3403: EXAM ONE

Intimacy

"A warm, meaningful feeling of joy" Five relational components: -Commitment -Affective intimacy -Cognitive intimacy -Physical intimacy -Interdependence

Myth 2: You'll Become Frail

-1/3 of people 65+ fall every year -Due in part to decrease in blood flow to the cerebellum (balancing center of brain) and inner ear and vision changes -Check your balance and strength -Be careful with blood pressure meds as they sometimes lower bp too much, causing dizziness when you stand and increasing risk of falls

Why is oral health important?

-A basic need -Age-related changes in the oral cavity, medical conditions, poor dental hygiene, and lack of dental care -Poor oral health is a risk factor for dehydration, malnutrition, and a number of systemic diseases -Pain from infected teeth, ill-fitting dentures, or oral candidiasis can limit eating ability and compromise comfort and quality of life

Retirement

-A developmental stage that may occupy 30 or more years of one's life -Stress associated with role changes -Growing concern for economic support for retirees -44% of retirees work for pay at some point after retirement (some for economic need and some for involvement) -Role changes - effect everyone in the family, involved different expectations (housework, child care for family members, social, identity crisis)

TeamSTEPPS® is a teamwork system designed for health care professionals that is:

-A powerful solution to improving patient safety within your organization. -An evidence-based teamwork system to improve communication and teamwork skills among health care professionals. -A source for ready-to-use materials and a training curriculum to successfully integrate teamwork principles into all areas of your health care system. -Scientifically rooted in more than 20 years of research and lessons from the application of teamwork principles. -Developed by Department of Defense's -Patient Safety Program in collaboration with the Agency for Healthcare Research and Quality.

TeamSTEPPS has a three-phased process aimed at creating and sustaining a culture of safety with:

-A pretraining assessment for site readiness. -Training for onsite trainers and health care staff. -Implementation and sustainment.

In most legal proceedings claiming that a patient's right to informed consent has been violated, plaintiffs are required to prove four elements if their action is to succeed:

-A specific risk that was not disclosed was involved with the procedure. -The party obtaining consent violated the applicable standard of disclosure. -The undisclosed risk occurred. -The failure of the party to disclose the risk caused injury to the patient.

Reasons for lack of oral care

-Access -Varies by Socioeconomic Status -Transportation -NO Medicare coverage for oral health Access to dental care for older people may be limited and cost prohibitive -Those with the poorest oral health are economically disadvantaged, lack insurance, disabled, homebound, or institutionalized -If a seriously ill or institutionalized individual needs dental care, it can be challenging to have him or her transferred to a dental office -Medicare does not provide any coverage for oral health care services; Medicaid coverage varies

roles of involvement in health-related decision-making as

-Active. -Passive. -Collaborative. -Avoiding information.

Insomnia

-Affects sleep quality and quantity -that a person has difficulty falling asleep for at least 1 month and that impairment in daytime functioning results -Risk factor for cognitive decline -most common sleep disorder in the world

Pharmacologic Treatments

-Analgesics (nonopioid and opioid agents) and adjuvant medications (antidepressants, anticonvulsants, and herbal preparations) -Need to consider age-related changes and conditions, -Medications started at the lowest dose possible and titrated up -Around-the-clock dosing best for chronic pain

Sleep in Nursing Homes

-As many as 22% to 61% of hospitalized patients experience impaired sleep -Noise, light, physical problems, and staff interactions interfere with sleep -Nurses play critical role

Assessment of Oral Health

-Assessment of the mouth, teeth, and oral cavity can identify oral health problems and serve as an early warning for some diseases -The MDS 3.0 requires information obtained from an oral assessment -Federal regulations mandate an annual examination for residents of long-term care facilities

Maslow's Hierarchy of Needs

-Assumes that all people share the basic human needs -Some needs are more basic than others -Most basic needs must be met before higher order needs can be met Nurses use Maslow's hierarchy of needs to understand the interrelationships of basic human needs ( Fig. 6.3 ). Basic human needs are necessary for human survival and health (e.g., food, water, safety, and love). Although each person has unique needs, all people share basic human needs, and the extent to which people meet their basic needs is a major factor in determining their level of health.

Nursing Responsibilities with pain

-Assuring that the patient is comfortable and has the highest possible health-related quality of life -Countering myths, stereotypes, and generalizations about aging and pain

Barriers to pain management

-Attitudes and practices of nurses and other health care providers and from those in pain -Compliance with taking analgesic prescriptions -Underreports of pain -Cost of the medications and fear of side effects -Attributing pain to normal burdens of "old age," belief that nothing can be done, or the fear of addiction -Barriers higher in cultural/racial/ethnic groups that aren't of the highest norm in the setting -Time -Have to assess pain in nursing homes as part of medicare and Medicaid requirements

Signs of Sexual Abuse

-Bruises or scratches in the genital or breast area -Fear or an unusual amount of anxiety related to either routine or necessary exam of the anogenital area -Torn undergarments or presence of blood

chronic pain

-Can develop slowly or after acute -Includes pain of 75% of individuals -Goal? Reduction for quality of life -Examples include postoperative, procedural, or posttraumatic

Capacity

-Can the person understand a problem and decision? (risks/benefits, options, and consequences) -How do they do with performing tasks? -Who can declare a person "incapacitated"? ONLY THE COURTS

How can nurses help with decision making?

-Care transitions: safe to go home or not? -POLST: decision on CPR or not? -Listening to rounds -Family care

Signs of Psychological Abuse

-Caregiver does all of the talking in a situation, even though the elder is capable -Caregiver appears angry, frustrated, or indifferent while the elder appears hesitant or frightened -Caregiver or the care recipient aggressive toward one another or the nurse

Possible Reasons for Neglect by Caregivers

-Caregiver personal stress and exhaustion -Multiple role demands -Caregiver incompetence -Unawareness of importance of the neglected care -Financial burden of caregiving limiting resources available -Caregivers' own frailty and advanced age -Unawareness of community resources available for support and respite

Signs of medical abuse

-Caregiver repeatedly requesting procedures that are not recommended and not desired by elder

Risk factors for dysphagia

-Cerebrovascular accident (CVA, stroke) -Parkinson's disease -Neuromuscular disorders: amyotropic lateral sclerosis (ALS), multiple sclerosis (MS), myasthenia gravis, dystonia -Dementia -Head and Neck cancer -Traumatic Brain injury -Aspiration pneumonia -Inadequate feeding technique -poor dentition

Aging Changes: Eyes and Vision

-Changes are both functional and structural -Change in visual acuity and ability to adapt -Near vision decreases and lens thickens -Dry eyes -Eyelids droop -Color perception decreases (especially to see blue, purple and green) -Sensitivity to glare -Decline in peripheral vision -Intraocular fluid reabsorption down

Factors Influencing Identification of Abuse of Older Adults

-Cultural or societal tolerance of violence, especially against women -Shame and embarrassment -Fear of retaliation -Fear of institutionalization -Social isolation -Unacceptability of emotional expression, especially that of fear or distress

Nonpharmacologic Treatments for Pain in Older Adults

-Cutaneous nerve stimulation (heat and cold packs watch for risk of burns) -Transcutaneous electrical nerve stimulation -Acupuncture and acupressure- pain is impulses and needles are supposed to interrupt that pain message. -Touch-healing touch, reiki, along with relaxation. Ask for permission -Biofeedback-cognitive behavioral theory that a person can learn to control body and thus pain response. Hard and need full body functioning and dexterity. -Distraction-draw attention to something use. Slow breathing, guided imagery, humor, singing/tapping -Relaxation, meditation, and imagery-relieve tension and anxiety which adds to pain -Pain clinics-multidisciplinary approach-some focus on specific approach to pain. Goal is to decrease pain and improve quality of life.

Aging Changes: Ears

-Ear loves sag, elongate and wrinkle -Course hairs in ears -Hearing loss often occurs (especially high frequency sounds) -Ear wax changes (bigger changes in men)

In studies of older adults, resilience was defined as comprising five characteristics:

-Equanimity: a balanced perspective of life. -Meaningfulness: a sense of purpose in life. -Perseverance: the ability to keep going despite setbacks. -Existential aloneness: the recognition of one's unique path and the acceptance of one's life. -Self-reliance: the belief in one's self and capabilities.

Myth 3: You Will Have No Interest in Sex

-For women, estrogen and testosterone levels decline by menopause, which can lower the sex drive and make sex physically uncomfortable. -Many older men still have a strong sex drive but might have erection problem because of low blood flow to the penis as a result of clogged arteries stemming from such conditions as high cholesterol and blood pressure levels.

Aging Changes: Immunological

-Immunity is reduced with age -Oral temperature is lower -Decreased response to antigens means that white blood cell count will change slower after an infection -Immunoglobulins increase

Pain Interventions

-Is there a reversible cause? -What comfort measures are helpful for this person? -How much activity can they tolerate? -How can risk/benefits be balanced? -Uses a holistic approach because of the complex nature of pain in later life -Determine if there is a reversible cause, such as a uti or a fracture, and address accordingly -Comfort measures include use of pillows for support or body positioning, appropriate and comfortable seating and mattresses, frequent rest periods, and pacing of activities -Encourage the patient to stay as active as possible within his or her comfort range

basic characteristics of a capacity examination

-It must be regarded as a "snapshot" of a patient's mental status and decision-making ability at a particular point in time -t it is not a global assessment of the patient's mental status and ability to make a multitude of decisions -can require consideration of multiple factors

Older adults who are not resilient have

-Lack of social supports -Accumulated stressors -Unresolved grief -Preexisting psychiatric illness -Cognitive impairment -Inadequate coping resources

Aging Changes: Cardiovascular

-Left ventricle wall thickens decreasing the ability of the body to respond to increased circulation and oxygen needs -left atrium size increases -decrease in blood flow -increased risk of heart failure -longer recovery time -vascular system has a decrease in elasticity which decreases blood vessels recoil -stretching of veins

Health Related Decision-Making: Internal Factors

-Life context -Personal values and beliefs -Degree of involvement desired -Role expectations -Competence to understand the issues relevant to the decision -Decisional congruence

Factors affecting fulfillment of healthy eating

-Lifelong eating habits -Acute and chronic illness -Medication regimens -Ethnicity and culture -Ability to obtain and prepare food -Mood -Socialization -Socioeconomic deprivation -Transportation and housing -Food knowledge

Prevention of Elder Mistreatment

-Make professionals aware of potentially abusive situations. -Help families develop and nurture informal support systems. -Link families with support groups. -Teach families stress management techniques. -Arrange comprehensive care resources. -Provide counseling for troubled families.

