2. Nursing Care of Older Adults Janet Duffey, RN, MS, APRN, BC

3. Aging Populations  Demographics  Population trends: Aging baby boomers  Health care system projections  Distinguishing characteristics

4. Aging & Ageism  Youth culture  Stereotypes of elderly  Minimization of functionality  Focus of some theories on aging  Verbal statements  Non-verbal

5. Why do we age? Biological theories on aging  Cross linking  Free radicals  Neuroendocrine  Autoimmune reactions

6. Psychosocial Theories  Disengagement  Activity  Continuity  Age stratification

7. Implications of Aging Theories  Past experiences in life  Health beliefs & values  Adjustment to limitations  Indications for wellness  Changes view of aging equates to illness

8. Cultural Interpretation of Aging  Physical traits  Functional  Symbolic  Numeric age  Status  Role of aged individuals  Meaning of aging  Expectations of aging experience

9. Aging  Personal philosophy  Societal view  Caregiving systems  Impact of ageism, on clients, individuals & nursing

10. Factors influencing health and aging: Positive or Negative  Culture  Ethnicity  Stress management - resiliency  Coping abilities

11. Contributors to Health Alterations  Excessive stress  Underlying disease(s)  Nutritional deficits  Drug induced effects  Falls and trauma

12. Health Promotion  "... A multidimensional pattern of self-initiated actions and perceptions that serve to maintain or enhance the level of wellness." Pender

13. Health Promotion Activities  Health assessment  Support esteem in appearance  Physical activity  Retirement (pro and con)  Part-time employment or volunteer  Social activity  Social support  Support sexuality

14. Nursing in Geriatric Settings  Uses the nursing process in ongoing manner, not just one time  Contributes to the treatment team  Data systematically collected, ongoing  Nursing diagnoses derived from assessment  NCP developed with patient and significant other and problems prioritized

15. Health Promotion Activities  Enc. and facilitate participation in plan  Give choices: food, grooming, activities  Facilitate care in least restrictive setting  Explore opportunities in community  Anticipate changes in mental and physical health

16. Legal Issues Associated With Aging  Consent for treatment  Establishing competence  Use of restraints  Injuries  Consent for participation in research  Maintenance of patient rights  Advanced directives  Do not resuscitate orders

17. Elder Abuse  “Elder maltreatment" refers to the seven types of abuse and neglect are physical abuse, sexual abuse, emotional or psychological abuse, financial or material exploitation, abandonment, neglect, and self-neglect.  At risk: female, frail, 80+, dependent on child or spouse  Mandatory reporting yielded 18% of all reports, families

18. Alterations in Sensory Function

19. Vision Changes  Accommodation  Narrowed visual field decreased at periphery  Opacity of lens  Steropsis  Altered color perception  Light sensitivity  Macular degeneration

20. Assessing Vision  History  Near focus  Distance vision  Peripheral testing  General assessment of function / ADLs and IADL’s

21. Cataracts  Interim lenses  Anticipate post-op course  Intraocular-lens implants  Precautions  Avoidance of increased intraoccular pressure  Antibiotic / anti-inflammatory eye drops

22. Alteration in Hearing  Functional, emotional, social impact  Affects 28-55% older adults  Presbycusis: bilateral, gradual decline  Sensoryneural type of impairment  Volume and high frequency consonants

23. Assessment of Hearing  Onset  Watch test  Speech discrimination: fair, sun, skies, shout, fun, sun  Conversational responses  Secondary complaints: tinnitus, pain, conversational difficulties

24. Interventions for Hearing Impairment  Determine presence of hearing difficulty  Encourage acceptance and USE of hearing devices  Analog aids  Digital programmed aids  Radio / television devices  Telephones  Maintenance

25. Hearing Aid Batteries

26. Verbal Communication  Slightly slower rate  Increase volume with moderation  Get patient's attention before speaking  Shorter sentences  Lower voice pitch  Remove distractions  Provide information visually  Non-verbal communication  Identify denial/embarrassment

27. Touch & Older Adults  Increased need  Assessment by functional measures  Sharp / dull response  Protective measures  Emotional responses

28.  Atrophy of papillae  Preference of high sugar & salty foods  Cost  Ability to chew food  Poor oral hygiene  Medications Alteration in Taste & Smell

29. Altered Olfactory Function  Smell impacted by lifestyle  Sinus infections  Related to head injury, CVA, tumors  Affects ability to enjoy food, environment  Monitoring function essential for safety