Nursing Care of OlderAdults

Janet Duffey, RN, MS, APRN, BC

Aging Populations

Demographics

Population trends: Aging baby boomers

Health care system projections

Distinguishing characteristics

Aging & Ageism

Youth cultureStereotypes of elderlyMinimization of

functionalityFocus of some theories on

agingVerbal statementsNon-verbal

Why do we age? Biological theories on aging

Cross linking

Free radicals

Neuroendocrine

Autoimmune reactions

Psychosocial Theories

Disengagement

Activity

Continuity

Age stratification

Implications of Aging Theories

Past experiences in lifeHealth beliefs & valuesAdjustment to limitationsIndications for wellnessChanges view of aging equates to illness

Cultural Interpretation of Aging

Physical traits Functional Symbolic Numeric age Status Role of aged individuals Meaning of aging Expectations of aging

experience

Aging

Personal philosophy Societal viewCaregiving systems Impact of ageism, on

clients, individuals & nursing

Factors influencing health and aging: Positive or Negative

Culture

Ethnicity

Stress management - resiliency

Coping abilities

Contributors to Health Alterations

Excessive stress

Underlying disease(s)

Nutritional deficits

Drug induced effects

Falls and trauma

Health Promotion

"... A multidimensional pattern of self-initiated actions and perceptions that serve to maintain or enhance the level of wellness."

Pender

Health Promotion Activities

Health assessmentSupport esteem in appearancePhysical activityRetirement (pro and con)Part-time employment or volunteerSocial activitySocial supportSupport sexuality

Nursing in Geriatric Settings

Uses the nursing process in ongoing manner, not just one time

Contributes to the treatment teamData systematically collected, ongoingNursing diagnoses derived from

assessmentNCP developed with patient and

significant other and problems prioritized

Health Promotion Activities

Enc. and facilitate participation in plan

Give choices: food, grooming, activities

Facilitate care in least restrictive setting

Explore opportunities in community

Anticipate changes in mental and physical health

Legal Issues Associated With Aging

Consent for treatment Establishing competence Use of restraints Injuries Consent for participation in

research Maintenance of patient rights Advanced directives Do not resuscitate orders

Elder Abuse

“Elder maltreatment" refers to the seven types of abuse and neglect are physical abuse, sexual abuse, emotional or psychological abuse, financial or material exploitation, abandonment, neglect, and self-neglect.

At risk: female, frail, 80+, dependent on child or spouse

Mandatory reporting yielded 18% of all reports, families

Alterations in Sensory Function

Vision Changes

Accommodation Narrowed visual field

decreased at periphery Opacity of lens Steropsis Altered color perception Light sensitivity Macular degeneration

Assessing Vision

HistoryNear focusDistance visionPeripheral testingGeneral assessment of function / ADLs

and IADL’s

Cataracts

Interim lensesAnticipate post-op courseIntraocular-lens implantsPrecautionsAvoidance of increased intraoccular

pressureAntibiotic / anti-inflammatory eye drops

Alteration in Hearing

Functional, emotional, social impactAffects 28-55% older adultsPresbycusis: bilateral, gradual declineSensoryneural type of impairmentVolume and high frequency consonants

Assessment of Hearing

Onset Watch test Speech discrimination: fair,

sun, skies, shout, fun, sun Conversational responses Secondary complaints:

tinnitus, pain, conversational difficulties

Interventions for Hearing Impairment

Determine presence of hearing difficultyEncourage acceptance and USE of hearing

devicesAnalog aidsDigital programmed aidsRadio / television devicesTelephonesMaintenance

Hearing Aid Batteries

Verbal Communication

Slightly slower rate Increase volume with moderationGet patient's attention before

speakingShorter sentences Lower voice pitchRemove distractionsProvide information visually Non-verbal communication Identify denial/embarrassment

Touch & Older Adults

Increased need

Assessment by functional measures

Sharp / dull response

Protective measures

Emotional responses

Atrophy of papillaePreference of high

sugar & salty foodsCostAbility to chew foodPoor oral hygieneMedications

Alteration in Taste & Smell

Altered Olfactory Function

Smell impacted by lifestyle

Sinus infectionsRelated to head injury,

CVA, tumorsAffects ability to enjoy

food, environmentMonitoring function

essential for safety