NCMB314 LEC PRELIM.pdf

NCMB314 LECTURE: Exam Week 06 BSN 3RD YEAR 1ST SEMESTER PRELIM 2022...

NCMB314 LECTURE: Exam Week 06 BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 Bachelor of Science in Nursing 3YA Professor: Caroline V. San Diego MAN, RN Prelim Topics: changes bring to bear on job performance and related Concepts, Principles, History and Theories in The outcomes (e.g., work motivation) Care of Older Adults 2) Understand age-related difference in life situations (e.g., Physiologic Changes in Aging and Changes in Mind temporal shifts in work versus non-work roles and their Nursing care of Older Adult in wellness associated demands) and offer age-conscious policies Health promotion, Health maintenance and home and provisions to support the work life interface (e.g., health considerations Family Care, including childcare and eldercare, flexible Nursing Care of the Older Adult in Chronic Illness time and place policies) 3) Acknowledge temporal dynamics in individual differences CONCEPTS, PRINCIPLES, HISTORY AND THEORIES IN THE (e.g., the age-graded re-organization of personality and CARE OF OLDER ADULTS motives; the accrual of tacit and explicit job knowledge Perspective of Older Adults through History and related job skills) and how these dynamics influence The members of the current older population in the United various work processes and outcomes. States have offered the sacrifice, strength, and spirit that 4) Advocate for the design of work systems that optimally made this country great. They were the proud GIs in world integrate various age-related changes, differences and wars, the brave immigrants who ventured into a new dynamics (e.g., institute complete task job design to country, the bold entrepreneurs who took risks that promote long term wellbeing and performance; afford created wealth and opportunities for employment, and the workers the latitude to proactively self-manage work tasks unselfish parents who struggle to give their children a and responsibilities via job crafting) better life. They have earned respect, admiration, and dignity. Today older adults are viewed with positivism Demographics of Aging rather than prejudice, knowledge rather than myth, and - Life expectancy – the average number of years that a concern rather than neglect. This positive view was not person can be expected to live always the norm. - Average life expectancy - 47 years (2004) In the time of Confucius, there was a direct correlation Figure had increased to 77.8 years between a person’s age and the degree of respect to What’s the IMPLICATION of this increasing life which he or she was entitled. The early Egyptians dreaded expectancy? growing old and experimented with a variety of potions - The Graying of America Percent of Total U.S. and schemes to maintain their youth. Opinions were Population over 65 in 2030 divided among the early Greeks. Plato promoted older In 2005, 13% of the U.S. pop. was over age 60 adults as society’s best leaders, whereas Aristotle denied - 18.3 million aged 65–74 older people any role in governmental matters. In the - 12.9 million aged 75–84 nations conquered by the Roman Empire, the sick and - 4.7% aged 85 or older aged were customarily the first to be killed. And, woven This number is estimated to increase: throughout the Bible is God’s concern for the well-being of - To 20 million in 2010 (6.8% of total), the family and desire for people to respect elders (Honor - To 33 million in 2030 (9.2%), and your father and your mother..Exodus 20:12).Yet the honor - To almost 50 million in 2050 (11.6%) bestowed on older adults was not sustained. By mid-21st century, old people will outnumber young Medieval times gave rise to strong feelings regarding the for the first time in history superiority of youth; these feelings were expressed in - “Age 65 and older” is widely accepted & used for reporting uprisings of sons against fathers. Although England demographic statistics about older persons; however developed Poor Laws in the early 17th century that turning 65 does not automatically means a person is “old”. provided care for the destitute and enabled older persons - Persons 65 years of age and older currently represent without family resources to have some modest safety net, about 13% of the total population. many of the gains were lost during the Industrial - The most rapid and dramatic growth for the older adult Revolution. No labor laws protected persons of advanced segment of the total U.S. population will occur between age; those unable to meet the demands of industrial work the year 2010 and 2030, when “baby boom” generations settings were placed at the mercy of their offspring of reach 65 years of age. forced to beg on the streets for sustenance. Why They Increase? Four ways to adopt a Lifespan Perspective on Aging at Improved sanitation work Advances in medical care 1) Recognize age-related changes in abilities (e.g., physical Implementation of preventive health services and cognitive capacities) and the impact that such J.A.K.E 1 of 25  CARE OF OLDER ADULTS – LEC: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 In 1900s, deaths were due to infectious diseases and The average life expectancy of men in the United States is acute illnesses 75.2 years Older population now faced with new challenge Male exposure to risk factors may account for the Chronic disease differences Health care funding Increases in female exposures to risk factors will reduce The ave. 75y/o has 3 chronic dses. & uses 5 rx meds. difference in life expectancy 95% of health care expenditures for older Americans are for chronic diseases Majority of older adults enjoy good health Changes in fertility rates But national surveys reveal that: Baby boom after WWII (1946 – 1964) 3.5 children per A 20% of adults 65y/o & above report a chronic disability. household Chronic disease - major cause of disability; Older population will explode between 2010 to 2030 when - Heart disease baby boomers reach age 65 - Cancer, Based on 1997 data, 4x as many widows as widower live - Stroke in the United States. About 5 % of persons over 65 reside - Alzheimer’s disease - 5th in nursing facilities, but % increases dramatically with - DM - 6th advancing age. Majority of deaths (US) occur in people 65y/o & older Estimates indicates that more than 80% of persons over 65 - 50% of deaths--caused by heart disease & cancer years of age have one or more chronic health conditions. 3 - In the past 50 years --- a noted decline in overall Leading Causes of Death for older persons, in order, heart deaths conditions, malignant neoplasms, & CVD’s o Due to the improvements in the prevention & early detection & treatment of diseases Impact of the Baby Boomers o Heart disease & cancer are two top causes of - In anticipating needs and services for future generations death, regardless of age, race, gender or ethnicity of older adults, gerontological nurses must consider the o Positive health reports declined with advancing realities of the baby boomers, those born between 1946 age and 1964, which will be the next wave of senior citizens. o African American and Hispanic or Latinos - less - Their impact on the growth of the older population is such likely to report good health than their Caucasian that it has been referred to as a demographic tidal wave. or Asian counterparts. - Baby boomers began entering their senior years in 2011 and will continue to do until 2030. Although they are a highly diverse group, representing people as different as Bill Clinton, Bill gates and Cher, they do have some clearly defined characteristics that set them apart from other groups: Most have children, but this generation’s low birth rate means that they will have fewer biologic children available to assist them in old age. They are better educated than preceding generations. Their household incomes tend to be higher than other groups, partly due to two incomes (three out of four baby boomer women are in the labor force). Majority of people 75y/o & over They favour a more casual dress code than previous - Remain functionally independent, and generations of older adults. - The proportion of older Americans with limitations in They are enamored with “high-tech” products and are activities is declining (CDC, 2007a). likely to own and use a home computer. 