Health Promotion and Care of the Older Adult PDF

HEALTH PROMOTION AND CARE OF THE OLDER...

HEALTH PROMOTION AND CARE OF THE OLDER ADULT 081‐NP02L001 ELO B∙ Version 2.0 Foundations and Adult Health Nursing, 8th ed., Chapter 33, pp. 1060‐1097 ENABLING LEARNING OBJECTIVE B In a classroom environment, given reading assignments, handouts, and scenarios explain the health promotion and care of the older adult without error. OLDER ADULT  4 subgroups  Young old: 65‐74 years  Middle‐old: 75‐84 years  Old‐old: 85‐99 years  Elite old: 100 years and older  Other terms  Frail elderly  Centenarians  Healthcare  More complex  Increased technology  Increased life expectancy WELLNESS, HEALTH PROMOTION, AND DISEASE PREVENTION  Wellness is more than the absence of disease  Health promotion takes a positive approach to health and emphasizes the strengths, resources, and abilities of an individual.  HEALTHY AGING: MYTHS AND REALITIES   HEALTHY AGING: COMMON THEORIES OF AGING   AGEISM  Term that describes prejudice against older adults  It reflects a negative response by younger people—  Personal dread of growing old or becoming disabled, and a fear of powerlessness, uselessness, and death.  Systematically stereotypes and discriminates against people because they are old, just as racism and sexism stereotypes and discriminates against people based on skin color and sex.  To enhance the quality of life for older adults, support the patient’s hope, pride, confidence, security, and integrity.  All members of the health care team should work toward eliminating negative attitudes and discriminatory practices.  LEGISLATION THAT AFFECTS OLDER ADULTS  Social Security Act 1935  Provide financial security for older adults  At the time it was passed few people lived long enough to collect significant benefits  Older Americans Act (OAA) 1965  Preserves the rights and dignity of older adults  Family Caregiver Support Program  Addresses the need for caregivers  Patient Protection and Affordable Care Act (ACA) 2010  The results of this legislation are still developing, but the law encourages payment for preventive services to Medicare recipients and provides a drug discount for eligible seniors in the “donut hole”.  PSYCHOSOCIAL CONCERNS OF THE OLDER ADULT  Stresses of Caregiving  Older people receiving care  Feel like a burden  Angry or frustrated  May become demanding  Caregivers are at risk for depression, anxiety, and physical problems  Sandwich Generation  Care for their parents as well as their own children  Increased stress from workplace, home and the elder  Nursing assessment should include needs of the caregive  Referrals to community resources  Respite care  LOSS, GRIEF, AND DEPRESSION  Significant psychosocial changes experienced by older adults  Personal, social and economic losses  Loss of significant others: parents, siblings, children, spouses, and friends  Physical changes  Short‐term or long‐term depression may result in response to the grief from real and perceived losses. PATIENT PROBLEM STATEMENTS  END OF LIFE CARE  Nurses assist with meeting needs of dying patient  Caring for families  Cultural and Religious knowledge  1991 Patient Self‐Determination Act (PSDA)  Patient’s wishes and directives are respected  Advanced directives  Living will  Durable power of attorney  Do not resuscitate  AGING BODY  Physiologic changes affect  Biologic, psychological, social, and environmental status.  Physiologic changes in the aging process result in a decreased  Immune response  Compensatory reserve  Loss of the body’s ability to repair damaged tissue efficiently.  Numerous physiologic changes occur in all body systems during the natural aging process.  AGING BODY: INTEGUMENTARY SYSTEM  AGE‐RELATED CHANGES  Loses tone and elasticity  Loss of fat  Lentigo  Hair grays and thins  Nails grow slowly, thicker and brittle  Touch sensation changes  Susceptibility to infection, ecchymosis and tearing  Wounds heal slowly  AGING BODY: INTEGUMENTARY SYSTEM  ASSESSMENT  Observe skin hydration status  Excessive dryness  Skin tears or lesions Note presence, location and exudate Examine lesion for changes  Hair for excessive loss, dryness, pr oiliness  Nails for color, length, shape, symmetry and cleanliness  AGING BODY: INTEGUMENTARY SYSTEM  Nursing Interventions  Pruritus  Older people may report dryness and itching  More common in cold weather  Soap is drying, antibacterial is very drying  Moles  Most are benign  Dermatologist to assess suspicious‐looking lesions  Nail abnormalities  Clubbing  Yellowed  Splintered  Brittle  AGING BODY: INTEGUMENTARY SYSTEM  Nursing Interventions  Pressure Injury  Significant risk for older adults and those with chronic disease  Thin skin  Lack of subcutaneous fat  Prevention:  Repositioning  Pressure reducing pads  Reduce friction, shearing forces and moisture  Prevention and healing depend on good nutritional status and adequate hydration  AGING BODY: INTEGUMENTARY SYSTEM  Patient Problem statement and Intervention for pressure injury  AGING BODY: GASTROINTESTINAL SYSTEM  Nutrition essential to health  Imbalanced diet contributes to  Obesity  Hypertension  Diabetes  Cancer  Cardiovascular disease  AGING BODY: GASTROINTESTINAL