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Chapter 19
The Geriatric Client
19-2Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
The US Census Bureau Definition of Older Adults
Persons 65 years and older divided into three categories:• 65 to 74 years• 75 to 84 years• 85 plus years
19-3Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
United States Demographics of Older Adults
In 1900, the average life expectancy was 47 years.
In 2000, the average life expectancy was over 75 years.
At present, the average American life span is nearly 85.
19-4Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
United States Demographics of Older Adults
In 2000, there were over 50,000 centenarians living in the United States.
By 2030, there are expected to be 70 million older persons (20% of the population).
19-5Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Quality of Life Among Older Adults
Older adults often assume new roles, such as grandparents as they mature.
19-6Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Theories of Aging
Biological Theories• Stochastic theories hypothesize that aging
occurs randomly and persistently with time.• Nonstochastic theories suggest that aging is
predetermined.
19-7Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Biological Theories of Aging
Stochastic Theories• Error• Free Radical• Cross-Link• Clinker• Wear and Tear
19-8Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Biological Theories of Aging
Nonstochastic Theories• Programmed• Neuroendocrine• Immunologic/Autoimmune
19-9Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Psychosocial Theories of Aging
Disengagement Theory Continuity Theory Activity Theory
19-10Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Disengagement Theory
As individuals age, they inevitably withdraw from society.
Society withdraws from them. This separation is mutually agreed upon.
19-11Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Continuity Theory
An individual’s values and personality develop over a lifetime.
Goals and individual characteristics will remain constant throughout life.
An individual will tend to repeat successful adaptive strategies.
19-12Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Activity Theory
Satisfaction with life depends on involvement in new interests, hobbies, roles, and relationships.
Volunteering is one way that many retirees stay connected to the community.
19-13Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Myths and Stereotypes of Aging
Society is youth-driven. Older adults are often stereotyped as
being ill, bald, hard of hearing, forgetful, rigid, grumpy, or boring.
Many younger Americans think that all older people live in nursing homes.
19-14Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Myths and Stereotypes of Aging
Ageism is the process of stereotyping and of discriminating against people because of their age.
Fear and lack of exposure to older individuals contribute to ageism.
19-15Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Quality of Life Among Older Adults
The increasing life span has both positive and negative outcomes.
Outlook and adaptation contribute to a high quality of life.
Most older people accept a certain amount of declining health as normal and expected.
19-16Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Biopsychosocial Changes Associated with Aging
Developmental Physiological Psychosocial
19-17Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Developmental Changes
Certain developmental challenges bring opportunities for older people to experience feelings of success.
19-18Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Opportunities for Older People to Experience Feelings of Success
Gaining insight or wisdom Developing better social skills Becoming more open-minded and
tolerant Finding an unexpectedly active and
pleasurable sexual dimension
19-19Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Opportunities for Older People to Experience Feelings of Success
Seeing children transform into responsible, successful adults
Becoming a grandparent Holding civic and community positions of
responsibility Developing new skills, hobbies, and
interests
19-20Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Opportunities for Older People to Experience Feelings of Success
19-21Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Opportunities for Older People to Experience Feelings of Success
Renewing and deepening one’s relationship with one’s spouse, significant others, or friends
Gaining new knowledge and experiences Accepting and adjusting to physical
changes associated with aging
19-22Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
More Challenging Developmental Tasks
Death of a spouse Major declines in health or physical ability Loss of social role, prestige, occupation,
income Loss of independent living Accepting a fixed income
19-23Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Physiological Changes Associated with Aging
Decrease in rate of cell mitosis Deterioration of specialized nondividing
cells (such as neurons) Decreased elasticity and increased
rigidity of connective tissue Decreased functional capacity
19-24Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Physiological Changes Associated with Aging
The rate of aging is influenced by:• Genetic composition• Lifestyle (dietary and exercise patterns)• Previous experience• Presence of chronic illnesses• Environmental influences
19-25Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Neurological Changes Associated with Aging
Sensory and perceptual responses are altered as a result of:• Dcrease in number of neurons• Slowed transmission of nerve impulses• Decreased number of neurotransmitters• Decreased sensory threshold
19-26Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Sensory and Perceptual Changes Associated with Aging
Vision Hearing Taste and Smell
19-27Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Sensory and Perceptual Changes Associated with Aging
Vision• Presbyopia• Cataracts• Glaucoma• Macular degeneration
19-28Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Sensory and Perceptual Changes Associated with Aging
Hearing• Cerumen becomes drier and can cause
blockage of transmission of sound.• Presbycusis is the hearing loss associated
with aging.
