Chapter 10: Life Span: Older Adults
functional limit with the oldest-old
can't stoop/kneel/reach overhead/walk 2+ blocks/lift 10 lbs 40% of men & 50% of women couldn't do at least one of these things
what is the fastest growing age group
the older adult ages 65 +
6 out of 7 leading causes of death among older adults are
*chronic disease* -heart disease -cancer -chronic lower respiratory disease -stroke -alzheimer disease -diabetes mellitus -influenza & pneumonia long term rarely cured most costly health condition preventable or modified with health behavior
cardiovascular
- decreased cardiac output - increased peripheral resistance, systolic BP
respiratory
- decreased elasticity of chest wall, intercostals muscle strength, cough reflex - increased anteroposterior diameter of chest, rigidity of lung tissue
genitourinary
- decreased glomerular filtration rate, blood flow to kidneys, bladder capacity, vaginal lubrication, hardness of erection
endocrine
- decreased insulin release, thyroid functions, estrogen & testosterone
neurological
- decreased nerve cells, neurotransmitters, REM sleep, blood flow to CNS
gastrointestinal
- decreased saliva production, GI motility, gastric acid production
cognitive
- decreased short-term memory - increased reaction time, information processing time
integumentary
- decreased skin elasticity, nail growth - increased dryness of skin, thinning of skin layers, nail thickening, hair thinning
sensory
- decreased visual acuity & depth of perception, tear production, pupil size, accommodation, acuity of smell & taste, hearing of high-frequency sound, sense of balance changes in pain sensation
nutrient for the oldest-old
- edentulism causes more of a inadequate nutritional intake - soft diet that are higher in fat - need to decrease these food to prevent obesity - and increase activity with exercise
personality
- increased cautiousness - retirement, widowhood, grandparenthood
young-old interventions
- moderate exercise & muscle strengthening - balancing & adapting exercise routines
middle-old interventions
- planned limited activity - exercise
alzheimer disease
- primary form is progressive - odds of this doubles every 5 years after age 65 - 1/2 adults 85+ have it
oldest-old interventions
- provide supportive environments - exercise to their ability - focus on nutrition
dementia makes it more difficult to:
- remember things - think clearly - communicate with others - take care of themselves - mood swings - can change a persons personality & behavior
A client, who is a 70-year-old white man, recently learned that he has osteoporosis. Which of the following are risk factors that could have contributed to your client's condition? SELECT ALL THAT APPLY. 1) Age 2) Gender 3) Cigarette smoking 4) Moderate alcohol consumption 5) Race 6) Lack of exercise
1) Age 3) Cigarette smoking 4) Moderate alcohol consumption 6) Lack of exercise
How can the nurse facilitate communication with an older adult? Select all that apply: 1) Assess for hearing deficit at the beginning of the interaction. 2) Speak more loudly than normal, and at a slightly higher pitch. 3) Pay special attention to cues from body language. 4) Speak slowly, allowing time for the patient to word his answers.
1) Assess for hearing deficit at the beginning of the interaction. 3) Pay special attention to cues from body language. 4) Speak slowly, allowing time for the patient to word his answers. Rationale: The nurse should check for sensory deficits at the beginning of the interaction so he can allow for lipreading, as needed. Because older adults sometimes have difficulty expressing themselves, body language (e.g., wringing hands, fidgeting) is especially important. Because older adults process information slowly, the nurse should speak slowly, allowing them to formulate their answers. Speaking slowly does not mean the nurse should speak loudly or at a higher pitch. Many older adults have high-pitch hearing loss.
The nurse would expect a client with early Alzheimer's disease to have problems with: 1) Balancing a checkbook. 2) Self-care measures. 3) Relating to family members. 4) Remembering his own name
1) Balancing a checkbook Rationale: In the early stage of Alzheimer's disease, executive functions or complex tasks (such as balancing a checkbook) would be the one of the first cognitive deficits to occur. The loss of self-care ability, problems with relating to family members, and difficulty remembering one's own name are all areas of cognitive decline that occur later in the disease process.
Which of the following would be the most important health assessment focus for older adulthood? 1) Cancer screening with the annual health examinations 2) Seeking information about consistent use of seat belts 3) Screening for eating disorders 4) A bone scan (DEXA test) for osteoporosis
1) Cancer screening with the annual health examinations Rationale: Chronic diseases, including cancer, are major health problems for older adults. In fact, cancer is the second leading cause of deaths for older adults. Older adults should also have an annual physical exam; they should receive cancer screening at that time. Habits for seat belt use should have already been established; although it may be important to reinforce seat belt use, the most important assessment is cancer screening. Eating disorders are more common in adolescence and young adulthood. Although loss of bone density is fairly common in older adults and can be pathological, it does not assume the status of cancer with regard to mortality for older adults.
