Chapter 33 Aging Quizlet 2

Genetic factors

People inherit a genetic program that determines their specific life expectancy

continuity theory

Personality remains the same, and behavior becomes more predictable as people age.

ageism

Ageism is a term that describes prejudice against older adults. It reflects a negative response by younger people - a personal dread of growing old or becoming disabled, and a fear of powerlessness, uselessness, and death. Ageism systematically stereotypes and discriminates against people because they are old, just as racism and sexism stereotypes and discriminates against people on the basis of skin color and sex. To enhance the quality of life for older adults, support the patient's hope, pride, confidence, security and integrity. All members of the health care team should work toward eliminating negative attitudes and discriminatory practices.

exchange theory

Aging is reduced interaction between older adults and society as a result of the decreasing value that the interaction has for both

inability to control urination / urgency due to overflow

Allow sufficient time for voiding (manual expression of urine from the bladder) and encourage double voiding (Urinate, relax, and repeat voiding (urinate, relax and repeat voiding attempt in 5 mins) Notify physician for an order for assessment of postvoid residual

Urinary incontinence

Another related problem for many older adults. Some do not leave their homes for fear they will have an accident in public. The several types of incontinence. These types may occur in combination, causing a mixed incontinence that is common in older adults. Stress incontinence is involuntary loss of a small amount of urine with increased abdominal pressure, such as coughing or sneezing. It is common in older women who have had multiple vaginal births or loss of muscle tone.

Patient problem for eyes/hearing loss disturbed sensory perception (specify)

Assess for sensory changes alert all caregivers to sensory problems of the individual determine most effective methods of communicating with individual with sensory impairment modify environment to remove hazards and reduce risks verify that assistive devices such as hearing aids or glasses are clean and functional

Older adults

Baby boomers geriatrics, young old: 65-74, middle old: 75-84, old old: 85-99, Elite old 100+

wear and tear theory

Cells and tissues of the body wear out from internal and external stress, including chemical damage, trauma, or dysfunction of body systems, and buildup of waste products

age related changes in endocrine system

DECREASED: -pituitary secretions (growth hormone) -production of TSH -insulin production (increased insulin resistance) DIABETES -production of PTH

orthostatic hypotension

Decrease in blood pressure related to positional or postural changes from lying to sitting or standing positions

Age related changes in the respiratory system

Decreased cough reflex, decreased cilary action, lungs become stiffer, decreased alveolar surface for gas exchange, loss of lean body mass. skeletal changes of the chest

Inability to control urination, due to urgency

Implement bladder training to increase awareness of the need to toilet encourage the patient to use the toilet at appropriate intervals provide information on urge inhibition teach pelvic floor exercises restrict caffeine intake, allowing no caffeine in the evening

age related changes to reproductive system

Diminished levels of male and female hormones estrogen and progesterone in women and androgen and testosterone in men. Diminished sexual function.

Inability to control urination, due to physical stress

Encourage the patient to use the toilet at appropriate intervals teach pelvic floor exercises provide toileting assistance and incontinence supplies as needed

Baby Boomers (1946-1964)

Experienced great economic prosperity, job security, optimism about their future

General fall guidelines

General care: Assess shoes for safety avoid wearing back less shoes or flip flops wear leather or rubber soled shoes illuminate darkened areas avoid storing items in overhead compartments assess assistive walking devices to ensure the tips and wheels are intact and functional use caution when standing from a sitting position allow time for the body to acclimate to positional changes avoid the use of alcohol do not use ladders or step stools unattended steps and floor surfaces: avoid the use of throw rugs, assess carpets for holes or frayed areas, avoid missing a step count them to ensure placement install banisters in stairways keep walk areas clear on landings, use carpeting that has color contract Bathroom: use assistive rails in the bath and shower area use a shower stool as needed

Functional urinary incontinence

Occurs as a result of inability or unwillingness to get to the toilet because of physical limitations, depression, or confinement to bed or use of restraints. Nursing interventions begin with an understanding that an older adult is not trying to get attention by requesting to go to the bathroom frequently and is not incontinent by choice. Never reprimand or humiliate an older adult for having to urinate or having accidents.

