GERIA-MIDTERMS-REVIEWER 2.pdf

NCM114J PREPARED BY: LEILA JOY ABDULHALIK GERIATRICS (CARE OF THE OLDER ADULTS) ELDERLY means old aging. 6. The older person’s negative attitude towards aging become self-fulfilling AG...

NCM114J PREPARED BY: LEILA JOY ABDULHALIK GERIATRICS (CARE OF THE OLDER ADULTS) ELDERLY means old aging. 6. The older person’s negative attitude towards aging become self-fulfilling AGING is part of life changes that occurs as one 7. Many studies show older people who are grows older or maturation process; inevitable and physically active have less joint pain, lower BP, les steadily progressive process that beings at the depression, fewer heart attacks and lower moment of conception and continuous throughout incidence of CA. the remainder of life. 8. Proper nutrition also has the same affect in the GERIATRIC come from the Greek meaning GERON aging process; it delays the progression of means “old man” and IATROS meaning “healer or debilitating illness or disability. medicine = related to caring for old people. 9. Recent research even suggests that weight loss GERONTOLOGY studies of all aspects the aging and exercise can reverse the severity of diabetes. process and its consequences in man, the scientific holistic study of aging process and problems of LACK OF SOCIAL STIMULATION aging. = POOR MENTAL HEALTH GERONTOLOGY NURSING is the branch of nursing/ 1. Having interest in something not only stimulates specialty of nursing pertaining to older adults an older person’s mind but also creates a better mental attitude which results often in better health. GERONTOPHOBIA is the fear of aging; of getting old; of the elderly 2. There is empirical evidence that using one’s brain may prevent dementia in older age. AGEISM means stereotyping and descripting MYTHS FACTS against an individual or groups on the basis of their IMPAIRED - Most people - Although short term- age; this maybe systematic or casual; coined in MEMORY age 65 and memory declines, 1969 by ROBERT NIEL BUTLER to describe older believed long term memory discrimination against seniors and patterned on that they have remains fairly intact. racism and sexism. Butler defined ageism as three moderate and connected elements; prejudicial attitude towards severe memory - A majority are not impairment. disabled. older people and the aging process; discriminatory practices against older people; and institutional - Moderate policies and practices that perpetuates stereotype severe about elderly people. Negative discriminatory disability. practices among people of old age or Age- LEARNING - You can’t - Older people can Related Bias NEW TRICKS teach and learn if given a bit oldie new tricks. more time. They are OLDER ADULTS more detail ad careful. YOUNG OLD 65 – 74 SEXUALITY - Older people - Although sexual gave no capacity declines MIDDLE OLD 75 – 84 interest or with age, it does not capacity for disappear. Intimacy sex. remains important OLD OLDER 85 AND OLDER throughout our life. PHYSICAL - Too old to - Physical activity at ACTIVITY take part in any age can PRESENTLY: 12.8% of population exercise or strengthen your 2030: will increase to 20% of population weight lifting heart, lungs, and program and it muscles; can also could actually lower your BP and ATTITUDES TOWARD AGING hurt them. helps slow bone loss. ON - Too late to - Never too late to SMOKING stop smoking. quit smoking. 1. Many elderlies buy into notion that they themselves re no longer useful and are a burden to SLEEP - The older the - Still good asleep person gets the hygiene. others. less sleeping 2. The aging makes little attempt to keep them they need. healthy and active after all, they are getting closer DRIVING - Older drivers - Older drivers have to the end of their lives. have most of fewer accidents per 3. They have no desire to try new things or to the driving miles driven and to accidents. avoid speeding and change themselves or to eat or exercise properly. driving at night. 4. There is a great deal of research that However, people demonstrated aging individuals can learn, retain over 70 are more memory and actively involved in business and their likely to die from community. crash injuries and 5. A lack of physical exercise, social involvement, should have their vision and hearing and mental stimulation in older adults often leads to checked regularly. deterioration of minds and their bodies. AIDS - Older people - Older people need don’t need to to take the same worry about precaution as getting AIDS. younger people do.  