70% of Physical Decline Related to Modifiable Risk Their leisure time is scarcer than other adults, and Factors they are morte likely to report feeling stressed at the - Smoking end of the day. - Poor nutrition As inventors of the fitness movement, they exercise - Physical inactivity more frequently than other adults. - Failure to use preventative and screening services Reason for the decline in limitations to activity of Older Feminization of Later Life Adult Women comprise 55% of the older population Improved nutrition, Women have a longer life expectancy Decreased smoking, The average life expectancy of women in the United States Increased exercise, and is 81 years J.A.K.E 2 of 25  CARE OF OLDER ADULTS – LEC: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 Early detection & treatment of risk factors such as First nursing journal for the care of older adults hypertension & elevated serum cholesterol levels. published : Journal of Gerontological Nursing by 1975 Slack,Inc. First nursing conference held at the Geriatrics International Congress of Gerontology. - From Greek – Geras, meaning “old age,” branch of ANA Geriatric Nursing Division changes name to medicine & deals with the diseases & problems of old age. 1976 Gerontological Nursing Division - Gerontology – from the Greek Geron, meaning “old man,” ANA division of Gerontological Nursing publishes is the scientific study of the process of aging and the 1981 statement on scope of practice problems of aged persons Development of Robert Wood Johnson Teaching 1982 - It includes biologic , sociologic , psychologic , and Home Nursing Program economic aspects. First university chair in gerontological nursing in the 1983 - “Gero” – old age, “Ology”- study of United States (case western reserve) - Older Age Group: ANA revises Standards and Scope of Gerontological Young old – ages 65-74 1987 Nursing Practice Middle Old – ages 75-84 First Phd program in gerontological nursing Old Old – 85 and up. 1988 established - Age Discrimination – emotional prejudice among the ANA certification established for Clinical Specialist older adult. 1989 in Gerontological nursing - Ageism – dislike of the aging and the older adult. Prejudice against the old just because they are old. ANA certification available for geriatric advanced - Senescence – Defined as a change in the behavior of an 1998 practice nurses as geriatric nurse practitioners or organism with age, leading to a decreased power of gerontological clinical nurse specialist survival and adjustment, occur as well. Barbara Davis Gerontology Nursing - She is the first nurse to speak before the American - This specialty of nursing involves assessing the health & Geriatric Society. functional status of older adults, planning and - First article on nursing curriculum regarding gerontologic implementing health care & services to meet the identified nursing is published. needs, and evaluating effectiveness of such care. Gerontologic Nurse Landmarks in the development of gerontological The nurse must meet all of the following requirements: nursing as a specialty - Currently hold an active registered nurse license in US or its territories. American Journal of Nursing (AJN) publishes first 1902 - Hold a baccalaureate or higher degree in nursing. geriatric article by an MD - Have practiced 2000 hours within past 3 years First geriatric nursing textbook, “Geriatric Nursing - Have had 30 contact hours Of continuing education (Newton), published - Applicable to gerontology/ Gerontologic nursing within 1950 First master’s thesis in geriatric nursing completed the past 3 years. by Eleanor Pingrey Gerontologic Nurse Practitioner Geriatric becomes a specialization in nursing The nurse must meet the following requirements: First geriatric nursing study published in Nursing - Currently hold an active RN license in the US or its 1952 territories Research - Hold a master’s or higher degree in nursing. ANA recommends specialty group for geriatric 1961 - Have been prepared as a nurse practitioner in either of the nurses following: ANA holds first National Nursing Meeting on 1962 A GNP master’s degree in Program Geriatric Nursing Practice - A formal postgraduate GNP track or program Within a ANA forms a geriatric nursing division, First school of nursing granting graduate-level academic credit 1966 Gerontological Clinical Nurse Specialist master’s Clinical Specialist in Gerontologic Nursing program begins at Duke University The nurse must meet all the following requirements: First RN (Laurie Gunter) presents at the - Currently hold an active RN license in the United States or 1968 International Congress of Gerontology its territories Development of standards for geriatric nursing - Hold a master’s or higher degree in gerontologic nursing 1969 - Hold a master’s or higher degree in nursing with a practice ANA creates the Standards of Practice for Geriatric specialization in gerontologic nursing. 1970 - Have practiced a minimum of 12 months after completion Nursing of the master’s degree ANA offers the first generalist certification in 1973 - Meet the following requirements in current practice: gerontological nursing J.A.K.E 3 of 25  CARE OF OLDER ADULTS – LEC: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 If a clinical specialist must have provided a minimum Aging Well of 800 hours (post-master’s) of direct client care or - 72% of seniors report having good to excellent health clinical management in Gerontologic Nursing within - Numbers living in nursing homes has declined the past 24 months - 1 out of every 5,578 people was 100 y/o or older If a consultant, researcher, educator, or administrator, - Older adults are active and healthy must have provided a minimum of 400 hours - Challenge to all nurses: To promote positive lifelong health behaviors among all populations because the Nursing Care of Older Adults impact of unhealthy behaviors and choices = CHRONIC - Gerontological nursing is provided in acute care, skilled DISEASE. and assisted living, the community, & home settings. Purpose Of Nursing Theory - Goals of care include: - Defines our practice Promoting & maintaining functional status, and - In gerontological nursing they must be comprehensive yet Helping older adults identify & use their strengths to consider individual differences achieve optimal independence. - A good GERONTOLOGICAL THEORY: Roles of the Gerontological Nurse Integrates knowledge, Provider of care Tells how and why phenomena are related, - Should be educated about disease processes & Leads to prediction, and syndromes commonly seen in the older population Provides process and understanding b) In addition, it must be holistic & take into account all Teacher/ Educator that impacts on a person throughout a lifetime of - Should focus their teaching on modifiable risk factors aging & health promotion through Manager Aging Theories - They balance concerns of the patient, family, nursing - Cultural, spiritual, regional, socioeconomic, educational, & the rest of the interdisciplinary team environmental factors, and health status impact the older - Must be skilled in: Leadership, Time management, adults perceptions and choices about their health care Building relationships, Communication & Managing needs change - Limited work has been done to identify nursing-specific - They may also supervise other nursing personnel aging theories Advocate - Aging is a distinct discipline that requires aging theories - Acts on behalf of the older adults to: that have an interdisciplinary perspective o Promote their best interests & Psychosocial Theories of