Discharge planning for the older adult

Older adults have less reserves to cope physically and emotionally with the effects of hospitalization and surgery. They need longer postoperative recovery and convalescent periods. The normal effects of immobility on body systems, including stasis of secretions orthostatic hypotension, and digestive and perceptual disorders, must be kept to a minimum. When adults in their 80s and 90s undergo surgery, their rehabilitation must being as soon after surgery as their condition stabilizes. Especially important are measures to prevent complications of immobility and techniques to support coping skills and independence. Turning, deep breathing, coughing, or other techniques for ventilation and removal of respiratory secretions are important with older adults because of the age related changes in the respiratory tract that in crease the risk of atelectasis and pneumonia. Depending on the type of surgery, older individuals are best ambulated within 8 - 24 hrs to decrease the risks of stasis in the circulation, kidneys, bladder, and respiratory tract. Getting up, even to stand or take a few steps, usually helps to stimulate peristalsis, peripheral vascular circulation, and muscle activity, expand the lungs and improve mental outlook. Encourage older individuals to perform self care activities at their own level of tolerance and with rest periods. Remember that the hospitalization and the surgical intervention have the potential to increase signs and symptoms of other chronic conditions, such as arthritis, which sometimes is cause for reports of discomfort or difficulty in ADLs. Discharge Planning: Older adults need to have the necessary knowledge, skill, and resources to meet self-care needs at home before discharge from a health care facility. Planning begins with assessment of the biophysical, psychosocial, educational, self care and environmental needs. Strategies depend on physical and emotional readiness to learn, educaiton level, and family and community resources available. Written or visual guidelines that reinforce verbal instructions should be provided. Learning is enhanced when the older adult is actively engaged in the learning process. Preserving as much of the older's adult's autonomy as possible is a prime consideration. First consider the individual's physical strength and remaining functional abilities, not just the current disabilities, before making modification to the home environment. Nurses initiate plan of care and provide care that requires judgment and skill including health and self care teaching, this teaching includes medications, medicatin administration, wound and decubitus care, urinary catheter care, ostomy care, postsurgical care, and care of the terminal patient. Some Home health nurses provide intravenous therapy, enteral and parenteral nutrition, and chemotherapy. Once the RN establishes the plan of care, LVS are permitted to provide skilled nursing and HHAs to provide personal care such as ADLs, hygiene, vital signs and other tasks ordinarily done by the patient or family. PATIENT TEACHING: Teach when the older adult is alert and rested. Allow for several shorter sessions, watching for signs of fatigue involve the individual in discussion or activity focus on the person's strengths use approaches that adapt for the presence of pain and impaired range of joint motion, impaired reception of stimuli such as slower reaction time, muscular weakness, reduced pain and temperature perception, reduced depth perception and color discrimination, and reduced visual acuity consider need for adaptive devices such as a syringe magnifier as needed, enlist eh help of the patient's significant other, or provide assistive personnel

Aging body

Physiological changes affect a person's biologic, psychological, social, and environmental status. Physiologic changes in the aging process result in a decreased immune response, a decrease in compensatory reserve, and a loss of body's ability to repair damaged tissue efficiently. Numerous physiologic changes occur in all body system during the natural aging process. There is strong evidence that inactivity is the most important contributor to declining physical mobility and function. Positive lifestyle modifications, including physical activity and proper nutrition, help optimize physical abilities and promote healthier aging. The degree and rate at which changes occur vary among individuals, systems, and organs, as does a person's ability to compensate.

Arthritis

Rheumatoid arthritis - systemic inflammatory disease thought to be of immune factor origin. Can affect any age Osteoarthritis, or degenerative joint disease, is a noninflammatory disorder in which the cartilage in the joints deteriorates and new bone forms on the surface. This is the most common type of arthritis in older adults. Affected joints most commonly include the hands, fingers, and toes and the knees, hiops and spine. warm bath range of motion heat or cold therrapy and gentle massage NSAIDs and monopioid analgesics steriod injections into the joints assistive devices surgical repair

steps of planning for older adult

Safety - fall risks frequent and easy access to bathroom external collection devices such as panty liners, or absorbent briefs careful evaluation of incontinence helps identify treatable factors of incontinence.

age related changes to the nervous system

Structural and functional changes of the nervous system are complex and depend on a number of variables, including the individuals genetic makeup and the specific brain regions affected. Changes are associated with aging include a decline in the number of brain cells and peripheral nerve cells and fiers, and synaptic changes that affect transmission and the sensitivity of target cells to neurotransmitters. Physiologically, nerve impulse transmission in the nervous system slows resulting in a longer reaction time for older adults. Until recently, neuron death was accepted widely as an inevitable result of normal aging. Age related declines inevitably result of normal aging. Age related decline in neuron numbers are not a significant part of normal aging. Unless pathologic degeneration occurs, changes in neuron size and weight bring few if any negative behavioral effects. Autonomic nervous system changes include decreased efficiency in maintaining normal body temperature and in the pulse returning to normal after exercise or stress. memory : common concerns for older adults include forgetting names, misplacing items, and poor recall of recent events or conversations. Changes in short term memory are common with aging. Long term recall usually is maintained. Strategies for adapting, such as making lists or posting reminders, are useful to manage short-term memory loss. Cognition - the process by which information is acquired stored, shared and used is termed cognitive function. The elements of this process include state of consciousness, general appearance and behavior, orientation, memory, language, intelligence, perception, insight and problem-solving ability, judgment, attention span and mood. Outcomes from cognitive function are thinking, remembering, perceiving, communicating and calculating. Many people think that cognitive abilities decline in old age. Only some people experience some deficits, and the decline occurs at different times in their lives.Intelligence and continued ability to learn is possible throughout the lifetime. Teaching strategies may need modification, and learning may require reinforcement because of the age-related changes in the senses and nervous system. Sleep disturbances Proprioception Personality - impaired emotional control, diminished initiative or withdrawal as indicators of other problems or an initial sign of brain dysfunction

Discharge planning for elderly

To be eligible for Medicare home health benefit, an individual must be homebound: have a condition that requires skilled, intermittent care and have a referring health care provider who approves the plan of treatment in writing. The home health nurse assesses the physical, functional emotional, socioeconomic, and environmental well being of patients and works on collaboration with other members of the home health team, including the physical therapist, occupational therapist, speech therpist, social worker, and HHA or personal care attendant.