SYSTEM  Factors that contribute to undernutrition  Reduction in taste and smell  Medications alter taste of food and decrease saliva production  Inactivity  Boredom  Mental health  Can result in over nutrition  AGING BODY: GASTROINTESTINAL SYSTEM  Age‐related changes  Decreased saliva  Diminished gag response  Stomach has decreased gastric motility, production of bicarbonate, and gastric mucus  Decreased or lack of production of intrinsic factor  Enzymes in the intestinal tract are also altered  Abdominal wall less firm, muscles weaken  Decreased tone of the intestine  Liver function decreases  AGING BODY: GASTROINTESTINAL SYSTEM  Assessment  Oral cavity  Ability to chew and swallow  For heartburn and nausea  Dietary intake  Weight  Bowel elimination  AGING BODY: GASTROINTESTINAL SYSTEM  Common Concerns  Obesity  Adults 75‐90 years need 30 calories per kilogram  1800‐2400 calories daily  Weight loss  Gradual loss overtime is normal  Unexplained weight loss more than 5% of weight in 6 months to 1 year needs medical evaluation  Fluids and dehydration  1500 mL daily  Often limit due to incontinence or other chronic diseases  Oral hygiene  Missing teeth not normal part of aging  Loss of appetite  AGING BODY: GASTROINTESTINAL SYSTEM  Common Concerns and nursing interventions  Obesity  Adults 75‐90 years need 30 calories per kilogram  1800‐2400 calories daily  Respect individual preferences  Vitamins A, C, E, and niacin may slow aging process  Weight loss  Gradual loss overtime is normal  Unexplained weight loss more than 5% of weight in 6 months to 1 year needs medical evaluation  AGING BODY: GASTROINTESTINAL SYSTEM  Common Concerns and nursing interventions  Fluids and dehydration  1500 mL daily  Often limit due to incontinence or other chronic diseases  Increase access to fluids and bathroom  Arthritis or other conditions make it difficult to poor or drink from a cup Use of an adapted cup Disoriented adults need reminders to drink  AGING BODY: GASTROINTESTINAL SYSTEM  Common Concerns and nursing interventions  Oral hygiene  Missing teeth not normal part of aging  Modern dental prophylaxis and oral hygiene habits  Missing teeth and loose‐fitting dentures make chewing difficult  Mouth care for those with dentures  Clean dentures  Brush gums and tongue, rinse the mouth  If dentures are damaged, loose or exert pressure refer to dentist  AGING BODY: GASTROINTESTINAL SYSTEM  Common Concerns and nursing interventions  Loss of appetite  Changes in saliva production  Decreased amount of taste buds  Prepare food with color and garnish  More seasoning  Serve favorite meals  Gastric motility slows  Medications  Eating is a social activity  Community meal programs  Church dinners  Senior citizen programs  AGING BODY: GASTROINTESTINAL SYSTEM  Common Concerns and nursing interventions  Gastric Reflux  Sphincter to opening of stomach is less efficient  Controlled by eating small meals  Avoiding eating before bedtime  Elevating head of bed  Food intolerance  Lactose  Common source of intolerance  AGING BODY: GASTROINTESTINAL SYSTEM  Common Concerns and nursing interventions  Dysphagia  Assess if dysphagia is with liquids, solids, or both  Progression of symptoms  More difficulty swallowing firm foods in liquid such as soup  Positioning  Verbal coaching  Thickeners AGING BODY: GASTROINTESTINAL SYSTEM  AGING BODY: GASTROINTESTINAL SYSTEM  Common Concerns and nursing interventions  Failure to thrive  Refusal to eat  Associated with mental disorders  Dementia  Depression  Social and economic factors  Specialized nutritional support  Inability to ingest, digest, or absorb nutrients  Feeding tubes  Nasogastric tubes  Standard enteral formulas  May be short term or long term  Transition to oral diet as soon as possible   AGING BODY: GASTROINTESTINAL SYSTEM  Common Concerns and nursing interventions  Gastrointestinal cancer  Follow‐up and diagnostic testing for  Change in bowel or bladder habits  Persistent oral lesion  Visible occult blood  Indigestion or difficulty swallowing  Unexplained weight loss  Constipation  Persistent bloating  AGING BODY: GASTROINTESTINAL SYSTEM  Common Concerns and nursing interventions  Fecal incontinence  Most common cause is fecal impaction associated with immobility, inadequate fiber and fluid intake  Soft stool oozes around impaction  Underlying disease  Gastrointestinal bleeding  Less protective mucus secretion  Assess for blood in stool, dizziness, pallor, tachycardia or hypotension  Laxatives, iron supplements, cimetidine, anticoagulants, aspirin, NSAIDs, and foods such as red meat may yield a false positive guaiac result  AGING BODY: GENITOURINARY SYSTEM  Bladder capacity decreases 50%  Incontinence  Decrease in bladder tone and capacity  UTI  Women  Estrogen level decrease  Intercourse may become painful  Vaginal opening constricts, shortens, loses tone and dies  Men  Prostate enlargement  Scrotum becomes pendulous  Erections develop slowly  Organisms become less intense  AGING BODY: GENITOURINARY SYSTEM  Assessment  Frequency  Amount  Color  Odor  Consistency  Ability to control urination  Satisfaction with sexuality and affectionate relationships AGING BODY: GENITOURINARY SYSTEM  Common concerns