Gero 1 Flashcards
Defining Aging
- described since birth
- old is 65; qualifies for retirement benefits
- biological aging based on cellular decline
- sociological aging is based on changes in roles and relationship
- psychological aging is based on aging as a developmental stage fo through
marital status
- 70% of people 65 and older are married
- older men are more likely to be married than older women
- women outlive men
- marital status impacts income, mobility, housing, intimacy, and social interaction
struggles of elderly women
- twice as likely to be poor
- pay inequity, occupational differnces
- rising health care cost
Financial status
- major source of income: social security
- half of older adults had less than 24,224 in yearly income
- poverty is major issue
- poverty: gender and race
Health concerns
- 80% of older adults have at least 1 chronic condition
- leading cause of death among older adults: heart disease, cancer, chronic lower res. disease, stroke, Alzheimer’s disease, and diabetes
- most common health concerns: arthritis and hypertension
comorbidities
more than 1 chronic diseases
cultural groups
- the largest growth in older adults is Hispanic pop
- united states is rich w diversity
- immigrant pop growing
- intergenerational conflict
- adaptation to institutional norms
ageism
- prejudice against older adults
- media portrayal of aging
- one’s attitude towards aging depends on culture and history
ADLS
activities of daily living
IADLs
instrumental activities of daily living
aging in place
remain were they live- own home
acute care
acute conditions with chronic issues (comorbidities)
Dangers- drug reactions, falls, immobility, confusion
Other issues- sepsis, nutritional status, never events/ wounds
Nursing care- promotion of safety, assessment of baseline function, goal is to max independence, and enhance functioning
Subacute care
pt are stable but still actue, do not need daily physician visits, services like rehab, IV therapy
Rehab units
located in hospital, subacute care, SNF
- goal is rehab to return to original place
community-based residential facility (CBRF)
a place where 5 or more unrelated people live together in a community setting
services provided include room and board, supervision, support services, and may include up to 3 hours of nursing care per week
Residential care apartment complexes (RCAC)
independent apartment units in which the following services are provided: room and board, up to 28 hours per week of supportive care, personal care and nursing services
Adult family home (AFH)
3-4 adults reside and receive care, treatment, or services that are above the level of room and board
SNF
the decision to move in depends on pt physical/cognitive needs, support system, community resources
emphasis on quality of life and residents rights
Resident assessments
RAI- ongoing comprehensive assessment of the resident, focusing on functional abilities - long term
- hearing & speech, vision, cognition, mood, behavior, routines, functional status (incontinence), bladder and bowel, active disease, oral health, skin, nutrition, meds
Home care
multiple services or just a few
criteria: must have skilled care needed, person must be homebound, require intermittent care
must have physicians statement supporting need for homecare
OASIS
-outcome and assessment info set
- mandated by CMS for performance improvement in home care
community programs and services
senior centers, adult day care, respite care, homemaker services
medicare
federal health insurance program
Medicaid
combo of state and federal funds to pay for SNF
legal and ethical issues
common concerns: capacity and competence to make own decisions, identification of decision makers, conflict about care, disclosure of info, long-term care decisions, end of life, fraud
OBRA
omnibus Budget Reconciliation act of 1987
major reform of nursing facilities
major parts: provision of services for nursing facilities, survey and certification process, enforcement of regulations
resident empowerment and rights
quality of care
- focus on SNF
- three major areas: reduce overuse of antipsychotics, reduce inappropriate use of restraints, reduce inappropriate use of indwelling urinary cath
resident rights
resident bill of rights
Older Americans Act (OAA)
directs states to provide various services for older adults
ombudsmen
a person to come in and speak up for residents of that facility
health insurance portability and accountability act of 1996 (HIPPA)
privacy and insurance coverage
abusive and protective servicies
- neglect
- abuse - domestic- individual with a special relationship, institutional - facility caregiver, self-abuse
-exploitation - mistreatment
-physical, sexual, emotional
The nurse as an interviewer
communication techniques, attitude, respect, consider barriers, be aware of verbal and non- verbal communication
education
teaching the individual in a place that feels safe for them and assessing their personal needs to learn in an environment
components of the assessment
health history, physical assessment, specific assessments (functional, adl, fall, nutritional)