Aging o Strengthen their autonomy & decision making - Attempt to explain aging in terms of behaviour, personality - It does not mean making decisions for older adults, and attitude change. but empowering them to remain independent and 1) Sociological Theories – changing roles, relationship, retain their dignity, even in difficult situations status and generational cohort impact the older adult’s Research Consumer ability to adapt. - Must remain abreast of current research literature, b) Activity theory reading & putting into practice the results of reliable & - Havighurst and Albrecht (1953) valid studies - Remaining occupied and involved is necessary to - The use of EVIDENCE-BASED PRACTICE RESEARCH satisfy late life. can improve the quality of patient care in all settings: - Activity engagement and positive adaptation. o Best method for delivery of care c) Disengagement Theory o Based on clinical guidelines derived from - Cumming and Henry (1961) research - Gradual withdrawal from society and o Coding system indicates the strength of the relationships serves to maintain social research equilibrium and promote internal reflection. a. All nurses should: d) Subculture Theory o Read professional journals specific to their - Rose (1965) specialty - The elderly prefer to segregate from society in an o Continue their education by attending seminars & aging subculture sharing loss of status and workshops societal negativity regarding the aged. o Participate in professional organizations e) Continuity Theory o Pursue additional formal education or degrees - Havighurst (1960) o Obtain certification - also known as Development Theory - Personality influences role and life satisfaction and remains consistent throughout life. - 4 Personality types: J.A.K.E 4 of 25  CARE OF OLDER ADULTS – LEC: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 Integrated - Older adults are more vulnerable to free radicals. Armored Defended b) Orgel/ Error Theory Passive Dependent - Errors in DNA and RNA synthesis occurs with Unintegrated aging. f) Age Stratification Theory c) Wear and Tear Theory - Riley (1960) - Cells wears out and cannot function with aging. - Society is stratified by age groups that are the - Like a machine which losses function when its basis for acquiring resources, roles, status and parts wears off. deference from others. d) Connective Tissue Theory / Cross link theory g) Person-Environment Fit Theory - With aging, proteins impede metabolic processes - Lawton (1982) and cause trouble with getting nutrients to cells - Function is affected by ego strength, mobility, and removing cellular waste products. health, cognition, sensory perception and the environment. 2) Non-Stochastic Theories of Aging – Based on the 2) Psychological theories – Explain aging in terms of mental genetically programmed events that cause cellular processes, emotions, attitudes, motivation, and damage that accelerates aging of the organism. personality development that is characterized by life stage a) Programmed Theory transitions. - Cells divide until they are no longer able to and a) Human needs - Maslow’s (1954) this triggers to apoptosis or cell death. - Five basic needs motivate human behaviour in a - Shortening of the TELOMERES – the distal lifelong process toward need fulfilment. appendages of the chromosomes arm. - Self – Actualization - TELOMERASE – an enzyme, “cellular fountain of b) Individualism Theory youth” - Jung (1960) b) Gene/ Biological Clock Theory - Personality consists of an ego and personal and - Cells have a genetically programmed aging code. collective unconsciousness that views life from a c) Neuroendocrine theory personal or external perspective. - Problems with the hypothalamus-pituitary- c) Stages of Personality Development endocrine gland feedback system causes disease. - Erikson (1963) - Increased insulin growth factor accelerates aging. - Personality develops in eight sequential stages d) Immunologic/ Autoimmune Theory with corresponding life tasks. The eighth phase, - Aging is due to faulty immunological function, integrity versus despair, is characterized by which is linked to general well-being. evaluating life accomplishments; struggles include letting go, accepting care, detachment, PHYSIOLOGIC CHANGES IN AGING AND CHANGES IN and physical and mental decline. MIND d) Life-course/Lifespan Development Physiologic Changes in Aging - Life stages are predictable and structured by 1) Integumentary Effects: roles, relationship, values and goals. Wrinkling Biological Theories of Aging Decrease of the skin’s immune responsiveness - Explains that physiologic processes that change with Dehydration and cracking of the skin aging. Decreased sweat production 1) Stochastic Theories – Based on random events that Decreased numbers of functional melanocytes cause cellular damage that accumulates as the organism resulting in gray hair and atypical skin pigmentation ages. Loss of subcutaneous fat a) Free Radical Theory A general decrease in skin thickness - Membranes, Nucleic acids and proteins are An increased susceptibility to pathological conditions damaged by free radicals which causes cellular Growth of hair and nails decreases; nails become injury, brittle with age - Exogenous Free radicals: Tobacco smoke, 2) Muskulo-skeletal Pepticides, organic solvents, Radiation, ozone Decreased height and selected Medications. Decreased ROM joints - Health Teaching: Increased postural sway/ difficulty balance Decrease calories in order to lower weight Shrinking vertebral disc, slight kyposis Maintain a diet high in nutrients using anti- Loss of bone mass, bones more brittle (increased oxidants resorption) Avoid inflammation Muscle Atrophy/ decreased lean body mass Minimize accumulation of metals in the body Joint degeneration (Cartilage surface) that can trigger free radicals reactions. Foot problems: bunions, coms, and calluses J.A.K.E 5 of 25  CARE OF OLDER ADULTS – LEC: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 3) Respiratory Smell Decreased chest wall compliance - Impaired ability to identify and discriminate Decreased maximal breathing capacity among odors Decreased number of alveoli Taste Decreased elasticity - High prevalence of taste impairment, although Decreased parenchyma most likely due to factors other than normal aging Impaired cough reflex because of defective Touch mucociliary function - Reduction in tactile sensation Increased vulnerability to hypoxia and emphysema 10) Endocrine Increased susceptibility to respiratory infections Decrease thyroid activity 4) Cardiovascular / Hematopoietic & Lymphatic ACTH secretion decreases Cardiac output decreases Pituitary gland decreases in volume by approximately Aorta becomes dilated and elongated 205 in older person Resistance to peripheral blood flow increases by 1% Gonadal secretion declines with age, including per year gradual decreases in testosterone, estrogen, and Blood pressure increases progesterone Decrease cardiac output TSH decreases Less elasticity of the vessel Insufficient release of insulin by beta cells of the More prominent arteries in head, neck, and pancreas extremities 11) Reproductive Stroke volume decreases by 1% per year Male 5) Hematopoietic & Lymphatic - Fluid-retaining capacity of seminal vesicles 6) Gastrointestinal reduces Decrease esophageal motility - Possible reduction in sperm count - Venous and arterial sclerosis of penis Atrophy of gastric mucosa - Prostate enlarges in most men Decrease stomach motility, hunger contractions, and emptying time Female - Fallopian tubes atrophy and shorten Less production of hydrochloric acid, lipase, and - Ovaries become thicker and smaller pancreatic enzymes - Cervix becomes smaller Fewer cells on absorbing surface of intestine - Drier, less elastic vaginal canal Slower peristalsis - Flattening of labia Decreased taste sensation - Endocervical epithelium atropies Esophagus more dilated - Uterus becomes smaller in size Reduced saliva and