Abuse & Neglect

Types of Abuse: physical abuse: The use of physical force that has potential to result in bodily injury pain or impairment sexual abuse: nonconsensual sexual contact of any kind with an elderly person, including those individuals unable to give consent psychological abuse: the infliction of anguish pain or distress through verbal or nonverbal acs including intimation of enforced social isolation misuse of assets medical abuse Withholding necessary treatment or aids for ADLS). subjecting a person to unwanted medical treatments or procedures, medical neglect occurs when a medically necessary and desired treatment is withheld Financial or material abuse or exploitation: the illegal or improper use of older adult's funds, property or assets Neglect The refusal / failure to fulfill any part of person's previously agreed obligation or duties to an elder dependent on the person for care or assistance Abandonment: the desertion of an elder by an individual who had assumed the responsibility of providing care or assistance. Common causes frustration and exhaustion of a caregiver, alcoholism, turbulent lifestyles, lack of financial, emotional, family and community resources. Abuse indicators: frequent unexplained crying unexplained fear of or suspicion of a particular person in the home

failure to thrive

a condition in which infants become malnourished and fail to grow or gain weight for no obvious medical reason. Associated with mental disorders, such as dementia and depression, and social and economic factors

constipation

abnormally infrequent or difficult passage of hard, dry feces. Failure to relieve constipation creates the risk of feces. Failure to relief constipation creates the risk of a fecal impaction. Constipation can be acute or chronic. Older adults are often very attention to their bowel function. Problems often are reported when a deviation occurs from wha is perceived as normal elimination even with relatively minor physiologic changes. Assessment relating to constipation includes dietary intake of fiber and fluids; use of medications such as opioid analgesics, antacids, iron preparations, anticholinergics, or overuse of laxatives; mechanical obstructions from fecal impaction, vovvulus, adhesions, strangulated hernia, or cancer, activity and exercise patterns and limitations such as inability to reach the toilet or a lack of privacy. Depression can be a contributing factor in some instances. Nursing interventions: interventions include adequate fluids, exercise, and a diet that contains fiber. Bran is a good source of fiber for older adults who are unable to eat enough vegetables and fruit. Up to 10 g of bran per day may be included in the diet. This is achieable if the daily meals include two slices of whole-grain bread, two bran muffins or biscuits, and two spoonfuls of bran added to or sprinkled over other food. Patient problem: infrequent or difficult bowel elimination related to inadequate intake of fiber and fluids NURSING INTERVENTIONS: assess frequency and consistency of bowel movements increase dietary fiber by encouraging cereals such as bran and fruits such as prunes, Determine fluid preferences, keep fluids at bedside, and offer them at frequent intervals, Administer stool softeners as ordered

pneumonia

aged related change and decreased resistance to respiratory infections cause more older individuals to contract and die of pneumonia than younger people. Even with modern antibiotics and sophisticated medical treatment, pneumonia has the potential to be life threatening for the older adult. older adults do not always exhibit usual signs of pneumonia - high fever, cough, pain and headache. they often shows signs and symptoms of lethargy, disorientation, anorexia and low or mild fever. Interventions for pneumonia: liquefy secretions by adequate intake of fluids, taking prescribed medications, assisting removal of secretions by teaching proper coughing technique to improve airway clearance and turning and deep breathing to improve gas exchange and prevent stasis of secretions

disengagement theory

aging is process in which older adults and society gradually withdraw from each other to the mutual satisfaction of both

Integumentary system changes in aging

aging skin becomes dry and thin and loses tone and elacticity Loss of fact under skin makes wrinkles Age spots called lentigo are tan or brown macules brought on by sun exposure and are more common in middle-aged and older people. Hair greys and thins, and the distribution patterns change, resulting in baldness. Nails develop ridges, and turn yellow. Touch sensation often changes as a result of thinning skin, disease process, and response to medication therapy. Susceptibility to infection, ecchymosis, and tearing increases with aging. Wounds tend to heal more slowly than those in a younger adult. Pruritus: Older people may report dryness and itching (pruritus) of the skin. this is more common in cold, dry weather because of reduced glandular secretions and moisture. Because sops tends to be drying, older adults should use soap sparingly and rinse the residue completely away. Antibacterial soap is very drying and usually is not a good option. In general, less frequent bathing recommended for sedentary older adults because of a decrease in body oils and perspiration. Moles: most benign but sun related skin changes, including precancerous actinic keratosis, basal cell or squamous cell carinoma, and malignant, melanoma, sometimes develop on sun-exposed areas. Nail abnormalities: bilateral clubbing of fingers indicates possible pulmonary or cardiac disease. Yellowed nails indicate possible fungal infection. Splintered nails indicate possible malnutrition, and pitting sometimes signals peripheral vascular disease, psoriasis, diabetes mellitus, or syphilis. Brittle nails are often associated with fluctuations in hormones that occur during menopause. Pressure injury: significant risk for older adults and patients with chronic disease. Thin skin and lack of subcutaneous fat predispose older adults to pressure injury development when their fragile skin is compressed between bony prominences of the body and other objects. Damage to the skin at these pressure points is best prevented by repositioning every 2 hours. Many pressure-reducing pads and aids are available, but only those that do not restrict circulation or create pressure on surrounding areas should be used. fragile skin bruises and tears skin easily. Measures should be instituted to prevent pressure, friction, shearing forces and moisture. Use draw sheets to avoid friction tears, gentle handling, equipment and assistance to lift/ambulate, tape on skin to be kept to minimum. Urine, drainage, or fecal material left in contact with the skin even for a short period of time potentially causes the skin to become impaired. Urine and stool tend to accelerate the formation of pressure injury at pressure points, such as the coccyx or hip. Treat with good hygiene, hydration and diet : protein, vitamins and minerals

