Chapter 23: The Older Adult

When the older adult faces illness, the greatest threat to health is:

loss of physiologic reserve of the organ systems. Explanation: The greatest threat to the health of older adults is loss of the physiologic reserve of the various organ systems.

A 78-year-old woman is status post right hip fracture after a fall. She has stopped going to her church over the past few months. She has also asked her neighbor to help her and do her gardening, an activity she previously loved. The client tells the nurse "I just don't enjoy gardening like I used to. I am always worried about falling." What would most concern the nurse regarding the client?

Depression Explanation: The nurse should assess the client and determine if depression is occurring first. Depression can be treated and the client's condition improved. If depression is not the issue, then the nurse could further assess and determine if there is another issue which should be addressed.

An 85-year-old client's daughter calls the nurse and states her father is recently having periods of confusion, is unable to dress himself, and is having periods of incontinence. Which of the following should the nurse do first?

Schedule an appointment for a physical examination Explanation: Drug interactions, circulatory or metabolic problems, nutritional deficiencies, or a worsening illness are likely causes for confusion and changes in function, thus a physical examination is indicated. Moving to an extended-care facility is premature until physical causes have been examined. Reminiscence therapy, a way for older adults to facilitate adaptation by reliving past experiences, is used for psychosocial development. A SPICES (sleep problems, problems with eating and feeding, incontinence, confusion, evidence of falls, and skin breakdown) assessment is used to identify problems that can lead to negative outcomes in the elderly client. Although it may be useful in this client, the priority is finding the cause for the physical changes.

There is an 86-year-old female on the medical inpatient unit. She explains that the hospital is quite noisy and that she is having difficulty sleeping. Which is not true regarding sleep in the older adult?

Sleep medications are usually the first choice in treating sleep disturbance. Explanation: Medications are typically the last choice for treating sleep disturbance because they can interact with other medications or have paradoxical effects on the older adult.

An adult child accompanies an older adult client to the clinic and states, "I am not sure what is going on with my parent but I think it is depression." What questions should the nurse ask the client to determine if he or she is depressed? Select all that apply.

"Can you tell me what your sleep patterns are?" "Have you had any changes in weight recently such as a gain or loss?" "Have you lost interest in things you previously found pleasurable?" Explanation: Extreme or prolonged sadness in an older adult may be a warning sign of depression. Depression is not a normal part of aging. Death of a spouse or friends and changes in living environment and financial resources can precipitate feelings of grieving that, if unresolved, may result in depression. There is usually a distinct change of behavior accompanied by other specific signs and symptoms of depression, such as sleep disturbances, weight loss (sometimes gain), difficulty with concentration, irritability or anger, loss of interest in once pleasurable activities, vague pains, crying, fatigue, and suicidal thoughts or preoccupation with death. Visual hallucinations are not part of the symptoms of depression and may be indicative of another form of mental illness or have an organic cause. Finding out what foods the client eats does not ask a question that relates to finding out if the client is depressed.

An older adult client comes to the health center reporting difficulty sleeping. Which statement by the client would the nurse need to address?

"I find myself napping on and off throughout the day." Explanation: The client's statement about napping throughout the day will need to be addressed by the nurse because this can interfere with the client's ability to sleep at night. Avoiding activity after dinner, having a routine bedtime, and avoiding caffeine and alcohol are healthy sleep habits.

A nurse is conducting an education session about appropriate measures to promote sleep with an older adult who is experiencing frequent awakenings at night and then awakening early in the morning. The nurse determines that the education was successful when the client states:

"I need to try and go to bed and get up at the same time each night." Explanation: Sleep measures include maintaining a routine, going to bed and getting up at the same time each night, avoiding exercise 3 to 4 hours before bed, using prescribed sleep medications only for the short-term (7 to 14 days), and avoiding alcohol, nicotine, and caffeine (which tea contains).

The geriatric nurse is evaluating a new nurse's understanding of the theories of aging. Which statement shows the new nurse understands the theories?

