Fundamentals Chapter 14 Older Adult
What happens to the Gastrointestinal System of an older adult?
-DECREASE in saliva and digestive enzyme production -DECREASE in absorbing cells in intestinal tract -Peristalsis SLOWS (^constipation) -Poor muscle tone leads to delayed stomach emptying
Common Characteristics of Aging
-Gradual -Individual -Vulnerability -Health Problems
Reminiscence
Recalling the past
What is the Continuity Theory? (Psychosocial)
**Developmental Theory** Suggests that PERSONALITY REMAINS STABLE and behavaiorr becomes MORE PREDICTABLE as people age
What is the Disengagement Theory? (Psychosocial)
**Oldest psychosocial theory** States aging individuals WITHDRAW from customary roles and engage in more INTROSPECTIVE SELF-FOCUSED activites
To improve Vision, what can the Nurse implement?
-Adequate lighting -Use reds/oranges/yellow for better visuals -Don't move belongings without discussion -Announce before touching -Night lights help -Artificial tears to prevent dryness (need MD order) **Reading should be in black & white, visuals can be the colors (R,O,V)**
Identify the early indicators of an acute illness
-Change in mental status (Delirium) -Dehydration & Malnutrition -Health care-associated infections -Transient urinary incontinence/dizziness -Skin Breakdown -Falls -Decrease in appetite -Loss of function
What happens to the Integumentary (skin) state of an older adult?
-Collagen changes leads to LOSS of turgor -Sweat glands DECREASE in size and number -Body temp DECREASES r/t metabolic rate -Hair loss -Lentigo senilus (liver spots) on hands and forearm
To improve Eating/Digestion, what can Nurses implement?
-Dentures in -Adequate fluids -Watch swallowing -Thickened liquids better -Ambulation -Heavy meal mid-day -Constipation prevention
To improve Hearing, what can the Nurse implement?
-Face the person when talking -Lower pitch before increasing volume -Hearing aids in with batteries -Use moderate rate -Avoid background noise (ask permission for TV & music sound to be lowered for less distractions)
What happens to the Musculoskeletal System of an older adult?
-Gradual DECREASE in speed -Power and bulk of muscles DECLINE -Intervertebral disc thin -Bone density DECREASES ***Synovial fluid thickens restricting joint movement and creating stiffness*** (scarring, reduces fluids, thickens)
What happens to the Vision of an older adult?
-Lens LOSES elasticity -LESS lacrimal secretions -Pupils DECREASE in size -Lens THICKENS impairing light passage -Lens yellows filtering blue and green colors -Cataracts can develop
What happens to the Respiratory and Circulation of an older adult?
-Lungs become more RIGID and structural configuration impedes thorax expansion -DECREASE cilliary action and muscle strength (^risk for infection) -Veins and arteries THICKEN, BP goes up 140\90 (^risk for infection) -Myocardium less efficient=decreased cardiac output=swellling
To improve Breathing/Circulation, what can Nurses implement?
-Move SLOWLY to adjust to blood pressure changes when sitting, standing, walking (orthostatic hypotension) -Sit with feet elevated to improve blood flow -Report any shortness of breath or chest pain immediately -Balance rest and activity -Support hose -Assess BP and apical pulse
Common Physiological Changes in the Neurological System
-Neurons and Neurotransmitters DECREASE in number -Brain cells DECREASE in number -Cerebral O2 supply DIMINISHES -Conduction speed of nerve fibers DECREASE
To improve Smell/Taste, what can Nurses implement?
-Offer a variety of herbal flavoring -May have to use sodium free flavorings -Smoke detectors in the home!
To improve Muscles/Bones, what can Nurses implement?
-Proper foot wear -Assistive devices -Encourage ambulation -Anticipate needs such as water, tissues, and call bell; keep near -Carbohydrates for energy (balance) -ROM -Encourage to go slow first -Diet (need protein for everything in body)
List general preventative measures to recommend to older adults
-Regular exercise -Smoking cessation -Weight reduction -Screening activities -Eating a low fat, well-balanced diet -Regular dental visits -Immunizations -Moderate alcohol use
What happens to the Hearing of an older adult?
