NRG-303 Geriatrics Lecture: Aging and Healthcare - PDF

NRG 303: GERIATRICS LEC THIRD YEAR - SECOND SEMESTER | SY. 2024 - 2025 and the consequences of these problems for older adults and so...

NRG 303: GERIATRICS LEC THIRD YEAR - SECOND SEMESTER | SY. 2024 - 2025 and the consequences of these problems for older adults and society. OVERVIEW OF AGING: CHAPTER 1 - ​ Affects nursing, health care, and all areas of our TRENDS AND ISSUES society—including housing, education, and politics. HISTORICAL PERSPECTIVE ON THE STUDY OF AGING GERONTICS, OR GERONTIC NURSING ​ 1960s-sociologists, psychologists, and health care ​ Coined by Gunter and Estes in 1979 -the nursing care providers focused their attention on meeting the and the service provided to older adults. needs of the typical or average adult: people between ​ Encompasses a holistic view of aging with the goal of 20 and 65 years of age. increasing health, providing comfort, and caring for ​ This group was the largest and most economically older adult needs productive segment of the population; they were raising families, working, and contributing to the ATTITUDE TOWARD AGING economy. ​ Before we look at the attitudes of others, it is ​ Only a small percentage of the population lived important to examine our own attitudes, values, and beyond age 65. Disability, illness, and early death knowledge about aging. The three Critical Thinking were accepted as natural and unavoidable. boxes that follow are designed to help you assess ​ late 1960s-research began to indicate that adults of how you feel about aging. all ages are not the same ​ At the same time, the focus of health care shifted from illness to wellness. ​ Disability and disease were no longer considered unavoidable parts of aging. *Increased medical knowledge, improved preventive health practices, and technologic advances helped more people live longer, healthier lives. ​ Older adults now constitute a significant group in society, and interest in the study of aging is increasing. The study of aging will be a major area of attention for years to come GERIATRIC ​ Greek words “geras,” meaning old age, and “iatro,” meaning relating to medical treatment. ​ Deals with the physiology of aging and with the diagnosis and treatment of diseases affecting older adults. ​ By definition, focuses on abnormal conditions and the medical treatment of these condition GERONTOLOGY ​ Greek words “gero,” meaning related to old age, and “ology,” meaning the study of. ​ Thus, gerontology is the study of all aspects of the aging process, including the clinical, psychologic, economic, and sociologic problems of older adults JULIANNA G. JOVENIR ♡ XANDRIXMIL ANGELOU PRIETO 1  ​ Ageism allows the young to separate themselves physically and emotionally from the old and to view older adults as somehow having less human value. AGE DISCRIMINATION ​ Age discrimination reaches beyond emotions and leads to actions; older adults are treated differently simply because of their age. ○​ Examples of age discrimination include GERONTOPHOBIA refusing to hire older people, not approving ​ the fear of aging and the refusal to accept older adults them for home loans, and limiting the types into the mainstream of society or amount of health care they receive. ​ senior citizens and younger persons can fall prey to ​ Age discrimination is illegal. such irrational fears ​ Some older adults respond to age discrimination with ​ Gerontophobia sometimes results in very odd a passive acceptance, whereas others are banding behavior. together to speak up for their rights ○​ Teenagers buy anti-wrinkle creams. ○​ Thirty-year-old women consider facelifts. The extreme forms of gerontophobia are ageism and age ○​ Forty-year-old women have hair transplants. discrimination ○​ Long-term marriages dissolve so that one spouse can pursue someone younger. HEALTHCARE PROVISIONS ​ Often these behaviors arise from the fear of growing MEDICARE AND MEDICAID older. ​ government program that provides health care funding for older adults and disabled persons. AGING: MYTH VERSUS FACT RISING COSTS AND LEGISLATIVE ACTIVITY MYTHS: OLDER ADULTS ​ costs of health care have increased dramatically in ​ Are pretty much all alike. recent years. ​ Generally are alone and lonely. ​ The United States spends more money on health care ​ Tend to be sick, frail, and dependent on others. than any other country in the world, yet health care is ​ Are often cognitively impaired. not provided for all U.S. citizens. ​ Suffer from depression. ​ Become more difficult and rigid with advancing years. ​ Can barely cope with the inevitable declines COSTS AND END-OF-LIFE CARE associated with aging. ​ Not all older people use the available health care resources equally. FACTS: OLDER ADULTS ​ Most health care services are consumed by the very ​ Aro a very diverse age group. ill or terminally ill minority, many of whom happen to ​ Typically maintain close contact with family. be older adults. ​ Usually live independently. ​ Financial concerns are forcing health care providers ​ May experience some decline in intellectual abilities, and society to face ethical dilemmas regarding the but it is usually not severe enough to cause problems allocation of limited health care resources. in daily living ​ Generally have lower rates of diagnosable depression when they live in community settings, when compared ADVANCE DIRECTIVE AND POLST with younger adults. ​ Tend to maintain a consistent personality throughout ADVANCE DIRECTIVES the life span. ​ Are legally recognized documents that specify the ​ Typically adjust well to the challenges of aging. types of care and treatment the individual desires when that individual cannot speak for himself or AGEISM herself. ​ Ageism is the disliking of aging and older adults ​ Areas typically addressed in advance directives based on the belief that aging makes people include: unattractive, unintelligent, and unproductive. 1.​ do not attempt to resuscitate (DNAR) or ​ It is an emotional prejudice or discrimination against allow natural death (AND) orders; people based solely on age. 2.​ directives related to mechanical ventilation; and JULIANNA G. JOVENIR ♡ XANDRIXMIL ANGELOU PRIETO 2  3.​ directives related to artificial nutrition and ​ The number of people in the younger generations is hydration. decreasing in proportion to the number of older ​ Two formal types of advance directive are members. recognized in most states: ​ There is an increasing number of widows who may be 1.