Care of the Older Person - COP LEC (PRELIMS) PDF

Care of the Older Person  The Older Person Gerontology is the study of the aging process. Geriatrics is the care of aging people. It is the medical specialty dedicated exclusively to providing high-quality, patient-centered care for older adults. Aging is normal. Normal Changes occu...

Care of the Older Person  The Older Person Gerontology is the study of the aging process. Geriatrics is the care of aging people. It is the medical specialty dedicated exclusively to providing high-quality, patient-centered care for older adults. Aging is normal. Normal Changes occur in body structure and function. Psychological and social changes also occur.  The Older Person * someone over the age of 65 is considered an older person. *before People live longer than ever today. *Retirement is the reward for a lifetime of working. *Not all people are lucky enough to have the money or health to enjoy it. *Chronic illness is common in older person. *Disability often results. *Many have at least one disability. AGING –associated with being “old” or reaching “older adulthood.” - most widely held view as just a part of the life cycle. - progressive physiological cycle leading to senescence, or a decline of biological functions and of the bodies ability to adapt to metabolic stress. > Ageism – a personal revulsion and distaste for growing old, disease, disability; and fear of powerlessness, “uselessness,” and death > Senescence refers to the progressive deterioration of body systems that can increase risk of mortality; a process by which a cell ages and permanently stops dividing but does not die. > Four Older Age Groups Young old (65-74) Middle old (75-84) Old old (85-99) Centenarians ( >100) (RA 11982) DEMOGRAPHICS OF AGING 2018: 8,013,059 Filipinos over 60 years old (8.2%) – 5,082,049 will be 65 years old and older PROJECTIONS Philippines will enjoy the benefits of a young population until 2030 Growth: 4.9% (2020) 5.6% (2025) 6.3% (2030) Increased life expectancy Average age: 68.5 (2017) to 74 (2018) https://www.youtube.com/watch?time_continue=13 &v=GASaqPv0t0g&embeds_referring_euri=https%3A %2F%2Fwww.physio- pedia.com%2F&source_ve_path=MjM4NTE Psychological changes in Aging cognitive and mental health like short term memory in cognition like slower reaction times and reduced problem solving abilities one in four older adults experiences a mental health problem such as depression, anxiety, schizophrenia or dementia.  SOCIAL CHANGES > Decreased social contact with friends and family - person may withdraw. > Reconciliation with past-resolving conflicts, losses, acceptance. > Changes in physical appearance maybe difficult. > Changes in roles/ tasks that people can manage and can make them feel they have less to contribute. Psychological-Social Changes Physical reminders of growing old can threaten self- esteem and independence. Social roles change-some are now being cared for by their children. How people cope with aging depends on: > Health status > Life experiences > Finances > Education > Social support system Housing Options-only 5% of the 65+ elderly live in nursing homes Live with family Adult day-care centers during the day Nursing Centers Assisted living residences Continuing care retirement communities (CCRC) Board and care homes Congregate housing (senior citizen housing)  Physical Changes Physical changes occur with aging These happen to everyone. The rate and degree of change vary with each person. They depend on diet, health, exercise, stress, environment, heredity, and other factors. Quality of life does not have to decline.  Integumentary System The skin losses its elasticity, strength, and fatty tissue layer. Secretions from oil and sweat glands decrease-don’t need baths as often. Blood vessels are fragile-bruise easily. Brown spots appear on sun-exposed areas. Loss of the skin’s fatty tissue layer affects body temperature-tend to be cold. Dry skin causes itching and skin is easily damaged-(use mild soap and apply lotion.)  Integumentary System Nails become thick and tough. Feet usually have poor circulation. The skin has fewer nerve endings-less able to feel pain. White or gray hair is common. Hair loss occurs in men. Hair thins on men and women. Facial hair may occur in women. Hair is drier from decreases in scalp oils. Skin disorders increase with age.  Muscoskeletal System Muscle cells decrease in number. Muscles atrophy(shrink) and decrease in strength. Bones lose minerals, especially calcium. Bones lose strength, become brittle and break easily. Vertebrae shorten. Joints become stiff and painful. Mobility decreases. Activity, exercise and diet help prevent bone loss and loss of muscle strength.  Nervous System Nerve cells are lost. Nerve conduction and reflexes slow. Blood flow to the brain is reduced. Changes occur in brain cells. Sleep patterns change Touch and sensitivity to pain and pressure are reduced. Taste and smell dull.  Eye Changes Blue and green colors are difficult to see. Eyelids thin and wrinkle. Tear secretion is less. The pupil becomes smaller and responds less to light. Clear vision is reduced. The lens of the eye yellows. Older persons become more farsighted unable to see close items. Ear Changes Changes occur in the acoustic nerve. Eardrums atrophy-high pitched sounds are hard to hear. Wax secretion decreases. Wax becomes harder and thicker. Circulatory System The heart muscle weakens. Arteries narrow and are less elastic. Sometimes circulatory changes are present. Rest is needed during the day. Overexertion is avoided. Respiratory System Respiratory muscles weaken Lung tissue becomes less elastic The person may lack strength to cough and clear the airway secretions. Digestive System Salivary glands produce less saliva. Dysphagia is a risk. Taste and smell dull. Loss of teeth and ill-fitting dentures cause chewing problems. Peristalsis decreases. Fewer calories are needed. Urinary System Kidney function decreases Kidneys atrophy Blood flow to the kidneys is reduced. The ureters, bladder an urethra lose tone and elasticity. Bladder size decreases. If men, the prostate gland enlarges. Urinary tract infections are risks. Male Reproductive System The hormone testosterone decreases slightly. It affects strength, sperm production, and reproductive tissues. An erection takes longer. The phase between erection and orgasm is longer. Orgasm is less forceful than when younger Erection are lost quickly. Women Reproduction Menopause occurs in women. The woman can no longer have children Female hormones(estrogen and progesterone) decrease. The uterus, vagina and genitalia atrophy Vaginal walls thin and there is vaginal dryness. Arousal takes longer. Orgasm is less intense. The pre-excitement state returns more quickly THANK YOU! Care of the Older Person THEORIES OF AGING SOCIOLOGICAL THEORIES are expected progressions from midlife to older life based on social factors. It focus on the roles and relationships within which individual engage in later life. a. Activity Theory - suggests that the aging process is slowed or delayed, and quality of life is enhanced when the elderly remain socially active