Geriatric Nursing Today and in the Future

Question 1

What is Robert Butler’s (1975) definition of ageism?

Answer 1

A deep and profound prejudice against the
elderly which is found to some degree in all of us, which results in older persons being “categorized as senile, rigid, and old-fashioned in morality and skills.”

Question 2

The Institute of Medicine (2008) reports [NEGATIVE/POSITIVE] attitudes toward older adults persist in the health care community and across professional disciplines

Answer 2

Negative

Question 3

Why might health care professionals have a biased view of older adults, compared to the general population’s view of OA?

Answer 3

Because they tend to see and treat only the most frail, and sick older
people (Kearney et al, 2000)

Question 4

What are some examples of ageism in health care?

Answer 4

• “Bed blockers”
• “Pleasantly confused”
• ”GOMER”
• Elderspeak
• Non-specific diagnoses (“failure to cope”) (25%)
• Less likely to be referred for surgery (Peake, 2003)
• Less willing to implement therapeutic strategies to help older suicidal patients (Barnow et al. 2004).

Question 5

Caris-Verhallen et al. (1999) found that nurses’ negative attitudes toward older adults reflected in their care in which ways?

Answer 5

The more negative the nurses’ attitudes, the shorter, more superficial, and more task-oriented their conversations with older patients were. The nurses tended to speak to older patients in a patronizing tone, and did not involve them in consultations or decisions

Question 6

How can “geriatric syndromes” best be defined?

Answer 6

A categorical term used to capture those clinical conditions in older persons that do not fit into discrete disease categories

Question 7

What is the relationship between an OA’s chief complaint and their true diagnosis?

Answer 7

Chief complaint does NOT represent the specific pathologic condition underlying the change in health status

Question 8

What are the main risk factors for geriatric syndromes, and which can be managed by nurses?

Answer 8

• Older age
• Cognitive impairment*
• Functional impairment*
• Impaired mobility*
• Poor Nutritional status*
• Female gender
• Depressive symptoms* (Chen et al. 2010)

Question 9

Describe multifactorial complexity and how it is useful for understanding geriatric syndromes

Answer 9

-Complex interactions between an individual’s vulnerabilities and exposure to
specific challenges, including non-biological considerations like social
determinants of health/economics/social domains
-Model offers a locus of where to target interventions of multiple pathways
contributing to geriatric syndromes

Question 10

What are some characteristics of older adults entering the health care system?

Answer 10

• Advanced age
• Heterogeneous group
• Co-existing multiple chronic health problems
• Changes in function, cognition and nutritional status
• = Increased vulnerability for adverse outcomes

Question 11

According to Lin (2011) what proportion of people over 70 yrs have a significant hearing impairment?

Answer 11

2/3

Question 12

How often does the prevalence of hearing loss double?

Answer 12

Every decade

Question 13

What is presbycusis?

Answer 13

Sensorineural hearing loss, caused by degeneration of hair cells in the cochlea and otic nerve loss (inner ear) = transmission of sound waves to the
brain is impaired

Question 14

What are risk factors for presbycusis?

Answer 14

• Aging
• exposure to loud noise
• Caucasian race
• ear structure damage

Question 15

What is the subjective experience of having presbycusis?

Answer 15

• Harder to hear consonant sounds
• Women’s voices and children’s voices are harder to hear; hard to talk on the phone
• Harder to hear in noisy environments; can’t separate the target voice from background noise

Question 16

What are some potential impacts of hearing loss on the older adult?

Answer 16

• impedes self-care and management of other chronic health conditions (e.g. receiving education about health issues)
• Loss of independence contributes to the higher rates of hospitalization
• Loss of independence adversely affects caregivers, leading to collateral third-person
disability in social and daily functioning.

Question 17

How does an OA’s hearing loss affect their caregiver?

Answer 17

Communication partners experience restricted social life, increased burden of communication, and poorer quality of life and relationship satisfaction

Question 18

How does hearing loss in OAs affect society as a whole?

Answer 18

Reduced speech understanding reduces the ability of the person to engage in
society (e.g., engaging in employment, attending social events/being active
community member)

Question 19

Sensory impairments increase the risk for costly health outcomes such as:

Answer 19

disability, depression, cognitive impairment,

and dementia

Question 20

Age-related hearing loss has been found to be INDEPENDENTLY associated with which 2 outcomes

Answer 20

Poorer cognitive functioning and incident dementia

Question 21

Compared to those with normal hearing, seniors with mild, moderate,
and severe hearing loss had a ___x, ___,x and ___x increased risk of developing
dementia, respectively

Answer 21

2x, 3x, 5x

Question 22

Which mechanisms may cause the link between hearing loss and dementia

Answer 22

• the effects of hearing loss on cortical processing (IFA, 2013)
• increasing cognitive load (Rogers & Langa, 2010)
• social isolation

Question 23

What are some technological hearing interventions?

Answer 23

• Pocket talker; directional microphones (noise cancellation algorithms,
and wireless capabilities that allow seamless integration with
smartphones).
• updated hearing aids ( only improves hearing by about 50%)
• cochlear implant surgery for those who are profoundly deaf
•Text message phone devices with closed captioning

Question 24

What is a Formal Hearing Assessment? What tests does it involve? What are the limitations of this assessment?

