Geriatric Nursing Nursing Elective Course

Termsgeriatrics- study of old age including physiology, pathology, dx., & treatment of diseases of old adults

gerontology- broader, the study of the aging process including biological, psychological, & sociological

gerontologic or gerontic nursing- specializes in care of the elderly

Agingnormal process of time related change

starting with birth & continuing throughout life

way person ages influenced by  ◦genetics◦lifestyle◦availability & quality of health care◦socioeconomics

old age- final phase of lifepredict by 2030- 69.4 Million (8 Mil. over 85)23% over 65 while only 18% under 18ageism- prejudice against distinct group

define by age boundaries

TermsOld Agedefinition varies with frame of reference

society indicates age 65 as beginning of old age

 ◦young-old- 65-74 ◦middle-old- 75-84◦old-old- 85 & up

Termslife span- maximum number of years

person can live under the best of conditions in absence of disease

 life expectancy- average number of years a person can be expected to live

2007: 77.7 yearsover 80% have @ least 1 chronic illness,

50% have 234 Million older- 4.4 Million (14.5%)

difficulty with @ least 1 ADL (eating, bathing, dressing, transferring, toileting)

about 1 of 8fastest growing age group- over 75

Myths vs Reality

1. families do not care for elder- 80% do take care

2. elderly- alone & deserted 67% live in family setting 66%- child within 30 minutes  62%- weekly visits 76%- talk weekly

3. sickness & aging synonymous almost 50% rate health as good or excellent

28% 65+ assessed poor health

Myths vs Reality

4. incapable of learning- although slowed due to reflexes, capable of learning new things

5. no longer interested in sexuality/ sexual act sexuality (lifelong need) can provide intimacy & love without sexual relations

6. constipation/ incontinence- expected never normal constipation due to inactivity or diet incontinence- seek medical help

Myths vs Reality

7. senility- expected result of age senility (dementia found in elderly) dementia- result of disease- not aging

8. elderly financially impoverished median net worth- $86,300 poverty rate- 12.9% median income- $28,983

9. spend last years in nursing home about 5% in nursing home  % increases with age (+1%- 65-74, +4%- 75-84, 20%- 85+)

Health Promotion & Maintenance

1. personal hygiene◦bath 2-3/ week◦ lotion prn◦shampoo 1-2/ week◦keep nails short◦dental supervision◦try to make dressing easier (loose clothing,

zippers, velcro)

2. exercise◦ individual planned◦consider- general health, ?chronic illness,

personal preference, environment, finances

3. nutrition◦balanced◦decrease CHO, caffeine, fat, & Na

Normal Aging Changes

Normal Aging Changes

Integumentary◦ skin thinner◦ less subcutaneous tissue◦ wrinkles◦ gray hair◦ skin drier & more susceptible to irritation◦ change in pigmentation (age or liver spots)◦ nails- thick & brittle◦ less efficient cooling system◦ less tolerance to temperatures◦ Recommend

avoid sun avoid heat dress warmly in winter bathe 1-2 weekly oil or lotion prn

Normal Aging Changes

Nervous◦slowed reactions◦altered sleep cycle◦short term memory loss◦impaired senses◦Recommendat risk for accidentsassist ADL prnwatch for possibility of burns prn

Normal Aging ChangesSensory

◦vision presbyopia reading glasses problem with blue vs green difficulty adjusting to dark-light changes (night blindness)

Recommend◦adequate lighting◦avoid glare◦vision aids◦large print◦contrasting colors

Normal Aging Changes Sensory◦hearing

presbycusis problem with some consonants cerumen accumulation Recommend

◦ low tone speaking voice◦ reduce background noise◦ face person◦enunciate clearly◦moderate pace◦gestures prn

◦touch sense of touch dulled pain threshold higher

◦taste dull salt & sweet (want more sweets) prefer salty & highly seasoned foods

◦smell- diminishes

Normal Aging ChangesRespiratory

◦decreased gas exchange & cough efficiency◦decreased activity tolerance◦more vulnerable to infection◦Recommend

exercise no smoking not in smoking areas force fluids flu vaccine avoid exposure to infection

Normal Aging ChangesReproductive

◦decreased hormone production◦menopause in female◦decreased vaginal secretions◦penis & testes decrease in size◦sperm production slowed◦Recommend

sexual desires & activity decline but not disappear

water-soluble lubricant sexual counselor prn

Normal Aging ChangesMusculoskeletal

◦osteoporosis◦pathologic fractures◦muscles lose strength, flexibility, & endurance

◦height loss◦changes in posture◦Recommend

high Ca, low Ph exercise handle gently reduce environmental hazards extra time to perform activities prevent deformities

Normal Aging ChangesCardiovascular

◦heart disease leading cause of death◦heart valves-thicker & stiffer◦arteries lose elasticity & accumulate deposits◦decreased response to stress◦B/P increases◦cardiac output decreases◦Recommend

exercise no smoking weight control low fat diet relieve stress check B/P

Normal Aging ChangesGI

◦decreased motility◦decreased teeth◦ill fitting dentures◦decreased saliva◦constipation

lack of bulk prolonged use of laxatives ignore urge to defecate drug side effects emotional problems inactivity insufficient fluid excess dietary fat

Normal Aging ChangesGIRecommend◦regular dental & oral care◦small frequent meals◦sit up after meals◦no heavy activity after meals

