Fundamentals of Nursing: Human Health and Function Chapter 9: Caring for the Older Adult

Learning Objectives 1. Describe the demographics of older adults in North America 2. Discuss a comprehensive knowledge base that can help nurses display commitment to providing humane and dignified care. 3. Explain functional and physiologic changes that place older adults at greater risk for declines in health and quality of life. 4. Identify health promotion and health maintenance strategies that can give older adults advantages in maintaining optimal health.

Demographics People 65 years or older: 37.9 million in 2008, increasing as Boomers age 12.8% of the U.S. population & growing Life expectancy has increased for both men and women  R/T decreased death in infants & children Population is older, more minority  Increase in chronic illness, multiple illnesses in older adults

Demography Number of people 65+ in US [in millions]

Considerations with older clients Mental status may be normal or impaired  Perception affects communication, memory, judgment  Always assess sensory perception and LOC Polypharmacy [many drugs] can cause interactions Self-care may be impaired  by physical and mental disease, decreased ROM, fatigue, fear of falling, decreased eyesight Age influences values and culture, health beliefs Use appropriate communication techniques for clients with different problems

Cognition and Communication, Mood, and Self- Care Cognition and communication  Irreversible confusion  Alzheimer’s, Parkinson’s Use validation not reorientation [don’t argue] Assess and meet current needs  Acute confusion  Delirium, medication effect Use reorientation, minimize sensory stimulation Reality orientation  Assess status of sensory aides and promote use

Cognition and Communication, Mood, and Self- Care (Cont’d) Mood  Depression  Often unrecognized; symptoms similar to dementia  Common with chronic illness, isolation, loss of independence  Older, white males have highest suicide rates  Delusional disorder, bipolar disorder, anxiety disorder, and schizophrenia  Not specific to older adults but meds side effects increase confusion, fall risk Self-care  Assess needs and make appropriate referrals

Mobility, Elimination, and Skin Integrity Mobility  Arthritis  Gait and balance disorders  Cataracts  Impairments: hemiparesis, ataxia, spasticity, coordination or balance problems  Assess degree of impairment, impact on ADL’s  Interventions to promote independence, safety

Mobility, Elimination, and Skin Integrity (Cont’d) Elimination  Incontinence [any involuntary urine loss]  Urge overactive bladder muscle– spasms  Stress Weak pelvic floor musculature  Either may increase fall risk [hurrying]  Overflow Distention of bladder  Functional Physical or psychological w/intact system  Interventions depend on type of incontinence

Mobility, Elimination, and Skin Integrity (Cont’d) Skin integrity Older skin is more easily damaged  Injury from falls  Problems with positioning  Incontinence  Pressure ulcers  Assess risk and skin integrity in all older clients

Question true or false: Pressure ulcers are lesions caused by unrelieved pressure that results in damage to underlying tissue.

Answer True. Rationale: Pressure ulcers are lesions caused by unrelieved pressure that results in damage to underlying tissue. Many factors predispose an individual to having pressure ulcers; factors can be physical, functional, and psychosocial.

Nutrition and Health Maintenance Food intake declines with aging Decline in physical activity Protein depletion

Chronic Illness, Infections, and Immunity Chronic illness  Contributes to poor nutrition in many ways  Medications, disease process, fatigue, mobility, $ Careful nutritional assessment and patient- specific interventions  Access Resources, treat dry mouth, assess needs Prompt and aggressive treatment of health disorders  Pain, dental problems, depression, altered taste

Chronic Illness, Infections, and Immunity (Cont’d) Infections and immunity  Humoral immunity declines  Lower antibody response to vaccines, pathogens  Increased risk of pneumonia, flu  New immunizations for older adults  Inadequate nutrition  Decreases immune response  Chronic illnesses  Decrease overall health and immune response

Sleep and Rest Sleep impaired due to the following:  Medications  Restless legs syndrome  Sleep apnea  Pain  Cardiovascular and pulmonary disorders

Question Which of the following conditions can interfere with sleep in older patients? a. Ataxia b. Spasticity c. Restless legs syndrome d. Hemiparesis

Answer c. Restless legs syndrome Rationale: The uncomfortable sensation in legs relieved by moving or rubbing legs is called restless legs syndrome. It affects sleep and rest. Ataxia, hemiparesis, and spasticity impair mobility.

Pain Management Chronic pain  Osteoarthritis  Neuropathic pain  Central or neuropathic pain after stroke  Postherpetic neuralgia  Phantom limb pain Barriers to effective pain management  Misconceptions, fear of addiction  Pain management crucial for quality of life

Loss and Grief, Loneliness, and Coping and Stress Loss and grief  Losses more frequent with aging Grief reactions: Shock, disbelief, anger, or denial of the loss Adaptive coping  Social support, therapy, religion, talking Maladaptive coping  Alcohol or drug use to numb pain Nursing interventions support adaptive coping

Loss and Grief, Loneliness, and Coping and Stress (Cont’d) Loneliness  Loss of important relationships  Spouse, friends, etc.  Sensory losses  Lead to isolation, communication problems  Depression  Increases isolation  Cognitive disorders  Decrease meaningful interactions  Cultural differences and language barriers  Impair communication, increase lonliness

Loss and Grief, Loneliness, and Coping and Stress (Cont’d) Coping and stress Older adults vary in perception and reaction to stressors – assess and treat individually  Emotion-focused  Change the way stress is perceived  Problem-focused  Change the situation

Question true or false: Emotion-focused coping involves attempts to reduce stress by changing the stressful situation.

Answer False. Rationale: Problem-focused coping involves attempts to reduce stress by changing the stressful situation. In emotion-focused coping, the individual attempts to change the way he or she thinks about or appraises a stressful situation rather than changing the situation itself.

Sexuality, Roles and Relationships, and Self- Perception Sexuality  Myth: Sexual desire or activity diminishes with age  Reproductive system loses efficacy  Physiologic changes  Medical conditions

Sexuality, Roles and Relationships, and Self- Perception (Cont’d) Roles and relationships  Multiple roles [caring for aging parents, children, grandchildren] may stress ability  Careful assessment of physical and psychological health  Referral to appropriate healthcare providers  Assistance in accessing agencies that provide help to caregivers

Sexuality, Roles and Relationships, and Self- Perception (Cont’d) Self-perception  The older adult’s multiple evolving roles define his or her self-concept  Incorporates physical functioning, cognition, social relationships, and life experiences

Values, Beliefs, and Spirituality Source of health and healing power  Coping mechanism  Support system Gerotranscendence  Shift from material world to cosmic world with age Approaching dying, end-of-life care