Gastrointestinal bleeding

as we age we have less protective mucus secretion so more susceptible to gastrointestinal (GI) bleeding. Assess for blood in stools in the prescence of dizziness, pallor, tachycardia, or hypotension. Rectal bleeding can be a sign of hemorrhoids, rectal fissures, or cancer. In older adults, consider a guaiac-positive stool an indication of pathologic disturbance until proven otherwise. Laxatives, iron supplements, cimetidine (Tagamet), anticoagulants, aspirin and nonsteroidal anti-inflammatory drugs (NSAIDS) and foods such as red meat may yield a false positive.

Patient problem: insufficient nutrition related to lack of interest in food

assess reasons for loss of interest such as depression or grief monitor daily intake weigh weekly determine individual food preferences provide oral hygiene before meals serve meals in attractive manner and assist as needed supplement meals with nutritious snacks if permitted consult with dietitian provide for social interaction during meals

patient problem for respiratory changes: inability to clear airway related to excessive tenacious secretions

assess respiratory patterns, effort and lung sounds observe for signs of cyanosis teach effective breathing and coughing promote adequate hydration suction secretions if necessary administer supplemental oxygen and nebulizer treatments as ordered

Urge incontinence

associated with cystitis, urethritis, tumors, stones, and central nervous system (CNS) disorders such as stroke, dementia, and Parkinson's disease. Urge incontinence is characterized by involuntary urine loss after a sudden urge to void.

Nursing interventions for decreased vision

be sure patient's eye glasses are clean and are available. increase the amount of light in environment reduce glare with use of shades on windows and lights and use nightlights to avoid light-to-dark changes. Use low vision aids such as large print, strongly contrasting colors (black on a white background), and magnifying glasses helps compensate for the decrease in visual acuity

gastrointestinal cancer

cancers that affect the digestive system. This includes cancers of the oesophagus, gallbladder, liver, pancreas, stomach, small intestine, bowel (large intestine or colon and rectum), and anus. Follow up and diagnostic testing if: change in bowel or bladder habits persistent oral lesions visible or occult blood indigestion or difficulty swallowing unexplained weight loss constipation persistent bloating

biologic programmed aging

cells in the body can reproduce only 40 to 60 times. Aging takes place when more and more cells no longer had the capacity to regenerate themselves.

Dysrhythmias

changes in the structure of the heart, the blood supply to the heart, and the pacemaker system sometimes make the heart more susceptible to irregular heart rhythms. Dysrhythmias cause the heart to be less effective ins supplying the blood to the body and have the potential to lead to heart failure. Nursing interventions include checking vital signs frequently noting the rate, regularity, and strength of the pulse; accurately monitoring fluid intake and output and observing and reporting an older person's response to medications. Other nursing interventions include keeping stress on the heart o a minimum by monitoring the response to activity and providing appropriate rest periods before and after activity

Hypothyroidism

condition of hyposecretion of the thyroid gland causing low thyroid levels in the blood that result in sluggishness, slow pulse, and often obesity

why do we need to exercise when we age?

exercise has been shown to prevent disease, lower the risk of falls, improve mental health and well-being, strengthen social ties, and improve cognitive function.

Patient problems for older adult with gastrointestinal system changes: compromised swallowing ability related to neurologic or vascular conditions

nursing intervention: refer to speech therapist for evaluation assess indviduals unique needs and problems verify condition of teeth or fit of dentures assist to sitting position with chin flexed toward chest allow adequate time for meals feed slowly give frequent verbal cues to swallow reduce distractions during meals keep suctioning equipment available in case of problems

Decreased tissue elasticity

decreased bladder capacity

How is urinary system affected in the older adult?

decreased number of functional nephrons - decreased filtration rate decreased blood supply - decreased removal of body wastes increased concentration of urine decreased muscle tone - increased volume of residual urine, stress incontinence, nocturia decreased tissue electricity - decreased bladder capacity increased size of prostate - increased risk of kidney infection, decreased stream of urine, increased hesitancy, frequency, nocturia