Which of the following is the primary goal for the oldest-old? 1) Maximize function 2) Prevent falls 3) Promote good nutrition 4) Prevent heart disease
1) Maximize function Rationale: The goal of interventions for the oldest-old is to maximize function and prevent loss of function or disability, thus ensuring independence for as long as possible. Supportive environments and conditions that allow a person to function are vital.
When interpreting a population pyramid, which of the following do you need to know? Select all that apply. 1) The youngest age group makes up the base of the pyramid. 2) Men are on the left side of the pyramid and women on the right. 3) The length of a bar indicates how many people are in that age category. 4) Adolescents are the youngest group on the pyramid.
1) The youngest age group makes up the base of the pyramid. 2) Men are on the left side of the pyramid and women on the right. Rationale: Age distribution of a population is often illustrated in a pyramid with the youngest age group (0-4) at the base and the oldest age group (85+) at the peak, men on the left of the figure and women on the right. The shape of a population pyramid changes to a rectangle in developed countries with fewer births and increased life expectancy. The length of a bar does not indicate the absolute number of people in a category; it indicates the proportion of the total population represented by that category.
list of age related physical changes
1. musculoskeletal 2. cardiovascular 3. respiratory 4. gastrointestinal 5. integumentary 6. genitourinary 7. neurological
hearing for the oldest-old
1/2 of men and 1/3 of women reporting difficulty hearing and was much higher over the age of 85
Which of the following should you advise a frail older adult to do to slow the spiral of frailty? Select all that apply. 1) Participate in a fall-preventive moderate-intensive group exercise program. 2) Eat a balanced diet, including enough protein, fiber, and fluids. 3) Keep the mind active (e.g., by reading and socializing). 4) Walk, as tolerated, for aerobic fitness and joint flexibility.
2) Eat a balanced diet, including enough protein, fiber, and fluids. 3) Keep the mind active (e.g., by reading and socializing). 4) Walk, as tolerated, for aerobic fitness and joint flexibility. Rationale: Available research suggests that the frail elderly do not appear to benefit from fall-preventive moderate-intensity group exercise programs, although they have positive effects on older adults before frailty occurs. Maintaining good nutritional status is also thought to be important in preventing or delaying frailty (Bartali, Semba, Frongillo, et al., 2006). Keep the mind active by socializing, working puzzles, reading, or playing games ("Frailty in Older Adults," 2006). Engage in daily physical activity to the extent possible: walking and weights to build aerobic fitness, build muscle, and improve joint stiffness and pain (Bartali, Semba, Frongillo, et al., 2006).
Which of the following is the best test of functional ability? 1) Geriatric Depression scale (GDS) 2) Katz Index of Independence in Activities of Daily Living 3) Client's heart rate after 2 minutes on a treadmill 4) Bone density scan to identify osteoporosis
2) Katz Index of Independence in Activities of Daily Living Rationale: Functional status is the ability to perform self-care and other activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The Katz Index of Independence in Activities of Daily Living allows you to rate a client's independence in bathing, dressing, toileting, transferring, continence, and feeding. The Geriatric Depression Scale (GDS) is a 30-item questionnaire that screens for depression. Although depression and decreased bone density might indirectly affect functional ability, they are not good tests of functional ability because they do not necessarily result in loss of ability to perform ADLs. They do not screen for overall functional ability.
In general, for young-old clients with no special problems, which of the following would you recommend for exercising? Select all that apply. 1) Walk 10 minutes a day and increase minutes and intensity slowly. 2) Perform muscle-strengthening activities on 2 or more days a week. 3) Participate in yoga and tai chi exercises. 4) See an exercise therapist for an exercise program.
2) Perform muscle-strengthening activities on 2 or more days a week. 3) Participate in yoga and tai chi exercises. Rationale: Clients should perform moderate or high-intensity muscle-strengthening activities on 2 or more days a week. The weight-bearing and toning exercises should involve all major muscle groups. Muscle-strengthening activities can include use of exercise bands; handheld weights; digging, lifting, and carrying as part of gardening; carrying groceries; and some yoga and tai chi exercises. Inactive older adults or those with a very low level of fitness should begin with 10 minutes of walking and increase minutes and intensity slowly with subsequent walks. Others should engage in 150 minutes a week of moderate-intensity aerobic exercise. Only those with chronic conditions may need to see an exercise therapist for help in making adaptations that allow them to exercise.
