Sleep, Safety and Security.pdf

SLEEP Chapter 17 Copyright © 2020 by Elsevier, Inc. All rights reserved. Geriatric Syndrome: Sleep Aging is associated with changes in the amount of sleep, sleep quality, and specific sleep pathologies. Copyright © 2020 by Elsevier, Inc. All rights reserved. Sleep  The human organism needs sleep: ...

SLEEP Chapter 17 Copyright © 2020 by Elsevier, Inc. All rights reserved. Geriatric Syndrome: Sleep Aging is associated with changes in the amount of sleep, sleep quality, and specific sleep pathologies. Copyright © 2020 by Elsevier, Inc. All rights reserved. Sleep  The human organism needs sleep:       Conserve energy Prevent fatigue Provide organ respite Relieve tension Spend 1/3 of our lives sleeping Affects cognition & performance Copyright © 2020 by Elsevier, Inc. All rights reserved. Healthy People 2020: Sleep Health Copyright © 2020 by Elsevier, Inc. All rights reserved. Sleep  Older adults need as much sleep as younger adults, but with age:       Older people report: More time in bed  Reduced total sleep time sleep is lighter  Prolonged sleep more fragmented latency (time to fall characterized by asleep) frequent awakenings  More frequent Decrease in REM sleep awakenings  Increased daytime Note: Review stages of somnolence Copyright © 2020 by Elsevier, Inc. All rights reserved. sleep  Sleep Disorders Insomnia   Most common sleep disorder worldwide Interferes with sleep quality and quantity and is associated with subjective complaints of sleep characterized by:       difficulty initiating sleep. difficulty maintaining sleep. premature morning awakening. nonrestorative sleep. Risk factors for sleep disturbance (Box 17-3) Alzheimer’s disease concerns Copyright © 2020 by Elsevier, Inc. All rights reserved. Medications Affecting Sleep Copyright © 2020 by Elsevier, Inc. All rights reserved. Sleep Disorders  Circadian Rhythm Sleep Disorders (CRSD)      Relatively normal sleep at abnormal times Irregular sleep-wake patterns Most commonly found in individuals with dementia Serious safety risk at night for cognitively impaired individuals that wander Interventions  Does it interfere with daily routine?  Increase light exposure during day and avoid bright light at night  Structured activity during day and quiet sleep environment at nightCopyright © 2020 by Elsevier, Inc. All rights reserved. Other Sleep Disorders  Sleep Disordered breathing & Sleep Apnea: people stop breathing when asleep     Restless Leg Syndrome/Willis-Ekbom disease: a sensorimotor neurological disorder characterized by unpleasant leg sensations   Untreated leads to complications such as: Risk factors include: box 17-12 Sleep study evaluation Diagnosed by sleep study Rapid Eye Movement Sleep Behavior Disorder: loss of normal voluntary muscle atonia during REM sleep associated with complex behavior while Copyright © 2020 by Elsevier, Inc. All rights dreaming reserved. Sleep Assessment Assessment for sleep disorders and contributing factors to poor sleep (pain, chronic illness, medications, alcohol use, depression, anxiety) are important  The FACIT fatigue scale: see handout in canvas  Complete assessment data (Box 17-5)  Sleep diary (Box 17-6)  Copyright © 2020 by Elsevier, Inc. All rights reserved. Promoting Healthy Aging: Implications for Gerontological Nursing (Cont.) Interventions  Nonpharmacological treatment  Directed at identifiable cause  Considered first-line treatment for insomnia  Interventions for Insomnia (Box 17-8) Sleep hygiene Relaxation techniques Sleep restriction measures Stimulus control Circadian interventions Hospital environment (Box 17-9) Copyright © 2020 by Elsevier, Inc. All rights reserved. Sleep Hygiene Rules            Make bedroom restful and comfortable Turn off electronic devices at least 30 min before bedtime Keep a routine, even on weekends Avoid naps; if you do, then no longer than 30 min Regular exercise, but not at night Get regular exposure to light Wind down in the evening: have a bedtime routine Limit caffeine, nicotine, diuretics and alcohol If you have reflux eat evening meal 3-4h before bed Do not watch the clock, get up after 20 min If you cannot fall asleep get up and go to another room until you are tired. Copyright © 2020 by Elsevier, Inc. All rights reserved. Promoting Healthy Aging: Implications