Village to Village Network *Administration for Community Living *Relocation stress syndrome. *AARP- liveable communities

Answer 129

*Decreased reaction time and reduced multitasking ability. *Presbyopia (farsightedness) *Presbycusis (hearing loss) *A reduced sense of touch, impacting foot position awareness on pedals. *Sleep disturbances, such as insomnia, which can cause drowsiness while driving. *Higher risks due to chronic diseases and medications: - Peripheral neuropathy, which can reduce foot sensation, affecting control over pedals. *Medications for hypertension, potentially causing orthostatic hypotension (low blood pressure and dizziness). *Psychoactive medications and opioid analgesics, which can cause drowsiness and confusion, increasing crash risk.

Answer 130

Discuss driving ability with the older adult to understand their perspective. Assess physical and mental conditions that could affect driving, such as recent medication changes, falls, cognitive impairment, or progressive health issues. Work with primary health care providers to manage conditions that may impact driving. Suggest alternative transportation options, if available. Talk with older adults and their families about driving concerns. Remind the older adult to wear glasses and hearing aids as prescribed. Recommend driver-refresher classes, like those offered by AARP. Refer to a certified driving specialist for an on-road driving assessment. Advise avoiding high-risk driving situations (e.g., busy interstates, bad weather). Report unsafe drivers to the state Department of Motor Vehicles if necessary.

Answer 131

Physiologic Changes of Aging and Health Conditions: Presbyopia, reduced sense of touch, decreased reaction time, peripheral neuropathy, arthritis, gait instability, weakness, history of falls, advanced age, multiple illnesses, visual impairment, nocturia, sleep disorders, cognitive decline, substance use, inadequate nutrition, relocation stress, and frailty. Medication Use: Polypharmacy, psychoactive medications, opioids, hypertension drugs, recent medication changes, and drugs increasing confusion or mobility limitations. Environmental Hazards: Home hazards (most accidents occur at home) and slippery or scattered surfaces increase fall risk.

Answer 132

*Medication assessment every 6 months or more *Collaborate with patient, family, providers, pharmacist *Promote adherence to drug regiment therapy exactly as prescribed *Encourage lifestyle changes and non-pharmacologic interventions. *Remind not to share/borrow drugs

Answer 133

Persistent pain Depression PTSD Severe anxiety Substance use disorder Homelessness.

Answer 134

More than one in four older adults experience at least one fall each year. * Falls are a primary cause of decreased mobility and chronic pain in old age. * Falls can lead to serious injuries such as fractures and head trauma. * Severe limitations in mobility are associated with increased falls that often lead to negative health outcomes. * Some individuals develop fallophobia, a fear of falling, which can cause them to avoid leaving their homes

Answer 135

Drug therapy Psychotherapy Reminiscence Music therapies

Answer 136

The 65-and-older population grew by 34.2% from the previous decade and by 3.2% from 2018 to 2019 The first Baby Boomers reached 65 years old in 2011 and since then, there’s been a rapid increase in the size of the 65 -and-older population, which grew by over a third since 2010. No other age group saw such a fast increase. In 2018, 52 million people age 65 and over lived in the United States, accounting for 16 percent of the total population. The older population in 2030 is projected to be more than twice as large an in 2000, growing from 35 million to 73 million and representing 21 percent of the total US population 122 percent of the population age 65 and over report having a disability as defines as having a lot of difficulty or being unable to do at least one of the following domains: vision, hearing, mobility, communication, cognition, or self-care Only 10% live in long-term health care facilities 2022 Leading causes of death for those over 65: Heart disease, cancer, COVID-19.

Answer 137

most common form of dementia (dementia = broad term meaning slow prog. Cog. decline) potential causes for the increase in motor vehicle crashes among older adults May be influenced by substance use

Answer 138

the second most common dementia dementia that results from a vascular disorder

Answer 139

1. Delirium Index (DI) 2. NEECHAM Confusion Scale 3. Mini-Cog

Answer 140

The ARPS is specifically designed for older adults, recognizing that age-related physiological changes, declining health, and medication use can increase the risk of alcohol-related problems at lower levels of consumption

Answer 141

Working to ensure high-quality care for all hospitalized patients aged 65 years and older . Some health care systems have established Acute Care of the Elderly (ACE) units. These units are staffed with geriatric resource nurses and geriatric clinical nurse specialists Patients in ACE units are cared for by geriatricians who specialize in the care of older adults . Programs are incentivized by the Nurses Improving Care for Healthsystem Elders (NICHE) project (continuously generates evidence-based practice guidelines for older-adult care)