b. Disengagement Theory – it is natural to withdraw from society c. Subculture Theory- as people age, they develop their own distinct subculture that is separate from the dominant culture. d. Continuity Theory- older adults will usually maintain the same activities, behaviors, personality traits, and relationships e. Age Stratification Theory - is a system of conferring power and respect onto certain age groups. f. Person-Environment Fit Theory- the interaction between the abilities of an older adult and the particular environment in which they live that create the conditions for overall well-being g. Gerotranscendence Theory - psychosocial theory that proposes older adults experience a mindset shift in multiple dimensions (cosmic, coherence, solitude)  PSYCHOLOGICAL THEORIES is a set of statements that summarizes and explains mental and behavioral patterns within the context of society and culture: Explain aging in terms of mental processes, emotions, attitudes, motivation and personality development that is characterized by life stage transitions a. Human Needs Theory - Five basic needs motivate human behavior in a life-long process toward need fulfilment; the needs are prioritized such that more basic needs take precedence before the complex need b. Theory of Individualism - Personality consists of an ego and personal and collective unconsciousness that views life from a personal or external perspective. Older adults search for life meaning & adapt to functional & social losses c. Life Course (Life Span) Paradigm - Blend key elements in psychological theories (life stages, tasks, & personality development) with sociological concepts (role behavior & interrelationship between individual & society); Goal achievement is associated with life satisfaction d. Selective Optimization with Compensation Theory - Individual copes with the functional losses of aging through activity/role selection, optimization, & compensation; Critical life points are morbidity, mortality, & quality of life; Facilitates successful aging  BIOLOGICAL THEORIES aging follows a biological timetable and may represent a continuation of the cycle that regulates childhood growth (programmed); is the age-related changes of the cell's ability to transfer chemicals, heat and electrical processes that impair it. A. Stochastic Theories -the body's inability to repair its systems and delay the onset of aging is the result of minor changes that occur gradually over time. - Based on random events that cause cellular damage that accumulates as organism ages Free Radical Theory o Membranes, nucleic acids, and proteins are damaged by free radicals which causes cellular injury and aging Orgel/Error Theory o Errors in DNA and RNA synthesis occur with aging Wear & Tear Theory o Cells wear out and cannot function with aging Connective Tissue/Cross-Link Theory o With aging proteins impede metabolic processes and cause trouble with getting nutrients to cells and removing cellular waste products  BIOLOGICAL THEORIES B. Nonstochastic Theories - Based on genetically programmed events caused by cellular damage that accelerates aging of the organism Programmed Theory o Cells divide until they are no longer able to; this triggers apoptosis or cell death Gene/Biological Clock Theory o Cells have a genetic programmed aging code Neuroendocrine Theory o Problems with the Hypothalamus-Pituitary- Endocrine Gland Feedback System causes disease; increased insulin growth factor increases aging Immunological Theory o Aging is due to faulty immunological function which is linked to general well being NURSING THEORIES OF AGING Functional Consequences Theory - focuses on the needs that are unique to older individuals. - Miller's functional consequences theory (2008) provides a framework for wellness promotion in older adults by helping nurses to recognize their potential for growth and using wellness nursing diagnoses to foster a sense of value and dignity. - It proposes that the ability of older adults to maintain maximal self care is affected by the interaction of normal age-related changes and additional risk factors the individual encounters. NURSING THEORIES OF AGING Theory of Thriving - Failure to thrive results from a discord between the individual and his or her environment or relationships. Nurses identify and modify factors that contribute to disharmony among these elements - Critical attributes of Thriving are defined as social connectedness, ability to find environment, adaptation to physical patterns, and positive cognitive/affective function.  Healthy aging and longevity Healthy aging is a continuous Longevity is the state in which years process of optimizing opportunities to in good health approach the biological maintain and improve physical and life span, with physical, cognitive and mental health, independence, and social functioning, enabling well-being quality of life throughout the life across populations; maximization course. Care of the Older Person MARIA LAILANI D. LLAMAS, MAN RN RM Care of the Older Person  The Older Person Gerontology is the study of the aging process. Geriatrics is the care of aging people. It is the medical specialty dedicated exclusively to providing high-quality, patient-centered care for older adults. Aging is normal. Normal Changes occur in body structure and function. Psychological and social changes also occur.  The Older Person * someone over the age of 65 is considered an older person. *before People live longer than ever today. *Retirement is the reward for a lifetime of working. *Not all people are lucky enough to have the money or health to enjoy it. *Chronic illness is common in older person. *Disability often results. *Many have at least one disability. AGING –associated with being “old” or reaching “older adulthood.” - most widely held view as just a part of the life cycle. - progressive physiological cycle leading to senescence, or a decline of biological functions and of the bodies ability to adapt to metabolic stress. > Ageism – a personal revulsion and distaste for growing old, disease, disability; and fear of powerlessness, “uselessness,” and death > Senescence refers to the progressive deterioration of body systems that can increase risk of mortality; a process by which a cell ages and permanently stops dividing but does not die. > Four Older Age Groups Young old (65-74) Middle old (75-84) Old old (85-99) Centenarians ( >100) (RA 11982) DEMOGRAPHICS OF AGING 2018: 8,013,059 Filipinos over 60 years old (8.2%) – 5,082,049 will be 65 years old and older PROJECTIONS Philippines will enjoy the benefits of a young population until 2030 Growth: 4.9% (2020) 5.6% (2025) 6.3% (2030) Increased life expectancy Average age: 68.5 (2017) to 74 (2018) https://www.youtube.com/watch?time_continue=13 &v=GASaqPv0t0g&embeds_referring_euri=https%3A %2F%2Fwww.physio- pedia.com%2F&source_ve_path=MjM4NTE Psychological changes in Aging cognitive and mental health like short term memory in cognition like slower reaction times and reduced problem solving abilities one in four older adults experiences a mental health problem such as depression, anxiety, schizophrenia or dementia.  