Urinary changes with aging

decreased number of functional neurons - decreased filtration rate decreased blood supply - decreased removal of body wastes increased concentration of urine decreased muscle tone - increased volume of residual urine, stress incontinence, nocturia decreased tissue elasticity - decreased bladder capacity increased size of prostate - increased risk of infection decreased stream of urine increased hesitancy, frequency, nocturia

loss of appetite

decreased saliva and taste buds sometimes make food unappealing. Gastric motility slows because of the loss of smooth muscle in the stomach which causes a delay in emptying time distention, and early satiety. Anorexia and weight loss often result. In addition, medications taken by older adults can produce side effects such as dyspepsia, nausea, vomiting, anorexia, diarrhea, and constipation, which affect the appetite. interventions: prepare food with color and garnishes, using attractive dishes and table settings with good lighting and bright colors, and providing foods that have more seasoning if there are no restrictions. Encourage the patient or caregiver to prepare homemade frozen dinners from extra portions of a favorite meal as an easy and effective way to provide a meal that will be enjoyed.

gastro aging

decreased secretion of saliva and diminished gag response, increases chance of choking and aspiration. Also medications may also reduce saliva. Stomach of older adult has decreased gastric motiility as well as decreased production of bicarbonate and gastric mucus. Decreased production or lack of production of the intrinsic factor causing the body to become unable to use ingested vitamin B12 leading to pernicious anemia. Enzymes in the intestinal tract also are altered. The abdominal wall becomes less firm, and abdominal muscles weaken. Decreased tone of the intestine occurs and it is common or peristalsis to become slower, leading to constipation. Normal changes intensified by medications commonly prescribed for other conditions, lack of fluids or dietary roughage or fiber, and lack of exercise or activity. Liver function often decreases, making drug metabolism less efficient. Obesity Weight loss fluids and dehydration oral hygiene Loss of appetite gastric reflux food intolerance dysphagia failure to thrive specialized nutritional support gastrointestinal cancer fecal incontinence gastrointestinal bleeding

dysphasia

difficulty swallowing may arise from many possible causes including stroke or other neurologic dysfunction, local trauma, and obstruction with a tumor. Assessment should focus on whether the dysphagia is with liquids, solids, or both and on the time frame for the progression of the symptoms. The older adult often has more difficulty swallowing fluids or foods that contain firm foods in liquid such as soup than swallowing semisolid or solid food Interventions : avoiding liquids, positioning and verbal coaching. Thickeners can be added to liquids to improve the ability to control swallowing. The upright position, leading slightly forward with the chin down, enlists the assistance of gravity to improve swallowing. Placing food on the unaffected side, reducing distractions in the room, and cueing the person to swallow are other ways to facilitate success.

CAD (coronary artery disease) risk factors

elevated serum cholesterol level. Total cholesterol level of 130 mg / dL raises the risk for cardiac disease decreasing saturated fat content in diet reduces cholesterol no more than 7% of calories should come from saturated fat, and no more than 200 mg of cholesterol should be consumed per day. The American hearts association recommends 20 - 30 mins of exercise per day 3 to 5 x per week

nocturia

excessive urination at night At least 50% of older men and 70% of older women have to get up two or more times during the night to empty their bladders, a condition known as nocturia (urination at night). The decrease in bladder capacity may be associated with the increase in voiding at night. This condition should be evaluated. It may also be attributed to other factors. Although nocturia does not jeopardize an individual's physical health, it is inconvenient, interferes with sleep, and tends to contribute to fatigue. Nursing interventions to decrease nocturia include limiting fluids in the evening, giving diuretic medications in the morning, and preventing fall hazards when an individual has to get up to urinate. A history of nocturia or an increase in the number of episodes necessitates medical evaluation, because it may indicate an infection and the need for medical treatment.

Aged related musculoskeletal system

gradual reduction is seen in the number and the size of active muscle fibers, and muscle tone, mass, and strength are decreased. The joints become less elastic and flexible with the loss and the calcification fo cartilage. An alteration occurs in the equilibrium between bone deposition and resorption. Falling estrogen levels in women increases bone resorption and decreases calcium deposition, resulting in bone loss and decreased bone density. The long bones and the vertebrae are especially vulnerable to the reduction of bone density. In the spine, narrowing of the intervertebral spaces results in a loss of 1.5 to 3 inches of height. The lumbar curve of the lower back changes, which results in a shift in the center of gravity (balance). Structural and postural changes may result in changes to the gait. The risk of fractures is increased in this population as a result of the interrelated factors How these affect every day life: stiffness of joints - inability to perform personal care (i.e. eating, bathing, dressing, grooming, and elimination) and other activities such as housework, driving, climbing stairs, caring for pets) standing and gait - including balance, posture, base of support, size of steps, ability to turn limping, numbness or tingling and change in skeletal contour muscle weakness, paralysis, tremors, spasms, clumsiness, muscle wasting and muscle aches falls, traumatic injury, surgeries on joint or bone and back problems