what percentage of the population will the older adult be by 2050
21%
Vision for the oldest-old
27% report trouble seeing
When assessing an older adult patient, which of the following should the nurse recognize as a normal age-related change? Select all that apply. 1) Urinary incontinence ("dribbling") 2) Frequent loss of balance 3) Diminished acuity of near vision 4) A decline in short-term memory
3) Diminished acuity of near vision 4) A decline in short-term memory Rationale: Urinary incontinence is not the result of usual age-related changes. It may signal a urinary tract infection, a prostate problem, excessive urogenital drying, or the need for in-home assistance. Frequent falls or loss of balance is not the result of normal age-related changes but could signal a neuropathology such as Parkinson's disease or early symptoms of dementia and should be reported to a healthcare provider. With aging, the lens of the eye thickens and there is increased glare sensitivity and decreased visual acuity. Reaction time slows in older adults, and short-term memory declines; it takes longer to respond to a stimulus, and it takes more time to process incoming information. However, there is no loss of intelligence as a person ages.
An 86-year-old patient had prostate surgery 2 days ago. Which nursing action best meets his developmental needs? 1) Perform a spiritual assessment and make referrals as needed. 2) Provide a complete bed bath and other hygiene needs. 3) Encourage the patient to perform self-care as much as possible. 4) Administer pain medications to keep the patient comfortable.
3) Encourage the patient to perform self-care as much as possible Rationale: An important nursing goal for all older adults should be to maintain the person's ability to function independently for as long as possible. Encouraging self-care will help to achieve that goal. A spiritual assessment is appropriate, but is not a need of older adults any more than of other age groups. Providing hygiene needs does not promote independence. Administering analgesics is appropriate, but does not encourage functional independence.
Which of the following would be an abnormal assessment finding for an older adult that the nurse would document and report to the primary care provider? Decreased: 1) Reaction time 2) Short-term memory 3) Intellectual ability 4) Cognitive processing speed
3) Intellectual ability Rationale: There should be no loss of intellectual ability. An elderly person can learn, although learning takes longer. Reaction time slows as we age, and it is also normal to have a decline of short-term memory, although long-term memory loss is not as common. Cognitive processing speed declines with age. This includes slower computational skills and reduced speed for problem-solving, but this does not imply that intellect is impaired.
A client tells the nurse, "I can't see well enough to read any more. I have new glasses, but it's still hard." What should the nurse advise her to do first? 1) Go back to the eye doctor and have him check your glasses. 2) Buy some audio books and listen to those. 3) Adapt to reading less and find a new leisure activity. 4) Install a bright but glare-free light near where she reads.
4) Install a bright but glare-free light near where she reads Rationale: With aging, there is decreased pupil accommodation, decreased tear production, and thickening of the lens of the eye. All of these contribute to impaired near vision (presbiopia). Decrease in pupil accommodation allows less light into the eye, so in order to read, the person needs a good light. However, there is also increased sensitivity to glare, so the light should have a glare-free bulb. The patient should try this first, since she already has new glasses. If this doesn't help, then perhaps she should have the glasses rechecked. If her vision cannot be improved, then she could think about buying audio books and other ways to adapt to her difficulty reading.
which of the following is a normal developmental change of aging? a. confusion and dementia b. dry skin c. joint pain
b. dry skin
disturbance in executive functioning
ability to organize, manage, & make decisions
Dementia involves memory impairment & at least one of these other areas:
aphasia apraxia agnosia disturbance in executive functioning
musculoskeletal (age related physical changes)
decreased: -muscle strength -body mass -bone mass -joint mobility increased: - fat deposit
cognitive development
decreased: -reaction time -short term memory takes longer time to respond to stimulus and process incoming information
demographics of older adults
fastest growing age population
Edentulism
having no natural teeth
agnosia
impaired ability to recognize or identify objects (family members or one's own reflection)
edentulism for the oldest-old
income related; 34% reported edentulism (42% below poverty line & 23% above poverty)
middle-old (74-84)
increasingly solitary, sedentary lifestyle - adapted physical activity (APA) - group exercise programs designed for persons w/ chronic conditions to correct sedentary lifestyle & prevent disability secondary to disease
normal memory declines, but _______ does not
intelligence
dementia
irreversible, progressive decline in mental abilities - common in 85+ (~50%) - not "normal" aging - Alzheimer's is primary form
apraxia
loss of ability to carry out purposeful movements
aphasia
loss of ability to communicate
young-old (65-74)
physical & psychological adaptations to retirement - self-perception of aging - deconditioned state (lack of exercise) - experiencing effects of chronic illnesses - lack of supplemental health insurance
frail (fragile) elderly
point which human organism is believed to jam its lease capacity for survival. Ex) could die of a cold bc of upper respirator infections because if lack of muscle to cough up congestion
oldest-old (85+)
sensory impairments, oral health, inadequate nutritional intake, & functional limitations - hearing, vision, edentualism - having no natural teeth, nutrition, functional limitations