1. Preventing Functional Decline through SPICES Mary Spear, RN-BC, MSN, GNP Geriatric Clinical Nurse Specialist

2. John Muir Health – proprietary and confidential 2 Objectives  Define components of SPICES  Identify Geriatric Syndromes associated with SPICES  Identify three (3) interventions to prevent functional decline

3. John Muir Health – proprietary and confidential 3 Functional Decline Prevention  Functional ability = indicator of health  Goal: Goal of interventions is to enable elders to function at highest level despite the presence of age related changes, risk factors, and disease (Miller, C. 2012)

4. John Muir Health – proprietary and confidential 4 Think: FUNCTION Think: MAXIMIZE FUNCTION Gawande, A. (April 30, 2007). The Way We Age Now. The New Yorker Annals of Medicine http://www.newyorker.com/magazine/2007/04/30/the-way- we-age-now

5. John Muir Health – proprietary and confidential 5 Educational Resources  Hartford Institute for Geriatric Nursing Hartfordign.org/practice/try_this/  NICHE – Nurses Improving Care of HS Elders www.nicheprogram.org Local universities – UC Berkeley, UCSF, Stanford Professional Organizations

6. John Muir Health – proprietary and confidential 6 Care of the Geriatric Patient  Complexity of care  Geriatric Syndromes  Syndrome is a group of signs and/or symptoms that occur together & characterize a particular abnormality  Underlying all of these issues is the presence of multiple problems and causes rather than only one or two

7. John Muir Health – proprietary and confidential 7 SPICES  SSkin Breakdown  PProblems with eating or feeding  IIncontinence  CConfusion  EEvidence of Falls  SSleep Disorder (Hartford Institute of Geriatric Nursing, 2012)

8. John Muir Health – proprietary and confidential 8 AGE-RELATED CHANGES  SKIN – epidermis changes (thins, loss of strength and elasticity), decreased sweat glands, decreased blood flow to skin, loss of subcutaneous fat  PROBLEMS with Eating/Feeding – decreased taste buds, thirst perception, muscle strength for chewing, saliva, teeth, gag reflex, GI acid, stomach emptying, absorption in small intestine, decreased sense of smell  INCONTINENCE – reduced bladder elasticity, muscle tone, capacity, increased postvoid residual, nocturnal urine production, BPH in males, prolapse in females

9. John Muir Health – proprietary and confidential 9 AGE-RELATED CHANGES  Confusion/Cognitive Decline – decrease in neurons, weight of brain, decline in ability to learn complex information, delayed response time, minor loss of recent memory, decline in ability to do complex tasks requiring multiple steps Pathological conditions of cognitive impairment seen with the older adult are: Depression Delirium Dementia

10. John Muir Health – proprietary and confidential 10 AGE-RELATED CHANGES  EVIDENCE OF FALLS – decline in muscle mass and strength, decline in size, number, quality of skeletal muscle fibers, bone loss, decreased cartilage in joints, reduced joint stability, intervetebral disc degeneration  SLEEP – normal changes in circadian patterns (sleep-wake) result in nocturnal awakenings, with increase in transient arousals, increase in time until sleep onset, decreased periods of REM sleep (restorative sleep) (Brown, J., Bedford, N, White, S. 1999)

11. John Muir Health – proprietary and confidential 11 Age Related Sensory Changes  Vision Presbyopia Cataracts Glaucoma Macular Degeneration  Hearing Presbycusis

12. John Muir Health – proprietary and confidential 12 Age Related Sensory Changes  Taste 4 basic tastes: Sweet, Salty, Sour, Bitter Loss of taste buds  Smell Decrease in number of sensory cells in nasal lining  Touch Decreased sensation; safety issues

13. John Muir Health – proprietary and confidential 13 Case Study  Pt. is a 75 y.o. female admitted after found on floor in home. She has had numerous falls, is unable to care for self, though refuses to leave her home. MM is a widow, husband died 4 yrs. Ago. She has no children nor relatives in the area. MM has a large dog at home and states, “I like animals more than I like people.”  Issues – SPICES

14. John Muir Health – proprietary and confidential 14 References  Brown, J., Bedford, N., White, S. (1999). Gerontological Protocol for Nurse Practitioners. Lippincott Williams & Wilkins  Miller, C. (2012). Nursing for Wellness in Older Adults, 6 th Ed. Philadelphia, PA. Wolters Kluwer Health/Lippincott Williams & Wilkins