Myth 4: Confusion and Memory Loss Are the Norm

-Mind does slow a bit -Brain neurochemicals change over time -Only up to 20% of people experience serious problems with thinking or memory

Changes based on sex: females

-More changes than men -Unable to have babies after ovulation: important physically and emotionally -Breasts are smaller and less firm, more saggy -Ovaries, uterus and cervix atrophy and get smaller -Estrogen levels decrease -Drying of the vagina

Elder mistreatment

-Most unrecognized and underreported social problems today -can include infliction of actual harm, a risk for harm to vulnerable older people through the action or behavior of others -it occurs irregardless of educational racial cultural religious socioeconomic background -it can occur in any and all family configurations and in every setting. elder abuse has far reaching effects -older adults who have been victims of violence have more health problems than other older adults

The Six Dimensions of Wellness and Cognition in Aging Adults

-Occupational Wellness -Social Wellness -Intellectual Wellness -Physical Wellness -Emotional Wellness -Spiritual Wellness

Common Aging Myths

-Older adults are disabled, ill, dependent and unattractive -Older adults are forgetful, confused, rigid, and unable to learn new info **Not true of all older adults -Knowledge of the elderly is outdated and of no value *Worth = productivity, and most of the elderly have left the work force

Myth 5: You'll Become Lonely and Depressed

-Older adults are no more likely than younger people to be depressed -Depression in older adults often stems from a loss associated with growing older

Nurses may work with people in different phases of retirement

-Participate in retirement education and counseling programs -Provide anticipatory guidance about transition to retirement -Identify those who may be at risk for lowered income and health concerns -Refer to appropriate resources -Advocate for policies and conditions that allow older people to maintain quality of life in retirement

PLISSIT Assessment of Sexuality

-Permission to discuss sexuality issues -Limited Information related to sexual health problems being experienced -Specific Suggestions—only when the nurse is clear about the problem -Intensive Therapy—referral to professional with advanced training if necessary

TeamSTEPPS provides higher quality, safer patient care by:

-Producing highly effective medical teams that optimize the use of information, people, and resources to achieve the best clinical outcomes for patients. -Increasing team awareness and clarifying team roles and responsibilities. -Resolving conflicts and improving information sharing. -Eliminating barriers to quality and safety.

Goals of pain interventions

-Promote comfort -Maintain the highest level of functioning and self-care possible -Balance the risks and benefits of the various treatment options

Malnutrition

-Recognized geriatric syndrome -Rising incidence in all settings -Has serious consequences, including infections, pressure ulcers, anemia, hypotension, impaired cognition, hip fractures, prolonged hospital stays, institutionalization, and increased morbidity and mortality -One occurs when the person does not consume sufficient micronutrients and macronutrients to maintain organ function and healthy tissue -Inflammation-related malnutrition develops as a consequence of injury, surgery, or disease that triggers inflammatory mediators that increase metabolic rate and impair nutrient use

Why be active?

-Reduced risk of disease -Reduced risk of falls -Better sleep -Better bone health -Increased life expectancy -Improved function

Is resiliency protective despite life circumstances?

-Resilience has been associated with better health in prior studies. -Successful aging can be defined as the enjoyment of health and vigor of the mind, body, and spirit into middle age and beyond. -Individuals with lower incomes may be less likely to achieve successful aging because of a higher prevalence of health risk factors. -Resilience appears to be positively and significantly associated with indicators of successful aging regardless of income.

Assessment of sleep

-Review of sleep patterns -Medication review -Information from sleep partner -Self-rating scales -Sleep study or polysomnogram -Review of sleep patterns -Presence of contributing factors -Sleep diaries or logs -Self-rating scales -Pittsburgh Sleep Quality Index -Epworth Sleepiness Scale -Polysomnography

Sleep and Aging

-Sleep complaints are linked to other health problems or disorders -REM sleep changes as we age

Sleep Cycle

-Sleep has five stages -Biorhythms vary -With aging, the natural circadian rhythm may become less responsive to external stimuli

Myth 1: You'll Sleep Poorly

-Sleep patterns do change as we age -Takes longer to fall asleep and tend to have more frequent awakenings -Less delta sleep (deeper stage that helps you consolidate memory) -Many sleep problems for older adults stem from other causes such as meds -Consider cognitive behavioral therapy for issues to help practice good sleep habits -Avoid sleeping pills

Pain

-Subjective sensation of physical, psychological, or spiritual distress -Multidimensional phenomenon -One type of pain is usually intertwined with another -Pain has many consequences, including questioning the meaning of one's life

Four generational subgroups

-Super-centenarians: ages 110+ -Centenarians: ages 100-109 -Those in-between: ages 79-99 -Baby boomers: ages 57-78

Acute pain

-Temporary -Universal experience -Often on top of other pain

The most common elements of the mental status examination include:

-Testing the patient's orientation to person, place, and time. -Conducting a serial seven test, where the examiner asks the patient to start with the number 100 and count backward by sevens. -Asking the patient to repeat and then a short time later recall three common, unrelated items. -Asking the patient to follow directions.

Importance of nutrition in the older adult

-The key element is preserving health -The quality and quantity of a diet will help prevent, delay the onset of, and manage chronic disease processes -Fulfillment of nutritional needs in aging is often affected by numerous factors -87% of older adults have diabetes, hypertension or high cholesterol

HIV/Aids and older adults

-The number of older people infected with the virus is growing ◦An older person's compromised immune system makes him or her more susceptible to HIV or AIDS ◦Normal changes in women increase the chance of infection

Health Related Decision-Making: External Factors

-Type of decision -Power relationships -Perception of risk and safety -Options available

Signs of physical abuse

-Unexplained bruising or lacerations in unusual areas in various stages of healing -Fractures inconsistent with functional ability

Signs of Medical Neglect

-Unusual delay between the beginning of a health problem and when help is sought -Repeated missed appointments without reasonable explanations

Adjuvant Medications

-Usually used with an analgesic but may be used alone -Most effective for neuropathic pain syndromes, such as postherpetic neuralgia and diabetic nephropathy -Topical agents (e.g., capsaicin, lidocaine patch) may have mild to moderate local effects

Signs of Neglect by Self or Caregiver

-Weight loss -Uncharacteristically neglected grooming -Evidence of malnutrition and dehydration -Fecal/urine smell -Inappropriate clothing to the situation or weather -Insect infestation

Screening for STIs in Older Adults

-any adult that is sexually active should be tested -can ask about HIV risk factors -all adults should be tested at least once for HIV -older women with risk factors should be screened annually -gay men should be screened once a year

Healthy People 2020

-approved in December 2010 -it promotes a society in which all people live long, healthy lives. -Healthy People 2020 identifies leading health indicators (LHIs) (e.g., access to health services; injury and violence prevention; maternal, infant, and child health), which are high-priority health issues in the United States. Although the United States has made great progress on the LHIs, it falls behind other developed countries on key measures of health and well-being, including life expectancy, infant mortality, and obesity. -health access for all

LGBTQI Individuals

-at especially high risk for discrimination as a result of having been marginalized or oppressed -1973: when homosexuality was removed as a mental health disorder -double stigma: being old and homosexual or having different gender identity -less likely to access health and social services or identify self as LGBTQI to providers -important to be asking questions, supportive and understanding -do not make assumptions -transgender older adults have hardest time with access to healthcare -more likely to have financial issues

Psychological Impacts on Sexuality

-attitudes -feelings -past experiences

Changes based on sex: males

-can still produce sperm, sperm motility changes -testes shrink -ejaculation is slower -testosterone level reduces -prostatic enlargement is common and can lead to urinary retention in some

Basic Processes of the Capacity Examination

-careful review of the patient's medical, surgical, and psychosocial histories -fully understand the situation that requires the capacity examination -interview the patient to determine mental status and assess any potential disturbances such as hallucinations -evaluation of the ability to communicate in some way -explain the purpose of the assessment to the patient and gauge the patient's understanding

Social Impacts on Sexuality

-culture -interpersonal -tv and radio -literature -family -school -teaching

Internal Variables Influencing Health and Health Beliefs and Practices

-developmental stage -intellectual background -perception of functioning -emotional factors -spiritual factors

Factors influencing sleep

-drugs and substances -lifestyle -usual sleep patterns -emotional stress -environment -exercise and fatigue -food and caloric intake

Who is most likely to abuse?

-family member -history of violence -substance abuse -isolated -poor impulse control -mental illness -personal stress/exhaustion

External Variables Influencing Health and Health Beliefs and Practices

-family role and practices -social determinants of health -socioeconomic factors -cultural background

Legal Issues in Gerontological Nursing

-financial issues -health care decisions -consent to treatments -capacity

Aging Changes: Endocrine

-glands shrink -secretion rate decreases -increased insulin resistance

Pain and culture

-important to remember that just because someone is part of a cultural group means they will act -Stoic- grin and bear it, minimize pain- northern Europe/Asian -Emotive-wants to validate pain, cries out-Hispanic, middle eastern, Mediterranean

Sleep disorders

-insomnia -sleep apnea -restless leg syndrome -REM sleep behavior disorder -circadian rhythm sleep disorder

Components of a nutritional assessment

-interview -history -physical exam -anthropometric data -labrotory data -food and nutrient intake -functional assessment

Aging Changes: Renal

-kidney blood flow decreases -size and function of the kidney decreases -increased susceptibility to both fluid and electrolyte imbalance -urine creatinine clearance decreases (kidney not getting rid of toxins the same as used to)

Indications for a Capacity Examination

-most common is a patient's refusal to accept medical treatment -primary provider simply does not feel comfortable, confident, or competent making the assessment.

Purpose of sleep and rest

-most important but least understood part of health -sleep is a basic need

Diet for older adults

-needs to have higher protein -more fiber -more fluid -less calories -more b12

pain in older adults with cognitive impairments

-often untreated -assume pain -watch behavior -Pain is consistently untreated and undertreated in older adults with cognitive impairments -Assume any condition that is painful to a cognitively intact person is painful to a person who cannot express him- or herself -Those who can no longer speak for themselves communicate pain through behaviors such as agitation, aggression, increased confusion, or passivity -Really watch for passivity bc may be ignored bc it's easy to care for *CNAs important role in assessment of pain

Risks of Sleep Apnea

-older -male -changes to anatomy of neck -family history -excess weight -substance use -hypertension

Moral Impacts on Sexuality

-religious, humanistic, pragmatic beliefs

Effects of Lack of Sleep

-restricting sleep to 4 hours a night results in higher blood pressures and reduced function of the entire cardiovascular system. -Inflammatory markers increase in the blood, amplifying any chronic pain or inflammatory diseases. -Cells begin showing insulin-resistant behaviors that are known to lead to diabetes. -Appetite increases and activity decreases, predisposing the individual to obesity. -Those who are sleep deprived develop less immunity from vaccines, implying impaired immune function. -Sleep deprivation increases symptoms of mental health disorders and decreases perceived coping ability. -Inadequate sleep is strongly linked to an increased risk of dying. -sleep deprivation has been shown to be associated with increased responsiveness to stress and sensitivity to stress-related disorders.

three dimensional model for assessing capacity:

-risk of the proposed treatment (high versus low) -the benefits of the treatment (high versus low) -the patient's decision regarding the treatment (accept versus refuse).

Biological Impacts on Sexuality

-sexual stimulation -puberty -reproduction -growth and development

Aging Changes: Skin

-skin is our largest organ -physical changes in the skin happen as a result of genetic and environmental factors -EPIDERMIS: thins and makes blood vessels and bruises more visible. fewer melanocytes leading to lighter appearance of skin. age spots and keratosis (thick brown raised lesions) appear -DERMIS: loses about 20% of thickness, blood vessels are reduced leading to paler skin, cooler overall skin temp, collagen synthesis decreases , elastin fibers thickened leading to loss of stretch and resilience (skin sag) HYPERDERMIS: atrophy happens, increased sensitivity to cold, inability to regulate temp.

4 Ways to Describe Aging

-social: role changes -functional: ability/loss of ability to do things -biological: changes in the body -chronological: numbers and birth dates

A Patient's Bill of Rights: Informed Consent

-the patient has the right to be informed about the kind of treatment or care suggested -alternatives of the suggested care must be discussed with the patient before informed consent can be secured -the patient's voluntary and competent assent to that treatment must be obtained

Risk Factors for oral cancer

-tobacco use, -alcohol use -sun exposure -Oncogenic viruses (especially human papillomavirus) -Genetic susceptibility

Aging Changes: Respiratory

-usually a result of exposure to environmental toxins and not just from the aging process -loss of recoil -stiffening of chest wall -gas exchanges are not as efficient -resistance to air flow increases -cough response and cilia are not as effective -increased risk for aspiration

Keypoints of Carroll article

1 Capacity is a measure of an individual's ability to make an informed and logical decision about a particular aspect of his or her health care. 2 The medical concept of capacity differs from the legal concept of competency, in that capacity is reserved for determination of person's ability to make a single decision and competency encompasses a global determination of one's ability to manage one's own affairs. 3 The threshold for capacity varies with the significance and risk of the decision being made. 4 A capacity examination requires a thorough review of the patient's medical and psychosocial history, as well as the use of a structured interview to determine the patient's understanding of the facts of the issue, mental status, and ability to make a logical decision.

