Geriatrics Foundations Chapter 32 Health Promotion

What percentage of men and women over the age of 65 are affected by incontinence?

17% of women 11% of men

What year was medicare, medicaid and the administration of aging established?

1965

How many calories does a adult 75 to 90 years of age need?

30 calories per kilogram of body weight (14 calories/lb), compared to 40 calories per kilogram of body weight (18 calories/lb) for those 20 to 37 years of age

Dementia

A progressive impairment of intellectual (cognitive) function that interferes with normal social and occupational activities.

Presbycusis

A sensorineural hearing loss and the most common form of loss in older adults. Typically the loss is bilateral, resulting in difficulty hearing high pitched tones and conversational speech

How often should women over 50 get a mammogram?

Every 2 years

What is the leading cause of accidental death in those over 65?

Falls

Presbyopia

Farsightedness resulting from a loss of elasticity of the lens of the eye

Shearing forces

Forces that can injure small blood vessels by sliding on a rough surface

What is decreased in the stomach of a older adult?

Gastric motility as well as decreased production of bicarbonate and gastric mucus

What is the second leading cause of blindness in the United States and what causes it?

Glaucoma, caused by an occlusion in the drainage of the fluid in the anterior chamber of the eye which produces an increase in intraocular pressure

What does prevention and healing of any pressure ulcer depend on?

Good nutritional status and adequate hydration. A well-balanced diet with attention to protein, vitamins, and minerals plays an important role in maintaining skin integrity

What are some age related changes in the musculoskeletal system?

Gradual reduction in the number and size of active muscle fibers and muscle tone, mass and strength are decreased. The joints become less elastic and flexible with the loss of calcification of cartilage Older adults are at a increased risk for fractures

What is a normal response to loss of body mass?

Gradual weight loss over time. Rapid weight loss may indicate an illness and should be reported to the health care provider

Baby Boomers

Group of people born between 1946 and 1964 that make up more than 70 million people. They are extremely diverse and better educated, more mobile, and more aware of how to achieve and maintain good health than any previous generation

What does pursed-lip breathing do?

Helps empty the lungs of used air which in turn promotes inhalation of adequate oxygen

What are some possible symptoms with a CVA?

Hemiplegia Dysarthria Dysphagia Hemianopia (defective vision or blindness in half the visual field) Aphasia Intellectual and emotional changes

What is the minimum amount of fluid an older person need per day?

1500 mL

Who is at risk for polypharmacy?

1. Those who take five or more prescription medications 2. Sometimes borrow medications 3. Use over the counter meds including vitamins, dietary supplements or herbal preparations 4. Request refills without seeing Dr. 5. Take medications who prescriptions come from more than one Dr. 6. Have prescriptions filled at more than one pharmacy

When might enteral feedings might be ordered for the short term?

After surgery, traumatic injury, or burns to improve nutritional intake. Transition to an oral diet occurs as soon as feasible

What are some causes of hearing loss with aging?

Aging causes rigidity of the ossicles which results in elasticity. Loud noises throughout life and age related changes lead to hearing loss of different tones which cause some sounds to be distorted and other absent Cerumen impaction can cause hearing loss

What is the most common cause of dementia?

Alzheimer's disease

Kyphosis

An abnormal curve in the upper spine sometimes called "dowager's hump." The chest wall is less able to expand because of changes in the skeletal system

Aphasia

An abnormal neurologic condition in which language function is defective or absent because of an injury to certain areas of the cerebral cortex

Akinesia

An abnormal state of motor and psychic hypoactivity

At what age does older adulthood begin?

Around 65 and continues until death

A holistic definition of health does not limit health to its physical and mental aspects but rather views health how?

As a state of being, an attitude.

How often should patients be repositioned?

Every 2 hours

What are some interventions for those with dysphagia?