19-29Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Sensory and Perceptual Changes Associated with Aging
Taste and Smell• Taste sensation decreases.• Olfactory nerve cells decrease in number.
19-30Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Sensory and Perceptual Changes Associated with Aging
Pain Perception• Some adults seem to lack specific
responses to pain.• Clients may have a silent myocardial
infarction, appendicitis, or delayed responses to cold or heat.
19-31Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Cardiovascular Changes Associated with Aging
Cardiovascular system functions less efficiently in general.
Reduced elasticity of the heart muscle and arteries leading to increases in systolic blood pressure.
Increased fat deposits form in the blood vessels.
19-32Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Cardiovascular Changes Associated with Aging
Decreases in arterial diameter due to arteriosclerosis
Thickening of venous walls leading to decreased elasticity
Thickening of aortic and mitral valves leading to incomplete closure
19-33Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Respiratory Changes Associated with Aging
Decreased functional respiratory reserve capacity
Generalized decreased elasticity and tone of muscles necessary for respiration
Fewer functioning alveoli Decreased number of cilia
19-34Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Gastrointestinal Changes Associated with Aging
Mouth• Loss of teeth• Atrophy of oral mucosa• Decreased saliva production
19-35Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Gastrointestinal Changes Associated with Aging
Gastrointestinal Tract• Decrease in peristaltic action• Relaxation of lower esophageal sphincter• Decreased emptying of the esophagus and
stomach
19-36Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Gastrointestinal Changes Associated with Aging
Gastrointestinal Tract• Slowing of intestinal motility• Shrinkage of gastric mucosa• Changes in levels of hydrochloric acid• Fat intolerance• Decreased absorption of nutrients and fluids
19-37Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Gastrointestinal Changes Associated with Aging
Gastrointestinal Tract• Constipation• Loss of sphincter control
19-38Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Genitourinary Changes Associated with Aging
Loss of muscle tone in bladder and ureters can lead to urinary retention.
Residual urine can lead to bladder infection.
19-39Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Genitourinary Changes Associated with Aging
Decreased Bladder Capacity • Nocturia (nighttime elimination)• Polyuria (excessive urination)
19-40Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Genitourinary Changes Associated with Aging
Risk for Renal Failure• Fewer functioning nephrons• Slowed glomerular filtration rate• Diminished blood flow to the kidneys
19-41Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Fluid and Electrolyte Imbalance
Secondary to fluid retention and/or dehydration.
Dehydration is a very real threat for many older adults.• Composition of body water declines from
60% to 40% of total body weight.
19-42Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Endocrine Changes Associated with Aging
Slowing of Metabolism Alteration in Pancreatic Activity
• Increased level of insulin and circulating glucose
19-43Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Endocrine Changes Associated with Aging
Decreased blood levels of growth hormone, estrogen, and testosterone evidenced by:• Enlargement of prostate gland• Loss of elasticity in breast tissue• Decreased size of uterus and fallopian tubes
19-44Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Reproductive/Sexual Changes Associated with Aging
Sexual dysfunction is not an inevitable result of the aging process.
Older adults who are sexually active may need education about sexually transmitted diseases (STDs), including AIDS.
19-45Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Reproductive/Sexual Changes Associated with Aging
Changes in men• Testes become softer and smaller.• Sperm production is inhibited or decreased.• Ejaculations are less forceful.• Causes of erectile dysfunction may have
multiple etiologies.
19-46Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Reproductive/Sexual Changes Associated with Aging
Changes in women due to decline in serum levels of estrogen:• Thinning of vaginal walls• Decrease in vaginal secretions• Decrease in vulva, external genitalia and
breast size• Sleep disturbances• Hot flushes or flashes, and diaphoresis
19-47Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Musculoskeletal Changes Associated with Aging
Decrease in height Stooped posture Osteoporosis and kyphosis)
• Occur primarily as a result of calcium loss• More common in women• Implicated in estrogen loss
19-48Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Musculoskeletal Changes Associated with Aging
Ligaments, tendons, and joints become hardened, more rigid, less flexible. • Secondary to collagen loss
Cartilage wears down around the joints, causing painful flexion.
19-49Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Integumenary Changes Associated with Aging
Skin • Dry, wrinkled, flaccid• Elongated ears, jowls, double chin• Decrease in subcutaneous fat • Decrease in moisture content• Decrease in numbers of elastic fibers • Decrease in numbers of epidermal cells • Skin tears more easily
19-50Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Integumenary Changes Associated with Aging
Lentigo senilis (age spots) • Benign, brown pigmented areas on face,
hands, and arms)
Hair becomes thinner, grey, on head and elsewhere on body.
Nails thicken and become more brittle.
