GERIA-REVIEWER-PRELIMS-1.pdf

NCM 114 – CARE OF OLDER ADULTS PRELIM TOPICS HENNESY TURINGAN Ms. Chona Guillermo OUTLINE Categories of Older People Perspective on...

NCM 114 – CARE OF OLDER ADULTS PRELIM TOPICS HENNESY TURINGAN Ms. Chona Guillermo OUTLINE Categories of Older People Perspective on Aging Young Old (65 – 74 years old) Aging is a Developmental Process Middle Old (75 – 84 years old) Old – Old (85 +) – Demography of Aging and Implications for Health and Centenarians (100 +) Nursing Care Global Aging Aging in the Philippines Aging in the Philippines The Philippines is a diverse country that will experience an increase in its aging Impact of Aging in the Family population soon. The country consists of approximately 103 million inhabitants, with Theories of Aging and its Nursing Implications less than 5% of the population 65 years Biologic Theories and older (Central Intelligence Agency, Physiologic Theories 2016). Currently, the age structure of the Philippines resembles many other developing countries because there is a Perspective on Aging greater proportion of younger Filipinos in Aging is a Developmental Process comparison to older Filipinos. The process of aging is unavoidable and unrelenting in human beings (J.S Schreck, The Philippines' population increased by 2014). over 35% over the last two decades with the older adult population (60 years and Aging is a gradual, continuous process of older) expected to overtake those aged 0– natural change that begins in early 14 years old by 2065 (Help Age Global adulthood. During early middle age, many Network, 2017a). Currently, life bodily functions begin to gradually decline expectancy of Filipinos is 57.4 years for (R. Stefanacci, 2022). males and 63.2 years for females. Females are projected to expect an Growing older, or chronological aging, is a increase of 4.0 years in life expectancy relentless and unstoppable process that and males an increase of 4.7 years in life happens to all humans (J.S Schreck, expectancy by 2030 (Help Age Global 2014). Network, 2017b). Senescence may be viewed most easily “Population ageing is not a bad thing. It as the passage of biological time as represents a story of our collective opposed to success as Filipinos. It means that we can chronological time. More specifically, it refers to “the conquer the challenges such as those time-dependent accumulation of damage at the related to income, health, and education,” molecular level that begins at fertilization and is said PIDS research fellow Michael Abrigo, eventually expressed as nonspecific vulnerability. one of the proponents of the study. impaired function, disease, and ultimately death” Impact of Aging Members in the Family (Carnes & Olshansky, 1993) Negative Emotional Effect Sadness Theories of Aging Anger Financial Strain 1. Biologic Fear and Anxiety 2. Sociologic Anticipatory Grief 3. Psychologic Emotionally Drained 4. Moral/Spiritual Resentment Perspective on Aging Positive Emotional Effect Demography of Aging and Implications for H Health and Nursing Care Enrichment Sense of Giving Back Financial Effect: Extra Costs Struggle Effects: Changes in Family Roles, Work, Lack of Self – Time, Managing Behavioral Problems Overall Negative Effects: Relationship Theories of Aging and Its Nursing Implications Theories of aging can be divided into two categories: those that answer the question “Why do we age?” and those that address the question “How do we age?” Only a few broad, overarching theories attempt to  NCM 114 – CARE OF OLDER ADULTS PRELIM TOPICS HENNESY TURINGAN Ms. Chona Guillermo explain why we and nearly all living DNA strand breaks and base organism’s age. These theories compete, modifications that cause gene modulation. making it unlikely that more than one of Exogenous Sources of Free Radicals: them could be true. Over time, some Tobacco Smoke theories have fallen out of favor as others Pesticides have become more widely accepted. Radiation and Organic Solvents Ozone BIOLOGICAL THEORIES Selected Medications The biological theories are concerned with STOCHASTIC THEORIES: answering basic questions regarding the ORGE/ERROR THEORY physiological processes that occur in all living organisms as they chronologically In the 1960s, Leslie Orgel proposed what age. is now known as the error catastrophe theory of aging, arguing that errors in The biological theories explain the protein translation that reduce the fidelity physiologic processes that change with of the protein-translating enzymes would aging. In other words, how is aging lead to a feedback loop of increasingly manifested on the molecular level in the inaccurate protein synthesis, terminating cells, tissues, and body systems; how in the death of the organism. does the body–mind interaction affect aging; what biochemical processes impact The error catastrophe theory of aging aging; and how do one’s chromosomes states that aging is the result of the impact the overall aging process? Does accumulation of errors in cellular each system age at the same rate? Does molecules that are essential for cellular each cell in a system age at the same function and reproduction that eventually rate? reaches a catastrophic level that is incompatible with cellular survival. Two categories of Biological Theories: STOCHASTIC THEORIES: 1. Stochastic WEAR AND TEAR THEORY 2. Non-stochastic The wear and tear theory of aging is an Stochastic Theories: idea proposed by German biologist, Dr. - A stochastic or statistical perspective, which August Wiesmann, in 1882. identifies episodic events that happen throughout one’s life that cause random cell damage and The theory suggests that aging results accumulate over time, thus causing aging. from a gradual deterioration of the cells and tissues of the body via wear and tear, Non-stochastic Theories: oxidative stress, exposure to radiation, - The non-stochastic theories, which view aging as a toxins, or other deteriorative processes. series of predetermined events happening to all organisms in a timed framework. These Dr. Weismann believed that the body and hypothesize that aging is predetermined through its cells were damaged by overuse and programmed cell changes in the neuroendocrine or abuse. Under this theory, aging is viewed immunologic systems. as almost a preprogrammed process-a process thought to be vulnerable to STOCHASTIC THEORIES: stress, or an accumulation of injuries or FREE RADICAL THEORY trauma, which may accelerate it. Oxidative free radical theory postulates Death occurs because a worn-out tissue that aging is due to oxidative metabolism cannot forever renew itself" - Weismann. and the effects of free radicals, which are the end products of oxidative metabolism. STOCHASTIC THEORIES: Free radicals are produced when the body CONNECTIVE TISSUE THEORY uses oxygen, such as with exercise. This theory emphasizes the significance of how Known as cross-linking theory, also cells use oxygen. (Hayflick, 1985). referred to as the glycosylation theory of Free Radicals Causes: aging, was proposed by Johan Bjorksten Extensive cellular damage to DNA, which in 1942. can cause malignancy and accelerated aging due to oxidative modification of According to this theory, an accumulation proteins that impact cell metabolism. of cross-linked proteins damages cells Lipid oxidation that damages and tissues, slowing down bodily phospholipids in cell membranes, thus processes resulting in aging. affecting membrane permeability.  