Factors Affecting the Responsibility of Nurses in Obtaining Informed Consent

1. Impaired sensory functioning 2. Low educational level 3. Low or limited health literacy 4. Low literacy of any kind 5. Questionable cognitive status 6. Complexity of procedure (e.g., surgery of any kind) 7. Participation in research

A Simple Framework for Determination of Capacity

1. Is the patient able to communicate? 2. Has the proposed treatment or procedure been discussed with the patient by a qualified clinician? 3. Can the patient explain the treatment or procedure, the rationale for it, as well as the risks and benefits of having the treatment? 4. Can the patient explain the consequences of not having the treatment or procedure? 5. Can the patient explain in a coherent manner the rationale for his or her decision and demonstrate a reasonable appreciation of the factors involved?

Articles are usually set-up in a systematic way:

1. Problem identified 2. Previous work reviewed 3. Question addressed 4. How the study was conducted 5. Results and data analysis 6. Conclusion

Example tips on reading nursing research

1. Start by identifying the conclusion: -Title -Abstract -Discussion 2.Read the whole article 3.Decide what it means to you

Self-neglect

A behavior in which people fail to meet their own basic needs in the manner in which the average person would in similar circumstances -refuses or fails to take care of themselves

Sleep Apnea

A condition in which people stop breathing while sleeping Symptoms: -loud periodic snoring -gasping and choking upon wakening -unusual nighttime activities -morning headaches -poor memory -Irritability -personality changes Sleep apnea significantly increases inflammation in the body and has been shown to lead to cardiovascular disease.

Supplemental Security Income (SSI)

A federal program established to provide assistance to elderly persons and persons with disabilities Not all older persons living in the United States have Social Security benefits adequate to provide even the most basic necessities of life. This has been especially true for many of today's older adults. If they spent their lives employed in the agricultural industry, as domestic workers, or in the service industry and were paid very low wages, Social Security taxes were not withheld by their employers, or they were paid on a cash basis. SSI was established in 1965 to provide a minimum level of economic support to older adults and select others.

Medicare

A federal program of health insurance for persons 65 years of age and older

Power of Attorney (POA)

A power of attorney (POA) is a legal document in which one person designates another person (e.g., family member, friend) to act on his or her behalf. The two types are a general POA and a durable POA. The appointed person becomes known as the attorney-in-fact. The attorney-in-fact named in a general POA usually has rights such as to make financial decisions and pay bills in defined circumstances, but not necessarily to make decisions related to health care. The attorney-in-fact appointed in a durable POA usually has additional rights and responsibilities to make health-related decisions for persons when they are unable to do so themselves. This person is known as the health care surrogate or proxy.

Risk Factors

A risk factor is any attribute, quality, environmental situation, or trait that increases the vulnerability of an individual or group to an illness or accident -increase the vulnerability of an individual or a group to an illness or accident Risk factors include: -Genetic and physiological factors -Age -Environment -Lifestyle

Sexual Health

A state of physical, emotional, mental, and social well-being related to sexuality Influencing factors ◦Expectations ◦Activity levels ◦Cohort and cultural influences ◦Biological changes with age ◦Sexual dysfunction

Abuse vs. neglect

Abuse: ◦Intentional ◦May be physical, psychological, medical, financial, or sexual Neglect ◦Most often it is passive ◦Failure of action/care ◦It is active when care is withheld deliberately and for malicious reasons

Maslow's Hierarchy of Needs

According to this model, certain human needs are more basic than others, and some needs must be met before other needs (e.g., fulfilling physiological needs before the needs of love and belonging). -Used to understand the interrelationships of basic human needs

Nonopioid analgesics

Acetaminophen -Used for the most common causes of physical pain -Should be considered a first-line approach Nonsteroidal anti-inflammatory drugs -Used when pain is from inflammation or during a short arthritic flare -Accompanied by higher risk for adverse drug effects

Activity Theory

Activity is possible when living in a stable society The older person has -Access to positive influences and significant others -Opportunities to participate in the broader society if he or she chooses to

Assessment of Patient Understanding

After gaining information about the patient's medical and psychosocial issues, the time comes to assess the patient's understanding of his or her medical condition. -the clinician assesses the patient's ability to understand the risks and benefits of the treatment or procedure, as well as the consequences of accepting or refusing the intervention. -Assessing the patient's level of understanding regarding the consequences of refusing the clinician's advice is important. -the patient must be able to offer a logical, coherent reason for accepting or refusing the intervention.

Degree of Involvement Desired

Another internal factor is degree of involvement desired by those making the decision. Not all decision-makers desire the same degree or extent of involvement in the decision-making process. -Active -Passive -Collaborative -Avoiding information. Those who preferred a more passive role in health-related decision-making were sicker, less educated, from a minority ethnic groups, male, and elderly. The degree of involvement desired was also influenced by the relationship of the decision-maker to the family or support individual. Degree of involvement, which otherwise may be referred to as degree of participation, may be impacted by beliefs about role expectations of different family members and the health care team, the nature of the decision, the severity of illness, and prior experiences. The degree of involvement desired may influence the role expectations of those involved in the health care decision.

Assessment of Activity

Assess -Function and mobility -Determine if adaptations are necessary Interventions -Counseling -Initiate a program -Educate -Provide suggestions

Insomnia and Alzheimer's Disease

Associated behaviors: -agitation, wandering, comorbid illnesses, primary sleep disorders Behavioral techniques: -sleep hygiene education, daily walking, and increased light exposure

Aging Changes: Neurological

CNS -Brain size and weight decreases causing a decrease in the number of neurons, dendrites can wear out and increased risk of trauma -Subtle changes in cognition and motor function in VERY old -Mild memory impairments -Balance changes -Length to perform tasks increases PNS -Reaction time is delayed -Decrease in tactile senses: fingertips, palms, lower extremities (touch and feel decreased) *Increased risk of injury from fire or falling

Cognitive Reserve (CR)

CR is based on the concept of neuroplasticity and refers to the strength and complexity of neuronal/dendrite connections from which information is transmitted and cognition/mentation emerges. The greater the strength and complexity of these connections, the more the brain can absorb damage before cognitive functioning is compromised. To maximize brain plasticity and CR, it is important to engage in challenging cognitive, sensory, and motor activities, as well as meaningful social interactions, on a regular basis throughout life.

Who can determine capacity?

Capacity is often confused with competency, which is a legal term and can only be determined by a court.

The Biological Clock Theory

Cell reproduction and death of cells is genteically preprogrammed. This helps determine a person's life span.

Cellular Functioning Theory

Cells need to reproduce and if that reproduction was always the same nothing would change. Cells become more complex as we age, they can get disorganized and not change/duplicate themselves in the same way and ultimately cellular death occurs. Says that because of these changes in our cells we age and die

Decisional Congruence

Choices considered congruent by the decision-maker are those decisions that are consistent with the older adult and the family's view of themselves and are personalized within the context of their lives. Incongruence, or lack of agreement among the decision-maker and family or support individual and the health care team member, may set up decisional conflict. Decisional conflict is defined as the lack of agreement between the presented alternatives and the older adult's value system.

Adult Cognition

Cognition is the process of acquiring, storing, sharing, and using information. Components of cognitive function include language, thought, memory, executive function (planning, organizing, remembering, paying attention, solving problems), judgment, attention, and perception. The determination of intellectual capacity and performance has been the focus of a major portion of gerontological research. Emerging research suggests that cognitive function and intellectual capacity is a complex interplay of age-related changes in the brain and nervous system and many other factors such as education, environment, nutrition, life experiences, physical function, emotions, biomedical and physiological factors, and genetics

Life Context

Decisions are generally believed to be congruous with individuals' views of themselves and are personalized through an individual's life context including past and present viewpoints, events, and relationships. In Gilligan's classic work about women's moral development, the interpretation of events and construction of reality are based on life context. Throughout their lives, individuals experience countless events. How individuals view these events and make decisions about them is based on individual life experiences and socioeconomic, personal, and cultural characteristics.

Delirium

Delirium, or acute confusional state, is a potentially reversible cognitive impairment that occurs suddenly and worsens at night. Delirium often has a physiological cause. Physiological causes include electrolyte imbalances, untreated pain, infection, cerebral anoxia, hypoglycemia, medication effects, tumors, subdural hematomas, and cerebrovascular infarction or hemorrhage. A new onset of delirium should trigger the nurse to assess for signs and symptoms of infections such as pneumonia and UTI. Delirium may also be caused by environmental factors such as sensory deprivation or overstimulation, unfamiliar surroundings, or sleep deprivation or psychosocial factors such as emotional distress. Although it occurs in any setting, an older adult in the acute care setting is especially at risk because of predisposing factors (physiological, psychosocial, and environmental) in combination with underlying medical conditions. Between 11% and 42% of hospitalized older adults develop delirium. Dementia is an additional risk factor that greatly increases the risk for delirium; it is possible for delirium and dementia to occur at the same time. The presence of delirium is a medical emergency and requires prompt assessment and intervention. Nurses are at the bedside 24/7 and in a position to recognize delirium development and report it. The cognitive impairment usually reverses once health care providers identify and treat the cause of delirium.

Dementia

Dementia is a generalized impairment of intellectual functioning that interferes with social and occupational functioning. It is an umbrella term that includes Alzheimer's disease (most common type), Lewy body disease, frontal-temporal dementia, and vascular dementia. Cognitive function deterioration leads to a decline in the ability to perform basic ADLs and IADLs. Unlike delirium, dementia is characterized by a gradual, progressive, and irreversible decline in cerebral function. Because of the similarity between delirium and dementia, you need to assess carefully to rule out the presence of delirium whenever you suspect dementia. Nursing management of older adults with any form of dementia always considers the safety and physical and psychosocial needs of the older adult and the family. These needs change as the progressive nature of dementia leads to increased cognitive deterioration. To meet the needs of older adults, individualize nursing care to enhance quality of life and maximize functional performance by improving cognition, mood, and behavior. Persons with dementia may exhibit behaviors that may be unsafe, putting them at risk for falls and other injuries. These behaviors are an expression of an unmet need, such as hunger, pain, anxiety, or the need to void or defecate. Therefore, the nurse should consider the meaning behind a person's actions. Nonpharmacological measures should be used first, before administering medications that may be sedating or have other undesirable effects. Box 14.5 lists general nursing principles for the care of older adults with dementia.

Treatment of Sleep Apnea

Depends on the type -Losing weight -Avoiding alcohol and sedatives -Stopping smoking -Avoiding supine sleeping -Wearing a continuous positive airway pressure (CPAP) device at bedtime

First Generation Theories

Early psychosocial theories of aging were an attempt to explain and predict the changes in middle and late life with an emphasis on adjustment. Adjustment was seen as an indication of success, at least by the academic theoreticians who developed them. The majority of these theories began appearing in the gerontological literature in the 1940s and 1950s. They were not based on extensive research. Early theories focused on adjustment as an indicator of success. They weren't really researched early on, but came from personal and professional experiences of clinicians. -Role Theory -Activity Theory **first generation theories criticized because hard to apply. Fail to consider social class, education, economic and cultural diversity. Good to know where we began!