"In the wear and tear theory, cells become exhausted from continual energy depletion." Explanation: The wear-and-tear theory holds that organisms wear out from increased metabolic functioning, and cells become exhausted from continual energy depletion. Cross-linkage is a chemical reaction that produces damage to the DNA and cell death. Free radical theory holds that free radicals formed during cellular metabolism are molecules with separated high-energy electrons that can have adverse effects on adjacent molecules, especially lipids. Age-associated changes in the immune system, known as immunosenescence, are thought to be responsible for the increase in infections such as pneumonia and septicemia, immune disorders, and cancer as adults age.

Which statement shows that the nurse does not practice ageism?

"Neither intelligence nor personality normally decline because of aging." Explanation: Although response time may be prolonged from a longer processing time, neither intelligence nor personality normally decreases because of aging. Loneliness results from losses, just as it does for people of all ages. Many adults are active in their communities. Incontinence is not a normal part of aging and requires medical attention. Older adults want to be attractive to others.

A nurse is teaching an elderly client's family about the causes of mental impairment. The nurse sees that the teaching has been effective when the family says which of the following?

"Sundowning is a common problem of dementia." Explanation: A common problem in patients with dementia is sundowning syndrome, in which an older adult habitually becomes confused, restless, and agitated after dark. Dementia is chronic and usually develops gradually. AD is the most common degenerative illness and is irreversible. Delirium, a temporary state of confusion, is an acute illness that can last from hours to weeks and resolves with treatment.

A nursing student is studying depression in the elderly adult. Faculty members knows the student has mastered the information when she states which of the following?

"Treatment of depression includes counseling." Explanation: Treatment of depression usually involves psychotherapy or counseling along with antidepressant medication. In an older adult, hopelessness rather than sadness is more often associated with suicidal intent. Depression usually does not resolve without treatment and is frequently underdiagnosed. There is usually a distinct change of behavior accompanied by other specific signs and symptoms of depression.

A female client asks the nurse why she urinates more frequently as she is getting older. Which of the following is the nurse's best response?

"Your bladder capacity decreases with age." Explanation: Bladder capacity decreases by 50% in the older adult and voiding becomes more frequent. Blood flow to the kidneys actually decreases due to decreased cardiac output. The number of functioning nephron units decreases by 50%, and waste products are filtered and excreted more slowly. Although the vaginal area experiences decreased secretions and thinning, this has no compensatory relationship to more frequent urination.

An occupational health nurse overhears an employee talking to his manager about a coworker 65 years of age. What would the nurse be concerned about when she hears the employee state "he should retire and make way for some new blood"?

Ageism Explanation: Ageism refers to prejudice against the aged. Intolerance is implied by the employee's statement, but the intolerance is aimed at the coworker's age, making this an incorrect answer. The employee's statement does not raise concern about dependence. The prejudice exhibited in the statement is very specific.

The nurse is caring for an older adult client who is confused and agitated. When the client's family comes to visit the nurse asks how long the client has been confused. The family states that the client has been confused for a long time and the confusion is getting worse. The client is subsequently diagnosed with dementia. What is the most common cause of dementia in an older adult client?

Alzheimer's disease Explanation: Alzheimer's disease is the most common cause of dementia in older adults. Approximately 10% of people over age 65 have Alzheimer's disease; about 50% of people over age 85 have the disease. Delirium, or acute confusion, is caused by an underlying disease and is not itself a cause of dementia. Depression is common in older adults but, in many cases, manifests itself in apathy, self-deprecation, or inertia — not dementia. Excessive drug use, commonly stemming from the client seeing multiple physicians who are unaware of drugs that other physicians have prescribed, can cause dementia. Although it is a problem among older adults, it is not as common as Alzheimer's disease.

One of the greatest causes of death in the United States and Canada is colon cancer. The nurse instructs the community on which of the following factors?

Annual screening after the age of 50 Explanation: Colorectal screening annually after the age of 50.

A 79-year-old female is admitted to a long-term care facility. She is incontinent of urine and feces and has impaired cognition. What is the best nursing intervention to prevent skin breakdown for this resident?

