3Y1S Care of Older Adult PDF

Lesson 2. Concepts, Principles and Theories in the Care of Older increase in life expectancy, aging population continue to rise. The number of people 65 years and above is projected to grow an es...

Lesson 2. Concepts, Principles and Theories in the Care of Older increase in life expectancy, aging population continue to rise. The number of people 65 years and above is projected to grow an estimated figure of 524 Introduction million in 2010 to nearly 1.5 billion in 2050 with expected increase in other The unit provides relevant information in the care of older adults. This field has developing countries. blossomed over the past years as the baby boomer's group has entered retirement The improvements in life expectancy were part of the changes in the age. It is an ever-growing challenge to provide efficient care for older adults. leading causes of disease and death. In the 20th century, the major health threats There has been a greater demand of gerontology nursing more than before. This were parasitic diseases, infections that most often claimed the lives of infants. module provides comprehensive theoretical and practical information regarding Now, no communicable diseases that affect adults which impose the greatest concepts and vital issues pertaining to the care of older adults. This course burden on health globally. would help students make clinical judgments while discussing concepts, skills and even techniques of gerontological nursing practice. B. (b) Living Arrangements of the elderly in the Philippines The living arrangements of older adults differ according to the preferences ⌗ Generation Guide : and needs of each person. Most of them prefer to live in their own homes and The Greatest Generation … 1901-1927 communities. 68% of older adult's home is a single family home. 19% The Silent Generation …. 1928-1945 apartment, 6% duplex, 6% mobile home (Johnson & Appold, 2017). The living Baby Boomers Generation …. 1946 - 1964 arrangement may include living alone, with family members or living with unrelated individuals. There are also those living independently which may Generation X …. 1965-1980 require additional in-home care like assisted living communities, group homes, Millenial or Generation Y …. 1981-1996 continuing care retirement communities or long term care facilities. The older Generation Z … 1997-2010 adult's overall degree of health and well-being greatly influence the selection of housing. As they age, they get to be more vulnerable to multiple loses. Generation Alpha …. 2010-2024 Advanced age is more associated with physical frailty, chronic disease, diminishing physical functioning, more likely to develop cognitive impairment. ⌗ Terminologies : Nevertheless, not all older adults are frail. Housing should be selected that Gerontology - study of aging process promotes functional independence, safety and social interaction Geriatrics - A term referred to the medical care of older adults Centenarian - older adult who has lived to be 100 years of age Life Expectancy - The number of years one can be expected to live based on the ye birth according to statistical probability Gerontologist - Morbidity and Mortality (Philippine health statistics, 2000) Geriatrician - A physician who has special education in geriatric Normal aging does not imply disease but the incidence of chronic medicine. diseases increase with age. Comorbidity is another problem ⌗ Chronological Classifications of aging The leading causes of death among older adults are not much 65-74 - Young old different from young people except for accidents. 75-84 - Old 85-94 - Old-old Common Chronic Illnesses among older adults 95 and older - Elite Old, chronologically gifted Arthritis ○ Inflammation of the joints causing pain, stiffness, and ⌗ Aging can be described as.. swelling. Chronological age - The number of years a person has lived. Physiologic age - Determination of age by body functions ○ GOUT Functional age - the ability of the person to contribute to society and A form of arthritis characterized by sudden benefit others and severe pain, redness, and swelling in the joints, often due to high levels of uric acid. A. Perspectives of Aging low-purine diet NO RED MEAT AND 1. Developmental Aging Process SEAFOOD Ageing is a natural process, same to all living organisms hydration to flush out uric acid There are lots of factors that influence the process of aging. ○ RHEUMATOID Unique knowledge are in the nursing process of older adults chronic inflammatory disorder affecting joints, Older adults are human beings that share common needs and potentially leading to joint damage and self-care like all other human beings. deformities. Gerontological nursing help other older adults obtain optimum levels ○ OSTEOARTHRITIS of physical, psychological, social and spiritual health for them to common form of arthritis, caused by wear and achieve wholeness. tear on joints, leading to pain and stiffness. 