-THICKENING of eardrum & changes in nerve tissue -HIGH pitched sounds are lost first -INCREASE accumulation of WAX (cerumen) **Ear must be irrigated before ear test**
To improve Elimination, what can Nurses implement?
-Toilet every 2 hours (q2h) and following meal -Confusion can be an early sign of a UTI -Encourage high fiber foods -Avoid caffeine products and decrease fluids before bed -Encourage water, cranberry juice (changes pH, reduce UTI) -Measure intake and output (I&O) -Know toxic medications
What happens to the Genitourinary System of an older adult?
-Urinary bladder DECREASES in capacity (weakens, not incompetent) -Relaxation of pelvic muscles -Kidneys DECREASE in filtering -Prostate enlarges leading to DECREASE bladder size and frequency -DECREASE in sperm count -SHRINKING of ovaries and uterus -DECREASE in vaginal secretions
For the skin, what actions does the nurse implement?
-Use lotions following bath -Avoid extreme heat/cold! (sensory diminished) -Hypothermia: wear layers -Watch for skin tears/pressure sores (Vascular is smaller and harder, blood supply gets cut off) -Trim nails by first soaking in H2O, refer to podiatrist if possible -Protect from direct sunlight (could be on meds that are light sensitive)
List the national initiative goals proposed for 20/20
1. Increase the number of older adults with one or more chronic conditions who report confidence in maintaining their conditions 2. Reduce the proportion of older adults who have moderate to severe functional limitations 3. Reduce the number of ED visits caused by falls 4. Increase the number of older adults who live at home but yet have unmet long-term services and support 5. Increase the proportion of older adults with reduced physical or cognitive function who engage in light, moderate, or vigorous physical activities
Types of Memory
1. Remote 2. Recent 3. Immediate
Identify the psychosocial changes that occur in older adults
1. Retirement 2. Social Isolation 3. Sexuality 4. Housing and Envionment 5. Death-affects older women than men
Theories of Aging
1. Stochastic (Biological) 2. Non-stochastic (Biological) 3. Disengagement (Psychosocial) 4. Activity (Psychosocial) 5. Continuity (Psychosocial)
Summarize the two types of ongoing care for older adults
1. The continuation of the recovery from acute illness or surgery that began in the acute care setting 2. The support of chronic conditions that affect day-to-day functioning
Interventions used to maintain the psychosocial health of older adults (6)
1. Therapeutic Communication 2. Touch 3. Reality Orientation 4. Validation Therapy 5. Reminiscence 6. Body image
Myths and Stereotypes of Older Adults
1. ill, disabled, and unattractive 2. forgetful, confused, rigid, boring, and unfriendly 3. unable to learn an understand new information 4. not interested in sex or sexual activities
Older adults are persons age ____ and over.
65
What is the definition of aging?
A gradual maturation & ongoing adaptation, both physiological and psychological aspects of "our being"
Cognitive: What is Delirium?
An ACUTE state of confusion, SUDDEN. Increases when hospitalized patients experience sleep deprivation, infection, dehydration, pain, sensory impairment, drug interactions, anesthesia and hypoxia. -Reversible (treat asap) -Often has a physiological cause -Can last 24hrs-1month, screening techniques if suspicious
Validation Therapy
An alternative approach to communication with a confused adult -Used for SEVERELY confused -Meet them in their world -Tap into the emotion expressed -Provides a sense of dignity
Body image
Assisting with GROOMING and HYGIENE
Scientific study of the process & phenomena of aging
Biologists, Psychologists, Sociologists, Public Health, and Policy
Alcohol abuse
Can be found in older adults. Causes are depression, loneliness, and lack of social support
Touch
Can significantly lower agitation levels in older adults with dementia
What is the Activity Theory? (Psychosocial)
Considers the continuation of activities PERFORMED DURING MIDDLE AGE as necessary for successful aging
What happens to the Smell and Taste to an older adult?
