Nursing for Wellness in Older Adults (2011) PDF

LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page i LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page i Nursing for Wellness in Older Adults LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page ii LWBK783-FM-i-...

LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page i LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page i Nursing for Wellness in Older Adults LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page ii LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page iii Nursing for Wellness in Older Adults S I X T H E D I T I O N Carol A. Miller, MSN, RN-BC, AHN-BC Gerontological Clinical Nurse Specialist and Nurse Case Manager Care & Counseling, Miller/Wetzler Associates Cleveland, Ohio Clinical Faculty Frances Payne Bolton School of Nursing Case Western Reserve University Cleveland, Ohio LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page iv Executive Acquisitions Editor: Elizabeth Nieginski Product Managers: Helene T. Caprari and Betsy Gentzler Design Coordinator: Holly Reid McLaughlin Art Director, Illustration: Brett MacNaughton Manufacturing Coordinator: Karin Duffield Prepress Vendor: Aptara, Inc. Sixth Edition Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2009, 2004 by Lippincott Williams & Wilkins. Copyright © 1999, 1995, 1990 by Carol A. Miller. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any informa- tion storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permis- sion, please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via e-mail at [email protected], or via our Web site at lww.com (products and services). 987654321 Printed in China Library of Congress Cataloging-in-Publication Data Miller, Carol A. (Carol Ann), 1945- author. Nursing for wellness in older adults / Carol A. Miller. — Sixth edition. p. ; cm. Includes bibliographical references and index. ISBN 978-1-60547-777-0 (hardback : alkaline paper) 1. Geriatric nursing. I. Title. [DNLM: 1. Geriatric Nursing. 2. Aged—psychology. 3. Health Promotion. 4. Nursing Theory. WY 152] RC954.M55 2011 618.97⬘0231—dc22 2010043818 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the author, editors, and publisher are not responsible for errors or omissions or for any conse- quences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this information in a partic- ular situation remains the professional responsibility of the practitioner; the clinical treatments described and rec- ommended may not be considered absolute and universal recommendations. The author, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with the current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indica- tions and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clear- ance for limited use in restricted research settings. It is the responsibility of the health care providers to ascertain the FDA status of each drug or device planned for use in his or her clinical practice. LWW.com LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page v D E D I C AT I O N S I lovingly dedicate this book to my parents, Margaret ‘n’ Bob Miller, who have always given me boundless support, encouragement, and inspiration—they have been shining examples of living long and full lives. This book also is dedicated to the many older adults and their families who teach invaluable lessons about successfully navigating the challenges of older adulthood. LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page vi LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page vii Contributors & Reviewers C O N T R I B U T O R S Georgia Anetzberger, PhD, ACSW A Student’s Perspective Contributors Assistant Professor, Health Care Administration These features were contributed by students Cleveland State University and Case Western Reserve from the following programs: Unviersity Brigham Young University Cleveland, Ohio Provo, Utah Western Michigan University Casey R. Shillam, RN, MSN, PhD Kalamazoo, Michigan Post-doctoral fellow Betty Irene Moore School of Nursing Angelo State University University of California Davis San Angelo, Texas Sacramento, California R E V I E W E R S Alice Brnicky Judith Draper, MSN, GNP, BC Texas Woman’s University University of Pennsylvania Irving, Texas Philadelphia, Pennsylvania Virginia Burggraf Marybeth K. Fischer, RN, MSN Radford University Instructor Radford, Virginia St. Luke’s School of Nursing Bethlehem, Pennsylvania Nathania Bush, MSN, APRN, BC Associate Professor of Nursing Patricia Fuehr, MSN, RN, FNP-BC Morehead State University Faculty Specialist Clay City, Kentucky Western Michigan University, Bronson School of Nursing Eunice Cleeland, MSN, RN Kalamazoo, Michigan Contract Faculty University of Alabama at Birmingham, School of Nursing Barbara A. Heise, PhD, APRN, BC Birmingham, Alabama Assistant Professor Brigham Young University, College of Nursing Kimberly F. Craven, BSN, MSN Provo, Utah Instructor of Nursing Jacksonville State University, School of Nursing and Barbara Hulsman, RN, MN Health Sciences Assistant Professor Jacksonville, Alabama Carson-Newman College, School of Nursing and Behavioral Health Winifred Dolph Jefferson City, Tennessee Mid-Plains Community College North Platte, Nebraska vii LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page viii viii Contributors & Reviewers Kathy J. Keister, PhD, RN, CNE Gregg Trueman, NP, PhD, CHPCN(c) Associate Professor Associate Professor, Faculty of Community and Wright State University, College of Nursing & Health Health Studies Dayton, Ohio Mount Royal College, School of Nursing Calgary, Alberta, Canada Norma Krumwiede, EdD, MEd, MN, RN Professor Joyce McCullers Varner, DNP, GNP-BC, GCNS Minnesota State University Associate Professor, Adult Health Nursing Department Mankato, Minnesota University of South Alabama, College of Nursing Mobile, Alabama Lisa A. Lacko, RN, MSN Assistant Professor Gail Vitale, EdDc, RN, GCNS-BC Cedar Crest College Associate Professor Allentown, Pennsylvania Lewis University, College of Nursing and Health Professions Bonnie Launhardt Romeoville, Illinois Grant MacEwan Community College Edmonton, Alberta, Canada Molly J. Walker, PhD, RN, CNS, CNE Associate Professor, Graduate Advisor Heidi McCoy, RN, MSN Angelo State University University of Nebraska Medical Center, College of Nursing San Angelo, Texas Lincoln, Nebraska Judith Webb, DNP, ANP-BC Siobhan McMahon, MSN, MPH, GNP-BC Clinical Assistant Professor Assistant Professor of Nursing MGH Institute of Health Professions The College of St. Scholastica, School of Nursing Boston, Massachusetts Duluth, Minnesota Donna Williams-Newman Elizabeth A. Peterson, DMin, RN Knox Community College, School of Nursing Associate Professor of Nursing Clarendon, Florida Bethel University St. Paul, Minnesota L. Sue Sprinkle, BSN, MSN, HFA, RN Assistant Professor Indiana Wesleyan University, Pre-Licensure Division School of Nursing Marion, Indiana LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page ix Preface W hen I began my nursing career in 1970, I chose to of life of older adults within the context of the nursing work in a visiting nurse program