AIDS can happen to assume responsibility for elder parents. somebody more than Unfortunately, this traditional attitude of respect 50 years old. often clashes now with dominant American PERSONALITY - Tend to - Personality is one of become the consonants of values, this culture clash results to 75% living with low, grumpy life; as people age, their children dropped to 66% lately. (bad tempered they likely to behave And miserable) much as they did as WHERE ARE WE GOING and set in their they were becoming ways. adults. Age related For the general population, the implication for the changes don’t affect aging population will require competent individuals the ability to enjoy train to respect and work with such diverse group. life. Factors include: - Personality seems to 1. Income be changing 2. Health care significantly might be 3. Poverty due to sensory 4. Religious and spiritual beliefs changes, depression and reactions to RESPECTING CULTURAL DIVERSITY medications or might  LISTEN to concerns be diet, lack of exercise, lack of  SHARE knowledge and build MUTUAL sleep or boring about UNDERSTANDING getting old or boring  SEEK collaborative solution about money.  RESPECT cultural diversity PHYSICAL - Exercise is  Identify and build upon STRENGHTS ACTIVITY imperative; exercise  Set children up for SUCCESS in learning can reverse the severity of diabetes.  SHARE and CELEBRATE successes FALLS - Common in seniors; PREPARING FOR OLD AGE: PREPARING fear of falling may lead to falls. FOR THE GOLDEN YEARS ISOLATION - Isolation may lead Four essential preparations for our rusty years: To depression. 1. Planning for the stages of Decline CULTURAL FACTORS/ETHNICITY RESPECT & 2. Initiating Family Planning Conversation HEALTH PERCEPTION FOR OLDER PERSON 3. Making End-of-life Arrangements 4. Getting our Financial Ducks in a Row WHERE WE HAVE BEEN each culture of elderly brings a unique history that has shaped and formed who PROBABLE STAGE OF ELDER DECLINE they are and how they view around them; there are common influences that cut across racial lines however looking at cultural and racial concerns one must identify the cultural meaning and the dynamics of the aging process with in specific minority groups. WHERE ARE WE NOW  Current generation of elderly as the Quiet Revolution defining them as a revolution off older individuals representing the broadest 1. INTRINSIC BIOLOGICAL THEORY range of ethnic, cultural, regional, religions, It maintains that aging changes arise from political, and socioeconomic diversity ever internal predetermined causes. witness in a certain society.  Kanlungan ni Maria Home for the 2. EXTRINSIC BIOLOGICAL THEORY Aged in NCR It maintains that environmental factors lead to  DSWD – home for the elderly in structural alterations which in turn cause Talon-Talon Z.C. degenerative changes.  As a result of poor adequate resources among the poor, life expectancy is six years less than A. Free-Radical Theory another populated group. Twice the total o It is very famous theory of aging was population for elderly in the Philippines in favor developed by Denham Harman MD on of living with relatives this is based on the idea of 1956. familia “family is forever” o (Free electron) are molecules with an extra  Social factors among family include: cellular charge, which alters the structure 1. High percentage that lives below poverty and function of the cell membrane. level o Increased unstable free-radicals produces 2. Inadequate health care brought about by harmful effects to biological systems, such poverty cultural factors as chromosomal and DNA changes. 3. High literacy rate o Oxidation of fat, protein and carbohydrates 4. Low occupational levels resulting from few within the body produces the free-radicals. benefits and retirement plans  Traditional Asian culture often observe a form of filial piety which demands family members usually the eldest son to respect, care for and  o Ex: more stressors (taking more weight) in younger age ultimately leads to tearing like spinal cord or joint problems. F. Genetic/Gene Theory o Genetic inclination; lifespan is largely determined by the genes we inherit. o Our longevity is primarily determined at the amount of conception and is largely reliant on our parents and their genes. G. Neuroendocrine Control/ Pacemaker Theory/ Aging Clock Hormone Theory B. Cross-Link Theory/Connective Tissue Theory o Results from the functional perturbations both in neuronal control and endocrine o The molecules of collagen and elastin, output of the hypothalamic-pituitary connective tissue components, from bonds adrenal axis. that increase the cell rigidity. o Result in dysfunction in the activity of various o Chemical reaction occurs as a chemical endocrine glands and their target organs. bond between cells it will separate normally bonded cells. 