for Gerontological Nursing (Cont.) Interventions  Pharmacological treatment  After non-pharmacological tried first and full assessment of sleep problem  Safety Alert pg 224 & 225  Health education on sleeping medications (Box 1710) Copyright © 2020 by Elsevier, Inc. All rights reserved. Question 1 What is the most common sleep disorder? a. OSA insomnia b. Restless leg syndrome c. Insomnia d. Circadian rhythm sleep disorders Copyright © 2020 by Elsevier, Inc. All rights reserved. Question 2 Untreated OSA can lead to which of the following? a. myocardial infarction. b. cardiac dysrhythmias. c. stroke. d. type 2 diabetes. e. All of the above Copyright © 2020 by Elsevier, Inc. All rights reserved. SAFETY AND SECURITY Ch 20 Copyright © 2020 by Elsevier, Inc. All rights reserved. Environmental Safety  A safe environment is one in which one is capable, with reasonable caution, of carrying out activities of daily living and instrumental activities of daily living (IADLs), as well as the activities that enrich one’s life, without fear of attack, accident, or imposed interference Copyright © 2020 by Elsevier, Inc. All rights reserved. Physical Vulnerability   Increasing vulnerability to environmental risks and mistreatment by others as older adults become less physically or cognitively able to cope or recognize real or potential hazards Decreased sensory deficits can impair the individual’s awareness of dangerous conditions or imminent threats Copyright © 2020 by Elsevier, Inc. All rights reserved. Home Safety      Home safety assessments must be multifaceted and individualized to the areas of identified risks Older adults with Alzheimer’s disease or dementia require special attention to environment and caregiver competence Tanner’s Home Safety assessment tool Assessment includes fall, injury, fire, and crime risks Assessment and interventions of home environment Box 20-1 Copyright © 2020 by Elsevier, Inc. All rights reserved. https://cdn2.hubspot.net/hub/139809/file-1361044217-jpg/infographics/ AugustInfographic.jpg Crimes Against Older Adults  Risks and Vulnerability  Living alone, memory impairments, loneliness may make elders more susceptible to crime  Property crime is the most common crime against persons 65 years and older  Crime reduction suggestions Box 20-2 Copyright © 2020 by Elsevier, Inc. All rights reserved. Crimes Against Older Adults Fraudulent schemes against elders  Fraud against elders ranges from solicitations from seemingly worthwhile charities to requests for a cash deposit to win a prize  Medical fraud is another serious type of fraud that effects older citizens on a national scale  Protection against fraud Box 20-3 Copyright © 2020 by Elsevier, Inc. All rights reserved. Fire Safety for Elders    Fire-related mortality rates are three times higher in people older than 80 years than in the rest of the population Most fires occur at home during the night, and deaths are attributed to smoke injury more often than burns Reducing fire risk in the home Box 20-4 Copyright © 2020 by Elsevier, Inc. All rights reserved. Vulnerability to Temperature Thermoregulation  Neurosensory changes in thermoregulation delay or diminish the individual’s awareness of temperature changes and may impair behavioral and thermoregulatory response to dangerously high or low temperatures  Drugs can affect thermoregulation  Economic, behavioral, and environmental factors may combine to create a dangerous thermal environment affecting the older person Copyright © 2020 by Elsevier, Inc. All rights reserved. Vulnerability to Temperature      Caretakers need to monitor the individual who has cognitive or physical limitations that affect ability to respond to changes in temperature Economics: can the older person afford proper heating or air conditioning Safety concerns might prompt older adults to bolt doors and windows, creating unsafe temperature in home environment Fever vs. Hyperthermia vs. Hypothermia Table 20-1 Heat Syndromes!! Copyright © 2020 by Elsevier, Inc. All rights reserved. Hypothermia vs Hyperthermia      Body temperature below normal rangeCore temp below 95f Issues: neurological changes, oxygenation, renal function, and fluid & electrolyte imbalance Serious: cardiac arrhythmias, respiratory Preventing: Box20-7 Tx for Rewarming:       