that addressed the process. For each aspect of functioning, nurses can use the unique needs of older adults in home settings. When assessment and intervention guidelines to identify and ad- asked why I would want to work full time with the “geriatric dress factors that affect the functioning and quality of life of population,” I enthusiastically responded that this presented older adults. Evidence-based boxes provide information a wide open opportunity to meet the needs of people who about recent research that supports assessment of and inter- were neglected by most health care professionals. At that ventions for conditions commonly addressed when caring for time, “geriatrics’” and “gerontology” were the newcomers in older adults. Nursing interventions focus on health promo- health care, and little was known about the unique nursing tion, and many of the intervention guides can be used as care needs of older adults. It would be 4 years before geron- health education tools to teach older adults, their families, tological nursing would be an approved specialization and and their caregivers about actions they can take to promote 5 years before the first gerontological nursing journal would wellness. Chapters also include information about applicable be published. During the past four decades, the percentage of wellness nursing diagnoses and wellness outcomes. Theory the U.S. population defined as “older adults” has been grad- illustrations at the beginning of chapters illustrate how the ually increasing, with projections that by 2050, 20% of the Functional Consequences Theory is integrated with the nurs- U.S. population will be aged 65 years and older. Concomi- ing process with regard to specific aspects of functioning. tantly, our knowledge about how to provide evidence-based care for older adults has been expanding at a rapid pace. Thus, ORGANIZATION it is imperative that nurses keep up-to-date on aging-related research and issues so that they can apply this knowledge to Nursing for Wellness in Older Adults has 29 chapters, organ- identify and address the unique needs of older adults. ized into five parts. Chapters in Parts 1 and 2 introduce topics In addition to the increasing focus on care of older adults, relevant to aging, wellness, older adults, and the role of nurses “wellness” has been emerging as a major focus of health care in promoting wellness in older adults. Chapters in Parts 3 and in recent years. The concept is usually associated with phys- 4 are organized around the Functional Consequences Theory ical fitness and “preventing aging”; however, a major premise of Gerontological Nursing, so each facet of physiologic or of this text is that there is no age limit to achieving wellness psychosocial function is presented according to age-related when it is holistically conceptualized in the context of one’s changes, risk factors, functional consequences, nursing as- body, mind, and spirit. Another major premise is that nurses sessment, nursing diagnosis, wellness outcomes, nursing in- have primary roles in promoting wellness for older adults be- terventions, and evaluation of nursing care. The three chapters cause we holistically address the needs of our patients, which in Part 5 helps nurses provide holistic care for older adults for older adults involves supporting their optimal level of during illness. functioning and quality of life. Thus, the intent of this text is The intent of Part 1 (Chapters 1 through 4), Older Adults to serve as a foundation for providing wellness-oriented nurs- and Wellness, is to help nurses apply a wellness philosophy ing care for older adults in any health care setting. to their care of older adults. Chapters 1 and 2 integrate the This sixth edition of Nursing for Wellness in Older Adults concepts of wellness and aging and provide an overview of has been extensively updated to incorporate recent evidence- characteristics and diversity of older adults. Chapter 3 expli- based information that is pertinent to providing wellness- cates the Functional Consequences Theory, which is applied oriented care for older adults. In addition, a major focus is on throughout this text as a framework for wellness-oriented the multitude of opportunities that nurses have for promoting nursing care of older adults. Chapter 4 provides an overview health and improving quality of life for older adults. As in of theories that are pertinent to aging well. previous editions, this text focuses on the aspects of physio- Part 2 (Chapters 5 through 10), Nursing Considerations logic and psychosocial function that are most relevant to nurs- for Older Adults, introduces gerontological nursing as a sub- ing care of older adults. The Functional Consequences specialty within nursing and addresses the unique challenges Theory provides a framework for identifying the many inter- of caring for older adults, with an extensive discussion of acting factors that affect the level of functioning and quality health promotion in relation to older adults. Roles for ix LWBK783-FM-i-xxx:Miller 11/11/10 9:37 PM Page x x Preface gerontological nurses are described in relation to diverse set- Progressive Case Studies provide real-life examples of tings that comprise the continuum of care for older adults. the effects of age-related changes and risk factors, begin- This section also covers the complex topics of assessment, ning in young-old adulthood and continuing through all medications, and legal and ethical concerns because nurses the stages of later adulthood. Thinking Points after each address these aspects of care with the majority of the older segment of the case assist the student in applying the con- adults for whom they provide care. Elder abuse and neglect tent of the chapter to the case example. Many chapters in- also is addressed in this section because nurses need to be clude a concluding Case Study with a sample Nursing aware of this concern when caring for older adults. Care Plan. Part 3 (Chapters 11 through 15), Promoting Wellness in Chapter Highlights in an easy-to-read bulleted format fa- Psychosocial Function, extensively reviews cognitive and cilitate review of the material. psychosocial function and provides guidelines for a compre- Critical Thinking Exercises, at the end of each chapter, hensive nursing assessment of psychosocial function, with help readers to gain insight and develop problem-solving emphasis on healthy older adults. In addition, this part covers skills through purposeful, goal-directed thinking. delirium, dementia, and depression, which are three of the References give readers additional information about the most commonly occurring pathologic conditions that have se- most up-to-date research that supports evidence-based rious psychosocial consequences for older adults. practice. Part 4 (Chapters 16 through 26), Promoting Wellness in Physical Function, includes chapters that address each of the following specific aspects of functioning in older adults: Practice-Oriented Features hearing, vision, digestion and nutrition, urinary function, car- NEW! Evidence-Based Practice boxes are included in diovascular function, respiratory