Nursing interventions for decreased hearing

hearing aids help but do not compensate for nerve damage or effectively screen out other distracting noises. To communicate with an individual with a hearing loss, face the individual and speak at normal base in lower pitch voice. eliminate background noise nonverbal communication such as gestures, smiles, nodding the head with the verbal message, and written communication. do not express annoyance or impatience

kyphosis

how it affects respiratory abnormal curve in the upper spine sometimes called "dowager's hump." The chest wall is less able to expand because of the changes in the skeletal system. Overall the older person's air exchange is reduced and secretions and residual air remain in the lungs. possible development of kyphosis, an abdominal curve in the upper spine called "dowager's hump" - chest wall less able to expand because of changes in the skeletal system

presbyopia

impaired vision as a result of aging farsightedness resulting from a loss of elasticity of the lens of the eye or narrowing of the peripheral field of vision, decreased ability to focus on near objects and a decrease in visual acuity as the pupil becomes smaller and less responsive to light. There is some clouding of the lens of eye. Yellowing of the lens and changes inc color perception cause older adults to have difficulty differentiating shades of some colors such as green, blue and violet. Depth perception is distorted and vision in dim light becomes difficult. General vision screening for individuals who wear glasses or contact lenses involves observation of reading print from a newspaper. Note the distance from the eyes the person holds the newspaper and verify the person's ability to see print clearly. Limited vision indicates the need for a more detailed eye examination. Although age related changes decrease visual capability blindness is not a normal result of aging.

free radical theory

in the course of the metabolic activity of the body that produces energy, extra electrons are released that build up in the body and combine chemically, demaaging cells and interfering with normal body function, resulting in aging

psychosocial: erikson's developmental stages

in the last stage of life, the task is acceptance of life and one's own lifestyle, which potentially results in anger and despair

incontinance

inability to control the bladder (common in elders)

Gastrointestinal aging

inadequate or imbalanced diet leads to obesity, hypertension, diabetes, cancer, and cardiovascular disease reduction in taste and smell medications may alter foods or result in a decrease in saliva production. Living alone - lack of interest in food or lack of financial resources to buy food inactivity/boredom, and mental health concerns may result in excessive food consumption.

senile

infirm, weak from old age

food interolerance

lactose, primarily found in milk, is a common source of food intolerance. Diary products are an important source of calcium, which is need to prevent osteoporosis.

overflow incontinence

when chronically full bladder increases bladder pressure to a higher level than urethral resistance is able to counter, resulting in a loss of a small volume of urine. It is accompanied by a weak urine stream, difficulty starting to pass urine, interrupted voiding, or feeling of incomplete emptying. This may be the result of an atonic bladder from diabetic neuropathy, a side effectof anticholinergic medication, spinal cord injury, or mechanical obstruction (e.g., prostatic hypertrophy or a large cystocele).

lung cancer

leading cause of death. increases ages 60 - 70 tobacco marijuana recurring inflammation exposure to asbestos talcum powder, or minerals or less frequently to radon vitamin A deficiency air pollution most common cancer: small cell lung carcinoma (SCLC), which sometimes metastasizes to the central nervous system, the bones, and the liver. Often no signs or symptoms are evident, or the signs are ignored or attributed to smoking or a preexisting lung disease. Nonspecific signs and symptoms may include cough, chest pain, and hemoptysis. The diagnosis of lung cancer is based on clinical history and chet x-ray studies or computed tomographic (CT) scan of the chest. Lung cancer staging provides the basis for treatment. Stage I is treatable with surgery. Treatment modalities for other stages include surgery, radiotherapy, and adjuvant chemotherapy. Stage IV treatment is palliative and includes radiotherapy, chemotherapy, and laser therapy. Nursing interventions include relief of pain, emotional support, counseling, and discussion of options and alternatives.

Age related changes to cardiovascular system

loss of structural elasticity because chambers are less elastic, the heart takes longer to contract and the chambers longer to fill. The heart valves become thicker and more rigid. A decrease in pacemaker cells occurs, and the electrical conduction pacemaker cells occurs, and the electrical conduction is slowed or altered, which can lead to dysrhythmias. With aging, the resting heart rate tends to decrease, and the heart loses some of its capacity to increase the rate in response to exercise. Arteriosclerosis develops as the blood vessels become less elastic and are lined with deposits, resulting in increased blood pressure. In the past the definition of hypertension in the older adult was less than or equal to a systolic pressure of 140 mm Hg. Some studies identify hypertension in the elderly as a systolic of 150 mm Hg. The patient's health care provider will determine the diagnosis of hypertension in the elderly based on individualized factors. stroke CAD Dysrhythmias peripheral vascular disease

patient problems and nursing interventions

maintaining weight bearing - osteoporosis self care deficit related to weakness, bathing/hygiene, dressing/grooming, feeding, toileting - assess ability to dress, feed, bathe and toilet self develop plan to enhance highest level of function allow adequate time to perform activities provide assistive devices as indicated consult with physical and occupational therapy modify environment to facilitate self care potential for falling, related to age related changes - assess balance, gait, strength, medications that cause vertigo or drowsiness, sensory problems, and impaired mobility maintain a regular weight bearing exercise routine that is enjoyable provide good lighting and assistive devices (walkers or canes) to assist balance eliminate environmental hazards, clutter, uneven walking surfaces, and scatter rugs encourage moving slowly from lying to standing to keep orthostatic hypotension (a sudden drop in blood pressure when standing up quickly to a minimum) moving slow to prevent orthostasis hypertension

Hip fractures in older adults are:

more common in modern societies than in previous ones. related to increased longevity. related to reduced activity levels in industrialized societies. All of the above.