2. Understanding ageing as a developmental process Hypertension The body changes and goes through varied periods all throughout the human life Heart disease cycle. Life's human cycle are as follows: P - I - T - C - P - O - A - M - O Hearing impairment Orthopedic impairment Pregnancy Cataract Infancy Sinusitis Toddler Diabetes Childhood Puberty Common Causes of Death Older adolescence Cardiovascular Adulthood Cancer Middle adulthood Cerebrovascular Accident (CVA) Older adults Lung disease Accidents (Fall). B. Demography of aging and its implications on health and nursing care Nurses nowadays find themselves caring for older adults in a wide Implications to health care delivery with older adults variety of settings. Demography refers to the distribution and vital statistics It is said that the future direction to health care is uncertain. Somehow, an urgent of the human population. need is needed for gerontology nurses to meet the needs of elderly in a wide variety of settings and continuum of care. As directed in all levels of prevention, Hence, review of older adult's demographic facts are as follows: models for care delivery is to develop with emphasis on prevention and health Approximately 103 million inhabitants are in the country with less than 5% of promotion community based services. It is a fact that most of the problems the total population 65 years and above (Central intelligence agency, 2016). experienced by older adults are within the scope of nursing practice. The Philippines' age structure is currently similar to other developing countries because the proportion of young Filipinos are greater compared to older adults. Implications of an aging population In spite of a huge number of young Filipinos, older adults are expected to rise Older adults population demand for health services. by 4.2%. Whereas, older adults 80 years and above are expected to increase Aging parents are expected to have less input in the lives of their by 0.4% from 2010 to 2030 (Help age-Global Network 2017). children. Most grandparents care for their grandchildren while parents are In US 60% of the older adult's population will increase by 5.4% from 2010 to working. 2030 (Help age 2015). Older adult's population increases by over 35% in the last Elderly may enjoy independence and freedom from responsibilities 2 decades, 65 years and above. By 2065. Those aged 0-14 years old is expected that family offers. to overtake (Help Age Global Network, 2017). Children are not obliged to meet the needs of aging parents for health services, housing or financial support. Now, The life expectancy of Filipinos is 57.4 years old for males and 63 years old for females. Life expectancy improvement in the Philippines can be Government efforts and programs attributed to advance in public health which have eradicated a lot of the diseases RA 7432 An act to maximize the contribution of senior citizens to that caused mortality among Filipinos (Coscoluella & Faustino, 2014). nation building. It allows senior citizens to conduct community services. Grant benefits and special privileges are provided. It B. (a) Global Aging provides the granting of 20% discount on fares, transportation, Globally, it is in the brink of demographic milestone. Young children have services from hotels, restaurants, lodging houses, theaters, recreation outnumbered their elders. In five years' time, the number of people 65 years and centers, purchase of drugs and medicines anywhere in the country. above will outnumber children below 5 years old driven by low fertility rates, 1  RA 8425 Institutionalization and enhancement of the social distribution of fats which contributes to the thinning and reform agenda by creating the National Anti- Poverty sagging of skin. Thinning of hair nails and wrinkles of the Commission ( NAPC). It provides a mechanisms for senior citizens skin are part of the aging process. Reduced amount of to participate in policy formulation on matters concerning poverty sebum and sweating ability would cause some older adults alleviation. to be intolerant of heat. Melanocyte cells become less active causing paler skin and lowered immunity. RA 9257 "Expanded Senior Citizens Act of 2003. It inreases the ○ Cold intolerance - risk hypothermia coverage of health benefits and priviledges for senior citizens by making it mandatory for business establishments to grant the 20% Musculoskeletal discount on goods and services. ○ The changes affecting the musculoskeletal system due to the aging process are as follows: RA 9336 " The general appropriation act of 2006. A mandate that Decrease in muscle mass, tone and strength all government agencies and instrumentalities should allocate a gradually occurring over time. The number of percent of their total agency budget to programs and projects for muscle cells decreases and being replaced by older persons and persons with disabilities. fibrous connective tissues. The elasticity of ligaments, tendons and cartilage decreases D. Theories of Aging including bone mass resulting in weaker Theories of ageing would explain the phenomenon of older adults over the bones. Posture and gait changes. Narrowing of lifespan. vertebral space causing loss of 1.5-3 inches in height. Convex curve of the back flattens. Major types of aging Extension and flexion of the lower back are Psychological decreased. biological ○ Skeletal : affects of quality of life Social osteoporosis impacts the quality of life by Biological Theories - Body's constant need to manufacture increasing the risk of fractures, metabolic activities causing toxic products to accumulate and leading to pain, disability, and cause cellular damage as organisms ages. decreased mobility. Individuals ○ Gene theory may experience fear of falling, ○ Somatic theory which can limit physical activity ○ Error theory and social interactions, contributing ○ Somatic theory to isolation and depression. ○ Cellular aging theory Respiratory system The aging process affects the respiratory system in numerous ways. Hence, the following are the changes: Reduces in peak flow 1. Stochastic aging theory (non-genetic theory)- events that happened all (how fast someone can exhale and that of carbon dioxide and oxygen exchange throughout once life that would result to cell damage accumulated overtime Lung functions decreases and weakening of the respiratory muscles occurs as examples: well as decline in the effectiveness in terms of defense mechanisms of the lungs. (1) free radical - happens when the membranes/proteins are being damaged