Crisis Proof:

Effective, combines the ability for change with the need for stability; shown to have more support and family stability

Electrical Field

Electrical Field There are numerous fields influenced by electrically charged particles from molecules, cells, and organs of different frequencies that work together harmonically and present as complex waves. Many electrical elements of a living organism's energy fields have been carefully measured, including electrocardiography and electroencephalogram. In addition to these well-known tests, the electroencephalography field near skin, which has been found to decline with aging, is used to noninvasively assess wound healing.1 Electricity is also used for healing. Transcutaneous Electrical Nerve Stimulation (TENS) that has been used to effectively treat chronic pain for decades and to repair tissue such as bone fractures.2-4 Depression can be treated with electrically stimulating seizure activity.5 Electricity can also be dangerous, even beyond the electric shocks we have all experienced. There have been links made between the presence of high-voltage power lines and increased risk of childhood leukemia.6 We are electrical beings, influenced by waves of electricity.

Generativity vs. Stagnation

Erikson's stage of social development in which middle-aged people begin to devote themselves more to fulfilling one's potential and doing public service -looking at finding important work in middle age -actual work, helping others, caring for the future, leaving the world a better place -might look different for everybody Stagnant would be staying stagnant and not finding that for yourself

Dietary Recommendations for older adults: fiber

Fiber is an important dietary component that some older people do not consume in sufficient quantities. A daily intake of 25 g of fiber is recommended and must be combined with adequate amounts of fluid. Insufficient amounts of fiber in the diet, as well as insufficient fluids, contribute to constipation. Fiber is the indigestible material that gives plants their structure. It is abundant in raw fruits and vegetables and in unrefined grains and cereals.

Conducting Mental Status Examinations and Evaluations

First, the professional nurse approaches the patient respectfully, asking him or her to participate in the examination. In all likelihood, the examination will be completed in approximately 10 minutes. With this approach, the nurse helps establish the necessary rapport with the patient. If the nurse callously or capriciously approaches an elderly patient, there is an increased risk the patient may refuse to participate in the assessment.

Formal Sources of Care

Formal care may occur in both the institutional and home settings. Formal care is either paid for privately with personal funds, long-term care insurance, or through government programs such as Medicaid, or Medicaid Waiver Programs

Erik Erikson

Freud had a strong influence on his psychoanalytical followers, including Erik Erikson (1902-1994), who constructed a theory of development that differed from Freud's in one main aspect: Erikson's stages emphasize a person's relationship to family and culture rather than sexual urgess.

Advance Care Planning

Gerontological nurses have the responsibility to encourage their patients, neighbors, and family members to discuss their wishes regarding potential incapacity, otherwise referred to as advance care planning. It is always advisable to appoint a legal surrogate or proxy and formally document one's wishes.

Gerontological Nursing Roles

Gerontological nursing roles encompass every imaginable venue and circumstance. The opportunities are limitless because we are a rapidly aging society. "Nurses have the potential to improve elder care across settings through effective screening and comprehensive assessment, facilitating access to programs and services, educating and empowering older adults and their families to improve their health and manage chronic conditions, leading and coordinating the efforts of members of the health care team, conducting and applying research, and influencing policy"

Dysphagia Interventions

Goal: Safe oral intake to maintain optimal nutrition and caloric needs Compensatory interventions include -Postural changes and proper positioning -Modification of bolus volume, consistency, temperature, and rate of presentation -Modified diets Neuromuscular electrical stimulation

Aging Changes: Hair and Nails

Hair: changes depend on genetics. thinning of hair on head and increased hair in ears, nose and eyebrows, hair pigmentation loss (grey hair). women may develop chin hair, and see decrease in hair on legs, underarms and pubic areas Nails become harder, thicker, dull and more brittle, flatter, vertical ridges can appear, fungal infections often occur

Financial abuse

Illegal taking, misuse, or concealment of money, benefits, property, or assets belonging to an elderly person Ex: Check cashing without permission, forging a signature, stealing money or possessions, coercing a signature on legal documents (e.g., will, trust), forcing or improper use of durable power of attorney, unpaid bills, unauthorized credit card use Potter, Patricia A.,Perry, Anne Griffin,Stockert, Patricia,Hall, Amy. Fundamentals of Nursing - E-Book (p. 190). Elsevier Health Sciences. Kindle Edition.

Chronological Aging

In most developed and developing areas of the world, chronological late life is recognized as beginning sometime between the ages 50 and 65, with the World Health Organization using the age of 60 in their discussions. In 1935, with the establishment of a national retirement system (Social Security), the time when one became "old" was set at 65 in the United States. In the 2000s this age is creeping toward 70 when one becomes eligible for pensions and other monetary benefits based on age.

Mandatory Reporting

In most states and U.S. jurisdictions, licensed nurses are "mandatory reporters," that is, persons who are required to report suspicions of abuse to the state, usually to a group called Adult Protective Services (APS) (National Adult Protective Services Association [NAPSA], 2014). The standard for reporting is one of reasonable belief; that is, the nurse must have a reasonable belief that a vulnerable person either has been or is likely to be abused, neglected, or exploited.

Discussion

In this section the author interprets the results of the study. The meaning of the data collected and analyzed is explained, as well as how the data answer (or do not answer) the research question(s). Limitations to the study (e.g., Are there particular populations to which the results do not apply? Are there factors not part of the study design that may have influenced the outcome of the study?) and what additional research is needed also are discussed. Many research articles have an application to practice section that suggests ways in which the results can be used in everyday practice.

Safety

Independence with risk is a way of life for frail older adults. At the intersection of risk and safety lie the concerns and preferences of the older adult, family members, and health care team members. Collopy discusses safety as a ubiquitous and conflictive issue in long-term care. At the crux of the debate are issues related to how much risk elderly individuals, family members, and health care professionals are willing to consider acceptable. Opie identified that the argument of safety is a powerful and difficult argument for family to resist. It is helpful if the discussion of safety in the elderly individual's specific situation occurs in such a way that there are opportunities for those involved to develop an understanding of the individual's interpretation about what it means to be safe and to retain the freedom to live as one wants. When there are fewer options available for living safely, or if the options are not consistent with the older adult's viewpoint, the health care decisions may become more difficult.

Guardians and Conservators

Individuals, agencies, or corporations that have been appointed by the court to have care, custody, and control of a disabled person to manage his or her financial responsibilities guardian: appointed to be responsible for another person conservator: appointed for finances

Informal Sources of Care

Informal care is generally defined as a network of individuals who provide care and support to an older adult, such as family, friends, or neighbors. Families are often both the preferred and actual source of support for three-quarters of impaired older adults who live in the community.

Options

Inherent in the definition of decision-making is the availability of options or choices. Older adults and their families may find that when long-term care is needed, the process is very stressful because there is limited time to make decisions and there are limited choices available. Nolan and Dellasega described the decision-making process associated with finding a nursing home as particularly prone to a lack of individual decisional control because of the lack of discussion between older adults and their families about their wishes, which made the situation more vulnerable to expert external control. Older adults in home care reported that they preferred no help, but recognized that they needed to have some help with activities of daily living (ADLs) to stay in their home. The degree of help that is available through family or community systems may influence decisions about health care.

Research on Aging

Inquiry into and curiosity about aging is as old as curiosity about life and death itself. Gerontology began as an inquiry into the characteristics of long-lived people, and we are still intrigued by them. Anecdotal evidence was used in the past to illustrate issues assumed to be universal. Only in the past 60 years have serious and carefully controlled research studies on aging flourished.

Neuroplasticity

It is very important to know that the aging brain maintains resiliency or the ability to compensate for age-related changes. Developing knowledge refutes the myth that the adult brain is less plastic than the child's brain and less able to strengthen and increase neuronal connections. The old adage "use it or lose it" applies to cognitive and physical health. Stimulating the brain increases brain tissue formation, enhances synaptic regulation of messages, and improves the development of cognitive reserve (CR).

Crisis Prone:

Lacks or believes it lacks control over its environments

Aging Changes: Musculoskeletal System

Ligaments, tendon and joints become dry, hardened and less flexible, muscle mass decreases, thinning of discs in vertebrae causing shortening of trunk, reduced bone mineral density which increases chance of fracture, reduced body water which increases the chance of dehydration -Many are not life threatening but affect someone's ability to function and their quality of life.

Magnetic Field

Like electricity, magnetics has its uses in measurement and treatment, but it also has a dangerous side. Historically, exposure to magnetic fields was not thought to be hazardous. Considerable evidence, however, has emerged on magnetic field exposure and long-term health effects including cancer, fertility difficulty, and numerous other health conditions in various systems of the human body. The magnetocardiogram examines the heart's magnetic field, and the magnetoencephalogram provides information on the head's magnetic field. The magnetoencephalogram can measure brain waves and neuronal and thinking activity by magnetic field changes around the head. This is a profound point. Thinking gives off a measurable field around the head. There is much theoretical discussion about how this field of wave activity then influences the cell membrane through a complex communication system of signals.

Injury and Cognitive Impairment

Little is known about the role of cognitive impairment in injury presentations or etiology. Because of the nature of the pathological process, persons with cognitive impairments may experience unique or an increased rate of injuries related to wandering, behavioral symptoms, and problems with judgment16; thus, they may be more likely to sustain falls or experience accidental injury. Moreover, persons with cognitive impairment are thought to be at a greater risk for elder abuse then the general older adult population; however, little is known about injuries from elder abuse in this population.

Rapid Eye Movement Sleep Behavior Disorder

Loss of voluntary muscle atonia during REM sleep -Violent behaviors while dreaming -Treatment: Medication (Clonazepam) and safety measures

Carroll: Assessment of Capacity for Medical Decision Making

Main points: ◦Autonomy to make decisions about the medical care we receive is a basic human right ◦Capacity is a measure of a person's ability to make an informed & logical decision about health care ◦If person lacks capacity, a surrogate (substitute) must be appointed Implications for nurses: we have a role in helping determine a person's capacity to make health care decisions

Integrity vs. Despair

Many older adults review their lives with a sense of satisfaction, even with their inevitable mistakes. Others see themselves as failures, with their lives marked by despair and regret. Older adults often engage in a retrospective appraisal of their lives. They interpret their lives as a meaningful whole or experience regret because of goals not achieved. Because the aging process creates physical and social losses, some adults also suffer a loss of status and function. These external struggles are met with internal struggles, such as the search for meaning in life. Meeting these challenges creates the potential for growth and the basic strength of wisdom Integrity: able to look back in your life and be satisfied Self-despair: unfulfilled, lack of purpose (Erikson)

Mental Health in Later Life

Mental health is not different in later life, but the level of challenge may be greater. Developmental transitions, life events, physical illness, cognitive impairment, and situations calling for psychic energy may interfere with mental health in older adults. These factors, though not unique to older adults, often influence adaptation. However, anyone who has survived 80 or so years has been exposed to many stressors and crises and has developed tremendous resistance. Most older people face life's challenges with equanimity, good humor, and courage. It is our task to discover the strengths and adaptive mechanisms that will assist them to cope with the challenges.

Mission of The Minnesota Elder Justice Center

Mobilizing communities to prevent and alleviate abuse, neglect, and financial exploitation of elders and vulnerable adults.