salivary ptyalin - Endometrium atropies 7) Urinary - More alkaline vaginal environment Decrease in nephrons - Loss of vulvar subcutaneous fat and hair Between ages 20 and 90, renal blood flow decreases 53%, and glomerular filtration rate decreases 50% Changes To The Mind Weaker bladder muscles - Psychological changes can be influenced by general Decreases size renal mass health status, genetic factors, educational achievement, Decrease tubular function activity, and physical and social changes. Decrease bladder capacity - Sensory organ impairment can impede interaction with 8) Nervous the environment and other people, thus influencing Decrease brain weight psychological status. Feeling depressed and socially Reduced blood flow in brain isolated may obstruct psychological function. Changes in sleep pattern - Recognizing the variety of factors potentially affecting Decrease conduction velocity psychological status and the range of individual Slower response and reaction time responses to those factors, some generalizations can be 9) Special senses discussed. Hearing Personality - Atrophy of hair cells of organ of corti - Drastic changes in basic personality normally do not - Tympanic membrane sclerosis and atrophy occur as one age. The kind and gentle old person was - Increased cerumen and concentration of keratin most likely that way when young; likewise, the cantankerous old person probably was not mild and meek Sight in earlier years. - More opaque lens - Decrease pupil size - More spherical cornea J.A.K.E 6 of 25  CARE OF OLDER ADULTS – LEC: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 - Excluding pathologic processes, the personality will be creative capacities, special perceptions, and aesthetic consistent with that of earlier years; possibly, it will be appreciation; this type of intelligence is believed to more openly and honestly expressed. decline in later life. Some decline in intellectual function - The alleged rigidity of older persons is more a result of occurs in the moments preceding death. High levels of physical and mental limitations than a personality change. chronic psychological stress have been found to be - For example, an older person’s insistence that her associated with an increased incidence of mild cognitive furniture not be rearranged may be interpreted as rigidity, impairment. but it may be sound safety practice for someone coping Learning with poor memory and visual deficits. Changes in - Although learning ability is not seriously altered with age, personality traits May occur in response to events that other factors can interfere with the older person’s ability alter self-attitude, such as retirement, death of spouse, to learn, including motivation, attention span, delayed loss of independence, income reduction, and disability. transmission of information to the brain, perceptual No personality type describes all older adults. Morale, deficits, and illness. attitude, and self-esteem tend to be stable throughout the - Older persons may display less readiness to learn and life span. depend on previous experience for solutions to problems Memory rather than experiment with new problem-solving - The three type of memory are short term, lasting from 30 techniques. seconds to 30 minutes; long term, involving that learned - Differences in the intensity and duration of the older long ago; and sensory, which is obtained through the person’s physiologic arousal may make it more difficult to sensory organs and lasts only a few seconds. extinguish previous responses and acquire new material. - Retrieval of information from long-term memory can be - The early phases of the learning process tend to be more slowed, particularly if the information in the difficult for older persons than younger individuals; consciousness while manipulating other information- however, after a longer early phase, they are then able to working memory function-is reduced. keep equal pace. - Older adults can improve some age-related forgetfulness - Learning occurs best when the new information is related by using memory aids (mnemonic devices) such as to previous learned information. Although little difference associating a name with an image, making notes or lists, is apparent between the old and the young in verbal or and placing objects in consistent locations. Memory abstract ability, older persons do show some difficulty deficits can result form a variety of factors other than with perceptual motor tasks. normal aging. - Some evidence indicates a tendency toward simply Intelligence association rather than analysis, Because generally a - In general, it is wise to interpret the findings related to greater problem to learn new habits when old habits exist intelligence and the older population with much caution and must be unlearned, relearned, or modified, older because results may be biased from the measurement persons with many years of history may have difficulty in tool or method of evaluation used. this area. - Early gerontological research on intelligence and aging Attention Span was guilty of such biases. Sick old people cannot be - Older adults demonstrate a decrease in vigilance compared with healthy persons; people with different performance (i.e. the ability to retain attention longer than educational or cultural backgrounds cannot be compared; 45 minutes). and one group of individuals who are skilled and capable - They are more easily distracted by irrelevant information of taking an IQ test cannot be compared with those who and stimuli and are less to perform tasks that are have sensory deficits and may not have ever taken this complicated or require simultaneous performance. type of test. - Longitudinal studies that measure changes in a specific NURSING CARE OF THE OLDER ADULT IN WELLNESS generation as it ages and that compensate for sensory, Assessment health, and educational deficits are relatively recent, and - Assess potential health hazard to identify risk factors for they serve as the most accurate way of determining illness and injury intellectual changes with age. - Risk Factors: - Basic intelligence is maintained; one does not become Habits more or less intelligent with age. The ability for verbal Lifestyle patterns comprehension and arithmetic operations are unchanged. Personal and family medical history - Crystallized intelligence, which is the knowledge Environmental conditions accumulated over a lifetime and arises from the dominant - Comprehensive Geriatric Assessment (CGA): hemisphere of the brain, is maintained through the adult Physical health years; this form of intelligence enables the individual to Mental health use past learning and experiences for problem solving. Functional status - Fluid intelligence, involving new information and Social functioning emanating from the nondominant hemisphere, control Environment emotions, retention of non-intellectual information, J.A.K.E 7 of 25  CARE OF OLDER ADULTS – LEC: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 MiniMetal State Examination - Mini-Mental State Exam (MMSE) is a widely used test of cognitive function among the elderly; it includes tests of orientation, attention, memory, language and visual- spatial skills. Functional Status Assessment - Functional status is considered a significant component of an older adult’s quality of life. Assessing functional status has long been viewed as an essential piece of the overall clinical evaluation of an older person. - Functional status assessment is a measurement of the older adult’s ability to perform basic self-care tasks, or ADLs, and tasks that require more complex activities for independent living, referred to as IADLs. - Determination of the degree of functional independence in these areas can identify a client’s abilities and limitations, leading to appropriate interventions. - The client’s situation determines the location and time when any of the scales or tools should be administered, as well