Generally, the effects of aging on the respiratory system are airway and lung by free radicals (cellular damage), we get free radicals from food or water, disorder. fried foods, pesticides, radiation, pollutants, selected medications free radicals cause cellular damage and affect dna that will give rise to Cardiovascular system malignasis (cancer), membrane permeability, tissue damage/injury ○ Arteriosclerosis is the most common manifestation of the (2) wear and tear - similar to car (overtime the parts deteriorate bc of cells aging process pertaining to the cardiovascular system. and tissues) ○ There is stiffness of the large arteries or the hardening (3) cross link of the arteries causing high blood pressure. (4) autoimmune theories ○ Hypertension becomes common as people age. ○ These arterial changes would cause diastolic blood 2. Non stochastic theory pressure to generally decline and systolic blood pressure (1) Program theory - programmed time when to age to Increase (2) Gene/biological clock theory - terminal stage ○ Cardiac output (3) Neuro endocrine - or aging clock theory/pacemaker theory CaseScenario. Imagine a person with a heart - effectiveness of body's homeostatic adjustment declines rate (HR) of 80 beats per minute (bpm) and a (4) Immunological - defective stroke volume (SV) of 70 milliliters (mL) per beat. Using the formula CO = HR x SV, the Psychological Theories cardiac output would be: 1. Human Needs Theory CO = 80 bpm x 70 mL/beat = 5600 mL/min 2. Individualism Theory (or 5.6 liters per minute). 3. Stages of Personality Development This means that their heart pumps 4. Lifespan Development Theory approximately 5.6 liters of blood per minute, S. Selective Optimization Theory with Compensation Theory which falls within the normal range of 4-8 liters per minute. (Lifespan development theory-describes that life changes are predictable structured by roles, relationships, values and goals) Hematopoietic and lymphatic system There is reduced lymphocytes and red (Selective-optimization-describes that individuals cope aging through activity, blood cells production as well as increase in the production of myeloid cells. role selection, optimization and compensation.) Hematopoietic changes are associated with increase malignant transformation and increase Incidence of leukemia's. The muscle cells decreases in nurnber and Psychosocial theory the muscle walls of the lymphatic vessels become thinner. Hence, the strength 1. Activity theory - opposite of disengagement theory and rate of the contraction is affected making the valves less able to close 2. Disengagement theory - properly. 3. Subculture - they want to belong to a group that is similar to them, identification of social group Gastrointestinal In aging, there is alteration in smell and taste, gastric motility, 4. Continuity - older people would like to continue their activities during their intestinal overgrowth and gastrointestinal hormone release which could be the younger years til they get older basis for anorexia among older adults. Gastrointestinal function changes often 5. Age-stratification - ranking of people into age groups lead to constipation and fecal incontinence. There is weakening of the colonic 6. Person-environment fit theory - would be best to let the older adult be in an muscular wall which produces diverticula. Malabsorption of iron and calcium is environment they really fit in (ex. not grouping them with millennials) associated with achlohydria. 7. Gerotranscendence theory - Urinary system E. Issues and Gaps ○ The bladder wall among older adults' changes. ○ The bladder muscles weaken. The increasing number of senior citizens who are victims of abandonment and ○ Hence the bladder cannot hold much urine as before. Its violence due to in and out migration of younger members of the family. elasticity becomes stiffer. ○ Normal age related impact of kidneys Noncompliance of some residential buildings and establishments in terms of Decreased Filtration: Reduced glomerular making the senior citizens facilities accessible filtration rate (GFR). Reduced Blood Flow: Stiffer renal blood Despite the efforts to advocate compliance with RA 9257, as many food vessels limit blood supply. establishments and drug stores fail to extend the full benefit of the 20% senior Loss of Nephrons: Gradual decline in the citizens discounts. number of filtering units. Lower Concentration Ability: Difficulty F. Physiologic changes of aging affecting various systems concentrating urine, increasing dehydration risk. Integumentary System ○ Normal urine output is 800-200ml ○ Generally, the skin is the first noticeable signs of aging ○ Incontinence and retention especially on the hands and face. It loses elasticity. The dermis exhibits reduced ability to regenerate leading to slower wound healing. There is reduction in the 2 Nervous system-As one age, the nervous system and brain changes naturally. ○ Department of Social Welfare and Development (DSWD), The spinal cord and brain lose nerve cells and weight (atrophy). Messages begin Philippines to pass the nerve cells more slowly than the past. Nerve cells may break down as APS safeguards vulnerable adults from abuse, waste products and chemicals like beta amyloid begin to collect in the brain neglect, and exploitation through tissues. identification, intervention, and community education initiatives. Special senses Our sensory functions declines with age which contributes to isolation from outside world. (5 senses- Taste, Smell, Touch, Vision, Hearing) All these 5 senses diminish as one gets older. Nursing Care for older adults in wellness Taste (Sense of taste declines at age 60. Mouth produces less saliva causing dry mouth and can affect sense of taste.) Smell ( Sense of