3. PSYCHOSOCIAL THEORY Aging attempts to explain age related changes in cognitive function such as intelligence, memory, learning and problem solving. A. Immunological Theory o Formulated by Cummings and Henry (1961) states that aging people are withdrawn from customary role and engage in more introspective, self-focused activities. o Decrease participation in society resulting from age related changed in health, energy, income and social roles. o This theory includes 4 basic concepts: 1. Aging person withdraws from society 2. Disengagement is biologically and psychologically intrinsic and inevitable C. Immunological Theory 3. Disengagement is considered necessary for successful aging o Some theorists suggest that the immune 4. Disengagement is beneficial for system is responsible for aging. older adults and society o An aging immune system is less able to attack and destroy body cells as if they are B. Continuity/ Developmental Theory foreign cells (antigen). o It results in destroying own body cells o Personality remains same and behavior through auto aggression or become more predictable as people age. immunodeficiency. o Mainly focus on personality and individual behavior over time. D. Error Theory C. Activity Theory o Decreased bonding of protein cells in response to stressors such as radiation. o The maintenance of optimal physical, o Leads errors in synthesis of RNA and DNA mental and social activity is necessary for that produces cells with impaired function. successful aging. D. Adjustment Theory E. Wear and Tear Theory o A serious of adjustment to retirement, to o Body cells, structures and function wear out grand parenthood, to changes in income, through exposure to internal and external to changes in social life and marital status stressors. and to potential deterioration of health and o Inherent in this theory is the idea that the well-being. more you abuse your body, the faster it will wear out.  E. Gerotranscendence Theory a. Chronological Age o Meaning of life is clear.  Refers to the number of years the person has o Aware of God purpose; prayerful; training lived. younger people; more on what you can  Most commonly used objective method. give to others.  Serves as a criterion in society for certain activities, such as driving, employment and F. Age Stratification Theory the collection of retirement benefits. Three categories: o Group together as one (bingo socials,  young old (ages 65 – 74) prayer meeting).  middle old (ages 75 – 84)  old-old (ages 85 and older) G. Selective Optimization with Compensation Theory b. Physiologic Age o Strategy for improving health and wellbeing  Determination of age by body function. in older adults and a model for successful aging thing’s you can’t do before, you c. Functional Age compensate doing similar.  Person’s ability to contribute to society and H. Functional Consequences Theory benefit others and himself. o Focuses on the needs that are unique to  Fastest growing segment of the older older individuals. population: age 75 o Proposes the ability of older adults to  Those who require help: frail elderly maintain maximal care is affected by the  Non-institutionalized adults ages 75 – 84 → interaction of normal age-related changes 25% need help with daily activity. and additional risk factors the individual  Aged 85 and older – ½ need help with ADLs. encounters. HUMAN NEEDS I. Adjustment Theory o Five basic needs motivate human behavior o A serious of adjustment to retirement, to in a lifelong process toward need fulfillment. grand parenthood, to changes in income, o Maslow surmised that a hierarchy of five to changes in social life and marital status needs motivates human behavior: and to potential deterioration of health and physiologic, safety and security, love and well-being. belonging, self-esteem, and self- actualization. J. Theory of Thriving o Integrates knowledge, tells how and why INDIVIDUALISM phenomena are related leads to prediction o Personality consists of an ego and a and provide process and understanding. personal and collective unconsciousness o Based on these criteria, the authors created that views life from a personal or external with a holistic lifespan perspective for perspective. studying people in their environments as they age. SOCIOECONOMIC ASPECTS OF AGING NORMAL AGING PROCESS 1. Age Cohorts 1. Hereditary factors  Persons who share the experience of a 2. Environmental factors: abiotic (pollutants, particular event or time in history are radiations) and biotic (living organisms) grouped together in what is called a cohort. 