Older Persons Chapter 18 PDF

Older Persons Chapter 18 By Rosemary Scofich Learning Objectives ▪ Describe health-promotion activities specifically targeted to older persons. ▪ Discuss various theories of aging. ▪ Describe how normal aging changes in the older person relate to health- promotion strategies. ▪ Discuss preventive...

Older Persons Chapter 18 By Rosemary Scofich Learning Objectives ▪ Describe health-promotion activities specifically targeted to older persons. ▪ Discuss various theories of aging. ▪ Describe how normal aging changes in the older person relate to health- promotion strategies. ▪ Discuss preventive strategies related to risk factors that could lead to health problems in older persons. ▪ Describe leading causes of mortality among older persons. ▪ Discuss how health-promotion activities can impact problems related to environmental, physical, biological, and chemical agents that contribute to disability, morbidity, and mortality in later adulthood. ▪ Analyze social and political issues that influence the well-being of older persons. ▪ Identify major resources for healthy living that are available for older persons. Biology and Genetics: Older Persons Health Promotion Challenges in meeting the health of older people: Misconceptions regarding the benefits of disease prevention and health promotion Difficulty in differentiating normal changes from pathological process and illness Multiple factors (Environmental, economic, physiological, genetic, psychological, social, and cultural) combine to influence the aging process. Prevalence of chronic illness and multiple health problems Impairs the ability and motivation to learn health behaviours Theories of Aging For many years, the cause of death on many older persons’ death certificates was listed simply as “old age.” No formula to predict how a person will age Debate about “old age” Questions of physiological, social, psychological reasons why people die Research into theories of aging No single theory Factors under study Genetics: predict development of disease Diet: what people eat or don’t eat Antioxidants: binding free radicals Gordon’s Functional Health Patterns Health Perception–Health Management Pattern Nutritional–Metabolic Pattern Elimination Pattern Activity–Exercise Pattern Sleep–Rest Pattern Cognitive–Perceptual Pattern Self-Perception–Self-Concept Pattern Roles–Relationships Pattern Sexuality–Reproductive Pattern Coping–Stress Tolerance Pattern Values–Beliefs Pattern  Health Perception–Health Management Pattern Nursing role: Help older persons understand the Motivation: Important for importance of health Not to underestimate maintaining health factors, to learn their their abilities. goals, and what motivates them. Encourage active Activities to promote Older Indigenous people participation in care rather health and prevent frailty have the poorest overall than performing care for health compared with any them. other ethnic group. 6 Health Perception–Health Management Pattern Recommended clinical preventive services for older persons: Immunizations (influenza and pneumococcal) Screenings for early detection Smoking-cessation counseling for those who smoke Health-maintenance behaviors Exercise, good nutrition, sexual safety, and appropriate sleep-rest patterns Regular health care checkups It is essential that nurses are culturally sensitive and understand that cultural values guide behavior Health assessment screening Renal insufficiency Alcoholism Polypharmacy Substance Use Mobility Devices for Older Persons Greatly enhance lifestyle of older persons with mobility issues Facilitate travel, visiting family and friends, ADL, independence, and socializing Nutritional–Metabolic Pattern Energy intake differs, depending on age. Adults aged 65 or older typically require fewer calories than younger adults. Although fewer calories are needed, older people require more nutrition from these calories to promote and protect health. Attention to important micro and macronutrient intake. Canada Food Guide emphasizes eating with others to diversify diet and important social contact. Poor nutrition affects overall health and higher healthcare costs. Physiological and metabolic changes associated with aging makes it difficult to evaluate the nutritional problems. SDoH create specific nutritional risk factors for older persons One-third (34%) of Canadians aged 65 or older are on the cusp of malnutrition Many older persons are not aware of food assistance programs Older persons do not lose their desire for foods high in fat, cholesterol, or sodium. Nutritional–Metabolic Pattern Obstacles to maintaining optimal nutrition o Access to food o Low income o Decline in GI absorption, metabolism, elimination o Deterioration of senses (taste, smell and vision) o High frequency of dental and swallowing problems o Cultural food preferences o Lifelong eating habits o Living environment (e.g., institutions) o Anorexia resulting from disease o Medications o Hospital stays Nutritional–Metabolic Pattern Ways to improve Encouraging family members to bring in special foods that the resident enjoys is helpful. Assess the person’s food preferences and any difficulties in eating, followed by careful planning of an appropriate menu, to encourage healthy eating. A pleasant setting with social interaction enhances the desire to eat. Obesity is a problem for older persons-can restrict movement Obesity Paradox: unlike in younger individuals, Older adults does not appear to be clearly associated with a shorter life span.  