smell declines after 70) ASSESSMENT Touch (Aging affect nerve endings associated with pain, temperature, Older Adults appropriate nursing care is built on the information gathered from pressure, vibration and body positions. Older adults may have assessment that starts with the patient’s profile. difficulty sensing extreme heat and cold. Reaction time is not that fast. Hence older adults are more vulnerable to burn injury, cold and Patient's Profile: pressure ulcers.) ➤Name Vision ( Old age affects every area of the eye. Pupils respond slowly ➤Age/ Gender to light and darkness. Cornea becomes sensitive and prone to injury. ➤Date of birth Lens harden that alters the path of light. There is atrophy of eye muscles that affect the ability to rotate the eyes. ➤Address Hearing (Not able to pick up sounds easily and may experience ➤Occupation difficulties in maintaining balance as sit, stand and walk. They also ➤Marital status experience tinnitus and experien can trigger depression, isolation and ➤Educational Attainment even cognitive Impairment. TALK IN LOW PITCH VOICE ➤Ethnicity ➤Religion Endocrine system The endocrine system undergoes age-related changes that ➤Preferrred Language affects its functioning. Older adults often experience disturbed sleep patterns, reduced metabolic rate, lose bones, accumulated body fats and increase in blood ➤Vital Signs glucose. (BP, Temp, HR, PR, Height, Weight, BMI) ➤Chief Complaint Reproductive system -Reproductive Changes in aging occurs as hormone levels fall. Vaginal walls get thinner, dryer, irritated and less elastic. Sex sometimes SUBJECTIVE DATA: becomes painful because of vaginal changes. Risk for vaginal yeast infections increases. ➤ Ask about medications & treatment used ➤ Ask about what aggravates his/her health Caring for older adults involves recognizing gender differences in health ➤ What alleviates his/her symptoms needs: ➤ What health concern to occur Women: Tend to live longer but may experience more chronic conditions like ➤ Other related health concerns osteoporosis and arthritis. They are more likely to be affected by urinary ➤ What affects life & daily activities incontinence and face higher risks of fractures due to bone loss. Men: Have shorter lifespans and higher risks of heart disease and certain ➤ Previous history cancers. They are also more prone to prostate-related issues and might delay seeking medical help. HEALTH HISTORY TAKING Erikson's stages of development: 1. Trust vs. Mistrust (Infancy): Developing trust when caregivers provide Past illness, medical attentions, special procedures & hospitalizations. History of reliable care. cardiovascular, respiratory, renal, neurologic, diabetes mellitus, falls, injuries, or 2. Autonomy vs. Shame/Doubt (Early Childhood): Building independence and cancer. Document all medication taken. confidence. 3. Initiative vs. Guilt (Preschool): Initiating activities and asserting power over ASK ABOUT: the environment. A. Childhood illnesses 4. Industry vs. Inferiority (School Age): Gaining competence through B. Allergies achievements. 5. Identity vs. Role Confusion (Adolescence): Developing a sense of self and C. Hospitalizations personal identity. D. Surgeries 6. Intimacy vs. Isolation (Young Adulthood): Forming meaningful relationships. E. Injuries 7. Generativity vs. Stagnation (Middle Adulthood): Contributing to society F. Psychiatric or Emotional problems and future generations. G. Traumas 8. Integrity vs. Despair (Late Adulthood): Reflecting on life with a sense of H. Check up fulfillment or regret. I. Immunization Status Maslow’s Hierarchy of needs PSLES J. Current medication 1. Physiological Needs: Basic survival needs like food, water, warmth, and rest. K. Obstetrical Health 2. Safety Needs: Security and safety, including health, property, and L. Family History employment. M. Social History 3. Love and Belonging: Social needs, including relationships, friendships, and intimacy. 4. Esteem Needs: Self-esteem and recognition from others, encompassing confidence and achievement. 11 FUNCTIONAL HEALTH PATTERNS (Gordon’s) 5. Self-Actualization: The desire to realize one’s full potential and pursue A useful tool to assess the health status of the older person personal growth and creativity. ➤ Health Perception Health Management Pattern Sleep Deprivation in Older Adults: ➤ Nutritional Metabolic Pattern - Older adults often face sleep deprivation due to chronic pain, ➤ Elimination pattern medications, and sleep disorders, leading to cognitive decline and ➤ Elimination Pattern increased fall risk. ➤ Activity/Exercise Pattern (Assess risk for falls) Nursing Interventions: ➤ Sleep/Rest pattern 1. Assess Sleep Patterns: Monitor sleep duration and quality. 2. Educate: Teach sleep hygiene practices. ➤ Cognitive-Perception Pattern 3. Optimize Environment: Create a quiet, dark sleeping space. ➤ Role & Relationship 4. Encourage Activity: Promote regular exercise. ➤ Sexuality & Reproductive Pattern 5. Review Medications: Consult on alternatives that may disrupt sleep. ➤ Coping & Stress tolerance ➤ Value and Belief Pattern Antihypertensive medications can contribute to impotence - as a side effect, particularly certain classes like diuretics and beta-blockers. These medications may affect blood flow, hormone OBJECTIVE DATA levels, and overall sexual function. (Psychological & Physical Data) Vital Signs Elder abuse Skin & Nails ○ refers to the intentional or negligent acts by a caregiver or Face another person that harm an older adult. ○ It encompasses physical, emotional, sexual, and financial Nose abuse, as well as neglect. Eyes ○ Risk factors include isolation, dependency, and cognitive Ears impairment. Mouth Adult Protective Services (APS) Neck& Back Breasts 3  Heart Geriatric units: A special