Avoid liquids, positioning and verbal coaching can help. Thickeners can be added to liquids to improve the ability to control swallowing. Sit upright, lean slightly forward with the chin down Reduce distractions in the room and cue the person to swallow can also help

Why does the body's ability to absorb, transport and eliminate meds decline with age?

Because of impaired circulation, changes in vessel walls and decrease in the number and efficiency of the glomeruli in the kidneys

Why is pruritus more common in cold, dry, weather?

Because of reduced glandular secretions and moisture

Are most moles benign or malignant?

Benign, should always have a dermatologist examine any lesion that looks suspicious

How fast does patients need to be treated for a stroke?

Between 3 to 4.5 hours after onset of symptoms to increase chances of recovery with little or no disability after 3 months

How should older adults be addressed?

By whatever name they choose to be called, this shows respect

What are the four main causes of visual impairment?

Cataracts Glaucoma Macular degeneration Diabetic retinopathy

What is the most common disorder found in the aging eye?

Cataracts ( a clouding of the normally clear and transparent lens of the eye) Symptoms include: Dimmed, blurred or misty vision The need for brighter light to read Sensitivity to glare and light

How is memory with aging affected?

Changes in short term memory is common, long term memory is usually maintained

What are some s/s of a TIA?

Changes in vision Headache Disorientation Ataxia Drop attacks (falling without losing consciousness) Symptoms sometimes last for as little as 20 minutes One in three who have a TIA have a stroke within 5 years

What are some assessments related to constipation that can be done?

Check dietary intake of fiber and fluids Use of medications such as opioid analgesics, antacids, iron preparations, anticholinergics or overuse of laxatives Make sure patient is getting plenty of fluids, exercise and a diet with fiber

What are some things lactose intolerant individuals may need to replace milk with?

Cheese and yogurt, which is processed and easier to digest. Older adults need calcium to prevent osteoporosis

What is COPD a combination of?

Chronic bronchitis, chronic asthma and emphysema in varying degrees as a result of progressive changes that are seen as individuals become older

What can inadequate circulation to the muscles result in?

Cold feet, numbness and intermittent claudication

What are the three categories of hearing impairment?

Conductive, sensorineural, mixed Conductive hearing loss results from interruption of the transmission of sound through the external auditory canal and middle ear and is usually related to cerumen impaction, otitis media and fixation of the auditory ossicles.

What does hypertension increase the risk of?

Coronary artery disease Stroke Development of heart failure renal failure Peripheral vascular disease

What is some teaching to prevent foot ulcers?

Daily cleansing of the feet with nondrying agents and daily inspection of the feet for blisters, cuts or infections with a mirror. Nails are best cut or filed straight across to prevent skin injury

What are some age related changes that affect the sense of touch?

Decrease in the number of receptor cells throughout the skin and joints Increased difficulty sensing temperature and maintaining balance, which places them at risk for falls and burns

Why is the metabolism of meds reduced with older adults?

Decreased blood flow in the liver, fewer functioning liver cells, and a decrease in the liver enzymes that function to break down and transform medications.

What are some factors that lead to falls?

Decreased circulation to the brain Diminished coordination Decreased ability to balance Decreased strength Changes in gait Slowed nervous system responses Limited activity Side effects of meds poor lighting environmental hazards pathway obstructed

What are the results of neurologic changes with aging concerning the decreased number of brain cells, nerve fibers and neuroreceptors?

Decreased number of brain cells leads to decreased reflexes Decreased number of nerve fibers leads to decreased coordination Decreased number of neuroreceptors leads to decreased perception of stimuli and decreased motor responses

Why do older adults frequently experience a loss of appetite?

Decreased saliva production and a decreased number of taste buds can 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 Dining alone can make eating less appealing.

What stress-related problems are caregivers at a high risk for?

Depression Anxiety Increased vulnerability to physical health problems

What is one third to one half of all health problems in older adults related to?

Dietary issues such as undernutrition or overnutrition

dysarthria

Difficult, poorly articulated speech, resulting from interference in the control over muscles of speech

Dysphagia

Difficulty swallowing

What are some age related changes in the reproductive system?