function, mobility and clinically oriented chapters to summarize guidelines for safety, integument, sleep and rest, thermoregulation, and sex- research-based care of older adults. ual function. Selected common pathologic conditions also are Wellness Opportunities are sprinkled throughout the addressed in these chapters when these conditions affect a clinically oriented chapters to draw attention to ways in particular aspect of functioning in older adults. which nurses can promote wellness during the usual Part 5 (Chapters 27 through 29), Promoting Wellness in course of their care activities. All Stages of Health and Illness, has been added to address A Student’s Perspective provides reality-based stories topics of caring for older adults during illness and when they written by nursing students that illustrate the application are experiencing pain or are at the end of life. of wellness concepts in clinical practice. Cultural Considerations boxes help the reader to appre- ciate cultural differences that may influence his or her ap- NEW AND SPECIAL FEATURES proach to a patient, resident, or client. Special features from past editions have been retained in this Diversity Notes give brief information about differences edition, and several new features have been added. among specific groups (e.g., men and women, whites and African Americans). Pedagogical Features Assessment Boxes provide the reader with specific ap- Learning Objectives help the reader identify important proaches for nursing assessment. Commonly used assess- chapter content and focus his or her reading. ment tools are described (and, in many cases, illustrated). Key Terms listed at the beginning of the chapter and Interventions Boxes provide succinct guides for nursing bolded in the text highlight important vocabulary. interventions, with a strong focus on health promotion. Theory Illustrations at the beginning of each chapter on Guides for “best practices” in nursing interventions are specific aspects of functioning present an overview of the given. Many of the interventions boxes can be used as Functional Consequences Theory in the context of the tools for teaching older adults and their caregivers about nursing process. how to improve functional abilities. Interventions boxes Icons identify the five major components of the Func- that double as teaching tools can be downloaded from tional Consequences Theory: at http://thepoint.lww.com/miller6e. Resources sections direct the reader to sources for clinical Age-related changes tools, evidence-based practice, and health education. Risk factors TEACHING AND LEARNING PACKAGE Functional consequences Instructor Resources Tools to assist you with teaching your course are available Nursing assessment upon adoption of this text on at http://thePoint. lww.com/Miller6e. Many of these tools are also included on Nursing interventions the Instructor’s Resource DVD-ROM. LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page xi Preface xi An E-Book allows access to the book’s full text and An E-Book allows access to the book’s full text and images online. images online. The Test Generator lets you generate new tests from a Journal Articles, corresponding to book chapters to offer bank of NCLEX-style questions to help you assess your access to current research available in Lippincott Williams students’ understanding of the course material. & Wilkins journals. PowerPoint Presentations provide an easy way for you Internet Resources, include links to clinical tools, evi- to integrate the textbook with your students’ classroom ex- dence-based practice, and health education materials. perience, either via slide shows or handouts. Multiple- Plus NCLEX alternate-item format tutorial, a Spanish– choice and True/False questions are integrated into the English audio glossary, Learning Objectives, and Inter- presentations to promote class participation and allow you ventions Boxes from the textbook. to use i-clicker technology. A sample Syllabus provides guidance for structuring your course. SUMMARY An Image Bank contains illustrations from the book in Providing wellness-oriented nursing care for older adults is formats suitable for printing and incorporating into an opportunity to care for people who are striving to meet the PowerPoint presentations and Internet sites. challenges of remaining healthy and functional as they cope Journal Articles, corresponding to book chapters, offer with age-related changes and risk factors that affect their access to current research available in Lippincott Williams functioning and quality of life. The goal of Nursing for Well- & Wilkins journals. ness in Older Adults is to provide nurses and nursing students Access to all student resources. with a practical approach to assisting older adults in meeting the many challenges of older adulthood in positive and Student Resources creative ways. Students can also visit at http://thePoint.lww.com/ miller6e and access the following tools and resources using Carol A. Miller, MSN, RN-BC, AHN-BC the codes printed in the front of their textbooks: LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page xii LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page xiii Acknowledgments I am deeply grateful to my family, friends, and colleagues I appreciate and acknowledge the many people who have who have supported me on my journey as this book has helped bring this text to fruition. I want to extend my deepest grown from a dream to a reality and now into its sixth edi- appreciation to the staff at Wolters Kluwer | Lippincott tion. Pat Rehm, in particular, has constantly supported and Williams & Wilkins who assisted with all phases of develop- encouraged me to pursue my goals as a nurse and author. My ment and production. I thank all these people, and many un- work with older adults and their families provides valuable named people, for the advice, guidance, support, assistance, lessons that have become part of this text. These experiences, and encouragement on my journey through all six editions of which cannot be learned in books, have taught me to care Nursing for Wellness in Older Adults. deeply about, and to care sensitively for, older adults. I thank these older adults and their families and appreciate their con- tributions to my life and my writings. xiii LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page xiv LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page xv Contents P A R T 1 Obtaining Information About Culturally Diverse Groups 22 Linguistic Competence in Care of Older Adults 23 Older Adults and Wellness 1 CULTURAL PERSPECTIVES ON WELLNESS 23 CHAPTER 1 HEALTH DISPARITIES 24 Seeing Older Adults Through the OVERVIEW OF CULTURAL GROUPS OF OLDER Eyes of Wellness 1 ADULTS IN THE UNITED STATES 26 African Americans 26 IMAGES OF AGING 1 Hispanics or Latinos 27 THE RELATIONSHIP BETWEEN WELLNESS Asians and Pacific Islanders in the United States 29 AND AGING 2 American Indians and Alaska Natives 30 Wellness and Older Adults 2 OLDER ADULTS IN OTHER DIVERSE GROUPS 31 Wellness and Nursing Care of Older Adults 2 Older Adults in Rural Areas 32 Definitions of Aging 3 Homeless