Nursing Fundamentals: Aging Well And Changes Related to Aging Module 2 PDF

BNUR1900 Nursing Fundamentals Module 2: Aging Well and Changes Related to Aging Thursday September 19, 2024 Karin Zekveld Learning Objectives During this module, students will:  Develop insight into the demographics of the older population...

BNUR1900 Nursing Fundamentals Module 2: Aging Well and Changes Related to Aging Thursday September 19, 2024 Karin Zekveld Learning Objectives During this module, students will:  Develop insight into the demographics of the older population  Develop insight into the trends in the care of the older adult (gerontological care)  Examine healthy aging from a holistic perspective: physical, social, emotional, spiritual, and cognitive  Briefly analyze and develop an understanding of key theories on aging and how they apply to working with older adults  Examine and develop an understanding of potential pathological changes associated with aging, including sensory alterations, and how they apply to working with older adults  Develop an understanding of the value of incorporating prevention and health promotion into the care of an older adult Entry to Practice Competencies 1.22 Incorporates knowledge from nursing science, social sciences, humanities, and health-related research into plans of care. 1.26 Adapts practice in response to the spiritual beliefs and cultural practices of clients. Plan Review of Module 1 and readings Discuss aging and health Break Perpetual case study Aging What is aging? How do you define aging? What is your perception of aging? Do you have much experience spending time with older persons? What are your assumptions or biases associated with aging? Aging in Canada Age of the Canadian Population  Gerontology: the multidisciplinary study of older persons concerned with the physical, mental, and social aspects and implications of Terminology aging Geriatrics: a medical specialty focused on the Commonly Used care and treatment of older persons in Health Care Gerontological nursing: an evidence-based nursing specialty that addresses the unique physiological, social, psychological, developmental, economic, cultural, spiritual, and advocacy needs of older persons. Focused on the process of aging Myths About Aging Common Myths about Aging 1. Older people aren’t interested in the outside world 2. Older people don’t want or need close relationships 3. Older people contribute little to society 4. As you age, you get more set in your ways 5. Mental and physical deterioration are inevitable in older age 6. Older people are impoverished 7. Older people are not interested in sex or intimacy 8. Older people can’t make good decisions about important issues 9. Older people lose their desire to live 10. Science has answered all of our questions about aging  Let’s End Ageism Ageism: discrimination based on age https://www.ted.com/talks/ashton_applewhite_let_ s_end_ageism  Needs Assessment What does health mean to someone? What is important to the individual? What is important as they age? How do they perceive their health? Illness? Disease? Wellness? (Potter & Perry, 2024) Age-Associated Changes Physiological Changes Functional Changes Cognitive Changes Psychosocial Changes Biological Theories of Aging Error (stochastic) theories Explain aging as the result of an accumulation of errors in the synthesis of DNA and RNA Wear-and-tear theory Cross-link theory Oxidative stress (free radical theory) (Boscart et al., 2023) Biological Theories of Aging Programmed aging (nonstochastic) theories Explain aging as a process that is predetermined or ‘preprogrammed’ at the cellular level Neuroendocrine-immunological theory (Boscart et al., 2023) Sociological Theories of Aging Activity Theory Continuity Theory Age-Stratification Theory Social Exchange Theory Modernization Theory Symbolic Interaction Theories (Boscart et al., 2023) Psychological Theories of Aging Jung’s Theories of Personality Developmental Theories Theory of Gerotranscendence (Boscart et al., 2023) Developmental Tasks of Aging Adjusting to decreasing health and physical strength Adjusting to retirement and reduced or fixed income Adjusting to the death of a spouse Accepting one’s self as an aging person Maintaining satisfactory living arrangements Redefining relationships with adult children Findings ways to maintain quality of life (Potter & Perry, 2024) Spirituality and Aging Spiritual well-being can be considered the ability to experience and integrate meaning and purpose in life through connectedness with self, others, art, music, literature, nature, or a power greater than oneself (Boscart et al., 2023) Common Physiological Changes with