1. Chapter 18 The Older Client Fundamentals of Nursing: Standards & Practices, 2E

2.  Copyright 2002 by Delmar, a division of Thomson Learning 18-2 Defining Old Age  Chronological age is the exact age of a person from birth.  Chronological age does not dictate the state of health, attitude toward daily life, or beliefs about living.  Young old is ages 65 to 75; middle old is ages 75 to 85; old is 85 years and older.

3.  Copyright 2002 by Delmar, a division of Thomson Learning 18-3  The U.S. population is rapidly aging.  Adults over the age of 65 are the fastest growing segment of the population, they are projected to make up 16% of the total population by the year 2020 (U.S. Bureau of the Census, 1999).

4.  Copyright 2002 by Delmar, a division of Thomson Learning 18-4 Theories of Aging  Biological theories Stress theory Cross-linkage theory Somatic mutation theory  Psychosocial theories Disengagement theory Continuity theory Activity theory

5.  Copyright 2002 by Delmar, a division of Thomson Learning 18-5 Myths and Stereotypes of Aging  In many cultures, older people are accorded a position of respect.  In American culture, older adults are often stereotyped as being ill, bald, hard of hearing, forgetful, and/or boring.  Ageism is the process of stereotyping and discriminating against people because they are old.

6.  Copyright 2002 by Delmar, a division of Thomson Learning 18-6  To many people, aging is synonymous with death.  Younger individuals can have a negative view of the aging process.  Many older adults have negative stereotypes about other older adults.  Nurses need to be aware of the myths and stereotypes and to separate them from the realities of the aging process.

7.  Copyright 2002 by Delmar, a division of Thomson Learning 18-7 Quality of Life Among Older Adults  One of the greatest fears associated with advancing age is poor health.  The trend is for people to live longer and healthier lives.  Although many people over 65 have some kind of chronic health problem, most have found ways to keep these ailments from lowering their enjoyment of life.

8.  Copyright 2002 by Delmar, a division of Thomson Learning 18-8 Changes Associated with Aging  Developmental changes  Physiological changes Neurological Sensory and perceptual Cardiovascular Respiratory Gastrointestinal Genitourinary

9.  Copyright 2002 by Delmar, a division of Thomson Learning 18-9 Endocrine Reproductive Musculoskeletal Integumentary Alterations in mental status

10.  Copyright 2002 by Delmar, a division of Thomson Learning 18-10  Psychosocial changes Retirement Social relationships and roles Living arrangements Coping with loss

11.  Copyright 2002 by Delmar, a division of Thomson Learning 18-11 Medications and the Older Adult  Adverse drug reaction Normal effects of aging alter how the body metabolizes and excretes drugs. Older adults are more sensitive to both the toxic and therapeutic effects of drugs. Older adults are at greater risk for adverse drug reactions due to the concurrent use of several medications (polypharmacy).

12.  Copyright 2002 by Delmar, a division of Thomson Learning 18-12  The older client’s response to drugs is highly individualized.  The nurse must accurately monitor the client for therapeutic effectiveness and signs of adverse drug reactions.

13.  Copyright 2002 by Delmar, a division of Thomson Learning 18-13  Compliance The nurse must assess the client’s knowledge of medications being used. Knowledge about the medication, its intended effects, possible side effects, and how to reduce the side effects can increase the client’s compliance with the medication regimen.

14.  Copyright 2002 by Delmar, a division of Thomson Learning 18-14 Factors that affect compliance include  Complicated dosing schedules  Multiple dosing throughout the day  Polypharmacy  Cost of drugs  Limited mobility  Impaired memory  Clients who need assistance

15.  Copyright 2002 by Delmar, a division of Thomson Learning 18-15 Mistreatment of the Elderly  There are many forms of elder abuse Physical abuse Neglect Psychological abuse Exploitation

16.  Copyright 2002 by Delmar, a division of Thomson Learning 18-16  When assessing for mistreatment, the nurse must be nonjudgmental and avoid any signs of disapproval that may evoke further feelings of anger and shame.  A private setting should be used for interviewing to promote sharing.  If the victim thinks the perpetrator is able to hear the interview, the victim may withhold information.

17.  Copyright 2002 by Delmar, a division of Thomson Learning 18-17 Nursing Process and the Older Client  Assessment The nurse draws facts and interpretations from the older client that will shed light on current health status and health concerns. Eliciting data requires time and patience on the part of both the nurse and client. The nurse may interview the client and the client’s support members.

18.  Copyright 2002 by Delmar, a division of Thomson Learning 18-18 The nurse must be knowledgeable about the normal physical changes of aging in order to conduct a physical examination of the older client. The client may need assistance with disrobing or position changes. The nurse must be alert to the potential for injury of the older client.

19.  Copyright 2002 by Delmar, a division of Thomson Learning 18-19  Diagnosis Nursing diagnoses of the older client will be as varied as the clients themselves. Client status may change frequently, so reevaluation of nursing diagnoses on a regular basis is warranted.

20.  Copyright 2002 by Delmar, a division of Thomson Learning 18-20  Diagnoses frequently seen in the older adult Impaired physical mobility Activity intolerance Self-care deficits Social isolation Risk for loneliness

21.  Copyright 2002 by Delmar, a division of Thomson Learning 18-21 Altered role performance Impaired home maintenance management Acute confusion

22.  Copyright 2002 by Delmar, a division of Thomson Learning 18-22  Outcome identification and planning Outcomes must be developed in partnership with the older client and the client’s support system. Outcomes should be targeted to maintaining a certain level of health or restoring the client to a former state of health.

23.  Copyright 2002 by Delmar, a division of Thomson Learning 18-23  Implementation Nursing interventions should focus on  Maintaining physical health  Supporting psychosocial well-being  Promoting safety

24.  Copyright 2002 by Delmar, a division of Thomson Learning 18-24  Evaluation The nurse must decide whether the original assessment is still pertinent and if its accompanying diagnoses have been resolved. New diagnoses need to be established on the basis of client progress and changing needs.

25.  Copyright 2002 by Delmar, a division of Thomson Learning 18-25 The nurse should consider the ongoing needs of the client and offer resources or make referrals to ensure that the health and well-being of the client will continue to be monitored and enhanced.