SOCIAL CHANGES > Decreased social contact with friends and family - person may withdraw. > Reconciliation with past-resolving conflicts, losses, acceptance. > Changes in physical appearance maybe difficult. > Changes in roles/ tasks that people can manage and can make them feel they have less to contribute. Psychological-Social Changes Physical reminders of growing old can threaten self- esteem and independence. Social roles change-some are now being cared for by their children. How people cope with aging depends on: > Health status > Life experiences > Finances > Education > Social support system Housing Options-only 5% of the 65+ elderly live in nursing homes Live with family Adult day-care centers during the day Nursing Centers Assisted living residences Continuing care retirement communities (CCRC) Board and care homes Congregate housing (senior citizen housing)  Physical Changes Physical changes occur with aging These happen to everyone. The rate and degree of change vary with each person. They depend on diet, health, exercise, stress, environment, heredity, and other factors. Quality of life does not have to decline.  Integumentary System The skin losses its elasticity, strength, and fatty tissue layer. Secretions from oil and sweat glands decrease-don’t need baths as often. Blood vessels are fragile-bruise easily. Brown spots appear on sun-exposed areas. Loss of the skin’s fatty tissue layer affects body temperature-tend to be cold. Dry skin causes itching and skin is easily damaged-(use mild soap and apply lotion.)  Integumentary System Nails become thick and tough. Feet usually have poor circulation. The skin has fewer nerve endings-less able to feel pain. White or gray hair is common. Hair loss occurs in men. Hair thins on men and women. Facial hair may occur in women. Hair is drier from decreases in scalp oils. Skin disorders increase with age.  Muscoskeletal System Muscle cells decrease in number. Muscles atrophy(shrink) and decrease in strength. Bones lose minerals, especially calcium. Bones lose strength, become brittle and break easily. Vertebrae shorten. Joints become stiff and painful. Mobility decreases. Activity, exercise and diet help prevent bone loss and loss of muscle strength.  Nervous System Nerve cells are lost. Nerve conduction and reflexes slow. Blood flow to the brain is reduced. Changes occur in brain cells. Sleep patterns change Touch and sensitivity to pain and pressure are reduced. Taste and smell dull.  Eye Changes Blue and green colors are difficult to see. Eyelids thin and wrinkle. Tear secretion is less. The pupil becomes smaller and responds less to light. Clear vision is reduced. The lens of the eye yellows. Older persons become more farsighted unable to see close items. Ear Changes Changes occur in the acoustic nerve. Eardrums atrophy-high pitched sounds are hard to hear. Wax secretion decreases. Wax becomes harder and thicker. Circulatory System The heart muscle weakens. Arteries narrow and are less elastic. Sometimes circulatory changes are present. Rest is needed during the day. Overexertion is avoided. Respiratory System Respiratory muscles weaken Lung tissue becomes less elastic The person may lack strength to cough and clear the airway secretions. Digestive System Salivary glands produce less saliva. Dysphagia is a risk. Taste and smell dull. Loss of teeth and ill-fitting dentures cause chewing problems. Peristalsis decreases. Fewer calories are needed. Urinary System Kidney function decreases Kidneys atrophy Blood flow to the kidneys is reduced. The ureters, bladder an urethra lose tone and elasticity. Bladder size decreases. If men, the prostate gland enlarges. Urinary tract infections are risks. Male Reproductive System The hormone testosterone decreases slightly. It affects strength, sperm production, and reproductive tissues. An erection takes longer. The phase between erection and orgasm is longer. Orgasm is less forceful than when younger Erection are lost quickly. Women Reproduction Menopause occurs in women. The woman can no longer have children Female hormones(estrogen and progesterone) decrease. The uterus, vagina and genitalia atrophy Vaginal walls thin and there is vaginal dryness. Arousal takes longer. Orgasm is less intense. The pre-excitement state returns more quickly THANK YOU! Care of the Older Person GERONTOLOGICAL NURSING GERONTOLOGICAL NURSING Gerontological nursing is the specialty of nursing pertaining to older adults. Gerontology is multidisciplinary and is concerned with physical, mental, and social aspects and implications of aging. Geriatrics is a medical specialty focused on care and treatment of older persons. Gerontological nurses, also called geriatric nurses, care specifically for elderly patients; specializing in this area often work in rehabilitation centers, hospice facilities, nursing homes, geriatricians' offices and patients' homes for one-on-one care. History of Gerontological Nursing The American Nursing Association (ANA) formed a specialized group for geriatric nurses in the 1960s to recognize geriatric nursing. the specialty of gerontological nursing emerged beginning in the 1950s, with the publication of the first gerontological nursing textbook. Establishment of NGNA & Scope and Standards of Gerontological Nursing Practice (1980’s) Established Hartford Foundation Institute of Geriatric Nursing at NYU Division of Nursing (1990’s) The Gerontology Nurses Association of the Philippines (GNAP) was officially launched on August 28, 2008 at the Philippine General Hospital. We believe that older persons have special nursing needs and concerns. PIONEERS IN GERONTOLOGICAL NURSING Florence Nightingale - first geriatric nurse - in the 19th century through her work caring for older helpers and maids (Care of Sick Gentlewomen ) Doreen Norton - focused career on care of the aged - described advantages of learning geriatric care in basic education Learning patience, tolerance, understanding and basic nursing skills Witnessing the terminal stages of disease and importance of skilled nursing care Preparing for the future Recognizing the importance of rehabilitation Being aware of the need to undertake research GERONTOLOGICAL NURSING The history and development of Gerontological Nursing is rich in diversity and experiences Focus is on increasing life expectancy Increasing numbers of acute & chronic health conditions Nurses provide disease prevention & health promotion Promote positive aging ROLES OF THE GERONTOLOGICAL NURSE "Nurses have to have the knowledge and skills to assist older adults in a broad range of nursing care issues, from maintaining health and preventing illnesses, to managing complex, overlapping chronic conditions and progressive, protracted frailty in physical and mental functions, to palliative care.