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Fundamentals of Nursing: Human Health and Function. Chapter 9: Caring for the Older Adult. Learning Objectives. 1 . Describe the demographics of older adults in North America

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fundamentals of nursing human health and function

Fundamentals of Nursing: Human Health and Function

Chapter 9: Caring for the Older Adult

learning objectives
Learning Objectives

1. Describe the demographics of older adults in North America

2. Discuss a comprehensive knowledge base that can help nurses display commitment to providing humane and dignified care.

3. Explain functional and physiologic changes that place older adults at greater risk for declines in health and quality of life.

4. Identify health promotion and health maintenance strategies that can give older adults advantages in maintaining optimal health.

demographics
Demographics
  • People 65 years or older: 37.9 million in 2008, increasing as Boomers age
  • 12.8% of the U.S. population & growing
  • Life expectancy has increased for both men and women
    • R/T decreased death in infants & children
  • Population is older, more minority
    • Increase in chronic illness, multiple illnesses in older adults
demography
Demography

Number of people 65+ in US

[in millions]

considerations with older clients
Considerations with older clients
  • Mental status may be normal or impaired
    • Perception affects communication, memory, judgment
      • Always assess sensory perception and LOC
  • Polypharmacy [many drugs] can cause interactions
  • Self-care may be impaired
    • by physical and mental disease, decreased ROM, fatigue, fear of falling, decreased eyesight
  • Age influences values and culture, health beliefs
  • Use appropriate communication techniques for clients with different problems
cognition and communication mood and self care
Cognition and Communication, Mood, and Self-Care

Cognition and communication

Irreversible confusion

Alzheimer’s, Parkinson’s

Use validation not reorientation [don’t argue]

Assess and meet current needs

Acute confusion

Delirium, medication effect

Use reorientation, minimize sensory stimulation

Reality orientation

Assess status of sensory aides and promote use

cognition and communication mood and self care cont d
Cognition and Communication, Mood, and Self-Care (Cont’d)
  • Mood
    • Depression
      • Often unrecognized; symptoms similar to dementia
      • Common with chronic illness, isolation, loss of independence
      • Older, white males have highest suicide rates
    • Delusional disorder, bipolar disorder, anxiety disorder, and schizophrenia
      • Not specific to older adults but meds side effects increase confusion, fall risk
  • Self-care
    • Assess needs and make appropriate referrals
mobility elimination and skin integrity
Mobility, Elimination, and Skin Integrity

Mobility

Arthritis

Gait and balance disorders

Cataracts

Impairments: hemiparesis, ataxia, spasticity, coordination or balance problems

Assess degree of impairment, impact on ADL’s

Interventions to promote independence, safety

mobility elimination and skin integrity cont d
Mobility, Elimination, and Skin Integrity (Cont’d)
  • Elimination
    • Incontinence [any involuntary urine loss]
      • Urge
        • overactive bladder muscle– spasms
      • Stress
        • Weak pelvic floor musculature
    • Either may increase fall risk [hurrying]
      • Overflow
        • Distention of bladder
      • Functional
        • Physical or psychological w/intact system
    • Interventions depend on type of incontinence
mobility elimination and skin integrity cont d1
Mobility, Elimination, and Skin Integrity (Cont’d)
  • Skin integrity
  • Older skin is more easily damaged
    • Injury from falls
    • Problems with positioning
    • Incontinence
    • Pressure ulcers
    • Assess risk and skin integrity in all older clients
question
Question

true or false:

Pressure ulcers are lesions caused by unrelieved pressure that results in damage to underlying tissue.

answer
Answer

True.