and nursing interventions  Nocturia  Urinary incontinence  Stress  Urge  Overflow  Functional AGING BODY: GENITOURINARY SYSTEM  AGING BODY: CARDIOVASCULAR SYSTEM  Age‐related Changes  Loss of structural elasticity  Heart takes longer to contract and the chambers longer to fill  Heart valves become thicker and more rigid  Decrease in pacemaker cells  Resting heart rate decreases  Arteriosclerosis  Hypertension as a systolic of 150 mmHg  Modifiable and nonmodifiable factors  Disparities  African American men and women have more cardiovascular disease  AGING BODY: CARDIOVASCULAR SYSTEM  Assessment  Dyspnea or orthopnea  Aggravated by exertion  Cough  Onset and duration  Pallor, rubor, or cyanosis  Chest pain  Onset, duration, relationship to activity, character, location, radiating, and severity  Apical and peripheral pulses  Compare both extremities  Capillary refill time  Presence of vertigo, syncope, and fatigue  AGING BODY: CARDIOVASCULAR SYSTEM  Assessment  Blood pressure  Lying, sitting, and standing positions  Note any significant changes  Edema  Note location and severity  AGING BODY: CARDIOVASCULAR SYSTEM  Common concerns and Nursing Interventions  Hypertension  Contributes to  Coronary artery disease  Stroke  Heart failure  Renal failure  Peripheral vascular disease  Pharmacological treatment  Treatment for HTN is patients older than 60 has decreased the rate of coronary events significantly  AGING BODY: CARDIOVASCULAR SYSTEM  Common concerns and Nursing Interventions  Coronary artery disease  Risk factors  Elevated serum cholesterol  Total cholesterol level 130 mg/dL  Decrease saturated fat content  20‐30 minutes of moderate intensity exercise 3‐5 times per week  Older adults should start with 10‐15 minutes warm‐up  Walking is best  AGING BODY: CARDIOVASCULAR SYSTEM  Common concerns and Nursing Interventions  Coronary artery disease  Encourage participation in cardiac rehabilitation  Consists of several phases starting in hospital and continuing to outpatient  AGING BODY: CARDIOVASCULAR SYSTEM  Common concerns and Nursing Interventions  Dysrhythmias  Changes in Heart structure Blood supply Pacemaker system  Cause the heart to be less effective in supplying blood to the body  AGING BODY: CARDIOVASCULAR SYSTEM  Common concerns and Nursing Interventions  Dysrhythmias  Check vital signs frequently Rate, regularity, and strength of pulses  Accurate intake and output monitoring  Observe and report response to medication  Keep stress to a minimum, Monitor response to activity Provide rest periods  AGING BODY: CARDIOVASCULAR SYSTEM  Common concerns and Nursing Interventions  Peripheral Vascular Disease  Spasms or atherosclerosis decrease circulation to tissues in the legs and feet Numbness, intermittent claudication Varicose veins  AGING BODY: CARDIOVASCULAR SYSTEM  Common concerns and Nursing Interventions  Peripheral Vascular Disease  Techniques to promote circulation  Walking  No prolonged standing  Do not cross legs  Compression stockings  Skin ulcerations and altered sensation  Compression stockings  Pneumatic compression pumps  Unna boots AGING BODY: CARDIOVASCULAR SYSTEM  AGING BODY: RESPIRATORY SYSTEM  Age‐Related Changes  Lungs and bronchi become less elastic more rigid  Ribs less mobile  Diminished oxygen‐carrying capacity  Muscles weaken decreased lung expansion and vital capacity  Kyphosis (Dowager’s hump)  Abnormal curve of upper spine  Chest wall less expansion  Lifestyle factors  Exercise has a positive effect; immobility has a negative effect  Smoking  Obesity  Diminished cough  AGING BODY: RESPIRATORY  SYSTEM Assessment  Assess Depth, Rhythm, and rate with activity and at rest  Inspect Chest  Shape and symmetry  Body position  Use of accessory muscles  Assess breath sounds  Assess activity level tolerance  Assess breathlessness on a scale of 0‐10  Assess presence of cough  Nonproductive  Productive  Amount, frequency, and color of sputum  AGING BODY: RESPIRATORY SYSTEM  Common Concerns and Nursing Interventions  Chronic Obstructive Pulmonary Disease (COPD)  Not a single disease  Combination of Chronic Bronchitis Chronic Asthma Emphysema  Progressive disease  Risk factors  Smoking  AGING BODY: RESPIRATORY SYSTEM  Common Concerns and Nursing Interventions  Assessment  Diminished breath sounds, Crackles, Wheezes, and barrel chest  Nursing Interventions  Pulmonary hygiene  Fluids to liquefy secretions  Breathing retraining  Pursed lip breathing  Chest physiotherapy  Chest percussion, postural drainage  Medications  Oral and inhaler, oxygen  Smoking cessation  Exercise programs  AGING BODY: RESPIRATORY SYSTEM Common Concerns and Nursing Interventions  Pneumonia Decreased resistance to respiratory infections Can be life threatening Older adults do not always exhibit signs and symptoms of pneumonia  They show signs and symptoms of lethargy, disorientation, anorexia, and low or mild fever AGING BODY: RESPIRATORY SYSTEM  AGING BODY: RESPIRATORY SYSTEM  Common Concerns and Nursing Interventions  Lung Cancer  Leading cause of cancer deaths  Increased incidence between ages 60‐70  Risk Factors  Tobacco or marijuana  Recurring inflammation  Exposure to asbestos, Talcum powder, minerals, radon  Heredity  