Cataracts

most common disorder found in the aging eye. By the age of 80 an estimated 50% of people either have cataracts or have had surgery to correct them. A cataract is a clouding of the normally clear and transparent lens of the ey. Degenerative changes to the lens protein and fatty deposits (lipofuscin) becomes so opaque that the transmission of light to the retina becomes impossible. The size and the location of a cataract determine the amount of interference with sight. Cataract symptoms include dimmed, blurred, misty vision, the need for brighter light to read and sensitivity to glare and light. management and treatment of cataracts is conservative until visual impairments affect normal activities such as reading and driving. Several types of surgery exist but the most recent technique involves the use of ultrasound to break the lens into small fragments which allows removal from a tiny incision. A substitute lens is used to restore vision, which is a permanent, plastic intra-ocular lens. Cataract surgery is highly successful.

exercise in old age

must be weight bearing pelvic floor muscle training / Kegal bladder retaining vaginal cone therapy, electrical stimulation device, and urethral plug Tai Chi for balance Why do we exercise in old age: the ability to maintain an upright position without falling, depends on the ability to use balance, posture, and movement. This requires a great deal of sensory input, motor output and central integration of balance and locomotion. Aging results in slower reflexes, diminished strength of muscles for posture, and increased postural sway. Conditions such as damage to the structures of the inner ear may affect peripheral and central control of mobility and thus affect balance. The ability to achieve proprioception declines with age.

patient problem: constipation infrequent or difficult bowel elimination related to inadequate intake of fiber and fluids

nursing intervention: assess frequency and consistency of bowel movements increase dietary fiber by encouraging cereals such as brans and fruits such as prunes determine fluid preferences keep fluids at bedside and offer them at frequent intervals administer stool softeners as ordered

chronic obstructive pulmonary disease (COPD)

nursing interventions: pulmonary hygiene (encouraging pt to drink plenty of fluids to liquefy secretions) breathing retraining - teaching deep diaphragmatic breathing and a variety of cough techniques to remove secretions and improve airway clearance (pursed lip breathing help empty the lungs of used air, which in turn promotes inhalation of adequate oxygen. chest physiotherapy - CPT includes chest percussion, postural drainage, vibration and rib shaking. Postural drainage consists of positioning the patient in a head down position to facilitate drainage of pulmonary secretions. Medications may be given orally, via a metered dose inhaler (MDI) or via nebulizer. Oxygen therapy also is considered a medication. The patient and the family need to learn correct oxygen liter flow, when it is to be used and care and use of the equipment medications - flu vaccines smoking cessation - avoid smoking and pollution exercise programs - moderate 20-30 mins 3-5 days per week / walking

Patient problems for urge incontinence: inability to control urination

nursing interventions: collect baseline bladder diaries to assess bladder habits, including frequency of urination and frequency of urinary incontinence Assess circumstances that precipitate incontinence (ie. coughing, sneezing, position changes, or urgency) Assess awareness of dribbling and ability to control urine elimination Assess general health, current medications, and past medical problems, current medications and medical, surgical and obstetric history Assess use of incontinence products or other responses to incontinence Assess for other urinary symptoms (i.e. burning, pain, blood in the urine, difficulty getting a steam, urgency, or difficulty emptying the bladder Assess physical and mental factors that may cause the patient to be unable to get to the bathroom on time Assess caregiver's willingness to participate in a behavioral program to treat incontinence

activity theory

older adults develop a positive concept of self as a result of maintaining ongoing social interactions. Well-being in later life is enhanced by substituting new roles in relation to family, recreation, and volunteer services for previous occupational roles

age related changes to genitourinary system

overall kidney function decreases with age. Even with a decrease of 50% the body has adequate reserve to support normal body functions unless kidney disease is present. Bladder capacity decreases approximately 50% with age. Some bladders in older adults only hold 150 mL. Incontinence sometimes occurs because bladder capacity decreases, urine residual increases, and bladder contractions increase. A decrease of bladder tone causes urine to remain in the bladder on emptying, which results in the sensation of a full bladder (frequency) within a brief period. Urinary tract infections also may trigger incontinence. In the older adult confusion may be the first symptom of an infection. Urinary incontinence (UTI) which affects more than 17% of women and 11% of men older than age 65 years of age, is embarrassing and debilitating. It is not a normal part of aging, although many believe that it is and do not seek treatment. Changes specific to women are related to perineal changes as estrogen levels decline. Intercourse may become painful as the vaginal opening constricts and vagina shortens, loses tone, and dries. Abnormal postmenstrual bleeding may indicate endometrial cancer and must be investigated. Changes specific to men include enlargement of the prostate glad, which results in the occlusion of the urethra, obstructing the flow of urine; also the scrotum becomes more pendulous. Although a man's libido does not normally decrease, erections may develop more slowly and orgasms become more less intense.

