Exercise for Older Adults

Focus on Older Adults - Helping Initiate and Maintain Exercise

• Encourage older adults to avoid prolonged sitting, promoting regular stretching to reduce the risk of joint contractures.
• Ensure older adults maintain proper body alignment when sitting to minimize joint and muscle stress.
• Instruct patients on using stronger joints or larger muscle groups to efficiently distribute workload and decrease joint stress and pain.
• Provide resources for planned exercise programs, noting weight-bearing and resistance exercises can slow bone loss and prevent fractures in older adults with osteoporosis.
• Recommend engaging in resistance- and agility-training programs, which can reduce the fear of falling and enhance the sense of well-being.
• Highlight that starting an exercise program is beneficial at any age, but advise consultation with a healthcare provider, especially for those with heart or lung conditions.
• Adjust exercise programs based on assessment data and physical therapy input for advanced age.
• Encourage older adults unable to partake in formal exercise to improve joint mobility and circulation through simple stretching during daily activities.

Major Health Problems in Older Adults and Community-Based Nursing

• Lists major health issues affecting older adults, alongside community-based nursing roles and interventions.

Hypertension

• Monitor blood pressure and weight, educate on nutrition and antihypertensive drugs, and teach stress management.
• Promote a balance between rest and activity, establish blood pressure screening programs, assess lifestyle, promote changes, and suggest dietary modifications like a diet diary.

Cancer

• Obtain health history, promote monthly breast self-examinations and recommended screening like Pap smears and mammograms.
• Encourage colorectal screening, regular physical exams: counsel smokers to quit, correct aging misconceptions, provide emotional support.

Arthritis

• Teach activity management, stress reduction on affected joints, availability of mechanical appliances, and adequate rest.
• Promote stress management, counsel the family to improve communication, role negotiation and use community resources.

Visual Impairment

• Provide support in well-lit, glare-free environments, use large, well-spaced print, aid in cleaning eyeglasses, and arrange vision exams/prostheses.

Hearing Impairment

• Speak clearly, face the audience during teaching, and arrange hearing exams/prostheses.
• Teach care for hearing aids.

Cognitive Impairment

• Conduct complete assessments, correct underlying causes if possible, create protective environments, and promote reality-reinforcing activities.
• Aid with hygiene, nutrition, and hydration; offer family support and suggest resources like adult day care, home care, and homemaker services.

Dementia

• Maintain function, protection, and safety, encourage dignity.
• Demonstrate techniques to dress, feed, and toilet adults to family caregivers and give them emotional support.
• Advocate for patients with respite care, protect patient rights, maintain family health/stability, and recommend financial services.

Dental Problems

• Perform oral assessments and refer to a dentist, emphasize brushing, flossing, nutrition, and dental exams.
• Encourage care of dentures, ease fears about dentists, and help with accessing financial services for dental care.

Substance and Alcohol Abuse

• Obtain drug use history, educate on drug safety and interactions, give drug information, and teach presorting techniques.
• Counsel adults about substance abuse, promote stress management, arrange detoxification if appropriate and provide community resources.

Sexually Transmitted Infections

• Perform a sexual risk assessment, build awareness regarding risks for HIV/AIDS.
• Educate about safe practices and offer referrals for testing and HPV immunization.

Age-Related Changes in the Ear and Hearing

• The pinna elongates due to loss of subcutaneous tissues and decreased elasticity, which is a normal age-related change

Nursing Adaptations for Pinna Changes

• Reassure patients that changes in the pinna are normal.
• Avoid folding the ear under the head when positioning patients on their side.

Hair in Ear Canal Changes

• Hair in the canal becomes coarser and longer, especially in men, which is a normal age-related change.

Cerumen Changes

• Cerumen tends to become drier, potentially impacting more easily and reducing hearing function.

Nursing Adaptations for Cerumen Changes

• Frequent ear irrigation may be needed to prevent cerumen clumping causing change in hearing.
• Teach patients and caregivers to irrigate the ear canal weekly or when hearing changes are noticed.

Tympanic Membrane Changes

• The tympanic membrane loses elasticity and may appear dull and retracted with age.

Hearing Acuity Changes

• Hearing acuity decreases with age, with high-frequency sounds being lost first.

Nursing Adaptations to Hearing Acuity

• Assess hearing with voice or watch tests and refer to a specialist if there's a deficit.
• Provide a quiet environment, face the patient, avoid bright lights, and ensure the patient uses glasses.
• Speak slowly, clearly, in a deeper voice, and emphasize beginning word sounds.
• Note that some patients benefit from using a stethoscope while listening to someone speak

Risk Factors for Falls in Older Adults

• Lists intrinsic (patient-related) and extrinsic (environmental) risk factors for falls in older adults.

Intrinsic Factors for Falls

• Includes history of falls, impaired vision, postural hypotension, mobility issues (arthritis, muscle weakness, neuropathy, foot problems).
• Also includes issues with balance/gait, bladder function, cognitive issues, medication reactions, slowed reaction times, deconditioning.

Extrinsic Factors for Falls

• Includes home hazards like poor lighting, slippery floors, tripping hazards (rugs, clutter), sidewalk and stair conditions.
• Notes improper footwear or assistive device use and unfamiliar hospital environments (clutter/equipment) as extrinsic hazards.