​ the durable power of attorney for health care; unprepared to provide for their own needs and will and need assistance. 2.​ the living will. ​ The role of women is changing. As women increasingly must work outside the home, many are ➔​ Information about both of these is typically attempting to meet the demands of their parents, provided when a person enters the hospital. home, children, and workplace. POLST (PHYSICIAN ORDERS FOR LIFE-SUSTAINING THE FAMILY TREATMENT) ​ a legal document that has been adopted by several AGE (YEARS) GENERATION states and takes the person’s wishes further by creating actual doctor’s orders to be carried out by 80+ Parents emergency personnel. ​ contains three or four sections, depending on the 60+ Children state, including specifics about: ○​ CPR (whether to attempt resuscitation or 40+ Grandchildren allow natural death), medical interventions (comfort care, limited interventions, or full 20+ Great-children treatment including when to transfer to Less than 20 Great-great-grandchildren hospital), ○​ antibiotics (use freely, use for comfort, or don’t use at all), and ➔​ A family crisis may occur when the aging person is no ○​ artificial nutrition (no tube feeding, trial of longer able to live alone. tube feeding, or long-term tube feeding). ➔​ Most families find that there is no perfect solution. ➔​ The two most common options: ◆​ bringing the aging parent into the home of one of the children ◆​ placing the parent in a long-term care facility THE NURSE AND FAMILY INTERACTIONS ​ When we as nurses care for older adults, particularly in hospital or nursing home settings, we see the person only as he or she is now. ​ We often forget that these people have not always been old. They lived, loved, worked, argued, and wept as each of us does. ​ Often, the older adults we care for are very ill or infirm, and, as nurses, we tend to focus on their physical needs, cares, and treatments. ​ In our preoccupation with our duties, we can easily lose our perspective of the older patient as both a person and a member of a family. ​ Coping with stresses related to aging is difficult for IMPACT OF AGING IN THE FAMILY both the aging individual and for the family. ​ The behavior we see at any given time is the best that DEMOGRAPHIC CHANGES AFFECTING THE FAMILY the person is capable of at that time. That does not ​ Extended life spans are leading to more older family mean that it is the best that he or she will be capable members. of at some other time. ​ More people are living with chronic conditions and ​ We as nurses need to examine the stresses affecting need some degree of care or assistance. the family so that we can best respond to the needs of all family members JULIANNA G. JOVENIR ♡ XANDRIXMIL ANGELOU PRIETO 3  ABUSE AND NEGLECT ​ Malnutrition or dehydration ​ are usually something done to someone, but, ​ Burns or pressure sores unfortunately, self-neglect is a common problem in the ​ Bruises, particularly clustered on trunk or upper arms ​ Bruises in various stages of healing that may indicate older adult population. repeated injury ​ Inadequate clothing or footwear SELF-NEGLECT ​ Inadequate medical attention ​ Self-neglect is defined as the failure to provide for the ​ Lack of food, medication, or care self because of a lack of ability or lack of awareness. ​ Verbalization of being left alone or isolated ​ Self-neglect is more likely to be seen when an older ​ Verbalization of fear of the caregiver person has few or no close family or friends, but it can ​ Verbalization of a lack of control in personal activities occur despite their presence. or finances ​ Because our society has laws to protect the rights of adults, it may be difficult for concerned parties to ABUSE can be physical, financial, psychological, or intervene until a situation has reached critical or even emotional. life threatening proportions. ​ Indicators of self-neglect include the following: Neglect and abandonment also constitute forms of abuse ○​ The inability to maintain activities of daily living such as personal care, shopping, meal preparation, or other household tasks ○​ The inability to obtain adequate food and ABUSIVE BEHAVIOR IN HEALTHCARE SETTINGS fluid as indicated by malnutrition or ​ Use of sedative or hypnotic drugs that are not dehydration medically necessary ○​ The inability to manage personal finances as ​ Use of restraints when they are not medically indicated by the failure to pay bills or by indicated hoarding, squandering, or giving away ​ Use of derogatory language, angry verbal money inappropriately interactions, or ethnic slurs ○​ Changes in mental function, such as ​ Withholding of privileges such as snacks or cigarettes confusion, inappropriate responses, ​ Excessive roughness in handling during care or disorientation, or incoherence during transfers ○​ Poor hygiene practices as indicated by body ​ Delay in taking a resident to the bathroom or allowing odor, sores, rashes, or inadequate or soiled a resident to lie in body waste clothing. ​ Consumption of a resident's food ○​ Failure to keep important business or ​ Theft of money or personal belongings medical appointments. ​ Physical striking or any other assaultive behavior ○​ Life-threatening or suicidal acts, such as toward a resident wandering, isolation, or substance abuse. ​ Violation of a resident's right to make decisions ​ Failure to provide privacy ABUSIVE BEHAVIOR CANNOT BE JUSTIFIED AT ANY TIME OR IN ANY WAY ELDER ABUSE IN INSTITUTIONS ​ Intentional abuse is most likely to occur in families ​ Abuse in institutional settings is most likely to occur with pre existing behavioral or social problems. when the nursing assistants are forced to work under ​ High risk families include those that have a history stressful condi-tions and have a poor ability to deal of family conflict and those with a history of violence with that stress. The risk for abuse increases when or substance abuse, those with mental impairment of caregivers perceive that they are not valued, either the dependent person or caregiver, and those supported, or acknowledged. with severe financial problems or unemployment. ​ The following are ways that may help decrease stress ​ Unintentional abuse or neglect is most likely to and the likelihood of abuse: occur when the caregiver lacks the necessary ○​ Create a