Older Adults 32 Descriptions of Successful Aging 4 Lesbian, Gay, Bisexual, and ATTITUDES TOWARD AGING 5 Transgender Older Adults 32 Shifting Trends 5 Ageism 5 CHAPTER 3 Effects of Ageism 6 Applying a Nursing Model for Promoting Addressing Attitudes of Nurses 8 Wellness in Older Adults 36 DEBUNKING MYTHS: UNDERSTANDING REALITIES ABOUT OLDER ADULTS IN THE A NURSING THEORY FOR WELLNESSFOCUSED UNITED STATES 8 CARE OF OLDER ADULTS 36 Demographics of Aging 9 CONCEPTS UNDERLYING THE FUNCTIONAL Health Characteristics 11 CONSEQUENCES THEORY 37 Socioeconomic Characteristics 11 Functional Consequences 37 Living Arrangements of Older Adults 13 Age-Related Changes and Risk Factors 39 OLDER ADULTS IN FAMILIES 14 Person 40 Trends in Caregiving 14 Nursing 41 Older Adults as Recipients and Givers Health 41 of Care 15 Environment 42 Grandparents Raising Grandchildren 16 APPLYING THE THEORY TO PROMOTE WELLNESS OLDER ADULTS IN THE WORLD 16 IN OLDER ADULTS 42 CHAPTER 2 CHAPTER 4 Addressing Diversity of Older Adults 20 Theoretical Perspectives on CULTURAL DIVERSITY IN THE UNITED STATES 20 Aging Well 45 CULTURAL COMPETENCE 21 HOW CAN WE LIVE LONG AND WELL? 45 Performing a Cultural Self-Assessment 21 Life Span and Life Expectancy 46 xv LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page xvi xvi Contents Rectangularization of the Curve and Evidence-Based Practice for Gerontological Compression of Morbidity 46 Nursing 61 Active Life Expectancy 47 HEALTH, WELLNESS, AND HEALTH Relationships Among Aging, Disease, PROMOTION 63 and Death 48 Health Promotion for Older Adults 64 Studies of Healthy Aging 48 Health Promotion Initiatives for Older Adults 64 HOW DO WE EXPLAIN BIOLOGIC AGING? 49 Types and Examples of Health Promotion Wear-and-Tear Theories 49 Interventions for Older Adults 65 Cross-Linkage Theory 49 Promotion of Physical Activity as a Nursing Free Radical Theory 49 Intervention for Wellness 68 Neuroendocrine and Immunity Theories 49 THE TRANSTHEORETICAL MODEL OF HEALTH Genetic Theories 50 PROMOTION 69 Apoptosis Theory 50 Caloric Restriction Theories 50 CHAPTER 6 Conclusions About Biologic Theories and Relevance to Nurses 50 Diverse Health Care Settings for SOCIOCULTURAL PERSPECTIVES ON AGING 51 Older Adults 75 Disengagement Theory 52 DEVELOPMENT OF A CONTINUUM OF Activity Theory 52 CARE FOR OLDER ADULTS 75 Subculture and Age Stratification Theories 52 ACUTE CARE SETTINGS 77 Emerging Sociocultural Theories 53 Specialized Geriatric Acute Care Units 77 Person–Environment Fit Theory 53 Subacute Care Units 77 Relevance of Sociocultural Theories of Hospital-at-Home Model 77 Aging to Nurses 53 Transitional Care Models 78 PSYCHOLOGICAL PERSPECTIVES ON AGING 54 Roles for Gerontological Nurses in Human Needs Theory 54 Acute Care Settings 78 Life-Course and Personality Development NURSING HOME SETTINGS 78 Theories 54 Levels of Nursing Home Care 78 Theory of Gerotranscendence 55 Admission to Long-Term Care 79 Theories About Gender and Aging 55 Trends in Nursing Home Care 79 Relevance of Psychological Theories of Roles for Gerontological Nurses in Aging to Nurses 55 Nursing Home Settings 80 A HOLISTIC PERSPECTIVE ON AGING NEWER MODELS OF NURSING HOME CARE 80 AND WELLNESS 56 The Culture Change Movement 80 Evidence for Positive Outcomes With Culture Change 81 P A R T 2 Pioneer Network 81 Assisted-Living Facilities 81 Roles for Nurses in Newer Models of Care 82 Nursing Considerations for HOME CARE SERVICES 82 Older Adults 59 Trends in Home Care Services 82 Skilled Home Care 83 CHAPTER 5 Long-Term Home Care 83 Sources of Home Care Services 83 Gerontological Nursing and Health Promotion 59 COMMUNITYBASED SERVICES FOR OLDER ADULTS 84 GERONTOLOGY AND GERIATRICS 59 Adult Day Centers 84 GERONTOLOGICAL NURSING 60 Respite Services 85 Gerontological Nursing Education and Practice 60 Parish Nursing Programs 85 Roles for Gerontological Nurses 61 Health Promotion Programs 85 LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page xvii Contents xvii Roles for Gerontological Nurses in Home and AGERELATED CHANGES THAT AFFECT BIOACTIVE Community Settings 85 SUBSTANCES IN OLDER ADULTS 118 MODELS ADDRESSING COORDINATION Changes That Affect the Action of Bioactive OF CARE 86 Substances in the Body 118 Comprehensive Models 86 Changes That Affect Behaviors Related to Chronic Care Models 87 Taking Bioactive Substances 120 Care and Case Management Services 87 RISK FACTORS THAT AFFECT BIOACTIVE PAYING FOR HEALTH CARE SERVICES SUBSTANCES 120 FOR OLDER ADULTS 88 Pathologic Processes and Functional Out-of-Pocket Expenses 88 Impairments 121 Medicare 88 Behaviors Based on Myths and Medigap Insurance 88 Misunderstandings 121 Medicaid 89 Communication Barriers 122 Older Americans Act 90 Lack of Information 122 Long-Term Care Insurance 90 Inappropriate Prescribing Practices 122 Polypharmacy and Inadequate Monitoring of CHAPTER 7 Medications 124 Medication Nonadherence 124 Assessment of Health and Financial Concerns Related to Prescription Functioning 94 Drugs 124 ASSESSING HEALTH OF OLDER ADULTS 94 Insufficient Recognition of Adverse Medication NURSING ASSESSMENT TOOLS 95 Effects 125 ASSESSING FUNCTION OF OLDER ADULTS 95 MEDICATION INTERACTIONS 125 Using Functional Assessment Tools 95 Medication–Medication Interactions 125 Assessing Activities of Daily Living 99 Medications and Herbs 126 Assessing Instrumental Activities of Daily Medications and Nutrients 127 Living 101 Medications and Alcohol 128 Assessing Function in Cognitively Impaired Medications and Caffeine 128 Older Adults 101 Medications and Nicotine 128 Assessing the Use or Potential Use of Adaptive FUNCTIONAL CONSEQUENCES ASSOCIATED and Assistive Devices 105 WITH BIOACTIVE SUBSTANCES IN OLDER COMPREHENSIVE GERIATRIC ASSESSMENTS 106 ADULTS 129 Altered Therapeutic Effects 129 ASSESSING OLDER ADULTS IN RELATION TO THEIR Increased Potential for Adverse Effects 129 ENVIRONMENTS 106 Anticholinergic Adverse Effects 130 ASSESSING AND ADDRESSING DRIVING Altered Mental Status 130 SAFETY 108 Tardive Dyskinesia and Drug-Induced Identifying Risks and Consequences 108 Parkinsonism 131 Addressing Risk Factors 109 Antipsychotics in People With Dementia 131 Referring to Community Resources 109 NURSING ASSESSMENT OF MEDICATION Working With Caregivers 110 USE AND EFFECTS 131 Communication Techniques for Obtaining CHAPTER 8 Accurate Information 132 Medications and Other Bioactive Scope of a Medication Assessment 132 Substances 113 Observing Patterns of Medication Use 134 INTRODUCTION TO BIOACTIVE SUBSTANCES 113 Linking the Medication Assessment to the Considerations Regarding Medications 113 Overall Assessment 135 Considerations Regarding Herbs and Identifying Adverse Medication Effects 135 Homeopathy 115 NURSING DIAGNOSIS 136 LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page xviii xviii Contents PLANNING FOR WELLNESS OUTCOMES 136 ELDER ABUSE AND NEGLECT IN NURSING NURSING INTERVENTIONS TO PROMOTE HEALTHY HOMES 166 MEDICATIONTAKING PATTERNS 136 FUNCTIONAL CONSEQUENCES ASSOCIATED WITH Implementing Evidence-Based Interventions 136 ELDER ABUSE AND NEGLECT 167 Teaching About Medications 137 NURSING ASSESSMENT OF ABUSED OR Teaching About Herbs and Other Bioactive