Nursing Actions to Reduce Fall Risk

• Environmental modifications such as improved lighting, removal of hazards, and appropriate footwear.
• Encouraging the use of assistive devices, and appropriate medication management.

Key Features of Urinary Tract Infections

• Identifies common and rare symptoms of urinary tract infections.

Common UTI Symptoms

• Frequency, urgency, dysuria, hesitancy, low back pain, nocturia, incontinence, hematuria, pyuria, bacteriuria, retention, suprapubic tenderness.

Rare UTI Symptoms

• Fever, chills, nausea/vomiting, malaise, flank pain.

UTI Symptoms in Older Adults

• Older adults may present with vague symptoms like increased confusion or falls; incontinence may worsen; Fever/tachycardia may indicate urosepsis.
• Common indications are loss of appetite, nocturia, and dysuria.

Patient-Centered Care - Skin Changes Due to Aging

• Outlines changes in the epidermis, dermis, subcutaneous layer, hair, nails, and glands with age.

Epidermis Changes and Nursing Actions

• Epidermal thinning can occur, leading increased skin fragility and delayed healing.
• Nursing actions: Handle patients gently to reduce friction and shear, assess for dryness/moisture, limit warm baths(3x weekly) and use emollients.
• Avoid tape on fragile skin; protect open areas; assess exposed skin for sun-induced changes; teach sun avoidance.
• Warn patients that degrees of redness and swelling do not correlate to the severity of skin injury.

Dermis Changes and Nursing Actions

• Decreased dermal blood flow leads to dry skin (xerosis in sun-exposed areas) and impairs the inflammatory response of the skin.
• Apply moisturizers when skin is still moist to avoid skin dryness.
• Dermal thinning and degeneration impact trauma.
• Encourage patient to take a multivitamin or calcium supplement with D

Subcutaneous Layer Changes and Nursing Actions

• Diminishing layer leads to an increased risk for hypothermia and pressure injuries.
• Ensure to dress warmly in cold weather.

Hair/Nail/Gland Changes and Nursing Actions

• Changes include: decreased growth, gradual loss of color (graying) as well as risk for fungal infection.
• Nursing actions: Inspect the nails of older adults, teach the patient to keep their feet clean.

Care of the Hospitalized Older Adult

• Special considerations are required when caring for older adults in a hospital setting.
• Identify older adults at risk for iatrogenesis.
• Consider discharge needs early, especially assistance with ADLs, IADLs, and medications.
• Encourage interprofessional teams and units with focus on older adult needs.
• Implement standard protocols to screen for common at-risk conditions such as UTI's, falls.
• Implement mobility programs to prevent functional decline.
• Monitor and prevent skin integrity changes.
• Focus on safety specifically falls.
• Advocate referrals to community-based services.

Best Practices of Assessing Risk Factors and Preventing Falls in Older Adults

• Factors such as history of falls, advanced age, multiple illnesses, generalized weakness, gait instability.
• Disorientation, use of certain medications, impaired vision, substance use, room location, and change of shift.

Risk Assessment

• Assess a patient's risk factors, environment, and medications; implement fall prevention measures.

Nursing Interventions

• Monitor activity, teach patients to call for help, and clean spills immediately.
• Provide walkers, assess the patient's mobility and safety with a physical therapist

Modifications for High-Risk Patients

• Relocate the patient for better visibility.
• Encourage family on staying on staff, and use technological devices to alert staff.

Falls in Older Adults - Intrinsic Factors

• Summarizes intrinsic risk factors, including gait/balance problems, impaired vision, postural hypotension, and medication use.

Falls in Older Adults - Extrinsic Factors

• Risk factors include: poor lighting, lack of handrails, poor stairwell or bathroom design, obstacles, uneven surfaces, improper use of devices, and footwear.

Focus on Older Adults - Nervous System Changes

• Focuses on age-related nervous system changes and implications.

Slower Processing Time Considerations

• Allow sufficient time for reactions, and utilize repetition and memory aids for reinforcement.

Memory Loss Adaptations

• Encourage the patient to look when walking, wear effective walking shoes, and change their position to promote better blood flow.

Changes in the Perception of Pain

• It is important to ask specific questions when finding health problems with the patient.

Sleep Pattern Strategies

• Adjust the patient's daily schedule to sleep and preference.

Patient Centered Care - System and Organ Changes in Older Adults

• Provides changes in skin, kidney, muscular, neurological, and endocrine due to older age.

Patient Considerations per System

• Discusses skin loss of elasticity/ decreased turgor/ decreased oil.
• Discusses kidney decreased glomerular filtration/ decreased concentrating capacity.
• Discusses muscular decreased muscle mass.
• Discusses neurological reduced thirst reflex.
• Discusses endocrine adrenal atrophy.

Enhancing Self-Concept in Older Adults

• Self-concept and self-esteem are important to overall well-being.

Implications for practice

• Clarify the impacts of health problems and more to provide full mental assessment.
• Encourage the use of storytelling and reviewing old photographs.
• Communicate value, respect, and praise, focusing on independence.

Physiological Changes of Aging and Their Effect on Patient Safety

• Physical changes such as visual, hearing, reflexes, memory impairments, nocturia, and more.

Implications for Practice

• Encourage annual vision/hearing, auto-safety, exercise, proper assistance devices, medication organizers, and review drug profiles to prevent serious adverse effects.