Healthy Aging Week 2 Notes PDF

Healthy Aging H&H II - Week 2 © DURHAM COLLEGE OR ITS LICENSORS 2022 Learning Objectives 1. Discussthe assessment and interventions for nutrition, oral health, dehydration, urinary & fecal incontinence in the older adult. 2. Explainage related changes that impact rest, sleep, a...

Healthy Aging H&H II - Week 2 © DURHAM COLLEGE OR ITS LICENSORS 2022 Learning Objectives 1. Discussthe assessment and interventions for nutrition, oral health, dehydration, urinary & fecal incontinence in the older adult. 2. Explainage related changes that impact rest, sleep, activity and associated interventions 3. Describe problems older adults experience with maintaining healthy skin and feet and associated interventions 4. Explain how to maintain mobility and environmental safety for older adults 5. Describe how to assess an older adult for the risk of falls 6. Explore the concept of safe medication use in older adults and associated complications of improper medication use 7. Explore the role of the health care professional in promoting driving safety for older adults © DURHAM COLLEGE OR ITS LICENSORS 2022 Normal Age Related Changes  A number of normal age related changes can impact older adults. These include:  Nutrition  Oral Health  Hydration  Urinary Incontinence  Fecal Incontinence © DURHAM COLLEGE OR ITS LICENSORS 2022 Nutrition  How do you think the following would impact a person’s nutrition as they age?  Life long eating habits  Socialization  Income Review pages 101-105 in Ebersole  & Hess' Gerontological nursing & Transportation healthy aging in Canada (3rd Ed.).  Physical changes © DURHAM COLLEGE OR ITS LICENSORS 2022 Factors Affecting Nutrition  Life Long Eating Habits – the way we eat throughout our lives will impact our nutritional intake as we age.  Socialization – Food is used in social and family settings, and is used to create belonging that is difficult to maintain as we age  Income – as we age our income changes which impacts the quality and amount of food eaten  Transportation – Access to nutritious foods may be limited  Age related changes to the GI System – Taste, Smell, Digestion & Appetite are affected © DURHAM COLLEGE OR ITS LICENSORS 2022 Nutrition Health Canada has a number recommendations to enhance nutrition in older adults. https://food-guide.canada.ca/en/tip s-for-healthy-eating/seniors/ Review Box 8-1 in Ebersole & Hess' Gerontological nursing & healthy aging in Canada (3rd Ed.). © DURHAM COLLEGE OR ITS LICENSORS 2022 Oral Health  Attention to a patient’s oral health must be a high priority for nurses  Poor oro-dental health can lead to systemic disease  Malnutrition, dehydration, aspiration, joint infections, cardiovascular disease, oral pain and poor glycemic control. © DURHAM COLLEGE OR ITS LICENSORS 2022  Oral Health Interventions  Utilizing interprofessional team expertise  Arrange regular oral exams by a dentist  Brushing and flossing twice daily  Mouth wash daily  Use of foam swabs while gums heal  A toothbrush that promotes grip and dexterity  Ultrasonic toothbrush  Prescription oral rinses (antimicrobial)  Daily cleaning of dentures  Adhesive / Resizing of dentures  Brush or clean dentures after each meal RNAO BPG - Oral Health Supporting Adults who Require Assis tance © DURHAM COLLEGE OR ITS LICENSORS 2022 Hydration  Maintaining hydration can be challenging for older adults and caregivers  Dehydration often results from an  in loss of fluids with a  in fluid intake  Risk Factors FOR  Dehydration AS a Risk Factor dehydration  Delirium, Seizures, Thromboembolic  Old age complications, Infection, Kidney stones,  Medications (such as diuretics, Renal failure, Constipation, Falls, laxatives, anticholinergics) Medication toxicity, Electrolyte  Lack of adequate staffing and supervision, imbalance, Hyperthermia and Delayed  Functional deficits, cognitive wound healing decline, comprehension, dysphagia and illness © DURHAM COLLEGE OR ITS LICENSORS 2022 Hydration Drugs End of Life High Fever Yellow Urine turns Assessment dark  Dizziness Pay attention to patients with vomiting, Reduced Oral Intake diarrhea Axillae dry  Monitor weight loss, malnutrition, fever & Tachycardia infection Incontinence (fear of)  Patients with dementia, delirium & functional Oral problems impairment are at high risk Neurological  impairment Lab tests: BUN, Sodium, Creatinine, Glucose, Sunken Eyes Bicarb & Osmolarity  Monitor Intake & output closely © DURHAM COLLEGE OR ITS LICENSORS 2022 Dehydration  Hydration Management is the "promotion of an adequate fluid balance to prevent complications resulting from abnormal and undesirable fluid levels” (Ebersole & Hess, 2019, p.125)  Goal is 3.7 L (men) or 2.7 L (women) of fluid per day, if active and not frail  Identify and treat any underlying causes of dehydration.  