positive team environment with full knowledge, stamina, or resources needed to care for staffing levels; convey true respect and an older loved one. appreciation for the work every team ​ Often, the caregiver is an older spouse or an aging member does. child who physically cannot meet the high-level care ○​ Encourage staff to take breaks on time, and demands. Situations that trigger abuse are more likely to rest and re-energize with healthy snacks. when the older person requiring care is confused or Provide a staff member responsible for needs continual care "break relief" so that care may continue during breaks. SIGNS THE OLDER PERSON MAY BE ○​ Rotate any "difficult" assignments, to avoid EXPERIENCING ABUSE overwhelming any one team member. ○​ Improve staff training to identify and defuse ​ Excessive agreement or compliance with the potential abuse situations. caregiver ○​ Initiate a stress-reduction program, including ​ Signs of poor hygiene such as body odor, staff support groups and exercise options. uncleanliness, or soiled clothing or undergarments JULIANNA G. JOVENIR ♡ XANDRIXMIL ANGELOU PRIETO 4  ○​ Recognize the value of nursing assistants to the team's effort by involving them in care planning and consulting with them regarding potential problems and possible solutions. ○​ Increase recognition of good, compassionate caregiving through verbal praise, employee-of-the-month recognition, bonuses, and other rewards. ○​ Institute a "get to know the resident" program, whereby on a monthly basis, one resident is featured, with accomplishments from his or her past. Team members may be surprised to learn that the dependent older adult they now care for once served as an elite military Special Forces member, raised twelve children, volunteered as a docent at the local aquarium, or played in a rock band. ○​ Provide an institutional mechanism for dealing with nursing assistants' complaints and concerns in a proactive rather than punitive manner SUPPORT GROUPS ​ Caregivers who want or need to share their experiences and frustrations have started forming support groups to help one another cope with stress. ​ Support groups allow caregivers to share their feelings and to learn new strategies to improve coping skills. ​ A wide variety of services to reduce abuse and to meet the emotional and physical needs of older adults and their caregivers are available. RESPITE CARE ​ Respite care allows the primary caregiver to have time away from the demands of caregiving, thereby decreasing stress and the risk for abuse. ​ Respite care gives the primary caregiver the opportunity to attend church, go shopping, conduct personal business, obtain medical care, or simply participate in leisure activities JULIANNA G. JOVENIR ♡ XANDRIXMIL ANGELOU PRIETO 5  CHAPTER 2 - THEORIES OF AGING ERROR THEORY ​ proposes that errors in ribonucleic acid protein synthesis cause errors to occur in cells in the body, “For the unlearned, old age is winter; for the learned, it resulting in a progressive decline in biologic function is the season of the harvest.” SOMATIC MUTATION THEORY INTRODUCTION ​ is similar but proposes that aging results from ​ The maximal life expectancy for humans today deoxyribonucleic acid (DNA) damage caused by appears to be 120 years, but why is this so? exposure to chemicals or radiation and that this ​ Theories of aging have been considered throughout damage causes chromosomal abnormalities that lead to disease or loss of function later in life. history as mankind has sought to find ways to avoid aging. FREE RADICAL THEORY ​ No one has identified a single unified rationale for why ​ The Free Radical Theory provides one explanation for we age and why different people live lives of different cell damage. lengths. Theories abound to help explain and give ​ Free radicals are unstable molecules produced by the some logical order to our observations. Observations, body during the normal processes of respiration and including physical and behavioral data, are collected metabolism or following exposure to radiation and and studied to scientifically prove or disprove their pollution. ​ These free radicals are suspected to cause damage effects on aging. to the cells, DNA, and the immune system. THEORIES VS. FACT EXCESSIVE FREE RADICAL ACCUMULATION ​ Fact: Observations about the world around us. ​ in the body is purported to contribute to the ○​ Example: “It’s bright outside.” physiologic changes of aging and a variety of ​ Theory: A well-substantiated explanation acquired diseases such as: through the scientific method and repeatedly tested ○​ Arthritis and confirmed through observation and ○​ Circulatory diseases experimentation. ○​ Diabetes ○​ Atherosclerosis ○​ Example: “When the sun is out, it tends to make it bright outside.” ➔​ One free radical, named lipofuscin, has been identified to cause a buildup of fatty pigment granules BIOLOGICAL THEORIES that cause age spots in older adults. PROGRAMMED THEORY ➔​ Individuals who support this theory propose that the ​ proposes that everyone has a “biologic clock” that number of free radicals can be reduced by the use of ANTIOXIDANTS, such as vitamins A, C, and E, starts ticking at conception. carotenoids, zinc, selenium, and phytochemicals. ​ In this theory, each individual has a genetic “program” specifying an unknown but predetermined CROSSLINK OR CONNECTIVE TISSUE THEORY number of cell divisions. As the program plays out, ​ Which proposes that cell molecules from DNA and the person experiences predictable changes such as connective tissue interact with free radicals to cause atrophy of the thymus, menopause, skin changes, bonds that decrease the ability of tissue to replace and graying of the hair itself. This results in the skin changes typically attributed to aging such as dryness, wrinkles, and loss of elasticity. RUNOUT-OF-PROGRAM THEORY ​ proposes that every person has a limited amount of WEAR-AND-TEAR THEORY genetic material that will run out eventually ​ presumes that the body is similar to a machine, which loses function when its parts wear out, damaged by RATE OF LIVING THEORY internal or external stressors. ​ proposes that individuals have a finite number of ​ When enough damage occurs to the body’s parts, breaths or heartbeats that are used up over time overall functioning decreases. This theory also proposes that good health maintenance practices GENE THEORY will reduce the rate