Resiliency in older adults

Most older adults manage transitions and stressors through resilience, hardiness, and resourcefulness

Aging Changes: Gastrointestinal (GI)

Mouth -teeth can lose enamel and dentin (more vulnerable to decay) -taste buds decline -salivary secretion lessens leading to dry mouth -gums can recede leading to greater risk of oral and heart disease Stomach -More sluggish, empty slower, increasing risk of gird -Decrease in gastric motility, will feel full faster -Decreased ability to produce intrinsic factor Intestines -Villi lower functioning affecting absorption and nutrients -Slowing peristalses -Constipation Liver -Reduced blood flow which affects medication solubility Gallbladder -Increased risk of gallstones

5 Myths About Aging

Myth 1: You'll Sleep Poorly Myth 2: You'll Become Frail Myth 3: You Will Have No Interest in Sex Myth 4: Confusion and Memory Loss Are the Norm Myth 5: You'll Become Lonely and Depressed

Neglect by a Caregiver

Neglect by a caregiver requires a socially (formally or informally) recognized role and responsibility of a person to provide care to a vulnerable other. Neglect is most often passive mistreatment, such as an act of omission. It is not only the failure to provide the goods and services—such as food, medication, medical treatment, and personal care—necessary for the well-being of the frail elder, but also the failure or inability to recognize the responsibility to provide such goods and services. Neglect is active when care is withheld deliberately and for malicious reasons. In some cases this level of neglect would be considered abuse as well. Neglect by caregivers occurs for many reasons.

Sexual Abuse

Nonconsensual sexual contact or activity of any kind; coercing an elder to witness sexual behaviors Ex: Unwanted touching, rape, sodomy, forced watching of pornography, coerced nudity, sexually explicit photography

nonmodifiable risk factors

Nonmodifiable risk factors such as age, gender, genetics, and family history cannot be changed. You use your understanding of nonmodifiable risk factors to select appropriate secondary prevention strategies. For example, a person's age increases the susceptibility to certain illnesses and accidents.

Sleep Interventions

Nonpharmacologic treatment -First-line treatment -Cognitive behavioral therapy Pharmacologic treatment -Used cautious with older adults -May be used with behavioral interventions Avoid sedative-hypnotics

circadian rhythm sleep disorder

Normal sleep occurs at abnormal times Two types: •Advanced sleep phase disorder (ASPD) •Irregular sleep-wake disorder (ISWD) Treatment (depends on type): •ASPD include hygiene practices and methods to delay the timing of sleep and wake •ISWD include increasing the duration and intensity of light exposure during the daytime

Nurse Evaluation of Pain

Nurse pt family all work together with meds and non pharm treatment. Need continual reassessment. Use same instruments for objective measures. treatment often multimodal. Draw on what has worked for them in the past

Variability Among Older Adults

Nursing care of older adults poses special challenges because of variations in their physiological, cognitive, and psychosocial health. Older adults also have a wide range of functional ability. Most older adults are active and involved in their communities. A smaller number have lost the ability to care for themselves, are confused or withdrawn, and/or are unable to make decisions concerning their needs. Most older adults live in noninstitutional settings.

Nursing Research

Nursing research draws from its own body of knowledge, as well as from other disciplines, to describe, monitor, protect, and evaluate the quality of life while aging and the services more commonly provided to the aging population, such as hospice care. Nurses have generated significant research on the care of older adults and have established a solid foundation for the practice of gerontological nursing. Research with older adults receives considerable funding from the National Institute of Nursing Research (NINR).

Pain Assessment

OLDCART (onset, location, duration, characteristics, aggravating factors, relieving factors, treatment) assessment tool -History and physical examination related to pain -Pain scales for those with cognitive impairments for treatment and those medications that have been tried -Medications -Pain scales

Physical Abuse

Occurs when older adults experience illness, pain, or injury as the result of physical force or the threat of physical injury. Ex: Hitting, beating, pushing, slapping, kicking, physical restraint, inappropriate use of drugs, fractures, lacerations, rope burns, untreated injuries

Older adults and pain

Older adults can have a delayed response in their recognition to pain-decreased tactile sensation and delayed reaction time.

Exercise Guidelines for older adults

Older adults need at least: • 2 hours and 30 minutes (150 minutes) of moderate-intensity aerobic activity (e.g., brisk walking, swimming, bicycling) every week and •Muscle-strengthening activities on 2 or more days that work all major muscle groups (legs, hips, abdomen, chest, shoulders, and arms)

Depression

Older adults sometimes experience late-life depression, but it is not a normal part of aging. Depression is the most common, yet most undetected and untreated, impairment in older adulthood. It sometimes exists and is exacerbated in patients with other health problems such as stroke, diabetes, dementia, Parkinson's disease, heart disease, cancer, and pain-provoking diseases such as arthritis. Loss of a significant loved one or admission to a nursing center sometimes causes depression. The Geriatric Depression Scale is an easy-to-use screening tool that can be used in conjunction with an interview with the older adult. Clinical depression is treatable. Treatment includes medication, psychotherapy, or a combination of both. Electroconvulsant therapy (ECT) is sometimes used for treatment of resistant depression when medications and psychotherapy do not help. Of special note, suicide attempts in older adults are often successful. Suicide rates in all age-groups are on the rise over the past several years; the age-group of 85 years of age and older has the second highest suicide rate of all age-groups. Therefore, suicide prevention considerations for older adults are similar to those for the general population.

Factors Influencing Mental Health Care: Attitudes and Beliefs

Older individuals with evidence of mental health disorders, regardless of race or ethnicity, are less likely than younger people to receive needed mental health care. Nearly half of people older than age 65 with a recognized mental or substance use disorder have unmet needs for services. Some of the reasons for this include reluctance on the part of older people to seek help because of pride of independence, stoic acceptance of difficulty, unawareness of resources, lack of geriatric mental health professionals and services, and lack of adequate insurance coverage for mental health problems. Stigma about having a mental health disorder ("being crazy"), particularly for older people, discourages many from seeking treatment. Ageism also affects identification and treatment of mental health disorders in older people.

Dietary Recommendations for older adults: vitamins and minerals

Older people who consume five servings of fruits and vegetables daily will obtain adequate intake of vitamins A, C, and E and also potassium. Americans of all ages eat less than half of the recommended amounts of fruits and vegetables. After age 50, the stomach produces less gastric acid, which makes vitamin B12 absorption less efficient. Vitamin B12 deficiency is a common and underrecognized condition that is estimated to occur in 12% to 14% of community-dwelling older adults and in up to 25% of those residing in institutional settings. Although intake of this vitamin is generally adequate, older adults should increase their intake of the crystalline form of vitamin B12 from fortified foods such as whole-grain breakfast cereals. Use of proton pump inhibitors for more than 1 year, as well as histamine H2-receptor blockers, can lead to lower serum vitamin B12 levels by impairing absorption of the vitamin from food. Metformin, colchicine, and antibiotic and anticonvulsant agents may also increase the risk of vitamin B12 deficiency (Cadogan, 2010). Calcium and vitamin D are essential for bone health and may prevent osteoporosis and decrease the risk of fracture (see Chapter 21).

Memory

Our ability to retain and store information and then get it back when we want it -familiarity, previous learning, and life experiences can compensate for memory loss

pain assessment in an older adult

Pain is an accepted part of the aging process May avoid giving an accurate assessment of pain for fear of losing independence Sensory and cognitive impairment may make communication and pain assessment more difficult VDS may be the most sensitive and reliable among older adults Scales rely on the patients ability to understand the scale and communicate a response

Three Phases of the TeamSTEPPS Delivery System

Phase 1—Assess the Need Phase 2—Planning, Training, and Implementation Phase 3—Sustainment

Phase 2—Planning, Training, and Implementation

Phase 2 is the planning and execution segment of the TeamSTEPPS initiative. Because TeamSTEPPS was designed to be tailored to the organization, options in this phase include implementation of all tools and strategies in the entire organization, a phased-in approach that targets specific units or departments, or selection of individual tools introduced at specific intervals (called a "dosing strategy" in TeamSTEPPS parlance). As long as the primary learning objectives are maintained, the TeamSTEPPS materials are extremely adaptable.

Steps of Changing Health Behaviors

Precontemplation: not planning to make a change in the next 6 months Contemplation: considering making a change in the next 6 months Preparation: making small changes; maybe in next month might make change Action: start making the change Maintenance: sustained change over time (6+ months)

What if you suspect abuse or neglect?

Priority is to find out if safe in current living situation -know how to report suspected abuse -think about if stress of patient or family member can be lessened

Developmental Theory

Psychologist Erik Erikson's theory of psychosocial development is one of the best known theories of personality in psychology. He theorized a predetermined order of developmental and specific tasks that were associated with specific periods in one's life course. The task of the last stage of life is ego integrity versus self-despair.

Aging and DNA

ROS and free radicals don't trigger process on their own. DNA mutations occur

Free Radical Theory

Radicals (natural bioproducts of cell) are always present. When young we have things such as hormones that make the radicals not dangerous. As we age we can no longer keep up with the free radicals in our body and they can begin to cause damage

Neglect

Refusal or failure by those responsible to meet basic needs Ex: Refusal or failure to provide basic necessities such as food, water, shelter, hygiene, and medical care

Activity

Regular physical activity throughout life is essential for healthy aging Recommendations? -2.5 hours weekly moderate activity -2 days of muscle-strengthening -Stretching and balance exercises

Describe the special circumstances of pain in those with cognitive or communication limitations

Research has suggested that older people with mild to moderate cognitive impairment can provide valid reports of pain using self-report scales, but people with more severe impairment and loss of language skills may be unable to communicate the presence of pain in a manner that is easily understood. For persons who are no longer able to express themselves verbally either because of dementia or as a result of other neurological conditions such as aphasia, communication of pain usually occurs through changes in behavior, such as changes in ambulation, agitation, aggression, increased confusion, or passivity. Caregivers should be educated to be particularly alert for the latter because the person is less disruptive and this may not be recognized as a change that may indicate pain. alzheimers: lose short-term memory and can not always identify the source of painful stimuli

Obesity Paradox

Research shows that people over 70 have a lower mortality rate if considered overweight -unclear if true

SPICES Tool for Overall Assessment of Older Adults

S: Sleep disorders P: Problems with eating or feeding I: Incontinence C: Confusion E: Evidence of falls S: Skin breakdown The nurse should complete further assessment if an older adult demonstrates changes in any of these areas

Mini Nutritional Assessment (MNA)

Screening tool which evaluates 1. Independence 2. Medications 3. Number of full meals consumed 4. Protein intake 5. F & V 6. Fluid 7. Mode of feeding In individuals >/=65 YO Acquire a minimum data set, a food and nutrient intake, 24 hr dietary recall or 3 day dietary history

Second Generation Theories

Second-generation theories expanded or questioned those of the first generation. These include the disengagement, continuity, age-stratification, social exchange, modernization, developmental, and gerotranscendence theories.

Role Theory

Self identity is believed to be defined as ones role in society (nurse teacher mailman). Successful would mean that as one completes one role, they replace it with another. From nurse, to volunteer to grandma/pa. Based primarily on culturally constructed expectations.

Restless leg syndrome

Sensorimotor neurologic disorder with leg sensations Symptoms: -Paresthesia -Creeping/crawling sensations -Tingling - Cramping -Burning -Pain Treatment: -Medications -Non-medications

Dietary Recommendations for older adults: fats

Similar to other age groups, older adults should limit intake of saturated fat and trans fatty acids. High-fat diets cause obesity and increase the risk of heart disease and cancer. Recommendations are that 20% to 35% of total calories should be from fat, 45% to 65% from carbohydrates, and 10% to 35% from proteins. Monounsaturated fats, such as olive oil, are the best type of fat because they lower low-density lipoprotein (LDL) level but leave the high-density lipoprotein (HDL) level intact or even slightly raise it.