“ Provider of Care Teacher Manager Advocate Research Consumer SCOPE AND STANDARDS OF GERONTOLOGICAL NURSING PRACTICE SCOPE – Assessment – Diagnosis – Outcome Identification – Planning – Implementation – Evaluation STANDARDS – Quality of Care – Performance Appraisals – Education – Ethics – Collaboration – Research – Research Utilization PRACTICE SETTINGS Acute Care Hospital Long-Term Care – Assisted Living – Intermediate Care -services are provided to patients, usually older people, after leaving hospital – Subacute or Transitional Care – Skilled Care – Alzheimer’s Care – Hospice Rehabilitation Community – Home Health Care – Foster Care or Group Homes – Independent Living – Adult Day Care MORTALITY AND MORBIDITY IN OLDER ADULTS Cardiovascular diseases, all forms 18.56% Pneumonia 6.21% Malignant neoplasms, all forms 5.11% COPD 3.42% Tuberculosis, all forms 3.04% Diabetes mellitus 2.74% GI ulcers & other GI diseases 1.42% Nephritis, nephrotic syndrome, nephrosis 1.19% Accidents and injuries 0.98% Chronic liver diseases & cirrhosis 0.55% Care of the Older Person QUESTIONS????  Care of the Older Person Biological Aspects of Aging Biological Aspects of Aging vital organs begin to lose some function as we age. changes occur in all of the body's cells, tissues, and organs, and these changes affect the functioning of all body systems. Biological Aspects of Aging Changes in the four basic types of tissue: 1. Connective tissue supports other tissues and binds them together. This includes bone, blood, and lymph tissues, as well as the tissues that give support and structure to the skin and internal organs. 2. Epithelial tissue provides a covering for superficial and deeper body layers. The skin and the linings of the passages inside the body, such as the gastrointestinal system, are made of epithelial tissue.  Biological Aspects of Aging Changes in the four basic types of tissue : 4. Nerve tissue is made up of 3. Muscle tissue includes three types of tissue: nerve cells (neurons) and is Striated muscles, such as those that used to carry messages to and move the skeleton (also called voluntary muscle) from various parts of the Smooth muscles (also called body. The brain, spinal cord, involuntary muscle), such as the and peripheral nerves are muscles contained in the stomach and other internal organs like the female made of nerve tissue. uterus Cardiac muscle, which makes up most of the heart wall (also an involuntary muscle) Common chronic conditions Common chronic conditions in the Philippines Common chronic conditions Common chronic conditions HYPERTENSION - is when the pressure in the blood vessels is too high (140/90 mmHg or higher). It is common but can be serious if not treated. HB is a common condition that affects the body's arteries. CAUSES: Adrenal gland tumors Blood vessel problems present at birth, also called congenital heart defects Cough and cold medicines, some pain relievers, birth control pills, and other prescription drugs Illegal drugs, such as cocaine and amphetamines Kidney disease Obstructive sleep apnea Thyroid problems Common chronic conditions Risk factors: High blood pressure has many risk factors, including: Age. The risk of high blood pressure increases with age. Until about age 64, high blood pressure is more common in men. Women are more likely to develop high blood pressure after age 65. Race. High blood pressure is particularly common among Black people. It develops at an earlier age in Black people than it does in white people. Family history. You're more likely to develop high blood pressure if you have a parent or sibling with the condition. Obesity or being overweight. Excess weight causes changes in the blood vessels, the kidneys and other parts of the body. These changes often increase blood pressure. Being overweight or having obesity also raises the risk of heart disease and its risk factors, such as high cholesterol. Lack of exercise. Not exercising can cause weight gain. Increased weight raises the risk of high blood pressure. People who are inactive also tend to have higher heart rates. Tobacco use or vaping. Smoking, chewing tobacco or vaping immediately raises blood pressure for a short while. Tobacco smoking injures blood vessel walls and speeds up the process of hardening of the arteries. If you smoke, ask your care provider for strategies to help you quit. Common chronic conditions Risk factors Too much salt. A lot of salt — also called sodium — in the body can cause the body to retain fluid. This increases blood pressure. Low potassium levels. Potassium helps balance the amount of salt in the body's cells. A proper balance of potassium is important for good heart health. Low potassium levels may be due to a lack of potassium in the diet or certain health conditions, including dehydration. Drinking too much alcohol. Alcohol use has been linked with increased blood pressure, particularly in men. Stress. High levels of stress can lead to a temporary increase in blood pressure. Stress-related habits such as eating more, using tobacco or drinking alcohol can lead to further increases in blood pressure. Certain chronic conditions. Kidney disease, diabetes and sleep apnea are some of the conditions that can lead to high blood pressure. Pregnancy. Sometimes pregnancy causes high blood pressure. Hypertension Management in Older and Frail Older Patients 1.Aim for a healthy weight. 2.Exercise. -Moderate activity, such as brisk walking or swimming 3.Eat a heart-healthy diet. - DASH 4.Cut down on salt. 5.Drink less alcohol. – (M) no more than two drinks a day; (F) no more than one drink/day 6.Don't smoke. - 7.Get a good night's sleep. 8.Manage stress. Common chronic conditions ARTHRITIS - redness and swelling (inflammation) of a joint. Osteoarthritis is the most common form of arthritis among older adults.; is a degenerative joint disease that happens when the tissues that cushion the ends of the bones within the joints break down over time. Common signs include swelling and tenderness, stiffness after getting out of bed, and a crunching feeling or sound of bone rubbing on bone. the most common causes of physical disability among adults. S/SX : joint pain, swelling, stiffness and limited movement.  Common chronic conditions ARTHRITIS - redness and swelling (inflammation) of a joint.  management of arthritis in old person Short-term treatments include: 1.Medications. Short-term relief for pain and inflammation may include pain relievers such as acetaminophen, aspirin, ibuprofen, or other nonsteroidal anti-inflammatory medications. 2.Heat and cold. 3.Joint immobilization. 4.Massage. 5.Transcutaneous electrical nerve stimulation (TENS). 6.Acupuncture. Common chronic conditions DIABETES MELLITUS -. is a condition that happens when your blood sugar (glucose) is too high. It develops when your pancreas doesn’t make enough insulin or any at all, or when your body isn’t responding to the effects of insulin properly. CAUSES: Insulin resistance Autoimmune disease Hormonal imbalances Common chronic conditions Common chronic conditions  Geriatric syndromes include a number of conditions typical of, if not specific to, aging, such as dementia, depression, delirium, incontinence, vertigo, falls, spontaneous bone fractures, failure to thrive, and neglect and abuse.  