Assist her to the toilet every 2 hours and after meals Explanation: Implementing a toileting schedule will help prevent skin breakdown. Turning will not address the incontinence issue. Since the resident has poor cognition, asking her to notify the nurse for elimination needs is unrealistic. An indwelling catheter may increase her risk for infection and will not address the fecal incontinence.

The nurse is evaluating a 42-year-old client who says that he is feeling stressed. Which of the following does the nurse know that could be a cause of stress for this age group?

Being caught in the sandwich generation Explanation: Middle-aged adults may be caught in a "generation sandwich," which includes involvement with children as well as aging parents and other family members. Retirement, the loss of driving privileges, and social isolation are often stressors for the older adult.

The nurse is assessing a middle-aged adult age 48 years in the clinic. The nurse recalls the changes that occur in middle age as they complete the physical and cognitive examination. Changes that occur include what?

Cardiac output decreases. Explanation: Middle age changes include the following: redistribution of fatty tissue around the middle and abdomen; drier skin; wrinkles develop; hair grays and men may experience baldness; cardiac output decreases; near-vision diminishes; presbyopia; hearing diminishes, especially high-pitched sounds; hormone levels decrease; calcium loss from bone occurs; decrease in muscle strength.

A nurse is caring for an older adult client who fell and sustained a hip fracture. Which intervention needs to be included in the nursing care plan? Select all that apply.

Cough and deep breathe every 2 hours. Avoid massaging over bony prominences. Auscultate breath sounds every 1-2 hours. Explanation: An older adult is more likely to develop complications after illness occurs. An older adult with a hip fracture is at high risk for pneumonia and skin breakdown because of immobility, a decreased ability to expel pulmonary secretions, and thinner, more fragile skin. Coughing, deep breathing, and auscultating breath sounds are interventions used in preventing and detecting impaired gas exchange (pneumonia). Maintaining skin integrity can be achieved by the avoidance of massage over bony prominences. Repositioning the client every 4 hours is not frequent enough; it should be done every 2 hours. Monitoring daily weights is not an intervention useful in pneumonia or skin breakdown.

An older adult client enjoys good overall health, but has just been diagnosed with pneumonia and has begun receiving an intravenous (IV) antibiotic. Shortly after being administered the first dose, the client pulled out his IV line and is now attempting to scale his bed rails. Which of the following phenomena most likely underlies this change in the client's cognition?

Delirium Explanation: Delirium is a temporary state of confusion that is often precipitated by drug interactions or the effects of new drugs. Dementia is rooted in organic brain changes and rarely has a sudden onset. The client is not showing signs or symptoms of depression. Disorientation is a manifestation of a problem rather than a cause.

A nurse is reading a journal article about mood disorders in the older adult population. Which information about these conditions would the nurse expect to find? Select all that apply.

Depression is often misdiagnosed. Symptoms often mimic those of other chronic comorbidities of the older adult. Suicide is the most serious consequence of depression. Explanation: Mood disorders (especially depression) are often unrecognized or misdiagnosed in older adults partly due to the false belief that depression is a natural reaction to illness, advanced age, or life changes that occur with age. Therefore, depression is not viewed as something that needs to be treated in the older adult. Furthermore, symptoms of depression may include poor cognitive performance, sleep problems, and lack of initiative ? symptoms commonly seen in people with multiple chronic comorbidities (such as diabetes or heart failure) or in clients with dementia or delirium, causing it to be unrecognized. Although depression is not a normal part of aging, older adults are at an increased risk of experiencing depression due to chronic illness and other age-related changes. The older adult population is also less likely to report symptoms due to the stigma attached. Suicide is the most serious consequence of depression.

A nurse is preparing to medicate an older adult client with an opioid analgesic. Which information will the nurse obtain first to decide about administering the medication?

Determining if the client is able to communicate pain verbally or nonverbally Explanation: The nurse should ascertain the level and intensity of the client's pain. The family is not able to give adequate information about the client's pain. Taking the client's vital signs can be of value as a baseline. A client may share indication of pain other than verbally, such as a grimace or moaning. Each client may exhibit different behaviors when in pain. This is not a reliable indicator as to a client's pain level.