NCM 114 – CARE OF OLDER ADULTS PRELIM TOPICS HENNESY TURINGAN Ms. Chona Guillermo It is the binding of glucose to protein that numbers of melatonin receptors in the causes various problems. SCN The theory indicates that there may be According to this theory, normally genes that trigger youth and general well- separated molecular structures are bound being as well as other genes that together through chemical reactions. accelerate cell deterioration. Primarily this involves collagen, which is a NONSTOCHASTIC THEORIES: relatively inert long-chain macromolecule NEUROENDOCRINE THEORY produced by fibroblasts. As new fibers are created, they become enmeshed with old Hypothalamus controls various chain fibers and form an actual chemical cross- reactions to instruct other organs and link. glands to release their respective hormones. The result of this cross-linkage process is When the stimulating and releasing an increase in density of the collagen hormones of the pituitary and the molecule but a decrease in the capacity to hypothalamus are out of synch with the transport nutrients 'to, and to remove endocrine glands, an increase in disease waste products from the cells. is expected in multiple organs and systems. Cross-linkage agents have been found in unsaturated fats, in polyvalent metal ions NONSTOCHASTIC THEORIES: and in association with NEUROENDOCRINE THEORY NONSTOCHASTIC THEORIES: It describes the normal aging process of PROGRAMMED THEORY humans and animals as being related to faulty immunological function. Programmed theories of aging assert that There is a decrease immune function as a aging is an essential and innate part of the person age biology of humans and that aging is The older adults are more susceptible to programmed into our body systems infections as well as cancers. (Stibich, 2020). There is a loss of T-cell differentiation, so Cells can only reproduce themselves a the body incorrectly perceives old, limited number of times. irregular cells as foreign bodies and The programmed theory of aging asserts attacks them. that aging and death are necessary parts of evolution, not of biology. If a species PSYCHOSOCIAL THEORIES did not have the genetic capacity for aging - The sociological theories focus on changing roles and death, then it would not be forced to and relationships, it is related to various social replicate to survive (Stibich, 2020). adaptations in the lives of older adult. This theory proposes that every person has a "Biologic clock" that starts ticking at SOCIOLOGICAL THEORIES: the time of conception. DISENGAGEMENT THEORY Predictable changes occur. Aging has a biological timetable or internal Introduced by Cumming and Henry in biological clock. 1961 Two theorists viewed aging' as a NONSTOCHASTIC THEORIES: developmental task in and of itself, with its GENE/BIOLOGICAL CLOCK THEORY own norms and appropriate patterns of behavior. Each cell has a genetically programmed Identified appropriate patterns of behavior aging code that is stored in the organism’s were conceptualized as a mutual DNA. agreement between older adults and A significant amount of research has been society on a reciprocal withdrawal. done on circadian rhythms and their influence on sleep, melatonin, and aging. SOCIOLOGICAL THEORIES: The primary circadian clock in mammals ACTIVITY/DEVELOPMENTAL TASK THEORY is in the suprachiasmatic nucleus (or nuclei) Activity is viewed by this theory as (SCN), a pair of distinct groups of cells necessary to maintain a person's life located in the hypothalamus. satisfaction and a positive self-concept. The SCN receive light and dark input from By remaining active, the older person retina and demonstrate high neuronal stays young and alive and does not firing during the day and low firing at night. withdraw from society because of an age Melatonin is secreted by the pineal gland parameter. Essentially, the person actively and is the hormone linked to sleep and participates in a continuous struggle to wake cycles because there are large remain "middle-aged."  NCM 114 – CARE OF OLDER ADULTS PRELIM TOPICS HENNESY TURINGAN Ms. Chona Guillermo This theory is based on three assumptions: we reach old age, our personalities are (1) it is better to be active than inactive, fully formed and tend to stay constant (2) it is better to be happy than unhappy, and throughout our lives. (3) an older individual is the best judge of his or her It is one of the three major psychosocial own success in achieving the first two assumptions theories which describes how people developed in old age. How a person has been throughout life is SOCIOLOGICAL THEORIES: how that person will continue through the GEROTRANSCEDENDENCE THEORY remainder of life. Old age is not a separate phase of life, but According to this theory, as people age, rather a continuation and thus an integral they go through a cognitive transition from component. a materialistic, logical viewpoint to Elders attend to continue with important "oneness" with the environment. activities elders perceive activities as continuous. Gerotranscendence theory is a way to Successful aging is characterized by how look at aging as a positive aspect of life. much continuity the elder has with According to Lars Tornstam, who took activities. more than 20 years to develop this theory, there are several ideas about human PSYCHOLOGICAL THEORY: aging that are often overlooked. The core AGE STRATIFICATION THEORY of his theory looks to include these forgotten elements. In the 1970s, sociologists began to There are 4 key points to consider when examine the interdependence between looking at the gerotranscendence theory: older adults and society, recognizing that 1. Aging includes an increased feeling aging and society are interrelated and of togetherness with past generations cause reciprocal changes to individuals, while decreasing interest in social age group cohorts, and society. Riley and interactions that are superfluous at colleagues observed that society is best. stratified into different age categories that 2. There is an enhanced feeling of are the basis for acquiring resources, universal awareness, with an roles, status, and deference from others in understanding that space, time, and society. life can all be redefined. Even death tends to have a