Aging Skin becomes thinner, loses moisture and elasticity Integumenta (with fat loss), glandular atrophy, spots may appear on the skin (pigmentation changes), skin becomes paler, ry System hair loss, hair turning grey or white, nail thickening and hardening Tendons, ligaments, joints dry and harden (less Musculoskel flexible), bone mass decreases, degenerative joint changes, sarcopenia, replacement of lean mass by etal System adipose tissue, thinning of vertebral discs Stiffening of the myocardium and blood vessels, Cardiovascul thickening of left ventricle, reduced blood flow, stroke volume, and cardiac output, decreased response to ar System sudden changes in oxygen demand, blood vessel thickening, decreased venous valve efficiency (Boscart et al., 2023; Potter & Perry, 2024)) Common Physiological Changes with Aging Respiratory Loss of elastic recoil, stiffening of the chest wall, inefficiency in gas exchange, increased air flow resistance, fewer alveoli, decreased System cough reflex Renal / Blood flow, ability to regulate body fluids, loss of nephrons, Genitourinary decreased bladder capacity System Changes in thyroid structure and diminished secretion of hormones Endocrine Reproductive Female: changes after menopause, decrease in estrogen System Male: enlargement of prostate (Boscart et al., 2023; Potter & Perry, 2024) Common Physiological Changes with Aging Dry mouth (xerostomia), decreased saliva, vulnerable Gastrointesti teeth, periodontal disease, presbyesophagus (less effective propulsion), decreased gastric motility and nal System volume, decreased nutrient absorption in intestines Decreased number of neurons, sleep changes (loss of Neurological deep sleep), increased risk for injury (loss of nerve endings in the skin and changes in proprioception), System sensory alterations (visual and auditory) Immune Decrease in innate immunity, adaptive immunity, and self-tolerance decreases T-cell function which can System create an autoimmune response (Boscart et al., 2023; Pottery & Perry, 2024)  Functional Changes Functional Status - refers to the ability for an older person to safely participate in activities of daily living (ADLs) Often linked to independence Physical, psychosocial, and cognitive health all impact functional status Factors that promote function: diet, activity, regular visits to and follow-up with health care providers, meaningful activities, stress management and avoidance of substance use A change in functional status can be an indicator of a change or decline in health (Potter & Perry, 2024)  ADLs IADLS Dressing Food preparation Ambulating Housekeeping Bathing Doing laundry Eating Shopping for Transferring groceries Toileting Using the telephone Managing medications Using transportation (O’Donovan & Morris, 2020 Senses Sight (visual) Hearing (auditory) Touch (tactile) Smell (olfactory) Taste (gustatory) Kinesthetic (proprioception)  Sensory Experience Reception: stimulation of a receptor nerve cell Perception: integration and interpretation of stimuli (in the brain) Reaction: to meaningful and significant stimuli (Potter & Perry, 2024) Sensory Alterations Sensory deficits: loss in the normal function of sensory reception and perception Sensory deprivation: inadequate quality or quantity of stimulation (reduced sensory input), elimination of pattern or meaning (strange environments), restriction of environment (bed rest) Sensory overload: multiple sensory stimuli that cannot be perceptually disregarded or selectively ignored (excessive sensory stimulation) (Potter & Perry, 2024) Common Visual Deficits Age-related macular degeneration (AMD) Cataract Diabetic retinopathy Glaucoma Refractive errors Dry eyes Retinal detachment (Potter & Perry, 2024) Common Sensory Deficits Taste Xerostomia: decrease in salivary production that leads to thick mucus and dry mouth Can result in taste alterations and decreased food intake Balance Benign peripheral vertigo resulting in vertigo or disequilibrium from vestibular dysfunction Impact balance, coordination In conjunction with peripheral neuropathy, can lead to falls (Potter & Perry, 2024) Common Auditory Deficits Conductive hearing loss Presbycusis Central auditory processing disorders Cerumen accumulation Meniere’s disease Otitis media Otosclerosis Sensoineural hearing loss Tinnitus (Potter & Perry, 2024) Implications for Caring for Older Persons with Sensory Changes Let’s go through each of the senses and consider some of the assessments and nursing interventions for each  Cognitive Changes Important: cognitive changes are not a normal part of aging 3 main cognitive conditions in aging: Delirium Dementia Depression Delirium A serious, often