as the number of times the client may need to be tested to enjoy to ensure accurate results. - Many tools are available, but the nurse should use only those which are valid, reliable, and relevant to the practice setting. The Katz Index - A useful tool to describe the client’s functional level - Katz Index of Independence in Activities of Daily Living, commonly referred to as the Katz ADL, is the most appropriate instrument to assess functional status as a measurement of the client's ability to perform activities of daily living independently. J.A.K.E 8 of 25  CARE OF OLDER ADULTS – LEC: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 PAR-Q AND YOU performance of activities of daily living (ADLs) and /or - Physical Activity Readiness Questionnaire (PAR-Q) is a instrumental activities of daily living (IADLs). common method of uncovering health and lifestyle issues Objective: Observe for cues that indicate effective prior to an exercise programmed starting. The management of deficits, including the physical questionnaire is short and easy to administer and reveals environment in which th client resides. any family history of illness. Nutritional / Metabolic Pattern - This pattern encompasses evaluation of dietary and other nutrition-related indicators. Subjective: Determine the older adult’s description, patterns, and perception of food and fluid intake and adequacy for maintaining a healthy body mass index. Objective: Observe general appearance and various body system indicators of nutritional status. Note height, weight, and fit of clothes. Coping/ Stress-Tolerance Pattern - This pattern encompasses the client’s reserve and capacity to resist challenges to self-integrity, and his or her ability to manage difficult situations. Subjective: Assess ways to handle big and little problems that occur in everyday life. Objective: Observe for the use of coping skills and stress-reducing techniques, and note their effectiveness. Cognitive/ Perceptual Pattern Gordon’11 Basic functional Health Patterns of Older - This pattern encompasses self-management of pain, ADULT presence of communication difficulties, and deficits in Self-Perception/ Self-Concept Pattern sensory function. - This pattern encompasses a sense of personal identity; Subjective: Inquire about difficulties with sensory body language, attitudes, and view of self in cognitive, function and communication, as well as the physical, and affective realms; and expressions of sense assessment of any cognitive changes. of worth and emotional state. Objective: Assess usual patterns of communication - Perceptions of self should be explored with direct and note the client’s ability to comprehend. questions, asked with sensitivity. Emotional patterns can Value/ Belief Pattern be identified during this exploration of perceptual patterns. - This pattern encompasses elements of spiritual well- Subjective: Determine the client’s feelings about his being that the older adult perceives as important for a or her competencies and limitations, withdrawal from satisfactory daily living experience and the philosophic previous activities, self destructive actions, excessive system that helps him or her function within society. grieving, and increased dependency on others. Subjective: Identify the older adult’s values and Objective: Identify verbal and nonverbal cues related beliefs about spirituality, with a special emphasis on to the above subjective data. how this influences health promotion behaviors. Roles/ Relationship Pattern Objective: Determine what is important in the older - This pattern encompasses the achievement of expected adult’s life to support coping strategies. developmental tasks. Activity/ Exercise Pattern - Basic needs for communication and interactions with - This pattern encompasses information related to health other people, as well as meaningful communications and promotion that encourages the older adult to achieve the satisfaction in relationship with others are examined. recommended 30 minutes daily of physical activity on Subjective: Determine family structure, history of most days of the week. relationships, and social interactions with friends and Subjective: Screen for safety related exercise and acquaintances. physical activity, using screening measures such as Objective: Examine the family dynamics of the physical activity readiness questionnaire (PAR-Q). interdependent, dependent, and independent Objective: Obtain vital signs and conduct practices among members. cardiopulmonary and musculoskeletal system Health Perception/ Health Management Pattern assessments. - This pattern encompasses the perceived level of health Rest and Sleep Pattern and current management of any health problems. - This pattern encompasses the sleep and rest patterns Subjective: Determine the level of understanding of over a 24-hour period and their effect on function. any treatments or therapy required for management Subjective: Assess usual sleep patterns, including of health deficits or activities; include assessment of bedtime and arousal time, quality of sleep, sleep J.A.K.E 9 of 25  CARE OF OLDER ADULTS – LEC: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 environment, and distribution of sleep hours within a HEALTH PROMOTION, HEALTH MAINTENANCE AND HOME 24-hour period. HEALTH CONSIDERATIONS Objective: Have a client keep a sleep diary that Promoting Healthy Aging includes naps and rest periods. Healthy People Initiative Sexuality/ Reproductive Pattern - An initiative of the US Department of Health and Human - This pattern encompasses the older adult’s behavioral Services that set forth health care objectives designed to expressions of sexuality. increase the quality and quantity of years of healthy life of Subjective: Assess client’s satisfaction or Americans and to eliminate health disparities. dissatisfaction with current circumstances related to - FOCUS: minimize the loss of independence associated sexual function and intimacy, including perceived with illness and functional decline. satisfaction or dissatisfaction with sexuality or sexual experiences. Components of Health Promotion for the Elderly Objective: Discuss current sexual relationship. When Exercise none is present, elicit the meaning this has for the - Regular exercise and physical activity can improve health client’s overall emotional and physical well-being. in a variety of ways: Elimination Pattern Reduction in Heart Disease, Diabetes, High Blood - This pattern encompasses bowel and bladder excretory pressure, Colon CA, Depression, Anxiety, Excess functions. weight, falling, bone thinning, muscle wasting and Subjective: Assess lifelong elimination habits and joint pain. excretory selfcare routines. - Nursing Implication: Objective: Perform abdominal and rectal examination; Motivate the elderly to have regular exercise and external genitalia and pelvic examination may be increase their physical activity. indicated. Advise the elderly to have continuous exercise. Promote the physical activity and exercise as a habit Planning for the elderly. Exploring older adults’ personal ideas and beliefs concerning health needs Reading current literature regarding latest update for specific health promotion Current health policy information that will safeguard client rights Understanding and use of behavior change theories Implementation Adopting a proactive stance toward an action plan for health promotion of the older individual Activities, locations, and means of disseminating health promotion Annual health promotion screening Program that provide vaccinations for older adult Screening for cancer , diabetes, and other condition Monthly health talks provided in senior centers Housing sites Continuing retirement communities Advocate and educate about health promotion Safe medication use Evaluation Determining effectiveness of care plan Check established goals Establish appropriate and realistic revised goals and realistic steps to