Diminished levels of estrogen and progesterone in women and diminished levels of androgen and testosterone in men. Aging diminishes sexual function but does not put a hold on it.

What does secondary prevention in older adults focus on?

Early detection and treatment of disease including screening for heart disease and hypertension, cancer, infectious disease, polypharmacy, nutrition, oral health, osteoporosis, falls and social isolation

What three stages is the progression of Alzheimer's disease divided into?

Early stage - gradual onset of memory loss an difficulty focusing attention Middle stage - Difficulty with language, object recognition, and judgement Terminal Stage - Some urinary and fecal incontinence, ability to ambulate or provide self-care and inability to communicate.

What is a major risk factor for coronary artery disease?

Elevated cholesterol levels Decreasing saturated fat content in the diet can help reduce cholesterol

How often should those over 50 have a complete physical, including cholesterol?

Every 1-3 years till the age of 75 then annually

What are the most common endocrine disorder in older adults?

Hypothyroidism and diabetes mellitus

Ataxia

Impaired ability to coordinate movement

What is likely the most important contributor to declining physical mobility and function in the older adult?

Inactivity

What signs and symptoms of pneumonia does older adults exhibit?

Instead of the usual signs such as high fever, cough, pain and headache they exhibit these signs and symptoms: Lethargy, disorientation, anorexia and low or mild fever

What is Urge incontinence?

Involuntary urine loss after a sudden urge to void Associated with cystitis, urethritis, tumors, stones and CNS disorders such as stroke, dementia and Parkinson's disease.

How is overall kidney function affected with age?

It decreases as does bladder capacity which may be part of the reason nocturia occurs Incontinence sometimes occurs because of the bladder capacity decreasing

What is involved in wellness?

It involves a balance among the individual's emotional, spiritual, social, cultural and physical states.

Explain what wellness means?

It is the individual operating at the optimal level of function, and even during chronic illness and dying, some level of well-being is attainable.

Why should antibacterial soap be avoided by the older adult?

It is very drying and usually is not a good option

Pruritus

Itching

What are some drug safety teaching for older adults?

Keep drugs in original container Dispose of outdated meds appropriately, do not throw in trash can Never share drugs with friends or family Always finish prescriptions Read labels carefully

What are some nursing interventions to decrease nocturia?

Limit fluids in the evening Give diuretic medications in the morning Prevent fall hazards when someone has to get up to urinate

What can Osteoporosis of the spinal vertebrae cause?

Loss of height of 1.5 to 3 inches Kyphosis, (development of a C shape to the cervical vertebrae which causes a stoop that is at times severe.

What are some characteristics of dementia?

Loss of memory and at least on other disturbance of intellectual function (e.g., orientation, attention, calculation, language, motor skills)

What is dementia characterized by?

Loss of memory and at least one other disturbance of intellectual function. (orientation, attention, calculation, language, motor skills) Personality changes are sometimes apparent

What is involved with cardiovascular changes with aging?

Loss of structural elasticity and since the chamber are less elastic the heart takes longer to contract and the chambers longer to fill

What are some interventions to compensate for age related changes in vision?

Make sure eyeglasses are clean and available Increase amount of light reduce glare with shades Use nightlights Large print, strongly contrasting colors (black on white background etc.) Magnifying glasses

How often will the person with Glaucoma need to have medical follow up?

Medical follow up and eye medication are required for the rest of their life. Eye drops are necessary to continue even in the absence of symptoms. After administering eye drops, put pressure on lacrimal duct for one minute to prevent rapid systemic absorption

Many people have found limitations in conventional medical approaches and have begun using what alternative health strategies?

Meditation Visualization Massage Magnets Aromas Acupuncture

How often should men over 50 perform a testicular self-examination?

Monthly

How often should women over 50 perform a breast self-examination?