NEGLECTED OLDER ADULTS 168 Substances 138 Unique Aspects of Elder Abuse Assessment 168 Addressing Factors That Affect Adherence 139 Physical Health 169 Decreasing the Number of Medications 141 Activities of Daily Living 171 EVALUATING EFFECTIVENESS OF NURSING Psychosocial Function 171 INTERVENTIONS 142 Support Resources 172 Environmental Influences 172 CHAPTER 9 Threats to Life 173 Cultural Aspects 173 Legal and Ethical Concerns 149 NURSING DIAGNOSIS 174 AUTONOMY AND RIGHTS 149 PLANNING FOR WELLNESS OUTCOMES 175 Competency 150 Decision-Making Capacity 150 NURSING INTERVENTIONS TO ADDRESS ELDER ABUSE AND NEGLECT 175 ADVANCE DIRECTIVES 151 Interventions in Institutional Settings 175 Living Wills and Do Not Resuscitate (DNR) Orders 152 Interventions in Community Settings 176 Durable Power of Attorney for Health Care 152 Interventions in Multidisciplinary Teams 176 LEGAL ISSUES SPECIFIC TO LONGTERM CARE Referrals 177 SETTINGS 153 Prevention and Treatment Interventions 177 ETHICAL ISSUES COMMONLY ADDRESSED IN LEGAL INTERVENTIONS 178 GERONTOLOGICAL NURSING 153 Adult Protective Services 179 Ethical Issues in Everyday Care of Older Adults 153 Ethical Issues 181 Ethical Issues Specific to Long-Term EVALUATING EFFECTIVENESS OF NURSING Care Settings 154 INTERVENTIONS 182 Ethical Issues Related to Artificial Nutrition and Hydration 154 3 CULTURAL ASPECTS OF LEGAL AND ETHICAL ISSUES 155 P A R T ROLE OF NURSES REGARDING LEGAL AND ETHICAL ISSUES 156 Promoting Wellness in Psychosocial Implementing Advance Directives 156 Facilitating Decisions About Care 158 Function 187 CHAPTER 10 CHAPTER 11 Elder Abuse and Neglect 162 Cognitive Function 187 OVERVIEW OF ELDER ABUSE AND NEGLECT 162 AGERELATED CHANGES THAT Characteristics of Elder Abuse 162 AFFECT COGNITION 187 Historical Recognition of a Social Problem 163 Central Nervous System 188 Prevalence and Causes 163 Fluid and Crystallized Intelligence 189 Cultural Considerations 164 Memory 189 RISK FACTORS FOR ELDER ABUSE AND Adult Psychological Development 190 NEGLECT 165 RISK FACTORS THAT AFFECT Invisibility and Vulnerability 165 COGNITIVE WELLNESS 191 Psychosocial Factors 165 Personal, Social, and Attitudinal Influences 191 Caregiver Factors 165 Physical and Mental Health Factors 192 LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page xix Contents xix Medication Effects 192 NURSING INTERVENTIONS TO PROMOTE HEALTHY Smoking and Environmental Factors 192 PSYCHOSOCIAL FUNCTION 213 FUNCTIONAL CONSEQUENCES AFFECTING Enhancing Self-Esteem 214 COGNITIVE FUNCTION 193 Promoting a Sense of Control 215 Involving Older Adults in Decision Making 215 NURSING ASSESSMENT OF COGNITIVE Addressing Role Loss 216 FUNCTION 193 Encouraging Life Review and Reminiscence 216 NURSING DIAGNOSIS 194 Fostering Social Supports 217 PLANNING FOR WELLNESS OUTCOMES 194 Addressing Spiritual Needs 217 NURSING INTERVENTIONS TO PROMOTE Promoting Wellness Through Healthy COGNITIVE WELLNESS 194 Aging Classes 218 Teaching About Memory and Cognition 195 EVALUATING THE EFFECTIVENESS OF NURSING Improving Concentration and Attention 195 INTERVENTIONS 221 Encouraging Participation in Mentally Stimulating Activities 195 Adapting Health Education Materials 197 CHAPTER 13 EVALUATING EFFECTIVENESS OF Psychosocial Assessment 226 NURSING INTERVENTIONS 198 OVERVIEW OF PSYCHOSOCIAL ASSESSMENT OF OLDER ADULTS 226 Purposes of the Psychosocial Assessment CHAPTER 12 Process 227 Psychosocial Function 202 Procedure for the Psychosocial Assessment 227 Scope of the Psychosocial Assessment 228 LIFE EVENTS: AGERELATED CHANGES AFFECTING PSYCHOSOCIAL FUNCTION 202 COMMUNICATION SKILLS FOR Retirement 203 PSYCHOSOCIAL ASSESSMENT 229 Relocation 204 Identifying Communication Barriers 229 Chronic Illness and Functional Impairments 204 Enhancing Communication With Older Adults 230 Decisions About Driving a Vehicle 204 Creating an Environment That Supports Good Widowhood 205 Communication 231 Death of Friends and Family 205 MENTAL STATUS ASSESSMENT 233 Ageist Attitudes 205 Physical Appearance 234 THEORIES ABOUT PSYCHOSOCIAL FUNCTION IN Motor Function and Psychomotor Behaviors 234 OLDER ADULTS 206 Social Skills 235 Theories About Emotional Development During Response to the Interview 235 Later Adulthood 206 Orientation 235 Theories About Stress 206 Alertness and Attention 236 Theories About Coping 207 Memory 236 Speech and Language Characteristics 237 FACTORS THAT INFLUENCE PSYCHOSOCIAL Higher Language Skills 238 FUNCTION IN OLDER ADULTS 208 Religion and Spirituality 208 DECISIONMAKING AND EXECUTIVE FUNCTION 238 Cultural Considerations 209 AFFECTIVE FUNCTION 240 RISK FACTORS THAT AFFECT PSYCHOSOCIAL Guidelines for Assessing Affective Function 240 FUNCTION 211 Mood 241 Anxiety 241 FUNCTIONAL CONSEQUENCES ASSOCIATED WITH Self-Esteem 242 PSYCHOSOCIAL FUNCTION IN OLDER ADULTS 212 Depression 243 NURSING ASSESSMENT OF PSYCHOSOCIAL Happiness and Well-Being 243 FUNCTION 212 CONTACT WITH REALITY 244 NURSING DIAGNOSIS 212 Delusions 244 PLANNING FOR WELLNESS OUTCOMES 213 Hallucinations and Illusions 247 LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page xx xx Contents Special Considerations for Assessing Contact With General Principles of Nursing Interventions in Reality in Older Adults 249 Different Settings 273 SOCIAL SUPPORTS 249 Improving Safety and Function Through Social Network 250 Environmental Modifications 275 Barriers to Obtaining Social Supports 251 Communicating With Older Adults With Economic Resources 251 Dementia 276 Teaching About Pharmacologic Interventions 276 RELIGION AND SPIRITUALITY 251 EVALUATING THE EFFECTIVENESS OF NURSING INTERVENTIONS 279 CHAPTER 14 Impaired Cognitive Function: Delirium CHAPTER 15 and Dementia 255 Impaired Affective Function: DELIRIUM 255 Depression 287 Overview and Types 255 THEORIES ABOUT LATELIFE DEPRESSION 287 Prevalence, Risk Factors, and Functional Psychosocial Theories 287 Consequences of Delirium 256 Cognitive Triad Theory 289 Nursing Assessment of Delirium 256 Biologic and Genetic Theories 289 Nursing Diagnosis and Outcomes 257 Theories About Depression and Dementia 289 Nursing Interventions for Delirium 257 CLASSIFICATION OF DEPRESSION 290 OVERVIEW OF DEMENTIA 259 RISK FACTORS FOR DEPRESSION IN OLDER Terminology to Describe Dementia 259 ADULTS 290 Theories to Explain Dementia 259 Demographic Factors and Psychosocial Influences 290 Diagnosing Dementia 260 Medical Conditions and Functional TYPES OF DEMENTIA 260 Impairments 291 Alzheimer’s Disease 261 Effects of Medications and Alcohol 292 Vascular Dementia 263 FUNCTIONAL CONSEQUENCES ASSOCIATED Lewy Body Dementia 264 WITH DEPRESSION IN OLDER ADULTS 292 Frontotemporal Dementia 264 Physical Health and Functioning 292 FACTORS ASSOCIATED WITH DEMENTIA 264 Psychosocial Function and Quality of Life 293 FUNCTIONAL CONSEQUENCES ASSOCIATED NURSING ASSESSMENT OF DEPRESSION WITH DEMENTIA IN OLDER ADULTS 265 IN OLDER ADULTS 294 Stages of Dementia 265 Identifying the Unique Manifestations of Self-awareness of People With Dementia 266 Depression 294 Personal Experiences of Dementia 266 Using Screening Tools 295 Behavioral and Psychological Symptoms of NURSING DIAGNOSIS 296 Dementia 268 PLANNING FOR