Treatment will depend on the severity of dehydration. IV Fluid Rehydration - orders include a Hypodermoclys bolus and then a is (CSCI) to maintenance avoid fluid infusion. Oral hospitalization Rehydration – and IV therapy first line manage-ment for those who can tolerate oral fluids © DURHAM COLLEGE OR ITS LICENSORS 2022 Urinary Incontinence  Urinary incontinence is the involuntary loss of urine.  Urinary incontinence is very common in older adults.  Associated with  Decreased quality of life  Skin irritation  Infection  Falls  Pressure ulcer development  Urinary incontinence is a condition that is significantly under-reported, under-diagnosed and under-treated. © DURHAM COLLEGE OR ITS LICENSORS 2022 Classification of Urinary Incontinence  Transient (Acute) UI usually has a sudden onset and last for less than 6 months and is caused by treatable factors such as UTI, constipation, stool impaction, increased urine production or delirium.  Established (Chronic) UI has a sudden or a gradual onset & includes the following subtypes: Urge incontinence (overactive bladder) is the most common type of UI in older adults. It is the involuntary urine loss that occurs soon after feeling an urgent need to void. Stress incontinence (outlet incompetence) is the involuntary loss of less than 50 mL of urine during actions that increase intra-abdominal pressure (e.g., coughing, sneezing, exercising, lifting, and bending). Urge or stress UI with high postvoid residual incontinence occurs when the bladder does not empty normally and becomes overdistended. This condition is accompanied by frequent or nearly constant urine loss. Functional incontinence occurs when the individual is unable to reach a toilet because of environmental barriers, physical limitations, or severe cognitive impairment. Mixed incontinence is defined asC OaL Lcombination © DURHAM E G E O R I T S L I C E Nof S O more R S 2 0 2 2than one type of UI, usually stress Assessment  First step is to ask your patient if they have any issues with UI.  Assessment should include a health history, targeted physical examination, urinalysis, and a determination of postvoid residual urine.  The health history should include a medical, neurological, and genitourinary history; functional assessment; cognitive assessment; psychosocial effects; strategies currently used to control UI; medication; & assess for symptoms of the UI.  Maintain a Urinary Diary to describe objective information about voiding patterns and the frequency and severity of UI events.  In LTC settings the use of a CHAMMP Tool can be helpful in the assessment and treatment of UI. © DURHAM COLLEGE OR ITS LICENSORS 2022 Interventions Behavioual – Behaviour modifications include: Scheduled (timed) voiding Prompted (asked) voiding Bladder Training Pelvic Floor Muscle Exercises (PFMEs) Lifestyle - Decrease caffeine, quit smoking, weight loss, bowel management, and physical exercise Absorbent products – use of undergarments or adult briefs. Urinary Catheters – Condom catheters are used in male patients who are incontinent. Pharmacological – Medications are not considered a first line treatment for UI Non-surgical Devices –urethral plugs, intravaginal support devices such as a pessary. Surgical – There are a number of surgical techniques come with many risks for the older adult. © DURHAM COLLEGE OR ITS LICENSORS 2022 Fecal Incontinence  Fecal Incontinence is the continuous or recurrent passage of fecal material for at least 1 month in a mature person.  Statistics  50-65% of older adults in long term care homes experience Fecal Incontinence  33% in hospitalized older adults experience Fecal Incontinence  50-70% of older adults have both Fecal and Urinary Incontinence.  Fecal Incontinence is often under assessed & under diagnosed  Transient FI it is often associated with episodes of diarrhea, acute illness, or fecal impaction.  