Risks for older adults

physiological changes: sight, hearing, and reflexes also: fall injuries, chronic diseases become "polyfarm" (multiple medications)

Why do we fall when we age?

poor eyesight or poor hearing Illnesses and physical conditions can affect your strength and balance Poor lighting or throw rugs in your home can make you more likely to trip or slip. The side effects of some medicines can upset your balance and make you fall. Medicines for depression, sleep problems and high blood pressure often cause falls. Some medicines for diabetes and heart conditions can also make you unsteady on your feet. You may be more likely to fall if you are taking four or more medicines. You are also likely to fall if you have changed your medicine within the past two weeks.

nursing interventions for loss

pt problem: complex grief, related to losses (specify): Encourage verbalization of feelings regarding loss Acknowledge reality of grief Plan care to promote consistency and reduce stress Encourage participation in activities to provide distraction Refer to spiritual counselor or other sources of support Spend time with isolated individual Pt problem: helplessness, related to personal, social, and economic losses: Nursing interventions - allow older person to make choices whenever possible Encourage person to do as much for self as possible Adapt environment to support independence Explain reasons for changes in plan of care

gastric reflux

reflux sphincter at the opening to the stomach becomes less efficient, which allows food and digestive enzymes to flow back into the esophagus. Symptoms include heartburn, sour stomach, and regurgitation of sour, bitter material. Reflux can be controlled by eating small meals, avoiding eating before bedtime, and elevating the head of the bed. Achieving and maintaining ideal body weight are also helpful.

delirium

senility - state of mental and physical deterioration associated with aging) is a fear and myth associated with aging. Delirium is a reversible condition of rapid onset. It has a fluctuating and traditionally brief course. The symptoms of delirium may manifest as behavioral changes including restlessness, agitation, or appearing withdrawn. Emotional changes may be strong, such as personality changes or mood shifts or subtler changes including apathy or depression. not disease of nervous system. delirium is syndrome that results from one or more causes: fever/infection dehydration/malnutrition electrolyte imbalances (Hyponatremia or hypocalcemia) sleep deprivation alcohol or drug use, abuse or withdrawal pain medications physiological conditions resulting in inadequate oxygeneration to the brain

Age related changes in sensory perception

senses provide a link to the outside environment by receiving and interpreting various stimuli including but not limited to vision, hearing, taste, and smell. visual and hearing impairments interfere with communication, social interactions, and mobility leading to social isolation. 2 groups of senses general and special general: touch, pressure, pain, temperature, vibration, and proprioception special senses: highly localized organs and sensory cells including sight, hearing, taste, smell and balance. Sensation or perception is the conscious awareness and interpretation of sensory stimuli by sensory receptors.

Functional inability to control urination

teach caregivers to implement a prompted voiding program, increasing awareness of the need to toilet and prompting the use of the toilet at appropriate intervals Encourage fluid intake of 1500-2000 mL per day unless contraindicated Modify environment to maximize the patient's ability to get to the bathroom Obtain referral for physical occupational therapy if indicated

decline of propioception with aging

the ability to maintain an upright position without falling, depends on the ability to use balance, posture, and movement. This requires a great deal of sensory input, motor output and central integration of balance and locomotion. Aging results in slower reflexes, diminished strength of muscles for posture, and increased postural sway. Conditions such as damage to the structures of the inner ear may affect peripheral and central control of mobility and thus affect balance. The ability to achieve proprioception declines with age.

immunologic

the immune system becomes less effective or less able to distinguish between foreign and host cells, and aging is a result of the consequentially diminished protection from infection or disease, and the immune system destroying body cells that it misreads as defective or foreign

fecal incontinence

the inability to control the passage of feces and gas through the anus most common in older adult is fecal impaction associated with immobilization and inadequate fiber and fluid intake. A soft or liquid stool may ooze around the impaction, giving the appearance of diarrhea. Underlying diseases such as cancer, inflammatory bowel disease, colitis, and neurologic disease have the potential to cause fecal incontinence. A digital rectal examination by the primary health care provider may be needed to determine the nature of the problem.

polypharmacy

use of five or more medications each medication has side effect and with each added medication risk increases of adverse effects. between 65-69 - average medications 14 70+ 18 medications responsible for 28% of hospital admissions 5th leading cause of death in USA higher risk of adverse effects - increased number, borrow medications from friends and families, do not regularly check in with their health care provider when refilling prescriptions and combine with over the counter (Pharmacy/Dr need to check for dangerous interactions)

peripheral vascular disease (PVD)

vascular changes affect the arteries or veins of the older adult. Spasms or atherosclerosis allow insufficient amounts of oxygenated blood to circulate to tissues in the legs and feet. Some older adults have inadequate circulation to the muscles, which results in cold feet, numbness, and intermittent claudication (cramping pain in the calves). Inadequate supply of arterial blood to the lower extremities results in a condition called peripheral vascular disease (PVD). Another common condition is varicose veins, which involves failure o fthe valves to close adequately because of distention and weakening of the venous walls. improving circulation: walking to stimulate venous return, avoiding standing in one place for long periods, and not crossing legs. Compression stockings provide support for varicose veins. Inadequate circulation results in skin ulcerations and ulcerations and altered sensation (numbess), nursing interventions may include compression stockings, pneumatic compression pumps, unna boots, maintenance of the cleanliness of the feet and legs, adequate shoes that give protection, and education of the older adult to be aware of situations that may cause injury, because sensation for hot and cold is decreased.