different definition. Age stratification transitioned aging theory 3. People as they age become less self- from a focus on the individual to a broader occupied and more selective of their context that alerted gerontologists to the social activities and other events they influence of cohort groups and the choose to pursue. socioeconomic and political impact on 4. Aging decreases personal interest in how individuals age (Marshall, 1996). material things, while time in solitude becomes a more attractive option. PSYCHOLOGICAL THEORY: HUMAN NEEDS THEORY SOCIOLOGICAL THEORIES: SUBCULTURE THEORY In this theory, Maslow surmised that a hierarchy of five needs motivates human According to this theory, older people behavior: physiologic, safety and security, create a distinct subculture inside society love and belonging, self-esteem, and self- to protect themselves against society's actualization. poor attitude about aging and the resulting loss of status. Movement is multidirectional and dynamic Views older adults as their own in a lifelong process toward need “subculture”, with their own interests, fulfillment. Self-actualization requires the norms, beliefs, habits, and issues that freedom to express and pursue personal separate them from the rest of society. A goals and be creative in an environment response to rejection/negativity by society. that is stimulating and challenging. This theory is less relevant today than it was when it was proposed in the 1960s. Maslow does not specifically address old age, physical, economic, social, and SOCIOLOGICAL THEORIES: environmental constraints can impede CONTINUITY THEORY need fulfillment of older adults. Maslow asserted that failure to grow leads to This theory acknowledges that our feelings of failure, depression, and the personalities have an impact on the roles perception that life is meaningless. we select and how we perform them, which in turn has an impact on our level of happiness in life. It implies that by the time PSYCHOSOCIAL THEORY:  NCM 114 – CARE OF OLDER ADULTS PRELIM TOPICS HENNESY TURINGAN Ms. Chona Guillermo PERSON-ENVIRONMENT-FIT THEORY have a corresponding life task that one may succeed at or fail to accomplish. Lawton’s (1982) person-environment fit Older adults experience the theory introduced functional competence developmental stage known as “ego in relationship to the environment as a integrity versus despair.” central theme. Stages throughout the life course. Each Functional competence is affected by represents a crisis to be resolved. multiple intrapersonal conditions such as ego strength, motor skills, biologic health, cognitive capacity, and sensory- perceptual capacity, as well as external conditions posed by the environment. The degree of competency may change as one ages, a-affecting functional ability in relationship to environmental demands. A person’s ability to meet these demands is a affected by his or her level of functioning and influences the ability to adapt to the environment. Those functioning at lower levels can tolerate fewer environmental demands. PECK’S Expansion of Erickson’s Theory PSYCHOSOCIAL THEORY: Erickson’s last two stages are expanded GEROTRANSCENDENCE THEORY to 7 Gerotranscendence has been tested in The final three of the development tasks several studies. In an ongoing longitudinal for old age: study based on the principles of 1. ego differentiation versus work role gerodynamics, Schroots (2003) is preoccupation investigating how people manage their 2. body transcendence versus body lives, cope with transformations, and react preoccupation to affective positive and negative life 3. ego transcendence versus ego events. preoccupation In nursing, Wadensten (2002) used the theory of gerotranscendence to develop LIFE-COURSE (LIFE-SPAN DEVELOPMENT) PARADIGM guidelines for care of older adults in a nursing home. The results indicate that German psychologist Paul Baltes, a these guidelines may be useful for leading expert on lifespan development facilitating the process of and aging, developed one of the gerotranscendence in nursing home approaches to studying development residents. called the lifespan perspective. PSYCHOLOGICAL THEORIES This approach is based on several key principles: THEORY OF INDIVIDUALISM Development occurs across one’s entire life or is lifelong. Jungs defined personality as being Development is multidimensional, composed of an ego or selfidentity with a meaning it involves the dynamic personal and collective unconsciousness. interaction of factors like physical, Personal unconsciousness is the private emotional, and psychosocial feelings and perceptions surrounding development. significant persons or life events. The Development is multidirectional and collective unconscious is shared by all results in gains and losses throughout life persons and contains latent memories of Development is plastic, meaning that human origin: characteristics are malleable or changeable. Development is influenced by 1. Origins Are Freudian contextual and sociocultural influences. 2. Self-Realization Is The Goal Of Personality Development is multidisciplinary. Development Normative age-graded influences 3. As Individual Ages, Each Is Capable Of Normative history-graded influences Transforming Non-normative life influences 4. Into A More Spiritual Being Lifespan vs. Life-expectancy STAGES OF PERSONALITY DEVELOPMENT THEORY Human Lifespan, or longevity, refers to According to Erikson (1963), personality the length of time a person can exist develops in eight sequential stages that under the most optimal conditions.  NCM 114 – CARE OF OLDER ADULTS PRELIM TOPICS HENNESY TURINGAN Ms. Chona Guillermo Oldest age documented is 122 years that would address older adults with (Guinness World Records, 2016) physical impairment and disability. Miller asserts that aging adults experience Life expectancy is the predicted number of environmental and biopsychosocial years a person born in a particular time consequences that impact their period can reasonably expect to live (Vogt functioning. & Johnson, 2016). Functional consequences theory assumes that quality of life is integrated with Life expectancy in the Philippines is 71 functional capacity and dependency years (Demographic of Life Expectancy, needs, and that positive consequences 2020) are possible despite age-related limitations. SELECTIVE OPTIMIZATION AND COMPENSATION This theory was used to create an THEORY assessment tool for the early detection of hospitalized elderly patients experiencing Baltes’s (1987) theory of successful aging acute confusion and to prevent further emerged from his study of psychological complications. processes across the lifespan and, like earlier theories, focuses on the individual. NURSING THEORIES OF AGING: He asserts that individuals learn to cope THEORY OF THRIVING with the functional losses of aging through processes