Vitamin D deficiency  Air pollution  AGING BODY: RESPIRATORY SYSTEM  Common Concerns and Nursing Interventions  Lung Cancer  Most common form is small‐cell lung carcinoma (SCLC)  Metastasizes to the central nervous system, bone, and liver  Often no signs or symptoms are evident, attributed to smoking or preexisting lung disease  Nonspecific signs and symptoms  Cough, chest pain, hemoptysis  Diagnosis  Clinical history, chest x‐ray or CT scan  Staging  Provides bases for treatment  Treatment  Nursing Interventions  Pain relief  Emotional support  AGING BODY: MUSCULOSKELETAL SYSTEM  Age‐related changes  Reduction in number and size of muscle fibers  Muscle tone, mass, and strength are decreased  Joints less elastic and flexible  Loss of calcification of cartilage  Alteration bone deposition and resorption  Falling estrogen increases bone resorption and decreases calcium depositions  Long bones are especially vulnerable to decreased bone density  Spine narrowing of intervertebral spaces results in loss of height  Lumbar curve changes  Postural changes result in changes to gait  Increased risk of fractures  AGING BODY: MUSCULOSKELETAL SYSTEM  Assessment  Assess passive range of motion  Assess joints  Assess ability to perform personal care  Assess standing, gait, balance, posture  Assess limping, numbness, tingling, deformity  Assess muscle weakness, paralysis, tremors, spasms, clumsiness, muscle wasting, and muscle aches  Assess pain 0‐10 scale  Assess history of falls, traumatic injury, surgeries, and back problems  AGING BODY: MUSCULOSKELETAL SYSTEM  Common Concern and Nursing Interventions  Arthritis  Rheumatoid  Inflammatory disease immune factor origin  Osteoarthritis  Most common in older adults  Chronic, affects functional ability and lifestyle  Joint protection  Energy conservation  Warm baths/shower  Range of motion  Heat/cold therapy  NSAIDs  Steroid injection  Assistive devices  AGING BODY: MUSCULOSKELETAL SYSTEM Common Concern and Nursing Interventions  Arthritis  Surgery for increased disability, severe pain Joint arthroplasty Joint fusion  AGING BODY: MUSCULOSKELETAL SYSTEM Common Concern and Nursing Interventions  Hip Fractures  Open  Closed  Tenderness,, edema, muscle spasm, deformity, bleeding, and loss of function  Fall may not be the precipitating factor Weaking of upper femur causes bone to break then fall occurs  Most disabling type of fracture in older adults  significant amount of patient die within 1 year after injury  AGING BODY: MUSCULOSKELETAL SYSTEM Common Concern and Nursing Interventions  Hip Fractures  Types of Hip Fractures  AGING BODY: MUSCULOSKELETAL SYSTEM Common Concern and Nursing Interventions  Hip Fractures  Affected extremity usually rotated externally and shortened  Tenderness and severe pain at fracture site  Joint immobilization is necessary  Surgical repair  Depends on the location and type of fracture  AGING BODY: MUSCULOSKELETAL SYSTEM  Common Concern and Nursing Interventions  Hip Fractures  Nursing interventions after surgery  Vital signs  I&Os  Frequent turning, deep breathing, coughing and incentive spirometer  Monitor for infection and bleeding  Assess movement, circulation, and sensation  Monitor mental status  Opioid analgesics used cautiously  Maintain alignment of extremity  Avoid movements that cause dislocation  Crossing legs and feet  Adduction of legs when patient is lying on unoperated side  Raised toilet seat  AGING BODY: MUSCULOSKELETAL SYSTEM Common Concern and Nursing Interventions  Hip Fractures  Nursing interventions after surgery  Multidisciplinary rehabilitation Gait transfer training Muscle strengthening Teaching use of assistive devices  Prevent depression with positive feedback  AGING BODY: MUSCULOSKELETAL SYSTEM  Common Concern and Nursing Interventions  Osteoporosis  Common in older women  Low bone mass and deterioration of bone tissue  Increased risk for fractures  Can cause decreased height if in spine  Dowager’s hump  Prevention begins with children and adolescents  Diet high in calcium and vitamin D  Regular exercise  Bone density testing  Avoid smoking and excessive alcohol use, limit caffeine  AGING BODY: MUSCULOSKELETAL SYSTEM Common Concern and Nursing Interventions  Osteoporosis  Perimenopause women Hormone replacement therapy Controversial Contributes to cancer Calcium intake 1200‐2000 mg daily Vitamin D 600‐800 IU daily Bisphosphonates Improve bone density lessen bone loss AGING BODY: MUSCULOSKELETAL SYSTEM  AGING BODY: ENDOCRINE SYSTEM Age‐Related Changes  AGING BODY: ENDOCRINE SYSTEM Assessment Assess laboratory results  Calcium  Glucose  Thyroid hormone levels  AGING BODY: ENDOCRINE SYSTEM Common Concerns and Nursing Interventions  Type 2 Diabetes Mellitus  Type I  Juvenile diabetes  Type II  More common  s/s thirst, increased appetite, large amounts of urine  Repeated infections  Slow healing  Blurred vision  Weight gain/loss  AGING BODY: ENDOCRINE SYSTEM Common Concerns and Nursing Interventions  Type 2 Diabetes Mellitus  Goal  Maintain a stable metabolic state  Diet  Weight control  exercise  Education  Medication  Disease process  monitoring blood glucose  s/s of hyperglycemia and hypoglycemia  Foot and eye care  AGING BODY: ENDOCRINE SYSTEM Common Concerns and Nursing Interventions  Type 2 Diabetes Mellitus  Active involvement of patient and family in treatment plan increases compliance  Educational Handouts at American Diabetes Association  Individualize diet to patients' personal preferences  Reduction in weight  Limit sugar  Increased risk of foot problems  Blood glucose level of 200 mg/dL or higher  Associated with altered immune function  Peripheral neuropathy  AGING BODY: ENDOCRINE SYSTEM  Common Concerns and Nursing Interventions  Hypothyroidism  Neoplasms and hypothyroidism and hyperthyroidism  Clinical manifestations are more subtle  Detected through routine serum testing  Progresses slowly toward thyroid failure  Signs associated with older adults  Unexplained elevation in triglycerides or plasma cholesterol  Nonspecific cognitive impairment  Slow metabolism  Chest pain  Atrial fibrillation  Constipation  Macrocytic anemia  Vague arthritic reports  Cold intolerance  Depression with underlying apathy and withdrawal  AGING BODY: ENDOCRINE SYSTEM  Common Concerns and Nursing Interventions  Hypothyroidism  Goal: stabilization of thyroid levels  Medication: levothyroxine  Monitor thyroid‐stimulating hormone (TSH)  Nursing Interventions Education Medication  AGING BODY: REPRODUCTIVE SYSTEM  Age‐Related Changes  AGING BODY: REPRODUCTIVE SYSTEM  Assessment  Sexuality assessment  Obtain permission to discuss the patient sexuality  Goal gather information that allows individuals to express sexuality safely  Assess past STI’s and sexual difficulties  Assess for signs of vaginal or penile ulceration, edema, or discharge  Assess for presence of lumps, dimpling, or drainage from breast  AGING BODY: REPRODUCTIVE SYSTEM  Common Concerns and Nursing Interventions  Sexual function  Misconceptions  Older adults are impotent and asexual  Reality  Continue to be sexually active on a regular basis  Sexuality  Encompasses sexual identity, intimacy, and touch  Positive correlation between sexuality and physical health  Supported by encouraging and helping them to look their best AGING BODY: REPRODUCTIVE SYSTEM AGING BODY: SENSORY PERCEPTION  AGING BODY: SENSORY PERCEPTION  Vision  Changes increase with age  Reduced size of pupil  Acclimating to changes in light become difficult  Muscles of the eyes less effective  Discerning differing colors becomes difficult  Tear production is lessened  Visual impairments lead to injury  4 leading visual impairments  Cataracts, glaucoma, macular degeneration, and diabetic retinopathy  AGING BODY: SENSORY PERCEPTION  Vision  Presbyopia (farsightedness)  Clouding of the lens  Yellowing of the lens  Depth perception is distorted  Blindness is not a normal result of aging  AGING BODY: SENSORY PERCEPTION  Glaucoma  2nd leading cause of blindness  Occlusion in the drainage of the fluid in the anterior chamber of the eye  Increases intraocular pressure causing pressure on the optic nerve causing damage  Primary open‐angle glaucoma is the most common type  Vision is reduced slowly and painlessly  Starts with peripheral vision  Acute angle‐closure glaucoma  Complete occlusion  Severe eye pain, erythema, clouded or blurred vision, nausea, vomiting, rainbow halo surrounding lights, pupil dilation and a steamy appearance of the cornea  Medical emergency  Iridectomy  AGING BODY: SENSORY PERCEPTION  Cataracts  Most common disorder of the aging eye  Clouding of the transparent lens  Lens focuses light on the retina to produce a sharp image  Cataract formation makes lens opaque causing little light to reach the retina  Size and location determine the amount of interference  Symptoms: dimmed, blurred, or misty vision, need for brighter light  Surgery  Ultrasound to break lens into small pieces that are removed through a tiny incision  Substitute lens is used to restore vision  AGING BODY: SENSORY PERCEPTION  Hearing and Balance  External ear  Middle ear  Inner ear  Involved in hearing and balance  Hearing impairment in older adults is frequent  Rigidity of ossicles  Atrophic changes of the auditory nerve  Exposure to loud noises  Older adult often denies hearing impairment  Rigidity of ossicles  Atrophic changes of the auditory nerve  Exposure to loud noises  AGING BODY: SENSORY PERCEPTION  Hearing and Balance  Encouragement and support to explore methods of improving hearing  Cerumen impaction  Hearing impairment falls into 3 categories  Conductive  Interruption of the transmission of sound through the external auditory canal and middle ear  Related to cerumen impaction, otitis media, and fixation of auditory ossicles  Sensorineural  Inner ear, auditory nerve, the brainstem, or the cortical auditory pathways do not function properly  Mixed  Conductive loss superimposed on a sensorineural hearing loss  AGING BODY: SENSORY PERCEPTION  Presbycusis  Most common form of sensorineural hearing loss  Difficulty hearing high pitched tones and conversational speech  Sounds lost 1st are f, s, th, ch, and sh then sounds b, t, p, k, and s  Cause is unclear  Signs: increasing the volume of the TV or radio, tilting head toward the person speaking, cupping a hand around one ear, trouble following conversation, lip reading, speaking loudly, not