The nurse understands that when caring for the older adult it is important to assist in maintaining independence and self-esteem. Assisting the client to adjust to a walker or wheelchair is an example of supporting which of Erikson's developmental tasks of the older adult?

Ego integrity and coping with reality of limitations Explanation: Age does affect the older adult due to many different physiological changes, as evidenced by a decrease of cardiac output, peripheral circulation, oxygenation of blood, decreased ability to control temperature, and a slower heart rate. Ego integrity is the task of the older adult, according to Erikson, including "wholeness," emotional integration, and acceptance of physical decline. The others are not developmental tasks described by Erikson.

Gould viewed the middle years as a time when adults increase their feelings of self-satisfaction, value their spouse as a companion, and become more concerned with health. Which nursing action best facilitates this process?

Encouraging a client to have regular checkups Explanation: Gould viewed the middle years as a time when adults look inward (ages 35 to 43); accept their lifespan as having definite boundaries, and have a special interest in spouse, friends, and community (ages 43 to 50); and increase their feelings of self-satisfaction, value spouse as a companion, and become more concerned with health (ages 50 to 60). The nursing action that best facilitates this process would be encouraging a client to have regular checkups.

Erikson identified ego integrity vs. despair and disgust as the last stage of human development, which begins at about 60 years of age. Which intervention would best foster older clients' ego integrity?

Encouraging life review Explanation: The intervention that would best foster older clients' ego integrity would be encouraging life review. Older adults search for emotional integration and acceptance of the past and present, as well as acceptance of physiologic decline without fear of death. Older adults often like to tell stories of past events. This phenomenon, called life review or reminiscence, has been identified worldwide. In a sense, this is a way for an older adult to relive and restructure life experiences and is part of achieving ego integrity. Integrity vs. despair and disgust would not be fostered by distracting the client, praising the client, or promoting independent living.

An 84-year-old client has returned from the postanesthesia care unit. The client is oriented to name only. The client's family is very upset because before having surgery the client knew the family. The client is diagnosed with delirium. Which action should the nurse take to help the family with their emotions?

Explain that delirium is a state of confused thinking and usually lasts only a short time. Explanation: By explaining what delirium is and that it usually is short-term provides the family with information that can decrease the family's worry. The hospital chaplain may help to provide emotional support but not all people are interested in religious counseling. The health care provider can be a good resource for information but the nurse should provide teaching to alleviate family concerns. It is not the nurse's place to coordinate a family meeting.

A group of nursing students is reviewing information about the older adult and mobility. The students demonstrate a need for additional study when they identify which statement as accurate?

Falls are the leading cause of death due to injury in individuals who are over the age of 75 years. Explanation: For people over the age of 65 years, falls are the leading cause of injury leading to death, with hip fractures resulting in significant morbidity and mortality. Numerous factors place the older adult at risk for falls, including a history of falls, fear of falling, cognitive and mood impairments, dizziness, functional impairments, and environmental hazards. Older adults are faced with dealing with the fear of falling and striving for independence. Medications often play a major role in contributing to falls and other complications in the older adult

Which of the following health promotion measures should occur most frequently in older adult women?

Fecal occult blood test Explanation: Fecal occult blood tests are recommended annually for older adults. Pap exams and pelvic exams are recommended at least every 3 years. Colonoscopy or sigmoidoscopy should be performed every 3 to 5 years, and a tetanus booster is only necessary every 10 years.

The middle adult is sometimes called the "sandwich generation". According to Erikson, the developmental task of the middle adult is what?

Generativity versus stagnation Explanation: The developmental task of the middle adult is "generativity versus stagnation." They are in a stage of guiding the next generation, accepting their own changes and adjusting to need of aging parents, as well as evaluating their own goals and accomplishments. "Initiative versus guilt" is the developmental task for toddlers. "Ego integrity versus despair" is the developmental task for older adults. "Goal attainment versus crisis" is not a developmental task.