3. Socio economic factors (stressors)  AGES 55 – 64: persons in this age group ADVANCE DIRECTIVE are generally healthy and have  Living will be regarding health matters. resources to maintain housing  Durable power of attorney for health  AGES 65 – 74: retirement ordinarily matters. causes income to decrease by about 35% or more. This reduction in income often offset by reduced expenditures associated with working, such as transportation, clothing and meals CARE OF THE OLDER PERSONS (away from home).  Government at 65 GSIS (x3) Demographic of Aging  Private at 65 SSS  A normal developmental process.  AGES 75 – 84: many persons in this age  Occurring throughout the human life span. group live alone, with affects their  Causes a mild progressive decline in body average household income system functioning.  AGES 85 AND OLDER: at risk for an increase in chronic dse, resulting in decreased ability to perform ADL and  increased expenses for assistance, advice or help, want to celebrate or are assistive devices and medication. Has grieving. the lowest average annual income level of all older people. AGING FAMILY 2. Poverty  Inadequate income may affect the quality FAMILY of life for older adults. A basic social unit consisting of parents and their  Delay seeking medical help. children, considered as a group, whether dwelling  May not follow through with the prescribed together or not: the traditional family treatment or medications. A social unit consisting of one or more adults together with children they care for: a 3. Education single-parent family. Any group of persons closely related by  Has been shown to have a strong blood, as parents, children, uncles, aunts relationship to health risk factors. The level of and cousins: to marry into a socially education influences earning ability prominent family. information absorption, problem solving ability, value systems and lifestyle behaviors. COMMUNITY Next unit of the society. 4. Health Status FAMILY MEMBERS  Persons over 65 an average of 2 chronic Form the nucleus of relationships for the majority of conditions (Lorig, 1993). the older adults and the support system if they  The most common chronic problems in 1994 become dependent. were arthritis (50%), followed by Intergenerational web (extended family): hypertension (36%), heart dse (32%), heart sons, daughters, stepchildren, in-laws, impairments (29%), cataracts (17%), nieces, nephews, grandchildren and great orthopedic impairments (16%), sinusitis (15%) grandchildren. and diabetes. All these people may play an important  Functional ability: measure by the part in maintaining satisfaction in later life. individual’s ability to perform ADLs and Everyone comes from a family. instrumental activities of daily living (IADLs) 1. ADLS: include size personal care Roles and Relationships activities: eating, toileting, bathing, transferring, dressing and continence Role of members CHANGE 2. IADLS: home-management activities: Grandparents assume parental roles to preparing meals, shopping, their grandchildren. managing money, using the Adult children may provide limited or telephone, doing light housework, extensive caring to their own parents. laundry, using transportation and This caregiving may be TEMPORARY or taking medication appropriately. LONGTERM.  Nurses can work with older adults – prolong independence by encouraging self- Families as a Resource or Risk Factor management of chronic conditions.  Self-management: learning and practicing Families are generally considered to be a vital the skills necessary to carry on an active resource and integral part of an individual’s social and emotionally satisfying life. network across the lifespan. Family relationships, like o Repeated demonstration to all relationships, vary in positive and negative promote the patient’s retention and qualities as they make an individual feel loved and involvement to task. cared for as well as irritated and frustrated. 5. Insurance Coverage Important Issues and Future Directions  Necessity for older adults because of The family – most precious naturally occurring and medical problems – therefore medical cost effect resources. Its role in protecting our elders expenses increase with age. must be supporter and augmented.  