achieve them Nutrition - Eating and drinking habits have been implicated in 6:10 leading cause of death in the elderly. - Older adults are more prone to Obesity and Malnutrition. J.A.K.E 10 of 25  CARE OF OLDER ADULTS – LEC: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 - Nursing Implication: Proper Nutrition Gait Disturbances Alcohol Consumption: Men twice a day, Women once Decreased proprioception a day. visual/cognitive impairment Decrease Fats, Decrease Cholesterol Diet polypharmacy Balance Caloric Intake Environmental conditions: Slippery surfaces, stairs, Daily Calcium, Vit. B12, Vit. D, Fruits and Vegetable. irregular surfaces, poor lightning, incorrect foot ware, Mental Health obstacles in the pathways. - Decrease life satisfaction due to: Decrease Income (50%) Fall-risk Assessment: “I HATE FALLING” Increase emotional losses I – nflammation of joints or joint deformity. Physical losses H – ypotension (Orthostatic Blood pressure changes) Caregiving responsibilities. A – uditory and Visual Impairments - Nursing Implication: T – remors Life Review – tool for preserving or enhancing the E – quilibrium problems. mental health of the older adults. F – oot problems. o Life domains A – rrythmias, heart block, valvular disease. o Autobiography, tape recording or videotape. L – eg Discrepancy Depression L – ack of conditioning (General Weakness) o losses that accompanying aging such as I – llness widowhood, chronic medical conditions and pain , N – utrition and functional dependence. G – ait disturbance o Depression may lead to physical Decline. o Plays a significant role in suicidal behaviors. Disease Prevention o Undetected in the elderly. - Helps prevent functional decline. Model Health Promotion Programs for Older Adult - Levels of Disease Prevention: - Programs that have received federal funding and 1) Primary Prevention – designed to completely prevent a foundation supports to evaluate their effectiveness and to disease from occurring. encourage their replication. 2) Secondary Prevention – early detection and - Focus: Older Adults. management of disease. a) Health wise – provides information and prevention 3) Tertiary Prevention – manage clinical disease in order tips on 190 common health problems. to prevent them from progressing or to avoid b) Chronic Disease Self-Management Program complications of the disease. - Founded by Nurse Researcher Kate Lorig. - Chronic Diseases: Self Management Program. Quality of Life c) Project Enhance – Enhance Fitness and Enhance - How a person rates his or her life as satisfactory or not. Wellness. - Degree of Satisfaction and Dissatisfaction with life. d) Ornish Program for Reversing Heart Disease - WHO (1994) An individual’s perception of his or her - Founded by Dr. Dean Ornish position in life in the context of their culture and value - Enhancement of Elderly Nutrition system where they live in and in relation to their goals, e) Benson’s Mind/Body Medical Institute expectations, standards and concerns. - Dr. Herbert Benson - Combination of Relaxation: Nutrition, Exercise, Quality of Life Model and Reframing from Negative thinking patterns. Physical Well Being – Functional Ability, Strength/Fatigue, f) Strong for life Model – exercised program for disabled Sleep/Rest, Nausea, Appetite and Constipation. and nondisabled older adults. Psychological Well Being – Anxiety, Depression, Re-Engagement Instead of Retirement enjoyment, leisure, pain distress, happiness, fear, - The likely alternative to retirement blessed with longevity, cognition/attention. education, health and positive attitude towards remaining Social Well Being – Caregiver burden, roles and engaged. relationship, affection/sexual function, appearance. Green House Spiritual Well Being – Suffering, meaning of pain, religiosity, - Founded by Dr. William Thomas transcendence. - An Innovative and home-like alternative to nursing homes. Safety Quality of Life Program - Falls – leading cause of unintentional injury death in older Active Aging adult. - Integrated health and quality of life program. - Elderly are vulnerable to falls as a result of: - Optimizing opportunities for health, participation in the Postural Instability community and safe living in order to enhance quality of Decrease muscle Strength life. J.A.K.E 11 of 25  CARE OF OLDER ADULTS – LEC: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 - Center of Active Aging: Provide quality of life to the elderly. Economic Determinants - Enhance Autonomy, Independence, and Activity. Social Services Determinants WHO’s Determinants of Health Guidelines for Primary and Secondary Health Promotion - Affects aging and the quality of life of individuals, Activities for Older Adults communities and nations. Health Supportive Behavioral Determinants Promotion Recommendation Evidence a) Physical Activity – contributes to muscle strength, activity flexibility, balance, cardiovascular health and positive Based on mood and improves cognition. Annually starting at age randomized trials; Mammogram 40 and continue q 1 to 3 evidence for age to b) Nutrition – powerful and modifiable lifestyle factors. years until ages 70-85 stop screening not - Increase in Vitamins and Minerals, increase in Vit. B6, well established B12, D, K and folic acids, anti-oxidants Vitamins A,C, Every 1-3 years after 2-3 Based on E, Beta-Carotene, Selenium, Calcium and Iron. Pelvic negative annual randomized trials; c) Smoking – single most important preventable risk factors Examination/ examinations; can evidence for age that cause Premature Death. cervical smear decrease or discontinue stop screening not - 5 A’s : Ask, Advise, Assess, Assist and Arrange. after ages 65-70 well established d) Alcohol Abuse and Alcoholism – Elderly have the Evidence from increase effects of Alcohol because of pharmacologic nonrandomized or changes associated with aging. retrospective Fecal occult Annually after age of 50 studies; fair - Four Steps in Treating Alcoholism: blood test evidence to Identify individuals requiring treatment support Determine individual’s readiness to discuss recommendation treatment. Based on expert Assess individual’s requiring detoxification. Annually after age 50 if opinions or other Plan for post detoxification treatment in Prostate considerations; life expectancy is at least coordination with other professional. examination limited evidence to 10 years support e) Medication Adherence recommendation - Non-Adherence to medication. Encourage aerobic and - Invisible epidemic resistance exercise as - Risk Factors: Exercise Based on tolerated; ideally 30 randomized trials Polypharmacy minutes of moderate Physical Impairments exercise daily Cognitive Limitations Keep daily fat intake at less than 35% of total Limited Access to or affordability of health care Low- calories, and saturated Guidelines not services. cholesterol fat and trans fatty acid well established Low-literacy patients. diet intake at less than 7% of - Strategy: calories Promote Self-efficiency. Moderate alcohol use, Empower patients to become informed defined as 1 drink daily medication consumers. that does not exceed 1.5 ounces (45ml) of liquor, 5 Guidelines/safety Avoid strategies that could intimidate. Alcohol intake ounces (180 ml) of wine, not well Help the patient to develop a lists of short term or a standard can of beer established goal and long term goals. (National Institute on Plan for regular follow-up Alcohol Abuse and Implement a reward system. Alcoholism,2001) Personal Determinants - Biological Home care and Hospice - Genetic Impacts Home Health Care Psychological Determinants - Consists of multiple health and social services delivered - Intelligence to recovering, chronically ill, or disabled individuals of all - Cognitive Capacity ages in their place of residence. Physical Determinants - Three main categories of home care providers: - Safe Housing 1) Home care organizations (National Association for Social Determinants Home Care) - Social