Modifiable risk factors

Some risk factors such as lifestyle practices and behaviors can be modified. Modifiable risk factors include poor nutrition, overeating, and insufficient rest and sleep. Some risk factors put a person at risk for developing specific diseases. For example, excessive sunbathing increases the risk of skin cancer; smoking increases the risk of lung diseases, including cancer; and a poor diet and being overweight increase the risk of cardiovascular disease.

System Resources

System resources are the informal or formal sources of care available to older adults who live in the community. System resources may include resources such as in-home care services, home health services, or family care.

The biofield

The Biofield All objects radiate a hierarchy of unique electrical, magnetic, and radioactive fields. Living beings are considered complex, open systems, always self-organizing, responding, and adapting to the environment to maintain homeostasis. The biofield-energy field model asserts that an electromagnetic/radiation field around living organisms is involved in homeostasis and the communication of body functions interacting with cellular health, emotions, social connections, the environment, and healing. The heart, for example, is known to give off electrical, magnetic, chemical, and thermal fields as well as signals that are uniquely different from all other body tissues and organs. The brain gives off waves that are measured and so important that they give information for decisions on whether life support should be discontinued. The body gives off numerous other waves, but we do not know how to measure or interpret them.

Health Belief Model

The Health Belief Model addresses the relationship between a person's beliefs and behaviors. Has 3 components: 1) involves an individual's perception of susceptibility to an illness. 2) an individual's perception of the seriousness of the illness. This perception is influenced and modified by demographic and sociopsychological variables, perceived threats of the illness, and cues to action (e.g., mass media campaigns and advice from family, friends, and medical professionals). 3)the likelihood that a person will take preventive action. This component results from a person's perception of the benefits of and barriers to taking action. Preventive actions include lifestyle changes, increased adherence to medical therapies, or a search for medical advice or treatment. A patient's perception of susceptibility to disease and his or her perception of the seriousness of an illness help to determine the likelihood that the patient will adopt healthy behaviors. This model helps you understand factors influencing patients' perceptions, beliefs, and behaviors to plan care so that you can more effectively help patients maintain or restore health and prevent illness.

Health Promotion Model

The Health Promotion Model (HPM) defines health as a positive, dynamic state, not merely the absence of disease. Health promotion increases a patient's level of well-being. The HPM describes the multidimensional nature of people as they interact within their environment to pursue health . The model focuses on the following three areas: (1) individual characteristics and experiences; (2) behavior-specific knowledge and affect; and (3) behavioral outcomes, in which the patient commits to or changes a behavior.

Health Promotion Model

The Health Promotion Model (HPM) defines health as a positive, dynamic state, not merely the absence of disease. Health promotion increases a patient's level of well-being. The HPM describes the multidimensional nature of people as they interact within their environment to pursue health. The model focuses on the following three areas: (1) individual characteristics and experiences; (2) behavior-specific knowledge and affect; and (3) behavioral outcomes, in which the patient commits to or changes a behavior. Each person has unique personal characteristics and experiences that affect subsequent actions. The set of variables for behavioral-specific knowledge and affect influence a patient's motivation to change or adopt healthy behaviors. When applying this model, you modify these variables through nursing actions. Health-promoting behaviors result in improved health, enhanced functional ability, and better quality of life at all stages of development.

Healthy People

The Healthy People initiative provides evidence-based, 10-year national objectives for promoting health and preventing disease. Healthy People provides a framework to help the United States increase its focus on health promotion and disease prevention (instead of illness care) and encourages cooperation among individuals, communities, and other public, private, and nonprofit organizations to improve health

Holistic Health Model

The Holistic Health Model of nursing promotes a patient's optimal level of health by considering the dynamic interactions among the emotional, spiritual, social, cultural, and physical aspects of an individual's wellness ( LaVela et al., 2017 ). You put your patients at the center of their care and recognize your patients as the ultimate experts concerning their own health. A patient's subjective experience is relevant in maintaining health or assisting in healing. The Holistic Health Model empowers patients to engage in their own recovery and assume some responsibility for health maintenance -Attempts to create conditions that promote optimal health

Competence

The ability to understand information that is relevant to the decision being made is part of the internal influence of competence. Determining decision-making capacity is at best an inexact science. Deciding that an older adult lacks decision-making capacity silences the voice of the elderly individual. To achieve autonomy, individuals must have rational capacity, sufficient knowledge about their situation, and no internal (mental or emotional) or external (physical) constraints. At best, determining decision-making capacity is a multi-level and complex construct. Older adults may be able to make decisions in one area of their life but not in another Older adults with mild to moderate cognitive impairment are consistently able to answer questions about choices, preferences, and make decisions about daily living activities.

Abstract

The abstract summarizes the entire study, usually in 100 words or less. Some journals require a particular format that addresses the question, subjects, methods, results, and conclusions in separate sections. The abstract gives a very broad understanding of the content of the entire article.

Impact of Elder Abuse

The abuse of elders has effects that are more far-reaching than is usually discussed. Those subjected to even minimal abuse have been found to have a 300% higher risk for death than those who have never been abused. In addition, older adults who have been victims of violence have more health problems than other older adults, including increased bone or joint problems, digestive problems, depression or anxiety, chronic pain, hypertension, and cardiovascular disease.

Validation Therapy

The caregiver accepts values and beliefs of the resident with dementia, even though they may differ from reality

Data collection

The characteristics, or variables, collected are described along with how the data were collected. If special equipment was used, it usually is described here. If a survey or questionnaire was used, the author may include sample questions or the entire set of questions. Practices to ensure that data were collected accurately over the course of the study are described. This might include information about training of data collectors, calibration of equipment, and reliability (same results over time) and validity (measure what it is supposed to measure) of questionnaires/surveys or tools/equipment used. The author is demonstrating that the right data werecollected from the right subjects in the right manner. At this point in the review, ask the following questions: 1. Did the researchers choose the ìrightî subjects? 2. Did the researchers choose the ìrightî variables? 3. Do the procedures used in this study make sense? 4. Was the data-collection process logical or was there too much potential for error?

Power and Coercion

The effects of unequal power relations in health-related decision-making is a significant issue. How decisions are framed and by whom has a significant impact on how the information is processed and used by the decision-maker. When health care team members position themselves as expert, and the older adult's or family's opinion fall secondary to the expert opinion, patient input into the discussion may be discouraged and the patient's and family's wishes or desires may not be given full credence or considered pertinent. It may be valuable to encourage the older adults and their families to give input into a discussion about possible care and services rather than to simply agree or disagree with recommendations. Other forms of disempowerment may include viewing patient dissention as refusal instead of voicing an independent decision. Topics that have strong emotional overtones, such as the patient's safety at home, are particularly vulnerable to the influences of expert power.

Signs of Mistreatment

The first signs that further evaluation may be necessary are if the histories given by the (usually cognitively intact) elder and the caregiver are inconsistent or the caregiver refuses to leave the elder alone with the nurse. Although it is always important to ask the elder if he or she is a recipient of abuse/shame/suffering/family disharmony/moral cruelty, one cannot assume that this will be acknowledged.

Healthy People 2030

The framework proposed by Healthy People 2030 will build on the previous editions of Healthy People, promote a holistic approach to health promotion and disease prevention, and help to engage community leaders to act and design policies to improve the health and well-being of all Americans

Phase 1—Assess the Need

The goal of Phase 1 is to determine an organization's readiness for undertaking a TeamSTEPPS-based initiative. Such practice is typically referred to as a training needs analysis, which is a necessary first step to implementing a teamwork initiative.

Phase 3—Sustainment

The goal of Phase 3 is to sustain and spread improvements in teamwork performance, clinical processes, and outcomes resulting from the TeamSTEPPS initiative. The key objective is to ensure opportunities exist to implement the tools and strategies taught, practice and receive feedback on skills, and provide continual reinforcement of the TeamSTEPPS principles on the unit or within the department

Sleep

The human organism needs rest and sleep to conserve energy, prevent fatigue, provide organ respite, and relieve tension. Sleep is an extension of rest, and both are physiological and mental necessities for survival. Sleep is a basic need. Rest occurs with sleep in sustained unbroken periods. Sleep occupies one-third of our lives and is a vital function that affects cognition and performance.

Circle of Control

The model "Circle of Control" was developed through a concept analysis of decision-making (Popejoy, 2001). The Circle of Control has three intersecting circles that represent the the older adult, the older adult's family or support individual, and health care team members. The circles and intersections of the circles may be larger or smaller depending on the amount of decision-making control and desire for involvement preferred by each member represented by circles. The amount of decision-making control is influenced by internal factors, outside resources, and system resources. The intersections of the circles represent shared decision-making responsibility of the older adult, family or support individual, and health care team member (Figure).

According to A Patient's Bill of Rights (1998):

The patient has the right to make decisions about the plan of care prior to and during the course of treatment and to refuse a recommended treatment or plan of care to the extent permitted by law and hospital policy and to be informed of the medical consequences of this action. In case of such refusal, the patient is entitled to other appropriate care and services that the hospital provides or transfer to another hospital. The hospital should notify patients of any policy that might affect patient choice within the institution.

Third Generation Theories

The third generation of theoretical development related to aging is also referred to as the "second transformation" occurring since the 1980s. The goal is "understanding the human meanings of social life in the context of everyday life rather than the explanation of facts". This may or may not rise to the level of a theory. -really look at life stories and understand human meaning

Title

The title indicates the general topic of the study. Most of the time, the title gives a very good idea of what the research study explored.

Immunological Theory

There are branches and changes that happen directly to the immune system and that aging is a result of the accumulation of damage that occurs to the immune system. There might be a chronic state of inflammation occurring that with damage to the immune system causes aging and death.

Role Expectations

There are many different roles that may be played by older adults, their family member(s), and the health care team in health care decisions. The role chosen by older adults and their family member(s) vary in scope and intensity, are very important to the decision-making process, and tend to be consistent with past decision-making incidents. Davison et al. in study about decision-making preferences in men with cancer found that a majority (58%) preferred a passive treatment decision role, 23% a collaborative role, and 19% an active role. In a study of men with prostate cancer, Clark, Wray, and Ashton found that men who had voiced regrets about their treatment choices were, in general, less satisfied about the role they played in making treatment decisions. Dissatisfaction with the degree of communication about health-related information was often related to an underestimation of patient need for information and involvement.

Decision Type

There are many types of decisions that range from everyday decisions to decisions about serious events that have long lasting implications. Major decisions as they relate to health care include making decisions about life and death issues, such as resuscitation, major surgery, or relocation to an institution. Minor decisions, or everyday decisions, relate to the multiple choices that arise daily in life, such as issues about recreation, food, clothing, and organization of daily routines. How stressful a decision is perceived to be may depend on the comfort level associated with making that decision

Dietary Recommendations for older adults: protein

There has been discussion that the Institute of Medicine's Recommended Dietary Allowance (RDA) for protein of 0.8 g/kg per day, based primarily on studies in younger men, may be inadequate for older adults. Protein intake of 1.5 g/kg per day, or 20% to 25% of total calorie intake, may be associated with a decline in risk of frailty in older adults. Older people who are ill are the most likely segment of society to experience protein deficiency. Those with limitations affecting their ability to shop, cook, and consume food are also at risk for protein deficiency and malnutrition.

Subjects

This section explains the candidates for participation in the study, often stating criteria for inclusion (who can be in) and exclusion (who cannot be in). Where the subjects were found (the setting) and how they were invited to participate in the study also are described.

