Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Health Care of the Older Adult

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Demographics of Aging The proportion of Americans 65 years of age and older has tripled in the past 100 years Life expectancy varies by gender and race Life expectancy has risen dramatically in the past 100 years

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Leading Causes of Death in Older Adults Heart diseases Malignant neoplasms Cerebrovascular diseases Chronic obstructive pulmonary diseases, allied conditions Alzheimer’s disease Diabetes

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Leading Causes of Death in Older Adults (cont’d) Pneumonia, influenza Nephritis, nephrotic syndrome, nephrosis Accidents (unintentional injuries) Septicemia

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Preventive Health Care Encouragement Community-based support services Promote lifelong health behaviors

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Cardiovascular Changes Decreased cardiac output Diminished ability to respond to stress Heart rate, stroke volume do not increase with maximum demand Slower heart recovery rate Increased blood pressure

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Respiratory System Increase in residual lung volume Decrease in muscle strength, endurance, vital capacity Decreased gas exchange, diffusing capacity Decreased cough efficiency

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Integumentary System Decreased subcutaneous fat, interstitial fluid, muscle tone, glandular activity, sensory receptors resulting in decreased protection against trauma, sun exposure, temperature extremes Diminished secretion of natural oils, perspiration Capillary fragility

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Reproductive System Female: vaginal narrowing, decreased elasticity; decreased vaginal secretions Male: less firm testes, decreased sperm production Male and female: slower sexual response

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Musculoskeletal System Loss of bone density Loss of muscle strength, size Degenerated joint cartilage

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Genitourinary System Male: benign prostatic hyperplasia Female: relaxed perineal muscles, detrusor instability (urge incontinence), urethral dysfunction (stress urinary incontinence)

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Gastrointestinal System Decreased sense of thirst, smell, taste Decreased salivation Difficulty swallowing food Delayed esophageal, gastric emptying Reduced gastrointestinal motility

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nervous System Reduced speed in nerve conduction Increased confusion with physical illness, loss of environmental cues Reduced cerebral circulation (becomes faint, loses balance)

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Special Senses Vision: diminished ability to focus on close objects; inability to tolerate glare, difficulty adjusting to changes of light intensity, decreased ability to distinguish colors Hearing: decreased ability to hear high-frequency sounds; tympanic membrane thinning, loss of resiliency Taste and smell: decreased ability to taste, smell

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? The leading cause of injury and preventable source of mortality and morbidity in older adults is falls.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Rationale: The leading cause of injury and preventable source of mortality and morbidity in older adults is falls.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Hearing and Vision Changes Presbycusis: decreased ability to hear high-pitched tones that naturally begins in midlife as result of irreversible inner ear changes Presbyopia: decrease in visual accommodation that occurs with advancing age

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question What is an age-related change in the body system of the older adult? A.Decreased blood pressure B.Decreased cardiac output C.Increase bone density D.Increased salivation

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B.Decreased cardiac output Rationale: Age-related changes in body systems include increased blood pressure, loss of bone density, and decreased salivation.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Mental Health Problems in the Older Adult Depression: most common affective disorder results from changes in reuptake of neurochemical serotonin, emotional stresses related to physical, social changes associated with aging process Delirium: acute, confused state that begins with disorientation –If not immediately evaluated and treated, can progress to changes in level of consciousness, irreversible brain damage, and sometimes death

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Dementia Broad term for syndrome characterized by general decline in higher brain functioning (reasoning) with pattern of eventual decline in ability to perform even basic activities of daily living (toileting, eating) –Alzheimer’s disease –Vascular dementia

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? The most common affective or mood disorder of old age is Alzheimer’s disease.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Rationale: The most common affective or mood disorder of old age is depression.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Care of the Older Adult Geriatrics: focuses on physiology, pathology, diagnosis, management of disorders, and diseases of older adults Gerontological/geriatric nursing: nursing process applied to older adults in all environments, including acute, intermediate, skilled care, and in the community Gerontology: combined biologic, psychological, sociologic study of older adults within their environment

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Management Supporting cognitive function Promoting physical safety Promoting independence in self-care activities Reducing anxiety, agitation Improving communication

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Management (cont’d) Providing for socialization, intimacy needs Promoting adequate nutrition Promoting balanced activity, rest Supporting home- and community-based care

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Pharmacologic Aspects Polypharmacy: administration of multiple medications at same time; common in older persons with several chronic illnesses Aging changes alter drug: –Absorption –Metabolism –Distribution –Excretion

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Implications Need adjustment of dosage due to age; “start low, go slow” Assess knowledge of medications and use Review need for medication, coordination of prescriber –Factors that affect compliance –Keep medication regimen as simple as possible –Strategies to improve compliance

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Geriatric Syndromes Impaired mobility Dizziness Falls, falling Urinary incontinence Susceptibility to infection Altered pain, febrile responses Altered emotional impact Altered systemic response

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Potential Economic Effects Social services Health care costs of aging Home health care Hospice services Aging with a disability