As person age, they visit the doctor more often (US Census Bureau, 2004): establishing The health of our older citizens can best be rapport. protected and improved by both supporting and educating the family as the primary vehicle for 6. Support Systems maintaining the health well-being of all members of our aging society.  Throughout life, people make new acquaintances, develop friendships and form family circles. People identify with schools, churches or synagogues, clubs, neighborhoods and towns. These are places and people they turn to when they need  URINARY STRUCTURE CHANGES IN THE OLDER PERSON & Kidneys THEIR IMPLICATIONS TO CARE o Shrink in length and width. o Change sin renal blood flow and glomerular CARDIOVASCULAR STRUCTURE filtration rate (GFR) account for a majority of functional disability in the kidneys with age. Cardiac Aging o Enlargement of heart chambers and Bladder coronary cells occurs with age, as does o Decrease in size and develops fibrous increased thickening of the heart walls, matter in the bladder wall, changing its especially in the left ventricle. overall stretching capacity and o Ventricles in the heart also begin to thicken contractibility. and stiffen in correlation with continued steady production of collagen. Urination o Amount of urine expelled from the body Vascular Aging decrease with age. o Aged arteries become extended and REPRODUCTIVE SYSTEM twisted. With age, large arteries begin to dilate and stiffen leading to hypertension. Ovaries o With age, the ovaries atrophy to such a small size that they can become RESPIRATORY SYSTEM impalpable during the exam. Alveoli Uterus o The volume of blood distributed to o Age-related decreases in uterine pulmonary circulation declines with age endometrial thickening during menstrual due to a decreasing number of capillaries cycles occur as the result of decreased per alveolus → impairs efficient passage of estrogen and progesterone levels → decline oxygen from the alveoli to the blood. in menstrual flow. Lung Elasticity Vagina o With age, this is a decrease in the lungs’ o With age, the vagina becomes shorter and elasticity, which in turn causes a change in narrower and the vaginal walls tens to thin the elastic recoil properties of the lungs. and weaken. As a result, the vagina can o Loss of elastic recoil = lunges closes become very dry, causing intercourse to be prematurely, trapping air inside and very painful preventing the lungs from emptying completely. Menopause o Declines in estradiol along with the onset of Chest Wall variable menstrual cycles. Periods of o Becomes stiffer with advancing age, amenorrhea trigger the move into the late decreasing the case with which the stages. thoracic cavity can expand. o The stiffness of the chest reduces its ability to Testes expand during inhalation and contract o Decrease in both size and weight, but with during exhalation. high variability among men. Although a decline in sperm production occurs in aging GASTROINTESTINAL SYSTEM males. The production never ceases, as a result, the older male remains fertile Pharynx and esophagus o Overall the, GI system appears to be Glands relatively preserved in aging with only minor o Changes in prostate gland. The lining and changes. The two GI are most affected by muscle layer of the prostate gland become age are the upper tract (pharynx and thinner with age, probably due to the esophagus) and the colon. reduced blood flow to the area. Benign  Lukewarm water; soft diet Prostatic Hypertrophy (BPH) – remains very o Stiffening of the esophageal wall affects the common among aging males. older patient’s ability to swallow. o Dysphagia, reflux, heartburn and chest pain Penis are common complaints o Show fibrous changes in erectile tissue around the urethra starting in the 30s and Large Intestine 40s. o Rectum, a colonic structure that is located o The fibrosis in erectile tissue → increase in the before the anus, shows age-related amount of time it takes to achieve an increase in fibrous tissue. erection in older males. o This increase reduces the rectum’s ability to stretch as feces pass through.  