Chapter 92 Gerontology: The Aging Adult

Gerontology Gerontology The study of the effects of normal aging and age- related diseases Geriatrics The branch of medicine concerned with the problems and illnesses of aging and their treatment Gerontological nursing Geriatric nursing

Activities of Daily Living ADLs Most older adults are active and healthy and able to perform typical activities of daily living (ADLs). IADLs As the individual ages, there is an increasing difficulty in the ability to perform more complex tasks such as household maintenance or managing money, which are referred to as instrumental activities of daily living (IADLs).

Common Changes in Aging Decreased functioning of organs, reaction time, tactile sensations, and decreased capacity for recovery from wounds, injury, or illness Changes in visual and auditory acuity Unsteady gait, decreased sense of balance, and stiff joints Increased emotional, socioeconomic, and physical losses Combinations of chronic illnesses, poor dietary habits, and lack of exercise

Effects of Aging on Body Systems Integumentary system Musculoskeletal system Nervous system Eyes, ears, and other senses Cardiovascular system Respiratory system Gastrointestinal system Urinary system Endocrine system Immune system Female reproductive system Male reproductive system

Care Settings for Older Adults Factors determining the choice of residence include: Time frame of recovery from chronic or acute illness or the combination of both The person’s ability to provide for physical, financial, and emotional self-care needs Physical, financial, and emotional support from family and friends Access to healthcare and rehabilitation services, including availability and transportation Need for protection and supervision

Care Settings for Older Adults (cont’d) Home care Senior centers Retirement complexes Long-term care options Assisted-living facility Rehabilitative care facility Long-term care facility (LTC) Subacute care facility

Question Is the following statement true or false? LTC facilities have all the required onsite services similar to an acute-care facility.

Answer False LTC facilities generally do not have some of the onsite services that can be found in an acute-care facility. Services such as occupational therapy, physical therapy, rehabilitation, and hospice may be available and used according to each resident’s individual needs. Other services are brought into the facility, as needed, or the resident may be transported to the location of the service.

Nutritional Needs Understanding the nutritional status of the older adult Special considerations Teeth and chewing Swallowing difficulties Medications and supplements Water Supplementing oral intake

Medication Administration Changes in aging as related to medication administration Decreased sense of thirst, dry oral mucosa, total body fluid volume or percentage Decreased muscle tissue, increased percentage of fatty tissue Decreased general circulation; circulation to colon, vagina, liver, and kidneys; fewer functioning nephrons Decreased stomach acids and other digestive fluids Confusion, forgetfulness

Personal Hygiene Needs Skin care Oral hygiene Hair care Nail and foot care Shaving Clothing

Question Is the following statement true or false? Nurses should encourage older people with dentures to check the condition of their gums regularly.

Answer True A nurse must encourage older people with dentures to check the condition of their gums regularly. Irritation can result from poorly fitting dentures. Cancer of the mouth sometimes occurs and may go undetected.

Elimination Needs Constipation Bladder or bowel incontinence Difficulty in voiding

Question Is the following statement true or false? Impaction in an elderly client is not likely to become serious.

Answer False Impaction in an elderly client can become very serious. Impaction can cause infarction of the bowels, which leads to death of intestinal tissue, and soon the client becomes critically ill. Death is not uncommon due to an unrecognized sequence of events: constipation impaction infarction = death

Mental Health Concerns in Older Clients Anxiety Depression Substance abuse

Emotional and Psychological Support Measures for emotional and psychological support Remotivation techniques Recreation Cognitive function Social life and activities Pet therapy Religious support Use of volunteers

Communication Visual impairment Presbyopia Sjögren’s syndrome Hearing loss Presbycusis Speech impairment Aphasia

Safety Loss of proprioception Safety devices Restraints (client safety devices)

Physical Activity and Exercise Walking is the single most highly recommended exercise for older adults. Benefits of exercise Cardiovascular system Musculoskeletal system Nervous system Kyphosis

Sexuality The older adult generally maintains the ability and desire to engage in sexual activity. Encourage clients to discuss with their healthcare provider the impact of health conditions on sexual activity.

Elder Abuse Emotional, physical, and sexual abuse Financial exploitation Neglect

Elder Abuse (cont’d) Risk factors Minimal respite to caregiver(s) of elderly, frequent or no visits to healthcare personnel History of unexplained injuries, untreated conditions or wounds, inability or lack of interest in self-care Malnutrition or weight loss, inappropriate medication administration, substance abuse of senior or caregiver Depression, withdrawal, fearfulness, accumulated loss, nontypical spending or donating money

Question Is the following statement true or false? Older adults often fail to report abuse.

Answer True Older adults often fail to report abuse, as witnesses are often difficult to obtain and many older victims often fear retaliation. The most common elder abusers are caregivers, which include adult children, other relatives, spouses, service providers, friends or neighbors, grandchildren, and siblings.

End of Presentation