of wear and tear, resulting in ​ proposes the existence of one or more harmful genes longer and better body function. that activate over time, resulting in the typical changes seen with aging and limiting the life span of CLINKER THEORY the individual. ​ combines the somatic mutation, free radical, and crosslink theories to suggest that chemicals produced by metabolism accumulate in normal JULIANNA G. JOVENIR ♡ XANDRIXMIL ANGELOU PRIETO 6  cells and cause damage to body organs, such as Many of these theories are specific in identifying the muscles, heart, nerves, and brain. life-oriented tasks for the aging person. Four of the most common theories—Erikson’s, Havighurst’s, Newman’s, NEUROENDOCRINE THEORY and Jung’s—are worth exploring. ​ Focuses on the complicated chemical interactions set off by the hypothalamus of the brain. ERIKSON’S EIGHT STAGES OF PSYCHOSOCIAL ​ With age, the hypothalamus appears to be less DEVELOPMENT precise in regulating endocrine function, leading to age - related changes such as decreased muscle If needs are mass, increased body fat, and changes in dependably met, reproductive function. Trust vs. 0-8 Infant infants develop a Mistrust months sense of basic RELIABILITY THEORY OF AGING AND LONGEVITY trust. ​ is a complex mathematical model of system failures first used to describe failure of complex electronic Toddlers learn to equipment. It is used as a model to describe Autonomy exercise will and do degradation (disease) and failure (death) of human 18 months vs Shame & Toddler things for body systems. - 3 years Doubt themselves, or they doubt their abilities. IMMUNOLOGIC THEORY ​ The Immunologic Theory proposes that aging is a Preschoolers learn function of changes in the immune system. to initiate tasks and ​ According to this theory, the immune system— an Initiative vs 3-5 carry out plans, or important defense mechanism of the body — Pre-schooler Guilt years they feel guilty weakens over time, making an aging person more about efforts to be susceptible to disease. independent. ​ The immunologic theory also proposes that the increase in autoimmune diseases and allergies seen Children learn the with aging is caused by changes in the immune pleasure of system. Industry vs 5 - 13 applying Grade-schooler Inferiority years themselves to PSYCHOSOCIAL THEORIES tasks, or they feel inferior. DISENGAGEMENT THEORY ​ This theory was developed to explain why aging Teenagers work at persons separate from the mainstream of society. refining a sense of ​ This theory proposes that older people are self by testing roles systematically separated, excluded, or disengaged and then Identity vs 13 - 21 integrating them to from society because they are not perceived to be of Role Teenager years form a single benefit to the society. Confusion iden-tity, or they ​ This theory further proposes that older adults desire become confused to withdraw from society as they age; the about who they disengagement is mutually beneficial. are. ACTIVITY THEORY Young adults ​ proposes that activity is necessary for successful struggle to form close relationships aging. Intimacy vs 21 - 39 and to gain the ​ Active participation in physical and mental activities Young Adult Isolation years capacity for helps maintain functioning well into old age intimate love, or ​ Purposeful activities and interactions that promote self they feel socially -esteem improve overall satisfaction with life, even at isolated an older age. ​ “Busy work” activities and casual interaction with The middle-aged others were not shown to improve the self -esteem of discover a sense of contributing to the older adults. Generativity 40 - 65 Middle-age world, usually vs years Adult through family and Life-course theories are perhaps the theories best known Stagnation work, or they may to nursing. These theories trace personality and personal feel a lack of adjustment throughout a person’s life. purpose JULIANNA G. JOVENIR ♡ XANDRIXMIL ANGELOU PRIETO 7  NEWMAN’S THEORY When reflecting on his or her life, the ​ Newman’s theory identifies the tasks of aging as: Integrity vs 65 years older adult may feel 1.​ Coping with the physical changes of aging; Older Adult 2.​ Redirecting energy to new activities and Despair onwards a sense of satisfaction or roles, including retirement, grandparenting, failure and widowhood; 3.​ Accepting one’s own life; and 4.​ Developing a point of view about death. EXAMPLES OF HAVIGHURST’S DEVELOPMENTAL TASKS JUNG’S THEORY AGE RANGE DEVELOPMENTAL TASKS ​ Proposes that development continues throughout life by a process of searching, questioning, and setting Infancy and Early ​ Learn to walk goals that are consistent with the individual’s Childhood ​ Learn to use the toilet personality 0-5 years old ​ Learn to talk ​ As aging continues, Jung proposes that the individual ​ Learn to form relationship with is likely to shift from an outward focus (with concerns others about success and social position) to a more inward focus. Middle Childhood ​ Learn school-related skills such as ​ Successful aging, according to Jung, includes 6-12 years old reading ​ Learn about conscience and values acceptance and valuing of the self without regard to ​ Learn to be independent the view of others ​ MIDLIFE CRISIS can lead to radical career or lifestyle Adolescence ​ Establish emotional independence changes or to the acceptance of the self as is. 13-17 years old ​ Learn skills needed for productive occupation IMPLICATION FOR NURSING ​ Achieve gender-based social role ​ Physical theories of aging indicate that, although ​ Establish mature relationships with biology places some limitations on life and life peers expectancy, other factors are subject to behavior and life choices. Early Adulthood ​ Choose a life partner ​ Nursing can help individuals achieve the longest, 18-35 years old ​ Establish a family healthiest lives possible by promoting good health ​ Take care of a home maintenance practices and a healthy environment. ​ Establish a career ​ Psychosocial theories help explain the variety of behaviors seen in the aging population. Middle Age ​ Maintain a standard of living ​ Understanding all of these theories can help nurses 36-60 years old ​ Perform civic and social recognize problems and provide nursing responsibilities interventions that will help aging individuals ​ Maintain a relationship with spouse successfully meet the developmental tasks of aging. ​ Adjust to physiological changes Reference: Williams: Basic Geriatric Nursing, 6th Edition Later Maturity ​ Adjust to deteriorating health Over 60 years old ​ Adjust to retirement. ​ Meet social and civil obligations ​ Adjust to loss of spouse ➔​ HAVIGHURST’S THEORY details the process of aging and defines specific tasks for late life, including: 1.