Geriatric syndromes DEMENTIA - A progressive deterioration in the intellectual abilities in such a severity that it interferes with the persons social and occupational performance, the prevalence increases with age. is not a specific disease but is rather a general term for the impaired ability to remember, think, or make decisions that interferes with doing everyday activities. characterized by: 1. losses in memory, abstract reasoning ability, judgment and language 2. Personality changes 3. deterioration of the ability to perform ADLs over time  Geriatric syndromes: DEMENTIA Symptoms are usually subtle in onset progressing slowly and eventually becoming obvious and devastating 3 General categories: a. cognitive b. functional c. behavioral Reversible causes: 3 most common nonreversible dementias a.alcohol abuse a.Multi –infarct dementia b.polypharmacy b.Alzheimer’s disease (AD) c.psychiatric disorders c.Mixed d.normal pressure hydrocephalus :  Geriatric syndromes: delirium is a serious change in mental abilities. It results in confused thinking and a lack of awareness of someone's surroundings. is a type of confusion that happens when the combined strain of illnesses, environmental circumstances or other risk factors disrupts your brain function. more common in adults over 65. is a serious and can cause long-term or permanent problems, especially with delays in treatment. is an acute neuropsychiatric syndrome and one of the most common presenting symptoms of acute medical illnesses in older people Geriatric syndromes: delirium Geriatric syndromes: delirium Geriatric syndromes: UI Geriatric syndromes: UI Geriatric syndromes: UI FALL IN OLDER PEOPLE Around 1 in 3 adults over 65 and half of people over 80 will have at least one fall a year. Most falls do not result in serious injury. But there's always a risk that a fall could lead to broken bones, and it can cause the person to lose confidence, become withdrawn, and feel as if they have lost their independence.. FALL IN OLDER PEOPLE FALL IN OLDER PEOPLE FALL Prevention What are universal fall precautions? Familiarize the patient with the environment. Have the patient demonstrate call light use. Maintain call light within reach. Keep the patient's personal possessions within patient safe reach. Have sturdy handrails in patient bathrooms, room, and hallway. ❑ Tinetti Balance and Gait Evaluation - use for patients with Parkinson disease or multiple sclerosis, traumatic brain injury, and stroke patients. - Using a standardized scoring system, the test assesses a patient's balance and gait ❑RISK FOR FALL CHECKLIST  Nutrition and hydration in older adults  Unique Needs of People Ages 60+ variety of foods from each food group to help reduce the risk of developing chronic diseases Choose foods with little to no added sugar, saturated fats, and sodium. Get enough protein during the day to maintain muscle mass – increase of 50% Focus on the nutrients needed, including potassium, calcium, vitamin D, dietary fiber, and vitamin B12. With age, they may lose some of their sense of thirst. Drink often. Low- or fat-free milk, including lactose-free options or fortified soy beverage and 100% juice can also help them stay hydrated. Maintain a healthy weight or prevent additional weight gain. Learn how much to eat from all five food groups and find out how many calories you need each day to help you maintain energy  My plate plan for old person DAIRY : 1 cup of milk, yogurt, or soy milk FRUITS: 1 ½ ounces of natural 1 cup of fruit cheese ½ cup of dried fruit 1 cup of 100% fruit juice GRAINS: 1 slice of bread 1 cup of ready-to-eat cereal ½ cup of cooked rice, cooked pasta, or cooked cereal PROTEIN: 1 ounce of meat, poultry or fish VEGETABLES: ¼ cup cooked beans 1 cup of raw or cooked 1 egg vegetables or vegetable juice 1 tablespoon of peanut butter 2 cups of raw leafy salad ½ ounce of nuts or seeds greens ¼ cup (about 2 ounces) of tofu 1 ounce tempeh, cooked Nutrition and hydration in older adults NUTRITIONAL ASSESSMENT A nutritional assessment is important because inadequate micronutrient intake is common in older persons. Several age-related medical conditions may predispose patients to vitamin and mineral deficiencies. Studies have shown that vitamins A, C, D, and B12; calcium; iron; zinc; and other trace minerals are often deficient in the older population, even in the absence of conditions such as pernicious anemia or malabsorption  NUTRITIONAL ASSESSMENT four components specific to the geriatric nutritional assessment: (1) nutritional history performed with a nutritional health checklist; (2) a record of a patient's usual food intake based on 24-hour dietary recall; (3) physical examination with particular attention to signs associated with inadequate nutrition or overconsumption; and (4) select laboratory tests, if applicable. One simple screening tool for nutrition in older persons is the Nutritional Health Checklist  Nutritional Health Checklist Statement Yes I have an illness or condition that made me change the 2 kind or amount of food I eat. I eat fewer than two meals per day. 3 I eat few fruits, vegetables, or milk products. 2 I have three or more drinks of beer, liquor, or wine 2 almost every day. I have tooth or mouth problems that make it hard for me 2 to eat. I don't always have enough money to buy the food I 4 need. I eat alone most of the time. 1 I take three or more different prescription or over-the- 1 counter drugs per day. Without wanting to, I have lost or gained 10 lb in the 2 past six months. I am not always physically able to shop, cook, or feed 2 myself.  Nutritional Health Checklist note: The Nutritional Health Checklist was developed for the Nutrition Screening Initiative. Read the statements above, and circle the number in the “yes” column for each statement that applies to you. Add up the circled numbers to get your nutritional score. scoring 0 to 2 = You have good nutrition. Recheck your nutritional score in six months. 3 to 5 = You are at moderate nutritional risk, and you should see what you can do to improve your eating habits and lifestyle. Recheck your nutritional score in three months. 6 or more = You are at high nutritional risk, and you should bring this checklist with you the next time you see your physician, dietitian, or other qualified health care professional. Talk with any of these professionals about the problems you may have. Ask for help to improve your nutritional status. Care of the Older Person  GERONTOLOGICAL NURSING Geriatrics – The study of old age, includes the physiology, pathology, diagnosis and management of the diseases of the older adults Gerontology- The broader field of geriatrics which is the study of the aging process including the biologic, psychological and sociologic aspects. Gerontologic nursing - the field of nursing that specializes in care of the elderly. this can be provided in the acute, chronic or community settings. Emphasis of care: a. promotes and maintain functional status- independence b. maintain dignity and maximum autonomy Ageism – Prejudice or discrimination against older people. Theories of aging; 1. Genetic or Mutation Theory – Changes in the replication of DNA-RNA are the causes of aging. 2. Autoimmune or Immunologic Theory – Aging is caused by a change in the immune system. 3. Wear and Tear Theory – Believes that the body is like a machine where parts wear out and the machine eventually breaking down. 4. Rate of Living Theory – States that the body has a fixed rate of potential for living. 