Answer 142

Acute and Chronic Confusion Avoid multiple drugs Promote adequate sleep Provide comfort NPSG- Joint Commission’s National Patient Safety Goals fall risk assessment Assess for risk factors

Answer 143

use admission and daily fall risk assessment tools for older patients specific standards that limit the use of physical restraints in hospitals and nursing homes

Answer 144

Use least restrictive device first Check pt every 30-60 minutes Release restraints every 1-2 hours turn , reposition, toilet

Answer 145

*Poor care coordination leads to high readmission rates, ED and PHCP visits *Establish system to address patients’ communication needs *Follow up after discharge *“Health coach” can be used

Answer 146

Assess functional and communication abilities for normal ADL’s Atypical signs/symptoms – muted illness – illness may not be recognized Less reserve, they need more time to recover = more risk for problems Gradual decline in function Unhealthy lifestyles - smoking, substance abuse, stress Rapid decline in function Acute illness – MI, hip fracture, CVA Confusion / Dementia – NOT normal aging

Answer 147

Neurosensory: Changes in vision (presbyopia), hearing (presbycusis), taste, smell, and proprioception. Cardiovascular: Decreased myocardial contractility. Pulmonary/Respiratory: Decreased lung capacity. Gastrointestinal: Slower digestion, constipation. Genitourinary: Kidney function decline. Musculoskeletal: Muscle mass and bone density decline. Integumentary: Skin thinning, wrinkles. Metabolic: Slower metabolism, weight gain. Reproductive: Changes in sexual function for both men and women.

Answer 148

Having a yearly physical examination and more frequent visits if health problems occur. Reducing dietary fat to not more than 30% of calories, with saturated fat providing less than 10%. Increasing daily dietary intake of complex carbohydrates and fiber, with five or more servings of fruits and vegetables and six or more servings of grains. Increasing calcium intake to between 1000 and 1500 mg daily and taking a vitamin D supplement as recommended. Allowing 10 to 15 minutes of sun exposure two to three times weekly for vitamin D intake, while avoiding prolonged exposure and using sunscreen. Exercising regularly three to five times a week. Managing stress through successful coping mechanisms. Socializing with people in different settings. Reminiscing about life through discussions or journaling. Teaching about balanced diets, fiber, fluid intake, and awareness of sensory and dental issues. Encouraging exercise and physical activity (even chair exercises for those with limited mobility) to maintain balance and prevent falls. Health promotion for stress and coping includes teaching coping mechanisms and supporting social connections. Accident prevention focuses on fall prevention, home modifications, and cautious medication use. Drug use and misuse: Educate about polypharmacy, drug interactions, and regular medication assessments (e.g., using the Beers Criteria). Inadequate cognition: Promote cognition through cognitive training, physical activity, social engagement, and proper nutrition. Substance use disorder: Health promotion includes decreasing or avoiding alcohol and illicit drugs, using screening tools like the SMAST-G and CAGE questionnaire. Elder neglect and abuse: Raising awareness and preventing abuse in older adults.

Answer 149

Health Care: Insurance, Medicare, Social Security, Advance Directives. Abuse & Institutionalization: Recognizing signs and knowing when to refer.

Answer 150

Middle Adulthood: 40-65 years: Conflict: Generativity vs. Stagnation Important Event: Parenting Description: the adult's ability to care for another person. *Does the adult have the ability to care and guide the next generation?. * Each adult must have some way to satisfy and support the next generation. Elements for a positive outcome: *To have and nurture children and/or become involved with future generations. Elements for a negative outcome: *An individual must deal with issues they are concerned with or it can lead to stagnation in later life. Examples: In this stage an adult will be concerned with issues such as: the future of the environment, what kind of world will we leave the next generation, equality for all people, etc.

Answer 151

*Maturity Age: Late Adulthood -- 65 years to death * Conflict: Integrity vs. Despair *Important Event: Reflection on and acceptance of one's life Description: event at this stage is coming to accept one's whole life and reflecting on that life in a positive manner. According to Erikson, achieving a sense of integrity means fully accepting oneself and coming to terms with death. Accepting responsibility for your life and being able to undo the past and achieve satisfaction Elements for a positive outcome: *The adult feels a sense of fulfillment about life and accepts death as an unavoidable reality. Elements for a negative outcome: * Individuals who are unable to obtain a feeling of fulfillment and completeness will despair and fear death. Examples: An aged person may find it necessary to reflect and analyze what they have accumulated throughout life and decide what offspring will receive from them upon death.