​ Adjusting to decreased physical strength and health; 2.​ Adjusting to retirement and decreased income; 3.​ Adjusting to the loss of a spouse; 4.​ Establishing a relationship with one’s age group; 5.​ Adapting to social roles in a flexible way; and 6.​ Establishing satisfactory living arrangements. JULIANNA G. JOVENIR ♡ XANDRIXMIL ANGELOU PRIETO 8  CHAPTER 3 - PHYSIOLOGIC CHANGES yellowing of nails INTRODUCTION Increased Increased facial hair in women ​ We can observe many normal changes in the body’s androgen/estrogen ratio structure and function during the aging process. ​ There are also changes that indicate the onset of disease or illness. ​ Nurses are expected to be able to distinguish between normal changes and abnormal changes that signify a need for medical or nursing intervention. ​ To identify these differences, nurses must have a good understanding of the normal body structures and functions. This knowledge should help nurses understand how normal and abnormal changes affect the day-to-day functional abilities of older adults. ​ As nurses, we must be aware of physical changes that are likely to occur, assess each person to determine the extent to which these changes have occurred, and then make our care plans in response to that individual’s needs. Seborrheic keratoses usually appear at approximately the fifth decade of life and gradually increase in number with age. INTEGUMENTARY SYSTEM These superficial, benign growths can enlarge to 20 mm in diameter and have a convoluted surface. EXPECTED AGE-RELATED CHANGES INTEGUMENTARY CHANGES ASSOCIATED WITH AGING PHYSIOLOGIC CHANGE RESULTS Decreased vascularity of Increased pallor in white skin dermis Decreased amount of Decreased hair color (graying) melanin Decreased sebaceous and Increased dry skin; decreased sweat gland function perspiration Decreased subcutaneous fat Increased wrinkling Xerosis Decreased thickness of Increased susceptibility to trauma NURSING ASSESSMENTS AND CARE STRATEGIES RELATED epidermis TO INTEGUMENTARY CHANGES Increased localized Increased incidence of brown spots pigmentation (senile lentigo) NURSING ASSESSMENTS CARE STRATEGIES Increased purple patches (senile Adjust room temperature and Increased capillary fragility Monitor skin temperature. provide adequate clothing or covers purpura) to prevent chilling. Decreased density of hair Decreased amount and thickness of growth hair on head and body Assess skin turgor over sternum or forehead, not Provide adequate fluid to prevent Decreased rate of nail forearm. Check tongue for dehydration. Increased brittleness of nails furrows growth Decreased peripheral Increased longitudinal ridges of Assess for skin breakdown Institute measures to reduce circulation nails; increased thickening and or changes in color or pressure over bony prominences; JULIANNA G. JOVENIR ♡ XANDRIXMIL ANGELOU PRIETO 9 pigmentation. possible dermatology referral. Assess areas where skin surfaces touch and trap Keep skin dry. Pad surfaces to moisture (under breasts, reduce friction. Report abnormal adipose rolls, etc.) for signs observations for treatment. of maceration or yeast Infection Determine adequacy of Modify skin care to reduce drying. hygiene and need for toenail Refer to podiatrist trimming. COMMON DISORDERS SEEN WITH AGING: INTEGUMENTARY SYSTEM BASAL CELL CARCINOMA AND MELANOMA ​ Cases of basal cell carcinoma are commonly observed in older adults who have spent significant amounts of time in the sun. ​ Older men are most at risk for melanoma, a potentially fatal form of skin cancer because of its ability to metastasize. ➔​ Pressure ulcers. A, Early-stage pressure ulcers, or I ​ The risk of melanoma doubles if someone has had lesions, are commonly dismissed as minor abrasions more than five sunburns at any age. because the primary attribute is nonblanchable ​ The unusual appearance of moles should be erythema. B, Stage II ulcer, is characterized by some suspected to be melanoma. Irregular shapes, skin loss, may be difficult to identify accurately irregular borders, changes in color, changes in size or because of its resemblance to a blister or abrasion symptoms, such as itching or bleeding, are all considered abnormal. INFLAMMATION AND INFECTION EXAMPLES OF BASAL CELL CARCINOMA (BCC) ROSACEA ​ appears as redness, dilated superficial blood vessels, and small “pimples” on the nose and center of the face. It may spread to cover the cheeks and chin ​ Common types of inflammation include rosacea and various forms of dermatitis. ​ Untreated: lead to swelling and the enlargement of the nose or to conjunctivitis. ​ Cause: UNKNOWN, but it is most common in postmenopausal women, people who flush easily, and BCC on a 92-year-old BCC on a 74 year old male’s individuals taking vasodilating medications male’s scalp forearm (it can resemble a sore ​ Treatment: lifestyle modification, for example that doesn’t heal) avoidance of triggers such as stressful situations, extreme heat, sun exposure, spicy foods, and alcoholic beverages. Oral and topical medications or PRESSURE ULCERS light and laser treatments may provide some benefits. ​ Shrinkage in the cushion provided by subcutaneous tissue along with vascular changes places the older adult at increased risk for pressure ulcers (breakdown of the skin and tissues located over bony prominences). This is a significant problem for immobilized people such as those who are bedridden or confined to wheelchairs JULIANNA G. JOVENIR ♡ XANDRIXMIL ANGELOU PRIETO 10  CONTACT AND ALLERGIC DERMATITIS Encourage regular low-impact ​ appears as redness, dilated superficial blood vessels, Determine activity patterns. exercise. and small ​ Contact and allergic dermatitis appear as rashes or inflammation that is either localized to certain areas of COMMON DISORDERS SEEN WITH AGING: the body or generalized MUSCULOSKELETAL SYSTEM ​ Seborrheic dermatitis is an unsightly skin condition characterized by yellow, waxy crusts that can be OSTEOPOROSIS either dry or moist ​ Excessive loss of calcium from bone combined with insufficient replacement results in