◦antacids with supervision◦limit laxatives

Normal Aging ChangesUrinary

◦decreased nephron activity◦lose of muscle tone results in more frequent voiding

◦retention, frequency, urgency, & incontinence common

◦Recommend ready access to toilet, void regularly pelvic floor exercises avoid bladder irritants (caffeine, ETOH, sweeteners)

Normal Aging Changes

Endocrine◦change in hormones◦decreased basal metabolic rate (BMR)

Immune◦decreased function◦more susceptible to infection & disease

◦atypical S&S of infection

Mental Health Disorders1. depression

a. most common affective, mood, or functional disorder

b. can be reaction to loss of independence, status or spouse

c. some medicationsd. physical illness & changese. nursing

encourage self expression & esteem improve appearance provide structure & routine assist to maintain or regain control kind & understanding attitude safety, security realize potential for suicide

◦about 25% occur in over 65◦white males over 75 highest rate

Mental Health Disorders

2. aggressive behaviora. abnormal anger, rage, or hostility

b. result of anxiety, stress, guilt, insecurity, forced dependence

c. nursingexpress feelingsset limits

3. other- regression, paranoid behavior

Mental Health Disorders

4. rehabilitation for mental problemsa. reality orientationb. remotivationc. reminiscenced. cognitive training

e. relaxation therapy

Role Changes1. crisis- sudden, not able to plan for appropriate

replacement, substitute not readily available, stress producing

2. gradual- develop slowly & allow time for preparation

3. changes generally crisis-forced retirement, loss of spouse, illness, friends move away or die, family relocate or assume new roles decreasing time for relationship

4. role losses- work (no longer bread winner), family (no longer decision maker, loss of esteem or independence)

5. role gains- new friends, activities, or interests, purpose & opportunity, rest & relaxation

Alterations in Life-style

1. employment◦increase in number of older females working

◦decrease in number older males working◦part-time employment more common◦early retirement◦involuntary limitations (health, sensory or perceptual alterations, decline in strength, endurance, & speed)

◦strengths (reliability, dependability, knowledge, expertise, experience)

Alterations in Life-style

2. retirement◦mandatory age raised to 70◦health problems major cause of voluntary retirement

◦increased leisure time◦stressful when decreased ability to handle stress

◦tremendous anxiety◦loss of daily routine & income

Alterations in Life-style

economic◦fixed incomes frequently below nation's poverty levels (1 of 10)

◦costs increase◦buying power decrease◦many not receiving full benefits due to lack of knowledge or inability to find out resources lack of mobility health problems

◦penalties of losing social security benefits if employed

Alterations in Life-style

health◦40% more than one chronic disease

increase in health care needs & costs

Alterations in Life-style

housing◦prefer to remain independent◦live with spouse, alone, or with family◦own home◦alternatives (mobile homes, retirement communities, foster homes, life care facilities, nursing homes, homes for the aged, convalescent homes, rest homes, house sharing, public housing, rooming houses, hotels for single room occupancy)

◦require special assistance (transportation, meals, health hotlines, house cleaners, homemaker services, social services, home care services)

Alterations in Life-style

recreation◦more time available◦problems (cost, health, decreased energy, lack of incentive, sensory losses, lack of environmental aids, lack of conveniently located facilities)

◦most depend on family◦alternatives (religious, community activities, day care, senior citizen centers, adult education, cultural events)

Intelligence

test scores decline but due to slowed responses not actual ability

learning capacity continuesmemory 

◦short term concentration & retention decline

◦remote generally betterpersonality basically unchanged

Drugs & Elderly

account for 34% of Rx. & 40% of OTCaverage more than 11 per yeardecreased dosage due to decreased

absorption, distribution, metabolism, & excretion

Recommend 

◦education◦administration times compatible with lifestyle

◦color coding◦larger print◦easily removable caps

Community

95% live in community31% live alonemarried (40% female, 74% male)48% females widowed but only 15%

males (more remarry)81% have living children

Elder Abuse

active or passive act or behavior that is harmful to the elderly

physical violence (battering, sexual)personal neglectmental anguish (threat of

institutionalization, social isolation, sensory deprivation)

financial exploitationviolation of rights (confinement or

restraint)denial of health careself-inflicted abuse

Safety

accidents ◦leading cause of death◦falls most ◦also fires & MVA◦more likely

decreased sense increased reflex time muscle weakness confusion, forgetful improper footwear environmental hazards drugs

Safety

prevention◦short or 3/4 sleeve◦no long garments◦chairs with arms◦no slip wax on floors, no scatter rugs or deep pile

◦avoid clutter◦rubber tips on canes◦tong reachers rather than stools or ladders◦temperature controlled faucets◦electric rather than gas, front controls◦avoid trash accumulation◦nonskid strips in tub or shower

Safety

◦handrails, high toilet seats, shower chairs◦night light◦side rails on bed prn◦telephone by bed◦proper lighting◦stair rails, colored strips on step edges◦no frayed wires◦readily available emergency numbers◦smoke detectors◦crime prevention assessment◦drug precautions

Personal Space

many are set in waysprefer to be in familiar place with memories

should allow as long as possible

Medicare

federal social insurance program designed to provide health care to elderly entitled to social security benefits

part A- hospitalpart B- medical 

◦(voluntary◦must pay additional fee◦out-patient◦office visits

not covered-nonskilled home nursing care, ongoing nursing home care, prescriptions, glasses, dental care

deductibleonly pays 45% of health care costs