pathways to the brain lead to a reduction in ANDROPAUSE: a decline in testosterone levels and the ability to identify and distinguish aromas. eventually deficiency significant enough to cause o Decrease in the sense of smell – hyposmia clinical symptoms. Unlike menopause, andropause occurs gradually over time and does not occur in Taste all aging males. Symptoms include: low libido, o Decrease in taste – hypogensia, usually decreased energy, strength and stamina, more noticeable around the age of 60 with increased irritability and cognitive changes. more severe declines occurring after the age of 70. NERVOUS SYSTEM Vision Aging Brain o Most common visual concerns in aging – o Memory changes can be observed by the presbyopia or the inability to focus on fifth decade, but changes remain variable nearby objects, such as newsprint → among individuals. farsightedness (normal signs of aging). o Decreases in size and weight as men and women age. Hearing o Changes in the inner ear Aging Spinal Cord o Hearing loss include the alteration and o Nerve Conduction decline in the ability to hear high frequency  May narrow due to pressure on the sounds, and the ability to discern. spinal cord resulting from bone o Age related hearing loss – prebycusis – most overgrowth. Due to this narrowing, common sensory deficit in the older changes in sensation can occur. population.  Talk slightly & slowly repeat in lower MUSCLE voice. A reduction in muscle mass occurs to at least some INTEGUMENTARY SYSTEM degree in all elderly persons as compared to young healthy, physically active young adults. The greatest changes in aging skin – dermis. There is → Sarcopenia a general thinning of the dermal layer, with loss of o Associated with tremendous increases in thickness averaging 20% in older persons. This functional disability and frailty. thinning of the dermis is due in large part to a general loss of collagen – approximately 1% loss per SKELETAL SYSTEM year in adulthood. Estrogen Deficiency IMMUNE SYSTEM o Key contributor to bone loss accelerates in women after menopause due to a decline Immunosenescence in estrogen levels. o Aging immune system. o Plays a role in bone loss among men – due o Associated with increased incidence of to a decline in levels of estrogen, not infectious disease such as bronchitis testosterone influenza. o It is also implicated in the increased Osteoporosis incidence of tumors and cancer that occurs o Reduction in bone quantity and strength with age. those are greater than the usual age- related reduction. o Bones with osteoporosis are very porous – CULTURAL FACTORS/ETHNICITY containing numerous holes or empty Ethnicity: race like African, European, Asian. pockets – prone to fracture. Nationality: geographic location of the person’s birth (or the country with which he or she identifies). SENSORY SYSTEM DIVERSITY OF ELDERS Touch o Ability to touch and distinguish texture and  Wide range of life experiences sensation tends to decline.  Lifestyles o Decrease in the number and alteration in  Health status the structural integrity of touch receptors or  Socioeconomic status Meissner’s corpuscles and pressure  Religion receptors or Pacinian corpuscles. o Receptors that are elated to the sense of touch are also known as mechanoreceptors. o Prone to burn. Smell o Decrease in the number of olfactory neurons and weakening of olfactory neutral  2. Respiratory Function PATTERNS OF HEALTH & DISEASE  Current medications/ history of smoking IN THE OLDER ADULT behavior and exposure to environmental pollutants. A. Disease that occur to varying degrees in most  Assess: current difficulties and anxieties older adults: associated with breathing, decreased Cataracts, arteriosclerosis, benign prostatic energy to complete everyday tasks, hypertrophy (males). frequent coughing and production of B. Disease with increased incidence with excess sputum. advancing age:  Observation of posture and breathlessness, Neoplastic dse, diabetes mellitus, dementia and listening to chest sounds. disorders  Pulmonary function test, chest x-ray and C. Disease that have more serious consequence in sputum analysis. the elderly: Pneumonia, influenza, trauma 3. Gastrointestinal Function D. Very common chronic disease:  Usual diet; appetite and changes in Arthritis, hypertension, heart disease appetite; nausea, vomiting, indigestion, E. Functional disability stomach discomforts, problems with bowel a) 32% of persons over 65 years have some function (constipation and diarrhea). limitation of functions.  Barium enemas and x-rays, stool analysis b) 25% of persons over 65 years require examination of the colon. help with at least one ADL or IADL.  