1. 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

2. Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858
Session 2
Topics:
Functional Assessment of Older Adults
Sleep/Rest in Older Adults
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3. Topic 1: Functional Assessment of Older Adults
Functional Assessment….What is it?
A comprehensive evaluation of physical and cognitive abilities required to maintain independence.
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4. What tools can we use to help?
Objective Assessment Tools
Can be well known, or something your agency has created
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5. Activities of Daily Living (ADLs)
Use of Katz Activities of Daily Living Tool
Bathing
Dressing
Toileting
Transferring
Continence
Feeding
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6. 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
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7. 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
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8. 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
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9. 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
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10. Psychological Function
Need to measure cognitive mental and affective functions independently
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11. 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
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12. What happens to function over time?
Chronic conditions increase with age
Arthritis
Hypertension
Heart disease
Hearing impairment
Orthopedic impairment
Cataracts
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13. 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
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14. 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
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How prepared are we?
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16. Topic 2: Sleep/Rest for Older Adults
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17. 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
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18. 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)
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19. 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.
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20. 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.
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21. 4 Categories of Sleep Disturbances
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22. 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
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23. 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
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24. 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,
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25. 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
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26. Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858
Category 3
Disorders associated with medical or psychiatric disorders
Examples:
Anxiety,
Depression
Medical problems
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27. 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
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28. 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)
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29. Other Causes of Sleep Disturbances
Onset of acute illness
Progression of chronic illness
Pain
Nocturia
Dementia
Alcoholism
Depression
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30. Supported by DHHS/HRSA/BHPr/Division of Nursing Grant #D63HP06858
How do I assess sleep?
4 Areas to Assess
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31. #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
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32. #2: Obtain a medical history
Various medical conditions can contribute to sleep disturbances
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33. 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

34. #4: Get a Psychosocial history
Begin with psychiatric illness
(anxiety, depression, dementia)
Follow with social history
(grieving, illness, loss, translocation)
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35. Nursing Interventions
Pharmacologic
Nonpharmacologic
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36. 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

37. 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

38. 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

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

41. 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

42. 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

43. 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