19-51Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Integumenary Changes Associated with Aging
Sweat glands decrease.• Heat exhaustion• Increased susceptibility to cold
19-52Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Physiological Changes Associated with Aging
Alteration in Mental Status• Acute Confusion• Dementia• Depression
19-53Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Alterations in Mental Status Associated with Aging
Acute Confusion• State of diminished awareness and attention• Typically of short duration• Varying levels of confusion
19-54Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Alterations in Mental Status Associated with Aging
Dementia• Chronic, irreversible, impaired cognitive
function• Alzheimer’s disease most common dementia
19-55Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Alterations in Mental Status Associated with Aging
Depression• Altered mood state lasting at least 6 weeks• Exaggerated sadness, apathy, and
preoccupation with negative thoughts
19-56Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Depression and Aging
Late life depression can be successfully treated.
19-57Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Psychosocial Changes Associated with Aging
Retirement• Factors related to successful retirement:
- Attitude- Staying connected to others.- Personal expectations- Financial status
19-58Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Psychosocial Changes Associated with Aging
Social Relationships and Roles• Widowhood• Relocation• Grandparenthood
19-59Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Psychosocial Changes Associated with Aging
Grandparenthood• Source of pride and happiness
19-60Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Grandparenting Caregiver Role
Factors related to grandchild’s parents: - Divorce, death- Unemployment- Abuse/neglect of child- Substance abuse- Incarceration
19-61Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Psychosocial Changes Associated with Aging
Living Arrangements• Options depend on income, health status,
activity level, support systems
19-62Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Psychosocial Changes Associated with Aging
Options for Living Arrangements• Independent living• Living with children• Assisted Living Facilities (ALFs)• Residing in a nursing home• Foster care• Group homes
19-63Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Psychosocial Changes Associated with Aging
Coping with Loss• Loss is an inevitable part of life.• The longer a client lives, the more losses will
be experienced.• Feelings of isolation, hopelessness, and
anger can lead to depression.
19-64Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Coping with Loss
Interventions that promote a sense of hope• Helping older adults stay connected with
others in the community• Reflection on successes and shortcomings
19-65Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Medications and the Older Adult
Polypharmacy Medication errors Noncompliance Adverse drug reactions Inappropriate prescribing Excessive drug costs
19-66Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Medications and the Older Adult
Factors related to noncompliance:• Polypharmacy• Cost of drugs• Limited mobility• Impaired memory• Complicated dosing schedules, regimens• Small print on medication labels
19-67Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Mistreatment of Older Adults (Elder Abuse)
Many abused older adults may not admit to abuse because of embarrassment and/or fear of reprisal.
Most states have an Adult Protective Services program.
19-68Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Mistreatment of Older Adults (Elder Abuse)
Physical abuse Neglect (includes self) Psychological abuse Exploitation
19-69Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nursing Process and the Older Adult
Gerontological nursing is one of the profession’s most challenging practice areas.
Professional standards for gerontological nurses were developed by the ANA in 1955.
19-70Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nursing Process and the Older Adult
Assessment• Health History• Physical Examination
19-71Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nursing Process and the Older Adult
Frequently selected nursing diagnoses• Impaired Physical Mobility• Activity Intolerance• Self-Care Deficit• Social Isolation• Acute Confusion
19-72Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nursing Process and the Older Adult
Outcome Identification and Planning• Individualized to each client• Developed in partnership with the older
client and client’s support system• Realistic for client’s current status and
desired goals• Targeted to maintain a certain level of health
or restore to a former state of health
19-73Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nursing Process and the Older Adult
Implementation• Maintaining physical health• Promoting safety• Providing restorative care• Supporting psychosocial well-being
19-74Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation
Maintain Physical Health• Skin care• Sensory deficits• Activity tolerance levels
19-75Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation
Support Psychosocial Well-Being• Use of touch and therapeutic communication• Encouragement of activities• Involvement of support system• Teaching how to cope with alterations in
mental status• Referrals to community services
19-76Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation
Promote a Safe Environment• Smoke alarms• Secure loose rugs• Grab bars in tub/shower • Shoes with flat rubber soles • Adequate nonglare lighting, nightlights• Handrails next to stairs and long hallways
19-77Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation (Rehabilitation)
Restorative Care• Clients who have residual impairment as a
result of disease or injury• Increase independence and ability to
perform self-care• Regain or continue maximal functional ability
19-78Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nursing Process and the Older Adult
Evaluation• Whether or not goals have been met or
partially met• Achievement of projected outcomes
19-79Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Advances in Quality of Life and the Human Genome Project
Improve the early diagnosis and prevention of disease
Identify more diseases that could be treated
Research in tissue replacement