5. Waste Theory – States that chemical wastes collect in the body and produce deterioration by interfering with cellular functioning. 6. Collagen Theory – Collagen stiffens with age, producing loss of elasticity in organs, skin, tendons, blood vessels and etc. 7. Endocrine Theory – Events occurring in the hypothalamus and pituitary are responsible for the changes in the hormone production and response that result in the organism’s decline. Cognitive aspects of aging: Misconceptions with regards to the decline in the mental functioning of the elderly are caused by the failure of early researchers to consider a multitude of factors that could alter the intelligence of the old adult population. Hospitalization, institutionalization, sudden change in the environment, medical therapy and altered role performance may cause temporary alterations in cognition. Intelligence: It has been demonstrated that when subjected to a test, older adults has a steady decline in their test results. However, health and the environment has been attributed to cause a profound influence on this and certain types of intelligence decline (spatial perceptions, nonintellectual information) while others do not (problem solving ability, verbal comprehension, mathematical ability). Learning and Memory The ability to acquire new skills and information decreases in the older adult but with adequate motivation they still continue to learn. Memory has 3 components that includes short term (5-30seconds), recent memory (1hr.-several days), long-term memory (lifetime). In the absence of pathology age related loss occurs more frequently with short-term and recent memory acquisition, recording, storing and recall(benign senescent forgetfulness). To facilitate learning: 1. Use of mnemonics 2. links new information with familiar information 3. use visual, auditory and other sensory cues 4. encourage wearing of prescribed sunglasses and hearing aids 5. provide a quiet, nondistracting environment 6. keep teaching periods short 7. pace learning task according to the endurance of the learner 8. encourage verbal participation 9. positive reinforcements PHYSIOLOGIC CHANGES OF AGING The well being of an individual depends on the physical, mental, social and environmental factors. Therefore, we need to determine these factors and the effects it has on our clients in order to appropriately effect our nursing interventions. Cardiovascular System Heart Disease- the leading cause of death among the aged Changes: Cardiac output decreases (1% annually after the age of 20) Less reserve and responds less effectively to stress Heart valves becomes thicker and stiffer Heart muscles and arteries lose their elasticity Calcium and fat deposits accumulate in the arterial walls 1  Veins become tortuous Manifests as Cardiac dysrrhythmias CHF CVA Intermittent claudication CAD PVD Hypertension MI Orthostatic hypotension Health promotion Regular exercise stress management Proper diet smoking cessation Weight control precautionary measures (sit-stand slowly) Regular BP monitoring Respiratory System Changes Increased AP chest diameter Kyphosis Calcification of the costal cartilages and reduced mobility of the ribs Diminished efficiency of the respiratory muscles Increased rigidity and loss of elastic recoil (increased RLV, decreased VC) Diminished gas exchange and diffusing capacity Decreased cough efficiency and reduced ciliary activity (prone to RTI) Manifests as: Altered lung capacity and function Respiratory tract infections Health promotion Regular exercise Influenza immunizations Appropriate fluid intake Smoking cassation Regular pneumococcal vaccination Integumentary System Changes: Thinning of the epidermis and dermis Diminished subcutaneous fats, especially of the extremities Collagen fibers become stiffer Reduced elastic fibers Diminished blood supply due to the decrease in the capillaries of the skin Decreased hair pigmentation Decreased sweat And sebaceous glands activities Manifests as Dry skin and increased susceptibility to infection Intolerance to extremes in temperature and sun exposure Graying of the hair Health promotion Avoid exposure to the sun Use lubricating skin cream Avoid excessive soaks in the tub Adequate intake of water Reproductive System Changes: Women Diminished ovarian and estrogen production Thinning of the vaginal wall, narrowed size, loss of elasticity Decreased vaginal secretions (dryness, itching, decreased acidity) Uterine and ovarian involution Decreased pubococcygeral muscle tone (relaxed vagina and perineum) Changes: Men Penis and testes decreased in size Diminished levels of androgens Manifests as: Decreased sexual desire and activity secondary to: Decreased vaginal lubrication, vaginal bleeding, painful sexual intercourse Erectile dysfunction Health promotion: Local estrogen replacements Vacuum penile pumps Vasostimulating medications Oral medication (viagra) Genitourinary System: Changes: Decreased kidney mass secondary to loss of nephrons Decreased filtration rate Diminished tubular function and less efficiency in resorbing and concentrating urine Slower restoration of acid-base balance in response to stress Stress/ urge incontinence BPH (men) Manifests as: 2  Urinary incontinence Retention of urine secondary to enlargement of the prostate Bladder infections Health promotion Adequate hydration Ready access to toilets Voiding every 3-4 hours while awake Practicing pelvic floor exercises (Kegel’s) -Identify the pubococcygeus muscle -Attempt to hold back flatus or stop the flow of urine without contracting the abdomen, buttocks or inner thigh then let go (tighten then relax) - 5 second contraction, 10 second rest interval, 30-80 repetitions per day High fiber diet Increase mobility Gastrointestinal System: Changes: Tooth decay and loss Decrease salivary flow Dry mouth Decreased gastric motility Diminished absorption of nutrients and vitamins in the small intestines Deficiencies in the absorption and tolerance to fat Manifest as: Periodontal diseases Delayed emptying of the stomach contents Constipation Abdominal discomfort and flatulence Fecal impaction Fecal incontinence and obstruction Predisposing factors Lack of dietary bulk Inactivity Prolonged laxative use Insufficient fluid intake Ignoring the urge to defecate Excessive dietary fat Medication side effects Health promotion: Regular dental care Adequate amount of fluids Eating small, frequent meals Regular bowel habits Avoiding heavy activity after eating Avoid using laxatives and antacids Eating a high fiber, low fat diet Nutritional Health Changes: Decreased physical activity reduces the number of calories needed to maintain Slower metabolic rate ideal weight of the older adult Manifest as: Sub optimal nutrient intake Predisposing factors: Apathy Loneliness Lack of oral health Immobility Poverty Lack of taste discrimination Depression Inadequate knowledge Health promotion Low sodium and low fat diet Increased fruit and vegetable diet Fish , potato, whole grains, brown rice Diet: 55-60% carbohydrates, 20-25% fat Fluids: 8-10 