Opioid Analgesics

Treat both acute and persistent physical pain Require utmost caution in their use with older adults -May produce a greater analgesic effect, a higher peak, and a longer duration of effect -Side effects (gait disturbance, dizziness, sedation, falls, nausea, pruritus, and constipation) -Sedation increases risk for falls

Health Care Insurance Plans in Later Life

Until 1965 there were only a few successful insurance plans for wealthier working people. In most cases health care was on a fee-for-service, out-of-pocket basis. This meant that each health care service could only be obtained if delivered by the provider, bartered, or purchased for cash (or "out-of-pocket"). When costs were reasonable, many older adults could continue to pay for their care. However, as people began to live longer with more chronic health problems, advances in technology escalated, and costs for health care increased, paying for health care out-of-pocket became harder and even impossible for many older adults who were entirely dependent on limited incomes.

Psychosocial/emotional abuse

Verbal and nonverbal acts that inflict mental pain, anguish, fear, and distress Ex: Insults, threats, humiliation, intimidation, harassment, social isolation, destroying property

Personal Values and Beliefs

Within life context are personal values and beliefs, which serve as a filter for processing information related to decisions and are integral to the decision-making process and outcomes. The values and beliefs of the individual decision-maker are vital, but of equal importance are the normative values and beliefs of the family or support individual. Health-related decision-making is either an individual or a collective process. In modern American society individualistic beliefs are more prevalent than collectivist belief structures. Those with individualistic beliefs value self-reliance, self-responsibility, and control. Those with collectivist beliefs involve others, particularly family members in life events and decisions. Latino and African American cultures are examples of people that may value collectivist beliefs more than individualistic beliefs

The Executive Interview

a 25- item examination tool that incorporates a variety of tests of executive function (i.e., the cognitive ability to organize information), as well as planning, initiating, and regulating complex behaviors. Testing executive function yields valuable information that goes beyond simple orientation and can offer insight into how well or poorly organized the patient's cognitive processes are. The test is scored on a 0-, 1-, or 2-point scheme on each item. A score of 15 or more is indicative of executive dysfunction. The test takes approximately 20 minutes to administer, and directions on the test itself explain how to perform each item, making it easy to administer with a little practice.

Vulnerability

a collection of individuals who are more likely to develop health problems as a result of excess risks limits and access to health care services are being dependent on others for care

Spiritual Wellness

a feeling of unity or oneness with people and nature and a sense of life's purpose, meaning, or value; for some, a belief in a supreme being or religion

Age Stratification Theory

a theory which states that members of society are stratified by age, just as they are stratified by race, class, and gender -age stratification is looking at age categories so young middle aged and old and this is just based on historical content and it's saying you know you can just lump people into these categories

Short Term Memory

activated memory that holds a few items briefly minutes to days

Health Belief Model

addresses the relationship between a person's beliefs and behaviors (positive or negative) 1st component: of this model involves an individual's perception of susceptibility to an illness. -ex: pt family member died from myocardial infarction perceives a risk of heart disease. 2nd component is an individual's perception of the seriousness of the illness. This perception is influenced and modified by demographic and sociopsychological variables, perceived threats of the illness, and cues to action -ex: pt may not perceive his heart disease as serious and may not take care of himself 3rd component is the likelihood that a person will take preventive action. This component results from a person's perception of the benefits of and barriers to taking action. Preventive actions include lifestyle changes, increased adherence to medical therapies, or a search for medical advice or treatment.

Cross-Link Theory

an accumulation of cross-linked proteins resulting from the binding of glucose to protein causes various problems

Obesity in Older Adults

an increasing concern as older adults age -associated with increased costs in healthcare, functional impairments, disability, chronic disease and nursing home admission -consider weight loss recommendations carefully and on an individual basis

Wear and Tear Theory

as time goes by, repeated use and abuse of the body's tissues cause it to be unable to repair all the damage

What cognitively should stay stable in a normal aging adult?

attention span, language, communication, understanding, and visual perception -ultimately the aging brain maintains resiliency or the ability to compensate for age related changes

Successful aging

can be defined as the enjoyment of health and vigor of the mind, body, and spirit into middle age and beyond. For many, it is also the freedom from impairment and the ability to live independently. As the population ages and more individuals are enjoying good health into their 80s and beyond, there is an accompanying interest in factors associated with successful aging.

Intermediate Memory

days to weeks

Dysphagia

difficulty swallowing or eating -affects a persons nutritional intake -obtain a hx of responses to dysphagia -observe and pay attention to this - watch during meal times to determine risk -often because of neurologic disease, dementia or behavioral, sensory or motor problems -swallowing studies are often done -important we assume that older adults are at risk for aspirations if swallowing study is ordered -Maintain NPO status until the evaluation is completed -Nutrition and hydration needs can be met by intravenous, nasogastric, or gastric tubes

Healthy People 2010

emphasized link between individual and community health -health of community influenced overall health of the nation

Social Security

federal program of disability and retirement benefits that covers most working people Social Security was designed as a pay-as-you-go system. Payroll taxes collected from employees and employers are immediately distributed to beneficiaries (retirees, the disabled, eligible spouses, or children). Although individually deposited, the revenues are not reserved for any one individual; that is, no one has an account reserved in his or her name. All funds that are not immediately paid to beneficiaries are "borrowed" by the federal government for regular operating expenses.

Secondary Prevention

focuses on preventing the spread of disease, illness, or infection once it occurs. Activities are directed at diagnosis and prompt intervention, thereby reducing severity and enabling the patient to return to a normal level of health as early as possible. Examples include identifying people who have a new case of a disease or following people who have been exposed to a disease but do not have it yet. It includes screening techniques and treating early stages of disease to limit disability by averting or delaying the consequences of advanced disease. Screening activities may lead to primary prevention intervention. For example, a nurse screens a patient who is obese for diabetes. After gathering more information from the patient, the nurse provides health education about physical activity and preventing hypertension. DETECT

Motivation:

force that acts on or within a person to cause them to act a certain way

Physical Wellness

good physical fitness and confidence in your personal ability to take care of health problems

What happens to cognition in aging?

how we have this executive functioning and know what to do so cognition can remain stable or decline with aging but the older brain may respond more slowly that's because of processing time

Sexuality

includes the physical act of intercourse and other types of physical activity -sex is a basic need

Erikson's theory of psychosocial development

individuals need to accomplish a particular task before successfully mastering the stage and progressing to the next one. Each task is framed with opposing conflicts, and tasks once mastered are challenged and tested again during new situations or at times of conflict

Neuropathic pain

involves a pathophysiological process of the peripheral or central nervous system and presents as altered sensation and discomfort. This type of pain may be described as stabbing, tingling, burning, or shooting.

The Confusion Assessment Method (CAM)

is another useful tool in evaluating delirium, which can greatly affect capacity. The CAM was designed as a tool to enable nonpsychiatric clinicians to assess delirium in the clinical and research setting. It is available in both short- and longform versions. It assesses the course of the delirium, disorganized thinking, disorientation, memory deficits, perceptual disturbances, and agitation. Using instruments such as these can provide a good measurement of baseline functioning, as well as provide measures of mental functioning that can be useful in cases where the courts or social agencies request objective data regarding a patient's mental status.

Nociceptive pain

is associated with injury to the skin, mucosa, muscle, or bone and is usually the result of stimulation of pain receptors. This type of pain arises from tissue inflammation, trauma, burns, infection, ischemia, arthropathies (rheumatoid arthritis, osteoarthritis, gout), nonarticular inflammatory disorders, skin and mucosal ulcerations, and internal organ and visceral pain from distention, obstruction, inflammation, compression, or ischemia of organs. Nociceptive mechanisms usually respond well to common analgesic medications and nonpharmacological interventions.

Injury etiology

is defined as the mechanism of injury, specifically the circumstances and forces that caused the injury, such as fall or assault. Examining relationships between specific injuries and etiologies can aid in distinguishing common accidental injuries from intentional injuries by increasing the understanding of injury potential following an event.

Injury presentation

is defined as the pattern of injury sustained by individuals including the type of injury (e.g., bruise, fracture, abrasion) and body location (e.g., torso, upper arm, head).

Primary Prevention

is true prevention. Its goal is to reduce the incidence of disease. Many primary prevention programs are supported by the government (e.g., federally funded immunization programs). Primary prevention includes health education programs, nutritional programs, and physical fitness activities. It includes all health promotion efforts and wellness education activities that focus on maintaining or improving the general health of individuals, families, and communities. Examples of primary prevention include promoting hearing protection in occupational settings and providing education to reduce cardiac disease risk factors. PREVENT

Components of cognition

language our thoughts our memories our judgment attention perception how we move our bodies

Life Review

life review is a more formal therapy technique than reminiscing is but it takes a person through his or her life in this structured in chronological order

Gerotranscendence Theory

looking at aging as this ever-evolving process that changes somebody's view of reality it changes their spirituality their meaning beyond themselves and so a person may withdraw from society to give themselves time for self-reflection

Modernization Theory

looking at the value and how technology urbanization and mass education have changed things -similar to social exchange theory

"The Great Imitator"

many of the symptoms (fatigue, weight loss, lack of appetite) for STD could be attributed to lots of things

age associated memory impairment

memory loss that is considered normal and light of a person's age and educational level. the general slowness in processing, storing, and recalling new information, difficulty remembering names and words

reality orientation

method of care used to promote awareness of reality in confused or disoriented patients

Gerontological Nursing

nursing practice that promotes wellness and highest quality of life for aging individuals

Tertiary Prevention

occurs when a defect or disability is permanent and irreversible. It involves minimizing the effects of long-term disease or disability by interventions directed at preventing complications and deterioration. Activities are directed at rehabilitation rather than diagnosis and treatment. For example, a patient with a spinal cord injury undergoes rehabilitation to learn how to use a wheelchair and perform activities of daily living independently. Care at this level helps patients achieve as high a level of functioning as possible, despite the limitations caused by illness or impairment TREAT

Sleep Quality and Aging

older adults tend to spend more time in bed awake before falling asleep -wake up more at night -tend to nap more during the day -early to bed early to rise -tend to have lighter sleep -more likely to have abnormal breathing or leg movements

Crystallized Intelligence

our accumulated knowledge and verbal skills; tends to increase with age -the knowledge and abilities that we get through education and life -often stays stable in older adults -ex: memorizing things, solving big math problems, learning to speak more than one language

Myth about pain

pain is a normal part of aging (does increase, but not inevitable), if pain isn't reported it isn't there (stoic, unable to respond, other barriers) narcotics are inappropriate (start small doses and often best meds for it)

Continuity theory

people should develop and maintain this consistent pattern of behavior over a lifetime and as they age that shouldn't change so they should have this stable personhood. thinks that successful aging means that they were able to continue their previous behaviors and roles or find something that's a suitable replacement -might work for some but wouldn't necessarily work for everybody

Self-efficacy:

person's perceived ability to successfully complete a task

Reminiscing

recalling the past -should provide something that the the older adult enjoys -thinking back on their life -increases their socialization -often done with family or friends or caregivers -good for communication and effort, personal growth, can decrease depression scores

Oxidative Stress Theory

rise in the level of ROS (reactive oxygen species) can come from things like pollution, inflammation in the body, or other environmental factors such as smoking. The increase in ROS ultimately leads to cell death. Cells are no longer able to function. The damage that happens is random and unpredictable. Some people can have a lot of these risk factors and not have cell death.

