Preventing Functional Decline through SPICES Mary Spear, RN-BC, MSN, GNP Geriatric Clinical Nurse...
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Transcript of Preventing Functional Decline through SPICES Mary Spear, RN-BC, MSN, GNP Geriatric Clinical Nurse...
Preventing Functional Decline through SPICES
Mary Spear, RN-BC, MSN, GNP
Geriatric Clinical Nurse Specialist
John Muir Health – proprietary and confidential2
Objectives
Define components of SPICES
Identify Geriatric Syndromes associated with SPICES
Identify three (3) interventions to prevent functional decline
John Muir Health – proprietary and confidential3
Functional Decline Prevention
Functional ability = indicator of health
Goal:
Goal of interventions is to enable elders to function
at highest level despite the presence of age related
changes, risk factors, and disease
(Miller, C. 2012)
John Muir Health – proprietary and confidential4
• Think: FUNCTION
• Think: MAXIMIZE FUNCTION
Gawande, A. (April 30, 2007). The Way We Age Now.
The New Yorker Annals of Medicine
http://www.newyorker.com/magazine/2007/04/30/the-way-we-age-now
John Muir Health – proprietary and confidential5
Educational Resources
Hartford Institute for Geriatric Nursing
Hartfordign.org/practice/try_this/
NICHE – Nurses Improving Care of HS Elders
www.nicheprogram.org
Local universities – UC Berkeley, UCSF, Stanford
Professional Organizations
John Muir Health – proprietary and confidential6
Care of the Geriatric Patient
Complexity of care
Geriatric Syndromes Syndrome is a group of signs and/or symptoms that
occur together & characterize a
particular abnormality
Underlying all of these issues is the
presence of multiple problems and
causes rather than only one or two
John Muir Health – proprietary and confidential7
SPICES
S Skin Breakdown
P Problems with eating or feeding
I Incontinence
C Confusion
E Evidence of Falls
S Sleep Disorder
(Hartford Institute of Geriatric Nursing, 2012)
John Muir Health – proprietary and confidential8
AGE-RELATED CHANGES
SKIN – epidermis changes (thins, loss of strength and elasticity), decreased sweat glands, decreased blood flow to skin, loss of subcutaneous fat
PROBLEMS with Eating/Feeding – decreased taste buds, thirst perception, muscle strength for chewing, saliva, teeth, gag reflex, GI acid, stomach emptying, absorption in small intestine, decreased sense of smell
INCONTINENCE – reduced bladder elasticity, muscle tone, capacity, increased postvoid residual, nocturnal urine production, BPH in males, prolapse in females
John Muir Health – proprietary and confidential9
AGE-RELATED CHANGES
Confusion/Cognitive Decline – decrease in neurons, weight of brain, decline in ability to learn complex information, delayed response time, minor loss of recent memory, decline in ability to do complex tasks requiring multiple steps
Pathological conditions of cognitive impairment seen
with the older adult are:
Depression
Delirium
Dementia
John Muir Health – proprietary and confidential10
AGE-RELATED CHANGES
EVIDENCE OF FALLS – decline in muscle mass and strength, decline in size, number, quality of skeletal muscle fibers, bone loss, decreased cartilage in joints, reduced joint stability, intervetebral disc degeneration
SLEEP – normal changes in circadian patterns (sleep-wake) result in nocturnal awakenings, with increase in transient arousals, increase in time until sleep onset, decreased periods of REM sleep (restorative sleep)
(Brown, J., Bedford, N, White, S. 1999)
John Muir Health – proprietary and confidential11
Age Related Sensory Changes
Vision
Presbyopia
Cataracts
Glaucoma
Macular Degeneration
Hearing
Presbycusis
John Muir Health – proprietary and confidential12
Age Related Sensory Changes
Taste
4 basic tastes: Sweet, Salty, Sour, Bitter
Loss of taste buds
Smell
Decrease in number of sensory cells in nasal lining
Touch
Decreased sensation; safety issues
John Muir Health – proprietary and confidential13
Case Study
Pt. is a 75 y.o. female admitted after found on floor in home. She has had numerous falls, is unable to care for self, though refuses to leave her home. MM is a widow, husband died 4 yrs. Ago. She has no children nor relatives in the area.
MM has a large dog at home and states, “I like animals more than I like people.”
Issues – SPICES
John Muir Health – proprietary and confidential14
References
Brown, J., Bedford, N., White, S. (1999). Gerontological Protocol for Nurse Practitioners. Lippincott Williams & Wilkins
Miller, C. (2012). Nursing for Wellness in Older Adults, 6th Ed. Philadelphia, PA. Wolters Kluwer Health/Lippincott Williams & Wilkins