eight ounce glasses/ day Musculoskeletal System Changes: Loss of bone mass (>40, F>M) Increased incidence of fracture (vertebra, humerus, radius, femur, tibia) Diminished muscle size, strength, flexibility and endurance Manifest as: Osteoporosis (associated with inactivity, inadequate calcium intake, loss of estrogens) Kyphosis (convexity of the spine) Flexion of the hips and the knees (affects balance, mobility, internal organ function) Decreased activity Back pain Health promotion: Calcium, vitamin D, estrogen, and fluoride supplements Regular Weight- bearing exercises (swimming and brisk walking): Done in moderation with short and frequent rests Effects - Increases the efficiency of heart contraction - Improves oxygen uptake by the cardiac and skeletal muscles 3  - Reduces fatigue - Increased energy - Increases muscle endurance, strength and flexibility - Reduces cardiovascular risk factors Hi- calcium intake: 1,500 mg/day : Sources -dairy products -dark green vegetables -broths from soup bone with vinegar Low phosphorous diet: Avoid - red meats - cola drinks - processed foods Nervous System: Changes: Loss Of nerve cells leading progressive loss of brain mass Reduction in the synthesis and metabolism of major neurotransmitters Reduced speed of nerve impulse conduction Less efficient function of the ANS Cerebral ischemia More difficulty in maintaining homeostasis Manifest as: Slower reaction and response increases the risk for falls and injuries Postural hypotension Health Promotion Allow a longer time to respond to a stimulus Move more deliberately Beware of sudden onset of confusion it may indicate UTI, pneumonia, medication interaction, and dehydration Sensory System: Sensory deprivation- the absence of stimuli in the environment or the inability to interpret stimuli secondary to sensory loss. - this may lead to boredom, confusion, irritability, disorientation and anxiety - this can be corrected by meaningful stimulation or substitution of one sense for another in interpreting the stimuli and enhancing sensory stimulation in the environment with colors, pictures, textures, sounds, smell and taste. Increased incidence of eye disease : cataracts, senile macular degeneration, diabetic retinopathy. Visual changes: Presbyopia – difficulty in reading at the usual distance, usually begins at the fifth decade of life Sensitivity to glare- yellowing cloudy lens of the eye causing the light to scatter Color blindness -the ability to discriminate between blue And green declines. Diminished accommodation – takes longer to adjust when going to and from light and dark environment as the pupil dilates slowly and less completely because of increased stiffness of the muscles of the iris Health Promotion: Reading glasses Dark glasses Allow for longer periods to adjust Auditory Changes: Presbycusis- deafness, may cause older people to respond inappropriately to conversation. May be mistaken for confusion Difficulty in discriminating between high frequency tones of consonants (f, s, th, ch, b, t, p). Wax builds up Taste and Smell Dulling of the sweet taste – may lead to preference of salty and highly seasoned foods Health Promotion Substitute salt in giving flavor to foods with herbs, onions, garlic and lemons MENTAL HEALTH DISORDERS DEPRESSION - The most common affective/ mood disorder of old age and is often responsive to treatment - It can be an early sign of illness or a result of physical illness - SSx : feelings of sadness feelings of guilt and worthlessness fatigue sleep and appetite disturbances restlessness diminished memory and concentration suicidal ideation impaired attention span 4  - Treatment: SSRI (Paxil, Prozac) may take 4-6 wks for symptoms TCA (Nortriptyline, Desipramine, Doxepine) to recede Psychosocial approach ECT DELIRIUM - A medical emergency, often called Acute Confusional State -SSx: Altered LOC (stupor-hyperactivity) delusions Disorganized thinking fear Short attention span anxiety Hallucinations paranoia - May occur secondary to: a. Physical illness f. Malnutrition b. Medication or alcohol toxicity g. Head trauma c. Fecal impaction h. Lack of environmental cues d. Dehydration i. Sensory deprivation or overload e. Infection - Permanent irreversible brain damage or death may follow if unrecognized and underlying cause is not treated. - Therapeutic interventions: Varies depending on the reason for the symptoms a. Withdrawal of non-essential medications b. Supervised nutritional and fluid intake c. Calm and quite environment d. Provide familiar environmental cues-(S.A. family members and friends touching and talking to the patient.) ALZHEIMER’S DISEASE AND OTHER DISORDERS Dementia- A progressive deterioration in the intellectual abilities in such a severity that it interferes with the persons social and occupational performance, the prevalence increases with age. - characterized by: 1. losses in memory, abstract reasoning ability, judgment and language 2. Personality changes 3. deterioration of the ability to perform ADLs over time - Symptoms are usually subtle in onset progressing slowly and eventually becoming obvious and devastating - 3 General categories: a. cognitive b. functional c. behavioral - Reversible causes: a. alcohol abuse b. polypharmacy c. psychiatric disorders d. normal pressure hydrocephalus - 3 most common nonreversible dementias: a. Multi –infarct dementia b. Alzheimer’s disease (AD) c. Mixed - Other non- Alzheimer’s dementia a. PD b. AIDS related dementia c. Pick’s disease MULTI- INFARCT DEMENTIA - Age of onset between 50- 70 years old, M>F - Risk factors: Cardiovascular and cerebrovascular diseases - MAKES UP around 15% of the cases, next to AD - Characterized by unpredictable, uneven, downward decline in mental functioning - Every small infarct is followed by some recovery followed by the next infarction Pathology: Disruption of the blood supply to the brain(multiple small strokes) Rapid infarction (death of the brain tissue) Cerebral damage Dizziness, headaches, decreased mental and physical vigor 5  Sudden confusion Gradual and spotty memory loss May hallucinate and become delirious AD- like manifestations in later stages ALZHEIMER’S DISEASE (AD) - Progressive, irreversible, degenerative, neurologic disease that begins insidiously and is characterized by gradual losses in cognitive function and disturbances in behavior and affect. - 1-10% of the cases is found among middle aged individuals - Risk factors: early onset AD late onset AD a. Family history a. Genes c. Environmental factors b. Down syndrome b. Life experiences Pathology: Neuropathologic changes (neuronal death) Biochemical changes (loss of acetylcholine) Neurofibrillary tangles cerebral cortex Senile/ neuritic plaques Decreased brain size Clinical Manifestations: Subtle memory loss (early stages, concealed with adequate cognitive function) Depression Marked/ obvious forgetfulness manifested in daily actions a. lose the ability to recognize familiar faces, objects, places b. gets lost in a familiar environment c. repeating the same stories they forget that they have already told Conversation becomes difficult and there are word finding difficulties The ability