Answer 152

Communication: Sensory Deprevation/Overload changes may affect how older adults communicate. Self Concept: Acceptance of physical and emotional changes. Cultural Identity: Varied views on aging across cultures. Social Support: Importance of family, friends, and caregivers. Spirituality: Role of religion and coping with death. *Health Care Delivery Systems / Community Based Resources *Financial Implications *Legal and Ethical Issues *Evidenced Based Practice – Quality of Care Improvement *AARP – Grey Panthers formerly the American Association of Retired Persons *Programs developed to improve life for older adults so that they can remain in their homes within their communities *Provider of driver-refresher classes aimed at enhancing the safety of older drivers

Answer 153

* Age-related factors * Sensory losses * visual - presbyopia * auditory - presbycusis * olfactory * gustatory * kinesthetic * tactile * proprioceptive * speech * Impacts appearance and body image * Sensory deprivation vs. overload

Answer 154

Acknowledgment of changes or difficulty accepting changes Living situation: multigenerational vs. seniors only – independent vs. assisted Balance of solitude and social interaction versus social isolation impacts growth and self-actualization

Answer 155

Who is the family or significant other(s)? What are the relationships? What is the role of the significant other(s) in the older adult’s life? Social support Physical support Who is/are the caregiver(s)? Must be included in decision-making What are the needs of the caregiver(s)? Nurse’s role?

Answer 156

Varied views and value of: Age, life, health, family support, spirituality European/American cultures, value of: youth, beauty, thinness, independence, productivity, age Hispanic/Black/Asian cultures, value of: elders , respect for age, increased family support, decreased institutionalization Nursing: unique cultures/family patterns respected

Answer 157

* Role of religion: pattern throughout life * Nurses respect differences: * assist to express feelings and needs * collaborate with family and spiritual advisor * When a patient is dying: * stages of grieving: denial, anger, bargaining, depression, acceptance - * patient vs. family When a patient is dying: Collaboration and Teamwork: advance directives, spiritual advisor, death and burial arrangements, unfinished business, hospice widow/widowers support groups—senior centers, churches Nurses grieve as well: colleague support assist in debriefing caring enriches life and prevents burnout

Answer 158

Patricia Bloom MD stated that “87% of married men and 89% of married women in the 60-64 age range.” And for those over 80, Bloom reports that 29% of men and 25% of women still engage in sexual activity. How do different groups in our society experience the aging process? Are there any experiences that are universal, or do different populations have different experiences? An emerging field of study looks at how lesbian, gay, bisexual, and transgendered (LGBT) people experience the aging process and how their experience differs from that of other groups or the dominant group....., but the number of LGBT seniors is expected to double by 2030 (Fredriksen-Goldsen et al.2011).

Answer 159

* Testosterone * Pubic hair * Scrotum * Penis * Seminal fluid * Ejaculation * Prostate * Bladder Male Aging Changes Prostate BPH= Benign Prostate Hyperplasia: a condition where there is an increased number of cells in a tissue or organ Complications Urinary Obstruction Cancer

Answer 160

* Menopause * Mons Pubis * Pubic Hair * Labia, Clitoris * Vagina * Bartholin’s Glands * Ovaries & Uterus * Breasts Abnormal Female Aging Changes Cancer Breast, Uterine Ovarian, Cervical Uterine Prolapse Urinary Incontinence Cystocele, Rectocele Vaginal Infections Dyspareunia

Answer 161

* Cancer Recognition Checks * Manual Prostate Checks * PSA Test * Recognition of Urination Pattern Changes * Treatment for Erectile Dysfunction * Teaching * Medication

Answer 162

* Menopause Symptom Management * Cancer Recognition Checks * Breast Self Exam - BSE * Mammogram * PAP Smear * Recognition of Abnormal Vaginal Discharge * Recognition of Changes in Urination Pattern * Incontinence * Kegel Exercises * Protection/Hygiene * Medication * Treatment for Dyspareunia * Teaching * Medication

Answer 163

Lack of a partner Negative body image Fear of rejection Physical disability Cultural and Social stereotypes Other stresses of aging

Answer 164

* Early in day * Before heavy meal * NTG-nitroglycerin beforehand if cardiac output deficiency * Use pillows, different positions – consider arthritic changes * Alternatives * Affection, Foreplay * Open Communication

Answer 165

* Emphasize normalcy of sexual activity * Expected physiologic changes * Cancer recognition tests * Hormone replacement therapy * Dyspareunia