Elderly
7 tasks of persons w/ chronic illness
1. Preventing and managing a crisis 2. Carrying out prescribed treatment regimen 3. Controlling symptoms 4. Reordering time 5. Adjusting to changes in course of disease 6. Preventing social isolation 7. Attempting to normalize interactions with others
Sleep
Adequacy of sleep is often a concern of the older adult because of altered sleep patterns. Older people experience a marked decrease in deep sleep and are easily aroused. Older adults have difficulty maintaining prolonged sleep.
Pharmacodynamics & pharmacokinetics of drugs
Drug-drug, drug-food, and drug-disease interactions all influence the absorption, distribution,The most dramatic changes with aging are related to drug metabolism and clearance. Overall, by age 75 to 80 there is a 50% decline in the renal clearance of drugs. Hepatic blood flow decreases markedly with aging, and the enzymes largely responsible for drug metabolism are decreased as well. As a result, the drug half-life is increased in older patients as compared with younger patients. metabolism, and excretion of drugs.
Older Adult Women
For the aging woman, the impact of an aging body and being a woman is considered a double jeopardy. Many factors have a significant negative impact on the health of the older woman. Many of these are directly related to reduced financial resources and the greater longevity experienced by women. Thus older women often experience disparities, including unequal access to quality health care.
Perioperative Nursing and Gerontologic Considerations
Greater Occurrence of Fluid and Electrolyte Imbalance Higher Risk for Complications
Health promotion
Health promotion and prevention of health problems in the older adult are focused on three areas: (1) reduction in diseases and problems, (2) increased participation in health promotion activities and (3) increased targeted services that reduce health hazards. A high value needs to be placed on health promotion and positive health behaviors.
Care Alternatives for Older Adults
Housing - For the older adult who chooses to remain in the home as functional abilities decline, home adaptations and modifications can be made. Adult day care programs Home health care LTCs - Three factors appear to precipitate placement in a long-term care facility: (1) rapid patient deterioration, (2) caregiver inability to continue care because of "burnout"—too much and too long, and (3) an alteration in or loss of family support system. Changes in orientation (e.g., increased confusion), incontinence, or a major health event (e.g., stroke) can accelerate placement.
Homeless Older Adults
Key factors that are associated with homelessness include (1) having a low income, (2) reduced cognitive capacity, (3) living alone, and (4) lack of affordable housing. Homeless older adults may be the chronically homeless or recently homeless due to a crisis in either health or economic status.
Primary prevention?
Measures such as proper diet, proper exercise, and immunizations that prevent the occurrence of a specific disease.
Types of elder abuse?
Physical Emotional Sexual Neglect/Abandonment Financial exploitation Healthcare fraud and abuse
Use of Restraints
Physical restraints are devices, materials, and equipment that physically prevent the individual from moving freely (by choice) in the environment. Chemical and physical restraints should be a last resort in the care of the older patient. If a physical or chemical restraint is used in the hospital or long-term care setting, use of the least restrictive restraint is required. Restraints require an order from a physician or an independent licensed nurse practitioner and frequent scheduled reviews of the ongoing necessity of the restraint.
Social Support and Older Adult
Social support for the older adult occurs at three levels. Family and kinship relations are the first and preferred providers of social support. Second, a semiformal level of support is found in clubs, churches, neighborhoods, and senior citizen centers. Last, the older adult may be linked to a formal system of social welfare agencies, health facilities, and government support.
Assessing older patient - SPICES
The comprehensive geriatric assessment is interdisciplinary and at a minimum includes the medical history, physical examination, functional abilities assessment, and social resources. The comprehensive geriatric assessment is often conducted by an interdisciplinary geriatric assessment team. The interdisciplinary team may include many disciplines, but the minimum components include the nurse, the physician, and the social worker. SPICES Sleep disorders Problems with eating Incontinence Confusion Sundowning Evidence of falls Skin Breakdown
Rural Older Adults
The rural older adult is often stressed by declining self-care abilities. Particularly vulnerable are rural, minority elders who have even less access to health care providers. In addition, the rural older adult is less likely to engage in health-promoting activities.
Nursing Implementation
When carrying out a plan of action for older adults, you may need to modify the approach and techniques used based on their physical and mental status. Small body size, common in the frail older adult, may necessitate the use of pediatric equipment (e.g., blood pressure cuff). Bone and joint changes often require transfer assistance, altered positioning, and use of gait belts and lift devices. The older adult with declining energy reserves may require additional time to complete tasks. A slower approach, restricted scheduling, and the use of a bedside commode or other adaptive equipment may be necessary.
Older adults demographics?
Young-old - 65-75 Old-old - 85+
Secondary prevention?
actions aimed at early detection of disease that can lead to interventions to prevent disease progression.
Prevention of chronic illness?
adoption of healthy behaviors such as eating nutritious foods, being physically active, and avoiding tobacco use can prevent or control the devastating effects of these diseases.1 Preventive health behaviors are those voluntary actions taken by an individual or group to decrease the potential threat of illness. These actions are not curative because they are taken while the person is asymptomatic for a specific disease.