Fecal incontinence can have devastating social implications and can result in significant social isolation © DURHAM COLLEGE OR ITS LICENSORS 2022 Assessment  An assessment for fecal impaction includes the following: History: a complete history and investigation into diet, stool consistency and frequency, use of laxatives or enemas, surgical and obstetrical history, medications as well as the effects of fecal incontinence on the quality of life of the individual. Physical Exam: a physical exam of the GI system, rectal exam and a bowel record. Tests: Stool Analysis and an abdominal x-ray should be completed. © DURHAM COLLEGE OR ITS LICENSORS 2022 Interventions Environmental Modifications: Modify the environment to ensure easy access to the toilet. Diet Alterations: High fibre diets, good hydration and avoiding excessive stimulants (eg: coffee) are important diet modifications. Skin Care: Ensure immaculate skin care to prevent skin irritation, breakdown and infections. Habit Training: Timed stooling includes obtaining a bowel diary and then timing toileting according the diary. Interprofessional Collaboration: Consult with OT/PT Medications: Advocate for the use of stool softeners for impaction Surgery: If fecal incontinence is the result of a condition that can resolve from surgery (eg: tumors) © DURHAM COLLEGE OR ITS LICENSORS 2022 Age Related Changes H&H II - Week 2.3 © DURHAM COLLEGE OR ITS LICENSORS 2022 Sleep  Rest and sleep are physiological and mental necessities for the preservation of life. Sleep that is Fragmented with frequent awakening Spending more time in bed Older Adults Reduced sleep time Describe Sleep Prolonged latency Changes As: Frequency of daytime naps Poor quality and quantity of sleep Sleep disorders developing with age  Sleep deprivation may impact cognitive function, pain, respiratory function and general health © DURHAM COLLEGE OR ITS LICENSORS 2022 Sleep Disorders Insomnia Nocturia Gastric Esophageal Reflux Disease (GERD) Dementia Review pages 142-144 Medications In Ebersole & Hess' Gerontological nursing & Obstructive Sleep Apnea healthy aging in Canada (3rd Ed.). Restless Leg Syndrome Rapid Eye Movement Sleep Behaviour Disorder © DURHAM COLLEGE OR ITS LICENSORS 2022 Assessment  Assessment should include a thorough assessment of sleep habits, scales to measure sleep and maintenance of a sleep log.  Assess the following:  What time the person goes to bed  How many times the person wakes up at night  What rituals occur at bedtime. (eating snacks, watching television, listening to music, and reading)  Amount and type of daily exercise, including activities done several hours before bedtime  Room environment (including temperature, ventilation, and illumination)  Review all medications  The person’s bed partner, caregivers, and family members can also provide valuable information about the person’s sleep habits and lifestyle. © DURHAM COLLEGE OR ITS LICENSORS 2022 Sleep Diary Record the following for 2 to 4 weeks: 1. The number of times a call for assistance is made 2. Whether the person appears to be asleep or awake when checked during the night. 3. Time and dosage of sleep medication. 4. Time the person awakens in the morning. 5. Where the person falls asleep in the evening. 6. Duration of daytime naps. © DURHAM COLLEGE OR ITS LICENSORS 2022 Interventions  Interventions to promote sleep are weight reduction, smoking cessation, alcohol elimination, aromatherapy, sleep hygiene and low dose medications to promote sleep  Patients should also cultivate good sleep hygiene habits  Limit daytime naps to 30 minutes.  Avoid stimulants (caffeine and nicotine) before sleeping.  Engage in daily exercise.  Avoid consuming spicy foods, fried meals, and carbonated drinks before bedtime.  Ensure adequate exposure to natural light duringBox the10.7 day in and darkness Ebersole at night & Hess'  Establish a regular bedtime routine Gerontological nursing &  Ensure the sleep environment is pleasant healthy aging in Canada (3rd Ed.). © DURHAM COLLEGE OR ITS LICENSORS 2022 Physical Activity  60% of older adults are considered inactive (PHAC,2003)  Frail older adults diagnosed with conditions such as arthritis, COPD, and dementia can benefit significantly from routine physical activity. Benefits of Physical Activity Maintaining functional ability Enhancing self-confidence & self-sufficiency Decreasing depression Improving general lifestyle Maintaining mental functional capacity Decreasing the risk for medical problems © DURHAM COLLEGE OR ITS LICENSORS 2022 Age Related Changes  Mobility and agility are affected by:  Strength of the muscles, flexibility, postural stability, vibratory sensation, cognition and perceived stability.  Muscles & Joints:  back and legs, and strength and flexibility of muscles and endurance decrease  Movement and range of motion  Is limited and less fluid and the joints change as the regeneration of tissue slows and muscle wasting occurs.  Normal wear and tear reduces the smooth cartilage of the joints.  