ore unit intended for the management of critically ill GI Tract order adults. Reproductive System (Male & Female) Musculoskeletal Sytem C. INTERVENTIONS Feet Care of older adult consider the gradual changes of aging — to include the Gait & Posture following: Nutritional Status Reference Skin and Mucous Membranes: ➤ Skin is the most visible sign of aging. B. PLANNING (for health promotion) ➤ Use fewer baths/showers with mild soap. ➤ Planning for successful aging ➤ Apply lotions, creams, and moisturizers daily for dry skin. ➤ Home care & hospice ➤ Use mouthwash and toothpaste; keep mucous membranes moist; drink plenty ➤ Community based services of water. ➤ Assisted living ➤ Special care units Bowel Elimination: ➤ Geriatric Units ➤ Regular assessments. ➤ Review medications, diet, hydration, and encourage physical activity. STEPS FOR SUCCESSFUL AGING ➤ Bladder Elimination: ➤Maintain & adopt positive lifestyles and health habits ➤ Regular assessment for incontinence. ➤Maintain Socialization& intellectual stimulation ➤ Address environmental factors for voiding. ➤Plan for financial stability ➤Maintain dignity & good health in old age Activity & Exercise: ➤Engage in regular exercise while considering personal limitations. ➤Maintain muscle strength, mobility, and balance. Home Health Care: Aims to improve functionality in older adults recovering from ➤Implement fall prevention strategies. injury or illness. Sleep & Rest: ➤ Provides intermittent skilled nursing care, speech language services, physical ➤Assess sleep patterns regularly. therapy, or other physician-prescribed treatments. ➤Promote consistent sleep schedules and environments conducive to quality sleep. ➤Intended for elderly with chronic conditions or those recovering from injury or surgery. Coping & stress of aging: ➤ Address challenges & threats in lives to reduce mental tensions. ➤Recipients must be homebound to qualify for benefits or Medicare. ➤ Avoid unnecessary worries, ovoid fatigue & low energy. ➤ Know the signs of stress & encourage older adults not to focus Skilled Home Health Care Services: on issues beyond their control. ➤ Caregiver and patient education. ➤ Wound care (including pressure sores). Values and beliefs: ➤ Nutrition therapy and intravenous therapy. ➤ Spirituality & Religion are Similar concepts. ➤ Injection skills. ➤ The search for the sacred affects various aspects of life. ➤ Positive outlooks improve health outcomes and reduce Hospice Care mortality. Helping older adults with advanced illness when medical treatments are no ➤ Meaning in life influences health behaviors. longer effective. Patients in the hospice care for those with prognosis, of six ➤Family beliefs and practices strengthen community and social months or less as certified by physician. support. Routine Hospice Care ➤ Activities of daily living is provided by family caregiver/friend Sexuality: ➤ Interdisciplinary team of hospice expert Aging in Women ➤ Decreased estrogen levels with menopause lead to vaginal dryness and LEVELS OF CARE thinning, causing discomfort during sex. ➤ In patient care ➤ Reduced sexual desire and longer time to become sexually aroused. ➤ Continuous care ➤ Respite care ➤Body changes (size & shape) can impact self-esteem. Common hospice service Aging in Men - 24/7 telephone access to hospice experts (can answer questions, ➤Decreased testosterone levels result in longer time to become sexually aroused dispatch clinicians to the patient) and achieve an erection. - If needed, delivery of medications, equipment & supplies. ➤ Erectile dysfunction is common but not universal. Special Care Units in Gerontology Impact of Other Conditions Designated areas in long-term care facilities. ➤ Hypertension, diabetes, heart disease, and depression can affect sex drive and Provide support and focused care for older adults with specific make sexual activity more challenging. conditions or needs. ➤ Medications may have side effects that impact sexual activity. Address unique requirements of those with complex issues, cognitive decline, and challenges not adequately managed in standard long-term care settings. Sensory Perception disturbances: Environmental factors: Types of Special Care Units ➤Poor safety hazards ➤ Skilled nursing units ➤ Lightning & cognitive impairment are all potential causes of sensory ➤ Rehabilitation units disturbances. ➤ Assisted living units ➤ Hospice units D. EVALUATION ➤ Respite units The Gerontology Nurses: ➤ Adult day care units Reassess and use critical thinking to evaluate if older adults' expected outcomes are met or not met within the established time frame. Community based services: A core for older adults that is coordinated, Provide essential data to determine if interventions should be integrated care in community setting. accepted, modified, or rejected. 4  Chronic Confusion also called dementia A. Disturbances in Sensory Perception Decline in cognitive ability, ability to think, learn and understand Key Aspects of disturbances in sensory perception in aging: Dementia is not a normal part of aging. It is an abnormal degeneration of the brain that leads to changes in a person's ability to Vision think, speak, socialize and take part in normal daily activities. Reduced color discrimination. They may have difficulty Long term progressive and degenerative process that occurs over distinguishing dim lighting ( between certain colors and has months or years. diminished ability to see in dim night vision). Usually involve problems with memory recall, problem solving, Decreased visual acuity. There is decline ability to see fine details language and attention. and focus on close objects (presbyopia) requiring the use of reading Difficulties with perception, rationalizing, judgment, abstract