of selection, optimization, and The theory of thriving (Haight et al., 2002) compensation. is based on the concept of failure to thrive SELECTION and Bergland and Kirkevold’s (2001) application of thriving to the experience of The adaptive task of the individual and wellbeing among frail elders living in society to concentrate on those domains nursing homes. that are of high priority. They discuss the concept in three Setting goals contexts: an outcome of growth and development, a psychological state, and ELECTIVE SELECTION an expression of physical health state. Failure to thrive first appeared in the aging refers to the delineation of goals to match literature as a diagnosis for older adults a person’s needs and motives with the with vague symptoms such as fatigue, available or attainable resources. cachexia, and generalized weakness. Other disciplines later defined LOSS BASED SELECTION undernutrition, physical and cognitive dysfunction, and depression as its major refers to changes in goals or the goal attributes (Braun, Wykle, & Cowling, system, such as reconstructing one’s goal 1988) hierarchy by focusing on the most important goals, adapting standards, or replacing goals that are no longer NURSING THEORIES OF AGING: achievable. THEORY OF SUCCESSFUL AGING OPTIMIZATION Baltes’s (1987) theory of successful aging emerged from his study of psychological Engaging in behaviors that enrich and processes across the lifespan and, like augment an individual’s general reserves. earlier theories, focuses on the individual. Make efforts to maintain and strengthen Aging individuals become more selective those most useful skills. in activities and roles as limitations present themselves; at the same time, COMPENSATION they choose those activities and roles that are most satisfying (optimization). Find ways to make up for (compensate) As people age, they pass through critical for cognitive deficits to function life points related to morbidity, mortality, adequately. and quality of life. Using devices, strategies, and resources. Selective optimization with compensation is a positive coping process that facilitates successful aging. NURSING IMPLICATIONS NURSING THEORIES OF AGING: FUNCTIONAL CONSEQUENCES Functional consequences theory was developed to provide a guiding framework  NCM 114 – CARE OF OLDER ADULTS PRELIM TOPICS HENNESY TURINGAN Ms. Chona Guillermo ▪ Has a more distinctive appearance ▪ Areas appear asymmetric with irregular borders, a variety of colors. ▪ Often identified with the ABCDE method OUTLINE Physiologic Changes in Aging Affecting Various Systems RISK FACTORS / WARNING SIGNS: 1. Integumentary 2. Musculo-skeletal Exposure to carcinogens over time 3. Respiratory Sun Exposure 4. Cardiovascular Immunosenescence 5. Hematopoietic and Lymphatic 6. Gastrointestinal ASSESSMENT AND DIAGNOSIS: 7. Urinary 8. Special Senses Annual Physical Examination 9. Endocrine Inspection of the skin for lesions 10. Reproductive Report any suspicious areas on their skin to the physician. Changes in: shape, color, whether a lesion is raised or bleeds INTEGUMENTARY SYSTEM INTERVENTIONS: Skin Cancer Prevention There are three major types of skin cancer: Basal Early Detection Cell, Squamous Cell and Malignant Melanoma Referred for Biopsy Nonsurgical Interventions: Cryotherapy, BASAL CELL CARCINOMA: Radiotherapy Electrodessication ▪ The most common skin cancer Curettage ▪ Often found on the head or face, Topical Ointments or other areas exposed to the Surgical Treatments sun. Adjuvant Treatments ▪ Nodular type - appears as a raised, firm, papule that is pearly Herpes Zoster or shiny with a rolled edge. ▪ Patients often complain that these Reactivation of the virus that causes lesions bleed and scab easily. chicken pox. ▪ When treated early, it is easily Older persons may be infected with this removed through surgery and is latent varicella virus after initial exposure not life-threatening. to it in the form of chickenpox. ▪ Often recurring RISK FACTORS / WARNING SIGNS: SQUAMOUS CELL CARCINOMA: ▪ Less serious than malignant Age over 55 years melanoma. Stress ▪ Common in African Americans Suppressed immune system. ▪ Also appears as lesion on areas For many older women particularly, of the body exposed to the sun, emotional, or psychological stress can or from other trauma. trigger reactivations. ▪ Human Papillomavirus (HPV) ▪ Metastasis is more common than SIGNS and SYMPTOMS: with BCC. ▪ Lesions of SCC appear scaly, Painful lesions that erupt on the sensory pink, and thicker than BCC. nerve path, usually beginning on the chest ▪ Borders may be more irregular, or face and the lesions may look more These weepy vesicles get pustular and like ulceration. crusty over several days, with healing occurring in 2–4 weeks. MALIGNANT MELANOMA: ▪ Responsible for majority of ASSESSMENT AND DIAGNOSIS: deaths from skin cancer. ▪ Older adults are 10 times more Diagnosis can be made by clinical likely to get it than adults under appearance of the lesions and a history of 40 years old. onset. Scraping  NCM 114 – CARE OF OLDER ADULTS PRELIM TOPICS HENNESY TURINGAN Ms. Chona Guillermo Severe pain that usually subsides in 3-5 Osteoporosis-related fractures may lead weeks to pain, immobility, and other Postherpetic neuralgia complications. If signs and symptoms are present besides fractures, they may take INTERVENTIONS: the form of pain and kyphosis. Diagnostic testing would reveal decreased Antiviral medications – acyclovir bone density and any pathological Topical Ointment fractures present via X-ray. On occasion, Pain medications hairline fractures do not manifest Preventive vaccine themselves with the initial X-ray but appear 5–10 days after the initial assault. NURSING INTERVENTIONS: INTERVENTIONS: Rest and comfort Patient should be advised to seek medical Eating a well-balanced diet with plenty of attention as soon as he or she suspects calcium and vitamin D. shingles. No smoking or excessive alcohol intake, Persons should not have direct contact Plenty of weight-bearing exercise, (even clothing) with pregnant women, Discussing any needed treatments with people who have not had chickenpox, the physician to minimize the risk of the other elderly persons, or those with disease. suppressed immune. systems. Treatment of existing osteoporosis takes The older person with shingles may many forms. Postmenopausal women are experience concerns with pain often prescribed bisphosphonates (such management and feel a sense of isolation. as Fosamax), calcitonin (Miacalcin), or Arranging for a family member or friend estrogen/hormone replacement who does not have a high risk of infection medications (such as Estratab or to check on the older person at home is Premarin). advisable. Weight-bearing exercises and getting Zostavax, a vaccine for shingles enough calcium in the diet or through supplementation are other treatments