Monthly

What are some nonmodifiable and modifiable risk factors for heart disease ( the leading cause of death in the US)?

Nonmodifiable: Age, gender, family history Modifiable: smoking, high blood pressure, high fat diet, obesity, physical activity and stress

Describe acute-closure glaucoma

Occurs suddenly as a result of complete occlusion in the path of the aqueous humor. Severe problems occur when intraocular pressure rises above 50 mm Hg. Without emergency medical attention severe vision loss occurs, blindness results in two days.

Which age group is depression most common in?

Older adults

What is Rheumatoid Arthritis?

One of two forms of arthritis that may occur in older adults. it is a systemic inflammatory disease thought to be of immune factor origin and can affect people of any age.

What is Osteoarthritis?

One of two forms of arthritis that may occur in older adults? Also known as degenerative joint disease and it 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 in older adults

What is the name of the systemic skeletal disorder that is one of the most common conditions in older women?

Osteoporosis

Hemiplegia

Paralysis of one side of the body

What is the second most common disorder that affects the nervous system in the older adult?

Parkinson's disease ( a progressive, degenerative disease whose defining characteristics are muscle rigidity, tremors and akinesia.) The individual has a mask like appearance, drooling, and shuffling gait and often experiences emotional instability. Intellectual function is not impaired

What are some of the immunizations recommended for older adults?

Pneumococcal Shingles Tdap (tetanus, diphtheria and pertussis) These three taken once over the age of 65 Take influenza vaccine yearly

What are some age related changes in vision?

Presbyopia Narrowing of peripheral field of vision Decreased ability to focus on near objects Decrease in visual acuity as the pupil becomes smaller and less responsive to light Some cloudiness of the lens of the eye Yellowing of the lens and changes in color perception lead to trouble differentiating shades of some colors Depth perception is distorted Vision in dim light becomes difficult

What is the most common type of Gluacoma?

Primary open-angle glaucoma (90%) Has the capacity to reduce vision so gradually and painlessly that a person is unaware of a problem until the optic nerve is badly damaged.

What are some nursing interventions to improve communication with hearing loss?

Providing good visual contact to allow lip reading Avoid situations in which there is a glare or shadows on the persons field of vision, reducing or eliminating background noise, and speaking at a normal rate and volume

What are some nursing interventions for older adults with mild to moderate COPD?

Pulmonary hygiene Breathing retraining Physiotherapy Medications Smoking cessation Exericse Fluids to liquefy secretions Deep breathing and coughing to remove secretions and improve airway clearance

Respite Care

Refers to the provision of care by nonfamily members with a goal of allowing the primary caregivers the opportunity for relief from the stressors and strains imposed by caring for an ill or debilitated family member.

What are some s/s of acute-closure glaucoma?

Severe eye pain Erythema Clouded or blurred vision N/V Rainbow halo surrounding lights Pupil dilation Steamy appearance of the cornea

What are some physical age related changes in the older adult?

Skin is dry and thin and loses tone and elasticity. The loss of fat under the skin makes wrinkles increasingly apparent. Age spots called lentigo are tan or brown macules brought on by sun exposure and are more common in middle aged and older adults. Hair grays and things Wounds tend to heal more slowly than younger people

What are some things to observe upon assessment of the older adult?

Skin tears or lesions. Note presence, location, and amount of exudate. Look for lesions that have changed size, color, or shape. Observe hair for excessive loss, dryness or oiliness Observe nails for color, length, shape, symmetry and cleanliness

What was the first major legislation that attempted to provide financial security for older adults? What year did this happen?

Social Security Act of 1935

How does vascular changes affect the arteries or veins of the older adult?

Spasms or atherosclerosis allows insufficient amounts of oxygenated blood to circulate to tissues in the legs and feet. Inadequate supply of arterial blood to the lower extremities results in PVD

What are some preventive measures for osteoporosis?