Mini-Mental State Examination (MMSE)

tests orientation, registration, attention and calculation, recall, and ability to follow commands. It takes approximately 5 to 10 minutes to administer, with a maximum score of 30 on 17 items. Scores of 23 or less indicate patients with diagnoses of dementia, schizophrenia, delirium, or affective disorders. Scores above 24 are considered within the normal range

Occupational Wellness

the ability to perform your job skillfully and effectively under conditions that provide personal and team satisfaction and adequately reward each individual

Social Wellness

the ability to relate well to others, both within and outside the family unit

Fluid Intelligence

the ability to see abstract relationships and draw logical inferences -consists of skills that are determined biologically, independent of experience or learning -older adults might become poorer in these areas -ex: navigating a subway system in the city that they haven't been before, assembling a piece of furniture using a diagram, or solving puzzles

Intellectual Wellness

the ability to think clearly, reason objectively, analyze, and use brain power to solve problems and meet life's challenges

Emotional Wellness

the ability to understand your own feelings, accept your limitations, and achieve emotional stability

Cognition

the process of how we get information, store it share it with others, and use it

Long Term Memory

the relatively permanent storage of information years

Epigenetics

the study of environmental influences on gene expression that occur without a DNA change Our genes are not fixed; we are not simply genetically determined. Our genes are modulated by our inner environment—the emotional, chemical, mental, energetic, and spiritual landscape—as well as our outer environment—the social and ecological systems in which we reside. Genes may be activated or deactivated by the meaning we assign to an experience. Truly we are formed and molded by the thoughts that stimulate the formation of neural pathways that either reinforce old patterns or initiate new ones.

Social Exchange Theory

thinks that as somebody ages they might have fewer and fewer resources economically to contribute to society. Ex: no job anymore, losing social status and potentially self esteem and power -those who can maintain that power and stay more of a full participating member of society will have better aging

What happens once it is determined that a patient does have capacity?

this should be specifically documented in the medical record. In cases where the decision is made that the patient lacks decision-making capacity, a surrogate decision-maker must be appointed. -In most states, the order of preference for surrogates is spelled out in some fashion in the mental health codes. It usually falls initially to the spouse, then to the parents, adult children, adult siblings, or to a person previously designated by a power of attorney

Disengagement theory

thought that in the natural course of aging the person does and should withdraw from society to allow that transfer of power to younger generations. they thought that this was necessary for social equilibrium but this sort of provided the basis for age discrimination. For example, when someone younger came into a job for it was often known and good that they would take the place of this older individual even if they weren't really ready to retire. so this is no longer considered an indicator of successful aging but I think still happens sometimes

Mixed or unspecified pain

usually has mixed or unknown causes. A compression fracture causing nerve root irritation, common in older people with osteoporosis, is an example of a mix of nociceptive and neuropathic pain.

What cognitively could change in a normal aging adult?

verbal fluency, logic, selective attention, naming of things, and more complex visuals spatial cues

Immediate Memory

within minutes or seconds

common developmental tasks of older adults

• Adjusting to decreasing health and physical strength • Adjusting to retirement and reduced or fixed income • Adjusting to death of a spouse, children, siblings, friends • Accepting self as aging person • Maintaining satisfactory living arrangements • Redefining relationships with adult children and siblings • Finding ways to maintain quality of life • Linked to the concept of developmental tasks appropriate for stages in life (deaths of friends and significant others, retirement and reduced or fixed income, changes in quality of life or living arrangements) • Structural and functional changes (failing health and physical strength) • Self-acceptance

Nursing Assessment Questions Regarding Sexuality

• Are you sexually active? • With whom do you have sex: men, women, or both? • How many sexual partners do you have (or have you ever had)? • How do you feel about the sexual aspects of your life? • Have you noticed any changes in the way you feel about yourself? • How has your illness, medication, or surgery affected your sex life? • It is not unusual for people with your condition to be experiencing some sexual changes. Have you noticed any changes, or do you have any concerns? • Are you in a relationship in which someone is hurting you? • Has anyone ever forced you to have sex against your will? • Tell me what you know about safe sex practices, use of contraceptives, or prevention of sexually transmitted infections. • Tell me the safe sex practices that you follow.

Predictors of Retirement Satisfaction

• Good health • Functional abilities • Adequate income • Suitable living environment • Strong social support system characterized by reciprocal relationships • Decision to retire involved choice, autonomy, adequate preparation, higher-status job before retirement • Retirement activities that offer an opportunity to feel useful, learn, grow, and enjoy oneself • Positive outlook, sense of mastery, resilience, resourcefulness • Good marital or partner relationship • Sharing similar interests to spouse/significant other

Factors Influencing Ability to Manage Stress

• Health and fitness • A sense of control over events • Awareness of self and others • Patience and tolerance • Resilience • Hardiness • Resourcefulness • Social support • A strong sense of self

Sleep Health Goals Healthy People 2020

• Increase public knowledge of how adequate sleep and treatment of sleep disorders improve health, productivity, wellness, quality of life, and safety on roads and in the workplace. • Increase the proportion of persons with symptoms of obstructive sleep apnea who seek medical evaluation. • Increase the proportion of adults who get sufficient sleep.

Changes in sleep with age

• More time spent in bed awake before falling asleep • Total sleep time and sleep efficiency are reduced • Awakenings are frequent, increasing after age 50 years (>30 min of wakefulness after sleep onset in >50% of older subjects) • Daytime napping • Changes in circadian rhythm (early to bed, early to rise) • Sleep is subjectively and objectively lighter (more stage 1, little stage 4, more disruptions) • Rapid eye movement (REM) sleep is short, less intense, and more evenly distributed • Frequency of abnormal breathing events is increased • Frequency of leg movements during sleep is increased

Dental Health Goals for Older Adults

• Prevent and control oral and craniofacial diseases, conditions, and injuries, and improve access to preventive services and dental care. • Reduce the proportion of adults with untreated dental decay. • Reduce the proportion of older adults with untreated caries. • Reduce the proportion of adults who have ever had a permanent tooth extracted because of dental caries or periodontal disease. • Reduce the proportion of older adults 65 to 74 years of age who have lost all of their natural teeth. • Reduce the proportion of adults 45 to 74 years of age with moderate or severe periodontitis. • Increase the proportion of oral and pharyngeal cancers detected at the earliest stages.

Healthy People 2020: Mental Health and Mental Disorders (Older Adults)

• Reduce the suicide rate. • Reduce the proportion of persons who experience major depressive episodes. • Increase the proportion of primary care facilities that provide mental health treatment onsite or by paid referral. • Increase the proportion of adults with mental disorders who receive treatment. • Increase the proportion of persons with co-occurring substance abuse and mental disorders who receive treatment for both disorders. • Increase depression screening by primary care providers. • Increase the proportion of homeless adults with mental health problems who receive mental health services.

Xerostomia

•Dry mouth •Affects eating, swallowing, and speaking •Contributes to dental caries and periodontal disease •If medication side effects are contributing to dry mouth, medications may be changed or altered •Affected persons should practice good oral hygiene practices, regular dental care, adequate water intake, and avoid alcohol •Saliva substitutes and salivary stimulants may help

Oral Cancer

•More than 60% of oral cancers are not diagnosed until an advanced stage •Early signs and symptoms may be subtle and not recognized by the individual or health care provider •Therapy options include surgery, radiation, and chemotherapy •If detected early, these cancers can almost always be treated successfully

Nutrition Implications for Gerontological Nursing

▪Comprehensive nutritional screening and assessment are essential in identifying older adults at risk for nutrition problems or who are malnourished ▪The role of nursing assessment and intervention should be comprehensive and include -Increased attention to the process of eating and the entire ritual of meals -Assessment of nutritional status -Thorough medication review

Nutrition Screening Tools

▪Nutrition Screening Initiative Checklist ▪Mini Nutritional Assessment (MNA) -Both a screening tool and a detailed assessment -Only valid for those older than age 65 years -Intended for use by professionals ▪Minimum Data Set (MDS) ▪Food and nutrient intake -24-Hour dietary recall -3-Day dietary history

Nurse assessment of sexuality and STDs

◦Ask elders about their sexual satisfaction ◦Screen for HIV/AIDS and other sexually transmitted diseases ◦Perform a medication review ◦Use the PLISSIT model as a guide for sexual discussion

Nurses Role: Losses

◦Assess nature of psychosocial and adaptations to changes ◦Communication: Explore strengths, coping skills, goals and desires ◦Coping methods ◦Hobbies and activities ◦Assess/explore: Is this person showing signs of depression?

2 categories of vulnerability under MN law

◦Categorical: based mostly on where someone lives (nursing home, assisted living) ◦Functional: based on level of dependency on others

Intimacy and chronic illness

◦Chronic illnesses and their related treatments may bring many challenges ◦Individuals want and need information ◦Providers need to become more knowledgeable and more actively involved

Who is most likely to be abused?

◦Confused ◦Dependent ◦Frail ◦Had abused in past or been abused ◦Alone ◦Women ◦Institution ◦"Hard" behavior ◦Feel they deserve it

Nursing roles include

◦Helping older patients deal with financial issues ◦Using their expert advocacy and negotiation skills

Erectile dysfunction (ED)

◦Inability to achieve and sustain an erection sufficient for satisfactory sexual intercourse ◦Multiple causes exist for this problem ◦Use of phosphodiesterase inhibitors has revolutionized treatment for ED (ED meds can't be used if pt has cardiac issues)

Sexuality and Dementia

◦Intimacy and sexuality remain important in the lives of persons with dementia and their partners Issues ◦Consent when cognitively impaired ◦Inappropriate sexual behavior ◦Sexual inappropriateness

Types of Loss

◦Loss of cognitive processes, mental capacity ◦Health ◦Mobility ◦Self-management ◦Financial resources & security ◦Loss of independence ◦Retirement and reduced income ◦Psychosocial ◦Touch ◦Housing

Plawecki & Amrhein article

◦Main points: ◦Patients have the right to refuse treatment. ◦ It must be determined that the elderly patient is capable of understanding the health care information and able to make a decision. ◦Implications for nurses: ◦Nurses may be asked to obtain "informed consent" from patients, and need to understand their accountability and legal liability.

Female sexual dysfunction

◦Mental health ◦Physical changes (post-menopause)

Multiples Losses

◦More than one loss at a time ◦Multiple health problems, chronic illnesses ◦Add relocation, death of spouse or partner

Who are included as part of a vulnerable population?

◦Older adults ◦People living in poverty ◦People who are homeless ◦Immigrant populations ◦People in abusive relationships ◦People with substance abuse ◦Those with severe mental illnesses ◦Children

Nurses responsibility in regards to sexuality and STDs

◦Provide an opportunity for discussion ◦Be an educator ◦Know one's feelings about sexuality

Ziminski, Phillips, & Woods article

◦Purpose of study: Describe injury presentations in emergency department of people > 65 years old with and without cognitive impairment ◦Explore the relationship of injury presentations to injury etiology (cause) among those with and without cognitive impairment ◦Main points: ◦It's important to understand & recognize common injuries in older adults so than uncommon injuries, such as those from abuse, can be identified. ◦Implications for nurses: ◦Recognize that accidents and injuries are important reasons for older adults to come to emergency departments (ED) for care

Sexuality in Long-Term Care Facilities

◦Sexual needs of older adults in long-term care facilities should be addressed with the same priority as nutrition, hydration, and other needs Issues ◦Attitudes of staff, family ◦Privacy

Sexuality of Older Adults

◦Sexuality allows a general affirmation of life ◦Various spheres

Losses of the Elderly

◦The longer people live, the more changes and losses they experience ◦Several losses may occur at the same time ◦Effect: High risk for illness and functional deterioration

Nurses are Mandated Reporters of Abuse & Neglect

◦This is the intersection of nursing and the law. We don't need to be lawyers to be nurses, but we need to understand our legal responsibilities to our patients. ◦Never judge; there are many factors involved in abuse & neglect