to consider. If vitamin supplementation is MUSKULOSKELETAL PROBLEMS used, it is essential that the patient take not only calcium but also vitamin D to Osteoporosis promote the absorption of the calcium. RISK FACTORS: Arthritis (Osteoarthritis) Personal history of fracture after age 50 RISK FACTORS: Current low bone mass History of fracture in a first-degree relative Modifiable risks: Being female Obesity, joint injury, occupation, Being thin and/or having a small frame structural alignment, and muscle Advanced age weakness. A family history of osteoporosis Estrogen deficiency because of Non-modifiable risks: menopause, especially early or surgically Gender (Women are more at risk), induced. age, race (White and Asian), and Abnormal absence of menstrual periods genetic predisposition. (amenorrhea) Anorexia nervosa SIGNS and SYMPTOMS: Low lifetime calcium intake Pain Vitamin D deficiency Stiffness (morning) Use of certain medications, such as Aching and come joint swelling. corticosteroids and anticonvulsants Inflammation Presence of certain chronic medical Heberden’s nodes (bony enlargement at conditions the end joints of the fingers) and Low testosterone levels in men Bouchard’s nodes (bony enlargements at An inactive lifestyle the middle joint of the fingers) Current cigarette smoking Excessive use of alcohol INTERVENTIONS: Being White or Asian, and African Americans and Hispanic Americans as Exercise programs for strengthening well muscles and weight loss. Alternative methods of pain control in DIAGNOSIS: combination with medications.  NCM 114 – CARE OF OLDER ADULTS PRELIM TOPICS HENNESY TURINGAN Ms. Chona Guillermo Acetaminophen (Tylenol), aspirin, - Fever or malaise could also be signs of infection ibuprofen and naproxen, COX-2 inhibitors, and should be promptly reported to the physician. tramadol (Ultram), and antidepressants. - Reminders about routine hip precautions, exercises, Injection of steroids (Synvisc) as a and ambulation as indicated by the PT, as well as lubricant in the absence of synovial fluid to traveling implications. provide comfort. Other therapies to preserve motion and decrease pain: Total knee arthroplasty Heat or cold application A person is experiencing: Splints - Decreased range of motion, trouble walking or Adaptive equipment climbing stairs, and increased degeneration of the Aquatic therapy joint so as to impair quality of life. Nutrition - Discomfort after knee surgery is generally severe in In cases of severe dysfunction and pain: the first few days. Surgery with joint replacement - Encourage use of cold packs on the operative area for the first day RISK FACTORS: - Take pain and sleeping medications as ordered. - Alternative therapies such as guided imagery. Female Having a certain predisposing gene Nursing implications include: Exposure to an infection. - Teaching the patient about signs and symptoms of Advanced age is a risk factor until age 70. infection, care of the surgical site, pain Cigarette smoking over a period of years management, and expectations for recovery. A range of motion from 0–90 degrees is the minimum needed for normal functioning. Rheumatoid Arthritis - After discharge, a walker is usually used in the 1st few weeks, followed by light activities 6 weeks post- DIAGNOSIS: op. Malaise Fatigue Amputation Symmetrical patterns of joint inflammation Pain and stiffness RISK FACTORS: Swelling, gelling (joints stiff after rest) Elevated sedimentation rate, presence of Diabetes with accompanying peripheral vascular serum rheumatoid factor, and elevated disease white blood cell count African American men with diabetes Radiographs will show erosion of the HgbA1c level - significant predictor of foot bone. amputation INTERVENTIONS: INTERVENTIONS: Pharmacological treatment Sterile dressing - kept in place and changed daily. Educational programs Staples or sutures will be removed. Exercise and mobility, counseling, An Ace wrap or stump shrinker sock preparation for individual physical and occupational wearing prosthesis. therapy When using the prosthesis at first, an older adult may tire Focus of independence in activities of easily. daily living (ADLs) with self-care Consider any coexisting problems when considering Pain coping and exercise training energy expenditure. Joint Replacement Teach patients and families about, Stump care, mobility, adaptation, coping, and self- Used for several different diagnoses, care. including fracture, immobility, and Home maintenance, dealing with complications or intractable pain. additional health problems. The two most performed joint replacement surgeries are: Wear and tear on non-weight-bearing joints Total hip arthroplasty Adapting to the environment, accessibility, stigma, - Indicated when an older person demonstrates, depression, role changes, decreased energy, and - Lack of function chronic pain. - Trouble with ADLs Phantom limb pain, or pain sensations in the nonexistent - Continued pain that is not sufficiently addressed limb. with traditional medical therapy. Massage and medications may help with this type - In women, body weight and older age of pain control. Nursing instruction to patients and family members should Proper wrapping of the stump may help decrease include: occurrence. - Watching for signs and symptoms of wound infection. CARDIOVASCULAR PROBLEMS - Report any redness, swelling, drainage, or odor from the operative site. Hypertension  NCM 114 – CARE OF OLDER ADULTS PRELIM TOPICS HENNESY TURINGAN Ms. Chona Guillermo Women often do not have the substernal chest RISK FACTORS: pain, but more often experience sharp pain, fatigue, weakness, and other nonspecific symptoms. Heredity Symptoms may occur as much as 1 month prior to Race (African American) the occurrence of a myocardial infarction. These Male gender symptoms include unusual fatigue (70%), sleep Increased age disturbance (48%), shortness of breath (42%), High sodium intake indigestion (39%), and anxiety (35%). Obesity DIAGNOSIS: Heavy alcohol consumption ECG, Angiogram, Cardiac catheterization Lack of physical activity Diabetes or renal disease WARNING SIGNS: Certain medications (eg. some pain meds, cold meds, antidepressants) Chest pain appearing as tightness, fullness, or pressure. DIAGNOSIS: Pain radiating to arms. Unexplained numbness in arms, neck, or back Based on several readings at different times or Shortness of breath with or without activity visits to the primary healthcare provider Sweating Types: Nausea Essential (primary) Hypertension Pallor Secondary Hypertension Dizziness *Unexplained jaw pain INTERVENTIONS: *Indigestion or epigastric discomfort, especially when not relieved with antacids Limit alcohol intake to one drink per day. Limit sodium intake. INTERVENTIONS: Stop smoking. Maintain a low-fat diet that still contains adequate Thrombolytic therapy (in the early course of MI) vitamins and minerals by adding leafy green While awaiting emergency treatment... (MONA) vegetables and fruits. 