responding when spoken to  Diagnosis: audiometric evaluation  Treatment: cochlear implant, hearing devices, auditory rehabilitation  Nursing Intervention: provide good visual contact, allow lip reading, reduce or eliminate background noise, speak at normal rate and volume  AGING BODY: SENSORY PERCEPTION  Touch  Tactile information involving pressure, vibration, and temperature  Age‐related changes  Decrease in the number of receptor cells throughout the skin and joints  Increased difficulty sensing temperature  Maintaining balance  Common disorders that affect tactile ability  Stroke  PVD  Diabetic neuropathy  Nursing interventions focus on preventing injury  AGING BODY: SENSORY PERCEPTION  Smell and Taste  Decrease in the number of olfactory and taste bud receptors  Assessment  Eyes: dryness, tearing, and signs of infection, vision and vision changes  Hearing: use of hearing aids and effectiveness  Changes in taste and smell  Common Concerns and Nursing Interventions  AGING BODY: SENSORY PERCEPTION  Common Concerns and Nursing Interventions  Decreased vision:  Eyeglasses are clean and available  Increase amount of light  Reduce glare  Nightlights  Low vision aids  Large print  Strong contrasting colors  Magnifying glasses  AGING BODY: SENSORY PERCEPTION  Common Concerns and Nursing Interventions  Decreased Hearing  Hearing aids  Face the individual  Speak at a normal or slightly slower pace  Do not exaggerate or shout  Lower tone of voice  Eliminate background noise  Nonverbal communication  Gestures  Smiles  Nodding the head  Written communication  AGING BODY: NERVOUS SYSTEM  Age‐Related Changes  AGING BODY: NERVOUS SYSTEM  Age‐Related Changes  Physiologically  Nerve impulse transmission slows  Declines in neuron numbers are not a significant part of normal aging  Decreased efficiency in maintaining normal body temperature, and in pulse returning to normal after exercise or stress  Functional ability does not consistently decline  Changes in sensorimotor and motor function, memory, cognition, sleep patterns, and proprioception occur at varying rates  Behavior, thoughts, and emotions remain constant during normal aging  AGING BODY: NERVOUS SYSTEM  Age‐Related Changes  Memory  Forgetting names, misplacing items, and poor recall of events or conversations  Changes in short term memory  Long term memory maintained  Strategies for adapting  Making Lists  Posting reminders  AGING BODY: NERVOUS SYSTEM  Age‐Related Changes  Cognition  Process by which information is acquired, stored, shared, and used  Elements of this process State of consciousness, general appearance, behavior, orientation, memory, language, intelligence, perception, insight and problem‐solving ability, judgement, attention span, mood and affect Only some experience deficits Intelligence and ability to learn are possible throughout lifetime Teaching strategy modifications: may need reinforcement  AGING BODY: NERVOUS SYSTEM  Age‐Related Changes  Medications  Sleep  Alcohol  Disturbances are  Drugs frequently reported  Nicotine  Cause is varied  Caffeine  Inability to go to sleep  Interrupted sleep  Sleep is not good restful quality  Related to Alzheimer’s disease  AGING BODY: NERVOUS SYSTEM  Age‐Related Changes  Proprioception  Ability to maintain an upright position without falling  Requires sensory input, motor output, central integration of balance and locomotion  Aging changes  Slower reflexes  Diminished strength of muscles  Increased postural sway  Ability to achieve proprioception declines with age  AGING BODY: NERVOUS SYSTEM  Age‐Related Changes  Personality  Remains stable  Any sign of impaired emotional control, diminished initiative, or withdrawal as indicators of other problems  Assessment  LOC: alertness, eye opening, verbal response, and ability to follow simple commands  Behavior and responses  Mental status: Mental Statue Questionnaire and Mini‐Mental State Examinations  Pain: severity, location, quality, duration, and precipitating events  Sleep Pattern: onset, duration, quality, and daytime napping  Laboratory results  CT Scan/ MRI results  AGING BODY: NERVOUS SYSTEM  Common Concerns and Nursing Interventions  Insomnia  Sleep patterns change  Fewer periods of deep sleep  Frequent periods of wakefulness  Nursing Interventions  Encourage a bedtime ritual  Promote an environment conducive to sleep  Avoid stimulation before bed  Sleep disorders  OTC medication  Prescription Medications  Can cause safety concerns  AGING BODY: NERVOUS SYSTEM  Common Concerns and Nursing Interventions  Delirium  Reversable condition  Rapid onset  Symptoms: behavioral changes, restlessness, agitation, or appearing withdrawn  Results from:  Fever/ Infection  Dehydration/ malnutrition  Sleep deprivation  Alcohol or drug use or withdrawal  Pain  Medications  Inadequate oxygen to the brain AGING BODY: NERVOUS SYSTEM  AGING BODY: NERVOUS SYSTEM  Common Concerns and Nursing Interventions  Delirium  Nursing Interventions  Educate nursing staff and caregivers about signs and symptoms  Orientation  Communication  Mobilization  Environmental modifications  Pain control  Management of elimination  Medication management  Reality orientation  AGING BODY: NERVOUS SYSTEM  Common