factors that affect the norm - lab values, atypical presentation of illness, loss or decrease in compensatory reserve, and decrease immune response
Physical assessment
challenges with assessment - nonspecific signs and symptoms, reduced energy level, pain, sensory deficits, multiple health issues
sensory changes
can lead to anxiety
causes of deprivation
-reduced sensory capacities
-restrictive, monotonous environments
sensory overload
-usually related to abrupt changes or hospital delirium
sensory changes 2
smell - decreased
taste - modest decrease
tactile - decreases skin changes, and decreased functioning of sensory neurons
eyes and vision - cataracts, glaucoma, need for more light, yellowing of lenses, decreased color and clarity
auditory - presbycusis
Integumentary
skin assessment - determine hydration status, potential for infection
changes in older adults
- decreased thickness, elasticity
- dry skin
- decrease vascular supply to skin and glands - decreased sweating
- decreased sensation
- decrease subq fat - body cooling system
hair - melanin decreases (hair turns gray)
hair loss
men - increase hair in ears, nose, and eyebrows
women- hair on face and chin (change in hormonal influences
nails- brittle, flat
Benign skin conditions
uneven pigmentation - age spots
seborrheic keratoses - think, brown raised lesions
cherry angiomas - increased vascularity in the dermis
skin tags - small flesh-colored tumors
dermatoporosis
chronic skin fragility
35% of older adults
skin changes
actinic purpura
white pseudoscars
arterial ulcers
- pain w exercise or rest
-cramping, burning, aching
-cool, thin, shiny, dry - loss of hair
- thick toenails
- ulcers - well defined, outer ankle, feet, toes
treatment - revascularization
venous ulcers
stasis ulcers
brownish skin discoloration (accumulation of erythrocytes)
medical aspect of lower leg
flat, shallow, exudate
treatment - prolonged elevation and compression therapy
diabetic lesions
neuropathy - risk factor
foot inspection and care
risk for amputation
pressure injury assessment
major risk factors
-shearing
-friction
-moisture
-nutritional status (protein deficiency)
Muscko
changes in stature and posture
decrease bone density
decrease joint movement
vertebral disc height thins
less flexibility
sarcopenia - age-related changes to muscles
-tissue mass decreases
-decreased strength and stamina
nursing implications
- mobility; assisted devices
- increase risk of falls
atherosclerosis
plac build-up , black stuff that builds up - not normal
arteriosclerosis
normal hardening of arterial walls
cardiovascular
arterial wall thickening and stiffening
left ventricular and atrial hypertrophy
sclerosis of atrial and mitral valves
strong arterial pulses, diminished peripheral pulses, cool extremities
decreased cardiac reserve and efficiency
respiratory
decreased respiratory muscle strength; stiffer chest wall
diminished ciliary & macrophage activity, drier mucus membranes
decreased cough reflex
increase risk of aspiration
decreased lung capacity
renal and urological
loss of nephrons, kidney mass, ability to concentrate urine, decreased kidney size and decreased blood flow to kidneys, decreased glomerular filtration rate (GFR), unable to tolerate dehydration or fluid overload as well as a younger adult, itching, edema, raised BP
digestion and nutrition
decreased sensitivity to insulin
changes in dental health
decreased taste buds and salivary secretions
decreased digestive juices
GERD
decreased absorption of nutrients
constipation is not a normal part of aging
Nervous system
most changes in aging are seen in CNS - decrease brain weight and size
loss of deep sleep
subtle changes in cognitive and motor functioning and balance
slower PNS functioning, prolonged recovery
increase risk of falls
reproductive system
women - menopause, structural changes typical of aging muscles and skin, vaginal dryness
men - able to procreate entire lives following puberty, but structure changes may interfere with sperm motility. BPH (Benign prostatic hypertension) is another common issue
other changes
decrease antibodies
slower healing
reduce cellular immunity
lean body mass declines and body water is lost
temp regulation issues
SPICES
-sleep disorders
-problems w eating or feeding
-incontinence
-confusion
-evidence of falls
-skin breakdown
functional assessment
- important because actual age does not reveal individual ability
- hospitalized older adults are at risk for loss of function skills
- loss of function is the major cause of institutionalization
goals of functional assessment
- restore/ improve health
- monitor changes in health
- enhance independence
- identify disabilities
- screen for issues needing further assessment and referral
- evaluate need for community resources, equipment
components of the functional assessment
- environmental
- physical
- psychological
- socio - economical
mobility
upper extremity
-touch palms to back of head
-reach up over the head
-tough hands together behind waist
lower extremity
-get up and go test
indications for therapy
fall risk assessment
tinettie balance and gait evaluation
morse fall scale
hendrich II scale
cognitive assessment
short portable mental status questionnaire
mini-mental state exam
mini-cog