The nurse is assigned to care for a client age 87 years admitted to the medical unit for congestive heart failure. It is the fourth hospital day, and the response to treatment has been good. The client is no longer short of breath and the lung sounds are clearing. There is still a diet restriction of decreased sodium and fluids are limited to no more than 1000 mL per day. The nurse is preparing the client and family for discharge. The nurse's discharge education, in order to promote the older client's health, will include which instructions? Select all that apply.

Gradually increase activities as tolerated. Do not use the salt shaker at meals. Increased stress may interfere with recovery. Explanation: Promoting health for older adults includes ensuring adequate nutrition (e.g., low-fat diet, other diet modifications); balancing calories and activities; planning exercise as a daily activity; and educating the client that illness is a physical and emotional stress and increases the risk for complications. Taking naps will interfere with sleep at night.

A nurse is assessing a 55-year-old female client. What is a normal physical change in the middle adult? Select all that apply.

Hearing acuity diminishes. Cardiac output begins to decrease. There is a loss of calcium from bones. Explanation: Normal physical changes that occur in the female middle adult include: hearing acuity diminishes, cardiac output begins to decrease, and there is a loss of calcium from bones. Skin becomes more dry, hormone production decreases, and cognitive ability does not diminish.

A older adult client is admitted to a nurse's unit with a community-acquired pneumonia requiring 14 days of intravenous antibiotic treatment. What does the nurse identify to the client as a contributing factor that affects the older adult client? Select all that apply.

Humoral immunity declines. Older adults are more susceptible to pneumonia following respiratory infections. Explanation: As people age, their immune system becomes less efficient. Their humoral immunity declines due to diminished T-cell function, and older adults have lower antibody response following respiratory infections to fight off pneumonia. Nutrition does not contribute to immune system function in older adults. Alcoholism may contribute to depression but not diminished immune function. Polypharmacy can lead to many situations with drug interactions but is not the cause of community acquired pneumonia.

A nurse encourages residents of a long-term care facility to continue a similar pattern of behavior and activity that existed in their middle adulthood years to ensure healthy aging. This intervention is based on which aging theory?

Identity-continuity theory Explanation: The identity-continuity theory assumes that healthy aging is related to the older adult's ability to continue similar patterns of behavior from young and middle adulthood. Older adults search for emotional integration and acceptance of the past and present, as well as acceptance of physiologic decline without fear of death. Older adults often like to tell stories of past events. This phenomenon, called life review or reminiscence, has been identified worldwide. Disengagement theory maintains that older adults often withdraw from usual roles and become more introspective and self-focused. This withdrawal was theorized as intrinsic and inevitable, necessary for successful aging, and beneficial for both the person and for society.

The nurse is reminiscing with a 72-year-old client with early onset dementia while providing care in a long-term care facility. How does the nurse implement this form of therapy to maximize the therapeutic value?

Listen to the client's stories and ask questions to facilitate ego integrity and provide companionship. Explanation: Reminiscence is a way for an older adult to relive and restructure life experiences and is part of achieving ego integrity. Listening and asking questions also provides a sense of companionship to clients as they often experience loneliness during dementia even though they may have family members that visit. , nor does it support the client's acceptance of declining health status.

A nurse is assessing middle-age adults living in a retirement community. What behavior would the nurse typically see in the middle-age adult?

Looks inward, accepts life span as having definite boundaries, and has special interest in spouse, friends, and community Explanation: Middle-age adults would be looking inward, accepting the life span as having definite boundaries, and having special interest in spouse, friends, and community. The other options are behaviors of the older adult.

The nurse practitioner is examining a 55-year-old female client. Which of the following findings would be uncommon for this age group?

Lower extremity pulses are weak Explanation: Normal physiologic changes of the middle-aged adult do not include peripheral pulses becoming weak and not always palpable. The other options can be seen in a middle-aged adult

A nurse is providing care at an ambulatory care center to a wide range of older adults from diverse racial and ethnic groups. Based on recent statistics, which group would the nurse most likely identify as projected to be the largest?