preventable disorder Medical emergency Sudden onset, rapid fluctuations in symptoms Most often the result of complex interactions among predisposing factors Individuals with a diagnosis of dementia are at higher risk Early recognition and immediate treatment of the underlying cause(s) are essential Often reversible Characterized by fluctuations in cognition, mood, attention, arousal, self-awareness (Boscart et al., 2023) Delirium Predisposing Factors Precipitating Factors Advancing age, male sex Medications Cognitive status Primary neurological disease Intercurrent illnesses (infections, Functional status dehydration, etc.) Sensory impairment Surgery Decreased oral intake Environmental Pain Medications Emotional stress Coexisting medical conditions Prolonged sleep deprivation (Boscart et al., 2023)  Dementia An irreversible state that progresses over years An umbrella term for major neurocognitive disorder Typically has a gradual onset, irreversible Memory impairment (amnesia) and decline in other cognitive abilities that is severe enough to interfere with daily life Other key features: Aphasia: loss of ability to express and understand language Apraxia: inability to carry out purposeful movement or perform familiar tasks Agnosia: inability to recognize common objects or familiar people Disturbances in executive functioning: difficulty planning, organizing, sequencing, abstracting (Boscart et al., 2023) Dementia Approximately 6.9% of the Canadian population has a diagnosis of dementia (PHAC, 2021) Prevalence tends to be higher in certain groups: Women Racial minorities Indigenous persons Numerous subtypes: Alzheimer’s disease, Lewy body dementia, Parkinson’s dementia, vascular dementia, Creutzfeldt-Jakob disease (CJD) (Alzheimer’s Society of Canada) Results in the loss of ability to perform activities of daily living (ADL) or functional decline (Boscart et al., 2023; Potter & Perry, 2024)) ‘Forgetfulness’ https://www.nia.nih.gov/health/10-myths-about-aging Depression The most common mental health issue in later life – not a normal part of aging A syndrome that includes numerous affective, cognitive, and somatic or physiological symptoms Older persons tend to report more somatic complaints like pain, changes in appetite Prevalence of major disorder in older persons in Canada between 1.5% and 3.3% (2016) Higher in hospitalized persons or those residing in LTC Prevalence of ‘milder’ depression between 4% and 18% (2015) In general, prevalence of individuals with symptoms of depression is higher and individuals with persistent conditions have higher rates of depression (Boscart et al., 2023)  Depression Often under diagnosed and undertreated There continues to be stigma and negative attitudes towards depression and mental illness Depression is associated with myriad negative outcomes including functional decline, decreased quality of life, malnutrition, substance use, etc. Essential that health care provides assess and treat depression and depressive symptoms Be aware of risk factors (Boscart et al., 2023) Depression Predisposing Factors Precipitating Factors Female Recent bereavement Widowed or divorced Moving to a LTC home Major physical and chronic illness Adverse life events Medications Long-term stress Excessive alcohol consumption Persistent sleep difficulties Isolation and low social support Family caregiving (Boscart et al., 2023) (RNAO, 2016) Common Health Concerns in Aging Heart Substance Cancer Smoking disease use Nutrition Oral health Exercise Arthritis Sensory Medication Falls Pain impairments use  Considerations for Assessment of Older Persons The inter-relation between physical and psychosocial aspects of aging Effects of disease and disability on functional status The decreased efficiency of homeostatic mechanisms The lack of standards for health and illness norms Aging is unique for each individual Altered manifestations of response to different disease processes  Sensory impairments (visual, Considerations auditory) Memory changes (deficits) for Assessment Cultural aspects Presentation of symptoms or disease Early indicators of change or acute illness Health Promotion for Older Persons Consider some of the unique psychosocial challenges: social isolation, cognitive impairment, stresses related to retirement, relocating, and loss Emphasize the strengths of the older person, recognize resilience, identify the resources they have available to them Interventions aimed at promoting independence and supporting self-care and participation in ADLs The nurse’s role is to promote and advocate for each individual to reach their optimal level of health within their context  General lifestyle preventive