Geriatric Nursing Flashcards
5 Geriatric Syndromes (DIFFP)
- Delirium, dementia, depression
- Incontinence
- Falls
- Functional decline
- Pressure ulcers
Other Geriatric Syndromes
a. Nutrition and weight loss
b. sarcopenia
c. dizziness and syncope
Ageism
“deep and profound prejudice against the elderly which is found to some degree in all of us..results in older persons being categorized as senile, rigid, and old-fashioned in morality and skills”
“Bed blockers”
older adults in acute care beds waiting for long term care - framed as blocking the bed for someone who needs it more
“GOMER”
Get out of my ER
Elderspeak
speaking to elder like children, patronizing tone
Non-specific diagnoses
“failure to cope/thrive”
Doesn’t mean anything about care
Seems to blame patient..who’s failure is it?
Consequences of Ageism
a. less likely to be referred to surgery
b. less willing to implement therapeutic strategies to help suicidal OAs
c. using wrong demographic assessments
d. the more negative the nurses’ attitudes, the shorter and more task-oriented their conversations
Syncope
temporary loss of consciousness due to lack of blood flow to the brain
Geriatric Syndromes
- a category of diagnoses
- multiple underlying factors involving multiple organ systems
- associated with substantial morbidity and poor outcomes, impact quality of life and disability
“multifactorial health conditions that occur when accumulated effects of impairments in multiple systems render person vulnerable to situational challenges”
Shared risk factors
- older age
- cognitive impairment
- functional impairment
- impaired mobility
- poor nutritional status
- female gender
- depressive symptoms
All shared risk factors can lead to frailty, a hallmark of geriatric syndromes
frailty causes GS, or GS causes frailty
Multifactorial Complexity
models for targeting pathophysiological relevant mechanism
a. linear (risk > early disease > advanced disease)
- does not capture complexity of GS
b. concentric
- intervention targeting one risk factor only addresses small portion of overall risk
c. interactive concentric
- risk factor synergism, design of interventions to target multiple risk factors
Presbycusis
sensorineural hearing loss; degeneration of hair cells in the cochlea and otic nerve loss (inner ear) resulting in impaired transmission of sound waves to wave
Risk factors: aging, exposure to loud noice, caucasian, ear structure damage
Impact of hearing loss
a. reduced quality of life of affected person
b. impeded self-care, loss of independence (OAs)
c. increased burden of communication, poorer relationship satisfaction (caregiver)
d. reduced speech understanding and ability to engage in society (society)
Relevance of hearing loss on cognition
sensory impairments increase risk for costly health outcomes
Age Related Hearing Loss associated with poorer cognitive functioning and incident dementia
- effect on cortical processing
- increased cognitive load
- social isolation
Strong link between hearing loss and loss of cognition
Hearing interventions
a. pocket talker (microphone)
b. hearing aids
c. cochlear implant surgery (only for profoundly deaf)
d. text message phone with closed captioning
e. Formal hearing assessment (Weber test, Rinne test)
f. community-based interventions are needed (integrate technologies)
Visual Impairment (Dev considerations)
a. extraocular - lower lid can turn inward/outward leading to dry eyes
b. ocular changes - glaucoma, light fractures, external glare, colour perception reduced
c. intraocular - less rods leading to reduced peripheral vision and colour clarity
Impact of vision impairment
a. reduced quality of life
b. increased chance of mortality and institutionalization
Vision interventions
a. glasses
b. technological devices (talking clocks and read out loud devices)
c. audiobooks and podcasts
d. magnifying glasses
e. cutlery that is bright red/orange
f. adequate lighting in the room
Dual sensory loss
Combination loss of hearing and sight
Impact:
a. further challenges cognitive functioning
b. poorer quality of life
c. increased depression
d. increase mortality risk
Communication with older adults
Influenced by their life experience, what the norm was at their time when they were younger
- use person-centred care
- “they are who they have always been”
Generational power
a. older adults (>65)
- influenced by austerity
- war
- respect for authority, pride in being responsible, cautious, family-oriented
b. baby boomers (50-64)
- less trusting of authority
- like to have control, equality, advocacy, sandwich generation taking care of parents and children
c. gen x (<50)
Clinical Communication Strategies
- Ask permission
- shows they have a voice and choice, hand over control - Show you care
- person-oriented, what they value - Work together
- Agree on next steps
- mutual understanding
Strategies for Effective Communication
Hearing
a. do not shout
b. do not assume hearing loss
c. inappropriate responses, inattentiveness may be signs of hearing loss
d. gain individual’s attention before you speak
e. determine if hearing is better in one ear and position accordingly
Vision
a. make sure you have person’s attention before you speak
b. get down to person’s eye level and face them when speaking
c. speak normally
d. do not rearrange room or personal items without permission
e. speak promptly, state who you are and when you are leaving
Cognitive impairment
a. one-step instructions
b. speak slowly
c. allow time for response
d. reduce distractions
e. one person at a time
