Post on 13-Dec-2015
Chapter 18
The Older Client
Fundamentals of Nursing: Standards & Practices, 2E
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.
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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).
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Theories of Aging
Biological theories• Stress theory• Cross-linkage theory• Somatic mutation theory
Psychosocial theories• Disengagement theory• Continuity theory• Activity theory
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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.
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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.
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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.
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Changes Associated with Aging
Developmental changesPhysiological changes
• Neurological• Sensory and perceptual• Cardiovascular• Respiratory• Gastrointestinal• Genitourinary
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• Endocrine• Reproductive• Musculoskeletal• Integumentary• Alterations in mental status
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Psychosocial changes• Retirement• Social relationships and roles• Living arrangements• Coping with loss
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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).
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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.
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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.
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• 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
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Mistreatment of the Elderly
There are many forms of elder abuse• Physical abuse• Neglect• Psychological abuse• Exploitation
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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.
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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.
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• 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.
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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.
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Diagnoses frequently seen in the older adult• Impaired physical mobility• Activity intolerance• Self-care deficits• Social isolation• Risk for loneliness
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• Altered role performance• Impaired home maintenance
management• Acute confusion
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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.
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Implementation• Nursing interventions should focus on
Maintaining physical health Supporting psychosocial well-being Promoting safety
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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.
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• 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.