Concerns and Nursing Interventions  Dementia and Alzheimer's disease  Dementia: progressive impairment of intellectual function  Reduced mental capacity affects relationships and other activities  Characterized by loss of memory, and at least one other disturbance of intellectual function  Affects short term, intermediate and long‐term memory  Aphasia  Agnosia  Apraxia  Agraphia  AGING BODY: NERVOUS SYSTEM  Common Concerns and Nursing Interventions  Dementia and Alzheimer's disease Alzheimer's disease most common cause of dementia Progressive disorder Brain atrophies Divided into 3 stages  Early stage  Middle stage  Terminal stage  AGING BODY: NERVOUS SYSTEM  Common Concerns and Nursing Interventions  Multiinfarct Dementia  MID, vascular dementia  2nd most common cause of dementia  Interruption of blood flow to the brain  Multiple strokes occur  Related to vascular disorder within the brain  Risk factors Arteriosclerosis, blood dyscrasis, cardiac decompensation, hypertension  AGING BODY: NERVOUS SYSTEM  Common Concerns and Nursing Interventions  Multiinfarct Dementia  Stair step decline rather than slow and steady  Symptoms  Depend on location of infarct  Abrupt onset symptoms:  Confusion  Problems with memory  Wandering  Getting lost in familiar places  Shuffling steps  Loss of bladder or bowel control  Inappropriate display of emotion  Difficulty following instructions  AGING BODY: NERVOUS SYSTEM  Common Concerns and Nursing Interventions  AGING BODY: NERVOUS SYSTEM  Common Concerns and Nursing Interventions  Goals: maintain maximum self‐care abilities and prevent injury  Break down task into small step by step actions  Use simple terms  Coaching about what to do  Keep environment calm  Routine is important  Patience is required  Impaired communication  Music  Reminiscence therapy  Assessing pain becomes challenging  Safety measures  AGING BODY: NERVOUS SYSTEM  Common Concerns and Nursing Interventions  Parkinson’s disease  2nd most common disorder of the nervous system  Progressive and degenerative  Muscle rigidity  Tremors  Akinesia  Masklike appearance  Drooling  Shuffling gait  Stress and frustration exacerbate the patients symptoms  AGING BODY: NERVOUS SYSTEM  Common Concerns and Nursing Interventions  Parkinson’s disease  Medication therapy  Nursing Intervention  Observe response to medication  Range of motion exercises  Safe environment  Assistive devices  Intellectual function not impaired but slow to respond  AGING BODY: NERVOUS SYSTEM  Common Concerns and Nursing Interventions  Transient ischemic attacks  Changes in vascular system  Thickening of vascular walls and atherosclerosis and arteriosclerosis  Small spasms or occlusions in the cerebral vessels  Signs and symptoms  Depend on location  Most common: changes in vision, headache, disorientation, ataxia, drop attacks  Symptoms last for as little as 20 minutes  1 out 3 have a stroke within 5 years  Need a neurological examination  AGING BODY: NERVOUS SYSTEM  Common Concerns and Nursing Interventions  Stroke  Cerebrovascular accident  3rd leading cause of death  Risk factors; incidence increases with age, heart disease, diabetes mellitus, physical inactivity  Symptoms:  Hemiplegia  Dysarthria  Dysphagia  Hemianopia  Aphasia  Intellectual and emotional changes  AGING BODY: NERVOUS SYSTEM  Common Concerns and Nursing Interventions  Stroke  Nursing Interventions  Support life functions  Rehabilitation  Assistive devices  Encourage patient to do activities and exercises  Do not rush, give encouragement  Physical therapy  Occupational Therapy AGING BODY: NERVOUS SYSTEM  CHECK ON LEARNING Name the five (5) psychosocial changes with gastrointestinal system that occur with an older adult.  CHECK ON LEARNING Name the six (6) psychosocial changes with respiratory system that occur with an older adult.  CHECK ON LEARNING Name the five (5) psychosocial changes with endocrine system that occur with an older adult.  CHECK ON LEARNING What are the methods of assessment for sensory perception for older adults?  CHECK ON LEARNING What is the suggested exam frequency for blood pressure for a 50‐year‐old person?  CHECK ON LEARNING How often should women at age 55 have a pelvic examination?  CHECK ON LEARNING How often should men and women over 50 years perform a glaucoma test?  CHECK ON LEARNING Name common psychosocial events that occur with the older adult.  CHECK ON LEARNING 5. What are the methods of assessment for cardiovascular for older adults? 6. What common concerns associated with musculoskeletal system for older adults? 7. What are the appropriate nursing interventions for the moles? 8. What are the appropriate nursing interventions for loss of appetite?  NCLEX QUESTIONS A patient has been experiencing visual changes from a loss of elasticity of the lens of the eye. What condition is associated with this phenomenon? a. Cataracts b. Presbyopia c. Glaucoma d. Macular degeneration  NCLEX QUESTIONS The nurse is caring for an older adult patient who has been diagnosed with depression. The nurse correctly recognizes what characteristics about depression in the older adult as being correct? (Select all that apply.) a. Depression is uncommon in older adults. b. Older people who receive psychotherapy for depression show improvement. c. Symptoms of depression are commonly misunderstood as normal changes of aging. d. Many older adults are treated for depression. e. Symptoms of depression in older adults may include crying, agitation, and hypochondria.  