Proactive and proper management of persistent illnesses and maintenance of a healthy lifestyle can forstall the onset of mobility limitations for older adults. © DURHAM COLLEGE OR ITS LICENSORS 2022 Conditions that Affect Physical Activity  Sarcopenia refers to the loss of skeletal muscle mass, strength and function.  Related to aging,  Is a marker of frailty in an older adult  Gait Changes  Narrower standing base,  Wider side to side swaying when walking,  Slower responses  Increased care in gait overall.  Agility refers to the body's ability to change positions efficiently. © DURHAM COLLEGE OR ITS LICENSORS 2022 Skin  There are several common skin disorders that affect the older adult. Read Box 11-1  Many reflect systemic disorders. Physiological Function of the Skin.  The role of the gerontological nurse is in Ebersole & Hess' to Gerontological nursing & healthy aging in  Educate regarding preventive measures, Canada (3rd Ed.).  Screen for common conditions of the skin,  Identify risk factors  Provide interventions to promote healing. © DURHAM COLLEGE OR ITS LICENSORS 2022 Skin Conditions  Xerosis - Abnormal Dryness  Puritis – Itchy sensation that causes excessive scratching  Herpes Zoster (Shingles) – is a very painful condition and can be difficult to control leading to decreased quality of life.  Keratosis – thick, scaly or crusty patches of skin that are associated with frequent exposure to sun. © DURHAM COLLEGE OR ITS LICENSORS 2022 Interventions  The assessment of and maintenance of healthy skin is an important role of the Read Box 11-2 Skin nurse. Care Tips for Older  Recommendations for healthy skin Adults in Ebersole & include: Hess' Gerontological Ensuring adequate hydration and nursing & healthy humidification aging in Canada (3rd The use of supe-fatted soaps and lotions or Ed.). emollients may prevent the loss of moisture Education regarding the use of sunscreen and avoidance of sun exposure © DURHAM COLLEGE OR ITS LICENSORS 2022 Feet  Promoting healthy feet and good care can alleviate disability and pain and decreased risk for falls.  Corns and Calluses - formed from growths of compacted skin that occur as a result of prolonged pressure,  Hammer Toes - permanently flexed toes that have a claw-like appearance.  Fungal Infections - usually take the form of a nail fungus and/or athletes foot  Bunions - boney deformities that develop from the squeezing together of first and second toes. © DURHAM COLLEGE OR ITS LICENSORS 2022 Medication Safety H&H II - Week 2.3 © DURHAM COLLEGE OR ITS LICENSORS 2022 Medication Use in Canada  In 2011, 83% of older adults were taking prescription medications, with 33% of those taking more than 5 prescription medications.  In addition, 88% of older adults acknowledge taking complimentary or alternative medications  The number of medications a person take directly corelates with the number of adverse drug reactions (ADR) they may experience. Adverse Drug Reactions are when a medication is combined with certain foods, beverages, vitamins, herbs or other medications resulting in an adverse reaction. © DURHAM COLLEGE OR ITS LICENSORS 2022 Polypharmacy Polypharmacy is a term used to describe one or more of the following: The use of a large number of medications The use of contraindicated medications The use of inappropriate medications The use of medications that are duplicated or unnecessary  The more medications a person takes, the more likely that one or more medications will interact with each other  Medications taken close together may potentiate the meds or make it ineffective  Misuse of medications may result of memory failure or cognitive impairment. © DURHAM COLLEGE OR ITS LICENSORS 2022 Medication Reconcilliation  "Medication reconciliation is a formal process in which health care providers (HCP) work together with patients, families and care providers to ensure accurate and comprehensive medication information is communicated consistently across transitions of care."  Goal of Medication Reconcilliation is to prevent potential adverse drug events.  Nurses engage in med rec at all points of care Queens University Medication Reconciliation: A Learning Guide © DURHAM COLLEGE OR ITS LICENSORS 2022 Medication Reconcilliation  Medication Reconciliation requires a team approach  Med rec process the three basic steps are outlined below: 1. Sitdown with the patient and / or family to obtain a complete and accurate list of the patient’s current medications. Best Possible Medication History (BPMH) 2. The prescriber uses the BPMH when writing medication orders 3. The team will compare the BPMH at all intersections / transfers of care 4. Anydiscrepancies must be brought to the attention of the most responsible person who will make changes and document in the patients chart © DURHAM COLLEGE OR ITS LICENSORS 2022 Nursing Implications Comprehensive Assessment (Box 14-2).  