Support 2) Medicare-certified agencies include hospice and - Violence and Abuse freestanding - Education and Literacy 3) Facility-based home health agencies. J.A.K.E 12 of 25  CARE OF OLDER ADULTS – LEC: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 - Benefits of HOME CARE services are individuals who: nursing assistant services, additional therapies as 1) Have a chronic medical conditions with exacerbations, needed (e.g., physical, occupational, and speech such as congestive heart Failure, COPD, therapy), in patient related to difficulty in managing unstable diabetes, kidney and liver disease with symptoms, medications, supplies, equipment, subsequent transplantation, or recent strokes volunteers, respite services, continuous care in times 2) Have chronic mental illnesses, such as depression, of crisis, and bereavement services. schizophrenia, and other Psychoses 3) Need assistance with medical regimens to prevent Community based service providers readmission to an acute care facility - Challenged to develop affordable and appropriate 4) Need continued treatment after discharge from a programs to assist older adults to remain in the home hospital facility (e.g. wound care, intravenous therapy). while maintaining a good quality of life. 5) Require short-term assistance at home after same- - Community-services for older adults include: day or outpatient surgery, are terminally ill and want Respite care – short-term relief or time off for persons to die, or have families that want them to die with providing home care to ill, disabled, or frail older dignity in the comfort of their homes. adults. Adult day care services are a form of respite - Role of Home Care Agency: provided outside the home. It provided at home or in Referrals are called in the home care agency (agency institutional settings such as specially designated confirms home care benefits) hospital or nursing facility. Schedules the admission visits Adult day care programs – provide a variety of health Communicates the referral information to the nurse and social services to older adults who live alone or who will admitting the client with their families in the community. - Nurse’s Role: Senior citizen centers – senior centers are community For initial evaluation facilities that provide a broad range of services to o Assess physical, functional, emotional, older adults in the community. These services include socioeconomic, and environmental well-being 1) health screening: o Initiate plan of care 2) health promotion and wellness programs; o Skills include: 3) social, educational, and recreational activities; - Health and self-care teaching 4) congregate meals; and - Coordination and case management of information and referral services for older complex care needs individuals and their families. - Medication administration and teaching Homemaker programs – Homemaker services include about all medications such things as housecleaning, laundry, food shopping, - Wound and decubitus care meal preparation, and running errands. - Urinary catheter care and teaching Home– delivered meals – Nutrition services provide - Ostomy care and teaching older adults with inexpensive, nutritious meals at - Postsurgical care home, or in group settings. - Care of terminally ill client Transportation – many communities provide - Case management transportation services for disabled older adults - Intravenous therapy, enteral and parenteral through public or private agencies. nutrition, and chemotherapy - Psychiatric nursing care Factors affecting the Health Care needs of non- Hospice institutionalized older adult - Dying is the final phase in the trajectory of a chronic Functional status – Term used to describe an individual’s illness. Terminal illnesses such as cancer and acquired ability to perform the normal, expected, or required immunodeficiency syndrome (AIDS) remain incurable. activities for self-care. However, because of pharmacologic and technologic Cognitive function – Assess cognitive impairment which advances in treatments, cancer and AIDS are now affects an individual’s functional status considered chronic illnesses. - Many chronically ill persons choose to remain their homes Housing Options for Older Adults during the last phase of their illness to prepare for death in Type of housing Description of housing familiar surroundings, together with family and friends. This is a self- contained apartment unit - Hospice provides care and services to terminally ill within a house that allows an individual to persons and their families that enable individuals to die in live independently without living alone. It facilities or at home. Accessory generates additional income for older apartment - Hospice Services homeowners and allows older renters to live Comprehensive hospice program include: Physician near relatives or friends and remain in a services, nursing care, medical social work, familiar community. counseling services and spiritual care, certified J.A.K.E 13 of 25  CARE OF OLDER ADULTS – LEC: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 Assisted living This is a rental housing arrangement that - 2 Categories in Community Services: facility (also provides room, meals, utilities, and laundry 1) Formal – services that provides assessment, called board and and housekeeping services for a group of observation, teaching, certain technical skills and care home; residents. Such facilities offer a homelike personal care for short-period of time. personal care atmosphere in which residents share meals 2) Informal services – include senior citizen centers, home; or and have opportunities to interact. What sheltered care, distinguishes these facilities from simple adult care services, nutrition services, transportation residential care, boarding homes is that they provide services, and telephone monitoring services. or domiciliary protective oversight and regular contact with care facility) staff members. Assisted Living Programs Congregate housing was authorized in 1970 - An increasingly attractive long-term care setting, placed by the housing and Urban Development Act. between home care and the nursing facility in the It is a group-living arrangement, usually an continuum of long-term care. Congregate apartment complex, that provides tenants - Regulations are minimum, so there is great diversity in the housing with private living units (including kitchen types of service delivery models used, the types of facilities), housekeeping services, and meals served in a central dining room. services offered, and the setting within which assisted Elder Cottage This is a small, self-contained portable unit living is provided. Housing that can be placed in the backyard or at the - Assisted living settings are homelike and offer an array of Opportunity side of a single-family dwelling. services, including meals, assistance with bathing and Foster care for adults is similar in concept to dressing, social and recreational programs, personal foster care for children. It is a social service laundry and housekeeping services, transportation, 24- administered by the state that places an hour security, an emergency call system, health checks, Foster home care older person who needs some protective medication administration, and minor medical treatments. oversight or a assistance with personal care - Many services are purchased individually as needed by in a family environment. the resident. Home sharing involves two or more Home sharing unrelated people living together in a house or apartment. Special Care Units This is facility designed to support the - Since the 1980s the popularity of specialized units for Life care or concept of “ aging in place”. It persons with dementia has expanded. continuing care retirement provides a continuum of living arrangements - Special care unit (SCU) is the designation given to and care-from assistance with household freestanding facilities or units within nursing