Oral health assessment – overlooked with older adults. GERIATRIC ASSESSMENT  Oral health practices including brushing, flossing and regular  A multidisciplinary diagnostic process contact with a dentist. intended to determine a frail older person’s 4. Genitourinary Function (sometimes neglected) medical, functional, and psychosocial status and limitations in order to develop a plan for  Abnormal bleeding, vaginal discharge, treatment and long-term follow-up. urinary symptoms. Pelvic examinations and  Diagnose and develop an overall plan of PAP smears. care for treatment and long term follow up.  Older men – enlarged prostate.  Optimizes independence and prevent  Chronic renal failure – complication of age- future disabilities. related dses (diabetes and hypertension).  Incontinence – not a normal part of aging. FUNCTIONAL ASSESSMENT  Health history – previous or current difficulties related to the frequency and voluntary flow  Identify an older adult’s ability to perform of urine during either the day or night; self-care, self-maintenance, and physical medication use. activities.  Urine analysis tests for blood, bacteria, and  Disability impact that health problems have other components. on an individual’s ability to perform tasks, 5. Neurological Function roles and activities.  Medications, medical diagnosis related to PHYSICAL ASSESSMENT the neurological system (history or family history of stroke).  Physical assessment with a “systems”  Previous and current impairment in speech, approach, reviews each body system first expression, swallowing, memory, orientation, by taking a history – then physical energy level, balance, sensation and motor examination. function.  Sleep disturbance, tremors, and seizures. 1. Circulatory Function 6. Musculoskeletal Function  Family history, current problems with chest pain/ discomfort (exertion); current  The most commonly reported illness among diagnoses and associated medications’ older adults is osteoarthritis (Weight-bearing over-the-counter and herbal medicines; joints-hips/knees). sources of stress; adherence to current  Observation of purpose and walking can medical regimens. assist in asking the appropriate questions.  Physical examination, blood pressure, chest  Does the older adult favor one side sounds, pulse rate. of the body while walking?  Exercise stress test, blood and serum tests,  Are assistive devices such as canes electrocardiograms and other tests for and walkers being used? imaging and assessing the condition of the  Canes and walkers should be heart and blood vessels. at the appropriate height in relation to body height.  philosophy and an 7. Sensory Function understanding of meaning and purpose in life.  Diminished vision and hearing – greatest impact on older adults --- negative effects 1. Physiologic Functioning on social interactions – social and psychological health.  Urinary Incontinence: common problem of o The following two screening the elderly and has tremendous impact on procedures are simple tests for both the morbidity and quality of life of functional vision: elderly peoples.  Ask the older adult to read a a) Stress incontinence: involuntary loss of newspaper headline and urine during activities that increase story. intraabdominal pressure (lifting,  Ask the older adult to read coughing, sneezing and laughing). the prescription bottle b) Urge incontinence: associated with  Hearing loss is a major concern for many strong, abrupt desire to void and the older adults. inability to inhibit leakage in time to o The following question is useful in reach the toilet. assessing ear and hearing problems: c) Reflex incontinence: results from  Are you experiencing a inhibited bladder contractions with no hearing problem or any ear sensation of needing to void or pain, ringing in the ears or ear urgency. discharge? d) Overflow incontinence: over distention  Older adults wearing aids – regularly of the bladder due to abnormal assessed and monitored. emptying. e) Functional incontinence: refers to 8. Integumentary Function problems from factors external to the  Skin problems and concerns and inspecting lower urinary tract (cognitive the skin. impairments, physical disabilities)  Skin injury = close monitoring and treatment.  Rashes, itching, dryness, frequent bruising Management of Incontinence: Managing and any open sore. hydration, prompted voiding, bladder training,  Color, hydration, circulation and intactness. pharmacological management COGNITIVE ASSESSMENT  Sleep disorder: more prevalent with age. Individuals with multiple illnesses rate their  Attention, memory, language sleep as being of poorer quality. o The most extensively used cognitive assessment tools are the Mini Mental Management of Sleep Disorder: sleep hygiene, State Examination (MMSE) – environmental restricting, medications – measures change in cognitive Zolpidem (Ambien), Zaleplon (Sonata). impairment. 