An appropriate care choice for an older adult living with an employed daughter but who requires assistance with activities of daily living is
adult day care.
Biologic aging
aging is defined as the progressive loss of function. This age-related decrease occurs along with decreasing fertility and increased mortality risk. The exact etiology or cause of biologic aging remains to be determined. Biologic aging is clearly a multifactorial process involving genetics, oxidative stress, diet, and environment.11,12 In part, biologic aging can be viewed as a balance of positive factors such as healthy diet, regular exercise, and coping resources and negative factors such as obesity, unhealthy lifestyle (smoking), chronic illness, and stress that exceeds the individual's coping resources
When older adults become ill they are more likely than younger adults to
alter their daily living activities to accommodate new symptoms.
Elder mistreatment
describes intentional acts by a caregiver or "trusted other" that cause harm or serious risk of harm to a vulnerable older adult and/or neglect meeting the basic needs of a vulnerable older adult. EM may occur in community (domestic) or long-term care (institutional) settings.
An ethnic older adult may experience a loss of self-worth when the nurse?
emphasizes that a therapeutic diet does not allow ethnic foods.
Chronic illness
most common in the older adult. The incidence of chronic illness triples after age 45. Most persons 65 years of age and older have at least one chronic condition and many have multiple conditions. The most common chronic conditions present in the older adult are hypertension, arthritis, heart disease, cancer, and diabetes.
Antipyretic
pain medication and fever reducers
A characteristic of a chronic illness is that it?
results in permanent deviation from normal & is associated with many stable and unstable phases.
Nursing interventions directed at health promotion in the older adult are primarily focused on
teaching positive health behaviors.
ethnogeriatric
the specialty area of providing culturally competent care to ethnic elders
5 barriers to healthcare?
transportation, limited supply of health care workers and facilities, lack of quality health care, social isolation, and financial limitations.
An important nursing action helpful to a chronically ill older adult is to
treat the patient as a competent manager of the disease.
Advance directives
written statements of a person's wishes regarding medical care (living will)
Polypharmacy
(the use of multiple medications by one patient who has more than one health problem), overdose, and addiction to prescription drugs are recognized as major causes of illness in the older adult.
Nutritional assessment of older adults
*SCALES* Sadness, or mood change Cholesterol, high Albumin, low Loss or gain of weight Eating problems Shopping and food preparation problems
Common nursing dx of older patients?
Cardiovascular System: • Activity intolerance • Decreased cardiac output • Fatigue • Ineffective peripheral tissue perfusion Respiratory System • Impaired gas exchange • Ineffective airway clearance • Ineffective breathing pattern • Risk for aspiration • Risk for infection Integumentary System • Impaired skin integrity Urinary System • Deficient fluid volume • Impaired urinary elimination Musculoskeletal System • Impaired physical mobility • Chronic pain • Risk for injury • Self-care deficit • Sedentary lifestyle
Cognitively Impaired Older Adults
Declining physical health is an important factor that influences cognitive impairment. The older adult who experiences sensory loss, heart failure, or cerebrovascular disease may show a decline in cognitive functioning.An appropriate cognitive assessment includes functional ability, memory recall, orientation, use of judgment, and appropriate emotional state.
Depression on older adults?
Depression is not a normal part of aging. However, it is often an underrecognized problem for many older adults. Approximately 15% of the community-dwelling older population has symptoms of depression. Rates of depressive symptoms in institutionalized older adults are higher. Older adults commit 20% of the suicides in the United States, and elderly white men have the highest rate of suicide. Depression in the older adult tends to arise from a loss of self-esteem and may be related to life situations, such as retirement or loss of a spouse.
Social Services for Older Adults
Medicare - federally funded health insurance program for people ages 65 years and older, as well as for some people with disabilities under age 65 and for people of all ages with end-stage renal disease requiring dialysis or a transplant. Medicaid - state-administered, needs-based program to assist eligible low-income people, including Medicare beneficiaries, with certain medical expenses.
Chronic illness trajectory
Onset - S&S are present; disease diagnosed Stable - Illness course/symptoms controlled by regimen; person maintains ADLs Acute - Active illness with severe and unrelieved symptoms or complications; hospitalization required for management. Comeback - gradual return to an acceptable way of life Crisis - life threatening situation; EMS is necessary Unstable - unable to keep symptoms/disease under control; life becomes disrupted
Ageism
negative attitude based on age, which leads to discrimination and disparities in the care given to older adults.
Frail Older Adults
older adults who, because of declining physical health and resources, are most vulnerable. Frailty is not directly related to age per se, although age is a risk factor. Frailty has been defined as the presence of three or more of the following: unplanned weight loss (≥10 lb in the last year), weakness, poor endurance and energy, slowness, and low activity. Risk factors include disability, multiple chronic illnesses, and dementia.