facilities that community chores to nursing facility care- all within a specialize in the care of people with Alzheimer’s disease (CCRC) single retirement community. and other types of dementing illnesses. (Philippines A non-stock and non-profit organization, - Behavioral manifestations of dementia are managed in the settings) Kanlungan ni Maria is a home for the aged in Kanlungan ni the Philippines serving to provide true home environment without the use of chemical or physical Maria Home for to all abandoned, poor, sick and homeless restraints whenever possible. the elderly in the country. Aged Geriatrics Units Golden Reception a 24-hour, 7-day-a-week and assessment/diagnostic and residential Action Center for care facility that provides residential care the to abandoned, neglected, unattached and Elderly and Other homeless Filipino Senior Citizen who are 60 Special years old. Cases Emmaus House of Apostolate, Inc. (EHA) is a shelter for the homeless, old and sickly people who have been given up by their EMMAUS house families for a lot of reasons. One common Subacute Care of apostolate thing, though, they need other people to love - Subacute care has become an increasingly popular level and care for them. (Matt 22: 39 /1 John 3: 18) of care. The growth of subacute care has been spurred by the belief that up to 40 % of clients in acute medical or Community-Based Services rehabilitation hospital units could be treated as effectively - Assessment of functional status aids in determining the in less costly settings. type of services an older adult needs to remain in his or - Persons in a subacute unit are stable and no longer her home. The type of services needed, the availability of acutely ill or requiring daily physician visits. They may the services, the cost of the services, and the require services such as rehabilitation, intravenous requirements to qualify for the services can be determined medication therapy, parenteral nutrition, complex by a home health agency. respiratory care, and wound management. J.A.K.E 14 of 25  CARE OF OLDER ADULTS – LEC: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 Physical Care of Older Adults (Aging skin and mucous irritation can be severe and can cause intense discomfort Membranes) to older adults. In fact, it may be so distracting that affected individuals cease to participate in social activities. - Dry, scaly skin commonly seen in older adults. Rashes and Irritation - Rashes and skin irritation can be caused by factors other than dryness. Medications, communicable diseases, and contact with chemical substances are common causes of skin rashes and pruritus. - Drug-induced skin reactions are seen more commonly among older patients than in younger patients. - Use of a potent topical corticosteroid has resulted in severe striae. - The atrophy was so severe that the skin tore, forming an ulcer. - Allergic response to medications can manifest as diffuse rashes over the body. Whenever a rash develops soon after administration of new medication, an allergy should be suspected. It is appropriate to withhold that particular medication and contact the physician to report the symptom. - One communicable source of skin irritation and severe pruritus is scabies. Scabies is a superficial infection caused by a parasitic mite (Sarcoptes scabiei var. hominis) that burrows under the skin. Older adults, especially individuals who suffer from chronic illness, - Complete assessment of skin, hair, and nails is best done dementia, or a depressed immune system, are particularly when the person is undressed so that all skin surfaces can vulnerable to scabies infections. Signs of scabies include be inspected. Skin assessment can be performed during a intense itching and fine, dark, wavy lines at the flexor bath, during daily personal hygiene, at bedtime, or at any surface of the wrist or elbow, the webbed area of the other convenient time for the older person. fingers, the axilla, and the genitals. Recognition of scabies - Independent older persons should be aware of what is may be difficult in older adults because it has an normal for themselves, and they should bring any changes asymptomatic incubation period of 4 to 6 weeks and to the attention of the physician. In a hospital or extended- because atypical presentations are common. When care setting, privacy must be maintained and modesty infestation is suspected, skin scrapings should be protected during the skin inspection. examined to determine the presence of ova or mites. - Assessment of the skin and ancillary structures is an Pigmentation important responsibility of nurses. - Changes in skin pigmentation are common with aging. - Nursing assistants and attendant health care workers who Many of the changes are cosmetic and do not cause assist with bathing or other care should be instructed to problems unless they are located on the face or arms, report any unusual or questionable observations promptly where they may be distressing to the affected person. to a nurse for further investigation. - Common conditions such as acne rosacea can be treated - Inspection should follow a logical order so that no with topical medications, which help heal the skin and pertinent observations are missed. Most nurses find that a reduce redness, whereas others can be concealed by head-to-toe progression is the most helpful. appropriate use of cosmetics. Dry Skin - Changes in the size or pigmentation of moles are of - One of the most common problems of aging. Various greater significance because these changes may indicate studies have shown that 75% to 85% of people older than the presence of a precancerous or cancerous condition 65 years of age experience some degree of problem with that needs immediate medical attention. dry skin. Tissue Integrity - Physiologic changes, excessive bathing, the use of harsh - Breaks in tissue integrity increase the older person’s risk soaps, and a dry environment all contribute to problems for infection and often result in the need for costly, time- with dry skin. consuming treatments. - Dry skin can result in itching (pruritus), burning, and - These breaks can cause disfigurement and are frightening cracking of the skin. Many older people develop a habit of to older adults. scratching or picking at dry or cracked skin, increasing - Skin tears, abrasions, lacerations, and ulcers most often their risk for further tissue damage and infection. Skin result from friction, shearing force, moisture, and pressure. J.A.K.E 15 of 25  CARE OF OLDER ADULTS – LEC: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 - Even simple incidents such as contact with furniture, Dysphagia – The incidence of swallowing difficulties sliding across bed linens, a grip during a transfer, or the increases with age. Dysphagia can be oropharengeal, removal of tape may result in significant skin trauma to characterized by difficulty transferring food bolus or liquid the older person. from the mouth into the pharynx and esophagus and more Pressure Ulcers common in persons with neurologic damage, or - Pressure ulcers are a particular risk to older adults who esophageal, involving difficulty with the transfer of food suffer from compromised circulation, restricted mobility, down the esophagus and more common in persons with altered level of consciousness, fecal or urinary motility disorders, sphincter abnormalities, or mechanical incontinence, or nutritional problems. obstructions caused by strictures. - Studies estimating the occurrence of pressure ulcers vary Fecal Impaction – Prevention of constipation aids in widely, but one consistent point is that they occur in all avoiding fecal impaction. Observing the frequency and settings. Although most studies show that the incidence character of bowel movements may aid in detecting the of pressure ulcers has declined, there is still much work to development of an impaction; bowel elimination record is be done. Pressure ulcers have negative e