2. Behavioral  Anxiety: tachycardia and palpitations, gastrointestinal disorders, insomnia and tachypnea. Nursing Care: decrease environmental stimuli, stay with the patient, make no demands and do not ask patient to make decisions, support current coping mechanism (crying, talking, etc.), don’t confront or argue with the patient, speak slowly in a soft, calm voice. PSYCHOLOGICAL ASSESSMENT  Depression: although depression is the most common mental health disorder in older  Weighted toward assessment of mental adults, it is not a normal consequence of disorders. aging  Clinical depression – most common mental Interventions: pharmacological therapy – health problem among older adults. tricyclic anti-depressants, exercise, counseling SOCIAL ASSESSMENT  Polypharmacy  Social network and on the interaction o The act of taking many medications between the older adult and family, friends, concurrently. neighbors and community. o The consequences of polypharmacy  Spiritual support: religiosity – believing in in the older adult range from mild God, organized rituals. annoying to life threatening.  Spirituality – ideas of belief o Adverse drug reactions/ drug-drug that encompasses personal interaction medication errors  o Non-adherence - not willing to follow elderly or disables people. Nursing home can also the instructions given for prescribes be referred to as skilled nsg. Facility, rest homes, treatments. convalescent homes or care. 3. Safety Home Care: services (as nsg or personal care)  Falls – an event which results in a person provided to a homebound individual (as one who is unintentionally coming to rest on the ground convalescing, disabled or terminally ill) home care or another lower level. as an alternative to institutionalization. Interventions: modify the environment, evaluate Gait and balance – assess muscle Adult Day Care Center: typically, a non-residential strength and ability frequently and institute facility that supports the health, nutritional, social appropriate measures for safe mobility and and daily living needs of adults in professionally transfer techniques, Review medications. staffed group setting. These facilities provide adults the transitional care short-term rehab following LEVELS OF CARE hospital discharge. I. PRIMARY: prevention of both illness and disease promotion of wellness. o Prevention there is vulnerability; promotion no vulnerability. o Disease causes illness: one can have a disease without illness II. SECONDARY: hospitalization or institutionalization to avoid chronicity. o Case finding III. TERTIARY REHABILITATION: with such health deviations to regain and maintain the highest level of function and independence. IV. QUATERNARY PREVENTION: experiencing illness buy there is no identified disease; to protect him from new medical invasion and suggest intervention which is ethically GORDON’S FUNCTIONAL acceptable. HEALTH PATTERN IN ELDERLY CARE SETTING LEVEL I – able to perform full self-care. LEVEL II – requires assistance or supervision of Actual Care: branch of 20 care where a px receives another person. active but short-term tx for a severe injury or LEVEL III – requires assistance or supervision of episodes of illness, an urgent medical condition or another person and equipment or device. during recovery from surgery. LEVEL IV – completely dependent and does not participate in activities. Long-term Care: involves a variety services designed to meet a person’s health or personal care needs during a short or long period of time these services help people to live as independently and safety possible when they can no longer perform the day activities on their own, long term provide a safe environment for chronically ill and functionally dependent. Short-term Care: type of tx that has a desired outcome; e.g. tx for an injury. Intermediate Care: an emerging concept in health care which may offer attractive alternatives to hospital care for elderly no longer as six weeks but can be as little as one or two weeks if the staff believe that is what you need to reach your goals Basic Services: In px care to pxs who have need to for skilled nursing supervision and need supportive care, but who do not require continue nursing care. Skilled Nursing Care: refers to a px’s need to care or tx that can only be performed by licensed nurse. A nursing home is facility for the residential care of