Best Nursing Practices in Care for Older Adults ELDER Project Fairfield University School of Nursing Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858 Session 2 Topics: Functional Assessment of Older Adults Sleep/Rest in Older Adults Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Topic 1: Functional Assessment of Older Adults Functional Assessment….What is it? A comprehensive evaluation of physical and cognitive abilities required to maintain independence. Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

What tools can we use to help? Objective Assessment Tools Can be well known, or something your agency has created Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Activities of Daily Living (ADLs) Use of Katz Activities of Daily Living Tool Bathing Dressing Toileting Transferring Continence Feeding Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Instrumental Activities of Daily Living (IADLs) Basic daily activities needed to live independently in the community: Shopping Cooking Using the phone Laundry Housekeeping Finances Maintaining home and property Performing duties for job or volunteer Traveling Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858 Lawton Scale for IADL Based on score from 8 – 28 The lower the score, the more independent Compare scores over time Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858 PULSES Profile P: Physical condition U: Upper limb function L: Lower limb function S: Sensory components E: Excretory functions S: Support factors Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858 SPICES S: sleep disorders P: problems with eating or feeding I: incontinence C: confusion E: evidence of falls S: skin breakdown Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Psychological Function Need to measure cognitive mental and affective functions independently Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858 Social Functioning Includes Social interaction and resources Subjective well being and coping Person-environment fit Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

What happens to function over time? Chronic conditions increase with age Arthritis Hypertension Heart disease Hearing impairment Orthopedic impairment Cataracts Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858 ADL’s 20% of people over 65 require assist with ADLs 45% of people over 85 require assist with ADLs Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858 How is the USA changing? 1990: 7 million older adult in the USA were over age 80 Estimation: By 2025: 14 million older adults will be over age 80 Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858 How prepared are we? Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Topic 2: Sleep/Rest for Older Adults Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Age Related Sleep Changes: Total sleep time decreases until age 80, then increases slightly Time in bed increases after age 65 Onset to time of sleep is lengthened(>30 min) Awakenings are more frequent Sleep is lighter Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858 Fact: With age, more time is spent awake in bed because of frequent sleep interruptions. (ie: wake up and can’t fall back asleep) Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858 Fact: Frequent arousals reduce the amount of nocturnal sleep. Napping during the day may increase the total sleep time over a 24-hour period. Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858 Frequent Complaints Difficulty falling asleep Sleep interruptions Daytime fatigue Some changes in sleep may be due to changes in circadian rhythms. Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

4 Categories of Sleep Disturbances Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858 Category 1: Dyssomnias: disorders of initiating and maintaining sleep and of excessive sleepiness Example of a cause: sleep apnea Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858 Apnea & Hypopnea Breathing disorders can cause sleep arousals The older adult may not recognize that the disorder is disturbing sleep Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858 Category 2 Parasomnias: unusual behavior during sleep Older adults may not relate these behaviors to sleep-related complaints Examples: Sleep walking, Nocturnal myoclonus (PLMS) Restless leg syndrome, Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Periodic Limb Movements in Sleep PLMS: may cause sleep disturbances in older adults, but they may not recognize that this condition is disturbing their sleep Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858 Category 3 Disorders associated with medical or psychiatric disorders Examples: Anxiety, Depression Medical problems Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Medical Problems That May Lead to Sleep Disturbances Cardiovascular: nocturnal ischemia Diabetes: nightmares; waking early due to blood glucose fluctuations GI: reflux Arthritis: pain COPD: dyspnea while prone Parkinsons: decreases REM sleep Alzheimers: nighttime wandering, agitation Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858 Category 4 Proposed sleep disorders (other various disorders that continue to be studied, in an effort to make them better defined) Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Other Causes of Sleep Disturbances Onset of acute illness Progression of chronic illness Pain Nocturia Dementia Alcoholism Depression Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858 How do I assess sleep? 4 Areas to Assess Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

#1: Assess sleep history Include impact of sleep complaint on the individual’s daily life Get a 24 hour sleep diary over 1-2 weeks to see patterns Remember to get observations of partners or caregivers Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

#2: Obtain a medical history Various medical conditions can contribute to sleep disturbances Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858 #3: Get a Drug History Include prescription and nonprescription medications Include alcohol, caffeine, and nicotine Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

#4: Get a Psychosocial history Begin with psychiatric illness (anxiety, depression, dementia) Follow with social history (grieving, illness, loss, translocation) Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Nursing Interventions Pharmacologic Nonpharmacologic Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858 Refer: If they have PLMS or sleep related breathing problems, they need further assessment Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858 1st Line of Treatment Remove contributing factors Examples: Treat a medical condition Reassess drugs that may be cause Counseling for alcohol, caffeine, nicotine use Reduce fluid intake in the evening Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858 More strategies Develop a sleep-preparation routine Change into night clothes, wash face, go to bathroom Establish a regular bedtime Use bedroom for sleep only, not for other daily activities Develop a sleep story that soothes Discourage daytime napping Daily exercise Sexual activity Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Pharmacologic Interventions Recommended for short term use only for elderly Benzodiazepine with short or intermediate acting action (ex: temazepam, triazolam) Two week maximum Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Reference: The content covered in this presentation is provided by the John A. Hartford Foundation Institute for Geriatric Nursing (2001) Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858 Reference: Various slides in this presentation, courtesy of Mathers Lifeways Mather Institute on Aging , 2002 Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858

Power Point Presentation Created by: Diana R. Mager, CRN, MSN Fairfield University School of Nursing ELDER Project Director Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858