to formulate concepts and think abstractly disappears (concrete interpretation) Impulsive behavior Difficulties with everyday activities a. handling money b. operating simple appliances Personality changes a. depressed b. hostile c. suspicious d. paranoid e. combative With progression of the disease intensification of the symptoms occurs: Speaking skills deteriorates to nonsense syllables Agitation and physical activities increase: patient may wander at night Total dependence on ADLs (eating, toileting) Dysphagia Incontinence terminal stages: lasts for months Immobile and requires total care Death: resulting from a. Pneumonia b. Malnutrition c. Dehydration Assessment and diagnostic findings: Health history Diagnostic tests a. CBC e. MRI b. HIV testing f. CSF c. Thyroid hormone levels g. CT scan d. EEG Depression scale and Cognitive function test Medical management: Tacrine HCL – enhances acetylcholine and manages symptoms of AD - hepatotoxic thus clients must be closely monitored Nursing management: Supporting cognitive function - a calm and predictable environment helps the person interpret the surroundings and his activities 6  a. Limit environmental stimuli and follow a regular routine b. Quite and pleasant manner of speaking, clear and simple explanations c. Use of memory aids and cues to minimize confusion and disorientation d. Prominently displayed clocks and calendars may enhance orientation to time e. Color coding the doorway to facilitate geographic orientation f. Advocate active participation to keep client maintain abilities for a longer period Promoting physical safety – a hazard free environment promotes maximum independence and a sense of autonomy a. Remove potential hazards b. Provide nightlights c. Monitor food and drug intake d. Allow smoking only with supervision e. Distraction and persuasion may reducer wandering behavior f. Avoid applying restraints since it increases agitation g. Secure doors leading from the house h. Supervise all outdoor activities i. Wear ID bracelet Reducing anxiety and agitation – patient may become aware of their diminishing abilities thus emotional support is needed to reinforce a positive self image a. Goals are adjusted to fit the client’s declining abilities b. Structuring activities c. Environment should be kept simple and familiar and noise free Catastrophic reaction- overreaction to excessive stimulation - combative, agitated state characterized by: screaming, crying and physical or verbal assault - managed by: listening to music, distraction, rocking or stroking. Improving communication a. Unhurried and reduction of noises and distractions b. Clear, easy to understand sentences c. Lists and simple written instructions d. Using an object / nonverbal language to communicate e. Tactile stimuli to reinforce affectation Promoting independence in self care activities – AD makes it difficult for the person to maintain functional independence, efforts are directed towards helping them remain functionally independent for as long as possible. a. Simplify daily activities into short achievable steps to give as sense of accomplishment. b. Direct supervision may sometimes be necessary. c. Encourage to make choices when appropriate and to participate in self care activities as much as possible Providing for socialization and intimacy needs – a. Visits, letters, and phone calls are encouraged, visits should be brief and non-stressful, limit visitors to 1-2 at a time to avoid over stimulation b. Encourage recreation and simple activities c. Set realistic goals that provide satisfaction d. Promote hobbies and activities to improve the quality of life (walking, exercise, socializing). e. Pet – may provide comfort, stimulation and contentment with its non-judgmental friendliness f. Encourage to verbalize about sexual concerns and provide sexual counseling g. Encourage meaningful expression of love such as touching and holding. Promoting adequate nutrition a. Mealtime should be kept simple and calm, without confrontations b. Offer familiar foods that look appetizing and taste good c. Offer one dish at a time, to avoid client playing with the food d. Cut food into small pieces to prevent choking e. Convert liquids to gelatin to facilitate swallowing f. Serve hot foods and beverages warm, check the temperature of foods to prevent burns g. Provide adaptive means for incoordination that interferes with feeding h. To protect clothing use apron or smock rather than a bib i. With progression it would be necessary to feed the patient. Promoting balanced activity and rest – Some clients may exhibit sleep disturbances, wandering and other inappropriate behaviors that may arise when some physical or psychological needs are unmet. As caregivers we need to discern the need of the patient exhibiting this type of behaviors to prevent further decline in their health with the problem remaining uncorrected. a. To promote sleep: milk, music or a back rub b. Promote a regular pattern of activity and rest c. Discourage long periods of daytime sleeping. GERIATRIC SYNDROMES: MULTIPLE PROBLEMS WITH MULTIPLE ETIOLOGIC FACTORS 7 Geriatric syndromes - Frequently seen in the elderly, when combined with decreased host resistance will lead to illness or injury - Not associated with normal aging and thus can be prevented with early interventions to help maximize the quality of life. Frailty - Used to describe those elders at higher risk for adverse health outcomes or geriatric syndromes - Applies to elderly people who are most vulnerable to significant problems as a result of any of the following: a. extreme old age (85 and above) b. inability to perform ADL and IADLs independently c. presence of multiple chronic diseases Impaired Mobility Multifactoral causes includes: PD OA Diabetic neuropathy Osteoporosis Cardiovascular compromise Sensory deficits Elderly clients should be encouraged to stay active as possible Bed rest should be kept to a minimum when ill to avoid deconditioning and other complications When in bed rest, perform AROM in unaffected aside and PROM in the affected part Change the position frequently Dizziness -Older people frequently seek help for dizziness, this is further aggravated by their inability to determine between: dizziness – a sensation of disorientation in relation to position vertigo – spinning sensation - Causes maybe cerumen build up dysfunction in the: cerebellum proprioceptive receptors cerebral cortex vestibular system brainstem - May lead to falls and injuries Falls and falling - Common and preventable source of mortality and morbidity related to greater decline in ability to perform ADL and social activities and increased incidence of institutionalization - Women > men - hip fx – most common Restraints- physical: lap belts, geriatric chairs, vest, waist and jacket restraints Chemicals: medications -May lead to injury or death: strangulation skin tears vascular and neurologic damage fractures pressure ulcers increased confusion significant emotional trauma -The time spent to supervise client on restraint is better used in addressing the unmet need that provoked the behavior that resulted in the use of the restraint. 8