Starts when they are younger, need a diet high in calcium and vitamin D. Regular weight bearing exercises lay the foundation for later. Bone density testing can help as well.

What are some things included in primary prevention?

Stop smoking Eat a well balanced diet low in excessive sugar, fat or alcohol Get recommended vaccinations

Health promotion takes a positive approach to health and emphasizes what three things?

Strengths Resources Abilities of an individual

What is the third leading cause of death in the US and what are risk factors for it?

Stroke (CVA), chances increase after age 55 Risk factors include heart disease, diabetes mellitus, physical inactivity

What can cause dysphagia?

Stroke or other neurologic dysfunctions local trauma obstruction with a tumor

What are some nursing interventions for PVD?

Techniques to promote circulation such as walking to stimulate venous return Avoid standing in one place for long periods Do not cross legs

Ageism

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

What is stress incontinence?

The involuntary loss of small amount of urine with increased abdominal pressure such as coughing or sneezing

Chronologic Age

The number of years a person has lived Not an accurate predictor of health or behavior Today more people are living longer, active lives

What is peripheral neuropathy?

The presence of abnormal sensation, numbness and burning sensations in the extremities. This condition increases with age, particularly in people who have DM. Decreased awareness of pain, temp changes and diminished circulation results in risk of injury

What does cognitive function refer to?

The process by which information is acquired, stored, shared and used

How are the heart rate and blood pressure affected by 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 line with deposits resulting in increased blood pressure

senile

The state of physical and mental deterioration associated with aging

What are some age related changes in the respiratory system?

The tissues of the lungs and bronchi become less elastic and more rigid with age. The ribs become less mobile and osteoporosis and calcification of the cartilage lead to rigidity and stiffness of the thoracic cage. Oxygen carrying capacity is often diminished. Exercise has a positive effect on respiratory and cardiovascular system while immobility has a negative effect. Diminished cough and arousal reflexes increase the likelihood of aspiration during sleep

What increases the older adults chances of choking and aspiration?

They have decreased secretion of saliva and a diminished gag response

Why are pressure ulcers a significant risk for older adults and patients with chronic disease?

Thin skin and lack of subq fat predispose older adults to pressure ulcer development when their fragile skin is compressed between bony prominences of the body and other objects.

What is a TIA?

Transient Ischemic Attack - a small spasms or occlusion in the cerebral vessel of the brain.

Difference in type one and type two diabetes?

Type one - body doesn't produce insulin Type two - characterized by the body's inability to produce and use insulin appropriately

Nocturia

Urination at night At least 50% of older men and 70% of older women get up two or more times in the night to empty their bladders

What are some nursing interventions for arthritis?

Warm baths or showers in the morning can reduce stiffness. Range of motion and other forms of mild exercise to maintain muscle strength and joint motion.

What type of lotions should be used after bathing?

Water-based lotions to dry areas. They usually increase comfort and avoids the feeling of oil residue that some people find uncomfortable

When might enteral tube feedings be use and where would they be placed?

When a patient has inability to ingest, digest or absorb nutrients. Feeding tubes can be placed in the stomach or the small intestine A PEG tube is inserted directly through the abdominal wall

Orthostatic hypotension

a decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within three minutes of standing when compared with blood pressure from the sitting or supine position.

Claudication

cramping pain in the calves

What does primary prevention stress to prevent cardiovascular disease, falls and depression?

exercise

What are some things the nurse should do when fluid deficit is caused by the older adult trying to avoid incontinence?

make fluids readily available Make toilet facilities more easily accessible Arrange the room so that access to the bathroom is unobstructed

Is loss of teeth a normal part of aging?

no, that is a misconception Oral hygiene is essential to eliminate debris that has the potential to interfere with taste or cause lesions

Should a nursing assessment include the needs of the caregiver?

yes, review the demeanor and responses of both the caregiver and the patient that may indicate fatigue in relation to the provision of care for the loved one. Referrals to social services and available community resources may be indicated