Nutritional–Metabolic + Elimination Pattern Diet plays a significant Bowel and bladder Gastro-intestinal motility role in problems with functions are altered by decreases as people age. intestinal motility and normal changes of aging. constipation. Lack of physical activity Many medications taken and changes in the Decreased intake of fluids by older persons also environment that and fibre contribute in cause elimination decrease privacy also large part to constipation. concerns. contribute to elimination problems. 12 Elimination Pattern - Issues & Strategies Elimination issues Constipation – can’t poo or hard poo Urinary incontinence o Stress incontinence - occurs when someone coughs or sneezes ▪ Many older persons may believe o Urge incontinence - when someone elimination problems are an cannot wait to void, once the urge to void is unavoidable part of aging felt. ▪ Embarrassed to discuss o Overflow – there’s an urge to urinate but ▪ It is important to reassure them that can only release a small amount due to through diet and exercise they can weak muscle or blockage, since bladder gain control of most elimination can’t empty fully, urine leaks out later problems with no urge to go. o Functional incontinence - associated with environmental barriers, physical limitations, or cognitive impairment in which the care recipient is unable to reach the toilet. Activity–Exercise Pattern Teach benefits of exercise Find culturally acceptable exercises Goal- help maintain flexibility, strength, and balance Strength training improves balance and reduces the risk of falls, strengthen bones and reduces blood sugar levels Popular activities: walking, aquatics, golf Other activities: swimming, weight-bearing, aquatic exercises Weight bearing – functional mobility, promoting independence, and prevent falls. Pre-exercise health evaluation is important o Need a gradual increase in activity o Normal changes of aging, pathological conditions, and environmental deterrents do not need to prevent an older person from exercising.  Sleep–Rest Pattern Inability to sleep is a common concern High prevalence of sleep disorders Nursing interventions Teach about normal changes in sleep with aging and why this occurs Identify normal bedtime rituals Keep a sleep log, recording times and duration of sleep throughout the 24-hour period for at least 1 week. Recommend increase in physical activity during the day Pain management: Pain meds or alternative pain relief before bedtime Environmental adjustments (lights and sound) Identify emotional disorders interfering with sleep- therapy could help Nap is beneficial but ensure that daytime napping doesn’t interfere with night-time sleep Sleep medications: short-term use 15  Brain weight decreases with aging. Shift occurs in the proportion of grey matter to white matter. Affects memory, comprehension, problem-solving, and decision-making. Cognitive problems Cognitive–Perceptual o Not a normal change of aging. Pattern: Cognition Dementia is not an inevitable outcome of aging. o Caution in assessing older people with confusion - Confusion is not always indicative of dementia. Can have metabolic causes o Assessment for dementia should be part of routine physical exams 16  Cognitive health interventions Keep minds active. Social stimulation Encourage to perform self-care activities, such as dressing, themselves. Elderly patients like consistency in their environment, Familiar environments and consistent routines and caregivers are encouraged. Exercise 17 Cognitive–Perceptual Pattern Postoperative cognitive dysfunction (POCD) o Temporary cognitive deterioration with surgery and anesthesia o Anxiety, insomnia, blurred vision, hallucination, inability to sleep, and depression. o Cognitive changes are subtle and extend over a longer period. o Changes are distressing to patient and family o No specific treatment. Anticipate needs of older people and their families o POCD is not the same as delirium Delirium: Acute/short-term change in cognition.  