1. Have the patient rest. Do some type of aerobic activity nearly every day of 2. Provide supplemental oxygen. the week. 3. Give nitroglycerin sublingually every 5 minutes Lose weight. three times and monitor vital signs. Have blood pressure checked regularly. Report any 4. Give aspirin if not contraindicated significant rise in blood pressure to the physician. Take medications as ordered. Do not skip doses. MEDICAL TREATMENT: Angioplasty, CABG, Pharmacological treatment Coronary Heart Disease Cardiac rehabilitation Angina: Strategies for Older Adults to Reduce Risk of Heart Attack: Symptoms: dyspnea, dizziness, or confusion versus classic chest pain 1. Exercise regularly. Risk factors: physical activity, emotional stress, extreme 2. Do not smoke. cold and heat, heavy meals, drinking excessive alcohol, and 3. Eat a balanced diet with plenty of fruits and cigarette smoking. vegetables; avoid foods high in saturated fats. Classification: stable or unstable 4. Maintain a healthy weight. Assessment: chest pain is shorter (less than 5 mins), 5. Manage stress appropriately. squeezing pain or pressure in the sternal area 6. Control existing diabetes by maintaining healthy blood sugars and take medications as prescribed. INTERVENTIONS: 7. Limit alcohol intake to one drink per day for women and two drinks per day (or less) for men. Weight Management 8. Visit the doctor regularly. Stress Management 9. After a heart attack, participate fully in a cardiac Limiting Caffeine rehabilitation program. Smoking Cessation 10. Involve the entire family in heart-healthy lifestyle Exercise Regimen modifications. Medication 11. Report any signs of chest pain immediately. Myocardial Infarction RISK FACTORS: Hypertension RISK FACTORS: Myocardial Infarction Hypertension, race (especially African American Diabetes Mellitus males with HTN), high-fat diet, sedentary lifestyle, diabetes, obesity, high cholesterol, family history, MANIFESTATIONS: cigarette smoking, excessive alcohol intake, and stressful environment. Common symptoms:  NCM 114 – CARE OF OLDER ADULTS PRELIM TOPICS HENNESY TURINGAN Ms. Chona Guillermo shortness of breath Sudden severe headache with no known cause swelling of legs ankles and feet coughing or wheezing fatigue lack of appetite or nausea confusion increased heart rate sudden weight gain CONSEQUENCES/COMPLICATIONS: decreased tolerance for physical activity. hemiplegia Atypical symptoms (in elderly): hemiparesis decreased appetite visual and perceptual deficits weight gain of a few pounds language deficits insomnia emotional changes swallowing dysfunction Strategies of Care: bowel and bladder problems Medications Lifestyle Modifications *Left-brain injury = right sided Valvular repair/replacement or heart transplant weakness Regular monitoring *Right brain injury = left-sided Weakness HEALTH TEACHINGS: INTERVENTIONS: A. Limit or eliminate alcohol use (no more than 1 oz. ethanol per day = one mixed drink, one 12 oz. beer, The first step in treatment is to determine the cause or one 5-oz. glass of wine). or type of stroke. B. Maintain a healthy weight. Extra pounds put added A CT scan or MRI must first be done to rule out stress and workload on the heart. Weigh daily and hemorrhagic stroke. report weight gains of 5 pounds or more to Hemorrhagic stroke treatment often requires healthcare provider. surgery to evacuate blood and stop the bleeding. C. Stop smoking (no tobacco use in any form). D. Limit sodium intake to 2–3 g per day—read the ACUTE MANAGEMENT: labels: avoid canned and processed foods. Take care with how foods are cooked or prepared at For ischemic stroke: home (e.g., limit oils and butters). Tissue plasminogen activator (t-PA) E. Take medications as ordered—do not skip doses. angioplasty, laser emulsification, mechanical clot F. Report any side effects to the physician. retrieval G. Exercise to tolerance level—this will differ for each cooling helmets person. Remain active without overdoing it. For thromboembolic stroke: H. Alternate rest and activity. Learn energy Medications that prevent clot formation conservation techniques. Post-Stroke Rehabilitation: Peripheral Artery Disease maximize functional ability. prevent complications. RISK FACTORS: promote quality of life Diabetes and Smoking (Major) encourage adaptation. enhance adaptation. Signs and Symptoms: refer accordingly. Leg Cramps *MAUK MODEL FOR POST-STROKE RECOVERY* Intermittent Claudication *majority experience no symptoms* Major Nursing Care Planning Goals: INTERVENTIONS: Improve mobility. Lifestyle Modifications Avoidance of shoulder pain Achievement of self-care Stroke (CVG) Relief of sensory and perceptual deprivation Prevention of aspiration WARNING SIGNS: Continence of bowel and bladder Improved thought processes Sudden numbness or weakness of face, arm, or Achieving a form of communication leg, especially on one side of the body Maintaining skin integrity Sudden confusion; trouble speaking or Restore family functioning. understanding. Improve sexual function. Sudden trouble seeing in one or both eyes. Absence of complications Sudden trouble walking, dizziness, or loss of balance or coordination RESPIRATORY PROBLEMS  NCM 114 – CARE OF OLDER ADULTS PRELIM TOPICS HENNESY TURINGAN Ms. Chona Guillermo a thorough history Pneumonia physical examination RISK FACTORS: COPD Heart Failure Immunosuppression CVD Tuberculosis Poor Mobility RISK FACTORS: MANIFESTATIONS: Persons who have been recently infected with TB Older adults may not present with typical symptoms bacteria. of chills, fever, chest pain, sweating, productive Persons with medical conditions that weaken the cough, or dyspnea and instead they may have immune system. acute alerted mental status (confusion/ delirium). fever, nonproductive hacking cough, muscle pain, ASSESSMENT & DIAGNOSIS: weakness, and shortness of breath. Mantoux test Chest X-ray DIAGNOSIS: Chest X-Ray, CBC, Sputum Culture *If positive, preventive treatment may be done with isoniazid INTERVENTIONS: INTERVENTIONS: isolation Bacterial pneumonia - antibiotics medications Viral pneumonia - symptom management (use of adequate rest, nutrition, and hydration antivirals is not common) infection control/prevention teachings Aspiration pneumonia - Avoid having the person in a laying position during and immediately after tube feeding. Have the head of the bed elevated or have HEMATOPOIETIC SYSTEM the patient in a sitting position when eating or receiving enteral nutrition. - Is responsible for the production, differentiation, and proliferation of mature blood cells from stem cells. RECOVERY: - The site of the blood cell production, or hematopoiesis, changes with the developmental Rest stage of an organism. Adequate fluids (to lose secretions) Tylenol/Aspirin if not contraindicated (for fever, NORMAL CHANGES