Rationale: Pressure ulcers are lesions caused by unrelieved pressure that results in damage to underlying tissue. Many factors predispose an individual to having pressure ulcers; factors can be physical, functional, and psychosocial.

nutrition and health maintenance
Nutrition and Health Maintenance

Food intake declines with aging

Decline in physical activity

Protein depletion

chronic illness infections and immunity
Chronic Illness, Infections, and Immunity

Chronic illness

Contributes to poor nutrition in many ways

Medications, disease process, fatigue, mobility, $

Careful nutritional assessment and patient-specific interventions

Access Resources, treat dry mouth, assess needs

Prompt and aggressive treatment of health disorders

Pain, dental problems, depression, altered taste

chronic illness infections and immunity cont d
Chronic Illness, Infections, and Immunity (Cont’d)
  • Infections and immunity
    • Humoral immunity declines
      • Lower antibody response to vaccines, pathogens
      • Increased risk of pneumonia, flu
      • New immunizations for older adults
    • Inadequate nutrition
      • Decreases immune response
    • Chronic illnesses
      • Decrease overall health and immune response
sleep and rest
Sleep and Rest

Sleep impaired due to the following:

Medications

Restless legs syndrome

Sleep apnea

Pain

Cardiovascular and pulmonary disorders

question1
Question

Which of the following conditions can interfere with sleep in older patients?

a. Ataxia

b. Spasticity

c. Restless legs syndrome

d. Hemiparesis

answer1
Answer

c. Restless legs syndrome

Rationale: The uncomfortable sensation in legs relieved by moving or rubbing legs is called restless legs syndrome. It affects sleep and rest. Ataxia, hemiparesis, and spasticity impair mobility.

pain management
Pain Management

Chronic pain

Osteoarthritis

Neuropathic pain

Central or neuropathic pain after stroke

Postherpetic neuralgia

Phantom limb pain

Barriers to effective pain management

Misconceptions, fear of addiction

Pain management crucial for quality of life

loss and grief loneliness and coping and stress
Loss and Grief, Loneliness, and Coping and Stress

Loss and grief

Losses more frequent with aging

Grief reactions: Shock, disbelief, anger, or denial of the loss

Adaptive coping

Social support, therapy, religion, talking

Maladaptive coping

Alcohol or drug use to numb pain

Nursing interventions support adaptive coping

loss and grief loneliness and coping and stress cont d
Loss and Grief, Loneliness, and Coping and Stress (Cont’d)
  • Loneliness
    • Loss of important relationships
      • Spouse, friends, etc.
    • Sensory losses
      • Lead to isolation, communication problems
    • Depression
      • Increases isolation
    • Cognitive disorders
      • Decrease meaningful interactions
    • Cultural differences and language barriers
      • Impair communication, increase lonliness
loss and grief loneliness and coping and stress cont d1
Loss and Grief, Loneliness, and Coping and Stress (Cont’d)
  • Coping and stress
  • Older adults vary in perception and reaction to stressors – assess and treat individually
    • Emotion-focused
      • Change the way stress is perceived
    • Problem-focused
      • Change the situation
question2
Question

true or false:

Emotion-focused coping involves attempts to reduce stress by changing the stressful situation.

answer2
Answer

False.

Rationale: Problem-focused coping involves attempts to reduce stress by changing the stressful situation. In emotion-focused coping, the individual attempts to change the way he or she thinks about or appraises a stressful situation rather than changing the situation itself.

sexuality roles and relationships and self perception
Sexuality, Roles and Relationships, and Self-Perception

Sexuality

Myth: Sexual desire or activity diminishes with age

Reproductive system loses efficacy

Physiologic changes

Medical conditions

sexuality roles and relationships and self perception cont d
Sexuality, Roles and Relationships, and Self-Perception (Cont’d)
  • Roles and relationships
    • Multiple roles [caring for aging parents, children, grandchildren] may stress ability
    • Careful assessment of physical and psychological health
    • Referral to appropriate healthcare providers
    • Assistance in accessing agencies that provide help to caregivers
sexuality roles and relationships and self perception cont d1
Sexuality, Roles and Relationships, and Self-Perception (Cont’d)
  • Self-perception
    • The older adult’s multiple evolving roles define his or her self-concept
    • Incorporates physical functioning, cognition, social relationships, and life experiences
values beliefs and spirituality
Values, Beliefs, and Spirituality

Source of health and healing power

Coping mechanism

Support system

Gerotranscendence

Shift from material world to cosmic world with age

Approaching dying, end-of-life care