Cognitive–Perceptual Pattern Screening: Mini-Mental Status Examination (MMSE) o 30-point scale o Less than 23 indicates cognitive impairment Older persons can continue to learn. Cognitive–Perceptual Pattern: Sensory Factors Vision o Safety concerns—driving o Annual eye examinations o Presbyopia, Cataracts, Glaucoma Hearing o Hearing deficits-common o Routine assessment of older persons for accumulation of cerumen. o Annual audiology testing o Presbycusis o Miscommunication, loss of self-esteem, depression, falls, safety risk, cognitive decline Cognitive–Perceptual Pattern: Sensory Factors Taste and Smell o Loss of taste buds o The flavors of sweet, sour, salty, and bitter become blurred. o Safe cooking and alternative seasoning o Inability to sense warning signal- smoke, rotten food o Teach- check dates on food packages frequently, be attentive while cooking and preparing meals o Dental health is important—semiannual dental visits Loss of teeth, caries, periodontitis, gingivitis Periodontitis or gum disease leading to tooth loss, a common contributor to decreased taste sensation and poor nutrition. Inability to chew, swallow food Cognitive–Perceptual Pattern: Sensory Factors Skin-Touch changes o Thinner, wrinkled, less elastic, and more fragile. o Impaired heat and cold sensations o Decreased sweating o Injuries take longer to heal o Skin remains capable of sensing and performing its protective role. o Sensation bought by touch diminishes-decrease in sensory nerve endings. Especially in presence of debilitating diseases –decreased pressure pain sensation- threaten safety. o Safety issues from decreased sensations. Burns from cooking, bathing. Educate on safe cooking practices (hot stove, appropriate temperatures for bathing showering, burn prevention). Risk of decubitus ulcer—localized tissue necrosis (from compression against bone) o Proper nutrition will help prevent this o Frequent skin assessment Self-Perception–Self-Concept Pattern: Erikson’s Theory of Development Ego integrity vs. despair o Ego integrity: acceptance of life; feeling “at peace” o Coming to terms with life o Fear of death and despair, feels life was “in vain” Predictors of satisfaction with retirement? o good health and functional ability o adequate income, a suitable living environment o a strong social support system o a positive outlook.  Roles–Relationships Pattern Frequently brings joy and happiness Grandparents raising children—stress issues Grandparenting: Counseling, support groups, education—all help with new role coping Influences: health, more time with family, wanting to do other things, not enjoying work Challenges: lower income, loss of friends, disease, Retirement disability, leaving home, widowhood 24  Sexuality–Reproductive Pattern More than 50% of adults aged over 75 continue to engage in sexual activity 3 or more times a month. Continued need to touch and to be touched. Sexual activity focus changes– quality more than quantity. More focus on touching, caressing, and kissing. Foreplay becomes the mainplay. Disabling medical conditions, normal aging affects the expression of sexuality (difficulty with penetration) Reduced availability of sex hormones – less rapid and less extreme vascular response to sexual arousal. Sexuality–Reproductive Pattern Lack of circulating hormones results in changes in the sexual system Some medications hinder the sexual response. Men o Experience less intense and slower erections, increased difficulty regaining an erection, decreased force of ejaculation and extended refractory time. o Erectile dysfunction Women o Many changes begin at perimenopausal age o Vagina becomes narrower, shorter, and thinner and less natural lubrication, tissues very tender Nurses can help older persons find ways to improve their sexual health o In long-term care facilities, there is a need to address the sexual needs of residents STIs and AIDS: a potential issue for older persons o Teach safe sexual practices  Coping–Stress Tolerance Pattern Depression Suicide Older person is at highest Risk factors for suicide risk include: social isolation, Medical conditions, losses, alcohol and substance physical changes abuse, psychosis, Depression is also caused bereavement, and serious by physiological changes in medical illness. the aging body. Challenge: promote value in life, alleviate suffering 27 Values–Beliefs Pattern Spirituality- Nursing role Spiritual assessment tools Promote spiritual health Open-ended questioning to encourage discussions Environmental Processes: Physical Agents Falls o Leading cause of morbidity and mortality o Accounts for about 40% of admissions to long-term care o Result in decreased, mobility, decreased ability to live independently, and increased risk of an early death o Risk assessment and prevention are essential o Even if an older person isn’t injured after a fall, they may develop a fear of falling, and therefore limit their activities and increase their risk for future falls. Preventing injury: driving considerations o Take a seniors’ driving safety course to learn how aging changes can affect their driving and strategies for safer driving. o Relearning the art of defensive driving can reduce the likelihood of being involved in a motor vehicle accident.  