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

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

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

Number of people 65+ in US[in millions]

Considerations with older clients

Mental status may be normal or impaired Perception affects communication, memory, judgment

Always assess sensory perception and LOCPolypharmacy [many drugs] can cause

interactionsSelf-care may be impaired

by physical and mental disease, decreased ROM, fatigue, fear of falling, decreased eyesight

Age influences values and culture, health beliefsUse appropriate communication techniques for

clients with different problems

Cognition and Communication, Mood, and Self-Care

Cognition and communication Irreversible confusion

Alzheimer’s, Parkinson’sUse validation not reorientation [don’t argue]Assess and meet current needs

Acute confusion Delirium, medication effect

Use reorientation, minimize sensory stimulationReality orientation

Assess status of sensory aides and promote use

Cognition and Communication, Mood, and Self-Care (Cont’d)

MoodDepression

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 riskSelf-care

Assess needs and make appropriate referrals

Mobility, Elimination, and Skin Integrity

MobilityArthritisGait and balance disordersCataracts 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)Elimination

Incontinence [any involuntary urine loss] Urge

overactive bladder muscle– spasms Stress

Weak pelvic floor musculatureEither may increase fall risk [hurrying]

OverflowDistention of bladder

FunctionalPhysical or psychological w/intact system

Interventions depend on type of incontinence

Mobility, Elimination, and Skin Integrity (Cont’d)

Skin integrityOlder skin is more easily damaged

Injury from fallsProblems with positioning Incontinence Pressure ulcersAssess risk and skin integrity in all

older clients

Question

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

AnswerTrue.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

Food intake declines with agingDecline in physical activity Protein depletion

Chronic Illness, Infections, and Immunity

Chronic illnessContributes 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)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 impaired due to the following:MedicationsRestless legs syndromeSleep apneaPainCardiovascular and pulmonary

disorders

Question

Which of the following conditions can interfere with sleep in older patients?a. Ataxiab. Spasticityc. Restless legs syndromed. Hemiparesis

Answer

c. Restless legs syndromeRationale: 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

Chronic painOsteoarthritisNeuropathic painCentral or neuropathic pain after strokePostherpetic neuralgiaPhantom limb pain

Barriers to effective pain managementMisconceptions, fear of addictionPain management crucial for quality of life

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)

LonelinessLoss of important relationships

Spouse, friends, etc.Sensory losses

Lead to isolation, communication problemsDepression

Increases isolationCognitive disorders

Decrease meaningful interactionsCultural differences and language

barriers Impair communication, increase lonliness

Loss and Grief, Loneliness, and Coping and Stress (Cont’d)

Coping and stressOlder adults vary in perception and reaction

to stressors – assess and treat individuallyEmotion-focused

Change the way stress is perceivedProblem-focused

Change the situation

Question

true or false:Emotion-focused coping involves attempts to reduce stress by changing the stressful situation.

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

SexualityMyth: Sexual desire or activity

diminishes with ageReproductive system loses efficacyPhysiologic changesMedical conditions

Sexuality, Roles and Relationships, and Self-Perception (Cont’d)

Roles and relationships Multiple roles [caring for aging parents, children,

grandchildren] may stress abilityCareful assessment of physical and

psychological healthReferral to appropriate healthcare

providersAssistance in accessing agencies that

provide help to caregivers

Sexuality, Roles and Relationships, and Self-Perception (Cont’d)

Self-perceptionThe older adult’s multiple evolving

roles define his or her self-conceptIncorporates physical functioning,

cognition, social relationships, and life experiences

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