glass. thinking, communication, emotional expression and the performance of routine tasks. Increased sensitivity to glare. Aging eyes may become more sensitive Progressive decline in cognitive function. to bright lights and glare, making it challenging to drive at night or in sunny conditions. Causes - It is caused by damage to nerve cells and the connections to the brain. The symptoms depend on the area of the brain that's damaged. Dementia can Hearing affect people differently. Presbycusis. casis. This is an age related hearing loss. It is common in older adults. It affects high-frequency sounds and can make it Signs and symptoms difficult to hear conversations especially in noisy environment. Unable to think clearly Difficulty with speech comprehension. Older individuals may Uncertain what is happening around them struggle to understand spoken words, particularly when there is Disoriented in terms of day and time background noise. Aggression Frustration Taste Unusual behavior or mood swings Reduced taste sensitivity. Aging can lead to a decreased ability to Anxiety taste and discriminate between flavors which can affect nutrition and enjoyment of food Progressive dementia - Types of dementia that is progressive, worsen and aren't reversible includes the following: Smell Alzheimer's disease Diminished sense of smell. The sense of smell often declines with Vascular dementia age, affecting one's ability to detect odors, which can influence taste Lewy body dementia perception and alertness to potential dangers. Frontotemporal dementia Mixed dementia Touch Decreased tactile sensitivity. They have reduced sensitivity to touch, Impaired Verbal Communication which can affect their ability to detect pain, temperature changes or It plays a crucial role in health care settings especially in the care of older adults. fine tactile discrimination. It can significantly impact the quality of care, necessary to comprehensively Slower reaction times. Age-related changes in the nervous system understand its cause, assessment, interventions and roles of nurses in addressing can result in slower reflexes and reaction times to sensory stimuli. the issues. Impaired verbal communication refers to the limitations or disruptions in the ability to express oneself verbally or understand verbal Managing Sensory Concerns/Comprehensive Nursing Care messages. Verbal Impairments may manifest in various ways, including difficulty articulating thoughts, speech disorders, cognitive decline affecting 1. Assessment of Sensory Changes - Evaluate how well the application works in communication skills and sensory deficits. detecting and recording sensory alterations in older people with chronic illness conditions. This includes assessing changes in vision, hearing, taste, smell and Nursing Interventions touch. Communication Strategies - Utilize clear and simple language to enhance understanding. Allow sufficient time for the patient to 2. Individualized Care Plans Assess the extent to which care plans are process information and responses. Use visual aids or written individualized to accommodate the specific sensory impairments of each patient. instructions to supplement verbal communication. Foster a quite and comfortable environment to reduce distractions. 3. Medication Management Review medication management practices Collaboration with interdisciplinary team - Work closely with particularly in cases where sensory deficits might impact medication adherence. Speech-language pathologists to develop tailored communication Ensure that medication labels are accessible and that patients fully understand plans. Engage in interdisciplinary meetings to share insights and their prescriptions. collaborate on holistic care approaches. Educational support - Provide education to family members and 4. Fall Prevention and Safety Measures - Evaluate fall prevention strategies that caregivers on effective communication strategies. Offer resources and takes into account about sensory impairments such as impaired vision. training programs to enhance the overall communication environment. 5. Psychosocial Support - Evaluate the program's approach to addressing the Technology integration - Explore assistive communication devices psychosocial impact of sensory changes which can lead to social isolation and to facilitate interaction. Integrate tele-health solutions to maintain depression. Consider the availability of counseling for patients and their family. regular communication with health care providers. 6. Regular Sensory Assessment Ensure that regular sensory assessments are part 1. Aging is of the ongoing care plan with adjustments made as needed based on changes in sensory perception. a. Disease process b. Developmental process 7. Communication Strategies Assess the use of effective communication c. Geriatric Process strategies and consider sensory impairments. Evaluate the training provided to d. Functional Process healthcare staff in taff in adapting communication to accommodate sensory deficits. 