WELLNESS OUTCOMES 296 NURSING ASSESSMENT OF DEMENTIA IN OLDER ADULTS 269 NURSING INTERVENTIONS TO Factors That Interfere With the Assessment of ADDRESS DEPRESSION 296 Dementia 269 Alleviating Risk Factors 297 Initial Assessment 269 Improving Psychosocial Function 297 Ongoing Assessment of Consequences 269 Promoting Health Through Physical Activity and Nutrition 297 NURSING DIAGNOSIS 270 Providing Education and Counseling 298 PLANNING FOR WELLNESS OUTCOMES 271 Facilitating Referrals for Psychosocial Therapies 299 NURSING INTERVENTIONS TO ADDRESS Teaching About and Managing Antidepressant DEMENTIA 271 Medications 299 Promoting Wellness for People With Dementia 273 Teaching About Electroconvulsive Therapy 301 Theoretical Frameworks for Nursing Teaching About Complementary and Interventions 273 Alternative Interventions 302 LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page xxi Contents xxi EVALUATING THE EFFECTIVENESS OF NURSING Communicating With Hearing-Impaired INTERVENTIONS 302 Older Adults 328 SUICIDE 302 EVALUATING EFFECTIVENESS OF NURSING Assessing the Risks for Suicide 303 INTERVENTIONS 329 Nursing Diagnosis and Outcomes 305 Nursing Interventions for Preventing Suicide 305 CHAPTER 17 Evaluating the Effectiveness of Nursing Vision 333 Interventions 305 AGERELATED CHANGES THAT AFFECT VISION 333 Eye Appearance and Tear Ducts 333 P A R T 4 The Eye 335 The Retinal–Neural Pathway 336 EFFECTS OF AGERELATED CHANGES ON VISION 336 Promoting Wellness in Physical Loss of Accommodation 337 Function 311 Diminished Acuity 337 Delayed Dark and Light Adaptation 337 Increased Glare Sensitivity 337 CHAPTER 16 Reduced Visual Field 337 Hearing 311 Diminished Depth Perception 337 AGERELATED CHANGES THAT AFFECT Altered Color Vision 338 HEARING 311 Diminished Critical Flicker Fusion 338 External Ear 311 Slower Visual Information Processing 338 Middle Ear 312 RISK FACTORS THAT AFFECT VISUAL Inner Ear 313 WELLNESS 338 Auditory Nervous System 314 FUNCTIONAL CONSEQUENCES AFFECTING VISUAL RISK FACTORS THAT AFFECT HEARING WELLNESS 339 WELLNESS 314 Effects on Safety and Function 339 Lifestyle and Environmental Factors 314 Effects on Quality of Life 340 Impacted Cerumen 315 Effects on Driving 340 Medication Effects 315 PATHOLOGIC CONDITIONS AFFECTING VISION 341 Disease Processes 316 Cataracts 341 FUNCTIONAL CONSEQUENCES AFFECTING Age-Related Macular Degeneration 343 HEARING WELLNESS 316 Glaucoma 343 Effects on Communication 316 NURSING ASSESSMENT OF VISION 345 Effects of Hearing Loss on Overall Wellness 317 Interviewing About Vision Changes 345 PATHOLOGIC CONDITION AFFECTING Identifying Opportunities for Health Promotion 345 HEARING: TINNITUS 318 Observing Cues to Visual Function 346 NURSING ASSESSMENT OF HEARING 318 Using Standard Vision Tests 347 Interviewing About Hearing Changes 318 NURSING DIAGNOSIS 348 Observing Behavioral Cues 320 PLANNING FOR WELLNESS OUTCOMES 348 Using Hearing Assessment Tools 320 NURSING INTERVENTIONS FOR VISUAL NURSING DIAGNOSIS 321 WELLNESS 348 PLANNING FOR WELLNESS OUTCOMES 322 Health Promotion for Visual Wellness 348 NURSING INTERVENTIONS FOR HEARING Comfort Measures for Dry Eyes 350 WELLNESS 322 Environmental Modifications 350 Promoting Hearing Wellness for All Older Low-Vision Aids 350 Adults 322 Maintaining and Improving the Quality of Life 351 Preventing and Alleviating Impacted Cerumen 323 EVALUATING EFFECTIVENESS OF NURSING Compensating for Hearing Deficits 323 INTERVENTIONS 353 LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page xxii xxii Contents CHAPTER 18 Promoting Optimal Nutrition and Digestion and Nutrition 358 Preventing Disease 376 EVALUATING EFFECTIVENESS OF NURSING AGERELATED CHANGES THAT AFFECT INTERVENTIONS 377 DIGESTION AND EATING PATTERNS 358 Smell and Taste 358 Oral Cavity 359 CHAPTER 19 Esophagus and Stomach 360 Urinary Function 383 Intestinal Tract 360 AGERELATED CHANGES THAT AFFECT Liver, Pancreas, and Gallbladder 360 URINARY WELLNESS 383 AGERELATED CHANGES IN NUTRITIONAL Changes in the Kidneys 383 REQUIREMENTS 360 Changes in the Bladder and Urinary Tract 385 Calories 361 Changes in Control Mechanisms 385 Protein 361 Changes Affecting Control Over Socially Carbohydrates and Fiber 361 Appropriate Urinary Elimination 386 Fats 361 RISK FACTORS THAT AFFECT URINARY Water 361 WELLNESS 386 RISK FACTORS THAT AFFECT DIGESTION Behaviors Based on Myths and AND NUTRITION 362 Misunderstandings 386 Conditions Related to Oral Care 363 Functional Impairments 387 Functional Impairments and Disease Processes 363 Pathologic Conditions 387 Medication Effects 364 Medication Effects 388 Lifestyle Factors 364 Environmental Factors 388 Psychosocial Factors 365 FUNCTIONAL CONSEQUENCES AFFECTING Cultural and Socioeconomic Factors 365 URINARY WELLNESS 389 Environmental Factors 366 Effects on Homeostasis 389 Behaviors Based on Myths and Effects on Voiding Patterns 389 Misunderstandings 367 PATHOLOGIC CONDITION AFFECTING URINARY FUNCTIONAL CONSEQUENCES AFFECTING FUNCTION: URINARY INCONTINENCE 390 DIGESTION AND NUTRITION 367 NURSING ASSESSMENT OF URINARY FUNCTION 391 Ability to Procure, Prepare, and Enjoy Food 367 Talking With Older Adults About Urinary Changes in Oral Function 367 Function 391 Nutritional Status and Weight Changes 368 Identifying Opportunities for Health Promotion 392 Quality of Life 368 Using Laboratory Information 393 PATHOLOGIC CONDITIONS AFFECTING NURSING DIAGNOSIS 395 DIGESTIVE WELLNESS: CONSTIPATION 369 PLANNING FOR WELLNESS OUTCOMES 395 NURSING ASSESSMENT OF DIGESTION AND NUTRITION 369 NURSING INTERVENTIONS TO PROMOTE Interviewing About Digestion and Nutrition 369 HEALTHY URINARY FUNCTION 395 Observing Cues to Digestion and Nutrition 370 Teaching About Urinary Wellness 395 Using Physical Assessment and Laboratory Promoting Continence and Alleviating Information 370 Incontinence 396 Using Assessment Tools 371 Managing Incontinence 401 NURSING DIAGNOSIS 372 EVALUATING EFFECTIVENESS OF NURSING INTERVENTIONS 402 PLANNING FOR WELLNESS OUTCOMES 374 NURSING INTERVENTIONS TO PROMOTE CHAPTER 20 HEALTHY DIGESTION AND NUTRITION 374 Addressing Risk Factors That Interfere With Cardiovascular Function 408 Digestion and Nutrition 374 AGERELATED CHANGES THAT AFFECT Promoting Oral and Dental Health 375 CARDIOVASCULAR FUNCTION 408 LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page xxiii Contents xxiii Myocardium and Neuroconduction CHAPTER 21 Mechanisms 409 Respiratory Function 435 Vasculature 410 Baroreflex Mechanisms 410 AGERELATED CHANGES THAT AFFECT RESPIRATORY FUNCTION 435 RISK FACTORS THAT AFFECT Upper Respiratory Structures 435 CARDIOVASCULAR FUNCTION 410 Chest Wall and Musculoskeletal Structures 436 Atherosclerosis 411 Lung Structure and Function 437 Physical Inactivity 411 Tobacco Smoking 412 RISK FACTORS THAT AFFECT RESPIRATORY Dietary Habits 412 WELLNESS 438 Obesity 412 Tobacco Use 438 Hypertension 412 Secondhand Smoke and Other Environmental Lipid Disorders 413 Factors 439 Metabolic Syndrome 414 Additional Risk Factors for Compromised Psychosocial Factors 414 Respiratory Function 439 Heredity and Socioeconomic Factors 415 FUNCTIONAL CONSEQUENCES AFFECTING Risk for Cardiovascular Disease in Women RESPIRATORY