osteoporosis. HYPOTHERMIA ​ Common fracture sites include the h(usually the ​ The decrease in subcutaneous tissue reduces the femoral neck), ribs, clavicle and wrist older adult’s ability to regulate body temperature. ​ Osteoporosis is characterized by porous, brittle, ​ Very thin older adults lose the insulation provided by fragile bones that are susceptible to breakage. subcutaneous and adipose tissue. This loss of ​ Spontaneous fracture of the vertebrae or other bones insulation is most likely to result in hypothermia if the can occur in the absence of obvious trauma. person is exposed to an environment that is too cold ​ In fact, spontaneous hip fractures may lead to a fall, rather than the fall leading to the hip fracture. MUSCULOSKELETAL SYSTEM ​ Simple falls or other traumas are more likely to result in fractures in people who have osteoporosis EXPECTED AGE-RELATED CHANGES ​ Bone mineral density (BMD) may bassessed in someone at risk for osteoporosis. MUSCULOSKELETAL CHANGES ASSOCIATED WITH AGING PHYSIOLOGIC CHANGE RESULTS Increased osteoporosis; Decreased bone calcium increased curvature of the spine (kyphosis Decreased fluid in Decreased height intervertebral disks Decreased blood supply to Decreased muscle strength muscles Decreased mobility and flexibility of Decreased tissue elasticity ligaments and tendons ➔​ Commonly prescribed antiresorptive medications include: Decreased strength; increased risk ◆​ alendronate (Fosamax), Decreased muscle mass ◆​ Risedronate (Actonel), for falls ◆​ Ibandronate (Boniva), ◆​ Raloxifene (Evista) NURSING ASSESSMENTS AND CARE STRATEGIES RELATED ◆​ Calcitonin (Calcimar) TO MUSCULOSKELETAL CHANGES ➔​ Calcium and vitamin D supplements are necessary for individuals who do not consume adequate amounts of these nutrients. NURSING ASSESSMENTS CARE STRATEGIES ➔​ Medications for osteoporosis generally fall into two categories: Provide assistance as needed, a.​ medications that increase bone strength and modify physical environment, initiate density (anabolic drugs); and Assess strength and safety precautions to decrease risk b.​ medications that inhibit bone loss functional mobility for falls, encourage range of motion (antiresorptive medications). (ROM) exercise, refer to physical or c.​ Newer research is suggesting improved occupational therapy effectiveness when these two classifications of medications are given together Educate regarding importance of ➔​ Hormone therapy (HT) has beneficial effects on bone Assess nutritional intake. calcium intake, administer density but also brings increased risk for heart attack, supplements as ordered blood clots, stroke, and breast cancer. ➔​ Use of HT is controversial and requires a candid risk/benefit analysis between the patient and physician. JULIANNA G. JOVENIR ♡ XANDRIXMIL ANGELOU PRIETO 11  ➔​ If medications are given for osteoporosis, BMD testing may be done every 2 years to evaluate treatment. DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS ​ Cause: unknown; however, risk factors have been identified, including age, obesity, joint injury or overuse, genetic predisposition, and muscle weakness (Arthritis Foundation, 2014) ​ Pain may occur with activity or exercise of the affected joints and may worsen with emotional stress. ​ Synovial membrane of the bursa may become damaged or inflamed. ​ This is particularly true in the weight bearing joints of the spine, hips, knees, and ankles. Obesity increases the stress on joints and can aggravate symptoms. ​ Osteoarthritis is treated with a combination of exercise, weight control, joint protection, physical or ​ THE STAGES OF RHEUMATOID ARTHRITIS: occupational therapy, and medications (NSAIDs). ○​ Stage 1: The body mistakenly attacks its own joint tissue. ○​ Stage 2: The body makes the antibodies and the joints start swelling up. ○​ Stage 3: The joints start becoming bent and deformed, the fingers become crooked. These misshapen joints can press on the nerves and can cause nerve pain as well ○​ Stage 4: If not treated, the disease will progress to the last stage, in which there's no joint remaining at all and the joint is essentially fused. BURSITIS ​ -inflammation of the bursa and the surrounding fibrous tissue, can result from excessive stress on a joint or from a localized infection RHEUMATOID ARTHRITIS ​ commonly results in joint stiffness and pain in the shoulder, knee, elbow, and hip, ultimately leading to ​ a collagen disease that results from an autoimmune restricted or reduced mobility process, affecting more women than men ​ Although bursitis can occur at any age, age-related ​ causes inflammation of the synovium, damage to the changes in the musculoskeletal system make it more cartilage and bone of joints, and instability of common in older individuals ligaments and tendons that support the joints ​ Treatment: ​ Onset: between ages 30 and 50, although a ○​ resting the joint significant number of individuals develop the disease ○​ NSAIDs. after age 60. ○​ Corticosteroid preparations are occasionally ​ characterized by periods of exacerbation (sometimes injected into the painful areas to reduce called flares), during which the symptoms are severe Inflammation. and cause further damage, and remission, during ​ Mild range-of-motion exercise is encouraged to which the progress of the disease—and the damage it prevent permanent reduction or the loss of joint causes—halts. function ​ Symptoms: ○​ Pain and stiffness, particularly after rest ○​ Warm, tender, painful joints GOUTY ARTHRITIS ○​ Fatigue ​ caused by an inborn error of metabolism that results ○​ Sense of feeling unwell in elevated levels of uric acid in the body ​ Treatment: ​ Crystals of these acids deposit within the joints and ○​ NSAIDs other tissues, causing episodes of severe, painful joint ○​ Corticosteroids swelling. -Some joints, such as those of the great toe, ○​ DMARDs are more commonly affected. ○​ Tumor necrosis inhibitors ​ Chills and fever may accompany a severe attack. ○​ Interleukin-1 inhibitor ​ Attacks of gout become more frequent with age. ​ Untreated, this disease can result in joint destruction. JULIANNA G. JOVENIR ♡ XANDRIXMIL ANGELOU PRIETO 12  ​ It is observed more often in men but is also common COMMON DISORDERS SEEN WITH AGING: RESPIRATORY in postmenopausal women. SYSTEM ​ Recommendations may include reduction of body weight and decreased intake of alcohol and foods rich CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) in