2. According to Help age global network 2017, that the life expectancy of a Filipino male is Nursing programs will have to properly address sensory perception deviations among older adults with chronic illnesses and eventually improve their overall a. 55.5 years 60 years quality of life and health outcomes. It is necessary to evaluate these components b. 57.4 years 63 years under the given parameters or criteria. c. 60 years d. 63 years B. Chronic Confusion (Dementia) 3. The life expectancy for Filipino female is Confusion - The state of disturbed consciousness with disruption of thought and decision making capacity. a. 55.5 years b. 57.4 years 2 types of confusion c. 60 years Acute confusion (Delirium) d. 63 years Chronic Confusion (Dementia) 4. Life expectancy improvement in the Philippines can be attributed to 5  c. Functional aging a. advance in public health eradicating diseases causing mortality d. Psychological aging among Filipinos b. Engaging in multidimensional researches 16. Referring to the decline in cognitive process that occurs as people get older c. Children have outnumbered their elders d. 85% of the population, 60 years old and above 2022 a. Social aging b. Psychological aging 5. Gerontology is the study of aging process from c. Biological aging d. Cognitive aging a. Childhood to later life b. Maturity to old age 17. The following are common chronic illness among older adults except c. Middle age to retirement d. Retirement to death a. Arthritis b. Hypertension 6. Geriatrics c. Heart disease d. Measles a. Is more multidimensional than gerontology b. Uses the bio psychosocial model c. Helps the Elderly gain greater insights 18. Demographic Aging refers to d. Focuses on preventing and managing disease in later life. a. Chronological aging 7. Chronological aging refers to b. Population aging c. Physical aging a. The number of years a person has lived d. Functional aging b. Determination of age by body functions c. The ability of the person to contribute to society and benefit others 19. The generation that lived through great depression and himself d. Normal aging a. Greatest generation b. Silent generation 8. Physiological aging refers to c. Baby boomers generation d. Generation X a. The number of years a person has lived b. Determination of age by body functions 20. The generation that is said to be the conformists c. The ability of the person to contribute to society and benefit others and himself a. Greatest generation d. Normal aging b. Silent generation c. Baby boomers generation 9. Functional Age d. Generation X a. The number of years a person has lived 21. The generation born 1997-2010 b. Determination of age by body functions c. The ability of the person to contribute to society and benefit a. Generation X others and himself b. Generation Y d. Normal aging c. Generation Z d. Generation Alpha 10. Geriatric refers to a. Medical care of older adults 22. A type of biological theory wherein the person has a limited amount of b. Study of aging genetic materials that will run out over time. c. Scope of nursing practice. d. Functional process of aging a. Program theory b. Run out of program theory 11. Under the classification of aging to chronological aging by WHO, Middle' c. Genes theory old falls under the age-range of d. Wear and Tear Theory a. 65-74 years old 23. The following are classified as cellular stochastic theories except b. 75-84 years oid c. 85-94 years old a. Free-radical theory d. 100 years b. Cross link c. Wear and Tear Theory 12. Young old is classified as d. Programmed theory a. 65-74 years old 24. ____ attempts to explain changes in behaviour roles and relationships that b. 75-64 years oid occurs as individual age c. 85-94 years old d. 95 years a. Psychological Theory b. Biological Theory 13 Old-old is c. Wear and Tear Theory d. Immunologic Theory a. 65-74 years old b. 75-84 years old 25. The theory that proposes about having active participation in physical and c. 85-94 years old mental activities that may help maintain functions and well-being into old age d. 95 years and above a. Disengagement Theory 14. The classification of aging referring to the capabilities of the individual to b. Wear and tear Theory function in a society c. Activity Theory d. Subcultural Theory a. Physiological aging b. Biological aging 26. An increase in life expectancy for both males and females is due to c. Functional aging d. Social aging a. Genetic factor b. Being the ideal weight for one's statue 15 The classification of aging referring to the changes in the roles and c. low blood pressure relationships as one age d. all of these a. Physiological aging b. Biological aging 27. The signs of aging include which of the following 6  a. Wear and tear theory a. Forgetfulness b. Free-radical theory b. Dryness and wrinkling of skin c. Cross-link theory c. loss of hair pigment d. Error theory d. All of the above 39. The generation that lived through the AIDS Pandemic 28. The process of aging can be slowed by a. Generation X a. Improved living conditions b. Generation Y b. Adequate sleep c. Generation Z c. Better nutrition d. Generation Alpha d. All of the above 40 The generation born after the world war II (1964) 29. The PACEMAKER theory is also known as: a. Greatest generation a. Gene theory b. Baby boomers generation b. Programmed theory c. Silent generation c. Neuroendocrine theory d. Generation X d. Immunological theory 41. Statistical study of human population 30. An Act to maximize the contribution of senior citizens, to nation buiding. Grant benefits and special pivileges are provided with 20% discount on fares, a. Demography transportations, medicines. b. Global aging c. aging in the Philippines a. RA 7432 d. Demographic trends b. RA 8425 c. RA 9257 42. Gerontology is d. RA 9336 a. The same thing as ageism 31. Institutionalization enhancement of the social reform agenda by creating the b. The study of prejudice & discrimination towards the elderly national anti-poverty commission (NAPC). Allowing senior citizens to c. The study of aging participate in policy formulation on poverty alleviation. d. The study of aging theories a. RA 7432 43. A theory that proposes the existence of one or more harmful genes that b. RA 8425 activate overtime resulting in the typical changes seen with aging and limiting c. RA 9257 the life span of the individual. d. RA 9336 a. Molecular theory 32. Expanded senior citizens act. An act granting additional benefits and b. Gene theory privileges to senior