WELLNESS 440 and Minority Groups 415 PATHOLOGIC CONDITION AFFECTING FUNCTIONAL CONSEQUENCES AFFECTING RESPIRATORY FUNCTION: COPD 441 CARDIOVASCULAR WELLNESS 416 NURSING ASSESSMENT OF RESPIRATORY Effects on Cardiac Function 416 FUNCTION 441 Effects on Pulse and Blood Pressure 416 Identifying Opportunities for Health Effects on the Response to Exercise 416 Promotion 441 Effects on Circulation 416 Detecting Lower Respiratory Infections 442 PATHOLOGIC CONDITIONS AFFECTING Assessing Smoking Behaviors 443 CARDIOVASCULAR WELLNESS: ORTHOSTATIC Identifying Other Risk Factors 444 AND POSTPRANDIAL HYPOTENSION 417 Physical Assessment Findings 444 NURSING ASSESSMENT OF CARDIOVASCULAR NURSING DIAGNOSIS 445 FUNCTION 417 PLANNING FOR WELLNESS OUTCOMES 445 Assessing Baseline Cardiovascular Function 418 NURSING INTERVENTIONS FOR RESPIRATORY Assessing Blood Pressure 418 WELLNESS 445 Identifying Risks for Cardiovascular Disease 418 Promoting Respiratory Wellness 445 Assessing Signs and Symptoms of Heart Disease 419 Preventing Lower Respiratory Infections 446 Assessing Knowledge About Heart Disease 422 Eliminating the Risk From Smoking 447 NURSING DIAGNOSIS 422 EVALUATING EFFECTIVENESS OF NURSING PLANNING FOR WELLNESS OUTCOMES 423 INTERVENTIONS 448 NURSING INTERVENTIONS TO PROMOTE HEALTHY CARDIOVASCULAR FUNCTION 423 CHAPTER 22 Addressing Risks Through Nutrition and Lifestyle Mobility and Safety 452 Interventions 423 Secondary Prevention 424 AGERELATED CHANGES THAT AFFECT Addressing Risks Through Pharmacologic MOBILITY AND SAFETY 452 Interventions 425 Bones 452 Preventing and Managing Hypertension 425 Muscles 453 Preventing and Managing Lipid Disorders 428 Joints and Connective Tissue 454 Preventing and Managing Orthostatic or Nervous System 454 Postprandial Hypotension 429 Osteopenia and Osteoporosis 454 EVALUATING EFFECTIVENESS OF NURSING RISK FACTORS THAT AFFECT MOBILITY INTERVENTIONS 429 AND SAFETY 454 LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page xxiv xxiv Contents Risk Factors That Affect Overall Musculoskeletal PATHOLOGIC CONDITIONS AFFECTING SKIN: SKIN Function 455 CANCER AND PRESSURE ULCERS 482 Risk Factors for Osteoporosis and Osteoporotic Skin Cancer 482 Fractures 455 Pressure Ulcers 483 Risk Factors for Falls 456 NURSING ASSESSMENT OF SKIN 487 PATHOLOGIC CONDITION AFFECTING Identifying Opportunities for Health Promotion 487 MUSCULOSKELETAL FUNCTION: Observing Skin, Hair, and Nails 487 OSTEOARTHRITIS 458 NURSING DIAGNOSIS 490 FUNCTIONAL CONSEQUENCES AFFECTING PLANNING FOR WELLNESS OUTCOMES 490 MUSCULOSKELETAL WELLNESS 459 NURSING INTERVENTIONS FOR SKIN Effects on Musculoskeletal Function 459 WELLNESS 491 Susceptibility to Falls and Fractures 459 Promoting Healthy Skin 491 Fear of Falling 460 Preventing Skin Wrinkles 491 NURSING ASSESSMENT OF MUSCULOSKELETAL Preventing Dry Skin 492 FUNCTION 460 Detecting and Treating Harmful Skin Lesions 492 Assessing Musculoskeletal Performance 460 EVALUATING EFFECTIVENESS OF NURSING Identifying Risks for Osteoporosis 461 INTERVENTIONS 492 Identifying Risks for Falls and Injury 462 NURSING DIAGNOSIS 464 CHAPTER 24 PLANNING FOR WELLNESS OUTCOMES 464 Sleep and Rest 496 NURSING INTERVENTIONS FOR MUSCULOSKELETAL WELLNESS 464 AGERELATED CHANGES THAT AFFECT Promoting Healthy Musculoskeletal Function and SLEEP AND REST PATTERNS 496 Preventing Falls 464 Sleep Quantity 497 Health Education About Osteoporosis 465 Sleep Quality 498 Preventing Falls and Fall-Related Injuries 467 Circadian Rhythm 498 EVALUATING EFFECTIVENESS OF NURSING RISK FACTORS THAT CAN AFFECT SLEEP 499 INTERVENTIONS 471 Psychosocial Factors 499 Environmental Factors 499 CHAPTER 23 Pathophysiologic Factors 500 Effects of Bioactive Substances 500 Integument 477 FUNCTIONAL CONSEQUENCES AFFECTING AGERELATED CHANGES THAT AFFECT SLEEP WELLNESS 501 THE SKIN 477 PATHOLOGIC CONDITION AFFECTING SLEEP: Epidermis 477 OBSTRUCTIVE SLEEP APNEA 502 Dermis 479 Subcutaneous Tissue and Cutaneous Nerves 479 NURSING ASSESSMENT OF SLEEP 503 Sweat and Sebaceous Glands 479 Identifying Opportunities for Health Promotion 503 Nails 479 Evidence-Based Assessment Tools 503 Hair 479 NURSING DIAGNOSIS 504 RISK FACTORS THAT AFFECT SKIN WELLNESS 480 PLANNING FOR WELLNESS OUTCOMES 504 Genetic Influences 480 NURSING INTERVENTIONS FOR SLEEP Lifestyle and Environmental Influences 480 WELLNESS 504 Medication Effects 480 Evidence-Based Interventions 504 FUNCTIONAL CONSEQUENCES AFFECTING Self-Care Actions to Promote Healthy SKIN WELLNESS 481 Sleep Patterns 505 Susceptibility to Injury 481 Complementary and Alternative Care Response to Ultraviolet Radiation 481 Practices 505 Comfort and Sensation 481 Improving Sleep for Older Adults in Cosmetic Effects 481 Institutional Settings 506 LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page xxv Contents xxv Modifying the Environment to Promote Sleep 507 CHAPTER 26 Educating Older Adults About Medications Sexual Function 525 and Sleep 507 Teaching About Management of Sleep AGERELATED CHANGES THAT AFFECT Disorders 507 SEXUAL FUNCTION 525 EVALUATING EFFECTIVENESS OF Changes Affecting Older Women 525 NURSING INTERVENTIONS 509 Changes Affecting Older Men 527 RISK FACTORS THAT AFFECT SEXUAL CHAPTER 25 FUNCTION 527 Societal Influences 527 Thermoregulation 513 Attitudes and Behaviors of Families and AGERELATED CHANGES THAT AFFECT Caregivers 528 THERMOREGULATION 513 Limited Opportunities for Sexual Activity 528 Response to Cold Temperatures 513 Adverse Effects of Medication, Alcohol, Response to Hot Temperatures 515 and Nicotine 529 Normal Body Temperature and Febrile Chronic Conditions 529 Response to Illness 515 Gender-Specific Conditions 530 RISK FACTORS THAT AFFECT Functional Impairments and Dementia 530 THERMOREGULATION 515 FUNCTIONAL CONSEQUENCES AFFECTING Pathophysiologic Conditions That Alter SEXUAL WELLNESS 530 Thermoregulation 515 Reproductive Ability 531 Environmental and Socioeconomic Influences 515 Response to Sexual Stimulation 531 Behaviors Based on Lack of Knowledge 516 Sexual Interest and Activity 531 FUNCTIONAL CONSEQUENCES ASSOCIATED WITH Male Sexual Dysfunction 532 THERMOREGULATION IN OLDER ADULTS 516 Female Sexual Dysfunction 532 Altered Response to Cold Environments 517 PATHOLOGIC CONDITION AFFECTING Altered Response to Hot Environments 517 SEXUAL WELLNESS: HUMAN Altered Thermoregulatory Response to Illness 517 IMMUNODEFICIENCY VIRUS 533 Altered Perception of Environmental Risk Factors for HIV 533 Temperatures 517 Role of Nurses in Assessment and Psychosocial Consequences of Altered Interventions 534 Thermoregulation 517 NURSING ASSESSMENT OF SEXUAL NURSING ASSESSMENT OF FUNCTION 534 THERMOREGULATION 518 Self-Assessment of Attitudes About Assessing Baseline Temperature 518 Sexual Function and Aging 534 Identifying Risk Factors for Altered Assessing Sexual Function in Older Adults 535 Thermoregulation 518 NURSING DIAGNOSIS 537 Assessing for Hypothermia 519 PLANNING FOR WELLNESS OUTCOMES 537 Assessing for Hyperthermia 519 Assessing the Older Adult’s Febrile NURSING INTERVENTIONS TO PROMOTE Response to Illness 520 HEALTHY SEXUAL FUNCTION 537 Teaching Older Adults About NURSING DIAGNOSIS 520 Sexual Wellness 537 PLANNING FOR WELLNESS OUTCOMES 