measures: Regular exercise (150 minutes/week) Balanced nutrition Health Management of hypertension and chronic disease Promotion Smoking cessation Immunizations for Older Dental care Sleep Persons Therapeutic communication Touch Cognitive stimulation Reminiscence Body image interventions Healthy Aging Perpetual Case Study Purpose of case study: To provide a care-based learning approach to the theoretical components of BNUR1900DG. This perpetual case study will enable students to apply key theoretical content to a ‘living’ case study. Students will work together in class to formulate answers to the specific case study. The case study will involve the same family and will build on, and incorporate, previous knowledge already addressed in the course. Intent is to have you begin to apply theories, pathological changes, sensory alterations and health promotion information from today’s class to the family members in the case study. Introduction of the Family David Lu, maternal Sandra Lu, maternal grandfather, age 70 grandmother, age 68 Jenny Lu, wife to Robert, Jay Lu, son of David and Robert Brant, husband to currently pregnant (20 Sandra, brother of Jenny, Jenny, father to Joshua, weeks) with their second age 36 age 34 child, age 32 Joshua Brant, son of Robert and Jenny, age 2.5 years Context of the Case Study Robert’s family (Robert, Jenny and Joshua) remain close with the family, but live in remote Northern Ontario and are not able to see them very often. David and Sandra live only 20 minutes away from Robert and Jenny and see them at least once a week. Jay, Jenny’s brother, lives within a one-hour drive from both David/Sandra and Robert/Jenny’s homes. Today’s Case Study Jenny has just come back from a visit with her parents. She is always happy to see how physically and socially active her parents are; she is happy they are aging so well. However, she has mentioned to Robert that she has noticed her dad often has to ask her to repeat herself. She is wondering if Robert has noticed it and if he thinks it might just be that David isn’t paying attention to the conversation like he used to do. Jenny also noticed that her dad likes to take a nap in the afternoon. This is new behaviour for him, and she is concerned that there may be something wrong. You are a student nurse who is visiting the Brant-Lu home with a midwife, who is caring for Jenny. Your role is to provide health information and clarify any questions the family may have, within your current knowledge level. Answer the following questions based on the information you have about the family, and your knowledge from today’s class. Today’s Case Study - Questions 1. Consider the theories on aging, discussed in today’s class. Apply two of the theories to David and Sandra. Discuss how this may help you, and the family, understand the current circumstances in the Lu home. 2. Consider Jenny’s concern about her dad’s hearing. Based on the information from today’s class, develop a response to Jenny about her concern. Consider the following: is this an expected change for his age? What might be some of the reasons for his need to have comments repeated? Should David be sent for a hearing test? Should David be sent for a cognitive assessment? 3. If you were visiting David and Sandra, consider how you might approach the subject of potential hearing loss with them. What might you need to say when you speak with them? For Consideration Between this class and the next scheduled class, consider the following: Review the pathological changes discussed in class; which one would you think would be the most difficult for you to accept? Consider why. Consider your first clinical placement that will occur during the last six weeks of the semester where most patients will be older adults. Consider your comfort level in working with older adults, many of whom will have some health concerns. What changes may create challenges for your interactions with patients? What can you do to prepare yourself for caring for the patients you are assigned to? Questions Assignment reminders OCMT – reminder to work through your modules Having trouble signing up? you need to come and speak to me! Reflective Journal Due this Sunday Any questions?  References O’Donovan, A., & Morris, L. (2020). Palliative radiation therapy in older adults with cancer: Age-related considerations. Clinical Oncology, 32(11). https://doi.org/10.1016/j.clon.2020.06.011 Registered Nurses Association of Ontario. (2016). Delirium, dementia, and depression in older adults: Assessment and care (2nd ed.). https://rnao.ca/sites/rnao-ca/files/bpg/RNAO_Delirium_Dementia_Depre ssion_Older_Adults_Assessment_and_Care.pdf