Non-Hispanic Whites Explanation: In 2012, 21% of people 65 and over were members of racial or ethnic minority populations. Racial and ethnic minority groups have increased from 6.1 million in 2002 (17% of the older population) to 8.9 million in 2012 (21% of the older population) and are projected to increase to 20.2 million in 2030 (28%% of the older population). Between 2012 and 2030, the white non-Hispanic population 65 years or older is projected to increase by 54%, compared with 123.5% for older racial and ethnic minorities, including Hispanics (155%); Blacks (104%); American Indian and Native Alaskans (116%); and Asians (119%).

A healthy 52-year-old client asks the nurse what she can do to maintain her health. Which of the following does the nurse recommend?

Perform self-examination of the skin every month Explanation: Guidelines for health-related screenings, examinations and immunizations for the adult include self-examination of the skin every month; beginning at age 50, colonoscopy every 3-5 years; physical examination every year from age 40; the zoster vaccine is recommended for adults 60 years and older.

A nurse caring for older adults in a long-term care facility is teaching a novice nurse characteristic behaviors of older adults. Which statement is not considered ageism?

Personality is not changed by chronologic aging. Explanation: Ageism is a form of prejudice, like racism, in which older adults are stereotyped by characteristics found in only a few members of their group. Fundamental to ageism is the view that older people are different and will remain different; therefore, they do not experience the same desires, needs, and concerns as other adults. The statement not considered ageism would be that personality is not changed by chronologic aging. Most older adults are not ill and institutionalized. Intelligence does not decline with age. Old age does not begin at age 65.

The home care nurse is visiting an older adult client in the home to assess a leg wound and change the dressings. The nurse is aware that the client receives money monthly but there is no food in the house, no adequate heat, and the client states, "My sister takes my check and cashes it every month." What is the correct action by the nurse?

Report the incident to social service informing them the client has no food or heat. Explanation: The client is apparently a victim of financial abuse and is being left without resources in order to live comfortably and to have basic needs cared for. The nurse should not confront the sister or have the client confront her due to the potential for violence. The incident must be reported to social service to have them involved with obtaining immediate resources for the client. Taking the client to the Emergency department would be against regulations for home health nurses and the client is not in need of immediate medical attention.

A nurse has attended an inservice workshop that addressed the phenomenon of ageism in the health care system. Which of the following practices is indicative of ageism?

Speaking to older adults with the presumption that they have mild cognitive deficits Explanation: Accommodation of normal, age-related changes such as decreased skin turgor and slightly decreased nutritional needs is not an indication of ageism. Similarly, safety measures are unlikely to be motivated by ageist beliefs. Assuming that all older adults have cognitively deficits, however, is an indication of ageism.

Which of the following assessment findings of a male client age 77 years should signal the nurse to a potentially pathologic finding, rather than a normal age-related change

The client is oriented to person and place but is unsure of the month. Explanation: Age-related physiologic changes include a weakening of bladder emptying, presbycusis, and a slow gait that may be accompanied by stooped posture. Disorientation to time, however, should always prompt the nurse to perform further assessment and should never be considered a normal accompaniment to the aging process.

A nurse is preparing a presentation for a group of older adults about health promotion. Which statistic would the nurse need to keep in mind about this group?

The group experiencing the largest growth is those 85 years of age and older. Explanation: The older population itself is older than it has been in the past. In 2012, the 65-74 age range was more than 10 times larger than in 1900; however, in contrast, the 75-84 age group was 17 times larger, and those age 85 years or older was 48 times larger. Life expectancy has increased for both men and women. Worldwide, the number of older adults has grown exponentially. Since 1900, the percentage of individuals 65 years or older has tripled, and the number has increased over 13 times. The older adult population itself is older than it has been in the past.

When providing nursing care to the elderly, it is most important to provide comfort due to which of the following changes?