purines, such as liver or dried beans or peas. ​ an umbrella term for the commonly occurring RESPIRATORY SYSTEM respiratory disorders of emphysema and chronic bronchitis. ​ often occur together and may coexist with asthma EXPECTED AGE-RELATED CHANGES ​ common in people who have a history of smoking or who have had a high level of exposure to RESPIRATORY CHANGES ASSOCIATED WITH AGING environmental pollutants. ​ Symptoms of COPD: ○​ productive cough PHYSIOLOGIC CHANGE RESULTS ○​ wheezing, cyanosis ○​ dyspnea on exertion. Decreased ability to humidify air ○​ They are at higher risk for developing Decreased body fluids resulting in drier mucous respiratory tract infections; in severe cases, membranes respiratory failure can occur. Decreased number of cilia Decreased ability to trap debris EMPHYSEMA ​ is characterized by changes in alveolar structure. The alveoli lose elasticity, become overinflated, and are Decreased number of Increased risk for respiratory ineffective in gas exchange macrophages infection CHRONIC BRONCHITIS Decreased tissue elasticity Decreased gas exchange; ​ involves inflammation of the trachea and bronchioles. in the alveoli and lower lung increased pooling of secretions Chronic irritation leads to excessive mucus secretion lobes and a productive cough. Decreased muscle strength Decreased ability to breathe deeply, INFLUENZA and endurance diminished strength of cough ​ often referred to as the flu, is a highly contagious respiratory infection caused by a variety of influenza Decreased number of Decreased gas exchange viruses. capillaries ​ Transmission: airborne droplets and moves quickly through groups of people who live or work in close contact with one another NURSING ASSESSMENTS AND CARE STRATEGIES RELATED ​ Incubation period: brief, often only 1 to 3 days from TO RESPIRATORY CHANGES the time of exposure ​ Onset of symptoms is sudden; NURSING ASSESSMENTS CARE STRATEGIES ​ Symptoms: chills, fever, cough, sore throat, and general malaise and may be dramatic and leave the Position to facilitate ease of victim feeling severely ill. Assess breathing depth and respiration. Encourage incentive ​ Influenza presents a special danger for older adults effort. spirometer or nebulizer as ordered. with a history of respiratory disease or other debilitating conditions. Encourage adequate fluid intake. ​ Yearly flu shots are recommended for all persons Assess cough and sputum Encourage smoking cessation and older than 65 years of age to reduce the chance of production. avoidance of environmental contracting influenza. pollutants PNEUMONIA Teach avoidance of individuals with ​ acute inflammation of the lungs caused by bacterial, active infection. Teach careful hand viral, fungal, chemical, or mechanical agents. Assess for signs and ​ In response to the agent, the alveoli and bronchioles washing and disposal of symptoms of respiratory become clogged with a thick, fibrous substance that contaminated secretions. infection. decreases the ability of the lung to exchange gases. Encourage annual influenza vaccination ​ Pneumonia can progress to a state in which the exudate fills the lung lobes, which then become consolidated or firm. - can be detected by radiologic examination JULIANNA G. JOVENIR ♡ XANDRIXMIL ANGELOU PRIETO 13  VIRAL PNEUMONIA (WALKING PNEUMONIA) increased risk for conduction ​ Symptoms: abnormalities ○​ headache ○​ fever Decreased baroreceptor Decreased adaptation to changes in ○​ aching muscles sensitivity blood pressure ○​ cough with mucopurulent sputum ​ Treatment: varies according to the symptom Increased incidence of Increased risk for heart murmurs valvular sclerosis BACTERIAL PNEUMONIA ​ Cause: Staphylococcus, Streptococcus, Klebsiella, Increased blood pressure, weaker and Legionella Increased atherosclerosis peripheral pulses ​ Symptoms: abrupt and dramatic in onset. ​ Chills, fever up to 105° F, elevated WBC count (leukocytosis), tachycardia, and tachypnea are NURSING ASSESSMENTS AND CARE STRATEGIES RELATED common, as is pain with respiration, or dyspnea. TO CARDIOVASCULAR CHANGES LUNG CANCER (BRONCHOGENIC CANCER) NURSING ASSESSMENTS CARE STRATEGIES ​ one of the most deadly forms of cancer in the US ​ diagnosis peaks is 55 to 65 years Observe closely for abnormal ​ results from exposure to carcinogenic, or sounds and irregularity of rhythm; cancer-causing agents, particularly tobacco smoke, determine presence and strength of air pollution, asbestos, and other hazardous industrial Assess apical and peripheral pulses comparing both substances. peripheral pulses. sides of the body. When assessing ​ Symptoms: lower extremities, start distally and ○​ Cough move toward trunk ○​ chest pain, ○​ blood-tinged sputum Hypotension is likely to occur while ​ Treatment Of Choice: Assess blood pressure lying, changing position; encourage ○​ surgical resection of the lungs sitting, and standing. patient to change positions slowly ○​ This procedure is associated with a high and to seek assistance if dizzy mortality rate in adults. ○​ Radiation and chemotherapy are used in Assess ability to tolerate Instruct patient to rest if short of some patients, varying amounts of success activity. breath or fatigued CARDIOVASCULAR SYSTEM COMMON DISORDERS SEEN WITH AGING: EXPECTED AGE-RELATED CHANGES CARDIOVASCULAR SYSTEM CARDIOVASCULAR CHANGES ASSOCIATED WITH AGING CORONARY ARTERY DISEASE ​ Many older adults have seriously obstructed coronary PHYSIOLOGIC CHANGE RESULTS arteries, yet they remain essentially asymptomatic. ​ Once circulation to the heart muscle decreases significantly, the amount of oxygen delivered to the Decreased tissue oxygenation Decreased cardiac muscle heart decreases and ischemia occurs. related to decreased cardiac output tone ​ The pain that may be experienced with ischemia is and reserve referred to as angina pectoris (literally, chest pain). ​ People experiencing an angina attack are advised to Increased heart size, left Compensation for decreased decrease their activity and rest until the episode ventricular enlargement muscle tone. passes. ​ Coronary vasodilators, such as nitroglycerin, or Increased chance of heart failure; βadrenergic blocking agents for people with ischemic Decreased cardiac output decreased peripheral circulation heart disease are prescribed. ​ When one or more coronary arteries become totally Decreased venous return; obstructed atherosclerosis or embolus, the person is increased dependent edena; said to have a myocardial infarction (MI), or heart Decreased elasticity of heart increased incidence of orthostatic attack muscle and blood vessels hypotension; increased varicosities and hemorrhoids SIGNS AND SYMPTOMS OF MYOCARDIAL INFARCTION IN OLDER ADULTS Heart rate 40 to 100 beats per Decreased pacemaker cells minute; increased incidence of 1.