Perform a comprehensive medication assessment As the patient to bring in all medications with them in a bag and ask the client how they take the medication.  24-hour recall - ask the patient what they took in the last 24 hours. Ask about OTC meds, vitamins & herbal remedies. Medication Reconciliation:  Work with your interprofessional team to complete medication reconciliation for your patient.  Communicate any discrepancies to the team. Monitor & Evaluation:  Monitor and evaluate the effectiveness of prescribed treatments and observe for ADR's. © DURHAM COLLEGE OR ITS LICENSORS 2022 Nursing Implications Patient Education: Environment to minimize distractions Timing of education session (eg: do not do a teaching session during periods of fatigue or after giving sedatives) Include key people in teaching sessions, such as family members, care givers or POA's. Provide any assistive devices needed such as glasses, hearing aids, additional light  Be sure to include memory aids, handouts, and follow the key messages in the Medication Matters document. © DURHAM COLLEGE OR ITS LICENSORS 2022 Driving Safety & Falls H&H II - Week 2.5 © DURHAM COLLEGE OR ITS LICENSORS 2022 Driving Safety  Vision changes, cognitive impairment, medical illness and functional impairments impact an older adults ability to drive  Older adults with dementia have a 2.5-4.7% greater risk of having an MVC  Older adults are more likely to die or take longer to recover after an MVC  Giving up driving is a significant loss of independence Who is responsible for making the difficult decision about driver retirement in Canada? © DURHAM COLLEGE OR ITS LICENSORS 2022 Driving Tests An evaluation of an older adult's driving includes: 1. Visual screening - checks to see if a person has ability to move their eyes as well as their ability to judge distance and peripheral vision. 2. Movement and strength - assesses whether the person’s arms and legs have enough movement and strength to control features of the car. 3. Perception and cognitive screening - assesses the person’s reaction times and includes other skill tests to assess memory, problem solving and interpretation of what is seen. Review the following  Ontario Ministry of Transport, Senior Drivers License Renewal Program  Engaging community partners to address at risk drivers with dementia © DURHAM COLLEGE OR ITS LICENSORS 2022 Falls  A fall is “an unplanned descent to the floor (or extension of the floor, e.g., trash can or other equipment) with or without injury to the patient” (Touhy et al, 2019, p.183)  Falls are the leading cause of death by injury  Falls are the most common cause of nonfatal injuries and hospital admissions  1 in 3 older adults will experience a fall, and ½ of those will fall more than once  20-30% of older adults fall each year. Those experiencing serious injury is increasing  81% of hospitalizations in older adults are due to falls © DURHAM COLLEGE OR ITS LICENSORS 2022 Common Causes of Falls Falls are considered a “geriatric syndrome” The reasons for falls are multifactorial   Wet floors Neurological  Tripping on rugs or furniture  Sensory  Getting up independently  Cognitive  Limited staffing  Medication  Lack of toileting programs  Musculoskeletal  Use of restraints  Impending physical illness  Side Rails © DURHAM COLLEGE OR ITS LICENSORS 2022 Falls Assessment  Assessment includes the use of a falls risk tool and a clinical assessment to determine other risks for falls.  A falls assessment risk scale is used in combination with an individual clinical assessment  Assessment tools: Hendrich II Fall Risk Model, the Morse Fall Scale and the Berg Balance Scale. © DURHAM COLLEGE OR ITS LICENSORS 2022 Falls Assessment  Nurses often notice the issues listed below and need to report their findings to the interprofessional team (IPT).  Medication use - Assess for high risk medication and alcohol use Vision - Ensure proper lighting and complete an eye exam Blood Pressure - Report high blood pressure readings to the team for diagnosis and treatment Balance - if balance is a concern, refer to medical and physiotherapy team for further assessment & interventions Neuro Exam - physician should complete to rule out any neurological concerns Cardiovascular Exam - physician should complete to rule out any cardiac concerns Environment - Exam the circumstances of a current fall or previous fall to assess environmental contributing factors © DURHAM COLLEGE OR ITS LICENSORS 2022