Thermoregulation Explanation: The body can adapt to environmental temperatures within broad limits, but age and health status greatly affect this capacity. Thus, in the provision of nursing care that focuses on comfort, the nurse must be aware of changes in thermoregulation.

The hospice nurse is visiting the spouse of a client who died 4 weeks prior. Which behavior by the spouse concerns the nurse?

Voices the inability to leave the home without the client Explanation: Grieving responses vary among all people. There is no "right or wrong" way to grieve; however, maladaptive behaviors, such as not leaving the home because the client is deceased, may threaten the health of the spouse. The nurse would investigate this statement further to assure the client is eating and has support from loved ones or friends. Crying when discussing the client's death is normal grieving. Leaving the client's clothes untouched is normal grieving for 4 weeks after the death. Keeping the picture of the client around at all times is normal grieving in this stage.

Which group of individuals in the older adult population is most likely to be widowed?

Women over the age of 75 Explanation: Loss and grief are a significant factor in the older adult population. In 2008, almost half of women (42%) were widowed by age 65, compared with 14% of men. Of women 75 years or older, only 28.9% lived with a spouse (AOA, 2009).

When creating a nursing care plan, what information should the nurse elicit from a client having difficulty sleeping?

amount of caffeine consumed per day Explanation: In order to develop a plan of care, the nurse should ask about the amount of caffeine consumed per day, as this may influence the quality of sleep. Clients who are having difficulty sleeping should consider changes in sleep hygiene. Asking the client what activities the bed is used for (such as reading or watching television) is important, but specifically asking where sexual intercourse occurs may be seen as inappropriate. Asking when the client performs personal hygiene is not relevant to sleeping habits. Family medical history would not be necessary to develop a plan of care regarding sleep.

When describing the older adult's risk for infection, which aspect would the nurse most likely address? Select all that apply

decline in humoral immunity lowered antibody responses inadequate nutrition Explanation: As people age, their immune systems become less efficient. Humoral immunity declines because of changes in T-cell function, and older adults have lower antibody response to microorganisms that cause influenza and pneumonia (Frasca, et al, 2010). Inadequate nutrition and chronic illnesses adversely affect the immune system and the ability to ward off infection. Without proper nutrients, basic body functions lack the necessary vitamins, minerals, and food substances (proteins, carbohydrates, and fats) to maintain optimal functioning.

An older adult client tells the nurse, "I just don't seem to have an appetite and food just doesn't taste as good as it used to." The nurse understands that which factor may be playing a role in this client's lack of appetite? Select all that apply.

decreased number of taste buds decreased saliva production Explanation: As people age, changes in the gastrointestinal tract can affect nutrition. For example, a decrease in the number of taste buds and saliva production can decrease taste sensation and appetite. Dental problems (e.g., poorly fitting dentures, difficulty chewing, and broken teeth) and difficulty swallowing make effective eating difficult, but would not affect a client's appetite or taste.

The nurse is caring for an older adult client on the medical unit admitted for diagnostic testing. The client is alert and oriented and lives independently. The client was wearing glasses upon admission. Which nursing intervention will be most effective in the prevention of falls for this client?

ensuring the client's glasses are close by the bed Explanation: This client does not require aggressive fall prevention measures since the client lives independently, is only having diagnostic testing, and is alert and oriented. Keeping the client's glasses close by will ensure the use of sensory appliances necessary to prevent falls.

A nurse is reviewing the medical records of clients at a long-term care facility who are experiencing weight loss. The clients' medical conditions have been ruled out as a cause. The nurse understands that which situation would most likely be a factor? Select all that apply.

evidence of depression use of appetite-suppressing drugs need for staff to assist with meals Explanation: When not directly attributable to underlying disease, weight loss in the institutionalized older adult is most commonly due to depression, use of anorexigenic drugs, and dependency on staff to assist with meals (U.S. Department of Health and Human Services, 2014). Lack of exercise and food choices have not been found to contribute to weight loss in the institutionalized older adult.