OF AGING aches, and pains) - Most of the changes of aging in the hematologic Avoid exposure to other people with contagious system are the result of the bone marrow’s reduced respiratory conditions. capacity to produce RBCs quickly when disease or Close monitoring esp of the respiratory status blood loss has occured. Follow-up chest x-ray - At about age 70, the amount of the bone marrow in the long bones (where most RBCs are formed) PREVENTION: begins to decline steadily. Additional changes of aging in the hematologic system include the Pneumonia Vaccine following: Flu Vaccine 1. The number of stem cells in the marrow is decreased. Chronic Obstructive Pulmonary Disease 2. The administration of erythropoietin to stimulate use of iron to form RBCs is less effective in CAUSE: older adults than in younger people. Smoking 3. Lymphocyte function, especially cellular immunity, appears to decrease with age. GENERAL CLINICAL MANIFESTATIONS: 4. Platelets adhesiveness increases with age. chronic cough 5. Average hemoglobin and hematocrit values sputum production decrease slightly with age but remain within dyspnea on exertion and at rest normal limits. weight loss - Many functions of the hematologic system remain barrel chest constant in healthy older adults, including RBC life span, total blood volume, RBC volume, total ASSESSMENT: lymphocyte and granulocyte counts, and platelet decrease in quality of life structure and function. activity limitations PHYSIOLOGIC CHANGES: DIAGNOSIS: pulmonary function and other tests  NCM 114 – CARE OF OLDER ADULTS PRELIM TOPICS HENNESY TURINGAN Ms. Chona Guillermo Increased Plasma Viscosity = Increased risk for Vascular - Monitoring for symptom burden and providing Occlusion patient education to mitigate symptoms and Decreased RBC Production = Increased incidence of anemia improve quality of life. Decreased Mobilization of Neutrophils = Less effective phagocytosis Hematologic Malignancies (Cancer) - Hematologic malignancies are cancers that begin in blood-forming tissue, such as the bone marrow, or in the cells of the immune system. There are three Anemia main types of hematologic malignancies: leukemia, lymphoma, and multiple myeloma. - Insufficient Hemoglobin Leukemia SYMPTOMS: - According to the National Cancer Institute, leukemia Include fatigue, shortness of breath, worsening is most frequently diagnosed among people angina, developing or worsening of peripheral between the ages of 65 and 74 years. The median edema, falls, increased hospitalizations, and age at diagnosis is 66. decreased quality of life. Dizziness and mental health status changes TREATMENT: Pallor - Chemotherapy tachycardia, palpitations, systolic murmurs, and - blood transfusions angina Lymphoma DIAGNOSTIC TOOLS: - Lymphoma is a frequent disease in older patients Laboratory Tests: and one half of lymphoma cases occur in patients - Measurement of hemoglobin, older than 65. - Hematocrit - RBC count Multiple Myeloma - Reticulocyte count - Multiple myeloma (MM) is a plasma cell malignancy - WBC count that occurs among older adults and accounts for - PLT count 15% of all hematologic malignancies in the United States. Thirty-five percent of patients are diagnosed TREATMENT: at age 75 or older. - Oxygen - Pain Relievers Deep Vein Thrombosis and Pulmonary Embolism - Oral and Intravenous Fluids - Abnormalities in the vessel walls caused by trauma, - Blood Transfusions atherosclerosis or intravenous medication - Folic Acid Supplements administration. - Antibiotics - Abnormalities within the circulating blood and hyper-coagulability seen with coagulation disorders, Chronic Myeloproliferative Disorder some cancers, and hormone (estrogen) use. - Abnormal proliferation of one or more - Stasis of blood flow secondary to immobility, heart hematopoietic processes failure, or age-related changes DIAGNOSTIC: INTERVENTIONS: - Identify older adults at risk, including those with a - Full medical history history of DVT, clotting disorders, heart failure, - Full physical exam orthopedic surgery, and other risk factors. - Blood tests: CBC - Get older adults up and walking as soon as possible - Blood cell examination after surgery or injury. - Biopsy - Change the position of bed-bound older adults at - Cytogenic Analysis least 2 hours to prevent circulatory compromise. - JAK2 gene mutation test - Urge older adults at risk for DVT to wear fitted support stockings, avoid sedentary lifestyle, TREATMENT: maintain adequate hydration, elevate legs during periods of rest, and perform meticulous skin care to - Low dose chemotherapy keep skin clean and intact. - A pill that is targeted against JAK2 - Urge the use of intermittent pneumatic compression - Surgery to remove your spleen boots postoperatively until older adults are - Radiation therapy to the spleen ambulatory. - Removal of a pint of blood periodically - Administer anticoagulants as prescribed. - Chronic Myeloid Leukemia( CML )is treated with oral chemotherapy pills LYMPHATIC SYSTEM - Bone marrow or stem cell transplant The lymphatic system is a one-way system that drains fluid, INTERVENTION: proteins, wastes, potentially harmful agents and fats from tissues and organs in the body and essentially sterilizes it  NCM 114 – CARE OF OLDER ADULTS PRELIM TOPICS HENNESY TURINGAN Ms. Chona Guillermo upon passage through the lymph nodes before it returns the - Elevating the affected areas fluid back to the venous system. - Caring for wounds - Exercising Their major roles are two: - Surgery in extreme cases 1. remove tissue fluid that leaks out of the capillaries and return that fluid to the cardiovascular system. 2. defense against pathogens – against particularly bacteria Lymphatic Malformation GASTROINTESTINAL DISORDERS - Lymphatic malformation is a relatively uncommon vascular malformation that can occur anywhere on Gastroesophageal Reflux Disease the body. It is most commonly on the head and neck. RISK FACTORS/WARNING SIGNS: - Infection is the most common complication of LM. Bleeding inside the LM can also occur. Both - Esophagus (reduced lower esophageal pressure infection and bleeding can cause LMs to swell and and length, impaired motility of the esophagus, and enlarge. reduced salivary secretion) - LMs are formed during a baby’s development - Hiatus Hernia before birth, but not all LMs are diagnosed at birth. - Certain medications and foods increase the risk for For many people, LMs are first found on imaging GERD. studies after an accident or trauma or as a child - Obesity and activities that increase intra-abdominal grows into an adult (during puberty) or during pressure. pregnancy. - Heartburn - Otorhino-laryngeal problems ASSESSMENT and DIAGNOSIS: - GI Bleeding - Esophageal adenocarcinoma - History and physical - MRI ASSESSMENT AND DIAGNOSIS: - UTZ - Endoscopy - CT Scan - Urea breath testing or stool antigen testing Elephantiasis INTERVENTIONS: The objectives of treatment include: - Elephantiasis is also known as lymphatic filariasis. (1) relief of symptoms It’s caused by parasitic worms and can spread from (2) healing of esophagitis person to person through mosquitoes. (3) prevention of further occurrences - Elephantiasis causes swelling of the scrotum, legs, (4) prevention of complications or breasts. - Elephantiasis is considered a neglected tropical - Lifestyle and dietary modifications are important disease (NTD). It’s more common in tropical and aspects of care. subtropical areas of the world, including Africa and - Medications should be reviewed, and offending Southeast Asia. It’s estimated that 120 million medications modified. people have elephantiasis. - Avoidance of food or beverages 3–4 hours prior to bedtime Risk factors: Elephantiasis can affect people at any age. It - weight loss appears in both women and men. It’s more common in - Elevation of the head of the bed on 6-to-8-inch tropical and subtropical parts of the world, such as: blocks Africa - Pharmacological treatments with antacids in Southeast Asia conjunction with histamine 2 (H2) blockers India - Proton pump inhibitors (PPIs) are the next drugs of South America choice. - Laparoscopic fundoplication surgery Common risk factors for elephantiasis include: living for a long time in tropical and subtropical areas Peptic Ulcer Disease having a high exposure to mosquitoes living in unsanitary conditions RISK FACTORS / WARNING SIGNS: Assessment and Diagnosis: - H. pylori infection - Physical Exams - Use of nonsteroidal anti-inflammatory drugs - Blood Tests (NSAIDS) - X-rays - Other risk factors include smoking, drinking alcohol, - UTZ caffeine, and stress. - Critical illness, surgery, or hypovolemia Treatment: - Ulcer-like Dyspepsia - Antiparasitic Drugs - Food provoked Dyspepsia - Using Good Hygiene - “Silent” PUD  NCM 114 – CARE OF OLDER ADULTS PRELIM TOPICS HENNESY TURINGAN Ms. Chona Guillermo - Treated with antibiotics, but in acute illness the ASSESSMENT AND DIAGNOS: person may require hospitalization for IV hydration, analgesics, bowel rest, and possible NG tube - The diagnosis is made through the history and placement physical. - Morphine sulfate should be avoided - The typical symptoms are episodic gnawing or - Colon resection burning epigastric pain, often occurring 2 to 5 hours - Patient education after meals. - The older adult should be evaluated for anemia, - The diet should include fresh fruits, vegetables, hematemesis, melena, or heme-positive stool whole grains, and increased fluid intake, unless suggesting a GI bleed. contraindicated. - Vomiting - Persistent upper abdominal pain radiating to the Constipation back. - Patients should be tested for H. pylori with a urea RISK FACTORS and WARNING SIGNS: breath test, stool antigen test, or endoscopic biopsy. - GI bleed - Impaired mobility - Medications INTERVENTIONS: - Depression, neurological conditions - Dehydration, low dietary fiber, metabolic - If H. pylori is present, then eradication with disturbances (hypothyroidism, hypercalcemia, antibiotics and antisecretory therapy for about 10 to hypokalemia, and uremia) 14 days is indicated. - Undergoing dialysis, mechanical obstruction, and - Administration of proton pump inhibitors (PPIs), decreased access to toilet. bismuth, many antibiotics, and an upper GI bleed - Warning signs include constipation with a family can lead to false negatives. history of colon cancer, rectal bleeding, unexplained - If the person is taking NSAIDs for pain, discuss anemia, weight loss, or narrowed caliber of stool. alternatives such as acetaminophen and nonpharmacological treatments. ASSESSMENT AND DIAGNOSIS: - Lifestyle modifications - PPIs or histamine H2-receptor blockers - Nurses should include assessment of bowel - Prevention should always be reinforced. elimination that focuses on predisposing causes. - History should include all over-the-counter Diverticulitis medications, diet and fluid intake, and physical activity. RISK FACTORS and WARNING SIGNS: - Other assessments include psychosocial, mental health (mood), cognitive, and laboratory studies - Obesity, chronic constipation, straining, irregular (CBC, electrolytes, glucose, and thyroid profile). and uncoordinated bowel contractions, and - Abdominal assessment and rectal exam should weakness of bowel muscle due to aging. include checking stool for occult blood. - Older than 40 years of age, - Low-fiber diet INTERVENTIONS: - Number of diverticula in the colon - Pain in the left lower quadrant (LLQ), can get worse Initial interventions should focus on lifestyle and dietary after eating, and may improve after a bowel modifications. movement. 1. Start with a clean bowel - Warning signs of diverticulitis include fever, 2. Try all-natural means first: fiber, fluids, activity, increased white blood cell count, bleeding that is timing, positioning. not associated with pain, tachycardia, nausea, and 3. Be sure the person is taking adequate fiber and vomiting. fluids before adding medications. 4. Change only one item at a time in the program. ASSESSMENT AND DIAGNOSIS: Allow several days to pass before evaluating the effectiveness of the change. If needed, add another - Evaluation of the abdomen may reveal tenderness intervention. in the LLQ and there may be rebound tenderness 5. Stool softeners are given for hardened stool, and with involuntary guarding and rigidity. the person must drink at least a liter of fluid per day - Bowel sounds may be initially hypo-active and can for them to be effective. be hyperactive if the obstruction has passed. 6.Peristaltic stimulators are useful when the person - Stool may be heme positive. is unable to move the stool down into the rectum. - Abdominal Xray Films 7.Use the least caustic type of suppository that is - Barium Enema effective for the older person. - CT Scan 8.Avoid the use of bedpans—have the person sit upright on the toilet or commode. INTERVENTIONS: 9. Avoid the regular use of enemas. - Bulk agents (e.g., psyllium, methylcellulose) should - High-fiber diet or daily fiber supplementation with be considered. psyllium. - Osmotic laxatives (e.g., lactulose, sorbitol)  NCM 114 – CARE OF OLDER ADULTS PRELIM TOPICS HENNESY TURINGAN Ms. Chona Guillermo - Stimulant laxatives (e.g., senna, bisacodyl) - Pernicious anemia; blood type A - Enemas should not be used on a regular basis and - Family history of gastric adenocarcinoma are other should be reserved for those who do not respond to risk factors. treatments or who have evidence of fecal impaction. - Nonpharmacological interventions ASSESSMENT AND DIAGNOSIS: - Encouragement of a high-fiber diet with adequate fluid intake (unless contraindicated). - Early in the disease patients may be asymptomatic or experience vague symptoms such as loss of Gastrointestinal Cancers appetite (especially for meat), malaise, and