DECREASE number of olfactory fibers and taste buds means decrease sense of smell and taste ex. Increase of sugar in coffee
Dental problems
Dental caries, gingivitis, broken or missing teeth, and ill-fitting dentures affect nutritional adequacy, cause pain and lead to infection
What is ageism?
Discrimination against people because of increasing age
Myth: Old age is synonymous with illness and frailty
FACT: -Only 5% in long term care facility -80% normal life, 15% chronic illness
Myth: Aged are unproductive and withdrawn. "Rocking Chair"
FACT: 25% employed, 35% volunteerism (They want to stay with society!)
Myth: Aging=lack of interest and/or ability for sexual activity
FACT: Elderly continue to enjoy sexual activity into old age on regular basis
Myth: Loss of mental function is inevitable
FACT: Most changes related to mental status comes from: -Medications -Depression -Brain Disease
Myth: Old Age is unpleasant, lonely and isolated
FACT: National survey reports that 3/4 elderly population are satisfied to very satisfied with lives
Myth: Resistant to change, rigid and unmotivated "Can't teach an old dog new tricks"
FACT: Resistance to change is a personality trait, have seen many changes
T or F: Aging is synonymous with disease
FALSE!
Smoking
Four most common causes of death and most preventable
Cognitive: What is Dementia?
It is a generalized impairment of INTELLECTUAL functioning -Irreversible, GRADUAL -Interferes with social and occupational functioning -Leads to Alzheimer's, eventually becomes dependent on others
Neurological: What is Sundowning Syndrome?
It is a habitual period of confusion occurring at DARKNESS or LATE AFTERNOON (around dinner) -Use Reality Orientation: Clocks, calendars, real part of the environment (season), talk about their family, puzzles, activities...distract! -Allow time for processing of information Important: Do not screw up sleep schedule
Heart disease
Leading cause of death
Nutrition
Lifelong eating habits and situational factors influence how older adults meet their nutritional needs. Can be based on tradition, ethnicity, religion influence, finances, and cognitive ability.
Memory Loss
Memory loss is the first sign of Alzheimer's (AD) -Recognize early. Other Illness's have memory loss and can be reversed. AD can not be reversed-treatment can maximize quality of life
Cognitive: What is Depression?
Most Common yet most undetected and under treated. Increases when there is loss of a loved one and loss of social contact. -Not normal for older adults, can be caused by stroke, dementia, Parkinson's disease, cancer, heart disease, and pain-provoking diseases such as arthritis -Approximately 1/3 experience depressive symptoms, but it is NOT part of normal aging process. -Treat therapeutically first, medication is not necessary -Can lead to suicide
Therapeutic Communication
Nurse expresses ATTITUDES of concern, kindness, and compassion
Medication
Older adults are at risk for adverse medication affects because of age-related absorption, distribution, metabolism, and excretion of drugs, referred to process of pharmacokinetics
What do Nurses need to do to recognize and address ageism?
Question prevailing negative attitudes and stereotypes, reinforce the realities of aging as they care for older adults in all care settings. We must respect older adults and actively involve the in care decisions and activities
Cancer
Second most common cause of death among older adults
Reality orientation
Technique to make older adults AWARE of time, place, and person
Stroke
Third leading cause of death in the U.S. As brain ischemia (inadequate blood supple to areas of the brain caused by arterial blockage
As we age, can we expect to eventually become incontinent?
This is not an expected part of the aging process, problem could be in result of a UTI
Polypharmacy
Use of many medications that increased risk of adverse effects
What is the Non-stochastic Theory? (Biological)
View aging as the result of GENETICALLY programmed PHYSIOLOGICAL MECHANISMS within the body that control the process of aging
What is the Stochastic Theory? (Biological)
View aging as the result of random CELLULAR DAMAGE that occurs over time. Accumulated damage leads to the PHYSICAL changes that are recognized as characteristics of the aging process