SAFETY AND SECURITY ISSUES FOR OLDER ADULTS  Falls  Leading cause of accidental death  25% adults over 65 years old fall each year  Underreported occurrence  Caused by a combination of factors  SAFETY AND SECURITY ISSUES FOR OLDER ADULTS  Polypharmacy  Use of 5 or more medications  May be prescribed or OTC  Each medication increases the risk  Tied to 28% of hospital admissions  5th leading cause of death  Review all medication including OTC  Ask patient regarding When medication was prescribed  Purpose  How it affects them  Age‐related changes also contribute to adverse reactions  ELDER ABUSE AND NEGLECT  American Medical Association issued guidelines for identification and treatment of abuse  5 classification  Physical or sexual abuse  Psychological abuse  Misuse of assets  Medical abuse  Neglect  Common reasons for abuse  Frustration  Caregiver exhaustion  Alcoholism  Turbulent lifestyles  Lack of financial, emotional, family, and community resources  ELDER ABUSE AND NEGLECT  National Center on Elder Abuse  2 most important indicators of abuse  Older person’s frequent unexplained crying  Older persons unexplained fear of or suspicion of a particular person(s) in the home  Older adults are often afraid to admit they are being abused or neglected  Mandatory reporting laws ELDER ABUSE AND NEGLECT  FINANCES  Older adults 2 biggest concerns  Finances and health  Healthcare can devastate financial security  Assistance from Medicare, Medicaid or both  Medicare supplemental  cover the 20% not covered by Medicare  Medicare part D  Prescription drug plans  Medicare advantage plans  Fixed income  Rely on social security, pensions  Spouses who never worked depend entirely on spouse  Qualify for spouse survivor benefits through social security  Financial problems are all too possible without careful planning  FINANCES  Financial problems are all too possible without careful planning  Assumptions:  Adequate pensions will be available  Social security benefits are available to everyone  Financial planning begins early in life  People live longer retirement lasts longer  Senior programs and agencies available to help  Homemaking assistance  Legal services  Low‐cost housing  Housing improvement  Heating assistance  Multiservice senior programs  Recreation programs  Information and referral services  HOUSING  Represents a certain degree of self‐concept and status  Moving and relocation is very stressful  May be necessary due to physical or financial concerns  Downsizing  Long‐term care residence  Assisted living facilities  HOUSING  Represents a certain degree of self‐concept and status  Moving and relocation is very stressful  May be necessary due to physical or financial concerns  Downsizing  Long‐term care residence  Assisted living facilities  CONTINUUM OF OLDER ADULT CARE  Population ages  Increase use of resources  80% of older adults have chronic illness  Half over 65 years old have at least 2 chronic conditions  HOSPITALIZATION, SURGERY, AND REHABILITATION  Increased risk for developing complications  Less reserve to cope physically and emotionally to the effects of hospitalization and surgery  Need longer postoperative recovery and convalescent periods  Measure to prevent complications DISCHARGE PLANNING  HOME CARE  Shorter hospital stays  Early discharge presents unique challenges  Referrals to community based services  Eligible for Medicare hoe health benefit  Home health Nurse  Assesses Physical, functional, emotional, socioeconomic, and environmental well being RN establishes plan of care LVN provides skilled nursing HHA provide personal care  ASSISTED LIVING  Fastest growing industry  Placed between home health and long‐term care facility  Services purchased individually as needed  Other living arrangement options  Retirement villages  Senior housing apartments  Single‐family homes  Group living  Sharing a home  LONG‐TERM CARE FACILITIES  Skilled nursing facilities  Utilized due to early discharge from hospitals  Patients still require skilled nursing  Referred to as residents  Facility is a temporary or permanent home  Usually require 24/7 care  Facility provides care  Care Cost Affected by location Average for semi‐private room is 83,000 annually Long‐term care insurance State and federal programs pay majority of cost  LONG‐TERM CARE FACILITIES  Skilled nursing facilities  Medicare cover only first 20 days of skilled rehabilitative care  Co‐pay from supplemental insurance needed for next 80 days if need for care continues  Medicaid cover all levels of care if they qualify  LONG‐TERM CARE FACILITIES  Skilled nursing facilities  Quality of Care  Highly regulated  Legislation passed to protect the rights of the resident  Interdisciplinary functional assessment  CHECK ON LEARNING 1. What are the requirements for Medicare home health benefit an individual must have?  SUMMARY 1. Health promotion 2. Care of the Older Adult QUESTIONS?