Body temperature above normal range >100.94F Causes: s/s: pale, sweaty skin, cool & moist, weakness and progresses Preventing: Box 20-5 Tx see next slide Copyright © 2020 by Elsevier, Inc. All rights reserved. Interventions to treat Hyperthermia More older adults die from excessive heat than from all other natural disasters combined Drink 2 to 3 L of cool fluid daily  Minimize exertion, especially during heat of day  Stay in air-conditioned places, or use fans when possible  Wear hats and loose clothing of natural fibers when outside; remove most clothing when indoors  Take tepid baths or showers  Apply cold, wet compresses, or immerse hands and feet in cool water  Evaluate medications for risk of hyperthermia  Avoid alcohol  Copyright © 2020 by Elsevier, Inc. All rights reserved. Vulnerability to Natural Disasters  Older people are at a great risk during and after disasters and have the highest casualty rate during disaster events when compared to all other groups  Nursing home residents are particularly vulnerable due to frailty, and nursing homes need to be prepared for disasters  Older adults most at risk during natural disasters  Limited mobility  Dependent on others for ADL’s  Social isolation  Cognitive impairment  Institutionalized adults Copyright © 2020 by Elsevier, Inc. All rights reserved. Transportation Safety      Available transportation is a critical link in the ability of older adults to remain independent and functional A “crisis in mobility” exists for many older people because of lack of an automobile, inability to drive, limited access to public transportation, health factors, geographical location, and economic considerations Adequate, affordable, and convenient transportation services are essential to health and quality of life, as well as the ability to age in place Adaptations for safe driving Box 20-8 SAFE DRIVE BOX 20-11 Copyright © 2020 by Elsevier, Inc. All rights reserved. Driving Safety Driver cessation Giving up driving is a major loss for an older person both in terms of independence and pleasure, as well as feelings of competence and self-worth  Planning for driver cessation should occur for all older adults before their mobility situations become urgent  Action strategies used to bring about driver cessation Box 20-10  Copyright © 2020 by Elsevier, Inc. All rights reserved. Emerging Technologies to Enhance Safety of Older Adults 31   Advancements in all types of technology hold promise for improving quality of life, decreasing the need for personal care, and enhancing independence and the ability to live safely at home and age in place Examples include:    Telehealth Smart homes Robots Copyright © 2020 by Elsevier, Inc. All rights reserved. Aging in Place   Developing elder-friendly communities and increasing opportunities to age in place can lead to enhanced health and well-being Components of elder-friendly community:     Addresses basic needs Optimizes physical health and well-being Maximizes independence for frail and disabled Provides social and civic engagement Copyright © 2020 by Elsevier, Inc. All rights reserved. Essential Elements of an Elder-Friendly Community 33 Copyright © 2020 by Elsevier, Inc. All rights reserved. Question #1 Hypothermia is defined as having a core body temperature (°F) of less than: a. 97.5 b. 95.0 c. 93.2 d. 90.5 Copyright © 2020 by Elsevier, Inc. All rights reserved. Question #2 A mildly elevated core temperature, decreased pulse pressure, altered mental status, and thirst are signs of: a. Heat fatigue b. Heat stroke c. Heat exhaustion d. Heat sensitivity Copyright © 2020 by Elsevier, Inc. All rights reserved. 36  Referenc es Touhy, T., & Jett, K. (2020). Ebersole and Hess’ Toward Healthy Aging Human Needs & Nursing Response. (9th ed.) St. Louis. MO: Elsevier. Statement of Copyright and Fair Use The author of this PowerPoint believes that the following presentation contains copyrighted materials used under the Multimedia Guidelines and Fair Use exemptions of U.S. Copyright law applicable to educators and students. Further use is prohibited. If owners of images used in this presentation feel otherwise, please contact the author and they will be taken down if other amicable resolutions cannot be agreed upon.  Copyright © 2020 by Elsevier, Inc. All rights reserved.