After graduation, if you especially want to care for the aged population, you would consider the nursing specialty that focuses on the health and illnesses of the aging. This specialty is:

gerontologic nursing. Explanation: Gerontologic nursing combines the knowledge and skills of nursing with specialized focus on the aging in both health and illness. Hospice is end-of-life care, long-term care is a type of care facility, and geriatrics is a branch of medicine.

An older adult client is prescribed a sleep medication. When explaining the medication to the client, the nurse would emphasize which aspect of therapy?

greatest effectiveness with short term use Explanation: Sleep medications may be used, but these drugs are most effective when limited to short-term use (7 to 14 days); otherwise, the medications may actually interfere with sleep and cause other adverse outcomes such as falls, confusion, and constipation. The risks for adverse effects depend on the drug prescribed. There is no need for follow up laboratory tests.

A nurse is performing a home assessment for a 90-year-old widower who lives in a third story apartment. The assessment reveals there are smoke alarm and carbon monoxide alarm systems; slip-proof surfaces in the bathtub and shower; no throw-rugs present; handrails on the steps; unlocked cabinets with potential poisons; adequate lighting; large flat screen TV on wall; and the water set at a safe temperature. As the nurse considers the client's home environment, what modification can be made to enhance safety for the client?

handrails in bathroom Explanation: As mobility impairment increases in persons over the age of 65, the risk of falls increases. Hip fractures are a particular risk factor for disability and death. Modification of the environment, such as slip-proof surfaces (bathtub, shower, floors); handrails in bathroom and stairway; lighting; removal of throw rugs; to prevent falls are key concerns for older adults. General concerns such as, but not limited to, smoke alarm and carbon monoxide alarm systems and water set at safe temperature range are also modifications to consider. It would be appropriate to ensure that large objects hanging on the wall are secured, but removal is not necessary. Ensuring there is an AED in the home is not necessary. If the client has dementia, concerns of poisoning and appliance use may be an issue; however, in this example there is no mention of confusion or dementia.

When providing care to a client with dementia, which interventions would be most appropriate? Select all that apply.

maintain levels of sensory stimulation that are tolerable ensuring the use of assistive sensory devices using validation therapy Explanation: Maintaining levels of sensory stimulation that are tolerable for a person with dementia minimizes confusion and fatigue. Appropriate sensory appliances (glasses and hearing aids) assist older adults in interacting appropriately with their environments. An inexpensive, handheld amplifier serves as an excellent alternative for communicating with clients who are hard of hearing and do not have an available hearing aid. Reality orientation can be useful for orienting people with reversible confusional states (e.g., delirium). In the latter stages of irreversible dementia, reality orientation is less successful and often causes agitated or angry responses. At this latter point, validation therapy (Feil, 2002) may be an effective strategy. In addition, the nurse should avoid criticizing, correcting, or arguing with the client.

A nurse is preparing a presentation for a group of older adults about promoting safety while maintaining their mobility. Based on the nurse's understanding of factors placing the older adult at risk for falls, which area would the nurse most likely address? Select all that apply.

medication use diminished strength environmental hazards Explanation: Multiple factors place the older adult at risk for falls, including the use of medications affecting balance, thinking, memory, and elimination; impaired vision; environmental hazards (e.g., slippery floors, throw rugs, poor lighting); decreased strength; loss of bone mass; and neurological and musculoskeletal problems. Hearing loss and changes in bowel function are not associated with an increased risk for falling.

An older adult is admitted to the health care facility with a diagnosis of depression. The nurse would be especially alert for:

suicidal thoughts. Explanation: Although poor cognitive performance, sleep problems, and lack of initiative are manifestations of depression, the nurse should be alert for indications of suicidal thoughts or behaviors. Suicide is the most serious consequence of depression.

Based on an understanding of the cognitive changes that normally occur with aging, what might the nurse expect a newly hospitalized older adult to do?

take longer to respond and react Explanation: The nurse would expect a newly hospitalized older adult to take longer to respond and react. It is normal for an older adult to take longer to respond and react, particularly in new or unfamiliar surroundings. Knowing this, the nurse should slow the pace of care and allow older clients extra time to ask questions or complete activities.