Area of Attention Intervention Stairways Secure handrails Illuminate stairways with light switches at both top and bottom Eliminate clutter on all steps and stair landings Use nonskid treads on steps Bedroom Use nightlights Tack down carpet Discourage use of throw rugs Arrange furniture so that it will not obstruct clear pathways Secure extension cords and telephone wires and remove them from walking areas For smokers, never smoke in bed Bathroom Use handrails near tub and toilet Use nonskid mats in tub area and on floor Use a bath thermometer to measure hot water in tub Use nightlights Kitchen Wear nonflammable, lightweight clothing when cooking Place dishes and cooking utensils at reasonable heights Use stepstools with a handrail according to specifications and only when not alone Keep off wet floor and refrain from using slippery wax Never climb on chairs Keep emergency numbers near the telephone Ensure locks can be easily opened in times of emergency Cook at front of the stove rather than at the back Do not use electrical appliances with frayed cords Living room Use furniture that is easy to get in and out of Eliminate clutter on all floor areas Install fire detectors at appropriate place 3 0Outdoors Make sure stairs are free of breaks and cracks, and clear of snow and ice Use safe handrails Provide good lighting for stairs and walkways  Elder Mistreatment Elder abuse: intentional or neglectful acts by caregiver Forms: physical abuse, neglect, emotional abuse, psychological abuse, verbal abuse and threats, financial abuse and exploitation, sexual abuse, abandonment Victims more likely to be single women >75 who depend on a caregiver for food or shelter Abuser is typically adult child with poor impulse control  Biological Agents Decreased immune function; potential lapsed vaccines Influenza: major cause of Recommendation: yearly vaccination morbidity and mortality COVID-19 Major cause of death for older persons Vaccination advised: booster if first vaccination before Pneumococcal infections age 65 and greater than 5 years Cancer rates for older persons Prostate cancer in men are high—50% of all cancers Breast cancer in women 32  Chemical Agents Effects of aging Drug absorption, metabolism, excretion changes Adverse effects of medication Medication–medication interactions Good medication history Start with lowest effective dose Polypharmacy Ability of older persons to self-administer Medication affordability 33  Alcohol and Tobacco Use Use underestimated or hidden Alcohol Underdiagnosed Older persons are more vulnerable to effects of alcohol Cumulative effects over lifetime Tobacco Promotes multiple chronic health conditions Smoking cessation beneficial even after age 65 34  Health care delivery system Care continuum Social Little coverage for health promotion Financial-planning issues are important Long-term care insurance, advance Acute care, long-term care, community settings, hospice care Determinants directives Home health care after discharge from hospital in some cases Residential options Palliative and hospice care use has increased Retirement communities; Hospice care can take place either at home or in assisted living a hospice facility. The focus of hospice care is to help the person remain alert but free of pain. Families are encouraged to participate in Community services caregiving. Visiting nurse, home health aide, transportation, adult day care, meals and food programs Continuing care retirement communities Health literacy (CCRC) offer long-term options, “aging in Degree seniors have capacity to obtain, place”. process, and understand health Expensive option: entrance fee, monthly information fees Health care delivery system Types of facilities Retirement community living is suited for a person who is oriented to person, place, and time and has a memory that is intact. Independent living may be appropriate for the person if she does not have a consistent pattern of memory loss. Assisted living or nursing facility living may be appropriate if the woman has difficulty with orientation to person, place, or time or has difficulty with confusion that results in anxiety, social withdrawal, or depression. A nursing facility is appropriate for patients who require much more extensive care up to and including total care.  Health-promotion interventions Motivation to adopt a healthy lifestyle is a primary predictor of successful interventions. Feeling that illness is an inevitable part of aging, leaving one’s health up to chance or assuming a fatalistic approach will not motivate a person to make necessary lifestyle changes. 37