​ Sudden-onset dyspnea ectopic or premature beats; 2.​ Chest tightness or heaviness (usually not crushing pain) JULIANNA G. JOVENIR ♡ XANDRIXMIL ANGELOU PRIETO 14  3.​ Anxiety and confusion ​ administration of diuretics (e.g., furosemide) to rid 4.​ Syncope fluid overload 5.​ Back pain ​ administration of cardiotonic medications (e.g., 6.​ Jaw (tooth) pain digoxin increase the pumping efficiency of the heart ​ planned levels of activity designed to reduce car ➔​ Moderate damage may limit a person's physical workload activity. Extensi damage or damage to a critical ar of ​ Use of medical devices, including pacemakers, left the heart may result in death vent assist devices, and implanted sensors, is increasing common. CORONARY VALVE DISEASE ​ heart valves become less pliable over time CARDIOMEGALY ​ calcium deposits may develop on the valves, ​ or enlargement of the heart, which is often related to preventing them from sealing completely. chronic HF ​ This can result in mitral valve prolapse, mitral ​ As we age, the muscular wall of the left ventricle regurgitation, and, ultimately, heart failure (HF). thickens. ​ Because arteries and veins lose elasticity with age, SIGNS AND SYMPTOMS OF MITRAL VALVE the heart must pump harder to move blood through PROLAPSE the vessels. ​ The muscles of the left ventricle hypertrophy in an 1.​ chest pain attempt to improve the output of blood from the heart 2.​ palpitations to meet the body’s tissue demands for oxygenated 3.​ fatigue blood. 4.​ dyspnea PERIPHERAL VASCULAR DISEASE ​ Calcium deposits on the valves roughen the lining and increase the risk for clot formation in the ​ ARTERIOSCLEROSIS: the walls of the arteries chambers of the heart and in the blood vessels. become elastic and plaque forms in the lumen, further restrict blood flow ➔​ Cardiac arrhythmias, including ventricular ​ Excessive plaque is often related to lifestyle factors or arrhythmias, atrial fibrillation, and conduction other disease conditions, most commonly obesity, disturbances, are increasingly common imaging. cholesterol intake, cigarette smoking, and diabetes ➔​ Heart block is a common conduction disturbances mellitus (DM). caused by disruption of the electrical conduction ​ decreased blood flow deprives the tissue of oxygen system of the heart nutrients and causes ischemia. -If the lumen is completely obstructed, tissue death result. HEART FAILURE OCCLUSIVE PERIPHERAL VASCULAR PROBLEMS ​ primarily a problem of the aging population ​ estimated that more than 2 million people suffer from ​ Thrombus formation (clotting) in the lumen of a vein is this disorder, resulting in almost one million a common problem, particularly in immobile older hospitalizations each year adults. ​ the patient’s lungs are often congested, and edema ​ These clots can form quickly because of sluggish appears because the heart’s pumping action is blood flow within the vessels. ineffective ​ Increasing the patient’s activity and using ​ HF is not a single disease but rather a syndrome that antiembolism stockings help prevent problems related accompanies and results from many other disorders to venous stasis or pooling. ​ most often in lower extremity veins, where they irritate SIGNS AND SYMPTOMS OF HEART FAILURE and inflame the vessel and cause thrombophlebitis 1.​ Dyspnea (shortness of breath) with exertion SIGNS 2.​ Orthopnea (dyspnea at rest when recumbent) 3.​ Coughing or wheezing with exertion or at rest 1.​ edema 4.​ Fatigue, weakness, or generalized muscle weakness 2.​ swelling with minimal exertion 3.​ warmth over the affected area 5.​ Peripheral edema 4.​ aching 6.​ Weight gain without an increase in food intake (as a 5.​ cyanosis result of fluid retention) 6.​ pallor 7.​ Nausea, vomiting, or anorexia 8.​ Paroxysmal nocturnal dyspnea (extreme orthopnea MEDICAL MANAGEMENT during sleep) 1.​ rest, 2.​ elevation of the affected leg MEDICAL MANAGEMENT 3.​ application of elastic stockings or wraps ​ dietary restriction of sodium to decrease fluid 4.​ administration of analgesics retention 5.​ anticoagulant therapy 6.​ sometimes application of heat JULIANNA G. JOVENIR ♡ XANDRIXMIL ANGELOU PRIETO 15  VARICOSE VEINS HEMATOPOIETIC AND LYMPHATIC SYSTEMS ​ seen when blood pools in the veins and dilates or stretches them. EXPECTED AGE-RELATED CHANGES ​ The decrease in vascular muscle tone that occurs with aging increases the risk for this. ​ Varicosities are most often seen as a twisting HEMATOPOIETIC AND LYMPHATIC CHANGES ASSOCIATED discoloration in the superficial veins of the lower WITH AGING extremities. ​ Older adults who are obese, are inactive, or spend a PHYSIOLOGIC CHANGE RESULTS great deal of time standing are more likely to have varicosities. Increased risk for vascular ​ The risk for inflamed varicosities increases with age. Increased plasma viscosity occlusion ​ Varicosities can result in leg cramps or a dull, aching pain in the legs. Decreased red blood cell ​ Prevention: Increased incidence of anemia production ○​ avoiding constricting garments, such as garters or rolled stockings, Decreased mobilization of ○​ refraining from sitting with crossed legs Less effective phagocytosis neutrophils ○​ by increasing activity ○​ by resting with the legs elevated Increased immature T-cells ○​ by wearing elastic stockings that promote Decreased immune response response venous return Ederma; increased levels of ANEURYSM Lower serum albumin levels medications that are highly protein ​ the pouching or ballooning of arteries, is common in bound older adults who suffer from arteriosclerotic blood vessel changes ​ Older adults with a history of angina, MI, or HF are at increased risk for developing aneurysms NURSING ASSESSMENTS AND CARE STRATEGIES RELATED ​ Aneurysms of the abdominal aorta are most common TO HEMATOPOIETIC AND LYMPHATIC CHANGES in older adults. ​ Rupture of an aneurysm results in massive, life NURSING ASSESSMENTS CARE STRATEGIES threatening hemorrhage. ​ Early detection and surgical repair of the damaged Monitor laboratory tests, Report abn