520 Addressing Risk Factors 537 NURSING INTERVENTIONS TO PROMOTE HEALTHY Promoting Sexual Wellness in Long-Term Care THERMOREGULATION 520 Settings 539 Addressing Risk Factors 520 Teaching Women About Interventions 539 Promoting Healthy Thermoregulation 521 Teaching Men About Interventions 540 EVALUATING EFFECTIVENESS OF EVALUATING EFFECTIVENESS OF NURSING NURSING INTERVENTIONS 521 INTERVENTIONS 541 LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page xxvi xxvi Contents 5 CULTURAL ASPECTS OF PAIN ASSESSMENT P A R T AND MANAGEMENT 563 NURSING ASSESSMENT OF PAIN IN OLDER ADULTS 565 Promoting Wellness in All Stages Collecting Pertinent Information 565 of Health and Illness 547 Assessment of Pain Components 566 Assessment in Cognitively Impaired Older CHAPTER 27 Adults 568 Caring for Older Adults During PRINCIPLES OF ANALGESIC MEDICATION 568 Illness 547 Classifications of Analgesics 569 The World Health Organization’s Three-Step CHARACTERISTICS OF ILLNESS IN OLDER Pain Relief Ladder for Pain Management 570 ADULTS 547 Management of Side Effects and Risks of CONNECTING THE CONCEPTS OF Tolerance, Dependence, and Addiction 571 WELLNESS, AGING, AND ILLNESS 548 Developing a Wellness-Focused Pain HOLISTICALLY CARING FOR OLDER Management Plan 571 ADULTS WHO ARE ILL: FOCUSING ON CARING AND COMFORTING 549 CHAPTER 29 APPLYING WELLNESS CONCEPTS IN SPECIFIC PATHOLOGIC OR CHRONIC CONDITIONS 550 Caring for Older Adults at the Promoting Wellness for Older Adults End of Life 575 With Cancer 550 THE DYING PROCESS AND DEATH 575 Promoting Wellness for Older Adults NURSING SKILLS FOR PALLIATIVE CARE 576 With Diabetes Mellitus 552 PERSPECTIVES ON DEATH AND DYING 576 Promoting Wellness for Older Adults Sites of Death and Dying 576 With Heart Failure 553 Views of Death and Dying in Western Culture 576 ADDRESSING NEEDS OF FAMILIES AND Older Adults’ Perspective on Death and CAREGIVERS 555 Dying 577 Health Care Professionals’ Perspective on Death and Dying 577 CHAPTER 28 Culturally Diverse Perspectives on Death and Caring for Older Adults Dying 578 Experiencing Pain 560 QUALITY OF CARE AT THE END OF LIFE 578 ACUTE VERSUS PERSISTENT PAIN 560 Promoting Wellness at the End of Life 579 ANATOMY AND PHYSIOLOGY OF PAIN 561 Hospice Care 580 TYPES OF PAIN 562 NURSING INTERVENTIONS IN ENDOFLIFE CARE 581 CAUSES OF PAIN IN OLDER ADULTS 562 Promoting Communication 581 AGERELATED CHANGES THAT AFFECT PAIN 563 Offering Spiritual Support 581 BARRIERS TO PAIN MANAGEMENT 563 Managing Symptoms 582 FUNCTIONAL CONSEQUENCES OF PAIN IN OLDER ADULTS 563 INDEX 589 LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page xxvii Assessment, Intervention & Evidence-Based Practice Boxes ASSESSMENT BOXES Digestion and Nutrition Safety and Functioning Box 18-2 Guidelines for Assessing Digestion and Nutrition, 370 Box 7-1 Criteria for Assessing Activities of Daily Living Box 18-3 Behavioral Cues to Nutrition and Digestion, 371 (ADLs), 100 Box 18-4 Physical Assessment and Laboratory Data, 372 Box 7-2 Criteria for Assessing Instrumental Activities of Daily Living (IADLs), 101 Box 7-3 Guidelines for Assessing the Safety of the Urinary Function Environment, 107 Box 19-2 Guidelines for Assessing Urinary Elimination, 392 Medications Box 19-3 Guidelines for Assessing Behavioral Cues to and Box 8-4 Guidelines for Medication Assessment, 133 Environmental Influences on Incontinence, 393 Psychosocial Assessment Cardiovascular Function Box 13-1 Self-Assessment of Attitudes About Psychosocial Box 20-2 Guidelines for Assessing Blood Pressure, 419 Aspects of Aging, 228 Box 20-3 Guidelines for Assessing Risks for Cardiovascular Box 13-3 Guidelines for Assessing Physical Appearance, Disease in Older Adults, 422 Motor Function, Social Skills, and Response Box 20-4 Guidelines for Assessing Cardiovascular Function to the Interview, 236 in Older Adults, 422 Box 13-4 Guidelines for Assessing Orientation, Alertness, and Memory, 237 Respiratory Function Box 13-5 Guidelines for Assessing Speech Characteristics, and Calculation and Higher Language Skills, 238 Box 21-2 Guidelines for Assessing Respiratory Box 13-6 Guidelines for Assessing Affective Function, 244 Function, 443 Box 13-7 Guidelines for Assessing Contact With Reality, 249 Box 21-3 Guidelines for Nursing Assessment of Older Box 13-8 Guidelines for Assessing Social Supports, 250 Adults Who Smoke, 444 Box 13-9 Guidelines for Assessing Spiritual Needs, 253 Mobility and Safety Impaired Cognitive Function Box 22-3 Guidelines for Assessing Overall Box 14-3 Assessing Progressive Cognitive Impairment in Musculoskeletal Function and Risks for Older Adults, 270 Falls and Osteoporosis, 461 Impaired Affective Function Integument Box 15-6 Guidelines for Assessing Suicide Risk, 304 Box 23-1 Interview Questions for Assessing the Hearing Integument, 488 Box 23-2 Observations Regarding the Integument, 490 Box 16-2 Guidelines for Assessing Hearing, 319 Box 16-3 Guidelines for Assessing Behavioral Cues Related to Hearing, 321 Sleep and Rest Box 16-4 Guidelines for Otoscopic and Tuning Fork Box 24-1 Guidelines for Assessing Sleep and Rest, 503 Assessment, 321 Thermoregulation Vision Box 25-2 Guidelines for Assessing Thermoregulation, 519 Box 17-1 Guidelines for Assessing Vision, 346 Box 17-2 Guidelines for Assessing Behavioral and Sexual Function Environmental Cues Related to Visual Performance, 347 Box 26-3 Assessing Personal Attitudes Toward Sexuality Box 17-3 Guidelines for Using Vision Screening Tests, 347 and Aging, 535 xxvii LWBK783-FM-i-xxx:Miller 10/11/10 3:56 PM Page xxviii xxviii Assessment, Intervention & Evidence-Based Practice Boxes Box 26-4 Guidelines for Assessing Sexual Function in Box 15-5 Interventions Commonly Used for Preventing or Older Adults, 536 Alleviating Depression, 302 Box 15-7 Nursing Interventions for People Who Are Illness Potentially Suicidal, 305 Box 27-2 Assessment Guidelines for Older Adults With Hearing Diabetes, 553 Box 27-3 Assessment Guidelines for Older Adults With Box 16-5 Health Promotion Teaching About Hearing, 322 Heart Failure, 554 Box 16-6 Use and Care of Hearing Aids, 327 Box 16-7 Techniques for Communicating With Hearing- Pain Impaired People, 328 Box 28-3 Sample Questions for Pain Assessment in Older Vision Adults, 566 Box 17-4 Health Promotion Teaching About Visual Wellness, 349 INTERVENTIONS BOXES Box 17-5 Eye Care Practitioners, 349 Health Promotion Box 17-6 Considerations for Optimal Illumination, 350 Box 17-7 Environmental Adaptations for Improving Visual Box 5-3 Guidelines for Prevention and Health Promotion Performance, 351 Interventions for Older Adults, 67 Box 17-8 Low-Vision Aids for Improving Visual Box 5-4 Health Education About Types of Exercise, 69 Performance, 352 Medications Box 17-9 Guidelines for Using Magnifying Aids, 353 Box 8-5 Tips on Safe and Effective Medication Use, 138 Digestion and Nutrition Box 8-6 Tips on the Use of Herbs and Homeopathic Box 18-5 Health Education Regarding Constipation, 375 Remedies, 139 Box 18-6 Health Education Regarding Oral and Dental Legal and Ethical Concerns Care, 376 Box 18-7 Guidelines for Daily Food Intake for Older Box 9-3 Model for Facilitating Decisions About the Care of Adults, 377