Answer 24

• Clinic-based audiologic evaluation
with audiologist
• Hearing tests: Weber test (tuning fork on the forehead); Rinne test
(tuning fork on mastoid process)
• Follow-up appointments for hearing aid fitting and adjustments is a
model of care that remains inaccessible (Lin, 2012)

Question 25

_________-____ ____________ are needed to ensure that older adults are able to integrate hearing technologies in their lives

Answer 25

Community-based interventions

Question 26

What % of people who need hearing aids actually wear them?

Answer 26

15%

Question 27

What % of adults over 65 wear glasses for close vision?

Answer 27

95%

Question 28

Which 3 categories of structural/functional changes in vision discussed in class cause visual impairment?

Answer 28

• Extraocular – lower lid can turn inward or outward leading to dry eye
• Ocular changes – glaucoma; light fractures; external glare is a problem; colour perception reduced
• Intraocular – less rods reduction in peripheral vision; colour clarity reduced

Question 29

What are some interventions for visual impairment?

Answer 29

• Glasses (most have outdated prescriptions; lost or broken)
• Technological devices for low vision: talking clocks, read out loud devices
• Audiobooks, podcasts
• Magnifying glasses
• Cutlery that is bright red or orange
• Make sure adequate lighting in the room

Question 30

What is the impact of dual sensory loss on the older adult’s life?

Answer 30

Dual sensory loss further challenges cognitive functioning (Heyl & Wahl, 2012) and is associated with poorer quality of life,
increased depression, and increased mortality risk

Question 31

Explain the quote “Men resemble the times than they do their fathers”

Answer 31

Members of a generation are linked through their life experiences in their formative years (teens and early 20’s)

• We are influenced not so much by how old we are but what the times were like when we were young – get to know your older adult!

Question 32

What was happening in the world in the 1950s that may impact an OA’s worldview?

Answer 32

Korean war; Vietnam war starts -30,000
Canadians served ; The Civil Rights Movement speaking out against inequality and injustice; Elvis Presley/Rock and Roll; communist regime in China

Question 33

What was happening in the world in the 1960s?

Answer 33

Cuban missile crisis; JFK assassination;

MLK assassination; Woodstock; man on the moon

Question 34

What are some generalizations to be made about older adults aged 80+, based on the era they were born into?

How can you use this to provide them person-centred nursing care?

Answer 34

• Influenced by austerity – influenced by tough times, saving food; storing items.
• War – seen family and friends go off to war and never come back
• Characteristics in older adults
are respect for authority; prides themselves on being very responsible; cautious; focused on family

• Establish trust; talk about your family

Question 35

What are some generalizations to be made about baby boomers (1946-1964), based on the era they were born into?

How can you use this to provide them person-centred nursing care?

Answer 35

• More privileged, as many grew up during a period of increasing affluence due in part to widespread post-war government subsidies in housing and education;
• less trusting of authority; like to have control; equality; advocacy; stressful lives and want simplification; sandwich
generation

Question 36

What are some practical considerations to keep in mind when communicating & caring for older adults?

Answer 36

• Older adults need more time to give you
information because they have a long range of life experiences to draw from
• They need time to sort through thoughts; nouns and names might be challenging to retrieve
• Your position relative to their position
• Pay attention to their facial expressions, body language – did they hear you?
• Distrust – fear that disclosing information will have consequences (e.g. take away license, have to leave their home)

Question 37

What are the 4 clinical communication strategies discussed in class? Name some examples of each strategy.

Answer 37

1. Ask permission (May I come in?)
2. Show you care (Stop, sit, focus, make eye contact)
3. Work together (Ask open ended qs, offer choices, personalize the data)
4. Agree on next steps (focus on top 3 things, verify understanding, establish what happens next and follow through)

Question 38

Identify 5 strategies for effective communication for hearing loss.

Answer 38

1. Do not shout – it increases pitch and makes it harder to hear
2. Determine if hearing is better in one ear than the other and position yourself accordingly
3. If hearing aid is used, make sure it is in place and battery is functioning
4. Use nonverbal approaches such as gestures, demonstrations, visual aids, written materials
5. Face the individual and don’t turn away when using verbal communication

Question 39

Identify 5 strategies for effective communication with vision loss.

Answer 39

1. Make sure you have the person’s attention before you start speaking.
2. Speak normally but not from a distance; do not raise or lower your voice, and continue to use gestures if that is natural for you
3. Always speak promptly and introduce yourself and others with you. State when you are leaving to make the person aware of your departure
4. When others are present address the visually impaired person by using their name as a preface
5. Use large, dark, evenly spaced printing and contrast in printed material

Question 40

Identify 5 strategies for effective communication with cognitive impairment.

Answer 40

1. Give one-step directions
2. Reduce distractions
3. Give clues and cues/ use gestures to pantomime an instruction
4. Follow the person’s lead, allowing the person to choose topics to discuss
5. Limit corrections and do not try to bring the person to reality – go where the person is and enjoy the conversation