citizens further amending republic act 7432. c. The run out of program theory d. Programmed theory Answer: RA 9257 44. A theory referring to personality and behavior that remains the same and 33. The following are classified as biological theories of aging except; becomes more predictable as people age. a. Genes Theory a. Disengagement theory b. Immunological Theory b. Activity theory c. Error Theory c. Continuity theory d. Disengagement Theory d. Subculture theory 34. Individual aging that reflects the ability to carry on an independent, 45. Erikson's stages of developmental task for older adults self-sufficient life in which we take care of our basic personal needs like self-care. a. Autonomy vs shame & doubt b. Integrity vs despair a. Chronological aging c. Initiative vs Guilt b. Physical aging d. Industry vs inferiority c. Functional aging d. All of the above 46 According to this theory of aging, older adults maintain the same internal and external structures as they did the earlier years of their lives 35. A theory that states "People share similar problems, interests, concerns and believed to have positive affinity for one another A. Continuity theory B. Activity theory a. Gene theory C. symbolic interaction b. Activity theory D. Social contact c. Subculture theory d. Exchange theory 47. The process of developing the appearance and characteristics old age 36. According to this theory that it is normal for the older adult to become less A. Development process and less involved B. Aging process C. Biological process a. Activity theory D. Demographics of aging b. Disengagement theory c. Continuity theory 48. The signs of aging include which of the following d. Free radical theory A. Forgetfulness 37. An aging theory that states "Organisms age because cells accumulate B. Dryness and wrinkling of skin chemicals that darnage over time. A37 C. Lose of hair pigment D. All of the above a. Free-radical theory b. Wear and tear theory 49. An age-related hearing loss is called c. age-stratification theory A. Presbyeusis d. Cross-link theory B. Glaucoma C. Presbyopia 38. Aging is attributed due to the binding of chemicals and the changes that D. Tinnitus happens in the body. 7 50. As you age visual acuity gradually declines. The most common problem is - This is the most severe form of aphasia, where individuals have difficulty focusing the eyes on close-up objects. This condition is called significant impairments in both expressive and receptive language abilities. They A. Presbycusis B. Glaucoma C. Presbyopia D. Tinnitus 3 Developmental task for Older Adults by ROBERT PECK 1. Ego Differentiation versus Work Role Preoccupation a. Stage where an old adult thinks about what he is going to do after retirement. b. Finding ways to affirm self-worth outside the work role. c. Must adjust values to place less emphasis on selves as workers or professionals and more on attributes that don't involve work, such as being a grandparent or a gardener. 2. Body transcendence versus Preoccupation a. Elderly individuals can undergo significant changes in their physical capabilities as a result of aging. b. Focusing on cognitive and social powers in order to "transcend" physical limitations. c. Individual must learn to cope with more beyond those physical changes. 3. Ego transcendence versus Ego Preoccupation a. Accepting that life is finite by findings ways to contribute to the welfare of the future generations. b. If people in late adulthood see these contributions, they will experience Ego Transcendence. If not, they may become preoccupied with the question of whether their lives had value and worth to society. Carl Gustav Jung Theory - process of searching, questioning, and setting goals Triglyceride: Triglycerides are a type of fat (lipid) found in the blood. When you eat, your body converts excess calories into triglycerides, which are stored in fat cells for later energy use. Elevated levels of triglycerides can increase the risk of heart disease and are often linked with metabolic conditions like obesity, diabetes, and high cholesterol. Lipoprotein Level: Lipoproteins are particles made of fat and protein that transport cholesterol and triglycerides through the bloodstream. Key types include LDL ("bad" cholesterol) and HDL ("good" cholesterol). Lipoprotein levels are important indicators of heart health, as high LDL levels can lead to plaque buildup in arteries. Tryptophan: Tryptophan is an essential amino acid found in various foods like turkey, chicken, and dairy. It plays a role in producing serotonin, a neurotransmitter that regulates mood, sleep, and appetite. Tryptophan deficiency can lead to mood disorders or sleep problems, while proper intake supports overall well-being. Mental Status of the older adults - MINI COG - RECALL TEST - CLOCK TEST Aphasia is a communication disorder that affects a person's ability to process language, and it is generally classified into several types, each with distinct characteristics. Here are the main types of aphasia: 1. Broca's Aphasia (Non-fluent Aphasia) - Characterized by difficulty in speech production, individuals with Broca's aphasia often speak in short, fragmented sentences. Their comprehension is relatively preserved, but they struggle to form complete sentences. - Key Features: - Effortful speech - Telegraphic speech (e.g., "Want cookie") - Relatively good comprehension 2. Wernicke's Aphasia (Fluent Aphasia) - Individuals with Wernicke's aphasia produce fluent speech but often with little meaning. They may use nonsensical words or create new words (neologisms) that can make their speech hard to understand. - Key Features: - Fluent but nonsensical speech - Poor comprehension - Difficulty recognizing their speech errors 3. Global Aphasia 8 9